Influence of different position modal parameters on milling chatter stability of orthopedic surgery robots.

This research is dedicated to exploring the dynamics of milling chatter stability in orthopedic surgery robots, focusing on the impact of position modal parameters on chatter stability. Initially, we develop a dynamic milling force model for the robotic milling process that integrates both modal coupling and regenerative effects. We then employ the zero-order frequency domain method to derive a chatter stability domain model, visually represented through stability lobe diagrams (SLDs). Through conducting hammer test experiments, we ascertain the robot's modal parameters at varying positions, enabling the precise generation of SLDs. This study also includes experimental validation of the chatter SLD analysis method, laying the groundwork for further examination of chatter stability across different positional modal parameters. Finally, our analysis of the variations in modal parameters on the stability of robot milling chatter yields a theoretical framework for optimizing cutting parameters and developing control strategies within the context of orthopedic surgery robots.

Cryoneurolysis versus radiofrequency ablation outcome on pain experience in chronic low back pain (COPE): a single-blinded randomised controlled trial.

OBJECTIVE: A comparison of cryoneurolysis or radio frequency (RF) with placebo in patients with facetogenic chronic low back pain (LBP) for patient global impression of change (PGIC), pain intensity, function and quality of life, with 1-year follow-up. DESIGN: Single-centre, single-blinded placebo-controlled randomised controlled trial. SETTING: Single-centre study. PARTICIPANTS: Inclusion from March 2020 to September 2022: consenting adults over 18 years of age, LBP>3 months, average Numeric Rating Scale LBP≥4 average last 14 days and a positive response to a diagnostic medial branch block (>50% pain reduction after 60 min). INTERVENTIONS: 120 patients were block randomised 1:1:1 to cryoneurolysis, RF or placebo of the medial branch nerves. Physical therapy was added after 4 weeks for all groups. MAIN OUTCOME MEASURES: Primary outcome was PGIC 4 weeks after the intervention. Secondary outcomes included pain intensity (Numeric Rating Scale, NRS), quality of life (Short Form 36, EQ-5D-5L), disability (Oswestry Disability Index), depression (Major Depression Inventory) and catastrophising (Pain Catastrophising Scale). Outcomes were measured at 4 weeks, 3, 6 and 12 months. RESULTS: There was no statistically significant difference in PGIC at 4 weeks between cryoneurolysis and placebo (risk ratio (RR) 2; 95% CI 0.75 to 5.33, p=0.17) and RF and placebo (RR 1.6; 95% CI 0.57 to 4.49, p=0.37), except PGIC for cryoneurolysis at 6-month follow-up (RR 5.1; 95% CI 1.20 to 22.03, p=0.03). No statistically significant differences were found in secondary follow-up endpoints. CONCLUSIONS: Denervation of the medial branch nerve by either cryoneurolysis or RF compared with placebo did not demonstrate significant improvement in PGIC, pain intensity, function and quality of life in patients with facetogenic chronic LBP at short-term or long-term follow-up. TRIAL REGISTRATION NUMBER: NCT04786145.

Preoperative prediction model for risk of readmission after total joint replacement surgery: a random forest approach leveraging NLP and unfairness mitigation for improved patient care and cost-effectiveness.

