bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Outcomes of Severe Turf Toe Injuries in High-Level Football Players
Authors: Waldrop Norman , Smith Kenneth 
Published: September 2017

Category: Sports Introduction/Purpose: Turf toe is a term used to describe a hyperextension injury to the first metatarsophalangeal joint. Although the vast majority of turf toe injuries can be treated successfully without surgical intervention, there are instances where surgery is required to allow the athlete to return to play. Surgical turf toe repair restores the continuity of the plantar plate structures, re-establishes stability, and simultaneously addresses any sesamoid pathology or cartilage lesions. Although there is extensive literature on turf toe injuries and its nonoperative management, there are currently no reports on surgical outcomes in athletes larger than three to four patients. Methods: After obtaining Institutional Review Board approval, we attained all cases of turf toe repair according to the ICD-10 procedural code. The inclusion criteria included: age greater than 16, turf toe injury requiring operative management and at least a varsity level high school football player. Our patient population consisted of thirteen patients. Their charts were reviewed for age, BMI, level of competition, injury mechanism (if known), football position, setting of injury (practice or game) and playing surface. In addition, we recorded the specifics of the surgical procedure, a listing of all injured structures, the surgical implants used and the great toe range of motion at final followup visit. In addition, a followup survey was administered to all patients. Results: The average patient was 19.5 years old with an average followup time of 21.4 months. Our group consisted of six linemen and seven skill position players. There was one semiprofessional player, ten collegiate players and two high school players. Eight of the 13 patients had complete rupture of both fibular and tibial phalangeal sesamoid ligaments while five patients had a partial injury. Seven of the patients had a suture only primary repair while in six patients suture anchors were utilized. The average playing time missed was 16.4 weeks. No patient had to stop playing football or change positions due to the injury or surgery. At final followup, the average patient had a VAS pain score of 0.21. Conclusion: Severe turf toe injuries are often debilitating and may require operative management to restore a pain-free, stable, and functional forefoot. The injuries sustained and procedures performed were variable in our patient population but every player was able to return to play at a high level with the use of a custom orthotic placed inside their cleat. This study represents the largest cohort of operatively treated severe turf toe injuries in the literature and demonstrates that good clinical outcomes can be expected with surgical repair.
Does Hardware Removal Improve Function Following Ankle Open Reduction and Internal Fixation?
Authors: Williams Benjamin , Chau Michael , McCreary Dylan , Cunningham Brian , Peña Fernando , Swiontkowski Marc 
Published: September 2017

Category: Ankle, Trauma Introduction/Purpose: Orthopaedic hardware removal (HWR) is one of the most common orthopaedic procedures performed, with rates reported between 5% and 16%. Despite the high rates of HWR, there is still no consensus or guideline for removal after osseous healing without infection. Outcome studies for HWR are scarce, particularly in the lower extremity. The purpose of this study is to evaluate the effect of removal of symptomatic ankle hardware using the Short Musculoskeletal Function Assessment (SMFA) dysfunction index as the primary outcome. We hypothesize that HWR after ankle fracture will result in improved functional outcomes. Methods: Utilizing a prospectively collected ankle fracture registry, all patients that underwent HWR between 2013 and 2016 were retrospectively reviewed. Inclusion criteria were skeletal maturity, closed intra-articular ankle fracture, symptomatic ankle hardware and completion of the SMFA questionnaire prior to and 5-months after hardware removal. Exclusion criteria were development of a nonunion, infection or complex regional pain syndrome from initial surgery. The primary outcome was change in SMFA score from baseline. Paired t-test was used to compare baseline and follow-up SMFA scores. A multiple linear regression model evaluated the effects of age, sex, body mass index (BMI), smoking status, number of comorbidities, and Lauge-Hansen fracture classification on outcomes. Results: The study included 43 patients (31 females, 12 males), mean age 49.9 (range, 19 to 83). Mean time from initial surgery to HWR was 37±46 months (range, 2.2 to 209). Follow-up SMFA questionnaires were completed 5.7±0.5 months (range, 5.1 to 7.4) after HWR. The fractures were classified as 23 (53%) supination-external rotation, 6 (14%) pronation-external rotation, 2 (4.7%) pronation-abduction and 1 (2.3%) supination-adduction. Eleven fractures (26%) were classified as pilons. The SMFA dysfunction index improved significantly from baseline to follow-up (3.71±7.4, p=0.002). Significant improvement was seen in the secondary outcomes of SMFA bother index (4.40±8.9, p=0.003) and SMFA daily activities domain (4.12±9.1, p=0.006). Regression analysis revealed a significant improvement in the bother index correlating with female gender (p=0.01) and decreasing number of comorbidities (p=0.03). Conclusion: Our study demonstrates that patients with ankle fractures have a significant improvement in function following the removal of symptomatic ankle hardware. Patients also showed a significant improvement in the bother index and daily activities domain of the SMFA. Further investigation into the specific indications for HWR and the impact of injury and fracture pattern on outcomes is warranted.
Publications Rates for Podium and Poster Presentations from the American Orthopaedic Foot and Ankle Society
Authors: Williams Benjamin , Kunas Grace , Deland Jonathan , Ellis Scott 
Published: September 2017

