bluuebunny/crossref_metadata_2025_split huggingface dataset:
Kidner Procedure: Alone or with Subtalar Arthroeresis for Symptomatic Accessory Navicular in Flexible Flatfoot—Is Combined Treatment Essential?
Authors: Mosquea Thelma R. Jimenez , Ubillus Hugo A. , Walls Raymond J. 
Published: December 2024

Category: Midfoot/Forefoot; Other Introduction/Purpose: The presence of an accessory navicular (AN) can alter the attachment of the tibialis posterior tendon (TPT), potentially leading to a flattened medial longitudinal arch. The Kidner procedure addresses painful AN by correcting the abnormal TPT insertion, facilitating arch elevation. Subtalar arthroeresis (STA) prevents excessive subtalar joint eversion, preventing arch collapse in flexible flatfoot (FF) deformity. Literature on AN treatment seldom explores options in FF deformity. This study compares outcomes of Kidner alone versus Kidner with STA for symptomatic AN with FF, aiming to offer treatment insights. Methods: During January 2024, the PubMed, Embase, and Cochrane Library databases were systematically reviewed to identify clinical studies examining outcomes following the Kidner procedure alone and the Kidner procedure with STA for the management of symptomatic AN with FF deformity. The level of evidence (LoE) of the included studies was evaluated using the Journal of Bone and Joint Surgery criteria. Data regarding subjective clinical outcomes, radiological outcomes, and complications were extracted and analyzed. Results: This review included 14 studies, comprising one with Level II evidence, ten with Level III, and three with Level IV. Among 362 cases of symptomatic AN, 246 underwent the Kidner procedure, while 116 underwent Kidner + STA. The weighted mean age was 15.7 ± 3.9 years for the Kidner cohort and 12.8 ± 3.0 years for the Kidner + STA cohort, with WM follow-up durations of 67.8 and 31.3 months, respectively. Pre-operative VAS scores were 6.4 for Kidner procedures and 4.4 for Kidner + STA, with post-operative scores of 1.6 and 1.7, respectively. Pre-operative AOFAS scores were 46.0 and 57.7, with post-operative scores of 85.5 and 89.2, respectively. At final follow-up, Meary’s angle improved in the Kidner + STA cohort from 0.8 to 13.1 degrees. Conclusion: In conclusion, this review highlights the efficacy of both the Kidner procedure and its combination with subtalar arthroeresis (STA) in managing symptomatic accessory navicular (AN) with flexible flatfoot (FF) deformity. While the Kidner procedure effectively treats AN with flatfoot deformity, it carries a risk of arch collapse recurrence. Combining it with STA provides a more stable biomechanical construct for the tibialis posterior tendon (TPT), preventing arch collapse. Despite study limitations, personalized treatment approaches are crucial. Further research with larger cohorts and longer follow-ups is necessary to confirm and refine treatment strategies for this complex condition.
Learning Curve of Novice Foot and Ankle Surgeon on Minimal Invasive Calcaneus Surgery Using the Sinus Tarsi Approach
Authors: Park Young Uk , Seo Youngwook 
Published: December 2024

Category: Trauma; Other Introduction/Purpose: Calcaneal fracture surgery represents one of the most challenging procedures for orthopedic surgeons. Recently, the use of the sinus tarsi approach for treating calcaneal fractures has been gaining popularity. Prior to this investigation, research was lacking on the learning curve of the sinus tarsi approach for calcaneal fracture surgeries among orthopedic surgeons newly initiating independent surgical practice. This study aims to delineate the learning curve of junior professors, who have recently completed their fellowship and are beginning to lead calcaneal fracture surgeries, using the sinus tarsi approach and its correlation with clinical outcomes, underscoring the critical importance of specialized surgical expertise. Methods: From October 2022 to January 2024, a total of 50 cases of calcaneal fractures, specifically Sanders types 3 and 4, treated surgically using the sinus tarsi approach at a single level 1 trauma center were analyzed to study the learning curve. The cutoff values for each parameter according to the number of surgical cases were analyzed using the cumulative sum test. The degree of correction for the Bohler angle, hindfoot varus angle, and posterior facet step-off was analyzed using preoperative and postoperative X-rays and Computed Tomography. Additionally, the number of C-arm fluoroscopy shots during surgery and the duration of the operation were examined. Postoperative complications, including infections, and the need for revision surgery were also analyzed. Results: The study included 23 cases of Sanders type 3 fractures and 27 cases of type 4 fractures. Significant improvements were observed with the Bohler angle increasing from an average of 12.2 degrees preoperatively to 26.3 degrees postoperatively, the hindfoot varus angle reducing from 15.2 degrees to 5.3 degrees, and the posterior facet step-off decreasing from 14.1mm to 0.56mm. The CUSUM for satisfactory correction of the Bohler angle and hindfoot varus was 21 cases each, and the posterior facet step off was 26 cases. The average duration of surgery was 104 minutes and the CUSUM was 24 cases. The average number of C-arm fluoroscopy shots during surgery was 141 and the CUSUM was 20 cases. Conclusion: As indicated by multidimensional statistical analyses, novice foot and ankle surgeon can achieve a plateau of proficiency after the initial learning period with 20 to 26 cases.
Long-term Results after Hallux Valgus Correction with Distal Metatarsal Reversed-L (ReveL) Osteotomy: Which Factors Influence Recurrence and the Clinical Outcome?
Authors: Weigelt Lizzy , Davolio Noah , Torrez Carlos , Haug Florian , Kühne Nathalie , Wirth Stephan H. 
Published: December 2024

