Field Of Orthopedics Research Articles

Needle Arthroscopic Subchondroplasty With Adipose-Derived Stem Cell Augmentation for the Treatment of Osteochondral Lesions of the Talus

Needle arthroscopy has enjoyed a tremendous growth concerning the quality of intraoperative images due to technical innovation, resulting in innovative possibilities concerning concomitant minimally invasive procedures and treatment of osteochondral lesions of the talus (OLT). These lesions have increasingly been receiving scientific attention in the orthopaedic (sports) medicine field, and, as such, the quality of evidence-based treatment for them has developed substantially. Treatment of OLTs—and specifically subchondroplasty. OLTs may also be suitable for needle arthroscopic interventions. The purpose of the present technical note is, therefore, to present an all-arthroscopic needle arthroscopic technique, including subchondroplasty with adipose-derived stem cells augmentation for osteochondral lesions of the talus.

Application and prospect of mixed reality technology in orthopedics

ABSTRACT In recent years, mixed reality (MR) technology has emerged as a new digital visualization tool and has been increasingly used in orthopedics. In comparison to traditional methods, MR provides a deeper integration of virtual information with the real world, offering users an intuitive display of anatomical details and facilitating the transition from two-dimensional to three-dimensional imaging data. With these significant features, MR has the potential to play a vital role in orthopedics. This article outlines the unique characteristics of MR and explores its technical advantages in doctor-patient communication, medical education, and surgical navigation within the field of orthopedics. This paper aims to inspire greater use of MR technology in the era of intelligent medicine.

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

Introduction: Fracture is a bone discontinuity followed by soft tissue damage such as blood vessels, muscles and nerves. One of the most common fractures is a 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 hasbeen highly developed in the treatment of femoral shaft fractures. Method: 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 byconsidering several risk factors and complications that can occur during the perioperative. 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. Result: 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 Hospital in January 2021 - December 2021. All obtained data analysed using SPSS statisics 22 software. A total of 12 patients were included in this study. 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. Conclusion: In this study was concluded that the most common femoral shaft fracture complication that performed ORIF PS is perioperative bleeding.

Doctor, will my sleep improve after the rotator cuff surgery?

A rotator cuff tear (RCT) is one of the most common causes of disability and shoulder pain, especially in older individuals due to age-related degeneration. It is not uncommon for patients to experience sleep disturbances due to aggravated pain at night. However, only around 15% of people may have an asymptomatic RCT. Sleep disturbance is a common finding in patients with RCT. A systematic review showed that only 11% of symptomatic rotator cuff patients were without sleep disturbances.2 The quality of sleep has become an important component of our health that requires attention in patients with a rotator cuff tear. Unfortunately, in the field of orthopedics, sleep disturbances were considered trivial and underappreciated, perhaps due to many related conditions that may contribute to sleep disturbances.

Risk of Pathological Fracture and Paralysis during Rehabilitation for Patients with Bone Metastases: A Questionnaire-Based Study.

Bone metastases can cause severe pain, pathological fractures, and spinal cord paralysis, which interrupt treatment for tumors and cause patients to be bedridden. In this study, we aimed to clarify therapists' problems in the rehabilitation of patients with bone metastases and their countermeasures using the results of questionnaires to therapists and recommend safer and more rational rehabilitation. Questionnaire forms were sent to 21 therapists in our department. The questionnaire was conducted anonymously about problems during the rehabilitation procedure such as the risk of pathological fractures and paralysis. All of the therapists had strong anxiety (43%) or some anxiety (57%) about the risk of pathological fractures or paralysis during a procedure. However, no therapist responded that this had ever occurred. Many of the respondents had changed a procedure to a milder one (81%) or interrupted a procedure (48%) due to the patient's condition on the day. Therapists chose many options to reduce the risk of pathological fractures and paralysis during the procedure. Among them, "pre-rehabilitation referral to orthopedic surgeon" (86%), "consultation with a doctor about changes in patient's symptoms and findings" (86%), and "regular cooperation between multiple occupations" (67%) were frequently selected. Our questionnaire survey of therapists regarding the treatment of patients with bone metastases found that there was considerable anxiety about the risk of pathological fractures and paralysis during treatment. Our findings suggest that it is necessary to strengthen cooperation with multiple occupations, especially those in the orthopedic field.