Category: Other Introduction/Purpose: National orthopaedic meetings are used to disseminate current research. These abstracts are commonly intended to go on to full-text publication in peer-reviewed journals. Several studies have reviewed the abstract to full-text journal publications for orthopaedic society meetings and reported a 34% to 73% publication rate. This has not been studied for the foot and ankle literature. The purpose of this study is to determine the full-text journal publication rates of podium and poster presentations from the American Orthopaedic Foot and Ankle Society (AOFAS) Annual meetings between 2008 and 2012. Methods: All abstracts submitted to and subsequently accepted for podium and poster presentations from the 2008 to 2012 AOFAS annual meetings were compiled from the AOFAS and the published meeting programs. In May 2016, PubMed searches were performed using individual key words in the abstract title with all authors’ names. The results were reviewed for matches to the meeting abstracts with regards to content similarities. Time to full-text publication was recorded. Full-text publication rates for podium and poster presentations were calculated per year. The top journals of publication for podium and poster abstracts were calculated. Continuous data was summarized using mean ± standard deviation and categorical data was summarized using counts and percents. Difference in publication rates between podium and poster presentations was determined by an odds ratio. Results: From 2008 to 2012, 1262 abstracts were submitted to the annual meeting. The overall abstract publication rate was 62.4%: 73.7% for podium abstracts and 55.8% for poster abstracts. Podium presentations were significantly more likely to be published compared to posters (p< 0.0001; odds ratio 2.17, 95% CI, 1.64-2.86). Mean time to publication was 1.53 and 1.37 years for podium and poster presentations, respectively (p=0.124). The three most common journals for published podium abstracts were Foot and Ankle International (FAI) (50.4%), Journal of Bone and Joint Surgery (JBJS) (13.0%) and The American Journal of Sports Medicine (AJSM) (4.3%). For poster abstracts, the three most common journals were: FAI (36.9%), Journal of Foot and Ankle Surgery (9.4%) and Foot and Ankle Specialist (8.5%). Conclusion: Podium abstracts were over two times more likely to be published compared to poster abstracts. The overall full- text publication rate for the AOFAS was one of the higher reported rates compared to other national orthopaedic society meetings. The significance of the high full-text publication rate is unclear; it may reflect the quality of presented material or commitment to publication by the authors. The top journal for podium and poster abstracts was FAI, indicating the presentations’ specialty-focus.
Comparative Study of Open Reduction and Internal Fixation and Primary Subtalar Arthrodesis for Sanders Type IV Intra-articular Calcaneal Fractures
Authors: Woo Seunghun , Chung Hyung Jin , Bae Su-Young , Goh Tae Sik 
Published: September 2017

