bluuebunny/crossref_metadata_2025 huggingface dataset:
Plain Radiographs Have Limited Utility in the Evaluation of Discoid Lateral Meniscus
Authors: Schlesinger Reid P. , Rangwani Sean M. , Patel Neeraj M.
Published: May 2022

Background:

Debate persists regarding which radiographic measurements are important when investigating a possible discoid lateral meniscus and the utility of x-rays in the diagnostic workup.

Hypothesis/Purpose:

The purpose of this study was to identify differences in various measurements between healthy knees and those with a discoid meniscus while controlling for other patient characteristics.

Methods:

Radiographs of patients with a confirmed discoid lateral meniscus were matched by age and sex to those with a healthy knee (verified by magnetic resonance imaging). The following parameters were associated with discoid meniscus in previous studies and were measured on x-ray for each subject: lateral joint space height (both in the central and medial portion of the compartment; LJSH-C and LJSH-M, respectively), medial joint space height, fibular head height (FHH), lateral tibial spine height, femoral inter-epicondylar distance, lateral tibial plateau obliquity, and chordal distance of the femoral condyle (medial and lateral). Ratios were calculated between LJSH-C/M and medial joint space height. Univariate analysis was followed by multivariate regression to adjust for confounders.

Results:

The study included 57 patients with a discoid meniscus and 55 controls with a mean age of 11.0±3.5 years (50% female). The median LJSH-C for subjects with a discoid meniscus was 7.3 mm [interquartile range (IQR) 2.1] compared to 5.8 mm (IQR 2.2) in normal knees (p<0.001). A similar difference was found for LJSH-M [6.9 mm (IQR 2.9) vs. 5.4 mm (IQR 2.4), p=0.002]. Mean FHH was lower for discoid menisci than controls (12.5±4.0 mm vs. 14.9±5.9 mm, p=0.01). No other radiographic measurements were significantly different between cases and controls. When adjusting for covariates in regression analysis, the presence of a discoid meniscus was predictive of a higher LJSH-C and LJSH-M and lower FHH. Of note, age and sex were also significantly predictive in these models. Patients with a discoid meniscus had 3.5 times higher odds of LJSH-C ≥7 mm [95% confidence interval (CI) 1.5-8.3, p=0.005), 3.3 times higher odds of LJSH-M ≥6 mm (95% CI 1.4-7.9, p=0.006), and 3.1 times higher odds of FHH <16 mm (95% CI 1.2-7.8, p=0.02).

Conclusion:

After controlling for other factors, LJSH-C, LJSCH-M, and FHH on plain radiographs were associated with a discoid lateral meniscus. However, many previously reported measurements were not predictive. While these parameters may aid diagnostic decision making when there is suspicion for a discoid meniscus, age and sex must also be considered. Advanced imaging may be required to confirm the diagnosis.
Altered Joint Powers During Running After Tibial Bone Stress Injury
Authors: Lyons Samuel M. , Morgan Jeffery J. , Chan Salinda K. , Kraus Emily A.
Published: May 2022

Background:

Tibial bone stress injuries (tib-BSI) are common in adolescent runners. Previous research has examined running mechanics as possible risk factors for tib-BSI’s and implications have been observed for both kinematic and kinetic measures. Combining these measures to examine power absorption and production of the lower extremity can provide context on mechanical differences in individuals with a history of tib-BSI.

Hypothesis/Purpose:

The purpose of this study was to examine total limb power and percent joint contribution in healthy adolescent runners compared to peers with a history of tib-BSI. It was hypothesized that runners with a history of tib-BSI would have a greater contribution of power production and absorption at the ankle, and less at the hip and knee joints, with no difference in total power.

Methods:

Twenty-six runners were divided into groups: history of tib-BSI (n=14; male=10, female=4; age=16±2) and healthy controls (n=12; male=5, female=7; age=18±7). Data were collected using 3D motion capture with embedded force plates during overground running at self-selected pace. Total limb power and percent joint contribution were calculated from joint work. Positive and negative joint work was summed from the integrations of the joint power-time curve in each plane. Joint work was divided by step-time to obtain total joint power. Joint powers for the hip, knee, and ankle were summed to determine total limb power and percentage of limb power was calculated for each joint. Variables were grouped by control limb (CON), uninvolved limb (UNI), and involved limb (BSI). Both limbs in the healthy controls were averaged to generate the CON group. A one-way ANOVA was used to compare the variables of limb and joint power.

Results:

There were no significant differences between BSI and UNI limbs for any variables measured. The CON group exhibited significantly greater hip negative power compared to the BSI group (p=0.047), and significantly less ankle negative power compared to the BSI (p=0.001) and UNI groups (p=0.002). Despite a significant difference in total positive power between groups (p=0.04), there were no differences in joint positive power. Variables are presented in Table 1.

