bluuebunny/crossref_metadata_2025_split huggingface dataset:
Distractor Application and Dry Arthroscopy to Improve Articular Visualization During Scapula Fracture Surgery Via a Posterior Approach
Authors: Saiz Augustine M. , Mayer Ryan , Kellam Patrick J. , Schultz Blake J. , Cunningham Bryce , Warner Stephen J. , Choo Andrew 
Published: February 2023

Summary
Intra-articular glenoid displacement is an indication for open reduction and internal fixation of scapular fractures. However, direct visualization of the glenoid is limited, and articular reductions are typically performed and assessed using extra-articular cortical reduction reads and fluoroscopic imaging. In this technique, we describe the application of a distractor for direct visualization of the glenoid articular surface. In this way, anatomic reduction of the glenoid articular surface can be assessed and achieved. In addition, we discuss the use of a portable, dry arthroscopy when needed. This technique has resulted in good-to-excellent articular reductions by adjusting extra-articular reads that seemed adequate before intra-articular visualization. This technique is safe, requires minimal extra set-up or instruments, and results in good-to-excellent articular reductions.
Surgeon-Estimated Blood Loss Is Discordant With Calculated Blood Loss in Acetabular and Pelvic Fracture Surgery
Authors: Lindsay Sarah E. , McKibben Natasha , Yang Qian , Zusman Natalie Lacey , Friess Darin M. , Working Zachary Mark 
Published: February 2023

Objectives:
To compare blood loss as estimated by surgeon-estimated blood loss (EBL), the Gross formula, and the HB equation in open pelvic and acetabular surgery.

Design:
Retrospective cohort study.

Setting:
Single Level I academic trauma center.

Patients:
We included 710 patients 18–89 years of age who underwent acetabular or pelvic surgery between 2008 and 2018 for the management of fracture.

Intervention:
Surgical treatment for the management of acetabular or pelvic fracture and blood transfusion when deemed clinically appropriate in the perioperative setting.

Main Outcome Measures:
Surgeon EBL and calculated blood loss (using the Gross formula, a Gross formula derivative, and the HB equation with both Moore and Nadler blood volume estimations).

Results:
One hundred ninety-two patients (27%) received intraoperative blood transfusions. Surgeon EBL significantly differed from all formulas except the Gross/Nadler and the modified Gross/Nadler calculations. Gross and HB calculation methods yielded similar results in the overall cohort but yielded significantly different results in the subgroup analysis. Use of a corrective transfusion factor mildly improved correlation of the Gross equation with EBL. At high levels of blood loss, surgeon EBL predictions became more discordant with calculated blood loss values. When assessing only patients who did not receive transfusions, concordance improved.

Conclusion:
Blood loss in pelvic and acetabular surgery is challenging to quantify, and this study demonstrates discordance between formula predictions and surgeon-estimated blood loss. At higher levels of blood loss, this discrepancy worsens. This exploratory study highlights the need for the development of improved methods of quantifying blood loss in orthopaedic trauma surgery.

Level of Evidence:
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Free Vascularized Fibula Graft for Staged Reconstruction of Infected Humerus Nonunions
Authors: Lefebvre Rachel , Bougioukli Sofia , Marecek Geoffrey , Howard Mark , Cohen Landon , Stevanovic Milan 
Published: February 2023

Objective:
To evaluate the union rate and rate of postoperative complications in patients with septic nonunions of the humerus after a two-stage reconstruction using a free vascularized fibula graft.

Design:
Retrospective case series.

Setting:
Academic, tertiary referral center.

Patients/Participants:
Adult patients with staged reconstruction for infected nonunion of the humerus with at least 2 years follow-up after vascularized fibula graft transfer.

Intervention:
First, infected nonunion debridement with antibiotic spacer and external fixator placement. After antimicrobial treatment, free vascularized fibula transfer with internal fixation.

Main Outcome Measurements:
Time to union, pain, affected extremity range of motion, and function.

