Periprosthetic joint infections contribute significantly to patient morbidity,prolonged hospital stays,and escalating healthcare costs.Defensive antibacterial coating(DAC®)hydrogel has emerged as a promising stra...Periprosthetic joint infections contribute significantly to patient morbidity,prolonged hospital stays,and escalating healthcare costs.Defensive antibacterial coating(DAC®)hydrogel has emerged as a promising strategy to combat these infections.It forms a biodegradable barrier that reduces bacterial adhesion and can deliver local antibiotics,thereby addressing a key mechanism in biofilm formation.Early clinical evidence suggests that DAC®effectively lowers infection recurrence in revision hip and knee arthroplasties,with additional benefits in trauma procedures and soft tissue repairs.Moreover,it has demonstrated compat-ibility with existing implants and surgical techniques,while potentially reducing overall antibiotic use and hospital stays.Despite these encouraging findings,data for its use in primary arthroplasty remains limited,underscoring the need for large-scale,high-quality studies.Future research is poised to refine DAC®’s antimicrobial efficacy through novel antibiotic combinations,personalised delivery systems,and broader applications beyond lower limb procedures.As the prevalence of comorbidities continues to rise,DAC®represents a valuable addi-tion to multifaceted infection control protocols,potentially transforming ortho-paedic care by enhancing patient outcomes and mitigating the economic and clinical burden of implant-related infections.展开更多
The gut microbiome,a complex ecosystem of microorganisms,has a significant role in modulating pain,particularly within orthopaedic conditions.Its impact on immune and neurological functions is underscored by the gut-b...The gut microbiome,a complex ecosystem of microorganisms,has a significant role in modulating pain,particularly within orthopaedic conditions.Its impact on immune and neurological functions is underscored by the gut-brain axis,which influences inflammation,pain perception,and systemic immune responses.This integrative review examines current research on how gut dysbiosis is associated with various pain pathways,notably nociceptive and neuroinflammatory mechanisms linked to central sensitization.We highlight advancements in meta-omics technologies,such as metagenomics and metaproteomics,which deepen our understanding of microbiome-host interactions and their implications in pain.Recent studies emphasize that gut-derived short-chain fatty acids and microbial metabolites play roles in modulating neuroinflammation and nociception,contributing to pain management.Probiotics,prebiotics,synbiotics,and faecal microbiome transplants are explored as potential therapeutic strategies to alleviate pain through gut microbiome modulation,offering an adjunct or alternative to opioids.However,variability in individual microbiomes poses challenges to standardizing these treatments,necessitating further rigorous clinical trials.A multidisciplinary approach combining microbiology,immunology,neurology,and orthopaedics is essential to develop innovative,personalized pain management strategies rooted in gut health,with potential to transform orthopaedic pain care.展开更多
The gut microbiome,a complex ecosystem of microorganisms in the digestive tract,has emerged as a critical factor in human health,influencing metabolic,immune,and neurological functions.This review explores the connect...The gut microbiome,a complex ecosystem of microorganisms in the digestive tract,has emerged as a critical factor in human health,influencing metabolic,immune,and neurological functions.This review explores the connection between the gut microbiome and orthopedic health,examining how gut microbes impact bone density,joint integrity,and skeletal health.It highlights mechanisms linking gut dysbiosis to inflammation in conditions such as rheumatoid arthritis and osteoarthritis,suggesting microbiome modulation as a potential therapeutic strategy.Key findings include the microbiome’s role in bone metabolism through hormone regulation and production of short-chain fatty acids,crucial for mineral absorption.The review also considers the effects of diet,probiotics,and fecal microbiota transplantation on gut microbiome composition and their implications for orthopedic health.While promising,challenges in translating microbiome research into clinical practice persist,necessitating further exploration and ethical consideration of microbiome-based therapies.This interdisciplinary research aims to link digestive health with musculoskeletal integrity,offering new insights into the prevention and management of bone and joint diseases.展开更多
The integration of WhatsApp,a widely-used instant messaging application(IMA),into the realm of orthopaedics and trauma surgery has emerged as a significant development in recent years.This paper explores the multiface...The integration of WhatsApp,a widely-used instant messaging application(IMA),into the realm of orthopaedics and trauma surgery has emerged as a significant development in recent years.This paper explores the multifaceted role of WhatsApp in orthopaedics,focusing on its clinical and non-clinical applications,advantages,disadvantages,and future prospects.The study synthesizes findings from various research papers,emphasizing the growing reliance on mobile technology in healthcare.WhatsApp’s role in orthopaedics is notable for its ease of use,real-time communication,and accessibility.Clinically,it facilitates triage,teleconsultation,diagnosis,treatment,patient advice,and post-operative monitoring.Non-clinically,it supports telemedicine,teleradiology,virtual frac-ture clinics,research,and education in orthopaedic surgery.The application has proven beneficial in enhancing communication among healthcare teams,providing quick responses,and motivating junior physicians.Its use in educational settings has been shown to improve learner’s understanding and patient care.However,the use of WhatsApp in orthopaedics is not without challenges.Risks include the potential spread of misleading information,privacy concerns,and issues with image quality affecting diagnosis and treatment decisions.The paper acknowledges the importance of maintaining professional boundaries and the need for oversight measures to ensure content accuracy.Looking forward,the potential of WhatsApp and similar IMAs in orthopaedics lies in their ability to streamline data collection and retrieval,improve doctor-patient communication,and address challenges like bureaucratic red tape and limited resources.The paper suggests that future orthopaedic practice,particularly in emergency departments,will increasingly rely on such technologies for efficient patient management.This shift,however,must be approached with an understanding of the ethical,legal,and practical implications of integrating social media and mobile technology in healthcare.展开更多
