Orthopedic Consultation Research Articles

Enhancements in Artificial Intelligence for Medical Examinations: A Leap from ChatGPT 3.5 to ChatGPT 4.0 in the FRCS Trauma & Orthopaedics Examination

IntroductionChatGPT is a sophisticated AI model capable of generating human-like text based on the input it receives. ChatGPT 3.5 showed an inability to pass the FRCS (Tr&Orth) examination due to a lack of higher-order judgement in previous studies. Enhancements in ChatGPT 4.0 warrant an evaluation of its performance. MethodologyQuestions from the UK-based December 2022 In-Training examination were input into ChatGPT 3.5 and 4.0. Methodology from a prior study was replicated to maintain consistency, allowing for a direct comparison between the two model versions. The performance threshold remained at 65.8%, aligning with the November 2022 sitting of Section 1 of the FRCS (Tr&Orth). ResultsChatGPT 4.0 achieved a passing score (73.9%), indicating an improvement in its ability to analyse clinical information and make decisions reflective of a competent trauma and orthopaedic consultant. Compared to ChatGPT 4.0, version 3.5 scored 38.1% lower, which represents a significant difference (p<0.0001; Chi-square). The breakdown by subspecialty further demonstrated version 4.0’s enhanced understanding and application in complex clinical scenarios. ChatGPT 4.0 had a significantly significant improvement in answering image-based questions (p=0.0069) compared to its predecessor. ConclusionChatGPT 4.0's success in passing Section 1 of the FRCS (Tr&Orth) examination highlights the rapid evolution of AI technologies and their potential applications in healthcare and education.

Accuracy and reliability of the AO/OTA classification for tibial shaft fractures

BackgroundAvailable literature lacks information regarding the accuracy and reliability of the AO/OTA classification for tibial shaft fractures. This study aimed to assess the inter- and intra-observer agreement and accuracy of the AO/OTA 42 classification (4-signs) for adult patients with tibial shaft fractures. Materials and methodsThe study design is an accuracy, inter- and intra-observer agreement study. Anterior posterior (AP) and lateral X-rays of the fracture were used in the examination. The raters comprised of two junior doctors and two orthopedic trauma consultants, who underwent patient scoring twice in a blinded and randomized set-up. A committee including two consultant orthopedic trauma surgeons, one consultant orthopedic radiologist, and one associate professor was established to represent the “gold standard.” The 3- and 4-signs AO/OTA 42 classification was used for classification. ResultsA total of 101 patients were included. X-rays were available for all 101 patients. Based on the gold standard classification, AO/OTA 42-A1 (56 %) was the most common fracture type, followed by AO/OTA 42-A3 (14 %). The agreement at 4-signs, when comparing the four raters and the gold standard classification was between 75 % and 86 % (Choen's kappa 0.53 to 0.79). Choen's kappa coefficient at 4-sgns for intra-and inter-observer agreement was between 0.47 and 0.74 and 0.31 and 0.60, respectively. ConclusionThis study showed substantial to moderate accuracy of the 4-signs AO/OTA 42- classification for tibial shaft fractures. Intra-observation agreements at 4-signs showed moderate to substantial agreement with and without available CT scans. Inter-observer agreements at 4-signs showed moderate to substantial agreement with only X-rays available. Inter-observer agreements for CT scan at 4-signs showed slight to moderate agreements.

How accurately can ChatGPT 3.5 answer frequently asked questions by patients on glenohumeral osteoarthritis?

Abstract Background Conversational artificial intelligence (AI) systems like ChatGPT have emerged as valuable assets in providing accessible information across various domains, including the healthcare system. The use of ChatGPT may contribute to better patient education and better general healthcare knowledge. However, there is a paucity of data on the reliability of responses generated by ChatGPT in the context of specific medical diagnoses. Methods We identified 12 frequently asked questions by patients about glenohumeral osteoarthritis. These questions were formulated in both English and German, using common and medical terms for the condition, thus creating four groups for evaluation. The questions were then presented to ChatGPT 3.5. The generated responses were evaluated for accuracy by four independent orthopedic and trauma surgery consultants using a Likert scale (0 = fully inaccurate to 4 = fully accurate). Results Although there were two questions in two groups, all questions across all versions were answered with good accuracy by ChatGPT 3.5. The highest score on the Likert scale was 3.9 for the group where questions were posed in English using the medical term “glenohumeral osteoarthritis.” The lowest score of 3.2 was for the group where questions were posed in English using the common term “shoulder arthrosis.” On average, questions in English received a score of 3.5 on the Likert scale, slightly higher than those in German, which received a score of 3.4. Conclusion ChatGPT 3.5 can already provide accurate responses to patients’ frequently asked questions on glenohumeral osteoarthritis. ChatGPT can therefore be a valuable tool for patient communication and education in the field of orthopedics. Further studies, however, have to be performed in order to fully understand the mechanisms and impact of ChatGPT in the field.

