bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contact Pressure Reduction in the Anterior Ankle During Placement of Short Leg Splints
Authors: Farrar Nicholas , Walley Kempland C. , Shams Kameron A. , Mell Kristopher , Walton David M. , Holmes James R. , Talusan Paul G. 
Published: January 2022

Category: Trauma; Ankle Introduction/Purpose: Lower extremity splints are commonly used in orthopaedic care throughout emergency departments, operating rooms, and outpatient clinics. Although the mainstay of ankle immobilization, they have been associated with ulcers due to high contact pressures over bony prominences and the anterior ankle. High contact pressures may occur in the anterior ankle when splint padding is applied while the ankle is in a plantarflexed position and subsequently dorsiflexed as the plaster or fiberglass hardens. The purpose of this study is to measure contact pressures in the anterior ankle when cast padding is applied in a plantarflexed position and subsequently dorsiflexed. We hypothesized, that the removal of padding over the anterior ankle following dorsiflexion would result in reduced anterior ankle contact pressures. Methods: Short leg posterior U-splints were applied to the right lower extremity in two healthy volunteers with an underlying pressure transducer [Tekscan I-Scan system (Tekscan Inc, South Boston, MA, USA)] on the skin surface centered over the tibialis anterior tendon. Anterior ankle surface pressures were measured when the padding was applied in maximum plantar flexion and dorsiflexed to neutral position as measured by a goniometer. This was then repeated in the same subjects but prior to dorsiflexion, a 3cm x 3cm square of padding was removed over the pressure transducer prior to dorsiflexion. Percent change from initial contact pressure centered on the tibialis anterior with either Webril (Covidien/Medtronic, Dublin, Ireland), or Specialist Cotton Blend Cast Padding (BSN Medical, Charlotte, NC, USA) was calculated. Results: There were 2 limbs analyzed for presentation of this pilot data. The percent change in anterior ankle contact pressure when padding was applied in plantar flexion and then placed in neutral was an average increase of 264% with just padding and 238% with padding and plaster. [TP1] Subsequently, the removal of padding from the anterior ankle resulted in an average decrease of 126% of[TP2] the increased pressure relative to baseline measurements (Figure 1). The reduction in contact force with the removal of Webril was greater than Specialist. Conclusion: In this pilot data, we report increases in anterior ankle contact pressures when splint padding is applied in plantar flexion and re-positioned into neutral. However, removal of anterior ankle padding reduces pressure over the anterior ankle and may reduce the risk of iatrogenic splint related ulcers in this area. Additionally, this technique may elicit varying reductions in anterior ankle pressure depending on the type of cast padding utilized. This data, though preliminary, underscores the importance of avoiding excess padding over the anterior ankle during splint application.
Two Year Patient Reported Outcomes of 334 Minimally Invasive Chevron Akin Osteotomies (MICA) in Hallux Valgus Surgery
Authors: Gordon David , Lewis Thomas L. , Ray Robbie 
Published: January 2022

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: There are many different procedures described for the correction of hallux valgus deformity. Minimally invasive surgery has become increasingly popular, with clinical and radiological outcomes comparable to traditional open osteotomy approaches. There is increasing interest in hallux valgus deformity correction using third-generation minimally invasive chevron akin osteotomy (MICA) technique. Objective: To assess the radiographic correction and 2-year clinical outcomes of third-generation MICA using validated outcome measures. Methods: This is a prospective single-surgeon case series of 420 consecutive feet undergoing MICA surgery between July 2014 and Jan 2019. Primary clinical outcome measures included the Manchester-Oxford Foot Questionnaire (MOXFQ), EQ-5D, and the Visual Analogue Pain Scale. Secondary outcome measures included radiographic parameters, and complication rates. Results: Pre-operative and 2 year post-operative patient reported outcomes were collected for 334 feet (79.5%). At minimum 2 year follow-up, the MOXFQ scores (mean +- standard deviation (SD)) had improved for each domain: pain; pre-operative 43.9+- 21.0 reduced to 9.1+-15.6 post-operatively (p<0.001), walking and standing; pre-operative 38.2+-23.6 reduced to 6.5+-14.5 post- operatively (p<0.001) and social interaction; pre-operative 47.6+-22.1, reduced to 6.5+-13.5 post-operatively (p<0.001). At 2 year follow-up, the VAS Pain score (mean +- SD) improved from a pre-operative of 31.3+-22.4 to 8.3+-16.2 post-operatively (p<0.001). 1-2 intermetatarsal angle (mean +- SD) reduced from 15.4°+-3.5° to 5.8°+-3.1° (p<0.001) and hallux valgus angle reduced from 33.1°+-10.2° to 9.0°+-5.0° post-operatively (p<0.001). Conclusion: Third-generation MICA showed significant improvement in clinical outcomes at 2 year follow-up and can be successfully used for correction of a wide range of hallux valgus deformities.
Effect of Long and Short Term HgbA1c on Surgical Treatment Outcomes of Diabetic Patients with Emergent Foot and Ankle Surgery
Authors: Gotewal Sunny , Panchbhavi Vinod K. , Jupiter Daniel 
Published: January 2022

