bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantitation and Patterns of Carbon Expenditure for 2019 AOFAS Annual Meeting Attendance
Authors: Bluman Eric M. 
Published: November 2022

Category: Other; Basic Sciences/Biologics Introduction/Purpose: Greenhouse gas production is the major driver of anthropogenic climate change (ACC). To counteract the current trends in ACC, climate experts recommend no more than 2 tonnes of CO2 be generated/person/year. Currently, the global average is 4 tonnes/person/year. Current approximate per capita national average for CO2 production in the U.S. is 20 tonnes/person/year. Airline travel is a major contributor to greenhouse gas production. Although many factors contribute to CO2 production by academic conference attendees, air travel is by far the greatest contributor. Prior to the COVID-19 pandemic the AOFAS annual meeting (AOFASAM) was held in-person without a virtual attendance option. We estimated and characterized the greenhouse gas production generated by attendance at the last all-in-person (2019) AOFASAM. Methods: We estimated departure airports for all registered participants attending the 2019 AOFASAM using a de-identified list of postal addresses. For each address, the nearest large airport (origin) was determined using a publicly available web-based locator. Using this origin, CO2 production for each round-trip flight to Chicago was determined using a publicly available web- based calculator. Total and average CO2 production for all registrants at the AOFASAM was calculated. Results: There were a total of 1271 registrants for the 2019 AOFASAM. Because of their proximity, 64 individuals were estimated to not have used air travel. A total of 1206.67 tonnes of CO2 was estimated to have been generated by round-trip flights for AOFASAM registrants. This averages to 0.95 tonnes CO2 generated per AOFASAM registrant (range 0.06 to 6.3 tonnes). No registrant with a U.S. address was estimated to have generated more than 1.04 tonnes of CO2. Individually, international registrants generated between 0.35 and 6.3 tonnes of CO2. A majority (58%) of registrants were estimated to have generated >1 tonne of CO2 (n=321 [25%], 1-2 tonnes; n=295 [23%], 2-3 tonnes and n=122 [10%], >3 tonnes). Conclusion: Travel to the AOFASAM results in substantial CO2 production. One-third of attendees exceeded the WHO recommended annual CO2 production/person/year by attending the meeting; another 25% generated 50-100% of this limit. To meet WHO guidelines for CO2/person/year production, and set a good example for the rest of society, we need to consider alternatives to in-person meetings or pay for offsets to do our part in curbing ACC. Reducing in-person conference attendance has potential negative social and networking consequences to be overcome. Interactions with industry partners will also need to adapt. Further development of virtual reality may help mitigate these consequences.
Analysis of a Single Centre's Protocol of the Treatment of 5th Metatarsal Fractures. What Patients Need a Face-To-Face Fracture Clinic Review?
Authors: Chapman James , Choudhary Zain A. , Gupta Shubhi , Davies Thomas , Airey Grace L. , Mason Lyndon W. 
Published: November 2022

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: 5th metatarsal fractures are a common injury attending foot and ankle clinics in the UK. Within our department, we established a protocol to reduce the burden on fracture clinic of 5th metatarsal fractures by limiting face-to-face consultations to Zone 2 and 3. We sought to investigate whether our practice was consistent and the ultimate patient destination. Methods: Patients were identified from our database. We included all 5th metatarsal fractures referred to our virtual fracture clinic with a confirmed 5th metatarsal fracture. Data was collected on virtual fracture clinic (VFC) outcomes including telephone review, clinic reviews and requirement of surgery. Plain AP radiographs were reviewed for fracture morphology. Fractures were defined as Zone 1.1, 1.2, 1.3, 2, 3, diaphyseal shaft (DS), distal metaphysis (DM) and head. A binary linear regression analysis model was used. All data was analysed using IBM SPSS v.27. Results: 1360 patients met the inclusion criteria (mean age of 48.1; range 16-95, sd=19.1). 430 (31.6%) were planned for face-to- face review, however following telephone review, 542 (39.9%) were sent appointments (p<.001 McNemar). On univariate analysis, only fractures in Zone 1.1 were associated with a plan to discharge from VFC (OR 2.851, p<.001), with Zone 3 fractures associated with a plan for face-face review (p<.001). Following telephone review, Zone 2 (OR 1.387, p=.034) and Zone 3 (OR 3.285, p<.001) fractures were the only fractures significantly associated attending a face-to-face clinic appointment, with Zones 1.1 (OR 0.573, p=.008) and 1.2 (OR 0.642, p=.033) negatively associated. Zone 3 fractures were the only fractures that retained significance for attending >1 appointment (OR 4.639, p>.001) and requiring surgery (OR 3.895, p=.037). Only 15 patients (1.1%) required surgery, with 9 being for non-union and 5 being acute operations in younger patients (median age = 34 vs 51). Conclusion: There was a significant increase in patients requiring face-face review after telephone conversation. In addition to Zone 3 injuries and Zone 2 injuries had also required face-face reviews following telephone consultation. Based on these results, all Zone 2 and 3 fractures should be considered for at least one face-to-face fracture clinic review. Operative management is rare and usually secondary to non-union.
Biomechanical Properties of Splint Materials Immediately Following Dipping
Authors: Cornelius Canon C. , Daniels Joseph , Garcia Hugo C. , Warner Stephen J. 
Published: November 2022

