bluuebunny/crossref_metadata_2025_split huggingface dataset:
Soft Tissue Thickness as a Predictor of Wound Complications after Total Ankle Arthroplasty: A Retrospective Study
Authors: Kalma Jeremy J. , El-Zein Zein S. , Koueiter Denise , Fortin Paul T. 
Published: January 2022

Category: Ankle Arthritis; Ankle Introduction/Purpose: Periprosthetic joint infection following total ankle arthroplasty (TAA) is a serious complication often related to the surrounding soft tissue envelope which can lead to poor patient outcomes. The purpose of this study was to determine the relationship between wound complications following TAA and the overlying soft tissue envelope thickness using standardized radiographic soft tissue measurements. We hypothesized that a smaller soft tissue thickness would correlate with an increase in complications. Methods: 197 patients who underwent primary TAA between October 2014 and December 2018 at a single institution with preoperative radiographs and 6 months of follow up were analyzed. We measured the horizontal distance from the posterior tibia to the overlying anterior skin surface and tibial width 2 cm above the tibiotalar joint on lateral ankle films. The ratio of the soft tissue thickness to the tibial width was calculated and named the ankle soft tissue thickness ratio (ASTR). The patients were divided into 2 groups based upon their ASTR. There were 102 patients in the low ASTR group (ASTR <1.38) and 95 patients in the high ASTR group (ASTR >1.38). Minor complications involved office-based treatment and/or oral antibiotics. Major complications involved surgical intervention. A chi-squared test determined complication incidence variance amongst patients in each ASTR group and an independent t-test determined mean ASTR difference. Results: Twenty-nine wound complications (14.7%) were identified among 197 patients, 24 (82.8%) minor and 5 (17.2%) major. There were 19 wound complications in the low ASTR group (17 minor and 2 major) and 10 wound complications in the high ASTR group (7 minor and 3 major). Complications were more frequent in the low ASTR group compared to high ASTR group, though not statistically significant (18.6% vs. 10.5%, P=0.158). There was no difference in the mean ASTR measurement between patients with and without wound complications (1.36 vs. 1.40, P=0.093). Conclusion: This study does not demonstrate a statistically significant difference in post-operative TAA wound complications based on standardized radiographic soft tissue thickness measurements. Though not statistically significant, complications were more frequent in patients with a lower ASTR. Lower surgical site soft tissue thickness may be a predictor of increased risk for wound complications following TAA however further research including studies with larger patient populations is needed to make this determination.
Calcaneal Bone Morphology in Association with Bone Mineral Density Status: A Cadaveric Study
Authors: Keeratiruangrong Jakkrit , Vaseenon Tanawat , Namwongprom Sirianong , Saengsin Jirawat 
Published: January 2022

Category: Basic Sciences/Biologics; Ankle; Other Introduction/Purpose: Displaced intra-articular calcaneal fractures are mostly treated by reduction and internal fixation. The calcaneal cortical thickness and regional bone density play an important role in the stability of the fixation construct. This study aims to assess the relationship between calcaneal bone morphology and bone mineral density (BMD) status. Methods: Seventeen fresh cadaveric specimens underwent a BMD scan at the femoral neck and were later classified according to WHO criteria into three groups, including normal five specimens, osteopenic six specimens, and osteoporotic groups six specimens. The calcaneus bone of each specimen was then dissected and evaluated for the bone morphology. The sustentaculum tali of the calcaneus was divided into anterior, middle, and posterior segment. The superior, inferior, and posterior cortices of the calcaneus were equally divided from medial to lateral into five segments and from anterior to posterior into three segments (Figure 1). The cortical thickness (mm) was measured at the center of each divided fragment. The calcaneal bone density (g/cm3) was quantified at three regions of interest (ROI), including superior, inferior, and posterior ROI (Figure 2). Results: The calcaneal cortical thickness and calcaneal bone density of each fragment or each ROI were demonstrated as the median and interquartile range (IQR) (Table 1-5, Figure 3). The overall cortical thickness and calcaneal bone density values were significantly lower in the osteopenic or osteoporotic group when compared with the normal BMD group. Notably, the cortical thickness of the normal group at the lateral one-fifth and/or lateral two-fifth fragment of the superior, posterior, and inferior cortices of the calcaneus were not significantly different when compared with the osteopenic or osteoporotic group. When focusing at the sustenaculum tali, the posterior cortical thickness was significantly different only when compared between the normal and osteoporotic groups. Inter and intra-rater reliability of the outcome measurements were all excellent (>0.80). Conclusion: The cortical thickness of the posterior aspect of the sustenaculum tali, as well as the cortical thickness of the lateral one-fifth and lateral two-fifth of the calcaneus, were less likely effected by the decrease in BMD status. However, the anterior part of sustenaculum tali, anteromedial area of superior and inferior cortex and inferomedial area of posterior cortex are thicker than others.
A Historical Analysis of Randomized Controlled Trials in Pediatric Orthopaedic Foot and Ankle Surgery
Authors: Khurshed Abdulaziz , Abuhantash Monther , Kay Jeffrey , Habib Anthony S. , Kishta Waleed , de SA Darren 
Published: January 2022

