bluuebunny/crossref_metadata_2025 huggingface dataset:
Who is a journalist now? Recognising atypical journalism work in the digital media economy
Authors: Zion Lawrie , Marjoribanks Timothy , O’Donnell Penny
Published: November 2022

For the past two decades, understandings of the scale of digital disruption in journalism work in post-industrialised countries have relied on data about newspaper closures, newsroom job losses and the creation of new full-time jobs in journalism. Yet, the digital economy has fostered new employment and work arrangements, and there is less secure employment in journalism, making it more difficult to define who is a journalist now. Using a case study of Australian journalists seeking re-employment after newsroom job loss, this article examines some of the emerging patterns of atypical journalism work. It concludes that attempts to measure the current extent of journalism work need to explicitly account for hybrid careers characterised by professional activities at the margins of or outside of traditional newsroom work. In the digital economy, journalists may undertake a range of journalism and non-journalism work simultaneously or sequentially.
How storytelling can work as a pedagogy to facilitate children’s English as a foreign language learning
Authors: Nguyen Thao Thi Phuong , Phillips Louise Gwenneth
Published: November 2022

Storytelling has a long tradition in education including language learning and teaching because of its extensive benefits in language development. In second and foreign language education, stories and storytelling have been integrated into school curricula to enhance language development; however, there is scarce empirical evidence about how storytelling facilitates children’s English as a foreign language (EFL) learning and its potential as a holistic pedagogy. This article explores a living educational theory (Whitehead & McNiff, 2006) of how storytelling works as a pedagogy in storytelling workshops with an English class at a private tuition centre in Vietnam to facilitate children’s EFL learning. Key pedagogical elements identified through the living theory methodology included storytelling as: a responsive strategy; multimodal scaffolding; mutual inspiration; and a linguistic model. Each of these elements is explained with illustrative examples from the storytelling workshops.
From causes to consequences: Investigating the effects of differentiated integration on citizens’ EU support
Authors: Vergioglou Ioannis , Hegewald Sven
Published: November 2022

Research on differentiated integration has paid considerable attention to its causes. However, we know very little about its consequences. Using the synthetic control method and interactive factor models, this article investigates the effects of differentiated integration on citizens’ support for the EU. We find that in cases where member states are granted an opt-out or are allowed to integrate into a policy area they were previously excluded from, support increases. In contrast, support decreases when member states are not granted a requested opt-out or are excluded from a policy area they would like to join. These findings carry important implications for the EU's legitimacy. While differentiated integration has the potential to enhance citizens’ legitimacy perceptions, it can also undermine them simultaneously.
Accelerating ventures in Kazakhstan: The case of ineffective effectiveness in talent retention
Authors: Abeuova Dana
Published: November 2022

Accelerators play an essential role in fostering regional development by offering various resources to entrepreneurs and their new ventures. Their services are critical for entrepreneurs in developing countries. However, the majority of the business incubator studies are concentrated on developed economies, while developing countries represent an under-researched domain. Scholars argue that research on accelerators and business incubators, in general, is not theoretical and mainly descriptive. Using the knowledge-based view and resource-based view theories, this study discusses how an accelerator based in Kazakhstan, a developing country in Central Asia, designs its programs. Then looking through the cognitive evaluation theory lens and comparing 13-month longitudinal data, it analyses how program design impacts talent retention. The study adds a theoretical perspective to the non-theoretical domain of accelerators and business incubators by emphasising the role of motivation in the retention of talent. It also theorises about the four main steps involved in the acceleration program design and discusses the critical factors that shape those steps in the context of emerging markets.
A Scoping Review on Sexual and Gender-Based Violence Medicolegal Service Provision in East Africa
Authors: Rockowitz Sarah , Flowe Heather , Bradbury-Jones Caroline
Published: November 2022

Sexual and gender-based violence (SGBV) is a leading cause of physical, emotional, and psychosocial problems around the world, with many countries in East Africa having rates above the global average. Despite the high prevalence in the region, service provision for post-SGBV care is often poorly funded, difficult to access, or simply nonexistent. This review reports the findings of a scoping review of literature from East Africa. The goals of this research were to evaluate existing service provision practices throughout the region, understand how provider bias may affect service provision, and compare existing practices to national policies and internationally agreed human rights treaties. This review identified 54 academic papers and reports through a search of electronic databases and grey literature sources, and four main themes emerged: (1) current models of service provision are inadequate to address the medical and psychosocial needs of survivors; (2) countries are not providing sufficient funding for services; (3) further research is needed into how to incorporate SGBV care into existing health systems and align with international human rights treaties; and (4) there is limited research in many countries in East Africa. The findings are likely to be of use to policy makers, nongovernmental organizations, and service providers working in the medical, legal, and justice systems.
The safety and effectiveness of the Contour Neurovascular System for the treatment of wide-necked aneurysms: A systematic review and meta-analysis of early experience
Authors: Ghozy Sherief , Lashin Basant I , Elfil Mohamed , Bilgin Cem , Kobeissi Hassan , Shehata Mostafa , Kadirvel Ramanathan , Kallmes David F
Published: November 2022

Background

The Contour is a new generation intrasaccular flow disruption tool that aims to cover the aneurysm neck and is sized according to the neck diameter. While several case series have been published, no literature review has been performed on this promising device.

