bluuebunny/crossref_metadata_2025 huggingface dataset:
Servant Leadership and Team Performance: The Mediating Role of Knowledge-Sharing Climate
Authors: Song Chanhoo , Park Kwangseo Ryan , Kang Seung-Wan
Published: December 2015

We examined servant leadership as a precursor to a knowledge-sharing climate and demonstrated the mediating role of knowledge-sharing climate in the relationship between servant leadership and team performance. Data from 67 teams, comprising 1,884 direct sales representatives of a large
cosmetics company in South Korea, were analyzed at the team level. Actual team sales data were obtained from the company 3 months after surveying, and regression analyses and bootstrapping were used to test the hypotheses. The results showed 2 key findings: servant leadership positively affected
the knowledge-sharing climate of the team; and knowledge-sharing climate mediated the relationship between servant leadership and team sales performance. Theoretical and practical implications of the findings are discussed.
Changes in mandibular incisor position and arch form resulting from Invisalign correction of the crowded dentition treated nonextraction
Authors: Duncan Laura O , Piedade Luis , Lekic Milos , Cunha Rodrigo S , Wiltshire William A
Published: December 2015

Objective: 

To investigate changes in mandibular incisor position resulting from Invisalign correction of the crowded dentition without extraction.

Materials and Methods: 

A retrospective chart review was completed on 61 adult White patients. Patients were categorized into three groups based on the value of pretreatment crowding of the lower dentition: 20 mild (2.0–3.9 mm), 22 moderate (4.0–5.9 mm), and 19 severe (>6.0 mm). Cephalometric radiographs were measured to determine lower incisor changes. Interproximal reduction and changes in arch width were also measured. Statistical evaluation of T0 and T1 values using paired t-tests and analysis of covariance were applied to evaluate mean value changes.

Results: 

Lower incisor position and angulation changes were statistically significant in the severe crowding group. There were no statistically significant differences in lower incisor position between the mild and moderate crowding groups. There was a statistically significant increase in buccal expansion in each of the three groups.

Conclusions: 

Invisalign® treatment can successfully resolve mandibular arch crowding using a combination of buccal arch expansion, interproximal reduction, and lower incisor proclination. When there is <6 mm of crowding, lower incisor position remained relatively stable. The lower incisors proclined and protruded in the more severely crowded dentitions (>6 mm).
Inverted Papilloma of the Maxillary Sinus: Surgical Approach and Long-term Results
Authors: Hong Sung-Lyong , Mun Sue Jean , Cho Kyu-Sup , Roh Hwan-Jung
Published: December 2015

Background

Inverted papillomas (IP) commonly develop in the maxillary sinus (MS). However, the MS is a complex structure, and all areas in the MS are not easily approachable.

Objective

This study reviewed our surgical outcome of patients with IPs that originated from the MS in long-term follow-up and suggests appropriate approaches according to the tumor origin.

Methods

Thirty-one patients who were diagnosed with IP that originated from the MS, underwent surgery by a single operator between 1999 and 2011, and had postoperative follow-up of >3 years were enrolled.

Results

In all the cases, the endoscopic endonasal approach (EEA) was attempted at first and then canine fossa puncture (CP), canine fossa opening via the Caldwell-Luc approach (CO), and Caldwell-Luc operation (CLO) were added in consecutive order as the occasion demands. Six patients (19.4%) were treated only with EEA, and they had IPs from the superior, posterior, or medial wall. Five (16.1%) were treated with EEA plus CP, which was added for removal of IPs that originated from the lateral wall. Sixteen (51.6%) were treated with EEA plus CO, which was for removal of tumors from the medial, anterior, or inferior wall. Four patients (12.5%) whose IP attached to the whole MS mucosa underwent CLO. Three (9.7%) experienced recurrences, and the mean period to recurrence was 20.7 months.

Conclusion

The overall recurrence rate was 9.7%. IPs that originated from the lateral wall of the MS can be removed by using CP. When IPs originate from the anterior, inferior, or medial wall of the MS, CO may be needed for the thorough removal of them.
Endoscopic Transantral and Transnasal Repair of Orbital Floor Fracture with the Ballooning Technique, and Classification and Characterization of Orbital Floor Fractures
Authors: Park Il-Ho , Lee Heung-Man , Yanagi Kiyoshi
Published: December 2015

Background

The level of difficulty during an endoscopic approach for an inferior orbital fracture depends on the fracture pattern and the presence of a ruptured membrane (orbital periosteum and sinus mucosa). The purpose of our study was to examine fracture patterns according to age group and to determine the relationship between the type of fracture and the type of membrane injury.

Methods

We reviewed the records of 30 patients who, from 2006 to 2010, underwent endoscopic transantral and transnasal approach with a balloon catheter technique to repair orbital floor fracture. The procedure was done through middle or inferior meatal antrostomy and two small antrostomies made in the anterior wall of the maxillary sinus by using an endoscope and specially designed curved dissectors.

Results

There were 3 linear, 20 trapdoor-type and 7 blowout fractures. There was a tendency toward a higher incidence of linear fractures at younger ages and of blowout fractures in older patients. All linear fractures had rupture of both membranes, whereas both membranes were intact in 15 of the 20 patients with trapdoor fractures. Among blowout fractures, there was no membrane rupture in five and both membranes were ruptured in two patients. No patient reported diplopia after fracture repair.

