bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modified Youngswick Osteotomy for Treatment of Hallux Rigidus in Athletes
Authors: Ceccarini Paolo , Novello Giovanni , Donantoni Marco , Rinonapoli Giuseppe , Caraffa Auro 
Published: December 2023

Category: Midfoot/Forefoot; Sports Introduction/Purpose: Hallux rigidus is a common condition that affects athletes, particularly those who engage in high-impact sports. This condition results in pain and limited range of motion in the big toe, and can significantly affect an athlete's performance. The goal of treatment is to alleviate pain, improve function, and return the athlete to their sport. There are various surgical options available for treating hallux rigidus, one of which is the Youngswick osteotomy. This procedure involves realigning the bones of the big toe to relieve pressure and improve range of motion. Methods: A retrospective study was conducted to evaluate the effectiveness of the modified Youngswick osteotomy in treating hallux rigidus in athletes. The study included 40 patients, with a median follow-up of 40 months. The patients were divided into two groups based on sex: 29 female and 11 male. The side affected was also recorded, with 26 patients having the condition on their right foot and 14 on their left. The grade of hallux rigidus was also recorded, with 25 patients having grade II and 15 patients having grade III. Results: The study found that the median preoperative American Orthopaedic Foot & Ankle Society (AOFAS) score was 39, with a range of 25-60. After the Youngswick osteotomy, the median AOFAS score improved to 81.8, with a range of 50-90. This improvement was statistically significant (p < .0001). The range of motion (ROM) of the big toe also improved after the surgery, with the median preoperative ROM being 15.4 degrees and the median postoperative ROM being 54 degrees. Subjective satisfaction with the surgery was also recorded, with 80% of patients reporting excellent results, 10% good results, 7.5% fair results, and 2.5% poor results. The study found that there was no significant difference in the results based on sex or the side affected. Conclusion: The results of this study suggest that the Youngswick osteotomy is an effective treatment option for hallux rigidus in athletes. The procedure significantly improves pain, range of motion, and overall function, allowing athletes to return to their sport. The results of this study provide valuable information for clinicians who are considering the modified Youngswick osteotomy for their patients with hallux rigidus. However, it should be noted that further research is needed to confirm these findings and to determine the long-term outcomes of this procedure.
Nonunion Rate of Evans Osteotomy Without Fixation Pediatric Flatfoot
Authors: Mathew Smitha E. , Gallagher Brian P. , Miles Megan , Guyton Gregory P. 
Published: December 2023

Category: Hindfoot; Other Introduction/Purpose: The Evans osteotomy is a calcaneal lateral column lengthening procedure commonly used to correct flatfoot deformities. Currently, there is no consensus on whether fixation is needed when performing this osteotomy. Also, large sized grafts have been found to lead to degeneration of the calcaneocuboid joint. The aim of this study was to determine the nonunion rate of an unfixed Evans osteotomy with use of an allograft wedge performed in patients undergoing flexible flatfoot reconstruction and if addition of a medial calcaneal slide osteotomy will help limit graft size. Methods: We retrospectively reviewed 39 pediatric patients with idiopathic symptomatic flatfoot deformity who underwent 46 unfixed Evans osteotomies with allogenic bone graft for flatfoot reconstruction between March 2013 and September 2017, with a mean follow-up of 49 (range 9.9- 243.9) weeks. Hospital record, preoperative, follow-up radiographs and complications were reviewed. Results: Of the 46 feet, 42(91.3%) underwent an associated medial displacement calcaneal osteotomy. Mean graft wedge size was 7.2mm(SD 1.6). Mean time to union was 10.3weeks (range, 6.7-13.9)(Table 1). There were no nonunions. There was significant improvement in all radiographic parameters at final follow-up (Table 2). Postoperative calcaneocuboid subluxation occurred in 70% of feet, with no correlation with wedge size(r=0.01,p=0.53). Magnitude of calcaneocuboid subluxation was small and only significant at 6-months (p=0.02), with regression to no significance by 1-year(p=0.3). Mean change in calcaneocuboid subluxation at final follow-up was 1.07mm(SD 2.18), with postoperative subluxation diminishing over time(Table 3). No correlation was observed between wedge size and change in lateral column length (r=0.01,p=0.45). One patient had persistent sinus tarsi pain requiring arthroscopic debridement of fibrosis and graft prominence. Conclusion: An unfixed Evans osteotomy for symptomatic pediatric flatfoot deformity resulted in a significant improvement in the radiographic alignment and achieved 100% union rate with minimal calcaneocuboid subluxation at final follow-up. Performing adjunctive procedures allowed the Evans procedure to be routinely limited to less than 10 mm of lengthening. Mean graft size in our cohort was smaller than that reported by other studies. While calcaneocuboid subluxation was detectable in 70% of feet, it was small in magnitude and diminished with longer postoperative follow-up.
