bluuebunny/crossref_metadata_2025_split huggingface dataset:
Open Reduction Internal Fixation versus Primary Arthrodesis for Lisfranc Injuries: A Prospective Randomized Study
Authors: Henning Jeffrey A. , Jones Clifford B. , Sietsema Debra L. , Bohay Donald R. , Anderson John G. 
Published: October 2009

Background: Dislocations and fracture-dislocations involving the tarsometatarsal joint are a relatively common injury. These injuries are associated with long-term disability from subsequent painful osteoarthritis and residual deformity. This study evaluated whether performing a primary arthrodesis (PA) resulted in improved functional outcome and fewer subsequent surgeries as compared to primary open reduction and internal fixation (PORIF). Materials and Methods: Forty patients with acute tarsometatarsal joint fractures or fracture dislocations were prospectively randomized to undergo either PORIF or PA. Clinical and radiographic examination, in addition to Short Form-36 (SF-36) and Short Musculoskeletal Function Assessment (SMFA) questionnaires, were evaluated at intervals of 3, 6, 12, and 24 months following surgery in 32 patients. A patient satisfaction phone survey was also performed. Results: The rate of planned and unplanned secondary surgeries, including hardware removal and salvage arthrodesis, between ORIF and PA groups, 78.6% vs. 16.7% was significantly different. No statistically significant differences were found with physical functioning for the PORIF or PA groups with regard to SF-36 or SMFA scores at any followup time interval. However, time from injury had a significant effect with impaired functioning at three months compared to all future intervals. No difference in satisfaction rates were found between PORIF and PA at an average of 53 months in a phone survey. Conclusion: PA of tarsometatarsal joint injuries resulted in a significant reduction in the rate of followup surgical procedures if hardware removal is routinely performed with no significant difference in SF-36 and SMFA outcome scores when compared to PORIF. Level of Evidence: I, Prospective Randomized Study
Instability of the First Metatarsal-Cuneiform Joint: Diagnosis and Discussion of an Independent Pain Generator in the Foot
Authors: Cooper Andrew J. , Clifford Paul D. , Parikh Viraj K. , Steinmetz Neil D. , Mizel Mark S. 
Published: October 2009

Background: First metatarsocuneiform (MC) instability is recognized as a pathologic contributor to hallux valgus. There are no studies identifying the first MC joint as an independent pain generator in the foot that may require surgical arthrodesis for its management. Materials and Methods: The authors reviewed the records of all patients with this newly described pathology in the first MC joint. There were 61 patients with 85 feet who underwent a fluoroscopically guided local anesthetic injection into the first metatarsocuneiform joint to assess pain relief. Patient's complaints, physical exam findings, treatment decisions, patient characteristics, and radiographic findings were evaluated. Results: Seventy-nine percent of patients (67/85) injected had relief of their symptoms. Eight or these 67 patients were eventually treated with first MC arthrodesis with complete relief of symptoms. The average time from onset of symptoms to presentation was 21 (range, 1 to 72) months. Eighty-five percent of feet (72/85) had multiple previous diagnoses. Radiographic plantar widening of the first M-C joint on weightbearing views was inconsistent with pathology. Conclusion: The first MC joint is an independent pain generator in the foot that can have variable presentations. Radiographic data can often be helpful, but clinical exam findings are paramount in the diagnosis. Fluoroscopically-guided long acting local anesthetic injections of this joint are helpful in the diagnosis, especially in the patient with multiple possible pain generators in the foot and ankle. Failure to recognize the first MC joint as a source of pain may lead to delay in treatment, misdiagnosis, and mistreatment of foot pathology. Level of Evidence: IV, Retrospective Case Series
Ankle Replacement: Current Practice of Foot & Ankle Surgeons in the United Kingdom
Authors: Goldberg Andrew J. , Sharp Robert J. , Cooke Paul 
Published: October 2009