Category: Ankle; Bunion; Lesser Toes; Midfoot/Forefoot; Trauma Introduction/Purpose: The primary objective of this systematic review was to comprehensively assess the quality of reporting of randomized controlled trials (RCTs) relating to pediatric orthopaedic foot and ankle conditions. Additionally, this current study looked at factors related to the quality of the RCTs and trends in the quality of reporting over time Methods: This systemic review was performed according to an agreed predefined protocol and conducted according to Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) statement standards. PubMed, Ovid (MEDLINE) and Embase were searched for all RCTs on foot and/or ankle surgery from the database inception until March 31, 2020. The quality of reporting was evaluated using the Detsky quality index and the Consolidated Standards of Reporting Trials (CONSORT) checklist for reporting trials of nonpharmacologic treatments. A multivariate regression analysis was used to assess predictors of quality reporting. Results: The online search yielded 3,697 articles, 22 of which met the inclusion criteria and were assessed for quality of reporting. The earliest identified RCT was published in 1991. Close to 70% of all RCTs have been produced over the past 10 years (since 2010), and over 90% have been published in the past 20 years (since 2000). There has been a significant increase in the number of RCTs published over time (p=0.042). The mean (SD) Detsky score across all included studies was 69.2% (13.8%). Nine (41%) of the studies were considered 'high-quality' with a standardized Detsky score greater than or equal to 75%. The strongest predictor of quality reporting was the inclusion of a CONSORT flow diagram (β-coefficient: 18.4, p=0.0013). Conclusion: Despite an increase in the quantity of pediatric F&A RCTs over time, the quality has not significantly improved. The use of a CONSORT flow diagram is a strong predictor of high-quality reporting. We encourage investigators to devote more efforts in conducting high-quality RCTs in pediatric orthopaedic foot and ankle, as these are scarce in the literature.
Radiographic Evaluation of the Normal Distal Tibiofibular Syndesmosis in Neutral to Dorsiflexion on Weight-Bearing
Authors: Kim Ki Chun , Lee Kyung-tai , Young Kiwon 
Published: January 2022

Category: Ankle; Sports Introduction/Purpose: Reliable landmarks of ankle syndesmosis change in various position is important for managing ankle injury. The purpose of our study was to investigate and compare radiographic landmarks of normal ankle in various positions. Methods: The study involved both ankle radiographs of 30 subjects (15 males, 15 females) without clinical or radiographic abnormality. Tibiofibular clear space (TFCS) and tibiofibular overlap (TFO) were measured on anteroposterior (AP) and mortise radiographs in non-standing (NS) and standing (S) neutral and dorsiflexion 10 (DF10) and 20 degrees (DF20). The radiographic measurements were used to calculate means, standard deviations, and intra- and interobserver reliabilities, and compare TFCS and TFO in various positions and genders. Results: On the AP view, the mean TFCS in NS, S, DF10, and DF20 positions were 4.00+-0.97, 4.00+-0.83, 4.35+-0.95, and 4.45+-0.89 and the mean TFO on the same positions were 6.58+-2.27, 4.27+-1.90, 3.44+-1.96, and 2.38+-1.91. On the mortise view, the mean TFCS in NS, DF10, and DF20 positions were 3.62+-0.88, 4.08+-0.86, and 3.88+-0.97 and the mean TFO on the same positions were 3.57+-2.13, 2.31+-1.77, and 3.57+-2.14. The reliabilities in all positions except TFCS on some positions were excellent. No measurement was significantly different between females and males except TFO in NS on mortise view (p=0.006) and DF10 on AP view (p=0.032). Conclusion: Increase of TFCS and decrease of TFO on AP view reflects syndesmosis change from non-standing to DF20 on standing. Clinically, Effect of weight-bearing and reliability of TFO should be considered.
Histological Findings Upon Patients Undergoing Revision Surgery after AMIC of the Talus
Authors: Krause Fabian , Anwander Helen , Schaefer Birgit 
Published: January 2022

