bluuebunny/crossref_metadata_2025_split huggingface dataset:
Corticosteroid Injection for Morton’s Interdigital Neuroma: A Systematic Review
Authors: Choi Jun Young , Kim Min Jin , Suh Jin Soo 
Published: January 2022

Category: Lesser Toes; Midfoot/Forefoot Introduction/Purpose: This review aimed to evaluate the effects of corticosteroid injections for Morton's neuroma using an algorithmic approach to assess the methodological quality of reported studies using a structured critical framework. Methods: Several electronic databases were searched for articles published until April 2020 that evaluated the outcomes of corticosteroid injections in patients diagnosed with Morton's neuroma. Data searches, extraction, analysis, and quality assessments were performed according to the PRISMA guideline, and the clinical outcomes were evaluated using various outcome measures. Results: With 3-12 months of follow-up, corticosteroid injections provided a satisfactory outcome according to Johnson satisfaction scores without two studies. Visual analogue scale scores showed maximal pain reduction between 1 week and 3 months post-injection. We found that 140 subjects out of 469 (29.85%) eventually underwent surgery after receiving corticosteroid injections due to persistent pain. Conclusion: Corticosteroid injections showed a satisfactory clinical outcome in patients with Morton's interdigital neuroma in spite of almost 30% of included subjects eventually underwent operative treatment. Our recommendation for the future study includes using more objective outcome parameters, such as foot and ankle outcome scores or foot and ankle ability measures. Moreover, studies about the safety and effectiveness of multiple injections at the same site are highly necessary.
Retrospective Study Analyzing Trends in Antibiotic Use in Patients with Osteomyelitis of the Ankle and Foot
Authors: Chokshi Shivan N. , Efejuku Tsola , Jupiter Daniel , Chen Jie , Panchbhavi Vinod K. 
Published: January 2022

Category: Ankle; Hindfoot; Midfoot/Forefoot Introduction/Purpose: Antibiotic resistance has quickly become one of the most pressing current public health challenges. Many studies have analyzed general prescription trends, but little information exists about how antibiotic therapy is utilized in orthopedic practice- particularly in patients with Osteomyelitis of the Ankle and Foot. Thus, a retrospective analysis was performed using EMR data to understand temporal tends in antibiotic use, as well as the impact of patient-specific factors on antibiotic use. Methods: Patients with Osteomyelitis of the Ankle and Foot who were given antibiotics within 12 weeks of their diagnosis were identified in the EMR database using ICD 10 codes (M86.17, M86.67, M86.8X7, M86.171, M86.172, M86.27, M86.679, M86.279, M86.671, M86.672, M86.07, M86.271, M86.37) for foot and ankle Osteomyelitis and the VA Drug Classification Code (AM000) for antibiotics. We then stratified these patients by age (0-9, 10-19, 20-29, 30-39, 40-49, 50-59, 60-69,70-79, 80-89, 90-99), gender (male, female), and year by decade (2001, 2010, 2020). In addition, pre-disposing risk factors of Osteomyelitis, such as Diabetes, Hypertension, and Chronic Ischemic Heart Disease, were analyzed for association with antibiotic use. Results: Our search identified 85,767 patients, of whom 50,043 (58.35%) received antibiotics within 12 weeks of Osteomyelitis diagnosis. Overall, Males (60.01%) were slightly more likely than Females (54.88%) to use antibiotics. Stratification by age revealed a skewed distribution with the highest incidence of antibiotic use seen in 50-59 year-olds (61.93%). This was more than double the incidence of antibiotic use seen among 20-29 year-olds (30.63%). Additionally, we discovered notable increases in antibiotic usage over time. The most substantial increases occurred from 2001 to 2010 (14.08% to 33.71%, respectively) and 2010 to 2020 (33.71% to 60.51%, respectively). Lastly, patients with pre-existing co-morbidities were found to have a higher usage of antibiotics, when compared to patients without the co-morbidity. Specifically, prior Hypertension increased use by 11.73%, followed by Chronic Ischemic Heart Disease (10.50% increase) and Diabetes (8.40% increase). The above differences were found to be statistically significant at a p-value of <.0001. Conclusion: This analysis provides insight into present and past antibiotic usage in patients with Foot and Ankle Osteomyelitis. Overall, patients aged 50-59, males, and with Chronic Ischemic Heart Disease are the most likely to take antibiotics within 12 weeks of their diagnosis. This is all against the background of rising antibiotic use, with notable increases since 2001. The data necessitates a deeper look into antibiotic use in patients with foot and ankle injuries as a whole.
Clinical and Patient Reported Outcomes Following Peroneus Brevis Reconstruction with Hamstring Tendon Autograft
Authors: Chrea Bopha , Eble Stephanie K. , Day Jonathan , Hansen Oliver B. , O'Malley Martin J. , Ellis Scott J. , Drakos Mark C. 
Published: January 2022

