bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low Profile Mesh Plating for Patella Fractures: Video of a Novel Surgical Technique
Authors: Verbeek Diederik O. , Hickerson Lindsay E. , Warner Stephen J. , Helfet David L. , Lorich Dean G. 
Published: July 2016

Summary:
Patella fractures can be challenging to treat particularly in the presence of inferior pole comminution. In this video we present a novel surgical technique for the treatment of patella fractures using a small fragment low profile mesh plate. Key points are the surgical exposure with direct visualization of the articular reduction, the preparation of the mesh plate to accommodate patellar anatomy and the augmentation of the construct using Krackow sutures to address inferior pole comminution. Low profile mesh plating allows for multiplanar fixation of patella fractures while avoiding implant and fixation problems related to tension band fixation. Our early experience with this technique is encouraging and it appears that this technique is useful for the treatment of the majority of patella fractures.
Split Thickness Skin Graft to Lower Leg
Authors: Fuller David A. 
Published: July 2016

Purpose:
The purpose of this video is to demonstrate the steps of harvesting, meshing, and applying a split thickness skin graft (STSG) to a lower leg to cover a lateral fasciotomy wound.

Methods:
A patient with a gunshot wound to his tibia has already undergone intramedullary rodding of the fracture and has had and medial and lateral fasciotomies for compartment syndrome. In the video, the lateral leg wound is covered with an STSG from the ipsilateral, lateral thigh. The graft is harvested with a dermatome, then meshed, and then inset for full coverage of the wound. A sterile, negative pressure dressing is applied at the conclusion of the case.

Results:
The video is 5 minutes, 46 seconds duration in time and 1,922,884,000 bytes in size.

Conclusion:
Various techniques of STSG have been described. This video demonstrates a successful strategy for coverage of a lateral leg wound with an STSG and negative pressure dressing.
Reverse Total Shoulder Arthroplasty for a 4-Part Proximal Humerus Fracture
Authors: Stahl Dan , Fuente Guadalupe de la 
Published: July 2016

Summary:
Proximal humerus fractures account for approximately 5% of all fractures and they are the third most common fracture seen in the elderly population. Complex fracture patterns, including 3-parts and 4-parts, have traditionally been amendable to shoulder hemiarthroplasty. However, several limiting factors, including poor patient satisfaction and low functional outcomes have guided further exploration for other treatment options. Reverse shoulder arthroplasty (RSA) has began to expand its traditional indications of rotator cuff arthropathy, massive rotator cuff tears, failed shoulder arthroplasties, and proximal humerus fracture sequelae. Overall, consistently improved functional outcomes are reported in RSA studies, including an increased postoperative range of motion, specifically external rotation. RSA has began to have a clinically significant role in the management of acute, complex proximal humerus fractures. Our video demonstrates the key features associated with positive patient outcomes, concluding with postoperative clinical videos.
In Situ Subtalar Arthrodesis for Posttraumatic Arthritis of the Calcaneus
Authors: Probe Robert 
Published: July 2016

Summary:
One of the most frequent complications after intraarticular fracture of the calcaneus is the development of posttraumatic arthritis of the subtalar joint. If conservative measures fail in the treatment of this condition, consideration of arthrodesis should be given. This video depicts the preoperative assessment and surgical technique applied to one such 54-year-old patient who had undergone internal fixation of a calcaneal fracture 9 years before. Shown within the video is exposure of the subtalar joint through a lateral incision, joint preparation, and the application of stable fixation. Subtleties of exposure, osteogenesis maximization, and postoperative management are covered.
Semiextending Nailing for Combined Shaft and Ankle Injuries of the Leg
Authors: Probe Robert 
Published: July 2016

Summary:
Over recent years, orthopaedic traumatologists have been gaining experience with tibial nailing in the extended position. Originally developed to address the complexities of alignment in proximal tibial fractures, this technique has also proven valuable in the treatment of tibial shaft fractures combined with ankle injuries. Depicted in this video presentation is the surgical techniques used to simultaneously address a spiral fracture of the distal tibia associated with a large coronal plane fracture of the tibial articular surface. Discussed are leg positioning, technical aspects of the medial approach, strategies for preliminary ankle stabilization, and fine details of aligning the tibial component of the injury. With a growing body of evidence suggesting similar knee outcomes with semiextended and conventional infrapatellar approaches, it is anticipated that this technique will become increasingly popular in coming years.
Reverse Sural Artery Pedicle Flap
Authors: Finkemeier Christopher G. , Neiman Rafael 
Published: July 2016

Objective:
To demonstrate the technical aspects of a reverse sural artery (RSA) flap.

