Serum IL-6 as a Surrogate Biomarker of Post-operative Complications in Invasive Orthopaedic Surgeries: A Prospective Observational Study.

Background: Interleukin-6 (IL-6) is a cytokine released in response to tissue injury. Elevated serum IL-6 levels in trauma patients have been linked with increased risk of complications such as inapparent hypoxia (SpO2 < 94%), acute respiratory distress syndrome, fat embolism syndrome (FES), systemic inflammatory response syndrome, multiple organ dysfunction syndrome and sepsis. This study aims to determine the role of serum IL-6 as surrogate biomarker of post-operative complications after invasive orthopaedic surgeries. Methods: Thirty-seven adults between 18 and 65 years of age undergoing invasive orthopaedic surgeries were included in this hospital-based study. Serum IL-6 levels were estimated serially in the pre-operative period, after 24 h and 7 days post-operatively. Cases were monitored for post-operative complications. Results: Serum IL-6 levels showed maximum rise in the first 24 h post-operatively especially among older patients (> 60 years). Older patients undergoing bipolar hemiarthroplasty for neck of femur fracture showed highest median post-operative IL-6 level of 258 pg/ml. Serum IL-6 level > 130 pg/ml measured 24 h after surgery was predictive of post-operative complications (sensitivity of 75%). Among the cases with post-operative complications, inapparent hypoxia was the most common complication/event observed. Cases with sub-clinical FES had highest level of serum IL-6 in first 24 h following surgery with median IL-6 level of 300 pg/ml (range 155-444 pg/ml). Conclusion: Monitoring serum IL-6 level may help in both anticipation and early detection of post-operative complications in patients undergoing invasive orthopaedic surgeries; potentially enhancing patient safety.

A Survey of the Estimated Cost of Surgical Consumable Items Within Trauma and Orthopaedic Departments.

Introduction The impact of the current economic and environmental climate, both nationally and globally, is further straining the NHS. This has led to scrutiny of high-expenditure areas, including consumables. Clinician's knowledge surrounding health economics is sparse, and we conducted this survey to assess cost-awareness within the Trauma and Orthopaedic (T&O) departmental staff. Methods A questionnaire was digitally distributed to T&O staff in the East Kent Hospitals Trust. This included demographic data and to make estimations of the cost of 10 specialty-specific items. The data were analysed to determine the average, median, and interquartile range (IQR) of the estimated prices and compared to the actual costs. Results Approximately 7.1% of all item estimates were deemed 'correct'. No correlation was seen between years of staff experience and the accuracy of estimates. 'Kenalog 1 mL ampoule' (Kenalog, Bristol-Myers Squibb, NJ) had the highest accuracy of estimation across all responses (13%), whilst both 'kirschner wires' and '3.2 drill bit' had the lowest accuracy (4% each). The median estimated cost was closest to the actual cost for 'cement pack' (median estimate/actual cost = 0.9). The median estimated cost was furthest from the actual cost for 'tourniquet cuffs' (median estimate/actual cost = 0.16). 'Velcro wrist splint' was the item that was the most overestimated (median estimate/actual cost = 1.57), with only two of the 10 items being overestimated ('velcro wrist splint' and 'dynamic hip screw and plate'). The most underestimated item was 'tourniquet cuffs' (median estimate/actual cost = 0.16). Conclusions There is a paucity of knowledge surrounding the cost of specialist T&O consumables. The limitations included the sample size (98 respondents) and geographical area (East Kent Hospitals Trust). This study shows that there is a need for further research into this topic, with long-term outcomes, which may be beneficial both economically and environmentally.

Single Position Prone Lateral Lumbar Interbody Fusion: A Review of the Current Literature.

