Foot & Ankle Orthopaedics最新文献

{"title":"Is Fibular Fixation Necessary with Increasing Proximity in Ankle Fractures: A Survey of OTA and AOFAS Surgeons","authors":"Zachary P. Herzwurm, Evan Loewy, Spencer Albertson","doi":"10.1177/2473011424s00078","DOIUrl":"https://doi.org/10.1177/2473011424s00078","url":null,"abstract":"Introduction/Purpose: Ankle fractures are one of the most common fractures encountered in orthopedics. The Maisonneuve fracture pattern is described as a pronation, external rotation injury involving the medial ankle structures, the syndesmosis, and the proximal third of the fibula. However, the actual distance from the proximal fibula has not been defined in what distinguishes a Maisonneuve fracture. With Weber C fractures, most surgeons tend to provide fixation to the fibula and reassess the syndesmosis afterwards. When dealing with the proximal fibula “Maisonneuve” fracture pattern, most surgeons would tend to ignore the fibula fracture and focus on syndesmotic reduction. Orthopaedic Trauma Association and American Orthopaedic Foot & Ankle Society provided their opinion via survey in treating increasing proximity of fibula fractures associated with unstable ankle fracture patterns. Methods: A survey was provided to eight OTA and AOFAS orthopedic surgeons. A powerpoint was provided to the surgeons that contained non-weightbearing injury films of eighteen patients. A questionnaire was provided giving two answer choices, address the fibular or syndesmosis primarily. The eighteen ankle fractures were selected based on increasing proximity of the fibula fracture, which ranged from 4.5cm to 32.3cm. The ankle fractures were grouped into four categories to include the Maisonneuve variant based on distance. These fracture radiographs were randomized in order to not influence the surgeon’s opinion during the study. The four groups were as follows: 1. 4.5cm – 7.4cm to include six ankle fracture radiographs 2. 8cm – 10.4cm to include four ankle fracture radiographs 3. 14.6cm to 23.3cm to include five ankle fracture radiographs 4. 30.7cm to 32.3 cm to include three Maisonneuve variant ankle fracture radiographs Results: Regarding section 1, the majority of surgeons responded with open reduction, internal fixation of the fibula as their initial reduction. Section 2, the responses remained consistent with a majority of surgeons choosing to address fibular fixation followed by syndesmotic evaluation. The total number of responses in this section scored 43 answer A selections to 5 answer B selections. Section 3 (14.6-23.3cm) provided the most variability in the responses provided. With 60 possible answer choices, the polled surgeons responded with answer choice A seventeen times and answer choice B 43 times. Section 4 (30.7-32.2cm) or the Maisonneuve produced a steady response of answer choice B. Syndesmotic reduction was performed 34 times compared to only two fibular fixation choices – or answer choice A. Conclusion: The purpose of this study was to evaluate expert opinion on differing treatment as the proximity of the fibular fracture increased in connection with an unstable ankle fracture pattern. General consensus under 10,4cm was to address fibular fixation. However, once the fibular fracture exceeded 14cm, significant variability was noted. These result","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"134 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140765131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"I Can’t Exercise Because My Foot Hurts Me Too Much.\" Does BMI Change after Common Foot and Ankle Surgeries? A Retrospective Review","authors":"Samantha N. Weiss, Margaret Higgins, Jonathan McKeeman, James R. Lachman","doi":"10.1177/2473011424s00072","DOIUrl":"https://doi.org/10.1177/2473011424s00072","url":null,"abstract":"Introduction/Purpose: The World Health Organization reports that 1.9 billion people worldwide have a body mass index (BMI) that classifies them as being either overweight (BMI > 25) or obese (BMI > 30). Patients often claim, prior to orthopaedic surgery, that their physical activity and exercise is negatively impacted by their orthopaedic condition. Hip and Knee arthroplasty literature has established that patients with high preoperative BMI continue to have high BMI post-operatively, despite also reporting improvements in their joint pain. No such studies exist in foot and ankle surgery. The purpose of this study was to analyze changes in BMI after many common foot and ankle surgeries. Methods: A retrospective review of all patients undergoing bunion correction, flatfoot correction, 1st MTP arthrodesis, and midfoot arthrodesis procedures between November 