bluuebunny/crossref_metadata_2025_split huggingface dataset:
Midterm Survivorship and Complications of the Cadence Total Ankle Arthroplasty
Authors: Kim C. James , Tsai Justin , Pedowitz David I. 
Published: December 2023

Category: Ankle Arthritis; Ankle Introduction/Purpose: The Cadence total ankle arthroplasty (TAA) system first entered clinical use in 2016. Short-term outcomes with a minimum of two-year follow-up time have demonstrated survivorship between 93.7% and 100% with improvements in patient-reported outcomes measures, coronal alignment, and range of motion1–4. The purpose of this study is to report the midterm survivorship and complications of Cadence TAA patients with a minimum of 4.5-year radiographic follow-up. Methods: A retrospective chart review was conducted to identify a total of 22 TAA patients with the Cadence implant and a minimum follow-up time of 4.5-years. Patient age, sex, body mass index, diabetes mellitus status, rheumatoid arthritis status, smoking status, laterality, and diagnosis for TAA were collected from patient chart reviews. Preoperative FAAM-ADL subscore, FAAM-Sport subscore, and VAS pain scores and the postoperative scores at the last follow-up visit was also collected. 13 out of 22 patients had preoperative FAAM-VAS scores available while 10 out of 22 patients had postoperative FAAM-VAS scores available. Postoperative complications in the form of wound-related issues and those requiring reoperation or revision were noted, with revision defined as removal or exchange of metal component. 5-view radiographs obtained preoperatively and at the last follow-up visit were used to measure coronal alignment, range of motion, evidence of subsidence or loosening, and osteolysis as previously described1. Results: 3 out of 22 patients required a revision surgery, 1 for loosening of tibial component and 2 for infection. 4 out of 22 patients underwent a reoperation, 2 for gutter debridement due to impingement or heterotopic ossification, 1 for periprosthetic medial malleolar fracture, and 1 for removal of painful medial malleolar screws. The average FAAM-ADL, FAAM-Sport, and VAS pain scores improved from 50.6, 26.5, and 59.9 to 69.5, 35.5, and 23.6, respectively. The coronal alignment angle decreased from 5.96 degrees from neutral to 2.31 degrees. The average dorsiflexion and plantarflexion angles were 14.74 and 17.18 degrees, respectively, for an average range of motion of 31.9 degrees. 3 out of 22 patients had evidence of osteolysis while no patients had evidence of loosening or subsidence. Conclusion: The midterm survivorship of Cadence TAA system in 22 patients was 86.4%. Excluding the two cases of infection which are typically not attributed to implant performance, the survivorship was 95.4%. The reasons for reoperation included impingement, heterotopic ossification, periprosthetic fracture, and removal of painful hardware. The average FAAM-ADL, FAAM- Sport, VAS pain scores and coronal alignment improved. Analysis of longer follow-up time in greater patient cohorts is necessary for clearer understanding of this fixed-bearing implant’s performance.
Obesity Significantly Impacts Patient Reported Outcomes after Total Ankle Arthroplasty: Results from 615 Controls and 478 Patients with Obesity
Authors: Kim Billy I. , Anastasio Albert T. , Wixted Colleen M. , DeOrio James K. , Nunley James A. , Easley Mark , Adams Samuel 
Published: December 2023

Category: Ankle Arthritis Introduction/Purpose: There is limited data evaluating the effect of obesity on outcomes following total ankle arthroplasty (TAA), especially in adequate sample sizes to detect impacts on patient reported outcomes (PROs). The purpose of this study was to assess the effect of obesity on complication rates and PROs. Methods: This was a single-institution, retrospective study of 1,093 primary TAA performed between 2001 and 2020. Minimum follow-up was 2 years. Patients were stratified by body mass index (BMI) into Control (BMI=18.5-29.9; n=615), Obesity Class I (BMI=30.0-34.9; n=285), and Obesity Class II (BMI>35.0; n=193) groups. Patient information, intraoperative variables, postoperative complications, PRO measures were compared between groups using univariable statistics. Multivariable Cox regression was performed to assess risk for implant failure. Mean follow-up was 5.6 years (sd:3.1). Results: Compared to Control and Class I, Class II patients had the lowest mean age (p=0.001), highest mean ASA score (p < 0.001), and greatest proportion of female sex (p < 0.001) and Black/African American race (p=0.005). There were no statistically significant differences in postoperative complications (infection, implant failure, or impingement) across the BMI classes (p>0.05). Preoperatively, Class II had lower (worse) mean scores for FAOS Pain and ADL subscales than Controls (posthoc pairwise p< 0.001 for both). At final follow-up, both Class II and Class I had lower (worse) mean SMFA (posthoc pairwise p< 0.001 and p=0.030, respectively) and SF36 scores (posthoc pairwise p< 0.001 and p=0.005, respectively) than Controls. Conclusion: At midterm follow-up, obesity was not associated with increased rates of complications after TAA. Patients with obesity reported worse musculoskeletal function and overall quality of life after TAA but there was no differential improvement in PROs across BMI classes. To our knowledge, this is the largest single institution study to date examining the effect of obesity on outcomes after primary TAA.
Outcomes and Complications of Tibiotalocalcaneal Arthrodesis
Authors: Fayed Aly M. , Mansur Nacime Salomao Barbachan , Glass Natalie , Phisitkul Phinit , Femino John 
Published: December 2023

