bluuebunny/crossref_metadata_2025 huggingface dataset:
STRESS FRACTURES OF THE ANTERIOR TIBIAL DIAPHYSIS
Authors: Beals Rodney K , Cook Robert D
Published: April 2021

ABSTRACT

Stress fracture of the anterior tibial diaphysis is rare and occnrs mostly in leaping athletes. Thirty-six of these fractures in 35 patients have been reported in the literature. These are combined with 15 similar fractures in onr experience to provide combined data on 51 anterior tibial stress fractures. Comparison of the varions treatments utilized disclosed that there is a high risk of complete fracture if affected patients are allowed full activity, and that treatment by rest alone allowed only 40% to return to full activity even after symptomatic improvement. The treatment recommended for these patients is excision of the fissure, transverse drilling at the fissure site, and cancellous bone grafting of the defect. In those patients who suffer a complete fracture, open reduction and internal fixation is superior to closed treatment.
ANTERIOR INTERBODY FUSION FOR SPONDYLOLISTHESIS
Authors: Kim Nam Hyun , Kim Dong Jun
Published: April 2021

ABSTRACT

We evaluated the clinical and radiologic results and the immobilizing effect of the Knight-Kim brace for bony union in 75 consecutive cases of spondylolisthesis treated by anterior interbody fusion. The fifth lumbar vertebra was the most common site involved (55%). The patients were followed for a minimum of 2 ½ years (range; 2 ½ to 14; average: 4.5). All cases were approached retroperitoneally, and autogenous bone graft was obtained from the iliac crest. The donor site was reconstructed by polymethylmethacrylate bone cement. Among the 75 cases of grade I, II, and III slippage according to Meyerding's grading system, 58 cases (77%) showed complete bony union after 1 year follow up. Excellent and good clinical results were obtained in 65 cases (87%) at 1 year postoperatively. The state of bony union did not always correlate with the clinical symptoms. We conclude that the simple KnightKim back brace was valuable for postoperative immobilization.
A CLINICAL STUDY OF STRESS FRACTURES IN SPORTS ACTIVITIES
Authors: Ha Kwon Ick , Hahn Sung Ho , Chung Minyoung , Yang Bo Kyu , Yi Seung Rim
Published: April 2021

ABSTRACT

One hundred thirty-one patients with 169 stress fractures were treated between January 1984 and January 1990. The highest incidence was in teenage girls (25.5%), and the predominant sites were tibia (31.5%) and femur (12.5%). The mean interval between the start of hard training and the onset of symptoms was 2.7 months and the mean amount of increased activities was 93.7%. Volleyball (24.3%) and running (17.3%) had the majority of incidents, and 95 (72.5%) patients were professional athletes. Radionuclide bone scans were needed in 61 (46.6%) patients and 16 (12.2%) showed multiple lesions. Asymptomatic stress fractures were found in 12 (9.2%) patients, and only five showed recurrence at the other sites. Eleven (6.5%) cases were treated operati vely, and involved the tarsal navicular (2.9%) and femur (2.4%).
ELECTROPHYSIOLOGY AND ELECTRODIAGNOSIS OF THE POST-POLIO MOTOR UNIT
Authors: Trojan Daria A , Gendron Daniel , Cashman Neil R
Published: April 2021

ABSTRACT

Post-poliomyelitis syndrome refers to new symptoms that may occur years after recovery from poliomyelitis. The most common of these symptoms are new weakness, fatigue, and pain. This article describes electrodiagnostic studies - conventional electromyography (EMG), single fiber electromyography (SFEMG), and macroelectromyography (macro-EMG) - that have provided information on the post-polio motor unit and on the possible etiology of some post-polio syndrome symptoms. Muscular fatigue, and indirectly, general fatigue, may be due to neuromuscular junction transmission defects in some post-polio individuals, as suggested by reduction of the compound motor action potentials on repetitive stimulation, and increased jitter and blocking on SFEMG. Progressive weakness and atrophy in post-polio syndrome is probably due to a distal degeneration of post-polio motor units with resultant irreversible muscle fiber denervation. Electrodiagnostic evidence of ongoing denervation includes fibrillation and fasciculation potentials on conventional EMG, increased jitter and blocking on SFEMG, and smaller macroEMG amplitudes in newly weakened postpolio muscles. However, even though electrodiagnostic studies have provided insight into the possible causes of some postpolio syndrome symptoms, no specific electrodiagnostic test for the syndrome is currently available.
IMMUNE RESPONSES TO OSTEOCHONDRAL ALLOGRAFTS: NATURE AND SIGNIFICANCE
Authors: Friedlaender Gary E , Horowitz Mark C
Published: April 2021

ABSTRACT

Osteochondral allografts evoke immune responses. The nature of these immune responses and their biologic significance are still only partially understood. It is clear, however, that cell surface antigens of the major histocompatibility complex represented on the cellular elements of bone grafts cause T-cell activation, specifically those of the suppressor/cytotoxic phenotype. In numerous animal models, the most immunogenic bone allografts (mismatched, fresh) have demonstrated the poorest clinical and biologic outcomes, while more closely matched and/or grafts treated to reduce immunogenicity (frozen, freeze-dried) have more successfully incorporated. These observations support the hypothesis that immune responses against bone-graft related antigens have biologic significance and that reducing these responses may improve clinical results.
FRESH AND FROZEN ARTICULAR CARTILAGE ALLOGRAFTS
Authors: Thmford William W , Springfield Dempsey S , Mankin Henry J
Published: April 2021

