bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complications and Radiographic Outcomes of Operatively Treated Navicular Fractures
Authors: Johnston Thomas R. , Donley Connor , McCormick William , Schick Samuel , Johnson Michael 
Published: December 2023

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Navicular fractures are uncommon foot fractures and there is scarce literature exploring the complications and radiologic outcomes of these fractures. The aim of this study is to examine fracture patterns and surgical data to see the effect they have on complications and radiographic outcomes after open reduction internal fixation of the navicular. Methods: A retrospective study was performed to identify patients who underwent operative treatment of a navicular fracture over a nine-year period (2013-2022). Patients were screened by review of CPT codes that included tarsal fractures and imaging review was used to identify those with navicular fractures. Minimum follow-up for inclusion was 6 months. Patient demographics were recorded and radiographs were reviewed and fractures were classified per the Sangeorzan and Schmid classification systems. Surgical data including approach(es), implants, and supplemental fixation was recorded. Postoperative radiographs were assessed for the presence of union, avascular necrosis, foot collapse, and arthritis. Complications defined as infection, unanticipated reoperation, and amputation were recorded. Results: 38 patients met inclusion criteria. 8 patients had a postoperative complication (21.1%). There was 1 superficial infection (2.6%) and 7 patients needed unanticipated reoperations: 2 (5.3%) for wound dehiscence, two (5.3%) for secondary arthritis, and 3 for symptomatic hardware removal (7.9%). Radiologic outcomes consisted of 7 cases of TNJ arthritis (18.4%), 6 cases of avascular necrosis (15.8%), and 7 cases of foot collapse (18.4%). There were significantly increased rates of TNJ arthritis in Schmid type III navicular fractures compared to type I and II (7 vs 0 vs 0, respectively; p=0.021), with 35% of Schmid type IIIs going on to develop TNJ arthritis. The need for reoperation of the navicular was increased if patients required a TNJ spanning construct [2 (50%) vs 2 (5.9%), p=0.007]. Conclusion: Navicular fractures that require ORIF have a high complication rate and a likelihood of developing suboptimal radiographic outcomes. We found that patients who dislocate their TNJ (Schmid Type-III), had an increased rate of TNJ arthritis which likely stems from the more severe nature of the injury, the keystone role of the navicular and the instability present across Chopart’s joint. For patients requiring a TNJ spanning construct there was an increased risk for unanticipated reoperation likely due to the size and nature of the spanning construct hardware. Patient education on these risk factors will guide treatment options and set proper expectations.
Conservative Treatment Outcomes for Achilles Tendon Re-Rupture Occurring in the Subacute Phase after Primary Repair
Authors: Choi Jun Young , Suh JinSoo , Kim Min Jin 
Published: December 2023

Category: Ankle; Sports Introduction/Purpose: Achilles tendon re-rupture (ATRR) during the subacute postoperative phase is the rupture of the repaired site combined with suture material failure induced by an unexpected traumatic event during postoperative months one to three after primary Achilles tendon repair. This study aimed to determine the effectiveness of conservative treatment for subacute ATRR. Methods: We retrospectively reviewed 390 cases (385 patients) who underwent primary Achilles tendon repair between January 2010 and August 2021. All patients had more than 12 months of follow-up and were divided into two groups based on the development of subacute ATRR (Group 1: 370 cases without ATRR; Group 2: 20 cases with ATRR). Then, we compared several outcome parameters between the groups after administering conservative treatment to those with ATRR. The baseline timepoints in Groups 1 and 2 were the primary repair and re-injury dates. Results: After primary Achilles tendon repair, 5.13% of patients experienced subacute ATRR. The time to performing a single heel raise (SHR) and performing ten repetitive SHRs did not differ between the groups (P = 0.281, 0.486). Likewise, isokinetic dynamometer results showed that the peak torque of 30o/s and 120o/s plantar flexions (the absolute value and the percentage to the contralateral side) also did not differ between the groups (P >0.05, each). However, the early Achilles tendon Total Rupture Score scale and the Foot and Ankle Ability Measure scores before six months were significantly lower in Group 2 than in Group 1 (both P < 0.05); at 12 months, the scores did not differ between the two groups (both P >0.05). Conclusion: Conservative treatment for subacute ATRR after primary Achilles tendon repair has comparable clinical outcomes to those without ATRR.
Deltoid Ligament Release for Varus Deformity Correction in Total Ankle Arthroplasty
Authors: Duff Joseph R. , Sarfani Shumaila , Ward Tyler , Doty Jesse F. , Murphy Garnett 
Published: December 2023

