bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survey of Utilization of WBCT within AOFAS Membership
Authors: Reddy Sudheer C. , Cesar Netto Cesar de 
Published: December 2024

Category: Other; Hindfoot Introduction/Purpose: WBCT (Weightbearing CT) has been increasingly employed to evaluate and treat patients with varied pathologies such as progressive collapsing foot deformity (PCFD), post-traumatic deformity, hallux valgus, ankle arthritis, Charcot arthropathy, lisfranc and syndesmosis injuries. However, little is known regarding its overall availability to foot and ankle providers and how it is being used in clinical practice. The goal of this study is to assess the utilization of WBCT among AOFAS members, identify the indications for use in clinical practice and potential barriers for implementation. Methods: A survey was emailed to AOFAS members inquiring about the use WBCT in clinical practice. Practice and demographic information were also collected. A total of 220 responses were collected over a 2-month period. Respondents were queried with respect to the availability of WBCT in practice, indications for use, frequency of use, ownership of the scanner and barriers to implementation. Results: 58% of respondents did not have access to WBCT. Most respondents were in practice 10 yrs or more (69%). Single-specialty private practice was the most common practice type. Of those with access to WBCT, 5 or fewer scans were ordered per week (57% of respondents). Evaluation of hindfoot/ankle deformity was the most common indication (69% of respondents) with it being used as a preoperative evaluation tool approximately 25% of the time (57% of respondents). Radiology dept owned WBCT in most institutions (34%). 75% of respondents with WBCT use it postoperatively less than 25% of the time. Of those without WBCT, 94% stated they would like to have it with cost being the most significant barrier to implementation. Conclusion: Most respondents surveyed did not have access to WBCT, with cost being the greatest barrier. However, 94% of those without it would like to have it. For those with access, it is used 5 or fewer times per week with evaluation of hindfoot/ankle deformity being the most common indication.
The Effect of Operative Time on Short Term Total Ankle Arthroplasty Outcomes
Authors: Rodriguez Materon Solangel , Patel Dev , Trynz Samantha , Morningstar Joshua L. , Gross Christopher E. , Scott Daniel J. 
Published: December 2024

Category: Ankle; Ankle Arthritis Introduction/Purpose: The incidence of total ankle arthroplasty (TAA) continues to increase as outcomes and surgeon comfort with the procedure improve. There is a paucity of literature investigating the association between operative time (case duration) and postoperative outcomes following TAA. Thus, this study seeks to evaluate the relationship between total operative time and postoperative outcomes following TAA. We hypothesize that increased operative time is statistically significantly associated with an increased risk of 30-day postoperative complications in patients undergoing total ankle arthroplasty. Methods: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried from 2007-2020 to identify 2,133 patients undergoing TAA. Demographics, medical comorbidities, concomitant procedures, hospital length of stay (LOS), and 30-day complication, readmission, and reoperation rates were compared between groups. Patients were excluded based on an operative time greater than 290 minutes (based on Inter-Quartile Range [IQR] proximity rule) to limit the influence of extreme outliers. The cohort was predominantly male (53.8%) and mean patient age was 64.10 (range 19-87) years with a mean BMI of 31.00 (range 17.14-57.78) m/kg2. The mean operative time of the cohort was 149.56 (standard deviation [SD]=49.60) minutes. Results: Demographic characteristics associated with increased operative time were younger age (p <.001), functionally dependent status (p=.041), general anesthesia instead of spinal (p <.001), not having diabetes (p <.001), and not having COPD (p=.005). Multivariate analysis, accounting for these variables, revealed that a 15-minute increase in operative time led to an increase in risk of any complication by 10% (p=.019), wound dehiscence by 30% (p=.005), urinary tract infection by 38% (p=0.009), readmission by 16% (p=0.003), reoperation by 16% (p=0.048), and extended length of stay by 6% (p=0.023). Increased operative (>1 SD above the mean), independently predicted readmission (OR=2.817; 95%CI=1.334-5.951; p=0.007), urinary tract infection (OR=6.410; 95%CI=1.384-29.6866; p=0.018), wound dehiscence (OR=5.127; 95%CI=1.282-20.508; p=0.021), and bleeding requiring transfusion (OR=18.364; 95%CI=1.846-182.682; p=0.013). Conclusion: The study found longer operative time during TAA is associated with a statistically significant increase in complications, including wound dehiscence, urinary tract infection, readmission, reoperation, and increased length of stay. Therefore, surgeons should prioritize measures to reduce operative time when appropriate while optimizing implant placement, deformity correction, and implant stability in TAA.
The Rate of Subsequent Hallux Interphalangeal Joint Fusion after First Metatarsophalangeal Fusion: A Large-Scale National Database Study
Authors: Alkaramany Eslam , Materon Solangel Rodriguez , Mansur Nacime Salomao Barbachan , Dai Amos , Guyton Gregory P. 
Published: December 2024

