Gender Differences in Self-Description: A Linguistic Analysis of Orthopedic Surgery Residency Application Personal Statements.

OBJECTIVE: The purpose of this study is to assess differences in language characteristics in personal statements written by male and female applicants to an orthopedic surgery residency program. DESIGN: This is a blinded retrospective analysis of personal statements from all applicants to an orthopedic surgery residency training program during 1 application cycle. Language characteristics were analyzed using a linguistic analysis software. This software evaluated 19 variables, including word count, 4 summary language variables (analytical thinking, clout, authenticity, and emotional tone), and 14 additional word categories. SETTING: Our study took place at [institution]. PARTICIPANTS: All applications submitted during the 2018-2019 residency application cycle were analyzed. 889 applicants were included in the study based on exclusion criteria, which omitted the 5 applicants who ultimately matched at our institution, as well as non-US citizens. RESULTS: Word count was not statistically significant between groups. Amongst the summary language variables, authenticity was higher in female applicants (p = 0.0142). Of the selected word categories, males averaged a higher score in certainty (p = 0.0418), while females averaged higher scores in curiosity (p = 0.0102), perception (p = 0.0486), and attention (p = 0.0293). CONCLUSIONS: Subtle differences exist in the language characteristics of personal statements written by male and female applicants to orthopedic surgery residency. The implications of our findings would be strengthened by new data on specific language characteristics and communication skills most desired by orthopedic program directors. Lastly, as evaluation metrics for residency applications continue to change, personal statements may assume an even more important role.

Anesthesia Strategies for the Perioperative Management of Severe Pulmonary Hypertension in Emergency Orthopedic Surgery: A Case Report.

This case report details the perioperative challenges and anesthesia strategies in managing severe pulmonary hypertension (PH) during emergency orthopedic surgery. An 86-year-old male with multiple comorbidities, including severe PH, presented with a hip fracture. Multidisciplinary collaboration was crucial for preoperative optimization, including transfusions, antithrombotic discontinuation, and thromboprophylaxis initiation. Anesthesia management included the use of spinal anesthesia combined with a precautionary epidural catheter insertion, low-dose hyperbaric bupivacaine, and continuous monitoring to prevent hemodynamic instability. Postoperatively, the patient was closely monitored in the surgical intensive care unit. This case highlights the necessity of meticulous planning and proactive monitoring in optimizing outcomes for severe PH in emergency orthopedic surgery.

Management of Rarest Type of Talus Fracture: A Case Report.

This is a case of the rarest type of talus fracture in a 28-year-old male who presented with pain in his right ankle and foot following a road traffic accident. He was unable to bear weight or walk after the injury. Imaging studies indicated fractures in the head and neck of the talus, as well as the talar dome, with a fracture line extending into the subtalar joint. The patient underwent open reduction and internal fixation using mini fragment plating and Herbert screw fixation for the osteochondral fragment. Both the intraoperative and postoperative periods were without complications. The patient was placed in plaster of Paris (POP) slab immobilization for four weeks and was advised to avoid weight-bearing while using a walker for eight weeks, after which physiotherapy commenced. Follow-up assessments showed satisfactory fracture union, good range of motion in the ankle, an excellent American Orthopedic Foot and Ankle Society (AOFAS) score, an excellent 17-Italian Foot Function Index (FFI) score, and a good Hawkins score.

Postoperative challenges addressed through nursing care of patients receiving lower extremity tumor prosthesis.

