bluuebunny/crossref_metadata_2025_split huggingface dataset:
Results of Hallux Valgus Surgery in Diabetic Patients with Percutaneous First Metatarsal Osteotomy and K-Wire Fixation
Authors: Yang Ding Cheng 
Published: December 2024

Category: Diabetes; Bunion Introduction/Purpose: Diabetes is a rising global prevalent disease. Patients with diabetes mellitus (DM) have potential neurovascular changes in their feet and ankles, which makes them vulnerable to surgical wound infection, as well as delayed healing of bones and wounds. Whether diabetes affects the outcomes of hallux valgus surgery is unknown. This study aims to investigate the impact of diabetes on the outcomes of hallux valgus surgeries using the minimally invasive surgery (MIS) technique. Methods: A total of 319 patients were included in this study, and 342 MIS Hallux Valgus procedures were performed from 2018 to 2023 at our institutions. Patients were divided into diabetic (DM-HV) and non-diabetic (NDM-HV) groups. DM was defined by elevated glycated hemoglobin A1c (HbA1c), blood glucose values, and medication history. MIS hallux valgus correction was performed with minimal surgical incisions of less than 2cm in length. Percutaneous Chevron first metatarsal osteotomies using the Shannon burr and Kirschner wire fixation were guided under fluoroscopy. The DM-HV group included 46 feet of 45 patients, and the NDM-HV group included 296 feet of 274 patients. Clinically, the preoperative and final follow-up American Orthopedic Foot & Ankle Society (AOFAS) score, radiographic hallux valgus angle (HVA), and first intermetatarsal angle (IMA) were evaluated. Procedure durations and patient complications were also assessed. Results: In the DM-HV group, the patients ranged from 51 to 87 years with a mean age of 73 (male 14, female 32). In the NDM-HV group, the patients ranged from 34 to 97 years, with a mean age of 58 (male 49, female 247). The mean AOFAS score improved from 41.42 preoperatively to 93.10 postoperatively in the DM-HV group, and from 42.50 to 94.38 in the NDM-HV group. 4.3% of complications in the DM-HA group and 4.7% in the NDM-HA group were in this study. Surgical complications included: K-wires broke, hallux varus, under correction, transfer metatarsalgia, medial incision dehiscence, and adhesion. There was no difference between DM-HV and NDM-HV groups in improved AOFAS scores, radiological deformity correction, durations of surgery, complications, and reoperation rates. Conclusion: Chevron osteotomy using the Shannon burr with Kirschner (K)-wire fixation is a safe, effective, reliable procedure on both non-diabetic patients and diabetic patients. Hallux Valgus MIS surgery with the K-wire fixation on diabetic patients has no high complication rate. Minimally invasive surgery for hallux valgus correction resulted in improved AOFAS scores and radiological outcomes, fewer complications, and a shorter duration of surgery. MIS can be a better option for correcting hallux valgus deformities in diabetic patients.
Risk Factors Associated with Subtalar Fusion Within 5 Years Following Calcaneal ORIF
Authors: White Elisabeth , Okoro Sylvester , Tabbaa Ameer , Nicolas Rodriguez Ariel , Sheth Bhavya , Horn Andrew , Razi Afshin , Abdelgawad Amr 
Published: December 2024

