bluuebunny/crossref_metadata_2025 huggingface dataset:
“Mouth Wide Shut”: Strategies of Female Sex Workers for Coping With Intimate Partner Violence
Authors: Puente-Martínez Alicia , Ubillos-Landa Silvia , García-Zabala Marina , Páez-Rovira Darío
Published: September 2016

The aim of this study was to explore the relationship between possible violence suffered by female sex workers in their intimate relationships, with their affects, coping strategies, and emotional regulation to overcome such violence and improve their well-being. Structured personal interviews were carried out with female sex workers in three different settings: street, club, and flats. The sample was composed of 137 Spanish female sex workers (85.4% are foreign and 20% Spanish-born sex workers). High levels of tension and problems with their partners were linked to an affective imbalance and poor well-being. Positive affectivity determined the use of adaptive strategies, whereas negative affectivity predicted dysfunctional strategies. Three different path analyses and theoretical support concluded that self-control was the only strategy related to improve well-being in female sex workers who reported lower potential tension and difficulty in their intimate relationships. In contrast, inhibition was associated with an increase on distress levels when negative affectivity predominated and sex workers had reported potential tension and difficulty situations with their partners. It was a cross-sectional study, and thus we cannot infer causality or direction from the observed associations. Given these findings, violence prevention strategies in the intimate relationships should be prioritized in the prostitution context.
Predicting the Effects of Sexual Assault Research Participation: Reactions, Perceived Insight, and Help-Seeking
Authors: Kirkner Anne , Relyea Mark , Ullman Sarah E.
Published: September 2016

This study examined effects of participating in survey research for women sexual assault survivors with other trauma histories to understand the role of study participation on perceived insight and long-term help-seeking behaviors. A diverse sample of 1,863 women from a large Midwestern city participated in a 3-year study on women’s experiences with sexual assault. Regression analyses were conducted to (a) examine predictors of immediate positive and negative reactions to survey participation and (b) assess the impact of the survey on perceived insight and women’s long-term help-seeking behavior. Overall, most women in the study had a higher positive than negative reaction to the survey (92%), with a significant proportion indicating they sought additional services as a result of participation (55%). Women with child sexual abuse (CSA), more emotion dysregulation, and more characterological self-blame had more negative reactions to the survey, whereas those with more education and individual adaptive coping had more positive reactions. Women who said they gained insight from answering survey questions were most likely to seek additional help. This study extends the literature by examining cumulative trauma and postassault symptoms in relation to the effects of survey participation. This is also the first study of women sexual assault survivors to find a relationship between gaining perceived insight from research and subsequent help-seeking. Participating in sexual assault research may help survivors gain greater insight into their recovery, which can lead them to seek out more resources for their ongoing trauma-related problems.
Community-Informed Health Promotion to Improve Health Behaviors in Honduras
Authors: Sullivan Brittney J. , Bettger Janet Prvu
Published: September 2016

Background: Honduras is the second poorest country in Central America. The already high burden of disease is disproportionately worse among individuals with less education and limited access to health care. Community engagement is needed to bridge the gap in health care resources with the need for health promotion and education. Culturally relevant health promotion activities can foster transcultural partnerships. Purpose: The purpose of this study was to partner nursing students with village leaders to assess a community’s health needs and implement health promotion activities in Honduras. Design: Participatory action research was used in the study. Method: U.S. nursing students ( n = 4) partnered with a nonprofit organization and community partners in Villa Soleada to interview mothers in Villa Soleada, a Honduran village of 44 families, and implement health promotion activities targeted to the health priorities of their families. Results: Structured interviews with 24 mothers identified gastrointestinal issues, health care access and quality, and malaria as the top three priorities. Ninety-two percent of respondents were interested in nurse-led health promotion. Activities engaged new community partners. Discussion: This partnership and learning model was well received and sustainable. The U.S. nurses involved in the partnership gained exposure to Honduran health issues and led locally tailored health promotions in Villa Soleada. The community’s response to health promotion were positive and future activities were planned. Implications: Nursing student’s immersion experiences to support population-based health activities in low-resource settings are a replicable model that can help build healthier communities with a sustainable local infrastructure. Transcultural nursing experiences enhance students’ perspectives, increase personal and professional development, strengthen nursing students’ critical thinking skills, and for some students, confirm their desire to practice in an international arena.
Code Saturation Versus Meaning Saturation
Authors: Hennink Monique M. , Kaiser Bonnie N. , Marconi Vincent C.
Published: September 2016

Saturation is a core guiding principle to determine sample sizes in qualitative research, yet little methodological research exists on parameters that influence saturation. Our study compared two approaches to assessing saturation: code saturation and meaning saturation. We examined sample sizes needed to reach saturation in each approach, what saturation meant, and how to assess saturation. Examining 25 in-depth interviews, we found that code saturation was reached at nine interviews, whereby the range of thematic issues was identified. However, 16 to 24 interviews were needed to reach meaning saturation where we developed a richly textured understanding of issues. Thus, code saturation may indicate when researchers have “heard it all,” but meaning saturation is needed to “understand it all.” We used our results to develop parameters that influence saturation, which may be used to estimate sample sizes for qualitative research proposals or to document in publications the grounds on which saturation was achieved.
Dialogic Reading
Authors: Towson Jacqueline A. , Gallagher Peggy A. , Bingham Gary E.
Published: September 2016

