bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Association Between Asymmetrical Hallux Valgus and Lumbar Spine Deformities: An Analysis from the Large General Population Cohort
Authors: Matsumoto Takumi , Takeda Ryutaro , Tanaka Sakae 
Published: December 2024

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Various factors contribute to hallux valgus (HV), including footwear, genetics, gender, anatomical factors, and joint laxity. Theoretically, these factors should affect both sides equally, yet overwhelmingly, bilateral cases are more common. Although rare, there are instances of unilateral cases or cases with significant asymmetry between the left and right sides. However, there is a lack of systematic investigation into the background of such cases. Methods: Data from the fifth survey of the Osteoarthritis/Osteoporosis Against Disability (ROAD) study, a nationwide prospective study in Japan, were analyzed. HV severity was categorized into 4 grades based on the radiographic HV angle, and asymmetric HV was defined as having at least one HV on either side with a difference of two or more severity grades between the left and right. Controls were matched from both the normal group (without HV on both sides) and the symmetric group (HV on at least one side with a difference of one or less severity grades). Univariate analysis assessed lumbar conditions, and multinomial logistic regression analysis explored the association between lumbar spine disorders and asymmetric HV. Results: Among 1,231 participants, 27 (2.2%) had asymmetric HV. The asymmetrical group showed a significantly higher prevalence of L5 spondylolisthesis and scoliosis (asymmetrical vs symmetrical vs normal: [L5 spondylolisthesis] 15% vs 5% vs 1%, p = 0.0178; [scoliosis] 42% vs 20% vs 14%, p = 0.0095). The results of the multiple logistic regression analysis revealed that the odds ratios for asymmetry, with normal as the reference, were 3.59 (95% CI: 1.11-11.58) in the presence of scoliosis and 6.98 (95% CI: 0.67-72.60) in the presence of L5 spondylolisthesis. Conclusion: Unilateral HV has been reported as a complication following spinal surgery. This study establishes a link between lumbar spine scoliosis and unilateral HV. It suggests the involvement of factors such as impairment of the hallux abductor muscle's innervating nerves or left-right load imbalance in the development of unilateral HV deformities.
The Mystery of Meary’s: 3D Analysis of First Ray Plantarflexion Deformity in Charcot-Marie-Tooth Disease
Authors: Blough Christian , Michalski Max P. , Song Jaehwang , Pfeffer Glenn 
Published: December 2024

Category: Midfoot/Forefoot; Other Introduction/Purpose: The typical cavovarus deformity seen in patients with Charcot-Marie-Tooth involves plantarflexion of the first ray. Surgical correction often includes a dorsiflexion osteotomy at the first metatarsal base or medial cuneiform. The exact apex of the deformity has never been proven, although it is presumed to be within the medial cuneiform. The aim of this study was to utilize weight-bearing computed tomography (WBCT) to localize and quantify the plantarflexion deformity in CMT patients. Methods: WBCTs of 16 CMT patients with lateral Meary’s angle >20 degrees were compared to controls utilizing semi-automated analysis software (Disior Bonelogic). Due to the complex deformity seen in CMT patients, a local coordinate system based on the first metatarsal was used. The tarsometatarsal angle was subdivided into components (cuneiform-cuneiform joint normal, tarsometatarsal joint and metatarsal-metatarsal joint normal) and compared between CMT and controls (Figure 1A). CMT patient’s first, second and third rays were also compared. Means were compared with a 2-sample t test (p <.05). Results: CMT patients had significantly more plantarflexion of the first ray than controls (8.8 versus 16.4 degrees respectively (p < 0.001)) (Figure 1B). The largest difference of was found at the cuneiform-cuneiform joint normal with 20.6 degrees of plantarflexion in CMT patients versus 14.8 degrees in controls (p <.0001). There was also approximately 2 degrees of plantar flexion at the TMT joint (p <.001) but no difference at the metatarsal-metatarsal joint normal angle. When comparing the flexion of the first ray versus the second, as well as the second versus the third rays, there were significant differences in the tarsometatarsal, cuneiform-cuneiform joint and metatarsal-metatarsal joint angles. Conclusion: Plantarflexion deformity in CMT patients is primarily an osseous deformity at the level of the medial cuneiform with a lesser contribution from the tarsometatarsal joint. This finding has implications for CMT surgery regarding location of a dorsiflexion osteotomy at the apex of deformity.
The Use of Knotless Fiber Tape Construct vs Screw Fixation for Lisfranc Injuries: A Cadaveric Biomechanical Study
Authors: Cardenas Cesar , McIver Natalia , Nelson Jessica , Chavez Tyler , Ahmad Aamir , Gross Jessica , Salas Christina , Gavin Katherine 
Published: December 2024

