bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retrospective Chart Review: Weight Bearing CT Scans and the Measurement of the Tibiofibular Syndesmosis
Authors: Falcon Spencer , McCormack Thomas J. , Mackay Matthew , Tarakemeh Armin , Mullen Scott , Schroeppel Paul , Wolf Megan R. , Vopat Bryan G. 
Published: January 2022

Category: Ankle Introduction/Purpose: Tibiofibular Syndesmosis injuries are commonly misdiagnosed due to their unreliable projection on plain films. Many studies have striven to establish baseline measurements of the distal tibial and fibular articulation. While cadaver, MRI, ultrasound, and non-weight bearing computer tomography (CT) have been utilized, weight bearing CT (WBCT) scans are a relatively new imaging modality that has not yet been utilized to establish reproducible and widely-referenced baseline anatomic positions. The hypotheses of this study are: 1. Standing, weight bearing CT scan will allow for evaluation and measurement of the tibio-fibular syndesmosis. 2. There will be no side to side variation or sex-based differences in syndesmosis measurements. Methods: A retrospective chart review was conducted using the electronic medical record. Inclusion criteria was applied as follows: Patients who have undergone weight bearing CT of the bilateral lower extremities from 2018 to 2020. One hundred twenty ankle CT scans were acquired for measurements. Measurements were collected by two independent reviewers twice in order to achieve inter- and intra-reliability. The measurements were then analyzed in order to establish a baseline for normal anatomy, compare injured to non-injured side, and observe any sex-based differences. Results: Measurements of uninjured legs were utilized to define normal parameters for tibiofibular syndesmosis on weight bearing CT. Averages were found for measurements of anterior incisura 3.2mm (SD=1.1mm), middle incisura 3.9mm (SD=1.1mm), posterior incisura 5.6mm (SD=1.7mm), alpha angle 16.3° (SD=6.3°), medial clear space 2.2mm (SD=0.6mm).Patients with syndesmotic injuries had significantly larger measurements for anterior (p<0.0001), middle (p=0.0007), and posterior incisura (p=0.002) when compared to uninjured ankles. Males had significantly higher medial clear space widening (p=0.0012) compared to female patients. Anterior incisura (p <0.0001), posterior incisura (p=0.0005) were found to significantly decrease as age increased. Conclusion: This study aims to assist in defining baseline anatomic measurements for syndesmotic parameters. The values and comparisons obtained were able to reinforce that weight bearing CT is valuable in identifying subtle injuries to the TFS while also demonstrating that there is male-to-female and age-related differences that should be kept in mind when radiographically evaluating imaging studies of injured patients.
Divergent vs Parallel Screw Configurations for Subtalar Arthrodesis: Comparing Clinical Outcomes
Authors: Fernandes Carlton , Johnson Eric B. , Moritz Brandon W. , McDonald Matthew R. , Amin Amgad M. Haleem , Kammerlocher Paul A. 
Published: January 2022

Category: Ankle Arthritis; Hindfoot Introduction/Purpose: Subtalar arthrodesis is a frequently performed surgery used to treat several hindfoot pathologies. Rigid fixation is essential for successful fusion and percutaneous screws are most commonly used. Controversy still exists regarding the most optimal screw configuration. While cadaveric biomechanical studies have shown diverging screw configuration to be superior to parallel screws, this has never been proven in the clinical setting. The aim of this study was to compare fusion rates and clinical outcomes between patients treated with divergent versus parallel screw constructs for subtalar arthrodesis. Methods: We conducted a retrospective review of 58 patients that underwent subtalar arthrodesis during a four-year period at our institutions. Patients were divided into two groups based on screw construct; diverging versus parallel. Outcomes measured were radiographic and clinical evidence of fusion at 3 months, American Orthopaedic Foot & Ankle (AOFAS) ankle-hindfoot and Visual Analog Scale (VAS) scores at final follow up and post-operative complications. Results: Thirty patients underwent subtalar fusion with a divergent screw construct and twenty-four with parallel screws. The mean age was 58.5+-13.9 years and mean follow up period was 44.5+-20.8 months. The overall fusion rate at 3 months was 94.8%. The fusion rate for the divergent screw group was 93.3% versus 96.4% for the parallel screw group, showing no statistical significance (p=0.60). Overall, the mean AOFAS and VAS scores improved post-operatively by 28.1+-5.49 and 4.27+-1.45 points respectively (p<.0001). In the divergent group, mean improvement in AOFAS and VAS scores was 28.5+- 4.99 and 4.39+-1.42 versus 27.7+-6.05 and 4.14+-1.48 in the parallel screw group, showing no statistical significance (p=0.59 and p=0.44). The overall complication rate was 5.2% with no statistically significant difference between the two groups (6.7% versus 3.6%, p=0.60). Conclusion: When used for fixation during subtalar arthrodesis, divergent and parallel screw constructs have similar radiological union rates and clinical outcomes when it comes to fusion rates at 3 months, post-operative improvement in AOFAS scores and complication rates. Screw configuration should be determined by surgeon experience and comfort level.
Proximal Fifth Metatarsal Fracture Treated with Plantar Plating: Retrospective Multi-Surgeon Case Series
Authors: Gardner Stephanie S. , Klavas Derek M. , Cosculluela Pedro E. , Hanson Travis W. , Heier Keith A. , Varner Kevin E. 
Published: January 2022