Conclusions

Rupture of the periosteum, which makes visualization and reduction of orbital tissue difficult for the surgeon during endoscopic repair of the orbital floor fracture, was observed in 3 of 3 linear fractures and 5 of 20 trapdoor fractures. We found that linear fractures were more common in pediatric patients. Care of pediatric orbital floor fracture requires particular caution.
The Orbital Floor is a Surgical Landmark for the Asian Anterior Skull Base
Authors: Wuttiwongsanon Chairat , Chaowanapanja Pattraporn , Harvey Richard J. , Sacks Raymond , Schlosser Rodney J. , Chusakul Supinda , Aeumjaturapat Songklot , Snidvongs Kornkiat
Published: December 2015

Background

Surgical landmarks for defining the level of the skull base during endoscopic sinus and skull base surgery (ESBS), e.g., the middle turbinate, may be distorted by tumor or previous surgery. The orbital floor is a valid fixed anatomic landmark for the white population, but it is not known if its use is useful for an Asian population.

Objectives

To define fixed anatomic landmarks for ESBS in an Asian population and to compare the level of the skull base and its relation with anatomic landmarks between Asian and white populations.

Methods

Computed tomographies performed on paranasal sinuses of Thai patients were retrospectively assessed. The distance between the nasal floor to four structures, the orbital floor, sphenoid planum, cribriform, and ethmoid roof, were measured. The level of skull base related to the orbital floor of an Asian population was compared with data of a white population from a previously published study.

Results

A total of 150 Thai patients (300 paranasal sinus systems) were assessed and compared with 150 white patients. The orbital floor was always below the skull base (600 sides [100%]). When compared with white patients, the Asian patients had significantly higher mean (standard deviation [SD]) values: orbital floor (35.2 ± 3.4 mm versus 33.9 ± 3.0 mm; p < 0.001), ethmoid roof (49.3 ± 3.8 mm versus 48.4 ± 4.5 mm; p = 0.01), cribriform (46.4 ± 3.6 mm versus 44.0 ± 3.7 mm; p < 0.001), and sphenoid roof (45.7 ± 3.7 mm versus 44.9 ± 3.7 mm; p = 0.01). The Asian population had a mean (SD) longer distance from the orbital floor to the cribiform (11.2 ± 2.5 mm versus 10.1 ± 2.7 mm; p < 0.001), a shorter distance to the sphenoid roof (10.5 ± 3.3 mm versus 11.0 ± 2.9 mm; p = 0.03), and a similar distance to the ethmoid roof(14.1 ± 3.1 mm versus 14.5 ± 3.5 mm; p = 0.09).

Conclusion

Although a statistical difference exists between racial groups, clinically, the orbital floor is a useful fixed anatomic landmark for ESBS for both Asian and white populations.
Association of Body Mass Index and Other Factors with Histamine Skin Reactivity in Adults with Allergic Nasal Symptoms
Authors: Park Do Yang , Kim Yoo Suk , Kim Jeong Hong , Kang Ju Wan
Published: December 2015

Background

The skin-prick test is the most commonly used method to diagnose allergy. In addition, histamine skin reactivity is used as a positive control for the skin-prick test. However, there is individual variation in histamine skin reactivity. The factors that influence individual variation in histamine skin reactivity remain unknown.

Objectives

We aimed to investigate the factors associated with histamine skin reaction.

Methods

Ninety-seven subjects who underwent a skin-prick test to diagnose allergic rhinitis were enrolled in this study. The skin-prick test was performed with six common allergens. The wheal size of the histamine skin reaction was analyzed; other variables included age, sex, body mass index (BMI), atopy, smoking history, and the testing season.

Results

The wheal size in the histamine skin test was significantly associated with age and BMI. The association between histamine skin reactivity and BMI was also present in multivariate analysis, adjusted for age, sex, atopy, smoking history, and season.

Conclusion

Histamine skin reactivity increased with BMI (degree of obesity). This association should be considered for better interpretation of the skin-prick test. Further studies regarding the mechanism for this association are needed.
Reduction of Adhesions and Antrostomy Stenosis with Topical Vitamin a after Endoscopic Sinus Surgery
Authors: Fang Kai-Min , Wang Chi-Te , Chen Ya-Wen , Huang Tsung-Wei
Published: December 2015

Background

Prevention of adhesion formation and restoration of mucociliary mucosa are major determinants of the success of endoscopic sinus surgery (ESS). Vitamin A (VA) can promote mucociliary differentiation of respiratory epithelium. However, whether topical VA can promote sinonasal wound healing or reduce adhesion formation after ESS in humans remains unexplored.

Objective

To investigate the effect of topical VA on sinonasal wound healing and adhesion formation after ESS.

Methods

This is a within-subject control study. Patients with chronic rhinosinusitis were included. Each patient underwent ESS, and topical VA was applied over the sinonasal wound. Postoperative outcomes were assessed by using the Lund-Kennedy score, and the antrostomy size was measured. In vitro wound healing assay of fibroblasts with or without VA was evaluated. Restoration of ciliated epithelium was examined by using scanning electron microscopy.

