bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sesamoidectomy Utilizing a Medial Approach with a Bur: Patient Outcomes and Early Complications
Authors: Engasser William M. , Coetzee J. Chris , Seybold Jeffrey D. , Den Hartog Bryan D. , Ebeling Patrick B. , Raduan Fernando C. , Seiffert Kayla 
Published: January 2022

Category: Midfoot/Forefoot; Sports Introduction/Purpose: Patients with pathology of the sesamoids can have significant pain and disability both with activities of daily living and high impact athletic movements. Sesamoidectomy is a widely used procedure for patients who fail conservative treatment measures. Traditional dorsal or plantar approaches for sesamoidectomy have shown to successfully alleviate pain but complications are noted, including hallux varus deformity, painful plantar incision, and clawing of the hallux. Additionally, the dorsal approach is technically difficult because of poor visualization, which can lead to unnecessary disruption of important plantar ligamentous structures. An alternative medial approach using a bur provides many advantages compared to traditional approaches. Methods: This was a retrospective chart review of patients undergoing sesamoidectomy using a bur with a medial approach to the sesamoid metatarsal articulation. Data collected included patient demographics, radiographic analysis, and outcomes: Veterans Rand 12 Item Health Survey (VR-12), Foot and Ankle Ability Measure (FAAM), Visual Analog Scale (VAS), patient satisfaction, and complications. Results: In patients (10 feet) with an average age of 36.5 (range, 13-77) years were analyzed. Six patients underwent medial sesamoidectomy, three underwent lateral sesamoidectomy, and one patient underwent excision of both medial and lateral sesamoids using a bur. The average latest follow up was 11.9 months. Scores were improved from pre-operatively to most recent follow-up for VR-12 Physical (29.43 vs 53.86), FAAM ADL (48.8 vs 94.1 points), FAAM Sports (7.8 vs 87.4 points), and VAS (57.8 vs 8.6). Patient satisfaction with the treatment was 96.4%. There were zero complications or additional procedures performed. Conclusion: In this series, sesamoidectomy utilizing a medial approach with a bur provided excellent pain relief, zero complications, and significantly improved outcome scores at early follow up. The medial approach is familiar to orthopedic foot and ankle surgeons, provides adequate exposure, and eliminates the possibility of a painful plantar incision. Furthermore, this technique allows for maintenance of the plantar plate, flexor hallucis brevis (FHB) tendon, and all other ligamentous structures that attach to the sesamoids. Larger studies with longer term follow up are needed to further our knowledge on this surgical technique.
Extended Chevron Osteotomy in the Management of Mild-Severe Hallux Valgus: Clinical Results in a Long-Term Follow-Up
Authors: Espinosa-Uribe Abraham , Garza Jaime I. Ortiz , Terán Jorge Luis R. , Garza Fernando Alfredo F. , Carranza-Cantú Eduardo R. , Gutierrez Jorge A. 
Published: January 2022

Category: Bunion Introduction/Purpose: Hallux Valgus (HV) is a forefoot complex deformity. More than 200 surgical techniques for its treatment have been described, Chevron Osteotomy and its modifications represent a widely accepted highly reproducible option in the HV treatment. Since described in 1991 the Extended Chevron Osteotomy (ECO) represents a distal osteotomy with a plantar diaphyseal extension. Biomechanically the advantages it offers are even greater stability, early consolidation by increasing the contact surface and correcting the facet with a minimum shortening. It also offers lower morbidity and a lower rate of complications. However, there is controversy regarding long-term follow-up for most of these procedures. This study aims to demonstrate ECO for the correction of moderate to severe HV in a long-term follow-up. Methods: We reviewed 25 feet (20 patients) with moderate to severe HV in which the Intermetatarsal Angle (IMA) greater than 16⁰. The mean age was 64 years and the patients were followed by a mean of 30 (14 to 59) months. Additionally, 8 patients (N=12 feet) were followed with a mean of 68 (50 to 86) months. The following scales were applied before and after surgery: the functional scale of the American Orthopaedic Foot & Ankle Society (AOFAS) for the forefoot and the Visual Analog Scale (VAS). In the same way, the radiographic measurements corresponding to HV were made pre and postoperative. This research study was approved by our institution and hospital research ethics committee. Additionally, all the patients were reviewed under the Mexican law NOM-004-SSA3-2012 regarding Clinical file and privacy rights. Results: In the AOFAS for forefoot and VAS scales an improvement of 51.28 (CI95% 46.34 to 56.21) -6.08 (CI 95%-6.65 to -5.50) points, respectively. Regarding the angular values, the correction was -9.08⁰ (CI 95% -10.29 to -7.86) for the IMA. There was one foot with post-surgical infection (4%) and two feet (8%) with transfer metatarsalgia. Additionally, we documented a mean AOFAS forefoot score of 90.16 (+- 5.27) and a mean of 0.8 (+- 0.4) VAS scale during a second follow-up period of 68 months (range from 50 to 86 months) in 8 patients (N=12 feet). Statistically significant differences (p <0.05) were documented by the means of these long-term follow-up periods in the AOFAS score and VAS scale regarding the pre-surgical scores. Conclusion: According to the results obtained, we consider that the ECO technique for the treatment of moderate to severe HV provides significant functional improvement and angular correction (p <0.05) and good clinical outcomes on both long-term follow-up periods. ECO technique represents a highly reproducible option when performing HV correction.
Long-Term Outcomes of Autograft Osteochondral Transplantation for Osteochondral Lesions of the Talus: Eight to Twelve Years Follow-Up
Authors: Gianakos Arianna L. , Mercer Nathaniel P. , Dankert John , Kennedy John G. 
Published: January 2022

