bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-Term Patient-Reported Functional Outcome of Polytraumatized Patients With Operatively Treated Pelvic Fractures
Authors: Bott Alasdair , Odutola Adekoyejo , Halliday Ruth , Acharya Mehool R. , Ward Anthony , Chesser Timothy J. S. 
Published: January 2019

Objectives:
To report the long-term functional outcome of a cohort of patients with operatively treated unstable pelvic fractures using validated patient-reported outcome measures.

Design:
Long-term observational study using prospective and retrospective data.

Setting:
Tertiary referral pelvic trauma center, Bristol, United Kingdom.

Patients:
Seventy-four polytraumatized patients with operatively treated unstable pelvic ring injuries (50 OTA/AO type B and 24 OTA/AO type C, mean Injury Severity Score 17) treated between 1994 and 2005.

Intervention:
Sixty-four (86%) patients were treated with internal fixation. The remaining 10 patients (14%) were treated with either combined percutaneous posterior fixation and anterior external fixation or external fixation in isolation.

Main Outcome:
Patient-reported functional outcome.

Measurements:
Short Form-36, with UK norm-based comparator scores and EQ-5D-3L.

Results:
Patients were between 11 and 22 years after injury (mean 15 years). We found no significant association between fracture classification and outcome score, but compared with age- and sex-matched scores for a UK population, differences were statistically significant in 3 of the 8 domains of health: physical function (P = 0.04), bodily pain (P = 0.001), and vitality (P = 0.001). The level of disability remained constant for these patients compared with their patient-reported outcome measure scores reported 8 years previously.

Conclusion:
Patients who sustain an unstable pelvic fracture continue to have significant functional limitations compared with an uninjured population. These changes were not found to be related to age, injury pattern, genitourinary injury, or neurological injury. Functional outcome scores did not change over the 2 long-term time points.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Unstable Pelvic Ring Injuries: How Soon Can Patients Safely Bear Weight?
Authors: Marchand Lucas S. , Working Zachary M. , Rane Ajinkya A. , Elliott Iain S. , Howenstein Abby , Haller Justin M. , Rothberg David L. , Higgins Thomas F. 
Published: January 2019

Objective:
To determine if time to weight bearing (WB) is associated with complications in operatively treated pelvic ring injuries.

Design:
Retrospective cohort study.

Setting:
Academic Level I trauma hospital.

Patients:
Two hundred eighty-six patients with pelvic ring injuries treated operatively over a 10-year period [OTA/AO 61-B1-3, 61-C1-3; Young-Burgess lateral compression (LC) 1–3, anterior–posterior compression (APC) 1–3, and vertical shear] were included.

Intervention:
Patients were stratified into early (≤8 weeks) and late (>8 weeks) time to full WB groups.

Main Outcome Measure:
Composite outcome of implant failure [broken screw(s)/plate(s), screw(s) loosening], revision surgery, and malunion.

Results:
We identified 286 patients with a mean age of 39.9 years (range: 18–81 years) and an average follow-up of 1.2 years (1.0–9 years). There were 132 and 154 patients in the early and late WB groups, respectively. A total of 142 Young-Burgess LC-1, 48 LC-2, 23 LC-3, 10 APC-1, 45 APC-2, 8 APC-3, and 8 vertical shear injuries were noted. Complications were noted in 47 patients (16%). Complications included 18 implant failures, 16 malunions, and 13 patients who required revision operations for loss of reduction. Time to WB was not associated with composite complication rates (P = 0.24). APC-2, LC-3, and injuries with bilateral rami fractures were noted to have a higher complication rates independent of time to WB (P = 0.005, 0.03, and 0.03, respectively).

Conclusions:
No difference in implant failure, malunion, or early loss of reduction between operatively treated pelvic ring injuries allowed to WB as tolerated before 8 weeks compared with those who remained on protected WB protocol for any time greater than 8 weeks was noted. These data may provide information to support early WB protocols.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Opiate Prescribing Practices After Common Isolated Lower Extremity Injuries
Authors: Rodriguez-Buitrago Andres , Attum Basem , Enata Nichelle , Evans Adam , Okwumabua Ebubechi , Gajari Vamshi , Obremskey William T. , Jahangir Alex 
Published: January 2019

Objective:
This retrospective study aimed at identifying opiate prescribing practices, the number of morphine milligram equivalents (MMEs) prescribed by orthopaedic and nonorthopaedic providers in patients with operatively treated isolated lower extremity fractures, and provide opiate prescribing recommendations.

