Is a vertical fracture fragment after indirect reduction acceptable in minimally invasive plate osteosynthesis for acute mid-shaft clavicular fractures?

Purpose: Reduction and intraoperative maintenance of fracture fragments during minimally invasive plate osteosynthesis (MIPO) pose technical difficulties, particularly when the interposed fragment is angulated, prompting surgeons to attempt reduction due to concerns about nonunion or malunion. We aimed to compare the clinical and radiological outcomes of MIPO for mid-shaft clavicular fractures based on the reduced status of the interposed fragments.

Method: Fifty-seven patients who underwent MIPO for acute mid-shaft Robinson type 2B clavicular fractures were divided into two groups based on the alignment of the interposed fracture fragment.

The benefit of national clinical guidelines for open lower limb fractures in reducing healthcare burden: A length of inpatient stay cost-analysis.

Introduction: Severe open lower limb fractures are complex and costly injuries. Studies reporting the costs associated with these injuries, the economic impact of complications, and the clinical benefit of adherence to national guidelines have been previously reported. However, the economic benefits of national guidelines and their relationship with length of inpatient stay have not been described.

The effect of bone relaxation on the simulated pull-off force of a cementless femoral knee implant.

Aseptic loosening is the primary cause of revision in cementless total knee arthroplasty (TKA), emphasizing the importance of strong initial stability for long-term implant success. Pre-clinical evaluations are crucial for understanding implant fixation mechanics and improving implant designs. Finite element (FE) analysis models often use linear elastic bone material models, which do not accurately reflect bone's mechanical behavior.

Impact of Antiplatelet Medication Continuation on Surgical Outcomes after Minimally Invasive Posterior Lumbar Decompression Surgery: Retrospective Cohort Study.

Study Design: Retrospective cohort study.

Objectives: Spinal surgeons face a dilemma regarding the continuation or discontinuation of antiplatelet agents during the perioperative period. Guidelines recommend considering the balance between thrombotic and bleeding risks.

Accelerometer-Assisted Physical Activity Outcomes During the First Year of Recovery After Anterior Cruciate Ligament Reconstruction: A Prospective Cohort Pilot Study.

Background: Wearable activity-measurement devices are increasingly popular among the public, but there is little information regarding their use among patients undergoing sports medicine procedures. The purpose of this study was to compare accelerometer-measured data with traditional patient-reported measures and to determine the trajectory of physical activity from before surgery to 1 year after anterior cruciate ligament reconstruction.

Materials And Methods: Adult patients undergoing primary anterior cruciate ligament reconstruction were enrolled in this prospective cohort pilot study.

Evaluating the Evolution of ChatGPT as an Information Resource in Shoulder and Elbow Surgery.

Background: The purpose of this study was to evaluate the performance and evolution of Chat Generative Pre-Trained Transformer (ChatGPT; OpenAI) as a resource for shoulder and elbow surgery information by assessing its accuracy on the American Academy of Orthopaedic Surgeons shoulder-elbow self-assessment questions. We hypothesized that both ChatGPT models would demonstrate proficiency and that there would be significant improvement with progressive iterations.

Materials And Methods: A total of 200 questions were selected from the 2019 and 2021 American Academy of Orthopaedic Surgeons shoulder-elbow self-assessment questions.

Analysis of the Top Articles and Authors of the Journal of Orthopaedic Trauma and Bibliometric Comparison of Impact Factors of Orthopaedic Surgery Journals.

Objectives: To determine the top 100 cited authors and the top 20 articles in the Journal of Orthopaedic Trauma (JOT) and compare its impact factor to orthopaedic and non-orthopaedic surgery literature.

Design: Review.

Methods: The Web of Science database was used to determine the top 100 cited authors and top 20 cited articles that originated in JOT from 1995 to the present.

Evaluating Surgeon-influenced Factors for Total Knee Arthroplasty Value-based Reimbursement.

Introduction: Clinical outcome measures used under value-based reimbursement models require risk stratification of patient demographics and medical history. Only certain perioperative patient factors may be influenced by the surgeon. The study evaluated surgeon-influenced modifiable factors associated with achieving literature-defined KOOS score thresholds to serve as the foundation of the newly established alternative payment models for total knee arthroplasties (TKA).

Falling Rates of Public Orthopaedic Surgery Reimbursements and Utilization, 2016 to 2024.

Background: Declining reimbursement rates can lead to decreased access and utilization of common orthopaedic surgeries for patients on Medicare, which is a particularly vulnerable population for musculoskeletal injuries.

Methods: Using the Centers for Medicare & Medicaid Services Physician Fee Schedule Look-Up Tool from 2016 to 2024 and utilization data for Medicare and part B beneficiaries from 2016 to 2022, we analyzed reimbursement and utilization trends. Simple linear regressions were executed to measure the annual trends, and Wilcoxon matched-pairs signed rank test were used to analyze the statistical significance of price and utilization changes.

Improved Risk Adjustment for Comorbid Diagnoses in Administrative Claims Analyses of Orthopaedic Surgery.

Background: The accurate inclusion of patient comorbidities ensures appropriate risk adjustment in clinical or health services research and payment models. Orthopaedic studies often use only the comorbidities included at the index inpatient admission when quantifying patient risk. The goal of this study was to assess improvements in capture rates and in model fit and discriminatory power when using additional data and best practices for comorbidity capture.

Incidence and Risk Factors for Orthopedic Device-Related Pressure Injuries: A Systematic Review and Meta-Analysis.

Background: As orthopedic trauma increases, the resultant use of orthopedic devices and associated pressure injuries has increased.

Objective: This study aims to systematically evaluate the incidence and risk factors for orthopedic device-related pressure injuries.