Comparison of Plating Fixation versus Intramedullary Nailing in the Treatment of Fracture Both-Bone Forearm in Children: A Systemic Review

Background Both bone forearm fractures (BBFFs) are a common injury in children, account for 41.1% of all fractures in children, the third most common fractures in the pediatric population. Diaphyseal forearm fractures account for the most common location of re-fractures in the pediatric population. The most common mechanism of injury is a fall onto an outstretched hand. There are many debates in the field of pediatric orthopedics, including when to operate, what constitutes an acceptable reduction and what age does remodeling capability inherent to children become less effective. Greater controversy exists regarding the optimal method of fixation in children between the ages of 10 and 14 years. Fractures in this age group that cannot be maintained in acceptable alignment with closed reduction can be treated with either IM nails or ORIF with plates. Closed reduction and cast immobilization remains the gold standard treatment for minimally displaced and stable pediatric forearm fractures. Aim of the Work is to introduce a systematic review comparing between plating and intramedullary nailing (IMN) for children with diaphyseal both-bone forearm fractures (BBFFs) as regards union, functional outcome and complications. Methodology This study is a systematic review. Children aged 5–14 years with both-bone diaphyseal forearm fractures were included. Surgical fracture fixation with plates and screws vs. IM nails were compared. Results We found no statistical difference in functional outcome as measured by range of movement. We also found no consistent difference in complication rates between the two groups, although this is a difficult outcome to objectively compare. There were more cases of compartment syndrome in the IMN group than in the plating group, although numbers were low for both, and it was not entirely clear if the cases in the IMN groups developed post-operatively as opposed to being consequences of the injuries themselves. Radiographically we found no study reporting significant difference in time to fracture union. Duration of surgery and cosmetic result (scar) seem to favor the IMN group. Conclusion Despite methodological deficiencies of the studies included, IM nailing has been shown as an effective and safe treatment option for those fractures, associated with shorter operation time, improved cosmesis, and easier hard ware removal.

Translation of nanotechnology-based implants for orthopedic applications: current barriers and future perspective.

The objective of bioimplant engineering is to develop biologically compatible materials for restoring, preserving, or altering damaged tissues and/or organ functions. The variety of substances used for orthopedic implant applications has been substantially influenced by modern material technology. Therefore, nanomaterials can mimic the surface properties of normal tissues, including surface chemistry, topography, energy, and wettability. Moreover, the new characteristics of nanomaterials promote their application in sustaining the progression of many tissues. The current review establishes a basis for nanotechnology-driven biomaterials by demonstrating the fundamental design problems that influence the success or failure of an orthopedic graft, cell adhesion, proliferation, antimicrobial/antibacterial activity, and differentiation. In this context, extensive research has been conducted on the nano-functionalization of biomaterial surfaces to enhance cell adhesion, differentiation, propagation, and implant population with potent antimicrobial activity. The possible nanomaterials applications (in terms of a functional nanocoating or a nanostructured surface) may resolve a variety of issues (such as bacterial adhesion and corrosion) associated with conventional metallic or non-metallic grafts, primarily for optimizing implant procedures. Future developments in orthopedic biomaterials, such as smart biomaterials, porous structures, and 3D implants, show promise for achieving the necessary characteristics and shape of a stimuli-responsive implant. Ultimately, the major barriers to the commercialization of nanotechnology-derived biomaterials are addressed to help overcome the limitations of current orthopedic biomaterials in terms of critical fundamental factors including cost of therapy, quality, pain relief, and implant life. Despite the recent success of nanotechnology, there are significant hurdles that must be overcome before nanomedicine may be applied to orthopedics. The objective of this review was to provide a thorough examination of recent advancements, their commercialization prospects, as well as the challenges and potential perspectives associated with them. This review aims to assist healthcare providers and researchers in extracting relevant data to develop translational research within the field. In addition, it will assist the readers in comprehending the scope and gaps of nanomedicine's applicability in the orthopedics field.