Objective

To assess the safety and effectiveness profile of the Contour Neurovascular System for wide-necked aneurysms.

Methods

We followed the recommendations of the PRISMA checklist Four databases were searched with a supplemental manual search. All data were analyzed using R software version 4.2.1.

Results

We finally included six studies with 131 treated aneurysms. The overall procedural time was 97.27 (95% CI = 70.07–124.47) minutes, ranging from 78.9 to 136.0 min. The pooled adequate occlusion rate was 84.21% (95% CI = 75.45–90.25), and the overall functional independence rate was 94.74% (87.97–97.79). The overall adverse event rate was 4.70 (95% CI = 3.24–6.76), varying among different events from 0.78 to 8.53%. Thromboembolic events were the most commonly encountered in 8.53% of the patients (95% CI = 4.78–14.74), followed by headache and minor stroke with incidence rates of 5.88 (95% CI = 2.83–11.83) and 4.35 (95% CI = 1.41–12.63), respectively. The overall procedural time in studies using the Contour system only was 86.17 (95% CI = 68.70–10.64) minutes, while it was 136 (95% CI = 90.96–181.04) in the Contour-assisted coiling procedures. However, both techniques were comparable regarding adequate occlusion rates and functional independence.

Conclusion

With the anticipation of future studies, the Contour Neurovascular System is a safe and effective treatment option for wide-necked intracranial aneurysms.
Two-year follow-up after treatment of an aortic transection in the presence of an aberrant right subclavian artery
Authors: Warm Tobias D , Gosslau Yvonne , Scheurig-Muenkler Christian , Hyhlik-Duerr Alexander
Published: November 2022

Objectives

An aberrant right subclavian artery (ARSA) is one of the most common anatomic variants of the aortic arch. The combination of an ARSA and a transection is naturally rare.

Methods

This case report describes the treatment of a transection in the presence of an ARSA and the follow-up of two years.

Results

We successfully treated the contained rupture with a stentgraft. Both subclavian arteries had to be covered in the emergency setting. At the two-year follow-up, the patient did not suffer from any neurological impairment.

Conclusions

In emergency settings, primary cover of both subclavian arteries with a stentgraft can be performed in individual cases after risk assessment. Severe complications such as development of upper limb ischaemia, ASAS or reduced perfusion of the posterior cerebral circulation should be considered in treatment planning.
COVID-19 related peripheral arterial thrombotic events in intensive care unit and non-intensive care unit patients: A retrospective case series
Authors: Nana Petroula , Dakis Konstantinos , Spanos Konstantinos , Tsolaki Vasiliki , Karavidas Nikitas , Zakynthinos George , Kouvelos George , Giannoukas Athanasios , Matsagkas Miltiadis
Published: November 2022

Objectives

COVID-19 associated arterial thrombosis has been attributed to multiple inflammation and coagulation mechanisms. The aim of this study was to report the experience of a tertiary center on COVID-19 patients managed for acute peripheral arterial thrombosis.

Methods

A single-center case series was conducted, including retrospectively collected data from all COVID-19 patients presenting arterial thrombosis, from March 2020 to February 2022. Intensive care unit (ICU) and non-ICU cases were included. The primary outcomes were mortality, successful revascularization, and amputation at 30 days.

Results

Twenty patients presented peripheral arterial thrombosis (90% males, mean age 65 years (16–82 years)). Eighteen were diagnosed with the Delta variant and none was previously vaccinated. All cases presented acute lower limb ischemia; in 20% with bilateral involvement. Nine patients were hospitalized in the ward while 11 in the ICU. From the non-ICU cases, five presented Rutherford IIb and four cases, Rutherford’s IIa ischemia. Six cases underwent revascularization (67%). Two of them were finally amputated (33%) and two died during hospitalization (33%). Two revascularizations were considered successful (33%). The ICU group presented mainly with Rutherford’s III ischemia (54.5%). The mortality in the ICU cohort was 72.7%. Only one patient underwent successful revascularization and two were amputated in this subgroup. Early mortality was 50% for the total cohort while the type of management was not related to mortality.

Conclusions

Covid-19 related arterial thrombosis in non-vaccinated population is associated with 50% early mortality; increased up to 72% in the ICU patients. The amputation rate was 20% while only 40% of the revascularizations were considered successful.
Priming effects in reading words with vertically and horizontally mirrored letters
Authors: Pittrich Katharina , Schroeder Sascha
Published: November 2022

We conducted two masked priming experiments to examine how the orthographic system processes words with mirrored letters. In both experiments, four different primes were used: an identity prime, an unrelated control prime, and two mirror-primes in which letters were either mirrored at their vertical or horizontal axis. Task was varied between experiments: In Experiment 1, we used a lexical decision task, and in Experiment 2, we used a cross-case same–different match task. We expected to see priming effects in both mirror-conditions with stronger effects in the vertically than in the horizontally mirrored letters. In the lexical decision task, we observed only vertical priming effects for words, whereas in the same–different task, priming effects were present in both mirror-conditions and for both words and non-words. We discuss the implications of our findings for extant models of orthographic processing.
Making Space for Midwifery in a Hospital: Exploring the Built Birth Environment of Canada’s First Alongside Midwifery Unit
Authors: Murray-Davis Beth , Grenier Lindsay N. , Plett Rebecca A. , Mattison Cristina A. , Ahmed Maisha , Malott Anne M. , Cameron Carol , Hutton Eileen K. , Darling Elizabeth K.
Published: November 2022

Background:

Canada’s first alongside midwifery unit (AMU) was intentionally informed by evidence-based birth environment design principals, building on the growing evidence that the built environment can shape experiences, satisfaction, and birth outcomes.

