bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heterotopic Ossification Following Total Ankle Arthroplasty with Fourth- Generation Prostheses
Authors: Rushing Calvin J. , Malloy McCoy Antonio M. , Steriovski James M. , Hyer Christopher F. , Berlet Gregory C. 
Published: January 2022

Category: Arthroscopy; Hindfoot Introduction/Purpose: The purpose of the present study was to assess the radiographic incidence, location, and classification of heterotopic ossification (HO) in patients who underwent total ankle arthroplasty (TAA) with a 4th generation prostheses at a minimum of 1-year follow up. Baseline demographic, radiographic, and operative factors between patents with and without HO were compared. Methods: Ninety ankles that underwent TAA with a 4th generation protheses, INFINITY (n = 62) or CADENCE (n = 28) were followed for an average of 23.7 (range, 12-49) months. Incidence and location of HO was assessed on weight bearing radiographs, and severity graded according to the modified Brooker classification. Data was compared between patents with and without HO to identity any predisposing factors. Results: In 90 ankles that underwent 4th generation TAA, HO incidence was 55.6% (n = 50); 56.5% (n = 35) for INFINITY, and 53.6% (n = 15) for CADENCE. Twenty-five cases of HO were observed posteriorly, 16 anteriorly, and 9 combined. Severity was as follows; class I in 19 cases (38%), class II in 20 (40%), class III in 9 (18%) and class IV in 2 (4%). A single ankle required a non- revisional reoperation for HO debridement; reoperation rate of 2%. Conclusion: The present study suggests a similarly high incidence of HO after TAA with two different 4th generation prostheses (INFINITY 56.5%, CADENCE 53.6%). A trend for differences in location and severity between the prostheses may also be present. Given the paucity of literature, additional studies with longer follow-up are warranted to discern the significance of HO following TAA with 4th generation prostheses.
Industry Payments to Foot and Ankle Surgeons and Their Effect on Total Ankle Arthroplasty Outcomes
Authors: Safavi Kiya Shazadeh , Rezvani Aryan , Healy Nicholas , Jupiter Daniel , Panchbhavi Vinod K. , Janney Cory 
Published: January 2022

Category: Ankle; Other Introduction/Purpose: The Centers for Medicare & Medicaid Services (CMS) Open Payments public (OPP) database provides a means for increased transparency of physicians' financial relationships with industry. Total ankle arthroplasty is a procedure with long term clinical implications and variable outcomes published in the existing literature. We compared physician-reported conflict-of-interest (COI) disclosures in Foot and Ankle International (FAI) with CMS database information to evaluate for discrepancies. Methods: Articles published in FAI reporting clinical outcomes of total ankle arthroplasty from 2015 and 2019 were reviewed. Payment information in the CMS database was cross-referenced with disclosure statements and International Committee of Medical Journal Editors (ICMJE) forms associated with the manuscript. Statistical analysis was performed to determine if industry payments were appropriately disclosed or influenced outcomes. Results: We reviewed 173 articles pertaining to ankle arthroplasty with 27 meeting inclusion criteria. Of 120 total authors with 98 unique authors, 114 (95%) disclosed appropriately in disclosure statements. Twenty-two papers (82%) had appropriate declarations for the entire manuscript. For the 27 senior authorships, only two discrepancies between manuscript disclosure and the OPP database were noted, showing 13 total disclosures in the OPP database vs 11 disclosed in the manuscript. We found there was no relationship between industry payment and the outcome of the manuscript (P =.725). Conclusion: The majority of author disclosure statements accurately reflected the OPP data. Additionally, payments were not significantly associated with positive outcomes reported for the specific implant. Overall, authors publishing on ankle arthroplasty in FAI are disclosing appropriately per our review.
Lesser Tarsal Metatarsal Joint Fusion Using Nitinol Staples, Bone Marrow Aspirate Concentrate and a Calcaneal Bone Dowel: A Retrospective Comparative Analysis
Authors: Scott Jared , Thompson Jay , Johnson Mark , Anderson Michael , Hawkins Bryan J. 
Published: January 2022