Category: Ankle; Other Introduction/Purpose: Peroneal tendon injuries are a common cause of lateral ankle pain and instability. While the use of hamstring autograft has been proposed as a viable surgical option for peroneus brevis reconstruction, reported outcomes with this technique are limited in the literature. We present patient-reported and clinical outcomes for patients who underwent peroneus brevis reconstruction with hamstring autograft. Methods: Thirty-one patients were retrospectively identified who underwent peroneus brevis reconstruction with hamstring autograft for peroneal tendinopathy between February 2016 and May 2019. All patients who had a peroneus brevis reconstruction were included and all concomitant procedures were noted. Patient-Reported Outcomes Measurement Information System (PROMIS) surveys were prospectively collected preoperatively and at a minimum of 1 year postoperatively (average 24.25, range 12-52.70) months. Retrospective chart review was performed to evaluate the incidence of postoperative complications and reoperations at an average of 30.23 (range, 14.62-53.72) months. Results: When evaluating pre and postoperative patient-reported outcome surveys (n=26; 84%), on average patients reported improvement in every PROMIS domain evaluated, with significant improvement in Physical Function (+5.99; p=0.006), Pain Interference (-8.11; p<0.001), Pain Intensity (-9.02; p<0.001), and Global Physical Health (+7.29; p=0.001). Three patients reported persistent pain at a minimum of 1 year postoperatively of which 2 required re-operation. No patient reported persistent pain or discomfort at the harvest site of the hamstring autograft. Conclusion: Patients undergoing peroneus brevis reconstruction with hamstring autograft experienced excellent patient- reported and clinical outcomes. Few postoperative complications were observed, and patients reported improvements across all patient-reported outcome domains, with significant improvements for pain and function domains. Reconstruction with hamstring autograft represents a viable surgical option in the setting of peroneal tendinitis or tears.
Presence of Complications in the Transition of a Bone Transport to a Definite Internal Fixation System without Pin Holiday: Case Report
Authors: Clarke Gonzalo Fernandez , Morales Eduardo Fuentes , Pacheco Florencia , Clarke Gonzalo Fernandez , Cataldo Mauricio , Fernández Ignacio , Duran Humberto 
Published: January 2022

Category: Trauma; Other Introduction/Purpose: Bone transports are an alternative in the treatment of severe injuries of lower extremities. They are generally associated to axis problems, delayed bone union in the docking site and pin infection. There is no evidence in the need of having a window period between the transport system and the definite internal fixation. Objetive: Describe the complications seen in a group of 6 patients that went through a tibial bone transport with circular external fixator and posterior internal fixation without pin holiday. Methods: Restrospective and decriptive study of 6 patient that went through tibial bone transport between 2012-2019, in a level 1 trauma center. Inclusion criteria considered patients >18 years old, with intra or extramedular internal fixation systems. We registered different parameters including patients comorbilities, transport time, transport index, type of internal fixation used and complications during the time of observation and treatment. We registered our clinical evaluation and both laboratory and imagenologic exams. Results: 100% of patients were men, with an average of 35.8 years old (22-48 yo). 66% of injuries compromised distal tibia, 83% considered open fractures. Average transport length was 7.43 centimeters (3-11cms) in 3.5 months (1.3-6 months), with average follow up of 52 months (24-72months). Tibial transport index in our study was of 1,2month/cm. The main complication in our study was bone consolidation delay in the docking site (50%), and 33% presented deep infection, all of them in the open fracture group. Conclusion: Pin holiday has been justified by the reduction in pin site infection. In our series there where no pin site infection cases, and only two deep infections which were associated with an important soft tissue injury that required free flap coverage.
Clinical Outcomes of Nano Arthroscopy in the Office Setting for the Treatment of Anterior Ankle Impingement
Authors: Colasanti Christopher , Mercer Nathaniel P. , Garcia Jeremie , Stornebrink Tobias , Kerkhoffs Gino , Dahmen Jari , Kennedy John G. 
Published: January 2022