Design:
Video case presentation.

Setting:
Community Level 2 Trauma Center.

Patients:
Single patient with a full thickness soft tissue loss over the posterior calcaneal tuberosity requiring soft tissue coverage.

Method:
Video demonstration of the stepwise planning and technical aspects of performing an RSA flap.

Outcome:
Successful soft tissue coverage of an exposed calcaneal tuberosity using an RSA flap.

Conclusion:
The RSA flap is a relatively simple fasciocutaneous flap that can be used to cover wounds of the lower leg and foot. Orthopaedic trauma surgeons can easily perform this procedure after a short time reviewing the neurovascular anatomy of the lower leg and understanding some of the important technical aspects of the procedure. This flap does not require microsurgical skills and can be done fairly quickly. The flaps usually have some partial necrosis that may require debridement, dressing changes, and surgeon patience. The main morbidity of the operation is lateral foot numbness and the need to harvest a split thickness skin graft.
Postoperative Computed Tomography for Articular Fractures: A Systematic Review
Authors: Stott Samantha , Balogh Zsolt J. 
Published: July 2016

Objectives:
To determine the current published patterns of computed tomography (CT) use postoperatively in peri-articular fractures and identify those populations whereby postoperative CT changes management or results in better clinical outcomes.

Data Sources:
Systematic review of MEDLINE and Cochrane using a combination of key words, including fracture fixation, fracture healing, and computed tomography. The final update search was performed on May 20, 2015. The search was limited to English language publications of human studies from the past 20 years.

Study Selection:
Eligible studies enrolled internally fixed peri-articular fractures in adults imaged routinely with postoperative CT. Facial and spinal fracture studies were excluded.

Data Extraction:
One thousand five hundred thirty-seven articles were identified using the search strategy. One thousand two hundred ninty-seven articles were excluded by title. One hundred eighty-three studies were excluded by abstract. Fifty-seven full text articles were assessed for eligibility, 31 studies were eligible for study inclusion.

Data Synthesis:
There was no intention to perform combined statistical analysis in the form of a meta-analysis as disparity was anticipated between study populations, interventions, and outcome measures. Routine CT use postoperatively in peri-articular fractures is limited to countries within the developed world, predominantly imaging the lower limb. Only 5 studies detailed postoperative CT leading to a change in patient management; within this pool, only 8 of the 361 individual patients received management changes due to CT scan findings.

Conclusions:
Use of postoperative CT in peri-articular fracture fixation has been demonstrated with minimal evidence, this leads to improved clinical outcomes. Based on available literature, postoperative CT scan use is questionable without convincing evidence of benefit. More research is required to identify selected patients who benefit from postoperative CT imaging.

Level of Evidence:
Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Risk of Implant Loosening After Cyclic Loading of Fusionless Growth Modulation Techniques
Authors: Yaszay Burt , Doan Joshua D. , Parvaresh Kevin C. , Farnsworth Christine L. 
Published: July 2016

Study Design.
Biomechanical evaluation using porcine spines.

Objective.
Compare the fixation strength of two currently used fusionless adolescent idiopathic scoliosis correction techniques following cyclic loading using porcine spines.

Summary of Background Data.
The ability of fusionless implants to control or correct scoliosis in a growing patient requires such implants to maintain spinal fixation. Because they cross the disc, motion may weaken fixation over time.

Methods.
Eight pig spines were divided into cycled segments (T10-T13) and uncycled segments (T7-T8, L2-L3). Initial range of motion (ROM) was determined in torsion, flexion-extension, and lateral bending (0.5°/s to 1.75 N·m).

Staple group (n = 4): 6 mm parallel staples were inserted on the right anterolateral spine across each intervertebral disc. Cycled segments received six staples (three adjacent discs) and uncycled segments received four staples (two separate discs).

