bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short Term Outcomes Utilizing Custom Total Talus Replacement with Subtalar Arthrodesis for Revision and Complex Total Ankle Arthroplasty
Authors: Horner Kevin , Schweser Kyle M. 
Published: December 2024

Category: Ankle; Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) in the setting of talar avascular necrosis (AVN) is a challenging problem and is often a contraindication for revision or primary TAA. However, 3D custom talar replacements offer a potential solution to this problem and has been shown to re-establish the normal alignment of the foot, preserve motion (with some achieving almost physiologic motion), and allow for almost normal ambulation. We performed this study to assess the short-term outcomes of 3D printed total talus replacements (TTRs) for revision TAA in the setting of talus AVN or collapse of the talar implant, or primary TAA in the setting of pre-existing talar AVN. Our hypothesis is that custom 3D printed talar body replacements lead to good outcome scores and patient satisfaction scores. Methods: We performed a retrospective chart review on 8 patients (9 TTRs) who underwent a TTR at our institution between May 2019 and October 2023. Initial data query yielded 14 patients (15 TTRs), TTR for acute trauma were excluded (n=6). All TTRs (9/9; 100%) had an associated subtalar ingrowth stem and were performed in conjunction with a primary TAA (5/9) or implanted in the setting of a previous TAA (4/9). One TTR had a talonavicular ingrowth surface. Patients included in this study had at least 12-week follow-up. Patient reported outcome measures (PROMs) included AAOS Foot and Ankle Questionnaire and visual analog scale (VAS) pain scores. Range of motion and 10-meter walking speed were evaluated. Results: Mean length of follow-up was 1.4 years. All patients achieved subtalar arthrodesis. Mean VAS score was 3 (range: 2-4) post-operatively. Average Foot and Ankle Core Standardized Mean was 70.5 (range: 52.2 - 93.6). Mean Shoe Comfort Standardized Mean was 64.5 (range: 40 – 88). Mean time to walk 10 meters post-operatively was 8.75 seconds (range: 6.2 – 10.4). Mean ankle dorsiflexion was 4.4° and plantarflexion was 23°. Three (3/9; 33%) TTRs had unplanned return to the operating room. The TTR with the talonavicular ingrowth stem went onto symptomatic nonunion of the TN joint requiring revision talonavicular fusion. Two TTRs had surgical wound dehiscence, one of which necessitated a radial forearm free fasciocutaneous flap but none had positive synovial fluid cultures, both were smokers. Conclusion: TTR for primary or revision TAA offers good outcomes and should be considered for patients presenting with a failed TAA or talar AVN with associated tibiotalar arthritis. Patient selection is important, as is education. This study adds to the current limited data on the use of 3D custom talar implants for revision and complex TAA and is the only one to the authors knowledge presenting data concerning concurrent subtalar arthrodesis utilizing on growth surfaces.
Social Determinants of Health Influence Clinical Outcomes of Patients Undergoing Total Ankle Arthroplasty: A Systematic Review
Authors: Butler James J. , Calton Megan , Manjunath Amit , Mener Amanda , Rosenbaum Andrew , Mulligan Michael , Samsonov Alan P. , Kennedy John G. 
