The Fay-Herriot model for multiply imputed data with an application to regional wealth estimation in Germany.

The increasing inequality of private income and wealth requires the redistribution of financial resources. Thus, several financial support schemes allocate budget across countries or regions. This work shows how to estimate private wealth at low regional levels by means of a modified Fay-Herriot approach that deals with (a) unit and item non-response, especially with used multiple imputation, (b) the skewness of the wealth distribution, and (c) inconsistencies of the regional estimates with the national direct estimate. One compelling example for financial redistribution is the promoted catching-up process of East Germany after the German reunification. This work shows that 25 years after the reunification differences are more diverse than just between the East and the West by estimating private wealth at two regional levels in Germany. The analysis is based on the Household Finance and Consumption Survey (HFCS) that the European Central Bank launched for all euro area countries in 2010. Although the application in this paper focuses particularly on Germany, the approach proposed is applicable to the other countries participating in the HFCS as well as to other surveys that make use of multiple imputation.

Skiing and snowboarding related deep laceration injuries. A five-season cross-sectional analysis from a level-1 trauma centre in the Swiss Alps.

OBJECTIVES: Lacerations comprise 5.6-33.6% of skiing/snowboarding related injuries. This study aimed to investigate the mechanism of injury and the location of these lacerations and propose preventive measures. METHODS: After our state ethics committee approval, we retrospectively reviewed the medical records and surgical protocols of 46 patients (mean age (±SD) 34.6 (±15.3); 71.4% men) treated for severe skiing/snowboarding lacerations at our level-1 trauma centre between 2016 and 2021. Patients were asked to answer a questionnaire on their skiing experience, equipment used and the circumstances of the accident. RESULTS: Lacerations around the hip, thigh, and knee accounted for 94%. The latter was the most common location (45%). Although 91.3% of patients wore appropriate clothing and full standard protection equipment, it did not offer any extra-resistance against skiing/snowboarding's edges. Skiers were more affected (91.3%) than snowboarders (8.7%). The most common mechanism of injury was inadvertent release of the bindings (52.2%), followed by insufficient ski level for the slope (21.7%) and collisions (17.4%). Long-term trends demonstrated an increasing incidence. CONCLUSION: Identification of body areas at risk and the mechanisms of injury were the most significant findings of this work. These data encourage the development of specific injury prevention programs as the occurrence of these lesions tended to increase over the last few years. To reduce their incidence, we propose skiers to have their bindings regularly adjusted and manufacturers to develop cut-resistant skiwear. LEVEL OF EVIDENCE: IV.

Tibial anterior compartment compressibility in healthy subject, measured using compression sonography.

INTRODUCTION: Compression sonography has been introduced for non-invasive measurement of compartment compressibility and possible diagnostic tool for acute or chronic compartment syndrome in studies using human cadavers and animal models. To date, standard values in healthy subjects are not yet defined. The aim was to define standard compartment compressibility values in healthy human subjects and to assess the reliability of this measurement method. METHODS: In 60 healthy volunteers, using ultrasound, the diameter of the tibial anterior compartment was measured while applying no pressure, 10mbar and 80mbar of external pressure. A pressure manometer on the ultrasound head was used to monitor the externally applied pressure. Compartment compressibility ratio (R0-80, respectively R10-80) was calculated as following: The delta of the compartment diameter with high and low external pressure, divided through the diameter with low external pressure. In 10 volunteers, two examinators conducted each two measurements to assess the reliability. RESULTS: Mean compartment compressibility ratio R10-80 was 15.9% ±3.6 (range: 7.2 - 22.2). Mean compartment compressibility ratio R0-80 was 18.2% ±5.0 (3.0 - 32.1). There was no significant correlation with lower leg circumference, height, weight, BMI, gender, hours of sport per week and type of sport (e.g. weightlifting/ cardio). For R10-80, intraobserver ICC 2.1 was 0.89 for an experienced observer and 0.79 for a non-experienced observer. Interobserver ICC 2.1 was 0.78. For R0-80, intraobserver ICC 2.1 was 0.71 for the experienced and 0.56 for the unexperienced observer. Interobserver ICC 2.1 was 0.59. DISCUSSION: In healthy volunteers between 18 and 50 years of age, mean compartment compressibility ratio R10-80 was 15.9% ±3.6, independent of demographic factors and sport activity. Application of 10mbar instead of 0mbar increased image quality. Subsequently, R10-80 showed lower standard deviation and both higher intraobserver and interobserver reliability than R0-80. Using R10-80, this measurement method is reliable with very high intra- and interobserver correlation.

