bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristics of Anterolateral Ankle Impingement Due to a Distal Fascicle of Anterior Inferior Tibiofibular Ligament
Authors: Park Chul Hyun 
Published: December 2024

Category: Arthroscopy; Ankle Introduction/Purpose: The pathomechanism of anterolateral ankle impingement (ALAI) due to a distal fascicle of the anterior inferior tibiofibular ligament (DF-AITFL) has not been fully elucidated. In addition, due to its rarity, no definitive diagnostic criteria have been established for ALAI by DF-AITFL. This study was performed to document the symptom characteristics, MRI and arthroscopic findings, and postoperative clinical outcomes of ALAI due to a DF-AITFL. Methods: Twelve patients (5 males and 7 females of mean age 34.4 years (range 21-76 years)) diagnosed with ALAI due to DF-AITFL from November 2017 to August 2021 and treated surgically were included in this study. Symptom characteristics and symptom-related medical histories were evaluated. Clinical outcomes were assessed using a visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot functional scale, and foot function index (FFI). In addition, magnetic resonance imaging (MRI) and arthroscopic findings were evaluated. Results: All 12 patients had a history of ankle sprain prior to symptom onset. Mean VAS, AOFAS ankle-hindfoot functional scale, and FFI improved significantly postoperatively. DF-AITFL was confirmed by MRI in all cases (Fig. 1). Bone edema of the talus was observed in two cases (16.7%), and cartilage abnormalities in three (25%). Arthroscopy showed that the DF-AITFL contacted the anterolateral aspect of the talar dome during ROM in all cases and that the AITFL was bent where it contacted the anterolateral dome of the talus in 3 cases (25%). Partial tear or adhesion of the DF-AITFLwas noted in seven cases (58.3%), and cartilage deformation at the anterolateral talar dome in 4 cases (33.3%). Conclusion: ALAI due to DF-AITFL should be considered a possible cause of anterolateral ankle pain, especially in cases of ankle sprain. Figure 1. (A) The coronal oblique plane was prescribed for the DF-AITFL (arrow) using standard axial planes parallel to the AITFL (arrowhead). (B) The axial oblique plane was prescribed using coronal oblique planes parallel to the AITFL. The DF-AITFL was in contact with the anterolateral dome of the talus. Abnormal findings, including bone edema (asterisk) (C) and cartilage abnormalities (circle) (D) related to DF-AITFL were evaluated by MRI.
Clinical Outcomes of All-Inside Arthroscopic Lateral Ankle Ligament Reconstruction for Chronic Lateral Ankle Instability: A Prospective Series with Minimum 12 Month Outcomes
Authors: Lewis Thomas L. , Vignaraja Vikram , Franklin Samuel , Ferreira Gabriel , Nunes Gustavo Araujo , Lam Peter , Ray Robbie 
Published: December 2024

Category: Ankle; Sports Introduction/Purpose: Chronic lateral ankle instability (CAI) is a common condition that can be effectively treated with lateral ankle ligament reconstruction to restore ankle stability and function. The aim was to assess the functional outcomes of arthroscopic lateral ligament reconstruction using the Manchester-Oxford Foot Questionnaire (MOXFQ), Visual Analog Score (VAS) and Euroqol-5D-5L (EQ-5D) patient-reported outcome measures (PROMs). Methods: This prospective series included 36 consecutive patients who underwent isolated arthroscopic lateral ligament reconstruction for CAI between November 2020 and November 2022 with minimum 12-month follow up. All patients completed the MOXFQ, VAS, and EQ5D PROMs preoperatively, and 12 months postoperatively. The MOXFQ is a validated foot and ankle-specific PROM that assesses foot and ankle function, the VAS measures pain and the EQ5D evaluates general health-related quality of life Results: Patients were followed up for 12-25 months. In all patients, there was significant improvement in all post-operative PROMs (p < 0.05). The MOXFQ index decreased from 59.1±19.2 to 13.5±18.1 (p < 0.01), EQ-5D index increased from 0.607±0.224 to 0.854±0.175 (p < 0.01) and VAS pain decreased from 36.6±22.3 to 13.6±18.4 (p < 0.01). Conclusion: Arthroscopic lateral ankle ligament reconstruction is an effective treatment for chronic ankle instability, with significant improvements in clinical and health-related quality of life outcomes.
Combined Randomised and Observational Study of Surgery for Type B Ankle Fracture Treatment (CROSSBAT) Minimum 5 Year Follow-Up
Authors: Mittal Rajat , Symes Michael , O'Keefe Ryan , Naylor Justine , Harris Ian 
Published: December 2024

