bluuebunny/crossref_metadata_2025_split huggingface dataset:
Calcaneus Fracture Fixation: Assessing the Adequacy of the Sinus Tarsi Surgical Fixation Technique
Authors: Kuljic Nebojsa , Kolla Lee A. , Thiessen Trent , Willms Scott 
Published: November 2022

Category: Trauma; Hindfoot Introduction/Purpose: Intra-articular calcaneus fractures are devastating injuries, and life-changing for patients that develop post-traumatic arthritis, a common outcome. Debate exists as to whether non-operative symptomatic management, or operative treatment, best manages these injuries, partially due to the difficulty of achieving anatomic subtalar joint reduction. Traditionally, a large, lateral extensile incision has been used, plagued with soft tissue complications quoted at rates upwards of 22%. A less invasive incision, the limited sinus tarsi approach (ST-a), has become more common, proposed to lower complication rates without compromising radiographic nor clinical outcomes. The primary purpose of this study was to objectively assess the adequacy of joint reduction along with the associated soft tissue complications using the ST-a and compare it to the standards of the lateral extensile incision. Methods: All calcaneus fractures fixated through the ST-a at our institution were reviewed between March 2017 and Jan 2020. Inclusion criteria included the presence of preoperative and post-operative X-rays and CT scans. Primary outcomes were radiographic measures, including Bohler's angle on X-ray, and the maximum summative step deformity at the posterior facet of the subtalar joint in all three planes on CT scan. Secondary clinical outcomes included soft tissue complications (infection, delayed wound healing) and the need for reoperation. Results: Thirty patients were included with an average age of 48.9 +- 13.9 (n=24 males, n=6 females) and Sanders classification of 2.8. Pre-operatively, the mean Bohler's angle and summative posterior facet step deformity were 5.8 +- 16.6° and 17.2 +- 9.3mm, respectively. These radiographic outcomes were significantly improved postoperatively to 27.2 +- 7.7° and 5.3 +- 2.9mm. Soft tissue complication rates were half that of the comparative extensile approach. Conclusion: Using the ST-a, radiographic joint reduction was acceptable compared to literature standards. There was subsequently a lower incidence of soft tissue complications than previously quoted for the lateral extensile approach. Although technically more demanding, the ST-a is a valuable method for the treatment of intra-articular calcaneal fractures and should be considered when planning operative management of intra-articular calcaneus fractures.
Arthroscopic-Assisted Minimal Invasive Surgery for Weber C Ankle Fractures: Comparation to Open Reduction Internal Fixation
Authors: Lee Sung Hyun , Yoo Byung min 
Published: November 2022

Category: Trauma; Arthroscopy Introduction/Purpose: After acceptable reduction and internal fixation for ankle fractures, some patients regularly suffer from residual symptoms, presumably due to occult intra-articular injuries. Recently, arthroscopic-assisted technique for ankle fractures was introduced. However, there was no previous study that investigate the outcomes of arthroscopic-assisted minimal invasive surgery (MIS) for pronation type ankle fractures. The aim of this study was to compare the clinical outcomes after arthroscopic- assisted MIS surgery to conventional open reduction internal fixation (ORIF) for Weber C ankle fractures. Methods: Between 2016 and 2019, 86 patients with Weber C type ankle fractures with minimum 2 years follow up were included. Patients were sorted to 2 groups according to operation technique (MIS group (n=34): arthroscopic-assisted MIS, ORIF group (n=52): conventional ORIF). In MIS group, fibula fractures were fixed using fibula nail. Medial and posterior malleolus fractures were fixed using cannulated screw arthroscopically assisted with pin point wound. Syndesmosis injury was treated with arthroscopic reduction and screw fixation. Intraarticular lesions such as loose body or osteochondral lesion of talus were removed or debrided arthroscopically. Clinical outcomes were compared using a visual analog scale (VAS), Foot and Ankle Outcome Score (FAOS). In addition, postoperative complications including posttraumatic arthritis were evaluated. Results: There were no significant differences between 2 groups in VAS, FAOS. There were 2 cases of postoperative infections and 4 cases of wound problems in ORIF group, but there was no complication in MIS group. There were 1 cases of obvious advanced posttraumatic arthritis in MIS group and 3 cases in ORIF group. Conclusion: Arthroscopic-assisted minimal invasive surgery was effective treatment option with low rate of wound problem in for Weber C ankle fractures.
What Makes Plantar Heel Spur Painful? A Matched Case-Control Study
Authors: Lee Wonyong , Metgud Neha A. , Moore Michelle 
Published: November 2022

