bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long term WEB results – still going strong at 5 years?
Authors: Alpay Kemal , Nania Alberto , Raj Rahul , Numminen Jussi , Parkkola Riitta , Rautio Riitta , Downer Jonathan 
Published: November 2022

Objective The aim of our multi-center study is to examine 5-year radiological outcomes of intracranial aneurysms (IAs) treated with the Woven EndoBridge (WEB). Methods All patients treated with WEB between January 2013 and December 2016 were included. Patient and aneurysm characteristic data was collected from the electronic patient record. Aneurysm occlusion was assessed using a 3-grade scale: complete occlusion, neck remnant, and aneurysm remnant. Complete occlusion and neck remnant were considered as adequate occlusion, whereas aneurysm remnant was assessed as an inadequate occlusion. Results A total of 66 patients (72.7% female) with 66 IAs (n = 25 acutely ruptured) were treated with WEB. The mean age of patients was 55.6 years (range: 36–71 years). The mean width of the aneurysm neck was 4.5 mm (range: 2−9 mm). 5-year imaging follow-up data was not available for 16.6% patients (n = 11). During the follow up period, 14.5% of IAs (n = 8/55) required retreatment within 24 months of initial treatment with the WEB. A total of 55 IAs were analyzed for 5-year radiological outcome. Of these, including IAs required retreatment, 47.3% of IAs (n = 26/55) were occluded completely, 36.4% (n = 20/55) had neck remnant and 16.3% (n = 9/55) had recanalized. 83.7% of IAs were occluded adequately. None of the IAs rebled after initial treatment with WEB. Conclusion WEB can provide acceptable adequate occlusion rates at 5 years. Furthermore, recanalization appears to be unlikely after the first two years post-treatment. The results of large studies are needed to confirm these promising long term radiological outcomes
A phase III, multi-arm multi-stage covariate-adjusted response-adaptive randomized trial to determine optimal early mobility training after stroke (AVERT DOSE)
Authors: Bernhardt Julie , Churilov Leonid , Dewey Helen , Donnan Geoffrey , Ellery Fiona , English Coralie , Gao Lan , Hayward Kathryn , Horgan Frances , Indredavik Bent , Johns Hannah , Langhorne Peter , Lindley Richard , Martins Sheila , Ali Katijjahbe Md , Middleton Sandy , Moodie Marj , Pandian Jeyaraj , Parsons Brooke , Robinson Thompson , Srikanth Velandai , Thijs Vincent ,   On behalf of the AVERT DOSE Trialist Collaboration
Published: November 2022

Rationale: The evidence base for acute post-stroke rehabilitation is inadequate and global guideline recommendations vary. Aim: To define optimal early mobility intervention regimens for ischemic stroke patients of mild and moderate severity. Hypotheses: Compared with a prespecified reference arm, the optimal dose regimen(s) will result in more participants experiencing little or no disability (mRS 0–2) at 3 months post-stroke (primary), fewer deaths at 3 months, fewer and less severe complications during the intervention period, faster recovery of unassisted walking, and better quality of life at 3 months (secondary). We also hypothesize that these regimens will be more cost-effective. Sample size estimates: For the primary outcome, recruitment of 1300 mild and 1400 moderate participants will yield 80% power to detect a 10% risk difference. Methods and design: Multi-arm multi-stage covariate-adjusted response-adaptive randomized trial of mobility training commenced within 48 h of stroke in mild (NIHSS < 7) and moderate (NIHSS 8–16) stroke patient strata, with analysis of blinded outcomes at 3 (primary) and 6 months. Eligibility criteria are broad, while excluding those with severe premorbid disability (mRS > 2) and hemorrhagic stroke. With four arms per stratum (reference arm retained throughout), only the single treatment arm demonstrating the highest proportion of favorable outcomes at the first stage will proceed to the second stage in each stratum, resulting in a final comparison with the reference arm. Three prognostic covariates of age, geographic region and reperfusion interventions, as well as previously observed mRS 0–2 responses inform the adaptive randomization procedure. Participants randomized receive prespecified mobility training regimens (functional task-specific), provided by physiotherapists/nurses until discharge or 14 days. Interventions replace usual mobility training. Fifty hospitals in seven countries (Australia, Malaysia, United Kingdom, Ireland, India, Brazil, Singapore) are expected to participate. Summary: Our novel adaptive trial design will evaluate a wider variety of mobility regimes than a traditional two-arm design. The data-driven adaptions during the trial will enable a more efficient evaluation to determine the optimal early mobility intervention for patients with mild and moderate ischemic stroke.
Relationship Between Diagnostic Anatomic Shoulder Parameters and Degenerative Rotator Cuff Tears: An MRI Study
Authors: Gulcu Anil , Aslan Ahmet , Dincer Recep , Özmanevra Ramadan , Huri Gazi 
Published: November 2022

