bluuebunny/crossref_metadata_2025 huggingface dataset:
Distal radius fractures
Authors: del Piñal Francisco , Jupiter Jesse B. , Rozental Tamara D. , Arora Rohit , Nakamura Toshiyasu , Bain Gregory I.
Published: July 2021

The management of distal radius fractures has evolved considerably in the last two decades. Techniques and hardware have improved so much that the surgeon can usually assure good results in these debilitating fractures. Yet no one method can be used for all injuries, as the personality of each fracture demands a customized approach. Furthermore, what works in one age group may not work in another. For this reason, every available treatment has its own space in our options. The need for surgeons to be well versed in all techniques is critical. We offer a concise update of important evolutionary and current treatment guidelines for this common fracture.
A novel technique for proximal interphalangeal joint fracture-dislocations: the second toe middle phalanx osteochondral graft
Authors: Nizzero Danielle , Tang Nicholas , Leong James
Published: July 2021

Many different surgical techniques have been used to treat unstable dorsal proximal interphalangeal joint fracture-dislocations. The authors have used the base of the middle phalanx of the second toe base as an alternative autograft to treat this type of injury. This retrospective study assessed the clinical outcomes of this procedure in 11 patients. Range of motion, grip strength, Disability of the Arm, Shoulder and Hand score and donor site morbidity were assessed at regular intervals postoperatively. Nine patients had acute injuries and two had chronic injuries. The mean range of motion in the proximal interphalangeal joint at final review was 65° for patients with acute injuries and 41° for patients with chronic injuries. Other outcomes were satisfactory and there were no complications.

Level of evidence: IV
Outcomes of 3-D corrective osteotomies for paediatric malunited both-bone forearm fractures
Authors: Roth Kasper C. , van Es Eline M. , Kraan Gerald A. , Verhaar Jan A. N. , Stockmans Filip , Colaris Joost W.
Published: July 2021

Closed treatment of paediatric diaphyseal forearm fractures carries the risk of re-displacement, which can lead to symptomatic malunions. This is because growth will not correct angulation deformity as it does in metaphyseal fractures. The purpose of this prospective cohort study was to evaluate the outcomes after 3-D-planned corrective osteotomy with patient-specific surgical guides for paediatric malunited forearm fractures causing impaired pro-supination. Our primary outcome measure was the gain in pro-supination at 12 months follow-up. Fifteen patients with a mean age at trauma of 9.6 years and time until osteotomy of 5.9 years were included. Preoperatively, patients displayed a mean pro-supination of 67° corresponding to 44% of the contralateral forearm. At final follow-up, this improved to 128°, achieving 85% of the contralateral side. Multivariate linear regression analysis revealed that predictors of greater functional gain after 3-D corrective osteotomy are severe preoperative impairment in pro-supination, shorter interval until 3-D corrective osteotomy and greater angulation of the radius.

Level of evidence: III
Important updates of finger fractures, entrapment neuropathies and wide-awake surgery of the upper extremity
Authors: Lalonde Donald , Ayhan Egemen , Ahmad Amir Adham , Koehler Steven
Published: July 2021

Hand surgery is rapidly changing. The wide-awake approach, minimum dissection surgery and early protected movement have changed many things. This is an update of some of the important changes regarding early protected movement with K-wired finger fracture management, simplification of nerve decompression surgery, such as elbow median and ulnar nerve releases, and some new areas in performing surgery with wide-awake local anaesthesia without tourniquet.
Efficacy of magnetic stimulation for female stress urinary incontinence: a meta-analysis
Authors: Sun Kai , Zhang Dongxu , Wu Gang , Wang Tianqi , Wu JiTao , Ren Hongxu , Cui Yuanshan
Published: July 2021

Aim:

This meta-analysis aimed to evaluate the efficacy of magnetic stimulation (MS) in treating female stress urinary incontinence (SUI) and providing an alternative treatment for patients who are unwilling to undergo surgery.

Methods:

Randomized controlled trials (RCTs) that evaluated MS as a remedy for female SUI were retrieved from various electronic databases, including MEDLINE, EMBASE, and the Cochrane Controlled Trial Registry system. Moreover, reference lists for related papers were carefully screened for relevant studies.

Results:

A total of six RCTs evaluating the effect of MS in treating female SUI were included in this study. Compared with the placebo group, the MS group exhibited higher quality-of-life scores [mean difference (MD) 0.59, 95% credibility interval (CI) 0.23–0.95; p = 0.001] and lower International Consultation on Incontinence Questionnaire scores (MD −3.93, 95% CI −5.85 to −2.01; p < 0.0001). Moreover, they exhibited a higher objective cure rate (odds ratio 8.49, 95% CI 3.08–23.37). In addition, MS treatment reduced the number of episodes of urinary incontinence (MD −1.42, 95% CI −2.24 to −0.59; p = 0.0007) and urine loss on pad test (MD −4.67, 95% CI −8.05 to −1.28; p = 0.007). There were no significant treatment-related adverse reactions.