Results:
10 patients with septic humerus nonunion treated with staged reconstruction using a free vascularized fibula graft, with a mean follow-up of 32.3 months were included. After the two-stage reconstruction using a free fibula, radiographic union was achieved in 6/10 patients, with a mean time to union of 19.9 weeks. The remaining 4 patients required an additional procedure with graft augmentation and/or implant revision. After the revision procedure, union was noted in 3/4 patients, 21 weeks postoperatively. Mean patient visual analog scale pain scores improved from 5.8 preoperatively to 0.9 at final follow-up (P = 0.02). Postoperatively, mean elbow flexion was 110 ± 20 degrees and extension 15 ± 7.5 degrees.

Conclusion:
A two-stage reconstruction using a free fibula graft can be used in patients with septic nonunions of the humerus in the setting of multiple failed prior surgeries and compromised local biology. Additional procedures may be needed in some to achieve final union.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Effects of Technical Errors on the Outcomes of Operatively Managed Femoral Neck Fractures in Adults Less than 50 Years of Age
Authors: Collinge Cory A. , Finlay Andrea , Harris Payton , Rodriguez-Buitrago Andres , de la Fuente Guadalupe , Beltran Michael , Mitchell Phillip , Archdeacon Michael , Tornetta Paul , Mir Hassan R. , Gardner Michael , Sagi H. Claude , LeBus George F. , Cannada Lisa K. , Smyth Brooke ,   and Young Femoral Neck Fracture Working Group
Published: February 2023

Objective:
To evaluate the effect of technical errors (TEs) on the outcomes after repair of femoral neck fractures in young adults.

Design:
Multicenter retrospective clinical study.

Setting:
26 North American Level 1 Trauma Centers.

Patients:
Skeletally mature patients younger than 50 years of age with 492 femoral neck fractures treated between 2005 and 2017.

Intervention:
Operative repair of femoral neck fracture.

Main Outcome Measurements:
The association between TE (malreduction and deviation from optimal technique) and treatment failure (fixation failure, nonunion, malunion, osteonecrosis, malunion, and revision surgery) were examined using logistic regression analysis.

Results:
Overall, a TE was observed in 50% (n = 245/492) of operatively managed femoral neck fractures in young patients. Two or more TEs were observed in 10% of displaced fractures. Treatment failure in displaced fractures occurred in 27% of cases without a TE, 56% of cases with 1 TE, and 86% of cases with 2 or more TEs. TEs were encountered less frequently in treatment of nondisplaced fractures compared with displaced fractures (39% vs. 53%, P < 0.001). Although TE(s) in nondisplaced fractures increased the risk of treatment failure and/or major reconstructive surgery (22% vs. 9%, P < 0.001), they were less frequently associated with treatment failure when compared with displaced fractures with a TE (22% vs. 69% P < 0.001).

Conclusions:
TEs were found in half of all femoral neck fractures in young adults undergoing operative repair. Both the occurrence and number of TEs were associated with an increased risk for failure of treatment. Preoperative planning for thoughtful and well-executed reduction and fixation techniques should lead to improved outcomes for young patients with femoral neck fractures. This study should also highlight the need for educational forums to address this subject.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Gender Diversity, Leadership, Promotion, and Opportunity Among the Members of the Orthopaedic Trauma Association (OTA)
Authors: Murphy Lynn , Miller Anna N. , Vallier Heather A. , Roffey Darren M. , Lefaivre Kelly A. 
Published: February 2023

Objectives:
To demonstrate the gender distribution in leadership positions and academic promotion of Orthopaedic Trauma Association (OTA) members.

Methods:
We conducted a cross-sectional examination of the 2020–2021 OTA membership cohort dataset provided by the OTA. Professional and academic information of OTA members at their site of appointment was also abstracted from publicly available online resources. Data included: gender, OTA membership category, OTA leadership position, trauma fellowship completion, trauma practice setting, level of trauma center, percentage of trauma work, year of first practice, academic rank, and university/hospital/institutional leadership role. Statistical analysis included chi-squared, Wilcoxon two-sample, and Fisher exact tests.

