bluuebunny/crossref_metadata_2025_split huggingface dataset:
Seven-Year Outcomes After Hysteroscopic and Laparoscopic Sterilizations
Authors: Mao Jialin , Guiahi Maryam , Chudnoff Scott , Schlegel Peter , Pfeifer Samantha , Sedrakyan Art 
Published: January 2019

OBJECTIVE:
To evaluate 7-year outcomes after hysteroscopic and laparoscopic sterilizations, including subsequent tubal interventions and hysterectomies.

METHODS:
This observational cohort study included women undergoing hysteroscopic and laparoscopic sterilizations in outpatient and ambulatory surgical settings in New York State during 2005–2016. We examined subsequent procedures (tubal ligation or resection, and hysterectomy not related to uterine leiomyomas or gynecologic tumors) after the index procedures. After propensity score matching, we used Kaplan-Meier analysis to obtain estimated risks of subsequent procedures within 7 years of index sterilization procedures, and Cox proportional hazard models to compare the differences between groups.

RESULTS:
We identified 10,143 and 53,206 women who underwent interval hysteroscopic and laparoscopic sterilizations, respectively, in New York State during 2005–2016. The mean age of the cohort was 34.2 years (range 18–80). The propensity score–matched cohort consisted of 10,109 pairs of women. The estimated risk of undergoing an additional tubal ligation or resection within 7 years was higher after hysteroscopic sterilization than it was after laparoscopic sterilization (3.9% vs 1.6%, HR 2.89, 95% CI 2.33–3.57). The difference was most pronounced within the initial year after attempted sterilization (1.5% vs 0.2%; HR 6.39, 95% CI 4.16–9.80). There was no significant difference in the risk of receiving a hysterectomy (0.9% vs 1.2%; HR 0.73, 95% CI 0.53–1.00) between women who underwent hysteroscopic and laparoscopic sterilizations.

CONCLUSION:
Patients undergoing hysteroscopic sterilization have a higher risk of receiving an additional tubal resection or ligation than those undergoing laparoscopic sterilization, particularly within the first year of the index procedure. There is no difference in undergoing a subsequent hysterectomy between the two groups. With limited evidence of outcomes after hysteroscopic sterilization beyond 7 years and existing reports of removals years after initial implantations, continuous monitoring of long-term outcomes for women who received the device is warranted.
Use of Direct-Connect for Remote Speech-Perception Testing in Cochlear Implants
Authors: Sevier Joshua D. , Choi Sangsook , Hughes Michelle L. 
Published: January 2019

Objectives:
Previous research has demonstrated the feasibility of programming cochlear implants (CIs) via telepractice. To effectively use telepractice in a comprehensive manner, all components of a clinical CI visit should be validated using remote technology. Speech-perception testing is important for monitoring outcomes with a CI, but it has yet to be validated for remote service delivery. The objective of this study, therefore, was to evaluate the feasibility of using direct audio input (DAI) as an alternative to traditional sound-booth speech-perception testing for serving people with CIs via telepractice. Specifically, our goal was to determine whether there was a significant difference in speech-perception scores between the remote DAI (telepractice) and the traditional (in-person) sound-booth conditions.

Design:
This study used a prospective, split-half-design to test speech perception in the remote DAI and in-person sound-booth conditions. Thirty-two adults and older children with CIs participated; all had a minimum of 6 months of experience with their device. Speech-perception tests included the consonant–nucleus–consonant (CNC) words, Hearing-in-Noise test (HINT) sentences, and Arizona Biomedical Institute at Arizona State University (AzBio) sentences. All three tests were administered at levels of 50 and 60 dBA in quiet. Sentence stimuli were also presented in 4-talker babble at signal to noise ratios (SNRs) of +10 and +5 dB for both the 50- and 60-dBA presentation levels. A repeated-measures analysis of variance was used to assess the effects of location (remote, in person), stimulus level (50, 60 dBA), and SNR (if applicable; quiet, +10, +5 dB) on each outcome measure (CNC, HINT, AzBio).