Category: Midfoot/Forefoot; Other Introduction/Purpose: The development of adjacent joint arthritis following arthrodesis is a universal concern in orthopaedic surgery. Arthrodesis of the hallux metatarsophalangeal (MTP) joint is an effective and commonly performed treatment for first MTP arthritis and other conditions. Despite its widespread use, the risk of symptomatic degeneration at the interphalangeal joint remains undetermined and is a common question from patients considering the procedure. This study investigated the rate of subsequent hallux interphalangeal joint (IPJ) fusion following arthrodesis of the first MTP joint using a large commercial database. Methods: Patients who underwent hallux interphalangeal arthrodesis after hallux metatarsophalangeal arthrodesis were identified from a large national commercial insurance database using CPT code identification (PearlDiver). The Kaplan-Meier curve for survivorship free of subsequent interphalangeal fusion was generated covering 10 years from the index operation. Results: Of 87,890 patients who had first metatarsophalangeal arthrodesis, 808 patients (0.91%) subsequently underwent subsequent hallux interphalangeal joint arthrodesis within 10 years. Because CPT codes were reported without laterality, it is possible that a small subset of patients may have undergone a subsequent contralateral IP fusion, and therefore this result should be regarded as an upper limit of the possible rate. Conclusion: This is the first large-scale data to address the common patient concern of subsequent degeneration of the interphalangeal joint following metatarsophalangeal fusion. The rate of subsequent fusion is less than 1%, a result that highlights the durability of the clinical result of the first MTP fusion and should reassure patients and surgeons considering the procedure relative to motion-sparing alternatives.
Tibiotalar and Tibiotalocalcaneal Arthrodesis Complication Rates by Surgical Construct
Authors: Shen Peter C. , Balu Abhinav R. , Dalloul John M. , Bergman Rachel , Chang Shaun , Kelikian Armen , Patel Milap , Kadakia Anish R. , Mutawakkil Muhammad Y. 
Published: December 2024

Category: Ankle; Ankle Arthritis Introduction/Purpose: Ankle arthrodesis (AA) is the gold standard for effectively treating end stage ankle arthritis. Anterior anatomic plate fixation has been shown to provide rigid reliable fixation across the fusion site. Tibiotalocalcaneal arthodesis (TTCA) with a retrograde intramedullary nail is an excellent alternative that can be used to address concomitant subtalar arthritis, correct severe hindfoot deformity, and avoid extensive soft tissue dissection. This study evaluates rates of complications and their effect on fusion across the ankle joint in AA with concomitant subtalar arthrodesis in TTCA. Methods: This was an IRB-approved retrospective cohort study of patients between 2013-2023 at a single institution who underwent tibiotalar arthrodesis. Patients with longitudinal follow-up were included. Outcomes analyzed in this study included bony union and complications such as revision surgery due to nonunion, irrigation and debridement for infection, removal of symptomatic hardware, and development of postoperative deep venous thrombosis (DVT). T-tests were conducted to determine p-values for the outcome measures and analysis was performed in Microsoft Excel and Python 3.11.7. Results: This study included 102 patients who were followed for an average of 1.4 years postoperatively. TTCA was performed using an intramedullary nail in 49 patients; AA was performed with anterior anatomic plate in 53 patients. For patients who underwent TTCA with intramedullary nail, 6% underwent revision surgery for nonunion, 8% underwent I&D for infection, 12% underwent symptomatic hardware removal, and 2% were diagnosed with postoperative DVT. Eleven percent of patients who underwent AA with anterior anatomic plate underwent revision for nonunion, 8% underwent I&D for infection, 9% underwent symptomatic hardware removal, and 0 patients were diagnosed with DVT. There were no significant differences in complication rates between these two groups. Conclusion: With the right indication, tibiotalar arthrodesis complication and union rate is comparable in isolated AA and TTCA. Concomitant subtalar joint fusion did not influence ankle joint fusion rate. There were no significant differences in rates of revision surgery due to nonunion, I&D for infection, removal of symptomatic hardware, or postoperative DVT.
Time Critical Charcot Foot Reconstructions Can Still be Performed in the Absence of Preoperative Glycemic Control When Delivered by MDT
Authors: Ahmed Shuaib , Bakir Adnan , Hester Thomas , Manu Chris , Vainieri Erika , Kavarthapu Venu 
Published: December 2024

