bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient Reported Pain After Successful Nonunion Surgery: Can We Completely Eliminate It?
Authors: Fisher Nina , Driesman Adam S. , Konda Sanjit , Egol Kenneth A. 
Published: January 2018

Objectives:
To investigate what factors are associated with continued long-term pain after fracture nonunion surgery.

Design:
Prospective cohort study.

Setting:
Single Academic Institution.

Patients/Participants:
Three hundred forty-one patients surgically treated for fracture nonunion were prospectively followed. Demographics, radiographic evaluations, VAS pain scores, and short musculoskeletal functional assessment (SMFA) scores were collected at routine intervals. Only patients who had a minimum of 1-year follow-up and complete healing were included this analysis. Patients were divided into a high-pain and low-pain cohort for comparison. Inclusion criteria for the high-pain cohort were defined as any patient who reported a pain score greater than one standard deviation above the mean.

Main Outcome Measures:
Long-term VAS pain scores and factors contributing to increased patient-reported long-term VAS pain scores.

Results:
Two hundred seventy patients met criteria and were included in this analysis, with 223 patients (82.6%) in the low-pain cohort and 47 patients (17.4%) in the high-pain cohort. The mean long-term pain score was 7.47 ± 1.2 in the high-pain group and 1.78 ± 1.9 in the low-pain group. Within the high-pain cohort, 55.6% of patients reported a net increase in pain from baseline to long-term follow-up compared with 10.5% in the low-pain cohort (P < 0.0005). High baseline pain score (P = 0.003), increased Charlson comorbidity index (CCI) (P = 0.008), lower income level (P = 0.014), and current smoking status (P = 0.033) were found to be significantly more prevalent in the high-pain cohort.

Conclusions:
Patients with higher baseline pain scores, elevated Charlson comorbidity index, lower income level or history of smoking are at an increased risk of reporting significant and potentially debilitating long-term pain after nonunion surgery. Although patients may expect complete relieve of pain, orthopaedic surgeons must inform patients of the possibility of experiencing pain 1 year or more postoperatively.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Does Posterior Fixation of Partially Unstable Open-Book Pelvic Ring Injuries Decrease Symphyseal Plate Failure? A Biomechanical Study
Authors: Metz Rachelle M. , Bledsoe J. Gary , Moed Berton R. 
Published: January 2018

Objective:
Recent clinical study suggests an advantage to adding an iliosacral screw to the anterior fixation construct for anteroposterior compression type-2 (OTA/AO type 61-B1), partially unstable open-book pelvic ring injuries. Others have described stress examination to determine any required supplemental fixation. However, biomechanical studies investigating iliosacral fixation requirements for this injury are lacking. Our objective was to determine whether adding an iliosacral screw to symphyseal plate fixation decreases displacement in a well-defined open-book pelvic ring injury model.

Methods:
An open-book pelvic ring injury was created in 10 human cadaveric pelves by unilaterally releasing the sacrospinous, sacrotuberous, and anterior sacroiliac ligaments plus transection of the pubic symphysis, approximating the classically described anteroposterior compression type-2 (APC-2) injury. Specimens were divided into 2 groups: (1) symphyseal plating and (2) plating plus an iliosacral screw. Using a standard bilateral stance model loaded at 550 N, displacement measurements were obtained at 210,000 and 500,000 cycles.

Results:
Three specimens failed before 210,000 cycles because of technical errors and were excluded from analysis. For the remaining 7, there was no significant difference in displacement between the 2 groups, and none sustained implant failure. Post hoc analysis showed that a large sample size (45/group) would be required to detect any difference with 80% power, indicating a small effect size with limited clinical application.

Conclusions:
Adding an iliosacral screw to the symphyseal plate fixation does not provide improved biomechanical outcome in classically described APC-2 injuries. Clinically, stress examination may be useful to determine the need for supplemental posterior fixation in APC-2 injuries.
Valgus Slipped Capital Femoral Epiphysis: Pathophysiology of Motion and Results of Intracapsular Realignment
Authors: Kalhor Morteza , Gharanizadeh Kaveh , Rego Paulo , Leunig Michael , Ganz Reinhold 
Published: January 2018

Objectives:
The purpose of this study was to report (1) a different but specific pattern of impingement in hips involved with valgus slipped capital femoral epiphysis (valgus SCFE) and (2) the results of surgical treatment using intracapsular realignment techniques.

