bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biomechanical Comparison of Intrapelvic and Extrapelvic Fixation for Acetabular Fractures Involving the Quadrilateral Plate
Authors: Gillispie Gregory J. , Babcock Sharon N. , McNamara Kyle P. , Dimoff Michaela E. , Aneja Arun , Brown Philip J. , Carroll Eben A. 
Published: October 2017

Objectives:
Elderly patients represent the fastest growing and most difficult to treat population sustaining acetabular fractures. When treated surgically, isolated extrapelvic or combined intrapelvic–extrapelvic constructs may be used. No biomechanical or clinical study has compared the merits of these 2 techniques in cadaveric models. This research aims to biomechanically quantify the additional benefit of intrapelvic fixation to a standard extrapelvic fixation construct.

Methods:
Ten cadaveric pelves underwent standardized anterior column and quadrilateral plate fracture creation. One hemipelvis from each subject received isolated extrapelvic fixation, whereas the other received adjunctive intrapelvic fixation. Specimens were then subjected to a 50% of body weight (BW) nondestructive stiffness test followed by loading to failure. For the 50% BW test, displacement at 50% BW and stiffness were calculated. For the load to failure test, stiffness, elastic energy, and plastic energy were calculated. Yield point, force at clinical failure (defined at 2 mm of displacement), and maximum force were also identified. A Wilcoxon matched-pairs t test was used to compare fixation groups.

Results:
The addition of an intrapelvic plate improved construct performance for all test parameters. A statistically significant difference (P < 0.05) was reached for yield force, maximum force, and plastic energy.

Conclusions:
These findings demonstrate that the addition of intrapelvic plating may offer distinct advantages in prevention of catastrophic construct failure in situations in which significant lateral to medial force is applied to the greater trochanter such as patient falling.
The Community Orthopaedic Surgeon Taking Trauma Call: Pediatric Phalangeal Fracture Pearls and Pitfalls
Authors: Abzug Joshua M. , Mehlman Charles T. 
Published: October 2017

Summary:
Pediatric phalangeal fractures are extremely common, especially among toddlers and older children/adolescents involved in sporting activities. The physical examination must include an assessment for deviation and malrotation. In addition, concomitant injuries must be assessed for such as tendon and/or neurovascular injuries. Plain radiographs are typically sufficient to make the diagnosis and determine the treatment. The majority of pediatric and adolescent phalangeal fractures can be treated with immobilization. Substantial deviation and malrotation must be addressed with closed reduction techniques with or without percutaneous pinning. Open reduction is reserved for cases with concomitant injuries, open fractures, older adolescents, and patients in whom an adequate closed reduction cannot be obtained. When diagnosed and treated appropriately, pediatric and adolescent phalangeal fractures typically result in excellent outcomes.
The Correlation Between the OTA/AO Classification System and Compartment Syndrome in Both Bone Forearm Fractures
Authors: Auld Thomas S. , Hwang John S. , Stekas Nicholas , Gibson Peter D. , Sirkin Michael S. , Reilly Mark C. , Adams Mark R. 
Published: October 2017

Objective:
To evaluate the efficacy of using the Orthopaedic Trauma Association (OTA/AO) classification for both bone forearm fractures in predicting compartment syndrome.

Design:
Retrospective cohort.

Setting:
Level 1 Academic Trauma Center.

Patients/Participants:
One hundred fifty-one patients 18 years of age and older, with both bone forearm fractures diagnosed from 2001 to 2016 were categorized based on the OTA/AO classification. Patients with both bone fractures caused by gunshot wounds were excluded.

Main Outcome Measurements:
The endpoint for our study was whether forearm fasciotomies were performed based on the presence of compartment syndrome.

Results:
Of a total of 151 both bone forearm fractures, 15% underwent fasciotomy. Six of 80 (7.5%) grouped 22-A3, 8 of 44 (18%) grouped 22-B3, and 9 of 27 (33%) grouped 22-C underwent fasciotomies for compartment syndrome (P = 0.004). The relative risks of developing compartment syndrome for group 22-B3 versus 22-A3 was 2.42 (P = 0.08), 22-C versus 22-B3 was 1.83 (P = 0.15), and 22-C versus 22-A3 was 4.44 (P = 0.002).