BACKGROUND: The Center for Medicare and Medicaid Services (CMS) imposes payment penalties for readmissions following total joint replacement surgeries. This study focuses on total hip, knee, and shoulder arthroplasty procedures as they account for most joint replacement surgeries. Apart from being a burden to healthcare systems, readmissions are also troublesome for patients. There are several studies which only utilized structured data from Electronic Health Records (EHR) without considering any gender and payor bias adjustments. METHODS: For this study, dataset of 38,581 total knee, hip, and shoulder replacement surgeries performed from 2015 to 2021 at Novant Health was gathered. This data was used to train a random forest machine learning model to predict the combined endpoint of emergency department (ED) visit or unplanned readmissions within 30 days of discharge or discharge to Skilled Nursing Facility (SNF) following the surgery. 98 features of laboratory results, diagnoses, vitals, medications, and utilization history were extracted. A natural language processing (NLP) model finetuned from Clinical BERT was used to generate an NLP risk score feature for each patient based on their clinical notes. To address societal biases, a feature bias analysis was performed in conjunction with propensity score matching. A threshold optimization algorithm from the Fairlearn toolkit was used to mitigate gender and payor biases to promote fairness in predictions. RESULTS: The model achieved an Area Under the Receiver Operating characteristic Curve (AUROC) of 0.738 (95% confidence interval, 0.724 to 0.754) and an Area Under the Precision-Recall Curve (AUPRC) of 0.406 (95% confidence interval, 0.384 to 0.433). Considering an outcome prevalence of 16%, these metrics indicate the model's ability to accurately discriminate between readmission and non-readmission cases within the context of total arthroplasty surgeries while adjusting patient scores in the model to mitigate bias based on patient gender and payor. CONCLUSION: This work culminated in a model that identifies the most predictive and protective features associated with the combined endpoint. This model serves as a tool to empower healthcare providers to proactively intervene based on these influential factors without introducing bias towards protected patient classes, effectively mitigating the risk of negative outcomes and ultimately improving quality of care regardless of socioeconomic factors.

An Update on Implant-Associated Malignancies and Their Biocompatibility.

Implanted medical devices are widely used across various medical specialties for numerous applications, ranging from cardiovascular supports to orthopedic prostheses and cosmetic enhancements. However, recent observations have raised concerns about the potential of these implants to induce malignancies in the tissues surrounding them. There have been several case reports documenting the occurrence of cancers adjacent to these devices, prompting a closer examination of their safety. This review delves into the epidemiology, clinical presentations, pathological findings, and hypothesized mechanisms of carcinogenesis related to implanted devices. It also explores how the surgical domain and the intrinsic properties and biocompatibility of the implants might influence the development of these rare but serious malignancies. Understanding these associations is crucial for assessing the risks associated with the use of medical implants, and for developing strategies to mitigate potential adverse outcomes.

"Now We Can Speak": Wheelchair Sport Participation in Areas of Armed Conflict.

This study sought to understand the lived experiences of wheelchair basketball athletes from low- and middle-income countries of recent or current armed conflict and the meaning that they ascribed to their participation. Wheelchair basketball athletes (N = 108) from eight national teams participated in semistructured focus-group interviews. Study data were analyzed thematically using an interpretive descriptive approach. Three themes were developed: "I can do anything I want; not only basketball," self-concept changes through sport participation; "Now they see me as a respectable person," societal belonging through sport; and "I have motivated other disabled people," influence on nonparticipating disabled persons. The findings indicated that participation in wheelchair sports may help disabled persons see themselves as capable individuals on the court and in aspects of daily living, perhaps even peer role models for other disabled persons in their communities and countries.

Musculoskeletal disorders of the upper and lower limb: Prevalence among patients in Eastern province, Saudi Arabia.

OBJECTIVES: To determine the prevalence of upper and lower limb musculoskeletal (MSK) disorders among adult patients referred to physical therapy. METHODS: Data were retrospectively analyzed from electronic health records of patients referred to physical therapy between April 2021 and April 2023. MSK disorders were categorized based on the affected body region (upper or lower limb). RESULTS: A total of 11,243 patients were referred to physical therapy, of whom 4,156 (37%) had MSK disorders. The 4 most commonly affected regions were the knee (27.7%), followed by the shoulder (26.9%), the ankle/foot (14.9%), and the wrist/hand (11.8%). Within each region, the most prevalent disorders were as follows: knee (arthritis [26.5%], sprain/strain [20.1%], pain [10.1%]); shoulder (pain [20.2%], rotator cuff-related syndrome [18.5%], adhesive capsulitis [8.5%]); ankle/foot (sprain/strain [23.3%], fracture [14.3%], pain [8.9%]); and wrist/hand (fracture [24.1%], pain [8.9%], sprain/strain [7.6%]). Cramer's V analysis revealed a strong association between age and the region of MSK disorders (Cramer's V=0.234, p<0.001) and between patient sex and the region of MSK disorders (Cramer's V=0.189, p<0.001). CONCLUSION: This study demonstrates the prevalence of upper and lower limb MSK disorders among adult patients referred to physical therapy. Further research involving larger, representative samples is warranted to fully understand the prevalence and risk factors of MSK disorders in Saudi Arabia.

