bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Medicaid Expansion Improve Access to Care for Ankle Sprains?
Authors: Hoch Caroline P. , Scott Daniel J. , Scott Daniel J. , Gross Christopher E. 
Published: January 2022

Category: Ankle; Sports; Other Introduction/Purpose: Prior research has found Medicaid patients face greater difficulty scheduling appointments with orthopaedic surgeons compared to those with other insurance. Recently, a number of states have expanded Medicaid coverage as part of the affordable care act, although it is unclear how this expansion impacts the ability of these patients to obtain access to orthopaedic surgeons. We questioned whether Medicaid patients face additional barriers to care for treatment of ankle sprains, an extremely common athletic injury. Our goal was to determine whether individual state Medicaid expansion status, as well as type of insurance accepted, affected access to care for ankle sprains. Methods: Four pairs of Medicaid expanded (Kentucky, Louisiana, Iowa, Arizona) and unexpanded (North Carolina, Alabama, Wisconsin, Texas) states in similar geographic locations were chosen. Twelve foot and ankle practices from each state (N=96) were randomly selected from the American Orthopaedic Foot & Ankle Society directory. Each clinic was called twice to request an appointment for a fictitious 16-year-old with a first-time ankle sprain with either in-state Medicaid insurance or Blue Cross Blue Shield (BCBS) private insurance. Results: An appointment was obtained at 63 (65.6%) clinics when calling with BCBS and 44 (45.8%) clinics with Medicaid (P=.006). There was a significant difference in appointment scheduling based on insurance status in Medicaid unexpanded states (Medicaid=21, 43.8% vs. BCBS=34, 70.8%; P=.007). However, this difference was not significant in Medicaid expanded states (Medicaid=23, 47.9% vs. BCBS=29, 60.4%; P=.219). In addition, in all states except Iowa, a Medicaid expanded state, more appointments were scheduled using BCBS than Medicaid. The three most common reasons for appointment denial were inability to provide an insurance identification number (47.1%), insurance status (23.5%), and lack of referral (17.6%). The waiting period for an appointment was not significantly different depending on insurance status or Medicaid expansion status (Medicaid=3.30 days, BCBS=3.43 days, P=.152). Conclusion: For patients with first-time ankle sprains, access to care is more difficult using Medicaid insurance rather than private insurance, especially in Medicaid unexpanded states. However, when granted an appointment, Medicaid patients waited a comparable amount of time to the appointment as those using private insurance.
Does the Radiographic Lateral View of the Lesser Toe Matter in A Trauma? A Retrospective Analyses of 378 Radiographs
Authors: Mansur Nacime S. , Kitagaki Danilo P. , Gonçalves João P. , Foni Noel O. , Araujo Caio Augustus F. , Sanchez Gustavo T. 
Published: January 2022

Category: Lesser Toes; Trauma Introduction/Purpose: To evaluate the importance of a radiographic lateral view in diagnosing lesser toes traumatic conditions. Methods: Between January 2018 and March 2018, 378 radiographs of 126 patients evaluated in an emergency care hospital for trauma in the lesser toe were retrospectively evaluated for presence of lesser toes traumatic conditions. Patients were selected if a complete series of radiographs were performed, anteroposterior (AP), lateral (LA) and Oblique (OB). Radiographs of the same patient were duplicated and divided in two groups: standard group (AP and OB) and complete group (AP + LA + OB). Images were examined by four independent examiners with different degrees of experience. Each examiner randomly evaluated the same patient twice (one for each group). Kappa index was used to evaluate intra and inter-examiner concordance, and the two- proportion equality test was used to calculate statistical significance. Results: Mean age of patients was 37.2 years (4-85yr), 144 injuries were diagnosed in standard group (28.6%) and 266 injuries (52.8%) in complete group (p<0.001). Individually, each examiner had an improvement in the number of lesions diagnosed when comparing group assessment (p<0.001). Kappa index was superior to 0.60 for all examiners in standard group. Conclusion: In conclusion, the addition of true lateral view was able to detect misdiagnosed injuries in lesser toes trauma and improved the number of diagnosed lesions in 84.6%.
Medial Approaches to the Posterior Malleolus: A Comparative Cadaveric Study
Authors: Palma Joaquin , Urrutia Tomas , Morales Sergio 
Published: January 2022

