bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Epidemiology of High Ankle Sprains in National Collegiate Athletic Association Sports
Authors: Mauntel Timothy C. , Wikstrom Erik A. , Roos Karen G. , Djoko Aristarque , Dompier Thomas P. , Kerr Zachary Y. 
Published: April 2017

Background: Ankle sprains are among the most common injuries experienced by collegiate athletes. The type of ankle sprain is rarely differentiated in epidemiological studies. This differentiation is necessary, as each ankle sprain type has a unique injury mechanism and recovery period. High ankle sprains commonly result in long recovery periods. Thus, a further examination of the epidemiology of high ankle sprains is warranted. Purpose: To describe the epidemiology of high ankle sprains in National Collegiate Athletic Association (NCAA) sports during the 2009/2010-2014/2015 academic years. Study Design: Descriptive epidemiology study. Methods: NCAA Injury Surveillance Program high ankle sprain data and athlete-exposures (AEs) from 25 sports were evaluated. Certified athletic trainers recorded sport-related injury, event, and AE data during team-sanctioned events. High ankle sprain injury rates per 10,000 AEs were calculated. Percentage distributions were calculated for the amount of time lost from sport and percentage of recurrent injuries. Injury rate ratios (RRs) and 95% CIs compared injury rates by event type, participation restriction time, and sex. 95% CIs not containing 1.00 were considered statistically significant. Results: The overall high ankle sprain injury rate was 1.00 per 10,000 AEs. Overall, 56.7% of high ankle sprain injuries occurred during competitions, and 9.8% of high ankle sprain injuries were recurrent. Men’s football (2.42/10,000 AEs), wrestling (2.11/10,000 AEs), and ice hockey (1.19/10,000 AEs) had the highest high ankle sprain injury rates. In sex-comparable sports, men had higher injury rates (RR, 1.77; 95% CI, 1.28-2.44). Player contact was the most common injury mechanism (60.4%), and 69.0% of injuries resulted in ≥1 day of participation restriction, with 47.1% resulting in ≥7 days of participation restriction and 15.8% resulting in >21 days of participation restriction. Conclusion: High ankle sprains resulted in significant participation restriction time from sport participation. The majority of high ankle sprain injuries resulted from player contact and were observed in contact/collision sports. The large proportion of high ankle sprains resulting from player contact, specifically in male contact sports, is worthy of further investigation. Clinical Relevance: The enhanced understanding of the epidemiology of high ankle sprains provided in our study will aid clinicians in developing targeted injury prevention strategies to mitigate the negative consequences of these injuries.
Microfracture Versus Autologous Chondrocyte Implantation for Articular Cartilage Lesions in the Knee: A Systematic Review of 5-Year Outcomes
Authors: Kraeutler Matthew J. , Belk John W. , Purcell Justin M. , McCarty Eric C. 
Published: April 2017

Background: Microfracture (MFx) and autologous chondrocyte implantation (ACI) are 2 surgical treatment options used to treat articular cartilage injuries of the knee joint. Purpose: To compare the midterm to long-term clinical outcomes of MFx versus ACI for focal chondral defects of the knee. Study Design: Systematic review. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to locate studies (level of evidence I-III) comparing the minimum average 5-year clinical outcomes of patients undergoing MFx versus ACI. Search terms used were “knee,” “microfracture,” “autologous chondrocyte implantation,” and “autologous chondrocyte transplantation.” Patients were evaluated based on treatment failure rates, magnetic resonance imaging, and patient-reported outcome scores (Lysholm, Knee Injury and Osteoarthritis Outcome Score [KOOS], and Tegner scores). Results: Five studies (3 level I evidence, 2 level II evidence) were identified that met the inclusion criteria, including a total of 210 patients (211 lesions) undergoing MFx and 189 patients (189 lesions) undergoing ACI. The average follow-up among all studies was 7.0 years. Four studies utilized first-generation, periosteum-based ACI (P-ACI), and 1 study utilized third-generation, matrix-associated ACI (M-ACI). Treatment failure occurred in 18.5% of patients undergoing ACI and 17.1% of patients undergoing MFx ( P = .70). Lysholm and KOOS scores were found to improve for both groups across studies, without a significant difference in improvement between the groups. The only significant difference in patient-reported outcome scores was found in the 1 study using M-ACI in which Tegner scores improved to a significantly greater extent in the ACI group compared with the MFx group ( P = .003). Conclusion: Patients undergoing MFx or first/third-generation ACI for articular cartilage lesions in the knee can be expected to experience improvement in clinical outcomes at midterm to long-term follow-up without any significant difference between the groups.
Lace Up for Healthy Feet: The Impact of Shoe Closure on Plantar Stress Response
Authors: Rahemi Hadi , Armstrong David G. , Enriquez Ana , Owl Joshua , Talal Talal K. , Najafi Bijan 
Published: April 2017