Conclusion:

This study is preliminary evidence that adolescent runners with a history of tib-BSI can present with adaptations in running mechanics that are not limited to the injured leg. Negative power may be more sensitive to change with the ankle increasing its contribution, comparatively. Clinicians and researchers should be aware of this adaptation after injury as it may influence treatment.
Remodeling of Adolescent Displaced Clavicle Fractures: A Facts Study
Authors: Pennock Andrew T. , Bae Donald S. , Boutelle Kelly , Busch Michael T. , Carroll Alyssa , Edmonds Eric W. , Ellis Henry B. , Hergott Katelyn , Kocher Mininder S. , Li Ying , Nepple Jeffrey J. , Pandya Nirav K. , Perkins Crystal , Sabatini Coleen S. , Spence David D. , Willimon Samuel C. , Wilson Philip L. ,   FACTS Study Group (Function after Adolescent Clavicle Trauma and Surgery [FACTS], prospective, multicenter cohort study), Heyworth Benton E
Published: May 2022

Background:

The phenomenon of bony remodeling of healed displaced clavicle midshaft fractures in adolescents remains poorly understood.

Hypothesis/Purpose:

The purpose of the current study was to evaluate and quantify clavicle remodeling in a large population of adolescents with completely displaced fractures treated non-operatively to understand the factors that may influence this process.

Methods:

Patients were identified from the database(s) of a multi-center study group investigating the functional outcomes of adolescent clavicle fractures. Patients between the ages of 10 and 19 years with completely displaced mid-diaphyseal clavicle fractures that were treated non-operatively who had further imaging of the affected clavicle at a minimum of 9 months from initial injury were included. Radiographic measurements were performed on the injury and final follow-up films. Fracture remodeling was subjectively classified as ‘complete/near-complete’, ‘moderate’, or ‘minimal’ (Figure 1) and subsequently analyzed quantitively and qualitatively to determine factors associated with deformity correction.

Results:

Eighty-one patients (mean age of 14.4±2.2 years) were analyzed at a mean radiographic follow-up of 34.8±24.3 months. Fracture shortening, superior displacement, and angulation significantly improved during the follow-up period by 60%, 57%, and 38% respectively. Fracture remodeling was found to be associated with patient age and follow-up time, with younger patients and those with longer follow-up undergoing more remodeling. All patients <14 years and 83% of patients ≥14 years-old at time of injury with a minimum follow-up of four years underwent complete/near-complete remodeling.

Conclusion:

Significant clavicle remodeling occurs in adolescent patients with displaced fractures, including older adolescents and particularly when followed for longer time intervals. This finding may help explain why symptomatic malunions are so infrequently observed in adolescent patients, even in severely displaced fractures. [Figure: see text]
Sport-Specific Amcamp: New Modular Tools For Measuring Adolescent Self-Confidence in Sport-Specific Movement
Authors: May Keith H. , Espinoza William C. , Guccione Andrew A.
Published: May 2022

Background:

Despite increasing interest throughout sports rehabilitation in psychological factors that affect outcome such as the impact of self-efficacy on readiness to return to play, few clinical tools are available to assess a patient’s self-confidence in performing sports-specific movement patterns in the pediatric/adolescent population prior to return to sport.

Hypothesis/Purpose:

The purpose of this study was to develop and validate sports-specific modules to supplement a general measure of movement self-efficacy, the Adolescent Measure of Confidence and Movement Performance (AMCaMP) and provide clinicians with reliable and valid tools to assess adolescent self-confidence in performing sports-specific movements.

Methods:

After preliminary testing for readability and ease of administration, we administered one of 12 sport-specific modules pertinent to the individual’s sport (baseball, softball, basketball, football, gymnastics, cheerleading, soccer, ballet, swimming, lacrosse, tennis, and cross country), to a total of 14,744 patients, 11-18 years of age, who were drawn from 12 pediatric sports physical therapy facilities in a single health care system. Respondents completed the assigned sport-specific self-report questionnaire both at their initial visits and upon conclusion of their episodes of care. Results were analyzed using classical test theory measures including but not limited to factor analysis suitability, exploratory factor analysis, and confirmatory factor analysis.

Results:

Based on sample sizes, Bartlett’s Test of Sphericity, and Kaiser-Myer-Olkin measures, nine of the 12 candidate modules (baseball, softball, basketball, football, gymnastics, cheerleading, soccer, ballet, and swimming) were deemed suitable for factor analysis. The sample for each module was then divided into a test sample and a validation sample to avoid model overfitting and to check for generalizability. Exploratory factor analysis revealed an underlying structure ranging from one to three factors depending upon the particular module. Subsequent confirmatory factor analyses fully supported the hypothesized factor structures for each module except swimming. Additional analyses to determine coefficient alpha (range=0.8-0.976), Standard Error of Measurement (range=1.12-2.33), and Minimum Detectable Change (range=3.1-6.47) confirmed the reliability of each of these modules.