Dialogic reading is an evidence-based practice for preschool children who are typically developing or at-risk; yet there is limited research to evaluate if it has similar positive effects on the language and preliteracy skills of children with disabilities. This quasi-experimental study examined the effects of dialogic reading, with the incorporation of pause time, on the language and preliteracy skills of 42 preschool children with disabilities. Following random assignment of students at the classroom level, participants were equally distributed into an intervention ( n = 21) and a comparison group ( n = 21). Children received either dialogic reading or typical storybook reading for 10 to 15 min per day, 3 days per week, for 6 weeks. Children in the intervention group scored significantly higher on receptive and expressive near-transfer vocabulary assessments. This occurred both for words that were specifically targeted during dialogic reading, and for additional vocabulary words in the storybook.
Effectiveness of Headless Bioabsorbable Screws for Fixation of the Scarf Osteotomy
Authors: Kim Jin su , Cho Hun ki , Young Ki Won , Lee Sang young , Kim Ji soo , Lee Kyoungtae
Published: September 2016

Background:

Scarf osteotomy has been used in hallux valgus surgery due to its large fixation surface for screws and low postoperative complications. However, screws may cause skin irritation from their head, which may require an additional surgical procedure to remove.

Methods:

This study included 115 patients (106 females and 9 males, 115 feet) who underwent hallux valgus correction with a scarf osteotomy using bioabsorbable screws between September 2010 and September 2012. Preoperative and postoperative 1-month and 1-year radiographic measurements, including intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), proximal phalangeal articular angle (PPAA), and lateral translational distance (LTD), were obtained. American Orthopaedic Foot & Ankle Society (AOFAS) hallux/forefoot scores were used for patient satisfaction.

Results:

Preoperative mean values of HVA, IMA, and PPA of 32.8 degrees, 14.6 degrees, and 7.52 degrees, respectively, improved to 10.7 degrees, 6.0 degrees, and 4.6 degrees, respectively at 1-year follow up ( P < .05). The difference in LTD between the 1-month and 1-year follow-up was not statistically significant. AOFAS hallux/forefoot score improved from 69.1 to 96.1 at the 1-year follow up ( P < .001). Complete screw absorption was not seen radiographically. Sixteen feet had complications reported. One patient complained of skin irritation over a small protrusion of the screw, and another patient had a foreign body reaction. There were 3 patients with neurologic injury from a popliteal block and 3 patients with dorsal cutaneous nerve symptoms. Four feet had metatarsal fracture during surgery.

Conclusion:

We found the scarf osteotomy using bioabsorbable screws to have satisfactory clinical and radiographic results with a low complication rate.

Level of Evidence:

Level IV, case series.
Realtime Achilles Ultrasound Thompson (RAUT) Test for the Evaluation and Diagnosis of Acute Achilles Tendon Ruptures
Authors: Griffin Matthew J. , Olson Kirstina , Heckmann Nathanael , Charlton Timothy P.
Published: September 2016

Background:

Acute complete Achilles tendon ruptures are commonly missed injuries. We propose the Realtime Achilles Ultrasound Thompson (RAUT) test, a Thompson test under ultrasound visualization, to aid in the diagnosis of these injuries. We hypothesized that RAUT testing would provide improved diagnostic characteristics compared with static ultrasound.

Methods:

Twenty-two consecutive patients with operatively confirmed acute Achilles tendon ruptures were prospectively evaluated with RAUT testing and static ultrasonography. RAUT video recordings and static ultrasound images from both ruptured and uninjured sides were randomized and graded by a group of novice reviewers and a group of expert attendings. From these observations, sensitivity, specificity, positive predictive value, and negative predictive value for RAUT and static ultrasound were calculated. In addition, κ interobserver coefficients were computed. Forty-seven novice reviewers and 11 foot and ankle attendings made a total of 4136 and 528 observations, respectively.

Results:

For static ultrasound, sensitivity and specificity were 76.8% and 74.8% for the novice reviewers and 79.6% and 86.4% for the attendings, respectively. For RAUT testing, sensitivity and specificity were 87.2% and 81.1% for the novice group and 86.4% and 91.7% for the attending group, respectively. The κ coefficient was 0.62 and 0.27 for novice and attending RAUT reviewers, indicating substantial and fair agreement, respectively, but only 0.46 and 0.12 for static ultrasonography, representing moderate and slight agreement, respectively.

Conclusion:

RAUT testing was a sensitive and specific test, providing a cost-effective adjunct to the clinical examination when diagnosing acute Achilles tendon ruptures. This test can be used by surgeons with minimal training in ultrasonography.

