bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of Diabetes Mellitus and Immediate Postoperative Complications after Total Ankle Replacement: A Large Database Analysis
Authors: Patel Shiv J. , Chokshi Shivan , Abdullah Mohammed , Panchbhavi Vinod K. 
Published: December 2024

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total Ankle Replacement (TAR) has rapidly grown in popularity over the last fifteen years as a treatment for ankle arthritis. With this growth, it is imperative to understand risk factors that may predispose patients to complications following the procedure. This information can be valuable in generating treatment plans and facilitating conversation regarding risks and benefits of those plans. Current literature on TAR-related outcomes is limited in timeframe and scope and does not investigate the association of diabetes with common post operative complications. The objective of this study was to perform a retrospective database analysis to quantify the risk of 90-day complications in patients with diabetes undergoing TAR when compared to patients without diabetes undergoing TAR. Methods: The TriNetX database was utilized for this study. Patients who underwent TAR were identified and stratified by those with a history of diabetes mellitus and those without a history of diabetes mellitus of any type. The cohorts were 1:1 propensity matched based on demographic information and medical history. The 90-day complication rates for readmission, inpatient service use, opioid use, anesthesia use, periprosthetic fracture, deep vein thrombosis, and wound dehiscence were calculated using chi-square analysis. Results: n=5,984 TAR patients were identified. 52% were male and 48% female with mean age of 73±10 years. There was a n=1,331 patients in each the patients with diabetes and without diabetes groups after cohort analysis and propensity matching. TAR patients with diabetes had a significantly higher 90-day odds ratio of inpatient service use (OR: 1.675, 95% CI 1.3082-2.144; p< 0.001). There was no significant difference between groups in opioid use (OR: 1.13, 95% CI 0.941-1.357; p=0.1908), anesthesia use (OR: 1.335, 95% CI 0.906-1.965; p=0.1424), and wound dehiscence (OR: 1.313, 95% CI 0.829-2.08; p=0.2445); Table 1. There was insufficient data to determine the role of diabetes on critical care services, periprosthetic fracture, and DVT within 90 days of TAR. Conclusion: TAR is a developing operation for ankle arthritis and little data exists on diabetes related perioperative complications. The results of this study show that although diabetes is significantly associated with a higher rate of inpatient service use, it may not have as large a role in opioid use, anesthesia use, and wound dehiscence in the immediate postoperative period. More information is still needed to address long term outcomes and the role diabetes plays in other postoperative complications.
Biomechanical Evaluation of Popular Lapidus Fixation Plates
Authors: Gross Christopher E. , Jacobson Eli , Peterson Nathan 
Published: December 2024

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: A 1st Tarsometatarsal (TMT) fusion or Lapidus is increasingly popular for moderate to severe hallux valgus with pronation. Hardware utilized for fixation consists of different combinations of plates, screws, and staples. Prior studies have suggested that constructs including a plate are superior to those consisting of screws or staples only. This biomechanical report compares a novel 1st TMT fusion U-plate to a predicate biplanar locking plating system. Methods: A total of 7 TMT U-plate systems were utilized for mechanical testing, with 3 samples undergoing static testing and 4 samples undergoing dynamic testing. Their mechanical properties were compared to those of one predicate device for static testing and 4 devices for dynamic testing. Standard 4th generation Sawbones models and bicortical screws were utilized in all cases. Static testing consisted of a uniform ramp to catastrophic failure using a cantilever bending model. Dynamic testing consisted of an incremental step procedure. A step size of 50,000 cycles at 3 Hz was used. The peak tensile load defined the step size with the valley tensile loading at one-tenth the peak loading. The first step used a 3.6 Nm moment with a peak tensile loading at 120 N. Results: Static testing of the TMT U-plate system demonstrated comparable or superior performance in load to failure testing than the predicate device (U-plate: mean = 351.3N, SD = 29.6; predicate: 324.4N). Dynamic testing demonstrated that the U-plate system survived 76,602 ± 43,275 cycles which was 261% greater than tested predicate constructs 29,338 ± 33,080 cycles. Additionally, cyclic failure loads were 151.3 ± 23.9 N for the U-plating system which was 120% greater than the predicate constructs at 126.3 ± 12.5 N. Conclusion: The TMT U-Plate demonstrated superior or comparable biomechanical properties to the predicate device in static and dynamic mechanical testing. Further investigation is needed to ascertain if these biomechanical differences have clinical correlations.
Breaking the Glass Ceiling: the Evolution of Female Speaker Representation and Visibility At American Orthopaedic Foot & Ankle Society Meetings Over Time
Authors: Kutzer Katherine , Garcia Raquel , Bitolas Rochelle , Aitchison Alexandra , Ralph Julia , Kuehn Sally , Adams Samuel B. , Anastasio Albert T. 
Published: December 2024