Results:
The results showed no significant effect of location for any of the tests administered (p > 0.1). There was no significant effect of presentation level for CNC words or phonemes (p > 0.2). There was, however, a significant effect of level (p < 0.001) for both HINT and AzBio sentences, but the direction of the effect was opposite of what was expected—scores were poorer for 60 dBA than for 50 dBA. For both sentence tests, there was a significant effect of SNR, with poorer performance for worsening SNRs, as expected.

Conclusions:
The present study demonstrated that speech-perception testing via telepractice is feasible using DAI. There was no significant difference in scores between the remote and in-person conditions, which suggests that DAI testing can be used as a valid alternative to standard sound-booth testing. The primary limitation is that the calibration tools are presently not commercially available.
Orthopaedic Trauma Quality Measures for Value-Based Health Care Delivery: A Systematic Review
Authors: DeBaun Malcolm R. , Chen Michael J. , Bishop Julius A. , Gardner Michael J. , Kamal Robin N. 
Published: January 2019

Objectives:
To assess the current portfolio of quality measures and candidate quality measures that address orthopaedic trauma surgery.

Data Sources:
We systematically reviewed the National Quality Forum, the Agency for Healthcare Research and Quality, and the Quality Payment Program for quality measures relevant to fracture surgery. We also searched MEDLINE/PubMed, Embase/Scopus, and Cochrane libraries.

Data Extraction:
Clinical practice guidelines were included as candidate quality measures if their development was in accordance with the Institute of Medicine criteria for development of clinical practice guidelines, were based on consistent clinical evidence including at least one Level I study, and carried the strongest possible recommendation by the developing body. We categorized the measures as structure, process, or outcome domains according to the framework described by Donabedian.

Data Synthesis:
From the 3809 articles initially identified and screened, a total of 189 combined quality or candidate quality measures were extracted from our review. With regard to the Donabedian framework, there were a total of 7% (13/189) structure, 52% process (99/189), and 41% (77/189) outcome measures identified.

Conclusions:
As quality measures progressively inform reimbursement in value-based health care models, quality measures evaluating the care of patients sustaining a fracture will become increasingly relevant to orthopaedic trauma surgeons.
Salter–Harris II Ankle Fractures in Children: Does Fracture Pattern Matter?
Authors: Binkley Allison , Mehlman Charles T. , Freeh Ellen 
Published: January 2019

Objectives:
To determine the correlation of Salter–Harris II fracture patterns with premature physeal closure (PPC) and resultant angular deformity of the ankle.

Design:
Retrospective review.

Setting:
Cincinnati Children's Hospital Medical Center (outpatient level of care).

Patients/Participants:
We searched the digital ankle radiographs taken at our institution from 2001 to 2010, identifying all skeletally immature patients with confirmed ankle fractures.

Intervention:
Fracture patterns were subclassified according to the Dias–Tachdjian classification system. Only patients with a minimum of 6 months of follow-up were included.

Main Outcome Measures:
Rates of PPC, initial operative interventions, subsequent surgical interventions, and final angular deformities of the ankle in the coronal plane were recorded and considered significant if more than 10 degrees.

Results:
One hundred forty-one patients met our criteria. Fifty-two pronation-external rotation (PER) injuries, 35 supination-external rotation (SER) injuries, and 54 supination-plantar flexion (SPF) injuries were included. Of the PER injuries, 15 (28.8%) PPCs occurred with 6 patients having a resultant angular deformity of the ankle of at least 10 degrees at latest follow-up. Thirteen (24.1%) of the SPF patients went on to PPC with no resultant angular deformities. Of the SER injuries, 4 (11.4%) went on to PPC also with no patients having resultant angular deformities. The PER group had a statistically significantly higher rate of resultant angular deformity (P = 0.021).

Conclusions:
Salter–Harris II fractures of the ankle are common in children, with fracture pattern directly related to PPC and the chance for angular deformity. PER injuries are more likely to have a PPC associated with an angular deformity compared with SER and supination-plantar flexion injuries. The odds ratio of having an angular deformity with PER injuries compared with SER and SPF injuries is 25.

