bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of Retrograde Intramedullary Beam Position Within Talar Body on Radiographic Failure of Medial Column Fusion
Authors: Wetzig Alexa , Gable Morgan , Cornelius Canon C. , Greaser Michael 
Published: December 2023

Category: Midfoot/Forefoot; Diabetes Introduction/Purpose: Intramedullary fixation in the form of retrograde beam or bolt has developed as an intriguing treatment option for unstable midfoot collapse. This is particularly true when it is desired to minimize the length of incision or to avoid surface implants in a compromised soft tissue envelope. However, prior studies have demonstrated high rates of complications associated with intramedullary midfoot fusion constructs (Ford et al., Butt et al). The goal of this study was to create a reproducible convention of classifying position of the terminal implant within the talar body and to uncover an association of relative position of the implant at the time of surgery with an increased risk of failure. Methods: Consecutive patients treated surgically from January 2017 to September 2022 with retrograde intramedullary fusion beam were identified; 44 were included in the final analysis. Average age was 62.7 years and mean radiographic follow up measured 12.86 months. Figure 1 demonstrates our classification of relative talar position. First, a line was drawn along the axis of the talar neck and carried posteriorly dividing the talar body into dorsal and plantar hemispheres. Then, a line was drawn from the anterior articular margin of the talar body to the lateral talar process. Parallel lines were then created in an equidistant fashion to divide the talar body into equal relative quartiles. At the time of surgery, the tip of the intramedullary beam was classified into relative axial and coronal position by a single observer. Our primary outcomes were hardware failure defined by implant fracture or cutout from the bone or additional surgery. Results: Successful midfoot fusion with intramedullary beam was achieved in 77% of our cases. 10 cases demonstrated hardware failure or the need for additional surgery. Relative implant position was classified as dorsal in 43% of cases and plantar in 57% of cases. Talar quartile depth was classified as 1st in 6% cases, 2nd in 32% of cases, 3rd in 30% of cases, and 4th in 32% of cases. There was no clinical or statistically significant difference between rates of failure based on relative implant position. Conclusion: Retrograde intramedullary fusion for medial column collapse remains a viable treatment option and our data supports successful fusion in most patients but a risk of failure remains significant. In this study, the relative position of the terminal implant within the talar body did not correlate with an increased risk of failure. There are likely other patient specific, or biomechanical factors leading to hardware fracture, cut out, or return of deformity. Continued analysis as sample size increases remains paramount to forming additional conclusions.
InternalBrace for Anatomic AITFL Augmentation and Syndesmotic Stabilization: Results at Long-term Follow Up
Authors: Zingas Nicolas , Schuch Matthew , Zingas Christopher 
Published: December 2023

Category: Ankle; Trauma Introduction/Purpose: In the light of recent randomized control trials, both suture-button and syndesmotic screw fixation are considered standard-of-care for syndesmotic fixation, but no gold standard currently exists. An alternative technique that has been described to stabilize the syndesmosis is with use of suture-tape (InternalBrace, Arthrex) to augment a torn AITFL. This method has been the subject of several biomechanical studies that show it better restores anatomic relationships and can provide a preinjury level of syndesmotic stability. Additionally, it is thought to allow for protected healing of native ligaments, which may be of benefit to patients in the long-term. With this study we sought to explore the long-term outcomes of anatomic augmentation of the AITFL with the InternalBrace for the treatment of syndesmotic injury. Methods: We identified 31 patients who had suffered an acute or subacute syndesmotic injury and were treated with the InternalBrace technique (with or without adjunctive syndesmotic fixation) over a 12-month period from 2019-2020 by a single surgeon. The primary outcome variable was the Olerud-Molander Ankle Score (OMAS) at long-term follow up (12-36 months). Other outcomes collected were FAOS scores, range of motion data, and complications. Additionally, radiographs at five timepoints were reviewed to determine maintenance of syndesmotic reduction. Results: At final follow-up, 15 patients completed the primary outcome with a mean OMAS of 78 (SD, 18). All 31 patients were determined to have a successful syndesmotic reduction at the time of the index procedure. No patients were noted to have a radiographic loss of reduction with a tibiofibular clear space > 6mm at time of final radiographic follow up (mean follow-up 439 days). For those patients with ROM data collected at final follow up, 12/15 patients were limited in dorsiflexion (average deficit 6 degrees), and 7/15 in plantarflexion (average deficit 14 degrees). In total, 10/31 patients developed symptoms of anterolateral impingement, for which six underwent secondary arthroscopic debridement. Conclusion: We report the first mid-to-long term clinical results of a newer alternative method of syndesmotic stabilization. Functional results are comparable to current standards-of-care. AITFL augmentation provides consistent anatomic reduction of the syndesmosis with enough biomechanical strength to resist rotation and diastasis. However, in some patients the development of irregular thickening/scarring of the AITFL contributed to symptoms of anterolateral impingement and stiffness. To avoid this complication, alterations in technique, such as a more proximal application of the suture-tape or avoidance of overtightening, are possible and emphasize the importance of future research.
Lateral Column Overload in Modified Double vs Triple Arthrodesis: A Biomechanical Study
Authors: Gallagher Brian P. , Guyton Gregory P. , Bifano Shawn , Abbasi Pooyan , Wisbeck Jacob 
Published: December 2023

