bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Care Interprofessional Education: Encouraging Technology, Teamwork, and Team Performance
Authors: Smith Kellie A.
Published: August 2014

It is critical to prepare nurses for future practice to work in teams by engaging students in interprofessional education (IPE) that fosters positive attitudes toward teamwork. The purpose of this study was to examine the effects of computer-supported IPE on students' attitudes and perceptions toward health care teamwork and team performance. A hybrid approach to IPE was used to provide students with an educational experience that combined the benefits of traditional face-to-face communication methodology with a computer-mediated platform that focused on reflection and team building. A statistically significant difference was found in students' perceptions of team performance after engaging in computer-supported IPE. No statistically significant difference in students' pretest–posttest composite attitude toward teamwork scores was noted; however, there was a positive trend toward improved scores.
J Contin. Educ Nurs.
2014;45(4):181–187.
The Alliance for Continuing Education in the Health Professions: A Brief Overview of Health Care CE Professionals
Authors: Balmer Jann T.
Published: August 2014

This article describes a professional membership organization dedicated to building a strong community of continuing education (CE) professionals across all health professions. As the health care system changes, the CE community needs to build relationships beyond a single profession to encompass performance improvement and health care professional competence in the workplace.
J Contin Educ Nurs.
2014;45(4):153–154.
Cerebral Vasospasm in Traumatic Brain Injury: A Case Study
Authors: Nelson Alexis , Nyquist Paul A. , Razumovsky Alexander , Marshall Scott A.
Published: August 2014

CME Educational Objectives

1.

Review the expanded differential diagnosis of mental status changes in the patient with mild to severe traumatic brain injury.

2.

Discuss the workup and monitoring for suspected cerebral vasospasm in patients with a history of traumatic subarachnoid hemorrhage.

3.

Review potential therapeutic options for mental status changes attributed to cerebral vasospasm.

An unemployed young man with a history of poly-substance abuse suffered a closed head injury as the result of a motor vehicle crash. At the scene, the patient had a prolonged period of unconsciousness and was intubated. Computed tomography (CT) of the brain upon arrival to the trauma center reveals a mild bilateral subarachnoid hemorrhage (SAH) in a nonspecific pattern. The imaging is thought to be consistent with trauma and is without a space occupying lesion.
Deep Brain Stimulation for Obsessive-Compulsive Disorder
Authors: Corse Andrew K. , Chou Tina , Arulpragasam Amanda R. , Kaur Navneet , Deckersbach Thilo , Cusin Cristina
Published: August 2014

CME Educational Objectives

1.

Provide an overview of the history and origins of deep brain stimulation (DBS) for treatment-refractory obsessive-compulsive disorder (OCD).

2.

Describe the various neuroanatomic targets of DBS implant for OCD as well as the neurocircuitry involved.

3.

Explain the effects of DBS for OCD, both intended and unintended, as well as the promise the treatment holds for select treatment-resistant OCD patients.

Obsessive-compulsive disorder (OCD) is a chronic anxiety disorder that affects approximately 2% to 3% of the population.
1
OCD is characterized by persistent, intrusive, and distressing thoughts (obsessions) and ritualistic behaviors (compulsions), such as counting, organizing, or cleaning, which are used to lessen anxiety caused by the obsessive thoughts. The symptoms of OCD generally manifest in childhood or adolescence and may result in significant impairment in everyday functioning. The etiology of OCD is hypothesized to involve a combination of genetic and environmental factors.
Addiction in Chronic Pain Patients: Evidence-Based Approaches for Monitoring Chronic Opioid Therapy
Authors: Patel Alkesh N.
Published: August 2014

CME Educational Objectives

1.

Appreciate the clinical interface between pain and addiction as it relates to the general neurobiological mechanisms of disease, analgesic effects of drugs of abuse, and genetic underpinnings.

2.

Understand the controversies surrounding chronic opioid therapy for the treatment of chronic noncancer pain and identify patients at risk of prescription opioid misuse.

3.

Appreciate how urine toxicology testing is used in monitoring chronic pain patients and outline the potential benefits and limitations of its use in clinical practice.

Pain and addiction share several common pathways that interface on neuroanatomic and neurobiological grounds. The clinical interaction between pain and addiction is often complex. Drugs of abuse often have analgesic effects, and the dysregulation of mood and behavior seen with addiction complicates the perception of pain. Genetic data suggest that chronic pain, opioid analgesia, and opioid addiction share similar patterns of gene expression.
1
Medical professions have increasingly been prescribing opioids to treat chronic pain. Randomized controlled trials show a lack of strong evidence supporting sustainable analgesic efficacy and improved function with chronic opioid therapy (COT).
Comorbidities in Schizophrenia: Challenges for Researchers and Clinicians
Authors: Opler Lewis A. , Hwang Michael Y. , Opler Mark G.
Published: August 2014

CME Educational Objectives

1.

Provide strategies for combining psychotropics in treating persons with schizophrenia plus other psychiatric disorders.

2.

Provide an understanding of the need to combine psychiatric genetics with epidemiology, neurobiology, and clinical experience in developing psychiatric nosologies.

3.

Indicate the importance of combining categorical and dimensional approaches in the diagnosis and treatment of psychiatric disorders.

