bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mechanism of membrane fusion induced by vesicular stomatitis virus G protein
Authors: Kim Irene S. , Jenni Simon , Stanifer Megan L. , Roth Eatai , Whelan Sean P. J. , van Oijen Antoine M. , Harrison Stephen C. 
Published: December 2016

Significance
Enveloped viruses—those with a lipid-bilayer membrane such as influenza, dengue, and human immunodeficiency viruses—enter cells by fusion of the viral membrane with a membrane of the cell. A viral surface glycoprotein, known as its “fusion protein,” facilitates this step. Previous work studying the kinetics of single virus particles fusing with a target membrane has outlined a mechanism by which conformational changes in the fusion protein accelerate merger of the two bilayers. In this paper, we extend that mechanism to a structurally distinct class of viral fusion proteins, providing strong evidence for its general applicability to all viral membrane fusion processes.
Localization of age-dependent anti-crowding populations
Authors: Hernández Gastón E. 
Published: December 2016

In this work we prove the existence of solutions and study the localization and nonlocalization of the population in the Gurtin-MacCamy model with age-dependence and diffusion

∂
ρ

∂
t

+

∂
ρ

∂
a

a
m
p
;
=

(
ρ

u
x

)
x

−
μ
(
a
,
u
)
ρ
,

ρ
(
x
,
t
,
0
)

a
m
p
;
=

∫
0
∞

β
(
a
,
u
)
ρ
(
x
,
t
,
a
)
d
a

,

ρ
(
x
,
0
,
a
)

a
m
p
;
=

ρ
0

(
x
,
a
)
≥
0
,

\begin{align*} \frac {{\partial \rho }}{{\partial t}} + \frac {{\partial \rho }}{{\partial a}} &= {(\rho {u_x})_x} - \mu (a, u)\rho , \\ \rho (x, t, 0) &= \int _0^\infty {\beta (a, u)\rho (x, t, a) da},\\ \rho (x, 0, a) &= {\rho _0}(x, a) \ge 0, \end{align*}

where
\[

u
(
x
,
t
)
=

∫
0
∞

ρ
(
x
,
t
,
a
)
d
a

u(x, t) = \int _0^\infty {\rho (x, t, a) da}

\]
and
\[

β
(
a
,
u
)
=
β
(
u
)

∑

k
=
1

n

b
k

a
k

e

−
α
a

,

μ
(
a
,
u
)
=
μ
(
u
)

.

\beta (a, u) = \beta (u)\sum \limits _{k = 1}^n {{b_k}{a^k}{e^{ - \alpha a}}, \qquad \mu (a, u) = \mu (u)}.

\]
Necessary and sufficient conditions for the oscillations of a multiplicative delay logistic equation
Authors: Grace S. R. , Győri I. , Lalli B. S. 
Published: December 2016

Necessary and sufficient conditions are presented for the oscillation of all positive solutions of the multiplicative delay logistic equation
\[

d
N

(
t
)

d
t

=
r

(
t
)

N

(
t
)

(

1
−

∏

j
=
1

m

(

N

(

g
j

(
t
)

K

)

)

\frac {{dN\left ( t \right )}}{{dt}} = r\left ( t \right )N\left ( t \right ) \left ( {1 - \prod \limits _{j = 1}^m { \left ( {\frac {{N\left ( {g_j}\left ( t \right ) \right .}}{K}} \right ) } } \right )

\]
about the positive equilibrium

K
K

. The cases when

r

(
t
)

=
r

r\left ( t \right ) = r

and

g
j

(
t
)

=
t
−

τ
j

{g_j}\left ( t \right ) = t - {\tau _j}

or

g
j

(
t
)

=

[

t
−

k
j

]

{g_j}\left ( t \right ) = \left [ {t - {k_j}} \right ]

, [•] denoting the greatest integer function, where

r
,

τ
j

r, {\tau _j}

, and

k
j

{k_j}

are positive constants,

j
=
1
,
2
,
.
.
.
,
m

j = 1, 2,...,m

, are also included.
Global asymptotics toward the rarefaction wave for solutions of viscous 𝑝-system with boundary effect
Authors: Matsumura Akitaka , Nishihara Kenji 
Published: December 2016

The initial-boundary value problem on the half-line

R
+

⋅
=

(
0
,
∞
)

