bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Treatment Outcomes of Achilles Tendon Rupture and Tendinosis Augmented with Synthetic Graft
Authors: Levy Jeffrey A. , Neufeld Steven K. , Sanders Thomas H. , Cuttica Daniel J. 
Published: January 2022

Category: Hindfoot; Sports; Trauma Introduction/Purpose: Surgical treatments for Achilles tendon ruptures (ATR) or insertional Achilles tendinitis (IAT) traditionally have prolonged postoperative recoveries. Patients are typically kept non-weight bearing or protected weight bearing on the operative extremity for weeks after surgery to protect the repairs. The purpose of this study is to show that augmentation of typical Achilles tendon repairs with a synthetic scaffold is safe, allows for early weight bearing while preserving functional outcome and has a high patient satisfaction. Methods: A retrospective chart review was performed on all patients surgically treated for ATR or IAT from 2018 - 2020. The surgeries were performed by two fellowship trained Foot and Ankle Orthopaedic surgeons. All repairs were augmented with a synthetic scaffold made of polycaprolactone-based polyurethane urea (PUUR). Achilles tendon ruptures were direct end-to-end repairs and IAT repairs were performed with double row biocomposite anchors in the calcaneus after a calcaneus exostectomy. Exclusion criteria included flexor hallucis longus transfer, non-insertional achilles tendinosis, patients undergoing additional surgical procedures, and ATR or IAT repairs not treated with PUUR. Patients were evaluated as a cohort as well as acute ruptures, chronic ruptures (defined as more than 6 weeks old), and IAT subgroups. Primary outcomes were date of weight bearing and patient satisfaction. Secondary outcomes were final strength and ankle dorsiflexion. The Wilcoxon signed-rank test (WSR) was used to compare baseline and final follow-up NRS scores. Results: A total of 33 patients met the inclusion criteria with 12 ATR (9 acute and 3 chronic) and 21 IAT. Mean follow-up length was 150 days (43 - 314). Mean weight bearing began on postoperative day (POD) 7.33 (6-13) for acute ruptures, 14.33 (6-19) for chronic ruptures, and 9.9 (5-42) for IAT. Patient satisfaction, based on a binary yes/no response at final followup, was obtained on 27 of 33 patients with 92.6% positive indicating satisfaction with surgical outcome. Final strength averaged 5/5 for 83.9% and 4/5 for 16.1% of all patients. Final active dorsiflexion of at least 10 degrees was obtained in 93.5%. Mean numerical rating scale (NRS) for pain significantly decreased from 5.2 to 0.6 for all patients (WSR p<0.001). No patients had loss of fixation or had a re-rupture. Complications included one patient with sural neuritis and another with minor wound breakdown that did not require surgical intervention. Conclusion: Augmentation of Achilles tendon ruptures and insertional Achilles tendonitis with PUUR graft is safe, allows for early weight-bearing, has a high patient satisfaction and has acceptable functional outcomes in regards to strength and motion.
Five-Factor Modified Frailty Index as a Predictor of Complications Following Total Ankle Arthroplasty
Authors: Lewis Lauren , Jupiter Daniel , Panchbhavi Vinod K. , Chen Jie 
Published: January 2022

Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: Ankle arthritis can significantly diminish the function and quality of life of affected individuals. Treatment options for end-stage ankle arthritis include total ankle arthroplasty (TAA). Ongoing research seeks to identify patient factors associated with a higher risk of post-operative complications following TAA. A 5-item modified frailty index (mFI-5) has been found to predict adverse outcomes of multiple orthopaedic procedures. The aim of this study was to evaluate the suitability of the mFI-5 as a risk stratification tool for patients undergoing TAA. Methods: A retrospective review of the National Surgical Quality Improvement Program (NSQIP) database was performed on patients undergoing TAA between the years of 2011 and 2017. Data on patient demographics, post-operative complications, and length of stay were collected. Bivariate analysis and multivariate logistic regression were subsequently performed to investigate frailty as a possible predictor of post-operative complications. Results: 1035 patients were identified (mean age = 63.9 years). Complication rates significantly increased with increasing mFI-5 score, from 5.24% in patients with no mFI-5 variables to 19.38% in patients with two or more mFI-5 variables present (P <0.0001). When comparing patients with an mFI-5 score of 0 to patients with an mFI-5 score of 2, 30-day readmission rate increased from 0.24% to 3.1% (P> 0.017), length of stay increased from 1.79 days to 2.18 days (P >0.007), adverse discharge rate increased from 3.81% to 15.5% (P <0.0001), and wound complications increased from 0.24% to 1.55% (> 0.02). After controlling for demographic factors, length of stay, and operative time, mFI-5 score remained significantly associated with patients' risk of developing any complication and 30-day readmission rate. Conclusion: Frailty as defined by the mFI-5 is associated with adverse outcomes following TAA. Implementing the mFI-5 as a risk stratification tool may assist in identifying patients who are at an elevated risk of sustaining a complication, and may allow for improved informed decision-making and perioperative care when considering TAA.
Anatomic Considerations of the Distal Fibula: A Computed Tomography Guided Analysis
Authors: Locker Philip H. , Waldman Leah , Michalski Max 
Published: January 2022

