Field Of Orthopedics Research Articles

Using Software to Implant Orthopaedic Hardware: Surgeon Intraoperative Confidence Increased with Latest Technological Updates.

Robotic-assisted total knee arthroplasty (TKA) has been associated with improved accuracy and precision of implant placement, protection of soft tissue, and improved patient-reported postoperative outcomes when compared to manual TKA techniques. Previous studies have highlighted the importance of surgical confidence throughout the learning curve when adopting robotic-assisted platforms. The purpose of this study was to evaluate the confidence and efficiencies of surgeons when utilizing computed tomography (CT)-based robotic TKA technology. A cross-sectional, questionnaire-based study was conducted with 20 arthroplasty-trained surgeons with prior experience in both manual TKA and robotic-assisted TKA techniques. The surgeons completed an initial learning period, with new software, during various stages of their experience. The new TKA software upgrade builds on the prior software version with new features. A Net Promoter Score (NPS), the measurement of a respondent's likelihood to recommend a product or service to others, was used during the analysis of survey questions. A NPS over 50 indicates a positive score. When compared to manual TKA techniques, 95% of surgeons reported that their overall intraoperative confidence increased with the new software upgrade for CT-based robotic technology and had an average rating of 8.9 out of 10 for their intraoperative confidence with the new software upgrade. Additionally, 100% of surgeons reported that they were more confident when performing intraoperative implant adjustments with the new software upgrade when compared to manual TKA. Surgeons determined that the overall use of the new software upgrade was intuitive (8.4 of 10 average rating) and were satisfied with the overall use of the new software upgrade (9 of 10 average rating). Also, surgeons reported that they would recommend the new software upgrade for CT-based robotic technology to colleagues (NPS of 85), as well as being used as a research tool (NPS of 85) or for a training and education tool in a fellowship program (NPS of 90). As new technology continues to enter the field of orthopedics, it is important to ensure upgrades and advancements continue to serve surgeons and provide efficiencies in the operating room. For established robotic surgeons, the new robotic technology assessed in this study provided increased confidence when compared to manual TKA. Based on these results, the new software upgrade demonstrated value during various stages of a TKA procedure and is highly recommended for use by others in the field of orthopedics.

Biocompatible implants in orthopedics: bone tissue engineering

Introduction Technological advances in bone tissue engineering have improved orthopaedic implants and surgical techniques for bone reconstruction. This approach allows overcoming inconvenience of the paucity of autologous materials available and donor site morbidity.Aim To demonstrate advances of the past 30 years in the development of bioimplants providing alternatives to bone grafting in reconstructive orthopaedics.Methods Preparing the review, the scientific platforms such as PubMed, Scopus, ResearchGate, RSCI were used for information searching. Search words or word combinations were bioactive osteoinductive implants, bone grafting, bone reconstruction, hydroxyapatite, bone scaffolds.Results The main trends in tissue engineering in the field of orthopaedics are represented by construction of three-dimensional structure implants guiding cell migration, proliferation and differentiation as well as mechanical support. Association with bone morphogenetic proteins, growth factors enables proliferation and differentiation of cell types of the targeted bone tissue. A promising advancement should be biodegradability with a controllable degradation rate to compliment cell/tissue in-growth and maturation in limb reconstruction.Discussion This review presents and discusses the experimental and clinical application of biotolerant, bioinert and bioactive materials for reconstructive bone surgery. Future generations of biomaterials are designed to be osteoconductive and osteoinductive.Conclusion Properties of polycaprolactone (PCL) filled with hydroxyapatite (from 10 to 50 wt %) make this hybrid material with controllable absorption a promising strategy for reconstructive surgery in comparison to other materials.

