bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between musculoskeletal pain with social isolation and loneliness: analysis of the English Longitudinal Study of Ageing
Authors: Smith Toby O , Dainty Jack R , Williamson Esther , Martin Kathryn R 
Published: September 2018

Introduction: Musculoskeletal pain is a prevalent health challenge for all age groups worldwide, but most notably in older adults. Social isolation is the consequence of a decrease in social network size with a reduction in the number of social contacts. Loneliness is the psychological embodiment of social isolation and represents an individual’s perception of dissatisfaction in the quality or quantity of their social contacts. This study aims to determine whether a relationship exists between musculoskeletal pain and social isolation and loneliness. Methods: A cross-sectional analysis of the English Longitudinal Study of Ageing (ELSA) cohort was undertaken. ELSA is a nationally representative sample of the non-institutionalised population of individuals aged 50 years and over based in England. Data were gathered on social isolation through the ELSA Social Isolation Index, loneliness through the University of California, Los Angeles (UCLA) Loneliness Scale and musculoskeletal pain. Data for covariates included physical activity, depression score, socioeconomic status, access to transport and demographic characteristics. Logistic regression analyses were undertaken to determine the relationship between social isolation and loneliness with pain and the additional covariates. Results: A total of 9299 participants were included in the analysis. This included 4125 (44.4%) males, with a mean age of 65.8 years. There was a significant association where social isolation was lower for those in pain (odd ratio (OR): 0.87; 95% confidence intervals (CI): 0.75 to 0.99), whereas the converse occurred for loneliness where this was higher for those in pain (OR: 1.15; 95% CI: 1.01 to 1.31). Age, occupation, physical activity and depression were all associated with increased social isolation and loneliness. Conclusion: People who experience chronic musculoskeletal pain are at greater risk of being lonely, but at less risk of being socially isolated. Health professionals should consider the wider implications of musculoskeletal pain on individuals, to reduce the risk of negative health implications associated with loneliness from impacting on individual’s health and well-being.
Glomus cell tumour on the head of a cat
Authors: Conte Alessandro , Scurrell Emma , Baines Stephen J 
Published: September 2018

Case summary A solitary, sessile, non-ulcerated, freely mobile cutaneous mass approximately 1 cm in diameter on the left temporal region of a 7-year-old neutered female cat was examined. A fine-needle aspirate and wedge biopsy were performed by the referring veterinary surgeon and indicated a neoplasm of uncertain cell lineage. On histopathological examination, the deep dermis contained a discrete, non-encapsulated and vascular neoplasm with morphological and immunophenotypical features typical of a glomus cell tumour. Neoplastic cells were immunopositive for vimentin, muscle actin and smooth muscle actin, and immunonegative for cytokeratin, S100, desmin and von Willebrand factor (factor VIII-related antigen). Relevance and novel information Glomus cell tumours arise from modified smooth muscle cells and are rare in animals, particularly cats. Specific immunohistochemistry is of fundamental importance in the correct diagnosis of these tumours and should be considered for masses when cytology and histology results are inconclusive or uncertain.
Patients’ Use and Perception of Internet-Based Orthopaedic Sports Medicine Resources
Authors: Koenig Scott , Nadarajah Vidushan , Smuda Michael P. , Meredith Sean , Packer Jonathan D. , Henn R. Frank 
Published: September 2018

Background: Current research is sparse regarding how patients with orthopaedic injuries perceive and use internet-based information resources. Hypothesis: The majority of patients use the internet to research their orthopaedic condition and are receptive to guidance from their provider. Study Design: Cross-sectional study. Methods: A total of 213 patients attending a sports medicine clinic on the East Coast of the United States were asked to complete a questionnaire regarding their use of internet-based information. Data from 185 patients were available for analysis. Bivariate and multivariate statistical analyses were used to determine the significance of identified associations. Results: Overall, 54% of patients used the internet to find information about their orthopaedic condition prior to their consultation. A higher percentage of internet users were women ( P = .01), were white ( P = .03), and had internet access at home ( P = .02). Multivariable analysis found home internet access to be the only significant independent factor predictive of patients using internet-based information sources ( P < .01). The majority of patients (61%) were neutral toward orthopaedic information found online, and only 32% of patients trusted the orthopaedic information they found online. The majority of patients (83%) reported they would be receptive to providers’ guidance on which internet resources to use. Conclusion: Only half of patients use the internet to research their orthopaedic condition. Most patients were either neutral toward or did not trust the internet-based information that they found and may forgo internet sources altogether. To help patients avoid misleading information, sports medicine providers should understand how patients are using the internet and guide patients in selecting high-quality, peer-reviewed sources of information. Doing so allows physicians to proactively educate their patients even after the clinic visit.
Surgical Decision Making for Acetabular Labral Tears: An International Perspective
Authors: Herickhoff Paul Kenneth , Safran Marc Raymond 
Published: September 2018

