bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between Socioeconomic Status and Increased Postoperative Emergency Department Utilization following Ankle Fracture Surgery
Authors: Ogawa Takahisa , Kwon John , DiGiovanni Christopher W. , Guss Daniel 
Published: December 2023

Category: Trauma; Ankle Introduction/Purpose: There is a paucity of literature regarding the effect of socioeconomic disparity on patient access to health care following surgery for acute musculoskeletal injuries. We hypothesized that lower socioeconomic status (SES) is independently associated with increased utilization of the emergency department (ED) for care, and less reliable outpatient follow up after ankle fracture surgery. Methods: A retrospective analysis was performed of 1,571 patients who underwent ankle fracture surgery between 2010 and 2020 at three large academic medical centers and one community hospital. Using 2010 United States Census data linked to place of residence, a summary measure of SES was created for each zip code. SES was divided into three percentile groups: 0-25%, 26-75% and 76-100%, wherein the 0- 25% group represented the lowest SES score. Independent patient and injury factors associated with ED visits and outpatient in-office follow up within 90 days of ankle fracture surgery were examined using multivariable Poisson regression models. Results: Patients in the lowest quintile of SES had a higher incidence of ED visits within 90 days after surgery (adjusted incidence ratio [aIR], 1.54, p< 0.001). Patients in the highest quintile of SES had a higher frequency of outpatient follow up within 90 days after surgery (aIR, 1.23, p< 0.001) compared to those in the middle SES quintile. Independent factors associated with increased ED visits following ankle fracture surgery were lower SES, lateral malleolus fracture, heightened comorbidities, increased BMI, Spanish-speaking patients, and patients with drug and/or alcohol dependence. Conclusion: Patients of lower socioeconomic status, those with substance use disorders, and those who must overcome language barriers to seek care demonstrate higher emergency resource utilization and are less likely to follow up in clinic after ankle fracture surgery. A better understanding of patient and injury factors associated with such increased ED visits may provide guidance as to which patient subpopulations may require more attention after ankle fracture surgery.
Biomechanical Comparison of Open vs Percutaneous Techniques for Primary Mid-Substance Achilles Tendon Repair: A Systematic Review and Meta-Analysis
Authors: Lawson Jonathan , Sequeira Sean , Imbergamo Casey , Guyton Gregory P. , Hembree Walter C. , Gould Heath P. 
Published: December 2023

Category: Hindfoot; Basic Sciences/Biologics Introduction/Purpose: Primary repair of mid-substance Achilles tendon rupture may be performed using an open or a percutaneous technique. Previous meta-analyses of clinical data comparing the two techniques have demonstrated mostly equivalent functional outcomes and re-rupture rates. Individual cadaveric studies have also compared the biomechanical properties of the two approaches. However, the results of these studies have been heterogeneous, and there is currently no consensus as to whether one technique may be biomechanically superior. The purpose of this meta-analysis was to evaluate the biomechanical properties of open versus percutaneous Achilles tendon repair. Methods: A systematic review of original research articles was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. To qualify for study inclusion, articles were required to be published in English, utilized a cadaveric laboratory design, and had to directly compare the biomechanical properties of open Achilles repair using a Krackow or Kessler technique versus percutaneous repair using either the PARS (Arthrex) or Achillon (Integra) tendon repair systems. Evaluated outcomes included displacement (mm), load to failure (N), and stiffness (N/m). Results: Nine studies met inclusion criteria, including 190 cadaveric specimens (open: 83, PARS: 56; Achillon: 51) that underwent primary mid-substance Achilles tendon repair. Pooled analysis demonstrated no statistically significant difference in displacement (p = 0.418; Figure 1), load to failure (p = 0.923; Figure 2), or stiffness (p = 0.195; Figure 3) between the open and percutaneous techniques. Among the percutaneous approaches, there was no difference in displacement (p = 0.109; Figure 4) between the PARS and Achillon tendon repair systems. Conclusion: The results of this study suggest that both open and percutaneous techniques are biomechanically viable approaches for primary mid-substance Achilles tendon repair. These biomechanical findings must be interpreted in the context of clinical outcomes data as well as the differing complication profiles of the two techniques to best inform the surgical decision-making process for primary mid-substance Achilles tendon repair.
Can the Contralateral Ankle be used for Preoperative Planning in Total Ankle Arthroplasty in the Posttraumatic Patient? A Prospective Study
Authors: Barbero Agustin , Efrima Ben , Maccario Camilla , Indino Cristian , Ovadia Joshua , Usuelli Federico Giuseppe 
Published: December 2023

