bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term Functional Consequences of Surgically Treated Pediatric and Adolescent Olecranon Fractures: Does the Presence of Associated Fractures and Surgical Procedure Affect the Results?
Authors: Onay Tolga , Çelen Zekeriya Ersin , Öncül Samet , Abul Mehmet Süleyman 
Published: February 2023

Background:
Olecranon fractures are rare conditions in childhood. The aim of this study was to investigate the factors affecting the results in surgically treated pediatric and adolescent olecranon fractures.

Methods:
The orthopaedic trauma database of a large academic tertiary center was retrospectively searched for patients who had sustained an olecranon fracture and were treated surgically between 2005 and 2021. Data related to demographic features, additional fractures, and the presence of any disease were obtained from the patient files. Mayo elbow performance score and the Turkish-language version of the shortened version of the disabilities of arm, shoulder, and hand scale were the main functional outcome measurements.

Results:
The study included 37 elbows of 34 patients with an average age at the time of surgery of 10.9±3.1 years. The mean follow-up period was 78.2±48.0 months (range, 12 to 196 mo). The 1-year fracture rate of contralateral olecranon was 75% in osteogenesis imperfecta patients. Concomitant fractures were 7 proximal radius, 1 medial epicondyle, and 2 capitellum fractures. The surgical treatment methods were tension band wiring (TBW), open reduction and isolated K-wire fixation, closed reduction and percutaneous fixation (CR-PP), and open reduction-plate fixation. The mean implant removal time in patients treated with closed reduction and percutaneous fixation was 2.2 months, open reduction and isolated K-wire fixation 4.7 months, and TBW 12.7 months (P=0.004). The mean disabilities of arm, shoulder, and hand scale was 1.9. The mean Mayo elbow performance score was 100. Grade 1 elbow arthritis was determined in 3 patients. No patient underwent revision surgery.

Conclusions:
All treatment modalities provided excellent long-term functional results and low complication rates without the need for revision. Closed reduction-percutaneous fixation and open reduction-isolated K-wire fixation were associated with shorter implant removal times compared with TBW.

Level of Evidence:
Level III.
Modernizing Our Understanding of Total Hip Arthroplasty in the Pediatric and Young Adult Patient: A Single-center Experience
Authors: Whitmarsh-Brown Meghan A. , Christ Alexander B. , Lin Adrian J. , Siddiqui Ali A. , Herman Renee Y. , Allison Daniel C. , Goldstein Rachel Y. 
Published: February 2023

Introduction:
Pediatric hip disorders represent a broad range of pathology and remain a significant source of morbidity for children and young adults. Surgical intervention is often required for joint preservation, but when salvage is not possible, joint replacement may be indicated to eliminate pain and preserve function. Although there have been significant updates in the management of both pediatric hip disease and the field of total hip arthroplasty (THA), there is a paucity of literature reflecting advancements in the area of pediatric and young adult (PYA) arthroplasty. No study has investigated the impact of approach on outcomes after PYA THA. The purpose of this study is to describe the indications, techniques, and early outcomes of THA in the PYA population in a modern practice setting.

Methods:
We performed a retrospective descriptive analysis of all patients undergoing primary THA performed at a tertiary care children’s hospital from 2004 to 2019. Ninety-three hips in 76 patients were evaluated. Demographics, intraoperative variables, postoperative pain and function ratings, and complication and revision rates were collected.

Results:
Eighty-five hips in 69 patients were included. Patients were aged 12 to 23 years old, with males and females represented equally (33 vs. 36, respectively). The most common cause of hip pain was avascular necrosis (AVN, 56/85, 66%), most commonly due to slipped capital femoral epiphysis (13/56, 23%) idiopathic AVN (12/56, 21%), and chemotherapy (12/56, 21%). Half of all hips had been previously operated before THA (43/85). Thirty-six procedures were performed via the posterolateral approach (36/85, 42%), 33 were performed via direct anterior approach (33/85, 39%), and 16 were performed via the lateral approach (LAT, 16/85, 19%). At final follow-up, 98% (83/85) of patients had complete resolution of pain, 82% (70/85) had no notable limp, and 95% (81/85) had returned to all activities. There were 6 complications and 1 early revision. Average Hip disability and Osteoarthritis Outcomes Score for Joint Replacement scores increased by 37 points from 56 to 93. The overall revision-free survival rate for PYA THA was 98.8% (at average 19-mo follow-up).