Is it possible to automate the discovery of process maps for the time-driven activity-based costing method? A systematic review

ObjectivesThe main objective of this manuscript was to identify the methods used to create process maps for care pathways that utilized the time-driven activity-based costing method.MethodsThis is a systematic mapping review. Searches were performed in the Embase, PubMed, CINAHL, Scopus, and Web of Science electronic literature databases from 2004 to September 25, 2022. The included studies reported practical cases from healthcare institutions in all medical fields as long as the time-driven activity-based costing method was employed. We used the time-driven activity-based costing method and analyzed the created process maps and a qualitative approach to identify the main fields.ResultsA total of 412 studies were retrieved, and 70 articles were included. Most of the articles are related to the fields of orthopedics and childbirth-related to hospital surgical procedures. We also identified various studies in the field of oncology and telemedicine services. The main methods for creating the process maps were direct observational practices, complemented by the involvement of multidisciplinary teams through surveys and interviews. Only 33% of the studies used hospital documents or healthcare data records to integrate with the process maps, and in 67% of the studies, the created maps were not validated by specialists.ConclusionsThe application of process mining techniques effectively automates models generated through clinical pathways. They are applied to the time-driven activity-based costing method, making the process more agile and contributing to the visualization of high degrees of variations encountered in processes, thereby making it possible to enhance and achieve continual improvements in processes.

3D-printed porous PEI/TCP composite scaffolds loaded with graphdiyne oxide on the surface for bone defect repair and near-infrared light-responsive antibacterial

Bone implants that promote osseointegration and have antimicrobial capabilities are necessary to ensure optimal long-term functionality of implants. In this study, a porous composite osteogenic scaffold was prepared using a twin-screw extruder and a fused deposition modeling three-dimensional (3D) printer. A polydopamine (PDA) coating was used to load graphdiyne oxide (GDYO) on the surface of the 3D printed polyetherimide-tricalcium phosphate (PEI-TCP) osteogenic scaffold through π–π double-bond interactions. The resulting P-T-GDYO composite scaffold was characterized, and its mechanical properties, ability to promote osteogenic differentiation, and light-responsive antibacterial activity were evaluated. When the scaffold was doped with 10 wt% β-TCP, its mechanical properties remained in the range of those of cancellous bone. In terms of osteogenic differentiation, the P-T-GDYO composite scaffold promoted adhesion and osteogenic differentiation of MC3T3-E1 cells, as well as effectively promoting endogenous bone regeneration of rabbit femoral condyle bone defects in osteogenesis experiments in vivo. In a mouse subcutaneous infection model, after near-infrared light irradiation, P-T-GDYO showed an antibacterial rate of 90.18 % against Staphylococcus aureus, while maintaining good tissue–organ compatibility. This study represents an important development in GDYO-based photothermal antibacterial materials in the field of orthopedics and expands its application in the biomedical field.

Haitian State Hospital Orthopedic Grand Rounds Series: A Virtual Curriculum to Address Global Surgery Needs.

Orthopedic Relief Services International (ORSI), in partnership with the Foundation for Orthopedic Trauma and the department of Orthopedic Surgery of La Paix University Hospital in Haiti, has developed a year-round Orthopedic Grand Round series. This series is moderated by Haitian faculty, features presentations by American orthopedic surgeons, and is broadcast to major state hospitals in Haiti for residents and attendings. To introduce clinical concepts and increase knowledge in an area that is medically underserved, especially in the field of orthopedics, through lectures that tailor to the educational needs of Haiti. Topics for lecture series are requested by Haitian attending orthopedic surgeons and residents in collaboration with American orthopedic surgeons to meet the educational needs of the residents in Haiti. These lectures reflect the case mix typically seen at state hospitals in Haiti and consider the infrastructural capacity of participating centers. Grand rounds are held an average of twice per month for an hour each, encompassing an educational lesson followed by an open forum for questions and case discussion. Feedback is taken from Haitian residents to ensure the sessions are beneficial to their learning. To date 95 sessions hosted by 32 lecturers have been completed over Zoom between the US and Haiti. The fourth year of the lecture series is currently ongoing with an expansion of topics. In an underserved medical area such as Haiti, programs that educate local surgeons are crucial to continuing the growth and development of the medical community. Programs like this have the potential to contribute to the educational infrastructure of countries in need, regardless of the specialty. The model of this program can be used to produce similar curricula in various specialties and areas around the world.