Category: Ankle; Diabetes; Midfoot/Forefoot Introduction/Purpose: Elevated HgbA1c are associated with higher postoperative complications. It is not as well understood whether the HgbA1c levels measured at the time of surgery, or those measured in the months prior to surgery, are more strongly associated with complications. We carried out a study of our EMR examining whether historic HgbA1c and burden of diabetes, are more or less impactful than more proximately measured HgbA1c. Methods: We identified patients using CPT codes for ankle, tibia, fibula, and femur fracture repair. Similarly, post-operative complications (infection, dehiscence, DVT, PE and SSI) were retrieved using ICD 9 and 10 codes. Variables recorded were comorbidities and complications, age, sex, race, ethnicity, marital status, and HgbA1c. HgbA1c was noted within a month before and a month after repair, and within 18 months and 6 months before repair. For each complication, the association with every other variable was assessed using t-test or chi-squared/Fisher's exact tests, for continuous and categorical variables, respectively. Results: 20 patients had the data needed to carry out the analysis. While t-test revealed no significant differences between those with and without complications, either in terms of long or short term HgbA1c, the differences between HgbA1c at a year prior to surgery appear to be larger. Conclusion: Given that differences between historic HgbA1c in those with and without complications appear to be larger than the differences in more recent HgbA1c using our small sample size, we would like to explore whether these relationships are significant, using larger data sets.
Transglutaminase Modification of Tendon Collagen
Authors: Gross Christopher E. , Rex James C. , Scott Daniel J. , Bradshaw Amy 
Published: January 2022

Category: Ankle Introduction/Purpose: Achilles tendinopathy is one of the most common overuse conditions encountered in foot and ankle surgery. Various etiological risk factors for this disease have been explored: age, body-mass index, and patient specific biomechanics. However, the pathogenesis remains poorly understood. Healthy tendon is composed primarily of type III and I collagen, which undergo post-translationally modification by lysyl oxidase and transglutaminase (TG) enzymes. The expression and activity in the latter of these two is poorly characterized in Achilles tendon. This study aims to describe the function of a specific transglutaminase, TG2, within solubilized collagen and Achilles tenocyte cultures, and to demonstrate evidence of TG2 activity within pathologic human Achilles tendon tissue. Methods: Acellular Collagen: Type I collagen gels were aliquoted into a silicone well plate. Gels were then seeded with either 2.4 ng of TG2 or a control. Two sets of gels were prepared; one undergoing a 10% stretch at 2Hz for 24 hours and the other a static control. TG2 substrates were labelled, and the relative quantity of higher molecular weight collagens produced by TG2 activity was compared. Tenocytes: Human tenocytes were grown in 3D cultures as well as traditional cultures in a conditioned fibroblast growth media. Proteins expressed by tenocytes in both cultures were extracted and examined for TG modification. Pathologic Tendon: After receiving Institutional Review Board approval, tissue was collected from patients undergoing debridement of Achilles tendinopathy. Collagen was extracted in 0.1M acetic acid and Western blot analysis was used to identify TG2 crosslink epitopes. Results: In each of three experimental paradigms: acellular, cellular, and human tendon extracts, evidence for transglutaminase modification of collagen I was noted. Dynamic conditions increased TG2 modification of collagen in acellular cultures, as evidenced by higher molecular weight collagen forms. Western blot analysis of protein expression demonstrated that tenocytes cultured in 3-D produced higher levels of TG-modified proteins than those in 2-D. Similarly, western blot analysis demonstrated presence of TG2 modification epitopes in the harvested human Achilles tendon tissue. However, the enzyme itself did not appear to be strongly expressed and could not be detected from the samples. Conclusion: Transglutaminase 2 expression by tenocytes in 3D culture and evidence for transglutaminase-dependent modification of collagen I by TG2 under dynamic loading supports a key role for transglutaminase in tendon biology and in repair. Though evidence of TG2 modification was found in diseased human samples, the absence of detectable TG2 expression suggests that it may play a significant role in the healthy physiologic turnover of Achilles tendon collagen.
Effect of Pathology on Patient Reported Outcomes of MTP Arthrodesis
Authors: Halstrom Jared R. , Andrews Nicholas A. , Tran Sterling , Ray Jessyca , Harrelson Whitt , Pate James , Hughes Austin , Jacob Roshan , Shah Ashish 
Published: January 2022