Results

Thirty patients were enrolled. The mean (standard deviation {SD}) scores for scarring/adhesion in the VA-treated side at 3 and 12 months after surgery (0.20 ± 0.40 and 0.23 ± 0.42, respectively) were significantly lower than those in the controls (0.47 ± 0.50 and 0.53 ± 0.62, respectively). The mean (SD) antrostomy size in the VA treated side at 1, 3, and 12 months after surgery (0.85 ± 0.30 cm2, 0.7 ± 0.30 cm2, and 0.70 ± 0.27 cm2, respectively) were significantly larger than those in the controls (0.79 ± 0.26 cm2, 0.60 ± 0.25 cm2, and 0.57 ± 0.24 cm2, respectively). Wound healing assay revealed that VA significantly inhibited the proliferation and migration of fibroblasts. Scanning electron microscopy showed mature ciliated cells in the VA-treated side.

Conclusion

Topical VA is a promising agent for sinonasal wound healing after ESS because it can promote mucociliary reepithelization, reduce adhesion, and prevent antrostomy stenosis.
How I do It: The Sphenoethmoidectomy: With Illustration and Video
Authors: Gudis David A. , Karnezis Tom K. , Soler Zachary M. , Schlosser Rodney J.
Published: December 2015

Background

Several techniques for performing the sphenoethmoidectomy have been described. We present a safe, effective, and efficient technique.

Objective

We present text, images, and video to demonstrate our preferred technique for performing a sphenoethmoidectomy.

Methods

A description of the technique without prospective or retrospective data, whereby a Kerrison rongeur and microdebrider were used to perform a total sphenoethmoidectomy by skeletonizing the skull base and lamina papyracea.

Results

In our hands, the Kerrison rongeur and microdebrider allowed for a reliably safe and efficient sphenoethmoidectomy for chronic sinusitis with or without polyposis or skull base approaches.

Conclusion

The technique described can be added to the armamentarium of the endoscopic sinus surgeon.
The Radiologic Evaluation of Osteitis Type and Formation in Chronic Rhinosinusitis with and without Nasal Polyposis
Authors: Emre Ismet Emrah , Celebi Irfan , Ercan Ibrahim
Published: December 2015

Objective

To evaluate the amount and type of osteitis observed in chronic rhinosinusitis with nasal polyposis (CRSwNP) and compare it with that of chronic rhinosinusitis without nasal polyposis (CRSnNP).

Setting

Sisli Etfal Research and Education Hospital, Istanbul, Turkey.

Study Design

Prospective, single-blind, cohort study.

Methods

Three different patient groups, designated as the CRSwNP, CRSnNP, and control groups, were included in the study. Forty patients who had CRSnNP and/or CRSwNP confirmed with a paranasal sinus computerized tomography (CT) study were included for the study group, and 20 individuals were included in the control group. Paranasal sinus CTs were evaluated and compared for osteitis.

Results

Hounsfield units obtained from the right and left agger nasi walls and the medial maxillary sinus wall in the control group were significantly different from the entire group. Similarly, values for the anterior ethmoid wall were statistically significant for the CRSwNP group compared with all the subjects. When the groups were compared to one another, there were significant differences in both the right and left agger nasi walls and the frontal sinus wall.

Conclusion

Differentiating and acknowledging osteitis induced by CRSwNP rather than CRSnNP may aid in preoperative planning and indicate where to be more aggressive when excising bony structures. This may help in reducing recurrence and in increasing quality of life.
Computed Tomographic Analysis of Frontal Recess Cells in Pediatric Patients
Authors: Al-Qudah Mohannad , Mardini Diala
Published: December 2015

Objective

To describe the prevalence of frontoethmoid cells and superior uncinate process attachment in pediatric patients with sinonasal symptoms.

Method

Fifty high-resolution computed tomographies of the paranasal sinuses for pediatric patients were evaluated for the presence of frontoethmoid cells and uncinate process insertion. The computed tomographies were randomly collected for patients with sinonasal symptoms (age range, 4-15 years) at our clinic. The prevalence of these cells was compared against age group and type of uncinate process.

Results

The prevalence of each structure was agger nasi cell (97%), type 1 frontal cell (39%), type 2 frontal cell (27%), type 3 frontal cell (11%), type 4 frontal cell (1%), supraorbital ethmoid cell (38%), suprabullar cell (57%), frontal bullar cell (9%), and interfrontal septal cell (16%). When excluding the agger nasi cell, 48 patients (96%) had at least one type of frontoethmoid cell and 43 (86%) had at least one frontal cell. The frequency of these cells did not significantly differ based on sex or uncinate process insertion, but it did with age. Lamina papyracea was the most common site of superior uncinate process attachment.

Conclusion

Our results indicated a high frequency of frontoethmoid cells in the pediatric age group. The prevalence of these variations changes during childhood development. As in adults, lamina papyracea is the most common site of superior uncinate process attachment. Recognition of these variations in the frontal recess can provide useful information for safe and efficient endoscopic dissection in the frontal recess region.
The Effect of Compound Nasal Surgery on Obstructive Sleep Apnea Syndrome
Authors: Hisamatsu Ken-ichi , Kudo Itsuhiro , Makiyama Kiyoshi
Published: December 2015

Background

Nasal surgery often fails to ameliorate the symptoms of obstructive sleep apnea syndrome (OSAS). We developed a compound nasal surgery (CNS) method that consists of septoplasty combined with submucosal inferior turbinectomy and posterior nasal neurectomy to ensure low nasal resistance during sleep.

Objective

To clarify the effect of CNS on OSAS, pre- and postoperative changes in sleep-related events were studied by using polysomnography, the Epworth sleepiness scale (ESS), the visual analog scale for snoring, and health-related quality of life (QOL).

