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BACKGROUND: Companionship and simple experience or naive practice (NP) rarely lead to expert level surgery, in contrast to deliberate practice (DP) where an expert analyzes the learner's errors and sets goals to improve performance. The main hypothesis was that using DP for learning would result in faster and/or greater progress than using NP. OBJECTIVES: The objective of this work was to compare the evolution of the learning curve for clavicle locking plate placement on a sawbone model of a clavicle fracture, by surgical trainees learning via two different methods; NP and DP. PATIENTS AND METHODS: Ten surgical residents, divided into 2 groups of 5, each placed 6 plates. The 6 trials were filmed. The NP group saw an expert video before each placement. The DP group saw this video once and then received personalized advice from the expert for improvement, by analyzing their own video after each subsequent trial. Objective performance (OP) was measured by a standardized evaluation grid (OSATS, with a score ranging from 10 to 50 points per trial), self-evaluation of performance by a numerical scale (from 0 to 10) and stress by an analgesia-nociception index (ANI, calculated by heart rate recording, from 0 to 100). RESULTS: The mean OP at the last trial of clavicle plate placement was 41.8 (NP group) and 48.2 (DP group), with a mean progression from the first to last trials of 0.8 in the NP group, and 5.1 in the DP group. The mean progression in self-evaluation between the first and last trials was 3.4 (NP group) and 4.6 (DP group). The mean progression of the ANI between the first and last trials was -4.5 (NP group) and +5 (DP group). DISCUSSION: The results of learning a clavicle plate osteosynthesis technique measured by OSATS were better with deliberate practice than with naive practice. The progression in self-evaluated performance was better with deliberate practice, but with a higher stress level. CONCLUSION: Deliberate practice is a technique for learning the surgical procedure which complements companionship and experience. It shortens the learning curve and improves the level of performance of surgical trainees. LEVEL OF EVIDENCE: IV; non-interventional research.
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BACKGROUND: The primary objective of this study was to compare the clinical outcomes of total elbow arthroplasty as the index procedure in the treatment of traumatic distal humerus fractures with those of secondary total elbow arthroplasty after failed internal fixation. The secondary objective was to compare the complication rates and the radiographic results in the 2 groups. Our hypothesis was that the clinical results of total elbow arthroplasty performed after failed internal fixation were comparable to those of primary total elbow arthroplasty in the treatment of distal humerus fractures in the elderly population. METHODS: We conducted a retrospective cohort comparison study, including 60 patients with a median age of 80 years (71-85 years), who either underwent a primary total elbow arthroplasty (group 1; 45 patients) or secondary total elbow arthroplasty after failed internal fixation (group 2; 15 patients) in the treatment of a post-traumatic supra and intercondylar fracture of the distal humerus, between January 2004 and January 2021. The clinical examination, including the Mayo Elbow Performance Score and triceps proficiency test, complication rates, and the need for reoperation were noted. The average clinical and radiographic follow-up was 40.8 months (24-120 months). RESULTS: The clinical results of the 2 groups were comparable when looking at the Mayo Elbow Performance Score (90.00 [85.00, 100.00], P = .486). With regard to complications, there were 2 surgical site infections in group 1 and 3 in group 2 (P = .099), 1 case of mechanical loosening of the humeral component in group 1 and 1 in group 2 (P = .448), and 1 patient with triceps insufficiency in group 1. CONCLUSIONS: Secondary total elbow arthroplasty after failed internal fixation has shown good functional results and a complication rate comparable to that of index total elbow arthroplasty in the treatment of articular fractures of the distal humerus in the elderly.
