Orthopaedic Community Research Articles

Status and future of modern technologies in arthroplasty : Results of asurvey of the German Society for Orthopedics and Trauma Surgery (DGOU).

The orthopedic community is divided on the question of whether modern technologies in arthroplasty improve outcomes. Therefore, the aim of this initiative of the working group on intraoperative imaging and technology integration (Arbeitsgemeinschaft intraoperative Bildgebung und Technologieintegration, AGiTEC) is to initiate the collection of additional data for the scientific evaluation of modern technologies. To what extent are modern technologies currently used and which implementations are planned? Do the members of the German Society for Orthopedics and Trauma Surgery (DGOU) consider the acquisition of additional data for scientific assessment necessary? Members of the DGOU were asked via an e‑mail survey about the distribution and projected introduction of modern technologies in arthroplasty. They were also asked whether sufficient data were collected for scientific evaluation and whether acquisition of additional data in studies or arthroplasty registries were considered necessary. Of the 7923 probands surveyed, 428 completed the questionnaire in full (5.4%). It was found that individual implants and navigation are currently the most frequently used (31% and 29%, respectively). The largest increases in the next 2years are projected for virtual reality and robotics (+30% and +23%, respectively), 85% of respondents indicated that insufficient data were collected for scientific evaluation, and 89% each requested initiation of multicenter studies and inclusion of technologies in the arthroplasty registry. The results of this study should motivate the scientific community, industry, and those responsible for the arthroplasty registries to collect and analyze data for the scientific assessment of modern technologies.

P79. Development of an evidence-based framework to increase patient-reported outcome response rates for orthopedic practices

<h3>BACKGROUND CONTEXT</h3> Collection of patient-reported outcomes (PROs) is increasingly viewed as the standard of care in various orthopedic surgeries given the intrinsic need for quality metrics and outcome collection requirements from government agencies and insurance carriers. Despite these incentives, low response rates to PRO collection tools remain a problem. Currently, most studies that address PRO response rates mainly focus on patients and few studies analyze strategies to improve response rates. To date, an evidence-based overview of successful PRO collection strategies incorporated into an overarching human-centered design framework is still absent. <h3>PURPOSE</h3> We aimed to systematically review existing literature, synthesize evidence, and develop an overarching framework of strategies to increase PRO collection rates. <h3>METHODS</h3> First, we systematically searched existing literature from 06-2011 to 06-2021 (using PubMed, EMBASE, Scopus, Business Source Complete) for studies that 1) included a primary or secondary outcome of PRO response rates evaluating one or more interventions, 2) included the PRO response rate achieved for each comparator group, 3) calculated response rates per PRO, 4) involved an orthopedic practice, 5) involved mainly adults. Included studies were assessed according to their focus on survey collection tool design or patient engagement; subsequently, a human-centered design approach was used to develop an evidence-based framework. In order to develop a comprehensive framework for strategies to increase PRO response rates, we developed a two-pronged framework: survey collection tool strategies and patient engagement strategies. <h3>RESULTS</h3> Among 15 included studies (conducted in 3 countries) there were 3 randomized controlled trials, 1 prospective study and 11 retrospective studies. PRO response rates achieved by interventions ranged from 46% to 100%; 3 studies included more than one intervention, and only 1 of these studies looked at each intervention separately. The remaining two were unable to identify which specific intervention was most effective. The most common intervention studied was the method of survey distribution modality, however, modalities' effectiveness was not uniform. Additional interventions studied were: dedicated research assistants, length of surveys, frequency of surveys, automated provider reminders and communication regarding standard of care. Having a dedicated research assistant, shorter surveys, and automated reminders for the provider showed an increase in response rate. Color-coding indicates which strategies have been studied and examples are included in italics. There are significant gaps in the literature, especially on the patient engagement side. The strategy studied most for patient engagement is the number of dedicated research assistants, which has higher associated costs due to dedicated labor hours. <h3>CONCLUSIONS</h3> Considering the two aspects of survey data collection: survey collection tool design and patient engagement, current literature has prioritized the former, leaving a considerable gap in the orthopedic community's understanding of strategies to improve PRO response rate. The framework presented strives to provide a systematic roadmap for orthopedic practices seeking to increase PRO response rates that do not drastically increase cost. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

A Validated Open-Source Shoulder Finite Element Model and Investigation of the Effect of Analysis Precision.