Category: Basic Sciences/Biologics; Trauma Introduction/Purpose: Many studies have evaluated splint strength at maturity with multiple splint materials, methods, and configurations. No study to date has tested them while they were curing. This is an important for both emergency room management and post-operative splints. Methods: Model splints of plaster, ten layers thick, and a standard prefabricated fiberglass splint were made of the same size, 125 total splints were made. They were dipped in two temperatures of water, room temperature (70oF) and warm temperature (100oF), an additional group of fiberglass with no water was tested as well. Then they were weighed to assure no outliers. A three-point bend was chosen at a constant displacement of 0.5 mm/s on an Instron 5848 machine. The splints underwent this test at three minutes, six minutes, nine minutes, twelve minutes and three days. Results: Two generalized linear models (GLM) were performed with the data. One model included all time periods, and one included just the short time periods of three, six, nine, and twelve minutes. The GLM including all time frames allow for T-tests to be perform that showed significant differences in yield load and ultimate loads after three minutes between fiberglass and plaster. Plaster had a lower displacement at its yield load after 3 minutes and a higher stiffness at 1o of angulation at all time points after six minutes. The GLM that excluded the three-day time point showed that temperature increased initial stiffness in the splints as three and six minutes. A Chi squared analysis was performed between mature versus not mature stress strain curves that showed plaster to achieve it's 'mature' curve faster. Conclusion: Fiberglass is stronger and faster than plaster regarding ultimate load and yield load, however those loads happened at significant angular deformity. In situations where the surgeon desires the strongest splint, fiberglass may be preferable. However, the initial stiffness of plaster is better than fiberglass. This combined with the less displacement at yield point would make plaster the choice when the surgeon would like to limit micromotion or hold an exact mold with a splint.
Outcomes of Surgical Treatment for Symptomatic Superficial Peroneal Neuromas
Authors: Cychosz Chris , Phisitkul Phinit , Glass Natalie , Buckwalter Joseph A. , Femino John E. 
Published: November 2022

Category: Ankle; Midfoot/Forefoot; Trauma; Other Introduction/Purpose: Peripheral nerve injury or entrapment is a common complication following surgery in the foot and ankle region. The superficial peroneal nerve is particularly at risk following ankle arthroscopy and lateral approaches to the ankle or fibula. Symptoms can result in intense pain and significant disability for patients. The purpose of this study is to investigate the outcomes of superficial peroneal nerve neurolysis and neurectomy. Methods: All patients were identified who underwent operative treatment by two foot and ankle specialists for superficial peroneal nerve related pain. Exclusion criteria included patients under the age of 18, prisoners, those who underwent concomitant osseous procedures, and less than 6-week follow-up. Demographic data, baseline outcomes including FFI, SF-36, FAAM, and VAS were recorded. Final follow-up questionnaires using PROMIS measures and FAAM were administered using REDCap. Results: 55 patients were included in this study with a mean age of 43.0 years (IQR, 33.0-48.0). At a median follow-upof 6.8 months (IQR 1.2-20.2 months), VAS improved from a median of 9.0 (IQR 6.0-9.0) preoperatively to 2.0 (IQR 0.00-5.0) after surgery, p < 0.05. Patients reported a median VAS improvement of 4.0 (IQR 2.0-7.0). At final follow-up patients reported PROMIS lower extremity function score median of 58.6 (IQR 45.2-58.6), PROMIS neuropathic pain quality score of 42.9 (IQR 37.2-55.5), and PROMIS pain interference of 50.5 (IQR 41.1-57.0). Worker's compensation claims were independently associated with significantly poorer post-operative function measured using FAAM ADL (58.58 WC vs 74.86 non-WC, p<0.02) and higher post- operative VAS scores (4.46 WC vs 2.36 non-WC, p<0.01). ). Patients with current or recent tobacco use within 3 months leading up to surgery reported significantly higher post-operative VAS pain scores compared to nonsmokers (4.54 vs 2.47, p<0.02). Conclusion: Neurectomy or neurolysis has potential to significantly improve somatic pain for entrapment or neuroma formation of the superficial peroneal nerve. Tobacco use as well as worker's compensation claims were associated with significantly poorer outcomes. Further studies are needed to optimize perioperative management and surgical techniques for these patients.
Disrupting Biofilms From Titanium with a CHG Antimicrobial Irrigation System
Authors: Eberle Tanya , Sanders Jessica , Laubach Isabel , Manser Jak , Davis Troy , Peterson Marnie , Twomey Carolyn L. 
Published: November 2022