Methods

Forty-five consecutive patients with OSAS and with nasal problems underwent CNS. Three months later, the postoperative effect on OSAS was assessed by using polysomnography findings, daytime sleepiness by the ESS, nasal allergy symptoms, and health-related QOL. Snoring was assessed by the family by using a visual analog scale.

Results

The indices of apnea, apnea-hypopnea, oxygen desaturation, and arousal; the ESS; allergic symptom score; health-related QOL; and snoring on a visual analog scale were all significantly improved.

Conclusions

CNS improves OSAS events without any pharyngeal surgical procedure in selected patients. If high nasal resistance associated with OSAS is present, then CNS should thus be considered.
Recurrent Asystole as an Electrocardiographic Artifact during Microdebrider use in Functional Endoscopic Sinus Surgery
Authors: Patadia Monica , Bartindale Matthew , Caballero Nadieska
Published: December 2015

Introduction

Electrocardiographic (EKG) artifacts can lead to unnecessary treatment and costly diagnostic workup. Two previous studies reported a ventricular tachycardia artifact as a result of microdebrider malfunction. In this study, we report the first case of EKG artifacts that mimick asystole from microdebrider use during functional endoscopic sinus surgery (FESS).

Case

A healthy 19-year-old woman presented with chronic rhinosinusitis, nasal polyposis, and a deviated nasal septum. She was scheduled for a bilateral FESS and septoplasty. During surgery, the microdebrider was changed after 1 hour. While using the second microdebrider, the EKG monitor showed three distinct asystolic events, all lasted approximately 3 seconds. The EKG tracing returned to normal sinus rhythm every time the microdebrider was stopped. The patient's oxygen saturation remained at 100%, and blood pressure remained stable during the episodes. The procedure was aborted, and an extensive cardiology workup was performed, which returned negative results. Biomedical engineering investigated the microdebrider and found a far greater than expected chassis leak, which likely caused electrical interference. Six months later, the patient underwent a right-sided FESS and revision left frontal FESS. There were no EKG abnormalities during the second surgery.

Discussion

Although other EKG artifacts have been reported in the literature, this is the first case report of an artifact that mimicked asystole that stemmed from microdebrider use. Improved awareness of this potential EKG artifact for both the surgeon and the anesthesiologist may prevent an unnecessary costly workup.
Alberta Infant Motor Scale (AIMS) Performance of Greek Preterm Infants: Comparisons With Full-Term Infants of the Same Nationality and Impact of Prematurity-Related Morbidity Factors
Authors: Syrengelas Dimitrios , Kalampoki Vassiliki , Kleisiouni Paraskevi , Manta Vassiliki , Mellos Stavros , Pons Roser , Chrousos George P. , Siahanidou Tania
Published: December 2015

Background

Only a few studies have been conducted with the objective of creating norms of the Alberta Infant Motor Scale (AIMS) for the assessment of gross motor development of preterm infants. The AIMS performance of preterm infants has been compared with that of the Canadian norms of full-term infants, but not with that of full-term infants of the same nationality. Moreover, the possible impact of prematurity-related morbidity factors on AIMS performance is unknown.

Objectives

The aims of this study were: (1) to evaluate AIMS trajectory in a large population of Greek preterm infants and create norms, (2) to compare it with the AIMS trajectory of Greek full-term infants, and (3) to examine the possible influence of neonatal morbidity on AIMS scores in the preterm sample.

Design

This was a cross-sectional study.

Methods

Mean AIMS scores were compared, per month (1–19), between 403 preterm infants (≤32 weeks of age, corrected for prematurity) and 1,038 full-term infants. In preterm infants, the association of AIMS scores with respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH) of grade ≤III, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and sepsis was assessed by hierarchical regression analysis.

Results

Alberta Infant Motor Scale scores were significantly lower in preterm infants than in full-term infants. Mean AIMS scores in preterm infants were significantly associated with RDS (b=−1.93; 95% CI=−2.70, −1.16), IVH (b=−0.97; 95% CI=−1.69, −0.25), and ROP (b=−1.12; 95% CI=−1.99, −0.24) but not with BPD or sepsis in hierarchical regression analysis.

Conclusions

Alberta Infant Motor Scale norms were created for Greek preterm infants. This study confirms that AIMS trajectories of preterm infants are below those of full-term infants of the same nationality. The influence of morbidity factors, including RDS, IVH, and ROP, should be taken into account when administering the AIMS in preterm infants.
Screw Placement in Subtalar Arthrodesis: A Biomechanical Study
Authors: Chuckpaiwong Bavornrit , Easley Mark E. , Glisson Richard R.
Published: December 2015

Background: Clinical outcomes of subtalar arthrodesis using screw fixation have been reported but biomechanical support for selection of screw trajectories and patterns has been lacking. This investigation was designed to assess the compressive and stabilizing abilities of different common screw insertion patterns for subtalar arthrodesis. Materials and Methods: Forty-two cadaveric subtalar joints underwent arthrodesis with a single talar neck screw, a single talar dome screw, double parallel screws, or double diverging screws. Single talar dome screw fixation was subdivided by screw tip placement in the anteromedial, posteromedial, anterolateral, or posterolateral dome. Joint compression, construct torsional stiffness, and joint angulation under torsional load were quantified. Results: Higher compressive force, torsional stiffness, and joint rotation resistance were achieved by double screw fixation compared to single screws ( p < 0.001). Torsional stiffness with double diverging screws exceeded that of double parallel screws in internal rotation ( p < 0.05). There was greater internal rotation with a single talar neck screw ( p < 0.001) and greater external rotation with an anterolateral talar dome screw ( p < 0.01) compared to the other single-screw orientations. Greater rotation in both directions was noted with the single screw tip located in the posterolateral talar dome ( p < 0.01). Conclusion: Under the described testing conditions, double diverging screws confer the highest compression, the greatest torsional stiffness, and the least joint rotation. When a single screw is used, placement of the screw tip in the talar neck or lateral talar dome should be avoided. Clinical Relevance: The results provide an objective basis for selection of optimal screw placement by the surgeon.
Open Versus Minimal Invasive Repair With Achillon Device
Authors: Aktas Seref , Kocaoglu Baris
Published: December 2015