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle arthroplasty (TAA) for posttraumatic osteoarthritis (OA) is becoming an increasingly popular treatment option. Clinical results and prosthesis longevity correlate directly with the hind foot and components' postoperative alignment. Therefore, a preoperative plan (PROP) that can accurately predict postoperative alignment of TAA could be valuable. Most PROPs use the diseased ankle as a reference despite the arthritic deformation. PROPs of the contralateral, unaffected limb have been tested in other fields, but not in TAA. In most cases of posttraumatic OA, the contralateral ankle is relatively preserved and therefore could serve as a valuable tool for preoperative planning. This prospective study aims to assess the accuracy of preoperative planning using a WBCT of the contralateral healthy ankle for TAA in the treatment of posttraumatic OA. Methods: A total of 44 patients were included. For each case, a preoperative WBCT scan of the contralateral foot was acquired. Individual PROPs consisted of virtual realignment and osteotomies prior to each surgery. After surgery, postoperative WBCT scan of the affected foot was performed. Six angles were used to assess the accuracy of the coronal and sagittal alignment of the prosthesis. Results: Forty-four ankles across 44 patients were operated on. Three angles had a statistically significant difference between the pre and postoperative measurements: (1) α angle was -3±4 degrees (p-value < 0.0001), (2) TTS 2.884±4 degrees (p-value < 0.00001), (3) TTR -7±14 mm (p-value < 0.001). Only 49% and 34% of the coronal and sagittal angles could be found within 3 degrees from the PROPs. Conclusion: In conclusion, the contralateral ankle cannot be used accurately as a preoperative planning tool for TAA. It should be used only in cases where the diseased ankle cannot be a referenced in the setting of deformation.
Chevron vs Oblique Medial Displacement Calcaneal Osteotomy - Which Is More Stable? Results From a Finite Element Analysis Study
Authors: Subasi Omer , Sharma Siddhartha , Karaismailoglu Bedri , Ashkani-Esfahani Soheil , Bejarano-Pineda Lorena 
Published: December 2023

Category: Hindfoot; Ankle Introduction/Purpose: The medial displacement calcaneal osteotomy is used to correct hindfoot valgus in adult-acquired flatfoot disease(AAFD). This is done by means of an oblique cut, which is then translated medially. The chevron variant of the MDCO has gained popularity in recent times. This osteotomy involves a V-cut, with the apex of the V placed anteriorly. This is thought to be inherently more stable than the conventional MDCO owing to its geometrical design and higher contact area, especially with higher magnitudes of translation of the osteotomized fragment. However, it is technically more demanding, and many surgeons may not be familiar with the technique. Moreover, there is no literature comparing the stability of the chevron and oblique MDCO. Hence, we conducted this study to address this knowledge gap. Methods: Computed Tomography (CT) scan of the foot of a patient diagnosed with Johnson stage 2 AAFD was segmented and converted into a 3D computational model. Subsequently, oblique and chevron (160o V-angle) calcaneal osteotomies were performed virtually. For each variant, the osteotomized fragment was translated medially by 8-, 10- and 12-mm and then fixed virtually with two 6.5 mm screws. The six models were imported into a Finite Element Software (ANSYS v19) and subjected to 500 N axial loading through the tibia to simulate a single-leg stance. The von Mises stresses at the osteotomy interfaces and the screws, and the total displacement of the posterior fragment was recorded for each model. Results: The compiled simulation results are presented in Table 1. For both osteotomies, the overall stresses at the osteotomy contact site and the screws increased incrementally with increasing medial translation. Similarly, sagittal plane displacement of the anterior fragment was noted to follow a similar trend. Across all translation levels, the stresses were recorded to be lower for chevron MDCO when compared to the oblique variants. Relative fragment displacement was also noted to be lower for the chevron MDCO. Conclusion: The chevron osteotomy results in lower contact stresses and osteotomy fragment displacement and may prove to be a more stable alternative to the oblique MDCO. However, these results need to be replicated in a larger cohort of patients, as well as in cadaveric studies to determine if surgeons can permit early weight-bearing with the chevron MDCO.
Corrective Distal Tibio-Fibular Osteotomy for Medial Ankle Osteoarthritis: Consecutive 67 Cases, Prognostic Factors and 3B Cases Outcomes Evaluation
Authors: Im Je-Min , Lim Jung-Won , Jung Hong-Geun 
Published: December 2023

