bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Study of Treatments of Congenital Clubfoot in Cerebral Palsy: A Systematic Review
Authors: Chu Alice , Hanna Aedan , Hanna Adeeb J. , Veliky Jacob , Hoon Choi Jae , Nguyen Julia , McGrath Aleksandra , Kaushal Neil , Edobor-Osula Folorunsho , Shihora Dhvani 
Published: November 2022

Category: Ankle; Other Introduction/Purpose: Cerebral palsy (CP) can lead to various foot deformities, including equinovarus, or clubfoot position. Patients with CP present a challenge when treating clubfoot as there is aberrant muscle tone and motor dysfunction. Many interventions with variable outcomes are available for patients with clubfoot and cerebral palsy, however, no studies exist that compare existing treatments and outcome measures. The purpose of this study is to investigate the existing body of evidence surrounding the treatments and outcomes of clubfoot in cerebral palsy by way of a systematic review. Methods: Using PRISMA guidelines a comprehensive search was conducted of PubMed, Cochrane, CINAHL, Scopus, and Web of Science. Publications were collected which represent all available literature on clubfoot. Articles were screened at the title, abstract, and then full-text level. Only articles that detailed the treatment of pediatric patients with clubfoot, CP, and contained three or more human subjects were included. Publications were excluded from further screening if they were found to be duplicate articles, historical reviews, professional opinions, case reports, or if subjects were non-human. At each level of screening, articles were screened by two independent reviewers to verify that each paper met the predetermined inclusion criteria. Following this, data extraction from primary sources was conducted for; number of patients, age of patients, follow-up length, treatment modality applied, and outcome measures. T-tests were performed using SAS statistical software to determine the relationship between age and type of intervention. Results: An initial search yielded 6,469 articles, after review and cross selection, 32 remained as shown in Table 1. Of these, 53.13% (n=17) articles documented surgical tibial tendon transfer (TT): anterior TT (n=5) (mean-age 10.12 +-3.40yrs), posterior TT (n=12) (mean-age 9.30 +-2.57yrs). Botox & casting was referenced in 15.63% (n=5) articles (mean age 5.34 +-1.21yrs), lengthening of tendon or muscle procedures 12.50% (n=4) (mean age 6.30 +-1.69yrs), botox alone 12.50% (n=4) (mean age 6.83 +-1.72yrs), and osteotomy 6.25% (n=2) (mean age 10.94 +-1.51yrs). There was a difference in age for patients receiving TT versus those receiving botox & casting (9.54+-2.75 years old vs 5.34 +-1.21yrs years, p<.05). Conclusion: These results indicate the preferred modality of clubfoot correction in the setting of cerebral palsy is tibial transfer. The average age of patients receiving surgical treatments was higher than those with casting, Botox, or orthotics. Due to a lack of standardized outcome measurements reported across studies, we recommend further research aimed specifically at evaluating intervention selection based on patient desired functional outcomes.
Functional Outcomes of Primary Arthrodesis vs Open Reduction and Internal Fixation in the Treatment of Lisfranc Injuries
Authors: Gal Zsombor T. , Pectol Richard W. , Kalbac Tyler , Dawson Ashley N. , Sneed Chandler , Albano Ashley Y. , Kavolus Matthew W. , Aneja Arun , Srinath Arjun K. 
