bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Proximal Tarsal Disruption in Lisfranc Fracture-Dislocations
Authors: Fashandi Ahmad , Anciano Victor , Cooper M. Truitt , Park Joseph 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: Lisfranc fracture/dislocations comprise of spectrum of injury including simple disruption of the lisfranc articulation to more complex tarsometatarsal fracture/dislocations. A further known variant of lisfranc injuries involves proximal tarsal disruption, specifically through the articulation of the medial and middle cuneiform. In the absence of polytrauma and high energy injury it is unknown what proportion of patients with sport or primary axial loading injury have proximal medial column variants of the lisfranc fracture. Recognizing and stabilizing this disruption is critical to establishing a stable medial column and restoring appropriate biomechanics of the foot. Methods: After IRB approval a retrospective cohort of patients was established at a single instutition utilizing CPT codes consistent with fixation of lisfranc/tarsometatarsal fracture-dislocations. Surgical encounters over a 3 year period were identified and retrospective chart review of operative reports and independent evaluation of imaging was used to determine medial column/proximal variants within the included subset of patients. Low energy fracture mechanisms with adequate imaging and operative reports were included in the study. Results: A total of 52 low energy lisfranc fracture-dislocations were included in the study for evaluation of injury patter. Based on imaging studies, intra-operative findings and fixation modalities 30 medial column variants (58%) were identified in this cohort. This subset of patients showed instability through the medial ray extending proximal to the lisfranc articulation and requiring intercuneiform fixation. Conclusion: Tarsometatarsal fracture-dislocations represent a spectrum of injury from disruption of the lisfranc joint to multiple midfoot dislocations. A proximal variant of this injury pattern with intercuneiform disruption is often noted, but prevalence has not been established. In low energy tarsometatarsal fracture-dislocations this study notes a 58% prevalence of medial column disruption requiring additional proximal fixation. Recognizing this injury pattern and appropriately addressing the pathology is critical for obtaining a stable foot and favorable outcome.
Virtual Scribe Services Are Associated with Higher Physician Satisfaction than Traditional Documentation
Authors: Hamid Kamran , Nwachukwu Benedict , Keating Timothy 
Published: September 2018

Category: Other Introduction/Purpose: Introduction of a novel virtual scribe service is theorized to eliminate waste from clinic operations. The iScribes virtual scribe application is activated in clinic and records audio proceedings of patient encounters. Recordings are transmitted to a remotely located medical scribe who translates patient-physician discussions into comprehensive clinic notes per the physician’s preferences. We hypothesize that virtual scribe services result in accurate notes, simple integration and high satisfaction. Methods: A modified version of a previously validated survey on physician documentation quality and satisfaction was digitally distributed to 193 orthopaedic surgeons who were using the iScribes system. The survey consisted of 16 domains relating to implementation, ease-of-use, efficiency, integration with electronic medical records, information quality, overall satisfaction and comparison to prior documentation systems. Results: Of the 193 physicians surveyed, 94 responded (49%). The majority (85%) were in private practice with the remaining in private-academic hybrids (2%), university systems (5%) and hospital employment (7%). Prior documentation modes were standard dictation (80%), Dragon voice-recognition (14%) and self-written/typed notation (6%). The average practice duration was 15 years (range: 1-34 years), and the average time utilizing the virtual scribe service was 12 months (range: 1-48 months). Providers rated the following domains as “agree” or “strongly agree”: easy to use (96%), fast (92%), integrates with workflow (94%), acceptable security (90%), allows me to perform work well (95%), reliable (90%), information is complete/accurate (88%), satisfaction with technical support (92%), overall satisfaction (92%) and prefer iScribes over previous system (93%) (Figure 1). Conclusion: The iScribes virtual scribe service was associated with high physician satisfaction in all tested domains and was preferred over traditional documentation in the present cohort of orthopaedic surgeons. Prospective analysis of time, quality and cost metrics is warranted.
