Orthopedic Research Articles

Ilizarov technology and chinese philosophy (To commemorate the 100th anniversary of the birth of Professor Ilizarov)

The Ilizarov technology was honored as a "milestone" in the history of orthopedics in the 20th century, benefiting tens of thousands of patients around the world, including Chinese patients. The paper presents an analysis of the integration of the method into Chinese medicine, taking into account national traditions, culture and clinical thinking. Ilizarov technology has revolutionized the orthopaedic surgery and clinical limb regeneration medicine in China. Ilizarov's methodology arose suddenly and brought about revolutionary changes in terms of theoretical guidance, methods of thinking, tools used and medical procedures. For the first time, Ilizarov's discovery made people realize that the human body, natural selection in biology and joint symbiotic evolutionary characteristics are common, namely, as long as the levers activate the tissue regeneration switch and changes in regulation, any tissue at any age and to any degree can complete the self-healing process in according to the requirements of doctors and the expectations of patients, similar to the growth of children. The process of working with an external Ilizarov fixator is like playing chess and changing a kaleidoscope, and the countless number of free combinations of stress configurations can be changed in accordance with the needs of the treatment. In China, Qin Xihe integrated the Chinese culture into the Ilizarov technology, thus forming the Chinese Ilizarov technology. He proposed new concepts such as the concept of natural reconstruction, evolutionary orthopedics, interpretation of body language, one walk, two lines, the principle of three balances, happy orthopedics, etc., which were introduced into clinical practice in the field of limb deformity correction and functional reconstruction. As of December 31, 2018, 35,075 cases of various deformities and disorders of the limbs were entered into the Qinsihe orthopedic database, of which 8113 cases were treated with external fixation (Ilizarov technology). The statistics of a large number of cases showed striking results: diseases treated with this technique covered almost all sections of orthopedic pathology and more than 10 sections of non-orthopedic and traumatological pathology, including vascular, nervous, genetic, metabolic, and skin diseases. In addition to orthopedic, there are more than 170 diseases in total. When Ilizarov's technology is applied, it can magically transform the old into the young. Therefore it is known as a "lifeboat". Conclusion Over the past 70 years, Ilizarov's ideas and technologies have been preserved, updated and augmented. Ilizarov's technology serves as an evolutionary phenomenon that transcends bone science. If you understand this technique, you will understand the direction of modern orthopedic surgery and regenerative medicine. Professor Ilizarov's morale and the spirit of fighting to alleviate the suffering of patients were transferred to the Chinese medical community. This awakened many Chinese doctors who followed the norms of the old and stereotyped medicine. After celebrating the centenary of the birth of Professor Ilizarov, ASAMI China will also prepare for the “Sixth ASAMI & ILLRS-BR World Conference (Beijing – 2023)”. We believe that orthopedics and allied disciplines around the world have a bright future.

Klebsiella pneumoniae blaNDM-1 carrying a class 1 integron causing a hospital outbreak in a Mexican attention center.

Infections acquired in hospitals are the cause of high morbidity and mortality and with the emergence of resistant bacteria, the problem is greater. The aim of this work was to determine the genetic characteristics and timeline of Klebsiella pneumoniae blaNDM-1 carrying a class 1 integron involved in an intrahospital outbreak. Investigation was made from the first detection of K. pneumoniae blaNDM-1, strain "466", and the last clone "423". 16S rRNA gene analysis showed that 466 strain and clones were related to K. pneumoniae. Extended-spectrum β-lactamases (ESBL) was detected according to the Clinical and Laboratory Standards Institute (CLSI) and real time-PCR. Typing of K. pneumoniae blaNDM-1 strains was carried by ERIC-PCR and sequencing the variable region of the integrons were performed. A cluster of six resistant isolates of K. pneumoniae blaNDM-1 was detected in intensive care unit (ICU), internal medicine (IM) and orthopedics (OT). Timeline revealed that the first bacterial identification was in ICU and the last clone in OT service. The array genetic of variable region was "IntI/aadA5-drfA17/qacEΔ1-Sul1". The evidences highlight the importance of the epidemiological surveillance of Extended-spectrum β-lactamases (ESBL) strains, as well as the need for molecular epidemiological studies to identify the routes of transmission and the contamination sources within health personnel.