{R_ + } \cdot = \left ( 0, \infty \right )

for a system of barotropic viscous flow

v
t

−

u
x

=
0
,

u
t

+
p

(
v
)

x

=
μ

(

u
x

v

)

x

{v_t} - {u_x} = 0, {u_t} + p{\left ( v \right )_x} = \mu {\left ( {\frac {{{u_x}}}{v}} \right )_x}

is investigated, where the pressure

p

(
v
)

=

v

−
γ

(
γ
≥
1
)

p\left ( v \right ) = {v^{ - \gamma }}\left ( \gamma \ge 1 \right )

for the specific volume

v
>
0

v > 0

. Note that the boundary value at

x
=
0

x = 0

is given only for the velocity

u
u

, say

u
−

{u_ - }

and that the initial data

(

v
0

,

u
0

)

(
x
)

\left ( {v_0}, {u_0} \right )\left ( x \right )

have the constant states

(

v
+

,

u
+

)

\left ( {v_ + }, {u_ + } \right )

at

x
=
+
∞

x = + \infty

with

v
0

(
x
)

>
0
,

v
+

>
0

{v_0}\left ( x \right ) > 0, {v_ + } > 0

. If

u
−

>

u
+

{u_ - } > {u_ + }

, then there is a unique

v
−

{v_ - }

such that

(

v
+

,

u
+

)

∈

R
2

(

v
−

,

u
−

)

\left ( {v_ + }, {u_ + } \right ) \in {R_2}\left ( {v_ - }, {u_ - } \right )

(the 2-rarefaction curve) and hence there exists the 2-rarefaction wave

(

v
2
R

,

u
2
R

)

(
x

/

t
)

\left ( v_2^R, u_2^R \right )\left ( x/t \right )

connecting

(

v
−

,

u
−

)

\left ( {v_ - }, {u_ - } \right )

with

(

v
+

,

u
+

)

\left ( {v_ + }, {u_ + } \right )

. Our assertion is that, if

u
−

>

u
+

{u_ - } > {u_ + }

, then there exists a global solution

(
v
,
u
)

(
t
,
x
)

\left ( v, u \right )\left ( t, x \right )

in

C
0

(

[
0
,
∞
)

;

H
1

(

R
+

)

)

{C^0}\left ( \left [ 0, \infty \right );{H^1}\left ( {R_ + } \right ) \right )

, which tends to the 2-rarefaction wave

(

v
2
R

,

u
2
R

)

(
x

/

t
)

|

x
≥
0

\left ( v_2^R, u_2^R \right )\left ( x/t \right )\left | {_{x \ge 0}} \right .

as

t
→
∞

t \to \infty

in the maximum norm, with no smallness condition on

|

u
+

−

u
−

|

\left | {{u_ + } - {u_ - }} \right |

and

‖

(

v
0

−

v
+

,

u
0

−

u
+

)

‖

H
1

{\left \| {\left ( {{v_0} - {v_ + }, {u_0} - {u_ + }} \right )} \right \|_{{H^1}}}

, nor restriction on

γ

(
≥
1
)

\gamma \left ( \ge 1 \right )

. A similar result to the corresponding Cauchy problem is also obtained. The proofs are given by an elementary

L

2

{L^{2}}

-energy method.
Existence and multiplicity of solutions of an equation from pool boiling on wires
Authors: Wang Shin-Hwa 
Published: December 2016

We investigate the existence and multiplicity of steady states of the equation
\[

∂
θ

∂
t

−

∂
2

θ

∂

x
2

+
σ
q

(
θ
)

−
a
λ

(
1
+
α
θ
)

=
0
,

0
>
x
>
1

\frac {{\partial \theta }}{{\partial t}} - \frac {{{\partial ^2}\theta }}{{\partial {x^2}}} + \sigma q\left ( \theta \right ) - a\lambda \left ( 1 + \alpha \theta \right ) = 0, \qquad 0 > x > 1

\]
with Dirichlet boundary conditions and initial conditions. This equation was derived and studied by Joly, Kernevez, and Llory [7] and Joly [8] in studying thermal effects from pool boiling, in which wires are heated by the Joule effect and are cooled in a bath of boiling water at constant pressure. They studied the steady-state problem for two kinds of heat flux density

q

(
θ
)

q\left ( \theta \right )