Arthroscopically-assisted reduction and percutaneous screws fixation of Sanders type Ⅱ of calcaneal fractures
Authors: Hong Jinsong 
Published: September 2018

Category: Trauma Introduction/Purpose: Compared the clinical effect of arthroscopy assisted reduction and application of sinus tarsal approach reduction when treating Sanders Ⅱ calcaneal fractures. Methods: It was a retrospective comparative study since August 2014 to February 2017.There are 68 cases with Sanders type Ⅱ displaced calcaneal fractures which was divided into two groups. Group 1 with 31 cases was treated with arthroscopy assisted reduction and percutaneous headless screws fixation. Group 2 with 37 cases was treated with reduction and internal fixation. Results: No statistically significant difference was found between the two groups compared with the time of fracture healing, the Maryland foot score and AOFAS, and the differences was not statistically significant(P>0.05). Compared with the open reduction group, arthroscopy group had lower VAS, the healing time of incision was significantly less, intraoperative and postoperative blood loss was less, and it had higher SF-36 score, the difference had statistical significance(P<0.001). Conclusion: Two different kinds of surgical treatment of Sanders type Ⅱ calcaneal fractures had good clinical outcomes, but the treatment of arthroscopy group had less injury, less pain after surgery, less complications of incision, and it was more helpful to improve patients quality of life.
Comparison of Midfoot and Metatarsal Dorsal Wedge Osteotomy to Treat Cavovarus Foot Deformity in Adolescents
Authors: Hong Jinsong 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: To compare the clinical result of midfoot and metatarsal dorsal wedge osteotomy for the treatment of cavovarus foot deformity in adolescents. Methods: A comparative retrospective study of 24 patients with cavovarus foot deformity in adolescents was conducted between March 2012 and March 2015 in the Guangzhou Orthopaedic Hospital. All patients were flexible deformity. 10 patients were treated with midfoot dorsal wedge osteotomy, while 14 patients received metatarsal dorsal wedge osteotomy. The clinical curative effects, complications and image differences were compared between the two groups. American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and Visual Analogue Scale (VAS) score were evaluated for each patient during the follow-up. All statistics were analyzed using the SPSS software system. Results: No early stage soft tissue complications occurred in all patients. All the patients obtained an average 21.5 months (ranged,10-30 months) follow-up.X-ray demonstrated that bone healing was obtained, the midfoot dorsal wedge osteotomy group at an average of 11.2 weeks (ranged,10-13 weeks). the metatarsal dorsal wedge osteotomy group at an average of 13.4 weeks (ranged,12-15 weeks). By AOFAS foot score and VAS pain score: There is no significant difference between the two groups (P=0.138). No complications of nonunion, recurrence of de-fortuity or implant failure were seen during follow-up. Conclusion: The midfoot and metatarsal dorsal wedge osteotomy are the effective methods for the treatment of cavovarus foot deformity in adolescents. For severe deformity midfoot metatarsal dorsal wedge osteotomy can provide more powerful correction.
Range of Motion Following Total Ankle Replacement and Subtalar Fusion Through Lateral Versus Anterior Approach. Biomechanics Analysis
Authors: Indino Cristian , Leardini Alberto , Manzi Luigi , Maccario Camilla , Usuelli Federico Giuseppe 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: A gait analysis of patients who underwent simultaneous total ankle replacement (TAR) and subtalar fusion allows to assess the ankle range of motion (ROM) with precision. In healthy subjects or in patients who underwent isolated TAR this is not possible because it is influenced by the subtalar ROM and it is not possible to analyse the two joints separately. Excluding the role of the subtalar joint, it is possible to analyse the consequences of different prosthetic designs and different surgical approaches on joint kinematics. The aim was to evaluate and compare with a gait analysis the effects of two different TAR designs on the functionality of the tibiotalar joint by exploiting the exclusion of the subtalar effect determined by the subtalar fusion simultaneously performed. Methods: Minimum follow-up was 12 months. 