bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Use of a Sustained Dynamic Compression Intramedullary Nail for Subtalar Arthrodesis
Authors: Shaheen Philip J. , Priester Jacob , Giza Eric , Kreulen Christopher D. 
Published: December 2023

Category: Hindfoot; Other Introduction/Purpose: Subtalar arthrodesis has traditionally been performed using fixation made of titanium or stainless steel. While these devices can provide initial compression, the compressive loads can be lost soon after surgery as bone settling or resorption occurs at the joint spaces. The DynaNail® Mini is a subtalar arthrodesis intramedullary nail that allows for compression during surgery and has a stretched nitinol element that attempts to contract but is held by talus and calcaneus screws providing sustained dynamic compression across the joint. There is minimal clinical data evaluating the effects of sustained compression devices on isolated subtalar arthrodesis. The goal of this study was to prospectively follow patients undergoing subtalar arthrodesis with the DynaNail® Mini and evaluate its clinical efficacy via fusion rate and patient reported outcomes. Methods: We prospectively enrolled patients aged 18-85 who underwent subtalar arthrodesis with the DynaNail® Mini from one of two academic surgeons. Demographic data and patient reported outcomes were collected preoperatively and at follow-up visits including Visual Analog Pain Scale (VAS), Foot Function Index (FFI), Foot and Ankle Ability Measure (FAAM) Sports Subscale, and Veterans Rand 12 (VR-12) physical and mental subscores. Patients were followed at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. The primary outcome measure was fusion rate via CT scan at 4 months with secondary outcomes consisting of the patient reported outcome data and rate of revisions. Results: 21 patients met inclusion criteria, 14 patients had a 4-month postoperative CT scan to assess for fusion with 78.6% of the CT scans (11 out of 14) demonstrating fusion at that time. 20 of the patients were followed through their 6 month visits, 16 patients through 1 year, and 16 patients were seen for their 2-year follow-up visit. All patient reported outcomes demonstrated improvement from preoperatively to final follow-up with VAS scores improving from 5.69 to 3.84, FFI improving from 56.43 to 37.88, FAAM-sports improving from 20.31 to 30.47, VR-12 Physical improving from 28.70 to 34.41, and VR-12 Mental improving from 43.64 to 49.81. Conclusion: This prospective study demonstrates that patients undergoing subtalar arthrodesis with the DynaNail® Mini demonstrate favorable clinical outcomes that are comparable to existing methods of subtalar arthrodesis with 78.6% of patients achieving fusion on a 4-month postoperative CT scan and with steady noted improvement in multiple validated patient-reported outcome measures.
Tolerability and Safety of Collagenase Clostridium Histolyticum Injection in Participants with Plantar Fibromatosis
Authors: Pollak Richard , Anderson C. James , Hernandez David , Xiang Qinfang , Vijayan Saji , Ortega Luis A. , Caporusso Joseph 
Published: December 2023

Category: Midfoot/Forefoot; Basic Sciences/Biologics Introduction/Purpose: Plantar fibromatosis (PFi) is a functionally disabling disorder characterized by fibrous collagen-containing nodules along the plantar fascia. Collagenase clostridium histolyticum (CCH) is a nonsurgical treatment approved for Dupuytren’s and Peyronie’s disease; both can coexist with PFi. Composed of two collagenases, CCH specifically hydrolyzes certain collagen types and may disrupt the nodule when injected directly. This proof-of-concept study evaluated pharmacokinetics, immunogenicity, and assessed tolerability 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 pharmacokinetic samples collected over 24hrs, followed by 5 follow-up visits. Post-ITP, participants with a remaining, palpable nodule could enter the retreatment period (RP) and receive additional CCH doses (at 2.25 mg/mL) with follow-up at specified intervals. Immunogenicity test sampling occurred at screening and at the end of ITP/RP. Adverse events (AEs) were monitored throughout. Results: Twenty-four participants enrolled into ITP, with 11 continuing into RP. Pharmacokinetic and immunogenicity findings were consistent with previous CCH studies in other therapeutic areas. CCH treatment was generally well tolerated, with no serious treatment emergent adverse events (TEAEs), drug discontinuations, or study withdrawals by study end. Over 70% of participants during ITP (19/24) and RP (8/11) reported at least 1 TEAE. Eighty-six TEAEs occurred during ITP and 35 in RP; most were mild in severity (73%, ITP; 83%, RP), and 67% of ITP and 49% of RP TEAEs were treatment related. TEAEs were reportedly injection site- related, with injection site bruising, pain, and swelling frequently recorded. Conclusion: CCH had an expected pharmacokinetics/immunogenicity profile and was safe and well tolerated in participants with PFi. CCH may be a potential nonsurgical intralesional option for PFi treatment.
Weight-Bearing Computed Tomography Evaluation of Acute SER4a Ankle Fractures
Authors: Michalski Max P. , Porter Giselle M. , Rockov Zachary A. , Little Milton , Moon Charles , Charlton Timothy 
Published: December 2023

