BACKGROUND Surgical site infection(SSI)is a major concern in orthopaedic surgery procedures as they can have devastating consequences for patients and their outcomes.Many infection prevention measures are routinely ta...BACKGROUND Surgical site infection(SSI)is a major concern in orthopaedic surgery procedures as they can have devastating consequences for patients and their outcomes.Many infection prevention measures are routinely taken in order to prevent infection during surgery,the main one being surgical skin preparation prior to any incision.AIM To investigate the efficacy of different perioperative surgical skin preparation products commonly used in orthopaedic surgery.METHODS Seven databases were searched from inception to January 25,2025,using a combination of keywords and medical subject headings terms,specifically for studies comparing any two surgical skin preparation products used at any point prior to skin incision for orthopaedic procedures.Titles and abstracts were screened and full texts reviewed based on inclusion criteria.Data was extracted on study design,interventions,and outcomes from studies that met inclusion criteria.Meta-analysis was not completed due to heterogeneity.RESULTS Thirty-two studies met the inclusion criteria in this systematic review.In extremity fracture surgery,evidence was mixed on whether iodine or chlorhexidine-based solutions are more effective at preventing SSI.No significant difference was found between iodine and chlorhexidine-based solutions in total joint arthroplasty,spine surgery,foot and ankle surgery,or upper extremity surgery.No tested preparation method was superior in reducing positive Cutibac terium acnes culture rates in upper extremity(shoulder)surgery.Adding adjuncts to iodine and chlorhexidine methods,such as isopropyl alcohol,hydrogen peroxide,or benzoyl peroxide showed no significant changes to SSI or bacterial cultures.CONCLUSION Current literature shows no significant difference between chlorhexidine-based and iodine-based skin preparation solutions in orthopaedic extremity or spine surgery regarding SSI prevention or culture results.Likewise,adding other antiseptic agents provided no clear benefit.While skin antisepsis is important,many different factors contribute to SSI risk outside of the skin preparation solution.展开更多
BACKGROUND Assessing academic productivity allows academic departments to identify the strengths of their scholarly contribution and provides an opportunity to evaluate areas for improvement.AIM To provide objective b...BACKGROUND Assessing academic productivity allows academic departments to identify the strengths of their scholarly contribution and provides an opportunity to evaluate areas for improvement.AIM To provide objective benchmarks for departments seeking to enhance academic productivity and identify those with significant improvement in recent past.METHODS Our study retrospectively analyzed a cohort of orthopaedic faculty at United States-based academic orthopaedic programs.5502 full-time orthopaedic faculty representing 178 programs were included in analysis.Variables included for analysis were National Institutes of Health funding(2014-2018),leadership positions in orthopaedic societies(2018),editorial board positions of top orthopaedic journals(2018),total number of publications and Hirsch-index.A weighted algorithm was used to calculate a cumulative score for each academic program.This study was performed at a large,United States medical school.RESULTS All 178 programs included in analysis were evaluated using the comprehensive weighted algorithm.The five institutions with the highest cumulative score,in decreasing order,were:Washington University in St.Louis,the Hospital for Special Surgery,Sidney Kimmel Medical College(SKMC)at Thomas Jefferson University,the University of California,San Francisco(UCSF)and Massachusetts General Hospital(MGH)/Brigham and Women’s/Harvard.The five institutions with the highest score per capita,in decreasing order,were:Mayo Clinic(Rochester),Washington University in St.Louis,Rush University,Virginia Commonwealth University(VCU)and MGH/Brigham and Women’s/Harvard.The five academic programs that had the largest improvement in cumulative score from 2013 to 2018,in decreasing order,were:VCU,SKMC at Thomas Jefferson University,UCSF,MGH/Brigham and Women’s/Harvard,and Brown University.CONCLUSION This algorithm can provide orthopaedic departments a means to assess academic productivity,monitor progress,and identify areas for improvement as they seek to expand their academic contributions to the orthopaedic community.展开更多
BACKGROUND It has been said that the number of orthopaedic claims has increased in the last few years. Investigation through the most prevalent cause would help to prevent further cases.AIM To review the cases of medi...BACKGROUND It has been said that the number of orthopaedic claims has increased in the last few years. Investigation through the most prevalent cause would help to prevent further cases.AIM To review the cases of medical complaints in orthopedic patients who had been involved in a traumatic accident.METHODS A retrospective multi-center review of trauma orthopaedic-related malpractice lawsuits from 2010 to 2021 was conducted utilizing the regional medicolegal database. Defendant and plaintiff characteristics along with fracture location, allegations, and litigation outcomes were investigated.RESULTS A total of 228 claims referred to trauma-related conditions with a mean age of 31.29 ± 12.56 were enrolled. The most common injuries were at hand, thigh, elbow, and forearm, respectively.Likewise, the most common alleged complication was related to malunion or nonunion. In 47% of the cases, the main problem that led to the complaint was the inappropriate or insufficient explanation to the patient, and in 53%, there was a problem in the surgery. Eventually, 76% of the complaints resulted in a defense verdict, and 24% resulted in a plaintiff verdict.CONCLUSION Surgical treatment of hand injuries and surgery in non-educational hospitals received the most complaints. The majority of litigation outcomes were caused by a physician’s failure to fully explain and educate the traumatic orthopedic patients and technological errors.展开更多
Background: Spontaneous heparin induced thrombocytopenia (HIT) is a medical phenomenon whereby patients develop clinical and laboratory features of HIT without prior exposure to heparin. Aim: We present a patient who ...Background: Spontaneous heparin induced thrombocytopenia (HIT) is a medical phenomenon whereby patients develop clinical and laboratory features of HIT without prior exposure to heparin. Aim: We present a patient who underwent bilateral total knee replacement complicated by spontaneous HIT causing bilateral adrenal hemorrhage and deep vein thrombosis. Our patient had no prior history of heparin exposure. We reconcile our patient’s presentation with other case reports of spontaneous HIT in patients who had orthopaedic surgery. Conclusion: Spontaneous HIT is a rare but potentially devastating complication associated with total knee arthroplasty.展开更多
