Orthopedic Complications Research Articles

Preventing deformities in paediatric cerebral palsy in poorly-resourced areas: A scoping review.

Managing children with cerebral palsy (CP) in poorly-resourced contexts, especially those with greater functional limitations, is challenging. Unmitigated orthopaedic complications can further restrict already compromised functional capacity. Where rehabilitation skills and knowledge are scarce, primary healthcare worker- and caregiver-implemented routines are warranted. The essential elements of a home-based routine to mitigate musculoskeletal (MSK) complications in children with severe CP in resource-limited settings (RLSs) have not been determined. To summarise the evidence for programmes and interventions that mitigate MSK complications in children with severe CP and make recommendations for a programme suited to RLSs. Scientific databases and professional websites were searched for studies and reports describing guidelines, interventions or programmes for children aged 0-18 years with severe, partially- or non-ambulant CP, that included aims for the prevention of MSK complications. Articles reporting on surgical, pharmacological and advanced or expensive technological interventions were excluded. A total of 57 studies or reports were included in the review. Low-grade evidence exists for 24-hour postural management (24-h PM), supported standing, sustained stretching and splinting to mitigate MSK complications in children with CP. Caregiver training and support, and integration of the programme into daily routines were identified as important components for successful implementation. Clinical guidelines and evidence that support caregiver-delivered interventions to reduce MSK complications in children with severe CP are limited, and only weak recommendations can be made. There is a need for context-specific, home-based intervention programmes to prevent MSK complications in children with CP in RLSs.

Clinical features of chronic tibial osteomyelitis: a single-center retrospective study of 282 cases in Xinjiang, China.

Chronic osteomyelitis is a highly prevalent and severe orthopaedic complication, representing a critical unresolved issue. The clinical symptoms of osteomyelitis are influenced by various factors, including geography, lifestyle, and pre-existing medical conditions.This study aims to provide theoretical basis for treatment and prevention of osteomyelitis by investigating and analyzing clinical features and pathogen distribution among 282 patients with chronic tibial osteomyelitis in xinjiang. A total of 282 patients with chronic tibial osteomyelitis from January 1, 2012 to January 1, 2022 in the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed. All data were collected from electronic medical record (EMR) system including demographics, etiology, risk factors, osteomyelitis location and clinical classification. Farmers, students, unemployed and retirees accounted for a relatively large proportion of the 282 patients. There were 233 males and 49 females with a gender ratio of 4.75:1. The average age was 40.21 ± 15.68 years and was mainly concentrated in 41-50 years, specifically, the mean age of females was slightly older than that of males. Education level was mostly primary and secondary school education, and illiteracy. Risk factors of chronic tibial osteomyelitis included history of smoking and drinking, history of multiple repeated surgeries, and impaired immunity. Frequent clinical symptoms were in the order of pain, local swelling, pus discharge and skin ulceration. Among all inflammatory markers, proportion of positive results were 30.85%, 59.93% and 53.90% for white blood cell (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), respectively. Positive rate of pathogenic microorganism culture was low and the three most common bacteria were Staphylococcus aureus (S. aureus), Pseudomonas aeruginosa (P. aeruginosa) and Escherichia coli (E. coli). The most frequent site of infection was middle tibia. According to Cierny-Mader osteomyelitis classification, the most common types were type IIIA, IVA and IIA. Number of visits due to chronic osteomyelitis increased year by year, with young and middle-aged male farmers and low education level as the main groups. Smoking and drinking were two considerable risk factors that should be attached to a great importance. No significant increase was found in inflammatory markers and lower positive rate of pathogenic microorganism culture was observed. Multi-drug resistant bacteria were common and S. aureus remained the most frequent pathogen. Elevated ESR had certain diagnostic value for osteomyelitis. Type III and type IV osteomyelitis accounted for a large proportion which posed great challenges for clinical diagnosis and treatment.

