bluuebunny/crossref_metadata_2025 huggingface dataset:
A 7-Week-Old Boy with Violaceous Patches and Skin Nodules
Authors: Whittington Adam , Kenner-Bell Brandi
Published: February 2014

A 7-week-old boy presented to the pediatric dermatology clinic for evaluation of diffuse blue lesions on the skin. The mother first noticed a bluish lesion on the left thigh at 6 to 7 weeks of age. The child quickly developed several similar lesions and deeper nodules on the head, arms, and trunk. He had a history of ankyloglossia and subsequent uncomplicated repair, as well as a sister with neonatal anemia. He was otherwise well and thriving. Review of systems was unremarkable. His birth involved an uncomplicated delivery, with negative maternal serology. There was no history of maternal infection or recent exposure to infection.

Physical exam revealed a well-appearing, non-dysmorphic, vigorous infant. Skin exam was notable for numerous dusky erythematous and violaceous-blue patches and nodules on the anterior scalp, bilateral arms, legs, face, and trunk — including the diaper area. Lesions ranged in size from 1 to 3 cm. The nodules were firm and non-tender. The remainder of his physical examination was normal without abnormal lymphadenopathy or hepatosplenomegaly noted. No mucosal lesions were noted. A biopsy was performed on a thigh lesion.

To read more and to earn CME credit for reading this article, access the full text by going to
Healio.com/Pediatrics
and searching: doi: 10.3928/00904481-20131223-15.
Improving Access to Care Through the Patient-Centered Medical Home
Authors: North Stephen W. , McElligot James , Douglas Gaye , Martin Amanda
Published: February 2014

School-based health centers (SBHCs) serve an essential role in providing access to high-quality, comprehensive care to underserved children and adolescents in more than 2,000 schools across the United States. SBHCs are an essential component of the health care safety net, and their role in the patient-centered medical home (PCMH) continues to evolve as both collaborating partners and, when fully functioning, independent PCMHs. The American Academy of Pediatrics (AAP) supports the use of SBHCs, citing the proven benefits and exciting potential as justification, but also offers caution and recommends a focus on communication within the community.
1
Traditional “brick and mortar” SBHCs are more likely to be located in urban communities (54.2% urban versus 18.0% rural) and be in schools with more students, allowing for a greater return on investment. Current SBHCs are located in schools with an average population of 997 students. The need for a large school population to help an SBHC approach financial viability excludes children in rural communities who are more likely to attend a school with fewer than 500 students, be poor, and have difficulty accessing health care.
2

The expansion of telehealth technologies allows the creation of solutions to decrease geographic barriers that have limited the growth of SBHCs in rural communities. Telehealth school-based health centers (tSBHCs) that exclusively provide services through telemedicine are operating and developing in communities where geographic barriers and financial challenges have prevented the establishment of brick and mortar SBHCs. TSBHCs are beginning to increase the number and variety of services they provide through the use of telehealth to include behavioral health, nutrition services, and pediatric specialists. Understanding the role of tSBHCs in the growth of the PCMH model is critical for using these tools to continue to improve child and adolescent health.
A 6-Week-Old Boy with Annular Skin Lesions
Authors: Hasbún Trinidad , Chamlin Sarah L.
Published: February 2014

A 6-week-old, otherwise healthy boy presented to the dermatology clinic for evaluation of an eruption involving his scalp, face, and trunk. The truncal lesions had been present for several weeks, and the facial and scalp lesions were noticed 5 days prior to presentation. The eruption was asymptomatic without scratching or discomfort noted by his mother.

Past medical history was remarkable for preterm delivery due to maternal hypertension during pregnancy. The infant was thriving and gaining weight appropriately. There was no family history of cutaneous or autoimmune disease. No one in the family had a recent tinea infection.

On physical exam, he was a well-appearing, vigorous infant. There were multiple erythematous papules and annular plaques involving his left pre-auricular and post-auricular areas, scalp, upper chest, and right abdominal wall (

Figures
1
and
2

). No other cutaneous or mucus membrane lesions were noted. His cardiac, lung, and abdominal exams were normal.

To read more and to earn CME credit for reading this article, access the full text by going to
Healio.com/Pediatrics
and searching: doi: 10.3928/00904481-20131223-08.
Cardiovascular Effects and Enjoyment of Exercise Gaming in Older Adults
Authors: Fachko Michael J. , Xiao Canhau , Bowles Kathryn H. , Robinson Keith M. , Libonati Joseph R.
Published: February 2014

The purpose of this study was to quantify the cardiovascular responses and enjoyment of one trial of electronic exercise gaming (EG) (Nintendo® Wii™ Tennis) in healthy, older adults (mean age = 81 [SD = 4 years]). Findings indicate that 15 minutes of EG moderately increased heart rate (p < 0.001), blood pressure (p < 0.001), and perceived exertion (p < 0.0001) compared to resting levels. This corresponded to achieving 64% of age-predicted maximum heart rate. No differences were observed for the cardiovascular responses to EG between genders, but participants taking beta-blocker drugs showed an attenuated response (p < 0.05). All participants completed EG tennis without excessive fatigue, with 86% of participants enjoying the experience. There were only a few cases of EG-related arrhythmias (n = 2) and post-exercise muscle soreness (n = 3). These results suggest that Nintendo Wii Tennis EG technology represents an enjoyable, moderate intensity physical activity for healthy, older adults. [Journal of Gerontological Nursing, 39(12), 43–54.]