Category: Hindfoot; Trauma Introduction/Purpose: Calcaneal fractures, commonly caused by high-energy trauma, present significant challenges for orthopedic surgeons. Open reduction internal fixation (ORIF) is a widely used surgical technique for managing these fractures; it can lead to subtalar joint arthritis and pain, requiring subtalar fusion when conservative treatments prove ineffective. Understanding the risk factors associated with subtalar fusion (STF) after calcaneal ORIF is crucial for optimizing patient outcomes and treatment strategies. In this study, we aimed to comprehensively evaluate these risk factors, including patient demographics, medical comorbidities, same day and 90-day reimbursement data. Methods: A retrospective analysis was performed using the PearlDiver Mariner 157 national claims database from January 1st, 2010 to October 31st, 2021. Patients who underwent calcaneal ORIF, identified using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-9, ICD-10) codes, were queried for 5-year rates of STF and reimbursement data. Patient demographics and comorbidities were recorded, and multivariate logistic regression was employed to determine the association of risk factors with STF. A p-value of less than 0.001 was considered significant after performing a Bonferroni correction. Results: Patients with STF had a higher proportion of alcohol abuse (21.3% vs. 16.2%), depression (58.1% vs. 43.1%), drug abuse (29.1% vs. 19.7%), obesity (40.3% vs. 28%) and tobacco use (62.2% vs. 50.3%), all exhibiting a p-value of less than 0.001. Those with depression (OR: 1.54; 99% CI:1.29-1.84; p< 0.001) and obesity (OR:1.58; 99% CI: 1.32-1.88; p< 0.001) as comorbidities had a higher odds ratio of association ith STF within 5 years following calcaneal ORIF. Conclusion: Our study demonstrates that patients who ultimately required STF within 5 years of calcaneal ORIF had higher rates of alcohol abuse, tobacco use, drug use, obesity, and depression prior to ORIF. In addition, there was no significant difference observed between those with and without STF in average same-day and 90-day reimbursements and demographics. Future patients with a calcaneal fracture along with multiple risk factors listed above should be in consideration for primary surgical fusion over calcaneal ORIF, with additional studies needed to aid orthopaedic surgeons in this decision making.
Risk Factors for Infectious and Soft Tissue Complications in Ankle Fracture Dislocations
Authors: Soni Chirag , Zhuang Adam , Faith Darden Kylee , Wynn Malynda , Benedick Alex , Szatkowski Jan P , Jang Yohan , Natoli Roman , Lopas Luke A 
Published: December 2024

Category: Trauma; Ankle Introduction/Purpose: Ankle fracture-dislocations (AFD) are violent injuries with reported worse prognosis compared to their non-dislocated counterparts. There is limited literature describing the demographic characteristics and risk factors for complications for these injuries. This study analyzed risk factors for deep surgical site infection and wound complications in AFDs. Methods: Ankle Fractures from 2013 to 2023 at a single Level I trauma center were reviewed. Patients with complete tibiotalar dislocation defined by absolute articular incongruity in either the lateral or anteroposterior radiographic views were included. Patients with pan-talar dislocations and those who were already successfully reduced at outside institutions were excluded. Successful reduction was defined as near anatomic articular congruity with less than 5 millimeters of medial clear space. Demographic characteristics were recorded. Primary outcomes assessed were deep surgical site infection (SSI), and wound complications. Wound complications were stratified into categories defined as delay in healing, superficial wound dehiscence, and deep wound dehiscence. Demographic and clinical characteristics were compared across primary outcomes using the Chi-Square test for categorical variables and the Student’s t-test, with the Fisher Exact test being used if the data were not normally distributed. Results: 113 patients were reviewed and met inclusion criteria. 15 had deep SSI. 75 had normal wound healing, 17 had delayed wound healing, 7 had superficial wound dehiscence, and 14 had deep wound dehiscence. Open fracture incidence was significantly associated with older age (p < 0.03). Neuropathy, open fractures, peripheral vascular disease, and polysubstance abuse were associated with deep SSI (p < 0.02, p< 0.05, p< 0.03, p< 0.05, respectively). Open fractures, chronic kidney disease, and polysubstance abuse were associated with overall wound complication occurrence (p < 0.01, p< 0.02, p< 0.04, respectively). Open fractures, neuropathy, and polysubstance abuse were associated with deep wound dehiscence (p < 0.05, p< 0.05, p< 0.05, respectively). There was no association between successful closed reduction and SSI or wound healing complications (p=.98, p=.744, respectively). Conclusion: The overall deep SSI prevalence in our cohort was 13%. Open fractures, neuropathy, and polysubstance abuse were significant risk factors for both SSI and wound healing complications. Successful anatomic reduction of ankle fracture dislocation was not associated with SSI or wound healing complications.
Shortening of the First Metatarsal During the Correction of Hallux Valgus: Never Be Allowed?
Authors: Ma Xin 
Published: December 2024