The Effect of the Mobile Subtalar Joint on Calcaneal and Supramalleolar Osteotomies.

BACKGROUND: The mobile subtalar joint (STJ) may compensate for supra- and inframalleolar deformities and counteract the effect of realigning calcaneal or distal tibial osteotomies. The purpose of this study was to evaluate the compensatory effect of the mobile STJ after supramalleolar osteotomy (SMOT) and calcaneus osteotomy (COT) and whether the extent of the compensation correlates with STJ shape and orientation. METHODS: In 10 human lower leg cadavers without evidence of deformity or prior trauma 700 Newton load were applied as a simulated standing pose. The center of force (COF) migration, maximum pressure (Pmax), and the area loaded were measured with high-resolution sensors in the ankle before and after 10-mm varus/valgus sliding COT and 10-degree varus / valgus SMOT. A computed tomographic evaluation of subtalar anatomy was conducted to correlate posterior facet curvature, its varus/valgus orientation in the coronal plane, and the effect on COF, Pmax, and area loaded. RESULTS: The COF migration was significant for both varus and valgus SMOTs (varus SMOT: 1.78 mm, P = .0029; valgus SMOT: 1.85 mm, P = .0018) but not for COT (varus COT: 0.45 mm, P = .85; valgus COT: 1.15 mm, P = .11). Pmax and area loaded changed but not significantly. The radius of the posterior STJ surface showed a moderate correlation (varus SMOT: r = 0.61, P = .063; valgus SMOT: r = 0.28, P = .43, varus COT: r = -0.61, P = .063; valgus COT: r = 0.13, P = .38) and the axis a weak inverse correlation (varus SMOT: r = -0.51, P = .013; valgus SMOT: r = 0.58, P = .079; varus COT: r = -0.51, P = .14; valgus COT: r = 0.38, P = .28) with the COF migration after the osteotomies. CONCLUSION: The compensatory capacity of a mobile STJ is relatively small but appears to limit the effect of COT more than SMOT. The COT is less effective in influencing ankle joint pressure for realignment purposes than SMOT in mobile STJ and clinically more consistent in stiff STJ. Correlations are moderate to weak, whereas the curvature more than orientation of posterior facet inversely correlates with osteotomy's effects. LEVEL OF EVIDENCE: Level IV, biomechanical cadaver study.

Spatio-temporal trends in caries: A study on children in Berlin-Mitte.

BACKGROUND: Significant inequalities in caries distribution among children in Germany have been reported, but small-scale areas remain understudied. AIM: To examine spatio-temporal trends in children's dental caries at the small-area level in Berlin-Mitte. DESIGN: Routinely collected data from Berlin's annual Health Examination Surveys were used, which also include information on age, sex, country of origin, and residential area. The study population consists of 14,866 children aged 5 to 7 between 2006 and 2014 in the district of Berlin-Mitte. Outcome variables are the dmft (decayed, missing, and filled teeth), the presence of any caries experience, untreated caries, and caries risk. The outcomes are summarized descriptively and graphically presented for 10 quarters and 41 communities within Berlin-Mitte. RESULTS: Relevant gaps in children's dental caries were discovered between the quarters of Mitte. Three quarters in the northeast part of Mitte have consistently indicated the lowest oral health status in all four outcomes, and children having high caries risk have been increasingly concentrating in this area over time. Despite the continuous improvements in the southern part, the averages in total of Mitte for all outcomes have risen. CONCLUSION: Our findings confirm the spatiotemporally mounting disparities in children's oral health between the quarters in Berlin-Mitte and that particular quarters need urgent attention. The small-area approach made it easier and more effective to reveal the spatial distribution of children's dental caries at the local level. The small-area analysis should be strongly encouraged in future caries research to narrow the inequalities in children's oral health.

[Myases from here and elsewhere†: pseudo-furonculosis and Ignatzschineria larvae bacteremia]. / Myiases d'ici et d'ailleurs†: pseudo-furonculose et bactériémie à Ignatzschineria larvae.