ABSTRACT

Fresh and frozen cartilage allografts both function well to relieve joint pain due to cartilage injury. Fresh cartilage allografts appear to remain alive for many months and are most applicable to small injuries such as osteochondritis dissecans, traumatic defects, and osteonecrosis. Frozen cartilage allografts have been used mostly for treatment of bone tumors which most often involve the subchondral and the metaphyseal areas of the long bones, particularly around the knee and hip. Frozen cartilage allografts appear to survive well and maintain joint space for several years. Deterioration of either type of graft does not appear to result in joint pain, making these grafts useful for long periods of time.
A NEW SCALE FOR THE CLINICAL ASSESSMENT OF SPINAL CORD FUNCTION
Authors: Botsford D J , Esses S I
Published: April 2021

ABSTRACT

The systems currently used for grading the severity of neurologic injuries have serious limitations. The authors have developed a neurologic grading system to assess spinal cord function. This is a new, functionally oriented scale which can be used at the bedside and requires no special tests other than those done in a routine clinical neurological examination. This scale includes assessment of motor and sensory function, rectal tone, and bladder control. A major advantage of this scale is that motor function is assessed on a functional rating system. To evaluate the usefulness of this scheme, patients who have been previously entered into a prospective study on the surgical treatment of burst fractures were re-evaluated. A significant number of patients under our new reclassification system were noted to have had significant improvement which had been overlooked using the Frankel Grade system. The authors conclude that their new spinal cord assessment technique has many advantages and suggest that it be used by spinal cord injury centers.
THE MEDIAL APPROACH TO THE HIP REVISITED
Authors: Mallon William J , Fitch Robert D
Published: April 2021

ABSTRACT

Several muscular intervals have been described to approach the hip through a medial incision. We studied in detail the original descriptions of these surgical planes and found that several of them are nearly identical. We attempt to clarify the anatomic intervals available to the surgeon in hope of eliminating ambiguity in future reporting.
THE BIOLOGY OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTIONS
Authors: McFarland Edward G
Published: April 2021

ABSTRACT

Ligaments, including the anterior cruciate ligament (ACL), have a limited biological response to injury. The same healing process affects graft tissues used to reconstruct the ACL. These biological processes interact with mechanical forces to transform the grafts into tissues, which are expected to functionally replace the ACL. Although these grafts may undergo "ligamentization," they may not undergo "ACL-ization." Further study of the important relationship between these biological and biomechanical interactions is warranted.
INTRAARTICULAR ACL RECONSTRUCTION USING THE PATELLAR TENDON: ARTHROSCOPIC TECHNIQUE
Authors: Baker Champ L , Graham John
Published: April 2021

ABSTRACT

Endoscopie ACL reconstruction using the bone-patellar tendon-bone autografi has been shown to have good, reliable results. The procedure provides excellent reproducible fixation immediately and allows for early aggressive rehabilitation that includes range of motion, strengthening) and rapid return to sports.
SOFT TISSUE COVERAGE FOR THE UPPER EXTREMITY
Authors: Watumull Denton , Orenstein Harry H
Published: April 2021

ABSTRACT

Soft tissue coverage of the upper extremity continues to be a challenging and evolving field. The expeditious and reliable methods of soft tissue coverage currently in use are discussed with reference to their shortcomings and advantages. For soft tissue coverage of fingertip injuries, open treatment or local flaps from the hand remain the mainstay of treatment. For dorsal and volar hand defects, distal axial flaps, such as the groin flap or microvascular tissue transfer, are utilized most commonly. For large defects proximal to the wrist, trunk axial pattern flaps, microvascular transfer, or the radial forearm flap have the greatest utility. Finally, technical points necessary for the success of some of the flaps are discussed.
RADIOLOGIC CASE STUDY
Authors: Klearman Debra J , Sundaram Murali
Published: April 2021

OSTEOMYELITIS OF THE CLAVICLE
USE OF LASERS IN ORTHOPEDIC SURGERY: CURRENT CONCEPTS
Authors: Abelow Stephen P
Published: April 2021

Abstract

A surgical laser is a new, multipurpose tool that can cut, coagulate, and vaporize tissues. It utilizes a low profile handpiece that allows easy access to tight places and small joints. The holmium laser at 2.1 µm wavelength is gaining wide acceptance among orthopedic surgeons as a useful arthroscopic surgical tool. It has a minimal amount of thermal necrosis and is able to cut and ablate tissues with great ease.

Current investigation with laser tissue - agglutination and tissue welding - may make it possible to repair torn tissues with laser energy. The future will bring minimally invasive and minimally damaging laser orthopedic surgery.
HOLMIUM LASER SURGERY
Authors: Dillingham Michael F , Price Janet M , Fanton Gary S
Published: April 2021

Abstract

This relatively new form of laser energy, with its powerful and precise ability to ablate the dense tissues of the musculoskeletal system as well as its transmissibility in fiberoptic cables and a fluid medium, makes this an ideal tool for use in orthopedic surgery. Its importance as a new orthopedic modality may well lie in its unique ability to gain access to small articular compartments while providing superior homeostatic control, thereby decreasing postoperative morbidity. While not yet in widespread use, its popularity is rapidly spreading and research into a variety of new applications is growing steadily.
OBTURATOR INTERNUS BURSITIS: A COMMON FACTOR IN LOW BACK PAIN
Authors: Swezey Robert L
Published: April 2021