BACKGROUND In the Spring of 2020,residency programs across the country experienced rapid and drastic changes to their application process as a result of the coronavirus disease 2019(COVID-19)pandemic.In response,resid...BACKGROUND In the Spring of 2020,residency programs across the country experienced rapid and drastic changes to their application process as a result of the coronavirus disease 2019(COVID-19)pandemic.In response,residency programs shifted to virtual events and began harnessing social media to communicate with applicants.AIM To analyze the changes in social media usage by orthopaedic surgery programs in response to the COVID-19 pandemic.METHODS Based on the 2019 residency and fellowship electronic database,accredited US orthopaedic surgery programs were reviewed for social media presence on Instagram and Twitter.Approximately 47000 tweets from 2011-2021 were extracted through the Twitter application programming interface.We extracted:Total number of followers,accounts following,tweets,likes,date of account creation,hashtags,and mentions.Natural language processing was utilized for tweet sentiment analysis and classified as positive,neutral,or negative.Instagram data was collected and deemed current as of August 11,2021.The account foundation date analysis was based on the date recognized as the start of the COVID-19 outbreak in the United States,before or after March 1,2020.RESULTS A total of 85(42.3%)orthopaedic surgery residency program Twitter handles were identified.Thirty-five(41.2%)programs joined Twitter in the nine months after the 2020 covid outbreak.In 2020,there was a 126.6%increase in volume of tweets by orthopaedic surgery residency accounts as compared to 2019.The median number of followers was 474.5(interquartile range 205.0-796.5).The account with the highest number of tweets was Hospital for Special Surgery(@HSpecialSurgery)with 13776 tweets followed by University of Virginia(@UVA_Ortho)with 5063 and Yale(@OrthoAtYale)with 899.Sentiment analysis before 2020 revealed 30.4%positive,60.8%neutral,and 8.8%negative sentiments across tweets.Interestingly,the positive sentiment percentage increased in 2020 from 30.4%to 34.5%.Of the 201 ACGME-accredited orthopaedic residency programs on Fellowship and Residency Electronic Interactive Database,115(57.2%)participate on Instagram,with 101(87.8%)identified as“resident”-managed vs 14(12.2%)identified as“department”-managed.Over three quarters(77.4%)of Instagram accounts were created after March 1,2020.The average number of followers per account was 1089.5 with an average of 58.9 total posts.CONCLUSION Our study demonstrates a substantial growth of Instagram and Twitter presence by orthopaedic surgery residency programs during the COVID-19 pandemic.These data suggest that orthopaedic residency programs have utilized social media as a new way to communicate with applicants and showcase their programs in light of the challenges presented by the pandemic.展开更多
BACKGROUND Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems.Reconstructive options are limited.Above knee amputation(AKA)is ...BACKGROUND Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems.Reconstructive options are limited.Above knee amputation(AKA)is often recommended.We present a surgical technique that was successfully used on four such patients to convert them to a knee fusion(KF)using a cephalomedullary nail.CASE SUMMARY Four patients with infected long stem revision knee replacements that refused AKA had a single stage removal of their infected revision total knee followed by a KF.They were all treated with a statically locked antegrade cephalomedullary fusion nail,augmented with antibiotic impregnated bone cement.All patients had successful limb salvage and were ambulatory with assistive devices at the time of last follow-up.All were infection free at an average follow-up of 25.5 months(range 16-31).CONCLUSION Single stage cephalomedullary nailing can result in a successful KF in patients with infected long stem revision total knees.展开更多
Mitochondrial dysfunction and oxidative stress are widely regarded as primary drivers of aging and are associated with several neurodegenerative diseases.The degeneration of motor neurons during aging is a critical pa...Mitochondrial dysfunction and oxidative stress are widely regarded as primary drivers of aging and are associated with several neurodegenerative diseases.The degeneration of motor neurons during aging is a critical pathological factor contributing to the progression of sarcopenia.However,the morphological and functional changes in mitochondria and their interplay in the degeneration of the neuromuscular junction during aging remain poorly understood.A defined systematic search of the Pub Med,Web of Science and Embase databases(last accessed on October 30,2024)was conducted with search terms including'mitochondria','aging'and'NMJ'.Clinical and preclinical studies of mitochondrial dysfunction and neuromuscular junction degeneration during aging.Twentyseven studies were included in this systematic review.This systematic review provides a summary of morphological,functional and biological changes in neuromuscular junction,mitochondrial morphology,biosynthesis,respiratory chain function,and mitophagy during aging.We focus on the interactions and mechanisms underlying the relationship between mitochondria and neuromuscular junctions during aging.Aging is characterized by significant reductions in mitochondrial fusion/fission cycles,biosynthesis,and mitochondrial quality control,which may lead to neuromuscular junction dysfunction,denervation and poor physical performance.Motor nerve terminals that exhibit redox sensitivity are among the first to exhibit abnormalities,ultimately leading to an early decline in muscle strength through impaired neuromuscular junction transmission function.Parg coactivator 1 alpha is a crucial molecule that regulates mitochondrial biogenesis and modulates various pathways,including the mitochondrial respiratory chain,energy deficiency,oxidative stress,and inflammation.Mitochondrial dysfunction is correlated with neuromuscular junction denervation and acetylcholine receptor fragmentation,resulting in muscle atrophy and a decrease in strength during aging.Physical therapy,pharmacotherapy,and gene therapy can alleviate the structural degeneration and functional deterioration of neuromuscular junction by restoring mitochondrial function.Therefore,mitochondria are considered potential targets for preserving neuromuscular junction morphology and function during aging to treat sarcopenia.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
Bone defects may impede normal biomechanics and the structural stability of bone as an organ. In many cases, the correction of bone defects requires extensive surgical intervention involving the use of bone-grafting t...Bone defects may impede normal biomechanics and the structural stability of bone as an organ. In many cases, the correction of bone defects requires extensive surgical intervention involving the use of bone-grafting techniques and other procedures in which healing is slow, there is a high risk of infection and considerable pain is provoked- with no guarantee of complete correction of the defect. Therefore, the search for surgical alternatives continues to present a major challenge in orthopaedic traumatology. The reamer-irrigator-aspirator(RIA) system, which was devised to avoid the problems that can arise with autograft harvesting from the iliac crest, consists of collecting the product of the femoral canal after reaming. The RIA technique improves osteogenic differentiation of mesenchymal stem cells, compared to bone marrow aspiration or cancellous bone harvesting from the iliac crest using a spoon. Another approach, the Masquelet technique, consists of reconstructing a long bone defect by means of an induced membrane grown onto an acrylic cement rod inserted to fill the defect; in a second surgical step, once the membrane is constituted, the cement rod is removed and cancellous autograft is used to fill the defect. Both in RIA and in the Masquelet technique, osteosynthesis is usually needed. Bone transportation by compression-distraction lengthening principles is commonly implemented for the treatment of large bone loss. However, complications are frequently encountered with these techniques. Among new techniques that have been proposed to address the problem of large bone loss, the application of stem cells in conjunction with tissue engineering techniques is very promising, as is the creation of personalised medicine(or precision medicine), in which molecular profiling technologies are used to tailor the therapeutic strategy, to ensure the right method is applied for the right person at the right time, after determining the predisposition to disease among the general population. All of the above techniques for addressing bone defects are discussed in this paper.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