Category: Ankle; Trauma Introduction/Purpose: Recent studies have reported cadaveric and early clinical data regarding Weber B supination-external- rotation (SER)4a ankle fractures. SER4a ankle fractures have discordance of the medial clear space (MCS) between weight-bearing (WB) and gravity stress (GS) radiographs, showing instability on the GS view which normalizes with WB. Unfortunately, evaluation of the medial clear space only provides a two-dimensional evaluation of a three-dimensional structure. Prior cadaveric research has shown significant decreases in the tibiotalar joint contact area with only 1 mm of displacement of the talus. The purpose of this study is to utilize weight-bearing computed tomography (WBCT) to evaluate differences in the tibiotalar joint contact area and rotational alignment in patients with acute SER4a ankle fractures compared to their contralateral uninjured ankle. Methods: Adult patients presenting within ten days of injury with an isolated Weber B fibula fracture and a normal MCS ( < 5 mm) on injury radiographs were evaluated with weight-bearing and gravity stress radiographs. Patients determined to have isolated Weber B SER4a ankle fractures (GS positive but WB negative radiographs) and no history of injury to the contralateral ankle were included. The ability to place equal weight on both extremities was confirmed by standing on side-by-side scales. WBCT scans were obtained of both the healthy and injured ankles. The images were evaluated using Disior Bonelogic (Paragon28, Helsinki, Finland) software to calculate the tibiotalar joint contact area, axial tibiotalar rotation, and talocrural angle. An a priori power analysis was performed with six patients needed. Results: Five out of ten patients have been enrolled in the study to date (3 females, 2 males, average age 52.4). Preliminary data show an average 4.3% (standard deviation (SD) 4.9) increase in tibiotalar joint contact area between the injured and uninjured extremity. The average difference in axial tibiotalar angle is 3.6 (SD 6.9) degrees of internal rotation of the injured ankle. The talocrural in the injured and uninjured extremity have an average difference of 0.062 (SD 1.8) degrees. Conclusion: This study provides the first in vivo evaluation of the joint contact area changes seen in SER4 ankle fractures. Although limited in sample size, the results demonstrate that SER4a ankle fractures do not have decreased tibiotalar joint contact area relative to the healthy, uninjured side. The trend towards increased surface area in the injured ankles is hypothesized to be a result of the increased reliance on joint congruency with injury to the fibula and deltoid.
A Comparative Retrospective Radiographic Analysis of the Outcomes of Double and Triple Arthrodesis in the Correction of Severe Flatfoot Deformity
Authors: Aravindan Shreyaas , Maher Moustafa A. , Zhu Mingjie , Huo Donglai , Guo Yi , Wipf Caleb , Lee Anna D. , Myerson Mark , Li Shuyuan 
Published: December 2023

