The Impact of the Dobbs v. Jackson Supreme Court Decision on Orthopaedic Residency Programs: A Collaborative Orthopaedic Education Research Group (COERG) Survey.

BACKGROUND: Recent changes in reproductive health care policy have now led to state-specific differences in abortion care access across the United States. Members of the medical community in particular have issued concerns regarding these new policies and their potential impact on graduate medical training.  Objectives: The purpose of this study was to sample orthopaedic surgery residency programs to gauge their perceptions of the Dobbs decision and its impact on residency training.  Materials and methods: A 25-item questionnaire was developed to assess the attitudes of orthopaedic surgery residency programs on the Dobbs v. Jackson Women's Health Organization decision. Our survey-based study was first endorsed by and then distributed amongst members of the Collaborative Orthopaedic Education Research Group (COERG). A total of 24 representatives from 24 Accreditation Council for Graduate Medical Education (ACGME) accredited orthopaedic surgery residency programs agreed to participate in the study.  Results: Twenty-four of 24 program correspondents completed the survey (100%). Of the 15 programs (68.2%) who reported that their institution does not have a contingency plan in place, only five (33.3%) see a need for one. Eighteen programs (75.0%) agreed that the ACGME should have a policy protecting residents or significant others needing reproductive care. Ten (41.7%) respondents indicated that the Dobbs decision will impact how students rank residency programs; however, none (0%) believe it will impact their ability to attract a diverse applicant pool.  Conclusion: Although some programs surveyed have a contingency plan in place, the majority believe the ACGME should develop a policy that addresses the reproductive needs of residents. Given the higher rate of pregnancy complications experienced by women training in orthopaedic surgery it is paramount to have policies that protect residents seeking reproductive care.

A Comparison of Functional Outcomes in Rotator Cuff Repairs Using Adjunctive Bone Marrow Aspirate Concentrate vs. Bone Marrow Aspirate Concentrate With Platelet-Rich Plasma: A Systematic Review and Meta-Analysis.

Regenerative medicine, specifically bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP), has become a novel adjunct that orthopedic surgeons have started to use with surgical rotator cuff repairs (RCR). Thus, we are conducting this systematic review to determine if either RCRs with BMAC alone or with BMAC and PRP result in superior functional outcomes. We conducted a comprehensive search using five databases including PubMed, Web of Science, Embase, Scopus, and Cochrane. After duplicates were removed, 1205 studies were screened by title and abstract using Rayyan, resulting in three included studies (one BMAC with PRP and two BMAC only). Only studies that reported functional outcomes using the American Shoulder and Elbow Surgeons Shoulder Score and the University of California Los Angeles Shoulder Score were included. Changes in assessment scores from baseline to follow-up evaluation were quantified using the effect size and used in the meta-analysis for each group. Interpretation of treatment efficacy was represented using Cohen's d. The effect size of BMAC with PRP (Cohen's d = 2.19) was not significantly different (p = 0.76) from that of BMAC alone (Cohen's d = 2.35). Between-group differences in functional outcomes were Cohen's d = 0.16, which was not significant. Given the lack of superiority and the small sample size, more research is required before a conclusion can be drawn as to the benefits of combining PRP with BMAC for RCR. If functional outcomes are the same, using BMAC alone as an adjunct may be optimal to reduce resources used and cost. Future studies should be conducted with a larger pool as our primary limitation is that only three studies were included.

A Comparative Study of Combined Spinal Epidural Anesthesia Versus Spinal Anesthesia in Major Lower Limb Orthopedic Surgeries.

