bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increasing Age and Modifiable Comorbidities are Associated with Short Term Complications after ORIF of Ankle Fractures
Authors: Adams Samuel B. , Danilkowicz Richard , Grimm Nathan L. , Kim Jaewhan , O'Donnell Jeffrey , Allen Nicholas B. 
Published: January 2022

Category: Trauma; Ankle Introduction/Purpose: Ankle fractures are common orthopedic injuries with complication rates fixation of up to 40%. Limited evidence exists in the literature regarding complications in the elderly population, and moreover, these studies frequently define elderly arbitrarily at 60-65 years old. The purpose of the present study was to utilize a large, validated database to evaluate whether there is an inflection point of age when postoperative complications after an ankle fracture significantly increase. Methods: A retrospective review of all patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent fixation of an ankle fracture between 2012-2018 was performed. Patients were identified within the database using the Current Procedural Terminology codes. Appropriate statistical analysis was performed with p-value less than 0.05 considered statistically significant. Results: A total of 27,633 fractures were including and comprised of 221 posterior malleolar, 1,567 medial malleolar, 8,495 lateral malleolar, 10,175 bimalleolar, and 7,175 trimalleolar. A total of 1,545 complications were encountered (5.6%). There was a statistically significant association between increasing age and complications (OR=1.03; p<0.001). Further analysis shows the largest spike in complications within the age 78+ bracket. There were no overall interaction effects between age and fracture subtype (p=0.223). Conclusion: ORIF of ankle fractures is a common orthopedic procedure performed on patients of all ages, with complications ranging in severity. In order to best counsel patients on their individual post-operative risks, large data sets are often necessary to prognosticate. This study found that postoperative complications increase with advanced age. The incidence of complications did not spike for patients around the age of 65, but rather followed an incremental linear pattern with the largest increase in odds ratio occurring at age 78 and above. Complication rate was not associated with specific fracture type based off of ICD codes.
Pain Mapping as a Predictive Model for Diagnosis and Treatment in Foot and Ankle Conditions
Authors: Adukia Vidhi , Hughes Martin , Best Alistair J. , Allen Patricia , Mangwani Jitendra 
Published: January 2022

Category: Other; Ankle; Ankle Arthritis; Bunion; Hindfoot; Lesser Toes; Midfoot/Forefoot Introduction/Purpose: With the COVID19 pandemic, virtual consultations are becoming a necessity. Clinicians are having to adapt consultations to determine where patients' symptoms are, and what the appropriate next line of investigation or treatment should be, without the benefit of traditional face-to-face contact. The aim of this project was therefore to use pain mapping in foot and ankle conditions, in order to see if there was a predictive correlation between certain symptomatic areas and the ultimate surgical treatment required by patients. Methods: Data was collected prospectively from patients attending foot and ankle clinics from 2014 to 2019, and this was cross- matched with operative data subsequently. Data included patient demographics, co-morbidities, smoking status and previous injuries or surgeries. In a structured questionnaire, patients also marked the regions of the foot and ankle that they thought were the most symptomatic. The foot and ankle was divided into 12 segments for the purpose of analysis. Results: A total of 2007 patients completed these questionnaires, from which operative data was available for 407 patients. In the first instance, data was analysed for 122 patients who underwent one of five specific procedures. Pain mapping was found to have a good predictive value for first MTP fusion and bunion surgery (n=20, 46), 1st metatarsal cheilectomy (n=10) and arthroscopic ankle arthrodesis (n=23). The least predictive pain mapping was seen for patients who had a triple arthrodesis (n=23), with those patients presenting with pain more globally in the foot and ankle. Conclusion: The results suggest that pain mapping can be used effectively as postal questionnaires, prior to a virtual consultation, as an aid to predict diagnosis and the ultimate treatment required in some specific foot and ankle conditions.
The Generation Game: Has Modern Contemporary Total Ankle Replacement (TAR) Improved Survivorship?
Authors: Ahluwalia Raju S. , St Mart Jean-Pierre , Goh En Lin , Hay Daniel , Pilkington Isobel , Bednarczuk Nadja 
Published: January 2022