Revision surgery for chronic pyogenic spondylitis: analysis of a monocenter cohort with a minimum 1 year follow-up

Objective. To analyze the structure of complications and follow-up results of revision surgeries in patients operated on for chronic nonspecific spondylitis (CNS).Material and Methods. Revision interventions due to the development of complications corresponding to type IIIB according to Clavien – Dindo classification were performed in 78 patients (mean age 58 years 6 months ± 11 years 2 months) with CNS who had previously undergone reconstructive surgery on the spine. The timing of complications was analyzed according to Prinz classification. The structure of complications and factors potentially influencing their development were evaluated. Predictors of infectious and orthopedic complications were differentiated. Follow-up period was at least 1 year (M ± m = 3 years 3 months ± 1 year 2 months). Statistical analysis was performed using SPSS, version 22.0.Results. The estimated frequency of Clavien – Dindo grade IIIB complications after surgical treatment of CNS was 11.3 %. In 44 (56.4 %) of 78 cases, indications for revision surgery were due to infectious complications, and in 34 (43.6 %) – to orthopedic complications. The Charlson comorbidity index was 4.5 ± 1.8 with no intergroup differences between infectious and orthopedic complications (p = 0.052). The duration of primary interventions (p < 0.001) and blood loss (p = 0.010) were higher in patients with infectious complications. The average preoperative ODI was 48.3 ± 13, with a higher value in the infectious complications group (F = 5.146, p = 0.026). The timing of complications and the location of primary reconstruction influenced both the ODI score (F = 6.622, p < 0.001) and the type of complications (Pearson’s χ2 = 14.224, p = 0.014). The patient age had no effect on the location of complications (p = 0.349, F value = 1.137). Preoperative neurologic deficit was noted in 23 patients, regression was recorded in 11 cases, including complete in 6 and within the same functional class in 5 cases. The complication rate in the long-term period after revision surgery was 14.1 %.Conclusion. Infectious complications of primary interventions in patients with chronic nonspecific spondylitis prevail over orthopedic ones. Significant predictors of the development of complications are the patient age > 55 years, the Charlson comorbidity index > 3, duration of surgery > 2 hours 30 minutes, and blood loss volume > 250 ml.

Osteogenic citric acid linked chitosan coating of 3D-printed PLA scaffolds for preventing implant-associated infections

>25 % of the patients who receive orthopedic implants have been reported with implant-associated osteomyelitis, which can result in inflammation, osteolysis, and aseptic loosening of implants. Current treatment methods doesn't ensure defect healing and prevention from reinfection. Thermoplastic-based 3D-printed scaffolds offer a bioresorbable, biocompatible, and mechanical strong implant system. However, the hydrophobicity and bio-inertness of these polymers prevent their use in clinics. In this study, we developed dual functionalized scaffolds with osteogenic and antibacterial properties by immobilizing citric acid-linked chitosan on oxygen plasma etched 3D-printed PLA scaffolds through an EDC-NHS coupling reaction. Acellular mineralization of these scaffolds in DMEM demonstrated the deposition of crystalline hydroxyapatite. In addition, the antibacterial properties of these surface-modified scaffolds have been determined against E. coli and S. aureus, where the citric-linked chitosan biofunctionalized 3D-printed PLA scaffolds showed significantly higher antibacterial activity in comparison to oxygen-etched PLA and PLA scaffolds due to the synergistic effect of citric acid and chitosan functionalities. MG-63 cells exhibited increased proliferation and osteogenic activity on the modified scaffolds compared to the PLA and OP-PLA. These 3D-printed scaffolds, coated with citric-linked chitosan, can be a potential solution to orthopedic complications such as critical-sized bone defects and implant-associated osteomyelitis.

Complex trauma sequelae: Mycobacterium goodii and Priestia endophytica Hardware infection in a patient with Ehlers-Danlos syndrome

A 26-year-old man with Ehlers-Danlos syndrome, recurrent otitis externa, and chronic otitis media sustained a left lower extremity amputation and open femur fracture with internal hardware fixation after a motor vehicle collision in Arizona. He presented to the emergency department at our institution with severe left leg pain and purulent discharge despite receiving two unidentified antibiotics upon discharge. Evaluations revealed an abscess and malunion of the femur. Initial cultures yielded scant Priestia endophytica, leading to daptomycin treatment. His condition worsened until Gram-positive bacilli identified as Mycobacterium goodii, a rare nosocomial mycobacterial species, were found. Significant improvement occurred with appropriate antibiotics. This case highlights the challenges in diagnosing and managing M. goodii infections in immunocompromised patients with orthopedic complications and notes P. endophytica as a previously unreported, possibly opportunistic human pathogen.

Preoperative and Postoperative Therapeutic Anticoagulation in Orthopaedic Surgery Increases the Risk of Bleeding: A Systematic Review and Meta-Analysis.