Category: Trauma Introduction/Purpose: To compare clinical outcome of Sanders type IV intra-articular calcaneal fracture treated with open reduction and internal fixation (ORIF) versus ORIF and primary subtalar arthrodesis (PSTA). Methods: Between March 2003 and November 2013, 22 patients with 22 Sanders type IV intra-articular calcaneal fractures were included in this study. Of these, 11 feet were treated with ORIF (ORIF group), 11 feet were treated with ORIF and PSTA (PSTA group). The mean follow-up periods was 34.6 months (range, 18-72 months). Clinical outcomes were assessed along with the American Orthopaedic Foot and Ankle Society’s Ankle-Hindfoot Scale (AOFAS score), the Visual Analog Scale Pain score (VAS score) at 6-, 12 month, and last follow-up. The patient satisfaction, returning to previous occupation and postoperative complications were also investigated. Results: Complete bone union were achieved in all patients. No statistical difference was found between the results for ORIF compared with PSTA: the mean preoperative Bohler angle were, respectively, -3.2±9.2 and -6.6±12.7 degrees (p=0.475); the mean last follow-up AOFAS scores were 73.8±14.9 and 80.5±4.6 (p=0.795); the mean VAS last follow-up VAS scores were 29.7±20.6 and 23.4±10.0 (p=0.986). Secondary subtalar arthrodesis were conducted in 5 patients (45.5%) of ORIF group due to subtalar osteoarthritis symptom within 2 years, postoperatively. Conclusion: We were unable to demonstrate a significant difference of clinical outcomes between ORIF and PSTA however, the patient satisfaction was higher in the PSTA group. PSTA may be considerable choice for patients who need fast recovery to daily activity and to prevent the need for secondary subtalar arthrodesis.
The Significance of Intraoperative First Metatarsal Traction Test in Hallux Valgus Surgical Decision Making
Authors: Xinyu Li , Yan Alan 
Published: September 2017

Category: Bunion Introduction/Purpose: To investigate the significance of using an intraoperative first metatarsal traction test in hallux valgus correction surgery in decision making of the procedure choice and operation designs. Methods: From Jun 2015 to Jun 2016, correction surgery performed in patients with hallux valgus 40 cases with 68 feet. We used the intra-operative first metatarsal traction test to judge the grade of laxity of the 1st TMT and the factual IMA and thus help to make the decision of the level of osteotomy and or fusion. We adopted distal Chevon osteotomy (11 cases 16.2%) when the congruence of the surface of the 1st MPJ remains more than ½ under tension with the traction test. Proximal Scarf osteotomy (54 cases 79.4%) was used when the congruence was less than ½. While if there was a complete incongruent dislocation, Lapidus procedure (3 cases 4.4%) was carried out. We measured IMA and HVA in the patients preoperative, intraoperative, 3 days after operation and at 6 months’ follow-up. Same measurements were done on the 40 patients from the same time without traction test Results: Retrospective review of the 2 groups showing significant improvement (p<0.001) but more reliable larger correction of IMA angles in the intraoperative traction test group. The patients of the intraoperative traction test group had average higher satisfaction rate with more reliable improvement of symptoms and less postoperative complications. Significant improvement (P<0.001) and postoperative AOFAS score average of 93.2 was recorded in traction test method group vs. a 84.3 in control group. The traction test group largely retained the correction in half year follow up which is significant when comparing to the control Conclusion: The intraoperative traction test of first metatarsal objectively guided the decision making of procedure choice and operation design optimization. The traction test gave a reliable assessment of the laxity of first TMT thus avoiding inadequate correction of Hallux Valgus with improper surgical designs. The test can be potentially used as an objective intraoperative guidance in avoidance of inadequate correction with inappropriate surgical choices and thus maintain the correction in the long term with patient satisfaction
Lost Wages Secondary to Ankle Arthritis in Patients Undergoing Ankle Fusion or Replacement
Authors: Younger Alastair , Wing Kevin , Veljkovic Andrea , Penner Murray , Gagné Oliver 
Published: September 2017

