bluuebunny/crossref_metadata_2025 huggingface dataset:
Value-added models
Authors: Amrein-Beardsley Audrey , Pivovarova Margarita , Geiger Tray J.
Published: September 2016

Being an expert involves explaining how things are supposed to work, and, perhaps more important, why things might not work as supposed. In this study, researchers surveyed scholars with expertise in value-added models (VAMs) to solicit their opinions about the uses and potential of VAMs for teacher-level accountability purposes (for example, in the areas of teacher evaluation, promotion, tenure, merit pay, and termination). Researchers found that respondents were most concerned about VAMs and their methodological and pragmatic flaws and limitations; their uses, misuses, and sometimes abuses in practice; and their unintended consequences. Education practitioners will benefit from this shared knowledge, intelligence, wisdom, and expertise to develop a deeper understanding of the merits and pitfalls of value-added models.
Engage me and I learn
Authors: Smith Eleanor K. , Pastor Margaret
Published: September 2016

Project-based learning presents an opportunity to engage both struggling students and high-achieving students. A special education teacher and a principal describe how this worked in one school by sharing the stories of two very different elementary school students. The high-achieving student learned to be more creative and take risks; the struggling student discovered that he could apply his knowledge in practical situations.
Students improve even amid evaluation controversy
Authors: Cronin John , Jensen Nate , Wise Steve
Published: September 2016

In 2012, New York education officials and the state’s teachers union announced one of the nation’s most aggressive programs for teacher and principal evaluation — the Annual Professional Performance Review system (APPR) — which required that 40% of an educator’s evaluation be based on student growth, using a combination of the state assessment and locally selected assessments; the other 60% to be based primarily on classroom observations. Positive student achievement and growth results for students in New York suggest that improvements to the teacher evaluation process that emphasize the importance of strong evaluation procedures, the systematic collection of evidence of teacher performance, and the use of data to inform the process, have promise for improving educator effectiveness far more than a narrower punitive approach. Such an approach is most likely to get the support of administrators and teachers and may also be the approach that will have the most positive effect on student achievement over time.
The Editor’s Note
Authors: Richardson Joan
Published: September 2016

Whirlpool Corp.’s Care Counts program places washers and dryers into schools with chronic absenteeism in an effort to improve attendance. During the 2015-16 school year, the company’s pilot program placed machines in 17 U.S. schools. At David Weir K-8 Preparatory Academy in Fairfield, Calif., the rate of chronic absenteeism dropped from 20% — students who missed 10% or more of school days — to 10% after one year. The experience of Weir is told through the eyes of principal Martha Lacy.
Under the Law
Authors: Underwood Julie
Published: September 2016

The rights of transgender students in U.S. schools are getting a lot of press. A guidance document set forth by the U.S. Departments of Justice and Education advises schools to treat all students consistent with their professed gender identity. However, there have been several recent challenges to the document. In the midst of this legal swirl, schools and educators in states that prohibit gender identity discrimination should follow state laws and policies. All educators are advised to consult with their district’s attorney regarding the most appropriate path for their jurisdiction.
Backtalk
Authors: Pittinsky Todd L.
Published: September 2016

Although it’s important to focus on the microaggressions we witness in the classroom — on those slights and insults that target students because of their ethnicity, gender, religion, or sexual orientation — educators also need to look at the flipside of the coin. Microaffirmations refer to small, sometimes unconscious actions that can make students feel welcome, valued, and encouraged. By modeling microaffirmations and fostering their use in the classroom, teachers can promote a supportive environment that encourages learning and serves the full diversity of K-12 students.
Trouble on the Docks
Authors: Nasiali Minayo
Published: September 2016

This essay explores the colonial context in which manly labor—particularly dock work—was performed, experienced and embodied in Marseille from the late 1940s through early 1960s. It takes seriously the spatial milieu in which masculinity was cultivated by paying particular attention to both the workplace and neighborhoods where diverse port workers lived and socialized. While scholarship on gender and labor has underscored how masculinity is constructed and performed in the workplace, recent studies have not fully explored the imperial contexts in which many of these negotiations have taken place. Marseille dockers—whether union member or scab, colonial subject or citizen—had varied understandings of the meaning, goal and consequences of labor. Port work was thus deeply coded by perceptions of gender, political affiliations, and racial differences and these understandings were forged on the docks as well as in the city’s many port district bars and cafés.
“My Most Beautiful Ornament Is My House”
Authors: Fretwell Elizabeth Ann
Published: September 2016

This article examines changing representations of women and the city during the years surrounding Senegal’s 1960 independence from France. By focusing on advertisements, images, and texts of the largest (and later only) political party’s newspaper, this article shows how women and their bodies were politicized by a nation-building process that relied on discourses of the “modern” city and the “traditional” countryside. In the late colonial period and immediately following independence, nationalists perceived a planned city of modern residents as foundational to the emerging nation. Imagery and textual references to women’s consumption and to their labor portrayed them as important participants in the construction of urban spaces and the development of modern citizens. However, as Senegal’s industrialized urban future became increasingly uncertain, text and imagery valorized rural Senegal and traditional bodies, adornment, and female sexuality. Their urbanized inverses were reinscribed as a potential threat to the national project.
Bulgarian Diary
Authors: Chappell Cary , Gold Marvin
Published: September 2016

