bluuebunny/crossref_metadata_2025 huggingface dataset:
The Most Important Meal of the Day: Why Children Skip Breakfast and What Can Be Done About It
Authors: Jackson Lisa Wilhelm
Published: August 2014

We all experience that morning rush to get somewhere — to work, to school, or to complete a number of important errands before we reach those final destinations. Many adults skip meals for a variety of reasons. Children and teenagers are no different.

Eating behaviors can promote or diminish healthy nutrition. A child consuming breakfast with family members on a regular basis is ideal but not always realistic. More and more children have two working parents who are rushing out to work in the morning, have limited income or a lack of healthy options at home, or possess a lack of education on the benefits of breakfast. Evidence shows that breakfast consumption reduces weight gain by improving satiety and decreasing binge eating later in the day. High-fiber cereals (ie, >2 g per serving) and whole-grain products improve satiety and decrease binge eating at lunch or after school. The total dietary fiber intake should equal age plus 5 g for young children and up to 14 g/1,000 calories for adolescents.

In the National Heart, Lung, and Blood Institute (NHLBI) Growth and Health Study, 2,379 white and black females aged 9 to 19 years were followed on an annual basis. The more frequently breakfast was consumed was associated with a higher calcium and fiber intake and, consequently, a lower body mass index. This article focuses on the NHLBI guidelines for cardiovascular risk reduction in children and adolescents, including practical suggestions about breakfast meal planning and food choices. These recommendations offer real-time dietary suggestions and practical advice for patients’ families.

CME Educational Objectives

1.

Discuss the important effects skipping meals can have on the overall long-term well-being of a child.

2.

Identify strategies parents can use to promote a consistent adequate breakfast meal.

3.

Provide specific ideas for a breakfast meal that match differing family lifestyles.
Childhood Obstructive Sleep Apnea Syndrome: A Review of the 2012 American Academy of Pediatrics Guidelines
Authors: Trosman Irina
Published: August 2014

CME Educational Objectives

1.

Review new 2012 American Academy of Pediatrics guidelines for the diagnosis and management of childhood obstructive sleep apnea syndrome (OSA).

2.

Outline the differences between the previous 2002 guidelines and the most recent guidelines.

3.

Highlight controversies and challenges in the diagnosis and management of pediatric OSA.

On a busy day at the pediatric office, child health care practitioners may see children of different ages present with symptoms such as inattentiveness, hyperactivity, aggression, behavioral problems, excessive sleepiness, difficulty waking up in the morning, learning problems, frequent awakening at night, restless sleep, morning headaches, and nocturnal enuresis. Children with these symptoms may be underweight or morbidly obese; healthy; or suffering from asthma, seasonal allergies, or other ailments. What they will likely have in common is a fairly well-known and yet under-recognized condition — obstructive sleep apnea syndrome (OSA).

The American Academy of Pediatrics first published “Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome” in 2002. However, with the increase in obstructive sleep apnea syndrome research, they revised these guidelines in 2012. These new guidelines evaluate obstructive sleep apnea syndrome diagnostic techniques, describe available treatment options, and provide follow-up recommendations. This article explores those revisions.
Just a Scary Dream? A Brief Review of Sleep Terrors, Nightmares, and Rapid Eye Movement Sleep Behavior Disorder
Authors: Haupt Mark , Sheldon Stephen H. , Loghmanee Darius
Published: August 2014

CME Educational Objectives

1.

Recognize the signs and symptoms of parasomnias in children.

2.

Develop a clinical framework to evaluate common parasomnias in children.

3.

Distinguish the unique features of sleep terrors, nightmares, and rapid eye movement sleep behavior disorder (RBD).

The clinical spectrum of sleep disorders in children is broad, ranging from primary snoring and obstructive sleep apnea (OSA) syndrome to complex sleep-related behaviors and movement disorders. Although snoring and OSA typically receive significant attention and discussion, other biologically based sleep disorders are as common, if not more common, in children. A general pediatrician is frequently presented with the complaint of sleep talking, sleep walking, or abnormal movements during sleep. Even more alarming is the presentation of the child suddenly and explosively screaming during sleep. Such complaints fall under the category of parasomnias. Exclusive to sleep and wake-to-sleep transitions, these parasomnias include arousals with abnormal motor, behavioral, autonomic, or sensory symptoms. Parasomnias can be noticeably dissimilar in clinical manifestations, but most share biologic characteristics. Three parasomnias associated with loud vocalizations associated with sleep that can present to general practitioners include sleep terrors, nightmares, and rapid eye movement sleep behavior disorder (RBD). Although usually benign, these sleep disorders can be disruptive and even potentially dangerous to the patient and can often be threatening to quality of life. In this article, we describe the clinical features of some of these disorders and how to differentiate between their alarming presentations.
Diagnosis and Treatment of Adolescent Idiopathic Scoliosis
Authors: Burton Monique S.
Published: August 2014

CME Educational Objectives

1.

Define scoliosis, including the three major types of scoliosis and the age breakdown for idiopathic scoliosis.

2.

Utilize an algorithm for scoliosis screening and the appropriate use of imaging modalities.

3.

Understand the appropriate management for adolescent idiopathic scoliosis, including indications for bracing and referral for surgery.