Level of Evidence:

Level II, diagnostic study.
Impact of a Computerized Antithrombotic Risk Assessment Tool on the Prescription of Thromboprophylaxis in Atrial Fibrillation: Hospital Setting
Authors: Pandya E. , Masood N. , Wang Y. , Krass I. , Bajorek B.
Published: September 2016

The computerized antithrombotic risk assessment tool (CARAT) is an online decision-support algorithm that facilitates a systematic review of a patient’s stroke risk, bleeding risk, and pertinent medication safety considerations, to generate an individualized treatment recommendation. The CARAT was prospectively applied across 2 hospitals in the greater Sydney area. Its impact on antithrombotics utilization for thromboprophylaxis in patients with nonvalvular atrial fibrillation was evaluated. Factors influencing prescribers’ treatment selection were identified. The CARAT recommended a change in baseline therapy for 51.8% of patients. Among anticoagulant-eligible patients (ie, where the risk of stroke outweighed the risk of bleeding) using “nil therapy” or antiplatelet therapy at baseline, the CARAT recommended an upgrade to warfarin in 60 (30.8%) patients. For those in whom the bleeding risk outweighed the stroke risk, the CARAT recommended a downgrade from warfarin to safer alternatives (eg, aspirin) in 37 (19%) patients. Among the “most eligible” (ie, high stroke risk, low bleeding risk, no contraindications; n = 75), the CARAT recommended warfarin for all cases. Discharge therapy observed a marginal increase in anticoagulation prescription in eligible patients (n = 116; 57.8% vs 64.7%, P = .35) compared to baseline. Predictors of warfarin use (vs antiplatelets) included congestive cardiac failure, diabetes mellitus, and polypharmacy. The CARAT was able to optimize the selection of therapy, increasing anticoagulant use among eligible patients. With the increasing complexity of decision-making, such tools may be useful adjuncts in therapy selection in atrial fibrillation. Future studies should explore the utility of such tools in selecting therapies from within an expanded treatment armamentarium comprising the non-vitamin K antagonist oral anticoagulants.
Geometric nonlinear finite element and genetic algorithm based optimal vibration energy harvesting from nonprismatic axially functionally graded piezolaminated beam
Authors: Biswal Alok Ranjan , Roy Tarapada , Kumar Behera Rabindra
Published: September 2016

The present article deals with optimal vibration energy harvesting from an axially functionally graded (FG) non-prismatic piezolaminated beam using genetic algorithm (GA). Geometric nonlinear based finite element (FE) formulation using Newmark method in conjunction with Newton-Raphson method is formulated to solve the obtained governing equation. A two noded beam element with two degrees of freedom (DOF) at each node is used in the present FE formulation. The FG material (i.e. non-homogeneity) in the axial direction is considered which varies (continuously decreasing from root to tip of such cantilever beam) using a proposed power law formula. The various cross section profiles (such as linear, parabolic and cubic) are modelled using the Euler-Bernoulli beam theory. The effects of nonlinearity on the responses (such as displacement, voltage and output power) are deliberated with arbitrary power gradient index. The effects of tapers (both width and height in length directions) on the output power and voltage are analysed. A real-coded genetic algorithm based constrained optimization technique is also proposed to determine the best possible design variables for optimal power harvesting within the allowable limits of ultimate stress of beam and breakdown voltage of PZT sensor.
Rotational invariance conditions in elasticity, gradient elasticity and its connection to isotropy
Authors: Münch Ingo , Neff Patrizio
Published: September 2016

For homogeneous higher-gradient elasticity models we discuss frame-indifference and isotropy requirements. To this end, we introduce the notions of local versus global SO(3)-invariance and identify frame-indifference (traditionally) with global left SO(3)-invariance and isotropy with global right SO(3)-invariance. For specific restricted representations, the energy may also be local left SO(3)-invariant as well as local right SO(3)-invariant. Then we turn to linear models and consider a consequence of frame-indifference together with isotropy in nonlinear elasticity and apply this joint invariance condition to some specific linear models. The interesting point is the appearance of finite rotations in transformations of a geometrically linear model. It is shown that when starting with a linear model defined already in the infinitesimal symmetric strain [Formula: see text], the new invariance condition is equivalent to the isotropy of the linear formulation. Therefore, it may also be used in higher-gradient elasticity models for a simple check of isotropy and for extensions to anisotropy. In this respect we consider in more detail variational formulations of the linear indeterminate couple-stress model, a new variant of it with symmetric force stresses and general linear gradient elasticity.
Health Care Planning and Education via Gaming-Simulation: A Two-Stage Experiment
Authors: Gagnon John H. , Greenblat Cathy Stein
Published: September 2016

A twos-stage process of gaming-simulation design was conducted: the first stage of design concerned national planning for hemophilia care; the second stage of design was for gaming-simulation concerning the problems of hemophilia patients and health care providers. The planning design was intended to be adaptable to large-scale planning for a variety of health care problems. The educational game was designed using data developed in designing the planning game. A broad range of policy-makers participated in the planning game.
Evaluation of Simulations and Games: A Comprehensive Procedure and a Case History
Authors: Thiagarajan Sivasailam
Published: September 2016