Category: Diabetes; Midfoot/Forefoot Introduction/Purpose: The management of glycemic levels in the perioperative setting is considered vital for reducing post-operative complications among patients with diabetes undergoing elective foot and ankle surgery. The current guidelines recommend a target HbA1c of 8.5. Patients waiting for Charcot foot deformity corrections with complicated diabetes often have extremely impaired mobility levels and fail to achieve adequate pre-operative glycemic control and risk getting their surgeries cancelled or postponed as a result. In our diabetic foot unit, the multidisciplinary team (MDT) recommends proceeding with surgery even if the target HbA1c levels are not achieved for those patients waiting for time-critical Charcot foot reconstructions despite their best efforts. To review the patient outcomes among patients with diabetes and variable pre-operative glycemic control undergoing Charcot foot reconstructions. Methods: We have reviewed the clinical outcomes of consecutive patients that had undergone elective Charcot foot reconstructions under the senior author with a minimum follow-up of 12 months. We have also reviewed the glycemic control achieved at 12 months post-reconstruction. Results: A total of 18 patients were operated between October 2020-August 2022. This included 8 midfoot, 2 hindfoot and 8 combined hindfoot-midfoot reconstructions. There were 11 males, with mean age 56.7 years (34-77). 10 had type 1 diabetes and 8, type 2. The mean preoperative HbA1c was 7.9 (5.4-11.8). The mean duration of waiting for surgery since the decision was 11 months. In 7 patients, the recommended target of 8.5 was not achieved (non-target group) within 6 weeks of their surgery. After one year 61% (n= 11) of the patients were able to mobilise independently in shoes. There was no difference in the outcomes between the patient groups with or without the targeted glycemic control. Postoperative HbA1c levels were available for 11 patients at 12 months. Conclusion: Although pre-operative glycemic optimization should be aimed for, the time critical Charcot foot reconstructions can still be performed in the absence of targeted glycemic control if delivered by MDT.
Topic Modeling of Foot & Ankle International: An AI-Driven Analysis of Journal Topics & Trends
Authors: Baird Henry , Gallegos Mauricio , Morningstar Joshua L. , McDonald Weston E. , Scott Daniel J. , Gross Christopher E. 
Published: December 2024