Scoliosis is defined as a lateral curvature of the spine greater than 10 degrees on radiography that is typically associated with trunk rotation. The three major types of scoliosis are congenital, idiopathic, and neuromuscular. Idiopathic scoliosis is divided into three subcategories based on the age of onset. Infantile idiopathic scoliosis affects patients younger than 3 years, juvenile idiopathic scoliosis appears in children between 3 and 10 years, and adolescent idiopathic scoliosis (AIS) occurs in skeletally immature patients older than 10 years.

AIS is the most common form of idiopathic scoliosis. Approximately 2% to 4% of children aged 10 to 16 years have some degree of spinal curvature. Although some researchers view routine screening for AIS as controversial, well-child examinations and sports physicals are an optimal time to evaluate for AIS in the clinical setting.

In 2008, the American Academy of Orthopaedic Surgeons, the Scoliosis Research Society, the Pediatric Orthopaedic Society of North America, and the American Academy of Pediatrics convened a task force to review the issues related to scoliosis screening and issued an information statement concluding that although screening has limitations, the potential benefits that patients with idiopathic scoliosis receive from early treatment can be substantial. Recommendations are now that females are screened twice, at age 10 and 12 years, and males once at age 13 or 14 years. Screening during routine well-child examinations and/or school-based evaluations will help identify patients who need ongoing monitoring. The evaluation of curvatures in conjunction with the level of skeletal maturity will help to guide the management of the curvature.
Skeletal Trauma in Child Abuse
Authors: Swoboda Sara L. , Feldman Kenneth W.
Published: August 2014

CME Educational Objectives

1.

Understand the key history elements and risk factors that raise suspicion for non-accidental trauma.

2.

Identify which fractures and injury patterns are concerning for nonaccidental trauma.

3.

Discuss mandatory reporter regulations regarding suspected child abuse.

Fractures and other skeletal injuries are common in childhood. Most are the result of falls, motor vehicle accidents, and other forms of accidental trauma. However, skeletal trauma is present in a significant number of abused children. Age and developmental abilities are key components in raising clinical suspicion for child abuse. Children who are unable to provide their own history because of age or developmental delay require increased attention. Younger children are more likely to have abusive fractures, whereas accidental fractures increase with age and developmental abilities. The consequences of missing abuse are high because children returned to their homes without intervention are likely to face further abuse and have an increased mortality risk. Because of the potentially high cost of undiagnosed child abuse, diagnosis of a skeletal injury is incomplete without diagnosing its etiology. All health providers for children should be able to recognize patterns of skeletal injury secondary to abusive trauma and understand the process for initiating Child Protective Services (CPS) investigations when necessary. Although they can occur accidentally, fractures in nonmobile children should always increase the clinician’s concern for abusive trauma. In light of the significant consequences for children when abuse is missed by a primary care provider, abuse should be on the differential diagnosis for all presenting childhood injuries.
Febrile Seizures
Authors: Patterson Janet L. , Carapetian Stephanie A. , Hageman Joseph R. , Kelley Kent R.
Published: August 2014

CME Educational Objectives

1.

Discuss the classification, epidemiology, and pathophysiology of febrile seizures in children.

2.

Review the evaluation, management, and prognosis of febrile seizures.

3.

Understand the long-term outcomes and implications for follow-up management and parental education of febrile seizures.

Febrile seizures are the most common form of childhood seizures, affecting 2% to 5% of children. They are considered benign and self-limiting; however, a febrile seizure is a terrifying event for most parents, and is one of the most common causes of trips to the emergency room.

A febrile seizure is “an event in infancy or childhood, usually occurring between 3 months and 5 years of age, associated with fever but without evidence of intracranial infection or defined cause.” This definition excludes seizures with fever in children who have had a prior afebrile seizure. In 2011, The American Academy of Pediatrics (AAP) published a clinical practice guideline defining a febrile seizure as “a seizure accompanied by fever (temperature ≥ 100.4°F or 38°C by any method), without central nervous system infection, that occurs in infants and children 6 through 60 months of age.” Febrile seizures are further classified as simple or complex. This article reviews the evaluation, management, and prognosis of simple and complex seizures, including febrile status epilepticus.
The Excessively Crying Infant: Etiology and Treatment
Authors: Akhnikh Samira , Engelberts Adèle C. , van Sleuwen Bregje E. , L’Hoir Monique P. , Benninga Marc A.
Published: August 2014

Excessive crying, often described as infantile colic, is the cause of 10% to 20% of all early pediatrician visits of infants aged 2 weeks to 3 months. Although usually benign and self-limiting, excessive crying is associated with parental exhaustion and stress. However, an underlying organic cause is found in less than 5% of these infants. In the majority of cases, treatment consists not of “curing the colic,” although usually it is possible to reduce crying, but of helping the parents to get through this challenging period in their baby’s development. The aims of this review are to discuss definition, etiology, and evaluate different treatment regimes in infants who cry excessively.
Biliary Dyskinesia in Pediatrics
Authors: Srinath Arvind , Saps Miguel , Bielefeldt Klaus
Published: August 2014