Understanding the loads and stresses on different tissues within the shoulder complex is crucial for preventing joint injury and developing shoulder implants. Finite element (FE) models of the shoulder joint can be helpful in describing these forces and the biomechanics of the joint. Currently, there are no validated FE models of the intact shoulder available in the public domain. This study aimed to develop and validate a shoulder FE model, then make the model available to the orthopaedic research community. Publicly available medical images of the Visible Human Project male subject's right shoulder were used to generate the model geometry. Material properties from the literature were applied to the different tissues. The model simulated abduction in the scapular plane. Simulated glenohumeral (GH) contact force was compared to in vivo data from the literature, then further compared to other in vitro experimental studies. Output variable results were within one standard deviation of the mean in vivo experimental values of the GH contact force in 0°, 10°, 20°, 30°, and 45° of abduction. Furthermore, a comparison among different analysis precision in the Abaqus/Explicit platform was made. The complete shoulder model is available for download at github.com/OSEL-DAM/ShoulderFiniteElementModel.

Evaluation of the National Institutes of Health–supported relative citation ratio among American orthopedic spine surgery faculty: A new bibliometric measure of scientific influence

BackgroundPublication metrics have been traditionally used to compare research productivity amongst academic faculty. However, traditional bibliometrics lack field-normalization and are often biased towards time-dependent publication factors. The National Institutes of Health (NIH) has developed a new, field-normalized, article-level metric, known as the “relative citation ratio” (RCR), that can be used to make accurate self, departmental, and cross-specialty comparisons of research productivity. This study evaluates the use of the RCR amongst academic orthopedic spine surgery faculty and analyzes physician factors associated with RCR values. MethodsA retrospective data analysis was performed using the iCite database for all fellowship trained orthopedic spine surgery (OSS) faculty associated with Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopedic surgery residency program. Mean RCR, weighted RCR, and total publication count were compared by sex, career duration, academic rank, and presence of additional degrees. A value of 1.0 is the NIH-funded field-normalized standard. Student t-tests were used for two-group analyses whereas the analysis of variance tests (ANOVA) was used for between-group comparisons of three or more subgroups. Statistical significance was achieved at P < 0.05. ResultsA total of 502 academic OSS faculty members from 159 institutions were included in the analysis. Overall, OSS faculty were highly productive, with a median RCR of 1.62 (IQR 1.38-2.32) and a median weighted RCR of 68.98 (IQR 21.06-212.70). Advancing academic rank was associated with weighted RCR, career longevity was associated with mean RCR score, and male sex was associated with having increased mean and weighted RCR scores. All subgroups analyzed had an RCR value above 1.0. ConclusionsAcademic orthopedic spine surgery faculty produce impactful research as evidenced by the high median RCR relative to the standard value set by the NIH of 1.0. Our data can be used to evaluate research productivity in the orthopedic spine community.

A systematic analysis of preprints in Trauma & Orthopaedic surgery.