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Transfer metatarsalgia is one of the potential complications after hallux valgus correction, of which shortening of the first metatarsal is thought to be an important cause. Thus many surgeons believe that shortening of the first metatarsal should be avoided or kept to a limited extent. However, we found that many patients with first metatarsal shortening did not really develop postoprative transfer metatarsalgia, but instead had easier correction of the hallux valgus in operation and better outcomes and even more benefit in walking due to reduced tension around the metatarsophalangeal joints and improved joint mobility. Up to now, few investigations have truly conducted large-scale long-term follow-up on this issue, and little is known about the appropriate level of first metatarsal shortening. Methods: This retrospective study included 835 feet in 712 patients who were treated with first metatarsal osteotomies without Weill osteotomies for hallux valgus during the period of January 2013 to January 2023. Standard weight-bearing dorsoplantar and lateral radiographs were collected before and at different time more than six months after surgery. The hallux valgus angle (HVA), intermetatarsal 1-2 angle (IMA) were evaluated. The absolute length of the first metatarsal as well as its relative length to the second metatarsal was both measured. Clinical evaluation included preoperative and postoperative symptom assessment, the range of motion (ROM) at metatarsophalangeal joint and AOFAS Scale. The incidence of postoperative complications was also specifically recorded, as well as information on where the metatarsalgia occurred, the nature of the pain, and how the pain occurred and relieved. Patients were divided into different subgroups according to the level of shortening of the first metatarsal. Results: The level of shortening of the first metatarsal was positively correlated with the reduction of the HVA, and inversely correlated with the recurrence rate. Those with shortening of 3 mm or more had significantly better first metatarsophalangeal joint mobility compared with those without shortening. Patients with a shortening of 6 mm or more were significantly more likely to have a metatarsalgia under the central metatarsal heads postoperatively (5.88% vs 3.01%). 5 feet (2.67%) developed recurrence of the hallux valgus in patients with a shortening of 6 mm or more, compared with 23 feet (4.07%) in patients with a shortening of 6 mm or less, and 6 feet (7.23%) in patients without shortening. Conclusion: Taking into account the correction of HVA, joint mobility, postoperative recurrence and the risk of metatarsalgia, it is recommended that the relative length of the shortening in the first metatarsal osteotomy can be extended up to 6 mm, especially in patients with severe hallux valgus, in order to obtain the easier correction of the HVA in the operation and best therapeutic results and function.
Surgical Costs Associated with Tibiotalar Fusion
Authors: Wagers Kade , Zhang Chong , Presson Angela , Nixon Devon 
Published: December 2024

Category: Ankle Arthritis; Ankle Introduction/Purpose: There is growing focus on the surgical costs related to common orthopedic procedures. In this investigation, we studied the costs associated with tibiotalar arthrodesis by comparing different surgical constructs (screws-alone vs. plate-screw fixation). Methods: Patients were retrospectively identified who had undergone primary fusion of the tibiotalar joint based on CPT codes from 2014 to 2020. Utilizing the Value Driven Outcome (VDO) tool implemented at our institution, we conducted an evaluation of both total direct costs and facility-related expenses. The VDO tool encompasses a comprehensive item-level database capable of capturing detailed cost information, which is subsequently presented as relative mean data. Adjustments were made to cost variables to reflect 2022 US dollars, and comparative analysis of costs in relation to treatment groups and other exposure variables was performed using generalized linear models to yield cost ratios along with 95% confidence intervals (CIs). Results: Our cohort consisted of 263 patients who underwent primary ankle fusion procedures done by one of four fellowship-trained orthopedic foot and ankle surgeons. There were no differences in demographic data or total OR time based on surgical construct (screws-alone N =229, plate-screws N =34). Total direct cost for plate-screw constructs were 72% higher than screws alone (ratio in cost =1.72, 95% CI 1.49~2.03, p< 0.001). There was no significant difference in regression analysis between plate-screw vs screws-alone for facility cost (ratio in cost =1.14, 95% CI: 0.99~1.34, p=0.10). For all fusion constructs, every 1 hour increase in total OR time increases total direct costs by 28% (ratio in cost =1.28, 95% CI 1.18~1.40, p< 0.001). Conclusion: Enhancing the cost-effectiveness of orthopedic care remains an important objective. Our investigation suggests that screw-only constructs, compared to plate-screw constructs, can notably lower overall total costs by 72%. Many variables are considered when selecting surgical constructs for ankle arthrodesis. When clinically appropriate, screw-only ankle arthrodesis constructs could be considered if there is a need to reduce overall total costs.
Talar OsteoPeriostic Grafting from the Iliac Crest (TOPIC): 2-year Results of a Novel Press-fit Surgical Treatment for Large Talar Osteochondral Lesions
Authors: Dahmen Jari , Rikken Quinten , Stufkens Sjoerd , M.M.J. Kerkhoffs Gino M 
Published: December 2024

