bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiographic Characterization of Midfoot and Transverse Tarsal Joint Osteoarthritis
Authors: Hoch Caroline P. , Caughman Alexander , Baxley David E. , McGurk Katherine M. , Scott Daniel J. , Gross Christopher E. 
Published: January 2022

Category: Ankle Arthritis; Midfoot/Forefoot Introduction/Purpose: Midfoot osteoarthritis affects over 16% of adults over the age of 50, interfering with activities of daily living and leisure. Non-operative management includes anti-inflammatory, carbon fiber shank/custom orthotics, and cortico-steroid injections. To improve accuracy, these injections are often done under fluoroscopic guidance. Operative intervention with midfoot fusions is sometimes performed, though non-union rates and continued pain after surgery can be challenging. Sometimes, there can be difficulty in determining exactly which midfoot joints are most arthritic/symptomatic based on radiographs. This study aims to quantify how well surgeons are able to diagnose midfoot and transverse tarsal joint arthritis on standing radiographs versus advanced imaging. Methods: We reviewed the records of 113 patients (144 feet) with midfoot arthritis, who were treated from 2015 to 2019 at an academic medical center by a single fellowship trained foot and ankle surgeon. The mean age was 63.0 years, the average BMI was 31.5, and 7 patients eventually underwent surgery. Each patient underwent both plain radiographs, according to a standardized protocol, and either a CT or MRI scan. Radiographs and advanced images were graded separately for the presence of joint space narrowing, subchondral cysts, and other signs of arthritis in the following joints: 1st tarsometatarsal (TMT), 2nd TMT, 3rd TMT, 4th TMT, 5th TMT, naviculocuneiforms (NC), talonavicular (TN), calcaneocuboid (CC), subtalar (ST), and 1st metatarsophalangeal (MTP). The sensitivity, specificity, precision, negative predictive value, and overall accuracy of radiographs compared to CT scans was calculated for each joint. Statistical significance was assessed using a paired t-test. Results: The most common joints affected by arthritis were the 2nd TMT (radiograph=75.7%, CT=79.9%) and 3rd TMT (radiograph=65.5%, CT=70.4%). Advanced imaging showed a significantly higher rate of arthritis in the 1st TMT (P<0.01), 4th TMT (P<0.01), and 5th TMT (P<0.01), as compared to radiograph. Only 16.9% of patients' radiographs had a direct correlation with the results of their CT scan. A CT scan showed one or two additional affected joints by 19.7% and 13.0 %, respectively; and rarely showed one or two less joints affected by arthritis (8.1% and 3.2%, respectively). We found radiographic sensitivity and specificity to be highly variable (1st TMT=61.3% & 92.3%, 3rd TMT=79.5% & 69.3%). Conclusion: Radiographs vary drastically in their sensitivities and specificities in diagnosing arthritic joints in the midfoot and transverse tarsal joints. When treating midfoot osteoarthritis surgically, we recommend obtaining advanced imaging preoperatively, rather than relying on plain radiographs alone to determine which joints may need to be managed surgically.
Coronal Plane Deformity and Total Ankle Replacement: When to Stage with Cement Spacer Ankle Arthroplasty for Deformity Correction
Authors: Hyer Christopher F. , Malloy McCoy Antonio M. , Thompson John M. , Thompson Mitchell , Consul Devon 
Published: January 2022