Dr. Fachko is Postdoctoral Fellow, Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Dr. Bowles is Professor and Ralston House Endowed Term Chair in Gerontological Nursing, and Director, Center for Integrative Science in Aging, School of Nursing, and Dr. Robinson is Chief of Rehabilitation, Philadelphia VA Medical Center, and Associate Professor, Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, and Dr. Libonati is Associate Professor and Director, Laboratory of Innovative and Translational Nursing Research, Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania; and Dr. Xiao is Postdoctoral Fellow, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.

The authors have disclosed no potential conflicts of interest, financial or otherwise. The authors acknowledge the Jonas Center for Nursing Excellence for support in providing scholarship funding for the principal investigator (M.J.F.) during his doctoral studies when these data were collected.

Address correspondence to Joseph R. Libonati, PhD, Associate Professor, Director, Laboratory of Innovative and Translational Nursing Research, Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, 135 Claire M. Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104-4217; e-mail:
jlibonat@nursing.upenn.edu.

 Received: August 31, 2012

 Accepted: February 15, 2013

 Posted Online: July 12, 2013
Geriatric Resources in Acute Care Hospitals and Trauma Centers: A Scarce Commodity
Authors: Maxwell Cathy A. , Mion Lorraine C. , Minnick Ann
Published: February 2014

The number of older adults admitted to acute care hospitals with traumatic injury is rising. The purpose of this study was to examine the location of five prominent geriatric resource programs in U.S. acute care hospitals and trauma centers (N = 4,865). As of 2010, 5.8% of all U.S. hospitals had at least one of these programs. Only 8.8% of trauma centers were served by at least one program; the majorities were in level I trauma centers. Slow adoption of geriatric resource programs in hospitals may be due to lack of champions who will advocate for these programs, lack of evidence of their impact on outcomes, or lack of a business plan to support adoption. Future studies should focus on the benefits of geriatric resource programs from patients’ perspectives, as well as from business case and outcomes perspectives. [Journal of Gerontological Nursing, 39(12), 33–42.]

Dr. Maxwell is Postdoctoral Fellow, Dr. Mion is Independence Foundation Professor of Nursing, and Dr. Minnick is Senior Associate Dean for Research, Vanderbilt University School of Nursing, Nashville, Tennessee.

The authors have disclosed no potential conflicts of interest, financial or otherwise. This study was presented in part at the annual meeting of the Gerontological Society of America, October 9–12, 2011, Minneapolis, Minnesota.

Address correspondence to Cathy A. Maxwell, PhD, RN, Postdoctoral Fellow, Vanderbilt University School of Nursing, 461 21st Avenue South, 409 Godchaux Hall, Nashville, TN 37240; e-mail:
cathy.maxwell@vanderbilt.edu.

 Received: October 09, 2012

 Accepted: March 19, 2013

 Posted Online: August 16, 2013
Differences in Assisted Living Staff Perceptions, Experiences, and Attitudes
Authors: Beeber Anna S. , Cohen Lauren W. , Zimmerman Sheryl , Gwyther Lisa P. , Washington Tiffany , Cagle John G. , Reed David
Published: February 2014

Research within residential care/assisted living (RC/AL) settings has shown that the attitudes of personal care (PC) staff toward their organization and its residents and families can affect the quality of resident care. This article describes the perceptions, experiences, and attitudes of PC staff and their supervisors, and considers these data in the context of non-hierarchical staffing patterns—a philosophically expected, yet unproven tenet of RC/AL. Using data collected from 18 RC/AL communities, these analyses compared the characteristics, perceptions, experiences, and attitudes of PC staff (
N
= 250) and supervisors (
N
= 30). Compared to supervisors, PC staff reported greater burden, frustration, depersonalization, hassles, and feeling significantly more controlling of, and less in partnership with, families (
p
< 0.05). Because the PC staff experience is crucial for resident outcomes, more work is needed to create an environment where PC staff are less burdened and have better attitudes toward work and families. [
Journal of Gerontological Nursing, 40
(1), 41–49.]
The Adverse Reactions to Care Scale: Identifying and Measuring Triggers During Transitions in Care
Authors: Anderson Keith A. , Fields Noelle L.
Published: February 2014

Transitions in care tend to be difficult and complicated periods for older adults, families, and staff in long-term care facilities. For some older adults, care activities and care environments in facilities can lead to adverse reactions, such as resisting assistance with care or agitation and anxiety. Unfortunately, current tools do not adequately assess for triggers to such behaviors. In the current study, the 8-item Adverse Reactions to Care (ARC) scale was developed and tested with 89 older adults and their caregivers (
N
= 89). Exploratory factor analysis revealed the ARC scale loaded onto two distinct factors: (a) reactions to care activities and (b) reactions to care environments, with high overall reliability (alpha = 0.84). With additional testing, the ARC scale may be useful for clinicians in long-term care settings and for researchers focused on understanding care transitions for older adults. [
Journal of Gerontological Nursing, 40
(2), 21–25.]
Influence of Cognitive Decline on Sexuality in Individuals With Dementia and Their Caregivers
Authors: Robinson Karen M. , Davis Samantha J.
Published: February 2014