Category: Ankle; Midfoot/Forefoot Introduction/Purpose: Metatarsophalangeal (MTP) joint arthrodesis of the hallux is a common and reliable procedure performed on patients with various pathologies including hallux rigidus and hallux valgus. While the effect of foot pathology on MTP arthrodesis union rates has been previously explored, there is a lack of literature comparing long term patient reported outcomes between pathology types. The purpose of this present study was to compare patient reported and clinical outcomes following MTP fusion between those with hallux valgus and hallux rigidus. Methods: Patients undergoing primary MTP arthrodesis from 2010-2020 were identified. Additionally, Radiographic follow-up of >12 weeks, no ongoing ipsilateral infection, and complete response to a postoperative patient report outcomes (PROMIS AND Foot Function Index (FFI)) survey were required. After these criteria, 112 patients remained and were grouped by hallux valgus (HV, 53) and hallux rigidus (HR, 59). Medical records were examined for patient characteristics, operative variables, and complications. Patients were grouped by indication and compared. Results: Nonunion rates and complications including wound dehiscence, infection, and reoperation were not different between indications. Patients completed the patient reported outcomes instruments a median of 1.9 years (IQR 2.6) postoperatively. All patient reported outcomes measures were not significantly different between pathology groups with PROMIS physical function ((median, IQR) HR 44.6, 9.9 vs. HV 44.1, 12.2), pain interference (HR 52.8, 9.9 vs. HV 52.4, 12.3), FFI pain scale (HR 33.3, 40.0 vs. HV 28.3, 37.0), FFI disability scale (HR 30.0, 41.0 vs. HV 28.9, 41.0), FFI activity limitation scale (HR 10.0, 27.0 vs. HV 10.0, 23.0), and FFI total (HR 25.8, 50 vs. HV 37.4, 37). Conclusion: Arthrodesis of the first MTP joint provides similar nonunion and complication rates between hallux valgus and rigidus groups. At intermediate follow-up, MTP arthrodesis provides comparable validated patient reported outcomes scores between these two groups. Surgeons should be aware of these results when prognosticating the effect of MTP arthrodesis.
Case Report: Tibiotalocalcaneal Arthrodesis Utilizing a Titanium Mesh Implant for Limb Salvage after Failed Charcot Reconstruction
Authors: Heidari Keemia S. , Lalli Trapper 
Published: January 2022

