bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short (175 mm) versus standard (220 mm) length intramedullary nail for trochanteric hip fractures: a randomized trial of 229 patients
Authors: Parker Martyn J. , Cawley Shirley 
Published: February 2020

Aims A lack of supporting clinical studies have been published to determine the ideal length of intramedullary nail in fixation of trochanteric fractures of the hip. Nevertheless, there has been a trend to use shorter intramedullary nails for the internal fixation of trochanteric hip fractures. Our aim was to determine if the length of nail affected the outcome. Methods We randomized 229 patients with a trochanteric hip fracture between two implants: a ‘standard’ nail of 220 mm and a shorter nail of 175 mm, which had decreased proximal angulation (4° vs 7°) and a reduced diameter at the level of the lesser trochanter. Patients were followed up for one year by a nurse blinded to the type of implant used to determine if there were differences in mobility and pain with two nail designs. Pain was assessed on a scale of 1 (none) to 8 (severe and constant) and mobility on a scale of 1 (full mobility) to 9 (immobile). Results The shorter nail did not require any reaming of the femur and was quicker to insert (mean difference 5.1 minutes; p < 0.001, 95% confidence interval (CI) of the difference 3.16 to 7.04). Those treated by the shorter nail were less mobile (mean difference in reduction in mobility score at one year 0.80; p = 0.007, 95% CI 1.38 to 0.22). In addition, there was a trend toward greater residual pain for those treated with the shorter nail, although this was not statistically significant (mean difference in pain score at one year 0.24; p = 0.064, 95% CI -0.01 to 0.49). Conclusion These results suggest that the increasing use of this very short intramedullary nail with its design modification may not be appropriate. Cite this article: Bone Joint J 2020;102-B(3):394–399
Effective treatment of single-stage revision using intra-articular antibiotic infusion for culture-negative prosthetic joint infection
Authors: Ji Baochao , Li Guoqing , Zhang Xiaogang , Wang Yang , Mu Wenbo , Cao Li 
Published: February 2020

Aims In the absence of an identified organism, single-stage revision is contraindicated in prosthetic joint infection (PJI). However, no studies have examined the use of intra-articular antibiotics in combination with single-stage revision in these cases. In this study, we present the results of single-stage revision using intra-articular antibiotic infusion for treating culture-negative (CN) PJI. Methods A retrospective analysis between 2009 and 2016 included 51 patients with CN PJI who underwent single-stage revision using intra-articular antibiotic infusion; these were compared with 192 culture-positive (CP) patients. CN patients were treated according to a protocol including intravenous vancomycin and a direct intra-articular infusion of imipenem and vancomycin alternately used in the morning and afternoon. In the CP patients, pathogen-sensitive intravenous (IV) antibiotics were administered for a mean of 16 days (12 to 21), and for resistant cases, additional intra-articular antibiotics were used. The infection healing rate, Harris Hip Score (HHS), and Hospital for Special Surgery (HSS) knee score were compared between CN and CP groups. Results Of 51 CN patients, 46 (90.2%) required no additional medical treatment for recurrent infection at a mean of 53.2 months (24 to 72) of follow-up. Impaired kidney function occurred in two patients, and one patient had a local skin rash. No significant difference in the infection control rate was observed between CN and CP PJIs (90.2% (46/51) versus 94.3% (181/192); p = 0.297). The HHS of the CN group showed no substantial difference from that of CP cases (79 versus 81; p = 0.359). However, the CN group showed a mean HSS inferior to that of the CP group (76 versus 80; p = 0.027). Conclusion Single-stage revision with direct intra-articular antibiotic infusion can be effective in treating CN PJI, and can achieve an infection control rate similar to that in CP patients. However, in view of systemic toxicity, local adverse reactions, and higher costs, additional strong evidence is needed to verify these treatment regimens. Cite this article: Bone Joint J 2020;102-B(3):336–344
Risk factors for surgery due to rotator cuff disease in a population-based cohort
Authors: Yanik Elizabeth L. , Colditz Graham A. , Wright Rick W. , Saccone Nancy L. , Evanoff Bradley A. , Jain Nitin B. , Dale Ann Marie , Keener Jay D. 
Published: February 2020

