bluuebunny/crossref_metadata_2025_split huggingface dataset:
FAT EMBOLISM SYNDROME
Authors: Johnson Michael J , Lucas George L 
Published: April 2021

ABSTRACT
Since it was initially described, fat embolism syndrome (FES) has remained one of the least clearly understood complications of trauma. This article is a review of the classic and current literature on FES with regard to its causes, pathophysiology, clinical presentation, diagnosis, and treatment. FES is associated with many traumatic and nontraumatic conditions, but is most commonly associated with fractures of long bones of the lower extremity. The pathophysiology is thought to be a cascade of events which can lead to adult respiratory distress syndrome (ARDS). Signs and symptoms of clinical FES usually begin within 24 to 48 hours after trauma. The classic triad involves pulmonary changes, cerebral dysfunction, and petechial rash. Clinical diagnosis is key because laboratory and roentgenographic diagnosis is not specific. Treatment consists of careful initial handling, early stabilization of fractures, careful volume replacement, analgesia, respiratory support, and perhaps steroids. The vast majority of patients today survive FES without sequelae.
THE MINIARTHROTOMY TECHNIQUE OF ANKLE ARTHRODESIS: A CADAVER STUDY OF OPERATIVE VASCULAR COMPROMISE AND EARLY CLINICAL RESULTS
Authors: Miller Stuart D , Paremain Guy P , Myerson Mark S 
Published: April 2021

ABSTRACT
We present a two-part study of the miniarthrotomy ankle fusion technique for minimally deformed joints: a laboratory investigation of ankle vascularity and a clinical review of the early results. In the laboratory portion, five pairs of cadaver legs were injected with radiographic dye, after which arthrodesis was performed via either the open technique (one leg of each pair) or the miniarthrotomy technique (the contralateral leg of each pair). Two legs in the open arthrodesis group had disruption of the peroneal arterial circulation, but no disruption was identified in the miniarthrotomy group. In the clinical portion of the study, we reviewed the results of 32 patients who had undergone ankle fusion via the miniarthrotomy technique. One patient had a nonunion and two patients had delayed union. The average time to union for the 31 patients was 8 weeks (range: 6 to 22). These results compare favorably to the arthroscopically assisted method of fusion and offers another choice for arthrodesis of minimally deformed ankles. We concluded that with minimal disruption, there is less likelihood of arterial injury and devascularization, which may indirectly have a positive effect on the rate of ankle arthrodesis.
Vascularized Fibular Grafting Compared With Core Decompression in the Treatment of Femoral Head Osteonecrosis
Authors: Kane Steve M , Ward W Alan , Jordan Linda C , Guilford W Bonner , Hanley Edward N 
Published: April 2021

ABSTRACT
A prospective study was undertaken to compare vascularized fibular grafting (VFG) with core decompression for Ficat Grade II and III femoral head osteonecrosis. The study group included 39 hips in 34 patients-20 VFGs and 19 core decompressions. Independent evaluation of results was performed by an orthopedic surgeon and a radiologist at a minimum of 2 years postoperatively (range: 2 to 5 years). Disease extent was assessed by Ficat radiographic gradings. VFGs failed (conversion to total hip arthroplasty for functionally incapacitating pain) at a rate of 20%, significantly lower than the 58% failure rate of core decompressions (P = .025). Complications included 2 proximal femur fractures in each group, ankle pain in 6 VFGs, and graft vessel thrombosis in 1 VFG. Vascularized fibular grafting appears superior to core decompression in prolonging hip joint survivorship for Ficat Grades II and III femoral head osteonecrosis.
Early Outcome of Total Hip Arthroplasty Using the Direct Lateral vs the Posterior Surgical Approach
Authors: Barber Thomas C , Roger Douglas B , Goodman Stuart B , Schurman David J 
Published: April 2021

