Risk Factors for Loss to Follow-up of Elderly Patients After Hip Fracture Surgery: A Retrospective Cohort Study.

Introduction: Non-attendance with scheduled postoperative follow-up visits remains a common issue in orthopaedic clinical research. The objective of this study was to identify the risk factors associated with loss to follow-up among elderly patients with hip-fracture postoperatively. Methods: A retrospective analysis of 1-year post-surgery was performed on patients aged over 60 years who underwent hip-fracture surgery from January 2017 to March 2019. Based on their completion of the appointed follow-up schedule, the patients were classified into 2 groups: the Loss to Follow-up (LTFU) Group and the Follow-up (FU) Group. Clinical outcomes were evaluated by Functional Recovery Score (FRS) questionnaires. Telephone interviews were conducted with patients lost to follow-up to determine the reasons for non-attendance. A comparative analysis of baseline characteristics between the 2 groups was implemented, with further exploration of statistical differences through logistic regression. Results: A total of 992 patients met the inclusion criteria were included in this study, of which 189 patients, accounting for 19.1%, were lost to follow-up 1 year postoperatively. The mean age of the patients in the LTFU Group was 82.0 years, significantly higher than the 76.0 years observed in the FU Group (P < 0.001). The FRS for the LTFU Group was marginally higher than that of the FU group (84.0 vs 81.0), with no significant difference (P = 0.060). Logistic regression analysis identified several significant predictors of noncompliance, including advanced age at surgery, femoral neck fracture, hip arthroplasty, long distance from residence to hospital, and the reliance on urban-rural public transportation for reaching the hospital. Conclusion: Postoperative follow-up loss was prevalent among elderly patients with hip fractures. Our study indicated a constellation of risk factors contributing to noncompliance, including advanced age, transportation difficulties, long travel distance, femoral neck fracture and hip arthroplasty surgery.

Characterisation of 3D-printed acetabular hip implants.

Three-dimensional printing is a rapidly growing manufacturing method for orthopaedic implants and it is currently thriving in several other engineering industries. It enables the variation of implant design and the construction of complex structures which can be exploited in orthopaedics and other medical sectors. In this review, we develop the vocabulary to characterise 3D printing in orthopaedics from terms defined by industries employing 3D printing, and by fully examining a 3D-printed off-the-shelf acetabular cup (Fig. 1). This is a commonly used 3D-printed implant in orthopaedics, and it exhibits a range of prominent features brought about by 3D printing. The key features and defects of the porous and dense regions of the implant are clarified and discussed in depth to determine reliable definitions and a common understanding of characteristics of 3D printing between engineers and medical experts in orthopaedics. Despite the extensive list of terminology derived here, it is clear significant gaps exist in the knowledge of this field. Therefore, it is necessary for continued investigations of unused implants, but perhaps more significantly, examining those in vivo and retrieved to understand their long-term impact on patients and the effects of certain features (e.g. surface-adhered particles). Analyses of this kind will establish an understanding of 3D printing in orthopaedics and additionally it will help to update the regulatory approach to this new technology.

Demographics and Characteristics of Vice Chairs in Academic Orthopaedic Surgery Programs: A Descriptive Study.

INTRODUCTION: The Vice-chair (VC) position is gaining popularity in academic orthopaedic surgery departments; however, there is a paucity of information regarding qualifications and career advancements associated with this role. The purpose of this study was to define the characteristics of current orthopaedic surgery department VCs. DESIGN: Descriptive study following a retrospective web-based search utilizing the Fellowship and Residency Electronic Interactive Database (FREIDA) database and orthopaedic surgery residency program websites. SETTING: 200 ACGME-accredited orthopaedic surgery residency programs across the United States. PARTICIPANTS: Program name and hospital affiliations were collected from the FREIDA database to account for all ACGME-accredited programs. The following information was derived from publicly available program websites: title, role description, previously trained institutions, academic rank, and concurrent roles of VCs. Research productivity was measured using the H-index. The previous roles of current Department Chairs (DC) were also evaluated. RESULTS: Of the 178 VCs identified, VC of Research (n = 36; 20%), Education (n = 25; 14%), and Clinical Operations/Affairs (n = 21; 12%) were the most common titles. Women made up 17% (n = 30) of the VCs. Trauma (n = 36; 20%) was the most common fellowship subspecialty among VCs. The average H-index for VCs was 25. Among VCs, 94 (53%) were professors, 78 were also Chiefs/Heads/Directors (44%), 7 (4%) were Fellowship Directors, and 18 (10%) were Residency Directors. Twenty-six of 95 (27%) current DC had VC experience. CONCLUSION: The findings can facilitate effective leadership development, promotion of diversity and inclusion in these roles, and guidance for those who seek such leadership positions.