Patient Reported and Radiographic Outcomes following the Malerba Osteotomy
Authors: Jain Akshay , Mizher Rami , El Masry Seif , Ellis Scott J. , Cody Elizabeth A. 
Published: December 2023

Category: Hindfoot; Other Introduction/Purpose: The Malerba calcaneal osteotomy is a step cut Z-type osteotomy with a lateral wedge resection used to treat hindfoot varus deformity. The osteotomy allows for lateral translation while the wedge resection enables lateral rotation of the calcaneal tuberosity. The technique enables a more powerful correction of hindfoot varus without excessive lateral translation of the calcaneus, which has been shown to cause tarsal tunnel syndrome. Thus far, there have been few published clinical and radiographic outcomes on the Malerba osteotomy. The purpose of this article is to report on patient reported outcome scores (PROMIS), complications, and radiographic improvement in a series of patients treated with this osteotomy. Methods: A prospectively collected foot and ankle registry was queried to retrospectively identify patients who underwent a Malerba osteotomy from February 2016 through January 2022. Patients were included if they were over 18 years of age, underwent a Malerba osteotomy, had preoperative and minimum 1-year postoperative PROMIS scores, and preoperative and postoperative radiographs. 40 patients met the inclusion criteria (average age 54.3 years). PROMIS scores from 6 domains including physical function, pain interference, pain intensity, global physical health, global mental health, and depression were compared preoperatively and postoperatively. Radiographic measures including talonavicular coverage angle (TNCA), calcaneal pitch (CP), and lateral talus-1st metatarsal angle (Meary’s angle) were measured and compared preoperatively and postoperatively. Complications and radiographic union were also recorded. Results: At a mean of 22 months, PROMIS domains including physical function, pain interference, pain intensity, global physical health, and global mental health improved significantly; the depression scale did not significantly change (Table 1). Calcaneal pitch and Meary’s angle significantly improved from 22.9 to 19.1 (p <.001) and 8.2 to 5 (p <.001), respectively. The talonavicular coverage angle did not significantly improve (p=.2). There were no delayed unions or nonunions. There was 1 case of sural neuritis but no instances of postoperative tarsal tunnel syndrome. There were 3 (8%) superficial infections treated nonoperatively and 0 deep infections. 4 patients (10%) required reoperation: 2 for removal of hardware and 2 for conversion to subtalar fusion. Conclusion: The Malerba calcaneal Z-osteotomy is an effective and safe method to treat adult hindfoot varus deformity. In our series, patients demonstrated an improvement in PROMIS and radiographic outcomes with minimal complications. In particular, the rate of neurologic complications was very low with only one case of sural neuritis and no cases of iatrogenic tarsal tunnel syndrome.
