bluuebunny/crossref_metadata_2025_split huggingface dataset:
Proximal Tibial Cortex Transverse Distraction Facilitating Healing and Limb Salvage in Severe and Recalcitrant Diabetic Foot Ulcers
Authors: Hua Qikai 
Published: December 2023

Category: Diabetes; Diabetes Introduction/Purpose: The management of severe and recalcitrant diabetic foot ulcers is challenging. Distraction osteogenesis is accompanied by vascularization and regeneration of the surrounding tissues. The longitudinal distraction of the proximal tibia stimulates increased and prolonged blood flow to the distal tibia. However, the effects of the transverse distraction of the proximal tibia cortex on severe and recalcitrant diabetic foot ulcers are largely unknown. Methods: Between July 2014 and March 2017, we treated 136 patients with diabetes and severe ulcers (University of Texas Grade 2B to 3D) that had not responded to treatment for at least 6 months. and their ulcers had a mean ± SD area of 44 cm2 ± 10 cm2. All 136 patients underwent tibial cortex transverse distraction. We compared these patients with the last 136 consecutive patients we treated with standard surgical treatment between May 2011 and June 2013; All patients received standard off-loading and wound care. We compared the groups with respect to ulcer healing (complete epithelialization without discharge, maintained for at least 2 weeks) in a 2-year follow-up, the proportion of ulcers that healed by 6 months, major amputation, recurrence, and complications in the 2-year follow-up. Foot arterial status and perfusion were assessed in the TCTD group using CT angiography and perfusion imaging. Results: The tibial cortex transverse distraction group had a higher proportion of ulcers that healed in the 2-year follow-up than the control group (96% versus 68% ; p < 0.001). By 6 months, a higher proportion of ulcers healed in the TCTD group than in the control group (93% versus 41% ; p < 0.001). Lower proportions of patients in the TCTD group underwent major amputation (2.9% versus 23%; p < 0.001) or had recurrences 2.9% versus 17%, OR 0.20 [95% CI 0.05 to 0.45]; p < 0.001) than the control group in 2-year follow-up. In the feet of the patients in the TCTD group, there was a higher density of small vessels and higher blood flow and blood volume 12 weeks postoperatively than preoperatively. Conclusion: Proximal tibial cortex transverse distraction substantially facilitated healing and limb salvage and decreased the recurrence of severe and recalcitrant diabetic foot ulcers. The surgical techniques were relatively straightforward although the treatment was unorthodox, and the complications were few and minor. These findings suggest that tibial cortex transverse distraction is an effective procedure to treat severe and recalcitrant diabetic foot ulcers compared with standard surgical therapy. Randomized controlled trials are required to confirm these findings.
Radiographic and Clinical Results of 4rd Generation Minimally Invasive Bunion Surgery for Symptomatic Hallux Valgus
Authors: Rodriguez-Materon Solangel , Lopez Kyra E. , Chapman Cary , Chapman Grant , Hodgkins Christopher , Giovanni Thomas P. San 
Published: December 2023