Methods:
Patients older than 18 years with isolated lower extremity (unicondylar, bicondylar, tibial shaft, pilon, and ankle) fractures between 2005 and 2016 were identified. Prescribing information was obtained from the State Controlled Substance Monitoring Database. Descriptive statistics were calculated for each injury and plotted for MME use. Mann–Whitney and Wilcoxon tests were used for data analysis. To aid in clinical relevance, MMEs were converted to number of pills of oxycodone 10 mg (OC 10 mg).

Results:
Three hundred forty-one patients met our inclusion criteria. Mean age was 45 years; 56% (192/341) were men. Forty-seven percent (159/341) were prescribed opiates before their injury. Orthopaedic providers prescribed more opiates to patients with pilon fractures compared with unicondylar (P = 0.010), tibial shaft (P < 0.001), and ankle (P < 0.001) fractures. Bicondylar plateau fracture patients also received more opiates when compared with unicondylar (P = 0.001), tibial shaft (P < 0.001), and ankle (P < 0.001) fractures. Nonorthopaedic providers prescribed more opiates to patients with pilon fractures when compared with unicondylar (P = 0.006), bicondylar (P < 0.001), tibial shaft (P < 0.001), and ankle fractures (P = 0.006). Differences between orthopaedic and nonorthopaedic MMEs prescribed are significantly different for each injury type (<0.05).

Conclusions:
Patients with pilon or bicondylar tibial plateau fractures are currently being prescribed more opiates when compared with other isolated fractures. We have developed an opiate prescription guideline based on what is being prescribed by orthopaedic providers.
Ultrasound-Guided Nerve Blocks as Analgesia for Nonoperative Management of Distal Radius Fractures–Two Consecutive Randomized Controlled Trials
Authors: Siebelt Michiel , Hartholt Klaas A. , van Winden Daniëlle F. M. , Boot Femke , Papathanasiou Dafni , Verdouw Bas C. , de Vries Mark R. , Mathijssen Nina M. , Kraan Gerald A. 
Published: January 2019

Objectives:
To investigate whether a conventional fracture hematoma block (FHB) or an ultrasound-guided peripheral nerve block has more superior analgesic effect during nonoperative management of distal radius fractures in an emergency department setting. Two peripheral nerve block types were investigated, one at the level of the elbow, or cubital nerve block (CNB), and another an axillary nerve block (ANB).

Design:
Two prospective randomized controlled studies were performed to compare the difference in pain intensity during closed reduction of a distal radius fracture between FHB-, CNB-, and, ANB-treated patients.

Setting:
Level 2 trauma center.

Patients:
One hundred ten patients with radiographic displaced distal radius fractures were randomized. Fifty patients were randomized between FHB and CNB, and 60 patients were randomized between CNB and ANB.

Intervention:
FHB, CNB, or ANB. These were performed by 3 physicians new to ultrasound-guided peripheral nerve blocks and trained before onset of this study.

Main Outcome Measurement:
Pain was sequentially measured using an NRS during closed distal radius fracture reduction.

Results:
CNB patients experienced less pain during block procedure (P = 0.002), finger trap traction (P = 0.007), fracture reduction (P = 0.00001), after plaster cast application (P = 0.01), and after control radiography (P = 0.01). In our second study, ANB-treated patients reported less pain during block procedure (P = 0.04), during finger trap traction (P < 0.0001), fracture reduction (P < 0.0001), after plaster cast application (P = 0.0001), and after control radiography (P = 0.0005).

Conclusions:
Although participating clinicians had minimal expertise using ultrasound-guided peripheral nerve blocks, nonoperative management of distal radius fracture using an ANB was less painful. These block types are expected to completely eradicate sensation the best. Future studies should address technical factors including adequate placement and time to let the block set up, as well as issues such as resource utilization including time and clinician availability to better determine the relative advantages and disadvantages to other analgesia techniques such as the FHB.