Category: Trauma; Midfoot/Forefoot Introduction/Purpose: Lisfranc injuries are often treated with open reduction and internal fixation using rigid fixation techniques. The use of flexible fixation to stabilize the Lisfranc joint is a newer technique. The purpose of this cadaveric study is to compare the amount of diastasis at the Lisfranc interval under physiologic loads when treated with a knotless fiber tape construct and a solid screw. Methods: Ten cadavers (20 feet) had native motion at the intact Lisfranc interval assessed at multiple physiologic loads representing guarded walking (69N), walking (138N), and running (207N). The Lisfranc ligamentous complex was then disrupted, and testing repeated to evaluate the amount of diastasis. Randomization was performed to determine type of fixation for each cadaver: a solid screw or knotless fiber tape construct. Once fixation was completed, specimens were cyclically loaded for 10,000 cycles at physiologic loads and diastasis was quantified after each load cycle to compare the interventions. Diastasis was measured using motion tracking cameras and retroreflective marker sets. A non-inferiority statistical analysis was performed. Results: Diastasis mean values were confirmed to be >2mm for all load bearing conditions in the injury model. Post-treatment, diastasis was significantly reduced when compared to the sectioned conditions (p=0.00) for both treatment options. Non-inferiority analyses showed that the knotless fiber tape construct did not perform inferior to screw fixation for diastasis at the Lisfranc interval at any of the compared load states. Conclusion: Under physiologic loads, there is no significant difference in diastasis at the Lisfranc interval when treating ligamentous Lisfranc injuries with a knotless fiber tape construct or solid screws. Both reduced diastasis from the injured state and were not different from the intact state.
The Utilization of Minimally Invasive Surgery for Os Trigonum Syndrome
Authors: Anastasio Albert T. , Baumann Anthony N. , Walley Kempland C. , Luo Emily Joan , Talaski Grayson M. , Curtis Devin , Johns William , Amendola Annunziato 
Published: December 2024

Category: Sports; Ankle Introduction/Purpose: A symptomatic os trigonum is a common cause of posterior ankle pain that has been traditionally managed with open excision. Minimally invasive surgery (MIS) has been proposed as an alternative to open excision for improved outcomes and decreased complication rates; however, no systematic review to date has examined the utilization of MIS for a symptomatic os trigonum. The purpose of this study was to examine patient outcomes, return to sport, and complications associated with MIS for a symptomatic os trigonum. Methods: A systematic review was performed on February 22, 2023, using the PubMed, CINAHL, MEDLINE, and Web of Science databases from database inception until February 22, 2023, on the topic of MIS for a symptomatic os trigonum. Results: From initial search, 17 articles (N = 435 patients) met inclusion criteria. Mean age of the cohort was 26.01 ± 4.68 years, with a mean follow-up time of 34.63 ± 18.20 months. For MIS patients, the mean preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 55.85 ± 12.75, the mean final postoperative AOFAS score was 94.88 ± 4.04, the mean preoperative visual analog scale pain score was 7.20 ± 0.43, and the mean final postoperative visual analog scale score was 0.71 ± 0.48. The mean time to return to sport for patients undergoing MIS was 7.76 ± 1.42 weeks. MIS had an overall complication rate of 5.0%, the majority of which consisted of transient neurapraxia of the sural or superficial peroneal nerve. Conclusion: Minimally invasive management of a symptomatic os trigonum appears to be a viable alternative to open surgery in terms of outcomes, return to sport, and complication rates. More high-quality evidence will be required to definitely recommend minimally invasive approaches as the standard of care over open surgery.
Total Ankle Arthroplasty with and without Tibial Stem: Exploring Differences in Post-Operative Migration and Beta Angle
Authors: Tallapaneni Jetha , Mirghasemi Ali , Vaupel Zachary , Fortin Paul 
Published: December 2024