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
BACKGROUND Osteoarthritis(OA)is the most prevalent form of degenerative whole-joint disease.Before the final option of knee replacement,arthroscopic surgery was the most widely used joint-preserving surgical treatment...BACKGROUND Osteoarthritis(OA)is the most prevalent form of degenerative whole-joint disease.Before the final option of knee replacement,arthroscopic surgery was the most widely used joint-preserving surgical treatment.Emerging regenerative therapies,such as those involving platelet-rich plasma,mesenchymal stem cells,and microfragmented adipose tissue(MFAT),have been pushed to the forefront of treatment to prevent the progression of OA.Currently,MFAT has been successfully applied to treat different types of orthopedic diseases.AIM To assess the efficacy and safety of MFAT with arthroscopic surgery in patients with knee OA(KOA).METHODS A randomized,multicenter study was conducted between June 2017 and November 2022 in 10 hospitals in Zhejiang,China.Overall,302 patients diagnosed with KOA(Kellgren-Lawrence grades 2-3)were randomized to the MFAT group(n=151,were administered MFAT following arthroscopic surgery),or the control group(n=151,were administered hyaluronic acid following arthroscopic surgery).The study outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)score,the visual analog scale(VAS)score,the Lequesne index score,the Whole-Organ Magnetic Resonance Imaging Score(WORMS),and safety over a 24-mo period from baseline.RESULTS The changes in the WOMAC score(including the three subscale scores),VAS pain score,and Lequesne index score at the 24-mo mark were significantly different in the MFAT and control groups,as well as when comparing values at the posttreatment visit and those at baseline(P<0.001).The MFAT group consistently demonstrated significant decreases in the WOMAC pain scores and VAS scores at all follow-ups compared to the control group(P<0.05).Furthermore,the WOMAC stiffness score,WOMAC function score,and Lequesne index score differed significantly between the groups at 12 and 24 mo(P<0.05).However,no signicant between-group differences were observed in the WORMS at 24 mo(P=0.367).No serious adverse events occurred in both groups.CONCLUSION The MFAT injection combined with arthroscopic surgery treatment group showed better mid-term clinical outcomes compared to the control group,suggesting its efficacy as a therapeutic approach for patients with KOA.展开更多
AIM To explore the current evidence surrounding the administration of prophylactic antibiotics for arthroscopic knee surgery. METHODS Databases were searched from inception through May of 2018 for studies examining pr...AIM To explore the current evidence surrounding the administration of prophylactic antibiotics for arthroscopic knee surgery. METHODS Databases were searched from inception through May of 2018 for studies examining prophylactic antibiotic use and efficacy in knee arthroscopy. Studies with patient data were further assessed for types of arthroscopic procedures performed,number of patients in the study,use of antibiotics,and outcomes with the intention of performing a pooled analysis. Data pertaining to "deep tissue infection" or "septic arthritis" were included in our analysis. Reported data on superficial infection were not included in our data analysis. For the pooled analysis,a relative risk ratio was calculated and χ~2 tests were used to assess for statistical significance between rates of infection amongst the various patient groups. Post hoc power analyses were performed to compute the statistical power obtained from our sample sizes. Number needed to treat analyses were performed for statistically significant differences by dividing 1 by the difference between the infection rates of the antibiotic and no antibiotic groups. An alpha value of 0.05 was used for our analysis. Study heterogeneity was assessed by Cochrane's Q test as well as calculation of the I^2 value.RESULTS A total of 49682 patients who underwent knee ar-throscopy for a diverse set of procedures across 19 studies met inclusion critera for pooled analysis. For those not undergoing graft procedures,there were 27 cases of post-operative septic arthritis in 34487 patients(0.08%) who received prophylactic antibiotics and 16 cases in 10911(0.15%) who received none [risk ratio(RR) = 0.53,95% confidence interval(CI): 0.29-0.99,P = 0.05]. A sub-group analysis in which bony procedures were excluded was performed which found no significant difference in infection rates between patients that received prophylactic antibiotics and patients that did not(P > 0.05). All anterior cruciate ligament reconstruction studies used prophylactic antibiotics,but two studies investigating the effect of soaking the graft in vancomycin in addition to standard intravenous(IV) prophylaxis were combined for analysis. There were 19 cases in 1095 patients(1.74%) who received IV antibioitics alone and no infections in 2034 patients who received IV antibiotics and had a vancomycin soaked graft(RR = 0.01,95%CI: 0.001-0.229,P < 0.01).CONCLUSION Prophylactic antibiotics are effective in preventing septic arthritis following simple knee arthroscopy. In procedures involving graft implantation,graft soaking reduces the rate of infection.展开更多
We are in the midst of exciting advancements in new technologies and innovative research in precision medicine.Among these,3D printing is one of the most frequently seen in clinical orthopaedic settings.This new techn...We are in the midst of exciting advancements in new technologies and innovative research in precision medicine.Among these,3D printing is one of the most frequently seen in clinical orthopaedic settings.This new technique has been adopted in a vast range of applications in spine surgery,such as producing anatomical models,surgical templates,preoperative plans,and spinal implants.Some studies on 3D printing technologies in spine surgery have reported the benefits of this emerging technology with more effective manufacturing,more visualisation for communication,and more precise navigation for screw insertion and osteotomy.In addition,in customised implant design and fabrication processes,3D printing products with anatomical adaptions and complex porous microstructure show some attractive advantages in terms of fit and osteoinductivity.However,there are still some concerns about the safety and feasibility of the application of 3D printing technology in spine surgery.We review the literature on and share our experiences with the application of 3D printing from the beginning of collaborations between doctors and computer-aided design(CAD)designers to the final follow-up of clinical patients.展开更多
BACKGROUND Glenohumeral dislocation is a common injury that may predispose patients to chronic pain and instability.However,there is a paucity of current data available regarding the epidemiological trends of this inj...BACKGROUND Glenohumeral dislocation is a common injury that may predispose patients to chronic pain and instability.However,there is a paucity of current data available regarding the epidemiological trends of this injury.AIM To provide an updated,comparative assessment of the epidemiology of shoulder dislocations presenting to emergency departments in the United States.We also sought to analyze patient demographic risk factors and consumer products associated with dislocation events.METHODS Data were obtained from the national electronic injury surveillance system database for glenohumeral dislocations between 2012 and 2021.Incidence,age,sex,and injury characteristics were analyzed using weighted population statistics as well as incidence rates and 95%confidence intervals(CI).RESULTS In total,an estimated 773039 shoulder dislocations(CI:640598-905481)presented to emergency rooms across the United States during the study period.The annual incidence rate was 23.96 per 100000 persons and the average patient age at the time of injury was 37.1 years.Significantly more male patients sustained dislocations than female patients(537189,69.5%,vs 235834,30.5%,P<0.001).With regard to associated consumer products,sports and recreation equipment were involved in the highest proportion of incidents(44.31%),followed by home structures and construction materials(21.22%),and home furnishings,fixtures,and accessories(21.21%).Regarding product sub-groups,stairs,ramps,landings,floors was cited in the greatest number of cases(131745).CONCLUSION The national annual incidence rate of glenohumeral dislocations throughout the study period was approximately 23.92 per 100000 persons.Male adolescents sustained the highest proportion of dislocations,with a peak incidence in age group 15-20 years,predominantly secondary to participation in sporting and recreational activities.Conversely,women experienced a relatively consistent incidence of dislocation throughout their lifespan.After age 63,the incidence rate of dislocations in females was found to surpass that observed in males.展开更多
