bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hindfoot Nail or Protibial Screw Fixation for Ankle Fracture: A Multi-Centre Study
Authors: Bethel Jordan L. , Najefi Ali-Asgar , Davies Monica , Gosney Eleanor , Patel Keval , To Christopher , Guryel Enis , McEwan Josephine , Buchan Stephanie , Northway Joseph , Quereshi Amir , Ahluwalia Raju 
Published: November 2022

Category: Ankle; Trauma Introduction/Purpose: Multi-centre assessment of utilisation and outcomes of hindfoot intramedullary fixation (HFN) or fibula pro-tibial screw fixation (PTS) in complex ankle fractures. Methods: From January 2020 - June 2021, demographic data, co-morbidities, was collected on all patients undergoing HFN or PTS for an AO44 ankle fracture at three Major Trauma Centre's (MTC's) in the UK. Outcomes of interest included post-operative complications, Charlson-Co-morbidity-Index-Score (CCIS), weight-bearing status, peri-operative information, soft tissue management and post-operative complications were recorded, Radiographs were assessed for metalwork breakage and anatomical reduction (Pettrone Criteria). Results: 77 patients were identified; 59 underwent HFN and 18 had PTS fixation. The mean age differed between techniques (80+-11.4 [HFN] vs. 66+-19.8 [PTS]) (p<0.001) and 10-year survival favoured patients undergoing PTS (30+-31.6% in the [HFN] and 55+-37.6%[PTS] (p<0.004). 17 (29%) HFN patients had diabetes compared with 7 (39%) PTS patients. 36 (61%) HFN's were open fractures, 7 (39%) PTS's were open fractures, differences in outcomes between primary closure/shortening/joint preparation and combined ortho-plastic management were noted in the HFN group.Time to full weight bearing was reduced in HFN vs. PTS (2.1+-3.1 vs. 8.0+-5.0) (p<0.001), only a minority of patients were allowed to WB immediately. 12 (27%) of patients with open fractures had post-operative complications compared with 5 (15%) of closed fractures. The mean Pettrone score for HFN was 1.3+-1.6 compared with 3.7+-0.6 for PTS, subgroup analysis showed Pettrone scores for open fractures treated with a HFN worsened(0.9 vs 2.3) (p=0.007). Conclusion: Comparing functional and outcome rates between the 2 techniques, PTS provides stable fixation, and a lower overall complication rates, with better radiological outcomes and expected survival. However, HFN is performed in frailer patients, with co-morbidities where early weight-bearing may be beneficial, accepting limited functionality and higher complication rate. Even though both techniques are designed for early mobility in the appropriate person this is not always realised, thus further studies are required to characterise which patients benefit most from each surgical technique.
Arthroscopic Evaluation of Subtle Syndesmotic Instability: Are We Pulling Correctly in the Coronal Plane?