Background: Numerous radiographic measurement methods related to rotator cuff tears (RCTs) have been described. The most widely used of these parameters is the critical shoulder angle (CSA) as measured via radiography. However, magnetic resonance imaging (MRI) measurements provide more accurate results than direct radiography. Purpose: To determine the relationship between anatomic shoulder parameters and RCT type via MRI scans. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The data and physical examination notes of 389 patients were retrospectively analyzed, and 242 patients were included in the study. Patients were divided into 2 groups: those with RCT (n = 127) and those without RCT (control group; n = 115). Using suitable MRI sections, the CSA, lateral acromial angle, acromial index, superior glenoid inclination, acromion–greater tuberosity impingement index, and acromiohumeral distance were compared between the RCT and control groups. The correlation of these shoulder parameters with the presence of RCT was investigated, and the predictive value of each parameter was examined using receiver operating characteristic (ROC) analysis. Results: There were significant positive relationships between the presence of RCT and CSA, acromial index, acromion–greater tuberosity impingement index, and superior glenoid inclination, with the strongest correlation belonging to CSA ( r = 0.716). There were also significant negative relationships between presence of RCT and lateral acromial angle ( r = –0.510) and acromiohumeral distance ( r = –0.222). The ROC analysis revealed CSA to be the best predictor for the presence of RCT (area under the ROC curve = 0.899). Conclusion: The study outcomes showed that CSA as measured on MRI is the best predictor for determining the presence of RCTs. In patients with shoulder pain attributed to RCT, it may be helpful to examine the CSA on MRI.
Muscle Activity During Scapular Muscle Exercises With Multijoint Compound Movement: Analysis Using Fine-Wire and Surface Electrodes
Authors: Adachi Gen , Oshikawa Tomoki , Akuzawa Hiroshi , Kaneoka Koji 
Published: November 2022

Background: Improvements in motor control of the scapular muscles are important for the prevention and rehabilitation of shoulder and elbow injuries in overhead athletes. Purpose: To clarify scapular muscle activity during multijoint compound movement exercises using fine-wire and surface electrodes. Study Design: Descriptive laboratory study. Methods: Sixteen healthy men performed 5 types of exercises (cat and dog, trunk rotation, A-exercise, T-exercise, and Y-exercise). Muscle activity was measured as percentage of maximum voluntary isometric contraction (%MVIC) by using fine-wire electrodes in the rhomboid major (Rhom) and using surface electrodes in the upper (UT), middle (MT), and lower (LT) trapezius and serratus anterior (SA) muscles. The Rhom/UT, MT/UT, LT/UT, and SA/UT muscle activity ratios were calculated. One-way analysis of variance was used to compare the %MVIC and muscle activity ratios between exercises. Results: There was no significant difference in Rhom activity between the exercises (34.6-54.2%MVIC; P = .25). LT activity was significantly greater in the trunk rotation (58.0 ± 24.6%MVIC) and Y-exercise (63.2 ± 40.1%MVIC) than in the cat and dog scapular retraction (19.6 ± 9.3%MVIC) and A-exercise (28.2 ± 14.2%MVIC) ( P < .05). SA activity was significantly greater in the cat and dog scapular protraction (26.7 ± 11.0%MVIC) and Y-exercise (25.6 ± 19.3%MVIC) than in the other exercises ( P < .05). The SA/UT activity ratio in the cat and dog scapular protraction exercise (9.64 ± 8.48) was significantly higher than in the other exercises ( P < .05). Conclusion: All the exercises were effective for activating the Rhom. The trunk rotation and Y-exercise were effective for activating the LT, and the cat and dog scapular protraction exercise was effective for activating the SA while suppressing the UT. Clinical Relevance: These results enable exercise selection based on muscle activity characteristics (moderate [20%-50%MVIC] and high [>50%MVIC] levels contribute to muscle activation) to prevent and rehabilitate shoulder and elbow injuries.
Presence of Anemia and Its Severity is Associated with Worse Outcomes Following Open Reduction Internal Fixation of Ankle Fractures
Authors: Ortiz-Babilonia Carlos D. , Badin Daniel , Gupta Arjun , Aiyer Amiethab A. 
Published: November 2022

