bluuebunny/crossref_metadata_2025_split huggingface dataset:
Autograft, Allograft, and Bone Graft Substitutes: Clinical Evidence and Indications for Use in the Setting of Orthopaedic Trauma Surgery
Authors: Baldwin Paul , Li Deborah J. , Auston Darryl A. , Mir Hassan S. , Yoon Richard S. , Koval Kenneth J. 
Published: January 2019

Summary:
Bone grafts are the second most common tissue transplanted in the United States, and they are an essential treatment tool in the field of acute and reconstructive traumatic orthopaedic surgery. Available in cancellous, cortical, or bone marrow aspirate form, autogenous bone graft is regarded as the gold standard in the treatment of posttraumatic conditions such as fracture, delayed union, and nonunion. However, drawbacks including donor-site morbidity and limited quantity of graft available for harvest make autograft a less-than-ideal option for certain patient populations. Advancements in allograft and bone graft substitutes in the past decade have created viable alternatives that circumvent some of the weak points of autografts. Allograft is a favorable alternative for its convenience, abundance, and lack of procurement-related patient morbidity. Options include structural, particulate, and demineralized bone matrix form. Commonly used bone graft substitutes include calcium phosphate and calcium sulfate synthetics—these grafts provide their own benefits in structural support and availability. In addition, different growth factors including bone morphogenic proteins can augment the healing process of bony defects treated with grafts. Autograft, allograft, and bone graft substitutes all possess their own varying degrees of osteogenic, osteoconductive, and osteoinductive properties that make them better suited for different procedures. It is the purpose of this review to characterize these properties and present clinical evidence supporting their indications for use in the hopes of better elucidating treatment options for patients requiring bone grafting in an orthopaedic trauma setting.
Fracture Pattern and Periosteal Entrapment in Adolescent Displaced Distal Tibial Physeal Fractures: A Magnetic Resonance Imaging Study
Authors: Park Jinhee , Cha Yunsik , Kang Michael Seungcheol , Park Soo-Sung 
Published: January 2019

Objectives:
To investigate the fracture pattern and periosteal entrapment in adolescent distal tibial physeal fractures.

Design:
Retrospective case series.

Setting:
Level I academic trauma center.

Patients/Participants:
Fifty patients (10–16 years of age) with displaced Salter–Harris type II, III, or IV distal tibial physeal fractures were retrospectively reviewed.

Intervention:
Periosteal involvement, fracture pattern.

Main Outcome Measurements:
We investigated the incidence and location of periosteal entrapment in those fractures and the angle of the fracture plane of metaphyseal fragments on axial plane by using magnetic resonance imaging.

Results:
Of the 15 type II, 12 type III (4 malleolar and 8 Tillaux), and 23 type IV (2 malleolar and 21 triplane) fractures, 72.0% (36/50) presented with periosteal entrapment. Among all type II and triplane fractures, periosteal entrapment was observed in the anterolateral corner when there was any displacement on that corner. By contrast, only 1 of 8 Tillaux fractures presented with periosteal entrapment. In almost all supinated foot injuries of type II and triplane fractures, the metaphyseal fracture line was parallel to the intermalleolar axis on axial plane.

Conclusions:
Salter–Harris type II and triplane fractures have a high risk of periosteal entrapment especially in the anterolateral corner. Therefore, even without preoperative magnetic resonance imaging, surgical repositioning of entrapped periosteum should be considered after failed closed reduction. In cases of supinated foot injuries of type II or triplane fractures requiring surgical fixation, a metaphyseal fracture plane parallel to the oblique coronal plane connecting the medial and lateral malleoli may assist surgeons in achieving appropriate metaphyseal fixation.

Level of Evidence:
Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Effect of Elbow Position on Load to Failure in Olecranon Fracture Fixation: A Biomechanical Cadaveric Study
Authors: Lindeman Robert W. , Morris Randal , Weatherby Paul , Neustein Adam , Maassen Nicholas H. 
Published: January 2019

Objectives:
This study evaluates if relative flexion or extension of the ulnohumeral joint affects the strength of repair in olecranon fractures treated with a precontoured locking plate.

