bluuebunny/crossref_metadata_2025_split huggingface dataset:
Black/African Americans Experience Disparate Outcomes after Lower Extremity Orthopaedic Injury Evaluation in U.S. Emergency Departments
Authors: Gupta Arjun , Singh Priya , Badin Daniel , Mo Kevin , Greenberg Marc , Musharbash Farah , Hughes Alice J. , Aiyer Amiethab A. , Ficke James 
Published: December 2023

Category: Trauma; Other Introduction/Purpose: Racial and ethnic disparities remain a major problem in orthopaedic surgery, driving inequitable resource distribution, disparate clinical outcomes, and increased healthcare costs. The objective of this study was to investigate potential racial/ethnic disparities in the incidence and injury patterns of orthopaedic lower extremity trauma (LET) in the U.S. over the last 10 years, as well as differences in final disposition outcomes. Methods: The National Electronic Injury Surveillance System (NEISS) database was queried for all orthopaedic LET presenting to U.S Emergency Departments (ED) from 2010–2020. Incidence rate ratios (IRR) were used to compare incidence rates between racial/ethnic groups at the population level. To compare outcomes specifically among patients with LET, adjusted odds ratios (aOR) were calculated for each racial/ethnic group using multivariate logistic regression. Results: Black/African Americans (Black/AAs) consistently experienced the highest incidence of LET over the ten-year period analyzed (709.108 per 100,000 person-years), followed by Whites (547.159 per 100,000 person-years) (Figure 1). Furthermore, Black/AAs had the highest incidence of polytrauma (114.19 per 100,000 person-years), over 1.7x greater than Whites (IRR: 1.73 [95% CI: 1.72–1.75]). Black/AAs had over 2-fold higher odds of death after LET compared to Whites (aOR 2.15 [95% CI: 1.78– 2.59]) (Figure 2). By 2019–2020, the incidence of deaths among Black/AAs reached more than triple that of Whites (IRR: 3.50 [95% CI: 2.74–4.46]). Black/AAs were also the most likely to be discharged AMA (aOR: 1.94 [95% CI: 1.92–1.96]), and the least likely to be admitted as inpatients (aOR: 0.683 [95% CI: 0.679–0.688]). Conclusion: Despite Black/AAs experiencing a disproportionately higher incidence of LET and over 2-fold greater odds of death compared to Whites, they were also the most likely to be discharged AMA and least likely to be admitted as inpatients. Improved patient education and more effective communication may help ensure that injuries in this patient population are not prematurely discharged, potentially improving clinical outcomes and reducing mortality.
Body Mass Index is a Predictor of Discharge to a Post-Acute Care Facility Following Total Ankle Arthroplasty
Authors: Bakaes Yianni , Gonzalez Tyler , Jackson J. Benjamin 
Published: December 2023

Category: Ankle Introduction/Purpose: The utilization of total ankle arthroplasty (TAA) continues to increase, and identifying preoperative factors that influence postoperative outcomes after TAA may be valuable. The use of post-acute care (PAC) facilities has also grown substantially, and discharge to a PAC facility can increase patient morbidity and postoperative costs. The purpose of this study is to define the effect of BMI on discharge to a PAC facility and hospital length of stay (LOS) following TAA. Methods: We performed a retrospective review to identify a large cohort of adult patients who underwent TAA between 2006 - 2020 from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Using overweight patients as the reference BMI group, we estimated a sex- and age- adjusted log-binomial regression model on BMI categories to estimate risk ratios to analyze the association between BMI and risk of being discharged to a PAC facility and/or hospital LOS. Results: Relative to overweight patients, obese patients had 1.47 times the risk (P=0.008), and morbidly obese patients had 2.26 times risk (P < 0.001) of being discharged to a PAC facility after TAA. Males had 0.47 times the risk of females (P < 0.001), and for each year older, patients had 1.07 times the risk (P < 0.001) of being discharged to a PAC facility. There was no difference in hospital LOS for underweight patients, but healthy weight patients stayed an additional 0.29 days (P=0.004), obese patients stayed an additional 0.18 days (P=0.010), and morbidly obese patients stayed an additional 0.34 days (P=0.006). Males stayed 0.30 fewer hospital days than females (P < 0.001), and for each year older, patients stayed 0.011 days longer (P < 0.001). Conclusion: This study found that women and patients who are obese and morbidly obese have a greater LOS and chance to be discharged to a PAC facility. Increasing age is also associated with an increase in LOS and discharge to a PAC. These may be important factors when discussing the postoperative plan with patients prior to TAA.
