Level Of Evidence Research Articles

A Modified Two-Flap Method for First-Stage Ear Reconstruction in Lobule-Type Microtia.

Autologous ear reconstruction typically involves a lengthy treatment period, often spanning 2 to 4 stages or utilizing skin expansion, to achieve satisfactory results. Consequently, an alternative procedure capable of shortening this treatment period would be advantageous for patients. We have made significant enhancements to the safety and outcomes of single-stage autologous ear reconstruction through a multitude of technical improvements. Herein, we propose a novel procedure capable of reconstructing a complete ear contour with postauricular sulcus in the first stage, with the option for subsequent tragus revision if needed. The key techniques of our first-stage ear reconstruction are as follows: preoperative design of the postauricular skin flap, meticulous elevation of a super-thin postauricular skin flap, fabrication of a modified three-layer framework, elevation of a postauricular fascial flap, postauricular skin grafting, and earlobe transposition. Between June 2020 and October 2023, 245 patients with lobule-type microtia underwent ear reconstruction surgery using our technique. The follow-up period ranged from 6 to 39months. Ninety-one percent of the patients and their families were satisfied with the outcomes. The overall complication rate was 7.5%. This modified first-stage autologous ear reconstruction technique can yield satisfactory and safe results in cases of lobule-type microtia. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Forehead Reduction Surgery: Outcomes and Complications of 650 Cases in a Multiracial Population.

Forehead reduction surgery (FRS) is gaining popularity as a cosmetic procedure for individuals with disproportionately large foreheads. A retrospective review was conducted on patients who underwent FRS from April 2018 to May 2023. Data included sex, age, ethnicity, facial thirds measurement, forehead reduction, dehiscence, hematoma, infection, seroma, and necrosis. Patients with >12-month follow-up (N = 287) were further analyzed for folliculitis, alopecia, postoperative effluvium, scar quality (SCAR scale) and patient satisfaction (5-point Likert scale). A total of 650 patients (95.5% female) underwent FRS, with an average skin excision of 2.29 cm, representing a 28% forehead reduction. Black ethnicity was associated with greater reductions, with an average advancement of 2.52 cm (p < 0.001). Complications included 14 cases of dehiscence, 6 seromas, 1 necrosis, 133 cases of folliculitis, 98 of postoperative effluvium, and 1 of alopecia. Men had significantly fewer cases of effluvium (p = 0.016). All scars were evaluated as good quality. White ethnicity and reductions exceeding 2.3 cm appeared to increase the risk of scar revision, though not statistically confirmed. FRS is an effective and safe technique with few complications and high patient satisfaction. It is essential to manage expectations and educate patients on the limitations, particularly regarding forehead shortening, correction of temporal recesses, scar development, and more frequent complications such as folliculitis. Patient selection should focus on capillary diseases that may impact long-term outcomes, such as male pattern baldness and frontal fibrosing alopecia, as well as addressing unrealistic expectations regarding the results. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Efficacy of Combined Conjoint Fascial Sheath and Levator Muscle Composite Flap Suspension for Recurrent Severe Ptosis.