2018 and December 2022 was conducted in this IRB approved, single center study. BMI data was collected from the electronic medical record for preoperative and 12 months postoperative time points. Descriptive statistics were reported for age, gender, diabetes, A1c for diabetic patients, smoking status, and overall follow up time. Repeated measures of analysis of variation were conducted with one between-groups factor being type of surgery. Results: 196 patients were included in the study. The average age was 62.1 years, 151(76.6%) patients were female. Average BMI amongst all patients preoperatively was 29.58 +/- 5.21, and postoperatively 29.79 +/- 5.33, with an overall average increase in BMI of 0.2182 +/- 2.21. Upon subgroup analysis, all surgical cohorts yielded an increase in postoperative BMI (bunion +0.2489 +/- 2.06, double arthrodesis +0.4767 +/- 1.37, 1st MTP fusion +0.2293 +/- 2.07, midfoot arthrodesis +0.0251 +/- 3.10) although these changes did not reach significance (p value 0.425). There was no significant difference observed in changes in BMI between surgical groups (p value 0.958). BMI outcomes were normally distributed with acceptable equality of error variances (Levene’s test p- values > 0.270). Conclusion: The current statistics surrounding the prevalence of overweight and obesity are staggering. The results of this study demonstrate that elective orthopaedic surgery of common foot and ankle procedures do not facilitate a change in BMI one year postoperatively, despite the goal of reducing chronic pain and increasing physical function, which is often cited as the primary restriction to exercise amongst patient populations. Additional studies are warranted to further elucidate changes in BMI to adequately council patients regarding postoperative expectations. Study Data Summary","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"195 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140776092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total Ankle Replacement with Built-in Antibiotic Spacer: A Paradigm Shift in the Management of Infected Ankles","authors":"T. Lalli, Abigail Smith, Reyanne Strong, Nathaniel Koutlas, James O. Sanders","doi":"10.1177/2473011424s00096","DOIUrl":"https://doi.org/10.1177/2473011424s00096","url":null,"abstract":"Introduction/Purpose: Infection of an ankle fracture is a devastating complication that can lead to chronic pain, limited motion or amputation. Traditional treatment strategies after infection involve aggressive surgical debridement, implant removal and prolonged antibiotic therapy. Non-anatomic cement spacers for the tibiotalar joint have previously been described with mixed results. Articulating spacers have shown improved outcomes and may be used as definitive treatment. Currently, there are no prefabricated TAR spacers on the market. The use of 3D printing to create custom implants is emerging, however, there is a paucity of literature regarding their use. We present a case of post-infectious ankle arthritis in 14 year old patient treated with a 3D printed total ankle replacement with built in antibiotic spacer (TAR-AS). Methods: A CT scan was performed in accordance with computer aided design (CAD) parameters. Bilateral lower extremities were scanned to allow the unaffected side to be mirrored and be the basis for implant design. Slice spacing less than 1.25mm with pixel size of 0.5mm. The studies were in DICOM files and within a timeframe where no significant change in patient anatomy had occurred. The implants were fabricated by selective laser melting (SLM) of cobalt chrome alloy (CoCrMo) by Restor3d (Durham, NC). Our design incorporated a stacked gyroid component to facilitate antibiotic cement impregnation. In terms of surgical technique, the custom TAR-AS followed a similar approach to a patient specific TAR procedure. Prior to implantation, the gyroid component of the TAR-AS was filled with Simplex bone cement with tobramycin (Stryker). Results: At six months postoperatively, our patient reported no limitation in activities. AOFAS scores improved from 46/100 preoperatively to 83/100 at six months postoperatively. Radiographic parameters showed no signs of implant failure, loosening or change in alignment. Intraoperative cultures remained negative. Conclusion: We present a case demonstrating the utilization of 3D generated prostheses for treatment of post-infection ankle arthritis. The TAR-AS represents a significant advancement in the management of ankle infections. This innovative approach combines the benefits of joint replacement and continued antibiotic elution. With further research and continued technological advancements, the TAR-AS