Patients requiring postoperative therapeutic anticoagulation may have increased risk of bleeding complications, infection, and poor wound healing. The purpose of this study was to perform a systematic review and meta-analysis assessing bleeding complication rates among orthopaedic surgery patients receiving perioperative therapeutic anticoagulation. A systematic review and meta-analysis was performed in concordance with the Preferred Reporting Items for Systematic Review and Meta Analysis 2020 guidelines. PubMed was queried for articles related to therapeutic anticoagulation in orthopaedic surgery and complications using keywords and medical subject headings. Inclusion/exclusion criteria were any study reporting bleeding complications after orthopaedic surgery among patients on perioperative therapeutic anticoagulation with a minimum 1-year follow-up. Studies were reviewed for heterogeneity and risk of bias. Pooled analysis was done to determine postoperative complication rates among patients on therapeutic anticoagulation. Thirty-seven studies with 3,990 patients were included. Studies were grouped by their surgical subspecialty with 16 from arthroplasty, one foot and ankle, two spine, one sports, 13 trauma, and four upper extremity. Among patients on therapeutic anticoagulation, the pooled rate and 95% confidence intervals of bleeding complications was 8% (5 to 11%) overall, 10% (5 to 15%) in arthroplasty, 6% (3 to 11%) in trauma, and 5% (1 to 30%) in upper extremity. The overall rates (95% CI) of venous thromboembolism (VTE) were 2% (2 to 4%), infection 5% (3 to 10%), and revision surgery 4% (3 to 6%). Upper extremity VTE rates were 0% (0 to 15%), infection 4% (3 to 6%), and revision surgery 4% (3 to 6%). Trauma VTE rates were 4% (2 to 5%), infection 2% (1 to 6%), and revision surgery 3% (2 to 4%). Arthroplasty VTE rates were 2% (1 to 5%), infection 9% (4 to 18%), and revision surgery 4% (2 to 7%). Therapeutic postoperative anticoagulation may increase the risk of bleeding complications when compared with the general population. Incidence of VTE was similar when compared with historical data.

Optimal inputs for machine learning models in predicting total joint arthroplasty outcomes: a systematic review.

Machine learning (ML) models may offer a novel solution to reducing postoperative complication rates and improving post-surgical outcomes after total joint arthroplasty (TJA). However, the variety of different ML models that exist paired with the increasing number of potential inputs can make the implementation of this tool challenging. Therefore, we conducted a systematic review to assess the most optimal inputs of different ML models in predicting postoperative (1) medical outcomes, (2) orthopedic outcomes, and (3) patient-reported outcome measures (PROMs) after total joint arthroplasty. The PubMed, MEDLINE, EBSCOhost, and Google Scholar databases were utilized to identify all studies evaluating ML models predicting outcomes following TJA between January 1, 2000, and June 23, 2023 (PROSPERO study protocol registration: CRD42023437586). The mean risk of bias in non-randomized studies-of interventions score, was 13.8 ± 0.5. Our initial query yielded 656 articles, of which 25 articles aligned with our aims, examining over 20 machine learning models and 1,555,300 surgeries. The area under the curve (AUC), accuracy, inputs, and the importance of each input were reported. Twelve studies evaluating medical complications with 13ML models reported AUCs ranging from 0.57 to 0.997 and accuracy between 88% and 99.98%. Key predictors included age, hyper-coagulopathy, total number of diagnoses, admission month, and malnutrition. Five studies evaluating orthopedic complications with 10ML models reported AUCs from 0.49 to 0.93 and accuracy ranging from 92 to 97%, with age, BMI, CCI, AKSS scores, and height identified as key predictors. Ten studies evaluating PROMs comprising of 12 different ML models had an AUC ranging from 0.453 to 0.97 ranked preoperative PROMs as the post-predictive input. Overall, age was the most predictive risk factor for complications post-total joint arthroplasty (TJA). These studies demonstrate the predictive capabilities of these models for anticipating complications and outcomes. Furthermore, these studies also highlight ML models' ability to identify non-classical variables not commonly considered in addition to confirming variables known to be crucial. To advance the field, forthcoming research should adhere to established guidelines for model development and training, employ industry-standard input parameters, and subject their models to external validity assessments.