Authors: Bhimani Rohan , Lubberts Bart , Hagemeijer Noortje , Zhao John Z. , Saengsin Jirawat , DiGiovanni Christopher W. , Guss Daniel 
Published: November 2022

Category: Ankle; Sports; Trauma Introduction/Purpose: While the lateral hook test (LHT) has been widely used to arthroscopically evaluate syndesmotic instability in the coronal plane, it is unclear whether the angulation of the applied force has any impact on the degree of instability. The aim of this study was to determine if changing the direction of the force applied while performing the LHT impacts the amount of coronal diastasis observed in purely ligamentous syndesmotic injuries. Methods: In 10 cadaveric specimens, arthroscopic evaluation of the distal tibiofibular joint in the coronal plane was performed. Anterior and posterior third coronal plane diastasis were assessed in the intact state and repeated after sequential transection of the, 1) anterior inferior tibiofibular ligament (AITFL), 2) the interosseous ligament (IOL) and the 3) posterior inferior tibiofibular ligament (PITFL). In all scenarios, the lateral hook test (LHT) was performed under 100N of laterally directed force. Additionally, LHT was also performed under 1) anterior inclination of 15 degrees and 2) posterior inclination of 15 degrees in the intact and AITFL+IOL deficient state. One-way ANOVA with post hoc Tukey HSD was used to test for significant differences in coronal plane measurements between each stage of ligament transection, and to determine the effect of different directions of force application on coronal space measurements in the intact and AITFL+IOL transected states. Results: Compared to the intact state, the distal tibiofibular joint remained stable after transection of AITFL under laterally directed force with no angulation. However, after additional transection of the IOL, the syndesmosis became unstable in the coronal plane (p = 0.029 and 0.025 for anterior and posterior third diastasis, respectively). This instability worsened further with subsequent transection of the PITFL (p = <0.001). Moreover, there was no statistical difference in anterior and posterior-third coronal diastasis in both intact and AITFL+IOL deficient states under neutral, anterior, and posteriorly directed force(p-values ranging from 0.816-0.993 and 0.396-0.80,respectively). However, in AITFL+IOL transected state, posteriorly directed forces resulted in greater diastasis than neutral or anteriorly directed forces. Conclusion: Angulation of the applied force ranging from 15 degrees anteriorly to 15 degrees posteriorly during intraoperative LHT has no effect on coronal plane measurements in patients with subtle syndesmotic instability. On the other hand, posteriorly directed forces result in more sizable diastasis, potentially increasing their sensitivity. When arthroscopically evaluating subtle syndesmotic instability, clinicians should assess coronal diastasis with the hook angled 15 degrees posteriorly.
Use of Flexible Carbon Fiber Insoles for Hallux Rigidus: A Randomized Controlled Trial
Authors: Bhimani Rohan , Sornsakrin Pongpanot , Vrolyk Michael A. , Lubberts Bart , Guss Daniel , DiGiovanni Christopher W. , Waryasz Gregory R. 
Published: November 2022

Category: Midfoot/Forefoot Introduction/Purpose: Rigid orthotics play an important role in the non-operative management of hallux rigidus. However, compliance can be low due to pain and discomfort. We hypothesized that patients with hallux rigidus who wear a carbon fiber orthotic that maintains some flexibility will report reduced pain, higher physical function, and higher compliance rates when compared with a more traditional, rigid Morton's extension insole. Methods: Four males and nine females (mean age of 56 years; range 35-79) diagnosed with unilateral 1st metatarsophalangeal arthritis were included in this randomized controlled trial. Participants randomly received either bilateral flexible carbon fiber insoles (VKTRY) (n=7) or unilateral Morton's extension insole (n=6). Outcome measures included patient self-reported compliance, comfort rate, and Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires Global Health, Pain Interference, v1.0 Pain Intensity, v2.0 Physical Function, and v1.0 Depression. Participants filled out questionnaires at the onset of the study and at two, six, and twelve weeks follow-up. Results: Compared to Morton's extension insole, use of flexible carbon fiber insole led to reduction of pain interference score at 6 and 12 weeks (median ∆∆ -9.5 vs 0.0 p=0.015; and median ∆∆ -15.1 vs -2.3 p=0.015, respectively), as well as reduction of pain intensity score at 6 and 12 weeks (median ∆∆ -11.9 vs -2.3 p=0.018; and median ∆∆ -11.9 vs -2.3 p=0.010, respectively). The compliance rate in flexible carbon fiber insole group was 100% at 2, 6 and 12 weeks, compared to 83%, 83% and 50% in the Morton group. In addition, patients wearing carbon fiber insoles experienced higher comfort levels (p-values ranging from <0.001 to p=0.007). There were no differences between the comparison groups at 2, 6, and 12 weeks in terms of the global health, physical function, and depression scores. Conclusion: Patients diagnosed with hallux rigidus may benefit from wearing more flexible carbon fiber insoles as compared to the traditionally used rigid orthotic insoles, such as the Morton's extension. Such inserts may better balance the need for mechanical shielding of the hallux while allowing some motion as, for example, occurs in the interphalangeal after fusion procedures.