Background: We prospectively analyzed and compared the functional and clinical results of patients with standard open and minimally invasive repair with the Achillon suture system at mid-term followup. Materials and Methods: From February 2004 to May 2007, 40 consecutive patients were operated for the treatment of acute Achilles tendon rupture with two different methods. None of the cases required adjunctive procedures like plantaris, flexor hallucis longus or gastrocnemius augmentation (Lindholm, Bosworth) to allow for acceptable end to end apposition. The patients were divided equally into two groups. In Group 1, only Krakow end-to-end suturing technique and in Group 2, Minimal invasive repair with Achillon suture system (Integra Life Sciences Corporation, Plainsboro, NJ) was used respectively. The average age of the patients was 40 years. Patients in study groups were followed up at mean of 22.4 (range, 10 to 48) months after surgery. At the end of the followup time, functional outcome scores and complications were evaluated. Results: The AOFAS hindfoot clinical outcome scores were 98.7 in Group 1, 96.8 in Group 2. Although there was a numerical increase in AOFAS Scores in Group 1, there was no significant difference. The surgical outcome concerning local tenderness, skin adhesions, scar and tendon thickness was better in Group 2 than in Group 1 with statistical significance. Conclusion: Although functional outcomes of both treatment groups were the same, minimally invasive repair with the Achillon suture system provided safe, reliable and practical treatment with low risk of complications in the treatment of acute Achilles tendon ruptures.
Effect of Turf Toe on Foot Contact Pressures in Professional American Football Players
Authors: Brophy Robert H. , Gamradt Seth C. , Ellis Scott J. , Barnes Ronnie P. , Rodeo Scott A. , Warren Russell F. , Hillstrom Howard
Published: December 2015

Background: The relationship between turf toe and plantar foot pressures has not been extensively studied. Two hypotheses were tested in a cohort of professional American football players: first, that a history of turf toe is associated with increased peak hallucal and first metatarsophalangeal (MTP) plantar pressures; second, that decreased range of motion (ROM) of the first MTP correlates with increased peak hallucal and first MTP plantar pressures. Materials and Methods: Forty-four athletes from one National Football League (NFL) team were screened for a history of turf toe during preseason training. Dorsal passive MTP ROM and dynamic plantar pressures were measured in both feet of each player. Anatomical masking was used to assess peak pressure at the first MTP and hallux. Results: First MTP dorsiflexion was significantly lower in halluces with a history of turf toe (40.6 ± 15.1 degrees versus 48.4 ± 12.8 degrees, p = 0.04). Peak hallucal pressures were higher in athletes with turf toe (535 ± 288 kPa versus 414 ± 202 kPa, p = 0.05) even after normalizing for athlete body mass index ( p = 0.0003). Peak MTP pressure was not significantly different between the two groups tested. First MTP dorsiflexion did not correlate with peak hallucal or first MTP pressures. Conclusion: This study showed that turf toe is associated with decreased MTP motion. In addition, increased peak hallucal pressures were found. Further study is warranted to determine whether these pressures correlate with the severity of symptoms or progression of turf toe to first MTP arthritis.
The “Giftbox” Repair of the Achilles Tendon: A Modification of the Krackow Technique
Authors: Labib Sameh A. , Rolf Robert , Dacus Rashard , Hutton William C.
Published: December 2015

Background: The Krackow locking loop technique has been used for Achilles tendon repair with documented success in allowing early range of motion with stable fixation. Previous studies documented failure at the rupture site by knot failure. We propose a modification of the traditional Krackow technique where the knots of the suture are tied away from the rupture site (aka the Giftbox technique). We compared the tensile strength of Achilles tendons repaired using the traditional Krackow technique with those repaired using the Giftbox technique. Materials and Methods: Thirteen pairs of fresh frozen cadaveric Achilles tendons were harvested. An Achilles tendon rupture was created 4 cm from the calcaneal insertion. Thirteen Achilles ruptures were repaired using the traditional Krackow technique and 13 pairs were repaired using the Giftbox technique. The Achilles tendons were then tested to failure as defined as a gap of 1 cm. Results: The mean force to failure for the tendons using the Giftbox technique was 168 N, whereas the mean for the traditional Krackow technique was 81 N ( p < 0.0001). Conclusion: Based on our biomechanical study, Achilles tendons repaired using the Giftbox technique are more than twice as strong as those repaired using the traditional Krackow technique. Clinical Relevance: We recommend the Giftbox modification to minimize gap formation and improve the strength of the repair of a ruptured Achilles tendon.
Intermetatarsal Angular Change Following Fusion of the First Metatarsophalangeal Joint
Authors: Pydah K.V. Satya , Toh Eugene M. , Sirikonda Siva P. , Walker Christopher R.
Published: December 2015