Background: The main surgical treatments for end stage ankle arthritis are arthrodesis and total ankle replacement (TAR). In Europe, there are now more than 11 different prostheses, most with limited outcome data. This study aimed to determine the number and types of implants used in the United Kingdom. Materials and Methods: A questionnaire based survey was sent to all Consultant members of the British Orthopaedic Foot & Ankle Society ( n = 180). Results: Sixty-eight percent completed the questionnaires. Thirty percent of respondents were not performing ankle joint replacements at the time of the survey. The mode number of ankle replacements carried out per year by Foot and Ankle Specialists was eight. Conclusion: The UK has a population of 60 million and surgeons are implanting at least 800 ankle replacements per year. More surgeons are beginning to perform ankle replacements in small numbers and a UK National Joint Registry for Ankle Replacements is in development. Currently, none of the fixed bearing implants being used in the United States are being used in the United Kingdom and although the number of ankle replacements implanted in the United States is unknown, it is predicted that this type of surgery could have a significant impact on insurers and healthcare providers in the future.
Clinical Evaluation and Radiographic Assessment of Bone Lysis of the AES Total Ankle Replacement
Authors: Besse Jean-Luc , Brito Nuno , Lienhart Christophe 
Published: October 2009

Background: AES mobile-bearing total ankle replacement is evolved from the Buechel Pappas model. We report medium-term results of a prospective study with AES. Materials and Methods: All patients who underwent AES TAR for ankle arthritis, by a single surgeon, from 2003 to 2006 were included, excluding neurologic disease, talar osteonecrosis and malalignment more than 20 degrees. All were reviewed at 6 months, 1 year, and at yearly intervals thereafter. X-rays were analyzed by three observers, using a 10-zone protocol. Fifty consecutive AES implants in 47 patients (mean age, 56 years; range, 21 to 79 year) were included, with at least 2 years' followup (mean 40 months). Preoperative diagnosis was mainly post-traumatic (50%) and osteoarthritis secondary to instability (36%). Associated procedures were performed in 38%. Results: Eighty-two percent had good functional results. The mean AOFAS score rose from 36.9 ± 1.7 preoperatively to 85.4 ± 12, dorsiflexion from 3 degrees to 7.3 degrees, and plantarflexion from 30.8 degrees to 37.8 degrees. Two ankles underwent secondary arthrodesis for talar subsidence and mechanical dislocation. Ninety-eight percent of implants were well positioned at 90 degrees ±4. Mean prosthesis ROM on X-ray was 22.1 degrees. There were tibia/implant interface cysts (greater than 5 mm) in 62% of cases, and talar/implant interface cysts in 43%. Conclusion: Although functional outcomes were comparable to the other mobile TAR in the literature, bone lysis with the AES prosthesis was more frequent with risk of subsidence. We therefore stopped implantation of this prosthesis and recommend preventive grafting for severe lysis. Level of Evidence: IV, Retrospective Case Series
Proximal Opening-Wedge Osteotomy of the First Metatarsal for Hallux Valgus Using a Low Profile Plate
Authors: Saragas Nikiforos P. 
Published: October 2009

Background: This retrospective study was conducted to evaluate the results of the proximal (basal) opening-wedge osteotomy of the first metatarsal for correction of symptomatic hallux valgus deformity, using a low profile plate. Materials and Method: The procedure was performed by a single surgeon over an 18-month period. Forty-six patients (64 feet) were treated for symptomatic hallux valgus with an average follow up of 20 months. A proximal opening-wedge osteotomy of the first metatarsal and fixation with a low profile plate in combination with a distal soft tissue release with the same postoperative protocol was used in all the patients. Improvement in the hallux valgus angle (HV) and I—II intermetatarsal angle (IM I—II) as well as the AOFAS forefoot score pre and postoperatively (obtained retrospectively from the medical records), were recorded; in particular, the length of the first metatarsal was noted pre- and postoperatively. Results: The HV and IM I—II angles improved by a mean of 14.7 degrees and 6.4 degrees, respectively. The AOFAS forefoot score improved from a mean of 51.3 to 86.8. The mean increase in the length of the first metatarsal was 2.3 mm. Of the more significant complications, five patients developed a hallux varus (early in the series), one of which was symptomatic, and there was one non-union requiring bone graft. Conclusion: The proximal opening wedge osteotomy of the first metatarsal in combination with a distal soft tissue release and stable fixation of the low profile plate was an effective method for correcting a moderate hallux valgus deformity. Guidance provided by the “First Metatarsal Opening Wedge Angle Reference Chart” was found to be helpful for the IM I–II angle correction. Level of Evidence: IV, Retrospective Case Series
Radiography versus Computed Tomography for Displacement Assessment in Calcaneal Fractures
Authors: Ogawa Brent K. , Charlton Timothy P. , Thordarson David B. 
Published: October 2009

