Common Orthopaedic Conditions Research Articles

An automated framework for pediatric hip surveillance and severity assessment using radiographs.

Hip dysplasia is the second most common orthopedic condition in children with cerebral palsy (CP) and may result in disability and pain. The migration percentage (MP) is a widely used metric in hip surveillance, calculated based on an anterior-posterior pelvis radiograph. However, manual quantification of MP values using hip X-ray scans in current standard practice has challenges including being time-intensive, requiring expert knowledge, and not considering human bias. The purpose of this study is to develop a machine learning algorithm to automatically quantify MP values using a hip X-ray scan, and hence provide an assessment for severity, which then can be used for surveillance, treatment planning, and management. X-ray scans from 210 patients were curated, pre-processed, and manually annotated at our clinical center. Several machine learning models were trained using pre-trained weights from Inception ResNet-V2, VGG-16, and VGG-19, with different strategies (pre-processing, with and without region of interest (ROI) detection, with and without data augmentation) to find an optimal model for automatic hip landmarking. The predicted landmarks were then used by our geometric algorithm to quantify the MP value for the input hip X-ray scan. The pre-trained VGG-19 model, fine-tuned with additional custom layers, outputted the lowest mean squared error values for both train and test data, when ROI cropped images were used along with data augmentation for model training. The MP value calculated by the algorithm was compared to manual ground truth labels from our orthopedic fellows using the hip screen application for benchmarking. The results showed the feasibility of the machine learning model in automatic hip landmark detection for reliably quantifying MP value from hip X-ray scans. The algorithm could be used as an accurate and reliable tool in orthopedic care for diagnosing, severity assessment, and hence treatment and surgical planning for hip displacement.

"Dr. AI Will See You Now": How Do ChatGPT-4 Treatment Recommendations Align With Orthopaedic Clinical Practice Guidelines?

Artificial intelligence (AI) is engineered to emulate tasks that have historically required human interaction and intellect, including learning, pattern recognition, decision-making, and problem-solving. Although AI models like ChatGPT-4 have demonstrated satisfactory performance on medical licensing exams, suggesting a potential for supporting medical diagnostics and decision-making, no study of which we are aware has evaluated the ability of these tools to make treatment recommendations when given clinical vignettes and representative medical imaging of common orthopaedic conditions. As AI continues to advance, a thorough understanding of its strengths and limitations is necessary to inform safe and helpful integration into medical practice. (1) What is the concordance between ChatGPT-4-generated treatment recommendations for common orthopaedic conditions with both the American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines (CPGs) and an orthopaedic attending physician's treatment plan? (2) In what specific areas do the ChatGPT-4-generated treatment recommendations diverge from the AAOS CPGs? Ten common orthopaedic conditions with associated AAOS CPGs were identified: carpal tunnel syndrome, distal radius fracture, glenohumeral joint osteoarthritis, rotator cuff injury, clavicle fracture, hip fracture, hip osteoarthritis, knee osteoarthritis, ACL injury, and acute Achilles rupture. For each condition, the medical records of 10 deidentified patients managed at our facility were used to construct clinical vignettes that each had an isolated, single diagnosis with adequate clarity. The vignettes also encompassed a range of diagnostic severity to evaluate more thoroughly adherence to the treatment guidelines outlined by the AAOS. These clinical vignettes were presented alongside representative radiographic imaging. The model was prompted to provide a single treatment plan recommendation. Each treatment plan was compared with established AAOS CPGs and to the treatment plan documented by the attending orthopaedic surgeon treating the specific patient. Vignettes where ChatGPT-4 recommendations diverged from CPGs were reviewed to identify patterns of error and summarized. ChatGPT-4 provided treatment recommendations in accordance with the AAOS CPGs in 90% (90 of 100) of clinical vignettes. Concordance between ChatGPT-generated plans and the plan recommended by the treating orthopaedic attending physician was 78% (78 of 100). One hundred percent (30 of 30) of ChatGPT-4 recommendations for fracture vignettes and hip and knee arthritis vignettes matched with CPG recommendations, whereas the model struggled most with recommendations for carpal tunnel syndrome (3 of 10 instances demonstrated discordance). ChatGPT-4 recommendations diverged from AAOS CPGs for three carpal tunnel syndrome vignettes; two ACL injury, rotator cuff injury, and glenohumeral joint osteoarthritis vignettes; as well as one acute Achilles rupture vignette. In these situations, ChatGPT-4 most often struggled to correctly interpret injury severity and progression, incorporate patient factors (such as lifestyle or comorbidities) into decision-making, and recognize a contraindication to surgery. ChatGPT-4 can generate accurate treatment plans aligned with CPGs but can also make mistakes when it is required to integrate multiple patient factors into decision-making and understand disease severity and progression. Physicians must critically assess the full clinical picture when using AI tools to support their decision-making. ChatGPT-4 may be used as an on-demand diagnostic companion, but patient-centered decision-making should continue to remain in the hands of the physician.