PURPOSE OF REVIEW: Spinal fusion, vital for treating various spinal disorders, has evolved since the introduction of the minimally invasive Lateral Lumbar Interbody Fusion (LLIF) by Pimenta in 2001. Traditionally performed in the lateral decubitus position, LLIF faces challenges such as intraoperative repositioning, neurological complications, and lack of access to lower lumbar levels. These challenges lead to long surgery times, increased rates of perioperative complications, and increased costs. The more recently popularized prone lateral approach mitigates these issues primarily by eliminating patient repositioning, thereby enhancing surgical efficiency, and reducing operative times. This review examines the progression of spinal fusion techniques, focusing on the advantages and recent findings of the prone lateral approach compared to the traditional LLIF. RECENT FINDINGS: The prone lateral approach has shown improved patient outcomes, including lower blood loss and shorter hospital stays, and has been validated by multiple studies for its safety and efficacy compared to the LLIF approach. Significant enhancements in postoperative metrics, such as the Oswestry Disability Index, Visual Analog Scale, and radiological improvements have been noted. Comparatively, the prone lateral approach offers superior segmental lordosis correction and potentially better subjective outcomes than the lateral decubitus position. Despite these advances, both techniques present similar risks of neurological complications. Overall, the prone lateral approach has emerged as a promising alternative in lumbar interbody fusion, combining efficiency, safety, and improved clinical outcomes.

Enhanced Surgical Techniques in Orthopedics: A Comprehensive Guide for Surgeons Based on Modification of the McFarland and Osborne Approach to the Hip.

INTRODUCTION: The implementation of various approaches in hip arthroplasties introduces distinct advantages and complications. Notably, widely adopted methods such as the posterior approach have been linked to elevated rates of posterior hip dislocations and iatrogenic sciatic nerve injuries, while the lateral approach has been associated with superior gluteal nerve injuries. In this study, we propose a refined modification of the McFarland and Osborne approach, aiming to amalgamate the most favorable aspects of prior modifications of the lateral approach to the hip. Additionally, our contribution extends to providing a comprehensive stepwise guide for the exposure and closure processes in cases of bipolar hemiarthroplasty or total hip replacement. This modification not only offers potential advantages to seasoned orthopedic surgeons but also serves as a valuable resource for young Turks venturing into hip surgeries. MATERIAL AND METHODS: 14 patients with femoral neck fractures underwent surgery using the modified McFarland and Osborne approach and were followed up for a period of six months. The functional outcome was analyzed by the Modified Mobility and Aids Scoring Matrix. RESULTS: Seven of the 14 patients attained pre-injury status with respect to the Mobility and Aids scoring matrix. six patients had a fall of 1, and one patient had a fall of 2, as compared to pre-injury status. CONCLUSION: Our research suggests that this method serves as a superior alternative to conventional approaches, demonstrating notable advantages in terms of dissection difficulty, reduced risk to neurovascular structures, and minimized post-operative hip dislocations. Additionally, it exhibits a favorable outcome, enabling a return to pre-injury levels of activity.

Anteroposterior cervical spine canal diameter: exploring ethnic variation between European and Polynesian populations.

BACKGROUND: Reduced spinal canal anteroposterior (AP) diameter and AP-transverse diameter ratio have been linked to the development of spinal cord injury and myelopathy. Previously unpublished data has suggested Maori and Pacifica individuals may have narrower cervical spine canals than their NZ European counterparts. PURPOSE: We evaluate the existence of potential differences in dimensions of the sub-axial cervical spine canal between New Zealand European, Maori and Polynesian individuals. STUDY DESIGN: A computed tomography (CT) analysis of 645 intact adult sub-axial cervical vertebrae from 129 patients. METHODS: A total of 645 human sub-axial (C3-C7) cervical vertebrae were analysed radiographically, using 1 mm resolution CT scans to measure AP diameter, transverse diameter and AP:transverse ratio. CT data were obtained from normal trauma scans demonstrating no acute pathology. CT data was reformatted in digital software allowing multi-planar reconstruction (MPR) to increase accuracy of measurements. Statistical analysis was performed using analysis of variance (ANOVA). RESULTS: A total of 245 vertebrae were from Maori individuals, 245 from NZ European and 155 from Polynesians. There were 455 male vertebrae and 215 female vertebrae. Statistically significant differences were found in AP canal diameter between all ethnic groups, at all spinal levels. The average cervical spine canal was around 2.5 mm narrower in Polynesians and around 1.5 mm narrower in Maori than NZ Europeans. No differences in Transverse canal diameter were observed, however statistically significant differences were found in the AP:transverse ratio at all spinal levels. CONCLUSIONS: Our study, utilizing a normal patient cohort, confirms differences in canal dimensions between ethnic groups. CLINICAL SIGNIFICANCE: Ethnic variation in cervical canal dimensions as herein described, must be considered when defining and diagnosing congenital stenosis. Neglecting to account for these differences may lead to misdiagnosis of congenital stenosis in normal individuals in certain ethnic groups.