Category: Midfoot/Forefoot; Lesser Toes Introduction/Purpose: Estimates suggest nonunion rates following lesser tarsometatarsal (TMT) fusion are up to 11.4%. Various techniques have been employed to improve fusion rates; however, none have shown significant improvement compared to other techniques. Autologous bone dowels, bone marrow aspirate concentrate (BMAC) and continuous compression devices (CCDs), such as nitinol staples, have each shown promising fusion rates in orthopedic literature. There is limited data that suggests using these techniques in conjunction with one another has been successfully employed in the fusion of lesser TMT joints. The aim of this study was to describe our technique using autologous calcaneal bone graft, CCDs and BMAC for lesser TMT fusion and to investigate whether this method improves fusion rates and decreases time to fusion in comparison to traditional constructs. Methods: All patients undergoing arthrodesis of the lesser (2nd/3rd) TMT joints from January 2015 to January 2020 were identified. Exclusion criteria included inadequate clinical or radiographic follow-up, those with only 1st TMT joint arthrodesis, and those less than 18 years old. Chart review allowed patient demographics, risk factors and surgical approach to be identified. Twenty patients (28 lesser TMT joints) treated with arthrodesis by the senior surgeon met inclusion criteria. These patients were then divided into two groups: 1) novel treatment (Nitinol staple, BMAC and calcaneal dowel) and 2) traditional treatment (compression plate and screw construct). We then assessed for radiographic union, time to union and complications. Results: All lesser TMT joints in the novel treatment arm went on to successful clinical and radiographic fusion. The radiographic union rate of the traditional treatment arm was 92% (P=.08). Overall time to fusion was 56 and 82 days for the novel and traditional constructs respectively (P <.05). All patients, regardless of construct, had returned to full weight bearing and maintained hardware at most recent follow-up (minimum 6 months). Conclusion: Continuous compression devices such as the nitinol staple and use of biologic adjuvants appear to decrease nonunion rates and significantly shorten overall time to fusion in lesser TMT joints. Further investigation towards identifying patient specific factors for nonunion is warranted.
Lateral Dorsal Cutaneous Nerve and Anastomotic Branch to the Intermediate Dorsal Cutaneous Nerve: A Review of Cadaveric Data and Comparison with 3 Tesla MRI
Authors: Shah Vrajesh J. , Mitchell Brendon , Ghetti Claudio B. , Huang Brady K. , Kent William , Foran Ian M. 
Published: January 2022

Category: Other; Hindfoot Introduction/Purpose: The lateral dorsal cutaneous nerve (LDCN) and anastomotic branch to the intermediate dorsal cutaneous nerve (AICN) can be injured during foot and ankle surgery. Cadaveric specimen studies are limited by small sample size.1-11 We sought to use high-field 3-tesla (3T) magnetic resonance imaging (MRI) to examine a significantly larger cohort and obtain a more representative sample of the course of the LDCN and AICN. A more generalizable understanding of the course and position of these structures will aid surgeons intraoperatively in avoiding iatrogenic injury when performing the sinus tarsi approach, as well as during percutaneous intramedullary fixation of the 5th metatarsal. Methods: High-field 3T MRI studies performed between January 2015 to January 2020 were reviewed. Three blinded reviewers at a single academic center measured the coronal distances of LDCN and AICN from the fifth metatarsal styloid (5MS). Intraclass correlation coefficients (ICC) were calculated to assess reviewer reliability. Foot and ankle MRIs with major structural abnormalities, such as tumor or the presence of hardware, were excluded. Results: A total of 125 foot and ankle 3T MRIs were identified. Intraclass correlation coefficient was excellent at 0.87 for LDCN to 5MS and 0.88 for AICN to 5MS. The mean distance of the LDCN to the 5MS was 0.8 cm (range 0.3-1.4 cm, CI 0.8-0.8 cm) and that from the AICN to the 5MS was 2.1 cm (range 1.6-3.2 cm, CI 2.0-2.2 cm. Height had no significant correlation with the nerves' distance from bony landmarks with r values of 0.14 and 0.29 for the LDCN and AICN, respectively. Similarly, we did not find BMI to significantly correlate, with r values of 0.10 and 0.30 for the LDCN and AICN, respectively. Conclusion: Our study demonstrated the LDCN and AICN can be found on average 0.8 cm and 2.1 cm, respectively, above the 5MS with no clear association to patient height or BMI. Literature studying the range of distances the LDCN is found from the 5MS is scarce, but one study noted the range to be 0.7-1.2 cm, which is significantly smaller than our range of 0.3-1.4 cm.3 To our knowledge, our study is first to note the range of distances the AICN can be found from the 5MS, which is 1.6-3.2 cm.
Minimally Invasive Management of a Rare Giant Cell Tumor of Talus: A Case Report and Literature Review
Authors: Sonawane Sandip S. 
Published: January 2022

