bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biomechanics of Fractures
Authors: Frankel Victor H. , Kaplan Daniel J. , Egol Kenneth A. 
Published: July 2016

Background:
This video presents the digitized, original, reel-to-reel footage of Victor Frankel's groundbreaking 1960s experiments demonstrating the viscoelastic properties and fracture mechanics of loaded bone. As can be seen, novel instrumentation was used that resulted in an easily reproducible method of controlling bone loading rates. The innovation, and associated experiments, radically advanced our understanding of the mechanisms of acute fractures and bone's response to energy.

Methods:
Using the “Standard Torsion Testing Machine” that he helped design, the author explains how the mechanical and functional properties of bone are affected by various defects. Examples used include an intact dog femur, a femur with a hole in the cortex, and a femur with an open section defect. Slow motion depiction allows the viewer to appreciate the potential soft tissue damage associated with bone fragmentation and how this varies with energy input. The video concludes with a demonstration of the effect of torsional motion on the vasculature.

Results:
Graphs produced by the torsion tester display torque versus angular deformation plots for each experiment. These illustrate the relationship between bone structure, fracture, and energy. The x-ray contrast segment provides an example of associated arterial damage secondary to a fracture.

Conclusion:
This previously unreleased piece of orthopaedic history provides viewers with perspective on the early days of biomechanical study and an easy-to-understand tutorial on acute fracture mechanics and the role of energy in injury.
Operative Fixation of Chronic Acromioclavicular Joint Dislocation With Hook Plate and Modified Ligament Transfer
Authors: McKee Michael D. 
Published: July 2016

Purpose:
The optimal treatment for acute dislocation of the acromioclavicular (AC) joint remains unclear, and prior randomized trials did not reveal any significant improvements in the operative groups. However, it is clear that some patients treated nonoperatively are dissatisfied with their outcome and request surgical correction. This video demonstrates one method of repair of a chronic dislocation of the AC joint in a patient with significant symptomatology following nonoperative treatment of a high-grade AC dislocation.

Methods:
This video demonstrates the open reduction of a chronically dislocated AC joint. After mobilization of the distal clavicle and debridement of the joint, a step cut is made in the anterior surface of the distal clavicle. The coracoacromial (CA) ligament is then identified and mobilized, taking care to preserve its acromial origin. An anterior acromioplasty is then performed with a microsaggital saw. The AC joint is reduced, and the acromial fragment is sculpted to fit the step cut in the distal clavicle, where it is then fixed with a small-fragment cancellous screw in lag fashion. The blade of the hook plate is then contoured to fit under the acromion (posteriorly) to hold the joint in a reduced position. The deltoid is repaired with number 1 absorbable sutures, followed by a standard closure.

Results:
Results are improved and complications minimized when care is taken to not avoid overreduction of the clavicle: an intraoperative radiograph, and/or comparison to the opposite side, may be useful. We do not shorten or resect the entire distal clavicle: this has been shown to lead to worse outcomes. We have found that CA transfer with a fragment of attached acromial bone results in more reliable healing than a CA transfer alone (the Weaver–Dunn transfer).

Discussion:
In the setting of a chronic AC dislocation, hook plate fixation provides excellent reduction of the joint and a stable mechanical environment: this allows for the optimal healing of the ligament transfer. Typically, 6–12 months postoperatively, the hook plate can be removed to improve motion and reduce local irritation because joint stability is then provided by the transfer with bone-to-bone healing.
The Anterior Subcutaneous Pelvic Fixator (INFIX) in an Anterior Posterior Compression Type 3 Pelvic Fracture
Authors: Vaidya Rahul , Tonnos Fred , Nasr Kerellos , Kanneganti Praveen , Curtis Gannon 
Published: July 2016

Objectives:
The purpose of this video is to describe the equipment, anatomy, and surgical technique of anterior subcutaneous pelvic fixation (INFIX) using pedicle screws and a rod in an Anterior Posterior Compression 3 pelvic fracture, as well as how to distract in lateral compression fractures.