This past summer, the Bulgarian government was the host country for an International Year of the Child World Assembly for youngsters gifted in the areas of art, music, and creative writing. G/C/T Editor Gold was contacted by Dr. Dorothy Sisk, then Director of the Office of Gifted and Talented, to be one of five adult American representatives. Dr. Sisk also requested that an Alabama youngster be identified as one of ten American children to be selected to go. A competition supported by a grant from the M. W. Smith, Jr. Foundation of Mobile was scheduled. The grand prize winner, Cary Chappell, was awarded a round trip ticket from Mobile, Alabama, USA to Sofia, Bulgaria. Diary entries by Chappell and Gold form the text of this article. All photos are by Editor Gold.
Double Perspective
Authors: Ginsberg Gina , Weiner Ann
Published: September 2016

We thought our son was advanced even as a baby, but as we had no other children we weren't sure. He began to cross-country ski with us when he was two, and learned to ice skate from a children's instructor at four. Now, at seven, he's on a pee-wee hockey team and won an award this past season.

We didn't know much about school programs and enrolled him without question in first grade. The following spring (he turned 6 in April) we took him for an independent evaluation at a university connected child study center. We were rather astounded by the findings. On the Binet test our son was found to have an IQ of 150. On an achievement-type test his placement looked like this: Math—grade 5.3, Word Recognition—grade 6.4, Reading Comprehension—grade 4.1, and Spelling—grade 4.2. On a silent reading test, he got a grade level score of 5.8.

We arranged a conference with his school principal and teacher and took the report. We felt our son ought to be given more to do as he'd been getting very restless. His teacher wouldn't even read the report as she said she didn't want to be swayed by information other than her own. The principal read it and said that tests didn't tell everything. They both said our son was becoming a behavior problem in the classroom and he shouldn't be given any advanced work until he could learn to control himself. They put him in second grade. Now at age 7, he's not interested in school, doesn't want to do anything hard. His teacher says he is worse than ever and he should be kept back in second grade until he learns to control himself. He has become disobedient and refuses to work at his assignments. We feel desperate. What can we do?
Gaming-Simulation and Health Education: An Overview
Authors: Greenblat Cathy Stein
Published: September 2016

Simulation entails abstraction and representation from a larger system in terms of process as well as structure. Central features are identified and simplified, less important elements are omitted from the model. In medical and health education, simulation enables learners to practice in an environment where mistakes are not costly, such as with simulated patients. Gaming-simulation incorporates role-playing into a defined system of interaction simulating a real world system and is characterized by the degree of structure of the roles and the focus on role interactions. Employment of gaming-simulation is embryonic in health education. Examples included in this Monograph concern problems of aging, hemophiliacs, and the dying; teaching interpersonal skills in psychiatric nursing; interactions of health care systems with their communities; and several other topics. Evaluation is discussed in a separate paper. A variety of health care gaming resources are described.
Use of Gaming Simulation by Health Care Professionals
Authors: Smoyak Shirley A.
Published: September 2016

Gaming-simulation is being developed for use in a variety of aspects of health care. A mental health diagnostic and therapeutic application is described for problems in parent-teenager relations; it features gaming, videotaping of interactions, and extensive discussion. Two applications which elucidate the nature of discord between couples and two applications for work-group problems are also described Gaming-simulation is used in basic and continuing education of health professionals for such issues as problems of dying patients and the aged, and prevention of coronary heart disease. Patients rights issues provide a potential focus for opening dialogues between patients and professionals about all facets of health and illness care.
Learning Outcomes in a Simulation Game for Associate Degree Nursing Students
Authors: Clark Carolyn Chambers
Published: September 2016

Learning outcomes of a simulation game designed to have one-to-one correspondence between behavioral objectives and game plays is reported The behavioral objectives were core concepts in psychiatric mental health nursing taught to associate degree nursing students. Decisions to use the simulation game method grew out of difficulties inherent in the community college nursing program, as well as the need for self-paced, efficient, learner-centered learning and evaluative tools.

After the trial and revision of the game, a number of research hypotheses were tested Simulation gaming was found to be an effective mode of learning, and students who acted as teachers for other students learned significantly more than those who were taught. Some of the recommendations for further research were to study varied nursing populations, to add a control group, to test the long-range learning effects of playing the game, to decrease experimenter bias, to study transfer of learning to actual nurse-patient situations and changes in attitudes toward psychiatric patients, and to develop more simulation games for nursing education.
National Nutrition Planning in Developing Countries via Gaming-Simulation
Authors: Duke Richard D. , Cary Robert
Published: September 2016

A nutrition game designed for the Food Policy and Nutrition Division of the Food and Agriculture Organization of the United Nations to aid in planning national nutrition education programs in Third World countries is described The Simulated Nutrition System Game allows high-level ministerial staff in developing countries to discuss, via a common language created by SNUS I, the issues, problems, and complexities of national nutrition programs.
Designing Simulations and Games: A Workshop for Health Care Professionals
Authors: Atkinson Francis D.
Published: September 2016

