bluuebunny/crossref_metadata_2025_split huggingface dataset:
Non-operative Success of Treating Midfoot and Transverse Tarsal Joint Osteoarthritis
Authors: Kulkarni Ronit , Hoch Caroline , Morningstar Joshua L. , Caughman Alex , Baxley David , Rodriguez-Materon Solangel , Scott Daniel , Gross Christopher E. 
Published: December 2023

Category: Midfoot/Forefoot; Other Introduction/Purpose: Midfoot osteoarthritis affects over 16% of adults over the age of 50, interfering with activities of daily living and leisure. One form of non-operative management is cortico-steroid injections, which are often done under fluoroscopic guidance to improve accuracy. Operative intervention is sometimes performed, although non-union rates and continued pain after surgery can be challenging. This study aims to quantify how well midfoot and transverse tarsal joint arthritis can be treated non- operatively with fluoroscopic-guided injections. Methods: We reviewed the records of 132 patients (155 feet), who were newly diagnosed with midfoot arthritis between 2015 and 2019. Conservative management included periodic fluoroscopic-guided steroid injections at an academic medical center by a single fellowship-trained foot and ankle surgeon. These joints were identified by computed tomography prior. Mean age was 62.7 years and mean BMI was 30.9 kg/m2. Twenty-five feet (16.1%) eventually underwent surgical treatment, and one of those (4.0%) underwent reoperation. Results: On average, each foot received 3.1 (range, 1-21) injections, this did not differ between the surgical and conservative cohorts (operative=3.9, non-operative=3.0; p=.147). Of the 95 feet (61.3%) that received more than one injection, mean duration was 21.6 (range, 0.9-67.4) months. Injection duration did not differ between cohorts (operative=21.8 months, non-operative=21.6 months; p=.952). Cases treated surgically did not receive any injections postoperatively. Patients with higher pre-treatment Pain Catastrophizing Scale (PCS) scores in all subsection5-depression=2.9, p=.046) over a greater injection duration (depression=22.2 months, non-depression=11.4 months, p=.046). Conclusion: Overall, fluoroscopic-guided injections are sufficient for the non-operative treatment of midfoot and transverse tarsal joint arthritis, as only 16.1% of our cohort failed conservative treatment and required surgery. Therefore, although not always successful, non-operative treatment with fluoroscopic guidance injections is able to provide patients relief for an extended period.
Opioid Consumption Following Foot and Ankle Surgery: A Systematic Review
Authors: DeMaio Christian , Nayfa Rob , Reasnor Ty D. , Fox Jake A. , Thompson Samuel , Amin Amgad Haleem 
Published: December 2023

Category: Other; Hindfoot Introduction/Purpose: The opioid epidemic in the United States has gained significant attention over the past few years. Subsequently, there have been several publications characterizing postoperative opioid consumption in patients who underwent foot and ankle surgery. Our goal was to systematically review the literature to identify trends in opioid consumption between procedures of the forefoot, midfoot, hindfoot and ankle and ultimately create finalized prescribing guidelines that treat patients’ pain adequately while limiting leftover pills. Methods: A systematic review was performed in concordance with the MOOSE guidelines. We included retrospective and prospective observational cohort studies that reported on mean opioid consumption following foot and ankle surgery, as well as unpublished data from our institution that fit the review’s parameters. We excluded studies that did not report this data or reported patients receiving alternative surgical techniques. The ROBINS-E tool was used to assess bias and the MINORS criteria was used to evaluate study quality. Results: Six studies met inclusion criteria from 395 identified articles. Reported data from 2,445 patients were analyzed for overall opioid consumption, region of surgery, and invasiveness of procedure. Five studies standardized opioids prescribed and consumed to a 5-milligram oxycodone "pill." Of the three studies reporting mean pill consumption by region of surgery, 16.1, 27.8, and 26.4 pills were consumed by forefoot, midfoot, and hindfoot patients, respectively. The largest mean and median pill consumption was observed in hindfoot patients (45.7 and 22, respectively). 4 of 5 studies found significantly higher opioid use in hindfoot and ankle patients, and 2 of 5 studies found significantly higher consumption among those undergoing bony versus soft-tissue procedures. Across all studies, patients used 45.7%-75.2% of their opioid prescriptions. Conclusion: In this systematic review, we identify literature reported mean number of recommended pills to be subscribed for each anatomical region, as prescriptions could be decreased by around half and still adequately control pain. This can be of significant aid in providing final guidelines to orthopedic surgeons to finalize prescription patterns in foot and ankle surgery based on the published literature.
Outcomes following Intra-Articular Hyaluronic Acid Injection for the Management of Hallux Rigidus: A Systematic Review
Authors: Randall Grace W. , Butler James J. , Petropolous Stephen J. , Azam Mohammad T. , Kennedy John G. 
Published: December 2023