Methods:
A cadaveric study was performed in matched pair cadaveric elbows. All soft tissue was dissected from the radius, ulna, and elbow of each specimen, leaving interosseous ligaments and joint capsules intact. Soft tissue from the humerus was dissected away, leaving only the triceps tendon and ulnar insertions intact. An oblique proximal to distal olecranon osteotomy was created in each specimen 1 cm from the tip of the olecranon. Internal fixation with standard precontoured locking plates and a Krackow augmentation suture with #2 FiberWire followed. Specimens were randomized to elbow position of 90 or 20 degrees° and loaded to failure via axial pull through the triceps. Load at failure, displacement at the time of failure, peak load, stiffness, and mechanism of failure was recorded and compared. The study was repeated a second time with the osteotomy more proximal, 0.6 cm creating a smaller fragment with less opportunities for locking screw fixation. This small fragment group was then tested as the large fragment group had.

Results:
There were no significant differences in load at failure, peak load, or stiffness between the elbow position in the large fragment group. Displacement at time of failure was significantly different, although not clinically relevant. Failure of fixation in this group was a mix of triceps avulsion and failure through fracture site. The smaller fragment group with less points of fixation demonstrated no statistically significant differences in any parameters. A majority of the failures were at the fracture site.

Conclusions:
Ulnohumeral position does not significantly affect overall construct strength even in olecranon fractures with small proximal fragments with limited points of fixation.
Risk Factors That Influence Subsequent Recurrent Instability in Terrible Triad Injury of the Elbow
Authors: Jung Sung-Weon , Kim Dong-Hee , Kang Seung-Hoon , Eho Yil-Ju , Yang Seong-Wook , Lee Gwang-Eun 
Published: January 2019

Objective:
To identify risk factors associated with subsequent recurrent instability and to identify predictors of poor outcomes in terrible triad injury of the elbow.

Design:
Retrospective cohort study.

Setting:
University trauma center.

Patients/Participants:
Seventy-six patients who were surgically treated for terrible triad injury of the elbow.

Intervention:
Review of charts and standardized x-ray images before surgery and 2 years after surgery. Patients were categorized into 2 groups: recurrent instability (group A) or concentric stability (group B).

Main Outcome Measurement:
Primary outcome measures were injury mechanism, time between injury and operation, fracture type, ligament injury, radial head fixation, coronoid fixation, ligament repair, period of postoperative immobilization, joint space restoration, healing progress, secondary operation, functional outcomes, and complications. Secondary outcome measures were age, sex, height, body mass index, bone mineral density, and comorbidities (hypertension and diabetes). Outcomes were measured before surgery and 2 years after surgery and were compared between groups.

Results:
Recurrent instability occurred in 19.7% of cases; revision surgeries were performed in 12 cases (80%). High-energy trauma (P = 0.012), time between injury and operation (P = 0.001), radial head comminution (P = 0.001), medial collateral injury (P = 0.041), and coronoid nonrepair (P = 0.030) were associated with recurrent instability. Posttraumatic arthritis developed more often in group A (P = 0.001).

Conclusions:
Recurrent instability was associated with high-energy trauma, time between injury and operation, Mason type III radial head fracture, medial collateral injury, and coronoid nonrepair. Patients with recurrent instability were more likely to require secondary surgery and develop posttraumatic arthritis than those with concentric stability.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Orthogonal Plating With a 95-Degree Blade Plate for Salvage of Unsuccessful Cephalomedullary Nailing of Atypic Femur Fractures: A Technical Trick
Authors: Rollick Natalie C. , Bear Jessica , Diamond Owen , Wellman David S. , Helfet David L. 
Published: January 2019

Summary:
Atypical femur fractures secondary to bisphosphonate use are often complicated by nonunion, which often results in progressive varus collapse, femoral head and neck bone loss, and eventual implant failure. We present a technique that uses orthogonal, dual plating of the proximal femur in addition to biologic augmentation for the management of these challenging fractures.
Are Geriatric Patients Who Sustain High-Energy Traumatic Injury Likely to Return to Functional Independence?
Authors: Shah Jason , Titus Alexander J. , O'Toole Robert V. , Sciadini Marcus F. , Boulton Christina , Castillo Renan , Breazeale Stephen , Schoonover Carrie , Berger Peter , Gitajn I. Leah 
Published: January 2019

Objectives:
To evaluate physical function and return to independence of geriatric trauma patients, to compare physical function outcomes of geriatric patients who sustained high-energy trauma with that of those who sustained low-energy trauma, and to identify predictors of physical function outcomes.