16 patients underwent a fix-bearing TAR through lateral approach (Zimmer Trabecular Metal Total Ankle), 7 patients underwent a mobile-bearing TAR through anterior approach (Hintegra). A six-camera motion capture system was used to measure foot static posture and foot segment kinematics. Rotations in the sagittal, frontal, and transverse planes between shank and the whole foot, shank and calcaneus, calcaneus and midfoot, midfoot and metatarsus, and calcaneus and metatarsus were calculated. Sagittal and transverse plane rotations of the first matatarso-phalangeal joint, medial longitudinal arch deformation, transverse plane angle between first and second metatarsal bone and between second and fifth metatarsal bone, and sagittal plane orientation of the first and second metatarsal bone with respect to the ground were also calculated. The following spatio-temporal parameters were calculated: stance time, swing time, stride length, normalized stride length, cycle time, cadence, walking speed, and normalized walking speed. Results: On average, the lateral approach group walked at a faster speed and with a longer stride length than the anterior approach group. However, spatio-temporal parameters in both groups were generally lower than the control values. No major differences were detected between the two groups in terms of ROM in any foot joint, with the exception of the frontal-plane motion of the midfoot with respect to the calcaneus (midtarsal joint) which was larger in the anterior approach group. Conclusion: patients with TAR through lateral approach seem to walk at a faster speed and with a longer stride length than patients with TAR through anterior approach; the midtarsal joint ROM was larger in the anterior approach group and this could mean that mobile bearing TARs through an anterior approach could lead to an overload of the midtarsal joint with respect to fixed-bearing TARs through a lateral approach. However, further studies with larger samples of patients are needed to confirm these results.
Consideration of Medial Anatomical Structures at Risk when Placing Quadricortical Syndesmotic Fixation
Authors: Kaiser Philip , Riedel Matthew , Ghorbanhoseini Mohammad , Qudsi Rameez , Kwon John 
Published: September 2018

Category: Trauma Introduction/Purpose: Surgical fixation of ankle fractures with syndesmotic instability using quadricortical fixation through the fibula and tibia is commonly performed to maintain mortise congruency. Quadricortical fixation can be achieved by screws or suture buttons however both involve unprotected drilling and placement of hardware through the medial distal tibia which places anatomic structures at iatrogenic risk. These structures may include the anterior tibialis tendon, the saphenous neurovascular bundle (SNVB) and posteriorly, the posterior tibialis tendon (PTT). This study aims to radiographically map the anatomic course of these structures at risk on a lateral radiograph as would be used intraoperatively during syndesmotic fixation. Methods: Eighteen fresh-frozen cadaveric feet were dissected with preservation of all soft tissue and neurovascular structures over the medial distal tibia. While preserving fascial and tendinous sheath attachments, the SNVB and the PTT were identified and marked with metal wiring. Standardized and calibrated lateral radiographs were obtained to determine the anatomic course of these structures. Lateral radiographs of the distal tibia and fibula were analyzed by a grid system comprised of 1 cm row-increments moving cranially from the ankle joint up to 5 cm and by 3 evenly distributed parallel columnar zones from anterior to posterior (see Figure). The anterior boundary of the columnar zone was placed at the anterior tibial shaft and the posterior boundary was placed at the posterior malleolus of the tibia. The position of respective metal wires placed within the SNVB and the anterior portion of the PTT were charted according to this grid system and results compiled. Results: The SNVB was located in zone 1 or 2 (or anterior to zone 1) in 97.3% of specimens (107/110). The SNVB traversed from proximal-posterior to distal-anterior. For the 16 specimens that crossed a columnar zone, the most common crossover was from zone 2 to zone 1 at 3-4 cm above the ankle joint which occurred in 43.8% (7 of 16) specimens. The PPT was found in zone 3 in all specimens (n=18) with only one specimen demonstrating crossover of a columnar zone into zone 2 at its most distal extent (0-1 cm). The PTT was noted to pass behind (radiographically overlap) with the tibia in 83.3% (15 of 18) of specimens between 1 and 3 cm above the ankle joint. Conclusion: Inappropriate placement of quadricortical syndesmotic fixation may place structures on the medial ankle at risk given blind drilling and hardware placement. The SNVB is at considerable risk along the anterior course of the distal tibial while the PTT is only at risk in zone 3 at the distal extent of the tibia when a true lateral radiograph is obtained. This grid system allows a simple intra-operative check to guide safer placement of quadricortical syndesmotic fixation.