ABSTRACT
A consecutive series of 49 patients who had a primary total hip arthroplasty (THA) for osteoarthritis is reviewed to determine the differences in clinical outcome between the direct lateral and the posterior surgical approaches to the hip. Group 1 comprised 28 patients who had THA by the same surgeon using a posterolateral approach. Group 2 comprised 21 patients who had THA using the direct lateral approach, modified from Hardinge. The improvement in the limp, abductor strength, Trendelenburg test, and range of motion over time was similar in the two groups. The average Harris hip score at 1 year was 90 for Group 1 (posterior approach) and Group 2 (lateral approach). At 2-year minimum follow up, the Harris hip score was 94 for both groups. Radiographic review showed that the incidence and severity of heterotopic bone was also similar for both groups. The authors conclude that the clinical and radiographic outcome for THA using the posterior and the lateral approaches to the hip yield similar clinical results.
An Open-Label, Randomized Study to Compare the Safety and Efficacy of Perioperative Epoetin alfa With Preoperative Autologous Blood Donation in Total Joint Arthroplasty
Authors: Stowell Christopher P , Chandler Hugh , Jové Maurice , Guilfoyle Mary , Wacholtz Mary C 
Published: April 2021

ABSTRACT
A multicenter, randomized, open-label, parallel-group study was conducted to compare the safety and efficacy of perioperative recombinant human erythropoietin (Epoetin alfa) with the safety and efficacy of preoperative autologous donation (PAD) in total joint arthroplasty. A total of 490 patients scheduled for total joint (i.e., hip or knee) surgery and having hemoglobin (Hb) levelss ≥ 11 to ≤ 13 g/dL were randomized to receive weekly doses of subcutaneous Epoetin alfa on preoperative Days -21, -14, and -7, and on the day of surgery, or to participate in a PAD program. The mean baseline Hb level in both groups was 12.3 ± 0.6 g/dL, increasing to 13.8 g/dL in the Epoetin alfa-treated group and decreasing to 11.1 g/dL in the PAD group before or on the day of surgery. In the PAD group, 156/219 (71 .2%) patients were transfused with autologous blood, and 42/219 (19.2%) patients were transfused with allogeneic blood. A smaller proportion, 27/209 (12.9%) patients, in the Epoetin alfa-treated group were transfused with allogeneic blood (P = .078 compared with the PAD group). Moreover, patients in the PAD group received a total of 325 units of blood (79 allogeneic units and 246 autologous units) compared with patients in the Epoetin alfa group who received a total of 54 units of blood. The mean postoperative Hb level was 11.0 g/dL in the Epoetin alfa-treated group and 9.2 g/dL in the PAD group. Compared with the PAD arm, mean Hb levels measured preoperatively, postoperatively on Day 1, and at discharge visits were significantly greater in the Epoetin alfa-treated arm (P < .0001).
Assessment of Postoperative Vigor in Patients Undergoing Elective Total Joint Arthroplasty: A Concise Patient- and Caregiver-Based Instrument
Authors: Keating E Michael , Ranawat Chitranjan S , Cats-Baril William 
Published: April 2021

ABSTRACT
Assessment of early postoperative recuperative power (i.e., vigor and functional ability) in surgery patients is considered to be important for optimizing patient rehabilitation, discharge planning, and health system resource utilization. However, no broadly accepted method of patient assessment has been available to measure these parameters. Therefore, a panel of experts was assembled to design an instrument to assess recuperative power in the total joint arthroplasty setting. The instrument consists of both subjective, patient-based, preoperative and postoperative, fixedended questions and objective, caregiver-based measures of patient function (i.e., muscle strength and hematocrit [HCT]). The prototype instrument employed the vitality subscale of the Short Form-36 (SF-36), the activities of daily living items from the Western Ontario and McMaster University Osteoarthritis Index (WOMAC-ADL), as well as three novel scales: Well-being, Ready to resume activities, and Ready to leave the hospital. The instrument was tested in 65 patients at two medical centers. The reliability and validity of the three novel psychometric scales were tested by measuring internal consistency and validity by comparison with the standard scales. Postoperative patient Well-being and Ready scales correlated strongly with muscle strength (P < .01), while postoperative HCT correlated with muscle strength (r = 0.4) and Ready scale (P < .01 ). This analysis suggested that patient well-being and readiness to resume normal activities may be the best surrogates of patient vigor and that these parametric assessments correlate well with functional and laboratory measures of vigor (i.e., muscle strength and HCT). Based on these findings, the final instrument (Version 4.2) consists of a patient questionnaire that can be completed within approximately 5 minutes (12 preoperative and 14 postoperative questions), and a caregiver questionnaire that includes two objective functional tests: muscle strength and HCT. In conclusion, postoperative vigor may be able to be assessed with a concise, patient-based instrument and may provide valuable information for rehabilitation and discharge planning. The utility of this instrument is currently being assessed in a prospective clinical study.
Migration of the Uncemented CLS Acetabular Component
Authors: Davies M S , Parker B C , Ward D A , Hern E , Hua J , Walker P S 
Published: April 2021