Category: Ankle Arthritis Introduction/Purpose: Degenerative ankle joint disease is a debilitating condition that causes significant pain, adversely affects function and quality of life. Though primary arthritis of the ankle can occur without deformity, frequently soft tissue imbalances or joint deformities complicate the clinical picture. Often, additional procedures are required to balance the foot and ankle during the index total ankle replacement procedure. When large deformities exist a staged approach to first, align the ankle joint to neutral as stage one and then implantation of the TAR as stage two can be deployed. This paper will further popularize the cement spacer staged TAR technique in correction of coronal deformities, share a clinical algorithm on approach, and depict a case series demonstrating its application. Methods: A case series was performed of 7 patients and 8 ankles, who underwent staged primary TAR utilizing a cement spacer to assist with deformity correction, between the years 2016-2019. Results: Patients' mean age 58.5 yrs., preoperative varus coronal plane deformity mean 19.1 degrees, preoperative valgus coronal plane mean 10.25 degrees. Mean time from stage 1 till 2 was 163.5, +-140.2 days. Stage 1 soft tissue procedures: Chrisman-Snook procedure with synthetic ligament graft, Brostrum-Gould with synthetic graft, Brostrum-Gould without graft, FDL transfer, and isolated medial release/peel. Osteotomies performed during stage one: Dwyer, MDCO, Cotton, and MDCO with medial malleolus osteotomy. Fusions performed during stage one consisted: Subtalar joint, talonavicular joint (TNJ), and STJ with 1st Metatarsophalangeal joint (MTPJ). Seven ankles were replaced with Cadence Total Ankle System (Integra), and one with INBONE II (Wright Medical Technology). Average follow-up time for included patients was 290.75 days (9.7 months). One revision was performed following index TAR procedure. Conclusion: This paper describes a cement wedge spacer staged total ankle arthroplasty technique for correction and stabilization of deforming forces at the ankle joint. While not all ankle deformities necessitate a staged approach, the complexity of the malalignment and the extent of tissue disruption needed to achieve a neutral ankle should be considered when correcting a given deformity with a staged or non-staged approach.
Scope Assisted Ankle Arthrodesis in a Young Male with Hemophilic Arthritis: A Case Study
Authors: Hyer Christopher F. , Malloy McCoy Antonio M. , Nguyen Kevin N. , Consul Devon 
Published: January 2022

Category: Ankle Arthritis; Arthroscopy Introduction/Purpose: Arthritis is a debilitating condition that negatively affects an individual's ability to carry out activities of daily living. While osteoarthritis is a term many have become familiar with, as it is the most common form of arthritis encountered, hemophilic arthritis is a condition not frequently seen or discussed. Hemophilia is a congenital bleeding disorder caused by the absence or decrease of clotting factor VIII (Hemophilia A) or XI (Hemophilia B). When severe, this X-linked disease commonly results in intra-articular bleeding which, can progress to joint destruction1-4. This subsequently leads to the progressive destruction of articular cartilage and bone6-7. Methods: Arthroscopic assisted ankle arthrodesis with calcaneal autograft was performed. Calcaneal autograft was acquired through a small linear incision along the lateral wall of the calcaneus, a power graft harvester was introduced into the medullary bone to procure the graft. The left lower extremity was then placed into a non-invasive Gould Ankle distraction system and the standard anteromedial and anterolateral ankle scope portals were established. A scope and shaver were utilized to extensively debride all visualized hemorrhagic synovium. The shaver was then exchanged for a burr following debridement to remove the articular cartilage to both the talus and tibia. Following adequate preparation of the joint margins for fusion, the ankle joint was filled with the calcaneal autograft and rhPDGF-BB. Results: Various treatments have been described for patients suffering from hemophilic arthritis. While the use of clotting factor concentrations (CFCs) may reduce the risk of hemarthrosis, the risk of bleeding cannot be completely avoided2. Arthroscopic or open synovectomies has been described to remove the pathogenic synovium. Chemical or radioisotopic synoviorthesis is an option for less severe cases, but the treatment of choice is joint fusion or arthrodesis for advanced stages of arthropathy3. Conclusion: In patients with hemophilia, regular replacement therapy with clotting factor concentrates (prophylaxis) is effective in preventing recurrent bleeding episodes into joints and muscles. However, despite this success, intra-articular and intramuscular bleeding is still a major clinical manifestation of the disease. The pathogenesis of hemophilic arthropathy is multifactorial, with changes occurring in the synovium, bone, cartilage, and blood vessels. Our case report presents a unique pathology and the successful outcome that can be accomplished through surgical intervention and a multidisciplinary treatment approach.
Opioid Usage after Hallux Valgus Correction Surgery
Authors: Jackson J.B. , Thier Zachary T. , Barfield Matthew E. , Altobello Kenna C. , Gonzalez Tyler A. 
Published: January 2022

