bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Air Leaks in the Newborn
Authors: Kastein Kim , Coe Kristi 
Published: January 2023

Background:
Air leaks, especially pulmonary interstitial emphysema (PIE), are increasingly uncommon respiratory complications of the newborn. Despite PIE having a decreasing incidence, it continues to have a high morbidity and mortality rate. This makes PIE one of the most severe respiratory complications to affect a newborn. Air leaks occur when there is overdistension of the terminal airways or alveoli, which results in air dissecting into extra-alveolar spaces. Recognizing the signs of air leaks is paramount to allow for appropriate diagnosis and treatment of the newborn to improve morbidity and mortality. Treatment modalities range from positioning the newborn in the decubitus position to surgical intervention.

Purpose:
To summarize current evidence on the pathophysiology, risk factors, diagnosis, treatment, and management of PIE and pneumothorax.

Data Sources:
Two databases were systematically reviewed with key words later. Articles in English with date restrictions from 2016 to current were included.

Study Selection:
Inclusion criteria of randomized controlled trials, case studies/reports, and review articles were utilized. Twenty articles, primarily case reports and studies, were reviewed.

Data Extraction:
Guidelines for data abstraction were followed via independent extraction by a single observer.

Results:
Qualitative results were utilized to formulate current treatment of air leaks.

Implications for Practice:
This article provides guidance for frontline neonatal providers on current treatment and management of air leaks in the newborn population.
Ogilvie Syndrome in Patients With Traumatic Pelvic and/or Acetabular Fractures: A Retrospective Cohort Study
Authors: Jensen Lasse Rehné , Possfelt-Møller Emma , Nielsen Allan Evald , Singh Upender Martin , Svendsen Lars Bo , Penninga Luit 
Published: February 2023

Objectives:
To assess the incidence, risk factors, and clinical outcomes of Ogilvie syndrome (OS) in patients with pelvic and/or acetabular fractures.

Design:
Retrospective cohort study.

Setting:
Level 1 trauma center.

Patients:
One thousand sixty patients with pelvic and/or acetabular fractures treated at Rigshospitalet, Copenhagen, between 2009 and 2020.

Intervention:
Interventions comprised the treatment of pelvic and/or acetabular fractures with emergency external and/or internal fixation.

Main Outcome Measurements:
Outcomes included diagnosis of OS, perioperative complications, ICU stay and length, length of admission, and mortality.

Results:
We identified 1060 patients with pelvic and/or acetabular fractures. Of these, 25 patients were diagnosed with OS perioperatively, corresponding to incidences of 1.6%, 2.7%, and 2.6% for acetabular, pelvic, and combined fractures, respectively. Risk factors included congestive heart failure, diabetes, concomitant traumatic lesions, head trauma, fractures of the cranial vault and/or basal skull, retroperitoneal hematomas and spinal cord injuries, and emergency internal fixation and extraperitoneal packing. Six (24%) patients underwent laparotomy, and all patients had ischemia or perforation of the cecum for which right hemicolectomy was performed. Ogilvie syndrome was associated with a significant increase in nosocomial infections, sepsis, pulmonary embolism, ICU stay, and prolonged hospital admission.

Conclusion:
Ogilvie syndrome in patients with pelvic and/or acetabular fractures is associated with increased risk of perioperative complications and prolonged hospital and ICU stays, resulting in an increased risk of morbidity and mortality.

Level of Evidence:
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
A Staged Protocol for Treatment of High-Energy Tongue-Type Calcaneus Fractures: Surgical Technique and Case Series
Authors: Goodnough L. Henry , Bunzel Eli W. , Benirschke Stephen K. , Githens Michael F. 
Published: February 2023