Intramuscular Haemangioma of Abductor Hallucis Muscle: A Rare Case Report
Authors: Boedijono Dimas R. , Luthfi Andi Praja Wira Yudha 
Published: November 2022

Category: Other Introduction/Purpose: Haemangioma is a slow growing benign soft tissue tumor and its presentation in the foot is rare. Intramuscular haemangioma (IH) are usually found before 30 years of age, with gender predominance is still inconclusive. Methods: An 18-year-old woman came with pain and mass in the left foot for the past 3 years. Magnetic Resonance Imaging (MRI) of the left foot shown a heterogenous multilobulated mass, with previously thought originated from flexor digitorum brevis (FDB) muscle. Wide excision was performed. Results: Intraoperative findings showed that the mass actually originated from abductor hallucis muscle. Post-operative histopathological findings confirmed the diagnosis of cavernous-type of intramuscular haemangioma. Conclusion: Literature research identified very few cases of intramuscular haemangioma of the foot. Wide excision of the muscle is a feasible surgical treatment option.
Early Complications Following Minimally Invasive Surgery for Hallux Valgus in Patients with and without Diabetes
Authors: Cafruni Virginia M. , Novillo Hinostroza Matias A. , Parise Ana C. , Conti Leonardo A. , Carrasco Nelly M. , Villena Daniel S. , Sotelano Pablo , Gala Santini Araujo Maria 
Published: November 2022

Category: Diabetes; Bunion; Midfoot/Forefoot Introduction/Purpose: Diabetes mellitus (DM) is a chronic disease with a high worldwide prevalence. People with DM are more likely to develop complications compared to non-diabetic patients undergoing foot and ankle surgery. Currently, orthopedic surgery tends to use minimally invasive surgery (MIS), this resource is used to successfully solve forefoot deformities such as Hallux Valgus (HV). So far there is no evidence enough on this type of surgery and its complications in people with DM. The objective of this study is to determine the types and rates of early complications of elective MIS procedure for hallux valgus in a population of diabetic patients (DBT) compared to a control group of non-diabetic patients (NDBT). Methods: This retrospective study was carried out at our institution between October 2017 and August 2020. During the study period, 874 feet were operated on with MIS technique. All diabetic adults with a diagnosis of HV who underwent percutaneous correction surgery with distal metaphyseal osteotomy and a minimum follow-up of 6 months were included. All diabetic patients who underwent surgery had controlled diabetes with glycosylated hemoglobin less than 7%.For each DBT patient, we randomly selected two aged-matched patients +-1 year without DM as controls. In bilateral surgery, only the first operated foot was taken into account. Patients with previous foot surgery, open lesions or history of previous ulceration, Charcot's neuropathy, metatarsophalangeal osteoarthritis, peripheral vascular disease, and incomplete clinical history were excluded. Complications were recorded and defined as any deviation from the normal postoperative course. Results: A total of 75 patients were analyzed, 25 DBT and 50 NDBT. The follow-up was 10.8 months (6-48). There were no significant differences in demographic characteristics except for the body mass index and the Charlson comorbidity index, both of them were higher in the DBT group (p = <0.001). The complication rate was 18% (n = 9) in NDBT and 24% (n = 6) in DBT patients (p=0.553). There were also no significant differences in the different types of complications. Table 1. It is important to highlight that 7 of 9 complications of the NDBT group required a new surgical intervention (5 osteosynthesis extractions, 1 pseudarthrosis treatment and 1 toilette). In the DBT group, superficial infections were successfully treated with oral antibiotics. Conclusion: This would be the first study that specifically evaluates complications in diabetes patients with elective hallux valgus MIS correction. In our results, diabetic patients have not been associated with a higher rate of complications compared to non- diabetic patients.