This article deals with the dimensions of evaluating simulations and games in health education, provides a procedural model which incorporates these dimensions, and illustrates this model with a case history of the evolution of a game through repeated evaluation. The four major dimensions of evaluating a game are the purposes of evaluation, sources of evaluative data, emphasis on main or side effects, and timing of evaluation. The procedural model incorporates these dimensions of evaluation and is divided into stages of self-evaluation, expert appraisal, informal player tryouts, typical-use testing, field testing, and long-term evaluation. The case history illustrates the application of each of these stages to a short game in consumer health education.
Effects of expanded vocabulary support on L2 listening comprehension
Authors: Pan Yi-Chun , Tsai Tzung-Hung , Huang Yueh-Kuey , Liu Dilin
Published: September 2016

Various forms of pre-listening support, such as the provision of vocabulary and topic information, have been used to help second language (L2) learners better understand what they listen to. Results of studies on the effects of vocabulary support have been mixed. Furthermore, there has been little research on the effects of different quantities of vocabulary items and types of word information provided on the listening performance of L2 students of different proficiency levels. Therefore, this study investigated the effectiveness of two different levels of 18-week vocabulary support (an expanded vocabulary-instruction support that targeted both a greater quantity of lexical items and a focus on multiword units vs. an unexpanded vocabulary-instruction support with a focus on single words only) for enhancing listening ability of students of English as a foreign language (EFL) defined as their performance on the listening test of the Test of English for International Communication (TOEIC). The results indicate that the group that received the expanded vocabulary support attained a significant gain and performed significantly better on the posttest than the group that received the unexpanded vocabulary support. The results also reveal that the expanded vocabulary support was particularly helpful for lower proficiency level students. Pedagogical and research implications are also discussed.
Manipulating task implementation variables with incipient Spanish language learners: A classroom-based study
Authors: Payant Caroline , Reagan Derek
Published: September 2016

A growing body of research has shown a positive role of task-supported instruction in second language (L2) learning (Ellis, 2003a; Loewen, 2015; Van Den Branden, 2006). From a pedagogical perspective, recycling or repeating parts of teaching materials is common practice and theoretical support for such practice is emerging (Bygate and Samuda, 2005). However, determining which aspects to repeat during task-supported interaction that fosters interaction-driven learning opportunities while maintaining student interest is currently underexplored. Further, few studies have considered learners’ perception during task completion. The current study thus examined the effects of task repetition on the production and resolution of language-related episodes (LREs) over time. English-speaking (first language, L1) students of Spanish (second language, L2) from two intact Spanish as a foreign language (FL) classroom ( n = 28) were assigned to one of the following task repetition groups: task with repetition (same task/same content) or task with procedural repetition (same task/new content). Learner–learner interaction produced during two-way decision-making tasks were transcribed and coded for LREs. Learner perception data was collected following task completion and analysed qualitatively. The results indicated that the task repetition had greater benefits on the occurrence and resolution of lexis-based LREs, but that both groups benefited similarly in terms of producing and resolving form-based LREs. Results are discussed in light of speech processing models and pedagogical implications for task-based instruction in FL settings are examined.
Numerical analysis of aerodynamic noise mitigation via leading edge serrations for a rod–airfoil configuration
Authors: Agrawal Bharat Raj , Sharma Anupam
Published: September 2016

Noise produced by aerodynamic interaction between a circular cylinder (rod) and an airfoil in a tandem arrangement is investigated numerically using incompressible large eddy simulations. Quasi-periodic shedding from the rod and the resulting wake impinges on the airfoil to produce unsteady loads on the two geometries. These unsteady loads act as sources of aerodynamic sound and the sound radiates to the far-field with a dipole directivity. The airfoil is set at zero angle of attack for the simulations and the Reynolds number based on the rod diameter is Red = 48 K. Comparisons with experimental measurements are made for (a) mean and root mean square surface pressure on the rod, (b) profiles of mean and root mean square streamwise velocity in the rod wake, (c) velocity spectra in the near field, and (d) far-field pressure spectra. Curle’s acoustic analogy is used with the airfoil surface pressure data from the simulations to predict the far-field sound. An improved correction based on observed spanwise coherence is used to account for the difference in span lengths between the experiments and the simulations. Good agreement with data is observed for the near-field aerodynamics and the far-field sound predictions. The straight leading edge airfoil is then replaced with a test airfoil with a serrated leading edge geometry while maintaining the mean chord. This new configuration is also analyzed numerically and found to give a substantial reduction in the far-field noise spectra in the mid- to high-frequency range. Source diagnostics show that the serrations reduce unsteady loading on the airfoil, reduce coherence along the span, and increase spanwise phase variation, all of which contribute to noise reduction.
Home-Based In Vivo Desensitization Treatment of Bathroom Avoidance in a Child With Autism Spectrum Disorder
Authors: Flood William A. , Luiselli James K.
Published: September 2016

We report the case of a 7-year-old boy who had autism spectrum disorder and displayed disruptive and avoidant behavior when using the bathroom at home with people present in adjoining rooms or nearby the bathroom door. Desensitization treatment was implemented by gradually exposing the boy to proximity of an in-home therapist when he was in the bathroom and positively reinforcing the absence of disruptive behavior. Treatment effectively eliminated bathroom avoidance and generalized to settings outside the home. Intervention outcome was maintained 6- and 7-months post-treatment.
Women on Parole, Identity Processes, and Primary Desistance
Authors: Stone Rebecca , Morash Merry , Goodson Marva , Smith Sandi , Cobbina Jennifer
Published: September 2016

