bluuebunny/crossref_metadata_2025_split huggingface dataset:
Convolutional Neural Networks Accurately Diagnose Lisfranc Injuries on Weightbearing and Nonweightbearing Radiographs
Authors: Sawatzke Alexander B. , Khela Monty , Ellis David , Windle John , Windle Thomas , Peng Dongming , Ma Jihyun , Antonson Neil 
Published: December 2024

Category: Other; Midfoot/Forefoot Introduction/Purpose: Convolutional neural networks (CNNs) predict Lisfranc injuries on weightbearing radiographs. Lisfranc injuries can be misdiagnosed 20%-50% of the time, thus leading to long-term sequela such as midfoot arthritis. Often Lisfranc injuries present to the Emergency department or general practitioner's office where Lisfranc injuries are more frequently misdiagnosed, and weightbearing films are less frequently obtained. CNNs are utilized to classify images, in particular, CNNs are successful at radiographic diagnosis of fractures, Lisfranc injuries, and classification of medical imaging. We aim to utilize CNNs to accurately diagnose Lisfranc injuries on both weightbearing and nonweightbearing films in a generalizable population of patients presenting to the emergency department, general practitioner, and orthopaedic clinics. Hypothesis: CNNs will accurately predict Lisfranc Injuries on weightbearing and nonweightbearing radiographs. Methods: In a retrospective study of 120 patients, 73 with Lisfranc injuries, and 47 without Lisfranc injuries were identified through medical record and imaging review. Radiographs and chart review were utilized to diagnose patients into Lisfranc and Not Lisfranc cohorts. A resnet-50 CNN model was trained, validated, and tested in a ratio (70:20:10) for each imaging view (anteriorposterior, lateral, oblique). Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, F score, and area under the curve (AUC) were calculated for each model and compared between weightbearing and nonweightbearing films. Results: The best deep learning model for Lisfranc identification has 94.5% sensitivity, 78.7% specificity, 90.2% negative predictive value, 87.3% positive predictive value, 88.3% accuracy, 90.8% F score, and 91.5% AUC. Only 2 out of 48 Lisfranc injuries were missed on nonweightbearing films and 3 out of 25 Lisfranc injuries were missed on weightbearing films. Conclusion: CNNs identify Lisfranc injuries on weightbearing and nonweightbearing radiographs with acceptable accuracy. The best model missed fewer Lisfranc injuries than frequently reported numbers for trained radiologists. F score and AUC indicate that this is an excellent test. This provides a method to improve and supplement diagnosis in patients with acute foot injuries, thus limiting long-term sequela from misdiagnosed Lisfranc injuries.
Custom Patient-Specific 3D-Printed Titanium Truss Tibiotalocalcaneal Arthrodesis Implants for Failed Total Ankle Replacements: Classification, Technical Tips and Treatment Algorithm
Authors: Lewis Thomas L. , Walker Roland , Alkhalfan Yousif , Latif Ahmed , Abbasian Ali 
Published: December 2024

Category: Ankle Arthritis; Ankle Introduction/Purpose: The management of failed total ankle replacements, with significant loss of bone stock, is challenging with high rates of complications and associated morbidity. Recent technological advances have enabled the development of patient-customized 3D-printed titanium truss arthrodesis implants which offer an alternative salvage option for failed total ankle replacements. Methods: A prospective observational study of six cases of failed total ankle replacements which were managed using custom patient-specific 3D-printed titanium truss arthrodesis implants. Technical tips, classification and a treatment algorithm were developed based on our initial experience. All p-values < 0.05 were considered significant. Results: Between November 2018 and March 2022, 6 patients underwent arthrodesis for failed total ankle replacements. Follow up was available for all cases. The mean follow up was 3.0 years (range 1-4.5). The mean MOXFQ Index improved from 73.1 to 32.3 (p< 0.05). The mean EQ-5D-5L Index improved from 0.366 to 0.743 (p< 0.05) and the EQ-VAS also improved from 53.0 to 63.3 (p=0.36). The mean VAS-Pain score at final follow up was 27.5. There were no cases of non-union. Conclusion: Custom patient-specific 3D-printed titanium truss arthrodesis implants are a viable alternative treatment option for failed total ankle replacements. MOXFQ Scores Following Custom Patient-Specific 3D-printed Titanium Truss Tibiotalocalcaneal Arthrodesis Implants for Failed Total Ankle Replacements
Development and Validation of Fully Automated Measurement Framework to Quantify 3D Foot and Ankle Alignment Using Weight-Bearing CT
Authors: Van den Borre Ide , Peiffer Matthias , Huysentruyt Roel , Huyghe Manu , Vervelghe Jean , Pizurica Aleksandra , Audenaert Emmanuel , Burssens Arne 
Published: December 2024