Biliary dyskinesia (BD) is a diagnosis that is being made increasingly in children. It is defined by abdominal pain thought to be biliary in nature based on location and character; a completely normal gallbladder on imaging tests, typically ultrasound; and decreased gallbladder contraction in response to a pharmacological stimulus. Unlike other functional gastrointestinal disorders (FGIDs) that are treated with medications, behavioral therapy, and/or dietary modification, current clinical practice has accepted cholecystectomy as the treatment of choice for BD, which now accounts for up to 50% of cholecystectomies in children. Although well-designed trials are missing, accumulating evidence argues against such an approach. First, BD is by definition a benign disorder without risk of truly relevant complications. Second, despite reportedly high rates of satisfaction with postoperative outcomes, most children continue to experience symptoms. Lastly, limited long-term studies have demonstrated comparable benefit of operative and conservative therapy. To summarize, BD should be seen as a more localized manifestation of functional abdominal pain, which may improve over time independent of the type of therapy chosen. Despite the widespread adoption of minimally invasive surgery in pediatrics, a different risk-benefit ratio favors conservative treatment for this benign disorder.
Adolescent Rumination Syndrome
Authors: Schroedl Rose Lucey , Di Lorenzo Carlo , Alioto Anthony
Published: August 2014

Adolescent Rumination Syndrome (ARS) is a relatively uncommon disorder, defined by the involuntary regurgitation of recently ingested food from the stomach to the mouth, where it is either expelled or re-swallowed. Although the disorder itself is not life-threatening, it typically has a significant medical and psychosocial impact on the patient and family. There continues to be limited awareness about the clinical presentation, diagnosis, and treatment of ARS among clinicians. As such, adolescents presenting with symptoms of ARS often are misdiagnosed and typically undergo avoidable, extensive, invasive, and costly testing. This article seeks to increase awareness and knowledge about ARS, and to provide the clinician with practical guidelines regarding the pathogenesis, assessment, diagnosis, and treatment of ARS.
Approach to Acute Ataxia in Childhood: Diagnosis and Evaluation
Authors: Sivaswamy Lalitha
Published: August 2014

Ataxia refers to motor incoordination that is usually most prominent during movement or when a child is attempting to maintain a sitting posture. The first part of the review focuses on the anatomic localization of ataxia — both within the nervous system and without — using a combination of historical features and physical findings. The remainder of the review discusses etiological considerations that vary depending on the age group under consideration. In infancy, certain specific diseases, such as opsoclonus myoclonus ataxia syndrome, must receive special mention because the underlying disease process may be amenable to surgical intervention. In the toddler- and school-age groups, certain conditions (such as stroke and acute cerebellitis) require immediate recognition and imaging, whereas others (such as post-infectious ataxia and concussion) require close follow-up. Finally, mention must be made of diseases outside of the central nervous system that can present with ataxia, such as Guillain-Barré syndrome.
Clinical Considerations for Care of Older Adult Cancer Survivors
Authors: Johnson Wendy , Cadogan Mary P.
Published: August 2014

The number of cancer survivors has been steadily increasing due in part to the aging population and advancements in cancer care and treatment. Of the current 13.7 million cancer survivors in the United States, most are 65 or older. Aging changes and the presence of comorbidities add complexity to the care of cancer survivors. In addition, common long-term cancer-related symptoms and late effects of cancer treatments provide challenges to nurses and other health professionals caring for older cancer survivors. Transition from oncology care to primary or shared care requires understanding of detailed information about the specific cancer diagnosis, treatments received, and recommendations for follow-up care to prevent recurrence, recognize treatment-associated health effects, and understand strategies for health promotion. Nurses in all practice areas will care for cancer survivors and must be prepared to deliver safe and effective care. [
Journal of Gerontological Nursing, 39
(9), 8–12.]
Older Adults’ Performance in Technology-Based Tasks: Cognitive Ability and Beyond
Authors: Schmidt Laura I. , Wahl Hans-Werner , Plischke Herbert
Published: August 2014

Considering both demographic and technological changes in society, the potential of technology to support older adults has recently attracted much attention. For physically frail individuals with cognitive impairment, user-friendly technologies may facilitate activities of daily living. The current study assessed the performance of older adults without cognitive impairment (
n
= 27) and with mild cognitive impairment (
n
= 26) using three types of technology. Relationships between performance in the technology-based tasks and cognitive abilities (e.g., visual-spatial abilities), personality characteristics (e.g., self-efficacy), and previous technology experience were examined using a mixed-methods approach including video analyses and psychological testing. Findings underscore that both cognitive abilities and personality-related characteristics contribute to individual differences in users’ performance. Nuanced knowledge of older adults’ specific difficulties, abilities, and resources may help improve the fit between user needs and technological requirements, with implications for technology developers and practitioners. [
Journal of Gerontological Nursing, 40
(4), 18–24.]
Role of Nutraceuticals in Dementia Care
Authors: Ford Jonathan M. , Brandt Nicole J.
Published: August 2014

With an increase in the number of patients diagnosed with Alzheimer’s disease, it is not surprising that there is a consistent increase in use of nutraceuticals and other over-the-counter medications to combat memory complaints and ideally treat dementia. Throughout this review article, the authors highlight recent literature updates on B vitamins, vitamin D, vitamin E, omega-3 fatty acids, and gingko biloba. Similar to any other medication, it is imperative to evaluate the risks and benefits in older patients, especially in light of comorbidities and existing medications. [
Journal of Gerontological Nursing, 40
(4), 11–17.]
Pain Assessment in Hospitalized Older Adults With Dementia and Delirium
Authors: Paulson Christina May , Monroe Todd , Mion Lorraine C.
Published: August 2014

