Orthopedic Research Articles

Interleukin-1 receptor antagonist enhances the therapeutic efficacy of a low dose of rhBMP-2 in a weight-bearing rat femoral defect model

In the clinical treatment of fractures, rhBMP-2 administration is associated with a well-established profile of side-effects, including osteolysis and ectopic bone formation, which are driven by pro-inflammatory processes triggered by the use of high doses. Immunomodulatory strategies could minimize the incidence of side-effects by enabling the use of lower, and safer, rhBMP-2 doses. This study investigated whether interleukin-1 receptor antagonist (IL-1Ra) can enhance the therapeutic efficacy of a low dose of rhBMP-2 in a weight-bearing femoral fracture healing model. Exogenous IL-1Ra, in combination with rhBMP-2, was delivered using a collagen-hydroxyapatite scaffold (CHA) to attenuate IL-1β produced in response to fracture. Femoral defects were treated with CHA scaffolds alone, or loaded with IL-1Ra (2.5 µg), rhBMP-2 (1 µg), IL-1Ra (2.5 µg) in combination with rhBMP-2 (1 µg). Bone healing was assessed over 14 weeks in comparison to control groups, empty defect, and a higher dose of rhBMP-2 (5 µg), which were recently demonstrated to lead to non-union, and successful bridging of the defect, respectively. The combination of IL-1Ra and rhBMP-2 led to significantly faster early bone formation, at both week 4 and 6, compared to a low dose of rhBMP-2 alone. By 14 weeks, the combination of IL-1Ra and a rhBMP-2 promoted full bridging of femurs, which were 3-fold more mechanically reliable compared to the femurs treated with a low dose of rhBMP-2 alone. Taken together, this study demonstrates that IL-1Ra can significantly enhance femoral bone healing when used in combination with a low dose of rhBMP-2. Statement of significanceEnabling the use of lower and safer doses of rhBMP-2, a potent inducer of bone formation, is of clinical relevance in orthopaedic medicine. In this study, the immunomodulatory interleukin-1 receptor antagonist (IL-1Ra) was investigated for its capacity to enhance the therapeutic efficacy of rhBMP-2 when used at lower doses in a weight-bearing femoral fracture healing model. The combination of IL-1Ra and rhBMP-2 led to significantly faster early bone formation, and resulted in more mechanically reliable healed femurs, compared to a low dose of rhBMP-2 alone. This demonstrates for the first time in a rat long bone healing model that IL-1Ra can significantly enhance bone healing when used in combination with a low dose of rhBMP-2.

Allogenic perinatal tissue for musculoskeletal regenerative medicine applications: a systematic review protocol

BackgroundMusculoskeletal ailments impact the lives of millions of people, and at times necessitate surgery followed by physiotherapy, drug treatments, or immobilization. Regenerative musculoskeletal medicine has undergone enormous progress over the last few decades. Sources of tissues used for regenerative medicine purposes can be grouped into autologous or allogenic. Although autologous sources are promising, there is a wide range of limitations with the treatment, including the lack of randomized controlled studies for orthopaedic conditions, donor site morbidity, and highly variable outcomes for patients. Allogenic sources bypass some of these shortcomings and are a promising source for orthopaedic regenerative medicine applications.MethodsA systematic search will be performed using PubMed, Elsevier, ScienceDirect, and Google Scholar databases for articles published in English before May 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and guidelines will be used. Studies will be eligible if they apply to acute and chronic orthopaedic musculoskeletal complications or animal or human disease models. Publications must include the use of MSCs and/or tissue obtained from amniotic/chorionic membrane, amniotic fluid, umbilical cord, and/or umbilical cord-derived Wharton’s jelly as an intervention. Placebos, noninjury models, acute injury models, non-injury models, and gold standard treatments will be compared. The study selection will be performed by two independent reviewers using a dedicated reference management software. Data synthesis and meta-analysis will be performed separately for preclinical and clinical studies.DiscussionThe results will be published in relevant peer-reviewed scientific journals. Investigators will present results at national or international conferences.Trial registration: The Protocol will be registered on PROSPERO international prospective register of systematic reviews prior to commencement.

Different Sources of Mesenchymal Stem Cells for Tissue Regeneration: A Guide to Identifying the Most Favorable One in Orthopedics and Dentistry Applications.