Category: Trauma; Ankle Introduction/Purpose: Preoperative anemia has been associated with significant postoperative morbidity following various types of orthopaedic procedures. However, to our knowledge, there is no study assessing postoperative outcomes following open reduction internal fixation (ORIF) of ankle fractures with varying severity of anemia. The purpose of this study was to determine the influence of preoperative anemia severity on 30-day postoperative outcomes following ankle fracture ORIF. Methods: The American College of Surgeons National Surgical Quality Improvement Program registry was queried from 2005 to 2019 for patients undergoing ankle fracture ORIF. Patients were stratified into 3 cohorts: non-anemic (hematocrit > 36% for women, >39% for men), mildly anemic (hematocrit 33%-36% for women, 33%-39% for men), and moderately to severely anemic (hematocrit <33% for both women and men) based on World Health Organization definitions. Patients with missing hematocrit data were excluded. Univariate analyses were utilized to assess differences in patient characteristics between cohorts. Multivariate logistic regressions controlling for differences between subgroups were performed to assess the effect of preoperative anemia on 30-day postoperative outcomes. Statistical significance was set at P<0.05. Results: In total, 22,413 patients that underwent ORIF for ankle fractures were included. Of these, 15,739 (70.22%) were not anemic, while 4,243 (18.93%) and 2,431 (10.85%) were mildly and moderately to severely anemic, respectively. Multivariate analysis revealed that mild preoperative anemia in patients undergoing ankle fracture ORIF was associated with higher odds of any adverse event (OR 1.62, P<0.001), superficial surgical site infections (SSIs) (OR 1.46, P=0.047), deep SSIs (OR 2.06, P=0.022), sepsis (OR 2.83, P=0.002), 30-day readmission (OR 1.61, P<0.001), and extended length of stay (LOS) (OR 1.56, P<0.001). Similarly, moderate to severe anemia in these patients was also associated with increased odds of any adverse event (OR 1.94, P<0.001), deep SSIs (OR 2.77, P=0.006), sepsis (OR 3.55, P=0.001), readmission (OR 2.07, P<0.001), and extended LOS (OR 2.21, P<0.001). In addition, moderate to severe anemia patients were associated with higher odds of unplanned reoperation (OR 2.31, P<0.001) and progressive renal insufficiency (OR 3.74, P=0.048). Conclusion: Preoperative anemia is associated with an increased risk of adverse postoperative outcomes in patients undergoing ORIF for ankle fractures. This association seems to be dose dependent, as the odds of adverse events increases with increases in anemia severity. Medical optimization of patients with moderate to severe anemia should take precedence.
Statistical Shape Model-Based Tibiofibular Assessment of Syndesmotic Ankle Lesions using Weightbearing CT
Authors: Peiffer Matthias , Last Matthias , Burssens Arne , Mits Sophie De , Buedts Kristian , Victor Jan M. , Audenaert Emmanuel 
Published: November 2022

