bluuebunny/crossref_metadata_2025 huggingface dataset:
Calorie Awareness Related to Weight Control
Authors: Fruh Sharon M. , Fulkerson Jayne A.
Published: February 2014

Obesity rates are high in all age groups. Individuals are often unaware of the calorie counts of food and the number of calories that they need each day to maintain their weight. Health care providers must promote calorie awareness in terms that are easy for patients to understand and implement. Awareness and understanding of calories can help empower individuals to make healthful food choices.

J Contin Educ Nurs.
2014;45(1):10–11.
Using Coaching to Create Empowered Nursing Leadership to Change Lives
Authors: Serio Ingrid Johnson
Published: February 2014

This article discusses the general theories used in professional coaching to create a stronger culture of nurse leadership in health care.

J Contin Educ Nurs.
2014;45(1):12–13.
Leading Through Meetings
Authors: Bleich Michael R.
Published: February 2014

Whether formal or informal, meetings reflect relational opportunities that are critical to effective leadership. Professional development educators can influence the quality, cost, and impact of meetings by emphasizing their structure, conduct, and behavioral dynamics.

J Contin Educ Nurs
. 2014;45(2):56–57.
Increasing Capacity for Evidence-Based Practice Through the Evidence-Based Practice Academy
Authors: Green Angela , Jeffs Debra , Huett Amy , Jones Luann R. , Schmid Barbara , Scott Angela R. , Walker Liz
Published: February 2014

Although mentoring is an important aspect of implementing evidence-based practice (EBP), few models exist for EBP education. The EBP Academy is an innovative, 6-month educational program designed to develop clinical staff as EBP nurse mentors. Sessions provide protected time for participants to work on their EBP projects with assigned mentors who have EBP expertise and similar clinical or research interests. Participants develop EBP projects focused on improving care in their clinical areas. Evaluation of the EBP Academy is based on a four-level model, including participant feedback about the program, perception of meeting program objectives, ability to apply knowledge to practice through EBP projects, and outcome data measured as a result of implementing the EBP changes. By developing EBP mentors, capacity to move nursing practice to a stronger evidence-based foundation can be enhanced. Positive, professional nursing and patient outcomes have been demonstrated when structured EBP education is provided.

J Contin Educ Nurs.
2014;45(2):83–90.
Using the ADDIE Model to Develop Online Continuing Education Courses on Caring for Nurses in Taiwan
Authors: Hsu Tzu-Chuan , Lee-Hsieh Jane , Turton Michael A. , Cheng Su-Fen
Published: February 2014

Background:

A hospital in Taiwan committed to implementing a framework of caring in clinical practice. This study was conducted to develop online courses on caring for the hospital's nurses.

Method:

The ADDIE (Analysis, Design, Development, Implementation, and Evaluation) model was applied to develop and evaluate this caring curriculum. Concrete caring and uncaring behaviors were identified through patient and nurse interviews. These were used to make 72 instructional videos and five live-action movies. Evaluation tools included quizzes, self-evaluations, focus group interviews, and a measurement of caring behavior. Patients used the same instrument to evaluate the nurses.

Results:

Nurses' self-evaluations showed positive results. No significant difference was found between pre- and postcourse patient evaluations.

Conclusion:

This study shows the usefulness of ADDIE and provides a model for how research data and results can be used to inform administratively mandated organizational change. It also provides evidence on the effects of caring education.
J Contin Educ Nurs.
2014;45(3):124–131.
The Cost-Effectiveness of Intensive Short-Term Dynamic Psychotherapy
Authors: Abbass Allan , Katzman Jeffrey W.
Published: February 2014

CME Educational Objectives

1.

Expose the reader to various sources of health care costs and diagnoses responsible for these.

2.

Review the evidence for multiple categories of cost reduction for intensive short-term dynamic psychotherapy (ISTDP).

3.

Review the return-to-work rates for patients receiving ISTDP treatment.

The health care burden of chronic disability, with mental illness and somatic symptom disorders leading the way, is crippling to global economies.
1
In the recent
JAMA
report by the U.S. Burden of Disease Collaborators, the top diseases with the largest number of years lived with disability in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. Migraine, drug use, alcohol use and dysthymia were also in the top 20. The authors noted that half of the health system cost is due to disability and morbidity.
1
Telemedicine and the Patient-Centered Medical Home
Authors: Herendeen Neil , Deshpande Prashant
Published: February 2014

Imagine an environment where health care coordination is seamless; where the pediatricians and their care teams could significantly reduce the time it takes to communicate and transfer the information between physicians, patients, and their families. Imagine a situation where unnecessary referrals and investigations are avoided, saving costs and anxieties for the patients. Welcome to the world of telemedicine and a patient-centered medical home (PCMH). Comprehensive health care delivered in the most efficient manner with the least expense is the cornerstone of these concepts.