Post-Operative Complications after Acute Achilles Tendon Rupture Repair: A Survival Analysis of Minimally Invasive vs Open Techniques
Authors: Hendriks Joris R.H , Sharma Siddhartha , Peiffer Matthias , Ashkani-Esfahani Soheil , Waryasz Gregory , Kerkhoffs Gino M.M.J. , Kwon John , DiGiovanni Christopher W. , Guss Daniel 
Published: December 2023

Category: Sports; Ankle Introduction/Purpose: Acute Achilles tendon ruptures (ATRs) can be treated surgically through either open repair or minimally invasive surgical techniques (MIS). While the relative complication rates between these techniques, including wound dehiscence, re-rupture, and sural nerve injury, have been debated, many studies demonstrate no significant difference between these two approaches. In this study, we conducted a Kaplan-Meier survival analysis to compare the incidence and timing of complications between open and MIS repair of acute ATRs and examine factors that may influence these rates. Methods: A retrospective study was conducted to evaluate the outcomes of patients (≥18 years) who underwent surgical intervention for acute ATR within a four-week period following injury, with a minimum follow-up of three months. Data on demographic variables, type of surgical procedure (MIS or open approach), and the occurrence and timing of postoperative complications were collected. Postoperative complications were classified as venous thromboembolism (VTE), re-rupture, surgical site infecti+D2on (SSI), wound dehiscence, and sural nerve injury.The Kaplan-Meier method was employed to compare the complication rates between the MIS and open repair groups. The log-rank test was used to test the equality of survivor functions. The Cox proportional hazards model was employed to determine predictors of complications. Results: In total, 417 patients were included in the final analysis. The MIS group had a higher proportion of patients with tobacco use. Fifty-two complications in 50 patients were recorded (Table 1). We found no significant difference in the complication rates between the MIS and open repair groups. However, Cox proportional hazards modeling revealed that body mass index (BMI) was a significant predictor of re-ruptures (HR 1.2, 95% CI = 1.05–1.4) and that surgical delay was found to be a significant predictor of wound dehiscence (HR 1.2, 95% CI =1.01–1.3) and sural nerve injury (HR 1.2, 95% CI =1.1–1.3). A surgical delay of more than 2 weeks was noted to have a positive likelihood ratio of 2.3 for wound dehiscence and 3.1 for sural nerve injury. Conclusion: The results of this study indicate that MIS and open repair techniques for acute ATRs demonstrate comparable complication rates. However, patients with elevated BMI exhibit an increased risk of re-rupture. Those with surgical delay beyond two weeks have an elevated likelihood of wound dehiscence and sural nerve injury, presumptively due to associated scaring and the requisite tissue manipulation. Surgeons and patients may consider these variables when formulating a surgical treatment plan.
Prevalence of Progressive Collapsing Foot Deformity in Hallux Valgus Patients
Authors: Fayed Aly M. , Carvalho Kepler A.M. , Schmidt Eli , Ehret Amanda , Maly Connor , Lalevee Matthieu , Chrea Bopha , Easley Mark , Mansur Nacime Salomao Barbachan , de Cesar Netto Cesar 
Published: December 2023

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Hallux valgus (HV) and progressive collapsing foot deformity (PCFD) are very common foot and ankle conditions in the adult population. Both could potentially disrupt the tripod construct of the foot which leads to chronic pain and arthritis. Several procedures were described to address HV deformity depending on deformity characteristics. PCFD could alter the management plan for HV if they occur simultaneously. The aim of this study was to detect the prevalence of PCFD in HV patients and study the frequency of individual PCFD classes. Methods: In this retrospective IRB approved study, patients > 18 years old who were evaluated for symptomatic hallux valgus and had a weight bearing computed tomography (WBCT) imaging were included. Patients were considered for further analysis if they have a hallux valgus angle (HVA) > 15° or inter-metatarsal angle (IMA) > 9°. All relevant demographic data were extracted. Two fellowship trained foot and ankle orthopaedic surgeon measured the following parameters: foot and ankle offset (FAO%) (Class A), talo-navicular coverage angle (TNCA) (Class B), Meary’s angle (Class C) and middle facet subluxation (MFS%) (Class D). Cases that showed FAO% > 4.6% and MFS% > 28.7% were diagnosed as PCFD. The prevalence of PCFD classes (A,B,C and D) was calculated using threshold values for its respective radiographic marker. Descriptive statistics were performed. Results: Thirty-four cases were included. 16 cases were females (46.06%) and 16 (46.06%) were right side. The average age was 52.51 years (SD ± 17.75), the average BMI was 30.14 (SD ± 7.15). The average HVA was 26.82 (SD ± 9.98) and the average IMA was 15.41 (SD ± 3.53). 13 patients (38.24%) had MFS% and FAO% above the threshold values. The average FAO was 4.75% (SD ± 4.92) and the average MFS was 29.17% (SD ± 15.89). Prevalence of Class A (FAO%) was 20 (58.82%), Class B (TNCA) was 12 (35.29%), Class C (Meary’s angle) was 15 (44.12%) and Class D (MFS%) was 16 (47.06%). Conclusion: Progressive collapsing foot deformity is prevalent in the hallux valgus population (38.24%). Class C which indicates medial column instability was prevalent in 44.12% of the cases. Given this high prevalence of PCFD, we believe that in addition to the classic hallux valgus parameters, PCFD classes evaluation could favor a surgical approach over another such as first tarsometatarsal joint procedures over isolated distal first metatarsal procedures to correct the HV deformity and simultaneously halt PCFD progression.
