bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sensitivity of the Saline Load Test for Traumatic Arthrotomy of the Ankle
Authors: Bohl Daniel , Frank Rachel , Lee Simon , Hamid Kamran , Holmes George , Lin Johnny , Lee Simon 
Published: September 2018

Category: Ankle Introduction/Purpose: The saline load test is routinely used to evaluate for traumatic arthrotomy in orthopaedics. The purpose of this study was to determine the volume of saline required to detect traumatic arthrotomy of the ankle. Methods: 42 patients undergoing elective ankle arthroscopy were prospectively enrolled. For each patient, a standard 4 mm anteromedial portal was established. Next, an 18-guage needle was inserted at the site of the anterolateral portal. Sterile saline was slowly injected through the needle until saline extravasated from the anteromedial portal. Saline volumes at the time of extravasation were recorded and analyzed. Results: The saline volume required to achieve extravasation ranged from 0.2mL-60.0 mL (Figure 1A). The median saline volume required to achieve extravasation (and interquartile range) was 9.7 mL (3.8-29.6 mL); however, five of 42 patients required volumes between 50.0 mL and 60.0 mL. A total of 50.0 mL was required to achieve 90% sensitivity, 55.0 mL to achieve 95% sensitivity, and 60.0 mL to achieve 99% sensitivity (Figure 1B). Conclusion: The previously recommended 30 mL of saline required to reliably detect traumatic arthrotomy of the ankle may be too small a volume. The present study suggests that clinicians should attempt to inject 60 mL in order to effectively rule out a traumatic arthrotomy injury.
Timing of Adverse Events Following Open Reduction and Internal Fixation of the Ankle
Authors: Bohl Daniel , Lee Simon , Hamid Kamran , Lin Johnny , Holmes George 
Published: September 2018

Category: Ankle Introduction/Purpose: There is increasing interest in the early identification and treatment of adverse medical events following orthopaedic procedures. The purpose of this study is to characterize the timing of adverse events following open reduction and internal fixation of closed fractures of the ankle. Methods: A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program. A total of 17,318 patients undergoing open reduction and internal fixation of closed ankle fractures were identified. For each of eight different adverse events, the median postoperative day of diagnosis, interquartile range for day of diagnosis, and middle 80% for day of diagnosis were determined. Timing was compared between uni-malleolar and bi-/tri-malleolar fractures. Results: The median day of diagnosis (and interquartile range; middle 80%) for myocardial infarction was 2 (1-5; 0-17), pneumonia 3 (2-7; 1-19), acute kidney injury 6.5 (2-18; 2-20), urinary tract infection 7 (2-14; 0-24), pulmonary embolism 10 (3-21; 0-27), sepsis 15 (4-22; 1-28), deep vein thrombosis 17 (10-22; 3-27), and surgical site infection 19 (14-25; 8-28; Figure 1). Myocardial infarction occured earlier in patients with bi-/tri-malleolar fractures than in patients with uni-malleolar fractures (median postoperative day 2 versus 10, p=0.041). Similarly, sepsis occured earlier in patients with bi-/tri-malleolar fractures than in patients with uni-malleolar fractures (median day 10 versus 20.5, p=0.022). For the other 6 adverse events, there was no difference in timing between patients with uni-malleolar and patients with bi-/tri-malleolar fractures (p>0.05 for each). Conclusion: These precisely described time periods for occurrence of specific adverse events enable heightened awareness amongst orthopaedic surgeons during the first month following open reduction and internal fixation of the ankle. Orthopaedic surgeons should have the lowest threshold for testing for each adverse event during the time period of greatest risk.