Objectives:

To assess the impact of the built environment of the AMU for both service users and midwives. This study aimed to explore the meanings that individuals attribute to the built environment and how the built environment impacted people’s experiences.

Methods:

We conducted a mixed-methods study using a grounded theory methodology for data collection and analysis. Our research question and data collection tools were underpinned by a sociospatial conceptual approach. All midwives and all those who received midwifery care at the unit were eligible to participate. Data were collected through a structured online survey, interviews, and focus group.

Results:

Fifty-nine participants completed the survey, and interviews or focus group were completed with 28 service users and 14 midwives. Our findings demonstrate high levels of satisfaction with the birth environment. We developed a theoretical model, where “making space” for midwifery in the hospital contributed to positive birth experiences and overall satisfaction with the built environment. The core elements of this model include creating domestic space in an institutional setting, shifting the technological approach, and shared ownership of the unit.

Conclusions:

Our model for creating, shifting, and sharing as a way to make space for midwifery can serve as a template for how intentional design can be used to promote favorable outcomes and user satisfaction.
Stability of longitudinal DTI metrics in MS with treatment of injectables, fingolimod and dimethyl fumarate
Authors: Alshehri Abdulaziz , Al-iedani Oun , Koussis Nikitas , Khormi Ibrahim , Lea Rodney , Lechner-Scott Jeannette , Ramadan Saadallah
Published: November 2022

Background and purpose

Diffusion MRI (dMRI) is sensitive to microstructural changes in white matter of people with relapse-remitting multiple sclerosis (pw-RRMS) that lead to progressive disability. The role of diffusion in assessing the efficacy of different therapies requires more investigation. This study aimed to evaluate selected dMRI metrics in normal-appearing white matter and white matter-lesion in pw-RRMS and healthy controls longitudinally and compare the effect of therapies given.

Material and methods

Structural and dMRI scans were acquired from 78 pw-RRMS (29 injectables, 36 fingolimod, 13 dimethyl fumarate) and 43 HCs at baseline and 2-years follow-up. Changes in dMRI metrics and correlation with clinical parameters were evaluated.

Results

Differences were observed in most clinical parameters between pw-RRMS and HCs at both timepoints ( p ≤ 0.01). No significant differences in average changes over time were observed for any dMRI metric between treatment groups in either tissue type. Diffusion metrics in NAWM and WML correlated negatively with most cognitive domains, while FA correlated positively at baseline but only for NAWM at follow-up ( p ≤ 0.05). FA correlated negatively with disability in NAWM and WML over time, while MD and RD correlated positively only in NAWM.

Conclusions

This is the first DTI study comparing the effect of different treatments on dMRI parameters over time in a stable cohort of pw-RRMS. The results suggest that brain microstructural changes in a stable MS cohort are similar to HCs independent of the therapies used.
Proximal humerus fractures and shoulder dislocations: Prevalence of concomitant rotator cuff tear
Authors: Green Matthew , Whetter Ross , Al-Dadah Oday
Published: November 2022

Background: Proximal humerus fractures and shoulder dislocations are relatively common. However, an associated rotator cuff tear is often missed with these injuries. The objective of this study was to assess the prevalence of a concomitant rotator cuff tear associated with common shoulder injuries. Methods: A cross-sectional epidemiological study of three patient populations: Group 1. Proximal Humerus Fractures; Group 2. Shoulder Dislocations; Group 3. Proximal Humerus Fracture-Dislocations. All patients within these three groups presented to and underwent subsequent management of their shoulder injury at a trauma unit. Management included both non-operative and operative intervention. Patients were evaluated for associated rotator cuff tears. Results: This study included a total of 196 patients: Group 1 = 146 Proximal Humerus Fractures; Group 2 = 37 Shoulder Dislocations; Group 3 = 13 Proximal Humerus Fracture-Dislocations. Of the 196 patients in total, 23 (11.7%) sustained a concomitant rotator cuff tear. The highest number of tears was found in Group 1 ( n = 14). However, the highest percentage prevalence of tears was in Group 2 (18.9%). There was noted to be a higher prevalence of rotator cuff tears with increasing age. Twenty-two (95.7%) rotator cuff tears were detected in patients over 50 years of age. The vast majority of rotator cuff tears were detected by ultrasound (78.3%) as opposed to magnetic resonance imaging (21.7%). The majority of tears were full-thickness (60.9%). Of the 23 patients with a concomitant rotator cuff tear, 17 involved a single tendon (73.9%) and supraspinatus was most common (69.6%). Conclusions: A concomitant rotator cuff tear in association with a proximal humerus fracture, shoulder dislocation or proximal humerus fracture-dislocation is relatively common. The overall rotator cuff tear prevalence in this study was 11.9%. Rotator cuff tears are more likely to occur in patients over 50 years old and those sustaining a shoulder dislocation.
Primary Ewing’s Sarcoma of the Spine: About a Case
Authors: Cherraqi Amine , Lemrabet Abir , Dokal Ibrahima Diallo , Lrhorfi Najlae , Belghiti Hicham , Allali Nazik , Chat Latifa
Published: November 2022

