bluuebunny/crossref_metadata_2025_split huggingface dataset:
Readability of Online Foot & Ankle Patient Resources
Authors: Cush Coleman , Foster Brian , Zhang Hui , Cush Gerard J. 
Published: January 2022

Category: Other Introduction/Purpose: The internet is a popular source of health information for patients. Professional organizations, such as the American Orthopaedic Foot & Ankle Society (AOFAS) and the American Academy of Orthopaedic Surgeons (AAOS) have created patient-directed websites containing high quality information. However, previous studies have demonstrated that these sites are often written at a level that is too complex for the average reader. We aimed to investigate the current landscape of the readability of these websites. Methods: Online patient resources on foot and ankle topics published by the AOFAS and AAOS were reviewed. Each page was analyzed using the Flesch Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) formulas. Sites were noted if they were written at or below an 8th grade reading level, which corresponds to the average US reading level. An independent two-sample t- test or chi-square test, where appropriate, were used to compare resource characteristics between the two professional societies. Results: 162 total sites were reviewed, including 113 from the AOFAS and 49 from the AAOS. Overall, the mean FKGL was 9.4 (range, 6.7 - 15.3) and the mean FRE was 56.3 (range, 24.4 - 73.1). Websites written by the AAOS had significantly lower FKGL scores than sites written by the AOFAS (9.0 vs 9.5, p=0.01). 31.3% of all sites were written at or below an 8th grade reading level. Websites published by the AAOS had significantly more sites published at this level than sites published by the AOFAS (44.9% vs 25.7%, p=0.02). Conclusion: Online patient information on foot and ankle topics published by professional organizations are often written at a level that is too complex for the average reader. There was a statistical but not clinically significant difference between sites published by the AAOS and AOFAS. Professional organizations should continue to develop their online patient resources, with emphasis on increasing their readability.
Percutaneous Fixation of Metatarsals Fractures with Kirchner’s Wire, Comparison of Antegrade and Retrograde Technique
Authors: Drago Sebastian R. , Zagal Alvarado Patricio Alfonso , Ugarte Jaime , Phillips Vicente , Contreras Martin , Bastias Gonzalo F. 
Published: January 2022

Category: Trauma; Midfoot/Forefoot Introduction/Purpose: The antegrade intramedullary nailing technique with Kirchner’s wire (K-wire) (EAK) for the management of metatarsal fractures (MTT) is recent and with few reports. Our objective was to evaluate and compare the clinical results among patients operated on in our center for MTT fractures using the EAK technique versus the traditional retrograde technique (ERK). Methods: Retrospective, analytical study. We reviewed the cases of patients with a diagnosis of MTT fracture and surgical indication operated with EAK or ERK between February 2010 and January 2016. First and fifth metatarsal fractures were excluded from the analysis, as well as patients in which a fixation method other than K-wire was used. Demographic data, clinical and radiological results were recorded. A total of 34 patients (34 feet, 70 metatarsals) were analyzed and were divided into two groups: Group 1, operated with EAK (15 feet, 22 metatarsals), and Group 2, operated with ERK (19 feet, 48 metatarsals). Statistical analysis was carried out with Fisher's exact test and Mann-Whitney U test for non-parametric variables, with fixed statistical significance at p <0.05. Results: The median age was 37 years [IQR = 51-25.25], p = 0.128. Both groups presented similar soft tissue involvement (p = 1,000), similar associated injury rate (20.0% vs 42.1%, p = 0.271), and similar proportions of diaphyseal and neck fractures (p = 0.659 and p = 0.733 respectively). The group operated with the EAK technique presented a lower report of metatarsalgia (6.7% (1) vs 47.3% (9), p = 0.020), shorter rest time since injury (94 days [IQR = 129-82] vs 144 days [IQR = 210-122], p = 0.002) and shorter time to full load (7 weeks [IQR = 9-6] vs 10 weeks [IQR 12.5-8.5], p = 0.002). EAK and ERK did not show differences in criteria for poor reduction (p = 1.00), number of re-interventions (p = 0.560), infections (p = 0.492), or metatarsophalangeal stiffness (p = 0.451). Conclusion: Metatarsal fracture fixation with EAK presented a lower rate of metatarsalgia and shorter rest time compared to ERK, demonstrating similarity in terms of quality of reduction and complication rate.
The Impact of Hallux Valgus on Function and Quality of Life in Females
Authors: Gordon David , Lewis Thomas L. , Ray Robbie 
Published: January 2022

