bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-Term Clinical Results of Arthroscopic Lift-Drill-Fill and Fixation (LDFF) Treatment for Osteochondral Lesions of the Talus
Authors: Rikken Quinten , Dahmen Jari , Stufkens Sjoerd A. , Kerkhoffs Gino 
Published: January 2022

Category: Ankle; Arthroscopy Introduction/Purpose: The purpose of this study was to describe the long-term (> 5 years) clinical results of a novel arthroscopic fixation technique for osteochondral lesions of the talus (OLT), named the Lift, Drill, Fill and Fix (LDFF) technique. Methods: 18 ankles (17 patients) underwent an arthroscopic LDFF procedure for a primary OLT. The mean follow-up was 6.8 years (range: 68 - 96 months). Pre- and postoperative clinical assessment was prospectively performed by measuring the Numeric Rating Scale (NRS) of pain at rest, during walking, and when running. Additionally, the Foot and Ankle Outcome Score (FAOS) including its subscores of pain, symptoms, activities of daily living, sports, and quality. Additionally, the Short Form-36 (SF-36) was assessed. Results: The mean NRS during running significantly improved from 7.8 pre-operatively to 3.7 post-operatively (p = 0.006), the NRS during walking from 5.7 to 1.5 (p < 0.001), and the NRS in rest from 2.3 to 1.0 (p = 0.015). The median FAOS at final follow- up was 80 for pain, 57 for other symptoms, 90 for activities of daily living, 70 for sport, and 55 for quality of life. A pre- and post- operative score comparison was available for fifteen patients, and improved significantly in most subscores. The SF-36 physical component scale significantly improved from 42.9 pre-operatively to 50.1 post-operatively. Conclusion: Arthroscopic LDFF of fixable primary OLTs results in excellent pain reduction and improvement of functional outcomes, with sustained results at long-term follow-up. These results indicate surgeons should consider fixation for a fixable OLT.
Total Ankle Arthroplasty with Anatomic Lateral Ankle Stabilization (ATLAS) using Synthetic Graft for Instability in Moderate and Severe Pre-Operative Varus Alignment
Authors: Rushing Calvin J. , Malloy McCoy Antonio M. , McKenna Bryon J. , Berlet Gregory C. 
Published: January 2022

Category: Ankle; Other Introduction/Purpose: More than 50% of patients undergoing Total Ankle Arthroplasty (TAA) have some degree of coronal deformity, which is the most common reason for additional procedures. The purpose of the present study was to assess the early clinical and radiographic outcomes for patients who underwent TAA and Anatomic Lateral Ankle Stabilization (ATLAS) using synthetic graft for instability in moderate and severe preoperative varus alignment. Methods: Seven ankles with moderate or severe varus alignment underwent TAA with a 3rd generation prosthesis (INBONE-2) and ATLAS using synthetic graft between September 2018 and February 2019 at a single institution, and were at least 1 year postoperative (mean 13.3 months, range 12-15). Medical records and charts were reviewed for any revisions, reoperations, or complications. Weight bearing radiographs were assessed using coronal and sagittal alignment parameters preoperatively, and during the latest follow-up. Results: Survivorship for INBONE-2 with ATLAS was 100%; recurrent instability was not observed. Symptomatic talonavicular joint arthritis was recorded for a single patient 12 months postoperatively; there were no revisions, or reoperations. Tibiotalar coronal alignment improved significantly from 17.7 +- 9.3 (range, 10.1-33.6) to 2.3 +- 1.2 (range, 0.9-4.4) degrees (p<0.006), and all ankles achieved neutral alignment in single stage. Regarding sagittal tibiotalar alignment, preoperatively 2 ankles (28.5%) were translated anteriorly and the rest were neutral (71.5%). Significant posterior translation was observed and during the latest follow- up, 4 ankles were neutral (57.1%) and 3 posterior (42.9%) (p<0.009). Conclusion: Satisfactory outcomes were observed at a minimum of 1-year follow-up for patients with moderate or severe varus alignment who underwent TAA with INBONE-2 and ATLAS. ATLAS using synthetic graft may afford advantages over previously described repair techniques. Comparative studies between the Brostrum-Gould and ATLAS are warranted in the TAA population.
Predisposing Factors for 30-Day Complications Following Leg Amputation
Authors: Safavi Kiya Shazadeh , Villarreal Joseph , Hussien Doha , Panchbhavi Vinod K. , Jupiter Daniel 
Published: January 2022