BACKGROUND Fellowship directors(FDs)in sports medicine influence the future of trainees in the field of orthopaedics.Understanding the characteristics these leaders share must be brought into focus.For all current spo...BACKGROUND Fellowship directors(FDs)in sports medicine influence the future of trainees in the field of orthopaedics.Understanding the characteristics these leaders share must be brought into focus.For all current sports medicine FDs,our group analyzed their demographic background,institutional training,and academic experience.AIM To serve as a framework for those aspiring to achieve this position in orthopaedics and also identify opportunities to improve the position.METHODS Fellowship programs were identified using both the American Orthopaedic Society for Sports Medicine and the Arthroscopy Association of North America Sports Medicine Fellowship Directories.The demographic and educational background data for each FD was gathered via author review of current curriculum vitae(CVs).Any information that was unavailable on CV review was gathered from institutional biographies,Scopus Web of Science,and emailed questionnaires.To ensure the collection of as many data points as possible,fellowship program coordinators,orthopaedic department offices and FDs were directly contacted via phone if there was no response via email.Demographic information of interest included:Age,gender,ethnicity,residency/fellowship training,residency/fellowship graduation year,year hired by current institution,time since training completion until FD appointment,length in FD role,status as a team physician and H-index.RESULTS Information was gathered for 82 FDs.Of these,97.5%(n=80)of the leadership were male;84.15%(n=69)were Caucasian,7.32%(n=6)were Asian-American,2.44%(n=2)were Hispanic and 2.44%(n=2)were African American,and 3.66%(n=3)were of another race or ethnicity.The mean age of current FDs was 56 years old(±9.00 years),and the mean Scopus H-index was 23.49(±16.57).The mean calendar years for completion of residency and fellowship training were 1996(±15 years)and 1997(±9.51 years),respectively.The time since fellowship training completion until FD appointment was 9.77 years.17.07%(n=14)of FDs currently work at the same institution where they completed residency training;21.95%(n=18)of FDs work at the same institution where they completed fellowship training;and 6.10%(n=5)work at the same institution where they completed both residency and fellowship training.Additionally,69.5%(n=57)are also team physicians at the professional and/or collegiate level.Of those that were found to currently serve as team physicians,56.14%(n=32)of them worked with professional sports teams,29.82%(n=17)with collegiate sports teams,and 14.04%(n=8)with both professional and collegiate sports teams.Seven residency programs produced the greatest number of future FDs,included programs produced at least three future FDs.Seven fellowship programs produced the greatest number of future FDs,included programs produced at least four future FDs.Eight FDs(9.75%)completed two fellowships and three FDs(3.66%)finished three fellowships.Three FDs(3.66%)did not graduate from any fellowship training program.The Scopus H-indices for FDs are displayed as ranges that include 1 to 15(31.71%,n=26),15 to 30(34.15%,n=28),30 to 45(20.73%,n=17),45 to 60(6.10%,n=5)and 60 to 80(3.66%,n=3).Specifically,the most impactful FD in research currently has a Scopus H-index value of 79.By comparison,the tenth most impactful FD in research had a Scopus H-index value of 43(accessed December 1,2019).CONCLUSION This study provides an overview of current sports medicine FDs within the United States and functions as a guide to direct initiatives to achieve diversity equality.展开更多
The World Health Organisation(WHO)declared coronavirus disease 2019(COVID-19)a pandemic on March 11,2020.COVID-19 is not the first infectious disease to affect Trinidad and Tobago.The country has faced outbreaks of bo...The World Health Organisation(WHO)declared coronavirus disease 2019(COVID-19)a pandemic on March 11,2020.COVID-19 is not the first infectious disease to affect Trinidad and Tobago.The country has faced outbreaks of both Chikungunya and Zika virus in 2014 and 2016 respectively.The viral pandemic is predicted to have a significant impact upon all countries,but the healthcare services in a developing country are especially vulnerable.The Government of Trinidad and Tobago swiftly established a parallel healthcare system to isolate and treat suspected and confirmed cases of COVID-19.Strick‘lockdown’orders,office closures,social distancing and face mask usage recommendation were implemented following advice from the WHO.This approach has seen Trinidad and Tobago emerge from the second wave of infections,with the most recent Oxford COVID-19 Government Response Tracker report indicating a favourable risk of openness index for the country.The effects of the pandemic on the orthopaedic services in the public and private healthcare systems show significant differences.Constrained by shortages in personal protective equipment and inadequate testing facilities,the public system moved into emergency mode prioritizing the care of urgent and critical cases.Private healthcare driven more by economic considerations,quickly instituted widespread safety measures to ensure that the clinics remained open and elective surgery was not interrupted.Orthopaedic teaching at The University of the West Indies was quickly migrated to an online platform to facilitate both medical students and residents.The Caribbean Association of Orthopedic Surgeons through its frequent virtual meetings provided a forum for continuing education and social interaction amongst colleagues.The pandemic has disrupted our daily routines leading to unparalleled changes to our lives and livelihoods.Many of these changes will remain long after the pandemic is over,permanently transforming the practice of orthopaedics.展开更多
Mg and its alloys are drawing huge attention since the last two decades as a viable option for temporary implants applications.A commendable progress has already been made in the development of these alloys.The biodeg...Mg and its alloys are drawing huge attention since the last two decades as a viable option for temporary implants applications.A commendable progress has already been made in the development of these alloys.The biodegradable nature of Mg,appreciable biocompatibility of elemental Mg,and its close resemblance to natural bone in terms of density and elastic modulus make them highly preferable option amongst other available alternatives in this field.This review article presents an overview covering the recent advancements made in the field of Mg-based biodegradable implants for orthopaedic implant applications.The paper focuses on alloy development and fabrication techniques,the state of the art of important Mg-based alloy systems in terms of their mechanical properties,in-vitro and in-vivo degradation behaviour and cytotoxicity.Further,the paper reviews the current progress achieved in the clinical transition of Mg-based alloys for orthopaedic fixtures.The review also includes the degradation mechanisms of the alloys in physiological environment and highlights the mismatch existing between the rate of bone healing and alloy degradation due to rapid corrosion of the alloys in such environment,which has still restricted their widespread application.Finally,the surface coating techniques available for the alloys as an effective way to reduce the degradation rate are reviewed,followed by a discussion on the future research prospects.展开更多