Unilateral Pushup-Induced Acute Median Neuritis.

Acute median nerve neuropathy is most often due to trauma; acute carpal tunnel syndrome is considered a surgical emergency and must be ruled out. A right-hand dominant male presented to the emergency department with progressive unilateral pain and numbness in the median nerve distribution after experiencing a pop while doing pushups. The evaluation was limited to pain, but there was no gross deformity, and the distal right upper extremity was neurovascularly intact. All imaging was unremarkable. The patient received adequate pain control and complete resolution of symptoms. Despite presenting with symptoms congruent with possible carpal tunnel syndrome, the patient's physical exam and imaging findings were inconsistent with the diagnosis. Acute median nerve neuritis is less commonly described, and no cases have been reported secondary to push-ups, but it should be considered in nontraumatic patients. With conservative management, patients can have complete resolution and no reoccurrence of symptoms.

Development and National Validation of a Musculoskeletal Emergency Medicine Assessment Tool.

Introduction Musculoskeletal (MSK) complaints and injuries are the fourth most common primary diagnosis in the emergency department in the United States (US). Despite the prevalence and economic impact on the US healthcare system, new emergency medicine (EM) residency graduates report feeling unprepared to treat MSK complaints. Currently, there are no reported means to assess MSK knowledge in EM resident physicians. The purpose of this study is to develop a validated and peer-reviewed multiple-choice assessment tool focused on MSK knowledge relevant to EM to allow us to better assess the knowledge of resident physicians. Methods A group of EM/Sports Medicine subject-matter experts (SMEs) created an initial list of the most important MSK topics in EM to generate a relevant question bank. The questions were validated by a different group of SMEs using a three-round modified Delphi method to obtain consensus on the importance of each question. Based on these results, the assessment was formed. Results From a list of 99 MSK topics, SMEs developed a final list of 37 MSK topics relevant to EM. Following round one, free-marginal kappa was 0.58, 95% CI [0.50, 0.66], with a moderate overall agreement of 71.95%. Following round two, the calculated free-marginal kappa increased to 0.88, 95% CI [0.83, 0.92], with an overall agreement of 91.79%. Using a five-point Likert scale, a threshold of an average score less than four was used to exclude questions in round three of validation and to create a final 50-question assessment tool. Conclusion Our proposed exam, titled Musculoskeletal Emergency Medicine Assessment Tool (MEAT), was successfully validated by experts in our field. It evaluates clinically important topics and offers a tool for assessing MSK knowledge in EM resident physicians. Future studies are needed to determine the feasibility of administering the tool and to establish a baseline score among different populations within the practicing field of EM.

Orthopedic Challenges in Avascular Necrosis Management: A Case Report of Surgical Complications and Multidisciplinary Care.

A 52-year-old woman, with a multifaceted medical background encompassing spinal cord injury, pneumonia, and recurrent hospitalizations, presents with enduring left hip and leg discomfort ultimately diagnosed as avascular necrosis (AVN). She previously underwent intraosseous direct anterior arthroplasty (DAA) of the left hip during the removal of orthopedic artifacts. Despite enduring hypertension, severe trochanter dislocation, and prosthesis fracture, she recovered and required additional surgery to address the dislocation and fracture. This case underscores the challenges in diagnosing and treating AVN, emphasizing the importance of meticulous postoperative care and a multidisciplinary approach. Challenges highlighted by AVN include delayed diagnosis, intricate surgical procedures, and the potential need for further interventions due to hardware complications and infection as seen in this patient.

Evaluating the Efficacy of Methocarbamol and Nefopam in Orthopedic Surgical Pain.