Category: Ankle; Ankle Arthritis Introduction/Purpose: The extent of migration of the ankle joint and associated joint space caused by ankle replacement is directly correlated to the efficacy and longevity of the implant. Recent advances have resulted in the increasing use of tibial implants with stems as a means to achieve greater stability. The purpose of this study was to ascertain the differences in said migration between implants with tibial stems and those without in order to conclude which style of replacement leads to greater stability and therefore greater longevity and utility. Methods: A series of cases, which consisted of patients receiving both tibial implants with and without stems, that met the inclusion criteria, was considered for this study in order to determine key differences in outcomes. Twenty patients received tibial implants with stems and twenty patients received tibial implants without stems. The average patient ages between the two groups were not significantly different- the mean age of patients with the stem was 65.4 compared to 68.7 for the non-stem group. The key variables considered included migration (AP and anterior/posterior, DTA, TTA, beta angles, gamma angles, coronal translation, and talar tilt. Two tailed T-tests were utilized to determine statistically significant results. Results: Differences in measurements from the first post-operative weight bearing x-ray to the most recent weight bearing x-ray were considered. The mean time between these two x-rays was 24 months for the patients who received tibial implants with stems and XX months for patients who received tibial implants without stems. Across the population considered, it was found that patients recieving the implants without the stem had significantly less migration in the AP view X-rays when compared to their tibial implant with stem patient counterparts in both X-rays considered (p< 0.03). Additionally, patients without the tibial stem had significantly larger beta angles than patients with the tibial stem in both x-rays considered (p< 0.04). Conclusion: Ankle replacements utilizing tibial stems lead to greater rates of migration when compared to those without said stems. Therefore, the supposed benefit of the stem falls into question. Greater beta angles are seen with tibial implants without stems, however. Further research regarding the efficacy and long-term outcomes of each of these implants for total ankle replacement must be conducted to refine these findings further.
Transfibular Approach in Treating Malunited Ankle Fracture
Authors: Zhu Yuan 
Published: December 2024

Category: Trauma; Ankle Introduction/Purpose: The surgical treatment of malunited ankle fracture is challenging. This study investigated the results of reconstruction for malunited ankle fracture involving lateral and posterior malleolus via transfibular approach. Methods: Between Jan 2015 and Feb 2017, 10 patients underwent reconstruction surgeries for malunited ankle fracture involving lateral and posterior malleolus were followed up. All the ten surgeries were performed via transfibular approach. The mean final follow-up was 26.2 months (range 24–36). American Orthopaedic Foot and Ankle Society (AOFAS)score, Visual Analogue Scale (VAS) for pain, and patients’ subjective satisfaction were used to measure clinical outcomes. Results: The mean AOFAS-AH score and VAS score improved from 43±10.7 to 79±7.8 points (p < 0.05), 6.7±1.0 to 2.0±1.2 points (p < 0.05), respectively. Five patients rated the result as excellent, 4 as good and 1 as fair. Conclusion: The transfibular approach can expose and reduce both the posterior and lateral malleolar malunion with minimal additional soft tissue disruption. It is a useful method to correct the malunited ankle fracture involving lateral and posterior malleolus.
Utilization of Orthobiologics by Foot and Ankle Orthopaedic Surgeons
Authors: Chan Jeremy Y. , Haleem Amgad , Thordarson David , Ellis Scott J. , Conti Matthew S. 
Published: December 2024