Ti Ni alloys, with their unique shape memory effects and super elastic properties, occupy an indispensable place in the family of metallic biomaterials. In the past years, surface treatment is the main technique to im...Ti Ni alloys, with their unique shape memory effects and super elastic properties, occupy an indispensable place in the family of metallic biomaterials. In the past years, surface treatment is the main technique to improve the bioinert nature of microcrystalline Ti Ni alloys and inhibit on the release of toxic nickel ions to obtain excellent osteogenesis and osseointegration function. In the present study, nanocrystalline Ti49.2Ni50.8 alloy has been fabricated via equal channel angular pressing(ECAP), and the in vitro and in vivo studies revealed that it had enhanced cell viability, adhesion, proliferation, ALP(Alkaline phosphatase)activity and mineralization, and increased periphery thickness of new bone, in comparison to the commercial coarse-grained counterpart. These findings indicate that the reduction of grain size is beneficial to increasing the biocompatibility of Ti49.2Ni50.8 shape memory alloy.展开更多
Damage control orthopaedics(DCO) originally consisted of the provisional immobilisation of long bone-mainly femur-fractures in order to achieve the advantages of early treatment and to minimise the risk of complicatio...Damage control orthopaedics(DCO) originally consisted of the provisional immobilisation of long bone-mainly femur-fractures in order to achieve the advantages of early treatment and to minimise the risk of complications, such as major pain, fat embolism, clotting, pathological inflammatory response, severe haemorrhage triggering the lethal triad, and the traumatic effects of major surgery on a patient who is already traumatised(the "second hit" effect). In recent years, new locations have been added to the DCO concept, such as injuries to the pelvis, spine and upper limbs. Nonetheless, this concept has not yet been validated in well-designed prospective studies, and much controversy remains.Indeed, some researchers believe the indiscriminate application of DCO might be harmful and produce substantial and unnecessary expense. In this respect, too,normalised parameters associated with the acid-base system have been proposed,under a concept termed early appropriate care, in the view that this would enable patients to receive major surgical procedures in an approach offering the advantages of early total care together with the apparent safety of DCO. This paper discusses the diagnosis and treatment of severely traumatised patients managed in accordance with DCO and highlights the possible drawbacks of this treatment principle.展开更多
An estimated 285 million adults(aged 20-79 years)worldwide were diagnosed to have diabetes mellitus(DM)in 2010,and this number is projected to grow to 439million adults by the year 2030.Orthopaedic surgeons,regardless...An estimated 285 million adults(aged 20-79 years)worldwide were diagnosed to have diabetes mellitus(DM)in 2010,and this number is projected to grow to 439million adults by the year 2030.Orthopaedic surgeons,regardless of their subspecialty interest,will encounter patients with DM during their career since this epidemic involves both developed and emerging countries.Diabetes results in complications affecting multiple organ systems,potentially resulting in adverse outcomes afterorthopaedic surgery.The purpose of this review is to discuss the pathophysiology of DM and its potential for impacting orthopaedic surgery patients.Diabetes adversely affects the outcome of all orthopaedic surgery subspecialties including foot and ankle,upper extremity,adult reconstructive,pediatrics,spine surgery and sports medicine.Poorly controlled diabetes negatively impacts bone,soft tissue,ligament and tendon healing.It is the complications of diabetes such as neuropathy,peripheral artery disease,and end stage renal disease which contributes to adverse outcomes.Well controlled diabetic patients without comorbidities have similar outcomes to patients without diabetes.Orthopaedic surgeons should utilize consultants who will assist in inpatient glycemic management as well as optimizing long term glycemic control.展开更多
BACKGROUND With the increasing complexity of surgical interventions performed in orthopaedic trauma surgery and the improving technologies used in threedimensional(3D)printing,there has been an increased interest in t...BACKGROUND With the increasing complexity of surgical interventions performed in orthopaedic trauma surgery and the improving technologies used in threedimensional(3D)printing,there has been an increased interest in the concept.It has been shown that 3D models allow surgeons to better visualise anatomy,aid in planning and performing complex surgery.It is however not clear how best to utilise the technique and whether this results in better outcomes.AIM To evaluate the effect of 3D printing used in pre-operative planning in orthopaedic trauma surgery on clinical outcomes.METHODS We performed a comprehensive systematic review of the literature and a metaanalysis.Medline,Ovid and Embase were searched from inception to February 8,2018.Randomised controlled trials,case-control studies,cohort studies and case series of five patients or more were included across any area of orthopaedic trauma.The primary outcomes were operation time,intra-operative blood loss and fluoroscopy used.RESULTS Seventeen studies(922 patients)met our inclusion criteria and were reviewed.The use of 3D printing across all specialties in orthopaedic trauma surgery demonstrated an overall reduction in operation time of 19.85%[95%confidence intervals(CI):(-22.99,-16.71)],intra-operative blood loss of 25.73%[95%CI:(-31.07,-20.40)],and number of times fluoroscopy was used by 23.80%[95%CI:(-38.49,-9.10)].CONCLUSION Our results suggest that the use of 3D printing in pre-operative planning in orthopaedic trauma reduces operative time,intraoperative blood loss and the number of times fluoroscopy is used.展开更多
Artificial intelligence and machine learning in orthopaedic surgery has gained mass interest over the last decade or so.In prior studies,researchers have demonstrated that machine learning in orthopaedics can be used ...Artificial intelligence and machine learning in orthopaedic surgery has gained mass interest over the last decade or so.In prior studies,researchers have demonstrated that machine learning in orthopaedics can be used for different applications such as fracture detection,bone tumor diagnosis,detecting hip implant mechanical loosening,and grading osteoarthritis.As time goes on,the utility of artificial intelligence and machine learning algorithms,such as deep learning,continues to grow and expand in orthopaedic surgery.The purpose of this review is to provide an understanding of the concepts of machine learning and a background of current and future orthopaedic applications of machine learning in risk assessment,outcomes assessment,imaging,and basic science fields.In most cases,machine learning has proven to be just as effective,if not more effective,than prior methods such as logistic regression in assessment and prediction.With the help of deep learning algorithms,such as artificial neural networks and convolutional neural networks,artificial intelligence in orthopaedics has been able to improve diagnostic accuracy and speed,flag the most critical and urgent patients for immediate attention,reduce the amount of human error,reduce the strain on medical professionals,and improve care.Because machine learning has shown diagnostic and prognostic uses in orthopaedic surgery,physicians should continue to research these techniques and be trained to use these methods effectively in order to improve orthopaedic treatment.展开更多
