Bone Surgery Research Articles

Integration of Augmented Reality in Temporal Bone and Skull Base Surgeries

Augmented reality technologies provide transformative solutions in various surgical fields. Our research focuses on the use of an advanced augmented reality system that projects 3D holographic images directly into surgical footage, potentially improving the surgeon’s orientation to the surgical field and lowering the cognitive load. We created a novel system that combines exoscopic surgical footage from the “ORBEYE” and displays both the surgical field and 3D holograms on a single screen. This setup enables surgeons to use the system without using head-mounted displays, instead viewing the integrated images on a 3D monitor. Thirteen surgeons and surgical assistants completed tasks with 2D and 3D graphical surgical guides. The NASA Task Load Index was used to assess mental, physical, and temporal demands. The use of 3D graphical surgical guides significantly improved performance metrics in cochlear implant surgeries by lowering mental, physical, temporal, and frustration levels. However, for Bonebridge implantation, the 2D graphical surgical guide performed better overall (p = 0.045). Participants found the augmented reality system’s video latency to be imperceptible, measuring 0.13 ± 0.01 s. This advanced augmented reality system significantly improves the efficiency and precision of cochlear implant surgeries by lowering cognitive load and improving spatial orientation.

Do prospective randomized controlled trials comply with filed protocols? Spin study of 206 trials from 2010 to 2023

IntroductionProspective randomized controlled trials (RCT) have a robust methodology, but some distortions may occur during the course of study. Some protocols may not be available at the time an article is reading. Some authors may change the methodology between the time the protocol was submitted and when the trial results are actually published. Others may distort results to favor more attractive findings and draw conclusions that support prior hypotheses. This has rarely been investigated and none explored the RCTs published in the Journal of Bone and Joint Surgery (JBJS). Therefore, we did a retrospective investigation aiming to determine: (1) the proportion of trials with a protocol deposited and accessible to the reader, (2) whether the trials scrupulously followed the filed protocols. HypothesisProtocols were available in over 80% of cases, and these protocols were followed in over 80% of trials for the primary endpoint. Patients and methodsThis was a retrospective study of articles published in the JBJS between January 2010 and November 2023. Differences in primary and secondary endpoints between protocols and articles were sought. ResultsOf the 206 RCT articles studied, 113 (54.9%) described clear and identifiable endpoints, and 93 (45.1%) were not identifiable and were inferred in the results; 184 (89.3%) articles identified a trial protocol. For the 184 articles (89.3%) declaring a trial protocol in the text, 23 (11.1%) protocols were not accessible. In all, 45 articles (21.8%) thus had no protocol available on the Internet (i.e., not available to the reader either because it was not cited in the text or because it was not accessible) so we analyzed 161 articles. The primary endpoint remained unchanged in 97 articles (60.2%) out of the 161 studied, was changed in 64 articles (39.8%), and was lacking (protocol not accessible) in 45 articles (21.8% of all articles). The secondary endpoints of the articles were unchanged in 61 articles (37.9%) out of the 161 studied. DiscussionLike other leading journals, JBJS publishes RCT articles containing a significant proportion of inconsistencies between preoperative trial protocols and the methods actually used in the research. Level of evidenceIII; retrospective comparative study non randomized

Cochrane Corner

The Cochrane Collaboration has produced three new reviews relevant to bone and joint surgery since the publication of the last Cochrane Corner. These are relevant to a wide range of musculoskeletal specialists, and include reviews in lateral elbow pain, osteoarthritis of the big toe joint, and cervical spine injury in paediatric trauma patients.

Less-Invasive Technique for Non-stabilized Mandibular Fracture in Mouse Models.

Non-stabilized fractures can be made at mandibular sites in mice, thus making it possible to analyze bone repair using an endochondral ossification mode. To most accurately reflect this process in vivo, it is necessary to have a standardized protocol to avoid excessive bone loss and soft tissue damage, particularly at the mandibular site, an anatomical site characterized by minimal access. To our knowledge, we describe for the first time a less-invasive protocol of non-stabilized mandibular fracture in mice. Adult mice are anesthetized with isoflurane and receive a preoperative dose of buprenorphine by subcutaneous injection. A submandibular approach is performed, with a skin incision made along the inferior border of the mandible. The masseter muscle is elevated in a subperiosteal plane along the mandibular ramus with a periosteal elevator. A vertical and complete fracture of the ramus is performed from the basilar border to the coronoid notch (between condylar and coronoid processes), using a piezoelectric bone surgery device under saline serum irrigation at the basilar edge and scissors to complete the fracture of the mandibular ramus. The skin approach is closed by silk sutures. This detailed procedure for non-stabilized mandibular fractures offers an efficient procedure allowing minimal bone loss and soft tissue damage. This technique ensures successful and consistent results to accurately reflect the process of endochondral bone repair in mouse models.