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle arthroplasty (TAA) with severe varus ankle deformity is balanced in the coronal plane by releasing medial soft tissue constraints. There are no previous reports examining the impacts of TAA with concomitant release of the deltoid. Progressive talar tilt and progressive collapsing foot deformity were evaluated. Methods: A retrospective review included patients undergoing TAA with confirmed preoperative varus deformity. Patients underwent complete soft tissue release of the deltoid ligament complex. Pre- and post-operative weightbearing radiographs quantified Meary’s angle, lateral talo-1st metatarsal angle, calcaneal pitch, talar coronal alignment, and the lateral distal tibial angle. The primary endpoints were degrees of coronal plane correction, longitudinal arch position, and complication rates. Results: Thirty-two patients were included with median 12.5 month follow-up. Coronal plane alignment and VAS pain scores improved significantly in all patients, and statistical analysis revealed that complete deltoid ligament release had no bearing on calcaneal pitch and Meary’s angle at final follow-up. Posterior tibial tenotomy was performed on 3 (9.3%) patients. Median coronal plane alignment correction averaged 17.5° improvement (X2(2)= 50.358, P<.001) from 19.5° varus (11.2-24.5°) to 2.0° varus (0.5- 3.5°)(P <.001). Two degrees of coronal plane varus alignment without tilt progression (0.6-3.4°)(P <.001) was maintained through follow-up. Final calcaneal pitch of 18.2° (14.4-23.2°) mirrored initial median measurement of 18.3° (15.7-21.1°). No significant differences were found between Meary’s angle measurements at any time points (P=.568). Eight of 32 patients had complications with five requiring further ankle surgery. Conclusion: Complete release of the deltoid ligament may improve coronal malalignment when performing TAA. Release did not lead to radiographic or clinical medial instability, valgus talar tilt, or medial arch collapse.
Do Patients who Undergo Fixation for Pilon Fracture Develop Symptoms Comparable to Primary Ankle OA?
Authors: Nicholson Alys , Nicolas Andrea Pujol , Ramaskandhan Jayasree R. , Siddique Malik , Qasim Sultan , Alkhreisat Mohammad , Chambers Simon 
Published: December 2023

Category: Ankle Arthritis Introduction/Purpose: Pilon fractures are challenging to manage and have poor functional outcomes and high complication rates. A significant proportion of these patients go on to develop post-traumatic ankle arthritis. Our aim was to assess the long term patient reported outcomes following pilon fracture fixation and how this compares to patients with end stage ankle osteoarthritis requiring surgical intervention in the form of total ankle arthroplasty. Methods: We retrospectively identified all patients who underwent pilon fracture fixation between April 2012 and December 2015 (Group A). Group B consisted of patients with primary ankle osteoarthritis awaiting elective total ankle replacement between 2015 and 2017. Patients completed a Patient Reported Outcome Measures questionnaire (MOX-FQ, EQ-5D and FAOS scores) pre and post-operatively. The average follow up was 8 years. Results: There were 18 patients in Group A and 22 in Group B. Ankle arthritis patients reported significantly worse score for MOXFQ Pain (P vs. AA; 39.0 ±29.5 vs. 68.0 ±27.1; p=0.001), Difficulty with Walking/ Standing (38.3±26.0 vs. 56.4±26.5; p=0.037) and difficulty with social activities (24.0 ±25.6 vs. 49.4 ±31.3; p=0.007) and FAOS domains of symptoms (68.7 vs. 52.1; p=0.005), ability to do Activities of Daily Living (18.9 vs. 27.5; p= 0.003) and Quality of life (56.6 vs. 32.5; p=0.012). There was no difference between groups for EQ-5D general health scores (78.8 vs. 68.8; p=0.156). Ankle arthritis group patients reported worse scores for mobility, ability to self-care and performed activities of daily living (p=0.012) compared to the pilon fracture group. Conclusion: Our 8 year follow up demonstrate good long term outcomes for patients following pilon fracture fixation. Patients did not develop symptomatic arthritis comparable to end stage ankle arthritis requiring surgical intervention and we therefore recommend primary treatment with fixation, irrespective of fracture severity.
Does Hallux Valgus Correction with Chevron-Akin Osteotomies Reduce the Length of the First Ray
Authors: Horani Keenan , Black Natalie R. , Panchbhavi Vinod , Chen Jie 
Published: December 2023