This article describes the important elements of a five-day workshop for teaching health care professionals to design and use simulation/gaming activities. Suggested guidelines are identified for planning and conducting a workshop. The importance of early planning is emphasized by identifying the specific objectives of the workshop and preparing the staff to facilitate the attainment of each objective. The selection of staff and participants is discussed. A day-to-day description of a typical workshop is presented. Also included is a description of several content presentations which teach the workshop participants the required skills and knowledge in design, selection, research, and evaluation of simulation/gaming activities.
Oberlin Procedure in Obstetric Brachial Plexus Palsy
Authors: Valbuena Sebastian , Gasiunas Vytautas
Published: September 2016

Objective: To present the functional results in obstetric brachial plexus palsy with Oberlin procedure. Materials and Methods: Between February 2010 and December 2015, 96 microsurgical explorations were performed in obstetric brachial plexus palsy, 42 cases presented C5-C6 or C5-C6-C7 compromise. In 17 cases, the Oberlin procedure was performed to restore the elbow flexion. Fourteen patients with complete follow-up of at least 12 months were included in this study. The power of elbow flexion was evaluated at 3, 6, 9, and 12 months with the Gilbert Score (M0-M3). The passive elbow motion and the functional active flexion (hand to mouth easy, hand to mouth difficult, active elbow flexion of 90°, and less than 90°) were assessed at the final follow-up. The results obtained at 6 and 9 months were compared with the final follow-up. The statistical analysis was performed using Student t test. Results: The mean age at surgery was 6.86 months (range, 3-11 months), the average follow-up was 40.7 months (range, 12-67 months), muscular power postoperatively at 3 months was 1.07 M (range, 0-2), at 6 months was 2.07 M (range, 1-3), at 9 months was 2.86 M (range, 2-3), at 12 months was 2.93 M (range, 2-3), and at the final follow-up was 3 M on average. There were no significant differences between the results obtained at 9 months and at the final follow-up ( P = .15). Statistically significant differences were found when compared with the results at 6 months and the final follow-up ( P = .0001). A total of 10 patients had hand to mouth easily, 3 had difficulty, and 1 presented M3 active elbow flexion to 90°. No motor or sensitive alteration was presented in the hand. No cocontraction triceps-biceps was found. Conclusion: The Oberlin procedure is an excellent alternative to reanimate elbow flexion in obstetric brachial plexus palsy (OBPP), and the results obtained at 9 months are similar to the final follow-up.
Oberlin Procedure in Concomitant With Anterior Shoulder Release in Management of Upper Obstetric Brachial Plexus Palsy
Authors: Noaman Hassan Hamdy
Published: September 2016

Objective: Describe a new procedure that combines Oberlin procedure with concomitant shoulder realise in Upper Obstetric Brachial Plexus Palsy. Methods: We present 18 children with upper obstetric brachial plexus palsy treated by transferring two motor fascicles out of the ulnar nerve to the biceps nerve in concomitant with anterior shoulder release. Eight were males, and 10 were females. The left-side brachial plexus was affected in 11 patients and the right side in 7 patients. Sixteen children had vaginal delivery and 2 children were delivered by cesarean section. The average birth weight was 3800 g (range, 3430-6000 g). Average age at the time of operation was 18 months (range, 12-26 months). The indication for the operation was absent active elbow flexion and no shoulder abduction with internal rotation contracture deformity. Oberlin’s ulnar nerve transfer was done in all cases in concomitant with anterior shoulder release without brachial plexus exploration. Results: The average follow-up was 18 months (range, 12-58 months). Nine children had biceps muscle M5, 6 of them had biceps muscle M4, and 3 children had <M3. Twelve children gained full shoulder abduction and 6 of them gained less than 120° shoulder abduction. Conclusion: We recommend Oberlin’s ulnar nerve transfer in concomitant with anterior shoulder release for upper-type obstetric brachial plexus palsy in children who have neither elbow flexion nor shoulder abduction with internal rotation contracture deformity in late presentation.
Pulley Reconstruction to Correct the Dynamic Direction of the Finger for Treatment of IIB Cleft Hand
Authors: Wang Bin , Zhou Shengbo , Jiang Yongkang , Yang Xi , Mao Hailei
Published: September 2016

Purpose: Manske IIB cleft hand is the most common type, which is characterized by severely narrowed first web and rotation of index finger. Some patients suffered from ulnar displacement of flexor tendon system. However, the ulnar displacement was poorly corrected during index to middle transposition during previous procedures and would usually lead to dysfunction of pinch and grip. Here, we developed a new method to correct finger dynamic direction by pulley transposition. Method: In 15 cases with Type IIB cleft hand, incisions from A1 to A2 pulleys were made with pedicle transposition of the flexor tendon and sheath system to the central. A1 pulleys of index and ring fingers were separated to reconstruct transverse ligament. Snow-Littler procedures were performed to reconstruct the first web. Postoperative assessment included subjective considerations of appearance, parent satisfaction, and ability to perform daily activities. Objective assessment included measurement of first web space, index-ring metacarpal separation, pinch strength, and rotation of the index finger. Results: All the patients and parents claimed to be satisfied with the surgery. Pinch grip reached 72% of the opposite hand when that was normal. The radiological measurement of the angle between the first and second metacarpals was 60.8º and the distance between the adjacent metacarpals across the closed cleft was 8 mm. Index rotation was only 1º and the mean thumb-index pinch was 5.6 kg. Conclusions: Pulley transposition can correct the ulnar displacement of flexor tendon system and improve pinch grip strength in Manske IIB cleft hand, which is a supplemental method for physiological and aesthetic reconstruction of cleft hand.
Single-stage Resection of Type II Constriction Rings in Limbs on the Basis of Histological and MRI Observations
Authors: Wang Bin , Jiang Yongkang , Mao Hailei , Yang Xi , Zhou Shengbo
Published: September 2016

