Opioid utilization after orthopaedic trauma hospitalization among Medicaid-insured adults.

Opioids are vital to pain management and sedation after trauma-related hospitalization. However, there are many confounding clinical, social, and environmental factors that exacerbate pain, post-injury care needs, and receipt of opioid prescriptions following orthopaedic trauma. This retrospective study sought to characterize differences in opioid prescribing and dosing in a national Medicaid eligible sample from 2010-2018. The study population included adults, discharged after orthopaedic trauma hospitalization, and receiving an opioid prescription within 30 days of discharge. Patients were identified using the International Classification of Diseases (ICD-9; ICD-10) codes for inpatient diagnosis and procedure. Filled opioid prescriptions were identified from National Drug Codes and converted to morphine milligram equivalents (MME). Opioid receipt and dosage (e.g., morphine milligram equivalents [MME]) were examined as the main outcomes using regressions and analyzed by year, sex, race/ethnicity, residence rurality-urbanicity, and geographic region. The study population consisted of 86,091 injured Medicaid-enrolled adults; 35.3% received an opioid prescription within 30 days of discharge. Male patients (OR = 1.12, 95% CI: 1.07-1.18) and those between 31-50 years of age (OR = 1.15, 95% CI: 1.08-1.22) were found to have increased odds ratio of receiving an opioid within 30 days of discharge, compared to female and younger patients, respectively. Patients with disabilities (OR = 0.75, 95% CI: 0.71-0.80), prolonged hospitalizations, and both Black (OR = 0.87, 95% CI: 0.83-0.92) and Hispanic patients (OR = 0.72, 95% CI: 0.66-0.77), relative to white patients, had lower odds ratio of receiving an opioid prescription following trauma. Additionally, Black and Hispanic patients received lower prescription doses compared to white patients. Individuals hospitalized in the Southeastern United States and those between the ages of 51-65 age group were found to be prescribed lower average daily MME. There were significant variations in opioid prescribing practices by race, sex, and region. National guidelines for use of opioids and other pain management interventions in adults after trauma hospitalization may help limit practice variation and reduce implicit bias and potential harms in outpatient opioid usage.

ChatGPT-4 generates orthopedic discharge documents faster than humans maintaining comparable quality: a pilot study of 6 cases.

BACKGROUND AND PURPOSE: Large language models like ChatGPT-4 have emerged. They hold the potential to reduce the administrative burden by generating everyday clinical documents, thus allowing the physician to spend more time with the patient. We aimed to assess both the quality and efficiency of discharge documents generated by ChatGPT-4 in comparison with those produced by physicians. PATIENTS AND METHODS: To emulate real-world situations, the health records of 6 fictional orthopedic cases were created. Discharge documents for each case were generated by a junior attending orthopedic surgeon and an advanced orthopedic resident. ChatGPT-4 was then prompted to generate the discharge documents using the same health record information. The quality assessment was performed by an expert panel (n = 15) blinded to the source of the documents. As secondary outcome, the time required to generate the documents was compared, logging the duration of the creation of the discharge documents by the physician and by ChatGPT-4. RESULTS: Overall, both ChatGPT-4 and physician-generated notes were comparable in quality. Notably, ChatGPT-4 generated discharge documents 10 times faster than the traditional method. 4 events of hallucinations were found in the ChatGPT-4-generated content, compared with 6 events in the human/physician produced notes. CONCLUSION:  ChatGPT-4 creates orthopedic discharge notes faster than physicians, with comparable quality. This shows it has great potential for making these documents more efficient in orthopedic care. ChatGPT-4 has the potential to significantly reduce the administrative burden on healthcare professionals.

Does exposure to polymethyl methacrylate bone cement increase the risk of surgical glove failure?