In 1993, Hwang and Hollander
1
described the co-occurrence of schizophrenic and obsessive-compulsive symptoms in their article “Schizo-Obsessive Disorders.” Subsequently, Hwang et al
2–4
have continued to study both theoretic and treatment approaches relevant to schizophrenia with comorbidity. The publication of the
Diagnostic and Statistical Manual for Mental Disorders, 5th edition
(
DSM-5
)
5
is appropriately leading to many articles and even more discussions regarding psychiatric diagnoses. In this article, we update our conceptualization of and treatment recommendations for schizophrenia with comorbidity and offer our perspective regarding impact of developments in
DSM-5
.
Substance Use Comorbidity in Patients with Schizophrenia
Authors: Vitacco Michael J. , Buckley Peter F.
Published: August 2014

CME Educational Objectives

1.

Be mindful of the association between the onset of schizophrenia and substance use.

2.

Understand and utilize the guidelines for clinical care of patients with schizophrenia and comorbid substance use.

3.

Consider the need for antipsychotic medications that will effectively treat schizophrenia without supporting addiction.

Comorbid substance use is common in people with schizophrenia and other psychotic disorders. Although there are discrepancies between studies reporting on the prevalence of this comorbidity, the most typical number reported is that approximately 50% of patients diagnosed with schizophrenia will have a substance use diagnosis at some point in their lives, and up to 25% of those people diagnosed with schizophrenia at any given time may be actively engaged in substance use.1,2The importance for understanding this dual diagnosis is clear when one considers that the combination of substance use and psychotic disorders leads to higher levels of violence and more severe psychopathology.3Various studies have addressed substance use as it relates to the etiology, pathogenesis, and treatment of schizophrenia, and yet fundamental questions remain. For instance, is substance use, on its own accord, a putative risk factor for schizophrenia? How does the presence of substance use impact the treatment of a person with schizophrenia? This article aims to provide an overview of recent empirical research on two notable areas influencing clinicians and researchers. First, we discuss explanatory models that aim to improve our understanding of the high prevalence between substance use and schizophrenia. Second, we review implications for the treatment of substance use comorbidity in people with schizophrenia and complications that stem from substance use in these patients.
Group Psychotherapy in Schizophrenia with Obesity and Eating Disorders: A Pilot Study
Authors: Yum Sun Young , Hwang Michael Y.
Published: August 2014

CME Educational Objectives

1.

Develop individualized treatment methods for patients with metabolic illness and schizophrenia.

2.

Anticipate the importance of body image, body weight and self-esteem in patients with stabilized schizophrenia.

3.

Incorporate psychotherapy in treatment regimens.

Despite an abundance of data on metabolic illnesses in patients with schizophrenia, their management is relatively less studied. In the few treatment studies, the goal is even less clear. Are we aiming to reduce weight? Why? Or are we aiming to reduce morbidities associated with obesity and, ultimately, cardiovascular mortality? If it is the latter, then weight is just one surrogate marker. We still do not know what weight is a surrogate of in patients with schizophrenia.
Assessment and Management of Late-Life Depression
Authors: Avari Jimmy N. , Yuen Genevieve S. , AbdelMalak Bassem , Mahgoub Nahla , Kalayam Balkrishna , Alexopoulos George S.
Published: August 2014

The diagnosis and treatment of late-life depression is often complicated by its clinical context. As a rule, late-life depression afflicts medically ill, disabled persons living under chronic stress and/or isolation. Symptoms and signs of medical illnesses and behavioral limitations from disability are often difficult to distinguish from depressive symptomatology. Under-reporting of depressed mood and other psychological symptoms is common by older adults and contributes to under-diagnosis of depression. Many antidepressant drugs and some psychotherapies have been found more efficacious than their respective comparison conditions. However, each of these treatments helps less than half of depressed older adults, necessitating a treatment strategy in which failure or intolerance of each treatment step informs the next. Clinical subpopulations of late-life depression — psychotic depression, dysthymic disorder, depression associated with an adverse life event, treatment-resistant depression, and residual symptoms of depression — require special attention.
Executive Functioning in Late-Life Depression
Authors: Manning Kevin J. , Alexopoulos George S. , McGovern Amanda R. , Morimoto Sarah Shizuko , Yuen Genevieve , Kanellopoulos Theodora , Gunning Faith M.
Published: August 2014

Executive functions are control mechanisms that regulate aspects of cognition and emotion. Impairments in executive functioning are prominent following disruption to frontolimbic connections involved in mood regulation. Executive dysfunction is common in older adults with major depression and is associated with poor course of illness and worse clinical outcome. Thus, elderly depressed patients with executive functioning impairment require careful treatment planning and close follow-up. This review aims to provide the clinician with a practical understanding of executive dysfunction in older adults with major depression. To this end, it provides an introduction to the neurobiology and clinical manifestations of executive dysfunction in late-life depression. Special attention is given to current assessment practices that can be used to enhance clinical evaluation and treatment planning.
Overview of Physical and Mental Health Issues: Women at War
Authors: Ritchie Elspeth Cameron
Published: August 2014