Category: Ankle Introduction/Purpose: Total ankle replacements (TARs) provide pain relief with preservation of movement and function. The most successful TARs are either 2nd or current 3rd generation in design, whilst 4th generation implants are steadily being introduced. This meta-analysis evaluates the survivorship of 2nd, 3rd and 4th generation ankle replacements used today to determine whether any difference between generations and bearing types exist. Methods: A systematic review and meta-analysis of published data from January 2000 to January 2020 was conducted following PRISMA guidelines. Inclusion criteria: English language papers, adult population, >= 20 ankles with a minimum follow up >= 24 months, pre- and post-operative functional scores available. Clinical outcomes of primary TARs were evaluated as well as their associated survivorship. Statistical analyses were undertaken to determine survivorship and complications associated with the second, third and fourth generation implants and the bearing design. Ankle generations were determined from the original studies and confirmed based on literature set definitions. The modified Coleman Methodology Score was used to evaluate the quality of studies. Results: A total of 4642 TARs in 4487patients from 51-studies were included. The mean age was 61.9years and mean follow up of 57.8months. The most common indications were post-traumatic-OA (54.5%), primary-OA (25.5%) and inflammatory-arthropathy (15.2%). Relative-risk calculations showed significant reductions in nerve-injury (p < 0.01), post-operative fracture ( p < 0.01), wound complications (p < 0.01), radiolucencies ( p < 0.01), or heterotopic bone formation (p < 0.01), aseptic loosening (p < 0.01) for later generations. Sensitivity analysis performed for the withdrawal of 2 prostheses showed 2yr survivorship for 2nd, 3rd and 4th generation TARs was 95.3%, 97.9% and 98.9% (p < 0.05). Third-generation TARs had better 10-yr survivorship compared to 2nd generation (83.50% vs. 70.76%) (p < 0.01). Bearing design had little influence on survivorship. Conclusion: In the real world subsequent generations of modern contemporary TAR demonstrate lower rates of complications and improved survivorship independent of bearing design, without reaching designer series levels. Population changes have meant a reduction in mean age at implementation and the commonest pathology for a TAR has become post traumatic OA without a observed detrimental affect in outcomes. Even so, superior short-term survivorship of fourth generation implants is promising for the future of modern TAR surgery.
Cost Analysis and Utilization of Weight Bearing CT
Authors: Alexander Nathaniel B. , Bettin Clayton C. , Sarfani Shumaila , Strickland Carson D. , Richardson David R. , Murphy G. Andrew , Grear Benjamin J. 
Published: January 2022

Category: Other Introduction/Purpose: Weightbearing Computed Tomography (WB CT) is becoming a valuable tool in the evaluation and understanding of foot and ankle pathology. With this, more practices may be interested in acquiring WB CT scanners and understanding cost effectiveness of acquisition. To date there are currently no US based reports of cost analysis of WB CT scanners. Our study is a cost analysis of WB CT at tertiary referral physician owned practice. Methods: Data was collected for all patients who underwent imaging utilizing a weight bearing CT scanner at our institution from the date of acquisition in 2016. For ease of analysis and applicability of information across orthopedic practices, Medicare reimbursement was used as a uniform estimation of reimbursement across all insurances at a rate of $163.50 per scan. We then compared the number of scans obtained per month to total costs related to acquiring and maintaining the WB CT machine. Secondary variables collected included patient demographic information, pathology location (forefoot, midfoot, hindfoot), and utilization of the device by subspecialty. Results: A WB CT scanner was acquired by a private group in 2016. A proforma analysis demonstrated $179,000 to acquire the machine, $30,000 for extended warranty, $995 for additional licenses. Between August 2016 and February 2021, 1702 unilateral studies and 100 bilateral studies were performed. Patients ranged in age from 6 to 92. Average age was 45 years with 45.9% male and 54.1% female. Forty-one staff utilized the CT scanner from various subspecialties with 5 Foot and Ankle (F&A) surgeons ordering 80% of scans. When dividing total costs by number of months since acquisition the monthly cost of the device is $3,318 which requires 20 scans per month when using Medicare reimbursement rates. Over a 55 month the average number of scans per month is 34. When dividing the cost of acquisition by reimbursement per scan, the breakeven point was 1,284 scans which occurred at approximately 3 years. Conclusion: As WB CT scans become a valuable tool for the analysis of foot and ankle pathology, groups may be interested in understanding the financial implications of such an investment. Our study is the only cost analysis based in the United States of WB CT. We found that WB CT is a cost-effective tool that can be used to evaluate a number or pathologies in the foot and ankle.
Ten-Year Outcomes of MobilityTM Total Ankle Replacement Confirms Radiological Loosening is Not Conclusive or Reliable for Long Term Survival Analysis
Authors: Alkhreisat Mohammad A. , Ramaskandhan Jayasree Ramas , Bennett Adam P. , Smith Karen , Siddique Malik S. 
Published: January 2022

