bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiographic Measurements Associated with Ankle Power Generation During Gait in Patients with Cerebral Palsy
Authors: Choi Yoon Hyo , Lee Dong Yeon , Kyung Min Gyu , Lee Kyoung Min , Lee Kyoung Min 
Published: December 2023

Category: Basic Sciences/Biologics; Ankle Introduction/Purpose: Pes planovalgus (PV) deformity accounts for lever arm dysfunction and compromises gait in patients with cerebral palsy (CP). However, the association between ankle power generation and radiographic indices is not yet understood. We aimed to investigate the association between ankle power and radiographic indices during gait in patients with CP concomitant with PV deformity. Methods: Patients older than 14 years with ambulatory CP and PV deformity were included. All the patients underwent three- dimensional gait analysis and weight-bearing foot radiography. Gait data were collected, including foot progression angle, tibial rotation, and ankle power generation. Radiographic measurements included anteroposterior (AP) talo-first metatarsal angle, lateral talo-first metatarsal angle, and hindfoot angle. A linear mixed-effects model was used for statistical analysis to identify significant radiographic indices associated with ankle power generation. Results: Thirty-one limbs from 15 patients with spastic diplegia and six with spastic hemiplegia were included. Statistical analysis demonstrated that ankle power generation was significantly correlated with the CP type (p=0.01) and AP talo-1st metatarsal angle (p=0.02). Conclusion: Ankle power generation was significantly associated with the AP talo-first metatarsal angle. Surgeons might need to pay attention to correcting forefoot abduction to restore ankle power when planning surgeries for pes PV deformities in patients with CP.
Rates of Depression and Post-Traumatic Stress Disorder Differ by Insurance Type in Chronic Ankle Instability Patient
Authors: Allen John R. , Hoch Caroline , Morningstar Joshua L. , Scott Daniel , Gross Christopher E. 
Published: December 2023

Category: Ankle; Other Introduction/Purpose: Chronic ankle instability (CAI) is one of the most commonly encountered clinical problems by orthopaedic foot and ankle surgeons, however, little research exists on the impact of insurance status on the incidence and outcomes of CAI. This study aims to investigate the association between psychiatric diagnosis and insurance status in CAI patients to determine if insurance subgroups differ in rate of surgery and postoperative success, as well as identify if psychiatric diagnoses are more common within certain insurance types. Methods: A retrospective review was conducted of 276 patients (280 ankles) treated between 2005 and 2021 at an academic medical center by one of three fellowship-trained foot and ankle orthopaedic surgeons, of which 56 (20.0%) underwent surgery, seven (2.5%) underwent reoperation, and 130 (46.4%) had a concomitant psychiatric diagnosis (i.e., anxiety=111, depression=105, post-traumatic stress disorder [PTSD]=19, obsessive-compulsive disorder [OCD]=6, bipolar disorder [BPD]=5). Insurance type was categorized as privately- (n=147) or government-funded (n=121). For further analysis, the government-funded cohort was broken into the following groups: Medicare (n=77), Veterans Affairs (n=20), Worker’s Compensation (n=18), and Medicaid (n=6). Eleven patients (12 feet) were uninsured. Data collected included demographics, conservative and operative treatments, patient- reported outcome measures (PROMs) (e.g., Foot and Ankle Ability Measure [FAAM]), and reoperation rate. Results: When examining binomial insurance groups, rate of surgery (private=15.6%, government=24.8%; p=.061) approached, but did not reach, significance and reoperation rate (private=17.4%, government=10.0%; p=.451) did not differ. Postoperatively, PROMs did not differ between private and government insurance types, but FAAM Physical Function (p=.046) and Total (p=.035) scores were best with Medicare insurance when analyzing all insurance groups. Instance of mental illness (p=.111) or certain psychiatric diagnoses did not differ between privately- and government-insured patients, but depression (p=.013) and PTSD (p=.050) were significantly less common among patients with Veterans Affairs insurance. Conclusion: CAI patients were not found to have differing need for surgery between insurance types. This was similar for postoperative success, aside from Medicare patients having better reported FAAM scores. Furthermore, patients with a psychiatric diagnosis were not more common to an insurance group, but specific depression and PTSD diagnoses were least common for Veterans Affairs patients.
Relationship Between Hallux Valgus Recurrence and Sesamoid Position on AP Standing Radiographs After Distal Chevron Metatarsal Osteotomy
Authors: Kim Jinkyung , Kim Taehoon , Choi Youngrak , Yu Youngtak 
Published: December 2023