Conclusion:

This study evaluated the efficacy and safety of MS in the treatment of female SUI. The results have important implications for patients who do not wish to undergo surgical therapy. We found that MS treatment for SUI has positive outcomes, however, future studies should aim at establishing the best protocol for optimizing the therapeutic effect.
A new nonlinear lifting line method for aerodynamic analysis and deep learning modeling of small unmanned aerial vehicles
Authors: Karali Hasan , Inalhan Gokhan , Umut Demirezen M , Adil Yukselen M
Published: July 2021

In this work, a computationally efficient and high-precision nonlinear aerodynamic configuration analysis method is presented for both design optimization and mathematical modeling of small unmanned aerial vehicles. First, we have developed a novel nonlinear lifting line method which (a) provides very good match for the pre- and post-stall aerodynamic behavior in comparison to experiments and computationally intensive tools, (b) generates these results in order of magnitudes less time in comparison to computationally intensive methods such as computational fluid dynamics. This method is further extended to a complete configuration analysis tool that incorporates the effects of basic fuselage geometries. Moreover, a deep learning based surrogate model is developed using data generated by the new aerodynamic tool that can characterize the nonlinear aerodynamic performance of unmanned aerial vehicles. The major novel feature of this model is that it can predict the aerodynamic properties of unmanned aerial vehicle configurations by using only geometric parameters without the need for any special input data or pre-process phase as needed by other computational aerodynamic analysis tools. The obtained black-box function can calculate the performance of an unmanned aerial vehicle over a wide angle of attack range on the order of milliseconds, whereas computational fluid dynamics solutions take several days/weeks in a similar computational environment. The aerodynamic model predictions show an almost 1-1 coincidence with the numerical data even for configurations with different airfoils that are not used in model training. The developed model provides a highly capable aerodynamic solver for design optimization studies as demonstrated through an illustrative profile design example.
Arthroscopic Management of Giant Cell Tumor of the Calcaneus
Authors: Wiratnaya I Gede Eka , Subawa I Wayan , Astawa Putu , Nugraha Hans Kristian
Published: July 2021

Giant cell tumor of the calcaneal bone is a very rare entity and generally seen in the 30 to 40 years age group. We report a case of a 17-year-old male with giant cell tumor of the calcaneus, presented with left heel pain without another obvious physical abnormality. Radiographs showed a lobulated, well-defined, lytic lesion of the calcaneus with narrow transitional zone without periosteal reaction, no extraosseal spread, and no lung metastases. Arthroscopic procedure was done directly for both diagnostic and curative procedures. All soft, grayish lesions were completely removed arthroscopically using direct lateral portals and the suspected reactive zones debrided using high-speed burr and injected with corticosteroid. Histopathology confirmed the suspected diagnosis. The postoperative clinical course was uneventful with immediate pain relief and full weight bearing and movement allowed soon. The patient had no recurrent pain as well as recurrent radiographic lesions, and normal joint mobility 9 months postoperatively. Considering the accessibility of the lesion, giant cell tumor of the calcaneal bone can be successfully treated arthroscopically using direct lateral approach.

Levels of Evidence: Therapeutic, Level IV: Retrospective, case report
High Risk Features Contributing to 30-Day Readmission After Acute Ischemic Stroke: A Single Center Retrospective Case-Control Study
Authors: Loebel Emma M. , Rojas Mary , Wheelwright Danielle , Mensching Connor , Stein Laura K.
Published: July 2021

Background and Purpose:

Risk of 30-day stroke readmission has been attributed to medical comorbidities, stroke severity, and hospitalization metrics. The leading etiologies appear to vary across institutions and remain a moving target. We hypothesized that patients with increased medical complexity have higher odds of 30-day readmission and the immediate time after discharge may be most vulnerable. We aimed to characterize patients with 30-day readmission after acute ischemic stroke (IS) and identify predictors of post-IS readmission.

Methods:

We performed a retrospective case-control study analyzing post-IS 30-day readmission between January 2016-December 2019 using data from Mount Sinai Hospital’s Get With The Guidelines database. We performed chi square analyses and multivariate adjusted logistic regression model including age, sex, coronary artery disease (CAD), renal insufficiency (RI), history of prior stroke or TIA, length of stay (LOS) > 7, and NIHSS ≥ 5.

Results:

6.7% (n = 115) of 1,706 IS encounters had 30-day readmission. The 115 cases were compared to 1,591 controls without 30-day readmission. In our adjusted model, CAD (OR = 1.7, p = 0.01), history of prior stroke or TIA (OR = 1.6, p = 0.01), LOS >7 (OR = 1.7, p = 0.02), and NIHSS ≥ 5 (OR = 4.5, p < 0.001) predicted 30-day readmission. 65% (n = 75) of readmitted patients had readmission within 14 days post-discharge.

Conclusions:

Patients with post-IS 30-day readmission were more likely to have complex medical comorbidities and history of stroke or TIA compared to controls. Patients with more severe stroke and longer LOS may benefit from individualized transition of care plans and closer follow up during the vulnerable 30-day post-stroke period.
3D bioprinting for skin tissue engineering: Current status and perspectives
Authors: Weng Tingting , Zhang Wei , Xia Yilan , Wu Pan , Yang Min , Jin Ronghua , Xia Sizhan , Wang Jialiang , You Chuangang , Han Chunmao , Wang Xingang
Published: July 2021

Skin and skin appendages are vulnerable to injury, requiring rapidly reliable regeneration methods. In recent years, 3D bioprinting has shown potential for wound repair and regeneration. 3D bioprinting can be customized for skin shape with cells and other materials distributed precisely, achieving rapid and reliable production of bionic skin substitutes, therefore, meeting clinical and industrial requirements. Additionally, it has excellent performance with high resolution, flexibility, reproducibility, and high throughput, showing great potential for the fabrication of tissue-engineered skin. This review introduces the common techniques of 3D bioprinting and their application in skin tissue engineering, focusing on the latest research progress in skin appendages (hair follicles and sweat glands) and vascularization, and summarizes current challenges and future development of 3D skin printing.
Prevalence of depressive symptoms due to COVID-19 and associated factors among healthcare workers in Southern Ethiopia
Authors: Wayessa Zelalem Jabessa , Melesse Girma Tufa , Amaje Hadona Elias , Wako Wako Golicha
Published: July 2021

Objectives:

Globally, novel coronavirus disease 2019 (COVID-19) has spread rapidly since it was first identified and challenging the provision of essential services for low-resource countries. Healthcare workers involved in providing care are at high risk of developing mental health problems. The aim of this was to determine the prevalence of depressive symptoms due to COVID-19 and associated factors among healthcare workers in the West Guji zone in public health facilities, southern Ethiopia.