Category: Other Introduction/Purpose: Natural Language Processing (NLP) can aid in navigating and synthesizing vast amounts of text data. Topic modeling, a subset of NLP, can identify topics and trends that might otherwise remain obscured in large text datasets. These techniques can be used to assess the dynamic and rapidly growing landscape of the orthopedic literature quickly and objectively. The field of foot and ankle orthopaedic research is rapidly changing with the evolution and implementation of new techniques and implants. This study employed an advanced topic model (Bidirectional Encoder Representations from Transformers Topic (BERTopic) Model), to analyze the trends and key topics in Foot & Ankle International literature from 1980 to 2023. Methods: Text from the titles and abstracts of 4945 original articles & reviews published from 1980 to 2023 were included and used to train the BERTopic AI model. AI-generated topics were then analyzed by frequency (i.e. number of studies classified to that topic) & popularity (i.e. “hot” & “cold” topic trends, based on linear regression models of topic frequency from 2018-2023). The BERTopic model yielded 41 distinct topics. Results: The top 10 most common topics from 1980-2023 (Figure 1A) were Hallux Valgus: Treatment, Ankle Replacement, Diabetic Foot Disease, Achilles Injury and Treatment, Plantar Fasciitis, Pes Planus: Treatment, Calcaneal Fractures, Osteochondral Lesions of the Talus, Plantar Foot Pressure, and Peroneal Tendon Tears. The most popular or “hot” topics from 2018-2023 (Figure 1B) were Pes Planus: Radiographical Assessment of Foot Alignment, Hallux Valgus: Biomechanics, Ankle Arthrodesis, Ankle Instability: Deltoid Ligament, Ankle Replacement, Achilles Injury and Treatment, Tarsal Tunnel, Bone Grafting, Supramalleolar Osteotomy, and Peroneal Tendon Tears; while the least popular or “cold” topics were Ankle Replacement: Surveys, Hallux Valgus: Treatment, Calcaneal Fractures, Osteochondral Lesions of the Talus, Hallux Rigidus: Treatment, Chronic Ankle Instability, Foot and Ankle-specific Patient Reported Outcome Measures, Syndesmotic Instability, and Lisfranc Injuries. Conclusion: This study demonstrates the power of AI in efficiently distilling and analyzing evolving research topics and trends, as well as the dynamic nature of foot and ankle orthopaedic research. The hottest topics over the past 5 years were Pes Planus: Radiographical Assessment of Foot Alignment, Hallux Valgus: Biomechanics, Ankle Arthrodesis, and Ankle Instability. However, recent years have seen increases in publications regarding total ankle replacement. These techniques may be used to complement traditional literature reviews and meta-analyses.
Weightbearing Computed Tomography Can Accurately Detect Subtle Lisfranc Instability
Authors: Bhimani Rohan , Daniel Thompson John , Suh Nina , Kadakia Rishin J. , Bariteau Jason T. , M.M.J. Kerkhoffs Gino M , Coleman Michelle M. 
Published: December 2024

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Early detection of Lisfranc instability is critical for improving clinical outcomes, but more subtle instability can be difficult to diagnose. Weightbearing computed tomography (WBCT) provides a unique opportunity to evaluate such injuries in three dimensions (3D) while under physiologic load. This study aimed to assess the utility of one-dimensional, two-dimensional, and three-dimensional measurements on weight-bearing computed tomography (WBCT) to diagnose subtle instability in isolated ligamentous Lisfranc injuries. Methods: Ten cadaveric specimens underwent WBCT evaluation of the Lisfranc joint complex in the intact state and subsequently with sequential sectioning of the dorsal Lisfranc ligament (DLL) and interosseous Lisfranc ligament (IOL) to create subtle Lisfranc instability, and finally after transectioning of plantar Lisfranc ligament (PLL) to create complete Lisfranc instability. Measurements performed on WBCT images included: (1) Lisfranc joint (medial cuneiform-base of second metatarsal) volume, (2) Lisfranc joint area, (3) C1-C2 intercuneiform area, (4) C1-M2 distance, (5) C1-C2 distance, (6) M1-M2 distance, (7) first tarsometatarsal (TMT1) alignment, (8) second tarsometatarsal (TMT2) alignment, (9) TMT1 dorsal step off distance, and (10) TMT2 dorsal step-off distance. Results: In subtle Lisfranc injury state, Lisfranc joint volume and area, C1-M2 distance and M1-M2 distance measurements on WBCT significantly increased, when compared with the intact state (P values 0.001 to 0.014). Additionally, Lisfranc joint volume and area, C1-M2 distance, M1-M2 distance, TMT2 alignment and TMT2 dorsal step off measurements were increased in complete Lisfranc injury state. Of all measurements, C1-M2 had the largest area under the curve (AUC) of 0.96 (sensitivity = 90%; specificity = 90%), followed by Lisfranc volume (AUC = 0.90; sensitivity = 80%; specificity = 80%) and Lisfranc area (AUC = 0.89; sensitivity = 80%; specificity = 100%). Conclusion: WBCT scan can accurately diagnose subtle Lisfranc instability. Among the measurements, C1-M2 distance exhibited the highest level of accuracy. The 2D Joint Area and 3D Joint Volume also proved to be accurate, with 3D volume measurements of the Lisfranc joint displaying the most significant absolute difference between the intact state and increasing severity of Lisfranc instability. These findings suggest that 2D Joint Area and 3D Joint Volume have potential as supplementary measurements to more accurately diagnose subtle Lisfranc injuries.
Weightbearing Protocols and Outcomes in Open Surgical Management of Haglund Syndrome: A Retrospective Analysis
Authors: Hinton Zoe , Kutzer Katherine , Morrissette Kali , Wu Kevin , Krez Alexandra , Anastasio Albert T. , Amendola Annunziato 
Published: December 2024

