bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trending the Incidence of 1st MTP Joint Arthrodesis in the Past Decade
Authors: Karzon Anthony L. , Kadakia Rishin J. , Coleman Michelle M. , Labib Sameh (Sam) A. , Jacobson Joseph E. , Bariteau Jason T. 
Published: November 2022

Category: Bunion Introduction/Purpose: Arthrodesis of the first metacarpophalangeal joint (MTPJ) is frequently performed for the most common conditions affecting the great toe, hallux rigidus and hallux valgus. However, there is no detailed depiction of the procedural incidence in recent years. We hypothesize that stratified incidences of patients undergoing this procedure in the last decade has risen. Methods: The Truven MarketScan database was queried to identify patients who underwent 1st MTPJ arthrodesis from January 2009 to December 2019 based on CPT coding. Population estimates from the US Census Bureau were used to calculate the annual incidence of 1st MTPJ arthrodesis. Volume and incidence were estimated for annual sums, gender, age subgroups, and four statistical geographical regions of the U.S. Results: In total, 184,016 1st MTPJ arthrodesis procedures were identified in the database from 2009 to 2019. Annual volumes have increased significantly by 70.8%, from 12,125 to 20,710 total procedures nationwide. Procedural incidence reported per 1,000,000 people significantly increased by 58.7%, at 63.8 in 2019. Growth in incidence was demonstrated in males and females of all defined age subgroups. Incidence stratified by region rose in all regions except for the Northeast, where a -0.5% change between 2010 and 2019 was noted, albeit insignificant. Conclusion: The epidemiology of 1st MTPJ arthrodesis has yet to be clarified in recent years. We have found that the annual volumes and incidence of 1st MTP arthrodesis has increased in the past decade. Growth in incidence was demonstrated in both sexes of all age cohorts as well as regionally in the United States. Identifying current trends in procedural incidences can help provide orthopedic surgeons with insight into temporal and quantitative changes in the field.
The Double Calcaneal Osteotomy for Pediatric Flatfoot
Authors: Kothari Ezan A. , Young Sean M. , Gilbert Shawn , Conklin Michael J. 
Published: November 2022

Category: Hindfoot Introduction/Purpose: The double calcaneal osteotomy combines a medial calcaneal sliding osteotomy and lateral column lengthening. Corrective osteotomies, as opposed to arthrodesis and arthroereises, are preferred for foot deformity correction in children and adolescents because they preserve joint mobility, shock absorption, and avoid concerns about adjacent joint degeneration. Individually, both types of osteotomies have demonstrated efficacy in achieving deformity correction and improved functional outcomes for patients. The literature regarding outcomes of this procedure in children is sparse. This retrospective study objectively analyzes outcomes of children who underwent double calcaneal osteotomies at our institution by comparing pre and postoperative radiographs and reporting postoperative complications. To our knowledge, this study contains the largest sample size of symptomatic flatfeet analyzed with regards to double calcaneal osteotomies in children. Methods: Patients who underwent a double calcaneal osteotomy over the past 5 years at our institution were analyzed. Pre and postoperative weightbearing radiographs of the foot were measured (Figure 1). Paired t tests were used to compare pre and postoperative measurements. Statistical significance was set at α < 0.05. Additional factors analyzed for each procedure include total operative time, torniquet time, hardware used for fixation, type of graft, concomitant procedures, and post-operative complications such as infection, nerve injury, nonunion, and reoperation. Results: A total of 20 patients and 26 feet were studied. Significant correction from pre to postoperative radiographic measurement was noted for the talo-first metatarsal angle, talonavicular coverage angle, calcaneal pitch, and tibiocalcaneal angle (p < 0.001). Complications were noted in 3 of the 20 patients, or 3 of 26 feet, and included infection, painful hardware, and hardware failure. Conclusion: The double calcaneal osteotomy was found to be effective in correcting the radiographic parameters associated with flatfoot deformity in children and adolescents with symptomatic flatfeet. The average postoperative radiographic measurements for the 26 feet analyzed were significantly improved from preoperative measurements. Pediatric orthopedists should strongly consider the double calcaneal osteotomy for appropriate surgical candidates.
Postoperative Isokinetic Evertor Strength is Important Prognostic Factor Following Arthroscopic Modified Brostrom Procedure in Chronic Ankle Instability
Authors: Lee Sung Hyun , Yoo Byung min 
Published: November 2022