ABSTRACT
The migration of uncemented press-fit CLS (Cementless Total Hip Replacement System) acetabular cups was measured retrospectively from standard anteroposterior pelvic radiographs using a digitizer and software specifically developed for this study. A radiographic and clinical review also were undertaken. There were 96 patients in the study group. The mean follow-up for radiographic review was 2.23 years, and the mean foilow-up for clinical review was 3 years. Migration was measured in the cranial and medial directions.
Mean migration of the cup at 2 years was 1 .35 mm in the cranial direction and 2.15 mm in the medial direction. Radiographic appearances altered little over the study period. Fifty-five (57.3%) patients demonstrated bone ingrowth onto the prosthesis, predominantly in DeLee and Chamley zone 1. Twenty-one patients demonstrated nonprogressive sclerotic lines; no lucent lines were encountered. Statistical analysis showed a significant correlation between acetabular ingrowth and reduced cup migration in the medial direction (P=.01 1 at 5 years). There was no statistical relationship between migration of the cup and radiographic features or clinical outcome.
The Effect of Varus Tilt on Contact Stresses in Total Knee Arthroplasty: A Biomechanical Study
Authors: Matsuda Shuichi , Whiteside Leo A , White Stephen E 
Published: April 2021

ABSTRACT
The contact stress produced in the tibiofemoral joint from a varus-tilted tibial component was tested in five total knee prostheses. Peak and mean stresses were measured with a digital electronic sensor under compressive load at 15° and 90° flexion. Stresses were measured with the tibial component tilted 0° and 5° in the mediolateral direction. At a 5° tilt, the Advantim, the Miller-Galante II, and the Omnifit prostheses, which have a flat configuration on the femoral and tibial surfaces in the coronal plane, had significantly greater stresses than the LCS and the Prof'ix prostheses, which have tibial and femoral components with matching curved surfaces in the coronal plane. These results suggest that the femoral component surface should have a radius of curvature that matches that of the tibial articular surface in the coronal plane to achieve a large contact area even in varus-valgus tilting.
The Significance of Stem-Cement Loosening of Grit-Blasted Femoral Components
Authors: Schmalzried Thomas P , Zahiri Christopher A , Woolson Steven T 
Published: April 2021

ABSTRACT
This study analyzed 1 5 patients who underwent revision for loosening at the stem-cement interface. The femoral components were from the same manufacturer and had grit-blast roughened surfaces. An apparent radiographic deficiency in the cement mantle was present in at least one zone in 1 3 patients. In 9 of 12 patients with localized osteolysis, the osteolysis developed in a zone with an apparent radiographic cement mantle defect. Loosening occurred due to tension failure of the stem-cement interface followed by axial subsidence and movement into relative retroversion. Motion between the stem and the cement mantle fueled an abrasive wear mechanism between the roughened metal surface and the cement mantle, generating excessive metal and cement particles that gained access to endosteal bone via defects in the cement mantle and resulting in localized osteolysis.
Although the roughened surface played a central role in these failures, it is unlikely the layer of polymethylmethacrylate (precoat) played a role in the mechanism of failure. In some cases, debonding occurred as a result of tension failure of the metal-precoat interface. In others, tension failure occurred within the cement mantle, leaving the precoat and some cement from the mantle on the stems. There was no difference in the mechanism of failure of stems with precoat proximally compared to stems with precoat proximally and distally. One stem had no precoat; findings in this patient were indistinguishable from the others. The significance of debonding depends on the surface roughness of the stem. Debonding carries a poorer prognosis with a rougher stem surface because of abrasive wear with the generation of numerous metal and cement particulates, which can lead to rapid osteolysis if there are cement mantle defects. Stems with a higher metal-cement bond strength may require a higher quality cement mantle for long-term success.
Atrophy of the Multifidus Muscle in Patients With Lumbar Disk Herniation: Histochemical and Electromyographic Study
Authors: Yoshihara Kiyoshi , Nakayama Yoshihito , Fujii Nobuhito , Aoki Takafumi , Ito Hiromoto 
Published: April 2021

