bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pre-contoured Allograft Wedge Resorption and Complication Rates in Foot and Ankle Surgery at a Single Institution from 2017-2022
Authors: Boden Allison L. , Masry Seif El , DiGiovanni Grace , Demetracopoulos Constantine , Cody Elizabeth A. 
Published: December 2024

Category: Other; Basic Sciences/Biologics Introduction/ Purpose: Structural allografts have long been used in foot and ankle reconstructive surgery. Pre-contoured allograft wedges, manufactured in a variety of shapes and sizes for specific uses, have gained popularity in recent years due to their ease of use and ability to decrease operative time. A high rate of resorption of such pre-contoured allograft wedges was noted anecdotally by the senior authors, particularly in 2022. There is no known literature describing this phenomenon and thus, the purpose of this study was to identify the resorption and complication rates of pre-contoured allograft wedges over time. Methods: A retrospective review of patients who had a pre-contoured allograft wedge (Paragon28, Englewood, CO) implanted during foot and ankle surgery between 2017 and 2022 at a single institution by one of 10 surgeons was performed. Chart review was used to obtain demographic and implant information and confirm the surgical procedure(s) performed. Radiographic review was completed in order to identify patients with graft resorption and/or nonunion, confirm the site of allograft implantation, and determine the method of fixation used at the allograft site. A linear regression model was utilized to determine if there was a statistically significant association between the year and the number of cases of resorption. Results: In the 320 patients that met inclusion criteria, there were 334 wedges implanted. There were 24 grafts that resorbed and an additional 10 wedges that developed a non-union without resorption. Resorption was noted as early as 5.7 weeks post-operatively and as late as 36.6 weeks post-operatively (average 12.9 weeks). Of the allografts that resorbed, the majority were Lapidus wedges (38%) and Cotton wedges (56%) (Table 1). Resorption rates were highest in the last 2 years studied (Figure 1). Of the 78 wedges used in 2022, 11 wedges resorbed and there were 3 non-unions without resorption, for an overall complication rate of 18%. There was a statistically significant association between the year and the number of patients that had graft resorption (p = 0.03). Conclusion: While complications of allograft wedges in foot and ankle surgery have previously been described, including nonunion, resorption of pre-contoured wedges has not. Over a 5-year period at a single institution, there was a wedge resorption rate of 7% and an overall radiographic complication rate of 10%. There was an increase in allograft resorption cases as well as overall resorption rate and complication rate in 2022 compared to previous years. The majority of cases in which there was a complication occurred with the use of a Cotton or Lapidus wedge; however, no concrete identifiable patient or surgical risk factors were identified.
Radiographic Measurement of Distal Metatarsal Articular Angle Does Not Correlate with In-Vivo Deformity for Juvenile Bunion Deformity
Authors: O’Sullivan Michael , Coe Kelsie , Zide Jacob R. , Hartman Rusty , Riccio Anthony I. 
Published: December 2024

