bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biomechanical Testing of a Transmetatarsal Base Screw in Lisfranc Injuries
Authors: Fitzpatrick Sean M. , Bologna Matthew , Reynolds Alan W. , Schimoler Patrick J. , Smolinski Anne , Kharlamov Alexander , Westrick Edward , Miller Mark Carl 
Published: May 2020

Objectives:
To compare displacement between the cuneiforms and metatarsals for a typical Lisfranc screw and a transmetatarsal base screw under biomechanical loading.

Methods:
Eight pairs of cadaveric feet (16 total) were evaluated. The Lisfranc ligamentous structures were transected in all specimens. All feet were repaired with screws traversing the first and second tarsometatarsal joints. A Lisfranc screw was placed from the first cuneiform to the second metatarsal in 8 specimens. A transmetatarsal base screw from the first metatarsal to the second metatarsal was placed in the remaining 8 corresponding feet. The repairs were randomized by side. Markers were placed on the dorsum of the midfoot for optical tracking. The feet were mounted into a load frame and loaded on the plantar forefoot to 100, 400, 800, and 1100 N. Displacement was measured and recorded using 3D camera tracking.

Results:
Displacement between the first cuneiform and second metatarsal base was found to be significantly less (P = 0.02) with the transmetatarsal screw than the Lisfranc screw. There were no significant differences between displacements at any other articulations.

Conclusions:
This study demonstrates biomechanical superiority using a modified transmetatarsal base screw compared with the highly used Lisfranc screw for fixation of ligamentous Lisfranc injuries.
Reliability of the Walter Reed Classification for Heterotopic Ossification Severity in Amputees
Authors: Hoyt Benjamin W. , Roach William B. , Lundy Alexander E. , D'Alleyrand Jean-Claude , Forsberg Jonathan A. , Potter Benjamin K. 
Published: May 2020

Objective:
At this time, there is no validated tool for describing heterotopic ossification (HO) severity or measuring efficacy of therapies after amputation. This study aims to validate the Walter Reed classification system for reliable characterization of HO burden in residual limbs.

Design:
Descriptive, Level IV.

Setting:
US Military Trauma Referral Center.

Study Population:
Five orthopaedic surgeon raters with varying experience levels assessed orthogonal radiographs of 100 randomly selected residual upper and lower limbs after combat-related amputation.

Intervention:
A standardized education session on the Walter Reed HO classification system followed by 2 grading sessions, separated by a 2-week waiting period.

Main Outcome Measures:
Scores were analyzed for interobserver and intraobserver reliability using weighted Cohen's kappa, intraclass correlation coefficient, and Krippendorff's alpha for ordinal variables.

Results:
After the waiting period, 89% of HO was rated the same by observers with an intraobserver kappa = 0.83 (95% confidence interval [CI] 0.75–0.92). Interobserver reliability was evaluated using group-wise comparison among observers, resulting in an overall Krippendorff's alpha = 0.78 (95% CI 0.76–0.80). Using intraclass correlation coefficient, interrater consistency was 0.94 (95% CI 0.91–0.96).

Conclusions:
The Walter Reed HO classification system is substantially reliable for use by raters with any level of orthopaedic training. In addition, it is reliable for evaluation of both through bone and disarticulation type amputations in the upper and lower extremities. However, in 11% of cases, a secondary read may vary, suggesting that this system is useful for understanding HO and developing interventions but may benefit from further refinement, including advanced imaging and clinical correlation.
The Fibular Intramedullary Nail Versus Locking Plate and Lag Screw Fixation in the Management of Unstable Elderly Ankle Fractures: A Cadaveric Biomechanical Comparison
Authors: Carter Thomas H. , Wallace Robert , Mackenzie Samuel A. , Oliver William M. , Duckworth Andrew D. , White Timothy O. 
Published: May 2020

Objectives:
To compare the biomechanical failure properties of the fibular intramedullary nail with locking plate and lag screw fixation in the management of unstable elderly distal fibular fractures.

Methods:
Twelve fresh-frozen cadaveric lower limbs (6 matched-pairs) were studied. A simulated OTA/AO 44-B fracture was created, then randomly allocated within each pair to intramedullary nail or locking plate fixation supplemented with an interfragmentary lag screw. The limbs were secured with the foot rigidly held in 20 degrees of supination, loaded to 700N and subjected to progressive external rotation until failure.