Category: Ankle; Sports Introduction/Purpose: The purpose of this study was to present the surgical technique and to evaluate the clinical and radiological outcomes of a new press-fit transplantation technique for large talar osteochondral lesions of the talus (OLTs), Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC). Methods: 60 patients, mean age 38 years, underwent a press-fit TOPIC procedure. Clinical assessment at 12- and 24-months follow-up included the American Orthopaedic Foot and Ankle Society (AOFAS) score, the Short-Form 36 (SF-36) Mental Component Scale (MCS) and Physical Component Scale (PCS), the Numeric Rating Scales (NRS) of pain at rest, during walking and stairclimbing, and the Foot and Ankle Outcome Score (FAOS). Remodeling of the contour of the talus, bone ingrowth and consolidation of the implanted graft were assessed on computed tomography (CT) one year post-operatively. Results: All patients were available for two-year follow-up. The AOFAS improved from 48 to 90 (p< 0.05). All NRS scores improved: during rest from 3 to 0 (p< 0.05), during walking from 5 to 1 p< 0.05), and stairclimbing from 5 to 1 (p< 0.05). Both SF-36 components improved. The PCS from 34 to 47 (p< 0.05) and the MCS from 37 to 66 (p< 0.05). All FAOS subscales significantly improved. All patients showed remodeling of the talus and all grafts showed bone ingrowth on the CT scans. Conclusion: The TOPIC procedure for large osteochondral lesions of the medial talar dome is an effective technique resulting in significant improvement in pain, as well as other outcomes, with 100% consolidation of the grafts.
The All-Medial Approach in Severe Plano-Valgus Foot & Ankle Deformity with Subtalar Dislocation. Anatomy, Indications, and Outcomes of a Promising New Technique
Authors: Raheman Firas , Budair Basil , Reichert Ines , Ahluwalia Raju 
Published: December 2024

Category: Midfoot/Forefoot; Diabetes Introduction/Purpose: The complex challenge of reconstructing severe planovalgus deformity of the foot and ankle, often accompanied by subtalar dislocation, is characterized by a heightened risk of lateral wound complications and significant anatomical distortions. These cases, typically arising from chronic conditions such as diabetes (Charcot neuroarthropathy), rheumatoid arthritis, or congenital deformities, necessitate careful consideration of their underlying anatomical pathology. In this study, we introduce a novel all-medial approach for correcting these deformities and provide insights gleaned from our clinical experience. Methods: Retrospective review of prospectively collected data of all patients with severe foot and ankle plano-valgus deformity between May 2014-Jan 2024 treated surgically utilising an all-medial approach. We identified 18-feet in 11 patients with an associated subtalar dislocation and describe the patho-anatomy and a single medial approach encompassing 3 surgical windows to the ankle joint, hind-foot, and mid-foot to reconstruct the deformity and stabilise the foot. Functional, radiological, and surgical outcomes are reported of the newly developed surgical approach. Results: The average age of patients undergoing surgery was 58 years (ranging from 47 to 78). The mean follow-up duration was 32.7 months (2.7 years), ranging from 8 to 82 months. In nine feet, the posteromedial neurovascular bundle was displaced inferior-laterally, leading to attrition of the flexor hallucis longus (FHL) tendon in three feet due to entrapment between the calcaneum and talus. Surgical intervention involved pan-talar fusion in 12 feet and medial column extension in nine feet. Only one patient experienced delayed wound healing necessitating the removal of metalwork, yet all patients were ambulatory at the two-year mark, with no instances of limb loss during the study period. Conclusion: The novel approach outlined in this study represents a safe and effective technique for reconstructing severe planovalgus foot and ankle deformities accompanied by dislocated subtalar joints. This approach offers predictable radiological and functional outcomes while circumventing the unique complications associated with traditional lateral approaches, thus enhancing patient safety and treatment efficacy.
The Cutting Edge of Charcot Reconstruction: Anatomical Osteotomies Benchmarking Optimal Survivorship in Charcot Reconstruction
Authors: Ahluwalia Raju , Raheman Firas , Kosa Peter , Reichert Ines 
Published: December 2024