Category: Ankle; Basic Sciences/Biologics; Trauma; Other Introduction/Purpose: Ankle fractures are a common injury in the general population with nearly sixty thousand operations performed in California for fractures involving the tibiotalar joint over a 10-year span. Reestablishing anatomic fibular alignment after fracture reduction leads to improved patient outcomes by restoring ankle mortise congruence. An in-depth understanding of fibular morphology may aid in fracture reduction, preoperative planning, plate positioning and intra-operative contouring. The goal of this study is to perform quantitative morphologic analysis of distal fibular anatomy using computed tomography (CT). Methods: Using Nuance mPower Clinical Analytics software, a database of CT tibia-fibula reports for patients ages 18 through 35 performed at our institution were searched for the term 'normal.' Inclusion criteria was absence of any reported osseous pathology. Examinations were excluded if the fibula was incompletely imaged. Twenty CTs were collected and analyzed. Measurements were performed at 5 mm increments from the tip of the fibula extending proximally to 10 cm. At each level the following measurements were obtained: lateral and posterior border lengths, lateral to medial (LM) bicortical distances at &frac14;, &frac12;, and &frac34; the length of the lateral border, posteroanterior (PA) bicortical distance at the center of the posterior border, and the angles of the lateral and posterior borders relative to the PA axis of the tibia (figure 1). The location of the maximal bicortical distance in the LM direction was recorded at each level. Results: The posterior border of the fibula broadens from an apex distally to 8.4+-1.6 mm at 10 cm proximal while rotating an average of 97.5 degrees. The lateral border of the fibula rotates 6.3 degrees from distal to proximal and begins with a width of 12.8+-3.1 mm and comes to an apex at 9 cm. In the distal fibula, the ratio of the maximal LM to PA bicortical length is 0.56. By 3 cm proximal, the ratio approaches 1 and is 1.6 at 10 cm. The distal 1 cm of the fibula has the largest LM diameter anteriorly and medially but from 1.5 cm to 10 cm proximal the posterior &frac14; has the largest LM diameter. Conclusion: The fibula has a complex distal geometry which changes with progression from the distal tip to 10 cm proximal. The posterior border of the fibula broadens and rotates over 90 degrees to become the lateral border proximally. The lateral border distally is broad but comes to an apex proximally with minimal rotation. The ratio of bicortical distances changes from distal to proximal as the distal posterior border rotates to face in a LM direction proximally. This information may aid in surgeons' understanding of the complex distal fibular morphology and assist with intra-operative decision making regarding hardware size, placement and manipulation.
Complications of Calcaneal Osteotomy: Are They Equal Between Different Osteotomy Types?
Authors: Madeley N. Jane , Senthil Kumar Chinnasamy , Alenezi Alia 
Published: January 2022