Category: Other; Ankle; Diabetes; Trauma Introduction/Purpose: Tibiotalocalcaneal (TTC) arthrodesis has been employed as a mean to achieve hindfoot fusion and limb salvage. A particular challenge in limb salvage is achieving successful fusion in the setting of massive bone deficit. Several augmentation strategies have been trialed in this setting, such as structural allografts, 3D printed implants, fibular strut grafts, to name a few. Methods: We present a case describing TTC fusion for limb salvage utilizing a titanium mesh implant, combined with bone graft in the setting of massive bone deficit in an individual with Charcot arthropathy from Diabetes Mellitus and HIV after Pilon fracture, performed as revision procedure after failed Charcot reconstruction with a ringed external fixator and femoral head allograft with subsequent nonunion. Results: At last follow-up (22 months postoperative) patient is weight bearing as tolerated in Charcot Restraint Orthotic Walker boot. CT imaging at 18 months postoperative demonstrates stable implant and arthrodesis. Conclusion: Use of a titanium mesh implant is a reasonable option combined with bone graft for augmentation of TTC fusion in the setting of massive bone deficit.
Efficacy of Bone Graft on Fusion Rates in Primary Open Ankle Arthrodesis: A Systematic Review
Authors: Heifner John , Monir Joseph G. , Reb Christopher W. 
Published: January 2022

Category: Ankle Arthritis; Basic Sciences/Biologics; Trauma Introduction/Purpose: Success in ankle arthrodesis has been reported between 74% and 100%. Despite many recent reports with success rates >95%, the modern literature details a precipitous increase in the use of biological adjuvants for primary ankle arthrodesis. These additions raise the cost of the procedure and potentially incur morbidity related to the donor site or adverse graft response. For these reasons the routine use of bone graft has come under scrutiny with no consensus regarding its use. The cost - both direct and indirect - of biological adjuvant should be weighed against its added value to clinical outcomes. This systematic review aimed to assess the efficacy of bone autograft versus no graft on achieving a clinically successful primary open ankle arthrodesis fixated using cannulated screws. Methods: Included studies were divided into 3 groups based on the use of bone graft: no bone graft (NBG), fibular onlay with local autograft (FOBG), and the use of autograft without fibular onlay (BG). Pooled data analysis was performed, and fusion rates were frequency weighted in order to appropriately judge the impact of each study. Cohen's d was used to evaluate effect size for the use of bone graft. Modified Coleman Methodology Score (MCMS) was calculated to analyze reporting quality. Results: These selected studies described outcomes for a total of 884 patients with mean follow up of 46 months. The reviewed literature was of moderate quality, with an MCMS of 60.6. The weighted mean rate of fusion for the 3 groups was 96% in the NBG group (n=182), 96% in the FOBG group (n = 257), and 95% in the BG group (n = 445), with no significant difference between the groups (p=0.98). Use of bone graft resulted in a Cohen's d effect size of 0.10 (95% confidence interval 0.07- 0.26). Time to fusion for the 3 groups was 13.60 weeks for the NBG group, 14.51 weeks for the FOBG group, and 15.10 weeks for the BG group, with no significant difference between the groups (p=0.87). Number needed to treat was 7 with the event of interest defined as a fusion rate less than 95%. Conclusion: Bone graft use in primary open ankle arthrodesis fixated with cannulated screws did not have a significant effect (p=0.98) on union rates and yielded a small effect size. Further data demonstrated that 7 ankle arthrodesis patients need to be treated with bone graft in order to prevent 1 clinically significant nonunion. The current findings are both clinically and economically relevant, as commercial bone graft carries additional cost and autologous graft harvest is not consistently a benign endeavor. With increased cost and potential for complication, bone graft use should demonstrably improve clinical outcomes in order to validate these additional burdens.
Are Preoperative PROMIS Scores Associated with Postoperative ED Visits?
Authors: Hughes Austin , Andrews Nicholas A. , Halstrom Jared R. , Dib Aseel G. , Patch David A. , Harrelson Whitt , Fellows Kenneth J. , Pate James , Naranje Sameer , Shah Ashish 
Published: January 2022