AimsPreprint servers allow authors to publish full-text manuscripts or interim findings prior to undergoing peer review. Several preprint servers have extended their services to biological sciences, clinical research, and medicine. The purpose of this study was to systematically identify and analyze all articles related to Trauma & Orthopaedic (T&O) surgery published in five medical preprint servers, and to investigate the factors that influence the subsequent rate of publication in a peer-reviewed journal.MethodsAll preprints covering T&O surgery were systematically searched in five medical preprint servers (medRxiv, OSF Preprints, Preprints.org, PeerJ, and Research Square) and subsequently identified after a minimum of 12 months by searching for the title, keywords, and corresponding author in Google Scholar, PubMed, Scopus, Embase, Cochrane, and the Web of Science. Subsequent publication of a work was defined as publication in a peer-reviewed indexed journal. The rate of publication and time to peer-reviewed publication were assessed. Differences in definitive publication rates of preprints according to geographical origin and level of evidence were analyzed.ResultsThe number of preprints increased from 2014 to 2020 (p < 0.001). A total of 38.6% of the identified preprints (n = 331) were published in a peer-reviewed indexed journal after a mean time of 8.7 months (SD 5.4 (1 to 27)). The highest proportion of missing subsequent publications was in the preprints originating from Africa, Asia/Middle East, and South America, or in those that covered clinical research with a lower level of evidence (p < 0.001).ConclusionPreprints are being published in increasing numbers in T&O surgery. Depending on the geographical origin and level of evidence, almost two-thirds of preprints are not subsequently published in a peer-reviewed indexed journal after one year. This raises major concerns regarding the dissemination and persistence of potentially wrong scientific work that bypasses peer review, and the orthopaedic community should discuss appropriate preventive measures.Cite this article: Bone Jt Open 2022;3(7):582–588.

AN OVERVIEW OF THE MANAGEMENT OF ANKLE FRACTURES IN GERIATRIC POPULATION

Background : Recent clinical studies have identified a significant increase in the incidence and severity of ankle fractures in the elderly population. Kannus et al reported that between 1970 and 2000 there was a three-fold increase in the number of ankle fractures among Finnish patients over 70 years old [1]. In addition, the authors demonstrated an increase in the more severe Lauge-Hansen supination-eversion stage four fracture, compared to more stable ankle fracture patterns in this elderly patient population. In the data available from the United States, ankle fractures have been reported to occur in as many as 8.3 per 1000 Medicare recipients, a figure that appears to be rising steadily [2] . There continues to be controversy within the orthopaedic community regarding the optimal management of geriatric ankle fractures. Operative fixation has been proven to be a safe and effective method of managing unstable ankle fractures in younger patients [3 ] . However, certain authors have recommended conservative treatment in older patients, based on poor surgical outcomes secondary to osteoporosis, diabetes, peripheral vascular disease and skin issues commonly seen with advanced age [4, 5, 6, 7] . Recommendations on appropriate management also appear to differ based on geographical location, evidenced by a recent study by Koval et al [2] . The authors demonstrated that the percentage of ankle fractures in patients older than 65 treated with surgical stabilization varied considerably in various parts of our country. The current paper reviews the complex issues associated with ankle fractures affecting the geriatric patient population, focusing on risk factors for fracture and surgical versus nonsurgical management. 30 patientsMethods: with closed displaced bimalleolar ankle fractures presenting to Dr B R Ambedkar medical college casualty from September 2020 to February 2022 who underwent surgery were taken into the study . The maximum studyResults: population belonged to the geriatric age group .At the end of follow-up (64.8%) had excellent clinical result, (35.2%) had good clinical result, and no patient had a poor functional outcome. For the radiological assessment, there were 20 patients (66.6%) with excellent, 7 (23.3%) with good, 3(10.%) with fair, while none with poor resu :Conclusion Treatment bimalleolar ankle is challenging because of limited soft tissue cover, poor bone quality with osteoporosis and less vascularity. There are various treatment options for these fractures starting from closed reduction with casting to open reduction and internal fixation with a plate. The excellent functional results and lack of soft tissue complications suggest that a surgical management with CC screw and plating should be considered as an option in bimalleolar ankle fractures. A balance between anatomical reduction and soft tissue stripping is required to avoid any complications.

Time to Venous Thromboembolism Events Following Total Hip Arthroplasty: A Comparison Between Aspirin and Warfarin.