INTRODUCTION: Surgical glove perforation has been linked to a double-fold increased risk of surgical site infection. Infection in the context of arthroplasty can have devastating consequences. In orthopaedics, use of polymethyl methacrylate (PMMA) bone cement is commonplace, and the impact on glove strength and perforation risk is not fully understood. This study aimed to examine the resistance to perforation and thickness of gloves following PMMA exposure, in accordance with the International Organization for Standardization (ISO) standard for glove integrity. METHODS: Pairs of gloves were separated and randomly sorted into exposure and control groups. Twenty pairs of latex and 40 pairs of polyisoprene gloves were used. Exposure group glove cuffs were in contact with cement from a single surface of the glove for 13 min as cement cured. Force to perforation and glove thickness were tested in accordance with ISO guidelines. RESULTS: Latex gloves were found to have a significantly increased force to perforation following PMMA exposure (10.26 Newtons (N) vs. 9.81 N, P = 0.048). Both polyisoprene under- and over-gloves were shown to have no significant change in strength to perforation post exposure (9.69 N vs. 9.83 N, P = 0.561, and 10.26 N vs. 10.65 N, P = 0.168, respectively). All groups were over the ISO standard minimum strength of 5 N. CONCLUSIONS: Exposure of latex and polyisoprene surgical gloves to PMMA bone cement does not appear to increase glove perforation risk and rather may improve natural rubber latex glove strength. This study supports the use of latex and polyisoprene surgical gloves in procedures that involve the handling of PMMA bone cement.

A simplified, 2-question grading system for evaluating abstracts in orthopedic scientific meetings: a serial randomization study.

BACKGROUND AND PURPOSE: Efficient abstract scoring for congress presentation is important. Given the emergence of new study methodologies, a scoring system that accommodates all study designs is warranted. We aimed to assess the equivalence of a simplified, 2-question abstract grading system with a more complex currently used system in assessing abstracts submitted for orthopedic scientific meetings in a serial randomized study. METHODS: Dutch Orthopedic Association Scientific Committee (DOASC) members were randomized to grade abstracts using either the current grading system, which includes up to 7 scoring categories, or the new grading system, which consists of only 2 questions. Pearson correlation coefficient and mean abstract score with 95% confidence intervals (CI) were calculated. RESULTS: Analysis included the scoring of 195 abstracts by 12-14 DOASC members. The average score for an abstract using the current system was 60 points (CI 58-62), compared with 63 points (CI 62-64) using the new system. By using the new system, abstracts were scored higher by 3.3 points (CI 1.7-5.0). Pearson correlation was poor with coefficient 0.38 (P < 0.001). CONCLUSION: The simplified abstract grading system exhibited a poor correlation with the current scoring system, while the new system offers a more inclusive evaluation of varying study designs and is preferred by almost all DOASC members.

Experimental assessment of pelvis slipping during postless traction for orthopaedic applications.

BACKGROUND: The application of lower limb traction during hip arthroscopy and femur fractures osteosynthesis is commonplace in orthopaedic surgeries. Traditional methods utilize a perineal post on a traction table, leading to soft tissue damage and nerve neuropraxia. A postless technique, using high-friction pads, has been considered as a potential damage-free alternative. However, whether these pads sufficiently prevent patient displacement remains unknown. Thus, this study systematically assesses the efficacy of commercial high-friction pads (PinkPad and CarePad) in restraining subject displacement, for progressively increasing traction loads and different Trendelenburg angles. METHODS: Three healthy male subjects were recruited and tested in supine and Trendelenburg positions (5° and 10°), using a customized boot-pulley system. Ten load disks (5 kg) were dropped at 15s intervals, increasing gradually the traction load up to 50 kg. Pelvis displacement along the traction direction was measured with a motion capture system. The displacement at 50 kg of traction load was analyzed and compared across various pads and bed inclinations. Response to varying traction loads was statistically assessed with a quadratic function model. RESULTS: Pelvis displacement at 50 kg traction load was below 60 mm for all conditions. Comparing PinkPad and CarePad, no significant differences in displacement were observed. Finally, similar displacements were observed for the supine and Trendelenburg positions. CONCLUSIONS: Both PinkPad and CarePad exhibited nearly linear behavior under increasing traction loads, limiting displacement to 60 mm at most for 50 kg loads. Contrary to expectations, placing subjects in the Trendelenburg position did not increase adhesion.

Survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association.

A survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association conducted in 2022 found considerable variation in care across the region. A Call to Action is proposed to improve acute care, rehabilitation and secondary fracture prevention across Asia Pacific. PURPOSE: Fragility fractures impose a substantial burden on older people and their families, healthcare systems and national economies. The current incidence of hip and other fragility fractures across the Asia Pacific region is enormous and set to escalate rapidly in the coming decades. This publication describes findings of a survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association (APOA) conducted in 2022. METHODS: The survey was developed as a collaboration between the Asia Pacific Osteoporosis and Fragility Fracture Society and the Asia Pacific Fragility Fracture Alliance, and included questions relating to aspects of care upon presentation, during surgery and mobilisation, secondary fracture prevention, and access to specific services. RESULTS: In total, 521 APOA members completed the survey and marked variation in delivery of care was evident. Notable findings included: Fifty-nine percent of respondents indicated that analgesia was routinely initiated in transit (by paramedics) or within 30 minutes of arrival in the Emergency Department. One-quarter of respondents stated that more than 80% of their patients underwent surgery within 48 hours of admission. One-third of respondents considered non-hip, non-vertebral fractures to merit assessment of future fracture risk. One-third of respondents reported the presence of an Orthogeriatric Service in their hospital, and less than a quarter reported the presence of a Fracture Liaison Service. CONCLUSION: A Call to Action for all National Orthopaedic Associations affiliated with APOA is proposed to improve the care of fragility fracture patients across the region.

The academic progress of female general surgery and orthopaedic surgery trainees in South Africa.

BACKGROUND: Globally, medical institutes have seen an increase in female graduates, however surgical disciplines remain male-dominated. An epidemiological shift towards non-communicable diseases and trauma may result in a shortage of surgical specialists. One strategy to improve the surgical workforce is the recruitment of female graduates. METHODS: A non-validated questionnaire was administered to females registered for the Master of Medicine (MMED) degree in General and Orthopaedic Surgery at the University of KwaZulu-Natal (UKZN) between 2000 and 2015. The study evaluated reasons for choice of surgery as a career, challenges faced on the domestic and work front, as well as factors that assisted with successful completion of training. RESULTS: Seventy-two female trainees in General Surgery and Orthopaedics were identified from the UKZN databases. The contact details for 62 of these trainees were available. The overall response rate was 71.0% (44/62). A total of 95.5% (42/44) of participants selected surgery due to a passion for the field. Major challenges identified were a poor home and work-life balance (72.1%, 31/43) and poor working conditions (62.8%, 27/43). Female trainees perceived that they were viewed as inferior by patients (65.9%, 29/44). Successful trainees had a good home support system (89.3%, 25/28) and mentorship during training (60.7%, 17/28), and 85.7% (24/28) did not regret their career choice. CONCLUSION: The recruitment and retention of females in surgery will contribute to maintaining an adequate surgical workforce. Training programmes need to improve work-life balance without compromising on producing competent surgeons. Improved visibility of female surgeons in leadership roles should be encouraged to promote mentorship and recruitment of trainees.

More anterior bone loss in middle vertebra after contiguous two-segment cervical disc arthroplasty.

BACKGROUND: Contiguous two-segment cervical disc arthroplasty (CDA) is safe and effective, while post-operative radiographic change is poorly understood. We aimed to clarify the morphological change of the three vertebral bodies operated on. METHODS: Patients admitted between 2015 and 2020 underwent contiguous two-level Prestige LP CDA were included. The follow-up was divided into immediate post-operation (≤ 1 week), early (≤ 6 months), and last follow-up (≥ 12 months). Clinical outcomes were measured by Japanese Orthopedic Association (JOA) score, visual analogue score (VAS), and neck disability index (NDI). Radiographic parameters on lateral radiographs included sagittal area, anterior-posterior diameters (superior, inferior endplate length, and waist length), and anterior and posterior heights. Sagittal parameters included disc angle, Cobb angle, range of motion, T1 slope, and C2-C7 sagittal vertical axis. Heterotopic ossification (HO) and anterior bone loss (ABL) were recorded. RESULTS: 78 patients were included. Clinical outcomes significantly improved. Of the three operation-related vertebrae, only middle vertebra decreased significantly in sagittal area at early follow-up. The four endplates that directly meet implants experienced significant early loss in length. Sagittal parameters were kept within an acceptable range. Both segments had a higher class of HO at last follow-up. More ABL happened to middle vertebra. The incidence and degree of ABL were higher for the endplates on middle vertebra only at early follow-up. CONCLUSION: Our findings indicated that after contiguous two-segment CDA, middle vertebra had a distinguishing morphological changing pattern that could be due to ABL, which deserves careful consideration before and during surgery.