The concept of PCMH was first introduced in 1967 by the American Academy of Pediatrics (AAP) Council on Pediatric Practice in the book,
Standards of Child Health Care
. The medical home concept originally referred to one central source of medical records for children with special health care needs. During the past 4 decades, this concept has transformed beyond data entry to methods of delivering the best quality of care for all children. In 2007, a joint statement by the AAP, the American Academy of Family Physicians, the American College of Physicians, and the American Osteopathic Association endorsed the PCMH concept.
Supporting Conversations Between Individuals With Dementia and Their Family Members
Authors: Karlsson Eva , Axelsson Karin , Zingmark Karin , Fahlander Kjell , Sävenstedt Stefan
Published: February 2014

Remembrance of recent events is a major problem for individuals with dementia. Consequently, this article explores the process of acceptance and integration of a digital photograph diary (DPD) as a tool for remembrance of and conversations about daily life events. A design for multiple case studies was used. Seven couples, in which one individual in the couple had Alzheimer’s disease, tested the DPD for 6 months. Data were collected in three sequences with interviews, observations, and screening instruments. In the analysis, all data were integrated to find common patterns of content. Some couples became regular users, while others used the DPD more sporadically. Factors contributing to regular use were how the DPD matched expectations, actual use, support, experienced usefulness, and reactions from family and friends. For those couples who became regular users, the DPD facilitated their conversation about recent daily activities. [
Journal of Gerontological Nursing, 40
(2), 38–46.]
“At Last I’ve Found You”
Authors: Simard Joyce
Published: February 2014

Click here to read a Letter to the Editor about this article.
Prevalence of Pressure Ulcers by Race and Ethnicity for Older Adults Admitted to Nursing Homes
Authors: Harms Susan , Bliss Donna Z. , Garrard Judith , Cunanan Kristen , Savik Kay , Gurvich Olga , Mueller Christine , Wyman Jean F. , Eberly Lynn , Virnig Beth
Published: February 2014

Little is known about the prevalence of pressure ulcers (PUs) among racial and ethnic groups of older individuals admitted to nursing homes (NHs). NHs admitting higher percentages of minority individuals may face resource challenges for groups with more PUs or ones of greater severity. This study examined the prevalence of PUs (Stages 2 to 4) among older adults admitted to NHs by race and ethnicity at the individual, NH, and regional levels. Results show that the prevalence of PUs in Black older adults admitted to NHs was greater than that in Hispanic older adults, which were both greater than in White older adults. The PU rate among admissions of Black individuals was 1.7 times higher than White individuals. A higher prevalence of PUs was observed among NHs with a lower percentage of admissions of White individuals. [
Journal of Gerontological Nursing, 40
(3), 20–26.]
Prostate Cancer and Quality of Life: Analysis of Response Shift Using Triangulation Between Methods
Authors: Serdà i Ferrer Bernat-Carles , Valle Arantza del , Marcos-Gragera Rafael
Published: February 2014

Quality of life (QoL) after prostate cancer treatment is uncertain. Patient responses to QoL questions shift for a number of reasons: measurement intervals no longer have the same psychological anchors (recalibration), the importance attributed to different QoL domains changes over time (reprioritization), and the definition of QoL differs throughout the disease continuum (reconceptualization). Therefore, the aim of this study was to describe QoL response shift in a cohort of 66 men with prostate cancer. The method involved carrying out a sequential triangulation between quantitative and qualitative methods. Patients were assessed at baseline (P1), followed by a posttest (P2) and a then-test measurement (P3). The difference between P3 and P1 was used to determine the response shift effect (recalibration). From baseline to posttest, QoL significantly decreased. The recalibration then-test confirmed a low QoL in all periods evaluated. Coping mechanisms were found to differ by age group, with older men less concerned about side effects than younger men. Health professionals should be alert to QoL changes over time and possible side effects, should coping skills fail. [
Journal of Gerontological Nursing, 40
(6), 32–41.]
Use of an Electronic System for Soft Tissue Balancing in Primary Total Knee Arthroplasty
Authors: D’Angelo Fabio , Binda Tommaso , Cherubino Paolo
Published: February 2014

Accurate soft tissue balancing during total knee arthroplasty has a direct effect on patellofemoral tracking and knee range of motion. Numerous instruments and methods are available to balance knee prostheses. The eLIBRA Dynamic Knee Balancing System (Synvasive Technology, Inc, Reno, Nevada) is an electronic device that establishes femoral component rotation using ligamentous tone. The eLIBRA is an articulating spacer that emulates implant trials before anteroposterior femoral cuts are made to obtain a dynamic gap symmetry.
One-stage Revision Anterior Cruciate Ligament Reconstruction With Impacted Bone Graft After Failed Primary Reconstruction
Authors: Ra Ho Jong , Ha Jeong Ku , Kim Jin Goo
Published: February 2014

Revision anterior cruciate ligament reconstruction can be performed in a 1- or 2-stage procedure. Restoration of bone stock using bone grafting is often required for good results. The authors performed 1-stage revision surgery with a more lateral and oblique femoral tunnel and an impacted bone graft to avoid the bone defect caused by the previous screw removal from a malpositioned tunnel. No evidence existed of revision surgery failure or viral transmission in any of 17 cases at 2-year follow-up. The authors’ technique is also useful for a slightly misplaced femoral tunnel.
Tissue Engineering Stratified Scaffolds for Articular Cartilage and Subchondral Bone Defects Repair
Authors: Liu Ming , Yu Xi , Huang Fuguo , Cen Shiqiang , Zhong Gang , Xiang Zhou
Published: February 2014

Educational Objectives

As a result of reading this article, physicians should be able to:

1.

Analyze the latest innovations in biomaterial scaffolds for the repair and regeneration of osteochondral defects.

2.

Discuss the design and manufacture of biomaterial scaffolds.

3.

Compare the advantages and disadvantages of stratified and nonstratified scaffolds.