Design:
Case series.

Setting:
Multiple academic centers.

Patients:
Six patients with 8 involved hips referred for valgus alignment of proximal femoral epiphysis (valgus SCFE).

Intervention:
Intracapsular realignment osteotomy combined with periacetabular osteotomy if needed.

Main outcome Measurement:
The clinical and radiographical results and pathophysiology of motion.

Results:
Eight hips in 6 patients were treated with subcapital (5 hips) or femoral neck (3 hips) osteotomy for realignment. The medially prominent metaphysis created an inclusive impingement at the anterior acetabular wall, whereas the high coxa valga favored impacting impingement at the posterior head-neck junction. The mean preoperative epiphyseal-shaft angle of 110.5 (range 90–125 degrees) was reduced to 62 degrees (range 55–70 degrees) postoperatively. At the last follow-up, all but 1 hip were pain-free and impingement-free, with normal range of motion. One hip was replaced after repeated attempts of correction. The overall hip functional result using modified Merle d'Aubigne scoring system was excellent in 5 hips (18–16 points), good in 2 hips (16–15 points), and poor in 1 hip (6 points).

Conclusions:
Impingement in valgus SCFE deformity is specific and complex. Anatomical realignment can lead to favorable results by the restoration of normal morphology and impingement-free range of motion.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Does Total Hip Arthroplasty Reduce the Risk of Secondary Surgery Following the Treatment of Displaced Acetabular Fractures in the Elderly Compared to Open Reduction Internal Fixation? A Pilot Study
Authors: Weaver Michael J. , Smith Raymond Malcolm , Lhowe David W. , Vrahas Mark S. 
Published: January 2018

Objectives:
The goal of open reduction and internal fixation (ORIF) is to anatomically reduce the facture and maintain a congruent hip joint. However, ORIF in the elderly is technically challenging. Therefore, there are advocates for acute total hip arthroplasty (THA) in this patient population. The primary purpose of this study was to evaluate the rate of revision surgery in elderly patients with acetabular fractures treated with ORIF or THA. The secondary purpose was to compare patient's self-reported functional outcomes.

Design:
Retrospective review.

Setting:
Two American College of Surgeons Level 1 trauma centers.

Patients/Participants:
Thirty-three patients were treated with ORIF and 37 were treated with THA. The mean follow-up was 22 months (range 6–89 months). Patients were interviewed, and radiographs were examined.

Intervention:
Treatment of displaced acetabular fractures with either ORIF or THA.

Main Outcome Measurements:
Need for reoperation. Harris Hip Score and SF-36 questionnaire.

Results:
Those treated with ORIF had a higher rate of reoperation (10/33, 30%) compared with those treated with THA (5/37, 14%); however, this was not statistically significant (P = 0.12). Patients reported better bodily pain scores as measured by SF-36 (48 vs. 39, P = 0.04), and a trend toward improved function as measured by patient reported Harris Hip Scores (82 vs. 63, P = 0.06) in those treated with THA compared with ORIF.

Conclusions:
Acute reconstruction of acetabular fractures with THA in the geriatric population seems to compare favorably with ORIF, with a similar rate of complications, but with improved pain scores. In addition, there was a high rate of conversion to THA within 2 years of injury when patients were treated with ORIF. Acute THA as primary treatment in this patient population merits further, more controlled, comparative study.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Use of Spring Plates in Fixation of Comminuted Posterior Wall Acetabular Fractures
Authors: Lee Christopher , Johnson Eric E. 
Published: January 2018

Objectives:
Surgical management of comminuted posterior wall acetabular fractures with marginal fragments remains difficult. The purpose of this study was to evaluate the use of spring plates as adjunctive fixation in comminuted posterior wall acetabular fractures.

Methods:
A retrospective review of patients treated for posterior wall acetabular fractures with the use of customized spring plates as adjunctive fixation between 2000 and 2017 was performed. Patients were evaluated radiographically according to the grading criteria of Matta. Complications including subsequent revision surgery and hardware failure were recorded.