Results:
2608 OTA members were identified; 14.1% were women. Female representation was highest in the Trauma Practice Professional category (67.1%) and significantly lower in the Active category (9.1%) (P < 0.0001). No statistically significant gender differences were observed regarding level of trauma center, percentage of trauma work, or trauma practice setting. In the Active, Clinical and Emeritus categories, men achieved a higher level of academic rank than women at their site of employment (P = 0.003), while more men completed trauma fellowships (P = 0.004) and had been in practice for significantly longer (P < 0.0001). Men held more of the highest leadership positions (eg, Board of Directors) (P = 0.0047) and the greatest number of leadership positions (P = 0.017) within the OTA compared with women.

Conclusion:
Gender disparity exists within the upper echelon of leadership and academic representation in orthopaedic trauma. Our findings will help inform strategic policies to address gender diversity within the OTA and the broader orthopaedic trauma subspecialty.
Transtibial Amputation With Fibulectomy and Fibular Collateral Ligament-Biceps Reconstruction: Surgical Technique and Clinical Experience
Authors: Harrington Colin J. , Kaplan Shane A. , Richards John T. , Smith Douglas G. , Souza Jason M. , Potter Benjamin K. 
Published: February 2023

Objectives:
To describe our clinical experience and surgical technique of transtibial amputation with fibulectomy and fibular collateral ligament-biceps reconstruction for management of, particularly short, transtibial amputations with proximal fibula prominence, overt instability, or inadequate soft-tissue coverage.

Design:
Retrospective review.

Setting:
Level II trauma center.

Patients:
Twelve consecutive patients who underwent transtibial amputation with fibulectomy and fibular collateral ligament-biceps reconstruction between 2008 and 2021.

Intervention:
We reviewed patient medical records, radiographs, and clinical photographs.

Main Outcome Measurements:
Complications, instability, and pain.

Results:
Eight patients underwent acute transtibial amputation with fibulectomy and reconstruction, whereas 4 patients underwent amputation revision with fibulectomy and reconstruction for chronic pain. All 12 patients were men, with a median age of 39 years (interquartile range, 33–46). All injuries were due to high-energy mechanisms, including improvised explosive device (n = 8), rocket-propelled grenade (n = 2), gunshot wound (n = 1), and motor vehicle accident (n = 1). After a median follow-up of 8.5 years (interquartile range, 3.4–9.3), there was one complication, a postoperative suture abscess. No patients had subjective lateral knee instability after the procedure, and the average pain scores decreased from 4.75 to 1.54 (P = 0.01). All patients returned to regular prosthesis wear and maintained independent functioning with activities of daily living.

Conclusions:
Our experience with fibulectomy and fibular collateral ligament-biceps reconstruction demonstrated no subjective or clinical postoperative instability and may be a useful adjunct for managing transtibial amputations with fibular instability or prominence, pain, or skin breakdown at the fibular head.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
An Acute Fixation Protocol for High-Energy Tibial Plateau Fractures Decreases Time to Fixation and Lowers Operative Costs Without Affecting Wound Complications and Reoperations
Authors: Kim Ye Joon , Scott Tyler , Richard Raveesh D. , Parry Joshua A. 
Published: February 2023

Objectives:
To investigate whether an acute fixation protocol for high-energy tibial plateau fractures increases the rate of wound complications.

Design:
Retrospective comparative study.

Setting:
Urban level 1 trauma center.

Patients/Participants:
One hundred thirty-four patients with high-energy tibial plateau fractures (OTA/AO 41B/C [Schatzker VI/V/VI]) treated with open reduction and internal fixation (ORIF).

Intervention:
Utilization of an acute ORIF (<48 hours) versus delayed ORIF protocol.

Main Outcome Measure:
Primary outcomes: wound complications (wound dehiscence/necrosis, superficial/deep infections) and reoperations. Secondary outcomes: total operative costs and hospital length of stay.