The purpose of this multicenter study was to evaluate the clinical performance of an ultrahigh molecular weight polyethylene (UHMWPE) fiber cable for re-attachment of the osteotomized greater trochanter in hip surgery...The purpose of this multicenter study was to evaluate the clinical performance of an ultrahigh molecular weight polyethylene (UHMWPE) fiber cable for re-attachment of the osteotomized greater trochanter in hip surgery. Included in the study were 85 hips that had undergone surgery with greater trochanter osteotomy, including 50 hip arthroplasty procedures and 35 hip osteotomies. The osteotomized greater trochanter was reattached using one or more UHMWPE fiber cables. The bone union and displacement of the greater trochanter were assessed in radiographs for up to 12 months after surgery. Non-union of the osteotomy site occurred in 4.7% of the cases. In approximately 90% of the cases, displacement was less than 2 mm at up to 12 months after surgery. The UHMWPE fiber cable was a good biomaterial for reattaching the osteotomized greater trochanter and may also be an option for osteosynthesis procedures.展开更多
On September 20,2017 Hurricane Maria,a category 4 hurricane,made landfall on the eastern coast of Puerto Rico.This was preceded by Hurricane Irma,a category 5 hurricane,which passed just off the coast 13 d prior.The d...On September 20,2017 Hurricane Maria,a category 4 hurricane,made landfall on the eastern coast of Puerto Rico.This was preceded by Hurricane Irma,a category 5 hurricane,which passed just off the coast 13 d prior.The destruction from both Hurricane Irma and Maria precipitated a coordinated federal response which included the Federal Emergency Management Agency(FEMA)and the United States military.The United States Army dispatched the 14^th Combat Support Hospital(CSH)to Humacao,a city on the eastern side of the island where Maria made landfall.The mission of the 14^th CSH was to provide medical humanitarian aid and conduct disaster relief operations in support of the government of Puerto Rico and FEMA.During the 14^th CSH deployment to Puerto Rico,1157 patients were evaluated and treated.Fifty-seven operative cases were performed to include 23 orthopaedic cases.The mean age of the orthopaedic patients treated was 45.7 years(range 13-76 years).The most common operation was irrigation and debridement of open contaminated and/or infected wounds.Patients presented a mean 10.8 d from their initial injury(range 1-40 d).Fractures and infections were the most common diagnoses with the greatest delay in treatment from the initial date of injury.The deployment of the 14^th CSH to Puerto Rico was unique in its use of air transport,language and local customs encountered,as well as deployment to a location outside the continental United States.These factors coupled with the need for rapid deployment of the 14^th CSH provided valuable experience which will undoubtedly enable future success in similar endeavors.展开更多
Objective:Smart insufflation(SI)techniques relying on valve and membrane-free insufflation are increasing in usage.Although considerable literature exists demonstrating the benefits of SI on procedural ease and patien...Objective:Smart insufflation(SI)techniques relying on valve and membrane-free insufflation are increasing in usage.Although considerable literature exists demonstrating the benefits of SI on procedural ease and patient outcomes,there remains a paucity describing the financial impact of these devices.The purpose of this study was to determine the financial and efficiency impact of these devices on the operating room and inpatient wards of a hospital.Methods:A discrete event simulation model representing a typical mid-sized North American hospital comparing SI to traditional insufflation(TI)was generated.The National Surgical Quality Improvement database from 2015 to 2019 was used to populate the model with data supplemented from the literature.Outcomes included length of stay(LOS),duration of surgery(DOS),annual procedure volume,profit,return on investment(ROI),and gross profit margin(GPM).From the literature review,DOS savings were 10e32 minutes/case,while LOS savings were 0e3 days/case.Results:Implementation of an SI led to an increase in annual throughput of 42e346(4.4%e36.6%)cases for all procedures and 38 to 297(4.3%e33.3%)cases for complex procedures.LOS was found to be decreased by 175e614(18.3%e64.2%)days for all procedures and 231 to 614(35.6%e77.9%)cases for complex procedures with the implementation of an SI.Together,this resulted in an increase in net profit of$104,685 per annum.The ROI of SI over the TI device was>1000%,and the GPM for the TI was 90.0%,while the GPM for the SI was 71.7%.Conclusion:Despite the initial financial investment being greater,the implementation of SI offsets these expenses and yields significant financial benefits.Our study demonstrates the financial benefits of SI over TI and illustrates how granular operational and financial analyses of technologies are essential to aid in sound healthcare procurement decision making.展开更多
Background: The growth and use of Artificial Intelligence (AI) in the medical field is rapidly rising. AI is exhibiting a practical tool in the healthcare industry in patient care. The objective of this current review...Background: The growth and use of Artificial Intelligence (AI) in the medical field is rapidly rising. AI is exhibiting a practical tool in the healthcare industry in patient care. The objective of this current review is to assess and analyze the use of AI and its use in orthopedic practice, as well as its applications, limitations, and pitfalls. Methods: A review of all relevant databases such as EMBASE, Cochrane Database of Systematic Reviews, MEDLINE, Science Citation Index, Scopus, and Web of Science with keywords of AI, orthopedic surgery, applications, and drawbacks. All related articles on AI and orthopaedic practice were reviewed. A total of 3210 articles were included in the review. Results: The data from 351 studies were analyzed where in orthopedic surgery. AI is being used for diagnostic procedures, radiological diagnosis, models of clinical care, and utilization of hospital and bed resources. AI has also taken a chunk of share in assisted robotic orthopaedic surgery. Conclusions: AI has now become part of the orthopedic practice and will further increase its stake in the healthcare industry. Nonetheless, clinicians should remain aware of AI’s serious limitations and pitfalls and consider the drawbacks and errors in its use.展开更多