Category: Trauma; Ankle Introduction/Purpose: Isolated Type B ankle fractures are common. The study (CROSSBAT: Combined Randomised and Observational Study of Surgery for Type B Ankle Fracture Treatment) demonstrated that surgical management was not superior to non-surgical management for the treatment of 44-B1 ankle (fibula) fractures with minimal talar shift at one-year post-injury. The current study presents longer term results of that cohort with a minimum 5-year follow-up. It aims to determine whether surgical management confers improved outcomes for participants with isolated AO type 44-B1 distal fibula fractures when compared with non-surgical management at minimum 5 years post- injury. Methods: A multi-centre, randomised controlled trial with an observational cohort was conducted. Participants were recruited from 22 hospitals across Australia and New Zealand. Participants consenting to follow-up but not randomisation formed the observational cohort. SURGICAL GROUP: Fracture fixation using a plate and screws. Post-operatively, ankles were splinted and participants were non-weight-bearing for 2 weeks, then weight-bearing was allowed; NON-SURGICAL GROUP: Ankles were splinted and participants were allowed to weight-bear. OUTCOMES: All participants were followed with a minimum 5-year follow-up. Primary outcomes were the American Academy of Orthopaedic Surgeons Foot and Ankle Outcomes Questionnaire (FAOQ) and the physical component score (PCS) of SF-12v2 general-health survey at 12 months. The randomised and observational cohorts were analysed separately. Results: Between August 2010 to October 2013 160 people were randomised (80 surgical and 80 non- surgical). 276 formed the observational cohort (19 surgical and 257 non-surgical). At minimum 5 year follow-up, 75 (47%) and 103 (37%) in the randomised and observational cohort respectively were contactable. Surgery was not superior for ankle function score or SF-12v2 compared with non-surgical group in the randomised or observational cohorts. Conclusion: Surgical management was not superior to non-surgical management in patients who sustained a distal fibula fracture with minimal talar shift.
Comparison Between Operative Methods in Treatment of Isolate Lisfranc Injury - Various Flexible Fixation of Subtle Lisfranc Ligament Injury
Authors: Yi Young , Chun Dongil , Kim Saintpee 
Published: December 2024

Category: Midfoot/Forefoot; Sports Introduction/Purpose: Recently, various suture button technique were introduced for isolated Lisfranc ligament(ILL) fixation. However, a few clinical and radiologic study focused on suture button fixation on the ILL injury has been reported. This study is comparative between conventional screw fixation versus various types of suture button(TightRopeTM, Internalbrace®) for the ILL ligament injury. Methods: This is a multicenter, retrospective study included patients were divided into two groups according to the treatment method: 35 conventional screw group, 34 TightRopeTM group and 30 internal brace fixation group. In terms of the clinical outcome, VAS score and AOFAS midfoot scale were used, evaluated at preoperative, postoperative 6 months, and last follow up period. In order to evaluate the radiologic outcome, weight bearing foot AP radiograph and weight bearing CT were taken to compare diastasis and side to side difference. Plantar foot pressure was measured in all the patients included after postoperative 6 months in three groups. Postoperative complications detected until the last follow up were analyzed between the three groups. Results: Two suture button groups showed better clinical outcome to conventional screw fixation group at postoperative 6 month follow up period. However, no significant difference between all groups was found at postoperative 1 year, and last follow up period. And no difference between three groups was found with regards to diastasis and side to side difference measured at weight bearing AP radiograph. Dorsal and plantar diastasis measured on WBCT were not significant different between three groups as well. Foot pressure was significantly elevated on conventional screw fixation group at forefoot then the other groups. Recurrent Lisfranc joint diastasis was found in a single case in conventional screw group and two cases in TightRopeTM group. but Internalbrace group was not found recurrent diastasis. Conclusion: Our investigation suggests that utilizing suture button fixation in the treatment of ILL injuries may offer reliable fixation stability with a few complications compare with standard screw fixation. And it may bring out better patient satisfaction in ILL in early postoperative follow up period.
Comparison of Ankle Fracture Outcomes Treated with Fibular Nail vs Conventional Fixation
Authors: Geiger Bryanna , Okonkwo Jude , Nwankwo Chima , Idris Maksat , Vosseller J. Turner , Chien Bonnie Y. 
Published: December 2024