Category: Ankle; Ankle Arthritis Introduction/Purpose: Different designs of Ankle replacement are being performed nowadays, long-term outcome data is the better way to understand these implants behaviour and survival. We compared the differences in demographic data, clinical, Radiological, and patient-reported outcomes among patients who underwent total ankle replacement performed with use of the uncemented stemmed mobile bearing (MOBILITY) Total Ankle System with 10 year follow up. Methods: We analysed 156 (15 bilateral ankles (3 non-mobility) Mobility TAR (of which 41, 45, 22 for OA, PTOA, Inflammatory arthritis respectively). Mean age 61.7 (SD 11.4) (Range 33-90). 70 Ankles had 10 years of follow up, 115 had 5 years follow up,. 96 were males, with 30 patients deceased before 10 years follow up covering 33 ankles. All from our local registry looking at the patient's demographic data, and patient-reported outcomes as measured with use of WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), the Foot and Ankle Outcome Score (FAOS), the 36-item Short-Form (SF-36) Health Survey, clinical and radiological outcomes and patient-satisfaction scores, collected preoperatively and at 1,3,5 and 10 years postoperatively. Results: Of the 156 ankles18 had wound complications after surgery two only needed surgical debridement. 5 CRPS,16 stress fractures 2 only requiring surgical fixation,11 had subsequent STJ fusion.77 had no signs of radiolucency. The rest had some degree of radiolucency on x-ray (55% on the tibia side) only 11 where symptomatic to require further surgery (6 revised to another TAR, 2 fused, and3 required bone grafting). 11 needed osteotomies after surgery. Aseptic loosening and infection are the least common complications requiring revision. There was significant improvement in WOMAC for pain (35.9 to 67.9), function (40.6 to 66.9) and stiffness (39.4 to 62.5) from pre-op to 1 year (p<0.05), this was maintained for 10 years. Although improvement noted in the composite physical component of SF=36 (28.3 to 34.5) there was no significant increase for composite mental component score. 77.5% reported satisfaction from pain relief,72.4% with return to ADL, 40% were dissatisfied with return to recreational activities and15.5% reported dissatisfaction with overall results of surgery. Mobility TAR shown about 86% survival in our 10 years cohort. Conclusion: With improved PROMS at 1,3,5,10 years showing Patient satisfaction score at 10 years indicates that uncemented mobile bearing implants have good long-term results, osteolysis and aseptic loosening as the least common cause of revision. It is pertinent that reporting of radiological loosening in an uncemented ankle is not conclusive or reliable for long term survival analysis.
Assessment of Ankle Fractures using Deep Learning Algorithms and Convolutional Neural Network
Authors: Ashkani-Esfahani Soheil , Mojahed-Yazdi Reza , Bhimani Rohan , Kerkhoffs Gino , Guss Daniel , DiGiovanni Christopher W. , Lubberts Bart 
Published: January 2022