Conclusion:

The AMCAMP sport-specific modules are reliable and valid self-report tools to capture self-confidence in performing essential movements specific to a sport and supplement the AMCAMP’s evaluation of self-efficacy in performing the general movements of everyday life. The results of this study support the use of the AMCAMP sport-specific modules as a reliable and valid self-report instruments as part of the overall clinical evaluation of psychological readiness to return to sport.
Covid-19 Restrictions and the Effects of Physical Activity on Mental Health in Midwestern Adolescent Adaptive Athletes
Authors: Choe Joshua , Azerf Saji , Lang Pamela
Published: May 2022

Background:

The COVID-19 pandemic and related lockdowns in 2020 negatively impacted high school students, with increased depression and anxiety especially in athletes who participated in team sports. For adolescents with disabilities, physical activity provides physical and mental health benefits; however, the impact of COVID-19 related adaptive sports cancellations have not been thoroughly investigated.

Hypothesis:

Adaptive athletes with lower activity levels during a period of COVID-19 related restrictions will have worse scores of depression, anxiety, and quality of life.

Methods:

Institutional Review Board (IRB) exemption was granted. Adaptive athletes ages 12-21 were identified through Midwestern adaptive athletic associations. Athletes completed a survey between June 2020 and January 2021 including Patient Health Questionairre-9 Item (PHQ-9) for depression, General Anxiety Disorder-7 Item (GAD-7) anxiety, Pediatric Functional Activity Brief Scale (PFABS) for activity level, and Pediatric Quality of Life Inventory 4.0 (PedsQL) for quality of life. PFABS and PedsQL were modified as appropriate to adaptive athletes. Univariate analysis was performed using chi-square tests to assess the association between activity and mental health. Student T-tests were used for multivariate analysis to assess the role of sex, grade in school, and individual vs team sport participation on quality of life.

Results:

Twenty-four respondents completed the survey in its entirety, with majority from Wisconsin, Minnesota, and Illinois. Demographics are shown in Table 1. There was no significant association between physical activity levels and GAD-7 (R2=-0.040), PHQ-9 (R2=-0.020) or PedsQL (R2=-0.043). Activity levels of adaptive sports athletes did not differ by gender, sport type or school grade (Table 1).

Discussion:

Unlike previous work in able-bodied adolescents, we found no correlation between physical activity and scores related to depression and anxiety among adolescent adaptive sports athletes during COVID-19. Additionally, there were no difference in activity levels nor mental health scores by gender, sport type nor school grade, a proxy for age. While, the sample size in this study was a fraction of those used in previous work, adaptive athletes are a small proportion of adolescent athletes. Adaptive athletes, who face greater challenges in society on a daily basis, may have had lower quality of life measures at baseline or more sophisticated coping mechanisms already in place providing fortitude in mental health in the face of the pandemic.

Conclusion:

In a small cohort of adaptive athletes in the Midwest region of the USA, sport related cancellations had no association with mental health scores from June 2020 to January 2021. [Table: see text]
Return to Play Rates of Young Athletes After Patellofemoral Instability Treatment
Authors: Brenner Madison , Cooper Savannah , Johnson Benjamin L. , Wyatt Charles W. , Wilson Philip L. , Ellis Henry B.
Published: May 2022

Background:

Following non-operative or operative treatment, many young patients with patellofemoral instability (PFI) desire to return to sport. The rate of return to play in young athletes following PFI treatment is not well known.

Hypothesis/Purpose:

To examine the return to play rates of skeletally immature and mature patients after either non-operative or operative treatment for PFI.

Methods:

Patients from a pediatric sports medicine clinic diagnosed with PFI prospectively followed over a 4+ year time frame were evaluated. Patients who had documented physical exam follow-up with a recorded date of return to play (RTP) were included in the study. Demographics, skeletal maturity, type of treatment, and physical exam details were included in the analysis.

Results:

Within this cohort of 62 knees, 35 of the 54 knees that played a primary sport (63.4%; mean age=14.87±2.02) ultimately returned to activity. 28 were skeletally immature (45.2%) and 34 were mature (54.8%). 5 knees received non-operative treatment (8.06%), and 57 received operative treatment (91.94%), including medial patellofemoral reconstruction, tibial tubercle osteotomy, and lateral release, among other procedures. 75.81% of patients were female, and 24.19% were male. The average time from PFI treatment to return to play was 236.48 days (±108.95). This time did not significantly differ between males and females, nor skeletally immature or mature knees (p=0.485; p=0.629). No physical exam points, such range of motion, J-sign, or patellar apprehension, were significant. Residual signs and symptoms were infrequent, but not absent at RTP: 11.1% positive apprehension, 8.5% mild J-sign, and 5.2% continued pain or instability in one or more locations on their knee at RTP. Significantly fewer skeletally mature patients returned to their primary sport after treatment (95.5% immature vs 40% mature, p<0.0001) not necessarily related to their knee or treatment. 32.76% of knees included had bilateral instability, which could increase average RTP if these athletes were not receiving simultaneous treatment.

Conclusion:

Over half of young athletes treated at a sports medicine clinic returned to play following PFI treatment.
Objective Diagnosis of Multidirectional Instability in Adolescent Patients Based on Glenohumeral Joint Capsule Dimensions on MR Analysis
Authors: Yoder Mason , Veerkamp Matthew , McDonald Colin , Parikh Shital N.
Published: May 2022

Background:

Multidirectional Instability (MDI) of shoulder in adolescents is a clinical diagnosis and there are no defined objective criteria to validate the diagnosis. Most patients with MDI have no identifiable labral or capsular tear pattern on MR imaging.