The Relationship Between Body Mass Index and Development of Gross Motor Skills Within 5 - 7 Years old Children

Background: Obesity in children and adolescents has become a major issue in global health in the 21st century. Previous studies have shown that obese children face substantial adverse short- and long-term health consequences, including asthma, chronic low-grade systemic inflammation, diabetes, numerous orthopedic complications, and more. Objectives: The purpose of this study was to investigate the relationship between Body Mass Index (BMI) and the development of gross motor skills in children aged 5 - 7 years. Methods: This cross-sectional study was conducted on children aged 5 - 7 years in Bojnourd city. The sampling method was multistage. A checklist containing demographic data and BMI of participants was completed. Ulrich's Test of Gross Motor Development (3rd edition) was used to assess gross motor skills in children. Results: The age range of participants was 5 - 7 years. The mean ± standard deviation of age was 6.24 ± 0.82 years, and the mean ± standard deviation weight was 24.8 ± 3.68 kg, with a range of 17.5 - 32.2 kg. There was a significant statistical difference in gross motor skills scores among the three groups: Obese, overweight, and optimal weight (P < 0.0001). There was also a significant difference in gross motor skills scores between the two gender groups (P < 0.0001). Conclusions: Higher weight groups had lower motor skills scores. Therefore, it is necessary to adopt appropriate policies for physical activity to reduce the prevalence of obesity and overweight in children.

Comparative evaluation of proximal femoral nail anti-rotation versus dynamic hip screw for stable intertrochanteric femoral fractures: A meta-analysis of clinical outcomes

In this study, a meta-analysis was conducted to compare the efficacy of proximal femoral nail anti-rotation (PFNA) and dynamic hip screw (DHS) as the treatment of stable intertrochanteric femoral fractures (AO type 31-A1). The comparison was focused on perioperative outcomes, Harris hip scores (HHSs), and major orthopedic complications. PubMed, Cochrane, ProQuest, and ScienceDirect were searched for studies comparing PFNA and DHS for stable intertrochanteric femoral fractures. The authors conducted separate screenings to determine eligible studies for this meta-analysis. The risk of bias was assessed using the Risk of Bias Tool for Randomized Trials 2 and the Risk of Bias in Non-randomized Studies–of Interventions-I. All outcomes were analyzed using Review Manager software version 5.4 and presented as forest plots. Ten studies were included in this analysis (three randomized controlled trials and seven observational studies) with 1149 patients. For the intraoperative parameters, PFNA had shorter mean operative time (mean difference [MD] −18.63, 95% interval [CI] [−27.92–−9.34], P < 0.0001) and led to less intraoperative blood loss (MD −88.84, 95% CI [−158.03–−19.65], P = 0.01). No significant differences in HHSs and complications were found between PFNA and DHS, and leg length discrepancy (risk ratio 0.40, 95% CI [0.17–0.92], P < 0.03) favoring PFNA. Overall, these two surgical methods have no meaningful differences in long-term functional outcomes and complications. The PFNA may be more beneficial in the perioperative aspect, including shorter surgical duration and lesser blood loss due to its minimally invasive nature.

Preoperative cardiology consultations for geriatric patients with hip fractures rarely provide additional recommendations and are associated with prolonged hospital stays and delayed surgery: a retrospective case control study.

Hip fractures are increasingly common among the elderly population, who often present with a high burden of comorbidities necessitating preoperative stabilization. As a result, preoperative cardiology consultations are frequently conducted in clinical practice. The aim of this study was to investigate the additional recommendations provided by preoperative cardiology consultations and the impact of consultations on the management and outcomes of elderly patients undergoing hip fracture surgery. This matched cohort study was performed to retrospectively assess the clinical data of patients who were treated for hip fractures at our institution between January 2016 and December 2017. Individuals who were 60years old or older with available clinical and radiological data were included. A total of 262 patients who met these criteria were included, with 192 undergoing cardiology consultation and 70 not. Through matching for age, sex, ASA grade, fracture type, and surgery type, two groups (Group A, preoperative cardiology consultation requested; Group B, preoperative cardiology consultation not requested) of 50 patients each were formed. The duration between hospital admission and surgery, recommendations provided by cardiology consultation, type of anaesthesia and surgery, length of hospital stay, incidence of medical and orthopaedic complications, and one-year mortality status were compared between the groups. The mean age of Group A was 78.5 (± 7.4) years, whereas that of Group B was 78.4 (± 7.4) years (p = 0.99). Both groups included 30 female patients and 20 male patients each. There were no significant differences in anaesthesia type or the incidence of medical or orthopaedic complications between the groups. However, Group A experienced a significantly longer duration between admission and surgery (5 [1/9] days vs. 3 [0/7] days; p = 0.00) and a longer hospital stay (7 [3/15] days vs. 5 [1/19] days; p = 0.01) than did Group B. The one-year mortality rate did not significantly differ between the groups (30% vs. 20%; p = 0.36). Notably, only 3 out of 50 patients received additional treatments following cardiology consultation beyond routine recommendations. Preoperative cardiology consultations before hip fracture surgery rarely leads to a change in treatment. Additionally, these evaluations delay surgery and extend the hospital stay.

