Methodology for Online Reliability Studies: A Primer for Orthopedic Surgeons.

In orthopedic surgery, there is an increasing number of papers about online studies on the reliability of classification systems. Useful classification systems need to be reliable and valid. Measurement of validity can be variable and is prone to observer bias.

Estimation of Alveolar Bone Loss in Periodontitis Using Machine Learning.

Aim: The objective of this research was to perform a pilot study to develop an automatic analysis of periapical radiographs from patients with and without periodontitis for the percentage alveolar bone loss (ABL) on the approximal surfaces of teeth using a supervised machine learning model, that is, convolutional neural networks (CNN).

Material And Methods: A total of 1546 approximal sites from 54 participants on mandibular periapical radiographs were manually annotated (MA) for a training set (n = 1308 sites), a validation set (n = 98 sites), and a test set (n = 140 sites). The training and validation sets were used for the development of a CNN algorithm.

Post-traumatic disturbance of the epiphysis of the humeral trochlea: a spectrum of pathology.

Background: Hegemann disease and fishtail deformity are classified as growth disturbances in the physeal plate of the humeral trochlea. It is questionable if these 2 diseases should be considered as 2 distinct conditions. The aims of this study are to (1) point out similarities between both conditions, (2) discuss etiology, and (3) provide diagnostic tools.

Early repolarisation among athletes.

Objectives: Traditionally, early repolarisation (ER) is considered a benign ECG variant, predominantly found in youths and athletes. However, a limited number of studies have reported an association between ER and the incidental occurrence of ventricular fibrillation or sudden cardiac death. Yet definite, direct comparisons of the incidence of ER in unselected, contemporary populations in athletes as compared with non-athletes and across different sports are lacking.

Follow-up radiographs in isolated Greater Tuberosity fractures lead to a change in treatment recommendation; an online survey study.

Introduction: It is common practice to obtain follow-up radiographs of non-operatively treated isolated greater tuberosity (GT) fractures 1 to 2 weeks after trauma. However, the majority of non-operatively treated GT fractures remain stable and do not require reconsideration of the initial treatment decision. Radiological follow-up therefore might be unnecessary.

Avascular Necrosis of the Scaphoid Preiser Disease.

No consensus regarding optimal treatment or etiology of Preiser disease exists. We described the epidemiology, classification and treatment characteristics of 18 patients with Preiser disease. Patients with changes related to previous trauma, and without radiographs were excluded.

Radiographic Predictors for Short-term Functional Outcome after Radial Head Arthroplasty in Patients with Persistent Symptoms after Treatment for Radial Head.

Background: Evaluation of the accurate position after radial head arthroplasty remains a challenge for surgeons. Standard radiographs are used to evaluate the position of the implant, however, results regarding radiographic deficiencies on clinical outcome are not consistent. In this retrospective study our main aim was to determine if subtle radiographic deficiencies after radial head arthroplasty can predict functional outcomes measured with the Mayo Elbow Performance Score (MEPS).

What Predicts Outstanding Orthopedic Residents among the Program?

Background: An oversupply of qualified applicants leads to intense competition for the limited number of first year orthopedic residency positions. Therefore, program directors can be more selective in choosing their future residents. However, it is unclear if there are resident characteristics that correspond with trainee performance.

How Well do Orthopedic Surgeons Recognize Different Models of Total Elbow Arthroplasties on Plain Radiographs with the Use of a Diagnostic Flowchart?

Background: Recognition of total elbow arthroplasties (TEAs) on plain radiographs is difficult due to a multitude of different types and models. Especially if surgery reports and documentation are not available, lost or when the primary surgery was performed in another hospital the prosthesis type may be undeterminable. Therefore we investigated in this platform study if a flowchart aids in recognition of thirteen different total elbow arthroplasty models on plain radiographs.

Unplanned Operations and Adverse Events after Surgery for Diaphyseal Fracture of the Clavicle.

Background: We used a database of patients treated at three hospitals to study the primary null hypothesis that there are no factors associated with unplanned reoperations or adverse events after surgical repair for diaphyseal clavicle fracture. Additionally we addressed the following secondary study questions: 1. What is the prevalence of unplanned reoperations or adverse events after surgical repair for diaphyseal clavicle fracture? 2.

Correction to: Tension band wiring for simple olecranon fractures: evaluation of surgical technique.

Unfortunately, after publication of this article [1], it was noticed that the author J. Carel Goslings was tagged incorrectly during the production process. This resulted in the PubMed display of the author name as 'J Carel Goslings'.

Interobserver Variability of the Diagnosis of Scaphoid Proximal Pole Fractures.

 Fractures of the proximal pole of the scaphoid are prone to adverse outcomes such as nonunion and avascular necrosis. Distinction of scaphoid proximal pole fractures from waist fractures is important for management but it is unclear if the distinction is reliable.  A consecutive series of 29 scaphoid fractures from one tertiary hospital was collected consisting of 5 scaphoid proximal pole and 24 scaphoid waist fractures.

Interobserver reliability of radiographic assessment after radial head arthroplasty.

Background: Radiographs are part of routine clinical care after radial head arthroplasty (RHA). Therefore, the aim of this diagnostic study was to assess the interobserver reliability of radiographic assessment following RHA.

