An Integrated System Using Ultrasound-Based Registration for Surgical Navigation of Iliosacral Screw Insertions.

OBJECTIVE: Pelvic fractures often require fixation through iliosacral joint, typically guided by fluoroscopy using an untracked C-arm device. However, this involves ionizing radiation exposure and potentially inaccurate screw placement. We introduce the Navigated Orthopaedic Fixations using Ultrasound System (NOFUSS), a radiation-free ultrasound (US)-based end-to-end system for providing real-time navigation for iliosacral screw (ISS) insertions. METHODS: We performed surgeries on 8 human cadaver specimens, inserting four ISSs per specimen to directly compare NOFUSS against conventional fluoroscopy. Six specimens yielded usable (marginal or adequate quality) US images. RESULTS: The median screw entry error, midpoint error, and angulations errors for NOFUSS were 8.4 mm, 7.0 mm, and 1.4◦, compared to 7.5 mm (p = 0.52), 5.7 mm (p = 0.30), and 4.4◦ (p = 0.001) for fluoroscopy respectively. NOFUSS resulted in 6 (50%) breaches, compared to 2 (16.7%) in fluoroscopy (p = 0.19). The median insertion time was 7m 37s and 12m 36s per screw for NOFUSS and fluoroscopy respectively (p = 0.002). The median radiation exposure during the fluoroscopic procedure was 2m 44s, (range: 1m 44s - 3m 18s), with no radiation required for NOFUSS. When considering the three cadavers that yielded only adequate-quality US images (12 screws), the measured entry errors were 3.6 mm and 8.1 mm respectively for NOFUSS and fluoroscopy (p = 0.06). CONCLUSION: NOFUSS achieved insertion accuracies on par with the conventionalfluoroscopicmethod,andreducedinsertiontimesandradiation exposure significantly. SIGNIFICANCE: This study demonstrated the feasibility of an automated, radiation-free, US-based surgical navigation system for ISS insertions.

Trajectory of Recovery following ORIF for Distal Radius Fractures.

Background Distal radius fractures are commonly seen among the elderly, though studies examining their long-term outcomes are limited. Purpose The aim of this study was to describe the 5-year trajectory of recovery of distal radius fractures treated with open reduction and internal fixation (ORIF). Methods Patients with distal radius fractures (AO/OTA 23.A-C) treated by ORIF were prospectively studied. Patient-Rated Wrist Evaluation (PRWE) score was measured at baseline (preinjury recall) and postoperatively at 6 months, 1 year, and 5 years. Clinically relevant change in PRWE score was assessed using the minimal clinically important difference (MCID). Results A total of 390 patients were included, of which 75% completed 5-year follow-up. Mean baseline PRWE score was 1.25 (standard deviation, SD: 2.9). At 6 months, mean PRWE score was at its highest up to 20.2 (SD: 18.4; p < 0.01). A significant improvement in mean PRWE score was observed at 1 year down to 15.2 (SD: 17.6; p < 0.01); 44% of patients were still one MCID outside of their baseline PRWE score at 1 year. Further significant improvement in mean PRWE score occurred at 5 years down to 9.4 (SD: 13.4; p < 0.01); 29% of patients remained one MCID outside of their baseline PRWE score at 5 years. Conclusion Recovery after ORIF for distal radius fractures showed significant worsening after surgery, followed by significant improvements up to 1 year and between years 1 and 5, albeit to a lesser extent. Statistically and clinically relevant wrist pain and disability persisted at 5 years. Future research should examine different treatment modalities and include a nonoperative treatment arm for comparison. Level of Evidence Prognostic level II.

Applications of Natural Language Processing for Automated Clinical Data Analysis in Orthopaedics.

Natural language processing is an exciting and emerging field in health care that can transform the field of orthopaedics. It can aid in the process of automated clinical data analysis, changing the way we extract data for various purposes including research and registry formation, diagnosis, and medical billing. This scoping review will look at the various applications of NLP in orthopaedics. Specific examples of NLP applications include identification of essential data elements from surgical and imaging reports, patient feedback analysis, and use of AI conversational agents for patient engagement. We will demonstrate how NLP has proven itself to be a powerful and valuable tool. Despite these potential advantages, there are drawbacks we must consider. Concerns with data quality, bias, privacy, and accessibility may stand as barriers in the way of widespread implementation of NLP technology. As natural language processing technology continues to develop, it has the potential to revolutionize orthopaedic research and clinical practices and enhance patient outcomes.

The double-edged scalpel: Experiences and perceptions of pregnancy and parenthood during Canadian surgical residency training.

