bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ankle Arthroplasty
Authors: Allport Jack , Bennett Adam , Ramaskandhan Jayasree , Siddique Malik 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) has been shown to be an effective treatment for end stage ankle arthritis. Achieving normal anatomical alignment has been shown to be important in long term outcomes and revision rates. Recent data from the British NJR has shown that revision rates are higher in patients with pre-operative fixed equinus. Although there is literature about surgical techniques to deal with pre-operative equinus we are not aware of any papers presenting patient outcomes. We present patient reported outcomes for our cohort of patients with pre-operative fixed equinus compared to those able to achieve a plantigrade ankle. Methods: This is a single surgeon, retrospective cohort study of consecutive cases. A mobile bearing prosthesis was used (Mobility TAA system, DePuy, Raynham, Massachusetts, USA). Cases were identified from a locally held joint registry which routinely records PROMS data pre-operatively and at annual intervals post-operatively. Patients undergoing primary TAA between March 2006 and June 2014 were included, revision procedures along with those with inadequate PROMS data were excluded. PROMS scores used were FAOS (WOMAC Pain, Function and Stiffness), SF-36 scores and patient satisfaction. All pre-operative lateral weight bearing xrays were reviewed to screen for potential fixed equinus deformity (tibia-sole angle >90 degrees). Clinical records were then reviewed to confirm clinical diagnosis of fixed equinus deformity. Results: 259 cases were identified, 95 cases were excluded based on our criteria leaving 164 cases for analysis (mean follow up 61.6 months). 144 were classified as neutral and 20 as fixed equinus. The fixed equinus group were significantly younger (neutral 64.2 vs equinus 53.9, p=0.0002), there was no difference in BMI or length of follow up. There was no difference in baseline scores except WOMAC stiffness, with the fixed equinus group significantly worse (36.9 vs 25.6, p=0.0014). Final PROMS score, change from baseline and patient satisfaction was the same in all domains for both groups. There was no difference in revision rates. Conclusion: A pre-operative fixed equinus deformity does not negatively impact on clinical outcomes in patients undergoing TAA. We are not aware of any previous studies to compare results. As expected the equinus group showed higher levels of stiffness pre-operatively. Contrary to the British NJR dataset we did not find a difference in revision rates.
Minimally Invasive versus Open Hallux Valgus Surgery
Authors: Frigg Arno , Pellegrino Alex , Maquieira Gerardo 
Published: September 2018

Category: Bunion Introduction/Purpose: About 20% of patients suffer from stiffness (arthrofibrosis) after hallux valgus surgery. Minimally Invasive Surgery (MIS) has been invented to reduce the rate of unfavorable result, MIS enjoys increasing popularity with both surgeons and patients and is applied in a growing number of cases. It is being advertised as delivering better results due to reduced soft tissue injury and quicker recovery while effecting a similar amount of deformity correction. However, to date there are no scientific data to support this claim. The aim of the current project is to fill this lacuna by comparing the outcomes of MIS and open hallux valgus surgeries prospectively at our institution. Methods: From 01/2014 to 12/2015, 123 patients were operated: 75 open (average age 51 years, 91% female) and 48 MIS (age 47 years, 88% female). Inclusion criteria were either open Chevron/Scarf or MIS-Chevron at our Foot and Ankle Center with 5 different hospitals and three surgeons. Exclusion criteria were radiological signs of osteoarthritis, extension of less than 30°, pain on motion or during the night, and all other hallux valgus surgeries (lapidus, open wedge, Akin and buniektomy only). Radiographs were taken of all patients 6 weeks and 1 year postop. All patient charts were screened by an independent research assistant for complications and reoperations. All radiographs were measured by two independent observers. All patients were examined in a blinded control by an independent study nurse at 24±6 months after surgery for the clinical results (for parameters please see Tab. 1). Results: All clinical and radiographic results, as well as all additional surgeries, reoperations and complications are shown in Tab.1. The results show that open and MIS surgery achieved a similar gain in AOFAS-score, flexion, extension, VAS and subjective foot value. The scar was significantly smaller in MIS than open, but the satisfaction with the scar was similar. The radiographic correction was equal. Open surgery was combined with more additional procedures than MIS, especially Weil osteotomies and plantar plate repairs. The rate of CRPS, prolonged pain, and stiffness was equal. The reoperation rate was significantly higher for MIS due to a screw removal rate of 34%. Conclusion: MIS is an interesting concept, but it enjoys no advantages over open surgery, at least when carried out with current methods. Calls for open-trained surgeons to switch to MIS are therefore premature. Both surgical techniques have similar clinical and radiological outcomes, while MIS had a higher screw removal rate. Furthermore, complex cases have to be operated with open surgery.
