bluuebunny/crossref_metadata_2025_split huggingface dataset:
Femur Deformity Correction Planning in Sagittal Plane Using Mechanical Axis
Authors: Vilenskiy Victor A. , Solomin Leonid Nikolaevich , Utekhin Alexander Igorevitch 
Published: April 2023

Recently, deformity correction planning using reference lines and angles is a standard procedure. At the same time, both anatomical and mechanical axes are used for the frontal plane. However, until nowadays, there was no algorithm for planning femoral deformity correction in the sagittal plane based on the mechanical axes of the bone fragments. The aim of this study was to develop a method of femur deformity correction planning in the sagittal plane based on mechanical axes.

Materials and Methods:
On the basis of computer tomography data of 23 adults with nondeformed femurs, we measured the angular relationships between the anatomical axis of the proximal femur in sagittal plane and mechanical axis (∠maj) and the angular relationships between the femoral neck axis and mechanical axis in sagittal plane (∠laj).

Results:
It was found that ∠maj was 16.0° ±7.6°, and ∠laj was 10.2° ±2.4°. Based on the data obtained, we developed a method for planning the correction of femoral deformities in the sagittal plane. According to this method, the mechanical axis of the proximal bone fragment can be determined using any of three options: (1) “Joint line based.” In this method, the proximal joint line of the femur is drawn, then from the center of the femur head with the angle 85° (mean value of mPPFA) to this line is drawn a line that is mechanical axis; (2) “Femoral neck based.” The neck axis is drawn first, then from the center of the femur head with the angle 16° (mean value ∠maj) to this line is drawn a line that is mechanical axis; and (3) “Anatomical axis based.” First, the anatomical axis of the proximal femur is drawn, then a line parallel to the anatomical axis from the center of the femoral head is drawn, then a line at an angle of 10° (mean value ∠laj) to it is drawn, that is the mechanical axis. Determination of the mechanical axis of the distal fragment in sagittal plane is made by the following: the distal joint line is drawn and divided into five equal segments. Then, the point located on the border of the front 2/5 and the rear 3/5 of the segment is found. From that point, at an angle of 81° (mean mPDFA), a mechanical axis of the distal femur fragment is drawn. The intersection of the mechanical axes of the proximal and distal fragments defines the apex of the deformity.

Conclusion:
The proposed method for planning deformity correction based on mechanical axes for the sagittal plane complements the existing planning methods for the frontal plane and improves the quality, namely the accuracy of preoperative planning.
Risk Factors for Focal Osteolysis in a Stainless-Steel Limb-Lengthening Device
Authors: Sax Oliver Charles , Conway Janet D. , Standard Shawn C. , Assayag Michael , Herzenberg John E. , McClure Philip Kraus 
Published: April 2023

Background:
Magnetic, telescoping intramedullary lengthening devices are widely used for treatment of limb length discrepancies. However, a routine radiographic review of a stainless-steel device demonstrated soft tissue and bony changes suggestive of osteolysis. Therefore, we sought to examine all patients implanted with a stainless-steel limb-lengthening nail. We specifically asked: (1) what is the incidence of periosteal reaction osteolysis? (2) Is a new biologic reaction classification system valid and reliable? and (3) Are there predictive factors for the development of osteolysis? We hypothesized that higher patient weight and femoral insertion would be risk factors for lysis, due to increased bending moments on the implants.

Materials and Methods:
A retrospective review of all patients implanted with a stainless-steel limb-lengthening nail between December 2018 and December 2020 was conducted at a single institution. A total of 57 nails in 44 patients were radiographically examined with an average follow-up of 6.2 months (range: 1–21 months). The incidence of osteolysis was calculated through review of patient radiographs. These were then classified according to a novel system by five fellowship-trained orthopedic surgeons with agreement assessed using an intraclass correlation coefficient (ICC). Logistic regression measured predictive factors for this phenomenon. A separate histologic analysis of two bone/soft-tissue biopsies at the time of routine explantation was conducted by an independent pathologist.

Results:
The incidence of periosteal reaction and osteolysis was 36.8% and 17.5%, respectively. Nails with progression to osteolysis increased to 34.6% (9/26) when examining nails with at least a 6-month follow-up. ICC testing yielded good inter-rater agreement for the novel classification system (average measure: 0.860, 95% confidence interval 0.828–0.888). Age >16 years (P = 0.024) and body weight >150 pounds (P = 0.038) were predictors of osteolysis. Histologic analysis of the biopsies demonstrated an abundance of particulate debris suggestive of chromium reaction.