Category: Bunion; Other Introduction/Purpose: Minimally invasive techniques for surgical treatment of hallux valgus has gained popularity over the past few years. Most published reports involve combined minimally invasive Chevron and Akin osteotomies (MICA) performed by a single surgeon. This study reports radiographic and clinical results on patients who underwent minimally invasive transverse distal 1st metatarsal and Akin osteotomies by 3 fellowship trained Foot & Ankle orthopedic surgeons. A minimally invasive transverse distal 1st metatarsal osteotomy has advantages over MIS chevron osteotomy as it is less technically demanding and in theory, the surgeon can control 1st metatarsal head rotation to improve sesamoid position. Methods: Ninety-five consecutive patients between 2019 and 2021 with symptomatic Hallux valgus without 1st tarsometatarsal or metatarsal phalangeal joint arthritis or TMT joint instability were followed for at least one year. Primary radiographic outcomes include pre and postoperative hallux valgus and 1-2 intermetatarsal angles. Pain relief was measured by VAS scores. Patient Reported Outcomes (PROMS) used were Foot and Ankle Mobility (FAAM) scores in the dimension of activities of daily living (ADL) and sports. PROMS measured at one year follow-up. Radiographic recurrence was defined as a change in HVA >2.6 degrees between any 2 postoperative radiographs and an HVA >15 degrees. Z-Scores were calculated depending on the patient's demographics based on normative values to assess the deviation from a normal population FAAM scores. Results: Demographics and preoperative bunion classification of all patients included in this study can be found in table 1. Average pre-op HVA and IMA were 24.9 and 12.2 degrees respectively and improved to 8.43 and 5.86 degrees (p < 0.01) at 3 months. From the 3 months to 12 months, the patients’ HVA and IMA average was 9.39 and 6.85, but this change was not statistically significant (p = 0.35). VAS scores improved from 5.37 preoperatively to 1.9 at final follow up (p < 0.01). The average postoperative FAAM ADL score was (86.34 +/- 17.18) and z-score was (-0.08 +/- 1.16). The average postoperative FAAM sport score was (66.12 +/- 30.93) and z-score was (-0.26 +/- 1.94). Conclusion: Overall, the results of the study affirm the literature that third generation MIS hallux valgus surgery remains a good option. This study showed no infections in patients undergoing MIS hallux valgus surgery and the correction of the hallux valgus angles that persisted at 12 months with low recurrence rates. At this time, the results show a trend toward lower FAAM scores postoperatively at one year follow-up that was significant in the sports subscore but the difference from a normal population is not significant in the ADL subscore. Longer follow-up is needed to evaluate the trend further.
Reliability of Cone Bean Weight-Bearing Measurements of the Postoperative Outcome of Total Ankle Arthroplasties and Inter-Method Reliability with Respect to the Weight Bearing x-rays
Authors: Barbero Agustin , Efrima Ben , Maccario Camilla , Indino Cristian , Ovadia Joshua , Usuelli Federico Giuseppe 
Published: December 2023

Category: Ankle Arthritis; Ankle Introduction/Purpose: Postoperative evaluation of the total ankle arthroplasty (TAA) alignment is a fundamental step in measuring the surgical outcome. The current reference standard, weight-bearing x-ray (WBXR), is subject to technical bias. Weight-bearing cone beam computer tomography (WBCT) allows visualization of the complex three-dimensional (3D) structure of the foot under the influence of its deforming forces. A WBCT-based measurement system to assess postoperative outcomes has yet to be validated. The purpose of this study was (1) to measure the surgical outcome of TAA using semiautomatic generated models, (2) to evaluate the agreement levels between two raters, and (3) to evaluate the inter-method reliability with respect to WBXR. Methods: Fifty-five consecutive patients were retrospectively viewed. Two raters independently created a 3D model using dedicated software. Each rater measured six different measurements: α angle tibiotalar angle, hind foot angle (HFA), β angle, γ angle, and Φ angle using a semiautomatic 3D model and one measurement, the tibiatalar ratio (TTR) using WBCT on sagittal view. Measurements were repeated two months apart in the same independent fashion. Results were compared to standard weight- bearing x-rays. Consequently, interobserver, intraobserver, and intermethod agreements were calculated. Results: All seven measurements showed good to excellent interobserver and interobserver reliability. (ICC 0.85-0.95). The intermethod agreement showed good agreement for the γ angle (0.79) moderate agreement levels for the α angle, TTS angle, β angle, and TTR (ICC 0.68, 0.69, 0.70, 0.69 respectively), a poor agreement for the HFA angle (ICC 0.25), and a negative agreement for the φ angle (ICC -0.2). Conclusion: Postoperative analysis of TAA using WBCT demonstrated good to excellent interobserver and intraobserver agreement and can be reliably used. When compared to WBXR, moderate to good agreement was measured for the sagittal and coronal alignment of the components. A poor agreement was measured for the coronal alignment of the hindfoot, and a negative agreement was measured for the axial rotation angle, indicating that the intermethod comparison is unreliable.
Anatomical Features of Patients with Recurrent Dislocation of the Peroneal Tendons
Authors: Nishimura Akinobu , Senga Yoshiyuki , Fujikawa Yuki , Sudo Akihiro 
Published: December 2023