Optimal Treatment and Management of Proximal Fifth Metatarsal Fractures
Authors: Heijboer Reinout , Breuking Sofie , Hagemeijer Noortje , Guss Daniel , DiGiovanni Christopher 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: Proximal fifth metatarsal fractures (PFMF) are among the most common fractures of the foot, and may be subdivided into tuberosity avulsion fracture, Jones fracture, and proximal diaphyseal fracture. However, for Jones fractures and proximal diaphyseal fractures optimal treatment is still debated in literature. The Torg criteria are used in deciding to treat surgically or conservative, whereby Torg type I and II indicates conservative treatment, and type III indicates surgical treatment. Yet failure rates of both management options vary and derive from small study groups. The aim of this study was to compare failure rates after surgical- and conservative treatment of Jones fractures and proximal diaphyseal fractures, to evaluate the incidence of treatment failure, and to assess factors associated with healing difficulties of PFMF. Methods: A total of 1,133 adult patients that were diagnosed and treated for PFMF between 2005 and 2015 in a tertiary care foot and ankle referral center were included. Retrospective chart review recorded patient demographics, suspected risk factors for impaired healing of PFMF (rheumatoid arthritis, diabetes mellitus, osteoporosis, nutritional and hormonal disorders, foot deformities, (neuropathic) arthropathy of the foot and/or ankle and peripheral neuropathy of the lower extremity), and treatment indication. Multivariable logistic regression analysis was used to determine factors associated with healing difficulties. Propensity score matching was used to minimize selection bias between treatments in Jones fractures and proximal diaphyseal fractures. Results: In total, 489(43.2%) patients were diagnosed with a tuberosity avulsion fracture, 391(34.5%) patients with a Jones fracture and 253(22.3%) patients with a proximal diaphyseal fracture. In the tuberosity fracture group, a nonunion was found in 5.3%(25/473) of the patients treated conservatively and in 0%(0/16) treated operatively. For the Jones fractures and proximal diaphyseal fractures the non-union rate for conservative treatment was 10%(35/337) and 5.9%(14/238), and for surgical treatment 11%(6/54) and 0%(0/15), respectively. No independent risk factors for complicating the healing process of PFMF were identified. With propensity score matching, 37 patients treated operatively were matched to 37 patients undergoing conservative treatment. The risk for a nonunion was lower in the operative group compared to the conservative treatment group (relative risk 0.8, P=0.006). Conclusion: In this propensity-matched cohort, surgical treatment for Jones fractures and proximal diaphyseal fractures were associated with better fracture healing compared to conservative treatment. In addition, no factors were found to be associated with healing difficulties of proximal fifth metatarsal fractures.
