bluuebunny/crossref_metadata_2025 huggingface dataset:
Likelihood of Craniofacial Injury and Hospitalization with Alcohol Use While Skateboarding and Scootering
Authors: Sorenson Thomas J. , Rich Matthew D. , Deitermann Annika , Gotlieb Rachael , Garcia Nicholas , Barta Ruth J. , Schubert Warren
Published: January 2022

Study Design: We designed a cross-sectional epidemiologic study to evaluate the influence of substance use on craniofacial injuries in a population of skateboard and scooter users.

Objective: The primary outcome of our study was craniofacial injury. The secondary outcome was hospitalization.

Methods: We report a cross-sectional study of patients reported to the National Electronic Injury Surveillance System (NEISS) from January 1, 2019, to December 31, 2020, in the United States. Patients were included in our study if they were evaluated in the emergency department (ED) for a skateboard- or scooter-related injury.

Results: There were over 5396 total patients who presented to a NEISS-participating ED after skateboard- or scooter- related trauma during the study period. There were 1136 patients with a craniofacial injury (primary endpoint), and patients under the influence of alcohol or drugs had greater odds of experiencing a craniofacial injury than those not under the influence (odds ratio [OR]: 4.16, 95% confidence interval [CI]: 3.24-5.32, P < .0001). Four hundred-thirty patients were hospitalized (secondary endpoint), and patients under the influence had greater odds of being hospitalized than those not under the influence (OR: 2.83, 95% CI: 2.04-3.91, P < .0001).

Conclusions: Alcohol and drug use while skateboarding or scootering drastically increases the likelihood of craniofacial injury and subsequent hospitalization and should be avoided whenever possible. The importance of wearing a helmet while operating these devices cannot be overstated.
Skin Testing Is Useful in Assessing Aeroallergen Sensitization in IgE Deficient Patients with Environmental Allergy-Like Symptoms
Authors: Cohen Barrie , Oprea Yasmine , Rosenstreich David , Ferastraoaru Denisa
Published: January 2022

Background

The value of aeroallergen skin testing is not known in IgE deficient individuals (IgE<2.5 kU/L).

Objective

To investigate the utility of skin prick (SPT), intradermal skin testing (IDST) and measuring serum specific IgE (ssIgE) in IgE deficient patients presenting with environmental allergy-like symptoms.

Methods

Individuals with IgE deficiency who had both SPT and IDST performed between 2010 to 2020 were matched (age and gender) to three different groups of non-IgE deficient patients with IgE≥2.5 kU/L (normal IgE [2.5 ≤ IgE<100], high IgE [100≤IgE<1000] and very high IgE levels [≥1000 kU/L]) who also had skin testing performed for evaluation of environmental allergy-like symptoms.

Results

Among 34 IgE deficient patients who completed SPT and IDST, 52.9% (18/34) had at least one positive skin test (4 ± 3 positive tests/patient), compared with 91.2% in those with normal, 94.1% with high or 97.1% with very high IgE levels (p < 0.01). In contrast, only one of the IgE deficient patients had detectable ssIgE, while ssIgE levels were significantly higher in all other IgE subgroups. Allergic immunotherapy was prescribed for 22.2% of the IgE-deficient patients with positive skin tests, similar to those with normal (2/31, 6.5%, p = 0.21), high IgE (9/32, 28.1%, p = 0.25) and very high IgE levels (8/33, 23.5%, p = 0.07), with similar efficacy in their symptoms control.

Conclusion

Individuals with IgE deficiency may present with environmental allergy-like symptoms. A combination of SPT and IDST is useful for diagnosing aeroallergen sensitizations in these patients, indicating the presence of skin mast cell-bound IgE in some of these individuals, despite very low serum IgE levels. Further studies are needed to assess the exact significance of positive skin tests and the benefits of immunotherapy in this group.
Histoplasmosis in African children: clinical features, diagnosis and treatment
Authors: Ekeng Bassey Ewa , Edem Kevin , Akintan Patricia , Oladele Rita O.
Published: January 2022