BACKGROUND:Few contemporary studies have assessed physicians’knowledge of radiation exposure associated with common imaging studies,especially in trauma care.The purpose of this study was to assess the knowledge of p...BACKGROUND:Few contemporary studies have assessed physicians’knowledge of radiation exposure associated with common imaging studies,especially in trauma care.The purpose of this study was to assess the knowledge of physicians involved in caring for trauma patients regarding the effective radiation doses of musculoskeletal(MSK)imaging studies routinely utilized in the trauma setting.METHODS:An electronic survey was distributed to United States orthopaedic surgery,general surgery,and emergency medicine(EM)residency programs.Participants were asked to estimate the radiation dose for common imaging modalities of the pelvis,lumbar spine,and lower extremity,in terms of chest X-ray(CXR)equivalents.Physician estimates were compared to the true effective radiation doses.Additionally,participants were asked to report the frequency of discussing radiation risk with patients.RESULTS:A total of 218 physicians completed the survey;102(46.8%)were EM physicians,88(40.4%)wereorthopaedicsurgeons,and28(12.8%)weregeneralsurgeons.Physicians underestimated the effective radiation doses of nearly all imaging modalities,most notably for pelvic computed tomaography(CT)(median 50 CXR estimation vs.162 CXR actual)and lumbar CT(median 50 CXR estimation vs.638 CXR actual).There was no difference between physician specialties regarding estimation accuracy(P=0.133).Physicians who regularly discussed radiation risks with patients more accurately estimated radiation exposure(P=0.007).CONCLUSION:The knowledge among orthopaedic and general surgeons and EM physicians regarding the radiation exposure associated with common MSK trauma imaging is lacking.Further investigation with larger scale studies is warranted,and additional education in this area may improve care.展开更多
文摘BACKGROUND Surgical site infection(SSI)is a major concern in orthopaedic surgery procedures as they can have devastating consequences for patients and their outcomes.Many infection prevention measures are routinely taken in order to prevent infection during surgery,the main one being surgical skin preparation prior to any incision.AIM To investigate the efficacy of different perioperative surgical skin preparation products commonly used in orthopaedic surgery.METHODS Seven databases were searched from inception to January 25,2025,using a combination of keywords and medical subject headings terms,specifically for studies comparing any two surgical skin preparation products used at any point prior to skin incision for orthopaedic procedures.Titles and abstracts were screened and full texts reviewed based on inclusion criteria.Data was extracted on study design,interventions,and outcomes from studies that met inclusion criteria.Meta-analysis was not completed due to heterogeneity.RESULTS Thirty-two studies met the inclusion criteria in this systematic review.In extremity fracture surgery,evidence was mixed on whether iodine or chlorhexidine-based solutions are more effective at preventing SSI.No significant difference was found between iodine and chlorhexidine-based solutions in total joint arthroplasty,spine surgery,foot and ankle surgery,or upper extremity surgery.No tested preparation method was superior in reducing positive Cutibac terium acnes culture rates in upper extremity(shoulder)surgery.Adding adjuncts to iodine and chlorhexidine methods,such as isopropyl alcohol,hydrogen peroxide,or benzoyl peroxide showed no significant changes to SSI or bacterial cultures.CONCLUSION Current literature shows no significant difference between chlorhexidine-based and iodine-based skin preparation solutions in orthopaedic extremity or spine surgery regarding SSI prevention or culture results.Likewise,adding other antiseptic agents provided no clear benefit.While skin antisepsis is important,many different factors contribute to SSI risk outside of the skin preparation solution.
文摘BACKGROUND Assessing academic productivity allows academic departments to identify the strengths of their scholarly contribution and provides an opportunity to evaluate areas for improvement.AIM To provide objective benchmarks for departments seeking to enhance academic productivity and identify those with significant improvement in recent past.METHODS Our study retrospectively analyzed a cohort of orthopaedic faculty at United States-based academic orthopaedic programs.5502 full-time orthopaedic faculty representing 178 programs were included in analysis.Variables included for analysis were National Institutes of Health funding(2014-2018),leadership positions in orthopaedic societies(2018),editorial board positions of top orthopaedic journals(2018),total number of publications and Hirsch-index.A weighted algorithm was used to calculate a cumulative score for each academic program.This study was performed at a large,United States medical school.RESULTS All 178 programs included in analysis were evaluated using the comprehensive weighted algorithm.The five institutions with the highest cumulative score,in decreasing order,were:Washington University in St.Louis,the Hospital for Special Surgery,Sidney Kimmel Medical College(SKMC)at Thomas Jefferson University,the University of California,San Francisco(UCSF)and Massachusetts General Hospital(MGH)/Brigham and Women’s/Harvard.The five institutions with the highest score per capita,in decreasing order,were:Mayo Clinic(Rochester),Washington University in St.Louis,Rush University,Virginia Commonwealth University(VCU)and MGH/Brigham and Women’s/Harvard.The five academic programs that had the largest improvement in cumulative score from 2013 to 2018,in decreasing order,were:VCU,SKMC at Thomas Jefferson University,UCSF,MGH/Brigham and Women’s/Harvard,and Brown University.CONCLUSION This algorithm can provide orthopaedic departments a means to assess academic productivity,monitor progress,and identify areas for improvement as they seek to expand their academic contributions to the orthopaedic community.
基金the Clinical Research Development Center of Taleghani and Imam Ali Hospital, University of Medical Sciences, Kermanshah, IranShohada Tajrish Clinical Research Development Center at Shahid Beheshti University of Medical Sciences in Tehran, Iran, for their support。
文摘BACKGROUND It has been said that the number of orthopaedic claims has increased in the last few years. Investigation through the most prevalent cause would help to prevent further cases.AIM To review the cases of medical complaints in orthopedic patients who had been involved in a traumatic accident.METHODS A retrospective multi-center review of trauma orthopaedic-related malpractice lawsuits from 2010 to 2021 was conducted utilizing the regional medicolegal database. Defendant and plaintiff characteristics along with fracture location, allegations, and litigation outcomes were investigated.RESULTS A total of 228 claims referred to trauma-related conditions with a mean age of 31.29 ± 12.56 were enrolled. The most common injuries were at hand, thigh, elbow, and forearm, respectively.Likewise, the most common alleged complication was related to malunion or nonunion. In 47% of the cases, the main problem that led to the complaint was the inappropriate or insufficient explanation to the patient, and in 53%, there was a problem in the surgery. Eventually, 76% of the complaints resulted in a defense verdict, and 24% resulted in a plaintiff verdict.CONCLUSION Surgical treatment of hand injuries and surgery in non-educational hospitals received the most complaints. The majority of litigation outcomes were caused by a physician’s failure to fully explain and educate the traumatic orthopedic patients and technological errors.
文摘Background: Spontaneous heparin induced thrombocytopenia (HIT) is a medical phenomenon whereby patients develop clinical and laboratory features of HIT without prior exposure to heparin. Aim: We present a patient who underwent bilateral total knee replacement complicated by spontaneous HIT causing bilateral adrenal hemorrhage and deep vein thrombosis. Our patient had no prior history of heparin exposure. We reconcile our patient’s presentation with other case reports of spontaneous HIT in patients who had orthopaedic surgery. Conclusion: Spontaneous HIT is a rare but potentially devastating complication associated with total knee arthroplasty.