Category: Midfoot/Forefoot; Sports; Trauma Introduction/Purpose: Proximal fifth metatarsal fractures are a common foot injury. Previous surgical treatments have consisted of intramedullary screw fixation and a newer technique of plantar plating due to non-union and refractures seen with screw fixation. Purpose of this multi-surgeon case series study is to evaluate clinical and radiographic outcomes and complication rates after fifth metatarsal plating for proximal fifth metatarsal fractures in recreational and elite athletes. Methods: Retrospective multiple surgeon case series involving patients who underwent fifth metatarsal plantar plating for proximal fifth metatarsal fractures with a mean follow-up of 33.1 months (range, 12-52). Elite and recreational athletes were included. Demographic data, radiographic evaluation, and clinical notes were analyzed. Patient phone conversations were made to document complications outside of our electronic medical record. Results: Forty-four patients (45 fractures) were treated with plantar plating technique with a mean age of 37.3 years (range 14- 80). Five patients sustained refractures (11.1% of patients), 2 at previous fracture site, 1 through a screw hole, 1 proximal to plate, and 1 distal to plate. All refractures were treated non-operatively. No wound complications were seen. No secondary revision surgery was needed and union rate was 100% at final follow up. Conclusion: With a one year minimum follow up, plantar plating of proximal fifth metatarsal fractures is a viable option for treatment of both acute and chronic fractures as well as after failed intramedullary screw fixation with low refracture rates and without non-unions. Plantar plating allows the surgeon to have direct visualization of fracture reduction and ease of access for bone grafting. Both elite and recreational athletes can benefit from the plating technique.
Outcomes Following Arthroscopy for Anterior Impingement in the Ankle Joint in the General and Athletic Populations: Does Gender Play a Role?
Authors: Gianakos Arianna L. , Ivander Axel , DiGiovanni Christopher W. , Kennedy John G. 
Published: January 2022

Category: Ankle; Arthroscopy; Sports Introduction/Purpose: To provide an overview of the clinical outcomes of arthroscopic procedures used as a treatment strategy for anterior ankle impingement and to determine if gender affects outcomes. Methods: A systematic literature search of the Medline, Embase, and Cochrane databases was performed during June of 2019. The combination of search terms utilized included the following: 'ankle', 'impingement', 'talus', 'osteophyte', 'arthroscopy', 'surgery', 'procedures', and 'treatment'. Two reviewers independently performed data extraction consisting of demographic data, intraoperative arthroscopic data, functional outcome scores, patient satisfaction, complications, return to play, and gender differences. Results: Twenty-eight articles evaluating a total of 1,506 patients were included in this systematic review. Sixty percent (17 of 28) and 14% (4 of 28) of studies assessed anterolateral and anteromedial impingement, respectively. Overall, good to excellent results were reported following arthroscopic treatment in patients with anterior ankle impingement with an average success rate of 81.04%. Eleven studies reported return to sport with an average return to sport of 8 weeks. The most common concomitant pathology found during arthroscopic evaluation included synovitis, osteophytes, meniscoid lesions, and AITFL injury. Four studies (15%) failed to report gender as a demographic variable. Only 7 (25%) studies reported gender analysis with four (57%) studies demonstrating differences when comparing gender outcomes. Female patients have higher rates of traumatic ankle sprains, chondral injury, and chronic ankle instability associated with anterior ankle impingement when compared with male patients. Conclusion: Our systematic review demonstrates that arthroscopic treatment for anterior ankle impingement provides good to excellent functional outcomes, and good return to sports rates in the athletic population. This study underscores that lack of statistical analysis evaluating outcomes comparing male and female populations. Our study does demonstrate that female patients have higher rates of traumatic ankle sprains, chondral injury, and chronic ankle instability associated with anterior ankle impingement when compared with male patients. Therefore, women may benefit from both AMI/ALI resection as well as lateral ankle ligament repair or reconstruction in order to address both impingement and chronic lateral ankle instability.
Sex-Specific Differences Following Lateral Ankle Ligament Repair
Authors: Goodrich Ezra , Vopat Matthew , Baker Jordan , Tarakemeh Armin , Templeton Kim , Mulcahey Mary K. , Schroeppel Paul , Mullen Scott , Vopat Bryan G. 
Published: January 2022