Attitude of aspiring orthopaedic surgeons towards artificial intelligence: a multinational cross-sectional survey study.

INTRODUCTION: The purpose of this study was to evaluate the perspectives of aspiring orthopaedic surgeons on artificial intelligence (AI), analysing how gender, AI knowledge, and technical inclination influence views on AI. Additionally, the extent to which recent AI advancements sway career decisions was assessed. MATERIALS AND METHODS: A digital survey was distributed to student members of orthopaedic societies across Germany, Switzerland, and Austria. Subgroup analyses explored how gender, AI knowledge, and technical inclination shape attitudes towards AI. RESULTS: Of 174 total respondents, 86.2% (n = 150) intended to pursue a career in orthopaedic surgery and were included in the analysis. The majority (74.5%) reported 'basic' or 'no' knowledge about AI. Approximately 29.3% believed AI would significantly impact orthopaedics within 5 years, with another 35.3% projecting 5-10 years. AI was predominantly seen as an assistive tool (77.8%), without significant fear of job displacement. The most valued AI applications were identified as preoperative implant planning (85.3%), administrative tasks (84%), and image analysis (81.3%). Concerns arose regarding skill atrophy due to overreliance (69.3%), liability (68%), and diminished patient interaction (56%). The majority maintained a 'neutral' view on AI (53%), though 32.9% were 'enthusiastic'. A stronger focus on AI in medical education was requested by 81.9%. Most participants (72.8%) felt recent AI advancements did not alter their career decisions towards or away from the orthopaedic specialty. Statistical analysis revealed a significant association between AI literacy (p = 0.015) and technical inclination (p = 0.003). AI literacy did not increase significantly during medical education (p = 0.091). CONCLUSIONS: Future orthopaedic surgeons exhibit a favourable outlook on AI, foreseeing its significant influence in the near future. AI literacy remains relatively low and showed no improvement during medical school. There is notable demand for improved AI-related education. The choice of orthopaedics as a specialty appears to be robust against the sway of recent AI advancements. LEVEL OF EVIDENCE: Cross-sectional survey study; level IV.

Applications of artificial intelligence for adolescent idiopathic scoliosis: mapping the evidence.

PURPOSE: Adolescent idiopathic scoliosis (AIS) is a common spinal deformity with varying progression, complicating treatment decisions. Artificial intelligence (AI) and machine learning (ML) are increasingly prominent in orthopedic care, aiding in diagnosis, risk-stratification, and treatment guidance. This scoping review outlines AI applications in AIS. METHODS: This study followed PRISMA-ScR guidelines and included articles that reported the development, use, or validation of AI models for treating, diagnosing, or predicting clinical outcomes in AIS. RESULTS: 40 full-text articles were included, with most studies published in the last 5 years (77.5%). Common ML techniques were convolutional neural networks (55%), decision trees and random forests (15%), and artificial neural networks (15%). Most AI applications in AIS were for imaging analysis (25/40; 62.5%), focusing on automatic measurement of Cobb angle, and axial vertebral rotation (13/25; 52%) and curve classification/severity (13/25; 52%). Prediction was the second most common application (15/40; 37.5%), with studies predicting curve progression (9/15; 60%), and Cobb angles (9/15; 60%). Only 15 studies (37.5%) reported clinical implementation guidelines for AI in AIS management. 52.5% of studies reported model accuracy, with an average of 85.4%. CONCLUSION: This review highlights the applications of AI in AIS care, notably including automatic radiographic analysis, curve type classification, prediction of curve progression, and AIS diagnosis. However, the current lack of clear clinical implementation guidelines, model transparency, and external validation of studied models limits clinician trust and the generalizability and applicability of AI in AIS management.

Top Three Healthcare Trends in Orthopaedics Affecting Musculoskeletal Care in the Elderly.