Most of the reviews on histoplasmosis documented in literature have been in the adult population. Very few studies highlight the peculiarities associated with histoplasmosis in Africa especially in the pediatric population. This review addresses the above concerns with clinical summaries and diagnosis of some case reports of histoplasmosis in African children. We highlighted 44 case reports of histoplasmosis in African children (1950–2021) distributed across Western Africa (38.6%, n = 17), Eastern Africa (9.1%, n = 4), Southern Africa (9.1%, n = 4), and Central Africa (43.2%, n = 19). No case report was found from Northern Africa. The age range was 1–17 years, with a mean of 9.2. Of the 44 case reports, 8 cases (18.2%, 8/44) were caused by Histoplasma capsulatum var capsulatum, 33 cases (75%, 33/44) were caused by Histoplasma capsulatum var duboisii, and specie identification was not found in 3 cases. Only three (6.8%) cases were HIV positive; 56.8% (25/44) were disseminated histoplasmosis, pulmonary histoplasmosis accounted for just one case (2.3%, 1/44). Extrapulmonary presentation included skin lesions (ulcers, fistulas, nodules, patches, pigmentations, papules, and abscesses), bone lesions, osteoarthritis, and fractures. The commonest sites affected were skin ( n = 29, 65.9%), bones ( n = 20, 45.5%), and lymph nodes ( n = 15, 34.1%). Histopathology was the commonest diagnostic method ( n = 33, 75%). Amphotericin B was first-line therapy in 45.5% of the cases ( n = 20) followed by ketoconazole (20.5%, n = 9); 27 cases (61.4%) had favorable outcomes, 8 cases (18.2%) had fatal outcomes, while in 9 cases, the outcome was not revealed. This review revealed several cases of histoplasmosis misdiagnosed as other conditions including tuberculosis ( n = 3, 6.8%), pneumonia ( n = 1, 2.3%), cancers ( n = 4, 9.1%), nephritic syndrome ( n = 1, 2.3%), leishmaniasis ( n = 1, 2.3%), and hyperreactive malarial splenomegaly syndrome ( n = 1, 2.3%). In addition, histoplasmosis was not considered in some case reports even when symptoms were suggestive. Diagnosis of histoplasmosis was made at autopsy with postmortem findings suggestive of histoplasmosis ( n = 3, 6.8%). This report highlights the need for a paradigm shift on the part of pediatricians in Africa. They need to look beyond clinical conditions considered common in our environment for this age group and evaluate for other diseases including histoplasmosis.
Married women’s decision-making autonomy on contraceptive use and its associated factors in Ethiopia: A multilevel analysis of 2016 demographic and health survey
Authors: Mare Kusse Urmale , Aychiluhm Setognal Birara , Tadesse Abay Woday , Abdu Mohammed
Published: January 2022

Introduction:

Women’s decision-making autonomy has a positive effect on the scale-up of contraceptive use. In Ethiopia, evidence regarding women’s decision-making autonomy on contraceptive use and associated factors is limited and inconclusive. Therefore, this study was intended to assess married women’s decision-making autonomy on contraceptive use and associated factors in Ethiopia using a multilevel logistic regression model.

Methods:

The study used data from the 2016 Ethiopia Demographic and Health Survey that comprised of a weighted sample of 3668 married reproductive age women (15–49 years) currently using contraceptives. A multilevel logistic regression model was fitted to identify factors affecting married women’s decision-making autonomy on contraceptive use. Akaike’s information criterion was used to select the best-fitted model.

Results:

Overall, 21.6% (95% confidence interval = 20.3%–22.9%) of women had decision-making autonomy on contraceptive use. Community exposure to family planning messages (adjusted odds ratio = 2.22, 95% confidence interval = 1.67–3.05), media exposure (adjusted odds ratio = 2.13, 95% confidence interval = 1.52–3.23), age from 35 to 49 years (adjusted odds ratio = 2.09, 95% confidence interval = 1.36–4.69), living in the richer households (adjusted odds ratio = 1.67, 95% confidence interval = 1.32–3.11), and visiting health facility (adjusted odds ratio = 2.01, 95% confidence interval = 1.34–3.87) were positively associated with women’s decision-making autonomy on contraceptive use. On the contrary, being Muslim (adjusted odds ratio = 0.53, 95% confidence interval = 0.29–0.95), being married before the age of 18 years (adjusted odds ratio = 0.33, 95% confidence interval = 0.12–0.92), and residing in rural residence (adjusted odds ratio = 0.48, 95% confidence interval = 0.23–0.87) were negatively associated with women’s independent decision on contraceptive use.

Conclusion:

Less than one-fourth of married reproductive age women in Ethiopia had the decision-making autonomy on contraceptive use. Media exposure, women’s age, household wealth, religion, age at marriage, visiting health facilities, community exposure to family planning messages, and residence were the factors associated with women’s decision-making autonomy on contraceptive use. The government should promote women’s autonomy on contraceptive use as an essential component of sexual and reproductive health rights through mass media, with particular attention for adolescent women, women living in households with poor wealth, and those residing in rural settings.
The outcome of radiocephalic after brachiocephalic and redo arteriovenous fistula
Authors: AL-Madhhachi Bahaa A
Published: January 2022

Introduction:

When created in appropriately selected patients, arteriovenous fistula requires fewer interventions and costs compared to arteriovenous graft. The outcome of radiocephalic after brachiocephalic and redo arteriovenous fistula is not studied well in the literature, and this study highlights the outcome of these arteriovenous fistulae.

Methods:

The retrospective, single-center study, based on patient record analysis of 1040 arteriovenous fistula, was created between January 2017 and October 2021. Thirty-nine (3.37%) patients met the inclusion criteria for radiocephalic after brachiocephalic arteriovenous fistula group, and 42 (4.04%) met the inclusion criteria for the redo arteriovenous fistula group. Preoperative Doppler ultrasound was performed by the operating surgeon in all patients. All patients were scheduled for a visit 2 months after surgery for assessment—only 34 of radiocephalic after brachiocephalic arteriovenous fistula and 35 of redo arteriovenous fistula patients presented for follow-up. The arteriovenous fistula was assessed for patency, maturation, and complications. SPSS version 22 (Chicago, USA) was used for data entry and analysis.

Results:

The redo arteriovenous fistula has a significantly lower maturation rate at 2 months of follow-up (62.85%) when compared to other brachiocephalic arteriovenous fistula (79.18%) ( p-value = 0.0245). The radiocephalic after brachiocephalic arteriovenous fistula has no significant difference in maturation rate at 2 months of follow-up (61.67%) when compared to other distal forearms radiocephalic arteriovenous fistula (68.18%) ( p-value = 0.5173). The incidence of some early complications was higher in the redo group.