Pain can have negative effects leading to prolonged hospital stays. Determining the presence of uncontrolled and untreated pain in patients with cognitive impairments such as delirium, dementia, and delirium superimposed on dementia (DSD) is challenging. One tool commonly suggested for use in assessment of pain in older adults with cognitive impairment is the Pain Assessment In Advanced Dementia (PAINAD) scale. Proper use of the PAINAD scale as part of a comprehensive pain management plan can help reduce the likelihood of a patient experiencing unrecognized and untreated pain. Using an individual example, this article illustrates best practices in pain assessment and management for a woman experiencing DSD during an acute hospitalization. [
Journal of Gerontological Nursing, 40
(6), 10–15.]
Novel Reconstruction Technique Using a Frozen Tumor-bearing Vertebra From a Total En Bloc Sponydylectomy for Spinal Tumors
Authors: Murakami Hideki , Kato Satoshi , Demura Satoru , Yoshioka Katsuhito , Hayashi Hiroyuki , Inoue Kei , Ota Takashi , Shinmura Kazuya , Yokogawa Noriaki , Fang Xiang , Tsuchiya Hiroyuki
Published: August 2014

This article describes a novel reconstruction technique using frozen tumor-bearing vertebrae in total en bloc spondylectomy for spinal tumors. Instead of harvesting autograft from the ilium or fibula, the resected lamina and vertebral body from the total en bloc spondylectomy are frozen in liquid nitrogen and used as grafted bone for spinal reconstruction. A retrospective review of 56 patients was undertaken. As a result of this review, it was determined that this technique has the benefits of no pain at the bone harvest site, shortened operative time, decreased blood loss, and an additional antitumor immune response.
Cross-sectional Analysis of Trends in Meniscectomy and Meniscus Repair
Authors: Montgomery Scott R. , Zhang Alan , Ngo Stephanie S. , Wang Jeffrey C. , Hame Sharon L.
Published: August 2014

Knee arthroscopy to address meniscus tears is among the most common orthopedic procedures performed, and technical advances in the treatment of meniscus tears have affected the treatment options available to orthopedic surgeons. The purpose of this study was to perform a large cross-sectional analysis of orthopedic patients to investigate trends in arthroscopic meniscectomy and meniscus repair in the United States. Patients who underwent arthroscopic meniscectomy (Current Procedural Terminology codes 29881 and 29880) and arthroscopic meniscus repair (Current Procedural Terminology codes 29882 and 29883) were identified using the PearlDiver Patient Record Database, which is a national database of insurance records. The authors identified 187,607 arthroscopic medial or lateral meniscectomies and repairs performed between 2004 and 2009. Ninety-six percent of patients underwent meniscectomy and 4% underwent repair. No change occurred in the incidence of medial or lateral meniscectomy. The incidence of medial meniscus repair decreased from 5.3 cases per 10,000 patients in 2004 to 3.8 in 2009 (
P
<.001), although no significant change occurred in the incidence of lateral meniscus repair. Medial meniscectomy was most commonly performed in patients aged 50 to 59 years, whereas lateral meniscectomy demonstrated a bimodal age distribution. Conversely, meniscus repairs were most frequently performed in patients aged 10 to 19 years. Sex differences were more pronounced with meniscus repair (63% male vs 37% female) compared with meniscectomy (53% male vs 47% female). A high frequency of meniscus debridement can be expected in arthroscopic knee surgery. Despite advances in meniscus repair techniques and devices, no increase occurred in the performance of meniscus repair compared with meniscectomy.
Quality of Information on the Internet About Carpal Tunnel Syndrome: An Update
Authors: Lutsky Kevin , Bernstein Joseph , Beredjiklian Pedro
Published: August 2014

The use of the Internet for health-related information has increased significantly. In 2000, the current authors examined the source and content of orthopedic information on the Internet. At that time, Internet information regarding carpal tunnel syndrome was found to be of limited quality and poor informational value. The purposes of the current study were to reevaluate the type and quality of information on the Internet regarding carpal tunnel syndrome and to determine whether the quality of information available has improved compared with 1 decade ago.

The phrase
carpal tunnel syndrome
was entered into the 5 most commonly used Internet search engines. The top 50 nonsponsored and the top 5 sponsored universal resource locators identified by each search engine were collected. Each unique Web site was evaluated for authorship and content, and an informational score ranging from 0 to 100 points was assigned. Approximately one-third of nonsponsored Web sites were commercial sites or selling commercial products. Seventy-six percent of sponsored sites were selling a product for the treatment of carpal tunnel syndrome. Thirty-eight percent of nonsponsored sites provided unconventional information, and 48% of sponsored sites provided misleading information. Just more than half of nonsponsored sites were authored by a physician or academic institution. The informational mean score was 53.8 points for nonsponsored sites and 14.5 points for sponsored sites.

