bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mechanical behavior of different fiber lengths mix-proportions carbon fiber reinforced concrete subjected to static, impact, and blast loading
Authors: Li Yeou-Fong , Ramanathan Gobinathan Kadagathur , Syu Jin-Yuan , Huang Chih-Hong , Tsai Ying-Kuan 
Published: November 2022

Impact and blast wave loadings act as high instant energy and might cause damage to reinforced concrete infrastructures. This research aims to investigate the effect of using different length proportions of carbon fiber on the mechanical behaviors of concrete. Moreover, in this study, original carbon fiber and sizing-removed carbon fiber were added into concrete with different mix-proportions. The sizing on the carbon fiber surface was removed by using heat-treated method. In addition, the carbon fiber was dispersed by a high-pressure air compressor. Lengths of 12 mm and 24 mm carbon fibers were used in different mix-proportions to find the highest mechanical strength of carbon fiber reinforced concrete (CFRC) under a 1% fiber-to-cement weight ratio. Compressive, flexural, and impact tests were conducted on CFRC specimens. The CFRC specimen with 50% 12 mm and 50% 24 mm sizing-removed carbon fiber attained the highest impact resistance, and it also had the best performance under blast wave loading compared with the other CFRC specimens. The broken CFRC specimens were examined by an optical microscope to identify the failure mode of the carbon fibers in CFRC specimens. The addition of 50% 12 mm and 50% 24 mm sizing-removed carbon fiber can significantly improve the compressive and flexural strength of reinforced concrete.
Imaging Diagnosis, Prevalence, and Clinical Outcomes of Arthroscopic Surgery for Anterior Inferior Iliac Spine Impingement: A Systematic Review and Meta-analysis
Authors: Kobayashi Naomi , Kamono Emi , Yamamoto Yuya , Yukizawa Yohei , Honda Hideki , Takagawa Shu , Misumi Toshihiro , Inaba Yutaka 
Published: November 2022

Background: Subspine impingement, or anterior inferior iliac spine (AIIS) impingement, is a type of extra-articular pathology associated with femoroacetabular impingement syndrome and often requires subsequent arthroscopic surgery. Purpose: To examine the diagnostic accuracy, prevalence, and clinical outcomes of arthroscopic treatment for AIIS impingement. Study Design: Systematic review; Level of evidence, 4. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist was applied. We searched for studies on the prevalence, diagnostic accuracy, and results of surgical treatment for AIIS impingement. For each included study, data synthesis and statistical analysis were performed to identify pooled prevalence, calculate clinical outcome scores, and estimate adverse events. The QUADAS (a quality assessment tool for diagnostic accuracy studies) was used to assess the quality of the diagnostic accuracy studies, and the Risk of Bias Assessment tool for Nonrandomized Studies was used to assess the quality of the studies on arthroscopic treatment efficacy. Results: Out of an initial 791 studies, 23 were included. AIIS impingement was diagnosed by plain radiography with 76% to 86% sensitivity, 3-dimensional computed tomography with 80% to 81.8% sensitivity, magnetic resonance imaging with 80% sensitivity, and ultrasound with 92.5% sensitivity. For patients who underwent hip arthroscopy, the pooled prevalence of AIIS impingement was 18%. Significant improvement between pre- and postoperative clinical outcomes was observed: 25.75 points for the modified Harris hip score (mHHS), 46.88 points for the Hip Outcome Score–Sport subscale, 20.85 points for the Nonarthritic Hip Score, and -2.92 points for the pain visual analog scale. The minimal clinically important difference on the mHHS was exceeded by 94% of patients. The pooled incidence of surgical complications was 1%. Of 6 included studies on diagnostic accuracy, 2 were identified as having a low risk of bias, and 4 included >2 factors with a high risk of bias. All 9 included studies on treatment outcomes had at least 1 factor with a high risk of bias. Conclusion: Several imaging modalities assist in the diagnosis of AIIS impingement. The overall prevalence of AIIS impingement in patients that underwent hip arthroscopy was 18%. Clinical outcomes after arthroscopic AIIS decompression were generally favorable, with a relatively low rate of surgical complications.
The Role of the Medial Meniscus in Anterior Knee Stability
Authors: Shiwaku Kousuke , Kamiya Tomoaki , Suzuki Daisuke , Yamakawa Satoshi , Otsubo Hidenori , Suzuki Tomoyuki , Takahashi Katsunori , Okada Yohei , Teramoto Atsushi , Ohnishi Hirofumi , Fujie Hiromichi , Yamashita Toshihiko 
Published: November 2022

