bluuebunny/crossref_metadata_2025_split huggingface dataset:
How Does Alcohol Use Disorder Impact Morbidity, Readmission Rates, and HealthCare Expenditures Following Open Reduction and Internal Fixation of Bimalleolar Fractures?
Authors: Monas Arie , Chatad Derrick , Rodriguez Ariel Nicolas , Lam Aaron , Abdelgawad Amr , Razi Afshin 
Published: December 2023

Category: Ankle; Trauma Introduction/Purpose: Bimalleolar ankle fractures are a common injury that can be treated with open reduction and internal fixation (ORIF). However, there is a paucity of literature evaluating the impact of patients with alcohol use disorder (AUD) on postoperative complications following ORIF of bimalleolar ankle fractures. Therefore, the purpose of this study is to investigate whether patients with AUD undergoing ORIF of bimalleolar ankle fractures have higher odds of (1) morbidity; (2) readmissions; and (3) costs of care. Methods: A retrospective query of the PearlDiver nationwide claims database was performed between January 2010 and October 2020. Baseline demographics were analyzed using Pearson’s Chi-Square Analyses. Multivariate binomial logistic regression was utilized to calculate the effect of AUD on 90-day medical complications. Costs of care were compared using Welch’s t-tests. A P value less than 0.001 was considered to be statistically significant. Results: The query yielded 64,563 patients within the study (AUD = 8,177; control = 56,386). Patients who have AUD were found to have significantly higher incidence and odds of developing 90-day medical complications (59.35% vs. 18.77; OR: 2.30; 95% CI: 2.16 to 2.46; p < 0.0001). AUD patients were found to have higher incidences of 90-day readmissions (9.14% vs. 5.56; OR: 0.95; 95% CI: 0.86 to 1.05; p=0.361); however, this failed to reach statistical significance. Patients with AUD also incurred significantly higher day of surgery costs ($4,433.33 vs. $3,979.85, p< 0.0001) and 90-day episode of care costs ($8,523.40 vs. $6,976.95, p< 0.0001). Conclusion: AUD patients have higher odds of 90-day postoperative complications and costs of care following ORIF of bimalleolar ankle fractures. The findings of this study can be used by orthopaedic surgeons to reduce healthcare costs as well as improve postsurgical outcomes by educating patients who have AUD on the potential complications that they may encounter after their procedure.
Incidence of Acute vs Chronic Post-op Complications Following TAA: Are They Preventable?
Authors: Nam Hannah H. , Martinazzi Brandon J. , Staub Jacob , Milne Indigo G. , Alwine Shelby , Kim Raymond Y. , Aynardi Michael 
Published: December 2023

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is becoming an increasingly common procedure with high patient satisfaction and improved outcomes. Although previous studies have explored various patient outcomes, there is variability in reporting methods and acute and chronic complications following TAA are poorly described. The purpose of this study was to evaluate the acute and chronic postoperative complications in patients undergoing TAA at our institution. Methods: Following institutional board approval, a retrospective chart review was conducted for all patients who underwent TAA from 2002-2017 at our institution. Patients were followed from the time of surgery to their 1 year follow-up. Demographics and post-op complications were recorded at 2 weeks, 6 weeks, and 1 year following surgery. Results: At our institution from 2002-2017, a total of 187 patients underwent TAA. The mean age of our cohort was 62.8 (Range 20-68). In our cohort, 106 were male and 81 were female, and the mean patient BMI was 31.6 (Range 33-89). At 4 weeks post- operatively, the most common acute complication was superficial infection (4.8%). Within 6 weeks post-operatively, 1 patient had a VTE (0.53%). The highest chronic complication following TAA was post-operative pain – 12.3% patients reported significant post-operative pain 1 year following surgery. 9.6% patients required hardware removal greater than 1 year following TAA. Conclusion: At our institution the most common acute complication at 4 weeks following TAA was surgical site infection (4.8%). The most common chronic complication was post-operative pain (12.3%). Further investigation is needed to understand the greatest contributing factors to these complications and future studies will focus on methods to minimize surgical site infection and post-operative pain following TAA.
Lateral Joint Distraction through Distal Fibula Lengthening Osteotomy for Lateral Compartment Ankle Osteoarthritis
Authors: Im Je-Min , Lim Jung-Won , Jung Hong-Geun 
Published: December 2023

