A Study on Distinguishing ChatGPT-Generated and Human-Written Orthopaedic Abstracts by Reviewers: Decoding the Discrepancies.

BACKGROUND: ChatGPT (OpenAI Incorporated, Mission District, San Francisco, United States) is an artificial intelligence (AI)-based language model that generates human-resembling texts. This AI-generated literary work is comprehensible and contextually relevant and it is really difficult to differentiate from human-written content. ChatGPT has risen in popularity lately and is widely utilized in scholarly manuscript drafting. The aim of this study is to identify if 1) human reviewers can differentiate between AI-generated and human-written abstracts and 2) AI detectors are currently reliable in detecting AI-generated abstracts. METHODS: Seven blinded reviewers were asked to read 21 abstracts and differentiate which were AI-generated and which were human-written. The first group consisted of three orthopaedic residents with limited research experience (OR). The second group included three orthopaedic professors with extensive research experience (OP). The seventh reviewer was a non-orthopaedic doctor and acted as a control in terms of expertise. All abstracts were scanned by a plagiarism detector program. The performance of detecting AI-generated abstracts of two different AI detectors was also analyzed. A structured interview was conducted at the end of the survey in order to evaluate the decision-making process utilized by each reviewer. RESULTS: The OR group managed to identify correctly 34.9% of the abstracts' authorship and the OP group 31.7%. The non-orthopaedic control identified correctly 76.2%. All AI-generated abstracts were 100% unique (0% plagiarism). The first AI detector managed to identify correctly only 9/21 (42.9%) of the abstracts' authors, whereas the second AI detector identified 14/21 (66.6%). CONCLUSION: Inability to correctly identify AI-generated context poses a significant scientific risk as "false" abstracts can end up in scientific conferences or publications. Neither expertise nor research background was shown to have any meaningful impact on the predictive outcome. Focus on statistical data presentation may help the differentiation process. Further research is warranted in order to highlight which elements could help reveal an AI-generated abstract.

The Role of 3D-Printed Patient-Specific Instrumentation in Total Knee Arthroplasty: A Literature Review.

Total knee arthroplasty (TKA) is currently one of the most common orthopedic surgeries due to the ever-increasing average life expectancy. The constant need for effective and accurate techniques was contributed to the development of three-dimensional (3D) printing in that field, especially for patient-specific instrumentation (PSI) and custom-made implants fabrication. PSI may offer numerous benefits, such as resection accuracy, mechanical axis alignment, cost-effectiveness, and time economy. Nonetheless, the results of existing studies are controversial. For this purpose, a review article of the published articles was conducted to summarize the role of 3D-printed PSI in TKA.

Atraumatic dislocation of a modern rotating hinge total-knee prosthesis. A rare but devastating complication.

The number of total knee arthroplasties (TKA) is rising in many countries along with the numbers of the revision TKA. Rotating hinge knee (RHK) implants have a fundamental role in the revision TKA and their design has evolved during the last years becoming appealing to many surgeons worldwide. They are mainly used in cases where large bone defects and severe soft tissue imbalance exist. However, despite their recent advancements, they are still associated with high complication rates such as infection, periprosthetic fractures and insufficiency of the extensor apparatus. An uncommon complication of the latest rotating hinge implants is their mechanical component failure. Here we present a rare case of such a devastating complication where a modern RHK prosthesis dislocated without a preceding traumatic event, a review of the corresponding literature and a potential cause for the failure of the mechanism. Moreover, insight on key aspects that need to be addressed is provided, like intrinsic and extrinsic factors which play a crucial role and shouldn't be overlooked for a successful outcome.

Comparison of various treatment modalities for the management of bone marrow edema syndrome/transient osteoporosis in men and non-pregnant women: a systematic review.

Transient osteoporosis (TO) or bone marrow edema syndrome (BMES) is a self-limited clinical condition, which affects middle-aged men and women. It can be treated with miscellaneous conservative and surgical measures, which are analyzed in this systematic review. INTRODUCTION: BMES/TO is a transient clinical entity, which can be treated with various therapeutic modalities. The aim of our study was to assess the efficacy of different therapeutic options for the alleviation of pain and reduction of bone marrow edema (BME) in patients with BMES/TO, as well as to propose a therapeutic algorithm. METHODS: PubMed, Scopus, Cochrane, and Google Scholar were searched. Eligibility and extraction of studies were conducted by two authors. Methodological quality assessment was carried out with the modified Delphi technique, Methodological Index for Non-Randomized Studies (MINORS) criteria, and Cochrane Collaboration's risk of bias tool. Outcomes that were compared were time of pain resolution, VAS pain scores, and BME regression on magnetic resonance imaging (MRI). RESULTS: A total of 36 articles (880 patients) were included. Bisphosphonates had higher efficiency in less than 1-month outcomes on pain resolution compared with core decompression (CD), while iloprost was more efficient at 1-3 months compared with bisphosphonates and CD. At 3-6 months, all three of the aforementioned showed equal results on pain resolution, and at a period of 6-12 months, CD and extracorporeal shockwave therapy (ESWT) showed excellent results followed by bisphosphonates and the conservative group (CG) consisting of non-steroidal anti-inflammatory drugs (NSAIDs) and/or analgesics and/or restricted weight bearing. On MRI at 1-3 months, bisphosphonates, iloprost, and CD had relatively the same outcomes on BME resolution, with the least promising being the CG. At 3-6 months, CD seemed to have achieved the best results on the resolution of BME, followed by ESWT, CG, and bisphosphonates group. At 6-12 months, ESWT had the best outcomes compared with the conservative, bisphosphonates, and iloprost groups. CONCLUSION: BMES/TO has been treated with many non-standardized measures due to the low number of highly reliable studies. Current literature shows promising results with regard to the reduction of the clinical course of BMES/TO, but further large multicenter randomized controlled trials, as well as standardized radiological and clinical scores, are warranted to acquire evidence-based recommendations on the therapeutic algorithm.