Introduction Pain after orthopedic surgeries represents a special concern in patients with fractures. The use of multimodal analgesia significantly reduced the opioid need and reduced the risk of their side effects. Objectives This study compared the effectiveness and safety of methocarbamol and nefopam in the reduction of post-operative pain for patients undergoing orthopedic surgeries. Method This prospective, double-blind, randomized controlled trial took place at Al-Sader Teaching Hospital in Basrah, Iraq, from the first of February 2022 to the end of October 2023. The study aimed to assess the post-operative pain relief efficacy and safety of intramuscular nefopam (20 mg) and intravenous methocarbamol (1 g) in 110 adults (aged 18-65) undergoing elective orthopedic surgeries. Exclusions were made for allergies to the drugs, substance abuse history, and severe hepatic or renal impairment. Participants were randomized into two groups, with pain intensity measured at one hour, six hours, and 12 hours post-operation using the visual analog scale (VAS). Side effects were also evaluated. Statistical analysis was done using SPSS 27, with a significance level set at p<0.05 and a 95% confidence interval (CI). Results  In this study, we conducted a rigorous comparison between two groups, methocarbamol and nefopam, to evaluate their efficacy and safety in post-operative pain management. We started by ensuring that the groups were well-matched in terms of age, gender distribution, and body mass index (BMI). The results showed remarkable similarities in mean age, gender distribution, and BMI, supported by robust p-values, affirming the effective matching of the two groups. Moving to pain management, we observed a significant advantage in favor of methocarbamol. At all-time intervals (one hour, six hours, and 12 hours post-operation), methocarbamol consistently demonstrated lower mean VAS scores compared to nefopam. These differences were highly statistically significant, underscoring the superior pain relief efficacy of methocarbamol. Exploring side effects, we found no statistically significant disparities in the occurrence of nausea and vomiting between the two groups. However, there was a noticeable trend toward higher tachycardia incidence in the nefopam group, though it did not reach statistical significance. Conclusion The present study showed a higher efficacy of methocarbamol in post-operative pain reduction in comparison to nefopam. No serious side effects were observed with both drugs.

Triggered Release of Ampicillin from Metallic Implant Coatings for Combating Periprosthetic Infections.

Periprosthetic infections caused by Staphylococcus aureus (S. aureus) pose unique challenges in orthopedic surgeries, in part due to the bacterium's capacity to invade surrounding bone tissues besides forming recalcitrant biofilms on implant surfaces. We previously developed prophylactic implant coatings for the on-demand release of vancomycin, triggered by the cleavage of an oligonucleotide (Oligo) linker by micrococcal nuclease (MN) secreted by the Gram-positive bacterium, to eradicate S. aureus surrounding the implant in vitro and in vivo. Building upon this coating platform, here we explore the feasibility of extending the on-demand release to ampicillin, a broad-spectrum aminopenicillin ß-lactam antibiotic that is more effective than vancomycin in killing Gram-negative bacteria that may accompany S. aureus infections. The amino group of ampicillin was successfully conjugated to the carboxyl end of an MN-sensitive Oligo covalently integrated in a polymethacrylate hydrogel coating applied to titanium alloy pins. The resultant Oligo-Ampicillin hydrogel coating released the ß-lactam in the presence of S. aureus and successfully cleared nearby S. aureus in vitro. When the Oligo-Ampicillin-coated pin was delivered to a rat femoral canal inoculated with 1000 cfu S. aureus, it prevented periprosthetic infection with timely on-demand drug release. The clearance of the bacteria from the pin surface as well as surrounding tissue persisted over 3 months, with no local or systemic toxicity observed with the coating. The negatively charged Oligo fragment attached to ampicillin upon cleavage from the coating did diminish the antibiotic's potency against S. aureus and Escherichia coli (E. coli) to varying degrees, likely due to electrostatic repulsion by the anionic surfaces of the bacteria. Although the on-demand release of the ß-lactam led to adequate killing of S. aureus but not E. coli in the presence of a mixture of the bacteria, strong inhibition of the colonization of the remaining E. coli on hydrogel coating was observed. These findings will inspire considerations of alternative broad-spectrum antibiotics, optimized drug conjugation, and Oligo linker engineering for more effective protection against polymicrobial periprosthetic infections.

Predictive Modeling for Spinal Metastatic Disease.

Spinal metastasis is exceedingly common in patients with cancer and its prevalence is expected to increase. Surgical management of symptomatic spinal metastasis is indicated for pain relief, preservation or restoration of neurologic function, and mechanical stability. The overall prognosis is a major driver of treatment decisions; however, clinicians' ability to accurately predict survival is limited. In this narrative review, we first discuss the NOMS decision framework used to guide decision making in the treatment of patients with spinal metastasis. Given that decision making hinges on prognosis, multiple scoring systems have been developed over the last three decades to predict survival in patients with spinal metastasis; these systems have largely been developed using expert opinions or regression modeling. Although these tools have provided significant advances in our ability to predict prognosis, their utility is limited by the relative lack of patient-specific survival probability. Machine learning models have been developed in recent years to close this gap. Employing a greater number of features compared to models developed with conventional statistics, machine learning algorithms have been reported to predict 30-day, 6-week, 90-day, and 1-year mortality in spinal metastatic disease with excellent discrimination. These models are well calibrated and have been externally validated with domestic and international independent cohorts. Despite hypothesized and realized limitations, the role of machine learning methodology in predicting outcomes in spinal metastatic disease is likely to grow.

Characterizing Surface Morphological and Chemical Properties of Commonly Used Orthopedic Implant Materials and Determining Their Clinical Significance.

The goal of the study was to compare the surface characteristics of typical implant materials used in orthopedic surgery and traumatology, as these determine their successful biointegration. The morphological and chemical structure of Vortex plate anodized titanium from commercially pure (CP) Grade 2 Titanium (Ti2) is generally used in the following; non-cemented total hip replacement (THR) stem and cup Ti alloy (Ti6Al4V) with titanium plasma spray (TPS) coating; cemented THR stem Stainless steel (SS); total knee replacement (TKR) femoral component CoCrMo alloy (CoCr); cemented acetabular component from highly cross-linked ultrahigh molecular weight polyethylene (HXL); and cementless acetabular liner from ultrahigh molecular weight polyethylene (UHMWPE) (Sanatmetal, Ltd., Eger, Hungary) discs, all of which were examined. Visualization and elemental analysis were carried out by scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS) and X-ray photoelectron spectroscopy (XPS). Surface roughness was determined by atomic force microscopy (AFM) and profilometry. TPS Ti presented the highest Ra value (25 ± 2 µm), followed by CoCr (535 ± 19 nm), Ti2 (227 ± 15 nm) and SS (170 ± 11 nm). The roughness measured in the HXL and UHMWPE surfaces was in the same range, 147 ± 13 nm and 144 ± 15 nm, respectively. EDS confirmed typical elements regarding the investigated prosthesis materials. XPS results supported the EDS results and revealed a high % of Ti4+ on Ti2 and TPS surfaces. The results indicate that the surfaces of prosthesis materials have significantly different features, and a detailed characterization is needed to successfully apply them in orthopedic surgery and traumatology.

High-Temperature Polylactic Acid Proves Reliable and Safe for Manufacturing 3D-Printed Patient-Specific Instruments in Pediatric Orthopedics-Results from over 80 Personalized Devices Employed in 47 Surgeries.

(1) Background: Orthopedic surgery has been transformed by 3D-printed personalized instruments (3DP-PSIs), which enhance precision and reduce complications. Hospitals are adopting in-house 3D printing facilities, using cost-effective methods like Fused Deposition Modeling (FDM) with materials like Polylactic acid (PLA) to create 3DP-PSI. PLA's temperature limitations can be overcome by annealing High-Temperature PLA (ann-HTPLA), enabling steam sterilization without compromising properties. Our study examines the in vivo efficacy of ann-HTPLA 3DP-PSI in pediatric orthopedic surgery. (2) Methods: we investigated safety and efficacy using ann-HTPLA 3DP-PSI produced at an "in-office" 3D-printing Point-of-Care (3DP-PoC) aimed at correcting limb deformities in pediatric patients. Data on 3DP-PSI dimensions and printing parameters were collected, along with usability and complications. (3) Results: Eighty-three ann-HTPLA 3DP-PSIs were utilized in 33 patients (47 bone segments). The smallest guide used measured 3.8 cm3, and the largest measured 58.8 cm3. Seventy-nine PSIs (95.2%; 95% C.I.: 88.1-98.7%) demonstrated effective use without issues. Out of 47 procedures, 11 had complications, including 2 infections (4.3%; 95% CI: 0.5-14.5%). Intraoperative use of 3DP-PSIs did not significantly increase infection rates or other complications. (4) Conclusions: ann-HTPLA has proven satisfactory usability and safety as a suitable material for producing 3DP-PSI in an "in-office" 3DP-PoC.

Computerized surgical navigation resection of pelvic region simulated bone tumors using skin fiducial marker registration: an in vitro cadaveric study.

INTRODUCTION: Computerized surgical navigation system guidance can improve bone tumor surgical resection accuracy. This study compared the 10-mm planned resection margin agreement between simulated pelvic-region bone tumors (SPBT) resected using either skin fiducial markers or Kirschner (K)-wires inserted directly into osseous landmarks with navigational system registration under direct observation. We hypothesized that skin fiducial markers would display similar resection margin accuracy. METHODS: Six cadaveric pelvises had one SPBT implanted into each supra-acetabular region. At the left hemi-pelvis, the skin fiducial marker group had guidance from markers placed over the pubic tubercle, the anterior superior iliac spine, the central and more posterior iliac crest, and the greater trochanter (5 markers). At the right hemi-pelvis, the K-wire group had guidance from 1.4-mm-diameter wires inserted into the pubic tubercle, and 3 inserted along the iliac crest (4 K-wires). The senior author, a fellowship-trained surgeon performed "en bloc" SPBT resections. The primary investigator, blinded to group assignment, measured actual resection margins. RESULTS: Twenty of 22 resection margins (91%) in the skin fiducial marker group were within the Bland-Altman plot 95% confidence interval for actual-planned margin mean difference (mean = -0.23 mm; 95% confidence intervals = 2.8 mm, - 3.3 mm). Twenty-one of 22 resection margins (95%) in the K-wire group were within the 95% confidence interval of actual-planned margin mean difference (mean = 0.26 mm; 95% confidence intervals = 1.7 mm, - 1.1 mm). CONCLUSION: Pelvic bone tumor resection with navigational guidance from skin fiducial markers placed over osseous landmarks provided similar accuracy to K-wires inserted into osseous landmarks. Further in vitro studies with different SPBT dimensions/locations and clinical studies will better delineate use efficacy.

Modified 5-Item Frailty Index: A Useful Tool for Assessing the Impact of Frailty on Postoperative Morbidity and Mortality Following Surgical Fixation of Thoracolumbar Fractures.

OBJECTIVES: The modified 5-item frailty index (mFI-5) is a comorbidity-based risk stratification tool to predict adverse events following various neurological surgeries. This study aims to quantify the association between increased mFI-5 and postoperative complications and mortality following surgical fixation of traumatic thoracolumbar fractures. METHODS: The 2011-2021 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) dataset was used to identify patients undergoing fusion surgeries for thoracolumbar spine fractures. The mFI-5 score was calculated based on the presence of five major comorbidities: congestive heart failure within 30 days before surgery, insulin-dependent or noninsulin-dependent diabetes mellitus, chronic obstructive pulmonary disease, partially dependent or totally dependent functional health status at the time of surgery, and hypertension requiring medication. Multivariate analysis assessed the independent impact of increasing mFI-5 scores on postoperative 30-day morbidity and mortality while controlling for baseline clinical characteristics. RESULTS: A total of 66,904 patients were included in our analysis (54.2% female, mean age 62.27 ± 12.93 years). On univariate analysis, higher mFI-5 score was significantly associated with increased risks of superficial surgical site infection, deep surgical site infection, wound dehiscence, unplanned reoperation, pneumonia, unplanned intubation, postoperative ventilator use, progressive renal insufficiency, acute renal failure, urinary tract infection, stroke, myocardial infarction, cardiac arrest, pulmonary embolism, deep vein thrombosis, bleeding requiring transfusion, sepsis, septic shock, and longer hospital length of stay (LOS). On multivariate logistic regression, increasing mFI-5 score versus a mFI-5 score of zero was associated with higher odds of overall complications (mFI-5 ≥2: odds ratio [OR] 1.38 CI: 1.24 - 1.54, p<0.001; mFI-5 = 1: OR 1.18 CI: 1.11 - 1.24, p<0.001) and 30-day mortality (mFI-5 ≥2: OR 2.33 CI: 1.60 - 3.38, p<0.001). CONCLUSION: This study demonstrates that frailty, when measured using the mFI-5, independently predicts postoperative complications, hospital LOS, and 30-day mortality after surgical repair of thoracolumbar fractures. These findings are important for risk stratification in patients undergoing thoracolumbar fusion surgery and for standardization in reporting outcomes after those procedures.

Influence of elevated liver enzyme level on 30-day mortality rates in patients undergoing nonemergency orthopedic surgery.

BACKGROUND: The effect of elevated preoperative liver enzyme levels on postoperative outcomes is a topic of concern to clinicians. This study explored the association between elevated preoperative liver enzyme levels and surgical outcomes in patients undergoing orthopedic surgery. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program database, we obtained data on adult patients who received nonemergency orthopedic surgery under general anesthesia between 2011 and 2021. RESULTS: We evaluated the data of 477,524 patients, of whom 6.1% (24 197 patients) had elevated preoperative serum glutamic oxaloacetic transaminase (SGOT) levels. An elevated SGOT level was significantly associated with 30-day postoperative mortality (adjusted hazard ratio, 1.62; 95% confidence interval, 1.39 to 1.90). We determined that the mortality rate rose with SGOT levels. The results remained unchanged after propensity score matching. CONCLUSION: Elevated preoperative SGOT levels constitute an independent risk factor for 30-day postoperative mortality and are proportionately associated with the risk of 30-day postoperative mortality.

RANGE OF MOTION AFTER BONE BLOCK PROCEDURES FOR SHOULDER INSTABILITY: SYSTEMATIC REVIEW.

Objective: to determine the surgical indications for glenoid bone grafting associated with better postoperative ranges of motion. Methods: This systematic review was conducted according to PRISMA. The included studies were subdivided according to the criteria used to indicate glenoid bone graft surgery: group for radiological indications only (Group R), group for radiological indications associated with clinical indications (Group R + C), and group for arthroscopic indications (Group A). The extracted and evaluated data were the range of motion of the shoulder. Results: in the electronic search conducted in October 2022, 1567 articles were selected. After applying the inclusion criteria, 14 articles were selected for the systematic review. Regarding the ranges of motion, group A had the highest number of statistically positive results together with group R. Group A showed positive results in elevation parameters, loss of lateral rotation in adduction, and medial rotation in abduction. Group R showed positive results in lateral rotation in adduction and loss of lateral rotation in adduction. On the other hand, Group R + C was the one that presented the highest number of statistically negative results, in the following parameters: elevation, lateral rotation in abduction, loss of lateral rotation in adduction, and medial rotation in abduction. Conclusion: the subgroups presented variable results in the evaluated parameters; however, the groups with arthroscopic and radiological indications showed the highest number of positive results, with the latter group showing the best results regarding lateral rotation. Level of Evidence II, Systematic Reviews.

Objetivo: Determinar as indicações cirúrgicas de enxertia óssea da glenoide associadas aos melhores arcos de movimento no pós-operatório. Métodos: De acordo com o Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 14 artigos de um total de 1.567, selecionados em busca eletrônica, foram escolhidos para a revisão sistemática. Os estudos incluídos foram subdivididos de acordo com os critérios de indicação da cirurgia: indicações somente radiológicas (grupo R), indicações radiológicas associadas a indicações clínicas (grupo R + C) e indicações artroscópicas (grupo A). Os dados avaliados foram os arcos de movimento do ombro. Resultados: Em relação aos arcos de movimento, os grupos que apresentaram a maior quantidade de resultados estatisticamente positivos foram o A ­ parâmetros elevação, perda de rotação lateral em adução e rotação medial em abdução ­ e o R ­ parâmetros rotação lateral em adução e perda de rotação lateral em adução. O grupo R + C apresentou a maior quantidade de resultados estatisticamente negativos nos parâmetros elevação, rotação lateral em abdução, perda de rotação lateral em adução e rotação medial em abdução. Conclusão: Os grupos de indicações artroscópicas e radiológicas apresentaram a maior quantidade de resultados positivos, sendo que o último apresentou os melhores resultados em relação à rotação lateral. Nível de Evidência II, Revisão Sistemática.

Prediction model of deep vein thrombosis risk after lower extremity orthopedic surgery.

Purpose: This investigation was conceived to engineer and appraise a pioneering clinical nomogram, crafted to bridge the extant chasm in literature regarding the postoperative risk stratification for deep vein thrombosis (DVT) in the aftermath of lower extremity orthopedic procedures. This novel tool offers a sophisticated and discerning algorithm for risk prediction, heretofore unmet by existing methodologies. Methods: In this retrospective observational study, clinical records of hospitalized patients who underwent lower extremity orthopedic surgery were collected at the Wuxi TCM Hospital Affiliated to the Nanjing University of Chinese Medicine between Jan 2017 and Oct 2019. The univariate and multivariate analysis with the backward stepwise method was applied to select features for the predictive nomogram. The performance of the nomogram was evaluated with respect to its discriminant capability, calibration ability, and clinical utility. Result: A total of 5773 in-hospital patients were eligible for the study, with the incidence of deep vein thrombosis being approximately 1 % in this population. Among 31 variables included, 5 of them were identified to be the predictive features in the nomogram, including age, mean corpuscular hemoglobin concentration (MCHC), D-dimer, platelet distribution width (PDW), and thrombin time (TT). The area under the receiver operating characteristic (ROC) curve in the training and validation cohort was 85.9 % (95%CI: 79.96 %-90.04 %) and 85.7 % (95%CI: 78.96 %-90.69 %), respectively. Both the calibration curves and decision curve analysis demonstrated the overall satisfactory performance of the model. Conclusion: Our groundbreaking nomogram is distinguished by its unparalleled accuracy in discriminative and calibrating functions, complemented by its tangible clinical applicability. This innovative instrument is set to empower clinicians with a robust framework for the accurate forecasting of postoperative DVT, thus facilitating the crafting of bespoke and prompt therapeutic strategies, aligning with the rigorous standards upheld by the most esteemed biomedical journals.

Scabies infestation might predispose surgical site infection: Case report.

INTRODUCTION AND CLINICAL IMPORTANCE: Human scabies is a contagious skin condition caused by the Sarcoptes scabiei mite, leading to skin damage and subsequent mechanical irritation from scratching. This impaired skin integrity predisposes individuals to skin infections. While the association between scabies and skin infections caused by Staphylococcus aureus and Streptococcus pyogenes is well-documented, there is limited literature on the risk of surgical site infections in such cases. CASE PRESENTATION: This case report aims to explore this risk by presenting a case of surgical site infection caused by Streptococcus pyogenes following surgery for a complex elbow injury in a patient with scabies infestation. DISCUSSION: Scabies infestation leads to direct spread of bacteria and contributes to bacterial infection. Furthermore, complement inhibition and dysbiosis induced by the scabies may facilitate the occurrence of these bacterial infections. CONCLUSION: Skin infections are frequently encountered in scabies infestations. Preferred incision should be evaluated meticulously before surgery. Further studies are needed to reach a definitive conclusion on this subject.