Background: Studies comparing acetabular labral repair with debridement have generally demonstrated better clinical outcomes with repair. However, it is not clear whether hip arthroscopic surgeons agree on the indications for labral repair and debridement, bringing the generalizability of these (and future) studies into question. Purpose: To investigate surgical decision making for acetabular labral tears, with a specific focus on indications for repair or debridement, by performing an international survey of hip arthroscopic surgeons. Study Design: Cross-sectional study. Methods: A total of 35 hip arthroscopic surgeons from around the world were invited to participate in this survey study. Surgeons selected the factors that they consider when deciding to repair or debride acetabular labral tears. For each variable selected, computerized adaptive logic prompted additional questions to better define how that variable affects decision making. Six deidentified intraoperative videos of a variety of labral tears were included to determine the level of agreement between the experts on which labral tears are repairable. Results: The survey response rate was 86%. A majority (77%) of hip arthroscopic surgeons selected the intraoperative appearance of the labrum as the most important factor affecting their decision making. Specific factors affecting surgical decision making included pattern of the labral tear (73% of surgeons), ossification of the labrum (70%), magnetic resonance imaging findings (70%), patient age (63%), activity level (57%), radiographic findings (53%), calcification of the labrum (50%), and thickness of the labrum (47%). Three intraoperative videos had ≥90% agreement for labral repair, while the other 3 had ≤76% agreement. Conclusion: The intraoperative appearance of the labrum is the most important factor affecting surgical decision making. However, different surgeons viewing the same tear arthroscopically may select different treatments. The indications to repair a torn acetabular labrum are highly variable among hip arthroscopic surgeons.
Visits for Nontraumatic Dental Conditions in Ontario’s Health Care System
Authors: Singhal S. , Quiñonez C. , Manson H. 
Published: September 2018

Background: Physicians’ offices and emergency departments (EDs) are not suited for addressing nontraumatic dental conditions (NTDCs); however, significant numbers of people in Canada, including Ontario, visit such settings for their dental complaints. Also, people sometimes visit hospitals for day surgery to get their complicated dental conditions treated. This reflects the inefficient usage of the health care system and gaps in accessing timely dental care. Methods: We assessed trends in the burden of NTDCs in Ontario by estimating the visits made for such conditions to physicians, EDs, and hospitals for day surgery. Aggregate data for years 2001 to 2015 were retrieved from Intellihealth Ontario. Descriptive analysis was conducted to calculate rates of visits as stratified by sex, age groups (0 to 6, 7 to 18, 19 to 64, and ≥65 y), and jurisdictions (public health unit level). Results: On average, 70,274 visits to physicians, 51,861 to EDs, and 13,889 to hospital day surgery are made each year in Ontario for NTDCs, which costs approximately CAN$29 million. Children aged 0 to 6 y visit more than their counterparts. Statistically significant increasing trends for physician and ED visits were observed over the years. Analyses show large variations in rates of visits across public health units, with higher rates in rural communities. Conclusion: A large number of visits for NTDCs, with jurisdictional variations, were consistently made to nondental health care settings in Ontario over the last 15 y. Central- and local-level policy options for optimizing resources and health care system use are required. Knowledge Transfer Statement: The findings of this study will provide oral and general health professionals a comprehensive understanding about the ineffective usage of a health care system for nontraumatic dental conditions. Quantifying the burden and associated dollars spent will promote crucial policy discussions to explore the possible options for providing emergency and essential dental services for all Canadians and possible equitable options to enhance access to dental care for vulnerable populations in Canadian society.
Non-union Rates in Hind and Midfoot Arthrodesis in Current, Ex-, and Non-smokers
Authors: Allport Jack , Ramaskandhan Jayasree , Siddique Malik 
Published: September 2018

