Orthopaedic Literature Research Articles

Antibiotic prophylaxis in alloplastic temporomandibular joint replacement surgery: A multi-national survey of temporomandibular joint surgeons

Temporomandibular disorders include a wide spectrum of extra-articular and intra-articular conditions affecting the temporomandibular joint (TMJ). In salvage cases involving intra-articular end-stage disease, alloplastic temporomandibular joint replacement (TMJR) is a management option which can be utilised to rehabilitate a disabled joint’s function and form. Whilst post-TMJR infection is rare, it is one of the most serious complications. The principles governing TMJR surgery antibiotic prophylaxis have been based on those established in orthopaedic surgery literature. Antibiotic resistance due to antibiotic over-use is a significant concern, therefore antibiotic stewardship has been developed to deal with this world-wide public health concern. The TMJ’s anatomical proximity to the external auditory canal and oral cavity creates the potential for bacterial contamination. The aim of this study was to explore the views of 39 sub-specialist TMJ surgeons across nine nations usual approach to antibiotic prophylaxis and their management of TMJR infection. To accomplish this, an international survey was developed and conducted using Google Forms. The results demonstrated that 97.4% of the respondents employ prophylactic antibiotics at TMJR surgery, 83.8% on discharge. Variability in antibiotic choice with additional antimicrobial perioperative practices were also reported. Opinions on the management of a TMJR infection also varied. This survey establishes there is an agreement on the use of antibiotic prophylaxis, However the variability in choice, timing, course, duration of antibiotic use as well as the management of a postoperative TMJR infection demonstrates the need for further study leading to development of standardised antibiotic prophylaxis and infection management protocols for TMJR surgery.

Machine learning review of hand surgery literature

Background: Latent Dirichlet Allocation is an artificial intelligence model which processes text into topics, and has had broad application in medicine, political science, and engineering. As the orthopedic hand literature continues to grow, such technology may have value in efficiently conducting identifying trends and conducting systematic reviews. The purpose of this study is to demonstrate the use of Latent Dirichlet Allocation and machine learning to review literature and summarize the past 21 yr of hand surgery research. Methods: All original research articles published in the Journal of Hand Surgery (American), Journal of Hand Surgery (European), Hand, Journal of Bone and Joint Surgery (JBJS), Clinical Orthopaedics and Related Research (CORR), Journal of the American Academy of Orthopaedic Surgeons (JAAOS) and Plastic and Reconstructive Surgery (PRS) from 2000-2021 were analyzed using Latent Dirichlet Allocation, generating 50 topics which were then ranked by popularity and trended over the previous 21 yr. Results: Research article abstracts totaling 11,501 from 2000-2020 were extracted and analyzed to create 50 topics. Conclusion: This is the first study of its kind to utilize machine learning models for reviewing the hand surgery literature. Machine learning possesses the ability to rapidly process a large body of test and assess the current state of research and trends or research topics, which can aid clinicians and researchers in time-intensive tasks to provide clues that will promote areas of further study.

Electric scooter-related orthopedic injuries: the experience of an Italian orthopedic center and literature review

BackgroundWith the increasing prevalence of electric scooters, a concomitant increase in the number of specific injuries, emergency department (ED) admissions and hospital admissions have been reported.ObjectivesAnalyze patient flow changes in...

Top fifty cited articles on humeral fractures

Humeral fractures (HF) are common orthopedic pathologies. Reviewing the content and quality of influential literature over time is important to advance scientific research regarding a specific topic. This study aims to explore and appraise the fifty most cited HF studies that had been published in orthopedic literature. The Web of Science database was used to conduct a systematic search for articles pertaining to HF. Articles were sorted out in descending order of citations and were included based on their relevance to HF. Data and metrics of the included studies were recorded. The methodological quality of the studies was assessed using the Modified Coleman Methodology Score (MCMS) and the Methodological Index for Non-randomized Studies criteria. Statistical analysis was conducted to explore any significant relationships between the date of publication and other relevant variables. Included articles (N= 50) were published between 1959 and 2015, with a total of 14,864 accumulated citations. Europe and North America contributed to all but one of the included studies. The Journal of Bone and Joint Surgery contributed to the highest number of included articles with 27 articles (54%). The proximal humerus was the most commonly explored HF location in our study (72%). The average MCMS and Methodological Index for Non-randomized Studies scores were reported to be 64.6 and 10.4, respectively, and the majority of articles (52%) were considered level four case series. Year of publication was found to have a positive correlation with increasing level of evidence(r=-0.301, P=.044), citation density (r= 0.734, P < .001), and MCMS score (r= 0.41, P= .01). The level of evidence, MCMS scores, and citation density of influential HF literature has been increasing with time, reflecting the increasing effort and work being put in that field. While the findings seem encouraging, additional high-quality research is needed to help achieve better treatment strategies and outcomes.

