bluuebunny/crossref_metadata_2025_split huggingface dataset:
Computerized Tomography Scans for Ankle Fracture: Diagnosis, Management and Surgical Plan Modifier
Authors: Mansur Nacime S. , Celestino Fausto Santana , Neves Caroline , Pereira Vinícius F. , Vargas Silva Pedro Debieux , Matsunaga Fabio Teruo , Nery Caio A. , Astur Diego C. 
Published: January 2022

Category: Trauma; Ankle Introduction/Purpose: Ankle fractures are one of the most operated injuries in orthopedic practice. The decision upon the best management is based on the displacement of the bone fragments and the presence of associated lesions (osseous and/or soft tissues). The therapeutic decision is classically established upon plain radiographs, which might be temerarious due to the usual difficulty in analyzing those exams. In recent years, some authors have advocated that computed tomography could be used as an assistant instrument on the decision-making. Our study aims to demonstrate the superiority of the association between both methods on diagnosis, therapeutic decision, and surgical plan for these injuries. Methods: Patients diagnosed with an ankle fracture, between 2011 and 2016, and assessed with CT and X-ray were included in our investigation. Seven examiners with different degrees of experience analyzed the exams, determined the injuries, chose how they would treat, and the defined surgical strategy when applicable. This was done, at first, only with radiographs and after with the combination of CT and radiographs. The data were statistically compared. Results: Fifty-three patients were included. The medial malleolus fractures characteristics (posteromedial fragment and anterior colliculus), the presence of posterior malleolus fracture and its characteristics (displacement, bone fragment greater than 25%, posteromedial or posterolateral segment), syndesmosis injury, and the absence of deltoid ligament lesion were more noticeable from the combination of CT and radiography. Concerning surgical treatment, the prone position, the posterolateral surgical approach (rather than anterolateral) on lateral malleolus osteosynthesis, the decision to surgically treat the posterior malleolus fracture (through posterolateral approach with posterolateral plate), the option to include the syndesmosis approach in the treatment, and not to include deltoid ligament repair were more noticeable from the combination of CT and radiography, among all groups of expertise, with high inter-observer reliability. Conclusion: The usual radiographs may fail to demonstrate subtle lesions, as posterior malleolus fractures and syndesmotic injuries. The tomographic evaluation increases the precision of diagnosis and improves the quality of information that the surgeon receives, providing data that can positively affect patient care.
Shock Wave Therapy Associated with Eccentric Strengthening vs Isolated Eccentric Strengthening for Achilles Insertional Tendinopathy Treatment: A Double Blinded Randomized Clinical Trial
Authors: Mansur Nacime S. , Carrazzone Oreste L. , Matsunaga Fabio Teruo , Faloppa Flávio , Sugawara Tamaoki Marcel Jun 
Published: January 2022

Category: Sports; Other Introduction/Purpose: Lack of consensus inhibits Achilles insertional tendinopathy (AIT) management. The condition is usually treated with eccentric exercises (EE), despite its absence of satisfactory and standing results. Shock wave therapy (SWT) was presented as an alternative, but it is still supported by a paucity of studies that shows moderate outcomes. The purpose of this study is to determine if the association of shock wave therapy (SWT) with the eccentric exercises (EE) protocol improve rates of pain and function in patients with AIT. Methods: This was a single-centre, double blind, placebo-controlled, in parallel groups, randomized clinical trial. 119 patients diagnosed with AIT, were evaluated, and enrolled in the study from February 2017 to February 2019. They were divided in two treatment groups, SWT associated to EE (SWT group) and EE associated to sham (CON group). Three sessions of radial shockwaves (or sham) separated by 2 weeks and eccentric training for three months were applied. The primary outcome was the Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A) at 24 weeks. Secondary outcomes included the Visual Analogue Scale (VAS), Algometry, the Foot and Ankle Outcome Score (FAOS) and the 12 Item Short Form Health Survey (SF-12). Results: Both groups showed significant improvement with the corresponding treatment in the study period. However, there were no between-group differences (all ps > 0.05) in any of the outcomes. At the 24th week evaluation, the SWT group exhibited a mean VISA-A of 63.2 (CI 8.0) and the CON group of 62.3 (CI 6.9), p=0.876. Failures were higher in the SWT (38.3% to 11.5%, p=0.002) and recurrences were superior in the CON side (34.6% to 17.0%, p=0.047). There were no complications. Conclusion: Extracorporeal shockwave therapy does not potentialize the effects of eccentric strengthening in the management of Achilles insertional tendinopathy.
Complications Associated with Anesthetic Choice for Elective Foot and Ankle Surgery
Authors: Martin John R. , Kisana Haroon , Hui Clayton , Stecher Chad , Hustedt Joshua 
Published: January 2022