Category: Bunion Introduction/Purpose: The effect of hallux valgus (HV) on health-related quality of life (HRQOL) and the relationship between radiographic severity of deformity and patient reported outcome measures (PROMs) is poorly understood. The aim of this study was to compare the HRQOL of female patients with HV to the UK population. The secondary aim was to assess the correlation between PROMs, including HRQOL, with radiographic severity of deformity. Methods: Weight bearing radiographic data (hallux valgus (HVA) angle; intermetatarsal (IM) angle) were measured in consecutive female patients presenting with symptomatic HV. Each patient prospectively completed the Euroqol EQ-5D-5L questionnaire (EQ- 5D), Visual Analogue Scale for Pain (VAS-Pain) and Manchester Oxford Foot Questionnaire (MOXFQ). Data were stratified into age ranges and compared with an EQ-5D United Kingdom general population reference dataset. Pearson R correlation values were calculated for the PROMs and radiographic deformity. Results: Between July 2015 and March 2020, 425 consecutive female patients presented with symptomatic HV for consideration for surgery. EQ-5D-5L data were prospectively collected for 396 of these patients (93.2%). EQ-5D-5L Index scores were significantly worse for females with HV when compared with females in the general population. There was a moderate correlation with MOXFQ Index score and EQ-5D-5L Index (R=-0.51, p<0.001) and VAS-Pain scores (R=0.54, p<0.001). There was no correlation between radiographic HV deformity and HRQOL measures or MOXFQ scores. Conclusion: Female patients presenting with HV deformity have a significantly reduced quality of life compared with the UK general population. The radiographic severity of deformity did not correlate with health-related quality of life measures or foot and ankle specific PROMs. Foot and ankle specific clinical PROMs do correlate with HRQOL and may be a better marker of the negative effect of symptomatic hallux valgus deformity on quality of life.
Effect of Achilles Tendon Repair on Performance Outcomes Following Return to Play in NCAA Division I Basketball Athletes
Authors: Hodgens Blake H. , Sanchez Rafael A. , Geller Joseph S. , Huntley Samuel R. , Kaplan Jonathan R. , Aiyer Amiethab A. 
Published: January 2022

Category: Sports; Ankle Introduction/Purpose: Achilles tendon ruptures are devastating injuries highly prevalent among athletes. Despite our understanding of the impact of Achilles tendon rupture in professional athletes, and in particular its relationship to basketball, no study has examined the effect of Achilles tendon rupture on performance metrics in National Collegiate Athletic Association (NCAA) Division I basketball players. Methods: NCAA Division I basketball players who sustained a surgically repaired Achilles tendon rupture between the 2000 and 2019 seasons were identified by systematic evaluation of individual injury reports from the NCAA career statistics and individual school statistics databases. 65 male and 41 female players were identified. Athletes were included if they participated in at least one collegiate season before tearing their Achilles tendon, and at least one season after operative repair. A total of 50 male and 30 female athletes were ultimately included in the analysis. Each injured athlete was matched to a healthy control by conference, position, starter-status at time of injury, class year, and number of games played. Matched controls were healthy players and experienced no significant injuries during their NCAA careers. Results: Following Achilles tendon rupture and subsequent surgical repair, male athletes played significantly more minutes per game (19.7 vs. 22.6, p=0.017), scored more points per game (6.7 vs 7.9, p=0.024), and had more assists per game (1.4 vs. 1.7, p=0.036), when compared to their pre-injury statistics. The only area of worsened athletic performance following injury was total blocks, which significantly decreased post-injury (18.1 vs. 10.2, p=0.004). Matched healthy controls demonstrated a higher percent change in assists per game (+39.0% vs +21.8%, p=0.036) and total blocks (+55.1% vs -43.5%, p=0.031) between the matched pre- injury and post-injury periods. Female athletes scored significantly more points per game after returning from injury (7.6 vs 6.3, p=0.032) but demonstrated a significantly lower 3-point shooting percentage (10% vs. 20%, p=0.047). Conclusion: Male athletes who returned to play following Achilles tendon rupture demonstrated significant increases in various offensive performance metrics, while suffering a significant decrease in total blocks. Female athletes demonstrated a significant improvement in points per game following Achilles tendon rupture, but suffered a significant decline in 3-point shooting percentage. Despite suffering an Achilles tendon rupture, 14% of the male cohort reached the NBA, and 16.7% of the female cohort reached the WNBA.
Ankle-Hindfoot Reconstruction by Tibiotalocalcaneal (TTC) Arthrodesis Using Multiple Cannulated Screws: 32 Cases
Authors: Im Jemin , Jung Hong-Geun , Lim Jung-Won , Song Won Tae 
Published: January 2022

