bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparing the Anatomical Landmarks Versus the Coracoid-Based Landmarks Techniques for Coracoclavicular Stabilization After High-Grade Acromioclavicular Injury: A Biomechanical Study
Authors: Klabklay Prapakorn , Kwanyuang Atichart , Tangjatsakow Preyanun , Kala Sataporn , Suklim Phachara , Naknual Nutnicha , Chuaychoosakoon Chaiwat 
Published: November 2022

Background: In acute high-grade acromioclavicular (AC) joint injuries, the aim of treatment is robust reduction and stabilization of the joint. The anatomical landmarks method is most commonly used for stabilization, but loss of reduction often occurs because of the suture tunnels. Purpose/Hypothesis: The purpose was to evaluate and compare the stability of coracoclavicular (CC) stabilization using the anatomical landmarks and coracoid-based landmarks techniques in treating a high-grade AC joint injury. It was hypothesized that stabilization using coracoid-based landmarks would provide better stability. Study Design: Controlled laboratory study. Methods: Twenty fresh-frozen cadaveric shoulders (8 male and 2 female pairs) were randomized into 2 operative technique groups: 10 shoulders in the anatomical landmarks group and 10 shoulders in the coracoid-based landmarks group. The CC ligaments and AC capsule were cut at the midlevel, and CC stabilization and AC capsule repair were performed. For the anatomical landmarks technique, two 2.5-mm clavicular tunnels were created at 25 and 45 mm from the AC joint, while for the coracoid-based landmarks technique, two 2.5-mm clavicular tunnels were drilled using the medial and lateral borders of the coracoid base to choose the tunnel sites. Before injury creation and after stabilization, each shoulder underwent a loading force of 70 N in the superior and anteroposterior directions, and the displacement distance and stiffness were compared between the 2 techniques using the paired t test. Results: The mean difference in displacement before and after stabilization was higher in the anatomical landmarks technique than the coracoid-based landmarks technique (1.82 ± 3.52 vs –0.18 ± 4.78 mm in the superior direction and 7.47 ± 9.35 vs 1.76 ± 3.91 mm in the anteroposterior direction), but none of the differences in displacement or stiffness were statistically significant between the groups. Conclusion: No significant biomechanical differences in displacement or stiffness were seen between the anatomical landmarks technique and the coracoid-based landmarks technique. Clinical Relevance: Either stabilization technique can be utilized for repair of the CC ligaments in an acute AC injury setting.
Patients’ Preferences for Androgen Deprivation Therapy in the Treatment of Intermediate-Risk Prostate Cancer
Authors: De Brian , Lowenstein Lisa M. , Corrigan Kelsey L. , Andring Lauren M. , Kuban Deborah A. , Cantor Scott B. , Volk Robert J. , Hoffman Karen E. 
Published: November 2022