Objective: To determine the feasibility of single-stage resection for type II congenital constriction rings via histological examination of resected specimens and imaging examination of affected extremities, and to evaluate the appearance and function of the extremities after the single-stage operation. Methods: The features of the skin on the constriction rings and the subcutaneous tissues were identified through continuous sectioning, hematoxylin and eosin (HE) staining, and immunohistological staining of specimens of type II constriction rings obtained via surgery. The relationship between the constriction rings and the deep main blood vessels was evaluated using magnetic resonance imaging (MRI). Single-stage resection of the constriction band, reduction of the fascial flap, and triangular flap plasty were performed for 21 patients. The appearance, lymphedema, and movement of the extremities were compared before and after the operation. Results: Type II constriction rings in the extremities had normal full-layer skin structures. Collagen was found deposited densely at the base of the grooves, but the normal subcutaneous tissue space still existed, and the vital nerves and blood vessels were unaffected. Complete resection of the constriction rings was achieved in all 21 patients, and lymphedema subsided 2 months after the operation. No episode of recurrence was found, and limb function was not affected at 26 months of follow-up. Conclusion: Type II congenital constriction rings in limbs possess normal subcutaneous tissue spaces. A single-stage operation, which includes complete resection of the rings, fascial flap reduction, and triangular flap plasty, could achieve satisfactory appearance and good function.
Quantitative Measurements of Cross-sectional Configuration of Flexor Pollicis Longus Tendon Using Ultrasonography in Patients With Pediatric Trigger Thumb
Authors: Kim Kahyun , Kim Jihyeung , Gong Hyun Sik , Rhee Seung Hwan , Baek Goo Hyun
Published: September 2016

Hypothesis: Pediatric trigger thumb is characterized by flexion deformity of the interphalangeal joint of the thumb. It usually occurs spontaneously in the childhood and can be resolved spontaneously without any treatments. The purpose of this study is to verify the causes of the flexion deformity of the thumb. Methods: We enrolled 42 patients who were diagnosed as pediatric trigger thumb with unilateral involvement and underwent ultrasonographic measurements of the flexor pollicis longus tendon at the level of A1 pulley and 1 cm proximal to the A1 pulley. The measurements were repeated in the contralateral normal side. The average age at the time of measurements was 33 months. Results: In the side of pediatric trigger thumb, the average anteroposterior and radioulnar diameters of the flexor pollicis longus tendon at the level of A1 pulley were 2.9 and 2.3 mm, respectively, and those 1 cm proximal to the A1 pulley were 4.5 and 2.7 mm, respectively. In the contralateral normal side, the average anteroposterior and radioulnar diameters of the flexor pollicis longus tendon at the level of A1 pulley were 3.0 and 2.0 mm, respectively, and those 1 cm proximal to the A1 pulley were 3.3 and 1.8 mm, respectively. The average ratio of the anteroposterior diameter of the flexor pollicis longus tendon 1 cm proximal to the A1 pulley compared with the A1 pulley was 1.58 in the side of pediatric trigger thumb, and 1.08 in the contralateral normal side. The average ratio of the radioulnar diameter of the flexor pollicis longus tendon 1 cm proximal to the A1 pulley compared with the A1 pulley was 1.17 in the side of pediatric trigger thumb, and 0.95 in the contralateral normal side. Conclusions: In the comparison of the cross-sectional configuration of the flexor pollicis long tendon and inner area of the A1 pulley, the anteroposterior and radioulnar diameters of the flexor pollicis longus tendon were more increased than those of inner area of the A1 pulley. The anteroposterior diameter of the flexor pollicis longus tendon was 58% longer than that of inner area of the A1 pulley, and the radioulnar diameter of the flexor pollicis longus tendon was 17% longer than that of inner area of the A1 pulley. The flexor deformity of the interphalangeal joint can be caused by increased anteroposterior diameter of the flexor pollicis longus tendon.
Congenital Flexion Deformity of the Long, Ring, and Little Fingers With an Aberrant Origin of the Flexor Digitorum Profundus
Authors: Xiong Ge
Published: September 2016

