bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sensory Mapping in Patients Following Excision of a Morton’s Neuroma
Authors: Jan Maryam , Ramaskandhan Jayasree Ramas , Torres Paulo 
Published: September 2017

Category: Lesser Toes, Morton’s neuroma Introduction/Purpose: Background: Morton’s neuromata are a common cause of forefoot pain. Surgical excision of the neuroma is expected to result in loss of sensation, however in the author’s experience post-operative sensation can be incongruent with the expected cutaneous innervation of the excised nerve. There is a lack of literature regarding this observed discrepancy. The purpose of this study was to carry out sensory mapping in post excision patients. Methods: Methods: Data was collated from the consecutive case series of a single surgeon from 2013-2015 resulting in a total of 19 respondents (23 excisions). All patients were a minimum of 7 months post-excision (average=23 months). Each toe was divided into 13 anatomical segments (total 65). Sensation was assessed using a 10 g monofilament and results were recorded on a sensory map. Results: 19 excisions were done from the 3 rd intermetatarsal space (group A) and 4 from the 2nd intermetatarsal space (group B). The range of patients from group A affected by complete sensory loss within any individual segment varied from 5.3%-47.4%. In the lesser toes (2, 3, 4 and 5), at least 10% of patients described decreased or absent sensation in =7/13 segments in each of all the lesser toes. Over 36.9% of patients reported decreased or absent sensation involving =7/13 segments in each the 3 rd and 4th toes. The percentage of patients who reported unaltered sensation ranged from 21.1%-100% across all 65 segments. Group B followed a similar pattern but had a much smaller cohort of patients. Conclusion: The results of the sensory mapping indicate an unexpected pattern of loss and preservation of sensation when considering the perceived knowledge of the cutaneous innervation of the forefoot. Further research is required to evaluate this intriguing pattern of innervation. A greater understanding would be useful in better informing our patients during the consent process.
Is osteoporosis a risk factor for ankle fracture?
Authors: Jeon Ji Young 
Published: September 2017

Category: Ankle, Trauma Introduction/Purpose: It is well known that fracture of the ankle is different from the typical osteoporotic fracture. Nevertheless, there remains controversy over osteoporotic feature of the ankle. Therefore, we investigated the possibility of the existence of a relationship between axial bone mineral density (BMD) in patients with ankle fracture with that of the normal population under control of other confounding factors such as body mass index (BMI). Methods: This study retrospectively reviewed medical records of patients who were treated in our institution from 2005 to 2015. A comparative analysis was carried out between 115 patients with ankle fracture and 72 patients admitted with other orthopedic reasons (control group). Sex, age, energy level of trauma, and BMI were analyzed as variables affecting axial BMD. Results: Patients in ankle fracture group were significantly younger as compared to control group (p=0.041). BMI of ankle fracture group was higher. The other variables showed no differences between the two groups. The energy level of trauma in ankle fracture group was related to only BMI (p=0.01). Only lumbar BMD was correlated with BMI in ankle fracture group (p=0.003). Conclusion: Axial BMD of ankle fracture patients showed no difference from that of normal population. The occurrence of ankle fracture is affected by only BMI rather than axial BMD. Moreover, it appears that axial BMD is not always correlated with BMI in non-osteoporotic population.
Association of a Modified Frailty Index with Postoperative Outcomes after Ankle Fractures in Patients Aged 50 Years and Older
Authors: Kadakia Rishin , Bariteau Jason , Vu Catphuong , Pao Andrew , Tenenbaum Shay 
Published: September 2017