Category: Hindfoot; Other Introduction/Purpose: Plantar heel spur has been considered one of the reasons for heel pain in plantar fasciitis although its pathophysiology is not clear. The purpose of this study is to investigate the demographic and radiographic differences between the plantar fasciitis cohort and age/sex-matched control cohort, and identify risk factors that make plantar heel spurs painful. Methods: Patients who visited the office under the diagnosis of plantar fasciitis from September 2020 to December 2021 and age/sex-matched control cohort were included. Demographics and radiographic findings between the two groups were compared. A subgroup analysis was performed on only patients who had plantar heel spur. Patients who had plantar feel spur from the study group and the control group were extracted. All demographics and radiographic data were compared between the two subgroups and a multivariable logistic regression analysis was performed to identify independent risk factors that make plantar heel spur painful. Results: 76 patients were enrolled in the study group (Painful heel) and age/sex-matched control group (Non-painful heel). BMI was significantly higher in the study group compared to the control group: 33.2 vs 28.7 (P < .001). In the study group, plantar heel spur was present in 67.1% (51 out of 76), while in 38.2% (29 out of 76) in the control group (P < .001). In the subgroup analysis, BMI in the study group was significantly higher compared to the control group: 34.6 vs 30.3 (P < .001). All variables which can have an effect on painful plantar heel spur in patients with plantar fasciitis were included in a multivariable logistic regression analysis. The analysis through this subgroup comparison identified high BMI as an independent risk factor of painful plantar heel spur. Conclusion: High BMI was the one single independent predictor of painful heel spur resulting in plantar fasciitis heel pain. Concerning the treatment for plantar fasciitis, we need to counsel patients on emphasizing protection and cushioning for plantar heel to relieve axial loading and weight loss to decrease BMI.
3D Printed Total Talus Replacement after Free Vascularized Medial Femoral Condyle Osteocutaneous Flap for Avascular Necrosis of the Talus Leads to Poor Clinical Outcomes
Authors: Madi Naji S. , Chopra Aman , Fletcher Amanda N. , Mithani Suhail K. , Parekh Selene G. 
Published: November 2022

Category: Hindfoot Introduction/Purpose: Talar avascular necrosis (AVN) is a difficult pathology to diagnose and manage. Traditional treatment options include both joint sparing procedures (vascularized bone graft, core decompression, intraosseous stem cell injection) and joint sacrificing procedures (arthrodesis or arthroplasty). Three dimensional (3D) printed total talus replacement (TTR) has recently gained more popularity as an intervention to salvage joint motion in patients with talus pathology. Although vascularized bone grafting can treat localized talar AVN, failure of this procedure to improve talar vascularity and prevent further subchondral collapse may require revision surgery. This is the first study to compare outcomes of patients with talar AVN who underwent primary 3D printed TTR and patients who underwent a secondary TTR subsequent to failure of a free vascularized medial femoral condyle (MFC) flap. Methods: This case series analyzed the outcomes of two patients who underwent a secondary 3D printed TTR subsequent to failure of the index revascularization procedure using an MFC flap in 2016. These patients were compared to a cohort of patients who underwent a primary 3D printed TTR to treat talar AVN between 2016 and 2019. Preoperative and postoperative assessment included ankle range of motion, foot and ankle outcome score (FAOS), visual analogue scale (VAS) pain scores, and radiographic imaging. A minimum 12-month follow-up period was reported for patients. Results: Within the group that underwent a secondary TTR after a failed revascularization, both patients had a mean followup of 23.5 months. The 25 patients in the comparison group who all underwent a primary 3D printed TTR had an mean follow-up period of 22.1 (range:12-43) months. All patients in the study experienced improved VAS pain scores and ankle dorsiflexion post- operatively. In the secondary 3D printed TTR group, both patients demonstrated reduced plantarflexion of 20 degrees and ankle motion of 15 degrees relative to the comparison group which showed a minimal increase in both. When analyzing FAOS functional outcome score subscales, patient two demonstrated improvement in pain from 44 to 46, symptoms from 29 to 46, and activities of daily living from 47 to 76. Patient one experienced a decrease in sports and recreation from 15 to 5 and quality of life from 38 to 31. Conclusion: This case series demonstrated poor functional outcomes of two patients who underwent 3D printed TTR after talar revascularization with MFC grafts when compared to the cohort of patients who solely underwent a primary 3D printed TTR for talar AVN. Further investigation is warranted to determine which patients may benefit from a revascularization procedure or a primary 3D printed TTR.
Patient Reported Outcomes Analysis with Cartiva Implant
Authors: Maestre Stephanie , Hogan MaCalus V. , Hasselman Carl T. , Kline Alex J. , Yan Alan Y. 
Published: November 2022