Category: Ankle Arthritis Introduction/Purpose: Lateral compartment ankle OA, commonly due to trauma such as ankle fracture, is not very rare. However there’s no definite established surgical treatment option. In this study, we suggest distal fibula lengthening osteotomy for lateral joint distraction as one of treatment surgical option. We have experienced favorable clinical outcome for 3 cases of post-traumatic lateral compartment ankle OA with joint space narrowing treated with distal fibula distraction osteotomy. We report the case series with the surgical technique and the clinical- radiological outcome. Methods: From April 2016 to August 2021, three ankles which underwent distal fibula distraction osteotomy were included in this study. All three ankles had a history of OR/IF due to fractures in the ankle joint and were diagnosed with lateral compartment OA. We defined lateral compartment OA when clinical symptoms and radiologic findings were consistent. Clinically, the point of pain was characterized as the lateral compartment of the ankle joint, not the syndesmosis or peri fibular area. Radiologically, joint space narrowing is showed in X-ray, and CT arthrography or MRI confirmed cartilage denudation of the lateral compartment. Results: 1) Clinical outcomes Case 1: The AOFAS score improved from 69 preoperatively to 93 postoperatively, and the Pain vas score improved from 7 to 0. According to patient’s subjective expression, daily activity became 'Boxing available' from 'Hard to run'. Case 2: The AOFAS score improved from 73 preoperatively to 91 postoperatively, and the Pain vas score improved from 5 to 0. According to patient’s subjective expression, daily activity became 'No pain on daily activity' from 'Hard to walk'. 2) Radiologic outcomes Lateral joint space, talocrural angle, talar tilt angle and tibia axis-talar dome angle were all changed close to the contralateral ankle index after surgery. Conclusion: Painful ankle OA localized to the lateral compartment in young age is uncommon and there is no definite surgical method. Distal fibula distraction osteotomy is reasonable surgical method that does not burden patients and surgeon. In our study, distal fibula distraction osteotomy showed favorable clinical-radiological outcomes. So, we recommend this method for painful lateral compartment OA in young ages.
Lateral Talar Subluxation Measurements in Non-Operatively Managed Weber B Ankle Fractures
Authors: Ge Laurence , Talusan Paul G , Holmes James , Walton David 
Published: December 2023