The informational quality on the Internet on carpal tunnel syndrome has improved over the past decade. Despite this progress, significant room exists for improvement in the quality and completeness of the information available.
Minimally Invasive Unilateral Pedicle Screw Fixation and Lumbar Interbody Fusion for the Treatment of Lumbar Degenerative Disease
Authors: Lin Bin , Xu Yang , He Yong , Zhang Bi , Lin Qiuyan , He Mingchang
Published: August 2014

Minimally invasive unilateral pedicle screw fixation for the treatment of degenerative lumbar diseases has won the support of many surgeons. However, few data are available regarding clinical research on unilateral pedicle screw fixation associated with minimally invasive techniques for the treatment of lumbar spinal diseases. The purpose of this study was to evaluate clinical outcomes in a selected series of patients with lumbar degenerative diseases treated with minimally invasive unilateral vs classic bilateral pedicle screw fixation and lumbar interbody fusion. Patients in the unilateral group (n=43) underwent minimally invasive unilateral pedicle screw fixation with the Quadrant system (Medtronic, Memphis, Tennessee). The bilateral group (n=42) underwent bilateral instrumentation via the classic approach. Visual analog scale pain scores, Oswestry Disability Index scores, fusion rate, operative time, blood loss, and complications were analyzed. Mean operative time was 75 minutes in the unilateral group and 95 minutes in the bilateral group. Mean blood loss was 220 mL in the unilateral group and 450 mL in the bilateral group. Mean postoperative visual analog scale pain score was 3.10±0.16 in the unilateral group and 3.30±1.10 in the bilateral group. Mean postoperative Oswestry Disability Index score was 15.67±2.3 in the unilateral group and 14.93±2.6 in the bilateral group. Successful fusion was achieved in 92.34% of patients in the unilateral group and 93.56% of patients in the bilateral group. Minimally invasive unilateral pedicle screw fixation is an effective and reliable option for the surgical treatment of lumbar degenerative disease. It causes less blood loss, requires less operative time, and has a fusion rate comparable with that of conventional bilateral fixation.
Subdeltoid Lipoma Arborescens Combined With Rotator Cuff Tears
Authors: Kim Min-hyung , Chung Seok Won , Yoon Jong Pil , Kim Sae Hoon , Oh Joo Han
Published: August 2014

Lipoma arborescens, a rare benign intra-articular lesion, is characterized by lipomatous proliferation of the synovium in which the subsynovial tissue is replaced by mature adipocytes. Subdeltoid bursa is a rare location for lipoma arborescens, and only a few cases have been reported in the literature. This article reports 2 cases of subdeltoid lipoma arborescens combined with rotator cuff tears, and the possible relationships between subdeltoid lipoma arborescens and rotator cuff tears are discussed. The intra-articular villous proliferations on fat-suppressed T2-weighted magnetic resonance imaging appeared as yellowish-white lipomatous villous proliferations on arthroscopy, and finger-like lipomatous proliferation of the synovium, where the subsynovial connective tissue is replaced by mature adipocytes, on histology. Although further evidence would be necessary, the bony proliferations, in addition to bone-to-bone abrasion and inflammatory processes, may contribute to the relationship between subdeltoid lipoma arborescens and rotator cuff tears. Because this is a rare disease in a rare location, no established treatment guidelines are available for lipoma arborescens in subdeltoid bursa. For the current patients, arthroscopic excision of the lipoma arborescens and concomitant rotator cuff repair were prescribed after more than 6 months of conservative management. All patients had symptom relief and were satisfied with their results. Paying special attention to the radiologic and arthroscopic characteristics of the lipoma arborescens will help physicians and surgeons to achieve a more accurate diagnosis and effective treatment strategy, especially in patients with concomitant rotator cuff tears.
Conversion Hemiarthroplasty and Valgus Osteotomy After Failed ORIF of Hip Intertrochanteric Fractures
Authors: Talmo Carl T. , Sambaziotis Chris , Bono James V.
Published: August 2014

Hip arthroplasty after open reduction and internal fixation of the proximal femur presents a challenge to reconstructive surgeons. Bony defects, fracture malunion, and non-union increase the risk of complications, including intraoperative fracture, unrecognized perforation, and trochanteric non-union. The authors describe a novel surgical technique using conversion hemiarthroplasty and valgus osteotomy for failed open reduction and internal fixation of intertrochanteric hip fractures. The described surgical technique resulted in trochanteric advancement and preservation of the bone stock in the intertrochanteric region. This technique was successful in eliminating pain and restoring ambulation and abductor function and resulted in stable ingrowth and healing in these patients.
Intra-articular Morphine Versus Bupivacaine for Postoperative Pain Management
Authors: Elkousy Hussein , Kannan Vijayaraj , Calder Cynthia T. , Zumwalt Juliette , O’Connor Daniel P. , Woods G. William
Published: August 2014

The purpose of this study was to determine whether morphine would be as effective as bupivacaine for postoperative pain control after knee arthroscopy with no worsening of the side effect profile. Eighty-two patients who underwent partial meniscectomy, chondral debridement, or both were prospectively randomized to receive 10 mg of morphine (10-cc volume) or 10 cc of .5% bupivacaine immediately postoperatively. Visual analog scale scores and side effect profiles were recorded in the postanesthesia care unit, in the transitional care unit, and then every 4 hours postoperatively until 24 hours.