As the demand for pharmaceutical services continues to grow, more and more attention has been paid to the pharmaceutical care effect. However, in China, the training pathways and practical work of clinical pharmacy ar...As the demand for pharmaceutical services continues to grow, more and more attention has been paid to the pharmaceutical care effect. However, in China, the training pathways and practical work of clinical pharmacy are still in the exploratory stage. In the present review, we aimed to discuss the impact of pharmacist-led interventions in reducing inappropriate drug use in orthopaedics. Results showed clinical pharmacists can assist orthopaedists and nurses in the rational use of medication in all aspects of antibiotic therapy, pain control and anticoagulation therapy. The clinical interventions by pharmacists have greatly reduced medication errors and medical costs. However, there is still a long time to develop pharmacy service, improve the professional quality of pharmacists and enact the Chinese Pharmacist Law.展开更多
Camera calibration is the key technique in a C-arm based orthopaedic surgical navigation system. The extraction of marker location information is a necessary step in the calibration process. Ideal marker images should...Camera calibration is the key technique in a C-arm based orthopaedic surgical navigation system. The extraction of marker location information is a necessary step in the calibration process. Ideal marker images should possess uniform background and contain marker shadow only, but in fact marker images always possess nonuniform background and are contaminated by noise and unwanted anatomic information, making the extraction very difficult. A target-orientated marker shadow extraction method was proposed. With this method a proper threshold for marker image binarization can be determined.展开更多
Medical treatment of patients inherently entails the risk of undesired complication or side effects. It is essential to inform the patient about the expected outcomes, but also the possible undesired outcomes. The pat...Medical treatment of patients inherently entails the risk of undesired complication or side effects. It is essential to inform the patient about the expected outcomes, but also the possible undesired outcomes. The patients preference and values regarding the potential outcomes should be involved in the decision making process. Even though many orthopaedic surgeons are positive towards shared decision-making, it is minimally introduced in the orthopaedic daily practice and decision-making is still mostly physician based. Decision aids are designed to support the physician and patient in the shareddecision-making process. By using decision aids, patients can learn more about their condition and treatment options in advance to the decision-making. This will reduce decisional conflict and improve participation and satisfaction.展开更多
BACKGROUND There is little research investigating how human immunodeficiency virus(HIV)affects outcomes in orthopaedic surgery.With advances in treatment,HIV has become a chronic health problem and the chance of ortho...BACKGROUND There is little research investigating how human immunodeficiency virus(HIV)affects outcomes in orthopaedic surgery.With advances in treatment,HIV has become a chronic health problem and the chance of orthopaedic surgeons encountering it in clinical practice is increasing.AIM To ascertain the quantity and quality of peer-reviewed publications in orthopaedic journals about HIV.METHODS A search of the Web of Science database was carried out,identifying any articles relating to HIV published in orthopaedic journals.These were assessed for geographic origin and level of evidence.RESULTS Of 48.7%of orthopaedic journals listed on the Web of Science database had published articles relating to HIV.There were 168 articles about HIV in orthopaedic journals with only 40.5%(n=68)published in the time frame we analysed(January 2007 to September 2017).Very few articles came from lowincome countries and any articles published from that setting were collaborations.All of the articles were low level of evidence.CONCLUSION There is a need for more high level orthopaedic and trauma research investigating the effects of HIV,particularly research from low-income countries,where higher level research will help to guide improvements in their treatment of its musculoskeletal manifestations and complications.展开更多
The irrational and prolonged use of antibiotics in orthopaedic infections poses a major threat to the development of antimicrobial resistance.To combat antimi-crobial resistance,researchers have implemented various no...The irrational and prolonged use of antibiotics in orthopaedic infections poses a major threat to the development of antimicrobial resistance.To combat antimi-crobial resistance,researchers have implemented various novel and innovative modalities to curb infections.Nanotechnology involves doping ions/metals onto the scaffolds to reach the target site to eradicate the infective foci.In this conno-tation,we reviewed silver nanoparticle technology in terms of mechanism of action,clinical applications,toxicity,and regulatory guidelines to treat ortho-paedic infections.展开更多
Nurses are trained to provide hands-on care to patients in a variety of settings, which include physical care which can range from total care to helping a patient prevent illness. The health of a patient can significa...Nurses are trained to provide hands-on care to patients in a variety of settings, which include physical care which can range from total care to helping a patient prevent illness. The health of a patient can significantly improve when they (patients) perceive caring nursing behaviours and are satisfied with the quality of care been received from their care giver. The aim of this study was to determine the caring behaviour of nurses as perceived by patients admitted to orthopaedic ward in some selected hospitals in Osogbo, Osun state, Nigeria. A descriptive comparative design was used. Convenient sample technique was used to select 616 respondents consisting of male and female patients admitted to orthopaedic wards of selected hospitals. The questionnaire on Caring Behaviour Assessment scale was adapted from CBI. The most highly ranked perceived nurses’ behaviour by patients rated “satisfactory” was the general perception of the patients and rendering of basic needs. The findings also revealed that patients rated nurses behaviour (care-giving) with respect to human needs assistance, the provision of safe environment, assisting in psychological care and giving physical comfort as average. Lastly, findings also revealed that patients rated perceived nurses behaviour (care-giving) as “not satisfactory” with regards to meeting their communication needs, nutritional needs and individualized care. In conclusion, care giving is an important branch of nursing and it depicts the quality of care received by a patient which in turn is capable of aiding speedy recovery.展开更多
