bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of ASA Score on Total Ankle Arthroplasty
Authors: Ashy Cody , Morningstar Joshua L. , Gross Christopher E. , Scott Daniel 
Published: December 2023

Category: Ankle; Other Introduction/Purpose: The American Society of Anesthesiologist (ASA) physical status classification system serves as a useful measure of patient comorbidities. Multiple studies have found an increased risk of readmission in patients undergoing total knee or hip arthroplasty with elevated ASA scores. There is a paucity of literature investigating the association of ASA score and postoperative outcomes following total ankle arthroplasty (TAA). Thus, this study seeks to evaluate the relationship between ASA score and postoperative outcomes following TAA. Methods: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried from 2007-2020 to identify 2210 TAA patients. Patients were stratified based on preoperative ASA score, 1-normal healthy patient (n=101), 2-mild systemic disease (n=1228), 3-severe systemic disease (n=855), 4-severe, life-threatening systemic disease (n=26). Demographics, medical comorbidities, concomitant procedures, hospital length of stay (LOS), and 30-day complication, readmission, and reoperation rates were compared between groups. The cohort was predominantly male (54.0%) and mean patient age was 63.99 (range 19-87) years with a mean BMI of 31.01 (range 17.14-57.78) m/kg2. Results: Patients with an ASA score ≥3 were significantly older (≤2 =62.78, ≥3 =65.81%; p<.001), with higher BMI (≤2 =29.72, ≥3=32.97; p<.001). 2210 patients were discharged following TAA, with 37 readmitted within 30 days following surgery. There was no statistically significant difference in readmission or reoperation rate based on ASA score. (Table 1) The average LOS following TAA was 1.81 (range 0-28) days, and increased ASA score was statistically significantly associated with longer length of stay (≤2=1.69 days, ≥3 =1.98 days; p<.001). Patients with ASA score ≥3 were discharged home at a significantly lower rate than those with lower ASA scores (≤2 =95.3%, ≥3 =87.4%; p<.001). There was no statistically significant difference in postoperative complication rates within 30 days of surgery. Conclusion: Higher ASA score was statically significantly associated with increased length of stay and non-home discharge disposition. These findings are valuable for physicians and patients to consider prior to TAA given the increased utilization of resources and cost associated with higher ASA scores.
Varying Distance Between Suture-Endobuttons Does Not Improve Stability of the Transected Syndesmosis in a Motion Tracking Cadaveric Model
Authors: Stauffer Taylor , Anastasio Albert T. , Brinson Kenneth , Kim Billy I. , Joseph Gabriel P. , Storaci Hunter , Chan Calvin , Oji David E. , Lau Brian , Chou Loretta 
Published: December 2023

Category: Ankle; Sports Introduction/Purpose: A growing body of evidence favors the use of dynamic fixation techniques such as suture endo button over rigid screw fixation for syndesmotic injuries. However, specific dynamic fixation techniques have been poorly evaluated. The purpose of this study was to compare single suture-endobutton fixation (single) to double fixation with suture-endobuttons placed one centimeter (cm) apart (double 1 cm) and double fixation with suture-endobuttons placed three cm apart (double 3 cm). Methods: Twenty-four lower leg specimens from twelve cadavers were tested using a custom biaxial apparatus. Internal rotation, external rotation, and anterior and posterior translation of the tibia and fibula were examined using motion tracking systems after transection of deltoid and syndesmotic ligaments to compare three syndesmotic repair techniques: 1) a single suture-endobutton placed 1 cm above the joint line, 2) two suture suture-endobuttons placed 2 and 3 cm above the joint line, and 3) two suture- endobuttons placed 1 and 4 cm above the joint line. Results: All three endobutton constructs improved the stability of the syndesmosis by reducing aberrant motion after transection. There was no clear superiority of either single suture-endobutton (SEB), double suture-endobuttons placed 2 and 3 cm above the joint line (DSEB 1), or double suture-endobuttons placed 1 and 4 cm above the joint line (DSEB 3). DSEB 3 and DSEB 1 showed equal median laxity for tibia internal rotation (2.7 degrees, DSEB 1 (2.0 – 3.2) degrees, DSEB 3 (2.3 – 2.8) degrees), tibia external rotation (-0.2 degrees, DSEB 1 (-0.4 - 0.4) degrees, DSEB 3 (-0.4 - 0.3) degrees), and fibula external rotation (-0.3 degrees, DSEB 1 (-0.7 - 0.3) degrees, DSEB 3 (-0.7 - 0.7) degrees). Conclusion: Cadaveric biomechanical studies are critical to evaluate various suture-endobutton constructs prior to widespread use in patients. Our results demonstrate that the added cost of a second suture-endobutton may not confer substantial additional stability to the syndesmosis. Likewise, increased spread between suture-endobuttons appears to have minimal impact of syndesmotic stability.
A Cross Sectional Analysis of Arch Height and Pressure Distribution in a Normalized Population of More than 1000 Subjects
Authors: Delahunty Nathan Patrick , Jackson J. Benjamin , Gonzalez Tyler , Dias Travis 
Published: December 2023

