bluuebunny/crossref_metadata_2025_split huggingface dataset:
Traumatic Peroneal Nerve Injuries: A Systematic Review
Authors: Vopat Bryan G. , Mackay Matthew , Ayres Jack M. , Harmon Ian , Tarakemeh Armin , Brubacher Jacob 
Published: January 2022

Category: Trauma Introduction/Purpose: The common peroneal nerve (CPN) is the most commonly injured peripheral nerve of the lower extremity in trauma patients. Traumatic CPN injuries have historically been associated with relatively poor outcomes and patient satisfaction, though recent outcome data appear promising. Given the variety of underlying injury modalities, treatment options, and prognostic variables, this study sought to evaluate and summarize current literature on traumatic CPN injuries and provide recommendations for treatment and future research. Methods: A systematic review was performed using PubMed, Embase and Cochrane databases per PRISMA guidelines. Search terms consisted of variations of 'peroneal nerve' and 'fibular nerve' combined with 'injury,' or 'laceration,' or 'entrapment,' or 'repair,' or 'neurolysis.' Information regarding treatment modality, outcomes and patient demographics were recorded and analyzed. Results: 2,301 articles were identified in the initial search, 42 met eligibility criteria (Figure 1). Factors associated with better clinical outcomes included shorter pre-operative interval, shorter graft length when an interposed graft was used, nerve continuity and younger patient age. Sex or gender did not affect outcomes in any studies in this review. Motor grades of M3 or greater on the MRC scale are typically considered successful outcomes. In studies we analyzed, this was achieved in 81.2% of patients who underwent neurolysis, 78.8% of patients who underwent end to end suture, 49.8% of patients who underwent nerve grafting, 62.9% of patients who underwent nerve transfer, 86.0% of patients who underwent posterior tibial tendon transfer (PTTT) and 73.9% of patients who underwent surgery with concurrent PTTT. Conclusion: Included studies were heterogenous, complicating our ability to further analyze the data. It is not possible to uniformly advocate for the best treatment option given diverse injury modalities, presentations and prognostic factors. Many studies do not report outcomes with respect to specific injury modality. Future studies should clearly report outcomes based on injury modality and surgical treatment option. This would allow for greater analysis on the most appropriate treatment option for a given mechanism of injury. Newer surgical techniques, such as addition of growth factors to nerve repairs and concurrent tendon transfer are promising and should be further explored.
Importance of Midfoot Ligaments in a Hallux Valgus Cadaveric Model
Authors: Wagner Emilio , Wagner Pablo , Pacheco Florencia , López Mario , Palma Felipe H. , Guzman- Venegas Rodrigo 
Published: January 2022

Category: Bunion Introduction/Purpose: Hallux valgus (HV) is of uncertain origin. Even though a huge amount of treatment options are available, no clear cause for this deformity exist. To be able to further understand this frequent pathology, a cadaveric model should be developed. A cadaveric model was developed trying to obtain similar deformities to the ones observed in Hallux valgus (first ray varus and pronation). The objective of this research is to recreate some characteristics of a HV deformity, through sequential ligaments sectioning. Methods: 8 fresh frozen lower leg specimens were used. Markers were attached to the medial and middle foot ray bones, including talus. A constant tibial axial load of 25 kg was used. Cyclic tibial rotation (to simulate gait phases) and 5 kg pull on the extensor and flexor hallucis tendons (EHL and FHL) were applied to the specimen. Limited and sequential medial and middle column ligamentous sectioning were performed, including the, dorsal and interosseous naviculo-cuneiform, intercuneiform, metatarso-cuneiform and intermetatarsal ligaments. After each ligament damage, bony alignment was measured including frontal (bone divergence) and axial plane (bone rotation). Results: After intercuneiform, Lisfranc and naviculo-cuneiform ligaments sectioning, a significant angular increase was found in the naviculo-cuneiform, intercuneiform and naviculo-metatarsal angles (p=0.001). Specifically, for bone rotation, the biggest change was found for the intercuneiform and naviculo-cuneiform angles. Regarding bone divergence, the biggest increase was found in the talo-metatarsal angle. No additional angular change was found after adding metatarso-cuneiform ligament damage. No change in the sagittal alignment was found. Conclusion: This model was able to recreate some parameters of the hallux valgus deformity. No flatfoot deformity was produced. Surprisingly, no significant angular change was produced after metatarso-cuneiform ligament damage. Most significant changes were found after intercuneiform and naviculocuneiform damage. Our findings suggest that midfoot instability has to be present to recreate a hallux valgus deformity.
Short Term Results of Treatment of Osteomyelitis in the Diabetic Foot with a Synthetic Bone Graft Sustitute
Authors: Waldecker Ute 
Published: January 2022