Methods:
The equipment required includes standard spine pedicle screw sets with long screws, 70–110 mm in length, and 7 or 8 mm in diameter. The approach is a mini open and one needs to be familiar with the iliac oblique, obturator outlet, and obturator inlet views. The length of the screw is measured from the sciatic notch to the skin, and they are placed so that the head sits just below the skin. The rod is passed just under the skin along the bikini line and the construct compressed or distracted against a c-clamp while monitored with fluoroscopy. In Orthopaedic Trauma Association C type injuries, we leave c-clamps on the outside the screws to reinforce them or use monoaxial screws. The implants are removed at 3–6 months postop.

Results:
The patients tolerate the implants and are able to sit and stand with out difficulty. Complications include lateral femoral cutaneous nerve irritation, heterotopic bone, loss of fixation if the implants are applied incorrectly.

Conclusions:
The INFIX procedure for anterior pelvic fixation is based on standard techniques that are familiar to the Orthopaedic Pelvic Surgeon including supraacetabular screws. Rod bending, rod passing, determining the ideal height of the screws, and distraction/compression maneuvers are demonstrated in this video.
Open Reduction, Internal Fixation Distal Intraarticular Distal Humerus Fracture
Authors: Fuller David A. 
Published: July 2016

Purpose:
The purpose of this video is to demonstrate the surgical repair of an intraarticular distal humerus fracture.

Methods:
A polytrauma patient with an intraarticular distal humerus fracture is shown. The patient is positioned laterally, with a posterior skin incision and olecranon osteotomy for exposure. An anatomic reduction is achieved, and internal fixation with perpendicular plating of the distal humerus is performed.

Results:
The video is 18 minutes, 34 seconds duration in time and 2,048,752,000 bytes in size.

Conclusions:
Open reduction with internal fixation of a distal humerus fracture is demonstrated in this video.
Knee Extensor Mechanism Repairs: Standard Suture Repair and Novel Augmentation Technique
Authors: Meyer Zachary , Ricci William M. 
Published: July 2016

Summary:
Patellar and quadriceps tendon ruptures are relatively common injuries. Rupture of the knee extensor mechanism may occur because of a forceful eccentric contraction of the quadriceps against a resisted flexed knee, though atraumatic cases have also been described. Patients at higher than normal risk for knee extensor mechanism rupture include those with systemic co-morbidities, fluoroquinolone use, and chronic tendinopathy. Early operative treatment and mobilization of acute extensor mechanism ruptures has proven effective, and numerous techniques have been described. A 46-year-old male on anastrozole therapy simultaneously ruptured his left patellar and right quadriceps tendons during a deadlift attempt. Diagnosis was by history and physical examination. Repair of both injuries was performed 5 days after injury. Described within and shown in the accompanying video is a standard technique for primary repair using Krackow stitches through the ruptured tendon that are passed through patellar bone tunnels and tied over a bone bridge. The finer points of this technique are emphasized. Also included is a technique to augment the standard repair with a figure-of-8 stitch passed through additional oblique patellar bone tunnels. The mechanical advantage of the adjuvant figure-of-8 stitch provides additional compression, which nicely reapproximates the tendon edges.
Percutaneous Sacroiliac Screw Technique
Authors: Tidwell John , Cho Rosa , Reid J. Spence , Boateng Henry , Copeland Carol , Sirlin Edward 
Published: July 2016

Summary:
Remembering that preoperative planning, surgical indications, and fracture reduction are paramount for this procedure, presented here is our technique for performing percutaneous sacroiliac screws, both transiliac-transsacral and sacral style. A combination of video, still pictures, and fluoroscopy images will guide the viewer through the process we routinely use highlighting specific details. Patient positioning and intraoperative fluoroscopy imaging are critical to a successful procedure. Although inlet and outlet films remain important, we find the procedure best started on the lateral sacral view to reduce the need for start site, trajectory, and imaging position changes during the case. A cannulated pig sticker (drill guide) used with long drill tip guide wires provide improved manual control to both finding a good start site and directing the trajectory. For patient safety, sacral anatomy and safe zones are discussed as well. Using these technical points will help make this a successful procedure.
Surgical Dislocation of the Hip in the Treatment of Complex Osteochondral Injury to the Femoral Head
Authors: Probe Robert 
Published: July 2016

Purpose:
The optimal treatment for osteochondral fracture of the femoral head associated with posterior dislocation remains unclear. A case can be made to treat small fragments and those that concentrically reduce nonoperatively. On the other end of the spectrum are those where significant size and residual displacement warrant consideration of operative fixation. This video demonstrates the treatment of a large complex multifragmentary osteochondral femoral head fracture with surgical dislocation.