Category: Midfoot/Forefoot; Other Introduction/Purpose: There has been an increased use of Cartiva implant in patients with first MTP arthritis. There are limited studies analyzing patient reported outcomes (PROs) with Cartiva implant. The goal of this study is to analyze validated patient reported outcomes on Cartiva patients. Methods: From a multi-center single institution, we analyzed patients who received the Cartiva implant and submitted PROs from December 2016 to December 2019. The following outcomes were analyzed: Foot and Ankle Ability Measure (FAMM), Global Rate of Change (GRC), and Patient Acceptable Symptom State (PASS). The PROs were analyzed by examining the postoperative score at any time interval after the procedure, a difference between preoperative score and postoperative time interval score (delta score), and at different time periods 0-2 months and >2 months after the procedure. Results: Of the 175 Cartiva patients, the average age was 57.1 years with 68% females and 32% males. The overall mean delta FAMM score was 5.5. The mean FAMM score at 0-2 months were 61.6 with the mean delta score -9.2. At > 2 months, the mean FAMM score was 74.7, and the mean delta score was 10.9. With GRC scores, overall GRC score 45.6 % report better, 35.1% report no change, 11.9% report worse. At 0-2 months, 38.1% report better, 42.9% report no change, and 19.1 % report worse. At > 2 months, 41.2% report better, 35.3% no change, 23.5% report worse. As for PASS scores, 53.3% said no, and 46.6% said yes. Conclusion: Overall FAMM scores with Cartiva implant overall show improvement compared to preoperative score. FAMM scores at 0-2 months are worse than preoperative but are better at >2month timeframe. There is a minimal difference between patients feeling better or no change after their procedure in GRC and PASS scores and analyzing at 0-2 and >2 month timeframes. Further studies are needed.
Impact of BMI on Outcomes after First Metatarsophalangeal Joint Arthrodesis
Authors: Manz Wesley J. , Webb Alexander R. , Fuqua Andrew , Novack Joseph C. , Coleman Michelle M. , Kadakia Rishin J. , Bariteau Jason T. 
Published: November 2022

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: First metatarsophalangeal joint (MTPJ) arthrodesis is a commonly performed procedure for patients with various disorders of the first ray including hallux rigidus, severe hallux valgus, failed 1st MTPJ replacement, and failed hallux valgus correction. Outcomes are generally favorable and similar outcomes have been shown in the young and elderly. It is well documented that medical comorbidities have deleterious effects on outcomes in foot and ankle surgery. Obesity - in particular - has been broadly studied among the foot and ankle literature and has been associated with increased complications. Presently, there is a paucity of studies examining obesity's effect on outcomes of 1st MTPJ arthrodesis. This study's purpose was to evaluate outcomes following 1st MTPJ arthrodesis in obese vs non-obese patients. Methods: A retrospective cohort study of 94 patients undergoing first MTPJ fusion over the age of 18 with a diagnosis of hallux valgus or hallux rigidus was performed. Surgical and postoperative outcomes, Visual Analog Pain scale (VAS), and Short Form 36 (SF-36) surveys were examined and stratified into 2 patient groups: BMI < 30 and 3 30, with sub-analyses conducted between Obesity class I (30-34.9) and Obesity class II (35-39.9) patients. Continueous, normally distributed data were compared with independent sample t-tests, while comparisons of categorical data were made using chi-squared tests. Alpha and beta were assumed to be 0.05 and 0.8, respectively. Results: Average overall VAS and SF-36 physical component scores improved significantly at 6 months (P< 0.0001, 0.006) and 1- year postoperative visits (P <0.0001, 0.007) following 1st MTP fusion in the cohort as a whole. No differences in VAS or SF-36 scores were found between the obese (BMI > 30) or non-obese cohorts. Amongst BMI classified subgroups, significantly greater changes in preoperative to 6-month and 1-year postoperative VAS pain were observed in the Obesity class I patients vs. Obsesity class II or greater (P=0.043, 0.022). Conclusion: Our study showed first MTPJ fusion reliably improves pain and physical quality-of-life in arthritic obese and non- obese patients without differences in nonunion, complications, or patient-reported measures. Additionally, we observed that obese patients experienced comparable improvements in VAS pain and SF-36 physical function scores as their non-obese peers. Our findings asset that first MTPJ fusion is an effective procedure for correction of MPTJ pathology in the obese.
Impact of Low Social Support Systems on Post-Operative Outcomes of Ankle, Hindfoot and Midfoot Surgery
Authors: Manz Wesley J. , Novack Joseph C. , Fink Juliet , Zaldumbide Joel A. , Jacobson Joseph E. , Bariteau Jason T. 
Published: November 2022