Abstract
A histochemical and electromyographic study of the lumbar multifidus muscle in 17 patients with L4-L5 lumbar disk herniation was performed. Electromyography (EMG) was recorded preoperatively with a needle electrode according to Haig's method. Biopsy specimens were obtained intraoperatively from the L5 band of the multifidus muscle on the affected and unaffected sides. Patients with lumbar disk herniation showed atrophy of type 1 and type 2 fibers with structural changes in the multifidus muscle at the involved level. Furthermore, patients with abnormal EMG results had severe muscle atrophy compared with patients with normal EMG results.
Restoration of Large Bone Defects Using a Hard-Setting, Injectable Putty Containing Demineralized Bone Particles Compared to Cancellous Autograft Bone
Authors: Turner Thomas M , Urban Robert M , Hall Deborah J , Cheema N , Lim T-H 
Published: April 2021

Abstract
An injectable, hard-setting, calcium sulfate-based putty containing demineralized bone matrix particles (AlloMatrix II, Wright Medical Technology, Inc, Arlington, Tenn) was compared to autogenous cancellous bone graft to evaluate healing in a canine model. Area fraction of new bone, modulus of elasticity, and compressive strength of new bone were evaluated, as was radiographic and histologic healing. Bilateral defects were created in the proximal humeri, and each defect was implanted with either the putty or autogenous bone according to a randomized schedule. Dogs were euthanized at 6, 13, and 26 weeks. The area fraction, modulus of elasticity, and compressive strength of newly formed bone was not significantly different between the putty and autogenous bone at 6, 13, or 26 weeks. The putty had excellent handling characteristics, was biocompatible, and was as effective as autograft bone in achieving near complete bony restoration of a large, critical-sized defect.
Resorption Evaluation of a Large Bolus of Calcium Sulfate in a Canine Medullary Defect
Authors: Turner Thomas M , Urban Robert M , Gitelis Steven , Haggard Warren O , Richelsoph Kelly 
Published: April 2021

Abstract
New bone formation and resorption of a calcium sulfate bone graft substitute implanted in five canines were evaluated in this study. Healing was assessed radiographically at 2, 6, and 13 weeks. At 13 weeks, the dogs were sacrificed, and the humeri were retrieved. High-resolution contact radiographs of the isolated humeri were obtained and the bones were sectioned for histology. Radiographically, the calcium sulfate appeared to be completely resorbed and replaced by bone at 13 weeks. Histological findings suggest that a residual amount of calcium sulfate remained, which may continue to act as an osteoconductive scaffolding. No adverse inflammatory response was observed.
Proximal/Distal Mismatch: Type A and C Femurs
Authors: Christie Michael , Brinson Martha F 
Published: April 2021

abstract
Femoral deformity in primary total hip arthroplasty can make restoration of joint biomechanics difficult. The S-ROM (DePuy Orthopaedics Inc., Warsaw, lnd) prosthesis' modular design allows for independent matching of diaphyseal and metaphyseal anatomy. Corrective osteotomy may also be performed because the stem achieves both proximal and distal stability, which resists the micromotion and torsional loads that would otherwise prevent ingrowth. Seventy-three hips were reviewed at a minimum of 10 years' follow-up. Osteolysis was common, occurring in 55% of hips, but no osteolysis distal to thé stem/sleeve junction was present. At mean 12 years' follow-up, the stem remains stable and no failures of the modular junction have been reported.
New Tension Band Material for Fixation of Transverse Olecranon Fractures: A Biomechanical Study
Authors: Lalonde James Allen , Rabalais R David , Mansour Alfred , Burger Evalina L , Riemer Barry L , Lu Yun , Baratta Richard V 
Published: April 2021

abstract
This study tested the use of braided polyethylene cable as an option for repairing transverse olecranon fractures. Six cadaveric elbows underwent a transverse olecranon osteotomy followed by fixation with tension band constructs usiag 18-gauge wire and Secure-Strand (US Surgical, North Haven, Conn). Distraction forces up to 450 N were applied to the triceps tendon while measuring fracture displacement with an extensometer. The average maximal fracture gap with the standard AO tension band technique using stainless steel wire was 0.66±0.43 mm, as opposed to 0.68±0.45 mm with braided polyethylene cable. A paired t test indicated no significant difference between the two materials. These results support the feasibility of braided polyethylene cable as an alternative to the standard steel-wire tension band.
Results with Navigated Bicontact Total Hip Arthroplasty
Authors: Lazovic Djordje , Kaib Niels 
Published: April 2021