Methods:
With the patient in lateral decubitus position, the trochanter is approached through lateral incision. The trochanter is cut and capsulotomy performed taking care to preserve the critical medial femoral circumflex artery. Fixation with headless screws is performed from the small comminuted fragments into the dominant section of intact femoral head.

Results:
Experience suggests that anatomic fixation through surgical dislocation can be carried out with low incidence of subsequent avascular necrosis and degenerative articular change. Given the degree of local osseous and muscular trauma, consideration should be given to prophylaxis of heterotopic bone.

Discussion:
Although small osteochondral fragments restricted to the acetabular fossa can be treated nonoperatively, the size and displacement of the presented fragment mandated operative reduction. Given the predicted complexity of repair, the surgical dislocation approach was chosen to provide maximum exposure optimizing the chances for successful fixation.
Anterolateral Approach to the Pilon
Authors: Hickerson Lindsay E. , Verbeek Diederik O. , Klinger Craig E. , Helfet David L. 
Published: July 2016

Summary:
This video reviews the indications, surgical approach, and case examples of the anterolateral approach to a distal tibial plafond fracture. If this approach is used in a staged fashion, when the soft envelope is ready, it affords excellent visualization for fracture fixation through thick skin flaps. An associated article reviews a cohort of 44 mainly type C3 pilon injuries treated by 2 orthopaedic traumatologist using the anterolateral approach after staged external fixation. An anatomic or good fracture reduction was obtained in 41 fractures with 13.6% of patients undergoing a secondary surgical procedure for infection or nonunion.
Treatment Options for Distal Femur Fractures
Authors: von Keudell Arvind , Shoji Kristin , Nasr Michael , Lucas Robert , Dolan Robert , Weaver Michael J. 
Published: July 2016

Summary:
Despite advances in implant design, the management of distal femur fractures remains challenging. Fracture comminution and intra-articular extension can make it difficult to obtain an adequate reduction while preserving the soft tissue attachments to bone fragments to allow for bone healing. Many implant manufacturers have developed optimal anatomically contoured, distal femoral locking plates with percutaneous guides. This environment allows for the application of lateral locked plates in a biologically friendly manner. Although initial reports had high success rates, more recently a high rate of nonunion has been found, particularly in elderly patients. Limited literature is available for the treatment of patients with osteoporotic bone and associated ipsilateral total knee replacement and hip replacement. We present a patient with a distal femur fracture with significant comminution in the setting of an ipsilateral total hip replacement.
Preliminary Evaluation of the Pathomechanisms of Dysphagia After Occipitospinal Fusion
Authors: Kaneyama Shuichi , Sumi Masatoshi , Takabatake Masato , Kasahara Koichi , Kanemura Aritetsu , Koh Akihiro , Hirata Hiroaki 
Published: July 2016

Study Design.
Kinematic analysis of swallowing function using videofluoroscopic swallowing study (VFSS).

Objectives.
The aims of this study were to analyze swallowing process in the patients who underwent occipitospinal fusion (OSF) and elucidate the pathomechanism of dysphagia after OSF.

Summary of Background Data.
Although several hypotheses about the pathomechanisms of dysphagia after OSF were suggested, there has been little tangible evidence to support these hypotheses since these hypotheses were based on the analysis of static radiogram or CT. Considering that swallowing is a compositive motion of oropharyngeal structures, the etiology of postoperative dysphagia should be investigated through kinematic approaches.

Methods.
Each four patients with or without postoperative dysphagia (group D and N, respectively) participated in this study. For VFSS, all patients were monitored to swallow 5-mL diluted barium solution by fluoroscopy, and then dynamic passing pattern of the barium solution was analyzed. Additionally, O-C2 angle (O-C2A) was measured for the assessment of craniocervical alignment.