Background: Coronal computed tomography (CT) scans are commonly used in fracture classification systems for calcaneus fractures. However, they may not accurately reflect the amount of fracture displacement. The purpose of this paper was to determine whether lateral radiographs provide superior assessment of the displacement of the posterior facet compared to coronal CT scans. Materials and Methods: Lateral radiographs of calcaneus fractures were compared with CT coronal images of the posterior facet in 30 displaced intra-articular calcaneus fractures. The average patient age was 39 years old. Using a Picture Archiving and Communication System (PACS), measurements were obtained to quantify the amount of displacement on the lateral radiograph and compared with the amount of depression on corresponding coronal CT scans. Results: On lateral radiographs, the angle of the depressed portion of the posterior facet relative to the undersurface of the calcaneus averaged 28.2 degrees; Bohler's angle averaged 12.7 degrees. These numbers were poorly correlated ( r = 0.25). In corresponding CT images from posterior to anterior, the difference in the amount of displacement of the lateral portion of the displaced articular facet versus the nondisplaced medial, constant fragment, was minimal and consistently underestimated the amount of displacement. Conclusion: Underestimation of the amount of depression and rotation of the posterior facet fragment was seen on the coronal CT scan. We attribute this finding to the combined rotation and depression of the posterior facet which may not be measured accurately with the typical semicoronal CT orientation. While sagittal reconstructed images would show this depression better, if they are unavailable we recommend using lateral radiographs to better gauge the amount of fracture displacement. Level of Evidence: IV, Retrospective Case Series
Side-to-Side Difference in Joint Position Sense and Kinesthesia in Unilateral Functional Ankle Instability
Authors: Lim Edwin Choon Wyn , Tan Mann Hong 
Published: October 2009

Background: Impairment in proprioception has been suggested to be one of the causes of FAI. This study aimed to establish intra-session reliability of the Biodex System 2 in assessing joint position sense (JPS) and kinesthesia (K) in addition to determining if there was any side to side difference in JPS and kinesthesia in people with unilateral functional ankle instability. Materials and Methods: Both JPS and K were determined by means of the Biodex Systems 2. During evaluation of JPS, participants' ability to actively reproduce ankle joint position was tested three times in each of the two predetermined positions. During evaluation of K, data collection began with the foot placed in a starting position of 0 degrees (neutral position). Results: A total of 25 participants (mean age 22.0 years, 95% confidence interval 19.9 to 24.1 years) were recruited into this study. No difference in JPS ( p = 0.162 to 0.764) and K ( p = 0.089 to 0.683) were found between the sprained and uninvolved ankle of subjects with unilateral functional ankle instability. There is moderate to good intra-session reliability in using the Biodex System 2 to assess JPS (ICC = 0.868 to 0.950, p < 0.01) and K (ICC = 0.825 to 0.893, p < 0.01). Conclusion: This study suggests that there is perhaps no difference in JPS and K between both ankles in people with unilateral FAI. Proprioceptive deficits may not always be present in every case of FAI. Clinical Relevance: Proprioceptive training may not be beneficial in some patients with unilateral FAI.
Neurosurgical implications of achondroplasia
Authors: King James A. J. , Vachhrajani Shobhan , Drake James M. , Rutka James T. 
Published: October 2009

Object
Achondroplasia is the most common form of human short-limbed dwarfism. The pediatric neurosurgeon is frequently required to treat children with achondroplasia who have hydrocephalus, cervicomedullary compression (CMD), and spinal canal stenosis. Accordingly, the authors have reviewed the experience of neurosurgery in children with achondroplasia at The Hospital for Sick Children.

Methods
The medical records and neurosurgery database at The Hospital for Sick Children were searched to identify all children with achondroplasia who underwent at least 1 neurosurgical procedure between 1956 and the present.