Results:
Fifty-two patients underwent surgical fixation of posterior wall acetabular fractures with the use of customized 3.5-mm spring plates combined with posterior buttress compression plating over the spring plates as definitive fixation. Mean follow-up was 13.9 months (range: 3–140 months). Forty-two patients had radiographic grades of excellent, with 6 good, 1 fair, and 3 poor. There were no hardware complications. Five patients underwent revision surgery, including 4 patients (7.7%) who underwent a total hip arthroplasty due to advanced arthritis.

Conclusions:
The use of customized spring plates is a viable method of adjunctive fixation for comminuted posterior wall fractures with marginal fragmentation.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Endosteal Substitution With an Intramedullary Rod in Fractures of the Femur
Authors: Spitler Clay A. , Bergin Patrick F. , Russell George V. , Graves Matthew L. 
Published: January 2018

Background:Morbid obesity and segmental fracture/bone loss are challenging problems in the treatment of fractures and nonunions of the distal femur. The use of an intramedullary rod as an endosteal substitute for a deficient medial cortex along with a lateral locked plate is 1-tool to combat these problems. This article describes the technique used and its results at a single Level 1 trauma center.Methods:Retrospective chart and radiographic review of all patients treated for acute fractures and nonunions of the distal femur using endosteal substitution with an intramedullary nail and a lateral locked plate. Fixation construct was determined at the surgeon's discretion and was strongly influenced by bone loss and patient body habitus.Results:Seven of 8 acute fractures and 8 of 8 nonunions healed without an unplanned reoperation. There were no cases of secondary displacement after fixation, and only 1 unplanned reoperation in the study group.Conclusion:Endosteal substitution with an intramedullary rod and the use of a lateral locked plate provides the stability needed to allow bone healing under prolonged or supraphysiologic loads seen in morbid obesity or segmental bone loss.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Impact of Low Muscularity and Myosteatosis on Long-term Outcome After Curative Colorectal Cancer Surgery: A Propensity Score–Matched Analysis
Authors: Sueda Toshinori , Takahasi Hidekazu , Nishimura Junichi , Hata Taishi , Matsuda Chu , Mizushima Tsunekazu , Doki Yuichiro , Mori Masaki 
Published: January 2018

BACKGROUND:
Muscle loss, characterized by reduced muscle mass (myopenia), and infiltration by intermuscular and intramuscular fat (myosteatosis), predicts a poor short-term prognosis in patients with colorectal cancer. However, little is known about the influence of myopenia and myosteatosis on long-term outcomes.

OBJECTIVE:
The present study aimed to evaluate the prognostic influence of both myopenia and myosteatosis on long-term outcomes after curative colorectal cancer surgery.

DESIGN:
This is a retrospective analysis using a propensity score–matched analysis to reduce the possibility of selection bias.

SETTINGS:
The study was conducted at a single institution.

PATIENTS:
We performed a retrospective analysis of 211 consecutive patients with stage I to III colorectal cancer who underwent curative surgery between 2010 and 2011.

INTERVENTION:
CT scans were analyzed to calculate the lumbar skeletal muscle index and mean muscle attenuation using a SYNAPS VINCENT.

MAIN OUTCOME MEASURES:
The primary outcome measure was cancer-specific survival. Secondary end points included overall survival and disease-free survival.

RESULTS:
Of 211 patients, a total of 102 and 106 were matched for myopenia and myosteatosis analyses. The median follow-up was 57.6 months. Versus the nonmyopenia group, the myopenia group manifested a significantly shorter cancer-specific survival, overall survival, and disease-free survival. Significantly shorter cancer-specific survival and overall survival times were also identified for the myosteatosis versus the nonmyosteatosis group. Before matching, multivariate analyses identified both myopenia and myosteatosis as independent prognostic factors for cancer-specific survival (p = 0.04 and p < 0.01), overall survival (p = 0.03 and p < 0.01), and disease-free survival (p < 0.01 and p < 0.01).

LIMITATIONS:
This study is limited by its retrospective, nonrandomized design.

CONCLUSIONS:
Myopenia and myosteatosis adversely affect long-term outcomes after curative colorectal cancer resection. See Video Abstract at http://links.lww.com/DCR/A463.
Symptom Severity and Quality of Life Among Long-term Colorectal Cancer Survivors Compared With Matched Control Subjects: A Population-Based Study
Authors: Hart Tae L. , Charles Susan T. , Gunaratne Mekhala , Baxter Nancy N. , Cotterchio Michelle , Cohen Zane , Gallinger Steven 
Published: January 2018

BACKGROUND:
Data are lacking regarding physical functioning, psychological well-being, and quality of life among colorectal cancer survivors >10 years postdiagnosis.