The release behavior and in vitro osteogenesis of quercetin-loaded bioactive glass/hyaluronic acid/sodium alginate nanocomposite paste

Injectable pastes based on bioactive compounds and natural polymers are of interest in non-invasive bone surgeries. Several quantities of quercetin (100, 150, and 200 μM) were added to a sol-gel derived mesoporous bioactive glass. Injectable pastes based on quercetin-loaded bioactive glass, sodium alginate, and hyaluronic acid were prepared. Aggregated nanoparticles of bioactive glass and quercetin-loaded bioactive glass with mesoporous morphologies were confirmed by TEM and BET techniques. The quercetin release study was assessed in phosphate-buffered solution medium over 200 h and the obtained data were fitted by different eqs. A sustained release of quercetin was found, in which a better regression coefficient was achieved using Weibull equation. Human-derived mesenchymal stem cells were utilized to determine alkaline phosphatase activity and bone-related protein expression by western blotting and real-time PCR evaluations. Quercetin-loaded pastes increased the levels of alkaline phosphatase activity and the expression of Collagen-1, Osteopontin, Osteocalcin, and Runx2 proteins in a concentration-dependent manner. Due to the mesoporous architecture and high specific surface area of bioactive glass, the paste made of these particles and sodium alginate/hyaluronic acid macromolecules is appropriate matrix for quercetin release, resulting in promoted osteogenesis. The further in vivo studies can support the osteogenesis capacity of the quercetin-loaded paste.

Functional Scaffolds for Bone Tissue Regeneration: A Comprehensive Review of Materials, Methods, and Future Directions.

Bone tissue regeneration is a rapidly evolving field aimed at the development of biocompatible materials and devices, such as scaffolds, to treat diseased and damaged osseous tissue. Functional scaffolds maintain structural integrity and provide mechanical support at the defect site during the healing process, while simultaneously enabling or improving regeneration through amplified cellular cues between the scaffold and native tissues. Ample research on functionalization has been conducted to improve scaffold-host tissue interaction, including fabrication techniques, biomaterial selection, scaffold surface modifications, integration of bioactive molecular additives, and post-processing modifications. Each of these methods plays a crucial role in enabling scaffolds to not only support but actively participate in the healing and regeneration process in bone and joint surgery. This review provides a state-of-the-art, comprehensive overview of the functionalization of scaffold-based strategies used in tissue engineering, specifically for bone regeneration. Critical issues and obstacles are highlighted, applications and advances are described, and future directions are identified.

A Retrospective Analysis of 1311 Oral Surgery Procedures Performed in a Pediatric Hospital in Barcelona: A Study of Their Characteristics and Age-Related Diagnoses.

Background: Oral surgery involves the diagnosis and surgical treatment of diseases affecting the soft and hard tissues of the oral cavity and encompasses a wide range of surgical interventions. The aim of this investigation was to study the characteristics and age-related diagnoses of these oral surgeries, as well as to describe the surgical procedures performed in a pediatric oral and maxillofacial surgery service. Methods: A descriptive, retrospective, observational, and relational study was conducted on children and adolescents aged from 0 to 22 years who were treated in a pediatric oral and maxillofacial surgery service at a children's hospital. Results: We analyzed 1311 surgical interventions (51.4% were on boys and 48.6% on girls), consisting of 24.8% soft tissue surgeries, 65.9% bone and dental tissue surgeries, and 9.3% mixed tissue surgeries. The most common pathologies were tooth eruption disorders (65.9%), followed by ankyloglossia (20.5%). The most frequent treatment was wisdom teeth extraction (31.3%). A statistically significant association (p < 0.05) was found between surgical treatments and variables such as age, sex, tissue type, and biopsy. Conclusions: This study enhances our understanding of pediatric oral surgery, emphasizing that the most common pathology is altered tooth eruption, while the most frequent surgical intervention is the extraction of wisdom teeth at different stages of development.