has the potential to become the gold standard for the treatment of infected TAR. Despite the promising results, challenges remain in the implementation of TAR-AS. Long term follow up studies are needed to evaluate the durability and longevity of the implant. Total ankle with built in antibiotic spacer Superior view of tibial tray with antibiotic cement packed in gyroid","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"72 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140770229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of the Most Popular Online Ankle Fracture–Related Patient Education Materials","authors":"Haad Arif, Gavin LeBrun, Simon T. Moore, David A. Friscia","doi":"10.1177/24730114241241310","DOIUrl":"https://doi.org/10.1177/24730114241241310","url":null,"abstract":"Background: Given the increasing accessibility of Internet access, it is critical to ensure that the informational material available online for patient education is both accurate and readable to promote a greater degree of health literacy. This study sought to investigate the quality and readability of the most popular online resources for ankle fractures. Methods: After conducting a Google search using 6 terms related to ankle fractures, we collected the first 20 nonsponsored results for each term. Readability was evaluated using the Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), and Gunning Fog Index (GFI) instruments. Quality was evaluated using custom created Ankle Fracture Index (AFI). Results: A total of 46 of 120 articles met the inclusion criteria. The mean FKGL, FRE, and GFI scores were 8.4 ± 0.5, 57.5 ± 3.2, and 10.5 ± 0.5, respectively. The average AFI score was 15.4 ± 1.4, corresponding to an “acceptable” quality rating. Almost 70% of articles (n = 32) were written at or below the recommended eighth-grade reading level. Most articles discussed the need for imaging in diagnosis and treatment planning while neglecting to discuss the risks of surgery or potential future operations. Conclusion: We found that online patient-facing materials on ankle fractures demonstrated an eighth-grade average reading grade level and an acceptable quality on content analysis. Further work should surround increasing information regarding risk factors, complications for surgery, and long-term recovery while ensuring that readability levels remain below at least the eighth-grade level.","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"225 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140772039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congruency of the TN Joint and Subtalar Joint Middle Facet Under With and Without Weightbearing: A Preliminary Report","authors":"Stephen Wittels, Mingjie Zhu, M. Myerson, Shuyuan Li","doi":"10.1177/2473011424s00056","DOIUrl":"https://doi.org/10.1177/2473011424s00056","url":null,"abstract":"Introduction/Purpose: Peritalar subluxation is a key feature of both flatfoot and cavovarus deformities. Our preliminary studies have found that on WBCT there is 20% subluxation of the middle facet of the subtalar joint in normal controls, and >35% in patients with flexible flatfoot deformities; In the spherical talonavicular joint there is physiological uncovering of the talar head regardless of whether the joint is bearing weight or not, since the articular area of the talar head is 1.2 times of the navicular. We hypothesize that there may be a tendency to overestimate the pathological peritalar subluxation on both XR and WBCT. This study aimed to investigate the congruency of each peritalar joint using a weightbearing 3D CT scan remodeling technique. Methods: Five below-knee-amputated fresh frozen cadaveric feet were used (no history of surgery, trauma, arthritis, and deformities). Each specimen was CT scanned using both non-weightbearing and weightbearing protocols. Segmentation on Materialise Mimics software was used to remodel each peritalar bone three dimensionally. Congruency of the restored talonavicular joint and subtalar middle facet was evaluated in the GeoMagic. The total articular surface area for each bone was reconstructed, calculated and recorded. The articulation of each joint with or without weightbearing was restored for analyzing joint uncoverage. Paired t-test (P value ≤0.05) was used to compare the coverage % differences. Results: In the anterior and middle facets of the subtalar joint, There was 16.40% uncoverage of the calcaneus under non- weightbearing, and 30.68% of uncoverage under weightbearing; 17.94% uncoverage of the talus under non-weightbearing, and 24.89% of uncoverage under weightbearing. In the posterior facet of the subtalar joint, the total