Published: November 2022

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: The lack of data regarding functional outcomes of midfoot primary arthrodesis (PA) and open reduction and internal fixation (ORIF) contributes to significant debate regarding the optimal method of treatment for Lisfranc injuries. Although PA is associated with lower rates of secondary procedure and posttraumatic arthritis, its impact on foot functionality has come into question due to sacrifice of tarsometatarsal (TMT) mobility. The authors hypothesize that there is no significant difference between patient recorded outcome measures (PROMs) among patients receiving PA and ORIF for the treatment of Lisfranc injuries. Methods: A retrospective cohort study of patients surgically treated for Lisfranc injuries between January 2010 and January 2019 at a Level I trauma center was undertaken. Retrospective chart review was utilized to obtain patient demographics, comorbidities, procedural information, complications, and additional treatments. Responding by survey, patients reported their functional competency in performing daily and sports-related activities via the validated Foot and Ankle Ability Measure (FAAM) instrument. For each patient, scores for the Activities of Daily Living (ADL) and Sports sections were calculated. Patients also reported their perceived current level of function on a percent scale with respect to functionality prior to TMT injury. Results: Twenty-four patients underwent PA, and 27 patients underwent ORIF. There were no significant differences between age (P=0.55), incidence of high energy injury mechanisms (P=0.14), comorbidities, or time to surgical intervention from injury (P=0.25) among PA and ORIF groups. There were no significant differences in FAAM scores among PA and ORIF groups. The average ADL scores for PA (72.42 +- 17.53) and ORIF (68.11 +- 28.24) were not significantly different (P=0.52), nor were the average Sports scores for PA (47.92 +- 25.48) and ORIF (48.56 +- 29.44) groups (P=0.94). However, patients in the PA group reported a significantly higher level of perceived ADL function (77.96% +- 17.97%) compared to patients in the ORIF group (60.04% +- 35.47%, P=0.03); this was not the case for perceived Sports functionality (P=0.67). Conclusion: This analysis of PROMs revealed no significant difference in the ability to participate in ADLs and sports between PA and ORIF groups. These results align with our hypothesis and suggest that despite sacrificing TMT joint mobility, functional outcomes of patients receiving PA were not significantly different from those receiving ORIF for Lisfranc injuries.
Septic Tenosynovitis of the Lower Extremity: A Case Report
Authors: Garber Hollie , Michel Chris , Abdelmalek George , Sudah Suleiman , Kerrigan Daniel J. , Dijanic Christopher M. , Ali Sayed 
Published: November 2022

Category: Other Introduction/Purpose: Tibialis anterior rupture is an exceptionally rare complication of septic tenosynovitis. One case of septic tenosynovitis of TA has been previously documented by Lowell et al. 2020 It is worth noting in this case, that TA was unruptured. In this abstract, we present a case of TA rupture secondary to septic tenosynovitis. Methods: A 46-year-old female with a past medical history of depression, HIV, HCV, Diabetes Mellitus, medication noncompliance and current heroin abuse presented with 2 days of right ankle pain. She also reported fever, chills, diaphoresis, nausea and vomiting. She was diagnosed with right foot cellulitis based on clinical findings of erythema, induration and tenderness. She underwent computed tomography (CT) with contrast of her right lower extremity which showed a peripherally enhancing fluid collection surrounding the tibialis anterior tendon consistent with tenosynovitis. There appeared to be medial extension beyond the tendon sheath (Figure 1). A sagittal view is provided in Figure 2, which further demonstrates the fluid collection. Results: She had an I&D of the fluid collection and started on IV vancomycin. After admission to the medical floor, blood cultures were drawn. The patient failed to improve after 2 days of vancomycin therapy. The blood cultures were negative. She subsequently had MRI of her right lower extremity that showed a persistent peripherally enhancing fluid collection anterior to the tibialis anterior tendon and high-grade partial tear of the tibialis anterior tendon (Figure 3). She was then taken to the operating room for a repeat incision and drainage where the tendon sheath of the tibialis anterior was incised and the tendon was exposed with washout. Wound cultures were drawn, and afterward, her antibiotic regimen was broadened with Piperacillin-Tazobactam. She was taken back to the operating room a third time for primary closure of the wound. Wound cultures grew methicillin- sensitive Staphylococcus Aureus resistant to clindamycin and she was discharged on Bactrim. Conclusion: Septic or suppurative tenosynovitis is the infection and inflammation of the closed synovial sheath of a tendon. These infections typically involve the tendons and tendon sheaths of the flexor muscles in the hand. The potential spaces of tendon sheaths create a walled-off environment ideal for pathogens to grow in isolation from host defenses. he pathogenesis of septic tenosynovitis typically involves trauma from a laceration, puncture or bite but other cases of disseminated hematogenous spread have been reported (Newman et al., 1989). Both medical and surgical management is recommended for the best possible outcome.
