bluuebunny/crossref_metadata_2025 huggingface dataset:
CHARNLEY LOW-FRICTION ARTHROPLASTY: 19- to 25-YEAR RESULTS
Authors: Wroblewski B M , Taylor G W , Siney P
Published: April 2021

ABSTRACT

Our review of 54 patients (57 Charnley low friction arthroplasties) with a 19 to 25 year follow up shows that clinical results remain excellent; clinical results bear no relation to the radiologic appearances of the bonecement interface on the acetabular side; and the long-term problem is socket wear. The need for regular follow up and study of factors affecting socket wear is emphasized.
MRI CLASSIFICATION OF LUMBAR HERNIATED INTERVERTEBRAL DISC
Authors: Kim Key Yong , Kim Yung Tae , Lee Choon Sung , Shin Myung Jin
Published: April 2021

ABSTRACT

A consecutive series of 28 patients with lumbar herniated intervertebral disc (HIVD) who exhibited positive magnetic resonance imaging (MRI) findings was analyzed and compared with operative findings to define the type of disc herniation. This prospective study showed that the overall accuracy of MRI in predicting the types of HIVD was 80.6%. Proton density image was the most helpful in differentiating protruded discs from extruded ones. Disruption of "posterior longitudinal ligament une," defined on T2-weighted sagittal image, was reliable in differentiating a transligamentous disc from subligamentous one. Sequestered disc could be more accurately diagnosed with Gadolinium-DTPA enhancement, which showed anterior rim enhancement of the sequestered portion on T1- weighted axial image.
IMPENDING FRACTURE ASSOCIATED WITH BONE DESTRUCTION
Authors: Thompson Roby C
Published: April 2021

ABSTRACT

In the patient with metastatic bone disease, destruction of bone threatens the structural support of the skeletal system. Osteoporosis, stress-risers, and the open-section effect result in pain, immobilization, and fractures. The establishment of more clear-cut indications for prophylactic fixation will lessen the morbidity associated with a pathologic fracture.
GENERAL PERSPECTIVES, PATHOGENESIS, PATHOPHYSIOLOGY AND SKELETAL DYSFUNCTION
Authors: Frassica Frank J , Sim Franklin H
Published: April 2021

ABSTRACT

A better understanding of the pathogenesis and pathophysiology of the metastatic process is leading to improvements in diagnosis and treatment. Evaluation of specific areas of disorder of skeletal function, including hematopoiesis, mineral metabolism, and structural support, is important. Continued developments are necessary to minimize or prevent effects on the skeleton related to the metastatic process.
METASTATIC DISEASE OF THE SPINE
Authors: O'Connor Mary J , Currier Bradford L
Published: April 2021

ABSTRACT

Advances in imaging studies and techniques of spinal stabilization permit improved surgical treatment of patients with metastatic disease of the spine. Preoperative evaluation, selection of patients for operative management, and results of published clinical series are reviewed. Surgical approaches for optimal tumor excision, neural decompression, and spinal stabilization are discussed.
METASTATIC DISEASE OF THE FEMUR
Authors: Wilkins Ross M , Sim Franklin H , Springfield Dempsey S
Published: April 2021

ABSTRACT

Metastatic involvement of the femur is a common clinical problem and accounts for the third highest incidence after the spine and pelvis. These patients are confronted with the possibility of losing the ability to ambulate during their remaining months. However, with improved prosthetic implants and internal fixation devices, most patients can resume their previous activities after operative treatment of their femoral fractures.
OVERDESIGN OF EXTERNAL FIXATION SYSTEMS
Authors: Habboushe M P
Published: April 2021

ABSTRACT

This article reviews 850 cases of open fractures of the extremities caused by high velocity missiles and shell fragments, and treated by two varieties of external fixation devices. If a protocol for grading the severity of injury is followed, the results encourage avoiding sophisticated, expensive, and overdesigned external fixation systems.
SUPRACONDYLAR FRACTURES OF THE HUMERUS IN CHILDREN
Authors: Harris Irwin E
Published: April 2021

ABSTRACT

Supracondylar fractures of the humerus in children are either flexion or extension in type. Associated nerve or vascular injury is common. Fractures that remain stable after reduction can be treated with elbow flexion. If the fracture is unstable or if circulation is compromised, percutaneous pinning or traction treatment is utilized. The ischemic hand is always evaluated for brachial artery damage or for the presence of a compartment syndrome. Varus positioning should always be avoided, but other malalignments either remodel or are not of functional significance.
SEPARATION OF TENDON ENDS AFTER ACHILLES TENDON REPAIR: A PROSPECTIVE, RANDOMIZED, MULTICENTER STUDY
Authors: Mortensen Niels Henrik Maagaard , Saether Jan , Steinke Martin Soe , Staehr Henrik , Mikkelsen Soren Sondergård
Published: April 2021

Abstract

Fifty-seven patients treated for an acute rupture of the Achilles tendon were studied. The patients were randomized into a Mason suture technique or a reinforced continuous six-strand suture technique, and markers were attached to each tendon end perioperatively. The postoperative separation of the markers was studied by repeat radiographic examination. Despite immobilization, separation developed after a Diphasic course, and after 7 weeks the mean separation was 10.5 mm. No difference was found between the two techniques. We attempt to correlate the separation to the clinical outcome, examined at 1 year follow up.
LUMBAR HERNIATED DISK DISEASE: COMPARISON OF MRI, MYELOGRAPHY, AND POST-MYELOGRAPHIC CT SCAN WITH SURGICAL FINDINGS
Authors: Janssen Michael E , Bertrand Styles L , Joe Clarence , Levine Monroe I
Published: April 2021

