bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of Isolated Ankle Dislocations in the United States
Authors: Ortiz-Babilonia Carlos D. , Gupta Arjun , Badin Daniel , Mo Kevin C. , Aiyer Amiethab A. 
Published: November 2022

Category: Trauma; Ankle Introduction/Purpose: Isolated ankle dislocations (IADs) are rare type of dislocation associated with significant morbidity. Prompt reduction is indicated to prevent negative sequelae. Considering the potential negative outcomes associated with this injury, we sought to identify populations at increased risk. Methods: The National Electronic Injury Surveillance System (NEISS) database was queried to identify patients who presented to Emergency Departments (EDs) in the U.S. for IADs between 2001-2019. NEISS codes indicating ankle dislocation as the primary diagnosis were utilized. Population estimates were derived from the U.S. Census Bureau for calculation of incidence in person- years. Chi-square analysis and Wald chi-square tests were performed to assess differences between subgroups. Results: An estimated 52,520 IADs (2,862 per year) were identified among a population at risk of 5,853,993,882 person-years. The estimated incidence of IADs in the general population presenting to EDs was 0.90 per 100,000 person-years. Patients with IADs were most commonly male (61.6%), white (71.9%), and between 15-35 years old (60.1%). Patients aged 15-20 years comprised the highest proportion of IADs (19.6%). Surprisingly, sport-related activities accounted for a minority of injuries (38.2%), with most of these occurring during basketball (47.8%), football (12.9%), and soccer (9.8%). Most IADs were due to non- athletic activity, with falls from stairs (30.8%) and ladders (13.4%), and skateboarding (5.0%) being the most common mechanisms. When comparing injured male and female patients, female patients were older (45.2 vs 32.0 years; P<0.001), more likely to be injured during non-athletic activities (83.9% vs 48.1%; P<0.001), and more likely to be hospitalized after ED visit (27.3% vs 17.6%; P<0.001). Conclusion: IADs are extremely rare. They occur most frequently during non-athletic activities in young-to-middle-aged Caucasian men. Although more common in males, females with IADs tend to be older, more likely to be injured during non- athletic activities compared to sports, and more likely to be hospitalized. This suggests that, when IADs do occur in women, they may be at higher risk for negative outcomes.
Trends in Ankle Sprains Presenting to Emergency Departments During the COVID-19 Pandemic
Authors: Ortiz-Babilonia Carlos D. , Gupta Arjun , Mo Kevin C. , Aiyer Amiethab A. 
Published: November 2022

Category: Trauma; Ankle Introduction/Purpose: It has been suggested that the COVID-19 pandemic has led to patients deferring evaluation and treatment of injuries due to fear of contagion. This, in addition to lockdowns and avoidance of outside activities, may have led to a decrease in the recorded incidence of activity-related injuries. The purpose of this study was to evaluate the effect of the 2020 COVID-19 period on Emergency Department (ED) visits for ankle sprains in the United States, including incidence, demographics, and etiology. Methods: The National Electronic Injury Surveillance System (NEISS) database was queried to identify patients who presented to EDs in the U.S. for ankle sprains between 2001-2020. Population estimates were derived from the U.S. Census Bureau from 2001- 2020 for calculation of incidence in person-years. Chi-square analysis and Wald chi-square tests were performed to assess differences between pre-pandemic (2001-2019) and during-pandemic (2020) periods. Results: Between 2001 and 2020, a total of 315,545 actual ankle sprains were identified in the NEISS database for an estimated 11,904,243 ankle sprains (610,445.2 per year) among a population at risk of 6,185,494,962 person-years. The estimated incidence of ankle sprains in the general population presenting to EDs was 1.92 per 1000 person-years. When analyzing pre- and during- pandemic cohorts, ankle sprain incidence was significantly lower during-pandemic (1.98 vs 0.89 per 1000 person-years; P<0.001). Additionally, patients that visited EDs for ankle sprains during the pandemic were older (30.5% vs 27.0%; P<0.001), more likely to be female (57.8% vs 51.8%; P<0.001), and more likely to be Asian (0.83% vs 0.44%; P=0.047), Native American (0.62% vs 0.18%; P=0.001), or of Pacific Islander race (0.13% vs 0.04%; P=0.008). Ankle sprains were due to sport-related activities in 38% of patients pre-pandemic, as opposed to 29% of patients during-pandemic (P<0.001). Conclusion: The incidence of ankle sprains decreased 65% in 2020, probably owing to activity restrictions during the COVID-19 pandemic. This was further supported by a significant decrease in the proportion of ankle sprains due to sport-related activities. Finally, changes in age, gender, and racial patterns were also identified for this injury type.
Rates of Complications and Readmissions: In-Patient vs Outpatient ORIF of Calcaneus Fractures
Authors: Patch David A. , Andrews Nicholas A. , Butler Reed , Campbell Collier , Byrd William , Devine Lee T. , Spitler Clay A. , Johnson Michael D. 
Published: November 2022