Several trends toward patient-centered multi-care models employing translational research strategies are currently emerging in orthopaedics. These align seamlessly with epigenetics discussions in pain, a clinical approach to pain management that prioritizes tailoring healthcare to individual needs, preferences, and circumstances. Recognizing the unique genetic and epigenetic factors influencing pain perception, healthcare providers can integrate personalized insights into their patient-centered approach, offering more targeted and effective pain management strategies tailored to each individual's experience. Custom 3D-printing technologies may also become increasingly relevant to more effectively and reliably treat painful degenerative structural abnormalities. They are expected to go hand-in-hand with the precision medicine redefinition of musculoskeletal care. More effective analysis of surgeons' clinical decision-making and patients' perception of high-value orthopaedic care is needed. Shared Decision Making (SDM) is critical to identifying the best solution for each patient and improving stakeholders' understanding of factors influencing the diverse prioritizing values of surgical or non-surgical treatments by payers, systems, and other providers. Identifying high-value orthopaedic surgeries via effective SDM in orthopedic surgery requires more than just presenting patients with information. The Rasch analysis of patient expectations can provide this nuanced approach that involves understanding patient values, addressing misconceptions, and aligning surgical recommendations with patient-specific goals. Optimizing orthopaedic treatment within the patient-centered framework can drive innovation in reimbursement policies that support the field more broadly. Research on separating high-value from low-value orthopaedic procedures may likely impact healthcare decision- makers' resource allocation.

Clinic of Hope: bridging infectious disease and orthopaedic surgery in prosthetic joint infection management.

Prosthetic joint infections (PJIs) following total joint arthroplasty are a significant and costly complication. To address fragmented care typically seen with separate management, we established a combined infectious disease and orthopaedic surgery clinic at Duke Health in July 2020. This clinic focuses on patients experiencing acute deterioration or multiple PJI episodes, often at the stage where amputation is the only option offered. From July 2021 to March 2024, the clinic completed 974 visits with 319 unique patients. The clinic maintained a low no-show rate of 5.0%. Treatment plans included procedures such as debridement, antibiotics and implant retention (38%), as well as implant explantation and one-stage exchange (32% each), with amputation required in only 4% of cases. The integrated clinic model facilitated real-time, multidisciplinary care, improving patient outcomes and operational efficiency. This approach offers a promising model for managing complex infections.

Utilization of telemedicine for diagnosis and follow-up within foot and ankle orthopaedic surgery: A narrative review of the literature.

BACKGROUND: Telemedicine has seen increasing adoption in healthcare over the past two decades, with proven clinical efficacy in several medical specialties. Orthopedics surgery has shown potential benefits from telemedicine implementation. OBJECTIVE: This review aims to evaluate the impact of telemedicine on clinical outcomes and patient and physician preferences in foot and ankle orthopedics, providing insight into the potential role of telemedicine within this subspecialty. METHODS: Multiple databases were searched for relevant articles on telemedicine in foot and ankle orthopedics. Inclusion criteria encompassed articles on telemedicine use and foot and ankle orthopedic care. Data included patient demographics, reasons for visits, duration of telemedicine, and outcomes. Analysis involved descriptive statistics, and a narrative approach to describe outcomes. RESULTS: Out of 218 articles, 12 met the inclusion criteria, comprising a total of 1,535 patients. Telemedicine visits were used for follow-up care, opinion consultations, monitoring, postoperative care, and treatment of various orthopedic conditions. Clinical outcomes demonstrated equivalence to in-person care. Patients expressed satisfaction with telemedicine but preferred in-person visits for future appointments. Physicians held neutral attitudes towards telemedicine, with concerns about the lack of physical examination. CONCLUSION: This review highlights the benefits of telemedicine in foot and ankle orthopedics. Telemedicine provides an alternative to in-person visits, improving patient access to care and offering cost and time savings. However, patient and physician preferences for in-person visits suggest a need to address concerns related to physical examination limitations. Telemedicine can supplement traditional care, but further research is required to explore its applicability in new patient consultations and optimize physician engagement.

Critical elements of international academic partnerships in orthopaedic surgery: a modified Delphi approach.