Category: Ankle Arthritis Introduction/Purpose: Failure after AMIC (autologous matrix-induced chondroplasty) of the talus is relatively rare and ranges between 2-6%. The purpose of the study was to analyze the histologic quality of the repair cartilage and potentially identify the mode of failure in 3 patients that underwent revision surgery after primary AMIC procedures. Methods: Out of 48 patients treated with AMIC for OLT between 2012 and 2018 at our institution, three patients (6.2%, average age 27.3 years) required revision surgery for various reasons. During revision, repair cartilage was evaluated about integration with the surrounding healthy cartilage and firmness, and specimen were taken for histologic assessment. Results: Only one patient that had, next to revision AMIC, a lateral ligament reconstruction for a secondary supination sprain, improved clinically after revision surgery (patient no.3). Despite repair SMOT (no.1) or deltoid ligament repair (no.1), the two other patients did not benefit from revision. Supposed reasons for ongoing symptoms were progressive posttraumatic arthritis (no.1 and 2) and neuropathic pain (no.2). Three types of soft connective tissues could be identified: (i) non-vascularized fibrocartilaginous tissue (patient no. 1-3), (ii) fibrous tissue (patient no. 1 and 2), and (iii) hyaline like cartilage (patient no. 3). Conclusion: Overall, data support the theory that patients with hyaline or hyaline-like repair cartilage tend to better clinical outcome over time. However, the growth of hyaline or hyaline-like repair cartilage appears to require ligamentous stability, neutral or even offloading hindfoot alignment, and absence of arthritis.
Percutaneous Bunionette Correction without Fixation: Clinical Results and Radiographic Evaluations Including Rotation of Metatarsal Head and Sagittal Angular Change of Fifth Metatarsal
Authors: Kurashige Toshinori 
Published: January 2022

Category: Lesser Toes Introduction/Purpose: Bunionette has been treated as an analogy of hallux valgus, and the surgical techniques are similar. However, only the anteroposterior image is generally evaluated pre- and postoperatively. There are few studies that evaluated on the lateral radiograph, and to the best of our knowledge, no study that evaluated changes in rotation of fifth metatarsal head. In percutaneous bunionette correction using a burr, shortening of fifth metatarsal and elevation of metatarsal head are inevitable. In addition, there is also the possibility of rotational change of metatarsal head without fixation. Methods: We evaluated 18 consecutive feet performed percutaneous bunionette correction without internal fixation. Mean age was 54.9 years. Mean follow-up was 10.1 months at least six months followup. On anteroposterior weightbearing radiograph, we measured the fifth metatarsophalangeal angle (MPA), fourth and fifth intermetatarsal angle (IMA), the fifth metatarsal head width (MHW), the lateral deviation angle (LDA) of the fifth metatarsal, and fifth metatarsal shortening. On the lateral weightbearing radiograph, we measured the lateral inclination angle (LIA) of the fifth metatarsal, the fifth distal metatarsal height (DMH), mid metatarsal height (MMH), proximal metatarsal height (PMH), and plantar bowing angle (PBA). To evaluate the rotation of the fifth metatarsal head, we devised a new original method measured at the medial tubercle location (MTL). Preoperatively and at the most recent follow-up visit, we applied the Japanese Society for Surgery of the Foot (JSSF) lesser scale and visual analogue pain scale (VAS). Results: Except for MTL, DMH and PMH, all parameters showed significant changes postoperatively.MPA, IMA and LDA reduced from 17.3 degrees to 6.4 degrees, from 9.9 degrees to 4.5 degrees, and from 2.3 degrees to -10.0 degrees, respectively. Shortening of fifth metatarsal was 2.5 mm. Despite not performing partial head resection, MHW decreased from 12.1mm to 11.4 mm. LIA decreased from 9.2 degrees to 6.1 degrees. MMH decreased from 11.6 mm to 10.9 mm. PBA decreased from 7.0 degrees to -1.3 degrees. Union was obtained at 6.9 weeks. MTL reduced from 3.4 to 2.8 but not significantly. However, MTL changed in 15 of 18 feet (83.3%) postoperatively. JSSF lesser scale improved from 66.7 to 97.8 points. VAS also improved from 3.6 to 1.0. One foot had a delayed union and an occasional pain. Conclusion: Percutaneous bunionette correction without fixation could achieved good clinical and radiographic results comparable with previously published outcomes of open and percutaneous surgery with fixation with less complication. The procedure could be adapted to different types of bunionette deformity. In this surgical method, bunionette is corrected in three dimensions.
Percutaneous Surgery for Interdigital and Lateral Fifth Toe Corns
Authors: Kurashige Toshinori 
Published: January 2022