Conclusions:
Modern PYA THA is dissimilar in indications and surgical techniques to historic cohorts, and conclusions from prior studies should not be generalized to modern practice. In our practice, PYA patients most commonly carry a diagnosis of AVN, and THA can be performed with modern cementless fixation with large cup and head sizes and ceramic-on-cross-linked polyethylene bearings utilizing any approach. Further study is required to better characterize middle-term and long-term results and patient-reported outcomes.

Level of Evidence:
Therapeutic Level IV—retrospective case series.
Younger Age and Left Side Are Risk Factors for Contralateral Trigger Thumb in Children
Authors: Huang Peng , Wang Dahui , Wu Chunxing , Song Jun , Ning Bo 
Published: February 2023

Background:
The metachronism of bilateral trigger thumb (TT) may lead to additional surgery under anesthesia. The aim of this study was to investigate the temporal development of bilateral TT, find risk factors for contralateral TT, and provide evidence for clinical practice.

Methods:
A retrospective analysis was performed on children diagnosed with TT in our hospital from January 2016 to December 2019. Age at onset, laterality, sex, the interval time of onset of contralateral symptoms, age at the time of surgery, and preoperative and postoperative follow-up times were collected. The cases were divided into 3 groups: (1) the unilateral group, (2) the simultaneous bilateral group, and (3) the separate bilateral group.

Results:
A total of 783 patients with 967 TTs were enrolled. There were 599 (76.5%) cases in the unilateral group, 157 (20.1%) cases in the simultaneous bilateral group, and 27 (3.4%) cases in the separate bilateral group. Seven (0.9%) patients underwent additional surgery on the contralateral side under anesthesia. Of these 7 patients, 6 (85.7%) had left-side onset and 5 (71.4%) patients developed bilateral TT by the age of 4. The mean age at the initial onset in the separate bilateral group was 20.1 months, and the mean age at diagnosis of the contralateral thumb was 33.6 months. Binary logistic regression analysis showed that age and side at initial onset had significant differences (P=0.043 and 0.000, respectively). Receiver operating characteristic curve analysis showed that the cutoff value of age at initial onset was 16 months.

Conclusions:
There was a low incidence of metachronous bilateral TT with additional surgery for the contralateral thumb. Age and side at initial onset are risk factors for contralateral TT.

Level of Evidence:
Level II; prognostic studies.
A Predictive Score for Infantile Blount Disease Recurrence After Tibial Osteotomy
Authors: Adulkasem Nath , Wongcharoenwatana Jidapa , Ariyawatkul Thanase , Chotigavanichaya Chatupon , Eamsobhana Perajit 
Published: February 2023

Introduction and Objective:
Several predictive factors for infantile Blount disease recurrence after tibial osteotomy were discovered. This study aimed to examine and utilize various predictors to develop a prediction score for infantile Blount disease recurrence after tibial osteotomy.

Methods:
We conducted a retrospective cohort study of infantile Blount disease patients who underwent tibial osteotomy between January 1998 and December 2020. Potential predictors, including clinical and radiographic parameters, were examined for their association with the disease recurrence after receiving tibial osteotomy. A predictive score was subsequently developed based on those potential predictors through multivariable logistic regression modeling.

Results:
A total of 101 extremities diagnosed with infantile Blount disease from 58 patients who underwent tibial osteotomy were included. Of those, 15 extremities (14.9%) recurred. Univariable logistic regression analysis identified age older than 42 months [odds ratio (OR)=4.28; P=0.026], Langenskiöld classification stage III (OR=9.70; P <0.001), LaMont classification type C (OR=15.44; P <0.001), preoperative femorotibial angle <−14 degrees (OR=4.21, P=0.021), preoperative metaphyseal-diaphyseal angle >16 degrees (OR=8.61, P=0.006), preoperative medial metaphyseal slope angle >70 degrees (OR=7.56, P=0.001), and preoperative medial metaphyseal beak angle >128.5 degrees (OR=13.46, P=0.001) as potential predictors of infantile Blount disease recurrence after tibial osteotomy. A predictive score comprised of age younger than 42 months, LaMont classification type C, and medial metaphyseal beak angle >128 degrees demonstrated an excellent predictive performance (area under the receiver operating characteristic curve =0.87), good calibration, and high internal validity.