Category: Midfoot/Forefoot; Basic Sciences/Biologics Introduction/Purpose: There are normal variations in the shape of an individual’s foot. However, recent investigations involving large, heterogenous populations are scarce, complicating attempts to create a uniform definition of clinical foot arch height. The purpose of this study was to determine the distribution of plantar foot pressures from the general population. Methods: 1015 randomly sampled individuals (2030 feet) had a bipedal standing profile obtained utilizing a high sensitivity pressure mat. Data collected included: total foot length (cm), peak pressure (kPa), peak contact pressure (kPa), and total contact area (cm2). Demographic information and data regarding individual comorbidities previously to be linked to pathologic arch height conditions were collected. A flatfoot was defined as Midfoot total area>Mean+1SD while a high arch was defined as Midfoot total area< Mean-1SD. Results: Our logarithmic transformation the data was representative of a normally distributed dataset and our demographic data closely reflective of the demographics United States population. Data for the right foot vs left foot were: 8.18% and 6.50% of participants had a flatfoot, 78.82% and 79.51% had normal arches, and 13.00% and 13.99% had high arches, respectively. The prevalence of normal bilateral arches was 70.54%, bilateral flat feet was 3.55%, and bilateral high-arched feet was 8.67%. Conclusion: Our data demonstrate a normalized distribution of plantar pressures and arch heights that were sampled from a population larger and more representative of the general populous than previously described. Given that our data may more accurately reflect the spectrum of normal adult foot. With these baseline characteristics defined, future research into arch height associated pathologies may proceed with a more standardized assessment when defining study populations.
Effect of Fibula Shortening on Medial Clear Space and Lateral Translation of the Talus: An Anatomical Cadaveric Study
Authors: Mason Lyndon W. , Heeran Niamh L. , Airey Grace , Gangadharan Rajkumar , Gomaa Abdul-Rahman , Bond Alistair P. , Roper Lucy 
Published: December 2023

Category: Ankle; Trauma Introduction/Purpose: Fibular shortening with an medial and syndesmotic ligament instability causes lateral translation of the talus. We hypothesise that the interaction of the anterior inferior tibiofibular ligament (AITFL) tubercle of the fibular with the anterior tibial incisura would precipitate lateral translation due to the size differential. Methods: Twelve cadaveric ankle specimens were dissected, removing all soft tissue except for ligaments. They were fixed onto a bespoke jig allowing tibial fixation and free movement of the talus and fibula. The fibula was progressively shortened in 5mm increments until complete ankle dislocation, measuring the medial clear space with each increment. Results: The larger AITFL tubercle interaction with the smaller tibial incisura caused a significant increase in lateral translation of the talus. This occurred in most ankles between 5-10mm of fibular shortening. The medial clear space widened following 5mm of shortening in 5 specimens (mean: 2.07, s.d: 2.53). All 12 specimens experienced widening by 10mm fibular shortening (Mean: 7.21mm, s.d: 2.21) and reached complete dislocation by 35mm fibular shortening. Conclusion: This study shows, that with fibular shortening, the interaction between the distal fibular AITFL tubercle and the anterior tibial incisura precipitates a lateral translation of the talus in an ankle fracture model where the medial and syndesmotic ligaments have been transected and the lateral ligaments remain intact. The interaction occurred between 5 and 10mm of fibular shortening. Beyond this point there was a near linear correlation between fibular shortening and medial clear space widening
How Much Subtalar and Ankle Joint Surface are Actually Destroyed when Reaming for Tibiotalocalcaneal (TTC) Nailing? A Cadaveric Study
Authors: Baker James , Schroeder Paul , Kimbler Tyra , Huh Jeannie 
Published: December 2023