OBJECTIVE:
The purpose of this study was to examine self-reported physical functioning, quality of life, and psychological well-being in long-term colorectal cancer survivors compared with age- and sex-matched unaffected control subjects.

DESIGN:
Participants completed a cross-sectional survey.

SETTINGS:
The colorectal cancer survivors and unaffected control subjects were recruited from the Ontario Familial Colorectal Cancer Registry.

PATIENTS:
A population-based sample of colorectal cancer survivors (N = 296) and their age- and sex-matched unaffected control subjects (N = 255) were included. Survivors were, on average, 15 years postdiagnosis.

MAIN OUTCOME MEASURES:
Quality of life was measured with the Functional Assessment of Cancer Therapy-General scale, bowel dysfunction with the Memorial Sloan–Kettering Cancer Center scale, urinary dysfunction with the International Consultation on Incontinence Questionnaire–Short Form, fatigue with the Functional Assessment of Chronic Illness Therapy–Fatigue scale, and depression with the Center for Epidemiologic Studies–Depression scale.

RESULTS:
In linear mixed-model analyses adjusting for income, education, race, and comorbid medical conditions, survivors reported good emotional, functional, physical, and overall quality of life, comparable to control subjects. Fatigue and urinary functioning did not differ significantly between survivors and control subjects. Survivors reported significantly higher social quality of life and lower depression compared with unaffected control subjects. The only area where survivors reported significantly worse deficits was in bowel dysfunction, but the magnitude of differences was relatively small.

LIMITATIONS:
Generalizability is limited by moderately low participation rates. Findings are likely biased toward healthy participants. No baseline assessment was available to examine change in outcomes over time.

CONCLUSIONS:
Long-term colorectal cancer survivors appear to have comparable quality of life and, in some areas, better well-being than their unaffected peers. Bowel dysfunction may continue to be an ongoing issue even 15 years after colorectal cancer diagnosis. Overall quality of life can be expected to be good in this group of older survivors. See Video Abstract at http://links.lww.com/DCR/A476.
Arc of Riolan-Preserving Splenic Flexure Takedown During Anterior Resection: Potentially Critical to Prevent Acute Anastomotic Ischemia
Authors: Toh James Wei Tatt , Matthews Ronnie , Kim Seon-Hahn 
Published: January 2018

INTRODUCTION:
The Arc of Riolan is a strategic vessel that provides collateral mesenteric circulation in 10% of individuals. The importance of identifying and preserving the arc of Riolan in reducing the risk of ischemia to the proximal anastomotic segment after high ligation anterior resection was evaluated.

TECHNIQUE:
The arc of Riolan is a vessel that crosses anterior to the inferior mesenteric vein horizontally below the level of the pancreas. A retrospective review of all recorded videos of laparoscopic and robotic low and ultra-low anterior resections was performed in September to December 2012 and prospective evaluation in April to July 2013. The main outcome measures were arc of Riolan identification and preservation, and this was correlated with postoperative transmural colonic ischemia requiring surgical reintervention. From July 2013 onward, we routinely performed arc of Riolan–sparing anterior resections.

RESULTS:
Arc of Riolan was observed in 17.8% of cases. Between 2006 and 2012, before routinely looking for and preserving the arc of Riolan, our rate of acute colonic transmural ischemia requiring an emergency Hartmann procedure after anterior resection was 0.8% (6/723). Between 2012 and 2016, after we started performing arc of Riolan–sparing splenic flexure takedown, there were no cases of acute colonic transmural ischemia requiring surgical reintervention (0/576) after anterior resection.

CONCLUSIONS:
Recognizing and preserving the arc of Riolan, if visualized, during high inferior mesenteric vein ligation and splenic flexure takedown may be an important step in reducing the risk of acute colonic ischemia postanterior resection. See Video at http://links.lww.com/DCR/A535.
Characteristics of Adrenal Masses in Familial Adenomatous Polyposis
Authors: Shiroky Jonah S. , Lerner-Ellis Jordan P. , Govindarajan Anand , Urbach David R. , Devon Karen M. 
Published: January 2018

BACKGROUND:
Adrenal masses are a known extraintestinal manifestation of familial adenomatous polyposis. However, the literature on this association is largely confined to case reports.

