bluuebunny/crossref_metadata_2025_split huggingface dataset:
Triceps brachii insertional footprint: Under-estimated complexity
Authors: Kamineni Srinath , Pooley Joseph , Bachoura Abdo , Yoshida Ruriko , Cummings Jason 
Published: November 2022

Background The detailed complexity of triceps brachii insertional footprint continues to challenge surgeons as evidenced by continued reports of triceps-associated complications following elbow procedures. The purpose of this study is to describe the three-dimensional footprint of the triceps brachii at its olecranon insertion at the elbow. Methods 22 cadaveric elbows were dissected leaving only the distal insertion of the triceps intact. The insertion was defined and probed with a three-dimensional digitizer to create a digital three-dimensional footprint allowing width, height, and surface area of the footprint to be recorded relative to the bare area. The insertional soft tissues of tendon versus muscle along with the shape of the footprints were qualitatively described. Results The mean width and surface area of the lateral segment was greater in males than in females (30.07 mm vs. 24.37 mm, p  =  0.0339 and 282.1 mm vs. 211. 56 mm, p  =  0.0181, respectively). No other statistically significant differences between the sexes were noted. The triceps insertional footprint was “crescent-shaped” and consisted of three regions: central tendon, medial muscular extension, and lateral muscular extension. Discussion These findings can help explain the importance of avoiding these muscular structures during triceps-off approaches and provides the framework for future clinical studies. Clinical Relevance: Basic Science, anatomy study, cadaver dissection.
Patient-reported outcomes measurement information system depression psychometrically underperforms compared to legacy measures and is poorly associated with postoperative functional outcomes in shoulder arthroplasty patients
Authors: Huddleston Hailey P , Mehta Nabil , Lavoie-Gagne Ophelie Z , Maheshwer Bhargavi , Fu Michael C , Cole Brian J , Verma Nikhil N , Forsythe Brian , Yanke Adam B 
Published: November 2022

Background The purpose of this study was to investigate the associations between each mental health patient-reported outcome measure with postoperative functional outcomes following shoulder arthroplasty, and to compare psychometric properties of patient-reported outcomes measurement information system depression to the legacy (VR-12 Mental) patient-reported outcome measure. Methods Patients who underwent primary shoulder arthroplasty from July 2018 to February 2019 were retrospectively reviewed. Patient-reported outcomes measurement information system depression and VR-12 Mental were administered preoperatively; American Shoulder and Elbow Surgeons and Single Assessment Numeric Evaluation were administered at 6-month and 1-year postoperatively. Rasch partial credit modeling analysis was used to compare psychometric properties of legacy versus patient-reported outcomes measurement information system instruments in assessing mental health. Results Ninety-three patients who underwent total shoulder arthroplasty ( n = 52), reverse total shoulder arthroplasty ( n = 39), or hemiarthroplasty ( n = 2) were included. Preoperative VR-12 Mental scores were moderately associated with American Shoulder and Elbow Surgeons at 6-months (coefficient: 0.52, P = 0.026) and 1-year (coefficient: 0.65, P = 0.002), while preoperative patient-reported outcomes measurement information system depression scores were not. Patient-reported outcomes measurement information system depression demonstrated significant floor effects (16%); VR-12 Mental demonstrated minimal floor and ceiling effects (1.1% for both). VR-12 Mental demonstrated broader coverage of mental outlook on Rasch modeling than patient-reported outcomes measurement information system depression and had adequate model fit after one round of reiterative item elimination. Discussion Patient-reported outcomes measurement information system depression was poorly associated with postoperative American Shoulder and Elbow Surgeons scores, demonstrated significant floor effects, and had limited coverage of mental health on Rasch modeling with reiterative elimination. Level of Evidence IV
Pediatric fractures following implant removal: A systematic review
Authors: Padgett Anthony M , Howie Cole M , Sanchez Thomas C , Cimino Addison , Williams Kevin A , Gilbert Shawn R , Conklin Michael J 
Published: November 2022

Objectives: To evaluate the available literature for postoperative fracture rates following implant removal in the pediatric population. Methods: A systematic review of articles in the PubMed and Embase computerized literature databases from January 2000 to June 2022 was performed using PRISMA guidelines. Randomized controlled trials, case-control studies, cohort studies (retrospective and prospective), and case series involving pediatric patients that included data on fracture rate following removal of orthopedic implants were eligible for review. Two authors independently extracted data from selected studies for predefined data fields for implant type, anatomic location of the implant, indication for implantation, fracture or refracture rate following implant removal, mean time to implant removal, and mean follow-up time. Results: Fifteen studies were included for qualitative synthesis. Reported fracture rates following implant removal vary based on several factors, with an overall reported incidence of 0%–14.9%. The available literature did not offer sufficient data for conduction of a meta-analysis. Conclusion: Our systematic review demonstrates that fracture following implant removal in pediatric patients is a relatively frequent complication. In children, the forearm and femur are the most commonly reported sites of fracture following removal of implants. Traumatic fractures treated definitively with external fixation have the highest reported aggregate rate of refracture. Knowledge of the incidence of this risk is important for orthopedic surgeons. There remains a need for well-designed studies and trials to further clarify the roles of the variables that contribute to this complication.
Status of Women’s Reproductive and Menstrual Health: A Socio-psychological Household Prognostication of Meena Tribal Community of Karauli, Rajasthan
Authors: Chaudhary Sambhawna , Chandna Vaneeta , Pathak Usha K. , Pandey B. W. 
Published: November 2022