Conclusions:
The modular junction of a stainless-steel lengthening device is susceptible to osteolytic changes, and this appears to be associated with increased age and weight. This phenomenon has an apparent time dependence: osteolysis increases with greater follow-up.
Multicentre Review of Intramedullary Lengthening Nails
Authors: Harrison William D. , Laubscher Maritz , Saifi Saleh Al , Abdelaziz Ahmed , Barnard Annette-Christi , Birkholtz Franz , Ferreira Nando 
Published: April 2023

Background:
Lengthening nails (ILN) are an established method of limb reconstruction for leg length discrepancy (LLD). Literature on these nails is predominantly from developed countries, with more accessible resources for the procurement of devices and post-operative therapies. This paper aims to present the results and lessons learned from four tertiary level limb reconstruction units working within two middle-income countries (MIC).

Methods:
Ethical approval was obtained from all four units. All ILN (PRECICE II, NuVasive, USA) undertaken between 2013 and 2020 were included. Demographics, etiology, surgical approach, and information about the planned versus achieved correction were compared. Data on time to consolidation and complications were recorded with a 12-month minimum follow-up. Complications were classified according to the Black et al. criteria.

Results:
Sixty limb segments lengthened in 56 patients, of which 46 were femora, 12 tibiae and two humeri. Etiology of LLD was predominately posttraumatic (33%), congenital (26%), and growth plate injuries (22%). Mean distraction length was 46 mm (20–90 mm). Fifty-four segments (90%) had <5 mm discrepancy of planned distraction lengths. Mean healing index was 34.6 days/cm (range: 18–180 days/cm). Thirteen patients experienced complications, of which ten required further surgery.

Conclusion:
The findings of our work support the use of intramedullary ILN in MIC with equivalent complication rates and healing indices compared to the literature. Patient compliance and remote geography were not an issue during treatment. The lack of access to weekly rehabilitation therapy did not seem to impact the majority of patients. Reusing nails for extensive LLD cases were safe but should be used with caution.
Acquired Long Bone Defect Classifications of the Diaphysis
Authors: Komarov Artem V. , Semenistyy Anton A. , Sheridan Gerard A. , Rozbruch S. Robert , Solomin Leonid N. 
Published: April 2023

Introduction:
The management of acquired long bone defects (LBDs) is a persistent problem in modern orthopedics with few effective solutions. The goal of this review is to conduct a thorough analysis of existing diaphyseal LBD classifications and to identify if any of these may be adopted for universal application in future.

Materials and Methods:
A literature review was performed analyzing articles between 1970 and 2019 on PubMed (English) and CyberLeninka (Russian) databases. All studies developing or utilizing a classification tool were eligible for inclusion. The search retrieved a total of 1032 articles from PubMed, 477 from CyberLennika, and 28 articles from reference lists. Any disagreement regarding the inclusion of articles was resolved by consensus between all authors.

Results:
A total of 18 classifications in the literature underwent analysis. Among the classifications we analyzed, 12 described posttraumatic defects, 6 described osteomyelitis defects or infected nonunions, and 5 described, among other defects, iatrogenic bone. Of the 18 classifications, 12 have a focus on a specific treatment method. We found that consensus exists between most authors regarding the criteria necessary to measure to determine the most appropriate treatment method. These key factors include the size and location of the bone defect.

Conclusion:
This analysis showed that despite the large number of publications devoted to the classification and treatment of LBD, there is still no consensus among authors regarding not only a universal clinical classification but also a general definition of the term “bone defect.” The classification proposed by Solomin et al. is very useful but in its present form, has significant drawbacks and requires further improvement before it can be adopted as a universal classification system for LBDs.
Orthopedic Implant Design from Concept to Final Tested Product
Authors: Pretorius Henry Sean , Ferreira Nando 
Published: April 2023

Background:
Orthopedic surgeons are invariably faced with situations where contemporary surgical techniques and implants are not satisfactory for a specific clinical scenario. One such scenario frequently arises around the lack of implant choice for intramedullary fixation of radius and ulna fractures. We will describe our experience designing and testing a new radius and ulna nail, inclusive of protecting the underlying intellectual property.