Background Neuraxial blockade includes epidural and spinal anesthesia (SA) that have gained wide acceptance for major lower limb orthopedic surgery. Both techniques are competent in rendering surgical anesthesia and pain relief, with specific advantages and disadvantages. SA has the merits of rapid onset and adequate anesthesia with a small volume of the drug but has significant hypotension and unpredictable duration. Epidural anesthesia allows for finer control over analgesia and the duration of anesthesia but requires more substantial volumes of drugs and is slower in onset. Combined spinal-epidural anesthesia (CSEA) combines the rapid commencement of action of SA with flexibility in epidural anesthesia, thus optimizing the management of the intraoperative and postoperative phases. This study aims to evaluate hemodynamic changes, compare the severity and duration of sensory and motor block, and track any problems related to CSEA and SA in major lower limb orthopedic procedures. Additionally, this study contrasts the hemodynamic, motor, and sensory changes in the two groups. Methodology A total of 30 individuals were randomized to one of two groups in this prospective comparative trial, which included 60 patients receiving major lower limb orthopedic surgery and meeting the American Society of Anesthesiologists physical status I-II criteria. Group A received CSEA, and Group B received SA. The degree and duration of sensory and motor blockade, hemodynamic changes, and complications were all recorded. A p-value of less than 0.05 was used to evaluate statistical significance using Student's t-test and chi-square test. Results The onset of sensory block in our study was earlier in Group B compared to Group A. In both groups, hemodynamic stability was maintained throughout the study. We recorded the onset/duration of sensory and motor block and hemodynamic changes and took mean values to find any significant difference. Postoperative complications and rescue analgesic requirements were monitored and managed and were a part of our study. Conclusions This study compared CSEA and SA regarding the severity and duration of sensory and motor block, hemodynamic stability, and associated complications in major lower limb orthopedic surgeries. The results shed light on the advantages and shortcomings of each anesthesia technique and, therefore, will help choose the correct method of anesthesia in a given surgery.

A Meta-Analysis Examining the Effect of Perioperative Biologic Disease-Modifying Anti-Rheumatic Medications on Postoperative Wound Complications in Various Orthopedic Surgeries.

This meta-analysis was designed to compare the risk of postoperative wound complications in various orthopedic surgeries (OSs) affected by the perioperative use of biologic disease-modifying anti-rheumatic drugs (bDMARDs). The odds ratio (OR) and mean difference (MD), with 95% confidence intervals (CIs), were calculated using dichotomous or continuous random or fixed-effect models, based on the meta-analysis data. This study incorporated 14 investigations conducted between 2005 and 2023, encompassing a total population of 19,021 individuals undergoing diverse OSs. Participants who continued their bDMARDs exhibited a substantially higher incidence of postoperative surgical site infections (OR, 1.39; 95% CI, 1.12-1.72, p = 0.002) compared to those who withheld bDMARDs. However, the study did not find any statistically significant difference between the continuation or withholding of bDMARDs regarding delayed wound healing (OR, 2.02; 95% CI, 1.00-4.06, p = 0.05) or disease flares (OR, 0.59; 95% CI, 0.28-1.25, p = 0.17). The results show that patients who continued their bDMARDs had a notably higher incidence of postoperative surgical site infections. However, no significant differences were observed in delayed wound healing or disease flares when compared to those who withheld bDMARDs. It is important to acknowledge the limitations of this analysis, such as the relatively small number of participants and the limited number of studies available for certain comparisons, which may impact the validity of the findings.

Lower Trapezius Tendon Transfer for Restoration of External Rotation in Brachial Plexus Birth Injury.

OBJECTIVE: Patients with brachial plexus birth injuries (BPBIs) are at risk for limitations in shoulder external rotation. The role of lower trapezius tendon transfer to restore shoulder external rotation in this population has not been well characterized. This study aimed to evaluate the utility of lower trapezius tendon transfer for restoration of external rotation in a subset of pediatric patients. METHODS: Seventeen pediatric patients with BPBI were treated with lower trapezius tendon transfer to restore external rotation of the shoulder. Mean age at surgery was 8 years, and 11 were female. Six patients had prior shoulder surgery to restore external rotation, while 1 had prior nerve surgery to restore shoulder function. Range of motion before lower trapezius transfer and at latest follow-up was obtained. Mean follow-up was 36 months. RESULTS: Active forward flexion did not significantly change from preoperative to final follow-up (mean, 147° and 141°; P = 0.46). External rotation in adduction significantly changed from preoperative to final follow-up (mean, 4° and 26°; P < 0.001). External rotation in abduction significantly changed from preoperative to final follow-up (mean, 75° and 84°; P = 0.048). Six patients (35%) had subsequent surgeries at average 17 months from this procedure. Significant univariate associations with subsequent surgery included certain intraoperative concomitant procedures-coracoid osteotomy/excision (P = 0.02) and biceps tenodesis (P = 0.04)-while bony glenoid augmentation/reconstruction trended toward significant association (P = 0.05). CONCLUSIONS: Lower trapezius tendon transfer for BPBI showed a statistically significant but unlikely clinically meaningful improvement in external rotation with a high rate of reoperation.

Pulmonary Embolism Post-Femoral Neck Fracture Surgery: A Critical Predictor of Five-Year Mortality.