ABSTRACT

One hundred eighty patients with suspected lumbar disk disease were evaluated preoperatively with magnetic resonance imaging (MRI)9 myelography, and post-myelogram computerized tomography (CT) scan. Sixty patients underwent surgery on 102 disk levels, allowing for anatomic confirmation of the diagnosis. Eight negative explorations were performed. The correlation between preoperative interpretations of each test and the observed surgical findings was analyzed statistically. Based on this analysis, MRI accurately predicted the operative findings in 98 of 102 disk levels (96%), while the accuracy of myelography (81%) and post-myelogram CT scan (57%) was significantly less. When myelography and CT scan were utilized jointly, the accuracy was 84%, a significant improvement over either test alone, as a diagnostic modality. There was only one false positive MRI study in the evaluation of lumbar herniated disk. The results of this study reflect that MRI is a clinically superior diagnostic test in the evaluation of patients with suspected lumbar disk herniation, and that it should be the diagnostic study of choice when available. Its noninvasive nature, multiplanar capabilities, and the lack of ionizing radiation are particularly desirable for patient and physician.
HYDROXYAPATITE COATINGS
Authors: Thomas Kevin A
Published: April 2021

ABSTRACT

A series of investigations over the past several years has evaluated a number of implant materials with and without plasma-sprayed hydroxyapatite (HA) coatings for use in load-bearing implant applications. HA-coated implants have exhibited greater interface shear attachment characteristics when compared to uncoated implants; these results have been demonstrated with dense (flat), porouscoated, and macrotextured implant surfaces. Maximum attachment strength also was found to occur within a shorter period of time postoperatively with the HA-coated samples, indicating a more rapid tissue adaptation to the implant surfaces. Plasma-sprayed HA coatings provide an osteophilic and osteoconductive surface that increases both the bone-implant attachment strength, as well as the rate of bone adaptation to the HA-coated implant surface.
MICRODISKECTOMY FOR LUMBAR DISK HERNIATION: A REVIEW OF 100 CASES
Authors: Lowell Troy D , Errico Thomas J , Fehlings Michael G , DiBartolo Tracy J , Ladosi L
Published: April 2021

ABSTRACT

One hundred patients who underwent microlumbar diskectomy over 5 years were retrospectively reviewed. L4-5 and L5-S1 were compared to determine whether a patient's post-surgical outcome is related to the level where a herniation has occurred. Overall results included 70 excellent, 19 good, 2 fair, and 9 poor. Statistical analysis showed that neither the level involved, length of follow up, nor degree of manual labor predicted outcome. Older patients and females tended to fare worse, but the trends were not significant. Three recurrent herniations occurred, 1 in the L4-L5 group and 2 in the L5-S1 group. No variable predicted recurrence.
IMPLEMENTATION OF GUIDELINES FOR PREVENTION OF DEEP VEIN THROMBOSIS IN A MANAGED CARE ENVIRONMENT
Authors: Brox W Timothy
Published: April 2021

ABSTRACT

Implementation strategies are key factors in determining the overall success of clinical guidelines. They are important for changing physician practices and expected to result in clinical improvement or cost savings. Within an organization, the method of implementation should be a major component of the development of the guideline itself. In a group practice system, clinical guidelines must be clear and provide numeric thresholds or explicit criteria for decision points and subsequent action. Assessing the overall impact of a clinical practice guideline provides excellent feedback in determining whether goals are being met and provides guidance for finetuning strategic approaches. With regard to the prevention of deep vein thrombosis (DVT) monitoring, the overall results of a clinical practice guideline would assess guideline compliance, complications of the guideline interventions, as well as the incidence of DVT, pulmonary embolism, hospital readmissions, and mortaiïty.
BALANCING THE CLINICAL OUTCOMES AND ECONOMICS ASSOCIATED WITH THROMBOEMBOLIC PROPHYLAXIS
Authors: Carter Charles A
Published: April 2021

ABSTRACT

The approach to the treatment of patients is being influenced by the movement towards integrating health care services. This trend presents several challenges to health care professionals as patients move through the cycles of wellness, prevention, acute treatment, and after-care. Consequently, the development of treatment guidelines based upon clinical and economic parameters is critical. Preventing thromboembolic complications is receiving a great deal of attention due to the tremendous medical and economic consequences of deep venous thrombosis and pulmonary embolism. The early discharge of patients from acute surgical and medical facilities is increasing the need to consider outpatient prophylaxis. Pharmacoeconomic modeling demonstrates that enoxaparin may be more cost-effective than warfarin for outpatient prophylaxis when used for 3 weeks or less. The requirement of a subcutaneous injection of enoxaparin is not a detraction to this recommendation. Patient self-medication is a common practice and is growing in prevalence. Patients are eager to learn about their illnesses and treatment options as a result of their attitudes regarding empowerment and responsibility for their own health care.
Low-Molecular-Weight Heparin: From the Bench to the Orthopedic Patient
Authors: Turpie A G G
Published: April 2021