This article will cover a wide range of health issues for women who deploy, either to combat or to other operations, such as humanitarian assistance. The introduction to the series gave the background on the role women have played in the military since September 11, 2001. This article then covers briefly some of the reproductive concerns that service women have, as they often try to plan child-bearing around deployments. Austere conditions in the field can lead to gynecological infections. Mental health issues, such as posttraumatic stress disorder, are of course important. Finally, the article ends with data on the number of killed and wounded female service members. More research is needed on gender-specific epidemiology and treatment. Clinicians should remember to ask about military service for all their patients.
A Spoonful of Cinnamon Makes the Medicine Go Down
Authors: Glover Juliet , Bouknight James , Srinivasan Shilpa
Published: August 2014

Schizotypal personality disorder is marked by symptoms resembling psychosis. A case report of a patient with odd medical beliefs related to schizotypal personality disorder is presented. These beliefs jeopardized the patient’s physical health and impacted decision-making capacity. Ethical dilemmas and challenges surrounding the case are discussed.

[
Psychiatr Ann
. 2014; 44(7):316–319.]
The CHILD 1 Diet: From Strategy to Practicality
Authors: Regis Adrienne
Published: August 2014

As described by the Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents report, the Cardiovascular Health Integrated Lifestyle Diet (CHILD 1) is the first-step diet for all children with elevated cardiovascular risk. Although the diet is specifically designed for cardiovascular disease risk reduction, it can also be used for the promotion of healthy dietary habits for children (older than the age of 2 years) and adolescents while still continuing to provide adequate nutrition for optimal growth and development. The diet provides guidance on caloric distribution, offers appropriate beverage and snack choices, and highlights the importance of adequate fruit and vegetable intake. Although the guidelines presented in the CHILD 1 diet provide a framework on which a healthy diet can be built, it can be challenging for some patients and families to put the recommendations into practice. This article focuses on explaining the key nutrition messages within the CHILD 1 diet and includes practical suggestions for meal planning.

CME Educational Objectives

1.

Understand the key components of the Cardiovascular Health Integrated Lifestyle Diet (CHILD 1).

2.

Determine food choices that make for a successful CHILD 1 diet.

3.

Identify strategies to help educate families to prepare foods consistent with a successful CHILD 1 diet.
Hyperinsulinism in a Neonate
Authors: Blanco Michelle , Khan Owais , Stanley Katherine , Hageman Joseph R. , Greeley Siri Atma W.
Published: August 2014

A male patient was born small for gestational age (SGA) at 33 weeks with a birth weight of 1,663 grams (< 10th percentile) and length 43 cm (10th percentile) to a 38-year-old G5P4 mother by cesarean section due to non-reassuring fetal heart tones. Prior to delivery, his mother experienced decreased fetal movement and decelerations. At birth, he was initially well-appearing and vigorous, with Apgar scores of 7 and 8 at 1 and 5 minutes, respectively. The physical examination was unremarkable — no skin findings, no facial anomalies, good tone, and the anterior fontanelle was soft and flat. The placenta, although noted to be healthy in appearance on prenatal ultrasounds, was atrophic and calcified by gross examination.

The patient developed respiratory distress 1 hour after birth and was found to have a blood glucose level of 24 mg/dL. Following an intravenous (IV) bolus of 10% dextrose in water (D10W) of 2 mL/kg, his glucose was 20 mg/dL. He was started on IV fluids with a glucose infusion rate (GIR) of 7.3 mg/kg/minute, with a subsequent rise in blood glucose to 46 mg/dL. Due to prematurity, respiratory distress, and persistent hypoglycemia, a diagnostic evaluation was initiated for possible sepsis, including a complete blood count with differential and platelet count and blood cultures. The patient was started empirically on IV ampicillin and gentamicin. The patient was subsequently found to have thrombocytopenia, hypomagnesemia, and hyponatremia on laboratory evaluation and was transferred to our neonatal intensive care unit (NICU) for further care.
Chronic Idiopathic Nausea
Authors: Kovacic Katja , Chelimsky Gisela
Published: August 2014

Chronic nausea is a prevalent but poorly described symptom in adolescents. It often co-occurs with other functional gastrointestinal disorders (FGIDs) but may also present in isolation. A multitude of triggers and complex neural pathways underlie the sensation of nausea. These include gastrointestinal and blood-borne insults, dysmotility, vestibular or central nervous system pathways, an aberrant autonomic nervous system, and psychosocial factors. Although clinical algorithms are lacking, diagnosis is typically made on the basis of a thorough clinical history and without extensive testing. Treatment is mainly empiric and may be directed at comorbid symptoms such as migraine, delayed gastric emptying, orthostatic intolerance, and visceral hypersensitivity. Chronic idiopathic nausea is an increasingly prevalent symptom that needs careful clinical assessment and individualized treatment plans.
A Neonate with Critical Congenital Heart Disease
Authors: Linder Jarrett , Dawson Emily , Williams Paula
Published: August 2014

Critical congenital heart disease (CCHD) is defined as a ductal-dependent congenital heart defect requiring surgical or percutaneous intervention via cardiac catheterization before 1 year of age. Most cases of CCHD can be diagnosed with prenatal ultrasound or fetal echocardiogram. If not prenatally diagnosed, CCHD can be stable in the newborn nursery due to persistent ductal patency, and the patient may only be diagnosed after ductal closure and development of cardiac symptoms at home. In this case, a 6-day-old female presented to the emergency department (ED) floppy with agonal respirations, poor capillary refill, and absent femoral pulses. On the day of presentation, the patient became increasingly fussy, refused feeding, and began to gasp. The patient was transported to the ED for evaluation, where a bedside echocardiogram revealed interrupted aortic arch (IAA), ventricular septal defect, minimal flow through a thread-like ductus arteriosus, and severely depressed cardiac function.