Conclusion:

The feasibility of doing radiocephalic arteriovenous fistula after failed brachiocephalic arteriovenous fistula is generally overlooked. The redo arteriovenous fistula is more technically challenging, associated with higher complications, but it provides reliable access in a specific group of patients.
A unified health algorithm that teaches itself to improve health outcomes for every individual: How far into the future is it?
Authors: Laroia Gaurav , Horne Benjamin D , Esplin Sean , Ramaswamy Vasant K
Published: January 2022

The single biggest factor driving health outcomes is patient behavior. The CHR Model (County Health Rankings Model) weights socioeconomic factors, lifestyle behaviors, and physical environment factors collectively at 80% in driving impact on health outcomes, to the 20% weight for access to and quality of clinical care. Commercial determinants of health affect everyone today and unhealthy choices worsen pre-existing economic, social, and racial inequities. Yet there is a disproportionate focus on therapeutic intervention to the exclusion of shaping patient behaviors to improve healthcare. If the recent pandemic taught us a critically important lesson, it is the imperative to look beyond clinical care. According to the Centers for Disease Control and Prevention (CDC), long-standing systemic health and social inequities put various groups of people at higher risk of getting sick and dying from COVID-19, including many racial and ethnic minority groups. The virus was simply more efficient in detecting such vulnerabilities than the guardians of these physiologies. These insights from the pandemic come at the heel of a confluence of three major accelerants that may radically reshape our approaches to hot-spotting vulnerabilities and managing them before they manifest in a derangement or disease. They are the recent strides in behavioral economics and behavior science; advances in remote monitoring and personal health technologies; and developments in artificial intelligence and data sciences. These accelerants allow us to imagine a previously impossible vision—we can now build and maintain a unified health algorithm for every individual that can dynamically track the two interdependent streams of risk, clinical and behavioral.
Development of an indicator of smoking status for people with multiple sclerosis in administrative data
Authors: Marrie Ruth Ann , Tan Qier , Ekuma Okechukwu , Marriott James J
Published: January 2022

Background

Administrative data lack health behavior information.

Methods

We developed an administrative case definition for past or current (‘ever smoking’) in 1320 individuals with MS from Manitoba, Canada. Candidate indicators for ‘ever smoked’ included smoking cessation medications, and diagnosis codes for tobacco use and chronic obstructive pulmonary disease, using variable lookback periods.

Results

When compared to self-reported smoking status, the case definition incorporating all indicators over a lifetime lookback period had a sensitivity of 31.98%, and positive predictive value of 78.26%.

Conclusion

This smoking status definition could only partially control for confounding due to smoking because of the low sensitivity.
Honey polyphenolic fraction inhibits cyclooxygenase-2 expression via upregulation of microRNA-26a-5p expression in pancreatic islets
Authors: Ahmed Syed Suhail , Al Nohair Sultan Fahad , Abdulmonem Waleed Al , Alhomaidan Homaidan T , Rasheed Naila , Ismail Mohamed S , Albatanony Manal A , Rasheed Zafar
Published: January 2022

Objectives

Honey total polyphenolic fraction (HTPF) is reported to have anti-disease potential, however the role of HTPF in the regulation of microRNAs (miRNAs) has never been investigated. This study was undertaken to investigate the potential of HTPF against inflammation via regulation of miRNAs in pancreatic islets of Langerhans.

Methods

Pancreatic islets were isolated from C57BL/6 mice and HTPF was purified from honey. Bioinformatics algorithms were used to determine miRNA target genes. Expression of miRNA and mRNA was determined using their specific taqman assays. Pairing between miRNA and 3′ untranslated region (3′UTR) of mRNA was confirmed using luciferase reporter clone containing the 3′UTR of mRNA sequences and results were verified by transfection of mouse pancreatic β-cell line Min6 with miRNA inhibitors.

Results

The data showed that mmu-miR-26a-5p is a direct regulator of cyclooxygenase-2 (COX-2) expression and HTPF inhibits COX-2 expression or prostaglandin E2 (PGE2) production via up-regulating mmu-miR-26a-5p expression. Transfection of islets with anti-miR-26a-5p significantly enhanced COX-2 expression and PGE2 production ( p < .01), while HTPF treatment significantly inhibited anti-miR-26a-5p transfection-induced COX-2 expression or PGE2 production ( p < .05). These findings were further verified in pancreatic β-cells Min6. Moreover, the data also determined that HTPF also inhibits glucose-induced nuclear transcription factor (NF)-κB activity.

Conclusion

HTPF suppresses glucose-induced PGE2 production and activation of NF-κB via negative regulation of COX-2 and mmu-miR26a-5p. These novel pharmacological actions of HTPF on glucose-stimulated pancreatic islets provide new suggestions that HTPF or HTPF-derived compounds inhibit glucose induced inflammation in pancreas by up-regulating the expression of microRNAs.
Effective Response to Human Trafficking in South Africa: Law as a Toothless Bulldog
Authors: Bello Paul Oluwatosin , Olutola Adewale A.
Published: January 2022