Category: Other Introduction/Purpose: Although female students comprise over half of U.S. undergraduate and medical school enrollment, representation among residents and practicing surgeons in orthopaedics remains disproportionately low at 15% and 6%, respectively. The decline in residency may stem from a lack of early exposure to female mentors. This study investigates female representation in speaker roles at American Orthopaedic Foot & Ankle Society (AOFAS) meetings over time. Methods: The annual AOFAS meeting programs for 2012, 2017, and 2022 were reviewed by three independent raters. Each speaker, moderator, and panelist was classified based on sex and role; 15% of the data was cross-checked and evaluated using Fleiss Multirater Kappa validation. Sessions discussing surgical or biomedical topics were categorized as “technical”, and all other sessions (i.e., welcome sessions) were categorized as “nontechnical.” Individual-year odds ratios (ORs) and confidence intervals (CIs) evaluating sex versus session status, as well as sex versus speaker role, are provided. Combined results controlling for year were calculated using the Cochran-Mantel-Haenszel method. Results: A total of 403 speaking sessions were analyzed; 12% of sessions were led by female speakers. On average, female speakers were significantly more likely than males to assume nontechnical speaking roles across the three years combined (OR 3.84; 95% CI, 1.43 to 10.33). Female speakers led 12.7% of the 381 technical sessions. Females also comprised 9.8% and 16.7% of moderator and panelist roles, respectively. Conclusion: Although our study reveals an increasing trend in female speakers, panelists, and moderators from 2012 to 2022, these data demonstrate a persistent lack of sex diversity at AOFAS annual meetings, especially within technical sessions and moderator roles. Increasing female representation at conferences while fostering mentorship opportunities for medical students may serve as a valuable opportunity to address disparities between males and females within orthopaedics. Female Representation in Speaker Roles at AOFAS and Session Category Odds Ratios
Cadaveric Evaluation of First Metatarsophalangeal Joint Preparation Using a 2.0 mm MIS Burr
Authors: Cooperman Steven R. , Christie Lauren , Smith Chad , Perkins Jacob , Brandao Roberto 
Published: December 2024

Category: Other; Bunion Introduction/Purpose: Minimally invasive techniques for foot and ankle procedures have gained popularity as an alternative to traditional open techniques, with proposed benefits including earlier weight-bearing, improved cosmesis, and decreased postoperative pain. The current study aimed to evaluate the efficacy of first metatarsophalangeal joint preparation using a minimally invasive burr while concurrently evaluating the risk of extensor hallucis longus tendon damage with this technique. Methods: Nine fresh, thawed cadaveric lower limbs were utilized for this investigation. A single, reproducible dorsomedial minimally invasive portal was created at the level of the first metatarsophalangeal joint, and a 2.0 mm burr was used to denude the cartilage for two minutes under fluoroscopic guidance. Digital calipers were used to measure the distance between the portal and the extensor hallucis longus tendon. The joints were then carefully disarticulated to evaluate the extent of cartilage debridement and surface area ratios were calculated. Results: Results identified an average distance of 7.13 mm between the portal and the extensor tendon, with minor partial damage occurring to the tendon in 1/9 specimens. The proximal phalanx and metatarsal head ratios averaged 0.76 and 0.75, respectively, indicating approximately 76% and 75% of the respective joints surfaces were denuded. Conclusion: This study demonstrates comparable cartilage debridement to traditional open techniques based on historical data. Results of this study suggest that first metatarsophalangeal joint preparation can be effectively achieved with the use of a minimally invasive burr technique with fluoroscopic assistance, with additional time and experience, with a low risk of injury to the extensor hallucis longus tendon.
Cohort Study on 5-Year Reoperation Rates: Total Ankle Arthroplasty and Ankle Arthrodesis in Patients with Prior Bariatric Surgery
Authors: Kubsad Sanjay , Kishan Arman , Bergstein Victoria E. , Fox Henry M. , Ficke James R. , Aiyer Amiethab A. 
Published: December 2024