Background: Despite the recent emphasis on promoting international collaborations within orthopaedic surgery, criteria for determining the strengths of such partnerships has not been established. The purpose of this study was to evaluate orthopaedic experts' perceptions of the most valuable characteristics of international academic partnerships. Methods: This study was conducted using a modified Delphi methodology. Experts were identified through the Consortium of Orthopaedic Academic Traumatologists (COACT). Responses were collected from February to September 2022. Three rounds of surveys listing possible topics on a 5-point Likert scale were used to develop consensus among a group of experts. Consensus criteria for topic inclusion in the final scale was determined as a rating of "strongly agree" or "agree" by ≥70% of the participants in the third survey. Results: The Round 1 survey was distributed to 96 invited participants within the COACT network, of which 50 experts (52.1%) completed the first survey. Consensus was reached on 54 topics organized into the following 5 categories: Research, Advocacy/Leadership, Training/Surgical Skills, Education/Knowledge Exchange, and Sustainability and Safety (RATES Criteria). Conclusions: Determining the most valuable characteristics of successful international academic partnerships can lead to more sustainable, mutually beneficial collaborations. The criteria identified in this study can provide the foundation for developing new partnerships and assessing existing ones.

Surgical site infection surveillance in knee and hip arthroplasty: optimizing an algorithm to detect high-risk patients based on electronic health records.

BACKGROUND: Surgical site infection (SSI) is an important cause of disease burden and healthcare costs. Fully manual surveillance is time-consuming and prone to subjectivity and inter-individual variability, which can be partly overcome by semi-automated surveillance. Algorithms used in orthopaedic SSI semi-automated surveillance have reported high sensitivity and important workload reduction. This study aimed to design and validate different algorithms to identify patients at high risk of SSI after hip or knee arthroplasty. METHODS: Retrospective data from manual SSI surveillance between May 2015 and December 2017 were used as gold standard for validation. Knee and hip arthroplasty were included, patients were followed up for 90 days and European Centre for Disease Prevention and Control SSI classification was applied. Electronic health records data was used to generate different algorithms, considering combinations of the following variables: ≥1 positive culture, ≥ 3 microbiological requests, antimicrobial therapy ≥ 7 days, length of hospital stay ≥ 14 days, orthopaedics readmission, orthopaedics surgery and emergency department attendance. Sensitivity, specificity, negative and predictive value, and workload reduction were calculated. RESULTS: In total 1631 surgical procedures were included, of which 67.5% (n = 1101) in women; patients' median age was 69 years (IQR 62 to 77) and median Charlson index 2 (IQR 1 to 3). Most surgeries were elective (92.5%; n = 1508) and half were hip arthroplasty (52.8%; n = 861). SSI incidence was 3.8% (n = 62), of which 64.5% were deep or organ/space infections. Positive culture was the single variable with highest sensitivity (64.5%), followed by orthopaedic reintervention (59.7%). Twenty-four algorithms presented 90.3% sensitivity for all SSI types and 100% for deep and organ/space SSI. Workload reduction ranged from 59.7 to 67.7%. The algorithm including ≥ 3 microbiological requests, length of hospital stay ≥ 14 days and emergency department attendance, was one of the best options in terms of sensitivity, workload reduction and feasibility for implementation. CONCLUSIONS: Different algorithms with high sensitivity to detect all types of SSI can be used in real life, tailored to clinical practice and data availability. Emergency department attendance can be an important variable to identify superficial SSI in semi-automated surveillance.

A 12-month retrospective cohort study investigating the incidence and short-term outcomes of e-scooter injuries in regional Western Australia.

BACKGROUND: The rise in popularity of ride share e-scooters has led to an increase in the number of e-scooter injuries, with existing literature reporting increases in rates of admission by more than 350%. In April 2023, the Broome Shire signed a contract to provide 300 e-scooters as part of a shared micro mobility platform. This study aimed to describe the demographics, clinical presentation and health system utilization of patients presenting with e-scooter-related injuries at Broome Regional Hospital (BRH). METHODS: A retrospective cohort study examined all e-scooter-related injuries presenting to BRH between April 1st 2023 and April 30th 2024. Patients with e-scooter injuries described in their Emergency Department (ED) electronic triage records were included. Data was collected from chart review. RESULTS: A total of 190 patients were identified as having sustained an e-scooter injuries over the 12-month trial period. The median age was 26 years with equal numbers of males and females. Most injuries occurred between 6 pm and 12 am (28%) with 53% of patients reporting being intoxicated, while 75% were not wearing a helmet. Almost all patients (80%) were managed in the emergency department because of the low severity of their injuries. Of the remaining patients, 22 were admitted, with 16 transferred for tertiary-level operative management. CONCLUSION: The introduction of e-scooters for shared micromobility represents a new cause of trauma related presentations to BRH. Our study's results have raised awareness regarding the incidence and severity of electric scooter injuries in Broome.