ABSTRACT

The presence of irritation of the obturator internus bursa (OIB) is identified as a common but thus far overlooked focus of myofascial irritability in association with low back pain. Eighteen of 50 consecutive patients with low back pain (36%) demonstrated the presence of tenderness at the anatomical site of the OIB. OIB was found in 11% of men and 43% of women. Nineteen of the 50 patients had regional myofascial pain; of these, eight (42%) had OIB tenderness. Palpation of the OIB will commonly reveal local tenderness in patiente suffering from low back pain. In these patients, conservative treatment of regional myofascial disorders may be made more effective when therapy and/or local steroid injections are appropriately directed to the obturator internus bursa.
SECONDARY PREVENTION OF VENOUS THROMBOEMBOLISM IN JOINT REPLACEMENT USING DUPLEX ULTRASONOGRAPHY
Authors: Walker Richard H
Published: April 2021

ABSTRACT

Prophylaxis of venous thromboembolism can be categorized as primary prevention and secondary prevention. Primary prevention is the deterrence of a disease process before it begins. Secondary prevention is the detection and treatment of an asymptomatic disease process before it becomes symptomatic.1 This discussion deals with duplex ultrasonography as a method of secondary prevention of venous thromboembolism after total joint replacement.

Routine screening by venography and by duplex ultrasonography has been advocated by several authors in cases of total hip arthroplasty (THA) and total knee arthroplasty (TKA).2-11 However, compared with venography, duplex ultrasonography has the advantages of being portable, painless, noninvasive, without side effects, less expensive and, depending on the institution, reliable as a screening and surveillance tool for managing deep vein thrombosis (DVT).

Part one of a three-part study was designed to substantiate reliability of duplex ultrasonography in detecting DVT after total joint replacement hi the lower extremity at our institution (Scripps CUnIc and Research Foundation in La Jolla, CaUf). Parts two and three were designed to evaluate the utility of duplex ultrasonography for routine screening and surveillance of DVT after THA and TKA.
ONE HUNDRED YEARS OF AUTOMOBILEINDUCED ORTHOPEDIC INJURIES
Authors: Duncan Gregory J , Meals Roy
Published: April 2021

ABSTRACT

As the automobile has evolved over its first 100 years, many changes have improved its safety and have resulted in lower fatality rates. To a great extent, physicians have provided the thrust for these improvements. Now, as more people survive automobile accidents, injuries to the musculoskeletal system take on importance as causes of individual disability and social cost. The patterns of automobile-induced orthopedic injuries continue to change. This article reviews the first 100 years of these injury patterns and relates their occurrence to specific automobile design features and oversights. Because any one automobile accident is likely to injure only a few people at most, trends and patterns are much more difficult to ascertain than for mass transit vehicular accidents. For this reason, physician awareness of contemporary injury patterns is the first step toward safer automobile design.
THE DIAGNOSIS OF DEEP VEIN THROMBOSIS IN THE MULTIPLY INJURED PATIENT WITH PELVIC RING OR ACETABULAR FRACTURES
Authors: Gruen Gary S , McClain Edward J , Gruen Rebecca J
Published: April 2021

ABSTRACT

Thirty-one patients with unstable displaced pelvic or acetabular fractures were admitted and underwent an open reduction and internal fixation of their fracture. All patients were studied prospectively for the incidence of proximal deep vein thrombosis (DVT) utilizing venous duplex ultrasound. Duplex scans were repeated at 1 week postoperatively in all patients. Additional scans were performed when clinically indicated. A total of 61 scans were completed. DVT developed in three patients (approximately 10%). Two of the three positive scans were noted only on postoperative examination. The third scan was positive on the preoperative phase. Duplex ultrasound was easily applied and well tolerated by the multiply injured patient.
RADIOLOGIC CASE STUDY
Authors: Holtz Peter , Sundaram Murali
Published: April 2021

ENCHONDROMA
THE EFFECT OF INTERCARPAL JOINT MOTION ON WRIST MOTION: ARE THERE KEY JOINTS? AN IN VITRO STUDY
Authors: Seradge Houshang , Owens Willis , Seradge Espanta
Published: April 2021

ABSTRACT

The contribution of each intercarpal joint individually and as a member of a regional group to total wrist motion was analyzed in 10 fresh, frozen cadaver specimens. Each intercarpal joint had an effect on the total wrist motion, but the contribution of each to the different planes of motion was not equal. The scaphoid-capitate joint had a governing effect on the motion of a region comprised of scaphoid-trapezium, scaphoid-trapezoid, and scaphoid-capitate. The lunate-capitate joint had a governing effect on the motion of a region comprised of the lunate-triquetrum, lunate-capitate, triquetrum-hamate, and hamate-capitate complex. Elimination of motion in either of the key governing joints affected total wrist motion the same as elimination of motion in all the joints in that region. Intercarpal fusion for treatment of ligament injury of the proximal intercarpal row may be limited to the scaphoid-capitate or lunate-capitate joint. There is no need to attempt fusion in all joints of either of the two regions.
THE ROLE OF HIP ARTHROSCOPY IN THE DIAGNOSIS AND TREATMENT OF HIP DISEASE
Authors: McCarthy Joseph C , Busconi Brian
Published: April 2021