The attitude and approach of orthopedic community for minimizing venous thromboembolism (VTE) has evolved over the last decade with the trend toward use of aspirin (and mechanical modalities) in lieu of aggressive anticoagulation. The optimal length of VTE prophylaxis following total hip arthroplasty (THA) still remains unknown. This study aimed to determine the timing of VTE in patients who received aspirin compared to warfarin, and determine if 30 days of prophylaxis remain adequate. This is a retrospective study of 18,003 patients undergoing primary and revision THA at a single institution between January 2008 and August 2020. During this time, our institution underwent a transition from the use of warfarin to aspirin as the main method for VTE prophylaxis. Symptomatic deep vein thrombosis and pulmonary embolism occurring within 90 days of surgery were identified from medical records and phone call logs. Aspirin and warfarin cohorts were matched to account for demographic and comorbidity differences. Timing of pulmonary embolism was determined based on either the date of diagnostic imaging or patient-provider phone calls confirming diagnosis. The cohorts included 46 patients in the warfarin group and 46 in the aspirin group. Time to VTE was significantly shorter in the warfarin group compared to aspirin (P= .021) with a median time to VTE of 3 days (interquartile range 2-14) and 10 days (interquartile range 4-19) respectively. Over 90% of the events occurred within 32 or 30 days of surgery in the warfarin and aspirin groups respectively. Based on the findings, a 30-day aspirin prophylaxis remains appropriate for patients undergoing THA.

Transphyseal Distal Humeral Fractures: A 13-Times-Greater Risk of Non-Accidental Trauma Compared with Supracondylar Humeral Fractures in Children Less Than 3 Years of Age.

The transphyseal distal humeral fracture has been well described as a concerning fracture pattern for non-accidental trauma (NAT) in young pediatric patients. Because of the infrequent presentation of this fracture, the association historically has been anecdotal. The purpose of this study was to determine and compare the incidence of NAT among displaced transphyseal distal humeral fractures and displaced supracondylar humeral fractures in children <3 years of age. All displaced transphyseal distal humeral fractures and displaced supracondylar humeral fractures in patients <3 years of age admitted because of injury during an 18-year period were reviewed retrospectively for inclusion. Patient demographics, mechanisms of injury, results of child protective services investigations, and medical records were reviewed. A chi-square test was utilized to analyze significance for categorical data; p values of <0.05 were defined as significant. The charts of 23 transphyseal distal humeral and 205 supracondylar humeral fracture cases were reviewed. NAT was the cause for 6 (26%) of the displaced transphyseal distal humeral fractures and 4 (2%) of the displaced supracondylar fractures. The associated risk of NAT was 13 times greater (95% confidence interval [CI], 4.05 to 43.7; p < 0.001) for children admitted for operative management of displaced transphyseal distal humeral fractures compared with those admitted for operative management of displaced supracondylar humeral fractures. The classic 1980 paper by DeLee et al. sensitized the orthopaedic community to the relationship between transphyseal distal humeral fractures and child abuse. Our study is the first, to our knowledge, to bring statistical weight to this association. We found a 13-times-greater risk of NAT for children <3 years of age who sustain a displaced transphyseal distal humeral fracture compared with a displaced supracondylar fracture. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

A Survey of Musculoskeletal Disorders in the Orthopaedic Surgeon: Identifying Injuries, Exacerbating Workplace Factors, and Treatment Patterns in the Orthopaedic Community.

Introduction:As demand for orthopaedic care increases, the orthopaedic community must preserve access to skilled physicians. Workplace hazards and related injuries or conditions contribute to musculoskeletal (MSK) stress on orthopaedic surgeons, which can lead to undesirable medical leaves of absence or early retirement. The purpose of this study was to identify and characterize work-related and non–work-related MSK conditions that affect orthopaedic surgeons and differential injury patterns among male and female surgeons. This study hypothesized that MSK conditions would be exacerbated by work, correlate with age, and show gender-based disparities. Identifying MSK conditions and associated workplace hazards may ultimately help guide preventive or protective efforts.Methods:Following IRB and society approvals, a modified 15-question physical discomfort survey was emailed to a randomized selection of American Academy of Orthopaedic Surgeons (AAOS) members and all Ruth Jackson Orthopaedic Society members. Data were deidentified and merged by AAOS; analyses were performed by the authors.Results:Most surgeons reported at least one MSK condition (86%; 95% male versus 82% female, P = 0.317), with an average of two conditions per surgeon. Low back pain (56%) and neck pain (42%) were the two most common conditions reported. Male surgeons were more likely to report medial epicondylitis (P = 0.040), lateral epicondylitis (P ≤ 0.001), low back pain (P = 0.001), and lumbar radiculopathy (P = 0.001); however, male respondents were significantly older than female respondents (57 versus 43 years, P ≤ 0.0001), and some conditions were age-correlated. Most respondents reported at least one work-attributed MSK condition (64%; 68% male versus 62% female, P = 0.806). Caseload was not associated with an increased number of work-related MSK conditions; yet, 60% of surgeons reported that work worsened symptoms. Surgical treatment was sought most often for lumbar radiculopathy (6%) and carpal tunnel syndrome (6%). Sixty-nine leaves of absence were reported; most less than 1 month (55%). Exacerbating workplace factors included positioning (patient/surgeon), instruments, and personal protective equipment.Discussion:Work-related MSK conditions are common among orthopaedic surgeons. Greater awareness of potential workplace-related hazards and conditions is needed to address and mitigate negative MSK health effects on orthopaedic surgeons.