Category: Ankle; Ankle Arthritis Introduction/Purpose: Tibiotalocalcaneal (TTC) arthrodesis is a salvage procedure that can be used as an alternative to amputation for various pathologic conditions of the ankle-hindfoot. The aim of this study is to evaluate the clinical-radiological outcome of TTC arthrodesis performed using the multiple cannulated screws. Methods: From 2003 to 2018, 32 ankles (31 patients) underwent TTC arthrodesis. The mean follow-up period was mean 32.5 (12-92) months and the average patient age at surgery was 59.6 years (43-75). The etiologies of TTC arthrodesis included posttraumatic osteoarthritis (18.8%), Charcot arthropathy (18.8%), paralytic deformity (21.9%), failure of total ankle arthroplasty (9.4%), and failure of arthrodesis (9.4%). For all of 32 cases, transfibular approach was used with or without auto fibular cancellous bone graft. 7.3mm cannulated screws were used for fixation of arthodesis for all of 32 cases, and in 23 of 32 cases (71.9%), screw- fixation was used exclusively without any additional plate or Ilizarov fixator. Especially for 11 of 32 cases with large bony defect, fresh-frozen allo-femoral head structural bone graft was used. Pre- and postoperative visual analog scale (VAS) pain, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot functional score, and radiographs including CT images were assessed. Results: Overall union rate was 81.3% (26/32). Mean VAS score decreased from 6.92 preoperatively to 1.46 postoperatively and the AOFAS score improved from 27.0 to 53.7 (Max=68) at the final follow-up. Complication of TTC arthrodesis included nonunion (18.8%, 6/32), infection (12.5%, 4/32), and one case of skin necrosis. Most frequent nonunion site was tibiotalar joint (6/32). For 3 of 7 cases with nonunion, patients were painless and could ambulate without severe functional impairment. There were two cases with infective nonunion and one case with active Charcot arthropathy after artrhdesis. Union rate of two groups with/without allo-femoral head bone graft were similar to each other (81.8%, 81.0%, respectively), however, final AOFAS scores were significantly superior in 'without' femoral head bone graft group. Conclusion: This study achieved a fusion rate comparable to other previous studies and obtained favorable clinical outcomes. Realignment TTC arthrodesis using multiple cannulated screws is a valid surgical option as a salvage procedure for various deformed or arthritic conditions of ankle-hindfoot. Allo-femoral head structural bone graft can be selected as useful option for TTC arthrodesis with large bone defect.
Endoscopic Insertional Achilles Reconstruction with Double Row Suture Bridge Reconstruction: A Technique Tip
Authors: Miller Christopher P. , Acevedo Jorge I. , McWilliam James R. , Michalski Max 
Published: January 2022