Published: December 2024

Category: Ankle Arthritis; Ankle Introduction/Purpose: Social determinants of health (SDOH) encompass environmental, institutional, and intrinsic conditions that can influence an individual's access to and utilization of healthcare over their lifespan. While SDOH effects are linked to disparities in patient-reported outcomes post hip and knee arthroplasty, their impact on total ankle arthroplasty (TAA) remains unclear. This study sought to examine how SDOH factors affect access to appropriate orthopedic treatment and their repercussions on patient-reported outcomes following TAA. Methods: In January 2024, a systematic review of the PubMed, Embase and the Cochrane Library was conducted to identify studies reporting at least 1 SDOH and its effect on access to health care, clinical outcomes, or patient-reported outcomes following TAA. Results: Fifty-eight studies, involving 212,944 patients, were analyzed. The INBONE system emerged as the most utilized Total Ankle Arthroplasty (TAA) system. Factors contributing to healthcare access delays included female gender, advanced age, worker's compensation claims, comorbidities, tobacco use, federally subsidized insurance, lower education, racial/ethnic minority status, low-income residence, low-volume surgery regions, unemployment, and preoperative narcotic use. Black patients experienced significantly worse postoperative clinical and patient-reported outcomes, along with heightened pain following TAA. Lower education level independently predicted poor surgical and patient-reported outcomes, increased pain, and lower patient satisfaction. Moreover, patients with federally subsidized insurance demonstrated significantly worse postoperative clinical and patient-reported outcomes. Conclusion: The impediments created by SDOH lead to worse clinical and patient-reported outcomes following TAA including increased risk of postoperative complications, TAA failure, higher rates of revision surgery, and decreased ability to return to work. Orthopedic surgeons, policy makers, and insurers should be aware of the aforementioned SDOH as markers for characteristics that may predispose to inferior outcomes following RCR.
Talar OsteoPeriostic Grafting from the Iliac Crest (TOPIC): Five-Year Prospective Results of a Novel Press-Fit Surgical Technique for Large, Complex Osteochondral Lesions of the Talus
Authors: Hollander Julian , Dahmen Jari , Stufkens Sjoerd , M.M.J. Kerkhoffs Gino M 
Published: December 2024

Category: Ankle; Ankle Arthritis Introduction/Purpose: Osteochondral lesions of the talus (OLT) are lesions that affect both the articular cartilage and underlying subchondral bone that often arise after trauma. Large OLTs may be treated using osteochondral autografts, for example from the ipsilateral knee. This, however, often results in donor site morbidity. Moreover, the cylindric nature of the osteochondral grafts does not allow for a perfect fit for the defect. The novel technique Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) overcomes these challenges by using an osteoperiosteal autograft of the ipsilateral iliac crest. The aim of the present study is to prospectively evaluate the clinical, radiological and safety outcomes after 5 years of follow-up for patients who underwent the new TOPIC procedure for an OLT. Methods: A prospective cohort study of patients who underwent the TOPIC procedure was conducted. The primary outcome was the Numeric Rating Scale (NRS) of pain during walking. Other clinical outcomes included the NRS during rest and stair climbing, the Foot and Ankle Outcome Score (FAOS) and the Mental Component Score (MCS) and Physical Component Score (PCS) of the Short Form-36 (SF-36). In addition, the AOFAS ankle-hindfoot score was measured. All clinical outcomes were measured preoperatively and after 6 months, 1 year, 2 years and 5 years of follow-up. Computed tomography (CT) scans were performed preoperatively and postoperatively at 12 weeks, 1 year, 2 years and 5 years to assess osteotomy union, graft consolidation and graft cyst development. In addition, complications and hardware removal were evaluated. Results: 36 patients (current data is 29pt; expected to be complete at congress) were assessed, and no patient were lost to follow-up. The NRS of pain during walking improved from 6.5 [5-8] preoperatively to 2 [1-3] at 5-year follow-up (p < 0.001). The NRS during rest and stair climbing improved with 2 (p = 0.002) and 4 points (p < 0.001), respectively. All FAOS subscales improved significantly. The SF-36 PCS improved (32 to 35; p = 0.059) and the MCS improved (39 to 47; p < 0.001). The AOFAS improved from 52 to 90 (p < 0.001). There was 100% union at the osteotomy site after 12 weeks and 100% of the graft showed consolidation at 1, 2 and 5 years postoperatively. No major complications occurred. Conclusion: The TOPIC procedure is an effective treatment option for large osteochondral lesions of the talus, with durable results after 5 years of follow-up. A significant improvement in clinical outcomes was observed, with excellent radiological results. No major complications were recorded.