Category: Sports; Arthroscopy Introduction/Purpose: Isokinetic eccentric muscular weakness has been considered an etiological factor for CAI by previous studies. It is widely accepted that initial management should be nonoperative in patients with CAI. In case of failure, however, surgical treatment may be considered. Even though, there were some studies evaluate the isokinetic muscle strength in sprain or CAI patients, there was few studies that investigate the isokinetic muscular result after arthroscopic modified brostrom (MBP) for CAI. The objective of this study was to evaluate the isokinetic ankle strength at 2 years after MBP and determine the effect of isokinetic ankle strength on clinical outcome. Methods: Between 2018 and 2019, we performed a retrospective review of 74 patients who underwent arthroscopic MBP and followed up to 2 years postoperatively with isokinetic strength test. Functional evaluation consisted of the Foot and Ankle Outcome Score (FAOS). Isokinetic peak torque values of dorsiflexion, plantarflexion, eversion and inversion at 2 angular velocities (30°/s and 120°/s) were measured in the injured and normal ankles. Paired t-test were performed to evaluate postoperative improvement of weakness (ratio of impaired side/intact side) of ankle strength, and linear regression test were performed for their correlation to clinical outcome using SPSS 20.0. Results: All clinical scores and isokinetic muscle strength were improved postoperatively. All units in FAOS except symptom unit corelated positively to the postoperative inversion strength (p<0.05, all). In addition, sports unit in FAOS was corelated to postoperative plantarflexion strength (p<0.05). Conclusion: Functional scores and all isokinetic muscle strength were significantly improved after arthroscopic MBP. However, the weakness of postoperative isokinetic eversion strength was still negative factor for clinical outcome after surgery.
A Case Series Evaluating Complications of Foot and Ankle Surgeries in Patients with Neuromuscular Disease
Authors: Levine Joshua , Mavrommatis Sophia , Vang Sandy , Anderson Sarah A. 
Published: November 2022

Category: Other Introduction/Purpose: Patients with neuromuscular diseases such as cerebral palsy often deal with foot and ankle deformity or dysfunction. These same patients are also living longer due to advances in medicine. This creates a significant population of patients that could benefit from corrective surgery. However, some surgeons are hesitant to offer surgery due to concern for complications. There is little in the literature to describe outcomes for foot and ankle surgery in this patient population. This study will provide information regarding complications associated with foot and ankle surgery in patients with neuromuscular disease. The primary study outcome was to describe the overall complication rates associated with foot and ankle surgery in patients with neuromuscular disease. Methods: The charts of neuromuscular patients undergoing foot and ankle surgery by the senior author from March 2010 to March 2020 were reviewed. Charts were analyzed for demographic data, medical history and diagnoses, and surgical treatment information. Index procedures were evaluated for any complications. For the purpose of our study, we identify an index procedure as the first surgical episode on a given extremity for a unique foot and ankle pathology. Charts were then analyzed for the presence or absence of a postoperative complication. We defined complication as the post-operative occurrence of wound dehiscence, superficial or deep infection, nonunion or delayed union, or a post-operative medical complication. Results: 46 patients with 57 extremities, and 66 index surgeries were identified. 20% of the index surgeries (13 of 66) had one or more complications. Patients ranged in age from 12 to 70 year of age with a mean of 33.8 years. Females comprised 61% of the patient cohort. CP was the most common neuromuscular diagnosis at 52% (24 of 46 patients). The number of procedures performed during a patient's index surgery ranged from 1 to 15 (mean: 3.4). Achilles lengthening was the most common procedure, performed in 44% of patients. A summary of complications can be seen in the attached table, along with patient demographic data. Conclusion: We identified an overall complication rate of 20%, with 12% wound complication rate and 7% nonunion rate. These rates were similar to previous literature on elective foot and ankle surgery. Our infection rate of 9% is higher than previously reported in the general foot and ankle literature. Of note, 31% of the total complications were in patients with spina bifida even though they made up just 9% of the population. We conclude that foot care of adult patients with neuromuscular disease s should be aware of the unique surgical challenges that this population faces.
Clinical and Radiologic Outcomes of the 3-Component Salto Total Ankle Arthroplasty for End-Stage Ankle Osteoarthritis
Authors: Lim Jung-Won , Jung Hong-Geun , Im Jemin 
Published: November 2022