Effects of combining thoracic lymphatic pump technique and exercises on patients with chronic mechanical low back pain

Purpose. The study aimed to compare the effects of combining thoracic lymphatic pump technique (TLPT) and exercises versus exercises alone on pain intensity, lumbar spine mobility, and functional disability in patients with chronic mechanical low back pain (CMLBP), the second most common orthopedic condition. Methods. Fifty-two CMLBP patients, whose mean age was 25 years, were classified into 2 equal groups randomly. Group (A) received exercises (hamstring stretching, lower back stretching, abdominal strengthening, and trunk extensor strengthening). Group (B) received the same exercises plus the thoracic lymphatic pump technique. Both groups received 12 sessions on nonconsecutive days. All patients were evaluated using the Visual Analogue Scale (VAS) for pain intensity, the Modified-Modified Schober test (MMST) for lumbar mobility (flexion-extension), and the Oswestry Disability Index (ODI) for functional disability. Assessments were performed prior to and after the end of treatment. For data analysis, the unpaired t-test, chi-squared test, and mixed MANOVA test were used. Results. The study found significant improvements in pain intensity, lumbar mobility (flexion, extension), and functional disability in both groups (P < 0.05), with no significant difference in pain intensity or lumbar spine mobility. However, group (B) had a statistically significant advantage in functional disability (P < 0.05). Conclusion. The addition of the thoracic lymphatic pump technique to therapeutic exercises significantly enhances pain, lumbar spine mobility, and functional abilities in CMLBP patients than therapeutic exercises alone.

5-Lipoxygenase: The Therapeutically Unexplored Target for Bone Health

Bone fracture is a common orthopedic condition that represents a significant health concern. Bone fracture repair process is a complex process that involves the harmonic and synchronized activity of bone cells. 5-lipoxygenase (5-LOX) is an enzyme responsible for the conversion of arachidonic acid to form leukotrienes. While leukotrienes have an empirical inflammatory role, various evidence suggests that these 5-LOX mediators, by switching the inflammatory environment and altering the activity of bone cells, have a detrimental effect on the bone fracture healing process. Additionally, various evidence suggests that 5-LOX inhibition shows improvement in the overall bone healing process and improves overall bone health. Despite this evidence, the clinical use of 5-LOX inhibitors in bone fracture healing is largely unexplored. The current review aimed to summarize the available evidences and pave the way for future large scale pre-clinical and clinical studies to evaluate the effectiveness of selective 5-LOX inhibitors in bone fracture healing. A comprehensive literature search was conducted in PubMed, Google Scholar, and ScienceDirect to identify relevant articles related to the effect of 5-LOX in bone health. The summary of available scientific evidence highlights that the selective 5-LOX inhibition can modulate the functioning of osteoclasts and osteoblasts, favoring faster bone fracture healing. The observations of this study support the selective 5-LOX inhibition as a potential treatment option that can improve bone fracture healing rate and therefore future clinical studies can be designed to confirm the observations of the current review study.

The Efficacy of Inhaled Methoxyflurane Versus Intravenous Sedation for the Reduction of Acute Shoulder Dislocation

Purpose: Anterior shoulder dislocation is one of the most common emergency orthopedic conditions. In general practice, intravenous sedation is the standard treatment to relax patients during shoulder reduction procedures. Sedatives and analgesics are drugs that have side effects after administration, especially when administered intravenously. They can depress neurological function and cause respiratory and cardiovascular system side effects. Self-inhaled methoxyflurane relieves moderate to severe pain. Hospitals may benefit from minimized respiratory and cardiovascular side effects. Methods: This randomized controlled trial included 50 patients who were randomly assigned to two groups: the inhaled methoxyflurane group (Inh Group) and the intravenous sedation group (IV Group). All patients were assessed for efficacy, procedure duration, pain score during reduction, patient satisfaction, and adverse effects. Results: Fifty patients satisfied the inclusion requirement: 25 each in the Inh and IV Groups. Reduction was successfully achieved in 92% and 88% of the patients in the Inh and IV Group, respectively. The mean procedural time was 6.4 min and 15.4 min the Inh and IV Group, respectively. Moreover, the mean recovery time was 22.5 min in the Inh Group and 32.4 min in the IV Group. Conclusions: Inhaled methoxyflurane has better efficacy in reducing acute shoulder dislocation than intravenous sedation alone. Procedural and recovery times were shorter in the Inh Group. Adverse events (hemodynamic instability, desaturation, nausea, vomiting, drowsiness, and dizziness) were more frequent in the IV Group than in the Inh Group.

