Anterolateral versus anteromedial plate osteosynthesis of midshaft humeral fractures; is there a difference in the rates of iatrogenic radial nerve palsy?

PURPOSE: The anterolateral (AL) and anteromedial (AM) surfaces of the humerus are typically used for plate placement during plate osteosynthesis of midshaft humeral fractures via the anterolateral approach. The purpose of this study was to determine if a significant difference exists in the rates of iatrogenic radial nerve palsy (IRNP) following either AL or AM humeral fracture plating. The research question is stated as follows: is anteromedial plating of humeral fractures associated with lower rates of IRNP when compared with anterolateral plating? METHODS: This multicenter prospective randomized study was undertaken following ethical review and approval with eligible patients who had midshaft humeral fractures or nonunions randomized into 2 groups, viz AL plate osteosynthesis group and AM plate osteosynthesis group. Following diagnostic and preoperative evaluation, patients had open plate osteosynthesis through the anterolateral approach with plate placement according to their study groups. Post-operatively, they were assessed for IRNP while obtained data was analyzed with SPSS version 23 and inter-group differences with P values less than 0.05 were considered statistically significant. RESULTS: Eighty-five eligible patients participated in the study with 43 patients in Group A (AL plate osteosynthesis group) and 42 patients in Group B (AM plate osteosynthesis group). The observed inter-group differences with regard to gender distribution, mean age and clinical diagnosis; acute fracture (AF) versus nonunion were not statistically significant. Furthermore, four (9.3%) patients amongst the 43 patients in Group A (AL plate osteosynthesis group) developed IRNP while two (4.8%) patients amongst the 42 patients in Group B (AM plate osteosynthesis group) had IRNP. The inter-group difference with regard to rates of IRNP was not statistically significant (P = 0.694). CONCLUSION: This study found that (in contrast to previous studies) there was no significant difference in the rates of IRNP following either open anterolateral or anteromedial plate osteosynthesis of midshaft humeral fractures through the anterolateral approach. Orthopaedic surgeons should therefore remain cautious when obtaining consent for surgery as well as when performing internal fixation of midshaft humeral fractures to limit medicolegal disputes that may arise from IRNP.

Monolateral external fixation versus internal fixation of Gustilo IIIB open tibial fractures: a multicenter comparative study.

PURPOSE: Gustilo IIIB open tibial fractures are associated with significant risks of complications particularly nonunion and fracture-related infections (FRI) due to the severity of the injuries. The commonly adopted viewpoint is that a Gustilo IIIB open tibial fracture is a relative contraindication for internal fixation. However, this study aims to assess the veracity of this viewpoint. The objective of this study was to evaluate the impact of the definitive fixation technique on fracture nonunion and FRI rates in Gustilo IIIB open tibial fractures. In this study, we compared the rates of nonunion and FRI rates in grade IIIB open tibial fractures managed definitively with either mono-lateral external fixation or internal fixation. METHODS: The study was a multicenter retrospective comparative study undertaken in seven Nigerian tertiary hospitals. Following ethical approval, medical records of patients diagnosed with Gustilo IIIB open tibial fractures (between 2019 and 2021) were retrieved, patients who had a minimum of nine months of follow-up period and were found eligible had their relevant data entered into an online data collection form. Data obtained was analysed with SPSS version 23, and chi-square test was used to determine the statistical significance of differences observed between the two groups with regard to nonunion and FRI rates. P values less than 0.05 were considered statistically significant. RESULTS: Out of a total of 47 eligible patients, 25 patients were managed definitively with mono-lateral external fixation whilst 22 patients were managed with internal fixation. Five of the 25 patients (20%) managed with external fixation had nonunion whilst two cases of nonunion were recorded amongst the 22 patients (9.1%) treated with internal fixation. The difference between the two techniques with regard to nonunion rates was not statistically significant (P = 0.295). 12 out of 25 patients (48%) in the external fixation group had FRIs whilst 6 out of 22 patients (27.3%) in the internal fixation group had FRIs. The rates of FRIs of the two groups were not significantly different (P = 0.145). CONCLUSION: Our findings suggest that mono-lateral external fixation and internal fixation do not differ significantly with respect to rates of nonunion and fracture-related infections in Gustilo IIIB open tibial fractures.

Exploring artificial intelligence in the Nigerian medical educational space: An online cross-sectional study of perceptions, risks and benefits among students and lecturers from ten universities.

Background: The impact of artificial intelligence (AI) has been compared to that of the Internet and printing, evoking both apprehension and anticipation in an uncertain world. Objective: This study aimed to explore the perceptions of medical students and faculty members from ten universities across Nigeria regarding AI. Methods: Using Google Forms and WhatsApp, a cross-sectional online survey was administered to clinical year medical students and their lecturers from ten medical schools representing all the six geopolitical zones of Nigeria. Results: The survey received 1003 responses, of which 708 (70.7%) were from students and 294 (29.3%) were from lecturers. Both groups displayed an average level of knowledge, with students (Median:4, range -5 to 12) significantly outperforming lecturers (Median:3, range -5 to 15). Social media (61.2%) was the most common form of first contact with AI. Participants demonstrated a favourable attitude towards AI, with a median score of 6.8 out of 10. Grammar checkers (62.3%) were the most commonly reported AI tool used, while ChatGPT (43.6%) was the most frequently mentioned dedicated AI tool. Students were significantly more likely than lecturers to have used AI tools in the past but <5% of both groups had received prior AI training. Excitement about the potential of AI slightly outweighed concerns regarding future risks. A significantly higher proportion of students compared to lecturers believed that AI could dehumanise health care (70.6% vs. 60.8%), render physicians redundant (57.6% vs. 34.7%), diminish physicians' skills (79.3% vs. 71.3%) and ultimately harm patients (28.6% vs. 20.6%). Conclusion: The simultaneous fascination and apprehension with AI observed among both lecturers and students in our study mirrors the global trend. This finding was particularly evident in students who, despite possessing greater knowledge of AI compared to their lecturers, did not exhibit a corresponding reduction in their fear of AI.

Comparison of single versus double tranexamic acid dose regimens in reducing post-operative blood loss following intramedullary nailing of femoral fracture nonunions.

INTRODUCTION AND AIM OF STUDY: Tranexamic acid has been found to be effective in reducing peri-operative blood loss and is widely used across surgical specialties including orthopaedic surgery. However, there is still no consensus on the most appropriate and effective dose regimen. This study therefore compared the efficacy of single versus double dose regimens in patients that had interlocking intramedullary nailing by assessing the volume of drain output with the objective of determining the more effective regimen. METHODS: The study was a multicenter prospective study amongst adult patients who had interlocking intramedullary nailing for femoral nonunions. Following ethical approval, consent was obtained from eligible patients who were randomly assigned into two study groups. Group A patients had single pre-incision tranexamic acid bolus of one gram while group B patients had a second (repeat) one gram bolus (at the completion of wound closure). The volume of drain output at 48 h postop was the primary outcome measure and data collection was via an online data collection form linked to the google drive of the principal investigator. The mean of the drain output of the two groups was compared for statistical significance. RESULTS: A total of 61 patients participated in the study with 30 patients in group A and 31 patients in group B. The demographic data and duration of fracture were comparable in the two groups. Group A had a mean drain volume of 274.80 ml (± 103.93 ml) while group B had a mean of 187.94 ml (± 41.95 ml) and the difference was found to be statistically significant. (P, 0.000). CONCLUSION: The findings suggest that double dose perioperative tranexamic acid regimen is superior to single-dose peri-operative tranexamic acid regimen in reducing post-operative blood loss in patients undergoing interlocking intramedullary nailing for femoral nonunions.