Myiasis is an infestation by maggots. In humans, it predominates in regions with low socio-economic development. We report on two cases of myiasis acquired during a tropical travel and in Switzerland, respectively. The first one presented as a furunculous-like disease due to the invasion of subcutaneous tissues by Cordylobia sp. larvae. The second corresponded to a chronic wound infestation that resulted in a rarely reported bacteremia due to Ignatzschineria larvae, a commensal bacteria of maggots' digestive tract. Surgery was necessary in both cases, mainly for psychological reasons in the first case. Both the entomologist and molecular biology were instrumental for treatment decisions.

La myiase est une infestation par des larves de mouches. Chez l'homme, elle prédomine dans les régions à faible niveau socio-économique. Nous rapportons ici deux cas de myiase, l'un acquis lors d'un voyage sous les tropiques et l'autre autochtone : une myiase furonculaire due à la pénétration d'une larve de diptère dans la peau, en l'occurrence Cordylobia sp. ; et une myiase de plaie survenue par ponte de mouches dans des tissus nécrotiques, avec une exceptionnelle bactériémie secondaire, due à une bactérie commensale du tractus digestif de ces larves, Ignatzschineria larvae. Dans les deux situations, la chirurgie a été nécessaire, pour une indication surtout d'ordre psychologique dans la première. Dans les deux cas, l'apport de l'entomologiste et de la biologie moléculaire a été déterminant dans la décision thérapeutique.

Return to Sport and Patient Satisfaction at 5-Year Follow-up After Nonoperative Treatment for Acute Achilles Tendon Rupture.

BACKGROUND: There is controversy whether nonoperative or operative treatment for Achilles tendon rupture is superior. It is unknown if patients with acute Achilles tendon rupture return to previous sports activity. The purpose of this study was to assess 5-year return to sport and subjective satisfaction, minimum 1-year functional outcomes, and complications in patients following nonoperative treatment of Achilles tendon rupture with early weightbearing rehabilitation. METHODS: An institutional review board-approved, retrospective observational study involving 89 patients was performed. Out of 114 consecutive patients, 89 (78%) responded to questionnaires for sports activity. Nonoperative treatment consisted of an equinus cast and rehabilitation boot that enabled early weightbearing. Sports activity at 1-year and 5-year follow-up was compared to the prerupture status. Based on the prerupture Tegner Activity Scale (TAS), patients were divided into low-level (<6) and high-level (≥6) activity groups. Clinical assessment at minimum 1-year follow-up was performed with the Thermann score. Mean clinical follow-up was 34 ± 23 months. RESULTS: Overall, >70% of the patients returned to their previous sports activity level after a nonoperative early weightbearing treatment. Return-to-sport rate was significantly (P = .029) higher for patients in the low-level activity group (91%) compared to patients (67%) in the high-level activity group at 5-year follow-up. Subjective satisfaction with treatment was good in both groups (93% and 96%, respectively). The mean Thermann score did not differ between the 2 groups at 1-year follow-up. There were 11 reruptures, 5 deep venous thromboses, and 1 case of complex regional pain syndrome. CONCLUSION: Nonoperative treatment for Achilles tendon rupture yielded good functional outcome and high patient satisfaction. For patients with a high preinjury activity level, return to previous sporting level (assessed by TAS) was possible in 67% of the patients compared to >90% of patients with low preinjury activity level. LEVEL OF EVIDENCE: Level III, retrospective comparative series.

Modelling the distribution of health-related quality of life of advanced melanoma patients in a longitudinal multi-centre clinical trial using M-quantile random effects regression.

Health-related quality of life assessment is important in the clinical evaluation of patients with metastatic disease that may offer useful information in understanding the clinical effectiveness of a treatment. To assess if a set of explicative variables impacts on the health-related quality of life, regression models are routinely adopted. However, the interest of researchers may be focussed on modelling other parts (e.g. quantiles) of this conditional distribution. In this paper, we present an approach based on quantile and M-quantile regression to achieve this goal. We applied the methodologies to a prospective, randomized, multi-centre clinical trial. In order to take into account the hierarchical nature of the data we extended the M-quantile regression model to a three-level random effects specification and estimated it by maximum likelihood.

Compression sonography for non-invasive measurement of lower leg compartment pressure in an animal model.