Anterior Tibial to Dorsalis Pedis Bypass to Manage Acute Ischemia Attributed to Pilon Fracture.

Pilon fractures of the distal tibia are usually the result of a high-energy trauma and can affect seriously the arterial vasculature carrying an increased risk of amputation at the malleolar level or higher. Such cases represent a challenge for the orthopedic surgeons and a multidisciplinary approach is mandatory in order to salvage the threatened limb. We present an unusual case of a closed pilon fracture with injury of all tibial vessels leading to acute limb threatening ischemia. The patient was treated successfully with external fixation and a short tibial-pedal bypass with use of an autologous reversed saphenous vein graft. This example dictates how a distal leg fracture can be dramatic and that awareness of vascular examination coupled with high suspicion of vascular damage can be limb-saving. Multidisciplinary approach is warranted since the topology and complexity of the ankle lesions necessitate staged orthopedic reconstructions with tibio-distal bypass and appropriate skin coverage of the distal anastomosis.

Hand compartment syndrome due to extravasation of contrast medium. A technical error. A report of a case and review of the literature.

The extravasation of contrast agents is one of the most common and remarkable complications during a computed tomography (CT) scan. The clinical manifestations are commonly minimal, leading to mild symptoms. However, in rare cases of high-volume extravasation, the complications are extremely threatening. Compartment syndrome of the hand and the forearm leads to critical dysfunction and upper limb necrosis. This article reported an unusual case of hand compartment syndrome following extravasation of iodinated contrast agent from a peripheral venous catheter, during a CT angiography, and its surgical treatment. Moreover, a literature review regarding all published similar surgically treated cases was conducted.

Bilateral Medial Epicondyle Fracture Without Elbow Dislocation in a High-Level Adolescent Gymnast Athlete: A Rare Case.

Isolated medial epicondyle fracture constitutes a common fracture in children's and adolescent's elbow and is highly associated with an elbow dislocation. Cases with bilateral medial epicondyle fracture with concomitant elbow dislocation have been previously described in literature, while cases without an associated elbow dislocation are lacking. In this article, a bilateral medial epicondyle fracture without elbow dislocation in an adolescent high-level gymnast athlete is reported. To the best of the authors' knowledge, this is the first case report in literature regarding such an extremely rare traumatic elbow injury.

Neglected Stiff Equinocavus Foot Deformity Treated with Cole Osteotomy, Combined with External Ilizarov Hinged Frame Fixation, Soft-Tissue Release, and Achilles Tendon Lengthening: A Case Report.

Stiff equinocavus foot deformities are challenging clinical entities that may be treated with osteotomies and extensive soft-tissue release. The most common causes of such lesions are neglected trauma and Charcot-Marie-Tooth disease; other causes include burns, neurologic diseases, and compartment leg syndrome. Conventional treatments, including extensive soft-tissue release, osteotomies, and arthrodesis combined with or without internal splinting, may result in severe complications such as neurovascular or soft-tissue damage and shortening of the foot. The Ilizarov technique may be superior to the traditional approach, because it allows surgeons to apply gradual and titrated correction of individual components of complex deformities and results in minimal surgical morbidity without shortening of the foot. This is the first case report in the literature describing the simultaneous use of Cole osteotomy, combined with external Ilizarov hinged frame fixation, soft-tissue release, and Achilles tendon lengthening for the treatment of an extreme neglected stiff equinocavus foot deformity.

Extreme stiff knee recurvatum following manipulation under anesthesia and botulinum neurotoxin injection.