Radiographic Analysis of Total Ankle Replacements
Authors: Le Vu (Brian) , Escudero Mario , Penner Murray , Wing Kevin , Younger Alastair , Veljkovic Andrea , Barahona Maximiliano 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: Total ankle replacements (TAR) are an increasingly common treatment for end-stage ankle arthritis but evidence on optimal alignment is not as well-established as in the hip and knee arthroplasty literature. Many believe that restoration of coronal and sagittal alignment is critical, while others suggest malalignment within a certain range has no impact on failure (Braito et al. 2015). There is controversy on the ideal TAR component positioning to minimize failure and requiring revision surgery. In this study we examine 9 radiographic measures of TARs, 6 of which have previously been described for TARs, 1 commonly used on preoperative ankles, and 2 novel measures on a database of 146 TARs to identify predictors of TAR re-operation. Methods: A retrospective review was performed on the Canadian Orthopaedic Foot and Ankle Society (COFAS) database of ankle arthritis, selecting for all total ankle replacements done at a single institution by one of three fellowship-trained foot and ankle surgeons between September 2004 and June 2015. Those with complete series of anteroposterior and lateral standing ankle radiographs both preoperative and postoperative, and minimum of 1 year of follow-up were included. Measurements were performed on the postoperative radiographs and included: coronal and sagittal distal tibial component angles, talar center migration, talar tilt angle, lateral talar station, tibial axis-talus ratio, talar component gamma angle, anterior and posterior tibial component overhang and underhang. Standard descriptive statistical methods were used to analyze the data. Results: Of a total of 296 TARs, 146 were included and 14 TARs failed (9.6%), defined as requiring re-operation, 8 of which were metal-component revisions (5%). The TARs were stratified into those with measurements within previously published normal values and those that fall outside that range. Time to failure ranged from 1.4 to 9.6 years. Our preliminary data analysis showed that TARs with coronal distal tibial component angles between 87-93 degrees demonstrated an odds ratio of 0.11 for re-operation compared with those beyond that range, p=0.003. TARs with talar tilt angles of 0 degrees demonstrated an odds ratio of 0.24 for re-operation compared with those whose talar tilt was not zero, p=0.02. Conclusion: Post-operative coronal alignment of TARs, namely distal tibial component angle and talar tilt, appear to be associated with TAR-reoperation. Specifically, if the measurements are within previously described normal limits, the odds ratio for re-operation is low and statistically significant. Further data analysis is underway and may demonstrate more parameters of significance in predicting TAR failure.
Driving After Total Ankle Arthroplasty
Authors: McDonald Elizabeth , Pedowitz David , Shakked Rachel , Daniel Joseph , Nicholson Kristen , Winters Brian , Raikin Steven 
Published: September 2018

Category: Ankle Introduction/Purpose: With the increase in number of total ankle arthroplasty surgery, physician guidelines on when to begin to consider patients’ return to driving is valuable. The ability to accurately and efficiently determine when a patient can return to driving is important both from a patient safety and a medicolegal perspective. The purpose of the study was to determine when patients’ brake reaction time (BRT) returns to a safe value after right total ankle arthroplasty. We also aimed to identify predictive factors that may identify those patients who may not be safe to drive. Methods: After institutional review board approval, fifty-five patients undergoing right total ankle arthroplasty were recruited prospectively. Patient demographics include an age range of 43 to 83 years (median 63 years), of which 31 were male (56%) and 24 were female (44%). BRT was tested at six weeks and repeated weekly until patients achieved a passing BRT. A control group of twenty healthy patients was used to establish a passing BRT of 0.850 seconds. Patients were given a validated, novel driver readiness survey to complete of which a 10/15 point or higher score was considered passing. Results: At 6 weeks, 50 patients (91%) achieved a passing BRT and were considered safe to drive, and the passing group average BRT was 0.662 seconds. At 9 weeks, 52 patients (100%) of those who completed the study achieved a passing BRT. Patients that failed at 6 weeks had statistically greater visual analog scale (VAS) for pain (p=0.037) and significantly diminished ankle plantarflexion (p=0.029). There is a significant (p<0.001) and large (r=-0.455) correlation between BRT and the validated driver readiness survey scores. 5/5 (100%) patients that failed the BRT also failed the driver readiness survey (p=0.049). Interestingly, males were more likely to think they were ready to drive based on their driver readiness survey but were no more likely to pass the BRT than females (p=0.002). Conclusion: Over 90% of patients may be eligible to return to driving as early as 6 weeks post-operatively. Indications that a patient is not safe to return to driving at 6 weeks are higher VAS, limited plantarflexion, and a failed driver readiness survey. Although many factors determine whether a patient may safely return to driving, patients may be informed that BRT normalizes 9 weeks after right total ankle arthroplasty.