Category: Lesser Toes Introduction/Purpose: Lateral fifth toe corns (LFC) form as a result of extrinsic pressure from footwear. Interdigital corns (IDC) form over the condyles of the phalanx between the toes, and can be soft and very painful in most cases. When conservative treatment fails, surgical treatment is indicated. Partial condylectomy for interdigital cornsis difficult because of the narrow webspace and risk of painful postoperative scar. No prior study has been published on percutaneous surgery for lateral fifth toe and interdigital corns, with the exception of some publications on the explanation of the technique. Methods: We performed percutaneous partial condylectomy for six toes in five patients with one LFC and five IDCs. The mean age was 71 years. The mean follow-up period was 16.2 months. All feet, except for one malalignment case after second proximal phalanx fracture, had both hallux valgus and bunionette. A small incision was made distal to the corn to allow the insertion of the entire cutting surface of a burr to avoid skin damage. The periosteum was removed from the eminence by a small rasp and provided an adequate working area. The bone eminence was then removed with 2-5 or 2-8 mm burrs. For hallux valgus and proximal phalanx malalignment after fracture, we also corrected them percutaneously. In some cases, the Japanese Society for Surgery of the Foot (JSSF) lesser toes scales and self-administered foot evaluation questionnaire (SAFE-Q) were evaluated pre- and postoperatively. Results: There was no complication, except for one valgus deformity in the second proximal interphalangeal joint after partial condylectomy. At the final follow-up visit, all patients had no recurrence of corns and no symptoms, and were very satisfied with the results during the follow-up period of one year. In case of IDC, JSSF lesser toes scale improved from 45 points to 100 points at the final follow-up. All SAFE-Q subscores were improved with regard to 'Pain and pain-related' sensations from 36.7 to 99.6, 'Physical functioning and daily living' from 54.5 to 100, 'Social functioning' from 37.5 to 100, 'Shoe-related' from 25 to 100, and 'General health and well-being' from 25 to 95. The visual analog scale of pain improved from 7 to 0.4. Conclusion: The percutaneous procedure consisted of partial condylectomy with correction of associated deformities achieved good results without major complications and recurrence over the one year follow-up period.
Radiographic and Clinical Results of Minimally Invasive Chevron Akin Osteotomy for Moderate to Severe Hallux Valgus Deformities
Authors: Kurashige Toshinori 
Published: January 2022