Fabrication of indocyanine green-loaded zeolitic imidazole frameworks-90 coating on titanium implants to enhance antibacterial and osteogenic effects

This work aims to fabricate a novel antibiotic-free antibacterial strategy for the construction of multifunctional coating on micro-nanosheets generated titanium (M-Ti) substrates (M-Ti@ZI) using indocyanine green (ICG)-loaded zeolitic imidazole frameworks-90 (ZIF-90@ICG) under near-infrared (NIR) light irradiation. Based on the results, M-Ti@ZI presented promising pH-responsive release properties of Zn2+, as well as strong antibacterial abilities against methicillin-resistant Staphylococcus aureus (MRSA). Importantly, the antibacterial effects on MRSA were significantly improved after NIR irradiation due to the photothermal effect of ICG. Moreover, M-Ti@ZI substrates presented good cytocompatibility and induced osteogenesis both in vitro and in vivo. Therefore, the ZIF-90@ZI has promising and broad clinical applications in the orthopedic field for improving the antibacterial and osteogenic abilities of Ti-based implants.

An Overview of Magnesium-Phosphate-Based Cements as Bone Repair Materials.

In the search for effective biomaterials for bone repair, magnesium phosphate cements (MPCs) are nowadays gaining importance as bone void fillers thanks to their many attractive features that overcome some of the limitations of the well-investigated calcium-phosphate-based cements. The goal of this review was to highlight the main properties and applications of MPCs in the orthopedic field, focusing on the different types of formulations that have been described in the literature, their main features, and the in vivo and in vitro response towards them. The presented results will be useful to showcase the potential of MPCs in the orthopedic field and will suggest novel strategies to further boost their clinical application.

HPV vaccinations in males; Knowledge, attitudes, and practices of physicians on human papilloma virus vaccinations for their sons

Background/Aim: The Human Papilloma Virus (HPV) infection is the most common sexually transmitted disease and has been shown to cause cancer. Both sexes have a lifetime risk of at least 50% of exposure to HPV. Male HPV vaccinations can yield advantages for both the individual and community, including reduced transmission of HPV and protection of male and female health. The approval of vaccinations is mainly influenced by parental perspectives on this matter. It is essential to examine the subject in terms of physicians, who have the highest knowledge about HPV in society. This cross-sectional study aims to investigate physicians' attitudes and knowledge about vaccinating their male children against the human papillomavirus. Methods: A total of 1670 physicians were included in this study. Working as a physician and having a son were determined as inclusion criteria. A digital questionnaire was given to the physicians participating in the study. The answers to the survey questions were rated on a 4-point Likert scale (agree, do not know, disagree, strongly disagree). The responses were compared with the variables, and statistical analysis was performed. Results: Of the physicians participating in the study, 34.4% were male and 65.6% were female. A small percentage of the physicians (6.2%) reported that they would vaccinate their boys against HPV, and 59.9% of them indicated that they would not but they would consider it. The physicians’ who were most likely to vaccinate their sons worked in the fields of radiology (97.3%), orthopedics (80%), and gynecology (78.8%). It was determined that the physicians who said they would never have their sons vaccinated against HPV were most frequently specialists in anesthesiology and reanimation, infectious diseases, and clinical microbiology. Conclusions: This study determined that physicians in some specialties hesitated to give the HPV vaccine to their sons. The HPV vaccine is crucial for boys, and it is essential to point out the significance of providing seminars to physicians, particularly in developing nations like Turkey, regarding this issue and its consequences.