Category: Trauma; Ankle; Diabetes; Other Introduction/Purpose: While amputation rates and amputation-related morbidity and mortality have been established for select populations, the impact of general demographic factors on postoperative surgical complications remains little studied. This study aims to analyze the influence of numerous demographic variables on specific surgical complications. Methods: We extracted data from the American College of Surgeons' National Surgical Quality Improvement Program database from 2012 to 2017 and searched for leg amputations using CPT codes 27881, 27882, 27884, and 27886, identifying 4,162 patients. The association of 29 demographic variables with 4 complications (surgical infection, additional service, deep vein thrombosis [DVT], and sepsis) was analyzed using t tests or chi-squared tests. A logistic regression allowed determination of independent risk factors for each outcome, based on results from the bivariate analyses. Variables found to have P < 0.2 on bivariate analysis were subsequently included in the multivariate analysis of the corresponding surgical complication. Results: Preoperative open, 'contaminated,' or 'dirty/infected' wounds, longer intraoperative times, development of sepsis prior to surgery, and admission of patients directly from home or from another hospital's emergency room were found to influence postoperative surgical infection rates. An individual's height, weight, total length of hospital stay, ethnicity, the presence of preoperative open or infected wounds, and wounds classified as 'dirty/infected' preoperatively affected postoperative additional service incidence. Preoperative congestive heart failure and large decreases in body weight, as well as a patient's total length of hospital stay, influenced postoperative DVT rates. A patient's preoperative functional heath status, total length of hospital stay, amputations conducted as emergency cases, as well as preoperative acute renal failure, open or infected wounds, sepsis, 'contaminated' or 'dirty/infected' wounds, impacted postoperative sepsis rates. Conclusion: Understanding these risk factors may allow providers to anticipate and address higher rates of complications in certain patient populations.
Comparing Bilateral Feet Computed Tomography Scans Can Improve Surgical Decision Making for Subtle Lisfranc Injury
Authors: Shim Dong Woo 
Published: January 2022

Category: Trauma; Midfoot/Forefoot; Sports Introduction/Purpose: Subtle Lisfranc injuries (SLIs) are challenging to diagnose. Although weightbearing (WB) radiographs have been suggested to identify SLIs, approximately 20% are missed on initial radiographic assessment. Computed tomography (CT) has been suggested as an alternative, but has not provided any diagnostic guideline. Therefore we compared measurement techniques on radiographs and bilateral foot CT scans for the efficiency of diagnosis and making surgical decisions for SLI. Methods: We retrospectively investigated patients diagnosed with SLIs between January 2014 and January 2020. Distances between both medial cuneiform and second metatarsal base (C1M2), and the first and second metatarsal bases (M1M2), were measured on bilateral WB radiographs. Bilateral foot CT scans were taken, and the distances between C1M2 were checked on the axial and three points of the coronal plane (top, middle, and base) (Figure 1). The surgical indication was > 1 mm of diastasis on CT scan. Clinical outcomes were evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) score at final follow-up. Intraobserver and interobserver agreements were assessed. Results: Thirty patients with SLIs were reviewed. Twenty-four patients underwent surgical fixation (Group A) and six patients were treated conservatively (Group B). The side-to-side difference (STSD) of C1M2 and M1M2 distances greater than 1 mm showed 91.7% and 54.2% sensitivity, and 66.7% and 16.7% specificity, respectively. Investigating STSDs of all points on CT scans were informative to discriminate both groups (P <= 0.038). Clinical outcomes showed no significant difference between the groups (P = 0.631). Intraclass and interclass correlation coefficient values showed good to very good reliability, except for STSD of WB M1M2 distance and the coronal top plane. Conclusion: Investigating bilateral foot CT scans was significantly efficient and reliable for the diagnosis and treatment plan for SLI. On radiographs, STSD of WB C1M2 distance was more sensitive than STSD of WB M1M2 distance.
Can Bedside Needle Arthroscopy of the Ankle be an Accurate Option in the Office Setting for Intra- Articular Delivery of Injectable Agents?
Authors: Stornebrink Tobias , Stufkens Sjoerd A. , Mercer Nathaniel P. , Kennedy John G. , Kerkhoffs Gino 
Published: January 2022