Effects of Local Opioid Antagonist on Diabetic Fracture Rat Model
Authors: Cain Jarrett D. , Titunick Michelle , McLaughlin Patricia , Zagon Ian 
Published: September 2018

Category: Diabetes Introduction/Purpose: Complications associated with the diabetes include increased incidence of fracture healing, delayed fracture healing, delayed osteoblasts cell replication, decreased angiogenesis, migration and/or osteoblast cell differentiation. The cellular events involved in bone healing are adversely affected by diabetes; however, can be modulated by the Opioid Growth Factor (OGF)–OGF receptor (OGFr) is an inhibitory peptide that downregulates DNA synthesis in a tissue nonspecific manner. Diabetes is associated with elevated serum levels of OGF and dysregulation of the OGFr leading to multiple complications related to healing, sensitivity, and regeneration. This study explores the presence and function of the OGF-OGFr axis in bone tissue from type 1 diabetic rats examining intact and fractured femurs during early phases of the repair process Methods: Seven-week-old Sprague Dawley rats were injected with streptozotocin (40mg/kg i.p.) to induce T1D; other rats received buffer only and served as controls. After one month, hyperglycemia rats underwent surgery to produce a fracture at the distal third of the femur. Four diabetic rats received opioid antagoinist (naltrexone) and calcium sulfate and all remaining rats received calcium sulfate with water only. X-rays were taken immediately after surgery and after rats were euthanized on post-surgery; femur and tibia were collected for protein isolation, western blot analysis along with frozen or paraffin-embedded for histological analysis Results: Immunofluorescence indicated approximately 90% increase in opioid growth factor receptor expression in diabetic femurs compared to age-matched normal femurs. Western Blotting also suggested an increase in the receptor protein in diabetic bones relative to normal bone. TRAP staining for osteoclasts was greater in control and opioid antagonist-treated diabetic fractures when compared to the number of osteoclasts in vehicle-treated diabetic fractured femurs. Safranin O stained sections revealed approximately more bone in opioid growth receptor antagonist-treated diabetic bone fractures than in vehicle-treated bone fractures Conclusion: These data support our hypothesis that expression levels of OGFr are dysregulated in the bone of diabetic patients leading to complications in bone healing. Moreover, modulation of the OGF-OGFr pathway with receptor antagonists restored some aspects of bone healing. With further study, these preliminary results support the role of the OGF-OGFr axis in treatment of diabetic bone healing. New therapies to target dysregulation of the OGF-OGFr regulatory pathway in diabetes would provide a safe and effective disease-modifying treatment for delayed bone healing.
Seasonal Variation of Achilles Tendon Injury
Authors: Caldwell Jon-Michael , Lightsey Harry , Swindell Hasani , Greisberg Justin , Vosseller J. Turner 
Published: September 2018

Category: Sports Introduction/Purpose: Achilles tendon ruptures are increasingly common injuries. There are several known risk factors for Achilles tendon rupture, although little is reported on the seasonal variation of the incidence of these injuries. Of the few studies in the literature touching on this question, the results have been varied. We sought to determine if there is any seasonal pattern of Achilles tendon ruptures. Knowledge of such a seasonal pattern could be advantageous for patient education, risk assessment, and ultimately prevention of these injuries. Methods: We queried billing records for CPT codes 27650, 27652, and 27654 as well as ICD diagnosis codes 727.67, 845.09, and S86.01x pertaining to Achilles tendon injury, repair, and reconstruction. Charts were screened and included if the patient suffered an acute Achilles tendon rupture on a known date. Charts were excluded if the patient had a chronic Achilles tear or underwent reconstruction or debridement for tendonitis, Haglunds deformity, tendon laceration, or any other indication aside from acute rupture. Data was analyzed using a chi-squared test for categorical variables, binomial tests for dichotomous variables and Mann-Whitney-U or Welch t-test for continuous variables. Significance was set at p < 0.05. Results: Our search yielded 499 cases with 245 meeting inclusion criteria. Sixty-six percent (66%) of injuries were identified as sports-related while 34% were non-sports related. When stratified by month, significant peaks occurred in April and July (p = .036, .011 respectively) with significantly fewer injuries occurring in October through December (p = 0.049). The highest rate of injury was seen in Spring (p = .015) and the lowest was seen in Fall (p < .001). There was no significant difference between seasons when only the non-sports related injuries were considered. Basketball was the most common sport involved (n=78) accounting for 51% of injuries (p < .001), followed by soccer and tennis. There was no significant variation between seasons in any particular sport. Conclusion: There was significant seasonal variation in the incidence of Achilles tendon ruptures. Both sports and non-sports-related injuries followed a similar pattern, with most injuries occurring during the Spring and Summer and fewer during Fall and Winter. This increase corresponds to the increase in activity in the recreational athlete population in the region which is often preceded by a time of relative inactivity. Our study confirms that the deconditioned athlete is at particularly elevated risk for Achilles tendon rupture during the Spring season when abrupt increases in sporting activity are common. Targeted education and prevention efforts could help mitigate this risk.