Objective: This study examined the impact of shoe closure on plantar thermal stress response (TSR), which is known to be a surrogate of shear stress and skin perfusion. It is aimed to explore potential impact of shoe closure on increasing risk factors associated with plantar ulcers in people with diabetic peripheral neuropathy (DPN). Methods: Fifteen eligible subjects were enrolled. The left foot was used as a reference and fitted to a self-adjusted and habitual lace-tightening method by each subject. The right foot was used as a test closure and fitted into three lace closure conditions: loose, tight, and preset optimal closure (reel clutch, BOA technology). Thermal images were taken after 5 minutes of acclimatization (pre-trial) and immediately after 200 walking steps in each shoe closure condition (post-trial). TSR was calculated from the thermal images. Results: TSR was significantly higher in the test closure with loose (70.24%, P = .000) and tight (66.85%, P = .007) and lower (−206.53%, P = .000) in the preset optimal closure when compared to the reference closure. Only lace closure conditions affected TSR with no significant impact from age, BMI, and gender in our sample in a multivariable regression model. Conclusion: The results from this study suggest that shoelace closure technique can have a profound effect on TSR. It therefore stands to reason that optimal lace closure may have an impact in reducing risk of plantar ulcers in people with DPN. Interestingly, results revealed that even a self-adjusted lace closure may not be necessarily optimal and a preset closure setting like reel clutch might ultimately be recommended to minimize risk. Further study is warranted to confirm or refute these interesting results.
Smoking literacy amongst adult Asian asthma patients in primary care
Authors: Ngoh Agnes Soh Heng , Chen Zhao Jin , Tai Bee Choo , Teo Stephanie Swee Hong , Tan Ngiap Chuan 
Published: April 2017

Background: Smoking is a known trigger of asthma exacerbation. Yet some patients with asthma continue to smoke. Little is known about their smoking literacy, which is defined as an individual’s capacity to comprehend and use healthcare information relating to smoking. This study aimed to determine the level of smoking literacy amongst patients with asthma, who were smokers (S) and non-smokers (NS). Methods: Standardised questionnaires were administered by trained research assistants to adult multi-ethnic Asian patients with asthma, who were managed in three public primary care clinics (polyclinics) in Singapore. Demographic data and information on a subject’s understanding and effects of smoking on health and complications were collected. The latter were computed into knowledge scores and the mean scores between S and NS were compared using the independent two-sample t-test with adjustment for potential confounders via multiple linear regression. Results: A total of 174 S and 183 NS were recruited with a higher proportion of younger male S. Overall, the knowledge score for S was significantly lower than NS (absolute mean difference (AMD) = −0.95, 95% confidence interval (CI) −1.58 to −0.33, p = 0.003). This was particularly for smoking associated specific respiratory disease (AMD = −0.23, 95% CI −0.44 to −0.02, p =0.034) and asthma symptoms (AMD = −0.73, 95% CI −0.98 to −0.47, p < 0.001). The differences persisted after adjusting for other important factors such as gender and education level. Conclusions: Compared with NS, S generally reported lower scores in their overall knowledge, and the knowledge in the association between smoking and specific respiratory diseases and asthma symptoms. Smoker patients may require measures to raise their smoking literacy during the counselling to optimise their smoking cessation success rates.
Epidemiology and Outcomes of Vertebral Artery Injury in 16 582 Cervical Spine Surgery Patients: An AOSpine North America Multicenter Study
Authors: Hsu Wellington K. , Kannan Abhishek , Mai Harry T. , Fehlings Michael G. , Smith Zachary A. , Traynelis Vincent C. , Gokaslan Ziya L. , Hilibrand Alan S. , Nassr Ahmad , Arnold Paul M. , Mroz Thomas E. , Bydon Mohamad , Massicotte Eric M. , Ray Wilson Z. , Steinmetz Michael P. , Smith Gabriel A. , Pace Jonathan , Corriveau Mark , Lee Sungho , Isaacs Robert E. , Wang Jeffrey C. , Lord Elizabeth L. , Buser Zorica , Riew K. Daniel 
Published: April 2017