Does Observation Improve Compliance to Standard Surgical Hand Scrubbing?

Background: Standard surgical hand scrubbing techniques are essential for the prevention of surgical site infections. Overt observation is the gold standard to assess compliance to surgical hand scrubbing techniques but is confounded by the Hawthorne effect. Objective: To compare the compliance of surgical hand scrubbing technique in Orthopaedic operation theatres as observed overtly and covertly by trained independent observers.Materials and Methods: We conducted this cross sectional study in Orthopaedic operation theatres of Lady Reading Hospital, Peshawar, from 15th November 2023 to 15th February 2024. All the participants fulfilling inclusion criteria were overtly and covertly observed by independent trained observers for compliance to WHO surgical hand scrubbing techniques. The difference in the rate of surgical hand scrubbing compliance between overt and covert observations served as a measure of the Hawthorne effect.Results: The total number of participants in our study were 48 including 11 Orthopaedic consultants and 37 Orthopaedic residents. The overt observation revealed that the compliance to the various steps of WHO surgical hand scrubbing ranges from 89.58% to 100% with a weighted mean of 95.76%. The compliance rate ranged from 60.41% to 89.58% with a weighted mean of 68.43% when data was collected through covert observation. The overall increased compliance rate reported through covert observation as compared to overt observation(P=0.007) is attributed to the Hawthorne effect. Conclusion: Compliance of the Orthopaedic consultants and residents to the standard surgical hand scrubbing technique in Orthopaedic operation theatre was significantly high with overt observation than with covert observation.Keywords: Compliance, Covert observation, Hand hygiene, Hawthorne effect, Overt observation, Surgical site infection.

Assessing diagnostic challenges in acute soft-tissue knee injuries.

This Delphi study assessed the challenges of diagnosing soft-tissue knee injuries (STKIs) in acute settings among orthopaedic healthcare stakeholders. This modified e-Delphi study consisted of three rounds and involved 32 orthopaedic healthcare stakeholders, including physiotherapists, emergency nurse practitioners, sports medicine physicians, radiologists, orthopaedic registrars, and orthopaedic consultants. The perceived importance of diagnostic components relevant to STKIs included patient and external risk factors, clinical signs and symptoms, special clinical tests, and diagnostic imaging methods. Each round required scoring and ranking various items on a ten-point Likert scale. The items were refined as each round progressed. The study produced rankings of perceived importance across the various diagnostic components. In Round 1, the study revealed widespread variability in stakeholder opinions on diagnostic components of STKIs. Round 2 identified patterns in the perceived importance of specific items within each diagnostic component. Round 3 produced rankings of perceived item importance within each diagnostic component. Noteworthy findings include the challenges associated with accurate and readily available diagnostic methods in acute care settings, the consistent acknowledgment of the importance of adopting a patient-centred approach to diagnosis, and the transition from divergent to convergent opinions between Rounds 2 and 3. This study highlights the potential for a paradigm shift in acute STKI diagnosis, where variability in the understanding of STKI diagnostic components may be addressed by establishing a uniform, evidence-based framework for evaluating these injuries.