The current study employs a prospective mixed-methods design to examine women parolees’ identities early in their supervision and the association of their identity development at that point to their record of subsequent arrests. Guided by narrative identity theory, we first conduct quantitative analysis of the relationship between redemption and contamination narratives and subsequent arrests. We then return to the qualitative interview data to search for additional explanatory themes that shed further light on women’s identity and desistance from crime. Results indicate that identity verification from parole officers and others increases women’s self-esteem and assists them in overcoming barriers to desistance.
Surface Replacement Arthroplasty of the Proximal Interphalangeal Joint in Border Digits Using a Lateral Approach
Authors: Renfree Kevin J.
Published: September 2016

Background: Proximal interphalangeal joint (PIPJ) arthroplasty in border digits is controversial because of unprotected external loading forces and limited canal sizes in the small finger. The use of neither a semiconstrained, surface replacement proximal arthroplasty (SRA) nor a lateral approach that preserves the external collateral ligament has been well described. Methods: Eight women (mean age, 66 years) underwent SRA of 5 index and 4 small digits for osteoarthritis. Active range of motion, deformity, and grip and pinch strengths were measured, and patients completed a visual analog pain scale, QuickDASH, and satisfaction survey. Radiographs were assessed for implant loosening or subsidence. Results: Mean follow-up was 29 months. Mean pain score decreased from 8.0 to 0.8. Mean coronal deformity decreased from 22° ulnar deviation to 6°. Average PIPJ arc of motion improved from 51° to 56°. No lateral instability was observed. Final lateral pinch averaged 4.4 kg in affected vs 4.0 kg in opposite hand. Average final grip strength was 19 kg in affected vs 16 kg in opposite hand. Postoperative QuickDASH averaged 24; postoperative satisfaction score averaged 3.7 (5-point Likert scale). Radiographic analysis showed no implant subsidence or radiolucent lines. Conclusions: PIPJ SRA appears to be a reasonable option in border digits, as is a lateral approach on the inside border of the affected digit. Pain relief and lateral stability are predictable, and motion improves slightly. If a longitudinal incision is made, placement slightly dorsal to the midaxial line away from the digital nerve may help to avoid a tender scar.
Boot-shaped Neurovascular Island Flap for Reconstruction of Radial Polydactyly
Authors: Shen Xiaofang , Rui Yongjun , Xue Mingyu
Published: September 2016

Hypothesis: Reconstruction of radial polydactyly with a boot-shaped neurovascular island flap can result in good outcomes. Materials and Methods: A number of techniques are used for reconstruction of radial polydactyly, with the aim of reconstruction to obtain a stable, mobile thumb of adequate size and shape. Techniques include preserving the ulnar (or radial) thumb, reconstructing a contour defect with a boot-shaped neurovascular island flap and the Bilhaut-Cloquet procedure. A persistent problem is the asymmetry between the reconstructed and normal contralateral thumb. Between 2013 and 2015, 9 thumbs in 8 patients had reconstruction with a boot-shaped neurovascular island flap. The study group included 1 Wassel type I, 6 Wassel type IV, and 2 Wassel type VII. A boot-shaped neurovascular island flap was dissected out from the thumb to be removed. Specific modifications include the use of Bruner incisions dorsally and volarly to reduce scarring at the interphalangeal joint and also complete mobilization of the island flap on its pedicle to allow easier inset. A flexor pollicis longus and extensor tendon rebalancing technique was used to correct deviation of the reconstructed thumb’s interphalangeal (IP) joint in the Wassel type IV thumb duplication. Results: All boot-shaped neurovascular island flaps survived with good contour and shape, and obtained symmetry eponychial fold compared with the contralateral thumb. Reconstruction of radial polydactyly with a boot-shaped island neurovascular flap allows for good symmetry in shape and size following reconstruction, especially where 2 digits are equal or almost equal in size. Summary Points: A boot-shaped neurovascular island flap can be used for reconstruction of radial polydactyly with good outcomes.
Long-term Outcomes of Free Nonvascularized Toe Phalanx Transfer for Symbrachydactyly
Authors: Kawabata Hidehiko , Higuchi Chikahisa , Tamura Daisuke , Nakura Akio , Hayashi Junichiro
Published: September 2016

