bluuebunny/crossref_metadata_2025_split huggingface dataset:
Proximal Phalanx Osteotomy in Percutaneous Correction of the Lesser Toe Deformities: A Cadaver Study
Authors: Leucht Anna-Kathrin , Wiewiorski Martin J. , Dalmau-Pastor Miki , Pellegrino Alexandro 
Published: January 2022

Category: Lesser Toes Introduction/Purpose: The correction of lesser toe deformities has been traditionally performed in an open fashion. With minimal-invasive foot surgeries becoming increasingly popular, correction of lesser toe deformities via percutaneous soft-tissue procedures and osteotomies is frequently performed. The aim of this study was to evaluate the site of percutaneous proximal phalanx osteotomy of the lesser toes in relation to the metatarsophalangeal joint line when performed without fluoroscopy guidance. Methods: In this experimental cadaver study, the metatarsophalangeal joints of the lesser toes of 20 cadaver samples (=80 toes) were palpated. A plantar skin stab incision was made just distal to the joint line without fluoroscopic control. Plantar closing osteotomies of the proximal phalanx were performed with a Shannon burr. Adorsoplantar view was taken with fluoroscopy. The location of the osteotomy and the relative distance from the metatarsophalangeal joint line was evaluated. Results: The majority (78/80; 97.5 %) of the osteotomies were localized in the metaphyseal region. No osteotomy violated the metatarsophalangeal joint. Conclusion: Percutaneous osteotomy of the proximal phalanx of the lesser toes guided by palpation without using the image intensifier is a safe procedure and does not violate the metatarsophalangeal joint.
Ankle/Hindfoot Arthrodesis as a Salvage Procedure for Failed Total Ankle Arthroplasty
Authors: Lim Jung-Won , Song Won Tae , Jung Hong-Geun , Im Jemin 
Published: January 2022

Category: Ankle; Hindfoot Introduction/Purpose: High failure rate after total ankle arthroplasty (TAA) in 10-year follow-up has been reported, ranging from 10 to 20%. Massive bony destruction after TAA often caused by periprosthetic osteolysis, implant subsidence or loosening, or periprosthetic infection, and it would be considerable challenge to many orthopedic surgeons. In some cases, it is difficult to perform revision arthroplasty. For failed TAA, ankle/hindfoot arthrodesis can be performed as a salvage procedure. In this study, we evaluate the clinical and radiologic outcomes of the ankle/hindfoot arthrodesis in patients with failed TAA. Methods: Ankle/hindfoot arthrodesis was performed in 10 ankles with failed TAA from October 2003 to March 2019 (at least 6- month follow-up). As for the clinical evaluation, visual analogue scale (VAS) pain scores, and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores were assessed. Postoperative complications such as skin necrosis, surgical site infection (SSI), or non-union were reviewed through medical records. Radiographs including CT images at last follow-up were assessed to confirm bone union. Results: The average follow-up was 49.1 months (range, 7-89). There were 6 cases performed with tibiotalocalcaneal (TTC) arthrodesis, and 4 cases with ankle arthrodesis. The operations were performed at mean postoperative 46.6 months (range, 8- 178) from index TAA. Allo-femoral head structural bone graft was used in 9 cases, and auto proximal tibia cancellous bone graft was used in 5 cases. Mean VAS pain score decreased from 7.6 pre-operatively to 2.2. AOFAS score increased from 15.6 to 42.0 (subjective assessment only; maximum score=68). 3 revision surgeries had been performed after initial arthrodesis (1 case for SSI, 2 cases for non-union), and bone union was obtained in 2 cases (1 case of SSI, 1 case of non-union). Conclusion: Ankle/hindfoot arthrodesis after failed TAA can be optimal surgical option for the patients with massive bony destruction which compromises revision arthroplasty. It acts as a salvage procedure for failed TAA and could yield favorable outcome.
Comparison of the Outcome of the 3-Component Salto Total Ankle Arthroplasty for Ankle with Preoperative Varus, Valgus and Neutral Alignment in End-Stage Osteoarthritis
Authors: Lim Jung-Won , Jung Hong-Geun , Im Jemin 
Published: January 2022