Design:
Retrospective.

Setting:
Urban Level I trauma center.

Patients:
Study group of 216 patients with high-energy trauma and comparison group of 117 patients with low-energy trauma.

Intervention:
Injury mechanism (high- vs. low-energy mechanism).

Main Outcome Measurement:
Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF) patient-reported outcome measure, and change in living situation and mobility.

Results:
Physical function outcomes and return to independence differed between patients with high-energy and low-energy injuries. High-energy geriatric trauma patients had significantly higher PROMIS PF scores compared with low-energy geriatric trauma patients (PROMIS PF score 42.2 ± 10.4 vs. 24.6 ± 10.4, P < 0.001). High-energy geriatric trauma patients were able to ambulate outdoors without an assistive device in 67% of cases and were living independently 74% of the time in comparison with 28% and 45% of low-energy geriatric trauma patients, respectively (P < 0.001, P < 0.001). Multivariate linear regression analysis demonstrated that low-energy mechanism injury was independently associated with a 13.2 point reduction in PROMIS PF score (P < 0.001).

Conclusions:
Geriatric patients greater than 1 year out from sustaining a high-energy traumatic injury seem to be functioning within the expected range for their age, whereas low-energy trauma patients seem to be functioning substantially worse than both age-adjusted norms and their high-energy cohorts.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Ability of a Risk Prediction Tool to Stratify Quality and Cost for Older Patients With Operative Ankle Fractures
Authors: Lott Ariana , Egol Kenneth A. , Lyon Thomas , Konda Sanjit R. 
Published: January 2019

Objectives:
To investigate the ability of a validated geriatric trauma risk prediction tool to stratify hospital quality metrics and inpatient cost for middle-aged and geriatric patients admitted from the emergency department for operative treatment of an ankle fracture.

Design:
Prospective cohort study.

Setting:
Single Academic Medical Center.

Patients:
Patients 55 years of age and older who sustained a rotational ankle fracture and who were treated operatively during their index hospitalization.

Intervention:
Calculation of validated trauma triage score, Score for Trauma Triage in Geriatric and Middle Aged (STTGMA), using patient demographics, injury severity, and functional status. Patients were stratified into groups based on scores to create a minimal-, low-, moderate-, and high-risk cohort.

Main Outcome Measurements:
Length of stay, complications, need for intensive care unit–/step-down unit–level care, discharge location, and index admission costs.

Results:
Fifty ankle fracture patients met inclusion criteria. The mean length of stay was 7.8 ± 5.2 days with a significant difference among the 4 risk groups (4.6-day difference between low and high risk). 73.1% of minimal-risk patients were discharged home compared with 0% of high-risk patients. There was no difference in complication rate or in need for intensive care unit–level care between groups. However, high-risk patients had a mean total inpatient cost 2 times greater than that of minimal-risk patients.

Conclusion:
The Score for Trauma Triage in Geriatric and Middle-Aged tool is able to meaningfully stratify older patients with ankle fracture who require operative fixation regarding hospital quality metrics and cost. This information may allow for efficient targeted reductions in costs while optimizing outcomes.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Health-related Quality of Life After Fractures of the Lateral Third of the Clavicle in Children and Adolescents
Authors: Liebs Thoralf R. , Ryser Basil , Kaiser Nadine , Slongo Theddy , Berger Steffen , Ziebarth Kai 
Published: January 2019

Introduction:
The health-related quality of life after pediatric fractures of the lateral third of the clavicle is unknown. Given the trend in the literature toward surgical management of clavicular fractures in adults, we frequently receive referrals for surgical management of lateral clavicular fractures in children.
Therefore, we examined (1) the health-related quality of life of patients who sustained a fracture of the lateral third of the clavicle in childhood and who were treated at a large regional pediatric trauma center, (2) if the health-related quality of life was associated with the age at the time of the injury, and (3) whether fracture and displacement patterns were associated with health-related qualify of life.

Methods:
This is a retrospective case series. We were able to identify 69 patients (21 girls and 48 boys) who sustained a fracture of the lateral third of the clavicle between the period spanning from January 2004 to June 2015. These patients were asked to fill in a questionnaire that included the Quick version of the Disability of Arm, Shoulder, and Hand (DASH) (primary outcome) and the Pediatric Quality of Life Inventory (Peds-QL). Until July 2017, we were able to get a response from 56 of these patients, resulting in a follow-up of 81%.