Conclusions:
There is a significant correlation between the OTA/AO classification and the need for fasciotomies, with group C fractures representing the highest risk. Clinicians can use this information to have a higher index of suspicion for compartment syndrome based on OTA/AO classification to help minimize the risk of a missed diagnosis.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Increased Incidence of Vascular Injury in Obese Patients With Knee Dislocations
Authors: Johnson Joey P. , Kleiner Justin , Klinge Stephen A. , McClure Philip K. , Hayda Roman A. , Born Christopher T. 
Published: October 2017

Objectives:
With rising rates of obesity in the United States, the burden of knee dislocations in this population remains unknown. This national epidemiologic study was designed to analyze the association of obesity with closed knee dislocation and vascular complications.

Design:
Retrospective cohort study.

Setting:
The deidentified Nationwide Inpatient Sample database was used to access the US inpatient data from 2000 to 2012.

Patients/Participants:
Patients with noncongenital closed knee dislocations were included. Examined variables included patient age, sex, vascular injury, and obesity status.

Main Outcome Measures:
Outcome measures included hospital length of stay, amputation, and inpatient hospitalization charge.

Results:
From 2000 to 2012, a total of 19,087 knee dislocations were identified, including 2265 in overweight/obese patients (11.9%). The annual incidence of knee dislocations reported in patients diagnosed as either obese or morbidly obese increased over the 13-year period (P < 0.0001). The overall average rate of vascular injury requiring intervention was 5.63%, whereas 7.2% of obese patients and 11.3% of morbidly obese patients with knee dislocations (P < 0.0001) sustained a vascular injury requiring intervention. The average length of stay and amputation rate for obese and morbidly obese patients who sustained a knee dislocation was not statistically different from nonobese patients when vascular injury was controlled. When patients with a vascular injury were excluded, obese and morbidly obese patients who sustained a knee dislocation had higher average cost of hospital stay than nonobese patients (P = 0.0262).

Conclusions:
This study demonstrates significant increases in costs of stay with obese patients sustaining knee dislocations when compared with normal weight knee dislocation patients. Vascular injuries were found to be far more common in obese and morbidly obese patient groups than nonobese patients. Providers should be on high alert when managing knee dislocations in obese patients because a significant number require prompt vascular intervention.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Is S3 a Viable Osseous Fixation Pathway?
Authors: Eastman Jonathan G. , Adams Mark R. , Frisoli Kendall , Chip Routt Milton L. 
Published: October 2017

Objectives:
To report the incidence of patients with a third sacral segment (S3) osseous fixation pathway (OFP) that could accommodate a transiliac-transsacral screw.

Design:
Retrospective case series.

Setting:
Regional Level 1 Trauma Center.

Patients/Participants:
A total of 250 patients without pelvic trauma from January 2017 to February 2017 were included.

Intervention:
The axial and sagittal reconstruction images of each patient's computed abdomen and pelvis tomography (CT) scans were reviewed.

Main Outcome Measurements:
Each CT was evaluated for the presence of sacral dysmorphism and whether an S3 OFP that could accommodate an intraosseous transiliac-transsacral screw exists.

Results:
There were 130 of the 250 patients (52%) with sacral dysmorphism. Overall, 38 of the 250 patients (15.2%) had an S3 OFP that could accommodate a 7.0-mm transiliac-transsacral style screw. When narrowed to patients who had an S3 OFP, 38 of 153 patients (24.8%) could accommodate a 7.0-mm transiliac-transsacral screw. Specific to the 38 patients with an adequate S3 OFP, 34 of 38 patients (89.5%) were noted to have sacral dysmorphism.

Conclusions:
Our study demonstrates that 15.2% of patients have an S3 OFP large enough to accommodate an intraosseous implant. Patients who have sacral dysmorphism are more likely to have an adequate S3 OFP. Additional studies are needed to quantify the S3 OFP, understand the bone quality of the S3 segment and accompanying biomechanical implications, and investigate the anatomical concerns associated with S3 screw placement.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Early Surgery Confers 1-Year Mortality Benefit in Hip-Fracture Patients
Authors: Maheshwari Kamal , Planchard Jeffrey , You Jing , Sakr Wael Ali , George Jaiben , Higuera-Rueda Carlos A. , Saager Leif , Turan Alparslan , Kurz Andrea 
Published: October 2017

Background:
To evaluate the relationship between surgical timing and 1-year mortality in patients requiring hip fracture repair.

Methods:
We analyzed all 720 patients (>65 years) who had hip fracture surgery between March 2005 and February 2015, identifying patients by ICD-9 diagnosis and procedure codes using electronic data query. Mortality data were obtained from the institutional database, state and Social Security Death Indices. The relationship between surgical timing (defined as the interval from admission to the start of surgery) and 1-year mortality was assessed using a multivariable logistic regression, adjusting for baseline clinical status and surgical factors.