Objective: The purpose of this study was to evaluate long-term outcomes of free nonvascularized toe phalanx transfer to reconstruct synbrachydactylic hands in children. Materials and Methods: We retrospectively reviewed 54 free nonvascularized toe transfers in 29 children with congenitally short fingers. Growth rate was calculated at 5-year follow-up and 10-year follow-up. Percent length against the original phalanx, remaining in the contralateral foot, was also calculated. When bilateral phalanx of the fourth toes was used, average length of the proximal phalanx of the third and fifth toes was used as a substitute. Incidence of the early physeal closure was recorded. Toe phalanx was harvested according to the technique described by Buck-Gramko in 1990. Fingers were explored using mid-dorsal longitudinal incisions. If remnant of the proximal phalanx was present, the toe phalanx was placed on the top of the remnant with 3 or 4 nonabsorbable sutures. If there was no remnant, loop of the extensor and flexor tendons were cut at the metacarpal head, and they were sutured with the toe phalanx that was held on the top of the metacarpal with 1 Kirschner wire. Collateral ligaments were also reconstructed. Results: Age at operation was 1.5 years on average. The proximal phalanx of the fourth toe was used in 51 and that of the third toe in 3. Seven toes were trimmed because the skin pocket was tight. Silastic expander was used for tissue expansion before toe phalanx transfer in 4 cases. Five cases required revision surgery for partial necrosis of the skin pocket. Five children (7 toes) were lost before 5-year follow-up, and hence excluded for evaluation. Six children underwent bone lengthening procedure between 5- and 10-year follow-up period, and 10 children did not reach 10 years after surgery. They, too, were excluded for the evaluation at 10-year follow-up. At 5-year follow-up, the physis was closed in 30%, growth rate was 0.8 mm/year, and %length was 87%. At 10-year follow-up, closure rate increased to 85%, growth rate decreased to 0.5 mm/year, and %length was 69%. Conclusion: Free nonvascularized toe phalanx transfer is a versatile procedure for reconstruction of the congenital finger deficit. Growth ability remains at least 5 years in most of the cases but it decreases when they reached 10-year follow-up period.
Neurovascular Island Flap for Pulp and Nail Augmentation in Hypoplastic Thumb Duplication Reconstruction
Authors: Liu Bo , Ho Pak-cheong , Tse Wing-lam , Chow Ching-san , Wong Wing-yee
Published: September 2016

Objective: Pulp and nail asymmetry is commonly seen in thumb duplication condition, particularly when both digits are significantly hypoplastic. Conventional or modified Bilhaut-Cloquet procedure can help to restore the symmetry but very often results in a major dorsal scar leading to cosmetic imperfection. The authors introduced a neurovascular island flap for pulp and nail augmentation, and combined with a dorsally based skin flap approach, to improve the aesthetic result in thumb duplication reconstruction. Materials and Methods: Eight patients, including 1 Wassel type II, 1 Wassel type III, and 6 Wassel type IV, were operated on between 2002 and 2010. The contralateral thumbs are all normal. All patients had significant hypoplasia and asymmetry of the pulp and nail of the planned retained digit. The average age of operation was 12 months (range, 8-15 months). A dorsally based skin flap centered on the site of bifurcation was raised for exposure and dissection of the abnormal structures. A neurovascular island flap, including part of the pulp tissue, nail bed, with or without the associated phalangeal bone, was raised from the planned ablated digit based on its single neurovascular bundle. After the standard procedure of ablation, ligament, and musculature reconstruction, with or without realignment osteotomy, the island flap was transferred to the proper digit with meticulous repair of the nail bed, nail fold, and pulp tissue using fine sutures under magnification with operating microscope. All patients were followed up with to monitor the aesthetic, functional, and radiological outcome. The average follow-up was 80 months (range, 25-120 months). An aesthetic scoring system was proposed to assess the cosmetic results of the thumb duplication reconstruction. Results: All flaps survived, with transient intraoperative ischemia of the transferred pulp in 1 case. The major portion of the surgical scar lied toward the volar aspect of the thumb, leaving the cosmetic dorsal aspect relatively intact. Pulp and nail fold symmetry was improved in all cases. The nail width discrepancy reduced from 25.2% preoperatively to 4.6% at final follow-up. The hypoplastic appearance of the pulp was improved in all cases. The pulp circumference was comparable with the contralateral normal thumb, with average pulp circumference discrepancy of 6.8% (range, 1.7%-13.0%) at final follow-up. Nail ridges were moderate in 2 early cases, minimal in 3 cases, and inconspicuous in 3 cases. Surgical scar was not obvious in all but 1 case. The proposed aesthetic scoring system was able to assess and highlight the cosmetic aspect of the outcome and correlated well with the parents’ satisfaction. Conclusions: In selected cases of thumb duplication with significant pulp hypoplasia and nail asymmetry, the neurovascular pulp and nail island flap is a safe and effective mean to restore symmetry for better aesthetic improvement.
Distal Humerus External Rotation Osteotomy for Hand Position in Arthrogryposis
Authors: Goldfarb Charles A. , Wall Lindley B. , Calhoun Valerie , Baker Stacey
Published: September 2016