Category: Ankle Arthritis; Ankle Introduction/Purpose: As the popularity of total ankle arthroplasty (TAA) increases and indications expand, surgeons require a better understanding of which factors are associated with the outcome. In this study, we evaluate the early clinical and radiologic outcomes of the Salto mobile bearing 3-component total ankle prosthesis. Methods: TAA was performed in 119 consecutive ankles (117 patients) by a single surgeon using 3-component Salto total ankle implant from June 2014 to May 2020. A prospectively collected database was used to identify all patients who underwent primary TAA with a minimum 1-year follow-up. All patients were followed up at two weeks, six weeks, three months, six months, at one year and yearly thereafter. Clinical outcome scoring was done pre-operatively and post-operatively. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot functional score, pain VAS, satisfaction score and clinical range of motion (ROM) were collected along with weight-bearing radiographs of the ankle. Post-operative coronal, sagittal alignment of the component were evaluated with radiographs. Results: The average follow-up was 22.1 months (range, 12-79). Mean VAS pain score decreased from 6.7 (range, 3-10) pre- operatively to 1.7 (range, 0-8) at last follow-up (p < 0.05). AOFAS score increased from 49.3 (range 8-85) to 85.1 (range 31-100) at last follow-up (p < 0.05). Eighty eight percent of the patients was satisfied with the surgical results at the last follow-up. There were 9 cases (7%) with complication. 1 case had low grade infection, 6 cases had wound marginal necrosis, and 2 cases had acute periprosthetic infection that was managed by irrigation and debridement without replacing the implants. Post-operative radiographic angles checked serially and significantly changed from preoperative status (p < 0.05). Conclusion: The TAA series using single Salto 3-componenet implant showed favorable radiologic and clinical outcomes. Also, the radiologic parameters showed statistically significant improvement.
Comparison of Clinical and Radiographic Outcomes Between Modified Lapidus and Proximal Reverse Chevron Metatarsal Osteotomy in Hallux Valgus Concomitant with Metatarsus Adductus
Authors: Lim Jung-Won , Im Jemin , Jung Hong-Geun 
Published: November 2022

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Operative treatment of hallux valgus (HV) in the setting of metatarsus adductus (MA) is reported to be difficult and poorer radiographic outcomes. Reduced space between the first and second metatarsals makes it difficult to translate the first metatarsal head laterally. This study aimed to compare the clinical and radiographic outcomes between HV with MA patients treated with modified Lapidus procedures and those with reverse proximal chevron metatarsal osteotomy (PCMO). Methods: The study included the patients of HV with MA (58 feet). 16 feet (Group 1) had been treated with modified Lapidus procedures by the senior author from December 2012 to November 2019. 42 feet (Group 2) had been treated with PCMO from February 2012 to March 2017. For the clinical assessment, visual analog scale (VAS) pain scores, AOFAS scores, and patients' postoperative satisfaction were evaluated. Radiographic assessment was performed with HV angle (HVA), intermetatarsal angle (IMA), and the first- to fifth-metatarsal width (1-5 MTW). Results: The mean follow-up duration was 16.8 (range, 12-54) months in Group 1, and 31.8 (range, 24-62) months in Group 2. The mean pain VAS score and AOFAS score improved from preoperative to the final follow-up in both group, however, Group 1 showed more significant improvement in clinical outcomes (ΔVAS: 6.0+-1.9 (Group 1) vs 5.1+-2.1(Group 2) (p=0.024), ΔAOFAS: 40.8+-11.5 (Group 1) vs 30.0+-11.3 (Group 2) (p=0.031)). As to radiographic assessment, Group 1 also showed more significant improvement in HVA and IMA (ΔHVA: 39.1+-9.1 (Group 1) vs 27.5+-9.8 (Group 2) (p<0.001), ΔIMA: 13.1+-3.0 (Group 1) vs 9.4+-4.5 (Group 2) (p=0.004). Conclusion: This study demonstrated that the HV patients with concomitant MA that treated with modified Lapidus procedures showed more significant clinical and radiographic improvement than those with PCMO. For the management of the HV patients accompanying MA in the setting of large preoperative HVA, modified Lapidus procedures would be good surgical option.
Early Results with the Use of Synthetic Cartilage Implant Augmented with 3D Printed Baseplate to Prevent Implant Subsidence for Treatment of Hallux Rigidus
Authors: Madi Naji S. , Fletcher Amanda N. , Chopra Aman , Parekh Selene G. 
Published: November 2022