Sexuality is an important element of human life that is strongly influenced by the social environment. People assess themselves and relate their roles to one another in terms of sexuality. More attention must be directed at the sexual needs of individuals with dementia and their caregivers. A myth believed by society is that individuals with dementia are asexual and that sexual desires and needs for connection will wane over time; whereas in reality many couples living with dementia remain sexually active as the disease progresses. The sexual needs of individuals with dementia are similar to those of younger people but might vary in occurrence and expression. An increase or decline in sexual desire is dependent on the level of cognitive impairment. Sexuality in individuals with dementia may be expressed as inappropriate or hypersexual behavior due to disinhibition and forgetting social cues. Although hypersexuality is often less common than other challenging behaviors that can occur in dementia, it affects both the health of the individual with dementia and the health of his or her caregiver. [
Journal of Gerontological Nursing, 39
(11), 30–36.]
The Application of Belmont Report Principles to Policy Development
Authors: Adams David P. , Miles Toni P.
Published: February 2014

Attention to ethical issues is a routine part of medical research. In this article, we propose that health policy development, like research, include a formal review of these issues. Ethical knowledge is a critical component of epistemology and inherent in development of laws and principles of justice. However, we cannot assume that new policies are subject to a formal ethics review. The Belmont Report of 1978 provides a platform for this process. Prior to the Belmont Report, there was no foundation defining this process in medical research. Based on this history, we propose that health care payment policy development include a formal assessment of risks and benefits using an approach that is familiar to all researchers. [Journal of Gerontological Nursing, 39(12), 16–21.]

Dr. Adams is Associate Professor, Department of Health Sciences, Armstrong Atlantic State University, Savannah, and Dr. Miles is Director, Institute of Gerontology, and Professor of Epidemiology, College of Public Health, University of Georgia, Athens, Georgia.

The authors have disclosed no potential conflicts of interest, financial or otherwise. The authors thank Eileen Sullivan-Marx, PhD, RN, FAAN, for review and comment on prior versions of this article.

Address correspondence to Toni P. Miles, MD, PhD, Director, Institute of Gerontology, 255 E. Hancock, Athens, GA 30602-5775; e-mail:
tonimile@uga.edu.

 Posted Online: November 07, 2013
Feasibility and Effects of TAI CHI for the Promotion of Sleep Quality and Quality of Life: A Single-Group Study in a Sample of Older Chinese Individuals in Hong Kong
Authors: Lo Catherine Mei-Han , Lee Paul H.
Published: February 2014

Poor sleep in later life is a global issue that reduces many individuals’ quality of life (QOL). The purpose of this pilot study was to test the feasibility and effects of a simplified tai chi exercise intervention on sleep quality and QOL among Chinese community-dwelling older adults with poor sleep quality. This single-group, descriptive feasibility study included 34 individuals with poor sleep quality who agreed to participate in a 12-week tai chi intervention. Twenty-six individuals completed the program (23.5% dropout rate). Older adults with poor sleep quality who completed the intervention showed significant improvement in the Medical Outcomes Study Short Form-36 mental component and the Pittsburgh Sleep Quality Index global and component scores. The low recruitment and attendance and high dropout rates might be associated with participants’ age, gender, and sleep quality. Further long-term studies are required to examine the potential effects of the tai chi intervention. [
Journal of Gerontological Nursing, 40
(3), 46–52.]
Myasthenia Gravis
Authors: Koch Julie A. , Steele Marlee R. , Koch Logan M.
Published: February 2014

Myasthenia gravis (MG) is a chronic neuromuscular disorder characterized by fluctuating skeletal muscle weakness and fatigue. This rare autoimmune condition can present a diagnostic challenge for the advanced practice nurse (APN). Because of its low incidence in clinical practice and frequently unrecognized symptoms, a delay of 1 to 2 years prior to diagnosis is not uncommon. Recognition of the clinical features is a key component of prompt diagnosis. To avoid delay in treatment, APNs should be aware of variations in MG symptoms and the tools used to confirm a suspected diagnosis. Because patients benefit from the care of neuromuscular specialists, APNs are not expected to be experts within MG treatment. But knowledge of general treatment principles affords the APN an opportunity to collaborate with the neuromuscular specialist to provide care for patients with MG. Using an individual example, this article reviews the experience of an older adult with MG from clinical presentation through treatment. [Journal of Gerontological Nursing, 39(12), 11–15.]

Dr. J. Koch is Assistant Professor, Valparaiso University, Valparaiso, Dr. Steele is Family Nurse Practitioner, Community Healthcare System, Cedar Lake, Indiana; and Mr. L. Koch is PharmD candidate, Drake University, Des Moines, Iowa.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Julie A. Koch, DNP, RN, FNP-BC, Assistant Professor, Valparaiso University College of Nursing, 836 LaPorte Avenue, Valparaiso, IN 46383; e-mail:
Julie.Koch@valpo.edu.