A novel operational protocol for the establishment of a medical facility for receiving returning hostages: structure, process and outcomes

BackgroundOn October 7, 2023, Hamas carried out an unprecedented attack on the State of Israel and kidnapped 251 people into captivity to the Gaza Strip. Several months later, as part of a humanitarian exchange deal, 105 hostages were released in five phases and admitted to one of six hospitals throughout the country for treatment. Shamir Medical Center (SMC) was one of these facilities. This study aims to describe the structure, process and outcomes of establishing a comprehensive, multi-step, operational protocol for receiving hostages returning from captivity.MethodThe process of preparing SMC as a receiving center, the establishment of procedures for implementation of the medical protocol, and the assessment of multi-disciplinary team preparedness and implementation and outcomes in an institutional protocol are described.Results24 returning hostages were received at SMC. Social workers, dietitians and translators were used by 100% of the majority group of returning hostages from the same country of origin and the sole individual from the other country of origin utilized a dietitian, social worker, ENT consultations, and a hearing test. Among the majority group, orthopedic and dermatological consultations were utilized by 17.4% and 13% received an ENT consultation. Of the administered imaging, 13% received a chest X-ray, 8.7% received a limb X-ray, 17.4% received a head CT scan, and 4.3% received an abdominal CT. In addition, 21.7% were provided antibiotic therapy. Protocol efficacy was measured by assessing time to various operational aspects of protocol implementation and medical procedures such as mean hours to room assignment, primary physician evaluation and social worker session. No correlation between age and operational variables was found.ConclusionThis novel operational protocol was successfully implemented and may serve as a framework for managing similar unpredictable sensitive events in the case of future need.

Impact of 3D-Printed Anatomical Models on Doctor-Patient Communication in Orthopedic Consultations: A Randomized Clinical Trial.

Effective communication between doctors and patients is essential for treatment adherence and better clinical outcomes. Although 3D printing has advanced in medicine, its impact on doctor-patient communication still requires further investigation. This randomized clinical trial evaluated the effectiveness of 3D anatomical models as a tool to facilitate communication in orthopedic consultations. This randomized clinical trial was conducted between May 2024 and September 2024, with 46 patients randomized into two groups: 21 patients received medical explanations with the aid of 3D models, and 25 without. Patients' knowledge was assessed before and after the consultation, and the quality of communication was measured using the Communication Assessment Tool (CAT). In the group using 3D models, 76.19% of patients reported improved knowledge of their conditions, while in the group without models, the increase was 52.00%. Additionally, 14 out of 15 CAT parameters showed statistically significant differences between the groups, with p-values ranging from 0.001 to 0.021. The use of 3D models significantly improved patients' understanding and facilitated communication with doctors, proving to be an effective tool for explaining complex medical conditions.

Altered Sensory Processing in People Attending Specialist Orthopaedic Consultation for Management of Persistent Shoulder Pain: An Observational Cross-Sectional Study.

OBJECTIVES: The primary objective was to compare sensory processing measures in people attending specialist orthopaedic consultation for management of persistent shoulder pain with control participants. The secondary objective was to compare the groups' sociodemographic, clinical, general health and lifestyle, and psychological characteristics. DESIGN: Observational cross-sectional. METHODS: Participants with shoulder pain for ≥3 months, who attended a public hospital orthopaedic department (n = 119), and community participants without shoulder pain (n = 44) underwent a standardized quantitative sensory testing protocol, measuring pressure pain threshold, temporal summation, and conditioned pain modulation. Sociodemographic, clinical, general health and lifestyle, and psychological characteristics were also collected. RESULTS: Participants with shoulder pain had significantly lower pressure pain thresholds at all sites (ie, local and widespread mechanical hyperalgesia) and significantly decreased conditioned pain modulation effect (ie, descending inhibition of nociception) than control participants. There was no significant difference between groups for temporal summation. Participants with shoulder pain had decreased general health and function, less healthy lifestyles, and poorer psychological health compared with controls. CONCLUSION: People referred to specialist orthopaedic care for management of persistent shoulder pain had clinical signs of altered sensory processing and poor health outcomes. J Orthop Sports Phys Ther 2024;54(10):1-10. Epub 25 July 2024. doi:10.2519/jospt.2024.12512.

How option-listing influences decision-making in orthopedic consultations: a conversation analytic study

ObjectivesExamine which practices orthopedists use to do option-listing, a technique that can facilitate shared decision-making (SDM). MethodsA conversation analytic study of 35 orthopedic consultations with newly referred patients with hip and/or knee osteoarthritis. ResultsOrthopedists implement option-listing in consultations using two organizational principles: 1) A fixed order of options that constitutes a scale (based on the severity of treatment). Presenting this scale (in two possible orders) encodes this fixed order; 2) Options are presented in relation to each other, rather than as individual options to be discussed incrementally. This format provides orthopedists with interactional slots to formulate their professional stance by presenting options as considered but rejected. Patients co-construct this list by taking a recipient role and not responding to the individual items of the list. ConclusionsOption-listing can facilitate SDM, allowing patients to choose amongst options. A drawback is that, while the organizational principles of option-listing allow orthopedists to express a professional opinion, they also place patients in an interactional position in which they have to address the orthopedists’ epistemic stance. On the other hand, patients can use the scale to propose their own preferences. Practical implicationsAwareness of the interactional consequences of option-listing might optimize SDM.