Summary
Displaced tongue-type calcaneus fractures are frequently associated with severe soft tissue injuries, and urgent relief of the displaced tongue fragment on the posterior soft tissues is essential to preventing soft tissue complications. If there is a complex articular injury, the soft tissue envelope often needs time for swelling to resolve to allow for a safe open anatomic reduction because premature open reduction internal fixation is often associated with increased complications. We have found that in high-energy tongue-type calcaneus fractures with complex articular injuries, a staged protocol consisting of initial percutaneous reduction and fixation with later definitive reconstruction is soft tissue friendly, allows early restoration of calcaneal morphology, and affords extensile approaches for eventual reconstruction. The purpose of this study was to describe our protocol of staged treatment of high-energy tongue-type calcaneus fractures, along with postoperative surgical outcomes, in a case series of 53 patients.
Our series of patients had a high rate of intra-articular injury with marked initial displacement (mean Bohler angle −8.4 ± 20.8 degrees). They were treated initially with percutaneous reduction and fixation at median 1 day postinjury (interquartile range [IQR] 0–1) and definitively at median 16 days postinjury (IQR 10–33). In this series, 2 of 53 (3.8%) patients developed a deep wound infection.
In high-energy tongue-type calcaneus fractures at risk for soft tissue compromise or with a significantly displaced tongue fragment without initial soft tissue compromise, we found that staged management represents a feasible management strategy to mitigate risk of soft tissue complications and therefore helps facilitate safe definitive open treatment.
Mortality Rates After Nonoperative Geriatric Hip Fracture Treatment: A Matched Cohort Analysis
Authors: Shin Edward D. , Sandhu Kevin P. , Wiseley Benjamin R. , Hetzel Scott J. , Winzenreid Alec E. , Simske Natasha M. , Johnson Kristina P. , Goodspeed David C. , Doro Christopher J. , Whiting Paul S. 
Published: February 2023

Objective:
To compare the mortality rate between geriatric patients with hip fracture treated nonoperatively and a matched cohort treated operatively.

Design:
Retrospective Observational Matched Cohort Study.

Setting:
Academic Level 1 Trauma Center.

Patients:
Geriatric patients who sustained femoral neck and intertrochanteric/peritrochanteric fractures, excluding isolated greater trochanteric fractures. All patients older than 65 years with hip fractures over a 10-year period were identified. Operative patients were matched at a 2:1 ratio, when possible, to nonoperative patients based on Charlson Comorbidity Index and American Society of Anesthesiologists score.

Intervention:
Nonoperative treatment or operative treatment (femoral neck fractures: cannulated screw fixation or hemiarthroplasty; intertrochanteric/peritrochanteric fractures: sliding hip screw or cephalomedullary nail fixation; or proximal femoral locking plate).

Main Outcomes:
Mortality calculated at 30 and 90 days, and 1-year after injury. Mortality was compared between groups using logistic regression while controlling for age, CVA/TIA, and dementia.

Results:
Seven hundred seventy-two patients (171 nonoperative and 601 operative) were initially identified. After applying the matching algorithm, 128 nonoperative and 239 operative patients were included in the analysis. There were no significant differences in age, sex, Charlson Comorbidity Index, or American Society of Anesthesiologists score between the cohorts. Nonoperative patients had a significantly higher 1-year mortality rate than operative patients [46.1% vs. 18.0%, Odds Ratio (95% confidence interval): 3.85 (2.34–6.41), P < 0.001].

Conclusions:
Geriatric patients with hip fracture treated nonoperatively had a 1-year mortality rate of 46.1%, more than double the rate among operative patients.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Biomechanical Comparison of Intramedullary Versus Extramedullary Implants for Fixation of Simple Pertrochanteric Fractures
Authors: Schader Jana F. , Zderic Ivan , Dauwe Jan , Sommer Christoph , Gueorguiev Boyko , Stoffel Karl 
Published: February 2023

Objectives:
To evaluate the biomechanical performance of the intramedullary TFN-ADVANCED Proximal Femoral Nailing System (TFNA) versus the extramedullary Femoral Neck System (FNS) for fixation of simple pertrochanteric fractures in a human cadaveric model.

Methods:
Ten human cadaveric femoral pairs were implanted pairwise with either TFNA or FNS. A simple pertrochanteric fracture OTA/AO 31-A1 was created and all specimens were biomechanically tested under progressively increasing cyclic loading until failure. Interfragmentary and bone-implant movements were monitored by motion tracking.

Results:
Axial stiffness was comparable between TFNA and FNS, P = 0.34. Similarly, varus deformation, femoral head rotation around neck axis and implant migration remained without significant differences between TFNA and FNS after 3000 cycles (800 N peak load), P ≥ 0.10. However, cycles to 15-mm leg shortening were significantly higher for TFNA versus FNS, P < 0.01.