Methods: Anteroposterior (AP) and lateral radiographs of 24 consecutive patients who underwent press-fit bipolar RHA were evaluated with respect to 14 parameters by 14 orthopaedic surgeons specializing in the elbow: shaft loosening (AP, lateral), subcollar bone resorption, nonbridging heterotopic ossification, capitellar erosion, capitellar osteopenia, implant size, ulnohumeral joint gapping, ulnohumeral joint degeneration, proximal radio-ulnar joint congruency, stem size, stem positioning (AP, lateral) and component dissociation or polyethylene wear of the head with increased angulation.

Ulnar Neck Fractures Associated with Distal Radius Fractures.

 There is little published data to guide management of ulnar neck fractures associated with fractures of the distal radius.  As unplanned surgery usually reflects adverse events and this injury combination is relatively uncommon, we used a large database to study the incidence of unplanned surgeries after surgical and nonsurgical treatment of distal metaphyseal ulna fractures associated with a distal radius fracture and identify factors associated with these unplanned surgeries.  We identified 277 patients with an ulnar neck fracture associated with a distal radius fracture.

The Effect of Priming With Questionnaire Content on Grip Strength in Patients With Hand and Upper Extremity Illness.

Background: Grip strength is a performance-based measure of upper extremity function that might be influenced by priming (the influence of a response to a stimulus by exposure to another stimulus). This study addressed the influence of questionnaire content on performance measurements such as grip strength between patients who complete the standard Pain Catastrophizing Scale (PCS) compared with patients who complete a positively adjusted PCS.

Methods: Between June 2015 and August 2015, we enrolled 122 patients who presented to 3 hand surgeons at 3 outpatient offices.

The Influence of Psychological Factors on the Michigan Hand Questionnaire.

Psychosocial factors help account for the gap between impairment and disability. This study examines the relationship between the Michigan Hand Questionnaire (MHQ) and commonly used psychological measures in patients with upper extremity illness. A cohort of 135 new or follow-up patients presenting to an urban academic hospital-based hand surgeon were invited to complete a web-based version of the MHQ, Abbreviated Pain Catastrophizing Scale (PCS), and two Patient-Reported Outcomes Measurement Information System (PROMIS)-based questionnaires: Pain Interference and Depression.

Diagnostic Wrist Arthroscopy for Nonspecific Wrist Pain.

This study addresses the prevalence of discrete pathophysiology accounting for patients' symptoms during diagnostic wrist arthroscopy in individuals with wrist pain without a specific preoperative diagnosis. Secondarily, we determined the number and type of surgeries subsequent to diagnostic wrist arthroscopy. Between January 2000 and January 2015, 135 diagnostic wrist arthroscopies were performed by 12 surgeons in 3 urban academic hospitals.

Graft Site Morbidity in Elbow Ligament Reconstruction Procedures: A Systematic Review.

Background: It is unclear which tendon harvest for ulnar or lateral collateral ligament reconstruction has the lowest graft site morbidity rate.

Purposes: To obtain graft site morbidity rates after tendon harvest for ulnar and lateral collateral ligament reconstruction procedures.

Study Design: Systematic review/Meta-analysis.

Tension band wiring for simple olecranon fractures: evaluation of surgical technique.

Background: In some settings, specific techniques for open reduction and internal fixation are preferred based on the eminence of a surgeon or professional organization. An emphasis on technical aspects of surgery that are not proved superior and vary substantially from surgeon to surgeon can be confusing for trainees. This study applied a numerical grading of the technical aspects of tension band wire (TBW) fixation for olecranon fracture; assessed the interobserver agreement of each criterion; and measured the correlation of the technical grading and objective and subjective long-term outcomes.

Outcomes of Concomitant Fractures of the Radial Head and Capitellum: The "Kissing Lesion".

Background: Radial head compression against the capitellum may cause concomitant fracture of the capitellum. The purpose of this study was to investigate if radial head fracture type is associated with a concomitant fracture of the capitellum.

Patients And Methods: Data were identified from five area hospitals.

A Meta-Analysis of the Effect of Corticosteroid Injection for Enthesopathy of the Extensor Carpi Radialis Brevis Origin.

Purpose: The null hypothesis that there is no effect of corticosteroid injection on visual analog scale for pain in patients with enthesopathy of the extensor carpi radialis brevis (eECRB) origin 6 months after treatment was tested. Our secondary hypotheses were that there is no effect of corticosteroid injection on pain intensity at 1 and 3 months after treatment; that there is no effect of corticosteroid injection on grip strength at 1, 3, and 6 months after treatment; and that there is no effect of corticosteroid injection on Disabilities of the Arm, Shoulder, and Hand scores at 1, 3 and 6 months after treatment.

Methods: EMBASE, PubMed Publisher, MEDLINE, OvidSP, Web of Science, Google Scholar, and the Cochrane Central were searched for relevant studies.

Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation.

Purpose: Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after operative treatment of bicolumnar distal humerus fractures. We also addressed agreement among surgeons regarding which fracture fixation will loosen or break and the influence of years in independent practice, location of practice, and so forth.

Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis: A Meta-analysis.

Background: The ability of injection of corticosteroids into the subacromial space to relieve pain ascribed to rotator cuff tendinosis is debated. The number of patients who have an injection before one gets relief beyond what a placebo provides is uncertain.

Questions/purposes: We asked: (1) Do corticosteroid injections reduce pain in patients with rotator cuff tendinosis 3 months after injection, and if so, what is the number needed to treat (NNT)? (2) Are multiple injections better than one single injection with respect to pain reduction at 3 months?

Methods: We systematically searched seven electronic databases for randomized controlled trials of corticosteroid injection for rotator cuff tendinosis compared with a placebo injection.