International Orthopaedic Volunteer Opportunities in Low and Middle-Income Countries.

ABSTRACT: Globally, the burden of musculoskeletal conditions continues to rise, disproportionately affecting low and middle-income countries (LMICs). The ability to meet these orthopaedic surgical care demands remains a challenge. To help address these issues, many orthopaedic surgeons seek opportunities to provide humanitarian assistance to the populations in need. While many global orthopaedic initiatives are well-intentioned and can offer short-term benefits to the local communities, it is essential to emphasize training and the integration of local surgeon-leaders. The commitment to developing educational and investigative capacity, as well as fostering sustainable, mutually beneficial partnerships in low-resource settings, is critical. To this end, global health organizations, such as the Consortium of Orthopaedic Academic Traumatologists (COACT), work to promote and ensure the lasting sustainability of musculoskeletal trauma care worldwide. This article describes global orthopaedic efforts that can effectively address musculoskeletal care through an examination of 5 domains: clinical care, clinical research, surgical education, disaster response, and advocacy.

A method for detection of lateral malleolar malrotation using conventional fluoroscopy.

Recent studies on ankle syndesmosis injuries have shown that a significant amount of rotational malediction of the distal fibula are missed and may lead to poor functional outcome. A new set of radiographic criteria were developed to help detect distal fibula internal and external rotation using conventional fluoroscopy. The criteria were tested using a cadaveric model for Weber C ankle fractures fixed with the fibula in various degrees of internal and external rotation. Using the criteria orthopaedic trauma surgeons were able to improve their accuracy and agreement on assessment of degree and direction of fibula rotation.

Can a novel rectangular footplate provide higher resistance to subsidence than circular footplates? An ex vivo biomechanical study.

STUDY DESIGN: Ex vivo biomechanical evaluation using cadaveric vertebral bodies. OBJECTIVE: To compare the subsidence characteristics of a novel rectangular footplate design with a conventional circular footplate design. SUMMARY OF BACKGROUND DATA: Cage subsidence is a postoperative complication after reconstruction of corpectomy defects in the thoracolumbar spine and depends on factors, such as bone quality, adjunctive fixation, and the relationship between the footplate on the cage and the vertebral body endplate. METHODS: Twenty-four cadaveric vertebrae (T12-L5) were disarticulated, potted in a commercial resin, loaded with either a circular or a rectangular footplate, and tested in a servo hydraulic testing machine. Twelve vertebral bodies were loaded with a circular footplate, and after subsidence the same vertebral bodies were loaded with a rectangular footplate. The second set of 12 vertebral bodies was loaded with a rectangular footplate only. Force-displacement curves were developed for the 3 groups, and the ultimate load to failure and stiffness values were calculated. RESULTS: The ultimate load to failure with the circular footplate was 1310 N (SD, 482). The ultimate load to failure with a rectangular footplate with a central defect and without a central defect was 1636 N (SD, 513) and 2481 N (SD, 1191), respectively. The stiffness of the constructs with circular footplate was 473 N/mm (SD, 205). The stiffness of the constructs with a rectangular footplate with a central defect and without a central defect was 754 N/mm (SD, 217) and 1054 N/mm (SD, 329), respectively. CONCLUSION: A rectangular footplate design is more resistant to subsidence than a circular footplate design in an ex vivo biomechanical model. The new design had higher load to failure even in the presence of a central defect. These findings suggest that rectangular footplates may provide better subsidence resistance when used to reconstruct defects after thoracolumbar corpectomy.