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Patients who undergo a successful surgical correction of hallux valgus have relieved toe pain and improvements in foot appearance. Prior studies have shown hallux valgus correction using a distal Chevron osteotomy with a concomitant Akin osteotomy has the potential to reduce forefoot width. There are no studies evaluating if similar changes occur in the length of the foot. The objective of this study is to check if similar reduction occurs in the patient's foot length. Methods: The operating room schedule of Dr. Panchbhavi and Dr. Chen were reviewed for Chevron/Akin Osteotomies from 2017-2022. Patient charts were excluded for contaminant operations of the foot. The preoperative and postoperative radiographs were then evaluated by one medical student with oversight from a Board-Certified Foot and Ankle Orthopedic Surgeon. The Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), Metatarsal Span (MS), first/second ray of the foot, and difference between first and second ray were all be measured based on predetermined methods. All variables were analyzed utilizing an unpaired t-test. Results: In total 12 Chevron/Akin patients met the criteria. The results indicated that with chevron/akin osteotomy measurements of the foot were affected in HVA, IMA, MS, and length of first ray relative to second ray. The average results for each of these values were a decrease of 9.2 degrees (SD 4.32), 7.93 degrees (SD 4.33), 11.63mm (SD 2.26) respectively. For results of change in difference of first and second ray, average results for those who underwent Chevron/Akin Osteotomy was -2.23mm (SD 2.23, p = 0.0281). Both changes to MS and length were statistically significant (p < 0.05). Conclusion: Our results were consistent with existing evidence, Chevron with contaminant Akin Osteotomy will produce statistically significant changes in width of the foot; however, also a significant decrease in the length of the first ray relative to the second ray. All measurements were done utilizing PACS software and can be reliably used in clinics as a clinical tool to gauge post- operative outcomes alongside providing adequate patient education on the potential changes in foot length and width.
Does the Radiographic Lateral View of Toes Matter? - A Retrospective Analyses of 378 X-Rays
Authors: de Britto Costa Lucas Plens , Gonçalves Joao Paulo , Foni Noel Oizerovici , Mansur Nacime Salomao Barbachan 
Published: December 2023

Category: Lesser Toes; Trauma Introduction/Purpose: Because lateral toes are anatomically on the distal aspect of foot, they are more exposed to axial load (stubbed toe) and crushing injuries. In this context, correct obtainment of imaging exams is fundamental for proper diagnosis of MSI. In the X-ray room, however, due to overlapping of smaller fingers or because the patient`s pain, most common practice is to suppress the lateral view. The purpose of this study is to demonstrate the importance of toe radiographs in diagnosis of interphalangeal fractures and dislocations, emphasizing need for lateral view for diagnosis of these injuries. Methods: 378 radiographs of 126 patients treated between Jan/2018 and Mar/2018 in an emergency care clinic of a Brazilian hospital were retrospectively evaluated for presence of fractures. Patients were selected from a search on medical records using ICD. After, the radiographs of the same patient were duplicated and divided in two groups: standard group (AP and Oblique) and complete profile group (standard views plus lateral view). They were examined by four independent examiners of different degrees of experience. Each examiner randomly evaluated the same patient twice (1 in each group). Kappa index was used to evaluate intra and inter-examiner concordance, and the two-proportion equality test was used to calculate statistical significance. Results: Mean age of patients was 37,2 years (4-85yr). 144 fractures were diagnosed in standard group (28,6%) and 266 fractures (52,8%) in complete profile group (p < 0,001). Individually evaluating each examiner, everyone had had an improvement in number of fracture diagnostics when compared the complete profile group with the other (p < 0,001). Kappa index was superior to 0,60 for all examiners in pattern group. Conclusion: Addition of true lateral view was able to improve the number of diagnosed fractures on patients with lesser toes trauma.
Does the Underlying Cause of Arthritis Affect the Outcome of Total Ankle Replacement? A 10 Year Follow Up Study
Authors: Nicolas Andrea Pujol , Porter Anna , Ramaskandhan Jayasree R. , Hakeem Samir , Abdul Nicole , Alkhreisat Mohammad , Chambers Simon , Qasim Sultan , Torres Paulo , Siddique Malik 
Published: December 2023