Design Process:
Phase 1: Identifying a need: Current intramedullary forearm devices have abandoned the ability to place interlocking screws at the nondriving end and are therefore not length stable. As current nails only come in 20 mm length increments, this may pose challenges in attaining accurate anatomical length restoration. Phase 2: Concept: (1) Anatomically designed in terms of length, diameter, and radius of curvature. (2) Nail inventory that has the optimal choice of implants to manage the majority of forearm injuries. (3) Locking system at the nondriving end that is easily targeted and has an acceptable radiation exposure for freehand locking. Phase 3: Anatomical study: Multiplanar reconstruction of upper limb computer tomography angiography scans were used to analyze the forearm osteology of 98 individuals. Primary measurements included the lengths of both radius and ulna shafts, the minimum canal diameter size, the proximal shaft angle of the ulna, and the radius of curvature of the radius. The size of the proximal ulna and distal radius were also measured for design parameters of the nondriving end of the nail. Phase 4A: Prototype design: To improve the usability of these nails, the design priorities were set as: (1) Locking hole design. (2) Jig and instrument design for insertion and removal. (3) Pressure release during insertion. Phase 4B: Prototype testing: Prototype testing consisted of nail insertion into human cadaver forearm bones using the initial prototype and instruments. The design aspects of the implant such as the locking holes with X-ray-assisted screw insertion or the radius of curvature were also evaluated. Mechanical testing will also be done.
Circular External Fixation as an Alternative Method of Stabilization for Extra-articular Tibia Fractures in the Elderly
Authors: Lovisetti Giovanni , Vulcano Ettore , Bettella Lorenzo , Cook Ralph , Sala Francesco , Muelle John D. , Talamonti Tazio 
Published: April 2023

Background:
Recent epidemiologic reports from national fracture registries demonstrate an increase in the incidence of tibia fractures in the elderlies. Objectives: the objective of this retrospective study is to evaluate Circular External Fixation (CEF) for primary and definitive fixation of tibia extra-articular fractures (TEF) in the elderly treated at a level I trauma center.

Materials and Methods:
we evaluated a subset of 31 elderly patients (over 70 years) with 31 TEF (mean age 76 years, range 70-89) of which six (19.4%) were open treated with CEF between 2010 and 2017. 29 (93.5%) fractures underwent definitive fixation with traditional Ilizarov, 2 were treated with Sheffield and Taylor Spatial frames and evaluated clinically and radiologically accordingly to ASAMI bone and functional scores.

Results:
All fractures consolidated without additional procedures at an average of 21.3 weeks (range 9-42). No deep infections were observed. Four malunions within 8° occurred. ASAMI bone results were excellent in 93.6% of patients and revealed an excellent result in 21 (67.7%) of patients, eight patients (25.8%) had a good result, and 2 (6.5%) a fair result.

Conclusions:
CEF gave excellent results in the treatment of a variety of tibial shaft fractures in an elderly population, in terms of early return to ambulation, with average time to union, rate of delayed union, and misalignment rate comparable or superior to intramedullary nail and plate osteosynthesis, that represent the options more frequently proposed in clinical practice and literature. Advantages of circular external fixation in osteosynthesis of extra-articular tibia fractures in these patients are the minimal impact on soft tissues and the stability of the construct, that allows immediate weight bearing and early return to ambulation.
Masquelet's Induced Membrane Technique for Reconstruction of Large Extra-Articular Intercalary Bone Defect
Authors: Soliman Mouhammed Elsayed , Elzohairy Mohamed Mansour , AbdelWahab Ahmed Mohamed , Khaira Yousuf Mohamed , Elbatrawy Yasser , Abdalla Usama Gaber , Mansour Saher Mohamed , Dabash Sherif , Abuomira Ibrahim Elsayed Abdellatif , Thabet Ahmed M. 
Published: April 2023

Background:
Intercalary bone defects are challenging for both surgeon and patient. The Masquelet's induced membrane technique saves bone consolidation time is less technically demanding than other techniques and achieves good results in the reconstruction of large extra-articular intercalary bone defects.

Patients and Methods:
This prospective study reviewed 60 patients treated with the induced membrane technique. Patients with femoral or tibial extra-articular intercalary bone defects ≥5 cm long, occurring either posttraumatically or after debridement of infected bone, were included in the study. Patients with bone defects <5 cm long were excluded from the study. The male-to-female ratio was 17:3. Patient age ranged from 10 to 50 years. Recorded outcomes included union, infection, residual deformity, soft-tissue healing, persistent pain, return to previous occupation, permanent joint contracture, and patient satisfaction.