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: The study objective was to evaluate the long-term results of hallux valgus correction with a distal metatarsal reversed-L (ReveL) osteotomy. Moreover, potential risk factors leading to recurrence and an inferior clinical outcome were assessed. Methods: Eighty-eight patients (131 feet) were evaluated after a mean follow-up of 14.2 (range, 10 – 18) years. Weightbearing foot radiographs were analyzed preoperatively, 6 weeks postoperatively, and at the final follow-up for the following parameters: hallux valgus angle (HVA), intermetatarsal angle (IMA), first metatarsophalangeal joint (MTPJ) congruence angle, sesamoid position, presence of round sign, first MTPJ arthritis. The Visual Analog Scale (VAS) and the Foot and Ankle Outcome Score (FAOS) assessed postoperative pain and function. Univariate and multivariate logistic regression analyses identified risk factors for hallux valgus recurrence and an inferior clinical outcome. Results: All radiographic parameters significantly improved at the 6-week and the final follow-up (p< 0.001). The recurrence rate (HVA ≥ 20°) was 13.7%. A preoperative HVA > 28° (OR 9.1; p= 0.02) and a 6-week postoperative HVA > 15° (OR 4.6; p= 0.03) were independent risk factors for recurrence. A preoperative BMI > 30 kg/m2 correlated with lower FAOS quality of life (p= 0.04), and postoperative hallux varus with lower FAOS activities of daily living (p < 0.05). First MTPJ arthritis ≥ grade 2 at the final follow-up significantly correlated with lower FAOS subscales. Recurrence had no impact on the long-term outcome. Disturbing hardware was the main cause of revision (14.5%). 94% were satisfied with the hallux appearance and 92% with pain reduction. Conclusion: Hallux valgus correction with a ReveL osteotomy leads to high long-term satisfaction rates. A preoperative HVA >28° and a 6-week postoperative HVA >15° increased the risk for hallux valgus recurrence. First MTPJ arthritis was the leading cause for an inferior clinical long-term outcome. Radiographic hallux valgus recurrence had no impact on the clinical results.
Low Rates of Return to Play and Reduced Levels of Performance in Athletes Participating in the National Football League Following Acute Achilles Tendon Ruptures: A Systematic Review
Authors: Butler James J. , Hedbany Davis , Vargas Luilly , Kingery Matthew T. , Lin Charles , Samsonov Alan P. , Kennedy John G. 
Published: December 2024

