bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Prospective Evaluation of Cost and Space Utilization Following Implementation of an Intelligent Delivery Platform for Forefoot Single-use Implants and Instrumentation in the ASC Setting
Authors: Maskill John D. 
Published: December 2023

Category: Midfoot/Forefoot; Other Introduction/Purpose: The transition of the US healthcare system from a fee-for-service model to a value-based care model calls for a deeper evaluation of patient care in order to uphold quality and efficiency. Sterile-packed single-use instruments have been introduced as a tool to help facilities streamline operating room logistics and reduce sterilization needs and requirements thus reducing cost, time, and valuable shelf space. With the added intelligent delivery platform, procedure mapping (physician specific stocking of implants) and automatic restocking is now possible1-3. The purpose of this study was to examine the efficiencies of cost savings and reduction of shelf space required for storage of an intelligent delivery platform (Pulse Intelligent Delivery Platform, Stryker, Memphis, TN) with single-use surgery-ready forefoot implants. Methods: A total of 19 cases were performed during a 3-month period (August to November 2022) at a single ambulatory surgery center. Instrument tray reduction was tabulated and compared to the number of trays typically utilized using reusable instruments. Tray management time was evaluated clinically by direct observation. A cost analysis of reprocessed instrumentation trays was then performed looking at sterilization, surgical delay, and instrumentation costs per tray and then compared to pricing for the sterile instrument kits. The instrument, sterilization, and case delay costs/tray at the facility were calculated2. A comparison of space utilization was also performed between the two groups (reprocessed trays versus sterile kits). Results: There was a substantial decrease in the need for reusable instrument trays by 80%. 70% of cases did not require even one tray of reusable instruments to be opened. The delivery platform was shown to lower instrument tray cost per case by 74.25%. Space was also evaluated, and the sterile kits were found to have an 85.9% reduction in space when compared to the reprocessed trays2,3. Conclusion: A forefoot single-use surgery ready intelligent delivery platform has been shown to effectively lower overall instrument tray cost per case by 74.25% in a highly efficient ASC. In addition, an 85.9% reduction in shelf space per tray was also seen comparing reprocessed instrumentation to sterile instrument kits. Pricing is variable per facility, and sterilization and usage processes vary1-6. However, we believe that sterile kits can be more cost effective than reprocessed sets. In addition, space can be saved with the use of sterile instrument kits adding to the established benefits of the delivery platform of procedure mapping and automatic restocking1-3.
A Systematic Review of Outcomes of Total Ankle Arthroplasty with INBONE II
Authors: Ashy Cody , Reid Jared J. , Morningstar Joshua L. , Scott Daniel , Gross Christopher E. 
Published: December 2023

Category: Ankle Arthritis; Ankle Introduction/Purpose: The INBONE II is a fixed-bearing implant with a stemmed tibial component commonly used for total ankle arthroplasty (TAA). Despite its frequent use and previously reported outcomes within individual clinical studies, no study has systematically reviewed outcomes of TAA with this implant. The purpose of this study was to perform a systematic review of the literature and report on outcomes of TAA with the INBONE II. Methods: A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. Databases searched included PubMed, Google Scholar, SCOPUS and CINAHL from database date of inception through February 28th, 2023. Clinical studies of INBONE II outcomes in peer reviewed journals were included. Outcomes included were survivorship, patient reported outcome measures (PROMs), and complications. Outcome results were compiled using weighted averages when possible. This review of 26 articles included 808 patients with 667 primary TAA and 141 revision TAA. Results: Survivorship, with failure defined as metal component revision, was 97.8% at an average follow-up of 49 months (range, 14-85.4 months) and 94.2% at an average follow-up of 25.7 months (range, 9.1-47.5) months for primary and revision TAA respectively. Complication rates for primary TAA included: 3.8% intra-operative fractures, 2.5% post-operative fractures, 1.8% deep infection, 8.0% wound complications, 1.6% rate of poly exchange, and 1.6% nerve injuries. Revision TAA complication rates included: 12.3% intra-operative fractures, 6.9% wound complications, 3.3% deep infections, and a 5.5% incidence of nerve injury. Average PROMs for primary TAA included: AOFAS American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score improved 41 points, visual analog scale (VAS) scores decreased 5.9, and patient satisfaction of 92.6%. Revision TAA PROMs were not consistently reported. Conclusion: This study is the largest compilation of INBONE II outcomes and survivorship. Primary and revision TAA with the INBONE II results in satisfactory improvement in PROMs and low complication rates. The overall survivorship is 97.8% and 94.2% at an average follow-up of 49 months (range, 14-85.4 months) and 25.7 months (range, 9.1-47.5) for primary and revision total ankle arthroplasty respectively. These findings support continued use of this implant in primary and revision TAA.
A Systematic Review of Tibialis Posterior Tendon Entrapment in Pilon and Trimalleolar Injuries
Authors: Mason Lyndon W. , Aamir Junaid , Syziu Anxhela 
Published: December 2023