Category: Hindfoot; Other Introduction/Purpose: Calcaneal osteotomy is regularly performed as part of the surgical management of a number of conditions. Complication rates are thought to be low, however are these risks the same for different osteotomy types? In our institution a Lateralising Closing wedge osteotomy is performed for Cavus foot correction and Varus alignment with instability, whilst Lateral Column Lengthening Osteotomy and Medialising Displacement Calcaneal Osteotomy (MDCO) are performed for Pes Planus with and without forefoot abduction respectively. In severe Pes Planus deformities both may be utilised. The purpose of this study was to examine complication rates in each group. Methods: This is a retrospective case series of consecutive calcaneal osteotomies performed at our institution between January 2010 and December 2019. The primary outcome measures were healing of the osteotomy, metalwork removal and any other reported complications related to the calcaneal osteotomy including infection and wound problems. Patient demographics, associated procedures, indication for surgery, incision, and fixation method were also recorded. Results: There were 141 patients in the series. 77 patients underwent a lateralising osteotomy, 55 underwent MDCO and 12 Lateral column lengthening (LCL) with opening wedge osteotomy of the anterior process of the Calcaneus. Fixation was with cannulated screws, or specific purpose locking plates. Patients were followed up for a minimum of three months and discharged from follow-up once a satisfactory level of recovery was reached..One non-union was seen in each of the Lateralising, MDCO and LCL groups. Delayed union was seen in 3 lateralising osteotomies, and 1 MDCO. Metalwork irritation requiring surgery for metalwork removal was 6.5% (4 with screws, 1 plate), 9.1% (all screws) and 0% for Lateralising, MDCO and LCL osteotomies respectively. Wound problems or sural nerve irritation were noted in 11.7%, 3.6% and 8.3% of Lateralising and MDCO and LCL osteotomy respectively. 1 superficial infection was seen in the Lateralising osteotomy group Conclusion: One non-union was seen in all groups, with a trend for bone healing to be slower in those having lateralising procedures. Patients should be advised of this possibility if undergoing calcaneal osteotomy. Wound problems and sural nerve irritation were also more common with lateralising procedures. Metalwork removal due to hardware irritation was common (7% overall), and fixation method rather than osteotomy type appears to influence this with 9 cases following cannulated screws and 1 following lateral locking plate fixation. Screw fixation is associated with higher hardware removal rates.
Percutaneous Distal Metatarsal Mini-Invasive Osteotomy: Comparison Between Standard vs Modified Intraosseous Approach: A Cadaveric Study
Authors: Mansur Nacime S. , Martins Fernando S. , Auch Elijah , Giarola Ivan C. , Li Shuyuan , Lalevée Matthieu , Dibbern Kevin N. , Femino John E. , Netto Cesar de Cesar 
Published: January 2022

Category: Midfoot/Forefoot Introduction/Purpose: Minimally invasive surgery (MIS) of the forefoot has gained popularity as an alternative to traditional open procedures for the treatment of metatarsalgia and hammertoe deformity. Distal metatarsal mini-invasive osteotomy (DMMO) is an extraarticular osteotomy done in a percutaneous manner, with minimal soft tissue dissection that permits elevation as well as shortening. However, there is concern for damage to vital structures due to lack of direct visualization. The objective of the study was to evaluate the structures at risk in standard versus modified DMMO. Methods: 11 thawed fresh-frozen cadaveric specimens underwent minimally invasive DMMO using both the standard and modified approach. The standard technique was performed by moving the burr in a circular motion with an angle of 45° (right- handed surgeon), which cut sequentially the left, plantar, right and dorsal cortices. It was compared to a modified intraosseous technique requiring less wrist supination while remaining intraosseous. After completion of the procedures, the cadavers were fully dissected and analysed to identify unintentional injury to soft tissue structures and to verify if cuts were completely extraarticular and performed with proper angulation. Results: In the standard group the most commonly injured structures were the metatarsal joint capsules (MJC) (27%), extensor digitorum longus (EDL) (18%), and extensor digitorum brevis (EDB) (9%). The modified intraosseous group demonstrated injury to the EDL (27%), while MJC (0%) and EDB (0%) were not damaged. Distances between osteotomies and structures were 6.08 +- 3.99 mm from the dorsal metatarsal head articular surface (DMHAS), 4.85 +- 2.45 mm from EDB and 0.76 +- 1.72 mm from the EDL in the standard group and 9.92 +- 3.42 mm from the DMHAS, 4.71 +- 3.24 mm from EDB and 1.24 +- 1.84 mm from the EDL in the modified group. Statistically significant difference was found among osteotomy site and DMHAS (p=0.02). Conclusion: The most frequently injured structure was the EDL tendon with both DMMO techniques used. Intra-articular positioning of the osteotomy was more frequently observed in the standard technique. There was also a statistically significant difference between the distance of the osteotomy site and the dorsal metatarsal head articular surface when comparing the standard group and the modified group. Overall, it appears that the modified method could be a safer, less complex alternative to the standard DMMO technique, especially for the inexperienced surgeons.
Austere Lower Extremity Splinting: A Head-To-Head Comparison of A New Novel 1-Step Spray-On Splint Verse Standard Splinting
Authors: Martin Kevin D. , Webb Tyler , Ly Thuan , Groth Adam T. 
Published: January 2022