Translation, cross-cultural adaptation and validation of psychometric properties of foot function index in Urdu-speaking population with ankle and foot disorders

BackgroundFoot and ankle problems are frequently prevalent, especially among the elderly, ranging from 70 to 80%. In primary care, foot, and ankle complaints stand out as one of the most frequent reasons for orthopedic consultations. Patient-reported outcome measures are significant in the assessment burden of any condition on the effects of intervention as well as research. The Foot Function Index (FFI) is a region-specific tool that was identified as one of the most commonly used evaluation tools for foot complaints. This study aimed to translate, cross-cultural adapt, and test the psychometric properties of FFI in the Urdu language.MethodologyThe FFI was translated into Urdu language (FFI-U) following Beaton et al. translation guidelines. The data were collected from 230 Urdu-speaking participants with different foot and ankle pathologies. Data collection started after the written informed consent from the participants. All participants completed the FFI-U, Visual Analogue Scale (VAS), SF-36, and the Foot and Ankle Outcome Score (FAOS) at baseline while only 30 participants completed ULFI-U after one week for test-retest reliability. The psychometric properties involved reliability and validity testing. Reliability was assessed where internal consistency was measured using Cronbach’s alpha and test-retest reliability through the intra-class correlation coefficient (ICC). FFI-U was tested for face validity and construct validity (convergent and discriminant). Psychometric criteria were examined against priori hypotheses, and alpha level (p-value < 0.05) was considered statistically significant.ResultsFFI-U demonstrated good reliability with internal consistency (α = 0.86) and test-retest reliability with intra-class correlation coefficient = 0.845 (0.78–0.89). A moderate correlation was found using Pearson correlation between FFI-U total score and physical components of SF-36, VAS (pain, disability), and FAOS (γ= -0.65, 0.72, 0.71, -0.68) respectively, indicating convergent validity however, a weak correlation was found with mental components of SF-36 (γ=-0.25) demonstrating discriminant validity. Face validity was assessed at the pre-final testing stage by interviewing patients. There were no floor and ceiling effects found for FFI-U.ConclusionThe FFI-U has been found reliable, valid, and feasible tool to be used as a patient-reported outcome measure to assess functional levels with different foot and ankle disorders in Urdu speaking population.

Pathway to Excellence: One Institution's Experience Obtaining the Joint Commission's Advanced Total Hip and Total Knee Replacement Certification.

As the prevalence of total hip and total knee arthroplasty procedures increase over the next decades, hospitals seek opportunities to improve quality outcomes while simultaneously limiting costs and mitigating risks of complications. The Joint Commission's Advanced Total Hip and Total Knee Replacement (THKR) certification is one of the highest quality standard certification programs in the nation and is the only one that collaborates with the American Academy of Orthopedic Surgeons. To obtain THKR certification, several requirements based on evidence-based clinical practice guidelines must be met. The process is described from initial identification of stakeholders to ongoing efforts to retain certification. Joint Commission THKR certification was awarded after rigorous review and on-site visit. Compliance with advanced care standards from the time of orthopedic consultation through postsurgical follow-up was reviewed. Joint Commission THKR certification provides supporting evidence of the institutions journey in processes toward delivering high quality clinical care. A multidisciplinary team with ongoing collaboration is necessary to obtain and retain certification.