A Prospective Evaluation of Opioid Consumption Following Orthopaedic Foot and Ankle Surgery
Authors: Saini Sundeep , McDonald Elizabeth , Nicholson Kristen , Rogero Ryan , Chapter Megan , Winters Brian , Pedowitz David , Raikin Steven , Daniel Joseph 
Published: September 2018

Category: Other Introduction/Purpose: The purpose of our study was to assess opioid consumption patterns following outpatient orthopaedic foot and ankle procedures in order to develop a pragmatic approach to narcotic drug prescription. Methods: Patients undergoing outpatient orthopaedic foot and ankle procedures who met inclusion criteria had the following prospective information collected: patient demographics, preoperative health history and Visual Analog Scale (VAS), anesthesia type, procedural details, and opioid prescription and consumption details. Utilization rates were compared using the Man-Whitney Test or the Kruskall-Wallis analysis of variance test with post-hoc Dunn’s multiple comparison test. Results: A total of 1,009 of 1,027 patients were included in this study (mean age: 49 years). Overall, patients consumed a median of 20 pills whereas the median number of pills prescribed was 40. This resulted in a utilization rate of 51% and nearly 21,196 pills left unused. Patients who received forefoot surgery used 6 pills less than those receiving hindfoot/ankle surgery (p=0.002). Patients between the ages of 60-79 consumed significantly less than those between 18-59 years old (p<0.012). Patients with preoperative VAS score =77 (p=0.002) or self-reported anxiety (p=0.070) a had an increase in opioid consumption compared to those who did not. Conclusion: Our study demonstrates that patients who undergo orthopaedic foot and ankle procedures are overprescribed narcotic medication by nearly twice the amount that is actually consumed. This leads to a significant surplus of narcotics available for potential diversion. We recommend that surgeons judiciously administer opioid prescriptions based on their patients’ consumption patterns and anatomic location of surgery.
Conventional Ultra-high Molecular Weight Polyethylene versus Highly Cross-linked Polyethylene from Semi-constrained, Fixed-bearing Total Ankle Arthroplasty Systems
Authors: Schipper Oliver , Haddad Steven , Fullam Spencer , Pourzal Robin , Wimmer Markus 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: The aim of this study was to compare the polyethylene wear rate, particle size, and particle shape of primary semi-constrained, fixed-bearing, bone-sparing total ankle arthroplasty using conventional ultra-high molecular weight polyethylene (CPE) versus highly cross-linked polyethylene (HXLPE) by applying a level walking input using a joint simulator. Methods: Two fixed-bearing total ankle replacement systems with different types of polyethylene liners were tested: 1.) CPE sterilized in ethylene oxide, and 2.) HXLPE sterilized with gas plasma after electron beam irradiation. Three implants for each design underwent wear testing using gravimetric analysis over 5 million simulated walking cycles. A fourth implant was used as a load soak control. Equivalent circle diameter (ECD) and equivalent shape ratio (ESR) were computed to determine particle size and particle shape, respectively. Results: The mean wear rate from 1.5-5 million cycles (MC) was 2.0±0.3mg/MC for HXLPE and 16.7±1.3mg/MC for CPE (P < 0.001). The total number of particles per cycle generated for HXLPE and CPE were 0.17x106 particles/cycle and 0.53x106 particles/cycle, respectively (P < 0.001). The mean ECD of HXLPE particles (0.22 ±0.11μm) was significantly smaller than the mean ECD of CPE particles (0.32±0.14μm) (P<0.001). HXLPE particles were significantly more round than CPE particles (P<0.001). Conclusion: HXLPE liners had a significantly lower wear rate and produced significantly fewer and rounder particles than CPE liners. The results of this study suggest that HXLPE has more favorable wear characteristics for total ankle arthroplasty.