Category: Ankle; Sports Introduction/Purpose: Chronic ankle instability is a common condition that can be treated with lateral ankle ligament repair. These procedures have a reported success rate greater than 85% in the literature, but little has been reported about the differences in postoperative outcomes between males and females. The purpose of this study was to evaluate sex-specific outcomes following lateral ankle ligament repair. Methods: In this systematic review and meta-analysis, we utilized Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) criteria to search for articles on electronic databases. Inclusion criteria consisted of English-language, in-vivo clinical studies, mean follow-up of at least one year, sex-specific evaluation of outcomes, and study participants who underwent primary lateral ligament repair. Functional postoperative outcomes for males and females were recorded and statistically analyzed. Results: Out of 2,768 studies, eight (0.29%) met inclusion criteria and were analyzed in this review. These studies included 631 patients (409 males [65%] and 222 females [35%]) who underwent primary lateral ligament repair for ankle instability. There was no statistically significant difference between males and females in terms of Karlsson scores (93.5 +- 1.6 for males, 92.7+- 2.3 for females, P =.1582) or American Orthopaedic Foot & Ankle Society (AOFAS) scores (90.44 +- 4.82 for males, 90.19 +- 3.54 for females, P =.1586). Postoperative success was defined as a 'good' or 'excellent' Karlsson score (>81), and success rate analysis revealed no statistically significant difference between males and females (86% +- 7.1% for males, 87% +- 3.5% for females, P =.9374). Conclusion: There was no difference in postoperative mean Karlsson scores, AOFAS scores, or success rates between males and females who underwent primary lateral ankle ligament repair. This surgical procedure appears to have comparable outcomes in both sexes; however, more research is warranted to further assess the impact of patient sex on postoperative outcomes.
Biomechanical Comparison of Cannulated Screws vs Nitinol Staple for Tarsometatarsal Fusion in A Cadaveric Model
Authors: Herrin Alexander S. , Koroneos Zachary , Elakkari Sherif T. , Lewis Gregory , Adebayo Temitope , Aydogan Umur 
Published: January 2022