BACKGROUND: Patients with primary Bone Sarcoma and Giant Cell Tumors in the lower extremities often require major surgery involving tumor prostheses. The postoperative course for this patient group can be complex and influenced by various factors and challenges that demand careful nursing care. This study aims to identify challenges related to the nursing care of individuals with primary bone tumors following surgery for tumor prostheses in the lower extremities. METHODS: A retrospective cohort study of 15 patients treated at Rigshospitalet, Copenhagen, Denmark, between November 5. 2016, and April 1. 2020 was conducted by medical record review, focusing on challenges related to postoperative nursing care. All patients with the surgery code "Bone Excision" were identified within the surgery booking system and screened for eligibility. RESULTS: Patients experienced postoperative challenges such as severe pain, prolonged time to mobilization (mean: 4 days), and defecation (mean: 5 days). The mean length of stay at the Rigshospitalet was 13 days. Furthermore, eleven patients (73%) reported disrupted sleep and nausea. CONCLUSION: Patients undergoing tumor prosthesis surgery in the lower extremities face considerable postoperative challenges that contribute to a prolonged hospital stay. These challenges, including severe pain, delayed mobilization, and gastrointestinal issues, significantly impact recovery. The findings highlight the urgent need for targeted nursing interventions to address these issues effectively. Enhanced pain management protocols, early mobilization strategies, and comprehensive postoperative care plans are essential to improve patient outcomes and reduce the length of hospital stays. Addressing these challenges through dedicated nursing care is crucial for optimizing the recovery process for patients receiving lower extremity tumor prostheses.

Impact of rapid response system in mortality and complications post-orthopedic surgery: a retrospective cohort study.

BACKGROUND: Rapid response systems (RRSs) are used in hospitals to identify and treat deteriorating patients. However, RRS implementation and outcomes in orthopedic and surgical patients remain controversial. We aimed to investigate whether the RRS affects mortality and complications after orthopedic surgery. METHODS: The National Health Insurance Service of South Korea provided the data for this population-based cohort study. Individuals who were admitted to the hospital that implemented RRS were categorized into the RRS group and those admitted to a hospital that did not implement the RRS were categorized into the non-RRS group. In-hospital mortality and postoperative complications were the endpoints. RESULTS: A total of 931,774 adult patients were included. Among them, 93,293 patients underwent orthopedic surgery in a hospital that implemented RRS and were assigned to the RRS group, whereas 838,481 patients were assigned to the non-RRS group. In multivariable logistic regression analysis, the RRS group was not associated with in-hospital mortality after orthopedic surgery compared with the non-RRS group (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.80, 1.08; P = 0.350). However, the RRS group was associated with a 14% lower postoperative complication rate after orthopedic surgery than the non-RRS group (OR 0.86, 95% CI 0.84, 0.86; P < 0.001). CONCLUSIONS: The RRS was not associated with in-hospital mortality following orthopedic surgery in South Korea. However, RRS deployment was related to a decreased risk of postoperative complications in patients undergoing orthopedic surgery.

Successful Midfoot Reconstruction in Müller-Weiss Disease Using a Reverse Fibular Flap: A Case Report and Literature Review.

Müller-Weiss disease (MWD) is a poorly understood orthopedic condition first described in 1927 that causes chronic pain across the midfoot and hindfoot. The etiology is uncertain but includes navicular dysplasia, osteochondritis, and trauma. The initial management is conservative, aiming to reduce the patient's symptoms, and includes analgesia, footwear, and activity modification. Surgical interventions such as joint fusion are considered when conservative measures fail, but there is little recorded for treatment beyond this. This case outlines the difficult management of a 52-year-old female patient with a long history of MWD. She had no history of previous trauma or neurological problems. A talonavicular fusion failed to unite, resulting in significant necrosis of the lateral navicular and navicular-cuneiform arthritis. We describe the novel use of a reverse vascularized pedicled fibular flap and extended midfoot fusion to manage the navicular bone defect. At six-year follow-up, the patient remains virtually pain-free and has returned to work with radiographs confirming good incorporation of the bone graft. We understand this to be the first documented use of a reverse vascularized fibular bone graft for recalcitrant MWD. Given the excellent clinical outcome in this case, surgeons should consider this combined ortho-plastics approach in the management of complex non-union with a bone defect in the midfoot.

Comparison of Mean Postoperative Hemoglobin Concentrations in Patients Undergoing Total Knee Arthroplasty With Intravenous Versus Intraarticular Administration of Tranexamic Acid.