Tether group (n = 4): 5.35 × 35 mm right anterolateral vertebral body screws were placed into each vertebra. Cycled segments received four screws and uncycled segments received four screws. Screws in cycled segments were connected with a flexible tether tensioned to straight alignment.
ROM of instrumented cycled segments was measured, and then segments were loaded to the measured ROM in flexion-extension (2000 cycles), lateral bending (1000 cycles), and axial rotation (2000 cycles). Implants were axially loaded to failure. Parametric tests compared pre- to postimplant ROM; nonparametric tests compared staple to screw pullout strength; P < 0.05 was significant.

Results.
There were no differences in ROM before instrumentation between groups. ROM was not changed except tethers decreased left lateral bending (–6.2°). Although staple pullout was less than screw pullout for cycled and uncycled segments (P < 0.05 and P = 0.057, respectively), there was no difference in pullout strength with and without cyclic loading for either group (P = 0.4).

Conclusion.
Tethers decreased lateral bending away from the tether. Screws had almost five times greater load to failure than staples. Five thousand cycles did not result in loosening of either staple or tether screws.

Level of Evidence: N/A
A Nonparametric Pharmacokinetic Approach to Determine the Optimal Dosing Regimen for 30-Minute and 3-Hour Meropenem Infusions in Critically Ill Patients
Authors: Mathew Sumith K. , Mathew Binu S. , Neely Michael N. , Naik Girish S. , Prabha Ratna , Jacob Gijoe G. , K Subramani , Fleming Denise H. 
Published: July 2016

Background:
Pharmacokinetics of meropenem differ widely in the critically ill population. It is imperative to maintain meropenem concentrations above the inhibitory concentrations for most of the interdose interval. A population pharmacokinetic/pharmacodynamic model was developed to determine the probability of target attainment for 3-hour and 30-minute infusion regimens in this population.

Methods:
This study was performed in an intensive care setting among adult patients who were initiated on meropenem at a dose of 1000 mg. Multiple blood specimens were collected at predetermined time points during the interdose period, and meropenem concentrations were measured using high performance liquid chromatography. Using Pmetrics, a pharmacokinetic/pharmacodynamic model was developed and validated. Monte Carlo simulation was performed, and probability of target attainment (100% T > minimum inhibitory concentration (MIC), with a probability >0.9) for doubling MICs was determined for different regimens of meropenem.

Results:
A 2-compartment multiplicative gamma error model best described the population parameters from 34 patients. The pharmacokinetic parameters used in the final model were Ke (elimination rate constant from the central compartment), Vc (volume of distribution of central compartment), KCP and KPC (intercompartmental rate constants), and IC2 (the fitted amount of meropenem in the peripheral compartment). Inclusion of creatinine clearance (CLcreat) and body weight as covariates improved the model prediction (Ke = Ke0 ×

JOURNAL/thdm/04.03/00007691-201610000-00006/inline-formula1/v/2023-08-14T200353Z/r/image-tiff

, Vc = Vc0 × Weight0.5). The Ke and Vc [geometric mean (range)] of the individuals were 0.54 (0.01–2.61)/h and 9.36 (4.35–21.62) L, respectively. The probability of attaining the target, T > MIC of 100%, was higher for 3-hour infusion regimens compared with 30-minute infusion regimens for all ranges of CLcreat.

Conclusions:
This study emphasizes that extended regimens of meropenem are preferable for treating infections caused by bacteria with higher MICs. The nonparametric analysis using body weight and CLcreat as covariate adequately predicted the pharmacokinetics of meropenem in critically ill patients with a wide range of renal function.
Mucormycosis of the Forehead and Sinuses in a Trauma Patient
Authors: Kumbla Pallavi A. , Lee Nathan , Kimbrough Mary K. 
Published: July 2016

Summary:
Mucormycosis is a rare fungal infection in immunocompetent patients. It is not commonly seen in trauma patients who sustain multisystem injuries and are often exposed to numerous infectious sources. A multidisciplinary approach between medical and surgical specialties is crucial to ensuring timely diagnosis and treatment as morbidity and mortality can be high once acquired. In addition to antifungal therapy, radical debridement and reconstruction by plastic surgery is often necessary. Review of the literature shows that there is no definitive reconstructive technique for mucormycosis of the forehead and sinuses because the amount of tissue destruction may be varied in location and depth, therefore requiring varying extents of debridement. However, other reconstructive techniques commonly used for oncologic and trauma reconstructions can be used to achieve functionality and a satisfactory cosmetic result. Few facial reconstructions after infection with mucormycosis have been documented in the literature.
Initial Experience Using Closed Incision Negative Pressure Therapy after Immediate Postmastectomy Breast Reconstruction
Authors: Gabriel Allen , Sigalove Steven R. , Maxwell G. Patrick 
Published: July 2016