A Comparison of the In Vivo Contact Pressure at the Tibiotalar Joint During Walking and Running
Authors: Campbell Bradley , Abramowitch Steven , Anderst William 
Published: September 2018

Category: Ankle Introduction/Purpose: Knowledge of cartilage pressure distribution in healthy ankle joints during gait is important for understanding the loading environment of articular cartilage and for providing a basis for comparison to evaluate how ankle pathology and surgical procedures affect cartilage loading. Finite element models of the ankle have been developed to examine in vitro loads at the tibiotalar joint during simulated standing in healthy and injured ankle joints [1, 2]. However, there are currently no in vivo studies of tibiotalar cartilage pressure during dynamic loading activities. The goal of this study was to develop a subject-specific finite element model of the tibiotalar joint to estimate contact pressure during walking and running. Methods: Informed consent was obtained from one healthy male, age 23 yrs., BMI 27 kg/m2). Synchronized biplane radiographs of the ankle were acquired at 100 and 150 frames per second during the support phase of overground walking and running, respectively, at a self-selected pace (1.5 m/s and 3.0 m/s, respectively). CT-based bone models of the tibia and talus were matched to the stereoradiographic images to precisely track the three-dimensional bone movement [3]. Six degrees-of-freedom joint kinematics were calculated for each bone model, and used to position bone models in the finite element analysis. Cartilage volumes for the distal tibia and proximal talus were created in Geomagic software by extruding the articulating bone surface. Bones were modeled as rigid bodies and cartilage was modeled as deformable bodies with uniform thickness of 1.3 mm [4-7]. Simulations were performed using FEBio software. The primary outcome parameter was peak cartilage pressure in the tibiotalar joint. Results: On average, peak tibiotalar cartilage pressure was approximately 25% greater during the midstance phase of running in comparison to walking (Figure 1). During walking, peak contact pressure occurred on the lateral-central region of the tibiotalar cartilage throughout the entire stance phase. During the early support phase of running, the location of peak contact pressure was also on the lateral-central region of the tibiotalar cartilage. During running push-off, pressure increased in the medial-central cartilage region and the overall peak cartilage pressure increased. Conclusion: A novel finding of this study is that the peak pressure in tibiotalar cartilage moves from the lateral to medial side of the joint during running, but remains on the lateral side throughout the support phase of walking. This suggests that the location and magnitude of the loads seen by tibiotalar joint cartilage are activity dependent, even in the healthy ankle joint. Future work will investigate cartilage loading in pathologic ankles before and after surgical intervention, as well as during other common athletic activities.
Prognosis of Medial Gutter Osteoarthritis Combined with Chronic Ankle Instability
Authors: Cho Byung-Ki , Choi Seung-myung 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: Although the frequent intraarticular pathologies associated with recurrent ankle sprains are well known, informations regarding treatment method for arthritic changes in the medial gutter are still insufficient. This study was performed to evaluate the intermediate-term clinical and radiological outcomes following modified Broström procedure and arthroscopic debridement in the middle-aged patients. Methods: Twenty-two patients with medial gutter osteoarthritis related to chronic lateral ankle instability were followed for more than 3 years after surgical treatment. All patients showed medial joint space narrowing of Takakura stage 2. The clinical evaluation consisted of the American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) for medial ankle pain during walking, and Foot and Ankle Ability Measure (FAAM). Results: Mean AOFAS and FAAM scores significantly improved from 51.2 and 45.7 points preoperatively to 80.3 and 78.4 points at final followup, respectively (P < .001). Although mean pain-VAS significantly improved from 6.8 points to 3.5 points (P < .001), 8 patients (36.4%) complained of discomfort at gait with considerable pain ≥ 4 points. There was only 1 patient (4.5%) with recurrent ankle instability, while 6 patients (27.3%) showed a progression in arthritis stage. Conclusion: Modified Broström procedure concomitant with arthroscopic debridement for medial gutter osteoarthritis secondary to chronic ankle instability is not effective enough to treat the medial ankle pain and functional impairment. Alternative treatment strategies for middle-aged cohort with arthritic changes are needed to improve the clinical outcomes and to prevent a progressive osteoarthritis.