Category: Ankle; Ankle Arthritis Introduction/Purpose: Obesity is an ongoing public health epidemic with wide-ranging implications for orthopaedic surgery. Bariatric surgery has been shown to be an effective method for weight reduction. This retrospective cohort study aimed to compare rates of reoperation between patients who underwent primary ankle arthrodesis (AA) and those who underwent total ankle arthroplasty (TAA) after undergoing bariatric surgery. Methods: Utilizing data from PearlDiver, patients who received primary AA or TAA with prior history of bariatric surgery to a cohort without prior bariatric surgery were retrospectively analyzed for reoperations. Both cohorts were propensity-matched based on age, sex and Charlson Comorbidity Index in a 1:4 ratio. Indications for reoperation included revision, prosthetic joint infection (PJI), hardware removal, adjacent joint fusion, and local open reduction internal fixation (ORIF). Kaplan-Meier survival analysis and hazard ratios were calculated for five years after the procedure. Results: Of the 801 patients with prior history of bariatric surgery, 519 (65%) underwent AA, while 282 (35%) underwent TAA. At 5 years post-operatively, patients who had undergone AA showed a higher incidence of adjacent joint fusion if they had prior history of bariatric surgery (Hazard ratio: 1.79, 95% Confidence Interval: 1.23 - 2.61, P-value < 0.001). No differences in reoperation rates were observed for PJI, hardware removal and ORIF. At 5 years, patients who had undergone TAA with history of bariatric surgery showed no difference in the incidence of revision, PJI, hardware removal, ORIF and adjacent joint fusion as compared to patients who underwent TAA with no history of bariatric surgery. Conclusion: Our findings suggest that patients undergoing primary TAA displayed comparable reoperation rates regardless of prior bariatric surgery history over a five-year post-procedure period. In contrast, patients undergoing primary AA exhibited an increased risk of adjacent joint fusions if they had history of bariatric surgery, although the rates of reoperation due to PJI, ORIF, and hardware removal remained comparable. Notably, our results do not position a prior history of bariatric surgery as a significant determinant in reoperation rates. These insights offer valuable guidance for orthopedic surgeons navigating the complexities of surgical interventions in the context of bariatric surgery.
Comparing the Use of Nitinol Compression Screws to Traditional Compression Screws in Foot and Ankle Surgery
Authors: Gauthier Chase , Guttman Anne , Anastasio Albert T. , Bakaes Yianni , Jackson J. Benjamin , Kaplan Jonathan , Schipper Oliver , Adams Samuel B. , Gonzalez Tyler 
Published: December 2024