IAA is very rare, with an incidence of three cases per 1 million live births. Patients require neonatal supportive care, continuous prostaglandin E1 infusion, and urgent referral for neonatal surgical repair in the first days to weeks of life. To reduce the volume of undiagnosed CCHD in the immediate newborn period, the U.S. Department of Health and Human Services Secretary’s Advisory Committee on Heritable Diseases in Newborns and Children (SACHDNC) recommended that CCHD screening via pulse oximetry be added to the recommended uniform screening panel. A positive screen results in an immediate referral for an echocardiogram.

Fetal diagnosis, newborn screening, and/or careful clinical examination may have resulted in detection of IAA in our patient prior to ductal closure.
An Unusual Cause of Respiratory Distress in an Infant
Authors: Rusciolelli Colleen H. , Hageman Joseph R. , Groner Abraham
Published: August 2014

Partial anomalous venous connection (PAPVC) is a congenital cardiovascular defect where one or more (but not all) of the pulmonary veins return anomalously back to the right atrium, either via a direct or indirect connection. It often occurs with other cardiac defects, most commonly a secundum atrial septal defect. Individuals with a large degree of shunting will present with dyspnea, fatigue, and, in some cases, heart failure. Clinical associations and variants of PAPVC include scimitar syndrome, pseudo-scimitar or meandering right pulmonary vein, sinous venosus defects, malposition of the septum primum, and Turner syndrome.

The patient in this case, a previously healthy, 6-month-old, full-term male, presented to the emergency department for evaluation of respiratory distress and wheezing. The infant was first seen in his pediatrician’s office, where he was noted to be tachypneic and wheezing. He was feeding without difficulty, voiding well, and was active and playful. The patient had passed critical congenital heart disease screening after his birth and prior to discharge, and the family history was negative for any respiratory or cardiac conditions.

Cardiac magnetic resonance imaging is becoming the mode of choice for diagnosis of PAPVC. The definitive treatment is surgical correction, but surgery is not indicated in all cases, especially if the patient is asymptomatic and the degree of shunting is small. Patients with isolated PAPVC who undergo surgical correction have good long-term outcomes.

In this case, the patient underwent the Warden procedure, which causes an increased risk of superior vena cava stenosis or obstruction to the right atrium. This patient will require lifelong follow-up to assess for new onset pulmonary venous obstruction.
Pediatric Upper-Extremity Fractures
Authors: Arora Rajan , Fichadia Utkarsh , Hartwig Earl , Kannikeswaran Nirupama
Published: August 2014

Upper-extremity fractures account for more than half of childhood bony injuries. The frequency of injury increases with increasing mobility. The most common mechanism is a fall on an outstretched hand while playing. Optimal management requires knowledge of the normal anatomy and variants unique to pediatric bones. The physician needs to maintain a high level of suspicion for growth plate injuries because if unrecognized, these may result in growth arrest. Although the vast majority of pediatric upper-extremity fractures will heal rapidly with minimal intervention, physicians should be aware of the complications that can arise from these injuries.
The Club Concept: Targeting Behavioral Issues in a Residential Setting for Cognitively Impaired Adults
Authors: DiBartolo Mary C. , Vozzella Stephen M. , Rebert Amy N.
Published: August 2014

Behavior and psychological symptoms of dementia are common in residential care facilities. These symptoms not only detract from the quality of life of the resident with dementia, but they can be disruptive to the unit and result in harm to staff and other residents. With the trend away from pharmacological management, other creative psychosocial-environmental strategies are being explored. One innovative approach involves the use of the club concept, where selected agitated residents spend a portion of the day in a separate structured environment. This program combines trained staff and tailored activities that optimize mental stimulation, functional independence, and self-esteem. Benefits include reduced incidents of aggressive behaviors and use of psychoactive medications, as well as enhanced quality of life. Not only do the participants benefit from time spent in this specialized setting, but the therapeutic milieu of the facility is also enhanced. Further evaluation of such strategies is needed to quantify the benefits of targeted behavioral interventions for those with cognitive impairment. [
Journal of Gerontological Nursing, 39
(10), 46–51.]
Is it Time for a Public Health Nursing Approach to Aging?
Authors: Sullivan-Marx Eileen M.
Published: August 2014

Following the enactment of Medicare in 1965, access to health care for older adults in the United States improved. At the same time, nurse researchers and policy leaders developed individual and family-centered care interventions and programs that led to improvements in quality of health and life. In the next 20 to 30 years, U.S. and global projections of an expanding aging cohort with potential increases in health care needs, coupled with continued nursing shortage projections, present challenges and opportunities to enhance gerontological nursing’s approach to aging care. Invigorating a public health nursing focus on the needs of a population of older adults could enhance nursing’s ability to create policy and programs of care that promote quality of life for older adults and their families. Nurses using public health approaches can lead and support social policies regarding the physical environment and daily life circumstances that contribute to health equity. Heightened attention to competencies in community/public health nursing education and promotion of public health nursing careers will be important policy considerations as we face the looming increase in a population of older adults throughout the world. [
Journal of Gerontological Nursing, 39
(9), 13–16.]
Access to Care for Hearing Loss: Policies and Stakeholders
Authors: Wallhagen Margaret I.
Published: August 2014