Ewing’s sarcoma is a primary malignant bone tumor affecting individuals in the second decade of life. Primary sarcomas of the spine are rare and the occurrence of primary Ewing’s sarcoma in the spine is very rare. There are 2 types of Ewing’s sarcoma of the spine, Ewing’s sarcoma of the sacral spine which is very aggressive with a poor prognosis and Ewing’s sarcoma of the non-sacral spine which is an extremely rare occurrence. The patient may have a neurological deficit when the tumor extends into the spinal canal, causing compression of the spinal cord. Magnetic resonance imaging (MRI) is very sensitive in diagnosing the tumor and Evaluation of the extent of the tumor. Here, we report the case of a 12-year-old boy who presented with low back pain, weakness of both lower limbs and bilateral spastic paraplegia progressively evolving since 1 month. The CT and MRI scans showed the presence of a tissue lesion process centered on the vertebral body of L1, heterogeneously enhanced after injection of Gadolinium respecting the posterior arch, without bulging of the posterior wall with epiduritis, endocanal extension and spinal cord compression. The patient underwent decompression with surgical biopsy and posterior stabilization of the spine. Histopathology and immunohistochemistry studies confirmed the diagnosis of Ewing’s sarcoma and the patient was referred to an oncopediatric center for combined chemotherapy and radiotherapy, but died at home a few days later before the start of treatment.
How do urban services facilities affect social segregation among people of different economic levels? A case study of Shenzhen city
Authors: Wu Yuyang , Yao Yao , Ren Shuliang , Zhang Shiyi , Guan Qingfeng
Published: November 2022

Social segregation hinders the development of cities and has become a hot topic in urban research. Existing studies have focused on the difference in the distribution of crowd activities to measure segregation but have ignored the impact of the urban environment on crowd gathering and segregation. To study the impact and understand social segregation more comprehensively, we coupled mobile phone datasets and housing price data to divide city dwellers into three socioeconomic levels. Considering that spatial colocation is a necessary condition for interaction among various social groups, spatial colocation probability was proposed to quantitatively describe the degree of social segregation at the community scale. Point-of-interest (POI) data were introduced to represent the urban service facilities. The effect of urban service facilities on the segregation of different groups was analyzed by using geographically weighted regression (GWR). The results indicate three points, as follows. (1) Significant social segregation in Shenzhen mostly occurs in suburban and downtown areas, and the interaction segregation of people mainly occurs between people with high and low socioeconomic levels. (2) More economically inclusive and necessary service facilities (e.g., medical and insurance companies) can promote crowd interaction and ease the segregation of social activities. (3) The impact of service facilities on the interaction of various social groups is related to the development of the area where the activities occur, and the most significant impact is in high-tech industrial zones. This study quantitatively calculated the impacts of different service facilities on different groups of people in different communities and times. From the results, detailed and reasonable suggestions were made for city planners.
Linking Migration, Diversity and Regional Development in India
Authors: Chakraborty Meghamrita
Published: November 2022

Diversity is important for cultural and economic factors. Diversity is an inclusive concept and has proven to enhance team performance, foster innovation and be better for overall economic factors. Migration is a continuing phenomenon in India, and each region possesses its own unique culture and skills. Migrants from different places of birth bring their own culture and specific skills which is beneficial for the regional human capital and economies. With the help of the fractionalisation index and panel regression models, the paper finds that diversity, as measured by migration by place of birth has a positive and significant relationship with the income growth of the states. This is consistent with a trend of increased migration to the industrialised or higher GDP states, such as Gujarat, Maharashtra, Tamil Nadu and Karnataka. The study shows that the diversity of people originating from different regions is beneficial for economic progress. This mobility and assimilation of people and cultures will positively affect a region and economy.
Increasing Rate of Shoulder Arthroplasty for Geriatric Proximal Humerus Fractures in the United States, 2010–2019
Authors: Shi Brendan Y , Upfill-Brown Alexander , Kelley Benjamin V , Brodke Dane J , Mayer Erik N , Devana Sai K , Kremen Thomas J , Lee Christopher
Published: November 2022

Introduction

The two historically dominant surgical options for displaced geriatric proximal humerus (PHFx) fractures are open reduction internal fixation (ORIF) and hemiarthroplasty (HA). However, shoulder arthroplasty (SA), predominantly in the form of reverse total shoulder arthroplasty (RTSA), has emerged as an attractive treatment option. We aim to compare the utilization trends, complications, and costs associated with surgical management of geriatric proximal humerus fractures (PHFs) between 2010 and 2019. We hypothesized that 1) the proportion of patients undergoing SA would increase over time, 2) the short-term complication rate in patients undergoing SA would decline over time, and 3) hospital related costs would decline for SA patients over time.