The Effects of Tibialis Anterior Tenotomy on Wound Problems after Anterior Fusion Plating for Severe Ankle Arthritis
Authors: Cho Byung-Ki , Choi Seung-Myung , Kim Sunghoo , Kim Seong-Hyeon 
Published: December 2023

Category: Ankle Arthritis; Ankle Introduction/Purpose: Because nonunion is known to be a relatively common complication following ankle arthrodesis, various fixation techniques have been introduced to enhance the stability and to improve fusion rate. With the use of anterior plate supplementation, postoperative wound problems have been frequently reported despite better fusion rate. This study was performed to determine the effects of tibialis anterior(TA) tenotomy on wound complications and functional outcomes after anterior fusion plating for severe ankle arthritis. Methods: Forty-six patients who underwent ankle arthrodesis using anterior fusion plate were followed for more than 3 years. TA tenotomy was performed prior to wound closure in all patients. As a control group, thirty-eight patients who underwent arthrodesis without TA tenotomy were analysed. Clinical outcomes were evaluated with Ankle Osteoarthritis Scale(AOS) and Foot and Ankle Ability Measure(FAAM). Wound complication rate, time to fusion, fusion rate, time to pain relief below 3 points in visual analog scale were evaluated. Results: Mean AOS and FAAM scores significantly improved to 32.6 and 69.4 points at final followup, respectively. As compared to control group (33.8 and 67.7 points), there were no significant differences in clinical outcomes. As postoperative wound complications, there were 1 case of wound dehiscence and 1 case of superficial wound infection. TA tenotomy group showed lower wound complication rate (4.3%) than control group (21.1%). While there were no significant differences in fusion rate, time to fusion, and time to pain relief between both groups, control group needed higher rate of implant removal. Conclusion: Ankle arthrodesis using anterior fusion plate in conjuction with TA tenotomy appears to be an effective surgical option for end-stage ankle arthritis, with higher fusion rate and less wound complication rate. Although there was no specific functional deficit related to a loss of the TA tendon, further studies are needed to determine the long-term effects of the TA tenotomy in patients with a fused ankle.