Category: Ankle; Ankle Arthritis Introduction/Purpose: As the popularity of total ankle arthroplasty (TAA) increases, indication of TAA also expands. Recently, the ankles more than 20° of varus or valgus deformity in the coronal plane are treated with TAA. However, severe varus or valgus deformity should be corrected in the coronal plane to avoid residual mal-alignment that leads to instability, insert wear, and clinical failure. In this study, we compare the clinical and radiologic outcome of the Salto mobile bearing 3-component total ankle prosthesis for ankles with preoperative varus, neutral, and valgus alignment. Methods: TAA was performed in 101 consecutive ankles (99 patients) by a single surgeon using 3-component Salto total ankle implant from June 2014 to October 2019. A prospectively collected database was used to identify all patients who underwent primary TAA with a minimum 1-year follow-up. We classified the enrolled ankles as neutral, varus, or valgus groups. More than 10° of tibial anterior surface angle, talta tilt angle, tibial axis-talar dome angle, talar dome-ground surface angle (TD-GSA), or tibio- calcaneal angle was defined as varus or valgus groups. All patients were followed up at postoperative three months, six months, at one year and yearly thereafter. Clinical outcome scoring was done pre-operatively and post-operatively. American Orthopaedic Foot & 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 alignment of the component were evaluated with radiographs. Results: The average follow-up was 21.6 months (range, 12-71). Preoperatively, there were 63 ankles (62%) with varus deformity, 27 ankles (27%) with neutral alignment, and 11 ankles with valgus deformity. In preoperative varus group, 13 ankles (21%) were performed with concomitant lateral sliding calcaneal osteotomy, and 23 ankles (37%) with deltoid release. No additional procedures for the correction of ankle and hindfoot deformity were performed in preoperative neutral and valgus groups. VAS pain score and AOFAS score were significantly improved in all groups (p < 0.05). Overall satisfaction rate was 88%. After TAA, there were no significant radiologic alignment among the groups (3.9° (range, 0.7°~9.7°) in varus group, 4.1° (range, 0.4°~6.8°) in neutral group, and 2.2° (range, -0.4°~4.4°) in valgus group; p > 0.05). Conclusion: There was no significant difference in outcome among the varus, neutral, and valgus groups postoperatively in the TAA series using single Salto 3-componenet implant. Postoperative neutral alignment was achieved in all ankles. For favorable long-term outcomes, coronal alignment should be corrected with proper additional procedures in TAA.
Characterization of Motor Performance in 200 Normal Ankles Through Isokinetic Evaluation
Authors: Mansur Nacime S. , Fonseca Lucas , Maciel Eduardo S. , Inojossa Thiago , Netto Cesar de Cesar , Astur Diego C. 
Published: January 2022

Category: Ankle; Sports Introduction/Purpose: The isokinetic test has been used diffusely as a way to evaluate the functional results after the rehabilitation of musculoskeletal injuries. In the ankle, in particular, most studies are related to lateral ligament injuries and Achilles tendon's injuries. However, different protocols are used and a lack of normative values is observed in the literature. The aim of this work is to perform a global isokinetic evaluation on healthy ankles in order to propose reference values for future patients. Methods: We evaluated 100 participants (200 ankles) using the Biodex 3 System for the eversion, inversion, dorsiflexion and plantar flexion movements of the ankle. The sample consisted of individuals aged 20-60 years, with an active life and practice of recreational physical activity (non-athlete) and without previous injuries. Five repetitions for strength (N / m) and work (J) at a speed of 30° / sec and 10 repetitions for power (W) at a speed of 120° / sec were performed in our protocol. Agonist / antagonist ratio and the Muscle Deficiency Index, which globally assesses the balance between the sides for each movement, were also evaluated, as well as the demographic variables. Different statistical analyzes were performed for each parameter. Results: The mean age was 38.5 years and BMI 25.8 (CI 2.7 and 0.8 respectively). The non-dominant side was consistently stronger (higher peak torque) in all movements (p <0.001 -). The mean values obtained for force in each movement were 29.9N / m (CI 1.4) for eversion, 34.8N / m (CI 1.6) for inversion, 48.6N / m (2.0) for dorsiflexion and 140.2 N / m (CI 6.1) for plantar flexion. There was no correlation between age or BMI with the maximum torque (N / m). The ratio of eversors / inverters was 88.8% (CI 3.1) and that of dorsiflexors / plantar flexors was 36.1% (1.3). The Muscle Deficiency Index showed a balance between the sides for each movement (p 0.062), with an average global difference of less than 10% between them (eversion 8.66 [CI 3.17], inversion 4.2 [3, 48], dorsiflexion 3.41 [3.04] and plantar flexion 5.18 [2.51]. Conclusion: As far as we know, this is the largest isokinetic assessment of normal ankles ever performed. The sample, although not stratified, was considered homogeneous (coefficient of variation <50%), which allows to propose several normative values for a non-athlete population in the isokinetic evaluation. It would be interesting to compare these data in the future with the functional results in patients after the treatment of certain injuries.
Deltoid Ligament Arthroscopic Repair in Ankle Fractures: Case Series
Authors: Mansur Nacime S. , Lemos Andre Vitor , Baumfeld Daniel , Sanchez Gustavo T. , Raduan Fernando C. , Prado Marcelo P. , Nery Caio A. 
Published: January 2022