Methods:

A facility-based cross-sectional study was conducted in public health facilities found in the West Guji zone. A simple random sampling technique was employed to select 283 study subjects. This study was used to assess the prevalence of depression symptoms using Depression, Anxiety and Stress Scale-21, a depression subscale. Descriptive statistics, binary and multiple logistic regressions were used. Adjusted odds ratios (AORs) with 95% confidence interval will be estimated to assess the strength of associations and statistical significance will be declared at a p-value < 0.05.

Results:

Out of 283 eligible healthcare workers, 275 respondents had participated in this study with a 97.2% response rate. The prevalence of depressive symptoms was 21.5%. The independent predictors associated with depressive symptoms due to COVID-19 were age (adjusted odds ratio = 2.35, 95% confidence interval = 1.126–3.95), family size (adjusted odds ratio = 3.56, 95% confidence interval = 1.09–11.62), alcohol use (adjusted odds ratio = 4.31, 95% confidence interval = 1.76–10.55), medical illness (adjusted odds ratio = 9.56, 95% confidence interval = 3.71–24.59), having training on COVID-19 (adjusted odds ratio = 0.37, 95% confidence interval = 0.17–0.81), and lack of knowledge on COVID-19 (adjusted odds ratio = 15.34, 95% confidence interval = 6.32–37.21).

Conclusion:

The prevalence of depressive symptoms among healthcare workers due to COVID-19 was high. Factors associated with depressive symptoms were age, family size, alcohol use, medical illness, having training on COVID–19, and lack of knowledge on COVID-19.
Thrombotic microangiopathy following saw-scaled viper (Echis carinatus) envenoming in Sri Lanka
Authors: Pirasath Selladurai , Athirayan Chandrakulasegeran , Gajan Dilani
Published: July 2021

The saw-scaled viper ( Echis carinatus) is considered as a highly venomous snake in Sri Lanka. The clinical manifestations are localized pain and swelling, coagulopathy and renal impairment. Thrombotic microangiopathy is rarely reported as a complication of saw-scaled viper envenoming. The clinical manifestations of thrombotic microangiopathy include thrombocytopenia, microangiopathic haemolytic anaemia and acute kidney injury. The consumption coagulopathy of post-envenoming could be followed by a syndrome consistent with thrombotic microangiopathy. We describe a patient with thrombotic microangiopathy following saw-scaled viper systemic envenoming which was managed with antivenom and supportive therapy. The dead snake which was brought by patient was identified by medical professional as saw-scaled viper ( E. carinatus) based on morphological features. This case illustrates a rare manifestation thrombotic microangiopathy following saw-scaled viper envenoming.
Diabetes mellitus remission in a cat with hyperadrenocorticism after cabergoline treatment
Authors: Miceli Diego D , Zelarayán Gabriela S , García Jorge D , Fernández Viviana , Ferraris Sergio
Published: July 2021

Case summary

A 7-year-old spayed female domestic shorthair cat weighing 5 kg was referred with polyuria, polydipsia, lethargy, abdominal distension and dermatologic abnormalities. Diabetes mellitus was diagnosed and treatment was started with a diet for diabetic cats and insulin glargine (1 IU q12h SC). Hyperadrenocorticism (HAC) was suspected and diagnosed based on clinical signs, increased urinary cortisol:creatinine ratio, lack of suppression on low-dose dexamethasone suppression test and abdominal ultrasonography demonstrating bilateral adrenal enlargement. Oral cabergoline (10 μg/kg every other day) was initiated. After the second administration of cabergoline, the cat suffered from clinical hypoglycemia and no longer required insulin. One month after insulin withdrawal, blood work and urine analysis results showed normoglycemia, a normal serum fructosamine concentration (244 μmol/l) and normal urine analysis without glycosuria. Diabetic remission persisted until its death 7 months later. In addition, cabergoline treatment was associated with improvement in clinical signs such as lethargy, seborrhea, alopecia and abdominal distension.

