bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trauma clinic follow-up: Predictors of nonattendance and patient-reported reasons for no show
Authors: Prescher Hannes , Haravu Pranav , Silva Amanda K , Reid Russell R , Wang Frederick 
Published: January 2022

Introduction The objectives of this study were to identify factors associated with nonattendance to follow-up in patients seen for traumatic hand and facial injuries at an urban Level 1 trauma center and to elucidate patient-reported reasons for nonattendance. Methods A retrospective chart review was performed for all patients seen for hand and facial trauma at our institution over a 2-year period. Demographic data, including race, insurance status, and incomes based on zip code data, were collected for all patients. Injury patterns, interventions, and patient disposition were analyzed. A binomial multivariate logistic regression was conducted to identify predictors of nonattendance to follow-up. All patients who were lost to follow-up over the last 12-month period were contacted via phone to identify reasons for nonattendance to determine whether they had followed up with another provider and to analyze long-term injury sequelae. Results After exclusion criteria were applied, there were 889 patients included in the analysis, with 31% of patients lost to follow-up. Factors significantly associated with follow-up nonattendance included patients who sustained injuries from gunshot wounds or assault, had no insurance or were out of network, and who received no acute intervention for their injuries. Forearm, wrist, and fingers fractures; facial fractures and lacerations; performing a procedure in the ED or operating room; and commercial insurance were all independent predictors of clinic attendance. The most common reasons for nonattendance cited by patients were “did not feel the need” (28%), lack of transportation (20%), and scheduling conflicts (19%). Conclusions Clinic follow-up for patients sustaining hand and facial trauma at a Level 1 trauma center is impacted by the socioeconomic factors that make this patient population particularly vulnerable to injury.
Engagement of older adults in regional health innovation: The ECOTECH concept mapping project
Authors: McNeil Heather , McMurray Josephine , Byrne Kerry , Grindrod Kelly , Stolee Paul 
Published: January 2022

Objectives: Regional health innovation ecosystems can activate collaboration and support planning, self-management and development and commercialization of innovations. We sought to understand how older adults and their caregivers can be meaningfully engaged in regional health innovation ecosystems focused on health and aging–related technology innovation. Methods: A six-phase concept mapping technique gathered data over six time points across Canada. Brainstorming conducted online and in person identified engagement ideas. Statements were sorted by similarity and rated by participants on importance and feasibility. Qualitative approaches and multidimensional scaling, hierarchical cluster analysis, descriptive statistics and t tests were used for analysis. Results: Sixty-two unique ideas were assembled into a seven-cluster framework of priorities for engagement in regional health innovation ecosystems including public forums, co-production and partnerships, engagement, linkage and exchange, developing cultural capacity, advocacy and investment in the ecosystem. Conclusions: This study identified a framework of priorities for directions and strategies for older adult and caregiver engagement in regional health innovation ecosystems. Next steps include collaborations to develop regional health innovation ecosystems that actively engage older adults and their caregivers in health and aging–related technology innovation.
Factors Influencing the Nonunion Rate Following First Metatarsophalangeal Joint Arthrodesis
Authors: Kachooei Amir R. , Raikin Steven M. , Daniel Joseph N. 
Published: January 2022