Results
Twenty-nine children with achondroplasia underwent 85 surgical procedures: 52 for CSF diversion in 12 patients, 20 for CMD in 18 patients, 8 for spinal disorders in 4 patients, and 5 for miscellaneous purposes in 4 patients. The CSF shunts were placed almost exclusively before 1990 and were associated with a significant number of complications. Patients undergoing CMD did very well, with only 1 patient failing to improve clinically.

Conclusions
This review provides a historical perspective on the evolution of treatment of pediatric patients with achondroplasia. The use of CSF diversion procedures, formerly fraught with complications, is now rare following the realization of the natural history of CSF space enlargement in these patients. Cervicomedullary compression is more commonly recognized due to better imaging. Central apnea is now better detected by routine sleep studies. Spine surgery, although rare, requires evaluation of both spinal stenosis and instability. These patients are best evaluated by a multidisciplinary team.
Passive range of motion functional magnetic resonance imaging localizing sensorimotor cortex in sedated children
Authors: Ogg Robert J. , Laningham Fred H. , Clarke Dave , Einhaus Stephanie , Zou Ping , Tobias Michael E. , Boop Frederick A. 
Published: October 2009

Object
In this study, the authors examined whether passive range of motion (ROM) under conscious sedation could be used to localize sensorimotor cortex using functional MR (fMR) imaging in children as part of their presurgical evaluation.

Methods
After obtaining institutional review board approval (for retrospective analysis of imaging data acquired for clinical purposes) and informed consent, 16 children underwent fMR imaging. All 16 had lesions; masses were found in 9 patients and cortical dysplasia was found in 4; the lesions in 3 patients were not diagnosed. Passive ROM was performed during blood oxygen level–dependent MR imaging sequences. Three of the patients also performed active motor tasks during the fMR imaging study. All patients were evaluated using passive ROM of the hand and/or foot; 3 patients were evaluated for passive touch of the face. In 9 cases, intraoperative electrocorticography (ECoG) was used. Five of the patients underwent intraoperative ECoG to evaluate for seizure activity. Four patients had intraoperative ECoG for motor mapping. Five of the patients had subdural grids placed for extraoperative monitoring.

Results
In 3 cases, the active and passive ROMs colocalized. In 4 patients ECoG was used to identify motor cortex, and in all 4 motor ECoG yielded results consistent with the passive ROM localization. Thirteen of 16 children have undergone resection based on passive ROM fMR imaging findings with no unanticipated deficits.

Conclusions
These preliminary data suggest that passive ROM fMR imaging can accurately detect functional hand, leg, and face regions of the sensorimotor cortex in the sedated child. This extends current extraoperative mapping capabilities to patients unable or unwilling to cooperate for active motor tasks.
The posterior petrosal approach: technique and applications in pediatric neurosurgery
Authors: Klimo Paul , Browd Samuel R. , Pravdenkova Svetlana , Couldwell William T. , Walker Marion L. , Al-Mefty Ossama 
Published: October 2009

Object
Various lesions occur in deep locations or at the skull base in pediatric patients and require skull base approaches for resection. Skull base surgery confers the advantages of improved line of sight, a wider operative corridor, and reduced brain retraction. The posterior petrosal approach provides simultaneous access to lesions in the posterior middle fossa and posterior fossa from the top of the clivus to the level of the jugular foramen. It allows visualization of the ventrolateral brainstem and may be combined with various other supra- and infratentorial approaches, thus giving the surgeon a wide array of access routes to the lesion.

Methods
The authors conducted a retrospective review of all cases involving pediatric patients undergoing a posterior petrosal approach, either alone or in combination with other cranial approaches. Preoperative and postoperative data were collected, including presentation, neurological examination, imaging findings, pathological condition, operative details, perioperative complications, and postoperative outcomes.

Results
There were 13 patients (6 female, 7 male) with a mean age of 12.6 years (range 14 months–9 years). The posterior petrosal was the sole skull base cranial approach in 4 patients, whereas the posterior petrosal was combined with 1 or more other cranial approaches in 9. A gross-total resection was achieved in 7 patients, subtotal resection in 5, and a biopsy was performed in 1. Complications occurred in 9 patients, including 7 new or worsened cranial neuropathies. There was no perioperative mortality.