Results:
Mean follow-up was 3.1 years (range, 2.2–4 years). Mean intercalary bone defect measured 7.5 cm (range, 5–13 cm) in length. Forty-five of 60 patients had open fractures. Thirty-nine underwent Ilizarov fixation, 12 with locked plates, and nine with a limb reconstruction system. The mean interval between the first and second stages was 56 days (range, 42–84 days). Bony union was achieved in 51 patients (85%). Twelve patients experienced relapsed infection during treatment, three because of flap failure, and nine because of inadequate debridement. Three were treated with repeat debridement and free vascularized flap after gastrocnemius flap, six underwent bone transport, and three required amputation.

Conclusion:
The Masquelet's induced membrane technique was highly effective in achieving the union of large femoral intercalary bone defects, with mixed results in the tibia.
New Measurements to Determine Changes after Intra-Articular High Tibial Osteotomy
Authors: Chaudhary Milind , Apte Aditya P. , Manna Jitsen , Bhadiyadra Ravi , Herode Prafulla 
Published: April 2023

Background:
Most high tibial osteotomies (HTO), performed for medial compartment osteoarthritis of the knee (MCOA) are extra-articular osteotomies of the upper tibia. Recently, attention has turned to detecting and treating intra-articular deformities of the upper tibia causing MCOA. Chiba introduced the tibial condylar valgus osteotomy (TCVO) in Japan and few English language articles have described indications, surgical techniques of results of these osteotomies. Two angles commonly measure and detect the intra-articular deformity and measure the difference between preoperative and postoperative parameters: Joint line convergence angle (JLCA) and condylar plateau angle (CPA).

Aims and Objectives:
JLCA is relatively easy to measure as it uses clearly visible landmarks to draw tangents to femoral and tibial condyles to subtend the angle. CPA is a little difficult to measure and we found it to be less reliable in intra-observer as well as interobserver readings.

Materials and Methods:
We decided to measure the intra-articular deformity by using spine edge angle (SEA) and spine vertical distance (SVD) as two new measurements. These have proved to be reliable in intra as well as interobserver measurements. We compared readings of SEA and SVD in 57 patients each who had an intra-articular TCVO and also an extraarticular medial open wedge HTO (OWHTO).

Results:
We found a significant change between preoperative and postoperative measurements of SEA and SVD in patients who underwent TCVO, but no change in patients who underwent OWHTO.

Conclusions:
The two new measurements of SEA and SVD accurately measure the change in intra-articular deformity parameters in patients who undergo TCVO and are more reliable than CPA.
Evaluating the Accuracy of the SMART Taylor Spatial Frame Software - Comparison with Manual Radiographic Analysis Methods
Authors: Ferreira Nando , Arkell Christopher , Fortuin Franklin , Saini Aaron Kumar 
Published: April 2023

Background:
The accuracy of hexapod circular external fixator deformity correction is contingent on the precision of radiographic analysis during the planning stage. The aim of this study was to compare the SMART Taylor spatial frame (TSF) in suite radiographic analysis methods with the traditional manual deformity analysis methods in terms of accuracy of correction.

Methods:
Sawbones models were used to simulate two commonly encountered clinical scenarios. Traditional manual radiographic analysis and digital SMART TSF analysis methods were used to correct the simulated deformities.

Results:
The final outcomes of all six analysis methods across both simulated scenarios were satisfactory. Any differences in residual deformity between the analysis methods are unlikely to be clinically relevant. All three SMART TSF digital analyses were faster to complete than manual radiographic analyses.

Conclusion:
With experience and a good understanding of the software, manual radiographic analysis can be extremely accurate and remains the gold standard for deformity analysis. In suite SMART TSF radiographic analysis is fast and precise to within clinically relevant parameters. Surgeons can with confidence trust the SMART TSF software to provide analysis and corrections that are clinically acceptable.
Early Marriage Causes Decreased Growth and Development in Children under the Age of Three
Authors: Rifai Achmad , Juliandi Juliandi , Saputri Ika Nur , Satria Beni , Wulan Sri , Simarmata Dewinita 
Published: April 2023

Introduction:
The purpose of this study is to investigate the relationship between early marriage and child development.