Category: Ankle Arthritis; Hindfoot Introduction/Purpose: Tibio-talo-calcaneal (TTC) arthrodesis is usually a salvage procedure to address several hindfoot and ankle conditions. Non-union rate after TTC fusion is variably reported 3.4% - 48%. The aims of this study were to describe the outcomes and complications of this procedure and to determine potential risk factors associated with non-union. Methods: In this IRB-approved retrospective cohort study, we used the following codes (28705,28725 and 27870) to search the medical records for all patients who underwent TTC fusion between 2006-2022. All relevant demographic data, surgical indications, surgery details (type of the graft, type of the implant, and surgical approach, associated procedures), post-operative course (complications and union rate) and follow-up duration were extracted. Descriptive statistics were performed, and continuous variables were described using median (interquartile range) and categorical variables were described using frequency (%) and mean (standard deviation, SD). Patients and surgery characteristics were compared between united and non-united cases using Wilcoxon Rank Sum Tests for continuous variables and Chi-squared or exact tests, as appropriate, for categorical variables. Analyses were performed using SAS statistical software version 9.4 (SAS Institute Inc., Cary, NC). Results: Fifty-one patients (53 feet) were included in the study. Long hindfoot fusion nails were used in 51 cases.Ten cases were routinely dynamized 8-10 weeks after surgery. In 24 (45.3%) patients, morselized allograft was combined with infuseTM and reamer irrigation aspiration autograft (RIA). In 20 (37.7%) patients, morselized allograft was combined with infuseTM only. There were 6 non-union cases (11.3%). When comparing patients and surgery characteristics between non-union versus union group, smoking (P = 0.0150) and routine dynamization (P= 0.0297) were higher in the non-union group. No difference in union rates between different types of graft. Frequency of other complications is listed in (Figure 1). Follow up duration was 27.2 months (range 4-108 months). Conclusion: TTC fusion achieves good union rate (88.68%), however it carries a relatively high risk of complications. Routine dynamization of the TTC nail at 8-10 weeks could be a risk factor for non-union. Smoking was also associated with a high non- union rate.
Outcomes following Open vs Minimally Invasive Chevron Osteotomy for the Management of Hallux Valgus Deformity: A Systematic Review and Meta-Analysis
Authors: Butler James J. , Rajivan Ragul , Konar Kishore , Randall Grace W. , Azam Mohammad T. , Kennedy John G. 
Published: December 2023