Category: Bunion Introduction/Purpose: Some authors reported the results from the third-generation minimally invasive chevron Akin osteotomy (MICA) to treat mild to moderate hallux valgus recently. However, there have been few studies evaluating the results of MICA for moderate to severe hallux valgus. The purpose of this study was to evaluate the radiographic and clinical results of MICA for correction of moderate to severe hallux valgus. Methods: A prospective review of 30 patients (40 feet) that underwent MICA for moderate to severe hallux valgus was conducted. The 28 feet (70%) were classified as severe deformity (hallux valgus angle (HVA) >= 40°and/or first intermetatarsal angle (IMA) >= 18°). Mean followup was 18.6 months. On the anteroposterior weightbearing radiographs, HVA, IMA, lateral shape of metatarsal head (round sign), tibial sesamoid position, and first metatarsal shortening were measured. On the lateral weightbearing radiographs, inclination angle of first metatarsal was measured. American Orthopaedic Foot & Ankle Society hallux metatarsophalangeal-interphalangeal (AOFAS) scores and Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were evaluated preoperatively and at the most recent follow-up. Results: Mean HVA reduced from 39.3° to 12.8°and mean IMA reduced from 18.6° to 8.4° postoperatively. Incidence of positive round sign of metatarsal head reduced from 57.5% to 5%. Tibial sesamoid position improved from 6.7 to 4.7 using Hardy's classification. Average first metatarsal shortening was 2.8mm. Inclination angle did not changed significantly, from 20.5°to 21.1°. Mean AOFAS score improved from 65.3 points to 97.9 points. All SAFE-Q subscores also significantly improved postoperatively. There were 5 complications required surgeries: 2 metatarsal screw removals and 3 bone eminence resections. There were some other complications including 3 under-correction cases and one numbness for at least 6 months. Conclusion: MICA could improve moderate to severe hallux valgus both radiographically and clinically. Accordingly, our results suggest that this procedure provides an effective means of correcting hallux valgus regardless of severity of deformity.
Correlation of Stress Radiographs to Injuries Associated with Lateral Ankle Instability
Authors: Lause Gregory E. , Sy Joshua , Lopez Andrew , Deal J. Banks , Lustik Michael , Ryan Paul M. 
Published: January 2022

Category: Ankle; Sports Introduction/Purpose: Stress radiographs have demonstrated superior efficacy in the evaluation of ankle instability. The purpose of this study is to determine if there is a degree of instability evidenced by stress radiographs that is associated with pathology concomitant with ankle ligamentous instability. Methods: A retrospective review of 87 consecutive patients aged 18-74 who had stress radiographs performed at a single institution between 2014 and 2020 was performed. These manual radiographic stress views were then correlated with MRI and operative findings. Results: A statistically significant association was determined for the mean and median stress radiographic values and the presence of peroneal pathology (p=0.008 for tendonitis and p= 0.020 for peroneal tendon tears). A significant inverse relationship was found between the presence of an osteochondral defect and increasing degrees of instability (p=0.043). Conclusion: Stress radiographs may assist the surgeon in clinical decision making.
Additional Inferior Extensor Retinaculum Augmentation after All-Inside Arthroscopic Anterior Talofibular Ligament Repair for Chronic Ankle Instability is Not Necessary
Authors: Lee Sung Hyun 
Published: January 2022

Category: Ankle; Arthroscopy; Sports Introduction/Purpose: Although several arthroscopic surgical techniques for the treatment of chronic ankle lateral instability (CAI) have been introduced recently, the effect of inferior extensor retinaculum (IER) augmentation remains unclear. The purpose of this study was to compare the clinical outcomes after arthroscopic anterior talofibular ligament (ATFL) repair according to whether additional IER augmentation was performed or not. Methods: Between 2016 and 2018, we performed a retrospective review of consecutive patients who underwent arthroscopic ATFL repair surgery for CAI. The mean age of the patients was 35.2 years (range, 19-51 years), and the mean follow-up period was 32.6 months (range, 24-48 months). Patients were divided into two groups according to the surgical technique used for CAI: Arthroscopic ATFL repair (group A, n = 37), and arthroscopic ATFL repair with additional IER augmentation (group R, n = 45). The Pain Visual Analog Scale, American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome score (FAOS), and the Karlsson Ankle Functional Score were measured as subjective outcomes, and posturographic analysis was performed using a Tetrax device as an objective outcome. Radiologic outcome evaluations were performed preoperatively and at 2 years postoperatively using stress radiographs and axial view MRI. Results: Out of 101 patients, 19 (18.5%) were excluded based on the exclusion criteria, and 82 patients were evaluated. We identified a total of six re-tears (7.3%) based on postoperative MRI evaluation. All patients who had ATFL re-tear on MRI (8.1% [3/37] in group A, and 6.7% [3/45] in group R) demonstrated recurrent CAI with functional discomfort and anterior displacement > 3 mm compared to the intact contralateral ankle. All clinical scores and posturography results were improved after surgery in both groups (P < 0.001). However, there were no significant differences in the clinical results and radiologic findings between the two groups. Conclusion: The clinical and radiologic outcomes of patients with CAI improved after all-inside arthroscopic ATFL repair. However, additional IER augmentation after arthroscopic ATFL repair did not guarantee better clinical outcomes.