Influence of Health Insurance Coverage on the Survival Rate for Primary Total Knee Arthroplasty: Minimum 5-Year Follow-Up Analysis.

This study investigated whether differences in survival rates and clinical outcomes exist in patients undergoing TKA by insurance type: National Health Insurance (NHI) vs. Medical Aid Program (MAP). This study conducted a retrospective analysis of 762 TKAs (NHI, n = 505; MAP, n = 257) with a mean follow-up of 8.4 ± 1.8 years. Patient-reported outcomes (PROMs) were evaluated using the American Knee Society's (AKS) score at the final follow-up. The survival rate of each group was analyzed using Kaplan-Meier survival analysis. Any postoperative complications and readmissions within 90 days of discharge were recorded and compared between the groups. There were no between-group differences in pre- to postoperative improvement in AKS scores. The estimated 10-year survival rates were 98.5% in the NHI group and 96.9% in the MAP group, respectively, with no significant differences (p = 0.48). However, the length of hospital stay (LOS) was significantly longer in the MAP group than in the NHI group (13.4 days vs. 13.1 days, p = 0.03), and the transfer rate to other departments was significantly higher in the MAP group than in the NHI group (3.9% vs. 1.4%, p = 0.04). Readmission rates for orthopedic complications for 90 days were 3.0% in the NHI group and 3.5% in the MAP group, respectively (p = 0.67). Patients' insurance type showed similar survival rates and clinical outcomes to those of primary TKA at a mean follow-up of 8.4 years, but the LOS and rate of transfer to other departments during hospitalization were influenced by insurance type.

FIXING THE PERIPROSTHETIC FEMUR FRACTURE PROBLEM: ARE WE ABLE TO PROVIDE SAFE, EFFECTIVE, AND TIMELY CARE IN NORTH WALES? A PAN BETSI COLLABORATIVE STUDY

The recruitment drive, investment and collaboration within Betsi Cadwaladr University Health Board (BCUHB) sites providing specialist lower limb arthroplasty and trauma service has evolved over last few years with aims to improve patient care and reduce reliance on tertiary referral centres. Through our service-evaluation project, we reviewed the results of treatment provided for periprosthetic femur fractures (PPFFs) presenting to BCUHB sites over last 4 years.We retrospectively reviewed consecutive PPFFs admitted at three BCUHB sites from January’20 to June’23 with mean follow-up of 20.8 ± 13.2 (8–49) months [n=161; Mean age: 82.2 ± 8.5 (59–101) years, Females:107]. Over the review period we noted a 23% increase in service demand for care of PPFFs. Majority were managed surgically [132/161] [38 revision arthroplasties; 94 ORIFs] at BCUHB sites and two patients were referred to tertiary centre. Average time to surgery was 3.5 days. 90% of the PPFFs were managed successfully with 10% (16/159) having orthopaedic complications needing further intervention. 6.3 (10/159) had medical complications and did not need orthopaedic re-intervention. In our series, 12-month re-operation rate was 6.1% (8/132) and 1-month, 3-month and 1-year mortality rate was 6.3%, 11.3% and 21.4% respectively. These results are comparable to the published results of PPFF management at tertiary centres. Potential cost savings compared to transfer to tertiary centre for PPFF management was £2.31 million. Thus, it is possible to successfully provide adequate care for PPFFs at DGHs and efforts should be made to appropriately equip and adequately staff DGHs, to provide service for local PPFF care.

Bone and joint infections due to melioidosis; diagnostic and management strategies to optimise outcomes.