Category: Ankle Arthritis; Ankle Introduction/Purpose: Supramalleolar osteotomy is a considerable technique for medial compartment ankle arthritis as a joint preservation and has been shown to be effective in several studies The indication for supramalleolar osteotomy is generally presented as early and mid-stage arthritis (Takakura stage 2 or 3A), and there is much arguments about the application of stage 3B. This study analyzes the results of suprmalleolar osteotomy performed in patients with Takakura stage 3B arthritis and seeks to identify factors that influence clinical outcomes. Methods: From August 2007 to May 2021, a total of 67 cases in which tibio-fibula osteotomy were performed for medial compartment arthritis of the ankle joint. We analyzed 67 cases and 19 cases of 3B stage before surgery which were possible for at least on year follow-up. Clinical assessments assessed VAS score, AOFAS score, and ROM, and radiological assessment assessed TAS angle, TLS angle, Talar tilt, and Contact surface percentage. Results: VAS pain scores improved from 6.6(3-9) to 2.3(0-6), AOFAS scores improved from 56.6(20-87) to 85.1(66-100), and ROM DF/PF improved from 15.3/30.6 to 16.7/34.6 degrees, which was not significantly different from the Takakura stage 2 or 3A group performed in this center at the same time. The preoperative and final follow-up TAS angle was 2.5 degrees overcorrection, from 84.7 to 97.2, and the TLS angle changed from 77.6 to 81.5. The talus tilt improved from 9.1 to 6.8 degrees, which was higher than in the Takakura stage 2 or 3A patient group. Except one case, All cases obtained bone union, with an average duration of 7.5 (3-12) months. And we found contact surface percentage help us anticipate possibility of correction and clinical outcomes. Conclusion: Compared to stage 2 or 3A, the results of supramalleolar osteotomy in Takakura stage 3B patients showed radiologically TAS overcorrection and higher talar tilt angles, but clinically there was no significant difference and showed good results. Therefore, it is believed that even in advanced medial compartment ankle arthritis at stage 3B, it may be a selectively good indication for supralleolar osteotomy.
Do Syndesmotic Injury Patterns Influence Functional and Radiological Outcomes in Complex Ankle Fractures? A Retrospective Cohort Study
Authors: Patel Sandeep , Dhillon Mandeep S. , Sharma Siddhartha , Nishani Manjunath 
Published: December 2023