Conjoint fascial sheath (CFS) and levator muscle (LM) composite flap suspension has been gradually accepted for the treatment of congenital severe blepharoptosis in recent years. This study is to evaluate the clinical efficacy of conjoint fascial sheath with levator muscle (CFS + LM) suspension in the treatment of recurrent severe ptosis. A total of 45 patients (51 eyes) with recurrent severe ptosis admitted to our hospital between February 2018 and October 2022 were treated with CFS + LM suspension. The surgical efficacy was evaluated by recording and analyzing the distance (in millimeters) from the pupillary reflex on the patient's cornea to the upper eyelid margin (MRD1), palpebral fissure height (PFH), lagophthalmos (LAG), degree of satisfaction and complications. A total of 45 patients (51 eyes) with recurrent severe ptosis were included in this study, including 26 males and 19 females, with an average age of 23.16 ± 10.68 years. The average levator function was 1.98 ± 1.35mm, and the average postoperative follow-up time was 19.71 ± 13.77 month. The preoperative MRD1 and PFH were - 0.18 ± 1.03mm and 3.90 ± 0.88mm, respectively. Postoperative follow-up was conducted at least 6 months, and the MRD1 and PFH values were 2.25 ± 0.77mm and 7.04 ± 0.82mm at the last follow-up, respectively; the differences with the corresponding preoperative values were significant (p< 0.05). All the operated eyes had different degrees of LAG, which also stabilized 6 months after surgery. The treatment was considered curative for 30 eyes (58.82%), to have made improvement in 11 eyes (21.57%), and ineffective for 10 eyes (19.61%). The overall effectiveness (curative + improvement) rate was 80.39%, and the total degree of satisfaction reached 77.78%. After surgery, conjunctival prolapse occurred in 3 patients, 2 of whom recovered after placement of fornix sutures. Conjunctival prolapse in 1 patient disappeared after conservative treatment. Exposure keratitis occurred in 1 patient and improved after drug treatment. No other complications occurred. CFS + LM suspension technique for correcting recurrent severe ptosis is easy to perform, causes minimal trauma, and results in good therapeutic effects and few complications. We recommend popularizing this technique in clinical practice. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Joint Position and General Hypermobility Affect Elbow Joint Congruence on Magnetic Resonance Imaging: A Prospective Cohort Study.

Patients with posterolateral rotational instability (PLRI) of the elbow exhibit a higher degree of joint incongruence on magnetic resonance imaging (MRI) than patients without PLRI. However, the influence of joint hypermobility and position of the elbow in healthy participants is yet unknown. To analyze the influence of general hypermobility and elbow joint position on joint congruence in healthy participants via MRI. Case-control study; Level of evidence, 4. Twenty participants with Beighton score <5 (normal group) and 20 with Beighton score ≥5 (hypermobile group) who had healthy elbows underwent bilateral MRI in full extension and supination, full extension and pronation, and 30° of flexion in both supination and pronation. Sagittal radiocapitellar joint incongruence and ulnohumeral joint incongruence (in sagittal, coronal, and axial planes) were measured according to a standardized protocol. Radiocapitellar congruence increased in pronation (P < .001) but did not change between flexion and extension (P > .05). Coronal ulnohumeral congruence increased significantly from extension and supination to pronation (P = .010) and to combined flexion and pronation (P = .011). Sagittal and axial ulnohumeral joint congruence did not change significantly between different elbow joint positions (P > .05). Significant differences between the normal and hypermobile groups were observed in 3 of the 4 evaluated joint positions. Overall, the hypermobile group showed an increased joint incongruence except in extension and pronation (P > .05). In MRI examination of healthy elbows, joint congruence increased significantly from supination to pronation. In combined extension and pronation, the elbow joint was equally congruent in the normal and hypermobile groups. When MRI scans in supination or combined flexion and pronation are evaluated, increased joint incongruence in hypermobile individuals is physiological and should not be confused with PLRI.

Pitch-Specific Advanced Analytic and Pitch-Tracking Risk Factors for Ulnar Collateral Ligament Injuries in Major League Baseball Pitchers.