Category: Ankle; Arthroscopy Introduction/Purpose: The hypothesis was that IONA would provide the patient with a unique experience of their pathology and facilitate their rapid recovery through an awareness of their own condition, and that using IONA would accelerate recovery to sports-specific activities compared to the literature using standard arthroscopic procedures. Methods: This was a retrospective cohort study investigating patients who underwent IONA for anterior ankle impingement between 2019 and 2020. Clinical outcomes were evaluated using the following methods preoperatively and at final follow-up: The Foot and Ankle Outcome Scores (FAOS) and Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference and Pain Intensity domains. A five-point Likert scale regarding patient satisfaction was evaluated at final follow-up. Wilcoxon signed-rank test was performed to compare preoperative and postoperative outcome scores. Results: Thirty-one patients were included in this study, which included eighteen males and thirteen females with a mean age of 41.7 +- 15.5 years (range, 17-69 years) and a mean body mass index (BMI) of 27.3 +- 5.7 kg/m2 (range, 19.37-41.5). The mean follow-up time was 12. +- 1.9 months (range, 11-15 months). There were 27 patients who participated in sports activity prior to IONA-arthroscopy procedure. Of those, 26 patients (96%) returned to their sports activities. The median time to return to sports was 3.9 weeks (range, 1.5 to 12 weeks). Patients reported an overall positive experience with a mean rating scale of 9.71 +- .8 (range, 6 to 10). Twenty-seven patients (87%) reported the highest rating (10/10) for overall positive experience and felt that seeing their procedure in real-time aided in their understanding of their underlying pathology. Lastly, twenty-nine patients (94 %) expressed willingness to undergo the same procedure again. Conclusion: The current study demonstrates that IONA treatment of anterior ankle impingement results in significant pain reduction, a low complication rate, and excellent patient-reported outcomes with high rates of return to work/sport. Additionally, IONA for anterior ankle impingement leads to high patient satisfaction with a significant willingness to undergo the same procedure again.
Risk Factors for Nonunion in Pediatric Lateral Column Lengthening (Mosca) Procedures
Authors: Conklin Michael J. , Strom Shane F. , Seidenstein Alexandra H. , Andrews Nicholas A. , Halstrom Jared R. , Doyle John S. , Shah Ashish 
Published: January 2022

Category: Hindfoot Introduction/Purpose: The Evans/Mosca procedure remains the most utilized extra-articular osteotomies for correction of pes planus. This desired lengthening is created by inserting a graft in the anterior aspect of the calcaneus through a complete transverse osteotomy. Failure of conservative methods, particularly for rigid pes planus, is a primary consideration for surgical management. Complications of the Evans procedure include delayed union, nonunion, malunion, subluxation of the calcaneocuboid joint, and persistent lateral column pain. Our study analyzes risk factors for development of non-union. Methods: After IRB approval 120 patients charts and 157 feet were analyzed for incidence of non-union which was defined by clinical and radiographic evidence of absence of union >6 months. Delayed union was diagnosed if there was clinical evidence of healing without complete union at >6 months. Exclusion criteria included age >18 and revision lateral column lengthening. Patients' medical records were reviewed for basic demographics, complications, and surgical technique. Results: The cohort consisted of 75 females (47.8%) and 82 males (52.2%). The median age was 12 with an interquartile range (IQR) of 3. A total of 6 patients (3.7%) had wound complications or nerve injury. Nonunion occurred in 7 of 157 feet (4.5%) with 2 of 157 feet (1.3%) experiencing delayed union. The median age for patients with nonunion was significantly higher than those who achieved union (13.2 (IQR 2.75) vs. 11.2 (IQR 3) respectively). The fixation construct used was associated with increased risk of nonunion. Patients with screw fixation had the highest rate of nonunion at 50% (2/2) compared to pin and/or staple fixation at 6.8% (5/73), no fixation at 4% (3/75), and plate fixation at 0% (0/2). Both delayed union patients were treated with ultrasound bone stimulation, both patients were able to achieve complete union. Revision was attempted in 5/7 nonunions with all operative patients achieving union. Conclusion: Our study analyzed risk factors for developing non-union in patients undergoing calcaneal lengthening osteotomy for pediatric pes planus. We found age at time of surgery and graft fixation method to be significant risk factors for development of non-union. Our study highlighted that those patients who had non-union was on average >2yrs older at time of surgery. Overall, lateral column lengthening is a well-tolerated procedure with a complication rate, including non-and delayed union, of 10.8%. Surgeons should be aware, in the largest cohort of pediatric Evans/Mosca procedures to date, patient age and type of fixation were associated with nonunion.
Time and State Legislation Have Decreased Opioid Prescribing in Elective Foot and Ankle Surgery in the United States
Authors: Cunningham Daniel J. , Kwon Nicholas , Allen Nicholas B. , Hanselman Andrew , Adams Samuel B. 
Published: January 2022