Category: Bunion; Other Introduction/Purpose: More than 200,000 surgeries for hallux valgus correction occur annually in the United States. Due to the post-operative pain associated with the procedure, opioids are often prescribed to help manage pain. Given the lack of objective data on opioid use and the difficulty of addressing a patient's post-operative pain, we sought to quantify, through a prospective analysis, patient's narcotic use after hallux valgus surgery. The purpose of our study was to determine the average quantity and type of post-operative opioids consumed after hallux valgus surgery and to assess potential predictive factors for increased opioid consumption. Methods: Adult patients undergoing primary hallux valgus surgery were recruited from two foot and ankle fellowship trained orthopedic surgeons at a single institution. At the pre-operative visit, patients were consented and completed a demographical questionnaire. Data was collected from the operative and PACU record, as well as the 2, 6, and 12-week post-operative visits. A statistical analysis was performed to determine the average quantity of opioid and non-opioid pain medication consumed post- operatively, as well as any statistically significant correlations. Results: For the 58 subjects who completed treatment and data collection in the PACU, 53 consumed opioids. Initial prescriptions for these patients included Hydrocodone, 39 (73.58%) Oxycodone, 13 (24.52%) and Meperidine, 1 (1.89%). The average number of opioid pills collectively consumed at the two-week and 12-week post-operative visit was 19.99 and 22.52, respectively. At the two-week postoperative visit, only patient BMI showed a statistically significant association with increased opioid use. Conclusion: On average, patients consumed 22-24 narcotic pain pills after hallux valgus reconstruction surgery. If a physician prescribed 24 narcotics pills after surgery to patients that are not currently utilizing narcotic pain medication, there is a 95% chance they will not need additional pain medication during the two-week postoperative period.
Diagnostic Accuracy of MRI in Diagnosing Plantar Plate Tear About Metatarsalgia: Incidental Finding of A Tear on Routine Magnetic Resonance Imaging
Authors: Kachooei Amir R. , Shakked Rachel J. , Roedl Johannes B. , Pedowitz David I. 
Published: January 2022

Category: Lesser Toes; Midfoot/Forefoot Introduction/Purpose: This study aimed to assess the rate of plantar plate tear finding on MRI study of symptomatic versus asymptomatic patients. We secondarily aimed to determine the correlation between PP tear grading and symptoms and to assess the diagnostic accuracy of MRI. Methods: Based on the physical examination report, patients were divided into Symptomatic and Asymptomatic groups. Data from the MRI reports were extracted for the second to fifth plantar plates. All MRIs were studied again by a musculoskeletal radiologist to measure the inter-rater agreement and MRI reports' reliability. MRI finding of the plantar plates was categorized as torn vs. intact. We used the anatomical grading system (AGS) to assess the plantar plate tear grading correlation with symptoms Results: There was an excellent inter-rater agreement (Kappa=0.92). Calculating the odds ratio reveals that the odds of finding intact PP in a symptomatic patient is 16 times more than finding a tear in the same patient. Diagnostic accuracy of MRI shows that PP tear finding on MRI is highly specific and has a low sensitivity meaning that the chance of incidental finding of a PP tear is extremely low. Conclusion: MRI is specific for diagnosing plantar plate tear and is suggested to confirm the diagnosis and plan for the surgery when the diagnosis is highly probable concerning the clinical examination.
First Metatarsophalangeal Joint Fusion with Orthogonal Memory Staple Fixation
Authors: Kasture Sarang P. , Walsh Anna S. , Sugathan Hari , Dalal Rakesh 
Published: January 2022

Category: Midfoot/Forefoot Introduction/Purpose: First metatarsophalangeal joint (MTPJ) fusion is one of the most commonly performed procedure for painful symptomatic arthritis. The implants used for osteosynthesis are variable and depend on surgeon preference. The aim of this paper was to study the outcome of first MTPJ fusion surgery using fixation with orthogonal shape memory alloy (Nitinol) staples. Methods: 75 consecutive patients who underwent first MTPJ fusion with orthogonal memory staples were included in the study. All patients underwent surgery using standard surgical technique with fixation of the arthrodesis with two 20 mm shape memory alloy (Nitinol) staples (Memo staples, Ortho Solutions Inc). The first staple placed medially and the second staple placed dorsally in orthogonal plane. The arthrodesis surfaces were prepared and temporarily fixed with K wire. Once the position and bone approximation was confirmed satisfactory under image intensifier guidance, a flat staple bed was prepared with saw blade to make sure the staples are not proud after fixation. All patients also received standard postoperative care with heel weight bearing shoe for six weeks and follow-up at 3,6 and 12 weeks as standard regimen. Patient demography, time to clinical and radiological union, early/late complications, rate of non-union, revision surgery and implant removal were noted. Results: Average age was 64.6 years. 42 patients had severe radiologic arthritic changes while 27 patients had associated moderate to severe hallux valgus deformity. Five patients were known to have inflammatory arthritis. The average follow-up was 18.3 weeks. There were two early complication of superficial infection treated successfully with oral antibiotics. Average clinical union was 7.2 weeks and radiological union at 12 weeks. Five patients (6.6%) had radiological non-union of which four underwent revision surgery with plate fixation. One patient had delayed union while one had dorsal staple back-out but did not warrant removal. None required staple removal from hardware prominence. There was no significant difference in union or complication rates with regards to gender or presence inflammatory arthritis. Conclusion: This study demonstrates that the outcome of 1st MTPJ fusion with two memory staples in orthogonal position is comparable with other modalities of fixation in terms of rate of union and resurgery. It is safe, simple and easily reproducible technique. Besides, none of the patients in this series required implant removal for hardware related complications. This could be advantageous compared to fewer other modalities like plate fixation, though larger studies are needed to confirm it.
Analyzing Risk Factors for Sequential Above Knee Amputation after Below Knee Amputation in Surgical Treatment of Ischemic and/or Infectious Foot Disease
Authors: Kim Ki Chun , Kim Sung-Jae , Sung Il-Hoon , Young Kiwon , Lee Kyung-tai , Lee Hong S. 
Published: January 2022