Melioidosis, a life-threatening infection caused by the gram negative bacterium Burkholderia pseudomallei, can involve almost any organ. Bone and joint infections (BJI) are a recognised, but incompletely defined, manifestation of melioidosis that are associated with significant morbidity and mortality in resource-limited settings. We identified all individuals with BJI due to B. pseudomallei managed at Cairns Hospital in tropical Australia between January 1998 and June 2023. The patients' demographics, their clinical findings and their treatment were correlated with their subsequent course. Of 477 culture-confirmed cases of melioidosis managed at the hospital during the study period, 39 (8%) had confirmed BJI; predisposing risk factors for melioidosis were present in 37/39 (95%). However, in multivariable analysis only diabetes mellitus was independently associated with the presence of BJI (odds ratio (95% confidence interval): 4.04 (1.81-9.00), p = 0.001). BJI was frequently only one component of multi-organ involvement: 29/39 (74%) had infection involving other organs and bacteraemia was present in 31/39 (79%). Of the 39 individuals with BJI, 14 (36%) had osteomyelitis, 8 (20%) had septic arthritis and 17 (44%) had both osteomyelitis and septic arthritis; in 32/39 (83%) the lower limb was involved. Surgery was performed in 30/39 (77%). Readmission after the initial hospitalisation was necessary in 11/39 (28%), 5/39 (13%) had disease recrudescence and 3/39 (8%) had relapse; 4/39 (10%) developed pathological fractures. ICU admission was necessary in 11/39 (28%) but all 11 of these patients survived. Only 1/39 (3%) died, 138 days after admission, due to his significant underlying comorbidity. The case-fatality rate from melioidosis BJI in Australia's well-resourced health system is very low. However, recrudescence, relapse and orthopaedic complications are relatively common and emphasise the importance of collaborative multidisciplinary care that includes early surgical review, aggressive source control, prolonged antibiotic therapy, and thorough, extended follow-up.

Use of orthoses in complex rehabilitation of children that have underwent oncological arthroplasty

Background: The urgency of medical rehabilitation for children with bone sarcoma is extremely high due to the significant impact on a socially important population and the increasing life expectancy of patients with bone sarcomas, leading to long-term orthopedic complications. This necessitates the development of highly effective, comprehensive programs not only for treatment but also for rehabilitation. AIM: Maximizing the recovery of residual quality of life abilities in children with bone sarcomas through the use of orthoses during various perioperative periods. MATERIALS AND METHODS: The study included 61 patients with bone tumors who underwent anti-tumor treatment and surgical intervention involving tumor removal with endoprosthesis implantation. Medical rehabilitation began from the moment of diagnosis and was conducted throughout all periods of anti-tumor therapy to help patients adapt to the treatment, restore functions in the postoperative period, and during remission, as well as to minimize the effects of aggressive specialized treatment. RESULTS: The functional outcome was assessed using the international MSTS scale. Limb function according to the MSTS scale was evaluated 12 and 24 months after surgery. No unsatisfactory results were observed. Functional outcomes improved over the course of 24 months. CONCLUSION: A dynamically evolving individualized rehabilitation program for children with bone sarcomas is necessary, tailored to the patient's condition and needs at the time of observation, along with personalized selection of orthoses and timely surgical correction of orthopedic consequences, which should be performed in orthopedic specialized hospitals.

Value of PET/CT Scanning in Detection of Osseous and Marrow Metastatic Lesions in Cancer Patients

Abstract Background Early diagnosis of cancer remains to be of paramount importance to maximize a patient’s long-term survival and reduce various neurological, hematological, and orthopedic complications that may arise. Skeletal metastasis (SM) is a frequently encountered and important complication of cancer which can lead to intolerable pain. Objectives The goal of the study was to illustrate the value of combined 18F-FDG PET/CT over isolated CT for detection of osseous metastases in cancer patients. Patients and Methods The study included 75 patients. 18F-PET/CT scans were performed. In this study, a lesion-based analysis was performed in detailed retrograde manner. Statistical analysis including specificity, Sensitivity, negative predictive value (NPV) and positive predictive value (PPV) of each of these modalities were calculated. A final diagnosis of metastasis was confirmed by biopsy. Results Combined PET-CT examination is highly sensitive imaging modality in detection of early bone marrow metastatic lesions which are not yet evident on conventional CT study. Conclusion Combined 18-F FDG PET/CT significantly improves the sensitivity and specificity of isolated CT for the detection of osseous and bone marrow metastases. Thus, it adds a significant value that can detect lesions and consequently start a treatment course and improve the overall outcome of the disease process.