Category: Ankle; Trauma Introduction/Purpose: Diagnosis and treatment of ankle medial ligament lesions in malleolar fractures has always been a matter of controversy. Even when deltoid involvement is clear, the direct repair of this structure is not a consensus. Recently, deltoid reparation through an arthroscopic technique was described aiming to potentialize better clinical results and minimize complications. We intend to demonstrate safety and functional results of operated ankle fractures that had an arthroscopic deltoid repair. Methods: This is a retrospective study in patients diagnosed with ankle fractures associated with acute deltoid injuries submitted to malleolar fixation and deltoid arthroscopic repair between June 2016 and January 2020. All patients were evaluated for pain and function according to the Visual Analogue Scale (VAS) and the American Orthopaedic Foot & Ankle Society Score (AOFAS) at a minimum of 6 months in follow-up. Results: Between January 2016 and January 2020, 20 ankles with fractures or dislocations were operated and the deltoid ligament rupture was repaired arthroscopically. A mean follow-up of 14.45 months (6-48) was observed, and patients presented an average AOFAS of 93.5 (SD 7.25) and a VAS of 0.75 (SD 1.05). Three minor complications were noticed and no signs of medial chronic instability, loss of reduction or osteoarthritis were observed. Conclusion: The repair of the deltoid complex and the low morbidity of the arthroscopic technique used may improve the clinical outcomes of these patients. Additional studies, with a prospective and comparative methodology are required to sustain this proposal.
Arthroscopic Reduction and Internal Fixation of Talus Fractures: An All-Inside Soft-Tissue Preserving Technique
Authors: Martin Kevin D. , Groth Adam T. 
Published: January 2022

Category: Ankle; Hindfoot; Trauma Introduction/Purpose: Talus fractures, although rare, can lead to devastating complications of posttraumatic osteoarthritis (PTA), mal-union, non-unions and avascular necrosis (AVN). The timing and method of fixation has been controversial, especially for open and extruded fractures. The purpose of this study is to present short term outcomes using a posterior talus arthroscopic reduction internal fixation (TARIF) technique. Methods: We performed a retrospective study on 12 consecutive patients undergoing primary posterior arthroscopic reduction internal fixation for talus fractures from August 2020 to January 2021. All cases were performed completely arthroscopically, utilizing a posterior approach and cannulated screws. Patient demographics, fracture pattern, perioperative complications, and radiographic findings were collected. Results: The mean age of our cohort was 37.3 years (range, 19-75), including 6 males and 6 females, with 58% utilizing nicotine. Motor vehicle accidents accounted for 58% of injuries, followed by falls and gunshot wounds. Fracture location included 7 body fractures, 5 neck fractures Hawkins type 2 (1), 3 (3), and 4 (1). Five fractures were open injuries, 2 of which had vascular injuries that underwent irrigation and debridement followed by external fixation. Intraoperatively, all patients had 2-3 anterior to posterior 3.5mm cannulated headless screws placed with a mean tourniquet time of 87 minutes (range, 0 - 88). Postoperatively, all fractures had the articular surface restored to within 2mm on radiographs. No patients required antibiotics and no debridement's were performed. No acute AVN has been recorded. Conclusion: Our short-term results indicate posterior arthroscopic reduction internal fixation of talus fractures are safe and able to restore the articular surfaces. It also suggests that an all-inside soft-tissue preserving technique may reduce short term complications.
The UK Foot and Ankle COVID-19 National (FAlCoN) Audit – Regional Variations in COVID-19 Infection and National Foot and Ankle Surgical Activity
Authors: Mason Lyndon W. , Malhotra Karan , Mangwani Jitendra 
Published: January 2022