Objectives: This study examines the impact of pulmonary embolism (PE) on mortality among patients with femoral neck fractures, exploring the predictive value of preoperative PE for postoperative occurrences and associated mortality over a 5-year follow-up period. Methods: We analyzed 2256 patients over 60 years old admitted with femoral neck fractures, focusing on those who developed DVT or PE postoperatively. Surgical intervention aimed within 48 hours without pharmacological thromboprophylaxis, utilizing mechanical prophylaxis instead. Postoperative management included Enoxaparin administration. Data analysis employed SPSS 21, with chi-squared tests, T-tests, and multivariate logistic regression to explore mortality and PE incidence. Results: PE was diagnosed in 1.4% of patients, with a notable mortality contrast between patients with PE (87%) and those without (59.7%) over 5 years. A history of preoperative PE emerged as a significant risk factor for postoperative PE. Despite surgical variations, no significant correlation was found between surgery type and PE incidence. Early postoperative weight-bearing and institutional rehabilitation did not significantly alter PE incidence rates. Conclusions: The study underscores the significant mortality risk associated with preoperative PE in femoral neck fracture patients. It highlights the necessity for vigilant PE risk assessment and management, challenging assumptions about the protective role of early mobility and rehabilitation in PE incidence. Further research is essential to refine patient care strategies and improve outcomes.

Effectiveness and safety of rivaroxaban or low-molecular-weight heparin in non-major orthopedic surgery: a meta-analysis of randomized controlled trials.

BACKGROUND: Patients undergoing non-major orthopedic surgery often face an increased risk of venous thromboembolism due to the necessity of immobilization postoperatively. Current guidelines commonly recommend the use of low-molecular-weight heparin (LMWH) for prophylaxis, but it is associated with low patient compliance and certain side effects. We conducted a meta-analysis of randomized controlled trials (RCTs) to assess the effectiveness and safety of rivaroxaban or LMWH for thromboprophylaxis following non-major orthopedic surgery. METHOD: Relevant literature was systematically searched in PubMed, Web of Science, Cochrane Library, and Embase from their inception to October 1, 2023, to evaluate the effectiveness and safety of rivaroxaban or LMWH in RCTs for thromboprophylaxis following non-major orthopedic surgery. RESULTS: A total of 5 randomized controlled trials involving 5,101 patients were included. There was no statistically significant difference in the preventive effect against venous thromboembolism (VTE) when using rivaroxaban or LMWH following non-major orthopedic surgery (RR 0.80; 95%CI 0.31 to 2.07). In terms of safety, there was also no statistically significant difference in the incidence of bleeding events in patients undergoing non-major orthopedic surgery when using rivaroxaban or LMWH (RR 1.15; 95% CI 0.75 to 1.76). CONCLUSION: In non-major orthopedic surgery, the risk of venous thromboembolism and bleeding complications is similar when using rivaroxaban or LMWH.

Comparative Efficacy and Safety of Robot-Assisted vs. Freehand Screw Placement in Femoral Neck Fractures: An Updated Systematic Review and Meta-Analysis.

Background: Femoral neck fractures pose significant surgical challenges with high morbidity and mortality. Traditional freehand screw placement often yields variable outcomes. Recent robotic advancements offer a promising alternative with enhanced precision. Methods: This systematic review compares the efficacy and safety of robot-assisted versus freehand techniques. A comprehensive literature search across multiple databases up to July 2024 included studies comparing both techniques. Primary outcomes were the union rate and time, functional outcomes, operative time, intraoperative parameters, and complication rates. Meta-regression analyses identified treatment response determinants. Results: Twenty-four studies (1437 patients) were included. Robot-assisted screw placement significantly improved the union rate, reduced the union time, and showed superior functional outcomes. Additionally, it resulted in shorter operative times, less intraoperative blood loss, and fewer instances of fluoroscopy and guide pin insertion. The risk of femoral neck necrosis was notably lower with robotic assistance. Meta-regression highlighted the robot type, patient age, and sample size as significant factors. Conclusions: Despite the promise of robot-assisted screw placement, limitations exist. The evidence being mainly from China raises concerns about generalizability. The lack of long-term follow-up data hinders assessment of technique durability. Unreported surgeon expertise levels and learning curves affect result validity. High initial costs and steep learning curves of robotic systems also present barriers to widespread adoption.