Category: Hindfoot; Basic Sciences/Biologics Introduction/Purpose: There are few comparative studies investigating differences between the modified double and triple arthrodesis of the hindfoot. Previous studies have suggested that stiffening the lateral column of the hindfoot can increase lateral plantar pressures, potentially precipitating lateral column pain. We sought to characterize the difference in forefoot plantar pressures between the native state, after talonavicular (TN)/subtalar (ST) arthrodesis and triple arthrodesis. Methods: Ten fresh-frozen cadaver legs were tested in 4 positions: neutral, dorsiflexion, inversion and eversion. Testing was done in a native state, after TN/ST arthrodesis then after triple arthrodesis for all 4 positions. Forefoot plantar pressures were recorded. Results: Peak pressures increased from the native state laterally underneath the 5th metatarsal (MT) head after TN/ST arthrodesis and triple arthrodesis respectively by 247% and 164% and fell medially underneath the 1st MT head to 38% and 41% in axially loaded legs at neutral (p < 0.025) without a difference between arthrodesis groups. Similarly, 5th MT head pressures were significantly increased from the native state after TN/ST and triple arthrodesis in the legs mounted in eversion by 129% and 109% respectively (p < 0.025), without differences between the two arthrodesis groups. Conclusion: In our cadaveric model of native, non-deformed legs, both a modified double (TN/ST) and triple arthrodesis led to increased lateral forefoot plantar pressures compared to the native state without a difference between the arthrodesis groups.
Ligamentous Injuries in Stable Ankle Fractures
Authors: Ho-Huynh Albert , Karanja Alex , Platt Simon , Walsh Tom 
Published: December 2023

Category: Ankle; Trauma Introduction/Purpose: When considering ankle fractures requiring fixation, it has been shown that stability is the key determinant. Lauge-Hansen supination external rotation (SER) 2 injuries are by definition stable and has been shown to be successfully managed non-operatively. SER 3 and SER 4 ankle fractures are unstable with complete syndesmosis disruption and the majority are managed operatively. We hypothesise that a percentage of radiologically stable injuries involve more structures than previously thought. The primary aim is to determine the prevalence of SER3 and SER4 ankle injuries amongst radiographically SER 2 injuries. Methods: This cross-sectional study uses baseline data from a longitudinal study at Gold Coast University Hospital and Health Service (GCHHS). Patients attending the GCHHS fracture clinic were invited to participate provided they had a radiographically stable SER 2 fracture. Those meeting the eligibility criteria were referred for ankle magnetic resonance imaging (MRI) to assess the integrity of the syndesmotic and ankle ligaments. Results: To date, this study has recruited 33 participants. Following MRI, 23 were determined to have true SER 2 injuries. Nine participants were however reclassified as SER 3 and one participant was reclassified as having an SER 4 injury. Of the SER 3 injuries six included a non-displaced posterior malleolus fracture, while the remaining three were purely ligamentous. Conclusion: This study demonstrates that a portion of radiographically stable ankle injuries involve more structures than previously thought. When radiographic SER 2 injuries were further evaluated with MRI, nearly half were reclassified as SER 3 and 4 injuries. This may suggest that some SER 3 and 4 injuries are functionally stable and can be managed successfully non-operatively.
Medial Column Soft Tissue Imbrication with Internal brace Augmentation Following Lateral Column Lengthening in the Ambulatory Pediatric CP with Pes Planovalgus Foot Deformities: A Novel Indication
Authors: Mathew Smitha E. , McKeon Kelly A. , Tabaie Sean A. 
Published: December 2023