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Artroplastia de Reemplazo de Codo , Articulación del Codo , Fijación Interna de Fracturas , Fracturas del Húmero , Reoperación , Humanos , Fracturas del Húmero/cirugía , Estudios Retrospectivos , Anciano , Femenino , Masculino , Fijación Interna de Fracturas/métodos , Artroplastia de Reemplazo de Codo/métodos , Anciano de 80 o más Años , Reoperación/estadística & datos numéricos , Articulación del Codo/cirugía , Resultado del Tratamiento , Insuficiencia del Tratamiento , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Lesiones de Codo , Fracturas Humerales DistalesRESUMEN
INTRODUCTION: After rotator cuff repair (RCR), return to work and return to sports is affected by various psychosocial factors. The role of one of these factors - mood and anxiety disorders (MAD) - is still not clear. The primary objective of this study was to determine the influence of prior MAD on the return to work and return to sports after RCR. Our hypothesis was that patients with a history of MAD would take longer to return to work and to sports after RCR, and the rate of return would be lower, than for patients without MAD. MATERIALS AND METHODS: This was a retrospective single-center study of patients who underwent arthroscopic RCR (distal supraspinatus tear). Patients who were employed and those who participated in sports before the surgery were included in the "working" and "sports" groups, respectively. The primary outcomes were the time to return to work and return to sports after surgery. The secondary outcomes were the ratio of patients returning to work and to sports at 3, 6 and 12 months; rate of return to same level of sports; need to change or stop working or sports. The effects of prior MAD on these various outcomes were determined using Bayesian multivariate analysis. RESULTS: The "working" group consisted of 158 patients (of which 16.5% had MAD) and the "sports" group consisted of 118 patients (of which 17.8% had MAD). In those with a history of MAD, return to work was 21±11 weeks later and the return to sports was 17±8 weeks later than in those without MAD. There was a 98% probability that return to work or return to sports was delayed by at least 4 weeks in patients with history of MAD. The likelihood that patients with prior MAD who undergo RCR will completely abandon their sport was 2.8 times higher (OR=2.8 [1; 7.8]). CONCLUSION: We found a negative influence of prior MAD on the return to work and return to sports after RCR. LEVEL OF EVIDENCE: III; retrospective case-control study.
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Trastornos de Ansiedad , Trastornos del Humor , Volver al Deporte , Reinserción al Trabajo , Lesiones del Manguito de los Rotadores , Humanos , Estudios Retrospectivos , Reinserción al Trabajo/estadística & datos numéricos , Masculino , Volver al Deporte/psicología , Femenino , Persona de Mediana Edad , Lesiones del Manguito de los Rotadores/cirugía , Trastornos de Ansiedad/psicología , Adulto , ArtroscopíaRESUMEN
BACKGROUND: The use of artificial intelligence (AI) is soaring, and the launch of ChatGPT in November 2022 has accelerated this trend. This "chatbot" can generate complete scientific articles, with risk of plagiarism by mining existing data or downright fraud by fabricating studies with no real data at all. There are tools that detect AI in publications, but to our knowledge they have not been systematically assessed for publication in scientific journals. We therefore conducted a retrospective study on articles published in Orthopaedics & Traumatology: Surgery & Research (OTSR): firstly, to screen for AI-generated content before and after the publicized launch of ChatGPT; secondly, to assess whether AI was more often used in some countries than others to generate content; thirdly, to determine whether plagiarism rate correlated with AI-generation, and lastly, to determine whether elements other than text generation, and notably the translation procedure, could raise suspicion of AI use. HYPOTHESIS: The rate of AI use increased after the publicized launch of ChatGPT v3.5 in November 2022. MATERIAL AND METHODS: In all, 425 articles published between February 2022 and September 2023 (221 before and 204 after November 1, 2022) underwent ZeroGPT assessment of the level of AI generation in the final English-language version (abstract and body of the article). Two scores were obtained: probability of AI generation, in six grades from Human to AI; and percentage AI generation. Plagiarism was assessed on the Ithenticate application at submission. Articles in French were assessed in their English-language version as translated by a human translator, with comparison to automatic translation by Google Translate and DeepL. RESULTS: AI-generated text was detected mainly in Abstracts, with a 10.1% rate of AI or considerable AI generation, compared to only 1.9% for the body of the article and 5.6% for the total body+abstract. Analysis for before and after November 2022 found an increase in AI generation in body+abstract, from 10.30±15.95% (range, 0-100%) to 15.64±19.8% (range, 0-99.93) (p < 0.04; NS for abstracts alone). AI scores differed between types of article: 14.9% for original articles and 9.8% for reviews (p<0.01). The highest rates of probable AI generation were in articles from Japan, China, South America and English-speaking countries (p<0.0001). Plagiarism rates did not increase between the two study periods, and were unrelated to AI rates. On the other hand, when articles were classified as "suspected" of AI generation (plagiarism rate ≥ 20%) or "non-suspected" (rate<20%), the "similarity" score was higher in suspect articles: 25.7±13.23% (range, 10-69%) versus 16.28±10% (range, 0-79%) (p < 0.001). In the body of the article, use of translation software was associated with higher AI rates than with a human translator: 3.5±5% for human translators, versus 18±10% and 21.9±11% respectively for Google Translate and DeepL (p < 0.001). DISCUSSION: The present study revealed an increasing rate of AI use in articles published in OTSR. AI grades differed according to type of article and country of origin. Use of translation software increased the AI grade. In the long run, use of ChatGPT incurs a risk of plagiarism and scientific misconduct, and needs to be detected and signaled by a digital tag on any robot-generated text. LEVEL OF EVIDENCE: III; case-control study.