ABSTRACT

Injuries to the hip are commonly encountered by orthopedic surgeons and will, for the most part, respond well to conservative therapy. When a patient's hip pain has not responded to the appropriate treatment and radiographic measurements have not shown any specific pathology, arthroscopy of the hip can be a valuable diagnostic and therapeutic procedure. We retrospectively reviewed 94 consecutive patients who experienced refractory hip pain that persisted longer than 6 months (average: 2.1 years) and who had an average follow up of 2.5 years. Statistical analysis was performed using Fisher's Exact Test (P value) and Pearson (r value) correlation coefficient to compare preoperative symptomatology and physical examination findings with intraoperative pathology. Statistically significant results were obtained when comparing preoperative symptoms of a painful hip click and mechanical symptoms of locking with acetabular labral injuries (P=.000, r=.896) and loose bodies (P=.000, r=.896), respectively. Radiologic studies were nondiagnostic in 76% of patients in this series. Hip arthroscopy can be a valuable and viable procedure in the diagnosis and treatment of protracted or progressive hip pain lasting more than 6 months.
Cemented Charnley Acetabular Failures
Authors: Ritter Merrill A
Published: April 2021

Acetabular Fixation Options in the 1990s
Anatomic Considerations for Anterior Instrumentation of the Lumbar Spine
Authors: Ebraheim Nabil A , Xu Rongming , Urbancic Richard , Yeasting Richard A
Published: April 2021

ABSTRACT

One hundred seventy lumbar vertebrae from L1-L4 were used to quantitatively evaluate the lumbar vertebral body and examine the relationship of the maximum posterior angles of screw placement to the spinal canal. Anatomic evaluation included dimensions of the vertebral body. Three entrance points on the lateral aspect of the vertebral body for screw insertion and an additional point 3 mm from the posterolateral corner of the spinal canal were defined and marked. The maximum posterior screw angles were determined as the angles between the line connecting the entrance point with the additional point and the corona! plane.

Results showed that vertebral body dimensions increased from L1-L4. The average vertebral body depth, width, and height were approximately 26 mm, 36 mm, and 22 mm at Ll , and 30 mm, 44 mm, and 23 mm at L4, respectively. The spinal canal may be penetrated if the screws are directed posteriorly 2°-5° at LI - L2 and 9°-14° at L3-L4 starting at the junction between the pedicle and vertebral body, 22°-32° at L1-L4 from the level of 1 0 mm anterior to the junction, and 43°-S0° from the level of 20 mm anterior to the junction. Therefore, mid-body screws should be directed perpendicular to the lateral plane of the vertebral body. For a more anteriorly placed screw, slightly posterior angulation is recommended.
Comparison of Postoperative Pain in Patients Receiving Interscalene Block or General Anesthesia for Shoulder Surgery
Authors: L Wu Christopher , Rouse Lucien M , Chen Jeffrey M , Miller Richard J
Published: April 2021

Abstract

A retrospective review of 114 patients who underwent elective shoulder surgery from January 1, 1995 to December 31, 1996 was performed. Eighty-eight patients received general anesthesia and 26 patients received regional anesthesia (interscalene block). There were no differences in surgical and anesthesia time and time to hospital discharge between groups. Patients who received regional anesthesia had a shorter recovery room stay (63±25 minutes versus 85±33 minutes [P=.002]) and required less intraoperative fentanyl (174±96 µg versus 379±193 µg [P<.0001]) and morphine in the recovery room (2±3 mg versus 6±7 mg [P=.006]). A higher percentage of patients who received regional anesthesia had a lower pain rating at 4 hours. Regional anesthesia for shoulder surgery decreases pain and facilitates recovery in the immediate postoperative period.
Radiolucency Adjacent to the Tibial Component in Total Knee Arthroplasty
Authors: Lundberg-Jensen Allan , Kourakis Anette Holm , Rossen Benni , Kofoed Hakon
Published: April 2021

Abstract

This study determined the accuracy of standard radiographs in observing radiolucency adjacent to the tibial component in total knee arthroplasty. A model of the proximal tibia was used. Plastic sleeves of different heights were glued under the tibial tray to imitate radiolucency. By tilting the x-ray tube 1° at a time, an investigation was performed to determine how many degrees it would take to cover the heights of the different plastic sleeves.

In a clinical study of patients at standard follow-up, 21 knees were examined using standard radiographs. Radiographs using image intensification were then taken of the same knees to obtain radiographs with views parallel to the plane of the tibial tray. The results of the study on the phantom showed that a 1 ° deviation of the x-ray beam from the optimal position would obscure a 0.5-mm "radiolucency." This was true for radiolucencies of 2, 3, 4, and 5 mm. This was confirmed in the clinical study where ≤4 mm of radiolucency was obscured on standard radiographs. Therefore, standard radiographs cannot be used to determine radiolucency. The 2-mm radiolucency normally associated with loosening is not clinically valid.
The Effect of Abduction Differences Between Cup and Contralateral Acetabular Angle on Polyethylene Component Wear
Authors: Kligman M , Michael H , Roffman M
Published: April 2021

Abstract

One hundred forty-two patients who underwent cemented or uncemented hip replacement were studied radiographically to determine acetabular component wear. Mean duration of follow-up was 58 months (range: 35-92 months). Average linear wear was 0.78 mm (range: 0-1.9 mm), and average wear rate was 0.16 mm/year (range: 0-0.45 mm/year). An increased wear rate per year correlated with a discrepancy >18.3° between contralateral acetabular angle and acetabular cup inclination (P<.005). Statistical analysis revealed no significant correlation between cup inclination and polyethylene wear, which was studied without considering the contralateral hip (P>3). There was no relationship between polyethylene wear and cup design, weight, and initial polyethylene thickness.
Vulnerability of the Spinal Accessory Nerve in the Posterior Triangle of the Neck: A Cadaveric Study
Authors: Lu Jike , Haman Steve P , Ebraheim Nabil A
Published: April 2021