Category: Diabetes Introduction/Purpose: Some patients with below knee (BK) amputation for treatment of ischemic and/or infectious foot disease eventually further progress to above knee (AK) amputation. We aimed to analyze predictors for sequential AK amputation after BK amputation. Methods: We retrospectively reviewed medical records and find 55 patients with BK amputation for surgical treatment of ischemic and/or infectious foot from 2013 to 2018. Twelve patients with sequential AK amputation after BK amputation were designated as group I, and 43 patients successfully treated with BK amputation only were designated as group II. Two groups were compared for various demographic, laboratory and physical state. Then, multivariate logistic regression analysis was done to find predictors for sequential AK amputation after BK amputation. Results: In univariate analysis between two groups, only 'knee contracture' showed significant difference between two groups (p= 0.003). In multivariate logistic regression analysis performed with variables showing p <0.1 during univariate comparison, knee contracture was found to be predictor for sequential AK amputation after BK amputation (odds ratio= 34.740, p= 0.041). Conclusion: Patients with intractable ischemic and/or infectious foot disease with knee contracture, optimal level of amputation may be above knee level. Careful decision on amputation level can reduce surgical burden for intractable ischemic and/or infectious foot patients.
Percutaneous Tarsometatarsal Arthrodesis of the Lesser Ray with Autograft using a Cannulated Screw
Authors: Kurashige Toshinori 
Published: January 2022

Category: Midfoot/Forefoot Introduction/Purpose: Tarsometatarsal (Lisfranc) joint arthritis can be a painful condition caused by primary osteoarthritis, inflammatory, and posttrauma. When conservative treatment failed, tarsometatarsal arthrodesis is indicated. There has been no study on percutaneous tarsometatarsal arthrodesis previously. The purpose of this study is to report our percutaneous tarsometatarsal arthrodesis technique and the results of case series. Methods: We report 11 joints from 6 feet with painful tarsometatarsal arthritis of lesser ray treated using percutaneous procedure using a wedge burr. The mean age at surgery was 67 years. The mean follow-up period was 12 months. Five feet of 4 patients had TMTj degeneration with hallux valgus. Another patient suffered from painful posttraumatic degenerative arthritis. Through 5-10 mm incision, a 2.9 mm-diameter wedge burr was introduced into the joint. Resection of subchondral bones was performed with the medial, lateral and plantar cortices preserved. The dorsal cortex except the burr insertion point was also remained. The iliac-crest bone grafts were taken using a 6-mm diameter trephine. Preoperatively and at the most recent follow-up visit, we applied the midfoot scale proposed by Japanese Society for Surgery of the Foot (JSSF). The validity and reliability of the JSSF scale has been confirmed in previous studies. Results: Though there was one nonunion with screw breakage, we achieved successful results with no need of revision surgery during mean one year follow-up period. Bone unions were achieved in 10 of 11 joints (91%) at the most recent follow-up. JSSF midfoot scale significantly improved from 62 points preoperatively to 89.6 points at the most recent follow-up (p= 0.04). Conclusion: Our percutaneous TMTj arthrodesis was achieved a union rate and clinical results comparable to other surgical technique. This procedure was an effective method for treatment of TMTj arthritis.
The Metatarsal Cortical Index as an Indicator of Insufficiency Fracture of the Foot
Authors: Lenz Christopher G. , Raith Constance , Urbanschitz Lukas , Tondelli Timo O. , Eid Karim , Niehaus Richard , Hodel Sandro 
Published: January 2022