A bibliometric analysis of the top 50 cited studies related to acromioclavicular joint instability

BackgroundAcromioclavicular joint (ACJ) injury is a common orthopaedic condition accounting for over 40 % of all shoulder injuries. The purpose of this study is to assess the research trends and characteristics of the top 50 cited articles on ACJ instability. MethodsA systematic search was conducted in Web of Science to identify articles primarily related to ACJ injury or instability. Characteristics including citation number, country of origin, journal and institution of publication, impact factor, authorship, level of evidence, patient demographics, and study type were analyzed and recorded. ResultsResearch output on ACJ instability has been steadily increasing, with the top 50 cited studies predominantly presenting Level IV evidence. These studies primarily focused on treatment outcomes which included predominantly male patients and exhibited a large variation in citation counts. The American Journal of Sports Medicine was the most productive journal, and the USA was the most productive nation. ConclusionThere is an increasing number of publications in the ACJ instability literature, primarily concentrated in a few institutions and journals, and focusing mainly on treatment outcomes. A significant portion of these publications are of low scientific quality, and there is a notable lack of research on outcomes for females.

Experimental long bone fracture healing in goats with cockle shell-based calcium carbonate bone paste

Long bone fractures are common orthopedic conditions. There are numerous ways to repair these fractures. Bone grafting becomes necessary when a broken bone has a significant gap. However, due to insufficient donor volume and donor site morbidity, substitutes are required. In veterinary orthopaedics, calcium carbonate from cockle shells could be used as a bone biomaterial. We investigated its efficacy as a bone biomaterial repair for goat femoral fractures. The study included 10 healthy adult male Black Bengal goats weighing 8 kg and aged 12–13 months. The study includes control and treatment groups. Intramedullary pinning stabilized an 8-mm right femur diaphyseal fracture in the treatment and control groups. The treated group received 2 ml of bone paste in the fractured gap, whereas the control group left it empty. We examined all goats with X-rays on the 7th, 45th, and 60th days, followed by gross and histological findings. Due to callus bridging, radiographs revealed faster bone growth in the treated group than in the control group. Gross examination demonstrates the treated group had a larger fracture callus than the control group. Histopathology showed that bone formed faster and included more osteocytes, osteoblasts, osteoclasts, and bony spicules than in the control group. The treated group had more periosteum osteoblasts, while the control group had fibroblasts. These results showed that the treated group had more osteogenic activity than the control group. This study demonstrates the potential of cockle shell-based calcium carbonate bone paste as a synthetic biomaterial for healing long bone fractures in goats.

Epidemiology of non-trauma orthopedic conditions among inpatients admitted at a tertiary teaching and referral hospital in Kenya: A chart review.

Non-traumatic orthopedic conditions are pathological conditions involving musculoskeletal system that includes muscles, tendons, bone and joints and associated with frequent medical and surgical care and high treatment costs. There is paucity of information on the pattern of non-traumatic orthopedic conditions in low and middle income countries. The purpose of this study was to determine the epidemiology of non-traumatic orthopedic conditions among inpatients at the Kenyatta National Hospital in Kenya. This was a cross-sectional study with a sample of 175 charts reviewed. Approximately, 70.3% of the inpatients were aged between 25 to 64 years of age with the mean age of 39.97 years (STD 18.78). Ever married tended to be older 53.5 (95% CI: 46.8-60.2) years than other marital statuses. Approximately, 60.6% were males, 38.9% had comorbidities and 49.1% were casuals or unemployed. All inpatients were Kenyans with Nairobi County comprising 52.6% of all inpatients. Approximately, 77.7% were self-referrals. The commonest non-trauma orthopaedic conditions were infection and non-union (35.4%) and spinal degenerative diseases (20.60%) and the least was limb deformities (1.70%). Compared to females, males were 3.703 (p<0.001) times more likely to have infection and non-union. Patients with primary, secondary and tertiary education were 88.2% (p<0.001), 75.6% (p<0.001) and 68.1% (p = 0.016) less likely to have infection and non-union compared to those with no or preschool education. Widows were 8.500 (p = 0.028) times more likely to have spinal degenerative disease than married. Males were 70.8% (p = 0.031) less likely to have osteoarthritis than females. Inpatients with secondary education were 5.250 (p = 0.040) times more likely to have osteoarthritis than those with no or preschool education. In conclusion, majority of inpatients were young and middle aged adults. Infection and non-union and spinal degenerative diseases were the most common non-trauma orthopedic conditions. While males and those with low education were more likely to have infection and non-union, married were more likely to have spinal degenerative disease. Osteoarthritis was more likely among female admissions.