Category: Ankle; Trauma Introduction/Purpose: The tibialis posterior tendon (TPT) entrapment is an uncommon complication associated with posterior malleolar and pilon fractures. If undiagnosed, TPT entrapment is associated with significant morbidity. Our aim was to perform a systematic review of all reported TPT entrapments in the literature to further understand its risks and outcomes. Methods: The electronic databases Scopus, PubMed, and Medline was utilised to identify the relevant publications regarding TPT entrapment in pilon and ankle fractures. Inclusion criteria: all adult studies published in English language reporting the outcome of TPT entrapment in patients with ankle injuries. To critically appraise the papers, CASP clinical appraisal tool was used. Results: Four retrospective studies and eight case reports were accepted in this review. Collectively there were, 489 Pilon fractures, 77 of which presented with TP entrapment (15.75%). There were 28 Tri-malleolar fractures, 12 of which presented with TP entrapment (42.86%). All the case report studies reported inability to reduce the fracture at initial presentation. The diagnosis of TPT entrapment was made in the early period in 25% of cases and delayed diagnosis in 75% of cases reported. Utilising modified Clavien-Dindo complication classification, 67% of the injuries reported GRADE IIIA complications, and the rest GRADE IIIB complications. Conclusion: In conclusion, TPT tendon was the commonest tendon injury associated with Pilon and Tri-malleolar ankle fractures. Early identification, utilising a clinical suspicion and CT imaging, could lead to early management of TP entrapment in these injuries which could potentially lead to better patient outcomes and reduced morbidity.
Acute Deltoid Injury in Ankle Fractures: A Biomechanical Analysis of Different Repair Constructs
Authors: Wagner Emilio , Wagner Pablo , Escudero Mario I. , Pacheco Florencia , Salinas David Andres , Godoy-Santos Alexandre Leme , Palma Felipe , Guzman-Venegas Rodrigo A. , Berral Francisco J. 
Published: December 2023

Category: Trauma; Ankle Introduction/Purpose: The importance of the deltoid ligament in the congruency of the tibiotalar joint is well known. The current trend is to repair it in cases of acute injuries in the context of ankle fractures, however, there is no information on how it should be reconstructed. The objective of this study was to compare different deltoid ligament repair types in an ankle fracture cadaveric model. Methods: 16 cadaveric foot-ankle-distal tibia specimens were used to conduct the study. All samples were prepared as a supination external rotation ankle fracture model. An axial load and cyclic axial rotations were applied on every specimen using a specifically designed frame. This test was performed without deltoid injury, with deltoid injury and finally with the ligament reconstructed. The reconstruction was performed in 4 different ways (anterior, posterior, middle, combined) using 4 specimens per group. Medial clear space (MCS) was measured for each condition on simulated weight-bearing and gravity stress radiographs. Reflective markers were utilized in tibia and talus, registering through a motion analysis system the kinematics, to record the tibiotalar uncoupling. Statistical analysis was performed using the SPSS software. Results: In all cases, the MCS increased significantly on gravity stress radiographs after damaging the deltoid ligament. There was no increase in the MCS on load radiographs. After repair, in all cases, the MCS was normalized. Kinematically, after damage the tibiotalar uncoupling increased significantly, decreasing after repair. All repairs significantly corrected the tibiotalar uncoupling, observing a significantly increased coupling effect (increased stiffness) with the combined repair. Conclusion: Our results show that deltoid repair recovers the tibiotalar coupling mechanism in an ankle fracture model. We suggest that the ideal repair should aim to repair the middle aspect of the deltoid ligament. The combined repair may lead to postoperative stiffness. Clinical studies are needed to prove these results and show clinically improved outcomes.
Analysis of Clinical and Radiological Results of Total Ankle Arthroplasty According to Varus Deformity
Authors: Jeong Bi O , Jung Cheol Hyun 
Published: December 2023