Results.
O-C2A in group D was −7.5 degrees, which was relatively smaller than 10.3 degrees in group N (P = 0.07). In group D, all cases presented smooth medium passing without any obstruction at the upper cervical level regardless of O-C2A, whereas the obstruction to the passage of medium was detected at the apex of mid-lower cervical ocurvature, where the anterior protrusion of mid-lower cervical spine compressed directly the pharyngeal space. In group N, all cases showed smooth passing of medium through the whole process of swallowing.

Conclusion.
This study presented that postoperative dysphagia did not occur at the upper cervical level even though there was smaller angle of O-C2A and demonstrated the narrowing of the oropharyngeal space towing to direct compression by the anterior protrusion of mid-lower cervical spine was the etiology of dysphagia after OSF. Therefore, surgeon should pay attention to the alignment of mid-cervical spine as well as craniocervical junction during OSF.

Level of Evidence: 4
Novel Screw Head Design of Pedicle Screw for Reducing the Correction Loss in the Patients With Thoracolumbar Vertebral Fractures
Authors: Ye Bin , Yan Ming , Zhu Huiyang , Duan Wei , Hu Xueyu , Ye Zhengxu , Luo Zhuojing 
Published: July 2016

Study Design.
A biomechanical study.

Objective.
To study the different biomechanical property among fixed-axis, monoplanar and polyaxial screws in the static and dynamic tests.

Summary of Background Data.
Correction loss is a common phenomenon in the patients with thoracolumbar vertebral fractures who underwent the posterior pedicle screw fixation. The incidence varies with the kinds of fixation instrumentation used. There is higher incidence in polyaxial pedicle screws group than in fixed-axis pedicle screws. Monoplanar pedicle screws, which are mobile in the axial plane but fixed in the sagittal plane, can be a better fixation instrumentation for thoracolumbar vertebral fractures in theory.

Methods.
A total of 30 porcine spinal units (L2–L4) were used for the static and dynamic tests, which were randomized into six groups (A1, A2, A3, B1, B2, and B3). Static test was performed in A1, A2, and A3. In this test, fixed-axis, monoplanar, and polyaxial screws were performed in A1, A2, and A3, respectively. The ultimate load was noted after tested. In addition, dynamic test was performed in B1, B2, and B3, used fixed-axis, monoplanar, and polyaxial screws, respectively. Correction loss (head-shank angle shift and anterior vertebral body height shift) was obtained and analyzed in each mode.

Results.
In static test, fixed-axis and monoplanar screws had significantly higher ultimate load than polyaxial screws (P < 0.05) and fixed-axis screws had a little higher ultimate load than monoplanar screws (P < 0.05). In dynamic test, correction loss was minimal in fixed-axis screws, medium in monoplanar screws, and maximal in polyaxial screws. However, the differences were statistically significant in all comparisons but not in the comparison of fixed-axis and monoplanar screws (P > 0.05).

Conclusion.
The findings from the current study suggest that monoplanar screws can significantly increase the stiffness in axial direction compared with polyaxial screws, and reduce the risks of correction loss. For thoracolumbar vertebral fractures, monoplanar screw is a better optional instrumentation for minimally invasive surgery.

Level of Evidence: N/A
Aseptic versus Sterile Acellular Dermal Matrices in Breast Reconstruction: An Updated Review
Authors: Lyons Daniel A. , Mendenhall Shaun D. , Neumeister Michael W. , Cederna Paul S. , Momoh Adeyiza O. 
Published: July 2016

Background:
As the use of acellular dermal matrices in breast reconstruction has become more commonplace and efforts are made to improve on postoperative outcomes, the method of acellular dermal matrix (ADM) processing (aseptic versus sterile) has become a subject of interest. This article provides an updated overview of the critical aspects of ADM processing in addition to application of ADMs in single- and two-stage breast reconstruction, a review of the morbidity associated with ADM use, and alternatives.

Methods:
A literature review was performed in PubMed identifying recent systematic reviews, meta-analyses, and head-to-head comparisons on aseptically processed ADM and sterile-processed ADM in implant-based breast reconstruction.