Category: Ankle; Arthroscopy Introduction/Purpose: To evaluate accuracy and patient experience of inspection-injections of the ankle with in-office needle arthroscopy in a relevant clinical setting - including patients with end-stage ankle pathology and/or a history of prior surgery. Methods: This was a prospective study that included adult patients who were scheduled for an injection with hyaluronic acid to the tibiotalar joint. In our center, these injections are used as a last resort prior to extensive surgery. The primary outcome was injection accuracy, which was defined as injecting through the arthroscopic cannula with intra-articular positioning confirmed by a clear needle arthroscopic view of the joint space. Secondary outcome measures included a patient reported numeric rating scale (NRS, 0-10) of pain during the procedure and willingness of patients to return for the same procedure. NRS of ankle pain at rest and during walking was collected during the intervention and at two-week follow-up. Complications were monitored from inclusion up to a two-week control visit. Results: We performed 24 inspection-injections (11 (46%) males, mean age 47.8 +- 14.5 years). The indication was end-stage osteoarthritis in 21 (88%) cases - eight (33%) Kellgren-Lawrence grade IV, 10 (42%) Kellgren-Lawrence grade III - and an osteochondral defect in three (13%) cases. Fourteen (58%) patients had had prior ankle surgery - 11 (46%) patients had had multiple prior surgeries. Accuracy was confirmed in 22 (88%) cases. The three unsuccessful injections all occurred in patients with Kellgren-Lawrence grade IV osteoarthritis. Median NRS of pain during the procedure was 1 (IQR 0 - 2). Willingness to return was 100%. Median NRS of pain in rest decreased from 4 (IQR 2 - 5) at intervention to 3 (IQR 1 - 5) at follow-up (p < 0.01). The median NRS of pain during walking decreased from 8 (IQR 6 - 8) to 7 (IQR 4 - 8) (p < 0.01). There were no complications. Conclusion: In-office needle arthroscopy of the ankle under local anesthesia is a procedure that is well tolerated by patients. It is able to provide intra-articular delivery of injectable agents with high accuracy. Accuracy can be expected to approach 100% if patients with total ventral joint obliteration and a history of extensive prior ankle surgery are excluded.
Surgical Takedown Approaches to Insertional Achilles Tendinopathy: A Systematic Review
Authors: Thompson John M. , McCoy Antonio M. Malloy , Nguyen Kevin N. , Casciato Dominick , So Eric , Prissel Mark A. , Ahluwalia Jaime A. , Tewilliager Tyler 
Published: January 2022

Category: Hindfoot Introduction/Purpose: Various techniques of surgical detachment for treatment of insertional Achilles tendinopathy have been described, including lateral release, medial release, central tendon splitting (CTS), and complete detachment. Methods: A systematic review of electronic databases was performed, encompassing 17 studies involving 703 patients and 746 feet, to compare outcomes associated with surgical takedown techniques. Results: Observed results include wound complication rates (CTS 2.8%; Lateral 0%; Medial 0.4%; Complete 1.3%), post-operative rupture rates (CTS 0.7%; Lateral 0.8%; Medial 0.7%; Complete 2.6%), rate of revision (CTS 0.4%; Lateral 0.9%; Medial 4.2%; Complete 2.6%), rate of infection (CTS 1.1%; Lateral 1.7%; Medial 3.7%; Complete 6.5%). Lateral takedown group was found to have a statistically significant lower rate of complications compared to the complete takedown group (p=0.0029). Conclusion: In light of these results, it is recommended that patient characteristics such as case specific tendon pathology and calcaneal morphology take precedent in determining the surgical approach to Achilles takedown.
An Oblique Trans-Syndesmotic Screw to Augment Fixation of Distal Fibula Fractures: A Technique Guide
Authors: Villarreal Eric D. , Strickland Carson D. , Richardson David R. 
Published: January 2022