Materials and Methods:
A cross-sectional study was conducted on a population of mothers with children <3 years old. The subjects of this study are mothers with children aged 3–36 months, who know their age at first marriage, are not currently divorced, and are willing to engage in the study.

Results:
There is a relationship between early marriage and impaired child growth and development.

Conclusions:
It was concluded that early marriage affects the growth and development of children <3 years old. Thus, the government or society needs to make efforts to prevent early marriage through the right approach in Indonesia.
Gastrointestinal transit time of radiopaque ingested foreign bodies in children: experience of two paediatric tertiary centres
Authors: Ang Chen Xiang , Mun Win Kai , Aw Marion Margaret , Lin Diana , Chong Shu-Ling , Ong Lin Yin , Nah Shireen Anne 
Published: April 2023

Abstract

Introduction:
Foreign body (FB) ingestion is a common paediatric emergency. While guidelines exist for urgent intervention, less is known of the natural progress of FBs passing through the gastrointestinal tract (GIT). We reviewed these FB transit times in an outpatient cohort.

Methods:
A retrospective review was performed on all children (≤18 years) treated for radiopaque FB ingestion at two major tertiary paediatric centres from 2015 to 2016. Demographic data, FB types, outcomes and hospital visits (emergency department [ED] and outpatient) were recorded. All cases discharged from the ED with outpatient follow-up were included. We excluded those who were not given follow-up appointments and those admitted to inpatient wards. We categorised the outcomes into confirmed passage (ascertained via abdominal X-ray or reported direct stool visualisation by patients/caregivers) and assumed passage (if patients did not attend follow-up appointments).

Results:
Of the 2,122 ED visits for FB ingestion, 350 patients who were given outpatient follow-up appointments were reviewed (median age 4.35 years [range: 0.5–14.7], 196 [56%] male). The largest proportion (16%) was aged 1–2 years. Coins were the most common ingested FB, followed by toys. High-risk FB (magnets or batteries) formed 9% of cases (n=33). The 50th centile for FB retention was 8, 4 and 7 days for coins, batteries and other radiopaque FBs, respectively; all confirmed passages occurred at 37, 7 and 23 days, respectively. Overall, 197 (68%) patients defaulted on their last given follow-up.

Conclusion:
This study provides insight into the transit times of FB ingested by children, which helps medical professionals to decide on the optimal time for follow-up visits and provide appropriate counsel to caregivers.
Logan’s problem for Jacobi transforms
Authors: Gorbachev Dmitry , Ivanov Valerii , Tikhonov Sergey 
Published: April 2023

AbstractWe consider direct and inverse Jacobi transforms with measures
$$\begin{align*}d\mu(t)=2^{2\rho}(\operatorname{sinh} t)^{2\alpha+1}(\operatorname{cosh} t)^{2\beta+1}\,dt\end{align*}$$
and
$$\begin{align*}d\sigma(\lambda)=(2\pi)^{-1}\Bigl|\frac{2^{\rho-i\lambda}\Gamma(\alpha+1)\Gamma(i\lambda)} {\Gamma((\rho+i\lambda)/2)\Gamma((\rho+i\lambda)/2-\beta)}\Bigr|^{-2}\,d\lambda,\end{align*}$$
respectively. We solve the following generalized Logan problem: to find the infimum
$$\begin{align*}\inf\Lambda((-1)^{m-1}f), \quad m\in \mathbb{N}, \end{align*}$$
where
$\Lambda (f)=\sup \,\{\lambda>0\colon f(\lambda )>0\}$
and the infimum is taken over all nontrivial even entire functions f of exponential type that are Jacobi transforms of positive measures with supports on an interval. Here, if
$m\ge 2$
, then we additionally assume that
$\int _{0}^{\infty }\lambda ^{2k}f(\lambda )\,d\sigma (\lambda )=0$
for
$k=0,\dots ,m-2$
.We prove that admissible functions for this problem are positive-definite with respect to the inverse Jacobi transform. The solution of Logan’s problem was known only when
$\alpha =\beta =-1/2$
. We find a unique (up to multiplication by a positive constant) extremizer
$f_m$
. The corresponding Logan problem for the Fourier transform on the hyperboloid
$\mathbb {H}^{d}$
is also solved. Using the properties of the extremizer
$f_m$
allows us to give an upper estimate of the length of a minimal interval containing not less than n zeros of positive definite functions. Finally, we show that the Jacobi functions form the Chebyshev systems.