Treatment options for canine hip dysplasia

Hip dysplasia is a common orthopaedic condition in dogs which is frequently encountered by general practitioners. Multiple management options exist and an understanding of the indications for each is required when advising owners on the treatment of such cases. The majority of cases of canine hip dysplasia will likely be managed conservatively; however, a proportion of cases will not respond and therefore require surgical intervention. This article provides general practitioners with further knowledge of the surgical options available and the indications for such procedures. Immature patients with mild hip dysplasia and a lack of secondary osteoarthritic changes may be candidates for prophylactic surgical procedures, such as juvenile pubic symphysiodesis or pelvic osteotomies. In older patients or those with more severe hip dysplasia, total hip replacement results in the best outcome, with full return to function reported in over 90% of patients when performed by an experienced surgeon.

Combined Medial Patellofemoral Ligament and Medial Quadriceps Tendon-Femoral Ligament Reconstruction With Single Knotless Anchor

Lateral patellar dislocations represent a common orthopaedic condition in young, active individuals who experience patellar instability. Despite increasing interest in re-creating the natural biomechanics and native knee anatomy when performing medial patellar soft-tissue reconstructive procedures, there is no consensus among surgeons regarding the best techniques to use when reconstructing the medial patellofemoral ligament and medial quadriceps tendon-femoral ligament. This article details a method to reconstruct the medial patellofemoral ligament and medial quadriceps tendon-femoral ligament using a single graft and a single all-suture knotless anchor on the patella.

Can Patients Rely on ChatGPT to Answer Hand Pathology-Related Medical Questions?

In recent years, ChatGPT has become a popular source of information online. Physicians need to be aware of the resources their patients are using to self-inform of their conditions. This study investigates physician-graded accuracy and completeness of ChatGPT regarding various questions patients are likely to ask the artificial intelligence (AI) system concerning common upper limb orthopedic conditions. ChatGPT 3.5 was interrogated concerning 5 common orthopedic hand conditions: carpal tunnel syndrome, Dupuytren contracture, De Quervain tenosynovitis, trigger finger, and carpal metacarpal arthritis. Questions evaluated conditions' symptoms, pathology, management, surgical indications, recovery time, insurance coverage, and workers' compensation possibility. Each topic had 12 to 15 questions and was established as its own ChatGPT conversation. All questions regarding the same diagnosis were presented to the AI, and its answers were recorded. Each question was then graded for both accuracy (Likert scale of 1-6) and completeness (Likert scale of 1-3) by 10 fellowship trained hand surgeons. Descriptive statistics were performed. Overall, the mean accuracy score for ChatGPT's answers to common orthopedic hand diagnoses was 4.83 out of 6 ± 0.95. The mean completeness of answers was 2 out of 3 ± 0.59. Easily accessible online AI such as ChatGPT is becoming more advanced and thus more reliable in its ability to answer common medical questions. Physicians can anticipate such online resources being mostly correct, however incomplete. Patients should beware of relying on such resources in isolation.

Outcomes of ECAP-controlled closed-loop spinal cord stimulation therapy in JAPAN: how to increase patient satisfaction with spinal cord stimulation