Category: Ankle; Ankle Arthritis; Arthroscopy; Bunion; Diabetes; Hindfoot; Lesser Toes; Midfoot/Forefoot; Sports; Trauma Introduction/Purpose: Wide-awake anesthesia (local anesthesia without sedation) is rarely utilized during elective foot and ankle surgery. As such, the rate of post-operative complications following wide-awake foot and ankle surgery is unknown. The aim of this study was to compare rates of early post-operative complications for wide-awake anesthesia to general/local anesthesia with sedation for elective foot and ankle procedures conditional on a wide range of observable patient characteristics and risk factors. Methods: Patients that underwent an elective foot or ankle surgery were identified in the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) dataset. The rate of thirty-day post-operative complications was compared between patients who received wide-awake anesthesia and those who received general/local anesthesia with sedation using logistic regressions that controlled for patient risk factors. Results: Between 2005 and 2017, 85,363 patients were identified has having any foot and ankle procedure. After excluding observations with missing anesthesia type data information and non-elective foot and ankle procedures, the analytic cohort had 16,743 patients. There were 1,401 (8.4%) patients who underwent wide-awake anesthesia and 15,342 (91.6%) patients who underwent general/local anesthesia with sedation over the entire sample. Starting in 2007, there was an annual increase in the likelihood of using general/local anesthesia with sedation for foot and ankle procedures of 0.7 percentage points (p = 0.001). Overall, general/local anesthesia with sedation increased the odds of experiencing any complication within the first thirty days by 1.523 (95% CI 1.152 - 2.014). Conclusion: Although wide-awake surgery is rarely performed for elective foot and ankle procedures, utilization of local anesthesia without sedation may result in fewer post-operative complications in the first thirty days. Existing trends in the use of sedation for foot and ankle procedures show that physicians are increasingly favoring general/local anesthesia with sedation, but our findings caution against this choice and suggest that post-operative complication rates may correspondingly increase.
Rates of Complications Following Lower Extremity Amputations: A Retrospective Chart Review
Authors: Martinazzi Brandon , Koroneos Zachary , Stauch Chris M. , Manto Kristen M. , Ptasinski Anna , Aynardi Michael C. 
Published: January 2022

Category: Ankle; Diabetes; Hindfoot; Lesser Toes; Midfoot/Forefoot; Trauma; Other Introduction/Purpose: Lower extremity amputations are commonly used in the field of orthopaedics to treat infections, trauma, and severe complications associated with diabetic foot ulcers. These procedures are often associated with high rates of unplanned reoperations, hospitalizations, and numerous postoperative complications. As a result, lower extremity amputations place added physical, emotional and financial stress on patients which can negatively impact outcomes. The aim of this study was to evaluate types of postoperative complications and the rate at which they occurred in an effort to improve future patient outcomes. Methods: Following institutional board approval, all patients at a single academic institution that underwent lower extremity amputation, by a single surgeon, from January 2017 to December 2020 were queried using hospital electronic medical records. Patient charts were followed from the date of surgery until their last follow up appointment in order to identify potential complications. Results: 135 patients underwent lower extremity amputation from 2017-2020. 102 were male (75.5%) and 33 were female (24.4%). The average age of the patients identified was 61.1. The oldest patient was 95 and the youngest patient was 13. The average number of days to a noted complication following amputation was 93.3. The earliest complication occurred 11 days after surgery, while the longest occurred 396 days. Of the 135 patients, 7 patients had revision of their amputation (5.2%), 4 had significant wound dehiscence (3%), 7 had delayed wound healing and excess fluid drainage (5.2%), 4 had postoperative infection (3%), and 4 were noted to have developed phantom limb (3%). Conclusion: Lower extremity amputations continue to be associated with high rates of postoperative complications. This data demonstrates that additional surgical revisions and delayed wound healing were the most common postoperative complications in our cohort.
Clinical Outcomes of Peroneal Tendon Tears: A Systematic Review
Authors: Mercer Nathaniel P. , Gianakos Arianna L. , Mercurio Angela M. , Kennedy John G. 
Published: January 2022