A comparison of orthopaedic surgery and internal\xa0medicine perceptions of USMLE Step 1 pass/fail scoring

BackgroundUnited States Medical Licensing Examination Step 1 will transition from numeric grading to pass/fail, sometime after January 2022. The aim of this study was to compare how program directors in orthopaedics and internal medicine perceive a pass/fail Step 1 will impact the residency application process.MethodsA 27-item survey was distributed through REDCap to 161 U.S. orthopaedic residency program directors and 548 U.S. internal medicine residency program directors. Program director emails were obtained from the American Medical Association’s Fellowship and Residency Electronic Interactive Database.ResultsWe received 58 (36.0%) orthopaedic and 125 (22.8%) internal medicine program director responses. The majority of both groups disagree with the change to pass/fail, and felt that the decision was not transparent. Both groups believe that the Step 2 Clinical Knowledge exam and clerkship grades will take on more importance. Compared to internal medicine PDs, orthopaedic PDs were significantly more likely to emphasize research, letters of recommendation from known faculty, Alpha Omega Alpha membership, leadership/extracurricular activities, audition elective rotations, and personal knowledge of the applicant. Both groups believe that allopathic students from less prestigious medical schools, osteopathic students, and international medical graduates will be disadvantaged. Orthopaedic and internal medicine program directors agree that medical schools should adopt a graded pre-clinical curriculum, and that there should be a cap on the number of residency applications a student can submit.ConclusionOrthopaedic and internal medicine program directors disagree with the change of Step 1 to pass/fail. They also believe that this transition will make the match process more difficult, and disadvantage students from less highly-regarded medical schools. Both groups will rely more heavily on the Step 2 clinical knowledge exam score, but orthopaedics will place more importance on research, letters of recommendation, Alpha Omega Alpha membership, leadership/extracurricular activities, personal knowledge of the applicant, and audition electives.

Limited intrarater and interrater reliability of acute ligamentous ankle injuries on 3 T MRI

ObjectivesTo determine the diagnostic reliability of the Schneck grading system for acute ligamentous injuries of (1) the three major ligamentous ankle complexes, (2) the individual ankle ligaments and (3) the Sikka classification for syndesmosis injury.MethodsAll acute ankle injuries in adult athletes (≥18 years), presenting to the outpatient department of a specialised Orthopaedic and Sports Medicine Hospital, within 7 days postinjury were screened for inclusion. Ankle injuries were excluded if imaging demonstrated a frank ankle fracture or if the 3 T MRI study could not be acquired within 10 days postinjury. Two radiologists graded the three major ligamentous complexes (lateral ankle complex, deltoid complex and syndesmosis complex) and their comprising individual ligaments according the four-grade Schneck grading system. Syndesmotic injuries were classified according the four-grade Sikka classification for consequent injury of the individual syndesmosis ligaments and the deltoid complex. Agreement and kappa (K) statistics were calculated to determine intrarater and interrater reliability.ResultsBetween September 2016 and September 2018, a total of 92 MR scans were obtained (87 patients). Interrater and intrarater reliability of the Schneck grading system was moderate to substantial for the lateral ankle complex (K=0.47–0.76), fair to almost perfect for the syndesmosis complex (K=0.37–0.89) and fair to moderate for the deltoid complex (K=0.14–0.51). For the individual ligaments, kappa values ranged from moderate to substantial for the anterior talofibular ligament (ATFL) (K=0.55–0.73), fair to substantial for the calcaneofibular ligament (K=0.31–0.62) and fair to almost perfect for the anteroinferior tibiofibular ligament (AITFL) (K=0.36–0.89). Diagnostic reliability of the Sikka classification ranged from moderate to almost perfect (K=0.51–0.95).ConclusionsGrading of the three major ligamentous complexes and of the individual ankle ligaments according the Schneck grading system resulted in limited diagnostic reliability. When dichotomised for the presence of complete discontinuity, the interrater reliability of the Schneck grading system improved to substantial and almost perfect for the ATFL and AITFL, respectively. Classification of syndesmosis injury according the Sikka classification resulted in moderate interrater reliability.

