Polylactic acid bioabsorbable implants of the hand: A review.

In the treatment of hand fractures, metal implants are often used to allow early range of motion and a stable fixation. Although they provide adequate bone union, metal implants have been known to cause joint stiffness, painful or prominent hardware, and adhesions, often leading to another surgery for hardware removal. Bioabsorbable implants have been shown to offer comparable results for fracture fixation in the hand while removing the complications seen with retained hardware. In this article, we review biomechanical and clinical studies focused on bioabsorbable implants made of polylactic acid used for orthopedic hand injuries in order to promote their continued use and future research.

The Joystick Method: A Mini Open Technique for Repairing Patellar Osteochondral Fractures With Concomitant Medial Patellofemoral Ligament Reconstruction.

Fixation of osteochondral fractures after patellar dislocation is typically done using an open approach due to the location of the defect. This is traditionally performed through a medial parapatellar arthrotomy to allow adequate visualization. By using the joystick method, adequate visualization is achieved with a smaller arthrotomy. Careful placement of the joystick in the planned anchor site of the medial patellofemoral ligament reconstruction reduces the number of drill sites in the patella.

Biomechanical Comparison of All-Suture, All-Inside Meniscus Repair Devices in a Human Cadaveric Meniscus Model.

OBJECTIVE: Newer all-suture, all-inside meniscus repair devices utilize soft suture anchors. The purpose of this study was to compare the biomechanical performance of 4 meniscus repair devices in human cadaver menisci: the JuggerStitch (all-suture, all-inside), the FiberStitch (all-suture, all-inside), a polyether ether ketone (PEEK) all-inside, and an inside-out device. DESIGN: Forty human cadaver menisci were tested after creating 20 mm longitudinal tears in the posterior meniscus. Each knee was randomized to 1 of 4 meniscus repair groups: JuggerStitch (all-suture, all-inside), FiberStitch (all-suture, all-inside), FAST-FIX 360 (PEEK-based anchor all-inside), and inside-out (with BroadbandTM tape meniscus needles). For each meniscus, 2 devices were used to prepare vertical mattress repair construct. The specimens were tested by pre-conditioning 20 cycles between 5 N and 30 N and then the tear diastasis was measured, followed by distraction to failure phase after imposing a displacement at a rate of 0.5 mm/s. RESULTS: Ten menisci were tested in each of the 4 groups. After pre-conditioning, there was no significant difference in the gap formation among groups (P = 0.212). The average failure load for the JuggerStitch, FiberStitch, PEEK all-inside, and inside-out was 384 N, 311 N, 207 N, and 261 N, respectively, with a significant difference between groups (P = 0.034). Post hoc analysis showed the JuggerStitch failure load was higher than the PEEK all-inside and inside-out (P = 0.005, and P = 0.045, respectively). There was no significant difference between the failure load of the JuggerStitch and FiberStitch (P = 0.225). CONCLUSION: The JuggerStitch all-suture device, FiberStitch all-suture device, PEEK all-inside, and inside-out devices have similar biomechanical properties for gapping and stiffness. The JuggerStitch all-suture, all-inside device has superior failure load compared with the PEEK all-inside and inside-out repair for longitudinal meniscus tear repair.

Are luggage scales a viable alternative to hand-held dynamometers for the measurement of shoulder scaption strength?

Background: The accurate and reliable measurement of muscle strength is a valuable tool in most medical practices. The use of dynamometers allows for objective muscle strength assessment. Even so, dynamometry has its limitations due to increased cost and inconvenience in the clinic. Isokinetic dynamometers, the gold standard, are typically very large and expensive. However, smaller hand-held dynamometers are a cheaper and more efficient alternative. Hand-held dynamometers have been shown to demonstrate comparable reliability to the more expensive isokinetic dynamometers, despite their reduced cost and ease of use. Even though hand-held dynamometers are cheaper and more convenient to use in the clinical setting, their price tag is still burdensome for most medical practices, commonly costing $1000 or more. The aim of this study is to assess the reliability of luggage scales vs. dynamometers for measuring shoulder scaption strength. Methods: One hand-held dynamometer was compared to two luggage scales using a set-up intended to mimic clinical testing. The set-up consisted of each device being tethered to the floor with the opposite end tied to a length of paracord that had been placed through a shoulder-height pulley and fastened to a flat plate used to hold the weight. In total, ten trials were completed, where a 2.3 kg (5 lb), 4.5 kg (10 lb), and 11.3 kg (25 lb). weight was measured by each device. Analysis of variance was used to compare the numerical data for the three groups. Results: Our results indicate that there were no significant differences in the force measurements between each device (P = .99). The average force measurements between the three dynamometers were: 2.3 kg trial: 2.3 kg, 2.4 kg, and 2.2 kg; 4.5 kg trial: 4.5 kg, 4.6 kg, and 4.5 kg ; and 11.3 kg trial: 11.4 kg, 11.3 kg, and 11.4 kg. for the digital dynamometer, digital luggage scale, and the analog luggage scale, respectively. Subgroup analysis showed there was also no difference in force measurements between the 3 devices for the 2.3 kg, 4.5 kg, and 11.3 kg. trials (P = .14, P = .49, and P = .40, respectively). Conclusion: Our data demonstrates that two inexpensive luggage scales showed no statistically significant differences in measurements compared to an expensive hand-held dynamometer. Utilization of luggage scales to measure shoulder scaption strength should yield similar results to handheld dynamometers. This may be an alternative, objective measure of manual muscle strength that is both efficient and economical.