Relevance and novel information

To our knowledge, this is the first reported case of the use of cabergoline in a cat with HAC, as well as the first reported case of diabetic remission in a cat with HAC after cabergoline treatment. Cabergoline could be an alternative treatment for diabetic cats with pituitary-dependent HAC. Further work should focus on different protocols with greater number of cases.
Designing mediation for Scottish Civil Courts: Options and opportunity
Authors: Ross Margaret L
Published: July 2021

In this article, the author examines whether the dispute resolution processes proposed in 2019 for civil courts in Scotland are suitable for the context of civil justice in Scotland in 2020 and the future. They are measured according to the policy context, what is known about the purposes of litigation, dispute system design and the needs and cultures of an adversarial civil justice system currently grappling with the impact of coronavirus restrictions.
Exposure to Violence Among Syrian Refugee Women Preflight and During Flight: A Population-Based Cross-Sectional Study in Sweden
Authors: Okenwa-Emegwa Leah , Tinghög Petter , Vaez Marjan , Saboonchi Fredrik
Published: July 2021

Violence against women (VAW) is a hidden aspect of humanitarian emergencies, especially during conflicts, and prevalence estimates remain scarce. An adequate response to VAW in humanitarian contexts requires information regarding the extent of the problem and associated factors, including the role of past violence. This study is a questionnaire survey of a random sample of 452 Syrian refugee women resettled in Sweden. Findings show that the prevalence of any violence preflight and during flight was 25.1% and 7.8%, respectively. Older women and women exposed to violence preflight were more likely to experience violence during flight. Findings suggest the need for more trauma-informed systems of handling asylum seekers and refugees, as a humanitarian principle. Other implications for research and practice are discussed.
Teachers’ Ratings of Students’ Learning Disabilities and Self-Reported Learned Helplessness of Polish Junior High School Students
Authors: Gindrich Piotr Alfred
Published: July 2021

The purpose of this study was to examine the levels of self-assessed dimensions of learned helplessness in a Polish sample of junior high school students. To qualify the students for the learning-disabled (LD) and the nonlearning-disabled (NLD) groups, the teachers’ ratings of the students’ learning disabilities (LDs) and comorbid disorders symptoms severity were used. The subjects were compared with respect to the three areas of learned helplessness: (a) contingency, (b) cognition, and (c) behavior. The T-tests analysis yielded that the students of LD group reported higher levels of learned helplessness in each of the three dimensions compared to the NLD group. In addition, the multivariate analysis of variance (MANOVA) effects of gender and group on the levels of learned helplessness were examined. Study limitations and the implications for teaching practice were also presented.
Using Metadiscourse to Enhance Persuasiveness in Corporate Press Releases: A Corpus-Based Study
Authors: Liu Shuai , Zhang Jingyuan
Published: July 2021

Previous studies have explored the genre characteristics and persuasive nature of press releases. However, systematic analyses of the metadiscursive devices for persuasive purposes are lacking for corporate press releases. Following a corpus-assisted approach, this study investigates the distribution patterns of different types of metadiscourse resources used to achieve persuasiveness in the corporate press release genre. A quantitative analysis of the corpus under study reveals the different frequencies of metadiscourse devices in corporate press releases, and comparisons are made across different genres with similar persuasive attempts. The factors underlying the similarities and differences in metadiscourse use across genres are also examined. A qualitative analysis supported with examples illustrates how different types of metadiscourse devices contribute to the rhetorical appeals of ethos, pathos, and logos and help to enhance persuasiveness. Major findings and their implications for business discourse learners and researchers as well as business practitioners are presented. The article ends with its limitations and recommends avenues for further research in this line of inquiry.
Text Cohesion in English Scientific Texts Written by Saudi Undergraduate Dentistry Students: A Multimodal Discourse Analysis of Textual and Logical Relations in Oral Biology Texts
Authors: Alyousef Hesham Suleiman
Published: July 2021

This qualitative study examined multimodal cohesive devices in English oral biology texts by eight high-achieving Saudi English-as-a-foreign-language students enrolled in a Bachelor of Science Dentistry program. A Systemic Functional Multimodal Discourse Analysis (SF-MDA) of the textual and logical cohesive devices in oral biology texts was conducted, employing Halliday and Hasan’s cohesion analysis scheme. The findings showed that students used varied cohesive devices: lexical cohesion, followed by reference and conjunctions. Although ellipsis was minimally employed in the oral biology texts, its discipline-specific uses emerged: the use of bullet points and numbered lists that facilitate recall. The SF-MDA of cohesion in multimodal semiotic resources highlighted the processes underlying construction of conceptual and linguistic knowledge of cohesive devices in oral biology texts. The results indicate that oral biology discourse is interdisciplinary, including a number of subfields in biology. The SF-MDA of pictorial oral biology representations indicates that they include instances of cohesive devices that illustrate and complement verbal texts. The results indicate that undergraduate students need to be provided with a variety of multimodal high-cohesion texts so that they can successfully extend underlying conceptual and logical meaning-making relations.
Unlocking a Continent of Opportunity: Entrepreneurship and Digital Ecosystems for Value Creation in Africa
Authors: Mafimisebi Oluwasoye P. , Ogunsade Adekunle I.
Published: July 2021

National policies framework for entrepreneurship and digital ecosystems play a key role in setting local communities and nations for the creation and capture of value in the digital age. This article draws on entrepreneurial ecosystems and high-growth entrepreneurship theory to explore opportunities and the challenges of digital economy in Africa. We theorize that entrepreneurial and digital ecosystems framework is key to creating a robust digital economy as unregulated organic digital ecosystems may not sustain business growth, value creation and poverty alleviation. A more system approach to entrepreneurship is advocated to facilitate disparate resources to collaboratively drive and unlock a continent of opportunities through digital economic growth. The study offers practical policy insights and digital entrepreneurship ecosystem framework that will provide direction and catalytic foundation to accelerate digital entrepreneurial capacity and growth in Africa.
Simultaneous Left Ventricular Aneurysm and Ventricular Septal Rupture Complicating Delayed STEMI Presentation: A Case-Based Review of Post-MI Mechanical Complications Amid the COVID-19 Pandemic
Authors: Goraya Muhammad Hassan Naeem , Kalsoom Sidra , Almas Talal , Amin Muhammad Kashif , Hussain Nadeem , Awan Junaid Rasul , Ehtesham Maryam , Niaz Muhammad Ali , Virk Hafeez Ul Hassan , Filby Steven J.
Published: July 2021