 Received: August 10, 2013

 Accepted: November 04, 2013

 Posted Online: December 02, 2013
The Modified Hospital Elder Life Program: Adapting a Complex Intervention for Feasibility and Scalability in a Surgical Setting
Authors: Chen Cheryl Chia-Hui , Saczynski Jane , Inouye Sharon K.
Published: February 2014

The purpose of this article is to provide the rationale and methods for adapting the Hospital Elder Life Program (HELP). The HELP is a complex intervention that has been shown to reduce rates of delirium and functional decline. However, modification of the program may be required to meet local circumstances and specialized populations. We selected three key elements based on our prior work and the concept of shared risk factors and modified the HELP to include only three shared risk factors (functional, nutritional, and cognitive status) that were targeted by three nursing protocols: early mobilization, oral and nutritional assistance, and orienting communication. These protocols were adapted, refined, and pilot-tested for feasibility and efficacy. We hope by reporting the rationale and protocols for the modified HELP, we will advance the field for others adapting evidence-based, complex nursing interventions. [
Journal of Gerontological Nursing, 40
(5), 16–22.]
Medication Management Roles in Assisted Living
Authors: Sikma Suzanne K. , Young Heather M. , Reinhard Susan C. , Munroe Donna J. , Cartwright Juliana , McKenzie Glenise
Published: February 2014

Residents in assisted living (AL) frequently need assistance with medication management. Rooted in a social model, AL serves people facing increasing health management challenges as they “age in place.” This study explored roles in AL medication management and satisfaction with unlicensed assistive personnel (UAP) as medication aides, a cost-effective staffing approach that is used frequently. The sample included 112 participants representing all parties involved in medication administration (residents, medication aides, administrators, RNs and licensed practical nurses, pharmacists, and primary care providers) in 15 AL settings in four states. Results include description of medication management roles; empirical validation of existing AL nursing professional standards; and satisfaction with the role of UAP as medication aide from all perspectives. Clinical implications include creating a supportive environment for medication aides (i.e., UAPs); the importance of the RN role as facilitator of AL medication management; and the need for collaboration and interprofessional team development across disparate settings. [
Journal of Gerontological Nursing, 40
(6), 42–53.]
Differences in Perceived Autonomy Among American and Japanese Older Adults
Authors: Matsui Miho , Capezuti Elizabeth
Published: February 2014

Perceived autonomy refers to perceived personal self-governance, or rather that a person feels free from external constraint to determine his or her own actions and behaviors. This study examined perceived autonomy among community-dwelling older adults residing in New York City and West Japan. A cross-sectional design was adopted using self-reports from 340 older adults (
n
= 220 Japanese,
n
= 120 Americans) recruited from senior centers. Perceived autonomy was quantified with the Hertz Perceived Enactment of Autonomy Scale (HPEAS), which includes three subscales: voluntariness, individuality, and self-direction. Compared to American respondents, more Japanese respondents were male (67.7% vs. 40.8%), more likely to live with others (78% vs. 25.7%), reported lower perceived autonomy (86.9 vs. 109.5), and scored lower on all three subscales of the HPEAS. Despite significant differences in perceived autonomy, a sociocultural factor such as social support was identified as an important factor for older adults in both groups. [
Journal of Gerontological Nursing, 40
(5), 36–44.]
Management of Partial Traumatic Hemipelvectomy
Authors: Wang Guodong , Zhou Dongsheng , Shen Wun-Jer , Xin Maoyuan , He Jiliang , Li Qinghu , Tan Guoqing
Published: February 2014

Partial traumatic hemipelvectomy is a devastating condition. Although by definition the affected limb is not totally transected from the trunk because of retained soft tissue, the reported mortality rate is actually higher than in complete traumatic hemipelvectomy. Between January 2000 and December 2011, a total of 917 patients were admitted to the authors’ institution for pelvic fracture. Seven of these patients met the criteria for partial traumatic hemipelvectomy. All 7 patients had multiple associated injuries and met the criteria for Baskett class IV hypovolemic shock on arrival at the emergency department. The amount of bleeding was the greatest issue, and control of hemorrhage and rapid blood transfusion were the initial goals. Abdominal aorta balloon occlusion, laparotomy and packing, and pelvic external fixation were useful to control bleeding. Two patients died during the initial resuscitation phase. Angiography (digital subtraction or computed tomographic) was performed in 4 patients but did not provide any treatment-altering information. Limb preservation was attempted in 2 patients; both of these patients eventually required hindquarter amputation. One patient died, and the second patient survived after a difficult postoperative course. The best results were obtained in 3 patients who underwent completion of the hindquarter amputation within 24 hours of trauma. All patients became wheelchair dependent, and no patient was able to return to work. Early completion of hindquarter amputation after hemorrhaging has been controlled is recommended in patients with partial traumatic hemipelvectomy. Angiography did not prove useful in decision making.
Resection Arthroplasty for Mason Type III Radial Head Fractures Yield Good Clinical but Poor Radiological Results in the Long Term
Authors: Yalcinkaya Merter , Bagatur A. Erdem , Erdogan Sinan , Zorer Gazi
Published: February 2014