Relationship between foot and ankle tendinopathies and dyslipidemia: a literature review

Objectives: Dyslipidemia is a multifactorial condition related to genetic factors, dietary patterns, sedentary habits, and socioeconomic conditions. Foot and ankle tendinopathies are a common problem in orthopedic consultations and can represent up to 30%, highlighting some risk factors, such as metabolic disorders. Methods: This study is an integrative review of the literature addressing the correlation between foot and ankle tendinopathy and dyslipidemia. The keywords used were: “tendinopathy,” “foot and ankle,” and “dyslipidemia,” with the operators “AND” and “OR” for the search. The following inclusion criteria were established: case reports, cohort studies, case and control studies, clinical trials, and biomechanical studies published between 2013 and 2024, indexed in the following databases: Pubmed (Medline), Scielo, Lilacs, and Scopus, published in English, Spanish, and Portuguese.Results: Several mechanisms have been proposed to explain the correlation between tendinopathies and dyslipidemia, although there is still no absolute clarity; it was shown that the Achilles tendon is the main tendon affected in the foot and ankle, especially by xanthomas, which lead to an increase in the area size, causing pain, edema, difficulty in movement and changes in gait. Conclusion: It is believed that females with dyslipidemia, elderly patients, and individuals with a body mass index below 18.5kg/m2 are more prone to tendinopathies. Level of evidence II; Diagnostic studies.

Outcomes After Implementation of a Fragility Fracture Pathway in Ground Level Falls

IntroductionFragility fractures occur due to low energy mechanisms and result in significant morbidity and mortality. This study reviews the implementation of a fragility fracture program at a level I trauma center. In this pathway, trauma surgery provides clearance followed by admission and management with medical service and orthopedic consultation for injuries which meet fragility fracture criteria. MethodsThis pathway, implemented in July 2021, includes patients with isolated fractures secondary to a low energy mechanism. We compared cohorts 2-ys before (PRE) and after (POS) pathway implementation. Demographics (age, sex, fracture location, injury severity score, American Society of Anesthesiologists score) and outcome data were collected and analyzed using between-subjects analyses. Measured outcomes included deep vein thrombosis/pulmonary embolism, hospital mortality, disposition to hospice, nonoperative rate, unplanned intensive care unit admission, time to surgery (TTS), and length of stay (LOS). ResultsThe study included n = 1137 patients (n = 564 PRE and n = 573 POS). POS patients had a higher injury severity score (P = 0.003) and different fracture location (P = 0.017), but no other demographics were different. Trauma admission decreased after implementation (P < 0.001; PRE: 21.5%, POS: 1.8%) with no differences in outcomes except increases in LOS (P < 0.001; PRE: 114 h, POS: 124 h) and TTS (P < 0.001; PRE: 15 h, POS: 18 h). ConclusionsMorbidity and mortality did not correlate with pathway implementation; however, TTS and LOS increased. Although TTS increased, it remained under the American Academy of Orthopedic Surgery 48-h recommendation. The TTS and LOS increases were potentially from COVID-19 or cohort demographic differences. Decreased trauma as admitting service demonstrates pathway adherence. These findings highlight the need for investigation to better understand fragility fracture pathways.

Gender diversity in the National Joint Registry.

Our primary aim was to establish the proportion of female orthopaedic consultants who perform arthroplasty via cases submitted to the National Joint Registry (NJR), which covers England, Wales, Northern Ireland, the Isle of Man, and Guernsey. Secondary aims included comparing time since specialist registration, private practice participation, and number of hospitals worked in between male and female surgeons. Publicly available data from the NJR was extracted on the types of arthroplasty performed by each surgeon, and the number of procedures of each type undertaken. Each surgeon was cross-referenced with the General Medical Council (GMC) website, using GMC number to extract surgeon demographic data. These included sex, region of practice, and dates of full and specialist registration. Of 2,895 surgeons contributing to the NJR in 2023, 102 (4%) were female. The highest proportions of female surgeons were among those who performed elbow (n = 25; 5%), shoulder (n = 24; 4%), and ankle (n = 8; 4%) arthroplasty. Hip (n = 66; 3%) and knee arthroplasty (n = 39; 2%) had the lowest female representation. Female surgeons had been practising for a median of 10.4 years since specialist registration compared to 13.7 years for males (p < 0.001). Northern Ireland was the region with the highest proportion of female arthroplasty surgeons (8%). A greater proportion of male surgeons worked in private practice (63% vs 24%; p < 0.001) and in multiple hospitals (74% vs 40%; p < 0.001). Only 4% of surgeons currently contributing cases to the NJR are female, with the highest proportion performing elbow arthroplasty (5%). Female orthopaedic surgeons in the NJR are earlier in their careers than male surgeons, and are less involved in private practice. There is a wide geographical variation in the proportion of female arthroplasty surgeons.

