bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Complex Hindfoot Trauma with Hindfoot Nail
Authors: Patch David A. , Lameka Megan , Halstrom Jared R. , Quade Jonathan H. , Spitler Clay A. , Johnson Michael D. 
Published: January 2022

Category: Hindfoot; Trauma Introduction/Purpose: Pilon fractures are often associated with severe bone comminution and soft tissue compromise. As a result, surgical salvage procedures such as hindfoot nailing may be indicated for patients who are not candidates for standard fixation techniques such as open reduction and internal fixation (ORIF). The purpose of this review was to access outcomes associated with complex hindfoot trauma acutely treated with hindfoot nailing. Methods: A case series at a Level I trauma center was performed to identify trauma patients with complex hindfoot fractures who underwent hindfoot nailing as definitive treatment after initial external fixation between 2012 and 2020. Indications included a combination of patient comorbidities, fracture severity, and soft tissue injury. Exclusion criteria included follow-up less than 3 months. Post-operative radiographs were interpreted by a fellowship-trained foot and ankle surgeon. Primary outcome measures included unplanned reoperation/revision and deep infection. Deep infection was defined as any patient requiring surgical debridement after definitive fixation with positive cultures or the presence of positive cultures at the time of planned surgery. Fractures were classified using the AO/OTA classification and injury characteristics and postoperative complications were recorded via chart review. Results: Twenty-six of 29 of identified patients met inclusion criteria. The most common AO/OTA classification was 43C (62%). The average age was 55 years (range, 31-94) and the most common mechanism of injury was motor vehicle crash (38%). Thirteen fractures (50%) were open with Gustilo Anderson grade IIIA fractures being the most common (38%). The overall deep infection rate was 15% with fifty percent of cases positive for a history of diabetes mellitus or smoking. Unplanned reoperations occurred in seven (27%) cases. Among these, a total of four (57%) occurred due to the development of deep infection, two (29%) were nonunions, and one (14%) was indicated for hardware failure. Below the knee amputation occurred in one patient with nonunion (4%), which was a grade IIIA open pilon fracture with significant bone loss. Union was achieved in the majority of patients (92%). Conclusion: Treatment of complex hindfoot trauma with intramedullary nailing has a high union rate as a salvage procedure in a poor host. Surgeons should consider this treatment in patients that are not candidates for standard open reduction and internal fixation techniques.
Early Failure of Paragon28 Phantom Hindfoot Fusion Nail: A Case Report
Authors: Pattisapu Naveen , Bettin Clayton C. , Friedmann Elizabeth , Sims Michael L. 
Published: January 2022

Category: Diabetes; Hindfoot; Trauma Introduction/Purpose: Tibio-talar-calcaneal (TTC) fusion nails are commonly used to treated acute ankle fractures in patients with diabetes, Charcot arthropathy or other comorbidities. Recently, Paragon28 released the Phantom Hindfoot Fusion Nail (Phantom nail) with a unique design feature-a proximal coil. Methods: We present the case of a diabetic patient with an ankle fracture-dislocation treated with the Paragon28 nail who experienced early implant failure. Results: A 48-year-old male with HIV, end-stage renal disease requiring hemodialysis, and insulin-dependent diabetes mellitus with severe peripheral neuropathy presented a trimalleolar ankle fracture-dislocation treated with a TTC nail. At his first follow- up, he presented with early implant failure at the nail-coil interface. Conclusion: The integrity of the Phantom nail, appropriate length, and placement of the flex coil require further evaluation. Unstable pathologies such as fractures may be better stabilized with a solid nail construct.
Fusion Rates Following First Metatarsophalangeal Arthrodesis using a Dynamic Nitinol Staple-Plate Construct, Minimum 1-Year Follow-Up
Authors: Philbin Terrence M. , Malloy McCoy Antonio M. , Chandra Amar , Consul Devon , Thompson Mitchell , Nguyen Kevin N. 
Published: January 2022

