bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correction of Ankle and Hindfoot Deformities by Supramalleolar Osteotomy
Authors: Sen Cengiz , Kocaoglu Mehmet , Eralp Levent , Cinar Murat 
Published: January 2017

Ankle and hindfoot deformities in 11 patients with a mean age of 15 (range, four to 35) have been gradually corrected by an Ilizarov external fixator. In all patients, supramalleolar osteotomy was utilized by percutaneous drilling and osteotomy technique. The patients were evaluated clinically by the AOFAS scoring system and radiologically by malorientation and malalignment tests described by Paley. The purpose of the current study is to evaluate the efficacy of supramalleolar osteotomy and correction by an Ilizarov device in treating hindfoot and ankle deformities. The mean external fixation period was five (2.5 to eight) months. The mean interval between the operation and last follow-up examination was 19 (13 to 26) months. The patients improved an average of 30 points after the operation regarding to AOFAS score. A plantigrade foot was achieved in the whole group. Radiologically, no malalignment or malorientation was measured. Equal leg lengths were achieved in all nine patients with one exception. Complications were graded after Paley as minor problems in 11 patients and as obstacles requiring surgical interventions in four patients. Sequelae remained in only one patient. Ankle and hindfoot deformities caused by various etiologies are complicated by poor soft tissue condition and a short foot. A supramalleolar osteotomy and Ilizarov external fixator can safely and effectively correct these deformities.
Flexor Hallucis Longus Transfer for Repair of Chronic Achilles Tendinopathy
Authors: Tashjian Robert Z. , Hur John , Sullivan Raymond J. , Campbell John T. , DiGiovanni Christopher W. 
Published: January 2017

Background: The flexor hallucis longus (FHL) tendon has been used to augment the repairs for chronic Achilles tendinopathy. Two common methods of FHL harvesting include a single incision (posterior) technique and a double incision (posterior and medial utility) technique. This cadaver study was designed to measure and compare the lengths of FHL tendon obtainable for reconstruction with each technique. Methods: Fourteen fresh-frozen cadaver lower limbs were utilized for FHL harvest. The tendon was first exposed through the single posterior-medial incision approach adjacent to the Achilles. A second medial utility midfoot incision was then made and the FHL was marked at the level of Henry's knot with a suture, to approximate the level of potential harvest via a two-incision technique. The FHL was then harvested and delivered into the posterior wound. Single incision technique graft length was then measured from the tip of the calcaneal tuber to the level of transection. The remaining in situ tendon was then also measured between its level of transection and the more distal suture placed at Henry's knot. These two lengths were then combined to determine the total potential tendon graft length obtainable using a double incision technique. Results: The average length of the FHL tendon harvested through the single posterior incision technique measured 5.16 cm (range, 3.4–6.9 cm, SD = 1.29). The average total tendon graft length available using the double incision technique measured 8.09 cm (range, 5.1–11.1 cm, SD = 1.63). The difference between the lengths obtained from these two techniques was significant ( p < .001). Conclusions: These results demonstrate approximate FHL graft lengths obtainable by using either a single or double incision harvest technique and show that a significantly longer graft can be obtained using a double incision technique. Further data need to be obtained, however, to support whether the extra surgery and graft length obtained from a double incision technique are of any benefit in improving the ultimate functional outcome of these repairs.
Ankle Arthropathy of Hemochromatosis: A Case Series and Review of the Literature
Authors: Davies Mark B. , Saxby Terry 
Published: January 2017

Background: Genetic hemochromatosis is a relatively common disease that may present as an arthropathy. In particular, arthropathy of the ankle is invariably bilateral and occurs in young men. However, the orthopaedic management of this condition has been poorly documented. Methods: Four patients with hemochromatic ankle arthropathy were treated with unilateral mobile bearing total ankle arthroplasty. Results: All four patients had good relief of symptoms after arthroplasty. Conclusions: Hemochromatosis should be considered when symmetrical ankle arthropathy occurs in a young man. Early diagnosis is necessary to prevent extra-articular progression of the disease and inappropriate management.
Postoperative Second Metatarsal Fractures Associated With Suture-Button Implant in Hallux Valgus Surgery
Authors: Weatherall Justin M. , Chapman Cary B. , Shapiro Steven L. 
Published: January 2017