Objective: To report a series of cases of congenital flexion deformity of the long, ring, and little fingers with an aberrant origin of the flexor digitorum profundus and to compare this disease with the Volkmann’s contracture. Materials and Methods: Five cases of congenital flexion deformity of the long, ring, and little fingers with an aberrant origin of the flexor digitorum profundus were reported. Two of them were children. All the patients were misdiagnosed as the Volkmann’s contracture in the local clinics. Radiographs and 3-D computed tomography (3-D CT) of the involved forearm were performed. There were no neural disorders in any case. Results: The 3-D CT showed there was a bone prominence on the proximal part of the ulna. During the operation, we could find an aberrant origin of the flexor digitorum profundus of 3 to 5 fingers was attached to the bone prominence. Resection of the aberrant origin could achieve a thorough release in children cases but further muscle sliding procedure was needed in adult cases. Conclusion: Congenital flexion deformity of the long, ring, and little fingers with an aberrant origin of the flexor digitorum profundus is a potentially ignored disease. Finding the bone prominence on the proximal part of the ulna is helpful for the early diagnosis. Resection of the aberrant origin with muscle sliding procedure can get good result.
Reconstruction for Dysplastic Radial Polydactyly With an Island Compound Flap
Authors: Weiyang Gao , Salman Fraooqi , Wei Shi , Jian Ding , Anyuan Wang , Long Wang , Zongwei Zhou
Published: September 2016

Purpose: To investigate the necessity and possibility of digit fusion with an advanced island flap in thumb dysplasia of radial polydactyly. Methods: We collected the patients with radial polydactyly, whose nail width or thumb girth was less than 80% of contralateral side, from February of 2007. Among them, some patients were also associated with radial deviation deformities in two thumbs or a shorter radial thumb compared with ulnar thumb. In these cases,the proper palmar digital artery island flap was harvested and advanced to eliminate the tension between the radial and ulnar duplicate. Besides the island compound flap containing a part of the distal phalanx and nail bed was harvested from the accessory radial duplicate to augment the retained ulnar duplicate. The patients only with a smaller thumb girth were treated by an island flap to augment the thumb size. There were 26 patients, including 29 sides. Preoperative Doppler ultrasonic examination was assigned to observe the amount and distribution of princepspollicisartery (PPA)and proper palmar digital artery (PPDA). Appearances were evaluated by Wang-Gao scoring system and functions were evaluated by Tada scoring system. Results: There were two basic artery forms through preoperative ultrasonography and surgical exploration in 29 hands: both thumbs only had one PPDA which was observed in 82.76% (24 hands); the main thumb had two while the extra thumb still had one which was observed in 17.24% (5 hands). All cases were operated according to preoperative design using an island compound flap. 26 hands in 23 patients were followed up more than 6 months. Flap results included survival in 22 patients, tension vesicle in 2 patients and tip necrosis in 2 patients. The incision was infected in one patient with the treatment of changing dressing regularly. The function results were excellent in 21 patients, good in 4, fair in 1. In terms of aesthetic, there were 13 excellent results, 4 good and 1 fair. Conclusion: There is one developed PDAA, which can be used to design a flap, in the accessory radial duplicate. The longitudinal advanced flap can also eliminate the tension caused by unequal length in two thumbs. Using an axial or island flap to reconstruct a new thumb can not only change the appearance, but also make the reconstructed thumb acquire two sets of blood supply and nerve system.
Flexion Crease and Web Space Reconstruction for Aesthetic and Functional Correction of Congenital Syndactyly
Authors: Ni Feng , Wang Bin
Published: September 2016

Purpose: To investigate the efficacy of congenital syndactyly correction with flexion crease and web space reconstruction using a dorsal hourglass-shaped flap without skin graft. Methods: We studied 116 syndactylies in 96 patients. Surgical strategy focused on flexion crease and web space reconstruction using an hourglass-shaped dorsal advancement flap. We assessed for flap necrosis, height and width of the webs according to the criterion of D’Arcangelo, and total active digital motion compared with the normal side. Scar formation was measured by the Vancouver Scar Scale score. We also administered a parent-based satisfactory questionnaire. Results: Mean follow-up was 4.2 years. All syndactylies could be corrected without skin grafts. Dorsal flap plasty facilitated the reconstruction of commissure with a slope of 45° in an hourglass shape. Two cases encountered partial flap loss but healed without surgical intervention. There were no recurrences. According to the criterion of D’Arcangelo, the height and width of 98 webs were good, 16 webs were fair, and 2 webs were poor. Mean total active motion of the index, middle, ring, and little fingers of the affected side was 160, 158, 153, and 150, respectively. Mean Vancouver Scar Scale score was 1.4. After surgery, all parents were satisfied with the appearance and function of the separated fingers. Conclusions: Reconstruction of the flexion crease and web space simultaneously with an hourglass-shaped dorsal advancement flap can achieve good aesthetic and functional outcomes.
Microsurgical Reconstruction for Complex Thumb Duplication
Authors: Jing-Yi Mi , Yong-Jun Rui , Xiao-Fang Shen , Gang Zhao
Published: September 2016