Category: Ankle; Hindfoot; Other Introduction/Purpose: Giant cell tumor (GCT) of small bones of hand and feet is rare. A benign but locally aggressive neoplasm with a tendency for local recurrence with undifferentiated mesenchymal stromal cells and the presence of abundant, multinucleated giant cells. It occurs in a slightly younger age group with usually an expansile and eccentric epiphyseo-metaphyseal region lytic lesion. A 22 yrs. old patient, presenting as lytic expansile lesion of talus, suspected Giant cell tumor (GCT) of talus preoperatively and intraoperatively and proven subsequently, is presented along with review of literature. This patient is the young and nearly 24th case reported in the literature for GCT of talus. Methods: Author reviewed the literature for the GCT of talus from 1964 to till 2021. The author reported a case of left ankle joint pain and swelling for 6 months in a 22 yrs. old male, which turns out to be aneurysmal bone cyst of talus on radiographs, Computed tomography and aspiration cytology. Campanacci grade II lesion was planned for the curettage and autologous bone grafting. Results: Retrospectively, the intraoperative biopsy confirmed the lesion as giant cell tumor with aneurysmal bone cyst. After 4 years the lesion showed the near complete resolution on radiographs and CT scan. However, because of the historical recurrence and metastasis reports of GCT, author is continuously monitoring patient's ankle with yearly follow up. Author reviwed the literarue for the GCT of talus from 1964 to till 2021. Author found total of 23 reported cases for GCT of talus in literature, out of which 2 cases showed recurrence and distant metastasis to chest which is 8.69 percent of total cases. Conclusion: Author concludes that the Campanacci grade I and II can be managed with mini-open lesional curettage and autologous bone grafting while grade III and IV needed osteotomy, en-bloc excisions and tibio-calcaneal fusion or below knee amputation in recurrent or aggressive lesions. As author found 8.69 percent cases of distant pulmonary metastasis out of total reported cases, he recommends yearly follow up of the lesions and look for distant metastasis in suspected cases.
Pes Planus Does Not Negatively Affect Clinical Outcomes after Hallux Valgus Surgery
Authors: Tay Adriel You Wei , Goh Graham , Thever Yogen , Yeo Nicholas , Koo Kevin 
Published: January 2022

Category: Bunion; Hindfoot; Midfoot/Forefoot; Other Introduction/Purpose: Pes planus is associated with hallux valgus development. Increased forefoot abduction and pressure through the hallux during the heel-rise phase of the gait in a pes planus foot is believed to contribute to hallux valgus formation. These abnormal forces through the hallux may result in poorer healing and more residual pain after surgical correction. We investigated if patients with increasing severity of pes planus presented with more severe hallux valgus deformity and whether these patients had more residual pain and poorer function following hallux valgus surgery. Methods: We evaluated 191 consecutive cases of hallux valgus surgery with Scarf osteotomy as the primary procedure. American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale, visual analog scale (VAS), Short Form-36 physical component summary (SF-36 PCS), mental component summary (SF-36 MCS) and a satisfaction questionnaire were assessed at baseline, 6 months and 24 months postoperatively. Pes planus angles measured were the talonavicular coverage angle (TNCA), lateral talus-first metatarsal angle (Meary's angle) and lateral talocalcaneal angle (LTCA). The cohort was stratified into controls (0°-4.0°), mild (4.1°-14.9°), moderate (15.0°-30.0°) and severe (>30.0°) pes planus groups according to Meary's angle. Clinical outcomes were compared among the groups. Multiple regression was used to determine association between pes planus angles and outcomes. Results: There were 78 controls, 95 mild, 18 moderate and no severe cases of pes planus. Meary's angle was independently associated with preoperative HVA (beta 0.408, 95% CI 0.104-0.712, P =.009). Patients with mild and moderate pes planus had significantly greater preoperative HVA (P <.001) compared to controls. Pes planus angles were not associated with pre- or postoperative VAS, AOFAS score, SF-36 PCS or SF-36 MCS. Among controls, mild and moderate pes planus groups, there were no significant differences in pre- or postoperative clinical scores (Table 1), and satisfaction was 84.6, 80.0% and 77.8%, respectively (P =.667). Conclusion: Patients with increasing severity of pes planus presented with greater severity of hallux valgus deformity. However, patients with pes planus had similar pre- and postoperative clinical outcomes and satisfaction after hallux valgus surgery in comparison to patients with neutral foot arches.
Early Results of a Novel Intramedullary Fixation Device for Proximal Fifth Metatarsal Fractures
Authors: Umbel Benjamin D. , Sharpe B. Dale , Hockman Taylor , Philbin Terrence M. 
Published: January 2022