Hypothesis: In the amyoplasia type of arthrogryposis, shoulder internal rotation, in addition to limited muscle development and joint contracture, may cause a reverse pronated grasp pattern. We hypothesized that repositioning the hands through external rotation distal humerus osteotomies (DHO) would allow for palm-to-palm grasp without crossover and would improve function and parent/patient satisfaction. Methods: The medical records of all patients treated surgically for arthrogryposis were reviewed at our hospital. Nine patients, 15 extremities, had undergone an external rotation distal humerus osteotomy to improve hand position. All patients had had preoperative and postoperative video recording of function. Preoperative upper extremity (UE) position was graded as 1 = facing away from midline, 2 = palm facing posterior, and 3 = palm facing midline. Postoperative Pediatric Outcomes Data Collection Instrument (PODCI) questionnaires were obtained, and parent satisfaction was evaluated. Results: Mean patient age at the time of surgery was 6.5 years. There were 6 patients who underwent staged, bilateral distal humerus osteotomies. There were a total of 3.5 additional upper extremity procedures in this population (range, 0-6). All patients had improved resting posture of the upper extremity after surgery, mean change 46° (range, 25°-90°). Thirteen extremities had a change in hand position affecting their grasp pattern, and 2 did not. There was a mean grade improvement of hand position of 1 level after surgery (range, 0-3). There was a wide range in postoperative PODCI scores for Upper Extremity Function and Global function, but Happiness scores were high, mean 89 (range, 60-100). Parents universally stated the procedure improved the child’s function “a great deal.” There was one complication of periprosthetic humerus facture. Summary Points: DHO is an effective procedure for correcting the internal rotation position of the UE in arthrogryposis. DHO improves hand opposition in arthrogryposis by a mean of 1 grade. Universally, there was perceived improved function resulting from DHO.
Identification of Associated Genes and Diseases in Patients With Congenital Upper Limb Anomalies
Authors: Baas M. , Hovius S. E. R. , Galjaard R. J. H. , van der Spek P. , van Nieuwenhoven C.A.
Published: September 2016

Purpose: Congenital upper limb anomalies (CULA) can present isolated or as a part of a syndrome or association. Therefore, surgeons dealing with CULA should be aware of associated diseases and anomalies. The newly accepted Oberg, Manske, and Tonkin (OMT) classification allows for registration of a wide spectrum of CULA. Therefore, providing associated diseases for each hand anomaly in the classification would aid differential diagnosis formulation in clinic and investigation of causal genes in research. The first aim of this study was to review the Human Phenotype Ontology (HPO) database for diseases and causative genes that can be related to hand anomalies present in the OMT classification. The second aim was to relate associated anomalies and inheritance patterns to improve differentiation between the diseases. Methods: The HPO database was reviewed for all diseases with a known causative gene related to hand anomalies. All hand phenotypes were classified according to the OMT classification; nonhand phenotypes were classified into anatomical groups. TIBCO Spotfire Software was used to visualize the contribution of each anatomical group to a given disease and to prioritize diseases based on this contribution. Results were compared with literature cases and to a current HPO tool, Phenomizer. Results: In total, 514 hand phenotypes were obtained, 384 could be classified in the OMT classification, and 1403 diseases could be related to the OMT classification. Differentiation between diseases is illustrated by examples. Comparison to recently published hand phenotypes reveals that all were present in our data set. Gene prioritization using our methodology was better than Phenomizer in 4/5 examples. Conclusions: We present an OMT-classification-based methodology to aid clinicians in differential diagnosis formulation in patients with CULA. Furthermore, we enable discrimination between the diseases by providing insight in the differences in disease presentation. Gene prioritization and visualization in the proposed system outperforms systems in current use.
The Application of the Oberg, Manske, and Tonkin Classification in Clinic
Authors: Baas M. , Zwanenburg P. R. , Hovius S. E. R. , van Nieuwenhoven C.A.
Published: September 2016

Introduction: Congenital upper limb anomalies (CULA) exhibit a wide spectrum of phenotypic manifestations. To describe the full nature of all anomalies, the Oberg, Manske, and Tonkin (OMT) classification was developed. The OMT classification aims to provide a classification which better fits the current concepts of the etiology and allow combined documentation of all anomalies present in a single limb. The introduction of the OMT classification was succeeded by multiple validation studies regarding its clinical application. However, all studies were mainly aimed to test usability of the classification and were not consistent in the classification strategy: In some studies, all anomalies were classified as suggested by the initiators, whereas others only used one diagnoses per limb. Therefore, the aim of this study was to evaluate the various classification strategies used with the OMT classification. Methods: We retrospectively reviewed all patients visiting the Erasmus MC Team for Congenital Hand and Upper Limb Malformations in the Sophia Children’s Hospital between December 2014 and February 2012. All congenital anomalies of both limbs individually were classified according to the OMT scheme as proposed by Tonkin et al; furthermore, all associated anomalies were recorded. In compound hand phenotypes, every hand anomaly present was classified to best describe the clinical features of every patient. To evaluate which hand anomalies commonly required multiple diagnoses used within one patient, the mean number of diagnosis and 95% confidence interval (CI) were calculated and plotted for each OMT class and diagnose specifically. To evaluate whether multiple OMT-term use was effective to discriminate different cohorts of patients, the group characteristics of patients requiring one OMT diagnosis versus patients requiring multiple OMT diagnoses were studied. Results: In total, 736 patients were eligible for inclusion and 953 OMT diagnoses were registered; 449 were unilateral (219 left-handed, 230 right-handed) and 504 were bilateral. The average number of diagnosis for each patient was 1.29 (95% CI, 1.25-1.34). In 20.5% of the patients ( n = 155), a combination of OMT diagnoses was used to describe the observed anomalies. The total number of unique combinations of OMT diagnosis was 101, of which 77 combinations were only used once and 24 were used repeatedly. We illustrate that in radial polydactyly, additional OMT diagnosis was often used to convey differentiating characteristics, such as additional ulnar polydactyly, the combination of which was more often observed in patients with a syndromal cause of the anomaly. Conclusion: We conclude that the strategy used in applying the OMT classification is of eminent importance for optimizing the discriminating features of the OMT classification. As suggested by the initiators, all terms necessary to convey the full nature of the anomaly should be used. We illustrate our point using case examples for radial polydactyly.
A Study of Conservative Treatment for Colles’ Fractures Using the Novel Classification by Lateral Radiographic View
Authors: Zenke Yukichi , Furukawa Kayoko , Sakai Akinori , Menuki Kunitaka , Hirasawa Hideyuki , Yamanaka Yoshiaki , Tajima Takafumi , Furukawa Hideki
Published: September 2016