An update on the advances in the field of nanostructured drug delivery systems for a variety of orthopedic applications

Nanotechnology has made significant progress in various fields, including medicine, in recent times. The application of nanotechnology in drug delivery has sparked a lot of research interest, especially due to its potential to revolutionize the field. Researchers have been working on developing nanomaterials with distinctive characteristics that can be utilized in the improvement of drug delivery systems (DDS) for the local, targeted, and sustained release of drugs. This approach has shown great potential in managing diseases more effectively with reduced toxicity. In the medical field of orthopedics, the use of nanotechnology is also being explored, and there is extensive research being conducted to determine its potential benefits in treatment, diagnostics, and research. Specifically, nanophase drug delivery is a promising technique that has demonstrated the capability of delivering medications on a nanoscale for various orthopedic applications. In this article, we will explore current advancements in the area of nanostructured DDS for orthopedic use.

Fracture related Infection - Challenges in definition and diagnosis

In the field of orthopedics and trauma surgery, the rise of periprosthetic joint infections following joint replacement and fracture-related infections (FRI) has become a growing concern. The recent establishment of a definitive definition for FRI aimed to standardize diagnosis and treatment approaches while considering unique aspects of implant-associated infections in the presence of concomitant bone fractures.Diagnosing FRI can be challenging due to the varied clinical symptoms, and confirmatory criteria may not always be evident, necessitating additional diagnostic measures. Blood markers like leukocyte count, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) have limited specificity. Although novel biomarkers such as D-dimer and interleukin-6 (IL-6) show potential, they require further investigation. The use of microbiological diagnostics with tissue samples and sonication has improved pathogen detection. Cross-sectional imaging techniques like CT scans and MRI scans help evaluate bone status, soft tissue infiltration, and abscesses. Nuclear medicine techniques are accurate but may not always be practical in routine clinical practice.Histopathological interpretation for FRI remains less standardized compared to periprosthetic joint infections (PJI). FRI diagnosis requires the identification of visible microorganisms in deep tissue specimens and the quantification of polymorphonuclear neutrophils (PMNs).The defined concept of FRI has opened doors for better diagnostic and treatment approaches. However, challenges persist, especially in preoperative diagnosis, particularly for cases with unclear clinical presentations. Future endeavors aimed at optimizing diagnostic procedures and establishing a histopathological classification for FRI could lead to improved treatment recommendations and outcomes.

One and two-step electrodeposition of composite films of calcium-deficient hydroxyapatite matrix with nanoscale Ag- and Zn-based particles

A fundamental study regarding the electrochemical synthesis of composite coatings with application in the orthopaedic field has been conducted. In particular, the electrodeposition of calcium phosphate coatings with Ag nanoparticles (AgNPs) from either a single electrolyte (one-step, 1S) or two electrolytes (two-step, 2S) on a β-Ti alloy (Ti-18Mo-6Nb-4Ta in wt%) was investigated. Pulse current deposition was implemented to produce the composite coatings by the 1S approach from a simple solution containing 42 mM Ca(NO3)2·4H2O, 25 mM NH4H2PO4, and 0.5 mM AgNO3 at 65°C. Meanwhile, the calcium phosphate matrix was also deposited by pulse current, and Ag was afterwards grown by direct current from 0.1 M KNO3 + x mM AgNO3 (x = 5, 10) at 25 °C (2S approach). The Ca/P ratio of the matrix was compatible with the formation of calcium-deficient hydroxyapatite (CDHA). The resulting Ag content in the composites could be varied between 4 and 13 wt% as a function of the working conditions. The 2S-derived coatings produced by electroplating Ag at j = –20.8 mA/cm2 from 0.1 M KNO3 + 10 mM AgNO3 furnished an optimal dispersion of the AgNPs on top of the CDHA matrix, while aggregation and/or dendritic growth was observed in other cases. Glow discharge optical emission spectrometry (GDOES) measurements indicated that a given amount of AgNPs becomes engulfed in the CDHA matrix during the 1S electrodeposition, whereas most of them decorate its outer surface in the 2S-derived coatings. The applicability of the two approaches was extended to the case of zinc oxide. ZnO-containing CDHA coatings in which the Zn element was homogeneously distributed across the film surface were obtained from 42 mM Ca(NO3)2·4H2O, 25 mM NH4H2PO4 and 1 mM Zn(NO3)2·6H2O at 65 °C (1S approach). On the contrary, ZnO-NPs could be clearly observed when deposition from 5 mM KNO3 + 5 mM Zn(NO3)2 was performed at 70 °C on top of previously grown CDHA (2S approach). The results indicated that the percentage and location of the antibacterial element (Ag, Zn) in the calcium phosphate matrix can be tuned on demand to a great extent by electrochemical means.