Incidences of Rocuronium Use during Anesthetic Induction in Adult Patients Undergoing Orthopedic Surgery Using Supraglottic Airway Devices: A Retrospective Analysis.

Background/Objectives: Neuromuscular blocking agents (NMBAs) are not usually necessary during the induction of general anesthesia in patients using supraglottic airway (SGA) devices. In this study, we assessed the incidences of rocuronium use in adult patients undergoing general anesthesia using SGA devices. Methods: From September 2022 to August 2023, the medical records of adult patients (≥19 years) who underwent orthopedic surgery using SGA devices were retrospectively investigated. The incidences of rocuronium use during anesthetic induction were analyzed according to the anesthetic induction drug. The association of rocuronium use during anesthesia was analyzed in terms of demographic (age, sex, height, and weight), surgical (surgical time), and anesthetic factors (premedication, anesthetic agent, anesthetic time). Results: In total, 321 patients were enrolled. The incidence rate of rocuronium use during anesthetic induction was 28.3%. In the subgroup analysis, patients receiving total intravenous anesthesia (TIVA) with propofol (PPF) and remifentanil showed a markedly lower incidence (14.4%) than the other anesthetic groups. Premedication or short anesthetic duration was associated with lower incidences of rocuronium use. Demographic and other anesthetic factors did not seem to affect the incidences of rocuronium use during anesthesia. Conclusions: The incidence of rocuronium use during anesthetic induction with SGA devices was significantly lower with the PPF-TIVA compared to that using remimazolam-TIVA or inhalational anesthesia. Premedication with midazolam and shorter operation times were associated with a significantly lower incidence of rocuronium use.

Delirium in Lower Limb Trauma: The Incidence and Risk Factors in a Prospective Observational Study.

Background: Delirium poses a significant challenge in musculoskeletal trauma patients, particularly the elderly, contributing to elevated morbidity and mortality. Despite unclear pathogenesis, various risk factors have been identified. This prospective observational study, conducted in a tertiary center, aims to estimate delirium incidence and identify associated risk factors in adult patients undergoing lower limb trauma surgeries. Methods: Between August 2021 and December 2022, 150 patients with lower limb trauma admitted for surgery were included. Initial assessments recorded Mini-Mental State Examination scores, Injury Severity Scores, and potential risk factors. Confusion Assessment Method scoring done preoperatively (excluding emergencies) and postoperatively on days 2 and 5 or at discharge. Daily delirium screening utilized Nursing 4-Abbreviated Trauma score, with severity assessed using CAM-Severity score. Risk factor analysis categorized patients into Group A (delirium) and Group B (non-delirium), with primary endpoint being delirium occurrence. Results: The study revealed a 10% delirium incidence. Delirium severity ranged from mild to severe. The median age (in years) was 79 vs 46 in delirium and non-delirium group respectively. Delirium patients had longer hospital stay (13 vs 8, p value 0.011). Similarly, factors like female gender, delayed surgery, hyponatremia, hypoproteinaemia, increased injury severity, midazolam use during induction, multiple blood transfusions, and heightened postoperative pain intensity were found significant (p value < 0.05). Conclusions: This study enhances our understanding of delirium in lower limb trauma patients undergoing surgeries. Identified risk factors offer insights for targeted interventions, emphasizing the need for comprehensive preoperative assessments and management strategies to reduce delirium incidence and improve patient outcomes.

Thermal Evaluation of Bone Drilling: Assessing Drill Bits and Sequential Drilling.

Sequential drilling is a common practice in dental implant surgery aimed at minimizing thermal damage to bone. This study evaluates the thermal effects of sequential drilling and assesses modifications to drilling protocols to manage heat generation. We utilized a custom drill press and artificial bone models to test five drill bits under various protocols, including sequential drilling with different loads, spindle speeds, and peck drilling. Infrared thermography recorded temperature changes during the drilling process, with temperatures monitored at various depths around the osteotomy. The results reveal sequential drilling does not eliminate the thermal damage zone it creates (well over 70 °C). It creates harmful heat to surrounding bone that can spread up to 10 mm from the osteotomy. The first drill used in sequential drilling produces the highest temperatures (over 100 °C), and subsequent drill bits cannot remove the thermal trauma incurred; rather, they add to it. Modifying drill bit design and employing proper drilling techniques, such as reducing drilling RPM and load, can reduce thermal trauma by reducing friction. Inadequate management of heat can lead to prolonged recovery, increased patient discomfort, and potential long-term complications such as impaired bone-to-implant integration and chronic conditions like peri-implantitis. Ensuring healthy bone conditions is critical for successful implant outcomes.