ABSTRACT

Standard heparin is widely used for the prevention and treatment of venous thromboembolism; however, it has several limitations including variable dose response, dose-dependent clearance and inhibition of platelet function. To overcome these disadvantages, standard heparin, which is composed of glycosaminoglycans of various molecular weights, has been fractionated into its low-molecular-weight component. Low-molecularweight heparin (LMWH) exhibits less binding to plasma proteins and endothelial cells than standard heparin resulting in a more predictable dose response profile, a dose-independent mechanism of clearance and a longer plasma half-life. LMWH also has a lower binding affinity for platelets and produces less microvascular bleeding. Evidence from randomized clinical trials demonstrates that LMWH is effective in the prevention of deep vein thrombosis (DVT) in high-risk orthopedic patients. There is also considerable evidence of its efficacy and safety in the initial treatment of proximal DVT. Recent studies have demonstrated the feasibility of home treatment with LMWH, which offers the advantage of greater clinical utility compared with current antithrombotic regimens and hence the possibility of cost savings.
Optimizing Hospital Reimbursement Through Physician Awareness: A Step Toward Better Patient Care
Authors: Cole Brian J , Flic Susan , Levine David B
Published: April 2021

ABSTRACT

We instituted a training program to improve the overall accuracy of medical record coding through greater physician awareness to enhance hospital reimbursement and maintain quality patient care. A physician-targeted course reviewed the prospective payment system, diagnosis-related group guidelines, ambulatory surgery reimbursement, and the relationship between accurate physician documentation and medical record coding. Annual increases in charges from prospective surgical case assignment, proper conversion of outpatient to inpatient status, and more accurate coding of inpatient comorbidities and complications led to an estimated increase in hospital charges of $1.6 million.
The Richards Series 2 Total Hip Prosthesis: A 13-Year Study and Radiographic Evaluation
Authors: Laursen Jens Ole , Petersen Birgitte , Mossing Niels B
Published: April 2021

ABSTRACT

This retrospective long-term study analyzes the clinical function, failures, and radiographic status of 131 Richards Series 2 prostheses in total hip arthroplasties (THAs) performed during 1981 and 1982. After a minimum follow-up period of 11 years, the results were evaluated. Sixty two (54%) patients with 71 THAs were available for follow-up; 44 (38%) patients with 49 THAs had died. Three patients with three THAs were lost to follow-up, and seven patients with eight THAs were unable to participate in the examination due to causes not related to their present hip status. Ten patients underwent revision THA during the observation period.

The median hip functional index (HFI) was 8.6 preoperatively and 15.8 at follow-up. Hip functional index correlated to radiographic signs of loosening. With revision as endpoint, the Kaplan-Meier survivorship for all 131 hips was 93% after 10 years and 91% after 12 years. The radiographic examination at follow-up revealed 5 (8%) definite loose cups and 12 (19%) definite loose stems. Including the number of aseptic loosened cups and stems confirmed at revision, aseptic loosening was found in 6% of all cups and 13% of all stems.

This radiographic evaluation confirmed that lack of containment of the cup and varus position of the stem were factors influencing the long-term stability of the prostheses, whereas etiology, type of arthritis, and ectopic ossification did not. A fixation and stability score that was modified for cemented prostheses was developed and was of value in detecting the prostheses at risk. The long-term results of the Richards Series 2 THA are acceptable and comparable with other long-term studies on conventional prosthestic designs. Ten percent to 20% revision THAs due to aseptic loosening can be expected. In addition, patients younger than age 60 at surgery and especially men were found to belong to a high-risk group with regard to revision THA. These patients must be evaluated carefully so that revision THA can be performed before the bone bed is destroyed.
Osteochondritis Dissecans of the Elbow Managed by Herbert Screw Fixation
Authors: Kuwahata Yoshio , Inoue Goro
Published: April 2021

ABSTRACT

Seven patients (eight elbows) with osteochondritis dissecans were treated with cancellous bone grafts and internal fixation of the fragment using a Herbert screw. Average follow-up was 32 months. All patients were pain-free and returned to previous sporting activities. The postoperative range of motion of the elbow increased by an average of 18°. Radiographs showed complete reossification of the capitular cyst and normaly contoured joint surface.
Treatment of Humeral Fractures by Closed Reduction and Retrograde Intramedullary Ender Nails
Authors: Shazar Nachshon , Brumback Robert J , Vanco Bohumil
Published: April 2021

ABSTRACT

A retrospective review of 94 humeral shaft fractures stabilized with retrograde Ender nails was performed to determine the safety and efficacy of this technique. Follow-up averaged 71 weeks. Eighty-six (91.5%) healed with no additional intervention (average: 14 weeks). There were eight (8.5%) nonunions. The functional results were good in 74 (81%), fair in 12 (1 3%), and poor in 5 (6%). There was one radial nerve palsy secondary to the operative procedure. The reoperation rate, including the repair of nonunions, was 19%. We conclude that intramedullary Ender nail fixation is a relatively simple and quick procedure, especially for the multiply injured patient, that adequately stabilizes most humeral fractures, yielding overall good results.
Follow-up of Intertrochanter Osteotomy of the Hip During a 25-Year Period
Authors: McGrory Brian J , Estok Daniel M , Harris William H
Published: April 2021

ABSTRACT

In 1984, in reporting follow-up on 67 hips in 61 patients who underwent intertrochanteric osteotomies for osteoarthritis of the hip, we found that between 1 2 and 1 5 years after osteotomy, 34% (23) of the 67 hips remained functional and the remainder had been converted to an arthroplasty. We now report on the fate of those osteotomies over a 25-year period.