4.

Review the latest fixation methods of scaffolds in vivo.

Due to their good biocompatibility and mechanical integrity, tissue engineering scaffolds have become a principal method of repair and regeneration of osteochondral defects. To improve their intrinsic properties, control their degenerative times, and enhance their cell adhesion and differentiation, numerous scaffold architectures and formation methods have been developed and tested, but the ideal scaffold design is still controversial. Moreover, scaffold fixation has a significant influence on repair and regeneration after implantation. The authors analyzed relative studies to address the latest scaffold designs, including biphasic scaffold, multilayered scaffold, and continuous nonstratified scaffold, and this article compares their advantages and disadvantages. In addition, the authors introduce a novel modified method for scaffold fixation known as magnetic fixation. Both stratified and nonstratified scaffolds can repair osteochondral defects, but continuous nonstratified scaffolds are more biomimetic compared with the native osteochondral structures, and they lead to a better regeneration of hyaline-like cartilage and structured bone tissue. Therefore, the authors suggest continuous nonstratified scaffolds are an effective option for treating osteochondral defects.
Patellar Instability With and Without Trochlear Dysplasia: New Arthroscopic Medial Soft Tissue Plication With Pullout Technique
Authors: Ahn Jin Hwan , Kang Jun Hee , Kasat Niraj Sharad , Kim Jae Gyoon
Published: February 2014

The aim of this study was to analyze clinical and radiologic results of an arthroscopic medial plication with the pullout technique and to define indications and limitations of this procedure for patellar instability. Records of 45 patients treated for patellar instability with arthroscopic medial plication with the pullout technique were reviewed. The mean patient age was 22.8±8.3 years. The tibial tuberosity-trochlear groove distance, trochlear depth (TD), and Insall-Salvati ratio were measured using magnetic resonance imaging taken preoperatively. Patients were evaluated clinically by the Insall and Kujala score and radiographically by measuring the congruence angle, lateral patellofemoral angle, and lateral patellar translation pre- and postoperatively. Patients were classified into 2 groups: group 1 comprised 23 patients with TD greater than or equal to 3.0 mm and group 2 comprised 22 patients with TD less than 3.0 mm. A significant improvement (
P
=.007) in postoperative clinical scores compared with preoperative values was observed. The congruence angle improved to 11.0°±20.6° (
P
=.006), the lateral patellofemoral angle improved to −1.6°±7.7° (
P
⩽.0001), and the lateral patellar translation improved to 8.7±5.3 mm (
P
⩽.0001) postoperatively. There were 5 (11%) failure cases. No significant difference existed in the number of failure cases and clinical scores between the 2 groups. This arthroscopic medial soft tissue pullout technique showed good clinical and radiologic results for patellar instability even in the presence of mild to moderate trochlear dysplasia. However, the technique showed limited success in severe trochlear dysplasia cases.
Arthroscopic Treatment of Anterosuperior Rotator Cuff Tears
Authors: Schnaser Erik , Toussaint Bruno , Gillespie Robert , Lefebvre Yves , Gobezie Reuben
Published: February 2014

This study evaluated pre- and postoperative clinical and structural outcome data on anterosuperior rotator cuff tears involving the supraspinatus and subscapularis treated by arthroscopic methods. Between June 2006 and October 2007, a total of 155 consecutive patients underwent an arthroscopic repair for a supraspinatus or supraspinatus and infraspinatus (superior) rotator cuff tear. Of these, 44 (28%) were identified on preoperative imaging to have involvement of the subscapularis. Confirmation of subscapularis tears occurred during arthroscopic repair of the superior rotator cuff. If the subscapularis was found to be torn, it was documented, and an arthroscopic repair was performed. Postoperative clinical and radiographic outcomes were assessed with the belly press and lift-off tests, range of motion, strength, pain score, Constant score, and either a magnetic resonance imaging arthrogram or a computed tomography arthrogram at an average of 15 months postoperatively. Failure was determined based on rotator cuff integrity on radiologic studies. Sixteen of the 44 anterosuperior rotator cuff tears identified on preoperative imaging were found to have a full-thickness subscapularis tear requiring repair on arthroscopic examination. On preoperative imaging, subscapularis tears were all either grade 1 or grade 2 (no complete grade 3 tears). Mean follow-up was 16.9 months (range, 13–24 months). Compared with preoperative values, significant postoperative improvements occurred in Constant scores, forward flexion, strength, and pain scores (
P
<.01). Patients also showed significant improvements in both the lift-off and belly press tests (
P
<.001). Mean postoperative patient satisfaction was 7.9 (range, 5–10) with 10 (59%) of 17 patients being extremely satisfied. Two of the 17 patients with an anterosuperior rotator cuff tear had confirmed retears of the supraspinatus (1 partial and 1 full-thickness) with no radiographic evidence of retear of any of the subscapularis repairs at most recent follow-up.
Arthroscopic Suture Fixation of Tibial Eminence Fractures
Authors: Kluemper Chase T. , Snyder Garret M. , Coats Aaron C. , Johnson Darren L. , Mair Scott D.
Published: February 2014