INTRODUCTION: Compression ultrasound is a non-invasive technique allowing for qualitative visualization and quantitative measurements of mechanical tissue properties. In acute compartment syndrome (ACS), cadaver studies have proven that the intra-compartmental pressure (ICP) measured by compression sonography correlates with the ICP measured invasively. This study aimed to evaluate compression sonography for compartment pressure measurements in an animal model. MATERIAL AND METHODS: The pressure in the anterior tibial compartment of 6 domestic pig legs was increased from baseline to 40mmHg in 5mmHg steps. Using compression sonography, the compartment diameter was measured without external pressure and during manual application of five levels of external pressure. The elasticity ratio (ER) was computed as the ratio of the compartment diameter with and without external pressure. At 40mmHg of external pressure the ERs at different ICP levels were compared using repeated ANOVA measurements. Post-hoc comparisons evaluated the lowest detectable ICP fulfilling the definition of ACS (ICP≥30mmHg) by starting from each pressure below 30mmHg (baseline, 20mmHg and 25mmHg, respectively). Receiver operator characteristic analyses defined ER limits with appropriate sensitivity and specificity to detect ACS. RESULTS: The ER increased from 79.0% at baseline ICP to 89.3% at 40mmHg ICP. The ER at baseline and at 20mmHg ICP significantly differed from the ER at 30mmHg ICP (p=0.007 and 0.002, respectively); the ER at 25mmHg ICP significantly differed from the ER at 40mmHg ICP (p=0.001). An ER less than 87.1% had a sensitivity of 94.4% and a specificity of 88.9% to proper diagnosis of ACS. CONCLUSION: Compression sonography might offer a non-invasive technique to guide treatment in cases of uncertain acute compartment syndrome. Further studies are needed to collect elasticity ratio data in humans and to clinically validate compression sonography for compartment pressure measurements.

Effect of Preoperative Deformity on Arthroscopic and Open Ankle Fusion Outcomes.

INTRODUCTION: Coronal deformity is considered a relative contraindication for arthroscopic ankle fusion. This study assessed whether preoperative coronal ankle joint deformity influenced the outcome of arthroscopic ankle fusion. METHODS: Ninety-seven patients had 62 arthroscopic and 35 open ankle fusions between 2005 and 2012. Clinical outcomes were prospectively recorded with use of the Ankle Osteoarthritis Scale (AOS) and Ankle Arthritis Scale (AAS) preoperatively and at 6, 12, and 24 months and final follow-up. Radiological alignment was measured using the tibiotalar angle, the tibial plafond angle, the lateral talar station, and the lateral tibiotalar angle. Both groups had the same demographics. RESULTS: Preoperative deformity was the same regarding sagittal alignment and overall coronal alignment, but the arthroscopic group had less tibial deformity (tibial plafond angle range 0-19 degrees vs 0-43 degrees). At final follow-up, the mean AOS was 34.2 for arthroscopic (95% confidence interval [CI], 23.3-45.2) vs 33.9 for open (95% CI, 17.8-49.9). The AAS at final follow-up was 26.0 for arthroscopic (95% CI, 21.0-31.0) vs 27.5 for open (95% CI, 19.7-35.2). Both groups had the same tibiotalar angle, lateral talar station, and lateral tibiotalar angle at follow-up. Regression analyses revealed no influence of type of surgery, preoperative deformity, postoperative radiological alignment, age, sex, body mass index, smoking status, etiology of the arthritis, and need for bone grafting on outcome scores (all P > .05). CONCLUSION: Arthroscopic and open ankle fusion yielded equivalent results for both patient-reported outcome measure and radiographic alignment in patients with coronal and sagittal joint deformity. Patients with higher tibial plafond angles more often underwent open fusion. LEVEL OF EVIDENCE: III, comparative series.

A rare case of non-traumatic, multi-level, bilateral pedicle fractures of the lumbar spine in a 60-year-old patient.