(corresponding to whether or not the radiation is taken into account) and for

α
≠
0

\alpha \ne 0

or

α
=
0

\alpha = 0

. (A) In the case with radiation and

α
=
0

\alpha = 0

, for given specific function

q

(
θ
)

q\left ( \theta \right )

and constants

σ
>
0

\sigma > 0

,

a
>
0

a > 0

, by numerical methods, they found an

S
S

-shaped bifurcation diagram and three solutions for some parameter values. We prove this rigorously, for a specific range of parameters of physical interest. Specifically, we show that, for specific values of

α
,
σ

\alpha , \sigma

, and

a
a

, there exist two positive numbers

λ
_

>

λ
¯

\underline {\lambda } > \bar \lambda

such that the steady-state problem has at least three solutions for

λ
_

>
λ
>

λ
¯

\underline {\lambda } > \lambda > \bar \lambda

, at least two solutions for

λ
=

λ
_

\lambda = \underline {\lambda }

or

λ
=

λ
¯

\lambda = \bar \lambda

, and exactly one solution for

0
≤
λ
>

λ
_

0 \le \lambda > \underline {\lambda }

or

λ
>

λ
¯

\lambda > \bar \lambda

. Moreover, we give lower and upper bounds for

λ
_

\underline {\lambda }

and

λ
¯

\bar \lambda

. (B) In the case without radiation and

α
≠
0

\alpha \ne 0

, we show that there exist two positive numbers

λ
_

>

λ
¯

\underline {\lambda } > \bar \lambda

such that the steady-state problem has at least two solutions for

λ
_

>
λ
>

λ
¯

\underline {\lambda } > \lambda > \bar \lambda

, at least one solution for

0
≤
λ
≤

λ
_

0 \le \lambda \le \underline {\lambda }

or

λ
=

λ
¯

\lambda = \bar \lambda

, exactly one solution for

0
>
λ
>

λ
_

0 > \lambda > \underline {\lambda }

A and

λ
\lambda

small enough, and no solution for

λ
>

λ
¯

\lambda > \bar \lambda

. Moreover, we give upper and lower bounds for

λ
_

\underline {\lambda }

and

λ
¯

\bar \lambda

. Also, we find and correct two mistakes in [7, Proposition 2.6, (i), (ii)].
Global existence in 𝐿⁴(𝐑₊×𝐑) for a nonstrictly hyperbolic conservation law
Authors: Zhao Huijiang 
Published: December 2016

We study the existence problem for the following nonstrictly hyperbolic system:
\[

u
t

+

1
2

(
3

u
2

+

v
2

)

x

=
0

{u_t} + \frac {1}{2}{\left ( 3{u^2} + {v^2} \right )_x} = 0

\]
,
\[

v
t

+

(
u
v
)

x

=
0

{v_t} + {\left ( uv \right )_x} = 0

\]
, with singular initial data, i.e.,
\[

(
u

(
t
,
x
)

,
v

(
t
,
x
)

)

|

t
=
0

=

(

u

0

(
x
)

,

v
0

(
x
)

)

∈

L

4

(
R
,

R

2

)

\left ( u\left ( t, x \right ), v\left ( t, x \right ) \right )\left | {_{t = 0}} \right . = \left ( {u_{0}}\left ( x \right ), {v_0}\left ( x \right ) \right ) \in {L^{4}}\left ( R, {R^{2}} \right )

\]
.
Finite Fourier self-transforms
Authors: Fedotowsky A. , Boivin G. 
Published: December 2016

This paper considers the integral equation
\[

λ
γ

(

t
′

)

=

(

2
π

)

−
N

∫
Ω

exp
⁡

(

−
i
ω
⋅

t
′

)

∫
T

γ

(
t
)

exp
⁡

(

i
ω
⋅
t

)

d
t
d
ω

\lambda \gamma \left ( {t’} \right ) = {\left ( {2\pi } \right )^{ - N}}\int \limits _\Omega {\exp \left ( { - i\omega \cdot t’} \right )\int \limits _T {\gamma \left ( t \right )} \exp \left ( {i\omega \cdot t} \right )dt d\omega }