Category: Hindfoot; Ankle Introduction/Purpose: Traditionally, foot and ankle alignment is quantified on 2D standing radiographs. This imaging method present limitations in capturing the 3D nature of our foot and ankle alignment and the obtained manual measurements are prone to observer error. This study aims to integrate weight-bearing CT (WBCT) imaging and advanced deep learning techniques to automate and enhance quantification our 3D foot and ankle alignment. Methods: Thirty-two patients who underwent a WBCT of the foot and ankle were retrospectively included. Training and validation of a 3D nnU-Net model on 45 cases to automate the segmentation into bony models was assessed by Hausdorff distance (measures how far two 3D bone model scans are from each other) and dice coefficient (measures the similarity between 3D bone model scans). Afterwards, 35 clinically relevant 3D measurements were automatically computed using a custom-made tool. Automated measurements were assessed for accuracy against manual measurements, while the latter were analyzed for inter-observer reliability. Results: Deep learning segmentation results showed a mean Hausdorff distance of 1.41mm and a mean dice coefficient of 0.95. A good to excellent reliability and mean prediction error of under 2 degrees was found for all angles except the talonavicular coverage angle and distal metatarsal articular angle, which were under 2.5 degrees. Conclusion: In summary, this study introduces a fully automated framework (Fig. 1) to quantify foot and ankle alignment and showcases reliability comparable to current clinical practice measurements. This operator-friendly and time-efficient tool holds promise for implementation in a clinical setting, benefitting both radiologists and surgeons. Future studies are encouraged to assess the tool's impact on streamlining image assessment workflows in clinical practice.
Direct Anterior Approach for AO43B/43C Pilon Fracture Fixation Demonstrates No Difference in Rate of Reoperation Compared to Other Surgical Approaches
Authors: Sokil Laura , Wong Liam H. , Roti Elizabeth , DeKeyser Graham , Working Zachary , Friess Darin , Meeker James 
Published: December 2024

Category: Trauma; Ankle Introduction/Purpose: The direct anterior (DA) approach is commonly used for reconstructive procedures to treat posttraumatic ankle osteoarthritis (PTOA), however, literature investigating utilization of the DA approach (defined as the interval between the tibialis anterior tendon and extensor hallucis longus tendon) for initial fixation of pilon fractures is lacking. This retrospective study of patients undergoing fixation of pilon fractures hypothesizes that there is no difference in reoperation rate for patients whose pilon fractures were treated with DA approach. Methods: A retrospective radiographic and chart review of patients undergoing surgical fixation of tibial plafond fractures over a nine year period (2013-2022) at an urban, level 1 trauma center was undertaken. Review of operative notes for reoperation for infection, PTOA, nonunion and symptomatic hardware was utilized to determine reoperation rates. Injuries were radiographically stratified by AO/OTA classification, and quality of fracture reduction was assessed via measurement of the lateral distal tibial angle (LDTA) and lateral talar station (LTS) at the first postoperative radiograph. Likelihood of reoperation within one year of index surgery was analyzed using Kaplan-Meier estimations. Reoperation risk factors were determined with multivariable logistic regression analyses created using a backwards stepwise process. Results: 135 fractures in 130 patients met inclusion criteria; 44 fractures were treated via a DA approach, 91 treated via all other approaches, many in combination. Between groups, AO/OTA classification, demographics, injury characteristics and operative time were no different. Overall reoperation rate was 40.7%. There was no significant difference between DA and all other approaches in rate of reoperation for infection (2.3% vs. 10%, p=0.21), nonunion (15.9% vs. 16.5%, p=1), PTOA (9.1% vs. 7.8%, p=1) and removal of symptomatic hardware (25% vs. 36.3%, P=0.27). Multivariable regression showed DA approach was associated with lower risk of reoperation within one year (OR 0.25, 95% CI 0.07-0.71, P=0.02). The DA group lateral talar station (LTS) was significantly greater (more anterior) by 0.9mm (2.75mm DA vs. 1.85mm all others, P=0.01). Conclusion: Utilization of the direct anterior approach to the ankle for initial fixation of pilon fractures has no difference in overall reoperation rates and a lower likelihood of reoperation within one year compared to all other combinations of approaches to the tibial plafond. Radiographic outcomes were different between groups, but the clinical significance of this is unclear. The DA approach should be considered for fracture patterns amenable to its use and may offer benefit should reconstructive procedures become necessary.
Distance Mapping of the Ankle to Assess Changes after Isolated Arthroscopic Anterolateral Subtalar Arthrodesis in Progressive Collapsing Foot Deformity
Authors: Bernasconi Alessio , Izzo Antonio , Fernando Céline , Lintz François 
Published: December 2024