Aims Few risk factors for rotator cuff disease (RCD) and corresponding treatment have been firmly established. The aim of this study was to evaluate the relationship between numerous risk factors and the incidence of surgery for RCD in a large cohort. Methods A population-based cohort of people aged between 40 and 69 years in the UK (the UK Biobank) was studied. People who underwent surgery for RCD were identified through a link with NHS inpatient records covering a mean of eight years after enrolment. Multivariate Cox proportional hazards regression was used to calculate hazard ratios (HRs) as estimates of associations with surgery for RCD accounting for confounders. The risk factors which were considered included age, sex, race, education, Townsend deprivation index, body mass index (BMI), occupational demands, and exposure to smoking. Results Of the 421,894 people who were included, 47% were male. The mean age at the time of enrolment was 56 years (40 to 69). A total of 2,156 people were identified who underwent surgery for RCD. Each decade increase in age was associated with a 55% increase in the incidence of RCD surgery (95% confidence interval (CI) 46% to 64%). Male sex, non-white race, lower deprivation score, and higher BMI were significantly associated with a higher risk of surgery for RCD (all p < 0.050). Greater occupational physical demands were significantly associated with higher rates of RCD surgery (HR = 2.1, 1.8, and 1.4 for ‘always’, ‘usually’, and ‘sometimes’ doing heavy manual labour vs ‘never’, all p < 0.001). Former smokers had significantly higher rates of RCD surgery than those who had never smoked (HR 1.23 (95% CI 1.12 to 1.35), p < 0.001), while current smokers had similar rates to those who had never smoked (HR 0.94 (95% CI 0.80 to 1.11)). Among those who had never smoked, the risk of surgery was higher among those with more than one household member who smoked (HR 1.78 (95% CI 1.08 to 2.92)). The risk of RCD surgery was not significantly related to other measurements of secondhand smoking. Conclusion Many factors were independently associated with surgery for RCD, including older age, male sex, higher BMI, lower deprivation score, and higher occupational physical demands. Several of the risk factors which were identified are modifiable, suggesting that the healthcare burden of RCD might be reduced through the pursuit of public health goals, such as reducing obesity and modifying occupational demands. Cite this article: Bone Joint J 2020;102-B(3):352–359
Surgery for femoral metastases
Authors: Tanaka Atsushi , Katagiri Hirohisa , Murata Hideki , Wasa Junji , Miyagi Michihito , Honda Yosuke , Takahashi Mitsuru 
Published: February 2020

AimsThe aim of this study is to evaluate the clinical results of operative intervention for femoral metastases which were selected based on expected survival and to discuss appropriate surgical strategies.MethodsFrom 2002 to 2017, 148 consecutive patients undergoing surgery for femoral metastasis were included in this study. Prognostic risk assessments were performed according to the Katagiri and revised Katagiri scoring system. In general, the low-risk group underwent resection and reconstruction with endoprosthetic replacement (EPR), while the high-risk group underwent internal fixation (IF) and radiation therapy. For the intermediate-risk group, the operative choice depended on the patient’s condition, degree of bone destruction, and radio-sensitivity. Overall survival, local failure, walking ability, and systemic complications were evaluated.ResultsA total of 83 patients underwent EPR (low-risk, 23%; intermediate-risk, 60%; high-risk, 17%) and 65 patients underwent IF (low-risk, 0%; intermediate-risk, 32%; high-risk, 68%). The one-year survival rate was 71% for EPR and 15% for IF (p < 0.001). The one-year local failure-free survival was 93% for EPR and 67% for IF, and the two-year and five-year local failure-free survival for EPR were both 88% (p = 0.016). Although the ambulatory rate was 99% for EPR and 60% for IF, the median time to ambulation was shorter in the IF (EPR, 28 days, interquartile range (IQR) 25 to 35; IF, 23 days, IQR 18 to 28; p < 0.001) The cause of non ambulation was mainly due to progression of cancer (89%). The rate of systemic complications was comparable between the two groups (EPR, 18%; IF, 22%; p = 0.598).ConclusionSelective use of EPR where survival is expected to be good offers correspondingly good long-term results. IF is less invasive with shorter treatment period, which is beneficial for patients with short-term expected survival. Prognosis is an important indicator in selecting operative procedures for femoral metastasis. Cite this article: Bone Joint J 2020;102-B(3):285–292
Factors affecting the outcomes of tibiotalocalcaneal fusion
Authors: Pitts Charles , Alexander Bradley , Washington Joshua , Barranco Hannah , Patel Romil , McGwin Gerald , Shah Ashish B. 
Published: February 2020