Category: Ankle, Trauma Introduction/Purpose: Frailty, a multifaceted syndrome resulting from a decrease in physiologic reserves, has been previously shown to play a significant role in elderly morbidity and mortality. The literature on frailty within orthopaedic surgery is limited currently. No study to date has assessed frailty as a predictor of postoperative outcomes in elderly patients with ankle fractures. We hypothesized that increasing frailty would be associated with increased 30-day reoperation rates and increased postoperative complications. Methods: The National Surgical Quality Improvement Project (NSQIP) was queried using the appropriate CPT codes to identify inpatients from 2005-2014 who were aged 50 years and older that sustained an ankle fracture and underwent operative fixation. Frailty was assessed using a modified frailty index (MFI), abbreviated with 11 variables from the Canadian Study of Health and Aging Frailty Index. The primary outcome was 30-day reoperation rate and secondary outcomes were postoperative surgical and medical complications, readmission rates, and length of stay. Bivariate and multivariate analysis was used to determine association between outcomes and MFI. Results: 6,749 patients were identified, and the mean age of these patients was 64.4 years. Patients with increased MFI scores had significantly higher rates of postoperative complications. In addition, increased MFI scores was also associated with increased 30 day readmissions and reoperations. Multivariate analysis also demonstrated that MFI was a stronger predictor of 30 day reoperation rates (odds ratio of 17.7, P < 0.001) than age, wound class, and ASA class. Conclusion: Frailty has the potential to be an important predictive variable of postoperative outcomes in patients aged 50 years and older who sustain ankle fractures. The modified frailty index can be a valuable preoperative risk assessment tool for the orthopaedic surgeon. Further study is necessary to examine the effect of the MFI in a larger prospective setting.
The Effect of Ankle Arthrodesis on the Biomechanical Function of the Foot
Authors: Kozanek Michal , Brodsky James , Kane Justin 
Published: September 2017

Category: Ankle, Ankle Arthritis, Basic Sciences/Biologics, Hindfoot Introduction/Purpose: Several studies on the effect on gait of total ankle arthroplasty (TAA) have demonstrated significant functional improvement post-operatively, compared to the patients’ preoperative function. While there are many post-operative studies showing abnormalities of gait in patients who have had ankle arthrodesis, there are very limited published data in ankle fusion which compare post-operative gait to the patients’ own preoperative function. Moreover, there are no published correlation of those gait changes with patient reported outcomes. Methods: Twenty-six consecutive ankle arthrodesis patients were prospectively studied, with pre- and post-operative three- dimensional gait analysis. Kinematic data were collected at 100 Hz with a twelve-camera digital Vicon motion capture system, and two OR6-5 AMTI force plates. Patients walked barefoot at a self-selected speed over a 10-meter walkway. A minimum 20 gait cycles were used for averaging and statistical analysis for temporal-spatial and kinematic parameters and a minimum of five force plate readings for kinetic parameters. Gait parameters were collected for both operated and unaffected limbs (i.e. control). Demographic data were compiled. Prospectively collected patient-reported outcomes included SF-36, VAS, AOFAS scores, which were repeated annually postoperatively. Results: Mean age was 56 (19 – 80) years, BMI 29.7 (18.6 - 45.6), and follow-up 21.9 (12 - 69) months. There were multiple objective parameters of gait which showed statistically significant functional improvements compared to preoperative performance. Temporal-spatial: Improvements were detected in walking speed, step length and cadence; single and double limb support time. Kinematic parameters: Increase in maximum plantarflexion, decrease in maximum dorsiflexion, but total sagittal range of motion was not diminished, and slightly increased (mean 1.8 degrees). The preservation of total sagittal motion after arthrodesis suggested either precise postoperative compensation by the hindfoot, or that most of the preoperative motion was already occurring in the surrounding hindfoot joints. Kinetic parameters: Improvement in ankle moment and hip power were detected. Patient reported outcomes (table) Conclusion: Ankle arthrodesis improves gait in end-stage arthritis, as demonstrated by statistically significant improvements in multiple, objective parameters. Moreover, the increase in sagittal plane motion of the hindfoot, presumed in the literature to be compensatory to the arthrodesis, was shown to be present pre-operatively, as well, suggesting it is also an effect of tibiotalar stiffness due to end-stage arthritis. Improvements in gait corresponded to clinical improvements as well, as demonstrated by improvements in patient reported outcomes in this population. Biomechanical improvements corresponded to clinical outcomes.
Functional Results of Open Reduction and Internal Fixation with Primary Arthrodesis for Injuries to the Tarsometatarsal Joint Complex
Authors: Lannon Sean , Clare Michael 
Published: September 2017