Results:
The mean specimen age was 86.5 years (61–97). Mean torque to failure was greater in the intramedullary nail group, but did not reach statistical significance (23.5 N·m vs. 21.6 N·m; P = 0.463). The nail failed at a significantly greater angle of rotation compared with plate fixation (66.5 degrees vs. 53.3 degrees; P = 0.046). There was no significant difference between the groups with respect to construct stiffness (P = 0.673) or energy absorbed (P = 0.075). The locking plate specimens failed through plate and screw construct pull off at the implant-bone interface. In contrast, the intramedullary nail specimens failed at the lateral ligament complex, whereas the fracture-implant construct remained intact.

Conclusion:
Intramedullary nailing and locking plate fixation have similar biomechanical characteristics when tested to failure. The benefits of the minimally invasive surgery offered by the intramedullary nail make it an attractive implant in the management of these patients.
Malunions and Nonunions of the Acromion and Coracoid Proceses: A Comparison of Functional Outcomes Before and After Reconstruction
Authors: Ogunleye Temi D. , Schirmers Joseph , Gilbertson Jeffrey A. , Schroder Lisa K. , Cole Peter A. 
Published: May 2020

Objectives:
To assess surgical and functional outcomes in a cohort of patients having operatively reconstructed scapula process malunions and/or nonunions.

Design:
Retrospective case series.

Setting:
Level I trauma center.

Patients/Participants:
Between 2003 and 2018, we identified 16 patients who presented to our institution with symptoms associated with a nonunion or malunion of closed, displaced fractures of the scapula processes after acute injury mechanisms.

Intervention:
Surgical osteotomy of the malunion or debridement of the nonunion and subsequent reconstruction.

Main Outcome Measurements:
The primary outcome measured included range of motion, strength, and DASH. Return to work was a secondary outcome.

Results:
Among 13 of the 16 (81%) patients with ≥12 months follow-up, the mean follow-up was 34 months (range, 12–112 months). Three patients were lost to follow-up. The mean DASH score improved from 56.4 ± 22.4 preoperatively to 23.4 ± 22.2 postoperatively (P < 0.001). Among the patients with ≥1-year follow-up, range of motion improved from preoperative to final follow-up in abduction (P = 0.020). Among the 15 of 16 patients for whom occupation data are available, 73% either returned to their original occupation (n = 7) or did not due to reasons other than their reconstructive surgery (n = 4). Two postoperative complications occurred including failure of acromion nonunion fixation at 4 months and went on to heal after revision surgery. All reconstructions united without malunion.

Conclusions:
Reconstruction of the scapula process malunion and nonunion is possible, providing restoration of function and symptom relief, with a low complication rate.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Thoracoscopic Vertebral Body Tethering for Adolescent Idiopathic Scoliosis: A Minimum of 2 Years’ Results of 21 Patients
Authors: Pehlivanoglu Tuna , Oltulu Ismail , Ofluoglu Ender , Sarioglu Ender , Altun Guray , Korkmaz Murat , Yildirim Kerem , Aydogan Mehmet 
Published: May 2020

Background:
Anterior vertebral body tethering (VBT) is a growth modulating and fusionless treatment option that is considered as a new promising method for the management of adolescent idiopathic scoliosis (AIS). This prospective cohort study aimed to present the minimum 2-year results of anterior VBT applied to 21 skeletally immature patients with AIS.

Methods:
Twenty-one skeletally immature patients with a diagnosis of AIS were included. A decision to proceed with surgery was established after the detection of curve progression despite the brace (>40 degrees) with a minimum curve flexibility of 30%.

Results:
Patients had an average age of 11.1 and an average follow-up period of 27.4 months. All patients underwent thoracoscopic placement of thoracic screws, from the convex side of curves. An average of 7.1 levels of tethering was undertaken. Average preoperative major thoracic curve magnitudes improved from 48.2 to 16 degrees on the first erect postoperative x-ray, and to 10 degrees at the last follow-up (P<0.001). Immediate postoperatively, 1 case with chylothorax was detected and treated conservatively, and another case with tether breakage was detected at the third postoperative year and replaced thoracoscopically. No other major complication was acquired.