Humanitarian concerns owing to the dreadfulness and impact of human trafficking prompted several stakeholders under the umbrella of the United Nations (UN) to approve legal measures to criminalize this menace. Several states that are parties to the UN anti-trafficking protocols and conventions have domesticated some of the provisions of these regulations by enacting comprehensive laws that criminalize the various components of human trafficking. Unfortunately, this approach has not brought about any significant reduction in the crime. This article adopted a qualitative approach and drew from the findings of a broader doctoral study. It evaluates the efficacy of current South African anti-trafficking legislation in the fight against human trafficking in the country. Findings indicate, among others, that anti-trafficking legislation is at best a stop-gap strategy in combating the crime, and not all-encompassing. It concludes that an effective response to human trafficking transcends the enactment of laws. Moreover, laws do not thrive in a vacuum, but rely on a range of factors, particularly the political will to address the underlying causes of a crime, and effective law enforcement capacity.
Understanding National Identity Construction in China-ASEAN Business Discourse
Authors: Yuan Zhou-min , Leng Tang-yun , Wang Hao
Published: January 2022

Few studies have investigated national identity construction in a diachronic and holistic manner. To address this gap, in applying constructivist views of international relations and Critical Discourse Analysis (CDA), this paper analyzes business news titles of Chinese and ASEAN (Association of South-East Asian Nations) country mainstream media to reveal identities that both parties construct of one another and relationships between discourse and identity construction. Findings suggest that ASEAN identities constructed by Chinese media are positive and complimentary, demonstrating its adherence to foreign policies of neighborliness and friendship. However, ASEAN countries develop a range of contradictory identities toward China. This paper concludes that such discourse manifests and constructs national identities and shapes international relations. The paper also proposes that in facing passive identities constructed by ASEAN countries China must construct a clear discourse theory to make its voice heard, project China’s stance on the international stage, respond actively to skepticism, and construct images of peace, development, and friendship.
Circumferential Bone Fusion in Adult Spinal Deformity via Combination of Oblique Lateral Interbody Fusion and Grade 2 Posterior Column Osteotomy
Authors: Zakaria Amir F. , Kaneko Shinjiro , Takeda Hiroki , Nagai Sota , Kawabata Soya , Ikeda Daiki , Fujita Nobuyuki , Yato Yoshiyuki , Asazuma Takashi
Published: January 2022

Study Design

Retrospective study

Objectives

The combination of oblique lateral interbody fusion (OLIF) with grade 2 posterior column osteotomy (PCO) is an effective treatment for adult spinal deformity. However, grade 2 PCO may lead to pseudoarthrosis because it involves complete removal of the bilateral posterior facet joints. The main study objective was to determine the achievement rate of anterior and posterolateral fusion resulting in circumferential fusion in patients who underwent combined OLIF and grade 2 PCO.

Methods

This retrospective study included consecutive patients who underwent OLIF and grade 2 PCO. The group comprised a long fusion group, with fusion from the thoracic level to the ilium, and a short fusion group, with fusion within the lumbar region. The OLIF with percutaneous pedicle screw insertion group was also used for reference. The Brantigan–Steffee–Fraser classification was used to assess interbody fusion and Lenke classification for assessment of posterolateral fusion.

Results

Sixty-six patients with 109 lumbar levels were included in the study. We observed 100% anterior fusion in all 3 groups. The fusion rate for posterolateral fusion between the OLIF-grade 2 PCO group was 97%, with very low (3%) non-circumferential fusion (pseudoarthrosis only at the osteotomy site). In most cases, solid posterolateral fusions (Lenke A) occurred within 24 months.

Conclusions

The combination of OLIF and grade 2 PCO resulted in circumferential fusion for most (97%) of the cases within 24 months. OLIF and grade 2 PCO are considered a good combination treatment to achieve sufficient lumbar lordosis and solid bone fusion.
Risk Factors for Loss of Active Shoulder Range of Motion in Massive Rotator Cuff Tears
Authors: Furuhata Ryogo , Matsumura Noboru , Oki Satoshi , Kimura Hiroo , Suzuki Taku , Iwamoto Takuji , Matsumoto Morio , Nakamura Masaya
Published: January 2022

Background:

Patients with massive rotator cuff tears often exhibit loss of active range of shoulder motion, which can interfere with activities of daily living. The risk factors for loss of motion remain largely unknown.

Purpose:

To clarify the predictive factors that affect the range of motion in chronic massive rotator cuff tears using multivariate analyses.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

The authors retrospectively reviewed 204 consecutive patients who were evaluated at their institution with chronic massive rotator cuff tears. In this study, the dependent variable was determined to be active anterior elevation limited to ≤90° or external rotation (ER) with the arm at the side limited to ≤0°. Explanatory variables included age; sex; affected side; duration of symptoms; smoking history; existence of diabetes, hypertension, or rheumatoid arthritis; involved tendons; presence of a 3-tendon tear; rupture of the long head of biceps tendon; superior migration of the humeral head; and cuff tear arthropathy. Baseline variables that were observed to be significant in the univariate analyses were included in multivariate models, which used logistic regression to identify independent predictors of loss of motion.

Results:

Overall, 73 patients (35.8%) exhibited limited anterior elevation, and 27 (13.2%) exhibited limited ER. Multivariate analyses showed that inferior subscapularis tear (odds ratio [OR], 14.66; 95% CI, 2.95-72.93; P = .001), smoking (OR, 4.13; 95% CI, 1.94-8.79; P < .001), superior migration of humeral head (OR, 3.92; 95% CI, 1.80-8.53; P = .001), and 3-tendon tear (OR, 3.29; 95% CI, 1.32-8.20; P = .011) were significantly associated with the loss of anterior elevation. Teres minor tear (OR, 73.37; 95% CI, 9.54-564.28; P < .001) and superior migration of the humeral head (OR, 3.55; 95% CI, 1.04-12.19; P = .044) were significantly associated with loss of ER.