Category: Other; Hindfoot; Midfoot/Forefoot; Trauma Introduction/Purpose: Degenerative conditions of the ankle, hindfoot and midfoot can markedly limit mobility, and functional disability due to bone and joint pathology has been demonstrated to predict mortality, and in some cases, decrease life expectancy by up to 10 years. Optimizing outcomes in surgical treatment of these conditions is therefore essential and requires analysis of both medical interventions and psychosocial factors. Physicians have only recently begun to identify social support to be a key factor in post-operative functional ability, though our understanding of their impact on surgical outcomes is limited. The purpose of this study was to elucidate the link between low social support and postoperative surgical foot and ankle outcomes. Methods: A single-center, prospective study was conducted on patients who underwent elective or non-elective ankle, hindfoot, or midfoot surgery between 2015 and 2019. Patients who were pre-operatively and post-operatively assessed at 6 month or 1 year follow up using the Short Form Health Survey (SF-36), Life-Space Assessment survey (LSA), and/or visual analog scale (VAS) for pain were administered a social support survey scoring the individuals social support system. Patient reported outcomes were compared between low social support patients (score <= 13) and high social support patients (score > 13). Results: Preoperative baseline and 6 month LSA scores in the low social support group were significantly lower compared to the normal social support group (P = 0.044, P = 0.038), a trend not observed at the 1 year post-operative mark. Low social support pre-operative SF-36 MCS scores (P = 0.015) were significantly lower than the high social support group with no difference detected in pre-operative SF-36 PCS scoring. At 6-month follow-up, the low social support group had significantly lower SF-36 PCS scores (P = 0.031) and SF-36 MCS scores (P = 0.006) compared to the high social support group. At 1 year follow up, these differences in PCS (P = 0.04) and MCS (P= 0.007) persisted. No significant differences in VAS scores were observed. Conclusion: Among adults undergoing foot and ankle surgery, low perceived social support was associated with lower degrees of perceived mental well-being and physical wellbeing up to 1 year postoperatively.
Arthroscopic Reduction and Internal Fixation of Talus Fractures: An All-Inside Soft-Tissue Preserving Technique
Authors: Martin Kevin D. , Curatolo Christian , Gallagher James , Alvarez Paul 
Published: November 2022

Category: Arthroscopy; Hindfoot; Trauma Introduction/Purpose: Talus fractures, although rare, can lead to devastating complications of posttraumatic osteoarthritis (PTA), mal-union, non-unions, and avascular necrosis (AVN). The timing and method of fixation has been controversial, especially for open and extruded fractures. The purpose of this study is to present short-term outcomes using a posterior talus arthroscopic reduction internal fixation (TARIF) technique. The authors hypothesized that talus fractures reduced arthroscopically and fixed percutaneously would have similar outcomes with reduced overall complications compared to traditional open techniques. Methods: We performed a retrospective study on 14 consecutive patients undergoing primary posterior arthroscopic reduction internal fixation for talus fractures from August 2020 to January 2021. All cases were performed completely arthroscopically, utilizing a posterior approach and cannulated screws. Patient demographics, fracture pattern, perioperative complications, and radiographic findings were collected. Results: The mean age of our cohort was 37.3 years (range, 19-75), including 8 males and 6 females, with 58% utilizing nicotine. Motor vehicle accidents accounted for 64% of injuries, followed by falls and gunshot wounds. Fracture location included 9 body fractures, 5 neck fractures Hawkins type 2 (1), 3 (3), and 4 (1). Five fractures were open injuries, 2 of which had vascular injuries that underwent irrigation and debridement followed by external fixation. Intraoperatively, all patients had 2-3 anterior to posterior 3.5mm cannulated headless screws placed with a mean tourniquet time of 87 minutes (range, 0 - 88). Postoperatively, all fractures had the articular surface restored to within 2mm on radiographs. No patients required antibiotics and no debridement's were performed. No acute AVN has been recorded. Conclusion: Our short-term results indicate posterior arthroscopic reduction internal fixation of talus fractures is safe and able to restore the articular surfaces. It also suggests that an all-inside soft tissue preserving technique may reduce short term complications.
Atypical Presentation of Tubulointerstitial Nephritis and Uveitis Syndrome, a Rare Disease
Authors: Fram Brandon , Randolph Jessica , Saadeh-Jackson Stephanie 
Published: November 2022