Category: Hindfoot; Sports Introduction/Purpose: The occurrence of peroneal tendon dislocation (PTD) may be influenced by anatomical variations in the peroneal muscles and ankle lateral malleolus. One such factor is peroneal groove crowding, which can result from increased muscle and tendons bulk within the peroneal tendon sheath. Another potential factor is the shape of the retromalleolar groove, which determines the inherent stability of the tendons in the groove. This study aims to examine the anatomical variations of the retromalleolar groove and peroneal muscles in patients with and without recurrent PTD (RPTD) using magnetic resonance imaging (MRI) and computed tomography (CT). Methods: This study included 30 patients (30 ankles) with recurrent PTD who underwent both MRI and CT before surgery (PD group) and 30 age- and sex-matched patients (control (CN) group) who underwent MRI and CT. The imaging was reviewed at the level of the tibial plafond (TP level) and the center slice between the TP and the fibula tip (CS level). CT images were used to assess the appearance of a malleolar groove (convex, concave, or flat) and the posterior tilting angle of the fibula. MRI images were used to assess the appearance of accessory peroneal muscles, height of the peroneus brevis muscle belly, and volume of the peroneal muscle and tendons. Low-lying muscle belly (LLMB) of the PB was defined as when the musculotendinous junction extended beyond the tip. The Mann-Whitney U test was used to compare continuous variables, and Fisher’s exact test was used to compare nominal variables. Results: There were no differences in the appearance of the malleolar groove, posterior tilting angle of the fibula, or accessory peroneal muscles at the TP and CS levels between the PD and CN groups. However, the peroneal muscle ratio was significantly higher in the PD group than in the CN group at both levels (both p< 0.001). The peroneal tendons ratio was not significantly different between the groups at both levels. The height of the peroneus brevis muscle belly was significantly lower in the PD group than in the CN group (p=0.001). LLMB of the PB was identified in 19 patients (63.3%) in the PD group and in eight patients (26.7%) in the CN group (p=0.009). Conclusion: The findings of this study suggest that LLMB of the PB and the peroneal muscle ratio are significantly related to RPTD, whereas retromalleolar bony morphology is not. Therefore, maintaining proper volume in the peroneal tunnel is more important than the groove shape. Reduction of the muscle belly of the peroneus brevis during RPTD surgery may help prevent peroneal tendon dislocation.
Comparison Total Joint Replacement with Arthrodesis of the 1st Metatarsophalangeal Joint
Authors: Richter Martinus , Zech Stefan , Meissner Stefan A. , Naef Issam 
Published: December 2023

Category: Midfoot/Forefoot; Other Introduction/Purpose: The aim of this study was to compare outcome (clinical, patient-reported outcome measures, radiological, joint motion and pedographic) of total joint replacement with Roto-Glide (RG) and arthrodesis (A) for severe osteoarthritis of the first metatarsophalangeal joint (MTP1). Methods: All consecutive patients with A and RG from January 23, 2011 until September 18, 2019 at the authors’ institution were considered for inclusion in the study. Preoperatively and at FU, radiographs and/or weight-bearing computed tomographic imaging were obtained. Standard dynamic pedography was performed. Visual-Analogue-Scale Foot and Ankle (VAS FA), European Foot and Ankle Society Score (EFAS Score), MTP1 range of motion for dorsi-/plantarflexion (DF/PF) were registered and compared pre- operatively and FU. Results: Seventy RG and 72 A were included. Preoperative VASFA/EFAS Score did not differ between RG and A (Average scores, VASFA, RG/A, 50.6/45,6; EFAS Score, RG/A, 10,7/10,6; each p>0.05). Wound healing delays without further operative measures were registered in 4 (6%) patients for RG and 5 (7%) for A (p=0.67), and 5 revisions in 5 (7%) for RG and 12 in 8 (11%) for A (p=0.05). The longest available FU was higher in RG than in A (RG/A, 47/37 months on average, p< 0.001). VASFA/EFAS Score at FU was higher in RG than in A (Average scores, VASFA, RG/A, 72,6/63,6; EFAS Score, RG/A, 16.1/14.1; each p< 0.05). DF/PF was only possible in RG (Average values DF/PF RG, 36.1/14.0) Conclusion: We found marginally lower revision rates and higher PROMs, joint motion (DF/PF) and more physiologic force distribution at slightly longer FU for the RG subgroup than the A subgroup. Longer follow-up and broader clinical reporting are needed to identify potential deficits of RG.
Effect of Plate and Screw Fixation on Stability of Weber B/Supination-External Rotation Fractures with Partial Deltoid Ligament Injury (SER4a): Robotic-Based Joint Testing
Authors: Gregersen Martin Greger , Dalen Andreas Fagerhaug , Nilsen Fredrik , Molund Marius 
Published: December 2023