Although hearing loss is common in old age and associated with a variety of negative outcomes, hearing aids and related services are not covered by Medicare or many other forms of insurance. Out-of-pocket costs are expensive and thus serve as a barrier for many individuals. Efforts at the national level to broaden coverage can confront surprising or unexpected opposition from a variety of groups. This article discusses how an experience as an Atlantic Philanthropies Health and Aging Policy Fellow helped inform how gaining an understanding of the positions held by such stakeholder groups is critical to developing strategies to promote a more effective payment structure that would improve access to hearing care. The implications for nurses desiring to influence policy are also highlighted. [
Journal of Gerontological Nursing, 40
(3), 15–19.]
Internal Fixation in a Combat Theater Hospital
Authors: Lindeque Bennie G.P. , Large Thomas M. , Bonds Cale , Howard Michael
Published: August 2014

Limited data are available on the use of internal fixation in combat zone hospitals. The authors performed a retrospective review of 713 surgical cases during 2 Operation Enduring Freedom deployments to a Level III theater hospital in 2007 and 2009 to 2010. The epidemiology and short- to intermediate-term outcomes of patients treated with internal fixation devices were studied. The authors found that, with judicious use, internal fixation under a damage control protocol in a combat theater hospital can be performed with acceptable complication rates.
Acute Lower-leg Compartment Syndrome
Authors: Stahel Philip F. , Mauser Nathan , Gissel Hannah , Henderson Corey , Hao Jiandong , Mauffrey Cyril
Published: August 2014

Acute compartment syndrome remains a challenging problem for orthopedic surgeons because its diagnosis is not always straightforward and it has a high risk of associated limb morbidity if left undiagnosed or untreated. Failure to diagnose and treat acute compartment syndrome is one of the most common causes of successful medical liability claims. The authors review the current literature concerning the diagnosis of acute compartment syndrome and discuss new non-invasive technologies that may allow for earlier and more accurate diagnosis of impending acute compartment syndrome.
Bench Testing of a Knee Joint Arthrometer
Authors: Barcellona Massimo G. , Christopher Tony , Morrissey Matthew C.
Published: August 2014

The KT1000 and KT2000 knee joint arthrometers (MEDmetric Corp, San Diego, California) have been shown to overestimate the measurement of knee joint sagittal laxity. The purpose of this study was to investigate the accuracy of the KT arthrometers as measures of anterior and posterior linear displacement. The anterior and posterior linear displacements of 3 KT arthrometers (2 KT1000 arthrometers and 1 KT2000 arthrometer) were compared with the simultaneous displacement measured by a precision linear Vernier Dial Test Indicator (Davenport Ltd, London, United Kingdom). The displacement calculated using the analog output of the KT2000 was also compared with the values on the KT2000 displacement dial.

Compared with the Vernier Dial Test Indicator, the KT arthrometers overestimated anterior linear displacement by between 22% and 24%. True anterior displacement for all 3 arthrometers, as recorded by the Vernier Dial Test Indicator, was found by multiplying the KT value by 0.79. When compared with the Vernier Dial Test Indicator, the KT arthrometers underestimated posterior linear displacement by between 18% and 19%. True posterior displacement, as recorded by the Vernier Dial Test Indicator, was found by multiplying the KT1000 value by 1.17 and the KT2000 value by 1.16.

The internal apparatus of the KT2000 and KT1000 knee joint arthrometers overestimates anterior displacement and underestimates posterior displacement with a predictable relative systematic error. Future validation studies should use these correction equations to assess the accuracy of the KT arthrometers. Sagittal plane knee laxity measured with the KT devices requires systematic correction for optimal accuracy.
Value of Forceps Biopsy and Kyphoplasty in Kümmell’s Disease
Authors: Wang Dalin , Wang Liming , Xu Jie , Zen Yiwen , Zheng Shengnai , Wang Gangrui
Published: August 2014

The diagnosis of Kümmell’s disease mainly depends on clinical and radiologic findings. However, these are not the gold standards for diagnosing this disease; bone biopsy is required.

The authors performed modified bone biopsy and cement-filling techniques during kyphoplasty and investigated the feasibility and efficacy of kyphoplasty for the treatment of Kümmell’s disease. This study included 28 patients (9 men and 19 women; average age, 71.9 years) with Kümmell’s disease. All patients underwent the modified biopsy procedure and kyphoplasty with the modified cement-filling technique. Treatment efficacy was evaluated using visual analog scale pain scores, Oswestry Disability Index scores, vertebral height, and Cobb angles pre- and postoperatively and at final follow-up. All patients tolerated the procedure well and had immediate back pain relief after kyphoplasty. Biopsy examination revealed necrotic bone in 24 patients and sparse cancellous bone in 2; it was unsuccessful in 2 patients. No severe complication occurred in any patient. Two patients had cement leakage but no clinical symptoms. All efficacy measures were significantly better at the postoperative assessments than the preoperative assessments (
P
<.05) but were similar at the postoperative and final follow-up assessments.

