bluuebunny/crossref_metadata_2025_split huggingface dataset:
Periprosthetic early insufficiency fracture after total knee arthroplasty: a retrospective case series
Authors: Jabalameli Mahmoud , Abedi Majid , Yahyazadeh Hooman , Sobhan Mohammad Reza 
Published: March 2021

Background:
Early periprosthetic insufficiency fracture after total knee arthroplasty (TKA) is a rare, yet serious debilitating condition. Identification of the risk factors predisposing patients to this fracture is crucial to reduce its incidence. We aimed to investigate if patients who experienced early periprosthetic insufficiency fracture after TKA shared any specific characteristics.

Methods:
In a retrospective study, the characteristic features of 17 patients with early periprosthetic insufficiency fracture were reviewed. The index TKA was performed using a medial parapatellar approach and a cemented posterior-stabilized prosthesis. The demographic characteristics of the patients, including body mass index (BMI), preoperative alignment deformity, and postfracture bone mineral density (BMD), were evaluated.

Results:
The study population included 14 women and three men with the mean age of 71.4±7.2 yr. All patients returned with sudden sharp knee pain and inability to walk after the surgery. The mean time from surgery to the diagnosis of fracture was 23±13.3 days. Preoperative varus and valgus deformities were detected in 16 (94.1%) and one (5.9%) patient, respectively. The fracture occurred in the lateral condyle in all patients with varus deformity and the medial condyle in the patient with valgus deformity. All patients were identified with osteoporosis based on the post-fracture BMD evaluation. Thirteen (76.4%) patients were categorized as obese, and four patients as overweight. The size of the femoral condyle was small in the majority of patients.

Conclusions:
Severe knee deformity, osteoporosis, high BMI, and small size of the femoral condyle were the main risk factors of early periprosthetic insufficiency fracture.

Level of Evidence:
Level IV.
Patients’ perceptions of receiving orthopaedic care during a pandemic: a patient survey
Authors: Comadoll Shea , Reams Megan , Only Arthur J. , Cunningham Brian P. 
Published: March 2021

Background:
Coronavirus 2019 (COVID-19) has had a great effect on the health care landscape, including altering the availability and methods of orthopaedic care. There is little information regarding patients’ perceptions of orthopaedic care during the pandemic. This study was designed to assess patient concerns surrounding orthopaedic care and determine what areas can be addressed to optimize orthopaedic care during this pandemic.

Methods:
In the spring of 2020, during this study that was exempt from institutional review board (IRB) approval, a survey designed to evaluate the attitudes and beliefs from healthcare consumers about receiving care during the COVID-19 pandemic was sent to a group of panelists via email.

Results:
Three hundred sixty-six (31%) out of 1,200 individuals completed the survey. The majority of participants expressed they would feel comfortable receiving care in orthopaedic clinics (48% immediately, 36% in 1 to 3 mo) in the immediate or near future. Participants reported they were more comfortable seeking orthopaedic care at an orthopedic urgent care facility (8% not comfortable) versus an emergency room (41% not comfortable). When thinking about receiving care at orthopaedic clinics, participants were most concerned about the risks of getting sick from other patients (18% extremely, 26% very). Seventeen percent of respondents reported that despite having orthopaedic concerns, they delayed seeking care due to COVID-19. One-third of respondents expressed a desire to know what precautions were in place to ensure safety.

Conclusions:
Patients remained interested in receiving orthopaedic care in the midst of a pandemic. As a result, physicians need to ensure that they effectively communicate what safety precautions are in place and what additional infection prevention measures are available.

Level of Evidence:
Level IV.
Outcomes of Patellar Tendon Imbrication With Distal Femoral Extension Osteotomy for Treatment of Crouch Gait
Authors: Hyer Lauren C. , Carpenter Ashley M. , Saraswat Prabhav , Davids Jon R. , Westberry David E. 
Published: March 2021

Background:
Crouch gait is a frequent gait abnormality observed in children with cerebral palsy. Distal femoral extension osteotomy (DFEO) with the tightening of the extensor mechanism is a common treatment strategy to address the pathologic knee flexion contracture and patella alta. The goal of this study was to review the results of a patellar tendon imbrication (PTI) strategy to address quadriceps insufficiency in the setting of children undergoing DFEO.