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle replacement (TAR) is gaining popularity as a treatment option for end stage arthritis. We analysed whether the underlying pathology leading to the arthritis has any bearing on patient reported or clinical outcomes. Methods: Patient-reported outcome measures (PROMs) for TAR performed from 2006 to 2010 by a single surgeon were reviewed. This included WOMAC score, SF-36 and patient satisfaction scores. Data was collected preoperatively and post- operatively at 1, 2, 5 and 10 year. The indications for TAR were obtained by review of clinical notes and radiographs and these included osteoarthritis (OA), inflammatory arthritis (IA), pilon fracture (PF), ankle fracture (AF), and post-traumatic arthritis without previous fracture (PTOA).PROMs were available for 156 TARs: 81 (51.9%, mean age 65.29) for OA, 28 (17.9%, mean age 65.29) for AF, 23 (14.7%, mean age 64.28) for IA, 11 (7%, mean age 55.01) for PF, and 13 (8.3%, mean age 51.08) for PTOA. Results: At 1 year WOMAC score showed significant worsening pain and stiffness on PTOA group (p=0.023, p=0.001) and worse general health and vitality for the IA group (p=0.0025, p=0.005). At 5 years The PTOA group showed significant worsening stiffness (p=0.048), social and emotional domains (p=0.004, P=0.029) and worsening pain, return recreational activities and surgery dissatisfaction (p < 0.05, p=0.032, p=0.023). At 10 years 50% of IA patients were unhappy with return to ADLs but no other difference were found between groups. There was a higher revision rate at 10 years in the PTOA group with 30.7% of patients being revised (4/13) compared to other groups (OA-6.17%, AF-3.57%, IA-4.35%, PF-9%) Conclusion: Similar outcomes in all groups were seen at 10 years but higher revision rates were present in PTOA group. In patients with PTOA careful consideration and counselling is needed prior to proceed with TAR.
Early-to-Intermediate Clinical and Radiographic Outcomes of the Vantage Total Ankle Arthroplasty
Authors: Anastasio Albert T. , Kim Billy I. , Wixted Colleen M. , Adams Samuel , DeOrio James K. , Nunley James A. , Easley Mark 
Published: December 2023

Category: Ankle Arthritis Introduction/Purpose: The Vantage total ankle arthroplasty (TAA) features a design based on careful study of arthritic ankles and current ankle biomechanics, with theoretical advantages of a vertically-oriented tibial fixation and a fully congruent talar dome bone-implant interface. In this design-team, single-institution investigation, we report early-to-intermediate term clinical and radiographic outcomes, implant survivorship, and complications of the Vantage TAA. Methods: We retrospectively reviewed prospectively collected data for 278 consecutive patients undergoing Vantage fixed-bearing TAA. Ankles with coronal plane deformity > 25 degrees and suspected poor bone quality were prospectively excluded. Prospectively collected data includes: PROMIS, SF-36, SMFA, VAS and AOFAS hindfoot-ankle scores. Using previously published and commonly accepted evaluation methods, independent radiographic analysis, performed by a non-design surgeon investigator, included pre-operative, 1-year, and most recent follow-up assessments of 2-plane alignment, component position, and the bone- implant interface. A non-design surgeon investigator with dedicated training in statistics performed the statistical analysis using descriptive statistics to report PROM and radiographic measures and Kaplan-Meier survivorship analysis. Results: Mean patient age was 64.8yrs (range:33-86), 44.2% were female, and mean follow-up was 3.1yrs (2.0-5.5). Mean preoperative and postoperative PROMs were as following: PROMIS-Depression 50.3+/-4.2 and 45.6+/-9.8, PROMIS-Physical Function 39.0+/-3.4 and 45.0+/-7.8, SF-36 total score 55.8+/-15.3 and 73.2+/-20.0, SMFA-Function 29.0+/-13.5 and 15.9+/-5.4, VAS 15.8+/-24.8 and 3.1+/-10.1, and AOFAS hindfoot-ankle 46.3+/-16.5 and 81.1+/-16.3 (Table 1). Radiographic lucency at the bone- implant interface was noted in 33 (18.5%) TAAs at final follow-up; 20 (11.2%) were progressive. Lucency was almost exclusive to the tibial component. Implant survivorship was 99.6% [98.9-100.0] at 1-year and 93.3% [88.7-98.2] at the 5-year mark (Table 2, Figure 1). We identified suboptimal bone preparation, initial component alignment and/or component position in all 11 implant failures (Table 3). Conclusion: At early-to-intermediate followup, we observed favorable clinical outcomes, radiographic results and implant survivorship for the fixed-bearing Vantage TAA, especially with optimal bone preparation and component position. Tibial component lucency remains a concern and warrants further investigation. Suboptimal bone preparation, initial component alignment and/or component position was observed in all implant failures.
Effect of Medial Closing Wedge Distal Femoral Varization Osteotomy on Coronal Ankle and Hindfoot Alignment
Authors: Choi Jun Young 
Published: December 2023