Aims Tibiotalocalcaneal (TTC) fusion is used to treat a variety of conditions affecting the ankle and subtalar joint, including osteoarthritis (OA), Charcot arthropathy, avascular necrosis (AVN) of the talus, failed total ankle arthroplasty, and severe deformity. The prevalence of postoperative complications remains high due to the complexity of hindfoot disease seen in these patients. The aim of this study was to analyze the relationship between preoperative conditions and postoperative complications in order to predict the outcome following primary TTC fusion. Methods We retrospectively reviewed the medical records of 101 patients who underwent TTC fusion at the same institution between 2011 and 2019. Risk ratios (RRs) associated with age, sex, diabetes, cardiovascular disease, smoking, preoperative ankle deformity, and the use of bone graft during surgery were related to the postoperative complications. We determined from these data which pre- and perioperative factors significantly affected the outcome. Results Out of the 101 patients included in the study, 29 (28.7%) had nonunion, five (4.9%) required below-knee amputation (BKA), 40 (39.6%) returned to the operating theatre, 16 (15.8%) had hardware failure, and 22 (21.8%) had a postoperative infection. Patients with a preoperative diagnosis of Charcot arthropathy and non-traumatic OA had significantly higher nonunion rates of 44.4% (12 patients) and 39.1% (18 patients) (p = 0.016) and infection rates of 29.6% (eight patients) and 37% (17 patients) compared to patients with traumatic arthritis, respectively (p = 0.002). There was a significantly increased rate of nonunion in diabetic patients (RR 2.22; p = 0.010). Patients with chronic kidney disease were 2.37-times more likely to have a nonunion (p = 0.006). Patients aged over 60 years had more than a three-fold increase in the rate of postoperative infection (RR 3.60; p = 0.006). The use of bone graft appeared to be significantly protective against postoperative infection (p = 0.019). Conclusion We were able to confirm, in the largest series of TTC ankle fusions currently in the literature, that there remains a high rate of complications following this procedure. We found that patients with a Charcot or non-traumatic arthropathy had an increased risk of nonunion and postoperative infection compared to individuals with traumatic arthritis. Those with diabetes, chronic kidney disease, or aged over 60 years had an increased risk of nonunion. These findings help to confirm those of previous studies. Additionally, our study adds to the literature by showing that autologous bone graft may help in decreasing infection rates. These data can be useful to surgeons and patients when considering, discussing and planning TTC fusion. It helps surgeons further understand which patients are at a higher risk for postoperative complications when undergoing TTC fusion. Cite this article: Bone Joint J. 2020;102-B(3):345–351.
Rate and risk factors for wound complications after internal hemipelvectomy
Authors: Ogura Koichi , Boland Patrick J. , Fabbri Nicola , Healey John H. 
Published: February 2020