Objective: Orthopedic surgeons commonly encounter patients with low back pain and leg pain. Despite conservative treatment, which may involve the use of weak opioids or NSAIDs, some patients do not experience improvement and may require increased dosages, contributing to concerns about opioid overuse overseas. Spinal cord stimulation (SCS) therapy, which can be trialed without surgical intervention, offers a potential treatment option. We evaluated Inceptiv (Medtronic), a generator that allows new stimulation settings using evoked compound action potentials (ECAPs)-controlled Closed-Loop technology. Methods: We evaluated six patients (four females, two males) who underwent implantation of the Inceptiv generator for SCS therapy. The average walking time (seconds) during a 2.1-meter walk and pain assessment using the Numerical Rating Scale (NRS) were conducted. Patient satisfaction was assessed using a 5-point scale: very satisfied (5), somewhat satisfied (4), neutral (3), somewhat dissatisfied (2), very dissatisfied. (1). Results: The average walking time improved from 11.8 seconds to 6.6 seconds, and the NRS score decreased from 7.6 to 4.2. Patient satisfaction was high, with four patients being very satisfied (5), one somewhat satisfied (4), and one neutral (3). Discussion: SCS therapy with Closed-Loop technology using the Inceptiv generator offers the potential to adjust electrical stimulation to minimize discomfort in daily activities and provide pain relief. It is considered a new treatment option for patients with common orthopedic conditions such as thoracolumbar compression fractures and lumbar spinal stenosis who suffer from chronic refractory pain in routine clinical practice.

Hand Function and Hand-Eye Coordination in Cervical Conditions – A Cross Sectional Study

Background of the study: Cervical Conditions are most common orthopaedic condition that may affect a large number of people. It compresses the nerve roots and may cause muscle weakness, numbness and loss of fine movements of the upper limbs. Hand Functions are movements of the hand and Hand eye coordination is the coordination of motor and visual inputs to produce a movement. This study helps to find out whether the hand function and hand eye coordination are affected in Cervical Conditions. Aim: Aim of this study is to find whether the hand function and hand eye coordination are affected in Cervical Conditions. Method: A total number of 212 subjects with cervical pain were screened for the study inclusion criteria and 132 subjects were selected for the study. The assessment of hand function, hand-eye coordination skills and shoulder disability were carried out for all the Subjects. NDI scale was used to evaluate the subject’s severity of pain and the associated disability among the samples. Hand function we evaluated using Purdue pegboard. Ball Tossing Task and Wall Ball Bounce Task were done to assess the Hand eye coordination. Results: On assessing the correlation between NDI and PURDUE, the results obtained on analysis is -0.108, which shows a negative relationship between the variables. The non-parametric correlation analysis using the spearman’s rho between the Neck disability index (NDI) with the PURDUE is -0.053, which shows a negative relationship between the variables. On assessing the correlation between NDI and Hand-Eye Task-1, the results obtained on analysis is -0.0081, which shows a negative relationship between the variables and the non-parametric correlation analysis is -0.162, which shows a negative relationship between the variables. On assessing the correlation between NDI and Hand-Eye Task-2, the results obtained on analysis is -0.023, which shows a negative relationship between the variables and the non-parametric correlation analysis is -0.092, which shows a negative relationship between the variables. Discussion: The purpose of the study is to find whether the hand function and hand eye coordination are affected in Cervical Conditions. Conclusion: This study concludes that the hand function and hand eye coordination are not affected in Cervical Conditions.

Extracellular vesicles derived from mesenchymal stem cells mediate extracellular matrix remodeling in osteoarthritis through the transport of microRNA-29a.

Knee osteoarthritis (KOA) is a common orthopedic condition with an uncertain etiology, possibly involving genetics and biomechanics. Factors like changes in chondrocyte microenvironment, oxidative stress, inflammation, and immune responses affect KOA development. Early-stage treatment options primarily target symptom relief. Mesenchymal stem cells (MSCs) show promise for treatment, despite challenges. Recent research highlights microRNAs (miRNAs) within MSC-released extracellular vesicles that can potentially promote cartilage regeneration and hinder KOA progression. This suggests exosomes (Exos) as a promising avenue for future treatment. While these findings emphasize the need for effective KOA progression management, further safety and efficacy validation for Exos is essential. To explore miR-29a's role in KOA, we'll create miR-29a-loaded vesicles, testing for early treatment in rat models. Extraction of bone marrow MSC-derived extracellular vesicles, preparation of engineered vesicles loaded with miR-29a using ultrasonication, and identification using quantitative reverse transcription polymerase chain reaction; after establishing a rat model of KOA, rats were randomly divided into three groups: Blank control group injected with saline, normal extracellular vesicle group injected with normal extracellular vesicle suspension, and engineered extracellular vesicle group injected with engineered extracellular vesicle suspension. The three groups were subjected to general behavioral observation analysis, imaging evaluation, gross histological observation evaluation, histological detection, and immunohistochemical detection to compare and evaluate the progress of various forms of arthritis. General behavioral observation results showed that the extracellular vesicle group and engineered extracellular vesicle group had better performance in all four indicators of pain, gait, joint mobility, and swelling compared to the blank control group. Additionally, the engineered extracellular vesicle group had better pain relief at 4 wk and better knee joint mobility at 8 wk compared to the normal extracellular vesicle group. Imaging examination results showed that the blank control group had the fastest progression of arthritis, the normal extracellular vesicle group had a relatively slower progression, and the engineered extracellular vesicle group had the slowest progression. Gross histological observation results showed that the blank control group had the most obvious signs of arthritis, the normal extracellular vesicle group showed signs of arthritis, and the engineered extracellular vesicle group showed no significant signs of arthritis. Using the Pelletier gross score evaluation, the engineered extracellular vesicle group had the slowest progression of arthritis. Results from two types of staining showed that the articular cartilage of rats in the normal extracellular vesicle and engineered extracellular vesicle groups was significantly better than that of the blank control group, and the engineered extracellular vesicle group had the best cartilage cell and joint surface condition. Immunohistochemical detection of type II collagen and proteoglycan showed that the extracellular matrix of cartilage cells in the normal extracellular vesicle and engineered extracellular vesicle groups was better than that of the blank control group. Compared to the normal extracellular vesicle group, the engineered extracellular vesicle group had a better regulatory effect on the extracellular matrix of cartilage cells. Engineered Exos loaded with miR-29a can exert anti-inflammatory effects and maintain extracellular matrix stability, thereby protecting articular cartilage, and slowing the progression of KOA.