Conclusions:
Anterior VBT as a growth modulating treatment option by allowing the correction of the scoliotic deformity and preserving coronal balance was detected to be a safe and effective option for the surgical treatment of AIS in skeletally immature patients, if applied under strict inclusion criteria. VBT by allowing preservation of spinal segmental motion is yielding promising radiographic results without causing any major complications.

Level of Evidence:
Level IV.
Intramuscular Liposomal Bupivacaine Decreases Length of Stay and Opioid Usage Following Lumbar Spinal Fusion
Authors: Roh Michael S. , Kucher Oksana A. , Shick Kyle M. , Knolhoff Daniel R. , McGarvey Jeremy S. , Peterson Susan C. 
Published: May 2020

Study Design:
A retrospective cohort review.

Objectives:
The objective of this study was to investigate the efficacy of liposomal bupivacaine (LB) in patients undergoing lumbar spinal fusion.

Summary of Background Data:
Historically, posterior spinal fusion has been recognized as a particularly painful surgery. Postoperative pain limits early patient mobilization and discharge, and negatively impacts patient satisfaction. Local infiltration of anesthetic agents combined with postoperative multimodal pain management is common. On the basis of existing data, the liposomal formulation of bupivacaine might play a role in promoting faster recovery during the immediate postoperative period. The purpose of this study was to investigate the potential impact of LB on postoperative opioid requirements, ambulation, and duration of hospital stay, as well as potential health care cost savings.

Materials and Methods:
A historical cohort of adult lumbar spinal fusion patients was retrospectively evaluated, in which 105 patients received nonliposomal anesthetic and 105 received LB. Both groups were managed with a standardized postoperative analgesia regimen. Demographic information, opioid consumption, length of stay, distance ambulated, and total cost of inpatient stay were collected.

Results:
Although there was no difference in the pain scores between the 2 groups, the LB group was associated with significantly lower opioid usage throughout the postoperative period. More patients in the LB group were discharged within 2 days of surgery compared with the control group (88.6% vs. 38.1%, P<0.05). The control group was able to walk for a longer median distances (175 vs. 150 ft, P=0.02) on the first attempt, however, a significantly larger proportion of the LB group walked within the first 12 hours after surgery (61% vs. 3%, P<0.001). Also, LB usage was associated with $218 higher pharmacological cost compared with the control group but an overall $3035 lower cost for the entire hospitalization (P<0.001).

Conclusion:
Adjunctive usage of LB with lumbar fusion surgeries promotes earlier mobility, lower opioid consumption, and shorter length of stay resulting in overall lower health care cost.

Level of Evidence:
Level III.
Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019-Induced Acute Respiratory Distress Syndrome: A Multicenter Descriptive Study*
Authors: Yang Xiao , Cai Shuhan , Luo Yun , Zhu Fangfang , Hu Ming , Zhao Yan , Zheng Ruiqiang , Li Xuyan , Hu Bo , Peng Zhiyong 
Published: May 2020

Objectives:
Severe acute respiratory distress syndrome is complicated with coronavirus disease 2019 and extracorporeal membrane oxygenation support may be necessary in severe cases. This study is to summarize the clinical features, extracorporeal membrane oxygenation characteristics, and outcomes of patients with severe acute respiratory syndrome coronavirus 2 pneumonia received extracorporeal membrane oxygenation.

Design:
Descriptive study from two hospitals.

Setting:
The ICUs from university hospitals.

Patients:
Patients with severe acute respiratory syndrome coronavirus 2 pneumonia received mechanical ventilation, including those underwent extracorporeal membrane oxygenation from Zhongnan Hospital of Wuhan University and Wuhan Pulmonary Hospital from January 8, 2020, to March 31, 2020.

Interventions:
None.