In-hospital data were available for all 82 patients, but postdischarge data were available for only 64 patients. Visual analog scale scores in the postanesthesia care unit decreased from 3.4 on admission to 2.4 on discharge for the morphine group and from 2.6 to 2.4 for the bupivacaine group (
P
>.217, all time points). Medication use was the same for both groups in the hospital (62% and 78%, respectively) with no statistical difference. Visual analog scale scores decreased from 3.0 to 1.5 for the morphine group and from 2.8 to 1.8 for the bupivacaine group between 4 and 24 hours postoperatively (
P
>.376, all time points). Medication use decreased between 4 and 24 hours postoperatively for both groups, from 71.7% to 52.9%, respectively, with no statistical difference at all time points. Four patients in the morphine group and 1 patient in the bupivacaine group experienced side effects.

This study indicates that 10 mg of intra-articular morphine is as effective as 10 cc of .5% bupivacaine for postoperative pain control for partial meniscectomy and chondral debridement of the knee. It minimally increases side effects initially and circumvents the issue of chondral toxicity of bupivacaine.
Steroid Injections in the Upper Extremity: Experienced Clinical Opinion Versus Evidence-based Practices
Authors: Kegel Gary , Marshall Astrid , Barron O. Alton , Catalano Louis W. , Glickel Steven Z. , Kuhn Margaret
Published: August 2014

A survey regarding upper-extremity steroid injection practices was distributed to all active members of the American Society for Surgery of the Hand (ASSH) and American Shoulder and Elbow Surgeons (ASES) using SurveyMonkey. Response rates for the ASSH and ASES were 26% and 24%, respectively.

The potency-adjusted dose of steroid injected for common hand and wrist injections ranged from 0.375 to 133.33 mg and for shoulder injections ranged from 0.375 to 250 mg. These ranges span 356-fold and 667-fold differences, respectively. Potency-adjusted doses differed significantly between steroid types for all injections evaluated in this study. American Society for Surgery of the Hand members gave significantly smaller doses of steroid for the glenohumeral and acromioclavicular joints than ASES members. Only 9% of respondents based injection practice on a scientific reference. Sixteen percent of ASSH and 31% of ASES respondents reported no specific rationale for their steroid injection practice; 78% of ASSH and 52% of ASES respondents attributed their rationale to some kind of instruction from their mentors or colleagues.

Upper-extremity surgeons demonstrate substantial variability in their practice of steroid injections, with up to a 667-fold range in steroid dose. Experienced clinical opinion is the principal rationale for these injection practices; little rationale is based on formal scientific evidence.
Patient Perception of Physician Reimbursement for Common Hand Surgical Procedures
Authors: Fowler John R. , Buterbaugh Glenn A.
Published: August 2014

Health care–related costs have been the focus of intense scrutiny in politics and in the media. However, public perception of physician reimbursement is poorly understood. The purpose of this study was to determine patient perception of physician reimbursement for 2 common hand surgery procedures: carpal tunnel release and open reduction and internal fixation of a distal radius fracture.

Anonymous surveys were completed by 132 patients in an outpatient hand and upper-extremity practice. The surveys asked patients to estimate reasonable surgeon fees and actual Medicare reimbursement for 2 common hand surgery procedures (carpal tunnel release and internal fixation of a distal radius fracture) and 2 common surgical procedures (coronary artery bypass and appendectomy). On average, patients estimated that a reasonable surgeon fee for carpal tunnel release and 90 days of postoperative care was $2629 and that actual Medicare reimbursement was $1891. Patients estimated that a reasonable surgeon fee for internal fixation of an extra-articular distal radius fracture and 90 days of postoperative care was $3874 and that actual Medicare reimbursement was $2671. Higher level of education, annual household income, and insurance status had no statistically significant effect on patient estimates of reimbursement.

Patients in an outpatient hand and upper extremity practice believe that surgeons are reimbursed at a rate 3.6 to 4.7 times greater than actual reimbursement. These misperceptions highlight the lack of understanding and transparency in health care costs and may interfere with the ability of patients to make well-informed decisions about health care.
Outcome and Range of Motion Using a High-flexion Cruciate-retaining TKA
Authors: Rosen Adam S. , Neville Lorraine , Pulido Pamela A. , Patil Shantanu , Walker Richard H. , Copp Steven N.
Published: August 2014

Increased knee flexion after total knee arthroplasty (TKA) may contribute to patients’ increased satisfaction and more active lifestyles. This study evaluated a TKA component designed for high flexion (more than 125°). The design features an anatomic sagittal femoral radius with short, flared femoral condyles to allow for femoral rollback. Fifty TKA procedures in 47 patients were evaluated prospectively regarding clinical outcomes using Knee Society knee and function scores, Short Form 12 physical component scores, and flexion measured clinically and by digital lateral supine active flexion radiographs. Preoperative and 1-year postoperative radiographs were analyzed by an independent observer.