In this article we report a case of stiff, neglected extreme recurvatum knee deformity in a 17-year-old female. This is the first reported case in the literature of an acquired ligamentous stiff extreme knee recurvatum following manipulation under anesthesia and botulinum neurotoxin injection. Μodified Judet quadricepsplasty combined with Ilizarov external hinged frame fixation was implemented. This dual technique can be considered as a rational approach for such an extreme deformity as it stabilizes, progressively corrects, and prevents recurrence. A patellar tendon rupture caused by the increasing tension of the extensor mechanism following the correction was treated successfully using a cadaveric Achilles tendon allograft.

Diagnostic and therapeutic approach to meniscal ossification: a systematic review.

PURPOSE: The purpose of this study was to systematically review case reports and case series about meniscal ossicle, to summarize existing evidence. Specifically, to identify the etiology, demographic characteristics, localization, clinical features, diagnostic procedures and treatment options of this rare entity. Although, case reports/ series are of low level of evidence, a systematic review of such studies can provide and help us to gain a better understanding and awareness of meniscal ossicle. METHODS: Two authors searched three online databases (MEDLINE, SCOPUS and GOOGLE SCHOLAR) from inception until March 2020 for the literature on meniscal ossicle. Inclusion criteria included case series, case reports and case-based reviews, available in full-text version, in English and that concern humans. Reports published in languages other than English were excluded, as well as articles with no electronic full text availability. Case reports using the term "meniscal ossicle" to describe an acute avulsion fracture of the tibial root of the meniscus, were also excluded. RESULTS: Of 453 initial studies, 38 studies satisfied inclusion criteria. In total 169 patients were included of whom 107 (63%) were males and 62 (37%) were females. Mean age was 44 years (range 12-87). According to Magnetic resonance imaging findings, in 144 knees (86%) the ossicle was localized at the posterior root or horn of the medial meniscus. 60% of the patients had a history of trauma. The predominant symptom in 87% of patients was knee pain. In all patients was detected an intra-articular density structure in computed radiography. 76% had associated meniscal tear, 61% had intraarticular cartilage loss, 34% meniscal extrusion and 28% anterior cruciate ligament injury. Treatment modalities included conservative regimen in 40 patients, while 59 patients underwent surgical excision. CONCLUSION: The most possible etiology of meniscal ossicle is posttraumatic heterotopic ossification and small occult bony avulsion fracture. It is commonly observed in individuals complaining about knee pain with history of antecedent trauma. The presence of a meniscal ossicle should alert the physician to the high likelihood of the patient having an associated meniscal tear, articular cartilage loss, ACL injury or meniscal extrusion. Along with the meniscal ossicle, the associated meniscal tear should be treated as well.

The efficacy and safety of bisphosphonates in patients with bone marrow edema syndrome/transient osteoporosis: A systematic literature review.

BACKGROUND: The purpose of our systematic literature review study was to critically analyze all current data including time to achieve pain relief and resolution of bone marrow edema (BME) on magnetic resonance imaging (MRI) in patients with bone marrow edema syndrome (BMES) when using bisphosphonates. METHODS: A systematic review was performed to address studies which concerned the efficacy and safety of bisphosphonates in patients with BMES. A systematic search was conducted by two investigators using databases including Pubmed and Scopus. RESULTS: Nine studies were included between July 2002 and June 2019 with a total of 187 patients out of whom 150 had been treated with bisphosphonates. Mean age of patients was 44,14 (mean ranges 34.9-54.0), 113 males and 54 females (excluding one study which did not mention ages). Five studies described the outcomes from MRI on follow-up (42 out of 78 patients achieved resolution with time ranging from 3 to 12 months with a mean of 3.85 months) and eight studies described the outcomes regarding pain resolution (128 out of 140 achieved resolution with mean time 4.20 months, ranging from 0.7 months to 12 months). Adverse events related to the administration of bisphosphonates included flue-like symptoms in 6 patients, musculoskeletal pain in 1 patient, arthralgias and fever in 9 patients. CONCLUSIONS: The outcome of this systematic review indicated that the effect of bisphosphonates on pain relief and on regression of BME on MRI is controversial, but due to the low level of evidence of the included studies, no definite conclusions can be acquired and no evidence based recommendation could be given.

Bone marrow edema syndrome/transient osteoporosis of the hip joint and management with the utilization of hyperbaric oxygen therapy.

Transient osteoporosis of hip (TOH) is a self-limited condition that affects young and middle aged women or men. The clinical manifestation is characterized by sudden or gradual onset of pain that is exacerbated on weight-bearing and at night. The treatment of TOH is either conservative or surgical. Conservative regimens include restriction of weight-bearing, pharmacological agents such as prostacyclin analogues (iloprost), non-steroid anti-inflammatory drugs (NSAIDs), extracorporeal shock wave and hyperbaric oxygen therapy (HBOT). Surgical intervention includes drilling or core decompression. The aim of this article is to review the clinical entity of TOH (clinical presentation, pathophysiology, diagnosis) and to further discuss the off-label utilization of HBOT as an alternative treatment regimen in patients suffering from TOH that fail to respond to other conservative methods.