Background:The traditional manual orthopaedic technology heavily relies on a surgeon's experience,so it certainly increases the instability of the surgery.Therefore,computer assisted orthopaedic surgery(CAOS) is b...Background:The traditional manual orthopaedic technology heavily relies on a surgeon's experience,so it certainly increases the instability of the surgery.Therefore,computer assisted orthopaedic surgery(CAOS) is becoming a hot research topic for its high accuracy and stability.We developed a new CAOS system WATO,which is mainly designed for total knee replacement(TKR).Methods:WATO system provides the interactive software for a surgeon's preoperative planning.Based on its two infrared cameras,infrared markers and infrared probe,WATO system gives a simple surgical positioning procedure of femur and tibia without additional surgery for the placement of fiducial markers.According to the reference alignment axis from positioning procedure,a surgeon can move the robot of WATO system to do accurate bone resection.Safety checking is also considered in WATO system.Results:Extensive experiments were conducted on phantoms and cadaver bones to verify the accuracy and stability of WATO system.Experimental results showed that TKR using WATO system had better performance compared with traditional and navigated TKR.Conclusion:WATO system shows its superiority in TKR,and has a broad application prospect in the future.We will develop its new functions for other orthopaedic surgery such as total hip replacement(THR).Current disadvantages such as bigger skin incision have to be resolved in the future.展开更多
文摘Periprosthetic joint infections contribute significantly to patient morbidity,prolonged hospital stays,and escalating healthcare costs.Defensive antibacterial coating(DAC®)hydrogel has emerged as a promising strategy to combat these infections.It forms a biodegradable barrier that reduces bacterial adhesion and can deliver local antibiotics,thereby addressing a key mechanism in biofilm formation.Early clinical evidence suggests that DAC®effectively lowers infection recurrence in revision hip and knee arthroplasties,with additional benefits in trauma procedures and soft tissue repairs.Moreover,it has demonstrated compat-ibility with existing implants and surgical techniques,while potentially reducing overall antibiotic use and hospital stays.Despite these encouraging findings,data for its use in primary arthroplasty remains limited,underscoring the need for large-scale,high-quality studies.Future research is poised to refine DAC®’s antimicrobial efficacy through novel antibiotic combinations,personalised delivery systems,and broader applications beyond lower limb procedures.As the prevalence of comorbidities continues to rise,DAC®represents a valuable addi-tion to multifaceted infection control protocols,potentially transforming ortho-paedic care by enhancing patient outcomes and mitigating the economic and clinical burden of implant-related infections.
文摘The gut microbiome,a complex ecosystem of microorganisms,has a significant role in modulating pain,particularly within orthopaedic conditions.Its impact on immune and neurological functions is underscored by the gut-brain axis,which influences inflammation,pain perception,and systemic immune responses.This integrative review examines current research on how gut dysbiosis is associated with various pain pathways,notably nociceptive and neuroinflammatory mechanisms linked to central sensitization.We highlight advancements in meta-omics technologies,such as metagenomics and metaproteomics,which deepen our understanding of microbiome-host interactions and their implications in pain.Recent studies emphasize that gut-derived short-chain fatty acids and microbial metabolites play roles in modulating neuroinflammation and nociception,contributing to pain management.Probiotics,prebiotics,synbiotics,and faecal microbiome transplants are explored as potential therapeutic strategies to alleviate pain through gut microbiome modulation,offering an adjunct or alternative to opioids.However,variability in individual microbiomes poses challenges to standardizing these treatments,necessitating further rigorous clinical trials.A multidisciplinary approach combining microbiology,immunology,neurology,and orthopaedics is essential to develop innovative,personalized pain management strategies rooted in gut health,with potential to transform orthopaedic pain care.
文摘The gut microbiome,a complex ecosystem of microorganisms in the digestive tract,has emerged as a critical factor in human health,influencing metabolic,immune,and neurological functions.This review explores the connection between the gut microbiome and orthopedic health,examining how gut microbes impact bone density,joint integrity,and skeletal health.It highlights mechanisms linking gut dysbiosis to inflammation in conditions such as rheumatoid arthritis and osteoarthritis,suggesting microbiome modulation as a potential therapeutic strategy.Key findings include the microbiome’s role in bone metabolism through hormone regulation and production of short-chain fatty acids,crucial for mineral absorption.The review also considers the effects of diet,probiotics,and fecal microbiota transplantation on gut microbiome composition and their implications for orthopedic health.While promising,challenges in translating microbiome research into clinical practice persist,necessitating further exploration and ethical consideration of microbiome-based therapies.This interdisciplinary research aims to link digestive health with musculoskeletal integrity,offering new insights into the prevention and management of bone and joint diseases.
文摘The integration of WhatsApp,a widely-used instant messaging application(IMA),into the realm of orthopaedics and trauma surgery has emerged as a significant development in recent years.This paper explores the multifaceted role of WhatsApp in orthopaedics,focusing on its clinical and non-clinical applications,advantages,disadvantages,and future prospects.The study synthesizes findings from various research papers,emphasizing the growing reliance on mobile technology in healthcare.WhatsApp’s role in orthopaedics is notable for its ease of use,real-time communication,and accessibility.Clinically,it facilitates triage,teleconsultation,diagnosis,treatment,patient advice,and post-operative monitoring.Non-clinically,it supports telemedicine,teleradiology,virtual frac-ture clinics,research,and education in orthopaedic surgery.The application has proven beneficial in enhancing communication among healthcare teams,providing quick responses,and motivating junior physicians.Its use in educational settings has been shown to improve learner’s understanding and patient care.However,the use of WhatsApp in orthopaedics is not without challenges.Risks include the potential spread of misleading information,privacy concerns,and issues with image quality affecting diagnosis and treatment decisions.The paper acknowledges the importance of maintaining professional boundaries and the need for oversight measures to ensure content accuracy.Looking forward,the potential of WhatsApp and similar IMAs in orthopaedics lies in their ability to streamline data collection and retrieval,improve doctor-patient communication,and address challenges like bureaucratic red tape and limited resources.The paper suggests that future orthopaedic practice,particularly in emergency departments,will increasingly rely on such technologies for efficient patient management.This shift,however,must be approached with an understanding of the ethical,legal,and practical implications of integrating social media and mobile technology in healthcare.