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: Choosing between a double arthrodesis or a triple arthrodesis in treating severe flatfoot deformities is often a matter of surgeon preference with proponents of each, and this study compared the radiographic outcomes of the two procedures. Methods: A retrospective chart review was performed for patients who underwent either a double or triple arthrodesis during a period of one year. Twenty-one double and 9 triple arthrodesis with at least one year of follow up were included in this study. Radiographic measurements on pre and postoperative anteroposterior and lateral weightbearing images were collected to reflect the correction of the hind and midfoot deformities, in particular, the relative height of the medial and lateral columns. Results: Both procedures significantly improved the talus-1st metatarsal angle (AP), talar declination angle, and the Meary’s angle. The double arthrodesis more significantly improved the talo-navicular coverage angle, while the triple arthrodesis significantly was far more effective in correcting the talar declination angle, the calcaneal pitch angle, and the cuneiform/cuboid height ratio. (Tables 1,2) Conclusion: Both double and triple arthrodesis have the ability to correct severe flatfoot deformities with improved radiographic outcomes. The triple arthrodesis has more power to improve the arch height as noted on the significant differences between the two groups in the calcaneal pitch angle and the medial cuneiform/cuboid height ratio.
A Retrospective Comparison of Single Screw vs Dual Screw Fixation for Treatment of Medial Malleolus Fractures
Authors: Mason Lyndon W. , Aamir Junaid , Caldwell Robyn , Long Sarah , Sreenivasan Sachith , Mavrotas Jason , Panesa Ayn , Lampridis Vasileios 
Published: December 2023

Category: Trauma; Ankle Introduction/Purpose: Medial Malleolus Fractures (MMF) are frequently managed by orthopaedic surgeons and are one of the most treated fractures of the ankle. Many approaches to fixation are described in the literature. Currently, there is a lack of consensus on the number of screws used in fixation when attempting lag-screw fixation of MMF. Aim: To compare the outcomes of MMF with patients between fractures which have either undergone single-screw (SS) or dual-screw (DS) fixation. Methods: Patients who had undergone surgical fixation of their MMF were identified from 2012 to 2022, using electronic patient records. Analysis of their pre-operative, intra-operative and post-operative radiographs was performed to determine the initial type of injury and then surgical outcomes relating to non-union, malunion and whether revision surgery was required. Results: A total of 653 patients were identified across a 10-year period. There were 271 patients (41.50%) in the SS group and 382 patients in the DS group (58.50%). When comparing the outcomes of SS compared to DS, a non-union rate of 19.19% (52/271) was found in the SS group as compared to 18.85% (72/382) in the DS group. There was a malunion rate of 11.07% (30/271) in the SS group as compared to 3.93% (15/382) in the DS group, which was statistically significant (p <.001). On multi regression analysis, the other factors which gained significance for development of non-union was non fixation of syndesmosis (p= .039), ankle dislocation on arrival (p <.001) and non-restoration of fibular length (p <.001). Conclusion: Use of a single screw rather than double screw showed a significant increase in non-anatomical reduction but did not increase non-union or reoperation rate. Syndesmosis fixation has clear impact on the stresses on the medial malleolus and should have a low index of suspicion of injury and fixation.
Anatomic Lateral Ligaments Repair Augmented with Suture-tape for Chronic Ankle Instability with Poor Quality of Remnant Ligamentous Tissue
Authors: Lee Yo-Han , Cho Byung-Ki , Choi Seung-Myung , Kim Sunghoo , Kim Seong-Hyeon 
Published: December 2023