Tibial eminence avulsion fractures are relatively rare injuries, most frequently occurring in skeletally immature patients. Screws or suture fixation can be used, with each offering different potential advantages. The purpose of this retrospective study was to evaluate the clinical outcomes of a suture fixation technique for displaced tibial eminence avulsion fractures using the Rotator Cuff Guide (RCG; Acufex Microsurgical, Mansfield, Massachusetts). In a 12-year period from 1998 to 2010, a total of 17 tibial avulsion fractures were treated using the RCG for suture fixation. Outcomes evaluated included pain at final assessment and findings from Lachman, drawer, pivot shift, flexion, extension, and varus/valgus stress tests. Demographic data, fracture type, mechanism of injury, and postoperative activity were obtained for 17 patients (16 males and 1 female) who underwent surgery during the study period. Average patient age was 16.8 years (range, 13–37 years). Average follow-up was 25 months (range, 2 months to 13 years). Postoperatively, all fractures in all patients were radiographically healed, and all patients had stable Lachman and negative pivot shift tests. Two patients had 3° of extension loss, and 1 patient lost greater than 10° of knee flexion. The length of follow-up was broad. Further limitations include a small sample size and suture versus T-Fix (Acufex Microsurgical, Mansfield, Massachusetts) fixation methods. This technique offers a simplified, reliable method of suture fixation that provides few long-term complications and predictable results. Patients can expect to return to preinjury levels of activity, with the majority of patients achieving full range of motion.
Clinical Outcome of Internal Fixation of Unstable Juvenile Osteochondritis Dissecans Lesions of the Knee
Authors: Webb Jonathan E. , Lewallen Laura W. , Christophersen Christy , Krych Aaron J. , McIntosh Amy L.
Published: February 2014

Juvenile osteochondritis dissecans (OCD) lesions of the knee are a common cause of knee pain in skeletally immature patients.The authors sought to determine lesion healing rates, the risk factors associated with failure to heal, and the clinical outcomes for patients who underwent internal fixation for unstable OCD lesions. A retrospective review was conducted of all patients who underwent internal fixation of OCD lesions from 1999 to 2009. Using validated scoring systems, clinical outcome and functional activity were evaluated at the follow-up. The study group comprised 19 patients (20 knees). Mean patient age was 14.5 years (range, 12–17 years). Mean clinical follow-up was 7 years (range, 2–13 years). Mean radiographic follow-up was 2.5 years (range, 0.5–9 years). Fourteen (70%) lesions were grade 3 and 6 (30%) were grade 4. Eleven knees had lateral condyle lesions and 9 had medial lesions. Bioabsorbable fixation was used in 13 knees, metal fixation was used in 5 knees, and 2 knees were fixed with a combination of methods. Osseous integration was evident in 15 (75%) of 20 knees at final follow-up. The 5 unhealed lesions were lateral condylar lesions. Mean Tegner activity scores improved from 3.3 preoperatively to 5.6 at final follow-up. Mean Lysholm and International Knee Documentation Committee scores were 86.8 and 88.7, respectively, at final follow-up. Further operative intervention was required in 11 knees, with 50% of patients undergoing removal of hardware and 15% requiring subsequent osteochondral allograft transplantation. The authors recommend bioabsorbable fixation for symptomatic stable lesions and metal compression screws with staged removal for unstable lesions.
Benign Subcutaneous Emphysema of the Upper Extremity
Authors: Fowler John R. , Rerko Michael A. , Grand Aaron G.
Published: February 2014

Benign subcutaneous emphysema is a rare clinical entity, documented by only a small collection of case reports. The presence of crepitus on physical examination and subcutaneous gas on radiographs is concerning for necrotizing fasciitis. Necrotizing fasciitis is a dangerous and deadly infection accounting for 500 to 1000 cases annually in the United States, with mortality rates of up to 76%. Delay in surgical treatment is related to increased morbidity and mortality; therefore, a high clinical suspicion should be maintained in patients with subcutaneous emphysema and/or crepitus. It is critical to recognize that no laboratory result or radiologic finding should delay surgical intervention if a high clinical suspicion for necrotizing fasciitis exists. However, not all subcutaneous emphysema represents a life-threatening infection. This article presents a case of benign subcutaneous emphysema treated with close observation and prophylactic antibiotics. Patients with necrotizing fasciitis typically appear ill and have the triad of swelling, erythema, and disproportionate pain. Patients who are not systemically ill and have minimal pain, no significant inflammatory changes at the site of crepitus, and stable hemodynamic parameters can be treated conservatively, with the caveat that close clinical monitoring is essential to avoid the unnecessary morbidity and mortality that can result from delaying intervention in the case of necrotizing fasciitis.
Tubercular Prosthetic Knee Joint Infection
Authors: Harwin Steven F. , Banerjee Samik , Issa Kimona , Kapadia Bhaveen H. , Pivec Robert , Khanuja Harpal S. , Mont Michael A.
Published: February 2014

This article reports a rare case of late-onset tubercular infection following total knee arthroplasty in a 60-year-old woman who had been treated with a full course of antitubercular therapy for latent tuberculosis almost 25 years ago. Because no clear guidelines exist for optimal management of disease reactivation in the prosthetic knee joint, the authors performed a literature review and attempted to provide a treatment algorithm based on the time of presentation. Two modes of presentation were identified for unsuspected tubercular prosthetic joint infections based on the onset of symptoms and time to diagnosis: an early-onset presentation that occurs within the first 6 to 8 weeks postoperatively and a late-onset presentation that usually manifests after 8 weeks. Early-onset presentations often can be treated with standard antitubercular chemotherapy alone, whereas late-onset presentation may require 2-stage reimplantation under cover of antitubercular medications. This report also highlights the fact that despite adequate treatment of latent tuberculosis, patients may remain at risk of prosthetic joint infection following total knee arthroplasty.
Leveraging the Plate: Reliably Restoring Volar Tilt of Distal Radius Fractures
Authors: McLawhorn Alexander S. , Cody Elizabeth A. , Kitay Alison , Goldwyn Elan M. , Golant Alexander , Quach Tony
Published: February 2014

