bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Inpatient and Outpatient Ankle Fracture Surgery
Authors: Saquib Zohair A. , Stal Drew , Phillips Geoffrey I. 
Published: October 2016

Category: Ankle Introduction/Purpose: One of the emerging trends in contemporary healthcare is the shift in surgical resources to the outpatient setting coupled with reductions in the inpatient length of stay. Through a multi-center retrospective review of surgically treated ankle fractures, we sought to determine whether the selection for outpatient surgery or inpatient admission was dependent upon specific patient demographics, associated medical co-morbidities, or surgeon practice management. Methods: A multi-center retrospective cohort study of 240 surgically treated ankle fractures over a two-year period was performed. Two tertiary care hospitals and their affiliated ambulatory surgery centers were included in the study. Patient selection criteria was based on CPT codes while exclusion criteria included pediatric patient, open trauma, pilon fracture, or history of prior ankle fracture. Patient age, presence of poly-trauma, medical co-morbidities (syncope, hypertension, diabetes, as well as coronary artery, pulmonary, renal or hepatic disease), and ordering of CT-scan were evaluated in the study. Surgeons were divided into three groups according to fellowship training: foot and ankle (Group 1), trauma (Group 2, and general / other (Group 3). There were 2 foot and ankle fellowship trained orthopedists, 5 trauma fellowship trained orthopedists, and 9 generalists whose fellowships included sports, hand, and spine. Results: 142 inpatient surgeries were performed with 5 days median length of stay and 98 surgeries were performed in the outpatient ambulatory care setting. The chi-square test or Fisher's exact test was used to compare inpatients and outpatients for each variable. Statistically significant higher percentages were recorded among inpatients in the following categories: age 65+ years (p < 0.0003), hypertension (p < 0.0230), presence of poly-trauma (p < 0.0149), and ordering of CT-scan (p < 0.0001). The majority of ankle fracture surgeries performed by Group 1 surgeons (84%) and Group 3 surgeons (61%) were outpatient cases compared with only 29% for Group 2 surgeons. There were no statistically significant differences in demographics and medical risk factors among patients in the three groups. Conclusion: Our data shows that age (65+ years-old) and specific medical co-morbidities are statistically linked with inpatient admission for ankle fracture surgery. In this multi-center review, trauma fellowship trained surgeons on-call were more likely to hospitalize their patients in preparation for surgery. With a 5 day median length of stay for these inpatient admissions, the health care institution may realize substantial practice management cost savings by shifting cases to the outpatient setting using the ambulatory care model of foot and ankle fellowship trained surgeons.
Correction of Hammer Toe Deformity with Novel Intramedullary PIP Fusion Device versus K-Wire fixation
Authors: Richman Seth H. , Siqueira Marcelo B. , Mccullough Kirk A. , Berkowitz Mark J. 
Published: October 2016

Category: Lesser Toes Introduction/Purpose: K-wire fixation is the most common operative procedure for hammertoe deformity today. However, intramedullary implants are gaining ground in both number of available choices and in procedures performed. This study aimed to compare the outcomes of hammertoe correction performed with K-wire fixation versus a novel intramedullary fusion device. Methods: A retrospective review of hammertoe correction by a single surgeon was performed from June 2011 to December 2013. Sixty patients (95 toes) underwent K-wire fixation and 39 patients (54 toes) underwent fusion with the intramedullary implant. Average age was 61.7 years and 61.4 years, respectively. Average length of follow up was 12.9 and 12.3 months, respectively. Patients were evaluated for medical comorbidities, smoking status, inflammatory arthritis, peripheral vascular disease, peripheral neuropathy, pre and postoperative visual analogue pain scale, bony union percentage, revision rate, complications (hardware and surgery-related), and persistent symptoms at last follow up. Results: There was no significant difference in demographics or comorbidities between the two groups (p>0.05). In the K-wire group, sixteen patients (18 toes) remained symptomatic (27%). Nine toes (9.5%) had recurrent deformity, three toes (3%) developed a late infection due to the recurrent deformity and one toe (1%) developed partial numbness. One patient suffered a calf DVT and peroneal nerve neuritis, one patient developed a foot drop, and three patients continued to complain of pain. Five toes required revision surgery (5.3%). In the intramedullary group three (7.7%) patients remained symptomatic. One patient developed CRPS in the foot, calf DVT, and a non-fatal PE. A second patient developed a painless recurrent deformity. A third patient had wound dehiscence. Nobody suffered hardware failure or required a second operation. Conclusion: The intramedullary device for hammertoe correction resulted in less complications, recurrent deformity, and reoperations than K-wire fixation.
Factors Affecting Foot Self-Care Practices in Individuals with Diabetes Mellitus Living in an Asian Population - A Quantitative Study
Authors: Cuttilan Amit N. , Sayampanathan Andrew A. , Pearce Christopher J. 
Published: October 2016