Background. For men with intermediate-risk prostate cancer (IRPC), adding short-term androgen deprivation therapy (ADT) to external beam radiation therapy (EBRT) has shown efficacy, but men are often reluctant to accept it because of its impact on quality of life. Methods. We conducted time tradeoffs (score of 1 = perfect health and 0 = death) and probability tradeoffs with patients aged 51 to 78 y who had received EBRT for IRPC within the past 2 y. Of 40 patients, 20 had received 6 mo of ADT and 20 had declined. Utility assessments explored 4 ADT-related side effects: hot flashes, fatigue, loss of libido/erectile dysfunction, and weight gain. Results. The most commonly reported “worst” treatment-related complication of ADT was fatigue (50% in both cohorts) followed by reduced libido/erectile dysfunction (40% in both cohorts). The utilities for fatigue were mean = 0.71 and median = 0.92 and for reduced libido/erectile dysfunction were mean = 0.81 and median = 0.92. Utilities did not differ significantly between cohorts. Assuming a 6-mo course of ADT, men reported being willing to trade 3 mo of life expectancy to avoid fatigue due to ADT and 1.8 mo to avoid sexual side effects. Patients in the ADT cohort were willing to accept the side effects of ADT in exchange for a mean 8% absolute increase in survival, whereas patients in the no ADT cohort required a 16% increase ( P < 0.001). Conclusions. When considering treatment with ADT, men with IRPC identified fatigue and sexual dysfunction as the most bothersome side effects. Patients who declined ADT expected a larger survival benefit than those who opted for treatment. Both groups expected a survival benefit exceeding that shown by recent trials, suggesting some men may be selecting treatments inconsistent with their preferences. Highlights This study demonstrates that prostate cancer patients receiving radiation therapy are reluctant to receive androgen deprivation therapy (ADT) most commonly due to anticipated fatigue and loss of libido/erectile dysfunction. Men who had received ADT reported they would require an average 8% absolute increase in survival to tolerate its side effects, whereas those who declined ADT would require an average 16% increase. Required thresholds are well above the estimated absolute survival benefit for ADT demonstrated in recent clinical trials, suggesting an unmet need for improved patient education regarding the risks and benefits of ADT.
Synovial Inflammation in Patients with Hallux Valgus is Similar to Changes Seen in Those with Hallux Rigidus
Authors: Karzon Anthony L. , Kadakia Rishin J. , Coleman Michelle M. , Labib Sameh (Sam) A. , Jacobson Joseph E. , Bariteau Jason T. 
Published: November 2022

Category: Basic Sciences/Biologics; Bunion Introduction/Purpose: Hallux valgus and hallux rigidus are common disorders that can have functional limitations for patients. Although both involve pathology centered around the first metatarsophalangeal joint (MTPJ), the surgical management for both greatly varies. Inflammatory changes in a joint play a critical role in the development of pain and dysfunction. It has been postulated previously that patients with bunion deformity can develop arthritic changes in the long-term. The purpose of this work is to study and compare the synovial tissue inflammation in patients with hallux valgus and hallux rigidus. Methods: A prospective study of patients aged 25 to 75 years undergoing either surgical management of hallux valgus or hallux rigidus between January 2021 and December 2021 was conducted following IRB approval. Tissue samples from the synovium were collected at the time of procedure and sent for processing and histology. The samples were graded in a blinded fashion based on the degree of inflammation. Morphological features of the synovectomy specimens undergoing histopathologic analysis were scored by synovial lining cell layer hyperplasia, the extent of inflammatory synovium infiltration, as well as pannus formation via activation of synovial stroma and resident cells. All parameters were graded from 0 (absent), 1 (slight), 2 (moderate), to 3 (strong). Statistical analysis was conducted to compare the level of inflammation between patients who had hallux valgus and those that had hallux rigidus. Results: A total of twenty-one samples were collected. One sample was excluded as there was inadequate tissue for analysis. There were eight patients with hallux rigidus and twelve patients with hallux valgus. Mean age at the time of sample collection was 59.3 years (SD=11.9). There was no significant difference in the synovium inflammatory scores (M=5.0, SD=2.25) between the two groups, t(18)= 1.704, p=.106, ([CI .95]: -0.388, 3.722). Moreover, Cohen's effect size value (d=0.78) suggests medium to high practical significance. Conclusion: Understanding the intra-articular impact of hallux valgus is important when considering treatment options. The amount of inflammation in the synovial tissue of hallux valgus patients in this study was similar to that of patients with hallux rigidus suggesting that there is intra-articular inflammation in patients with hallux valgus. Further work will need to be performed to determine if this increased inflammation influences outcomes or has an effect on treatment.
Analyzing Risk Factor for Wound Healing after Delayed Primary Closure of Diabetic Foot
Authors: Kim Ki Chun , Kim Sung-Jae , Lee Hong Seop , Song Se Yong , Young Kiwon , Lee Kyung-tai , Sung Il-Hoon 
Published: November 2022