The Association of Social Determinants of Health and Patient-Reported Outcomes In Patients with Surgical Treatment of Osteochondral Lesion of the Talus
Authors: Ullmann Henri , Ashkani-Esfahani Soheil , Ebrahimi Alireza , Ranganathan Noopur , Bejarano-Pineda Lorena , Kwon John Y. , Guss Daniel , M.M.J. Kerkhoffs Gino M , DiGiovanni Christopher W. , Waryasz Gregory 
Published: December 2024

Category: Ankle; Sports Introduction/Purpose: Osteochondral lesions of the talus (OLT) commonly arise after chronic ankle sprains and fractures. Conservative treatment is the first step, yet surgical intervention is often warranted in patients with persistent symptoms. The effect of social determinants of health (SDOH) on treatment outcomes of this patient population has rarely been investigated to date. Methods: Patients with OLT who were 18 years of age and older and underwent operative treatment, with at least one patient-reported outcome and SDOH data available, were included. Patient-Reported Outcome Measures (PROMs) and Visual Analog Scale (VAS) pain scores were collected, and their trends were analyzed based on the patients’ SDOH, including Area DeprivationIndex(ADI)andSocialVulnerabilityIndex(SVI). Pre-operativePROMsorVAS pain scores had to have been collected within 90 days of surgery, immediate post-operative PROMs or VAS scores were recorded within 90 days of surgery were and post-operative PROMs or VAS scores within 180 days (± 30 days). Exclusion criteria were presence of concomitant pathologies such as fractures, bone lesions, cysts, foot and ankle deformities, presence of hardware, and lack of follow-up visits and lack of any patient reported outcomes in their profile. A P-value < 0.5 was considered statistically significant. Results: 109 of 551 confirmed patients with OLT met the inclusion criteria. Significant correlations were found between SDOH and PROMs, elucidating disparities in pain scores, physical function, and depression. A multitude of SVI components, but most profoundly overall SVI, and ADI rank, were found to be significantly correlated to VAS pain scores (Table 1.). Furthermore, insurance status showed a significant impact on pain intensity and depression measures. Nuanced influences of race, insurance status, and social vulnerability were observed. Conclusion: This study shows that SDOH have a significant effect on postoperative PROMs and VAS scores. Based on our results, these most prominently include overall SVI, insurance status, ethnicity, and race. Systemic interventions guided by neighborhood-level measures of disadvantage are key in advancing health equity.
The Efficacy of Polyhexamethylene Biguanide (PHMB) with Negative Pressure Wound Therapy in Open Diabetic Foot Amputation
Authors: Ahn Jiyong , Ranganathan Noopur , Jung Jaewoong , Waryasz Gregory R. , DiGiovanni Christopher W. , Ashkani-Esfahani Soheil , Bejarano-Pineda Lorena 
Published: December 2024

Category: Diabetes; Midfoot/Forefoot Introduction/Purpose: The therapeutic efficacy of negative pressure wound therapy (NPWT) in treating skin defects in diabetic foot ulcers has been demonstrated, although the management of bacterial biofilms remains controversial. Limited clinical data exist on outcomes when utilizing polyhexamethylene biguanide (PHMB) alongside NPWT. This study aims to assess the efficacy of PHMB in diabetic foot ulcers compared to conventional methods during NPWT. Methods: After receiving IRB approval from a single center Korean institution, sixty patients with Wagner 3 or 4 diabetic foot ulcers undergoing open amputation of forefoot and midfoot were included from March 2020 to August 2021. NPWT was administered at two-day intervals post-amputation by an expert surgeon affiliated with the institution. Patients were assigned to 3 different adjuvant therapies; 1) Saline; 2) povidone iodine; and 3) hydrochloric PHMB irrigation solutions. Bacterial cultures were performed, assessing time to negative bacterial culture. Wound analysis utilized a three-dimensional infrared camera (inSight®, eKare, Fairfax, VA, United States) to measure volume and area continuously and its correlation of risk factors. Results: Patients with hydrochloric PHMB therapy exhibited faster wound recovery rates in terms of volume and area compared to those treated with saline and povidone iodine solutions (p=0.001) (Figure 4 and 5). Hydrochloric PHMB and povidone iodine groups showed significantly shorter times to bacterial negativity compared to the saline group (p=0.001) (Figure 6). HbA1c, body mass index, dialysis status, age, smoking history, and diabetes duration did not significantly impact wound recovery rates. Conclusion: Hydrochloric PHMB with NPWT can be useful to treat open diabetic foot ulcers, with a high wound recovery rate and moderate antimicrobial efficacy, as the combination decreases wound toxicity and intermediate bactericidal effects in comparison to normal saline and povidone-iodine solutions.