Category: Midfoot/Forefoot; Sports; Trauma Introduction/Purpose: Proximal fifth metatarsal fractures are commonly treated surgically due to their poor healing capacity. While intramedullary screws may be the most popular operative treatment choice, newer fixation methods continue to develop that offer fracture compression in addition to maintenance of length, alignment and rotation. We present a case-series utilizing a novel intramedullary fixation device for proximal fifth metatarsal fractures. To our knowledge, no other study in the literature has assessed the safety and efficacy of this novel fixation method Methods: A retrospective analysis was performed for 16 patients with proximal fifth metatarsal fractures who underwent fixation with the same novel intramedullary device. Patient charts were reviewed for fracture union, plantar fracture gapping, time to weightbearing, refracture, perioperative complications, and secondary surgeries. Results: Sixteen patients with an average age of 43.3 years old underwent fixation with this novel device from 2015 to 2020. Mean follow-up was 32.4 weeks. Fifteen of the 16 patients achieved radiographic union at a mean of 8.9 weeks. One patient suffered a non-union. Mean time to full weight-bearing in, and out of, a walking boot was 6.4 and 9.8 weeks, respectively, for healed fractures. Mean plantar fracture gap improved from 1.22 mm to 0.88 mm following surgery. There were zero infections, refractures or hardware complications. Three patients suffered iatrogenic distal diaphyseal fracture during implant insertion, however postoperative progression to weightbearing was not altered in these patients relative to the remainder of the cohort. Conclusion: To our knowledge, this is the first report of early results for this novel intramedullary device. Excellent union rates, acceptable time to weight bearing, and a low complication profile can be achieved. Additionally, plantar fracture gapping, which has been shown to delay time to union, was improved using this novel implant. Based on our early findings, we propose a viable treatment option that is safe and effective for proximal fifth metatarsal fracture stabilization.
Return to Run Rates Following Hallux Valgus Correction: A Retrospective Comparison of Metatarsal Shaft Osteotomies vs the Modified Lapidus Procedure
Authors: Unangst Alicia M. , Ryan Paul M. 
Published: January 2022

Category: Bunion; Other Introduction/Purpose: Hallux valgus affects 23 -36% in general populations. The purpose of this study was to evaluate return to run following either a modified Lapidus procedure or a metatarsal osteotomy. We hypothesized that there would be no difference in the ability to return to running. Methods: A Retrospective review of a consecutive series of patients at a single institution with surgical correction was performed. 51 patients were identified. 35 were treated with a metatarsal shaft osteotomy and 16 with a modified Lapidus. Results: No difference was found between the cohorts in terms of age, sex, or pre- operative hallux valgus angle (HVA). 27/35 (77%) with metatarsal shaft osteotomy were able to return to running versus 13/16 (81%) with modified Lapidus. There was no significant difference in the ability to return to running between cohorts (p=1.00). Conclusion: Our study showed no statistical difference for the modified Lapidus versus metatarsal osteotomies relative to return to running.
Underutilization of Patient Reported Outcomes Data in the Recent Foot and Ankle Literature
Authors: Vander Griend Robert A. 
Published: January 2022