The success of regenerative medicine in various clinical applications depends on the appropriate selection of the source of mesenchymal stem cells (MSCs). Indeed, the source conditions, the quality and quantity of MSCs, have an influence on the growth factors, cytokines, extracellular vesicles, and secrete bioactive factors of the regenerative milieu, thus influencing the clinical result. Thus, optimal source selection should harmonize this complex setting and ensure a well-personalized and effective treatment. Mesenchymal stem cells (MSCs) can be obtained from several sources, including bone marrow and adipose tissue, already used in orthopedic regenerative applications. In this sense, for bone, dental, and oral injuries, MSCs could provide an innovative and effective therapy. The present review aims to compare the properties (proliferation, migration, clonogenicity, angiogenic capacity, differentiation potential, and secretome) of MSCs derived from bone marrow, adipose tissue, and dental tissue to enable clinicians to select the best source of MSCs for their clinical application in bone and oral tissue regeneration to delineate new translational perspectives. A review of the literature was conducted using the search engines Web of Science, Pubmed, Scopus, and Google Scholar. An analysis of different publications showed that all sources compared (bone marrow mesenchymal stem cells (BM-MSCs), adipose tissue mesenchymal stem cells (AT-MSCs), and dental tissue mesenchymal stem cells (DT-MSCs)) are good options to promote proper migration and angiogenesis, and they turn out to be useful for gingival, dental pulp, bone, and periodontal regeneration. In particular, DT-MSCs have better proliferation rates and AT and G-MSC sources showed higher clonogenicity. MSCs from bone marrow, widely used in orthopedic regenerative medicine, are preferable for their differentiation ability. Considering all the properties among sources, BM-MSCs, AT-MSCs, and DT-MSCs present as potential candidates for oral and dental regeneration.

Enhancing the function of PLGA-collagen scaffold by incorporating TGF-β1-loaded PLGA-PEG-PLGA nanoparticles for cartilage tissue engineering using human dental pulp stem cells.

Since cartilage has a limited capacity for self-regeneration, treating cartilage degenerative disorders is a long-standing difficulty in orthopedic medicine. Researchers have scrutinized cartilage tissue regeneration to handle the deficiency of cartilage restoration capacity. This investigation proposed to compose an innovative nanocomposite biomaterial that enhances growth factor delivery to the injured cartilage site. Here, we describe the design and development of the biocompatible poly(lactide-co-glycolide) acid-collagen/poly(lactide-co-glycolide)-poly(ethylene glycol)-poly(lactide-co-glycolide) (PLGA-collagen/PLGA-PEG-PLGA) nanocomposite hydrogel containing transforming growth factor-β1 (TGF-β1). PLGA-PEG-PLGA nanoparticles were employed as a delivery system embedding TGF-β1 as an articular cartilage repair therapeutic agent. This study evaluates various physicochemical aspects of fabricated scaffolds by 1HNMR, FT-IR, SEM, BET, and DLS methods. The physicochemical features of the developed scaffolds, including porosity, density, degradation, swelling ratio, mechanical properties, morphologies, BET, ELISA, and cytotoxicity were assessed. The cell viability was investigated with the MTT test. Chondrogenic differentiation was assessed via Alcian blue staining and RT-PCR. In real-time PCR testing, the expression of Sox-9, collagen type II, and aggrecan genes was monitored. According to the results, human dental pulp stem cells (hDPSCs) exhibited high adhesion, proliferation, and differentiation on PLGA-collagen/PLGA-PEG-PLGA-TGFβ1 nanocomposite scaffolds compared to the control groups. SEM images displayed suitable cell adhesion and distribution of hDPSCs throughout the scaffolds. RT-PCR assay data displayed that TGF-β1 loaded PLGA-PEG-PLGA nanoparticles puts forward chondroblast differentiation in hDPSCs through the expression of chondrogenic genes. The findings revealed that PLGA-collagen/PLGA-PEG-PLGA-TGF-β1 nanocomposite hydrogel can be utilized as a supportive platform to support hDPSCs differentiation by implementing specific physio-chemical features.

Graphene-MoS2 polyfunctional hybrid hydrogels for the healing of transected Achilles tendon.