Category: Midfoot/Forefoot Introduction/Purpose: The choice of fixation, biomechanical stability, and hardware density might influence the union after the first metatarsophalangeal (MTP) arthrodesis. This study aimed to assess the influencing factors on the union rate and fixation failure after MTP-1 arthrodesis. Methods: In this retrospective cohort study, we included 359 patients with 378 feet from the practice of two foot and ankle surgeons. The surgical technique was identical. The providers randomized patients to receive either the locking plate or cross screws, which comprised 187 (50%) plate fixation and 191 (50%) cross screw fixation. Radiographic union was assessed at three months and the final follow-up and was further categorized as symptomatic versus asymptomatic nonunion. Results: Accounting for potential interaction between variables using multivariable logistic analysis, plate fixation (P=0.018), and diabetes (P=0.044) were significantly associated with a higher nonunion rate. At three month follow-up, 15 (8.3%) patients in the locking plate group and 5 (2.5%) patients in the cross screws group showed nonunion. Of 15 nonunion with plate fixation, 6 (40%) underwent a second surgery because of device failure, while none of the screw fixations required a second surgery (P<0.001). In comparison to asymptomatic nonunion, remaining symptomatic at three months follow-up was a significant risk factor for developing a nonunion with possible device failure at the final follow-up requiring intervention. Conclusion: Cross screw fixation is significantly associated with a lower nonunion, device failure, and secondary surgery rate than plate fixation, which might be related to contact surfaces and biomechanical stability. Besides, the cost saving is more with the cross screws than plate and screws. Diabetic patients should be counseled about the higher nonunion rate.
10 Year Outcomes of Unilateral vs Bilateral (Staged) Total Ankle Replacement
Authors: Abdul Nicole G. , Ramaskandhan Jayasree Ramas , Smith Karen , Alkhreisat Mohammad A. , Bennett Adam P. , Siddique Malik S. 
Published: January 2022

Category: Ankle Arthritis; Ankle Introduction/Purpose: Comprehensive long-term outcomes of total ankle replacement (TAR) help guide clinicians when they are deciding on the management of patients with more than single joint arthritis. Some patients will only require unilateral TARs, while others will need bilateral TARs. When deciding on treatment plans for patients, it is important to know the long-term surgical outcomes of both of these groups before treatment can be recommended. Currently there is a paucity of literature on long-term outcomes of unilateral versus bilateral TARs. The aim of the study is to assess long-term outcomes in patients who underwent unilateral vs. staged bilateral TARs. Methods: We performed a retrospective review of a prospectively completed hospital registry database for TAR. This consisted of a consecutive series of TARs performed by one senior surgeon from 2006 to December 2010 with 10-years of follow up. Clinical complications, radiological complications (lucency, cysts, and osteolysis), and patient reported outcome measures (WOMAC score, SF-36, general health survey, and patient satisfaction survey) were included for all patients. Outcomes were evaluated pre-operatively and at 1, 3, 5, and 10 years post-operatively. Three component mobile bearing implants were used in all patients. Results: There were 132 unilateral TARs (Group A) vs. 24 staged bilateral TARs (Group B). WOMAC scores significantly improved from pre-op to 1 year for pain (45.3 to 77.8; 52 to 76) function (49.1 to 77.8; 53.6 to 76) and stiffness (39.8 to 67.9; 55 to 65) in both groups respectively (p<0.05). At 5 years, Group B reported higher function scores than Group A (79.1 vs. 65.7; p=0.05). At 10 years Group B reported significantly better stiffness scores than Group A (78.5 vs. 59.5; p=0.034). There was no significant difference in SF-36 scores between groups at 5 and 10 years. Group A was 40% dissatisfied with return to recreational activities compared to 30% in Group B (p>0.05). Group A reported 16% dissatisfaction with surgery compared to 10% in Group B (p>0.05). At 5 years there were a higher number of radiological and clinical complications in Group A compared to Group B. Conclusion: For patient reported outcomes, staged bilateral TAR patients had more improvement in function at 5 years, and stiffness at 10 years, when compared to unilateral TAR patients. Unilateral TAR patients had higher rates of complications compared to staged bilateral TAR patients at 5 years.A limitation of this study was the smaller size of Group B patients compared to Group A. We will be able to present a detailed breakdown of outcomes at each time point if the abstract is selected for presentation.
Racial Disparities in Total Ankle Arthroplasty: An Analysis of a Large National Dataset
Authors: Adams Samuel B. , Long Jason , Danilkowicz Richard , Grimm Nathan L. , O'Donnell Jeffrey , Kim Jaewhan 
Published: January 2022