Category: Ankle; Trauma Introduction/Purpose: Isolated Weber B ankle fractures are common orthopedic injuries; however, indications for surgical management can be controversial. Stress radiographs have been utilized to evaluate the competence of the deltoid ligament, and recently lateral talar subluxation (LTS) has been described as a measurement tool for evaluating these injuries. It has been suggested that LTS >4mm on gravity stress radiographs may be utilized to determine need for surgical intervention. In this study we review the LTS measurements in a cohort of non-operatively treated isolated Weber B fibula fractures to determine its utility as a tool to potentially guide treatment decisions and its association with patient outcomes. Methods: Our group previously presented a novel algorithm for non-operative management of isolated Weber B ankle fractures and enrolled a cohort of patients. Outcome scores were reported including American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot, Olerud-Molander (OMA), Foot and Ankle Ability Measure for Activities of Daily Living (FAAM/ADL), and Visual Analog Scale (VAS) scores. All patients achieved union of their fracture. For each patient we measured LTS on the injury gravity stress view x-rays as well as the un-injured contralateral side which has not been previously reported. A Kruskal-Wallis non-parametric test was used to determine whether there was any association of outcomes with extent of LTS. Results: 42 patients were included, with minimum 1 year follow-up. The average age was 49 years (range 19 to 72). On injury gravity stress radiographs, mean medial clear space (MCS) was 4.45 mm (SD = 0.93), superior clear space (SCS) 3.46 mm (SD = 0.70), and LTS 2.33 mm (SD = 1.57, range 0 – 4.7 mm), with 35 (83.3%) patients having LTS ≤ 4 mm. Contralateral (un-injured) gravity stress mean MCS was 3.39 mm (SD = 0.63), SCS 3.15 mm (SD = 0.50), and LTS 1.30 mm (SD = 1.28, range 0 - 4.8). There was no significant difference in outcome measures based on amount of LTS ( < 2 mm, 2 to 4 mm, >4 mm): AOFAS (p=0.41), OMA (p=0.40), FAAM/ADL (p=0.41), pain VAS (p=0.16). Conclusion: All patients in our cohort were successfully treated non-operatively. Most patients had injury LTS ≤ 4 mm, although those with LTS >4 mm had excellent outcome scores as well. Amount of LTS did not correlate with outcomes. We present a large range of LTS measurements in normal ankles, which may be attributed to the high variability of these measurements and sensitivity to ankle rotation on radiographs. LTS may be a useful adjunct in evaluating isolated Weber B ankle fractures but may not be entirely reliable on its own. Further studies are required to validate LTS as a quantitative decision-making tool.
Minority and Lower Socioeconomic Status Patients Receive Ankle Fracture Care at Higher Cost Sites
Authors: Chawla Sagar S. , Ford Samuel , Odum Susan , Yu Ziqing 
Published: December 2023

Category: Ankle; Trauma Introduction/ Purpose: Socioeconomic disparities exist in the delivery of orthopedic care. Inequitable outcomes based on socioeconomic status (SES), including income, race, and geography, have been studied in association with outcomes following lower extremity trauma care. As orthopedic surgical care shifts increasingly towards providing care in hospital outpatient departments (HOPD) and freestanding ambulatory surgery centers (ASC), there is an opportunity to address socioeconomic disparities. We aimed to assess the association between patient SES and the outpatient facility type (HOPD versus ASC) where ankle fracture care was performed. We hypothesize: (1) White patients are more likely to receive care at ASCs, (2) Minority and lower income patients are more likely to receive care at HOPDs, and (3) Total charges for care are higher for minority and lower income patients. Methods: Data in patients ≥16 years old was sourced from the State Inpatient Database and Healthcare Utilization Project State Ambulatory Surgery Database (SASD) (for Florida, North Carolina, and Wisconsin) from 2016-2019. These 3 states were selected because their SASDs include a variable defining the location of service as a hospital outpatient department (HOPD) or ASC. Cases were identified using CPT codes converted to ICD-10 procedural codes for ankle fracture open reduction and internal fixation (ORIF). 85,749 cases were included: 50,411 (59%) inpatient, 28,536 (33%) HOPD, and 6,802 (8%) ASC, representing approximately 20% of inpatient and 11.5% of outpatient cases performed in the United States. Patient and facility characteristics were abstracted. Appropriate statistical analyses were conducted to describe and compare differences between facility type and patient characteristics. Results: Significant race and income disparities exist in outpatient ankle fracture care by facility type. Most patients receiving care were White (71%). Of the patients who received care at an HOPD, 32% were Black compared to 6% at ASCs (OR 0.795, CI 0.728-0.869). Of patients receiving care at an HOPD, 27% were other minorities compared to 9% at ASC (OR 1.213, CI 1.213- 1.309). More patients at HOPDs were in the lowest income level (26%) compared to ASC (18%). Factors found to associated with higher charges for surgery included patient being of minority race, patient of lower income level, and surgery performed at HOPD versus ASC. Conclusion: Ankle fractures treated at ASCs were more likely to be White and of higher income. These socioeconomic and racial/ethnic disparities are also associated with receiving care with higher total charges. These data indicate inequitable access to ankle fracture care performed at ASC facilities. More attention to social determinants of health is critical in the context of ankle fracture care to address potential inequitable outcomes and higher cost of care.
Outcomes following Particulated Juvenile Allograft Cartilage for Osteochondral Lesions of the Talus: A Systematic Review
Authors: Butler James J. , Rizlan Muhammad Raziq Mohammed , Azam Mohammad T. , Campbell Hilary T. , Kennedy John G. 
Published: December 2023

Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: The purpose of this systematic review was to evaluate the clinical and radiological outcomes together with the complication rates and failure rates at short-term follow-up following Particulated Juvenile Allograft Cartilage (PJAC) for the management of osteochondral lesions of the talus (OLT). Methods: During November 2022, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following PJAC for the management of OLTs. 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: Twelve studies were included. In total, 241 patients underwent PJAC for the treatment of OLT at a weighted mean follow-up of 29.0±24.9 months. The weighted mean lesion size was 138.3±59.6 mm2 and 69.4% of OLTs were located at the medial talar dome. Prior surgical intervention was recorded in 7 studies, the most common of which was microfracture (65.9%). Concentrated bone marrow aspirate was utilized in 66 patients (27.3%). The weighted mean AOFAS score improved from a pre- operative score of 58.5±3.2 to a post-operative score of 83.9±5.3. The weighted mean post-operative MOCART score was 48.2±3.3. The complication rate was 16.5%, the most common of which was graft hypertrophy (7.0%). Thirty failures (12.4%) were observed at a weighted mean time of 9.8±9.6 months following the index procedure. Conclusion: This systematic review demonstrated a moderate improvement in subjective clinical outcomes following PJAC for the treatment of OLT at short term follow-up. However, post-operative MOCART scores were reported as poor. In addition, a moderate complication rate (16.5%) and a moderate failure rate (12.4%) was observed, calling into question the efficacy of PJAC for the treatment of large OLTs. Further studies are warranted to identify the optimal role of PJAC in the management of OLTs.
Outcomes following Surgical Intervention for Hallux Varus deformity: A Systematic Review
Authors: Butler James J. , Joudi Rakan , Azam Mohammad T. , Kennedy John G. 
Published: December 2023

Category: Midfoot/Forefoot; 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 hallux varus deformity. Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following surgical intervention for hallux varus deformity. Data regarding study characteristics, patient demographics, osteoarthritis severity, 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: Twelve studies were included. In total, 168 patients (186 feet) underwent surgical intervention for hallux varus deformity. at a weighted mean follow-up of 49.6±36.6 months. The weighted mean AOFAS score improved from a pre-operative score of 60.5±18.4 to a post-operative score of 83.9±9.0. The weighted mean hallux valgus angle improved from a pre-operative angle of 16.9±6.5° of varus to a post-operative angle of 5.9±6.6° of valgus. The weighted mean inter-metatarsal angle improved from a pre- operative angle of 12.7±10.0° to a post-operative angle of 7.7±3.4°. The complication rate was 21.5%, the most common of which was 1st MTPJ joint pain and stiffness. Eleven failures (5.9%) were observed at a mean time of 25.0 months following the index procedure. Conclusion: This systematic review demonstrated improvements in subjective clinical outcomes together with a low failure rate following surgical intervention for hallux varus deformity at mid-term follow-up. A high complication rate was recorded. However, the marked heterogeneity between included studies and paucity of high quality comparative studies limits the generation of any robust conclusions. Further research with a longer follow-up is warranted to determine the optimal surgical technique for hallux varus deformity correction.
Prospective Study of the Destabilization Maneuver in Inversion for the Treatment of Acute Ankle Ligament Injury: Case Series
Authors: Galati Danilo Antonio , Mansur Nacime Salomao Barbachan 
Published: December 2023