Significance:
Fracture pattern of the ankle is related to growth disturbance, which must be taken into consideration when treating these injuries and addressed with the patient and family.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Biomechanical Evaluation of Interfragmentary Compression of Lag Screw Versus Positional Screw at Different Angles of Fixation
Authors: Kuzma Alexander L. , Luo Tianyi David , De Gregorio Michael , Coon Grayson D. , Danelson Kerry , Halvorson Jason J. , Carroll Eben A. , Aneja Arun 
Published: January 2019

Objectives:
To compare the compressive force achieved and retained with the lag versus positional screw technique at various angles of screw application.

Methods:
Sixty humeral sawbones were stratified into 6 groups based on the technique (lag or positional) and fixation angle (30, 60, or 90 degrees relative to the fracture plane). A sensor was placed between fragments to record compressive force. Absolute screw force is the final screw force. Normalized force is the final screw force minus force generated by reduction forceps. Retained force is the quotient of absolute force relative to reduction forceps force.

Results:
Lag screws attained higher force than positional at 60 degrees (absolute force 41% higher, P = 0.041; normalized force 1300% higher, P = 0.008; retained force 60% higher, P = 0.008) and 90 degrees (absolute force 86% higher, P = 0.006; normalized force 730% higher, P = 0.005; retained force 70% higher, P = 0.011), but not at 30 degrees. For lag screws, compressive force was similar at 60 and 90 degrees (absolute force P = 0.174, normalized force P = 0.364, and retained force P = 0.496), but not 30 degrees. For positional screws, no difference was found between the 3 angles of fixation for absolute force (P = 0.059). Normalized force and retained force were similar at 60 and 90 degrees (P = 0.944 and P = 0.725, respectively), but not 30 degrees.

Conclusions:
Lag screw technique compressive force was superior to positional screw technique at 60 and 90 degrees. Comparison of force at angles of 60 and 90 degrees showed no significant difference for both techniques. Indicating 30 degrees deviation from perfect technique is tolerated without significant decrease in compressive force.
Correlation of Fracture Energy With Sanders Classification and Post-traumatic Osteoarthritis After Displaced Intra-articular Calcaneus Fractures
Authors: Rao Karan , Dibbern Kevin , Day Molly , Glass Natalie , Marsh J. Lawrence , Anderson Donald D. 
Published: January 2019

Objectives:
To quantify fracture severity for a series of displaced intra-articular calcaneal fractures (DIACFs) and to correlate it with Sanders classification, post-traumatic osteoarthritis (PTOA), and patient outcomes.

Design:
Retrospective review and fracture severity analysis.

Setting:
Level 1 trauma center affiliated with the University of Iowa in Iowa City, IA.

Patients/Participants:
Thirty-six patients with 48 DIACFs were selected from 153 patients previously treated. All patients 18 years of age and older who had available electronic preop and postop computed tomography (CT) scans, good-quality postop and follow-up radiographs, and a follow-up ≥18 months were selected for study.

Intervention:
Fractures were treated with percutaneous reduction, using multiple small stab incisions and fluoroscopy to guide manipulation of articular fragments using cork screws or Steinmann pins, with subsequent fixation using 3.5- and 4.0-mm screws.

Main Outcome Measurements:
Preop CT scans were used to grade fractures according to the Sanders classification and to quantify fracture severity. Fracture severity was objectively quantified using a CT-based measure of fracture energy. PTOA was assessed on follow-up radiographs using the Kellgren–Lawrence scale. Patient outcomes were assessed using the Short Form 36 (SF-36) questionnaire and a visual analog scale pain score.

Results:
Fracture energies for the 48 DIACFs ranged from 14.1 to 26.2 J (19.3 ± 3.1 J) and correlated with Sanders classification (rho = 0.53, P = 0.0001); type I (16.3 ± 0.9 J); type II (18.0 ± 2.7 J); type III (20.8 ± 2.8 J); and type IV (22.0 ± 0.7 J). Fracture energy was higher for fractures in which the subtalar joint developed PTOA (19.5 ± 2.7 J) than for those that did not (18.9 ± 3.3 J), but the difference did not reach statistical significance. The Sanders classification predicted PTOA risk [odds ratio (OR) = 4.04, 95% confidence interval = 1.43–11.39, P = 0.0084]. No relationship was observed between fracture energy and visual analog scale pain scores. Higher fracture energy correlated with lower SF-36 scores.