Category: Diabetes; Midfoot/Forefoot Introduction/Purpose: The aim of the study was to evaluate short term results of osteomyelits of the diabetic foot treated with cerament Methods: 16 diabetics with a mean age of 61.6 years underwent surgical therapy of infection of the foot using Cerament and a 6- week resistance-based antibiotic therapy. The surgical procedures included bony debridement, temporary vacuum therapy, arthrodesis or resection arthroplasty. Postoperative treatment included clinical investigation and MRI control of the affected foot. The foot ulcerations were classified preoperatively. Pathological assessments of osteomyelitis were made. The recurrence rates of osteomyelitis and ulcerations, the number of surgical procedures, and the complication rates were determined. Results: A foot ulcer was found preoperatively in 56.3% of the patients. 10 patients (62.5%) were diagnosed with chronic osteomyelitis, 6 with florid osteomyelitis. The number of necessary surgical procedures was 2 in 8 patients (50%), 4 in 4 patients (25%), 3 in 3 patients (18.8%) and 1 in 1 patient (6.3%). After a median followup of 8.6 months, no recurrence of osteomyelitis could be detected in 13 patients (81.3%). With regard to foot ulcerations, the ulcer healed completely in 15 patients (93.8%). One patient had ulcer recurrence. The complication rate was 18.8% (3 patients). The statistical analysis also showed that the patient's age had no significant influence on the recurrence rate of osteomyelitis and ulceration.Furthermore, there were significant differences between patients with chronic and florid osteomyelitis. Patients with chronic osteomyelitis were more likely to have osteomyelitis recurrences, while patients with a proven florid infection were more likely to have ulcer recurrences. Conclusion: The osteomyelitis treatment of the diabetic foot shows good results in terms of the recurrence rates of osteomyelitis and foot ulceration. With regard to the differentiated consideration of the results in chronic and florid osteomyelitis, additional investigations are necessary.
Anterior Ankle Skin Surface Pressures in Lower Extremity Splints: Minimizing Insult after Injury
Authors: Walton David M. , Farrar Nicholas , Shams Kameron A. , Mell Kristopher , Holmes James R. , Talusan Paul G. 
Published: January 2022

Category: Ankle; Trauma; Other Introduction/Purpose: Though ubiquitously utilized in orthopaedic trauma, lower extremity splints are not without their associated iatrogenic risk of morbidity. In fact, improper splinting not only necessitates replacement, but splint-related soft tissue complications are the second most common iatrogenic cause for referral to plastic surgery. Improper splinting techniques include inadequate molding of plaster/fiberglass splints, inadequate padding over bony prominences, excessive compressive forces from elastic bandages applied too aggressively, and/or pressure areas created by applying padding and casting material in varying joint positions. While clinicians commonly pad bony prominences to minimize skin pressure, the effect of joint position on skin pressure and, more specifically, changing joint position, is understudied. The purpose of this study is to evaluate anterior ankle skin pressure secondary to joint position change during splinting. Methods: Following ethics approval by our institutional review board, various constructs of lower extremity, short-leg splints were applied to two healthy subjects (2 limbs total in this preliminary data set) with an underlying pressure transducer (Tekscan I- Scan system (Tekscan Inc, South Boston, MA, USA) on the skin surface centered on the anterior ankle on the tibialis anterior tendon. All subjects underwent anterior ankle surface pressure assessment when padding was applied in maximum plantar flexion and neutral position for conventional short leg splints application. Percent change from initial contact pressure centered on the tibialis anterior with either Webril (Covidien/Medtronic, Dublin, Ireland), or Specialist Cotton Blend Cast Padding (BSN Medical, Charlotte, NC, USA) were calculated. Neutral position of the foot/ankle will be confirmed with goniometer. Results: There were 2 limbs total that were analyzed for the presentation of pilot data for this study. The percent change in anterior ankle contact pressure when padding was applied in maximum plantarflexion (PF) and then placed in neutral was increased at least two-fold without the addition of plaster and subsequently with the addition of plaster in lower extremity short leg splints (Figure 1). Conclusion: In this pilot data, we report significant increases in anterior ankle contact pressures when splint padding is applied in plantar-flexion and re-positioned into neutral during splint application which may precipitate iatrogenic pressure ulcers in patients sustaining foot/ankle trauma. This data, though preliminary, underscores the importance in proper splinting techniques for all clinicians that manage lower extremity trauma (eg, orthopaedic surgery, emergency medicine, urgent care, etc).
Identifying Risk Factors for Nonunion of the Modified Lapidus Procedure for the Correction of Hallux Valgus
Authors: Wang Benjamin , Manchanda Kshitij , Lalli Trapper , Liu George T. , VanPelt Michael D. , Raspovic Katherine M. , Wukich Dane K. , Johnson Matthew J. 
Published: January 2022