Category: Midfoot/Forefoot Introduction/Purpose: Arthrodesis has long been the procedure of choice for end-stage arthritis of the first metatarsophalangeal joint (MTP). Multiple constructs have been described through literature with good fusion rates and patient outcomes. Methods allowing for ease of application and reduction of OR time without sacrificing surgical outcomes and fusion rates are therefore of considerable interest. Methods: In this study, we retrospectively reviewed a cohort of 33 patients undergoing arthrodesis of the first MTP utilizing a dynamic Nitinol staple and plate construct. The primary focus of our study was to evaluate the fusion rates following the aforementioned procedure. All patients within the study received a compression staple-plate construct placed across the first MTP and underwent the same post-operative protocol with radiographs taken at set intervals to evaluate fusion across the joint. Results: Our results demonstrated a 100% fusion rate with 3 delayed unions and no incidences of hardware failure. The time to fusion and fusion rates seen in this study are comparable to those previously reported in literature. Conclusion: We conclude that utilization of this construct is a viable option for arthrodesis of the first MTP, and its ease of application may decrease overall operating time which could prove advantageous over other, more commonly used methods.
Diabetic Kidney Disease is Associated with Increased Complications Following Operative Management of Ankle Fractures
Authors: Polachek William S. , Baker Hayden P. , Dahm James S. , Strelzow Jason , Hynes Kelly K. 
Published: January 2022

Category: Trauma; Ankle; Diabetes Introduction/Purpose: Diabetes mellitus and peripheral neuropathy are established risk factors for complications in operatively treated ankle fractures. Generally, the presence of peripheral neuropathy and diabetic nephropathy have been used as dependent variables in studies of diabetic ankle fracture cohorts, but these factors are typically treated as binary risk factors. Thus, we sought to quantify additional risk factors for complication specific to diabetic patients undergoing fracture fixation. Methods: We identified 617 rotational ankle fractures treated operatively at a single academic medical center from 2010-2019, of which 160 were identified as diabetic. Of these, 91 ankle fractures in 90 diabetic patients met criteria for retrospective review of clinical and radiographic data. Criteria included perioperative laboratory studies, including Hemoglobin A1c and estimated glomerular filtration rate (eGFR), as well as follow-up radiographs in the electronic record. We defined complications in this surgical cohort as deep surgical site infection, unplanned return to the OR and failure of fixation. Logistic regression was performed, and odds ratios (OR) calculated. Results: The overall the complication rate was 24.2% (22/91) in this cohort. Median follow-up was 29 weeks (range: 5-520 weeks). Mean perioperative Hemoglobin A1c in patients who experienced postoperative complications was 7.6% (Range: 5.1%- 14.2%) compared to 7.8% (Range:5.6%-13.5%) who did not (p=0.69). Diabetic patients with chronic kidney disease (eGFR<60 ml/min/BSA) (OR=5.29, p=0.006) and peripheral neuropathy (OR=4.61, p=0.003) were at significantly higher risk of all complications compared to diabetic patients without these comorbidities. Of note, we did not find an association between perioperative Hemoglobin A1c or Body Mass Index and complication rate. Conclusion: Patients with diabetes complicated by chronic kidney disease are at significantly higher risk of complications following operative management of ankle fractures. Our study also corroborated previous reports that within this high-risk cohort, the presence of peripheral neuropathy is a significant risk factor for complications. These sequalae of diabetic disease extends beyond simple glycemic and are manifestations of microvascular disease, glycosylation of soft tissues and impaired metabolic pathways. Identifying these risk factors in diabetic patients allows for patient specific risk stratification, education, and management decisions of ankle fractures.
Preoperative Opioid Prescription is a Risk Factor for Extended Opioid Filling After Ankle Arthroscopy
Authors: Polachek William S. , Lee Cody , Scott Bryan L. , Hynes Kelly K. 
Published: January 2022