Arthroscopic Shoulder Simulation Studies Reveal Improvements in Performance Metrics without Proven Transferability to the Operating Room: A Systematic Review.

PURPOSE: The purpose of this systematic review was to evaluate the use of shoulder arthroscopic simulation in Orthopaedic surgery trainees. METHODS: A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Medline (Ovid), and EMBASE library databases. Inclusion criteria were experimental studies reporting pre- and post-test results of shoulder arthroscopic simulation in orthopaedic trainees (studies reporting results of comparison between groups not within the groups were excluded). Participant demographics, type of simulator training, simulator tasks assessed and performance outcome measures were systematically reviewed. Each performance outcome measure was graphically represented in a Forest plot with point estimates of the incidence of performance outcomes with corresponding 95% confidence intervals and I2. RESULTS: Fifteen studies met inclusion criteria with a total of 353 participants. The most common procedures simulated were diagnostic shoulder arthroscopy (n=9 [60%]), arthroscopic Bankart repairs (n=3 [20%]), and rotator cuff repairs (n =2 [13%]). Simulations primarily utilized virtual reality (60%) and bench top models (40%). The primary outcomes measured were time to task completion and Arthroscopic Surgical Skill Evaluation Tool (ASSET) scores. Time to task completion improved significantly with training (range 13-439 seconds pre-test to 8-253.29 seconds post-test), with substantial heterogeneity across studies (I2=87%). ASSET scores improved in 60% of the studies (ranging from 14-20.9 pre-test to 17.9-28.5 post-test), with low heterogeneity (I2=20%). Additionally, both camera and probe distances decreased after simulation use, while the 14-point anatomic checklist showed no pre to post-test differences. CONCLUSION: Arthroscopic simulation training benefits technical skills in shoulder arthroscopy, but the quality, assessment, and validity of these protocols vary. The translation of simulation training into the operating room has yet to be conclusively demonstrated.

International publication activity in orthopaedic surgery over a ten-year interval.

PURPOSE: International English language publication activities in orthopaedic surgery comparing the years 2008/09 to 2018/19 were analyzed. METHODS: 20 international journals listed on PubMed were examined. The impact factor (IF) for each journal was determined using the InCites Journal Citation Report. RESULTS: 9,205 publications in 2008/09 and 15,549 in 2018/19 with 21,435 cumulative IF (CIF) in 2008/09 and 50,552 in 2018/19 were registered. Most publications consisted of narrative reviews (42.0%), followed by clinical studies (22.0%), experimental investigations (16.9%), randomized controlled trials (6.0%), and meta-analyses (5.6%). The highest increase in publications was observed for narrative reviews from 33.5% in 2008/09 to 41.1% in 2018/19. The USA had the highest number of publications (2,981 and 4,796), followed by UK (806 and 879) and Germany (606 and 922) in 2008/09 and 2018/19, resp. Per 1 Mio inhabitants, Switzerland (13.6 and 28.4), Sweden (10.9 and 18.1), the Netherlands (9.6 and 15.4), and Denmark (9.0 and 21.8) were the most productive countries in 2008/09 and 2018/19, resp. CONCLUSIONS: International publishing activity in orthopaedic surgery has increased substantially over the last 10 years. The quality of the published articles has not increased in the same way, as evidenced by the disproportionate rise in narrative reviews. Over the entire period, the US were the leader with respect to number of publications and CIF. In terms of population, however, smaller countries such as Switzerland and Sweden were much more active.

Assessment of stress level and depression among orthopaedic surgeons in Saudi Arabia.