Postoperative delirium among elderly elective orthopedic patients in Addis Ababa Ethiopia: a multicentere longitudinal study.

BACKGROUND: Delirium is a neurocognitive disorder characterized by an acute and relatively rapid decline in cognition, disturbance of consciousness, reduced ability to focus, and shift of attention. It mainly affects elderly patients with an incidence of about 8-23% after an operation. It frequently occurs between 24-hrs and 5 days after surgery. It results in serious medical management problems. Hence, identifying the incidence and associated factors may help prevent and manage its sequel in the elderly. OBJECTIVE: Assessment of the incidence and associated factors of postoperative delirium(POD) among elderly elective orthopedic surgical patients in Addis Ababa public hospitals, Ethiopia, 2024. METHODS: A multi-centered longitudinal study was conducted on 220 elderly (age ≥ 65 years) patients in four selected public hospitals of the study area from February 2024 to May 2024, and a systematic sampling technique was used to select the study units. Data was collected through chart review and interviews of patients, and postoperative delirium was assessed using the confusion assessment method (CAM). Both bivariable and multivariable logistic regression models were used for statistical analysis. The strength of association was determined with an adjusted odds ratio (AOR) with a 95% confidence interval(CI) at a p-value of < 0.05. RESULTS: A total of 220 patients were studied, and the incidence of POD among elderly elective orthopedic surgical patients was 33.7%. Age 65-75(AOR = 0.47, 95%CI (0.226-0.97)), Induction using ketamine (AOR = 1.32, 95%CI(1.109-3.87), p = 0.003)), perioperative opioid use (AOR = 2.20, 95%CI(1.073 4.5313)), intraoperative anticholinergic use(AOR = 2.24,95%CI(1.831-4.235)), recent hospitalization history (AOR = 2.24,95%CI(1.202-4.206)), and transfusion (AOR = 2.83,95%CI(1.295-6.193)) were significantly associated with POD (p < 0.05). CONCLUSION AND RECOMMENDATIONS: The incidence of POD in the study area was high (33.7%); advanced age, hospitalization history, Anesthesia induction by Ketamine, perioperative anticholinergic uses, opioid use, and blood transfusion use were associated factors for postoperative delirium. We recommend giving due attention to elderly patients with advanced age, history of hospitalization, perioperative Ketamie use, perioperative anticholinergic uses, opioid use, and blood transfusion use undergoing elderly elective orthopedic surgery.

How option-listing influences decision-making in orthopedic consultations: a conversation analytic study.

OBJECTIVES: Examine which practices orthopedists use to do option-listing, a technique that can facilitate shared decision-making (SDM). METHODS: A conversation analytic study of 35 orthopedic consultations with newly referred patients with hip and/or knee osteoarthritis. RESULTS: Orthopedists implement option-listing in consultations using two organizational principles: 1) A fixed order of options that constitutes a scale (based on the severity of treatment). Presenting this scale (in two possible orders) encodes this fixed order; 2) Options are presented in relation to each other, rather than as individual options to be discussed incrementally. This format provides orthopedists with interactional slots to formulate their professional stance by presenting options as considered but rejected. Patients co-construct this list by taking a recipient role and not responding to the individual items of the list. CONCLUSIONS: Option-listing can facilitate SDM, allowing patients to choose amongst options. A drawback is that, while the organizational principles of option-listing allow orthopedists to express a professional opinion, they also place patients in an interactional position in which they have to address the orthopedists' epistemic stance. On the other hand, patients can use the scale to propose their own preferences. PRACTICAL IMPLICATIONS: Awareness of the interactional consequences of option-listing might optimize SDM.

Quality of Postoperative Pain Management in Orthopedic Patients and Its Impact on Sleep Quality and Patient Satisfaction: An Integrative Review.