文摘BACKGROUND In the Spring of 2020,residency programs across the country experienced rapid and drastic changes to their application process as a result of the coronavirus disease 2019(COVID-19)pandemic.In response,residency programs shifted to virtual events and began harnessing social media to communicate with applicants.AIM To analyze the changes in social media usage by orthopaedic surgery programs in response to the COVID-19 pandemic.METHODS Based on the 2019 residency and fellowship electronic database,accredited US orthopaedic surgery programs were reviewed for social media presence on Instagram and Twitter.Approximately 47000 tweets from 2011-2021 were extracted through the Twitter application programming interface.We extracted:Total number of followers,accounts following,tweets,likes,date of account creation,hashtags,and mentions.Natural language processing was utilized for tweet sentiment analysis and classified as positive,neutral,or negative.Instagram data was collected and deemed current as of August 11,2021.The account foundation date analysis was based on the date recognized as the start of the COVID-19 outbreak in the United States,before or after March 1,2020.RESULTS A total of 85(42.3%)orthopaedic surgery residency program Twitter handles were identified.Thirty-five(41.2%)programs joined Twitter in the nine months after the 2020 covid outbreak.In 2020,there was a 126.6%increase in volume of tweets by orthopaedic surgery residency accounts as compared to 2019.The median number of followers was 474.5(interquartile range 205.0-796.5).The account with the highest number of tweets was Hospital for Special Surgery(@HSpecialSurgery)with 13776 tweets followed by University of Virginia(@UVA_Ortho)with 5063 and Yale(@OrthoAtYale)with 899.Sentiment analysis before 2020 revealed 30.4%positive,60.8%neutral,and 8.8%negative sentiments across tweets.Interestingly,the positive sentiment percentage increased in 2020 from 30.4%to 34.5%.Of the 201 ACGME-accredited orthopaedic residency programs on Fellowship and Residency Electronic Interactive Database,115(57.2%)participate on Instagram,with 101(87.8%)identified as“resident”-managed vs 14(12.2%)identified as“department”-managed.Over three quarters(77.4%)of Instagram accounts were created after March 1,2020.The average number of followers per account was 1089.5 with an average of 58.9 total posts.CONCLUSION Our study demonstrates a substantial growth of Instagram and Twitter presence by orthopaedic surgery residency programs during the COVID-19 pandemic.These data suggest that orthopaedic residency programs have utilized social media as a new way to communicate with applicants and showcase their programs in light of the challenges presented by the pandemic.
文摘BACKGROUND Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems.Reconstructive options are limited.Above knee amputation(AKA)is often recommended.We present a surgical technique that was successfully used on four such patients to convert them to a knee fusion(KF)using a cephalomedullary nail.CASE SUMMARY Four patients with infected long stem revision knee replacements that refused AKA had a single stage removal of their infected revision total knee followed by a KF.They were all treated with a statically locked antegrade cephalomedullary fusion nail,augmented with antibiotic impregnated bone cement.All patients had successful limb salvage and were ambulatory with assistive devices at the time of last follow-up.All were infection free at an average follow-up of 25.5 months(range 16-31).CONCLUSION Single stage cephalomedullary nailing can result in a successful KF in patients with infected long stem revision total knees.
基金supported by grants from Collaborative Research Fund(Ref:C4032-21GF)General Research Grant(Ref:14114822)+1 种基金Group Research Scheme(Ref:3110146)Area of Excellence(Ref:Ao E/M-402/20)。
文摘Mitochondrial dysfunction and oxidative stress are widely regarded as primary drivers of aging and are associated with several neurodegenerative diseases.The degeneration of motor neurons during aging is a critical pathological factor contributing to the progression of sarcopenia.However,the morphological and functional changes in mitochondria and their interplay in the degeneration of the neuromuscular junction during aging remain poorly understood.A defined systematic search of the Pub Med,Web of Science and Embase databases(last accessed on October 30,2024)was conducted with search terms including'mitochondria','aging'and'NMJ'.Clinical and preclinical studies of mitochondrial dysfunction and neuromuscular junction degeneration during aging.Twentyseven studies were included in this systematic review.This systematic review provides a summary of morphological,functional and biological changes in neuromuscular junction,mitochondrial morphology,biosynthesis,respiratory chain function,and mitophagy during aging.We focus on the interactions and mechanisms underlying the relationship between mitochondria and neuromuscular junctions during aging.Aging is characterized by significant reductions in mitochondrial fusion/fission cycles,biosynthesis,and mitochondrial quality control,which may lead to neuromuscular junction dysfunction,denervation and poor physical performance.Motor nerve terminals that exhibit redox sensitivity are among the first to exhibit abnormalities,ultimately leading to an early decline in muscle strength through impaired neuromuscular junction transmission function.Parg coactivator 1 alpha is a crucial molecule that regulates mitochondrial biogenesis and modulates various pathways,including the mitochondrial respiratory chain,energy deficiency,oxidative stress,and inflammation.Mitochondrial dysfunction is correlated with neuromuscular junction denervation and acetylcholine receptor fragmentation,resulting in muscle atrophy and a decrease in strength during aging.Physical therapy,pharmacotherapy,and gene therapy can alleviate the structural degeneration and functional deterioration of neuromuscular junction by restoring mitochondrial function.Therefore,mitochondria are considered potential targets for preserving neuromuscular junction morphology and function during aging to treat sarcopenia.
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Bone defects may impede normal biomechanics and the structural stability of bone as an organ. In many cases, the correction of bone defects requires extensive surgical intervention involving the use of bone-grafting techniques and other procedures in which healing is slow, there is a high risk of infection and considerable pain is provoked- with no guarantee of complete correction of the defect. Therefore, the search for surgical alternatives continues to present a major challenge in orthopaedic traumatology. The reamer-irrigator-aspirator(RIA) system, which was devised to avoid the problems that can arise with autograft harvesting from the iliac crest, consists of collecting the product of the femoral canal after reaming. The RIA technique improves osteogenic differentiation of mesenchymal stem cells, compared to bone marrow aspiration or cancellous bone harvesting from the iliac crest using a spoon. Another approach, the Masquelet technique, consists of reconstructing a long bone defect by means of an induced membrane grown onto an acrylic cement rod inserted to fill the defect; in a second surgical step, once the membrane is constituted, the cement rod is removed and cancellous autograft is used to fill the defect. Both in RIA and in the Masquelet technique, osteosynthesis is usually needed. Bone transportation by compression-distraction lengthening principles is commonly implemented for the treatment of large bone loss. However, complications are frequently encountered with these techniques. Among new techniques that have been proposed to address the problem of large bone loss, the application of stem cells in conjunction with tissue engineering techniques is very promising, as is the creation of personalised medicine(or precision medicine), in which molecular profiling technologies are used to tailor the therapeutic strategy, to ensure the right method is applied for the right person at the right time, after determining the predisposition to disease among the general population. All of the above techniques for addressing bone defects are discussed in this paper.
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.
基金the National Natural Science Foundation of China,No.82274547the Major Program of the National Natural Science Foundation of Zhejiang Province,No.LD22C060002+1 种基金the State Administration of Traditional Chinese Medicine of Zhejiang Province,No.GZY-ZJ-KJ-23064the Zhejiang Provincial Research Foundation for Basic Public Welfare Research,No.LGF20H270005.