PURPOSE: The aim of this study was to assess the stress level and depression among orthopaedic surgeons in Saudi Arabia. In addition, to evaluate orthopedic training programs related factors that might have a critical role in the development of depression among orthopaedic surgeons. METHODS: The study adopted a cross-sectional study design. Two validated questionnaires were utilized, the Patient Health Questionnaire 9 (PHQ-9) and the Perceived Stress Scale (PSS-10) for assessing depressive symptoms and stress levels. Data was collected by sending the survey to the Saudi Commission for Health Specialties so they could be distributed throughout all registered orthopaedic surgeons. RESULTS: The study sample consisted of 325 participants. The results revealed that the severity of depression varied across the different groups. As per the PHQ-9 criteria, 74 (22.8%) were initially diagnosed with major depression. Among assistant consultants, 39.5% reported severe depression, while 34.9% reported mild depression. Consultants predominantly reported moderate perceived stress (82.9%) with a notable proportion experiencing high perceived stress (12.4%). Assistant consultants showed a balanced distribution, with 93.0% reporting moderate perceived stress and 4.7% reporting high perceived stress. Demographic variables gender, relationship status and having children revealed statistically significant relationship with PHQ-9 scores (p-value < 0.05) but not with PSS-10 scores. CONCLUSION: The study highlights pressing need to address mental health concerns within orthopaedic surgeons. To address these challenges, healthcare institutions should implement comprehensive mental health support programs offering resources for stress management, counseling services, and peer support groups.

Wireless In-Ear Communication for Total Joint Arthroplasty: A Simulated Operating Room Evaluation.

Effective communication is vital for patient safety, yet failures are common, often due to outdated methods. This study aimed to assess whether in-ear communication devices improve communication in orthopedic surgery simulations compared to traditional loud voice methods. Fifteen participants underwent simulations using both in-ear wireless devices and standard communication. Results showed significant improvements with in-ear devices in correctly identifying phrases (78.6% vs 44%), effectiveness (7.9/10 vs 4.9/10), and clarity (8/10 vs 4/10), all P < .001. Participants also favored in-ear devices in usability assessments. Sound levels recorded were comparable between groups. In conclusion, in-ear communication is safe and effective in orthopedic settings, potentially enhancing efficiency and safety. These devices can mitigate loud noises, benefiting surgeon well-being and patient outcomes.

Applications and accuracy of 3D-printed surgical guides in traumatology and orthopaedic surgery: A systematic review and meta-analysis.

Background: Patient-Specific Surgical Guides (PSSGs) are advocated for reducing radiation exposure, operation time and enhancing precision in surgery. However, existing accuracy assessments are limited to specific surgeries, leaving uncertainties about variations in accuracy across different anatomical sites, three-dimensional (3D) printing technologies and manufacturers (traditional vs. printed at the point of care). This study aimed to evaluate PSSGs accuracy in traumatology and orthopaedic surgery, considering anatomical regions, printing methods and manufacturers. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies were eligible if they (1) assessed the accuracy of PSSGs by comparing preoperative planning and postoperative results in at least two different planes (2) used either computer tomography or magnetic resonance imaging (3) covered the field of orthopaedic surgery or traumatology and (4) were available in English or German language. The 'Quality Assessment Tool for Quantitative Studies' was used for methodological quality assessment. Descriptive statistics, including mean, standard deviation, and ranges, are presented. A random effects meta-analysis was performed to determine the pooled mean absolute deviation between preoperative plan and postoperative result for each anatomic region (shoulder, hip, spine, and knee). Results: Of 4212 initially eligible studies, 33 were included in the final analysis (8 for shoulder, 5 for hip, 5 for spine, 14 for knee and 1 for trauma). Pooled mean deviation (95% confidence interval) for total knee arthroplasty (TKA), total shoulder arthroplasty (TSA), total hip arthroplasty (THA) and spine surgery (pedicle screw placement during spondylodesis) were 1.82° (1.48, 2.15), 2.52° (1.9, 3.13), 3.49° (3.04, 3.93) and 2.67° (1.64, 3.69), respectively. Accuracy varied between TKA and THA and between TKA and TSA. Conclusion: Accuracy of PSSGs depends on the type of surgery but averages around 2-3° deviation from the plan. The use of PSSGs might be considered for selected complex cases. Level of Evidence: Level 3 (meta-analysis including Level 3 studies).