Category: Midfoot/Forefoot; Bunion Introduction/ Purpose: Recurrence of the hallux valgus deformity has various causes, and the incomplete reduction of sesamoids may be one of the important issues. However, we have seen several patients with postoperative lateral sesamoid displacement on AP standing radiographs who did not experience hallux valgus recurrence. Therefore, we hypothesized that lateral displacement of the sesamoid on AP standing radiographs does not cause hallux valgus recurrence. Methods: The study included 269 feet (185 patients) with hallux valgus treated with distal chevron metatarsal osteotomy. Mean patient age was 64.26 (range, 15–80) years. Patients were followed-up for an average of 33.85 (range, 12–228) months between April 2002 and December 2019. The patients were divided into four groups, according to the presence or absence of hallux valgus recurrence and sesamoid reduction. Results: During outpatient follow-up, we discovered 99 feet (42.1%) in which hallux valgus did not recur despite lateral sesamoid displacement (grade IV–VII) on AP standing radiographs. HVA, IMA, sesamoid grades all deteriorated over time after surgery, and each indicator was statistically significantly altered, and changes in the three indicators had a statistically significant positive correlation. Changes in HVA and IMA between feet with and without sesamoid reduction on AP standing radiographs increased over time, with the differences in HVA and IMA being significant at final follow-up. Regardless of whether sesamoid reduction was achieved on AP standing radiographs, the final analysis showed that HVA and IMA in both groups worsened over time. There were no differences between the two groups in the patterns of change over time. Conclusion: In our cohort postoperative sesamoid position on on AP standing radiographs was not associated with hallux valgus recurrence based on radiographic criteria.
Safe and Effective Is Not Always Acceptable: The Case for PASS Scores in Foot and Ankle Orthopaedic Surgery
Authors: Mathew Smitha E. , Guyton Gregory P. 
Published: December 2023

Category: Other Introduction/Purpose: Determining the success of a clinical intervention can be challenging even with modern patient-reported outcomes. Traditionally studies have used the Minimum Clinically Important Difference (MCID), the smallest difference in an outcome that is felt to have clinical significance. More recently some authors have emphasized the alternative model of the Patient Acceptable Symptomatic State (PASS), the threshold of a PRO defining where patients consider their overall status to be acceptable. PASS scores have not yet seen wide use in the foot and ankle literature, but may add insight to surgical outcomes beyond simply measuring the minimal changes implied by the MCID. Methods: The most universal patient-reported outcome in the foot and ankle literature is the simple Visual Analog Pain Scale (VAS), in which a patient rates their pain along an analog scale between 0 to 10 cm. Articles in Foot and Ankle International from December 2020 to August 2022 that reported VAS pain scores and variance following an intervention were included. Although specific PASS thresholds for VAS scores in many conditions in the foot and ankle have not been determined analytically, values ranging from 2.0 to 3.0 are typical for orthopaedic conditions, corresponding to the intuitive statement “I would like my pain to be less than 2 or 3 out of 10.” A PASS threshold of 2.0 has been used previously in the foot and ankle literature. The studies were therefore analyzed against PASS thresholds for the VAS of 2.0, 2.5, and 3.0. Results: Twenty-one studies were included. Five had multiple internal groups, yielding a total of 27 total sets of VAS scores.All 27 (100%) showed improvements well beyond the MCID and were considered successful. 17 (81%) of the 21 studies subjectively described their intervention as “reliable”, “good”, “effective” or “satisfactory”. Despite this, 8 (38%) of the 21 studies reported final mean VAS scores for all internal groups above a PASS threshold of 2.0. An analytically calculated weighted average final VAS pain score for all studies was 1.78 +/-1.89. Based upon this, the expected percentages of patients included in FAI studies whose results failed to meet VAS PASS thresholds were 45% for a threshold of 2.0, 35% for a threshold of 2.5, and 26% for a threshold of 3.0. Conclusion: Studies in the foot and ankle literature almost universally report positive results, both subjectively in their discussions and by statistically demonstrating improvement of patient-reported outcomes beyond the MCID. PASS threshold analysis yields a much less positive interpretation and emphasizes the number of negative outliers in the population who do not find their outcome acceptable. A fuller picture of the outcome of foot and ankle procedures and overall patient satisfaction can be gained from reporting both changes in the mean and comparing final outcomes to PASS thresholds.
The Effect of Tranexamic Acid on Reducing Blood Loss and Transfusion Rates in Total Ankle Arthroplasty: A Systematic Review and Meta-Analysis of Clinical Comparative Studies
Authors: Butler James J. , Rajivan Ragul , Konar Kishore , Azam Mohammad T. , Kennedy John G. , Walls Raymond J. 
Published: December 2023