Ten patients with 10 osteotomies did not require an arthroplasty, having died without requiring conversion to total hip arthroplasty at an average of 18.3 years after osteotomy (range: 11 to 24.1 years). Two others were living at an average of 25.2 years after osteotomy without requiring conversion. Thus, for 18% of the hips, no further hip surgery was performed. For the remaining 55 hips in 49 patients, the osteotomy had served for an average of 9.8 years (range: 1 .3 to 26.1 years) before requiring arthroplasty.

The cumulative probability of osteotomy survival was 57.8% (standard error: 6.0%) at 1 0 years, 20.0% (standard error: 4.9%) at 20 years, and 5.7% (standard error: 2.9%) at 25 years by Kaplan-Meier survivorship analysis.
ACL Reconstruction in Children With Open Physes
Authors: Bisson Leslie J , Wickiewicz Thomas , Levinson Michael , Warren Russell
Published: April 2021

ABSTRACT

Nine male patients with wide open physes who underwent intra-articular anterior cruciate ligament (ACL) reconstruction using semitendinosus and gracilis tendon grafts passed through the tibial physis and over the top of the femoral condyles were retrospectively reviewed at an average follow-up of 39 months (range: 24 to 72 months). Five patients underwent reconstruction <6 weeks following injury (range: 11 days to 41 days); the other four underwent reconstruction 2, 3, 5, and 24 months following injury. Seven patients had excellent results and fully returned to their sport. Mean Lysholm score in these patients was 99 (range: 95 to 100), and the mean maximum KT-1000 difference (available for six patients) was 2.8 mm (range: 0 to 5.5 mm). Four of six intact grafts had a mean maximum KT-1000 difference ^3.5 mm. Two grafts ruptured and were considered failures (one complete rupture at 10 months and one partial rupture at 3 years). Postoperative height increase averaged 10.7 cm (range: 4 to 22.9 cm). No patient had a clinically significant leg-length discrepancy, angular deformity, or radiographic evidence of physeal injury.
Polymethylmethacrylate Removal From the Femur Using a Crescentic Window Technique
Authors: Buehler Knute O , Walker Richard H
Published: April 2021

ABSTRACT

This article describes a technique to aid in removal of polymethylmethacrylate during total hip arthroplasty revision. The technique is a modification of prior windowing techniques and requires no specialized instruments, offers substantial flexibility regarding cement removal and femoral prosthetic choice, and minimizes the amount and duration of stress on the femur.

The technique involves making an oblong window in the anterior or anterolateral femur. Proximal and distal osteotomies are made with a crescentic oscillating saw and connected by straight beveled anterior and posterior longitudinal osteotomies using a straight oscillating saw. Once the intramedullary canal is prepared, either a nonecmented or cemented femoral prosthesis can be placed. The cortical window is replaced with a single cable used for fixation.
Location of the Sacral Pedicle, Foramina, and Ala on the Lateral Aspect of the Sacrum: A Radiographic Study
Authors: Ebraheim Nabil A , Xu Rongming , Challgren Eric , Heck Bruce
Published: April 2021

ABSTRACT

Twenty-one adult dry-bone sacral specimens were used to quantitatively determine the location of the sacral pedicle, foramina, and ala on the lateral radiographic view of the sacrum. The anterior and posterior sacral foramina from SI to S3, the midlines of the anterior sacrum and cephalad border of the S1 vertebral body, and the lateral limit of the lateral sacral mass were outlined with wires. A lateral radiograph was taken, and measurements were made directly from the radiograph.

The average sacral pedicle height for both male and female specimens was approximately 20 mm for Sl , 1 2 mm for S2, and 7 mm for S3. The sacral foramina height averaged approximately 1 3 mm for S1 and S2, and 10 mm for S3. The average ala and S1 body-ala angles were 88° and 35°. The distance from the ala tip to the anterior aspect of the sacrum averaged 1 2 mm, and the average anterior height of the Sl vertebral body above the ala was 11 mm. These measurements, in conjunction with inlet and outlet radiographs, may aid in the recognition of the vital structures of the sacrum on the lateral radiographic view and enhance the safety of dorsal sacral screw placement.
RADIOLOGIC CASE STUDY
Authors: Cully Brent E , Folzenlogen Darcy , Kentner Keith , Griffiths Harry J
Published: April 2021

Following pregnancy, a 17-year-old girl presents with worsening intermittent right knee pain. There was an alleged twist 9 months previously. Your diagnosis?
Treatment of Articular Cartilage Defects in Athletes: An Analysis of Functional Outcome and Lesion Appearance
Authors: Blevins Field T , Steadman J Richard , Rodrigo Juan J , Silliman Jim
Published: April 2021

ABSTRACT

This article characterizes chondral injuries and reviews the results of microfracture treatment in high-level competitive and recreational athletes. Thirty-eight high-level and 140 recreational athletes completed functional questionnaires preoperatively and yearly postoperatively, recording symptoms, function, and activity level. Second-look arthroscopy tapes were available in 26 high-level and 54 recreational athletes.