Category: Trauma; Ankle Introduction/Purpose: Forced external rotation is hypothesized as the key mechanism of syndesmotic ankle injuries, inducing a three-dimensional deviation from the normal distal tibiofibular joint alignment. These lesions, especially when subtle, present a deceitful diagnostic challenge. Current diagnostic imaging modalities are impeded by a two-dimensional assessment, without considering ligamentous stabilizers. Accurate diagnosis of syndesmotic lesions should involve 3D weightbearing osseous imaging in combination with - preferably automated- inclusion of patient-specific ligamentous information. Therefore, our aim is two-fold: (1) to construct a three-dimensional articulated statistical shape model of the normal distal tibiofibular joint with inclusion of ligamentous morphometry and (2) to detect differences in predicted syndesmotic ligament length of patients with syndesmotic lesions with respect to normative data. Methods: Training data comprised non-weightbearing CT scans from asymptomatic controls (N= 76, Mean age 63 +/- 19 years), weightbearing CT scans from patients with syndesmotic ankle injury (N = 13, Mean Age 35 +/- 15 years) and their weightbearing healthy contralateral side (N = 13). CT scan segmentation was used to generate 3D bone models in the control and patient group. All ankles were aligned based on the tibia. Path and length of the syndesmotic ligaments were predicted using a discrete element model, wrapped around bony contours. Statistical shape model evaluation was based on accuracy, generalization and compactness. The predicted ligament length in patients with syndesmotic lesions was compared to healthy controls by use of two-tailed Two- Sample student's t-test. Results: Our presented skeletal shape model described the training data with an accuracy of 0.23 +/- 0.028 mm. Mean prediction accuracy of ligament insertions was 0.53 +/- 0.12 mm. Mean length of the Anterior inferior tibiofibular ligament was 12.26 +- 1.89mm for the control cases, 12.32 +- 1.58 mm for the contralateral cases and 14.13 +- 1.48 mm for the cases with syndesmotic lesions. Statistically significant differences were found between the latter two (95% CI [ 0.323.29], p = 0.017) There was a significant correlation between presence of syndesmotic injury and the positional alignment between the distal tibia and fibula (r = 0.873, p < 0,001). Conclusion: Statistical shape modelling combined with patient-specific ligament wrapping techniques can facilitate the diagnostic workup of syndesmotic ankle lesions under weightbearing conditions. In doing so, an increased anterior tibiofibular distance was detected, corresponding to an 'anterior open-book injury' of the ankle syndesmosis as a result of anterior inferior tibiofibular ligament elongation/rupture (Figure 1).
Results of Minimally Invasive Distal Metatarsal Osteotomies (Dmmo) Limited to the 2nd and 3rd Rays: About 112 Cases
Authors: Piclet-Legre Barbara 
Published: November 2022

Category: Lesser Toes Introduction/Purpose: The objective of this study was to evaluate the clinical and radiological results of DMMO limited to the second and third rays in patients suffering from metatarsalgia with lesion of the plantar plate of the second ray associated with a hallux valgus. Our hypothesis was that this gesture allowed an improvement of the clinical and paraclinical symptoms Methods: For this retrospective, single-center, single-operator study, 112 patients (mean age 65.52 years, 91% women, 127 feet) operated between June 2015 and October 2020 were included based on the following criteria: metatarsalgia complicated by lesion of the plantar plate with hallux valgus. Secondary metatarsalgia, congenital malformation, pes cavus, Freiberg's disease, gastrocnemius retraction were excluded The surgery began with DMMOs of the 2nd and 3rd metatarsals, then a minimally invasive chevron osteotomy adjusted the length of the 1st metatarsal in relation to the lateral rays. The position of the toes was guided by a bandage for 2 weeks relayed by a molded orthoplasty for 4 weeks. Support was complete with a rigid flat shoe. At a mean follow-up of 3 years (14-80 months), the AOFAS functional score and radiographic measurements (Maestro criteria, bone consolidation) were evaluated. Results: The clinical improvement was significant with an AOFAS score going from 44.9 to 91.8 (p>0.05)We observed 8.7% of complications: 4 transfer metatarsalgia on the 4th or 5th metatarsal, 1 asymptomatic callus under M4, 1 asymptomatic nonunion of M2, 5 spontaneously resolving delayed consolidation, 1 algodystrophy.The radiographic improvement was significant on our morphotypes which were disharmonious in 92% with M45 hypoplasia in 76% and long M23 in 16%.Indeed, the DMMO limited to the 2nd and 3rd metatarsal allowed a significant reduction in the difference in length between the 3rd and 4th metatarsal (p>0.05)Our 4 cases of transfer metatarsalgia under M4 or under M5 were not explained radiologically by relative length anomaly. Conclusion: Performing DMMO limited to the 2nd and 3rd metatarsals appears to be a reliable solution in the management of metatarsalgia by lesion of the plantar plate associated with hallux valgus, the risk of transfer metatarsalgia was not increased compared to the data of literature.
Older Age is Not a Contraindication for Surgical Treatment of Closed Calcaneal Fractures using the Sinus Tarsi Approach
Authors: Reed Logan , Mihas Alexander K. , Andrews Nicholas A. , Wall Kevin , Agarwal Abhinav , Spitler Clay A. , Johnson Michael D. 
Published: November 2022