\]
as well as a more general one wherein the Fourier kernels are weighted. When

Ω
\Omega

and

T
T

are

N
N

-dimensional spherical domains, the eigenfunctions of the integral equation are generalized prolate spheroidal functions for which a new nomenclature is proposed. Many properties of the eigenfunctions are developed and summarized. Because of the importance of these functions in Fourier transform theory, old as well as new properties are included.
On a functional equation arising in the stability theory of difference-differential equations
Authors: Castelan W. B. , Infante E. F. 
Published: December 2016

The functional differential equation
\[

Q
′

(
t
)

=
A
Q

(
t
)

+
B

Q
T

(

τ
−
t

)

,
−
∞
>
t
>
∞

Q’\left ( t \right ) = AQ\left ( t \right ) + B{Q^T}\left ( {\tau - t} \right ), - \infty > t > \infty

\]
, where

A
A

,

B
B

are

n
×
n

n \times n

constant matrices,

τ
≥
0

\tau \ge 0

,

Q

(
t
)

Q\left ( t \right )

is a differentiable

n
×
n

n \times n

matrix and

Q
T

(
t
)

{Q^T}\left ( t \right )

is its transpose, is studied. Existence, uniqueness and an algebraic representation of its solutions are given.
A Liapunov functional for linear Volterra integro-differential equations
Authors: Abrahamson D. L. , Infante E. F. 
Published: December 2016

Liapunov functionals of quadratic form have been used extensively for the study of the stability properties of linear ordinary, functional and partial differential equations. In this paper, a quadratic functional

V
V

is constructed for the linear Volterra integrodifferential equation
\[

x
˙

(
t
)

=
A
x

(
t
)

+

∫
0
T

B

(

t
−
τ

)

x

(
τ
)

d
t
,

t
≥

t
0

,

x

(
t
)

=
f

(
t
)

,

0
≤
t
≤

t
0

\dot x\left ( t \right ) = Ax\left ( t \right ) + \int _0^T {B\left ( {t - \tau } \right )x\left ( \tau \right ) dt, \qquad t \ge {t_0}, \\ x\left ( t \right ) = f\left ( t \right ), \qquad 0 \le t \le {t_0}}

\]
. This functional, and its derivative

V
˙

\dot V

, is more general than previously constructed ones and still retains desirable computational qualities; moreover, it represents a natural generalization of the Liapunov function for ordinary differential equations. The method of construction used suggests functionals which are useful for more general equations.
Initial-boundary value problems for the equation 𝑢_{𝑡𝑡}=(𝜎(𝑢ₓ))ₓ+(𝛼(𝑢ₓ)𝑢_{𝑥𝑡})ₓ+𝑓
Authors: Kuttler K. , Hicks D. 
Published: December 2016

Existence and uniqueness theorems are proved for global weak solutions of initial-boundary value problems corresponding to the equation
\[

u

t
t

=

(

σ

(

u
x

)

)

x

+

(

α

(

u
x

)

u

x
t

)

x

+
f

{u_{tt}} = {\left ( {\sigma \left ( {{u_x}} \right )} \right )_x} + {\left ( {\alpha \left ( {{u_x}} \right ){u_{xt}}} \right )_x} + f

\]
under assumptions that do not require smoothness or monotonicity of

σ
\sigma

. The initial data are not assumed to be smooth, the boundary data are allowed to be time dependent, and

f
f

is only assumed to be in

L
2

{L^2}

.
GWAlpha: genome-wide estimation of additive effects (alpha) based on trait quantile distribution from pool-sequencing experiments
Authors: Fournier-Level Alexandre , Robin Charles , Balding David J 
Published: December 2016

Abstract

Motivation
Sequencing pools of individuals (Pool-Seq) is a cost-effective way to gain insight into the genetics of complex traits, but as yet no parametric method has been developed to both test for genetic effects and estimate their magnitude. Here, we propose GWAlpha, a flexible method to obtain parametric estimates of genetic effects genome-wide from Pool-Seq experiments.

Results
We showed that GWAlpha powerfully replicates the results of Genome-Wide Association Studies (GWAS) from model organisms. We perform simulation studies that illustrate the effect on power of sample size and number of pools and test the method on different experimental data.

Availability and Implementation
GWAlpha is implemented in python, designed to run on Linux operating system and tested on Mac OS. It is freely available at https://github.com/aflevel/GWAlpha.