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: Nitinol is a metal alloy with high elastic flexibility and shape memory characteristics, making it effective in orthopedic surgery. Although nitinol staples have shown similar efficacy to traditional implants for foot and ankle surgery, the literature is limited regarding nitinol screws. The purpose of this study is to determine whether there is a difference in outcomes and complications between nitinol screws and traditional screws used for foot and ankle surgery. Methods: A multicenter retrospective cohort study was conducted for patients who underwent a foot and ankle procedure utilizing traditional compression screws or nitinol compression screws, between February 1st, 2021, and July 1st, 2023. Demographic factors, type of implant, and outcomes were recorded. Student’s t-test and Wilcoxon rank sum test were used to compare continuous variables, while the chi-squared test was used to compare categorical variables. Results: A total of 163 patients were included in the study, with 106 patients treated with traditional screws and 58 treated with nitinol screws. There was no significant difference between those treated with nitinol screws and those treated with traditional screws in complication rate (8.6% vs 11.3%, P=0.78), non-union rate (5.2% vs 8.5%, P=0.54), revision surgeries (1.7% vs 2.8%, P=1), hardware removal (3.4% vs 11.3%, P=0.14), or 90-day hospital readmissions (0% vs 2.8%, P=0.55) for foot and ankle surgery. Conclusion: Our study found no difference in terms of complications or postoperative outcomes between those treated with nitinol screws and those treated with traditional screws for elective foot and ankle procedures. Our findings suggest that nitinol screws appear to be safe and effective for foot and ankle surgery with positive postoperative outcomes and a trend in lower complication and non-union rates. However further investigation is warranted to assess if faster time to union and quicker weight bearing may be possible with this type of fixation.
Comparison of Prevalence of Arthroscopically Detected Intra-Articular Pathologies Between Supination and Pronation Type Ankle Fractures
Authors: Suksintharanon Methasit , Kittinopphadol Chavapol , Sripanich Yantarat , Rungprai Chamnanni 
Published: December 2024

Category: Arthroscopy; Ankle Introduction/Purpose: Ankle fractures are among the most common fractures of the lower extremity. Most unstable ankle fractures have good outcomes following operative fixation; however, residual pain and swelling are not uncommon despite anatomical bone reduction. Untreated associated injuries, including syndesmotic injury, deltoid ligament injury, and osteochondral injury, are potential causes for suboptimal outcomes. These pathologies are often underappreciated. The Lauge-Hansen classification is used to categorize fractures based on the mechanism of injury and thus has the potential to predict intra-articular pathology. To date, there is limited literature reporting the comprehensive prevalence of arthroscopically diagnosed intra-articular pathologies in acute ankle fractures based on the mechanism of injury. This study aims to report the prevalence of each intra-articular pathology between different fracture patterns. Methods: A retrospective database review was conducted on 203 patients with rotational ankle fractures who underwent arthroscopic-assisted open reduction and internal fixation for unstable acute ankle fractures between 2016 and 2023. Patients with open fractures, pilon fractures, delayed treatment, and children with open physes were excluded from the study. The patients were categorized into groups according to the Lauge-Hansen classification: Supination-Adduction (SA), Supination-External Rotation (SER), Pronation-External Rotation (PER), and Pronation-Abduction (PA). Syndesmotic injuries were determined by the arthroscopic drive-through sign with a 3mm shaver, while deltoid ligament injuries and osteochondral injuries were identified using arthroscopic visualization. Results: There were 3 patients (1.48%) with SA fractures, 143 patients (70.44%) with SER fractures, 6 patients (2.96%) with PA fractures, and 51 patients (25.12%) with PER fractures. The prevalence of arthroscopically diagnosed syndesmotic instability following malleoli fixation was extremely high in most fracture patterns except the SA mechanism (PER: 98.04%, PA: 100%, SER: 89.51%, SA: 33.33%). The prevalence of osteochondral injury was higher in pronation-type injuries than supination-type injuries (73.78% vs 53.9%, p=0.03). Deltoid ligament injury was found in 56.74% of SER fractures and 68.42% of PA/PER fractures. Conclusion: The prevalence of intra-articular pathologies in ankle fracture was higher in pronation-type injuries. However, the prevalence of these pathologies, especially syndesmotic instability, in SER fracture patterns was also alarming. The authors advocate for routine ankle arthroscopy simultaneously with ankle fixation to provide adequate treatment and predict prognosis.
Correction of Talar Sagittal Alignment Using a Novel Biased Polyethylene Insert for a Fixed Bearing Total Ankle Arthroplasty
Authors: Khan Ryan , Halai Mansur , Daniels Timothy R. , Pinsker Ellie , Kooner Sahil , Kayum Shahin , Singh Maninder Shah 
Published: December 2024