Long-term clinical and radiographic outcomes of primary resection for Mason type III radial head fractures were evaluated in 13 patients (14 elbows) with a mean age of 38.8 years (range, 20–67 years) at the time of surgery. All patients had isolated radial head fractures without associated injuries. Mean follow-up was 14.7 years (range, 9–26 years). Proximal migration of the radius and the carrying angle were measured, and radiographs were reviewed for degenerative elbow and wrist arthritis and periarticular ossification. Five results were excellent and 9 were good. In 8 cases, the radii had migrated proximally and the carrying angle had increased an average 6.3°; the increases in both ulnar variance and the carrying angle were significant, and a significant negative correlation was found between the carrying angles and the clinical scores. Degenerative changes occurred in 8 elbows and 4 wrists, and periarticular heterotopic ossification was present in 3 elbows. Despite the satisfactory long-term outcomes, radial head resection resulted in proximal migration of the radius and an increase in the carrying angle; in addition, osteoarthritic changes in both elbows and wrists as well as periarticular heterotopic ossification were frequent findings without pronounced functional impairment.
Medial and Lateral Retinaculum Plasty for Congenital Patellar Dislocation due to Small Patella Syndrome
Authors: Wang Cheng-hai , Shu Lei , Ma Long-fei , Zhou Jian-wei , Ji Gang , Wang Fei , Wang Juan
Published: February 2014

The objective of this study was to explore the clinical effect of medial and lateral retinaculum plasty for congenital patellar dislocation due to small patella syndrome. Twelve patients with congenital patellar dislocation due to small patella syndrome treated at the authors’ hospital between January 2005 and February 2010 were enrolled in the study. The study group comprised 4 men (4 knees) and 8 women (8 knees) with an average age of 10.58±6.91 years. All patients underwent medial and lateral retinaculum plasty. Clinical evaluation included the number of patellar redislocations, patellar apprehension sign, Kujala score, subjective questionnaire score, and patella lateral shift and patellar tilt angle measured using a cross-sectional computed tomography scan. All patients were followed up, and the shortest follow-up time was 2 years. Kujala scores improved from 49.20±6.20 preoperatively to 80.10±5.80 postoperatively. Subjective questionnaire scores indicated that the excellent and good rate was 75%. In addition, a significant difference existed in the patellar tilt angle and patella lateral shift between pre- and postoperative results (
P
<.05). Medial and lateral retinaculum plasty for patients with congenital patellar dislocation due to small patella syndrome can be effective to correct the tracking of the patellofemoral joint and improve knee function.
Anterior Versus Posterior Approach for Four-level Cervical Spondylotic Myelopathy
Authors: Lin Dasheng , Zhai Wenliang , Lian Kejian , Kang Liangqi , Ding Zhenqi
Published: February 2014

The purpose of this study was to compare the results of 2 surgical strategies for 4-level cervical spondylotic myelopathy: a hybrid procedure using anterior cervical diskectomy and fusion (ACDF) combined with segmental corpectomy versus posterior laminectomy and fixation. Between 2002 and 2010, fifty-one patients with consecutive 4-level cervical spondylotic myelopathy were treated surgically, with 27 patients undergoing the hybrid procedure and 24 undergoing posterior laminectomy and fixation. Radiologic data were compared between the 2 groups, including cervical curvature and cervical range of motion (ROM) in the sagittal plane. Pre- and postoperative neurological status was evaluated using the Japanese Orthopaedic Association (JOA) scoring system and the Nurick grading system. Mean ROM at last follow-up was not significantly different between the 2 groups (
P
>.05). In the hybrid group, mean JOA score and Nurick grade improved from 9.6±1.4 and 2.74±0.45 respectively, preoperatively, to 13.9±1.3 and 0.86±0.38 respectively, postoperatively. In the fixation group, mean JOA score and Nurick grade improved from 9.4±1.2 and 2.81±0.42 respectively, preoperatively, to 13.1±1.5 and 1.32±0.36 respectively, postoperatively. The JOA scores and Nurick grades at last follow-up were significantly different between the 2 groups (
P
<.05). In patients with preoperative cervical kyphosis, preoperative JOA score and Nurick grade were not significantly different between the 2 groups (
P
>.05); however, JOA scores and Nurick grades at last follow-up showed better improvement in the hybrid group than in the fixation group (
P
<.01). In patients with preoperative cervical lordosis, the preoperative and last follow-up JOA score and Nurick grade were not significantly different between the 2 groups (
P
>.05).
Fifteen-year Survivor of Renal Cell Carcinoma After Metastasectomies for Multiple Bone Metastases
Authors: Kato Satoshi , Murakami Hideki , Takeuchi Akihiko , Demura Satoru , Yoshioka Katsuhito , Kawahara Norio , Tomita Katsuro , Tsuchiya Hiroyuki
Published: February 2014

This article describes a patient with multiple metastases from renal cell carcinoma who survived and maintained an ambulatory status for 15 years with no recurrence in the spine after en bloc resection of solitary spinal metastasis. Skeletal metastasis from renal cell carcinoma is common, second only to lung metastasis. Surgery plays an important role in the treatment of the metastasis because of its resistance to chemotherapy and radiotherapy.