Category: Ankle Introduction/Purpose: Autologous osteochondral transplantation (AOT) is a replacement strategy used to treat osteochondral lesions of the talus (OLT), typically reserved for the treatment of lesions of larger sizes, highly cystic lesions, or in patients who have failed previous treatment. The purpose of this study was to evaluate the long-term (>8 years) clinical and radiographic outcomes of AOT for the treatment of OLT in the form of a retrospective case series. Methods: Patients who underwent AOT between 2006 and 2008 were evaluated. Functional outcomes were assessed pre- and post-operatively using the Foot and Ankle Outcome Score (FAOS), and Short-Form-12 (SF-12) general health questionnaire. The most recent post-operative MRI was evaluated with the modified Magnetic resonance Observation of Cartilage Repair Tissue (MOCART) score. Results: Twenty-eight patients who underwent AOT were included and evaluated at a mean follow-up of 122.9 months. The mean FAOS pain subscale improved from 52.7 to 82.9 and the mean SF-12 improved from 30.3 to 58.3 at final follow-up (both, p < 0.01). The mean FAOS pain subscale then decreased to 77.6 at final follow-up, but this decrease was not statistically significant (p=0.293). At the final follow-up, the mean FAOS subscale scores of symptoms, pain, daily activities, sports activities, and quality of life were 66.6, 77.6, 86.0, 60.4, and 53.6, respectively. The mean VAS score was 2.2 at a final follow-up. The mean MOCART score was 83.8 with a mean MRI follow-up of 82.8 months. Ten patients (35.7%) had additional surgery, with the most common procedure being arthroscopic anterior ankle debridement. One patient failed AOT and developed osteoarthritis of the ankle requiring a total ankle replacement. Conclusion: AOT appears to be an effective treatment for OLT with good long-term clinical and radiographic outcomes. Secondary procedures were typically minor and the overall clinical failure rate was low.
Standardization of the Foot Sagittal Axis for Measurement of Hindfoot Alignment Using Weight- Bearing Computed Tomography (WBCT)
Authors: Godoy-Santos Alexandre L. , Pires Eduardo A. , Lobo Carlos , Netto Cesar de Cesar , Fonseca Fabio C. , Sposeto Rafael B. 
Published: January 2022