Unnecessary care in orthopaedic surgery.

Unnecessary care, where the potential for harm exceeds the potential for benefit, is widespread in medical care. Orthopaedic surgery is no exception. This has significant implications for patient safety and health care expenditure. This narrative review explores unnecessary care in orthopaedic surgery. There is wide geographic variation in orthopaedic surgical practice that cannot be explained by differences in local patient populations. Furthermore, many orthopaedic interventions lack adequate low-bias evidence to support their use. Quantifying the size of the problem is difficult, but the economic burden and morbidity associated with unnecessary care is likely to be significant. An evidence gap, evidence-practice gap, cognitive biases, and health system factors all contribute to unnecessary care in orthopaedic surgery. Unnecessary care is harming patients and incurring high costs. Solutions include increasing awareness of the problem, aligning financial incentives to high value care and away from low value care, and demanding low bias evidence where none exists.

Nursing Leadership in a Post-Pandemic Elective Orthopaedic Theatre Department: A Detailed Thematic Analysis of an Open-Ended Qualitative Survey.

BACKGROUND: The COVID-19 pandemic has impacted nursing theatre staff, departmental activity, and delivery of services to patients. This work-based project aimed to investigate the challenges of nursing leadership in an elective orthopaedic department at current times. METHODS: The study collected qualitative data exploring theatre staff's expectations from leadership, offering insight on how the pandemic has influenced the way of working and exploring how the future in this unit may look. The answers from 20 practitioners to an anonymised open-ended survey were examined using thematic analysis. RESULTS: The participants described a leader as a good communicator who focuses on empowering others and supporting the team, identified by the majority as a senior team member. From the findings, three topics were identified: immediate changes, delayed changes, and pre-existing conditions. The answers painted a reality that is complex and multifaceted, where numerous variables play a part in the physical and mental health of each candidate, impacting their performance as well as their work/life balance. Overall, the strongest subjects recurring in the findings were the need for nursing leadership to focus on supporting staff with training opportunities, to actively plan for a reduction in staffing shortages, and to be constantly mindful of staff well-being. CONCLUSIONS: This study pointed out that the need for constant communication with their staff, building honest relationships, and being a reliable leader, focused on empowering others and supporting the team were important factors for the nursing management during the COVID-19 pandemic and post-COVID-19 era.

Legacy of Compassion: The Life and Contributions of Dr. Ronald Joseph Garst in Advancing Orthopaedic Surgery in Bangladesh.

Dr. Ronald Joseph Garst, a distinguished spine surgeon and missionary, significantly impacted the field of orthopaedic surgery in Bangladesh, especially during and after the country's Liberation War, when the nation had no orthopaedic specialists. His experiences during Bangladesh's struggle for independence inspired him to establish rehabilitation centers for injured freedom fighters and to found the Rehabilitation Institute and Hospital for the Disabled (RIHD), which later became the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Bangladesh's first tertiary-level trauma center. In Bangladesh, Dr. Garst was critical in organizing care for injured freedom fighters, setting up a central limb and brace center, and launching a post-graduate training program for orthopaedics, physiotherapists, and occupational therapists. He successfully raised funds, attracted international support, and provided essential training to Bangladeshi doctors, nurses, and limb-makers.  Dr. Garst's legacy extends beyond his medical achievements; his humanitarian spirit and dedication to helping the underprivileged earned him honorary citizenship in Bangladesh. He remained committed to supporting ongoing efforts at RIHD, frequently visiting Bangladesh and contributing equipment and training materials until his passing. Dr. Garst's contributions, such as initiating morning academic sessions at RIHD, continue to influence the orthopaedic community in Bangladesh. This article explores Dr. Garst's remarkable journey, his influence on orthopaedic surgery in Bangladesh, and the enduring impact of his work.