Exploring the potential of chitosan from royal shrimp waste for elaboration of chitosan/bioglass biocomposite: Characterization and “in vitro” bioactivity

Exploiting royal shrimp waste to produce value-added biocomposites offers environmental and therapeutic benefits. This study proposes biocomposites based on chitosan and bioglass, using shrimp waste as the chitosan source. Chitin extraction and chitosan preparation were characterized using various analytical techniques. The waste composition revealed 24 % chitin, convertible to chitosan, with shells containing 77.33-ppm calcium. (X-ray diffraction) XRD analysis showed crystallinity index of 54.71 % for chitin and 49.14 % for chitosan. Thermal analysis indicated degradation rates of 326 °C and 322 °C, respectively. The degree of deacetylation of chitosan was 97.08 % determined by proton nuclear magnetic resonance (1H-NMR) analysis, with an intrinsic viscosity of 498 mL.g−1 and molar mass of 101,720 g/mol, showing improved solubility in 0.3 % acetic acid. Royal chitosan (CHR) was combined with bioglass (BG) via freeze-drying to create a CHR/BG biocomposite for bone surgery applications. The bioactivity of the CHR/BG was tested in simulated body fluid (SBF), revealing a biologically active apatite layer on its surface. Inductively Coupled Plasma Optical Emission Spectroscopy (ICP-OES) analysis confirmed enhanced bioactivity of the CHR/BG compared to commercial chitosan. The CHR/BG biocomposite demonstrated excellent apatite formation, validated by Scanning Electron Microscopy (SEM), highlighting its potential in bone surgery.

Validity of the Musculoskeletal Tumor Society Score for lower extremity in patients with bone sarcoma or giant cell tumour of bone undergoing bone resection and reconstruction surgery in hip and knee

BackgroundThe Musculoskeletal Tumor Society Score (MSTS) is widely used to evaluate functioning following surgery for bone and soft-tissue sarcoma. However, concerns have been raised about its content validity due to the lack of patient involvement during item development. Additionally, literature reports inconsistent results regarding data quality and structural validity. This study aimed to evaluate content, structural and construct validity of the Danish version of the MSTS for lower extremity (MSTS-LE).MethodsThe study included patients from three complete cohorts (n = 87) with bone sarcoma or giant cell tumour of bone who underwent bone resection and reconstruction surgery in hip and knee. Content validity was evaluated by linking MSTS items to frameworks of functioning, core outcome sets and semi-structured interviews. Data quality, internal consistency and factor analysis were used to assess the underlying structure of the MSTS. Construct validity was based on predefined hypotheses of correlation between the MSTS and concurrent measurements.ResultsContent validity analysis revealed concerns regarding the MSTS. The MSTS did not sufficiently cover patient-important functions, the item Emotional acceptance could not be linked to the framework of functioning, the items Pain and Emotional acceptance pertained to domains beyond functioning and items’ response options did not match items. A two-factor solution emerged, with the items Pain and Emotional acceptance loading highly on a second factor distinct from functioning. Internal consistency and construct validity showed values below accepted levels.ConclusionThe Danish MSTS-LE demonstrated inadequate content validity, internal consistency, and construct validity. In addition, our analyses did not support unidimensionality of the MSTS. Consequently, the MSTS-LE is not a simple reflection of the construct of functioning and the interpretation of a sum score is problematic. Clinicians and researcher should exercise caution when relying solely on MSTS scores for assessing lower extremity function. Alternative outcome measurements of functioning should be considered for the evaluation of postoperative function in this patient group.

Assessment of Knowledge and Awareness of Ultrasonic Bone Surgery Among Periodontology and Oral Surgery Postgraduate Students in Maharashtra.