Category: Ankle; Trauma Introduction/Purpose: Tibiotalocalcaneal (TTC) nailing in the setting of acute ankle trauma has become increasingly popular over the last decade, with expanding indications. Potential advantages of TTC nailing include: less soft tissue dissection, decreased wound burden, and earlier weightbearing. No consensus exists as to whether formal joint preparation is necessary, and at one or both joints. While some argue that joint preparation is not necessary due to inherent joint destruction from the injury and reaming during TTC nailing, others advocate for preparation to facilitate fusion and ensure no further motion occurs at the joint which could lead to nonunion and/or hardware failure. The purpose of this study was to quantify the proportion of ankle and subtalar joint articular surface destruction associated with reaming for TTC nail fixation. Methods: Twelve cadaver feet from 6 specimens were procured. The specimens were reduced and pinned into neutral ankle dorsiflexion and neutral hindfoot alignment. Prior to reaming, each specimen was secured in a simulated supine position. Per standard TTC nailing technique, a 3.0 millimeter (mm) guide wire was inserted under fluoroscopy, retrograde from the calcaneus, through the talus, and into the tibia, followed by a 12mm opening reamer. The specimens were then dissected, exposing the tibial plafond (TP), talar dome (TD), posterior facet of the talus (PFT), and posterior facet of the calcaneus (PFC). Clinical images of each joint were obtained at an angle of 90 degrees and 12 centimeters (cm) from the joint surface. The images were processed using the ImageJ software platform. The total joint surface area, area of articular destruction, and the remaining joint surface area were calculated. The percentage of joint destruction associated with reaming was then calculated. Results: The mean surface area values and percentages of articular surface destruction are summarized in Table 1. The mean surface area (cm2) after reaming was 11.82, 13.70, 9.23, and 7.79 for the TP, TD, PFT, PFC, respectively. The percentage of articular cartilage destruction was 9.32%, 10.33%, 8.89%, and 10.28% for the TP, TD, PFT, PFC, respectively. No joint destruction was observed in the middle facets of the subtalar joint. Conclusion: This study demonstrates that reaming for TTC nail placement involves only a small portion (roughly 8-10%) of each of the articular surfaces of the ankle and subtalar joints. Violation of the middle facet of the subtalar joint did not occur. These results suggest that a significant portion of hindfoot articular surface remains after reaming for TTC nail. Formal joint preparation may be beneficial to aid with fusion after TTC nail placement, particularly when used in younger, more active individuals who sustain hindfoot and ankle trauma.
Increased Metal Component Failure with STAR Total Ankle
Authors: Newton William , Morningstar Joshua L. , Nadeau Elizabeth K. , Ottofaro Trevor D. , Gross Christopher E. , Scott Daniel 
Published: December 2023