Casting is a Cost-Effective Management Option in Appropriate Cases of Charcot Neuroarthropathy
Authors: Shehaj Andrea , Dopke Kelly , Mansfield Kirsten N. , Saloky Kaitlin L. , Stauch Christopher , Ozdemir Erdi , Aynardi Michael 
Published: December 2023

Category: Diabetes; Midfoot/Forefoot Introduction/Purpose: Charcot Neuroarthropathy (CN) is a chronic and debilitating condition that impacts the nerves of the foot. The progression of CN may result in severe joint deformities, ulcers, and amputation in certain cases. Treatment options for CN include surgical interventions (e.g., arthrodesis, exostectomy, and amputation) and non-surgical interventions (e.g., casting). A cost analysis on the various treatment modalities can guide physicians to help their patients make informed decisions about their care. Here, we aim to characterize the total costs associated with the various treatments of CN, in addition to the physical therapy (PT) related costs. Methods: Following IRB approval, a sample of patients at a single institution diagnosed with CN of the lower extremity, who underwent exostectomy, arthrodesis, amputation, and/or casting were identified through patient records. Various demographics such as age, sex, and race were collected. Individuals were placed in their respective categories based on the first procedure they had performed. The groups were divided as follows: exostectomy, arthrodesis, major amputation, minor amputation, casting, and failed casting (the group that first received casting but later needed further intervention with other treatment modalities). Each procedure and PT appointment was counted toward the total cost. Descriptive statistics, t-tests, and one-way ANOVA were performed for statistical analysis. Results: Two-hundred and sixteen patients were identified; exostectomy (n = 81), arthrodesis (n = 47), major amputations (n = 10), minor amputations (n = 28), failed casting (n = 16), and casting (n = 34). The average age was 58 ± 12.1 years, and males accounted for 54% of the sample size with the various demographic information depicted in table 1. The effect of procedure type on total cost demonstrated a statistically significant difference between at least two groups (F-value = 18.53, p-value < 0.01), as demonstrated in figure 1. The total costs for casting were significantly lower than all other treatment modalities (p-value < 0.05). Furthermore, there was no statistical significance related to physical therapy costs among the groups (figure 2). Conclusion: Casting was demonstrated to be a more cost-effective management strategy for patients diagnosed with CN. However, it is important to note that this cost-related benefit is only apparent when CN patients are appropriately treated with casting, exemplified by the failed casting group. It is critical to utilize casting with appropriate patients in order to reduce the cost burden associated with these various management modalities. Early surgical intervention should still be strongly considered for patients who are not appropriate candidates for casting.