Kyphoplasty is a relatively effective and safe method for treating Kümmell's disease when modified techniques are performed to prevent cement leakage, and forceps biopsy can be used in the differential diagnosis of this condition.
Minimally Invasive Plating Osteosynthesis for Mid-distal Third Humeral Shaft Fractures
Authors: Lian Kejian , Wang Lei , Lin Dasheng , Chen Zhiwen
Published: August 2014

Mid-distal third humeral shaft fractures can be effectively treated with minimally invasive plating osteosynthesis and intramedullary nailing (IMN). However, these 2 treatments have not been adequately compared. Forty-seven patients (47 fractures) with mid-distal third humeral shaft fractures were randomly allocated to undergo either minimally invasive plating osteosynthesis (n=24) or IMN (n=23). The 2 groups were similar in terms of fracture patterns, fracture location, age, and associated injuries. Intraoperative measurements included blood loss and operative time. Clinical outcome measurements included fracture healing, radial nerve recovery, and elbow and shoulder discomfort. Radiographic measurements included fracture alignment, time to healing, delayed union, and nonunion. Functional outcome was satisfactory in both groups. Mean American Shoulder and Elbow Surgeons score and Mayo score were both better for the minimally invasive plating osteosynthesis group than for the IMN group (98.2 vs 97.6, respectively, and 93.5 vs 94.1, respectively;
P
<.001). Operative time was shorter and less intraoperative blood loss occurred in the minimally invasive plating osteosynthesis group than in the IMN group. Average time to union was similar in both groups. Primary union was achieved in 23 of 24 patients in the minimally invasive plating osteosynthesis group and in 22 of 23 in the IMN group. Minimally invasive plating osteosynthesis may have outcomes comparable with IMN for the management of mid-distal third humeral shaft fractures. Minimally invasive plating osteosynthesis is more suitable for complex fractures, especially for radial protection and motion recovery of adjacent joints, compared with IMN for simple fractures.
3.0-Tesla MRI and Arthroscopy for Assessment of Knee Articular Cartilage Lesions
Authors: Reed Marty E. , Villacis Diego C. , Hatch George F. (Rick) , Burke Wendy S. , Colletti Patrick M. , Narvy Steven J. , Mirzayan Raffy , Vangsness C. Thomas
Published: August 2014

The purpose of this study was to evaluate the ability of 3.0-Tesla magnetic resonance imaging (MRI) to accurately assess knee articular cartilage lesions. Sixteen patients who had knee 3.0-T MRI and underwent knee arthroscopy for partial meniscectomy were included. Three fellowship-trained sports medicine orthopedic surgeons reviewed all images. Articular lesions on MRI were graded from I to IV and compared with arthroscopic grading using the Outerbridge and the International Cartilage Repair Society (ICRS) classifications. The articular surface was divided into 6 regions.

Based on MRI findings, of the 288 articular surface evaluations, 113 (39%) surface evaluations were classified as disease-positive (grade 2 to 4). Kappa interrater reliability scores for MRI evaluation, Outerbridge classification, and ICRS classification were 0.13, 0.54, and 0.41, respectively. Using the Outerbridge classification as a reference standard, the sensitivity, specificity, and accuracy were 57%, 71%, and 63%, respectively. Using the ICRS classification, sensitivity, specificity, and accuracy were 59%, 71%, and 69%, respectively. When isolating the articular grading to the senior author on MRI evaluation vs Outerbridge classification, the sensitivity, specificity, and accuracy were 54%, 92%, and 75%, respectively. Based on the current findings, 3.0-T MRI is as an invaluable noninvasive tool with good diagnostic value for assessing articular cartilage lesions of the knee, although it may not be as sensitive and accurate as previously reported.
Operative Treatment of Acetabular Fractures in the Medicare Population
Authors: Hayes Peter J. , Carroll Colin M. , Roberts Craig S. , Seligson David , Lau Edmund , Kurtz Steven , Ong Kevin , Malkani Arthur L.
Published: August 2014

The purpose of this study was to determine the incidence of and evaluate the risk for complications and mortality following open treatment of acetabular fractures in the Medicare population. Patients treated with open reduction and internal fixation (ORIF) for acetabular fractures were identified using current procedural terminology codes in a 5% national sample of Medicare records. Complications within 90 days and within 1 year were evaluated based on the presence of ICD-9-CM diagnosis codes and Current Procedural Terminology reoperation codes. A total of 1286 fractures were treated closed and 359 were treated with ORIF. Multivariate Cox regression was performed to compare complication rates and risk factors. The incidence of acetabular fractures in the Medicare population has increased by 29% since 1998. Complications in the ORIF group included cardiac complications, deep venous thrombosis, infection, pulmonary embolism, refixation, and conversion to total hip arthroplasty. Risk factors for complications with ORIF included advanced age and comorbidities. Mortality in the ORIF group was 14.4% at 1 year. The incidence of reoperation with conversion to total hip arthroplasty or revision fixation following ORIF is 10% and 15%, respectively. Further investigation is required to improve outcomes and decrease complications in this group of patients, especially cardiac, deep vein thrombosis, and infection.
One-stage Posterior Surgical Treatment for Lumbosacral Tuberculosis With Major Vertebral Body Loss and Kyphosis
Authors: Sun Lin , Song Yueming , Liu Limin , Gong Quan , Zhou Chunguang
Published: August 2014