Category: Ankle; Other Introduction/Purpose: A significant body of literature exists that documents the racial/ethnic disparities in orthopedics. Previous studies have looked at racial disparities in total ankle arthroplasty and have shown concerning TAA utilization rates. One such study detailed a two fold difference in rate per 100,000 of 0.14 in Whites vs. 0.07 in Blacks in 1998, which continued to worsen and by 2011 the utilization rate was 1.17 in Whites vs. 0.33 in Blacks, a 4-fold difference. The purpose of this study was to update the literature and analyze the utilization rates of TAA by race as well as to detect any differences in outcomes between the groups through the most updated data available in the National Surgical Quality Improvement Program (NSQIP) database. Methods: A retrospective cohort study was performed utilizing the National Surgical Quality Improvement Program (NSQIP) database. Patients were identified for inclusion using the Current Procedural Terminology (CPT) codes 27700 and 27702, corresponding to arthroplasty ankle and arthroplasty ankle with implant, respectively. All patient's with known race were included, non-Hispanic White, non-Hispanic Black, Asian, Native American, and Hispanic. A total of 1164 patients met inclusion criteria for this study. Results: A total of 1164 patients with known race undergoing TAA from 2012-2018 were included in this analysis. Of these patients 1051 (90.3%) were non-Hispanic white (White), and 113 (9.7%) were non-Hispanic Black, Asian, Native American, and Hispanic (Non-White). The mean patient age for White patients was 63.7 years, compared to 55.3 years for Non-White patients which was statistically significant. (p-value <0.01). There was a similar distribution of males and females in each group, and smoking status and presence of diabetes mellitus was similar in both groups. In the listed postoperative complications, non-white patients were at no increased risk of developing superficial wound infection, deep wound infection, PE, DVT, requiring a blood transfusion, requiring another operation, or requiring readmission to the hospital within 30 days. Conclusion: Based on this large national data set, between the years 2012 and 2018 there was nearly 10-fold more non-Hispanic white patient's undergoing TAA when compared to other racial/ethnic groups. This unfortunately highlights the continued, if not worsening racial disparities present in TAA. Additionally, no differences were found in post-operative outcomes based on racial or ethnic group. This indicates that different racial or ethnic groups are doing no worse post-operatively from TAA when compared to Whites.
MTP Arthrodesis: Percutaneous Interfragmentary Screw Placement and Nerve Injury
Authors: Andrews Nicholas A. , Patch David A. , Jacob Roshan , Sutherland Charles R. , Harrelson Whitt , Agarwal Abhinav , Shah Ashish 
Published: January 2022

Category: Basic Sciences/Biologics; Midfoot/Forefoot Introduction/Purpose: Iatrogenic cutaneous nerve injury is the most common complication encountered in foot and ankle surgery with limited evidence to inform surgeons on neuroprotective techniques. The purpose of this study was to assess risk for injury to the dorsomedial cutaneous nerve (DCN) during insertion of percutaneous interfragmentary screws used in metatarsophalangeal (MTP) arthrodesis. Methods: Ten mid-tibia fresh frozen cadaver specimens were obtained for execution of this study. All cadavers were grossly and radiographically inspected for any evidence of existing pathology or prior operative intervention. Percutaneous placement of interfragmentary screw in both distal to proximal and proximal to distal fashion was performed. Only the skin was incised before reaming and screw placement. After screw placement, dissection of the great toe was conducted. The distance between the screws and the DCN was obtained. The DCN was also inspected for injury. Results: A total of 10 cadavers were included. The average age of our population was 64 (+- 12.6). Males represented 80% of our included specimens. Injury to the DCN was not reported using the proximal to distal screw fixation. The mean distance from the dorsal cutaneous nerve using proximal to distal interfragmentary screw fixation was 7.45+- 3.85 mm compared to 4.30+-2.71 mm in the distal to proximal screw. Distal to proximal screw fixation was associated with 10% risk of nerve injury with no nerve injuries occurring at the site of proximal to distal screws. Conclusion: In our cadaver study, proximal to distal screw fixation seems to offer neuroprotection in the setting of MTP arthrodesis. The DCN is known to have many anatomic variants, and DCN injuries can be a pretext for painful neuroma formation. Surgeons should consider careful dissection to the joint capsule in effort to decrease the risk of neurogenic injury when placing interfragmentary screws in MTP arthrodesis.
Correlation Between X-Ray and Weight-Bearing Computed Tomography for Imaging Evaluation of Hallux Valgus Deformity
Authors: Aravena Raul M. Espinoza , Chaparro Felipe R. , Ortiz Cristian A. , Carcuro Giovanni M. , Pellegrini Manuel J. 
Published: January 2022