Background: Few studies have compared the force distribution between the anterolateral, posterolateral, and medial structures of the knee. Purpose: To investigate the important structures in an intact knee contributing to force distribution in response to anterior tibial load. Study Design: Controlled laboratory study. Methods: Nine fresh-frozen cadaveric knee specimens underwent robotic testing. First, 100 N of anterior tibial load was applied to the intact knee at 0°, 15°, 30°, 60°, and 90° of knee flexion. The anterior cruciate ligament (ACL), anterolateral capsule, lateral collateral ligament, popliteal tendon, posterior root of the lateral meniscus, superficial medial collateral ligament, posterior root of the medial meniscus (MM), and posterior cruciate ligament were then completely transected in sequential order. After each transection, the authors reproduced the intact knee motion when a 100-N anterior tibial load was applied. By applying the principle of superposition, the resultant force of each structure was determined based on the 6 degrees of freedom force/torque data of each state. Results: At every measured knee flexion angle, the resultant force of the ACL was the largest of the tested structures. At knee flexion angles of 60° and 90°, the resultant force of the MM was larger than that of all other structures with the exception of the ACL. Conclusion: The MM was identified as playing an important role in response to anterior tibial load at 60° and 90° of flexion. Clinical Relevance: In clinical settings, the ACL of patients with a poorly functioning MM, such as tear of the MM posterior root, should be monitored considering the large resultant force in response to an anterior tibial load.
Fibula Nail Outcomes in Soft Tissue Compromised Ankle Fractures
Authors: Ahmed Maryam , Barrie Andrew , Kozhikunnath Arun , Thimmegowda Abliash , Ho Sebastian , Kunasingam Kumar , Guryel Enis ,   MEFNO Collaborative
Published: November 2022

Category: Trauma; Ankle Introduction/Purpose: Lower limb fractures account for a third of all orthopaedic injuries of which 22% are ankle fractures. With a gradual move toward minimally invasive surgery for ankle fractures, intramedullary implants have evolved over the years to dedicated fixation devices for fibula fractures. The aim of this study was to determine the clinical outcomes following fibula nail fixation and to identify the indication for the use of fibula nails in ankle fractures. Methods: A retrospective study of adult patients from 2 major trauma centers (MTCs) and 9 trauma units (TUs) who underwent fibula nail fixation for AO/OTA 44 fractures between January 1, 2018, and October 31, 2020 was conducted. Fracture were classified based on the Weber or AO/OTA classification. Operative fixation was performed using the Acumed Fibula Rod (Acumend Fibula Rod System, Hilsboro, OR, USA) and a minimally invasive direct approach to the lateral malleolsus with radiography-guided percutaneous screw insertion was used in all patients. The outcome measures included infection, metalwork complications, nonunion or malunion, time to union, and length of inpatient hospital stay. Results: Ninety-five patients were included, with a mean age of 66 years; 57.9% of patients were female. The average body mass index was 30. Sixty-nine patients (72.6%) sustained a Weber B and 24 (27.4%) sustained a Weber C fracture. In addition, 26.3% were open fractures and all patients had soft tissue compromise affecting the lateral malleolus. The calculated infection rate for fibula nail was 4.2% and metalwork complication rate was 5.2%. The nonunion and malunion rate was 8.4% and rate of removal of hardware was 2.1%. The average time to union was 12.5 weeks, and length of inpatient stay was 9.4 days (SD 10). Conclusion: This is the largest multicenter to date which demonstrates that use of a fibula nail appears to be a safe approach to treating patients who have a physiologically higher risk of surgery, poor skin condition, and a complex fracture pattern. The risks of wound and metalwork complicatons appear relatively low following fibula nail fixation in comparison to ankle ORIF's.
Do Concomitant Posterior Malleolus Fractures Affect Mid-Term Functional Outcomes in Tibial Shaft Fractures?
Authors: Bastias Gonzalo F. , Ignacio Quezada Morales Jose , Gutierrez Paulina , Diaz Felipe G. , Melo Rodrigo , Cuchacovich Mikenberg Natalio R. , Munoz Gerardo , Filippi Jorge 
Published: November 2022