The treatment goals of tuberculous spondylitis are to eradicate infection and to prevent or treat instability, deformity, and neurologic deficit. The purpose of this study was to evaluate the clinical outcomes following chemotherapy with 1-stage posterior debridement, correction, and instrumentation and fusion for the treatment of lumbosacral tuberculosis with major vertebral body loss and kyphosis. Fourteen patients with lumbosacral tuberculosis with major vertebral body loss and kyphosis underwent 1-stage posterior surgery. Clinical assessments included low back ache, Oswestry Disability Index, Scoliosis Research Society-22 scores, neurologic deficit, erythrocyte sedimentation rate, and C-reactive protein level. Radiographic parameters included kyphosis angle, anteroposterior translation, local scoliosis, lumbar lordosis, pelvic parameters, sagittal offset, and fusion. Thorough debridement was performed. Patients were followed for an average of 39.3 months. Constitutional symptoms, low back ache, and functional outcome improved in all patients postoperatively. At final follow-up, Frankel Grade improved by 0 to 2 grades, mean kyphosis angle improvement was 44.3°, and satisfactory spinopelvic and sagittal balance were achieved. Spinal posterolateral fusion was obtained in all patients and no fixation loosening was found at 2-year follow-up. Differences existed between the pre- and postoperative radiographic parameters (
P
<.05). Correction loss at last follow-up was not statistically significant (
P
>.05). No surgical complications or infection recurrence occurred. Tuberculosis can be cured and effective correction of kyphosis can be achieved for lumbosacral tuberculosis with major vertebral body loss and kyphosis by performing 1-stage posterior surgery and chemotherapy.
Venous Arterialization for the Treatment of Large-area Foot Skin Retrograde Avulsion
Authors: Xiao Wan-an , Jiang Jia-xi , Tian Feng , Li Xiao-chuan , Tian Li-jie
Published: August 2014

Between 2009 and 2011, three patients with large-area foot skin retrograde avulsion (more than 1% of the body surface area) underwent venous arterialization. Anastomosis of the artery in the wound surface with the vein in the skin flap and an appropriate number of venous end-to-end anastomoses were performed. The skin flaps survived in all 3 patients. Six months postoperatively, the flap elasticity and appearance were close to that of normal skin, and foot function was better without scar contracture.

When venous arterialization is used to treat foot avulsion, the following points should be noted. Surgical indications include no fresh bleeding from the wound edge of the avulsed skin after debridement, more complete avulsed skin, and superficial veins that do not completely separate from the avulsed skin. Venous arterialization is not suitable to avulsion with fresh bleeding, avulsed skin in small fragments, and avulsion with a subcutaneous venous network embolism. During debridement, the subcutaneous venous network should be protected to avoid exposing the vein stems outside the fat layer. If the avulsion is less than 1% of the body surface area, arterial-venous anastomosis can provide adequate blood supply. Venous-venous anastomosis is performed as much as possible to enhance venous return and decrease microcirculatory pressure, which is conducive to the establishment of effective blood circulation.
Clavicle Fracture With Intrathoracic Displacement
Authors: Lohse Grant R. , Lee Donald H.
Published: August 2014

Clavicle fractures are common, and most are isolated injuries. Injury to the nearby subclavian vessels and brachial plexus have classically been described as potential complications of clavicle fractures. However, in the setting of a substantially displaced clavicle fracture, concomitant thoracic trauma is relatively frequent. Injury to the thorax can be difficult to identify on physical examination, and advanced imaging modalities may be required for diagnosis.

The evaluation, workup, and management of a patient with intrathoracic displacement of a clavicle fracture are described. Despite the significant fracture displacement and associated pneumothorax, the injury severity was not clinically obvious. Imaging, including a screening chest radiograph and subsequent axial computed tomography, played an important role in diagnosis and management. The patient underwent successful open reduction and plate fixation. A thoracostomy tube was not required at any point during the hospitalization. The patient recovered uneventfully and returned to full work duty by 3 months postoperatively.

Including the current report, only 3 cases of intrathoracic displacement of the clavicle have been published in the English literature. All involved fractures of the middle third of the clavicle. The severity of displacement was not obvious in any patient, and diagnosis was dependent on additional imaging. Given the frequency of associated chest trauma and limitations of physical examination, chest radiography should be considered in the evaluation of patients with substantially displaced clavicle fractures.
Prevention of Cortical Breach During Placement of an Antegrade Intramedullary Femoral Nail
Authors: Scolaro John A. , Endress Christina , Mehta Samir
Published: August 2014