The utilization of new pitch-tracking metrics has driven player development and provides more predictive pitch-specific data on physical characteristics and performance. Given the differences in each pitcher's arsenal, these pitch-specific metrics provide new potential variables to investigate ulnar collateral ligament (UCL) injury risk. To evaluate the association of several pitch-specific advanced analytic and pitch-tracking metrics on UCL surgery rates in Major League Baseball (MLB) pitchers. Case-control study; Level of evidence, 3. We performed a retrospective case-control study on all MLB pitchers who underwent primary UCL reconstruction or repair from April 2018 to November 2023. Exclusion criteria included pitchers without 2 qualifying seasons of preoperative pitch-tracking data or who previously underwent UCL surgery. Matched controls were identified in a 2:1 manner by using season, age, position, handedness, and pitch count as covariates. Pitch-specific advanced analytic and pitch-tracking metrics used commonly in the evaluation of MLB players were collected from public web sources sponsored by MLB. Statistical analysis consisted of unpaired t tests comparing preinjury metrics between the case and control groups, along with binary logistic regression. A total of 115 MLB pitchers who underwent UCL reconstruction or repair were compared with 230 matched controls. Increased velocity for fastballs, changeups, and sinkers were all associated with UCL surgery. A decreased horizontal release point for fastballs, curveballs, and sinkers were also associated with UCL surgery, along with an increased horizontal approach angle above average for fastballs and sinkers. An increased spin rate for sliders and an increased release extension for cutters were also associated with surgery. Large statistically significant differences in Pitching+ and Location+ for fastballs, changeups, and sinkers, and in Stuff+ for changeups, were associated with surgery. There were no differences in pitch-specific pitch count, active spin, spin axis, vertical release point or approach angle, or overall pitch movement between cases and controls. Binary logistic regression showed that higher velocity fastballs, sliders, and changeups were all associated with UCL surgery, along with sliders with a higher spin rate and cutters with a longer release extension. This study demonstrated that pitch-specific associations with UCL surgery exist compared with matched controls. Specifically, higher velocity fastballs, sliders, and changeups were all associated with UCL surgery, along with sliders with a higher spin rate and cutters with a longer release extension. Fastballs, changeups, and sinkers with superior ability (Pitching+) and command (Location+) were also associated with UCL surgery. While fastball velocity appears to play a role in the rise of UCL injuries, recent trends in decreased fastball usage and improved secondary pitches suggest that an increased focus on entire pitching arsenals is warranted. This study investigated a number of pitch-specific advanced analytic and pitch-tracking metrics as potentially new variables to assess UCL injury risk.

The palmar intra-articular extended window approach for distal radial fractures: a biomechanical cadaveric study.

The palmar intra-articular extended window approach for distal radial fractures: a biomechanical cadaveric study.

Neglected Achilles tendon ruptures: literature review

Objective: Review the literature on the current treatment of neglected Achilles tendon ruptures, their results, and potential complications. Methods: Bibliographic review on the state of the art in national and international databases. Articles published in indexed journals between 1991 and 2022 that addressed the treatment of Achilles tendon ruptures with more than four weeks of evolution were selected; however, only articles with less than 22 years of publication (2000-2022) were analyzed. Results: Surgical treatment is well-established in patients with significant functional demands. The various surgical techniques described in the literature and currently used have similar success rates and complications, especially regarding patient satisfaction, functional results, anthropometric measurements, and return to work and sports activities. Conclusion: Several techniques can be used to treat neglected Achilles tendon ruptures. When choosing the most appropriate technique, gap size, patient characteristics, and surgeon experience should be considered. Level of evidence I; Type of study; Evaluation of results.

Effect of Slope-Reducing Tibial Osteotomy With Primary Anterior Cruciate Ligament Reconstruction on Clinical and Radiological Results in Patients With a Steep Posterior Tibial Slope and Excessive Anterior Tibial Subluxation: Propensity Score Matching With a Minimum 2-Year Follow-up.