A 60-year-old man had T1N2M1 renal cell carcinoma in the right kidney and synchronous bone metastases at T12 vertebral body and the right humerus. The patient underwent right nephrectomy and en bloc resection of T12 metastasis at the same time using a retroperitoneal approach. He also underwent curetted total excision of metastasis in the right humerus. He underwent radiotherapy and an additional 7 tumor excision surgeries in the right humerus due to repeated tumor recurrences and a pulmonary metastasectomy in the right lung. Thirteen years after initial surgery, he underwent right forequarter amputation due to tumor recurrence and surgical site infection. Fifteen years after initial surgery, he is still alive with no evidence of disease. He has been ambulatory with no tumor recurrence in the spine for 15 years. En bloc resection of solitary spinal metastasis allowed the patient to be ambulatory without recurrence. This contrasts with curetted total excision of bone metastasis in the humerus that resulted in repeated recurrences and surgeries and loss of the arm.
Discoid Medial Meniscus Completely Coalesced With the Anterior Cruciate Ligament
Authors: Joshi Deepak , Jain Vineet , Goyal Ankit , Bahl Vibhu , Chaudhary Deepak
Published: February 2014

Discoid meniscus is an abnormality of the knee in which the meniscus is discoid rather than semilunar in shape. Medial discoid menisci are rare, and no specific associated symptoms suggest this condition. Several medial meniscus anomalies, including discoid variants, have been reported in the literature. This article describes a rare case of medial discoid meniscus completely coalesced with the anterior cruciate ligament (ACL).

A 22-year-old man presented with intermittent right knee pain of 6 months’ duration. Physical examination revealed mild wasting of the quadriceps with medial joint line tenderness but no effusion. Radiographically, hypoplasia of the lateral tibial spine, increased medial joint space, and increased concavity of the medial tibial condyle were noted in both knees. Arthroscopic examination revealed a complete discoid medial meniscus that was contiguous with the ACL. On probing, a horizontal tear in the medial meniscus was noted. A meniscectomy was performed, and deep longitudinal furrows with exposed subchondral bone were noted underlying the posteromedial tibial condyle. At the patient’s 6-month follow-up visit, he had no knee symptoms and had returned to his daily activities, which included jogging.

Discoid medial meniscus is a rare anomaly, and this case represents only the second reported in the literature of discoid medial meniscus completely coalesced with ACL. This case supports the theory that the ACL and menisci can be differentiated from 1 mesenchyme.
Early Experience With the Proximal Femoral Locking Plate
Authors: Floyd Mark W. , France John C. , Hubbard David F.
Published: February 2014

The purpose of this study was to evaluate the failure rate of proximal femoral locking plates after an initial 2 years of use at a Level I trauma center. This retrospective chart review included 13 patients with intertrochanteric or peritrochanteric femoral fractures who underwent open reduction and internal fixation. Average patient age was 47 years (range, 23–80 years); average follow-up was 12.7 months (range, 2 weeks to 23 months). Three (23%) patients experienced catastrophic failure of the implant. The overall revision rate was 46% (6 of 13). One patient experienced avascular necrosis and required a planned total hip arthroplasty. In the appropriate setting, the proximal femoral locking plate can offer stable fixation for fractures involving the proximal femur; however, this series highlights the difficulties associated with treating these injuries, especially in patients with multiple injuries. Care must be taken to avoid varus malalignment and to address metabolic bone dysfunction.
Outcomes in Patients With Minimal Back Pain Undergoing Prophylactic Lumbar Fusion for Iatrogenic Instability
Authors: Baker Abdul A. , Glassman Steven D. , Carreon Leah Y.
Published: February 2014

For most patients undergoing lumbar fusion, back pain is a substantial part of their preoperative symptomatology. Occasionally, there are patients with minimal back pain in whom the extent of decompression required to treat leg symptoms requires a concomitant fusion to prevent postoperative instability. Although these patients may obtain relief of their leg pain, an additional concern is whether they will develop increased back pain after fusion. This study’s primary cohort comprised 1144 patients with complete preoperative and 2-year postoperative data including the Oswestry Disability Index (ODI), Short Form 36 (SF-36), and numeric rating scales (NRS) for back and leg pain. Thirty-nine patients with a preoperative back pain score of 3 or less were identified. Propensity scoring was used to match these patients to patients with moderate back pain (NRS 4–6) and severe back pain (NRS 7–10) based on demographics, baseline health-related quality of life, and surgical characteristics, resulting in 35 patients in each group. Paired
t
tests were used to determine within-group differences, and analysis of variance was used to determine between-group differences. A statistically significant improvement occurred in ODI, SF-36 Physical Component Summary, and NRS leg pain scores from preoperatively to 2 years postoperatively (
P
<.0001) within all groups; and a statistically significant improvement occurred in back pain scores in the moderate and severe back pain groups. No statistically significant change occurred in back pain from preoperatively to 2 years postoperatively (
P
=.528) in the minimal back pain group. Patients undergoing lumbar fusion for predominant leg pain with minimal back pain had acceptable outcomes, with no increase in back pain postoperatively.
Clinical Comparison of THA With a Standard-length or Short Femoral Component
Authors: Christensen Christian P. , Jacobs Cale A.
Published: February 2014