Background: Removing the nondominant part and reconstructing the dominant part is the most common procedure for thumb duplication. But the results for complex congenital deformities are not satisfied. This study demonstrates our microsurgical reconstruction procedures for complex thumb duplication. Methods: For Wassel types I, II, and IV, a neurovascular pedicle flap was elevated from the deleted thumb and improved the contour of remained thumb. There were multiple procedures included with bone wedge osteotomy, tendon rebalancing, and ligament reconstruction. For Wassel types V and VI, both thumbs were used to achieve better contour. A neurovascular pedicle wrap-around flap or combined flap was harvested. The relative normal bone and joint were kept, while others were removed. With this procedure, a combined thumb was reconstructed. Percutaneous K-wire was always used to fix the bone and joint after ligament reconstruction completed. The wire was removed after 1 month. Splint was used 8 to 12 weeks after surgery. Results: From 2004 to 2013, 35 children with congenital complex thumb duplication were treated. The age of children at the time of operation was between 8 and 37 months old. The mean follow up after surgery was 27 months. All flaps and transferred thumbs were survived. We had no cases of delayed union or bone resorption. The appearance and function were all satisfactory. Conclusion: This microsurgical procedure can provide a satisfactory option for complex congenital thumb duplication.
Severity Grading and Estimation of Hand Quality in Radial Club Hand Evaluation
Authors: Vilkki Simo
Published: September 2016

Hypothesis: Bayne-Klug classification for Radial Club Hands is based on skeletal defects. Hand quality and functional capacity differ considerably inside Bayne-Klug types III and IV. A detailed Severity Grading is the key for proper evaluation of radial longitudinal deficiency (RLD). Methods: Systematic preoperative assessment was used in a series of 44 radial club hands in 32 patients. There were 34 Bayne-Klug type IV hands, 7 Bayne-Klug type III hands, and 3 Bayne-Klug type II hands, according to x-ray findings. Analysis of the function of fingers, hand, wrist, elbow, and shoulder was done. A chart was filled assuming that severity of different findings is negatively related to hand quality and to overall functional capacity. Presented Severity Grading gives 10 severity points for Hand quality (H), 10 points for Wrist tightness (W), and 10 points for Proximal functional defects (P). Combined severity scores, named as Severity Index for Radial Club Hand, are comparable when using the sum of Hand and Wrist scoring and adding the value of proximal lesions separately. Results: Radial Club Hands could be scored into three groups: (1) Mild: H + W + P gave 4 to 8 severity points (in mean, 5.8). There were 8 (18%) radial club hand (RCH) extremities. Proximal (P points in mean, 1.1) lesions were very rare in these extremities. (2) Moderate: H + W + P gave 9 to 16 severity points (in mean, 11.5). There were 21 (48%) RCH extremities. Mild proximal (P points in mean, 2.2) lesions were found. (3) Severe: H + W + P gave 17 to 30 severity points (in mean, 21.1). This group had 15 (34%) RCH extremities. Proximal (P points in mean, 5.4) lesions were found in all extremities. In repeated x-ray studies, a weakness in Bayne-Klug classification was noticed as the type IV will change during the growth very often into type III. In our series, the change due to ossification of the early invisible proximal radius occurred in 41% of forearms in the group of 19 patients followed over 11 years. Summary Points: Severity Index, a sum of severity points for Hand quality, Wrist tightness, and Proximal lesions, is a new evaluation criteria for RCH. Severity grading of Radial Club Hands improves assessment of functional prognosis, treatment planning, and comparison of similar extremity groups before and after treatment. Bayne-Klug classification appears to have a particular weakness because type IV will often change into type III during the growth.
Do Patients With an Inferior Subjective Result 12 Months After a Distal Radius Fracture Improve Over Time? A Prospective Register Study
Authors: Tägil Magnus , Kopylov Philippe , Abrtamo Antonio , Landgren Marcus
Published: September 2016

Objective/Hypothesis: The majority of patients with a distal radius fracture recover during the first half year, but approximately 10% to 15% have substantial problems still after 1 year when evaluated using patient-reported outcome scores. In the present study, we used the data from a prospective register to evaluate the longer term subjective outcome in patients who had a suboptimal subjective outcome at the 12-month follow-up. We hypothesized that the subjective outcome would improve over time. Methods: At our hospital, approximately 450 adult patients (18 years and older) are treated for a distal radius fracture each year. Since 2001, these patients are prospectively and consecutively registered, and a subjective outcome questionnaire (Disability of the Arm, Shoulder and Hand [DASH]) is sent to the patients after 3 and 12 months. In the present study, we arbitrarily defined a suboptimal DASH score of >35 and found 463/2666 patients in the register with a fracture between 2003 and 2012, who exceeded DASH 35 at 12 months. In fall 2014, 2 to 9 years after the fracture, a DASH inquiry was sent to the surviving 351 patients. Results: In all, 279 patients returned the new DASH inquiry. Forty-six percent had improved over time, reporting a DASH score below the cutoff, but 56% remained at a high suboptimal level of >35. No time dependent improvement could be detected, regardless if the minimum 2 or the maximum 9 years had passed since the fracture. Patients with a persisting high DASH score were older at the time of fracture (66.5 years vs 63.6, P = .04). Men seemed to improve more than women, from median 52 at 12 months after fracture to 25, compared with women who improved from median 50 to 39 ( P = .02). The men, however had a substantially lower mean age at time of fracture (53.7), compared with the women (67.4, P < .01). Conclusion: (1) An inferior result after 1 year will remain over time for many patients. (2) About half the patients improve and end up below the arbitrarily set threshold. (3) About half the patients continue to report a suboptimal subjective outcome. (4) No trend was found indicating that these patients get better with time. (5) Given the high incidence of a distal radius fracture, a small proportion of suboptimal results do matter and every effort should be made to improve the early results.
Functional Outcome Following Removal of Locked Volar Distal Radius Plates
Authors: Tan Jun , Chen Jing , Ye Ming , Tang Jinbo
Published: September 2016