Comparison Between Weightbearing and Non-weightbearing Measurements for Evaluation of Tibiofibular Syndesmotic Injuries
Authors: Shakoor Delaram , Osgood Greg , Orapin Jakrapong , Qahnavieh Iman Khodarahmi , Thawait Gaurav , Ficke James , Schon Lew , Demehri Shadpour 
Published: September 2018

Category: Ankle Introduction/Purpose: The distal tibiofibular syndesmosis maintains the integrity of ankle mortise during weight bearing. Syndesmotic injuries are common and even slight malreduction are associated with long-term development of tibiotalar osteoarthritis. Radiographic as well as CT based measurements are being employed to detect syndesmotic injuries, however, subtle injuries are commonly overlooked. In the present study we intend to investigate whether measurements obtained from weight-bearing (WB) cone-beam computed tomography (CBCT) images are different from measurements obtained from NWB images in subjects with clinical suspicion of syndesmotic injury and “inconclusive” plain radiograph findings Methods: In this prospective study, following IRB approval, the injured ankles of 20 patients (10 men and 10 women; mean age: 46.1 years; range: 19-82) with persistent ankle pain following ankle trauma and clinical suspicion of syndesmotic injury underwent simultaneous WB and NWB CBCT scans. Following a detailed literature review, a set of 21 syndesmotic related measurements in all WB and NWB images, assessing fibular displacement in medio-lateral, cranio-caudal, antero-posterior planes were performed by three independent readers. Inter-observer and intra-observer reliabilities were evaluated by intra-class correlation (ICC) and Pearson/Spearman’s correlation, respectively. We used Paired student t-tests or Wilcoxon-rank-sum tests to compare the measurements from the two scans. Bootstrapping with 10000 samples was used to extract P-values for 99% uncertainty levels Results: we observed almost perfect intra-observer reliability for WB and NWB measurements (r = 0.8-0.98). Inter-observer reliability was significant for all measurement with overall fair to perfect agreement (ICC=0.36-0.97). Mean values of medio-lateral measurements including posterior tibiofibular distance, tibiofibular clear space and diastasis were significantly higher in WB images compared to NWB CBCT images (P-value< 0.05). Mean values of angular measurement, bi-malleolar angle, lateral clear space and fibular length were significantly lower in WB images (P-value<0.05). The difference between other measurements were not statistically significant. Conclusion: Of syndesmotic measurements available in the literature, certain measurements are different between WB and NWB CBCT examinations with moderate to perfect intra- and inter-observer reliability in post-traumatic ankles with clinical suspicion of syndesmotic injury and inconclusive plain radiographs. These measurements should be further investigated for detection of biomechanical instability associated with syndesmotic injury compared to those obtained from asymptomatic ankles
Ankle and Hindfoot Kinematics of a Next Generation Total Ankle Replacement During Simulated Gait
Authors: Sturnick Daniel , Saito Guilherme , Ellis Scott , Demetracopoulos Constantine 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) has developed as a viable treatment option for end-stage ankle arthritis. The primary benefit proposed with TAA is that allows for maintained motion of the ankle and hindfoot joint compared to the alternative option of an ankle arthrodesis. Consequently, recent TAA systems have focused on designs that advance kinematic function. Cadaveric gait simulation is a valuable tool for investigating the direct effects of surgical procedures and devices on foot and ankle biomechanics. The objective of this study was to assess whether a next generation TAA system permits normal ankle and hindfoot kinematics using cadaveric gait simulation. Methods: Ten mid-tibia cadaveric specimens were secured to a static mounting fixture relative a six-degree of freedom robotic platform to simulate gait in native-intact and TAA conditions. A force plate was moved relative to the stationary specimen through an inverse tibial kinematic path calculated from in vivo data while extrinsic tendons were actuated using physiologic loads (Figure 1A). Ankle and hindfoot kinematics were measured from reflective markers attached to bones via surgical pins. TAA was performed using a next generation, fixed bearing total ankle system by a fellowship trained foot and ankle surgeon using manufacturer described protocol (Cadence Total Ankle, Integra LifeSciences). Ankle and hindfoot joint kinematics were directly measured using the same kinematic inputs and muscle force as the intact condition. Non-parametric, bias-corrected bootstrapping was used to calculate 95% confidence intervals to compare motion between intact and total ankle replacement conditions. Results: Analyses revealed that no significant difference in average ankle or hindfoot joint kinematics were found between intact and TAA conditions (Figure 1B). This result was consistent in each the ankle, subtalar, and talonavicular joints, and in each plane of motion. Conclusion: This study found that normal kinematics were permitted on average by a next generation, fixed bearing TAA. This finding may indicate that improved functional outcomes following could be expected. However, increased variability and some characteristic differences in the paths of motion throughout stance were observed qualitatively. This report represents an initial analysis of preliminary data, future work will include further analyses and investigation on the influence of factors such as component position and alignment on outcomes. That said, the findings of this study are encouraging and may represent improved kinematic performance in new TAA designs.