Predicting 90-day return to the emergency department in orthopaedic trauma patients in the Southeastern USA: a machine-learning approach.

Introduction: Return-to-acute-care metrics, such as early emergency department (ED) visits, are key indicators of healthcare quality, with ED returns following surgery often considered avoidable and costly events. Proactively identifying patients at high risk of ED return can support quality improvement efforts, allowing interventions to target vulnerable patients. With its predictive capabilities, machine learning (ML) has shown potential in forecasting various clinical outcomes but remains underutilised in orthopaedic trauma.

Synovial Fluid Immune Cell Composition Following Intraarticular Fracture May Contribute to Posttraumatic Osteoarthritis.

Intra-articular ankle fracture (IAF) often leads to post-traumatic osteoarthritis (PTOA), resulting in significant long-term morbidity. While previous research has focused on the inflammatory cytokines and matrix metalloproteinases within the synovial fluid fracture hematoma (SFFH), the immune cell populations within SFFH that contribute to PTOA development remain underexplored. This study aimed to characterize the immune cell populations in SFFH to better understand their role in the inflammatory response and potential for inducing lasting cartilage damage.

The impact of socioeconomic factors on 90-day postoperative readmissions and cost in shoulder arthroplasty patients.

Background: Understanding the impact of Social Drivers of Health on shoulder arthroplasty is pivotal for the development of equitable value-based payment models that enhance the quality of patient care. This investigation aims to understand the influence of Area Deprivation Index (ADI) on hospital admissions, readmissions, and associated costs postshoulder arthroplasty.

Methods: We conducted an analysis using US Medicare claims data from 2019 to 2021, identifying patients who received shoulder arthroplasty in either an inpatient or outpatient setting using Current Procedural Terminology codes.

Racial and Ethnic Disparities in Hip Fracture Surgery: A Systematic Review and Meta-Analysis.

Background: Hip fractures are common injuries that result in substantial loss of quality of life to elderly patients. To date, no meta-analyses have been performed to consolidate findings related to racial and ethnic disparities in hip fracture care.

Purpose: We sought to examine associations between racial or ethnic identity and several metrics of hip fracture care.

Health care policy and arthroscopic rotator cuff repair prices in the United States.

Background: Arthroscopic rotator cuff repair (ARCR) is one of the most common orthopedic procedures in the general population. Despite its prevalence, the price of ARCR varies significantly across regions, hospital models, and settings. The purpose of this study was to examine the effect of Geographic Region, Certificate of Need (CON) laws, and Medicaid expansion on ARCR pricing.

Sociopolitical, clinical, and ethical challenges of sustainable fracture care in Haiti.

Introduction: In low- and middle-income countries such as Haiti, musculoskeletal injuries are the leading cause of morbidity and mortality. Untreated injuries can contribute to decreased mobility, leading to disability and reduced productivity for individuals. The accessibility of timely fracture care poses a substantial challenge in Haiti, where socioeconomic instability and recent surges in gang violence exacerbate an already strained healthcare infrastructure.

Exploring versatile applications of a vacuum-assisted bone harvester in orthopedic surgery.

Background: Orthopedic procedures often require removing bone or pathological tissue, with traditional methods involving instruments like curettes and rongeurs. However, these methods can be time-consuming and lead to increased blood loss. To mitigate these side effects, vacuum-assisted tools have been developed to aid in tissue removal.

Racial and Ethnic Disparities in Providing Guideline-Concordant Care After Hip Fracture Surgery.

Importance: Institutions have adopted protocol-driven standardized hip fracture programs (SHFPs). However, concerns persist regarding bias in adherence to guideline-concordant care leading to disparities in implementing high-quality care for patients recovering from surgery for hip fracture.

Objective: To assess disparities in the implementation of guideline-concordant care for patients after hip fracture surgery in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Targeted Hip Fracture (THF) Database.

The impact of political partisanship, certificate of need, Medicaid expansion, and area deprivation index on total shoulder arthroplasty prices in the United States.

Background: Recent mandates from the Center for Medicare and Medicaid Services require United States hospitals to disclose health care service pricing. Yet, there's a gap in understanding how state-level factors affect hospital service pricing, like total shoulder arthroplasty (TSA). Comprehending these influences can help policymakers and health care providers manage costs and improve care access for vulnerable populations.

The Effect of Social Drivers of Health on 90-Day Readmission Rates and Costs After Primary Total Hip and Total Knee Arthroplasty.

Introduction: The effect of social drivers of health (SDOH) on readmissions and costs after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is poorly understood. Policies such as the Hospital Readmissions Reduction Program have targeted overall readmission reduction, using value-based strategies to improve healthcare quality. However, the implications of SDOH on these outcomes are not yet understood.

Persistent racial disparities in postoperative management after tibia fracture fixation: A matched analysis of US medicaid beneficiaries.

Introduction: Racial and ethnic disparities in orthopaedic surgery are well documented. However, the extent to which these persist in fracture care is unknown. This study sought to assess racial disparities in the postoperative surgical and medical management of patients after diaphyseal tibia fracture fixation.