The Rotator Cable Does Not Stress Shield the Crescent Area During Shoulder Abduction.

It is accepted by the orthopaedic community that the rotator cable (RCa) acts as a suspension bridge that stress shields the crescent area (CA). The goal of this study was to determine if the RCa does stress shield the CA during shoulder abduction. The principal strain magnitude and direction in the RCa and CA and shoulder abduction force were measured in 20 cadaveric specimens. Ten specimens underwent a release of the anterior cable insertion followed by a posterior release. In the other 10, a release of the posterior cable insertion was followed by an anterior release. Testing was performed for the native, single-release, and full-release conditions. The thicknesses of the RCa and CA were measured. Neither the principal strain magnitude nor the strain direction in either the RCa or the CA changed with single or full RCa release (p ≥ 0.493). There were no changes in abduction force after single or full RCa release (p ≥ 0.180). The RCa and CA thicknesses did not differ from one another at any location (p ≥ 0.195). The RCa does not act as a suspension bridge and does not stress shield the CA. The CA primarily transfers shoulder abduction force to the greater tuberosity. The CA is important in force transmission during shoulder abduction, and efforts should be made to restore its continuity with a repair or reconstruction.

Challenging the dogma to \u201calways operate\u201d acute hip fractures: a proof-of-concept pilot study for nonoperative management of undisplaced femoral neck fractures

BackgroundThe notion that all acute hip fractures are a surgical entity requiring either surgical fracture fixation or hip replacement represents a historic dogma, particularly within the orthopaedic community of the United States. The present study from a European regional trauma center was designed to challenge the notion that stable and undisplaced femoral neck fractures represent an absolute indication for surgical management.MethodsThe purpose of this study was to investigate the hypothesis that stable and undisplaced femoral neck fractures of the Garden types 1 and 2 can be safely managed nonoperatively. A retrospective observational cohort study was carried out at a regional orthopaedic trauma center in Germany from January 1, 2016 to June 30, 2021. The inclusion criteria specified patients older than 18 years suffering a < 24 h, traumatic, femoral neck fracture Garden types 1 and 2. Exclusion criteria included Garden types 3 and 4 femoral neck fractures, pregnancy, active infection or previous surgery, tumor-associated fractures, medical history of femoral neck necrosis, vascular injury associated with femoral neck fractures, nerve injury associated to a femoral neck fracture and ≥ 24 h femoral neck fracture. The primary intention of this research was to identify deterioration of fracture retention with an ensuing unplanned trip to the operating room in femoral neck fractures Garden types 1 and 2. Secondary were included unplanned readmissions and complications such as surgical site infection.ResultsA total of 41 undisplaced femoral neck fractures (Garden types 1 and 2) were included in this study; n = 20 were in the resulting admission operatively treated (group 1) and n = 21 were treated conservatively. The mean age in group 1 was 76 years; women (70%). In group 2 it was 81 years with a female dominance (71.4%). Admission status: Garden types 1 and 2, group 1 n = 13/7 and group 2 n = 15/6. Subsequent femoral neck fracture displacement (Y/N) (in case of operation, before operation) group 1 n = 14/6 and group 2 n = 6/15.ConclusionAccording with our results, patients sustaining Garden type 1 femoral neck fractures, depending on age and comorbidities, should be treated conservatively with weight bearing and under physiotherapeutic instructions. In case of femoral neck fractures Garden type 2, a surgical treatment should be performed in order to avoid femoral neck fractures to slip after weight bearing by lacking of fracture impaction.