Amid the coronavirus disease 2019 (COVID-19) pandemic, there is an unprecedented increase in public avoidance of hospitals predominantly driven by fear of contracting the virus. Recent publications highlight a re-emergence of rare post–myocardial infarction complications. While mechanical complications are infrequent in the era of primary percutaneous coronary intervention, they are associated with high mortality rates. The concurrent occurrence of mechanical complications such as left ventricular aneurysm and ventricular septal rupture is an extremely rare entity. We hereby delineate a unique case of a 53-year-old Caucasian male who underwent successful concomitant closure of a ventricular septal rupture, left ventricular aneurysmectomy, and 3-vessel coronary artery bypass grafting. Due to a delayed initial presentation owing to the patient’s fear of contracting COVID-19, the surgery was carried out 3 months after the myocardial infarction. His postoperative evaluation confirmed normal contractility of the left ventricle and complete closure of the ventricular septal rupture. Six months postoperatively, the patient continues to do well. We also present a literature review of the mechanical complications following delayed presentation of myocardial infarction amid the COVID-19 pandemic. This article illustrates that clinicians should remain cognizant of these extremely rare but potentially lethal collateral effects during the ongoing global public-health challenge. Furthermore, it highlights a significant concern regarding the delay in first medical contact due to the reluctance of patients to visit the hospital during the COVID-19 pandemic.
MEAN 6 YEAR CLINICAL OUTCOMES, SURVIVORSHIP, AND RETURN TO SPORTS AFTER ARTHROSCOPIC CAPSULAR REPAIR WITH SUTURE ANCHORS FOR ADOLESCENT MULTIDIRECTIONAL SHOULDER INSTABILITY
Authors: Mitchell Brendon C. , Siow Matthew Y. , Carrol Alyssa , Pennock Andrew T. , Edmonds Eric W.
Published: July 2021

Background:

Multidirectional shoulder instability (MDI) refractory to rehabilitation can be treated with arthroscopic capsulolabral reconstruction with suture anchors. No studies have reported on outcomes or examined the risk factors that may contribute to poor outcomes in adolescent athletes.

Hypothesis/Purpose:

To identify risk factors for surgical failure by comparing anatomic, clinical, and demographic variables in adolescents who underwent surgical intervention for MDI.

Methods:

All patients undergoing arthroscopic shoulder surgery at one institution between January 2009 and April 2017 were reviewed. Patients >20 years old at presentation were excluded. Multidirectional instability was defined by positive drive-through sign on arthroscopy plus positive sulcus sign and/or multidirectional laxity on anterior and posterior drawer testing while under anesthesia. Two-year minimum follow-up was required, but those whose treatment failed earlier were included for reporting purposes. Demographics and intraoperative findings were recorded, as were Single Assessment Numeric Evaluation (SANE) scoring, Pediatric and Adolescent Shoulder Survey (PASS), and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) results.

Results:

Eighty adolescents (88 shoulders) were identified for having undergone surgical treatment of MDI. Of these 80 patients, 42 (50 shoulders; 31 female, 19 male) were available at a minimum of 2-year follow-up. Mean follow-up was 6.3 years (range, 2.8-10.2 years). Thirteen (26.0%) shoulders experienced surgical failure defined by recurrence of subluxation and instability, all of which underwent re-operation. Time to re-operation occurred at a mean of 1.9 years (range, 0.8-3.2). Our cohort had an overall survivorship of 96% at 1 year after surgery and 76% at 3 years. None of the anatomic, clinical, or demographic variables tested, or the presence of generalized ligamentous laxity, were correlated with subjective outcomes or re-operation. Number of anchors used was not different between those that failed and those that did not fail. Patients reported a mean SANE score of 83.3, PASS score of 85.0, and QuickDASH score of 6.8. Return to prior level of sport (RTS) occurred in 56% of patients.

Conclusion:

Multidirectional shoulder instability is a complex disorder that can be challenging to treat. Adolescent MDI that is refractory to non-surgical management appears to have long-term outcomes after surgical intervention that are comparable to adolescent patients with unidirectional instability. In patients who do experience failure of capsulorraphy, we show that failure will most likely occur within 3 years of the index surgical treatment. [Table: see text][Figure: see text]
ANTERIOR CRUCIATE LIGAMENT TEAR FOLLOWING SURGICAL TREATMENT OF PEDIATRIC TIBIAL EMINENCE FRACTURE IN A MULTICENTER COHORT
Authors: O’Donnell Ryan , Bokshan Steven , Brown Kelsey , Aoyama Julien T , Ganley Theodore J , Fabricant Peter D , Patel Neeraj M. , Ellis Henry B , Green Daniel W , Jagodzinski Jason E , Kushare Indranil , Lee R Jay , McKay Scott , Rhodes Jason , Sachleben Brant , Sargent Catherine , Schmale Gregory A. , Yen Yi-Meng , Mistovich R Justin , Cruz Aristides I.
Published: July 2021

Background:

While operative treatment of displaced pediatric tibial eminence fractures has generally been shown to be safe, post-operative complications including arthrofibrosis, infection, fixation failure, and postoperative ipsilateral ACL injuries remain prevalent. The purpose of this study was to describe the prevalence of and risk factors for post-operative ACL tears in a cohort of patients surgically treated for tibial eminence fracture.