Category: Arthroscopy; Ankle; Sports; Other Introduction/Purpose: Opioids can be an important tool in the management of postoperative pain, however, increased prescribing of these medications following orthopaedic procedures has significantly contributed to the current opioid crisis. Post- operative opioid utilization and duration varies greatly among surgeons, procedures, and patients. We sought to investigate patterns of opioid prescription following ankle arthroscopy and determine patient factors associated with increased postoperative opioid prescribing. Methods: A national claims-based database was queried for patients undergoing first-time ankle arthroscopy. Only patients with continuous database inclusion for at least one year prior to and one year after index ankle arthroscopy were included. Patients carrying an International Classification of Diseases (ICD)-9 or ICD-10 code(s) for diagnosis of septic ankle joint or a CPT code for total ankle arthroplasty prior to index ankle arthroscopy were excluded from the study. Patients who filled at least 1 opioid prescription between 1 and 4 months prior to surgery were defined as preoperative opioid-use group. Monthly relative risk ratios for filling an opioid prescription were calculated for the first year after surgery. Multiple logistic regression analysis was performed to identify factors associated with opioid prescription refills at 3, 6, 9, and 12 months after ankle arthroscopy. For analysis, P<0.05 was defined as significant. Results: We identified 6,039 patients who underwent primary ankle arthroscopy. The preoperative opioid-use group consisted of 1,514 patients (25.1%), of which 24 (1.6%) filled opioid prescriptions at 6 months postoperatively compared to 39 (0.9%) of opioid-naive patients (relative risk [RR], 1.84 95% confidence interval [CI], 1.11-3.05). Multivariate analysis determined that the preoperative opioid-use group was at increased risk of filling prescriptions at 3 (odds ratio [OR], 2.22; 95% CI 1.42-3.48) and 6 months (OR, 1.74; 95% CI, 1.01-2.95) postoperatively. Patients with Body Mass Index (BMI) > 30 were also at increased risk at 3 months (OR, 1.65; 95% CI, 1.04-2.62) and 6 months (OR, 2.01; 95% CI, 1.17-3.49) postoperatively. Comorbidities such as diabetes, hypertension, fibromyalgia, alcohol, and tobacco abuse were not associated with opioid filling (P>0.05). Conclusion: Preoperative opioid prescription filling and BMI 30 were associated with an increased risk of extended opioid prescription utilization following ankle arthroscopy. Overall, prolonged opioid prescribing was not widespread in either group postoperatively. This may represent the indications and outcomes of ankle arthroscopy. Patients presenting with preoperative opioid-use and increased BMI may benefit from multimodal pain management and additional perioperative education around non- pharmacologic pain-management strategies to decrease risk of prolonged opioid use.
Mortality in Patients after Diabetic Charcot Foot-Related Procedures
Authors: Ptasinski Anna , Koroneos Zachary , Stauch Chris M. , Martinazzi Brandon , Aynardi Michael C. 
Published: January 2022

Category: Diabetes; Hindfoot; Midfoot/Forefoot Introduction/Purpose: Diabetic Charcot foot is a chronic and progressive disease, following neuropathic loss of protective sensation and causing destruction of the joints. It is classically identified through a rocker-bottom deformity and may also present with a collapse of the medial arch, bony prominences, and ligamentous instability. Charcot leads to further morbidities, and patients may require surgeries including below the knee amputations or limb salvage reconstruction to treat the disease if conservative treatments fail. Previous literature demonstrated that foot ulceration is associated with mortality in diabetic patients, but no clear association between Charcot diagnosis and mortality has been identified. The purpose of this study was to investigate the mortality in patients diagnosed with acute diabetic Charcot foot. Methods: After institutional review board approval, all patients at a single institution that underwent an orthopaedic surgery for the treatment of Charcot during 2015-2020 were queried using hospital and public records. Demographic data, as well as the 30- day, 90-day, 1-year, and 5-year mortality were recorded. Results: 79 patients were identified, with 57 (72%) males and 22 (28%) females with Charcot-related surgeries between 2015 and 2020. At the time of surgery, the average age was 58.2 (28-83) years. At the time of analysis, 61 (77%) patients were still living, but 18 (23%) patients were deceased with mortality within 30 days (1), 90 days (5), 1 year (9), and 5 years (18) of the Charcot-related procedure. For deceased patients, the average age of death was 59.6 years (30-83 years). The average number of days post- operation until death was 460 days (23-1613 days). Conclusion: Diabetic Charcot foot is a serious and debilitating complication of diabetic neuropathy. This data demonstrates that 23% of patients analyzed expired an average of 1.26 years after Charcot-related surgery. In addition, patients that were deceased were an average of 59.6 years of age, suggesting that Charcot may be associated with early mortality. Future studies will include an analysis of possible predictors of mortality for patients diagnosed with Charcot foot to evolve clinical and surgical management of patients.
Anatomy of the Intermetatarsal Facets of the Fourth and Fifth Metatarsals
Authors: Qatu Mossub , Jastifer James R. 
Published: January 2022