Category: Hindfoot Introduction/Purpose: Arthrodesis is a safe and effective treatment for a number of hind and midfoot conditions. However, non-union rates have historically been reported as high as 41%. A number of factors have been identified that increase non-union rates, the most notable and readily modifiable is a patient’s smoking status. Smoking rates in the UK in 2015 were 19.3% for men and 15.3% for women. We have examined the effect of smoking status (current, ex-smokers and non-smokers) on union rates for a large cohort of patients undergoing hind or midfoot arthrodesis. Methods: This is a single surgeon, retrospective cohort study of consecutive cases. The surgeon’s logbook was used to identify patients undergoing any hind and midfoot arthrodesis procedures from January 2010 until September 2016. Revision procedures and charcot arthropathy cases were excluded along with cases with insufficient records available. Demographic data was collected along with: joints involved, surgical implant used, bone grafting, the use of ultrasound bone stimulation (EXOGEN, Bioventus LLC, Durham, USA) therapy, complications and final outcome with regards to union. Patients were divided according to self-reported smoking status at pre-operative assessment; current smokers, ex-smokers and non-smokers. Union outcome was based on clinical notes and included patient symptoms and radiographic evidence. Delayed union was classed as union occurring after 6 months. The effect of smoking status on deep infection rates and the need for EXOGEN therapy was also analysed. Results: 381 joints were included (see image). The smoking prevalence was 14.0% (accounting for 12.3% of joints) and 32.2% ex-smokers (35.4%). The groups were comparable with regards to gender, diabetes status and BMI. Smokers were younger, had less co-morbidities and were less likely to have had multiple joints fused (p<0.05). Non-union rates were statistically higher in current smokers with a relative risk of 5.81 (95% CI 2.54-13.29, P<0.001), there was no statistically significant difference between ex-smokers and non-smokers. Active smokers had higher rates of deep infection (P=0.05) and the need for EXOGEN use (P<0.001). Within the smoking group there was a trend toward slower union (delayed + non-union) with heavier smoking (p=0.054). Conclusion: This large retrospective cohort study confirms previous evidence that smoking has a considerable negative effect on union in arthrodesis (despite other differences between the groups likely to favour union in smokers). A 5.8 relative risk in a modifiable risk factor is extremely high. Arthrodesis surgery should be undertaken with extreme caution in patients who are actively smoking. Our study shows that after cessation of smoking the risk returns to normal, however we have not quantified the time frame. Further research is needed to quantify the necessary time frame for smoking cessation to reduce non-union risk.
Midfoot Strikers Are Different from Forefoot Strikers, but Similar to Rearfoot Strikers
Authors: Davis Irene , Mulloy Francis 
Published: September 2018

Category: Sports Introduction/Purpose: Rearfoot strike (RFS) patterns have an impact transient that is associated with running injuries. These transients are not present in FFS patterns. Midfoot strike (MFS) runners are often grouped with FFS runners in studies as they are both non-heel strike patterns and assumed to be similar. However, this has not been tested. Tibial shock (TS) provides a measure of impacts and can be easily assessed in the field. Therefore, the purpose of this study was to compare TS among differing footstrike patterns measured during a marathon race. We hypothesized that MFS would have greater impacts than FFS, but lower than RFS. We also aimed to examine how impacts vary across speeds. We hypothesized that impacts would increase with speed similarly in RFS, MFS and FFS. Methods: 224 healthy runners (119 M, 105 F; 44.1±10.8 yrs) running the 2016 Boston marathon volunteered for the study. Prior to the race, participants ran on a treadmill to determine their habitual footstrike pattern (169 RFS, 32 MFS, 23 FFS). On race day, they ran the course wearing an accelerometer strapped onto their right medial ankle. For this part of the study, the average of the peak TS recorded between the 5 km and 10 km point of the race. This region was used as it had a flat gradient. The peak TS was recorded for each footstrike and averaged over the 5 km distance. This value was compared between the three footstrike patterns using an ANOVA (p<0.05). A regression analysis was used to determine the interaction of FSP and speed for each FSP using individual marathon runner data points. An ANOVA (p<0.05) was used to assess significance of the regression. Results: TS in FFS runners was significantly less than in MFS (P=0.01) and RFS (P=0.01) runners. (Figure 1, top panel). There was no difference between RFS and MFS (P=0.49). When examining the relationship between TS and speed, a significant positive correlation was noted for RFS (p<0.00). and MFS (p=0.02), but not for FFS (p=0.82) (Figure 1, bottom panel). Conclusion: In contrast to common belief, MFS runners exhibit impacts that are like RFS runners, and both are higher than FFS runners. This suggests that MFS runners should be grouped with RFS runners, and not FFS runners, when assessing impacts. In addition, both RFS and MFS runners exhibited greater impacts as speed increased. However, FFS runners appear to be able to maintain lower impacts at faster speeds. This may be due to greater calf activation, mitigating the effect of increasing speed on impacts. This may offer protection from impact-related injuries in FFS runners.
What Is the Rate of Recurrence of Peroneal Groove Deepening for Subluxation/Dislocation
Authors: Ward Patrick , Anderson Robert , Ellington J. Kent , Davis W. Hodges , Jones Carroll , Cohen Bruce 
Published: September 2018