Purpose:

To identify objective criteria for MDI diagnosis in adolescent patients based on glenohumeral capsular dimensions on MR imaging.

Methods:

In a comparative retrospective study, the clinical records and MR arthrogram of adolescent patients treated for shoulder instability at our center between 2008 and 2019 were reviewed. Twenty-four patients treated for MDI were age-matched to 25 patients treated for Bankart tears. The width and depth of the rotator interval and multiple linear dimensions of the glenohumeral capsule were measured on sagittal-oblique MR arthrography sequences, after controlling for glenoid size. These dimensions were compared between the 2 groups using Student’s t-test. Power analysis showed a sample size of 16 in each group to be sufficient to detect 5 mm difference in average capsular dimension of 20 mm (power 0.8).

Results:

24 patients (28 shoulders) 20 females, 4 males were in the MDI group; average age at time of surgery was 15.2 years (range, 8-20 yrs). The Bankart group consisted of 25 patients (27 shoulders), 9 females, 16 males; average age at time of surgery was 15.4 years (range, 11-18 yrs). The rotator interval depth was significantly greater in the MDI group than the Bankart group (MDI 8.5mm; Bankart 6.1mm) (p <0.01). The inferior, posteroinferior, and posterior dimensions (posterior-inferior quadrant, 3 to 6 o’clock position for left shoulder) of the glenohumeral joint capsule were significantly greater in the MDI group (inferior 24.5mm; posteroinferior 26.4mm, posterior 22.5mm) than in the Bankart group (inferior 20.4mm, posteroinferior 21.9mm, posterior 19.3mm) (p <0.01). Rotator interval width and all other capsular dimensions showed no statistically significant difference between the 2 groups.

Conclusion:

The depth of the rotator interval and dimension of the glenohumeral joint capsule in the posteroinferior quadrant on MR arthrography were significantly greater in adolescent patients with MDI. This is the first study to objectively quantify capsular volume in adolescent patients with MDI. This information needs to be further validated in prospective fashion and compared to normal capsular dimensions to calculate cut-off values for MDI diagnosis on MR analysis. [Figure: see text][Table: see text]
Arthroscopic Labral Repair of Adolescent Athlete Shoulder Instability With Knotted Versus Knotless Suture Anchors
Authors: Michelin Richard M. , Gornick Bryn R. , Schlechter John A.
Published: May 2022

Background:

Shoulder instability is a common and complex problem seen in adolescent athletes. The use of bioabsorbable suture anchors with arthroscopically hand tied knots is widely accepted and has shown to provide reliable biomechanical and clinical results. Knotless suture anchor technology has become increasingly popular with proposed advantages of minimizing technical difficulty as well as mitigating knot migration and subsequent intraarticular cartilage irritation and damage. While there have been studies comparing knotted versus knotless suture anchors, studies comparing clinical outcomes solely focused on the adolescent athlete are limited.

Purpose:

To evaluate and compare outcomes of adolescent athletes treated with arthroscopic labral repair using knotted versus knotless bioabsorbable suture anchors.

Methods:

Adolescent athletes with shoulder instability treated arthroscopically with labral repair and a minimum of 2 year follow up were retrospectively reviewed. All patients had < 20% glenoid bone loss and a non-engaging Hill Sachs lesion at surgery. Patients were divided into three cohorts based on suture anchor knot management – knotted, knotless and combined. Data points examined included post-operative return to primary sport, recurrent instability, re-operation, and patient reported outcome measures (PROMs) utilizing the Pediatric/Adolescent Shoulder Survey (PASS). PASS was only collected on patients with no reported subsequent instability events.

Results:

51 adolescent athletes (average age 16.3 ± 2.6 years) were identified. There were 20 athletes in the knotted fixation group, 17 in the knotless, and 14 in the combination group. Average follow up was 4.25 ± 1.2 years (Range 2.09-6.34 years). 46/51 athletes (90.2%) returned to sports post-operatively with only 34/51 athletes (66.7%) returning to their primary sport. Of the 17 athletes who did not return to their primary sport 14/17 athletes (82.4%) switched sports by choice, while the other 3/17 (17.6%) athletes stopped due to their shoulder. There were no significant differences between cohorts based on return to sport, re-operation, or post-operative PASS (average 90.2 ± 11.7). Recurrent instability episodes were reported in 12/51 athletes (23.5%), with significantly higher recurrence in the knotted group (7/20 athletes, 35%) and combination group (5/14 athletes, 35.7%), when compared to the knotless group (0/17 athletes, 0%). (p < 0.05).

Conclusion:

Arthroscopic labral repair for adolescent shoulder instability demonstrated high return to sport rates and equivalent PROMs with a significantly higher incidence of recurrent instability noted with knotted fixation when compared to knotless fixation. Favorable outcomes can be achieved in adolescent athletes undergoing shoulder stabilization with knotless suture anchors.
Low-Risk Foot and Ankle Stress Fractures in The Pediatric Population: A Case Series
Authors: Gremillion Matthew , Ghanta Ramesh , Borici Neritan , Kushare Indranil
Published: May 2022

Background:

Stress fractures are a common overuse injury in the pediatric population. Distal fibular and calcaneal stress fractures are considered low-risk stress fractures. Due to their rarity, they have not been studied as thoroughly as other stress fractures.