Iatrogenic Fracture Gapping During Fixation of Jones Fractures
Authors: Kaiser Philip , Riedel Matthew , Qudsi Rameez , Kwon John 
Published: September 2018

Category: Trauma Introduction/Purpose: Surgical fixation of Jones fractures is often recommended to facilitate recovery and achieve union. Iatrogenic fracture displacement during intramedullary screw fixation is a commonly encountered technical issue. This may be related to fracture location in relation to the surrounding ligamentous attachments, namely the robust intermetatarsal ligaments found at the proximal articulation of the 4th and 5th metatarsals. This study examines the relationship between fracture line and its location in regards to the surrounding ligamentous structures and its effect on Jones fracture displacement, reduction and fixation in a cadaveric model. Methods: Eighteen fresh-frozen cadaveric feet were dissected with preservation of all ligamentous attachments. Given the similar anatomic distal extent of the dorsal and plantar intermetatarsal ligaments on the 5th metatarsal, measurements were obtained detailing the anatomic position of the dorsal intermetatarsal ligament (DIL) only. The specimens were divided into two groups with modelled fractures created at the 4th & 5th metatarsal articulation proximal to the distal extent of the DIL (Group 1) or just distal to the DIL (Group 2). Fractures were fixed in standard fashion with serial fluoroscopic images obtained to study fracture gapping and rotation. Results: There was approximately 5 mm of fracture gapping created iatrogenically during tapping with no statistically significant differences between Group 1 and Group 2 (4.53 mm versus 5.25 mm, p=0.5430). The distal aspect of the DIL was anatomically located 2.77 mm (Range 1.58 mm – 4.46 mm) distal to the 4th & 5th metatarsal articulation. Conclusion: Considerable iatrogenic fracture gapping occurs during intramedullary screw fixation of Jones fractures in a cadaveric model regardless of fracture location in relation to the intermetatarsal ligamentous attachments. Intraoperative displacement may be related to iatrogenic distraction caused by canal tapping when utilizing a common surgical method. Specific techniques may be required to maintain anatomic alignment during tapping and screw fixation to prevent iatrogenic displacement.
Dorsal Suspension for Morton’s Neuroma
Authors: Kang Chan , Song Jae-Hwang , Ahn Ki jun , Choi Bo Sung , Hwang Sungjin , Lee Gi-Soo , Lee Jeong-kil , Seo Gangwon , Kim Dong Yeol 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: We performed a dorsal suspension of neuroma using the dorsal transverse ligament for the treatment of Morton’s neuroma. The purpose of this study was to investigate and compare the functional outcomes and complications of dorsal suspension with those of neurectomy. Methods: We conducted a retrospective study of thirty-eight (40 feet, 40 neuromas) and thirty-six (36 feet, 36 neuromas) patients who underwent dorsal suspension and neurectomy, respectively. At twenty-four month follow-up, the visual analog scale was used to evaluate pain, and the Foot and Ankle Ability Measure (FAAM) was used to investigate patient-reported function of activities of daily living and sports. Satisfaction analysis was performed using the Coughlin scale, and postoperative complications were also evaluated. Results: Both groups reported significant pain relief, and there were no significant differences between the groups with respect to postoperative pain (dorsal suspension group, mean, 12.0; neurectomy group, mean, 25.8; p = .99). The postoperative FAAM outcomes showed no significant between-group differences in activities of daily living (dorsal suspension group, mean, 89.5, neurectomy group, mean, 77.2; p = .22) or sports subscales (dorsal suspension group, mean, 85.5; neurectomy group, mean, 69.4; p = .97). Satisfaction analysis showed ‘excellent’ and ‘good’ results in the dorsal suspension and neurectomy groups (95% and 77.7%, respectively). Complications reported in the dorsal suspension and neurectomy groups were numbness (5% vs 61.1%, respectively, p < .05) and paresthesia (5% vs 33.3%, respectively, p < .05). Conclusion: Compared with neurectomy, dorsal suspension provided comparable pain relief and improvement in terms of functional outcomes, as measured by the FAAM. With its lower rate of complication and high satisfaction, dorsal suspension can be another operative option for the treatment of Morton’s neuroma.