Category: Ankle; Arthroscopy Introduction/Purpose: Insertional Achilles tendinopathy can be a debilitating condition that often fails to improve with non- surgical management such as bracing and physical therapy. Traditional surgical techniques include an open debridement of the diseased tendon and resection of calcaneal spurs. This is followed by repair of the tendon. Suture anchors are often used to secure the tendon, but recent advances in tendon fixation, including the advent of double row repairs, has allowed better biomechanical repairs and faster rehabilitation. Additionally, minimally invasive surgery (MIS) and endoscopic techniques have advanced to allow successful treatment of all aspects of the condition while minimizing wound complications and infection Methods: The authors present a technique to treat insertional Achilles tendinopathy and calcaneal bone spurs using MIS techniques while also incorporating a percutaneous double row suture anchor repair. The technique utilizes four portals to access two endoscopic working planes. The burr is inserted deep to the tendon and the calcaneoplasty is performed. Subsequently, the endoscope is inserted alongside a shaver to remove bony debris and debulk the anterior aspect of the Achilles areas of tendinopathy. Following this, the portals are used to place a double row suture anchor repair. Results: With over 75 surgeries performed, there have been zero wound complications and patients have been able to return to full weight bearing within 10 days after surgery. Follow up outcome data is currently being collected and will be reported as a case series once sufficient patients have completed their follow up. Conclusion: This study presents double-row repair following an endoscopic assisted MIS calcaneoplasty and Achilles debridement. The technique combines the benefits of the double row suture bridge repair with a minimal incision technique to debride the insertional tendinosis. In order to adequately debride the tendon and the posterior calcaneal tuberosity, the tendon foot print is elevated as the burr removes the bone at the insertion. The anterior portion of the tendon, which may be a pain generator as well, isdebrided endoscopically with the shaver. Finally, a double row suture bridge repair is performed in order to allow early weight bearing and rehabilitation.
Comparing Infection Rates from Using Different Surgical Preparation Solutions and Techniques in Foot & Ankle Elective Surgery
Authors: Molloy Andrew P. , Tangirala Ravishanker , Lyle Shirley A. , Heyes Gavin 
Published: January 2022

Category: Other Introduction/Purpose: Surgical site infection (SSI) after Foot & Ankle surgery ranges from 1.2% to 13.2%, higher than any other elective orthopaedic procedure. Infection is of concern for the patient and expensive for the healthcare system. SSI is multifactorial and can be divided into host-related and perioperative factors. Skin preparation is one of the key peri-operative factors in reducing SSI. The current literature supports a combined chlorhexidine and alcohol preparation technique, although there is some conflicting evidence. Most studies to date have used proxy outcomes such as growth from swabs shortly after skin preparation. There are no large scale studies which have looked at definitive clinical outcomes such as the rate of postoperative SSI. Methods: A retrospective review of data was undertaken for two longitudinal cohorts which were using two different skin preparation solutions and techniques due to a change in hospital protocol. Each cohort was continuous and derived from the same overall populationIn cohort 1, Povidine-Iodine (Betadinetm) followed by Alcoholic Chlorhexidine was used on swabs (Double prep group). In cohort 2, 2 Alcoholic Chlorhexidine was used in a prep stick applicator. Standard criteria for diagnosing surgical site infection were used. All open injuries, procedures for ongoing infection, amputations for osteomyelitis /diabetic foot and COVID- 19 positive cases were excluded. Results: After applying standard exclusion criteria, 919 elective F&A procedures in the Double prep group and 491 procedures were included for the Single prep groupAs these were continuous longitudinal cohorts of large scale from the same population, there is a justifiable presumption of group matchingIn cohort 1 there were 15 superficial infections (1.6%) and 3 deep (0.3%). In cohort 2 there were 18 superfical infections (3.6%) and 1 deep (0.3%). The total infections in cohort 1 were 18 (2%) and 19 in cohort 2 (3.9%)There was an increase in superficial, and therefore total infection rates, in the single prep group compared to the double prep group. These increases were statistically significant; p <0.05 with regards to superficial infection and total infection rates in the single prep group. Conclusion: Double skin preparation, with Povidone-Iodine followed by alcoholic Chlorhexadine, statistically significantly decreases foot and ankle surgical infection rates as compared to a single alcoholic chlorhexidine skin preparation
Plantar Plating in the Modified Lapidus Procedure: Evaluation of Function and Impairment of the Tibialis Anterior Tendon
Authors: Niehaus Richard , Hodel Sandro , Eid Karim , Lenz Christopher G. 
Published: January 2022

