bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metal Allergy in Foot & Ankle: A Systematic Review
Authors: Cristofaro Caroline , Halai Mansur , Daniels Timothy R. , Pinsker Ellie 
Published: November 2022

Category: Basic Sciences/Biologics; Other Introduction/Purpose: Metal hypersensitivity is common in the general population, affecting between 10-15%. Many different metals are constituents of orthopaedic devices used for foot and ankle surgery; therefore, it is expected to influence patient outcomes. A variety of different reactions, both systemic and localized, have been reported, along with treatment strategies. However, there is no accepted protocol to evaluate, diagnose and manage patients with suspected metal hypersensitivity reactions. Current literature characterizing metal hypersensitivity in foot and ankle and guidance on management is lacking. Methods: A comprehensive literature search of Ovid MEDLINE and EMBASE was performed from inception to 23-Nov-2021 using MeSH search terms focusing on the foot and ankle, orthopaedic surgeries, a variety of metal types, and hypersensitivity reactions. A total of 43 studies were identified. All full-text, English, experimental and observational studies, reporting on metal hypersensitivity in the context of foot and/or ankle surgeries using metal-containing orthopaedic devices were included. Article screening, quality assessment, and data extraction was performed by two reviewers. Disagreements were resolved by discussion or the vote of a third reviewer. Results: A total of 45 patients (18 male and 27 female) were included from 15 papers. Mean age was 55.5 years. There were 42 static and three arthroplasty implants included. Metal hypersensitivity diagnosis was performed with specialist consults, and most commonly, patch testing (e.g. with standard array or implant components). Patch testing was most commonly positive to nickel (thirteen), followed by cobalt (four), vanadium (three), and other less commonly used metals. Mean follow up was 20.8 months. Fifteen patients (12 with a positive patch test, 1 with a negative patch test and two not tested), all symptomatically improved following metallic implant removal; four patients had implants removed for unclear reasons; one patient remained symptomatic despite implant removal but had a negative patch test. The remaining 25 patients retained their implants without significant symptoms regardless of patch test result. Conclusion: Metal hypersensitivity in the context of foot and ankle surgery is not widely reported. It should be considered as a differential diagnosis in patients who present with hypersensitivity-type symptoms with previous surgery with metallic implants, after infection and mechanical failure have been ruled out. Patch testing can be helpful in identifying these patients. Removal of static implants after fracture union in trauma cases typically resulted in symptom resolution. Metallic arthroplasty implant removal presents more of a clinical challenge. Future research should focus on creating a framework to identify at risk patients and diagnose foot and ankle patients with metal allergy.
Current Literature Definitions of Failure in Lateral Ankle Instability Surgery: A Systematic Review
Authors: Dallman Johnathan , Wolf Megan R. , Campbell Tanner , Herda Trent J. , Tarakemeh Armin , Vopat Bryan G. 
Published: November 2022

Category: Ankle; Other Introduction/Purpose: Treatment for lateral ankle instability (LAI) varies drastically from conservative to operative management depending on the individual's injury, symptoms, and lifestyle. Typically, surgical treatment is recommended when conservative treatments fail for LAI. The importance of determining the most effective treatment is necessary due to LAI costing $2 billion annually within the health care system [1]. Furthermore, residual physical disability following failed treatment for LAI occurs in up to 70% of patients [2]. Unfortunately, despite exceedingly high incidences and economic impact, a standard definition of failure for the surgical treatment of LAI alludes clinicians and researchers. Therefore, the purpose of this project is to identify LAI treatment 'failure' definitions that are currently in the literature and work towards standardization of the definition. Methods: A systematic search of Medline, SportDiscus, CINAHL, Embase, and Web of Science was conducted to identify clinical studies that included patients who underwent surgical treatment for lateral ankle instability and included information about surgical failures. Studies with level of evidence I to IV were included for this review. Animal studies, biomechanical studies, cadaveric studies, review articles, and expert opinion were excluded. These studies were then reviewed for definitions of failure of any surgical procedure used to correct lateral ankle instability. Results: Of the 1,200 studies, 3.5% (42/1,200) studies published between 1984 and 2020 met inclusion criteria and were analyzed. After reviewing the data, numerous definitions were found in the literature for LAI surgical failure. The most common was 'recurrent instability' (40%, 17/42) followed by 're-rupture' (24%, 10/42). For the original operation, the Modified Brostrom Gould technique was used most frequently (40%, 17/42) in cases treated operatively. The failure rate of this procedure ranged from 1.1% to 45.2% depending on the definition of 'failure.' Conclusion: There were multiple definitions of failure for surgical treatment of lateral ankle instability and is one of the reasons why the rate of failure can vary greatly. The literature would benefit greatly from a standardization of ankle instability treatment 'failure' definition. This definition should incorporate multiple facets, including history, physical examination findings, outcome scores, imaging, and surgical findings for an inclusive understanding of failure.
Treatment of Moderate to Severe Hallux Valgus without Osteotomy or Arthrodesis
Authors: Deckey David G. , Verhey Jens , Haglin Jack , Carlson Alicia , Kile Todd A. , Hinckley Nathaniel 
Published: November 2022