Results:
Among the 720 patients, 159 patients (22%) died within 1 year. The median time from admission to surgery was 30 hours. A linear relationship between the surgical timing and 1-year mortality was demonstrated. Delaying surgery was significantly associated with increased 1-year mortality, odds ratio 1.05 (95% CI: 1.02–1.08) per 10-hour delay (P = 0.001).

Conclusions:
A linear relationship was observed between surgical timing and 1-year mortality. Each 10-hour delay from admission to surgery was associated with an estimated 5% higher odds of 1-year mortality. Therefore, we suggest that hip fractures should be treated urgently similar to other time-sensitive pathology such as stroke and myocardial ischemia.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Implant Density at the Apex Is More Important Than Overall Implant Density for 3D Correction in Thoracic Adolescent Idiopathic Scoliosis Using Rod Derotation and En Bloc Vertebral Derotation Technique
Authors: Delikaris Alexandre , Wang Xiaoyu , Boyer Laure , Larson A. Noelle , Ledonio Charles G.T. , Aubin Carl-Eric 
Published: October 2017

Study Design.
Biomechanical analysis of 3D correction and bone–screw forces through numerical simulations of scoliosis instrumentation with different pedicle screw patterns.

Objective.
To analyze the effect of different screw densities and distributions on 3D correction and bone–screw forces in adolescent idiopathic scoliosis (AIS) instrumentation.

Summary of Background Data.
Instrumentation constructs with various numbers of pedicle screws and patterns have been proposed for thoracic AIS instrumentation. However, systematic biomechanical studies have not yet been completed on the appropriate screw patterns for optimal 3D correction.

Methods.
Patient-specific biomechanical models of the spine were created for 10 AIS cases (Lenke 1). For each case, surgical instrumentation patterns were computationally simulated using respectively a reference screw pattern (two screws per level fused) and six alternative screw patterns with fewer screws. Simulated surgical maneuvers and model definition were unchanged between simulations except the number and distribution of screws. 3D correction and bone–screw forces were compared.

Results.
A total of 140 posterior instrumentations were computationally simulated. Mean corrections in the coronal and sagittal planes with alternative screw patterns were within 4° to the reference pattern. Increasing screw density in the apical region from one to two screws per level improved percent apical vertebral rotation (AVR) correction (r = 0.887, P < 0.05). Average bone–screw force associated with the reference screw pattern was 243N ± 54N and those with the alternative screw patterns were 11% to 48% lower.

Conclusion.
Compared with the reference maximal screw density pattern, alternative screw patterns allowed similar corrections in the coronal and sagittal planes. AVR correction was strongly correlated with screw density in the apical region; AVR correction varied significantly with screw patterns of the same overall screw density when an en bloc vertebral derotation technique was simulated. High screw density tended to overconstrain the instrumented spine and resulted in higher forces at the bone–screw interface.

Level of Evidence: N/A
Histopathology of Calciphylaxis: Cohort Study With Clinical Correlations
Authors: Chen Tiffany Y. , Lehman Julia S. , Gibson Lawrence E. , Lohse Christine M. , el-Azhary Rokea A. 
Published: October 2017

Abstract:
Calciphylaxis is a rare, painful, and life-threatening condition with a high mortality rate. Although the etiology of calciphylaxis is not well understood, it has been proposed that calcium deposition within and around subcutaneous vessels restricts blood flow chronically, thereby predisposing the patient to acute pannicular and dermal thrombosis. Given increasing recognition of the role of hypercoagulability in calciphylaxis, this retrospective cohort study sought to evaluate the presence of thromboses and dermal angioplasia in calciphylaxis. Moreover, we aimed to validate previous observations about the histopathology of calciphylaxis compared with skin biopsies from patients with end-stage renal disease but without calciphylaxis. After a meticulous clinical chart review, we assessed the corresponding skin biopsies for the presence of vessel calcification, thromboses, and dermal angioplasia in skin biopsies from patients with calciphylaxis (n = 57) and compared with those from patients with end-stage renal disease but without calciphylaxis (n = 26). Histopathologic findings were correlated with clinical features such as chronic kidney disease, diabetes, or associated malignancy. Our results validated a prior observation that calciphylaxis was significantly more likely to show calcification of dermal vessels and diffuse dermal thrombi. This study reports the frequent finding of dermal angioplasia, a potential marker of chronic low-grade ischemia, as another frequent microscopic finding in calciphylaxis. Among cases of calciphylaxis, histopathologic changes in patients with chronic kidney disease were indistinguishable from those in patients without chronic kidney disease, thereby implying a final common pathogenic pathway in both uremic and nonuremic calciphylaxis. In future, larger, prospective studies may be useful in validating these findings.
Primary Cutaneous Sarcomatoid Anaplastic Lymphoma Kinase-Positive Anaplastic Large-Cell Lymphoma With Linear Distributional Lesions
Authors: Chen Hao , Xiong Jing-shu , Sheng Nan , Zong Wen-kai , Wang Yi-hua , Li Min , Sun Jian-fang 
Published: October 2017