Copper bonding silicon nitride substrate using atmosphere plasma spray

Silicon nitride (Si3N4) is an excellent engineering ceramic with high strength, fracture toughness, wear resistance, and good chemical and thermal stability. Recently, the enhanced thermal conductivity enables Si3N4 to have potential application prospects in the electronic and orthopedic fields. Metal bonding with Si3N4 is often the key to these applications. Here we report a facile approach for the titanium-activated Cu bonding on Si3N4 substrates using an atmosphere plasma spray (APS) process. With X-ray diffraction (XRD) and high-resolution transmission electron microscopy (HRTEM) observation, it was shown that the interaction between the pre-bonded Ti (by APS) on Si3N4 promoted the adhesion and high bonding strength of APS Cu on Si3N4. The interfacial structure and phases were characterized, and tensile strength, electrical resistivity, thermal conductivity, and residual stress of Cu bonded Si3N4 were measured accordingly. The APS deposited Cu layer is dense, has a high purity, and is joined firmly with Ti pre-bonded Si3N4 substrate. The maximum tensile strength between Cu and Si3N4 is as high as 89.4 MPa. The Si3N4 substrate bonded with highly dense Cu demonstrates a low surface resistivity of 8.72 × 10−4 Ω∙mm, and high thermal conductivity of 98.12 W/m·K, which shows potential applications in electronic devices.

Preparing High Strength and Elongation of Biodegradable Zinc–Magnesium Alloys with Superior Antibacterial Properties and Biocompatibility

The extrusion-formed Zn–0.5Mg alloy got a improved elongation and tensile strength by the addition of Mn. The influence of Mn on the strength contribution was investigated by comparing the microstructures of the designed Zn–0.5Mg and Zn–0.5Mg–0.2Mn alloys. The deformed binary Zn–Mg alloy had a grain size of 9 μm, and the grain size of the deformed ternary Zn–Mg–Mn alloy was 3 m. This result indicated that the extrusion-formed Zn–Mg–Mn alloy had a greater contribution to grain boundary strengthening than the extrusion-formed Zn–Mg alloy. Furthermore, the precipitates in the two alloys show significant differences in size, morphology, density, and variety. Precipitates in the Mn-containing Zn alloy showed a smaller size, higher density, and the ratio of length and diameter. The high elongation rate of the extrusion-formed Zn–Mg–Mn alloy was attributed to the fully fragmented Mg2Zn11 and deformable MnZn13 phases. In addition to enhancing its mechanical characteristics, the Zn–Mg–Mn alloy, as extruded, exhibits the same corrosion rates, antibacterial properties, and biocompatibility. These results are helpful in expanding the applications of Zn alloys in the orthopaedic field.

What Are the Trends in Women's Representation Among Lead Investigators of Orthopaedic Clinical Trials?

Serving as a principal investigator for a clinical trial can bring national visibility and recognition to physicians, and it can have a substantial impact on their promotion and tenure. In the field of orthopaedics, there is a well-known gender gap in terms of representation and leadership. Examining the representation of women in clinical trial leadership may help to inform and enable the design of targeted interventions and policies to foster a more inclusive and diverse environment in clinical trial leadership. (1) What is the proportion of women principal investigators in orthopaedic clinical trials, and has this changed over time? (2) Are there trial characteristics (trial phase, status, funding source, and intervention) associated with women principal investigators? (3) What is the geographic distribution globally and regionally within the United States of clinical trials led by women principal investigators? A cross-sectional survey of clinical trials using the ClinialTrials.gov registry and results database provided by the NIH was performed on August 22, 2022. Trial characteristics included principal investigator names and gender, trial phase, type, funding source, intervention, and location (defined by continent and US Census region). Our primary outcome was the overall proportion of women orthopaedic principal investigators over time. We assessed this by comparing the proportion of women principal investigators from 2007 to 2022. Our secondary outcomes were trial characteristics (trial phase, status, funding source, and intervention) and geographic distribution (globally and within the United States) associated with women principal investigators. Baseline characteristics of the clinical trials were calculated using frequencies and percentages for categorical variables. Fisher exact tests were conducted to evaluate differences in gender proportions based on the included clinical trial characteristics. Univariate linear regression was applied to analyze trends in the annual proportion of women principal investigators over time. The overall proportion of women principal investigators was 18% (592 of 3246), and this proportion increased over the study period. Specifically, the proportion of women leading clinical trials was 13% (16 of 121) in 2007 and 22% (53 of 242) in 2022 (r 2 = 0.68; p < 0.001). This trend was also observed when evaluating only US women principal investigators (r 2 = 0.47; p = 0.003) and non-US women principal investigators over the study period (r 2 = 0.298; p = 0.03). There was no difference in the distribution of trial phases between men and women principal investigators. Most men and women were involved in "not applicable" or Phase IV trials. Similarly, there was no difference in trial status or funding source. However, women principal investigators had a higher proportion of studies involving behavioral interventions (11% [67 of 592]) compared with men principal investigators (3% [74 of 2654]; p = 0.03). The proportion of women principal investigators over the study period by world region revealed a higher proportion of women principal investigators in Asia (23% [88 of 391]), followed by South America (24% [12 of 49]), North America (18% [306 of 1746]), and Europe (16% [136 of 833]). Among all US trials over the study period, the proportion of women principal investigators across the US Census region was Northeast (19% [62 of 329]), South (18% [90 of 488]), West (20% [97 of 492]), and Midwest (13% [22 of 168]). Although there has been a notable increase in the proportion of women principal investigators over time, the overall representation remains relatively low. The disparities observed in trial characteristics and geographic distribution of women principal investigators further emphasize the need for targeted interventions and policies to foster a more inclusive and diverse environment in clinical trial leadership. These results underscore the importance of adopting practices and strategies that foster gender equity in the leadership of orthopaedic clinical trials. By establishing mentorship and sponsorship programs, early-career women surgeons can be connected with experienced leaders, cultivating a supportive network and offering valuable career guidance. Additionally, addressing geographic disparities in the representation of women principal investigators can involve the implementation of mentorship and sponsorship programs in regions with lower representation.