Category: Ankle; Sports Introduction/Purpose: The purpose of this study was to provide an overview of the available evidence on peroneal tendon tears and the outcomes after surgical intervention. Methods: A systematic review of the literature was performed using MEDLINE, Embase, and Cochrane. Criteria for inclusion were clinical studies reporting outcomes after treatment for peroneal tendon tear from August 2010 to August 2020. Results: Nine studies evaluating 336 patients (146 males/190 females) and 336 ankles were included in this review. The mean age of included patients was 46.3 years (range, 46.0 - 56.9 years). The weighted mean follow-up was 23.8 months (range 9.2 - 78.0 months. Five surgical interventions were reported: primary repair with tenodesis, primary repair without tenodesis, FDL tendon transfer, FHL tendon transfer, and allograft reconstruction. Four studies recorded the AOFAS score, with a weighted mean preoperative score of 69.6 and a weighted mean postoperative score of 88.8. FAAM score was measured in 3 studies, which showed an improvement from 41.1 preoperatively to 84.4 postoperatively. The average overall complication rate was 38.7% (130/336) with the most commonly reported minor complication being ankle pain, which made up 46.2% of all minor complications (56/121). Primary repair without tenodesis was associated with a higher complication rate compared to any other surgical intervention (p=.001176). Conclusion: The current systematic review showed that overall clinical outcomes were positive in lieu of the different modalities of surgical intervention for peroneal tendon tears.
The Triplanar Hallux Abducto Valgus Classification System: Is it Valid?
Authors: Padovano Alexander G. , Lalli Trapper , Tennant Joshua N. , Martin Kevin D. , Santrock Robert D. 
Published: January 2022

Category: Bunion Introduction/Purpose: Historically, two-dimensional radiographic study techniques have been used to classify and describe hallux valgus deformities and guided treatment based on severity of deformity in the transverse plane only. These two-dimensional radiographic studies and were not able to assess rotational deformity and may explain the high recurrence and dissatisfaction rates which have been reported. Recently, a triplanar hallux abducto valgus classification (THAVC) system was proposed. This key elements of this classification system are the pathologic alignments in all three anatomic planes. The THAVC system is intended to clarify the deformity and apply a triplanar anatomic algorithm for treatment. To our knowledge, this classification system has not been validated. Our objective was to assess the intra-reader and inter-reader reliability of the THAVC. Methods: After approval by the Institutional Review Board, patients with hallux abducto valgus (HAV) were identified from a foot and ankle registry. Electronic medical records and digital radiographs were reviewed by the principal investigator (PI). Selected radiographs were then deidentified of patient information and assembled in a digital slide presentation and presented to the reviewers. The eligibility criteria required complete weightbearing radiographic studies and represented varying degrees of HAV. The reviewers included three board certified, fellowship trained orthopaedic foot and ankle surgeons. Images of twenty cases of hallux valgus and five normal cases were distributed electronically, who independently classified all 25 cases according to the THAVC system for a total of 75 observations. After an eight week washout period, the order of the HAV cases was randomized and redistributed to the reviewers. The three reviewers were blinded to the results of the both radiographic reviews until after statistical analysis had occurred. Results: We evaluated the intra-reader consistency by Cohen's kappa for the agreement between two measurements from the same reader. The average kappa value from three readers was 0.241 with 95% CI (0.093-0.374), indicating a fair agreement. The inter-reader agreement was 0.046 with 95% CI (-0.041-0.112), showing poor agreement between readers. Conclusion: The Triplanar HAV Classification is the first classification system that utilizes anatomic, multi-plane evaluation. Our results indicate while this is the first known HAV classification system, by this analysis it lacks reliability. This study shows that the reading of 2D radiographs still present a difficulty in assessing a 3D problem. Perhaps a scoring system utilizing advanced imaging such as 3D WBCT could prove more reliable and applicable.
The impact of phacoemulsification surgery on vision-related quality of life in senile cataract patients
Authors: Akpolat Cetin , Demir Mehmet , Cevher Seval , Ozturk Sibel Zorlu , Yesiltas Sumeyra 
Published: January 2022