The Effect of Peroneal Muscle Strength on Functional Outcomes After the Modified Broström Procedure for Chronic Ankle Instability
Authors: Cho Byung-Ki , Choi Seung-myung 
Published: September 2018

Category: Sports Introduction/Purpose: Although the peroneal muscle is known to be a major dynamic lateral stabilizer of the ankle, few informations are available regarding the changes of muscle strength and relationship with the outcomes after lateral ligaments repair surgery. The purpose of this study was to identify the effects of peroneal strength on the validated functional outcome measures after the modified Broström procedure(MBP) for chronic ankle instability. Methods: Forty-one patients (41 ankles) underwent MBP using suture anchors were eligible and followed up to 2 years postoperatively. Functional evaluation consisted of the Foot and Ankle Outcome Score(FAOS), Foot and Ankle Ability Measure(FAAM). The changes of peroneal strength were evaluated using isokinetic dynamometer. Differences in the functional outcomes between the 3 groups divided according to recovery rate of peroneal strength were analysed. Results: Peak torque and total work for eversion in 60º/sec angular velocity significantly improved from a mean 8.1 Nm, 5.2 Nm preoperatively to 11.4 Nm, 6.9 Nm at postoperative 2 years, respectively (P < .001, P = .038). Deficit ratio of peak torque for eversion significantly improved from a mean 38.6% to 17.4%, and a significant side to side difference was found (P = .011). There were no significant differences in FAOS, FAAM, and measurements of stress radiograph between the 3 groups. Conclusion: Although restoration of peroneal strength postoperatively was about 82.6% of unaffected ankle, patient-reported function in daily and sport activities were satisfactorily improved. Postoperative isokinetic strength of the peroneus demonstrated no statistically significant effects on the functional outcomes after MBP.
Early Outcomes on the Use of an Anterior Plate for complicated Ankle Fusions
Authors: Coetzee J. Chris , Stone Rebecca 
Published: September 2018

Category: Ankle Introduction/Purpose: An ankle fusion is indicated for severe osteoarthritis of the ankle. An anterior ankle fusion plate for tibiotalar fusions provides a rigid and reproducible solution to treat ankle arthritis. With a plate fixation it might be possible to treat more complex deformities and provide additional stability in compromised patients. This study documents the early outcomes on the use of an anterior plate for patients undergoing an ankle arthrodesis. Methods: All ankle fusions using the anterior plate at our center were included and followed. Fifty-one patients (53 ankles) presented to the senior author between September 2014 and February 2017. Patients experienced ongoing ankle pain due to degenerative changes, a previous ankle fusion, post-traumatic arthritis (PTA) or failure of a total ankle arthroplasty (TAA). All patients’ medical and ankle surgical history was documented. This study was conducted in compliance and approved with a local IRB. Outcomes were evaluated pre-operatively and post-operatively with the Veterans Rand Health Survey (VR-12), Ankle Osteoarthritis Scale (AOS) and Visual Analog Scale (VAS) Pain scale. A patient satisfaction survey was distributed to all patients and results were tabulated. Average follow up for outcome scores 16.8 months (range 6 – 38 months). Results: Fifty-one patients(29 females) with the mean age of 56.56 years(26.3–74.8) had a mean follow-up of 16.6months(6– 38months). Diagnoses included 17 primary, 10 revision, 6 TAA failures and 20 PTA. 86.3%(44 patients) were non-diabetic. Non-smokers included 43.1%(22). VR-12 Physical improved from 29.46 to 37.72, and Mental 47.34 to 52.55 pre-operatively to post-operatively, respectively. AOS Pain improved: 462.41 to 252.8; AOS Disability: 567.52 to latest 387.77. Mean VAS improved from pre-operatively of 54.28 to latest of 30.61. Arthrodesis rate was 98%(52/53 ankles). 45 ankles were fused at 3 months by x-rays. Symptomatic patients (with pain) had a CT scan done at a minimum of 3 months (1/8 CT scans showed non-union & 7 were fused). Major complications were 3.8%(2 patients). There were no wound complications. Conclusion: An anterior plate construct is more invasive compared to arthroscopic or other arthrodesis options. However, the stability of the construct allows for a reliable option in complex situations, and the arthrodesis rate appears to be exceptional. In this complex patient population, the arthrodesis rate was 98%, while major complications only 4%. Summary Sentence: Anterior plate construct is more invasive compared to arthroscopic/other arthrodesis options. However, stability of the construct allows for a reliable option and fusion rates seem to be exceptional.