Results:
Treatment was conservative in all cases but one. In these cases, after a mean follow-up of 6.5 years (range, 1 to 13.2 y), the mean Quick-DASH was 1.2 (SD, 4.4) at a scale of 0 to 100, with lower values representing better quality of life. The mean physical function score of the Peds-QL was 97.8 (SD, 4.4), and the mean psychosocial function score was 91.8 (SD, 10.8), both at a scale of 0 to 100, with higher values representing better quality of life.
There was no statistically significant association of age at the time of injury on the primary outcome Quick-DASH.
There were no statistically significant associations between fracture or displacement patterns with regard to health-related quality of life.

Conclusions:
Conservative treatment of lateral clavicular fractures in children and adolescents is associated with excellent health-related quality of life, as measured with the disease-specific Quick-DASH and the non–disease-specific Peds-QL at a mean follow-up of 6.5 years (range, 1 to 13.2 y). There was no effect of age at the time of injury, and we were unable to identify associations to commonly analyzed risk factors, such as displacement patterns.
As the conservative treatment of this type of fracture in children and adolescents is associated with such a good health-related quality of life, it is unlikely that these results could be further improved by surgical interventions.

Level of evidence:
Level IV—case series.
Risk Factors for Rapidly Progressive Neurological Deterioration in Cervical Spondylotic Myelopathy
Authors: Takasawa Eiji , Sorimachi Yasunori , Iizuka Yoichi , Tsunoda Daisuke , Mieda Tokue , Iizuka Haku , Chikuda Hirotaka 
Published: January 2019

Study Design.
A retrospective single-center study.

Objective.
This study sought to clarify the risk factors and to evaluate the surgical outcome in patients with rapidly progressive cervical spondylotic myelopathy (rp-CSM).

Summary of Background Data.
CSM is a degenerative spine disease presenting a slow development of myelopathy. Some patients, however, show rapidly progressive neurological deterioration (especially gait disturbances) without any trauma. At present, there is little information about this condition.

Methods.
We studied 71 consecutive CSM patients (52 men, 19 women) with a mean age of 67.1 years, and the follow-up period was 1 year. Patients were divided into two groups: rp-CSM and chronic-CSM (c-CSM) groups. The Japanese Orthopaedic Association score and various clinical differences, including age, sex, comorbidity, the waiting period from symptomatic onset to surgery, cervical range of motion, and intramedullary MR T2-hyperintensity were analyzed, and independent risk factors were determined using a logistic regression analysis.

Results.
Eighteen of 71 patients (25.4%) were diagnosed with rp-CSM. There were no significant differences between the two groups with regard to age, sex, or cervical range of motion. In the rp-CSM group, the preoperative upper/lower extremities and bladder functions were worse, and the waiting period for surgery was shorter (rp-CSM 1.2 mo, c-CSM 25.7 mo). Patients with rp-CSM had a history of cardiovascular event (CVE) (rp-CSM 44.4%, c-CSM 15.1%) and presented with MR T2-hyperintensity (rp-CSM 94.4%, c-CSM 58.5%), especially at the C4/5 disc level. Independent risk factors were a history of CVE (odds ratio = 4.7) and MR T2-hyperintensity (odds ratio  = 12.5). The rp-CSM group showed a better neurological recovery after decompression surgery (the Japanese Orthopaedic Association recovery rate: rp-CSM 64.5%, c-CSM 40.7%).

Conclusion.
A history of CVE and MR T2-hyperintensity were risk factors for rp-CSM. Despite rapid neurological deterioration, rp-CSM patients showed a good neurological recovery after surgery, and thus indicating that rp-CSM is a reversible condition.

Level of Evidence: 4
Long-term Tumor Control With Radiotherapy for Symptomatic Hemangioma of a Vertebral Body
Authors: Parekh Akash Dipak , Amdur Robert J. , Mendenhall William M. , Morris Christopher G. , Zlotecki Robert A. 
Published: January 2019

Study Design.
Retrospective outcomes review.

Objective.
To analyze and report long-term outcomes in a cohort of patients treated with radiotherapy (RT) for symptomatic hemangioma of a vertebral body.