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Plantar Plating in the Modified Lapidus Procedure (MLP) to treat severe Hallux Valgus deformities (HVD) or hypermobility of the first ray has become more popular. Due to biomechanical considerations, early weightbearing can be achieved. The surgical procedure and some plate designs make a release of the Tibialis Anterior tendon (TAT) necessary and screws have to be placed through or close to its insertion. We investigate if there are detectable changes of the tibialis anterior tendon or the function of the tibialis anterior muscle (TAM). Methods: We retrospectively reviewed 22 Feet (17 patients) after plantar plating for a modified Lapidus procedure. All patients underwent a MRI at an average of 27 months (range 12-49 months) postoperatively for evaluation of the tendon. Clinical outcome was evaluated using the EFAS score. Dorsiflexion strength was measured and compared to the healthy contralateral extremity. Complications and union rates were assessed. Results: The subjective satisfaction was rated at a mean of 8.2 (range, 5 - 10; SD +-1.5) on a scale from 0 to 10. Fourteen (82%) patients would undergo the same surgical treatment again. MRI images showed signs of tendinopathy of the TAT in 13 feet (59%). There were no ruptures, signs of thinning of the tendon or fatty infiltration detected. Complication rate was low with only on case with performed revision surgery. Regarding the Range of Motion, the force data comparing both feet of the patients is statistically close in comparison to the other side without any statistical differences. Conclusion: The MLP using a plantar-positioned locking plate leads to high patient satisfaction rates and provides significant improvement of preoperative deformity in severe HVD at midterm follow-up. Inversion strength was reduced, and MRI showed signs of tendinopathy in more than half of the cases. However, these findings did not seem to have any effect on the clinical outcome. None of the present patients had a high degree of fatty infiltration of the TAM in accordance with the Goutallier grading. Plantar-positioned locking plates do not seem to impair the TAM or the TAT.
Porous Titanium Wedges in Revision First Metatarsophalangeal Arthrodesis
Authors: Noble David M. , Small Benjamin , Cooper M. Truitt , Park Joseph S. , Perumal Venkat 
Published: January 2022

Category: Midfoot/Forefoot; Other Introduction/Purpose: First metatarsophalangeal (MTP) arthrodesis is a common procedure for hallux MTP pathology. In the setting of prior procedures with resultant bone loss, porous titanium wedges provide an alternative to allograft or autograft. The purpose of this study was to report clinical and radiographic outcomes achieved with titanium wedges used in 1st MTP arthrodesis in a revision setting. Methods: A retrospective analysis was performed in 10 patients (mean age 65.8) with prior 1st MTP procedures who underwent 1st MTP arthrodesis with use of porous titanium wedges from February 2014 to March 2020. Outcomes were assessed using both clinical (Visual Analogue Scale, Foot and Ankle Ability Measure, Mental Health Continuum Short Form, 36-Item Short Form Survey, need for revision) and radiographic parameters. Patients were followed from a minimum of 6 months up to 6 years (mean 31.4 months). Results: Average Foot and Ankle Ability Measure (FAAM) score was 91.1 +/- 14.7 (75.1 +/- 5.3 FAAM Activities of Daily Living; 17.9 +/- 9.9 FAAM Sports). Average pain visual analogue scale was 1.9 +/- 1.7. Average Mental Health Continuum-short form score was 34.2 +/- 8.5. Postoperative computed tomography (CT) imaging demonstrated lack of osseous integration in two of six CT scans obtained. Four patients underwent subsequent revision procedures, 3 for hardware prominence and 1 for failure of fusion. Conclusion: To our knowledge, these data represent the first reported clinical and radiographic outcomes in patients undergoing revision 1st MTP arthrodesis with use of porous titanium wedges. Further research should focus on comparative data with other commonly performed operative techniques.