Category: Basic Sciences/Biologics; Sports Introduction/Purpose: Over the past two decades, there have been significant advancements and increased utilization of orthobiologic technologies. The use of orthobiologic products is often determined by individual surgeons given the limited available literature on efficacy. Currently, there is a paucity of data available evaluating the prevalence of orthobiologics use among foot and ankle orthopaedic surgeons. The primary aim of this study was to investigate orthobiologic utilization among American Orthopaedic Foot & Ankle Society (AOFAS) members. Methods: Members of the AOFAS were sent a survey in 2023 that was designed to assess for usage, motivation for use, and treatment indications in operative and nonoperative settings for the following orthobiologics: leukocyte-poor (PRP-LP), leukocyte-rich (PRP-LR) and leukocyte-unknown (PRP-UNK) platelet rich plasma, bone marrow aspirate concentrate (BMAC), adipose-derived mesenchymal stromal cells, hyaluronic acid, recombinant human bone morphogenic protein (rhBMP-2), recombinant human platelet derived growth factor (rhPDGF-BB), amniotic membrane products, and small cell binding peptide. The survey was completed by 129 respondents representing a balanced cohort in regards to geographic spread, time in practice, and medical practice setting. Results: 92% of respondents utilized ≥1 orthobiologic with no significant differences in utilization based on demographics. Perceived efficacy and support from literature were cited as common reasons to use orthobiologics. Among orthobiologic users, the most common product used was BMAC (74%), followed by rhPDGF-BB (62%) and rhBMP-2 (43%) (Figure 1). The most common indications for BMAC were revision arthrodesis, osteochondral surgery and primary arthrodesis. For rhPDGF-BB and rhBMP, the most common indications were revision and primary arthrodesis. The most common pathology for nonoperative use of PRP-LR and PRP-UNK was tendinopathy versus plantar fasciitis for PRP-LP, whereas the most common operative use of any formulation of PRP was for osteochondral lesions. Among non-users, 70% cited lack of evidence and 50% cited costs in their decision making. Conclusion: Among AOFAS surgeons, there is a high rate of utilization of orthobiologic products. Bone marrow aspirate concentrate was the most common orthobiologic used overall, though there remains significant variability in the usage and treatment indications for each individual orthobiologic. Given that evidence from the literature was frequently cited as a motivation for both users and nonusers for orthobiologics, there remains a need for future studies evaluating the efficacy of orthobiologic products in foot and ankle orthopedics.
FDA-approved therapies for chronic GVHD
Authors: Lee Stephanie J. , Zeiser Robert 
Published: December 2024

Abstact
Despite novel prophylactic regimens, chronic graft-versus-host disease (cGVHD) remains a challenging complication after allogeneic hematopoietic cell transplantation. cGVHD can affect multiple organs and reduces quality of life, and treatment can cause serious adverse effects. In the past 10 years, the drugs ibrutinib, ruxolitinib, belumosudil, and axatilimab were approved by the US Food and Drug Administration (FDA) for cGVHD. Here, we discuss which signaling pathways and cell types are targeted, the clinical studies that were the basis for FDA approval, and future directions for clinical research.
Bakelite beak retrieval: a case report of a simple strategy using suture material
Authors: Lima Daniel Xavier , Pereira Claudinei Tavares , Rocha Valdinei Oliveira 
Published: December 2024

Abstract
Background
The detachment of a resectoscope sheath tip during transurethral prostate resection can lead to the troubling issue of an iatrogenic-retained foreign body if not promptly identified. Various endoscopic techniques designed to prevent the necessity for open surgery are well documented in the literature. However, most of these strategies involve considerable cost or require equipment that may not always be readily available. Here, we describe a novel and simple technique for removal that does not require expensive materials.

Case presentation
The tip of a standard Storz 26 Fr continuous flow resectoscope inner sheath was successfully retrieved using a 2–0 polypropylene thread and a rigid cystoscope during a prostate resection procedure to treat benign hyperplasia of the gland. Addressing surgical complications, especially the removal of foreign bodies from the bladder, is often challenging, particularly when technical resources are limited. Various approaches for removing a detached resectoscope tip have been described, indicating that none offer a perfect solution. To our knowledge, this is the first report detailing the effective use of a simple surgical suture and endoscopic forceps in conjunction with a rigid cystoscope for removing a foreign body from the bladder.