Category: Hindfoot; Trauma Introduction/Purpose: The sinus tarsi (ST) approach for calcaneus fractures has gained popularity in recent years; however, the literature surrounding early complications rates based on age differences for this specific approach is lacking. The objective of this study was to determine if rates of early complications based on age varied for patients undergoing open reduction and internal fixation (ORIF) of calcaneus fractures using the ST approach. Methods: A retrospective review of patients undergoing ORIF for closed calcaneus fractures from 2012 to 2020 was performed. Inclusion criteria was based on an age greater than 18 years old, surgical management of a closed calcaneus fracture using a ST approach, requirement of a preoperative CT scan, and a minimum of 90 days follow-up. Patients were divided into two groups: those under the age of 50 and those over the age of 50. Measurement outcomes included wound dehiscence, superficial surgical site infection, deep infection, and implant removal. Results: A total of 175 patients (186 fractures) were included with 108 patients in the <50 age group and 86 patients in the >50 age group. Mean age was 34.8 and 58.7 years in the younger and older groups, respectively. The older group had similar rates of wound dehiscence (1.3% vs. 1.9%, P=0.761), superficial surgical site infection (1.3% vs. 0.9%, P=0.816), and deep infection (5.1% vs. 4.6%, P=0.876) as compared to the younger group. Eleven (10.2%) fractures in <50 age group required implant removal compared to 13 (16.7%) fractures in the >50 age group (P=0.193). Postoperative Gissane and Bohler angles were not significantly differnet between the two groups. Conclusion: Calcaneal fractures can be debilitating injuries, especially in the older patient population. The present study found that patients with intraarticular calcaneus fractures treated via the ST approach maintain similar early complication rates as compared to younger individuals.
Reliability of Weight-Bearing Ultrasonography for Assessment of Sesamoid Position and Rotation: A Cadaveric Study
Authors: Saengsin Jirawat , Vaseenon Tanawat , Klongkaew Phatchaya , Kanthawang Thanat , Chalidapong Pawee 
Published: November 2022

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Ultrasonography is increasingly used to evaluate the stability of various joint in the field of foot and ankle. This study aims to assess sesamoid position and rotation under stimulated weight bearing condition compared to the standard weight-bearing imaging. All the measurements were assessed using ultrasonography, fluoroscopy, and direct gross measurement under weight-bearing condition. We hypothesize that there is a correlation between ultrasonographic and fluoroscopic position and rotation measurements, or between ultrasonographic and direct gross measurements. Methods: Fifteen fresh below-knee amputated cadaveric specimens were simulated with 600N force weight bearing condition. The data of sesamoid rotational and metatarsal rotation were measured under ultrasound (GE, LOGIQ E-9 ultrasound machine, Chicago, Illinois, USA), fluoroscopy, and direct measurement method. And also, joint congruity and grading of sesamoid position were subjectively evaluated under three methods by investigators. The set-up axis of rotation measuring was controlled by digital Halo machine. Correlations of the sesamoid and metatarsal rotation on each method were analyzed using Pearson's correlations. The agreement of joint congruity and grading of sesamoid position on each method were described. Results: A total of 15 feet from 15 cadavers were included to the study. The correlation of sesamoid and metatarsal rotation between ultrasonography and fluoroscopy were 0.78 and 0.58, respectively. The correlation of sesamoid and metatarsal rotation between ultrasonography and gross measurement were 0.88 and 0.74, respectively. The correlation of sesamoid and metatarsal rotation between fluoroscopy and gross measurement were 0.65 and 0.47, respectively. For joint congruity evaluation, there were 100% agreement between fluoroscopy and gross measurement and 93.3% agreement between ultrasonography and gross measurement. For sesamoid position, there was 7% agreement between ultrasonography and fluoroscopy. Inter- and intra- observer reliability between the MSK radiologist and the foot-ankle surgeon were substantial. Conclusion: Weight-bearing ultrasonography is ability to assess the grading of sesamoid and metatarsal rotation including joint congruity assessment when compared with fluoroscopy. However, the sesamoid position could not be evaluated by ultrasonography. The benefits of non-radiation hazard and mobile device usage could allow investigator to easily evaluate deformity in the clinic.