Conclusions:
Fracture energy positively correlates with Sanders classification for DIACFs, which can be used to identify more severe fractures at greater risk of progressing to PTOA.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Effect of Mental Health Conditions on Complications, Revision Rates, and Readmission Rates Following Femoral Shaft, Tibial Shaft, and Pilon Fracture
Authors: Foster Brock D. , Kang Hyunwoo Paco , Buser Zorica , Carney John , Wang Jeffrey C. , Marecek Geoffrey S. 
Published: January 2019

Objectives:
To evaluate the effect of pre-existing mental health (MH) conditions on 90-day complication, 90-day readmission, and all-time revision surgical intervention rates following femoral, tibial, and pilon fractures.

Design:
Data were collected using a commercially available database software for which Current Procedural Terminology codes were used to identify patients who underwent surgical treatment of tibial, femoral, or pilon fractures. These patients were then subdivided into those with and without pre-existing MH condition using International Classification of Disease, Ninth Edition codes. Ninety-day postoperative complications, revision surgery, and 90-day readmission rates were then compared between those with and without MH conditions.

Setting:
National databases of 70 million combined patients from 2007 to 2015.

Patients/Participants:
Humana and Medicare insured patients.

Intervention:
Surgical treatment of tibial, femoral, and pilon fractures.

Main Outcome Measurements:
Ninety-day readmission, 90-day complications, and all-time revision surgical intervention.

Results:
The total number of patients for femoral, tibial, and pilon treatment, respectively, included 6207, 6253, and 5940 without MH conditions and 4879, 5247, and 2911 with MH conditions. Femoral, tibial, and pilon readmission rates, revision rates, and complication rates were significantly higher among patients with MH disorders in matched cohorts after controlling for medical comorbidities (P ≤ 0.05 for all).

Conclusions:
Comorbid MH conditions are associated with higher postoperative complication, readmission, and revision surgery rates for treated femoral, tibial, and pilon fractures.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Fewer Hospitals Provide Operative Fracture Care to Medicaid Patients Than Otherwise-Insured Patients in 4 Large States
Authors: Brodke Dane J. , Morshed Saam 
Published: January 2019

Objective:
To determine whether Medicaid patients receive operative fracture care at an equal number of hospitals as otherwise-insured patients and to compare travel distances between Medicaid and otherwise-insured patients.

Design:
Retrospective, population-based cohort study of administrative health data.

Setting:
One thousand seventy-five hospitals in California, Florida, New York, and Texas.

Participants:
Two hundred forty thousand three hundred seventy-six patients who underwent open reduction and internal fixation of a fracture of the radius/ulna, tibia/fibula, or humerus between 2006 and 2010 in Texas or New York, or between 2010 and 2014 in California or Florida.

Intervention:
Open reduction and internal fixation of the radius/ulna, tibia/fibula, or humerus.

Main Outcome Measurements:
The number of unique hospitals visited and the distance traveled for care were compared by payer status and admission acuity. The distance traveled was also stratified by urban versus rural geographic area.

Results:
In nonemergent settings, 7%–16% fewer hospitals saw Medicaid patients than otherwise-insured patients. In emergent settings, the gap between the number of hospitals seeing Medicaid and otherwise-insured patients was less than 5% in every state except Texas, where the gap was 11%–14%. The Medicaid and Medicare groups had longer travel distances in the nonemergent setting than in the emergent setting. Medicaid patients did not travel longer distances than otherwise-insured patients except in Texas, where they traveled 3–5 miles further than otherwise-insured patients in the nonemergent, urban setting.

Conclusions:
Fewer hospitals provide operative fracture care to Medicaid patients than otherwise-insured patients, but Medicaid patients do not travel longer distances to the hospital on a population level.