Complications and Revision Surgery in Orthopedics Focusing on Traumatology.

Orthopedic traumatology, a vital component of orthopedic surgery, poses significant challenges in managing complications and necessitating revision surgeries. These challenges impact clinical outcomes, healthcare economics, and patient well-being. This study aimed to provide insights that informed clinical decision-making and improved patient outcomes by thoroughly examining the range of complications encountered in orthopedic traumatology. Specifically, the research focused on the indications, techniques, and outcomes of revision surgeries. This retrospective cohort research looked at orthopedic traumatology complications and revision procedures over a thorough two-year period from March 2021 to March 2023 at Hayatabad Medical Complex in Peshawar, Pakistan. The following information was gathered from 316 patients receiving orthopedic surgery for traumatic injuries: demographics, kinds of trauma, surgical methods, complications, indications, methods, and results of revision surgery. For data analysis, chi-square tests and descriptive statistics were used, with the goal of finding patterns and correlations within the research population. The average age of the 316 patients was 42.5 years, and 64.76% of them were male (n = 192). The most frequent kind of trauma (n = 218; 69.01%) was fractures, which were mostly brought on by falls (n = 147; 46.52%). The most common surgical method (n = 138; 43.67%) was found to be internal fixation, which was followed by external fixation (n = 67; 21.20%). The most common complication (n = 78; 24.68%) was surgical site infection, which resulted in revision procedures mostly for infection (n = 68; 21.52%) and implant failure (n = 56; 17.72%). Debridement was the most often used revision approach (n = 95; 30.10%), and it was substantially correlated with surgical outcomes, such as increased function (31%) and full resolution (36%). This research emphasizes the need to maximize patient outcomes for improved well-being and highlights the crucial role that careful care plays in managing complications and revision operations in orthopedic traumatology.

Efficiency of Orthopaedic Audits in a Level-1 Trauma Centre Using a Modified Clavien–Dindo Complications Classification

Background: Complications are an inevitable part of orthopaedic surgery, and how one defines complications can have an impact on the ability to learn from them. There have been issues with a commonly used classification system first outlined by Clavien and Dindo. Our aim was to evaluate a modification of this classification system developed for use in our department, with our hypothesis being that this could make our audit presentations more efficient. Methods: A modified Clavien–Dindo Classification was prospectively applied to all complications recorded in the orthopaedic departmental audits at our institution for a 12-month period. The audit discussion was recorded and analysed and compared with the complication audits for the preceding 12-month period. Results: We analysed eight audit presentations before and eight audit presentations after the introduction of a modified Clavien–Dindo classification to our orthopaedic complications over a 2-year period. The number of PowerPoint™ slides (103 vs. 84, p = 0.03) and the time spent on each presentation (88 vs. 71 min, p = 0.02) decreased significantly with the introduction of the modified classification. The novel system was found to have high inter-observer reliability. Conclusions: The modified Clavien–Dindo classification system is a reproducible classification system for orthopaedic complications. It made our audit presentations more efficient.

Prevalence of Depression in Hemophilia Patients: A Cross-Sectional Study

Background: Chronic and debilitating diseases induce several psychiatric consequences. The current research determines the prevalence of depression in hemophilia patients. Methods: This is a cross-sectional study of 80 hemophilia patients referred to Mohammad Kermanshahi Hospital in Iran in 2020. The subjects were selected using the sampling method. The data collection tool includes a demographic information checklist, clinical and medical records, and Beck Depression Inventory-Second Edition (BDI-II). Data analysis was performed using frequency, percentage, and Chi-square tests. Results: The results demonstrated that the prevalence of depression in hemophilia patients was 57.5%. Furthermore, the prevalence of depression was not associated with age, education, occupation, marital status, type of hemophilia, disease severity, age of onset (i.e., disease diagnosis age), orthopedic complications, and monthly bleeding episodes ( P-Values > 0.05). However, among the patients who consumed narcotics, only 25.8% were not depressed; on the other hand, 53.1% of those who did not consume narcotics were. A clear statistically significant correlation between narcotics use and the prevalence of depression was presented (P-Value < 0.01). Conclusions: The present study reveals a significant prevalence of depression among hemophilia patients, with a notable correlation observed between depression rates and the use of narcotics drugs.