Category: Ankle; Trauma Introduction/Purpose: Syndesmosis injury can be of a varying magnitude; little information exists about the influence of degree of initial syndesmotic injury/instability on functional outcomes in ankle fractures, nor is there any correlation of this with follow up radiological parameters. Aims and Objectives: To identify and define morphological patterns of syndesmotic injury in ankle fractures according to a zone based evaluation, and correlate initial degree of instability with mid-term functional and radiological outcomes using validated scores Design: Retrospective cohort study, to review a prospective question. Methods: 40 complex ankle fractures out of 120 ankle fractures in our ankle registry met the inclusion criteria ie significant documented syndesmosis involvement needing stabilization, with all initial clinical and radiological records available. The patients were followed up between January 2020 to July 2021. Injury characteristics, fracture morphology of posterior malleolus, medial malleolus and fibula were noted and classified by validated classification systems based on x-rays and CT scan. The syndesmosis was analyzed on axial CT scan; it was divided into 3 zones, A,B,C from anterior to posterior, and degree of displacement and morphology was noted. Immediate post-operative radiographs were evaluated for fracture and syndesmosis reduction. The patients were evaluated at final follow up with both ankle specific scores (Olerud Molander score, Ankle-Hindfoot scale, Manchester-Oxford Foot questionnaire) and quality of life score (SF-12). Ankle Osteoarthritis grade was used to evaluate radiological outcomes. Results: Mean follow-up was 19 months. 22(55%) patients had syndesmotic widening on plain radiographs; however in pre- operative CT scan evaluation 40(100%) patients had syndesmotic injury based on the Zone evaluation of the syndesmosis. 22 patients had Zone A injury (widening, AITFL, Chaput, Wagstaff). 22 patients had widening of Zone B. Zone C was involved in 30 patients (PM fracture,PITFL involvement). At final follow up; the mean OMAS was 83.38±16.35, mean Ankle-Hindfoot scale= 88±9.98, mean Mox-FQ score=27.15±13.35 & mean SF-12 were (MCS=56.59±8.24, PCS=51.18±8.48). There was no significant difference in outcome scores based on fracture types, Posterior malleolus morphology, or based on zones of syndesmosis injury. Syndesmosis malreduction contributed to significantly poorer outcomes (SF-12, OMAS, MoxFQ) Conclusion: Despite a zonal classification of syndesmotic injury on CT and more clarity of injury patterns, we could not corelate the site and extent of syndesmotic injury with final functional and radiological outcomes. The one factor that has significant influence is initial accurate reduction of both the malleolar fractures and syndesmosis injury. In this the CT based axial classification may play a role.
Does Suture Type or Configuration Matter in Percutaneous Achilles Tendon Repairs?
Authors: Benner Nathan , Branam Grant , Chin Kenneth , Telfer Scott , Keller Hana 
Published: December 2023

Category: Trauma; Sports Introduction/Purpose: The human Achilles tendon is functionally important for dynamic activities and is a common site of injury, resulting in pain, weakness, and removal from sport. While treatment options vary and the opinions regarding optimal management are not uniform, percutaneous repair through commercially available guides is one option that has been used in the United States. The purpose of this study was to test the mechanical properties of four suture permutations. Methods: This biomechanical study included Porcine toe flexor tendons as an analogue for the human Achilles tendon. Simulated rupture was performed and tendons repaired using a percutaneous guide. Technique was uniform with pre-determined allotment into one of four groups based on suture configuration (single or double locked) and type (round or flat) with a total of 10 specimens in each group. Specimen then underwent static creep test, a dynamic load creep test, and finally load to failure test. An analysis of variance test was performed, followed by pairwise comparisons using independent t-tests to assess inter-group differences if significant effects were found, adjusted for multiple comparisons. Results: No significant differences were seen between conditions for the creep tests. The suture configuration used was determined to have a significant effect on the maximum load to failure of the constructs (p = 0.018) and maximum stress in the construct during the load to failure test (p = 0.019). Double Tape had a significantly greater load to failure than the Single Round (66N (0.021, [25, 107]) and Single Tape (72N (0.037, [18, 126]) conditions, and reached greater stresses before failure (0.1N/mm^2 (0.04, [0.03, 0.17] and 0.1N/mm^2 (0.04, [0.02, 0.18], respectively). No significant differences were found between the double tape and double round techniques, nor the Double Round and either of the Single techniques for any of the load to failure variables. Conclusion: Currently, there is no compelling data to support surgical over non-surgical management of Achilles tendon ruptures. However, by patient or surgeon preference, many patients undergo operative intervention, and percutaneous repair through a guide is a popular modality. The results of this study, using a porcine model to simulate a minimally invasive technique for Achilles tendon repairs, suggest that the use of a double locked tape suture configuration leads to a stronger overall construct. The clinical implications of these findings will be the subject of future work.
Effect of Tibial Cortex Transverse Transport in Patients with Recalcitrant Diabetic Foot Ulcers: A Prospective Multicenter Cohort Study
Authors: Hua Qikai , Zhao Jinming 
Published: December 2023