Pulsed Electromagnetic Fields Induce Skeletal Muscle Cell Repair by Sustaining the Expression of Proteins Involved in the Response to Cellular Damage and Oxidative Stress

Pulsed electromagnetic fields (PEMF) are employed as a non-invasive medicinal therapy, especially in the orthopedic field to stimulate bone regeneration. However, the effect of PEMF on skeletal muscle cells (SkMC) has been understudied. Here, we studied the potentiality of 1.5 mT PEMF to stimulate early regeneration of human SkMC. We showed that human SkMC stimulated with 1.5 mT PEMF for four hours repeated for two days can stimulate cell proliferation without inducing cell apoptosis or significant impairment of the metabolic activity. Interestingly, when we simulated physical damage of the muscle tissue by a scratch, we found that the same PEMF treatment can speed up the regenerative process, inducing a more complete cell migration to close the scratch and wound healing. Moreover, we investigated the molecular pattern induced by PEMF among 26 stress-related cell proteins. We found that the expression of 10 proteins increased after two consecutive days of PEMF stimulation for 4 h, and most of them were involved in response processes to oxidative stress. Among these proteins, we found that heat shock protein 70 (HSP70), which can promote muscle recovery, inhibits apoptosis and decreases inflammation in skeletal muscle, together with thioredoxin, paraoxonase, and superoxide dismutase (SOD2), which can also promote skeletal muscle regeneration following injury. Altogether, these data support the possibility of using PEMF to increase SkMC regeneration and, for the first time, suggest a possible molecular mechanism, which consists of sustaining the expression of antioxidant enzymes to control the important inflammatory and oxidative process occurring following muscle damage.

Machine Learning assisted systematic reviewing in orthopaedics

BackgroundMachine learning assisted systematic reviewing may help to reduce the work burden in systematic reviews. The aim of this study is therefore to determine by a non-developer the performance of machine learning assisted systematic reviewing on previously published orthopaedic reviews in retrieving relevant papers. MethodsActive learning for Systematic Reviews (ASReview) was tested against the results from three previously published systematic reviews in the field of orthopaedics with 20 iterations for each review. The reviews covered easy, intermediate and advanced scenarios. The outcomes of interest were the percentage work saved at 95% recall (WSS@95), the percentage work saved at 100% recall (WSS@100) and the percentage of relevant references identified after having screened the first 10% of the records (RRF@10). Means and corresponding [95% confidence intervals] were calculated. ResultsThe WSS@95 was respectively 72 [71–74], 72 [72–73] and 50 [50–51] for the easy, intermediate and advanced scenarios. The WSS@100 was respectively 72 [71–73], 62 [61–63] and 37 [36–38] for the easy, intermediate and advanced scenarios. The RRF@10 was respectively 79 [78–81], 70 [69–71] and 58 [56–60] for the easy, intermediate and advanced scenarios. ConclusionsMachine learning assisted systematic reviewing was efficient in retrieving relevant papers for systematic review in orthopaedics. The majority of relevant papers were identified after screening only 10% of the papers. All relevant papers were identified after screening 30%–40% of the total papers meaning that 60%–70% of the work can potentially be saved.