A steep posterior tibial slope (PTS) and excessive anterior tibial subluxation of the lateral compartment (ASLC) have been considered to be associated with inferior graft outcomes in primary anterior cruciate ligament (ACL) reconstruction (ACLR). Case series studies have demonstrated that combined slope-reducing tibial osteotomy can greatly improve knee functional scores and stability in revision ACLR. However, there is currently no comparative study evaluating the clinical benefits of osteotomy procedures in primary ACLR. To assess the feasibility of combined slope-reducing tibial osteotomy and primary ACLR in patients with a steep PTS and excessive ASLC and to explore the suitable threshold for osteotomy. Case series; Level of evidence, 4. Between 2016 and 2022, of the 108 patients with ACL injuries who had a steep PTS (≥15°) and a follow-up ≥2 years, 30 patients with excessive ASLC (≥6 mm) underwent concomitant slope-reducing tibial osteotomy and ACLR (osteotomy group), and 78 patients underwent isolated ACLR (control group). Propensity score matching at a 1:2 ratio was used to match preoperative variables between the 2 groups. After matching preoperative variables, 25 and 48 patients underwent combined surgery and isolated ACLR, respectively. The primary outcome was ACL graft status (failure and laxity rates). The secondary outcomes were ASLC and anterior tibial subluxation of the medial compartment (ASMC), KT-1000 arthrometer side-to-side difference (SSD), pivot-shift grade, and second-look arthroscopic findings. Stratified analysis was performed with 1° PTS increments to explore the osteotomy threshold. Both groups were comparable in terms of age, sex, side, body mass index, PTS, graft diameter, time from injury to surgery, ASLC, ASMC, KT-1000 arthrometer SSD, pivot-shift grade, and meniscal injuries (all P > .05). The mean PTS significantly decreased from 18.2° to 6.7° (P < .001) in the osteotomy group. The 2-year rate of ACL graft laxity was 12.0% in the osteotomy group and 35.4% in the control group, with a statistically significant difference (P = .033). There was no significant difference in the 2-year rate of ACL graft failure between the 2 groups (8.0% vs 12.5%, respectively; P = .559). The final follow-up data showed that improvements in ASLC (4.5 vs 6.4 mm, respectively; P = .012) and ASMC (2.8 vs 4.5 mm, respectively; P = .014) were more significant in the osteotomy group compared with the control group. On the second-look arthroscopic examination, the incidence of graft roof impingement in the control group was significantly higher than that in the osteotomy group (22.9% vs 4.0%, respectively; P = .039). No significant differences were observed between the 2 groups in terms of KT-1000 arthrometer SSD and high-grade pivot shift (P > .05). Furthermore, stratified analysis revealed that the combined procedure significantly reduced the ACL graft failure rate and improved the KT-1000 arthrometer SSD in patients with a preoperative PTS ≥16°. Slope-reducing tibial osteotomy combined with primary ACLR significantly decreased the amount of anterior tibial subluxation, the incidence of graft roof impingement, and the graft laxity rate for patients with a steep PTS (≥15°) and excessive ASLC (≥6 mm). Furthermore, in patients with a PTS ≥16°, the combined procedure improved anterior knee stability and reduced the graft failure rate. Therefore, a PTS ≥16° plus ASLC ≥6 mm may be considered an appropriate indication for combining slope-reducing tibial osteotomy with primary ACLR.

A Novel Assessment of Sagittal Proximal Tibial Morphology and Relationship to Proximal Posterior Tibial Slope: Lateral Supratubercle Angle.

Multiple techniques have been utilized to measure posterior tibial slope (PTS) without consensus on which imaging modality, view, and axis combination is most consistent for risk assessment and preoperative planning in primary and revision anterior cruciate ligament (ACL) surgery. An exclusively proximal-based measurement of PTS has yet to be defined. The purpose of this study was to establish normal values for novel measurements of sagittal proximal tibial morphology, the lateral supratubercle angle (LSTA) and the lateral supratubercle distance (LSTD), in normative and primary ACL tear cohorts. The secondary aim was to establish cutoff values and determine if these tibial measurement values are predictive of the presence of an ACL tear. It was hypothesized that LSTA will be significantly different between cohorts. Case-control study; Level of evidence, 3. The medical records of patients with a knee complaint between August 2016 and June 2024 were retrospectively reviewed, and the patients were placed into either the normative or primary ACL tear cohort. Three independent observers measured LSTA, LSTD, and PTS along both the lateral (L) and medial (M) tibial plateaus on standard lateral knee radiographs. Means were calculated for each measurement and compared between groups. The receiver operating characteristic curve was used to determine the sensitivity and specificity of significant measurements. Significant differences were found between normative (n = 150) and primary ACL tear (n = 150) groups in LSTA-L (normative: 9.9°± 4.4° vs primary ACL tear: 11.1°± 4.4°; P = .02), LSTA-M (normative: 10.3°± 4.4° vs ACL tear: 11.4°± 4.6°; P = .03), and PTS-M (normative: 9.2°± 3.2° vs primary ACL tear: 10.0°± 3.1°; P = .03). Mean values and ranges for LSTA and LSTD have been established in normative and primary ACL tear cohorts. LSTA-L, LSTA-M, and PTS-M significantly differed between the cohorts. Future studies with LSTA will evaluate the utilization of these proximal tibial deformity-based measurements in ACL surgery, retear risk assessment, and slope-reducing osteotomy planning.