Background: Phacoemulsification surgery may have beneficial effects on the quality of life of patients with senile cataract. These effects can be evaluated with the help of questionnaires and tests. Purpose: To evaluate the effect of the phacoemulsification surgery on the vision-related quality of life (VR-QOL) in patients with senile cataract using the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) and functional independence measure (FIM) tests. Methods: The data collection was prospective. NEI-VFQ-25 and FIM tests were measured by a masked ergo-therapist. The patients who underwent phacoemulsification surgery were included in this study. Mean best-corrected visual acuity (BCVA), NEI-VFQ-25 and FIM scores were compared in the preoperative period and at least 3 months after the surgery according to demographic properties including gender, age, education status, as well as the BCVA level and laterality. Results: Preoperative mean BCVA and NEI-VFQ-25 composite scores improved significantly ( p < 0.001 and p = 0.001, respectively). All NEI-VFQ-25 subscale scores except the general health ( p = 0.235) and driving ( p = 0.226) showed a significant postoperative increase. The postoperative NEI-VFQ-25 composite scores showed a significant increase in all subgroup analyses ( p < 0.05 for all). Patients with poorer BCVA, bilateral surgery, and low education status had lower preoperative NEI-VFQ-25 composite scores than the patients with better BCVA, unilateral surgery, and high education status ( p = 0.026, p = 0.016, and p = 0.032, respectively). All FIM scores were similar in the preoperative and postoperative periods regardless of subgroup analyses ( p > 0.05 for all). Conclusion: Phacoemulsification surgery can provide a satisfying improvement in VR-QOL in patients with cataracts. As a valid and reliable test, the NEI-VFQ-25 scale can be used to measure the visual function after the ocular surgeries.
The bidirectional temporal relationship between headache and affective disorders: longitudinal data from the HUNT studies
Authors: Giri Samita , Tronvik Erling Andreas , Hagen Knut 
Published: January 2022

Abstract
Background
Few prospective population-based studies have evaluated the bidirectional relationship between headache and affective disorder. The aim of this large-scale population-based follow-up study was to investigate whether tension-type headache (TTH) and migraine had increased risk of developing anxiety and depression after 11 years, and vice-versa.

Methods
Data from the Trøndelag Health Study (HUNT) conducted in 2006-2008 (baseline) and 2017-2019 (follow-up) were used to evaluate the bidirectional relationship between migraine and TTH and anxiety and depression measured by Hospital Anxiety and depression Scale (HADS). The population at risk at baseline consisted of respectively 18,380 persons with HADS score ≤ 7 and 13,893 without headache, and the prospective data was analyzed by Poisson regression.

Results
In the multi-adjusted model, individuals with HADS anxiety (HADS-A) and depression scores (HADS-D) of ≥8 at baseline nearly doubled the risk of migraine (Risk rations (RR) between 1.8 and 2.2) at follow-up whereas a 40% increased risk (RR 1.4) was found for TTH. Vice versa, the risk of having HADS-A and HADS-D scores of ≥8 at follow-up were increased for TTH (RR 1.3) and migraine (RR 1.3-1.6) at baseline. Migraine with aura was associated with 81% (RR 1.81, 95% 1.52-2.14) increased risk of HADS-A score of ≥8.