Results:
Overall, 83.9% (26/31) of patients received definitive fixation within 48 hours under the acute ORIF protocol versus 18.4% (19/103) of patients treated under the standard delayed protocol with no observed differences in the rate of wound complications (proportional difference (PD) −4.6%, confidence interval (CI) −17.2% to 11.3%; P = 0.78) or reoperations (PD 2.0%, CI, 13.0% to 12.5%; P = 1.00). The acute ORIF protocol lowered operative costs (median difference (MD) $-2.563.00, CI, 3021.00 to −1661.00; P < 0.001) and hospital length of stay (MD 4.0 days, CI, 6.0–1.0; P = 0.001). On multivariate analysis, wound complications were associated with increasing age (odds ratio (OR) 1.05, CI, 1.01–1.10; P = 0.01) and tobacco use (OR 3.75, CI, 1.19–11.82; P = 0.02).

Conclusion:
An acute ORIF protocol for high-energy tibial plateau fractures decreased time to fixation and lowered operative costs without increasing the risk of wound complications or reoperations.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Variability in Pain Management Practices for Pediatric Anterior Cruciate Ligament Reconstruction
Authors: Wagner K. John , Beck Jennifer J. , Carsen Sasha , Crepeau Allison E. , Cruz Aristides I. , Ellis Henry B. , Mayer Stephanie W. , Niu Emily , Pennock Andrew T. , Stinson Zachary S. , VandenBerg Curtis , Ellington Matthew D. 
Published: February 2023

Background:
The opioid epidemic in the United States is a public health crisis. Pediatric orthopaedic surgeons must balance adequate pain management with minimizing the risk of opioid misuse or dependence. There is limited data available to guide pain management for anterior cruciate ligament reconstruction (ACLR) in the pediatric population. The purpose of this study was to survey current pain management practices for ACLR among pediatric orthopaedic surgeons.

Methods:
A cross-sectional survey study was conducted, in which orthopaedic surgeons were asked about their pain management practices for pediatric ACLR. The voluntary survey was sent to members of the Pediatric Orthopaedic Society of North America. Inclusion criteria required that the surgeon perform anterior cruciate ligament repair or reconstruction on patients under age 18. Responses were anonymous and consisted of surgeon demographics, training, practice, and pain management strategies. Survey data were assessed using descriptive statistics.

Results:
Of 64 included responses, the average age of the survey respondent was 48.9 years, 84.4% were males, and 31.3% practiced in the southern region of the United States. Preoperative analgesia was utilized by 39.1%, 90.6% utilized perioperative blocks, and 89.1% prescribed opioid medication postoperatively. For scheduled non-narcotic medications postoperatively 82.8% routinely advocated and 93.8% recommended cryotherapy postoperatively.
Acetaminophen was the most used preoperative medication (31.3%), the most common perioperative block was an adductor canal block (81.0%), and the most common postoperative analgesic medication was ibuprofen (60.9%). Prior training or experience was more frequently reported than published research as a primary factor influencing pain management protocols.

Conclusions:
Substantial variability exists in pain management practices in pediatric ACLR. There is a need for more evidence-based practice guidelines regarding pain management.

Level of Evidence:
Level V
Does Transitioning to a Brace Improve HRQoL After Casting for Early Onset Scoliosis?
Authors: Henstenburg Jeffrey , Heard Jeremy , Sturm Peter , Blakemore Laurel , Li Ying , Ihnow Stephanie B. ,   Pediatric Spine Study Group, Shah Suken A. 
Published: February 2023

Background:
Serial casting is favored for the initial treatment of early onset scoliosis (EOS), but there is concern about significant morbidity and caregiver burden. Studies have examined the utility of bracing as an alternative to casting, but little is known about differences in health-related quality of life (HRQoL) between treatments. We hypothesized that patients with a diagnosis of idiopathic EOS experience an improvement in HRQoL when transitioning from serial casting to bracing as measured by the 24-Item Early Onset Scoliosis Questionnaire (EOSQ).