What are These Cysts Doing in My Graft? A Meta-Analysis on Cystic Occurrence After Autografting and Allografting for Osteochondral Lesions of the Talus.

BackgroundThe exact incidence of cyst formation after graft transplantation for osteochondral lesions is unknown. The primary purpose was to assess and compare cystic occurrence after autografting, allografting, and osteoperiosteal grafting for osteochondral lesions of the talus. Our secondary aim was to assess the correlation of clinical outcomes with the presence of postoperative cysts.MethodsA literature search was performed up to October 2023 through PubMed, Embase (Ovid), and Cochrane Library. The primary outcome was the postoperative cystic occurrence rate. A random-effects model with moderator analysis was used to calculate differences in occurrence rates between treatment groups. The relationship between the presence of cysts and clinical outcomes was described.ResultsThirteen studies were included with 382 ankles. The average radiological follow-up at which the presence of cystic occurrence was assessed ranged from 12 to 84 months. The rates of cystic occurrence for the osteochondral autograft transplantation group, the allograft transplantation group, and the osteoperiosteal transplantation group were 42% (95% confidence interval [CI] = 24-61), 58% (95% CI = 40-74), and 34% (95% CI = 12-67), respectively, without any significant differences noted. No relationship between the presence of cysts and clinical outcomes was found.ConclusionPostoperative cystic occurrence is common after osteochondral autograft transplantation (42%), allograft transplantation (58%), and osteoperiosteal transplantation (34%) in osteochondral lesions of the talus-without significant intertreatment differences. The postoperative presence of cysts was not correlated with clinical outcomes. Future research should assess whether the postoperative presence of cysts correlates with (clinical) outcomes at longer follow-up.Level of Evidence:Level IV, systematic review and meta-analysis.

Allograft Reconstruction of a Ruptured Flexor Hallucis Longus Tendon in a Professional Dancer: A Case Report.

Stenosing tenosynovitis/tendinitis of the flexor hallucis longus (FHL) tendon is a relatively common occurrence in dancers. When nonoperative management fails, surgical tenolysis/tenosynovectomy has been shown to successfully reduce pain and restore function. In this study, we present the case of a professional contemporary dancer with FHL stenosing tenosynovitis/tendinitis who underwent a z-lengthening of the FHL proximal to the intact tendon sheath which resulted in a rupture of the FHL upon return to dance. He subsequently underwent a FHL reconstruction with tendon allograft. He returned to unrestricted professional dance at 11 months postoperative, which has been maintained at 4-year clinical and MRI follow-up.Level of evidence: V.

Total ankle replacement with antibiotic-impregnated cement: a case report on the infected ankle management

Ankle fracture infection is a devastating complication that can lead to chronic pain, limited motion, post-infectious end-stage anklearthritis, osteomyelitis, and amputation. Treatment historically involves aggressive debridement, hardware removal, and long-termantibiotic therapy. We describe a case of post-infectious end-stage ankle arthritis treated with a custom, fixed-bearing, 3D printed totalankle replacement with antibiotic-impregnated cement. The provided treatment allows continued elution of high-dose local antibioticswhile preserving the ankle range of motion and allowing immediate weight bearing postoperatively. Level of evidence V; Therapeutic studies; Expert opinion.

Trends of robotic total joint arthroplasty utilization in the United States from 2010 to 2022: a nationwide assessment.