Conclusions
The technique described here may be considered a safe, cost-effective, and relatively straightforward procedure that could be beneficial to urological surgeons, particularly when working under suboptimal conditions.
Patient and parent knowledge, understanding, and concerns after a new diagnosis of Ehlers Danlos syndrome
Authors: Jones Jordan T. , Black Lora L. , Black William R. 
Published: December 2024

Abstract
Introduction
After diagnosis of Ehlers Danlos Syndrome (EDS), it is unclear what information patients and parents need and understand about EDS. The objective of this study is to characterize patient and parent knowledge and concerns about EDS after a diagnosis of EDS is made to determine patient and parent concerns and identify barriers that cause discomfort with the diagnosis.6

Methods
A convenience sample of patient and parent dyads were recruited after new diagnosis of EDS. Patients and parents completed questionnaires that assessed knowledge, comfort, and barriers of EDS before and after diagnosis, EDS education materials accessed, and additional clinical needs and concerns.

Results
Seventy-two dyads completed the survey.

Conclusion
Many respondents actively seek information on the diagnosis and management of EDS. Parents and patients look for information about EDS differently. Parents have more concerns after diagnosis and both want well-constructed, empirically supported educational materials delivered via multiple modalities, which makes clinical guidelines more essential.
Sex differences in the relationships between 24-h rest-activity patterns and plasma markers of Alzheimer’s disease pathology
Authors: Van Egroo Maxime , Beckers Elise , Ashton Nicholas J. , Blennow Kaj , Zetterberg Henrik , Jacobs Heidi I. L. 
Published: December 2024

Abstract
Background
Although separate lines of research indicated a moderating role of sex in both sleep-wake disruption and in the interindividual vulnerability to Alzheimer’s disease (AD)-related processes, the quantification of sex differences in the interplay between sleep-wake dysregulation and AD pathology remains critically overlooked. Here, we examined sex-specific associations between circadian rest-activity patterns and AD-related pathophysiological processes across the adult lifespan.

Methods
Ninety-two cognitively unimpaired adults (mean age = 59.85 ± 13.77 years, range = 30–85, 47 females) underwent 10 days of actigraphic recordings, and blood drawing. Standard non-parametric indices of 24-h rest-activity rhythm fragmentation (intradaily variability, IV) and stability (interdaily stability, IS) were extracted from actigraphy data using the GGIR package. Plasma concentrations of neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), amyloid-β42/40 (Aβ42/40), total tau, and tau phosphorylated at threonine 181 (p-tau181) or threonine 231 (p-tau231) were measured using Single molecule array technology. Multiple linear regression models were adjusted for age, sex, education, body mass index, and actigraphic recording duration.

Results
Higher IV, indicating worse 24-h rest-activity rhythm fragmentation, was associated with elevated levels of plasma NfL (t(85) = 4.26, P < 0.0001), GFAP (t(85) = 2.49, P = 0.01), and at trend level with lower Aβ42/40 ratio values (t(85) = -1.95, P = 0.054). Lower IS, reflecting less day-to-day stability in the 24-h rest-activity rhythm, was linked to elevated levels of plasma NfL (t(85) = -2.24, P = 0.03), but not with the other plasma biomarkers. Importantly, interaction models demonstrated that male participants were driving the observed relationships between IV and plasma NfL (t(84) = 4.05, P < 0.001) or GFAP (t(84) = 3.60, P < 0.001), but also revealed a male vulnerability in models testing interactions with p-tau181 (IV: t(76) = 3.71, P < 0.001; IS: t(76) = -3.30, P = 0.001) and p-tau231 (IV: t(82) = 3.28, P = 0.002). Sensitivity analyses further showed that accounting for potential confounding factors such as APOE genotype, depression, and self-reported symptoms of possible sleep apnea did not modify the observed relationships.

Conclusions
These findings suggest that the association between disrupted circadian rest-activity patterns and AD pathophysiological processes may be more evident in cognitively unimpaired males. Our results contribute to the precision medicine approach, and they have clinical implications for improved early detection and selection of at-risk individuals to be enrolled in preventive interventions.