Predicting conversion of ambulatory ACDF patients to inpatient: a machine learning approach

Background ContextMachine learning is a powerful tool that has become increasingly important in the orthopedic field. Recently, several studies have reported that predictive models could provide new insights into patient risk factors and outcomes. Anterior cervical discectomy and fusion (ACDF) is a common operation that is performed as an outpatient procedure. However, some patients are required to convert to inpatient status and prolonged hospitalization due to their condition. Appropriate patient selection and identification of risk factors for conversion could provide benefits to patients and the use of medical resources. PurposeThis study aimed to develop a machine-learning algorithm to identify risk factors associated with unplanned conversion from outpatient to inpatient status for ACDF patients. Study Design/SettingThis is a machine-learning-based analysis using retrospectively collected data. Patient SamplePatients who underwent one- or two-level ACDF in an ambulatory setting at a single specialized orthopedic hospital between February 2016 to December 2021. Outcome MeasuresLength of stay, conversion rates from ambulatory setting to inpatient. MethodsPatients were divided into two groups based on length of stay: (1) Ambulatory (discharge within 24 hours) or Extended Stay (greater than 24 hours but fewer than 48 hours), and (2) Inpatient (greater than 48 hours). Factors included in the model were based on literature review and clinical expertise. Patient demographics, comorbidities, and intraoperative factors, such as surgery duration and time, were included. We compared the performance of different machine learning algorithms: Logistic Regression, Random Forest (RF), Support Vector Machine (SVM), and Extreme Gradient Boosting (XGBoost). We split the patient data into a training and validation dataset using a 70/30 split. The different models were trained in the training dataset using cross-validation. The performance was then tested in the unseen validation set. This step is important to detect overfitting. The performance was evaluated using the area under the curve (AUC) of the receiver operating characteristics analysis (ROC) as the primary outcome. An AUC of 0.7 was considered fair, 0.8 good, and 0.9 excellent, according to established cut-offs. ResultsA total of 581 patients (59% female) were available for analysis. Of those, 140 (24.1%) were converted to inpatient status. The median age was 51 (IQR 44–59), and the median BMI was 28 kg/m2 (IQR 24–32). The XGBoost model showed the best performance with an AUC of 0.79. The most important features were the length of the operation, followed by sex (based on biological attributes), age, and operation start time. The logistic regression model and the SVM showed worse results, with an AUC of 0.71 each. ConclusionsThis study demonstrated a novel approach to predicting conversion to inpatient status in eligible patients for ambulatory surgery. The XGBoost model showed good predictive capabilities, superior to the older machine learning approaches. This model also revealed the importance of surgical duration time, BMI, and age as risk factors for patient conversion. A developing field of study is using machine learning in clinical decision-making. Our findings contribute to this field by demonstrating the feasibility and accuracy of such methods in predicting outcomes and identifying risk factors, although external and multi-center validation studies are needed.

Effect of Atmospheric Pressure Plasma Jet Treatments on Magnesium Phosphate Cements: Performance, Characterization, and Applications.

Atmospheric pressure plasma treatments are nowadays gaining importance to improve the performance of biomaterials in the orthopedic field. Among those, magnesium phosphate-based cements (MPCs) have recently shown attractive features as bone repair materials. The effect of plasma treatments on such cements, which has not been investigated so far, could represent an innovative strategy to modify MPCs' physicochemical properties and to tune their interaction with cells. MPCs were prepared and treated for 5, 7.5, and 10 min with a cold atmospheric pressure plasma jet. The reactive nitrogen and oxygen species formed during the treatment were characterized. The surfaces of MPCs were studied in terms of the phase composition, morphology, and topography. After a preliminary test in simulated body fluid, the proliferation, adhesion, and osteogenic differentiation of human mesenchymal cells on MPCs were assessed. Plasma treatments induce modifications in the relative amounts of struvite, newberyite, and farringtonite on the surfaces on MPCs in a time-dependent fashion. Nonetheless, all investigated scaffolds show a good biocompatibility and cell adhesion, also supporting osteogenic differentiation of mesenchymal cells.