Purpose:

To present a descriptive case series of distal fibular and calcaneal stress fractures in the pediatric population and elaborate on demographics, mechanism of injury, management and outcomes.

Methods:

IRB-approved retrospective study included patients under 18 years at a tertiary children’s hospital who were diagnosed with a distal fibular or calcaneal stress fracture/reaction. Demographic data, mechanism of injury, physical exam, radiographic findings, treatment, and outcomes were collected. Descriptive statistical analysis was conducted.

Results:

11 patients, 6 distal fibula (4 female, 2 male) and 5 calcaneus (2 female, 3 male) with stress injury on clinical exam and on X-ray or MRI were included. Mean age was 11 years (1-15) and average BMI of 23.5 (16-30.7). The common presenting complaint was pain aggravated by activity that began an average of 3 weeks prior. 7/11 (63.6%) participated in competitive sports: 4/6 with fibular stress fractures were runners (cross country, soccer and sprinting) compared to 0/5 patients with calcaneal involvement. Typical radiographic findings (periosteal reaction, cortical thickening) and a corresponding physical exam was sufficient to diagnose fibular stress fractures in 5/6 patients, with one requiring MRI for definitive diagnosis. 4/5 patients with calcaneal stress fractures required an MRI for a definitive diagnosis, delaying the diagnosis by an average of 3 weeks. 5/6 patients with fibular stress fractures had no other associated pathology, such as additional stress fractures, bone cysts, or osteoid osteomas, whereas 3/5 with calcaneal injuries had at least one of these associated pathologies. Patients with isolated fibular or calcaneal stress fractures (7/11) improved with conservative management, including a controlled ankle motion (CAM) boot, PT, and full activity rest over an average of 6.5 weeks. Out of the remaining 4 patients with associated pathologies, 3/4 improved with conservative management alone after an average of 20 weeks; however, one patient required surgical removal of a bone cyst before complete recovery.

Conclusion:

A history of pain with significant running, X-ray findings, and physical exam findings were sufficient for diagnosis of fibular stress fractures; however, calcaneal stress fractures were often occult, requiring MRI for definitive diagnosis, and were associated with other pathologies. Conservative management was sufficient for treatment of 91% of patients, regardless of additional fractures or pathology. [Figure: see text][Figure: see text]
What are the Causes and Consequences of Delayed Surgery for Pediatric Tibial Spine Fractures?
Authors: Patel Neeraj M. , Leska Tomasina M. , Ganley Theodore J. , Aoyama Julien T. , Cruz Aristides I. , Ellis Henry B. , Fabricant Peter D. , Green Daniel W. , Jagodzinski Jason E. , Johnson Benjamin , Kushare Indranil , Lee Rushyuan J. , McKay Scott D. , Rhodes Jason T. , Sachleben Brant C. , Sargent M. Catherine , Schmale Gregory A. , Yen Yi-Meng , Mistovich R. Justin
Published: May 2022

Background:

The uncommon nature of tibial spine fractures may result in delayed presentation, diagnosis, and treatment. Elucidation of the contributing factors to such delays may provide an opportunity to improve patient care. Additionally, the outcomes of delayed surgery are unknown.

Hypothesis/Purpose:

The purpose of this study is to evaluate risk factors for, and consequences of, delayed surgical treatment of pediatric tibial spine fractures.

Methods:

We performed a retrospective cohort study of tibial spine fractures treated surgically at 10 institutions between 2000 and 2019. Demographic and pre-operative data were collected, as was intra-operative information and post-operative complications. Attention was focused on delays in evaluation and treatment, which were treated as both continuous and categorical variables. Surgery ≥21 days after injury was considered “delayed”. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors.

Results:

A total of 368 subjects (mean age 11.7±2.9 years) were included, 21.2% of which underwent surgery ≥21 days after injury. Patients who experienced delayed surgery had 3.8 times higher odds of being diagnosed with a TSF 1 or more weeks after injury [95% confidence interval (CI) 1.1-14.3, p=0.04], 2.3 times higher odds of having seen multiple clinicians prior to the treating surgeon (95% CI 1.1-4.8, p=0.02), 5.8 times higher odds of having magnetic resonance imaging 1 or more weeks after injury (MRI; 95% CI 1.6-20.8, p<0.007), and were 2.4 times more likely to have public insurance (95% CI 1.3-4.2, p=0.003). Meniscal injuries were encountered intra-operatively in 42.3% of those that had delayed surgery compared to 16.6% of patients that did not (p<0.001), resulting in 2.8 times higher odds in multivariate analysis (95% CI 1.6-5.0, p<0.001). Delayed surgery was also a risk factor for procedure duration longer than 2.5 hours (odds ratio 3.3, 95% CI 1.4-7.9; p=0.006). Patients who experienced delayed surgical management and an operation longer than 2.5 hours had 3.7 times higher odds of developing arthrofibrosis (95% CI 1.1-12.5, p=0.03).