The Kinematic Effect of Anatomic Deep Deltoid Ligament Stabilization in a Cadaveric Model of Syndesmotic Instability with Deep Deltoid Ligament Instability
Authors: Elghazy Mohamed Abdelaziz , Hajewski Christina , Duchman Kyle , Goetz Jessica , Femino John 
Published: December 2024

Category: Trauma; Sports Introduction/Purpose: The objective of this work was to investigate the utility of a suture augmented deep deltoid ligament (DDL) stabilization with different accepted treatments of distal tibiofibular syndesmosis injuries. We hypothesized that adding DDL stabilization would improve the rotational stability of the ankle. Also, that flexible syndesmotic stabilization using suture button fixation, AITFL suture stabilization, with DDL stabilization would restore the kinematics of an intact ankle most closely during external rotation stress (ERS). Methods: Ten matched pairs of through-the-knee cadaveric ankle specimens were mechanically tested in 5 Nm of ERS under 750 N of axial load. Specimens were tested intact, after transection of all the syndesmotic and deep deltoid ligaments and after each iteration of one of two stabilization sequences: 1) AITFL + suture button (SB) stabilization; AITFL+SB + DDL suture stabilization; syndesmotic screw with or without DDL stabilization; or 2) AITFL+SB+DDL; AITFL+SB; syndesmotic screw with or without DDL stabilization. Optical motion tracking was used to capture the kinematics of the tibia, fibula, and talus. CT scans of each specimen with markers were used to transform kinematic data into an anatomic coordinate system. Individual bony kinematics were extracted by decomposing the transformation matrices needed to align the starting test position to the ending test position and tracking points on the anterior medial and anterior lateral talus. Results: The average axial rotation of the talus was significantly increased after destabilization from 5.15 to 9.02 as compared to the intact state (P< 0.001). All the four fixation constructs reduced the axial rotation of the talus without significant difference when compared to intact (figure 1). Addition of DDL stabilization reduced the talar axial rotation with both screw and flexible stabilization. The axial plane translation direction changed from 16.22 degrees in intact stage to 53.21 after destabilization (P=0.044). The range of axial plane translation direction after all stabilizations was 35.02 to 44.43, however, they were not significantly different as compared to the intact state. Conclusion: DDL stabilization improved rotational stability of the talus. Although there were no significant changes in the axial plane translation direction of the talus after any stabilizations, there was a 19 to 28 degree difference as compared to the intact stage. This could be clinically significant over the course of years since the latency period of posttraumatic ankle arthritis is known to be approximately 20 years. The apparent over-tightening of both flexible and screw stabilization of syndesmosis with DDL stabilization should be thought of as time zero due to creep of flexible fixation that was observed at the conclusion of testing.