3-Dimensional Analysis of First Tarsometatarsal Joint after First Metatarsal Osteotomy with Weightbearing CT (WBCT)
Authors: Cain Jarrett D. , Stolle Jordan T. , Siegler Sorin 
Published: November 2022

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: The pathology of the bunion deformity consists of deformities in the axial, coronal, and sagittal planes of the first metatarsal and its articular surface with the medial cuneiform. While weightbearing radiographs have been utilized for assessment of these deformities, such methods have limitations with regard to image magnification, patient position, and superimposition of bone alignments. With advances with weightbearing computed tomography (WBCT), evaluation of the 3- dimensional components of the first metatarsal along with its proximal articular surface can be assessed with greater precision. This study aims to observe the effect of the midshaft osteotomy on the alignment of the tarsometatarsal joint in three dimension Methods: Ten feet in 10 subjects underwent midshaft first metatarsal osteotomies. Weight-bearing (using a load equivalent to body weight) CT scans with .3mm cubic voxel size using an original loading device preoperatively and postoperatively were collected from each of the subjects in neutral standing position. Scans were segmented, and 3D renderings of the medial cuneiform, first metatarsal, and the first phalanx were also generated from the segmentations followed by definition of reference frames to evaluate changes in the metatarsal in relationship to the medial cuneiform. (Fig.1) Results: The measurements of the rotational parameters showed greater changes in the sagittal plane postoperatively with dorsiflexion of the first metatarsal relative to the medial cuneiform at the first tarsometatarsal joint (p<0.05).(Fig.2) Post-operative changes in the coronal plane and axial plane with relationship of the first metatarsal to the medial cuneiform were noted. Distance mapping showed a significant increase in surface-to-surface distance at the dorsal tarsometatarsal joint post-operatively with a reduced distance at the inferior portion of the tarsometatarsal joint. (Fig.3). Conclusion: Based on the results of the study, midshaft osteotomies of first metatarsal can cause increased dorsiflexion in the sagittal plane, significant eversion in the coronal plane, and external rotation in the axial plane at the tarsometatarsal joint. Distance mapping analysis on WBCT images identified differences in surface-to-surface interaction of the first metatarsal and the medial cuneiform
Is the Diagnosis of 5th Metatarsal Fracture Type Consistent? An Inter-Observer Reliability Study
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: Treatment pathways of 5th metatarsal fractures are commonly directed based on fracture classification, with Jones types for example, requiring closer observation and possibly more aggressive management. Our primary objective was to investigate the reliability of assessment of subtypes of 5th metatarsal fractures by different observers. Methods: Patients were identified from our prospectively collected database. We included all patient referred to our virtual fracture clinic with a suspected or confirmed 5th metatarsal fracture. Plain AP radiographs were reviewed by two observers, who were initially trained on the 5th metatarsal classification identification. Zones were defined as Zone 1.1, 1.2, 1.3, 2, 3, diaphyseal shaft (DS), distal metaphysis (DM) and head. Patients were excluded from analysis if neither observer could identify a fracture or if one or more observers could not access the images. An inter-observer reliability analysis using Cohen's Kappa coefficient was carried out, and degree of observer agreement described using Landis & Koch's description. All data was analysed using IBM SPSS v.27. Results: 1360 patients who met the inclusion criteria were identified. The two observers had moderate agreement when identifying fractures in all zones, apart from zone 1.2 and DM fractures, which only achieved 'fair' agreement (K=.308 and .381 respectively). Zones 1.1 (K=.538), 1.3 (K=.511), 2 (K=.515), 3 (K=.57), DS (K=.545) and Head (K=.558) all tended towards but did not achieve substantial agreement. Slight agreement with the next proximal and distal adjacent zones were found in Zones 1.1, 1.2 and 1.3. Slight agreement with the adjacent distal zone was found in Zone 2 and DM fractures. Zone 3 has slight agreement with Zone 2 proximally and there is an apparent difficulty with distal DS fractures resulting in a lot of crossover with DM, achieving a fair level of agreement (DS 312 vs 196; DM 120 vs 237; K=.398, p<.001). Conclusion: Reliability of sub-categorising 5th metatarsal fractures using standardised instructions conveys moderate agreement in most cases. If the region of the fracture is going to be used in an algorithm to guide a management plan and clinical follow up during a virtual clinic review, defining fractures of zones 1-3 needs careful consideration.