Aims Although internal hemipelvectomy is associated with a high incidence of morbidity, especially wound complications, few studies have examined rates of wound complications in these patients or have identified factors associated with the consequences. The present study aimed to: 1) determine the rate of wound and other complications requiring surgery after internal hemipelvectomy; and 2) identify factors that affect the rate of wound complications and can be used to stratify patients by risk of wound complications. Methods The medical records of 123 patients undergoing internal hemipelvectomy were retrospectively reviewed, with a focus on both overall complications and wound complications. Logistic regression analyses were performed to examine the association between host, tumour, and surgical factors and rates of postoperative wound complications. Results The overall rate of postoperative complications requiring surgery was 49.6%. Wound complications were observed in 34.1% of patients, hardware-related complications in 13.2%, graft-related complications in 9.1%, and local recurrence in 5.7%. On multivariate analysis, extrapelvic tumour extension (odds ratio (OR) 23.28; 95% confidence interval (CI), 1.97 to 274.67; p = 0.012), both intra- and extrapelvic tumour extension (OR 46.48; 95% CI, 3.50 to 617.77; p = 0.004), blood transfusion ≥ 20 units (OR 50.28; 95% CI, 1.63 to 1550.32; p = 0.025), vascular sacrifice of the internal iliac artery (OR 64.56; 95% CI, 6.33 to 658.43; p < 0.001), and use of a structural allograft (OR, 6.57; 95% CI, 1.70 to 25.34; p = 0.001) were significantly associated with postoperative wound complications. Conclusion Internal hemipelvectomy is associated with high rates of morbidity, especially wound complications. Several host, tumour, and surgical variables are associated with wound complications. The ability to stratify patients by risk of wound complications can help refine surgical and wound-healing planning and may lead to better outcomes in patients undergoing internal hemipelvectomy. Cite this article: Bone Joint J 2020;102-B(3):280–284
Ten techniques for improving navigated spinal surgery
Authors: Cawley Derek , Dhokia Rakesh , Sales James , Darwish Nagy , Molloy Sean 
Published: February 2020

With the identification of literature shortfalls on the techniques employed in intraoperative navigated (ION) spinal surgery, we outline a number of measures which have been synthesised into a coherent operative technique. These include positioning, dissection, management of the reference frame, the grip, the angle of attack, the drill, the template, the pedicle screw, the wire, and navigated intrathecal analgesia. Optimizing techniques to improve accuracy allow an overall reduction of the repetition of the surgical steps with its associated productivity benefits including time, cost, radiation, and safety. Cite this article: Bone Joint J 2020;102-B(3):371–375.
Aristotle on Self-Sufficiency, External Goods, and Contemplation
Authors: Gasser-Wingate Marc 
Published: February 2020

Abstract
Aristotle tells us that contemplation is the most self-sufficient form of virtuous activity: we can contemplate alone, and with minimal resources, while moral virtues like courage require other individuals to be courageous towards, or courageous with. This is hard to square with the rest of his discussion of self-sufficiency in the Ethics: Aristotle doesn‘t generally seek to minimize the number of resources necessary for a flourishing human life, and seems happy to grant that such a life will be self-sufficient despite requiring a lot of external goods. In this paper I develop an interpretation of self-sufficiency as a form of independence from external contributors to our activity, and argue that this interpretation accounts both for Aristotle‘s views on contemplation and for the role self-sufficiency plays in his broader account of human happiness.
Perception and Pluralism: Leibniz’s Theological Derivation of Perception in Connection with Platonism, Rationalism and Substance Monism
Authors: Robert Gastón 
Published: February 2020

AbstractThis article discusses Leibniz’s claim that every substance is endowed with the property of perception in connection with Platonism, rationalism and the problem of substance monism. It is argued that Leibniz’s ascription of perception to every substance relies on his Platonic conception of finite things as imitations of God, in whom there is ‘infinite perception’. Leibniz’s Platonism, however, goes beyond the notion of imitation, including also the emanative causal relation and the logical (i.e. definitional) priority of the absolute over the limited. It is proposed that Leibniz’s endorsement of Platonism, in conjunction with some rationalist elements of his philosophy, implies a monistic conception of particulars as modifications of a single substance. Following some scholars and opposing others, the article offers evidence that Leibniz accepted this implication during the last years of his Paris period. However, it is further argued that it was precisely the idea of perception as a property of every substance that allowed Leibniz to find a way out of monism after that period. More specifically, the article defends the view that what made room for ontological pluralism within Leibniz’s rationalist and Platonic outlook was the idea that perception is the property which constitutes the very being of substances: substancesaretheir perceptions.
The Kantian Capacity for Moral Self-Control: Abstraction at Two Levels
Authors: Vujoševiċ Marijana 
Published: February 2020