Background: Arthrodesis of the first metatarsophalangeal (MTP) joint with a low profile fixed angle plate allows for a consistent resultant hallux valgus angle. There is no clear consensus on whether a separate corrective osteotomy of the first metatarsal should be performed in addition to the first metatarsophalangeal joint fusion in patients with an increased intermetatarsal angle. We quantified the amount of correction of the intermetatarsal angle as well as the position of the tibial sesamoid in this group of patients following fusion of the first MTP joint. Materials and Methods: A consecutive cohort of 69 feet (13 bilateral) who underwent a standard primary fusion of the first metatarsophalangeal joint using a dorsal approach between May 2006 and January 2008 were reviewed. Radiological measurements were taken from 6-week postoperative weightbearing radiographs and included the hallux valgus angle, intermetatarsal angle as well as the position of the tibial sesamoid in accordance to the American Orthopaedic Foot and Ankle Society guidelines. Results: Postoperatively, there was an improvement in the hallux valgus angle from 33.0 degrees to 10.4 degrees ( p < 0.001). The mean intermetatarsal angle also improved from 13.1 degrees preoperatively to 8.6 postoperatively ( p < 0.001). The position of the tibial sesamoid generally improved by at least one grade (Spearman's r = 0.74). There was a strong correlation ( r = 0.77, p < 0.001) between the preoperative intermetatarsal angle and the postoperative intermetatarsal angle. Conclusion: Both the intermetatarsal angle and position of the tibial sesamoid reliably improved following arthrodesis of the first MTP joint, negating the need for a separate osteotomy of the first metatarsal.
Radiographic Evaluation of Hallux Valgus Treated with Opening Wedge Osteotomy
Authors: Randhawa Sunil , Pepper Dean
Published: December 2015

Background: There are many techniques described for treatment of hallux valgus. The role of proximal osteotomies of the 1st metatarsal is well documented. However the opening wedge osteotomy has become less popular in contemporary practice. The purpose of this paper was to report our experience with an opening wedge osteotomy for the treatment of hallux valgus using L-Plate fixation. Materials and Methods: Twenty-nine patients underwent 31 basal opening wedge osteotomies of the first metatarsal. Fixation was achieved with the Arthrex® low profile titanium plate. The IMA on the WB radiograph preoperatively, and at least 12 months postoperatively was measured. Four patients received a 3.5-mm plate, 15 received a 4.0-mm plate, and 12 received a 5.0-mm plate. Results: The 3.5-mm group had a mean preoperative IMA of 13.8 degrees (range, 6 to 18), and postoperative IMA of 5.8 (range, 3 to 8), with a mean correction of 8.0. The 4.0-mm plate group had a mean preoperative IMA of 16.9 (range, 11 to 30) and postoperative IMA of 8.9 (range, 4 to 11) with a mean correction of 9.0. The 5.0-mm plate group had a mean preoperative IMA of 24.7 (range, 15 to 35) and postoperative IMA of 9.8, (range, 3 to 22) with a mean correction of 14.9. Conclusion: We report on a successful method for correcting hallux valgus with a basilar first metatarsal opening wedge osteotomy. It was highly effective for correcting moderate to severe intermetatarsal deformities.
Biplanar Proximal Phalanx Closing Wedge Osteotomy for Hallux Rigidus
Authors: Hunt Kenneth John , Anderson Robert B.
Published: December 2015

Background:

Many procedures have been described for surgical treatment of symptomatic hallux rigidus. Dorsal cheilectomy of the metatarsophalangeal joint combined with a dorsal-based closing wedge osteotomy of the proximal phalanx (i.e., Moberg procedure) has been described as an effective procedure. For patients with hallux rigidus and clinically significant hallux valgus interphalangeus, the authors previously described a dorsal cheilectomy combined with a biplanar closing wedge osteotomy of the proximal phalanx, combining a Moberg osteotomy with an Akin osteotomy. The purpose of this study was to describe the clinical results of this procedure.

Methods:

This article is a retrospective review of prospectively gathered data that reports the clinical and radiographic results of dorsal cheilectomy combined with a biplanar oblique closing wedge proximal phalanx osteotomy (i.e., Moberg–Akin procedure) for patients with symptomatic hallux rigidus and hallux valgus interphalangeus. Consecutive patients were followed and evaluated for clinical and radiographic healing, satisfaction, and ultimate need for additional procedure(s). Thirty-five feet in 34 patients underwent the procedure.

Results:

All osteotomies healed. At an average of 22.5 months of follow-up, 90% of patients reported good or excellent results, with pain relief, improved function, and fewer shoe wear limitations following this procedure. Hallux valgus and hallux interphalangeal angles were radiographically improved. Other than one patient who requested hardware removal, no patients required additional surgical procedures.

Conclusions:

Dorsal cheilectomy combined with a Moberg-Akin procedure was an effective and durable procedure with minimal morbidity in patients with hallux rigidus combined with hallux valgus interphalangeus. Level of Evidence: IV, Retrospective Case Series
Novel Surgical Technique and Early Kinesiotherapy for Acute Achilles Tendon Rupture
Authors: Jielile Jiasharete , Sabirhazi Gulnur , Hu Geyang , Chen Jiangtao , Aldyarhan Kayrat , Zheyiken Jangannuer , Zhao Qin , Bai Jingping
Published: December 2015

Background:

This prospective study was performed to investigate the contribution of early kinesiotherapy, the active exercise and movement of the ankle and knee joints, following a novel surgical technique for reconstruction of the acutely ruptured Achilles tendon and the underlying mechanisms involved.