Conclusion:

When surgery for a TSF was performed ≥21 days after injury, patients were at increased risk for concomitant meniscal pathology, longer case duration, and possibly post-operative arthrofibrosis. Those who experienced delays in diagnosis or MRI, saw multiple clinicians, and had public insurance were more likely to have a delay to surgery. These results provide an opportunity to optimize care for children that are at highest risk for delayed treatment.
Progression to Surgery in Adolescent Osteochondritis Dissecans of the ELBOW
Authors: Sandridge Brionna M. , Howell David R. , Albright Jay C.
Published: May 2022

Background:

Osteochondritis dissecans (OCD) is a disorder characterized by the separation of subchondral bone and articular cartilage from underlying bone due to lack of blood supply. Effective treatment and knowing whether a patient will need to have surgery is still debated.

Purpose:

The purpose of this study is to compare the characteristics and clinical outcomes of adolescent patients with OCD of the elbow whose treatment either progressed to surgery or did not.

Methods:

We performed a retrospective chart review of patients 7-17 years of age who were diagnosed with OCD of the elbow at a regional children’s hospital sports medicine surgery practice. Demographic and radiographic variables such as age, sex, skeletal maturity, range of motion, and lesion size were obtained. Clinical outcomes collected included time to return to sport and need for second surgery.

Results:

We identified 41 patients to meet inclusion criteria; 34 progressed to surgery and 7 did not. Of the 34 that eventually required surgery, 11 (32%) initially presented with stable lesions. There were no significant differences between groups regarding sex, age, skeletal maturity, or insurance type (Table 1). Loss of range of motion in the elbow was seen in 79% of patients who progressed to surgery and in 29% of those who did not (Table 1). Patients who progressed to surgery had significantly greater average lesion sizes on x-ray than those who did not (Table 2). Those who progressed to surgery also had significantly higher grade lesions on MRI compared to those who did not (Table 2). After adjusting for the independent effect of loss of range of motion, each increase in MRI lesion grade resulted in a 4.8X greater odds of eventually progressing to surgery (adjusted odds ratio=4.8, 95% CI=1.21, 19.17, p=0.026). We did not observe any significant differences between groups in time to return to sport.

Conclusions:

Overall, we observed that patients who progressed to surgery had initially worse OCD lesion grades compared to those who did not. This may be clinically useful when considering initial conservative treatment versus surgical intervention in these patients. Long term outcomes, including need for second surgery and return of symptoms, should be further investigated. [Table: see text][Table: see text]
The Racial Elevator Speech: How Multiracial Individuals Respond to Racial Identity Inquiries
Authors: Heilman Monica
Published: May 2022

Scholars have increasingly acknowledged that race is composed of multiple dimensions and that these dimensions do not always match. For example, an individual’s sense of personal identity can differ from the race they mark on surveys and/or how others interpret their racial identity based on appearance. The potential for racial mismatch is even greater for multiracial individuals, who are commonly asked racial identity inquiries by others wanting to know their racial background. In this article, I focus on multiracial individuals’ responses to racial identity inquiries to examine how these instances of expressed race may “mismatch” their internal race. Drawing on in-depth interviews with 30 multiracial young adults, I find that despite the wide range of identity options that multiracial Americans are presumed to have, participants typically responded to inquiries about race with consistent scripts that did not necessarily align with their personal identities. I refer to these scripts as “racial elevator speeches,” and discuss how they are primarily constructed not to express personal identity but to meet the expectations of others and mitigate the microaggressive nature of these questions. However, by constructing racial elevator speeches designed to be legible to others, individuals’ scripts inadvertently reify U.S. racial structures.
Media Framing of COVID-19 Racial Disparities: Lessons from Memphis, Tennessee
Authors: Turchi Jennifer , Melton-Fant Courtnee
Published: May 2022

COVID-19 has impacted millions of people in the United States, but Black individuals have been disproportionately burdened by this disease. Researchers find that individuals have used news media, especially local news media, to inform themselves about the coronavirus pandemic. Because of this, media has power in shaping the way we see and understand unfolding events related to COVID-19. Using framing theory and critical race theory, we conducted a thematic analysis of 59 Memphis news stories printed or aired between April 2020 and June 2020. We were interested in understanding how local media framed racial disparities in COVID-19 cases and deaths. We find that local media relied on individualist or biological explanations for why more Black Americans got COVID-19 and died from it. In addition, while some journalists acknowledged the role of systemic racism in COVID-19 health outcomes, most reaffirmed racial stereotypes grounded in cultural racism. Health inequities due to structural racism are persistent, yet local news overwhelmingly reported COVID-19 race disparities as an outcome due to individual health behavior instead of acknowledging the contemporary and historical systemic barriers that produced racial disparities in COVID-19 outcomes. The consequence was a public health response that relied on individual responsibility instead of proactive approaches to mitigating the spread and negative effects of COVID-19.
‘Preparation and Transition into Adult Life—Guide for Professionals’: An Educational Tool from the SOS Children’s Villages
Authors: Lobo Joana , Urbano Cláudia , de Carvalho Maria João Leote
Published: May 2022