Category: Bunion Introduction/Purpose: Hallux valgus is a multi-planar deformity that has historically required osteotomies to correct a soft tissue deficiency. We present a novel technique for the treatment of moderate to severe hallux valgus and subsequent radiographic results of a method to correct the intermetatarsal abnormality without utilizing osteotomies or arthrodesis. Methods: One hundred and thirty-six patients undergoing primary metatarsal re-alignment with modified McBride for moderate to severe hallux valgus were included. After each patient underwent standard distal soft tissue procedure via modified McBride bunionectomy, the first metatarsal was manually reduced and brought parallel to the second. It was then held temporarily with a K-wire and position assessed to ensure the first and second metatarsal heads are in the same transverse plane to prevent relative plantar or dorsiflexion of the first ray. A bioabsorbable screw was then placed obliquely from the base of the first into the bases of the second and third metatarsals. Patients were assessed pre-operatively, at 2 weeks, 6 weeks, and 3 months for early clinical outcome, complications, and radiographic evaluation. The hallux valgus angle (HVA) and intermetatarsal angle (IMA) were recorded and used to monitor any progression or change over time. Results: This procedure allows for significant correction of moderate and severe hallux valgus deformities with little radiographic evidence of loss of reduction in early clinical follow-up. One and two-year follow-up was included for patients where available. Pre-operative assessment of HVA and IMA were 32.3° (95% CI: 31.1-33.5) and 14.8° (95% CI: 14.2-15.3), respectively. Post- operative HVA was significantly improved at 2 weeks (10.4°), 6 weeks (11.1°), and 3 months (12.1°). IMA was improved at 2 weeks (6.0°), 6 weeks (6.8°) and 3 months (7.8°). One (48 patients) and two-year follow-up (20 patients) show maintenance of correction of both HVA (1yr: 12.7°, 2yr: 10.8°) and IMA (1yr: 7.9°, 2yr: 8.0°). Complications were few including iatrogenic hallux varus (2/136, 1.4%), peri-implant fractures at the second metatarsal base (3/136, 2.2%), and valgus relapse, which was the only complication requiring re-operation (3/136, 2.2%). Conclusion: When combined with modified McBride bunionectomy, this proximal metatarsal realignment procedure provides a simple and effective method for the treatment of moderate to severe hallux valgus deformities. Additionally, there is minimal radiographic evidence of loss of reduction over time. This procedure is simple to perform, easy to learn, and does not 'burn any bridges' with regards to future surgery.
Low Ankle Arthroscopy Procedural Volume Amongst Graduating Orthopedic Surgery Residents
Authors: Garber Hollie , Sudah Suleiman , Michel Chris , Faccone Robert D. , Dijanic Christopher M. , Kerrigan Daniel J. , Gabisan Glenn 
Published: November 2022