Category: Diabetes; Midfoot/Forefoot Introduction/Purpose: Patients with hallux abducto-valgus typically require first-tarsometatarsal arthrodesis procedures for which the method of fixation is controversial. Nitinol staples have increased in popularity due to their pseudoelastic, and fatigue resistant properties that allow for shape memory. The objective of this study was to evaluate the performance of a Nitinol staple and crossed-screws through three-dimensional diastasis measurements for the first-tarsometatarsal joint in a 4-point bending isolated cadaveric joint model. We tested the hypothesis that a medially applied Nitinol staple would provide the same dynamic stability as crossed-screws while allowing for more physiologic motion. Methods: Seven matched-pairs of lower limb cadaveric specimens were thawed and dissected to isolate the first-tarsometatarsal joint including the first-metatarsal, medial cuneiform, and joint capsule. One specimen from each donor was fixed with a Nitinol staple placed on the medial side of the joint while the other specimen was fixed with two cannulated crossed-screws. Specimens were potted and tested in an MTS test frame (MTS FlexTest 40 MTS, Eden-Prarie, MN) in a 4-point bending setup (Figure 1A) while maintaining a temperature of 37°C. The diastasis between the first-metatarsal and medial cuneiform was measured at two points on the plantar aspect of each bone near the joint (Figure 1B). Specimens were pre-loaded to 10 N, then stepwise increases in cyclic loading performed at 1 Hz and 50 cycles, at 5 N force intervals until failure (complete separation) at the joint occurred. Diastasis measurements were recorded after every 25 N (250 cycles). Results: 3 of 7 matched pairs of specimens have been tested to date. All specimens were able to endure loading up to a peak load of 225 N (2000 cycles) (Figure 1C). At this peak-load, specimens fixed with the Nitinol staple had an average diastasis of 0.79 mm +/- 0.70 mm (average +/- std deviation) versus 0.39 mm +/- 0.16 mm in specimens fixed with screws. Specimens fixed with the staple construct failed at 277 N +/- 51 N whereas those fixed with screws failed 315 N +/- 48 N. Results for 4 additional matched pairs are pending. Conclusion: There has been debate as to whether the rigid fixation of crossed-screws or the compressive shape memory properties of Nitinol staples are advantageous for tarsometatarsal arthrodesis. No previous study has compared the two methods of fixation in a cadaveric model. In this study no significant differences between the two methods have been detected to date. However, other benefits of the staple construct may include decreased procedural time, decreased time under anesthesia, and possible permittance of earlier post-operative weightbearing.
Vascular Evaluation of Diabetic Patients Presenting with Radiographic Calcified Vessels of the Foot and Ankle
Authors: Herscovici Dolfi J. , Scaduto Julia M. 
Published: January 2022

Category: Diabetes Introduction/Purpose: Calcification of the vessels is a common finding in patients with peripheral arterial disease (PAD) and can indicate a compromised extremity. The incidence of PAD disease has been reported in approximately 29% of diabetics and calcification may also indicate a foot or ankle at risk. The purpose of this study was to evaluate toe pressures (TP) in patients who presented with radiographic calcification of vessels in the foot and ankle and determine if adequate flow existed despite the calcification. Methods: Using a Diabetic Registry from January, 2011 through February, 2021, a retrospective review was used to identify patients who presented with x-ray calcifications of the foot and ankle and was compared to patients who had undergone TP. For the purpose of this study, the findings of Vitti et al., who demonstrated that no surgical failures occurred in patients with TP >68 mm Hg, were used to stratify patients as having adequate (68 mm Hg) or a compromised (<68 mm Hg) blood flow to the foot. The patients' age, body mass index (BMI), hemoglobin A1C, smoking history, use of insulin, whether they could adequately detect a 5.07 monofilament and whether they had adequate TP were all recorded. Results: A total of 43 patients were identified with radiographic calcification of the foot and ankle. Within this population the average age was 68.1 years (45-89), the average BMI was 30. 8 (18.4-51.1), with an average A1C of 7.7 (5.5-14.2). Three patients (7%) were smokers. Eighteen patients (42%) could adequately detect a 5.07 monofilament and only 20 patients (47%) were on insulin. A TP evaluation was performed on a total of 53 patients. A total of 13 patients who had calcification of the vessels and who had TP evaluations were identified. Within this group, 11 patients demonstrated TP values > 68 mm Hg with only 2 patients demonstrating compromised TP. Conclusion: Calcification of vessels in the foot and ankle has been stated to suggest vascular compromise and indicate a foot and ankle at risk. These patients are obese, older individuals with poor glycemic control who, for the most part, are neuropathic. However, in this small study group, patients who had calcification of their vessels and had TP, demonstrated that despite the calcifications, adequate blood flow was achieved into the foot. This may indicate that combined with improved glycemic control, patients can undergo elective or semi-elective surgical procedures with adequate healing rates expected.
Comparison of Clinical Results Between Locking Plate Fixation and Screw Fixation for Intra-Articular Calcaneal Fractures
Authors: Hio Naohiro , Taki Masanori 
Published: January 2022