Category: Ankle Arthritis Introduction/Purpose: This study aimed to evaluate the clinical and radiological results of total ankle arthroplasty, performed in ankle arthritis patients with varus deformity, according to the rotation and displacement types. Methods: Among the patients who had undergone total ankle arthroplasty using Hintegra, a 3-part prosthesis for end-stage ankle arthritis, 44 cases that were followed up for at least 1 year were included in this study. The patients were classified into either rotation or displacement type, and the clinical and radiological results of each group were analyzed. For clinical evaluation, the VAS and AOFAS ankle-hindfoot scale were used. Radiological evaluation was measured by using mechanical axis deviation (MAD), medial distal tibial angle (MDTA), talar tilt angle, tibiotalar angle (TTA), talus center migration (TCM), tibia-talar ratio (TTR), anterior distal tibial angle (ADTA) and hindfoot alignment angle (HAA). Results: Of the 44 cases, both the rotation and the displacement types were 22 cases each. VAS improved from 6.0±1.4 points and 6.0±1.5 points in each group before surgery to 2.0±0.9 points and 0.0±0.8 points at the final follow-up, showing a significant difference between the two groups (p < 0.001). The AOFAS scale improved from 59.5±11.0 points and 50.0±15.1 points in each group to 80.0±11.9 points and 97.0±8.0 points at the final follow-up, and the difference between the two groups was statistically significant (p=0.003). Most of the radiological indicators in each group were significantly improved. TCM was changed from 1.4±2.5mm and 6.7±2.6mm in each group before surgery to 0.8±2.2mm and 3.4±1.3mm at the last follow-up, and there was a significant difference in the displacement group (p < 0.001). Conclusion: Clinical and radiological improvements were obtained after total ankle arthroplasty, regardless of the deformity type. Displacement-type strains showed better clinical measures than rotational strains. The more normal the alignment of the hindfoot was, the better the clinical scale was. In patients with end-stage arthritis accompanied by medial displacement of the center of the talus, efforts to restore the normal alignment are needed.
Analysis of Patient-Reported Outcomes Following Triple Arthrodesis: A Minimum Two-Year Followup
Authors: McCrosson Matthew J. , Sanchez Thomas , Scheinberg Mila , Underwood Meghan , Young Matt , Earla Rishi , Brannigan Matthew J. , Sisk Morgan , Shah Ashish 
Published: December 2023

Category: Hindfoot Introduction/Purpose: Adult acquired flatfoot deformity (AAFD) is a debilitating condition that is common in the United States. Triple arthrodesis (TA) is a treatment option reserved for advanced disease. Evidence on patient outcomes following this procedure remains limited. This study aims to report patient-reported outcomes following TA via patient reported outcome measurement information systems (PROMIS). Secondary aims are to delineate any demographics or patient characteristics that significantly impact PROMIS scoring. Methods: In this single institution study, we identified all patients who underwent triple arthrodesis between 2014 and 2021 based on CPT coding. Patients who underwent a TA procedure for AAFD with a minimum of 24 months follow-up were eligible for inclusion in this study. Patients under the age of 18, those undergoing revision surgeries, or those with pathologies other than AAFD were excluded from this study. Patient demographics and surgical complications were collected through chart review. The Patient Reported Outcomes Measurement Information System (PROMIS) survey and Foot Function Index (FFI) scores were collected via telephone interview. PROMIS scores were analyzed with a Type III “SS” ANOVA test to stratify independent risk factors and account for confounding variables. Results: 49 patients (43%) submitted responses to the survey. Patient outcomes were collected at an average of 5.50 years postoperatively. There were no significant differences in the rates of complications among any of the variables analyzed. The average PROMIS physical function score was 38.35, the average pain interference score was 61.52, and the average depression score was 49.82. Males and patients with prior foot and ankle procedures had significant increases in PROMIS physical function scores (p <.05). The mean FFI scores were 58.56 for pain, 60.07 for disability, and 48.07 for activity limitation. Patients > 50 years old had significantly higher FFI pain, disability, and total scores (p <.05). VAS scores decreased preoperatively to postoperatively from 5.4 to 2.6. Conclusion: Our study is the first to examine variables significantly impacting PROMIS, FFI and VAS scores for patients undergoing TA for AAFD. Treatment of AAFD with TA appears to be beneficial in long-term reduction of pain. This study is one of the largest to date involving patient reported outcomes following TA and can serve as a prognostic tool for physicians to use when counseling patients prior to this procedure.
Arthrodesis of the Second and Third Tarsometatarsal Joints: Comparison of Clinical Results Using Combined or Individual Plating Techniques
Authors: Ankers Thomas H. , Mason Lyndon W. , Singh Anjani , Walker Christopher R. , Sirikonda Siva 
Published: December 2023