Conclusions:
Our developed predictive score accurately predicted infantile Blount disease recurrence after tibial osteotomy. The results from our developed prediction tool allow physicians to inform prognosis, increase awareness during the follow-up period, and consider additional interventions to prevent disease recurrence.

Level of Evidence:
Level II
4-in-1 Quadricepsplasty for Habitual and Fixed Lateral Patellar Dislocation in Children
Authors: Parikh Shital N. , Lopreiato Nicholas , Veerkamp Matthew 
Published: February 2023

Background:
Habitual and fixed patellar dislocations represent extreme forms of patellar instability and can lead to significant functional loss. The underlying complex pathoanatomy of a laterally positioned and shortened extensor mechanism poses challenges in its management. The purpose of our study was to evaluate the anatomic risk factors and outcomes of a 4-in-1 quadricepsplasty (wide lateral releases, Insall proximal tube realignment, Roux-Goldthwait patellar tendon hemi-transfer, and step-wise quadriceps lengthening) for stabilization of habitual and fixed patellar dislocation.

Methods:
In a retrospective study, all patients with habitual and fixed patellar dislocation who underwent 4-in-1 quadricepsplasty and had a minimum 2-year follow-up were identified. Preoperative magnetic resonance imagings were evaluated for the presence of anatomic risk factors. As a prospective part of the study, patient-reported outcomes were collected using validated instruments including Pedi-IKDC, HSS-Pedi FABS activity score, BPII 2.0 score, Kujala score, and KOOS score.

Results:
Seventeen knees (12 patients) formed the study cohort. Twelve knees had habitual dislocation (9 in extension and 4 in flexion) and 5 had fixed dislocation. Mean age was 9 years. 6/17 (35.3%) knees were associated with syndromes. On magnetic resonance imaging, trochlear dysplasia was the most common anatomic risk factor present in 15/17 (88.2%) knees. 13/17 (76%) knees had presence of 2 or more risk factors. At the mean follow-up of 43.3 months, the mean Pedi-IKDC score was 88.1, the HSS-Pedi FABS activity score was 15.6, the BPII 2.0 score was 78.2, the Kujala score was 90, KOOS score was 93.9, and overall patient satisfaction score was 83.3. For complications, 3/17 knees (17.6%) had recurrent patellar instability, 1 knee had postoperative stiffness that required manipulation under anesthesia and 1 knee had a superficial wound infection.

Conclusions:
Most patients with habitual and fixed patellar dislocation present during the first decade of life. There are several underlying anatomic risk factors, the most common being trochlear dysplasia and patellar tilt. The 4-in-1 quadricepsplasty technique provides reliable patellar stabilization, satisfactory clinical results, and acceptable patient-reported outcomes at a minimum 2-year follow-up, with a 17.6% redislocation rate.

Level of Evidence:
Level IV.
Long-term Impact of Planovalgus Foot on Activities of Daily Living in Patients With Down Syndrome
Authors: Galán-Olleros María , Ramírez-Barragán Ana , Rodríguez-Zamorano Patricia , Egea-Gámez Rosa M. , Serrano J. Ignacio , Martínez-Caballero Ignacio 
Published: February 2023

Introduction:
Planovalgus foot (PVF) is the most common orthopaedic abnormality in children with Down syndrome (DS), and as a result these patients rarely develop an adequate plantar arch in adulthood. The present study aims to evaluate the impact of PVF on activities of daily living and participation in sports among young adults with DS and determine whether this impact is related to the degree of foot deformity based on clinical and imaging studies.

Methods:
Observational analytical study examining a database of 649 patients with DS from a pediatric referral center, identifying those individuals over age 20 years at the time of the study with a childhood diagnosis of PVF. Finally, 51 patients (102 feet) were evaluated based on clinical and imaging studies, and function was assessed using the The Foot and Ankle Outcome Score (FAOS) and the Visual Analogue Scale (VAS) pain scale. A correlation analysis was performed to determine the clinical and radiographic variables associated with functional outcomes. Linear regression models were obtained to quantify the impact of these variables on function.