Patients and Methods

The National Inpatient Sample was queried from 2010 to 2019 to identify all PHFx in patients aged 65 or older that underwent ORIF, SA, or HA. Multivariable regression was used to evaluate differences between fixation methods regarding health care utilization metrics, hospital costs, and index hospital complications. The primary outcome of interest was the method of surgical management utilized in the treatment of geriatric PHFs, and secondary outcomes of interest included hospitalization cost, length of stay (LOS), discharge destination and index hospitalization complications.

Results

A total of 105 886 geriatric patients that underwent surgical management of PHFx were identified. While the proportion undergoing ORIF decreased from 59% to 29%, the proportion undergoing SA increased from 9% to 67%. Hospital costs decreased over time for patients treated with SA and increased for those treated with ORIF. Compared to ORIF, SA was associated with higher cost, decreased length of stay, and lower mortality and complication rates.

Conclusion

Over the last decade, SA has become the most common surgical treatment modality performed for geriatric PHFx. Index hospital complications are reduced in SA patients compared to ORIF patients, driven largely by a lower rate of blood transfusion. Although costs are decreasing and average length of stay is now lower in SA patients compared to ORIF patients, SA remains associated with higher hospital costs overall.
Hemiarthroplasty of the Ankle Joint: Mid-Term Results
Authors: Mombello Franco L. , Ortiz Cristian A. , Carcuro Giovanni M. , Pellegrini Manuel J. , Redlich Alex , Chaparro Felipe R.
Published: November 2022

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Tendinopathy of the flexor hallucis longus is a common condition that occurs with considerable frequency, but in some specific situations, due to a content (tendon)/continent (retomalleolar groove) conflict, could manifest a scenario in which the tendon suffers entrapment during its entry to the tunnel and clinically represented as hallux saltans

Methods:

We present a case report of a young active patient without any of the conditions or etiological agents previously described in the literature that could explain the cause of this rare condition. After failing conservative treatment, we performed arthroscopic release of the tendon and the fibrous tunnel, achieving direct visualization and minimal soft tissue injury

Results:

At 6 months, the patient resumed sports and activity of daily living without any type of sequelae.

Conclusion:

Hallux saltans is a rare condition mostly idiopathic in its origin. After conservative measures fail, surgical management is an option, which consists of resecting FHL enlargement to its original width and freeing the fibro-osseous tunnel in the back of the talus in order to solve the space conflict during its normal gliding. An arthroscopic approach is optimal as it allows a good visualization without harming soft tissues and allowing a quicker recovery.
‘Haleem's Hen’: A Mnemonic for the Anatomy of Hindfoot Structures at the Level of Sustentaculum Tali on Coronal T1-Weighted Magnetic Resonance Images
Authors: Moritz Brandon W. , Amin Amgad M. Haleem
Published: November 2022

Category:

Hindfoot; Ankle

Introduction/Purpose:

Magnetic resonance anatomy of the hindfoot as seen at the level of the sustentaculum tali is intricate due to surrounding muscles, tendons, aponeurosis and ligaments. The objective of this work is to provide a mnemonic with illustrative figures to simplify this complex anatomical region on coronal T1-weighted magnetic resonance images (T1-MRIs).

Methods:

One hundred and twenty-four patients referred for foot and ankle complaints were scanned utilizing standard MRI imaging protocols for evaluation of the hindfoot. Only coronal T1-MRIs of the calcaneus at the level of sustentaculum tali of unremarkably reported patients were selected for the development of this mnemonic. T1- and T2-MRIs of an additional set of patients with hindfoot pathologies were selected to demonstrate how this mnemonic is adapted to identify specific pathologies.

Results:

Upon viewing the calcaneus with the adjacent anatomical structures on coronal T1-MRIs, the overall appearance resembles a ''Hen in the Nest with Four Eggs.'' The calcaneus represents the body of the hen, while the sustentaculum tali forms the head and neck. The posterior tibial tendon represents the crest of the hen, and the flexor digitorum longus and flexor hallucis longus tendons represent its beak and wattle, respectively. The peroneus brevis and peroneus longus tendons represent the tail, and the long plantar ligament represents the flexed legs of Haleem's hen. The plantar aponeurosis represents the hen's nest. Whereas the abductor hallucis, flexor digitorum brevis, abductor digiti minimi and quadratus plantae muscles are the four eggs. Pes planus, flexor digitorum brevis hemangioma, Baxter's neuropathy associated with chronic denervation abductor digiti minimi atrophy and peroneal tendonitis are some of the hindfoot pathologies that can be identified utilizing the mnemonic.

Conclusion:

The mnemonic, 'Haleem's Hen in the Nest with Four Eggs,' serves as a simplified phrase for orthopedic surgeons, radiologists and other physicians to easily recall the anatomy of the hindfoot when viewing it at the level of the sustentaculum tali on coronal T1-MRIs. In addition, this mnemonic could be particularly useful when utilized in medical education curriculum for residents, fellows, and medical students. Further research is required to validate this mnemonic as an educational tool in medical training and detail additional hindfoot pathologies that can be identified with it.
Proximal Flexor Hallucis Longus Transfer to Peroneus Brevis for Treatment of Peroneal Muscle Paralysis
Authors: Moses Alex M. , Mustafa Moawiah , Haupt Edward T.
Published: November 2022

Category:

Hindfoot; Ankle; Other

Introduction/Purpose:

Equinovarus foot deformities typically present with equinus contractures, hindfoot varus, dorsiflexion of the medial midfoot, and adduction deformities of the forefoot. Whether of neurologic or muscular origin, all forms result muscular imbalance. Flexor hallucis longus (FHL) transfer to peroneus brevis (PB) is indicated when both peroneal muscles are in unrepairable condition to restore active eversion. However, in cases of muscle paralysis where the PB is still in continuity, we recommend a novel technique where FHL is tenodesed proximal to the peroneal retinaculum within the leg to avoid the additional morbidity associated with more distal fixation or tenodesis.