The mean follow-up for the high-level athletes was 3.7±1.4 years. Chondral defects averaged 223±180 mm
p 2
. Lesion size and follow-up were not significantly different in the recreational group. Functional questionnaire responses demonstrated significant improvements from the time of microfracture to final follow-up. Improvement in function and symptoms was similar for the competitive and recreational athletes.
Long-Term Results of Periosteal Transplantation in Osteochondritis Dissecans of the Knee
Authors: Madsen Bjørn L , Noer Hans Henrik , Carstensen Jan P , Nørmark Finn
Published: April 2021

ABSTRACT

Between 1986 and 1991, a total of 18 patients (11 men and 7 women) with osteochondritis dissecans of the knee were treated with periosteal transplantation. Median patient age was 19 years (range: 1 6-45 years). Eight patients were reoperated up to 8 years postoperatively, due to reduced range of motion, synovitis, or formation of an exostosis in the transplanted area. Of 14 patients who were available for follow-up after 8 years (range: 5-10), 2 were completely pain free. Six patients had reduced range of motion, knee instability, or quadriceps muscle atrophy. The number of reoperations and the presence of continued knee pain in most patients does not justify the extensive procedure of periosteal transplantation.
Rotator Cuff Tears and Associated Nerve Injuries
Authors: Brown Treg D , Newton Peter M , Steinmann Scott P , Levine William N , Bigliani Louis U
Published: April 2021

ABSTRACT

A series of 15 patients with concomitant rotator cuff tears and infraclavicular brachial plexus injuries treated between 1 980 and 1 989 were reviewed. There were 6 men and 9 women with a mean age of 65 years. Seventeen nerve injuries were identified, including 12 axillary nerves, 4 suprascapular nerves, and 1 musculocutaneous nerve. One patient had an injury to all three nerves. Thirteen patients underwent operative repair of the torn rotator cuff, and 2 patients who refused surgery were treated conservatively. The average time from injury to surgery was 7.7 months.

Follow-up averaged 5.5 years (range: 2-10 years). Clinical results were graded according to pain, range of motion, and strength. Postoperatively, mean active forward elevation was 1 37° and mean active external rotation was 40°. Clinically, 8 patients achieved complete nerve recovery and 7 had an incomplete recovery. Satisfactory pain relief was achieved in 87% of patients with 60% having excellent or good function. Overall, the results of rotator cuff repair with concurrent nerve injury are less favorable than those of isolated cuff repairs. Careful preoperative assessment of concomitant nerve injury should be performed to better predict outcome.
Technique for Removal of Snared Silicone Drains
Authors: Rue John-Paul H , Johnson Carl A
Published: April 2021

The use of postoperative drains in orthopedics is common. Rarely, these drains may be inadvertently stitched into the wound at the time of closure, resulting in possible breakage during removal. This article describes a noninvasive technique for removing snared silicone drains.
A Comparison of Magnetic Resonance Imaging and Arthroscopic Evaluation of Chondral Lesions of the Knee
Authors: Irie Kazunori , Yamada Takayuki , Inoue Kazuhiko
Published: April 2021

ABSTRACT

This study compared the sensitivity of magnetic resonance imaging (MRI) to arthroscopy in detecting localized chondral lesions of the knee, especially lesion depth, in 28 patients with 32 femoral and tibial lesions. Average patient age was 24.3 years. Chondral lesions were classified according to five grades. The sensitivity of MRI was 100% for grade 3 (deep) and higher lesions, but was less for superficial chondral lesions. Arthroscopic and MRI grades coincided for only three lesions. Magnetic resonance imaging was not so accurate regarding depth even for deep chondral lesions, although subchondral lesions undetectable by arthroscopy often were detected by MRI.
Lateral Femoral Split: An Alternative for Uncemented Femoral Stem Revision Surgery
Authors: Bañuls Miguel , Crawshaw Charles
Published: April 2021

A simple technique for the removal of uncemented femoral components in revision hip surgery involves producing an incomplete longitudinal split in the lateral aspect of the femur using an oscillating saw.
Adhesive Capsulitis of the Shoulder in Male Cardiac Surgery Patients
Authors: Tuten H Robert , Young D Christopher , Douoguih Wiemi A , Lenhardt Kimberly M , Wilkerson John P , Adelaar Robert S
Published: April 2021

ABSTRACT

Two hundred fourteen consecutive mate cardiac surgery patients were retrospectively evaluated for the incidence of adhesive capsulitis of the shoulder and were assessed for risk factors. Only male patients were included, as the study took place at a Veteran's hospital. Patients who had no shoulder problems prior to cardiac surgery and were experiencing shoulder pain or stiffness postoperatively underwent history, physical examination, and radiographic studies. Thirty-five patients who had shoulder complaints were identified and evaluated. A 33% incidence (seven patients) of adhesive capsulitis of the shoulder in a male post-cardiac surgery population was established.
Influence of Facet Joint Angles and Asymmetric Disk Collapse on Degenerative Olisthesis of the Cervical Spine
Authors: Pellengahr C , Pfahler M , Kuhr M , Hohmann D
Published: April 2021

ABSTRACT

This study examined the facet angles of the joint facets of the intervertebral joints, the anterior and posterior heights of the intervertebral disks, and cervical lordosis as possible parameters of olisthesis. Lateral radiographs of the cervical spine in 1 23 patients were examined, and parameters were correlated to anterolisthesis and retrolisthesis in each segment. Results indicate anterolisthesis is caused by a decrease of the facet angles of the caudal joint facets. This process is favored by loss of anterior height of the intervertebral disks and a flattened position of the cervical spine. Loss of posterior height of the intervertebral disks promotes retrolisthesis.
Occipital Screws in Occipitocervical Fusion and Their Relation to the Venous Sinuses: An Anatomic and Radiographic Study
Authors: Nadim Yasser , Lu Jike , Sabry Fady F , Ebraheim Nabil
Published: April 2021

ABSTRACT

This study examined the safe zone for placement of occipital screws without endangering the sinuses. In the first part of the study, 10 cadaveric skulls were exposed. The borders of the confluences and the transverse sinuses were located on the outer table of the occiput. In the second part of the study, six cadaveric skulls were used and screws were placed in different sites and angiography of the venous sinuses was performed.