Ramp lesion of the medial meniscus.

Ramp lesion of the medial meniscus used to be completely disregarded in the past.Ramp lesion has been now put under the spotlight by orthopaedic and sport medicine surgeons and requires attention.It is closely associated with anterior cruciate ligament injury. Major risk factors include chronic laxity, lateral meniscal lesion, anterior cruciate ligament reconstruction revision, anterolateral ligament tear concomitant with anterior cruciate ligament injury, time from injury, pre-operative side-to-side laxity > 6 mm, age < 30 years old, male sex, etc.Radiologists attempt to create diagnostic criteria for ramp lesion using magnetic resonance imaging. However, the only definite method to diagnose ramp lesion is still arthroscopy. Various techniques exist, among which posteromedial approach is the most highly recommended.Various treatment options are available. The success rate of ramp repair is very high. Major complications are uncommon.Cite this article: EFORT Open Rev 2021;6:372-379. DOI: 10.1302/2058-5241.6.200126

Inertia to Integrate Orthobiologics into Orthopaedic Practise: Are We Asking the Right Question?

Inertia to Integrate Orthobiologics into Orthopaedic Practise: Are We Asking the Right Question?

Assessment of the interventional outcome of non-traumatic avascular necrosis head of femur in young age group with core decompression with fibular bone grafting

Objective: Assessing the intervention outcome of non-traumatic avascular necrosis head of femur in young age group (Core Decompression with Fibular Bone Grafting). Materials and Methods: Random prospective study on in young age group patients affected with avascular necrosis head of femur, admitted to in the Department of Orthopaedics in Tertiary care hospital. The study period was from March 2016 to March 2019 with total number of 32 patients. All patients underwent the intervention surgery followed with 4 weeks, 8 weeks, 12 weeks, 6 months and 12 months follow ups for assessing the intervention outcome. Results: There weren’t much difference in both the duration of surgery and hospital stay. After 12 months follow ups following treatment, 31 cases had no pain or evidence of progression but in one patient the lesion had progressed with collapse of the infarcted segment and enlargement of the lesion within 12 months following the intervention surgery. The patient was subsequently treated with total hip arthroplasty. None of the other 31 cases needed another operation. Conclusion: Non-traumatic avascular necrosis of the femoral head affects younger and working age group which leads to morbidity and functional disability. With combination of surgical intervention we aim to prevent the collapse of head of femur and provide a better management of preserving the hip in the early stages itself and comparative cheaper than hip replacement surgery. Keywords: AVN, Osteonecrosis, Core decompression, Avascular necrosis.

Outcome of technique of total knee arthroplasty by independent total femoral first followed by tibial cuts as a measured resection based on anatomical landmarks along with scientific soft tissue balancing: A surgicoclinical study

Introduction: Total knee arthroplasty is one of the commonest musculoskeletol pain relieving surgery now a days. The long legacy of the different surgical techniques attracts the orthopaedic surgeons to opt for better results oriented techniques. Since in the mid 19s of origin of early knee arthroplasty to 2014 of gap balancing vs measured resection technique from US to the recent navigation & robotics era, different study showed improved results. For developing countries with financial constrains cost effective & results oriented more studies warranted. Objectives: To study the results of all femoral cuts first followed by tibial cuts as a measured resection technique based on anatomical landmarks followed by scientific soft tissue balancing for total knee arthroplasty. Materials and Methods: We have analyzed total (n= 126) the total knee replacement surgeries operated by our team during last 48 months retrospectively. Mean age was 66 years. All the Knee arthritis classified by Kellgren & Lawrence classification preoperatively. Results were evaluated by Oxford knee score (OKS). Results: According to OKS 92.91% had excellent to good results & 7.09% had fair to poor results (95% CI).Out of fair to poor results group 33.56% patients were 65 years of age. Conclusion: Total femur first followed by tibial measured resection cuts based on anatomical landmarks backed up with scientific soft tissue balancing & admission of all the other disciplines for total knee arthroplasty is a results oriented technique for increasing burden of operative patients & decreasing social morbidity. Keywords: Knee arthroplasty, Soft tissue balancing, Anatomical land marks, Arthritis, Femur first.