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: There is a paucity of literature attempting to characterize risk factors for nonunion of the modified Lapidus procedure for correction of hallux valgus. The purpose of this study was to evaluate several patient factors to determine which may contribute to increased odds of nonunion. Methods: Patients who underwent modified Lapidus procedure between 2009 to 2018 were retrospectively reviewed. Patient age, sex, body mass index (BMI), history of previous bunionectomy, history of tobacco use, fixation method, presence of diabetes mellitus (DM), and presence of hypothyroidism were recorded along with changes in radiographic parameters. A multiple logistic regression analysis was implemented to estimate the odds of nonunion. Results: Of the 222 patients who met inclusion criteria, nonunion with modified Lapidus procedure was observed in 20 patients (9.01%). Odds of nonunion with modified Lapidus procedure were greater for patients as BMI increased (OR=1.101, 95% CI: 1.029 to 1.177), tobacco users (OR=3.511, 95% CI: 1.182 to 10.425), had a change in intermetatarsal angle (IMA) (OR=1.313, 95% CI: 1.099 to 1.569), a change in Meary's angle (OR=1.133, 95% CI: 1.024 to 1.255), and a change in calcaneal pitch (OR=1.192, 95% CI: 0.997 to 1.426), but lower for patients who had a change in hallux valgus angle (OR=0.912, 95% CI: 0.846 to 0.983). Compared with the union group, patients with nonunion had lesser mean degrees correction of IMA (4.25° vs. 7.02°) and greater mean degrees correction of Meary's angle (1.62° vs. 0.46°) and calcaneal pitch (1.09° vs. 0.38°). No increased odds of nonunion were found between fixation methods. Conclusion: Predicted odds of nonunion with modified Lapidus procedure increased in patients with high BMI, smokers, and increased change in intermetatarsal angle, calcaneal pitch, and Meary's angle pre and postoperatively.
Comparison of 3D Surface Rendering CT to Plain Lateral Radiographs for Quantification and Characterisation of Posterior Malleolar Fracture Fragment Size and Morphology
Authors: Weigelt Lizzy , Mason Lyndon W. , Lambert Laura-Ann , Heyes Gavin 
Published: January 2022

Category: Ankle; Trauma Introduction/Purpose: The aim of this study was to compare the size of the posterior malleolar fracture (PMF) fragment on plain lateral radiographs compared to three-dimensional (3D) surface rendering CT imaging, and to compare both modalities in the characterisation of PMF morphology. Methods: Measurements of 180 lateral radiographs of PMF's were compared to their respective 3D surface rendering CT reconstructions, by two independent observers reviewing percentage articular involvement of the PMF fragment. Morphology of the PMF was categorised initially by the CT scan as classified by Mason and Molloy and was compared to this classification using radiographs. Results: When calculating the percentage joint surface involved by the PMF fragment, inter-observer variability was greater than 0.8 for radiographic and CT measurement. Significant differences in size of PMF on radiograph compared to CT were found for type 1 and type 2A fractures (p<0001 type 1, p=.071 type 2A). Radiographs consistently over-estimated the PMF fragment size, although in type 2B fracture patterns there was an equivalent number that were under-estimated due to the underappreciation of the posteromedial fragment. Comparison of fracture fragment morphology found that type 2A and 2B fractures (rotational Pilon's) had poor agreement between radiographs and CT (34.15%). Conclusion: This study shows that the use of a lateral radiograph in a PMF to estimate fracture size and morphology is poor. Additional CT imaging is imperative to allow for appropriate treatment planning in the management of PMF.
Identification and Fixation of Intermetatarsal Coronal Plane Instability Following Modified Lapidus Procedure
Authors: Wetzig Alex , Pechero Guillermo R. , Berken David C. , Ebaugh Pierce , McGarvey William C. 
Published: January 2022