Conclusions:
From a biomechanical perspective, with its current design, FNS does not seem to be a valid alternative to TFNA for treatment of simple pertrochanteric fractures.
Risk Factors for Nonunion of Distal Femur Fractures
Authors: Cone Ryan , Roszman Alex , Conway Yvonne , Cichos Kyle , McGwin Gerald , Spitler Clay A. 
Published: February 2023

Objectives:
To determine patient, fracture, and construct related risk factors associated with nonunion of distal femur fractures.

Design:
Retrospective cohort study.

Setting:
Academic Level I trauma center.

Participants:
Patients 18 years and older presenting with OTA/AO 33A and 33C distal femur fractures from 2004 to 2020. A minimum follow-up of 6 months was required for inclusion. OTA/AO 33B and periprosthetic fractures were excluded, 438 patients met inclusion criteria for the study.

Main Outcomes:
The primary outcome of the study was fracture nonunion defined as a return to the OR for management of inadequate bony healing. Patient demographics, comorbidities, injury characteristics, fixation type, and construct variables were assessed for association with distal femur fracture nonunion. Secondary outcomes include conversion to total knee arthroplasty, surgical site infection, and other reoperation.

Results:
The overall nonunion rate was 13.8% (61/438). The nonunion group was compared directly with the fracture union group for statistical analysis. There were no differences in age, sex, mechanism of injury, Injury Severity Score, and time to surgery between the groups. Lateral locked plating characteristics including length of plate, plate metallurgy, screw density, and working length were not significantly different between groups. Increased body mass index [odds ratio (OR), 1.05], chronic anemia (OR, 5.4), open fracture (OR, 3.74), and segmental bone loss (OR, 2.99) were independently associated with nonunion. Conversion to total knee arthroplasty (TKA) (P = 0.005) and surgical site infection (P < 0001) were significantly more common in the nonunion group.

Conclusion:
Segmental bone loss, open fractures, chronic anemia, and increasing body mass index are significant risk factors in the occurrence of distal femoral nonunion. Lateral locked plating characteristics did not seem to affect nonunion rates. Further investigation into the prevention of nonunion should focus on fracture fixation constructs and infection prevention.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Intermediate-term Outcomes in Adolescent Recurrent Ankle Instability Managed With a Modified Broström-Gould Procedure Augmented With Distal Fibular Periosteum Incorporation
Authors: Boutelle Kelly E. , Rickert Kathleen D. , Carroll Alyssa N. , Pennock Andrew T. , Manhard Claire E. , Edmonds Eric W. 
Published: February 2023

Background:
Once a child has developed chronic ankle instability with recurrent events despite conservative treatment, then ligamentous repair is warranted. We utilize a modification of the modified Broström-Gould technique that further incorporates the distal fibular periosteum into the construct. The purpose of this study was to describe the intermediate-term outcomes of our modified Broström-Gould technique for chronic lateral ankle instability in childhood athletes.

Methods:
A retrospective review of children who underwent the surgical technique over a 10-year time period (2010 to 2019) was performed, excluding those with <2 years of follow-up. Demographic, surgical, and clinical data were recorded, as well as outcome scores: (1) the Marx activity scale, (2) University of California, Los Angeles activity score, and (3) foot and ankle outcomes score. Recurrent instability events, repeat surgeries, satisfaction with the surgical experience, and return to sport (if applicable) were also recorded.

Results:
Forty-six children (43 females) with 1 bilateral ankle met the criteria with a mean age at surgery of 14.8 years, and a mean follow-up duration of 4.9 years. The mean Marx activity score was 9.0±5.1, the mean University of California, Los Angeles score was 8.3±1.8, and the mean total foot and ankle outcomes score was 84.0±15.6. Twenty-six ankles (55.3%) reported having at least 1 recurrent episode of instability and 6 of the ankles (12.8%) underwent revision surgery between 3.5 months and 6.5 years of the index procedure. Thirty-nine (84.8%) patients responded that they would undergo our surgery again.

Conclusion:
A modified Broström-Gould procedure can be performed in children with the incorporation of the adjacent periosteum, but recurrence of instability is distinctly possible with longer follow-up with a risk for revision surgery despite good subjective outcomes.