The adoption of robotic assistance in total knee arthroplasty (TKA) and total hip arthroplasty (THA) is growing rapidly worldwide. This study aims to evaluate recent trends in the utilization of robotic-assisted TKA and THA across the United States spanning a 12-year period. This retrospective analysis utilized the PearlDiver All Payer Claims Database to identify patients who underwent primary, elective primary TKA or THA between 2010 and 2022. Procedures were categorized as conventional or robot assisted based on International Classification of Diseases (ICD-9), ICD-10, and Current Procedural Technology (CPT) codes. Patient demographics were captured including age, sex, and comorbidities. Annual usage trends for each modality were analyzed. Simple linear regressions were utilized to evaluate changes in the proportion of annual robot-assisted TJA performed over time relative to total procedures. P values < 0.05 were significant. Of the 2,294,076 total TKAs performed between 2010 and 2022, 1.58% were robotic assisted. Similarly, of the 1,235,577 total THAs performed, 1.26% utilized robotic assistance. Robotic TKA accounted for a steadily increasing percentage of total TKA procedures, significantly growing from 0.35% in 2010 to 3.45% in 2022, peaking at 4.39% in 2019 (P < 0.001). Similarly, robotic THA utilization showed significant growth, increasing from 0.26% in 2010 to 2.36% in 2022, peaking at 3.59% in 2019 (P < 0.001). The use of robotic-assisted TKA and THA has seen significant growth across the United States. Robotic TKA and THA have become increasingly utilized technologies, with steady growth in adoption since 2010.Level of evidence: III.

Investigating the Therapeutic Potential of Salvianolic Acid B in Ischemic Wound Healing: In Vivo and In Vitro Study.

Ischemic wounds pose a challenge to conventional treatments due to insufficient blood and oxygen supply, exacerbating patient distress and often rendering traditional treatments ineffective. Thus, improving the healing rate of ischemic wounds remains a significant challenge requiring further research and solutions. HaCaT and HUVEC were exposed to Sal-B under hypoxic conditions in vitro to assess proliferation, migration, and angiogenesis. Further, the mechanisms of action were investigated. In vivo, a mouse ischemic wound model was treated with Sal-B topically, with group comparisons including control (PBS), VEGF (100ng/ml), and Sal-B (50μmol/L, 100 μmol/L) utilizing immunofluorescence and H&E staining. Salvianolic acid B notably increased HaCaT and HUVEC proliferation, migration, and tube formation in vitro and improved ischemic wound healing rates in vivo. It modulated crucial factors such as HIF-1α, TGF-β, MMP2, and bFGF. This study indicates that salvianolic acid B promotes the healing of ischemic wounds under hypoxic conditions through multiple mechanisms. Specifically, salvianolic acid B effectively reduces the expression of HIF-1α while increasing the levels of TGF-β and bFGF, which are crucial for cell proliferation and new blood vessel formation during the wound healing process. Additionally, salvianolic acid B significantly enhances the proliferation, migration, and tube formation of HaCaT and HUVEC, accelerating wound closure, validating its potential for clinical application and highlighting new treatment strategies. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evaluating the Efficacy of Large Language Models in Generating Medical Documentation: A Comparative Study of ChatGPT-4, ChatGPT-4o, and Claude.

Large language models (LLMs) have demonstrated transformative potential in health care. They can enhance clinical and academic medicine by facilitating accurate diagnoses, interpreting laboratory results, and automating documentation processes. This study evaluates the efficacy of LLMs in generating surgical operation reports and discharge summaries, focusing on accuracy, efficiency, and quality. This study assessed the effectiveness of three leading LLMs-ChatGPT-4.0, ChatGPT-4o, and Claude-using six prompts and analyzing their responses for readability and output quality, validated by plastic surgeons. Readability was measured with the Flesch-Kincaid, Flesch reading ease scores, and Coleman-Liau Index, while reliability was evaluated using the DISCERN score. A paired two-tailed t-test (p<0.05) compared the statistical significance of these metrics and the time taken to generate operation reports and discharge summaries against the authors' results. Table 3 shows statistically significant differences in readability between ChatGPT-4o and Claude across all metrics, while ChatGPT-4 and Claude differ significantly in the Flesch reading ease and Coleman-Liau indices. Table 6 reveals extremely low p-values across BL, IS, and MM for all models, with Claude consistently outperforming both ChatGPT-4 and ChatGPT-4o. Additionally, Claude generated documents the fastest, completing tasks in approximately 10 to 14 s. These results suggest that Claude not only excels in readability but also demonstrates superior reliability and speed, making it an efficient choice for practical applications. The study highlights the importance of selecting appropriate LLMs for clinical use. Integrating these LLMs can streamline healthcare documentation, improve efficiency, and enhance patient outcomes through clearer communication and more accurate medical reports. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Man Versus Machine: A Comparative Study of Human and ChatGPT-Generated Abstracts in Plastic Surgery Research.