Category: Hindfoot; Trauma Introduction/Purpose: Calcaneus fractures are common injuries to the hindfoot. The safety of in-patient versus outpatient treatment in patients with calcaneus fractures remains unclear. The aim of the present study was to assess differences in wound complications and readmissions in operative calcaneus fractures treated with open reduction and internal fixation (ORIF) in an in- patient versus outpatient setting. Methods: Patients undergoing ORIF for calcaneus fractures from 2012 to 2020 were reviewed. Inclusion criteria were age greater than 18 years and an operative calcaneus fracture treated with the sinus tarsi approach (STA). Exclusion criteria consisted of a minimum of three months follow-up, open calcaneal fractures or fracture dislocations, inpatients with polytrauma, and patients without a preoperative computed tomography (CT) scan. A total of 113 patients met inclusion criteria with 24 (21%) managed inpatient and 89 (79%) managed as outpatient. The primary outcomes were deep infection defined as return to the operating room for debridement with positive cultures and readmissions. Secondary outcomes included implant related pain and unplanned return to the operating room. Results: Inpatients had a higher percentage of ASA classification 3&4 patients (58.3% vs 29.2%, p=0.008). Outpatients had a longer delay in days between injury and definitive fixation (mean 8 (8.9 SD, 0-31 range) vs. 14 (12.4 SD, 0-91 range) days, p=0.009). There were no statistically significant differences in the incidence of deep infections (8.3% vs. 4.5%, p=.606), implant related pain (8.3% vs. 15.7%, p=.516), return to the operating room (16.7% vs. 15.7%, p=1.0) or readmissions (4.2% vs. 3.4%, p=1.0) between inpatient and outpatient groups including in binary logistic regression models (p>.3 for all). In our retrospective study of patients undergoing operative repair of isolated calcaneus fractures with STA, there was no increased risk of wound complications or readmissions when calcaneus fractures were treated in an outpatient setting. Conclusion: In our retrospective study of patients undergoing operative repair of isolated calcaneus fractures with STA, there was no increased risk of wound complications or readmissions when calcaneus fractures were treated in an outpatient setting.
Resection of a Symptomatic Os Vesalianum with Peroneus Brevis Reattachment: A Report of 3 Cases and Literature Review of 100 Years
Authors: Rammelt Stefan , Neumann Annika Pauline 
Published: November 2022

