bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes Following Intramedullary Nail vs Plate Fixation for Tibiotalocalcaneal Arthrodesis: A Systematic Review
Authors: Hegeman Erik , Dowd Thomas C. , Huh Jeannie 
Published: January 2022

Category: Ankle Arthritis; Hindfoot; Trauma Introduction/Purpose: Tibiotalocalcaneal arthrodesis (TTCA) is indicated to treat pain and dysfunction that may result from a variety of ankle and hindfoot pathologies by achieving fusion of the tibiotalar and subtalar joints. Two common fixation methods exist to achieve TTCA: retrograde intramedullary nail (IMN) fixation and plate fixation using a lateral trans-fibular or posterior Achilles-tendon splinting approach. The purpose of this study is to review the literature and compare the outcomes of TTCA using IMN fixation with those of plate fixation using a lateral trans-fibular approach. Methods: A comprehensive search of the PubMed, Cochrane, and EMBASE databases was performed on 01 February 2021 for studies of all levels of evidence pertaining to TTCA using IMN and plate fixation. Reasons for exclusion included: no formal joint preparation, non-English language, concomitant methods of fixation (e.g., IMN with additional plate fixation) and follow-up less than 12 months. Results: Fourteen studies (11 level III and 3 level IV) met criteria and were included. A total of 386 fusions were documented in 356 patients [259 (67%) IMN and 127 (33%) plate fixation]. In the IMN group, union rates at the tibiotalar joint (TTJ) were 84% (219/259) and subtalar joint (STJ) were 90% (229/259) with an overall complication rate of 20% (53/259). Average initial AOFAS scores were 34.3+-7.9, increasing to 72.4+-9 postoperatively. In the plate fixation group, union rates at the TTJ were 82% (103/127) and STJ were 86% (108/127) with an overall complication rate of 30% (39/127). Average initial AOFAS scores were 37.0+-6.9, increasing to 74.4+-12.5 postoperatively. No statistical differences were noted between the TTCA IMN and plate cohorts when comparing rates of TTJ or STJ union (p= 0.6, and p=0.2, respectively) and postoperative AOFAS scores (p=0.59). However, the plating group had a statistically higher overall complication rate (p=0.02). Conclusion: A systematic review of the available literature suggests that there is no statistical difference in union rates or functional outcomes between TTCA using intramedullary nail or lateral trans-fibular plate fixation. However, the lateral trans- fibular plate has a statistically higher complication rate when compared to intramedullary nails. Further comparative prospective cohort studies and randomized controlled trials are needed to further elicit differences between these groups and confirm the findings of this systematic review.
Assessing the Influence of Pain and Resiliency Scores on Post-Operative Outcomes
Authors: Hoch Caroline P. , Pire Jonathan R. , Pire Jonathan R. , Scott Daniel J. , Gross Christopher E. 
Published: January 2022

Category: Other; Ankle; Hindfoot; Midfoot/Forefoot Introduction/Purpose: Resilience is defined as the ability to recover after stressful events and has been shown to correlate with surgical outcomes across multiple fields. To date, there has been minimal research on the impact of patient resiliency on outcomes of foot and ankle surgery. Thus, this study aimed to look for an association between resilience, as measured by the Brief Resilience Scale (BRS); pain, as measured by the Pain Disability Index (PDI) and Pain Catastrophizing Scale (PCS); and post-operative outcomes after foot and ankle surgery. Methods: At a single academic medical center, a retrospective review of prospectively collected data was conducted on orthopaedic foot and ankle (n=201) and podiatric (n=7) patients who completed a pre-operative BRS and underwent surgery between 2019 and 2020 (N=208). The cohort consisted of 46 post-operative opioid users and 162 non-users. Data collected included demographics, comorbidities, diagnoses, procedure (i.e., removal of implant=22, Brostrom=15, tenolysis of flexor or extensor tendons=11, 1st MTP fusion=11, cheilectomy=10, etc.), PDI and PCS scores, complications, outcome markers, and pre- and post-operative opioid and benzodiazepine use. Data was analyzed with one-way ANOVA and linear and multivariate regressions formulated by SPSS software. Results: The PDI score significantly correlated with post-operative benzodiazepine (p=.011) and opioid use (p=.006), the BRS score significantly correlated with post-operative benzodiazepine use (p=.007), and the PCS score significantly correlated with longer length of follow-up (p=.011). Pre-operative opioid use was associated with an increased rate of 30-day readmission (users=6.52%, non-users=2.47%; p<.001). The multiple regression analysis indicated that the BRS score remained significantly correlated to post-operative benzodiazepine use (p=.004). Results of the multiple regression analysis also indicated that higher PCS scores were significantly correlated with increased rates of 30-day readmission (p=.047) and longer length of follow-up (p=.005). No outcome measure was significantly correlated with PDI score, according to the multiple regression analysis. Conclusion: In conclusion, the PCS was not shown to be an effective tool for measuring post-operative outcomes in orthopaedic foot and ankle patients, despite evidence of the contrary in other fields of orthopaedics. Additionally, the BRS and PDI were only valuable in their association with post-operative narcotic usage. Pre-operative opioid use was shown to correlate with worse higher rates of readmission and limited follow up, as corroborated by numerous previous studies. This study did not find the BRS, PDI, or PCS as useful indicators of surgical outcomes in foot and ankle patients.
Effect of Postoperative Ketorolac Administration on the Union Rate Following First Metatarsophalangeal Joint Arthrodesis
Authors: Kachooei Amir R. , Hester William , Gaston Tara , Corr Daniel O. , Daniel Joseph N. 
Published: January 2022