Characterization of Motor Performance in 200 Normal Ankles Through Isokinetic Evaluation
Authors: Maciel Eduard Souza , Fonseca Lucas , Mansur Nacime Salomao Barbachan , Netto Cesar de Cesar , Inojossa Thiago , Astur Diego 
Published: December 2023

Category: Ankle; Sports Introduction/Purpose: The isokinetic test has been used diffusely as a way to evaluate the functional results after the rehabilitation of musculoskeletal injuries. In the ankle, in particular, most studies are related to lateral ligament injuries and Achilles tendon’s injuries. However, different protocols are used and a lack of normative values is observed in the literature. The aim of this work is to perform a global isokinetic evaluation on healthy ankles in order to propose reference values for future patients. Methods: We evaluated 100 participants (200 ankles) using the Biodex 3 System for the eversion, inversion, dorsiflexion and plantar flexion movements of the ankle. The sample consisted of individuals aged 20-60 years, with an active life and practice of recreational physical activity (non-athlete) and without previous injuries. Five repetitions for strength (N / m) and work (J) at a speed of 30º / sec and 10 repetitions for power (W) at a speed of 120º / sec were performed in our protocol. Agonist / antagonist ratio and the Muscle Deficiency Index, which globally assesses the balance between the sides for each movement, were also evaluated, as well as the demographic variables. Different statistical analyzes were performed for each parameter. Results: The mean age was 38.5 years and BMI 25.8 in 69 men and 31 women. In 78 participants, the dominant ankle was the right one. The non-dominant side was consistently stronger in all movements (p < 0.001). The mean values obtained for force in each movement were 29.9N/m for eversion, 34.8N/m for inversion, 48.6N/m for dorsiflexion and 140.2 N/m for plantar flexion. Such parameters for men and women were also obtained (p < 0.001) and there was no correlation between age or BMI with the maximum torque through Spearman's Correlation. The ratio of eversors/inverters was 88.8% and that of dorsiflexors/plantar flexors was 36.1%. The Muscle Deficiency Index showed a balance between the sides for each movement, with an average global difference of less than 10% between them. Conclusion: As far as we know, this is the largest isokinetic assessment of normal ankles ever performed. The sample, although not stratified, was considered homogeneous (coefficient of variation < 50%), which allows to propose several normative values for a non-athlete population in the isokinetic evaluation. It would be interesting to compare these data in the future with the functional results in patients after the treatment of certain injuries.
Classification of the Os Calcis Subtalar Morphology in Symptomatic Flexible Pediatric Pes Planus Deformity Using Weight-Bearing CT and Distance Mapping
Authors: Efrima Ben , Barbero Agustin , Indino Cristian , Maccario Camilla , Ovadia Joshua , Usuelli Federico Giuseppe 
Published: December 2023

Category: Basic Sciences/Biologics; Hindfoot Introduction/Purpose: The etiology of symptomatic pediatric pes planus (PP) deformity, is unclear. Reduced os calcis subtalar joint (OCST) anterior facet morphology has been suggested to result in less support to the talar head and a higher propensity to develop PP deformity. Weight Bearing Computed Tomography (WBCT) and Distance Mapping (DM) offer new opportunities to investigate PP deformity and the OCST specifically. The purpose of this study is to examine the OCST morphology using DM and to classify PP subtalar subtypes with DM using Bruckner's A-D classification system. Methods: Forty feet in 25 patients in a national referral center were evaluated for symptomatic PP deformity that failed nonoperative treatment. A WBCT scan was performed as part of the preoperative evaluation. Visualization of the distance distribution between the articulating surfaces of the subtalar joint was based on a DM technique. Intra- and interobserver agreement of the subtalar morphology was assessed using Bruckner's classification system. Results: The mean age was 10.7 ± 1.4 years. The following mean ± s.d and median +-ranges. Measures were semiautomatically measured for this group: Meary’s angle -21 ± 8, calcaneal inclination 15 ± 4 degrees, talar coverage angle 39 (range 32.6- 49) degrees, and hind-foot moment-arm 16 ± 5 millimeters. Classifying subtalar morphology using DM yielded an excellent intra- and interobserver agreement.The individual percentages of each individual subtype were calculated; type A 5%, type B 38%, type C 4%, type D in 44%. Conclusion: This study demonstrated excellent intraobserver and interobserver agreement in classifying the OCST using DM. A higher prevalence of types B and D were observed compared to types A and C in this PP cohort.