Category: Other; Ankle; Ankle Arthritis; Arthroscopy; Basic Sciences/Biologics; Bunion; Diabetes; Hindfoot; Lesser Toes; Midfoot/Forefoot; Trauma Introduction/Purpose: Aims: This paper details the impact of COVID-19 on foot and ankle activity in the UK. It describes regional variations and COVID-19 infection rate in patients undergoing foot and ankle surgery before, during and after the first national lock-down. Methods: Patients & Methods: This was a multicentre, retrospective, UK-based, national audit on foot and ankle patients who underwent surgery between 13th January and 31st July 2020. Data was examined pre- UK national lockdown, during lockdown (23rd March to 11th May 2020) and post-lockdown. All adult patients undergoing foot and ankle surgery in an operating theatre during the study period included from 43 participating centres in England, Scotland, Wales and Northern Ireland. Regional, demographic and COVID-19 related data were captured. Results: 6644 patients were included. In total 0.53% of operated patients contracted COVID-19 (n=35). The rate of COVID-19 infection was highest during lockdown (2.11%, n=16) and lowest after lockdown (0.16%, n=3). Overall mean activity during lockdown was 24.44% of pre-lockdown activity with decreases in trauma, diabetic and elective foot and ankle surgery; the change in elective surgery was most marked with only 1.73% activity during lock down and 10.72% activity post lockdown as compared to pre-lockdown. There was marked regional variation in numbers of cases performed, but the proportion of decrease in cases during and after lockdown was comparable between all regions. There was also a significant difference between rates of COVID- 19 and timing of peak, cumulative COVID-19 infections between regions with the highest rate noted in South East England (3.21%). The overall national peak infection rate was 1.37%, occurring during the final week of lockdown Conclusion: National surgical activity reduced significantly for all cases across the country during lockdown with only a slow subsequent increase in elective activity. The COVID-19 infection rate and peaks differed significantly across the country.
The UK Foot and Ankle COVID-19 National Audit – Rate of COVID-19 Infection and 30 Day Mortality in Foot and Ankle Surgery in the UK
Authors: Mason Lyndon W. , Mangwani Jitendra , Malhotra Karan 
Published: January 2022