articular surface on the talus side (683.96±112.07 mm2) was 1.13 times larger than the calcaneus side (606.78±107.23 mm2). In the talonavicular joint, the total articular surface on the talus side (714.18±124.97 mm2) was 1.28 times larger than the navicular side (556.76±97.65 mm2). Conclusion: Our preliminary study in this group of normal cadaver feet has found that in both the talonavicular and middle facet of the subtalar joints, there is physiological uncovering or subluxation regardless of whether the joint is bearing weight or not. Further investigation with a larger sample size is in process.","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"85 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140790484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Complication Rates and Surgical Costs for Total Ankle Replacements Performed in the Outpatient vs Inpatient Setting","authors":"Devon Nixon, Hyunkyu Ko, Brook Martin","doi":"10.1177/2473011424S00054","DOIUrl":"https://doi.org/10.1177/2473011424S00054","url":null,"abstract":"Introduction/Purpose: Increasing data has highlighted the safety and cost-effectiveness of outpatient hip, knee, and shoulder arthroplasty. However, limited evidence – mainly small, single institution case series – has explored complication rates and costs between outpatient and inpatient total ankle arthroplasty (TAA) surgeries. Methods: Utilizing Medicare claims from 2016 to 2019, we retrospectively identified patients ≥65 years of age who underwent TAA based on CPT coding. Patients on Medicare HMO, under age 65, and dual-eligible patients were excluded. Within this dataset, we compared surgeries performed in the outpatient versus inpatient setting. We compared groups based on readmission, all-complication, and infection rates within 1-year of TAA using logistic regressions controlling for age, sex, race, and comorbidity. To help mitigate bias, we also performed a propensity matched model with the same variables. Data were reported as percentage point (PPT) differences (95% CI) between groups, with a positive number indicating higher complication rates and costs among patients treated in the inpatient setting. Results: In total, 8,281 total ankle arthroplasty cases were identified (outpatient: 5,524 and inpatient: 2,757. Compared to inpatient cases, outpatient TAA surgeries were performed on younger, healthier (as assessed by Charlson Comorbidity Index (CCI) scores) patients who were more likely to be female (p < 0.001). In logistic regression analyses, outpatient TAA cases had lower readmission, all-complication, infection, mortality, and device-associated complication rates (p < 0.001) as compared to inpatient surgeries. Further, outpatient surgeries had sizable cost reductions compared to inpatient surgeries (p < 0.001). Conclusion: TAA performed in the outpatient setting appears to have less complications and decreased cost compared to inpatient procedures – though inpatient surgeries were presumably riskier as they were performed on older patients with increased co-morbidities. When clinically appropriate, though, TAA as an outpatient procedure appears to provide substantial reductions in cost with notable reductions in surgical risk.","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"180 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140783456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Fallacy of the “Learning Curve”","authors":"John T. Campbell, George B. Holmes, Christopher P. Chiodo, T. Clanton, Ellie Pinsker, Stefan Rammelt, Robert A. Vander Griend, Charles L. Saltzman","doi":"10.1177/24730114241247250","DOIUrl":"https://doi.org/10.1177/24730114241247250","url":null,"abstract":"","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"312 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140757675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DARI Evaluation Syndesmosis","authors":"Victor Anciano, Campbell Edwards, Elive F. Likine, Ernest Rimer, Jonathan Holland, Brett Hayes","doi":"10.1177/2473011424S00057","DOIUrl":"https://doi.org/10.1177/2473011424S00057","url":null,"abstract":"Introduction/Purpose: Return to play (RTP) assessment and decision-making protocols are among the most discussed topics in sports medicine. Given the lack of validated guidelines, physicians and rehabilitation practitioners often rely on subjective functional evaluation to guide decisions to RTP. Biomechanical assessment using motion capture may be a useful strategy to evaluate an athlete’s post-injury functional status, and to estimate their ability to RTP with reduced risk of re-injury. The purpose of this case-study was to determine the efficacy of using