Supplementary information
Supplementary data are available at Bioinformatics online.
Impact and Cost-effectiveness of Selective Human Papillomavirus Vaccination of Men Who Have Sex With Men
Authors: Lin Allen , Ong Koh J. , Hobbelen Peter , King Eleanor , Mesher David , Edmunds W. John , Sonnenberg Pam , Gilson Richard , Bains Irenjeet , Choi Yoon H. , Tanton Clare , Soldan Kate , Jit Mark 
Published: December 2016

Abstract

Background.
Men who have sex with men (MSM) have a high lifetime risk of anogenital warts and cancers related to infection with human papillomavirus (HPV). They also benefit less from herd protection than heterosexual males in settings with female-only HPV vaccination.

Methods.
We evaluated the potential health impact and cost-effectiveness of offering vaccination to MSM who visit genitourinary medicine (GUM) clinics. We used a mathematical model of HPV 6/11/16/18 sexual transmission within an MSM population in England, parameterized with sexual behaviour, GUM attendance, HPV prevalence, HIV prevalence, warts, and cancer incidence data. Interventions considered were offering HPV vaccination to either HIV-positive MSM or MSM regardless of HIV status, for age bands 16–25, 16–30, 16–35, and 16–40 years.

Results.
Substantial declines in anogenital warts and male HPV-related cancer incidence are projected to occur following an offer of vaccination to MSM. MSM not attending GUM clinics will partially benefit from herd protection. Offering vaccination to HIV-positive MSM up to age 40 is likely to be cost-effective if vaccine procurement and administration costs are below £96.50 a dose. At £48 a dose, offering vaccination to all MSM up to age 40 is likely to be cost-effective.

Conclusions.
Quadrivalent HPV vaccination of MSM via GUM clinics is likely to be an effective and cost-effective way of reducing the burden of HPV-related disease in MSM.
United States Health Care Reform Progress to Date and Next Steps
Authors: Obama Barack 
Published: December 2016

(Abstracted from JAMA 2016;316(5):525–532)
The economy, federal budgets, and the financial well-being of American families are all impacted by health care costs. To combat the issues of the rapid rise in health care costs as well as to address the issue of a significant proportion of the population being uninsured, the Affordable Care Act (ACA) was the most important health care legislation enacted in the United States since the creation of Medicare and Medicaid in 1965.
Epigenetic Germline Inheritance of Diet-Induced Obesity and Insulin Resistance
Authors: Huypens Peter , Sass Steffen , Wu Moya , Dyckhoff Daniela , Tschöp Matthias , Theis Fabian , Marschall Susan , de Angelis Martin Hrabě , Beckers Johannes 
Published: December 2016

(Abstracted from Nat Genet 2016;48:497–499)
Several genetic risk factors for diabetes and obesity have been identified. In addition to genetic risk factors, it has been proposed that epigenetic alterations in gametes are another potential mechanism of disease risk inheritance.
Symptomatic Implant Removal Following Dual Mini-Fragment Plating for Clavicular Shaft Fractures
Authors: Czajka Cory M. , Kay Andrew , Gary Joshua L. , Prasarn Mark L. , Choo Andrew M. , Munz John W. , Harvin William H. , Achor Timothy S. 
Published: December 2016

Objectives:
To determine the proportion of patients requiring secondary surgery for symptomatic implant removal after open reduction, internal fixation using dual mini-fragment plating technique for clavicular shaft fractures.

Design:
Retrospective observational study.

Setting:
Single university Level 1 trauma center.

Patients:
Eighty-one patients treated with open reduction, internal fixation using dual mini-fragment plating technique for clavicular shaft fractures (OTA/AO 15-B1, B2, and B3) with minimum 12-month follow-up (median 477 days; range 371–1549 days).

Intervention:
Open reduction, internal fixation using dual mini-fragment plating technique for clavicular shaft fractures.

Main Outcome Measurements:
Incidence of secondary surgery, QuickDASH (Disabilities of the Arm, Shoulder, and Hand) scores.

Results:
Six of 81 patients (7.4%) underwent secondary surgery for implant removal for any reason. Of these, 3 (3.7%) underwent symptomatic implant (soft-tissue irritation) removal, 2 (2.5%) required implant removal in the setting of infection, and 1 patient (1.2%) required revision open reduction internal fixation for early implant failure. The mean QuickDASH score in this series was 8.44 (±6.94, range 0–77.27). The associated implant cost of the typical construct utilized in this series was $1511.38. The mean surgical time was 97 minutes (range 71–143 minutes).