Category: Trauma; Ankle Introduction/Purpose: A subset of patients with low, transverse fractures of the lateral malleolus are at increased risk of malreduction and late loss of reduction. In patients with poor bone quality and transverse or short oblique fractures at or distal to the tibiotalar joint, distal fixation is often inadequate with a single interfragmentary lag screw. Furthermore, these fractures are susceptible to malreduction by pre-contoured locking plates. To address this, a technique was developed to augment fixation of the distal fragment and decrease the likelihood of loss of reduction. The senior author's technique for this procedure, as well as indications for the technique and a few representative cases, are provided. Methods: This technique involves placement of an oblique tricortical or quadricortical screw from the distal fibula into the tibia in an distal-lateral to proximal-medial direction. The screw is placed either outside of or through the distal-most hole of a one-third tubular plate placed in a neutralization position. The screw trajectory is similar to that of a typical syndesmosis screw in the sagittal plane but is aimed proximally rather than parallel to the tibial plafond. The screw enters the tibia at Chaput's tubercle, just lateral to the joint. The indications for this technique are transverse and short oblique Danis-Weber B distal fibular fractures in which there is inadequate purchase between the plate and the distal fragment. While the purpose of this screw is not to stabilize the syndesmosis, it can be used with other augmentation techniques, such as trans-syndesmotic screws, in high-risk patients with osteoporosis and/or neuropathy. Results: This technique has been used for many years by the senior author. There have been no implant failures (e.g. broken screws) or major complications associated with this technique. Three representative cases demonstrate appropriate indications and outcomes for this technique. These include patients with significant neuropathy or osteoporosis who present with a particularly troublesome fracture pattern (transverse fibular fracture at or below the level of the tibiotalar joint). This screw, along with any other syndesmotic screws, is removed at 3-4 months according to the senior author's protocol. Conclusion: A distal oblique trans-syndesmotic screw can be used to supplement current fibular fracture fixation constructs. It is easy to place under fluoroscopic guidance and generally is removed after fracture union, similar to standard syndesmosis screws. The use of this screw helps prevent the malreduction that can potentially occur when treating transverse or short-oblique Weber B distal fibular fractures with a locking plate. In our series of patients at a large urban tertiary referral center, this technique has produced good outcomes with no reportable complications.
Defining an Anatomic and Radiographic Safe Zone for Posterior Malleolar Ankle Hardware Fixation
Authors: Williams Caroline , Momenzadeh Kaveh , Michalski Max , Kwon John Y. , Miller Christopher P. 
Published: January 2022

Category: Ankle; Trauma Introduction/Purpose: There is a lack of consensus regarding optimal management of Posterior Malleolar Fractures (PMFs). Indirect reduction and fixation with posterior-anterior (PA) screw shows promise of avoiding the risks associated with direct reduction or indirect anterior to posterior (AP) approaches. Some authors have raised concerns about potential risk to nearby structures with PA technique, including hardware prominence into the syndesmosis. This study highlights the use of a posteromedial vertical syndesmotic line as a fluoroscopic landmark, helping surgeons avoid intra-syndesmotic placement. Methods: Indirect PA screw placement was completed on ten cadaveric specimens, followed by fluoroscopy in mortise and lateral views. Dissection was performed to assess screw placement relative to the posteromedial border of the syndesmosis. The posterior border of the syndesmosis was marked with a radiopaque wire. Repeat imaging was completed to validate the fluoroscopic posteromedial vertical syndesmotic line is representative of the posteromedial border of the tibial incisura. Results: On dissection, 9 of 10 cadavers had accurate screw placement with no penetration into the syndesmosis (Figure 1, bottom left & bottom right). Corresponding imaging showed the screw head to be medial to the marker on mortise view. For the specimen with penetration into the syndesmosis, imaging confirmed that the screw head was lateral to the marker on mortise views (Figure 1, top center & top right). The radiopaque marker correlated with the posteromedial vertical syndesmotic line for all specimens when comparing anatomic to radiographic findings. A radiographic safe zone is defined for the PA screw 12 mm medial to the vertical syndesmotic line to ensure no iatrogenic injury to the FHL tendon. Conclusion: This study demonstrated that the posterior incisura tibialis fluoroscopic landmark is unambiguous in localizing the posterior syndesmotic border (Figure 1, top left) and that screws medial to this line are safely out of the syndesmosis, while screws placed lateral are either in or at risk of intra-syndesmotic placement. A safe zone is defined for screw placement.
Prediction of cellulose nanofibril (CNF) amount of CNF/polypropylene composite using near infrared spectroscopy
Authors: Murayama Kazushige , Kobori Hikaru , Kojima Yoichi , Aoki Kenji , Suzuki Shigehiko 
Published: January 2022