The essential role of a physiatrist in recommending a COVID‐19 vaccine

PM&RVolume 13, Issue 6 p. 647-648 Letter to the Editor The essential role of a physiatrist in recommending a COVID-19 vaccine Alyssa Warden DO, Alyssa Warden DO orcid.org/0000-0002-0065-8975 Department of Orthopedics & Rehabilitation Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USASearch for more papers by this authorKristin Caldera DO, Corresponding Author Kristin Caldera DO [email protected] Department of Orthopedics & Rehabilitation Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA Correspondence Kristin Caldera, DO, Department of Orthopedics & Rehabilitation Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705-2281, USA. Email: [email protected]Search for more papers by this author Alyssa Warden DO, Alyssa Warden DO orcid.org/0000-0002-0065-8975 Department of Orthopedics & Rehabilitation Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USASearch for more papers by this authorKristin Caldera DO, Corresponding Author Kristin Caldera DO [email protected] Department of Orthopedics & Rehabilitation Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA Correspondence Kristin Caldera, DO, Department of Orthopedics & Rehabilitation Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705-2281, USA. Email: [email protected]Search for more papers by this author First published: 28 February 2021 https://doi.org/10.1002/pmrj.12582Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume13, Issue6June 2021Pages 647-648 RelatedInformation

A retrospective analysis of a commercially available platelet-rich plasma kit during clinical use.

Point-of-care analyses of platelet-rich plasma (PRP) are not routine in the orthopedic regenerative medicine field. Therefore, many physicians rely on the manufacturer's reported content for commercial preparation kits. This contributes to a knowledge gap between injectate content and patient outcome. To assess whether the EmCyte PurePRP II 60-mL preparation kit returns PRP content that meets the manufacturer's expectations when used during routine clinical care for a heterogenous patient population, and to determine whether a change in PRP yield volume affects injectate content. Protocol A (exclusion of granulocytes and low hematocrit) and Protocol B (inclusion of granulocytes and higher hematocrit) were evaluated. Retrospective review. Private practice. One hundred five patients (118 preparations) treated for orthopedic conditions over an 8-month period via PRP injection. Thirteen patients had two independently made preparations on different treatment days that qualified for analysis. Not applicable. Complete blood count (absolute counts and calculated fold enrichment from baseline of platelets, white blood cells, red blood cells, granulocytes, lymphocytes, monocytes; and hematocrit levels). Confounding variables included age, gender, and preparation yield volume. During routine clinical use, the cellular content of both Protocols A and B met or exceeded the manufacturer's expectations of platelet enrichment and granulocyte inclusion or exclusion. Hematocrit values were slightly higher than anticipated from Protocol A preparations. The modification of yield volume from 7 to 4mL led to a significant difference in platelet enrichment without affecting absolute cell counts (2.88; 95% confidence interval [CI] 1, 4.76; P=.003). Both gender and age moderately affected the level of platelet enrichment from baseline but did not significantly affect absolute platelet counts. In the absence of widespread characterization, confirming the variation in commercial PRP kits during clinical use is crucial.

P114 STING. Steroid Injections DurinG Covid-19. A cross speciality call

IntroductionAn important clinical question during the Covid -19 pandemic is the safety of steroid use. Guidelines published by rheumatology, physiotherapy, orthopaedic and pain medicine societies have advised on the restricted use of corticosteroids for musculoskeletal and rheumatic conditions. For clinicians across the specialities there is a challenge to safely conducting best practice, yet ensuring patients have access to the significant functional benefits of steroid injections.MethodsThe STING prospective service evaluation will collect data on steroid injections undertaken during this part of the pandemic. Clinicians will be able to input information on patient demographics, background Covid risk and steroid injection specifics. At follow up at 4-6 weeks complications and Covid specific outcomes will be recorded, as well as patient perceived symptom improvement.Each unit collecting data will have assigned collaborator(s), with a senior consultant validating the data.Data will be collected and managed using Research Electronic Data Capture (REDCap). Data collection and management will adhere to Caldicott II principles and GDPR.ResultsResults will be analysed through RedCap and compared to national Covid incidence. Local complication and patient reported outcomes will be compared between specialities, environments and steroid specifics (volume, location etc.).ConclusionA pan-speciality look at steroid injection use during the pandemic will be useful primarily to contribute to understanding the safety of steroid use. Secondarily to look at cross speciality differences in administration, PROMs and to appreciate patient groups who may be excluded from steroid treatment.Join the team! Head to RSTN to get involved.