Methods:

We performed a retrospective review of children undergoing treatment of a tibial eminence fracture at 10 tertiary children’s hospitals.. The primary outcome was subsequent ACL rupture. Patients with 2 year follow up data and those that had met the primary outcome within the 2 year period, were analyzed for demographics, risk factors and survival analyses

Results:

385 pediatric patients were reviewed. Overall, 46 patients had either 2 year follow up data or met the primary outcome measure of an ACL tear prior to the 2 year mark. Mean age was 11.2 years old (SD 2.8), and the median follow time was 36.4 months (SD 17.7 months) There was a 21.7% incidence of subsequent ACL tear in the cohort analyzed. Subsequent ACL tears occurred at a median of 10.2 months (SD 19.5 months) postoperatively. There was a statistically significant association with higher Myers & McKeever grade tibial spine fractures (Type III and IV) and subsequent ACL rupture ( p=0.006). Subsequent ACL tears occurred in patients who were older when they had their original tibial eminence fracture, 13.4 years old versus 11.3 years old ( p=0.035). There was no statistically significant relationship between ipsilateral ACL tear and body mass index, operative time, fixation method used, postoperative weight bearing status, type of postoperative immobilization, contact versus non-contact injury mechanism, type of post-operative physical therapy protocol based on chi-squared or t-test ( p>0.05).

Conclusion:

Subsequent ipsilateral ACL tears following operatively treated pediatric tibial eminence fractures in a large multicenter cohort occurred at a rate of 21.7%. They were associated with completely displaced (Type III or IV) tibial eminence fractures, and older patients. Clinicians should therefore continue to follow patients for at least 2 years after treatment of pediatric tibial eminence fractures in order to track this potential complication. [Table: see text]
PREOPERATIVE 3D MODELING AND PRINTING FOR GUIDING PERIACETABULAR OSTEOTOMY
Authors: Shelton Trevor J. , Shafagh Monazzam , Calafi Arash , Leshikar Holly B. , Haus Brian M.
Published: July 2021

Background:

Achieving adequate acetabular correction in multiple planes is essential to the success of Periacetabular Osteotomy (PAO). Three-dimensional (3D) modeling and printing has the potential to improve preoperative planning by accurately guiding intraoperative correction.

Hypothesis/Purpose:

We, therefore, asked the following questions: 1) For a patient undergoing a PAO, does 3D-modeling with intraoperative 3D-printed models create a reproducible surgical plan to obtain predetermined parameters of correction including lateral center-edge angle (LCEA), anterior center-edge angle (ACEA), Tonnis angle, and femoral head extrusion index (FHEI), 2) Can 3D computer modeling accurately predict when a normalized FHEI can be achieved without the need for a concomitant femoral sided osteotomy?

Methods:

A retrospective review was conducted on forty-two (42) consecutive patients that underwent a PAO. 3D-modeling software was utilized to simulate a PAO in order to achieve normal LCEA, ACEA, Tonnis angle, and FHEI. If adequate FHEI was not achieved, a femoral osteotomy was simulated. 3D-models were printed as intraoperative guides. Preoperative, simulated, and postoperative ACEA, LCEA, Tonnis angle, and FHEI were measured and compared statistically.

Results:

40 patients had a traditional PAO, and 2 had an anteverting-PAO. The simulated LCEA, ACEA, Tonnis angle, and FHEI were within a median difference of 3º, 1º, 1°, and 0% of postoperative values, respectively and showed no statistical difference. Of those that had a traditional PAO, all thirty-four (34) patients were correctly predicted to need a traditional acetabular sided correction alone and the other six (6) were correctly predicted to need a concomitant femoral osteotomy for a correct prediction in 100% of patients.

Conclusion:

This study demonstrated that in PAO, 3D-modeling and printing allow the surgeon to accurately create a reproducible surgical plan to obtain predetermined postoperative hip coverage parameters. This new technology has the potential to improve preoperative/intra-operative decision making for hip dysplasia and other complex disorders of the hip.
INTER-RATER RELIABILITY OF THE PRONE APPREHENSION RELOCATION TEST (PART)
Authors: Watchmaker Lauren E. , Hetzel Scott J. , Sink Ernest L. , Spiker Andrea M.
Published: July 2021

Background:

Hip dysplasia and related instability can cause pain, limit hip function, and ultimately result in osteoarthritis. The Prone Apprehension Relocation Test (PART) augments existing radiographic markers and clinical provocative maneuvers in diagnosing hip dysplasia. Reproducibility of the PART between examiners has not been previously studied.

Hypothesis/Purpose:

One measure of the potential clinical utility of the PART depends on the reproducibility of test results by evaluating providers including physicians, licensed athletic trainers, and physical therapists. The purpose of this study is to determine the inter-rater reliability of the PART between health care professionals.

Methods:

We retrospectively identified patients in our institution’s hip preservation registry who presented between September 2017 and June 2019 for evaluation of hip pain. Patients included in the study had the PART performed by two health care professionals who were blinded to the other’s results. Inter-rater reliability was assessed using the Cohen 𝜅, with a value of 𝜅 ≥ 0.75 considered excellent inter-rater reliability, between 0.75 and 0.40 moderate, and ≤ 0.40 poor.

Results:

96 patients (190 hips) were included, with 63 females and 35 males, average age 32 ± 12.1 years. 23 hips had a positive PART from both examiners. Inter-rater reliability was excellent between health care professionals for the PART when evaluating the right hip (𝜅 = 0.80), left hip (𝜅 = 0.82), and when combining the results for left and right (𝜅 = 0.81). A sub-analysis of patients who had a positive PART from both raters demonstrated that 19 of the 23 hips had a lateral center edge angle > 25°.