Category: Midfoot/Forefoot; Other Introduction/Purpose: Pes planovalgus foot deformity is common in children with cerebral palsy (CP), and with failed bracing or painful progression, surgery is often needed. This study examines the effect of flatfoot reconstruction utilizing a novel approach to address the redundant medial soft tissue on these measures when compared to matched cohort undergoing the traditionally described soft tissue plication (STP) (Figure 1). Methods: An IRB approved, retrospective review of ambulatory pediatric CP, GMFCS I-III, patients with pes planovalgus foot deformities was conducted. Patients underwent a lateral column lengthening (LCL) along with medial column STP, with/without internal brace (IB) augmentation at a single tertiary institution by the same surgeon from 2017 to 2020. Patients were divided into two groups: without IB, and with IB augmentation. Radiographic indices on orthogonal weightbearing (WB) x-rays were measured at multiple timepoints: Preoperative, immediate postoperative and at the 3/6/12/24 months postoperative follow-up periods. Variables measured included AP and lateral talus-first metatarsal angles (TFMA), talonavicular coverage angle (TCA) and calcaneal pitch (CP). Means and standard deviation for continuous radiographic variables were calculated, followed by one-sided t-tests to compare the values between the two groups at all intervals. Results: 58 patients were identified, 31 without IB and 27 with IB augmentation. Both groups were well matched with respect to age, CP type, GMFCS level and gender. Preoperative WB radiographs showed no statistical difference between the two groups: Mean AP TFMA (26° vs. 28°, p=0.073), lateral TFMA (27° vs. 30°, p=0.067), TCA (34° vs. 30°, p=0.059) and CP (4° vs. 2°, p=0.069)(Table 1). Both cohorts maintained improved radiographic indices at the final 2-year timepoint. However, radiographs showed that the IB group had less midfoot collapse, maintaining a statistically significant difference in all radiographic parameters at final 2-year follow-up: Mean AP TFMA (13° vs. 5°, p< 0.001), lateral TFMA (11° vs. 2°,p < 0.001), TCA (15° vs. 6°,p < 0.001) and CP (10° vs. 19°,p < 0.001) Table 2). Conclusion: Internal brace augmentation is an innovative surgical technique that provides additional stability to the medial column soft tissues following LCL. This procedure will help prevent mid-foot collapse and better maintain long-term foot shape when WB. Utilizing this novel technique helps maintain proper biomechanical orientation of foot following reconstruction of pes planovalgus deformities in the ambulatory pediatric CP population.
Midfoot and Hindfoot Charcot Deformity Correction is Well Maintained with Beam Fixation
Authors: Guareschi Alexander S. , Moore Andrew , Goodloe Jonathan , Hoch Caroline , Morningstar Joshua L. , Scott Daniel , Gross Christopher E. 
Published: December 2023