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus (HR) of the first metatarsophalangeal joint (MTPJ) is a common arthritic disease which causes pain and stiffness. Synthetic cartilage implant (SCI) resurfacing has become a popular treatment option since it has similar biomechanical properties as native cartilage, reduces pain, and preserves MTPJ motion. However, recent studies have reported on implant subsidence leading to SCI treatment failure and subsequent revision surgery. A novel solution involves proximally inserting a custom 3D printed baseplate in the metatarsal head to prevent SCI subsidence. The purpose of this study is to evaluate the clinical and radiographic outcomes of patients who underwent SCI resurfacing augmented with a 3D printed beasplate for the treatment of HR by a single surgeon. Methods: Electronic health records were queried from August 2017 to August 2021 for patients who were treated with SCI (Cartiva Synthetic Cartilage Implant; Cartiva Inc., Alpharetta, GA) augmented with a custom 3D printed baseplate by a single surgeon. Through a dorsal approach to the MTPJ, the custom 3D printed baseplate is inserted in the metatarsal head and the SCI implant is positioned two millimeters proud from the cortex. An akin osteotomy is then performed and fixed with a staple. For the study, surgical indications included symptomatic HR and revision of previously failed SCI treatment. Patient demographics, body mass index (BMI), medical comorbidities, and followup periods were recorded. Preoperative and postoperative range of motion, visual analog scale (VAS) pain scores, and x-ray imaging were compared. Descriptive and univariate statistics were used to analyze data. Results: Twenty-one patients underwent SCI resurfacing augmented with a 3D printed baseplate. The cohort consisted of 18 females, and presented with a mean BMI of 30.4+-5 Kg/m2, mean age of 56.4+-10 years, and mean followup of 9.8+-13 months since the procedure. Patients experienced a significant improvement in VAS pain (P=0.002) scores. The SCI augmented with 3D printed baseplate survivorship was 90.4%, with only two (9.5%) patients requiring revision to first MTPJ arthrodesis for SCI subsidence and sesamoidal arthritis. Two (9.5%) patients additionally underwent reoperation for staple removal and infection. The first MTPJ space was maintained on x-ray imaging for 19 (90.5%) patients, with only two (9.5%) patients demonstrating implant subsidence. Conclusion: SCI resurfacing augmented with a custom 3D printed baseplate demonstrated significant improvements in pain and prevented implant subsidence in patients suffering from symptomatic HR. Future prospective studies should be performed to expand upon the clinical outcomes data analyzing this novel technique to prevent SCI subsidence in the treatment for HR.
The Position and Morphology of the Peroneus Longus Tubercle in Hallux Valgus: A Weight-Bearing CT Assessment
Authors: Marusza Christopher James , Stringer Howard , Redfern James , Sangoi Dhrumin , Welck Matthew , Mason Lyndon W. , Malhotra Karan 
Published: November 2022