The Influence of Diabetes on Acute Achilles Tendon Rupture Repair
Authors: Kaplan Jonathan , Hillam Jeffery , Aiyer Amiethab , Smyth Niall 
Published: September 2018

Category: Sports Introduction/Purpose: Diabetes Mellitus (DM) is an epidemic affecting millions of individuals in the United States. Multiple studies have demonstrated an increase in complications in foot and ankle surgery in patients with DM, including wound healing complications, surgical site infections (SSI), or surgical failure. The goal of this study was to retrospectively review outcomes data from the National Surgical Quality Improvement Program (NSQIP) to determine the impact of DM on operative treatment of achilles tendon ruptures. Methods: Using the NSQIP from 2006-2015, patients were identified using common procedure terminology (CPT) for Achilles tendon ruptures. Diabetic and non-diabetic cohorts were evaluated to compare demographics, comorbidities, perioperative details and 30-day outcomes. Statistical evaluation included a power analysis for the primary outcome measure of wound disruption as well as univariate analysis was performed using chi-squared or Fisher’s exact and Wilcoxon signed-rank tests. Results: A total of 2,014 patients were identified having sustained an Achilles tendon rupture. There were 1,981 patients without DM and 33 patients with DM. There were no significant differences in postoperative complications, including SSI, medical complications, and 30-day outcomes between patients with DM and non-DM patients undergoing surgical repair of acute Achilles tendon ruptures. The power analysis for wound disruption showed a P=0.9 with an alpha of 0.05, sample size of n=2014, and Pearson correlation coefficient of r=0.0721 Conclusion: While DM has been shown to have an increase in complications in various foot and ankle procedures, this study demonstrates that there is no significant difference in postoperative complications and 30-day outcomes between patients with DM and non-DM patients undergoing surgical repair of acute Achilles tendon ruptures using the NSQIP database from 2006-2015. Based on this data, patients with diabetes mellitus can be considered adequate surgical candidates for acute Achilles tendon rupture repair.
Clinical significance and morphological analysis of the os subfibulare using radiologic assessment in patients with chronic lateral ankle instability
Authors: Lee Doo Jae , Lee Dong Yeon , Lee Jae Hee 
Published: September 2018

Category: Ankle Introduction/Purpose: Although os subfibulare has been associated to various clinical problems in patients with chronic lateral ankle instability (CLAI), there are a few studies on the analysis of morphological characteristics of os subfibulare. The purpose of this study is to analyze morphologic characteristics of the os subfibulare and to evaluate the clinical significance of the os subfibulare in patients with CLAI. Methods: Among 252 patients who visited our training hospital with the symptom of lateral ankle instability for more than 1 year after sustaining ankle injury, 71 patients with os subfibulare who underwent magnetic resonance imaging (MRI) of the ankle were included in this study. For each patient, the simple radiologic assessment was also performed. The shape and size of ossicles were measured on a sagittal MR images. The location of the subfibular ossicle was classified into 3 zones by relation with the attachment site of the anterior talofibular ligament. The talofibular impingement, in which ossicles impinged to the talar articular surface. Results: The most common shape of ossicles was oval, and the most common site of ossicles was ATFL attach site. 61% of patients showed talofibular joint impingement on axial MR images, whereas 28 cases showed normal congruency of the talofibular joint. Forty-eight cases in 71 patients with CLAI had an enlarged fibular shape instead of a contralateral fibula on simple radiographs. The age; sex; the shape, location, and size of the ossicle; talofibular articular impingement; and history of major trauma were associated with surgical treatment in statistical analysis. Conclusion: The morphological analysis of the os subfibulare revealed that the ossicle manifested radiographic differences based on its size, location, and morphology. Based on the findings of our study, we suggest it is crucial to understand the morphologeical characteristics of the os subfibulare in patients with CLAI and to establish the treatment plan accordingly.