The purposes of this 2-part study were to determine whether reduced distal femoral component geometry allows for routinely larger component sizes to be used and whether clinical or radiographic outcomes differ between total hip arthroplasty (THA) patients treated with either standard-length or short femoral components. Femoral component size and ongrowth surface area were retrospectively compared in a group of bilateral THA patients that had both a standard-length component and a contralateral short component. Then, clinical and radiographic outcomes were compared between matched groups of THA patients that had either a standard-length or short femoral component. The use of the short component resulted in a significantly larger femoral component size being used (
P
=.01), and the potential ongrowth surface area was significantly larger for the short component than for the standard component (median, 36.69 vs 35.55 cm
2
;
P
=.02). In the matched-pairs analysis, no group differences were noted in modified Harris Hip Scores (
P
=.43) or femoral component subsidence (
P
=.35), but there was a significantly greater prevalence of radiolucent lines in Gruen zone 8 with the short component (
P
=.008). The use of a short femoral component was associated with consistently larger component sizes being used, which corresponded with a larger potential ongrowth surface area. Short-term clinical and radiographic outcomes did not differ between standard-length and short femoral components. Studies are necessary to determine whether the increased proximal ongrowth surface area may result in improved long-term fixation or, on the contrary, may increase the risk of periprosthetic fracture.
Proximal Humeral Nonunion Treated With an Intramedullary Tantalum Cylinder
Authors: Georgiadis Gregory M. , Georgiadis Andrew G.
Published: February 2014

Nonunion is uncommon after proximal humerus fracture surgery. There is no agreement about preferred method of treatment. Traditional approaches have included laterally based locking plates, autogenous grafting, and endosteal support to provide improved biomechanical stability. Open reduction and internal fixation (ORIF) of proximal humeral nonunion has been performed with various methods, including blade plates and bone grafting, as well as intramedullary support with autologous or allogenic grafts. Both malunion and nonunion have occurred after ORIF with locking plates. Endosteal support in the form of a fibular allograft incorporated into the locking plate construct can increase mechanical stability in selected cases.

An ideal implant for proximal humeral nonunion provides medial column mechanical support and osteoconductive and osteoinductive properties. Porous intramedullary tantalum metal may play a role in nonunion surgery as an alternative to fibular allograft because of its versatility of use and salutary biological effects. It offers many material advantages for use in nonunion surgery. Tantalum is extensively porous (75%–80%), has a stiffness close to that of native bone, and offers the possibility of being a carrier for osteoinductive materials. It may also be suitable for patients who refuse allograft material. This article describes a 65-year-old woman with recalcitrant proximal humeral nonunion who was successfully treated with revision ORIF with intramedullary tantalum cylinder augmentation with a lateral-based locking plate and autogenous cancellous bone grafting. At 5-year follow-up, she had excellent motion and clinical and radiographic union.
Identical Osteochondritis Dissecans Lesions of the Knee in Sets of Monozygotic Twins
Authors: Gans Itai , Sarkissian Eric J. , Grant Struan F.A. , Ganley Theodore J.
Published: February 2014

Osteochondritis dissecans (OCD) is a focal, idiopathic alteration of subchondral bone structure with the risk for secondary damage to adjacent articular cartilage and the development of premature osteoarthritis. The exact etiology of OCD is unknown, although repetitive microtrauma and vascular insufficiency have been previously described. A genetic predisposition has been suggested, but the existing evidence is sparse. There are multiple case reports of twins and siblings with OCD and a few large family series in the literature, promoting the theory that OCD may have a genetic component to its etiology.

This article describes 2 sets of monozygotic twins presenting concurrently with OCD of their dominant knees, offering further support for a genetic component to the etiology of OCD. Interestingly, in both sets of twins, 1 was left-handed and 1 was right-handed. Both sets of twins had simultaneous presentations and clinical courses, lending support to a genetic element to OCD. The development of the OCD lesion in the dominant knee of each patient suggests an environmental influence, perhaps due to repetitive microtrauma and overuse.

Recently, a genome-wide linkage study identified a prime candidate locus for OCD. However, despite the suggested association, genetic and developmental factors in the development of OCD remain relatively unstudied. The authors believe monozygotic twins provide an excellent clinical opportunity for future examination of the role of familial inheritance in the etiology of OCD.
Pelvic Deformity Secondary to Tensor Fascia Lata Tightness Associated With Desmoid Tumor
Authors: Dhamangaonkar Anoop C. , Joshi Deepak , Goregaonkar Arvind B. , Phalak Mukesh
Published: February 2014