In Vitro Evaluation of Lateral Femur Condyle Free Chondral Fragment Swelling after Soaking in Normal Saline.

OBJECTIVE: After traumatic knee injuries, chondral fragments can avulse off bone with the progeny fragment becoming a loose body. The loose fragment may be larger than expected when trying to surgically repair the fragment back to its original site. The purpose of this study was to determine whether a loose chondral fragment from the lateral femur condyle would increase in size and weight after soaking in normal saline (NS) for 14 days. DESIGN: Twelve 6-mm OAT (osteoarticular transfer) plugs were harvested from 6 cadaver knees on the lateral femoral condyle to simulate a chondral fragment. The chondral fragments were then placed inside an airtight specimen container with NS (0.9% sodium chloride) and were measured over 14 days. RESULTS: After 14 days, the chondral fragments showed no increase in diameter as they measured an average of 5.567 ± 0.448 mm on Day 1 and 5.702 ± 0.253 mm on Day 14 (P = 0.183). The chondral fragments showed an increase in mass from an average of 0.058 ± 0.012 g on Day 1 to 0.073 ± 0.012 g on Day 14 (P < 0.001) and an increase in thickness from an average of 2.038 ± 0.346 mm on Day 1 to 2.229 ± 0.297 mm on Day 14 (P = 0.033). CONCLUSIONS: Chondral fragments in NS increase in mass and thickness over time, but do not change in diameter. When surgeons are evaluating loose chondral fragments for fixation, they should consider that these fragments may appear thicker than the recipient location.

Comparison of ChatGPT-3.5, ChatGPT-4, and Orthopaedic Resident Performance on Orthopaedic Assessment Examinations.

INTRODUCTION: Artificial intelligence (AI) programs have the ability to answer complex queries including medical profession examination questions. The purpose of this study was to compare the performance of orthopaedic residents (ortho residents) against Chat Generative Pretrained Transformer (ChatGPT)-3.5 and GPT-4 on orthopaedic assessment examinations. A secondary objective was to perform a subgroup analysis comparing the performance of each group on questions that included image interpretation versus text-only questions. METHODS: The ResStudy orthopaedic examination question bank was used as the primary source of questions. One hundred eighty questions and answer choices from nine different orthopaedic subspecialties were directly input into ChatGPT-3.5 and then GPT-4. ChatGPT did not have consistently available image interpretation, so no images were directly provided to either AI format. Answers were recorded as correct versus incorrect by the chatbot, and resident performance was recorded based on user data provided by ResStudy. RESULTS: Overall, ChatGPT-3.5, GPT-4, and ortho residents scored 29.4%, 47.2%, and 74.2%, respectively. There was a difference among the three groups in testing success, with ortho residents scoring higher than ChatGPT-3.5 and GPT-4 ( P < 0.001 and P < 0.001). GPT-4 scored higher than ChatGPT-3.5 ( P = 0.002). A subgroup analysis was performed by dividing questions into question stems without images and question stems with images. ChatGPT-3.5 was more correct (37.8% vs. 22.4%, respectively, OR = 2.1, P = 0.033) and ChatGPT-4 was also more correct (61.0% vs. 35.7%, OR = 2.8, P < 0.001), when comparing text-only questions versus questions with images. Residents were 72.6% versus 75.5% correct with text-only questions versus questions with images, with no significant difference ( P = 0.302). CONCLUSION: Orthopaedic residents were able to answer more questions accurately than ChatGPT-3.5 and GPT-4 on orthopaedic assessment examinations. GPT-4 is superior to ChatGPT-3.5 for answering orthopaedic resident assessment examination questions. Both ChatGPT-3.5 and GPT-4 performed better on text-only questions than questions with images. It is unlikely that GPT-4 or ChatGPT-3.5 would pass the American Board of Orthopaedic Surgery written examination.