Study Design: A multicenter retrospective case series was compiled involving 21 medical institutions. Inclusion criteria included patients who underwent cervical spine surgery between 2005 and 2011 and who sustained a vertebral artery injury (VAI). Objective: To report the frequency, risk factors, outcomes, and management goals of VAI in patients who have undergone cervical spine surgery. Methods: Patients were evaluated on the basis of condition-specific functional status using the Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) score, the Nurick scale, and the 36-Item Short-Form Health Survey (SF-36). Results: VAIs were identified in a total of 14 of 16 582 patients screened (8.4 per 10 000). The mean age of patients with VAI was 59 years (±10) with a female predominance (78.6%). Patient diagnoses included myelopathy, radiculopathy, cervical instability, and metastatic disease. VAI was associated with substantial blood loss (770 mL), although only 3 cases required transfusion. Of the 14 cases, 7 occurred with an anterior-only approach, 3 cases with posterior-only approach, and 4 during circumferential approach. Fifty percent of cases of VAI with available preoperative imaging revealed anomalous vessel anatomy during postoperative review. Average length of hospital stay was 10 days (±8). Notably, 13 of the 14 (92.86%) cases resolved without residual deficits. Compared to preoperative baseline NDI, Nurick, mJOA, and SF-36 scores for these patients, there were no observed changes after surgery ( P = .20-.94). Conclusions: Vertebral artery injuries are potentially catastrophic complications that can be sustained from anterior or posterior cervical spine approaches. The data from this study suggest that with proper steps to ensure hemostasis, patients recover function at a high rate and do not exhibit residual deficits.
A Multicenter Review of Superior Laryngeal Nerve Injury Following Anterior Cervical Spine Surgery
Authors: Tempel Zachary J. , Smith Justin S. , Shaffrey Christopher , Arnold Paul M. , Fehlings Michael G. , Mroz Thomas E. , Riew K. Daniel , Kanter Adam S. 
Published: April 2017

Study Design: A retrospective multicenter case-series study; case report and review of the literature. Objective: The anatomy and function of the superior laryngeal nerve (SLN) are well described; however, the consequences of SLN injury remain variable and poorly defined. The prevalence of SLN injury as a consequence of cervical spine surgery is difficult to discern as its clinical manifestations are often inconstant and frequently of a subclinical degree. A multicenter study was performed to better delineate the risk factors, prevalence, and outcomes of SLN injury. Methods: A retrospective multicenter case-series study involving 21 high-volume surgical centers from the AO Spine North America Clinical Research Network. Medical records for 17 625 patients who received subaxial cervical spine surgery from 2005 to 2011 were reviewed to identify occurrence of 21 predefined treatment complications. Descriptive statistics were provided for baseline patient characteristics. A retrospective review of the neurosurgical literature on SLN injury was also performed. Results: A total of 8887 patients who underwent anterior cervical spine surgery at the participating institutions were screened, and 1 case of SLN palsy was identified. The prevalence ranged from 0% to 1.25% across all centers. The patient identified underwent a C4 corpectomy. The SLN injury was identified after the patient demonstrated difficulty swallowing postoperatively. He underwent placement of a percutaneous gastrostomy tube and his SLN palsy resolved by 6 weeks. Conclusions: This multicenter study demonstrates that identification of SLN injury occurs very infrequently. Symptomatic SLN injury is an exceedingly rare complication of anterior cervical spine surgery. The SLN is particularly vulnerable when exposing the more rostral levels of the cervical spine. Careful dissection and retraction of the longus coli may decrease the risk of SLN injury during anterior cervical surgery.
Misplaced Cervical Screws Requiring Reoperation
Authors: Peterson Jeremy C. , Arnold Paul M. , Smith Zachary A. , Hsu Wellington K. , Fehlings Michael G. , Hart Robert A. , Hilibrand Alan S. , Nassr Ahmad , Rahman Ra’Kerry K. , Tannoury Chadi A. , Tannoury Tony , Mroz Thomas E. , Currier Bradford L. , De Giacomo Anthony F. , Fogelson Jeremy L. , Jobse Bruce C. , Massicotte Eric M. , Riew K. Daniel 
Published: April 2017