Category: Other Introduction/Purpose: Orthopedic device-related infections can be difficult to treat and decrease the success of surgical interventions. The implant provides a surface for bacterial attachment and biofilm formation, which decreases antimicrobial efficacy. This study was conducted to assess the ability of the Chlorhexidine Gluconate (CHG) Antimicrobial Irrigation System to disrupt biofilms from titanium coupons using an adapted ASTM E2871-19 method, 'Standard Test Method for Determining Disinfectant Efficacy Against Biofilm Grown in the CDC Biofilm Reactor Using the Single Tube Method.' Methods: CDC Biofilm Reactor was inoculated with Staphylococcus epidermidis (ATCC 14990TM), methicillin-resistant Staphylococcus aureus (ATCC 43300TM), Pseudomonas aeruginosa (ATCC 15442TM), or Escherichia coli (ATCC 25922TM). The reactors were run in a batch phase for 24 h, followed by continuous flow phase for an additional 24 h to produce single-species biofilms on titanium coupons. After coupons were washed with PBS to remove planktonic bacteria, growth control coupons were placed into standard sampling solution with 1% Tamol (SST) (neutralizer) or treated with CHG Antimicrobial Irrigation System according to Instructions for Use (IFU) followed by a 60 sec dwell or no dwell. Coupons were rinsed with normal saline following treatment and placed in SST. Then coupons were sonicated and vortexed to release bacteria and plated for enumeration. A coupon from each group was fixed for SEM imaging. Results: The CHG Antimicrobial Irrigation System disrupted biofilms of all organisms from titanium coupons with the greatest log reduction per coupon in the 60 sec dwell treatment group (log10 reduction 2.02 to 4.56 CFU/coupon from controls) (Table). Overall, S. epidermidis and E. coli biofilms had the greatest reductions in bacterial densities. SEM images confirmed biofilm disruption from the titanium surface. Conclusion: his study determined that the CHG Antimicrobial Irrigation System disrupted biofilms from titanium coupons when used according to the instructions for use.
Patients' Opinions on Critical Portions of Surgical Procedures in Foot and Ankle Surgery
Authors: Flaherty Alexandra , Mathur Vasundhara , Heyrani Nasser , Lubberts Bart , Waryasz Gregory R. , Guss Daniel , Ashkani-Esfahani Soheil , DiGiovanni Christopher W. 
Published: November 2022