Category: Trauma; Hindfoot Introduction/Purpose: The purpose of this study is to compare the results of the two fixation groups for intra-articular calcaneal fractures based on the hypothesis that the locking plate group (P-group) can have a less corrective loss but smaller range of motion due to soft tissue contracture than the screw alone group (S-group). Methods: P-group included ten feet, five feet of which were categorized as Sanders classification type 2, four as type 3, one as type 4. S-group included 11 feet, nine as type 2, two as type 3. In both groups, small incisions such as sinus tarsi approach were used, and P-group was fixed with a locking plate, and canulated cancellous screws if necessary, while S-group was fixed with canulated cancellous screws only. We assessed range of motion of the ankle joint and subtalar joint, Creighton-Nebraska scale (CN scale) and pre- and postoperative width and height of the calcaneal body and step of subtalar joint surface. Results: The mean postoperative range of motion in the P-group / S-group was 15°/46.2° / 13.2°/45.9° for ankle dorsiflexion/plantarflexion, and 5°/13° / 5.5°/16° for subtalar joint eversion/inversion, respectively. The mean postoperative clinical score was 89.8+-9.5 points / 93.9+-8.0 points on the CN scale, and the mean pre- and postoperative imaging evaluation showed improvements in the mean width from 120.7+-8.9% to 107+-6.7% / 122.6+-13.4% to 112.9+-10.7%, in the mean height from 88.7+-4.6% to 97.8+-3.3% / 88.3+-5.8% to 99.4+-5.3%, and in the mean step of subtalar joint surface from 6.2+-5.3 mm to 0.7+-1.1 mm / 10.5+-7.6 mm to 1.5+-2.5 mm. As complications, peroneal tendinopathy and transient peroneal neuropathy were observed in one case each in the both groups. Conclusion: There was no significant difference between the two groups in the corrective loss and postoperative range of motion.
Effect of Preoperative Ulceration on Outcomes of Tibiotalocalcaneal Arthrodesis
Authors: Hoch Caroline P. , Newton William , Newton William , Gross Christopher E. , Scott Daniel J. 
Published: January 2022

Category: Hindfoot; Diabetes Introduction/Purpose: Tibiotalocalcaneal (TTC) arthrodesis is commonly performed for complex deformity, arthritis, or unstable Charcot about the hindfoot. In patients with neuropathy, hindfoot deformity, and preoperative hindfoot ulceration, management options can be limited and very challenging. Previously, some authors have advocated for fine wire circular frames and avoidance of internal fixation in an effort to decrease the risk of infection in patients with preoperative ulceration, however, there is very limited data on the outcomes of TTC arthrodesis with internal fixation in this patient population. We hypothesized that internal fixation of TTC arthrodesis in patients with preoperative ulceration would lead to higher infection rates compared to patients without ulceration. Methods: A retrospective review was conducted on the TTC fusions performed from 2016-2020 by a single fellowship trained foot and ankle surgeon at an academic medical center. Preoperative diagnosis and indications, fixation method, clinical success, and complications were obtained from the patients' charts. Patients were excluded if their clinical or radiographic data were unavailable for review, or if they had less than 3 months of follow-up. 34 patients (34 ankles) underwent TTC arthrodesis Mean age was 60.7 years and mean follow-up was 1.3 years. Statistical analysis was performed using t-Student and Chi-squared tests with a p-value of 0.05 defining significance. Midline tibiotalar angle (MTA) was measured before and after surgery to assess position of fusion. Nine patients had preoperative ulcers at the time of surgery. Results: Common surgical indications included Charcot neuropathy (n=17), post-traumatic (n=14), and cavovarus (n=3). All patients with preoperative ulcers underwent TTC fusion with an intermedullary rod. Of the patients without ulceration, 18 underwent intermedullary nailing, 5 underwent plating, and 1 had an external fixator placed. There was no difference in deep wound infection rates between patients with (2/9, 22.2%) and without (2/25, 8.0%; p=.386) preoperative ulceration; nor was there a difference in rate of fusion, wound healing, or radiographic alignment. One patient without preoperative ulceration underwent a below knee amputation due to infection. Conclusion: TTC arthrodesis with internal fixation appears to be a reasonable consideration in patients with a preoperative hindfoot ulcer. There was no statistical difference in infection rate in patients undergoing TTC fusion with and without preoperative ulceration. Further, the rate of infection in those with an ulcer and internal fixation was acceptable, and internal fixation can be considered in these patients.