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Correction of juvenile bunion deformities has historically been fraught with high recurrence rates leading to dissatisfaction among patients and surgeons alike. It is now recognized that these historically poor results have likely been due to a failure to correct the elevated distal articular metatarsal angle (DMAA) encountered in the vast majority of juvenile bunions. Though preoperative planning for deformity correction hinges on plain radiographic measurement of the DMAA, accuracy of this measurement in the juvenile population has not been studied. The purpose of this study is to compare plain radiographic measurements of the DMAA to in-vivo DMAA measurement. Methods: This is an IRB-approved retrospective r¬eview of prospectively enrolled patients over a 4-year period at single pediatric institution who underwent a scarf osteotomy for management of a juvenile bunion deformity. Children with neurologic disorders, autoimmune disease, congenital foot or extremity deformities, or history of prior ankle or foot surgery were excluded. Pre-operative DMAA was measured on standardized weight-bearing foot radiographs. In-vivo DMAA goniometric measurement was made at the time of surgery following capsulotomy and direct visualization of the articular surface of the metatarsal head. A Pearson’s correlation coefficient was calculated to assess the relationship between radiographic and in-vivo measurements. Results: 19 feet in 20 patients with an average age at surgery of 15.9 years (range 13.1 -17.9 years) met inclusion criteria. Radiographic DMMA averaged 25.2o (range 7o - 32o) and intra-operative DMAA averaged 18.1o (range 5o - 69o). Pearson correlation coefficient revealed no correlation between radiographic and in-vivo DMAA measurements (r=0.186, p=0.45). Repeat analysis after removing three outliers with very high in-vivo DMAA measurements (greater than 40o) also showed no correlation between radiographic and anatomic DMAA measurements (r=0.051, p=0.85). As the in-vivo DMAA increased, radiographic measurements were more likely to underrepresent the true degree of deformity present (Figure 1). Conclusion: Plain radiographic DMAA measurements do not correlate to actual articular deformity in children with juvenile bunions. Moreover, as the degree of in-vivo DMAA increases, radiographic assessment is increasingly likely to underrepresent the extent of deformity correction required to achieve a normal DMAA intra-operatively. Surgeons should therefore not rely solely on plain radiography for preoperative planning or to assess adequacy of surgical correction of the juvenile bunion deformity. This is of particular importance for those performing minimally invasive bunion surgery as neither the amount of desired correction nor the surgical correction achieved can be reliably determined using plain radiography alone.
Radiographic Predictors of Surgical Management of Symptomatic Calcaneal Spurs: A Retrospective Cohort Study
Authors: McCahon Joseph A.S , Kohring Adam , Schultz Matthew , Massaglia Joseph , Parekh Selene G. , Pedowitz David I. , Daniel Joseph N. 
Published: December 2024

Category: Hindfoot; Other Introduction/Purpose: Insertional Achilles tendinopathy (IAT) is one of the most common causes of posterior heel pain and affects thousands of patients every year. Enthesophytes can form at the Achilles tendon insertion in response to excessive loads and lead to pain and discomfort. There is limited evidence regarding patient factors associated with likelihood of failing non-operative management, specifically the size of the enthesophyte and its proximity to the posterior heel skin. The purpose of this study was to investigate the relationship between radiographic characteristics of retrocalcaneal enthesophytes in IAT and likelihood of failing non-operative management. Methods: A retrospective cohort study of 295 patients diagnosed IAT with symptomatic enthesophytes were identified and separated into operative and nonoperative cohorts. A power analysis was conducted and determined that a minimum of 100 patients within each cohort was required. All patients had lateral weight bearing radiographs which were used to measure the Calcaneal Spur-to-Skin Distance (CSK), Calcaneal Spur Width (CSW), Calcaneal Spur Height (CSH), and the Fowler-Philip Angle (FPA). Demographic and radiographic parameters were compared between both groups. Multivariate regression analysis was performed to identify independent risk factors associated with failing nonoperative management. Results: The operative group had significantly smaller CSK (6.0 mm vs. 6.6 mm; p = .02), larger CSW (7.9 mm vs 6.2 mm; p < .001), and larger CSH (14.1 mm vs. 11.1 mm; p < .001) compared to the nonoperative group. There was no significant between-group difference in FPA (61.9° nonoperative vs 63.3° operative; p = .052). Multivariate logistic regression analysis demonstrated CSK, CSW, and CSH as independent risk factors for failing nonoperative management. Conclusion: Radiographic measurements of retrocalcaneal enthesophytes are a simple and reliable method for predicting which patients have a higher likelihood of failing nonoperative management of IAT.
Radiographs Over-Estimates Joint Space Narrowing in Hallux Rigidus in Comparison to Weight-Bearing Computed Tomography
Authors: Fayed Aly M. , Mallavarapu Vineel , Mansur Nacime Salomao Barbachan , de Cesar Netto Cesar 
Published: December 2024