Category: Other; Ankle Introduction/Purpose: Over the last decade, simultaneous or overlapping procedures in orthopedic surgery have come under increased media attention and public scrutiny. While little is known about what surgeons consider to be 'critical portions' of the myriad of foot and ankle procedures performed, even less is known about the expectations and opinions of patients themselves. In this study we aimed to elucidate patients' expectations of foot and ankle surgeons regarding their presence at different portions of a given surgery and what portions of a surgery they considered to be 'critical'. Methods: In this survey, data was collected using a questionnaire that was filled out by 49 patients presenting to an orthopedic foot and ankle tertiary referral clinic. The questions were designed around three common foot and ankle procedures: open reduction, internal fixation of fractures (ORIF), Achilles tendon repair, and ankle arthroscopy. For each procedure, the key steps were identified, and the responding patient was asked to characterize each step as 'Always Critical' 'Often Critical' 'Sometimes Critical' 'Rarely Critical' or 'Never Critical.' Additionally, demographics, education level, number of prior surgeries, and profession were also collected from the patients. Data were described using means, ranges, and percentages. Results: Of the 49 patients surveyed, the average age was 52.9 years old; 59% were female and 41% were male; 76% of respondents were college graduates, 8% completed some college, and 12% were high school graduates. Overall, 12% of respondents work in a healthcare related field. The average number of previous surgeries was 2.0, with a minimum of 0 and a maximum of 14. In all three procedures, the steps for which more than 50% of the patients identified as 'Always Critical' were discussion of risks, benefits, and alternatives, marking the surgical site, pre-operative time-out, skin incision for ORIF, soft tissue dissection, reduction of fracture, fracture fixation with hardware, repair of the tendon, and scoping the ankle. Across all three procedures, transferring the patient between operating table and bed, applying a sterile bandage, and applying a splint were categorized as the least critical portions of the procedure (Figure 1). Conclusion: The result of this study offers insight on what the most critical portion of three common foot and ankle procedures from the patient's perspective. Generally speaking, patients perceived initial dissection and even closure to be critical, in addition to procedural elements such as fracture reduction. Ongoing research aims to correlate these findings with the perceptions of foot and ankle surgeons themselves. Nonetheless, it highlights the potential discrepancy in perceptions between clinicians and patients as it pertains to 'critical portions' of a given procedure.
Does Severe Ankle Deformity Affect the Outcomes of a 4th Generation Total Ankle Prosthesis? A 2- Year Follow-Up
Authors: Gross Christopher E. , Friscia David A. , Doty Jesse F. , Vora Anand M. , Strasser Nicholas L. 
Published: November 2022

Category: Ankle Arthritis Introduction/Purpose: Fourth generation ankle replacements benefit from improved surgical technique, respect for bony preservation, and increased surgeon awareness of operative indications. In some studies, pre-operative degree of deformity has been reported to influence survivorship, pain, and functional outcomes. The purpose of this multi-institutional study was to evaluate whether pre- operative deformity affects prospectively collected patient reported outcome measures (PROMs) of a fourth-generation total ankle replacement. Methods: Patients presenting for a total ankle replacement at 9 institutions were prospectively enrolled and implanted in a variety of academic and private settings. Each patient received an INFINITY ankle prosthesis. (Styker, Memphis, TN, USA). The degree of deformity was radiographically classified pre-operatively as severe if ankle varus or valgus was greater than 10° in the coronal plane. PROMs were recorded pre-operatively and at 6 months, 12 months, and 24-month intervals. The following PROMs were collected: Ankle Osteoarthritis Score (AOS), PROMIS Global Physical Health, and Foot and Ankle Outcome Score (FAOS). The preoperative and latest follow-up scores for patients with two years of follow-up were analyzed. Results: A total of 147 patients were enrolled in the study. Fifty-two patients exhibited a pre-operative ankle deformity of greater than 10° varus or valgus. Eighty-eight patients had 24 months of follow-up. All patients with severe deformity had significant improvements in all domains of the AOS, PROMIS, and FAOS Scores (p<0001). The degree of deformity, ankle instability, or hindfoot arthritis did not impact the PROMs (AOA p=.2661, PROMIS p=.543, FAOS p=.684) in those with 2-year follow-up.There were three revisions with varying degrees of deformity. Two patients had revisions for aseptic loosening (6o valgus and 10o varus). One patient had a revision for tibial subsidence (11o varus). Conclusion: Severe pre-operative deformity did not impact PROMs in patients undergoing implantation with a 4th generation total ankle replacement. In carefully selected patients, greater deformity did not necessarily correlate with an increased need for revision surgery.
The Statistical Fragility of Platelet-Rich Plasma as Treatment for Plantar Fasciitis: A Systematic Review and Meta-Analysis
Authors: Gupta Arjun , Ortiz-Babilonia Carlos D. , Xu Amy L. , Rogers Davis L. , Vulcano Ettore , Aiyer Amiethab A. 
Published: November 2022