Rapid Batch Surface Modification of 3D-Printed High-Strength Polymer Scaffolds for Enhanced Bone Regeneration In Vitro and In Vivo

In the emergency treatment of acute injuries in orthopedics, 3D-printing technology shows great promise due to its ability to rapidly and mass production of implants with complex structures. However, further surface modification on 3D-printed implants can often be complicated and time-consuming, leading to a prolonged timeframe from manufacturing to implantation. Therefore, there is an urgent need for rapid batch surface modification technology that can be effectively integrated with 3D-printing technology within the field of orthopedics. In this study, air-plasma treatment was used to rapidly modify 3D-printed polyetherimide (PEI) porous scaffolds and compared it with sulfonation treatment. Both methods achieved rapid surface modification of complex porous scaffolds in seconds to minutes (10 minutes), helping establish a cell-friendly surface morphology that encourages osteogenesis. Some new functional groups such as -OH and -SO3H were also introduced to promote osteogenesis. Interestingly, the air-plasma treated group enhanced cell adhesion, as indicated by a 1.6-fold increase in the number of cells compared to the control group. While sulfonation treatment accelerated the osteogenesis process, evidenced by a 1.7-fold increase in the number of calcium nodules in the sulfonation treated group compared to the control group in 7 days. To combine the advantages of air-plasma treatment and sulfonation treatment, the biological properties of their combined application were studied in vitro and in vivo for the first time. It was surprising to find that the combined application actually decreased the biological property of the material, which was associated with the generation of new free radicals. The results of this study will hopefully be applied to the rapid batch surface modification in 3D-printed porous implants to enhance their biological activity and improve the efficiency from manufacturing to implantation.

Comparison of compositional MRI techniques to quantify the regenerative potential of articular cartilage: a preclinical minipig model after osteochondral defect treatments with autologous mesenchymal stromal cells and unseeded scaffolds.

The field of orthopedics seeks effective, safer methods for evaluating articular cartilage regeneration. Despite various treatment innovations, non-invasive, contrast-free full quantitative assessments of hyaline articular cartilage's regenerative potential using compositional magnetic resonance (MR) sequences remain challenging. In this context, our aim was to investigate the effectiveness of different MR sequences for quantitative assessment of cartilage and to compare them with the current gold standard delayed gadolinium-enhanced MR imaging of cartilage (dGEMRIC) measurements. We employed ex vivo imaging in a preclinical minipig model to assess knee cartilage regeneration. Standardized osteochondral defects were drilled in the proximal femur of the specimens (n=14), which were divided into four groups. Porcine collagen scaffolds seeded with autologous adipose-derived stromal cells (ASC), autologous bone marrow stromal cells (BMSC), and unseeded scaffolds (US) were implanted in femoral defects. Furthermore, there was a defect group which received no treatment. After 6 months, the specimens were examined using different compositional MR methods, including the gold standard dGEMRIC as well as T1, T2, T2*, and T1ρ techniques. The statistical evaluation involved comparing the defect region with the uninjured tibia and femur cartilage layers and all measurements were performed on a clinical 3T MR Scanner. In the untreated defect group, we observed significant differences in the defect region, with dGEMRIC values significantly lower (404.86±64.2 ms, P=0.018) and T2 times significantly higher (44.24±2.75 ms, P<0.001). Contrastingly, in all three treatment groups (ASC, BMSC, US), there were no significant differences among the three regions in the dGEMRIC sequence, suggesting successful cartilage regeneration. However, T1, T2*, and T1ρ sequences failed to detect such differences, highlighting their lower sensitivity for cartilage regeneration. As expected, dGEMRIC is well suited for monitoring cartilage regeneration. Interestingly, T2 imaging also proved to be a reliable cartilage imaging technique and thus offers a contrast agent-free alternative to the former gold standard for subsequent in vivo studies investigating the cartilage regeneration potential of different treatment modalities.