Conclusions
In this large-scale population-based follow-up study we found a bidirectional relationship between anxiety and depression and migraine and TTH. For anxiety, this bidirectional association was slightly more evident for migraine than TTH.
Practice effect and test-retest reliability of the Mini-Mental State Examination-2 in people with dementia
Authors: Lee Ya-Chen , Lee Shu-Chun , Chiu En-Chi 
Published: January 2022

AbstractBackgroundThe Mini-Mental State Examination-Second Edition (MMSE-2) consists of three visions: a brief version (MMSE-2:BV), a standard version (MMSE-2:SV), and an expanded version (MMSE-2: EV). Each version was equipped with alternate forms (blue and red). There was a lack of evidence on the practice effect and test-retest reliability of the three versions of the MMSE-2, limiting its utility in both clinical and research settings. The purpose of this study was to examine the practice effect and test-retest reliability of the MMSE-2 in people with dementia.MethodsOne hundred and twenty participants were enrolled, of which 60 were administered with the blue form twice (i.e., the same-form group, [SF group]) and 60 were administered with the blue form first and then the red form (alternate-form group, [AF group]). The practice effect was evaluated using a pairedt-test and Cohen’sd. The test-retest reliability was examined using the intraclass correlation coefficient (ICC).ResultsFor the practice effects, in the SF group, no statistically significant differences were found for the MMSE-2:BV and MMSE-2: EV total scores and eight subtests (p = 0.061–1.000), except for the MMSE-2:SV total score (p = 0.029). In the AF group, no statistically significant differences were found for all three versions of the total scores and subtests (p = 0.106–1.000), except for the visual-constructional ability subtest (p = 0.010). Cohen’sdof all three versions’ total scores and subtests were 0.00–0.20 and 0.00–0.26 for SF group and AF group, respectively. For the test-retest reliability, ICC values for all three versions and eight subtests in SF and AF groups were 0.60–0.93 and 0.56–0.93, respectively.ConclusionOur results demonstrated that the practice effect could be minimized when alternate forms of the MMSE-2 were used. The MMSE-2 had good to excellent test-retest reliability, except for three subtests (i.e., visual-constructional ability, registration, and recall). Caution should be taken when interpreting the results of visual-constructional ability, registration, and recall subtests of the MMSE-2.
Unseen, unheard: a qualitative analysis of women’s experiences of exclusively expressing breast milk
Authors: Anders Lisa A. , Robinson Karen , Ohlendorf Jennifer M. , Hanson Lisa 
Published: January 2022

Abstract
Background
Breast milk feeding has numerous benefits for women and infants. Positive maternal experiences with breast milk feeding impacts exclusivity, duration, and maternal mental health. Most research focuses on women feeding directly at the breast. Some women elect to feed exclusively expressed milk to their healthy, term infants rather than feed directly at the breast. Little is known about what constitutes a positive experience among this population. Therefore, the aim of this study was to explore women’s experiences of exclusive expression (EE).

Methods
Interviews were conducted via Microsoft Teams to collect qualitative data from a purposive sample of 21 women practicing EE. Interviews were analyzed for themes.

Results
Three themes: Unseen and Unheard, Doing it My Way, and Getting into the Groove, and 8 subthemes: Breast is Best, Missed Opportunities for Healthcare Provider Support, Fighting for it, What Works for Us, A Sense of Control, Preparation, Tricks of the Trade, and Making it Manageable were identified. Despite challenges, including a lack of support from healthcare providers and a lack of acknowledgement as breastfeeding mothers, exclusive expression offered participants a method to continue breast milk feeding in a way that they found to be satisfying.

Conclusion
This study provides insight into experiences of exclusive expression that clinicians can use to improve their support of breast milk feeding during perinatal encounters. Societal pressure to feed from the breast may have negative emotional consequences for women electing to exclusively express. There is a need for more information and support for breast milk expression from healthcare providers along with a reframing of how breast milk feeding is discussed and promoted.