The present study hovers around the socio-cultural factors among the women of Meena tribe which pose a grave threat to their reproductive health and also takes into account subjects like menstrual hygiene. Reproductive health and hygiene have always remained stigmatic and dogmatic topics of discussion. The significance of the proverb ‘Prevention is better than cure’ is a saying whose importance cannot be overemphasised. Hygiene then is the foremost requirement for a healthy and good life. The key issues of reproductive rights include the basic right to decide the birth timing space between successive births (or what is known as the pregnancy gap), and also the right to decide the number of offspring in marital life. Some other basic reproductive rights are access to methods of family planning and access to hygienic conditions, health services, education and information. Due to gross misinformation, ignorance and deep-seated taboos, the subject of reproductive health has eluded people for long. The most noticeable detriments are maternal mortality and unhygienic menstrual conditions, thereby leading to women’s lower status not just socially but also mentally and physically. This study reveals how the socio-cultural position of tribal Meena women affects them and adds to the misery and risks faced by them with respect to their health, menstrual hygiene and their selection of health services. This is established by conducting on-field surveys and interviews. The research also derives its findings from various primary and secondary data along with necessary sample collections.
Clinical and Radiological Results of a Human Bone Graft Screw in Tarsometatarsal II/+III Arthrodesis
Authors: Bock Peter 
Published: November 2022

Category: Midfoot/Forefoot Introduction/Purpose: Osteoarthritis of the lesser Lisfranc joints is a debilitating foot condition. Arthrodesis is a well known procedure to eliviate pain and improve quality of life of the affected person. The use of a transplant screw made of allogenic human bone material is considered a new technique for lesser Lisfranc joint arthrodesis. This article investigates the clinical outcome and radiological integration of the allogenic bone screw for arthrodesis of the tarsometatarsal joints II/+III. Methods: This is a prospective study involving 20 feet of 17 patients who received TMT II/+III arthrodesis with an allogenic bone screw. A Visual Analogue Scale (VAS pain and function), Foot Function Index (FFI), American Orthopaedic Foot & Ankle Society Outcome Score (AOFAS) and Foot and Ankle Outcome Score (FAOS) were used as measures to compare preoperative with postoperative results. Radiologic integration in the recipient bone was also evaluated. Results: A significant mean pre- to postoperative improvement of all evaluated scores has been observed (P< .05) after a mean follow-up of 16 months (12-33). VAS (pain) decreased from 7.6 points to 1.4 points, VAS (function) from 7.25 points to 1.8 points. The FFI improved from 62.3% to 16.7%, the AOFAS score from 29.7 points to 79.9 points of the. In all surveyed subscales of the FAOS score an increase was observed: symptoms: 55.2 to 85.6; pain: 30.5 to 86.9; function: 33.1 to 88.3; quality of life: 27.8 to 79.7. The radiologic evaluation did not show any pseudarthrosis at last follow-up. Moreover, in 19 of 20 feet (95%) a complete radiological integration of the screw into the receiving bone was seen after a minimum follow-up time of 12 months and was no longer distinguishable from the original bone. Conclusion: With these first results of the use of an allogenic bone screw in TMT II/+III arthrodesis, a significant improvement from preoperative to postoperative clinical status was confirmed and a full radiographic integration demonstrated in all feet.
Risk Factors for Surgical Site Infection after Operative Management of Pilon Fractures
Authors: Boyd Brandon , Wilson Anthony L. , Cichos Kyle , Murali Sudarsan , Mihas Alexander K. , Patch David A. , McGwin Gerald , Johnson Michael D. , Spitler Clay A. 
Published: November 2022