Introduction Ultrasonic bone surgery, or piezosurgery, is a novel technique utilizing ultrasonic vibrations to cut bone while minimizing damage to adjacent soft tissues. This study aims to evaluate the knowledge and awareness of ultrasonic bone surgery among periodontology and oral surgery postgraduate students in Maharashtra, India. Methods A cross-sectional, questionnaire-based study was conducted among 180 postgraduate students (84 in periodontology and 96 in oral surgery). A Google Form questionnaire (Google LLC, Mountain View, CA, United States) with 15 close-ended questions was distributed via email. Data were analyzed using SPSS Statistics version 25 (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.) employing frequency percentages and Pearson Chi-square tests for intergroup comparisons. Results Of the participants, 80 (95.3%) of periodontology and 91 (94.7%) of oral surgery postgraduates were aware of ultrasonic bone surgery. Significant differences were found in the knowledge of critical bone damage temperature (p=0.009) and postoperative complications (p=0.037), with periodontology postgraduates showing higher awareness. Both groups recognized ultrasonic bone surgery's precision, safety, and reduced trauma advantages. Overall knowledge and awareness were higher among periodontology postgraduates (n=84, 87.5%) than oral surgery postgraduates (n=96, 78.3%). Conclusion Both groups demonstrated a good understanding of ultrasonic bone surgery, with periodontology postgraduates showing notably higher awareness. These findings underscore the importance of integrating ultrasonic bone surgical techniques into dental education to enhance patient care and keep pace with technological advancements. Further studies with larger sample sizes across India are recommended.

Long-term survival after metasectomy in patients with bone or soft-tissue metastases from renal cell carcinoma.

227 Background: Renal cell carcinoma (RCC) is reported to be associated with long-term survival, and surgical resection is now recommended in patients with metastatic lesions. This study evaluated the long-term outcome of surgery for bone or soft tissue metastases from RCC. Methods: Between 1993 and 2014, 58 patients (46 men and 12 women) underwent surgery, excluding palliative surgery, for bone or soft tissue metastatic lesions from RCC at our institution. These patients were retrospectively evaluated for factors associated with prognosis by using the log-rank test and Cox proportional hazards analysis. Results: The patients’ mean age was 60 years, and the mean follow-up period was 52 months. The surgical sites included the spine (33 patients), limb bone (10 patients), pelvis (8 patients), thoracic bone (4 patients), and soft tissue (3). The surgical procedures were total en bloc spondylectomy (TES) in 33 patients, wide excision in 13 (6 of them were also treated with prosthesis), and curettage and bone grafts in 12 (4 of them were treated with internal fixation). The 3-, 5-, 10-, and 15-year overall survival (OS) rates were 75%, 62%, 48%, and 25%, respectively. According to the surgical methods, the 5-year OS was 64% for TES, 62% for wide excision, and 46% for curettage and bone grafts. According to the surgical site, the median survival time was 127 months for the spine, 140 months for the limb bone, and 54 months for the pelvis. In multivariate analysis, preoperative lung metastasis and the pathological type, except for clear cell carcinoma, were independent risk factors for poor prognosis. However, age, performance status, Motzer classification, and abnormal blood test results were not significant risk factors. Conclusions: Our findings suggest that the surgical resection of bone and soft tissue metastatic lesions from RCC is a favorable option for improving prognosis even in patients with unfavorable conditions such as an advanced age or poor performance status. Now that treatment outcomes for renal cell carcinoma are improving, bone metastases can be treated with surgery.

Two-Step Conservative Surgery for Complicated Forms of Diabetes-Related Foot Osteomyelitis.

Diabetes-related foot osteomyelitis (DFO) is a common yet complex condition, often complicated by concurrent soft tissue infections (STIs). This study evaluates the efficacy of a two-step conservative surgical approach, hypothesizing that it offers comparable outcomes to a one-step procedure. Conducted on a cohort of 93 patients with DFO, the study categorized cases into two types: OM1 (osteomyelitis without STI) and OM2 (osteomyelitis with STI). OM2 was further subdivided into OM2a (early diagnosis) and OM2b (late diagnosis), with OM2 patients undergoing initial soft tissue debridement followed by elective bone surgery. The results indicated no significant differences in infection recurrence or amputation rates between the two surgical approaches, with recurrence observed in 20.7% of cases and amputations in 10.8%. The two-step procedure was associated with higher inflammatory responses and greater need for antibiotics and hospital admissions. However, these factors did not translate into increased recurrence or amputation compared to the one-step procedure. The study supports the two-step approach as a safe and effective method for managing complicated DFO cases, providing a viable alternative to immediate amputation or single-stage surgery. Despite some limitations, including regional specificity and potential underdiagnosis in late-diagnosed cases, the findings offer valuable insights for clinical management and suggest further research to refine treatment protocols. The study's strengths include confirmed histopathological diagnoses and consistent follow-up, reinforcing the validity of the two-step surgical approach for complex DFO treatment.