Methods:
After institutional review board approval, all patients with crouch gait treated at a single institution with DFEO and PTI were identified. Clinical, radiographic, and instrumented gait analysis data were analyzed preoperatively and at 1 year following surgery.

Results:
Twenty-eight patients (54 extremities) with a diagnosis of cerebral palsy and crouch gait were included. Significant improvements were appreciated in the degree of knee flexion contracture, quadriceps strength, knee extensor lag, and popliteal angle (P<0.01). Knee flexion at initial contact and during mid-stance improved significantly (P<0.0001), and knee moments in late stance were significantly reduced (P<0.01). The anterior pelvic tilt, however, significantly increased postoperatively (P<0.0001). Radiographic improvements were seen in the knee flexion angle and patellar station as assessed by the Koshino Sugimoto Index (P<0.0001). Four patients (14.2%) developed a recurrence of knee flexion contracture requiring further intervention.

Conclusions:
PTI is a simplified and safe technique to address quadriceps insufficiency when performing DFEO. The short-term results of patients who underwent DFEO with PTI demonstrated improvements in clinical, radiographic, and gait analysis variables of the knee. Investigating long-term outcomes, comparing techniques, and assessing quality of life measures are important next steps in research.

Level of Evidence:
Level IV—case series.
Open Reduction of Medial Epicondyle Fractures in the Pediatric Population: Supine Versus Prone Position
Authors: Baghdadi Soroush , Weltsch Daniel , Arkader Alexandre , Harwood Kathleen , Lawrence John T.R. 
Published: March 2021

Background:
Operative treatment of medial epicondyle fractures can be performed in either a supine or prone position. In the supine position, fracture visualization is sometimes difficult due to the posterior position of the medial epicondyle. However, the prone position requires extensive patient repositioning but may improve visualization. The purpose of this study was to compare the results and complications between the supine and prone position when treating medial epicondyle fractures.

Methods:
In a retrospective chart review, patients below 18 who underwent open reduction and internal fixation of an acute medial epicondyle fracture from January 2011 to August 2019 were identified. Patients with <2 months follow-up and concomitant fractures were excluded. Surgical variables, outcomes, and complications were recorded and compared between the supine and prone positions.

Results:
Sixteen surgeons treated the 204 patients evaluated in this study. The mean age was 11.7 years. In all, 122 (60%) patients were treated in the supine position, and 82 (40%) in the prone position. The mean time in the room was 113 minutes in the supine group, and 141 minutes in the prone group (P<0.001). Tourniquet time was similar between groups (P=0.4). Displacement of the fracture on the first postoperative x-rays was 2.06 mm for the supine position and 1.1 mm for the prone position (P<0.001). We also found good interobserver and intraobserver reliability for the measurements. Five patients (2.5%) required reoperation due to stiffness, 2 patients due to nonunion, 1 patient due to tardy ulnar nerve palsy, and 53 (26%) had surgical hardware removal. The surgical position was not associated with complications or reoperation.

Conclusions:
While the prone position requires additional time in the operating room, presumably for positioning, the length of the surgical procedure itself does not differ between the 2 positions. Although the trend of the surgeons at our center is towards the prone position, with surgeons that try it usually doing all their subsequent cases that way, both positions provide excellent clinical outcomes with minimal complications.

Level of Evidence:
Therapeutic level III—retrospective cohort study.
Turkish Validity and Reliability Study of Scoliosis Research Society-30 Questionnaire in Adolescent Idiopathic Scoliosis Patients
Authors: Aksekili Mehmet Atif Erol , Demir Pervin , Iyigun Abdullah , Akcaalan Serhat , Korkmazer Selcuk , Tecimel Osman , Senkoylu Alpaslan 
Published: March 2021

Study Design.
Methodological.

Objective.
Turkish validity and reliability study of Scoliosis Research Society-30 (SRS-30) questionnaire.

Summary of Background Data.
SRS-30 is the most current questionnaire of SRS, which is widely used in the evaluation of the treatment of patients with idiopathic scoliosis. There is no validity and reliability study for the Turkish language.