Category: Other; Bunion Introduction/Purpose: Twenty years ago, Coughlin and Shurnas proposed a clinical and radiographic classification grading scale for hallux rigidus (HR). Radiographic grading was based on weight-bearing anteroposterior and lateral conventional radiographs. Radiographic metrices include joint space width, a narrowing percentage of the dorsal joint space, and sesamoidal changes such as enlargement, irregularities, and sclerosis. Dorsal osteophytes were the main findings in all grades. The aim of this study was to compare hallux rigidus radiographic findings between conventional and weight-bearing computed tomography (WBCT). We hypothesized that radiographs overestimate joint space narrowing due to bone overlap and osteophytes. Methods: In this IRB approved study, all patients who had weight-bearing radiographs and WBCT for HR were included. Patients with previous hallux surgeries or associated severe hallux valgus were excluded. The first metatarsophalangeal joint (1st MTPJ) was measured using the summation method. (figure1) Dorsal osteophytes were measured. We measured the percentage of narrowing of the dorsal articular surface on a weight-bearing lateral/sagittal view. We evaluated the proximal phalanx (P1), first metatarsal (M1), and sesamoids (SS) for cysts. (Figure 1) All measurements were performed by two fellowship-trained orthopaedic foot and ankle surgeons. A comparison between groups was performed using the t-test or the Mann-Whitney U test according to data normality. Inter-rater reliability was evaluated using inter class correlation coefficient. Significant differences were established for p-values under 0.05. Results: The study included 21 patients; 13 were males. The average age was 55.9 ± 12.5 and the BMI was 28.9 ± 6.5. The joint space width was significantly larger on WBCT (1.9mm ± 0.44) vs. (0.92mm ± 0.53) (P < 0.001). WBCT showed less narrowing of the dorsal articular surface (46.59% ± 18.8%) vs. (22.78% ± 8.71). There was no difference in the size of dorsal spurs (4.57 mm ± 1.49) vs. (4.39 mm ± 1.56) (P = 0.684). WBCT detected loose bodies in nine patients, while radiographs detected them only in six patients. Sesamoid changes were appreciated on the WBCT image of all patients. Conclusion: Radiographic parameters of the Coughlin classification of hallux rigidus are better evaluated with WBCT. WBCT showed less narrowing of the dorsal joint space as it’s not affected by the overlap of other bones. Dorsal spurs may give the false impression of joint space narrowing on radiographs. Dedicated radiographic sesamoid views (not routinely ordered) are required to study sesamoid changes. The detection of less joint space affection could potentially lead to more joint sparing surgeries.
Readability of Patient Education Material on Ankle Arthroplasty
Authors: Fanfan Dino , Todd George , Murray Daniel , Chapman Cary B. 
Published: December 2024

Category: Ankle; Ankle Arthritis Introduction/Purpose: Health literacy has recently gained attention in the literature as it has been consistently shown to be an important predictor of patient outcomes. Total ankle arthroplasty (TAA) has recently increased in popularity, and it tracks that patient education regarding this procedure should be comprehensive and easily understandable. However, few studies have examined online patient educational materials (PEMs) for TAA for easy consumption and comprehension among the general public. The purpose of this study was to assess the readability of total ankle arthroplasty PEMs found on the websites of the top 100 orthopedic hospitals in the United States. Methods: The top 100 ranked orthopedic hospitals were identified from the U.S. News and World Report website. Our search was performed on Google with the name of the hospital as listed on the report followed by the words “total ankle arthroplasty.” We stratified the hospital websites based on their ranking in the report and evaluated their websites using four unique validated readability assessment tools: Coleman-Liau Index, Flesch Reading Ease test, Flesch-Kincaid grade level, and Gunning Fog Index. Statistical analysis was conducted to compare readability scores between hospitals in the upper and lower 50th percentiles. Results: 56 unique websites were evaluated. There were no statistically significant differences in the readability outcomes across percentiles for the Coleman-Liau Index, Flesch-Kincaid, Gunning-Fog Index, and Flesch Reading Ease. The average scores were 11.87, 10.04, 12.93, and 50.04, respectively. 28% of websites were written at or below an 8th grade reading level. Higher ranked institutions had significantly higher word counts for TAA PEMs on average. There was no significant differences between higher and lower ranked hospital websites in the readability of TAA PEMs according to any of the four assessments. Conclusion: Our findings underscore a discrepancy between the readability of online PEMs on TAA and the average literacy level of the U.S. population. Despite the importance of health literacy in informed decision-making, most PEMs are written in language that may be inaccessible to many. Collaboration between healthcare professionals and patients is essential to develop clear and concise PEMs that bridge the literacy gap and empower patients to make informed healthcare decisions. Future efforts should focus on creating accessible materials using plain language techniques and incorporating patient feedback to ensure effectiveness in enhancing patient understanding and decision-making in the context of TAA.
Return to Sport and Clinical Outcomes Among Athletes Following Turf Toe Repair
Authors: Cho David , Drakos Mark , O'Malley Martin , Johnson A. Holly , Shamrock Alan , Kukadia Saanchi , Josephson Brian 
Published: December 2024