Virtual operation for hip joint replacement implemented by Sensable_FreeForm_Modelling: A surgical drill.

To design a virtual operation of joint replacement for surgical drills using a haptic device, SenSable_FreeForm_Modelling (SFM), to enhance surgeons' efficiency and enable "Virtual tutorial without reality" for interns. A patient with hip joint osteoarthritis is randomly selected to perform Total Hip Replacement (THR). The hip images were input into Mimics in the format of *.dicom after CT scan and then exported to SFM using the stereolithographic (*.stl) format. A surgical toolkit can be created virtually with Computer Aided Design software such as Pro-E or Ghost SDK and a visual drill scenario of THR directed by a force-respondent stick, namely Phantom. 3D models of the hip joint were rebuilt illustrating clearly that the geometrical shapes of the surgical equipment created are similar to real instruments, and the THR operation is emulated distinctly in novelty. In obedience to an ancient maxim, so called 'genuine knowledge originated from practice', this simulative operation offers hands-on experience for students in the orthopaedics field with remarkable effects, contributing not only teaching cases for medical courses but also a planning basis for physical surgery.

Physiologic postoperative presepsin kinetics following primary cementless total hip arthroplasty: A prospective observational study.

Presepsin is an emerging biomarker in the diagnosis of sepsis. In the field of orthopaedics, it could be useful in diagnosing and managing periprosthetic joint infections. To define the normal postoperative presepsin plasmatic curve, in patients undergoing primary cementless total hip arthroplasty (THA). Patients undergoing primary cementless THA at our Institute were recruited. Inclusion criteria were: Primary osteoarthritis of the hip; urinary catheter time of permanence < 24 h; peripheral venous cannulation time of permanence < 24 h; no postoperative homologous blood transfusion administration and hospital stay ≤ 8 d. Exclusion criteria were: The presence of other articular prosthetic replacement or bone fixation devices; chronic inflammatory diseases; chronic kidney diseases; history of recurrent infections or malignant neoplasms; previous surgery in the preceding 12 mo; diabetes mellitus; immunosuppressive drug or corticosteroid assumption. All the patients received the same antibiotic prophylaxis. All the THA were performed by the same surgical and anaesthesia team; total operative time was defined as the time taken from skin incision to completion of skin closure. At enrollment, anthropometric data, smocking status, osteoarthritis stage according to Kellgren and Lawrence, Harris Hip Score, drugs assumption and comorbidities were recorded. All the patients underwent serial blood tests, including complete blood count, presepsin (PS) and C-reactive protein 24 h before arthroplasty and at 24, 48, 72 and 96 h postoperatively and at 3, 6 and 12-mo follow-up. A total of 96 patients (51 female; 45 male; mean age = 65.74 ± 5.58) were recruited. The mean PS values were: 137.54 pg/mL at baseline, 192.08 pg/mL at 24 h post-op; 254.85 pg/mL at 48 h post-op; 259 pg/mL at 72 h post-op; 248.6 pg/mL at 96-h post-op; 140.52 pg/mL at 3-mo follow-up; 135.55 pg/mL at 6-mo follow-up and 130.11 pg/mL at 12-mo follow-up. In two patients (2.08%) a soft-tissue infection was observed; in these patients, higher levels (> 350 pg/mL) were recorded at 3-mo follow-up. The dosage of plasmatic PS concentration is highly recommended in patients undergoing THA before surgery to exclude the presence of an unknown infection. The PS plasmatic concentration should be also assessed at 72 h post-operatively, evaluate the maximum postoperative PS value, and at 96 h post-operatively when a decrease of presepsin should be found. The lack of a presepsin decrease at 96 h post-operatively could be a predictive factor of infection.