Methods.
All translation and cross-cultural adaptation stages of the SRS-30 English version to Turkish were implemented. SRS-30 Turkish and Short Form-36 questionnaires were administered to 96 patients with adolescent idiopathic scoliosis simultaneously. Two weeks later, the SRS-30-Turkish version was applied again. Internal validity was examined using the Rasch model, and external construct validity (convergent validity) was evaluated with the Spearman rho correlation test. Person Separation Index was used for reliability. The internal consistency was analyzed with Cronbach alpha. For test re-test reliability, intraclass correlation coefficient between the two measurements was calculated.

Results.
As a result of the Rasch analysis, it was observed that the Turkish version of SRS-30 has a multidimensional structure and the disordered threshold problem was observed in some items. Overall fit is provided for each of the four sub-dimensions of SRS-30 Turkish. There was no difference in the functioning of the items in terms of gender and age groups. The lowest Person Separation Index value was obtained with 0.539 in the satisfaction of the treatment sub-dimension. Cronbach alpha values were over 0.70 for all domains. The intraclass correlation coefficient value was found in satisfaction with management dimension (0.463) and above 0.60 in other dimensions.

Conclusion.
It was concluded that the SRS-30 Turkish questionnaire was valid and reliable in evaluating the treatment of patients with adolescent idiopathic scoliosis. Considering the studies related to SRS scales in the literature, especially those applied Rasch analysis, it is seen that the reply categories of the items should be reviewed.

Level of Evidence: 2
Fractional Curve in Adult Spinal Deformity
Authors: Plais Nicolas , Bao Hongda , Lafage Renaud , Kim Han Jo , Gupta Munish , Smith Justin S. , Shaffrey Christopher , Mundis Gregory , Burton Douglas , Ames Christopher , Klineberg Eric , Bess Shay , Hostin Richard A. , Schwab Frank , Lafage Virginie , ISSG  
Published: March 2021

Study Design:
This was a retrospective review of the multicenter adult spine deformity database.

Objective:
The objective of this study was to investigate the role of the fractional curve (FC) on global coronal malalignment.

Summary of Background Data:
Despite being very common, the role of the coronal FC as either a driver or compensation for global coronal malalignment is not well documented

Materials and Methods:
Patients with the following characteristics were extracted from a prospective multicenter database: lumbar/thoracolumbar (TL) major coronal curve >15 degrees, apex at T11–L3, lower end vertebra at L3 or L4, above 45 years old, and FC >5 degrees. In addition to the classic radiographic parameters, baseline analysis included Cobb angle, pelvic obliquity (PO), fractional ratio (fractional Cobb/main Cobb), the sum of PO and FC, as well as the coronal Qiu classification. Curves distribution (TL vs. FC) were compared across the 3 Qui types, and the role of the FC was investigated.

Results:
A total of 404 patients (63 y old, 83.3% female) were included: 43 patients were classified as type B, 120 as type C, and 241 were coronally balanced (type A). Compared with the balanced patients, type C patients had similar major TL Cobb angles but significantly larger fractional Cobb angles (17.5 vs. 22.3 degrees, P<0.001). By opposition, type B patients had significantly larger major TL Cobb angles (49 vs. 41 degrees, P=0.001) but smaller fractional Cobb angles (P<0.001). PO>5 degrees in the same direction as FC was more common in type B patients (20%) than in type C patients (7.5%), which suggests the preferential role of pelvic compensation.

Conclusions:
Our findings challenge the idea that FC is only a compensatory curve below a main lumbar or TL curve. In type B patients, FC acts as a compensation mechanism but fails to maintain coronal alignment despite the presence of PO. In type C patients, however, the lumbosacral FC acts as a primary driver of coronal malalignment.