文摘BACKGROUND Fellowship directors(FDs)in sports medicine influence the future of trainees in the field of orthopaedics.Understanding the characteristics these leaders share must be brought into focus.For all current sports medicine FDs,our group analyzed their demographic background,institutional training,and academic experience.AIM To serve as a framework for those aspiring to achieve this position in orthopaedics and also identify opportunities to improve the position.METHODS Fellowship programs were identified using both the American Orthopaedic Society for Sports Medicine and the Arthroscopy Association of North America Sports Medicine Fellowship Directories.The demographic and educational background data for each FD was gathered via author review of current curriculum vitae(CVs).Any information that was unavailable on CV review was gathered from institutional biographies,Scopus Web of Science,and emailed questionnaires.To ensure the collection of as many data points as possible,fellowship program coordinators,orthopaedic department offices and FDs were directly contacted via phone if there was no response via email.Demographic information of interest included:Age,gender,ethnicity,residency/fellowship training,residency/fellowship graduation year,year hired by current institution,time since training completion until FD appointment,length in FD role,status as a team physician and H-index.RESULTS Information was gathered for 82 FDs.Of these,97.5%(n=80)of the leadership were male;84.15%(n=69)were Caucasian,7.32%(n=6)were Asian-American,2.44%(n=2)were Hispanic and 2.44%(n=2)were African American,and 3.66%(n=3)were of another race or ethnicity.The mean age of current FDs was 56 years old(±9.00 years),and the mean Scopus H-index was 23.49(±16.57).The mean calendar years for completion of residency and fellowship training were 1996(±15 years)and 1997(±9.51 years),respectively.The time since fellowship training completion until FD appointment was 9.77 years.17.07%(n=14)of FDs currently work at the same institution where they completed residency training;21.95%(n=18)of FDs work at the same institution where they completed fellowship training;and 6.10%(n=5)work at the same institution where they completed both residency and fellowship training.Additionally,69.5%(n=57)are also team physicians at the professional and/or collegiate level.Of those that were found to currently serve as team physicians,56.14%(n=32)of them worked with professional sports teams,29.82%(n=17)with collegiate sports teams,and 14.04%(n=8)with both professional and collegiate sports teams.Seven residency programs produced the greatest number of future FDs,included programs produced at least three future FDs.Seven fellowship programs produced the greatest number of future FDs,included programs produced at least four future FDs.Eight FDs(9.75%)completed two fellowships and three FDs(3.66%)finished three fellowships.Three FDs(3.66%)did not graduate from any fellowship training program.The Scopus H-indices for FDs are displayed as ranges that include 1 to 15(31.71%,n=26),15 to 30(34.15%,n=28),30 to 45(20.73%,n=17),45 to 60(6.10%,n=5)and 60 to 80(3.66%,n=3).Specifically,the most impactful FD in research currently has a Scopus H-index value of 79.By comparison,the tenth most impactful FD in research had a Scopus H-index value of 43(accessed December 1,2019).CONCLUSION This study provides an overview of current sports medicine FDs within the United States and functions as a guide to direct initiatives to achieve diversity equality.
文摘The World Health Organisation(WHO)declared coronavirus disease 2019(COVID-19)a pandemic on March 11,2020.COVID-19 is not the first infectious disease to affect Trinidad and Tobago.The country has faced outbreaks of both Chikungunya and Zika virus in 2014 and 2016 respectively.The viral pandemic is predicted to have a significant impact upon all countries,but the healthcare services in a developing country are especially vulnerable.The Government of Trinidad and Tobago swiftly established a parallel healthcare system to isolate and treat suspected and confirmed cases of COVID-19.Strick‘lockdown’orders,office closures,social distancing and face mask usage recommendation were implemented following advice from the WHO.This approach has seen Trinidad and Tobago emerge from the second wave of infections,with the most recent Oxford COVID-19 Government Response Tracker report indicating a favourable risk of openness index for the country.The effects of the pandemic on the orthopaedic services in the public and private healthcare systems show significant differences.Constrained by shortages in personal protective equipment and inadequate testing facilities,the public system moved into emergency mode prioritizing the care of urgent and critical cases.Private healthcare driven more by economic considerations,quickly instituted widespread safety measures to ensure that the clinics remained open and elective surgery was not interrupted.Orthopaedic teaching at The University of the West Indies was quickly migrated to an online platform to facilitate both medical students and residents.The Caribbean Association of Orthopedic Surgeons through its frequent virtual meetings provided a forum for continuing education and social interaction amongst colleagues.The pandemic has disrupted our daily routines leading to unparalleled changes to our lives and livelihoods.Many of these changes will remain long after the pandemic is over,permanently transforming the practice of orthopaedics.
文摘Mg and its alloys are drawing huge attention since the last two decades as a viable option for temporary implants applications.A commendable progress has already been made in the development of these alloys.The biodegradable nature of Mg,appreciable biocompatibility of elemental Mg,and its close resemblance to natural bone in terms of density and elastic modulus make them highly preferable option amongst other available alternatives in this field.This review article presents an overview covering the recent advancements made in the field of Mg-based biodegradable implants for orthopaedic implant applications.The paper focuses on alloy development and fabrication techniques,the state of the art of important Mg-based alloy systems in terms of their mechanical properties,in-vitro and in-vivo degradation behaviour and cytotoxicity.Further,the paper reviews the current progress achieved in the clinical transition of Mg-based alloys for orthopaedic fixtures.The review also includes the degradation mechanisms of the alloys in physiological environment and highlights the mismatch existing between the rate of bone healing and alloy degradation due to rapid corrosion of the alloys in such environment,which has still restricted their widespread application.Finally,the surface coating techniques available for the alloys as an effective way to reduce the degradation rate are reviewed,followed by a discussion on the future research prospects.