Category: Trauma; Ankle Introduction/Purpose: Fibular fractures with signs of concomitant deltoid ligament injury have been operated on with plate and screw fixation of the fibula for decades. More recently, clinical studies have suggested that some fibular fractures have only partial deltoid ligament injury and that the deep posterior tibiotalar ligament may be intact (SER4a), allowing for nonoperative treatment. The purpose was to determine whether fibula fracture fixation using plate and screws improves stability and restores normal joint kinematics in such fractures. It was hypothesised that fixation of the fibula fracture does not add significantly to the stability of SER4a models or restore normal joint kinematics. Methods: Fifteen cadaveric foot and ankle specimens underwent biomechanical testing using a six-degrees-of-freedom force- movement robotic arm in three states: intact joint, SER4a model (anterior inferior tibiofibular ligament sectioned + oblique trans syndesmotic fibular osteotomy + superficial layer of deltoid ligament sectioned + deep anterior tibiotalar ligament sectioned) and SER4a model + plate and screw fixation of the fibula. Joint stability was measured in lateral translation, valgus, and talar internal- and external rotation in three talocrural joint positions: 20° plantarflexion, neutral, and 10° dorsiflexion. Fluoroscopy was used to measure isolated talar lateralisation and talar tilt. The foot was rigidly fixed to a custom pedestal, while the tibia was rigidly fixed to the robot arm through a load cell. Talar lateral translation at neutral ankle position was the primary outcome. Results: Fixation of the fibular fracture reduced lateral translation by 0.16 millimetres (P = .101) at neutral ankle position (See Figure 1). In general, the tests for lateral translation and valgus showed no differences between the SER4a models and the SER4a models with fibular fracture fixation. As for talar internal rotation, the fixation only slightly increased stability. But, when the talus was externally rotated, the fixation provided stability. Although the fixation improved stability during rotations, it did not fully restore the native ankle kinematics. Conclusion: The results suggest that plate and screw fixation of the fibular fracture does not significantly reduce instability or restore intact joint stability in SER4a models. These results support the nonoperative treatment of these fractures, as suggested by previous clinical studies.
Efficacy of Collagenase Clostridium Histolyticum Injection, a Potential Nonsurgical Intralesional Treatment Option for Plantar Fibromatosis: A Randomized, Open-Label, Dose-Ranging Study
Authors: Caporusso Joseph , Pollak Richard , Hernandez David , Dalton Shannon , Xiang Qinfang , Vijayan Saji , Anderson C. James 
Published: December 2023

Category: Midfoot/Forefoot; Basic Sciences/Biologics Introduction/Purpose: Plantar fibromatosis (PFi) is characterized by collagen-containing nodules on the foot along the plantar fascia that can cause pain and functional disability. Current treatments focus on symptom relief, which may become ineffective, or surgery, which can have lengthy recovery times. Collagenase clostridium histolyticum (CCH) is approved for Dupuytren’s and Peyronie’s disease treatment, which are both fibroproliferative disorders that may coexist in patients with PFi. This dose-ranging study assessed the efficacy and safety of CCH treatment of PFi. Methods: In this Phase 1, multicenter study, participants were randomly allocated (1:1:1) to receive 0.6, 1.2, or 2.25 mg/mL CCH. All participants underwent the initial treatment period (ITP) and received 1–2 intralesional injections per nodule on Day 1 with 5 follow-up assessments. Participants with palpable treated nodules could receive additional CCH doses (at 2.25 mg/mL; retreatment period, RP), with follow-up at specified intervals. Assessments included a 5-scale measure of nodule hardness (0 [nonpalpable] to 4 [hard]), and the Foot Function Index-Short Form23 (FFI-SF23) reported as a composite score (0 – 100) of 3 subscale scores (disability, difficulty, and pain subscales). Results: After ITP (n=24), 100% (8/8) of participants receiving 2.25 mg/mL CCH showed improvement in nodule hardness, compared with 87.5% (7/8) and 75% (6/8) of participants receiving 1.2 and 0.6 mg/mL, respectively. FFI-SF23 also showed a negative change from baseline across treatment groups, indicating improvement. Participants that received 2.25 mg/mL reported the largest percent improvement (-83.7%). After RP (n=11), 81.8% (9/11) of participants showed improvement in nodular hardness and an FFI-SF23 score change of -9.3%, indicating further improvement from baseline after ITP. CCH had a consistent safety profile in ITP/RP. Conclusion: CCH caused dose-dependent improvement of nodule hardness after treatment, with 2.25 mg/mL utilized for nodule retreatment; FFI-SF23 scores correlated with this finding, indicating CCH may be a potential nonsurgical intralesional option for PFi treatment.
Opposing Flanks vs Parallel Flanks – the Influence of Headless Screw Design on Compression and Pull- Out Resistance
Authors: Tan Rachel , Patterson Alba Morillo , Taylor Stephen JG , Patel Shelain , Bernasconi Alessio , Malhotra Karan 
Published: December 2023