Bioinformatic analysis of related immune cell infiltration and key genes in the progression of osteonecrosis of the femoral head.

Osteonecrosis of the femoral head (ONFH) is a common orthopedic condition that will prompt joint dysfunction, significantly impacting patients' quality of life. However, the specific pathogenic mechanisms underlying this disease remain elusive. The objective of this study is to examine the differentially expressed messenger RNAs (DE mRNAs) and key genes linked to ONFH, concurrently investigating the immune cell infiltration features in ONFH patients through the application of the CIBERSORT algorithm. Microarray was applied to scrutinize mRNA expression profiles in both ONFH patients and healthy controls, with data integration sourced from the GEO database. DE mRNAs were screened using the Limma method. The biological functions of DE mRNAs were explored through the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis, Gene Ontology (GO) functional analysis, and Gene Set Enrichment Analysis (GSEA). Additionally, support vector machine-recursive feature elimination (SVM-RFE) and the least absolute shrinkage and selection operator (LASSO) were employed to discern diagnostic biomarkers associated with the disease. Receiver operating characteristic (ROC) analysis was utilized to assess the statistical performance of the feature genes. The validation of key genes was performed using qRT-PCR in bone tissues obtained from ONFH patients and healthy controls. Osteogenic differentiation of BMSC was then performed and detected by alkaline phosphatase staining (ALP) and qRT-PCR to verify the correlation between key genes and osteogenic differentiation. Finally, immune cell infiltration analysis was executed to evaluate immune cell dysregulation in ONFH, concurrently exploring the correlation between the infiltration of immune cells and key genes. After consolidating the datasets, the Limma method revealed 107 DEGs, comprising 76 downregulated and 31 upregulated genes. Enrichment analysis revealed close associations of these DE mRNAs with functions such as cell migration, osteoblast differentiation, cartilage development and extracellular region. Machine learning algorithms further identified APOD, FBXO43 and LRP12 as key genes. ROC curves demonstrated the high diagnostic efficacy of these genes. The results of qRT-PCR showed that the expression levels of key genes were consistent with those of microarray analysis. In addition, the results of in vitro experiments showed that APOD was closely related to osteogenic differentiation of BMSC. Immune infiltration analysis suggested a close correlation between ONFH and imbalances in levels of Neutrophils, Monocytes, Macrophages M2, Dendritic cells activated and Dendritic cells resting. APOD is closely related to osteogenic differentiation of BMSCs and can be used as a diagnostic marker of ONFH. Immune cell infiltration significantly differs between controls and ONFH patients.

Misinformation About Orthopaedic Conditions on Social Media: Analysis of TikTok and Instagram.