INTRODUCTION: Only 34% of Canadian surgeons in 2022 were female. The protracted length of surgical residency training, concerns regarding infertility, and increased rates of obstetrical complications have been shown to contribute to the disproportionate lack of females in surgical specialties. METHODS: A novel online survey was sent to all surgical residents in Canada. Respondents were asked about perceptions of pregnancy and parenthood during surgical training, and parents were asked about parental leave, accommodations they received, and pregnancy complications. Chi squared tests were used to compare opinions of male and female residents. RESULTS: A total of 272/2,419 (11.2%) responses were obtained, with a high response from females (61.8%) and orthopaedic residents (29.0%). There were 56 women reporting 76 pregnancy events during training, 62.5% of which had complications. Notably, 27.3% of men and 86.7% of women 'agreed' or 'strongly agreed' that surgeons have higher pregnancy complication rates than the general population (p<0.001). Men were much less likely to believe that pregnant residents should be offered modified duties (74.2% of men, 90.0% of women, p = 0.003). Women were much more likely to experience significant stigma or bias due to their status as a parent (43% of women, 0% of men, p<0.001). Women reported negative comments from others at a higher rate (58.5% of women, 40.7% of men, p = 0.013). Women believe there is negative stigma attached to being pregnant during training (62.7% of women, 42.7% of men, p = 0.01). The limitations of our study include a small sample size and response bias. CONCLUSION: Challenges and negative perceptions exist around pregnancy and parenthood in surgical residency, which disproportionately affect women trainees.

Radiographic Union Assessment in Surgically Treated Distal Femur Fractures: A Systematic Review.

BACKGROUND: Distal femur fractures are known to have challenging nonunion rates. Despite various available treatment methods aimed to improve union, optimal interventions are yet to be determined. Importantly, there remains no standard agreement on what defines radiographic union. Although various proposed criteria of defining radiographic union exist in the literature, there is no clear consensus on which criteria provide the most precise measurement. The use of inconsistent measures of fracture healing between studies can be problematic and limits their generalizability. Therefore, this systematic review aims to identify how fracture union is defined based on radiographic parameters for surgically treated distal femur fractures in current literature. METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Medline, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection databases were searched from inception to October 2022. Studies that addressed surgically treated distal femur fractures with reported radiographic union assessment were included. Outcomes extracted included radiographic definition of union; any testing of validity, reliability, or responsiveness; reported union rate; reported time to fracture union; and any functional outcomes correlated with radiographic union. RESULTS: Sixty articles with 3,050 operatively treated distal femur fractures were included. Operative interventions included lateral locked plate (42 studies), intramedullary nail (15 studies), dynamic condylar screw or blade plate (7 studies), dual plate or plate and nail construct (5 studies), distal anterior-posterior/posterior-anterior screws (1 study), and external fixation with a circular frame (1 study). The range of mean follow-up time reported was 4.3 to 44 months. The most common definitions of fracture union included "bridging or callus formation across 3 of 4 cortices" in 26 (43%) studies, "bony bridging of cortices" in 21 (35%) studies, and "complete bridging of cortices" in 9 (15%) studies. Two studies included additional assessment of radiographic union using the Radiographic Union Scale in Tibial fracture (RUST) or modified Radiographic Union Scale in Tibial fracture (mRUST) scores. One study included description of validity, and the other study included reliability testing. The reported mean union rate of distal femur fractures was 89% (range 58%-100%). The mean time to fracture union was documented in 49 studies and found to be 18 weeks (range 12-36 weeks) in 2,441 cases. No studies reported correlations between functional outcomes and radiographic parameters. CONCLUSION: The current literature evaluating surgically treated distal femur fractures lacks consistent definition of radiographic fracture union, and the appropriate time point to make this judgement is unclear. To advance surgical optimization, it is necessary that future research uses validated, reliable, and continuous measures of radiographic bone healing and correlation with functional outcomes. LEVEL OF EVIDENCE: Level IV. See Instructions for Authors for a complete description of levels of evidence.

Evaluation of the trajectory of recovery following surgically treated acetabular fractures.

Aims: Acetabular fractures are associated with long-term morbidity. Our prospective cohort study sought to understand the recovery trajectory of this injury over five years. Methods: Eligible patients at a level I trauma centre were recruited into a longitudinal registry of surgical acetabular fractures between June 2004 and August 2019. Patient-reported outcome measures (PROMs), including the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS), were recorded at baseline pre-injury recall and six months, one year, two years, and five years postoperatively. Comparative analyses were performed for elementary and associated fracture patterns. The proportion of patients achieving minimal clinically important difference (MCID) was determined. The rate of, and time to, conversion to total hip arthroplasty (THA) was also established. Results: We recruited 251 patients (253 fractures), with a 4:1 male to female ratio and mean age of 46.1 years (SD 16.4). Associated fracture patterns accounted for 56.5% of fractures (n = 143). Trajectory analysis showed all timepoints had significant disability versus baseline, including final follow-up (p < 0.001). Elementary fractures had higher SF-36 PCS at six months (p = 0.023) and one year (p = 0.007) compared to associated fractures, but not at two years (p = 0.135) or five years (p = 0.631). The MCID in SF-36 PCS was observed in 37.3% of patients (69/185) between six months and one year, 26.9% of patients (39/145) between one and two years, and 23.3% of patients (20/86) between two and five years, highlighting the long recovery potential of these injuries. A significant proportion of patients failed to attain the MCID after five years (38.1%; 40/105). Conversion to THA occurred in 13.1% of patients (11/110 elementary and 22/143 associated fractures). Approximately two-thirds of THAs (21/33 patients; 63.6%) were performed within two years of index surgery. Conclusion: Acetabular fractures significantly impact physical function. Recovery trajectory is often elongated beyond one year, with two-thirds of our patients displaying persistent clinically relevant long-term disability.