Category: Diabetes Introduction/Purpose: Diabetic foot complications and subsequent lower limb amputations commonly occur in diabetic patients due to poor foot care. We aimed to understand the extent of proper footcare practices and to identify the factors which influence these among diabetic patients in a multi-ethnic Asian population. Methods: A cross-sectional multi-centre quantitative study was performed. Inclusion criteria was all patients attending hospital outpatients clinics for diabetes. Patients were only excluded if they were unable to understand basic English. Demographic information, medical history (including formal assessment for peripheral neuropathy) and Nottingham Assessment of Functional Footcare (NAFF) scoreswere collected. All data was analysed using SPSS Version 21. Results: 350 valid responses were obtained. The mean NAFF score was 49.6±7.19. Univariate analysis revealed that ethnically non-Chinese patients had significantly better scores than did Chinese patients. After linear regression analysis, a statistically significant correlation with better foot care practices was found for patients with higher education levels, active employment and the presence of previous diabetic foot complications. Conclusion: The mean NAFF scores in our study were lower than those published in other populations which may in part account for the huge burden of diabetic foot disease in Singapore. Patients appear to start to look after their feet better only after suffering a complication.Cultural and financial factors probably account for the differences in our risk factor findings and those published in other populations. Future studies should i evaluate the effectiveness of targeted interventions for the specific groups that we have identified who have poorer NAFF scores.
First Metatarsophalangeal Arthrodesis Fixation with an Intramedullary System
Authors: Álvarez M. Concepción Castro , Luque Juan M. Morell , Pérez Vicente J. López , González Oscar Escudero , García Félix Castillo , Andrade Cristóbal Martínez , Zabala Ibon López 
Published: October 2016

Category: Midfoot/Forefoot Introduction/Purpose: Artrhrodesis is a commonly and successfully used procedure to deal with advanced hallux rigidus, severe hallux valgus, inflammatory and posttraumatic arthritis and as a salvage of previous failed surgeries. Many different techniques, in terms of joint preparation and fixation constructs, have been reported. The purpose of this study is to evaluate our short time results with an intramedullary device to perform the first metatarsophalangeal (MTP) arthrodesis. Methods: A descriptive observational study with prospective follow-up was developed. We included 21 arthrodesis using an Intramedullary Fusion Device, which consists in a 6.5 mm intramedullary metatarsal implant and a hooked 4.0 mm lag screw. The indications were hallux rigidus grade 4 in 10 cases, severe hallux valgus in 7, two patients with hallux varus and two cases of salvage surgery of a previous Keller Brandes. Clinical outcomes were assessed with American College of Foot and Ankle Surgeons (ACFAS) scoring scale preoperatively and at the time of the radiological fusion. The degree of satisfaction of patients was also evaluated using the Coughlin and Mann scale. Results: Fusion was achieved at five to twelve weeks in 19 patients. The grade of satisfaction was excellent and good in 18 patients. In two cases, implant breakage occurred. ACFAS score improved 40 points respect to preoperative status. No complications related to infection were reported. Conclusion: Dorsal plate fixation augmented with plantar lag screw fixation is nowadays the reference technique to perform first MTP arthrodesis, nevertheless titanium staples and crossed screws have also reported good results. In these constructs, sometimes is necessary a second surgery to remove some disturbing material. An intramedullary device would avoid the soft tissue irritation due to the underlying material and seems reliable to provide a strong fixation to achieve early MTP fusion with good short-term evolution.
Mid-Term Follow-Up of the Result of Periarticular Osteotomy in Treating Asymmetrical Ankle Arthritis
Authors: Zhu Yuan 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: A retrospective control study to evaluate periarticular osteotomy in treating asymmetrical ankle arthritis. Methods: Fifty-two consecutive patients with asymmetrical ankle arthritis were collected between 2009 and 2012. Forty-two of them were followed up. All the cases were performed the surgery of periarticular osteotomy including supramalleolar tibial osteotomy in 14 cases, supramalleolar tibial and fibular osteotomy in 5 cases, supramalleolar osteotomy combined with calcaneal osteotomy in 23 cases. Thirty cases got ligament reconstruction procedures. The age of surgery ranged from 31 to 70 years old (mean, 55.5). According to the Takakura classification of ankle arthritis, there were 16 cases in grade Ⅲa, and 26 cases in grade Ⅲb. The AOFAS-HA score and radiographic examinations including TAS and TLS were recorded and compared before and after surgery. Magnetic resonance imaging of the ankles were obtained before and after surgery (midterm result) in fifteen patients to evaluated the condition of the cartilage. Results: The average follow-up time was 44.5 months (36 to 75 months). All the patients got complete bone healing with an average healing time of 8 weeks. Average postoperative AOFAS -HA score by the last followup was 76.6±4.4 (compare with 35.7±5.6 preoperatively). Delayed wound healing occurred in 5 cases and was solved by wound care. All the cases had improvements in Takakura ankle arthritis classification by the last follow-up after surgery. Twenty-two patients felt the result of excellent, 20 felt good. The radiological assessment by the last followup showed no worsening of the ankle arthritis grade. None of these patients received or want to receive further surgeries such as ankle arthrodesis or ankle replacement. Conclusion: Periarticular osteotomy is a sound method in treating asymmetrical arthritis of the ankle in the midterm followup. This procedure can alter or decrease the contact pressures on the degenerated cartilage with mechanical realignment and can prolong the life span of the ankle itself.
Pain After Forefoot Surgery Comparing Day-Surgery and Conventional Hospitalization
Authors: Besse Jean-Luc , Chaudier Philippe , Bourdin Muriel , Gauthier Jerome , Fessy Michel-Henry 
Published: October 2016