AI-Generated Graduate Medical Education Content for Total Joint Arthroplasty: Comparing ChatGPT Against Orthopaedic Fellows.

Background: Artificial intelligence (AI) in medicine has primarily focused on diagnosing and treating diseases and assisting in the development of academic scholarly work. This study aimed to evaluate a new use of AI in orthopaedics: content generation for professional medical education. Quality, accuracy, and time were compared between content created by ChatGPT and orthopaedic surgery clinical fellows.

Multisite Study of the Management of Musculoskeletal Infection After Trauma: The MMUSKIT Study.

Background: The optimal duration and choice of antibiotic for fracture-related infection (FRI) is not well defined. This study aimed to determine whether antibiotic duration (≤6 vs >6 weeks) is associated with infection- and surgery-free survival. The secondary aim was to ascertain risk factors associated with surgery- and infection-free survival.

Prediction of 30-Day Mortality Following Revision Total Hip and Knee Arthroplasty: Machine Learning Algorithms Outperform CARDE-B, 5-Item, and 6-Item Modified Frailty Index Risk Scores.

Background: Although risk calculators are used to prognosticate postoperative outcomes following revision total hip and knee arthroplasty (total joint arthroplasty [TJA]), machine learning (ML) based predictive tools have emerged as a promising alternative for improved risk stratification. This study aimed to compare the predictive ability of ML models for 30-day mortality following revision TJA to that of traditional risk-assessment indices such as the CARDE-B score (congestive heart failure, albumin (< 3.5 mg/dL), renal failure on dialysis, dependence for daily living, elderly (> 65 years of age), and body mass index (BMI) of < 25 kg/m2), 5-item modified frailty index (5MFI), and 6MFI.

Outcomes and complications of revision reverse shoulder arthroplasty after failed primary anatomic shoulder arthroplasty or hemiarthroplasty: a systematic review.

Background: The purpose of this study is to systematically review the evidence in the literature to ascertain the functional outcomes, range of motion (ROM), and complication and reoperation rates after revision reverse shoulder arthroplasty (RSA) for a failed primary total shoulder arthroplasty (TSA) or hemiarthroplasty (HA).

Methods: Two independent reviewers performed the literature search based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the EMBASE, MEDLINE, and The Cochrane Library databases. Studies were included if they reported clinical outcomes for revision RSA for a failed primary TSA or HA.

The Utilization of Preoperative Steroids Safely Decreases the Risk of Postoperative Delirium in Geriatric Patients After Hip Fracture Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Objectives: Postoperative delirium is an acute neurocognitive complication that can have adverse effects on outcomes of geriatric patients after undergoing hip fracture surgery. The objective of this study was to examine the efficacy of preoperative steroids in preventing postoperative delirium after hip fracture surgery.

Data Sources: A systematic review and meta-analysis was performed using PubMed, SPORTDiscus, CINAHL, MEDLINE, and Web of Science from database inception until September 28, 2023.

Haitian State Hospital Orthopedic Grand Rounds Series: A Virtual Curriculum to Address Global Surgery Needs.

Background: Orthopedic Relief Services International (ORSI), in partnership with the Foundation for Orthopedic Trauma and the department of Orthopedic Surgery of La Paix University Hospital in Haiti, has developed a year-round Orthopedic Grand Round series. This series is moderated by Haitian faculty, features presentations by American orthopedic surgeons, and is broadcast to major state hospitals in Haiti for residents and attendings.

Objective: To introduce clinical concepts and increase knowledge in an area that is medically underserved, especially in the field of orthopedics, through lectures that tailor to the educational needs of Haiti.

Association between radiographic soft-tissue thickness and increased length of stay, operative time, and infection rate after reverse shoulder arthroplasty.

Background: Reverse shoulder arthroplasty (RSA) is a widely performed surgical procedure to address various shoulder pathologies. Several studies have suggested that radiographic soft-tissue thickness may play a role in predicting complications after orthopedic surgery, but there have been limited studies determining the use of radiographic soft-tissue thickness in RSA. The purpose of this study was to evaluate whether radiographic soft-tissue thickness could predict clinical outcomes after RSA and compare the predictive capabilities against body mass index (BMI).

Management of Intraoperative Acetabular Fractures During Total Hip Arthroplasty.

Intraoperative fractures of the acetabulum are a rare but serious complication during total hip arthroplasty. Acute fractures generally require attention with plating, whereas chronic acetabular fractures may be approached with distraction, a Burch-Schneider cage, or a custom implant. It is imperative for arthroplasty surgeons to possess a thorough understanding of how to identify and manage these injuries.

Updates on Residual Limb Management in Lower Extremity Amputation From Nerve to Bone.

Traumatic extremity amputation can be devastating for patients' functional and psychological health. Challenges of initial management and considerations for limb salvage versus amputation for mangled lower extremities are well documented. However, literature geared toward orthopedic surgeons highlighting management considerations for the residual limb of an amputation is scarce.