Category: Sports; Other Introduction/Purpose: The purpose of this systematic review was to evaluate rates of return to play and levels of performance following acute Achilles tendon ruptures (AATR) in the National Football League (NFL). Additionally, we sought to determine the prevalence rates of AATR and identify any risk factors for the development of AATR. Methods: During November 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following treatment of acute Achilles tendon ruptures (AATR) in the NFL. Twelve studies were included. Results: In total, 676 players (698 Achilles) sustained an AATR in the NFL. The playing positions that sustained the highest rates of AATRs was linebackers (19.0%), wide receivers (11.9%) and running backs (9.0%). 139 AATRs (50.4%) occurred in the preseason, 135 AATRs (48.9%) occurred during the regular season and 2 AATRs (0.7%) occurred during a post-season game. Playing surface was not associated with an increased risk of AATR. The return to play rate was 66.2% at a weighted mean time of 10.9±1.3 months. The mean number of games played per season following AATR was 12.9 games and the weighted mean career length following AATR was 2.2 ± 0.8 seasons. Overall, player performance deteriorated significantly following AATR, as demonstrated by lower power rankings and position specific metrics. Conclusion: This systematic review found was that the proportion of athletes participating in the NFL who returned to play following AATR was 66.2%. Both the mean number of games played per season and the mean number of seasons played decreased significantly following AATR. Overall, player performance deteriorated following AATR, regardless of player position. This study reinforces the potentially devastating sequelae following AATR in the elite athletic population.
Minimally Invasive Surgical Management of Bunionette Deformity (Tailor’s Bunion) Using Fifth Metatarsal Osteotomies: A Systematic Review and Meta-Analysis
Authors: Lewis Thomas L. , Lam Peter , Alkhalfan Yousif , Ray Robbie 
Published: December 2024

Category: Lesser Toes; Bunion Introduction/Purpose: There has been increasing interest in the use of percutaneous or minimally invasive osteotomy techniques for bunionette correction. The aim of this systematic review is to investigate the clinical and radiographic outcomes following percutaneous or minimally invasive surgery for bunionette deformity correction. Methods: A systematic review following PRISMA guidelines was undertaken. All clinical studies published in Medline, Embase, PubMed and the Cochrane Library Database from inception until December 2023 reporting on the use of a percutaneous or minimally invasive osteotomy techniques for bunionette deformity correction were included. The primary outcome was radiographic deformity correction. A meta-analysis of clinical and radiographic outcomes was performed to assess the mean difference following surgery. Risk of bias was assessed using the ROBINS-I tool. Results: A total of 942 potential studies were identified of which 18 were included encompassing 714 feet in 580 patients. There were no comparative studies identified. The majority of studies utilised an unfixed distal osteotomy technique. All studies showed a statistically significant improvement in clinical outcomes (AOFAS and VAS Pain) and radiological outcomes (4-5 intermetatarsal angle and fifth metatarsalphalangeal angle). Complication rates ranged from 0-21.4%. The non-union rate was 0-5.6%. Overall risk of bias was low-moderate. The most common complication was development of a hypertrophic callus which tended to resorb over time without needing further surgical intervention. Conclusion: Percutaneous techniques for bunionette deformity correction are clinically safe and effective with significant improvement in radiographic alignment and patient reported outcome measures.
Modular Augmented Arthroplasty System to Manage Larger Bone Defects in the Ankle: A Case Series
Authors: Martin Rebecca , Dean Michael , Murty An , Kakwani Rajesh , Sharpe Ian , Townshend David 
Published: December 2024

Category: Ankle Arthritis; Ankle Introduction/Purpose: Large bone defects such as those encountered after failed total ankle replacement have previously been a relative contraindication to revision ankle replacement due to inadequate bone stock. We describe our early experience and patient reported outcomes with a modular ankle replacement system with tibial and talar augments. Methods: This is a retrospective case series analysis of patients who underwent a total ankle replacement using the INVISION system across two centres between 2016 and 2022. Local approvals were granted. Patients completed f the Manchester-Oxford Foot Questionnaire (MOXFQ), Ankle Osteoarthritis Scale (AOS) and EQ-5D pre-operatively and then post-operatively at 6 months, 1 year, 2 years, 3 years and 5 years. Medical records were reviewed for complications and re-operations. X-rays were reviewed for cysts or lucencies and alignment. Results: 17 patients were included in the study; 14 men and 3 women with an average age at the time of surgery of 67.9 years (range 56 years to 80 years). The average follow-up post operatively was 40.5 months (range 7 to 78). The indication for surgery was revision of failed TAR in 16 and revision of failed ankle fusion in 1. An augmented tibia was used in 13, augmented talus in 13, and both augmented tibia and talus in 9 cases. There were no early surgical complications. One patient required debridement and implant retention for late deep infection. No implants have been revised. The average MOXFQ score improved by 19.3 points at most recent follow up. The average AOS score improved by 25.2 points. Conclusion: The early results of a modular augmented ankle arthroplasty system have shown satisfactory patient outcomes with a low complication and re-operation rate, however, this study is confined to two centres, has a small patient number and relatively short follow up period. Further research with longer follow up periods will be beneficial in the future to support revision ankle replacement systems as another option for patients with larger bone defects.
Acceptability of human papillomavirus vaccination in the United Kingdom: a systematic review of the literature on uptake of, and barriers and facilitators to HPV vaccination
Authors: Karakusevic Anna , Foss Anna M. 
Published: December 2024