Conclusion:

In the current study, a history of smoking, type of torn tendons, and superior migration of the humeral head were associated with loss of active shoulder motion. In particular, the status of inferior subscapularis or teres minor contributed to the onset of pseudoparalysis in massive rotator cuff tears.
Pre-Anesthetic Medical Evaluations: Criteria Considerations for Telemedicine Alternatives to Face to Face Visits
Authors: Khera Kushal D. , Blessman Joseph D. , Deyo-Svendsen Mark E. , Miller Nathaniel E. , Angstman Kurt B.
Published: January 2022

Background

The number of pre-anesthetic medical evaluations (PAMEs) being conducted in primary care is increasing. Due to the COVID-19 pandemic, the use of telemedicine has surged, providing a feasible way to conduct some of these visits. This study aimed to identify patient-related factors where a face to face (FTF) evaluation is indicated, measured by the need for pre-operative testing.

Methods

A retrospective chart review was conducted on patients age ≥ 18 years who had a PAME between January 2019–June 2020 at a rural primary care clinic in Southeast Minnesota. Data collected included age, gender, Charlson Comorbidity Index Score, medications, revised cardiac risk index (RCRI), smoking status, exercise capacity, body mass index, and pre-operative testing. Logistical regression modeling for odds ratios of outcomes was performed.

Results

254 patients were included, with an average age of 64.1 years; 43.7% were female. Most were obese (mean BMI 31.6), non-smoking (93.7%) with excellent functional capacity (87.8% ≥ 5 METs). 76.8% of the planned surgeries were intermediate or high risk. 35.0% ( n = 89) of visits resulted in medication adjustments and 76.7% ( n = 195) in pre-operative testing. Age ≥ 65 years, ≥7 current medications, and diabetes all significantly increased the odds of requiring pre-operative testing ( P < .05).

Conclusions

This study was able to identify patient-related factors that increased the likelihood of requiring pre-operative testing. Patients who are age ≥ 65 years, ≥7 current medications, and those with diabetes could be scheduled for a FTF evaluation. Others could be scheduled for a telemedicine visit to minimize health-care exposures.
Do Parents Matter for Student Loan Repayment after Graduation?
Authors: Oh Byeongdon
Published: January 2022

Previous studies suggest that a college degree is the great equalizer leveling the playing field. However, the rapidly growing educational debt of college graduates might restrict their life chances throughout adulthood, particularly for those raised in socioeconomically disadvantaged families. This study uses data from the National Survey of College Graduates to examine whether parents’ socioeconomic status is related to their children’s student loan repayment after graduation. Holding the amount borrowed for completing higher education constant, college graduates with less educated parents hold a larger amount of educational debt in adulthood compared with their counterparts with more educated parents. The association between family background and student loan repayment remains significant with the addition of controls for various covariates related to college graduates’ education, occupation, income, and other labor market outcomes. This study suggests that educational debt burdens imposed on individual college graduates limit the meritocratic power of higher education.
Book review: Wendy Doniger, The Ring of Truth and Other Myths of Sex and Jewelry
Authors: Chakrabarty Ankita
Published: January 2022

Wendy Doniger, The Ring of Truth and Other Myths of Sex and Jewelry. New York, NY: Oxford University Press, 2017. 424 pp., ₹413, ISBN: 978-0-19-026711-7
Book review: Anil Kumar (Ed.), Women, Gender, and Justice: Issues and Perspectives
Authors: Ojha Abhiruchi
Published: January 2022

Anil Kumar (Ed.), Women, Gender, and Justice: Issues and Perspectives. Delhi: Pragati Publications, 2019, xxiv + 248 pp., ₹895, ISBN: 978-81-7307-176-8.
Book review: Awadhendra Sharan, Dust and Smoke: Air Pollution and Colonial Urbanism, India, c.1860-c.1940
Authors: Dutta Anuja
Published: January 2022

Awadhendra Sharan, Dust and Smoke: Air Pollution and Colonial Urbanism, India, c.1860-c.1940. New Delhi: Orient BlackSwan Private Limited, 2020, ix+319 pp., ₹795. ISBN 9789390122868.
Is Repair of the Superficial Deltoid Ligament Alone Enough to Restore Medial Ankle Stability in Deltoid Ligament Injuries? A Cadaveric Study
Authors: Abd-Ella Mohamed M.
Published: January 2022

Category:

Trauma

Introduction/Purpose:

Deltoid ligament injuries are controversial in many aspects: the best method to assess the stability of a Weber B fibular fracture, the indications of deltoid repair after lateral side surgical fixation, the best technique of deltoid repair and the efficacy of superficial deltoid repair alone, compared to repair of both deep and superficial deltoid ligaments, to restore medial ankle stability. The last point is specifically important because of the technical difficulty of repairing the deep deltoid ligament, specially if performed after fixation of the fibular fracture and the syndesmosis, which is the common scenario. The aim of the study was to evaluate the ability of superficial deltoid repair without deep deltoid repair to restore medial ankle stability in cases of deltoid ligament injuries.