Methods: A systematic review and meta-analysis was conducted by searching PubMed, Embase, Cochrane Library, Web of Science, ClNAHL, China National Knowledge Infrastructure, Wanfang Database, and Chinese BioMedical Literature Database from their inception until November 30, 2023.

The impact of anticoagulant-related bleeding on quality of life: Development of a novel measure based on perspectives from older adults.

Background: Venous thromboembolism (VTE) and atrial fibrillation (AF) disproportionately affect older adults, who are at increased risk of bleeding from treatment with anticoagulant therapy. The impact of bleeding on older adults' quality of life (QoL) is poorly understood due to the lack of a validated measure of their experience. This study's purpose is to describe the first evidence-based steps in developing a new condition-specific patient-reported outcome measure (PROM) for the effect of anticoagulant-related bleeding on older adults' QoL.

Modified musculofascial lengthening technique for submuscular ulnar nerve transposition in cubital tunnel syndrome.

Objective: Cubital tunnel syndrome is a common peripheral neuropathy of the upper extremity. Anterior transposition of the ulnar nerve is an established surgical treatment option for this condition. This study aimed to introduce a novel musculofascial lengthening technique that uses only a portion of the flexor-pronator muscle mass for submuscular anterior transposition of the ulnar nerve and investigate its clinical outcomes.

Regional Anesthesia and Pain Outcomes After Anterior Cruciate Ligament Reconstruction Surgery in Pediatric Patients: Society of Pediatric Anesthesia Improvement Network.

Background: Optimal perioperative pain management is unknown for adolescent patients undergoing anterior cruciate ligament reconstruction (ACLR). The study aimed to determine the association of nerve blocks with short- and long-term pain outcomes and factors influencing self-reported neurological symptoms.

Methods: We performed a multisite, prospective observational study of adolescent patients undergoing ACLR.

Autologous Peripheral Blood-Derived Orthobiologics for the Management of Elbow Disorders: A Review of Current Clinical Evidence.

Introduction: Elbow ailments are common, but conventional treatment modalities have shortcomings, offering only interim pain relief rather than targeting the underlying pathophysiology. The last two decades have seen a marked increase in the use of autologous peripheral blood-derived orthobiologics (APBOs), such as platelet-rich plasma (PRP), to manage elbow disorders. Platelet-rich plasma (PRP) is the most widely used APBO, but its efficacy remains debatable.

A head-to-head comparison of the adult EQ-5D-5L and youth EQ-5D-Y-5L in adolescents with idiopathic scoliosis.

Background: Multiple diseases, such as Adolescent Idiopathic Scoliosis (AIS), present at adolescent age and the impact on quality of life (QoL) prolongs into adulthood. For the EQ-5D, a commonly used instrument to measure QoL, the current guideline is ambiguous whether the youth or adult version is to be preferred at adolescent age. To assess which is most suitable, this study tested for equivalence along predefined criteria of the youth (EQ-5D-5L) and adult (EQ-5D-Y-5L) version in an adolescent population receiving bracing therapy for AIS.

Revolutionising Osseous Biopsy: The Impact of Artificial Intelligence in the Era of Personalised Medicine.

In a rapidly evolving healthcare environment, artificial intelligence (AI) is transforming diagnostic techniques and personalised medicine. This is also seen in osseous biopsies. AI applications in radiomics, histopathology, predictive modelling, biopsy navigation, and interdisciplinary communication are reshaping how bone biopsies are conducted and interpreted.

The Impact of Physical Therapy Postprofessional Education Programs on Productivity in a Large Academic Medical Center.

Introduction: Emerging evidence shows positive impact of postprofessional physical therapy education (residency and fellowship) specific to participants; however, outcomes on organizational impact are largely unknown. The purpose of this project was to describe the impact residency and fellowship training has on financial metrics. A secondary purpose of this case study was to describe trends associated with higher productivity.

Improving Diagnostic Efficiency for Knee Osteoarthritis with the Knee Intake Patient Survey (KIPS).

Objectives: Knee Osteoarthritis (OA) is one of the most frequently encountered conditions in orthopedic practice. This study aimed to validate the Knee Intake Patient Survey (KIPS), a short-form questionnaire designed to assist in the initial diagnosis and treatment stratification for knee OA.

Methods: Patient intake survey results from a single adult reconstruction clinic were retrospectively analyzed alongside clinical diagnoses and treatment recommendations.

Perioperative Venous Thromboembolism Prophylaxis in Orthopedic Trauma: A Practical Review.

Background: Orthopedic trauma patients are at high risk for venous thromboembolic (VTE) complications. Despite this, VTE prophylaxis is often held peri-operatively out of concern for increased bleeding and associated complications. This review's purpose is to examine guidelines and studies on withholding prophylactic anticoagulation peri-operatively.

Salvianolic acid A promotes bone-fracture healing via balancing osteoblast and osteoclast differentiation.

Nonunion is a significant complication in fracture management for surgeons. Salvianolic acid A (SAA), derived from the traditional Chinese plant Salviae miltiorrhizae Bunge (Danshen), exhibits notable anti-inflammatory and antioxidant properties. Although studies have demonstrated its ability to promote osteogenic differentiation, the exact mechanism of action remains unclear.

Tranexamic dosing for major joint arthroplasty in adult patients with chronic kidney disease: A pharmacokinetic study and new dosing regimen.

Background: Tranexamic acid is an anti-fibrinolytic agent routinely used during hip and knee joint replacement surgery to minimize bleeding. Chronic kidney disease is a common chronic health problem seen among adults requiring major arthroplasty surgery. Tranexamic acid is renally cleared and may accumulate in chronic kidney disease.