Category: Ankle Arthritis Introduction/Purpose: Wait lists for consultation and surgery for ankle arthritis are often over three years in our Province. While waiting for surgery patients may become unemployed and lose income. Earlier consultation and earlier treatment may allow these patients to return to work. The purpose of this paper is to calculate the lost wages annually and over the remaining working lifetime of a cohort of patients, and use this to extrapolate the lost wages for patients undergoing ankle arthritis surgery in the Province of British Columbia. Methods: Using data from an ankle outcome database, patients under the age of 60 were studied. Employment was recorded at the time of surgery, at 2 years, and an average 6.7 years follow up. Using the MODEMS instrument, patients self classified as (1) working, (2) on leave of absence, (3) unemployed, (4) homemaker, (5) student, (6) Retired (not due to ill health), (7) disabled or retired due to ill health. Items 2,3,7 were considered unemployed and items 1,4,5,6 employed. Using annual rates of ankle arthritis surgery from our Province of 4.6 million people, the cumulative lost income was determined using the statistics Canada website (http://www12.statcan.gc.ca/nhs-enm/2011). Lost wages were calculated from the time of surgery until 75. All figures are quoted in Canadian dollars. Results: 127 of 276 database patients (46%) were under the age of 60 at the time of surgery. The average age was 51 years. 61 (48%) were unemployed. 2 years after surgery the unemployment rate was 42% and remained a similar rate at mean 6.7 years after surgery. There were 140 ankle arthritis operations in 2013 in our Province. Using the database rates the lost wages the working lifetime of these patients is $ 22.8 million. Using prior statistics (FAI 2015) the total surgical cost of ankle arthritis surgery in the Province is $ 1.1 million (1/20th the lost income). The cumulative lost wages per million population per year for ankle arthritis is 4.9 million dollars, and the money spent on surgery is 0.24 million dollars. Conclusion: The lost wages within the ankle arthritis population is of concern with regards to productivity, as well as the mental health and financial stability of these patients and their families. Earlier access to care may maintain the employment status in this patient group. Once patients are out of the work force it is very hard for them to return. The money spent on surgery is 1/20th of the lost wages.
Treatment Outcomes of Buttress Plating for Posterior Pilon Fractures
Authors: Yu Guang-Rong , Zhang Mingzhu 
Published: September 2017

Category: Ankle Introduction/Purpose: The purpose of current study was to retrospectively analyze the clinical outcomes of buttress plate treatment of posterior pilon fractures Methods: Between January 2005 and December 2009, 16 patients with posterior pilon fractures underwent buttress plate fixation. There were 11 males and 5 females and the mean age was 37.6 years (range, 23 to 62 years). Preoperative radiographs, CT scans and three dimensional reconstructions were used to evaluate the fracture patterns. On the basis of the extension of the fracture lines presented on the CT scans, a posterolateral approach or a combination of both posterolateral and posteromedial approaches were used to reduce and fixate the posterior malleolar fragments. Clinical and radiographic examinations were used for postoperative follow-up. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the Visual Analogue Scale (VAS) were used to evaluate the functional outcomes. Results: According to the CT scan images, the posterior pilon fractures were classified into 3 types. 14 patients were available for follow-up. The mean time of follow-up was 37.6 months (range, 16 to 52 months). The mean AOFAS score was 86.4 points (range, 70 to 98 points), and the mean VAS score was 1.4 points (range, 0 to 3 points). One patient was found with ankle joint swelling and long term walking discomfort at 2-year follow-up. Other patients received favorable functional outcomes. No hardware failure occurred. Conclusion: The clinical outcomes of buttress plate treatment of posterior pilon fractures were satisfactory. Buttress plating availed the patients to return to earlier weight-bearing and functional exercises.
Surgical treatment for Müller-Weiss Disease
Authors: Zhang Mingzhu , Yu Guang-Rong 
Published: September 2017