The Performance of Bio-Integrative Mineral-Fiber Reinforced Screws in a Load Bearing Osteotomy Model in Sheep
Authors: Netto Cesar de Cesar , Nyska Abraham , Rousselle Serge 
Published: December 2024

Category: Basic Sciences/Biologics Introduction/Purpose: Injuries to weight-bearing bones can be detrimental to patient mobility, often requiring surgical intervention, as mechanical failure leads to non-union, joint stiffness, and compromised function. Metal implants are widely used for fracture fixation; however, stress concentration, irritation, and pain often result in hardware removal, driving the development of non-permanent implants, traditionally polymer-based. These, in turn, lack strength and may cause adverse inflammatory reactions. Thus, an unmet need exists for more robust, safely eliminated fixation devices. This study aimed to evaluate the performance of bio-integrative, mineral fiber-reinforced screws, currently utilized for multiple surgical procedures in Orthopedic Foot and Ankle Surgery, in an in vivo fully load-bearing distal femur fracture model in sheep. Methods: Five sheep were subjected to femur lateral condyle osteotomy. Fixation was performed using two 3.5mm fiber-reinforced compression screws made of mineral fibers comprised of elements found in native bone, bound by PLDLA [poly (L-lactide-co- D, L-lactide)]. Animals recovered to full load-bearing conditions. Micro CT and histopathology were performed at 26, 78, 104, and 130 weeks (W). Osteotomy healing, new bone formation, tissue ingrowth into the implant wall, and biocompatibility measures were evaluated. Results: All animals demonstrated uneventful recovery. Stable reduction was evident by optimal bone healing on imaging and histological evaluation. At 12 weeks, all sites demonstrated anatomical alignment and complete bone bridging across osteotomy sites, with no implant failure. Cellular response was dominated by anti-inflammatory M2 macrophages and multinucleated giant cells associated with the expected phagocytic response. Implant bio-integration was completed by 130W, with no material remaining and no adverse effects. Conclusion: Large animal models are considered benchmarks for the long-term effects of orthopedic implants due to their similarity to humans with respect to bone composition, dimensions, physiology, biomechanics, and remodeling. This fully load-bearing femoral osteotomy sheep model demonstrates the safe and effective use of bio-integrative implant technology, suggesting its applicability in various orthopedic foot and ankle indications.
The Presence of An Avulsion Fracture of the 1st Tarso-Metatarsal Joint in Lisfranc Injuries is a Useful Adjunct in Detecting 1st TMTJ Instability
Authors: Singh Prashant , Jones Neil , Malagelada Francesc , Patel Amit , Jeyaseelan Lucky 
Published: December 2024

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Lisfranc fracture-dislocations are uncommon injuries that are often missed or diagnosed late. The consequences of this include post-traumatic osteoarthritis and deformity. Injuries with ligamentous involvement injuries often have avulsion fractures at the level of the tarso-metatarsal joint (TMTJ) on either plain radiographs or CT scan. A proportion of these will have a congruent TMTJ joint on initial imaging. However, it has been suggested that many of these patients will have an unstable TMTJ which requires stabilisation. The purpose of this study was to determine the relationship between the presence of an avulsion fracture on initial imaging and instability or incongruence of the first TMTJ. Methods: A prospectively maintained database of all Lisfranc fracture-dislocations presenting to our centre was collected. Initial plain radiographs and CT scans were analysed for the presence of 1st TMTJ avulsion fractures independently by two senior authors. Data were collected regarding the initial mechanism of injury, fracture classification (Myerson and Qenu). Injuries which were managed non-operatively were excluded from the study. All included cases were managed with examination under anaesthesia (EUA) and intra-operative screening with stress testing under image intensification prior to fixation or arthrodesis surgery. The rate of instability for each fracture classification type was also determined. The sensitivity and specificity of the presence of an avulsion fracture of the 1st TMTJ in detecting an unstable joint was determined. Results: 153 patients with a Lisfranc injury were included. The mean age was 35.2 years, and 68% of patients were male. 99 injuries (64.7%) were identified as having an avulsion fracture at the level of the 1st TMJ on either plain radiographs or CT scan. Of these, 76.7% were found to have a congruent joint on XR or CT scan. 91.9% of patients with an avulsion fracture of the 1st TMTJ were found to have instability on EUA stress testing. Amongst the 54 patients who had no avulsion fracture, 23 (42.6%) demonstrated instability of the 1st TMTJ on EUA. The presence of an avulsion fracture of the 1st TMTJ had a sensitivity of 79.8% and a specificity of 79.5% in the detection of an unstable joint. Conclusion: The presence of an avulsion fracture of the 1st TMJ is highly suggestive of instability of the joint and may be a useful adjunct in assessment and decision making for Lisfranc injuries. This finding on pre-operative radiographs should alert clinicians to have a low threshold to perform further imaging in the form of CT scanning or EUA and dynamic stress testing of the 1st TMTJ. A high proportion of Lisfranc injuries without avulsion fractures have instability at the level of the 1st TMTJ, and therefore the absence of this finding does not provide a reliable indication of joint stability.