bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical indications for CT angiography in lower extremity trauma
Authors: Patterson Joseph T. , Fishler Thomas , Bohl Daniel D. , Piper Greta L. , Leslie Michael P. 
Published: July 2016

Background:
Missed vascular injuries in lower extremity trauma may lead to a preventable lower extremity amputation. CT angiography (CTA) is an accurate and expedient, but costly and potentially harmful, test for vascular injury in lower extremity trauma. Specific physical examination findings and injury patterns may be predictive of detection of a vascular injury by CTA and could guide CTA use in lower extremity trauma.

Methods:
This was a retrospective review of consecutive trauma patients at an academic level 1 trauma center who underwent CTA of a lower extremity from January 2006 through December 2012. The positive predictive values of injury pattern and physical examination signs for CTA detection of a vascular injury and vascular intervention, adherence to published guidelines for CTA use, and CTA-related adverse events were assessed.

Results:
Diagnostic CTA studies demonstrated a vascular injury in 55.6%. A vascular intervention followed in 13.9%, while 5.6% of studies led to a contrast-related adverse event. The positive predictive value of a CTA affecting treatment was significantly higher in the presence of high-risk injuries and hard examination findings than in the presence of low-risk injuries and soft examination findings (84.6%, 95% CI [54.6–98.1%] vs. 16.7%, 95% CI [3.6–41.1%]). Palpable pulses and ankle brachial index (ABI)>0.9 led to observational management without complications, regardless of CTA findings or other signs of vascular injury.

Conclusions:
The utility of CTA is improved by assessing the pretest positive predictive value of vascular injury from injury pattern and physical examination. The Eastern Association for the Surgery of Trauma guidelines may miss some vascular injuries in patients with high-risk injuries and normal ABI. CTA is not indicated in lower extremity trauma when physical examination and injury pattern do not suggest a vascular injury.
Analysis of needle type for musculoskeletal lesion biopsy: results of a novel steerable needle
Authors: Palisch Andrew , Patel Raj G. , Gutowski Christina , Zoga Adam C. , Colucci Phillip , O’Hara Brian J. , Roberts Catherine C. , Abraham John 
Published: July 2016

Background:
Needle biopsy has proven to be a potentially adequate method for initial biopsy of many soft-tissue and bone lesions. To help optimize this procedure, this study sought to test the characteristics of several needles, including a steerable needle.

Materials and Methods:
Five needle types were tested, including a steerable needle. Animal muscle tissue was used for all testing. The following experiments were performed: (1) sample collection with different needle types, (2) histological analysis of needle track, (3) observation of steerable needle characteristics using CT-guidance.

Results:
Sample collection: The Menghini 21 g and Chiba 22 g needles were graded as excellent for ease of use and integrity of sample. Histologic evaluation showed good specimen preservation with all needle types. Histological analysis of needle track: tracks created by the Menghini 21 g and Spinal 20 g needles both showed no histologically detectable damage to surrounding tissue. Observation of steerable Menghini needle under CT-guidance: needle advanced easily through tissue, even when maximally curved. Small, large, and double curves were feasible to avoid obstacles and reach targets. There was no deflection or change in position of the needle tip when the stylet was removed. Needle withdrawal did not damage surrounding tissue.

Conclusions:
Compared to the other needles, the steerable needle was found to be durable and easy to use, allowing for precise navigation around vital structures yielding superior integrity of sample tissue.
PROMIS Computer Adaptive Tests Compared With Time to Brake in Patients With Complex Lower Extremity Trauma
Authors: Kim Chang-Yeon , Wiznia Daniel H. , Averbukh Leon , Torres Andrea , Kong Edward , Kim Seewan , Leslie Michael P. 
Published: July 2016

Objectives:
To compare the PROMIS Physical Function and Pain Interference Computer Adaptive Tests (PROMIS PF CAT and PROMIS PI CAT) with time to brake (TTB) in patients with complex lower extremity traumas for evaluating whether patients can safely return to driving.

Design:
Prospective.

Setting:
Level-1 trauma center.