AbstractThe final goal of this study is to establish a classification method of cellulose nanofibril (CNF)/plastic composites such as their CNF amount, CNF types, and resin types, which are expected to progress the commercialization in the future, using near infrared (NIR) spectroscopy. To achieve this goal, NIR spectra of injection and film samples with different types and addition ratios of CNFs in CNF/polypropylene (PP) composites were measured and analyzed in the range of 1000–2200 nm. The results of the principal component analysis using all samples suggest that CNF addition ratio and sample shape could be expressed by principal component (PC) 1 and PC2 scores, which relate to the chemical components of PP and CNF complexly. Furthermore, the partial least-squares (PLS) regression model was able to predict the CNF addition ratio with about 2.0% accuracy, regardless of CNF type and sample shape. To develop an easier model compared to the PLS model, it was calculated to the simple linear regression model, which used the absorbance quotient of optimum wavelengths combination (OWC). Although this model did not have the accuracy to use the quality control, it is able to discriminate CNF addition ratio of CNF/PP composites with almost the same accuracy as the PLS model. However, if it is possible to separate the sample shapes before the analysis, it is suggested that the OWC regression model is able to predict CNF addition ratio of CNF/PP composites with less than 1% accuracy.
Self-efficacy beliefs and expectations during an Emergency Medicine Clerkship
Authors: Cevik Arif Alper , Cakal Elif Dilek , Alao David , Elzubeir Margret , Shaban Sami , Abu-Zidan Fikri 
Published: January 2022

Abstract
Background
Undergraduate emergency medicine (EM) training is important because all medical graduates are expected to have basic emergency knowledge and skills regardless of their future speciality. EM clerkship should provide opportunities to improve not only knowledge and skills but also the self-efficacy of learners. This study aims to evaluate the expectations, opinions, and self-efficacy beliefs of medical students during a 4-week mandatory EM clerkship.

Methods
This study used a prospective longitudinal design with quantitative and qualitative survey methods. It includes final year medical students of the 2015–2016 academic year. Voluntary de-identified pre- and post-clerkship surveys included 25 statements. The post-clerkship survey included two open-ended questions asking participants to identify the best and worst three aspects of EM clerkship. Responses were analysed to determine themes or commonalities in participant comments indicative of the EM clerkship learning experiences and environment.

Results
Sixty-seven out of seventy-nine (85%) students responded to both pre- and post-clerkship surveys. Medical students’ expectations of EM clerkships’ effect on knowledge and skill acquisition were high, and a 4-week mandatory EM clerkship was able to meet their expectations. Medical students had very high expectations of EM clerkships’ educational environment. In most aspects, their experiences significantly exceeded their expectations (p value < 0.001). The only exception was the duration of clerkship, which was deemed insufficient both at the beginning and at the end (p value: 0.92). The students perceived that their self-efficacy improved significantly in the majority of basic EM skills and procedures (p value < 0.001). Emergent qualitative themes in the study also supported these results.

Conclusion
This study showed that a 4-week mandatory EM clerkship increased medical students' perceived self-efficacy in basic emergency management skills. The EM clerkship met students' expectations on knowledge and skill acquisition, and exceeded students’ expectations on educational environment.