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Ortopedia , Traumatología , Humanos , Estudios Retrospectivos , Inteligencia Artificial , Estudios de Casos y ControlesRESUMEN
PURPOSE: The two stage revision procedure is the gold standard surgical technique in chronic shoulder periprosthetic joint infection (PJI). Series of one stage revision have been published with similar outcomes but with preoperative selection of patients. The aim of this work was to report the outcomes (infection eradication, functional, and radiographic) after systematic one stage revision, without preoperative selection of patients, in chronic shoulder PJI. METHODS: This was a retrospective monocentric study including 40 patients (14 women and 26 men) with a diagnosis of periprosthetic joint infection after a shoulder arthroplasty. A one stage shoulder prosthesis revision was performed in all patients, for a PJI evolving for more than three weeks, without preoperative patient selection. The primary endpoint was the absence of signs of persistent infection at a minimum follow-up of two years. Secondary endpoints were clinical and radiological outcomes. RESULTS: At the last follow-up, 36/40 patients had no recurrence of infection after the one stage revision, i.e., 90% of our series. In 45% (18/40) of the cases, the microbial organism was not known at the time of the one stage revision. Cutibacterium acnes was the most frequent pathogen, found in 67.5% (27/40) of the patients. The infection was polymicrobial in 40% (16/40) of the cases. At last follow-up, mean absolute Constant score was 48.4% (16-93) and weighted score was 65.5% (22-100), and satisfaction was evaluated by the patients as excellent or good in 75% (30/40). About 20% (8/40) of the patients had a postoperative complication. CONCLUSION: A one stage revision procedure, combined with appropriate antibiotic therapy, made it possible to eradicate the PJI in 90% of the shoulders in our series with satisfactory functional outcomes.
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Artritis Infecciosa , Artroplastía de Reemplazo de Hombro , Infecciones Relacionadas con Prótesis , Articulación del Hombro , Masculino , Humanos , Femenino , Artroplastía de Reemplazo de Hombro/efectos adversos , Estudios Retrospectivos , Infección Persistente , Infecciones Relacionadas con Prótesis/epidemiología , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/cirugía , Antibacterianos/uso terapéutico , Artritis Infecciosa/cirugía , Reoperación/efectos adversos , Resultado del TratamientoRESUMEN
PURPOSE: Skin closure disorders in ankle surgery are a recurrent problem not only in traumatology but also in elective surgery. The aim of the study was to describe the anatomical basis of the fasciocutaneous vascularization of the lateral malleolus region to develop a posterior cover flap for the region. METHODS: We dissected ten fresh frozen specimens after arterial injection of an Indian ink preparation and individualized the perforating arteries. Their positions and diameters were collated. Then, the surgical technique was clinically applied for two different cases by transferring the fasciocutaneous flap posterior to the lateral malleolus to cover a loss of skin substance. RESULTS: There were in average 5 fibular perforators over the last 100 mm of the fibula. The average diameter of the first two perforating arteries was 0.6 ± 0.12 mm and 0.9 ± 0.25 mm, respectively, and the consistency of the latter makes it possible to produce a skin flap with anterior translation. This is an axial flap. Two patients were operated on using this technique. There was no necrosis of the posterior fibular flap and healing was achieved by the third post-operative week. CONCLUSION: This study showed the presence of fibular perforating arteries with a high reproducibility of their dissection. This anatomical description served as the basis for the description of a new distal fibular perforating flap.
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Peroné , Procedimientos de Cirugía Plástica , Humanos , Peroné/irrigación sanguínea , Reproducibilidad de los Resultados , Colgajos Quirúrgicos/irrigación sanguínea , Extremidad InferiorRESUMEN
The aim of this study is to determine whether adjuvant Distal Clavicle Resection (DCR) improves outcomes of Rotator Cuff Repair (RCR) in terms of ROM, clinical scores as well as reducing complications and/or reoperations. This systematic review conforms to the PRISMA guidelines. Studies were included if they compared outcomes of RCR with and without adjuvant DCR and reported on postoperative ROM, clinical scores, complications, and/or reoperations. Seven studies that comprised 1572 shoulders which underwent RCR at a follow-up ranged 8-54 months: 398 with adjuvant DCR and 1174 without DCR. No significant differences were found between patients that had DCR versus those that did not have DCR, in terms of postoperative clinical scores (ASES, Constant, pVAS), postoperative ROM (AFE, external and internal rotation), retear rate and reoperation rate. There were no significant differences in ROM, clinical scores, or rates of retears and reoperations between patients that underwent RCR with or without adjuvant DCR. There is insufficient evidence to support routine DCR during RCR; the incidence of new or residual acromioclavicular joint (ACJ) pain after RCR with adjuvant DCR is higher than following isolated RCR, which could in fact induce iatrogenic morbidity and therefore does not justify the additional surgery time and costs of routine adjuvant DCR.