Conclusions
Although infrequently used in pediatric neurosurgery, the posterior petrosal approach is a highly versatile approach that can access intra- and extraaxial pathology centered on the petrous bone. The authors believe that patient outcomes are directly related to the degree of experience using this approach. Therefore, if this approach is to be used, they recommend collaboration with a skull base neurosurgeon.
Prioritizing neurosurgical education for pediatricians: results of a survey of pediatric neurosurgeons
Authors: Aldana Philipp R. , Steinbok Paul 
Published: October 2009

Object
Pediatricians play a vital role in the diagnosis and initial treatment of children with pediatric neurosurgical disease. Exposure of pediatrics residents to neurosurgical diseases during training is inconsistent and is usually quite limited. After residency, opportunities for pediatricians' education on neurosurgical topics are few and fall mainly on pediatric neurosurgeons. The American Association of Neurological Surgery/Congress of Neurological Surgeons Joint Section on Pediatric Neurological Surgery Committee on Education undertook a survey of practicing pediatric neurosurgeons to determine whether focused education of practicing pediatricians might lead to better patient outcomes for children with a sampling of common pediatric neurosurgical conditions.

Methods
An Internet-based 40-item survey was administered to practicing pediatric neurosurgeons from the US and Canada identified from the roster of the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Section of Pediatric Neurological Surgery. Survey topics included craniosynostosis and plagiocephaly, occult spinal dysraphism and tethered cord, hydrocephalus and endoscopic third ventriculostomy, Chiari malformation Type I, mild or minor head injury, spastic cerebral palsy, and brain tumors. Most questions pertained to diagnosis, initial medical treatment, and referral.

Results
One hundred three (38%) of the 273 practicing pediatric neurosurgeons completed the survey. Two-thirds of the respondents had completed a pediatric neurosurgery fellowship, and two-thirds were in academic practice. Eighty-two percent of the respondents agreed that the care of pediatric neurosurgical patients could be improved with further education of pediatricians. In the opinion of the respondents, the 3 disease topics in greatest need of educational effort were craniosynostosis and plagiocephaly, occult spinal dysraphism and tethered cord, and hydrocephalus. Head injury and spasticity were given the lowest priorities.

Conclusions
This survey identified what practicing pediatric neurosurgeons perceive to be the most important knowledge deficits of their colleagues in pediatrics. These perceptions may not necessarily be congruent with the perceptions of practicing pediatricians themselves; nevertheless, the data from this survey may serve to inform conversations between neurosurgeons and planners of continuing medical education for pediatricians, pediatrics residency program directors, and medical school pediatrics faculty.
Pediatric thalamic glioblastoma associated with Ollier disease (multiple enchondromatosis): a rare case of concurrence
Authors: Ranger Adrianna , Szymczak Artur , Hammond Robert R. , Zelcer Shayna 
Published: October 2009

Ollier disease and Maffucci syndrome are rare syndromes in which there is deforming dysplasia of cartilage, primarily but not exclusively involving the metaphyses and diaphyses of long bones. In a minority of patients, dysplasia can lead to sarcomatous degeneration, producing chondrosarcomas. There also appears to be an association with other neoplasms. Little has been written about the association between Ollier disease and intracranial tumors, and these papers have largely consisted of case reports in adults. The authors present the case of a 6-year-old girl with left arm osseous changes consistent with Ollier disease and a biopsy-proven thalamic glioblastoma multiforme. They then examine the co-occurrence of brain tumors in conjunction with a dyschondroplasia syndrome in children and adolescents to assess the presentation, treatment offered, and disease course of similar cases.
Eight other such cases were identified, 6 in patients with Ollier disease (ranging in age from 7 to 18 years), and 2 with Maffucci syndrome (both in late adolescence). Including our own patient, 7 of the 9 cases of comorbid dyschondroplasia and intracranial malignancy occurred in girls. Some patients presented soon after the acute onset of symptoms, and others had a more subtle, protracted course over as many as 2 years. Some tumors were deemed resectable and others not. In only 1 instance was follow-up beyond 1 year reported.