ABSTRACT

Injury to the accessory nerve results in an obvious shoulder droop, loss of shoulder elevation, and pain. Prevention of inadvertent injury to the accessory nerve is critical in neck dissection. No previous study, however, anatomically demonstrates the mechanism of the spinal accessory nerve traction injury. Anatomic determination of the location and course of the spinal accessory nerve may be helpful for a better understanding of the mechanism of the nerve injury. The accessory nerve courses obliquely across the posterior triangle on the surface of the levator scapula muscle and reaches the trapezius. The length of the spinal accessory nerve in the posterior triangle is 34.7±6.3 mm. The nerve passes through the posterior border of the sternocleidomastoid muscle 50.7±12.9 mm below the tip of the mastoid process and reaches the anterior border of the trapezius 49.8±5.9 mm above the clavicle. It makes a posterior angle of 73.1°±19.4°, on average, relative to the posterior border of the stemocleidomastoid. When the shoulder is pulled down and the head is turned to the opposite direction, the spinal accessory nerve is stretched in the posterior triangle. In the posterior triangle, the nerve is vulnerable, since it is superficial and covered only by skin and subcutaneous fascia. Therefore, extreme caution should be taken with any surgical procedures in the posterior triangle. Traction injury of the spinal accessory nerve in the posterior triangle cannot be ignored.
Early Results of a Reverse Design Prosthesis in the Treatment of Arthritis of the Shoulder in Elderly Patients With a Large Rotator Cuff Tear
Authors: Boulahia Aziz , Edwards T Bradley , Walch Gilles , Baratta Richard V
Published: April 2021

Results of shoulder arthroplasty in patients with a deficient rotator cuff often are suboptimal with significant limitations in postoperative active mobility. Short-term results using a reverse design prosthesis in the treatment of the cuff-deficient arthritic shoulder are encouraging. This prosthesis compares favorably, particularly with regard to postoperative active anterior elevation, to other treatment options in this challenging patient population.
Fixed- Versus Mobile-Bearing Total Knee Arthroplasty: Technical Issues and Surgical Tips
Authors: Crossett Lawrence S
Published: April 2021

Abstract

Mobile-bearing knee arthroplasties have been used clinically for 25 years. The success of this technology depends on strict adherence to the principles of flexion-extension gap technique. The use of the fixed femoral landmarks for the rotational positioning of the femoral component (measured resection technique) is not acceptable if bearing dislocation is to be avoided. The principles of flexion-extension gap balancing, as well as the surgical technique, are reviewed in this article.
Advanced Mobile-Bearing Surgical Technique
Authors: Beverland David
Published: April 2021

Abstract

Consistent success in total knee arthroplasty (TKA) is dependent on achieving basic surgical goals that include a neutral mechanical axis, a restored joint line, and equally balanced flexion and extension gaps. Although these surgical goals apply to both fixedbearing and mobile-bearing TKAs, concerns about bearing stability in mobile-bearing implants require surgeons to be aware of flexion gap stability. The increased awareness required to achieve flexion gap stability with the mobile-bearing implant not only provides stability but also encourages surgeons to adhere to basic surgical principles.
Hyperbaric Oxygen
Authors: Strauss Michael B , Bryant Brandon
Published: April 2021

This cutting edge article discusses the most frequent uses of hyperbaric oxygen for the orthopedic surgeon. Hyperbaric oxygen therapy is an adjunct to orthopedic interventions when healing problems are anticipated due to wound hypoxia or uncontrolled infection.
Preoperative Administration of Epoetin Alfa to Total Joint Arthroplasty Patients
Authors: Rauh Michael A , Bayers-Thering Mary , LaButti Ronald S , Krackow Kenneth A
Published: April 2021

Abstract

Epoetin alfa is indicated to reduce allogeneic transfusions in patients undergoing major operations. This study included 40 patients undergoing total joint arthroplasty who received 600 IU/kg doses of epoetin alfa 21, 14, and 7 days preoperatively. Statistically equal matches were obtained according to preoperative hemoglobin, operation, sex, and age. After controlling for autologous donation, the average hemoglobin level on postoperative day one in the treatment group (10.93 g/dL) was significantly higher than the matched patient group (9.86 g/dL). Likewise, treated patients were transfused with significantly less blood (0.68 units/patient) compared to the matched group (1.6 units/patient). In these patients, administration of epoetin alfa was associated with significantly higher perioperative hemoglobin levels and significantly fewer transfusions than matched counterparts. The use of epoetin alfa in this heterogeneous surgical population illustrates its success in a varied population.
Bilateral Proximal Third Fibular Stress Fractures in an Adolescent Female Track Athlete
Authors: Lehman Thomas P , Belanger Michael J , Pascale Mark S
Published: April 2021

Proximal fibular stress fracture is an uncommon injury in athletes but has been frequently reported in the military population. Although the true incidence is unknown and its pathophysiology is not completely understood, proximal fibular stress fracture is believed to be a rare injury and awareness of it will help clinicians make the proper diagnosis and provide appropriate treatment
Anterior Bone Block: Treatment of Calcaneus Deformity After Failed Soft-Tissue Operations
Authors: Abdel-Aal Ahmed M
Published: April 2021