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Controversy remains as to the optimal treatment of injuries to the tarsometatarsal (Lisfranc) joint complex. Recent studies have described open reduction internal fixation (ORIF) with primary arthrodesis as a viable treatment option but there is limited orthopaedic literature as to the functional results of primary arthrodesis for these injuries. The senior author began treating these injuries with primary arthrodesis in 2005. We present the functional results of a consecutive series of patients with injuries to the TMT joint complex treated by ORIF with primary arthrodesis. Methods: Sixty-eight consecutive patients underwent ORIF with primary arthrodesis from 2006 to 2015. Seventeen patients were unable to be evaluated or contacted and were therefore lost to follow up, leaving 51 patients available for follow-up evaluation. Clinical follow up and/or telephone interviews was conducted. AOFAS Midfoot scores and Foot and Ankle Ability Measure (FAAM) were collected as a measure of functional outcome at final follow up. Results: Sixty-seven of 68 patients (98.5%) went on to radiographic union following the index procedure. Among patients with a low energy mechanism (32 patients), AOFAS and FAAM were 88.7 and 94.0; among those with a high- energy mechanism (19 patients), AOFAS and FAAM were 86.9 and 89. Outcome scores were higher in the low energy group: AOFAS by 2.1(p=0.667); and FAAM by 5.0 (p=0.021). Injury to the lateral midfoot necessitating fixation was less likely in the low energy group compared to the high-energy group (7.5% versus 37.0%; p=0.0032). Eighteen of the 51 patients participated in professional, collegiate or recreational sports preoperatively. All 18 were able to return to their previous sport, with a mean FAAM sports sub scale score of 93. Conclusion: ORIF with primary arthrodesis remains a viable treatment for injuries to the tarsometatarsal (Lisfranc) joint complex, with functional results in the good to excellent range at midterm follow up. Patients with low energy mechanisms demonstrated higher functional scores compared to patients with high energy mechanisms, but outcomes remained good to excellent in both groups. Of those who participated in athletics prior to injury, all were able to return to their previous sport.
Radiographic Measurements Associated with the Natural Progression of the Hallux Valgus Deformity during at Least Two Years of Follow-up
Authors: Lee Kyoung Min , Lee Seung Yeol , Ahmed Sonya , Cho Byung Chae , Park Moon Seok , Sung Ki Hyuk , Koo Seungbum , Kim Sung Jin , Choi Hyun 
Published: September 2017