Category: Ankle; Trauma Introduction/Purpose: Ankle fractures are the most common fractures of the lower extremity. In spite of that, there is still no consensus regarding the best way to approach posterior malleolus (PM) fractures. The aim of this study is to compare the degree of PM exposure, tension of the flap containing the medial neurovascular bundle (NVB) and distance between the surgical incision and the NVB using three different posteromedial ankle approaches. Methods: Three different posteromedial approaches were compared: direct medial (DM) modified posteromedial (MPM) and posterior paramedian (PPM). Each approach was performed four times using a standardized technique. With a digital tensiometer, the minimal tension of the flap containing the NVB that allowed proper exposure of the PM was measured. In a second stage, an axial cut 1cm proximal to the tibiotalar joint was performed in nine frozen pieces and PM exposure degree and distance between the incision and the NVB was measured. Results: The median minimal tension was DM: 14,78 N, MPM: 8N and PPM: 5,75N. The median distance between the incision and the NVB was DM: 17mm, MPM: 6mm and PPM: 28mm. The median degree of exposure was DM: 51%, MPM: 58% and PPM: 72%. Conclusion: The PPM approach achieved the highest degree of PM exposure, with the lowest tension applied to the NVB and allowing the greatest distance between the incision and the NBV. Thus, we believe it should be considered the approach of choice for large fractures compromising the posteromedial and posterolateral aspect of the PM.
Are Outcomes Following Crossed Lag-Screw Modified Lapidus Technique for Hallux Abductovalgus Comparable to Plate-Screw Fixation Technique? A Study of Costs, Radiographic and Patient Reported Outcomes
Authors: Paranjape Chinmay S. , Lalli Trapper , Tennant Joshua N. 
Published: January 2022

Category: Bunion; Diabetes Introduction/Purpose: The modified Lapidus (ML) for tri-planar HAV correction is a powerful procedure for correcting hallux valgus (HV) and metatarsal rotation. We assessed implant costs, radiographs, and pre and postoperative patient reported outcome measures of Patient Reported Outcome Information System Physical Function (PROMIS-PF) Computerized Adaptive Test scores (CAT) at an average of 20.2 months followup. Methods: We examined patients retrospectively from January 2014 to December 2019. Pre and postoperative PROMIS-PF, radiographic parameters (intermetatarsal angle, IMA and HV angle, HVA), complications, and total surgical time were reviewed from the medical chart. Estimated surgical implants costs were obtained from manufacturers. Results: 83 patients underwent lag screw lapidus. All had radiographs, 71 had complete PROMIS-PF. Patients were a median age 55.80 (45.55, 53.85), 6.7% male, and 20% diabetic (median A1c 6.4%). Complications included 6.7% delayed wound healing, 13.3% painful hardware, 13.3% superficial infections. Others (7/83 or 8.4%) included complex regional pain syndrome in one, overcorrection in two, paresthesia in one and symptomatic nonunion in three. Preoperative angles were hallux valgus angle 33 (30, 40), IMA 15 (12, 16) which improved at final postoperative follow up to HVA 9 (5, 15) and IMA 7 (6, 9). PROMIS-PF was 43 (37,52) preoperatively, 37 (31, 39) at six weeks, 46 (42, 51) at three months, and 49 (41, 53) at > 360 days. The drop in PROMIS- PF between preop and 6 weeks and the rise from 6 weeks to 3 months were significant. There was no difference between pre and postoperative PROMIS-PF. Implants averaged $140 USD. Conclusion: Patients achieved good radiographic correction of HV following ML by our technique. While physical function, measured by the PROMIS-PF, decreased in the acute postoperative period, it increased to near final levels by three months postoperatively. Low complication rate, low cost, and high patient postoperative functional expectations with excellent radiographic correction were demonstrated.
The Course of Tarsal Tunnel Syndrome after Ultrasound-Guided Injections
Authors: Park Joseph S. , Atesok Kivanc , Pierce Jennifer , Small Benjamin , Perumal Venkat , Cooper M. Truitt 
Published: January 2022