Knowledge and compliance towards alendronate therapy among postmenopausal women with osteoporosis in Palestine

BackgroundPostmenopausal women compliance to alendronate therapy is suboptimal due to the complex dosing requirements. The poor compliance may increase their potential of fractures and the prevalence of side effects. In this study, the compliance of osteoporotic women on bisphosphonate therapy to the complex dosing instructions and their knowledge of alendronate-interactions were assessed.MethodsThis is a cross-sectional study, using self-administered questionnaire involving 224 osteoporotic women on alendronate therapy, who visited the orthopedic clinics and community pharmacies in the West Bank. Data was collected using a validated questionnaire consisting of 4 sections and analyzed by descriptive statistics. Moreover, associations between patient's socio-demographic characteristics and the extent of compliance and knowledge of alendronate interactions are established in this study.ResultsA total of 300 questionnaires were distributed and 224 were completed. The median compliance score to alendronate dosing instructions was 5 out of a possible maximum 7, and the median knowledge score about alendronate interactions was 7 out of a possible maximum 14. Factors found to affect either or both the knowledge and compliance to alendronate dosing instructions were, residency, and the source of instructions.ConclusionThis study identified the importance of compliance and knowledge gaps among postmenopausal women treated with alendronate. Therefore, appropriate knowledge about the importance of proper compliance to dosing instructions and avoidance of interactions is of a great benefit for maximizing clinical effectiveness, lowering fracture risk and prevention of adverse effects of alendronate among patients treated with alendronate in Palestine.

Low-Intensity Pulsed Ultrasound in the Treatment of Nonunions and Fresh Fractures: A Case Series

It is estimated that approximately 5% to 10% of fractures will evolve into nonunions. Nonunions have a significant impact on patient quality of life and on socioeconomic costs. Low-intensity pulsed ultrasound (LIPUS) is a non-invasive therapy widely used within the orthopedic community to accelerate the healing of fresh fractures, to minimize delayed healing, and to promote healing of nonunions. In this case series, 46 nonunions and 19 fresh fractures were treated with LIPUS for at least three months or until fracture healing. Bone healing was assessed both at a radiological and a functional level. Of the nonunions healed, 89% had a mean healing time of 89 ± 53 days. In the group of fresh fractures, the healing percentage was 95% with a mean healing time of 46 ± 28 days. LIPUS treatment is proven to be safe and well tolerated; there were no adverse events related to the use of the device, even in the presence of internal fixations and infections. LIPUS therapy should be considered a low-risk option both as an adjunct to surgery or as a standalone therapy in the management of nonunion and fresh fractures.

Asia Pacific Fragility Fracture Alliance - Asia Pacific Osteoporosis and Fragility Fracture Society Collaboration

In the orthopaedic community, osteoporosis is often under-diagnosed and undertreated in patients being treated for fragility fractures. A need for a specific section that focuses on osteoporosis and fragility fractures was identified at the Asia Pacific Orthopaedic Association (APOA) 2021 Congress. In response, a new section of the APOA, the Asia Pacific Osteoporosis & Fragility Fracture Society (APOFFS) was formed. APOFFS has several objectives including to increase awareness, knowledge and promote best practice in osteoporosis and fragility fracture care. As its first project, APOFFS collaborated with the Evidence Generation Working Group of Asia Pacific Fragility Fracture Alliance (APFFA) to survey the APOA membership on the awareness and attitudes to the management of fragility fractures. This presentation highlights key features of this survey along with some early findings. With the close alignment of APOFFS's objectives with the mission and vision of the APFFA, fruitful collaboration is anticipated. The findings of this survey will inform future educational efforts to enhance best practice in osteoporosis and fragility fracture care.