Objective: The objective of this study is to elucidate the changes in radiographic parameters over time in conservative treatment of Colles’ fractures. Participants and Methods: The participants were 60 patients with Colles’ fractures (60 wrists) that were treated conservatively. They were l3 males and 47 females with a mean age of 72.5 years (range, 55-96 years). Based on the AO Foundation and Orthopaedic Trauma Association (AO/OTA) fracture and dislocation classification, the numbers of patients with type A2, A3, Cl, C2, and C3 fractures were 33, 5, 5, l2, and 5, respectively. The cause of injury was limited to a fall from eye height, and we excluded patients with a concurrent fracture of the distal ulnar metaphysis and patients with comminution of the palmar cortex. All the patients underwent manipulative reduction immediately after diagnosis. We focused on the palmar cortex in lateral radiographic views to classify the fractures into the intramedullary type, the anatomical type, and the extramedullary type, and measured the palmar tilt (PT), radial inclination (RI), and ulnar variance (UV) at the time of injury, immediately after reduction, and in final observation. Statistical Analysis: We analyzed the correction loss of PT, RI, and UV by Tukey-Kramer after one-way analysis of variance (ANOVA). Results: The fracture types immediately after reduction were the intramedullary type in 11 patients, the anatomical type in 42 patients, and the extramedullary type in 7 patients. The correction loss in PT and in RI was negative in each group, with no significant differences among the 3 groups, whereas UV was positive in each group. The correction loss was significantly greater in the intramedullary group than in the anatomical group and the extramedullary group. Conclusion: We analyzed radiographic parameter changes over time associated with reduced position in the conservative treatment of Colles’ fractures. The correction loss in UV immediately after reduction until the final observation was significantly greater in the intramedullary group than in the anatomical group and the extramedullary group.
Diagnostic Test Study of the Skyline View for Dorsal Screw Protrusion After Fixation of Distal Radius Fractures
Authors: Navas-Reyes Monica , Rodriguez-Ricardo Maria C. , Moreno-Serrano Constanza , Quintero Jorge I. , Bermudez Julio C.
Published: September 2016

Background: Distal radius fractures are one of the most common orthopedic injuries, and around 50% of them are intra-articular which leads to requiring open reduction and fixation. One of the most common complications involving the distal radius volar locking plate, when used as a method for fixation, is the possibility of leaving the distal screws to long and crossing the dorsal cortex leading to rupture of the extensor tendons of the wrist and hand. The skyline view of the wrist allows the evaluation of different aspects of the fixation in distal radius fractures, including the screw that crosses the dorsal cortex; however, no studies report the accuracy of this view to predict this and eventually prevent tendon ruptures. Objectives: Describe the accuracy of the skyline view (specificity, sensibility) to predict protrusion of the screws in the dorsal cortex compared with a postoperative computed tomographic (CT) scan in patients who underwent volar fixation of distal radius fractures. Methods: A retrospective analysis was undertaken on patients with fixation of distal radius fractures using distal radius volar locking plates between January 2013 and January 2016 that had the skyline view of the wrist taken immediately after the end of the surgery and had a CT scan in the follow-up. Patients that had any other type of fixation were excluded from the study. The sample size predicted a total of 36 x-rays. Only patients operated by orthopedic hand surgeons were included. Two experienced orthopedic hand surgeons evaluated both the skyline view and the CT scan (used as gold standard) and evaluated in each image whether any screw crossed the dorsal cortex of the distal radius. Results: A total of 44 patients with distal radius volar locking plate fixation were identified, including 27 females and 21 males with a mean age of 52 (range, 25-87 years), and the leading cause of the fractures was low-energy trauma. The skyline view and the CT scans were randomized for each observer, meaning that each observer analyzed 44 x-rays and 44 CT scans. The prevalence of protruded screws in the dorsal cortex of the distal radius was 25% confirmed with the gold standard study the CT scan. The sensibility of the skyline view to predicting protruded screw in the dorsal cortex was 81% and the specificity 94%. The positive predictive value was 81% and a negative predictive value 94%, all values with P values less than .05. Conclusions: The skyline view is an accurate tool to evaluate protrusion of the screws in the dorsal cortex of the distal radius when using distal radius volar locking plates as a method for fixation of distal radius fractures. With a high specificity and sensibility allowing orthopedic hand surgeons an easy and accessible tool to assess the appropriate length of the distal screws for the distal radius volar locking plate in radius fractures to prevent possible tendon ruptures.