Introduction Social media outlets such as TikTok (TT) and Instagram (IG) have surged as a method to disseminate information. More recently, healthcare professionals have targeted this space as a means to provide medical education and advice. With the ever-growing content on these applications, there is significant variability and quality of material available, which can lead to the dissemination of misinformation. This study aims to evaluate the accuracy and popularity of content on common orthopaedic pathology on TT and IG. Methods Content on TT and IG related to six common orthopaedic conditions - achilles tendon tear, ACL tear, meniscus tear, tennis elbow, rotator cuff tear, and ankle sprains - was evaluated between April and June 2022. The top ten posts for the top two associated hashtags for each condition were reviewed. The quality of each post was analyzed using the DISCERN instrument, rating each on a scale of 1 to 5. Each post was characterized by the author's profession (physician, physical therapist, chiropractor, etc.) and content type (educational, testimonial, personal, promotional, and entertainment). Popularity and engagement metrics such as "comments," "likes," and "shares" were also collected. Results There were 165,666,490 views on TT and 9,631,015 views on IG amongst the six common aforementioned orthopaedic conditions. Content created by physicians had less overall engagement (16.1%) compared to content created by non-physicians (83.9%). The quality of content on average was low (mean misinformation index 2.04 ± 1.08 (1-5)1. Physician-created posts in comparison to non-physician posts were significantly more accurate (mean misinformation index score 3.38 ± 1.12 vs 1.89 ± 0.94, p<0.0001). Conclusions Common orthopaedic conditions such as Achilles tendon tears, ACL tears, and meniscus tears are frequently the focus of content posted on TT and IG; however, this information is often not medically accurate. Increased physician engagement may help to rectify this misinformation.

A pilot study on the efficacy of GPT-4 in providing orthopedic treatment recommendations from MRI reports

Large language models (LLMs) have shown potential in various applications, including clinical practice. However, their accuracy and utility in providing treatment recommendations for orthopedic conditions remain to be investigated. Thus, this pilot study aims to evaluate the validity of treatment recommendations generated by GPT-4 for common knee and shoulder orthopedic conditions using anonymized clinical MRI reports. A retrospective analysis was conducted using 20 anonymized clinical MRI reports, with varying severity and complexity. Treatment recommendations were elicited from GPT-4 and evaluated by two board-certified specialty-trained senior orthopedic surgeons. Their evaluation focused on semiquantitative gradings of accuracy and clinical utility and potential limitations of the LLM-generated recommendations. GPT-4 provided treatment recommendations for 20 patients (mean age, 50 years ± 19 [standard deviation]; 12 men) with acute and chronic knee and shoulder conditions. The LLM produced largely accurate and clinically useful recommendations. However, limited awareness of a patient’s overall situation, a tendency to incorrectly appreciate treatment urgency, and largely schematic and unspecific treatment recommendations were observed and may reduce its clinical usefulness. In conclusion, LLM-based treatment recommendations are largely adequate and not prone to ‘hallucinations’, yet inadequate in particular situations. Critical guidance by healthcare professionals is obligatory, and independent use by patients is discouraged, given the dependency on precise data input.

The epidemiology of patellar luxation in an insured Swedish dog population.

Patellar luxation (PL) is a common orthopaedic condition in dogs. This study aimed to evaluate the incidence and cause-specific mortality rate, age at diagnosis, and risk factors for medial PL (MPL), lateral PL (LPL), and bidirectional PL (BPL). Other diagnoses in dogs with PL were also explored. The study population included just over 600,000 dogs insured by Agria Pet Insurance in Sweden (2011-2016). There were 2726 dogs with PL. Medial patellar luxation affected 90 % of the dogs with PL, followed by LPL (5.9 %), BPL (2.4 %), and unspecified PL (1.6 %). The median age at first diagnosis during the study period was 2.8 years for MPL, 2.7years for LPL, and 1.5 years for BPL. In total, 168 (6.2 %) of the dogs with PL had cruciate ligament rupture. There were substantial breed-specific differences in the risk of PL: almost all breeds at increased risk of MPL were small-sized, while several of the breeds at increased risk of LPL were large-sized. The breeds at high risk of BPL varied in size. Females had an increased risk of MPL (RR 1.2, 95 % CI: 1.1-1.3, p<0.001) and a decreased risk of LPL (RR 0.72, 95 % CI: 0.51-1.0, p=0.042) compared to males. In total, 116 dogs were euthanised due to PL and the breeds with the highest risk of PL-related euthanasia were the Pyrenean mountain dog, Dogue de Bordeaux, and German pinscher. The median age for PL-related euthanasia was 2.2 years.