Study Design: A multicenter, retrospective case series. Objective: In the past several years, screw fixation of the cervical spine has become commonplace. For the most part, this is a safe, low-risk procedure. While rare, screw backout or misplaced screws can lead to morbidity and increased costs. We report our experiences with this uncommon complication. Methods: A multicenter, retrospective case series was undertaken at 23 institutions in the United States. Patients were included who underwent cervical spine surgery from January 1, 2005, to December 31, 2011, and had misplacement of screws requiring reoperation. Institutional review board approval was obtained at all participating institutions, and detailed records were sent to a central data center. Results: A total of 12 903 patients met the inclusion criteria and were analyzed. There were 11 instances of screw backout requiring reoperation, for an incidence of 0.085%. There were 7 posterior procedures. Importantly, there were no changes in the health-related quality-of-life metrics due to this complication. There were no new neurologic deficits; a patient most often presented with pain, and misplacement was diagnosed on plain X-ray or computed tomography scan. The most common location for screw backout was C6 (36%). Conclusions: This study represents the largest series to tabulate the incidence of misplacement of screws following cervical spine surgery, which led to revision procedures. The data suggest this is a rare event, despite the widespread use of cervical fixation. Patients suffering this complication can require revision, but do not usually suffer neurologic sequelae. These patients have increased cost of care. Meticulous technique and thorough knowledge of the relevant anatomy are the best means of preventing this complication.
Esophageal Perforation Following Anterior Cervical Spine Surgery: Case Report and Review of the Literature
Authors: Hershman Stuart H. , Kunkle William A. , Kelly Michael P. , Buchowski Jacob M. , Ray Wilson Z. , Bumpass David B. , Gum Jeffrey L. , Peters Colleen M. , Singhatanadgige Weerasak , Kim Jin Young , Smith Zachary A. , Hsu Wellington K. , Nassr Ahmad , Currier Bradford L. , Rahman Ra’Kerry K. , Isaacs Robert E. , Smith Justin S. , Shaffrey Christopher , Thompson Sara E. , Wang Jeffrey C. , Lord Elizabeth L. , Buser Zorica , Arnold Paul M. , Fehlings Michael G. , Mroz Thomas E. , Riew K. Daniel 
Published: April 2017

Study Design: Multicenter retrospective case series and review of the literature. Objective: To determine the rate of esophageal perforations following anterior cervical spine surgery. Methods: As part of an AOSpine series on rare complications, a retrospective cohort study was conducted among 21 high-volume surgical centers to identify esophageal perforations following anterior cervical spine surgery. Staff at each center abstracted data from patients’ charts and created case report forms for each event identified. Case report forms were then sent to the AOSpine North America Clinical Research Network Methodological Core for data processing and analysis. Results: The records of 9591 patients who underwent anterior cervical spine surgery were reviewed. Two (0.02%) were found to have esophageal perforations following anterior cervical spine surgery. Both cases were detected and treated in the acute postoperative period. One patient was successfully treated with primary repair and debridement. One patient underwent multiple debridement attempts and expired. Conclusions: Esophageal perforation following anterior cervical spine surgery is a relatively rare occurrence. Prompt recognition and treatment of these injuries is critical to minimizing morbidity and mortality.
Anterior Cervical Infection: Presentation and Incidence of an Uncommon Postoperative Complication
Authors: Ghobrial George M. , Harrop James S. , Sasso Rick C. , Tannoury Chadi A. , Tannoury Tony , Smith Zachary A. , Hsu Wellington K. , Arnold Paul M. , Fehlings Michael G. , Mroz Thomas E. , De Giacomo Anthony F. , Jobse Bruce C. , Rahman Ra’Kerry K. , Thompson Sara E. , Riew K. Daniel 
Published: April 2017