Category: Basic Sciences/Biologics Introduction/Purpose: The intermetatarsal joint between the fourth and fifth metatarsals (4-5 IM) is important in defining fifth metatarsal fractures. The purpose of the current study was to quantify this joint in order to determine the mean cartilage area, the percentage of the articulation that is cartilage, and to give the clinician data to help understand the joint anatomy as it relates to fifth metatarsal fracture classification. Methods: Twenty cadaver 4-5 IM joints were dissected. Digital images were taken and the articular cartilage was quantified by calibrated digital imaging software. Results: For the lateral fourth proximal intermetatarsal articulation, the mean area of articulation was 188 + 49 mm, with 49% of the area composed of articular cartilage. The shape of the articular cartilage had 3 variations: triangular, oval, and square. A triangular variant was the most common (80%, 16 of 20 specimens). For the medial fifth proximal intermetatarsal articulation, the mean area of articulation was 143 + 30 mm, with 48% of the joint surface being composed of articular cartilage. The shape of the articular surface was oval or triangular. An oval variant was the most common (75%, 15 of 20 specimens). Conclusion: This study supports the notion that the 4-5 IM joint is not completely articular and has both fibrous and cartilaginous components.
Ankle Fractures Involving the Posterior Malleolus: 7-Year Results in 100 Cases
Authors: Rammelt Stefan , Neumann Annika P. 
Published: January 2022

Category: Ankle; Trauma Introduction/Purpose: The presence of a posterior malleolar (PM) fragment has a negative prognostic impact in ankle fractures. The best treatment is still subject to debate and new concepts continue to emerge. The aim of this study was to assess the medium- to long-term clinical and functional outcome of ankle fractures with a PM fragment in a larger patient population treated with an individualized treatment approach. Methods: One hundred patients with ankle fractures involving the PM were identified retrospectively and reevaluated at an average follow-up of 7.0 years. Fixation of the PM was tailored to the individual fracture pattern. Bartoníček-Rammelt type I PM fractures (extraincisural shell-like fragments) were not fixed surgically. Displaced Type II (posterolateral fragments) and type III PM fractures (two-part with medial extension) were mostly fixed with direct posterior screw or plate fixation. Intercalary joint fragments were fixed with lost K-wires or resorbable pins. Type IV PM fractures (large triangular fragments) were treated with either posterior screw / plate fixation or indirect anteroposterior screw fixation with direct transfibular control of reduction, if feasible. Results: Internal PM fragment fixation was negatively correlated with the need for syndesmotic screw placement at the time of surgery (p=0.010). At 7 years, the mean Foot Function Index was 16.5, the Olerud Molander Ankle Score averaged 80.2 and the American Orthopaedic Foot & Ankle Society ankle/hindfoot score averaged 87.5. The physical (PCS) and mental health component summary (MCS) scores of the SF-36 averaged 47.7 and 50.5, respectively. Range of motion was within 3.4 degrees of the uninjured side. The size of the PM fragment had no prognostic value. There was a trend to lower outcome scores with anterior or posterior shift of the distal fibula of 1 mm within the tibial incisura. Patients who underwent primary internal fixation had significantly superior SF-36 MCS than patients who underwent staged internal fixation (p=0.031). Two patients (2%) needed secondary ankle fusion following deep infection. Conclusion: With an individualized treatment protocol, tailored to the CT-based assessment of PM fractures, favorable medium and long-term results can be expected. The mere size of the PM fragment is just one of the factors guiding treatment, other important criteria are fragment displacement, impaction of the tibial plafond and incisura involvement. PM fixation provides direct bone-to-bone fixation of the syndesmosis and significantly reduces the need for additional transsyndesmotic fixation with a screw or flexible implant.
Thirty Days vs One-Year Complications and Reoperations after Foot Amputation and Below Knee Amputation: A Large Database Study
Authors: Riepen Dietrich , Sambandam Senthil , Mounasamy Varatharj , Wukich Dane K. 
Published: January 2022