COVID-19 Physician Burnout: Louisiana's Workforce Vulnerability and Strategies for Mitigation.

Background: Louisiana is historically one of the lowest-performing states in terms of health outcomes in the United States. Hurricane Katrina led to a decrease in available health care resources, with a larger impact on resources for those living below the poverty line. Subsequently, the coronavirus disease 2019 (COVID-19) pandemic has been shown to have had disproportionately large impacts on minority communities, uninsured populations, and rural communities-all of which are found in Louisiana. Methods: This review focuses on the unique challenges of health care in Louisiana, the influence of COVID-19 on physician burnout, and methods of reducing work exhaustion for those in the health care field. Results: A national survey showed that physician satisfaction decreased from June 29, 2021, through September 26, 2021, compared to before the pandemic. A critical component in the provision of the essential services of public health is the ability to build and sustain a clinically skilled and diverse physician workforce. Maintaining well-being and retaining the physician workforce are prerequisites to the equitable provision of access to health care services. Conclusion: Maintaining one's own wellness is critical to occupational sustainability, particularly when unique stressors such as those encountered during the COVID-19 pandemic are present. The future of a vital health care system depends on physicians maintaining healthy habits and seeking help when burnout symptoms are recognized, both at the individual and institutional level.

Glossopharyngeal Neuralgia: Epidemiology, Risk factors, Pathophysiology, Differential diagnosis, and Treatment Options.

Purpose of Review: This is a comprehensive review of the most recent literature on glossopharyngeal neuralgia (GPN), a relatively rare form of neuropathic facial pain. It covers the epidemiology, risk factors, pathophysiology, and differential diagnosis given that glossopharyngeal neuralgia can often be confused with other facial pain syndromes. Finally, we extensively review recent findings regarding medical or conservative measures, minimally invasive, and surgical options for potentially treating and managing glossopharyngeal neuralgia. Recent Findings: An in-depth analysis of the recent literature indicates that glossopharyngeal neuralgia is not only rare but its etiology and pathophysiology are complex and are often secondary to other disease processes. Regardless, current management options are shown to be effective in controlling pain. Conservatively, first-line management of GPN is carbamazepine, but gabapentin and eslicarbazepine acetate are suitable alternatives. In terms of current minimally invasive pain management techniques, pulsed radiofrequency ablation, nerve blocks, or percutaneous radiofrequency thermocoagulation are effective. Finally, surgical management involves microvascular decompression and rhizotomy. Summary: While there are currently many viable options for addressing glossopharyngeal neuralgia pain ranging from conservative to surgical management, the complex nature of GPN etiology, pathophysiology, and involved anatomical structures prompts further research for more effective ways to treat the disease.

Occipital Nerve Stimulation: An Alternative Treatment of Chronic Migraine.

PURPOSE OF REVIEW: This paper will examine the efficacy and safety of occipital nerve stimulation as a non-pharmacological alternative treatment for migraine. RECENT FINDINGS: Migraine is characterized as a primary headache disorder with possible premonitory and aura phases, both of which vary greatly in symptomatology. The most common treatments for chronic migraine are pharmacological and are aimed at both acute relief (e.g., nonsteroidal anti-inflammatory drugs, triptans, and ergots) and prophylaxis (e.g., propranolol, valproic acid, and topiramate). For patients with medically refractory migraine, acute relief medication overuse can increase the risk of developing more severe and more frequent migraine attacks. Occipital nerve stimulation is a non-pharmacological alternative treatment for chronic migraine, which could eliminate the risk of adverse effects from acute relief medication overuse. Neurostimulation is thought to prevent pain by blocking signal transduction from small nociceptive fibers with non-painful signaling in larger adjacent fibers. Existing data from clinical trials support the overall safety and efficacy of occipital nerve stimulation for the treatment of chronic migraine. However, few large controlled, double-blinded studies have been conducted, due to both practical and ethical concerns. Currently, occipital nerve stimulation is available as an off-label use of neurostimulation for pain prevention but is not approved by the FDA specifically for the treatment of chronic migraine.

Medial Transmalleolar Portal Technique for Ankle Arthroscopic Headless Screw Fixation of Talar Osteochondritis Dissecans Lesions.

This article describes a technique for arthroscopic fixation of an osteochondritis dissecans (OCD) lesion of the medial talar dome with headless compression screws. This technique involves creation of a medial transmalleolar portal using a guide and drill. The medial transmalleolar portal grants perpendicular access for screw fixation of OCD lesions in addition to the potential for osteochondral autograft transplantation (OAT). Advantages include access to the medial talar dome without performing a medial malleolar osteotomy. After completion of OCD fixation, an inverted osteochondral plug can be used to backfill the portal.