Healing of injured tendon is a major clinical challenge in orthopaedic medicine, due to the poor regenerative potential of this tissue. Two-dimensional nanomaterials, as versatile scaffolds, have shown a great potential to support, trigger and accelerate the tendon regeneration. However, weak mechanical properties, poor functionality and low biocompatibility of these scaffolds as well as post-surgery infections are main drawbacks that limit their development in the higher clinical phases. In this work, a series of hydrogels consisting polyglycerol functionalized reduced graphene oxide (PG), polyglycerol-functionalized molybdenum disulfide (PMoS2) and PG/PMoS2 hybrid within the gelatin matrix are formulated in new scaffolds and their ability for the healing of injured Achilles tendon, due to their high mechanical properties, low toxicity, cell proliferation enhancement, and antibacterial activities is investigated. While scaffolds containing PG and PMoS2 showed a moderate tendon regeneration and anti-inflammatory effect, respectively, their hybridization into PG/PMoS2 demonstrated a synergistic healing efficiency. Along the same line, an accelerated return of tendon function with low peritendinous adhesion and low cross-sectional area in animal group treated with scaffold containing PG/PMoS2 was observed. Taking advantage of the high biocompatibility, high strength, straightforward construction and fast tendon regeneration, PG/PMoS2 can be used as a new scaffold for the future tissue engineering.

Finite element analysis of the influence of porosity and pore geometry on mechanical properties of orthopaedic scaffolds

PurposeScaffolds play a key role in regenerative medicine in the repair of injuries, defects and cancerous changes in long bones. For this reason, scaffolds should meet certain mechanobiological requirements, such as adequate porosity and pore geometry to ensure appropriate osteointegration as well as load transfer. Taking into account the most frequently used cell units, this study attempted to evaluate the porous structures of orthopaedic scaffolds in terms of their strength parameters. Materials and methodsFour pore geometries were selected for analyses: sphere, octagonal prism, cube and triangular prism, all with porosities of 10% up to 60%. Three different material properties were considered: Ti6Al4V alloy, CoCr alloy, 316 L steel. Strength compression simulations were carried out on 144 models, 72 structures of cell units with dimensions of 4 × 4 × 4 mm and 72 structures of scaffolds with a diameter of 16 mm and a height of 15 mm. Effective Young's modulus, as well as 0.2%, offset effective yield strength was estimated. ResultsResearch has shown that scaffolds with bone-like strength properties should be made of Ti6Al4V alloy. The value of 40% turned out to be of the best porosity. The remaining porosities showed much lower or much higher strength parameters and were significantly different from the properties of the bones. ConclusionsThe obtained data allow to indicate the most functional porous structure with Young's modulus similar to that possesses by core bone, while maintaining mechanical strength, allowing for its appropriate use in orthopaedic regenerative medicine.

Evaluating the Academic Influence of Orthopedic Surgeons in Spinal Literature Through Relative Citation Ratio.

Introduction: The innovative iCite tool applies the relative citation ratio (RCR) to gauge the time and field-adjusted scientific influence of a publication. This study examines scholarly effects on spine surgery to distinguish the impact made by orthopedic surgeons, neurosurgeons, and several other specialists.Materials and methods: From 2013 to 2017, 100 of the highest RCR-rated articles were gathered for each of the following terms: cervical disc herniation (CDH), lumbar disc herniation (LDH), lumbar spinal stenosis (LSS), neurogenic claudication (NC), radiculopathy (RAD), and sciatica (SC). The first, second, and last authors were queried for background and academic qualifications and placed into the following specialty categories: orthopedic surgery, neurosurgery, pain management, medicine, and others. To provide an alternative degree of influence, the Scopus database was employed to classify the h-index associated with each author.Results: Across the six search terms, there were 526 orthopedic surgeons among 1,730 authors (30.4%), with the highest representation in LSS (118/290, 40.7%), and the lowest in SC (45/286, 15.7%). Orthopedics was the most influential specialty across all six research terms by median RCR (p = 0.012). Compared to their neurosurgical counterparts, orthopedic authors had a greater influence in CDH (3.93 vs. 2.63, p = 0.0492), LDH (5.10 vs. 4.99, p = 1.0000), NC (2.16 vs. 1.40, p = 0.2370), and SC (3.35 vs. 3.04, p = 0.5285), but had a lower influence in LSS (5.13 vs. 5.32, p = 0.7736) and RAD (5.03 vs. 6.05, p = 0.3938).Conclusion: Orthopedic surgeons lead other specialties when determining scholarly influence through RCR across six of the pre-designated research domains within spine surgery. For orthopedics, a modest influence in LSS and RAD may suggest potential areas of future focus. The use of bibliometrics to analyze available literature enables us to identify other specialties that have contributed to our field and promote interdisciplinary collaboration.