BACKGROUND:  Total knee arthroplasty (TKA) may result in significant blood loss, but it is an effective and affordable treatment for severe osteoarthritis in the knees. While intravenous (IV) tranexamic acid (TXA) is a commonly used technique, intraarticular (IA) TXA has just recently started to gain traction in joint replacement procedures. The purpose of this research was to examine the mean postoperative hemoglobin concentration in order to assess the effectiveness of TXA administered IV vs IA after TKA. OBJECTIVE: To assess the effectiveness of intraarticular TXA against intravenous administration. MATERIALS AND METHODS: The six-month randomized controlled experiment was started from October 5, 2022, to April 4, 2023, at "the Orthopedics Department of Sir Ganga Ram Hospital in Lahore". The experiment included 60 patients undergoing TKA, ranging in age from 30 to 70. All members of the surgical team, including the supervisor (a consultant surgeon), assistants, and researchers, were present throughout the surgery. A high, thigh tourniquet was employed in every case, and a medial parapatellar technique was performed as well. Before the tourniquet was inflated, individuals in the intravenous group received 1 g of TXA intravenously 15-30 minutes beforehand. In the IA group, the "patient received an injection of 2 g of TXA in a 20 mL solution" straight into the joint after the prosthesis was implanted and secured. Data were analyzed using SPSS (version 26), with numerical data (age, BMI, surgical length, and hemoglobin levels) presented as mean ± SD and categorical factors (gender, American Society of Anesthesiologists (ASA) class, anatomical side) shown as frequency and percentage. The mean postoperative hemoglobin levels were compared between groups using an independent sample t-test, with data stratified by various factors and p ≤ 0.05 considered significant. RESULTS: There were 60 patients in this study, ranging in age from 30 to 70. The mean±SD age was 48.73±10.35 years. Patients' mean BMI was 25.51±4.48 kg/m², with representation across underweight, normal, overweight, and obese categories. The procedure took 173.10±32.61 minutes. The overall postoperative hemoglobin concentration was significantly higher in the IA TXA group (12.12±1.32 g/dL) compared to the IV TXA group (11.11±1.10 g/dL), with a p-value of 0.02. Additionally, when stratified by age, the IA TXA group consistently demonstrated higher postoperative hemoglobin levels across all age brackets, with significant differences observed in the 51-60 years (p = 0.001) and 61-70 years (p = 0.011) groups. Gender-based comparisons showed that IA TXA was associated with higher postoperative hemoglobin levels for both males (p < 0.05) and females (p < 0.05) compared to IV TXA. CONCLUSION: This study demonstrates that IA administration of TXA is more effective in maintaining higher postoperative hemoglobin concentrations compared to IV TXA in patients undergoing TKA. The IA TXA group consistently achieved significantly higher hemoglobin levels across various age groups and both genders, indicating superior efficacy in reducing blood loss associated with TKA. These findings suggest that IA TXA could be a preferable alternative to IV TXA for enhancing postoperative hemoglobin recovery and potentially improving patient outcomes in knee arthroplasty procedures.

Thermal Evaluation of Bone Drilling with a One-Drill Protocol.

This study evaluates the thermal impact of a one-drill protocol for osteotomy preparation in dental implant surgery. Our findings demonstrate a significant reduction in heat generation compared to traditional sequential drilling, suggesting potential benefits for implant osseointegration and patient comfort. Specifically, the one-drill protocol was associated with lower peak temperatures and a reduced duration of elevated temperatures. These findings suggest that the one-drill protocol may contribute to improved implant stability and reduce the risk of thermal-induced bone damage. While further research is needed to confirm these findings in clinical settings, the results of this study provide promising evidence for the potential advantages of the one-drill protocol in dental implant surgery. Additionally, the one-drill protocol may offer simplified surgical workflows and reduced instrument management, potentially leading to improved efficiency and cost-effectiveness in dental implant procedures.

Analysis of orthopedic surgery-related incidents in operating rooms using a nationwide incident reporting database.