Clinical Outcomes of Insertional Achilles Tendinopathy Patients Treated with Reattachment and Dorsal Closing Wedge Calcaneal Osteotomy: A Meta-analysis
Authors: Karaismailoglu Bedri , Subasi Omer , Sharma Siddhartha , Peiffer Matthias , Guss Daniel , Kwon John , DiGiovanni Christopher W. , Ashkani-Esfahani Soheil 
Published: December 2023

Category: Hindfoot; Sports Introduction/Purpose: Posterior heel pain at the Achilles tendon insertion is a prevalent and debilitating condition that is not yet fully understood. It results from a combination of bony and soft tissue abnormalities, including insertional Achilles tendinopathy, retrocalcaneal bursitis, and posterosuperior bony prominence. While the most commonly used surgical technique for treatment is debridement and reattachment of the tendon, dorsal closing wedge calcaneal osteotomy (DCWCO) has recently gained popularity. In this meta-analysis, we aimed to analyze the published literature related to both surgical techniques and compare their outcomes. Our hypothesis was that DCWCO can provide similar clinical outcomes with a lower complication rate. Methods: We conducted a literature search in Medline, Embase, and Scopus databases. Clinical studies reporting at least one of the clinical outcomes among AOFAS score and complications, with an open technique and sufficient data to extract and pool, were included. The extraction was made by two users using the Covidence platform. Studies with less than 10 patients or less than 12 months follow-up were excluded. Initial search yielded 329 papers, and after excluding duplicates and irrelevant studies, 43 papers were left. After a full-text review of these 43 papers, we found 15 papers eligible for meta-analysis. We used the Modified Coleman Methodology to assess the quality of papers. Results: Out of the 15 articles, seven included reattachment patients, while eight included DCWCO patients. 171 feet underwent reattachment, while 239 feet underwent DCWCO. The average follow-up of patients was significantly higher in the DCWCO group (42.2 months) than reattachment group (23.2 months). The average AOFAS score improvement was similar between the groups. The total complication numbers were 30 (16.6%) in the reattachment group and 28 (9.2%) in the DCWCO group, but the difference did not reach significance since the confidence intervals were overlapping. However, wound complications were significantly more common in Reattachment group (10.1%) compared to DCWCO (2.5%). The number of revision surgeries and neurological complications (sural neuritis, hypersensitivity, etc.) were similar between the groups. The average AOFAS score improvement was similar between the groups. Conclusion: Both techniques yielded comparable clinical outcomes. The overall complication rate was similar, but DCWCO exhibited a lower wound complication rate than reattachment. Therefore, the study results imply that DCWCO can provide similar clinical outcomes with fewer wound complications. However, further well-designed studies are necessary to reach a definitive conclusion on this matter and compare both techniques in the same study setting.
Comparison of Clinico-Radiographic Outcome of the 3-Component Salto Total Ankle Arthroplasty According to Degree of Ankle Varus Deformity for End-Stage Ankle Arthritis
Authors: Lim Jung-Won , Jung Hong-Geun , Im Je-Min 
Published: December 2023

Category: Ankle Arthritis Introduction/ Purpose: As the popularity of total ankle arthroplasty (TAA) increases, indication of TAA also expands. Recently, the ankles more than 20º of varus or valgus deformity in the coronal plane are treated with TAA. Commonly, patients with ankle osteoarthritis have preoperative varus deformity. However, preoperative varus deformity should be corrected in the coronal plane to avoid residual mal-alignment that leads to instability, insert wear, and clinical failure. In this study, we compare the clinical and radiologic outcome of the Salto mobile bearing 3-component total ankle prosthesis for ankles according to preoperative degree of ankle varus deformity. Methods: TAA was performed in 106 ankles using 3-component Salto total ankle implant from June 2014 to October 2019. A prospectively collected database was used to identify all patients who underwent primary TAA with a minimum 1-year follow-up. All patients were followed up at postoperative three months, six months, at one year and yearly thereafter. Clinical outcome scoring was done pre-operatively and post-operatively. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot functional score, pain VAS, satisfaction score and clinical range of motion (ROM) were collected along with weight-bearing radiographs of the ankle. Post-operative coronal alignment of the component were evaluated with radiographs. More than 10º of tibial anterior surface angle, talta tilt angle (TTA), tibial axis-talar dome angle (T-TDA), talar dome-ground surface angle (TD- GSA), or tibio-calcaneal angle (TCA) was defined as varus deformity. We classified the enrolled ankles as neutral ( < 10 º), moderate varus (10º~20º), and severe varus groups (>20º). Results: The average follow-up was 21.9 months (range, 12-72). Preoperatively, there were 37 ankles (35%) with neutral alignment, 48 ankles (45%) with moderate varus deformity, and 21 ankles (20%) with severe varus deformity. There were no significant differences in mean pain VAS, AOFAS score, and ROM among the groups (p > 0.05). Overall satisfaction rate (more than satisfied) was 87%, and no significant differences were found among the groups. As to radiographic alignment, there were no significant differences among the groups in T-TDA and TD-GSA (p > 0.05). Concomitant additional procedures such as deltoid release, calcaneal osteotomy, and first tarsometatarsal dorsiflexion arthrodesis were more significantly performed in preoperative varus groups. Conclusion: There was no significant difference in clinical and radiographic outcomes a according to degree of ankle varus deformity in the TAA series using single Salto 3-componenet implant. Postoperative neutral alignment was achieved in all ankles. For favorable long-term outcomes, coronal alignment should be corrected with proper additional procedures in TAA.
Comparison of Outcomes Between Fixed and Mobile-Bearing Total Ankle Arthroplasty: A Systematic Review and Meta-Analysis
Authors: Butler James J. , Chin Lana-Kailey , Konar Kishore , Randall Grace W. , Azam Mohammad T. , Walls Raymond J. , Kennedy John G. 
Published: December 2023

Category: Ankle Arthritis; Other Introduction/Purpose: End stage ankle osteoarthritis is a significantly debilitating pathology that is most commonly preceded by trauma. The emergence of 3rd and 4th generation total ankle arthroplasty (TAA) implant designs have led to more favorable outcomes compared to its predecessors. TAA implants can be broadly divided into fixed bearing and mobile bearing implant designs, however, no consensus has been reached regarding the optimal TAA implant design for the management of end stage ankle arthritis. The purpose of this systematic review and meta-analysis was to compare outcomes between patients who received fixed bearing TAA implants and mobile bearing TAA implants. Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies comparing outcomes between patients who underwent fixed bearing TAA implant and patients who underwent mobile bearing TAA implant for the management of end stage ankle arthritis. Data regarding surgical characteristics, subjective clinical outcomes, radiographic outcomes, failure rates and complications were extracted and analysed. Results: Overall, 13 studies were included in this review. In total, 2793 patients underwent mobile bearing TAA implant and 2241 patients underwent fixed bearing TAA implant for the management of end stage ankle arthritis. No difference existed between the 2 cohorts with regards to post-operative subjective clinical outcome scores nor radiological outcomes. The mobile bearing TAA implant cohort was associated with higher complications (RR = 1.4710; [1.0375-2.0857]; p = 0.0373) and failures (RR = 1.3916; [1.2038 - 1.6086]; p = 0.0032) compared to the fixed bearing TAA implant cohort. Conclusion: This systematic review and meta-analysis found no difference in subjective clinical outcomes and radiological outcomes between patients who underwent mobile bearing TAA implant and fixed bearing TAA implant for the management of ankle arthritis. Interestingly, the mobile bearing TAA implant cohort was associated with higher complications and failures compared to the fixed bearing TAA implant cohort. Due to the marked under-reporting of data and significant heterogeneity between the included studies, further high quality research is warranted to determine the optimal TAA implant type for the management of end stage ankle arthritis.