Tendon Transfers for Knee Extension Following Femoral Nerve Injury After Hip Arthroplasty.

Femoral nerve injury is a rare but devastating complication of direct anterior approach total hip arthroplasty that occurs in about 1% of the cases and could potentially lead to debilitating loss of knee extension. In this case report, we present a case of femoral nerve injury following direct anterior approach hip arthroplasty with an inability to extend the affected knee, gait instability, and multiple falls. For this patient, an innovative functional adductor magnus muscle transfer was performed to restore knee extension. At 6 months after surgery, the patient's knee extension was partly restored, and ambulation was significantly improved.

The Perspective of Brazilian Women Orthopaedic Surgeons on Gender Discrimination: Initial Insights to Understand Gender Bias in the Brazilian Healthcare System.

Despite the societal progress made in recent years, gender discrimination is still common in healthcare, especially in some surgical specialties such as orthopaedics. In Brazil, where the participation of women in the medical profession has been increasing, little is known about women's perceptions on the issue of gender discrimination. This study aims to examine women orthopaedic surgeons' experiences in dealing with conflict in the workplace and contextualize the impact that gender discrimination has had or currently has on their careers and well-being. As a secondary objective, the work seeks to understand whether there are differences in the perception of the issue among practicing women orthopaedic surgeons and those in training. For a cross-sectional qualitative study, a survey was distributed exclusively to 300 practicing orthopaedic surgeons and orthopaedists in training (residents and fellows). A total of 99 women participated in the survey, of whom 66 were practicing orthopaedic surgeons and 33 were orthopaedists in training. The study showed that women orthopaedic surgeons in training in Brazil have a lower number of publications and a moderate level of involvement in academic society activity. In addition, orthopaedic surgeons in training experience a statistically significantly higher number of conflicts in the workplace. The comments from the questionnaires highlighted the physical and psychological consequences arising from these situations of professional conflict, most frequently occurring with orthopaedic surgeons who are men. Our findings indicate that respondents expressed a feeling of inequality towards women in the workplace, ultimately reducing the level of job satisfaction among female orthopaedic surgeons, which may contribute to disinterest and abandonment of the specialty. The results of this work support recent evidence that there is an implicit and often overlooked bias against the participation of women and ethnic minorities in the orthopaedic community in Brazil.

Evaluation of the Early Administration of Tranexamic Acid in Geriatric Hip Fractures in the Emergency Department: A Retrospective Study.

Introduction Tranexamic acid (TXA) administration perioperatively has demonstrated efficacy in reducing postoperative drops in hemoglobin levels and the need for transfusions among patients with peritrochanteric hip fractures. This study aims to perform a retrospective analysis to assess the impact on hemoglobin levels by comparing patients with fragility hip fractures who received TXA in the ED, in addition to the standard perioperative TXA dose, with those who did not receive TXA in the ED. Methods This study retrospectively reviewed 64 patient records from May 2020 to May 2021 at a Level II trauma center that were classified into two groups: patients who received one gram (g) of TXA in the ED, within five hours of injury (new protocol), or patients who received no TXA in the ED (old protocol). The primary outcomes of the study were hemoglobin and adverse events. An independent t-test was performed on continuous variables. A chi-square test was used to analyze noncontinuous variables. Statistical Product and Service Solutions (SPSS, version 25; IBM SPSS Statistics for Windows, Armonk, NY) was used for analysis. Statistical significance was set at a p value < 0.05. Results We measured the difference between hemoglobin on the day of surgery or day zero and on arrival in the ED, which was not statistically significant between the two protocols (p value = 0.322). The difference between hemoglobin levels on postoperative day one and on arrival in the ED was also not statistically significant (p = 0.339). Adverse events were lower in the new protocol but not statistically significant between the two protocols (p = 0.178). Conclusion Our study showed improved outcomes in postoperative hemoglobin with early administration of TXA in the ED. This is demonstrated by continuous higher postoperative hemoglobin in the new protocol group without an increase in adverse events. While the data did not achieve statistical significance, we believe there is clinical benefit in the early administration of TXA in the ED, a finding that continues to be explored and supported in the literature.