Category: Midfoot/Forefoot; Other Introduction/Purpose: The purpose of this systematic review was to evaluate outcomes following intra-articular 1st MTPJ hyaluronic acid injection for the management of hallux rigidus. Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies evaluating outcomes in patients who underwent intra-articular 1st MTPJ hyaluronic acid injection for the management of hallux rigidus. Data regarding injection characteristics, subjective clinical outcomes, failure rates and complications were extracted and analysed. Results: In total, 5 studies were included in this review. In total, 209 patients underwent intra-articular 1st MTPJ hyaluronic acid injection for the management of hallux rigidus at a weighted mean follow-up of 4.4 ± 1.4 months. The weighted mean VAS improved from a pre-injection score of 6.4 ± 0.3 to a post-injection score of 2.8 ± 0.4. A 10.1% complication rate was noted, the most common of which was transient 1st MTPJ swelling. One infection (0.5%) was reported. A symptomatic recurrence rate of 18.6% was observed at a weighted mean time of 7.3 ± 4.2 months Conclusion: This systematic review demonstrated that intra-articular 1st MTPJ hyaluronic acid injection for the management of hallux rigidus led to a reduction in pain and a moderate complication rate at short-term follow-up. In addition, intra-articular 1st MTPJ hyaluronic acid injection for the management of hallux rigidus produced a symptomatic recurrence rate of 18.6% at approximately 7.3 months, suggesting that HA provides short-term relief. The lack of quality comparative studies limits the generation of robust conclusions, reinforcing the need for further research to identify the optimal role of HA in the management of hallux rigidus.
Outcomes following Polyvinyl Alcohol Hydrogel Implant for Hallux Rigidus: A Systematic Review
Authors: Butler James J. , Samsonov Alan P. , Randall Grace W. , Azam Mohammad T. , Kennedy John G. 
Published: December 2023

Category: Midfoot/Forefoot; Other Introduction/Purpose: The purpose of this systematic review was to evaluate outcomes following polyvinyl alcohol hydrogel implant for the management of hallux rigidus. Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies evaluating outcomes in patients who underwent polyvinyl alcohol hydrogel implant for the management of hallux rigidus. Data regarding surgical characteristics, subjective clinical outcomes, radiographic outcomes, failure rates and complications were extracted and analysed. In total, 15 studies were included in this review. Results: In total, 1536 patients (1578 feet) underwent polyvinyl alcohol hydrogel implant for the management of hallux rigidus at a weighted mean follow-up of 39.4 ± 17.3 months. The weighted mean VAS score improved from a pre-operative score of 6.2 ± 1.3 to a post-operative score of 3.0 ± 1.6. There was limited data regarding improvements in range of motion. The complication rate was 15.7% and the failure rate was 9%. Conclusion: This systematic review demonstrated improvement in subjective clinical outcomes following PVA hydrogel implant for the management of hallux rigidus. A moderate complication rate and failure rate was noted at short term follow-up. Further studies with longer follow-up periods are warranted to elucidate the precise outcomes following PVA hydrogel implant for the management of hallux rigidus.
Outcomes following Surgical Intervention for Freiberg's Infraction: A Systematic Review
Authors: Butler James J. , Omar Vian , Konar Kishore , Azam Mohammad T. , Kennedy John G. 
Published: December 2023

Category: Lesser Toes; Other Introduction/Purpose: The purpose of this systematic review was to evaluate the clinical and radiological outcomes together with the complication rates and failure rates following surgical intervention for Freiberg's Infraction. Methods: During December 2022, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following surgical intervention for the management of Freiberg's Infraction. Data regarding study characteristics, patient demographics, lesion characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed. In addition, the level of evidence and quality of evidence for each individual study was also assessed. Results: Eighteen studies were included. In total, 299 patients (302 feet) underwent surgical intervention for the management of Freiberg's Infraction at a weighted mean follow-up of 49.9±45.1 months. The distribution of patients by Smillie's (SI-V) classification was recorded in as follows: SI (0 patients), SII (20 patients), SIII (42 patients), SIV (69 patients), SV (54 patients). The most common surgical procedure was dorsal closing wedge metatarsal osteotomy. The weighted mean AOFAS score improved from a pre-operative score of 60.3±9.0 to a post-operative score of 84.3±24. The weighted mean total ROM improved from 46.4±11.7° pre-operatively to 66.2±15.1° post-operatively. The weighted mean time to osseous union was 7.4±3.6. The complication rate was 5.2%, the most common of which was pain. Four failures (1.6%) were observed. Conclusion: This systematic review found improvements in subjective and objective clinical outcomes together with a low complication rate following surgical intervention for Freiberg's infraction at mid-term follow-up. However, the level and quality of evidence of the included studies were low and there was marked heterogeneity and under-reporting of data between the included studies. Although surgical intervention appears to is the mainstay treatment option for Freiberg's infraction, further higher quality comparative studies are warranted to determine the optimal surgical technique for Freiberg's infraction.
Outcomes following Surgical Treatment for Symptomatic Accessory Navicular: A Systematic Review
Authors: Randall Grace W. , Butler James J. , Fur Rachel Lai Fat , Konar Kishore , Rampersad Chelsea , Azam Mohammad T. , Kennedy John G. 
Published: December 2023