Category: Trauma Introduction/Purpose: Fracture immobilization in low resource environments is a critical and common aspect of austere medical care. However, there are few studies that critically investigate the efficacy and consistency of current practices. The purpose of this study was to compare austere immobilization techniques for lower extremity fractures while validating a splint application evlauation score sheet. Methods: Six orthopaedic surgical residents and 2 medical students participated in a prospective analysis of austere splinting techniques that utilized a cadaveric model with a distal third tibia-fibula fracture. Each participant was observed and scored by 3 Orthopaedic surgeons. All scoring was independent using a Likert scale based on 10 splinting criteria, including quality of radiographic reduction and time to completion. The participants utilized standard equipment that included structural aluminum malleable (SAM) splints and 6-inch ACE wraps in their first attempt. A second immobilization attempt was done with a 1-step spray-on foam splint. After each splinting attempt the reduction was verified with radiographic imaging. Results: The 1-step spray-on foam splinting technique was significantly superior (P <.05) in all parameters. Respectively yielding a mean score of 42.3 (range: 38-50), safety 4.7 (range: 3-5), longitudinal traction 4.5 (range: 3-5), time 136 seconds (range: 99-162). The standard splinting resulted in a mean score of 34.2 (22 - 46), safety 2.8 (range: 1- 5), longitudinal traction 4.1 (range: 3-5), time 169.5 seconds (range: 94-254). No catastrophic failures were noted in either group. A strong interobserver reliability was established. Conclusion: A 1-step spray-on foam splinting technique demonstrated consistent superiority in reducing fracture motion, potential soft-tissue damage, and sustained longitudinal traction as compared to the standard technique. Secondly, our results validate our splinting evaluation criteria allowing for further utilization in training austere splinting.
Quality of Life Improvement Following Reconstruction of Midtarsal Charcot Foot Deformity: A Five Year Follow-Up
Authors: McGregor Patrick C. , Lyons Madeline M. , Pinzur Michael S. 
Published: January 2022

Category: Diabetes Introduction/Purpose: Previous data has suggested that patients have significant clinical improvement after reconstruction of diabetes-associated Charcot foot arthropathy at one year postoperatively. The purpose of this study is to re-evaluate a cohort of patients who were previously surveyed pre-operatively and 1 year post-operatively following Charcot foot reconstruction to determine if improvements in quality of life measures were sustained at a 5-year interval post-operatively. Methods: Twenty-four patients were contacted to repeat the Short Musculoskeletal Function Assessment (SMFA) 5 years after their index Charcot foot reconstruction. The same cohort of patients had completed the SMFA pre-operatively and at 1 year post-operatively. The response to items were summated to establish scores on the dysfunction and bother indices. The scores were then standardized to range from 0 to 100 with use of the published scoring formula. Poorer function is indicated by higher scores. Descriptive statistics were utilized to analyze the differences between the preoperative and five year data for the group. Sixteen of the initial 24 study patients (66.6%) were successfully contacted and completed the SMFA survey at five years postoperatively; 2 of the 16 had subsequently undergone amputation. Results: Fourteen patients who had previously completed the SMFA preoperatively and 1 year postoperatively after Charcot foot reconstruction in a circular frame were contacted and again completed the SMFA instrument. Improvement was noted in all domains measured by the SMFA between preoperative scores and five years postoperative scores; there was a 17-point decrease in the SMFA standardized functional index and a 3.6-point decrease in bother index. Similarly, when looking at individual domains, there was a 8.7-point decrease in difficulty with daily activities, 4-point improvement in emotion, and 5.7-point improvement in mobility. There was a statistically significant improvement in difficulty with daily activities at five years (p = 0.037), All other domains assessed by the SMFA demonstrated improvement between the two time periods, but did not reach significance due to the limited sample size. Conclusion: Successful correction of non-plantigrade midtarsal Charcot foot arthropathy is associated with a clinically meaningful improvement in health-related quality of life at both one and five years postoperatively, including independence with daily activities. This further supports the modern paradigm shift towards operative correction of this deformity.
Return to Play and Clinical Outcomes in the Surgical Treatment of Peroneal Tendon Dislocation and Subluxation
Authors: Mercer Nathaniel P. , Gianakos Arianna L. , van Dijk Pim , Mercurio Angela , Kerkhoffs Gino , Kennedy John G. 
Published: January 2022