BACKGROUND: Patient safety is crucial in high-risk specialties such as orthopedic surgery due to the significant incidence of preventable adverse events. Analyzing extensive databases of orthopedic surgery-related incidents in operating rooms is vital for enhancing medical safety and identifying targeted interventions. This study analyzed orthopedic surgery-related incidents in operating rooms using a nationwide incident reporting database in Japan to identify risk factors associated with severe harm. METHODS: We extracted orthopedic surgery-related incidents in the operating room from the Japan Council for Quality Health Care's database, which contained 127,207 near-miss and adverse event reports recorded between January 1, 2010 and September 30, 2022. We analyzed 882 incident cases, focusing on patient demographics, incident timing, surgical site, incident causes, and severity levels. RESULTS: The most incidents involved surgeons (93.3 %) with an average of 16.0 ± 8.5 years of experience. The frequent causes were "failure to check" (48.0 %) and "misjudgment" (24.0 %), which were non-technical errors. "Errors in methods/procedures" accounted for 37.1 % of incidents, possibly due to a wide variety of surgical approaches and implants used in orthopedic surgeries. Regarding severity, 86 % were critical incidents that threatened patients' livelihoods or lives. Surgeries involving surgeons had a significantly higher risk of severe harm than those involving healthcare professionals other than surgeons (odds ratio: 3.311, 95 % confidence interval: 1.858-5.901). CONCLUSIONS: This study revealed that most of orthopedic surgery-related incidents in operating rooms involved experienced surgeons and resulted in severe patient harm. The frequent causes were failure to check, misjudgment, and errors in methods/procedures. These highlight the crucial role of orthopedic surgeons in actively contributing to medical safety databases and fostering a culture of reporting within their field.

Prevalence of Vitamin D Deficiency in Orthopedic Trauma Patients: A Cross-Sectional Survey From a Tertiary Care Trauma Center.

Background Vitamin D deficiency is prevalent globally, with potential consequences for bone health and trauma outcomes. This study aimed to assess the prevalence of vitamin D deficiency in orthopedic trauma patients and investigate its correlation with various demographic and injury-related factors. Methodology A cross-sectional investigation was undertaken at a tertiary care center. An evaluation of serum 25-hydroxyvitamin D3 levels was conducted on 124 individuals, aged 20 to 70 years, who were hospitalized with orthopedic injuries. Demographic information, the injury method, the bone involvement pattern, and socioeconomic status were documented. Statistical analysis was employed to evaluate the correlations between vitamin levels D and these variables. Results The overall prevalence of vitamin D deficiency was 54 (43.6%) cases, with nine (7.3%) cases exhibiting severe deficiency and 45 (36.3%) cases exhibiting moderate deficiency. Higher rates of deficiency were associated with lower socioeconomic status (p = 0.044) and low-velocity trauma (p = 0.037). No significant association was found with age, sex, or residence. Interestingly, patients with multiple fractures were more prone to deficiency compared to those with single fractures. Conclusions This survey revealed a significant vitamin D deficiency among orthopedic trauma patients. Factors such as socioeconomic status and the nature of the injury emerged as significant risk factors. While conducting routine vitamin D assessments might pose challenges in developing nations, consistent supplementation could prove advantageous in enhancing fracture healing and overall health outcomes among this demographic. There is a call for future research to delve deeper into the role of vitamin D in trauma management and refine supplementation strategies.

Perioperative Pain Management in Hemophilic Patient Undergoing Orthopedic Surgery: A Narrative Review.

BACKGROUND: Hemophilia type A and B is associated with spontaneous bleeding in muscle tissues and joints. Acute hemarthrosis, representing 70-80% of all bleedings in severe hemophilia patients, is extremely painful. When surgical procedures are needed in hemophiliac patients, perioperative management should be planned with a multidisciplinary team. Our narrative review, through a rigorous analysis of the current literature, focuses on pain management in hemophiliac patients. METHODS: The report synthesizes a literature review on hemophilia, adapting PRISMA guidelines. It identifies a research question on surgical procedures and perioperative pain management. Various sources, including electronic databases, are utilized. Study inclusion criteria are defined based on the research question. Forty studies are included. A detailed study selection is illustrated. RESULTS: Guidelines for managing acute postoperative pain in the general population advocate for a multimodal analgesic administration to enhance synergistic benefits, reduce opioid requirements, and minimize side effects. Recent recommendations from the World Federation of Hemophilia (WFH) for postoperative pain management in hemophilia patients suggest tailoring treatment based on pain levels, in coordination with anesthesiologists. CONCLUSIONS: Pain management in hemophiliac patients undergoing orthopedic interventions requires a multidisciplinary approach, with further research needed to define a reliable global standard of treatment.

Mechanical Performance of Cellulose Nanocrystal and Bioceramic-Based Composites for Surgical Training.