Pain is one of the most common manifestations in the postoperative stage and it has a detrimental effect on both sleep and patient satisfaction. Consequently, this integrative review seeks to identify the outcomes of pain management specifically concerning sleep quality and patient satisfaction among the patients receiving orthopedic surgeries. In a stepwise manner, peer-reviewed articles manually searched in four databases including Scopus, Science Direct, PubMed, and CINAML (Cumulated Index to Nursing and Allied Health Literature) published between 2019 and 2023 were selected. The current review finally encompassed 22 studies. The review elaborates and reaffirms the notion that pain after surgery is still a critical issue that impacts the quality of patients' sleep as well as their overall satisfaction. Chronic sleep disturbance is generally linked with pain while other factors such as light exposure and hospital environment were found to influence sleep quality. It is thus crucial to develop clear multifaceted pain management guidelines that include patient-tailored pharmacological and non-pharmacological interventions aimed at helping patients recover better, sleep better, and be satisfied with the procedures and results.

Repair of an Isolated Sternal Head Tear of the Myotendinous Junction of the Pectoralis Major Using Knotless Suture Anchors: Case Report and Literature Review.

Although considered a relatively uncommon sports injury, publications on pectoralis major (PM) injuries have increased in the last couple of decades. Knowledge of the complex anatomy of the PM muscle is important in diagnosing, understanding the complexity of the injury, and determining the suitable modality of management of these injuries. Despite the increase in publications, there is no consensus on the superiority of any proposed surgical management. We present a case of a recreational body builder who presented to our clinics with a rare pattern of isolated musculotendinous junction of the lower fibers of the PM muscle and proposed a new technique of surgical management of such injuries using knotless suture anchors and running locked suture pattern in different directions. We then conducted a comprehensive review of literature of these injuries and presented a review on the pathophysiology, the various patterns of these injuries, and the available described modalities of surgical management. Understanding the complex anatomy of the PM, the various pattens of injury, and the aid of an MRI read by an expert musculoskeletal radiologist is crucial before managing these injuries. We believe that acute surgical repair of musculotendinous junction injuries using running Krackow/Brunnell locked configuration and the use of knotless suture and anchors will provide adequate and practicable surgical repair of these injuries.

Emerging Technologies in Hand Orthopedic Surgery: Current Trends and Future Directions.

Emerging technologies are changing hand surgery by improving surgical precision, minimizing tissue disruption, and expediting patient recovery. These advancements have the potential to revolutionize surgical procedures, patient outcomes, and rehabilitation processes. However, there are still challenges that need to be addressed before these technologies can be widely adopted. These challenges include the learning curve for surgeons, high costs, and ethical considerations. Future research should focus on addressing the limitations of these technologies, exploring their long-term effects, and evaluating their cost-effectiveness. To successfully implement them, a collaborative approach involving clinicians, researchers, engineers, and policymakers is necessary. This review provides an overview of current and future trends in emerging technologies for hand orthopedic surgery.

The effect of perineural dexamethasone on nerve injury and recovery of nerve function after surgery: A randomized controlled trial.

Background: While numerous studies have examined the influence of perineural dexamethasone on nerve block duration, its potential impact on postoperative nerve injury has not been adequately addressed. Objective: This study aims to elucidate the effect of perineural dexamethasone on nerve injury and nerve function recovery after surgery. Design: A prospective randomized double-blinded trial. Setting: The First Affiliated Hospital of Chengdu Medical College, Chengdu, China. The study was conducted between 14 June and 30 December 2022. Participants: Patients aged 18 - 80 years, ASA I - II, scheduled for elective orthopedic or burn and plastic surgery. Interventions: Patients were randomized to receive either perineural dexamethasone (D group) or no dexamethasone (ND group). Main outcome measures: Primary outcomes were the incidence and recovery of nerve injury. Secondary outcomes included postoperative pain scores, analgesic consumption, and adverse events. Results: Initial postoperative nerve injury rates were similar between groups (D: 30.4 %, ND: 33.3 %, P > 0.05). At 12 weeks post-discharge, significantly more patients in the ND group recovered from nerve deficits (78.8 % vs 60.3 %; OR = 2.45, 95 % CI = 1.05 - 5.72, P < 0.05). No significant differences were observed in postoperative hyperglycemia or surgical site infection rates. Conclusion: Perineural dexamethasone may impede nerve function recovery, suggesting caution in its use, particularly for patients with pre-existing nerve damage or diabetes. Further research is needed to elucidate the long-term effects of dexamethasone on nerve tissue recovery. Trial registration: chictr.org.cn, ChiCTR2200059424.

Cell-based therapy in the treatment of musculoskeletal diseases.