Category: Ankle Arthritis; Ankle Introduction/Purpose: The Cadence Total Ankle System is unique in that it has modular polyethylene components with both an anterior and posterior biased option that may improve reduction of the talus in the sagittal plane. As such, the purpose of this study is to evaluate the effectiveness of anterior and posterior biased polyethylene liners in improving sagittal component alignment and functional outcomes after TAA. Methods: This was a retrospective cohort study of consecutive patients that underwent TAA with the Cadence Total Ankle system using biased polyethylene liners with at least 12 months follow-up. Results: Study included 66 TAAs that required the use of a biased polyethylene liner. The primary outcome was radiographic sagittal talar alignment, the cohort was broken down into three groups depending on preoperative sagittal alignment: anterior alignment (A, n=38), neutral alignment (N, n=17), and posterior alignment (P, n=11). Patients with anterior or posterior preoperative sagittal alignment demonstrated significant improvement in sagittal alignment using both the TT ratio and talar station. Overall, the proportion of patients that achieved neutral sagittal balance significantly improved from 25.76% to 50.00% postoperatively (χ2 [df=1, n=66] = 18.24, p < 0 .01). Anterior bias liners were associated with anterior preoperative alignment, while posterior bias liners were associated with neutral and posterior preoperative alignment (χ2 [df=2, n=66] = 17.55, p < 0 .01, V = 0.52). Conclusion: The Cadence TAA system has novel anterior and posterior biased polyethylene liners that may augment correction of sagittal talar deformities. This study demonstrates that biased liners are effective in correction of pathological sagittal talar deformities to near anatomic alignment clinical with significant improvement in functional outcomes.
Differences in Cortical Activation During Dorsiflexion and Plantarflexion in Chronic Ankle Instability: A Task-fMRI Study
Authors: Wang Xu , Geng Xiang , Wang Zhifeng 
Published: December 2024

Category: Sports Introduction/Purpose: Chronic ankle instability is a common sports injury that often presents with increased plantarflexion and restricted dorsiflexion. The cumulative effect of peripheral injuries may induce neuroplasticity in the central nervous system. However, the relationship between dorsiflexion or plantarflexion and the central nervous system in patients with chronic ankle instability remains unknown. Methods: December 2020 and May 2022, we treated 400 patients who had chronic ankle instability. Ten percent (40 patients; mean ± standard deviation age 29 ± 7 years; 17 male patients) were randomly selected to participate in this study.The control group underwent MRI with good image quality. Ankle function and disease severity were assessed using three clinical scales: the Cumberland Ankle Instability Tool, Karlsson-Peterson Ankle Function Score, and the American Orthopaedic Foot & Ankle Society Score. A uniplanar and nonweightbearing ankle dorsiflexion-plantarflexion paradigm (a recognized model or pattern) was performed using a short-block design during the functional MRI scan.The cerebral excitability patterns between patients with chronic ankle instability and controls were analyzed using t-tests.Spearman analysis was performed to explore the correlation between activation regions and the three clinical assessment scales. Results: Patients with chronic ankle instability showed a large effect size compared with controls (Cohen d > 0.8). During plantarflexion, the number of activated voxels in the supplementary motor area had a modest, positive correlation with the Karlsson-Peterson Ankle Function Score (r = 0.52; p = 0.01), and the number of activated voxels in the primary motor cortex (M1) and primary sensory cortex (S1) had a weak, positive correlation with the American Orthopaedic Foot & Ankle Society Score in patients with chronic ankle instability (M1: r = 0.45; p = 0.02, S1: r = 0.49; p = 0.01). Conclusion: Compared with volunteers with normal ankle function, patients with chronic ankle instability had increased cortical activation during plantarflexion and decreased cortical activation during dorsiflexion. We analyzed the central neural mechanisms of chronic ankle instability in patients with sports injuries and provided a theoretical basis for the development of new central and peripheral interventions in the future.