Needs Assessment of Essential Anatomy: A Perspective from Anesthesiology, Emergency Medicine, ObGyn and Orthopedics Resident

IntroductionCurricular development begins with identifying a problem, followed by a needs assessment of curricular components. Changes in pedagogical approaches and reductions in curricular time for gross anatomy have been identified as problems in undergraduate medical education. The objective of this study was to conduct a needs assessment of the most essential anatomy for residents in Anesthesiology (AN), Emergency Medicine (EM), Ob/Gyn (OB), and Orthopedics (OR) at Beaumont Health in Royal Oak, MI (the teaching hospital for Oakland Univ. William Beaumont School of Medicine).MethodsResidents completed a survey to assess the clinical importance of 907 anatomical structures for the back, upper limb (UL), lower limb (LL), thorax (Thx), abdomen (Abd), pelvis and perineum (P&P), and head and neck (H&N) on a 1‐4 Likert‐scale (1=not important; 4=essential). Kruskal‐Wallis analyses with a Bonferroni correction (p<0.007) were used to assess differences of top‐level items for each region between residency groups. The 3 and 4 rating response frequencies for each structure formed a basis for classifications of importance: structures rated 3 or 4 by ≥75.0% were essential, 50.0‐74.9% more important, 25.0‐49.9% less important, 0.0‐24.9% not important.ResultsFifty‐five residents (AN, N=6; EM, N=l5; OB, N=13; OR, N=21) completed the survey. Ratings by OR residents were significantly higher for the limbs than AN, ER, and OB, and higher for the back than EM and OB. Ratings by OB residents were significantly higher for P&P than by AN and ER residents. No ratings differences were found for Thx, Abd, or H&N. Classifications of essential and more important for all structures across body regions were: AN, 71.8%; EM, 64.5%, OB: 52.0%, OR: 99.9%. Individual regions with ≥70% of structures essential or more important were: AN (Back, Thx, Abd, H&N), EM (UL, Thx, H&N), OB (Abd, P&P), OR (all regions). Regions with ≥20% of structures as not important were: AN (UL, P&P), EM (Back), OB (UL). With few exceptions, the following were classified as essential or more important: surface anatomy, meninges, heart, great vessels, respiratory tract, thoracic skeleton, peritoneum, diaphragm, abdominal veins, skull, cervical fascial spaces, cranial nerves, thyroid and parathyroid glands, and the lumbar and brachial plexuses.ConclusionsThis study conducted a needs assessment of anatomy curricular content solely from the perspective of selected non‐primary care residents at a single clinical site. Significant differences in ratings were found between residents for body regions in which residents would be expected to focus their clinical (surgical) activity (notably, OR and OB).SignificanceThis data provides insight into the importance that non‐primary care residents placed on specific anatomical structures. The authors suggest that the classifications of importance for specific anatomy by these residents were informed by their clinical perspective, and can serve as a guide for curricular development in the context of reduced contact hours, new pedagogies, and vertical integration.

Corrosion Behavior of Selective Laser Melting (SLM) Manufactured Ti6Al4V Alloy in Saline and BCS Solution.

The frequency of surgeries involving the use of metal implants in orthopedic medicine to replace degenerative or fractured joints is increasing, and it is therefore important to optimize the lifespan and quality of these implants. Advances in additive manufacturing (AM), or 3D printing, are creating new opportunities to personalize implants in ways that reduce mechanical stress at the joint implant interface and improve bone ingrowth and implant stability; however, it is not well understood if and to what degree the AM process alters the corrosion behavior of the materials it produces. In this study, six Ti6Al4V prints manufactured via a selective laser melting (SLM) method were examined regarding their corrosion behavior in both saline and bovine calf serum (BCS) solutions. Ecorr and Icorr values were comparable between the CM-Ti6Al4V control and SLM-EDM surfaces; however, SLM surfaces were found to have more narrow passivation behavior evidenced by significant decreases in Epass values relative to CM-Ti6Al4V. We believe this is a consequence of microstructural differences between CM-Ti6Al4V and SLM-Ti6Al4V. Specifically, the SLM-Ti6Al4V demonstrated a dominant α' martensitic microstructure and decreased vanadium-rich β-phase. BCS solution had a detrimental effect on potential parameters, Ecorr and OCP, decreasing these values relative to their saline counterparts. Increased surface roughness of the SLM-printed surface seemed to amplify the effects of the BCS solution. Furthermore, modest decreases in Epass and Ipass were observed in BCS solution, suggesting that the presence of protein may also interfere with passivation behavior. These findings have implications for how SLM-Ti6Al4V implants will perform in vivo and could possibly influence implant longevity and performance.