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BACKGROUND: Few data are available about the impact of operative time on outcome of rotator cuff repair. AIM: The aim of this study was to evaluate the impact of operative time on clinical outcome and tendon healing after arthroscopic rotator cuff repair. METHODS: Patients operated on for distal supraspinatus tear in our institution between 2012 and 2018 were included retrospectively. Operative time, from skin incision until skin closure, was extracted from medical files. For statistical analysis, operative time was treated as a quantitative variable. Endpoints were clinical outcome (Constant score, range of motion), tendon healing (on CT or MRI) and complications at 1 year. The significance threshold was set at p = 0.05. RESULTS: A total of 219 Patients, with a mean age of 54.6 years (range 40-70 years), were included. Mean operative time 44.9 min (range 14-140 min). Significant correlations (p < 0.05) were found for Constant score and external rotation at 1 year: increasing operative time by 1 min led to a decrease in Constant score of 0.115 points, or 6.9 points for a 60-min increase (p = 0.0167) and a decrease in external rotation of 0.134°, or 8.04° for a 60-min increase (p = 0.0214). No significant correlations were found for anterior elevation at 1 year (p = 0.2577), tendon healing at 1 year (p = 0.295) or onset of complications during follow-up (p = 0.193). DISCUSSION: The minimal clinically important difference in Constant score in patients undergoing rotator cuff surgery is between 6 and 10 points. An increase of more than 60 min in operative time significantly impacted clinical outcome of arthroscopic distal supraspinatus repair, but not tendon healing. LEVEL OF EVIDENCE: Level III: Retrospective Cohort Design. Therapeutic Study.
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Lesiones del Manguito de los Rotadores , Manguito de los Rotadores , Humanos , Adulto , Persona de Mediana Edad , Anciano , Manguito de los Rotadores/diagnóstico por imagen , Manguito de los Rotadores/cirugía , Estudios Retrospectivos , Tempo Operativo , Resultado del Tratamiento , Lesiones del Manguito de los Rotadores/cirugía , Imagen por Resonancia Magnética , Artroscopía/efectos adversos , Rango del Movimiento ArticularRESUMEN
BACKGROUND: A pre-existing mood and anxiety disorder (MAD) is often present in patients with rotator cuff pathology, but its presumed negative effect on the outcomes has not been demonstrated. AIM OF STUDY AND HYPOTHESIS: The primary objective of this study was to evaluate how a history of MAD affects the clinical outcomes 1 year after arthroscopic rotator cuff repair (RCR). The secondary objectives were to evaluate how a history of MAD affects tendon healing, analgesic consumption and the occurrence of complications. MATERIALS AND METHODS: The study population consisted of 219 patients (mean age 54.5±6.6 years) who underwent arthroscopic repair for a distal supraspinatus tendon tear, with 17% (38/219) presenting an history of MAD (depression, unspecified mood disorder, anxiety, and bipolar disorder). Using univariate and multivariate analyses, the joint range of motion, Constant score, analgesic consumption, occurrence of complications during the first postoperative year and tendon healing at 1 year (MRI or CT arthrography) were compared between the two groups (with or without MAD). RESULTS: The Constant score was lower preoperatively in patients with history of MAD (-4 points, p=.04) but there were no significant differences between the two groups at the various postoperative follow-up time points (p>.05). No significant difference was found between the two groups of patients in their analgesic consumption at the various postoperative time points (p>.05), tendon healing at 1 year (p=.17) or the occurrence of postoperative complications (p=.59). DISCUSSION/CONCLUSION: Pre-existing MAD had no effect on the clinical outcomes after arthroscopic RCR at 1 year and no effect on tendon healing, analgesic consumption or the occurrence of complications in our study population. LEVEL OF EVIDENCE: III; retrospective case-control study.