Treatment of Symptomatic Bunionette Deformity with Distal Metatarsal Metaphyseal Osteotomy with no Fixation or Strapping
Authors: Al Ramlawi Akram , Patel Dev , Ashinsky Beth G. , Vulcano Ettore 
Published: December 2023

Category: Lesser Toes; Bunion Introduction/ Purpose: Bunionette deformity (BD) is a painful condition of the fifth metatarsal characterized by an osseous prominence and varus deformity. The purpose of this study is to assess the clinical, functional, and radiographic outcomes of percutaneous distal metatarsal metaphyseal osteotomy (DMMO) without fixation or post-operative strapping of the foot. Methods: A retrospective case series was performed on 111 patients (132 feet) with symptomatic BD who underwent percutaneous DMMO of the fifth metatarsal from September 2020 to January 2022. Patient-reported clinical outcome measures, including the Foot Function Index (FFI) questionnaire, the Visual Analog Score (VAS), and overall satisfaction were collected. Four- Five intermetatarsal angle (IMA) correction, time to bone union, and complication rates were assessed in all patients. Results: The mean post-operative follow-up time was 24.1 months. Both radiographic parameters and patient-reported outcome measures significantly improved after DMMO procedure. The average fourth-to-fifth IMA improved from 12.2 degrees, preoperatively, to 4.4 degrees, postoperatively (p <.001). Pre-operatively, patients had a mean VAS of 7.6, which improved to 0.6 at the last follow-up (p <.001). Furthermore, The average FFI significantly decreased from 19.2 to 4.4 (p <.001). 108 out of 111 patients reported being satisfied with the outcomes of the procedure. Average bone union was achieved at 12.6 weeks post- operation, with a minimum of 12 and a maximum of 25 weeks. The complication rate was 1.5%, including one case of an asymptomatic cock-up deformity and one case of lateral fifth metatarsal shaft bone overhang pain, which resolved with an exostectomy. Conclusion: The results of this study suggest that percutaneous DMMO of the fifth metatarsal without internal fixation or postoperative immobilization or strapping is effective at improving radiographic alignment, pain, function, and overall satisfaction with minimal complication.
A 3D Surface Mapping-Based Morphology Study of the Cartilaginous Surfaces of the 1st TMT Joint
Authors: Oudakker Jessica , Zhu Mingjie , Kumar Aditya , Reyes Katherine Colón , Pierce Robyn M. , Wittels Stephen , Orr Caley M. , Hunt Kenneth , Myerson Mark , Li Shuyuan 
Published: December 2023

Category: Midfoot/Forefoot; Other Introduction/Purpose: The first tarsometatarsal (TMT) joint plays a crucial role in maintaining the stability of the midfoot and medial column. Disorders of this joint are associated with hallux valgus, hallux rigidus, flatfoot, Lisfranc injury and arthritis, and many others. It has been proven that there is a high variability in the morphology of the joint which may be related to joint stability thereby leading to certain deformities. Understanding the morphology of the articular surfaces comprising the joint is necessary. While prior studies have used XR and CT to analyze the joint[1], we present our work using 3D surface mapping to evaluate the cartilaginous articulation of the1st TMT joint. Methods: 22 fresh-frozen cadaveric feet without trauma nor surgery or significant deformities were dissected to expose the medial cuneiform (MeC) and 1st metatarsal (MT) bones, and the articular surfaces of the 1st TMT joint. Surface mapping of the articular surfaces and the two bones was completed using an Artec Space Spider 3D scanner and Mmics. Further digital analysis was completed using GeoMagic Studio 10. Results: Means and Standard Deviations (SDs) of the articular surface and the bone length were summarized in Table 1. The average articular area of the 1st TMT joint was 337.26 (±63.43) mm2 on MeC, and 337.94 (±66.16) mm2 on the 1st MT, with the length of the bones measured 25.50 (±2.56) mm for MeC and 63.93 (±4.22) mm for the 1st MT. There were statistically significant linear correlation between the articular-area and the length of the bone on both sides. 1 mm bone length increase was correlated with 11.48 mm2 articular-area increase on MeC; and 10.33 mm2 articular-area increase on 1st MT. (Figure 1,2) There were three types of morphologies of the 1st TMT joint (Type 1, with 2 facets linked to each other; Type 2, with 2 facets separated; Type 3, 1 large dorsal facet and two separate smaller facets inferiorly). The facet pattern is more obvious on the 1st MT than the MeC side. (Figure 3) Conclusion: Previous studies of the 1st TMT morphology were done using either direct manual measurements with descriptive reporting which does not reflect the exact contour of the joint, or XR/WBCT which cannot demonstrate the cartilaginous articulation. This study used a novel technique of surface mapping which overcame the above issues. The remodeled cartilaginous articular surfaces provide foundations for further comparison study, as well as integration of 3D surface mapping with weight- bearing CT analysis, which is currently under investigation by our research group. This will provide important information for diagnosis, surgical planning, and follow-up treatment for relevant disorders.