Category: Diabetes; Midfoot/Forefoot Introduction/Purpose: Below knee amputation (BKA) and Foot amputation (AA) are two commonly performed procedures for diabetic foot conditions. Aim of this study was to analyze the characteristics of the complications and reoperations at 30 days and 1 year in a matched sample of BKA and FA in diabetic patients in a large database population. Methods: Commercially available patient database record (PearlDiver) was used for this study. Diabetic Patient undergoing BKA and FA were identified using CPT code. After matching two groups for smoking, obesity and comorbidities scores, the differences in the risk of complications at 30 days, 90 days and 1 year and the risk of reoperation at 1 year were noted in both groups. Results: There were 8555 patients in each matched group. Most patients were male (71.6%) and 6891 patients were smokers and 5292 patients were obese. More than 50% of general and systemic complications happened after 30 days. Incidence of 30 days, 90 days and 1 year general complications including Acute kidney injury, cardiac arrest, Cerebrovascular event, myocardial infarction, Pulmonary embolism, Pneumonia, sepsis and transfusion were higher in the BKA group. AKI was the most common general complication and PE was the least common general complication observed at 30 days, 90 days and 1 year. The risk of wound dehiscence, surgical site infection and overall wound complications were higher in FA group. One year reoperation for infection and dehiscence were higher in the FA group and reoperation for hematoma formation was higher in BKA group. The risk of revision to a BKA in the FA group at 1 year was 16.4% (1410 patients). Conclusion: FA is associated with higher risk of local complications at 30 days, 90 days and 1 years and higher reoperation rate at 1 year for local complications. However, BKA is associated with higher systemic major complications and higher risk of reoperation for hematoma formation. Most complications in the FA and BKA group happened after 30 days which highlights the fact that studies reporting 30 days complications after FA and BKA may underestimate the complications.
Outcomes of Bone Marrow Stimulation for Secondary Osteochondral Lesions of the Talus Equal Outcomes for Primary Lesions
Authors: Rikken Quinten , Dahmen Jari , Van Bergen Christiaan v. , Stufkens Sjoerd A. , Kerkhoffs Gino 
Published: January 2022

Category: Ankle Introduction/Purpose: To compare clinical, sports, work, and radiological outcomes between primary and secondary OLTs (<15mm) treated with arthroscopic BMS. Methods: Ethical approval was obtained before the start of the study. A power analysis was performed for the primary outcome measure, the Numeric Rating Scale (NRS) during activities. Secondary OLTs were matched to primary OLTs in a 1:2 ratio using lesion size, patient age, body mass index, and sex as prognostic covariates to control for confounding. Secondary outcomes included pre- and one-year postoperative clinical assessment of the NRS at rest, American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS) subscales, and the EQ-5D general health questionnaire. The rates and time to return to work and sports were collected. Radiological examinations were performed preoperatively and at final follow-up using computed tomography (CT). The postoperative outcomes were compared with a Wilcoxon rank-sum test; a univariate linear regression analysis was used to investigate the influence of covariates on clinical outcome scores. Results: After matching, 22 and 12 patients with smaller (<15 mm) OLTs were included in the primary and secondary group, respectively. The NRS during activities was not different between primary cases (median: 2, IQR: 1 - 4.5) and secondary cases (median: 3, IQR: 1 - 4), P= 0.5. Both groups showed a significant difference between all pre- and postoperative clinical outcome scores, except for the FAOS symptoms subscale in the primary group and NRS at rest in the secondary group. No significant differences in any clinical outcome scores were found between both groups at one-year follow-up, nor did any covariate significantly influence the clinical outcome scores. The return to sport rate was 90% for primary cases and 83% for secondary cases (P= 0.6). All patients returned to work. Lesion filling on CT was complete (67% - 100%) in 59% of primary cases and 67% of secondary cases (P= 0.6). Conclusion: No differences in outcomes were observed between arthroscopic bone marrow stimulation in primary and secondary OLT at one-year follow-up. Repeat BMS may therefore be a viable treatment option for failed OLTs in the short term.