SOS Children’s Villages work to protect and improve the lives of children and young people placed in alternative care system. The goal is to break the cycle of family and social disadvantage within this framework, it is essential to provide tools to professionals to support young people path towards autonomy and social integration as active citizens in civil society. This article aims to present and discuss the preparation and transition into adult life—A guide for professionals recently implemented in SOS Children’s Villages, Portugal, within the context of Project PORTA. Educating for autonomy arises as the main concern for the organization, individually and collectively, since it is responsible for the care and support of development needs of children and young people in its programmes. With this aim, this guide helps professionals and young people to promote better practices for developing autonomy skills and preparing transition to adult life, through the explanation of resources and structured intervention individual plans. Thereby, knowledge and practices are shared, expecting to be useful for others as well. A special focus is dedicated to the reinforcement of specific skills, protective factors and social areas, aiming the preparation for autonomy people in close collaboration with all the intervenient and, in particular, with the participation of young people.
Developing urban biking typologies: Quantifying the complex interactions of bicycle ridership, bicycle network and built environment characteristics
Authors: Beck Ben , Winters Meghan , Nelson Trisalyn , Pettit Chris , Leao Simone Z , Saberi Meead , Thompson Jason , Seneviratne Sachith , Nice Kerry , Stevenson Mark
Published: May 2022

Extensive research has been conducted exploring associations between built environment characteristics and biking. However, these approaches have often lacked the ability to understand the interactions of the built environment, population and bicycle ridership. To overcome these limitations, this study aimed to develop novel urban biking typologies using unsupervised machine learning methods. We conducted a retrospective analysis of travel surveys, bicycle infrastructure and population and land use characteristics in the Greater Melbourne region, Australia. To develop the urban biking typology, we used a k-medoids clustering method. Analyses revealed 5 clusters. We highlight areas with high bicycle network density and a high proportion of trips made by bike (Cluster 1; reflecting 12% of the population of Greater Melbourne, but 57% of all bike trips) and areas with high off-road and on-road bicycle network length, but a low proportion of trips made by bike (Cluster 4, reflecting 23% of the population of Greater Melbourne and 13% of all bike trips). Our novel approach to developing an urban biking typology enabled the exploration of the interaction of bicycle ridership, the bicycle network, population and land use characteristics. Such approaches are important in advancing our understanding of bicycling behaviour, but further research is required to understand the generalisability of these findings to other settings.
Minimally Invasive Distal Chevron Osteotomy for Symptomatic Bunionette: Clinical and Radiologic Results of a 31-Case Retrospective Study
Authors: Benavente Valdivia Juan Carlos , Thull Daniel M.
Published: May 2022

Background:

Bunionette is a common forefoot deformity that usually leads to significant discomfort. Multiple surgical techniques have been described for correcting bunionette. The purpose of this study is to analyze the clinical and radiologic outcomes of a new surgical technique via minimally invasive distal Chevron osteotomy of the fifth metatarsal without fixation, trying to find an effective technique with fewer complications.

Methods:

We retrospectively analyzed the data of 28 patients (31 feet) who presented with symptomatic bunionette that was resistant to conservative treatment and who underwent surgery at our center from February 2018 to February 2020. A minimum follow-up of 20 months was obtained (mean follow-up 26 months, range 20–37). Clinical results were evaluated using the visual analog scale (VAS) and the American Orthopaedic Foot & Ankle Society (AOFAS) score; 5 different radiologic parameters were analyzed.

Results:

After surgery, the mean AOFAS score increased by 29 points ( P < .001) and the mean VAS scores decreased by 6 points ( P < .001). An adequate radiologic correction was observed with a decrease in the M4–M5 intermetatarsal angle from 10.3 to 4.8 degrees ( P < .001), metatarsophalangeal angle by a mean of 16.05 degrees ( P < .001), and lateral deviation angle of the fifth metatarsal from 8.5 to 0.97 degrees ( P < .001). Moreover, the length of the fifth metatarsal and the forefoot width was reduced ( P < .001). The only complication was an asymptomatic delay in bone healing, but a complete bone consolidation was achieved after therapy.