Category: Diabetes; Other Introduction/Purpose: The primary objective was to determine the incidence of COVID-19 infection and 30-day mortality in patients undergoing foot and ankle surgery during the global pandemic. Secondary objectives were to determine if there was a change in infection and complication profile with changes introduced in practice. Methods: Design: Multicentre retrospective national audit. Setting: UK-based study on foot and ankle patients who underwent surgery between the 13th January to 31st July 2020 - examining time periods pre- UK national lockdown, during lockdown (23rd March to 11th May 2020) and post-lockdown. Participants: All adult patients undergoing foot and ankle surgery in an operating theatre during the study period included from 43 participating centres in England, Scotland, Wales and Northern Ireland. Main Outcome Measures: Variables recorded included demographics, surgical data, comorbidity data, COVID-19 and mortality rates, complications, and infection rates. Results: 6644 patients were included. In total 0.52% of operated patients contracted COVID-19 (n=35). The overall all cause 30- day mortality rate was 0.41%, however in patients who contracted COVID-19, the mortality rate was 25.71% (n=9); this was significantly higher for patients undergoing diabetic foot surgery (75%, n=3 deaths). Matching for age, ASA and comorbidities, the OR of mortality with COVID-19 infection was 11.71 (95% CI 1.55 to 88.74, p=0.017). There were no differences in surgical complications or infection rates prior to or after lockdown, and amongst patients with and without COVID-19 infection. After lockdown COVID-19 infection rate was 0.15% and no patient died of COVID-19 infection. Conclusion: COVID-19 infection was rare in foot and ankle patients even at the peak of lockdown. However, there was a significant mortality rate in those who contracted COVID-19. Overall surgical complications and post-operative infection rates remained unchanged during the period of this audit. Patients and treating medical personnel should be aware of the risks to enable informed decisions.
The Anatomic Reconstruction for Chronic Lateral Ankle Instability Utilizing Absorbable Synthetic Graft (ATLAS Procedure): Description and Short Term Follow Up
Authors: McKenna Bryon J. , Malloy McCoy Antonio M. , McKenna Bryon J. , Rushing Calvin J. , Hyer Christopher F. , Berlet Gregory C. , Tewilliager Tyler 
Published: January 2022

Category: Ankle Introduction/Purpose: The traditional modified Brostrom-Gould has long been the procedure of choice for addressing chronic lateral ankle instability. However, more robust techniques including anatomic reconstruction are favored for larger deformity, poor tissue quality and revision surgery. Given the inherent disadvantages of allograft and non-elastic synthetic materials, material science has sought to impact the graft choice providing alternative load sharing, permeable materials with high strength. Our institution has performed anatomic lateral ligament stabilization, termed the 'ATLAS' procedure, using a novel synthetic graft (Artelon, Marietta, GA) with anecdotal success in recent years. In this study, we present our surgical technique and early experience. Methods: A retrospective cohort review was performed, evaluating the failure rate, complications and radiographic changes in anatomic alignment. A review of all patients undergoing the ATLAS procedure was performed, a total of 27 patients were included. The study included only those patients with at least 1 year follow up from the procedure. Results: Only one patient had symptoms of early failure of the procedure, while none of the patients required a revision procedure. The most common complication was minor wound dehiscence (11.1%). Overall, our short-term results with this procedure were excellent. Conclusion: We conclude that the ATLAS procedure is a predictable and effective lateral ligament reconstruction technique with no donor site morbidity, no donor tissue transmission risk, low risk of over-constraint and accomplished with a predictable technique.
Safe and Effective Anterior Ankle Arthroscopy with A 2-mm Diameter Operative System
Authors: Stornebrink Tobias , Altink Nienke , Appelt Daniel , Wijdicks Coen A. , Stufkens Sjoerd A. , Kerkhoffs Gino 
Published: January 2022

Category: Ankle; Arthroscopy; Basic Sciences/Biologics Introduction/Purpose: The purpose of this study was to assess whether all significant structures in the ankle could be visualized and surgically reached during 2-mm diameter operative arthroscopy, without inflicting iatrogenic damage. Methods: A novel, 2-mm diameter arthroscopic system was used to perform a protocolled arthroscopic procedure in 10 fresh- frozen, human donor ankles. Standard anteromedial and anterolateral portals were utilized. Visualization and reach with tailored arthroscopic instruments of a protocolled list of articular structures were recorded and documented. A line was etched on the most posterior border of the talar and tibial cartilage that was safely reachable. The specimens were dissected and distances between portal tracts and neurovascular structures were measured. The articular surfaces of talus and tibia were photographed and inspected for iatrogenic damage. The reachable area on the articular surface was calculated and analysed. Results: All significant structures were successfully visualized and reached in all specimens. The anteromedial portal was not in contact with neurovascular structures in any specimen. The anterolateral portal collided with a branch of the superficial peroneal nerve in one case, but did not cause macroscopically apparent harm. On average, 96% and 85% of the talar and tibial surfaces was reachable respectively, without causing iatrogenic damage. Conclusion: 2-mm diameter operative arthroscopy provides safe and effective visualization and surgical reach of the anterior ankle joint. It may hold the potential to make ankle arthroscopy less invasive and more accessible.