Abstract:
We report a case of cutaneous anaplastic lymphoma kinase-positive anaplastic large-cell lymphoma (ALCL) with linear distributional lesions and sarcomatoid histologic features. A sarcomatoid variant is the rarest morphological pattern of ALCL. Interestingly, the morphology of tumor cells in the present case transitioned from a sarcomatoid variant of ALCL at first diagnosis to a classic variant at relapse. The case is a diagnostic challenge considering both the clinical and histologic aspects. Awareness of the sarcomatoid variant of ALCL and its morphological changes can lead to a correct diagnosis.
Randomized, Evaluator-Blinded Study Comparing Safety and Effect of Two Hyaluronic Acid Gels for Lips Enhancement
Authors: Hilton Said , Sattler Gerhard , Berg Anna-Karin , Samuelson Ulf , Wong Cindy 
Published: October 2017

BACKGROUND
Hyaluronic acid (HA) fillers may differ in terms of gel characteristics and ease of use and it is of interest whether this might affect safety and duration of effect.

OBJECTIVE
To compare the long-term safety and effect of 2 HA fillers produced by 2 different technologies for lip enhancement.

MATERIALS AND METHODS
Subjects with very thin to moderately thick lips were randomized and treated with HA-RK (N = 31) or HA-JV (N = 29) to improve lip fullness by ≥ 1 grade on a 5-point scale, using a maximum of 3 mL of product.

RESULTS
A smaller volume of HA-RK compared with HA-JV was required to improve lip fullness by ≥ 1 grade (mean: 1.54 mL vs 1.94 mL, p < .001). Despite the smaller volume, lip fullness and global aesthetic improvement were comparably sustained in both groups. At 6 months, 60.0% versus 57.7% of subjects (HA-RK vs HA-JV) had improved lip fullness. At 12 months, 71.4% versus 76.0% had aesthetic improvement (blinded evaluations) and 85.7% versus 86.2% felt more attractive. Both products were well tolerated.

CONCLUSION
Both products achieved durable improvement in lip fullness and aesthetic appearance. A significantly smaller amount of HA-RK was required compared with HA-JV to achieve optimal treatment effect.
Atypical Melanocytic Proliferations: A Review of the Literature
Authors: Ensslin Courtney J. , Hibler Brian P. , Lee Erica H. , Nehal Kishwer S. , Busam Klaus J. , Rossi Anthony M. 
Published: October 2017

BACKGROUND
Ambiguous histopathologic diagnoses represent a challenge for clinicians because of a lack of definitive diagnosis and related uncertainty about management.

OBJECTIVE
To review the literature on atypical melanocytic proliferations and detail synonymous terms, epidemiology, diagnostic work-up, histopathology, treatment, and prognosis.

METHODS
Databases from PubMed and Web of Science were searched for articles related to atypical melanocytic proliferations.

RESULTS
Intraepidermal melanocytic proliferations with features worrisome for possible melanoma in situ (MIS) are generally excised as for MIS. Reported rates of upstaging of such cases to invasive melanoma on review of the excision are very low. Because invasion, lymph node spread, and metastasis can occur in atypical melanocytic lesions with a thick intradermal component, these are often treated as for malignant melanoma.

CONCLUSION
Because the diagnosis dictates treatment, it is incumbent to establish a diagnosis as definitive as possible, obtaining second or third opinions and using ancillary studies when appropriate. When the diagnosis remains uncertain, it is difficult to provide guidelines for treatment. Clinical care decisions for patients with an uncertain diagnosis are best done on a case-by-case basis weighing probabilities of adverse outcomes against potential benefits and risks from various treatment options.
Hyaluronic Acid Gel With (HARRL) and Without Lidocaine (HAJU) for the Treatment of Moderate-to-Severe Nasolabial Folds: A Randomized, Evaluator-Blinded, Phase III Study
Authors: Fagien Steven , Monheit Gary , Jones Derek , Bank David , Sadick Neil , Nogueira Alessandra , Mashburn Jay H. 
Published: October 2017

BACKGROUND
Hyaluronic acid (HA) dermal fillers are frequently used to correct or smooth facial wrinkles and folds such as nasolabial folds.