Category: Other Introduction/Purpose: The importance of collecting outcomes information was promoted by Ernest Codman in the early 1900's. He stated the importance of 'Following every patient treated long enough to determine whether or not the treatment has been successful, then inquire-if so or if not- WHY?', ' He stressed the importance of evaluating outcomes for each patient as an individual and not from groups of patients. Since that time numerous outcomes measures have been validated and are in current use. The purpose of this study was to review all publications in Foot and Ankle International from 2019-2020 which included outcomes data. Then to determine if these principles (use of individual versus group data and WHY treatment was successful or not) were followed. Methods: All articles published in Foot and Ankle International during 2019-2020 were reviewed. Articles which included patient outcomes data were selected for further review. This review then included assessment of outcomes measure(s) used, organization of outcomes data, utilization of this data by the study, analysis of individual versus group data, and any assessment of WHY the outcomes scores had improved or not. Results: Eighty-five publications were selected. Eleven different outcomes measurement tools were used. All were reportedy validated tools except for the AOFAS scoring system. Every study reported outcomes data as group means (some with standard deviations, some with range of scores). These studies then compared group means (of different treatment groups or preop vs post op). No specific individual patient outcomes data was provided. There was no specific assessment of WHY scores improved or not. There was also no analysis of individual questions from these outcomes tools (e.g. can you put on your own shoes?–if patient answered 'no' there was no further explanation of why this response was selected). When the range of scores were provided it was common to have scores on the low end of the scale before and after treatment with overall conclusion of improvement based on group means but no assessment of why individual patients improved or not. Conclusion: Outcomes measures are generally considered to be part of the 'standard of care'. They may be considered important by third party payers, used in evaluation treatment options, and are usually necessary for publication. However trhis data is being underutilized. It is commonly reported as group means +/- range or standard deviations with provides little information about the individuals in a group or groups. Even with methodologies to minimize Type I or II errors evaluation of group means can obscure significant progress, lack of progress, or decline by individual patients. Methods to more effectively utilize outcomes measures are needed.
Does Surgical Placement of Syndesmosis Screws Affect Breakage Rate? A Retrospective Comparative Study
Authors: Vander Maten Josh W. , McCraken Matt , Roebke Logan , Liu Jiayong 
Published: January 2022

Category: Ankle Introduction/Purpose: Fixation of syndesmosis disruption with metal screws remains a frequent and efficacious treatment modality. Screw breakage remains a complication seen in many patients following metal fixation. Overtime physiologic rotation or the tibia and fibula can lead to bone erosion and pain in patients with screw breakage. The purpose of this study is to compare patients with syndesmosis screw breakage and patients with intact screws based surgically controlled variables. Methods: A retrospective analysis of patients who underwent syndesmotic screw fixation from 2008 - 2020 was performed. Ninety-seven patients were found to have syndesmosis screw breakage, of which 88 met inclusion criteria. A control group of patients without syndesmosis screw breakage was selected at random and analyzed until 88 patients met inclusion criteria. The number of screws used, width, length, fracture type and number of cortices were all collected. Further analysis included radiographic measurement syndesmosis screw angle and height of placement above the tibial plafond. A regression analysis was performed to compare to the two groups, including a separate analysis comparing unbroken screws within syndesmosis screw breakage cohort versus their broken screws, as this provided an absolute control group. A stratified analysis of screw placement and angle was also performed based on standard deviation. Results: The average screw width in the breakage group was 3.67 (SD =.38) and 4.06 (SD =0.04) in the intact group (P =<.001). Average screw angle was 94.82 (SD = 12.75) in the breakage group and 94.67 (SD 12.31) in the intact group (based on 90 degrees relative to tibial plafond). Screw placement of the tibial plafond was 20.39 (SD =10.389) in the breakage group and 16. 75 (SD = 9.28) in the intact group. 70.3% of broken screws were placed > 20mm above the tibial plafond, compared to 64.0% in the control group. Most screws were placed at angle > 82 degrees relative to the tibial plafond; 76% (n =92) of broken screws and 81.2% (n=211) of intact screws). Decreased screw width (P =<.001) and screw placement > 20mm above the tibial plafond (P =<.001) were all associated with an increased risk of screw breakage. Conclusion: Metal screw fixation remains an efficacious treatment method of syndesmotic disruption. Despite extensive research the cause of syndesmosis screw breakage and the necessity of screw removal remains without consensus. The is study aims to analyze surgical variables in attempt to find correlation with screw breakage. An increased BMI was seen to predispose to screw breakage. Placement of the syndesmosis screw <20 mm above the tibial plafond and increased screw width provide protection against syndesmosis breakage. No significant differences were found between groups based on screw angle, number of cortices, screw length, or number of screws used.