Category: Hindfoot; Ankle Introduction/Purpose: To date, only a few studies have reported postoperative changes in coronal ankle alignment after valgus knee correction through Medial Closing Wedge Distal Femoral Varization Osteotomy (MCWDFO). This study aimed to measure the changes of MCWDFO on coronal ankle and hindfoot alignment. Methods: We retrospectively reviewed the radiographic findings of 27 consecutive patients (34 cases) with knee valgus malalignment who underwent MCWDFO for either lateral knee joint osteoarthritis (OA) or recurrent patellar subluxation/dislocation (RPD) . Several radiographic parameters were measured and compared based on the reason for operation, followed by the status of preoperative hindfoot alignment (hindfoot alignment angle [HAA] > 4°, varus; -4° HAA 4°, neutral; HAA < -4°, valgus) in each group. Results: Overall, pre- and postoperative hindfoot alignments were within the neutral alignment range and were not significantly changed after the operation (P > 0.05). Nineteen cases were for lateral knee OA and 15 were for RPD, respectively. In both groups, preoperative neutral hindfoot alignments accounted for the largest portion (52.6% in the lateral OA group; 80.0% in the RPD group). Postoperatively, regardless of the reason for operation, hindfoot alignments changed toward the neutral range in all subgroups (i.e., no changes in the preoperative neutral group; increased in the valgus group; decreased in the varus group). Conclusion: We recommend that surgeons leave the hindfoot untouched when they plan the MCWDFO to correct knee joint valgus malalignment concomitant with hindfoot valgus or varus deviation as the hindfoot malalignment appears to change towards neutral range postoperatively.
Effects of Soccer Cleats Worn vs Lower Extremity Injuries in the English Premier League
Authors: DeShazo Sterling , Pescatore Sabrina M. , Weiss William M. 
Published: December 2023

Category: Sports; Trauma Introduction/Purpose: As the most popular sport in the world, soccer has driven increased physical demands and higher levels of intensity, resulting in higher injury incidence amongst players. Biomechanical and epidemiological studies suggest that cleats likely play a significant role in the risk of lower extremity injuries for soccer players. The purpose of our study is to analyze cleat models and stud patterns worn by players who sustained lower extremity injuries during the English Premier League (EPL) 2021-22 season. Methods: Player injury data for 20 soccer teams was analyzed from the EPL 2021-22 season, which spanned from August 13, 2021 to May 22, 2022. The injured player cohort was established using Transfermarkt.com , a large, European-based website specializing in soccer-related news, scores, and statistics. Player injuries were separated into seven categories: ankle, calf, foot, hamstring, knee, lower leg, and thigh. Soccer cleat data was obtained from footballbootsdb.com, a publicly available, statistical database that includes information from the top European-based leagues and from major soccer tournaments such as the World Cup. Product attributes including the number of studs, stud geometry, upper material, upper thickness, upper fit, lacing mechanism, and weight were collected and confirmed using the product websites along with online third-party cleat reviews. After exclusions, a total of 221 EPL players and their respective cleats were analyzed. Results: Our results suggest that certain cleat models and stud patterns have higher associated risk of lower extremity injuries. Very aggressive stud patterns were found to have significantly more injuries when directly compared to mildly aggressive stud patterns (p=0.005). Additionally, the odds of a player sustaining an injury to their ankle (OR=1.394, p=0.042), hamstring (OR=0.892, p=0.027), or knee (OR=1.595, p=0.037) were significant with very aggressive stud patterns, while the odds of a player sustaining a hamstring injury were significant with non-aggressive stud patterns (OR=1.297, p=0.037). When considering specific cleat models, there were significantly higher odds of a player sustaining a lower extremity injury in Nike Mercurial (OR=1.256, p=0.007), Adidas X (OR=1.622, p=0.008), Nike Phantom GT (OR=0.924, p=0.018), Adidas Predator (OR=1.290, p=0.030), and Nike Tiempo (OR=0.714, p=0.048). Conclusion: In the EPL 2021-2022 season, players that wear very aggressive stud patterns may be at higher risk for lower extremity injuries, when compared to those who wear mildly aggressive stud patterns. We suggest that players, clubs, and manufacturers should evaluate their choice in footwear to best mitigate their risk of lower extremity injury.