Category: Midfoot/Forefoot; Sports Introduction/Purpose: Os vesalianum is a very rare accessory foot bone located adjacent to the fifth metatarsal base. The estimated prevalence is below 1 %. In most cases it remains asymptomatic and is diagnosed as an incidental radiographic finding. Rarely the os vesalianum causes pain in the lateral midfoot. Therefore, only a few case reports about a symptomatic os vesalianum were published in the past. Here, we present what we believe to be the first small case series on that subject together with a review of the literature. Methods: Over a course of 10 years, we have treated three female patients (aged 18-36 years) who presented with pain on exercise in their lateral midfoot over the fifth metatarsal base. All of them had been diagnosed having a nonunion of the fifth metatarsal base, two after having sustained a direct or indirect trauma to the foot. The diagnosis of an accessory bone (os vesalianum) adjacent to the fifth metatarsal base fracture and with a joint facet to the cuboid bone could be made in retrospect in all cases by critically evaluating the initial radiographs. Technetium bone scans revealed an isolated increased uptake at the fifth metatarsal base. Upon surgical exploration, an irritation of the lateral facet of the cuboid with focal cartilage lesion through the accessory bone was noted in all 3 cases as a potential source of pain. Results: In all three cases, resection of the symptomatic os vesalianum and reinsertion of the peroneus brevis tendon into the fifth metatarsal base with a suture anchor was performed an led to a complete relief of pain within 3 months. At a minimum of 12 months follow-up all three patients fully returned to all previous activities including sports. The foot function index (FFI-D) improved from an average of 25.7 to an average of 3.67 at follow-up. One patient had a prominent subcutaneous suture knot removed, otherwise no complications were seen and no revision surgeries were needed in the further course. A systematic review of the literature revealed just 20 reported cases of a symptomatic os versalianum over 100 years (between 1922 and 2021). Previous treatment included observation, rest, resection with or without tendon reattachment, internal fixation and bone grafting. Conclusion: The knowledge of the location and morphology of accessory bones is indispensable when searching for rare causes of chronic foot pain. An os vesalianum may become symptomatic after direct and indirect trauma. The differential diagnosis must include an acute fifth metatarsal base fracture, non-union, or apophysitis (Iselin's disease), a distal peroneus brevis tendon lesion and lateral plantar fasciopathy. Resection of a symptomatic os vesalianum with reattachment of the peroneus brevis tendon to the 5th metatarsal base leads to a foot that is pain free and fully functional in most reported cases including the present series.
Validating Foot Center Axis and Ankle Rotation using Weight-Bearing CT
Authors: Rascoe Alexander S. , Aitchison Alexandra H. , Ridenour Ryan M. , Wang Miqi , Adams Samuel B. 
Published: November 2022

Category: Ankle; Ankle Arthritis Introduction/Purpose: Even as its popularity increases, there remain many unanswered questions regarding total ankle arthroplasty. One debate considers the proper rotation of the talar component to restore native, non-osteoarthritic anatomy. The foot center axis is a unique anatomic concept that considers the position of the native foot relative to the ankle. The present pilot study sought to evaluate the reproducibility of axial alignment measurements, including the foot center on weight-bearing CT in patients without ankle osteoarthritis. Methods: Following IRB approval, charts were reviewed to identify patients without ankle osteoarthritis, trauma or other deformity who received a weightbearing CT scan. A pilot group of n=8 patients were included for a total of n=10 limbs. Average age was 50.1 +/- 14 and there were 38% female patients. All measurements were made on MPR (multiplanar reformation) axial reconstructions. Cobb angle measurements between the anatomic foot center, the second, the fourth metatarsal and the gutter bisector or medial gutter line were recorded by n=4 observers. Intraclass correlation (ICC) was produced using a two-way random effects model with absolute agreement and other statistical testing was performed by IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY. Results: The average gutter bisector angle was 6.2 deg +/- 2.0 and the average angle between the medial base of the 1st metatarsal head, lateral base of the 5th metatarsal head and the posterior calcaneus was 33.0 deg +/- 2.6. Amongst the observers, the ICC for these landmarks were 0.95 and 0.96 respectively. The average cobb angle measurement between the gutter bisector angle and the second metatarsal was 8.3 deg +/- 7.3, with a corresponding ICC of 0.96. The average cobb angle measurement between the gutter bisector angle and the anatomic foot center was 5.6 deg +/- 4.3 and the average cobb angle measurement between the medial gutter line and the anatomic foot center was 6.23 deg +/- 6. Amongst the observers, the ICC for these measurements were 0.81 and 0.81 respectively. Conclusion: In a small pilot study of patients without osteoarthritis who underwent weight-bearing CT scans there was good (ICC>0.75-0.90) to excellent (ICC>0.90) agreement amongst observers for measurements of foot center axis and ankle rotation. These findings validate the reproducibility and agreement of these manually constructed measurements for assessing the relationship between the foot center axis and ankle rotation. Future studies will expand upon the use of these measurements to define non-arthritic anatomy. The anatomic foot center may be a useful guide for establishing intra-operative foot orientation when performing total ankle arthroplasty.
The Effect of Chilled vs Room Temperature Irrigation on Thermal Energy Dissipation During MIS Calcaneal Osteotomy
Authors: Reddy Sudheer C. , Schipper Oliver N. , Li Jihui 
Published: November 2022