Category: Ankle Arthritis Introduction/Purpose: With the increasing total ankle arthroplasty (TAA) literature, there is a need to further examine the outcomes across a wide variety of implants. The purpose of this study is to review the existing literature and identify trends among current individual TAA implants. Methods: A comprehensive search of MEDLINE for all articles published between 1996 and 2021 was conducted with a minimum two-year mean follow-up. Two reviewers evaluated each study to determine whether it was eligible for inclusion and abstracted the data of interest. Meta-analytic pooling of group results across studies was performed, examining for individual implant survival and component failure. Seventy-three implant groups met inclusion criteria (3rd and 4th generation implants only), composed of STAR (20), Salto (mobile bearing) (10), Salto Talaris (11), Hintegra (8), Zimmer (6), INBONE II (6), INBONE I (4), Infinity (4), Cadence (4). 41 groups (56.2%) were implanted with mobile bearing devices and 32 (43.8%) with fixed bearing implants. In total, 6498 subjects were included with a mean age of 61.77 years and mean BMI of 28.5 kg/m2. At mean follow-up of 62.2 months, the overall reoperation rate was 21.13% and metal component revision rate was 10.16%. Results: Multivariate analysis of all implants, controlling for follow-up duration, found a statistically significant difference in the metal component survival rate (p=.036) and reoperation rate (p=.007) with the STARs TAAs surviving significantly worse and undergoing reoperation at a significantly higher rate than all other implants. There was no statistically significant difference in the rate of metal component revision (p=.768), tibial component failure rate (p=.095), or talar component failure rate (p=.089). Analysis of the Salto Talaris vs Salto found a significant difference in metal component survival rate (Salto=90.68%, Salto Talaris=97.81%; p=.002). Lastly, analysis of the INBONE I vs II implants found INBONE I had a significantly greater rate of revision due to metal component failure (INBONE I=9.8%, INBONE II=3.4%; p=.002). Conclusion: Based on current literature, it appears that the STAR total ankle implant has a statistically significantly lower rate of metal component survival and higher rate of reoperation than the other 3rd and 4th generation implants examined, even when controlling for study follow-up duration. The fixed bearing Salto Talaris had statistically significantly better survival rate than the mobile bearing Salto. These findings are important to physicians when considering implants for total ankle arthroplasty.
Mid Term Followup of Patient Reported Outcomes in Patients <50 years with a Total Ankle Arthroplasty
Authors: Giambelluca Lacey Leigh , Umbel Benjamin D. , Anastasio Albert T. , Kim Billy I. , Nunley James A. 
Published: December 2023

Category: Ankle Arthritis Introduction/Purpose: End stage arthritis is a debilitating condition that significantly affects patients’ quality of life. Ankle arthritis differs from arthritis of the hip and knee in that ankle arthritis is often posttraumatic in nature and affects a younger patient population. Historically, younger age was a contraindication to total ankle arthroplasty (TAA) and ankle arthrodesis was the mainstay of treatment. Advances in TAA implant design and revision implants has expanded indications and increased usage of TAA. Despite this, many surgeons remain hesitant due to the lack of long term data on patient outcomes and survivorship in these patients. The purpose of our study was to evaluate patient reported outcome measures and survivorship after primary TAA in patients < 50 years of age at the time of surgery. Methods: A retrospective chart review was conducted of patients < 50 years of age who underwent primary TAA at a single institution from 2010-2020. Patient demographics, outcome measures, and complications were recorded. All patients had a minimum clinical follow up of 5 years. Patient reported outcome (PRO) measures collected included FADI, VAS, SMFA SF-36, AOFAS hindfoot scores, and FAOS scores. Outcome measures were evaluated preoperative, 1 year postoperative, and at final clinical follow up. Paired t-tests were performed to compare individual patients’ changes in PRO from preoperative to postoperative timepoints. Multiple comparisons correction was performed using the Bonferroni method. Implant survivorship was evaluated based on need for revision of either the tibial or talar component. Results: A total of 59 patients were included in the study. The average age at time of surgery was 43.2 years. All patients had a minimum follow up of 5 years with a mean follow up time of 8.8 years. Mean FADI improved from 53.3 (sd:14.1) preoperatively to 16.1 (sd:11.4) (p < 0.001) at 1-year postoperatively. Mean VAS and SMFA also improved from preoperative to 1-year postoperative timepoints [VAS: 68.2 (sd:27.0) to 10.3(sd:13.1) (p < 0.001); SMFA: 36.1 (sd:12.2) to 14.8 (sd:13.7) (p < 0.001)]. A total of 5 patients required revision of components during the follow up period. Three patients required complete revision of both tibial and talar components, 2 due to aseptic loosening and 1 due to deep infection requiring explant of components. Conclusion: Patients < 50 years undergoing TAA for end stage ankle arthritis have improved patients reported outcomes greater than 5 years after surgery. Despite the increased demands of the younger population, survivorship of total ankle implants in our study was 85% at a mean of 8.8 years postoperative. We believe that TAA is a safe and reliable option for young patients with high patient satisfaction at mid term follow up.
Palliative care, homelessness, and restricted or uncertain immigration status
Authors: Hudson Briony F. , Dzeng Elizabeth , Burnett Angela , Yeung Michelle , Shulman Caroline 
Published: December 2023