Level of Evidence:
Prognostic Level III.
Radiographic Outcome and Complication Rate of 34 Graduates After Treatment With Vertical Expandable Prosthetic Titanium Rib (VEPTR): A Single Center Report
Authors: Studer Daniel , Büchler Philippe , Hasler Carol C. 
Published: January 2019

Background:
The final strategy for graduates from growth-sparing surgery is challenging. The purpose of this study was to evaluate the radiographic outcome and complications of patients with early onset scoliosis (EOS) who have graduated from vertical expandable prosthetic titanium rib (VEPTR) treatment, either undergoing final fusion surgery or following a nonfusion approach.

Methods:
Final treatment for VEPTR graduates was divided in “VEPTR in situ without final fusion,” “removal of VEPTR without final fusion,” and “removal of VEPTR with instrumented final fusion.” Radiographic evaluations included main coronal Cobb angle and main kyphosis pre and post VEPTR implantation, at the end of implant lengthening, after final fusion (if applicable), and at latest follow-up. Complications during VEPTR treatment and in case of final fusion were reported.

Results:
In total, 34 VEPTR graduates were included; 17 underwent final fusion surgery, and 17 followed a nonfusion strategy. Average coronal Cobb angle before VEPTR implantation was 70±23 degrees (range, 21 to 121 degrees), and 65±22 degrees (range, 17 to 119 degrees) at latest follow-up. Average main kyphosis angle was 53±27 degrees (range, 6 to 137 degrees) before VEPTR, and 69±34 degrees (range, 10 to 150 degrees) at latest follow-up. There was a 41% complication rate with final fusion surgery.

Conclusions:
There is a high complication rate during VEPTR treatment and with final fusion surgery. The stiffness of the spine and thorax allow for only limited correction when performing a final instrumented spondylodesis. Avoiding final fusion may be a viable alternative in case of good coronal and sagittal alignment.

Level of Evidence:
Level IV—therapeutic.
An In Vitro Study of the Intervertebral Disc Structure Using 3 T Magnetic Resonance Imaging
Authors: Wijayathunga Vithanage N. , Tanner Steven F. , Ridgway John P. , Wilcox Ruth K. 
Published: January 2019

Study Design.
An in vitro magnetic resonance imaging (MRI) study.

Objective.
Investigate the potential of high-field MRI for producing higher quality images of the intervertebral disc (IVD) to better distinguish structural details.

Summary of Background Data.
Higher spatial and contrast resolution are important advantages when imaging the complex tissue structures in the spine such as the IVDs. However, at present it is challenging to capture the substructural details in the IVD such as the lamellae.

Methods.
Three MRI sequences; two-dimensional proton-density-weighted Turbo-Spin-Echo (PD-TSE), 2D T2-weighted Turbo-Spin-Echo (T2W-TSE) with fat-saturation (FS), and 3D Spoiled-Gradient-Echo (3D-GE), were modified based on the image quality and scan duration. IVDs of three intact cadaveric lumbar-spines (T12–S1, Age 83–94 yr) were imaged using these optimized sequences. Thereafter each IVD was transversely sectioned and the exposed surfaces were photographed. Landmark observations from corresponding MRI slices and photographs were compared to confirm the MRI captured morphology. The image quality was evaluated using signal-to-noise ratio (SNR), and relative-contrast values. Finally, the underlying tissue structures, including specific pathological features, were qualitatively compared between the MR images and photographs.

Results.
Observations from photographs and corresponding MRI slices matched well. The PD-TSE sequence had better overall SNR, but the relative contrast between the tissue types was relatively poor. The 3D-GE sequence had higher relative contrast between the IVD and bone, but not between annulus and nucleus regions. The T2W images provided the best relative contrast between the annulus and nucleus, however the standard deviations here were high. Structural details including fissures, vascular and granular tissue proliferation, and pathologies in the endplate region, were identifiable from the MR images obtained using the optimized sequences.

Conclusion.
The results demonstrate the potential of high-field MRI to capture the IVD structural details. Since the acquisition durations were within clinically acceptable levels, these methodological improvements have the potential to enhance clinical diagnostics.

Level of Evidence: 4