Quantifying the Scope of Artificial Intelligence-Assisted Writing in Orthopaedic Medical Literature: An Analysis of Prevalence and Validation of AI-Detection Software.

Introduction: The popularization of generative artificial intelligence (AI), including Chat Generative Pre-trained Transformer (ChatGPT), has raised concerns for the integrity of academic literature. This study asked the following questions: (1) Has the popularization of publicly available generative AI, such as ChatGPT, increased the prevalence of AI-generated orthopaedic literature? (2) Can AI detectors accurately identify ChatGPT-generated text? (3) Are there associations between article characteristics and the likelihood that it was AI generated?

Methods: PubMed was searched across six major orthopaedic journals to identify articles received for publication after January 1, 2023. Two hundred and forty articles were randomly selected and entered into three popular AI detectors.

Analysis of Serial Foot Radiographs to Determine Foot Height Multipliers.

Background: The multiplier method is an arithmetic calculation that estimates the amount of growth remaining until skeletal maturity. When predicting lower limb length discrepancy, differences in foot height are added to femur and tibia discrepancies. Foot height multipliers have not been calculated using radiographic measurements, so it is unclear whether foot height develops at the same pace as the femur and tibia.

Alpha Angle and Anterior Femoral Neck Offset Identify Different Cohorts of Cam Morphology: An Osteologic Study.

Purpose: To explore differences in cam morphology defined by alpha angle (AA) and anterior femoral neck offset (AFNO) in the context of other anthropometric parameters in an osteologic collection to further elucidate whether each measurement tool is identifying the same underlying pathology.

Methods: Anthropometric measurements of 992 cadaveric hips from the Hamann-Todd Osteological Collection were analyzed. Femurs with cam morphology were identified by AA >55° or AFNO <7 mm.

How Prominent Are Gender Bias, Racial Bias, and Score Inflation in Orthopaedic Surgery Residency Recommendation Letters? A Systematic Review.

Introduction: Letters of recommendation are considered an important factor in the holistic ranking of orthopaedic residency applications. The standardized letter of recommendation (SLOR) was introduced in 2017 in response to the inherent bias and limited comparative value of traditional LORs. It includes standardized questions about an applicant's orthopaedic qualifications, designed to enable fair comparisons among candidates.

Analyzing Pelvic Asymmetry by Sex and Ancestry: Insights From an Osteological Collection.

Introduction: Pelvic asymmetry has been noted in pelvic imaging, and might influence the development of various spinal pathologies, most notably scoliosis. There is a limited understanding of the relationship between pelvic asymmetry and sex and ancestry, and limited use of 3D modeling. The purpose of this study was to identify pelvic asymmetry and morphology differences between sex and ancestry utilizing 3D modeling on young adults in an osteological collection.

Torsional Deformity Significantly Impacts Lateral Ankle Radiographic Imaging Parameters.

Background Optimal lateral ankle imaging is important for the diagnosis and treatment of multiple ankle conditions. The effects of limb deformity on lateral ankle imaging are not well described and are clarified in this osteological study. Materials and methods We utilized an osteological collection and imaged all specimens after the first positioning of the talus in the lateral position and positioning the tibia and fibula to match.

The Relationship Between Height and Income With Potential Application to Treatment of Limb Length Discrepancy.

Purpose When treating limb length discrepancy (LLD), decisions regarding lengthening versus contralateral shortening require careful consideration of deformity and patient factors. Using the National Longitudinal Survey of Youth 1979 (NLSY79) database, and income as a quantitative representation of overall socioeconomic benefit, we sought to determine the height at which incremental gains in height have the greatest value. Methods Using the NLSY79 database, we collected demographic data, height, yearly income from wages, college education (full- or part-time), and receipt of government financial aid.

Optimizing calibration of modern skeletal maturity systems.

Purpose: Greulich and Pyle is the most used system to estimate skeletal maturity but has significant drawbacks, prompting the development of newer skeletal maturity systems, such as the modified Fels skeletal maturity systems based on knee radiographs. To create a new skeletal maturity system, an outcome variable, termed a "skeletal maturity standard," must be selected for calibration of the system. Peak height velocity and 90% of final height are both considered reasonable skeletal maturity standards for skeletal maturity system development.

Developmental Anatomy of the Radial Bow in Pediatric Patients Using 3D Imaging.

Background: While radial bow shape is well characterized in adults, its development in children is not well understood. Previous studies on the radial bow use radiographs, thus, rotational positioning of the forearm could alter bowing measurements. This study used 3D imaging to better assess the pediatric radial bow.

The Addition of Hand-specific Skeletal Maturity Parameters Does Not Improve Skeletal Maturity Estimation Accuracy of the Modified Fels Wrist System.

Background: The Modified Fels Wrist system is potentially the most accurate clinically accessible skeletal maturity system utilizing hand or wrist radiographs. During development, parameters distal to the metacarpals were excluded. We attempted to further optimize the Modified Fels wrist system through the inclusion of hand parameters distal to the metacarpals.

Association of Idiopathic Cam Morphology With Femoral and Acetabular Version: Analysis of 986 Cadaveric Hips.

Background: Studies have correlated symptomatic femoroacetabular impingement (FAI) with femoral retroversion and cam lesions.

Purpose: To investigate any association between femoral and acetabular versions with cam deformity in a largely asymptomatic population.