Methods:
Subjects with idiopathic EOS were retrospectively identified from a multicenter database. EOSQ scores were compared before treatment, after index casting, after transition out of cast to brace, and at the most recent follow-up. Available major curve magnitudes were also compared during these time points. Data were compared using repeated-measures ANOVA with post hoc Bonferroni correction.

Results:
Sixty-six subjects met the inclusion criteria. Thirty-seven (56%) subjects were male and the average age at the time of index treatment was 1.9 (0.37-6.4) years. The average follow-up was 3.2 (0.90-6.8) years. In 57 subjects, the major curve magnitude improved from a mean of 33 (CI 28-37) degrees before treatment initiation to 27 (CI 23-30) degrees after casting and to 24 (CI 20-29) degrees at the most recent follow-up. The HRQoL subdomain showed a significant decrease in HRQoL during casting treatment 75.7 (CI 72.9-78.5) from pre-index treatment 84.9 (CI 81.4-88.5), during brace treatment 84.8 (CI 81.8-88.0) and at most recent follow-up 87.0 (CI 83.6-90.3) (P<0.001). The parental impact subdomain improved from the beginning to the end of treatment (77.7 to 87.7, P=0.001) (n=64). Satisfaction improved from casting to bracing (73.4 to 86.7, P<0.001) (n=63) and to the most recent follow-up (73.4 to 87.9, P<0.001).

Conclusion:
Patients treated with casting for EOS experience reversible declines in HRQoL. After patients transition from casting to bracing, EOSQ scores recover to pretreatment baseline levels and are maintained at follow-up. This information must be balanced with the effectiveness of treatment for EOS with either method and customized for each patient.

Level of Evidence:
Level III—retrospective comparative study.
Previous Emergency Department Admission Is Associated With Increased 90-Day Readmission Following Cervical Spine Surgery
Authors: Amakiri Uchechukwu O. , Dominy Calista , Kumar Anish , Arvind Varun , Pitaro Nicholas L. , Kim Jun S. , Cho Samuel K. 
Published: February 2023

Study Design:
This was a retrospective case-control study.

Objective:
The objective of this study was to evaluate whether prior emergency department admission was associated with an increased risk for 90-day readmission following elective cervical spinal fusion.

Summary of Background Data:
The incidence of cervical spine fusion reoperations has increased, necessitating the improvement of patient outcomes following surgery. Currently, there are no studies assessing the impact of emergency department visits before surgery on the risk of 90-day readmission following elective cervical spine surgery. This study aimed to fill this gap and identify a novel risk factor for readmission following elective cervical fusion.

Methods:
The 2016–2018 Nationwide Readmissions Database was queried for patients aged 18 years and older who underwent an elective cervical fusion. Prior emergency admissions were defined using the variable HCUP_ED in the Nationwide Readmissions Database database. Univariate analysis of patient demographic details, comorbidities, discharge disposition, and perioperative complication was evaluated using a χ2 test followed by multivariate logistic regression.

Results:
In all, 2766 patients fit the inclusion criteria, and 18.62% of patients were readmitted within 90 days. Intraoperative complications, gastrointestinal complications, valvular, uncomplicated hypertension, peripheral vascular disorders, chronic obstructive pulmonary disease, cancer, and experiencing less than 3 Charlson comorbidities were identified as independent predictors of 90-day readmission. Patients with greater than 3 Charlson comorbidities (OR=0.04, 95% CI 0.01–0.12, P<0.001) and neurological complications (OR=0.29, 95% CI 0.10–0.86, P=0.026) had decreased odds for 90-day readmission. Importantly, previous emergency department visits within the calendar year before surgery were a new independent predictor of 90-day readmission (OR=9.74, 95% CI 6.86–13.83, P<0.001).

Conclusions:
A positive association exists between emergency department admission history and 90-day readmission following elective cervical fusion. Screening cervical fusion patients for this history and optimizing outcomes in those patients may reduce 90-day readmission rates.