Outcomes of Hemiepiphysiodesis in Treatment of Juvenile Hallux Valgus (Systematic Review)
Authors: Chaudry Faran , Ahmad Ihtisham , Gaber Karim E. , Shehab Mohammed , Wariach Sajid , Kishta Waleed 
Published: November 2022

Category: Bunion Introduction/Purpose: The aim of this study was to evaluate the efficacy of percutaneous hemiepiphysiodesis for JHV by investigating the available literature on the procedure. Methods: The literature search was conducted by using the following bibliographic electronic databases: EMBASE, MEDLINE, and PubMed.gov. Study screening at all stages was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. The Methodological Index for Non-Randomized Studies (MINORS) scale was used to evaluate the quality of included studies. Data on patient characteristics, radiological and clinical outcomes, and notable complications were also collected. Results: Of the 91 studies identified by our search strategy, 4 met the inclusion criteria. The identified studies included 62 patients and 109 feet. The mean hallux valgus angle (HVA) improved preoperative to postoperative at a range of Δ3.45 to Δ5.5. The mean intermetastartal angle (IMA) improved preoperative to postoperative at a range of Δ2.2 to Δ4.0. The mean HVA progression per month improved from preoperative to postoperative at a range of Δ0.07 degrees/month to Δ0.17 degrees/month. The mean IMA progression per month improved from preoperative to postoperative at a range of Δ0.046 degrees/month to Δ0.067 degrees/month. Of the studies that reported a mean American Orthopaedic Foot and Ankle Society (AOFAS) score or a mean Hallux Metatarsophalangeal Interphalangeal Scale (HMIS), there was an improvement at a range of Δ16.5 to Δ36. Conclusion: Percutaneous Hemiepiphysiodesis can serve as an effective procedure for treating Juvenile Hallux Valgus.
A Novel Technique of Minimally Invasive Calcaneal Osteotomy for Intractable Insertional Achilles Tendinopathy Associated with Haglund Deformity
Authors: Choi Jun Young , Suh Jin Soo 
Published: November 2022

Category: Hindfoot Introduction/Purpose: To date, minimally invasive surgery (MIS) involving calcaneal osteotomy for Haglund deformity associated with intractable insertional Achilles tendinopathy has not been reported. This study presents the radiographic and clinical outcomes of our novel MIS-dorsal closing wedge calcaneal osteotomy (DCWCO) technique compared to open Haglund resection. We hypothesized that earlier clinical improvement after MIS-DCWCO could be achieved by leaving the Achilles tendon insertion site untouched. Methods: We retrospectively reviewed and compared the clinical and radiographic parameters of patients who underwent MIS- DCWCO (11 cases) or open Haglund resection (14 cases) between January 2012 and June 2019. The minimum duration of follow-up for inclusion was 18 months. We measured the calcaneal pitch, Meary's, Fowler-Philip, and Böhler's angles. Clinical outcomes were evaluated using the visual analogue scale (VAS) and Victorian Institute of Sports Assessment-Achilles (VISA-A) scores measured preoperatively and at 3, 6, 9, 12, and >=18 months, postoperatively. Results: In both groups, the Meary's and calcaneal pitch angles did not change significantly, whereas the Fowler-Philip and Böhler's angles were significantly changed postoperatively. Significant improvements in VAS and VISA-A scores were observed in both groups (P < .001). The extent of correction of the four radiographic and two clinical parameters were not significantly different between the two groups. However, VAS and VISA-A scores at postoperative 6 months were significantly different, whereas these parameters were not significantly different at all other time points. Conclusion: Both techniques provided similar postoperative clinical and radiographic improvement. However, MIS-DCWCO achieved earlier clinical improvement than open Haglund resection.