Category: Other; Ankle; Ankle Arthritis; Arthroscopy; Bunion; Hindfoot; Lesser Toes; Midfoot/Forefoot; Sports Introduction/Purpose: The opioid epidemic has focused attention on opioid overprescribing. State legislation has been enacted to reduce acute opioid prescribing. However, the impact of this legislation on elective foot and ankle surgery is largely unknown. The purpose of this study was to evaluate the impact of opioid limiting legislation on opioid prescribing in elective foot and ankle surgery. Methods: 90-day perioperative opioid prescription filling in oxycodone 5-mg equivalents was identified in all patients ages 18 and older undergoing non-trauma, non-arthroplasty foot and ankle surgery from 2010 - 2019 using a commercial database. States with and without legislation were identified and opioid prescription filling before and after legislation was tabulated. Unadjusted and adjusted analyses were performed to evaluate the impact of time and state legislation on perioperative opioid prescribing in this patient population. Results: Initial and cumulative opioid prescribing decreased significantly from 2010 to 2019 (39 vs 35.7 initial and 98.1 vs 55.7 cumulative oxycodone 5-mg equivalents, p<0.001). States with legislation had larger and more significant reductions in initial and cumulative opioid prescribing compared to states without legislation over similar timeframes (41.6 to 35.1 with legislation vs 40.6 to 39.1 without legislation initial oxycodone 5-mg equivalents prescription filling volume and 87.7 to 62.8 vs 88.6 to 74.1 cumulative oxycodone 5-mg equivalents prescription filling volume, p<0.001). The figure shows state-level changes in opioid prescription filling from pre-act to post-act. Conclusion: State legislation and time have been associated with large, clinically relevant reductions in 90-day perioperative cumulative opioid prescription filling although reductions in initial opioid prescription filing have remained low. These results encourage states without legislation to enact restraints to reduce the impact of the opioid epidemic.
Second-Look Arthroscopy after Surgery for Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis
Authors: Dahmen Jari , Vreeken Jelmer T. , Stornebrink Tobias , Emanuel Kaj , Stufkens Sjoerd A. , Kerkhoffs Gino 
Published: January 2022

Category: Ankle Introduction/Purpose: The primary aim was to assess and compare cartilage quality after different surgical interventions evaluated by second-look arthroscopy (SLA). Secondary aims were to report concomitant diagnoses found during SLA, and to correlate the cartilage quality with clinical- and radiological outcomes. Methods: A literature search was performed through PubMed, Embase (Ovid), and Cochrane Library. The primary outcome was the difference of cartilage quality as assessed with SLA between different surgical interventions. The Moderator analysis was used to calculate differences between treatment groups. Associated 95% confidence intervals (CI) were calculated with the Clopper- Pearson interval. Additionally, correlations between the cartilage quality and clinical- or radiological outcomes were calculated and percentages of concomitant diagnoses per treatment group were reported. Results: Nineteen studies comprising 447 ankles having undergone SLA 14 months after the initial surgery were included. The cartilage quality success rate for bone marrow stimulation (BMS) was 53% (95% CI 38-68%), for Retrograde Drilling (RD) 100% (95% CI 66-100%, for fixation (FIX) 92% (95% CI 70-89%), for Osteochondral Transplantation (OCT) 94% (95% CI 69-99%) and Chondrogenesis-Inducing Techniques (CT) this was 81% (95% CI 70-89%). The success rate of BMS was significantly lower than FIX, OCT and CIT. There were no significant differences in success rates between the other treatment options. The incidence of concomitant diagnoses found during second-look arthroscopy differed among different treatment strategies. For BMS, a positive correlation was found between the International Cartilage Repair Society score (ICRS) and AOFAS-scores (rc =.67, p <0.01). For OCT, no significant correlation was found between the MOCART score and the ICRS (rc =.36, p =.23). Conclusion: Bone marrow stimulation yields inferior cartilage quality as assessed with SLA in comparison to fixation, osteo(chondral) transplantation and cartilage implementation. The role of the quality of the subchondral bone and its repair must be highlighted concerning correlation with clinical outcomes and long-term success as well as prevention of development of osteo- arthritis.
Incidence of Deep Vein Thrombosis (DVT) in Patients Using A Knee Scooter
Authors: Davidson Stuart , Pogorzelski Nina , Dowd Thomas C. , Huh Jeannie 
Published: January 2022