Calcaneus deformity is almost always the result of a neural disorder. It is progressive, disabling, and resistant to bracing and usually requires surgery. In immature feet, soñ-tissue operations are the procedures of choice but have the disadvantage of recurrence due to stretching of son tissues. However, bony operations will lead to growth center damage. Anterior bone block corrects the deformity without damaging the growth centers.
The Influence of Preoperative Nutritional Status in Wound Healing After Replacement Arthroplasty
Authors: Rai Jaswant , Gill S S , Kumar B R J Satish
Published: April 2021

Abstract

Patient nutritional status was evaluated preoperatively using the serological parameters serum albumin, serum transferrin, and total lymphocyte count in 40 patients who underwent replacement arthroplasty (33 hips and 7 knees). Using the standard criteria, the overall incidence of malnutrition was 40% (16 cases). Ten percent (4 patients) had a negative value in the Rainey McDonald nutritional index. On follow-up, no patient had delayed wound healing or wound infection. Attention to surgeondependent factors can offset the high risk of delayed wound healing imposed by patient-dependent factors.
The Effects of Dynamization and Destabilization of the External Fixator on Fracture Healing: A Comparative Biomechanical Study in Dogs
Authors: Arazi Mehmet , Yalcin Hakan , Tarakcioglu Necmettin , Dasci Zafer , Kutlu Abdurrahman
Published: April 2021

Abstract

This study compared the effects of axial dynamization and staged destabilization on fracture healing. Bilateral midshafts of canine tibiae were osteotomized and fixed with an external fixator. The hind limbs were divided into two groups: the destabilized group in which the fixator's stiffness was progressively reduced over time and the axially dynamized group in which the fixator was axially dynamized. The healed tibiae were tested for 3-point bending in the anteroposterior plane. The biomechanical tests performed 2 months postoperatively revealed that the side with the destabilized fixator was more rigid than the side with the axially dynamized fixator, but the differences were insignificant (P=.20). This study showed staged destabilization of the fixator's stiffness was as effective on the enhancement of fracture healing as axial dynamization.
Use of an Advanced Formulation of β-Tricalcium Phosphate as a Bone Extender in Interbody Lumbar Fusion
Authors: Linovitz Raymond J , Peppers Timothy A
Published: April 2021

Abstract

Despite numerous advances in the development of bone graft substitutes over the past 20 years, iliac crest autograft remains the gold standard for lumbar spinal fusion. However, donor site morbidity associated with the harvesting of iliac crest autograft remains problematic. Acute and chronic pain, prolonged operative time, bleeding, infection, deformity, and nerve and vascular injury still produce significant postoperative morbidity, even in the presence of careful surgical technique. Although allograft circumvents donor site morbidity, the growing number of spinal fusions performed in the United States and worldwide is creating a shortage of cadaver bone acceptable for use. Additionally, the extensive processing and storage of allograft is expensive. Synthetic materials, such as ß-tricalcium phosphate (β-TCP), have been developed as alternatives to both autograft and allograft. A novel formulation of ultraporous β-TCP (Vitoss, Orthovita, Malvern, Pa) offers interconnected microporosity, providing it with good wicking and hydrophilic properties. These properties allow the migration of nutrients, growth factors, and osteogenic cells into the ultraporous β-TCP scaffold, thereby promoting new bone growth and concurrent scaffold resorption. This study presents a retrospective review of 7 patients who underwent anterior (ALIF) or posterior (PLIF) interbody fusion at 12 levels with a 3- to 6-month follow-up. At the patients' last radiographic examination, all 12 levels were solidly fused with interbody grafting material consisting only of allograft plus a combination of ultraporous β-TCP and venous blood as an extender. Additionally, all 7 patients had segmental pedicle-screw fixation.
Percutaneous Compression Plating for Intertrochanteric Hip Fractures: Treatment Rationale
Authors: Gotfried Y
Published: April 2021

Percutaneous compression plating was developed after thorough consideration of each stage in the surgical procedure for intertrochanteric fractures and the ways in which they might be improved. This system represents a minimally invasive method of fracture stabilization and fixation, providing enhanced rotational stability and bone sparing, which reduces both peri- and postoperative complications including cut outs and fracture collapse.
The Relationship Between Serum Relaxin and Knee Joint Laxity in Female Athletes
Authors: Arnold Christopher , Van Bell Craig , Rogers Vincent , Cooney Timothy
Published: April 2021

Abstract

Gravidity studies have intimated a relationship between serum relaxin levels and joint laxity. To assess its applicability to eumenorrheic athletes, weekly serum relaxin and knee arthrometry measurements were obtained in 57 collegiate women and 5 men for 4 consecutive weeks. The former included athletes, ACL-injured athletes, and nonathletes, while the latter formed an a priori hormonal control. Analysis of variance revealed a significant change in weekly serum relaxin levels in females but not in anterior translation. Regression analysis failed to disclose a relationship between these variables. Therefore, we conclude relaxin does not affect knee laxity.
Factors Associated With Short Form-36 Outcomes in Nonoperative Treatment for Ipsilateral Fractures of the Clavicle and Scapula
Authors: Edwards Scott G , Wood George W , Whittle A Paige
Published: April 2021