Methods:

Ten fresh frozen ankle cadaveric specimens were used. Anteromedial dissection was performed to expose the ankle joint and to visualize the deltoid ligament. After good exposure, stress valgus and stress external rotation tests were performed with observation of the medial gutter and the medial part of the ankle joint for any widening. In all specimens, the ankle was stable at this point. Then, the superficial deltoid ligament was detached by sharp dissection from the medial malleolus followed by transection of the deep deltoid ligament completely at its midportion. Stress valgus and stress external rotation tests were repeated to demonstrate the gross instability of the ankle joint. Then, the superficial deltoid ligament was repaired using a suture anchor to the medial malleolus without any repair of the deep deltoid ligament. Then, stress valgus and stress external rotation tests were performed again to assess the medial ankle stability.

Results:

All ankles were stable initially as confirmed by stress valgus and stress external rotation tests. After cutting both components of the deltoid ligament, the ankles were found to be grossly unstable using the same tests. After repair of the superficial deltoid, all ankles were stable again with a medial space equal to the initial status and with negative stress valgus and stress external rotation tests.

Conclusion:

Surgical repair of the superficial deltoid ligament without repair of the deep deltoid ligament in cases of deltoid ligament injury may be sufficient to restore medial ankle stability. Limitations of the study include that all potential secondary restraints are intact in the cadaveric study compared to the actual situation where other structures like the capsular attachments may be injured especially if a fracture dislocation is encountered. Clinical trials are needed to confirm this finding.
Risk Factors for Postoperative Falls in Foot and Ankle Surgery
Authors: Andrews Nicholas A. , Halstrom Jared R. , Fellows Kenneth J. , Hughes Austin , Patch David A. , Harrelson Whitt , Sinha Tanvee , Shah Ashish
Published: January 2022

Category:

Other

Introduction/Purpose:

Falls following orthopaedic surgery are a known entity in the healthcare field possessing significant patient morbidity and driving increased healthcare cost. The vast majority of studies have focused on the incidence and risk factors for postoperative falls in the inpatient setting, however, this is in direct contrast to shifts seen toward same-day outpatient orthopaedic surgery over the past decade. It is crucial to better understand the incidence and risk factors for falls in a mixed inpatient and outpatient model. Additionally, no study to date has examined the risk factors for falls after foot and ankle surgery.

Methods:

A total of 168 patients were administered a questionnaire and interviewed to investigate the incidence of postoperative falls. Patients completed surveys pertaining to fall history pre- and post-operatively, fall risks, current medical status, and use of an ambulatory assist device. Medical records were reviewed. Questionnaires and interviews were completed at 2 week and 6-week post-operative follow up visits. Factors found to be associated with postoperative falls in univariate analysis (p<.05) were included in a binary logistic regression model.

Results:

Full six-week follow-up was present in 138 patients. A total of 87 (63.0%) females and 51 (37.0%) males with a median age of 52 (21 IQR) and BMI of 32.4 (11 IQR) were included. The total fall incidence in the first six postoperative weeks was 29.7% (41 patients). In multivariate analysis, antidepressant use and VAS score at two weeks postoperatively were independently associated with falls OR 3.6 (95% CI 1.3 - 10.1) and OR 1.3 (95% CI 1.1 -1.5), respectively. The results of other variables included in the model were as follows: The Johns Hopkins Fall Risk Score OR 1.0 (95% CI.87-1.2), total number of medications excluding as needed OR.85 (95% CI.65-1.1), anticonvulsant use OR 1.8 (95% CI.67 - 5.0), and history of falls in the past six months preoperatively 1.6 (.95% CI.44 - 5.7).

Conclusion:

The high outpatient fall rate in foot and ankle surgery warrants awareness of risk factors. Antidepressant use has been associated with falls, but has not been established as a risk factor for postoperative falls. Surgeons should be aware of the risk of postoperative falls in this patient population. The postoperative VAS score at two weeks was also shown to be independently associated with falls. Adequate postoperative pain control is vital to minimize such falls. This study has identified antidepressant use and postoperative VAS score at two weeks as two independent risk factors for postoperative falls in foot and ankle surgery.
Predictors of Outcomes of Microfracture for Osteochondral Lesions of the Talus
Authors: Dankert John , Kennedy John G. , Shimozono Yoshiharu , Deyer Timothy , Mercer Nathaniel P.
Published: January 2022

Category:

Ankle

Introduction/Purpose:

Microfracture has been widely published as a treatment modality for osteochondral lesions of the talus (OLT). However, little is known about the outcome predictors following microfracture for smaller-sized OLT (<100mm2). This study sought to define the predictors of both clinical and magnetic resonance imaging (MRI) outcomes for small OLT treated with microfracture.

Methods:

A retrospective cohort study investigating patients who received arthroscopic microfracture for OLT (<10mm or 100mm2) between 2008 and 2017 were evaluated. Multivariate regression models were used to evaluate factors affecting post- operative Foot and Ankle Outcome Scores (FAOS) and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scores. Kaplan-Meier survival curves with log-rank test were constructed and endpoint was defined as the requirement of revision surgery.

Results:

Eighty-seven patients were included in the study. The mean follow-up time was 41.4+-28.7 months. The mean FAOS pain score significantly improved from 60.4+-14.8 preoperatively to 79.3+-12.8 at final follow-up (p<0.001). Patients with uncontained- type OLT had an approximately 9-point worse FAOS pain score compared to contained-type OLT (p=0.036). Patients with cystic OLT also had an approximately 9-point worse pain FAOS compared to non-cystic OLT (p=0.026). Patients with larger lesion sizes had worse postoperative MOCART scores (p=0.012). Both Uncontained-Cyst and Uncontained-Noncyst groups had significantly worse FAOS pain than the Contained-Noncyst group (p<0.001, p=0.026). Survival rates in uncontained and contained lesions were 51.5% and 84.4%, respectively (p=0.616).