Methods:

Surgical intervention first involved a posterolateral approach to the ankle and an Achilles tendon Z-lengthening to fix her equinus contracture. The ankle and subtalar joint capsules were contracted requiring release. Flexor digitorum longus (FDL) and FHL were tenotomized, which immediately corrected her claw toes. Since the tendon had already been released, we were able to deliver the FHL tendon into the posterolateral leg wound. The peroneal fascia and sheath were opened proximal to the superior peroneal retinaculum to prevent tendon subluxation. PB was identified by confirming that it produced foot eversion and by visualizing the peroneus longus (PL). The tension of PB was confirmed by observing that it did not cause tension at PL insertion on the plantar 1st ray. FHL was then transferred to the PB utilizing a Pulvertaft weave technique with the tendon appropriately tensioned in mid eversion in the middle of the Blix curve (Figure 1).

Results:

After FHL transfer, the patient was immediately allowed to weight bear as tolerated in a short leg cast. This was due to her deconditioned state to limit atrophy and the effects of prolonged recumbency in this medically fragile young woman. The patient ultimately was casted for 10 weeks total as she was unable to tolerate a CAM boot or other orthotic due to the weight and problems with the fit. At 4 months follow up, her foot is corrected and she is able to stand in a neutral, plantigrade position. Using a new AFO, she can walk without issue. Her foot remains well balanced and plantigrade.

Conclusion:

This simple FHL transfer technique decreases morbidity since the transfer occurs within the leg, proximal to the superficial peroneal retinaculum (SPR). The transfer pulls on the paralyzed, but intact PB instead of routing the FHL to the 5th metatarsal base or PB stump. This technique is only recommended if PB is intact but non-functional. It should be noted that adequate tensioning is essential for a successful transfer. Benefits of this procedure include no cluttering under the SPR and no risk of scarring that region which can lead to decreased tendon excursion.
Risk Factors for Amputation in Opioid-Related Compartment Syndrome
Authors: Mun Frederick , Gupta Arjun , Fleuriscar Jean , Mo Kevin C. , Greenberg Marc , Sotsky Rachel B. , Hughes Alice , Aiyer Amiethab A.
Published: November 2022

Category:

Trauma; Other

Introduction/Purpose:

Increase in opioid use has been associated with a higher incidence of compartment syndrome. To our knowledge, there is no long-term or large database study that analyzes this unique patient population. We sought to compare the clinical outcomes of opioid-related compartment syndrome (ORCS) and non-opioid related compartment syndrome (NORCS), and assess risk factors for amputation in ORCS.

Methods:

Data on 154 patients (132 NORCS and 22 ORCS patients) from January 1, 2016 to December 31, 2021 who presented with compartment syndrome was collected through a multicenter billing database. We analyzed demographic and clinical findings, including cause of compartment syndrome, time until initial evaluation, length of hospital stay, number of surgeries, rate of amputation, and peak creatinine kinase (CK) and lactate levels. Bivariate statistics were used to assess the data.

Results:

The most common cause of compartment syndrome was trauma (62%) in the lower leg (79%). Twenty-one ORCS patients (96%) had a delayed presentation after immobilization in dependent position for >=8 hours. ORCS patients had significantly higher mean peak CK and lactate levels (p<0.001), length of hospital stay (p<0.001), and number of operations (p=0.03) compared to NORCS. All parameters, except for mean peak CK and lactate, were significantly greater among ORCS patients with subsequent amputation, compared to ORCS patients without amputation. ORCS patients with amputation had a significantly greater mean peak CK and lactate levels compared to ORCS without amputation (p=0.04).

Conclusion:

ORCS patients with subsequent amputation are associated with a longer and more complicated clinical course compared to ORCS and NORCS patients. As opioid use continues to rise, physicians should be aware of the unique challenges associated with ORCS patients.
Chronic Plantar Fasciitis: Comparison of Ultrasonic Guided Percutaneous Fasciotomy vs New Technique Combining Fasciotomy with Amniotic Membrane Allograft
Authors: Nakagawa Hirotaka F. , Sung Kyungje , Ashkani-Esfahani Soheil , Waryasz Gregory R. , May Tabitha , Sussman Walter
Published: November 2022

Category:

Basic Sciences/Biologics

Introduction/Purpose:

Plantar fasciitis is a common condition affecting approximately one in ten people in their lifetime. Treatment is typically conservative and symptoms are self-limiting. Operative treatment is indicated in recalcitrant cases. Minimally-invasive partial plantar fasciotomy can be performed using ultrasound-guided percutaneous techniques and is an attractive alternative to traditional surgery.