Computed Tomography Scan vs Saline Load Test in the Detection of Traumatic Arthrotomies of the Ankle: A Cadaveric Study
Authors: Gheewala Rohan A. , Lakra Akshay , Mori Benjamin Villacres , Carroll Jeremy D. , Mulligan Michael 
Published: November 2022

Category: Trauma Introduction/Purpose: The diagnosis of traumatic arthrotomy is typically made through a saline load test (SLT), though there has been a growing base of literature regarding the use of computed tomography (CT) scan in various joints for diagnosis. To date, there has been little data supporting the use of CT to diagnose traumatic arthrotomy of the ankle. Through simulated arthrotomies of the ankle in cadavers, we aim to assess the sensitivity and ability of CT for diagnosing traumatic arthrotomy. SLT were also performed in each specimen to determine the volume of saline needed for diagnosis. Methods: Six fresh-frozen cadavers with twelve ankles were initially included in this study. The presence of intra-articular air prior to arthrotomy was excluded with a baseline CT scan. Ankles underwent arthrotomy at the anterolateral, anteromedial, posteromedial, posterolateral portals with fluoroscopic guidance. A subsequent CT scan was obtained to identify the presence of intra-articular air. Ankles then underwent SLT and volumes resulting in extravasation were recorded. Results: Eleven ankles were included, with one exclusion due to the presence of implants. Arthrotomies were made in three ankles at the anterolateral portal, three at the anteromedial portal, two at the posteromedial portal, and three at the posterolateral portal. Following arthrotomy, intra-articular air was detected in all eleven ankles by CT scan. All eleven ankles were subjected to SLT, with each demonstrating extravasation through the arthrotomy site. The mean volume of saline needed for extravasation was 7.7 mL, with a range of 3 to 22 mL and a standard deviation of 5.4. Conclusion: CT scan was demonstrated to be sensitive and effective in diagnosing traumatic arthrotomy in a cadaveric model.
Does Sesamoid Pathology Adversely Impact Outcomes of Cheilectomy in the Treatment of Hallux Rigidus?
Authors: Gheewala Rohan A. , Bono Olivia J. , Rosenbaum Andrew J. 
Published: November 2022

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus (HR) is the most common degenerative pathology of the foot, marked by degenerative osteoarthritis of the first metatarsophalangeal joint (MTPJ) and reduced sagittal motion. Cheilectomy remains the standard of treatment, with satisfactory pain relief and increases in MTPJ range of motion (ROM). While the majority of these patients have satisfactory outcomes, a subset remains dissatisfied with persistent pain and poor ROM. In this study, we aim to assess the effect of sesamoid pathology on the functional outcomes of those undergoing cheilectomy for hallux rigidus. Methods: Electronic medical records were retrospectively reviewed to identify patients who underwent cheilectomy, with or without a corrective osteotomy (Moberg or Akin) for a diagnosis of HR, identified through CPT code 28289. The data referenced was from November 2019 through November 2021, belonging to three fellowship-trained foot and ankle specialists at a single high volume orthopedic practice. Exclusion criteria included revision procedures, loss of follow-up prior to one year, and prior sesamoidectomy. Our assessment included the presence of sesamoid arthritis or degeneration, demographic data, stage of HR according to the Coughlin and Shurnas classification on preoperative plain radiographs, a patient-reported pain scale, postoperative satisfaction, ROM, and return to activity. Patients were followed at 6 weeks, 3 months, 6 months, and 1 year. Complications were recorded. Statistical analysis was performed using Pearson's chi-square analysis and a two-sample t-test with significance set at alpha <0.05. Results: In this retrospective study, 74 patients who underwent cheilectomy for the treatment of hallux rigidus were examined; 1 with grade 0 HR, 7 with grade 1 HR, 51 with grade 2 HR, and 15 with grade 3 HR. There were 33 with radiographic evidence of sesamoid arthritis, 41 without. Those with sesamoid arthritis trended towards having less pain relief over the course of our study (p=0.290) and more restricted postoperative ROM (p=0.385), though neither reached significance. There was no difference in complication rates between the two groups (p=0.661). Conclusion: The presence of sesamoid pathology appears to trend towards worse outcomes after cheilectomy for the treatment of hallux rigidus. Patients with sesamoid pathology may go unrecognized and may warrant consideration for modalities of treatment beyond cheilectomy for hallux rigidus for more satisfactory outcomes. This study is limited in its power and would benefit from greater sample sizes and more objective parameters of measurement. Nonetheless, this data allows for recognition of these patients in whom cheilectomy does not result in pain relief with the goal of identifying factors to improve care and provide sufficient treatment.