OBJECTIVE:
This study aimed to determine the characteristics of adrenal masses in familial adenomatous polyposis and their clinical significance, as well as to estimate their prevalence. Mutational analysis was conducted to determine if any potential genotype-phenotype correlations exist.

DESIGN:
This is a retrospective cohort study.

SETTING:
Analysis included all patients meeting the criteria of classic familial adenomatous polyposis who were registered with the Familial Gastrointestinal Cancer Registry, a national Canadian database.

PATIENTS:
Appropriate imaging or autopsy reports were available in 311 registry patients. Patients with adrenal metastases were excluded.

OUTCOME MEASURES:
Data collection included demographic data, mutation genotype, adrenal mass characteristics, surgical interventions and mortality.

RESULTS:
The prevalence of adrenal masses was 16% (n = 48/311). The median age at diagnosis of adrenal mass was 45 years. The median diameter of adrenal mass at diagnosis was 1.7 cm (interquartile range, 1.4–3.0) with a median maximal diameter of 2.5 cm (interquartile range, 1.7–4.1) with median imaging follow-up of 48 months. The majority of adrenal masses were benign (97%, n = 61/63). Surgery was performed on 7 patients because of concerns for size, malignancy, or hormonal secretion. One adrenal-related death was due to an adrenocortical carcinoma. Mutation analysis did not identify any specific genotype-phenotype correlations.

LIMITATIONS:
There were incomplete or insufficient endocrinology data available in the registry to allow for the analysis of hormone secretion patterns.

CONCLUSIONS:
Adrenal masses are approximately twice as prevalent in the familial adenomatous polyposis population as in previous studies of the general population. Nearly all mutations led to truncation of the APC gene; however, there was no genetic signature to help predict those at increased risk. The majority of adrenal lesions identified were of benign etiology; thus, an intensive management or surveillance strategy with imaging screening is likely unwarranted. See Video Abstract at http://links.lww.com/DCR/A507.
Systematic Review and Meta-analysis of Objective Assessment of Physical Fitness in Patients Undergoing Colorectal Cancer Surgery
Authors: Lee Chun Hin Angus , Kong Joseph C , Ismail Hilmy , Riedel Bernhard , Heriot Alexander 
Published: January 2018

BACKGROUND:Gas exchange-derived variables obtained from cardiopulmonary exercise testing allow objective assessment of functional capacity and hence physiological reserve to withstand the stressors of major surgery. Field walk tests provide an alternate means for objective assessment of functional capacity that may be cheaper and have greater acceptability, in particular, in elderly patients.OBJECTIVE:This systematic review evaluated the predictive value of cardiopulmonary exercise testing and field walk tests in surgical outcomes after colorectal surgery.DATA SOURCE:A systematic search was undertaken using Medline, PubMed, Embase, CINAHL, and PEDro.STUDY SELECTION:Adult patients who had cardiopulmonary exercise testing and/or field walk test before colorectal surgery were included.MAIN OUTCOME MEASURE:The primary outcomes measured were hospital length of stay and postoperative morbidity and mortality.RESULTS:A total of 7 studies with a cohort of 1418 patients who underwent colorectal surgery were identified for inclusion in a qualitative analysis. Both pooled oxygen consumption at anaerobic threshold (range, 10.1–11.1 mL·kg–1·min–1) and peak oxygen consumption (range, 16.7–18.6 mL·kg–1·min–1) were predictive of complications (OR for anaerobic threshold, 0.76; 95% CI, 0.66–0.85,p<0.0001; OR for peak oxygen consumption, 0.76; 95% CI, 0.67–0.85,p<0.0001). Patients had significant increased risk of developing postoperative complications if their anaerobic threshold was below this cut point (p<0.001). However, it was not predictive of anastomotic leak(p= 0.644). Shorter distance (<250 m) walked in incremental shuttle walk test, lower anaerobic threshold, and lower peak oxygen consumption were associated with prolonged hospital length of stay, which was closely related to the development of complications.CONCLUSIONS:Variables derived from cardiopulmonary exercise testing are predictive of postoperative complications and hospital length of stay. Currently, there are insufficient data to support the predictive role of the field walk test in colorectal surgery.