Assessing Skeletal Maturity: Searching for the Holy Grail: Commentary on an article by Ryan J. Furdock, MD, et al.: "Systematic Isolation of Key Parameters for Estimating Skeletal Maturity on Anteroposterior Wrist Radiographs".

Commentary Ryan J. Furdock and his fellow researchers have produced a highly sophisticated study focused on a topic of wide interest to the orthopaedic community: simplified and improved assessment of skeletal maturity. A number of existing methods of estimating skeletal maturity were assessed in this study: the Fels hand-wrist method, the Greulich and Pyle atlas, the Sanders hand system, and the distal radius and ulna classification. Using a subset of data from the Bolton-Brush growth study (80 pediatric patients with serial radiographs up to skeletal maturity), they produced what they have termed a “modified Fels wrist skeletal maturity system” (named for businessman and philanthropist Samuel Simeon Fels [1860-1950]) that takes a dizzying list of radiographic parameters and boils them down to the key 8 (7 from the Fels system and 1 from the Greulich and Pyle system). The psychometrics of the modified system are quite favorable, with interrater and intrarater reliability of 0.79 to 0.97 in addition to the best precision and the least outlier estimates as compared with the other methods. The authors also mention a free mobile phone application considered to streamline use of the modified Fels wrist system. The authors acknowledge inherent limitations of the Bolton-Brush data set, which was collected from a predominantly Caucasian population in northern Ohio from 1929 to 1942, and suggest that race and sex-based corrections may be necessary to maximize accuracy. The concern about essentially mono-racial data from nearly 100 years ago is not new and criticism has usually focused on the generalizability of these data to current multi-ethnic/multi-racial populations. However, I would submit that another concern is whether skeletal maturation has measurably changed in 100 years. Fels longitudinal growth data (which ironically also dates back to 1920s Ohio—starting in Yellow Springs, Ohio, in 1929) has recently been further assessed by researchers at the University of Missouri, who compared children born in the 1930s to those born in the 1990s1. Bone maturation was noted almost 1 full year earlier in the 1990s group. These changes in bone maturation have also been shown to vary according to anatomic area and sex as well as tempo and duration2,3. In pediatric orthopaedics, an endless array of syndromes and conditions (e.g., myelomeningocele) with their own skeletal growth quirks may also cause us to question Bolton-Brush-derived data4. Clearly, more work remains to be done. The simplicity and accuracy of what Furdock et al. are offering are certainly attractive, but as the authors themselves have stated, “the system needs external validation in a modern, diverse pediatric cohort.”

Assessing the academic achievement of United States orthopaedic departments.

BACKGROUNDAssessing academic productivity allows academic departments to identify the strengths of their scholarly contribution and provides an opportunity to evaluate areas for improvement. AIMTo provide objective benchmarks for departments seeking to enhance academic productivity and identify those with significant improvement in recent past.METHODSOur study retrospectively analyzed a cohort of orthopaedic faculty at United States-based academic orthopaedic programs. 5502 full-time orthopaedic faculty representing 178 programs were included in analysis. Variables included for analysis were National Institutes of Health funding (2014-2018), leadership positions in orthopaedic societies (2018), editorial board positions of top orthopaedic journals (2018), total number of publications and Hirsch-index. A weighted algorithm was used to calculate a cumulative score for each academic program. This study was performed at a large, United States medical school.RESULTSAll 178 programs included in analysis were evaluated using the comprehensive weighted algorithm. The five institutions with the highest cumulative score, in decreasing order, were: Washington University in St. Louis, the Hospital for Special Surgery, Sidney Kimmel Medical College (SKMC) at Thomas Jefferson University, the University of California, San Francisco (UCSF) and Massachusetts General Hospital (MGH)/Brigham and Women’s/Harvard. The five institutions with the highest score per capita, in decreasing order, were: Mayo Clinic (Rochester), Washington University in St. Louis, Rush University, Virginia Commonwealth University (VCU) and MGH/Brigham and Women’s/Harvard. The five academic programs that had the largest improvement in cumulative score from 2013 to 2018, in decreasing order, were: VCU, SKMC at Thomas Jefferson University, UCSF, MGH/Brigham and Women’s/Harvard, and Brown University.CONCLUSIONThis algorithm can provide orthopaedic departments a means to assess academic productivity, monitor progress, and identify areas for improvement as they seek to expand their academic contributions to the orthopaedic community.