Mean maximum flexion measured clinically was 115° preoperatively and 120° one year postoperatively, with 76% of TKAs achieving more than 120° and 44% achieving more than 125°. Sex, body mass index, and preoperative flexion were not predictors of postoperative flexion. Mean flexion by radiograph was 108° preoperatively and 111° one year postoperatively, with 31% of knees achieving more than 120° and 14% more than 125°. Mean Knee Society knee and function scores and the Short Form 12 physical component scores were 52, 55, and 32 preoperatively, respectively, and 89, 77, and 40 one year postoperatively, respectively. Of the 50 knees, 84% had improvement in their Knee Society function scores, and 76% had improvement in their Short Form 12 physical component scores. The study revealed evidence of increased early postoperative flexion with the use of a cruciate-retaining high-flexion TKA design.
Late Repair of Combined Extensor Carpi Radialis Longus and Brevis Avulsion Fractures
Authors: Gurich Richard W. , Tanksley John A. , Pappas Nick D.
Published: August 2014

Concomitant avulsion fractures of the extensor carpi radialis longus and brevis tendons are relatively rare injuries. The usual injury mechanism is forced hyperflexion to an actively extended wrist. No consensus exists regarding the appropriate management of this injury, with some surgeons advocating closed treatment and others favoring operative fixation. The authors describe a novel surgical technique for the late repair of combined extensor carpi radialis longus and brevis tendon avulsion using suture anchor repair of the extensor carpi radialis brevis and tenodesis of the retracted extensor carpi radialis longus to the brevis.
Fluoroscopic Imaging of Acetabular Cup Position During THA Through a Direct Anterior Approach
Authors: Alvarez Andres M. , Suarez Juan C. , Patel Preetesh , Benton Edward G.
Published: August 2014

Mobile image intensifiers are more readily used to assess acetabular cup placement when performing a total hip arthroplasty through a direct anterior approach. However, patient positioning affects pelvic tilt and rotation, which in turn requires proper C-arm fluoroscopy adjustments for image interpretation. The authors provide insight into the interpretation of acetabular cup positioning based on the fluoroscopic images obtained to ensure appropriate cup positioning using the direct anterior approach for total hip arthroplasty.
Current Concepts in the Treatment of Distal Radial Fractures
Authors: Ipaktchi Kyros , Livermore Meryl , Lyons Christopher , Banegas Rodrigo
Published: August 2014

Distal radial fractures are among the most commonly encountered traumatic fractures of the upper extremity. Initial trauma mechanism, fracture pattern, associated injuries, and patient age influence treatment and outcome. Although stable fractures are commonly treated conservatively, the past decade has seen changes in surgical practice and techniques. Indications for surgery have been extended and refined based on new insight into the pathophysiology of the distal end of the forearm and technological advances in implant design. Despite the frequency of this fracture, only limited higher-level evidence exists to guide practitioners in decision making for this injury. This article highlights key concepts in the treatment of distal radial fractures and summarizes current evidence.
Use of Fine-threaded K-wires in the Treatment of Coronoid Fractures in Complex Elbow Instability
Authors: Giannicola Giuseppe , Polimanti David , Gumina Stefano , Cinotti Gianluca
Published: August 2014

The coronoid process is one of the main elbow constraints that provides ulnohumeral joint stability. Coronoid fractures may be fixed using multiple techniques, including transosseous sutures, screws, and plates. The goal of this study was to analyze the clinical and radiographic outcomes in a series of patients with complex elbow instability in whom coronoid fractures were repaired using fine-threaded K-wires.

Eight men and 10 women (mean age, 47 years) were followed prospectively for a mean of 26 months. Surgical treatment consisted of open reduction and internal fixation of all fractures; radial head replacement in Mason III injuries; lateral collateral ligament repair in all patients; and, in cases of persistent instability, medial collateral ligament repair, hinged fixator application, or both. Coronoid fixation was performed using 2 or more fine-threaded K-wires, depending on the fragment size, inserted from the posterior aspect of the ulna and directed toward the coronoid fragment using a 1-step fixation technique. At last follow-up, mean extension was 15°, mean flexion was 133°, mean pronation was 78°, and mean supination was 69°; mean Disabilities of the Arm, Shoulder and Hand score was 9.7, mean American Shoulder and Elbow Surgeons score was 85, and mean Mayo Elbow Performance Score was 89. According to the Mayo Elbow Performance Index, 10 excellent, 7 good, and 1 fair result were recorded. All but 1 patient had a stable elbow. Fracture healing was observed in all but 1 patient. No secondary coronoid fragment dislocation or implant failures were reported.

This study shows that using fine-threaded K-wires provides easy, minimally invasive, stable, and successful 1-step fixation that can be used to obtain osteosynthesis of coronoid fractures in patients with complex elbow instability.
Changes in Surgical Procedures for Acromioclavicular Joint Dislocation Over the Past 30 Years
Authors: Takase Katsumi , Yamamoto Kengo
Published: August 2014

Generally, surgical treatment is recommended for Rockwood type 5 traumatic acromioclavicular joint dislocations. Since 1980, the authors have performed the modified Dewar procedure, the modified Cadenat procedure, and anatomical reconstruction of the coracoclavicular ligaments for this injury. The goal of this study was to determine the ideal surgical procedure for acromioclavicular joint dislocations by comparing these 3 procedures.

The modified Dewar procedure was performed on 55 patients (Dewar group), the modified Cadenat procedure was performed on 73 patients (Cadenat group), and anatomical reconstruction of the coracoclavicular ligaments was performed on 11 patients (reconstruction group). According to the UCLA scoring system, therapeutic results averaged 27.3 points in the Dewar group, 28.2 in the Cadenat group, and 28.4 in the reconstruction group. The incidence of residual subluxation or dislocation in the acromioclavicular joint was evaluated at final radiographic follow-up. Subluxation occurred in 21 patients in the Dewar group, 18 in the Cadenat group, and 3 in the reconstruction group. Dislocation occurred in 3 patients in the Dewar group. Osteoarthritic changes in the acromioclavicular joint occurred in 20 patients in the Dewar group, 9 in the Cadenat group, and 1 in the reconstruction group.