Category: Midfoot/Forefoot; Sports Introduction/Purpose: Turf toe, a plantar plate injury of the first metatarsophalangeal joint, commonly occurs in athletes participating in outdoor cutting sports. To the knowledge of the authors, this study reports on clinical and return to sport outcomes after surgical repair of turf toe for the largest cohort of patients presenting with a Grade III turf toe injury. The purpose of this study is to identify risk factors for turf toe and analyze foot function after turf toe injury and surgical repair. This study reports on clinical outcomes and return to sport for athletic patients treated for a turf toe injury at our institution. We hypothesize that patients will have significant improvement in pre- to postoperative clinical outcomes and quickly return to sport after surgical repair. Methods: This was a single-center retrospective study conducted from the institutional review board-approved Foot and Ankle Registry data, and the protocol was approved by the steering committee at the investigators’ institution. Inclusion criteria included athletes of at least high school level competition who underwent plantar plate repair at the first metatarsophalangeal joint between 2016 to 2023 by 3 fellowship-trained foot and ankle orthopedic surgeons. Excluded were patients with histories of ipsilateral forefoot surgeries, rheumatoid arthritis, or gout. Twenty-eight patients were identified. Patient-reported outcomes via PROMIS scores were collected preoperatively and at least one year postoperatively for all patients. Return to sport surveys were distributed to patients at least one year postoperatively. Results: The average time from surgery to final follow-up was 2.8 (range, 1-5.3) years. PROMIS scores were found to significantly improve for Physical Function, Pain Interference, Pain Intensity, and Global Physical Health domains. 21 return to sport surveys were completed from the patient cohort. 19 out of 21 (90.5%) of patients were able to return to pre-injury levels of physical competition with an average time to return to sport was 20.35 (range, 12-32) weeks. Conclusion: This study compared short- to medium-term patient-reported clinical outcomes and return to sport data for athletes after a Grade III turf toe injury and surgical repair. Patients demonstrated significant improvement in patient-reported outcomes and were able to return to sport approximately five months after surgery.
Return to Work Outcomes Related to Operative Versus Nonoperative Treatment of Calcaneal Fractures
Authors: Luo Emily Joan , Wu Kevin , Eaton Kaleb , Talaski Grayson M. , Anastasio Albert T. , Adams Samuel B. 
Published: December 2024

Category: Hindfoot; Trauma Introduction/Purpose: Calcaneal fractures are a common work-related injury that can be treated both operatively and nonoperatively. Operative management typically consists of open reduction with internal fixation via either an extensile lateral or sinus tarsi approach. Conservative treatment employs a combination of immobilization, rest, and elevation. Given that return to work is a critical milestone for many of these patients, it is crucial that the best management option is chosen. While there have been studies that compared operative versus conservative treatment, there has been no summative review on this topic. Thus, the goal of this study was to conduct a systematic review and meta-analysis on the impact of operative versus nonoperative management on return to work outcomes. Methods: MEDLINE (PubMed), Embase (Elsevier), and Cochrane Library were searched for the concepts of calcaneal fracture and return to work. Inclusion criteria consisted of studies that reported on operative or nonoperative treatment of calcaneal fractures and outcomes relating to timing of return to work. Abstract only studies, biomechanical studies, cadaveric studies, case reports, studies involving pediatric patients, and non-English texts were excluded. Factors that were extracted included fracture type, pre-injury workload, mechanism of injury, treatment, return to work, functional outcomes, and complications. Revman 5.3 software was used for meta-analysis. Studies that did not qualify for meta-analyses were described qualitatively. Results: 2462 studies were identified on initial search. 52 texts met inclusion and exclusion criteria. A total of 3338 patients were included. Operative management had significantly improved return to work outcomes compared to nonoperative treatment, with an overall mean difference of 40.79 days [95% Confidence Interval (CI), -69.55 to -12.03, p < 0.05]. Operative treatment was also associated with significantly lower pain scores [Mean difference: -1.14; 95% CI, -2.24 to -0.04, p < 0.05] and higher SF-36 scores [Mean difference: 13.89; 95% CI, 7.69 to 20.10, p < 0.0001]. Operative treatment did have expectedly higher risk of all complications compared to the nonoperative group [Risk Ratio: 1.80; 95% CI, 1.22 to 2.66, p < 0.05]. Conclusion: While operative management was associated with higher risk of complications, patients had improved return to work, pain, and functional outcomes compared to nonoperative treatment. Careful consideration should be taken when determining treatment options for calcaneal fracture patients. Further research is needed to better elucidate differences between operative treatment options.
Use of Gastric Electrical Stimulation May Predict Hospital Length of Stay in Patients with Gastroparesis Syndromes
Authors: Guzman Rojas Patricia , Naing Le Yu , Mathur Prateek , Stocker Abigail , Mandzhieva Bayarmaa , Daniels Michael W. , Abell Thomas L. 
Published: December 2024