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Weight-bearing computed tomography (WBCT) has emerged as a valuable diagnostic tool for foot and ankle pathologies. Hallux valgus deformity values are well described in the literature, but there is a lack of correlation studies between x-rays and WBCT for the most widely used imaging parameters. The role of coronal plane deformity has gained importance in the last few years as a recurrence predictor factor. Most radiological descriptions in this topic are indirect measures of this rotational deformity. WBCT seems more precise to evaluate hallux valgus 3D deformity. Purpose: Correlate Hallux Valgus deformity parameters, metatarsal head morphology, and sesamoids position on x-rays compared to WBCT. Methods: Hallux valgus (HVA), intermetatarsal (IMA), interphalangeal (IFA), and the distal metatarsal articular angle of the first metatarsal (DMAA) was measured on standing AP load-bearing radiographs (WBXR) and WBCT by 2 observers in hallux valgus patients. Deformity parameters obtained by both imaging methods were correlated with the Spearman Correlation (SCC) and the Intraclass Correlation Coefficient (ICC). Also, WBXR was analyzed to estimate the first metatarsal head rotation (pronation) by the round sign and sesamoids position. Then, direct pronation measurement was measured on WBCT by obtaining the Alpha Angle (AA) and sesamoids position in relation to the metatarsal head was defined. The Kappa concordance index (KCI) was determined. Results: 40 feet with Hallux Valgus were evaluated. In WBXR the medians of HVA, IMA, IFA, and DMAA were 24.5, 12, 8.98, and 13.08 degrees respectively. In WBCT the medians were 24.75, 12.93, 6.05, and 13.03 respectively. The SCC was 0.934 for HVA, 0.956 for IMA, 0.713 for IFA, and 0.487 for DMAA, and the ICC was excellent for HVA, IMA, and IFA for both methods, excellent for DMAA in WBXR, but poor for WBCT. For rotation deformity, the correlation between metatarsal head morphology and AA was poor with a KCI of -0.073, and also for the position of the sesamoids between both methods and the KCI was 0.061. Conclusion: Evaluated deformity parameters had an excellent correlation between WBXR and WBCT. Both methods are useful for determining HVA, IMA, and IFA in Hallux Valgus patients, but it was poor for DMAA. Also the correlation between first metatarsal head morphology on WBXR (Round sign) with metatarsal head pronation (Alpha Angle) on WBCT was poor, as well as sesamoids position. Given greater WBCT precision to evaluate rotational deformity, we believe it should be considered in the diagnostic process to most accurately understand this complex deformity.
Volume Measurements on Weightbearing Computed Tomography Can Detect Subtle Syndesmotic Instability
Authors: Ashkani-Esfahani Soheil , Bhimani Rohan , Lubberts Bart , Kerkhoffs Gino , Waryasz Gregory R. , DiGiovanni Christopher W. , Guss Daniel 
Published: January 2022