The exact location of the venous sinuses on the outer table of the occiput were analyzed. The examination of the relationship between occipital screws placed at different sites and the venous sinuses clearly demonstrated that whenever the screws were inserted at the level of the external occipital protuberance, or 1 cm below it, sinus injury could rarely be avoided. To enhance the safety of the occipitocervical fusion, the external occipital protuberance should be avoided, and occipital screws should be placed at least 2 cm below the superior nuchal line.
Anterior Approach to the Cervical Spine: Surgical Anatomy
Authors: Lu Jike , Ebraheim Nabil A , Nadim Yasser , Huntoon Mac
Published: April 2021

ABSTRACT

While performing the anterior approach to the cervical vertebral bodies, injury to important anatomic structures in the vicinity of the dissection represents a serious risk. The midportion of the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve are encountered in the anterior approach to the lower cervical spine. The recurrent laryngeal nerve is vulnerable to injury on the right side, especially if ligation of inferior thyroid vessels is performed without paying sufficient attention to the course and position of the nerve, and the external branch of the superior laryngeal nerve is vulnerable to injury during ligature and division of the superior thyroid artery. Avoiding injury to the recurrent laryngeal nerve (especially on the right side) and superior laryngeal nerve is a major consideration in the anterior approach to the lower cervical spine. The sympathetic trunk is situated in close proximity to the medial border of the longus colli at the C6 level (the longus colli diverge laterally, whereas the sympathetic trunk converges medially). The damage leads to the development of Horner's syndrome with its associated ptosis, meiosis, and anhydrosis.

Awareness of the regional anatomy of the sympathetic trunk may help in identifying and preserving this important structure while performing anterior cervical surgery or during exposure of the transverse foramen or uncovertebral joint at the lower cervical levels. Finally, the spinal accessory nerve (embedded in fibroadipose tissue in the posterior triangle of the neck) is prone to injury. Its damage will result in an obvious shoulder droop, loss of shoulder elevation, and pain. Prevention of inadvertent injury to the accessory nerve is critical in the neck dissection.
Culture Results and Amputation Rates in High-Pressure Paint Gun Injuries of the Hand
Authors: Mirzayan Raffy , Schnall Stephen B , Chon Jae H , Holtom Paul D , Patzakis Michael J , Stevanovic Milan V
Published: April 2021

ABSTRACT

High-pressure paint gun injuries have been well described in the literature, and the use of antibiotics is recommended as part of their management. However, there is no scientific evidence to support the use of antibiotics. In addition, the type of paint injected (water- versus oil-based) has never been investigated to determine the extent of morbidity resulting from these injuries. This study examines the organisms cultured in wounds resulting from these injuries and whether the type of paint injected had an influence on amputation rates. Charts of 35 patients with high-pressure paint gun injuries to their hands were reviewed. The amputation rate was 50% with oil-based paints and 0% with water-based paints. Forty-seven percent of wound cultures were positive, with gram-negative bacteria found in 58% of isolates. Our findings support the use of antibiotics, which should cover both gram-positive and gram-negative organisms.
Adolescent Idiopathic Scoliosis Managed by a Nighttime Bending Brace
Authors: Bowen J Richard , Keeler Kathryn Ann , Pelegie Steve
Published: April 2021

ABSTRACT

This study evaluated and compared the effectiveness of managing adolescent idiopathic scoliosis with a total contact bending spine orthosis worn only during nighttime sleep with established bracing programs and electrical stimulation treatment. Brace treatment was prescribed for 30 patients with adolescent idiopathic scoliosis for the management of 50 spinal curvatures averaging 28.5° (range: 1 3°-40°). Average patient age at the initiation of brace wear was 12± 10 years (range: 9±10 to 16±8 years). All 30 patients were skeletally immature (Risser sign, 0-3) at initiation of orthotic treatment and underwent follow-up to maturity. Patients were instructed to wear the braces for at least 8-10 hours a day during nighttime sleep. Eighteen of 30 patients were compliant with the bracing program. Compliance with the nighttime bending brace was no better than the reported compliance with established thoracolumbosacral orthosis programs. Moreover, noncompliant patients and those treated by the ineffective electrical stimulation program also did not differ in curve progression. Curve progression was controlled in 56% of the compliant patients, and the nighttime bending brace was considered as effective as the Wilmington brace in controlling adolescent idiopathic scoliosis. Both braces were more effective than the ineffective electrical stimulation treatment.
Radiographic Evaluation of Transverse Sacral Fractures
Authors: Ebraheim Nabil A , Sabry Fady F , Tosic Aleksander
Published: April 2021