基金supported by the National Key R&D Program of China (No. 2018YFC1106600)National Natural Science Foundation of China (NSFC)+4 种基金the Russian Foundation for Basic Research (RFBR) NSFC-RFBR Cooperative Project (No. 51611130054)the National Natural Science Foundation of China (Nos. 51431002 and 51871004)the National Natural Science Foundation of China (NSFC)the Research Grants Council (RGC) of Hong Kong NSFC-RGC Joint Research Scheme (Grant No. 5161101031)the financial support from Saint Petersburg State University in the framework of Call 3 project (id 26130576)
文摘Ti Ni alloys, with their unique shape memory effects and super elastic properties, occupy an indispensable place in the family of metallic biomaterials. In the past years, surface treatment is the main technique to improve the bioinert nature of microcrystalline Ti Ni alloys and inhibit on the release of toxic nickel ions to obtain excellent osteogenesis and osseointegration function. In the present study, nanocrystalline Ti49.2Ni50.8 alloy has been fabricated via equal channel angular pressing(ECAP), and the in vitro and in vivo studies revealed that it had enhanced cell viability, adhesion, proliferation, ALP(Alkaline phosphatase)activity and mineralization, and increased periphery thickness of new bone, in comparison to the commercial coarse-grained counterpart. These findings indicate that the reduction of grain size is beneficial to increasing the biocompatibility of Ti49.2Ni50.8 shape memory alloy.
文摘Damage control orthopaedics(DCO) originally consisted of the provisional immobilisation of long bone-mainly femur-fractures in order to achieve the advantages of early treatment and to minimise the risk of complications, such as major pain, fat embolism, clotting, pathological inflammatory response, severe haemorrhage triggering the lethal triad, and the traumatic effects of major surgery on a patient who is already traumatised(the "second hit" effect). In recent years, new locations have been added to the DCO concept, such as injuries to the pelvis, spine and upper limbs. Nonetheless, this concept has not yet been validated in well-designed prospective studies, and much controversy remains.Indeed, some researchers believe the indiscriminate application of DCO might be harmful and produce substantial and unnecessary expense. In this respect, too,normalised parameters associated with the acid-base system have been proposed,under a concept termed early appropriate care, in the view that this would enable patients to receive major surgical procedures in an approach offering the advantages of early total care together with the apparent safety of DCO. This paper discusses the diagnosis and treatment of severely traumatised patients managed in accordance with DCO and highlights the possible drawbacks of this treatment principle.
文摘An estimated 285 million adults(aged 20-79 years)worldwide were diagnosed to have diabetes mellitus(DM)in 2010,and this number is projected to grow to 439million adults by the year 2030.Orthopaedic surgeons,regardless of their subspecialty interest,will encounter patients with DM during their career since this epidemic involves both developed and emerging countries.Diabetes results in complications affecting multiple organ systems,potentially resulting in adverse outcomes afterorthopaedic surgery.The purpose of this review is to discuss the pathophysiology of DM and its potential for impacting orthopaedic surgery patients.Diabetes adversely affects the outcome of all orthopaedic surgery subspecialties including foot and ankle,upper extremity,adult reconstructive,pediatrics,spine surgery and sports medicine.Poorly controlled diabetes negatively impacts bone,soft tissue,ligament and tendon healing.It is the complications of diabetes such as neuropathy,peripheral artery disease,and end stage renal disease which contributes to adverse outcomes.Well controlled diabetic patients without comorbidities have similar outcomes to patients without diabetes.Orthopaedic surgeons should utilize consultants who will assist in inpatient glycemic management as well as optimizing long term glycemic control.
文摘BACKGROUND With the increasing complexity of surgical interventions performed in orthopaedic trauma surgery and the improving technologies used in threedimensional(3D)printing,there has been an increased interest in the concept.It has been shown that 3D models allow surgeons to better visualise anatomy,aid in planning and performing complex surgery.It is however not clear how best to utilise the technique and whether this results in better outcomes.AIM To evaluate the effect of 3D printing used in pre-operative planning in orthopaedic trauma surgery on clinical outcomes.METHODS We performed a comprehensive systematic review of the literature and a metaanalysis.Medline,Ovid and Embase were searched from inception to February 8,2018.Randomised controlled trials,case-control studies,cohort studies and case series of five patients or more were included across any area of orthopaedic trauma.The primary outcomes were operation time,intra-operative blood loss and fluoroscopy used.RESULTS Seventeen studies(922 patients)met our inclusion criteria and were reviewed.The use of 3D printing across all specialties in orthopaedic trauma surgery demonstrated an overall reduction in operation time of 19.85%[95%confidence intervals(CI):(-22.99,-16.71)],intra-operative blood loss of 25.73%[95%CI:(-31.07,-20.40)],and number of times fluoroscopy was used by 23.80%[95%CI:(-38.49,-9.10)].CONCLUSION Our results suggest that the use of 3D printing in pre-operative planning in orthopaedic trauma reduces operative time,intraoperative blood loss and the number of times fluoroscopy is used.
文摘Artificial intelligence and machine learning in orthopaedic surgery has gained mass interest over the last decade or so.In prior studies,researchers have demonstrated that machine learning in orthopaedics can be used for different applications such as fracture detection,bone tumor diagnosis,detecting hip implant mechanical loosening,and grading osteoarthritis.As time goes on,the utility of artificial intelligence and machine learning algorithms,such as deep learning,continues to grow and expand in orthopaedic surgery.The purpose of this review is to provide an understanding of the concepts of machine learning and a background of current and future orthopaedic applications of machine learning in risk assessment,outcomes assessment,imaging,and basic science fields.In most cases,machine learning has proven to be just as effective,if not more effective,than prior methods such as logistic regression in assessment and prediction.With the help of deep learning algorithms,such as artificial neural networks and convolutional neural networks,artificial intelligence in orthopaedics has been able to improve diagnostic accuracy and speed,flag the most critical and urgent patients for immediate attention,reduce the amount of human error,reduce the strain on medical professionals,and improve care.Because machine learning has shown diagnostic and prognostic uses in orthopaedic surgery,physicians should continue to research these techniques and be trained to use these methods effectively in order to improve orthopaedic treatment.