Category: Ankle Arthritis Introduction/Purpose: The purpose of this systematic review and meta-analysis was to compare the volume of blood loss, transfusion rates and complication rates between patients who were administered tranexamic acid (TXA) versus patients who were not administered TXA during total ankle arthroplasty (TAA). Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies comparing outcomes between patients who were administered TXA versus patients who were not administered TXA during TAA. Data regarding surgical characteristics, subjective clinical outcomes, total blood loss, intra-operative blood loss, total complications and wound complications rates were extracted and analysed. In total, 5 comparative clinical studies were included in this review. Results: 194 patients received TXA and 187 patients did not receive TXA during TAA. There was a statistically significant reduced volume of total blood loss in favor of patients who received TXA compared to patients who did not receive TXA during TAA (SMD:-0.7832; p< 0.0001). A statistically significant reduced volume of intra-operative blood loss between the TXA cohort and the control cohort was also observed in favor of the TXA cohort (SMD:-1.14; p< 0.0001]. A statistically significant reduced volume of hemoglobin loss was found in favor of patients who received TXA compared to the control cohort (SMD: -0.9548; p< 0.02). A higher transfusion rate was found in the control cohort (1.1%) compared to the TXA cohort. No difference in complication rates was observed between the cohorts. Conclusion: This systematic review and meta-analysis found that patients who received peri-operative TXA had statistically significant reduced total blood volume loss, intra-operative blood volume loss, hemoglobin loss together with no statistically significant difference in complication rates following TAA. Further randomised control trials with improved data collection are necessary to elucidate the optimal dosage, frequency and role of TXA in the peri-operative setting for TAA.
The Fate of Delayed Unions After Isolated Ankle Fusion
Authors: Parker Emily Belle , Lause Gregory E. , Stupay Kristen L. , Chiodo Christopher P. , Bluman Eric M. , Martin Elizabeth A. , Miller Christopher , Smith Jeremy 
Published: December 2023

Category: Ankle Arthritis Introduction/Purpose: Despite advancements in surgical techniques, implants, and biologics, nonunion remains the most common major complication of ankle arthrodesis. While previous studies have reported delayed union or nonunion rates, few have elaborated on the clinical course of patients experiencing delayed union. We sought to better understand the trajectory of patients with delayed union by determining the rate of clinical success and failure and whether the extent of fusion on computed tomography (CT) was associated with outcomes. Methods: Delayed union was defined as incomplete ( < 75%) fusion seen on CT scan between 2 and 6 months postoperative. A total of 36 patients met inclusion criteria: isolated tibiotalar arthrodesis with delayed union. Patient-reported outcomes were obtained and patients were asked about satisfaction with their fusion. Success was defined as patients who were not revised and reported satisfaction with the procedure. Failure was defined as patients who progressed to revision or reported being not satisfied. Fusion was assessed by measuring the percent of osseous bridging across the joint on CT scan. The extent of bony bridging was categorized as absent (0%-24%), minimal (25%-49%), or moderate (50%-74%). Results: We determined the clinical outcome in 28 of the 36 eligible patients (78%) with mean follow-up of 5.6 years (range, 1.3 to 10.2 years). The majority (71%) of patients failed. A mean of 3.9 months (standard deviation, 1) elapsed between time of surgery and CT scan. Patients with minimal or moderate fusion on CT were more likely to succeed clinically than those with ‘absent’ fusion (X2 = 4.215, p = 0.040). Of those with absent ( < 25%) fusion, 11 of 12 (92%) failed. In patients with minimal or moderate fusion, 9 of 16 (56%) failed. Conclusion: We found that 71% of patients with a delayed union at roughly 4 months after ankle fusion required revision or were not satisfied. Patients with less than 25% osseous bridging on CT had an even lower rate of clinical success. These findings may help surgeons in counseling and managing patients experiencing a delayed union after ankle fusion.
Topography and Morphometrics of the Cartilage Surfaces in the Peritalar Joints
Authors: Kumar Aditya , Oudakker Jessica , Zhu Mingjie , Pierce Robyn M. , Wittels Stephen , Orr Caley M. , Hunt Kenneth , Myerson Mark , Li Shuyuan 
Published: December 2023