Category: Ankle; Trauma Introduction/Purpose: Ankle fracture fixation can benefit from minimizing postoperative complications, particularly with wound healing and infection. Less invasive implant options necessitating smaller incisions have emerged, including the fibular intramedullary nail (i.e. Arthrex Fibulock) to minimize incisions and potentially allow earlier mobilization. The purpose of this study is to investigate the efficacy and clinical outcomes of a fibular intramedullary nail (Arthrex Fibulock) in ankle fracture treatment across a diverse patient cohort. Methods: A retrospective chart review from 2018 to 2022 was conducted in order to determine eligible patients. Inclusion criteria included adult patients treated for an ankle fracture with at least 3 months of follow-up and sufficient imaging available. Exclusion criteria included open fractures, other concomitant injuries, pilon and tibial shaft fractures, or previous ankle surgery. Results: A total of 132 patients were consecutively included, 44 in the conventional fixation group (33.33%) and 88 in the fibular nail group (66.67%). 4 out of 88 fibular nail patients (4.55%) and 3 out of 44 conventional patients (6.82%) had a postoperative infection (P = .43). 8 fibular nail (9.09%) and 6 conventional (13.64%) fixation patients underwent hardware removal postoperatively, which was not statistically significantly different (P = .55). Conclusion: This study shows no difference between the fibular nail device and a conventional plate and screw fixation approach in the treatment of ankle fractures when looking at postoperative infection and removal of hardware rates. The rate of postoperative infection and hardware removal trended higher in the conventional fixation patients but did not reach statistical significance. As such, the use of the fibular nail may offer a viable alternative for all patients undergoing ankle fracture operative treatment.
Comparison of Elasticity and Load to Failure for Three Different Syndesmosis Devices: A Biomechanical Study
Authors: Younger Alastair S.E. , Parekh Selene G. , Morgan Steven , Wedam Brandon 
Published: December 2024

Category: Basic Sciences/Biologics; Trauma Introduction/ Purpose: A syndesmosis injury can result in degenerative change and poor outcomes after an ankle fracture. This can occur in combination with an ankle fracture, with a proximal fibular fracture or with separation of the tibia and fibula without a fracture being present. Fixation of the fibula to the tibia can be rigid with a screw or flexible with a suture device. Flexible syndesmosis fixation has been shown to have superior outcomes and less hardware removals compared to fixed devices. However a more elastic device may result in opening of the syndesmosis before healing. A device with a lower failure load may fail in a heavier patient being more active. Three commercially available suture devices were therefore tested to assess their elasticity and failure load. Methods: Eight each of three commercially available syndesmosis suture devices were tested: Acumed Acu-Synch Knotless (AAK), Arthrex Tightrope (AT) and Zimmer Biomet ZipTight (ZT). An Instron testing machine was used to apply cyclical load through mounting blocks to the suture devices configured to match the distance between the tibia and fibular anchor points. The anchors were inserted based on the operative technique. Synthetic bone blocks with cortical and cancellous bone densities were used. The blocks were preloaded to 53 N with the displacement reset to zero. The specimens were cycled from 53 to 113 N at a rate of 2 Hz for 420,000 cycles and the displacement measured. Testing was discontinued if the suture, fibula button or flip button broke. If 3 mm or greater elongation occurred the specimen was considered failed. For the specimens not failing by 420K cycles load was applied until failure. The mode of failure was recorded. Results: The ZipTight (ZT) devices failed at an average of 122 +/- 185K cycles with 6 of 8 specimens failed by 3 mm. The ultimate load was 424 +/- 122 N. The Acu-Sinch Knotless (AAK) devices all completed 420 +/- 0 K cycles. The displacement 1.9 +/- 0.26 mm. The ultimate load to failure was 1018 +/- 46N. The Tightrope (AT) devices all completed 420 +/- 0 k cycles. The displacement averaged 1.97 +/- 0.16 mm. The failure load was 890 +/- 118 N. The ZT device had fewer cycles to failure than the AAK and AT devices. The ZT device had a greater degree of displacement on repeat loading compared to the AA and AT devices. Conclusion: The ZT device had a lower failure load compared to the AA and AT devices. The AA and AT devices had the same cycles to failure and the same displacement to failure. The AA device was significantly stronger than the AT device in failure mode. The AA and AT flexible syndesmosis fixation showed better mechanical properties than the ZT fixation. The AA device had a higher load to failure than the AT device. The mechanical properties could be relevant in clinical fixation with regards to failure of surgical stabilization.
Comparison of Percutaneous Repair and Open Repair for Delayed Treatment of Achilles Tendon Rupture
Authors: Choi Seung-myung , Cho Byung-Ki , Bae Seung-Hwan , Choi Seo-yool 
Published: December 2024