Purpose: To expand the current knowledge of tubulointerstitial nephritis and uveitis syndrome (TINU), which might assist other ophthalmologists in recognizing and treating patients with this rare disease. Methods: A patient with atypical demographics and features was compared with previously described TINU cases. The case was analyzed in terms of how it compares with more “classic” cases, and the differences were identified. Results: The diagnosis of TINU is ultimately clinical, although aided by previous studies. Thus, it might present challenges when patients do not have the typical demographics or presenting features of TINU. Conclusions: Our patient showed features that deviated from classic TINU. Knowledge of the disease and a comprehensive view of the patient’s medical state might help lead to accurate diagnosis and treatment.
Retinal Vasculitis in a Patient With Isaacs Syndrome and Inclusion Body Myositis
Authors: Martinez-Velazquez Luis , Zhou Paul , López-Font Francisco J. , Hoyek Sandra , Feldman Candace H. , Amato Anthony A. , Sobrin Lucia , Patel Nimesh A. 
Published: November 2022

Purpose: To report a case of bilateral occlusive retinal vasculitis in a patient with autoimmunity. Methods: A case was analyzed and a literature review performed. Results: A 55-year-old woman with autoimmune diagnoses of Isaacs syndrome and inclusion body myositis (IBM) reported decreased vision for 3 months. A fundus examination showed peripheral intraretinal hemorrhages in the right eye and an inferotemporal subhyaloid hemorrhage with adjacent intraretinal hemorrhages and preretinal fibrosis in the left eye. Fluorescein angiography showed temporal peripheral leakage and capillary dropout in both eyes, consistent with occlusive vasculitis. Scatter laser treatment to peripheral areas of retinal nonperfusion was followed by an intravitreal bevacizumab injection. Four months later, vision had stabilized at 20/15 in both eyes and the peripheral leakage had resolved. Conclusions: This patient developed retinal vasculitis associated with the rare autoimmune neuromuscular disorders of Isaacs syndrome and IBM. An extensive workup showed the most plausible mechanism for the vasculitis was autoimmunity with a history of previously elevated antibodies levels associated with the antiphospholipid syndrome.
Overlaps between obstructive sleep apnoea and other respiratory diseases, including COPD, asthma and interstitial lung disease
Authors: Bouloukaki Izolde , Fanaridis Michail , Testelmans Dries , Pataka Athanasia , Schiza Sophia 
Published: November 2022

In the past, there was limited research relating to the role of sleep in respiratory diseases. Physicians treating these patients tended to focus mainly on the daily disabling symptoms, overlooking the possible significant role of coexisting sleep disorders such as obstructive sleep apnoea (OSA).Nowadays, OSA has been recognised as an important, highly prevalent comorbidity for respiratory diseases such as COPD, asthma and interstitial lung diseases (ILDs). Overlap syndrome refers to the coexistence of chronic respiratory disease and OSA in the same patient. Although, in the past, overlap syndromes have been poorly studied, recent data underline that they result in increased morbidity and mortality compared with either underlying disorder alone. OSA and respiratory disease may be of different severity, and this, along with the existence of various clinical phenotypes, points to the necessity of an individualised therapeutic plan. Early recognition and OSA management could offer key benefits, such as improved sleep, quality of life and disease outcomes.Educational aimsDescribe pathophysiological aspects of OSA in chronic respiratory diseases such as COPD, asthma and ILDs.Understand the bidirectional clinical importance when OSA coexists in chronic respiratory diseases.Review current knowledge of treatment strategies towards an individualised therapeutic plan resulting in patient-centric outcomes.