Category: Diabetes; Other Introduction/Purpose: Part of hospitalized diabetic foot disease patients with infectious necrosis develop wound dehiscence after delayed primary closure for improved wound status without erythema and induration following appropriate wound management, amputation, and vascular intervention. Dehisced wound could be the source of reinfection, further admission, financial burden. We aimed to analyze predictors for failure of wound management. Methods: We retrospectively reviewed medical records and find 105 patients with delayed primary closure among 403 ischemic and/or infectious diabetic foot admitted cases from 2013 to 2021. Vascular intervention was performed for patient with ankle brachial index (ABI) less than 0.8. Total stitches were removed two to three weeks after delayed primary closure. Wound dehiscence was decided when it was developed within two weeks. Eighty-two cases (78.1%) with wound healing were designated as group I, and twenty-three cases (21.9%) with dehiscence 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 failure of wound management. Results: In univariate analysis between two groups, smoking, wound site, initial C-reactive protein (CRP), White blood cell count (WBC), albumin (initial and adjacent to closure) and sequential negative culture result between two groups among 22 potential risk factors. In multivariate logistic regression analysis performed with variables showing p <0.05 during univariate comparison, there was no significant predictor. Conclusion: The wound healing ratio for delayed primary closure reached to 78.1% in patients with improved wound status and ABI more than 0.8 in ischemic and/or infectious diabetic foot disease irrelevant to specific factors.
Comparison of Diagnostic Accuracy of Virtual Assessments vs In-Clinic Assessment in the Foot & Ankle Clinic
Authors: Lau Johnny T. , Gotal Tamara 
Published: November 2022

Category: Basic Sciences/Biologics; Other Introduction/Purpose: Remote video consultations between clinicians and patients have been increasing in popularity3, and while there is a universal consensus that virtual assessments play an integral role in delivering health care to remote locations there has not been any longitudinal investigations into the diagnostic accuracy between virtual consultations and that of in-clinic assessments. Accordingly, our study aims to validate the diagnostic acuity of virtual consultation of patients in comparison to in- clinic assessments along with assessing the satisfaction that patients have experienced with their virtual assessments. Methods: The Foot & Ankle clinic at Toronto Western Hospital prospectively collected data via virtual video assessment of patients from March 2020 till April 2021. We retrospectively analyzed the diagnoses of virtual assessments vs. in-clinic assessments and whether there was a change in diagnosis from these visits. 582 patients were assessed via virtual video consultations of which we used the University Health Network Electronic Patient Records to compare the diagnoses documented in the consultation notes done virtually & the in-clinic notes. Along with this the satisfaction scores were populated for the 192 patients who answered the questionnaire. Satisfaction scores were weighted 0-5, of which 0 represented 'Not At All' and 5 represented 'Definitely'. Results: Analysis of the 582 virtual video consults resulted in 30% of those patients who required in-clinic examination. Assessing these patients, we found a diagnostic accuracy of 95%, with most of the virtual assessments having an appropriate diagnosis. We did nonetheless find that 10% of patients assessed in-clinic demonstrated additional pathology in conjunction with the pathology diagnosed virtually. Assessment of the satisfaction scores demonstrated that 78.6% of patients were satisfied (4/5 & 5/5) with the virtual assessment and 8.34% were not satisfied (1/5 & 0/5). Conclusion: Our study demonstrates that high diagnostic accuracy is attainable through virtual video assessments, thus making it an integral tool for delivery of health care to patients at a time when the COVID-19 pandemic has created significant barriers. Given the constraints placed on our health care systems, this study also demonstrates that patients are satisfied with the virtual assessments conducted through the OTN system. [GT1] Additionally, the implications of such a tool provides benefits to reducing costs to health care systems and to patients who live in remote locations.
Non-Anatomic All-Inside Arthroscopic Anterior Talofibular Ligament Repair with a High Position Anchor Shows Inferior Clinical Outcomes: A 3D-CT Based Analysis in Chronic Ankle Instability Patients
Authors: Lee Sung Hyun 
Published: November 2022