Category: Midfoot/Forefoot; Other Introduction/Purpose: The purpose of this systematic review was to examine the clinical and radiological outcomes of various surgical treatments for symptomatic accessory naviculars. Methods: During February 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following surgical treatment for symptomatic accessory navicular. Data regarding surgical characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analyzed. 26 studies were included for review. Results: In total, 520 patients (614 feet) underwent surgical treatment for the management of symptomatic accessory navicular. The weighted mean age was 28.18 ± 8.18 and the weighted mean follow-up time was 46.23 ± 34.76 months. The mean AOFAS score was 49.9 ± 7.39 preoperatively and 88.9 ± 5.61 postoperatively. The mean complication rate at final follow-up was 9.02% and the failure rate was 4.23%, with only 2.7% of patient ultimately requiring a further procedure. We also compared outcomes in patient who underwent a Kidner or Modified Kidner procedure (n=245) with those treated with a different surgical technique such as fusion or simple excision (n=275). There was no significant difference in outcome scores, complication rates, failure rates, or secondary surgical procedure rates between these cohorts. Conclusion: This systematic review demonstrated improvement in clinical outcomes following surgical treatment for symptomatic accessory naviculars. The markedly low complication and failure rates further indicate that surgical intervention is beneficial in the management of symptomatic accessory naviculars. Kidner and Modified Kidner procedures resulted in equivocally good outcomes compared with other surgical approaches such as fusion and simple excision. However, the marked heterogeneity between the included studies and few high level comparative studies limits the generation of any robust conclusions for optimal surgical technique. Further research is warranted to determine whether the Kidner procedure confers any particular advantages over other approaches.
Patient Reported Outcomes Following Open Broström-Gould Procedure: Minimum 5 Year Follow Up
Authors: McCrosson Matthew J. , Sanchez Thomas , Scheinberg Mila , Sisk Morgan , Shah Ashish 
Published: December 2023

Category: Hindfoot; Sports Introduction/Purpose: The purpose of this study is to demonstrate five-year patient-reported outcomes following the Broström- Gould procedure for the treatment of CAI in the general population. This is the first study utilizing PROMIS and FAAM scores at a minimum followup of five years and will provide valuable insight into the long term efficacy of the BG procedure. Additionally, our regression analysis portrays information on which individual patient factors independently influence patient reported outcome scores. Methods: Following approval from our institution’s IRB, the electronic medical record was queried for CPT code 27698 (Broström-Gould) from Jan 2010 to June 2017. Patients were included if they had a preoperative diagnosis of chronic lateral ankle instability and failed nonoperative management. Patients were excluded if they had undergone any surgeries since their BG repair (except revision BG repair), had a follow up of less than five years, were under the age of 18, or declined to answer all PROMIS and FAAM surveys. Surveys were conducted in the clinic and through phone interviews. Utilizing the EMR, patient charts were reviewed to obtain basic patient demographic information including sex, age, race, and body mass index (BMI). Comorbidities including, but not limited to, tobacco use, diabetes, hypothyroidism, rheumatoid arthritis were also recorded. Results: Our results show that the minimum 5-year patient reported PROMIS scores for patient’s following a Brostrom-Gould procedure are as follows: PROMIS PF - 50.5, PROMIS PI, 48.2, and PROMIS D - 38 2. This indicates, at a minimum, that patients 5-years removed from the procedure are within one standard deviation of the general population in regards to PROMIS physical function and pain. Our patient reported FAAM, ADL, and FAAM S scores were 59.6 and 13.0 respectively. Conclusion: This study is the first paper to report minimum five year patient reported PROMIS scores following the Broström- Gould procedure. We believe it is a valuable contribution to the literature as it provides both the treating surgeon and patient with evidence that the BG is a safe and effective procedure at the 5-year mark. Additionally, we have isolated potential factors that independently correlate with PROMIS outcomes including tobacco use, diabetes, and sports participation. We have shown the efficacy of the BG at 5-years and have provided the framework for future comparison studies hoping to utilize the PROMIS system to assess outcomes.
Patient Reported Outcomes with the Use of Fibular Nail Fixation, Retrospective Review of 41 Cases
Authors: Rodriguez-Materon Solangel , Lopez Kyra E. , Trynz Samantha , Fleites Jorge , Chapman Cary , San Giovanni Thomas P. , Hodgkins Christopher 
Published: December 2023