Category: Midfoot/Forefoot Introduction/Purpose: To decrease postoperative opioid consumption, nonsteroid anti-inflammatory drugs (NSAIDs), including ketorolac, is considered a proper substitute with few side effects. This study aimed to assess the nonunion rate after the first metatarsophalangeal (MTP) joint arthrodesis and five-day ketorolac administration. We secondarily aimed to compare the observed rate of nonunion in our study with the reported rate of 5.4% in a systematic review. Methods: In a retrospective cohort study, we included 181 primary MTP arthrodeses from 2016 to 2020 in a single surgeon practice. The surgical technique was identical using a dorsal locking plate after preparing the joint with the cup-and-cone technique. Ketorolac was administered every 6 hours for five consecutive days postoperative. Patients were placed in a heel weight-bearing CAM boot for a minimum of 6 weeks. Union was determined radiographically at three months and the final follow- up. Nonunion was categorized as symptomatic versus asymptomatic. Results: At three months postoperative, patient characteristics did not show any statistically significant difference between union and nonunion groups. However, at the final follow-up, hallux rigidus was significantly associated with a higher rate of the union in comparison to the preexisting hallux valgus deformity (odds=3.7; P=0.04). of 181 feet, 15 (8.3%) at three months and 12 (6.6%) at the final follow-up revealed nonunion. Of 15, 7 (45%) were asymptomatic, and 8 (55%) were symptomatic. Six (75%) of the 'symptomatic' nonunion underwent an unplanned secondary surgery. Almost 50% of the asymptomatic nonunions at three months healed by the final follow-up; however, none of the symptomatic nonunions healed. Comparing the observed proportion of nonunions at three months (8.3%) and the final follow-up (6.6%) in our study to the mean nonunion rate of 5.4% found in the literature revealed no significant difference between our results and the literature (P=0.067 and 0.27, respectively). Conclusion: A short course of oral ketorolac does not seem to affect the union rate after MTP arthrodesis. Ketorolac can be used safely and effectively to decrease postoperative opioid consumption.
Apoptosis Occurs in Anterior Talofibular Ligament of Chronic Lateral Ankle Instability: Biochemical Evidence from Bench to Bed
Authors: Kim Yoon-Chung , Cho Sung Hyun 
Published: January 2022