This study evaluated the mechanical performance of a cellulose nanocrystal (CNC)-based composite, consisting of hydroxyapatite and natural fibers, mimicking the mechanical properties of real bone. The effect of natural nanofibers on the cutting force of the composite was evaluated for suitability in surgical training. Although hydroxyapatite has been extensively studied in bone-related applications, the exploration of epoxy-based composites incorporating both hydroxyapatite and CNC represents a novel approach. The evaluation involved a load cell with an oscillating saw. The uniform distribution of CNCs within the composite was assessed using 3D X-ray imaging. The cutting force was found to be 4.005 ± 0.5469 N at a feed rate of 0.5 mm/s, comparable to that required when cutting real bone with the osteon at 90°. The 90-degree orientation of the osteon aligns with the cutting direction of the oscillating saw when performing knee replacements on the tibia and femur bones. The addition of CNCs resulted in changes in fracture toughness, leading to increased material fragmentation and surface irregularities. Furthermore, the change in the cutting force with depth was similar to that of real bone. The developed composite material enables bone-cutting surgeries using bioceramics and natural fibers without the risks associated with cadavers or synthetic fibers. Mold-based computed tomography data allows for the creation of various bone forms, enhancing skill development for surgeons.

Ethical Considerations in the Management of Orthopedic Surgery Waste: Balancing Environmental Protection and Participant Safety.

The healthcare sector significantly contributes to global greenhouse gas (GHG) emissions, with orthopedic surgery generating substantial waste, including single-use devices and hazardous materials. These practices exacerbate climate change and environmental degradation. This article explores the environmental and ethical implications of waste management in orthopedic surgery, focusing on the need for sustainable practices. Key approaches include recycling and reusing materials, implementing closed-loop supply chains, and promoting sustainable procurement. Case studies from various countries, such as Asia (India, Pakistan, Bangladesh), Africa, and Latin America, highlight the challenges and progress in managing medical waste, emphasizing the substantial potential for recycling preoperative waste. Ethical considerations revolve around ensuring safe waste handling to protect healthcare workers, patients, and communities while maintaining high standards of care. This should be done as per infection control and biomedical waste protocols. National and international ethical guidelines extend their discussion to the principles of biomedical and health ethics (autonomy, beneficence, non-maleficence, and justice), especially regarding informed consent and the reuse of medical devices. Patients should be fully informed about environmental and waste management practices, with an emphasis on transparency and voluntary participation. The reuse of external fixators, while cost-effective, raises questions about ownership, safety, and cost transparency. The article underscores the importance of adopting eco-friendly practices and green technologies in healthcare to mitigate the sector's carbon footprint. Initiatives such as energy-efficient buildings, renewable energy sources, and comprehensive recycling programs are vital. The conclusion calls for regulatory bodies and healthcare organizations to enforce guidelines for ethical waste management, balancing cost-effective practices with patient autonomy and environmental responsibility. Ethical waste management in orthopedic surgery is crucial for protecting the environment and the service providers and ensuring the well-being of all stakeholders involved.

Linear and Volumetric Polyethylene Wear Patterns after Primary Cruciate-Retaining Total Knee Arthroplasty Failure: An Analysis Using Optical Scanning and Computer-Aided Design Models.