Summary:
Although immediate postmastectomy breast reconstruction is favored over delayed reconstruction, it remains associated with high complication rates. Potential complications include seroma formation, dehiscence, infection, and tissue necrosis along incision edges. Closed incision negative pressure therapy (ciNPT; Prevena Incision Management System, KCI, an Acelity company, San Antonio, Tex.) has been reported to help hold incision edges together, protect incisions from external contamination, and remove fluid and infectious material. We investigated outcomes of applying ciNPT with a customizable dressing over closed incisions in 13 patients (25 breasts) who received immediate postmastectomy reconstruction as part of 2-stage expander/implant breast reconstruction. Nipple-sparing mastectomy was performed on 14 breasts, reduction-pattern mastectomy on 6 breasts, and skin-sparing mastectomy on 5 breasts. All breasts had ciNPT with a customizable dressing applied over the entire clean closed incision immediately after surgery at −125 mmHg for an average of 4.3 days. At 3-month follow-up, 24 of the 25 (96%) breasts had achieved healing. Delayed hematoma occurred on postoperative day 13 in 1 breast in the nipple-sparing mastectomy group and resolved. In the reduction-pattern mastectomy group, superficial dehiscence occurred on 3 breasts and resolved with local wound care. One breast in that group developed flap necrosis requiring surgical revision. Less drainage was observed in attached closed-suction drains, so time to drain removal was reduced from an estimated average of 12–14 days to 8.2 days. Based on the initial experience in this study, larger studies are warranted to evaluate the use of ciNPT with customizable or peel-and-place dressings after immediate postmastectomy breast reconstruction.
Meal frequency and timing: impact on metabolic disease risk
Authors: Varady Krista A. 
Published: July 2016

Purpose of review
The purpose of this article is to provide an overview of the most recent human intervention trials that have examined the impact of meal frequency or meal timing on metabolic disease risk factors.

Recent findings
Findings from intervention studies published over the past 12 months indicate that weight loss may be more pronounced with decreased meal frequency (two meals per day) versus increased meal frequency (six meals per day) under hypocaloric conditions. However, under isocaloric conditions, no effect on body weight was noted. Plasma lipid concentrations and glucoregulatory factors (fasting glucose, insulin, and insulin sensitivity) were not affected by alterations in meal frequency. As for meal timing, delaying the lunchtime meal by 3.5 h (from 1.30 p.m. to 4.30 p.m.) has no impact on body weight, but may impair glucose tolerance in young healthy adults.

Summary
In sum, altering meal frequency has little impact on body weight, plasma lipids, or glucoregulatory factors, whereas eating the majority of calories later in the day may be detrimental for glycemic control. These preliminary findings, however, still require confirmation by longer term, larger scale controlled trials.
Comparison of patency and cost-effectiveness of self-expandable metal and plastic stents used for malignant biliary strictures: a Polish single-center study
Authors: Budzyńska Agnieszka , Nowakowska-Duława Ewa , Marek Tomasz , Hartleb Marek 
Published: July 2016

Introduction
Most patients with malignant biliary obstruction are suited only for palliation by endoscopic drainage with plastic stents (PS) or self-expandable metal stents (SEMS).

Objective
To compare the clinical outcome and costs of biliary stenting with SEMS and PS in patients with malignant biliary strictures.

Patients and methods
A total of 114 patients with malignant jaundice who underwent 376 endoscopic retrograde biliary drainage (ERBD) were studied.