The modified Cadenat procedure can provide satisfactory therapeutic results and avoid postoperative failure or loss of reduction compared with the modified Dewar procedure. However, the modified Cadenat procedure does not anatomically restore the coracoclavicular ligaments. Anatomic restoration of both coracoclavicular ligaments can best restore acromioclavicular joint function.
Endo-Modell Rotating-hinge Total Knee for Revision Total Knee Arthroplasty
Authors: Bistolfi Alessandro , Rosso Federica , Crova Maurizio , Massazza Giuseppe
Published: August 2014

The goal of this study was to analyze the clinical and radiographic results and the survival rate of a series of rotating-hinge implants used for revision total knee arthroplasties in mild and severe instability.

Between December 1991 and June 2004, fifty-three revision total knee arthroplasties were performed using the Endo-Modell (Waldemar LINK GmbH and Co, Hamburg, Germany) rotating-hinge prosthesis; 7 (13.2%) patients underwent partial revision of a previous Endo-Modell. All patients were evaluated preoperatively, 3 and 6 months postoperatively, and annually thereafter using the Hospital for Special Surgery (HSS) knee score and the Knee Society Roentgenographic Evaluation System (KS-RES). Mean follow-up was 155.2±40.1 months (range, 78–240 months), with 32 patients examined at the final follow-up. All HSS knee scores increased from preoperatively to last follow-up. No statistically significance differences were found in the HSS knee scores between septic and aseptic revisions and between total or partial revisions. Progressive radiolucent lines were detected in 8 (25%) patients. Implant failure occurred in 11 (20.7%) patients; the cumulative survival of the implants was 80.4% at 150 months for the final 32 patients.

The authors recommend use of this implant for revision total knee arthroplasty, especially in patients with severe instability and bone loss.
Randomized, Controlled Trial of the Modified Stoppa Versus the Ilioinguinal Approach for Acetabular Fractures
Authors: Ma Kunlong , Luan Fujun , Wang Xuan , Ao Yongxing , Liang Yu , Fang Yue , Tu Chongqi , Yang Tianfu , Min Jing
Published: August 2014

The objective of this study was to determine whether the modified Stoppa approach or the ilioinguinal approach is better for the treatment of acetabular fractures by comparing the results of those 2 approaches. A randomized trial was undertaken of 60 consecutive patients with acetabular fractures treated with either the modified Stoppa or the ilioinguinal approach. In addition to the patients’ demographics, the assessed preoperative parameters included fracture pattern, associated injuries, time to surgery, and Injury Severity Score; intraoperative parameters included blood loss and operative time for each procedure; and postoperative parameters included wound drainage, blood transfusion, perioperative complications, early operative complications, late operative complications, quality of reduction, radiological results, and clinical outcomes.

The study showed no significant differences in all measured preoperative variables between the 2 groups (all
P
>.05). In addition, no significant differences were found in the intraoperative complication rate, early operative complication rate, late operative complication rate, quality of reduction, radiological results, and clinical outcomes (all
P
>.05). However, compared with the ilioinguinal approach, the modified Stoppa approach reduced intraoperative blood loss—and in doing so decreased wound drainage and the need for blood transfusion—and shortened operative time (all
P
<.05).

The authors recommend using the modified Stoppa approach rather than the classical ilioinguinal approach to treat acetabular fractures when anterior exposure of the acetabulum is required.
Effectiveness of Local Tenoxicam Versus Corticosteroid Injection for Plantar Fasciitis Treatment
Authors: Guner Savas , Onder Haci , Guner Sukriye Ilkay , Ceylan Mehmet Fethi , Gökalp Mehmet Ata , Keskin Siddik
Published: August 2014

Plantar fasciitis is one of the most common causes of foot pain in adults. In this prospective study, the outcomes of local tenoxicam injection and corticosteroid therapy for the treatment of plantar fasciitis were compared.

Patients were randomly assigned to either the tenoxicam or corticosteroid group. The tenoxicam group (n=31) was treated using a local injection of 1 mL of tenoxicam (20 mg/2 mL) and 1 mL of 2% lidocaine, whereas the steroid group (n=30) was treated with a local 1-mL injection containing 40 mg of methylprednisolone acetate and 1 mL of 2% lidocaine. Clinical evaluations, which were performed before the injection and 6 and 12 months after the injection, consisted of patient-assessed pain using a visual analog scale. In addition, patient satisfaction was measured using the Roles and Maudsley score. Comparison of pre- and posttreatment visual analog scale scores demonstrated a statistically significant difference in both groups (
P
<.05). Furthermore, no significant difference was found between the steroid and tenoxicam groups in terms of visual analog scale scores measured 12 months after injection (
P
>.05).

The tenoxicam injection was not significantly more effective than the corticosteroid injection. However, both methods were effective and successful in treating patients with plantar fasciitis. Tenoxicam therapy appears to provide pain relief, but its effectiveness in the long term should be explored in additional studies.