OBJECTIVE
To compare the efficacy and safety of 2 HA gels, formulated by 2 different manufacturing processes: XpresHAn Technology (HARRL [with lidocaine]) and Hylacross technology (HAJU—a comparator product without lidocaine).

PATIENTS AND METHODS
One hundred seventy subjects with bilateral nasolabial folds rated as moderate or severe, according to the Wrinkle Severity Rating Scale (WSRS), received injections of HARRL in the nasolabial folds on one side of the face and HAJU on the other side. Investigator- and subject-assessed wrinkle severity was measured up to 48 weeks after final injection.

RESULTS
HARRL exhibited a similar safety and efficacy profile compared with HAJU. Noninferiority of HARRL was demonstrated at 24 weeks (WSRS mean change from baseline mean difference −0.1 [95% confidence interval: −0.15, 0.01], p = .090). Incidence of adverse events was 40% for both treatments.

CONCLUSION
HARRL exhibited a similar safety and efficacy profile compared with HAJU.
Impact of National Comprehensive Cancer Network Guidelines on Case Selection and Outcomes for Sentinel Lymph Node Biopsy in Thin Melanoma
Authors: Nguyen Bichchau , Karia Pritesh S. , Hills Victoria M. , Besaw Robert J. , Schmults Chrysalyne D. 
Published: October 2017

BACKGROUND
In 2010, the National Comprehensive Cancer Network (NCCN) recommended sentinel lymph node biopsy (SLNB) for thin melanomas ≤1 mm with mitotic rate (MR) ≥1. In 2016, the criteria were changed to Breslow depth >0.75 mm and MR ≥1.

OBJECTIVE
To compare the impact of 2010 and 2016 NCCN guidelines on SLNB case selection and thin melanoma outcomes.

MATERIALS AND METHODS
Ten-year retrospective cohort of primary thin melanomas at an academic hospital was retroactively stratified for SLNB eligibility using the 2010 and 2016 NCCN guidelines. Nodal recurrence-free survival (NRFS) and disease-free survival (DFS) were compared.

RESULTS
Eight hundred two patients with 859 tumors and median follow-up of 79 months were included. Eleven percent fewer tumors qualified for SLNB under 2016 versus 2010 NCCN guidelines (19% vs 8%, p < .001). The 2016-qualifying cases also had lower 10-year NRFS (70.7% vs 95.2%, p < .001) and DFS (64.7% vs 91.4%, p < .001). Among 2016-qualifying cases, those that received SLNB had improved NRFS (85.6% vs 35.3%, p = .001) and DFS (80.2% vs 30.5%, p < .001) as compared to those that did not receive SLNB.

CONCLUSION
The 2016 NCCN guidelines reduced the number of thin melanomas qualifying for SLNB and more accurately selected cases with higher risks of nodal recurrence and death.
Cohesion of Hyaluronic Acid Fillers: Correlation Between Cohesion and Other Physicochemical Properties
Authors: Edsman Katarina L.M. , Öhrlund Åke 
Published: October 2017

BACKGROUND
There are several published articles on characterization of fillers, describing methods for both chemical and physicochemical characterization. Recently a lot of focus has been on the development of methods for measuring cohesion of hyaluronic acid (HA) fillers.

OBJECTIVE
The aim of this study is to investigate and compare the drop-weight method and the correlation between cohesion and other physicochemical properties using a variety of HA fillers.

MATERIALS AND METHODS
HA fillers covering several product families and manufacturing techniques were used. The HA fillers also covered a range of HA concentrations from 12 to 24 mg/mL. Cohesion was determined using sensory evaluation and the drop-weight method. Other physicochemical properties evaluated were rheology and the swelling factor.

RESULTS
In this study, it was verified that values obtained by the drop-weight method reflect the perceived cohesion very well. The correlation with rheology is affected by the HA concentration in the products. A remarkably good correlation between swelling factor and cohesion was found.

CONCLUSION
Cohesion correlates with other physicochemical methods. It could be discussed whether there is a need for a separate cohesion method because other already established physicochemical methods such as rheology and swelling factor can describe the underlying properties that affect cohesion.