Category: Ankle; Arthroscopy; Sports Introduction/Purpose: The purpose of this study was to evaluate trends in graduating orthopedic resident case volume and variability for ankle arthroscopy. Methods: The Accreditation Council for Graduate Medical Education surgical case log data from 2016 to 2020 for graduating United States orthopedic surgery residents was assessed. Arthroscopy procedures of the leg/ankle were identified. The average number of cases performed per resident was compared from 2016 to 2020 to determine the percent change in case volume. The 10th, 30th, 50th, 70th, and 90th percentiles of case volumes from 2016 to 2020 were presented to demonstrate case volume variability. Results: There was no significant change in the average number of leg/ankle arthroscopy cases from 2016 to 2020 [6.2 +- 5 [range 0 to 35] vs. 6.1 +- 6 [range 0 to 76] [p=0.732], despite a 19% increase in the average number of total leg/ankle procedures performed over time (168.4 +- 47 [range 55-414] in 2016; 200.8 +- 57 in 2020 [range 67-601], p <0.001). There was wide variability in ankle arthroscopy case volume amongst residents. The 90th percentile of residents performed 13 cases in 2020, compared to 5 in 50th percentile, and 1 in the 10th percentile. Conclusion: Despite the growing popularity of ankle arthroscopy, orthopedic resident exposure to this technical procedure remains generally low. Understanding trends in case volume and variability is important for programs to ensure that orthopedic residents are gaining adequate exposure to increasingly popular procedures. Implementing minimum case requirements for ankle arthroscopy during orthopedic residency may be helpful to increase exposure to ankle arthroscopy and reduce variability in experience.
2-Octyl Cyanoacrylate Adjuvant Use in Calcaneal Tendon Repair: Comparative Experimental Study in Rabbits
Authors: Gomes Rogério d. , Padua Bruno J. , Gomes Anderson H. , Magalhães João Murilo B. , Fonseca Wagner V. 
Published: November 2022

Category: Basic Sciences/Biologics; Ankle; Sports Introduction/Purpose: The best alternative for treating calcaneal tendon rupture is still controversial. The treatment can be conservative or surgical; the latter is better indicated in high-performance athletes. The pursue of faster recovery, reductions in skin complications and re-ruptures have brought about improvements to the tendon repair technique and to early assisted rehabilitation programs. Our goal was to check whether or not the adjuvant use of 2-octyl cyanoacrylate provides additional mechanical resistance to the calcaneal tenorraphy, when compared to suture alone, using the same tenorraphy technique. Methods: We used 45 three-month-old New Zealand rabbits, distributed into three groups of 15 animals each. The rabbits underwent two surgical procedures at a 30-day interval. In the first procedure, we performed the complete calcaneal tendon section on the right side, and then we repaired it using three different techniques: suture alone in group 1, suture with 2-octyl cyanoacrylate in group 2, and 2-octyl cyanoacrylate alone in group 3. After 30 days, we slaughtered the rabbits, and resected their right-side calcaneal tendon, and sent the specimen for pathology analysis. Then, we performed a cross section of the left calcaneal tendon, and used the same three repair techniques. After 15 minutes, we subjected the repaired tendons to the linear traction mechanical strength test. Results: The results from the linear strength test showed that suture with glue outperformed suture alone (p = 0.0427), and glue alone (p <0.0001). There was no rupture pattern difference between the groups, whether due to suture rupture or slipping. The pathology results were evaluated according to inflammation, repair process and tendon thickness. The report mentioned a high- intensity mixed inflammatory pattern (acute and chronic), outstanding neovascularization, tissue necrosis and abscess in most of the cases that used cyanoacrylate. However, there were no local or systemic clinical signs of an infectious process, or difference in tendon thickness between the three groups. Conclusion: 2-octyl cyanoacrylate added immediate mechanical strength to the calcaneal tendon repair in the rabbits, without increasing local complications, despite pathological changes (focal necrosis, microabscesses and granulomatous reaction) in up to 30 days after the repair.
Portable Ultrasound Equals Arthroscopy for Assessment of Syndesmotic Instability
Authors: Hagemeijer Noortje , Sato Go , Bhimani Rohan , Lubberts Bart , Elghazy Mohamed Abdelaziz , Sierevelt Inger , Waryasz Gregory R. , Kerkhoffs Gino , DiGiovanni Christopher W. , Guss Daniel 
Published: November 2022