Category: Sports; Ankle Introduction/Purpose: Because modified Broström procedure for chronic ankle instability provides a restoration of mechanical stability by reinforcing attenuated host tissue, poor quality of remnant ligamentous tissue can be considered as a prognostic factor for anatomic ligament repair surgery. The aim of this study was to evaluate the intermediate-term clinical outcomes after anatomic lateral ligaments repair augmented with suture-tape for chronic ankle instability with poor quality of ligament remnants. Methods: Thirty-six patients with the insufficient lateral ligament remnants confirmed by preoperative magnetic resonance image and intraoperative inspection were followed for more than 3 years after the augmented Broström repair. The clinical evaluation consisted of the Foot and Ankle Outcome Score(FAOS), Foot and Ankle Ability Measure(FAAM). Measurements on stress radiographs were performed to evaluate the changes of mechanical instability. To identify the changes of functional ankle instability, postural control ability was evaluated using single leg stance test with eyes closed. Results: FAOS and FAAM scores had significantly improved from preoperative average 56.3 and 51.8 points to 90.2 and 88.5 points at final follow-up, respectively (p < .001). Talar tilt angle and anterior talar translation had significantly improved from preoperative average 16.3° and 13.2 mm to 3.5° and 4.3 mm at final follow-up, respectively (p < .001). Balance retention time had significantly improved from preoperative average 3.8 seconds to 6.6 seconds at final follow-up (p < .001). Complications included two wound problems (one with superficial infection and one with marginal necrosis) and one superficial peroneal nerve injury with temporary paresthesia. Although 8 patients sustained an ankle sprain after operation, only 1 patient(2.8%) showed a recurrence of subjective and mechanical instability. Conclusion: Modified Broström procedure augmented with suture-tape appears to be an effective alternative for chronic ankle instability with poor quality of ligament remnants. Through the suture-tape augmentation and the direct repair of attenuated ligaments, this combined procedure can provide reliable stability and advantages of the anatomic ligament repair.
Anterolateral Ankle Impingement due to Bassett’s Ligament
Authors: Park Chul Hyun , Woo InHa 
Published: December 2023

Category: Arthroscopy; Ankle Introduction/Purpose: The Bassett’s ligament, an accessory band of the anterior inferior tibiofibular ligament (AITFL), is known to be a normal ligamentous structure present in 21-92% of cases. The Bassett’s ligament is also known as a structure that causes anterolateral impingement of the ankle joint after an ankle sprain. However, not much is known about the cause or prognosis of anterolateral impingement by Bassett's ligament. In this study, the symptoms, characteristics, and postoperative results of impingement by Bassett's ligament were reported. Methods: From November 2017 to August 2021, 12 patients who underwent surgical treatment for pain in the anterolateral aspect of the ankle joint, which did not improve with conservative treatment, were enrolled. There were 5 males and 7 females, and the average age was 34.4 years (21-76). The symptoms complained of by the patients and accompanying injuries were analyzed. And the arthroscopic findings and postoperative results were analyzed. Results: All patients had a history of ankle sprain before symptoms. All patients complained of pain and tenderness in the anterolateral aspect of the ankle joint, and the pain improved after injection of lidocaine. And 3 patients (25%) complained of snapping during ankle ROM. Ankle instability was present in 10 patients (83.3%), and OLT was present in 2 patients (16.7%). Arthroscopic findings showed that the Bassett’s ligament impinged with the anterolateral aspect of the talar dome during ROM in all cases. And synovitis was found around the Bassett ligament in all cases, fraying of the Bassett ligament in 5 cases (41.7%), and fraying of the cartilage of the dome of the talus in 4 cases (33.3%). Anterolateral ankle pain disappeared in all patients after surgery. Conclusion: Impingement between the talar dome and the Bassett’s ligament should be considered as one of the causes of anterolateral ankle pain, especially in patients with ankle sprains.
Ballooning Periprosthetic Osteolysis Related to Crystalline Arthropathies Following Total Ankle Arthroplasty: A Case Series
Authors: Umbel Benjamin D. , Anastasio Albert T. , Haghverdian Brandon A. , Ricci A. Gianni , Hanselman Andrew , Easley Mark , Nunley James A. , Schweitzer Karl M. 
Published: December 2023