Category: Ankle; Trauma Introduction/Purpose: Functional limitations after lower extremity injury often require the use of an assistive device such as a knee scooter. Many patients find these devices to be easier and more comfortable to use than crutches or walkers. There is concern regarding the possible correlation between scooter use and DVT. Prior literature demonstrated decreased venous flow with the knee flexed, and venous stasis is a known risk factor for DVT1-3. Further, healthy volunteers using a scooter demonstrated a significant decrease in volumetric blood flow rate at the popliteal fossa4. We report the incidence of DVTs after prescription of a scooter following lower extremity injury. We hypothesized that DVT rates would be higher in patients using a scooter compared to rates of DVT in the NSQIP database Methods: A retrospective record review of adult patients age 18-74 within the Military Health System (MHS) database between 2010-2020 was completed to identify the total number of patients who were prescribed a knee scooter and those who subsequently developed a DVT. Additional demographic and clinical data were collected on patients who had both a scooter and a DVT. This was compared with recorded 2015 NSQIP data on DVT incidence in major orthopaedic surgery procedures. Results: Between 2010 and 2020, 46,840 of patients within the MHS database were prescribed a rolling scooter after a lower extremity injury or surgery. Of those patients who were prescribed a scooter, 377 subsequently developed a DVT within 90 days of prescription. DVTs were diagnosed on average 26.5 days after scooter prescription. The incidence of DVT of in this population was 0.8%. Conclusion: In the Military Health System database, the use of a knee scooter following lower extremity injury or surgery is associated with a higher incidence of DVT compared to the 2015 NSQIPS incidence of DVT following major orthopedic surgery (0.80% vs 0.55%), and is most frequently diagnosed within 30 days of scooter prescription. Higher level study is needed to confirm these findings and identify risk factors of patients who experience DVTs associated with scooter use after lower extremity injury or surgery.
Flexor Digitorum Longus Transfer for Posterior Tibial Tendon Dysfunction is the Standard of Care: Does the Evidence Support It?
Authors: Dooley Sean W. , Evashwick-Rogler Thomas , Murawski Christopher D. , Guyton Gregory P. , Smyth Niall A. 
Published: January 2022

Category: Basic Sciences/Biologics; Hindfoot; Other Introduction/Purpose: Flexor digitorum longus (FDL) transfer, in conjunction with osseous procedures, is used routinely for the treatment of posterior tibial tendon dysfunction (PTTD). It is well established however that the relative power of the FDL tendon is significantly inferior than that of the native posterior tibial tendon. The purpose of this study is to systematically evaluate the evidence that supports or refutes the use of an FDL transfer in the surgical treatment of PTTD. Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta- Analysis. Using the terms 'flexor digitorum longus OR FDL AND posterior tibial tendon dysfunction OR PTTD OR adult acquired flatfoot OR AAFD' we searched the PubMed/Medline database. Both clinical and biomechanical studies were eligible for inclusion. Results: Forty-one studies met the inclusion criteria, including 31 clinical studies and 10 biomechanical in vitro studies. All 31 clinical studies consisted of Level IV evidence, and support the use of an FDL transfer. There was significant heterogeneity of the clinical evidence due to the variety of concomitant procedures. Of the 10 biomechanical in vitro studies, 2 support the use of an FDL transfer, although these did not assess the procedure in isolation. 8 biomechanical in vitro studies specifically assessing the effect on of an FDL transfer contradict its use for PTTD. Conclusion: There is poor quality clinical evidence to support the use of an FDL transfer for PTTD and the biomechanical literature refutes the use of the procedure. It remains unknown if the clinical improvement reported in the literature can be attributed to the FDL transfer or the concomitant osseous procedures. Additional studies are needed to assess the validity of the FDL transfer and whether alternatives are available to preserve the PTT muscle.