Reporting form and content of research priorities identified in knee osteoarthritis clinical practice guidelines: a methodological literature analysis.

OBJECTIVES: Clinical practice guideline (CPG) developers conduct systematic summaries of research evidence, providing them great capacity and ability to identify research priorities. We systematically analysed the reporting form and content of research priorities in CPGs related to knee osteoarthritis (KOA) to provide a valuable reference for guideline developers and clinicians. DESIGN: A methodological literature analysis was done and the characteristics of the reporting form and the content of the research priorities identified in KOA CPGs were summarised. DATA SOURCES: Six databases (PubMed, Embase, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, Wanfang and Chinese Biomedical Literature Database) were searched for CPGs published from 1 January 2017 to 4 December 2022. The official websites of 40 authoritative orthopaedic societies, rheumatology societies and guideline development organisations were additionally searched. ELIGIBILITY CRITERIA: We included all KOA CPGs published in English or Chinese from 1 January 2017 that included at least one recommendation for KOA. We excluded duplicate publications, older versions of CPGs as well as guidance documents for guideline development. DATA EXTRACTION AND SYNTHESIS: Reviewers worked in pairs and independently screened and extracted the data. Descriptive statistics were used, and absolute frequencies and proportions of related items were calculated. RESULTS: 187 research priorities reported in 41 KOA CPGs were identified. 24 CPGs reported research priorities, of which 17 (41.5%) presented overall research priorities for the entire guideline rather than for specific recommendations. 110 (58.8%) research priorities were put forward due to lack of evidence. Meanwhile, more than 70% of the research priorities reflected the P (population) and I (intervention) structural elements, with 135 (72.2%) and 146 (78.1%), respectively. More than half of the research priorities (118, 63.8%) revolved around evaluating the efficacy of interventions. Research priorities primarily focused on physical activity (32, 17.3%), physical therapy (30, 16.2%), surgical therapy (27, 14.6%) and pharmacological treatment (26, 14.1%). CONCLUSIONS: Research priorities reported in KOA CPGs mainly focused on evaluating non-pharmacological interventions. There exists considerable room for improvement for a comprehensive and standardised generation and reporting of research priorities in KOA CPGs.

Design and In Vitro Validation of an Orthopaedic Drill Guide for Femoral Stem Revision in Total Hip Arthroplasty.

OBJECTIVE: Cemented total hip arthroplasty (THA) demonstrates superior survival rates compared to uncemented procedures. Nevertheless, most younger patients opt for uncemented THA, as removing well-fixed bone cement in the femur during revisions is complex, particularly the distal cement plug. This removal procedure often increases the risk of femoral fracture or perforation, haemorrhage and weakening bone due to poor drill control and positioning. Aim of this study was to design a novel drill guide to improve drill positioning. METHODS AND PROCEDURES: A novel orthopaedic drill guide was developed, featuring a compliant centralizer activated by a drill guide actuator. Bone models were prepared to assess centralizing performance. Three conditions were tested: drilling without guidance, guided drilling with centralizer activation held, and guided drilling with centralizer activation released. Deviations from the bone centre were measured at the entry and exit point of the drill. RESULTS: In the centralizing performance test, the drill guide significantly reduced drill hole deviations in both entry and exit points compared to the control ([Formula: see text]). The absolute deviation on the exit side of the cement plug was 10.59mm (SD 1.56) for the 'No drill guide' condition, 3.02mm (SD 2.09) for 'Drill guide - hold' and 2.12mm (SD 1.71) for 'Drill guide - release'. The compliant drill guide centralizer significantly lowered the risk of cortical bone perforation during intramedullary canal drilling in the bone models due to better control of the cement drill position. Clinical and Translational Impact Statement: The drill guide potentially reduces perioperative risks in cemented femoral stem revision. Future research should identify optimal scenarios for its application.