Category: Ankle; Arthroscopy Introduction/Purpose: Syndesmotic instability, when subtle, can be challenging to diagnose-and often requires visualization of the syndesmosis during applied stress. Portable ultrasonography is increasingly used to evaluate ankle instability at the point of care. This study aims to evaluate 1) whether portable ultrasonography (P-US) can diagnose syndesmotic instability in the sagittal plane, and 2) how P-US measurements compare to arthroscopic evaluation. Methods: Eight fresh, above-knee cadaveric specimen were used. The syndesmosis was evaluated with P-US and arthroscopy in the intact state, and thereafter with progressive sectioning of, 1) anterior-inferior tibiofibular ligament (AITFL), 2) interosseous ligament (IOL), and 3) posterior-inferior tibiofibular ligament (PITFL). Sagittal plane translation was simulated with 100N of anterior to posterior (A to P) and posterior to anterior (P to A) directed force using a bone hook. Separately, a 50N manual force was applied to the fibular tip and measured with P-US to simulate a fibular 'shuck test' performed in the clinical setting. Results: When all three syndesmotic ligaments were transected, there was a significant increase in fibular motion in the sagittal plane when evaluated using portable ultrasonography with application of 50N of manual pressure and when applying a 100N hook test when measuring total sagittal plane motion (p=<0.001 and p=0.009). Arthroscopy demonstrated significant increased motion with a 100N hook test when measuring total sagittal plane motion (p<0.001). Conclusion: P-US performed similarly to arthroscopy when diagnosing syndesmotic instability in the sagittal plane. P-US also offers several advantages over arthroscopy, including availability, non-invasiveness, low cost, and affording contralateral comparison. The promise of this technique suggests it should be further explored as a potential future standard for the diagnostic assessment of occult syndesmotic instability in the sagittal plane.
Radiographic Correction of Bunionette Deformity using Minimally Invasive Fifth Metarsal and Akinette Osteotomy
Authors: Hurst Kaitlyn M. , Neufeld Steven K. , Cuttica Daniel J. , Sanders Thomas H. 
Published: November 2022

Category: Midfoot/Forefoot; Lesser Toes; Other Introduction/Purpose: Bunionette Deformity is defined as a painful lateral prominence of the fifth metatarsal head. Conservative treatment entails footwear and activity modification. Symptoms can be exacerbated in the athletic population and activities with specific footwear such as cycling, winter sports and water sports. In refractory cases, patients may pursue operative intervention. Historically, open surgical correction carried risks of wound complications, prolonged recovery time, and nonunion risk. Minimally invasive techniques have gained popularity due to the decreased risk of wound complications, preservation of blood supply and healing potential, and faster operative and recovery times. The purpose of the current study is to examine radiographic and clinical outcomes of minimally invasive bunionette correction with a sliding distal 5th metatarsal osteotomy and lateral closing wedge proximal phalanx (Akinette) osteotomy. Methods: A retrospective review examined 36 feet in 28 patients who underwent minimally invasive bunionette correction from 01/2021 to 12/2021. The study patients were treated at a single center by 3 participating providers trained in minimally invasive techniques. All patients underwent a distal 5th metatarsal osteotomy and Akinette osteotomy of the proximal phalanx. Length of follow up ranged from 3 to 12 months. Radigraphic measurements including 4,5 intermetatarsal angle (IMA), 5th metatarsophalangeal angle, and osteotomy displacement (mm) were compared pre and postoperatively. Patients were asked to complete postoperative satisfaction survey and lesser toe American Orthopaedic Foot & Ankle Society (AOFAS) score. Results: Preliminary analysis shows a radiographic 4,5 IMA correction of 4.9 degrees to 3.4 degrees. Fifth metatarsophalangeal angle was corrected from 20.3 degrees preoperatively to 5.3 degrees postoperatively. Average medial displacement of the metatarsal osteotomy was 2.64 mm. There was one nonunion of the 5th metatarsal in a revision case that had previously been treated at an outside facility with open techniques, which was treated with bone grafting. Two other patients underwent revision surgery for complications from concomitant procedures that were performed (1 lapidus nonunion and 1 lapidus wound dehiscence). There were no wound or neurovascular complications involving the 5th ray. Conclusion: Our data shows that minimally invasive bunionette correction with sliding 5th metatarsal and Akinette osteotomy leads to reliable radiographic correction and clinical improvement. This operation has favorable safety profile with low incidence of complications and a high union rate.
Lateral Joint Distraction Through Distal Fibula Lengthening Osteotomy for Lateral Compartment Ankle Osteoarthritis
Authors: Im Jemin , Jung Hong-Geun , Lim Jung-Won 
Published: November 2022