Category: Bunion Introduction/Purpose: There have been few longitudinal studies regarding hallux valgus deformity. This retrospective study aimed to investigate the radiographic measurements associated with the progression of hallux valgus deformity during at least two years of follow-up. Methods: Seventy adult patients (mean age, 58.0 years; standard deviation [SD], 12.3 years; 13 males and 57 females) with hallux valgus who were followed-up for at least two years and underwent weight-bearing foot radiography were included. Radiographic measurements included the hallux valgus angle (HVA), hallux interphalangeal angle, intermetatarsal angle (IMA), metatarsus adductus angle, distal metatarsal articular angle (DMAA), tibial sesamoid position, anteroposterior (AP) talo-first metatarsal angle, and lateral talo-first metatarsal angle. Progression of hallux valgus deformity was defined as an increase of 5 degrees or more in the HVA during follow-up. Patients were divided into progressive and non-progressive groups. Binary logistic regression analysis was performed to identify factors that significantly affect the progression of hallux valgus deformity. The correlation between change in HVA and changes in other radiographic indices during follow-up was analyzed. Results: Eighteen out of 70 patients showed progression of 5 degrees or more in the HVA during the mean follow-up of 47.0 months (SD, 19.8 months). The DMAA (p=0.027) and AP talo-first metatarsal angle (p=0.034) at initial presentation were found to be significant factors affecting the progression of hallux valgus deformity. Change in the HVA during follow-up was significantly correlated with changes in the IMA (r=0.423; p=0.001) and DMAA (r=0.541; p<0.001). Conclusion: Special attention needs to be given to patients with pes planovalgus and increased DMAA during follow-up. Change in HVA was significantly correlated with changes in IMA and DMAA. Therefore, progression of hallux valgus deformity is considered to be closely related to the progressive instability of the first tarsometatarsal joint.
Comparison of Clinical Outcomes in Patients with Generalized Ligamentous Laxity and without Generalized Laxity in the Arthroscopic Modified Broström Operation for Chronic Lateral Ankle Instability
Authors: Lee YoungKoo , Yoo Jungwoo , Yun Keon Hee , Park Ji Yong 
Published: September 2017

Category: Sports Introduction/Purpose: The arthroscopic modified Broström operation (MBO) has been developed and frequently used to treat chronic lateral ankle instability (CLAI). Clinical outcome of arthroscopic MBO was reported as good or excellent. But there were no report about comparison of clinical outcomes between patients with generalized ligamentous laxity (laxity) and without generalized ligamentous laxity (no laxity). The purpose of this study is to compare the clinical outcomes of the group with generalized ligamentous laxity and without generalized ligamentous laxity in chronic lateral ankle instability. Methods: From January 2013 to November 2015, Arthroscopic MBO was performed in 99 patients for CLAI. We retrospectively analyzed 99 consecutive patients were included in terms of inclusion criteria. All patients had giving way, persistent pain and an inability to resume one’s preinjury activity level for more than 6 months. Patients were divided into 2 groups: laxity group (24 ankles) and no laxity group (75 ankles). Evaluation was performed preoperatively and at a final follow-up a minimum of 12 months postoperatively using the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot ankle score, pain Visual Analogue Scale (VAS)(0~100), and talar tilt angle. Results: In terms of radiological outcomes, the preoperatively talar tilt angle was greater in patients in laxity group than in no laxity group (p < .001). The last follow-up talar tilt angle was the same between in patients in laxity group and in no laxity group (p=0.413). But preoperative-last follow up difference was found between two groups (p=0.03). The variation from preoperative to last follow up talar tilt angle showed significant greater value in laxity group (-6.9 ± 5.2) than in no laxity group (-4.2 ± 4.2)(p=0.03). In terms of clinical outcome, last follow up AOFAS and VAS in all groups were improved than preoperative scores (27.5 ± 23.7, 24.1 ± 18.4, respectively). But preoperative-last follow up differences were not found between two groups (P=0.52). Conclusion: In terms of radiologic outcomes, there was difference outcome variation between two groups, in terms of clinical outcomes, there were no difference outcome variations between two groups. All groups achieved successful clinical and radiological last follow up outcomes even though there was difference outcome variation in talar tilt. Arthroscopic MBO should be considered as a reasonable method in patients who have chronic lateral ankle instability regardless of generalized ligamentous laxity.
The Road to Recovery for Bunion Surgery
Authors: MacDonald Ashlee , Houck Jeff , Baumhauer Judith 
Published: September 2017