Methods:

A retrospective review was performed on consecutive patients who underwent either an ultrasound-guided fasciotomy or a combined percutaneous fasciotomy with a flowable amniotic matrix allograft. All ultrasound-guided percutaneous fasciotomy procedures were performed using the Tenex TX2 cutting device. Human amniotic allograft consisted of an injection of 0.5 mL of a flowable placental tissue matrix. Outcomes were assessed at short-term (2, 8, and 16 weeks) and long-term follow-up (26 and 52 weeks).

Results:

Both groups demonstrated a significant reduction in pain from baseline after the respective interventions and demonstrated a high level of patient satisfaction. The only significant difference in the 2 groups was at short-term follow-up in which the percutaneous fasciotomy with the amniotic membrane allograft (n=12) showed a statistically-significant reduction (p<0.05) in pain when compared to the fasciotomy alone group (n=11). There was no difference between the 2 groups at long- term follow-up.

Conclusion:

Treatment of chronic plantar fasciitis using ultrasound-guided fasciotomy is an attractive alternative to traditional surgery. Ultrasound-guided fasciotomy did improve pain from baseline with high level of patient satisfaction. Furthermore, the combination of percutaneous fasciotomy with a flowable amniotic matrix allograft may provide a greater reduction in pain earlier in the post-operative period, but does not seem to alter the long-term outcome of the procedure. More subjects are needed to possibly detect long-term effects.
Minimally Invasive Chevron Akin: Locking the Metatarsal-Cuneiform Joint
Authors: Nunes Gustavo A. , Carvalho Kepler , Ferraz Gabriel F. , Baumfeld Daniel , Baumfeld Tiago S. , Filho Miguel V. Pereira
Published: November 2022

Category:

Bunion

Introduction/Purpose:

Minimally Invasive Chevron Akin (MICA) can be used to treat hallux valgus (HV) associated with a hypermobility of the first metatarsal-cuneiform joint (1MTCJ). The aim of this study was to perform a radiographic analysis of the MICA, focused on evaluating the 1MTCJ.

Methods:

Forty patients (50 feet) with moderate to severe HV underwent a MICA procedure. Radiographic analysis included hallux valgus angle (HVA), intermetatarsal angles between the first and second rays (IMA), the intermetatarsal angle between the proximal fragment of the osteotomy and the second ray (IAPF) and the distance between a point 3 cm distal from the base of the second metatarsal and a point located at the same height for the first metatarsal base (Dist 1-2). The IAPF was compared with the preoperative IMA and the other parameters were compared pre and post-operatively. The radiographic complications were also recorded

Results:

The majority of patients were female (92%). The mean age was 50.4 years (SD =16.1) and the mean follow-up was 16.1 months (SD = 3.5). The average HVA improved from 32.5 to 7.3 degrees and the average IMA from 14.2 to 4.2 degrees. The IAPF and Dist1-2 values showed an increase of 4.8 and 3.2mm respectively. There were no radiographic complications

Conclusion:

Minimally Invasive Chevron Akin: Locking the Metatarsal-Cuneiform Joint.
Prospective Study of the Inversion Destabilization Maneuver in the Treatment of Acute Ankle Ligament Injury: Case Series
Authors: Oliveira Danilo A. , Mansur Nacime SB
Published: November 2022

Category:

Ankle; Sports; Trauma

Introduction/Purpose:

Ankle sprains are highly prevalent injuries in athletes whether they are amateurs or professionals. It is estimated that around 5,000 sprains occur a day in the UK, while American data point to around 23,000 cases daily (1/10,000 individuals). The world literature has pointed out that about 7 - 10% of orthopedic visits in an emergency service are due to ankle sprains, corresponding to about 25% of all musculoskeletal injuries. The objective of this paper is to present the clinical results obtained from the prospective observation of a series of patients with lateral ankle sprains treated by the destabilization technique in Inversion of the ankle added to the conventional treatment.

Methods:

Design Case series, prospective, single center location. The study will be carried out at Hospital São Paulo - University Hospital of UNIFESP (HSP-UNIFESP), at the Orthopedics Outpatient Clinic of the Department of Orthopedics and Traumatology (DOT)/EPM-UNIFESP. Inclusion criteria - Over 18 years of age of both sexes; - Complaint of ankle sprain up to 48 hours - Complete or partial injury to any of the ligaments of the lateral ankle complex; - Isolated or associated ligament injuries; Non-Inclusion Criteria - Past history of surgery on the affected foot or ankle; - Previous complaint in the ankle region; - Any fracture associated with the sprain or influencing injuries; - Any condition that is a contraindication to the proposed therapies; - Refusal to participate in the study

Results:

We observed in our series of 100 individuals with lateral ankle sprains 6 new episodes of sprain in a follow-up of 12 month. we did not observe the occurrence of spontaneous ankle sprains in the 6 cases, external causal factors were pointed out by the patients. In 1 case the patient stepped on a squash ball, 1 case the patient had his ankle stepped on during a soccer match, in another case the patient suffered a fall while walking with high heel shoes. We also observed a fall from the stairs, a fall on another player's foot during a volleyball game and in the last case the patient suffered a fall after stepping on a hole in the sidewalk during street racing.