Level of Evidence:
Level IV; retrospective case series.
Exposed Intramedullary Fixation Produces Similar Outcomes to Buried Fixation for Acute Pediatric Monteggia Fractures
Authors: Lightdale-Miric Nina R. , Obana Kyle K. , Fan Bensen B. , Padilla Abigail N. , Lin Adrian J. , Bennett James T. , Wren Tishya A.L. 
Published: February 2023

Background:
Treatment of acute pediatric Monteggia fractures requires ulnar length stability to maintain reduction of the radiocapitellar joint. When operative care is indicated, intramedullary ulna fixation can be buried or left temporarily exposed through the skin while under a cast. The authors hypothesized that treatment with exposed fixation yields equivalent results to buried fixation for Monteggia fractures while avoiding secondary surgery for hardware removal.

Methods:
A retrospective review of children with acute Monteggia fractures at our Level 1 pediatric trauma center was performed. Patient charts and radiographs were evaluated for age, fracture type, fracture location, Bado classification, type of treatment, complications, cast duration, time to fracture union, time to hardware removal, and range of motion.

Results:
Out of 59 acute Monteggia fractures surgically treated (average age 6 y, range 2 to 14), 15 (25%) patients were fixed with buried intramedullary fixation and 44 (75%) with exposed intramedullary fixation under a cast. There were no significant differences between buried and exposed intramedullary fixation in cast time after surgery (39 vs. 37 d; P=0.55), time to fracture union (37 vs. 35 d; P=0.67), pronation/supination (137 vs. 134 degrees; P=0.68) or flexion/extension (115 vs. 114 degrees; P=0.81) range of motion. The exposed fixation had a return to OR of 4.5% (2 out of 44), and the buried fixation returned to the OR for removal on all patients.

Conclusion:
Exposed intramedullary fixation yielded equivalent clinical outcomes to buried devices in the treatment of acute pediatric Monteggia fractures while eliminating the need for a second surgery to remove hardware, reducing the associated risks and costs of surgery and anesthesia, but had a higher complication rate. Open Monteggia fractures or patterns with a known risk of delayed union may benefit from buried instead of exposed intramedullary fixation for earlier mobilization.

Level of Evidence:
III.
A Five-Year Cost-Utility Analysis Comparing Synthetic Cage Versus Allograft Use in Anterior Cervical Discectomy and Fusion Surgery for Cervical Spondylotic Myelopathy
Authors: Raad Micheal , Xu Amy L. , Ortiz-Babilonia Carlos , Marrache Majd , Durand Wesley M. , Greenberg Marc , Jain Amit 
Published: February 2023

Study Design.
Retrospective cost-utility analysis.

Objective.
To conduct a cost-analysis comparing synthetic cage (SC) versus allograft (Allo) over a five-year time horizon.

Summary of Background Data.
SC and Allo are two commonly used interbody choices for anterior cervical discectomy and fusion (ACDF) surgery. Previous analyses comparative analyses have reached mixed conclusions regarding their cost-effectiveness, yet recent estimates provide high-quality evidence.

Materials and Methods.
A decision-analysis model comparing the use of Allo versus SC was developed for a hypothetical 60-year-old patient with cervical spondylotic myelopathy undergoing single-level ACDF surgery. A comprehensive literature review was performed to estimate probabilities, costs (2020 USD) and quality-adjusted life years (QALYs) gained over a five-year period. A probabilistic sensitivity analysis using a Monte Carlo simulation of 1000 patients was carried out to calculate incremental cost-effectiveness ratio and net monetary benefits. One-way deterministic sensitivity analysis was performed to estimate the contribution of individual parameters to uncertainty in the model.

Results.
The use of Allo was favored in 81.6% of the iterations at a societal willing-to-pay threshold of 50,000 USD/QALY. Allo dominated (higher net QALYs and lower net costs) in 67.8% of the iterations. The incremental net monetary benefits in the Allo group was 2650 USD at a willing-to-pay threshold of 50,000 USD/QALY. One-way deterministic sensitivity analysis revealed that the cost of the index surgery was the only factor which significantly contributed to uncertainty.