Results
ERBD with the placement of PS was performed in 80 patients, with one-step SEMS in 20 patients and two-step SEMS in 14 patients. Significantly fewer ERBD interventions were performed in patients with one-step SEMS than PS or the two-step SEMS technique (2.0±1.12 vs. 3.1±1.7 or 5.7±2.1, respectively, P<0.0001). The median hospitalization duration per procedure was similar for the three groups of patients. The patients’ survival time was the longest in the two-step SEMS group in comparison with the one-step SEMS and PS groups (596±270 vs. 276±141 or 208±219 days, P<0.001). Overall median time to recurrent biliary obstruction was 89.3±159 days for PS and 120.6±101 days for SEMS (P=0.01). The total cost of hospitalization with ERBD was higher for two-step SEMS than for one-step SEMS or PS (1448±312, 1152±135 and 977±156€, P<0.0001). However, the estimated annual cost of medical care for one-step SEMS was higher than that for the two-step SEMS or PS groups (4618, 4079, and 3995€, respectively).

Conclusion
Biliary decompression by SEMS is associated with longer patency and reduced number of auxiliary procedures; however, repeated PS insertions still remain the most cost-effective strategy.
No difference in mortality between terlipressin and somatostatin treatments in cirrhotic patients with esophageal variceal bleeding and renal functional impairment
Authors: Hung Tsung-Hsing , Tsai Chen-Chi , Tseng Chih-Wei , Tseng Kuo-Chih , Hsieh Yu-Hsi , Tsai Chih-Chun 
Published: July 2016

Objective
To study the differences in mortality between terlipressin and somatostatin treatments in cirrhotic patients with esophageal variceal bleeding (EVB) and renal functional impairment (RFI).

Methods
The National Health Insurance Database, part of the Taiwan National Health Insurance Program, was used to enroll cirrhotic patients who had received endoscopic variceal ligation plus somatostatin or terlipressin for EVB and who were hospitalized between 1 January 2007 and 31 December 2010. The differences in mortality between the two vasoactive agents were compared and the risk factors for 30-day mortality because of EVB were identified.

Results
A total of 2324 cirrhotic patients with EVB were enrolled. The 30-day mortality data showed no significant differences between the somatostatin and the terlipressin groups (P=0.232). The risk of 30-day mortality was significantly higher in male patients [hazard ratio (HR): 1.50, P=0.002] and patients with hepatic encephalopathy (HR: 1.82, P<0.001), ascites (HR: 1.32, P=0.008), bacterial infections (HR: 2.10, P<0.001), hepatocellular carcinoma (HR: 2.09, P<0.001), and RFI (HR: 3.89, P<0.001). A subgroup analysis of cirrhotic patients with RFI was carried out. The overall 30-day mortality was higher in patients treated with somatostatin than in those treated with terlipressin (52.6 vs. 42.3%), but the difference failed to reach significance (adjust HR: 1.49, 95% confidence interval: 0.94–2.37, P=0.091).

Conclusion
RFI was the most important risk factor for 30-day mortality in EVB patients. Terlipressin and somatostatin had similar effects on 30-day mortality in cirrhotic patients with EVB and RFI.
The 4-hour standard is a meaningful quality indicator: correlation of performance with emergency department crowding
Authors: Higginson Ian , Kehoe Anthony , Whyatt Justin , Smith Jason E. 
Published: July 2016

Background
The 4-h standard performance is a controversial quality indicator. Crowding in emergency departments (EDs) causes increased patient morbidity and mortality. The aim of this study was to investigate the relationship between 4-h standard performance and ED crowding as measured by occupancy.

Methods
A retrospective observational study was carried out using the computerized Emergency Department Information System. Daily occupancy was considered in three ways: as minutes per day spent at occupancy thresholds of 70, 80, 90 and 100%; as the peak occupancy of resuscitation and majors beds at any point in the day; and as a percentage of the total potential ED bed minutes used during the day.

Results
An inverse relationship was observed between occupancy and 4-h standard performance using each method. Performance could be sustained at 70% occupancy, but deteriorated in a linear manner at a progressively increasing rate at 80, 90 and 100% occupancy (all P<0.01). A stepwise decrease in the mean performance was observed with increasing peak occupancy (P<0.001). A similar decrease in performance was observed with increasing 24-h overall occupancy (P<0.001).

Conclusion
This study has identified a clear and consistent correlation between ED crowding and performance against the 4-h standard. Because crowding is associated with harm, the 4-h standard is a meaningful quality metric for UK hospitals. Systematic measurement of ED crowding using occupancy may play a role in improving the quality of care delivered within the urgent care system.