Level of Evidence:
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
A Practical Analgesia Approach to Fragility Hip Fracture: A Single-Center, Retrospective, Cohort Study on Femoral Nerve Block
Authors: Li Jinlei , Dai Feng , Chang Daniel , Harmon Emily , Ibe Izuchukwu , Sukumar Nitin , Halaszynski Thomas M. , Rubin Lee E. , O'Connor Mary I. 
Published: January 2019

Objective:
To determine whether an effective opioid-sparing pain control modality is desirable for an aging population.

Design:
Retrospective observational study

Setting:
Academic medical center

Patients:
192 patients with various types of fragility hip fractures

Intervention:
A single-injection femoral nerve block (FNB)

Main outcome measurements:
Pain score, opioid consumption

Results:
We observed statistically significant effects of FNB on visual analogue scale pain score and the rate of opioid consumption diminution in all commonly encountered types of fragility hip fractures. The pain score reduction by FNB in subcapital femoral neck fracture, transcervical femoral neck facture, and intertrochanteric fracture are all statistically significant (P < 0.0001). There was a statistically more significant pain score reduction in intracapsular fractures than in extracapsular fractures (P = 0.006). On average, the hip fracture patients required 0.9 and 0.1 mg morphine equivalent/hour before and after FNB block placement. This decrease in opioid consumption when calculated per unit time was statistically significant in subcapital femoral neck fracture, transcervical femoral neck facture, and intertrochanteric fracture (P < 0.0001). There were no complications related to FNB placement.

Conclusions:
FNB is a sustainable, safe, and useful analgesic modality for commonly encountered fragility hip fractures.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Fassier-Duval Rods are Associated With Superior Probability of Survival Compared With Static Implants in a Cohort of Children With Osteogenesis Imperfecta Deformities
Authors: Spahn Kimberly M. , Mickel Timothy , Carry Patrick M. , Brazell Christopher J. , Whalen Karen , Georgopoulos Gaia , Miller Nancy H. 
Published: January 2019

Background:
The survival of Fassier-Duval (FD) telescoping rods as compared with static implants in children affected by osteogenesis imperfecta is not well characterized. The purpose of this study was to compare risk of lower extremity implant failure in FD rods versus static implants.

Methods:
Data were retrospectively collected from patients with osteogenesis imperfecta who underwent surgical treatment using either FD rods or static implants (Rush rods, flexible nails, or Steinmann pins) between 1995 and 2015. The timing of implant failure was the primary outcome variable of interest. Comparisons were limited to limbs with no previous history of implants. Cox-proportional hazards regression analyses were used to compare the hazard of implant failure across implants. Negative binomial regression analyses were used to compare the incidence of surgical procedures in the 2 implant groups.

Results:
The final cohort consisted of 64 limbs (n=21 patients). The static implant group (n=38) consisted of 24 Rush rods (63%), 14 flexible nails (37%), and 2 Steinmann pins (5%). The hazard of implant failure in the static implant group was 13.2 times [95% confidence interval (CI), 2.5-69.6; P=0.0024] the hazard of implant failure in the FD rod group. The hazard of implant failure among females was 4.8 (95% CI, 1.4-16.7; P=0.0125) times the hazard of implant failure among males. The total surgery rate in the static implant group was 7.8 (95% CI, 1.8-33.0; P=0.0056) times the total surgery rate in the FD group.

Conclusions:
Among surgically naive limbs, FD rods were associated with significantly improved probability of survival compared with static implants.

Level of Evidence:
Level II—retrospective study.
Effects of Baseline Thrombocytopenia and Platelet Decrease Following Renal Replacement Therapy Initiation in Patients With Severe Acute Kidney Injury*
Authors: Griffin Benjamin R. , Jovanovich Anna , You Zhiying , Palevsky Paul , Faubel Sarah , Jalal Diana 
Published: January 2019

Objectives:
Thrombocytopenia is common in critically ill patients with severe acute kidney injury and may be worsened by the use of renal replacement therapy. In this study, we evaluate the effects of renal replacement therapy on subsequent platelet values, the prognostic significance of a decrease in platelets, and potential risk factors for platelet decreases.

Design:
Post hoc analysis of the Acute Renal Failure Trial Network Study.