Rare primary patellar resurfacing does not lead to more secondary patellar resurfacing: analysis of 70,014 primary total knee arthroplasties in the Dutch Arthroplasty Register (LROI).

Background and purposeCurrent literature provides no conclusive evidence in support of a patellar resurfacing vs. non-resurfacing regime. Therefore, we compared the incidence of secondary patellar resurfacing among hospitals using 3 different primary patellar resurfacing regimes in the Netherlands. Secondarily we identified patient and surgical characteristics associated with primary patellar resurfacing and secondary patella resurfacing following non-resurfaced primary total knee arthroplasty (TKA).Patients and methodsWe used data from 2014–2016 of the Dutch Arthroplasty Register. Hospitals were divided into rare (0–10%), selective (>10% to 90%), and usually primary patellar resurfacing (>90%) regimes. We performed a logistic regression analysis for associated factors of primary patellar resurfacing in the selective resurfacing subgroup and for secondary patellar resurfacing in the rare resurfacing subgroup.ResultsThe rate of primary resurfacing was 5.2% for the rare and 36% for the selective patellar resurfacing regimes, with similar secondary patellar resurfacing (1.1% vs. 0.9%). Predictors for primary patellar resurfacing were being female (OR 1.3) and younger (50–59 years, OR 1.4). The PS prosthesis design had a higher OR (4.1) than the CR design. Younger age (50–59 years, OR 1.5) and PS prosthesis (OR 2.7) were significant predictors of secondary patellar resurfacing. Particular surgical systems have a higher rate of primary and secondary patellar resurfacing.InterpretationLow rates of secondary patellar resurfacing in hospitals with a rare resurfacing regime indicate that this regime does not lead to more secondary patellar resurfacing then selective resurfacing. In the Dutch orthopedic community primary and secondary patellar resurfacing is associated with using a posterior stabilizing design, being younger, and using particular TKA systems.

Edward Hickling Bradford (1848-1926): The Founder of Pediatric Orthopedics in America.

Edward Hickling Bradford (1848-1926) is considered as 1 of the most important figures in American and world orthopedics during 19th and early 20th century. His teaching ability, his gifted surgical skills and his innovations in orthopedics attracted the interest of the world orthopedic's community and gave him a long lasting reputation. But most of all he is considered as the founder of pediatric orthopedics in America.

Impact of the recurrent wave of COVID-19 pandemics on orthopedics practice and training in India

Emerging pandemics show that humans are not infallible and communities need to be prepared. Coronavirus outbreak was first reported towards the end of 2019 and has now been declared a pandemic by the World Health Organization. Since then many researches are going worldwide to understand this corona virus disease, its impact on human body, prevention and treatment. As of now it has been observed that its can affect every organ of body and it’s not only the respiratory manifestation but it has shown other clinical sign and symptoms in various patients. This review article is highlighting the impact of COVID-19 on on orthopedics practice and training in India which helps us to understand the various problems faced by orthopaedic community and guide us to overcome the recurrent waves of COVID-19.

Patela bipartida – uma apresentação clínica atípica

Bipartite patella is usually an asymptomatic entity. In adults, the incidence is between 0.2% to 6% and only 2% of these is symptomatic. Bipartite patella may cause anterior knee pain, the gold standard treatment is conservative, and the surgical treatment is reserved when the conservative treatment fails. The authors present an atypical clinical presentation of bipartite patella. Because this is a clinical entity that is often underdiagnosed, the subject in question is of paramount importance. The orthopedic community should include this entity in the differential diagnosis of anterior knee pain, and it is important to define guidelines for its diagnosis and treatment.