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Introduction/Purpose: The incidence of primary total ankle arthroplasty (TAA) in the treatment of end-stage ankle arthritis has increased substantially over the last decade. TAA may be performed alone or in conjunction with additional procedures including subtalar (ST) or triple arthrodesis as end-stage ankle arthritis is often associated with degenerative disease affecting neighboring joints. Prior literature has demonstrated that the ipsilateral hindfoot arthrodesis may increase the risk for revision after TAA and that simultaneous ST arthrodesis with TAA could result in significant short term clinical and radiologic improvements. However, there is limited research comparing staged versus simultaneous hindfoot arthrodesis with concomitant TAA. The purpose of this study is to compare the reoperation rates after TAA with simultaneous hindfoot arthrodesis versus staged hindfoot arthrodesis followed by TAA. Methods: Patients who underwent primary TAA from 2015-2022 were identified in the PearlDiver database using international classification of diseases (ICD) and current procedural (CPT) codes. Patients were only selected if they contained 1-year database follow-up after the index TAA. Patients were sorted into three cohorts: (1) primary TAA without any history of hindfoot arthrodesis (control), (2) those with staged hindfoot arthrodesis prior to TAA, and (3) those with hindfoot arthrodesis at the same time as TAA. Demographic characteristics including age, gender, and Charlson Comorbidity Index (CCI) were assessed for each cohort. The 1-year rate of reoperation and revision were the primary outcomes of this study. Univariate analysis using chi- square tests and student T-tests were performed to analyze any differences in patient demographics, comorbidities, and complications. Multivariate analysis using logistic regression was subsequently conducted to account for any confounding variables and covariates. Results: 9,912 patients underwent TAA without prior hindfoot arthrodesis, 297 patients underwent TAA with prior hindfoot arthrodesis and 174 with hindfoot arthrodesis concurrently with TAA. The incidences of reoperation (OR 3.52, 12.6% vs. 3.9%, P

Introduction/Purpose: Many patients use the internet as a source for medical information regarding their medical condition. However, the accuracy and reliability of the information is variable. The recent release of general population facing artificial intelligence (AI) chatbot programs has created a potential alternative medical information source for patients. Our study examined the accuracy of the information provided by ChatGPT for total ankle arthroplasty (TAA), as determined by four fellowship-trained foot and ankle orthopedic surgeons. Methods: GPT-4, the latest ChatGPT model, was asked the 12 of the most common questions patients have regarding TAA. Its responses were recorded and evaluated by four fellowship-trained foot and ankle orthopedic surgeons on a scale of 1 – 4, with 1 representing an excellent response not requiring clarification and 4 representing an unsatisfactory response requiring significant clarification. Averages of scores for each question were recorded and an average of every score was used to develop an overall accuracy score. Results: The overall accuracy score of GPT-4 was 1.35. The responses by GPT-4 received a score of 1 for 32 of 48 (66.7%) responses. There was found to be no significant difference in scores for any of GPT-4’s responses. Conclusion: Our study found that GPT-4 performed well in providing accurate and near complete information to commonly questions asked to physicians by patients regarding TAA. Our results suggest that AI models, like GPT-4, may be an effective alternative source of medical information for patients. Further study with subsequent AI models and direct patient interaction may shed further light on the utility of this potential patient education modality. ChatGPT Response Accuracy Score Accuracy scores for ChatGPT, as determined by four foot and ankle fellowship-trained orthopedic surgeons

Category: Midfoot/Forefoot Introduction/Purpose: Lisfranc fracture/dislocations comprise of spectrum of injury including simple disruption of the lisfranc articulation to more complex tarsometatarsal fracture/dislocations. A further known variant of lisfranc injuries involves proximal tarsal disruption, specifically through the articulation of the medial and middle cuneiform. In the absence of polytrauma and high energy injury it is unknown what proportion of patients with sport or primary axial loading injury have proximal medial column variants of the lisfranc fracture. Recognizing and stabilizing this disruption is critical to establishing a stable medial column and restoring appropriate biomechanics of the foot. Methods: After IRB approval a retrospective cohort of patients was established at a single instutition utilizing CPT codes consistent with fixation of lisfranc/tarsometatarsal fracture-dislocations. Surgical encounters over a 3 year period were identified and retrospective chart review of operative reports and independent evaluation of imaging was used to determine medial column/proximal variants within the included subset of patients. Low energy fracture mechanisms with adequate imaging and operative reports were included in the study. Results: A total of 52 low energy lisfranc fracture-dislocations were included in the study for evaluation of injury patter. Based on imaging studies, intra-operative findings and fixation modalities 30 medial column variants (58%) were identified in this cohort. This subset of patients showed instability through the medial ray extending proximal to the lisfranc articulation and requiring intercuneiform fixation. Conclusion: Tarsometatarsal fracture-dislocations represent a spectrum of injury from disruption of the lisfranc joint to multiple midfoot dislocations. A proximal variant of this injury pattern with intercuneiform disruption is often noted, but prevalence has not been established. In low energy tarsometatarsal fracture-dislocations this study notes a 58% prevalence of medial column disruption requiring additional proximal fixation. Recognizing this injury pattern and appropriately addressing the pathology is critical for obtaining a stable foot and favorable outcome.