Materials and Methods:

One hundred and seven patients with an acute Achilles tendon rupture received postoperative early kinesiotherapy treatment following the novel “Pa-bone” surgical technique. Clinical outcomes were evaluated using the Achilles tendon rupture score, a score for measuring outcomes related to symptoms and physical activity, and bilateral ultrasonographic examination of the Achilles tendon.

Results:

Range-of-motion recovery equal to the intact side averaged 7 weeks. Double-legged heel rises and sustained single-leg heel rise exercises were possible at an average of 1 week and 60 ± 2 days, respectively. All patients could perform single-leg heel rise of the injured foot for 60 ± 23 seconds at an average of 12 weeks. No rerupture was observed. In addition, ultrasonographic examination revealed that the cross-sectional areas of the ruptured tendon were significantly larger than those of the healthy side. Overall reconstruction of the Achilles tendon was obtained for most of the patients.

Conclusion:

Postoperative early kinesiotherapy treatment following Pa-bone surgical technique resulted in excellent clinical outcomes and contributed to the overall reconstruction of the Achilles tendon. Level of Evidence: IV, Retrospective Case Series
Validation of Foot and Ankle Outcome Score for Hallux Valgus
Authors: Chen Lan , Lyman Stephen , Do Huong , Karlsson Jon , Adam Stephanie P. , Young Elizabeth , Deland Jonathan T. , Ellis Scott J.
Published: December 2015

Background:

Patient-reported outcome questionnaires such as the Foot and Ankle Outcome Score (FAOS) are useful in evaluating results after orthopedic interventions. However, despite being frequently used in the literature, its validity has not been established for forefoot disorders. Our study aimed to validate the FAOS for use in assessing outcomes of hallux valgus surgery.

Methods:

From 2006 to 2009, 195 patients with nonarthritic hallux valgus were included in the construct validity portion of the study. Patients had a SF-36 and a FAOS completed. Forty additional patients, both preoperative and postoperative, were given questionnaires to assess the relevance of each of the FAOS questions as it pertained to their bunions. Patients were also given the FAOS 1 month after the first to assess FAOS reliability. Responsiveness of the FAOS was included with 40 patients who had both preoperative and postoperative FAOS scores.

Results:

Four out of five FAOS subscales demonstrated acceptable correlation with the SF-36. The FAOS symptoms subscale showed the least correlation with SF-36, demonstrating the foot-specific nature of the questions. Both preoperative and postoperative patients rated the FAOS quality of life questions as the most relevant. All five subscales achieved acceptable test-retest reliability. The FAOS sports and recreation subscale was the least responsive.

Conclusion:

Patient-based assessments have become increasingly important in evaluating treatment effectiveness. This study has shown that the FAOS has acceptable construct validity, reliability, and responsiveness in hallux valgus patients and is a useful patient-based tool in assessing these patients.
Seizures in supratentorial meningioma: a systematic review and meta-analysis
Authors: Englot Dario J. , Magill Stephen T. , Han Seunggu J. , Chang Edward F. , Berger Mitchel S. , McDermott Michael W.
Published: December 2015

OBJECT

Meningioma is the most common benign intracranial tumor, and patients with supratentorial meningioma frequently suffer from seizures. The rates and predictors of seizures in patients with meningioma have been significantly under-studied, even in comparison with other brain tumor types. Improved strategies for the prediction, treatment, and prevention of seizures in patients with meningioma is an important goal, because tumor-related epilepsy significantly impacts patient quality of life.

METHODS

The authors performed a systematic review of PubMed for manuscripts published between January 1980 and September 2014, examining rates of pre- and postoperative seizures in supratentorial meningioma, and evaluating potential predictors of seizures with separate meta-analyses.

RESULTS

The authors identified 39 observational case series for inclusion in the study, but no controlled trials. Preoperative seizures were observed in 29.2% of 4709 patients with supratentorial meningioma, and were significantly predicted by male sex (OR 1.74, 95% CI 1.30–2.34); an absence of headache (OR 1.77, 95% CI 1.04–3.25); peritumoral edema (OR 7.48, 95% CI 6.13–9.47); and non–skull base location (OR 1.77, 95% CI 1.04–3.25). After surgery, seizure freedom was achieved in 69.3% of 703 patients with preoperative epilepsy, and was more than twice as likely in those without peritumoral edema, although an insufficient number of studies were available for formal meta-analysis of this association. Of 1085 individuals without preoperative epilepsy who underwent resection, new postoperative seizures were seen in 12.3% of patients. No difference in the rate of new postoperative seizures was observed with or without perioperative prophylactic anticonvulsants.

CONCLUSIONS

Seizures are common in supratentorial meningioma, particularly in tumors associated with brain edema, and seizure freedom is a critical treatment goal. Favorable seizure control can be achieved with resection, but evidence does not support routine use of prophylactic anticonvulsants in patients without seizures. Limitations associated with systematic review and meta-analysis should be considered when interpreting these results.
Stroke prevention by direct revascularization for patients with adult-onset moyamoya disease presenting with ischemia
Authors: Kim Tackeun , Oh Chang Wan , Kwon O-Ki , Hwang Gyojun , Kim Jeong Eun , Kang Hyun-Seung , Cho Won-Sang , Bang Jae Seung
Published: December 2015

OBJECT

Moyamoya disease (MMD) is a progressive disease that can cause recurrent stroke. The authors undertook this retrospective case-control study with a large sample size in an attempt to assess the efficacy of direct or combined revascularization surgery for ischemia in adults with MMD.