Abstract

Twenty consecutive patients with ipsilateral fractures of the clavicle and scapula were treated nonoperatively with immobilization and physical therapy. Results were evaluated using the Herscovici, Rowe, and Constant scoring systems and the Short Form-36 (SF-36) questionnaire. The average comprehensive SF-36 score was lower than the scores obtained using the other scoring systems. In the SF-36 questionnaire, physical scores were strongly associated with nonphysical scores (/><.001). No association was found between SF-36 physical scores and age (A=. 37), fracture pattern (clavicle, P=.81; scapula, P=. 1 8), fracture displacement (P=. 1 8), or injury severity score (P=.52). Outcomes were found to relate more to nonphysical factors than to the physical injury.
Scaphoid Fractures: Dorsal Versus Volar Approach
Authors: Polsky M Brian , Kozin Scott H , Porter Scott T , Thoder Joseph J
Published: April 2021

Abstract

Twenty-six patients with scaphoid fractures were treated with internal fixation using a cannulated differential pitch compression screw. Sixteen patients underwent a dorsal approach (group 1) and 10 patients a volar approach (group 2). Average time from injury to surgery was 6.6 months (range: 0.3-19 months) for group 1 and 8.3 months (range: 0.3-24 months) for group 2. The rate of union, determined by radiographs and clinical examination, was 81 % in group 1 and 80% in group 2. No significant differences were noted between the groups for dorsiflexion/palmar flexion, radial deviation, grip strength, and pain level.
Complications and Surgical Considerations in Posterior Lumbar Interbody Fusion With Carbon Fiber Interbody Cages and Steffee Pedicle Screws and Plates
Authors: Stromberg Lynn , Toohey John S , Neidre Arvo , Ramsey Michael , Brantigan John W
Published: April 2021

Abstract

Sixty consecutive patients undergoing posterior lumbar interbody fusion with a carbon fiber cage and posterolateral fusion using Steffee VSP (Depuy, Raynham, Mass) pedicle screw and plate instrumentation were reviewed. Perioperative complications, operative blood loss, and operative time were evaluated.

Six dural tears, three transient sensory deficits, and two cases of deep venous thrombosis were reported. Operative blood loss for primary cases averaged 269 cc for one level and 569 cc for two levels fused. Patients with prior surgery averaged 378 cc for one level and 470 cc for two levels fused. Operative time for primary cases averaged 202 minutes for one level and 251 minutes for two levels fused. Patients with prior surgery required 208 minutes for one level and 251 minutes for two levels fused.

Posterior lumbar interbody fusion with instrumented posterolateral fusion can be performed with a low intraoperative complication rate. Blood loss and operative time compare favorably with alternative methods of obtaining 360° fusion. Radiographic fusion was obtained in 1 00% of patients. Outcome analysis revealed 67% excellent or good results.
A Technique to Prevent Ender Nail Back-Out
Authors: Yadav V , Marya K M
Published: April 2021

Ender nails are advantageous in the treatment of certain fractures; however, inadequate fixation and back-out are frequent complications. This article presents a simple looping technique that prevents Ender nail back-out
Economic Consequences of Operative Delay for Hip Fractures in a Non-Profit Institution
Authors: Shabat Shay , Heller Eyal , Mann Gideon , Gepstein Reuben , Fredman Brian , Nyska Meir
Published: April 2021

Abstract

This retrospective study evaluated the economic consequences of delaying hip fracture surgery in 191 elderly patients. Data was collected regarding fracture type, surgery, timing of surgery, background diseases, postoperative hospital stay, and complications. In addition, calculation of the drugs administered to the patients, cost of the surgery, blood transfusion, physiotherapy, laboratory examinations, radiographs, and any financial data were evaluated. Spending more resources for performing hip surgery within 48 hours is more cost-effective than delaying surgery past the third day.
Immunohistological Detection of Relaxin Binding to Anterior Cruciate Ligaments
Authors: Galey Stephanie , Konieczko Elisa M , Arnold Christopher A , Cooney Timothy E
Published: April 2021

Abstract

Relaxin, a member of the insulin-like growth factor family, alters collagen metabolism in fibroblasts. It was hypothesized that relaxin interacts with the anterior cruciate ligament (ACL), contributing to its elasticity. Twelve ACL specimens were collected from reconstruction surgeries, sectioned, rinsed, and exposed to rh-relaxin overnight. Polyclonal antirelaxin antibodies, in conjunction with HRP-AEC, localized areas of tissue binding. Controls were used to infer binding specificity. Staining was present in the positive control and all 1 2 ACL specimens; little or no staining occurred in the negative controls. These data suggest that relaxin binding to the ACL is specific, indicative of a receptor-mediated event.
Concurrent Little Leaguer’s Elbow and Shoulder in a 15-year-old Baseball Pitcher and Football Quarterback
Authors: Domes Christopher M. , Petering Ryan C. , Chesnutt James C. , Mirarchi Adam
Published: April 2021