INTRODUCTION: We report a 60-year-old patient who sustained non-traumatic, multi-level, bilateral lumbar pedicle fractures in the setting of unilateral lumbar spondylolysis. A possible fracture mechanism is evaluated and a review of the literature is presented. Whereas contralateral pedicle fractures of lumbar vertebrae with unilateral spondylosis are well described in young athletes, there is only one case report of multi-level, bilateral pedicle fractures of the lumbar spine in a young patient who sustained a high-impact motorcycle accident. To our knowledge, this is the first report of multi-level, bilateral pedicular fractures of the lumbar spine without a history of trauma. METHODS: The clinical case of a 60-year-old patient with lumbar pain radiating in both legs without antecedent trauma is presented. Besides an idiopathic primary adrenal failure, no further co-morbidities existed. Radiologic investigations showed acute bilateral pedicles' fractures of the lumbar vertebrae two to four (L2-4) and a unilateral spondylolysis L4-5. Dorsoventral instrumentation from L1 to L5 was performed in two steps. RESULTS: The patient had no neurological deficits at discharge. Perioperative cortisol substitution was arranged and continued in the course. At final follow-up after 6 years the patient was pain-free and radiographs confirmed complete fusion of L1-5 with mild degeneration of the adjacent segments. CONCLUSION: The presented fracture pattern has not been described to date. Because of multi-level involvement, instability requiring operative stabilisation was presumed and confirmed during surgery.

Longitudinal analysis of the strengths and difficulties questionnaire scores of the Millennium Cohort Study children in England using M-quantile random-effects regression.

Multilevel modelling is a popular approach for longitudinal data analysis. Statistical models conventionally target a parameter at the centre of a distribution. However, when the distribution of the data is asymmetric, modelling other location parameters, e.g. percentiles, may be more informative. We present a new approach, M-quantile random-effects regression, for modelling multilevel data. The proposed method is used for modelling location parameters of the distribution of the strengths and difficulties questionnaire scores of children in England who participate in the Millennium Cohort Study. Quantile mixed models are also considered. The analyses offer insights to child psychologists about the differential effects of risk factors on children's outcomes.

Current Swiss Techniques in Management of Lisfranc Injuries of the Foot.

The outcome after Lisfranc injuries correlates with anatomic and stable reduction. The best surgical treatment, particularly for the ligamentous Lisfranc injuries, remains controversial. Recent publications suggest that the ligamentous injuries may benefit from primary partial Lisfranc arthrodesis. Most surgeons agree that an appropriate reduction is better and easier achieved by open reduction and stable temporary screw or dorsal plate fixation or by open primary partial arthrodesis than by closed reduction or Kirschner wire fixation. Despite correct surgical technique and postoperative management, symptom-free recovery is uncommon. This article outlines current techniques in the management of Lisfranc injuries and resultant postoperative outcomes in a level I trauma center.

Supramalleolar Osteotomies for Posttraumatic Malalignment of the Distal Tibia.

Supramalleolar osteotomies of the tibia (SMOT) for posttraumatic distal tibial malalignment has shown to reduce pain, improve function and radiographic signs of osteoarthritis, and delay ankle arthrodesis or total joint replacement. The procedure also protects the articular cartilage from further degenerative processes by shifting and redistributing loads in the ankle joint. It is technically demanding and requires extensive preoperative planning. The type of osteotomy (opening vs closing wedge) does not influence the final outcome. However, based on the limited evidence, a grade I treatment recommendation has been given for supramalleolar osteotomies of the tibia to treat mild to moderate ankle arthritis in the presence of distal tibial malalignment.

Operative Treatment of Acute Fractures of the Tarsal Navicular Body: Midterm Results With a New Classification.

BACKGROUND: Treatment of displaced tarsal navicular body fractures usually consists of open reduction and internal fixation. However, there is little literature reporting results of this treatment and correlation to fracture severity. METHODS: We report the results of 24 patients treated in our institution over a 12-year period. Primary outcome measurements were Visual-Analogue-Scale Foot and Ankle score (VAS-FA), AOFAS midfoot score, and talonavicular osteoarthritis at final follow-up. According to a new classification system reflecting talonavicular joint damage, 2-part fractures were classified as type I, multifragmentary fractures as type II, and fractures with talonavicular joint dislocation and/or concomitant talar head fractures as type III. Spearman's coefficients tested this classification's correlation with the primary outcome measurements. Mean patient age was 33 (range 16-61) years and mean follow-up duration 73 (range 24-159) months. RESULTS: Average VAS-FA score was 74.7 (standard deviation [SD] 16.9), and average AOFAS midfoot score was 83.8 (SD = 12.8). Final radiographs showed no talonavicular arthritis in 5 patients, grade 1 in 7, grade 2 in 3, grade 3 in 6, and grade 4 in 1 patient. Two patients had secondary or spontaneous talonavicular fusion. Spearman coefficients showed strong correlation of the classification system with VAS-FA score (r = -0.663, P < .005) and talonavicular arthritis (r = 0.600, P = .003), and moderate correlation with AOFAS score (r = -.509, P = .011). CONCLUSION: At midterm follow-up, open reduction and internal fixation of navicular body fractures led to good clinical outcome but was closely related to fracture severity. A new classification based on the degree of talonavicular joint damage showed close correlation to clinical and radiologic outcome. LEVEL OF EVIDENCE: Level IV, retrospective case series.

