#lowbackpain on TikTok: A New Frontier for Orthopaedic Medical Education.

INTRODUCTION: Low back pain has become a substantial health problem in all developed countries. Many healthcare professionals and content creators have begun sharing their treatment methods and opinions through social media, especially the video-based platform TikTok. TikTok has been downloaded more than 2.6 billion times with over a billion daily users. Its influence on public health makes it imperative that information be accurate and safe. This study aims to analyze TikTok's most popular content on lower back pain and how orthopaedic surgeons contribute on this growing platform. OBJECTIVES: To analyze TikTok's most popular content on lower back pain and how orthopaedic surgeons are and can contribute on this growing platform. METHODS: A TikTok search conducted on April 22, 2023, using the terms '#lowerbackpain'and '#lowbackpainrelief,' resulted in numerous videos, 100 of which met inclusion criteria. Videos were included if they were related to the content, had more than 1000 views, were in English, and were not duplicates. Video characteristics were recorded and evaluated for quality by two reviewers using DISCERN. A two-sample t-test was used to assess differences. RESULTS: Overall, the top videos on lower back pain had an average of 2,061,396 views, with a mean DISCERN score of 34. The mean total DISCERN score was 36 and 34 for physicians and nonphysicians, respectively, while the video by the orthopaedic surgeon (n = 1) scored 31. The most recommended treatments included at-home exercises (n = 75) and visiting a chiropractor (n = 4). CONCLUSION: We find that the information presented by nonphysicians offered quick, at-home fixes to medical problems without offering any research or proven data to support their claims. We cannot overlook Tiktok's immense influence in the realm of orthopaedic health as it has become a sphere of information dissemination and education. Thus, we suggest that there is not necessarily a need for a greater number of surgeons and/or resident physicians to involve themselves on the platform, but rather the involvement of governing bodies and spine societies to put out position statements for our patients.

Accuracy of radiographic techniques in detection of the calcaneofibular ligament calcaneal insertion for lateral ankle ligament complex surgery.

BACKGROUND: Grade III ankle sprains that fail conservative treatment can require surgical management. Anatomic procedures have been shown to properly restore joint mechanics, and precise localization of insertion sites of the lateral ankle complex ligaments can be determined through radiographic techniques. Ideally, radiographic techniques that are easily reproducible intraoperatively will lead to a consistently well-placed CFL reconstruction in lateral ankle ligament surgery. PURPOSE: To determine the most accurate method to locate the calcaneofibular ligament (CFL) insertion radiographically. METHODS: MRIs of 25 ankles were utilized to identify the "true" insertion of the CFL. Distances between the true insertion and three bony landmarks were measured. Three proposed methods (Best, Lopes, and Taser) for determining the CFL insertion were applied to lateral ankle radiographs. X and Y coordinate distances were measured from the insertion found on each proposed method to the three bony landmarks: the most superior point of the postero-superior surface of the calcaneus, the posterior most aspect of the sinus tarsi, and the distal tip of the fibula. X and Y distances were compared to the true insertion found on MRI. All measurements were made using a picture archiving and communication system. The average, standard deviation, minimum, and maximum were obtained. Statistical analysis was performed using repeated measures ANOVA, and a post hoc analysis was performed with the Bonferroni test. RESULTS: The Best and Taser techniques were found to be closest to the true CFL insertion when combining X and Y distances. For distance in the X direction, there was no significant difference between techniques (P = 0.264). For distance in the Y direction, there was a significant difference between techniques (P = 0.015). For distance in the combined XY direction, there was a significant difference between techniques (P = 0.001). The CFL insertion as determined by the Best method was significantly closer to the true insertion compared to the Lopes method in the Y (P = 0.042) and XY (P = 0.004) directions. The CFL insertion as determined by the Taser method was significantly closer to the true insertion compared to the Lopes method in the XY direction (P = 0.017). There was no significant difference between the Best and Taser methods. CONCLUSION: If the Best and Taser techniques can be readily used in the operating room, they would likely prove the most reliable for finding the true CFL insertion.

Delayed Presentation of Sciatic Nerve Palsy Due to Post-traumatic Pseudoaneurysm Following Pelvis Fracture: A Case Report.