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: The peroneus longus is one of the main dynamic stabilisers of the first ray acting through its primary insertion at the first metatarsal base and has the theoretical possibility to be defunctioned in hallux valgus (HV). In this study, our primary objective was to report and compare the position and morphology of the peroneus longus tubercle (PLT) in feet with and without HV, using weightbearing CT (WBCT). Methods: A retrospective analysis of WBCT scans was completed using 40 feet in 23 patients. Feet were divided into two equal groups - the normal, 'non-hallux valgus' (non-HV) group and the 'HV' group (Mean age 60.45 and 60.60 respectively). The morphology and position of the PLT was assessed between groups. The intermetatarsal angle (IMA) and metatarsal pronation angle (MPA) were assessed. We also introduce and have assessed the novel measurements of tubercle-to-floor distance (T-F distance), the bisecting angle of the PLT, tubercle-to-metatarsals angle (T-MT angle) as well as the metatarsal cross-sectional area. Results: Between the non-HV group and the HV group, significant differences were found in the T-F distance (mean 26.7mm and 23.35mm respectively, p = .001), illustrating a lower medial column in HV. There was a moderate correlation between IMA and T- F distance (r = -.475, p < .001) confirming depression of the first ray with increasing IMA. The bisecting angle was lower in the HV group as compared to non-HV (mean 61.65 degrees and 66.60 degrees respectively, p=0.017), demonstrating pronation of the PLT in relation to the floor in the HV. We found a significant difference in T-MT angle between the HV and non-HV groups (mean 31.85 degrees and 35.85 degrees respectively, p=0.041) and a strong correlation between the T-MT angle and bisecting angle (r = .817, p< .001) suggesting the pronation occurred in the first metatarsal to a larger degree than the remainder of the forefoot. Conclusion: In this study we have demonstrated a difference in the position of the PLT between HV and non-HV individuals, with a pronated PLT noted in individuals with HV.
Incidence of Venous Thromboembolism Following TAA: Does Chemoprophylaxis Work?
Authors: Martinazzi Brandon J. , Nam Hannah , Dopke Kelly , Mansfield Kirsten N. , Koroneos Zachary , Ptasinski Anna , Manto Kristen , Kirchner Gregory , Aynardi Michael C. 
Published: November 2022

Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: Venous thromboembolism is a devastating and costly complication following TAA. The true incidence of VTE is unknown and the decision to prescribe chemoprophylaxis in foot and ankle surgery continues to be debated. At our institution, all patients receive a four-week course of chemoprophylaxis following TAA. The purpose of this study was to evaluate the incidence of VTE at our institution in patients receiving routine chemoprophylaxis. Methods: Following institutional board approval, a retrospective chart review was conducted for all patients that underwent TAA from 2018-2021 by a single surgeon. Patients were followed from the time of surgery to their six-week follow-up. Demographics and the type of chemoprophylaxis was recorded. For comparison, a large online database was queried using ICD and CTP codes in order to determine the incidence of VTE at 2 week and 6 weeks postoperatively for patients that underwent TAA and did not receive any form of chemoprophylaxis. Results: At our institution, from 2018-2021, 56 patients underwent TAA. The mean age of our cohort was 60.9 (Range, 56-83). In our cohort, 31 patients were male, 25 were female, and the mean patient BMI was 33.8 (Range, 21-56.2). Of the 56 patients, 12 received aspirin (81 mg), 25 received aspirin (325 mg), 16 received enoxaparin (40 mg), 2 received apixaban (5 mg), and 1 received rivaroxaban (20 mg). The total incidence of VTE at 6 weeks was 0%. For comparison, using a large online database (from 2011- 2021), 1,463 patients underwent TAA and did not receive postoperative chemoprophylaxis. Of these patients, 13 (0.89%) developed a postoperative VTE at 6-weeks following surgery. Conclusion: At our institution, the rate of VTE at 6-weeks postoperatively was 0%. This was lower than a large online database rate (0.89%) in patients that did not receive chemoprophylaxis. Further investigation is needed.