First Metatarsophalangeal Joint Degeneration: Arthroscopic Treatment.

Arthroscopic treatment of hallux rigidus is appropriate after failed nonoperative treatment. Debridement with cheilectomy, and fusion are the main indications for arthroscopic treatment of hallux rigidus. If the cartilage damage is extensive and the patient has consented, then a fusion is performed at the same sitting.

Displaced supracondylar humeral fractures: influence of delay of surgery on the incidence of open reduction, complications and outcome.

BACKGROUND: Closed reduction and pinning is the accepted treatment choice for dislocated supracondylar humeral fractures in children (SCHF). Rates of open reduction, complications and outcome are reported to be dependent on delay of surgery. We investigated whether delay of surgery had influence on the incidence of open reduction, complications and outcome of surgical treatment of SCHFs in the authors' institution. METHODS: Three hundred and forty-one children with 343 supracondylar humeral fractures (Gartland II: 144; Gartland III: 199) who underwent surgery between 2000 and 2009 were retrospectively analysed. The group consisted of 194 males and 149 females. The average age was 6.3 years. Mean follow-up was 6.2 months. Time interval between trauma and surgical intervention was determined using our institutional database. Clinical and radiographical data were collected for each group. Influence of delay of treatment on rates of open reduction, complications and outcome was calculated using logistic regression analysis. Furthermore, patients were grouped into 4 groups of delay (<6 h, n = 166; 6-12 h, n = 95; 12-24 h, n = 68; >24 h, n = 14) and the aforementioned variables were compared among these groups. RESULTS: The incidence of open procedures in 343 supracondylar humeral fractures was 2.6 %. Complication rates were similar to the literature (10.8 %) primarily consisting of transient neurological impairments (9.0 %) which all were fully reversible by conservative treatment. Poor outcome was seen in 1.7 % of the patients. Delay of surgical treatment had no influence on rates of open surgery (p = 0.662), complications (p = 0.365) or poor outcome (p = 0.942). CONCLUSIONS: In this retrospective study delay of treatment of SCHF did not have significant influence on the incidence of open reduction, complications, and outcome. Therefore, in SCHF with sufficient blood perfusion and nerve function, elective treatment is reasonable to avoid surgical interventions in the middle of the night which are stressful and wearing both for patients and for surgeons. LEVEL OF EVIDENCE: III (retrospective comparative study).

The modified Lapidus fusion.

Due to its proximal correction site and long lever arm, the Lapidus fusion, modified or not, is a powerful technique to correct hallux valgus deformities. The disadvantages are a high complication rate and a long postoperative rehabilitation period. It is only performed in 5% to 10% of all hallux valgus deformity corrections but remains, however, an important procedure, especially in moderate to severe deformities with intermetatarsal angles more than 14°, hypermobility of the first ray, arthritis of the first tarsometatarsal joint, and recurrent deformities. This article provides an overview of the procedure with special focus on the surgical technique.

Conservative treatment of asymmetric ankle osteoarthritis.

This review article summarizes the currently available (poor) evidence of conservative treatment of asymmetric ankle osteoarthritis in the literature and adds the authors' experience with the particular technique. The use of dietary supplementation, viscosupplementation, platelet-rich plasma, nonsteroidal anti-inflammotory drugs, corticosteroid injections, physical therapy, shoe modifications and orthoses, and patient's education in asymmetric ankle osteoarthritis is outlined. There definitively is a place for conservative treatment with reasonable success in patients whose ankles do not qualify anymore for joint-preserving surgery and in patients with medical or orthopedic contraindications for realignment surgery, total ankle replacement, and ankle arthrodesis.