Introduction: Pseudoaneurysms are vascular lesions occurring after injury to a blood vessel wall. Peripheral artery pseudoaneurysms as a fracture complication are uncommon and typically appear immediately after trauma or surgery. We report a unique case of sciatic nerve palsy associated with external iliac artery pseudoaneurysm arising 20 years after pelvic trauma, presenting within the fracture site as an erosive bone lesion masquerading as a possible malignancy. To the best of our knowledge, no cases of delayed external iliac artery pseudoaneurysm involving sciatic pain have been reported. Case Report: We present a 78-year-old female who sustained an acetabular fracture with an uneventful recovery for 20 years. The patient presented post-injury with symptoms and physical examination findings consistent with sciatic nerve palsy. Computed tomography angiography and duplex imaging revealed a pseudoaneurysm of the external iliac artery. The patient was taken to the operating room for endovascular repair of the external iliac artery using a covered stent. Conclusion: This case of sciatic nerve palsy is a unique contribution to the literature concerning the specific vascular injury observed and the delayed presentation of pseudoaneurysm causing sciatic nerve palsy. Orthopedic surgeons must consider a wide differential when confronted with suspicious pelvic masses. Failure to diagnose these as a vascular etiology could prove catastrophic should the surgeon attempt an open debridement or sampling.

Endoscopic Spine Surgery: Advertisement or Game Changer?

Endoscopic spine surgery is a rapidly developing technique. Initially used for diskectomies, endoscopic spine surgery is now considered for bony decompressions and fusions. Endoscopic spine surgery uses one or two small incisions so a camera can be inserted for visualization under high magnification while a working window is provided through the camera apparatus or through a separate incision. The suggested benefits of endoscopic spine surgery include less muscle trauma, decreased need for anesthesia, reduced blood loss, and faster recovery. The typical complications associated with spinal surgery such as bleeding, infection, nerve injury, and durotomy still exist. Although the disadvantages may have historical claims, recent literature suggests endoscopic spine surgery may outperform traditional techniques for certain pathologies. However, the learning curve of endoscopic spine surgery may present challenges with adoption by practicing spinal surgeons. The outcomes of appropriately applied endoscopic techniques provide support that endoscopic spine surgery has the potential to revolutionize spine surgery.

Pediatric Humeral Shaft Fracture Nonunion: A Case Report.

Humeral shaft fractures in the pediatric population are a commonly encountered injury in everyday practice. Most patients with these injuries are treated without surgery and go on to have an uneventful recovery. Nonunion of these injuries in the pediatric population has been reported only once in the literature. This case report follows a 13-year-old female after a seemingly standard transverse humeral shaft fracture. The patient was treated with a fracture brace initially. No signs of healing were noted at the eight-week post-injury follow-up. The family elected for continued conservative management until the patient returned at four months post-injury with persistent gross motion at the fracture site and no healing on radiographs. Laboratory testing did show that she has mild-to-moderate vitamin D deficiency, which was addressed. The patient underwent nonunion treatment with open reduction, internal fixation, and bone grafting. She went on to full union with an uncomplicated postoperative course. This case presents an interesting and unique case presentation. This report shows that, while rare, it is a potential outcome of humeral shaft fractures in the pediatric population. This case also demonstrates that using the standard adult operative technique for nonunion treatment with rigid internal fixation and bone grafting in a pediatric patient will lead to full-bone healing.

The Preoperative Risks and Two-Year Sequelae of Postoperative Urinary Retention: Analysis of the Michigan Spine Surgery Improvement Collaborative (MSSIC).

OBJECTIVE: Although postoperative urinary retention (POUR) is common after spine surgery, the association of this adverse event with other morbidities and patient-reported outcomes is not fully understood. We sought to examine the sequelae of POUR after lumbar spine surgery. METHODS: The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a large prospective multicenter registry. MSSIC was queried with multivariate analysis for factors that are associated with POUR, the association of POUR with 90-day adverse events, and the effect of POUR on 2-year patient-reported outcomes and satisfaction. RESULTS: Multivariate analysis identified hardware revision (odds ratio [OR], 0.61), 1 operative level (OR, 0.74), and ambulation on postoperative day zero (OR, 0.65) to be protective for POUR. Factors associated with POUR included age (OR, 1.19), male gender (OR, 1.58), body mass index <25 (OR, 1.22), diabetes (OR, 1.28), coronary artery disease (OR, 1.20), fusion surgery (OR, 1.27), and longer surgery (OR, 1.11). Patients who had POUR were more likely to be readmitted, develop a urinary tract infection, and develop an infection (P < 0.001). POUR was associated with decreased likelihood of achieving Oswestry Disability Index minimal clinically important difference at 90 days (P < 0.001), but not at 1 year after surgery. POUR was associated with dissatisfaction with surgery at 90 days (P < 0.001), 1 year (P = 0.004), and 2 years after surgery (P = 0.011). CONCLUSIONS: POUR is common after lumbar spine surgery, and the demographic, diagnostic, and surgical factors that are associated with POUR are identified. POUR is associated with several adverse events, and patients who have POUR were less likely to be satisfied with surgery up to 2 years after surgery.