Category: Midfoot/Forefoot Introduction/Purpose: Müller-Weiss disease is an uncommon osteonecrosis of the tarsal navicular of unknown etiology. The surgical treatment is introduced when conservative treatments are failed. Methods: From January 2005 to Septermber 2014, we treated 49 patients suffering from Müller-Weiss disease, using the surgical arthrodesis of the talonavicular joint and naviculocuneiform joint with tricortical autologous iliac crest block fixed by screws and plate. They were 15 males and 34 females with a median age of 52.4 years. According to the Maceira staging system, 6 feet was grade 2, 20 feet were grade 3, 19 feet were grade 4, and 4 feet were grade 5.We reviewed the medical records of the patients and took the radiological preoperative and postoperative evaluation. The preoperative and postoperative clinical functions were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot Scale. To treat Müller-Weiss disease, we introduced a surgical arthrodesis of the talonavicular joint and naviculocuneiform joint with tricortical autologous iliac crest bone block fixed by screws and plate. Results: The median follow up was 26 months. All the feet fused solidly. The median time for complete fusion was 13 weeks. The median AOFAS ankle-hindfoot score improved from 45 points preoperatively to 86 points at last follow-up. But the symptoms free duration took 9 months in average. Conclusion: In conclusion, the results of this series demonstrate the arthrodesis of the TNJ and NCJ with tricortical autologous iliac crest graft is a reasonable way for treatment of Müller -Weiss disease. Based on our experience with the patients, we believe that emphasis of the restoration of the length and alignment of the medial column could achieve a good outcome. The surgeon should consider the increased risk of pain along with its associated morbidity and discuss this with the patient preoperatively when considering arthrodesis.
Kinetics and biomarkers of severe cytokine release syndrome after CD19 chimeric antigen receptor–modified T-cell therapy
Authors: Hay Kevin A. , Hanafi Laïla-Aïcha , Li Daniel , Gust Juliane , Liles W. Conrad , Wurfel Mark M. , López José A. , Chen Junmei , Chung Dominic , Harju-Baker Susanna , Cherian Sindhu , Chen Xueyan , Riddell Stanley R. , Maloney David G. , Turtle Cameron J. 
Published: September 2017

Key Points
Characterization of the kinetics and risk factors for severe CRS after CD19 CAR T cells will facilitate preemptive therapy and management. Severe CRS is characterized by endothelial activation.
Characteristics of tracheostomy phonation valves
Authors: Prigent H. , Orlikowski D. , Blumen M. B. , Leroux K. , Legrand L. , Lejaille M. , Falaize L. , Ruquet M. , Raphael J-C. , Lofaso F. 
Published: September 2017

Phonation valves are commonly used devices that allow the restoration of speech in tracheostomised patients. However, their use should not compromise the physiological benefit of tracheostomy.Six commercialised phonation valves were studied in a dynamic set-up simulating a respiratory frequency of 20 breaths·min−1, a tidal volume of 0.5 L and a peak flow rate of 0.5 L·s−1. Resistance and additional work of breathing (WOB) were calculated. In 10 tracheostomised patients, evaluations using no phonation valve (baseline), and the most and one of the least resistive valves were carried out. Respiratory patterns and gas exchanges were recorded. Inspiratory difficulty was evaluated using the modified Borg scale.Valves displayed a wide array of resistance ranging 1.3–5.9 cmH2O·L−1·s−1. Additional WOB varied with a ratio of 4.4 between the best and the worst valve. While the different clinical conditions did not modify respiratory patterns and gas exchanges, a significant effect on the Borg scale rating was observed using ANOVA andpost hocanalysis of baselineversusworst valve and one of the best valvesversusworst valve.In conclusion, the variety of aerodynamic characteristics of phonation valves should be considered when choosing the device, according to the underlying condition of the patients benefiting from their use.
Allopurinol improves endothelial function in sleep apnoea: a randomised controlled study
Authors: El Solh A. A. , Saliba R. , Bosinski T. , Grant B. J. B. , Berbary E. , Miller N. 
Published: September 2017

Increased oxidative stress in obstructive sleep apnoea is thought to contribute to endothelial dysfunction. The objective of this study was to test the hypothesis that inhibition of xanthine oxidase by allopurinol can improve endothelial function in patients with obstructive sleep apnoea.A randomised double-blind placebo-controlled crossover study was performed on 12 patients with moderate-to-severe obstructive sleep apnoea, comparing 300 mg allopurinol daily for 2 weeks with placebo. Endothelial function was assessed using hyperaemia-induced flow-mediated vasodilation (FMD) at baseline and following treatment. Plasma malondialdehyde levels were compared in order to assess significant changes in oxidative stress.Baseline FMD correlated significantly with the severity of sleep apnoea and the time spent with an arterial oxygen saturation of <90%. Allopurinol caused a significant increase in FMD compared to placebo (10.4±3.2versus7.4±2.8%, respectively). Plasma malondialdehyde levels were significantly reduced with allopurinol treatment (1.5±0.3versus1.2±0.3 μmol·L−1), consistent with reduced oxidative stress.Allopurinol improves endothelial dysfunction in patients with moderate-to-severe obstructive sleep apnoea. These observations suggest that xanthine oxidase contributes significantly to vasodilatory impairment.