Category: Other Introduction/Purpose: Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores have been shown to be predictive of postoperative success in orthopedic foot and ankle patients. The purpose of this study was to determine if an association exists between pre-operative PROMIS scores and patients going to the emergency department (ED) in the first 60 days following their operation. Methods: PROMIS scores, including physical function (PF) and pain inference (PI), were collected from 290 patients prior to foot and ankle procedures. Patients with presence of ongoing infection were excluded. Electronic medical record (EMR) data was retrospectively gathered for each patient to determine if they visited the ED for any reason during the first 60 days following their operation. A Backward Stepwise Logistic Regression analysis was conducted for postoperative ED visits with p<0.1 in univariate analysis required for entry into the model. Results: The median age was 50.0 with an interquartile range (IQR) of 20.0, while the median BMI was 33.1 with an IQR of 11.6. In univariate analysis, Preoperative PROMIS PF and PI scores were significantly associated with ED visits within the first 60 days after surgery. Patients who visited the ED had lower preoperative PROMIS PF (median 34.9 (IQR 10.2)) and higher PROMIS PI (median 66.9 (IQR 9.1)) compared to patients who did not visit the ED, PROMIS PF (median 38.0 (IQR 10.2)) and PROMIS PI (63.6 (IQR 9.0)), respectively. In multivariate analysis, only PROMIS PF was associated with lower risk of ED visits OR 0.92 (95% CI.85-.99). Other factors independently associated with ED visits included non-traumatic surgical indication OR 3.7 (95% CI 1.1- 12.9), any pulmonary disease OR 4.2 (95% CI 1.4-12.8), ASA classification OR 4.4 (95% CI 1.3-14.9), and wound complications OR 10.2 (95% CI 2.6-39.9). Conclusion: Patients with lower PROMIS PF scores preoperatively were significantly more likely to visit the ED postoperatively. While all of the factors found to be associated with ED visits are not modifiable by the surgeon, preoperative PROMIS scores could quickly and easily be used to identify patients for potential interventions. This study demonstrates the potential of the PROMIS outcomes system outside of quantifying surgical outcomes. Further study is being conducted to investigate the optimal PROMIS PF cutoff for best identifying patients at risk for ED visits.
Weight Bearing CT Analysis of the Transverse Tarsal Joint During Eversion and Inversion
Authors: Jeng Clifford L. , Rowe Nicholas , Robertson Cassandra E. , Singh Stuti , Campbell John T. 
Published: January 2022

Category: Basic Sciences/Biologics; Hindfoot Introduction/Purpose: Current understanding of the kinematics of the transverse tarsal joint continues to evolve. Unfortunately, most prior studies have been in cadavers or under non-physiologic conditions. Weight bearing CT scans may provide more accurate in vivo information about the position of the transverse tarsal joint during eversion and inversion. Methods: Institutional Review Board approval was obtained. Five normal volunteers underwent bilateral weight bearing cone- beam PedCAT scans (CurveBeam LLC, Hatfield, PA) while standing on platforms that positioned both hindfeet in 20o of valgus and then 20o of varus. The CT scans had a field-of-view diameter of 350 mm and a field-of-view height of 200 mm. The scan exposure time was 9 seconds, with a total scan time of 54 seconds. The datasets were reconstructed using filtered back projection with 0.37mm isotropic voxels. The resulting volumes were then segmented, identifying the [x, y, z] coordinates that comprised each bone. Each bone of the hindfoot was segmented on the scan images and the motion between the talus and calcaneus was analyzed. A similar analysis was done for motion between the navicular and cuboid. Two-tailed paired Student's t- tests were used to compare the angle and distance measurements between valgus and varus positions. Results: In the coronal plane, the axis of the talus rotated by 17.0° relative to the axis of the calcaneus as the hindfoot moved from eversion to inversion (p=0.03). The distance between the centers of the talar head and the anterior calcaneus also moved closer to each other by 7.1 mm (p=0.00005). There was no significant change in angle or distance between the navicular and cuboid when moving from eversion to inversion. The angle between the navicular and cuboid axes changed 2.1° (p=0.7), while the distance changed 0.8 mm (p=0.7) Conclusion: Previous work proposed that the transverse tarsal joint locking mechanism occurs from the talonavicular and calcaneocuboid joint axes diverging (less parallel) as the hindfoot inverts. The current weight bearing CT data shows that not only do the talar and calcaneal axes rotate relative to each other during inversion, but the center of the talar head and anterior calcaneus translate to move closer together. Because the navicular and cuboid do not move, transverse tarsal joint locking may occur due to tightening of the joint capsules and ligaments. Further in vivo study is warranted, especially under dynamic weightbearing conditions.