Conclusions:
The utilization of a dual mini-fragment plating technique in the treatment of clavicular shaft fractures results in a low rates of secondary surgery for symptomatic implant removal (3.7%) and similar QuickDASH scores when compared with historical controls treated with 3.5-mm plates placed on the superior clavicle. Potential disadvantages in using this technique include a higher surgical implant cost and length of surgery.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Advanced Imaging Lacks Clinical Utility in Treating Geriatric Pelvic Ring Injuries Caused by Low-Energy Trauma
Authors: Natoli Roman M. , Fogel Harold A. , Holt Daniel , Schiff Adam , Bernstein Mitchell , Summers Hobie D. , Lack William 
Published: December 2016

Objectives:
Is advanced imaging necessary in the evaluation of pelvic fractures caused by low-energy trauma in elderly patients?

Design:
Retrospective review.

Setting:
Single institution, Level 1 Trauma Center.

Patients:
Age ≥60 years old treated for low-energy traumatic pelvic ring injuries.

Intervention:
None.

Main Outcomes:
Posterior pelvic ring injuries diagnosed on advanced imaging, radiographic displacement, admission status, hospital length of stay, change in weight-bearing status recommendations, and whether operative treatment was pursued.

Results:
Eighty-seven patients met the inclusion criteria, of which 42 had advanced imaging to evaluate the posterior pelvic ring (10 magnetic resonance imaging, 32 computed tomography). More posterior pelvic ring injuries were identified with advanced imaging compared with radiographs alone (P < 0.001). There was no statistically significant difference in rate of admission (P = 0.5) or hospital length of stay (P = 0.31) between patients with radiographs alone compared with patients evaluated with radiographs plus advanced imaging. The rate of displacement >1 cm at presentation and 6-week follow-up was unaffected by the presence of a posterior injury diagnosed on advanced imaging. Treatment for all 87 patients remained weight-bearing as tolerated with assist device irrespective of advanced imaging findings, and no patient underwent surgical intervention by 12-week follow-up.

Conclusions:
Despite frequent identification of posterior pelvic ring injuries in patients evaluated with advanced imaging, admission status, length of hospital stay, radiographic displacement, and treatment recommendations were unaffected by these findings. The use of advanced imaging in elderly patients with low-energy traumatic pelvic ring fractures may not be necessary.

Level of Evidence:
Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
The Role of Computed Tomography in Surgical Planning for Trimalleolar Fracture. A Survey of OTA Members
Authors: Gibson Peter D. , Bercik Micheal J. , Ippolito Joseph A. , Didesch Jacob , Hwang John S. , Koury Kenneth L. , Sirkin Michael , Adams Mark , Reilly Mark C. 
Published: December 2016

Objective:
Does the additional information provided by computed tomography (CT) alter surgeons' treatment plans for trimalleolar ankle fracture?

Design:
Prospective.

Setting:
Electronic survey.

Patients/Participants:
Members of the OTA.

Intervention:
Compare management of trimalleolar ankle fracture before and after CT.

Main Outcome Measurements:
Compare types of fixation used, indication for fixation, and approach need for fixation before and after CT.

Results:
Overall, OTA members' operative technique changed in 430 of the 1710 (25.1%) cases after review of the CT images. Of the 430 observations in which the operative technique was altered, the surgeon had initially stated that they would not have requested a CT in 51.2% incidences. When analyzing if CT affected whether or not operative fixation was indicated, a total of 16.3% responses changed. Surgeons were significantly more likely to change from no fixation to fixation (11.5%) than vice versa (4.8%) after reviewing CT imaging. A total of 17.8% of responses changed operative approach after reviewing the CT; 11.7% changed to open reduction internal fixation, whereas 6.1% changed away from open reduction internal fixation.

Conclusion:
A consensus on the ideal treatment of trimalleolar fractures remains elusive, evidenced by a high variation in treatment preference, both before and after CT review. Our results demonstrate with the additional information delineated on CT, a surgeons' operative plan, technique, and approach often change. With greater than 25% of respondents changing their treatment strategy after seeing CT imaging, radiographs alone limited surgeon understanding of fracture pattern. Because of difficulty understanding the posterior fracture fragment, we recommend preoperative CT on all trimalleolar fractures.

Level of Evidence:
Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.