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Patient reported outcomes (PROs) can provide information on individual patient’s progress throughout a treatment course and additionally, with common surgeries, powerful numbers can be generated to provide data analytic curves to provide a recovery road map for patients and surgeons. Those who deviate negatively from the predicted path may have a complication and early intervention can be initiated. Those who deviate positively have the potential to need less physical therapy, early return to sports or work. Hallux valgus (HV) is a common condition of the foot with 4.4 million patients seeking care yearly and surgery is equally common. The purpose of this study was to determine if PROMIS PROs can be used to construct data analytic curves for HV surgery. Methods: PROMIS scores were prospectively obtained from patients evaluated in a specialty foot and ankle clinic between February 2015 and November 2016. Using ICD-9/10 and CPT codes, a total of 65 patients with hallux valgus who underwent a bunionectomy by a single surgeon were identified. Those with less than two-month follow-up, multiple procedures during the follow-up period, as well as incomplete PROMIS assessment scores at any time point were excluded, resulting in 34 patients. Using a previously described method, bunionectomy-specific pre-operative cut-off values to achieve and fail to achieve minimally clinically important differences (MCID) in PF with 95% specificity and 95% sensitivity were determined. We then stratified patients based on their pre-operative PF T-scores as above or below the MCID cut-off. PF was evaluated using two-way ANOVA at 4 follow-up time periods and pre-operative cut-offs (above or below MCID cut-off) as factors to establish data analytic curves based on pre- operative scores. Results: Bunionectomy-specific PF cut-off for 95% specificity of exceeding MCID was 39.6 and 50.2 for 95% sensitivity for failing to achieve MCID. Patients were stratified based on PF T-scores above (n = 13) or below (n = 21) the MCID cut-off of 50.2. Data analytic curves were generated for above the PF cut off and below PF cut off. (Figure 1) Pairwise comparison demonstrated that those starting with a T-score above the bunionectomy specific cut-off had significantly better PF pre-operatively (p < 0.01) and again at 6-12 week follow-up (p = 0.02). There were no differences at 1 week or 3-4 week follow-up time points. Conclusion: This data confirms pre-operative PROMIS PF scores are significant post-operative predictors. While patients with pre-operative scores below the bunionectomy-specific cut-off met MCID changes in PF, their T-scores were significantly lower at 6-12wk follow-up than patients with high pre-operative T-scores. Although longer term follow-up is desirable, this short term follow up suggests a significant clinical impact of using PROMIS scores for pre-surgical decisions as well as provides a road map for recovery for patients and surgeons.
Percutaneous proximal oblique osteotomy fixed (ludloff) to the surgical treatment of severe hallux valgus
Authors: Marijuschkin Igor 
Published: September 2017

Category: Bunion Introduction/Purpose: to present the clinical and radiographic results of surgical correction of severe hallux valgus using percutaneous proximal oblique osteotomy (Ludloff) fixed with screw. Methods: we evaluated prospectively 15 feet in 14 patients with severe hallux valgus considering the hallux valgus angle (HVA) greater than 30 degrees and the intermetatarsal angle (IMA) greater than 17 degrees. The average follow-up was 18 months (12 to 36). Were submitted to percutaneous proximal oblique osteotomy, put a K wire proximal to dislocate the first metatarsal head and fixed the osteotomy with a screw (picture). After we associated this technique with percutaneous Akin procedure, exostectomy and distal soft tissue release. Patients were evaluated by the AOFAS score, followed by radiographic evaluation and by the degree of subjective satisfaction of Johnson. Results: we present as a result 15 feet operated on 14 patients being 93% female with an average age of 66.9 years (29 a 78), HVA of 39.7° (30 to 51), IMA of 18.6° (17 to 22) and 43 points of AOFAS, while postoperative the HVA was 18° (8 to 28), IMA 13.8° (7 to 17) and average AOFAS 86.6 points. We have complications in 33% of cases, we had 1 recurrence of deformity in less than 1 year, 1 transference metatarsalgia, 2 withdrawals of synthesis and 1 complaint of dorsal callosity due to probable elevation of 1 metatarsal. No major complications were noted. We present a patient unhappy with the result (recurrence case). Conclusion: the surgical technique described proved effective in the treatment of severe valgus halux with improvement of the AOFAS score, high level of patient satisfaction and good radiographic corrections.