Category: Sports; Hindfoot Introduction/Purpose: Delays in diagnosis or treatment of acute Achilles tendon rupture are relatively frequent either due to the injury being misdiagnosed or the patient disregarding its severity. In the delayed presentation of Achilles tendon rupture, open repair is generally recommended for mobilization of the adherent and retracted tendons from the thickened paratenon layer repair although this introduces the risk of wound complications. Although a minimally invasive technique for acute Achilles tendon rupture has demonstrated lower infection rates, with functional results equivalent to those of open repair, their use in patients presenting in a delayed fashion has not been thoroughly investigated. The objective of this study is to compare the outcomes of percutaneous and open repair in cases of delayed presentation of acute Achilles tendon rupture. Methods: This was a retrospective study of prospectively collected data on consecutive patients who underwent either percutaneous or open repair for delayed presentation of Achilles tendon rupture and were followed up for at least one year. Delayed Achilles tendon rupture was defined as if patients underwent surgery 14 to 30 days after the injury and had received no treatment before surgery. The percutaneous repair was a modified Bunnell suture with an additional incision enough to permit mobilization of the tendon ends and core suture. An identical postoperative rehabilitation protocol was implemented in both groups: with below-knee cast in maximum plantarflexion, full weightbearing on the metatarsal heads was immediately allowed as tolerated. Postoperatively, the AT Resting Angle (ATRA), patient-reported functional outcomes using the AT Rupture Score (ATRS), and Calf circumference difference were evaluated. Postoperative complications, including re-rupture, wound infection, and sural nerve injury, were assessed. Results: There were no significant differences in demographic data between the percutaneous repair group (N =23) and the open repair group (N =23). The elapsed time from injury to surgical treatment and the gap between the proximal and distal stumps assessed on the MRI between the groups were similar. there were no statistically significant differences observed in ATRA (-2.9 ± 1.8 vs -2.1 ± 1.7, p = 0.687), ATRS (92.2 ± 2.5 vs 93.1 ± 2.6, p = 0.814), or calf circumference difference. Additionally, there were no cases of re-rupture in either group. A deep wound infection occurred in one patient in the open repair group. Symptoms related to sural nerve injury were observed in two patients in the percutaneous repair group, which resolved with conservative treatment. Conclusion: In cases of delayed presentation of Achilles tendon rupture, the percutaneous tendon repair technique is considered to yield comparable outcomes to the open tendon repair technique.
Depressive Disorder and Trimalleolar Fractures: An Analysis of Outcomes and Costs
Authors: Fudala Maddie , Blank Lindsay , Tabbaa Ameer , Rodriguez Ariel Nicolas , Conway Charles , Lam Aaron , Razi Afshin , Abdelgawad Amr 
Published: December 2024