Category: Basic Sciences/Biologics; Hindfoot; Sports Introduction/Purpose: Plantar fasciitis (PF) is estimated to account for 8% of all running-related injuries, affecting nearly 1 out of every 10 adults aged 50 and older. Recent randomized controlled trials (RCTs) suggest platelet-rich plasma (PRP) injection may be an effective non-operative treatment option for chronic, refractory PF. However, RCTs in general have come under scrutiny due to a frequent lack of reproducibility, which is largely attributable to shortcomings of the commonly used p<0.05 threshold for significance. Fragility indices may be an appropriate tool to gauge the clinical importance of RCT findings in these situations. In this study, we utilize the continuous fragility index (CFI) and continuous fragility quotient (CFQ) to determine the statistical robustness of data from RCTs evaluating PRP for PF. Methods: RCTs comparing outcomes after PRP injection versus other conservative treatment in chronic PF patients were evaluated. Representative datasets were generated for each reported outcome event using summary statistics. The CFI was determined by manipulating each dataset until reversal of significance (a=0.05) was achieved. The corresponding CFQ was calculated by dividing the CFI by the sample size. Results: Of 259 studies screened, 27 studies (59 outcome events) were included in this analysis. The median CFI for all events was 9 (CFQ=0.177), suggesting that altering the treatment of only 9 patients (or 17.7 out of 100) would be sufficient to reverse trial significance (Table 1). Of the 36 outcome events reporting lost to follow-up data, 10 events (27.8%) lost >=9 patients. Outcome events that were originally reported as significant (p<0.05) were considerably more fragile (CFI=5; CFQ=0.122) than events that were reported as nonsignificant (CFI=10; CFQ=0.179). Conclusion: Fragility indices are a useful adjunct to p-values and provide an assessment of how easily statistical significance can be overturned. While there is some preliminary evidence supporting the clinical efficacy of PRP, our fragility analysis suggests that RCT findings may be underpowered in some cases. Over 27% of outcome events may have experienced a reversal of significance if the studies had simply maintained follow-up. Given the importance of RCTs in clinical decision-making, fragility indices should be reported alongside p-values to indicate the strength of statistical findings.
No Association Between Cavovarus Alignment and Risk of Non-Union or Delayed Union in Jones Fractures
Authors: Holmes Scott , Webb Alexander R. , Manz Wesley J. , Jacobson Joseph E. , Coleman Michelle M. , Kadakia Rishin J. , Bariteau Jason T. 
Published: November 2022

Category: Midfoot/Forefoot; Other Introduction/Purpose: It has been well documented in the literature that fractures of the base of the fifth metatarsal are often associated with varus hindfoot alignment. Zone two fractures at the metaphyseal-diaphyseal junction, commonly referred to as Jones fractures, have specifically been noted to have a higher incidence of delayed union and nonunion. This has historically been attributed to the tenuous blood supply in this region. Although it is known that hindfoot varus may predispose to these fractures, there is little information on whether a cavovarus alignment may also contribute to the increased risk of nonunion. The purpose of this study is to determine whether cavovarus foot alignment is associated with delayed union or nonunion in Jones fractures. Methods: We identified patients who sustained a proximal fifth metatarsal fracture between the years 2016-2021 at a single academic institution. Weightbearing foot radiographs were then reviewed to identify zone 2 fractures. Talo-first metatarsal, talonavicular coverage, and talocalcaneal angles were then measured on the AP view and calcaneal pitch, talocalcaneal, and talo- first metatarsal angles were measured on the lateral view to assess foot alignment. The primary outcome measure was the presence of a nonunion or delayed union. T-tests, Mann Whitney U tests, and ANOVA analyses were conducted to assess for differences. Results: We identified a total of 117 patients with 118 zone 2 proximal fifth metatarsal fractures. Of those fractures, there were 23 of which were considered either delayed union (n=8) or nonunion (n=15). Similar rates of nonunion and delayed union were observed between patients undergoing nonoperative and operative management of their Jones fractures (p=0.514, p=0.200, respectively). For all patients with a nonunion or delayed union, no differences in anteroposterior (AP) talo-first metatarsal angle, AP talonavicular coverage angle, AP talocalcaneal angle, lateral calcaneal pitch, lateral talo-first metatarsal angle, or lateral talocalcaneal angle from those with expected healing were observed (p = 0.773, p = 0.084, p = 0.874, p = 0.751, p = 0.471, and p = 0.386 - respectively). Conclusion: Overall, no measured foot alignment values (talo-first metatarsal angle, talonavicular coverage, talocalcaneal angle, or calcaneal pitch) were statistically associated with increased risk of delayed union or non-union among patients with Jones fractures undergoing either operative or non-operative treatment. Furthermore, there was no measured difference in these foot alignment parameters between those patients undergoing operative treatment and those undergoing non-operative treatment. In conclusion, cavovarus alignment is not associated with an increased risk of non-union or delayed union in the operative or non-operative treatment of Jones fractures.