Category: Basic Sciences/Biologics; Midfoot/Forefoot Introduction/Purpose: The diagnosis of metatarsal stress fractures is challenging. Standard imaging often shows false negative results. The aim of this study was to create reliable radiologic outcome parameters to predict insufficiency fractures of the metatarsals Methods: We performed an age- and sex-matched case-control study of patients with (n = 18) and without insufficiency fracture (n = 18) of the foot. To measure the ratio between the outer cortical border and the endosteal diameter, the MCI was developed as a novel radiographic measurement on dorsoplantar images. The MT was divided into thirds, and the width from the outer cortical border to the endosteal diameter was measured at the junction of the proximal to the middle third (proximal), at the midshaft (middle), and at the junction of the middle to the distal third (distal). The metatarsal cortical index (MCI) for each metatarsal was developed to predict an insufficiency fracture. The MTs were sequentially numbered as MT I-V. To correct for potential bias due to MT length, the Coughlin index and Maestro method were used in all patients. Results: The MCI of each metatarsal was significantly decreased in the insufficiency fracture group compared with the control group (p <.01). The MCI of the fourth ray yielded the highest area under the curve among the analyzed MCI values (area under the curve, 0.79; 95% confidence interval, 0.61-0.90). A cut-off value of 1.62 for the MCI of the fourth ray yielded a sensitivity of 78% and a specificity of 78% to predict insufficiency fracture of the foot (odds ratio, 12.25; 95% confidence interval, 2.54-58.97), and enabled accurate allocation to the insufficiency fracture group versus the control group in 74% of cases. Conclusion: A decreased MCI is associated with metatarsal insufficiency fractures and enables an accurate diagnosis in three out of four cases. Despite the highly variable anatomy and morphology of the MTs, we were able to show that the MCI is a reliable tool to determine insufficiency fracture of the MT on plain radiography. The MCI might aid clinicians in identifying insufficiency fracture, and raise the suspicion of the diagnosis without additional imaging studies.
Does Sagittal Tibiotalar Alignment of TAR Predict Failure?
Authors: Leucht Anna-Kathrin , Salat Peter , Phisitkul Phinit , Amendola Annunziato , Femino John E. , Veljkovic Andrea N. 
Published: January 2022

Category: Ankle Arthritis Introduction/Purpose: The long term outcome of total ankle replacement is contingent on restoring the anatomic tibiotalar alignment of the ankle joint. Prior studies have mainly looked at the effect of coronal and hindfoot alignment of TAR on outcome and failure with few studies focusing on the effect of sagittal tibiotalar alignment. From these, we know that sagittal alignment has a greater impact on joint mechanics and that proper positioning of the talar component in the sagittal plane results in greater postoperative pain relief and better functional outcome, especially ankle range of motion. The goal of this study was to define a sagittal radiographic value that predicts failure in TAR. Methods: We analyzed the data of a retrospective patient cohort of consecutive TAR patients, which were treated from 2004 and 2011. Patients with two types of prosthesis were included, Salto Talaris (fixed bearing) and STAR (mobile bearing). All measurements were completed by two blinded observers, including the sagittal distal tibial articular angle (sDTAA), the lateral talar station (LTS) and the talar component inclination angle (γ angle). A total of 90 patients were included, 51 were male and 39 female patients. Seventy-seven patients received a Salto and 13 patients a STAR prosthesis. The average age was 63.7 years. Results: The mean sDTAA was 83.9 degrees and the mean γ angle was 21 degrees, both without significant difference in the two different prosthesis designs. A significant association (p=0.03) between post-op LTS as a continuous variable per unit increase and clinical failure was demonstrated, which included all the revision cases, with an odds ratio of 1.25. In addition a significant association (p=0.03) between increased LTS and sDTAA change of >5°, which is indicative of anterior subsidence, was shown. This was associated with an odds ratio of clinical TAR failure of 1.27. Conclusion: The abnormal radiographic post-op lateral talar station appears to predict clinical TAR failure and correlates with the abnormal sDTAA; the anterior translated talus loads the anterior tibia leading to anterior subsidence of the prosthesis. Limitation of this study is the inclusion of two different types of prosthesis designs.