Category: Basic Sciences/Biologics; Basic Sciences/Biologics Introduction/Purpose: Screws generate and maintain compression against distracting forces when performing osteotomy or fusion surgery. Headless screws with opposing flank angles (OFA) between the threads of the head and shaft are purported to achieve better compression. The purpose of this study was to compare OFA designs against traditional parallel flank angle (PFA) headless screws and headed screws to determine differences in compression and pull-out resistance (POR). Methods: In this biomechanical in-vitro study, four screw designs were compared: headless screws with OFA (Screw_A and Screw_B), headless screws with PFA (Screw_C), and headed screws (Screw_D). All screws were 4.0x50mm partially threaded cannulated screws. Screw_B had a 1.4mm shorter head length and 0.5mm narrower head thread diameter than Screw_A and Screw_C, which were similar. A custom apparatus was designed for measuring compression and POR. Osteotomies were created on synthetic bone blocks (density 0.32g/cm3) simulating cancellous bone. Screws were inserted perpendicular to osteotomies in accordance with manufacturer guidance and maximum compression recorded. Increasing distracting forces were then applied to the blocks until the screws pulled out. For each screw type, five screws were tested. Results: There was no significant difference in maximum compression between screw designs: Screw_A=38.7N±14.2N, Screw_B=48.7N±15.6N, Screw_C=51.9N±36.4N, Screw_D=32.0N±9.2N; p=0.921. When assessing POR, all screws failed at the head-bone interface (screw heads subsided into block). Pull-out forces significantly differed between all groups: Screw_A=466N±29.0N, Screw_B=310N±22.0N, Screw_C=399N±46.0N, Screw_D=183N±12.9N; p< 0.001 (ANOVA). Screw_Ahad the highest POR but the other OFA design (Screw_B) had significantly lower POR. Conclusion: Screw design, whether headless (OFA or PFA) or headed did not appear to influence compression generated. However, headed screws had significantly lower POR than headless designs. Within headless designs, OFA may increase POR, but other screw head features (number / diameter of threads) had an apparently greater influence than flank angle.
Prevalence of Heterotopic Ossification following Total Ankle Arthroplasty: A Systematic Review
Authors: Healy Hazel , Butler James J. , Anil Utkarsh , Randall Grace W. , Walls Raymond J. , Kennedy John G. 
Published: December 2023

Category: Ankle Arthritis Introduction/Purpose: End-stage ankle osteoarthritis is a debilitating pathology and is most commonly preceded by trauma. Surgical intervention via ankle arthrodesis or ankle arthroplasty is the mainstay management option. Heterotopic ossification (HO) is a common finding following joint arthroplasty. However, no consensus regarding the impact of heterotopic ossification on clinical outcomes following total ankle arthroplasty has been reached to date. The purpose of this systematic review and meta- analysis was to evaluate the prevalence and clinical outcomes of heterotopic ossification following total ankle arthroplasty. Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies reporting heterotopic ossification following TAA. Data regarding surgical characteristics, subjective clinical outcomes, radiographic outcomes, failure rates and complications were extracted and analysed. Results: Twenty-seven studies with 2639 patients (2695 ankles) at a weighed mean follow-up time of 52.8 ± 26.9 months were included. The pooled prevalence rate was 45% (0.25; 0.66). The implant with the highest rate of HO was the INBONE I (100%) and BOX (100%) implants. The most common modified Brooker staging was grade 1 (120 patients, 33.9%). Random effects models of standardized mean differences found no difference in AOFAS, VAS and ROM between patients with HO and patients without HO. Random effects models of correlation coefficients found no correlation between AOFAS, VAS and ROM and the presence of HO. The surgical intervention rate for symptomatic HO was 10.5%. Conclusion: This systematic review and meta-analysis found that HO is a common finding following TAA that is not associated with inferior clinical outcomes. Surgical intervention was required only for moderate-severe, symptomatic HO following TAA. This study is limited by the significant heterogeneity and low level and quality of evidence of the included studies. Further higher quality studies are warranted to determine the precise prevalence and impact of HO on outcomes following TAA.