A limited number of tissues can spontaneously regenerate following injury, and even fewer can regenerate to a state comparable to mature, healthy adult tissue. Mesenchymal stem cells (MSCs) were first described in the 1960s-1970s by Friedenstein et al as a small population of bone marrow cells with osteogenic potential and abilities to differentiate into chondrocytes. In 1991, Arnold Caplan coined the term "mesenchymal cells" after identifying these cells as a theoretical precursor to bone, cartilage, tendon, ligament, marrow stroma, adipocyte, dermis, muscle, and connective tissues. MSCs are derived from periosteum, fat, and muscle. Another attractive property of MSCs is their immunoregulatory and regenerative properties, which result from crosstalk with their microenvironment and components of the innate immune system. Collectively, these properties make MSCs potentially attractive for various therapeutic purposes. MSCs offer potential in sports medicine, aiding in muscle recovery, meniscal tears, and tendon and ligament injuries. In joint disease, MSCs have the potential for chondrogenesis and reversing the effects of osteoarthritis. MSCs have also demonstrated potential application to the treatment of degenerative disc disease of the cervical, thoracic, and lumbar spine.

Inter-rater and intrarater reliability of superior labrum anterior to posterior lesion classification using magnetic resonance arthrography.

Background: The glenoid labrum is a fibrocartilaginous ring that affixes the joint capsule and ligaments of the glenohumeral joint. Superior labrum anterior to posterior (SLAP) lesions are a subset of injuries that affect the superior glenoid labrum, most common in laborers and overhead-throwing athletes. In 1990, Snyder et al classified SLAP lesions into one of four types. Later, Maffet et al expanded this scale to include three additional subclassifications. At present, arthroscopy is considered the gold standard for SLAP tear diagnosis. Classification under arthroscopy has demonstrated low to moderate inter-rater reliability. Magnetic resonance arthrography (MRa) is an alternate, less invasive test for diagnosing SLAP lesions. The reliability of MRa for diagnosing slap tears is uncertain. Methods: Magnetic resonance arthrograms were identified using the Picture Archiving and Communication System (PACS). In total, 273 shoulder arthrograms were reviewed, and 20 were selected with the desired pathology. Three orthopedic surgeons and three musculoskeletal radiologists were asked to classify the SLAP lesions into one of seven categories (Snyder & Maffet classification systems). Data was collected on two separate occasions at an interval of at least two months. Inter-rater and intrarater reliability were calculated using Fleiss Kappa and Cohen's Kappa, respectively. Results: Between all raters, there was poor inter-rater reliability for each round of data collection (κ = .177, κ = .124 for rounds 1 and 2, respectively). Between orthopedic surgeons, there were poor levels of agreement (κ = -.056, κ = .114), whereas, between radiologists, there was fair to moderate agreement (κ = 0.479, κ = 0.340). Within orthopedic raters, κ values ranged from -0.059 to 0.125, indicating, at best, poor intrarater reliability. Within radiologists, κ values ranged from 0.545 to 0.553, indicating moderate agreement within raters. The analysis determined that none of the orthopedic values for inter or intrarater reliability could be deemed statistically different from zero. Conclusion: Overall, classification using MRa resulted in significant disagreement between and within raters. Trained radiologists demonstrated higher overall levels of agreement than orthopedic surgeons. In summary, when using MRa to assess SLAP lesions, Snyder and Maffet classification demonstrates poor reliability by orthopedic surgeons and moderate reliability when used by musculoskeletal radiologists.

Gamification and Serious Games in Orthopedic Education: A Systematic Review.

Gamification and serious games have successfully been used in surgical specialties to improve technical skills related to systematic procedures. However, the use of gamified education material has remained limited in orthopedic residency training. The objective of this systematic review is to summarize the current use, development, and future directions of gamification for developing orthopedic skills. A comprehensive literature search was performed on Ovid MEDLINE, Web of Science, and Scopus between January 1, 2012, and the search date of July 1, 2023. After screening 1,915 papers, a total of four publications that utilized elements of gamification in acquiring and/or improving orthopedic skills were included. Three studies showed a positive correlation between video gaming experience and orthopedic skill performance, acquisition, or both. One study showed a positive response from residents when training sessions were hosted in a competitive, but friendly environment with direct observation from their attendings. Gamified learning has the potential to improve orthopedic education, but its current use is largely unexplored. A competitive or rewarding environment promotes engagement and active learning. To enable the highest and most efficient level of training, future development should be geared toward virtual reality simulators that incorporate haptic feedback to better simulate other orthopedic-based tasks.