文摘BACKGROUND Osteoarthritis(OA)is the most prevalent form of degenerative whole-joint disease.Before the final option of knee replacement,arthroscopic surgery was the most widely used joint-preserving surgical treatment.Emerging regenerative therapies,such as those involving platelet-rich plasma,mesenchymal stem cells,and microfragmented adipose tissue(MFAT),have been pushed to the forefront of treatment to prevent the progression of OA.Currently,MFAT has been successfully applied to treat different types of orthopedic diseases.AIM To assess the efficacy and safety of MFAT with arthroscopic surgery in patients with knee OA(KOA).METHODS A randomized,multicenter study was conducted between June 2017 and November 2022 in 10 hospitals in Zhejiang,China.Overall,302 patients diagnosed with KOA(Kellgren-Lawrence grades 2-3)were randomized to the MFAT group(n=151,were administered MFAT following arthroscopic surgery),or the control group(n=151,were administered hyaluronic acid following arthroscopic surgery).The study outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)score,the visual analog scale(VAS)score,the Lequesne index score,the Whole-Organ Magnetic Resonance Imaging Score(WORMS),and safety over a 24-mo period from baseline.RESULTS The changes in the WOMAC score(including the three subscale scores),VAS pain score,and Lequesne index score at the 24-mo mark were significantly different in the MFAT and control groups,as well as when comparing values at the posttreatment visit and those at baseline(P<0.001).The MFAT group consistently demonstrated significant decreases in the WOMAC pain scores and VAS scores at all follow-ups compared to the control group(P<0.05).Furthermore,the WOMAC stiffness score,WOMAC function score,and Lequesne index score differed significantly between the groups at 12 and 24 mo(P<0.05).However,no signicant between-group differences were observed in the WORMS at 24 mo(P=0.367).No serious adverse events occurred in both groups.CONCLUSION The MFAT injection combined with arthroscopic surgery treatment group showed better mid-term clinical outcomes compared to the control group,suggesting its efficacy as a therapeutic approach for patients with KOA.
文摘AIM To explore the current evidence surrounding the administration of prophylactic antibiotics for arthroscopic knee surgery. METHODS Databases were searched from inception through May of 2018 for studies examining prophylactic antibiotic use and efficacy in knee arthroscopy. Studies with patient data were further assessed for types of arthroscopic procedures performed,number of patients in the study,use of antibiotics,and outcomes with the intention of performing a pooled analysis. Data pertaining to "deep tissue infection" or "septic arthritis" were included in our analysis. Reported data on superficial infection were not included in our data analysis. For the pooled analysis,a relative risk ratio was calculated and χ~2 tests were used to assess for statistical significance between rates of infection amongst the various patient groups. Post hoc power analyses were performed to compute the statistical power obtained from our sample sizes. Number needed to treat analyses were performed for statistically significant differences by dividing 1 by the difference between the infection rates of the antibiotic and no antibiotic groups. An alpha value of 0.05 was used for our analysis. Study heterogeneity was assessed by Cochrane's Q test as well as calculation of the I^2 value.RESULTS A total of 49682 patients who underwent knee ar-throscopy for a diverse set of procedures across 19 studies met inclusion critera for pooled analysis. For those not undergoing graft procedures,there were 27 cases of post-operative septic arthritis in 34487 patients(0.08%) who received prophylactic antibiotics and 16 cases in 10911(0.15%) who received none [risk ratio(RR) = 0.53,95% confidence interval(CI): 0.29-0.99,P = 0.05]. A sub-group analysis in which bony procedures were excluded was performed which found no significant difference in infection rates between patients that received prophylactic antibiotics and patients that did not(P > 0.05). All anterior cruciate ligament reconstruction studies used prophylactic antibiotics,but two studies investigating the effect of soaking the graft in vancomycin in addition to standard intravenous(IV) prophylaxis were combined for analysis. There were 19 cases in 1095 patients(1.74%) who received IV antibioitics alone and no infections in 2034 patients who received IV antibiotics and had a vancomycin soaked graft(RR = 0.01,95%CI: 0.001-0.229,P < 0.01).CONCLUSION Prophylactic antibiotics are effective in preventing septic arthritis following simple knee arthroscopy. In procedures involving graft implantation,graft soaking reduces the rate of infection.
基金the National Key Research and Development Program of China(No.2017YFB1104104)the Special Foundation for Innovation of Science and Technology of Shanghai Jiao Tong University(Nos.GXQ201810 and GXQ202003)。
文摘We are in the midst of exciting advancements in new technologies and innovative research in precision medicine.Among these,3D printing is one of the most frequently seen in clinical orthopaedic settings.This new technique has been adopted in a vast range of applications in spine surgery,such as producing anatomical models,surgical templates,preoperative plans,and spinal implants.Some studies on 3D printing technologies in spine surgery have reported the benefits of this emerging technology with more effective manufacturing,more visualisation for communication,and more precise navigation for screw insertion and osteotomy.In addition,in customised implant design and fabrication processes,3D printing products with anatomical adaptions and complex porous microstructure show some attractive advantages in terms of fit and osteoinductivity.However,there are still some concerns about the safety and feasibility of the application of 3D printing technology in spine surgery.We review the literature on and share our experiences with the application of 3D printing from the beginning of collaborations between doctors and computer-aided design(CAD)designers to the final follow-up of clinical patients.
文摘BACKGROUND Glenohumeral dislocation is a common injury that may predispose patients to chronic pain and instability.However,there is a paucity of current data available regarding the epidemiological trends of this injury.AIM To provide an updated,comparative assessment of the epidemiology of shoulder dislocations presenting to emergency departments in the United States.We also sought to analyze patient demographic risk factors and consumer products associated with dislocation events.METHODS Data were obtained from the national electronic injury surveillance system database for glenohumeral dislocations between 2012 and 2021.Incidence,age,sex,and injury characteristics were analyzed using weighted population statistics as well as incidence rates and 95%confidence intervals(CI).RESULTS In total,an estimated 773039 shoulder dislocations(CI:640598-905481)presented to emergency rooms across the United States during the study period.The annual incidence rate was 23.96 per 100000 persons and the average patient age at the time of injury was 37.1 years.Significantly more male patients sustained dislocations than female patients(537189,69.5%,vs 235834,30.5%,P<0.001).With regard to associated consumer products,sports and recreation equipment were involved in the highest proportion of incidents(44.31%),followed by home structures and construction materials(21.22%),and home furnishings,fixtures,and accessories(21.21%).Regarding product sub-groups,stairs,ramps,landings,floors was cited in the greatest number of cases(131745).CONCLUSION The national annual incidence rate of glenohumeral dislocations throughout the study period was approximately 23.92 per 100000 persons.Male adolescents sustained the highest proportion of dislocations,with a peak incidence in age group 15-20 years,predominantly secondary to participation in sporting and recreational activities.Conversely,women experienced a relatively consistent incidence of dislocation throughout their lifespan.After age 63,the incidence rate of dislocations in females was found to surpass that observed in males.