Category: Hindfoot; Basic Sciences/Biologics; Other Introduction/Purpose: Minimally Invasive (MIS) calcaneal osteotomy has grown in popularity in recent years to address hindfoot deformity. A potential complication is thermal bone necrosis secondary to heat generation from the burr, leading to nonunion of the osteotomy. Irrigation is commonly employed to reduce this risk. The effect of irrigation on reducing this risk remains an understudied area. The purpose of this study was to evaluate the effect of cooled versus room-temperature irrigation on thermal energy dissipation on a temperature curve during calcaneal osteotomy using a Shannon burr. Methods: Ten cadaveric limbs (5 pairs) at room temperature (68 0F) were randomized to receive either cooled saline or room temperature irrigation during MIS calcaneal osteotomy. Two thermocouple probes (EL-USB-TC-LCD, Lascar Electronics) were inserted 5mm away from the plane of the osteotomy, on proximal and distal sides respectively (Fig. 1). The probes were inserted to a depth of 2cm. A 3 x 30mm Shannon burr was used to perform the osteotomy. The burr was run continuously under continuous irrigation using either room temperature (680F) and chilled (370F) irrigation, until the osteotomy was completed. All osteotomies were performed in approximately 60 seconds. Temperature was recorded at 15sec, 30sec, 45 sec and 60 sec for the two groups and used as a measure of thermal energy generation. Results: Both room temperature and chilled irrigation were effective in minimizing temperature change. On the proximal side, an overall mean increase of 2.60F (70.60F) with room temperature irrigation and a mean increase of 0.70F (68.70F) with chilled irrigation were observed at the 60 sec interval (p=0.09). On the distal side both irrigation methods were more effective in heat control (70.20F vs 67.10F; p=0.17). Conclusion: For the duration of a MIS calcaneal osteotomy, both continuous room temperature and chilled irrigation can reduce thermal energy generation. Use of chilled irrigation can be considered for osteotomies of denser bone that may take longer to perform and generate higher temperatures.
Bilateral Hindfoot Osteonecrosis Associated with Treatment for Cutaneous T-Cell Lymphoma
Authors: Ricci Gianni , Gruenberger Eric H. , Stewart Matthew G. 
Published: November 2022

Category: Hindfoot; Basic Sciences/Biologics Introduction/Purpose: There are reports of bilateral atraumatic osteonecrosis of the talus associated with some chemotherapy agenst for cutaneous T-cell lymphomas (CTCL), and systemic glucocorticoid treatment is by far the most common. We report the case of a 63-year old woman with CTCL previously treated with a high-affinity folate analog, pralatrexate, and multiple short- courses of prednisone dose packs who developed bilateral ankle and hindfoot stress fractures which progressed to hindfoot necrosis involving the talus and calcaneus. Methods: Chart Review Results: MRI was used for the diagnosis of stress fractures and osteonecrosis. The right foot was most symptomatic at presentation and was treated with a 6-month period of protected weight bering in a CAM boot. Follow up imaging demonstrated complete collapse of the talar dome. The patient underwent tibiotalarcalcaneal fusion which was complicated by wound healing issues requiring a skin graft. During this time, left sided symptoms worsened, and MRI confirmed insufficiency fractures with adjacent areas of edema and necrosis about the calcaneus, talus, and lateral malleolus. Considering her recent wound healing difficulties, the left foot was definitively treated in a CAM walker boot with some improvement in symptoms. Conclusion: Insufficiency fractures of the hindfoot are known to progress to osteonecrosis and are typically associated with long- term or high dose systemic steroid administration. Cases presenting after short-courses of oral steroids are uncommon; those associated with methotrexate (a lower affinity folate analog) are rare, and cases associated with pralatrexate or CTCL outside osteonecrosis of the jaw were not found during literature review. Despite cessation of chemotherapy and CTCL remission and early institution of protected weight, this patient rapidly progressed to bilateral hindfoot collapse. Providers and patients should be aware of the associated risks and potential for less favorable outcomes.
Return to Play and Performance Measures for National Football League Athletes Following Operative Ankle Fractures
Authors: Robbins Jordan , Jupiter Daniel , Panchbhavi Vinod K. , Weiss William M. , Hagedorn John C. , Chen Jie 
Published: November 2022