Category: Midfoot/Forefoot Introduction/Purpose: At present, there are no guidelines for foot-surgery procedures that can be performed in day-surgery. The aim of our study was to evaluate early postoperative pain after forefoot day-surgery compared to a conventional hospitalization. The hypothesis was that patients operated in day-surgery showed as much pain as those hospitalized, without more complications. Methods: All patients operated for forefoot surgery by one senior surgeon (JLB) were included; those eligible for day-surgery according to SFAR (French Society of Anesthesia and Reanimation) recommendations were operated in day-surgery. Patients were distributed into 4 groups according to surgical procedure: 1.minor procedure (isolated lesser ray) – 2.light (isolated first ray) – 3.intermediate (first ray plus one or two lesser rays) – 4.complex (all forefoot). Patients living alone, further than 50 kilometres from our hospital, or in group 4 were hospitalized for 48 hours. The study included 317 patients; 40% were operated on in day-surgery. Those hospitalized were significantly older (60±3.8 versus 55±3.9, p=0.0006) and with higher ASA scores (p=0.0024) without difference in comorbidity. Main etiology was hallux valgus (70% in both groups); revision surgery counted for 9% of etiologies in the day-surgery versus 14% in the hospitalization group. Results: The highest daily pain rate was on day 1 (4.2/10±2.5 in day-surgery versus 4.4/10±2.4 in hospitalization, p=0.53) without significant difference between groups. Pain was evaluated as extreme (≥8/10) by 9% of patients in day-surgery versus 11% of those hospitalized. We found a statistically significant difference at day 0 for the light surgical procedures (category 2), with higher pain in day-surgery (4.4± 2.4 versus 3.3± 2.5, p=0.02). Concerning anaesthesia, time to recovery of sensitivity after nerve block was comparable regardless of the type of hospitalization or surgical procedure (6.0 hours ± 3.7 in day-surgery versus 5.8 hours ± 5.4, p=0.9). One patient in the day-surgery group had crossover for bleeding. Concerning the self-assessment questionnaire, patients operated in day-surgery described significantly more alertness and attention disturbances following surgery (p=0.01), and more frequent disappearance of pain after day 7 (p=0.02). Conclusion: There was no significant difference in pain or complications between groups. All patients were very satisfied. We can then reasonably recommend performing forefoot day-surgery in good collaboration with the anaesthetist and patient, without exposing the latter to greater pain and further complications.
Plantar Fasciitis Treatment With Particulated Human Amniotic Memebrane
Authors: Garras David N. , Scott Ryan T. 
Published: October 2016

Category: Basic Sciences/Biologics Introduction/Purpose: Plantar Fasciitis is the most common cause of heel pain in adults, and is estimated to affect nearly 1 million patients annually. Conservative treatments include rest, orthotics, night splint, stretching and non-steroidal anti- inflammatory drugs and are successful in nearly 90% of patients. However, more invasive treatments are required for patients whose symptoms persist greater than six months. Fetal tissues, including the umbilical cord (UC) and amniotic membrane (AM) have been increasingly used to modulate healing in different parts of the body over the last two decades. These tissues have been demonstrated to possess anti-inflammatory and anti-scarring properties in addition to containing growth factors, cytokines, and matrix components to promote healing, and offer a potential therapy for plantar fasciitis. Methods: In this series, we aim to evaluate the efficacy of cryopreserved, particulate UC/AM tissues as a treatment for plantar fasciitis as well as to determine if multiple injections provide an even greater benefit compared to a single injection. A multicenter prospective study was performed where patients were randomized to receive 25, 50, or 100 mg UC/AM tissue and either a single injection or two injections (at baseline and six weeks). All injections were administered under ultrasound guidance into the plantar fascia. At six, 12, and 18 weeks, patients returned and data on foot pain as well as the FAAM questionnaire were collected. Results: Interim six-week data for 18 patients has been collected. Patient foot pain was found to be reduced by approximately 50% from baseline (7.1 to 3.5 on a 10 point scale). FAAM scores also improved significantly. All patients showed variable degrees of improvement with no patients showing any deterioration. Conclusion: Hanselman et al evaluated the safety and efficacy of cryopreserved, particulate human amniotic membrane (cHAM) injections against a corticosteroid. They found cHAM injections safe and comparable to corticosteroids. In addition, the outcomes suggested a possible additive effect, with multiple injections of cHAM tissue showing a greater improvement in foot pain. The finding of our study are similar to the average verbal percentage improvement compared to baseline reported by Hanselman et al for the cHAM study group (46% improvement at six weeks). Overall, a total of 60 subjects will be enrolled in the present study.
Subtalar Arthrodesis in Patients With Avascular Necrosis of the Talus
Authors: Pellegrini Manuel J. , Schiff Adam P. , Dekker Travis J. , Easley Mark E. , DeOrio James K. , Nunley James A. , Adams Samuel B. 
Published: October 2016