Category: Ankle; Hindfoot Introduction/Purpose: Surgical options to address Haglund deformity include endoscopic and open approaches. After surgery, patients receive varying degrees of weightbearing limitation (nonweightbearing, touchdown weight bearing, or partial weight bearing). Given the scarcity of large-scale literature on the topic, this study aims to evaluate the impact of postoperative weightbearing protocols on outcomes after open surgical management of Haglund Syndrome. Methods: Following institutional approval, a retrospective review of patients undergoing surgery at a single institution by *** providers for Haglund Syndrome was performed. Patients were included if the surgery was performed by a currently active, fellowship-trained Foot and Ankle orthopaedic surgeon, without simultaneous management of other foot pathologies. This cohort of patients was reviewed for the following variables: date of birth, body mass index (BMI), smoking status (never, quit, active), American Society of Anesthesiologists Physical Status Classification (ASA), date of surgery, laterality, type of repair (corkscrew, speed bridge, suture anchor), current procedural terminology codes (CPT), postoperative weightbearing recommendations, postoperative outcomes (Achilles rupture, wound breakdown, persistent pain, debilitating plantarflexion weakness, revision), and date of most recent follow up. Statistical analysis was conducted using R with statistical significance set at p < 0.05. Results: Across 390 patients, the cohort averaged 55.14 years old and was 66.4% female. Postoperative recommendations varied from NWB (68.7%), TDWB (14.4%), WBAT (13.8%), and PWB (2.3%). Overall, 75 (19.2%) patients experienced a complication, including 40 (10.3%) persistent pain, 32 (8.2%) wound breakdowns, and 1 (10.3%) rupture, with 7 (1.8%) requiring revision. There were no significant differences in characteristics including age, diabetes, gender, BMI, and smoking status between weightbearing protocol groups. There were no statistically significant differences in complication rate between weightbearing protocols (p= 0.48354). The WBAT group experienced the highest rate of pain (14.8%) and a higher rate of the need for revision surgery in the WBAT group (3.7%), though not significant. The highest rate of wound breakdown occurred in the NWB group (9.7%). Conclusion: The study suggests that postoperative weightbearing protocols do not significantly influence the outcomes of open surgical treatment for Haglund Syndrome. This indicates that surgeons may choose the most appropriate weightbearing protocol based on individual patient needs and preferences. Future research should aim to further validate these findings and explore the impact of postoperative immobilization on outcomes in more granular detail.
SPDEF ameliorates UUO-induced renal fibrosis by transcriptional activation of NR4A1
Authors: Wang Hongshuang , Wei Ziheng , Xu Chang , Fang Fang , Wang Zheng , Zhong Yan , Wang Xiangting 
Published: December 2024

Abstract
Nuclear receptor 4A1 (NR4A1) is a gene that increases the likelihood of chronic kidney disease (CKD) and contributes to its development. Previous research has shown that the SAM pointed domain containing Ets transformation-specific transcription factor (SPDEF) can activate NR4A1, but its mechanism of action in renal fibrosis is not yet clear. In this study, we used adenovirus to create a mouse kidney model with a specific knockdown of NR4A1 gene. Our results showed that the knockdown of NR4A1 can accelerate unilateral ureteral obstruction (UUO)-induced renal fibrosis in mice, and overexpression of NR4A1 can significantly reduce transforming growth factor-β1-induced (TGF-β1) fibrosis in HK-2 cells. Additionally, we found that overexpression of SPDEF can improve UUO-induced renal fibrosis in mice and TGF-β1-induced fibrosis in HK-2 by transcriptionally activating NR4A1. These findings suggest that SPDEF can activate NR4A1 transcriptionally and improve renal fibrosis.