Conclusion:

Based on the findings of the present study, we concluded that in a 12-month follow-up, the ankle inversion destabilization maneuver proved to be efficient in preventing new episodes of lateral ankle sprain, however, new studies with a longer follow-up time, as well as and in order to compare the maneuver described in the study with techniques already described in the literature and used by physical therapists in their clinical practice should be performed.
Outcomes of PIPA/DIPA with Retrograde Screw Fixation for Correction of Lesser Toe Deformities
Authors: Pitts Charles C. , Hamid Rasikh N. , Irwin Todd A. , Jones Carroll P.
Published: November 2022

Category:

Lesser Toes; Midfoot/Forefoot

Introduction/Purpose:

Hammertoes and other lesser toe deformities represent extremely common foot problems, affecting nearly one-third of the general population. When surgery is indicated, correction of these deformities has traditionally been described using a PIP arthroplasty technique with a smooth, temporary Kirschner-wire for fixation. This method can produce excellent results, but there are well-described risks including deformity recurrence, secondary deformities, painful nonunion, and pin tract infections. Our goal is to describe a more modern technique that includes preparation and arthrodesis of both the PIP and DIP joints with intramedullary screw fixation.

Methods:

A retrospective chart review was conducted at one tertiary referral center of patients who underwent correction of lesser toe deformity between 2017 and 2021. Inclusion criteria were patient age greater than 18, use of the PIPA/DIPA technique with screw, and a minimum 10 weeks of follow up with radiographs. Charts were reviewed for patient demographics, comorbidities, preoperative characteristics, and postoperative complications. Our primary outcome variable was deformity correction achieved and maintained at minimum 10 weeks postoperatively based on both chart review and radiographs. Secondary outcomes included hardware failure, infection, vascular complication, screw removal for any reason, nonunion, and amputation.

Results:

129 patients and 374 operative toes were identified on chart review and met inclusion criteria. Of these patients, 370 toes (98.9%) maintained deformity correction both clinically and radiographically at 10 weeks and did not undergo revision surgery. 17 toes (4.5%) required screw removal for any reason. 3 toes (0.8%) experienced deep infection, and 1 patient experienced superficial infection that resolved with oral antibiotic treatment. Furthermore, in addition to a concomitant deep infection, one toe experienced vascular compromise and required amputation. There were no symptomatic nonunions, and there were 7 (1.8%) asymptomatic nonunions as seen on radiographs.

Conclusion:

With respect to previously and classically described methods of lesser toe deformity correction, the PIPA/DIPA technique with a retrograde screw presents an acceptable and safe method for sustained deformity correction.
Evaluating the Association of Anesthesia Type with Postoperative Complications in Patients Undergoing Ankle Fracture Repair
Authors: Quan Theodore , Malyavko Alisa , Ifarraguerri Anna Maria M. , Kim Yumin , Mcdaniel Lea , Manzi Joseph E. , Agarwal Amil R. , Chen Frank , Gu Alex , Tabaie Sean
Published: November 2022

Category:

Ankle

Introduction/Purpose:

General and neuraxial anesthesia are both successful anesthesia techniques used in many orthopaedic procedures. Neuraxial anesthesia involves local anesthetics placed around the central nervous system (CNS) and spinal anesthesia is a subtype where the anesthetic is injected into intrathecal space. General anesthesia is usually recommended in ambulatory surgeries for its rapid onset of action. However, current literature shows contradicting complication profiles between these two anesthesia types. The purpose of this study was to compare the complications and length of hospital stay between patients who underwent general anesthesia versus neuraxial anesthesia during the repair of ankle fractures.

Methods:

Patients undergoing open reduction and internal fixation (ORIF) for ankle fracture from 2014 to 2018 were identified in the National Surgical Quality Improvement Program database. Patients were stratified into 2 cohorts: general anesthesia and neuraxial anesthesia. In this analysis, demographics data, comorbidities, and postoperative complications were collected and compared between the two cohorts. Bivariate analyses and multivariable logistical regression were performed.

Results:

Of 3,585 patients who underwent operative treatment for ankle fracture, 3,315 patients (92.5%) had general anesthesia and 270 (7.5%) had neuraxial anesthesia. Compared to patients who had general anesthesia, those who had neuraxial anesthesia were more likely to be older (58.0 vs 49.6 years old; p<0.001), Caucasian (80.0% vs 71.9%; p=0.001), and have an ASA classification of III (38.1% vs 25.0%; p<0.001). On bivariate analyses, patients who had neuraxial anesthesia were more likely to develop pulmonary complications (p=0.173) or extended length of stay more than 5 days (p=0.342) compared to the general anesthesia group. Following adjustment on multivariate analyses, the neuraxial anesthesia cohort no longer had increased likelihood of pulmonary complications or extended length of stay compared to the general anesthesia group.

Conclusion:

Prior studies have shown that neuraxial anesthesia methods are as effective as general anesthesia with fewer short- term outcomes. When compared to patients who underwent general anesthesia during ORIF for ankle fracture, neuraxial anesthesia patients experienced no significant increases in postoperative complications or extended length of hospital stay. In terms of the variables we explored in the NSQIP database, healthy ankle fracture patients could also benefit from neuraxial anesthetic methods, and they should be considered for this anesthetic type regardless of their lack of comorbidities that would make them high risk for general anesthesia.