Category: Bunion Introduction/Purpose: First metatarsophalangeal (MTP) joint arthrodesis is widely accepted as a treatment option for severe hallux valgus deformities. Although successful results of first MTP joint arthrodesis for hallux valgus have been reported in previous studies, the reported rates of fusion have been lower than for the general hallux rigidus population. The purpose of this study was to demonstrate the failure rate of first MTP joint arthrodesis for severe hallux valgus deformities and to evaluate radiographic correction of hallux valgus parameters after the surgery. Methods: From January 2014 to June 2017, 34 patients underwent first MTP joint arthrodesis surgery for severe hallux valgus deformity and were included in this retrospective study. Severe hallux valgus was defined as having a hallux valgus angle (HVA) of greater than 40 degrees and an intermetatarsal angle (IMA) greater than 15 degrees. For radiographic evaluation, the patients were evaluated by measuring the IMA and HVA in preoperative and postoperative weight-bearing AP foot x-rays. We defined failure after first MTP joint arthrodesis as non-union, incomplete union, or implant breakage or migration leading to a symptomatic recurrence of hallux valgus deformity. Results: The mean preoperative IMA and HVA were 16.7 ± 4.2 degrees (range 8.4 to 26.5) and 45.2 ± 8.6 degrees (range 28.7 to 71.1) respectively, and the postoperative IMA and HVA were 11.3 ± 3.8 degrees (range 4.1 to 20.4) and 20.9 ± 11.8 degrees (range 0.4 to 51.1) respectively. The postoperative IMA and HVA were significantly improved after surgery (< 0.001). Among the 34 patients in this study, a 14.7% failure rate was reported (n=5). For fusion procedures performed without lag screw fixation, there was a 12.6-fold increase in failure risk when we used the small dorsal locking plate compared with the medium dorsal locking plate (Odds ratio = 12.571). Conclusion: First MTP joint arthrodesis is an effective and reliable option for severe hallux valgus correction. However, for this challenging cohort, the 14.7% failure rate in this study is consistent with other studies in the literature. For severe hallux valgus deformities, selection of implant may play a more significant role. The use of longer plates to gain additional purchase in the diaphyseal bone, lag screw augmentation, and utilizing flat cuts instead of cup and cone reaming to realign the joint may help mitigate the increased stresses placed on the fixation constructs for MTP arthrodesis.

Category: Hindfoot Introduction/Purpose: Lateral column lengthening (LCL) is a common procedure for reconstruction of stage II flexible adult acquired flatfoot deformity (AAFD). The recent development of porous titanium wedges for this procedure provides an alternative to allograft and autograft. The purpose of this study was to report radiographic and clinical outcomes achieved with porous titanium wedges in LCL. Methods: A retrospective analysis of 34 feet in 30 patients with AAFD that received porous titanium wedges for LCL from January 2011 – October 2014. Deformity correction was assessed using both radiographic and clinical parameters. Radiographic correction was assessed using the lateral talo-first metatarsal angle, the talonavicular uncoverage percentage, and the first metatarsocuneiform height. The hindfoot valgus angle was also obtained. Results: Patients were followed from a minimum of six months up to 48 months (mean 16.1 months). Patients underwent concomitant procedures including medial displacement calcaneal osteotomy (94.1%), flexor digitorum longus transfer (70.6%), posterior tibial tendon tenolysis (64.7%), gastrocnemius recession (20.6%), and cotton osteotomy (4.9%). Postoperative radiographs demonstrated significant correction in all three radiographic criteria as well as the hindfoot valgus angle compared to their preoperative measurements. There were no cases of nonunion, no wedge migration, no infections, and no patients required removal of hardware. The most common complication was calcaneocuboid joint pain (14.7%). Conclusion: AAFD is a problem with various treatment modalities. Porous titanium wedges in LCL can achieve good radiographic and clinical correction of AAFD with a low rate of nonunion and other complications.