Category: Midfoot/Forefoot; Other Introduction/Purpose: The purpose of this systematic review and meta-analysis is to compare outcomes between patients who underwent open chevron osteotomy (OCO) and minimally invasive Chevron osteotomy (MICA) for the management of hallux valgus deformity. Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies comparing outcomes between patients who underwent open chevron osteotomy (OCO) and minimally invasive Chevron osteotomy (MICO) for the management of hallux valgus deformity. Data regarding surgical characteristics, subjective clinical outcomes, radiographic outcomes, failure rates and complications were extracted and analysed. In total, 6 comparative studies were included in this review. Results: In total, 183 patients (208 feet) underwent OCO and 209 patients (244 feet) MICA for the management of hallux valgus deformity. Meta-analysis demonstrated no difference in post-operative MOFXQ scores (SMD: 0.0849, [-0.2584, 0.4282], p = 0.6277), hallux valgus angle (SMD: -0.1245, [-0.4204, 0.1715], p = 0.4099), intermetatarsal angle (SMD:-0.2565, [-0.5539, 0.0408], p = 0.909) and failures (RR: 1.0765, [0.0993, 11.6760], p = 0.9278) between the OCO cohort and the MICO cohort. There was a lower complication rate in the OCO cohort compared to the MICO cohort (RR: 0.2614, [0.1453, 0.4704], p < 0.0001). Conclusion: This systematic review found comparable improvements in subjective clinical outcomes, functional outcomes and radiographic outcomes following both OCO and MICO at short-term follow-up. However, a lower RR with respect to complications was found in the OCO cohort compared to the MICO cohort. Despite the significant heterogeneity across the included studies, the similar outcomes between the 2 cohorts reinforces that further research is warranted to determine the optimal role of OCO and MICO in the management of hallux valgus deformity.
Patterns of Anterior Inferior Tibiofibular Ligament Avulsion Fracture Accompanied by Ankle Fracture
Authors: Kim Dae-Yoo , Seo Won-Seok 
Published: December 2023

Category: Ankle; Trauma Introduction/Purpose: The anterior inferior tibiofibular ligament (AITFL) avulsion fracture accompanying an ankle fracture cause compromising ankle stability, and requires accurate evaluation and clarifies pathophysiology. The aim of this study was to investigate the correlation between AITFL avulsion fracture and Lauge–Hansen, Wagstaffe classification. Methods: 128 patients (70 males and 58 females) operated at the present institution between January 2013 and July 2017 were included. AITFL avulsion fractures occurred in 68 patients. Fracture was diagnosed based on the preoperative simple radiographs obtained of the ankle joint in the anteroposterior, lateral and mortise views. In cases wherein diagnosis was difficult using radiographs alone, CT was additionally used. AITFL avulsion fractures were classified based on the fracture site according to the Wagstaffe classification system. The anteroposterior and horizontal lengths as well as the height of the avulsed bone fragment were measured using CT scans in the coronal, sagittal and axial views. Thereafter, the relationship between the Lauge-Hansen classification of ankle fractures and the characteristics of AITFL fracture was statistically analysed using the Fisher exact test. Results: Type II of the modified Wagstaffe classification system was 39 examples, followed by type III (9 examples) and type IV (8 examples). Out of 7 pronation-abduction fractures, 3 were those of AITFL avulsion fracture, while out of the 21 pronation- external rotation fracture examples, 9 were those of AITFL avulsion fracture. Out of the 95 examples of supination-external rotation fracture, there were 56 examples (59%) of AITFL avulsion fracture. Of the pronation fractures, 0% was a fibular avulsion fracture and 43% were a tibial avulsion fracture. Of the supination fractures, 44% were a fibular avulsion fracture and 16% were a tibial avulsion fracture. The difference in the ratio of fibular and tibial avulsion fractures between the pronation and supination fractures was significant. (p < 0.0001) Conclusion: Some of the AITFL avulsion fractures examined in this study may have been caused by collisions with the talus rather than the traction of the AITFL. Although Wagstaffe fractures accompanied by a supination–external rotation-type fracture results from the traction of the AITFL, a tibial avulsion fracture in a patient with a modified Wagstaffe type 4 fracture and a supination fracture appears to result from a continuous external rotation and repeated collisions of the talus with the anterolateral corner of the distal tibia.
Retrospective Review of 200 Consecutive, Single Surgeon, Fibula Nails with Proximal and Distal Fixation
Authors: Rodriguez-Materon Solangel , Lopez Kyra E. , Trynz Samantha , Chapman Cary , Fleites Jorge , Hodgkins Christopher , Hodgkins Christopher 
Published: December 2023