Category: Trauma; Ankle Introduction/Purpose: The association between diaphyseal tibial fractures and posterior malleolus fracture has been reported between 4 to 25% of cases. Early diagnosis requires a high level of suspicion and may change the surgical strategy. To our knowledge, no studies had compared the functional and quality of life results of tibial fractures with and without posterior malleolus extension. Methods: A retrospective comparative study including patients sustaining tibial shaft fractures classified by AO type 42, 43A, and 43B1.1, with a minimum one-year follow-up. Exclusion criteria included open fractures, pathological bone fractures and patients with a previous history of ipsilateral bone injury. Patients were divided into two groups, tibial shaft injuries with posterior malleolus fracture (PM) and fractures without posterior malleolus fracture (WPM) diagnosed using computed tomography (CT) preoperatively. The posterior malleolus fracture was fixed before the tibial fracture, either with 1 or 2 percutaneous anteroposterior or posteroanterior screws. Postoperative CT was used to assess the quality of reduction in all patients. Functional and quality of life results were evaluated using the Lower Extremity Function Score (LEFS), visual pain analog scale (VAS), and Short Form (SF12). We compared times of return to work/sports, complications and additional procedures during follow-up. Shapiro-Wilk test and Student t-test were used for statistical analysis. Results: Twenty patients in the PM group and 22 in the WPM group were included with a mean follow-up of 43 months (R:8-43). Groups were demographically comparable, with an average age of 47.6 and 43.3 years (p:0.34), respectively. All fractures healed, CT showed an anatomical articular reduction in all patients. Tibial shaft fracture was treated with intramedullary nailing in 15 patients of the WPM group and seven patients in the PM group. Percutaneous medial plating was used in the rest of the cases. At final follow-up, LEFS score in the PM group was 73.6 vs. 70.6 in the WPM group, with no significant difference (p:0.23). There were also no significant differences in VAS scale, time of return to work and sports in both groups. The PM group scored better in physical (p:0,02) and mental (p:0,01) SF-12. Conclusion: In this series of closed tibial shaft fractures, the presence of a posterior malleolus fracture did not affect functional results, time to return to work, or return to sports. Moreover, the SF-12 was superior in the PM group. All patients in the PM group had a timely diagnosis and anatomical reduction, which probably influenced the good clinical results. There were no additional procedures or degenerative complications in the PM group.
A Scoping Survey of BOFAS Membership: What are the Perceived Barriers and Facilitators of Day- Case Surgery for Major Foot and Ankle Procedures in the UK?
Authors: Berry Amber L. , Houchen-Wolloff Linzy , Mangwani Jitendra , Clayton Robert A. 
Published: November 2022