Background: The purpose of this study was to perform a retrospective review of a nonosteotomy technique for the reduction of the intermetatarsal (IM) angle in hallux valgus (HV) surgery using a modified nonabsorbable suture-button implant previously described for ankle syndesmotic injuries and to report on the outcomes and complications associated with this technique. Methods: A retrospective review was performed of consecutive patients with a minimum follow-up of 1 year. Twenty-five patients, a total of 25 feet, were identified with a mean follow-up of 22.5 months. The mean age was 60 years. The pre- and postoperative HV and IM angles were compared. Each postoperative radiograph was assessed for loss of correction, implant failure, and second metatarsal (MT) stress fracture. The postoperative hallux American Orthopaedic Foot & Ankle Society (AOFAS) scores were obtained at the patient’s final follow-up visit. Statistics were performed using the paired Student t test with the P value set at .05 to determine statistical differences. Results: The preoperative mean IM and HV angles were 15.1 and 30.5 degrees, respectively. The postoperative mean IM and HV angles were 8.2 and 10.2 degrees, respectively. The reductions in the IM and HV angles were statistically significant ( P < .05). The average postoperative AOFAS hallux score was 85. Two patients developed hallux varus (8%). Eight patients (32%) developed second metatarsal stress fractures. One patient (4%) with a second metatarsal stress fracture had a failure of the implant that required implant removal. The remaining stress fractures healed uneventfully. Conclusion: Suture-button fixation in hallux valgus achieved a satisfactory reduction in the first–second intermetatarsal angle compared with first metatarsal osteotomies but was associated with a high rate of second metatarsal stress fractures. Level of Evidence: Level IV, retrospective case series.
Operative Treatment of Freiberg Disease Using Extra-articular Dorsal Closing-Wedge Osteotomy
Authors: Lee Hyun-Joo , Kim Jeong-Woo , Min Woo-Kie 
Published: January 2017

Background: Extra-articular dorsal closing wedge osteotomy has been used with successful results for Freiberg disease; however, there has been concern regarding the technical difficulty. The purpose of this study was to address technical tips and report on the clinical and radiographic outcome using Kirchner wire–assisted dorsal closing wedge osteotomy. Methods: A retrospective review of 13 patients with a mean age of 29.1 years was conducted. Extra-articular dorsal wedge osteotomy was performed after debridement of the joint. Two Kirschner wires were inserted and used as a joystick to manipulate the osteotomized bone. The osteotomy site was fixed with crossed pins. Clinical outcome was assessed according to American Orthopaedic Foot and Ankle Society score, range of motion of the metatarsophalangeal joint, and visual analogue scale. Head necrosis was classified according to Smillie stage; time to bone union and metatarsal shortening were reviewed. Patients were followed for a mean period of 44.2 months. Results: Mean American Orthopaedic Foot and Ankle Society score at the latest follow-up was 92.2 (range, 92-100). The range of motion of the metatarsophalangeal joint showed a mean increase of 6.2 degrees (range, –10 to 25) at the latest follow-up. The mean visual analogue scale score decreased from 7.5 (range, 5-10) preoperatively to 1 (range, 0-4) at the latest follow-up ( P < .01). All osteotomies healed on average after 7.0 weeks (range, 4-13.6) without nonunion. The average metatarsal shortening was 0.5 mm (range, –3.1 to 3.5). None of the patients showed progression of osteonecrosis or joint space narrowing. Conclusion: Extra-articular closing dorsal wedge osteotomy can yield good articular congruity with bone remodeling, with easy performance of the procedure with temporary Kirschner wires without complication. Level of Evidence: Level IV, retrospective case series.
The Relationship between Size and Performance of Primary Care Organisations in England
Authors: Wilkin David , Bojke Chris , Coleman Anna , Gravelle Hugh 
Published: January 2017

Objectives: To examine the relationship between the size and performance of primary care organisations, the effect of and the reasons for mergers. Methods: Data on size, proxy measures of performance and merger intentions for 71 organisations were extracted from telephone and mail surveys of primary care groups and trusts (PCG/Ts). Results: Of the 22 performance measures examined, only two were significantly associated with size, and over half were not associated with any of the potential explanatory variables. Most organisations (70%) were planning mergers. If all planned mergers take place, the mean size of primary care organisations will double to nearly 200 000. The main reasons for mergers were to make better use of resources and for PCGs to become PCTs. Conclusions: There is little evidence that the performance or efficiency of a primary care organisation is associated with its size. Optimal size may differ for different functions. Mergers are seen as a way of increasing management capacity and may reflect the desire of managers to manage large organisations. There is a risk that larger primary care organisations will recreate hierarchies and lose local ownership and participation.
Treatment of Rectal Mucosal Prolapse with Radiofrequency Coagulation and Plication — A New Surgical Technique
Authors: Gupta P. J. 
Published: January 2017