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide, with HPV and HPV-related diseases representing a substantial disease burden. HPV vaccination has reduced HPV infections and HPV-related diseases; however, there is growing evidence of delayed or refused vaccination due to a lack of trust in vaccines. Understanding the factors that impact vaccine uptake will allow the development and implementation of successful vaccination programmes. Objectives: This study aimed to evaluate the acceptability of HPV vaccination among adolescents and parents in the United Kingdom (UK). Design: Systematic review. Methods: Online databases (Embase, Medline and Cochrane) and grey literature sources were searched to identify publications pertaining to ‘adolescents’, ‘parents’, ‘vaccine uptake’, ‘vaccine hesitancy’ and ‘barriers or facilitators to vaccination’. Searches were limited to English language and articles published specific to the United Kingdom between 2017 and 2023. Results: Following a review of 152 abstracts, 24 publications met the inclusion criteria. While HPV vaccination is widely accepted in the UK, with coverage reported ⩾80% in peer-reviewed literature, the UK Health Security Agency report that vaccine coverage estimates in England between 2020–2023 remain below 80% and are lower than pre-COVID levels. Several important barriers were identified that may impact vaccine uptake, including system-level (challenges with obtaining consent), psychological/behavioural (perception of HPV risk vs vaccine risks), and sociodemographic factors, with similar factors reported among adolescents and parents. Conclusion: HPV vaccination coverage remains below pre-COVID levels in the UK and common barriers among adolescents and parents have been identified that must be addressed to improve coverage rates. There is currently limited evidence among adolescent boys to fully evaluate any differences in vaccination coverage, or barriers, compared to girls. More research is required into facilitators to vaccination (especially to address sociodemographic barriers), to identify approaches to tackle the barriers that currently impede HPV vaccination uptake.
Anticipated facilitators and barriers for long-acting injectable antiretrovirals as HIV treatment and prevention in Vietnam: a qualitative study among healthcare workers
Authors: Dang My T. , Le Yen N. , Naz-McLean Sarah , Vo Nhung T. T. , Do Phuong T. , Doan Linh T. T. , Do Nhan T. , Nguyen Mai T. , Phan An H. , Dziuban Eric J. , Bhatia Ramona , Cosimi Lisa , Phan Huong T. T. , Pollack Todd M. 
Published: December 2024

Abstract
Background
Long-acting injectable antiretrovirals (LAI-ARVs) for HIV prevention and treatment have been demonstrated in clinical trials to be non-inferior to daily oral medications, providing an additional option to help users overcome the challenges of daily adherence. Approval and implementation of these regimens in low- and middle-income settings have been limited.

Method
This study describes the anticipated barriers and facilitators to implementing LAI-ARVs in Vietnam to inform future roll-out. From July to August 2022, we conducted 27 in-depth interviews with healthcare workers and public health stakeholders involved in HIV programs at national, provincial, and clinic levels across four provinces in Vietnam. The interviews followed a semi-structured questionnaire and were audio recorded. Data were analyzed using a rapid thematic analysis approach to identify facilitators and barriers to the adoption of LAI-ARVs.

Results
In total, 27 participants from 4 provinces were interviewed including 14 (52%) men and 13 (48%) women. Participants median age was 48 years and they had 11.5 years of experience with HIV services and programs. Perceived user-level facilitators included the greater convenience of injectables in comparison to oral regimens, while barriers included the increased frequency of visits, fear of pain and side effects, and cost. Clinic-level facilitators included existing technical capacity to administer injections and physical storage availability in district health centers, while barriers included lack of space and equipment for administering injections for HIV-related services, concerns about cold chain maintenance for LAI-ART, and workload for healthcare workers. Health system-level facilitators included existing mechanisms for medication distribution, while barriers included regulatory approval processes and concerns about supply chain continuity.

Conclusion
Overall, participants were optimistic about the potential impact of LAI-ARVs but highlighted important considerations at multiple levels needed to ensure successful implementation in Vietnam.