Physical activity and depression symptoms in people with osteoarthritis-related pain: A cross-sectional study.

Osteoarthritis is a leading cause of chronic pain and is associated with high rates of depression. Physical activity reduces depression symptoms and pain levels. It remains unknown if physical activity is associated with lower symptoms of depression irrespective of pain levels in individuals with osteoarthritis. We explored whether pain mediated or moderated the relationship between levels of physical activity engagement and depression symptoms. Individuals with osteoarthritis who were waiting for an orthopaedic consultation at a public hospital in Melbourne, Australia, were recruited. Data collected on pain levels, physical activity engagement and depression symptoms. Descriptive statistics were used to summarise participant characteristics. Moderation and mediation analyses were used to establish the impact of pain on the relationship between physical activity and depression, after adjusting for demographic and joint specific characteristics. The results indicated that the inverse association between physical activity and depression depended on the level of pain, such that the association was stronger in people with greater pain. The mediation results confirm that participating in physical activity is indirectly, inversely associated with symptoms of depression through lower levels of pain. The highest levels of pain were associated with the most potential benefit in terms of reduction in symptoms of depression from engaging in physical activity. Physical activity may be particularly important to manage depression symptoms in people with greater osteoarthritis-related pain as patients with the highest pain may have the greatest benefits.

Creating Novel Standards for Datapoints on an Elective Orthopaedic Theatre List Document.

Orthopaedic theatre lists are an important tool which must convey essential information to all staff to run an effective and safe theatre list. However, there are no set standards or guidelines on the components of an Orthopaedic theatre list. The objective of this study is to formulate guidelines for elective Orthopaedic theatre lists which improve efficiency and reduce errors. We looked at 326 elective Orthopaedic theatre lists from October to November 2018. Various factors such as: theatre and patient demographics, surgical team, type of anaesthesia, Surgery, acronyms and finally extra information such as allergies. Additionally, a survey was distributed to a variety of theatre staff to understand their requirements from a theatre list. Thereafter, we created a proforma for waiting list coordinators. Subsequently, we re-audited six more weeks of theatre lists (255) from November to December 2019. The orthopaedic consultant in charge was noted for 100% of patients compared to 85% previously. There was an improvement in documenting the required anaesthesia such as noting 14.5% required spinal compared to 0.3% previously. Prosthesis/equipment was mentioned for 34% of patients compared to 23%. Fluoroscopy was noted as being required for 25% of patients compared to 11%. We believe standards should be in place in order for us to follow to ensure we carry out safe and efficient Orthopaedic theatre lists, and these standards should entail the parameters we have audited. The 'William Harvey theatre list standard' should be used as a gold standard for all elective Orthopaedic theatre lists.

Splinting of Low-Risk Pediatric Fractures.

This review covers common orthopedic injuries seen after acute traumatic injury. A thorough physical examination and radiographic review of these injuries are key to ensuring appropriate management. Although many injuries may require urgent or emergent orthopedic consultation and management, this review focuses on injuries that are low-risk and amenable to splinting with outpatient orthopedic follow-up. This review covers key physical examination features, radiographic findings that help providers assess injuries, as well as reviewing splinting application to help facilitate rapid management of these injuries in the acute care setting.

Accuracy of Clinical Suspicion for Rotator Cuff Tears by Orthopedic Surgeons When MRI Was Ordered on Initial Visits: Should Physical Therapy Be Mandated by Insurance Before MRI?