Category: Ankle Introduction/Purpose: Recent advances in minimally invasive surgery and improved post-operative pain management make it possible to perform major foot/ ankle operations as day-case. This could have significant impact on length of stay, saving resources and is in keeping with government policy. However there is no consensus of barriers reducing foot/ankle operations being performed as day-case.The aim of this survey was to scope the practice of UK foot and ankle surgeons in terms of perceived barriers and facilitators to performing day-case surgery for major foot/ankle procedures. Methods: An online survey (19 questions) was sent to UK foot and ankle surgeons via BOFAS (British Orthopaedic Foot & Ankle Society) membership list in August 2021. Major foot/ankle procedures are defined as surgery that is usually performed as an inpatient and day-case as same day discharge, with day surgery as the intended treatment pathway. Results: A total of 132 respondents: 80% working in Acute NHS Trusts. 78% of respondents thought that more procedures could be performed as day-case at their centre (currently 45% of respondents perform less than 100 day-case surgeries per year for these procedures). The top 2 perceived barriers to performing more major foot and ankle procedures as day-case were: no physiotherapy provision pre/ post-operatively 23%, no out of hours support for patients 21%. Conclusion: There is consensus among surgeons to do more major foot/ ankle procedures as day-case. Despite theoretical concerns about post-operative pain and satisfaction this was only measured by a third of those surveyed. Out of hours support and physiotherapy input pre/post-op were perceived as the main barriers to increasing the number day-case procedures. There is a need for nationally agreed protocols to optimise the delivery of care for this patient group and to scope the provision of physiotherapy pre/post-operatively at sites where this is a perceived barrier.
Does a 1st Metatarsophalangeal Fusion in a Patient with Pes Planus Improve the Pes Planus Deformity? A Retrospective Case Series
Authors: Chapman James , Jenkinson Hollie , Dalal Neel , Airey Grace L. , Molloy Andrew P. , Singh Anjani K. , Sirikonda Siva , Mason Lyndon W. 
Published: November 2022

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: A pes planus deformity is a pathology relating to the loss of normality of the complex interaction of the bones and joints of the foot resulting in a flattening of the medial longitudinal arch with or without abduction of the midfoot. The distal aspect of the medial longitudinal arch can be a feature of the deformity. The fusion of the 1st metatarsophalangeal joint (MTPJ) is a common operation. In patients with concomitant pes planus deformity, it is unknown if reducing and stabilising the distal aspect of the medial ray through a 1st MTPJ fusion can subsequently improve the pes planus deformity. We sought to analyse the pes planus deformity pre and post 1st MTPJ fusion with the null hypothesis that there was no difference. Methods: We identified patients who had undergone 1st MTPJ fusion using our electronic database from January 2011 to October 2021. To meet the inclusion criteria, cases required pre- and post-operative weightbearing plain radiographs, with a Meary's angle of >4 degrees on pre-operative imaging. Routine pes planus measurements were undertaken by 2 independent observers. Pre- and post-operative measurements were tested for significant change using Wilcoxon Signed Rank Test or Paired T-Test depending on the normality testing of the data. Routine demographic data was also collected. Data was analysed using IBM SPSS v.27. Results: Following radiographic analysis, 25 feet fitted the inclusion criteria. The mean patient age was 63 years. There was no pre-operative correlation between Meary's angle and the hallux valgus angle (Kendall's tau p=.441). Pre-operatively, Meary's line broke at the talo-navicular and navicular-cuneiform joints in 12 cases each; the remaining case broke at the tarsal-metatarsal joint. A statistically significant improvement between the pre- and post-operative measurements was identified in Meary's angle, calcaneal pitch angle, talo-navicular coverage angle, intermetatarsal angle and talo-navicular angle (see table). Significant changes were also noted in the medial cuneiform height (mean increase of 2.74mm; p=.022). A post-operative Meary's angle of <4°was only achieved in 4/25 (16%) of cases. Of the remaining 21 cases, the point at which Meary's line broke moved proximally one joint in 4 and distally one joint in 3 cases; it remained at the same joint in 14 cases. Conclusion: Our results suggest that 1st MTPJ fusion improves axial alignment of the foot as well as reducing Meary's angle by a statistically significant amount, although diagnostic criteria for pes planus remained in most cases.
Treatment Strategy for Posterior Malleolar Fractures: Different Operative Strategies are Needed for Each Morphological Type
Authors: Choi Seung-myung 
Published: November 2022