Since its 2022 release, ChatGPT has gained recognition for its potential to expedite time-consuming writing tasks like scientific writing. Well-written scientific abstracts are essential for clear and efficient communication of research findings. This study aims to explore ChatGPT-4's capability to produce well-crafted abstracts. Ten abstract-less plastic surgery articles from PubMed were uploaded to ChatGPT, each with a prompt to generate one abstract. Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease Score (FRES) were calculated for all abstracts. Additionally, three physician evaluators blindly assessed the ten original and ten ChatGPT-generated abstracts using a 5-point Likert scale. Results were compared and analyzed using descriptive statistics with mean and standard deviation (SD). The original abstracts averaged an FKGL of 14.1 (SD 2.9) and an FRES of 25.2 (SD 14.2), while ChatGPT-generated abstracts had scores of 15.6 (SD 2.4) and 15.4 (SD 13.1), respectively. Collectively, evaluators identified two-thirds of the ChatGPT abstracts, but preferred the ChatGPT abstracts 90% of the time. On average, the evaluators found the ChatGPT abstracts to be more "well written" (4.23 vs. 3.50, p value < 0.001) and "clear and concise" (4.30 vs. 3.53, p value < 0.001) compared to the original abstracts. Despite a slightly higher reading level, evaluators generally preferred ChatGPT abstracts, which received higher ratings overall. These findings suggest ChatGPT holds promise in expediting the creation of high-quality scientific abstracts, potentially enhancing efficiency in research and scientific writing tasks. However, due to its exploratory nature, this study calls for additional research to validate these promising findings. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The projected economic burden and complications of revision hip and knee arthroplasties: Insights from national registry studies.

The rising volume of primary hip and knee arthroplasties has led to a parallel increase in revision surgeries, creating significant clinical and economic challenges for healthcare systems worldwide. This study synthesizes national arthroplasty registry data to evaluate trends in revision aetiology, associated costs and regional disparities. While advancements in prosthetic design have reduced aseptic loosening rates (declining to 35.1% for hips and 18.3% for knees), septic complications now account for a growing proportion of revision cases, rising to 18.2% for hips and 21.6% for knees. Additionally, instability and malalignment persist at 15.9% and 14.1%, respectively. Revision procedures are 76% more costly than primary surgeries, with two-stage septic revisions incurring costs of up to $37,297 per case. Beyond direct surgical costs, prolonged recovery and productivity loss contribute to a broader economic impact. Regional variations, such as higher periprosthetic fracture rates in England and Wales, highlight inconsistencies in data reporting and healthcare practices. Addressing these challenges requires standardized infection definitions, enhanced registry collaboration and investment in infection prevention strategies. The role of referral centres in improving outcomes and reducing costs through multidisciplinary care is increasingly recognized. By integrating evidence-based infection management protocols and leveraging emerging technologies, the orthopaedic community can optimize patient outcomes and reduce the financial burden of revising arthroplasties. LEVEL OF EVIDENCE: Level IV.

Minimum Important Change for the Patient Evaluation Measure in patients with finger fractures and joint injuries.

Minimum Important Change for the Patient Evaluation Measure in patients with finger fractures and joint injuries.

Changing patterns in joint replacement surgery in the hand in Sweden: a population-based study of 5382 patients.

Changing patterns in joint replacement surgery in the hand in Sweden: a population-based study of 5382 patients.

Effects of medications on the human electroretinogram: A comprehensive review.

Effects of medications on the human electroretinogram: A comprehensive review.