Background: This study was designed to assess the outcome of using a new technique of mucosal ablation using a radiofrequency device followed by its plication for rectal mucosal prolapse and to compare the results with those under the conventional ligature and excision procedure. Materials and Methods: The procedure of radiofrequency ablation and mucosal plication (RAMP) is described. A Ellman radiofrequency generator was used for the procedure. Out of the 46 patients with rectal mucosal prolapse, 24 patients were randomized to undergo ligature and excision procedure (LEP) and 22 were operated with RAMP. The operating time, amount of pain (VAS scale)[Primary end points], postoperative analgesic requirement, time to return to work, wound healing period and postoperative complications were documented. Results: Radiofrequency ablation and mucosal plication procedure on an average resulted in shorter operation time (9 vs. 32 minutes, p < 0.0001), shorter hospitalization (16 vs. 42 hours, p < 0.0001) significantly lesser postoperative pain, fewer cumulative requests for analgesia by the patients (21 vs. 54 tablets, p < 0.0001), earlier return to work (7 vs. 18 days, p < 0.0001) and faster wound healing time (14 vs. 35 days, p < 0.0001). The complication rate was 9 %with RAMP group and 29 %with LEP group. Conclusion: The procedure of radiofrequency ablation and plication of mucosa shows promising results in patients with rectal mucosal prolapse. Being safe, effective, and a swift technique, it can be proposed as an improved alternative to conventional surgical procedure.
Traumatic Injuries Associated with Horseback Riding
Authors: Carrillo E. H. , Varnagy D. , Bragg S. M. , Levy J. , Riordan K. 
Published: January 2017

Background: According to the Center for Disease Control and Prevention (CDC), an estimated 30 million people ride horses each year in the United States. Horseback riding related injuries are common, with an estimated 50,000 emergency room visits annually. The popularity of recreational horseback riding has increased in South Florida and the incidence of associated traumatic injuries is a reflection of this. Material and Methods: Retrospective review of patients admitted to a state designated Level I trauma center that sustained horseback riding associated injuries between January 2000 and December 2003. Information extracted from the Trauma Center's data base included demographics, mechanism of injury and toxicology screening. Results: During the review period, twenty-seven patients were identified. There were 12 men and 15 women. The average age was 36 years. The injuries occurred during pleasure riding in 23 patients and thoroughbred related activities in 4 patients. Multiple severe injuries were common and documented in 24 patients. All patients required hos-pitalization with an average stay of 5 days. Five patients had a positive toxicology screen on admission. No deaths were documented in this review. Conclusion: Horseback riding related injuries tends to be serious. Alcohol and recreational drugs may contribute to exacerbate the extent of these injuries. The use of proper protective equipment, instructions for safe riding, and discouraging drug and alcohol use during riding activities should be emphasized.
Enhanced Recoveryafter Colorectal Surgery. Results from Aprospective Observational Two-Centre Study
Authors: Miohn A. C. , Bernardshaw S. V. , Ristesund S.-M. , Hansen P. E. Hovde , Rœkke O. 
Published: January 2017

Background and Aims: Enhanced recovery after surgery (ERAS) has reduced the median hospital stay from 8–10 days with traditional peri-operative routines to four days. The aim of the present study was to introduce the principles of ERAS in our hospital and measure the effect on hospital stay, complications and quality of life after discharge from hospital. Material and Methods: 94 consecutive patients, 40 males, 54 females, median age 66 years, were included in a prospective non-randomised observational study at Haukeland University Hospital and Haugesund Hospital from October 2000 until February 2003. After a three-month preparation period, the principles of ERAS were implemented. The results were evaluated with questionnaires and by follow-ups 8–10 and 30 days after surgery. The results were compared to the results of colorectal surgery before introduction of accelerated recovery. Results: 45 (48%) and 73 (78%) patients were discharged within three and five days after surgery with ERAS, compared to zero and seven (5%) patients with traditional recovery. The complication rate with ERAS was 31%, and the readmission rate was 15%. After one week, 57% had resumed their daily activities at home. After 30 days, 65% of the patients had resumed their normal and leisure activities. Conclusion: After a proper preparation period, ERAS principles may be implemented in surgical department, and is followed by a reduced median hospital stay and rapid return to normal daily activities for most patients after colorectal surgery.
Stress among the Family Caregivers of Liver Transplant Recipients
Authors: Cohen Miri , Katz Dafna , Baruch Yaacov 
Published: January 2017