Background: People experiencing homelessness have limited access to palliative care support despite high levels of ill health and premature mortality. Most research exploring these challenges in the United Kingdom has focused on people living in hostels or temporary accommodation. People with uncertain or restricted immigration status are often unable to access this accommodation due to lack of entitlement to benefits. There is little research about the experiences of those in the United Kingdom who cannot access hostels or temporary accommodation due to restricted or uncertain immigration status with regards to palliative and end-of-life care access. Aim: To explore the barriers to palliative and end-of-life care access for people with uncertain or restricted immigration status, who are experiencing homelessness and have advanced ill health, and the experiences of UK hospices of supporting people in this situation. Design: A multi-method cross-sectional study. Setting/participants: An online survey for hospice staff followed by online focus groups with staff from inclusion health, homelessness and palliative care services, charities and interviews with people experiencing homelessness. Results: Fifty hospice staff responded to the online survey and 17 people participated in focus groups and interviews (focus groups: n = 10; interviews: n = 7). The survey demonstrated how hospices are not currently supporting many people with restricted or uncertain immigration status who are homeless and that hospice staff have received limited training around eligibility for entitlements or National Health Service (NHS) care. Interview and focus group data demonstrated high levels of unmet need. Reasons for this included a lack of consistency around eligibility for support from local authorities, issues relating to NHS charging, and mistrust and limited knowledge of the UK health and social care system. These barriers leave many people unable to access care toward the end of their lives. Conclusion: To advocate for and provide compassionate palliative and end-of-life care for people with uncertain immigration status, there is need for more legal literacy, with training around people’s entitlement to care and support, as well as easier access to specialist legal advice.
Single-Cell Transcriptomics Identifies Pituitary Gland Changes in Diet-Induced Obesity in Male Mice
Authors: Ruggiero-Ruff Rebecca E , Le Brandon H , Villa Pedro A , Lainez Nancy M , Athul Sandria W , Das Pratyusa , Ellsworth Buffy S , Coss Djurdjica 
Published: December 2023

Abstract
Obesity is a chronic disease with increasing prevalence worldwide. Obesity leads to an increased risk of heart disease, stroke, and diabetes, as well as endocrine alterations, reproductive disorders, changes in basal metabolism, and stress hormone production, all of which are regulated by the pituitary. In this study, we performed single-cell RNA sequencing of pituitary glands from male mice fed control and high-fat diet (HFD) to determine obesity-mediated changes in pituitary cell populations and gene expression. We determined that HFD exposure is associated with dramatic changes in somatotrope and lactotrope populations, by increasing the proportion of somatotropes and decreasing the proportion of lactotropes. Fractions of other hormone-producing cell populations remained unaffected. Gene expression changes demonstrated that in HFD, somatotropes became more metabolically active, with increased expression of genes associated with cellular respiration, and downregulation of genes and pathways associated with cholesterol biosynthesis. Despite a lack of changes in gonadotrope fraction, genes important in the regulation of gonadotropin hormone production were significantly downregulated. Corticotropes and thyrotropes were the least affected in HFD, while melanotropes exhibited reduced proportion. Lastly, we determined that changes in plasticity and gene expression were associated with changes in hormone levels. Serum prolactin was decreased corresponding to reduced lactotrope fraction, while lower luteinizing hormone and follicle-stimulating hormone in the serum corresponded to a decrease in transcription and translation. Taken together, our study highlights diet-mediated changes in pituitary gland populations and gene expression that play a role in altered hormone levels in obesity.