Professor Yücel Tümer, MD; a legend, mentor in children's orthopaedics in Turkey.

Professor Yücel Tümer, MD; a legend, mentor in children's orthopaedics in Turkey.

Bone Cement Formulation with Reduced Heating of Bone Cement Resin

Bone cement material is one of the key materials in bone surgery and orthopedic medicine. In this study, commercial polymethyl-methacrylate bone cement was mixed with boric acid and zinc borate to reduce the reaction temperature of the bone cement. The observation of temperature changes during the polymerization using laser thermometer and thermal camera showed that the use of boron compounds decreased the temperature of the bone cement at least 10 °C which is very critical for the biomaterial uses as it affects the biocompatibility of the material. Besides temperature monitoring, microbiological tests showed that the materials have certain antibacterial effect. Water contact angle studies also supported the biocompatibility studies. In the last part, mechanical tests showed that there was not significant change in the tensile strength and tensile modulus values. Antibacterial tests exhibited that zinc borate addition shows antimicrobial activity against S.epidermidis as well as boric acid addition over %5 concentration. According to the cell culture studies, boric acid can be interpreted as non-toxic up to 10%, while 10% and 20% zinc borate has toxic effect. This is the first study to use boron compounds in bone cement and it is proved that boric acid at low concentrations can be used for bone cement applications but zinc borate would not be suitable to use in medical applications due to toxic effects.

Three-dimensional Printing in Orthopaedic Surgery: Current Applications and Future Developments.

Three-dimensional (3D) printing is an exciting form of manufacturing technology that has transformed the way we can treat various medical pathologies. Also known as additive manufacturing, 3D printing fuses materials together in a layer-by-layer fashion to construct a final 3D product. This technology allows flexibility in the design process and enables efficient production of both off-the-shelf and personalized medical products that accommodate patient needs better than traditional manufacturing processes. In the field of orthopaedic surgery, 3D printing implants and instrumentation can be used to address a variety of pathologies that would otherwise be challenging to manage with products made from traditional subtractive manufacturing. Furthermore, 3D bioprinting has significantly impacted bone and cartilage restoration procedures and has the potential to completely transform how we treat patients with debilitating musculoskeletal injuries. Although costs can be high, as technology advances, the economics of 3D printing will improve, especially as the benefits of this technology have clearly been demonstrated in both orthopaedic surgery and medicine as a whole. This review outlines the basics of 3D printing technology and its current applications in orthopaedic surgery and ends with a brief summary of 3D bioprinting and its potential future impact.

Cellular Therapy in the Treatment of Musculoskeletal Disorders

The number of injuries and diseases of the musculoskeletal system is constantly increasing every year. Given the world’s population aging, more and more attention is paid to disease prevention and the development of specific treatment options. Recently, there has been a dynamic growth of cell technology.The aim. To evaluate the safety and effectiveness of cell-based medicinal products from adipose tissue for the treatment of musculoskeletal disorders and compare them with each other.Materials and methods. In 2018-2020, at the premises of the Department of Traumatology and Orthopedics of Zaporizhia Medical Academy of Post-Graduate Education of the Ministry of Health of Ukraine and the Department of Orthopedics, Aesthetic and Regenerative Medicine of Vitacenter General Hospital, 45 patients with orthopedic disorders were treated using cell-based medicinal products made from native adipose tissue.In 40 cases, stromal-vascular fraction obtained from native adipose tissue using various devices (Goisis, Regenlab, Arthrex SVF, Lipogems®) was injected. Five patients were treated with cultured autologous chondrocytes and multipotent mesenchymal stromal cells from adipose tissue obtained in collaboration with a specialized laboratory “Ilaya.regeneration”, Kyiv.Results and discussion. In the first group, 4 patients had no adverse reactions, only one patient after administration had manifestations of gonarthritis with subsequent improvement. No patients had adverse reactions to the introduction of stromal-vascular fraction. Patientsof both groups were observed for 3-5 days after the procedure, and then once a month; the assessment was performed using VAS, IKDC, WOMAC, KOOS, KSS. All the patients showed gradual decrease in pain improved joint function, and improved quality of life. It is probably incorrect to compare these groups in terms of the number of patients, but we saw a similar pattern in clinical manifestations in both groups. Our observations showed a difference only in the duration of positive changes noted by patients. In the group of patients who received cellbased medicinal product from the stromal-vascular fraction, the positive effect gradually decreased within 1.5-2 years. After the introduction of cultured cell-based products in patients, their clinical condition improved to a level that was maintained for 3 years without significant changes