Restoration of volar tilt is critical when performing open reduction and internal fixation of distal radius fractures. A reproducible technique is required to consistently achieve this goal. A simple technique using the locking plate and an electrocautery scratch pad as reduction tools can reliably generate volar tilt. This technique can be performed with minimal aid from surgical assistants. [
Orthopedics.
2013; 36(12):918–921.]
Current State and Use of Biological Adhesives in Orthopedic Surgery
Authors: Shah Neil V. , Meislin Robert
Published: February 2014

Educational Objectives

As a result of reading this article, physicians should be able to:

1.

Describe the difference between adhesives and sealants.

2.

Recognize fibrin adhesives commonly used in practice today and identify other biological adhesives with rising potential.

3.

Analyze how fibrin sealants work relative to fibrin and fibrinogen.

4.

Identify anatomical areas and techniques in which fibrin sealants are used.

Bone and tissue adhesives are common and beneficial supplements to standard methods of musculoskeletal tissue suture repair. Knowledge and development of biologically derived or inspired adhesives useful in orthopedic surgery are rapidly advancing. Recent literature demonstrates the increased adjunct or primary use of biological adhesives in the repair of musculoskeletal soft tissues, chondral fractures, and osteochondral fractures. Adhesives offer more benefits and enhancements to tissue healing than current fixation methods afford, including improved biocompatibility, resorbability, and nonimmunogenicity. Further investigation is required to determine the extent of the role that these bioadhesives can play in orthopedic surgery.

The largest group of biologically derived adhesives and sealants is fibrin sealants, which include first- and second-generation commercially available fibrin sealants, autologous fibrin sealants, and variants. Other groups include gelatin-resorcin aldehydes, protein-aldehyde systems, collagen-based adhesives, polysaccharide-based adhesives, mussel adhesive proteins, and various biologically inspired or biomimetic glues.

Potential uses include applications in orthopedic-related blood conservation, arthroplasty, articular cartilage disorders, sports medicine, spine surgery, trauma, and tumors. The development of an adhesive with universal application is likely unfeasible, given the unique characteristics of various musculoskeletal tissues. However, the literature demonstrates the overall underuse of adhesives and indicates the rising probability of the development of a successful variety of bioadhesives for use in orthopedic surgery. [
Orthopedics
. 2013; 36(12):945–956.]
Acetabular Component Positioning in Primary THA via an Anterior, Posterolateral, or Posterolateral-navigated Surgical Technique
Authors: Nam Denis , Sculco Peter K. , Su Edwin P. , Alexiades Michael M. , Figgie Mark P. , Mayman David J.
Published: February 2014

The purpose of this study was to compare the acetabular component alignment in patients undergoing primary total hip arthroplasty (THA) via 3 surgical techniques: direct anterior using intraoperative fluoroscopy, posterolateral using an external alignment guide (posterolateral conventional), and posterolateral using computer navigation (posterolateral navigated). Two surgeons performed the direct, anterior THAs; 2 surgeons performed the posterolateral-conventional THAs; and 1 surgeon performed the posterolateral-navigated THAs. The most recent 110 THAs performed using each approach were reviewed, and Einsel-Bild-Roentgen analysis software was used to measure the acetabular component abduction and anteversion. One-way analysis of variance showed the anterior cohort to have a more horizontal alignment of the acetabular component (
P
<.001); 90.9% of the acetabular components in the posterolateral-navigated cohort were within 40°±10° and 15°±10° for both acetabular abduction and anteversion, respectively, vs 70% in the posterolateral-conventional (
P
<.001), and 68.2% in the anterior cohort (
P
<.001). The anterior technique using intraoperative fluoroscopy does not improve acetabular positioning compared with the conventional, posterolateral technique.
How Frequent Is Rotational Mismatch Within 0°±10° in Kinematically Aligned Total Knee Arthroplasty?
Authors: Nedopil Alexander J. , Howell Stephen M. , Rudert Maximilian , Roth Josh , Hull Maury L.
Published: February 2014

Rotational mismatch of the tibial component on the femoral component within 0°±10° is associated with better function after mechanically aligned total knee arthroplasty (TKA). Kinematically aligned TKA has gained interest; however, the percentage of kinematically aligned TKA within 0°±10° is unknown. The authors prospectively followed all patients who underwent TKA for primary osteoarthritis between December 2011 and April 2012 (194 patients, 195 knees). Each underwent kinematically aligned TKA with manual instruments. Aligning the anteroposterior axis of the tibial component parallel to the line that bisects the oval boundary of the lateral tibial condyle set internal/external rotation. Removing bone from the posterior femoral condyles equal in thickness to the femoral component after correction for cartilage wear set internal/external rotation and anteroposterior translation of the femoral component. Rotational mismatch of the tibial component on the femoral component was determined from a computed tomography scan of the knee. Ninety-seven percent of kinematically aligned TKA with fixed-bearing components had a rotational mismatch within 0°±10° (overall range, −11° to 11°). This percentage was higher and the range narrower than the 85% of TKA within 0°±10° and the −14° to 16° range reported for mechanically aligned TKA. The use of manual instruments to kinematically aligned TKA reliably limited rotational mismatch to within 0°±10°, which has been associated with better function.
Orthopedic Inpatients’ Ability to Accurately Reproduce Partial Weight Bearing Orders
Authors: Yu Serena , Physiotherapy B , McDonald Tony , Jesudason Christabel , Stiller Kathy , Sullivan Thomas
Published: February 2014