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: There are many described techniques to approach surgical correction of bunion deformity and prevention of recurrence is still a topic of interest. Coronal plane instability evidenced by intermetarsal angle (IMA) widening with weight bearing is a cause for concern with respect to recurrence. The identification of patients who are at risk for recurrence intraoperatively is challenging and currently there are few described tests that guide physician treatment. The aim of this study was to demonstrate an intraoperative intermetarsal coronal plane 'squeeze stress test' utilized by the senior surgeon along with the clinical and radiographic outcomes of patients who underwent fixation for their identified instability following the modified Lapidus procedure for hallux valgus correction. Methods: All patients included in this study presented with clinical and radiographic documentation of hallux valgus that was treated by a first tarsometatarsal arthrodesis with additional middle column fixation following widening on intraoperative fluoroscopy 'squeeze stress test' (Figure 1) by a single senior surgeon from 2015-2020. Fixation of the middle column was achieved via endobutton (5), screw (23), or endobutton plus screw (5). Clinical descriptions were reviewed for the presence of symptomatic recurrence and for the need of revision surgery. A single observer measured the HVA and the IMA angle of the preoperative and final post-operative weight-bearing radiographs, respectively. A total of 33 patients were included with an average age of 58.5 (range, 40-80) years of age and a mean follow-up of 8.3(range, 1.5-30) months. Mean BMI was 29 (range, 19- 54). Statistical analysis of this data set utilized the chi-square test and two sample t-test. Results: Pre-operatively, the patients with identified coronal plane instability had a mean HVA and IMA of 33 (range, 16-74) and 14 (range, 7-23) degrees, respectively. At final follow-up, these patients maintained a mean HVA of 9.8 (range, 0-32) and IMA of 4.5 (range, 0-15). No patients sustained clinical recurrence. Two patients underwent elective removal of hardware. One patient sustained a deep infection that required removal of hardware and formal debridement, this subsequently resolved. Conclusion: Coronal plane instability remains one of the unsolved facets of effectively treating symptomatic hallux valgus. Vigilance is the first step in prevention of recurrence in these patients and the 'squeeze stress test' is a simple, quick option for their identification. Our case series demonstrates satisfactory outcomes in terms of clinical recurrence for these patients utilizing this new evaluation technique. We believe further investigation of the squeeze stress test as an instability identifier is warranted in all types of bunion correction procedures.
Comparison Between Mini-Invasive Distal and Proximal Chevron Osteotomies in the Correction of Hallux Valgus Deformity
Authors: Yang Ding C. 
Published: January 2022

Category: Bunion Introduction/Purpose: The potential advantages of minimal incision surgery for hallux aboducto valgus (HAV) correction are to reduce surgical exposure, diminish soft-tissue stripping, and lessen blood supply impairment. The purpose of this study was to assess the safety and efficacy of minimally invasive techniques. Currently, there are insufficient studies to recommend one minimally invasive technique over another. Methods: From 2018 to 2020, 141 cases with hallux abducto valgus were treated with minimal incision osteotomy using Kirschner wire fixation. 120 patients had distal chevron osteotomies and 21 patients had proximal first metatarsal osteotomies. The patient age range was between 29 yo and 96 yo, with 118 female and 23 male patients. 48 patients were 65 yo and over, and 93 patients were less than 65yo. The preoperative and postoperative hallux abducto valgus angles (HVA), intermetatarsal angles (IMA), American Orthopaedic Foot & Ankle Society (AOFAS) scores were measured and evaluated. Results: The average AOFAS scores improved from a preoperative median of 41.4 points to a postoperative median of 88.6 points. The mean HVA and IMA angles significantly decreased after the operation. There were no complications of nonunion or delayed union, avascular necrosis, infection, or hallux varus. The technique has been largely accepted by the patients due to the short procedure time, the reduced postoperative pain, and the fast functional recovery. For the hallux aboducto valgus deformity with HVA over 35 and IMA over 16 degrees, the procedure with proximal chevron osteotomy achieved better corrections. Conclusion: Both proximal and distal chevron osteotomy techniques showed comparable results. The distal percutaneous osteotomy was effective for the treatment of mild to moderate hallux abducto valgus deformity, and the proximal percutaneous osteotomy was effective for the treatment of severe hallux abducto valgus deformity. This study indicated that the minimal incision osteotomy was a simple and reliable technique for treating hallux abducto valgus with minimal complications. Through minimally invasive approaches, the hallux abducto valgus corrections performed in this study resulted in minimal soft tissue injury, less postoperative pain, and good cosmetic results.
Contact Pressures Change According to Displacement Shape in Isolated Medial Malleolar Fracture: Cadaver Study
Authors: Yeo Eui Dong , Lee Young Koo , Im Jungtaek 
Published: January 2022