Category: Sports; Ankle; Trauma Introduction/Purpose: Ankle fractures are common injuries in the National Football League (NFL). Yet, there is a need for deeper understanding about the impacts of surgically managed ankle fractures on athletes' careers. Purpose: To investigate return to play (RTP) for NFL players after operative ankle fractures and the associated impacts on career longevity and player performance. Methods: NFL athletes that underwent surgery to repair ankle fractures between 2013 and 2018 were identified from injury reserve (IR) list transactions and press release archives. Athlete demographics and regular season metrics were collected for the seasons before and after injury. Athletes were then matched to uninjured controls. Statistical analysis was performed to evaluate for differences in recorded variables. Results: Of the 46 NFL athletes screened, 31 players fit study criteria. Nine (29.0%) players with surgically treated ankle fractures were unable to return to play in the NFL. Compared to the twenty-two (71.0%) athletes that successfully returned to play, players that did not RTP were no different (P > .05) in age, BMI, number of games or seasons played prior to injury, or snaps per game the season prior to injury. Players that did not RTP had a significantly lower (42.6%, P = .013) pre-injury season approximate value (SAV) from players that did RTP. Athletes that successfully returned to play spent an average of 98 days on IR and continued playing for 41 games across 3.5 seasons. There were no differences (P > .05) in SAV or snaps per game at 1 or 2 seasons following injury when compared to the athletes' pre-injury season or when compared to uninjured controls. Conclusion: NFL athletes that receive surgery to repair ankle fractures have a RTP rate of 71%. A high pre-injury SAV is a positive predictive measure for successful RTP. NFL players that do return see no difference in game time or performance metrics from pre-injury baseline or uninjured controls.
Surgical Site Infection after Foot and Ankle Surgery: A Retrospective Analysis of Incidence using a Low Concentration Chlorhexidine Gluconate (CHG) 0.05% in Sterile Water
Authors: Rushing Calvin J. 
Published: November 2022

Category: Other; Ankle; Bunion; Diabetes; Sports; Trauma Introduction/Purpose: Surgical site infection (SSI) after foot and ankle procedures adversely impacts both the quality and cost of health care delivery; increasing hospital length of stay, the number of re-operations, and readmission rate(s). The purpose of the present study was to assess the incidence of SSI in patients who underwent foot and ankle surgery with concurrent intraoperative lavage containing low concentration Chlorhexidine Gluconate (CHG) 0.05% in sterile water. Methods: Seventy-three patients underwent reconstructive foot and ankle procedures which utilized low concentration CHG 0.05% for intraoperative lavage between September 2020 and October 2021, at a single institution. Minimum follow-up for inclusion was at least 90 days; procedures with concurrent use of topical vancomycin powder, or prophylactic antibiotics postoperatively were excluded. Demographic data, and the incidence of complications including postoperative erythema, delayed wound healing, dehiscence, SSI, as well as reoperations were recorded. Univariate and multivariate analyses were performed. Results: Twelve complications occurred in 73 patients (16%): 1 erythema (1.4%), 4 delayed wound healing (5.5%), 1 dehiscence (1.4%), and 6 SSI's (8.2%). Of the 6 SSIs, 2 were superficial and 4 deep; representing an incidence rate of 2.7 and 5.5%, respectfully. Six reoperations were performed in 4 patients for deep SSI; 3 (75%) had a previously documented history of SSI after orthopedic surgery. A history of previous SSI infection after orthopedic surgery was identified as an independent predictor of future SSI following foot and ankle surgery (p <.05). No associations were identified for purported risk factors. Conclusion: The present study is the first to assess the utility of a low concentration CHG 0.05% as an intraoperative irrigation agent for the purpose of mitigating postoperative SSI after foot and ankle surgery. The data suggests a low incidence of deep SSI in patients without a documented history of previous SSI after orthopedic surgery; without the concurrent use of topical vancomycin or prophyaltic antibitiocs, postoperatively. Additional studies are warranted to better understand the potential association identified.