marker-less 3D motion capture to provide an objective functional evaluation to tailor rehabilitation and aid RTP status for a patient who underwent syndesmotic fixation. Methods: In this case-study, a National Collegiate Athletic Association Division I collegiate football offensive lineman (Height: 1.96 m, Weight: 141 kg) performed a movement screen 5 weeks after left ankle syndesmotic fixation for purely ligamentous syndesmotic injury. Testing was performed at the anticipated time of RTP. After a standardized warm-up, the patient performed a series of 14 movements consisting of upper and lower extremity actions in all three planes of motion, including bilateral and unilateral lower extremity actions. Kinematic data was captured using an 8-camera marker-less motion capture system (MLMCS). Left and right joint-specific ranges of motion were compared for symmetry and to normative data produced by the MLMCS manufacturer. Results: The participant successfully performed all 14 movements without limitation. Ankle flexion was symmetrical during bilateral and unilateral squatting actions. However, left ankle (i.e., involved side) flexion was consistently less than right ankle flexion during more dynamic actions (Table 1). Despite the asymmetries, ankle range of motion was within normal ranges for both sides in all movements. From a performance standpoint, left-side jump heights were consistently less than the right-side efforts during the unilateral countermovement jump (left: 34.5 cm versus right: 41.1 cm; -16.0%) and consecutive hops (left: 29.5 cm versus right: 33.0 cm; -10.8%). Results were shared with the athletic trainer to focus rehabilitation efforts. The patient was able to fully RTP at 6 weeks. Conclusion: In this case-study, the patient successfully performed a movement screen without limitation at the time of RTP after left ankle syndesmotic fixation. A MLMCS detected kinematic differences that would be difficult to qualitatively recognize. Specifically, the patient expressed reduced ankle flexion and jumping performance on the operative side. No baseline screening was performed, but the observed asymmetries were consistent with what would be expected from the specific injury. Further research is needed to compare baseline measures to kinematic changes. These findings suggest that a basic movement screen using MLMCS can detect kinematic asymmetries after syndesmotic fixation. Table 1. Kine","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"65 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140757112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior Talo-Fibular Ligament Tensile Properties Compared to Suture Tape, Allograft, and Copolymer Augmentation Elements: An Isolated Biomechanical Study","authors":"S. J. Ingwer, Ryan Rigby, Andrew Rosenbaum, Oliver Hauck, Anthony N Khoury, D. Pedowitz","doi":"10.1177/2473011424s00047","DOIUrl":"https://doi.org/10.1177/2473011424s00047","url":null,"abstract":"Introduction/Purpose: The modified Brostrom-Gould (MB) technique incorporates the inferior extensor retinaculum for added strength of anatomic Anterior Talo-Fibular Ligament (ATFL) repair. A major limitation of the MB technique is the inability to restore native ATFL biomechanics. Surgical augmentation methods have been introduced to address the MB insufficiency. The purpose of this study is to investigate the isolated biomechanical performance of common MB augmentation elements including suture tape, allograft, and copolymer compared to that of native ATFL. Methods: A total of 24 samples were tested in this study, n=6 in each group. An electromechanical testing system (Instron, Norwood, MA) was used to investigate the biomechanical performance of native ATFL, UHMW-PE suture tape (FiberTape™, Arthrex, Inc., Naples, FL), allograft (Semitendinosus Graft), and copolymer (FlexBand™, Artelon, Marietta, GA). Native ATFL ligaments were isolated from cadaver specimens (mean age: 63 years; range: 45-80), semitendinosus allografts were obtained from LifeNet Health (Jacksonville, FL). Samples measured 20 mm between rigid fixtures and oriented parallel with the long axis of the load cell to simulate worse-case loading. Samples were loaded to failure at 305 mm/min. Biomechanical outcomes included elongation, stiffness, and ultimate load to failure. One-way ANOVA was used to evaluate significant effects of all biomechanical variables. If significance was observed, post-hoc comparisons of augment element and native ATFL were performed with either Tukey or Holm-Sidak test (SigmaPlot,14.0, Systat). Results: Stiffness was greatest for the suture tape group (246.4±52.1N/mm) and least for the copolymer (9.4±2.9N/mm). Significant