AI = Appropriate Insight? ChatGPT Appropriately Answers Parents' Questions for Common Pediatric Orthopaedic Conditions

Background: Artificial intelligence services, such as ChatGPT (generative pre-trained transformer), can provide parents with tailored responses to their pediatric orthopaedic concerns. We undertook a qualitative study to assess the accuracy of the answer provided by ChatGPT in comparison to OrthoKids (“OK”), a patient-facing educational platform governed by the Pediatric Orthopaedic Society of North America (POSNA) for common pediatric orthopaedic conditions.Methods: A cross-sectional study was performed from May 26 to June 18, 2023. OK website (orthokids.org) was reviewed and 30 existing questions were collected. The corresponding OK and ChatGPT responses were recorded. Two pediatric orthopaedic surgeons assessed the answer provided by ChatGPT against the OK response. Answers were graded as: AGREE (accurate information; question addressed in full), NEUTRAL (accurate information; question not answered), DISAGREE (information was inaccurate or could be detrimental to patients' health). The evaluators' responses were compiled; discrepancies were adjudicated by a third pediatric orthopaedist. Additional chatbot answer characteristics such as unprompted treatment recommendations, bias, and referral to a healthcare provider were recorded. Data was analyzed using descriptive statistics.Results: The chatbot's answers were agreed upon in 93% of questions. Two responses were felt to be neutral. No responses met disagreement. Unprompted treatment recommendations were included in 55% of its responses (excluding treatment-specific questions). The chatbot encouraged users to “consult with a healthcare professional” in all responses. It was nearly an equal split between recommending a generic provider (46%) in contrast to specifically stating a pediatric orthopaedist (54%). The chatbot was inconsistent in related topics in its provider recommendations, such as recommending a pediatric orthopaedist in 3 of 5 spine conditions.Conclusion: Questions pertaining to common pediatric orthopaedic conditions were accurately represented by a chatbot in comparison to a specialty society-governed website. The knowledge that chatbots deliver appropriate responses is reassuring. However, the chatbot frequently offered unsolicited treatment recommendations whilst simultaneously inconsistently recommending an orthopaedic consultation. We urge caution to parents utilizing artificial intelligence without also consulting a healthcare professional.Level of Evidence: IVKey Concepts•Artificial intelligence chatbots are becoming increasingly popular, as demonstrated by the rapid rise of publications on the topic in the last 3 months, and they represent a novel patient education online platform.•In comparing 30 common pediatric orthopaedic conditions, >90% of the chatbot's responses were felt to be in agreement with a specialty society's parent-patient-facing education platform.•The chatbot's responses were largely unbiased and referred patients to a healthcare professional. However, the responses lacked references or citing sources for the provided information.

Effects of kidney tonic herbs for primary osteoporosis: A systematic review and meta-analysis.

Primary osteoporosis (POP) is one of the most common orthopedic conditions with a high risk of fractures. Effective treatment of POP is crucial for reducing disability rates and improving quality of life. Kidney tonic therapy is a classical traditional Chinese medicine approach for treating POP. This study aims to provide a comprehensive and reliable assessment of the clinical evidence of kidney tonic herbs (KTH) in treating POP patients. An extensive literature search was conducted in 8 electronic databases from their inception through September 30, 2022, to evaluate the efficacy and safety of KTH for POP. We included 43 randomized controlled trials with 4349 participants. The qualified studies will be chosen and evaluated separately by 2 researchers. The primary outcome measure was bone mineral density (BMD) of lumbar. RevMan 5.3 and Stata 16 were used to carry out the meta-analyses. Our meta-analysis showed 29 studies with significantly increased lumbar BMD (mean difference [MD] = 0.06; 95% confidence interval [CI]; I2 = 98%, P = .003), 18 studies with noticeably higher femoral neck BMD (MD = 0.08; 95% CI; I2 = 98%, P = .0005), 6 studies with significantly increased femoral trochanter BMD (MD = 0.10; 95% CI; I2 = 97%, P = .002), 4 studies with noticeably higher ward's triangle BMD (MD = 0.13; 95% CI; I2 = 100%, P = .04), and 3 studies with noticeably higher distal radius BMD (MD = 0.06; 95% CI; I2 = 86%, P = .009). One study showed 12 falls and 8 fallers in the intervention group, 28 falls and 17 fallers in the control group at 36 months. 3 studies showed a significant difference in fracture incidence between the intervention group and the control group (95% CI: 0.15-0.81; I2 = 0%, P = .01). Additionally, the meta-analysis demonstrated that KTH offered superior pain relief (8 trials, n = 980; 95% CI: -1.05 to -0.74; I2 = 94%, P < .00001). Besides, KTH found no serious harmful effects. KTH may increase BMD and decrease the likelihood of fractures in POP patients. However, further research is necessary to investigate the effectiveness of KTH in reducing falls and fractures.