Image Findings of Juxtacortical Lesions

Juxtacortical lesions appear as neoplastic formations on the outer cortical surface of bone. They can arise from nonneoplastic and neoplastic origin, the latter of which might be malignant. Juxtacortical lesions of neoplastic origin can be categorized into bone-forming lesions, cartilaginous lesions, fibrous lesions, lesions of local vascular or neurogenic origin, or metastatic lesions. Forming a differential diagnosis can be challenging for any physician assistant. We selected a series of cases from our tertiary care clinic that have been subject to discussion for their similarity but vastly different prognosis. Our aim is to provide a rubric to compare juxtacortical lesions with guide orthopaedic and sport medicine providers in determining the immediacy of referral and follow-up.

Optimizing the Impact of Your Foot and Ankle Research: Publication Trends in the Orthopedic Literature

Category:OtherIntroduction/Purpose:Research plays a central role in advancing orthopedic medicine. Not only do high publication volumes encourage greater transparency and evidence-based practice, early-career physicians are also often evaluated by the number and impact of their publications. According to 2020 NRMP match data, 81% of medical students who successfully matched into orthopedics have five or more publications. With the expanded number and variety of journals available today, however, it can be burdensome for authors to effectively determine the journal that is most suitable for a given project. This study aims to provide a comprehensive guide to the current foot and ankle orthopedic literature and to help physicians quickly identify where they may have the greatest impact.Methods:We examined 61 orthopedic journals, including both general orthopedic and foot and ankle (FA) specialty journals. We applied the National Library of Medicine's MEDLINE database for keyword searches, and Web of Science's (WOS) Journal Citation Report for citation data. Journals were excluded from this study if they were not indexed in both MEDLINE and WOS over the last five years (2016-2020). As a measure of relevance, we used a keyword search to determine the number of articles that are foot and ankle specific for each journal (FA %). We calculated the five-year impact factor for both the total journal (Total IF) and specifically for foot and ankle articles in the journal (FA IF). Impact factors were calculated following standard Journal Citation Reports methods. Other variables, such as publishing nationality, number of authors, and article type were also collected to identify variables that may be associated with higher impact.Results:43/61 journals met the indexing inclusion criteria and 47,680 publications were thereafter analyzed (Table 1). Foot and ankle articles make up less than 20% of all non-FA journals, with KSSTA (17% FA) and JOT (15% FA) publishing the most. While there is a fair correlation between the impact factor of a journal and the impact factor of FA articles (R2=0.89), journal-wide impact factors do not always predict success. KSSTA, for example, has a high FA article impact factor of 4.11 despite a journal- wide impact factor of 3.74. Author demographics also vary widely depending on the journal publishing country. While 42.4% of all articles feature an author from the US, the number of US authors in American and international journal articles is 64.3% and 20.3%, respectively.Conclusion:There are few tools specific to foot and ankle topics that authors can use to assess journals appropriate for a given project. Bibliometric analyses offer an efficient and objective method for authors to identify relevant journals, and readerships, they may not have otherwise considered. While some non-FA journals offer a higher average impact for FA articles, FA articles compose a small percentage of the journal portfolio. Journals vary in acceptance of review articles and case reports versus original research. A better understanding of journal publication trends may facilitate optimal journal selection, and improve publication efficiency and impact.

Electrical stimulation waveform-dependent osteogenesis on PVDF/BaTiO3 composite using a customized and programmable cell stimulator.