Category: Hindfoot; Ankle Introduction/Purpose: Recent studies have highlighted the important role of peritalar joint congruence in maintaining the alignment of the hindfoot. Peritalar subluxation is associated with a variety of pathological deformities including flatfoot, cavovarus foot, clubfoot, as well as foot and ankle stress fractures. To date, studies of peritalar joint congruence have all been performed using either XR, WBCT based direct measurements, or 3D segmentation and analysis. However, none of these techniques can demonstrate the cartilage location nor disruption, nor the exact location of the articulation on the bone surface. Data bias caused by the limitations of these study methodologies is therefore inevitable. This study used 3D surface mapping to assess morphometrics of the cartilage surfaces of the peritalar joints. Methods: 11 fresh-frozen cadaveric feet without trauma nor surgery or significant deformities were dissected to expose the calcaneus, cuboid, talus, and navicular bones, and the articular surfaces. 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. T-test was used for statistical comparisons, with p< 0.05 as statistically significantly different. Results: Detailed information of the articular surfaces is summarized in Table 1. The average articular area on both sides of the joint matched each other well in the posterior facet of the subtalar joint (4% difference), and calcaneocuboid joint (3% difference) without significant statistical difference, but not in the anterior & middle facets of the subtalar joint, nor the talonavicular joint. In the anterior & middle facets of the subtalar joint, the cartilage articular area on the talar side was 124% of that on the calcaneus (p < 0.05), and in the talonavicular joint the cartilage articular area on the navicular was 138% of that on the talus (p < 0.05). Conclusion: The cartilage articular surfaces in certain peritalar joints do not match its opposing surface in size. In the talonavicular joint, it is easy to understand since area of the socket must be much smaller than that of the ball in order for the joint to glide and rotate. There must be functional reasons for this phenomenon to happen in the anterior and middle facets of the subtalar joint, which need further investigation. This study shows that the extent of subluxation of the peritalar joints may be physiological and should not necessarily be considered as pathological.
Treatment of Complicated Clubfoot Using External Fixation: A Scoping Review
Authors: Herzog Isabel , Fisher Mark , Hanna Aedan , Chu Alice 
Published: December 2023

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: The treatment of relapsed, resistant, or neglected clubfoot presents a challenge — some patients may not respond to the traditional Ponseti method. Studies involving gradual distraction using external fixators for treatment of these cases have been performed, but no systematic review has been conducted on the subject. Methods: A comprehensive search was conducted of PubMed, Cochrane, CINAHL, Scopus, and Web of Science according to PRISMA guidelines. Only articles that pertained to the treatment of pediatric patients with clubfoot using external fixation and contained three or more human subjects were included. Reviews, professional opinions, and studies with non-human subjects were excluded. Results: Of 6,469 articles generated from the initial search, 25 met inclusion criteria. 609 total feet (490 total patients) were included, and 533 of these feet (445 patients) were treated with external fixation. The mean age of patients was 8.5 [2-18] years with a mean follow-up length of 40.9 [5-126] months. 21 (84%) studies used the Ilizarov apparatus, two used Joshi’s external stabilization system, and one used the Taylor spatial frame. The most reported primary scoring systems were the 60-point International Clubfoot Study Group (ICFSG) score (20%), Dimeglio classification (12%), Pirani score (8%), and Reinker and Carpenter scales (8%). All but one study found significantly improved primary outcomes for the majority of respective patients. Conclusion: External fixation, which may or may not include open surgery, is a promising intervention for neglected or relapsed clubfoot. However, encouraging more standardized outcome measurements would allow for more thorough comparisons between studies.
Online learning in palliative care education of undergraduate medical students: a realist synthesis
Authors: Martucci Gianfranco , Pereira Jose , Busa Csilla , Centeno Carlos , Csikos Agnes , Franchini Luca , Elsner Frank , Raccichini Melania , Mihailescu-Marin Maria-Mirabela , Mosoiu Daniela , Rubio Bernabé Sandra , Scherg Alexandra , Consorti Fabrizio 
Published: December 2023