Category: Trauma; Ankle Introduction/Purpose: Ankle fractures are one of the most common injuries presenting to orthopedic surgeons. Unstable ankle fractures require surgical intervention and the most common fixation method is the use of a plate and screw construct. However, this requires an extensive open incision, which potentially increases the risk of post-operative wound complications and the possibility of hardware irritation. The purpose of this abstract is to evaluate the clinical outcomes of the treatment of unstable lateral malleolar fractures using a fibula nail with both proximal and distal locking capabilities from our original cohort, and in our increased cohort of 200 consecutive single surgeon fibula nails using a mini open incision to anatomically reduce. Methods: We retrospectively reviewed 200 consecutive FibuLock Fibula Nail® fixation constructs (Arthrex, Naples, FL, USA) of a single surgeon in a private practice community hospital. Demographic, operative, clinical, and radiographic outcome data were analyzed. Results: The average follow-up time of the patients was 18.5 months. The demographics of the patients can be found in table 1. There were no cases of infection, loss of reduction, delayed union, or nonunion. All fractures healed. There were two cases of focal superficial epidermal lysis treated with local wound care, that did not require antibiotics. One patient required removal of the nail as a result of it being proud, which was an iatrogenic error. In our previously reported first 110 nails, we had to convert two fractures to plate fixation intraoperatively due to excessive comminution, which made the implantation more difficult. There were no further episodes of this in our next 90 cases due to adoption of plate assisted nail technique. Conclusion: The use of an intramedullary nail with a mini-open technique allows for anatomic fracture reduction and no-profile fixation, thus reducing the risk of wound complications and providing stable fixation. Our technique results in anatomic healing in nearly all patients. Also, there were no incidents of delayed or malunion and no postoperative loss of reduction. Our results demonstrated a very low complication rate compared to traditional plate fixation with good patient reported outcomes.
Risks of Increased Operative Time and Longer Hospital Stays Based on Age in Total Ankle Arthroplasty
Authors: Peairs Emily M. , Anastasio Albert T. , Kim Billy I. , Walley Kempland , Adams Samuel 
Published: December 2023

Category: Ankle Arthritis Introduction/Purpose: Total joint arthroplasty is increasingly being performed in younger individuals across the United States. While age-specific outcomes have been evaluated in total hip and knee replacements, the data are not as clear for total ankle arthroplasty (TAA). The purpose of this study was to analyze TAA outcomes and complications by age to improve shared decision-making when considering ankle replacements. Methods: A total of 1,619 primary and revision TAAs from 2012-2020 were collected and included from the National Surgical Quality Improvement Program. Patients were stratified by age into groups less than 55, between 55-70, and greater than 70 years of age. Demographics, medical comorbidities, ASA class, operative time, 30-day complications, and comorbid conditions were compared by univariable analysis. Multivariable analysis was used to analyze readmission rates, reoperation rates, operative time, and hospital length of stay. Results: By univariable analysis, patients greater than 70 have significantly more comorbidities when compared to patients younger than 55. Younger patients have a significantly longer hospital stay, with an average of 1.64 days for those younger than 55 compared to patients 55-70 (1.50 days) and patients older than 70 (1.38 days, p< 0.001). Younger patients also have a significantly longer operative time and a higher risk of still being in the hospital after 30 days (p < 0.001, p=0.034). By multivariable analysis, patients 55-70 have a statistically lower risk of readmission compared to the other two cohorts (p = 0.043). Conclusion: As the incidence of total ankle arthroplasty increases across all ages, it is important to understand specific risks for each age group. Patients younger than 55 experience higher operative times and longer lengths of stay. Patients between 55-70 have a significantly lower risk of reoperation but longer hospital stays. Patients older than 70 tend to have lower reoperation rates, lower readmission rates, and shorter operative times.
Semi-Automatic 3D Assessment of Zadek Osteotomy Effects
Authors: Nunes Gustavo Araujo , Carvalho Kepler A.M. , Mansur Nacime Salomao Barbachan , Kim Ki Chun , Chrea Bopha , Mann Tania Szejnfeld , Godoy-Santos Alexandre Leme , de Cesar Netto Cesar 
Published: December 2023