Category: Diabetes; Midfoot/Forefoot Introduction/Purpose: Charcot neuroarthropathy is a debilitating condition that frequently leads to skeletal instability, deformity and an increased risk of ulceration leading to infection. This often necessitates prolonged periods of immobilization and casting. Nonetheless, opting for reconstruction presents an opportunity for limb preservation and the potential for weight-bearing functionality, contrasting starkly with the higher mortality rates associated with amputation. Methods: We present findings from a prospective study involving 102 patients who underwent Charcot reconstruction surgery conducted by two experienced surgeons from May 2014 to Oct 2024. Our approach incorporated advanced techniques such as 3D modeling and standardized osteotomies, including the King’s Cut and ARK osteotomy, to achieve precise anatomical corrections of Meary’s angle, as well as the anterior-posterior and lateral talo-calcaneal angles, along with calcaneal pitch. Additionally, patients underwent either primary or staged reconstruction in cases where osteomyelitis was suspected due to pre-existing ulceration. Definitive stabilization was achieved through internal fixation targeting the stabilization of unstable foot columns. A multivariate analysis was conducted to evaluate potential risk factors associated with failure, with statistical significance determined at P>0.05. Survivorship was defined by the absence of ulceration, catastrophic failure, or the necessity for amputation. Results: In the study, 79 feet were analyzed, with 46 undergoing single-stage and 43 two-stage reconstruction. Predominantly male (62.7%) with an average age of 56 years, most patients (89.63%) had type 2 diabetes, 56% hypertension, and 16% chronic kidney disease requiring dialysis. Among single-stage reconstructions, 52.1% had pre-operative ulcers, 13 ischemic heart disease, and 56 peripheral artery disease. 81% achieved normalized angles (P < 0.05); 3.4% required further surgery for infection, 17.9% experienced delayed wound healing. Survivorship rates were 98% at 3 years and 94% at 6 years, higher for those with vascular disease. At final follow-up, all maintained mobility, contributing to an overall 94.4% survivorship at 6 years, with 98% achieving ambulatory weight-bearing in shoes at 2 years. Conclusion: Strategic patient selection, multidisciplinary teamwork, and precise anatomic reconstruction, rather than merely achieving a plantigrade foot, are pivotal factors in achieving consistent and predictable outcomes for functional limb salvage. Research evidence underscores the importance of addressing pre-operative vascular compromise, as it significantly influences survivorship rates.
The Effect of Osteoporosis on Postoperative Outcomes Following Total Ankle Arthroplasty
Authors: Kulkarni Ronit , Morningstar Joshua L. , Friedman Richard J. , Gross Christopher E. , Scott Daniel J. 
Published: December 2024

Category: Ankle; Ankle Arthritis Introduction/Purpose: Recent literature, particularly in the fields of total joint arthroplasty, has raised concern for increased perioperative complications following joint arthroplasty in patients with osteoporosis. The purpose of this study is to evaluate the influence of preoperative osteoporosis on 6-month postoperative outcomes following total ankle arthroplasty (TAA). Methods: The Nationwide Readmissions Database (NRD) was queried from 2015-2020 to identify 29,705 patients undergoing primary elective TAA. Patients were divided into two cohorts based on the presence of preoperative osteoporosis (as defined by ICD-10 CM codes M81, M80, M80.07XX), with 943 (3.3%) having this diagnosis. Preoperative demographics, comorbidities, postoperative outcomes, cost of admission, and total length of stay (LOS) were analyzed between cohorts. Multivariate regression analyses were conducted to control for predictors of adverse postoperative outcomes other than preoperative osteoporosis. Results: The overall cohort was majority male (54.2%) with mean age of 64.15 (range 17-90) years, and Charlson-Deyo Comorbidity Index (CCI) score of 0.65 (range 0-12). Patients diagnosed with preoperative osteoporosis patients were statistically significantly older (Osteoporosis=68.72 years; non-osteoporosis=65.03 years; p<.001), more likely to have Medicare insurance (p<.001), and had a higher CCI score (Osteoporosis=0.98; Non-Osteoporosis=0.64; p<.001). Multivariate regression analysis of 180-day postoperative outcomes found that preoperative osteoporosis was significantly predictive of increased risk of any complication (OR=1.428; p<.001), transfusion (OR=3.370; p<.001), pulmonary embolism (OR=5.625; p=.016), Pneumonia (OR=3.872; p<.001), adverse discharge (OR=1.445; p<.001), and extended stay greater than 4 days (OR=1.310; p<.001). Further, the presence of osteoporosis is predictive of nearly a $3,000 increase in total cost of procedure (β= 2980.22; p<.001). Conclusion: The presence of osteoporosis was significantly predictive of higher rates of postoperative complications, LOS, and a substantially higher cost of procedure following TAA. Physicians and patients alike should consider this comorbidity when stratifying risk for outcomes following total ankle arthroplasty.