A machine learning-based predictive model of causality in orthopaedic medical malpractice cases in China.

PURPOSE: To explore the feasibility and validity of machine learning models in determining causality in medical malpractice cases and to try to increase the scientificity and reliability of identification opinions. METHODS: We collected 13,245 written judgments from PKULAW.COM, a public database. 963 cases were included after the initial screening. 21 medical and ten patient factors were selected as characteristic variables by summarising previous literature and cases. Random Forest, eXtreme Gradient Boosting (XGBoost) and Light Gradient Boosting Machine (LightGBM) were used to establish prediction models of causality for the two data sets, respectively. Finally, the optimal model is obtained by hyperparameter tuning of the six models. RESULTS: We built three real data set models and three virtual data set models by three algorithms, and their confusion matrices differed. XGBoost performed best in the real data set, with a model accuracy of 66%. In the virtual data set, the performance of XGBoost and LightGBM was basically the same, and the model accuracy rate was 80%. The overall accuracy of external verification was 72.7%. CONCLUSIONS: The optimal model of this study is expected to predict the causality accurately.

The Role of Perioperative Nutritional Status and Supplementation in Orthopaedic Surgery: A Review of Postoperative Outcomes.

¼ Identification of malnourished and at-risk patients should be a standardized part of the preoperative evaluation process for every patient.¼ Malnourishment is defined as a disorder of energy, protein, and nutrients based on the presence of insufficient energy intake, weight loss, muscle atrophy, loss of subcutaneous fat, localized or generalized fluid accumulation, or diminished functional status.¼ Malnutrition has been associated with worse outcomes postoperatively across a variety of orthopaedic procedures because malnourished patients do not have a robust metabolic reserve available for recovery after surgery.¼ Screening assessment and basic laboratory studies may indicate patients' nutritional risk; however, laboratory values are often not specific for malnutrition, necessitating the use of prognostic screening tools.¼ Nutrition consultation and perioperative supplementation with amino acids and micronutrients are 2 readily available interventions that orthopaedic surgeons can select for malnourished patients.

[Artificial intelligence and the extinction of the orthopedist]. / La inteligencia artificial y la extinción del ortopedista.

No Abstract available.

[Predatory journals in Orthopedics and Traumatology]. / Revistas depredadoras en Ortopedia y Traumatología.

Predatory journals are distinguished from legitimate journals by their lack of adequate reviews and editorial processes, compromising the quality of published content. These journals do not conduct peer reviews or detect plagiarism, and accept manuscripts without requiring substantial modifications. Their near 100% acceptance rate is driven by profit motives, regardless of the content they publish. While they boast a prestigious editorial board composed of renowned researchers, in most cases, it is a facade aimed at impressing and attracting investigators. Furthermore, these journals lack appropriate ethical practices and are non-transparent in their editorial processes. Predatory journals have impacted multiple disciplines, including Orthopedics and Traumatology, and their presence remains unknown to many researchers, making them unwitting victims. Their strategy involves soliciting articles via email from authors who have published in legitimate journals, promising quick, easy, and inexpensive publication. The implications and negative consequences of predatory journals on the scientific community and researchers are numerous. The purpose of this work is to provide general information about these journals, specifically in the field of Orthopedics and Traumatology, offering guidelines to identify and avoid them, so that authors can make informed decisions when publishing their manuscripts and avoid falling into the hands of predatory journals or publishers.