Little Leaguer’s elbow and Little Leaguer’s shoulder are overuse pathologies seen in overhead-throwing athletes. No instance of simultaneously occurring pathologies has been published. A 15-year-old baseball pitcher and football quarterback developed pain in his throwing shoulder and elbow during spring baseball, which partially resolved with several months of rest. During fall football practice, he felt a pop and pain over his medial throwing elbow. Five days after the initial injury, medial elbow tenderness, mild swelling, and decreased range of motion were noted. Radiographs revealed a Salter I avulsion fracture of the medial humeral epicondyle (Little Leaguer’s elbow) and a periosteal reaction along the lateral aspect of the humeral metadiaphysis with slight widening (Little Leaguer’s shoulder). Surgical fixation of the medial epicondyle fracture and nonoperative treatment of the shoulder pathology were performed. Two-year follow-up radiographs showed a healed medial epicondylar fracture and resolution of the periosteal reaction of the humeral metadiaphysis. The patient returned to full activity and was starting quarterback for his football team. Biomechanical forces specific to overhead-throwing activities are associated with the development of Little Leaguer’s elbow and shoulder. Treatments of both pathologies remain controversial, with either initial operative vs nonoperative care. In this patient, a good outcome was achieved with surgical fixation of the elbow fracture and conservative management of the shoulder pathology. Educating coaches and parents on proper throwing technique and pitching limits should be the first step in reducing the occurrence of either pathology in this population.
Student Career Goal Changes During Doctoral Education in Nursing
Authors: Zebelman Edna S , Olswang Steven G
Published: April 2021

ABSTRACT

As a relatively new doctoral discipline, nursing appears to be following the research focus of other disciplines in its doctoral programs. One original intent of awarding doctoral degrees in nursing was to prepare faculty. This study sought to determine how many doctoral students in nursing identified the goal of a career as faculty in schools of nursing at the beginning of their doctoral program, and how many would choose faculty positions after being enrolled in a doctoral program for more than one year. The population included 785 doctoral students in nursing from 35 schools in the United States. A cross-sectional study design was used to compare newly enrolled doctoral students with students who had been enrolled for more than one year.

Although first-year and more experienced students have similar career goals upon entering a doctoral program, the career goals of doctoral nursing students do change over time. More experienced students become less interested in faculty positions, especially in nondoctoral schools of nursing, and more interested in positions involving research and consultation. Within specific programs, students in EdD programs became more interested in faculty positions in doctoral universities. Students in DNS programs who changed their goals became more career goal oriented, thus compounding the shortage of doctoral faculty. These changes in career goals warrant examination.
Learning to Care-A Qualitative Perspective of Student Evaluation
Authors: Leino-Kilpi Helena
Published: April 2021

ABSTRACT

There is a school reform going on in nursing education in Finland, which emphasizes all qualitative aspects of learning. The purpose of this study was to examine the qualitative evaluation of student performance, with the final examination of nursing education taken as an example. The objective was to develop methods to "measure" the depth of the learning process in nursing education. The data consisted of the students' answers to the final exam questions (N =418). The answers were those of the surgical and psychiatric nursing students in Finland in 1985. Data was analyzed by the method of discursive content analysis. For describing the cognitive complexity of the knowledge, the concepts of the level of information processing (surfacedeep), the form of the knowledge (atomistic-holistic), and the structure of the knowledge (pre-structured - relating) were used. In the students' answers, a tendency towards superficial cognitive learning and the production of fragmentary information without a basic learning idea can be seen.
Role Deprivation in Baccalaureate Nursing Students Pre and Post Curriculum Revision
Authors: Carroll Theresa L
Published: April 2021

ABSTRACT

This study documents that the Role Deprivation of senior generic baccalaureate nursing students ( n - 194 ) in a newly revised conceptually based, 8-term, health-oriented curriculum was significantly greater (p < .05) than the role deprivation of senior baccalaureate nursing students (n - 174) in the same school when the program was based on a ??-term, medical model, illness-oriented curriculum. Role deprivation was measured by the Corwin (1960) Role Conception-Role Deprivation (RC-RD) Scale which was used extensively by Kramer in her studies (1969, 1970, 19741 of nurse's adjustment to the hospital work world. In these studies, Kramer used role deprivation as an indirect measure of reality shock. Unresolved reality shock leads to anger, frustration, and disillusionment that eventually can lead to exit from the profession (Kramer, 1974). Kramer has demonstrated that changes in learning experiences in an educational program can affect new graduates' adaptation to the hospital work world.
Psychometric Evaluation of the Clinical Stress Questionnaire (CSQ)
Authors: Pagana Kathleen Deska
Published: April 2021

ABSTRACT

The purpose of the Clinical Stress Questionnaire (CSQ) was to assess the appraisal of stress in the clinical experience of nursing students as threatening or challenging. The CSQ consists of a 20-item Likert scale and some open-ended questions. The instrument was administered to 246 female nursing students from 7 different colleges and universities in Pennsylvania after their first day of their medicalsurgical clinical experience. Alpha coefficients of .85 and .84 were obtained for the challenge and threat scales, respectively. Factor analysis supported construct validity. A paired T-test indicated that the students were significantly more challenged than threatened. However, the students' comments focused more on the negative aspects of stress and threat.
Nurse Practitioner Education: Enhancing Performance Through the Use of the Objective Structured Clinical Assessment
Authors: Bramble Karna
Published: April 2021

ABSTRACT

An Objective Structured Clinical Assessment (OSCA) was implemented in a graduate nurse practitioner (NP) program to determine the effect that participation in this type of clinical simulation would have on the cognitive and clinical competency of students. Based on the analysis of data, participation in the OSCA simulations did not lead to significantly better cognitive or clinical performance. Support for the OSCA was shown, however, by NP students when subjectively evaluating their experiences. All students agreed or strongly agreed that OSCA participation was a valuable learning experience and that the feedback provided was beneficial to their clinical and cognitive performance.