The radius of curvature of femoral intramedullary nails does not match the average radius of curvature of the human femur. Anterior cortical breach of the distal femur during nail placement has been reported in certain fracture patterns, in femora with a smaller radius of curvature, and at the starting point of the nail. The authors describe a novel technique used to prevent anterior cortical disruption of the femur using multiple percutaneously placed Steinmann pins. This technique ensures safe passage of medullary reamers and the femoral nail.
Posterolateral Corner of the Knee: Microsurgical Analysis of Anatomy and Morphometry
Authors: Osti Michael , Tschann Peter , Künzel Karl Heinz , Benedetto Karl Peter
Published: August 2014

Reconstruction of the posterolateral corner (PLC) of the knee is essential to restore knee joint function. Controversy exists regarding a standardized nomenclature, the connective attachments and the relationships between them, and the frequency of occurrence among all structures of the PLC. Thirty human cadaveric knee specimens were investigated. The lateral collateral ligament, popliteus tendon, popliteofibular ligament, fabellofibular ligament, arcuate ligament, oblique popliteal ligament, posterior meniscofemoral ligament, and popliteal hiatus (including the popliteomeniscal ligaments) were studied. The length, diameter, variations, course, and morphology of these structures, as well as the position and dimension of the insertion, were measured and referenced the footprints to adjacent bony landmarks. Compared with existing studies, the lateral collateral ligament footprint was more proximal to the lateral femoral epicondyle (average, 3.61±0.75 mm) and the popliteus tendon insertion was more distal and anterior to the lateral collateral ligament footprint (average, 5.69±1.36 mm and 4.97±1.73 mm, respectively). Only minor data have been published on the fabellofibular ligament (average length, 33.79±4.98 mm; average diameter, 4.04±1.22 mm), arcuate ligament (average length, 31.54±2.82 mm; average diameter, 7.27±1.56 mm), oblique popliteal ligament (average length, 45.56±4.67 mm; average diameter, 14.90±4.67 mm), posterior meniscofemoral ligament (average length, 23.75±3.17 mm; average diameter, 3.62±1.03 mm), and popliteomeniscal ligaments (average mediolateral popliteal hiatus diameter, 9.83±2.16 mm; average superoinferior popliteal hiatus diameter, 8.23±1.86 mm).
Comparison of Insertional Trauma Between Suprapatellar and Infrapatellar Portals for Tibial Nailing
Authors: Gaines Robert J. , Rockwood Jason , Garland Joshua , Ellingson Christopher , Demaio Marlene
Published: August 2014

The purpose of this study was to determine differences in insertional articular trauma in infrapatellar tibial portal and suprapatellar portal intramedullary tibial nail insertion techniques. A cadaveric study was performed on 10 matched pairs of fresh-frozen adult cadaver lower extremities with intact extensor mechanisms.

Two study groups with 10 limbs each were created: left lower limbs were treated with a standard medial parapatellar nailing portal and right lower limbs were treated with a suprapatellar tibial nailing portal. Start points were created under fluoroscopic guidance in anteroposterior and mediolateral planes. A start wire was placed and opening reaming was performed on the specimens using instrumentation specific to the nailing portal. Specimens were then dissected by medial parapatellar arthrotomy, revealing the intra-articular condition of the knee structures. The border of the tibial entry reamer hole was measured to the anterior horns of the menisci, anterior cruciate ligament root, and intermeniscal ligament using a digital caliper accurate to 0.02 mm. The structure was considered damaged if the structure was obviously damaged on visual inspection or if a measurement was less than 1 mm. Impact to intra-articular structures was numerically lower in the suprapatellar group (2/10) compared with the infrapatellar group (4/10), but the difference was not statistically significant between the 2 groups (
P
=.629).

The suprapatellar portal approach to the tibial start point demonstrated a lower overall incidence of damage to intra-articular structures, but no significant statistical difference existed between the 2 treatment groups.
Antegrade Femoral Nailing in Acetabular Fractures Requiring a Kocher-Langenbeck Approach
Authors: Bishop Julius A. , Cross William W. , Krieg James C. , Chip Routt M.L.
Published: August 2014

Ipsilateral displaced acetabular and femoral shaft fractures represent a dilemma for orthopedic surgeons because antegrade femoral nailing may complicate a Kocher-Langenbeck acetabular exposure. The goals of this study were to review the results of ipsilateral femoral and acetabular fractures treated with antegrade femoral nailing and a Kocher-Langenbeck approach and to evaluate the assertion that this treatment strategy is associated with increased morbidity. This was a retrospective cohort study at a regional Level I trauma center.

Sixteen patients with a femoral fracture treated with antegrade nailing and an ipsilateral acetabular fracture treated with a Kocher-Langenbeck approach were identified. One patient died as a result of his injuries, and 2 were not available for long-term follow-up. One had a deep infection requiring irrigation, debridement, and intraveonous antibiotics. One patient developed a hematoma requiring irrigation and debridement. At final follow-up, 2 patients had no heterotopic ossification about the hip, 4 had Brooker class I heterotopic ossification, 3 had Brooker class II heterotopic ossification, 2 had Brooker class III heterotopic ossification, and 2 patients had Brooker class IV heterotopic ossification requiring excision. Ipsilateral femoral and acetabular fractures represent a rare and severe injury constellation. Antegrade nailing of the femur with ipsilateral Kocher-Langenbeck exposure for fixation of the acetabulum was not associated with excessive rates of wound-healing complications, but the incidence of heterotopic ossification was increased.