Human-Written vs AI-Generated Texts in Orthopedic Academic Literature: Comparative Qualitative Analysis.

As large language models (LLMs) are becoming increasingly integrated into different aspects of health care, questions about the implications for medical academic literature have begun to emerge. Key aspects such as authenticity in academic writing are at stake with artificial intelligence (AI) generating highly linguistically accurate and grammatically sound texts. The objective of this study is to compare human-written with AI-generated scientific literature in orthopedics and sports medicine. Five original abstracts were selected from the PubMed database. These abstracts were subsequently rewritten with the assistance of 2 LLMs with different degrees of proficiency. Subsequently, researchers with varying degrees of expertise and with different areas of specialization were asked to rank the abstracts according to linguistic and methodological parameters. Finally, researchers had to classify the articles as AI generated or human written. Neither the researchers nor the AI-detection software could successfully identify the AI-generated texts. Furthermore, the criteria previously suggested in the literature did not correlate with whether the researchers deemed a text to be AI generated or whether they judged the article correctly based on these parameters. The primary finding of this study was that researchers were unable to distinguish between LLM-generated and human-written texts. However, due to the small sample size, it is not possible to generalize the results of this study. As is the case with any tool used in academic research, the potential to cause harm can be mitigated by relying on the transparency and integrity of the researchers. With scientific integrity at stake, further research with a similar study design should be conducted to determine the magnitude of this issue.

Prescription opioid use increases resource utilization following ventral hernia repair

Previous studies showed that preoperative opioid use is associated with increased postoperative opioid use and surgical site infection (SSI) in patients undergoing ventral hernia repair (VHR). Orthopedic surgery literature cites increased resource utilization with opioid use. This study aimed to determine the effect of preoperative opioid use on resource utilization after open VHR. A retrospective institutional review board-approved study of VHRs from a single tertiary care practice between 2013 and 2020 was performed. Medical records, the National Surgical Quality Improvement Program database, and Kentucky All Schedule Prescription Electronic Reporting data were reviewed for patient demographics, comorbidities, dispensed opiate prescriptions, hernia characteristics, and outcomes. Univariate logistic regression analyses assessed the effect of each patient's demographic and clinical characteristics. Multivariate logistic regression models analyzed significant factors from the univariate analyses. The primary outcome was resource utilization measured as readmission, emergency department visit, or >2 postoperative clinic visits within 45 days after VHR. Overall, 381 patients who underwent VHR were identified; of which 101 patients had preoperative dispensed opioids. Multivariate analysis demonstrated that patient gender at birth, any new-onset SSI, and any preoperative opioid use were associated with increased postoperative resource utilization (odds ratio, 1.76; P=.026). Preoperative opioid use was determined as a risk factor that increased resource utilization after open VHR. An understanding of the drivers of the increased use of resources is essential in developing strategies to improve healthcare value. Future research will focus on strategies to reduce the utilization of resources among patients who use opioids.

(045) Comparing Bacterial Presence with the Usage of 0.05% Chlorhexidine Gluconate (CHG) Lavage During Urologic Prosthesis Revision Surgery: Update on Results

Abstract Introduction An Inflatable Penile Prosthesis (IPP) is third line surgical therapy for refractory ED. An IPP uses a fluid-filled reservoir with a pump and valve system to activate inflation and deflation. Although penile implants achieve the highest success rates in ED treatment, the possible presence of bacteria on the device itself or bacteria exposure accumulated during the surgery increases the risk of progression into biofilm or infection. Biofilm complicates the bacteria eradication effort and can ultimately jeopardize the implant. Often, the only way to treat the post-op infection is with implant removal. Currently, many preventative measures, such as different perioperative irrigations, are being studied to reduce the number of penile implant infections. Research has shown that irrigation at the time of both infectious and noninfectious surgery lowers subsequent infection rates. Different solutions like saline, antibiotic, betadine, and hydrogen peroxide solutions have been considered. Recently, orthopedic literature has shown that 0.05% Chlorhexidine Gluconate (CHG) lavage has effectively reduced biofilm in artificial joint procedures. Objective The purpose of this study is to determine the effectiveness of CHG lavage on bacterial presence in IPP implant spaces. We hypothesize that CHG will lower bacterial presence after washing out implant spaces at time of replacement for infections and mechanical failure. Methods We aimed to investigate a series of patients who underwent revision IPP surgery while utilizing FDA-approved CHG lavage for irrigation and compared the bacterial presence before and after CHG washout. Additionally, