História da construção de saberes em enfermagem traumato-ortopédica / History of knowledge construction in trauma and orthopedic nursing care / Historia de la construcción del conocimiento en enfermería traumatológica ortopédica

Objetivo: analisar o desenvolvimento da enfermagem traumato-ortopédica a partir da primeira turma de residentes de um hospital especializado. Método: o estudo seguiu a metodologia histórica com abordagem qualitativa. As fontes foram documentos escritos e orais. Resultados: trabalhar em uma instituição especializada foi o ponto de partida para a busca por especialização de enfermeiras atuantes no cuidado traumato-ortopédico, que perceberam o saber/poder adquirido no trabalho assistencial, além da intenção de qualificar a assistência e elevar o hospital a instituto. Estratégias empregadas reúnem a busca por parcerias com instituições universitárias e associativas, além da criação de uma associação própria. Considerações finais: a enfermagem traumato-ortopédica ampliou seu espaço científico ao criar um curso de especialização com uma unidade acadêmica. Foi possível delimitar o poder acadêmico e institucional da enfermagem na instituição de saúde pela formação de enfermeiras especialistas constituindo um grupo de reconhecido pelo saber científico.

Objective: to analyze the development of trauma and orthopedic nursing care from the very first class of residents of a specialized hospital. Method: historical methodology study with a qualitative approach. The sources consisted of written and oral documents. Results: working in a specialized institution was the starting point for nurses who were seeking specialization in the field of trauma and orthopedic care as they noticed the power-knowledge acquired through care work, plus they were willing to improve assistance and take the hospital up to an institute level. Strategies used include the search for partnerships with universities and associative-type institutions, in addition to creating their own association. Final considerations: trauma and orthopedic nursing care expanded its scientific space by creating a specialization course together with an academic unit. It was possible to define the academic and institutional power of the nursing staff in the health institution by considering the training process of its nurse specialists, who consisted of a group recognized for their scientific knowledge.

Objetivo: analizar el desarrollo de la enfermería traumatológica ortopédica a partir del primer grupo de residentes de un hospital especializado. Método: estudio con metodología histórica con un enfoque cualitativo. Las fuentes fueron documentos escritos y orales. Resultados: el trabajo en una institución especializada fue el punto de partida para la búsqueda de la especialización de las enfermeras que trabajaban en la atención traumatológica ortopédica, quienes notaron el saber/poder adquirido en el trabajo asistencial, además de la intención de cualificar la atención y elevar el hospital al nivel de instituto. Las estrategias empleadas incluyen la búsqueda de alianzas con instituciones universitarias y asociaciones, y la creación de una asociación propia. Consideraciones finales: la enfermería traumatológica ortopédica amplió su espacio científico mediante la creación de un curso de especialización con una unidad académica. Se logró delimitar el poder académico e institucional de la enfermería en la institución de salud a través de la formación de enfermeros especialistas, que es un grupo reconocido por el conocimiento científico.

Successful Midfoot Reconstruction in Müller-Weiss Disease Using a Reverse Fibular Flap: A Case Report and Literature Review.

Müller-Weiss disease (MWD) is a poorly understood orthopedic condition first described in 1927 that causes chronic pain across the midfoot and hindfoot. The etiology is uncertain but includes navicular dysplasia, osteochondritis, and trauma. The initial management is conservative, aiming to reduce the patient's symptoms, and includes analgesia, footwear, and activity modification. Surgical interventions such as joint fusion are considered when conservative measures fail, but there is little recorded for treatment beyond this. This case outlines the difficult management of a 52-year-old female patient with a long history of MWD. She had no history of previous trauma or neurological problems. A talonavicular fusion failed to unite, resulting in significant necrosis of the lateral navicular and navicular-cuneiform arthritis. We describe the novel use of a reverse vascularized pedicled fibular flap and extended midfoot fusion to manage the navicular bone defect. At six-year follow-up, the patient remains virtually pain-free and has returned to work with radiographs confirming good incorporation of the bone graft. We understand this to be the first documented use of a reverse vascularized fibular bone graft for recalcitrant MWD. Given the excellent clinical outcome in this case, surgeons should consider this combined ortho-plastics approach in the management of complex non-union with a bone defect in the midfoot.

Successful Management of a Neglected Talonavicular Joint Dislocation Using Corrective Osteotomy and Subtalar Fixation: A Case Report.

The complete loss of articular relationships between the talus and navicular bone is known as talonavicular joint (TNJ) dislocation. Medial dislocation of the TNJ is more common than lateral dislocation. Lateral dislocation is usually associated with a fracture of the calcaneocuboid joint. Surgeons encounter difficulties when treating these dislocations. It occurs following high-energy trauma and is managed with immediate closed reduction of the joint and immobilization, but some complicated cases require open reduction and fixation to achieve alignment, strength, and function. This case report describes a six-month-old neglected case of TNJ dislocation managed with corrective osteotomy and subtalar fixation. Fusion of the talonavicular and talocalcaneal joints was performed. This procedure had a satisfactory outcome, as the patient was completely relieved of pain.

OrthoTV: Broadcasting Orthopedics around the World.

OrthoTV has emerged as a pioneering platform in the field of orthopedic education, leveraging technology to create a comprehensive and accessible knowledge repository. Originating from the vision of the Indian Orthopedic Research Group in 2013, OrthoTV has evolved into a global educational hub, streaming thousands of hours of surgical videos, webinars, and podcasts. It provides a dynamic learning environment through live interactive sessions, fostering real-time engagement with experts and facilitating a global exchange of knowledge. OrthoTV's expansion during the COVID-19 pandemic underscored its vital role in continuing medical education amidst travel restrictions. The platform extends beyond educational resources to include career support, collaborative research initiatives, and even virtual fellowships, embodying a multifaceted approach to professional development. With the introduction of OrthoAI, OrthoTV integrates advanced artificial intelligence to offer personalized, evidence-based responses to queries, setting a new standard in digital medical education. This narrative review highlights OrthoTV's foundational principles, its significant impact on orthopedic education and practice, and its commitment to democratizing knowledge across the globe. OrthoTV's innovative use of technology bridges geographical barriers enriches learning experiences, and fosters a vibrant community of orthopedic professionals, marking a significant advance in the field of medical education.

Exploring Factors Influencing Orthopedic Patients' Willingness to Recommend a Hospital: Insights From a Cross-Sectional Survey.

Patient satisfaction and the willingness to recommend a hospital are critical for healthcare quality improvement. This study focuses on orthopedic patients, recognizing their unique healthcare experiences. We aimed to explore factors influencing orthopedic patients' willingness to recommend the hospital, considering various demographic and clinical variables. A cross-sectional survey of 200 orthopedic patients hospitalized between July and December 2023 in north-central Israel was conducted. Results revealed a positive association between age and willingness to recommend (odds ratio [OR] = 2.44), while emergency department stay length showed a negative association (OR = 0.58). Satisfaction with hospital care positively influenced the willingness to recommend (OR = 1.96). Gender, comorbidities, and hospital stay length did not significantly impact willingness to recommend. The study highlights the role of satisfaction and the impact of extended emergency department stays, emphasizing the need for nuanced strategies to optimize orthopedic patient experiences. Valuable insights are offered for healthcare providers and policymakers.

Gender Differences in Self-Description: A Linguistic Analysis of Orthopedic Surgery Residency Application Personal Statements.

OBJECTIVE: The purpose of this study is to assess differences in language characteristics in personal statements written by male and female applicants to an orthopedic surgery residency program. DESIGN: This is a blinded retrospective analysis of personal statements from all applicants to an orthopedic surgery residency training program during 1 application cycle. Language characteristics were analyzed using a linguistic analysis software. This software evaluated 19 variables, including word count, 4 summary language variables (analytical thinking, clout, authenticity, and emotional tone), and 14 additional word categories. SETTING: Our study took place at [institution]. PARTICIPANTS: All applications submitted during the 2018-2019 residency application cycle were analyzed. 889 applicants were included in the study based on exclusion criteria, which omitted the 5 applicants who ultimately matched at our institution, as well as non-US citizens. RESULTS: Word count was not statistically significant between groups. Amongst the summary language variables, authenticity was higher in female applicants (p = 0.0142). Of the selected word categories, males averaged a higher score in certainty (p = 0.0418), while females averaged higher scores in curiosity (p = 0.0102), perception (p = 0.0486), and attention (p = 0.0293). CONCLUSIONS: Subtle differences exist in the language characteristics of personal statements written by male and female applicants to orthopedic surgery residency. The implications of our findings would be strengthened by new data on specific language characteristics and communication skills most desired by orthopedic program directors. Lastly, as evaluation metrics for residency applications continue to change, personal statements may assume an even more important role.

IN-HOSPITAL MORTALITY OF OLDER ADULT PATIENT WITH PROXIMAL FEMORAL FRACTURE TREATED SURGICALLY DURING THE COVID-19 PANDEMIC.

Objectives: Evaluate the prevalence of hospital mortality in older adult patients with femoral fracture undergoing surgical treatment during the COVID-19 pandemic period, and to evaluate whether COVID-19 infection, clinical, and orthopedic factors interfered with mortality. Material and Methods: A retrospective study was conducted by reviewing medical records. Patients over 60 years of age with proximal femoral fracture undergoing surgical treatment were included. Overall mortality was calculated, as well as mortality whose primary or secondary cause was COVID-19 infection, to determine if infection influenced patient mortality. Clinical and orthopedic factors that interfered with mortality were evaluated. Categorical variables were compared using the Chi-square test or Fisher's exact test. Both unpaired t-test (parametric variables) and Mann-Whitney test (non-parametric variables) were used. The Kaplan-Meier mortality curve was constructed. Conclusion: The mortality of older adult patients with femoral fracture undergoing surgical treatment during the COVID-19 pandemic was 4.2%. Male sex, older age, and those who underwent blood transfusion had higher mortality rates. COVID-infected patients had ten times more chance of death and died twice as fast as the non-infected population. Level of Evidence II, Retrospective Study.

Objetivos: Avaliar a mortalidade hospitalar de pacientes idosos com fratura de fêmur submetidos ao tratamento cirúrgico durante o período pandêmico de covid-19. Avaliar se a infecção pelo vírus do covid-19 e os fatores clínicos e ortopédicos interferiram na mortalidade. Material e Métodos: Realizou-se um estudo retrospectivo por levantamento de prontuários. Foram incluídos pacientes acima de 60 anos associados a fratura da extremidade proximal do fêmur e que submetidos a tratamento cirúrgico. Calculou-se a mortalidade geral e também aquela cuja causa principal ou secundária foi a infeção pelo covid-19 para determinar se essa influenciou na mortalidade dos pacientes. Foram avaliados se os fatores clínicos e ortopédicos interferiram na mortalidade e variáveis categóricas foram comparadas pelo teste de Qui-quadrado ou exato de Fisher, utilizando tanto o teste t não pareado (variáveis paramétricas) como o teste de Teste Mann-Whitney (variáveis não paramétricas). Por fim, construiu-se a curva de mortalidade de Kaplan-Meier. Conclusão: A taxa de mortalidade de pacientes idosos com fratura de fêmur submetidos ao tratamento cirúrgico durante a pandemia de Covid foi de 4,2%. Pacientes do sexo masculino, idosos e os que foram submetidos à transfusão sanguínea evoluíram com maior mortalidade. Pacientes infectados pelo Covid tiveram dez vezes mais chance de evoluir para óbito e de forma duas vezes mais rápida que a população não infectada. Nível de Evidência II, Estudo Retrospectivo.

IMPACT OF THE COVID-19 PANDEMIC ON EMERGENCY UPPER LIMB SURGERIES IN A QUATERNARY HOSPITAL.

The COVID-19 pandemic has triggered a global crisis in health systems worldwide. Emergency care services have been overloaded, and there have been different changes in the patient's profile and the most frequent diagnoses. The aim of the study was to compare the number of emergency surgeries in the Hand and Microsurgery group of the quaternary hospital (IOT-FMUSP) from March 2020 to February 2022, the pandemic period, with the previous two years, March 2018 to February 2020. Two hundred and seventy-two patients were evaluated, with a mean age of 39.54 ± 17 years (range 1 to 90 years), 12.50% (n = 34) women and 87.50% (n = 238) men. Between March 2018 and February 2020, 142 (52.21%) emergency upper limb surgeries were performed; between March 2020 and February 2022, 130 surgeries were performed (47.79%). There was a reduction in upper limb surgeries in patients between 26-45 years and blunt injury surgeries. There was also an increase in surgeries in patients over 46, amputations, fractures, re-implantation procedures, and open fracture fixation. Level of evidence III, Retrospective Comparative Study.

A pandemia por COVID-19 desencadeou uma crise global nos sistemas de saúde ao redor do mundo. Serviços de atendimento de urgência sofreram sobrecarga e diferentes mudanças no perfil do paciente atendido bem como dos diagnósticos mais frequentes. O objetivo do estudo foi comparar o número de cirurgias de urgência, no grupo de Mão e Microcirurgia, do hospital quaternário (IOT-FMUSP) ocorridos de março de 2020 a fevereiro de 2022, período pandêmico; com os dois anos anteriores, de março de 2018 a fevereiro de 2020. No total foram avaliados 272 pacientes com idade média de 39,54 ± 17 anos (variação 1 a 90 anos), sendo 12,50% (n = 34) de mulheres e 87,50 % (n = 238) de homens. Entre março de 2018 a fevereiro de 2020 foram realizadas 142 (52,21%) cirurgias de urgência em membro superior e de março de 2020 a fevereiro de 2022, 130 cirurgias foram realizadas (47,79%). Identificou-se redução do número de cirurgias em membro superior em pacientes entre 26-45 anos e do número de cirurgias por ferimentos corto contusos. Além do aumento no número de cirurgias em pacientes acima de 46 anos, número de casos de amputações, fraturas, procedimentos de reimplante e fixação por fraturas expostas. Nível de evidência III, Estudo restrospectivo comparativo.

Evaluation of the utility of surgical simulation software in medical postgraduate education.

Background: The use of medical simulation software in medical institutions is growing to address teaching challenges. The study aims to assess the effectiveness of the Touch Surgery app, a free medical simulation software, as a supplement to the teaching methodology of unified surgery for medical students. Methods: Twenty-three postgraduate students, divided into three groups based on residency training years, and five senior orthopedic surgeons took part in the study. Each participant completed three modules within the Large External Fixators module using the Touch Surgery app. The results achieved by orthopedic specialists and postgraduates in the test module were recorded separately. The orthopedic specialists' first test module scores were used as a baseline. A Likert survey assessed the usefulness and content accuracy of the app. Statistical analysis included analysis of variance and 2-tailed t-test. Results: The first and second scores achieved by the postgraduates in the three groups were significantly different from the baseline of the orthopedic specialists, but the mean scores of all postgraduate's groups increased with simulator usage for learning and by the third attempt they were at the same level as the orthopedic specialists. However, no significant performance differences were observed between postgraduates with different training years. Postgraduates expressed a positive opinion of the usefulness and content of Touch Surgery in the questionnaire and their intention to continue using it in their future studies. Conclusions: This study shows that the use of Touch Surgery improves postgraduates' performance and ultimately enables them to reach the level of orthopedic specialists in simulated surgery, and received positive ratings for the software's experience and content. Touch Surgery can be a valuable complement to traditional surgical teaching methods, bridging the gap between theoretical learning from textbooks and guided rehearsals of surgical steps and skills.

Postoperative challenges addressed through nursing care of patients receiving lower extremity tumor prosthesis.

BACKGROUND: Patients with primary Bone Sarcoma and Giant Cell Tumors in the lower extremities often require major surgery involving tumor prostheses. The postoperative course for this patient group can be complex and influenced by various factors and challenges that demand careful nursing care. This study aims to identify challenges related to the nursing care of individuals with primary bone tumors following surgery for tumor prostheses in the lower extremities. METHODS: A retrospective cohort study of 15 patients treated at Rigshospitalet, Copenhagen, Denmark, between November 5. 2016, and April 1. 2020 was conducted by medical record review, focusing on challenges related to postoperative nursing care. All patients with the surgery code "Bone Excision" were identified within the surgery booking system and screened for eligibility. RESULTS: Patients experienced postoperative challenges such as severe pain, prolonged time to mobilization (mean: 4 days), and defecation (mean: 5 days). The mean length of stay at the Rigshospitalet was 13 days. Furthermore, eleven patients (73%) reported disrupted sleep and nausea. CONCLUSION: Patients undergoing tumor prosthesis surgery in the lower extremities face considerable postoperative challenges that contribute to a prolonged hospital stay. These challenges, including severe pain, delayed mobilization, and gastrointestinal issues, significantly impact recovery. The findings highlight the urgent need for targeted nursing interventions to address these issues effectively. Enhanced pain management protocols, early mobilization strategies, and comprehensive postoperative care plans are essential to improve patient outcomes and reduce the length of hospital stays. Addressing these challenges through dedicated nursing care is crucial for optimizing the recovery process for patients receiving lower extremity tumor prostheses.

Impact of rapid response system in mortality and complications post-orthopedic surgery: a retrospective cohort study.

BACKGROUND: Rapid response systems (RRSs) are used in hospitals to identify and treat deteriorating patients. However, RRS implementation and outcomes in orthopedic and surgical patients remain controversial. We aimed to investigate whether the RRS affects mortality and complications after orthopedic surgery. METHODS: The National Health Insurance Service of South Korea provided the data for this population-based cohort study. Individuals who were admitted to the hospital that implemented RRS were categorized into the RRS group and those admitted to a hospital that did not implement the RRS were categorized into the non-RRS group. In-hospital mortality and postoperative complications were the endpoints. RESULTS: A total of 931,774 adult patients were included. Among them, 93,293 patients underwent orthopedic surgery in a hospital that implemented RRS and were assigned to the RRS group, whereas 838,481 patients were assigned to the non-RRS group. In multivariable logistic regression analysis, the RRS group was not associated with in-hospital mortality after orthopedic surgery compared with the non-RRS group (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.80, 1.08; P = 0.350). However, the RRS group was associated with a 14% lower postoperative complication rate after orthopedic surgery than the non-RRS group (OR 0.86, 95% CI 0.84, 0.86; P < 0.001). CONCLUSIONS: The RRS was not associated with in-hospital mortality following orthopedic surgery in South Korea. However, RRS deployment was related to a decreased risk of postoperative complications in patients undergoing orthopedic surgery.

Comparison of Mean Postoperative Hemoglobin Concentrations in Patients Undergoing Total Knee Arthroplasty With Intravenous Versus Intraarticular Administration of Tranexamic Acid.

BACKGROUND:  Total knee arthroplasty (TKA) may result in significant blood loss, but it is an effective and affordable treatment for severe osteoarthritis in the knees. While intravenous (IV) tranexamic acid (TXA) is a commonly used technique, intraarticular (IA) TXA has just recently started to gain traction in joint replacement procedures. The purpose of this research was to examine the mean postoperative hemoglobin concentration in order to assess the effectiveness of TXA administered IV vs IA after TKA. OBJECTIVE: To assess the effectiveness of intraarticular TXA against intravenous administration. MATERIALS AND METHODS: The six-month randomized controlled experiment was started from October 5, 2022, to April 4, 2023, at "the Orthopedics Department of Sir Ganga Ram Hospital in Lahore". The experiment included 60 patients undergoing TKA, ranging in age from 30 to 70. All members of the surgical team, including the supervisor (a consultant surgeon), assistants, and researchers, were present throughout the surgery. A high, thigh tourniquet was employed in every case, and a medial parapatellar technique was performed as well. Before the tourniquet was inflated, individuals in the intravenous group received 1 g of TXA intravenously 15-30 minutes beforehand. In the IA group, the "patient received an injection of 2 g of TXA in a 20 mL solution" straight into the joint after the prosthesis was implanted and secured. Data were analyzed using SPSS (version 26), with numerical data (age, BMI, surgical length, and hemoglobin levels) presented as mean ± SD and categorical factors (gender, American Society of Anesthesiologists (ASA) class, anatomical side) shown as frequency and percentage. The mean postoperative hemoglobin levels were compared between groups using an independent sample t-test, with data stratified by various factors and p ≤ 0.05 considered significant. RESULTS: There were 60 patients in this study, ranging in age from 30 to 70. The mean±SD age was 48.73±10.35 years. Patients' mean BMI was 25.51±4.48 kg/m², with representation across underweight, normal, overweight, and obese categories. The procedure took 173.10±32.61 minutes. The overall postoperative hemoglobin concentration was significantly higher in the IA TXA group (12.12±1.32 g/dL) compared to the IV TXA group (11.11±1.10 g/dL), with a p-value of 0.02. Additionally, when stratified by age, the IA TXA group consistently demonstrated higher postoperative hemoglobin levels across all age brackets, with significant differences observed in the 51-60 years (p = 0.001) and 61-70 years (p = 0.011) groups. Gender-based comparisons showed that IA TXA was associated with higher postoperative hemoglobin levels for both males (p < 0.05) and females (p < 0.05) compared to IV TXA. CONCLUSION: This study demonstrates that IA administration of TXA is more effective in maintaining higher postoperative hemoglobin concentrations compared to IV TXA in patients undergoing TKA. The IA TXA group consistently achieved significantly higher hemoglobin levels across various age groups and both genders, indicating superior efficacy in reducing blood loss associated with TKA. These findings suggest that IA TXA could be a preferable alternative to IV TXA for enhancing postoperative hemoglobin recovery and potentially improving patient outcomes in knee arthroplasty procedures.

Tibiotalocalcaneal Nail: A Novel Tool in the Management of Old Neglected Ankle Dislocation With Deformity.

Ankle dislocations, particularly those that are old and neglected, pose significant challenges in orthopedic management due to the development of arthritic changes and surgical difficulties of reduction. The optimal treatment often involves stabilization and realignment to ensure proper healing. The closed reduction is rarely achieved in old neglected dislocations. Open reduction with internal or external fixation is the treatment for old neglected dislocations. Ankle and subtalar arthrodesis ensure painless plantigrade foot. The case report describes a case of an 8-month-old unreduced ankle dislocation with equinus deformity managed with ankle and subtalar arthrodesis using tibiotalocalcaneal nail. The equinus deformity was corrected and painless stable ankle joint was achieved.

Orthopedic disease classification based on breadth-first search algorithm.

Orthopedic diseases are widespread worldwide, impacting the body's musculoskeletal system, particularly those involving bones or hips. They have the potential to cause discomfort and impair functionality. This paper aims to address the lack of supplementary diagnostics in orthopedics and improve the method of diagnosing orthopedic diseases. The study uses binary breadth-first search (BBFS), binary particle swarm optimization (BPSO), binary grey wolf optimizer (BGWO), and binary whale optimization algorithm (BWAO) for feature selections, and the BBFS makes an average error of 47.29% less than others. Then we apply six machine learning models, i.e., RF, SGD, NBC, DC, QDA, and ET. The dataset used contains 310 instances and six distinct features. Through experimentation, the RF model led to optimal outcomes during comparison to the remaining models, with an accuracy of 91.4%. The parameters of the RF model were optimized using four optimization algorithms: BFS, PSO, WAO, and GWO. To check how well the optimized RF works on the dataset, this paper uses prediction evaluation metrics such as accuracy, sensitivity, specificity, F-score, and the AUC curve. The results showed that the BFS-RF can improve the performance of the original classifier compared with others with 99.41% accuracy.

Anesthesia Strategies for the Perioperative Management of Severe Pulmonary Hypertension in Emergency Orthopedic Surgery: A Case Report.

This case report details the perioperative challenges and anesthesia strategies in managing severe pulmonary hypertension (PH) during emergency orthopedic surgery. An 86-year-old male with multiple comorbidities, including severe PH, presented with a hip fracture. Multidisciplinary collaboration was crucial for preoperative optimization, including transfusions, antithrombotic discontinuation, and thromboprophylaxis initiation. Anesthesia management included the use of spinal anesthesia combined with a precautionary epidural catheter insertion, low-dose hyperbaric bupivacaine, and continuous monitoring to prevent hemodynamic instability. Postoperatively, the patient was closely monitored in the surgical intensive care unit. This case highlights the necessity of meticulous planning and proactive monitoring in optimizing outcomes for severe PH in emergency orthopedic surgery.

Management of Rarest Type of Talus Fracture: A Case Report.

This is a case of the rarest type of talus fracture in a 28-year-old male who presented with pain in his right ankle and foot following a road traffic accident. He was unable to bear weight or walk after the injury. Imaging studies indicated fractures in the head and neck of the talus, as well as the talar dome, with a fracture line extending into the subtalar joint. The patient underwent open reduction and internal fixation using mini fragment plating and Herbert screw fixation for the osteochondral fragment. Both the intraoperative and postoperative periods were without complications. The patient was placed in plaster of Paris (POP) slab immobilization for four weeks and was advised to avoid weight-bearing while using a walker for eight weeks, after which physiotherapy commenced. Follow-up assessments showed satisfactory fracture union, good range of motion in the ankle, an excellent American Orthopedic Foot and Ankle Society (AOFAS) score, an excellent 17-Italian Foot Function Index (FFI) score, and a good Hawkins score.

A Prospective Randomized Controlled Study of Stratafix versus Standard-of-Care for Deep Tissue Closure in Orthopedic Surgery.

Background: Orthopedic deep surgical incisions require the approximation of 1 or multiple tissue layers. This prospective randomized controlled study aimed to assess the usefulness and effectiveness of a barbed suture technique (Stratafix symmetric PDS plus) versus the conventional interrupted knotted suture technique for deep tissue closure in orthopedic surgery by comparing deep fascia suture time, relative cost, and wound-related complications. Methods: A total of 254 patients with deep surgical incisions who underwent orthopedic surgery between October 1, 2020, and June 30, 2021, were recruited. Their general characteristics (age, sex, weight, height, body mass index, American Society of Anesthesiologists physical status score, total operation time, and length of deep incision) and factors related to deep incision wounds (suture type and number, wound closure time, and operation site outcomes) were collected. Results: The general characteristics did not differ between the Stratafix and conventional groups. There were no between-group differences observed in total operation time or total anesthesia time. The wound suture times differed significantly. In the conventional group, the suture time per unit length was lower in the group with the length of deep incision under 20 cm but did not differ significantly for each wound size. In the Stratafix group, the suture time per unit length was lower in the group under 15 cm, with the shortest time observed for 10-14.9 cm, followed by 5.0-9.9 cm and the group under 5 cm. The conventional group developed 4 cases of superficial wound infection or surgical wound necrosis. One case of protruded suture tap occurred in the Stratafix group. Conclusions: The average suture time per unit length increased for lengths under 5 cm as barbed sutures required more time from the start of the first suture to finish of the last suture. There was no significant benefit for very short suture length. One barbed suture material allows a suture of approximately 10-12 cm; sutures beyond that require more time because the surgeon has to start again. The Stratafix group used less suture material than the conventional group.

The use of peripheral nerve block decrease incidence of postoperative cognitive dysfunction following orthopedic surgery: A systematic review and meta-analysis.

BACKGROUND: Postoperative neurocognitive disorders (PNDs) frequently occur following orthopedic surgery and are closely associated with adverse prognosis. PNDs are an emerging concept that includes both postoperative cognitive dysfunction (POCD) and postoperative delirium (POD). The prevention of combined use of peripheral nerve block (PNB) and general anesthesia (GA) on POCD and/or POD incidence following orthopedic surgery remains unknown. We aimed to investigate the effect of this combined anesthesia method on POCD/POD incidence after orthopedic surgery, compared with GA. METHODS: The databases of PubMed, Web of Science, Embase via Ovid, and the Cochrane Central Register of Controlled Trials were searched for all available randomized controlled trials (RCTs). The incidence of POD/POCD was the primary outcome. Continuous and dichotomous outcomes are represented as standardized mean differences [SMD, 95% confidence interval (CI)] and risk ratios [RR, 95%CI], respectively. RESULTS: Meta-analysis of twelve RCTs with a total of 1488 patients revealed that compared with GA, PNB plus GA decreased the incidence of POCD (RR: 0.58, 95%CI: 0.35 to 0.95, P = 0.03, I2 = 0%), while the incidence of POD had no significant difference (RR: 0.87, 95%CI: 0.54 to 1.40, P = 0.57, I2 = 67%). Compared with GA alone, a significant decrease of intraoperative and postoperative opioid consumption (SMD: -1.54, 95%CI: -2.26 to -0.82, P < 0.0001, I2 = 89%; SMD: -7.00, 95%CI: -9.89 to -4.11, P < 0.00001, I2 = 99%) and postoperative nausea and vomiting incidence (RR: 0.16, 95%CI: 0.06 to 0.44, P = 0.0004, I2 = 0%) was found with PNB plus GA. CONCLUSIONS: The combined use of PNB and GA decreases the incidence of POCD but not POD following orthopedic surgery. TRIAL REGISTRATION: The protocol of this study was registered with PROSPERO (Registration Number: CRD42022366454).

Investigation of treatment outcomes for severe extremity trauma in an independent orthopedic trauma center: A case series.

BACKGROUND: Severe extremity trauma is one of the most challenging injuries to treat. Limb salvage after severe extremity trauma requires rapid revascularization, accurate and appropriate bone and soft tissue reconstruction, and appropriate management to address critical complications. The purpose of this study was to report the treatment outcomes for severe extremity trauma injuries at our independent orthopedic trauma center. METHODS: This study included patients with severe extremity trauma who underwent major vascular repair or soft tissue reconstruction. Bone reconstruction method, presence or absence of revascularization, and flap type were investigated. Complications were investigated, including revascularization failure, flap failure, infection, and ultimately, whether amputation was required. Additionally, we investigated the number of surgeries performed on each patient at the time of initial hospitalization. RESULTS: Thirty-five patients who underwent revascularization or soft tissue reconstruction were included in this study. Plate fixation was performed in 18 patients, intramedullary nail fixation in 8, screw fixation in 1, pinning in 4, and without implant fixation in 4. Revascularization was performed in six patients, and no vascular complications occurred. Pedicled and free flaps were used in 17 and 16 patients, respectively. Partial flap necrosis occurred in four patients, and arterial occlusion occurred in one. Infection occurred in 10 patients who were treated with frequent irrigation and high-concentration antibiotics local infusion therapy. None of the 35 patients required limb amputation. Mean number of surgeries was 12.5. CONCLUSIONS: The limb of all the 35 patients with severe extremity trauma treated at our independent orthopedic trauma center were salvaged.

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.