Category: Hindfoot Introduction/Purpose: Avascular necrosis (AVN) of the talus can lead to subtalar arthritis, pain, and decreased function. Isolated subtalar arthrodesis has been attempted in these patients, potentially allowing re-vascularization of the talus from calcaneal bone ingrowth while preserving the tibiotalar joint. The purpose of this study is to determine the union rate and complications of subtalar arthrodesis in patients with AVN of the talus. Methods: After obtaining IRB approval, a retrospective review of subtalar arthrodeses performed at a single academic institution, from 2000 to 2014, was conducted. Patients were included if they had a preoperative diagnosis of avascular necrosis of the talus, underwent subtalar arthrodesis and had a minimum follow up of 12 months. Exclusion criteria include: age younger of 18 years, incomplete clinical and radiological data or those whom underwent a concomitant tibiotalar arthrodesis. Results: Twelve patients with a mean age of 46.6 ± 13.9 years were included in the study. The fusion rate was 58% with a mean time to fuse of 35 weeks (range, 14-146). Seventeen percent of the patients had diabetes or vascular disease and an additional 17% had a positive history for tobacco use. The overall complication rate was 67% (8 patients). Five patients progressed to non-union (42%) and three of them underwent revision to tibiotalocalcaneal arthrodesis. Two patients (17%) had progression of AVN, one of which necessitated a tibiotalocalcaneal arthrodesis. Two patients (17%) developed a wound dehiscence that healed uneventfully with local wound care and oral antibiotics administration. One patient (8%) underwent hardware removal. Conclusion: With a fusion rate as low as 58% and a 67% complication rate, caution should be exhibited when considering an isolated subtalar arthrodesis in the setting of AVN of the talus. In selected cases, consideration should be given to extending the arthrodesis site to include the tibiotalar or talonavicular joint or revascularization procedures such as concomitant vascularized bone grafts.
The Use of a Cellular Bone Allograft Containing Multipotent Adult Progenitor Cells for Foot and Ankle Arthrodeses
Authors: Adams Samuel B. , White Peter , Gross Christopher E. , Parekh Selene G. 
Published: October 2016

Category: Basic Sciences/Biologics Introduction/Purpose: Arthrodesis procedures are commonplace in foot and ankle surgery. Unfortunately, nonunion rates have been reported to be as high as 40%. To combat nonunion, autograft bone is often used but has been associated with morbidity and poor cell quality. Therefore, the use of cellular bone allograft (CBA) has become commonplace. Traditional CBAs are osteoconductive, osteoinductive and the cellular component is typically osteogenic but not angiogenic. The added property of angiogenesis may be beneficial in achieving fusion. The purpose of this study was to determine the efficacy of a CBA composed of MAPC-class cells that have both osteogenic and angiogenic properties. Methods: The CBA (map3, RTI Surgical, Alachua, FL) was used in 41 distinct foot and ankle arthrodesis sites in 37 consecutive patients with a mean age of 52 years (range, 19-88). In all cases the graft was interposed between the prepared bone surfaces prior to hardware placement. All patients were followed until fusion occurred or a revision procedure was performed in cases of nonunion. Successful fusion required >50% osseous bridging on CT scan and the presence of bridging bone without signs of nonunion on plain radiographs. Additionally, successful fusion required resolution of preoperative symptoms and maintenance of fixation across all treated joints. Results: Overall, fusion was achieved in 88% (36/41) arthrodesis sites. There were 11 patients/sites of previous nonunion. In these revision cases, the fusion rate was 82% (9/11). There were no complications attributed to the use of map3. Conclusion: Fusion rates using map3 were higher than or comparable to fusion rates with autograft that have been reported in the recent literature. Map3 was a safe and effective graft material to achieve fusion and may provide an effective autograft replacement for foot and/or ankle arthrodeses.