Category: Other; Ankle; Hindfoot; Midfoot/Forefoot; Sports Introduction/Purpose: Local ultrasound (US)-guided injections of anesthetics with corticosteroids are commonly performed for the conservative treatment of tarsal tunnel syndrome (TTS). This retrospective study aimed to investigate the course of TTS after US-guided injections. Methods: The study included patients who were diagnosed with TTS and received US-guided injections as their initial conservative treatment. The patients' pain levels were noted on a scale between zero and ten before and after each injection. The patients were divided into two groups: nonsurgical and surgical groups. The nonsurgical group included patients who had received US-guided injections and were not treated surgically, and the surgical group included those who received US-guided injections and ultimately underwent surgical tarsal tunnel release (TTR). The two groups were compared in terms of age, gender, post-injection follow-up time, and the amount of pain reduction immediately after injection (ΔPN). In the surgical group, the presence or absence of additional foot and ankle pathologies requiring operative treatment during TTR, and outcomes of surgical treatment were also assessed. Results: 218 patients were diagnosed with TTS and received US-guided injections as their initial treatment. After the injections, 169 patients (77.5%) required no TTR (nonsurgical group) and 49 patients (22.5%) underwent TTR (surgical group). The average ages for the nonsurgical and surgical groups were 53.8 and 48.9 years (P = 0.03). The average time between the injection and final follow-up for the nonsurgical group was 339 days. The average time between the injection and TTR for the surgical group was 145 days. There were no differences in pain relief after the injections between the nonsurgical and surgical groups (mean ΔPN: 3.6 and 3.8, respectively). In the surgical group, 16 patients (32%) presented with additional foot and ankle pathologies that were surgically treated during TTR. The average post-surgical follow up time was 117 days. At final follow up, 41 patients (84%) in the surgical group had no pain or functional impairment. Conclusion: US-guided injection can be an effective conservative treatment option for patients with TTS. Surgical release of tarsal tunnel may improve and resolve the overall symtoms of TTS in majority of the patients who do not respond to nonsurgical treatment. Younger age and additional foot and ankle pathologies appear to be associated with greater likelihood of undergoing TTR.
The STAMP Test: A Novel Clinical Test in Diagnosing Achilles Tendon Ruptures
Authors: Porter Giselle M. , Haupt Edward T. , Kaplan Jonathan R. , Charlton Timothy P. 
Published: January 2022

Category: Ankle Introduction/Purpose: Achilles tendon ruptures are common injuries, and an estimated 20-25% injuries are missed acutely. Chronic and acute Achilles tendon rupture patients typically present with nonspecific complaints and physical exam findings. Commonly used physical exam maneuvers such as the Thompson test have variable sensitivity and reliability for the examiner. The patient with an Achilles tendon rupture will have expected plantar-flexion weakness, however clinical data utilizing plantarflexion weakness to develop a physical exam maneuver is lacking. We propose two new tests with sensitivity and specificity analysis to evaluate this understanding in the clinical setting: the Stand and Maintain Plantarflexion (STAMP) and Tendo-Achilles Rise (TAR) tests. We hypothesize that the STAMP and TAR exams maneuvers will have high sensitivity for diagnosis of acute and chronic Achilles tendon rupture. Methods: Data was collected from a single surgeon's practice at two large urban treatment centers. Data was retrospectively acquired over a period of 7 years and then prospectively acquired over a period of 5 years. Patients with mid-substance Achilles tendon rupture confirmed with MRI imaging or operative treatment were included. We examined clinical data regarding ambulation, resting tension, palpable Achilles gap, Thompson test, and STAMP and TAR tests on initial presentation. The STAMP test is performed by the patient attempting a wall assisted double leg heel rise and lifting the uninjured foot off the ground. It is consistent with an Achilles tendon rupture if the patient is unable to maintain this position for five seconds. The TAR test is performed by the patient attempting a wall assisted single leg heel rise. It is consistent with an Achilles tendon rupture if the patient is unable to maintain this position for five seconds. Results: 71 patients with complete mid-substance Achilles tendon ruptures that met inclusion criteria were identified. 45 (63%) presented acutely and 26 patients (37%) presented chronically. The Thompson test displayed a diagnostic sensitivity of (12 26 46%) for chronic ruptures and (38 45 84%) for acute ruptures. The STAMP and TAR tests displayed a diagnostic sensitivity of (22 26 85%) for chronic ruptures and (45 45 100%) for acute ruptures with a diagnostic specificity of (89%). Conclusion: Achilles tendon ruptures can be difficult to diagnose due to inconsistent symptoms and clinical exam findings. The STAMP and TAR physical exam tests have high sensitivity to clinically diagnose Achilles tendon rupture both in the acute and chronic setting and are superior to well-described physical exam tests. The findings support that the addition of the STAMP and TAR diagnostic protocol may be clinically beneficial when diagnosing Achilles tendon ruptures in both the acute and chronic setting. Future work should be focused on providing direct comparison to other exam maneuvers as well as identifying data reliability.
“In-Situ” Joint Preparation Technique for First Metatarsophalangeal Joint Arthrodesis: A Retrospective Comparative Study with “Flat-Cuts” Technique
Authors: Prat Dan , Pridgen Eric , Lee Wonyong , Wapner Keith L. , Chao Wen , O'Connor Kathryn , Farber Daniel C. 
Published: January 2022