Category: Trauma; Ankle Introduction/Purpose: The operative indication for posterior malleolar fracture (PMF) remains controversial. This study aimed to assess the midterm outcomes of PMF treatment for developing a treatment strategy for each morphological type. Methods: In this retrospective analysis, 472 patients undergoing operative treatment for an unstable ankle fracture involving PMF were included after at least 3 years of follow-up. PMFs were classified by fracture morphology, according to the Haraguchi classification, and the outcomes of the groups wherein PMF was either fixed through a posterior approach or unfixed were compared (PMF fixation and nonfixation groups, respectively). The radiographic evaluation included the development of posttraumatic osteoarthritis. The clinical evaluation included the AOFAS score and postoperative complications. Results: The mean patient age was 45.8 years, and the mean follow-up was 51 months. The intercalary fragment (ICF) was more frequently observed for type 1 PMFs preoperatively in the fixation group (P < .001). The postoperative outcomes of the two groups showed no significant differences. For type 2 PMFs, the radiological and clinical outcomes of the PMF fixation group were statistically superior to those of the nonfixation group (both P < .001). Overall, postoperative complications occurred more frequently in the fixation group (40.4% vs. 24.4%, P < .001). Compared with the patients with and without syndesmotic stabilization in type 3 PMF, no significant differences in the postoperative outcomes were observed. The radiological and clinical parameters showed no significant intergroup differences, including the postoperative complications when comparing PMF fixation using a plate and posterior screw. Conclusion: Different treatment strategies are required for each PMF morphological subtype. The operative treatment might not lead to favorable outcomes for all PMF subtypes: potential indicators for operation are the presence of an ICF preventing the reduction of the posterior malleolus in type 1 and all type 2 PMFs.
Management, Complications, and Radiographic Follow-Up of Total Ankle Arthroplasty in the Setting of Talar Bone Loss
Authors: Cornelius Canon C. , Duncan Leslie A. , Wetzig Alex , Gauvain Taggart T. , Greaser Michael C. , McGarvey William C. 
Published: November 2022

Category: Ankle Arthritis; Ankle Introduction/Purpose: As the incidence and indications for total ankle arthroplasty (TAA) continue to expand the need to better understand the properative risk factors becomes increasingly important. Talar bone loss whether from avascular necrosis, osteoarthritis, or post traumatic arthritis can be a challenging problem to deal with in TAA. The aim of this study is to report the operative characteristics, clinical complications, and radiographic changes in patients’ status post TAA in the setting of talar bone loss. Methods: A retrospective review using CPT codes for four surgeons over a three year period at an academic institution was performed. A single surgeon reviewed the immediate preoperative plain radiographs for 200 consecutive patients captured by the CPT codes for talar bone loss. The mortise and lateral views were used to measure the lesions and an example measurement is shown in Figure 1. 38 patients were identified as having talar bone defects of greater than 20 percent when the two measurements were averaged and the depth of the penetrance was categorized by dividing the talus into thirds. A chart review was then performed that included demographic information, additional procedures at the primary procedure, use of adjuvants, reoperation rates and, subsidence rates. Results: The average patient age and follow up were 59 years and 23 months respectively. The average defect was 44 percent with a range of 20 to 100 percent. 16 out of 38 defects were contained to the upper third of the talus and 17 had a corresponding tibial lesion. Overall the reoperation rate was 34 percent with the plurality being I&Ds of both superficial and deep infections. Two patients ended up with below knee amputations. Subsidence of talar components occurred at a rate of 43 percent with about half of these having a reoperation. 68 percent of the patients had additional procedures such as tendo achilles lengthening, lateral ligament reconstruction, and various osteotomies. 35 percent of talar components were cemented and there was an intra operative complication rate of 14 percent with the most common being intra operative fracture. Conclusion: While TAA for patients with talar bone loss can be a good option for both the patient and surgeon it has a higher complication rate in our series than previously described. Careful surgical strategy including implant choice is paramount and the need for additional procedures should be considered.