Setting:
The Acute Renal Failure Trial Network study was a multicenter, prospective, randomized, parallel-group trial of two strategies for renal replacement therapy in critically ill patients with acute kidney injury conducted between November 2003 and July 2007 at 27 Veterans Affairs and university-affiliated medical centers.

Subjects:
The Acute Renal Failure Trial Network study evaluated 1,124 patients with severe acute kidney injury requiring renal replacement therapy.

Interventions:
Predictor variables were thrombocytopenia at initiation of renal replacement therapy and platelet decrease following renal replacement therapy initiation.

Measurements and Main Results:
Outcomes were mortality at 28 days, 60 days, and 1 year, renal recovery, renal replacement therapy free days, ICU-free days, and hospital-free days. Baseline thrombocytopenia in patients requiring renal replacement therapy was associated with increased mortality and was also associated with lower rates of renal recovery. A decrease in platelet values following renal replacement therapy initiation was associated with increased mortality. Continuous renal replacement therapy was not an independent predictor of worsening thrombocytopenia compared with those treated with intermittent hemodialysis.

Conclusions:
Baseline thrombocytopenia and platelet decrease following renal replacement therapy initiation were associated with increased mortality, and baseline thrombocytopenia was associated with decreased rates of renal recovery. Continuous renal replacement therapy did not decrease platelets compared with hemodialysis.
Meta-analysis of overall incidence and risk of ALK inhibitors-induced liver toxicities in advanced non-small-cell lung cancer
Authors: Li Jingjie , Yuan Zhi , Wang Qun , Fan Weijie , Zhang Guoping 
Published: January 2019

Abstract

Aim:
Activation of the anaplastic lymphoma kinase (ALK) gene has been found in several human cancers, including non-small-cell lung cancer (NSCLC). Currently, novel drugs targeting ALK gene have been extensively investigated in NSCLC. However, concerns about ALK inhibitors-induced liver toxicities have been increasing.

Materials and Methods:
Eligible prospective clinical studies have been searched in several databases. Primary outcomes of interest were incidence rates of liver toxicities, relative risks (RRs), and 95% confidence intervals (CIs).

Results:
Data from 2418 patients (1873 in the experimental arm; 545 in the control arm) were included. The incidences of all-grade alanine transaminase (ALT) and aspartate aminotransferase (AST) elevation were 26.0% (95% CI: 17.4%–37%), and 23.2% (95% CI, 16.7%–31.4%), respectively. The incidences of high-grade ALT and AST elevation were 8.4% (95% CI, 5.1%–13.4% and 7.0% (95% CI: 5.4%–9.0%), respectively. Sub-group analysis according to the ALK inhibitors found that pooled incidence of liver toxicities associated with ceritinib was higher than that of crizotinib and alectinib. In comparison with chemotherapy, ALK inhibitors significantly increased the all-grade and high-grade ALT elevation (RR 2.37, 95% CI, 1.97–2.86; P < .001; RR 7.34, 95% CI, 3.95–13.63; P < .001) and AST elevation (RR 3.27, 95% CI, 2.47–4.34; P < .001; RR 11.54, 95% CI, 4.33–30.7; P < .001), respectively. No publication bias was detected for RR of ALT and AST.

Conclusions:
The findings of the present study offer substantial evidence that ALK inhibitors treatment in advanced NSCLC significantly increases the risk of developing all-grade and high-grade liver toxicities in comparison with controls. Clinicians should recognize liver toxicities promptly as early interventions may alleviate future complications.
The effectiveness and safety of 3-dimensional printed composite guide plate for atlantoaxial pedicle screw
Authors: Wang Fei , Li Chang-Hong , Liu Zhi-Bin , Hua Zhang-Jian , He Yong-Jin , Liu Jun , Liu Yan-Xiong , Dang Xiao-Qian 
Published: January 2019