Category: Ankle; Basic Sciences/Biologics; Sports Introduction/Purpose: Chronic lateral ankle instability (CLAI) is a common entity that can result in degenerative arthritis if left untreated. CLAI is treated operatively, while acute ligament injury, so-called 'ankle sprain' is primarily treated nonoperatively with good clinical outcomes. This widely accepted opinion has been proved by clinical scoring system, physical examination, stress radiographs, ultrasonography, or magnetic resonance imaging. However, some surgeons often rush to perform the operative repair for acute ankle ligament injury. Apoptosis has been demonstrated as a considerable cause of ligament degeneration. Up to date, there are few reports of biomolecular and histochemical evidence focused on the 'apoptosis' that occurred in the torn anterior talofibular ligament (ATFL). The aim of this study is to elucidate the apoptosis that occurs within the ATFL of CLAI. Methods: Ligamentous tissues were collected from 15 patients undergoing modified Broström operation (group C) and 10 patients undergoing distal fibular fracture surgery as controls (group A). We allocated distal fibular fracture patients as an alternative to acute lateral ankle ligament injury to harvest acutely injured ATFL tissue. In both groups, the tissue samples were harvested at ATFL. Apoptotic cells were determined by TUNEL (terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end labeling) assay. Caspase 3/7, 8, 9, and cytochrome c activities were measured to determine the intracellular apoptosis pathway using Western blot. Immunohistochemistry staining was also performed to detect the expression of caspases and cytochrome c. Results: The TUNEL assay revealed a large number of positive staining cells in group C that included ATFL of CLAI. The apoptotic activities of ligaments from group C were significantly higher than those of group A (P < 0.05). Immunohistochemistry also revealed an increase in expression of caspase 3/7, 8, 9, and cytochrome c more in group C than in group A. Conclusion: This study demonstrates that the degenerated ATFL following CLAI showed higher apoptotic activity than acutely sprained ligament. Based on our biochemical findings, we could remind previous understanding about surgical indication and timing of lateral ankle ligament injury. We suggest that a clinical relevance between our laboratory research and previous knowledge Further study should be conducted to focus on biological augmentation to reverse or prevent further apoptosis within the lateral ankle ligament complex including ATFL.
Biomechanical Comparison of Fibertape Augmentation with Intercuneiform Adjunct and Cannulated Screws for Ligamentous Lisfranc Injuries: 3D Visualization of Complex Movement
Authors: Koroneos Zachary , Manto Kristen M. , Martinazzi Brandon , Stauch Chris M. , Bifano Shawn M. , Pace Gregory I. , Lewis Gregory , Aynardi Michael C. 
Published: January 2022

Category: Midfoot/Forefoot; Sports; Trauma Introduction/Purpose: The preferred method of fixation for ligamentous Lisfranc injuries is controversial, with the traditional method being transarticular screws. Unfortunately screw removal is often required leading surgeons to seek alternative fixation methods including fibertape constructs. Our lab has published biomechanical results on the safety and efficacy of a fibertape construct for the treatment of ligamentous Lisfranc injuries demonstrating biomechanical superiority with the supplementation of an intercuneiform limb. The purpose of this biomechanical study is to compare transarticular screws to a fibertape construct under loading and utilizing 3D visualization software. Methods: Three matched pairs of cadaveric specimens were dissected to allow for the placement of three screws on the dorsal aspect of the each bone involved in the Lisfranc complex. The diastasis between bones were measured at three midfoot joints in the Lisfranc articulation while each specimen was loaded to 75% of donor bodyweight. Measurements were obtained for the pre- injured specimens. The MC-2MT joint was sectioned under fluoroscopic imaging and re-measured to produce at least 2 mm of gapping. Specimens were then fixed with either transarticular screws or fibertape with an intercuneiform limb and computed tomography scans were performed. Post-fixation measurements were obtained for 250 N of axial loading with subsequent 100 N increases up to 650 N. CT scans were imported as DICOM images and the three bones were segmented to analyze the gapping that occurred at the dorsal, interosseous, and plantar portions of the ligament. Results: There were no significant differences detected for the diastasis between bones in the Lisfranc complex between the fibertape and screws. After loading to 650 N, no specimens had reached a diastasis of 2 mm through coordinate digitized measurements (Figure 1A and B). At 650 N of loading the fibertape specimens displayed an average diastasis of 0.78 mm while the specimens fixed with screws also displayed an average diastasis of 0.78 mm. 3D diastasis measurements showed coordinate digitized measurements were within 0.2 mm of those measured from 3D reconstruction of CT scans. The largest diastasis occurred at the dorsal aspect of the ligament. Conclusion: The use of a fibertape device involving a supplementary intercuneiform limb appears to provide a biomechanically viable alternative to screws for ligamentous Lisfranc injuries. Diastasis was verified using 3D computer models. Future efforts involve increasing the number of specimens, applying cyclic loading, and determining the effects on each portion of the ligament for each fixation type.
3D Assessment in Posttraumatic Ankle Osteoarthritis
Authors: Kvarda Peter , Heisler Lukas , Krähenbühl Nicola , Steiner Caspar S. , Ruiz Roxa , Susdorf Roman , Sripanich Yantarat , Barg Alexej , Hintermann Beat 
Published: January 2022