Insurance companies often mandate six weeks of physical therapy (PT) prior to approving MRIs for patients with atraumatic rotator cuff (RTC) tears. While this is designed to limit unnecessary imaging orders, it can increase healthcare costs and delay diagnosis and surgery. This study investigated the incidence of full- and partial-thickness tears when an MRI was ordered at the time of initial consultation for shoulder pain by an orthopedic provider. A retrospective review of patients who had an MRI ordered upon initial orthopedic consultation for chronic shoulder pain was conducted. The primary outcome measured was the presence of RTC tears as determined by the MRI report. The cost of six weeks of PT versus the cost of immediate MRI in these patients was collected from our institution's financial database.ANOVA, independent T-test, and chi-square test were used to analyze the differences between groups. A total of 365 patients were included. There were no significant differences in demographics between patients with full, partial, or no tears, with the exception that patients with full-thickness tears were older. Specifically, 43.0% had a full-thickness tear, 24.7% had a partial-thickness tear, and 32.2% had no tear on MRI. A total of 56.1% of the full-thickness tears proceeded to surgery. The cost of an upper extremity MRI without contrast averages $2,268, while two sessions of PT per week for six weeks totals $2,328. Over 67% of MRI orders yielded a positive finding of an RTC tear and remained at 67.2% in the absence of a history of conservative treatment, validating a specialist's clinical suspicion for an RTC tear and indication for MRI. Pre-MRI PT to satisfy insurance requirements may therefore delay intervention and increase healthcare costs when an orthopedic provider believes an MRI is warranted for clinical decision-making.

Individuals with musculoskeletal conditions awaiting orthopaedic surgery consultation: an untapped opportunity for patient health management?

To describe the health characteristics, condition-specific measures, chronic disease risk factors, and healthcare and medication use over time of individuals with musculoskeletal conditions awaiting orthopaedic surgical consultation. Study importance: Musculoskeletal conditions are highly prevalent in the general population and often coexist with chronic diseases. However, little is documented about the overall health of this group. This study describes the health of these individuals, with particular emphasis on modifiable risk factors of chronic disease. A repeated measures longitudinal cohort study of individuals referred for orthopaedic consultation across three time points (2014, 2015 and 2016). This study was undertaken in the orthopaedic outpatient service of a public tertiary referral hospital in New South Wales, Australia. Participants were aged 18 years and older and were referred for and awaiting orthopaedic surgical consultation for a musculoskeletal condition (back, neck, hand or wrist pain, or hip or knee osteoarthritis). Measures included patient demographics, condition-specific indicators (e.g. pain, disability, quality of life [QoL]) and chronic disease risk factors (e.g., excess weight, smoking). The mean age of participants was 57.7 years, and 7.3% identified as Aboriginal and/or Torres Strait Islander. Back (43.1%) and knee (35.0%) pain were the most prevalent conditions. At baseline (N = 1052), participants reported moderate pain (mean numerical pain rating scale score of 6.4, standard deviation [SD] 2.4) and QoL (Physical Component Score of 32.7, SD 10.7; Mental Component Score of 46.6, SD 13.3). Chronic disease risk factors were highly prevalent, with 74.6% of participants having three or more. For most measures, there were only small changes over time. Individuals with musculoskeletal conditions who are awaiting orthopaedic surgical consultation have a complex clinical picture and numerous chronic disease risk factors. Given the modifiable nature of many of these risk factors, identifying and addressing them before or while awaiting consultation may improve the health of these individuals.

Evaluation of Ultrasound Screening Method and Prevalence for Developmental Hip Dysplasia In The Central Anatolia

Objectives:This study aimed to assess the frequency and subsequent results of developmental dysplasia of the hip (DDH) in newborns in Central Anatolia who were admitted to Konya City Hospital and evaluate the efficiency of the existing screening and treatment methods in detecting and managing DDH in infants. Methods: Total of 10,650 infants were evaluated who had Graf USG screening in Konya City Hospital. İnfants born at or after 38 weeks of gestation were included, while premature infants were excluded. Additionally, we included infants who underwent USG screening between 30 and 90 days after birth, and whose hip development physiology was adequately visualized and assessed during the USG examination. Results: The study examined 8,695 term infants (52.5% male, 47.5% female) who underwent USG screening between 2020 and 2022. Participants mean gestational age at the time of the first USG examination was 7.94±2.07 weeks. Graf type 1 was higher in males (%97-96,5) and graf type 2 was higher in females (%7,2-7,8). Radiologists prefer to re-examine after 1 month for type 2a(%84,49-82,02) but orthopaedic consultation for type Type-2B, 2C, and type-3. The majority of infants (93.6%) underwent only one USG screening. No patients who continued regular USG control and treatment required surgical treatment requiring osteotomy. Conclusion: USG is an early diagnostic method for developmental hip dysplasia (DDH), which allows for simple treatment options and prevention of complications. It is a simple, inexpensive, and non-invasive method. Our study supports that regular USG screenings in infants eliminate the need for surgical procedures requiring osteotomy.