Conclusion:

The proposed surgical technique shows a good correction capacity with excellent clinical and radiologic results and low complication rates. Level of Evidence: Level IV, retrospective case series.
Just water transitions at the end of sugar in Maui, Hawai‘i
Authors: Knudson Chris , Cantor Alida , Kay Kelly
Published: May 2022

In December 2016, Hawai‘i saw its last sugar harvest on a 36,000-acre plantation in Maui. In the preceding decades, Native Hawaiians had struggled to regain their water rights from a failing sugar industry that had dewatered the island's streams for centuries. Now, with the end of sugar, Native Hawaiian and environmental groups are working to restore traditional practices and diversified agriculture—goals which hinge upon changing water management practices and rewatering Maui's streams. In this paper we combine frameworks from the water justice literature with a just transitions framework typically applied to energy landscapes in order to examine ‘just water transitions’ in Maui. By synthesizing these frameworks, we show how water-based economic transitions can address the tradeoffs and reconfigurations of infrastructure and power required for a more just future. We examine three distinct visions of water management promoted by coalitions of actors in support of different types of agricultural production systems for the island. We argue that a just water transition – that is, a move toward a more culturally, politically, and ecologically just management of water – must engage with water-specific, place-specific, and historically grounded factors including the legacies of infrastructure, water laws, and powerful agricultural interests.
Energopower, statecraft and political legitimacy
Authors: Chandrashekeran Sangeetha
Published: May 2022

This paper draws on the notion of energopower ( Boyer 2014 ) to show the foundational role of electricity in the (re)production of political power in Australia. I show how conflicts surrounding electricity have reconstituted state-market-society relations and rescaled governance. I study a series of notable national-scale interventions and argue that, through the contingent and chaotic play of events in the political sphere, market-oriented governance regimes for electricity have been weakened, and the issue of electricity decarbonisation has become ‘weaponised’ for electoral benefit. I explain how national political leadership in Australia has stepped in from a constitutionally-weak position to govern electricity under pressure for environmentally-driven adaptation. I show four statecraft techniques that reconstitute electricity in new ways: discursively linking electricity governance to socio-environmental futures; national interest framings that are weaponized for electoral gain; tactical governance through parliamentary compromise and appeasement; and jettisoning market logics in favour of state intervention. This study recognises the limits of centralized state-making under a Federalist system but shows the potential for statecraft to reshape scalar-territorial relations and strengthen the role of the central state vis-à-vis the market. Vital resources like electricity are not just struggled over but, under the right conditions, can come to shape political power. There is neither infinite potential for state rescaling through the performance of legitimacy, nor do rigid scalar hierarchies simply block reconfigurations of state power. To understand the potential for resource struggles to re-scale state power attention must be paid to the techniques of statecraft that support and undermine legitimacy.
Water with larvae: Hydrological fertility, inequality, and mosquito urbanism
Authors: Acevedo-Guerrero Tatiana
Published: May 2022

Aedes aegypti, the primary vector for dengue, chikungunya and zika, breeds mainly in stored/stagnant water and thrives in contexts of rapid urbanization in tropical countries. Some have warned that climate change, in conjunction with urbanization, could drive the proliferation of Aedes aegypti mosquitoes. In Colombia dengue has been endemic since the 1990s and the country had the highest number of cases of zika virus in the world after Brazil. Studies have found that domestic stored water contributes to high percentages of the total Ae. aegypti pupal population in Colombian urban sectors. In particular, neighborhoods where water service provision is intermittent are vulnerable to mosquito-borne diseases as water is stored inside households. This article draws on archival work, interviews, and entomological literature to reflect on the ways in which rapid urbanization in the context of armed conflict, infrastructural inequality, the absence of formal jobs, and specific water laws and regulations produce water and Aedes aegypti in the city. It offers an initial attempt to theorize water with larvae by focusing on two interrelated processes. First, the historical and geographic processes that underlie the production of stored water, which despite being treated can become a place of fertility where mosquitoes can flourish. Secondly, the processes by which water, mosquitoes, pathogens, and human bodies become interrelated. This entails thinking about some homes in Barranquilla as socioecological assemblages that are dynamically produced, socially and materially.
Working with the end of water: Infrastructure, labour, and everyday futures of socio-environmental collapse in Mexico city
Authors: De Coss-Corzo Alejandro
Published: May 2022

This paper analyses how everyday futures of socio-environmental collapse are constituted by the situated interactions of people and infrastructure in Mexico City. I posit that everyday futures emerge at the intersection of infrastructures as accretions of socio-environmental projects, processes, and promises, and the situated practices that specific groups and individuals deploy when engaging with them. Here, I develop this argument by analysing the labour practices through which repair and maintenance workers and engineers at SACMEX, Mexico City's public water utility, engage with infrastructures that are tensed on the edge of breakdown. To do so, I introduce the notion of ‘modes of everyday futurity’, which holds together the infrastructural conditions that enable the emergence of everyday futures, and the labour practices that enact them differentially. I show how Mexico City's hydraulic infrastructures are shaped by austerity, the demands to supply and dispose of water to deal with the historical problems of excess and scarcity, and by the specific geological and hydrological conditions of the city. I then look at how workers and engineers engage differently with these infrastructures and show how these interactions produce two distinct modes of everyday futurity: management and displacement. The former enacts a future where catastrophe has already happened but not yet fully unfolded and can only be tactically contained in uneven ways. The latter enacts one where catastrophe might be still displaced spatiotemporally through the construction of new hydraulic infrastructures which promise to reiterate urban modernity not as a dream of equal progress but one of unequal survival. Interrogating the making of everyday futures in Mexico City through these modes, I contribute to literature on futurity, temporality, labour, and infrastructure across the social sciences by theorising the role that infrastructures, and the forms of labour that sustain them, have in making plural, non-linear futures.