Category: Ankle Arthritis; Basic Sciences/Biologics Introduction/Purpose: From 2009-2019, there has been a 120% increase in the incidence of total ankle arthroplasty (TAA) in the United States. With the rise in primary TAA, future increases in revision TAA cases is anticipated. Aseptic loosening with periprosthetic osteolysis continues to account for a significant number of revisions. While several factors may contribute to the pathophysiology of osteolysis, an underlying inflammatory response surrounding TAA implants may play a primary role. It is well known that monosodium urate (gout) and calcium-pyrophosphate (pseudo-gout) crystals evoke a highly inflammatory response and may involve the foot and ankle joints. However, the effect of these conditions following TAA has not yet been reported. We present a small case series of patients with ballooning osteolysis following TAA with confirmed crystalline arthropathy. Methods: This is a retrospective study from a single academic institution looking at patients who underwent TAA revision surgery for periprosthetic osteolysis and concern for aseptic loosening. Revision surgeries were performed by three orthopedic foot and ankle fellowship trained surgeons. Case characteristics, including pre-operative imaging, clinical presentations, intra-operative findings and surgical treatments performed were analyzed and presented in this small case series. Results: We report 5 patients whom underwent revision surgery for ballooning periprosthetic osteolysis following TAA. Intra- operative pathology samples from periprosthetic cysts returned positive for monosodium urate (MSU) or calcium pyrophosphate (CPP) crystalline deposition (1 MSU and 4 CPP) in all 5 patients. Final intra-operative cultures were all negative for infection. Upon gross intra-operative inspection, all polyethylene liners were considered to be normal without abnormal wear characteristics. Periprosthetic cysts were isolated to the tibial component in 2 patients and involved both the tibial and talar components in 3 patients. Staged TAA revision was performed in 2 patients. Bone cyst curettage, bone grafting and polyethylene liner exchange was performed in 3 patients. Conclusion: Periprosthetic osteolysis is a known complication following TAA and often leads to implant loosening, functional disability and subsequent revision surgery. An objective strategy for management of this condition has not been agreed upon amongst orthopedic foot and ankle surgeons, as uncertainty remains surrounding the pathophysiology of osteolysis in TAA. To our knowledge, we are the first to describe a small case series of patients with crystalline arthropathy as a potential cause for periprosthetic osteolysis following TAA. Future prospective studies are warranted to better elucidate this potential cause of TAA failure.
Biomechanical Analysis about Syndesmotic Stability for AITFL Augmentation with Fibular Plate
Authors: Takahashi Katsunori , Teramoto Atsushi , Murahashi Yasutaka , Watanabe Kota , Yamashita Toshihiko 
Published: December 2023

Category: Trauma; Sports Introduction/Purpose: Surgical technique to treatment syndesmosis injury is controversial. Additional suture-tape (ST) augmentation of anterior inferior tibiofibular ligament (AITFL) has been reported to improve syndesmotic stability compared with only suture-button (SB) fixation. ST fixation on the fibula is mainly performed with suture anchors, but suture holes with fibular plates can also be used. However, there is no biomechanical study about syndesmotic injury treated with ST augmentation using fibular plate. The aim of this study is to evaluate the stability of the syndesmosis injury model treated with ST augmentation using fibular plate. Our hypothesis is that ST augmentation using fibular plate can provide equivalent syndesmotic stability compared with ST augmentation using suture anchor. Methods: 8 normal fresh-frozen cadaver legs (4 males and 4 females) were used. The mean age at the time of death was 84.3 (70- 101). The specimens were tested while applied traction and rotational forces to represent dorsiflexion and external rotation of ankle joint. The fibular rotational angle related to the tibia (FRA) and anterior tibiofibular diastasis(aTFD) were measured using the magnetic tracking system while each load was applied. Intact, injured, SB + ST augmentation using suture anchor (anchor model), SB + ST augmentation fixation using fibular plate (plate model) models made, and loaded forces and measured FRA and aTFD with each model. One-way ANOVA was used to evaluate the relationship of the angles or the diastasis among each model. Post-hoc analysis for differences among the models were checked using Dunnett’s test. P value of 0.05 was chosen as the level of significance. Results: With dorsiflexion forces, in the injured model, both FRA and aTFD were significantly increased compared with intact model. In the anchor and plate model, both FRA and aTFD were not significantly different compared with intact model. With external rotation forces, in the injured model, both FRA and aTFD were significantly increased compared with intact model. In the anchor and plate model, both FRA and aTFD were not significantly different compared with intact model. Conclusion: The result of this study presented that ST augmentation using fibular plate provide syndesmotic stability similarly with ST augmentation using suture anchor. This technique was considered to be useful in cases of syndesmosis injury with lateral malleolar fracture. Particularly, it is difficult to use suture anchor for ST fixation to the fibula when there is a comminuted fracture near the AITFL attachment of the fibula. Using plate allows for stable ST fixation to the fibula without worrying about it.