A Review of Authorship Inflation and Multicenter Collaboration Trends in Orthopedic, Medical, and Surgical Journals Over the Last 60 Years.

Over the past six decades, authorship numbers in academic publications have increased significantly, a phenomenon known as authorship inflation. This study aims to analyze comparative authorship trends and the influence of multicenter collaborations across major orthopedic, medical, and surgical journals. We reviewed metadata from The New England Journal of Medicine (NEJM), Annals of Surgery (AS), and The Journal of Bone and Joint Surgery (JBJS) from January 1, 1960, to December 31, 2019. The number of authors per publication, the prevalence of multicenter studies, and their correlation were analyzed. Data was visualized using heat maps and box plots, and trends were statistically tested using the Jonckheere-Terpstra, Mann-Kendall, and generalized linear mixed models (GLMMs). A total of 73,062 articles were analyzed, with 1,190 articles identified as originating from multicenter studies. The number of multicenter trials was found to have increased significantly over time (p < 0.001), plateauing in NEJM but continuing to rise in JBJS and AS. There was a significant increase in authorship numbers per publication over time, across all journals (p < 0.0001). There was a significant statistical correlation (p < 0.0001) as indicated by the coefficient of determination (r2), for the association between the proportion of publications with >10 authors and the proportion of multicenter publicationsacross all three journals. Authorship inflation in academic publishing may be attributable to the rise in multicenter collaborations. The rate of increase in authorship was more pronounced in medical and surgical journals compared to orthopedic journals, reflecting differing trends across specialties. These findings highlight the evolving nature of research collaboration and authorship practices in academic publishing.

Comparison of endoscopic tympanoplasty, cartilage vs. temporalis fascia in chronic suppurative otitis media with inactive mucosal disease: A prospective randomised study.

The introduction of endoscopy into middle ear has open up new opportunities for minimal invasive temporal bone surgery. The present study was planned to compare anatomical and functional outcome in patients who underwent endoscope assisted tympanoplasty using cartilage and temporalis fascia graft. The present prospective observational randomized study was carried out in the Department of Otorhinolaryngology of a tertiary care teaching hospital of Rajasthan, India from September 2020 to July 2021. Fifty patients of age group 18-60 years, with diagnosis of chronic otitis media having inactive mucosal disease were enrolled in the study and divided into two groups viz. cartilage (group I) and temporalis fascia group (group II). Each patient postoperatively underwent otoscopic examination of ear and pure tone audiometery at 8 weeks and 3rd month. Local wound condition, graft uptake and healing and hearing were assessed and compared. Graft uptake was 92% in cartilage group and 84% in temporalis fascia group. Air conduction and air-bone gap of patients in both the groups showed significant improvement after 3 months of surgery. (p˂0.05) Regarding bone conduction, both groups had shown non-significant changes. (p > 0.05) Hearing gain was comparable on both groups which was 6.71dB in cartilage group vs. 5.9 dB in other group. The present study showed that graft placement time for temporalis fascia graft was less than cartilage graft, but the difference was insignificant. Hearing improvement, graft uptake and clinical improvement were found to be statistically insignificant between both groups.

Redisplacement rate after bony hip reconstructive surgery in nonambulatory patients with cerebral palsy: a systematic review and meta-analysis.

Up to 90% of nonambulatory patients with cerebral palsy (CP) experience hip displacement during their lifetime. Reconstructive surgery is recommended. Redisplacement rate is an outcome parameter. In a systematic literature review (MEDLINE, Embase and CENTRAL databases) until January 2023 we searched for reports with redisplacement rates after bony hip reconstructive surgery in nonambulatory patients. Quantitative data synthesis, subgroup analysis and meta-regression with moderators were carried out. The pooled mean redisplacement rate was 16% (95% CI: 12-21%) with a prediction interval of 3-51% (Q: 149; df: 32; P < 0.001; I2: 78%; τ2: 0.67 and τ: 0.82) in 28 studies (1540 hips). Varus derotation osteotomy (VDRO) alone showed a higher redisplacement rate than VDRO + pelvic osteotomy (30% vs 12%, P < .0001). Mean age in the VDRO-alone subgroup was 7.1 years and in the combined group 9.5 years (P = .004). In meta-regression, lower redisplacement rates were observed with higher preoperative migration index (MI) (correlation coefficient: -0.0279; P = .0137), where comprehensive surgery was performed. Variance in true effects are explained by type of bone surgery (57%), preoperative MI (11%), age (5%) and MI for definition of failure (20%). No significant reduction in the redisplacement rate could be observed over the mid-years of studies (1977-2015). Our pooled data support the more extensive surgical approach in patients with high preoperative MI and emphasize the superiority of combined surgery. Studies should report a coordinated set of parameters and outcome classifications according to internationally accepted gradings to reduce redisplacement in future.