Conclusion:

Our study demonstrates that the PART is a reliable physical exam maneuver in the evaluation of hip pain.
THE EPIDEMIOLOGY OF PEDIATRIC MENISCAL ALLOGRAFT TRANSPLANTATION IN THE UNITED STATES
Authors: Smith Haley E. , Lyons Madeline M. , Patel Neeraj M.
Published: July 2021

Background:

Meniscal allograft transplantation (MAT) is an option to slow the progression of degenerative disease in the setting of substantial meniscal deficiency. This may be especially important in children and adolescents, but there is little literature on MAT in this population.

Hypothesis/Purpose:

The purpose of this study was to evaluate the epidemiology of MAT in the pediatric population, with specific attention to regional and demographic trends.

Methods:

The Pediatric Health Information System, a national database consisting of 49 children’s hospitals, was queried for all patients undergoing MAT between 2011 and 2018. Demographic information was collected for each subject as well as data regarding previous and subsequent surgeries. The database was also queried for all meniscus surgeries (including repairs and meniscectomies) performed during the study period. Demographic and geographic data from this control group were compared to that of children undergoing MAT. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors.

Results:

A total of 27,168 meniscus surgeries were performed in 47 hospitals, with MAT performed 67 times in 17 hospitals. Twelve patients (18%) underwent a subsequent procedure after transplantation. In multivariate analysis, each year of increasing age resulted in 1.1 times higher odds of having undergone MAT rather than repair or meniscectomy (95% CI 1.03-1.1, p=0.002). Patients that underwent transplantation had 2.0 times higher odds of being female (95% CI 1.2-3.3, p=0.01) and 2.0 times higher odds of being commercially insured (95% CI 1.1-3.6, p=0.02). MAT was performed most frequently in the Northeast (4.9/1000 meniscus surgeries) and least often in the South (1.1/1000 meniscus surgeries, p<0.001). Furthermore, transplantation was more likely to be performed in larger cities. The median pediatric population of cities in which MAT was performed was 983,268 (range 157,253-3,138,870) compared to 662,290 (range 4,420-4,311,500) in cities where it was not (p=0.04).

Conclusion:

In the United States, patients that underwent MAT were older, more likely to be female, and have commercial insurance than those undergoing meniscus repair or meniscectomy. MAT was only done in 17/47 children’s hospitals that perform meniscus surgery and was most frequently performed in the Northeast and in larger cities. These trends highlight the need for further research, especially regarding differences along the lines of sex and insurance status.
NUMERICAL RATING SCALE AS A PREDICTOR OF AN UNDERLYING PATHOLOGY IN PEDIATRIC BACK PAIN USING MAGNETIC RESONANCE IMAGE AS DIAGNOSTIC TOOL
Authors: Lindsay Eduardo A. , Olivella Gerardo , Rodríguez Manuel , Burgos-Rossy Edwin , Torres-Acevedo Natalia , Ramírez-Roggio Daniela , Iriarte Iván , Ramírez Norman
Published: July 2021

Background & Objectives:

Recently, constant and night pain has been discarded as adequate clinical markers to predict the presence of an underlying pathology in pediatric back pain. The pain intensity has been recognized as an important domain in the pain assessment. Numerical Rating Scale (NRS) is one of the most common validated tools to assess pediatric pain intensity in children above 8 years of age. The aim of this study is to assess NRS as a predictor of underlying pathologies found by magnetic resonance image (MRI) in pediatric back pain. We hypothesize that a higher NRS score is associated with a high sensitivity, specificity and likelihood ratio to identify the present of organic pathology in pediatric chronic back pain.

Methodology:

After obtaining Institutional Review Board approval, a retrospective electronical medical record review was conducted. All pediatric patients who reported back pain lasting > 4 weeks between 2009 to 2018 were enrolled in the study. As per regular protocol, a pediatric orthopedic surgeon evaluated all patients who presented with back pain. After a non-diagnostic history, physical examination and spinal x-ray; spine MRI was order. Pain was graded with the use of NRS from 0 to 10. Patients were divided in two groups: NRS (1-5) & NRS (6-10). Variables such as gender, age, pain frequency, night pain, neurological exam, and the presence of an underlying pathology were compared between both groups. Patients that presented with injury due to trauma, previous diagnosis of back pain or cervical pain were excluded.

Results:

A total of 467 patients were evaluated in the study. Mean age of subjects was 15 years; 69% being female. An underlying pathology was identified in 131/315 (41.6%) patients with NRS (6-10), and 55/152 (36.2%) patients with NRS (1-5) (P=0.27). Patients with NRS (6-10) had two times more probability of suffering constant pain (P<0.03) and three times more likely of having an abnormal neurological examination (P<0.05). See table 1.

Conclusion:

Evaluation and treatment of children and adolescent with chronic back pain is challenging. Our study shows a strong association between NRS high (6-10) and constant pain and/or abnormal neurological exam. However, the use of NRS of (6-10) was not found as adequate predictor for the presence of an underlying organic pathology in children and adolescent patients. Therefore, physicians should not rely only high NRS score to recommend advance imaging study to assess chronic back pain in children and adolescent patients.