Measurements and Main Results:
Clinical records, laboratory results, ventilator parameters, and extracorporeal membrane oxygenation-related data were abstracted from the medical records. One-hundred twenty-nine critically ill patients with severe acute respiratory syndrome coronavirus 2 pneumonia were admitted to ICU of the two referral hospitals. Fifty-nine patients received mechanical ventilation and 21 of them received extracorporeal membrane oxygenation support (fourteen from Zhongnan hospital and seven from Wuhan pulmonary hospital). Compared to mechanical ventilation patients without extracorporeal membrane oxygenation support, there was a tendency of decline in mortality but with no significant difference (no-extracorporeal membrane oxygenation group 24/38 [63.2%] vs extracorporeal membrane oxygenation group 12/21 [57.1%]; p = 0.782). For those patients with extracorporeal membrane oxygenation, 12 patients died and nine survived by April 7, 2020. Among extracorporeal membrane oxygenation patients, the Paco
2 prior to extracorporeal membrane oxygenation was lower (54.40 mm Hg [29.20–57.50 mm Hg] vs 63.20 mm Hg [55.40–72.12 mm Hg]; p = 0.006), and pH prior to extracorporeal membrane oxygenation was higher (7.38 [7.28–7.48] vs 7.23 [7.16–7.33]; p = 0.023) in survivors than nonsurvivors.

Conclusions:
Extracorporeal membrane oxygenation might be an effective salvage treatment for patients with severe acute respiratory syndrome coronavirus 2 pneumonia associated with severe acute respiratory distress syndrome. Severe Co
2 retention and acidosis prior to extracorporeal membrane oxygenation indicated a poor prognosis.
Rapid Retooling, Acquiring New Skills, and Competencies in the Pandemic Era: Implications and Expectations for Physician Continuing Professional Development
Authors: Price David W. , Campbell Craig M. 
Published: May 2020

Abstract:
The SARS-CoV-2 (COVID 19) pandemic has necessitated changes in health care delivery, including increases in delivery of care through asynchronous or virtual means, and deployment of clinicians in different teams and settings. Physical distancing and redeployment of clinicians has also necessitated changes in health care continuing professional development (CPD). Health care delivery and CPD is unlikely to fully return (in the near term, if at all) to pre-pandemic status. The authors raise questions and opportunities for development and provision of CPD during and after the pandemic
Comparing the performance of air pollution models for nitrogen dioxide and ozone in the context of a multilevel epidemiological analysis
Authors: Butland Barbara K. , Samoli Evangelia , Atkinson Richard W. , Barratt Benjamin , Beevers Sean D. , Kitwiroon Nutthida , Dimakopoulou Konstantina , Rodopoulou Sophia , Schwartz Joel D. , Katsouyanni Klea 
Published: May 2020

Background:
Using modeled air pollutant predictions as exposure variables in epidemiological analyses can produce bias in health effect estimation. We used statistical simulation to estimate these biases and compare different air pollution models for London.

Methods:
Our simulations were based on a sample of 1,000 small geographical areas within London, United Kingdom. “True” pollutant data (daily mean nitrogen dioxide [NO2] and ozone [O3]) were simulated to include spatio-temporal variation and spatial covariance. All-cause mortality and cardiovascular hospital admissions were simulated from “true” pollution data using prespecified effect parameters for short and long-term exposure within a multilevel Poisson model. We compared: land use regression (LUR) models, dispersion models, LUR models including dispersion output as a spline (hybrid1), and generalized additive models combining splines in LUR and dispersion outputs (hybrid2). Validation datasets (model versus fixed-site monitor) were used to define simulation scenarios.

Results:
For the LUR models, bias estimates ranged from −56% to +7% for short-term exposure and −98% to −68% for long-term exposure and for the dispersion models from −33% to −15% and −52% to +0.5%, respectively. Hybrid1 provided little if any additional benefit, but hybrid2 appeared optimal in terms of bias estimates for short-term (−17% to +11%) and long-term (−28% to +11%) exposure and in preserving coverage probability and statistical power.

Conclusions:
Although exposure error can produce substantial negative bias (i.e., towards the null), combining outputs from different air pollution modeling approaches may reduce bias in health effect estimation leading to improved impact evaluation of abatement policies.
Model-Informed Bayesian Estimation Improves the Prediction of Morphine Exposure in Neonates and Infants
Authors: Euteneuer Joshua C. , Mizuno Tomoyuki , Fukuda Tsuyoshi , Zhao Junfang , Setchell Kenneth D. R. , Muglia Louis J. , Vinks Alexander A. 
Published: May 2020

Background:
Pain control in infants is an important clinical concern, with potential long-term adverse neurodevelopmental effects. Intravenous morphine is routinely administered for postoperative pain management; however, its dose–concentration–response relationship in neonates and infants has not been well characterized. Although the current literature provides dosing guidelines for the average infant, it fails to control for the large unexplained variability in morphine clearance and response in individual patients. Bayesian estimation can be used to control for some of this variability. The authors aimed to evaluate morphine pharmacokinetics (PKs) and exposure in critically ill neonates and infants receiving standard-of-care morphine therapy and compare a population-based approach to the model-informed Bayesian techniques.