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: The most common joint preparation techniques mentioned in literature for 1st metatarsophalangeal (MTP) joint arthrodesis are 'cup and cone' and 'flat-cuts'. A third option of an 'in-situ' technique, has rarely been studied. This study compares the clinical, radiographic, and patients-reported outcomes of 'in-situ' joint preparation with a traditional 1st MTP joint preparation technique. Methods: The 'in-situ' technique utilizes the same dorsal surgical incision as traditional techniques. Cartilage and osteophyte removal are carried out using standard techniques without the use of specific reamers or a sagittal saw. The arthrodesis is performed in-situ with the similar freedom of joint positioning as the cup and cone technique, and traditional fixation constructs are applied. In this study, A retrospective chart review was performed for patients who underwent 1st MTP joint arthrodesis between January 2015 and December 2019. The complication, revision and non-union rates were examined in a multivariable logistic regression model. Patient reported outcome were analyzed in a repeated measures general linear model. Analysis of variance and Receiver Operating Characteristic were used to assess radiographic measurements. Results: Total of 388 1st MTP joint arthrodesis cases were included. Overall, 262 'Flat-Cuts' and 126 'In-Situ' cases were analyzed. Mean follow-up time was 292 days (median 174, SD 305). Joint-preparation technique did not have statistically significant impact on union rates (p=0.311) or revision rates (p=0.898). Diabetes-Mellitus was the most powerful predictor of non-union (p<0.001, OR 6.558, 95% CI: 2.534-16.969) and revision (p=0.02, OR 3.662, 95% CI: 1.230-10.905). The rate of transfer- metatarsalgia was significantly higher in 'flat-cuts' (p=0.015, OR 6.808, 95% CI: 1.460-31.744). Visual-Analogue-Scale and PROMIS- CAT-Physical significantly improved at 6-weeks, 3-months, and at last follow-up in both techniques (p<0.001, p=0.001), and the improvement was comparable between the techniques (p=0.078, p=0.100).'In-situ' technique resulted in significantly less mean 1st- ray shortening (3.05mm vs 7.64mm, p<0.001). In a Receiver-Operating-Characteristic analysis of transfer metatarsalgia and 1st ray shortening, the optimal diagnostic cut-off was 6.87 mm (LR 1.67, AUC 0.652, p=0.005, 95% CI: 0.56-0.74). Conclusion: 'In-situ' joint preparation technique is a simple, safe, and cost-effective technique for 1st MTP joint arthrodesis. In our series, 'in-situ' technique had a similar or better complication profile than the 'flat-cuts', while providing similar patient- reported outcomes. 'In-situ' technique resulted in significantly less 1st ray shortening, which was a predictor of transfer metatarsalgia.
A New Approach for Stage 2 Adult Acquired Flatfoot Deformity
Authors: Raduan Fernando C. , Coetzee J. Chris , Den Hartog Bryan D. , Seybold Jeffrey D. , Cammack Paul M. , Stone Rebecca M. , Fritz Jacquelyn E. , Seiffert Kayla 
Published: January 2022