Orthotics and prosthetics by 3D-printing: Accelerating its fabrication flow

Orthoses and socket prostheses are rarely used orthopaedic devices in veterinary medicine. Recently, more pet owners have sought these treatments for pets with orthopaedic conditions. However, veterinarians often lack substantial scientific evidence on device outcomes and may expect high costs, the main limiting factor, if human orthopaedic market prices are assumed. This discrepancy creates an imbalance between pet owners' expectations, veterinarians' recommendations, and actual patient benefits. To address economic constraints and enhance knowledge about these devices, this study used 3D technology—namely 3D scanning and printing via fused deposition modelling—to design, modify, and manufacture orthoses and socket prostheses for ten patients, including nine dogs and one calf. An equation was devised and applied to all printed devices to streamline the resizing process for sockets and orthoses. The 3D-printed devices were fitted to the patients, and their adaptation was assessed using three novel scales based on prior scientific literature in the small animal orthopaedic field. The orthoses were well-tolerated, with successful and straightforward adaptation. Although socket prostheses were tolerated, the dogs' adaptation was suboptimal, while the calf demonstrated excellent and immediate adaptation.

Strontium-loaded magnesium phosphate bone cements and effect of polymeric additives

Magnesium phosphate-based cements (MPCs) are nowadays regarded as promising materials in the field of bone repair. The inclusion of Sr ions in the formulations may represent a valuable strategy to improve their bone regeneration performances, but the effect that such ion exerts on the physico-chemical properties of the material have not been investigated so far. In this work we describe the development of Sr-MPCs obtained including Sr ions in different forms, i.e., using Sr-substituted tri-magnesium phosphate precursor powder or including in the formulation Sr-based salts (SrCl2 and SrHPO4). The materials were characterized both in the form of pastes and hardened cements, finding that according to the type of Sr precursor used we can tune the setting time, the amount of binding phases in the cements, their morphology and thermal behavior. The dissolution behavior and the release kinetics of Mg2+ and Sr2+ can as well be modulated, and in particular the use of SrCl2 in the formulation leads to a higher dissolution and a faster release of a significant amount of both Mg2+ and Sr2+, compared to the other samples. Given the unsatisfying performances obtained during the injectability and anti-washout tests, we also included two polymeric additives, namely poly(N-isopropylacrylamide) and mucin, in the Sr-MPCs formulations. The results demonstrate that it is possible to obtain Sr-MPCs with promising properties for applications as bone cements, that can be tuned according to the form under which Sr is included in the formulation. In addition, mucin markedly improves the cohesion and injectability of the Sr-MPC pastes, providing a simple but effective strategy to develop materials of interest in the orthopedic field.

Different internal fixation methods for Hoffa-like fractures of the tibial plateau: a finite element analysis.