The iliotibial band is a thick, condensed fascia that, when contracted, leads to a hip flexion, abduction, and external rotation contracture in addition to other joint contractures. Iliotibial band tightness occurs secondary to iliotibial band friction syndrome, which commonly occurs at the lateral femoral epicondylar region. However, a proximal cause of iliotibial band/tensor fascia lata friction syndrome leading to a secondary hip contracture is swelling around the hip; this swelling being a desmoid tumor has not been explicitly described in the literature. The authors present a rare case of a hip contracture in a 28-year-old active man who presented with a functionally disabling hip flexion contracture of 20° with further flexion possible up to 130°, a 45° abduction contracture, and a 20° external rotation contracture with further rotation possible up to 40° with a bony hard swelling in the left gluteal region. Ober’s test was positive. Opposite hip and spine examinations were normal. The goals of treatment were to establish the causality between the 2 and to diagnose the etiology of the gluteal mass. Radiographs were normal, with only a pelvic obliquity evident. Magnetic resonance imaging revealed an extra-articular mass abutting the iliac blade. Histopathology confirmed the mass to be a desmoid tumor in the left gluteal region. A wide surgical excision of the mass was performed with negative margins; no postoperative radiotherapy was administered. After rigorous physiotherapy, the hip deformity disappeared at 6 months and there was no evidence of recurrence at 2.5-year follow-up, with the patient able to sit cross-legged and squat.
Using Cement Plugs in Soft Tissue Infection and Osteomyelitis
Authors: Yan Alan Y. , Faro Frances D. , Schon Lew C.
Published: February 2014

Operative foot and ankle osteomyelitis is challenging for orthopedic surgeons because of the area’s unique anatomy, high trauma incidence, local and systemic disease effects, and often limited space. Standard treatment includes aggressive operative debridement with local and systemic antibiotic administration to control infection. Dead space management is critical yet technically demanding. The authors report a modified antibiotic cement bead therapy technique in which antibiotic sticks, minnows, and mushroom-shaped plugs are used to strike a balance between the stability of the load-bearing unit and radical removal of infection to preserve a functional foot. Three cases are presented. [
Orthopedics.
2014; 37(1):32–36.]
Prevention of Arthrofibrosis After Arthroscopic Screw Fixation of Tibial Spine Fracture in Children and Adolescents
Authors: Parikh Shital N. , Myer David , Eismann Emily A.
Published: February 2014

Arthrofibrosis is a major complication of tibial spine fracture treatment in children, potentially resulting in knee pain, quadriceps weakness, altered gait, decreased function, inability to return to sports, and long-term osteoarthritis. Thus, prevention rather than treatment of arthrofibrosis is desirable. The purpose of this study was to evaluate an aggressive postoperative rehabilitation and early intervention approach to prevent permanent arthrofibrosis after tibial spine fracture treatment and to compare epiphyseal and transphyseal screws for fixation.

A consecutive series of 24 patients younger than age 18 with displaced type II and III tibial spine fractures who underwent arthroscopic reduction and screw fixation between 2006 and 2011 were retrospectively reviewed. Final range of motion was compared between patients with epiphyseal (n=12) and transphyseal (n=9) screws. One-third (4 of 12) of patients with epiphyseal screws underwent arthroscopic debridement and screw removal approximately 3 months postoperatively; 3 patients lacked 5° to 15° of extension, 1 experienced pain with extension, and 1 had radiographic evidence of screw pullout, loss of reduction, and resultant malunion. In the transphyseal screw group, 3 patients had 10° loss of extension, and all corrected after arthroscopic debridement and screw removal. The two groups did not significantly differ in time to hardware removal or return to sports or final range of motion. No growth disturbances were identified in patients after transphyseal screw removal.

An aggressive approach of postoperative rehabilitation and early intervention after arthroscopic reduction and screw fixation of tibial spine fractures in children was successful in preventing permanent arthrofibrosis.
Laminar Reclosure After Single Open-door Laminoplasty Using Titanium Miniplates Versus Suture Anchors
Authors: Hu Wei , Shen Xingqin , Sun Tianwei , Zhang Xueli , Cui Zijian , Wan Jun
Published: February 2014

Laminar closure is associated with expansive open-door laminoplasty. Suture anchor fixation and titanium miniplate fixation are used to prevent laminar reclosure. However, few studies have compared the clinical effects of the 2 fixation methods. The authors performed a prospective study of 55 patients with cervical spondylotic myelopathy who underwent single open-door laminoplasty with suture anchor fixation (n=30) or titanium miniplate fixation (n=25) from June 2005 to May 2011. Clinical and radiologic outcomes were evaluated at 1 week and 1 year postoperatively. There were no significant differences between the 2 groups in terms of Japanese Orthopaedic Association (JOA) scores, JOA recovery rates at 1 week postoperatively, and the incidence of C5 palsy. Compared with the suture anchor group, the recovery rate in the titanium miniplate group was significantly higher at 1 year postoperatively, and the incidence of axial symptoms and mean axial symptom scores were significantly lower at 1 week, but not 1 year, postoperatively. Radiologic examination showed no significant differences in the anteroposterior diameter of the spinal cord and the vertebral body-to-spinal cord distance between the 2 groups. At 1 year postoperatively, the opening angle in the suture anchor group was significantly less than that in the titanium miniplate group. Titanium miniplate fixation is more effective than suture anchor fixation in preventing laminar closure, accompanied by a higher JOA recovery rate at 1-year follow-up and a lower incidence of axial symptoms.