A Prospective Evaluation of a 4th Generation Total Ankle Prosthesis with 2-Year Follow-Up
Authors: Gross Christopher E. , Strasser Nicholas L. , Vora Anand M. , Friscia David A. , Doty Jesse F. 
Published: November 2022

Category: Ankle Arthritis; Ankle Introduction/Purpose: The availability of fourth-generation ankle replacements has burgeoned over the past several years. These ankle replacements benefit from improved surgical technique, respect for bony preservation, and increased surgeon awareness of operative indications. Documentation of implant survivability and comparison studies of the latest generation implants are limited. The purpose of this study is report on prospectively collected patient reported outcome measures (PROMs) in a multi-institutional study of a fourth-generation total ankle. Methods: Patients presenting for a total ankle replacement at 9 institutions were prospectively enrolled and implanted in both academic and private settings. Each patient received an INFINITY ankle prothesis (Stryker, Memphis, TN, USA) Patients had demographics and PROMs recorded pre-operatively and at 6 month, 12 months, and 24- month intervals. The following PROMs were collected: Ankle Osteoarthritis Score (AOS), PROMIS Global Physical Health, Foot and Ankle Outcome Score (FAOS), and satisfaction scores. The preoperative and latest follow-up scores for patients with two years of follow-up were analyzed. Results: A total of 147 patients were enrolled :(54.7% male) average age of 64.2 +- 9.4 years old, average BMI of 31.0 +- 5.2. pre- operative diagnosis for arthritis type was degenerative arthritis (48.7%), rheumatoid arthritis (2.7), post-traumatic arthritis (47.9%), and other (0.70%). Thirty-seven percent of patients had previously undergone surgery at the index joint. Eighty-eight patients had at least two years of follow-up. There were 3 (1.3%) clinical failures:(2 with aseptic tibial component loosening: at months 17 and 21, and 1 tibial subsidence at month 14). The patients improved in all PROMs domains at two years including: Mean Total AOS (17.2 +- 18.3, p<.0001); PROMIS Global Physical Health (47.6 +- 7.4, p<.0001); Total FAOS (76.3 +- 18.7, p<.0001). 97.5% of patients were satisfied with their surgery. Conclusion: At two-year post-implantation follow-up, the INFINITY total ankle replacement had a low revision rate and proved to be safe and effective compared to historical ankle replacement outcomes. Patients were overwhelmingly satisfied and had statistically significant clinical improvements in each domain of their PROMs.
Do COFAS Scores Effect the Outcomes of a 4th Generation Total Ankle Prosthesis? A 2-Year Follow- Up
Authors: Gross Christopher E. , Strasser Nicholas L. , Friscia David A. , Vora Anand M. , Doty Jesse F. 