The Role of Journals in Reporting Sex and Gender-Based Outcomes: Should We Adopt Guidelines, and What Else Can We Do to Improve Reporting?

➤ Sex and gender are inconsistently reported in musculoskeletal research. A panel of journal editors and other interested parties who participated in The Journal of Bone and Joint Surgery Sex and Gender Reporting in Musculoskeletal Research Symposium met in 2023 to help define the roles of journals and other stakeholders in addressing this issue.➤ This report summarizes the resulting recommendations and presents several different ways in which orthopaedic journals may elect to introduce to their readers, reviewers, and authors the importance of considering sex and gender in orthopaedic research.➤ Many current sex and gender-related funding agency mandates as well as the Sex and Gender Equity in Research (SAGER) guidelines are most readily applied to prospective research and/or randomized controlled trials.➤ The panel was supportive of endorsing SAGER or a similar set of guidelines as a tool that can help authors to consider the most effective means of evaluating the influences of sex and gender within the context of orthopaedic research.➤ Engaging readers, reviewers, and authors on multiple fronts, with purpose and intention, is likely the most important approach to increase awareness and to enhance the quality of evidence utilized to support clinical decisions in orthopaedic surgery.

Trends and predictors of reporting social determinants of health in shoulder surgery

IntroductionThe role of social determinants of health (SDH) in patient outcomes, quality of life, and overall well-being has been well documented. However, the inclusion of these variables in randomized control trials (RCTs) remains limited; thus, the extent of generalizability from such trials is brought into question. The purpose of this study is to explore the rates of reporting SDH variables in RCTs focused on shoulder surgery from the past decade. MethodsThe PubMed database was searched for RCTs with a focus on shoulder surgery from 2013-2023. Duplicates, responses to the editor, biomechanical studies, and non-shoulder studies were excluded. Each article was reviewed and data pertaining to patient demographics, socioeconomic covariates. Journal of publication was recorded, and studies from the five most common journals were analyzed. These journals were the Journal of Shoulder and Elbow Surgery (JSES), the Journal of Bone and Joint Surgery (JBJS), the American Journal of Sports Medicine (AJSM), the Bone and Joint Journal (BJJ), and The Journal of the American Medical Association (JAMA). Multivariate logistic regression was performed to determine the independent effect of study characteristics on the reporting rates of SDH. ResultsA total of 255 articles were reviewed. Of these, 93.3% and 90.2% of articles reviewed reported age and sex, respectively. Employment status was reported in 11.8% of articles. Fewer than 10% reported race, ethnicity, income, insurance, and housing, with even less performing formal analyses on these variables. Studies that were conducted in the United States (US), multicenter, had a sample size 251+, and had a combination of public and private funding were significantly more likely to report on race and ethnicity. Reporting employment status was significantly associated with being European-based, multicenter, sample size 251+, double-blinded, and published in AJSM, Newer studies were significantly less likely to report education. Only publication in AJSM was significant for reporting income. Study intervention and topic were not significant for any SDH reporting. DiscussionThis data reflects how small of a proportion of RCTs report and analyze on SDH variables. These findings reflect a need for future RCTs to accurately report SDH variables that influence outcomes, such as race, ethnicity, education, employment, income, housing status, and insurance.. ConclusionsSDH are infrequently reported and analyzed in RCTs pertaining to shoulder surgery. Academic medical journals should incorporate guidelines to encourage studies to include such variables and enable the assessment of outcomes to apply to a broader population.