Patients:
Sixty-three patients with lower extremity injuries to the pelvis, acetabulum, hip, femur, knee, tibia/fibula, ankle, and foot within 15 weeks of treatment.

Intervention:
The TTB of patients with complex lower extremity trauma were tested at various time points postoperatively on a computerized driving simulator. Patients concurrently completed PROMIS PF CAT and PROMIS PI CAT.

Main Outcome Measure:
Correlations between TTB, PROMIS PF CAT, and PROMIS PI CAT.

Results:
The mean TTB for the healthy control group was 0.61 seconds. There was a statistically significant correlation between time since treatment and TTB (B = −0.008 s/d; P = 0.041) for right-sided lower extremity injuries below the knee (tibia/fibula, ankle, foot). TTB for right-sided injuries below the knee also significantly correlated with PROMIS PI CAT (B = 0.022; P = 0.029). The PROMIS PI CAT value was 43 when the healthy control group TTB was equal to 0.61 seconds.

Conclusions:
This study suggests that the PROMIS PI CAT can be used as an adjunct to the TTB in assessing whether a patient can safely return to driving.
Tissue Bioengineering in the Treatment of Osteochondritis Dissecans of the Talus in Children With Open Physis: Preliminary Results
Authors: Pagliazzi Gherardo , Baldassarri Matteo , Perazzo Luca , Vannini Francesca , Castagnini Francesco , Buda Roberto 
Published: July 2016

Background:
Juvenile osteochondritis dissecans of the talus (JOCDT) is a focal idiopathic lesion primarily of the subchondral bone leading to subsequent cartilaginous damage. The majority of the papers dealing with JOCDT reported heterogeneous case studies of patients treated with different cartilage repair techniques. The purpose of this paper is to retrospectively review both clinical and radiologic results among 7 patients affected by JOCDT treated with arthroscopic bone marrow aspirate concentrate (BMAC) transplantation with the 1-step technique.

Methods:
Both standard anterior-posterior and lateral radiographs and a 1.5 T magnetic resonance imaging of the affected ankle were preoperatively performed in all the patients. The American Orthopaedic Foot and Ankle Society (AOFAS) score and the visual analogue scale were administered to the patients preoperatively and at the final follow-up.

Results:
Patients were followed up to an average of 48.1±18.4 months. According to the Berndt and Harty classification, 6 lesions were found to be in stage III and 1 lesion in stage IV. The average preoperative AOFAS score was 58.8±7.6 points. At the mean follow-up of 48.1 months the average AOFAS score improved to 95.7±5.4 points (P<0.05). Visual analogue scale improved from 6.3 preoperatively to 0.4 at final follow-up (P<0.05). Complete radiographic healing, in terms of complete bony filling, was observed in 3 of 7 cases. The magnetic resonance imaging analysis showed a complete filling of the osteochondral defect in 4 patients, whereas in 1 patient a hypotrofic tissue was observed.

Conclusions:
BMAC transplantation is able to provide good to excellent results in the treatment of JOCDT. The 43% of our patients showed a complete radiographic healing, but all the patients were satisfied with the procedure. Because of the rareness of the lesion, further studies involving more patients and with a longer follow-up are required, to establish the advantage of performing a regenerative procedure like the BMAC transplantation in a pediatric population.

Level of Evidence:
Level IV.
How Many Patients Who Have a Clubfoot Treated Using the Ponseti Method are Likely to Undergo a Tendon Transfer?
Authors: Zionts Lewis E. , Jew Michael H. , Bauer Kathryn L. , Ebramzadeh Edward , Sangiorgio Sophia N. 
Published: July 2016

Background:
The Ponseti method has become the standard of care for the treatment of idiopathic clubfoot. A commonly reported problem encountered with this technique is a relapsed deformity that is sometimes treated in patients older than 2.5 years by an anterior tibial tendon transfer (ATTT) to the third cuneiform. Presently, there is insufficient information to properly counsel families whose infants are beginning Ponseti treatment on the probability of needing later tendon transfer surgery.