Category: Hindfoot Introduction/Purpose: Adult Acquired Flatfoot Deformity (AAFD) is a common progressive pathology that mainly affects patients after their 50s. Even though it is not clear yet what causes AAFD, the great majority of patients have their talonavicular (TN) joint sub dislocated in one or more planes. According to the severity of the deformity and its flexibility, different surgical procedures can be performed to realign the foot. The deformities usually happen around the TN joint, making it the center of rotation and angulation (CORA). Corrections on the CORA realign deformities in different planes and his concept can be applied to mostly any deformity. The objective of this study is to evaluate clinically and radiographically patients with stage 2 AAFD submitted to isolated TN fusion. Methods: Fifty-four patients (59 feet) from July 2013 to December 2019 with stage 2 AAFD were submitted to isolated TN fusion. All patients had clinical deformity and arch foot collapse associated with pain along the medial hindfoot. Weight-bearing x- rays were performed pre-operatively, the Meary's and calcaneal pitch angles were measured on lateral view and the Talar coverage and Simmon's angle were measured on antero-posterior view. Angles were measured by a fully trained foot and ankle surgeon. Post-operative measurements were done with the same set of images by the same surgeon, one month after the initial measurements. FAAM and VR12 were used to compare patient's clinical status. Patients with previous surgeries on the foot or ankle and patients submitted to other fusions or hindfoot osteotomies were excluded from the study. Gastrocnemius lengthening and toes corrections were not an exclusion criterion. Results: Thirty-seven females and seventeen males were evaluated with a mean age 61 years at the time of surgery. Only the FAAM score significantly improved from pre-operative (FAAM = 48.48, VR-12 Mental = 55.73, VR-12 Physical = 37.25) to most recent mean follow-up of 16.2 months (FAAM = 58.45 (p<.001), VR-12 Mental = 57.19 (p=.179), VR-12 Physical = 37.53 (p=.832). The lateral view X-Rays showed Meary's and calcaneal pitch angles mean improving from 27 and 15 degrees pre-operatively to 9 and 18 degrees post operatively (p<.001), whereas Front view foot X-Rays showed Talo-Naviciular coverage angle and Simmon's angle going from 35 and 20 degrees to 5 and 6 degrees respectively (p<.001) Conclusion: Isolated talonavicular fusion can correct the deformity on its multiple planes providing not only significant improvement on radiographic alignment but also the FAAM clinical outcome score. Comparative studies should be performed to determine which is the best technique for patients with stage 2 AAFD.
Arthroscopic Bone Marrow Stimulation or Non-Operative Treatment for Osteochondral Lesions of the Tibial Plafond
Authors: Rikken Quinten , Dahmen Jari , Stufkens Sjoerd A. , Kerkhoffs Gino 
Published: January 2022

Category: Ankle; Arthroscopy Introduction/Purpose: A paucity of clinical results from osteochondral lesion of the tibial plafond (OLTP) treatment exists in the literature. The primary purpose of this study was therefore to compare the patient reported outcomes of OLTPs treated with arthroscopic bone marrow stimulation (BMS) and non-operative treatment. The secondary purpose was to compare the reintervention- and complication rates. Methods: Patients treated either with BMS (BMS group) or any form of non-operative treatment (non-operative group) at a minimum follow-up of 12 months were selected from a retrospective database query of patients treated between 1990 and 2020. Eligible patients were contacted by phone and cross-sectionally included. The primary outcome was the Numeric Rating Scale (NRS) during weightbearing. Secondary outcomes included; the NRS in rest, the Foot and Ankle Outcome Score (FAOS), and the Short Form Health Survey (SF-36) general health questionnaire. Additionally, the reintervention- and complication rates were collected. Results: A total of 55 patients were included, which consisted of 15 patients for the non-operative group and 40 patients for the BMS group were analyzed at a mean 73.2 +- 62.9 and 100.5 +- 72.1 months respectively (Table 1). The median NRS during weightbearing was 2 (IQR: 1-5) for the non-operative group and 1.5 (IQR: 0-4) for the BMS group (P= 0.43). The NRS in rest was, similarly, not significantly different between groups. None of the FAOS subscales were found to be significantly different between treatment groups. No reoperations or major complications after follow-up treatment were recorded. Conclusion: Clinical outcomes following arthroscopic BMS and non-operative treatment yield moderate to good clinical results in this cross-sectional cohort OLTP patients. Although this study was the first to report outcomes of non-operative treatment of OLTPs and to compare these to BMS, prospective studies are highly needed for these understudied lesions.