Partial weight bearing is often prescribed for patients with orthopedic injuries. Patients’ ability to accurately reproduce partial weight bearing orders is variable, and its impact on clinical outcomes is unknown. This observational study measured patients’ ability to reproduce partial weight bearing orders, factors influencing this, patients’ and physiotherapists’ ability to gauge partial weight bearing accuracy, and the effect of partial weight bearing accuracy on long-term clinical outcomes. Fifty-one orthopedic inpatients prescribed partial weight bearing were included. All received standard medical/nursing/physiotherapy care. Physiotherapists instructed patients in partial weight bearing using the hand-under-foot, bathroom scales, and/or verbal methods of instruction. Weight bearing was measured on up to 3 occasions during hospitalization using a force-sensitive insole. Factors that had the potential to influence partial weight bearing accuracy were recorded. Patients and their physiotherapists rated their perception of partial weight bearing accuracy. Three-month clinical follow-up data were retrieved from medical records. The majority of patients (72% or more) exceeded their target load, with mean peak weight bearing as high as 19.3 kg over target load (285% of target load). Weight bearing significantly increased over the 3 measurement occasions (
P
<.001) and was significantly associated with greater body weight (
P
=.04). Patients and physiotherapists were unable to accurately gauge partial weight bearing accuracy. The incidence of clinically important complications at 3 months was 9% and not significantly associated with partial weight bearing accuracy during hospitalization (
P
≥.45). Patients are unable to accurately reproduce partial weight bearing orders when trained with the hand-under-foot, bathroom scales, or verbal methods of instruction.
Comparison of Radiographic Appearance and Bone Scintigraphy in Fracture Nonunions
Authors: Niikura Takahiro , Lee Sang Yang , Sakai Yoshitada , Nishida Kotaro , Kuroda Ryosuke , Kurosaka Masahiro
Published: February 2014

Many surgeons assess the biological activity of fracture nonunions by the presence or absence of callus on radiographs. However, the assessment of biological activity by radiographic appearance alone is controversial. Bone scintigraphy reflects blood flow and new bone formation; therefore, it is useful in assessing such biological activity in nonunion cases. This retrospective study compared radiographs with Tc-99m bone scintigraphy in 48 patients with uninfected nonunions. Positive uptake was observed in all cases. The uptake patterns were classified into 4 types: type 1, intense, uniform uptake; type 2A, a definite photon-deficient cleft between 2 areas of intense uptake; type 2B, a photon-deficient area other than type 2A; and type 3, an intermediate pattern with uneven, distributed uptake. The percentage of type 1 with intense uptake does not decrease with time, and type 2 does not increase. When uptake was compared in patients with a nonunion and a united fracture, higher uptake in nonunion was seen in 46% and lower uptake was seen in 27%. All cases of hypertrophic and more than half of oligotrophic nonunions were type 1. Type 2 was seen in 17% of oligotrophic, 67% of comminuted, 100% of defect, and 57% of atrophic nonunions. Poor callus visualization may not preclude biological activity. Long duration from injury may not equate to declines in biological activity. Comparing uptake in nonunions and united fractures in the same patient may help to assess biological activity. The photon-deficient area is helpful to assess the necessity of bone graft or other osteogenic supplementation.
Dual-incision Approach for Repair of Peroneal Tendon Dislocation Associated With Fractures of the Calcaneus
Authors: Mak May Fong , Tay Guan Tzu , Stern Richard , Assal Mathieu
Published: February 2014

Dislocation of the peroneal tendons associated with calcaneus fractures should be repaired during fracture fixation to prevent complications. The only documented approach for repair is by proximal extension of the vertical limb of the lateral extensile approach to the calcaneus. However, enlarging the inherently fragile calcaneus flap places it at further risk of damage. Using a separate anterior incision to repair the dislocation, thus avoiding problems caused by excessive flap elevation, seemed intuitive. This approach proved technically effective and reliable in producing favorable outcomes in a series of 14 patients. [
Orthopedics.
2014; 37(2):96–100.]
Giant Cell Tumor of Bone
Authors: Amanatullah Derek F. , Clark Tyler R. , Lopez Matthew J. , Borys Dariusz , Tamurian Robert M.
Published: February 2014

Educational Objectives

As a result of reading this article, physicians should be able to:

1.

Identify at-risk populations for giant cell tumor of bone.

2.

Recognize the biology that drives giant cell tumor of bone.

3.

Describe modern surgical and adjuvant techniques to effectively treat giant cell tumor of bone.

4.

Recognize the complications associated with radiation therapy, poor resection, and adjuvant treatments.