Category: Midfoot/Forefoot; Diabetes Introduction/Purpose: Charcot arthropathy is a neurotraumatic foot disorder seen in patients with peripheral neuropathy. Surgical reconstruction via medial column arthrodesis with beams can restore plantigrade foot anatomy with decreased soft tissue dissection and improved bony compression. Methods: We identified 12 patients with midfoot (n=7) or hindfoot (n=5) Charcot who underwent medial column beaming arthrodesis between 2015 and 2021 b y one of two fellowship-trained foot and ankle surgeons at an academic medical center. Data collected from patient charts included demographics, medical history, complications, and reoperation rate. Meary’s angle was measured on lateral weightbearing radiographs preoperatively and up to two years postoperatively. Mean follow-up time was 2.50 (range, 1.04-6.98) years. Statistical analysis included correlation, two-tailed Student t-test, and Chi-squared test. Results: Meary’s angle was recorded preoperatively for 12 patients (19.3° ± 6.7°) and postoperatively at three months for 12 patients (4.0° ± 6.7°), at six months for 12 patients (7.1° ± 9.7°), at one year for 11 patients (6.1° ± 9.4°), and at two years for five patients (10.2° ± 6.4°). However, two (16.7%) patients showed a loss of deformity correction, which was demonstrated by a Meary’s angle that was greater at final follow-up than preoperatively. Overall complication, infection, reoperation rates were 50.0%, 41.7%, and 58.3%, respectively. Finally, dependent on preoperative ulceration, those with and without an ulcer did not differ in Meary’s angle at any time point, overall complication, infection, nor reoperation rate. Conclusion: Although the results showed a relatively high complication rate, the use of beaming arthrodesis was generally able to maintain a plantigrade foot and overall alignment, while decreasing the recurrence of plantar ulceration.
Midterm Outcomes of the Salto Talaris Total Ankle Arthroplasty
Authors: Kim C. James , Winters Brian S. , Tsai Justin , O’Neil Joseph T. , Fuchs Daniel , Sidhu Verinder S. , Campbell Benjamin R. , Shakked Rachel , Daniel Joe 
Published: December 2023

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle arthroplasty (TAA) has become an accepted alternative to ankle arthrodesis for end-stage ankle arthritis and has seen significantly increased utilization in the past decade1. The Salto Talaris total ankle prosthesis has shown excellent short-term and mid-term survivorship results since its FDA approval in the U.S. in 20062,3. At a minimum of five-year follow-up, the currently reported midterm survivorship has ranged from 93.3% to 100% with equally satisfactory clinical outcomes as evidenced in short-term outcome studies4–8. The purpose of this study is to report the outcomes of one of the largest cohort of patients who underwent a Salto Talaris total ankle arthroplasty with a minimum of five-year follow-up. Methods: 103 Salto Talaris TAA patients with 5-view weight-bearing series of radiographs and minimum follow-up time of 5 years since index surgery were included. Age at time of surgery, gender, body mass index, diagnosis, diabetes status, and tobacco use were collected through chart review. Radiographic imaging was assessed at the most recent follow-up for evidence of radiolucency and osteolysis as previously described9. Range of motion was assessed on plantarflexion and dorsiflexion views on sagittal radiographs as previously described10. The Foot and Ankle Ability Measure (FAAM) and Visual Analog Scale for pain (VAS) scores were obtained at the most recent follow up visit and compared with preoperative scores. Baseline characteristics were compared between groups using Wilcoxon rank-sum test for continuous data or Fisher exact test for discrete data. Survivorship probability was calculated using a Kaplan-Meier analysis for revisions and reoperations. Revisions were defined as exchange or removal of metal component. Results: The survivorship for revision surgery was 93.2% (95% CI [89.8,98.8]). 5 out of the 7 patients requiring revision surgery experienced talar subsidence, 1 patient experienced an infection, and 1 patient experienced lateral impingement. The survivorship for reoperation was 90.2% (95% CI [83.4-95.4]). 5 out of the 10 patients requiring reoperation experienced pain from impingement, 2 experienced periprosthetic fractures, 1 experienced infection, and 2 experienced osteolytic cysts. At last follow- up, the FAAM-ADL, FAAM-Sport, and VAS pain scores were improved from preoperatively. The average range of motion at last follow-up was 31.6 degrees. On the AP view, radiolucency and osteolysis were most frequently detected in zones 3 and 4, while on the lateral view they were most frequently seen in zones 2 and 6. Conclusion: Patients undergoing Salto Talaris prosthesis showed improvements in patient-reported outcomes with satisfactory survival rates.
Minimally Invasive Transverse Distal Metatarsal Osteotomy for Hallux Valgus Correction: Is there a Difference in Outcome Between Moderate and Severe Deformities?
Authors: Yoon Yeokwon , Shim Dong Woo , Park Kwang Hwan , Han Seung Hwan , Lee Jin Woo 
Published: December 2023