Clinical trial number
Not applicable.
Outbreak of cholera in the Southwest region of Cameroon, 2021-22: an epidemiological investigation
Authors: Bangwen Eugene , Akoachere Jane-Francis Tatah Kihla , Mabongo Daniel , Bime Adeline , De Vos Elise , Meudec Marie , Ngwa Wilfred , Fru-Cho Jerome , Esso Linda , van der Sande Marianne , Ingelbeen Brecht , Colombe Soledad , Liesenborghs Laurens 
Published: December 2024

Abstract
Background
In October 2021, a large outbreak of cholera was declared in Cameroon, disproportionately affecting the Southwest region, one of 10 administrative regions in the country. In this region, the cases were concentrated in three major cities where a humanitarian crisis had concomitantly led to an influx of internally displaced persons. Meanwhile, across the border, Nigeria was facing an unprecedented cholera outbreak. In this paper, we describe the spread of cholera in the region and analyse associated factors.

Methods
We analysed surveillance data collected in the form of a line list between October 2021 and July 2022. In a case-control study, we assessed factors associated with cholera, with specific interest in the association between overcrowding (defined by the number of household members) and cholera.

Results
Between October 15, 2021 and July 21, 2022, 6,023 cases (median age 27 years, IQR 18–40, 54% male) and 93 deaths (case fatality 1.54%) were recorded in the region. In total 5,344 (89%) cases were reported from 6 mainland health districts (attack rate 0.47%), 679 (11%) from 4 maritime health districts (attack rate 0.32%). More than 80% of cases were recorded in 3 of 10 health districts: Limbe, Buea, and Tiko. The first cases originated from maritime health districts along the Nigeria-Cameroon border, and spread progressively in-country over time, with an exponential rise in number of cases in mainland health districts following pipe-borne water interruptions. Case fatality was higher in maritime health districts (3.39%) compared to mainland districts (1.5%, p < 0.01). We did not find an association between overcrowding and cholera, but the results suggest a potential dose-response relationship with an increasing number of household members (>5 people: (crude OR 1.73, 95% CI 0.97–3.12) and 3–5 people: (crude OR 1.47, 95% CI 0.85–2.60)), even after adjusting for internally displaced status and number of household compartments in the multivariable model (aOR 1.54, 95% CI 0.80–3.02).

Conclusions
We report the largest cholera outbreak in the Southwest region. Our findings suggest the cross-border spread of cases from the Nigerian outbreak, likely driven by overcrowding in major cities. Our study highlights the need for cross-border surveillance, especially during humanitarian crises.
Strongyloidiasis mimics duodenal lymphoma in a patient with systemic lupus erythematosus and antiphospholipid syndrome: a case report
Authors: Basham Ayoub , Soleimani Sanaz , Ab Parvar Atash , Rahimi Arash , Evazi Ebrahim , Moosavy Seyed Hamid 
Published: December 2024

Abstract
Background
Systemic lupus erythematosus is a multi-organ autoimmune disorder that is treated by immunosuppressive agents that weaken the immune defense against opportunistic pathogens and latent infections such as strongyloidiasis. Herein, we report the case of a 43-year-old woman known to have systemic lupus erythematosus who presented with gastrointestinal symptoms, edema, and bone pain 2 months after receiving immunosuppressive treatment.

Case presentation
A 43-year-old Iranian female known to have systemic lupus erythematosus and antiphospholipid syndrome presented with abdominal pain, nausea, vomiting, and generalized edema. She was on CellCept, prednisolone, and hydroxychloroquine. The vital signs were within the normal range. On physical examination, no rash was observed on the skin. There was only a mild tenderness in epigastric region. The results of blood analysis revealed hypochromic microcytic anemia, normal leukocyte count with mild eosinophilia. Liver enzymes as well as renal function tests were within the normal range. Stool examination was negative for trophozoites, ova, or cysts of parasites. Endoscopic findings included a generalized nodular appearance of duodenum with an infiltrative mucosa in the wall of duodenum, suggesting lymphoma. The pathology report determined the diagnosis of strongyloidiasis. Cap albendazole 400 mg was administered twice a day for 2 weeks. Abdominal pain was completely relieved 1 week after starting the treatment. The patient was eventually discharged after 10 days.

Conclusion
The significance of this case report is the necessity to send complete blood count and serologic assays to screen latent strongyloidiasis before receiving immunosuppressive agents in patients with systemic lupus erythematosus.