Bioactive material‑sodium alginate-polyvinyl alcohol composite film scaffold for bone tissue engineering application

Road accidents and infection-causing diseases during bone surgery are serious problems in orthopedics, and thus, addressing these pressing challenges is crucial. In the present study, the 70S30C calcium silicate bioactive material (BM) is synthesized by a sustainable approach employing a precipitation method using recycled rice husk and eggshells as a precursor of silica and calcium. Further, 70S30C BM is composited with sodium alginate (SA) and polyvinyl alcohol (PVA), and the films were prepared by solvent casting method. The composite films were prepared without the addition of acid, binder, and crosslinking agents. Further, the films were characterized by BET, XRD, ATR-FTIR, SEM, and EDS mapping. The in vitro bioactivity and biodegradation study is performed in the simulated body fluid (SBF). The in vitro haemolysis study is executed using human blood and the results demonstrate haemocompatibility of the composite films. The ex ovo CAM assay also exhibits good neovascularization. The in vitro and in vivo biocompatibility assay proves its non-toxic nature. Further, the in vivo study reveals that the engineered composite film demonstrates accelerated osteogenesis. This work broadens the orthopedic potential of the composite film and offers bioactivity, haemocompatibility, angiogenesis, non-toxicity, and in vivo osteogenesis which would serve as a potential candidate for bone tissue engineering application.

Analysis of the orthopaedic trauma literature utilizing machine learning and latent dirichlet allocation

Objectives: To demonstrate a new method to review literature utilizing machine learning and latent Dirichlet allocation and summarize the past 20 years of orthopaedic trauma research. Methods: All original research articles published in the Journal of Bone and Joint Surgery American volume, Journal of Orthopaedic Trauma, Journal of Bone and Joint Surgery British volume, Trauma, Injury, Clinical Orthopaedics and Related Research, and the Journal of the American Academy of Orthopaedic Surgeons from 2000-2020 were analyzed using latent Dirichlet allocation (LDA), which is a form of machine learning. 100 topics were created by the algorithm and only topics that were relevant to trauma were included, leaving 30 topics ranked by popularity and associated with a best-fitting article and trend over the past 20 years. Results: Research article abstracts totaling 21,968 from 2000-2020 in the orthopaedic trauma literature were analyzed to create 30 topics. The topics were ranked by popularity, trended over the specified time period, and associated with a best fitting article. The 3 “hottest” and “coldest” topics were visualized in graphical form. Conclusions: This is the first study of its kind to utilize machine learning as a method of reviewing the orthopaedic trauma literature. Machine learning possesses the ability to rapidly synthesize a large body of literature to assess the current state of research and trends of research topics. Machine learning can aid clinicians and researchers in time-intensive tasks to quickly provide clues that will promote avenues further research.

A prospective comparison of WALANT technique and general anesthesia in forefoot surgery

IntroductionWide Awake Local Anesthesia No Tourniquet (WALANT) technique has been widely used in hand surgery, but there are few prospective data on its use in forefoot surgery. HypothesisThe WALANT technique reduces pain compared to general anesthesia for bone surgery on the first ray of forefoot. MethodsThis was a prospective, longitudinal, comparative, non-randomized cohort study in adult patients undergoing bone surgery on the first ray of forefoot. The primary objective was the level of pain (0–10 visual analogic scale) 4 h after the procedure with WALANT technique versus general anesthesia supplemented by ropivacaine infiltration. ResultsA total 37 patients were analyzed in the WALANT group and 24 in the general anesthesia group (women, 90.2%; mean age, 51.3 years; hallux valgus, 85.2%; first metatarsal osteotomy, 80.3%). After generalized linear regression adjusted on a priori defined factors, there was no statistically difference for pain ≤3 at 4 h in WALANT vs. general anesthesia (odds-ratio 1.66; 95% CI, 0.17–20.49; p = 0.2548). At 24 h, pain level was also comparable in the two groups. Time spent in operating room was significantly shorter with WALANT (40.8 vs. 49.7 min; p = 0.0001). Mean length of stay in the recovery room was also significantly shorter with WALANT (4.4 vs. 75.6 min; p < 0.0001). Anxiety before/after surgery, uptake of analgesic/anti-inflammatory drugs and quality of life were comparable in the two anesthesia groups. ConclusionPostoperative pain with WALANT technique or general anesthesia was comparable. Time spent in the operating room and in recovery room was significantly shorter with WALANT technique. Level of evidenceIII; prospective non-randomized comparative study.