Conclusion:

Lesion uncontainment and the existence of cysts are independent predictors of poor clinical outcome following arthroscopic microfracture for smaller-sized OLT (<100mm2).
Return to Physical Activity after Isolated Subtalar Arthrodesis
Authors: Grimm Patrick D. , Irwin Todd A. , Jones Carroll P.
Published: January 2022

Category:

Hindfoot

Introduction/Purpose:

Subtalar arthrodesis has been shown to provide reliable pain relief and deformity correction for a variety diagnoses including include primary arthritis, posttraumatic arthritis, inflammatory arthritis, talocalcaneal coalitions, and hindfoot deformity. However, the level of functional activity achievable following this procedure is unknown. The aim of this study was to assess physical activity and functional outcomes in patients following isolated, primary subtalar arthrodesis.

Methods:

A retrospective review of isolated primary subtalar fusions was performed. Inclusion criteria were: age between 18 and 65, isolated primary subtalar fusion that achieved bony union, minimum 4 month radiographic follow up (XR or CT), and 1 year minimum questionnaire follow up. Patients who had neuromuscular diagnoses, adjacent joint arthritis, inflammatory arthritis, contralateral ankle or hindfoot pathology, significant medical comorbidities, or were treated under worker's compensation were excluded. The primary outcome measure was the Foot and Ankle Ability Measure. Additional patient reported outcomes included a novel functional assessment questionnaire, Coughlin Satisfaction Score, and a contralateral hindfoot comparison score.

Results:

Patient reported outcome measures were collected from 15 (10 F, 5 M) patients at a median of 78 (49, 106) months following surgery. The median FAAM ADL subscore was 83.3 (71.4, 98.8) and the sports subscore was 59.4 (40.6, 87.5). The majority (58%) of patients maintained the same level of physical activity before and after surgery. Fewer patients were able to golf, rollerskate/ice skate, run, weightlift, or take aerobics/yoga after surgery. More patients were able to dance, hike, play tennis/pickleball, or walk for exercise. More patients were able to wear shoes without limitations and fewer patients required a brace or orthotics. Good and excellent outcomes were reported by 73% of the cohort. The median contralateral comparison score for the cohort was 90 (50, 100).

Conclusion:

Isolated subtalar arthrodesis can provide reliable pain relief and allow reasonable functional outcomes as demonstrated in this patient cohort. In general, most patients maintain their level of function and have fewer limitations with shoe wear. Select, higher impact activities may be more challenging for patients with a fused subtalar joint. These findings may be used to help surgeons appropriately counsel patients about expected postoperative physical activity following an isolated subtalar arthrodesis.
Subtalar Arthrodesis and Dynamic Medial Column Stabilization in the Surgical Treatment of Rigid Progressive Collapsing Foot Deformity: A Comparative Analysis with Triple Arthrodesis
Authors: Kim Jaeyoung , Ji-Beom Kim , Lee Woo-Chun
Published: January 2022

Category:

Hindfoot; Midfoot/Forefoot

Introduction/Purpose:

In the surgical treatment of rigid progressive collapsing foot deformity (PCFD), triple arthrodesis has been commonly used for its ability to correct multiplanar deformities. However, complications associated with postoperative stiffness resulting from the added number of arthrodesis have led to an interest in more joint sparing options. A recent study has shown that dynamic medial column stabilization (DMCS), which transfers flexor hallucis longus tendon to the first metatarsal base, successfully restores medial longitudinal arch without the need for arthrodesis. This study aimed to evaluate the results of subtalar arthrodesis with dynamic medial column stabilization (DMCS) in treating rigid PCFD compared to the triple arthrodesis.

Methods:

Sixteen patients (18 feet) who underwent triple arthrodesis (TA group) and 24 patients (24 feet) who underwent subtalar arthrodesis and DMCS (SA+DMCS group) for surgical correction of rigid PCFD were reviewed. Five radiographic parameters were measured preoperatively, 3 months, 6 months postoperatively, and at the last follow-up (minimum 2 years) to compare the amount of correction and its maintenance. Clinical outcomes were assessed using a visual analogue scale (VAS) and foot function index (FFI). Complications such as non-union, development of adjacent joint arthritis were recorded.

Results:

TA group demonstrated a greater amount of correction in the Meary angle than the SA+DMCS group at 3 months postoperatively. However, the TA group showed a significant decrease in the medial cuneiform height, navicular-1st metatarsal angle, and Meary angle at 6 months compared to the initial reduction at 3 months. In contrast, the SA+DMCS group maintained initial correction throughout the follow-up (Figure 1). Clinical scores improved in all patients. Degenerative arthritis in the NC and TMT joints newly developed in nine and one foot, respectively, in the TA group. In contrast, there were no patients with newly developed arthritis in the SA+DMCS group. Postoperative valgus talar tilt occurred with nine ankles in the TA group, whereas only one ankle in the SA+DMCS group. One non-union of the subtalar arthrodesis occurred in the SA+DMCS group.