Category: Ankle; Trauma Introduction/Purpose: Early and accurate detection of ankle fractures is crucial for reducing future complications. Radiographs are the most abundant imaging techniques for assessing fractures. We believe deep learning (DL) methods, through adequately trained deep convolutional neural networks (DCNNs), can assess radiographic images fast and accurate without human intervention. In this study, we aimed to assess the performance of two different DCNNs in detecting ankle fractures using radiographs compared to the ground truth. Methods: In this retrospective study, our DCNNs were trained using radiographs obtained from 1050 patients with ankle fracture and the same number of individuals with otherwise healthy ankles. Inception V3 and Renet50 pre-trained models were used in our algorithms. Danis-Weber classification method was used. Out of 1050, 72 individuals were labeled as occult fractures as they were not detected in the primary radiographic assessment. Using single-view radiographs was compared with 3-views (anteroposterior, mortise, lateral) for training the DCNNs. Results: Our DCNNs showed a better performance using 3-views images versus single-view based on greater values for accuracy, F-score, and area under the curve (AUC). The sensitivity and specificity in detection of ankle fractures using 3-views were 97.5% and 93.9% using Resnet50 compared to 98.7% and 98.6 using inception V3, respectively. Resnet50 missed 3 occult fractures while Inception V3 missed only one case. In cases that detected the fracture, the saliency map showed the location of the fracture ( Figure 1 ). Conclusion: The performance of our DCNNs showed a promising potential that can be considered in developing the currently used image interpretation programs or as a separate assistant to the clinicians to detect ankle fractures faster and more precisely.
Intramedullary Nailing vs Plating of the Fibula for Ankle Fractures in the Young Active Patient
Authors: Bastias Gonzalo F. , Mikenberg Natalio R. Cuchacovich , Diaz Felipe G. , Gutierrez Paulina , Munoz Gerardo , Melo Rodrigo , Jofre Magdalena I. , Filippi Jorge 
Published: January 2022

Category: Ankle; Trauma Introduction/Purpose: The use of fibular nailing (FN) for fixation of lateral malleolar fractures has been rising in recent years. Currently, it has been validated as an effective minimally invasive approach to ankle fractures specially in patients with high risk of wound dehiscence, diabetics and elderly low-demand patients. While most of the studies comparing the use of a fibula nail versus plating (PL) are carried out in this population at risk, the use of FN in younger patients with higher functional demands has been hardly studied. The aim of this study is to compare the functional and quality of life outcomes of patients treated with FN and PL in an active population. Methods: We performed an IRB-approved retrospective study including ankle fractures treated in our hospital from January 2017 to February 2020, with a minimum followup of one year. We included only patients between 18 and 55 years old treated by five fellowship-trained foot and ankle surgeons and divided into two groups according to the method of fixation of the fibula: intramedullary nailing (FN) or plating (PL). Demographics, medical comorbidities, type of fracture, reoperations and complications were collected. Functional and clinical evaluation included the Lower Extremity Functional Score (LEFS) and Short form 12 (SF 12) were obtained at an average of 28 months follow-up (range 14-50). Results: Eighty-five patients were included in this study with a mean age of 36.9 years old (range 16-55). The FN group was conformed by 31 patients (18 men) while the PL group consisted of 54 patients (32 men). Both groups were comparable in terms of age, sex, type of fracture, open fractures, number of malleoli compromised (P>0.05). Union was achieved in all patients. The complication rate was 3.2% (1 patient) in the FN group versus 5,5% (3 patients) in the PL group (p=0.66). Two patients (6.5%) in the FN group and 7 patients (13%) in the PL group required hardware removal (p=0.36). There were no significant differences in SF-12 physical component (p=0.30), SF-12 Mental component (p=0.52) and LEFS Score (p=0.88). Conclusion: In this comparative study, there were no differences between the FN and PL groups for fixation of the fibula in terms of functional results and quality of life at an average of 28 months follow-up. Complications and hardware removal rates had no statistical differences between both groups. This is the first report on the literature comparing both fixation strategies on an active high-demand population.
Ankle Fusion Outcomes Utilizing Anterior Ankle Plating Techniques: A Systematic Review
Authors: Berlet Gregory C. , Prissel Mark A. , Zulauf Emily E. , Malloy McCoy Antonio M. 
Published: January 2022