Published: November 2022

Category: Ankle Arthritis; Ankle Introduction/Purpose: Fourth generation ankle replacements benefit from improved surgical technique, respect for bony preservation, and increased surgeon awareness of operative indications. In order to better compare and stratify pre-operative ankle arthritis patients, the Canadian Orthopaedic Foot and Ankle (COFAS) pre-operative classification for end-stage ankle arthritis score was developed. The purpose of this study is report on how the COFAS scores effects prospectively collected patient reported outcome measures(PROMs) in a multi-institutional study of a fourth-generation total ankle replacement. Methods: Patients presenting for a total ankle replacement at 9 institutions were prospectively enrolled and implanted in both academic and private settings. Each patient received an INFINITY ankle prosthesis (Stryker, Memphis, TN, USA). Patients had their COFAS pre-operative classification for end-stage ankle arthritis scores, and PROMs recorded pre-operatively and at 6 months,12 months, and 24-month intervals. The following PROMs were collected: Ankle Osteoarthritis Score (AOS), PROMIS Global Physical Health, and Foot and Ankle Outcome Score (FAOS). The preoperative and latest follow-up scores for patients with two years of follow-up were analyzed. Results: A total of 147 patients were prospectively enrolled. for study participation. COFAS types; were delineated as Type 1 (42.6%, isolated ankle arthritis), Type 2 (27.0%, ankle arthritis with varus or valgus deformity, tight Achilles, ankle instability), Type 3(4.7%, ankle arthritis with hindfoot deformity, tibial malunion), and Type 4 (25.8%, Types 1-3, plus hindfoot arthritis). Eighty-eight (88) patients had at least 24 months of follow-up. COFAS Types 1, 2, 3, and 4 patients had significant improvements in all domains of the AOS, PROMIS, and FAOS Scores (p<0001). The type and severity of deformity or amount of hindfoot arthritis, hindfoot deformity, or ankle instability significantly effected the PROMs in those patients with at least 2-year follow-up. Implant revision rates were not affected by COFAS type, and there were three revisions (One Type 4 and two Type 2). Conclusion: At two-year follow-up, all study participants had significant improvements in PROMs, regardless of COFAS Type. These results suggest that COFAS type has little impact on patient outcomes using current generation total ankle replacements. Longer term follow-up may serve to further confirm these promising early results.
Effect of Insertion Trajectory on the Compressive Performance of Intramedullary Devices for Subtalar Arthrodesis
Authors: Gross Christopher E. , Beals Caitlyn , Dupont Kenneth , Safranski David L. 
Published: November 2022

Category: Hindfoot; Other Introduction/Purpose: Subtalar arthrodesis is a common procedure to treat hindfoot pathologies. Prior studies have evaluated the effect of screw trajectory on the initial compression of the subtalar joint. More recently, intramedullary (IM) devices using pseudoelastic NiTiNOL, developed for subtalar arthrodesis, can apply sustained dynamic compression (SDC). Headed screws' compression is achieved via the lag effect and is dependent upon its fixation in bone. The SDC device's compression is achieved by a manual mechanism; however, its fixation is dependent upon transverse screws. However, it is unknown how the trajectory of these devices in the subtalar joint alters compression. The aim of this study is to determine how the trajectory of both static compression screws and sustained dynamic compression devices affects joint compression. Methods: Based upon previously published methods, a synthetic talus and calcaneus were mechanically isolated in a custom fixture, and the compression measured via a load cell located in parallel to the subtalar construct. Static headed screws were inserted either in a parallel configuration across the posterior facet or in a diverging configuration across the posterior and anterior facets. A single IM SDC device was inserted across the posterior facet or the anterior facet and secured in the talus and calcaneus via transverse cortical screws. The resulting compression was measured in a thermal chamber at 37°C (n=8/group). Devices were inserted following the manufacturer's recommended instructions. Data was tested for normality using the Kolmogorov-Smirnov test. A one-way ANOVA was performed with a post-hoc Tukey test (α=0.05). All values are given as mean +- standard deviation. Results: The SDC device's compression was 398+-47N in the posterior facet and 417+-31N in the anterior facet (p=0.64). The screws' compression was 267+-31N in the parallel configuration and 269+-21N in the diverging configuration (p=0.99). The single SDC device, regardless of position, had significantly greater compression than the parallel or diverging headed screws configuration (p<0.01). Conclusion: The SDC device's compression is not affected by insertion trajectory, thus allowing for surgeon preference in anatomic placement. The SDC device is able to generate more compression than the headed screws, regardless of trajectory or screw configuration.