Directing cellular functionalities using biomaterial-based bioelectronic stimulation remains a significant constraint in translating research outcomes to address specific clinical needs. Electrical stimulation is now being clinically used as a therapeutic treatment option to promote bone tissue regeneration and to improve neuromuscular functionalities. However, the nature of the electrical waveforms during the stimulation and underlying biophysical rationale are still not scientifically well explored. Furthermore, bone-mimicking implant-based bioelectrical regulation of osteoinductivity has not been translated to clinics. The present study demonstrates the role of the electrical stimulation waveform to direct differentiation of stem cells on an electroactive polymeric substrate, using monophasic direct current (DC), square waveform, and biphasic waveform. In this regard, an in-house electrical stimulation device has been fabricated for the uninterrupted delivery of programmed electrical signals to stem cells in culture. To provide a functional platform for stem cells to differentiate, barium titanate (BaTiO3 , BT) reinforced poly(vinylidene difluoride) (PVDF) has been developed with mechanical properties similar to bone. The electrical stimulation of human mesenchymal stem cells (hMSCs) on PVDF/BT composite inhibited proliferation rate at day 7, indicating early commitment for differentiation. The phenotypical characteristics of DC stimulated hMSCs provided signatures of differentiation towards osteogenic lineage, which was subsequently confirmed using alkaline phosphatase assay, collagen deposition, matrix mineralization, and genetic expression. Our findings suggest that DC stimulation induced early osteogenesis in hMSCs with a higher level of intracellular reactive oxygen species (ROS), whereas the stimulation with square wave directed late osteogenesis with a lower ROS regeneration. In summary, the present study critically analyzes the role of electrical stimulation waveforms in regulating osteogenesis, without external biochemical differentiation inducers, on a bone-mimicking functional biomaterial substrate. Such a strategy can potentially be adopted to develop orthopedic implant-based bioelectronic medicine for bone regeneration.

Allogenic Amniotic Tissue for Treatment of Knee and Hip Osteoarthritis.

Osteoarthritis (OA) impacts millions of people and places a high burden on healthcare systems in the United States. Current treatment modalities have limitations and do not address underlying pathology. Lately, there has been an immense growth in the use of biologics, including perinatal allogenic tissues for orthopedic regenerative medicine applications. Amniotic tissue is an exciting new alternative for such applications. Despite several published studies that reported its use for treatment of ophthalmic conditions and complex wounds, there are limited clinical studies evaluating its safety and efficacy in treating patients suffering with knee or hip OA. In this manuscript, I focused on three prospective clinical studies which evaluated the safety and efficacy of amniotic tissue in patients suffering with moderate knee or hip OA. The results from these studies presented the scientific community with much needed, well-executed, and prospective clinical trials. Though these trials demonstrated that administration of amniotic tissue in knee or hip joint is safe and potentially effective, more multi-center, prospective, double-blinded, randomized controlled trials are warranted to further establish the efficacy of amniotic tissue to mitigate symptoms of knee and hip OA to ultimately justify its clinical use.

Medical student residency preferences and motivational factors: a longitudinal, single-institution perspective

BackgroundA high proportion of medical school graduates pursue specialties different from those declared at matriculation. While these choices influence the career paths, satisfaction, and potential regret students will experience, they also impact the supply and demand ratio of the shorthanded physician workforce across many specialties. In this study, we investigate how the choice of medical specialty and the factors motivating those choices change between the beginning and end of medical school training.MethodsA questionnaire was administered annually from 2017 to 2020 to a cohort of medical students at the University of Connecticut to determine longitudinal preferences regarding residency choice, motivational factors influencing residency choice, future career path, and demographic information.ResultsThe questionnaire respondent totals were as follows: n = 76 (Year 1), n = 54 (Year 2), n = 31 (Year 3), and n = 65 (Year 4). Amongst newly matriculated students, 25.0% were interested in primary care, which increased ~ 1.4-fold to 35.4% in the final year of medical school. In contrast, 38.2% of matriculated students expressed interest in surgical specialties, which decreased ~ 2.5-fold to 15.4% in the final year. Specialty choices in the final year that exhibited the largest absolute change from matriculation were orthopedic surgery (− 9.9%), family medicine (+ 8.1%), radiology (+ 7.9%), general surgery (− 7.2%), and anesthesiology (+ 6.2%). Newly matriculated students interested in primary care demonstrated no differences in their ranking of motivational factors compared to students interested in surgery, but many of these factors significantly deviated between the two career paths in the final year. Specifically, students interested in surgical specialties were more motivated by the rewards of salary and prestige compared to primary care students, who more highly ranked match confidence and family/location factors.ConclusionsWe identified how residency choices change from the beginning to the end of medical school, how certain motivational factors change with time, how these results diverge between primary care and surgery specialty choice, and propose a new theory based on risk-reward balance regarding residency choice. Our study promotes awareness of student preferences and may help guide school curricula in developing more student-tailored training approaches. This could foster positive long-term changes regarding career satisfaction and the physician workforce.