Category: Sports Introduction/Purpose: Peroneal tendon subluxation is an uncommon, yet well-known, condition that can occur after injury to the lateral ankle. The diagnosis can be difficult and is often missed or delayed. This may lead to recurrent or chronic subluxation or dislocation. Surgical management is often recommended, both in the acute and subacute setting. Multiple different surgical procedures have been described ranging from soft tissue repair to fibular groove deepening procedures. Soft tissue procedures alone may be inadequate to treat this pathology, especially in the case of shallow peroneal grooves. Multiple fibular groove deepening techniques have been described, although the population size in each study has been low. This investigation will evaluate the largest cohort of patients undergoing fibular groove deepening for peroneal subluxation or dislocation. Methods: Forty-four patients (Age 39.3 +/- 15.6, BMI 27.9 +/- 5.9) who underwent fibular groove deepening without concomitant bony procedures were able to return to clinic with a minimum two year follow-up. Demographic and operative data was collected via chart review. A standing CT scan, physical examination and functional outcome data was collected at the time of the office visit. The primary outcome was revision surgery. Secondary outcomes included radiographic findings(depth of groove), physical examination data (subluxation/dislocation, strength, ROM) and functional scores(FAAM). Results: 44 patients who underwent isolated peroneal groove deepening were enrolled. Rate of revision surgery was 3/44. CT scan showed an average depth on the operative side of (4.4 mm +/- 2.6) compared to (0.6 mm +/- 1.9) on the contralateral side. On physical exam 5% had objective subluxation, 2% dislocation, 84% had full strength to eversion. The median dorsiflexion and plantarflexion range of motion was 14 (0,100) and 40 (15,155) degrees, respectively. FAAM scores for ADL and Sports were (88.6% +/- 16.4% and 71.7% +/- 20.5%, respectively). 84% of patients would undergo the operation again. Conclusion: Our results show that peroneal groove deepening has a low recurrence rate but results in decreased strength and modest decreases in plantar flexion. The majority of patients were satisfied and would have the operation again. There was low incidence revision surgery (7%), and postoperative dislocation (2%). This is the first study to our knowledge that looked at postoperative CT scans. We showed that deepening is preserved and in our study increased peroneal groove depth by 3.8 mm on average.
Ankle fracture – correlation of Lauge-Hansen classification and patient reported fracture mechanism
Authors: Boszczyk Andrzej , Rammelt Stefan 
Published: September 2018

Category: Trauma Introduction/Purpose: The genetic Lauge-Hansen classification is considered to provide a link between mechanism of ankle injury and resulting fracture morphology. In this study, we addressed the question of agreement between the mechanism of the fracture as postulated by the Lauge-Hansen classification and mechanism reported by the patient in rotational ankle fractures. Understanding of the actual mechanisms of ankle fracture may guide treatment decisions. Methods: Of 110 screened patients with acute malleolar fractures, 78 were able to provide information on their fracture mechanism and were included in the study. The study group consisted of 43 women and 35 men with a mean age of 47.8 (range 19.5-88.4) years. Patients were asked to describe the direction of deformation with primary question being pronation and supination as demonstrated by the examiner. As hyperplantarflexion and hyperdorsiflexion has been spontaneously reported by the patients, these directions were added to the analysis. Radiographs were analyzed according to Lauge-Hansen classification and compared with fracture mechanisms reported by the patients. Results: The majority (35/78 = 44.8%) of patients reported pronation as their fracture mechanism, 27 (34.6%) patients reported supination, 15 (19.2%) patients reported hyperplantarflexion (3 pure, one combined with pronation and 11 combined with supination), and 1 patient reported hyperdorsiflexion combined with pronation. Radiographs revealed 61 supination-external rotation (79%), 1 supination-adduction (1.3%), 14 pronation-external rotation (18%), 1 pronation-abduction (1.3%) fractures. One x-ray was unclassifiable with the Lauge-Hansen classification. The patient reported mechanisms were in concordance with the mechanism deducted from the x-rays in 49% of cases. Only 17% of patients who recalled a pronation trauma actually had radiographs classified as pronation fractures while 76% of patients who recalled a supination trauma were also radiographically classified as having sustained supination type fractures. Conclusion: The Lauge-Hansen classification should be used with caution for determining the actual mechanism of injury as it was able to predict the patient reported fracture mechanism in less than 50% of cases. A substantial percentage of fractures appearing radiographically as supination type injuries may have been actually produced by a pronation fracture mechanism.