Conclusion.
Cost-utility analysis suggests that Allo maybe a more cost-effective option compared with SCs in adult patients undergoing ACDF for cervical spondylotic myelopathy.
Development and External Validation of a Risk Calculator for Prediction of Major Complications and Readmission After Anterior Cervical Discectomy and Fusion
Authors: Shah Akash A. , Devana Sai K. , Lee Changhee , Olson Thomas E. , Upfill-Brown Alexander , Sheppard William L. , Lord Elizabeth L. , Shamie Arya N. , van der Schaar Mihaela , SooHoo Nelson F. , Park Don Y. 
Published: February 2023

Study Design.
A retrospective, case-control study.

Objective.
We aim to build a risk calculator predicting major perioperative complications after anterior cervical fusion. In addition, we aim to externally validate this calculator with an institutional cohort of patients who underwent anterior cervical discectomy and fusion (ACDF).

Summary of Background Data.
The average age and proportion of patients with at least one comorbidity undergoing ACDF have increased in recent years. Given the increased morbidity and cost associated with perioperative complications and unplanned readmission, accurate risk stratification of patients undergoing ACDF is of great clinical utility.

Methods.
This is a retrospective cohort study of adults who underwent anterior cervical fusion at any nonfederal California hospital between 2015 and 2017. The primary outcome was major perioperative complication or 30-day readmission. We built standard and ensemble machine learning models for risk prediction, assessing discrimination, and calibration. The best-performing model was validated on an external cohort comprised of consecutive adult patients who underwent ACDF at our institution between 2013 and 2020.

Results.
A total of 23,184 patients were included in this study; there were 1886 cases of major complication or readmissions. The ensemble model was well calibrated and demonstrated an area under the receiver operating characteristic curve of 0.728. The variables most important for the ensemble model include male sex, medical comorbidities, history of complications, and teaching hospital status. The ensemble model was evaluated on the validation cohort (n=260) with an area under the receiver operating characteristic curve of 0.802. The ensemble algorithm was used to build a web-based risk calculator.

Conclusion.
We report derivation and external validation of an ensemble algorithm for prediction of major perioperative complications and 30-day readmission after anterior cervical fusion. This model has excellent discrimination and is well calibrated when tested on a contemporaneous external cohort of ACDF cases.
Prospective Randomized Control Trial to Compare the Role of Injection Cerebrolysin for 10 Days Duration Against Placebo in Operated Cases of Degenerative Cervical Myelopathy
Authors: Sharma Ayush , Agrawal Harsh , Naseem Atif , Marathe Nandan , Gajbhiye Komalchand , Subramanian Santhoshkumar , Rocos Brett 
Published: February 2023

Study Design.
Prospective randomized control trial.

Objective.
To analyze outcomes following the injection of cerebrolysin in surgically treated patients with degenerative cervical myelopathy (DCM).

Summary of Background Data.
Previous research has concluded that superior functional outcomes are achieved with the use of cerebrolysin in surgically treated patients of DCM for 21 days. Our study has been conducted to analyze the use of this drug for a shorter duration (10 days) and compare its clinical efficacy.

Methods.
Ninety operated cases of mild to severe DCM were randomized into two groups. Sixty patients received the injection Cerebrolysin for 10 days postoperatively. The remaining 30 patients received a placebo. Functional outcomes were measured using modified Japanese Orthopaedic Association (mJOA) scores and visual analogue scale (VAS). The American Spinal Injury Association (ASIA) scale was used to document neurological recovery. Hand function was assessed by measuring the grip strength and the upper limb function score the upper extremity motor mJOA plus upper extremity sensory mJOA score. Assessments were performed and preoperatively and postoperatively and at one-month, three-month, six-month, and one-year following surgery.

Results.
Preoperative mJOA and VAS scores were comparable in both groups (P>0.05). Both groups experienced an improvement in mJOA and VAS scores at all time-points during follow-up as compared with preoperative scores. However, the cerebrolysin group demonstrated significantly greater mJOA scores (16.37±1) when compared with the placebo (15.2±1.8) at one-year follow-up (P<0.0001). Neurological improvement with cerebrolysin therapy was also superior (P=0.04). No significant adverse reactions were documented.

Conclusion.
Injection cerebrolysin, when administered for 10 days postoperatively, can result in significantly greater neurological improvement and hand function in patients with DCM who also receive surgery.