Level of Evidence:
Level III.
Sphenoid Wing Dysplasia in the Absence of Neurofibromatosis: Diagnosis and Management of a Novel Phenotype
Authors: Zapatero Zachary D. , Kalmar Christopher L. , Kosyk Mychajlo S. , Carlson Anna R. , Bartlett Scott P. 
Published: March 2021

Summary:
Congenital sphenoid wing dysplasia is one of the major diagnostic criteria for neurofibromatosis type 1, and is often considered pathognomonic for the disease. Between 5% and 12% of neurofibromatosis type 1 cases have evidence of sphenoid wing dysplasia. Sequelae of this deficiency include slow expansion of the middle temporal fossa and progressive herniation of the temporal lobe into the orbital cavity, resulting in pulsatile exophthalmos. Herein, we report a patient with greater sphenoid wing agenesis and middle temporal fossa enlargement requiring transcranial orbital reconstruction in the absence of neurofibromatosis. To our knowledge, this represents a novel craniofacial phenotype of sphenoid wing agenesis in the absence of neurofibromatosis previously not described in the literature.
Early Recurrent Carpal Tunnel Syndrome in Patients with Mucopolysaccharidoses
Authors: Park Keon Min , Tai Chau , Rahgozar Paymon 
Published: March 2021

Summary:
Early-onset carpal tunnel syndrome (CTS) is a well-known manifestation of mucopolysaccharidoses (MPS) due to excessive deposition of glycosaminoglycans in soft tissues. Standard treatment has been carpal tunnel release surgery, with the conventional technique of dividing the transverse carpal ligament. With advancement of treatments for MPS, these patients now have a longer life expectancy and are presenting with recurrent CTS. Management of recurrent CTS in these patients is not well studied. Here, we report 2 cases of recurrent CTS in MPS patients after a carpal tunnel release operation. We describe the findings on repeat operations and propose a unique technique for treating CTS in MPS patients to minimize recurrence during the initial CTS surgery. Our method involves resection of a portion of the transverse carpal ligament and use of a hypothenar fat pad flap over the median nerve.
Descemet Membrane Endothelial Keratoplasty in Congenital Hereditary Endothelial Dystrophy: Initial Experiences
Authors: Mittal Vikas , Sehdev Nancy , Mittal Ruchi 
Published: March 2021

Purpose:
To report our early experiences with Descemet membrane endothelial keratoplasty (DMEK) in congenital hereditary endothelial dystrophy (CHED).

Methods:
Retrospective analysis of medical records of eyes with CHED that underwent DMEK between January 1, 2018, and April 30, 2019, and had a minimum of 1-year follow-up.

Results:
Three eyes of 2 CHED patients (a 10-year-old girl and a 22-year-old man) were included. Both had decreased vision and hazy corneas from birth and underwent DMEK during the study period. Surgery was performed by a single surgeon and was uneventful in all 3 eyes. Within 1 month of surgery, the corneal edema cleared, and vision improved significantly. The mean decimal visual acuity improved from 0.15 ± 0.08 (baseline) to 0.33 ± 0.19 at 3 months. The mean central corneal thickness improved from 928 ± 2.3 μm (baseline) to 555.3 ± 25.8 μm at 3 months. The final visual outcome was less in 1 eye because of dense amblyopia. In all 3 eyes, a subtle stromal haze persisted even after resolution of edema. One eye had graft rejection 7 months after surgery because of discontinuation of medications, effectively managed by increasing the frequency of topical steroids.

Conclusions:
DMEK may be a viable option in phakic eyes with CHED.
Distributions of crystalline lens tilt and decentration and associated factors in age-related cataract
Authors: Chen Xiaoyun , Gu Xiaoxun , Wang Wei , Jin Guangming , Wang Lanhua , Zhang Enen , Xu Jingmin , Liu Zhenzhen , Luo Lixia , Liu Yizhi 
Published: March 2021

Purpose:
To investigate the characteristics and factors associated with crystalline lens tilt and decentration measured by CASIA2 anterior segment optical coherence tomography.

Setting:
Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Design:
Cross-sectional study.

Methods:
1097 eyes of 1097 patients who planned to undergo cataract surgery were enrolled. All patients underwent a general ophthalmologic examination. Lens thickness (LT), front curvature radius (FCR), back curvature radius, lens equator diameter (LED), tilt, and decentration of preoperative crystalline lenses were measured by CASIA2. Univariate and multivariate regression analyses were performed to evaluate the relationships between the tilt and decentration of crystalline lens with related factors.