Methods:
All idiopathic clubfoot patients seen at the authors’ institution during the study period who met the inclusion criteria and who were followed for >2.5 years were included (N=137 patients). Kaplan-Meier Survival analysis was used to determine the probability of survival without the need for ATTT surgery. In addition, the influence of patient characteristics, socioeconomic variables, and treatment variables on need for surgery was calculated.

Results:
On the basis of the survivorship analysis, the probability of undergoing an ATTT remained below 5% for all patients at 3 years of age, but exceeded 15% by 4 years of age, increasing steadily afterwards such that by 6 years of age, the probability of undergoing an ATTT reached 29% of all patients. Overall, controlling for all other variables in the analysis, parent-reported adherence with bracing reduced the odds of undergoing surgery by 6.88 times, compared with parent-reported nonadherence (P<0.01).

Conclusions:
This is the first study to report the probability of undergoing ATTT surgery as a function of age using survivorship analysis following Ponseti clubfoot treatment. Although the overall probability reached 29% at 6 years, this was significantly reduced by compliance with bracing. This information may be useful to the clinician when counseling families at the start of treatment.

Level of Evidence:
Level III—theraputic.
Complications After Plate Fixation of Displaced Pediatric Midshaft Clavicle Fractures
Authors: Li Ying , Helvie Peter , Farley Frances A. , Abbott Matthew D. , Caird Michelle S. 
Published: July 2016

Background:
Operative treatment of displaced pediatric midshaft clavicle fractures has become increasingly popular, despite lack of evidence that surgical management leads to superior outcomes. Complications, such as plate irritation necessitating removal and wound infection, have been reported in adults. The purpose of this study was to evaluate complications after plate fixation of midshaft clavicle fractures in the pediatric population.

Methods:
We retrospectively identified patients 10 to 18 years old who had undergone plate fixation of a displaced midshaft clavicle fracture between 2009 and 2014. Patients who had surgery for a malunion or nonunion, and patients with <6 months of follow-up were excluded. Demographic data, radiographic union, time to return to activity, and complications were recorded. Any complication that led to unplanned surgery was considered a major complication.

Results:
We analyzed 36 patients (25 males, 11 females) with 37 fractures. The average age at surgery was 14.5±1.7 years and mean follow-up was 1.3±1.0 years. All of the fractures healed and average time to return to activity was 58±28 days. The overall postoperative complication rate was 86% (32/37): 59% (22/37) implant prominence or irritation, 16% (6/37) anterior chest wall numbness, 5% (2/37) superficial wound dehiscence or infection, 3% (1/37) refracture adjacent to the plate, and 3% (1/37) refracture after implant removal. The major complication rate was 43% (16/37). Fifteen patients underwent a second surgery for implant removal secondary to prominence or pain. One patient underwent revision open reduction and internal fixation after he sustained a refracture at the distal aspect of the plate that resulted in a painful nonunion. Only 1 patient had a refracture after implant removal and this was treated nonoperatively.

Conclusions:
Implant prominence or irritation is common after plate fixation of displaced pediatric midshaft clavicle fractures. A second surgery for implant removal may be necessary. Patients should be appropriately counseled regarding complications before plate fixation of midshaft clavicle fractures.

Level of Evidence:
Level IV—therapeutic.
Management of Scoliosis in Patients With Loeys-Dietz Syndrome
Authors: Bressner Jarred A. , MacCarrick Gretchen L. , Dietz Harry C. , Sponseller Paul D. 
Published: July 2016

Background:
Loeys-Dietz syndrome (LDS) is a genetic connective tissue disorder. We sought to determine the incidence of scoliosis in patients with LDS, characterize the spectrum of spinal deformity, determine the results of bracing and surgery, and define surgical complications.

Methods:
Patients were selected from our institution’s database of 183 patients with LDS. Imaging measurements were performed for 141 patients whose records permitted spinal evaluation. Deformity changes and complications after intervention were recorded for patients who underwent bracing or surgery, and associations were tested using Student t tests (significance, P<0.05).