Category: Midfoot/Forefoot; Other Introduction/Purpose: Arthrodesis is an effective treatment of midfoot arthritis in reducing pain and improving function. However, there is a known risk of non-union. Our aim was to compare the outcomes of individual plating versus dual plating for combined fusion of the 2nd and 3rd tarsometatarsal joints (TMTJs). Our primary outcome was bone healing and secondary outcomes include patient reported outcome measures. Methods: All cases underwent primary arthrodesis of the 2nd and 3rd TMTJs. Arthrodesis was performed using either a single ‘H- shaped’ plate (combined plating group) or using two separate plates (individual plating group). The outcome measures were bony union and the Manchester-Oxford Foot Questionnaire score. Results: Forty-five procedures were undertaken with a mean follow-up of 527 days. The combined plating group had 28 cases and individual plating group had 17 cases. There were 10 cases (35.71%) of non-union in the combined plating group and 2 cases (11.76%) in the individual plating group. Muti-variate regression analysis showed a significant relationship of non-union with use of the combined plating group (p =.047, OR 5.822). Patients who had also undergone 1st TMTJ fusion had an increase chance of union (p=.043, OR 9.896). No other factors showed significance. MOX-FQ scores were superior in the individual group at 6 months post-surgery although this significance was lost when the non- unions were excluded. Conclusion: This study is the first to report a difference in union between combined plating and individual plating techniques in arthrodesis of the 2nd and 3rd TMTJs. We believe that individual plates permit a more anatomical reduction and greater compression at the site of arthrodesis as compared to a dual plate technique. Achieving union results in a better functional outcome.
Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in Chondral Lesions at the Ankle as Part of a Complex Surgical Approach: 5-Year Follow-up
Authors: Richter Martinus , Zech Stefan , Meissner Stefan A. , Naef Issam 
Published: December 2023

Category: Ankle Arthritis; Ankle Introduction/Purpose: The aim of the study was to assess 5-year-follow-up (5FU) after Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in chondral lesions at the ankle as part of a complex surgical approach. Methods: In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral lesion at the ankle treated with AMIC+PBC from July 17, 2016 to May 31, 2017 were included. Size and location of the chondral lesions, the Visual-Analogue- Scale Foot and Ankle (VAS FA) and the EFAS Score before treatment and at 5FU were analysed and compared with previous 2- year-follow-up (2FU). Peripheral Blood Concentrate (PBC) was used to impregnate a collagen I/III matrix (Chondro-Gide, Wolhusen, Switzerland) that was fixed into the chondral lesion with fibrin glue. Results: One hundred and twenty-nine patients with 136 chondral lesions were included in in the study. The chondral lesions were located as follows (n (%)), medial talar shoulder only, 62 (46); lateral talar shoulder only, 42 (31); medial and lateral talar shoulder, 7 (10); tibia, 18 (13). The average for lesion size was 1.8 cm2, for VAS FA 45.7 and for EFAS Score 9.8. 2FU/5FU was completed in 105 (81%)/104(81%) patients with 112/111 previous chondral lesions. VAS FA improved to 79.8/84.2 and EFAS Score to 20.3/21.5 (2FU/5FU). No parameter significantly differed 2FU and 5FU. Conclusion: AMIC+PBC as part of a complex surgical approach led to improved and high validated outcome scores at 2FU/5FU. 2FU and 5FU did not differ.
Biomechanical Comparison of Nitinol Compression Staples vs Fully Threaded Lag Screws for Talonavicular Arthrodesis
Authors: Reddy Prati Jahnu , Schweser Kyle M. , Cook James , Garlapaty Ashwin , Manning Blaine T. , Bezold Will 
Published: December 2023

Category: Hindfoot; Other Introduction/Purpose: The talonavicular joint is a crucial component of the hindfoot complex. Talonavicular arthrodesis has significant effects on foot biomechanics and motion. Current techniques for talonavicular arthrodesis vary and include a variety of constructs. Despite favorable clinical results, there is a lack of data regarding the biomechanical performance of second-generation nitinol compression staples compared to screw fixation for talonavicular arthrodesis. The objective of this study was to compare nitinol compression staples with fully threaded lag screws in talonavicular fusion with respect to their clinically relevant biomechanical properties during functional testing. Methods: A single orthopaedic surgeon used either two nitinol compression staples (Arthrex, Naples, FL) or two fully threaded lag screws (Arthrex, Naples, FL) on cadaveric feet (n=12; 6 matched pairs) to perform surgical arthrodesis of the talonavicular joint; each pair undergoing each procedure in random order and alternating between left and right feet. Optical tracking markers were attached to the talus and navicular bone to track displacements. Specimens were loaded at 89N/sec from 30N to 445N for 1 minute. A continuous compressive load of 445N was applied while cycling from 30° plantarflexion to 15° dorsiflexion for 10 cycles. Translation data were recorded along the X, Y, Z planes. Rotation data were recorded for roll, pitch, and yaw. Significant (p < 0.05) differences were determined using paired t-Tests, comparing staple fixation versus screw fixation for each measured variable. Results: There were no statistically significant differences between staples and screws between translation in the X, Y, and Z planes. When comparing rotation (roll, pitch, and yaw), there were no statistically significant differences with the exception of increased roll rotation for staple fixation versus lag screw fixation during static compression testing only (p=0.009). Conclusion: Based on clinically relevant biomechanical properties measured during functional robotic testing of the hindfoot, nitinol compression staples are a viable option for use in talonavicular arthrodesis.