Category: Ankle; Trauma Introduction/Purpose: Lateral compartment ankle OA, commonly due to trauma such as ankle fracture, is not very rare. However there's no definite established surgical treatment option. In this study, we suggest distal fibula lengthening osteotomy for lateral joint distraction as one of treatment surgical option. We have experienced favorable clinical outcome for 3 cases of post- traumatic lateral compartment ankle OA with joint space narrowing treated with distal fibula distraction osteotomy. We report the case series with the surgical technique and the clinical-radiological outcome. Methods: From April 2016 to August 2021, three ankles which underwent distal fibula distraction osteotomy were included in this study. All three ankles had a history of OR/IF due to fractures in the ankle joint and were diagnosed with lateral compartment OA. We defined lateral compartment OA when clinical symptoms and radiologic findings were consistent. Clinically, the point of pain was characterized as the lateral compartment of the ankle joint, not the syndesmosis or peri fibular area. Radiologically, joint space narrowing is showed in X-ray, and CT arthrography or MRI confirmed cartilage denudation of the lateral compartment. Results: 1) Clinical outcomes (Table 1) Case 1: The AOFAS score improved from 69 preoperatively to 93 postoperatively, and the Pain vas score improved from 7 to 0. According to patient's subjective expression, daily activity became 'Boxing available' from 'Hard to run'. Case 2: The AOFAS score improved from 73 preoperatively to 91 postoperatively, and the Pain vas score improved from 5 to 0. According to patient's subjective expression, daily activity became 'No pain on daily activity' from 'Hard to walk'. Case 3 is not described because there has been no progress for more than 1 year after surgery. 2) Radiologic outcomes (Table 2) Lateral joint space, talocrural angle, talar tilt angle and tibia axis-talar dome angle were all changed close to the contralateral ankle index after surgery. Conclusion: Painful ankle OA localized to the lateral compartment in young age is uncommon and there is no definite surgical method. Distal fibula distraction osteotomy is reasonable surgical method that does not burden patients and surgeon. In our study, distal fibula distraction osteotomy showed favorable clinical-radiological outcomes. So, we recommend this method for painful lateral compartment OA in young ages.
The effect of the emergency service work environment on the patient safety attitudes of nurses
Authors: Kizir Nuriye , Ozsaker Esma 
Published: November 2022

Background A safe working environment in the health sector contributes significantly to employee and patient safety and supports positive patient outcomes. Nurses play an important role in improving the healthcare quality related to patient safety practices. This study aimed to investigate the effect of the emergency service work environment on nurses’ patient safety attitudes. Methods This cross-sectional study was conducted in the emergency departments of 15 tertiary public hospitals and university hospitals in Izmir, Turkey. 288 nurses who worked 6 months or more in emergency departments were included in the sample. The personal information form, safety attitudes questionnaire, and work environment scale were used in the data collection. Results The total mean score for the safety attitudes questionnaire was 136.69 ± 22.14, and the total mean score for Work Environment Scale was 84.51 ± 12.02. A positive correlation was detected between the Safety Attitudes Questionnaire total score and Work Environment Scale total score ( r = 0.38, p < 0.001). Conclusion The patient safety attitudes of the emergency room nurses were moderately positive, the nurses evaluated the working environment positively, and positive work environments affected patient safety attitudes positively.