ChatGPT in orthopedics: a narrative review exploring the potential of artificial intelligence in orthopedic practice.

The field of orthopedics faces complex challenges requiring quick and intricate decisions, with patient education and compliance playing crucial roles in treatment outcomes. Technological advancements in artificial intelligence (AI) can potentially enhance orthopedic care. ChatGPT, a natural language processing technology developed by OpenAI, has shown promise in various sectors, including healthcare. ChatGPT can facilitate patient information exchange in orthopedics, provide clinical decision support, and improve patient communication and education. It can assist in differential diagnosis, suggest appropriate imaging modalities, and optimize treatment plans based on evidence-based guidelines. However, ChatGPT has limitations, such as insufficient expertise in specialized domains and a lack of contextual understanding. The application of ChatGPT in orthopedics is still evolving, with studies exploring its potential in clinical decision-making, patient education, workflow optimization, and scientific literature. The results indicate both the benefits and limitations of ChatGPT, emphasizing the need for caution, ethical considerations, and human oversight. Addressing training data quality, biases, data privacy, and accountability challenges is crucial for responsible implementation. While ChatGPT has the potential to transform orthopedic healthcare, further research and development are necessary to ensure its reliability, accuracy, and ethical use in patient care.

Advancing patient care: unleashing the potential of artificial intelligence in orthopaedics

I am writing to highlight the remarkable strides that artificial intelligence (AI) has taken in the field of orthopaedics, paving the way for transformative changes in patient care and clinical outcomes. As the realm of medical science evolves, integrating AI into orthopaedics has the potential to revolutionize diagnosis, treatment, and management strategies, enhancing both the precision and efficiency of orthopaedic care.

Outcome of Plate and Screw Fixation in Femoral Shaft Fracture at Sanjiwani General Hospital Gianyar in 2021

Background: Femoral shaft fracture that reported the one year mortality rate post trauma is still high around 10-20%and it is a challenged in orthopedics. Surgical therapy in the orthopedic field has been highly developed in the treatment of femoral shaft fractures. Gold standard therapies that have been used for femoral shaft fractures is intramedullary nail but the ORIF PS method is still often used especially in hospitals that have inadequate health facilities by considering several risk factors and complications that can occur during the perioperative.&#x0D; Methods: This study is a retrosepctive descriptive study that aims to indentify the outcome of plate and screw fixation in femoral shaft fracture at Sanjiwani General Hospital Gianyar in 2021. Medical record, surgical procedure, and outpatient control reports were reviewed to colect pre-, intra-, and postoperative details by identifying data on complications that occur in patients with open and closed femoral shaft fractures who had performed ORIF PS at Sanjiwani General Hospital in January 2021 - December 2021. &#x0D; Result: Major complication were represented by perioperative bleeding (33%), redisual pain (8%), no complication of implant failure, deep infection, minor infection such as superficial infection and impaired wound healing in this study.&#x0D; Conclusion: In this study was concluded that the most common femoral shaft fracture complication that performed ORIF PS is perioperative bleeding pain and other complications are very rare due to several factors&#x0D; Keywords: Open reduction internal fixation; Femoral shaft fracture; Complication; Human and medicine

Enhancement of adhesion strength and in-vivo evaluation of electrodeposited calcium phosphate/chitosan biocoatings on titanium substrate