Results:
Patients had a mean age of 26.14±3.88 years and body mass index of 24.51±4.57. Clinically, 63.65% presented grade 3 or 4 PVF, and most were flexible. Radiographically, midfoot flattening was mild-moderate in 92.16%, 58.82% had medial talo-navicular uncoverage, and 30.39% had an increased hallux valgus (HV) angle. Mean scores for all FAOS subscales were between 65 and 71% and the mean VAS score was 1.45±1.96. An association analysis revealed a tendency toward lower scores on all FAOS subscales and greater pain according to the VAS scale in more severe PVF and in cases of moderate HV with asymmetry between feet. Linear regression models showed that major contributors to functional scores were radiographic evidence of hindfoot valgus, midfoot abduction, and flattening, and HV.

Conclusions:
Young adults with DS who are diagnosed with PVF in childhood have acceptable functional scores and low pain. Alteration of radiographic parameters toward flatter, more valgus and abducted feet and greater and asymmetric HV tend to be associated with worse long-term functional scores in activities of daily living and sports participation and increased pain. Therefore, non-operative management of these patients is justified, although individualized treatment is recommended.

Level of Evidence:
Level IV, Case series.
Clinical Improvements in Myelopathy Result in Improved Patient-Reported Outcomes Following Anterior Cervical Discectomy and Fusion
Authors: Lambrechts Mark J. , Toci Gregory R. , Karamian Brian A. , Siniakowicz Claudia , Canseco Jose A. , Woods Barrett I. , Hilibrand Alan S. , Schroeder Gregory D. , Vaccaro Alexander R. , Kepler Christopher K. 
Published: February 2023

Study Design.
Retrospective cohort study.

Objective.
To determine if myelopathy severity predicted the magnitude of improvement in health-related quality of life metrics following anterior cervical discectomy and fusion (ACDF).

Summary of Background Data.
Surgery for myelopathy is primarily performed to halt disease progression. However, it is still controversial if these patients can expect significant health-related quality-of life improvements following ACDF. We explore the relationship between modified Japanese Orthopaedic Association (mJOA) improvements and its effect on other health-related quality-of life metrics.

Materials and Methods.
Patients undergoing ACDF for myelopathy were grouped based on preoperative mJOA scores into mild (15–17), moderate (12–14), and severe (<12) groups. Patients were subsequently categorized based on if they attained the minimum clinically detectable improvement (MCID) threshold for mJOA. Multivariate linear regression was performed to determine the magnitude of improvement in ∆patient-reported outcome measures.

Results.
A total of 374 patients were identified for inclusion. Of those, 169 (45.2%) had mild myelopathy, 125 (33.4%) had moderate, and 80 (21.4%) had severe myelopathy. Only the moderate and severe groups had significant improvements in mJOA following surgery (mild: P=0.073, moderate: P<0.001, severe: P<0.001). There were no significant differences in the magnitude of improvement for any patient-reported outcome measure based on myelopathy severity, except for mJOA (mild: 0.27, moderate: 1.88, severe: 3.91; P<0.001). Patients meeting the MCID for mJOA had better ∆Short-Form 12 Mental Component Score (3.29 vs. −0.21, P=0.007), ∆Short-Form 12 Physical Component Score (6.82 vs. 1.96, P<0.001), ∆Visual Analog Scale Neck (−3.11 vs. −2.17, P=0.001), ∆Visual Analog Scale Arm (−2.92 vs. −1.48, P<0.001), ∆Neck Disability Index (−18.35 vs. −7.86, P<0.001), and ∆mJOA (3.38 vs. −0.56, P<0.001) compared with patients who did not.

Conclusions.
Worse baseline myelopathy severity predicts worse postoperative outcomes. However, baseline myelopathy severity is not predictive of the magnitude of postoperative improvement with the exception of mJOA. Patients who attain MCID improvement in mJOA had greater postoperative improvement for other health-related quality of life metrics.
Incidence of Compression-Induced Microinjuries in the Cartilage Endplate of the Spine
Authors: Zehr Jackie D. , Quadrilatero Joe , Callaghan Jack P. 
Published: February 2023

Study Design.