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: End-stage subtalar osteoarthritis in the context of Progressive Collapsing Foot Deformity (PCFD) is usually treated through subtalar joint (SJ) arthrodesis. In this study we set out to assess the changes occurring at the ankle joint after Anterolateral Arthroscopic Subtalar Arthrodesis (ALAPSTA). Methods: In this retrospective study, we evaluated pre- and post-operative (at 6 months) weight bearing computed tomography (WBCT) images of patients diagnosed with PCFD with a degenerated SJ (2A according to PCFD classification) and/or peritalar subluxation (2D) with or without associated flexible midfoot and/or forefoot deformities (1B, 1C and 1E) which underwent ALAPSTA as a standalone procedure between 2017 and 2020. Hindfoot alignment was assessed using multiple measurements. Distance Mapping (DM) at the ankle joint (divided in 9 regions) allowed to assess changes in terms of joint interaction between pre and postoperative images. Results: Out of 94 PCFD treated, thirtythree feet (33 patients, median age 62) were included in the study. Hindfoot alignment significantly improved, with a median Foot and Ankle Offset significantly decreased from 9.3 to 4 points (p< 0.001). We found a significant increase in mean distances occurring posterolaterally at the ankle (from 4.5 mm (SD 1.2) to 5.4 mm (SD 1.5), p< 0.001) along with a significant decrease occurring anteromedially (from 9.1 mm (SD 1.2) to 8.3 mm (SD 1.4), p< 0.001). In the three anterior regions there was a significant reduction of the mean distance between surfaces (all p= or < 0.01) while in two of the three posterior regions the distance between the tibia and talus significantly increased (p< 0.01). Conclusion: In patients diagnosed with PCFD undergone ALAPSTA, we observed significant changes in terms of interaction between the articular surfaces at the ankle joint, demonstrating a an external rotation and dorsiflexion on the talus in keeping with a ‘re-saddling’ effect over the calcaneus achieved through the procedure.
Does Timing of Hindfoot Reconstruction Before or after Primary Total Knee Arthroplasty Impact Reoperation Rates?
Authors: Larwa Joseph , Dohse Nicolas , Moses Alexander , Ledford Cameron , Haupt Edward T. 
Published: December 2024

Category: Hindfoot; Other Introduction/Purpose: Total knee arthroplasty (TKA), ankle arthrodesis/arthroplasty, and hindfoot arthrodesis are effective procedures in treating end-stage osteoarthritis and deformity of the knee and hindfoot, respectively. Risk of reoperation remains a significant complication associated with these major lower extremity surgeries. Our study aimed to evaluate revision/reoperation rates and etiologies in patients undergoing staged ipsilateral TKA and hindfoot reconstruction (HFR). Methods: A retrospective review identified 162 patients undergoing ipsilateral TKA and HFR procedures between 2000 and 2022. Groups were stratified according to their index surgery: TKA first (n=81) versus HFR first (n=81). Reoperations rates, complications, and indications were compared via descriptive statistics. Mean follow-up was 4 years from the second surgery. Results: For the TKA first cohort, the overall rate of any reoperation was 28% (23/81), including a significantly higher rate of HFR than TKA reoperations (22% vs. 7%, respectively, p< 0.01). The most common etiology for HFR reoperation was arthrodesis nonunion (8/18, 44%) whereas for reoperation indication for TKA was evenly divided between instability, aseptic loosening, and patellar dysfunction. For the HFR first cohort, the overall rate of any reoperation was 16% (13/81), including similar rates of HFR and TKA reoperations (9% and 10%, respectively, p=0.4). The most common etiologies of HFR and TKA reoperations after F&A surgery first were adjacent joint disease (6/7, 86%) and patellar-related complications (4/8, 50%), respectively. Conclusion: Reoperation after a HFR appears to be higher when an ipsilateral TKA is performed first, primarily due to arthrodesis nonunion. Our series represents a first report of the temporal relationship between TKA and ankle/hindfoot reconstruction.
Early Clinical Outcomes and Complications of Transfibular Total Ankle Arthroplasty: The Australian Experience
Authors: Wines Andrew , Mittal Rajat , Symes Michael , Clugston Ellery , Scholes Corey , Wilton Alex 
Published: December 2024