Chitosan/calcium phosphate nanocomposites are widely used as a biocompatible coatings for titanium bioimplants in the fields of dentistry and orthopedics to enhance the integration between the implants and the hard bone. However, the poor adhesion strength between the coating and the metal substrate was found to be one of the major problems in the clinical application of these implants. In the current study, we reported the formation of Ca/P coating on titanium (Ti) substrate using electrodeposition. The key factor of the bath ingredients is the change of chitosan's solvent from a commonly used acetic acid to acrylic acid in the electrolyte. The structural analysis including X-ray diffraction (XRD), Raman spectroscopy, and attenuated total reflectance (ATR) confirmed the formation of three phases of Ca/P octacalcium phosphate (OCP), dicalcium phosphate dihydrate (DCPD) brushite, and hydroxyapatite (HA). The bond strength was performed by the tape test (ASTM D3359-09) which showed that nearly 65% of the coatings were removed in the case of using 2, 4, and 6% (v/v) acetic acid as chitosan solvent, while only 5% of the coatings were removed when high concentrations (4 and 6%) of acrylic acid is used in addition to increasing of the surface wettability. Furthermore, the morphology and thickness of the calcium phosphate layer coated on the surface of Ti metal were inspected by scanning electron microscopy (SEM). Finally, an in vivo application was conducted on the optimized coating by surgically placing the coated and control discs into rats’ clavicular bones for 2-weeks healing period. Then biomechanical evaluation was performed to verify the effect of treatment on the interface resistance to shear force, and histological analysis was performed to evaluate the bone tissue reactions to coated discs. The results showed that using acrylic acid instead of acetic acid to dissolve chitosan before in-situ electrodeposition might be an innovative approach to enhance the adhesion strength between chitosan/calcium phosphate-based coatings and titanium metal to be used in orthopedic and dental implant technology.

Developing a Zn alloy with high strength and uniform elongation as a biomedical device

The equal channel angular pressing (ECAP) process was used to develop a Zn-1Mg alloy with a tensile strength of 440 MPa and uniform elongation of 11%. The uniform elongation of the ECAPed Zn-1Mg alloy is higher than that of other Zn alloys with strengths over 400 MPa. The microstructure of the ECAPed Zn-1Mg alloy evolved through dynamic recrystallization (DRX), resulting in a refined grain structure. Additionally, the lamellar eutectic structure was fragmented into sub-micrometer particles (∼0.9 μm). The high strength of the Zn-1Mg alloy is due to both grain boundary strengthening and second phase strengthening. The high uniform elongation is attributed to the presence of plate-shaped precipitates with a high density of 1014m−2. The in-vitro results indicate that ECAPed Zn-1Mg alloy has high cell viability (>100%). Meanwhile, the Zn-1Mg alloy processed by ECAP exhibited better ALP activity and alizarin red results than pure Zn. These results demonstrate that Zn-1Mg alloy is beneficial to the proliferation and differentiation of osteoblasts, and also promote blood vascular formation. The good osteogenic and angiogenic properties of the alloy are attributed to the release of Mg2+ and Zn2+ during the degradation process, which play a critical role in biochemical reactions in the human body. Therefore, the high uniform elongation and good biological properties make Zn-Mg based alloys a promising material for expanding applications in the orthopedic field.

The Influence of pH Value on the Microstructure and Properties of Strontium Phosphate Chemical Conversion Coatings on Titanium.

Strontium (Sr) is a trace element in the human body that can promote bone formation and inhibit bone absorption. A conversion coating of strontium phosphate (Sr-P) on the surface of titanium (Ti) can improve its biological properties and has many potential applications in the fields of dentistry and orthopedics. In the present study, Sr-P coatings with SrHPO4 and Sr3(PO4)2 crystals on Ti are prepared by a phosphate chemical conversion (PCC) treatment and the effect of pH values on the properties of the Sr-P coatings is researched. The results prove that the phase composition, morphology, and corrosion resistance of the coated Ti vary according to the pH values of the PCC solution. The morphology of the conversion deposition on Ti changes from plat-like to cluster-like and then to homogeneous microcrystals as the pH value changes from 2.50 to 3.25. Only discrete SrHPO4 crystals are generated on the substrate at lower pH values, while relatively stable Sr3(PO4)2 and SrHPO4 crystals grow and subsequently form an integrated coating on the Ti as the pH exceeds 2.50. The cross-sectional morphologies and bonding strength of different coatings are also researched. The corrosion resistance of coated Ti improves compared with that of bare Ti because of the Sr-P coatings with a Sr3(PO4)2 phase. In addition, it is indicated that the Sr-P coatings on Ti can improve the adhesion and differentiation of BMSCs.