Category: Trauma; Ankle Introduction/Purpose: Traditionally, open reduction and internal fixation of unstable lateral malleolus fractures with plate and screw constructs has been considered the gold standard treatment. More recently, the use of an intramedullary fibula nail has gained popularity as an alternative treatment method using a mini open incision to obtain anatomic reduction. The minimally invasive nature of this technique and the no profile load bearing/sharing implant is reported with very low complication rates and a much lower incidence of implant irritation and removal. We report our surgical and patient reported outcomes for a cohort of single surgeon consecutive fibula nails with proximal and distal locking fixation. Methods: We retrospectively reviewed prospectively collected data on 41 patients that were implanted with the Fibulock® Fibula Nail (Arthrex, Naples, Florida, USA). All nails were implanted by a single surgeon. Intraoperative reduction quality was recorded, and patients were followed post operatively with radiographs that were assessed for maintenance of reduction, healing, and complications. Patient reported outcome questionnaires (PROMs) were collected preoperatively and at 3, 6, 12, and 24 months postoperatively. The Foot and Ankle Ability Measure (FAAM) assessed the patient’s functional status in terms of activities of daily living and sports. The Visual Analogue Score (VAS) was also collected. Results: All 41 patients had one- to two- year follow-up (14.68 months ± 5.92). Demographics are listed on table 1. Forty of the patients were reduced via mini open incision and one was reduced closed. There were no conversions to a plate, no intraoperative complications, and no cases of loss of reduction postoperatively. No patient required revision surgeries, no cases of delayed union or nonunion, and zero superficial or deep postoperative infections. Statistical analysis revealed a significant difference between preoperative and postoperative FAAM scores overall (+67.52, p < 0.001), within activities of daily living (+68.07, p < 0.001), and sport (+65.95, p < 0.001). Also, there was a significant difference between preoperative VAS and postoperative VAS (+4.73, p < 0.001). Conclusion: Our results support existing literature that fixation of fibula fractures with an intramedullary nail with proximal and distal locking capabilities is an alternative option to a plate and screw construct, with a very low incidence of hardware related complications requiring removal, and favorable patient reported outcomes.
Pediatric Osteochondral Lesions of the Talus: A Systematic Review and Treatment Algorithm
Authors: Liu Hanson , Varghese Jacob , Sritharan Praveen , Gaber Karim , Kishta Waleed 
Published: December 2023

Category: Hindfoot; Ankle Introduction/Purpose: Osteochondral lesions of the talus (OLT) peak in incidence during childhood, yet there exists a paucity of research on treatment among skeletally immature populations due to their high potential for spontaneous recovery without interventions. Unfortunately for patients who do require treatment, existing guidelines are based on adult studies, which likely differ in prognoses and outcomes due to varying capacity for regeneration. This paper compares outcomes across conservative and various surgical interventions for pediatric OLTs, with the synthesized evidence forming the basis of a treatment algorithm. Methods: An electronic literature search was conducted across PubMed, EMBASE, and MEDLINE databases for primary studies published prior to January 2022. Pediatric status in OLTs was defined as age < 18 at diagnosis, since many studies did not assess skeletal maturity. The main outcomes were clinical and radiological success rates, defined as achievement of good or fair outcomes according to measures used by individual studies. Articles were categorized by treatment method, and outcome rates were obtained via simple pooling. Results: 35 studies involving 714 lesions were included. Studies were categorized into five overarching treatment methods – (1) conservative treatment, (2) bone marrow stimulation, (3) retrograde drilling, (4) fixation, and (5) osteochondral transplantation. These interventions had pooled clinical success rates of (1) 45%, (2) 85%, (2) 90%, (4) 82%, and (5) 74%, respectively. The pooled radiological success rates were (1) 58%, (2) 85%, (3) 55%, (4) 89%, and (5) 81%. Escalation from conservative to surgical treatment occurred at a rate of 62% among studies in which this was reported. Articles were heterogeneous in measurement tools and pre- treatment characteristics; average baseline lesion size was (1) 129.8, (2) 131.0, (3) 87.8, (4) 137.8, and (5) 237.5mm^2 across the five treatment methods, and initial Berndt-Harty staging was likewise disparate. Conclusion: Conservative treatments yielded lower clinical and radiological success rates than surgical interventions, but warrant an initial trial in stable lesions due to their cost-effective and non-invasive nature. Surgery should be indicated for unstable lesions, or failed conservative treatment. Drilling and bone marrow stimulation are effective in lower grade lesions, while fixation should be considered for loosened fragments, and transplantation for large, non-salvageable lesions. Future research utilizing more robust methodology and reporting outcomes according to baseline lesion characteristics will consolidate these guidelines.