Study Design: Retrospective multi-institutional case series. Objective: The anterior cervical discectomy and fusion (ACDF) affords the surgeon the flexibility to treat a variety of cervical pathologies, with the majority being for degenerative and traumatic indications. Limited data in the literature describe the presentation and true incidence of postoperative surgical site infections. Methods: A retrospective multicenter case series study was conducted involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network, selected for their excellence in spine care and clinical research infrastructure and experience. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, inclusive, were reviewed to identify the occurrence of 21 predefined treatment complications. Patients who underwent an ACDF were identified in the database and reviewed for the occurrence of postoperative anterior cervical infections. Results: A total of 8887 patients were identified from a retrospective database analysis of 21 centers providing data for postoperative anterior cervical infections (17/21, 81% response rate). A total of 6 postoperative infections after ACDF were identified for a mean rate of 0.07% (range 0% to 0.39%). The mean age of patients identified was 57.5 (SD = 11.6, 66.7% female). The mean body mass index was 22.02. Of the total infections, half were smokers (n = 3). Two patients presented with myelopathy, and 3 patients presented with radiculopathic-type complaints. The mean length of stay was 4.7 days. All patients were treated aggressively with surgery for management of this complication, with improvement in all patients. There were no mortalities. Conclusion: The incidence of postoperative infection in ACDF is exceedingly low. The management has historically been urgent irrigation and debridement of the surgical site. However, due to the rarity of this occurrence, guidance for management is limited to retrospective series.
Prevalence and Outcomes in Patients Undergoing Reintubation After Anterior Cervical Spine Surgery: Results From the AOSpine North America Multicenter Study on 8887 Patients
Authors: Nagoshi Narihito , Fehlings Michael G. , Nakashima Hiroaki , Tetreault Lindsay , Gum Jeffrey L. , Smith Zachary A. , Hsu Wellington K. , Tannoury Chadi A. , Tannoury Tony , Traynelis Vincent C. , Arnold Paul M. , Mroz Thomas E. , Gokaslan Ziya L. , Bydon Mohamad , De Giacomo Anthony F. , Jobse Bruce C. , Massicotte Eric M. , Riew K. Daniel 
Published: April 2017

Study Design: A multicenter, retrospective cohort study. Objective: To evaluate clinical outcomes in patients with reintubation after anterior cervical spine surgery. Methods: A total of 8887 patients undergoing anterior cervical spine surgery were enrolled in the AOSpine North America Rare Complications of Cervical Spine Surgery study. Patients with or without complications after surgery were included. Demographic and surgical information were collected for patients with reintubation. Patients were evaluated using a variety of assessment tools, including the modified Japanese Orthopedic Association scale, Nurick score, Neck Disability Index, and Short Form-36 Health Survey. Results: Nine cases of postoperative reintubation were identified. The total prevalence of this complication was 0.10% and ranged from 0% to 0.59% across participating institutions. The time to development of airway symptoms after surgery was within 24 hours in 6 patients and between 5 and 7 days in 3 patients. Although 8 patients recovered, 1 patient died. At final follow-up, patients with reintubation did not exhibit significant and meaningful improvements in pain, functional status, or quality of life. Conclusions: Although the prevalence of reintubation was very low, this complication was associated with adverse clinical outcomes. Clinicians should identify their high-risk patients and carefully observe them for up to 2 weeks after surgery.