Category: Arthroscopy; Sports Introduction/Purpose: In chronic ankle instability (CAI), it is important to repair the anterior talofibular ligament (ATFL) at the anatomic origin site. However, there are limited reports on the clinical outcomes according to anatomical ATFL repair. The purpose of this study is to compare the clinical outcomes after arthroscopic ATFL repair, according to whether the anchor is fixed at an anatomic position. Methods: We performed a retrospective review of consecutive patients who underwent arthroscopic ATFL repair for CAI and were available for a minimum of 2 years follow-up. The patients were divided into three groups according to the anchor position at the distal fibula on 3-dimensional computer tomography: group A, anatomical arthroscopic ATFL repair; group S, sub- anatomical arthroscopic ATFL repair; and group N, non-anatomical arthroscopic ATFL repair. The pain (visual analogue scale [VAS]) score, foot and ankle outcome score (FAOS), and the Karlsson ankle functional score were measured as subjective outcomes. Posturographic analysis and radiologic evaluation using stress radiographs and axial view magnetic resonance imaging were performed as objective outcomes. Results: Of 96 patients, 16 were excluded based on the exclusion criteria, and 80 were evaluated (group A, n = 24; group S, n = 42; and group N, n = 14). The mean age of the patients was 34.5 years, and the mean follow-up period was 27.4 months. A between-group comparison revealed significant differences in the FAOS, Karlsson score, and fall risk evaluated by posturography at the final follow-up. Post hoc analysis revealed that group A patients showed better clinical scores in the FAOS than group N patients in all five domains (all p < 0.017). Patients in groups A and S showed better Karlsson score and fall risk than those in group N (p = 0.004 and 0.013, respectively). In terms of objective outcomes, patients in groups A and S showed better outcomes in fall risk than those in group N (both p = 0.001). Conclusion: Non-anatomic ATFL repair showed inferior outcomes compared to anatomic ATFL repair. When performing arthroscopic ATFL repair, the anchor should be fixed in the anatomical position to improve prognosis.
Predisposing Factors for Posttraumatic Osteoarthritis after Operation for Malleolus Fracture in Patients Aged 50 Years Or Less with a Minimum Follow-Up of 5 Years
Authors: Lee Sung Hyun , Yoo Byung min , Youngchae Choi , Sung-ju Kang 
Published: November 2022

Category: Trauma; Ankle Arthritis Introduction/Purpose: The purpose of this study was to identify the risk factors for posttraumatic osteoarthritis (OA) after surgery for ankle fractures in patients aged 50 years or less. Methods: We performed a retrospective review of consecutive patients who underwent surgery for ankle fractures and were followed up for a minimum period of 5 years. The patients were assigned to 2 group according to the presence of advanced OA at the last follow-up. Binary logistic regression was used to model the correlation between various risk factors and OA. Functional outcomes were assessed using the Foot and Ankle Outcome Score. Results: The data of 332 patients who met the study inclusion criteria were included in the analysis. The overall rate of posttraumatic arthritic change was 27.7% (non-arthritis group: 240 patients, arthritis group: 92 patients). The arthritic change was significantly affected by BMI (p = 0.011; adjusted odds ratio [OR] >= 30, 6.56), fracture-dislocation injury (p = 0.025; adjusted OR, 4.06), posterior malleolus (PM) fracture (p = 0.031, adjusted OR > 25% of the articular surface, 5.72), and postoperative articular incongruence (p = 0.034; adjusted OR, 7.21). The mean scores of the arthritis group were lower than those in the non-arthritis group (p <0.05). Conclusion: Obesity, fracture-dislocation injury, concomitant large PM fracture, and articular incongruence were significant risk factors of posttraumatic OA after surgery for ankle fractures. Surgeons should be aware that accurate reduction is critical in patients with ankle fractures with associated large PM fractures, especially those with obesity or severe initial injuries such as fracture-dislocation.
The Efficiency of Highly Porous β-Tricalcium Phosphate (β-TCP) with Bone Marrow Aspirate Concentrate (BMAC) in Midfoot Joint Arthrodesis
Authors: Lee Wonyong , Prat Dan , Chao Wen , Farber Daniel C. , Wapner Keith L. 
Published: November 2022