Category: Trauma; Hindfoot Introduction/Purpose: The prevalence of depression is rising globally, and it has been noted in recent literature that the COVID-19 pandemic has exacerbated the increase in depressive disorders. Studies have suggested a strong association between depression and poor outcomes following various orthopedic surgeries, particularly joint arthroplasties. However, depression’s impact on complications following open reduction/internal fixation (ORIF) of Trimalleolar fractures has not been elucidated, despite the high complication rate of this procedure. Therefore, the aims of this study were to determine whether depression is associated with higher rates of 1) readmissions and 2) medical complications following ORIF of Trimalleolar fractures. Methods: Using the Mariner nationwide database from January 1, 2010, to March 31, 2021, a total of 50,154 adults aged 18 or older were identified as having undergone Trimalleolar ORIF using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-9, ICD-10) coding. Patients with depression were matched 1:1 to controls without depression by age, sex, COPD, anxiety, diabetes, hypertension, obesity, and tobacco use. Primary endpoints compared 90-day all-cause readmissions and medical complications. Logistic regression was used to calculate odds-ratios (OR) of the effect of depression on readmissions and medical complications. A p-value of less than 0.05 was significant. Results: Patients with depression who underwent ORIF of Trimalleolar fractures had significantly higher odds of being readmitted within 90-days of the initial procedure (OR: 1.37; 95%CI: 1.27 – 1.48; p< 0.0001). 90-day odds of developing medical complications were significantly higher (OR: 4.61; 95%CI: 4.38 – 4.86; p< 0.0001) in patients with depression compared to patients within the control group. Conclusion: This study demonstrated that patients with depression undergoing Trimalleolar ORIF are at an increased risk of readmission and a multitude of postoperative complications. This information is crucial for orthopedic surgeons considering the already high burden of complications following ORIF of Trimalleolar fractures and increasing prevalence of depression worldwide.
Diabetic Neuromuscular Foot and Ankle Deformities Reconstructed with Long-Segment and Rigid Internal Fixation Lead to Optimal Outcomes
Authors: Haldar Anil , Kwok Iris HY , Hester Thomas , Kavarthapu Venu 
Published: December 2024

Category: Hindfoot; Diabetes Introduction/Purpose: Severe neuromuscular foot and ankle deformities can develop due to progressive muscle imbalance on the background of diabetic peripheral neuropathy not related to Charcot neurarthopathy (CN). Our unit has a concentrated experience of treating severe deformities arising from diabetic CN using the principles of durable, long segment and rigid internal fixation with optimal opposition. We present a series of diabetic neuromuscular deformities reconstructed using these principles. Methods: This was a single centre, retrospective study including 20 patients who had diabetic neuromuscular foot and ankle deformities, in the absence of CN, operated on between October 2009 to December 2021. The deformity was corrected using wedge bone resections and tendon balancing procedures, followed by fixation. Data was collected on clinical and radiographic outcomes with a minimum 1-year follow-up. Results: 20 cases were included with a mean age of 53.7 years and follow-up of 42.1 months (range 12-94). 9 patients had Type 1 and 11 patients had Type 2 diabetes. Mean pre-operative HbA1c was 8.1. 15 had pre-operative ulceration. There were 6 isolated hindfoot, 2 midfoot and 12 combined hindfoot and midfoot deformities. All pre-operative ulcers healed and all achieved a stable and plantigrade foot. Full bone union was noted in 1/2 midfoot, 5/6 hindfoot and 10/12 combined corrections 12 months post-surgery. 15/20 patients returned to full weight bearing, 12 of whom were in surgical shoes. Metal work failure was noted in 5 patients. No recurrent or new ulcers in the reconstructed areas were noted and no patients developed Charcot activation during the post-operative period. Conclusion: Reconstruction of neuromuscular foot and ankle deformities due to diabetic peripheral neuropathy using principles of durable, long-segment and rigid internal fixation with bone opposition provided good radiological and clinical outcomes with good bone fusion rates, low complications, no ulcer recurrence and no Charcot activation.