Radially patterned transplantable biodegradable scaffolds as topographically defined contact guidance platforms for accelerating bone regeneration

BackgroundThe healing of large critical-sized bone defects remains a clinical challenge in modern orthopedic medicine. The current gold standard for treating critical-sized bone defects is autologous bone graft; however, it has critical limitations. Bone tissue engineering has been proposed as a viable alternative, not only for replacing the current standard treatment, but also for producing complete regeneration of bone tissue without complex surgical treatments or tissue transplantation. In this study, we proposed a transplantable radially patterned scaffold for bone regeneration that was defined by capillary force lithography technology using biodegradable polycaprolactone polymer.ResultsThe radially patterned transplantable biodegradable scaffolds had a radial structure aligned in a central direction. The radially aligned pattern significantly promoted the recruitment of host cells and migration of osteoblasts into the defect site. Furthermore, the transplantable scaffolds promoted regeneration of critical-sized bone defects by inducing cell migration and differentiation.ConclusionsOur findings demonstrated that topographically defined radially patterned transplantable biodegradable scaffolds may have great potential for clinical application of bone tissue regeneration.

Nanofibrous hyaluronic acid scaffolds delivering TGF-β3 and SDF-1α for articular cartilage repair in a large animal model

Focal cartilage injuries have poor intrinsic healing potential and often progress to osteoarthritis, a costly disease affecting almost a third of adults in the United States. To treat these patients, cartilage repair therapies often use cell-seeded scaffolds, which are limited by donor site morbidity, high costs, and poor efficacy. To address these limitations, we developed an electrospun cell-free fibrous hyaluronic acid (HA) scaffold that delivers factors specifically designed to enhance cartilage repair: Stromal Cell-Derived Factor-1α (SDF-1α; SDF) to increase the recruitment and infiltration of mesenchymal stem cells (MSCs) and Transforming Growth Factor-β3 (TGF-β3; TGF) to enhance cartilage tissue formation. Scaffolds were characterized in vitro and then deployed in a large animal model of full-thickness cartilage defect repair. The bioactivity of both factors was verified in vitro, with both SDF and TGF increasing cell migration, and TGF increasing matrix formation by MSCs. In vivo, however, scaffolds releasing SDF resulted in an inferior cartilage healing response (lower mechanics, lower ICRS II histology score) compared to scaffolds releasing TGF alone. These results highlight the importance of translation into large animal models to appropriately screen scaffolds and therapies, and will guide investigators towards alternative growth factor combinations. Statement of significanceThis study addresses an area of orthopaedic medicine in which treatment options are limited and new biomaterials stand to improve patient outcomes. Those suffering from articular cartilage injuries are often destined to have early onset osteoarthritis. We have created a cell-free nanofibrous hyaluronic acid (HA) scaffold that delivers factors specifically designed to enhance cartilage repair: Stromal Cell-Derived Factor-1α (SDF-1α; SDF) to increase the recruitment and infiltration of mesenchymal stem cells (MSCs) and Transforming Growth Factor-β3 (TGF-β3; TGF) to enhance cartilage tissue formation. To our knowledge, this study is the first to evaluate such a bioactive scaffold in a large animal model and demonstrates the capacity for dual growth factor release.

Performance of the Hendrich Fall Risk Model II in Patients Discharged from Rehabilitation Wards. A Preliminary Study of Predictive Ability.