Results:
The natural crystalline lenses showed a mean tilt of 5.16 degrees toward the inferotemporal direction and a mean decentration of 0.22 mm toward the temporal direction. Of the total 1097 eyes, 119 eyes (10.85%) had a tilt greater than 7 degrees, and 89 eyes (8.11%) had a decentration more than 0.4 mm. Multivariate regression analysis showed that larger decentration, thicker LT, shorter axial length (AL), and FCR were associated with greater lens tilt (P < .001, P = .007, P = .006, and P = .003, respectively). In addition, greater tilt, older and thinner LT were correlated with larger decentration (all P < .001).

Conclusions:
Preoperative crystalline lens had a certain degree of tilt and decentration in age-related cataract. The greater tilt of the crystalline lens was, the larger decentration of it was. In addition, AL, FCR, LT, and age also correlated with tilt and decentration.
Age-related changes in crystalline lens tilt and decentration: swept-source OCT study
Authors: Li Zhangliang , Zhu Zehui , Li Xiuyuan , Meng Ziqi , Qu Wenyong , Zhao Yune 
Published: March 2021

Purpose:
To investigate the age-related tilt and decentration of crystalline lenses using a swept-source optical coherence tomography biometer (SS-OCT) (CASIA2, Tomey Corp.).

Setting:
Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.

Design:
Cross-sectional study.

Methods:
The direction and magnitude of the crystalline lens were evaluated in 230 participants with ages ranging from 7 to 90 years using SS-OCT. The participants were divided into 4 age groups, and the differences among the groups were analyzed. Multiple linear regression was used to investigate the main factors influencing crystalline lens tilt and decentration.

Results:
The natural crystalline lens tilted toward the inferotemporal direction with a mean magnitude of 4.3 ± 1.5 degrees (range 0.7 to 8.95 degrees). The mean decentration toward the superotemporal direction was 0.17 ± 0.12 mm (range 0.03 to 1.15 mm). There was mirror symmetry between the right and left eyes. There were statistically significant differences in the crystalline lens tilt and decentration among the age groups. Multiple linear regression showed that changes in crystalline lens tilt depended on angle α (P < .01) and anterior chamber depth (ACD; P = .008), whereas crystalline lens decentration depended on angle κ (P = .003), age (P < .01), and angle α (P = .002).

Conclusions:
Although there was a statistically significant difference in crystalline lens tilt and decentration among age groups, the variation in the crystalline lens position was partially affected by age. The crystalline lens tilt was greater in eyes with wider angle α and shallower ACD, whereas crystalline lens decentration was greater in younger eyes with wider angles κ and α.
A Chart Audit Study of Clozapine Utilization in Early Psychosis
Authors: Leclerc Louis-David , Demers Marie-France , Bardell Andrea , Bilodeau Isabelle , Williams Richard , Tibbo Phil , Roy Marc-André 
Published: March 2021

Abstract

Purpose
This study aimed to document the treatment trajectories and clozapine use in first-episode psychosis patients and to document the underlying reasons for using or not using clozapine in patients not achieving psychosis remission.

Methods
We conducted a retrospective chart audit of patients aged 18 to 30 years having DSM-5 diagnoses of schizophrenia spectrum psychotic disorders treated in 3 Canadian early intervention programs for psychosis. The severity of the patient's illness (using the Clinical Global Impression Severity [CGI-S] scale) and remission of psychosis were rated before and after each antipsychotic trial.

Results
One hundred and forty-seven patients were included in the study. There were 19.7% patients exposed to clozapine after an average of 2.4 antipsychotic trials and a mean delay of 470.8 days. There were 75.9% patients who improved their CGI-S score (mean improvement, 2.5) after the clozapine trial and 62.1% achieved a CGI-S score ≤3. Full remission of psychosis on clozapine was achieved in 69.0% of the patients. Clozapine was successfully used for some patients with a nonadherent profile in our sample (eg, personality disorder, substance use disorder). Although the mean duration of clozapine trials during the observation period was 688.6 days, no patient discontinued clozapine because of adherence issues.

Conclusions
Clozapine use in these early intervention programs were at a rate consistent to what is expected from the literature and allowed a majority of patients to achieve remission of psychosis and to experience a robust improvement of severity of illness.