ABSTRACT

This study clarifies the pattern of fracture lines and facilitates diagnosis of transverse sacral fracture on plain radiographic images. Eight cadaveric sacra were used in this study. A U-shaped transverse sacral fracture at the S2-S3 level was created in all specimens. The fracture line was marked by painting with radio-opaque material and solder metal wires. The following radiographic views were taken: anteroposterior, lateral, AP with 35° cephalad orientation, and inlet view. A double shadow in the upper sacral area can be identified in the plain AP view. As a consequence of the fracture, there are changes in the orientation of the planes of the foramina from the coronal to, more or less, axial plane. Anteroposterior with 35° cephalad orientation radiographs provide good assessment for evaluation of the transverse sacral fracture.
Classification of Heterotopic Ossification About the Elbow
Authors: Ilahi Omer A , Bennett James B , Gabel Gerard T , Mehlhoff Thomas L , Kohl Harold W
Published: April 2021

This article describes a system to aid surgeons in grading heterotopic ossification of the elbow. No special radiographic views or instruments are needed, and the system yields excellent reproducibility.
The Partial Pelvic Replacement Cup in Severe Acetabular Defects
Authors: Lietman Steven A , Bhavnani Kirankumar
Published: April 2021

Severe bone loss resulting in pelvic discontinuity may result in <50% coverage of the socket by native bone. The goal in these cases is to bridge the gap by using bone grans, methylmethacrylate, or both. The partial pelvis cup helps protect bone grafts during their incorporation and also provides a stable construct to the acetabulum for weight bearing.
Comparison of Interactive Voice Response and Written Self-Administered Patient Surveys for Clinical Research
Authors: Agel Julie , Rockwood Todd , Mundt James C , Greist John H , Swiontkowski Marc
Published: April 2021

ABSTRACT

This study compared the use of an interactive voice response (IVR) system with a written survey to collect data. Consecutive patients seen in an orthopedic clinic completed the Short Musculoskeletal Function Assessment (SMFA) by either IVR or written questionnaire and then were asked to complete the form again 3-7 days later using the opposite modality. Patient response rates were analyzed for differences between the self-administered IVR and written modes of administration. Three orthopedic clinics participated in the study. No significant differences between method of administration or individual differences in response per patient were found. Therefore, no significant differences in measurement are found when IVR is compared to the written SMFA.
Effect of Bone Morphogenetic Protein-2 on Tendon–Bone Integration in an In Vitro Cell Culture
Authors: Struewer Johannes , Crönlein Moritz , Ziring Ewgeni , Schwarting Tim , Kratz Marita , Ruchholtz Steffen , Frangen Thomas Manfred
Published: April 2021

The goal of this study was to evaluate the influence of bone morphogenetic protein-2 (BMP-2) on tendon–bone integration in a bovine in vitro cell culture. Seventy-two bovine tendons were cultivated over 3 months. The effects of BMP-2 were evaluated by generation in 4 subgroups. The groups differed in 2 parameters: the application of BMP-2 and the application of primary bovine osteoblasts. Results were analyzed biochemically by determining alkaline phosphatase activity and histologic tendon calcification, both markers for graft incorporation. Histological analysis demonstrated a positive effect of BMP-2 on the production of extracellular matrix and therefore the induction of osteogenesis. In addition, the results showed a superior cell ingrowth on the tendon in the BMP-2–stimulated groups. Calcium carbonate–like structures and organized ossification zones could only be detected in the BMP-2–stimulated tendons. The histological results matched those of the biochemical alkaline phosphatase analysis. The highest alkaline phosphatase activity was detected using BMP-2 stimulation in the first month (
P
<.001). High alkaline phosphatase values suggest high osteoblast activity and a high potential for mineralization. Furthermore, a positive effect of BMP-2 on fibroblasts existed with regard to the overall integration process. These results confirm the positive influence and triggering effect of BMP-2 on the mineralization process. Bone morphogenetic protein-2 seems to accelerate and optimize tendon–bone integration in the early process of graft incorporation. Besides the influence of BMP-2 on bovine osteoblasts, an additional positive effect of BMP-2 on bovine fibroblasts was detected; therefore, graft incorporation may be carried out by osteoblasts and fibroblasts.
The Efficacy of Orthopedic Telemedicine Encounters During the COVID-19 Crisis
Authors: Zhang Dafang , Blazar Philip , Benavent Kyra , Earp Brandon E.
Published: April 2021

Telemedicine technology was rapidly and widely adopted during the early phase of the coronavirus disease 2019 (COVID-19) response, and its efficacy in orthopedic surgery is still undetermined. The objective of this study was to determine the efficacy of new patient orthopedic surgery ambulatory encounters performed using telemedicine during the early phase of the COVID-19 crisis. Failure of the telemedicine encounter was assessed in this study by 2 separate criteria: (1) an unplanned visit to the emergency department (ED) within 6 weeks of the telemedicine encounter and (2) a planned subsequent in-person encounter for inability to formulate a complete diagnosis virtually. The authors retrospectively identified all new patient orthopedic surgery ambulatory encounters performed using telemedicine in the orthopedic surgery department of an academic tertiary care center during the first 6 weeks of the COVID-19 response, from March 16, 2020, to April 26, 2020. The study cohort included 298 new patients treated by 41 providers. The mean age of the 298 patients was 48 years, and 59% were women. Two hundred encounters were performed with video, and 98 were performed with telephone only. Three (1%) patients presented to the ED within 6 weeks of their new patient telemedicine encounter, and 8 (3%) patients presented for a planned in-person encounter. The authors concluded that new patient orthopedic surgery ambulatory encounters performed using telemedicine were able to effectively direct patients to a variety of treatments and dispositions, with a low rate of unplanned presentation to the ED or need for supplementary in-person assessment. [
Orthopedics
. 2021;44(2):e211–e214.]
The Influence of Parkinson's Disease on Outcome and Complication Rate of Reverse Total Shoulder Arthroplasty: A Matched Group Analysis
Authors: Borbas Paul , Kriechling Philipp , Fehler Selina , Bouaicha Samy , Wieser Karl
Published: April 2021