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Lesiones del Manguito de los Rotadores , Manguito de los Rotadores , Humanos , Persona de Mediana Edad , Manguito de los Rotadores/cirugía , Estudios Retrospectivos , Estudios de Casos y Controles , Trastornos de Ansiedad , Resultado del Tratamiento , Lesiones del Manguito de los Rotadores/cirugía , Artroscopía , Imagen por Resonancia Magnética , Rango del Movimiento Articular , AnalgésicosRESUMEN
INTRODUCTION: After centromedullary nailing (CMN) of 4-parts (4P) cephalo-tuberositary fractures of the proximal humerus (PH), shoulder immobilization for a few weeks is usual, although no scientific justification does support this attitude, nor the duration of immobilization. The objective of this study was to assess the impact of early mobilization after CMN of PH 4P fractures on clinical, radiological outcomes and complication rates. The hypothesis was that early mobilization would not lead to a deterioration in results or an increase in the complication rate. MATERIALS AND METHODS: All patients operated on for a 4P-PH fracture by CMN in our institution between 2010 and 2018 were included retrospectively. 2 groups were formed according to the duration of post-operative immobilization of the shoulder: 0-2 weeks (group A) and 3-6 weeks (group B). All patients had a clinical examination (Range of motion ROM and Constant score) and X-rays of the shoulder at least 24 months of follow-up. 58 patients (average age 66 years (39-89)) were included, with 25 in group A and 33 in group B. RESULTS: The average follow-up was 38.5 (24-73) months. The active ROM at the last follow-up was: active anterior elevation 149° (80°-180°) in group A versus 134 (60°-180°) in group B (p = 0.099); active external rotation 145° (15°-70°) in group A versus 42° (15-70°) in group B (p = 0.6). The Absolute Mean Constant score was 78.29 for Group A (45-100) versus 68.59 points (45-96) for Group B (p = 0.065). Regarding complications: in group A, we found 2 retractile capsulitis, 2 pseudarthrosis and 2 osteonecrosis of the humeral head. In group B, we found 5 retractile capsulitis, 1 infection of the surgical site, 3 osteonecrosis of the humeral head and 1 pseudarthrosis. CONCLUSION: Early mobilization after CMN of 4P-PH fractures did not lead to an increase in the complications rate and in particular secondary displacements or osteonecrosis. There was a trend toward improved clinical outcomes with early mobilization, although this trend was not statistically significant. EVIDENCE LEVEL: IV, retrospective study.
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Fijación Intramedular de Fracturas , Fracturas del Húmero , Osteonecrosis , Seudoartrosis , Fracturas del Hombro , Humanos , Anciano , Fijación Intramedular de Fracturas/efectos adversos , Fijación Intramedular de Fracturas/métodos , Estudios Retrospectivos , Hombro , Seudoartrosis/etiología , Ambulación Precoz , Húmero , Fracturas del Hombro/diagnóstico por imagen , Fracturas del Hombro/cirugía , Cabeza Humeral , Osteonecrosis/etiología , Fracturas del Húmero/etiología , Resultado del TratamientoRESUMEN
INTRODUCTION: Onset of radial neck osteolysis (RNO) has been reported after radial head replacement (RHR), but data are sparse regarding impact and risk factors. We therefore conducted a retrospective study, 1) to quantify RNO after RHR, 2) to assess clinical and radiological impact, and 3) to identify risk factors. HYPOTHESIS: RNO prevalence is high, but functional impact is limited. MATERIAL AND METHOD: A single-center retrospective study included all patients undergoing RHR for acute radial head fracture between 2008 and 2017: 53 patients, with a mean age of 53.8±15.7 years [range, 21-85 years]. At a minimum 2 years' follow-up, patients were assessed clinically on joint range of motion and Mayo Elbow Performance Score (MEPS) and radiologically on standard radiographs. Associations between RNO and various parameters were assessed. RESULTS: At a mean 46.7±19.8 months' follow-up [range, 24-84 months], RNO was found in 54.7% of cases (29/53), with mean 4.0 ±2.8mm distal extension [range, 1.2-13.4mm], corresponding to 13.4±7.3% of stem height [range, 2.7-27.7%]. RNO at last follow-up was not significantly associated with reduced flexion-extension (121.9° versus 114.0°; p=0.11), pronation-supination (152.6° versus 138.3°; p=0.25) or MEPS (84.7 versus 84.8; p=0.97), or with higher rates of postoperative complications (11/29 (37.9%) versus 7/24 (29.2%); p=0.782) or surgical revision (11/29 (37.9%) versus 10/24 (41.7%); p=0.503). RNO was significantly associated with cementless fixation (19/29 (65.5%) versus 7/24 (29.2%); p=0.01), unipolar prosthesis (21/29 (72.4%) versus 7/24 (29.2%); p=0.002), high filling-ratio, whether proximal (88% versus 77%; p=0.002), middle (84% versus 75%; p=0.007) or distal (69% versus 59%; p=0.032), and shorter radial stem (33.2mm versus 46.3mm; p=0.011). No demographic parameters showed significant association with RNO at last follow-up. CONCLUSION: RNO was frequent after RHR, but without clinical or radiological impact in the present series. The risk factors identified here argue for involvement of stress shielding. LEVEL OF EVIDENCE: IV, cohort study.