Category: Ankle; Ankle Arthritis; Hindfoot; Other Introduction/Purpose: Auto-generated 3-dimensional (3D) measurements based on weightbearing cone-beam computed tomography (CT) scan technology may allow for a more accurate hind- and midfoot assessment. The current study evaluated the reliability and clinical relevance of such measurements in patients with posttraumatic end-stage ankle osteoarthritis. Methods: Seventy-two patients treated at our institution for posttraumatic end-stage ankle osteoarthritis, with available weightbearing conventional radiographs and a cone-beam CT scan, were analyzed. Twenty healthy individuals aged between 40 and 70 years served as controls. Seven variables were measured on the conventional radiographs (2D) and compared to 3D measurements that were based on reconstructions from cone-beam CT scans. The reliability of each measurement was calculated and subgroups formed according to commonly observed deformities. Results: Inter- and intraobserver reliability was superior for 3D compared to 2D measurements. The accuracy of 3D measurements performed on osteoarthritic ankles was similar to 3D measurements performed on healthy individuals. Thirty-three of the 72 included patients (46%) evidenced an inframalleolar compensation of a supramalleolar/intra-articular ankle deformity (78% = varus compensation; 22% = valgus compensation), whereas 24 of those 72 patients (33%) showed no compensation or a further increase of a supramalleolar/intra-articular ankle deformity (67% = varus deformity; 33% = valgus deformity). Conclusion: Auto-generated 3D measurements of the hind- and midfoot are reliable in both healthy individuals and patients with posttraumatic end-stage ankle osteoarthritis. Such measurements may be crucial for a detailed understanding of the location and extent of hindfoot deformities, possibly impacting decision making in the treatment of end-stage ankle osteoarthritis.
High Reliability for Weightbearing CT Based Automated 3D Measurements to Assess Progressive Collapsing Foot Deformity
Authors: Kvarda Peter , Krähenbühl Nicola , Susdorf Roman , Burssens Arne , Ruiz Roxa , Barg Alexej , Hintermann Beat 
Published: January 2022

Category: Hindfoot; Midfoot/Forefoot; Other Introduction/Purpose: In progressive collapsing foot deformity (PCFD), hind- and midfoot deformities are paramount. However, an accurate assessment thereof, using weightbearing radiography, remains challenging. Automated three-dimensional (3D) measurements derived from weightbearing computed tomography (WBCT) scans may provide a more accurate approach for deformity assessment. In this study, automated 3D measurements based on WBCT were compared to two-dimensional (2D) measurements performed on weightbearing radiographs. Furthermore, it was investigated whether various stages of PCFD could be identified using automated 3D measurements. Methods: Twenty patients treated at our institution with either a flexible (N=10) or rigid (N=10) PCFD were identified, retrospectively analyzed and compared to a control group of thirty healthy individuals. Four angles and two distances measured on weightbearing radiographs were compared to the automated 3D measurements derived from WBCT scans. Results: In 5 out of 6 variables, the reliability of the measurements derived from weightbearing radiographs was lower than the automated measurements that derived from WBCT scans. The automated 3D measurements showed: the talar tilt in the ankle mortise was more valgus in patients with a rigid PCFD when compared to patients with a flexible PCFD; medial facet subluxation was present in all but one patient; patients with a sinus tarsi impingement evidenced a higher overlap between the talus and calcaneus (12.4+-2.6 mm) compared to patients without impingement (7.8+-3.9 mm; P=0.020). Conclusion: A higher reliability of automated 3D measurements derived from WBCT scans, was evident for most variables when compared to measurements based on weightbearing radiographs. Besides being less prone to errors, automated 3D measurements may provide more reliable information regarding the hind- and midfoot alignment in patients with PCFD. Future studies may show to what extent 3D measurements could contribute to current diagnostic algorithms and treatment concepts of patients with PCFD.
A Systematic Review of Third-Generation Total Talus Replacements
Authors: Lindsey Benjamin B. , Lindsey Benjamin B. , Sarfani Shumaila , Bettin Clayton C. 
Published: January 2022