Las revistas depredadoras se diferencian de las revistas legítimas por su falta de adecuadas revisiones y procesos editoriales, lo que compromete la calidad del contenido publicado. Estas revistas no llevan a cabo revisiones por pares ni realizan acciones que detecten y prevengan el plagio y aceptan manuscritos sin exigir modificaciones sustanciales. Su tasa de aceptación cercana al 100% se debe a su enfoque lucrativo, sin importarles el contenido que publican. Aunque presumen tener un comité editorial compuesto por investigadores destacados, en la mayoría de los casos es una simulación destinada a impresionar y atraer a los investigadores. Además, estas revistas carecen de prácticas éticas adecuadas y no son transparentes en sus procesos editoriales. Las revistas depredadoras han afectado a múltiples disciplinas, incluida la Ortopedia y Traumatología y su presencia es aún desconocida para muchos investigadores, lo que los convierte en víctimas sin saberlo. Su estrategia consiste en solicitar artículos por correo electrónico a autores que han publicado en revistas legítimas, prometiendo una publicación rápida, sencilla y económica. Las implicaciones y consecuencias negativas de las revistas depredadoras en la comunidad científica y los investigadores son numerosas. El propósito de este trabajo es proporcionar información general sobre estas revistas y específicamente en el campo de la Ortopedia y Traumatología, brindando pautas para identificarlas y evitarlas, para que los autores puedan tomar decisiones informadas al publicar sus manuscritos y evitar caer en manos de revistas o editoriales depredadoras.

Coronavirus disease-2019 and orthopedics: A bibliometric analysis of the literature.

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic has had a dramatic impact on global health, with orthopedics among the most affected specialties. An increasing number of COVID-19-related orthopedic studies have been published. The purpose of this study was to analyze the orthopedic literature published during the COVID-19 pandemic to guide future research. METHODS: The Scopus database was searched for relevant literature published between 2020 and 2022. The keywords used in the retrieval process were ("COVID-19" OR "Coronavirus" OR "2019-nCoV" OR "SARS-CoV-2" OR "Betacoronavirus" OR "novel coronavirus 2019" OR "novel coronavirus" OR "coronavirus-19" OR "COVID 19" OR "nCOV" OR "COVID-2019" OR "COVID 2019") and ("orthopedic" OR "orthopedics" OR "orthopedic" OR "orthopedical" OR "orthopedical" OR "orthopedics"). Spreadsheet software (Excel, Microsoft Corp., Redmond, WA) was used to analyze the top 10 cited authors, countries, journals, and articles. The top 5 publication types were also analyzed. VOSviewer (Center for Science and Technology Studies, Leiden, Netherlands) was used to network and visualize the literature. RESULTS: A total of 1619 publications relevant to COVID-19 and orthopedics were reviewed. Among these publications, the most active country, author, and publication type included the United States, Vaishya R, and original articles, respectively. The most frequently used keywords were human, coronavirus disease-2019, pandemic, and orthopedics. The Journal of Bone and Joint Surgery American Volume was the most cited journal, whereas the greatest number of articles was published in the Journal of Clinical Orthopedics and Trauma. CONCLUSIONS: This study provides a perspective on the development of orthopedic publications during the COVID-19 pandemic and evidence for researchers worldwide to strengthen global cooperation in fighting the epidemic.

PA and NP burnout in orthopedic surgery.

OBJECTIVE: To quantify the burnout rate among physician associates/assistants (PAs) and NPs in a large orthopedic surgery practice affiliated with an academic institution. METHODS: The Maslach Burnout Inventory (MBI) and original research questions were given to all PAs and NPs in orthopedics at the facility. Burnout was defined as a high level of emotional exhaustion or depersonalization on the MBI subscale. RESULTS: Of the 129 PAs and NPs in orthopedics at our institution, 91 (70.5%) completed all survey items. Nearly 42% of respondents were burned out, as defined by high depersonalization or emotional exhaustion. PAs and NPs who met the burnout criteria were significantly older than those who did not (41.8 ± 10 versus 36.5 ± 7.71 years, P = .007) and spent longer in practice (12.4 ± 6.66 versus 9.35 ± 6.41 years, P = .01). CONCLUSIONS: The prevalence of burnout is high among PAs and NPs in orthopedics who practice in an academic setting.