(1) Background: Falls are a dangerous adverse event in patients discharged from rehabilitation units, with the risk of falling being higher in the first weeks after discharge. In this study, we assessed the predictive performance of the Hendrich Fall Risk Model II tool (HIIFRM) when administered before discharging patients to their home from rehabilitative units in orthopedic (OR), neurologic (NR) and pulmonary (PR) rehabilitation wards. (2) Methods: Over a 6-month period, all adult patients who returned home after discharge were assessed by HIIFRM. At six months from discharge the occurrence of falls was obtained by performing a structured survey. The HIIFRM predictive performance was determined by the area under the ROC curve (AUC), sensitivity (Se) and specificity (Sp) for the whole sample and split by ward. (3) Results: 85 of 141 discharged patients were living at home and agreed to take part in the survey. Of these, 19 subjects fell, 6 suffered fractures or head traumas and 5 were hospitalized. The AUC was 0.809 (95% CI: 0.656–0.963), Se was 0.67 (0.30–0.93) and Sp was 0.79 (0.63–0.90) for OR patients. (4) Conclusions: Our preliminary results support the use of HIIFRM as a tool to be administered to OR patients at discharge and provides data for the design of a large study of predictive ability.

Systematic Review of Orthopaedic and Sports Medicine Injuries and Treatment Outcomes in Women's National Basketball Association and National Basketball Association Players.

Background:Athletes in the Women’s National Basketball Association (WNBA) and National Basketball Association (NBA) are subject to high injury rates given the physical demands of the sport. Comprehensive data regarding injury patterns and rates in these athletes are limited.Purpose:To summarize available data on orthopaedic and sports medicine–related injuries through 2020 in professional female and male basketball players.Study Design:Systematic review; Level of evidence, 4.Methods:A search was conducted using PubMed and Embase through April 5, 2020, to identify injury studies regarding WNBA and NBA players. Studies were included if the injury or surgery was considered a direct consequence of game play including musculoskeletal/orthopaedic, concussion, ophthalmologic, and craniomaxillofacial injuries. Systematic reviews, screening studies, or studies without sufficient WNBA or NBA player subgroup analysis were excluded.Results:A total of 49 studies met inclusion criteria, 43 (87.8%) of which detailed musculoskeletal injuries. The lower extremity represented 63.3% of studies. A majority (59.2%) of studies were level 4 evidence. The source of data was primarily comprehensive online search (n = 33; 67.3%), followed by official databases (n = 11; 22.4%). Only 3 studies concerned WNBA athletes compared with 47 that concerned NBA athletes. The lowest return-to-play rates were cited for Achilles tendon repairs (61.0%-79.5%). Variability in return-to-play rates existed among studies even with similar seasons studied.Conclusion:The majority of literature available on orthopaedic and sports medicine–related injuries of NBA and WNBA athletes is on the lower extremity. The injuries that had the greatest effect on return to play and performance were Achilles tendon ruptures and knee cartilage injuries treated using microfracture. The reported outcomes are limited by heterogeneity and overlapping injury studies. There are limited available data on WNBA injuries specifically.

Clinical Study on 320 Cases of Senile Osteoarthritis Treated by Traditional Chinese Medicine Orthopedics based on Big Data Analysis

Objective: To analyze the clinical efficacy of traditional Chinese medicine orthopedic rehabilitation in the treatment of senile osteoarthritis based on the analysis of big data. Methods: 640 elderly patients with osteoarthritis were randomly divided into control group and observation group. The patients in the control group were treated with celecoxib capsules. The patients with neonates were treated with traditional Chinese medicine orthopedic rehabilitation. The clinical efficacy of the two groups was compared. The pain and functional recovery were evaluated by VAS and JOY scores. RESULTS: There was no significant difference in VAS and JOY scores between the two groups (P>0.05). The VAS and JOY scores of the New Zealand patients were significantly better than those of the control group (P<0.05). The total effective rate of patients with neonatal observation was 93.3%, which was better than that of the control group (70.0%). The difference was statistically significant (P<0.05). Conclusion: The effect of traditional Chinese medicine orthopedic rehabilitation on senile osteoarthritis is better than that of celecoxib alone. It is worthy of clinical application.