Category: Hindfoot; Other Introduction/Purpose: The radiographic measurement of hindfoot alignment (HA) suggested by Saltzman, worldwide accepted, uses the medial aspect of the foot as the sagittal axis. When defining the medial face of the foot as its axis, the adduction and abduction deformities of the forefoot are disregarded, making it necessary to rotate the ankle internally or externally to acquire the radiographic image according to Saltzman protocol. The emergence of weight-bearing computed tomography (WBCT) allowed immeasurable advancements for a better understanding of the joints relations of the foot and ankle under stress. Previous studies using this technology adopted several sagittal axes to measure HA. Our hypothesis is that the adduction observed in the forefoot of the cavovarus feet illusively accentuates the real deformity of the hindfoot. Methods: Two evaluators calculated the HA of twenty-eight feet - 14 cavovarus and 14 neutral or slightly valgus (control group) - in three different sagittal axes (second metatarsal axis, calcaneus - second metatarsal axis and talar dome axis). Measurements were compared by Student's t-test after normality test by Shapiro-Wilk method. Observers' agreement was evaluated by intraclass correlation coefficient (ICC). P-values <.05 were considered significant. Results: We found excellent intra-observer (0.93) and inter-observer (0.9) agreements following the measuring assessment. The average Foot and Ankle Offset (FAO) of the cavovarus feet group was -3.35 (-0.64 - -7.01), while the control group was 2.01 (-1.3 - 6.4). The mean difference in HA when comparing the axis of the talar dome with the axis of the second metatarsal was 9.88 ° (3.1 ° - 17 °), while in the control group the mean difference was 3.16 (0.2 ° - 7.5 °). All of these data showed statistical significance. Conclusion: As a great variability was observed in the measurements of hindfoot alignment in the cavovarus foot group in the sagittal axes analyzed, this article suggests standardizing the measurement of hindfoot alignment using the talar dome axis. In addition, it becomes possible to quantify adaptations of the hindfoot secondary to modifications of the forefoot in an isolated manner.
Epidemiology of Ankle Sprain in the Military: A Systematic Review of Literature
Authors: Goodrich Ezra , Morris Brandon L. , Hermanns Christina , Herda Ashley A. , Tarakemeh Armin , Vopat Bryan G. 
Published: January 2022

Category: Ankle; Sports Introduction/Purpose: Ankle sprains occur frequently within the general population, however, the extent to which this injury impacts the military population remains unknown. The purpose of this study was to systematically review the literature describing ankle sprains in the military population. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, articles were retrieved from PubMed, Embase, and Cochrane Library using the search terms 'military,' 'epidemiology,' 'incidence,' 'prevalence,' 'ankle sprain,' and 'ankle instability.' Inclusion criteria consisted of active military duty status, English language, and levels of evidence I-IV. Results: Nineteen articles were included, representing 1,671,763 study participants from six countries and four branches of the military. Among the ten studies that reported ankle sprain incidence in terms of overall injury incidence, seven studies reported ankle sprain as the most common injury, with an incidence ranging from 2.20% to nearly one third of all injuries in the paratrooper population. Ankle sprain was also reported as the most common injury among lower extremity injuries in two studies, with incidences of 35% and 38.7%, respectively. Ankle sprain incidence rate per 1,000 person-years was reported in four studies, with values ranging from 15.3 to 58.4. Incidence rate was also reported for males and females separately in three of these studies, ranging from 33.89 to 52.7 for males, and 41.17 to 96.4 for females. The number of days lost to ankle sprain ranged from one to eight days per servicemember. Conclusion: Ankle sprains are among the most prevalent injuries within the military population, with a reported incidence that is higher for females than males. This injury results in time away from active duty, which impacts overall readiness within the military system.
Prevalence of Asymptomatic Bone Marrow Edema in the Talus in Professional Ballet Dancers: Preliminary Data from 2-Year Prospective Study
Authors: Harlow Ethan R. , Khambete Pranav , Ina Jason , Miskovsky Shana N. 
Published: January 2022

