Factors Associated With Symptom Recurrence After Surgical Treatment of Interdigital Neuroma: A Retrospective Chart Review of 127 Patients.

INTRODUCTION: Interdigital neuroma (IN) is a benign enlargement of tissue surrounding the common plantar digital nerve. Although the standard surgical treatment of IN remains debated, recent attention has been given to less-invasive surgical decompression by intermetatarsal ligament (IML) release with neurolysis. This study aimed to compare the outcomes of IML release with neurolysis with standard interdigital neurectomy. METHODS: A retrospective chart review was conducted on 350 consecutive patients who underwent surgical treatment of IN. Patients who satisfied our inclusion and exclusion criteria were categorized into two groups based on the surgical treatment received: IML release with neurolysis or interdigital neurectomy. Outcomes assessed included recurrence of symptoms, rate of revision surgery, and postoperative wound infection. RESULTS: Of the total sample, 40 patients (31.5%) reported recurrence of symptoms within a 12-month follow-up period. Patients who underwent IML release with neurolysis had a markedly higher recurrence rate (47.50%) than those who underwent interdigital neurectomy (24.14%). The rate of postoperative wound infection was similar between the two groups. Binary logistic regression revealed that only the surgical technique was associated with the recurrence of symptoms. Despite the higher rate of symptom recurrence in the IML release with neurolysis patient group, the rate of revision surgery in those with symptom recurrence was similar between both groups. DISCUSSION: IML release with neurolysis seems to have a higher risk of symptom recurrence than interdigital neurectomy. No patient-specific factors were identified as being associated with symptom recurrence. However, patients who did experience symptom recurrence in either surgical group had similar rates of revision surgery, which may be due to mild recurrent symptom severity in the IML release group that does not warrant revision surgery in these patients. Future studies should consider objective symptom recurrence severity and patient satisfaction. LEVEL OF EVIDENCE: Level III.

Increases in trade secret designations in hydraulic fracturing fluids and their potential implications for environmental health and water quality.

Hydraulic fracturing is an increasingly common method of oil and gas extraction across the United States. Many of the chemicals used in hydraulic fracturing processes have been proven detrimental to human and environmental health. While disclosure frameworks have advanced significantly in the last 20 years, the practice of withholding chemical identities as "trade secrets" or "proprietary claims" continues to represent a major absence in the data available on hydraulic fracturing. Here, we analyze rates of trade secret claims using FracFocus, a nationwide database of hydraulic fracturing data, from January 1, 2014 to December 31, 2022. We use the open-source tool Open-FF, which collates FracFocus data, makes it accessible for systematic analysis, and performs several quality-control measures. We found that the use by mass of chemicals designated as trade secrets has increased over the study time period, from 728 million pounds in 2014 to 2.96 billion pounds in 2022 (or a 43.7% average yearly increase). A total of 10.4 billion pounds of chemicals were withheld as trade secrets in this time period. The water volume used (and therefore total mass of fracturing fluid) per fracturing job has shown a large increase from 2014 to 2022, which partly explains the increase in mass of chemicals withheld as trade secrets over this time period, even as total fracturing jobs and individual counts of proprietary records have decreased. Our analysis also shows increasing rates of claiming proppants (which can include small grains of sand, ceramic, or other mineral substances used to prop open fractures) as proprietary. However, the mean and median masses of non-proppant constituents designated as trade secrets have also increased over the study period. We also find that the total proportion of all disclosures including proprietary designations has increased by 1.1% per year, from 79.3% in 2014 to 87.5% in 2022. In addition, most disclosures designate more than one chemical record as proprietary: trade secret withholding is most likely to apply to 10-25% of all records in an individual disclosure. We also show the top ten reported purposes that most commonly include proprietary designations, after removing vague or multiple entries, the first three of which are corrosion inhibitors, friction reducers, and surfactants. Finally, we report the top ten operators and suppliers using and supplying proprietary chemicals, ranked by mass used or supplied, over our study period. These results suggest the importance of revisiting the role of proprietary designations within state and federal disclosure mechanisms.