A Preoperative Risk Assessment Tool for Predicting Adverse Outcomes among Total Shoulder Arthroplasty Patients

With the increased utilization of Total Shoulder Arthroplasty (TSA) in the outpatient setting, understanding the risk factors associated with complications and hospital readmissions becomes a more significant consideration. Prior developed assessment metrics in the literature either consisted of hard-to-implement tools or relied on postoperative data to guide decision-making. This study aimed to develop a preoperative risk assessment tool to help predict the risk of hospital readmission and other postoperative adverse outcomes. We retrospectively evaluated the 2019-2022(Q2) Medicare fee-for-service inpatient and outpatient claims data to identify primary anatomic or reserve TSAs and to predict postoperative adverse outcomes within 90days postdischarge, including all-cause hospital readmissions, postoperative complications, emergency room visits, and mortality. We screened 108 candidate predictors, including demographics, social determinants of health, TSA indications, prior 12-month hospital, and skilled nursing home admissions, comorbidities measured by hierarchical conditional categories, and prior orthopedic device-related complications. We used two approaches to reduce the number of predictors based on 80% of the data: 1) the Least Absolute Shrinkage and Selection Operator logistic regression and 2) the machine-learning-based cross-validation approach, with the resulting predictor sets being assessed in the remaining 20% of the data. A scoring system was created based on the final regression models' coefficients, and score cutoff points were determined for low, medium, and high-risk patients. A total of 208,634 TSA cases were included. There was a 6.8% hospital readmission rate with 11.2% of cases having at least one postoperative adverse outcome. Fifteen covariates were identified for predicting hospital readmission with the area under the curve of 0.70, and 16 were selected to predict any adverse postoperative outcome (area under the curve =0.75). The Least Absolute Shrinkage and Selection Operator and machine learning approaches had similar performance. Advanced age and a history of fracture due to orthopedic devices are among the top predictors of hospital readmissions and other adverse outcomes. The score range for hospital readmission and an adverse postoperative outcome was 0 to 48 and 0 to 79, respectively. The cutoff points for the low, medium, and high-risk categories are 0-9, 10-14, ≥15 for hospital readmissions, and 0-11, 12-16, ≥17 for the composite outcome. Based on Medicare fee-for-service claims data, this study presents a preoperative risk stratification tool to assess hospital readmission or adverse surgical outcomes following TSA. Further investigation is warranted to validate these tools in a variety of diverse demographic settings and improve their predictive performance.

Epidemiological Trends and Outcomes of Unicompartmental Knee Arthroplasty Among 104 Million Patients in the United States

BackgroundUnicompartmental knee arthroplasty (UKA) is an alternative to total knee arthroplasty (TKA) for localized osteoarthritis. Recent advancements in UKA implant design and expanding patient criteria may have increased its utilization. However, few studies have examined the use of UKA in the United States. Thus, this study assessed the current and projected future trends of UKA and robotic UKA in the United States through 2035, along with postoperative outcomes. MethodsA collaborative healthcare research network was queried to identify patients who had undergone UKA. Primary outcomes measured included prevalence (P), incidence proportion (IP), and incidence rate (IR) from 2012 to 2022. Chi-squared analyses were done to compare outcomes across categorical data. Regression modeling was performed to project UKA to the year 2035. Statistical significance was held at P < .05 for all analyses. ResultsIn 2022, 1,662 UKAs were performed within the network, a 590% increase from 2012 (241 performed). The IP increased on an average annual basis by 41.8%, the IR by 50%, and the P by 51.3%. A year following UKA, conversion to TKA was the most common orthopaedic complication (39.9%). As of 2022, there were 68 robotic UKAs performed, a 518% increase from the 11 performed in 2012. Regression analysis for UKA through 2035 showed that IP will be 0.04%, IR will be 1.75 × 10−6 cases/person-day, and P will be 0.3%. ConclusionsThese findings are consistent with prior studies indicating a higher utilization of UKA over the past decade. Reported complications were not uncommon, as nearly 40% of patients required a conversion to a TKA. Further research is needed to optimally identify criteria for appropriate patients and determine the benefits robotic UKA may provide, specifically reducing the risk of conversion to a TKA.