differences were observed between all augment elements except when comparing ATFL to allograft (p=0.086). Ultimate load was greatest for the suture tape group (544.1±59.7N) and least for the copolymer (146.7±8.9N). Analysis revealed that suture tape ultimate load was statistically greater than copolymer (p < 0.001, Fig.1). Elongation at ultimate failure was greatest for the copolymer group (30.0±8.7mm) and least for suture tape (2.6±0.5mm). Significant interactions were detected for all ultimate load comparisons except for allograft and ATFL (p=0.691), allograft and suture tape (p=0.537), and ATFL and suture tape (p=0.436). See Figure 1 for all data and statistical outcomes. Conclusion: ATFL augmentation elements require thorough evaluation for clinical adoption. Copolymer was 79% weaker in ultimate load and elongated 131% more than the native ATFL. Conversely, suture tape group exhibited 47% greater ultimate load and 82% less elongation at failure compared to ATFL. Clinically, these results suggest the copolymer maintains elastic properties incapable of supporting ATFL ligament healing under load. ATFL augmentation with suture tape offers advantageous post- operative load-sharing support and may allow return to preinjury level activity soon","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"158 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140760068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucose Lability and Complications in Diabetic Ankle Fractures","authors":"Ryan LeDuc, Michelle Shimizu, P. C. McGregor, Carlo Eikani, Kamran Hamid, Michael S Pinzur, Adam P Schiff","doi":"10.1177/2473011424s00070","DOIUrl":"https://doi.org/10.1177/2473011424s00070","url":null,"abstract":"Introduction/Purpose: Rotational ankle fractures in diabetics have long posed difficult clinical challenges, with several observational studies noting increased risk of complications and amputation following treatment of unstable ankle fractures in diabetics. Several treatment options exist, including non-operative management, external fixation, open reduction internal fixation, staged fixation, and fusion. Hemoglobin A1C produces a mean blood glucose level over a three-month period. There is mounting evidence that glucose variability may be an alternative predictor of complication profile in non-orthopedic procedures, as well as in the total joint arthroplasty literature. The purpose of this investigation is to retrospectively analyze complication rates for diabetics with rotational ankle fractures at a single institution and assess their association with both the hemoglobin A1C and glucose variability. Methods: After obtaining Institutional Review Board approval, all patients from 2015-2022 with a diagnosis of diabetes and ankle fracture were retrospectively identified based on ICD-9/ICD-10 codes. These charts were manually reviewed to determine fracture classification and treatment. For operatively and non-operatively managed ankle fractures, the patient’s hemoglobin A1C was recorded when available within 3 months of the date of injury. Glucose variability was calculated using a coefficient of variation. Results: Two-hundred patients were included for analysis, of which 29% (n=58) were treated non-operatively. The majority of surgically treated patients underwent acute ORIF (58%, n=116). 8.5% were treated with staged fixation, 3.5% with acute hindfoot fusion, and 1% with external fixation alone. The overall complication rate was 27.5% (n=55). There were no statistically significant differences in both A1C (7.81 +/- 1.89 vs 7.73 +/- 1.96) and glucose variability, as measured by the covariance of variation (0.23 +/- 0.15 vs 0.20 +/- 0.13) in patients who did and did not experience postoperative complications. Higher glucose variability did trend towards predicting complications, though not in a statistically significant fashion (OR=1.57, p=0.35). Conclusion: Ankle fractures in patients with diabetes pose a challenge for orthopedic surgeons, as evidenced by the high medical and surgical complication rate observed in this study and others. No statistical significance was found between higher A1C and complication rate or between glucose variability and complication rate. Further investigation on the impact of glucose variability on complication rates in a larger cohort of this patient population is warranted. Univariable logistic Regression Results for the association of the odds of post-operative complication with patient characteristics.","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"53 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140764910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}