Results:
Eighty-eight of 141 (62%) patients with LDS had scoliosis, with main thoracic and thoracolumbar curves being most common. Fifteen patients were braced (mean age, 9±3 y) for a mean of 2.3 years. They had a mean postbracing curve progression of 12±21 degrees (5±9 deg./y). There were no significant differences in age, sex, curve type, or prebracing curve magnitude between successfully braced (n=4) and unsuccessfully braced (n=11) patients (P>0.05). Nine patients, (mean age, 12±3 y), underwent 24 surgical procedures (16 growing rod procedures, 8 fusions). Mean curve corrections were 61% for growing rods and 73% for fusions. Associated blood loss for these procedures was 400 mL and 1293 mL, respectively, and normalized blood loss for fusion was 2.34 mL/kg/level. Fifteen of 24 surgical procedures involved complications (63%), including cerebrospinal fluid leaks (n=7) and blood loss >20% of estimated total blood volume (n=11).

Conclusions:
Scoliosis was present in 62% of our sample of LDS patients. Bracing did not halt curves in 11 of 15 patients, whose curves progressed >5 degrees or to >50 degrees by completion of bracing. At latest follow-up, 47% of the braced patients had undergone surgery after prior bracing attempts. The high blood loss associated with these operations is believed to be related to vascular fragility in patients with LDS.

Level of Evidence:
Level IV—retrospective cohort study.
Snapshots of Growing Up: Youth with Autism Explore Adulthood Through Photovoice
Authors: Cheak-Zamora Nancy C. , Teti Michelle , Maurer-Batjer Anna , Halloran Donna 
Published: July 2016

Abstract:

Objective:
Youth with autism spectrum disorder (ASD) experience significant challenges transitioning to adulthood. We utilized Photovoice to better understand youth's desires for and perspectives on becoming adults.

Method:
Youth with ASD (N = 11) photographed their life experiences, attended group and individual photo-sharing and discussion sessions, and exhibited their work publicly. Thematic analysis was used to identify salient recurring patterns in the data.

Results:
Thematic analysis identified important topics in session transcripts and 184 photographs. Youth with ASD expressed many perspectives about their adult lives, which centered around 3 themes: the meaning of adulthood; desire for independent living; and employment goals.

Conclusion:
Findings identified what youth with ASD want and need to achieve adulthood. This study demonstrated the utility of a new methodology to provide opportunities for youth to share their experiences and define their priorities.
Review of gynecologic and reproductive care for women with developmental disabilities
Authors: Abells Dara , Kirkham Yolanda A. , Ornstein Melanie P. 
Published: July 2016

Purpose of review
Care for women with developmental disabilities requires special consideration for unique needs related to their cognitive and physical abilities. These women and their caregivers require more support and guidance during reproductive health care. We review the literature and provide expert opinion surrounding gynecological issues for women with developmental disabilities to support healthcare providers better understand and care for this population.

Recent findings
Women with developmental disabilities are more vulnerable to abuse and experience poorer gynecological healthcare outcomes. Many women with developmental disabilities are fertile and participate in sexual activity without adequate knowledge. They are at higher risk of pregnancy and birth complications. They are less likely to receive appropriate preventive screening.

Summary
The review highlights important issues and practice suggestions related to the reproductive health care of women with developmental disabilities. Topics include clinic visits, menstruation, sexuality, sexual abuse, sexual health education, contraception, sexually transmitted infections, pregnancy, labor and delivery, and cancer screening/prevention. We emphasize the need for an individualized, comprehensive approach for these patients and review perceived and actual barriers to care. More education is needed on the aforementioned topics for women with developmental disabilities, their caregivers, and their providers.
L-positioned Perforator Propeller Flap for Partial Breast Reconstruction with Axillary Dead Space
Authors: Yamamoto Mao , Yano Tomoyuki , Shimizu Daisuke , Yokoyama Akiko , Ito Osamu 
Published: July 2016