In vitro biomechanical study.

Objective.
This study investigated the incidence of microstructural endplate injuries caused by cyclic compression loading. The covarying effects of joint posture, loading duration, and peak compression variation were assessed.

Summary of Background Data.
The endplate is physiologically and functionally important for the maintenance of spine health. Despite the ability to radiographically diagnose and classify macroscopic endplate injuries, the mechanical mechanisms of injury initiation and progression remain largely unknown.

Methods.
One hundred and fourteen porcine cervical spinal units were examined. All spinal units were exposed to preconditioning tests, followed by cyclic compression testing that differed by posture (flexed, neutral), loading duration (1000, 3000, 5000 cycles), and peak compression variation (10%, 20%, 40%). Microstructural injuries were examined via immunofluorescence staining for collagen I (i.e., subchondral bone) and collagen II (i.e., hyaline cartilage endplate). From the 678 acquired images, the incidence of node, avulsion, cartilage, and circumferential pore microinjuries were determined. The distribution of microinjuries between postures, spinal levels, and vertebrae were evaluated along with the associations of incidence and size of injuries with loading duration and variation.

Results.
The incidence of avulsion injuries was significantly greater in caudal endplates (92%, P=0.006). No other injuries differed between vertebrae (P≥0.804) and no significant differences were observed between spinal units (P≥0.158). With respect to posture, 100% (P<0.001) and 90% (P<0.001) of avulsion and node injuries, respectively, occurred in flexed postures, whereas 82% (P<0.001) of cartilage microinjuries occurred with neutral postures. Loading duration was significantly associated with microinjury incidence (P<0.001) and lesion size (P≤0.003).

Conclusion.
Mechanical factors such as posture did not appreciably affect the incidence of endplate injury, but microinjury types were differently distributed between flexed and neutral postures. The duration of compression was shown to have an important role in the incidence of microinjury and lesion size.
A Comparison Between Cortical Bone Trajectory Screws And Traditional Pedicle Screws in Patients With Single-Level Lumbar Degenerative Spondylolisthesis: Five-Year Results
Authors: Kwon Ji-Won , Park Yung , Lee Byung Ho , Park Si Young , Lim Chae Kwang , Yang Jae Ho , Ha Joong-Won , Suk Kyung-Soo , Moon Seong-Hwan , Kim Hak-Sun 
Published: February 2023

Study Design.
A retrospective observational study.

Objective.
This study investigated the clinical and radiological results of using cortical bone trajectory (CBT) screws versus traditional pedicle (TP) screws in transforaminal lumbar interbody fusion (TLIF) during a five-year follow-up of patients with single-level lumbar degenerative spondylolisthesis.

Summary of Background Data.
Few studies have compared five-year follow-up outcomes between CBT screws and TP screws in TLIF.

Materials and Methods.
We reviewed outcome data of patients with single-level lumbar degenerative spondylolisthesis who underwent TLIF procedures with CBT screws (131 patients) or TP screws (80 patients) between 2011 and 2015. Patient-reported clinical outcome data included Oswestry disability index scores and visual analog scale (VAS) scores for back and leg pain at baseline, six months, and one year, two years, and five years postoperatively. The radiographic fusion rate and prevalence of secondary surgery for adjacent segment disease were also measured.

Results.
During the follow-up over five years, the CBT group had significantly lower VAS scores for back pain (P<0.0001, respectively). At two years after surgery, the CBT group had significantly higher VAS scores for leg pain (P=0.007). At five years postoperatively, no significant differences existed in the VAS score for leg pain or in the Oswestry disability index score between the two groups. Radiographic fusion rates (CBT vs. TP: 95.5% vs. 95.9%; P=0.881) and adverse events during the five years after surgery were not significantly different. At two years postoperatively, the prevalence of secondary surgery to treat adjacent segment disease was significantly different between the two groups (CBT vs. TP: 13.7% vs. 5.0%; P=0.044).

Conclusions.
Our results suggest that, during a five-year followup, CBT screws for TLIF were an effective treatment compared to TP screws in the setting of single-level lumbar degenerative spondylolisthesis. However, when using CBT screws for TLIF, surgeons should consider the higher rate of secondary procedures to treat symptomatic adjacent segment disease.