Context Family members of liver transplant patients continue caregiving activities for a lengthy period after transplantation. Objectives To assess the effect of stress-related factors on psychological distress and perceived health of family caregivers of liver transplant recipients. Setting and Participants Twenty-four caregivers of liver transplant recipients treated at a liver unit serving the northern part of Israel. Main Outcome Measures Pearlin's caregiving stress questionnaire was administered to assess the subscales of patients' symptoms as perceived by caregivers, caregiving activities, perceived overload, relational deprivation, personal gain, and social support; also, a depression questionnaire and a perceived caregivers' health questionnaire were administered to participants. Results Caregivers experienced considerable caregiving overload. Women reported performing more caregiving activities, higher perceived overload, and higher level of depression than men. Increasing passage of time since transplantation, higher perceived overload, higher sense of relational deprivation, and lower sense of personal gain were significantly associated with higher level of depression and worse perceived health. Perceived support and level of depression were not significantly associated with perceived health. Conclusions Caregiving stress endures after transplantation. Professional intervention is needed to improve caregivers' quality of life and, consequently, that of transplant recipients as well.
Segmental Identity and Vulnerability in Cerebral Arteries
Authors: Lasjaunias P.L. 
Published: January 2017

Clinical experience shows that certain diseases involve specific areas of the vascular tree and remarkably spare others. Topographic differences in the vascular environment already suggest a regional specificity of the vascular anatomy. The biological grounds of such regional differences, although unknown, can account for the specificity of biological responses to stimuli. Such segmental specificities are beyond morphological analysis. They create an invisible discontinuity in an apparently homogenous anatomical, histological and haemodynamic system. We call this property segmental identity and thus vulnerability. Most of this identity is established during development and is preserved throughout life; its expression, however, may vary over time according to various stresses and create various clinical phenotypes. The memory of the evolutionary steps and their chronology is imprinted on the arterial anatomy and thus potentially readable. One can postulate that since the age of each arterial segment is different, its resistance to time and stimuli is most likely variable. The vulnerability of these segments cannot be permanent both in a qualitative and quantitative way. Some genetic functions only seem to be active during a short period of time: during vasculogenesis for example. Therefore either the trigger is always active and the target vulnerability window of the cells time-limited, or the target is permanently exposed and the trigger agent can either be exogenous and rare, or most of the time inactive or inactivated.
Early Clinical Experience with a Dedicated Portable Computed Tomography Scanner in a Biplane Neuroangiography Suite: Assessment of Feasibility and Utility in Neurointerventional Practice
Authors: Mangla S. , Chaloopka J.C. , Huddle D.C. 
Published: January 2017

The ability to have on-site access to cross-sectional imaging in a biplane neuroangiography suite has tremendous potential for enhancing current neurointerventional practice. Although a few prototypical multimodality suites have been created, several problems/limitations have prevented widespread implementation. Recently, a portable CT scanner has been developed, which may overcome previous shortcomings. We review our recent clinical experience with this new modality, exploring numerous adjunctive diagnostic and therapeutic applications. Forty-one patients underwent periprocedural CT using the Tomoscan M/EG portable CT (Philips). The portable CT scanner is kept at the “head-end” of the biplane neuroangiography suite, being moved into position as needed before, after, or during a procedure. A pivoting angiographic table permits excellent z-plane mobility for rapid gantry to fluoroscopy positioning. Five mm slices at five mm increments were obtained. High quality images were obtained in all cases. The portable CT scanner could be quickly positioned and activated within five min. Total scanning time for a typical case, including initial positioning and set-up was 10–12 min. Twelve of 41 cases were performed adjunctively during diagnostic angiography; 29/41 were performed in an interventional setting. Twenty of 29 scan evaluated baseline or post-therapeutic status of the brain (e.g., Guglielmi detachable coil aneurysm obliteration, arteriovenous malformation (AVM) embolisation, local thrombolysis); 9/29 provided cross-sectional guidance to various interventions (direct puncture embolisation, percutaneous vertebroplasty, spinal biopsy, discography). Use of the portable CT scanner permitted rapidly accessible high quality cross sectional imaging within the biplane neuroangiography suite, which augmented diagnostic and therapeutic decision-making, and therapeutic intervention.
Intradural Aneurysm Caused by Arterial Injury during Surgery
Authors: Oran I. , Parildar M. , Dalbasti T. , Memis A. , Ozdamar N. 
Published: January 2017

We described a patient with subarachnoid hemorrhage due to a ruptured intradural aneurysm caused by arterial injury during surgery and severe symptomatic vasospasm. The iatrogenic posttraumatic aneurysm was occluded by using GDC with preservation of parent artery followed by intraarterial infusion of papaverine to treat vasospasm as an one-stage procedure. This resulted in significant angiographic resolution of the vasospasm and the patient's clinical outcome was excellent. Endovascular approach to posttraumatic intracranial aneurysms and endosaccular GDC embolization of aneurysm with concomitant intraarterial papaverine infusion to treat vasospasm are discussed.