Methods:
The PKs and exposure of morphine and its active metabolites were evaluated in a prospective opportunistic PK study using 221 discarded blood samples from 57 critically ill neonates and infants in the neonatal intensive care unit. Thereafter, a population-based PK model was compared with a Bayesian adaptive control strategy to predict an individual's PK profile and morphine exposure over time.

Results:
Among the critically ill neonates and infants, morphine clearance showed substantial variability with a 40-fold range (ie, 2.2 to 87.1, mean 23.7 L/h/70 kg). Compared with the observed morphine concentrations, the population-model based predictions had an R2 of 0.13, whereas the model-based Bayesian predictions had an R2 of 0.61.

Conclusions:
Model-informed Bayesian estimation is a better predictor of morphine exposure than PK models alone in critically ill neonates and infants. A large variability was also identified in morphine clearance. A further study is warranted to elucidate the predictive covariates and precision dosing strategies that use morphine concentration and pain scores as feedbacks.
Ten Tips Based on Anatomy and Design to Refine Face and Neck Lift Surgery
Authors: Frey Jordan D. , Zide Barry M. 
Published: May 2020

Background:
Any face/neck lift operation has a natural flow of slower and speedier portions; slower when dissecting under the superficial musculoaponeurotic system and around nerves while faster during opening, undermining, defatting, and closing. Surgeons can maximize efficiency with these simple maneuvers.

Methods:
We introduce and demonstrate ten reproducible surgical techniques based on anatomy, which span aspects of the entire face and neck lift procedure including markings, skin flap elevation, sub-superficial musculoaponeurotic system manipulation, preplatysmal fat management, skin re-draping, and post-operative dressings.

Results:
As examples, altered scissors facilitate “push” undermining, scoops reduce time for fat removal in the neck, a non-inset method for lobule creation, and digital measurements for certain technical maneuvers are discussed. Moreover, a block and tackle method of facial nerve blocks is reviewed which permits local-only face and neck lifting as well as hematoma drainage without patient intolerance.

Conclusions:
Implementation of these surgical techniques in face and neck lift procedures allows the surgeon to potentially decrease operative time and work towards minimizing post-operative edema while attaining aesthetic and natural results.
Establishing Photographic Standards for Facial Transplantation: A Systematic Review of the Literature
Authors: Wolfe Erin M. , Najera-Sweeney Guillermo , Berman Zoe P. , Alfonso Allyson R. , Diep Gustave K. , Ramly Elie P. , Rodriguez Eduardo D. 
Published: May 2020

Background:
Photography provides a means for objective assessment and dissemination of clinical information. The American Society of Plastic Surgeons (ASPS) and Plastic Surgery Foundation (PSF) published photography guidelines in 2006 to optimize its clinical use. However, photographic documentation of outcomes in facial transplantation (FT) continues to lack standardization. We therefore appraised the current state of FT photography in the peer-reviewed literature.

Methods:
A PubMed search was conducted from July 2005 to July 2019. Studies containing photographs of partial or full FT recipients were included. Non-English language articles, cadaveric and animal studies, technique papers, and case reports were excluded. Data were extracted from 91 articles. Adherence rates were calculated to determine whether published FT photographs followed ASPS/PSF guidelines. Proposed photographic standards particular to FT were then formulated to guide standardization of practice.

Results:
Only 28.6% (26/91) of articles adhered to the photographic conventions of preparation, positioning, and views. Of 162 patient appearances in the 91 articles, 95% (154/162) met the criteria for preparation, 98.8% (160/162) met the criteria for positioning, but only 24.7% (40/162) met the criteria for views.

Conclusions:
Photographic documentation of FT outcomes in the peer-reviewed literature is limited, with inconsistent adherence to ASPS/PSF guidelines. There is substantial deficiency in provision of alternative views, with the majority of publications only depicting the frontal view. FT photography standards should specifically incorporate alternative views, proper lighting and framing, and elimination of distractions, and accommodate for remote patient self-photography. This will promote a transparent and consistent longitudinal evaluation of the surgical results.