Rehabilitation after musculoskeletal injury: an overview of systems in the United States and Canada.

As North America is largely industrialized with a variety of available private transportation options, trauma is a common occurrence, resulting in significant burdens of disability and costs to the health care system. To meet increasing trauma care needs, there is a robust organization of trauma and rehabilitation systems, particularly within the United States and Canada. The American and Canadian health care systems share multiple similarities, including well-equipped Level I trauma centers, specialized inpatient rehabilitation units for polytrauma patients, and thorough evaluations for recovery and post-discharge placement. However, they also have several key differences. In Canada, the criteria for admission to inpatient rehabilitation vary by location, and inpatient rehabilitation is universally accessible, whereas outpatient rehabilitation services are generally not covered by insurance. In the United States, these admission criteria for post-acute inpatient rehabilitation are standardized, and both inpatient and outpatient services are covered by private and government-funded insurance with varying durations. Overall, both health care systems face challenges in post-acute rehabilitation, including benefit limitations and limited provider access in rural areas, and must continue to evolve to meet the rehabilitation needs of injured patients as they reintegrate into their communities.

Challenges of perioperative pain control in opioid use disorder patients following intramedullary nail fixation.

BACKGROUND: Outcomes of patients with opioid use disorder undergoing elective procedures have been well studied, but research is lacking in the orthopaedic trauma population. AIM: The aim was to compare perioperative pain and morphine equivalents required by patients with versus without opioid use disorder following intramedullary nail fixation of femoral or tibial fractures. METHODS: We conducted a retrospective review of all patients with isolated femoral or tibial diaphyseal fractures treated with intramedullary nail fixation. Outcomes were compared between patients with diagnosed opioid use disorder and controls without, including daily morphine equivalents and patient-reported pain scores. RESULTS: Patients with opioid use disorder (n = 42) required greater morphine equivalents and reported higher pain than controls (n = 42) at all time points but did not differ in change of morphine equivalents over the perioperative period. CONCLUSION: This highlights the challenge of perioperative pain control in this population and need for improved specific pain management protocols.

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.

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.

Acute Compression of the Anterior Interosseous Nerve After a Proximal Both-Bone Forearm Fracture: A Case Report.

Anterior interosseous nerve (AIN) syndrome is a rare condition characterized by isolated weakness in the flexor pollicis longus (FPL) muscle, sometimes accompanied by weakness in the index flexor digitorum profundus (FDP) muscle. In this clinical case report, an 18-year-old male presented with a right proximal both-bone forearm fracture that was sustained while playing soccer, with subsequent development of AIN palsy, without sensory deficits or progressive pain. Preoperative imaging was performed, showing a proximal third radius and mid-shaft ulna fracture. Given the progressive presentation of an acute AIN palsy, the patient was indicated for urgent operative intervention. During exploration and decompression of the AIN within the pronator tunnel, the nerve was found to be in continuity but was compressed by a large hematoma and the distal radial shaft. The patient recovered full median nerve function by his six-week postoperative examination and by his final follow-up recovered full range of motion with painless return to full activities. In proximal or mid-shaft both-bone forearm fractures, a careful neurovascular exam is essential, as uncommon conditions like anterior interosseous syndrome (AIS) can present without obvious sensory deficits or pain. Potential etiology for traumatic AIN compression includes significant fracture displacement, soft tissue injury, active extravasation on advanced imaging, and/or clinical concern for compressive hematoma. Patients presenting with FPL and/or index FDP weakness in the absence of sensory deficits or pain on passive stretch may benefit from dedicated surgical exploration and decompression of the AIN to prevent irreversible nerve damage.

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.

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.

SUPRACONDYLAR FRACTURES IN CHILDREN: A SYSTEMATIC REVIEW OF TREATMENT OPTIONS.