Summary of Background Data.
Data are scarce on the rate of tumor control with long-term (>5 yr) follow-up after RT for symptomatic hemangioma of a vertebral body.

Methods.
We retrospectively reviewed the medical records of patients treated at our institution between 1971 and 2008 for symptomatic hemangioma of a vertebral body, updated their follow-up, analyzed complications, and calculated the tumor control rate. Tumor control by imaging was defined as no increase in tumor size on computed tomography (CT) or magnetic resonance (MR) scan. Clinical tumor control was defined as no symptoms of recurrent tumor.

Results.
Ten patients were eligible for analysis. All patients had pain from visible hemangioma at the time of radiotherapy for which surgical resection or interventional radiology procedures were likely to result in high morbidity. Tumors were located in the lumbar (40%), thoracic (50%), or cervical (10%) areas of the spine. The mean radiotherapy dose delivered was 47 Gy.
Mean imaging follow-up after completion of radiotherapy was 8.1 years; mean clinical follow-up was 21.2 years. The tumor control rate was 90% (9/10). One patient who may have developed a tumor recurrence had radiographic and clinical evidence of tumor progression 30 years after radiotherapy. The actuarial rate of tumor control was 100% at 5, 10, 20, and 25 years. There was no grade more than or equal to three treatment toxicities, no evidence of malignant transformation, and no evidence of second tumors in treatment area (with the possible exception of the one tumor recurrence).

Conclusion.
RT for symptomatic hemangioma of the spine provides long-term tumor control with a low risk of serious complications. Radiotherapy is a good option when surgery or an interventional radiology procedure is high-risk. Our preferred dose is 45 Gy at 1.8 Gy/fraction.

Level of Evidence: 4
Artificial Intelligence Based Hierarchical Clustering of Patient Types and Intervention Categories in Adult Spinal Deformity Surgery
Authors: Ames Christopher P. , Smith Justin S. , Pellisé Ferran , Kelly Michael , Alanay Ahmet , Acaroğlu Emre , Pérez-Grueso Francisco Javier Sánchez , Kleinstück Frank , Obeid Ibrahim , Vila-Casademunt Alba , Shaffrey Christopher I. , Burton Douglas , Lafage Virginie , Schwab Frank , Shaffrey Christopher I. , Bess Shay , Serra-Burriel Miquel 
Published: January 2019

Study Design.
Retrospective review of prospectively-collected, multicenter adult spinal deformity (ASD) databases.

Objective.
To apply artificial intelligence (AI)-based hierarchical clustering as a step toward a classification scheme that optimizes overall quality, value, and safety for ASD surgery.

Summary of Background Data.
Prior ASD classifications have focused on radiographic parameters associated with patient reported outcomes. Recent work suggests there are many other impactful preoperative data points. However, the ability to segregate patient patterns manually based on hundreds of data points is beyond practical application for surgeons. Unsupervised machine-based clustering of patient types alongside surgical options may simplify analysis of ASD patient types, procedures, and outcomes.

Methods.
Two prospective cohorts were queried for surgical ASD patients with baseline, 1-year, and 2-year SRS-22/Oswestry Disability Index/SF-36v2 data. Two dendrograms were fitted, one with surgical features and one with patient characteristics. Both were built with Ward distances and optimized with the gap method. For each possible n patient cluster by m surgery, normalized 2-year improvement and major complication rates were computed.

Results.
Five hundred-seventy patients were included. Three optimal patient types were identified: young with coronal plane deformity (YC, n = 195), older with prior spine surgeries (ORev, n = 157), and older without prior spine surgeries (OPrim, n = 218). Osteotomy type, instrumentation and interbody fusion were combined to define four surgical clusters. The intersection of patient-based and surgery-based clusters yielded 12 subgroups, with major complication rates ranging from 0% to 51.8% and 2-year normalized improvement ranging from −0.1% for SF36v2 MCS in cluster [1,3] to 100.2% for SRS self-image score in cluster [2,1].

Conclusion.
Unsupervised hierarchical clustering can identify data patterns that may augment preoperative decision-making through construction of a 2-year risk–benefit grid. In addition to creating a novel AI-based ASD classification, pattern identification may facilitate treatment optimization by educating surgeons on which treatment patterns yield optimal improvement with lowest risk.

Level of Evidence: 4