Conclusion:

SA+DMCS group demonstrated a comparable amount of correction as the TA group and maintained initial correction throughout the follow-up period. Additionally, the SA+DMCS group developed fewer complications than the TA group. The current findings suggest that SA+DMCS may be a viable option in treating rigid PCFD deformity with less concern for the complications related to the stiffness.
2021 Roger A. Mann Award Winner: Long-Term Revision Rates and Functional Outcomes of Total Ankle Arthroplasty and Ankle Arthrodesis
Authors: Loewy Evan M. , Goodson Kevin M. , Huang Kevin , Perkins Alexandrea , Walling Arthur K.
Published: January 2022

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Recent studies have shown acceptable long-term survival rates with TAA however there remains a general paucity of information directly comparing ankle arthroplasty to arthrodesis over long-term follow-up. This study compares revision rates and functional outcomes for a large cohort of patients undergoing ankle arthrodesis or arthroplasty. All surgeries were performed by a single surgeon from 1999 to 2013. Ankle arthrodesis was performed using a standardized 3-screw technique with anterior plate supplementation. Arthroplasty was performed utilizing the Scandinavian Total Ankle Replacement (STAR) prosthesis.

Methods:

A retrospective chart review was performed for 335 consecutive cases in 326 patients (198 ankles in the arthrodesis group and 137 in the arthroplasty group). Patient demographics including age, sex, body mass index (BMI), and preoperative diagnoses were collected. Foot Function Index (FFI) scores were obtained and recorded at final outpatient follow-up. Primary outcomes included the rate of revision surgery and functional outcome scores. Secondary outcomes included perioperative complications such as polyethylene fracture and patients who went on to undergo postoperative subtalar fusion for symptomatic adjacent joint arthritis.

Results:

Ten (6%) ankles in the arthrodesis group and twenty-one (15%) in the arthroplasty group required revision surgery at a mean of 8.9 +- 6.5 and 61.1 +- 52.9 months, respectively [P=.039]. One hundred four of the 335 cases were available to complete functional outcome surveys at final follow-up at a mean of 11.2 +- 4.1 years from time of surgery (minimum 6-year follow-up). Mean FFI scores were significantly better in the arthroplasty group (40.3 +- 36.9) than in the arthrodesis group (61.5 +- 45.1) [P=.011]. Thirteen polyethylene components in 12 TAAs (8.7%) required replacement for fracture at an average of 9.6 +- 4.2 years postoperatively. Seven (3.5%) cases in the arthrodesis group and three (2.2%) in the arthroplasty group went on to undergo subtalar fusion at an average of 4.9 +- 3.9 years post-operation [P=.536].

Conclusion:

Long-term functional outcome scores were better in TAA patients; however, the revision rate for major complications was found to be greater over time. While the ankle arthroplasty group did show a slightly lower frequency of adjacent joint arthritis progression leading to subsequent subtalar fusion, this difference was not statistically significant. To our knowledge, this is the largest and longest-term follow-up comparing the STAR prosthesis to ankle arthrodesis published in the United States to date.
Inter-Rater Reliability of Classifications for Fifth Metatarsal Base Fractures
Authors: Michalski Max , Kwon John Y. , Ingall Eitan M. , Chiodo Christopher P.
Published: January 2022

Category:

Trauma; Midfoot/Forefoot; Sports

Introduction/Purpose:

Fractures of the fifth metatarsal base have been a source of confusion since their original description by Jones in 1902. The term Jones' fracture has been used indiscriminately leading to further confusion. Zone classifications have been described but never evaluated for their reliability. The most recent classification, metaphyseal versus metaphyseal-diaphyseal is unknown to most surgeons. The purpose of this study was to evaluate the inter-rater reliability of American Orthopaedic Foot & Ankle Society (AOFAS) members classifying fractures of the base of the fifth metatarsal.

Methods:

A survey was emailed to members of the AOFAS including radiographs of 18 fifth metatarsal base fractures. Demographic information was collected in addition to evaluation of the 18 sets of radiographs using three classification systems. Surgeons were asked if the fracture is a Jones' fracture, zone of the fracture and if the fracture was metaphyseal or metaphyseal- diaphyseal. A total of 223 surgeons with an average experience of 14 years in practice (range: fellow - 50 years) completed the initial survey for inter-rater reliability. Additionally, each surgeon was asked which zones or zone junctions they consider a Jones' fracture. Reliability was tested using Fleiss' Kappa scores.

Results:

Inter-rater agreement for use of the term Jones' fracture was moderate (kappa 0.533, 95% confidence interval (CI) [0.530, 0.535]). The zone classification had an inter-rater agreement was moderate (kappa 0.537, 95% CI [0.535, 0.539]). Inter- rater agreement for metaphyseal versus metaphyseal-diaphyseal was substantial (kappa 0.705, 95% CI [0.702, 0.708]). Results of surgeon definition of a Jones' fracture is seen in Figure 1.

Conclusion:

This is the largest study of its kind looking at inter-rater reliability of an orthopaedic classification with 223 raters. The terminology regarding the classification of fifth metatarsal base fractures remains confusing and inconsistent. The term Jones' fracture has little meaning in terms of communicating these injuries as there is only moderate agreement when surveying surgeons and it is defined differently by most. The zone classification has similar reliability as the Jones' fracture. The terms metaphyseal and metaphyseal-diaphyseal was the most reliable means to describe these fractures.