Objective: Volar plate fixation has become the preferred method of internal fixation for distal radius fractures. Most of the literature reports volar plate fixation for distal radius fracture can acquire satisfactory treatments. However, little information is available about the outcome after implant removal following the operative treatment of distal radius fracture. The functional outcome may significantly improve because of removal of the plate. The purpose of this study was to evaluate the functional outcome following the distal radius plate removal. Materials and Methods: From January 2012 to December 2014, 30 patients were treated with internal fixation and plate removal. Inclusion criteria of the patients requested to remove the plate included age of 18 to 80 years and a minimum follow-up of 6 months after plate removal. Exclusion criteria include tendon irritation, implant breakage, or a persistent infection, and if they could not be reached for follow-up. Nineteen patients were available at the last follow-up, including 11 men and 8 women with a mean age of 48.2 years (range, 19-70 years). We obtained data before and after surgery on wrist motion, forearm supination and pronation, grip and lateral pinch strength, as well as Disabilities of the Arm, Shoulder and Hand (DASH) scores, Visual Analog Scale (VAS) scores, and Gartland-Werley scoring system. Wrist motions included extension-flexion and radioulnar deviation. For continuous data, mean ± SD (parametric data) were calculated. Differences were assessed using the Student’s t test (parametric data) or the Mann-Whitney U test (nonparametric data). Categorical data were compared using the rank-sum test. Results: All hardware was successfully removed from the 19 patients. Mean time was 28 minutes. No patients presented with new complaints following implant removal. Functional outcome had significantly better VAS and Gartland-Werley scores, grip strength, and range of motion of flexion, extension, and pronation after the plate removal. No statistical difference in pinch strength, radioulnar deviation, and forearm supination was detected between preoperation and postoperation. Conclusions: Implant removal following operative distal radius fracture treatment can improve the functional outcome of the hand and forearm. The existence of the plate is one of the most important factors affecting the functional outcome of distal radius fracture. Thus, when we evaluate the surgical treatment outcome of distal radius fracture, the factor of the plate should be considered.
Early Wrist Mobilization After Distal Radius Fractures Stabilized by Volar Locking Plate
Authors: Quadlbauer S. , Pezzei Ch. , Jurkowitsch J. , Keuchel T. , Beer T. , Hausner T. , Leixnering M.
Published: September 2016

Objective/hypothesis: Distal radius fractures (DRFs) are very common, and operative treatment by volar locking plate became the standard therapy in the last decade. Furthermore, incidence of DRF will increase of 50% by 2030. So surgical treatment and aftercare is of great interest. Main reason for open reduction and stabilization with a palmar locking plate is the possibility for early postoperative mobilization. There are only a few studies that compare early postoperative mobilization after DRF with immobilization. Main aim of this study was to compare early postoperative mobilization after DRF with a 5-week cast immobilization. Null hypothesis was that early mobilization leads to equal results in range of motion (ROM) and functional outcome scores than an immobilization of 5 weeks. Materials and Methods: Thirty patients with an isolated DRF treated by open reduction and internal fixation with a single volar locking plate without bone graft were prospectively randomized in 2 groups. One group (“early mobilization” [EM]) received a removable thermoplastic splint for 1 week and was allowed to move the wrist directly postoperative. The other group (“immobilization group” [IM]) received a not removable cast for 5 weeks. Both groups underwent physiotherapy 2 times a week. At 6 weeks, 9 weeks, 3 months, 6 months, and 1-year postsurgery ROM, grip strength and radiographs had been evaluated. In addition, Quick Disability of the Arm, Shoulder and Hand (QuickDASH) questionnaire, Patient-rated Wrist Evaluation (PRWE), modified Green O’Brien (Mayo) score, and pain according to the Visual Analog Scale (VAS) score were analyzed. Results: Patients in the EM group had significant better ROM in the sagittal plane and grip strength up to 6 months ( P = .03; P = .04), in the frontal plane up to 9 weeks ( P = .04), and in forearm rotation up to 6 weeks ( P = .03). As well QuickDASH and PRWE Score had been better up to 6 weeks after surgery ( P = .002; P = .02). The modified Green O’Brien score differed significantly up to 1 year ( P = .002). At 1 year, 93% “excellent” and “good” results in the Green and O’Brien score with a mean QuickDASH of 5.98 ± 10.94, and PRWE score of 4.27 ± 9.23 was observed in the EM group. No differences in respect of loss of reduction, pain, duration of physiotherapy, and sick leave had been detected. Conclusion: Early wrist mobilization after DRFs, stabilized by a volar locking plate (without bone graft), is a save postsurgery treatment and leads to an improved ROM and grip strength up to 6 months after surgery compared with a 5-week immobilization.
Comparative Study of Surgical Treatment of Articular Fractures of the Distal Radius With Volar Locking Screw Plate System in Patients With Workers Compensation
Authors: Bernal Nazira , Cifras José Luis , Osses Leonardo , Sanhueza Miguel , Valderrama Juan José
Published: September 2016