Category: Ankle; Sports Introduction/Purpose: To provide an overview of the available evidence on peroneal tendon dislocation and subluxation as well as the outcomes after surgical intervention. Methods: A systematic review of the literature was performed using MEDLINE, Embase, and Cochrane. Criteria for inclusion were clinical studies reporting outcomes after surgical treatment for peroneal tendon dislocation and subluxation within the last 10 years Results: Fourteen articles evaluating a total of 321 patients were included in this review consisting of 240 males and 81 females. The weighted mean age of patients was 28.7 years (range 18-47). The weighted mean follow-up was 38.1 months (range 18 - 58). The weighted mean time to surgery was 5.32 months (range 3 - 9.5). Surgical treatments were categorized into 4 groups which comprised 13 of the 14 studies. Eleven studies recorded the AOFAS score with a weighted mean preoperative score of 65.97 and a weighted mean postoperative score of 92.9. Overall, 90% (145/162) of patients reported their satisfaction as either 'excellent' or 'good'. Time to return to play (RTP) was faster for patients who underwent SPR repair alone compared to SPR repair with groove deepening (p=0.001) Conclusion: The current systematic review showed that overall clinical outcomes were positive in lieu of the different modalities of surgical intervention for peroneal tendon dislocation and subluxation. However, patients who received SPR repair with groove- deepening returned to sport faster than patients who received SPR repair alone.
Research During Foot and Ankle Orthopaedic Fellowship and Association with Careers Following Fellowship
Authors: Patel Tamanna , Williams Benjamin R. , Ellis Scott J. 
Published: January 2022

Category: Other Introduction/Purpose: Performing research during fellowship continues to develop vital critical thinking skills for orthopaedic surgeons as they move into their careers. As fellowships and academic careers become more competitive, research plays an important role in fellow selection and future academic appointments. The purpose of this study was to assess if research during fellowship, measured through journal publications, was associated with careers in academic medicine and if those who published early in their training continued to do so into their careers. Methods: A list of foot and ankle fellows, from 2008-2013, were collected from the AOFAS website. In February 2021, all collected fellows were searched on pubmed.gov to generate all orthopaedic publications with a PubMed identifier published before residency, during residency, during fellowship and after fellowship. Each publication's 2020 Thomson Reuters 5-Year Journal Impact Factor and fellows first authorship were noted. The collected fellows were searched through Doximity.com for the name of their medical school, residency and fellowship. The fellows were further searched for their current location of employment and whether it was academic or not. An employment location was considered academic if they were listed on a department website that also was involved in teaching residents. The number of publications, journal Impact Factor and number of first authorships were compared between the academic and non-academic groups during their time before residency, during residency, during fellowship and after fellowship. Results: A total of 246 fellows were included, with a mean (+- SD) of 0.8 +- 1.4 publications per fellow during fellowship. During the years in review, 27% (67/246) of fellows entered a career in academics. Before residency, there was no difference in the number of publications between those that went into academic and those that did not [academics 0.54 +- 1.85, non-academic 0.27 +- 1.05 (p=0.154)]. During residency and fellowship, those that went into academics were statistically significantly more likely to publish than those that did not go into academics [during residency: academic 2.82 +- 4.53, non-academic 1.24 +- 2.00 (p=0.0002); during fellowship: academic 1.10 +- 1.57, non-academic 0.69 +- 1.34 (p=0.038)] as well as more first authorships and in journals with higher impact factors. Conclusion: As fellowships and academic positions become more competitive, the quality and number of journal publications are likely to become increasingly more important. This study noted that an interest in academics likely develops during orthopaedic residency. This study may help improve mentorship earlier on to those who are more likely to pursue a career in academics.