abstract
The position of the cup is crucial for the overall quality of a total hip arthroplasty. A malpositioning of the cup leads to increased risk of dislocation, wear, and revision. The position of the stem influences leg length and may cause impingement and dislocation. These faults may increase with minimally invasive procedures. From November 2001 to June 2005, 1081 consecutive THA patients were evaluated. Cup navigation resulted in a better alignment and additional improvement when the cup and stem were navigated. In stem navigation, a good control of the leg lengthening and a reliable prediction of the safe range of motion could be seen.
Intraoperative Evaluation of the Anatomical Double-Bundle Anterior Cruciate Ligament Reconstruction With the OrthoPilot Navigation System
Authors: Ishibashi Yasuyuki , Tsuda Eiichi , Tazawa Koji , Sato Hideki , Toh Satoshi 
Published: April 2021

abstract
The purpose of this study was to assess double-bundle anterior cruciate ligament (ACL) reconstruction, which reproduces the anteromedial bundle and posterolateral bundle, using a navigation system. In 32 patients, anteroposterior (AP) displacement and rotation of the tibia were measured before reconstruction and after posterolateral bundle fixation, anteromedial bundle fixation, and double-bundle ACL reconstruction (in posterolateral and anteromedial bundles fixation). The posterolateral bundle has an important role in the extension position, whereas the anteromedial bundle restricts AP displacement from extension to flexion. AP displacement after double-bundle ACL reconstruction was significantly improved compared to AP displacement after posterolateral bundle or anteromedial bundle fixation. Although traditional reconstruction for reproducing the anteromedial bundle is reasonable, double-bundle ACL reconstruction is recommended for improved knee stability.
Computer-Assisted Navigation and Anterior Cruciate Ligament Reconstruction: Accuracy and Outcomes
Authors: Koh Jason 
Published: April 2021

abstract
As many as 175,000 anterior cruciate ligament (ACL) reconstructions are performed annually in the United States at a cost > $1 billion. Estimates of the rate of revision surgery are as high as 10%-20%, potentially resulting in as many as 35,000 revisions a year. In addition, errors that are not obvious at short-term or mid-term follow-up may have significant long-term effects in young patients. Studies have demonstrated that the majority of revisions are related to technical errors, primarily tunnel placement. Computer-aided navigation systems provide enhanced precision in tunnel placement and may reduce the rate of revision surgery. Computer-aided systems can provide valuable data on rotational and translational laxity of the knee.
Clinical Results of Computer-Navigated Anterior Cruciate Ligament Reconstructions
Authors: Valentin Peter , Hofbauer Marcus , Aldrian Silke 
Published: April 2021

abstract
Growing participation in sports activities over recent years has increased the number of anterior cruciate ligaments (ACL) injuries. Thus, more surgeons became active in this field, leading to a high incidence of transplant failure. In the past 2 ½ years, 235 patients were treated through navigated ACL reconstruction with semitendinosus-gracilis tendon (STG) autograft. One hundred patients who returned for the follow-up examinations were evaluated. In all cases without concurring injuries, the clinical outcome was excellent or very good. Postoperative radiological examination showed correct positioning of the EndoButton (Smith and Nephew, Mansfield, Mass.) and the Suture Plate (B. Braun-Aesculap, Tuttlingen, Germany) in all patients. The subjective and objective stability assessment did not show any significant difference to the uninjured opposite side.
Demographic Characteristics of RN and Generic Students: Implications for Curriculum
Authors: Baj Pamela A 
Published: April 2021

ABSTRACT
The overwhelming majority of nurses today continue to be prepared at the diploma or associate degree level despite the call of nursing leadership to make the BSN degree the minimum credential for entry into practice. Substantial numbers of registered nurses return to school for a BSN. The purpose of the study was to compare and contrast certain demographic characteristics of RN students with the generic BSN student enrolled in the same program. All junior and senior baccalaureate nursing students enrolled in California colleges and universities which admit RN students to NLN-accredited generic baccalaureate nursing degree programs comprised the study population. There were 3,421 students in the total designated population available for sampling. Of these, 251 actually participated in the study. Findings and implications for Nursing Educators are discussed within the context of the manuscript.