Expert credibility in climate change.

Although preliminary estimates from published literature and expert surveys suggest striking agreement among climate scientists on the tenets of anthropogenic climate change (ACC), the American public expresses substantial doubt about both the anthropogenic cause and the level of scientific agreement underpinning ACC. A broad analysis of the climate scientist community itself, the distribution of credibility of dissenting researchers relative to agreeing researchers, and the level of agreement among top climate experts has not been conducted and would inform future ACC discussions. Here, we use an extensive dataset of 1,372 climate researchers and their publication and citation data to show that (i) 97-98% of the climate researchers most actively publishing in the field surveyed here support the tenets of ACC outlined by the Intergovernmental Panel on Climate Change, and (ii) the relative climate expertise and scientific prominence of the researchers unconvinced of ACC are substantially below that of the convinced researchers.

Reorientational Proximal Femoral Osteotomies for Correction of Hip Contractures in Children with Arthrogryposis.

INTRODUCTION: Reorientational osteotomy of the proximal part of the femur for children with arthrogryposis repositions the various arcs of hip motion into a more functional sphere of motion, addressing the hip contractures that otherwise are the main mechanical impediments to ambulation. STEP 1 PREOPERATIVE ASSESSMENT: Determine hip range of motion clinically and obtain radiographs to confirm that the hips are located and there are no unusual structural abnormalities. STEP 2 PATIENT POSITIONING AND DRAPING: Position the patient supine with a bump at the sacrum, and drape to allow access to both hips simultaneously. STEP 3 INITIAL PERCUTANEOUS ANTERIOR HIP RELEASE: Perform an initial anterior hip release for patients with a palpable soft-tissue flexion contracture. STEP 4 SURGICAL APPROACH TO THE PROXIMAL PART OF THE FEMUR: Make a standard approach to the lateral aspect of the proximal part of the femur. STEP 5 BLADE-PLATE POSITIONING: Position a guidewire for the appropriate correction; then cut a track for the blade plate with a seating chisel. STEP 6 WEDGE-SHAPED INTERTROCHANTERIC OSTEOTOMY: Perform 2 intertrochanteric osteotomy cuts to provide cut surfaces that, when joined together, will position the lower extremity optimally. STEP 7 APPLYING THE BLADE PLATE AND CLOSURE: Impact the blade plate into the proximal fragment and secure it to the distal fragment. STEP 8 POSTOPERATIVE MANAGEMENT: Apply a Petrie cast, and instruct the parents on how to maintain hip motion. STEP 9 PLATE REMOVAL: Remove the blade plate on an outpatient basis 12 to 18 months after the osteotomy, through the smallest incision possible to allow a quicker recovery. RESULTS: We performed reorientational osteotomies on 68 consecutive children with arthrogrypotic multiplanar hip contractures over a 5-year span, and 65 were followed for at least 2 years; 54 of these patients had a bilateral hip contracture, for a total of 119 reorientational osteotomies.

Reorientational Proximal Femoral Osteotomies for Arthrogrypotic Hip Contractures.

BACKGROUND: Severe hip contractures in arthrogrypsosis are multiplanar, which can preclude or can greatly complicate sitting and ambulation. The reorientational osteotomy at the intertrochanteric level preserves preoperative hip motion but moves it to a more functional domain. We retrospectively compared preoperative and postoperative hip motion and evaluated the ambulatory abilities of patients who underwent the procedure. METHODS: Since 2008, 65 patients with arthrogryposis had 119 reorientational proximal femoral osteotomies with a minimum follow-up of 2 years. The mean patient age at the time of the surgical procedure was 48 months. An intertrochanteric wedge osteotomy aligned the femoral shaft with the body axis, leaving the hip joint in its preexisting position. A cannulated hip blade plate was used for fixation. Hip motions were recorded preoperatively, at implant removal, and at the time of the latest follow-up, as was ambulatory ability. RESULTS: Eighty-one hips had a mean flexion contracture of 52° preoperatively, which improved by 35°; 84 hips with a mean preoperative adduction of -20° improved by 42°; 101 hips with a mean preoperative internal rotation of -16° improved by 35° (p < 0.0001 for all). The flexion-extension total arc of motion for the 119 hips improved by 13° (p < 0.0001). Only 11 of 94 hips that preoperatively flexed ≥90° did not do so postoperatively, but none of the patients reported seating difficulties and one of the patients had already regained hip flexion of >90° by a soft-tissue release. At a mean follow-up of 40 months, 36 patients were independently ambulatory and 20 patients were walker-dependent. CONCLUSIONS: Children with arthrogryposis often have the potential for ambulation if the limb positioning can be optimized. The reorientational hip osteotomy corrects the hip contractures by altering the range of motion but not the total arc of motion. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Syndromic Feet: Arthrogryposis and Myelomeningocele.

Treatment of myelomeningocele and arthrogrypotic foot deformities has been controversial; many different procedures have been advocated for each type of deformity. In most cases, outcomes have had variable success rates, and many complications can occur. Treatment strategies should highlight care that avoids the development of a stiffened foot and allows for a variety of options to regain correction when a relapse occurs. This is particularly true in myelomeningocele, whereby a stiff foot runs a high risk for skin ulceration, leading to osteomyelitis. Discussion includes appropriate circumstances for the use of presented procedures and the author's preferred treatment for each deformity.

Treatment of the neglected and relapsed clubfoot.

Treatment of the neglected and the relapsed clubfoot is one of the most controversial topics in pediatric foot care. This article reviews the breadth of treatment options for practicing podiatrists or orthopedists with a specialty in complex clubfoot treatment. Discussion includes the appropriate circumstances for the use of the different procedures presented and the author's preferred treatment algorithm, based on 15 years of treating neglected, relapsed, and nonidiopathic clubfeet.