Introduction: Gastric electrical stimulation (GES) offers potential benefits for patients with drug-refractory gastroparesis syndromes (GpS). However, its impact on reducing hospital readmissions, particularly within 30 days post-discharge, remains unclear. GES placement might positively influence 30-day readmissions in patients frequently hospitalized for GpS symptoms. Methods: This prospective study included 110 patients admitted with GpS to a university-affiliated hospital over 5 years. The cohort had a mean age of 42 years. Hospital admissions were categorized into GpS-related flares and non-GpS-related causes. The Wilcoxon signed-rank test and generalized linear models (GLM) were used to compare pre-and post-GES outcomes. Results: The 110 patients had 1,690 admissions, of which 760 (45.0%) were related to GpS flare-ups. Less than 2% of admissions occurred within 30 days of GES placement. After GES placement, the median number of gastroparesis-related admissions decreased from 3 to 2 ( p = .002), and the median length of stay (LOS) dropped from 12.5 days to 7.5 days ( p = .004). The median LOS for GES placement was 1.0 days [1.0, 3.8]. Conclusions: GES placement significantly reduced the number of gastroparesis-related admissions and the overall length of stay in hospitalized GpS patients. Our GLM analysis revealed that each additional day of hospitalization slightly decreased the odds of experiencing GpS-related symptoms. These findings suggest that GES can reduce hospital burden and improve quality of life in GpS patients. Further research into strategies for minimizing hospital admissions for severe gastroparesis flares, including bioelectric interventions, is recommended.
Purification of C1 Esterase Inhibitor from Human Plasma
Authors: Verma Sachin , Makadia Savan , Dolia Sheetal , Pawar Amit , Kumar Narendra 
Published: December 2024

Background Plasma-derived human C1-esterase inhibitor (C1-INH) concentrates are indicated for the treatment of acute episodes of hereditary angioedema. Intravenous C1-INH concentrate provides rapid relief to patients with acute hereditary angioedema symptoms. Objective To develop a safe and efficient purification process for C1-INH from human plasma. Design A combination of anion exchange and hydrophobic interaction chromatography was used to purify C1-INH from human plasma. Method The cold insoluble fraction (cryoprecipitate) was separated via centrifugation; then, the cryoprecipitate-poor plasma was subjected to different separation techniques to purify C1-INH. First, separation was performed using diethylaminoethyl (DEAE) anion exchange chromatography to capture coagulation factors. Then, C1-INH was purified from the remaining plasma using quaternary amine (a strong anion exchanger) chromatography, followed by DEAE (a weak anion exchanger) chromatography. The final product was purified via hydrophobic interaction chromatography, followed by ultrafiltration to concentrate the purified C1-INH. This process is cost-effective because coagulation factors were captured before C1-INH purification and the waste fraction after the capture stage was diverted to Cohn fractionation to isolate other potential plasma products. Results The final C1-INH preparation had a specific activity of >12 IU/mg protein, which is sufficient for its intended purpose. The purified preparation was characterized via sodium dodecyl sulfate–polyacrylamide gel electrophoresis, and coagulation factors were measured in the purified preparation. Furthermore, viral activity decreased via solvent detergent treatment and virus filtration. Conclusion We successfully developed a purification process for C1-INH from human plasma. This process is easily adaptable and has been successfully scaled up to approximately 15-fold. It can be further scaled up for the large-scale production of C1-INH.