Summary:
Partial breast reconstruction using perforator flaps harvested from the lateral chest wall has become a well-established surgical technique recently. In the case of a partial mastectomy with an axillary lymph node dissection, there are 2 main defects; one is a partial breast defect and the other is an axillary dead space. To reconstruct the 2 separate defects with local flaps, basically 2 different flaps are needed, and usually, it is rather difficult to harvest 2 different local flaps in the adjacent area. To resolve this problem, we introduce the L-positioned perforator propeller flap (PPF). We used an L-positioned PPF on 2 female patients, aged 46 and 47 years old, who were suffering from breast cancer in the upper outer quadrant. The concept of this flap design is as follows: the partial breast defect is reconstructed with the longer lobe of the L-positioned PPF and the axillary defect is filled with the smaller lobe of the L-positioned PPF at the same time. The reconstruction time was 2 hours and 0 minutes and 1 hour and 46 minutes in each case. The patients were successfully provided with aesthetically acceptable breast reconstruction without postoperative complications. Moreover, both patients had consecutive postoperative radiotherapy on the reconstructed area without complications. With this flap design, it is possible for patients to have safe and aesthetic reconstruction with only 1 local flap and fewer invasive procedures.
INCIDENCE OF ACUTE EXUDATIVE MACULOPATHY AFTER REDUCED-FLUENCE PHOTODYNAMIC THERAPY
Authors: Mammo Zaid , Forooghian Farzin 
Published: July 2016

Purpose:
To describe the incidence and features of acute exudative maculopathy (AEM) after half-fluence photodynamic therapy (PDT) and/or very minimal fluence PDT.

Methods:
Retrospective chart review of all patients treated over a 7-year period.

Results:
A total of 52 patients (58 eyes, 140 treatments) were treated with half-fluence PDT and/or very minimal fluence PDT. Patients were diagnosed with either central serous chorioretinopathy (CSCR) or neovascular age-related macular degeneration (nAMD). Two patients (1 CSCR and 1 nAMD) returned to the clinic with acute vision loss after treatment and were identified as having developed AEM. In the CSCR case, resolution occurred after intravitreal bevacizumab treatment. The nAMD case resolved with topical difluprednate treatment. We were unable to identify any risk factors for the development of AEM.

Conclusion:
AEM seems to be a rare (incidence 1.4% per treatment) and unpredictable reaction related to the proinflammatory effects of half-fluence PDT and very minimal fluence PDT. Because of the inherent limitations of this study, the true incidence of AEM after reduced-fluence PDT may be higher.
Corneal Haze as Prognostic Indicator of Intraocular Pressure in Primary Congenital Glaucoma
Authors: Li Xintong , Mukkamala Lekha , Origlieri Catherine A. , Holland Bart K. , Fechtner Robert D. , Khouri Albert S. 
Published: July 2016

Purpose:
To perform a longitudinal analysis on the association of corneal haze with intraocular pressure (IOP) in eyes with primary congenital glaucoma (PCG) over 3 years.

Patients and Methods:
Charts of all patients diagnosed with glaucoma of childhood from 2002 to 2012 at our institution were retrospectively reviewed. Inclusion criteria were age 18 years and below, plus elevated IOP or characteristic clinical signs. Exclusion criteria were eyes with secondary glaucoma or corneal haze not from PCG and patients with prior ocular surgery or incomplete follow-up.

Results:
Of 79 eyes with childhood glaucoma during this period, 36 eyes had PCG [25 patients; 15 male (60.0%), 14 bilateral (56.0%)]. Eighteen eyes (13 patients) presented with corneal haze, whereas 18 eyes (12 patients) did not. Eyes with haze were diagnosed at a younger age than eyes without haze (0.79 vs. 5.2 y, P<0.02). During year 1, eyes with haze underwent significantly more IOP-lowering procedures and used significantly fewer IOP-lowering medications. Multivariate analysis revealed that corneal haze increased IOP by 4.63 mm Hg when controlling for treatment over time (P<0.01). Eyes with haze had lower survival curves and a failure hazard of 1.3 times that of eyes without haze. These eyes had a lower proportion of qualified successes than eyes without haze at year 1 (P<0.05) but this was reversed at year 3 (P<0.02).

Conclusions:
Eyes with PCG-related corneal haze generally presented more severely than did those without haze, but postmanagement outcomes may be similar to those in eyes without haze.