文摘The purpose of this multicenter study was to evaluate the clinical performance of an ultrahigh molecular weight polyethylene (UHMWPE) fiber cable for re-attachment of the osteotomized greater trochanter in hip surgery. Included in the study were 85 hips that had undergone surgery with greater trochanter osteotomy, including 50 hip arthroplasty procedures and 35 hip osteotomies. The osteotomized greater trochanter was reattached using one or more UHMWPE fiber cables. The bone union and displacement of the greater trochanter were assessed in radiographs for up to 12 months after surgery. Non-union of the osteotomy site occurred in 4.7% of the cases. In approximately 90% of the cases, displacement was less than 2 mm at up to 12 months after surgery. The UHMWPE fiber cable was a good biomaterial for reattaching the osteotomized greater trochanter and may also be an option for osteosynthesis procedures.
文摘On September 20,2017 Hurricane Maria,a category 4 hurricane,made landfall on the eastern coast of Puerto Rico.This was preceded by Hurricane Irma,a category 5 hurricane,which passed just off the coast 13 d prior.The destruction from both Hurricane Irma and Maria precipitated a coordinated federal response which included the Federal Emergency Management Agency(FEMA)and the United States military.The United States Army dispatched the 14^th Combat Support Hospital(CSH)to Humacao,a city on the eastern side of the island where Maria made landfall.The mission of the 14^th CSH was to provide medical humanitarian aid and conduct disaster relief operations in support of the government of Puerto Rico and FEMA.During the 14^th CSH deployment to Puerto Rico,1157 patients were evaluated and treated.Fifty-seven operative cases were performed to include 23 orthopaedic cases.The mean age of the orthopaedic patients treated was 45.7 years(range 13-76 years).The most common operation was irrigation and debridement of open contaminated and/or infected wounds.Patients presented a mean 10.8 d from their initial injury(range 1-40 d).Fractures and infections were the most common diagnoses with the greatest delay in treatment from the initial date of injury.The deployment of the 14^th CSH to Puerto Rico was unique in its use of air transport,language and local customs encountered,as well as deployment to a location outside the continental United States.These factors coupled with the need for rapid deployment of the 14^th CSH provided valuable experience which will undoubtedly enable future success in similar endeavors.
基金funding to conduct this study was provided by a research innovation grant provided by CONMED Corporation(#IRB 22-0113-C).
文摘Objective:Smart insufflation(SI)techniques relying on valve and membrane-free insufflation are increasing in usage.Although considerable literature exists demonstrating the benefits of SI on procedural ease and patient outcomes,there remains a paucity describing the financial impact of these devices.The purpose of this study was to determine the financial and efficiency impact of these devices on the operating room and inpatient wards of a hospital.Methods:A discrete event simulation model representing a typical mid-sized North American hospital comparing SI to traditional insufflation(TI)was generated.The National Surgical Quality Improvement database from 2015 to 2019 was used to populate the model with data supplemented from the literature.Outcomes included length of stay(LOS),duration of surgery(DOS),annual procedure volume,profit,return on investment(ROI),and gross profit margin(GPM).From the literature review,DOS savings were 10e32 minutes/case,while LOS savings were 0e3 days/case.Results:Implementation of an SI led to an increase in annual throughput of 42e346(4.4%e36.6%)cases for all procedures and 38 to 297(4.3%e33.3%)cases for complex procedures.LOS was found to be decreased by 175e614(18.3%e64.2%)days for all procedures and 231 to 614(35.6%e77.9%)cases for complex procedures with the implementation of an SI.Together,this resulted in an increase in net profit of$104,685 per annum.The ROI of SI over the TI device was>1000%,and the GPM for the TI was 90.0%,while the GPM for the SI was 71.7%.Conclusion:Despite the initial financial investment being greater,the implementation of SI offsets these expenses and yields significant financial benefits.Our study demonstrates the financial benefits of SI over TI and illustrates how granular operational and financial analyses of technologies are essential to aid in sound healthcare procurement decision making.
文摘Background: The growth and use of Artificial Intelligence (AI) in the medical field is rapidly rising. AI is exhibiting a practical tool in the healthcare industry in patient care. The objective of this current review is to assess and analyze the use of AI and its use in orthopedic practice, as well as its applications, limitations, and pitfalls. Methods: A review of all relevant databases such as EMBASE, Cochrane Database of Systematic Reviews, MEDLINE, Science Citation Index, Scopus, and Web of Science with keywords of AI, orthopedic surgery, applications, and drawbacks. All related articles on AI and orthopaedic practice were reviewed. A total of 3210 articles were included in the review. Results: The data from 351 studies were analyzed where in orthopedic surgery. AI is being used for diagnostic procedures, radiological diagnosis, models of clinical care, and utilization of hospital and bed resources. AI has also taken a chunk of share in assisted robotic orthopaedic surgery. Conclusions: AI has now become part of the orthopedic practice and will further increase its stake in the healthcare industry. Nonetheless, clinicians should remain aware of AI’s serious limitations and pitfalls and consider the drawbacks and errors in its use.
文摘BACKGROUND:Few contemporary studies have assessed physicians’knowledge of radiation exposure associated with common imaging studies,especially in trauma care.The purpose of this study was to assess the knowledge of physicians involved in caring for trauma patients regarding the effective radiation doses of musculoskeletal(MSK)imaging studies routinely utilized in the trauma setting.METHODS:An electronic survey was distributed to United States orthopaedic surgery,general surgery,and emergency medicine(EM)residency programs.Participants were asked to estimate the radiation dose for common imaging modalities of the pelvis,lumbar spine,and lower extremity,in terms of chest X-ray(CXR)equivalents.Physician estimates were compared to the true effective radiation doses.Additionally,participants were asked to report the frequency of discussing radiation risk with patients.RESULTS:A total of 218 physicians completed the survey;102(46.8%)were EM physicians,88(40.4%)wereorthopaedicsurgeons,and28(12.8%)weregeneralsurgeons.Physicians underestimated the effective radiation doses of nearly all imaging modalities,most notably for pelvic computed tomaography(CT)(median 50 CXR estimation vs.162 CXR actual)and lumbar CT(median 50 CXR estimation vs.638 CXR actual).There was no difference between physician specialties regarding estimation accuracy(P=0.133).Physicians who regularly discussed radiation risks with patients more accurately estimated radiation exposure(P=0.007).CONCLUSION:The knowledge among orthopaedic and general surgeons and EM physicians regarding the radiation exposure associated with common MSK trauma imaging is lacking.Further investigation with larger scale studies is warranted,and additional education in this area may improve care.