Giant cell tumor of bone (GCT) is a benign, locally aggressive bone tumor. Giant cell tumor of bone primarily affects the young adult patient population. The natural history of GCT is progressive bone destruction leading to joint deformity and disability. Surgery is the primary mode of treatment, but GCT has a tendency to recur locally despite a range of adjuvant surgical options. Pulmonary metastasis has been described. However, systemic spread of GCT rarely becomes progressive, leading to death. This review presents the clinicopathologic features of GCT and a historical perspective that highlights the current rationale and contro-versies regarding the treatment of GCT. [
Orthopedics.
2014;37(2):112–120.]
Value of Knee MRI in the Diagnosis and Management of Knee Disorders
Authors: Subhas Naveen , Patel Sunny H. , Obuchowski Nancy A. , Jones Morgan H.
Published: February 2014

The primary objectives of this study were to determine how frequently knee magnetic resonance imaging (MRI) changes (1) diagnosis, (2) diagnostic confidence, and (3) management. A secondary objective was to correlate these changes with specific patient/physician characteristics and develop a prediction model using these characteristics. Six orthopedic specialists prospectively completed surveys when ordering knee MRI (n=93). Pre-MRI surveys recorded history, symptoms, signs, diagnosis, diagnostic confidence, and planned management. Post-MRI surveys recorded diagnosis, confidence, and planned management. Changes in diagnosis, management, and diagnostic confidence were correlated with patient/physician characteristics using chi-square and logistic regression tests. A multiple variable model was created with the most significant variables from the univariate analysis, and a c-index was used for cross-validation. Magnetic resonance imaging changed diagnosis in 29.3% and management in 25.3% of cases. Confidence in diagnoses after MRI increased, on average, by 10.6%. Change in diagnosis was significantly correlated with lateral joint line pain (
P
=.012) and tenderness (
P
=.006). The 3 most significant predictors for change in management were ligament pathology (
P
=.017), medial-sided pain/tenderness (
P
=.051), and age (
P
=.133). A 3-variable model using these predictors was significantly better than chance alone at predicting management changes (c-index: model=0.766; cross-validation=0.661). Magnetic resonance imaging frequently changed diagnosis and management and improved diagnostic confidence in a large minority of patients with internal derangement of the knee, even after evaluation by subspecialized physicians. A statistical model using specific patient characteristics can be created to predict when MRI will change management.
Disparities in Internet Use Among Orthopedic Outpatients
Authors: Walsh Kenneth P. , Rehman Saqib , Goldhirsh Jessie
Published: February 2014

Internet access has lagged behind for patients with lower incomes and from certain ethnic groups. This study investigated the possible improvement of access to health-related information on the Internet for all patients in an urban outpatient setting, regardless of socioeconomic background. A 28-question survey was completed by 100 orthopedic outpatients evaluating associations between their age, ethnicity, income, or education level and their access to the Internet. The survey also examined how patients used the Internet to obtain information about their medical condition, their privacy concerns when conducting online research, and their use of mobile phones as a primary means of Internet access.

The Internet was used by 57% of orthopedic outpatients in this urban setting. Internet access decreased with advancing age but increased with increasing income and education, findings consistent with similar studies. Despite the inability to identify an association between ethnicity and Internet access in this patient population, fewer Latinos (33%) than whites (67%) or African Americans (77%) sought information about their medical condition. Among patients who used a mobile phone as the primary method for online access, 74% were African American or Latino and 26% were white. This difference in mobile phone use for online access suggests that mobile phones have provided ethnic minorities with greater Internet access and thus may have narrowed the digital divide among the races.
Cost-effectiveness of MRI to Assess for Posttraumatic Ligamentous Cervical Spine Injury
Authors: Murphy Joshua M. , Park Paul , Patel Rakesh D.
Published: February 2014

Magnetic resonance imaging (MRI) has been shown to be sensitive in identifying ligamentous injury to the cervical spine. The major drawbacks to its routine use are cost and availability. The purpose of this study was to compare the cost of using MRI to rule out ligamentous injury of the cervical spine with the cost of immobilization in a cervical collar and outpatient follow-up. Neurologically intact and nonobtunded patients with neck pain and normal findings on radiographs evaluated for ligamentous injury of the cervical spine were studied. Patients were either evaluated with MRI or immobilized in a cervical collar and followed up for repeat clinical and radiographic evaluation as outpatients. The authors gathered year 2011 fees from their institution and 2011 Medicare reimbursement data and compared the costs of MRI with the costs of cervical collar and outpatient follow-up. In addition, the median income of the local community was used to estimate opportunity costs associated with cervical collar immobilization. After 7 days of lost wages at the median local income, MRI became a less costly option when comparing hospital fees. Alternatively, when considering Medicare reimbursement, MRI became less costly after only 2 days of lost wages at the median local income. On the basis of these findings, MRI of the cervical spine is less costly than other current management strategies when opportunity costs are considered.
CT Characterizing the Anatomy of Uninjured Ankle Syndesmosis
Authors: Mendelsohn Elliot S. , Hoshino C. Max , Harris Thomas G. , Zinar Daniel M.
Published: February 2014