Category: Ankle Arthritis; Ankle Introduction/Purpose: We report the short-term outcomes of a retrospective cohort of Trabecular Metal total ankle arthroplasties (TAAs) via a transfibular approach from a single, nondesigner surgeon in Australia. Methods: This was a retrospective cohort study. Demographic, clinical, and patient-reported outcome measures (PROMs) were collected. The primary outcome was the Foot and Ankle Outcome Score (FAOS), and secondary outcomes included patient satisfaction, the EuroQol-5 Dimension (EQ5D), and complications including revision rates. Results: Between 2016 and 2019, 84 trabecular metal prostheses were implanted in 84 patients. Mean age (SD) at time of surgery was 68 (7.8) years, and 46 (55%) were male. Mean follow-up (SD) was 26.1 (13) months. There were significant improvements in the FAOS (Pain (47.9 to 79.1), activities of daily living (59.5 to 83.7), and quality of life (25.5 to 60.2)) and EQ-5D (0.55 to 0.75) (P < .001), and overall satisfaction was 69.6%. Complications included wound infection/breakdown (11.9%), fibular nonunion (3.5%), plate irritation (3.5%), and tibial nerve neuropathy (3.5%). There were no thromboembolic complications. Implant survivorship was 100%, with Trabecular Metal components retained in all patients. Two patients developed deep infection, with 1 requiring debridement and polyethylene exchange. No patients experienced implant loosening. Conclusion: Our results demonstrate that the trabecular metal survival rates are comparable with other total ankle implants in the Australian Orthopaedic Association National Joint Replacement Registry and as published in other international literature. Overall patient satisfaction was high, as were PROMs. However, the data highlight potential complications uniquely associated with this implant. The authors believe that these figures support TAA via a transfibular approach as a viable option in the treatment of ankle arthritis.
Early Outcomes of the 3-Component Salto Total Ankle Arthroplasty and Management of Major Complications
Authors: Lim Jung-Won , Im Je-Min , Jung Hong-Geun 
Published: December 2024

Category: Ankle; Ankle Arthritis Introduction/Purpose: The popularity of total ankle arthroplasty (TAA) increased. Despite the favorable outcomes reported after TAA, there are many complications and subsequent reoperations after surgery. In this study, we evaluate the early clinical and radiologic outcomes of the Salto mobile bearing 3-component total ankle prosthesis, especially in terms of complications and reoperations. Methods: TAA was performed in 120 consecutive ankles (115 patients) by a single surgeon using 3-component Salto total ankle implant from June 2014 to May 2021 with at least 2-year follow-up. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot functional score, pain VAS, satisfaction score and clinical range of motion (ROM) were collected along with weight-bearing radiographs of the ankle. Radiographic outcomes were also evaluated with standing manner. Reoperation is defined as non-revisional secondary surgery involving the ankle not the prosthesis. Results: VAS pain score decreased from 6.7 (range, 2–10) pre-operatively to 1.5 (range, 0–8) at last follow-up (p < 0.05). AOFAS score increased from 36.2 (range 3–85) to 86.0 (range 15–100) at last follow-up (p < 0.05). Overall satisfaction rate was 88%. Even with such good clinical outcomes, complications were also identified. There were 22 cases with osteolysis, and 14 cases among them required additional bone graft or cementation. One ankle with talar component subsidence underwent revision procedure. Three ankles with surgical site infection also needed reoperation procedure, and 1 case among them was converted to tibio-talo-calcaneal arthrodesis at 3 months postoperatively. Post-operative varus tilted ankle were observed in 5 ankles that underwent reoperation procedures such as lateral ligament reconstruction. Conclusion: The TAA using single Salto 3-componenet implant showed favorable early outcomes. Nevertheless, there were many complications that needed reoperation procedures during the 2-year follow-up, so periodic close observation is necessary. In reoperation, proper diagnosis of problems and skilled procedures are required.
Epidemiology of Pickleball-Related Foot and Ankle Injuries (2015 – 2023)
Authors: Kingston Kiera , Parker Emily Belle , Higgins Alexander , Smith Jeremy T. 
Published: December 2024