Due to the low incidence of posteromedial tibial plateau fractures and limited clinical data available, the optimal treatment for this type of fracture remains to be established. This type of fracture, also known as Hoffa-like fracture of the tibial plateau, shares a similar mechanism of injury with the Hoffa fracture of the femoral condyle. In the field of orthopedics, finite element analysis is considered a valuable method to guide clinical decision-making. In this study, four methods used for internal fixation of Hoffa-like fractures of the tibial plateau were compared using computer simulation and applying a finite element method (FEM). The methods compared were lateral L-plate fixation alone (Model A); lateral L-plate combined with posterior anti-slip plate (reconstruction plate/T-plate) fixation (Model B); lateral L-plate combined with posterior hollow nail fixation of the fracture block (Model C); and lateral L-plate combined with anterior hollow nail fixation of the fracture (Model D). The maximum displacement of the model and the maximum stress of the internal fixation material were analyzed by applying an axial load of 2,500 N. The results showed that, in the normal bone model, the maximum displacement of the fracture in Model A was 0.60032 mm, with improved stability through the addition of posterior lateral plate fixation in Model B and reduction of the displacement to 0.38882 mm. The maximum displacement in Model C and Model D was comparable, amounting to 0.42345 mm and 0.42273 mm, respectively. Maximum stress was 1235.6 MPa for Model A, 84.724 MPa for Model B, 99.805 MPa for Model C, and 103.19 MPa for Model D. In the internal fixation analysis of the osteoporotic fracture model, we observed patterns similar to the results of the normal bone model. The results indicated that Model B yielded the overall best results in the treatment of Hoffa-like fractures of the tibial plateau. The orthopedic surgeon may wish to implement these insights into the perioperative algorithm, thereby refining and optimizing clinical patient care. In addition, our findings pave the way for future research efforts.

Medical Students' Perceptions of Orthopedics as a Career for Women.

To determine potential factors influencing female medical students' interest and subsequent application to orthopedics, and to evaluate female and male medical students' perceptions of women in the field of orthopedics. An institutional review board-approved survey was distributed in March 2020 and subsequently in April 2022 to medical students in the classes of 2023 and 2024 at the University of Alabama at Birmingham Heersink School of Medicine. Study data were collected and managed using REDCap electronic data capture. An e-mail link to the REDCap survey was sent to students across the southeast region of the United States, followed by three reminder e-mails. All 25 allopathic medical schools in the southeastern United States with an Orthopedics Interest Group listed on their institution's Web site were invited to participate in the study. Nine Orthopedics Interest Group leaders interested in participating were asked to provide the researchers with a list of fourth-year medical students who attended an event hosted by that group (215). A total of 39 respondents who completed the survey were included in this study. Overall, the majority of students (n = 35, 90%) believed that women faced more barriers to a career in orthopedics than did men. The most significant barriers to women entering the field of orthopedics were the perceived expectations of an orthopedic surgeon (n = 34, 87%), difficulty balancing career and family (n = 28, 72%), and demanding schedule (n = 13, 33%). This study demonstrates that both male and female medical students believe there are significant additional barriers to success for women in the field. Study participants report that expectations set by physicians, other healthcare professionals, and patients contribute to creating greater barriers that deter medical students interested in orthopedics from ultimately applying to the specialty.

Characteristics and Research Trends of the 100 Most-Cited Flatfoot Articles.

Bibliometric studies in the field of orthopedics have increased because of the large volume of the available literature that prevents understanding the general status of the related field. This study aimed to identify and analyze the 100 most-cited articles related to flatfoot to reveal their characteristics and research trends. Available literature on the Web of Science database until the end of 2020 were analyzed, and the 100 most-cited articles were determined. The characteristics of articles including publication year, authors, institutions, country, journal, number of pages, number of references, study design, level of evidence, main topic, age group, the specialty of the first author, and availability of funding were extracted and statistically analyzed for any association with the number of citations or citation density. The average citation number was 63.1 ± 43.8 (range, 30-278). The average citation density was 3.4 ± 1.8 (range, 0.8-12.6). The United States was the leading country with 65 articles, followed by Taiwan and the United Kingdom with five articles from each. Twenty-six papers had Level III evidence and 36 papers had Level IV evidence. Only three studies had Level I evidence and three had Level II evidence. The majority of articles (43 papers) were published in Foot & Ankle International. Citation density was positively correlated with publication year (P < .001) and the number of references (P = .004). The available data provide general characteristics of the 100 most influential papers about flatfoot. The vast majority of papers had a low level of evidence, indicating the need for higher quality research.