Category: Diabetes; Other Introduction/Purpose: Management of recalcitrant diabetic foot ulcer (DFU) remains difficult. Distraction osteogenesis mediates new bone formation and angiogenesis in the bone itself and the surrounding tissues. Recently it was reported that tibial cortex transverse transport (TTT) was associated with neovascularization and increased perfusion at the foot in patients with recalcitrant DFUs and facilitated healing and limb salvage. However, the findings were from several single-center studies with relatively small populations, which need to be confirmed in multicenter cohort studies with relatively large populations. Furthermore, the effect of this technique on patient's health-related quality of life is still unclear. Methods: We treated patients with recalcitrant (University of Texas wound grading system 2-C to 3-D and not responding to prior routine conservative and surgical treatments for at least 8 weeks) DFUs from seven centers using TTT (a 5 cm 1.5 cm corticotomy followed by 4 weeks of medial and lateral distraction) between July 2016 and June 2019. We analyzed ulcer healing, major amputation, recurrence, health-related quality of life (physical and mental component summary scores), and complications in the 2-year follow-up. Foot arterial and perfusion changes were evaluated using computed tomography angiography and perfusion imaging 12 weeks postoperatively. Results: A total of 1175 patients were enrolled. Patients who died (85, 7.2%) or lost to follow-up (18, 1.7%) were excluded, leaving 1072 patients for evaluation. The mean ulcer size was 41.0 8.5 cm2 and 187 (16.6%) ulcers extended above the ankle. During the follow-up, 1019 (94.9%) patients healed in a mean time of 12.4 5.6 weeks, 53 (4.9%) had major amputations, and 33 (3.1%) experienced recurrences.Closed tibial fracture at the corticotomy site was found in 8 (0.7%) patients and was treated using external fixation and healed uneventfully.Compared to preoperatively, the patients had more small arteries and higher foot blood flow (8.1 2.2 versus 28.3 3.9 ml/100 g/min, p ¼ 0.003) and volume (1.5 0.3 versus 2.7 0.4 ml/100 g, p ¼ 0.037) 12 weeks postoperatively. Conclusion: TTT promotes healing, limb salvage, and health-related quality of life in patients with recalcitrant DFUs as demonstrated in this multicenter cohort study. The surgical procedure was simple and straightforward and the complications were few and minor. The effect of this technique was associated with neovascularization and improved perfusion at the foot mediated by the cortex distraction. The findings are required to confirm in randomized controlled trials.
Intra-Articular Calcaneus Osteoid Osteoma With an Ankle Varus and a Red-Brown Synovial Fluid in the Affected Joint, a Case Report
Authors: Ngo Dat Quoc , Cao Thi 
Published: December 2023

Background: Only one article described ankle varus as a typical symptom in the late stage of the intra-articular osteoid osteoma of the calcaneus. And the red-brown color of synovial fluid in the affected joint hasn’t been reported. This report shows a patient with intra-articular osteoid osteoma of the calcaneus who had the 2 above symptoms. Case presentation: A 39-year-old man had left ankle pain and the diagnosis was delayed for 20 months. At the late stage, the ankle was gradually varus. In our hospital, the withdrawal of the subtalar joint gave a red-brown synovial fluid. Together with the typical lesion on MRI, the diagnosis of intra-articular osteoid osteoma of the calcaneus was made. An open operation was performed for treatment. In the procedure, the red-brown synovial fluid was exuded. A specimen was harvested for biopsy confirming osteoid osteoma. Conclusions: It is still essential that intra-articular calcaneal osteoid osteoma should be considered in patients with prolonged pain and varus of the ankle. The red-brown synovial may be used as a finding for diagnosis.