Category: Ankle; Sports Introduction/Purpose: Ankle sprains are highly prevalent injuries in athletes, whether amateurs or professionals. It is estimated that they cause around 5,000 sprains a day in the UK, while American data point to around 23,000 cases daily (1/10,000 individuals). The most current literature has pointed to early diagnosis followed by functional strategies as the approach with the highest success rate for lateral ankle sprains, thus contributing to the prevention of chronic instabilities. offering better quality of life and safety to patients are necessary. Objective: The objective of this work is to present the clinical results obtained from the prospective observation of a series of patients with lateral ankle sprains treated with the destabilization technique in Ankle Inversion added to the conventional treatment. Methods: Design: Comparative prospective study in a single center without a control group Location: The study was carried out at Hospital São Paulo – University Hospital of UNIFESP (HSP-UNIFESP), at the Orthopedics Ambulatory of the Department of Orthopedics and Traumatology (DOT)/EPM-UNIFESP. Inclusion criteria -Over 18 years old of both sexes; -Complaint of ankle sprain within 48 hours -Complete or partial injury to any of the ligaments of the lateral ankle complex; -Isolated or associated ligament injuries; Non-Inclusion Criteria -Past history of surgery on the affected foot or ankle; -Previous complaint in the ankle region; -Any fracture associated with sprains or injuries that influence; -Any condition that is a contraindication to the proposed therapies; -Refusal to participate in the study Sample size: 100 Individuals Results: We conclude that statistically we have a higher percentage of No Re-sprains with 94% against 6% of Re-sprains. This index has a CI (confidence interval) of 4.7%, that is, we have that the Reentorse index was 6.0% ± 4.7% which is the same as saying that the index can vary from 1 .3% to 10.7% with 95% statistical confidence. Conclusion: Based on the findings of the present study, we concluded that in a 12-month follow-up, the ankle inversion destabilization maneuver proved to be effective in preventing new episodes of lateral ankle sprains. and in order to compare the maneuver described in the study with techniques already described in the literature and used by physiotherapists in their clinical practice, should be performed.
Racial, Socioeconomic, and Payer Status Disparities in Utilization of Total Ankle Arthroplasty Compared with Ankle Arthrodesis
Authors: Schmerler Jessica , Dhanjani Suraj , Wenzel Alyssa , Kurian Shyam J. , Srikuaran Uma , Ficke James 
Published: December 2023

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle arthroplasty is increasingly being used for the treatment of ankle osteoarthritis when compared to arthrodesis. However, there has been limited investigation into disparities in utilization of these comparable procedures. This study examined racial/ethnic, socioeconomic, and payer status disparities in the likelihood of undergoing total ankle arthroplasty compared with ankle arthrodesis. Methods: Patients with a diagnosis of ankle osteoarthritis from 2006 through 2019 were identified in the National Inpatient Sample, then subclassified as undergoing total ankle arthroplasty or arthrodesis. Multivariable logistic regression models, adjusted for hospital location, total hospital charges, primary or secondary osteoarthritis diagnosis, and patient characteristics (age, sex, infection, diabetes, neuropathy, and Elixhauser Comorbidity Index), were used to examine the effect of race/ethnicity, socioeconomic status, and payer status on the likelihood of undergoing total ankle arthroplasty versus arthrodesis. Results: There were 6,966 patients who underwent TAA and 5,681 patients who underwent arthrodesis over the study period. Black and Hispanic patients were 42% and 32% less likely than White patients to undergo total ankle arthroplasty rather than arthrodesis (P <.001). Patients in income quartiles 3 and 4 were 17% and 23% more likely, respectively, than patients in quartile 1 (the lowest quartile) to undergo total ankle arthroplasty rather than arthrodesis (P=.001 and P=0.01, respectively). Privately insured and Medicare patients were 67% and 117% more likely, respectively, than Medicaid patients to undergo total ankle arthroplasty rather than arthrodesis (P <.001). Conclusion: Racial/ethnic, socioeconomic, and payer status disparities exist in the likelihood of undergoing total ankle arthroplasty versus arthrodesis for ankle osteoarthritis. More work is needed to establish drivers of these disparities and identify targets for intervention, including improvements in parity in relative procedure utilization.