Category: Ankle; Ankle Introduction/Purpose: Ankle arthrodesis is a time-tested surgical treatment for end-stage ankle arthritis. Fixation constructs continue to evolve with recent advancements in anterior ankle plating. A systematic review of anterior approach ankle arthrodesis using anterior plating was performed to analyze outcomes such as time to weight bearing, union rate, and complications. Methods: A systematic literature search was performed following Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines was performed. Inclusion criteria were as follows: 1) prospective or retrospective comparative study or consecutive case series reporting clinical outcomes following ankle arthrodesis; 2) surgeon technique includes anterior incisional approach with anterior plating construct; 3) minimum 3 months follow-up; and 4) reported outcomes including time to weight bearing, union or nonunion rate, complications, and patient population characteristics including age and comorbidities. Thirteen citations met inclusion criteria. Studies were organized into three groups based on similar time to weightbearing protocols. Results: Mean time to weightbearing was as follows: Group A. 0.6 weeks, Group B. 6 weeks, and Group C. 9 weeks with fusion rates of 95.2%, 95.4%, and 96.6%, respectively. The average time to weightbearing post-operation across all groups was 4.6 weeks with a mean union rate of 95.3% (82 to 100%). Conclusion: Wound healing complications and infection rates did not increase with earlier weight bearing guidelines. This systemic review revealed comparable fusion rates across different weight bearing regimens following anterior plate fixation for ankle arthrodesis, supporting re-evaluation of historically accepted weightbearing protocols.
The Medial Gastrocnemius Release: A Safe and Effective Alternative for Treatment of Isolated Gastrocnemius Contracture
Authors: Bull Patrick E. , Malloy McCoy Antonio M. , Thompson Mitchell , McGann Maria R. , Berlet Gregory C. 
Published: January 2022

Category: Basic Sciences/Biologics Introduction/Purpose: Gastrocnemius recession is a popular procedure utilized to treat a myriad of lower extremitychronic conditions related to isolated gastrocnemius contracture (IGC). Recent anatomical research detailing the variable relationship between the distal gastrocnemius and soleus tendons has raised important questions regarding the safety of some traditional recession procedures. Alternative gastrocnemius recession strategies may offer comparable clinical results while avoiding the surgical risk related to conjoint tendon anatomical variability. Methods: Ten matched pairs of above-knee fresh frozen cadavers were randomized to receive either a medial gastrocnemius recession (MGR) procedure or a gastrocnemius intramuscular recession 'Baumann' procedure. Postoperative dorsiflexion improvement was measured and then compared between groups. Detailed post-operative surgical dissections were performed on all specimens to assess structures at risk, conjoint tendon morphology, and anatomical symmetry. Results: MGR and GIAR procedures were equally effective at producing significant increases in passive ankle dorsiflexion. No sural nerve injuries were observed. 35% of specimens showed direct muscular fusion of at least a portion of the distal gastrocnemius muscular tissue to the adjacent soleus, with sections of no distal transactable gastrocnemius tendon present. Conclusion: The MGR produced comparable results to the Baumann/GIAR in a cadaver model. We feel that the MGR is an attractive alternative to traditional gastrocnemius recession techniques due to the simple approach, the region's predictable anatomy, its low risk to surrounding vital structures, and its early evidence of effectiveness. We also concluded that the conjoint tendon anatomy is highly variable and that surgeons must account for this unpredictability when surgically treating IGC. We predict that the biggest risk associated with conjoint tendon region recession procedures is inadvertent soleus transection and subsequent over lengthening related plantar flexion weakness.
Benefits of Ankle Arthroscopic Debridement in Acute and Subacute in Ankle Fractures
Authors: Ceccarini Paolo , Marzano Fabrizio , di Giacomo Lorenzo , Rinonapoli Giuseppe , Caraffa Auro 
Published: January 2022

Category: Ankle; Arthroscopy; Trauma Introduction/Purpose: The purpose of this study was to evaluate the benefits of ankle arthroscopy at the time of ORIF or after six months in patients with residual symptoms. The hypothesis was that in patients treated arthroscopically at the time of ORIF, there were faster and better clinical results than those treated after or untreated with arthroscopy. Methods: In this retrospective study, we compared three homogeneous groups of selected patients with specific inclusion criteria (144in total, mean age 38.2 years). They have been surgically treated for an ankle fracture (bimalleolar or trimalleolar without frank syndesmotic injuries) with open technique (ORIF) or arthroscopic ORIF (AORIF), between 2016 and 2019. The AO classification system was used for each patient. The clinical assessment was based on the Foot and Ankle Outcome Score (FAOS). Results: At the final follow-up (mean 36 months), both patients treated with ankle arthroscopic debridement at the time of ORIF and patients treated with arthroscopic debridement after ORIF showed a significant improvement of the FAOS, which reported84 and 85 respectively at final follow-up. Conclusion: Through direct visualization of intra-articular structures, ankle arthroscopy can offer an essential option for patients both in acute and in sequelae after an ankle fracture. More studies are needed to understand the real effectiveness of the procedure, especially in acute at the same time of osteosynthesis.