OBJECTIVE: To compare the outcomes of surgical stabilization of pediatric supracondylar humeral fractures with the use of crossed Kirschner wires versus divergent lateral pinning wires. METHODS: This is a systematic review with meta-analysis carried out by searching the MEDLINE/PubMed, Science Direct and Scielo databases. In these, the search for journals was carried out between January and August 2023, where 695 studies were found. To assess the quality of the studies, the Jadad and the MINORS scales were used.. The selection and reading of relevant articles were carried out by the researchers and 11 studies met the selection criteria. RESULTS: From the 11 selected studies, 963 patients who met the criteria for the surgical treatment of these fractures were grouped. After the statistical analysis, we found that the ulnar nerve injury had a higher incidence when the crossed-K wire technique was used; and the lateral fixation is safer for the ulnar nerve. CONCLUSION: Both fixation techniques determine good functional results. However, fixation with lateral Kirschner wires proves to be safer considering the risk of iatrogenic injury to the ulnar nerve. Crossed-K wire fixation is more effective in terms of stability and maintenance of fracture reduction. Level of Evidence II, Systematic Review of Level II or Level I Studies with discrepant results.

Objetivo: Comparar os desfechos da estabilização cirúrgica das fraturas supracondilianas do úmero pediátricas com o uso de fios de Kirschner cruzados versus fios laterais divergentes. Métodos: Trata-se de uma Revisão Sistemática com metanálise realizada pela pesquisa nas bases de dados MEDLINE/PubMed, Science Direct e Scielo. Nessas, a busca dos periódicos foi realizada entre janeiro e agosto de 2023, e foram encontrados 695 estudos. Para a avaliação da sua qualidade, foram utilizadas a escala de Jadad e a escala MINORS. A seleção e a leitura dos artigos pertinentes foram realizadas pelos pesquisadores e 11 estudos preencheram os critérios de escolha. Resultados: Dos estudos selecionados, agrupamos 963 pacientes que preenchiam os critérios para o tratamento cirúrgico das fraturas. Após a análise estatística, observamos que maior incidência de lesão do nervo ulnar quando foi utilizada a técnica de pinagem cruzada; e a fixação lateral demonstrou ser mais segura para tal. Conclusão: Ambas as técnicas de fixação determinam bons resultados funcionais. Entretanto, a fixação com fios de Kirschner laterais demonstra ser mais segura, considerando o risco de lesão iatrogênica do nervo ulnar. A fixação com fios cruzados é mais eficaz, levando em conta a estabilidade e a manutenção da redução das fraturas. Nível de evidência II, Revisão sistemática de Estudos de Nível II ou Nível I com resultados discrepantes.

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.

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.

Does regional implementation of a clinical pathway for older adult patients with pelvic fragility fractures after low-energy trauma improve patient outcomes (PELVIC): a multicentre, stepped-wedge, randomised controlled trial.

INTRODUCTION: Patients with pelvic fragility fractures suffer from high morbidity and mortality rates. Despite the high incidence, there is currently no regional or nationwide treatment protocol which results in a wide variety of clinical practices. Recently, there have been new insights into treatment strategies, such as early diagnosis and minimally invasive operative treatment. The aim of this study is to implement an evidence-based and experience-based treatment clinical pathway to improve outcomes in this fragile patient population. METHODS AND ANALYSIS: This study will be a regional stepped-wedge cluster randomised controlled trial. All older adult patients (≥50 years old) who suffered a pelvic fragility fracture after low-energetic trauma are eligible for inclusion. The pathway aims to optimise the diagnostic process, to guide the decision-making process for further treatment (eg, operative or conservative), to structure the follow-up and to provide guidelines on pain management, weight-bearing and osteoporosis workup. The primary outcome is mobility, measured by the Parker Mobility Score. Secondary outcomes are mobility measured by the Elderly Mobility Scale, functional performance, quality of life, return to home rate, level of pain, type and dosage of analgesic medications, the number of falls after treatment, the number of (fracture-related) complications, 1-year and 2-year mortality. Every 6 weeks, a cluster will switch from current practice to the clinical pathway. The aim is a total of 393 inclusions, which provides an 80% statistical power for an improvement in mobility of 10%, measured by the Parker mobility score. ETHICS AND DISSEMINATION: The Medical Research Ethics Committee of Academic Medical Center has exempted the PELVIC study from the Medical Research Involving Human Subjects Act (WMO). Informed consent will be obtained using the opt-out method and research data will be stored in a database and handled confidentially. The final study report will be shared via publication without restrictions from funding parties and regardless of the outcome. TRIAL REGISTRATION NUMBER: NCT06054165. PROTOCOL VERSION: V.1.0, 19 July 2022.