The use of intra‐articular platelet rich plasma for the symptomatic management of osteoarthritis of the knee: a pilot study

Osteoarthritis of the knee is a chronic inflammatory condition resulting in significant patient disability, with intra-articular platelet rich plasma (PRP) injections having shown potential to improve symptomatic outcomes. This retrospective cohort pilot study aimed to observe whether PRP injections were beneficial in the symptomatic management of knee osteoarthritis in an Australian population, based on patient reported outcomes. An additional aim was to observe for an association between the number of injections and patient characteristics, such as body mass index, age, sex and radiologically determined severity of the disease. The cohort was drawn from those who attended Ballarat Orthopaedic and Sports Medicine for PRP injections and who had completed the appropriate pre- and post-injection Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire. WOMAC scores were analysed to observe for any difference following a course of PRP injections. The data suggest that the use of PRP improved patient reported WOMAC scores. Additionally, it was shown that two injections had a greater effect than one injection, with a third injection providing no further benefit. Finally, there was an association with lower WOMAC scores post PRP therapy amongst male participants compared to female participants. These results suggest two PRP injections are optimal for the symptomatic management of knee osteoarthritis, identifying a need for further prospective research in this Australian population.

Sensitivity Analysis of a Smart 3D-Printed Hand Prosthetic

In this study, prosthesis performance was examined in the direction of prosthesis comfort, which may be incorporated into clinical practice as considerations for the fabrication of patient-specific prostheses. The need to produce patient-specific prosthetics is very germane to assist in orthopedic and trans-radial amputation medicine. The prosthesis makes use of a relatively simple brain-computer interface that receives electroencephalogram (EEG) signals as input and drives actuators connected to cables to actuate the 3D-printed fingers and the wrist. Both mechanical and electrical simulations were carried out to investigate the response to loading conditions, after which sensitivity analysis was conducted to validate the prosthesis performance.

Brain Diseases and Fall-Related Surgery in Older Persons

Background: It is known that age-related brain symptoms (gait difficulty and dementia) increase the likelihood of fall-related surgery. In contrast, it is not known which types of brain disease underlie such symptoms most. Objective: The aim of this study was to correlate brain diseases with the types of surgeries performed at our hospital for patients who had fallen. Methods: This was a retrospective study at a multifaculty university hospital in Japan, with a 12-month recruiting period, a follow-up period of 3.0 ± 2.5 weeks, and ≥1×/week visits. We assembled a neurogeriatric team to diagnose brain diseases with the use of brain imaging to the extent possible and correlated the diagnoses with types of fall-related surgery. Results: Fall-related surgery was conducted by the orthopedics (OP) and neurosurgery (NS) faculties (total n = 124) at a ratio of about 2 to 1. The underlying brain diseases differed by faculty; for OP, surgery was most commonly performed in patients with a combination of white matter disease (WMD) and Alzheimer’s disease (AD) (79%) followed by dementia with Lewy bodies. In contrast, for NS, the most common surgery was for patients with alcoholism (50%) followed by a combination of WMD and AD. Conclusion: Fall-related surgery was performed by the OP and NS faculties at a 2 to 1 ratio. The major underlying brain diseases were a combination of WMD and AD (79%) for OP and alcoholism (50%) for NS.

Qatar 2021 National Guidelines on Physical Activity and Sedentary Behaviour: A descriptive review

Background: Regular physical activity (PA) is an effective preventative measure for diverse health risks among all age groups 1. Global PA guidelines provide recommendations on the required levels for active lifestyle based on evidence-based behavioral benchmarks to increase awareness and reduce overall morbidity and mortality rates 2. The Qatar National Physical Activity Guidelines (QNPAG) were first developed in 2014. The recently released QNPAG-2021 provides an updated evidence-based practical guide on PA prescription for practitioners, physicians, educators, and individuals who wish to engage in regular PA. This review aims to provide a summary of how the second QNPAG was developed. Methods: QNPAG was developed by Aspetar Orthopaedic and Sports Medicine Hospital in collaboration with key stakeholders in Qatar; such as the Ministry of Public Health, Qatar University, Hamad Bin Khalifa University, Hamad Medical Corporation, Primary Health Care Corporation, Naufar and others. The steering committee formed a technical advisory group of local and international sport medicine scientists, epidemiologists, and public health experts. Recent literature and global guidelines were evaluated and synthesized. Specific health outcomes and population groups were then proposed taking into consideration the prevalence of diseases, culture, and geographical location. Results: Three main chapters were added on PA benefits and sedentary behavior-associated risks for healthy population; people with medical conditions; and people with special challenging conditions. QNPAG 2021 included additional sections on pandemics, outbreaks and quarantine; humidity and air pollution; substance use; and locations for PA in Qatar. Other topics were added targeting obesity, osteoporosis, cancer, disabilities, mental health disorders, and down's syndrome. Detailed exercise prescription (Frequency/Intensity/Time/Type), and relevant examples were provided together with safety tips. Conclusion: The updated QNPAG is expected to raise awareness and help increase PA levels in Qatar. However, more emphasis on PA recommendations and strategical implementation is required through promotion, practice, and policies within the different sectors in the country.