Background: Although training in palliative care (PC) is increasingly frequent in medical schools, some barriers still hamper the design and implementation of effective educational programs. Information Technology-based distance learning (IT-DL) might contribute to the development of appropriate knowledge on PC in students, but it is still not clear how to best develop such curricula and how to deliver methodologically sound learning activities, allowing students to work on the complex skills required in PC. Objectives: To describe how internet-based education can be used in undergraduate medical PC education, in terms of realist theorization. Design: A realist review was carried out, producing a framework – or, in the terms of a realist review, a theory – focusing on finding out what might work, for whom, and in which circumstances, describing these variables in terms of Contexts, Mechanism, and Outcomes. Methods: An international group of experts of PC education assessed the relevance and pertinence of 256 articles resulting from systematic retrieval of literature and expert suggestions. Results: The final synthesis, mainly informed by the 43 articles rated as most relevant, is presented in propositions regarding three groups: (1) Educational theory, where (a) Cognitivism (learning as an increase in knowledge); (b) Constructivism (learning as a social, cultural, and negotiated process); and (c) Behaviorism (learning as an observable modification of behaviors) appear to be consistent with the learning outcome of PC. (2) Desired effect of the technology, suggesting the simple use of IT-DL is not an additional value per se, as it should overcome objective limits set for face-to-face activities. (3) Contextualization and duration of the curricular activity, suggesting PC training activities should be included in an organic and legitimate way in the overall curriculum. Conclusion: This field is expected to experience huge growth soon, and present and future research could use a realist approach like the one here presented to make sense of all the different variables involved.
Refusal of the hospitalization: a distressed dilemma in obstetric practice
Authors: Unal Canan , Fadiloglu Erdem , Cagan Murat , Ziyadova Gunel , Kaya Esra , Tanacan Atakan , Beksac Mehmet Sinan 
Published: December 2023

Background: Pregnant women are a special population in which hospitalizations are more recommended due to physiological changes mimicking pathologies and medico-legal concerns. Objectives: We aimed to assess the obstetric outcomes of expectant mothers who were admitted to the obstetrics emergency outpatient clinic and declined the hospitalization advised by doctors. Additionally, we examined the appropriateness of physicians’ recommendations. Design: We have retrospectively evaluated the patients admitted to the ‘Obstetric Emergency Outpatient Clinic’ and refused hospitalization between 1 January 2019 and 31 December 2019. Methods: Cases were classified into three groups based on the trimester, considering the substantial variation between complaints and complications in each trimester. The complaints of pregnant women were categorized as psychosocial causes, obstetric complications, maternal systemic complaints, and suspicion of labor. We evaluated the compatibility of the hospitalization decision with the pregnancy outcome of patients. Results: A total of 958 pregnant women were included in the study. Leading causes for admissions were obstetric complications, maternal systemic complaints, and suspicion of labor in first, second, and third trimesters, respectively. Psychosocial causes were mostly observed in the second trimester. Readmission to the hospital within a week was highest in the third trimester group. According to pregnancy outcomes, 12.5% (94/753) of our recommendations were appropriate in all trimesters. Conclusion: Obstetricians seem overcautious in managing obstetric patients and willing to offer hospitalization more often than the actual requirements.