Category: Hindfoot; Sports Introduction/Purpose: Zadek's procedure is a surgical option to treat insertional Achilles tendinopathy(IAT). This procedure consists of a closing wedge osteotomy of the calcaneus with biomechanical consequences. Great modifications in the hindfoot alignment can result in poor functional outcomes for athletes. Additionally, some authors stated that Zadek osteotomy is a good choice for patients with IAT associated with cavovarus foot. This study aims to analyze the hindfoot alignment and the parameters related to Haglund's syndrome after Zadek's osteotomy using a virtual surgical simulation by specific software. The authors hypothesize that the Zadek is an effective technique to decompress the Achilles tendon against the Haglund deformity without major modifications in the alignment. Methods: A total of 20 WBCT scans of patients with IAT were included. The WBCT images were run through the Foot & Ankle module of Disior's BonelogicTM software, creating a 3D virtual model. With this 3D model built into this software, 20 virtual Zadeck osteotomies standardized with a 10 mm resection wedge were performed using the virtual osteotomy module of Bonelogic®. The Calcaneal Inclination angle (sagittal view)7; Talocalcaneal angle (sagittal view)8; Talocalcaneal angle (axial view)8; Saltzman angle (45 degrees view)9; Saltzman angle (20 degrees view)9; Hindfoot moment arm angle;10 Hindfoot angle10; Fowler Philips angle11 and the calcaneal length7 were measured before and after the virtual osteotomy. These results were compared and statistically analyzed. Results: A virtual Zadek osteotomy was realized in 20 WBCT from patients with an insertional Achilles tendinopathy. Most of the patients were female, and the mean age was 55 years. There were significant statistical differences in the average of the calcaneal length (79 mm to 73 mm), Fowler Philips angle (57º to 43º), calcaneal pitch ( 24º to 20º ), sagittal talocalcaneal angle (55º to 47º ), and the hindfoot moment arm angle (20 º to 21,8º). The axial talocalcaneal angle, Saltzman view 45 º and 20 º, and Hindfoot moment arm showed subtle modifications. Conclusion: The virtual analysis of Zadek's osteotomy decreased the Fowler Philips angle, shortened the calcaneus, and modified the alignment in the sagittal view. It suggests that Zadek's procedure reduces the bone impingement with Achilles and the Achilles push. The effect of this osteotomy in Hindfoot Alignment was subtle, modifying only the sagittal plane.
Sex Differences in Muscle Hypertrophy Response to Training of the Peroneus Longus and Peroneus Brevis Muscles
Authors: Tamura Yuki , Urabe Yukio , Maeda Noriaki , Komiya Makoto , Arima Satoshi , Oda Sakura 
Published: December 2023

Category: Ankle; Trauma Introduction/Purpose: It has been reported that there are no significant sex differences in muscle hypertrophy response after strength training for the quadriceps muscles (Roth et al., 2002). After an ankle sprain, the peroneus longus (PL) and peroneus brevis (PB) muscles develop morphological changes and dysfunction, which requires training for the PL and PB (Arima et al., 2022). However, to our knowledge, sex differences in muscle hypertrophic response to the PL and PB training have not been studied. This study aimed to compare the changes in muscle cross-sectional area (CSA) after the PL and PB training between men and women, and to examine the possible influence of sex on the muscle hypertrophy response to training for the PL and PB. Methods: Eighteen healthy adults (9 men and 9 women) were participated. All participants performed two types of ankle eversion training on the right leg with Thera-Band on separate days. PL training in which the Thera-Band was placed on the ball of foot and pushed out from the contact point, and PB training in which the Thera-Band was pushed out from the base of the fifth metatarsal. An ultrasound imaging device was used to measure the CSA of the peroneal muscles at the proximal 25% and distal 75% of the line connecting the fibular head and the lateral malleolus. The measurements were taken before (pre), immediately after (post), 10, 20, and 30 minutes after each training, and the amount of change over time relative to pre was calculated. Unpaired t-tests were used to compare the change in CSA between men and women at each time. Statistical significance was set at 5%. Results: After the PL training, the amount of change in CSA of the PL was significantly greater by 29.7 mm² in women than in men only at post (p < 0.05), but there were no significant differences at other times (10 minutes: p = 0.06, 20 minutes: p = 0.19, 30 minutes: p = 0.11). After the PB training, the amount of change in CSA of the PB was significantly greater by 16.0 mm² at post (p < 0.05) and 3.1 mm² at 30 minutes (p < 0.01) in women than in men. However, there were no significant differences at 10 and 20 minutes (10 minutes: p = 0.27, 20 minutes: p = 0.55). Conclusion: The results indicate that sex differences may influence the immediate muscle hypertrophic response to training for the PL and PB. The immediate muscle hypertrophy response after training is due to edema resulting from muscle damage, reflecting an immediate effect of training (Damas et al., 2016), which suggests that women are more likely to achieve effects of the PL and PB training than men in similar loads. Furthermore, the results also show that the effect of the PB training may be maintained longer in women, thus it is necessary to investigate the long-term effects of the training in the future.