Category: Ankle; Trauma Introduction/Purpose: The ability to compare the ankle joints bilaterally in a 3D manner under physiologic weight provided by weight-bearing CT has led to a more accurate diagnostic method. While weight-bearing computed tomography (WBCT) allows 3D visualization of the distal syndesmosis, image interpretation has largely relied on 1D distance and, more recently, 2D area measurements. This study aimed to: 1) determine the sensitivity and specificity of 2D area and 3D volume WBCT measurements towards detecting subtle syndesmotic instability, 2) evaluate whether the patterns of changes in the 3D shape of the syndesmosis can be attributed to the type of ligament injury. Methods: A total of 24 patients with unilateral subtle syndesmotic instability and 24 individuals with uninjured ankles (controls) with bilateral ankle WBCT were assessed retrospectively. First, 2D areas at 0, 1, 3, 5,10 cm, and 3D volumes at 1, 3, 5, and 10cm above the tibial plafond were measured bilaterally. Secondly, given the volume measurement at the level of 5 cm proximal to the platform as the most sensitive and specific method introduced in this study, the 3D model of the distal tibiofibular space was created based on WBCT in a subset of 8 patients out of 24 in whom the type of ligament injury was recognized via MRI. The 3D model of the injured side was superimposed on the uninjured contralateral side to visualize the pattern of changes in different planes. P<0.05 was considered statistically significant. Results: No specific pattern was observed in 2D and 3D models of the syndesmotic space which can be attributed to a specific ligamentous tear. However, in patients with IOL rupture, the volume increased by >=39% at 5 cm height while without IOL injury the volume increased up to 26% (figure 1). The percentage of changes in 2D areas and 3D volumes showed significant differences in areas at 0cm (19.2%; p=0.004), 1cm (24.1%; p=0.002), 3cm (27.3%; p=0.003), 5cm (28%; p=0.002), and 10cm (29.3%; p=0.003) as well as volumes at 1cm (31.2%; p=0.003), 3cm (26.5%; p=0.001), 5cm (25.4%; p<0.001), and 10cm (24.7%; p=0.004) proximal to tibial plafond. Volume up to 5cm showed the lowest p-value, higher sensitivity (95.8%, 95%CI:87.8-100), and specificity (83.3%, 95% CI:68.4-98.2) for detection of syndesmotic instability. Conclusion: We suggest 3D volume measurements, best measured up to 5cm proximal to the plafond, as a promising means of diagnosing syndesmotic instability, particularly for subtle cases that are hard to detect.
Modified Brostrom with and without Suture Tape Augmentation: A Systematic Review
Authors: Bedrin Michael D. , Piscoya Andres S. , Lundy Alexander , Eckel Tobin T. 
Published: January 2022

Category: Ankle; Sports Introduction/Purpose: The Modified Brostrom (MB) has become the gold standard for operative management of chronic lateral ankle instability. Despite overall good clinical outcomes with this procedure, recent biomechanical data has called into question the strength and durability of this technique. Accordingly, the addition of suture tape to the MB construct has been described in an attempt to more closely recreate the natural biomechanical properties of the ankle lateral ligament complex. Despite its increasing popularity, the Modified Brostrom with suture tape augmentation (MBA) remains controversial due to a lack of clinical data. The purpose of this study is to determine the differences in clinical outcomes of MB compared to MBA. Methods: A systematic review of the literature was performed using PubMed, Embase, and CINAHL to identify English-language articles from 2009 - present discussing outcomes with the MBA technique. Total number of patients, patient demographics, follow-up time, subjective and objective outcome measures, return to sport, recurrent instability, and complications were evaluated. Results: A total of 4 studies (2 retrospective cohort studies, 2 case series) involving 156 patients with MBA met inclusion criteria. Average follow-up time was 13.8 months. Of the 3 studies reporting patient-reported outcome measures both pre-and post- operatively, there was a significant improvement in all measures (p<0.05). Two studies compared MB directly to MBA, one of which found a statistically significant difference in the Foot and Ankle Ability Measure (FAAM) in favor of the MBA (93.1 vs 90.5, p=0.027), while American Orthopaedic Foot & Ankle Society (AOFAS) score was not significantly different (p>0.05) between MB and MBA across studies. One study reported a significantly greater rate of return to sport at 12 weeks in the MBA group versus the MB (82% vs 27%, p<.001). There were no significant differences in complications between MB and MBA. Conclusion: MBA for chronic lateral ankle instability can produce good short-term clinical outcomes with few complications, comparable to MB. The overall quality of evidence is low, and long-term, prospective, head-to-head comparison data will be needed to determine the clinical efficacy, complication profile, and cost-benefit relationship of the MBA technique as it compares to the MB.