METHODS

The authors investigated cases involving patients with moyamoya disease presenting with ischemia who visited Seoul National University Bundang Hospital and Seoul National University Hospital between 2000 and 2014. Among 441 eligible patients, 301 underwent revascularization surgery and 140 were treated conservatively. Variables evaluated included age at diagnosis, sex, surgical record, Suzuki stage, and occurrence of stroke. Patients were stratified into 2 groups based on whether or not they had undergone revascularization surgery. Actuarial 1-, 5-, and 10-year stroke rates were calculated using the life table method. Risk factor analysis for 5-year stroke occurrence was conducted with multivariate regression.

RESULTS

Of the 441 patients, 301 had been surgically treated (revascularization group) and 140 had not (control group). The mean follow-up durations were 45 and 77 months, respectively. The actuarial 10-year cumulative incidence rate for any kind of stroke was significantly lower in the revascularization group (9.4%) than in the control group (19.6%) (p = 0.041); the relative risk reduction (RRR) was also superior (52.0%) in the revascularization group, and the number needed to treat was 10. The 10-year rate of ischemic stroke was greater (13.3%) in the control group than in the revascularization group (3.9%) (p = 0.019). The RRR for ischemic stroke in the revascularization group was 70.7%, and the number needed to treat was 11. However, the actuarial 1- and 5-year rates of ischemic stroke did not significantly differently between the groups. Overall, revascularization surgery was shown to be an independent protective factor, as revealed by multivariate analysis.

CONCLUSIONS

Direct or combined revascularization for patients with adult-onset moyamoya disease presenting with ischemia can prevent further stroke.
Panventriculomegaly with a wide foramen of Magendie and large cisterna magna
Authors: Kageyama Hiroshi , Miyajima Masakazu , Ogino Ikuko , Nakajima Madoka , Shimoji Kazuaki , Fukai Ryoko , Miyake Noriko , Nishiyama Kenichi , Matsumoto Naomichi , Arai Hajime
Published: December 2015

OBJECT

The authors’ goal in this paper is to provide the first clinical, radiological, and genetic studies of panventriculomegaly (PaVM) defined by a wide foramen of Magendie and large cisterna magna.

METHODS

Clinical and brain imaging data from 28 PaVM patients (including 10 patients from 5 families) were retrospectively studied. Five children were included. In adult patients, the age at onset was 56.0 ± 16.7 years. Tetraventricular dilation, aqueductal opening with flow void on T2-weighted images, and a wide foramen of Magendie and large cisterna magna (wide cerebrospinal fluid space at the fourth ventricle outlet) were essential MRI findings for PaVM diagnosis. 3D fast asymmetrical spin echo sequences were used for visualization of cistern membranes. Time-spatial labeling inversion pulse examination was performed to analyze cerebrospinal fluid movement. Copy number variations were determined using high-resolution microarray and were validated by quantitative polymerase chain reaction with breakpoint sequencing.

RESULTS

Adult patients showed gait disturbance, urinary dysfunction, and cognitive dysfunction. Five infant patients exhibited macrocranium. Patients were divided into 2 subcategories, those with or without downward bulging third ventricular floors and membranous structures in the prepontine cistern. Patients with bulging floors were successfully treated with endoscopic third ventriculostomy. Genetic analysis revealed a deletion in DNAH14 that encodes a dynein heavy chain protein associated with motile cilia function, and which co-segregated with patients in a family without a downward bulging third ventricular floor.

CONCLUSIONS

Panventriculomegaly with a wide foramen of Magendie and a large cisterna magna may belong to a subtype of congenital hydrocephalus with familial accumulation, younger age at onset, and symptoms of normal pressure hydrocephalus. In addition, a family with PaVM has a gene mutation associated with dysfunction of motile cilia.
Sports participation with arachnoid cysts
Authors: Strahle Jennifer , Selzer Béla J. , Geh Ndi , Srinivasan Dushyanth , Strahle MaryKathryn , Martinez-Sosa Meleine , Muraszko Karin M. , Garton Hugh J. L. , Maher Cormac O.
Published: December 2015

OBJECT

There is currently no consensus on the safety of sports participation for patients with an intracranial arachnoid cyst (AC). The authors' goal was to define the risk of sports participation for children with this imaging finding.

METHODS

A survey was prospectively administered to 185 patients with ACs during a 46-month period at a single institution. Cyst size and location, treatment, sports participation, and any injuries were recorded. Eighty patients completed at least 1 subsequent survey following their initial entry into the registry, and these patients were included in a prospective registry with a mean prospective follow-up interval of 15.9 ± 8.8 months.

RESULTS

A total 112 patients with ACs participated in 261 sports for a cumulative duration of 4410 months or 1470 seasons. Of these, 94 patients participated in 190 contact sports for a cumulative duration of 2818 months or 939 seasons. There were no serious or catastrophic neurological injuries. Two patients presented with symptomatic subdural hygromas following minor sports injuries. In the prospective cohort, there were no neurological injuries

CONCLUSIONS

Permanent or catastrophic neurological injuries are very unusual in AC patients who participate in athletic activities. In most cases, sports participation by these patients is safe.