Category: Ankle; Sports Introduction/Purpose: Bone marrow edema (BME) appears as increased interstitial fluid accumulation within the bone marrow on magnetic resonance images (MRI). Asymptomatic BME has been found incidentally and described in competitive athletes, long- distance runners, and patients with altered biomechanics where the true etiology remains unclear. The natural history and clinical implications of asymptomatic BME in the elite and actively-competing athlete is not well characterized. Moreover, there is debate on how to manage and counsel patients on these findings in a high-risk bone such as the talus. This study presents early data from a prospective enrollment study of professional ballet dancers characterizing the prevalence of asymptomatic BME in the talus. Methods: Fourteen (14) professional ballet dancers enrolled in the 2-year prospective, IRB-approved study after informed consent was obtained. Exclusion criteria included: subjects reporting foot and ankle pain or disability on initial preseason evaluation, foot and ankle surgery or injury within the last year prior to evaluation, and any contraindications for MRI. Subjects underwent a physical examination and completed Foot and Ankle Ability Measure (FAAM) and Foot and Ankle Disability Index scores (FADI). Bilateral foot and ankle MRIs without contrast were completed upon study enrollment and interpreted by a blinded, fellowship-trained musculoskeletal radiologist. Results: Of 14 professional ballet dancers enrolled in the study, 6 were female, 8 were male, and the mean age was 24.4 years. All dancers reported no pain or disability in their feet and ankles at the time of evaluation and had physical exam findings unremarkable for performance-limiting pathology. Of the 14 dancers, 64% (9) had MRI evidence of talar BME. 6 subjects had bilateral talar BME and 3 had unilateral findings. 53% (8) had BME localized to the posterior process of the talus, 13% (2) localized in the talar body, 13% (2) localized to the talar head and neck, and 20% (3) subjects had pan-talar BME. All subjects had BME seen only on T2 sequences with one patient demonstrating bilateral pan-talar BME on both T1 and T2 sequences. There was no significant correlation using Welch’s unequal variances t-test (α = 0.05) between talar BME and either FADI or FAAM scores. Conclusion: These findings demonstrate a high prevalence (64%) of talar bone marrow edema in asymptomatic professional ballet dancers with benign physical exams and normal functional scores. Yet, the long-term clinical significance of these findings are unknown.
Increased Complication Rate Associated with Podiatric Surgery
Authors: Hoch Caroline P. , Scott Daniel J. , Brinton Daniel L. , Maldonado Lizmarie , Gross Christopher E. 
Published: January 2022

Category: Other; Ankle; Bunion; Diabetes; Hindfoot; Midfoot/Forefoot Introduction/Purpose: Nationally, there has been an increase in the scope of practice between orthopaedic surgeons and podiatrists. However, there is a paucity of studies in the literature comparing outcomes between orthopaedic and podiatric surgeons in different areas of foot and ankle surgery. Methods: A retrospective analysis was conducted using 2016-2017 5% US national sample of the Medicare limited dataset (LDS). This included a total of 527 patients undergoing one of 14 CPT foot and ankle specific codes. Basic demographics, medical comorbidities, and 1-year post-surgical complications were reviewed. One-hundred and eighteen patients were operated on by a podiatrist versus 409 who were operated on by a physician. Mean age was 69. Common procedures included gastrocnemius recession (n=168), ankle fracture open reduction internal fixation (168), and Achilles tendon repair (72). Continuous variables were compared using Wilcoxon-Mann Whitney test and categorical variables with chi-squared test. In addition, a multivariable regression was performed, evaluating the impact of various factors on odds of complication. Results: Between cohorts, there were no statistically significant differences in demographics, Charlson Score, COPD, hypothyroidism, hypertension, or obesity. There was a higher rate of peripheral vascular disease in patients treated by a podiatrist versus a physician (8.5% vs. 2.4%; P=.0025). Univariate analysis showed complication rates were higher among podiatrist compared to physicians (29.7% vs. 18.8%; P=.0113). Specifically, there were high rates of complications for bunion correction (4.2% vs. 1.0%; P=.0160), diabetic wound infection (11.0% vs. 1.5%; P<0.0001), and plantar fascia release (7.6% vs. 0.1%; P=.0001). Multivariable logistic regression showed patients operated on by a podiatrist had 84.1% greater odds of suffering a complication than those operated on by a physician (OR: 1.84, 95% CI: 1.15-2.96). Conclusion: Surgical treatment of multiple types of foot and ankle conditions by orthopaedic surgeons was associated with lower complication rates when compared with podiatrists. The reasons for these differences are likely multifactorial, but warrants further investigation. Our findings have important implications for policymakers, as well as for large healthcare systems and patients when selecting a treating provider for surgical problems.
Vancomycin Powder Associated with Decreased Surgical Site Infections in Lower Extremity Trauma
Authors: Hoch Caroline P. , Robinson Christopher L. , Robinson Christopher L. , Rovner Alex , Waggett Raines M. , Horn Ryan , Scott Daniel J. , Gross Christopher E. 
Published: January 2022