Results:
Recent meta-analyses have shown a 2- to 3-fold increase in infections and tissue expander/implant explantation rates and a 3- to 4-fold increase in seroma formation compared with non-ADM reconstruction techniques. Comparisons of aseptic and sterile ADMs in multiple studies have shown no significant difference in infection rates and equivocal findings for other specific complications such as seroma formation.

Conclusions:
Current evidence on the impact of processing techniques that improve ADM sterility on postoperative morbidity in implant breast reconstruction is unclear. Deficiencies of the available data highlight the need for well-designed, multicenter, randomized controlled studies that will aid in optimizing outcomes in implant-based breast reconstruction.
A Bibliometric Analysis of the 100 Most-cited Articles in Rhinoplasty
Authors: Sinha Yashashwi , Iqbal Fahad M. , Spence John N. , Richard Bruce 
Published: July 2016

Introduction:
Citation analysis aims to quantify the importance and influence of a published article within its field. We performed a bibliometric analysis to determine the most highly cited articles within rhinoplasty and their impact on current practice.

Methods:
The 100 most-cited articles relating to rhinoplasty, between and inclusive of January 1864 to September 2015, were extracted from Web of Science in October 2015. Title, source journal, publication year, total citations, average citations/year, type of article, level of evidence, country of origin, main focus, use of outcome measures, incorporation into “Selected Readings in Plastic Surgery,” and funding status were recorded.

Results:
The total number of citations per article ranged from 61 to 276 (1.5–12.1 average citations per year). Surgical technique was the focus of 53% of articles, particularly those for reconstruction (75%). The United States produced 72% of articles compared with 8% from the United Kingdom. The top 100 articles were published within 20 journals; “Plastic and Reconstructive Surgeons” contributed the most articles (n = 57). None of the articles achieved level 1 or 2 of evidence (Oxford Centre for Evidence-Based Medicine levels of evidence, 2011), with most achieving level 4 evidence (n = 64). Case-series were the most popular methodology (n = 37). Few articles used validated outcome measures (n = 21). Twenty-nine percent were referenced in “selected readings.” Eighty-nine percent were unfunded studies.

Conclusions:
These top 100 articles are used in current teaching material and underpin surgical decision making. Developing and using validated objective assessment tools will benefit surgeons, patients, and the greater scientific community in objectively evaluating techniques with the most favorable results.
An Alternative Technique for Immediate Direct-to-Implant Breast Reconstruction—A Case Series
Authors: Downs Ronald K. , Hedges Kellee 
Published: July 2016

Background:
The practice of breast reconstruction continues to evolve with the introduction of new technologies. The authors describe a unique approach allowing immediate direct-to-implant reconstruction that can be performed on an outpatient basis.

Methods:
After a nipple-sparing mastectomy, acellular dermal matrix (ADM)-covered implants are placed in a prepectoral position in an immediate reconstruction. Assessment of results was performed via a retrospective review of demographic and procedural data.

Results:
Forty-five patients (79 breasts), mean age 46.8 years, were treated with direct-to-implant reconstruction using ADM-wrapped implants placed above the muscle with mean follow-up of 23.1 months (median 22 mo). Mean body mass index was 24.3, and 15 patients (33.3%) were current or former smokers. Twenty-seven patients (60%) had prior breast surgery with 22 (49%) exposed to chemotherapy and 34 (76%) radiation. Procedure time averaged 155 minutes and hospital length of stay averaged 0.6 days. Complications included flap necrosis in 22 cases (28%), seroma in 12 (15%), infection in 8 (10%), rippling in 28 (35%), and contracture in 8 (10%). In 14 breasts (18%), postoperative wound complications (flap necrosis or infection) led to implant loss.

Conclusions:
The availability of ADM and cohesive gel implants has allowed us to perform above-the-muscle implant breast reconstruction in reduced time and often on an outpatient basis. Complication rates were comparable to expected results of standard expander-to-implant, staged breast reconstruction. This technique is a viable option delivering clinically and aesthetically acceptable results in select patients.