(1) Background: Analyses of retrieved inserts allow for a better understanding of TKA failure mechanisms and the detection of factors that cause increased wear. The purpose of this implant retrieval study was to identify whether insert volumetric wear significantly differs among groups of common causes of total knee arthroplasty failure, whether there is a characteristic wear distribution pattern for a common cause of failure, and whether nominal insert size and component size ratio (femur-to-insert) influence linear and volumetric wear rates. (2) Methods: We digitally reconstructed 59 retrieved single-model cruciate-retaining inserts and computed their articular load-bearing surface wear utilizing an optical scanner and computer-aided design models as references. After comprehensively reviewing all cases, each was categorized into one or more of the following groups: prosthetic joint infection, osteolysis, clinical loosening of the component, joint malalignment or component malposition, instability, and other isolated causes. The associations between volumetric wear and causes of failure were estimated using a multiple linear regression model adjusted for time in situ. Insert linear penetration wear maps from the respective groups of failure were further processed and merged to create a single average binary image, highlighting a potential wear distribution pattern. The differences in wear rates according to nominal insert size (small vs. medium vs. large) and component size ratio (≤1 vs. >1) were tested using the Kruskal-Wallis test and the Mann-Whitney test, respectively. (3) Results: Patients with identified osteolysis alone and those also with clinical loosening of the component had significantly higher volumetric wear when compared to those without both causes (p = 0.016 and p = 0.009, respectively). All other causes were not significantly associated with volumetric wear. The instability group differentiated from the others with a combined peripheral antero-posterior wear distribution. Linear and volumetric wear rates showed no significant differences when compared by nominal insert size (small vs. medium vs. large, p = 0.563 and p = 0.747, respectively) or by component (femoral-to-insert) size ratio (≤1 vs. >1, p = 0.885 and p = 0.055, respectively). (4) Conclusions: The study found increased volumetric wear in cases of osteolysis alone, with greater wear when combined with clinical loosening compared to other groups. The instability group demonstrated a characteristic peripheral anterior and posterior wear pattern. Insert size and component size ratio seem not to influence wear rates.

The Effect of Patient Education on Pain Level and Fear of Pain in Orthopedic Surgery: A Randomized Controlled Trial.

PURPOSE: Patients experience pain after surgery, an expected symptom, and a common and important care problem. The purpose of the study was to determine the effect of patient education on pain level and fear of pain in orthopedic trauma patients. DESIGN: The study is a randomized controlled trial research design. METHODS: A total of 52 patients, 26 in the experimental group and 26 in the control group, were included in the study. The experimental group received patient education about the operative process and pain management the day before the operation and the morning of the surgery. The Information Form, Fear of Pain Scale-III, and Visual Analog Scale were used to gather data. FINDINGS: We found that the patients' pain levels were low. Patients had a fear of severe pain above the average level, fear of mild pain below the average level, and fear of medical pain at the time of hospitalization and discharge. The medical pain level of the patients in the experimental group at the time of discharge was lower than the fear of medical pain at the time of hospitalization. CONCLUSIONS: Preoperative pain management education for orthopedic trauma patients is effective in reducing the fear of medical pain. We identified that pain management patient education to orthopedic trauma patients before surgery was effective in decreasing the fear of medical pain. TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov. Identifier: NCT05887596.

Postoperative Complications in Patients With Metabolic Syndrome Following Unicompartmental Knee Arthroplasty.

INTRODUCTION: Metabolic syndrome is associated with increased risk of postoperative complications following various orthopedic surgeries. This study looked to identify specific postoperative complications in these patients following unicompartmental knee arthroplasty (UKA). METHODS: Adult patients undergoing primary UKA were queried in the National Surgical Quality Improvement Program database from 2006-2019. Metabolic syndrome was defined by the simultaneous presence of hypertension, diabetes, and body mass index >30 kg/m2. Two patient groups were categorized in this study: patients with metabolic syndrome and patients without metabolic syndrome. Baseline characteristics and postoperative outcomes were compared between the two cohorts with the use of bivariate and multivariate analyses. RESULTS: In total, 10,557 patients underwent UKA. Of these, 9,511 patients (90.1%) did not have metabolic syndrome whereas 1,046 (9.9%) had metabolic syndrome. Following adjustment for potential confounding variables on multivariate analysis, metabolic syndrome patients had an increased risk of an extended length of stay greater than four days (OR 1.66; p=0.016) compared to patients without metabolic syndrome. CONCLUSION: Metabolic syndrome was associated with an increased risk of extended length of stay greater than four days following UKA. Physicians should be prepared for this complication as well as others when discussing treatment with metabolic syndrome patients.

Does Preoperative Virtual Reality Experience Enhance Implant Positioning Accuracy in Total Hip Arthroplasty?