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: We compared the radiological and clinical outcomes of moderate and severe hallux valgus (HV) treated with minimally invasive distal metatarsal transverse osteotomy (MITO) performed by a single surgeon. Methods: Eighty-four patients who underwent MITO between May 2018 and March 2020 were recruited and followed for at least 24 months. The severe group was defined as having a preoperative hallux valgus angle (HVA) greater than 40° or preoperative first-to-second intermetatarsal angle (1–2 IMA) greater than 16°; the moderate group was defined as having an HVA less than 40° and a 1–2 IMA less than 16°. Pre- and postoperative measurements of the HVA, 1–2 IMA, distal metatarsal articular angle, and tibial sesamoid position were obtained. The Visual Analogue Scale for pain, the Foot and Ankle Outcome Score, and the Medical Outcomes Study Short Form Health Survey-36 Physical Component Summary were used to assess clinical outcomes. Results: Both groups showed significant improvements in all radiologic parameters postoperatively with the degrees of correction greater in the severe group than in the moderate group. All clinical scores improved significantly from the preoperative to the last follow-up visit. Final clinical outcomes and degrees of improvement were comparable in both groups. Conclusion: This study showed that short-term radiographic results for patients with either moderate or severe HV treated with MITO were favorable. Overall clinical outcomes were comparable to those of conventional treatments. MITO with screw fixation is a satisfactory surgical option for patients with HV deformities.
Multiple Ankle Injuries are Associated with an Increased Risk of Subsequent Concussion in National Football League Players
Authors: Bergstein Victoria E. , Shu Henry , Bodendorfer Blake , DeFroda Steven , Aiyer Amiethab A. 
Published: December 2023

Category: Sports; Ankle Introduction/Purpose: Ankle injuries are among the most common musculoskeletal injuries in National Football League (NFL) players. Concussions are also concerningly frequent, especially given increasing post-mortem observations of chronic traumatic encephalopathy (CTE) in former NFL players. There is a gap in the literature regarding musculoskeletal risk factors for concussion, which is an avenue that must be explored to promote player safety. The purpose of this study is to observe if ankle injuries, especially multiple ankle injuries, are associated with an increased risk of subsequent concussion in NFL players. Methods: The public online database ProFootballReference.com was utilized to identify ankle injuries and concussions in NFL players, as well as demographic variables such as BMI and age. Multivariable logistic regression for subsequent concussion and ankle injury was performed, adjusting for BMI and player position. For descriptive statistics, unpaired T-tests with unequal variance were performed for continuous variables, including BMI and age. Chi-squared testing was performed for categorical variables, including player position, and whether the position was offensive (quarterback, running back, tight end, wide receiver, offensive line), defensive (defensive back, defensive line, linebacker), or on special teams (kicker, punter, long snapper). Results: 5,538 NFL players from the 2009-2010 to 2019-2020 seasons were included in the study. The mean BMI and age of the cohort was 31.06 (SD 4.55) and 24.41 (SD 3.63), respectively. Of these players, 941 had an ankle injury, 633 had a concussion, and 240 had both an ankle injury and a subsequent concussion. The adjusted odds ratio (aOR) for concussion following a single ankle injury was 0.90 (95% CI 0.72 – 1.14, p = 0.387), however, the aOR for concussion following multiple ankle injuries was 2.88 (95% CI 1.28 – 6.74, p = 0.015). The kicker position was determined to have the lowest risk for concussion following ankle injury, and the positions with comparatively greater risk are outlined in Table 1. Conclusion: Multiple ankle injuries were associated with an increased risk of a subsequent concussion by 188% after adjusting for BMI, player position, and offense/defense/special teams designation. Special teams as a group and by position (kicker, long snapper, punter) had the lowest risk of concussion following ankle injury, likely owing to the lower-impact nature of these positions. These findings can inform injury prevention practices in the National Football League.