Although it is expert opinion that transsyndesmotic screws are placed obliquely 30° from posterolateral to anteromedial in the transverse plane, this has not been formally studied, and there is inconsistency regarding the congruency of the distal tibiofibular joint. Thirty-eight computed tomography (CT) scans of the lower extremity were used to examine the rotational profile of the axis of the syndesmotic joint in relation to the femoral transepicondylar axis and to describe the congruency of this joint. The axis of the distal tibiofibular joint was 32°±6° externally rotated in relation to the transepicondylar axis. The average anterior, central, and posterior widths of the syndesmotic joint space 10 mm superior to the joint line were statistically significantly different: 1.7±0.9 mm, 1.7±0.6 mm, and 2.3±1.1 mm, respectively (P=.004). This study demonstrates that the axis of the uninjured distal tibiofibular joint is approximately 30° externally rotated in relation to the transepicondylar axis. Therefore, reduction clamps and screws should be placed at this angle to avoid malreduction of the syndesmosis. The posterior joint space width is significantly wider than the anterior and central joint spaces. This study’s results provide a description of the anatomy of the uninjured distal tibiofibular joint to guide reduction maneuvers and establish a baseline for evaluation of postreduction CT scans.
Clinical Comparison of 2 Implantation Systems for Single-level Cervical Disk Replacement
Authors: Shi Rui , Li Juan , Liu Hao , Ding Chen , Hu Tao , Li Tao , Gong Quan
Published: February 2014

The safety and effectiveness of 2 implantation systems for single-segment cervical disk replacement—the Bryan Cervical Disc System (Medtronic Inc, Minneapolis, Minnesota) and the ACCEL system (Medtronic Inc)—have not been clinically compared. A prospective, nonrandomized controlled study in consecutive patients with a minimum 2-year follow-up was performed. Fifty patients with single-level cervical disk degeneration who responded poorly to conservative treatment and underwent Bryan Cervical Disc replacement were involved. Fifty patients were included (24 in group A [Bryan Cervical Disc System] and 26 in group B [ACCEL system]).The patients’ visual analog scale scores, Neck Disability Index (NDI) scores, Short Form 36 (SF-36) scores, Odom scores, operative time, blood loss, and complications were compared. Patients’ baseline statuses were similar (
P
>.05). Visual analog scale for neck and arm pain, NDI, and SF-36 were significantly improved postoperatively (
P
<.05) in both groups, and no clinical differences were found between the groups (
P
>.05). All Odom scores were better than good. Mean operative time and average blood loss in group A (173±42.5 minutes and 250±159.8 mL, respectively), were both significantly higher than the values in group B (137.5±19.3 minutes and 138.1±86.7 mL, respectively) (
P
<.05). Complications included intraoperative bleeding, temporary throat discomfort, and slight migration of the prosthesis; there was no significant difference in the total complication rates between the 2 groups (
P
>.05). The 2 implantation systems displayed equal clinical effectiveness and safety, but the ACCEL system appears to have the advantages of shorter operative time and less blood loss.
Loosening of the Patellar Component and Extra-articular and Transcutaneous Migration After TKA
Authors: Helito Camilo Partezani , Gobbi Riccardo Gomes , Tirico Luis Eduardo Passarelli , Pecora Jose Ricardo , Camanho Gilberto Luis
Published: February 2014

Replacement of the patella during total knee arthroplasty (TKA) remains controversial. Despite some attempts to establish guidelines for this procedure, there is still no consensus in the literature. When the patella is replaced, the patient is subjected to certain complications, including loosening of the component. The loosened patellar component most commonly migrates to the intra-articular region of the knee. However, there have been a few reports of migration of the component to the extra-articular region, particularly when release of the lateral retinaculum and osteonecrosis of the patella are involved. The authors report a case of patellar component loosening and extra-articular and transcutaneous migration of the component 9 years after TKA. This report is unique because, during the primary procedure, no lateral release was performed and no patellar necrosis was evident on radiographs. The component was removed in the operating room and the wound cleaned and closed. Because of the probable slow migration of the component, there was no communication between the external environment and the joint at the time of surgery. There were no further complications after the wound healed. This case emphasizes the need for periodic radiographic follow-up after TKA.
Intra-articular Osteoid Osteoma of the Proximal Ulna
Authors: Kraus Gabriel , Fortes Sofia , Vazquez Joyce , Renfree Kevin J.
Published: February 2014

Osteoid osteoma is a common benign osteogenic bone neoplasm characterized histologically by increased osteoid tissue formation with an intracortical nidus surrounded by cortical thickening and vascular fibrous stroma and sclerosis. The clinical presentation classically includes severe nocturnal pain that is improved with nonsteroidal anti-inflammatory drugs. Younger men (second and third decades) have the highest incidence, with the most frequent sites of involvement being the long bones or axial skeleton. Osteoid osteoma may be missed due to the lesion occurring in an atypical location or due to failure to obtain advanced imaging studies such as computed tomography (CT). Intralesional or wide excision, or CT-guided radiofrequency ablation if available, leads to predictable and rapid pain relief. The authors report the case of a 24-year-old man who had a painful flexion contracture of his dominant right elbow for 1.5 years, secondary to an intra-articular osteoid osteoma. Attempted motion, passive or active, produced a marked exacerbation of pain. Previous surgeries, including an elbow synovectomy and an ulnar nerve transposition, had been unsuccessful in relieving his pain. Plain radiographs demonstrated a small area of periosteal thickening adjacent to the sublime tubercle. Fine-cut CT scan demonstrated an osteoid osteoma within the articular surface of the trochlear notch of the olecranon, adjacent to the sublime tubercle. Because of a perceived risk to the surrounding articular cartilage, CT-guided radiofrequency ablation was not performed. Wide en bloc surgical excision of the nidus was performed, with complete resolution of pain and rapid return to normal function.