Parkinson's disease (PD) is associated with a higher complication rate after common orthopedic procedures, such as spinal fusion, knee arthroplasty, or hip arthroplasty. A few reports have also suggested higher complication rates after reverse total shoulder arthroplasty (RTSA). The aim of this study was to assess the outcome and complication profile of patients with RTSA and PD. A total of 17 patients (mean age, 73.9±9.5 years) with PD and RTSA with a minimum follow-up of 2 years were identified on screening of the authors' institutional RTSA database. These patients were compared with a 1:4 matched cohort group of 68 patients (mean age, 73.9±7.9 years) without PD. Complications and revisions for all patients were assessed by review of medical records. Outcome scores included the Constant–Murley score and the Subjective Shoulder Value. At a mean follow-up of 49.5±24 months, statistically significant improvements were obtained in postoperative Subjective Shoulder Value, Constant–Murley score, pain, flexion, abduction, internal rotation, and strength for both groups. However, the control group had significantly greater improvements in flexion, abduction, strength, Subjective Shoulder Value, and Constant–Murley score. Postoperative complications (35% vs 6%; odds ratio, 8.7) and reinterventions (29% vs 1%; odds ratio, 27.9) were substantially greater for patients with PD, with the most frequent complications being fractures of the scapular spine and the acromion. Reverse total shoulder arthroplasty is associated with a significantly higher complication rate and revision rate and an inferior outcome in patients with PD compared with neurologically healthy patients. Indications for RTSA should be carefully evaluated and questioned for patients with PD. [
Orthopedics
. 2021;44(2):86–91.]
A Framework for Conceptualizing Stress in Clinical Learning
Authors: Strauss Sarah S , Hutton Elisabeth B
Published: April 2021

ABSTRACT

The Transactional Model of Stress is utilized as a framework for conceptualizing nursing students' responses to stress inherent in the learning environment. The five stages of the model and variables influencing each stage are discussed with examples. Areas where inadequate information exist are identified along with suggestions for further investigation.
Relationship of Anxiety Level and Recall of Information to the Interval Between Orientation and First Patient Care Day
Authors: Lewis L Lucile , Gadd Holly Ford , O'Connor Kathleen
Published: April 2021

ABSTRACT

Sophomore students' responses to two different intervals between orientation and first clinical day in medical/ surgical nursing were examined. Variables studied were anxiety state and ability to recall information which had been presented. Prior to orientation all students were given the Spielberger STAI-S and STAI-T anxiety scales. At the beginning of the first laboratory session the students completed the STAI-S scale and a teacher-made quiz on information presented in orientation. Students in Group I (n=51) had their first laboratory one week after orientation. Group II (n=39) had their first laboratory the day following orientation. There was no significant difference between the two groups on cumulative grade point average, beginning STAI-T or STAI-S. Likewise, there was no significant difference between the scores made on the quiz. The validity and reliability of the quiz were not determined. ) There was a significant difference between the two groups on changes in state anxiety from orientation to the first laboratory. Group I (laboratory one week after orientation) was more anxious than Group II (laboratory one day after orientation) (p=0.024). Both groups were significantly more anxious in the Spring than Fall quarter (p=0.034). It was concluded that anxiety related to a new clinical experience might be lessened if the first clinical day closely followed orientation. It was also noted that students may be more anxious in the Spring than in the Fall of the year.
Training on Selected Self-Management Techniques and the Generalization and Maintenance of Interpersonal Skills for Registered Nurse Students
Authors: Farley Roy C , Baker A J
Published: April 2021

ABSTRACT

This study examined the effects of training on selected self-management procedures (post-workshop practice, selfmonitoring, self-assessment, and self- reinforcement) on the generalization and maintenance of interpersonal skills with a group of registered nurse students. The findings indicate that those self-management procedures enabled the student nurses to maintain a positive attitude toward the use of interpersonal skills in their work and maintain their skill level over a period of time significantly better than a control group who received interpersonal skills training only. No significant differences were observed between the two groups as to their ability to maintain their knowledge of the concepts taught during training or their ability to generalize their skills to the hospital ward immediately following training.
The New Non-Traditional Student in Nursing
Authors: Seidl Ann H , Sauter Diane
Published: April 2021

ABSTRACT

Because different types of new, non-registered nurse students seek baccalaureate nursing education, this study was conducted comparing traditional undergraduate generic students with a group of non-traditional students to dispel myths and to develop policies and educational strategies. Traditional and non-traditional students were differentiated by age, sex, marital status, and experience in higher education.

Traditional and non-traditional undergraduate students were compared on demographic variables, educational goals, sources of psychological and financial support, study habits, learning style, and clinical judgment skills.

Non-traditional students were found to be an excellent risk for admission, having higher semester grade point averages and being more skilled in making professional judgments. Learning style differentiated traditional and non-traditional students, however, teaching methods were similar. Suggestions for educational planning and policies are made.