Category: Trauma; Basic Sciences/Biologics Introduction/Purpose: Ankle fractures, representing 9% of all fractures, are among the most common types of fractures worldwide. 1 of 5 ankle fractures is an isolated medial malleolar fracture (IMMF). IMMF were treated surgically, but recently it was concluded that all IMMF(<=2mm) should be treated conservatively. The indication for surgery or conservative treatment of IMMF remains unclear. The purpose of the present study is to check the change of pressure in the ankle joint according to the shape and the displacement in the medial malleolus fractures. Methods: Twenty pairs of fresh-frozen cadaveric lower legs, disarticulated at the knee, will be used. Specimen pairs were assigned at random into 1 of 2 groups. This study measures the pressure change in the ankle joint according to Muller type C and D. The specimen was mounted in the materials testing machine with the plantar aspect of the foot in contact with the foot-plate. Load was applied with the ankle in the neutral position. Contact area and contact pressure were quantitated with low-grade pressure-sensitive film (Prescale film; Fuji Photo Film, Tokyo, Japan). The color densities were converted to measurements of pressure. After osteotomy the medial malleolus in Muller type C and D, displace each 2mm and fix it with diameter 4.0mm and length 45 mm cortical bone screws. Pressure measurement is done in the same way as above. Results: The median value and wilconxon singed rank test was used for the results. The median value of normal ankle contact area was 3.15cm2 [2.61.;3.51], the mean pressure was 2.18 Mpa(Megapascal) [2.00.;2.43], and the median value of contact area after transverse osteotomy was 2.89cm2 [2.41.;3.24], mean pressure was 2.37Mpa [2.14.;2.75], and the median value of contact area after oblique osteotomy was 2.72cm2 [2.50.;3.16], mean pressure was 2.50Mpa [2.33.;2.74]. P value of the mean area and mean pressure change after transverse and oblique was <0.05. Conclusion: At 2mm transverse and oblique displacement, ankle contact area and pressure decreased significantly.
Obesity is an Independent Risk Factor for Achilles Tendon Rupture: A Nationwide Longitudinal Cohort Study in South Korea
Authors: Yoon Yeo Kwon , Park Jae Han , Han Seung Hwan , Lee Jin Woo , Park Kwang Hwan 
Published: January 2022

Category: Hindfoot; Sports Introduction/Purpose: Obesity is an increasing comorbidity that can negatively affect the clinical outcomes of various disease in orthopaedics. However, there was no study to evaluate an association between Achilles tendon rupture and obesity in a nationwide study. We aimed to investigate the incidence of Achilles tendon rupture through a nationwide longitudinal cohort in Korea and evaluate the influences of demographic data including body mass index (BMI). Methods: Between 2002 and 2015, sociodemographic factors including gender, age, BMI, income, comorbidities, and sport activity level were retrieved from National Health Insurance Service-National Sample Cohort (NHIS-NSC). NHIS-NSC database was searched for individuals treated with ATR. We excluded individuals who were less than 20 years-old. Results: 736 (0.116%) of total 636,921 individuals in NHIS-NSC database underwent Achilles tendon repair (ATR). Multivariable logistic regression analysis revealed that obesity (BMI>= 25kg/m2) was significantly associated with ATR (odds ratio, 1.99; 95% confidence interval, 1.68 to 2.36). Other significant factors were age, male, total cholesterol, moderate sport activity, and income. After propensity score matching of all factors, obesity was significantly associated with ATR with odds ratio 1.95 (95% confidence interval, 1.60 to 2.39). Conclusion: Obesity is an independent predictive factor for the occurrence of Achilles tendon rupture followed by ATR.