文摘As the demand for pharmaceutical services continues to grow, more and more attention has been paid to the pharmaceutical care effect. However, in China, the training pathways and practical work of clinical pharmacy are still in the exploratory stage. In the present review, we aimed to discuss the impact of pharmacist-led interventions in reducing inappropriate drug use in orthopaedics. Results showed clinical pharmacists can assist orthopaedists and nurses in the rational use of medication in all aspects of antibiotic therapy, pain control and anticoagulation therapy. The clinical interventions by pharmacists have greatly reduced medication errors and medical costs. However, there is still a long time to develop pharmacy service, improve the professional quality of pharmacists and enact the Chinese Pharmacist Law.
基金Project of Science and Technology Committee of Shanghai Municipality (No.2528(3))
文摘Camera calibration is the key technique in a C-arm based orthopaedic surgical navigation system. The extraction of marker location information is a necessary step in the calibration process. Ideal marker images should possess uniform background and contain marker shadow only, but in fact marker images always possess nonuniform background and are contaminated by noise and unwanted anatomic information, making the extraction very difficult. A target-orientated marker shadow extraction method was proposed. With this method a proper threshold for marker image binarization can be determined.
文摘Medical treatment of patients inherently entails the risk of undesired complication or side effects. It is essential to inform the patient about the expected outcomes, but also the possible undesired outcomes. The patients preference and values regarding the potential outcomes should be involved in the decision making process. Even though many orthopaedic surgeons are positive towards shared decision-making, it is minimally introduced in the orthopaedic daily practice and decision-making is still mostly physician based. Decision aids are designed to support the physician and patient in the shareddecision-making process. By using decision aids, patients can learn more about their condition and treatment options in advance to the decision-making. This will reduce decisional conflict and improve participation and satisfaction.
文摘BACKGROUND There is little research investigating how human immunodeficiency virus(HIV)affects outcomes in orthopaedic surgery.With advances in treatment,HIV has become a chronic health problem and the chance of orthopaedic surgeons encountering it in clinical practice is increasing.AIM To ascertain the quantity and quality of peer-reviewed publications in orthopaedic journals about HIV.METHODS A search of the Web of Science database was carried out,identifying any articles relating to HIV published in orthopaedic journals.These were assessed for geographic origin and level of evidence.RESULTS Of 48.7%of orthopaedic journals listed on the Web of Science database had published articles relating to HIV.There were 168 articles about HIV in orthopaedic journals with only 40.5%(n=68)published in the time frame we analysed(January 2007 to September 2017).Very few articles came from lowincome countries and any articles published from that setting were collaborations.All of the articles were low level of evidence.CONCLUSION There is a need for more high level orthopaedic and trauma research investigating the effects of HIV,particularly research from low-income countries,where higher level research will help to guide improvements in their treatment of its musculoskeletal manifestations and complications.
文摘The irrational and prolonged use of antibiotics in orthopaedic infections poses a major threat to the development of antimicrobial resistance.To combat antimi-crobial resistance,researchers have implemented various novel and innovative modalities to curb infections.Nanotechnology involves doping ions/metals onto the scaffolds to reach the target site to eradicate the infective foci.In this conno-tation,we reviewed silver nanoparticle technology in terms of mechanism of action,clinical applications,toxicity,and regulatory guidelines to treat ortho-paedic infections.
文摘Nurses are trained to provide hands-on care to patients in a variety of settings, which include physical care which can range from total care to helping a patient prevent illness. The health of a patient can significantly improve when they (patients) perceive caring nursing behaviours and are satisfied with the quality of care been received from their care giver. The aim of this study was to determine the caring behaviour of nurses as perceived by patients admitted to orthopaedic ward in some selected hospitals in Osogbo, Osun state, Nigeria. A descriptive comparative design was used. Convenient sample technique was used to select 616 respondents consisting of male and female patients admitted to orthopaedic wards of selected hospitals. The questionnaire on Caring Behaviour Assessment scale was adapted from CBI. The most highly ranked perceived nurses’ behaviour by patients rated “satisfactory” was the general perception of the patients and rendering of basic needs. The findings also revealed that patients rated nurses behaviour (care-giving) with respect to human needs assistance, the provision of safe environment, assisting in psychological care and giving physical comfort as average. Lastly, findings also revealed that patients rated perceived nurses behaviour (care-giving) as “not satisfactory” with regards to meeting their communication needs, nutritional needs and individualized care. In conclusion, care giving is an important branch of nursing and it depicts the quality of care received by a patient which in turn is capable of aiding speedy recovery.
文摘Background:The traditional manual orthopaedic technology heavily relies on a surgeon's experience,so it certainly increases the instability of the surgery.Therefore,computer assisted orthopaedic surgery(CAOS) is becoming a hot research topic for its high accuracy and stability.We developed a new CAOS system WATO,which is mainly designed for total knee replacement(TKR).Methods:WATO system provides the interactive software for a surgeon's preoperative planning.Based on its two infrared cameras,infrared markers and infrared probe,WATO system gives a simple surgical positioning procedure of femur and tibia without additional surgery for the placement of fiducial markers.According to the reference alignment axis from positioning procedure,a surgeon can move the robot of WATO system to do accurate bone resection.Safety checking is also considered in WATO system.Results:Extensive experiments were conducted on phantoms and cadaver bones to verify the accuracy and stability of WATO system.Experimental results showed that TKR using WATO system had better performance compared with traditional and navigated TKR.Conclusion:WATO system shows its superiority in TKR,and has a broad application prospect in the future.We will develop its new functions for other orthopaedic surgery such as total hip replacement(THR).Current disadvantages such as bigger skin incision have to be resolved in the future.