Percutaneous Posterior to Anterior Screw Fixation of the Talar Neck
Authors: de Cesar Netto Cesar , Roberts Lauren , Dos Santos Alexandre Godoy , Staggers Jackson , Lee Sung , Smith Walter , Hudson Parke , Araoye Ibukunoluwa , Naranje Sameer , Shah Ashish 
Published: September 2018

Category: Trauma Introduction/Purpose: Fractures of the talar neck and body can be fixed with percutaneously placed screws directed from anterior to posterior or posterior to anterior. The latter has been found to be biomechanically and anatomically superior. Percutaneous pin and screw placement poses anatomic risks for posterolateral and posteromedial neurovascular and tendinous structures. The objective of this study was to enumerate the number of trials for proper placement of two parallel screws and to determine the injury rate to neurovascular and tendinous structures. Methods: Eleven fresh frozen cadaver limbs were used. 2.0 mm guide wires from the Stryker (Selzach, Switzerland) 5.0-mm headless cannulated set were percutaneously placed (under fluoroscopic guidance) into the distal posterolateral aspect of the ankle. All surgical procedures were performed by a fellowship-trained foot and ankle surgeon. Malpositioned pins were left intact to allow later assessment of soft tissue injury. The number of guide wires needed to achieve an acceptable positioning of the implant was noted. Acceptable positioning was defined as in line with the talar neck axis in both AP and lateral fluoroscopic views. After a layered dissection from the skin to the tibia, we evaluated neurovascular and tendinous injuries, and measured the shortest distance between the closest guide pin and the soft tissue structures, using a precision digital caliper. Results: The mean number of guide wires needed to achieve acceptable positioning for 2 parallel screws was 2.91 ± 0.70 (range, 2 - 5). The mean distances between the closest guide pin and the soft tissue structures of interest were: Achilles tendon, 0.53 ± 0.94 mm; flexor hallucis longus tendon, 6.62 ± 3.24 mm; peroneal tendons, 7.51 ± 2.92 mm; and posteromedial neurovascular bundle, 11.73 ± 3.48 mm. The sural bundle was injured in all the specimens, with 8/11 (72.7%) in direct contact with the guide pin and 3/11 (17.3%) having been transected. The peroneal tendons were transected in 1/11 (9%) of the specimens. The Achilles tendon was in contact with the guide pin in 6/11 (54.5%) specimens and transected in 2/11 (18.2%) specimens. Conclusion: The placement of posterior to anterior percutaneous screws for talar neck fixation is technically demanding and multiple guide pins are needed. Our cadaveric study showed that important tendinous and neurovascular structures are in close proximity with the guide pins and that the sural bundle was injured in 100% of the cases. We advise performing a formal small posterolateral approach for proper visualization and retraction of structures at risk. Regardless, adequate patient education about the high risk of injury from this procedure is crucial.