[Table: see text]
CLEARANCE BASED ON STANDARDIZED RETURN TO SPORTS ASSESSMENT FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN PEDIATRIC AND ADOLESCENT PATIENTS
Authors: Bergman Rachel , Kent Robert , Kellum Jessica , Crawford Eileen
Published: July 2021

Background:

Return to sports (RTS) is often the primary concern of patients following anterior cruciate ligament reconstruction (ACLR). Unfortunately, RTS at the preinjury level is not commonplace in pediatric patients despite advances in rehabilitation and measures of recovery, and second injury rates are highest among the young adolescent population. RTS criteria have become more rigorous in recent years. The impact of these new RTS assessments (RTSA) is still unfolding, and their application in a mixed pediatric and adolescent population is unclear.

Purpose:

To assess whether adolescent patients who undergo standard ACLR pass a rigorous RTSA sooner than those undergoing pediatric ACLR.

Methods:

This study was a retrospective chart review of patients ages >5 and <18 with primary, unilateral ACL tear who underwent ACLR from January 2017 to December 2019. Subjects were identified using current procedural terminology codes from the hospital electronic medical record then grouped based on ACL reconstruction technique: Adolescent (transphyseal approach) and Pediatric (complete or partial physeal-sparing approach). All subjects underwent a rigorous and standardized RTSA used by the operating surgeons to guide clearance to RTS. The primary outcome measure was post-operative time to clearance for RTS, with secondary analyses controlling for sex, concomitant pathology at the time of ACLR, number of RTSAs prior to clearance, and physical therapy provider. Parametric and nonparametric statistical comparisons were respectively performed via unpaired Student t-tests and Mann-Whitney U tests (p<0.05).

Results:

Of 426 identified ACLR patients, 97 (84 Adolescent, 13 Pediatric) met the inclusion criteria for the final analysis (39 M, 58 F; Adolescent mean age 16.44 ± 1.7 years, Pediatric mean age 13.21 ± 1.4 years). There were no significant differences in gender distribution or concomitant pathology between the groups. Median post-operative time to clearance for RTS was 12.2 months in the Pediatric group (95% CI: 10.9-12.7) and 9.3 months in the Adolescent group (95% CI: 8.9-9.8) (p<0.001). This difference in time to RTS between groups remained statistically significant after adjusting for the secondary variables described above (all p≤0.002).

Conclusions:

When applying a rigorous and standardized RTSA to determine readiness for RTS, Pediatric subjects who underwent a partial or complete physeal-sparing technique took nearly 3 months longer to be cleared than Adolescent subjects who underwent a standard transphyseal approach. Notably, Adolescent subjects averaged more than 9 months of rehabilitation prior to RTS. These findings help inform patient expectations for a safe recovery period following ACLR.
MAGNETIC RESONANCE IMAGING OF LATERAL MENISCAL POSTERIOR ROOT TEARS IN THE ADOLESCENT KNEE: IS THE DIAGNOSIS MISSED, MENTIONED, OR MADE?
Authors: Schlechter John A. , Gornick Bryn , McDonald Edward J. , Pak Theresa
Published: July 2021

Background:

The meniscal roots play a vital role in maintaining proper knee kinematics. Neglected meniscal root tears place excess stress on the articular cartilage and increase the risk of premature osteoarthritis. As opposed to medial meniscal root tears, lateral meniscal posterior root tears (LMPRTs) are more likely to be associated with anterior cruciate ligament (ACL) pathology. Failure to identify and address meniscal root tears may place undue loads on ACL grafts and lead to inferior post-surgical outcomes.

Purpose:

To examine preoperative knee magnetic resonance imaging (MRI) radiologist interpretations for the identification of lateral meniscal root pathology in children and adolescents.

Methods:

We performed a retrospective review of children and adolescents that underwnent knee arthroscopy between 3/1/2010 and 4/1/2020 and had an arthroscopically confirmed LMPRT. Arthroscopic findings were compared to the reading radiologist’s preoperative MRI interpretations. LMPRTs were graded using the LaPrade classification. ANOVA was performed to assess if body mass index (BMI), open physes, time from injury to MRI, time from MRI to surgery, MRI magnet field strength, musculoskeletal radiologist designation, insurance type and tear grade were associated with the preoperative MRI identification of a LMPRT.

Results:

During the study period, 1285 knee arthroscopies were performed. 607 of which were ACL reconstructions. 54 children were found to have a LMPRT arthroscopically and all were associated with an ACL tear 54/607 (9%). One patient had 2 preoperative MRIs for a total of 55 MRIs in 54 pateints. Average age was 16 years (range 14-21). Preoperative MRI diagnosis of a LMPRT was made in only 14/55 (25%) and missed in 22/55 (40%). In 19/55 (35%), pathology of the lateral meniscus nonspecific to the root was mentioned. Lateral joint line tenderness was present in 23/54 (46%). There was no statistical significance found in regards to patient BMI, skeletal maturity, time from injury to MRI, time from MRI to surgery, MRI magnet strength, if the radiologist was musculoskeletal fellowship-trained, or insurance type, with a reliable diagnosis. (Table)

Conclusion:

The final interpretation of preoperative MRIs did not provide a clear definitive diagnosis of a LMPRT in 75 % in patients. As the intraoperative management of LMPRTs can be involved and diverge from standard meniscal work, preoperative diagnosis would be advantageous. All LMPRTs in this study were associated with a concomitant ACL tear. Surgeons caring for ACL tears in children and adolescents should be prepared to treat a LMPRT regardless of a inconclusive MRI interpretation for meniscal root pathology. [Table: see text]