Category: Midfoot/Forefoot Introduction/Purpose: Nonunion is one of the most common and devastating complications following midfoot joint arthrodesis. Many different types of bone grafts and bone substitutes have been used to promote osseous fusion. However, there is no consensus on the gold standard bone grafting material and whether biologic materials should be used alone or in combination. The purpose of this study is to investigate the efficiency of highly porous β-tricalcium phosphate (β-TCP) with Bone Marrow Aspirate Concentrate (BMAC) in midfoot joint arthrodesis. Methods: This retrospective comparative study included patients who underwent midfoot joint arthrodesis using compression screws from January 2014 to May 2019. A total of 44 patients (46 feet) including 89 joints were included in this study. The cohort was then stratified into two groups: 25 patients (26 feet) in arthrodesis with highly porous β-TCP and BMAC (group A) and 19 patients (20 feet) in arthrodesis without highly porous β-TCP and BMAC (group B). The osseous union rate was compared between the two groups. Demographic and operative data including age, sex, body mass index (BMI), smoking, etiology of arthritis, comorbidities such as diabetes mellitus and rheumatoid arthritis, number of joints fixed, use of bone graft or bone substitute, and postoperative midfoot anatomic alignment in the two groups were compared. Results: There was a significant difference in the union rate between the two groups: 91.5 % (43 out of 47 joints) in arthrodesis with highly porous β-TCP and BMAC (group A) and 76.2 % (32 out of 42 joints) in arthrodesis without highly porous β-TCP and BMAC (group B) (P = 0.048). During the follow-up period, a total of four postoperative complications were reported in this study. In group A, two patients developed hardware irritation, and all of them underwent removal of hardware procedure. In group B, one patient had a superficial wound infection, which was resolved completely without further treatment. The other patient in group B developed a deep wound infection with dehiscence, and it was managed with irrigation and debridement followed by vacuum assisted wound closure therapy. Conclusion: This study investigated the efficiency of highly porous β-TCP and BMAC to promote bony healing in midfoot joint arthrodesis. A significantly higher union rate was shown when arthrodesis was performed with highly porous β-TCP and BMAC compared to arthrodesis without them, suggesting that highly porous β-TCP and BMAC can be a viable and effective adjunct to the fixation in midfoot joint arthrodesis.
Degenerative Injuries of the Metatarsophalangeal Plantar Plate on Magnetic Resonance Imaging: A New Perspective
Authors: Mann Tania S. , Nery Caio A. , Baumfeld Daniel 
Published: November 2022

Category: Lesser Toes Introduction/Purpose: The magnetic resonance imaging diagnostic criteria for a complete tear of metatarsophalangeal plantar plate are well-established. However, more subtle abnormalities can also occur and be a source of pain. The objectives of this study are to determine the prevalence of degenerative plantar plate injuries in patients with metatarsalgia who underwent magnetic resonance imaging examination of the forefoot and describe the main abnormalities found. Our hypothesis is that mild capsular fibrosis will have high sensitivity but low specificity for plantar plate degenerative injuries. Methods: A retrospective cross-sectional study was conducted with 85 consecutive individuals (105 feet) with metatarsalgia who underwent forefoot magnetic resonance imaging examinations using a specific protocol to study metatarsophalangeal plantar plate. An experiment observer classified second toe plantar plate as normal, complete rupture or degenerative lesion and described the main MRI findings. Results: A normal plantar plate was observed in 75 (71.4%) of the 105 feet assessed, in 25 (24%) feet there were degenerative plantar lesions, and in 5 (4.6%) feet there were complete ruptures. Degenerative injury of the plantar plate was best identified in coronal short-axis intermediate-weighted images, with high sensitivity (92%). Pericapsular fibrosis below the intermetatarsal ligament was identified in 96% of cases, with high sensitivity (96%) for diagnosis of degenerative plantar plate injury. Conclusion: Degenerative lesions of the metatarsophalangeal plantar plate were more prevalent than complete ruptures and were best viewed in coronal short-axis intermediate-weighted sequences. Pericapsular fibrosis below the intermetatarsal ligament was the indirect finding most strongly associated with degenerative plantar plate injury.