Purpose Total hip arthroplasty (THA) requires precise implant positioning to ensure long-term success. Herein, we evaluated the effect of virtual reality (VR) on the surgical precision of THA, particularly when used by experienced surgeons. Methods In this single-center, prospective, case-control study, 34 patients who underwent primary THA performed by a single experienced surgeon were divided into the control (without VR simulation) and VR (with VR simulation) groups. Preoperative planning involved the creation of three-dimensional models from computed tomography scans using ZedHip® software (Lexi, Tokyo, Japan). The primary outcomes assessed included the accuracy of implant placement, operative time, and intraoperative blood loss. The secondary outcomes included postoperative hospital stay and in-hospital complications. Results A significant improvement in radiographic inclination (RI) was observed in the VR group as compared to controls. Other surgical parameters, such as radiographic anteversion, operation time, blood loss, and postoperative hospital stay, showed no significant differences between the groups. Discrepancies in planned versus actual implant sizes were noted but were not significantly different between groups. Conclusion VR application in preoperative planning improved the RI accuracy in acetabular cup placement for THA, demonstrating its potential to enhance surgical precision for experienced surgeons. This study highlights the evolving role of VR, from a training tool to an integral part of advanced surgical planning in orthopedics.

Enhancing the precision of continuum robots in orthopedic surgery based on mechanical principles.

Introduction: In the field of orthopedic surgery, the notched continuum robot has garnered significant attention due to its passive compliance, making it particularly suitable for procedures in complex and delicate bone and joint regions. However, accurately modeling the notched continuum robot remains a significant challenge. Methods: This paper proposes a high-precision mechanical modeling method for the notched continuum robot to address this issue. The flexible beam deflection prediction model based on the beam constraint model is established. The force balance friction model considering internal friction is established. An accurate static model is obtained, which can accurately estimate the deformation and deflection behavior of the robot according to the input driving force. The kinematic model of the notched continuum robot based on the static model is established. This method achieves high accuracywhile ensuring computational efficiency. Results: Experimental results demonstrate that the static model's error is only 0.1629 mm, which corresponds to 0.25% of the total length of the continuum robot, which is 66 mm. Discussion: This research provides valuable insights into the modeling and control of continuum robots and holds significant implications for advancing precision in orthopedic surgery.

Substantial medial para-meniscal cyst with a complex meniscal tear: A case report.

INTRODUCTION AND IMPORTANCE: Meniscal cysts, while infrequent with a prevalence of 1 %-8 %, may result in considerable knee discomfort and functional limitations. The cysts are categorized according to their position in relation through the meniscus, labeled as either intrameniscal or parameniscal. Although parameniscal cysts are often small and asymptomatic, they may expand and become painful with time. This case report describes an uncommon instance of a medial parameniscal cyst. CASE PRESENTATION: A 28-year-old male presented with persistent pain and swelling in the medial aspect of his left knee, lasting for 8 months. His symptoms were exacerbated by activities such as stair climbing and general mobility. On physical examination, a firm, fluctuating mass measuring 5 × 3 cm was noted. MRI revealed a complex tear in the posterior horn of the medial meniscus, along with a cyst measuring 4.9 × 3.2 × 2.0 cm. Arthroscopy identified a degenerative medial meniscus tear, and the cyst was excised through open surgery. The patient's recovery was uneventful, with full restoration of knee function within three months. CLINICAL DISCUSSION: Parameniscal cysts often coexist with horizontal meniscal tears, influenced by factors like knee laxity, trauma, and degeneration. MRI is the preferred diagnostic tool, but high-resolution ultrasound can be beneficial. Treatment options include conservative management and surgical interventions like partial meniscectomy, emphasizing the need for comprehensive diagnosis and appropriate management. CONCLUSION: This unique case of a medial parameniscal cyst highlights the critical need for timely diagnosis and intervention. Surgical treatment, including meniscectomy or meniscal repair, offers significant pain relief and functional improvement, demonstrating its effectiveness in managing such cases.

Long-term administration of alendronate sodium caused an atypical femoral shaft fracture in a 36-year-old woman: a case report and literature review.

Long-term bisphosphonate therapy is associated with atypical or insufficiency fractures, particularly in the proximal femur. We observed a case of an atypical femoral shaft fracture in a patient with a long-term history of alendronate therapy. A 36-year-old woman was admitted with a complaint of pain in her right mid-thigh following low-energy trauma. She had been taking alendronate for more than 15 years. X-rays indicated a fracture of the right femoral shaft. The patient was treated with proximal femoral nail antirotation (PFNA) fixation. This case highlights concerns regarding long-term bisphosphonate therapy and its potential complications.