Category: Ankle; Ankle Arthritis; Arthroscopy; Bunion; Hindfoot; Midfoot/Forefoot; Sports; Trauma Introduction/Purpose: The use of intraoperative topical vancomycin powder has recently increased in popularity as a method of theoretically decreasing post-operative surgical site infections; however, there is limited research in orthopaedic trauma to support its use. This study evaluates the use of topical vancomycin powder to decrease post-operative infections following lower extremity trauma. We also investigated socio-demographic factors and medical comorbidities that were associated with post- operative surgical site infections. Methods: We conducted a review of 226 patients at a single Level 1 Trauma Center following surgery between the years 2015 and 2020. These patients were treated predominantly by a single fellowship trained foot and ankle orthopaedic surgeon. Demographic factors, medical comorbidities, postoperative infections, and use of vancomycin powder were reviewed. Analysis of 4 groups (no infection, superficial infection, deep infection, or both) was performed using Fischer's exact test and Student t-test. A logistic regression model was utilized to identify independent demographic factors and medical comorbidities that were associated with surgical site infection. Results: The final cohort included 221 patients, of which 26 received intraoperative vancomycin powder. There were 23 total post-operative surgical site infections. Of those, 14 infections were superficial, 3 were deep, and 6 were both superficial and deep. All but one of these infections were in patients without vancomycin powder applied. Patients who received intraoperative vancomycin powder were statistically significantly less likely to acquire post-operative surgical site infections than those who did not (1 vs. 22, p=0.031). The one postsurgical site infection with vancomycin use was a deep infection in a patient with chronic kidney disease that had previously undergone three irrigation and debridement surgeries for a gunshot wound. Male sex was the only demographic or comorbidity factor associated with postoperative surgical site infection (p=0.009, OR=4.006). Conclusion: We found an association between topical vancomycin use and lower likelihood of developing postsurgical wound infections in lower extremity trauma. This is consistent with similar studies in spinal surgery. In contrast to previous studies, we did not find a significant association between medical comorbidities or demographic factors other than male sex and surgical site infection. Future studies should aim to identify which patients would have the greatest reduction of risk for postsurgical wound infections with the use of intraoperative topical vancomycin powder.
Clinical and Radiological Outcomes of Modified Lapidus Procedures Using 2 Compression Cannulated Screws in Hallux Valgus Deformity
Authors: Im Jemin , Jung Hong-Geun , Lim Jung-Won 
Published: January 2022

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Hallux valgus is common disease. Surgical correction is usually required because, conservative treatment can not correct deformity and lacks evidence for prevention of progression of deformity. Among the various methods for the correction of hallux valgus deformity, the modified Lapidus procedure is known to be performed in less than 10%. The purpose of this study is to investigate the clinical and radiological outcomes of patients who underwent the modified Lapidus method. Methods: From January 2010 to December 2019, 34 cases of patients who underwent the modified Lapidus procedure and followed up for at least 6 months were included in the study. For clinical evaluation, VAS score, AOFAS score, and patient satisfaction (very satisfied, satisfied, dissatisfied, very dissatisfied) were used. For radiological evaluation, hallux angle and 1-2 metatarsal angle on anterior and posterior foot x-ray of the weight-bearing were used. Furthermore, rate of bone union and the period until bone union were also evaluated. Results: The mean follow-up period was 21.0 (6~108) months. The indications for surgery were: Severe hallux valgus in 30 cases, metatarsus adductus in 17 cases, recurrent hallux valgus in 4 cases, and hypermobility of the first tarso-metatarsal joint in 10 cases. In terms of VAS score, between pre-operation and the last follow-up was significantly improved from 5.8+-2.1 to 1.1+-1.4 (p<0.05), and the AOFAS score from 52.8+-15.0 to 92.3+-9.8 (p<0.05). In terms of patient satisfaction, 33 patients (97.1%) showed overall satisfaction (very satisfied and satisfied). Complications were nonunion in 3 cases (8.8%), incomplete union in 1 case, delayed union in 1 case, and hallux varus in 1 case. There was no additional surgery for these complications. At preoperative and last follow-up, the hallux angle improved from 46.0°+-10.7° to 5.9°+-11.7°, and the 1-2 IMA improved from 18.2°+-5.1° to 5.5°+-4.5°. In the cases excluding complications, the average period to bone union was 3.9(3-8) months. Conclusion: In our study, the modified Lapidus method using 2 compression cannulated screws was showed satisfactory clinical, radiological outcomes and relatively satisfactory bone union (91.2%) in a short follow-up. The modified Lapidus method using 2 compression cannulated screws is a considerable option for severe hallux valgus deformity.