Academic, Leadership, and Demographic Characteristics of Orthopaedic Sports Medicine Division Chiefs in the United States.

Introduction:Division chiefs (DCs) play an integral role within the department, making critical decisions and helping shape the future of both the division and the department. This study aimed to investigate the demographic characteristics and scholarly work of DCs in academic orthopaedic sports medicine division in the United States.Methods:Orthopaedic residency programs at academic centers were identified using the Association of American Medical Colleges' Electronic Residency Application Service. DCs were identified using the program's respective websites where data points such as sex, race/ethnicity, fellowship training institution, time since graduating fellowship, academic rank, number of degrees, and additional leadership titles were collected. Scopus database was used to determine h-indices.Results:From the 191 programs identified, 100 had a DC for the sports medicine subspecialty division, and 66 programs offered a sports medicine fellowship. Most DCs (96%) were men. The racial/ethnic demographics of the DCs were mostly White (86%), followed by Asian (11%), African American (1%), Hispanic/Latino (1%), and mixed ethnicity (1%). On average, the DCs were 19.6 years past their fellowship completion. The average h-index was 21.2. Many (48%) had an academic rank of professor, 28% associate professor, and 12% assistant professor. Four held additional graduate degrees. The fellowship programs that trained the most DCs were Hospital for Special Surgery (11), Kerlan Jobe Orthopaedic Clinic (8), University of Pittsburgh (7), American Sports Medicine Institution (5), Cleveland Clinic (5), Cincinnati Sports Medicine (4), Massachusetts General Hospital (4), and Steadman Hawkins Clinic (4).Discussion:DCs in academic orthopaedic surgery plays a crucial role in the department and is a topic that is understudied. A lack of diversity exists among DCs in academic Sports Medicine in orthopaedics. The position is held predominately by White men with a rank of either full or associate professor and extensive leadership experience. More efforts are needed to increase the diversity of sports medicine leadership within academic orthopaedic programs in the United States.

Real-world experience of treating frozen shoulder using active manipulation under local anesthetic: A retrospective study.

Currently, there is limited evidence to guide treatment and no standard management guidelines exist for treating frozen shoulder (FS). A general management approach consists of initial evaluation, range of motion (ROM) exercises, intra-articular injection of glucocorticoid, home exercise program (HEP), and/or physical therapies. However, the general approach lacks detail and has limited evidence of its effectiveness. This retrospective cohort study evaluates the short-term recovery of near-full to full-ROM technique followed by an instructed HEP for strengthening and coordinating shoulder girdle muscle group for FS management. This study details our experiences following a general approach to managing FS and aims to fill this knowledge void, providing additional context of the efficacy of FS management in the real-world. Seven-two adult patients with FS (46 females, 26 males; mean age of 66; standard deviation of 15.1; range 23–87) from an orthopedic and physical medicine and sport medicine office between 2014 and 2018 were included in this study. Following general management of FS, patients received a glucocorticoid–lidocaine mixture injection administered to the respective shoulder at the glenohumeral joint space and/or subacromial separately. Immediately, patients underwent active manipulation of the affected shoulder in 3 directions: forward flexion, abduction, and extension in the sagittal plane. Lastly, patients were instructed to perform movements similar to the active manipulation protocol as a HEP. The abduction and forward flexion ROM showed significant improvements with the described protocol. Following treatment, there was a 90.20° and 77.33° increase in average shoulder abduction and forward flexion ROM, respectively (P < .05). The immediate goal of this protocol was to gain maximum ROM in different directions of shoulder mobility. Following the general management of FS, active manipulation under local anesthetic was a highly effective treatment modality for adhesive capsulitis that was time-saving and cost-effective.