Category: Trauma; Ankle Introduction/Purpose: Pilon fractures are complex injuries that most commonly result from high-energy trauma. The extensive soft tissue damage and high rates of associated infection seen in these injuries remains a challenging concern for surgeons. The purpose of this study is to identify risk factors associated with surgical site infection (SSI) following operative management of pilon fractures. Methods: A retrospective review of all operatively managed pilon fractures at a single level 1 trauma center from 2014 to 2019 was performed. Minimum six-month follow-up and skeletal maturity was required for inclusion. Patients with amputation prior to definitive fixation were excluded. SSI consisted of superficial (defined as infection resolving with oral antibiotics) and/or deep infections (defined as return to the operating room for debridement with positive cultures). Patients were grouped based on presence or absence of SSI. Demographics, injury and operative characteristics, and surgical outcomes were compared between the two groups. Results: A total of 279 patients met inclusion criteria for the study, with 40 patients developing SSI (14.3%). Average follow-up was 3.2 years. Patients that developed SSI had a significantly higher proportion of open fractures (47.5% vs 23.4%, p=0.003); however, there were no significant differences in Gustilo-Anderson classification or open wound location compared to controls. The SSI group required significantly higher rates of skin grafts (25.0% vs 4.2%, p<0.001) and muscle flap coverage (20.0% vs 1.7%, p<0.001). Average operative time was significantly longer in the SSI group (283.1 vs. 222.3 minutes, p=0.002). Patients with SSI displayed significantly higher rates of nonunion at six-month follow-up compared to those without SSI (55.0% vs 10.9%, p<0.001). There were no significant differences in mechanism of injury, AO/OTA fracture classification, associated ipsilateral lower extremity injuries, bone grafting, surgical approach, or presence of medial column fixation between the two groups. Conclusion: The present study showed that SSI after pilon fractures can lead to significant morbidity, with 55% of patients having nonunion at six months. Risk factors for SSI in these patients included open fracture, need for soft tissue coverage, and longer operative times. Future multicenter studies are needed to further investigate risk factors for SSI after operative management of pilon fractures.
Dual Approach to Talar Body Fractures Increases Talar Dome Access for Fracture Care without Osteotomy
Authors: Campbell Megan L. , Lenz Amy L. , Peterson Andrew , DeKeyser Graham J. , Haller Justin , O'Neill Dillon C. 
Published: November 2022

Category: Trauma; Ankle; Hindfoot Introduction/Purpose: No consensus surgical treatment algorithm exists for talar body fractures, with authors recommending both soft-tissue and osteotomy-based approaches. This study evaluated the utility of dual approaches to the talar dome through anterolateral transligamentous (ATL) and modified posteromedial (mPM) approaches, both with and without distraction. Methods: Ten cadaveric legs (5 matched pairs) were included. A mPM approach, between FHL and Achilles tendon, and an ATL approach, utilizing an anterolateral incision with transection of the ATFL and CFL fibular insertions, were performed on each specimen. Order of approach was alternated within each pair. Accessible dome surface area (DSA) was outlined by drilling with a 1.6-mm Kirschner wire at the visualized talar dome margin both with and without 4mm of tibiotalar distraction. Specimens were analyzed by micro-computed tomography. Primary outcome was total accessible DSA. Student's t-tests compared DSA accessed by different exposure methods. Results: An initial mPM approach allowed access to 25.6% and 33.6% of DSA without and with distraction (p=0.002). An initial ATL approach provided access to 47.0% and 58.1% of DSA without and with distraction, respectively (p=0.003). No significant difference in DSA accessibility were observed for either approach when they were performed second. Accessibility via dual approaches was 71.7% and 93% of DSA without and with distraction with an initial ATL approach and 71.3% and 87.5% of DSA without and with distraction with an initial mPM approach (p=0.96 and 0.37, respectively). (Figure 1) Conclusion: Dual approaches provided access to greater than 70% and 85% of DSA without and with distraction. Order of approach did not change access. These results may promote soft-tissue only treatment strategies in talar body fracture care.
Ultrasound Guidance vs Anatomical Landmark for Ankle Arthroscopic Portal Insertions: A Cadaveric Study
Authors: Cheong Wei Lun , Mehta Kinjal V. 
Published: November 2022