Study Design: Descriptive laboratory study.

Prospective Multicenter Preliminary Validation of Limb Deformity-modified Scoliosis Instruments in Pediatric Patients With Limb Deformity.

Introduction: There are few disease-specific patient-reported outcome measures (PROMs) for use in pediatric limb deformity (LD), with authors instead relying on generic PROMs such as the Pediatric Outcomes Data Collection Instrument (PODCI) to assess treatment outcomes from the patient's perspective. The purpose of this study was to perform preliminary validation of 2 disease-specific PROMs in pediatric patients with LD.

Methods: LD modifications were created by substituting the word "limb" for "back" in the Early Onset Scoliosis Questionnaire (EOSQ, ages 10 and younger) and the Scoliosis Research Society (SRS, ages 11 to 18) survey, creating the LD-EOSQ and LD-SRS instruments.

Correlation between Femoral Neck Version, Sagittal Femoral Bowing Angle and Sagittal Offset of the Femoral Head from the Distal Femur Axis in an Osteological Collection.

Aim: Radiographic analysis of lower limb alignment is crucial for the planning and evaluation of deformity correction. Assessment in the sagittal plane is often overlooked compared with the coronal plane for a variety of reasons. We aimed to investigate the relationship between the femoral head in the sagittal plane and femoral neck version in the axial plane, and how sagittal femoral bowing angle (sFBA) may contribute.

The Modified Fels and Abbreviated Modified Fels Knee Skeletal-Maturity Systems in the Prediction of Leg-Length Discrepancy.

Background: The Modified Fels (mFels) and Abbreviated Modified Fels (abFels) knee systems have been recently developed as options for grading skeletal maturity without the need for a separate hand radiograph. We sought to determine the interobserver reliability of these systems and to compare their prediction accuracy with that of the Greulich and Pyle (G-P) atlas in a cohort managed with epiphysiodesis for leg-length discrepancy (LLD).

Methods: Three reviewers scored 20 knee radiographs using the mFels system, which includes 5 qualitative and 2 quantitative measures as well as a quantitative output.

The Reliability of the Modified Fels Knee Skeletal Maturity System.

Background: The recently described Modified Fels knee skeletal maturity system (mFels) has proven utility in prediction of ultimate lower extremity length in modern pediatric patients. mFels users evaluate chronological age, sex, and 7 anteroposterior knee radiographic parameters to produce a skeletal age estimate. We developed a free mobile application to minimize the learning curve of mFels radiographic parameter evaluation.

Correlations Between Eight Comprehensive Skeletal Maturity Systems in a Modern Peripubertal Pediatric Population.

Background: Several skeletal maturity systems allow for accurate skeletal age assessment from a wide variety of joints. However, discrepancies in estimates have been noted when applying systems concurrently. The aims of our study were to (1) compare the agreement among 8 different skeletal maturity systems in modern pediatric patients and (2) compare these discrepancy trends qbetween modern and historic children.

Assessment and Validation of Anterior Humeral Line for Diagnosing Supracondylar Humerus Fractures in the Pediatric Population.

Introduction: Pediatric supracondylar humerus fractures are commonly evaluated using the anterior humeral line (AHL) on a lateral radiograph. Rotational variations in radiographic projection are common due to child discomfort and could lead to changes in management based on where the AHL intersects the capitellum. The purpose of this study was to establish whether rotational variations in elbow rotation leads to significant changes in AHL position and whether drawing the AHL based on the distal humerus versus shaft is more tolerant to rotation.

Intramedullary Fixation for Pediatric Femoral Nonunion in Low- and Middle-Income Countries.

Background: Pediatric femoral shaft nonunion after use of a plate or intramedullary nail (IMN) is uncommon in the United States. In low and middle-income countries, as defined by The World Bank, these complications may occur with greater frequency. We assessed the rates of union and painless weight-bearing after IMN fixation of pediatric femoral shaft nonunion in lower-resource settings.

Disparities in Pediatric Orthopedic Surgery Care During the COVID-19 Pandemic Pre-vaccine and Post-Vaccine Availability.

Background: The COVID-19 pandemic has led to significant disruptions in medical care, resulting in an estimated 40% of US adults avoiding care. However, the return to baseline health care utilization following COVID-19 restrictions within the pediatric orthopedic population remains unexplored. We sought to analyze the visit volume and demographics of pediatric orthopedic patients at 3 timepoints: prepandemic (2019), pandemic (2020), and pandemic post-vaccine availability (2021), to determine the impact of COVID-19 restrictions on our single-center, multisite institution.

Applicability of Shoulder, Olecranon, and Wrist-based Skeletal Maturity Estimation Systems to the Modern Pediatric Population.

Background: The proximal humerus ossification system (PHOS), olecranon apophyseal ossification system (OAOS), and modified Fels wrist skeletal maturity system (mFWS) were recently developed or updated using a historical, mostly White, pediatric population. These upper extremity skeletal maturity systems have demonstrated skeletal age estimation performance superior or equivalent to Greulich and Pyle in historical patients. Their applicability to modern pediatric populations has not yet been evaluated.

Less common than expected: late displacement after minimally displaced pediatric lateral condyle fractures of the elbow.

The incidence of late displacement among pediatric lateral condyle fractures has been described as 1.3-26%. However, prior studies are limited by small cohort sizes.