Background: Distal articular radius fractures occur in general in patients at middle age and who are occupationally active. The objective is to evaluate the usefulness of arthroscopy assistance on the reduction and fixation with volar locking screw system in articular fractures of the distal radius in patients with workers compensation. Materials and methods: Retrospective and descriptive study of 53 patients with a mean age of 47.1 years (20-77 years) who underwent surgery in a period of 1 year. The mean age of the 37 patients in the control group was 46.1 years (20-64 years), and the mean age of the 16 patients in the arthroscopic assistance group was 49.5 years (28-77 years). The patients were matched according to several variables: age, sex, type of fracture (according to the Arbeitsgemeinschaft für Osteosynthesefragen [AO] classification), time between the accident and the surgery, number of reoperations and the time of labor reinsertion (discharge) quantify as days off with medical leave. Results: The groups were comparable because there were no significant differences in the variables studied. The mean age of the control group was 46.1 years and the arthroscopy group was 49.5 years ( P = .3396, Student t test). Sex of control group was 22 males (59.5%) and 15 females (40.5%), and the arthroscopic group was 11 males (68.75%) and 5 females (31.25%), P =.522 (chi-square test). The type of fracture was B1-B2-C1-C2 and C-3. The arthroscopic group was type C1-C2-C3 ( P = .738, chi-square test). The time to surgery in control group was 11.9 days and in the arthroscopic group 12.1 days ( P = .9271, Student t test). Significant differences were shown in the time of labor reinsertion and in the numbers of reoperations. Time of labor reinsertion in the control group was 188.3 days (5.5 months) and in the arthroscopic group was 89.8 days (2.9 months), P = .00025, Student t test. The number of reoperations in the control groups was 13 (35.14%) and in the arthroscopic group was 1 (6.25%), P = .000, chi-square test. Conclusion: Patients with articular distal radius fractures with workers compensation treated with a volar locking screw plate system and arthroscopic assistance show less number of reoperation and less time to labor reinsertion compared with patients who underwent the same surgery without arthroscopic assistance.
Treatment of Distal Radius Metaphyseal Comminution Fracture by Volar Locking Plate Fixation
Authors: Je Kang Hong , Hyun Lee Sung , Woong Choi Ji , Hee Kim Dong
Published: September 2016

Objective: The pronator quadratus (PQ) has important functions such as pronation and robust blood supply of metaphysis. However, PQ repair is difficult when using conventional approach, which is necessary to release PQ for volar plate fixation of distal radius fracture. In addition, anatomical reduction is difficult in patients with distal radius metaphyseal comminution fracture. Therefore, the purpose of this study is to compare the results of volar locking plate fixation using PQ sparing technique and conventional volar approach technique for patients with distal radius metaphyseal comminution fracture. Materials and Methods: In total, 30 patients treated with volar locking plate using PQ sparing approach were compared with 29 patients using conventional approach in distal radius metaphyseal comminution fracture. Mean follow-up periods were 19 and 26 months each. Postoperative clinical evaluation was performed with wrist range of motions, pronation power, and modified Mayo wrist score measured at last follow-up. Radiologic evaluation was performed with mean bone union period and measurement of radial length, radial inclination, and volar tilt at last follow-up. Results: Mean range of motion, pronation power, and modified Mayo wrist score were significantly superior in PQ sparing approach group. Bony union was achieved in all two groups. However, mean bone union period was superior in PQ sparing approach group (8.7 weeks in PQ sparing group vs 12.5 weeks in conventional group). Radial length, radial inclination, and volar tilt did not show significant differences. Conclusion: We propose that a volar locking plate fixation using PQ sparing technique is a more effective treatment method than conventional approach for patients with distal radius metaphyseal comminution fracture.
Treatment of Reducible Unstable Fractures of the Distal Radius
Authors: Neto Jorge Paduan , Belloti João Carlos , dos Santos João Baptista Gomes , de Moraes Vinicius Ynoe , Galopa Flávio , Fernandes Carlos Henrique
Published: September 2016

Objective: In the treatment of unstable fractures of the distal radius, there is no conclusive evidence about the greater effectiveness of the reduction and fixation methods: bloodless external fixation (BEF) or open locked volar plate (LVP). The goal is to determine which of the two methods is most effective. Methods: Eighty patients were enrolled in this randomized clinical trial. The primary endpoint was the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and measurement of pain (Visual Analog Scale [VAS]). The final assessment was given at 12 months postoperatively. Results: In the final evaluation, there was no difference between groups in assessments of the DASH questionnaire (3.71 for the LVP group and 2.72 for the BEF group, P = .58), and pain by VAS (0.84 for the LVP group and 0.53 for the BEF group, P = .39). Treatment with LVP was more effective than one with BEF in early evaluation with 8 weeks to DASH questionnaire (21.82 for the LVP group and 39.88 for the BEF group, P = .0012). In the group treated with LVP, there were 11.7% of complications, and in the group treated with external fixator, 26.3%. There were 3 treatment failures in the group treated with LVP and none in the other group. Conclusions: There were no assessed differences between groups in the final evaluations of the DASH questionnaire and the pain by VAS. In the early 8-week assessment, there was a positive difference to the LVP method.