Abstract
This study aims to evaluate the effectiveness and safety of the application of a 3-dimensional (3D)-printed composite guide plate for atlantoaxial pedicle screw.
This was a retrospective study. A total of 43 atlantoaxial dislocation patients admitted in our hospital between January 2014 and October 2016 were retrospectively analyzed. According to the different methods of operation, patients were divided into 2 groups: 3D-printed plate group (n = 19) and traditional fixation group (n = 24). Placement time, operation duration, fluoroscopy number, intraoperative bleeding volume, and the neck and shoulder pain visual analog scale and Japanese Orthopaedic Association cervical nerve function scores were compared between pre- and postoperation.
Differences in general data between these 2 groups were not statistically significant (P > .05). For patients in the 3D-printed plate group, a total of 68 assisting screws were placed at the pedicle, the accuracy rate of screw placement was 94.1%, placement time was 2.2 ± 0.4 minutes, fluoroscopy number was 4.6 ± 1.1 times, operation duration was 197 ± 41 minutes, and intraoperative bleeding volume was 395 ± 64 mL. In the traditional fixation group, a total of 76 screws were placed at the pedicle of patients, the accuracy rate of screw placement was 76.3%, placement time was 3.4 ± 0.7 minutes, fluoroscopy number was 9.4 ± 2.7 times, operation duration was 245 ± 67 minutes, and intraoperative bleeding volume was 552 ± 79 mL. Differences in accuracy rate, placement time, fluoroscopy number, operation duration, and intraoperative bleeding volume between these 2 groups were statistically significant (P < .05).
The effectiveness and safety of 3D-printed composite guide plate for atlantoaxial pedicle screw were better than traditional method.
The Managment of cervical spine abnormalities in children with spondyloepiphyseal dysplasia congenita
Authors: Al Kaissi Ali , Ryabykh Sergey , Pavlova Olga M. , Ochirova Polina , Kenis Vladimir , Chehida Farid Ben , Ganger Rudolf , Grill Franz , Kircher Susanne Gerit 
Published: January 2019

Abstract
Spondyloepiphyseal dysplasia congenita (SEDC) is an autosomal dominant disorder, characterized by disproportionate dwarfism with short spine, short neck associated with variable degrees of coxa vara. Cervical cord compression is the most hazardous skeletal deformity in patients with SEDC which requires special attention and management.
Ten patients with the clinical and the radiographic phenotypes of spondyloepiphyseal dysplasia congenita have been recognized and the genotype was compatible with single base substitutions, deletions or duplication of part of the COL2A1 gene (6 patients out of ten have been sequenced). Cervical spine radiographs showed apparent atlantoaxial instability in correlation with odontoid hypoplasia or os-odontoideum.
Instability of 8 mm or more and or the presence of symptoms of myelopathy were the main indications for surgery. Posterior cervical fusion from the occiput or C1–3, decompression of C1–2 and application of autorib transfer followed by halo vest immobilization have been applied accordingly.
Orthopedic management of children with spondyloepiphyseal dysplasia congenita (SEDC) should begin with the cervical spine to avoid serious neurological deficits and or mortality.
Effect of parecoxib in the treatment of postoperative cognitive dysfunction
Authors: Huang Song , Hu Haijun , Cai Yue-Hong , Hua Fuzhou 
Published: January 2019

Abstract

Background:
Parecoxib is a selective cyclooxygenase (COX)-2 inhibitor widely used as an analgesia technique in perioperative period for its potent anti-inflammatory and analgesic effects. However, litter is known about its effect on postoperative cognitive dysfunction (POCD). The purpose of this meta-analysis of randomized controlled trials (RCTs) was to evaluate the effect of parecoxib in the treatment of postoperative cognitive dysfunction.

Methods:
We searched PubMed, Cochrane Library and Embase databases for relevant studies up to October 2017. We selected fixed-effect model for analysis of data heterogeneity. Statistical analyses were performed by using Review Manager Version 5.3 for Windows.

Results:
Four RCTs with 904 patients that underwent surgical operations were included. The meta-analysis demonstrated parecoxib could significantly decrease the incidence of POCD on postoperative day 1, day 3, day 5, and day 7 when compared with control treatment; IL-6 and S100β concentrations were lower up to postoperative day 2. The consumption of morphine, fentanyl and tramadol in parecoxib groups were lower than control groups.

Conclusion:
Our meta-analysis suggested that the administration of Parecoxib was effective in treating early POCD within 7 days and reducing IL-6 and S100β concentrations within 2 days after operations. Nevertheless, our current study with some limitations such as the small sample size only provided limited quality of evidence, confirmation from further meta-analysis with large-scale, well-designed RCTs is required.