Category: Hindfoot; Ankle Introduction/Purpose: Total talus replacement (TTR) has emerged as a novel treatment for talar avascular necrosis and severe trauma to the talus. Despite TTR first being described over 35 years ago, many questions still remain regarding the procedure. The objective of this study was to summarize the evidence on third-generation TTR's, focusing on surgical indications, surgical technique, prosthesis design, clinical outcomes, and postoperative complications. Methods: MEDLINE and EMBASE were queried and data abstraction was performed by 2 independent reviewers. Inclusion criteria for the articles were (1) peer-reviewed clinical studies with levels of evidence from I to IV, (2) with at least 5 patients, (3) reporting clinical outcomes of third-generation TTR's that were not done in conjunction with a total ankle arthroplasty, and (4) with a minimum clinical follow-up of at least 6 months. Results: Five studies met inclusion criteria for analysis including 101 ankles in 97 patients. The mean reported patient age was 52.8 years. The most common indication for TTR was avascular necrosis (86%), followed by trauma (10%), and tumor (4%). The mean follow up was 40 months. 98% of TTR's were performed through an anterior approach. There was significant variation in implant material, with 60% alumina ceramic, 27% cobalt chromium, 9% titanium, and 4% stainless steel. Only 3 studies obtained preoperative outcome measures, but these all demonstrated improvement at final follow up. Average dorsiflexion after TTR was 6.1 degrees and average plantarflexion was 35.1. Only 5% of ankles had complications requiring return to the operating room and only 2% of the total taluses were revised. Conclusion: While evidence is limited, short-term and mid-term results are promising for TTR as it demonstrates improvement in ankle function and has a low rate of revision. As the consequences of failure of a TTR are significant, including pantalar fusion or below knee amputation, higher quality studies and long-term results are needed to further evaluate this procedure.
Return to Driving after Elective Foot & Ankle Surgery: A Systematic Review
Authors: Lundy Alexander , Piscoya Andres S. , Bedrin Michael D. , Rodkey Daniel L. , Nelson Sarah , Eckel Tobin T. 
Published: January 2022

Category: Ankle; Arthroscopy; Midfoot/Forefoot; Other Introduction/Purpose: Studies investigating when patients can safely return to driving are becomingly increasingly numerous in the orthopedic literature because of the recognition of the importance of the activity to the lives of most adults. Previous systematic reviews have proven helpful by collecting and summarizing these studies to establish concise guidelines that can be presented to patients during the counseling surrounding a procedure. Having these guidelines can be even more crucial when discussing elective procedures. This systematic review summarizes the available studies investigating when it is safe to return to driving following elective foot and ankle procedures. Methods: A systematic review of the literature was performed using PubMed, Embase, and CINAHL to identify English-language studies from 1999 to present that investigate return to driving after right-sided elective foot and ankle procedures. Qualitative assessment of each of the included studies was performed independently by two authors. Then data from each study was extracted and broken down into distinct categories for comparison: study details, population, control group, method of evaluation, and results. Results: Eight studies met inclusion criteria. All of the studies investigate brake reaction time (BRT), via a driving simulator, as their primary outcome. A variety of objective and subjective secondary outcomes were collected. Patients undergoing right ankle or subtalar arthroscopic procedures have no significant difference in BRT compared to controls at 2 weeks post-operatively. 92% of patients undergoing right ankle arthroplasty had a BRT that was not significantly different to the control group at 6 weeks post- operatively. Patients who had an ankle arthrodesis had significantly delayed BRT compared to controls even past 1-year post- operatively. The majority of patients after corrective hallux valgus surgery have no significant difference in BRT at 6 weeks post- operatively compared to their pre-operative baselines depending upon how they are doing clinically. The included studies used a variety of patient reported outcomes that were helpful in predicting which patients would fail the driving simulation at the various timepoints. Conclusion: The recommendations from these reviewed studies can guide physicians when counseling their patients on when they can expect to safely return to driving after a specific, elective foot and ankle procedure. However, these recommendations are reliant on routine healing post-operatively and may need to be adjusted if a patient is experiencing any complications. A variety of patient surveys and other subjective scores can be very helpful in assuring a routine post-operative course.