Category: Sports; Ankle Introduction/Purpose: Pickleball, a paddle sport that combines elements of tennis, badminton, and ping-pong, is the fastest-growing sport in the United States. The surge in pickleball’s popularity is largely attributed to a growing population of older adults in search of a relatively low-impact yet engaging physical activity. While pickleball is great for promoting both physical fitness and social interaction, it is not without risk of injury. This study seeks to describe the epidemiology of pickleball-related foot and ankle injuries with a goal of providing insight into injury demographics, injury types, and injury patterns. Methods: For this cross-sectional retrospective study, we queried our institutional database for patients with documentation including “pickleball” or “pickle ball” who were seen by a foot and ankle provider between 1/2015 – 12/2023. Sites included two large academic medical centers and two community hospitals. Clinical notes were reviewed and only patients with foot and ankle injuries directly associated with playing pickleball were included. Patient demographics (age, sex, BMI), date of injury, laterality, diagnosis, treatment, and mechanism of injury (when available) were collected. We calculated the annual incidence of injuries over the study period and conducted descriptive analyses on patient demographics, diagnoses, and treatment approaches. Results: We identified 198 patients with pickleball-related foot and ankle injuries. The annual injury incidence rose rapidly over the study period, increasing 6.5-fold from 2019 to 2023 (Figure 1). The mean age at time of injury was 58.3 years (SD=12.2) and mean BMI was 26.7kg/m2 (SD=4.1). The majority of patients (58.6%) were male and reported a traumatic injury (77.8%) versus exacerbation of a chronic injury. The most common diagnoses were Achilles tendon rupture (39.4%), gastrocnemius injury (16%), and Achilles tendinopathy (12.1%). Of patients with documentation of the mechanism of injury (n=101), the most common causes were running or lunging forward (29.7%), inverting the foot/ankle (14.8%), and moving backward (8.0%). While the majority of injuries (72.7%) were treated non-operatively, 60% of Achilles tendon ruptures were treated surgically. Conclusion: The incidence of pickleball-related foot and ankle injuries has increased dramatically over recent years. Most injuries identified in our cohort were traumatic, with Achilles tendon rupture being the most common diagnosis. Injuries occurred more often in men and players older than 50-years-old while running or lunging for the ball. As the popularity of pickleball increases, there is a corresponding need for expanded education regarding strategies to help prevent foot and ankle injuries among pickleball players, with particular attention towards preventing Achilles tendon rupture. Further research is needed examining functional outcomes and return to sport after pickleball-related foot and ankle injuries.
Association between serum uric acid levels and chronic tension-type headache: A case–control study
Authors: Algul Fatma Ebru , Kablan Yuksel 
Published: December 2024

Background Tension-type headache (TTH) is the most common type of primary headache. Its etiology has not been clearly elucidated, and conflicting results have been reported in studies on oxidative stress. Uric acid is a molecule with antioxidant properties and is the end product of purine catabolism. Total oxidant-antioxidant status may potentially play an important role in the pathophysiology of chronic TTH. In this study, we investigated whether there was a difference in uric acid levels, an oxidative stress marker, between patients with tension-type headache and healthy controls. Methods The study was designed retrospective observational case–control study. The diagnosis of chronic TTH was made according to the diagnostic criteria established by the International Classification of Headache Disorders. A total of 164 people, including 94 patients with chronic tension-type headache and 70 healthy controls were included in the study. Hemoglobin, blood urea nitrogen (BUN), creatinine, albumin, and serum uric acid levels were studied from the serum of the participants. The Kolmogorov Smirnov Normality test, Mann–Whitney U test, and binary logistic regression test were used for statistical analysis. Results There was no statistically significant difference between our control and patient groups in terms of age and BUN ( p = 0.069 and p = 0.547). The serum albumin ( p = 0.000), creatinine ( p = 0.047), and hemoglobin levels ( p = 0.000) in our patient group were found to be significantly low compared to the healthy control group. The serum uric acid levels in the TTH and control groups were 4.28 ± 1.16 and 5.32 ± 1.31 mg/dL, respectively ( p = 0.000). Lower uric acid levels correlate with an increased likelihood of TTH presence in both males and females. Conclusion We demonstrated that serum uric acid levels in TTH patients were lower than in controls. Further studies with larger populations are needed to determine whether uric acid plays a protective role in the etiology of TTH by reducing oxidative stress.