Category: Arthroscopy Introduction/Purpose: Ankle arthroscopy can be used for a variety of ankle pathology including soft tissue and bony impingement, loose bodies, osteochondral defects, ankle fractures, osteoarthritis and instability. However, complication rates associated with ankle arthroscopy range from 3.4 to 9%, with half of them consisting of neurovascular and tendon injuries due to arthroscopic portal placement. The purpose of the study is to determine the safety and efficacy of using ultrasound in topographic marking of the neurovascular structures and tendons in the foot and ankle and identification of a safe zone for arthroscopic portal creation, compared to using anatomical landmarks. Methods: Twelve cadaveric samples were divided into two groups of six. The first group underwent ultrasound assessment by a board certified radiologist, who identified zones of safety for ultrasound guided insertion of anteromedial, anterolateral and posteromedial arthroscopic portals. Ankle arthroscopy was then performed. The other group underwent similar ankle arthroscopy assessment utilizing conventional anatomical landmarks. Straws were used to delineate arthroscopy portal tracts. The cadaveric samples were then dissected. The following distances were measured between the portals and important anatomical structures: the anterolateral portal and superficial peroneal nerve (SPN) as well as extensor digitorum longus (EDL); anteromedial portal and the great saphenous vein (GSV) as well as tibialis anterior (TA); and the posteromedial portal and the flexor hallucis longus (FHL). Results: No neurovascular structures or tendons were injured in all twelve cadaveric samples. Compared with the non- ultrasonography group, the group that underwent ultrasonography assessment had statistically significant larger distance of the SPN, EDL and TA from the anterolateral and anteromedial arthroscopic portals (p values = 0.045, 0.046 and 0.025 respectively). No difference was found between the distance of the GSV from the anteromedial arthroscopic portal, as well as the distance of the FHL from the posteromedial arthroscopic portal. Conclusion: Ultrasound assessment and topographic identification of the safe zone for ankle arthroscopic portal creation is a safe and effective process that may reduce the risk of iatrogenic injury to neurovascular structures and tendons in anterior and posterior ankle arthroscopy.
Limited Open Achilles Repair without Instrument Guided Assistance: A Surgical Technique
Authors: Chopra Aman , Parekh Aarav S. , Parekh Selene G. 
Published: November 2022

Category: Sports Introduction/Purpose: The limited open Achilles tendon repair technique has recently gained popularity as a treatment option for acute Achilles tendon ruptures. This surgical technique video describes a limited open Achilles tendon repair without instrument guided assistance, demonstrating improved clinical outcomes for patients while also reducing reliance on operative equipment, cost, and the duration of surgery. Methods: The indications for this limited open Achilles tendon repair technique include an Achilles tendon rupture less than six weeks from injury occurring in the watershed area. The patient is prone and a two to three centimeter longitudinal incision is made over the Achilles tear. In the proximal stump, three non-absorbable sutures are passed horizontally from proximal to distal direction. In the distal stump, the same is done in a non-locking manner. The stumps are then reflected and the deep fascial compartment is released. The foot is plantarflexed to reduce tension on the repair site. The non-locking sutures are tied sequentially from distal-distal to proximal-proximal direction. A running box suture using a non-absorbable suture followed by 0- Vicryl around the rupture site is performed. Results: This technique has demonstrated, at a median follow-up of 3.7 years, restored preinjury function along with no wound complications, reruptures, or reoperations in 33 patients. The median time from injury to surgery was 10 (range, 1-45) days and the mean time for returning to preinjury level of activity was 5.6 (range, 1.7-22.1) months. After the procedure, patients demonstrated significant improvements in mean Foot and Ankle Disability Index (49.1 to 98.4), mean Visual Analog Scale pain score (4.8 to 0.2), and mean Foot and Ankle Outcome Score (FAOS) subscales such as FAOS pain (54.8 to 99.2), FAOS symptoms (84.6 to 97.0), FAOS activities of daily living (61.4 to 97.2), FAOS sports and recreational activity (39.5 to 98.5), and FAOS quality of life (39.7 to 88.7). Conclusion: Patients who underwent a limited open Achilles tendon repair without instrument guided assistance demonstrated significant improvements in outcome scores with minimal complications.
Cross-Cultural Adaptation and Validation of the Short Musculoskeletal Function Assessment (SMFA) into Spanish (Chile)
Authors: Cortes Aaron , Espinoza Carolina Avilés , Escudero Mario I. , Carcuro Giovanni M. , Pellegrini Manuel J. , Chaparro Felipe R. , Ortiz Cristian A. , Mombello Franco L. 
Published: November 2022

Category: Other; Ankle; Hindfoot; Midfoot/Forefoot Introduction/Purpose: The purpose of this study is to adapt and validate the English version of the Short Musculoskeletal Function Assessment (SMFA) into Chilean Spanish according to the WHO guidelines. Methods: Cross-sectional study where through 897 surveys of patients with non-trauma surgical orthopaedic pathologies, internal consistency, validity and acceptability were evaluated, including correlation with the short form 36 (SF-36) medical score. Results: The preliminary version resulted from the forward and back-translation and a pilot administration. The validation response rate was 99,66%. The SMFA-CL had excellent internal consistency (Cronbach's α = 0.962). The dysfunction and discomfort items showed a value of 0,952 and 0,884 respectively, eliminating one item in the dysfunction sub-scale. The principal component analysis was forced to four factors explaining 55.5% of the variance. SMFA-CL sub-scales significantly correlated with SF-36 components and subcomponents. Conclusion: The first version of the SMFA-CL version (Spanish-Chilean) scale is reported. This culturally adapted score, demonstrated a high rate of reliability, validity and ability to objectively evaluate foot and ankle pathologies.