AbstractAs a rule, the Kantian capacity for self-control is interpreted as a kind of tool for compelling ourselves to act on the basis of the maxims we have adopted. To the extent that we merely acknowledge its role in following already-adopted maxims, however, we fail to capture the distinctive aspect of moral self-control identified by Kant. In this paper, I propose a fuller account of the Kantian capacity for moral self-control; I do so mainly by analyzing this capacity as our ability to “abstract from” various sensible impressions. This analysis shows that Kant’s conception of moral self-control involves two intimately related levels, which are subject to different criteria. Whereas the first level is connected to our ability to adopt moral maxims and requires that we abstract from all sensible impressions, the second is associated with our ability to follow these maxims and does not necessarily require this radical abstraction.
Legal Contests with Unilateral Delegation
Authors: Park Sung-Hoon , Lee Sanghack 
Published: March 2020

Abstract
We examine a legal contest in which only one litigant hires a delegate who expends his effort on behalf of the litigant. The delegation contract between the litigant and the delegate is either observable or unobservable. Comparing the equilibrium outcomes of the two legal contests, we derive the effect of the observability of the contract. We find that the favorite litigant and his delegate prefer the observable contract to the unobservable one. If the litigant is the underdog, however, there is conflict of interest between the litigant and his delegate as the litigant prefers the observable contract to the unobservable one while his delegate prefers the unobservable contract. We also show that the legal contest with the observable contract incurs more total expenditure than the legal contest with the unobservable contract if the litigant hiring the delegate is the favorite, and vice versa.
Psychotherapist’s empathic responses to client’s troubles telling/feelings talk in psychotherapy: A conversation analysis
Authors: Wu Yijin 
Published: March 2020

Abstract
Using the method of conversation analysis, this study has examined the sequential organization of empathic talk in psychotherapy, analyzed its turn design as well as investigated its variations on turn construction. The empathic sequence can be characterized as a four-part structure: (1) the therapist soliciting troubles/feeling telling from the client; (2) the client’s report on the troubles/feelings talk; (3) the therapist’s empathy, and (4) the client’s response. Moreover, in addition to its unmarked turn construction “empathic talk without prefacing”, this study has found empathic talk takes on other three types of turn construction including so-prefaced empathic talk, particle-prefaced empathic talk and particle(s)+so-prefaced empathic talk. The research findings could reveal the interactional details of empathy in psychotherapy and thus contributes to the understanding of the nature and process of psychotherapy and counselling.
Time, the deer, is in the wood: Chronotopic identities, trajectories of texts and community self-management
Authors: Bartlett Tom 
Published: March 2020

AbstractThis paper opens with a problematisation of the notion ofreal-timein discourse analysis – dissected, as it is, as if time unfolded in a linear and regular procession at the speed of speech. To illustrate this point, the author combines Hasan’s concept of “relevant context” with Bakhtin’s notion of the chronotope to provide an analysis of Sorley MacLean’s poemHallaig, with its deep-rootedness in space and its dissolution of time. The remainder of the paper is dedicated to following the poem’s metamorphoses and trajectory as it intertwines with Bartlett’s own life and family history, creating a layered simultaneity of meanings orienting to multiple semio-historic centres. In this way the author (pers. comm.) “sets out to illustrate in theory, text analysis and (self-)history the trajectories taken by texts as they cross through time and space; their interconnectedness with social systems at different scales; and the manner in which they are revoiced in order to enhance their legitimacy before the diverse audiences they encounter on their migratory paths.” In this process, Bartlett relates his own story to the socioeconomic concerns of the Hebridean island where his father was raised, and to dialogues between local communities and national and external policy-makers – so echoing Denzin’s call (2014.Interpretive Autoethnography (2nd Edition). Los Angeles: Sage: vii) to “develop a methodology that allows us examine how the private troubles of individuals are connected to public issues and to public responses to these troubles”. Bartlett presents his data through a range of legitimation strategies and voicing techniques, creating transgressive texts that question received notions of identity, authorship, legitimacy and authenticity in academia, the portals of power, and the routines of daily life. The current Abstract is one such example. As with the author’s closing caveat on the potential dangers of self-revelation, offered, no doubt, as a flimsy justification for the extensive focus in the paper on his own life as a chronotope, I leave it for the individual reader to decide if Bartlett’s approach is ultimately ludic or simply ludicrous.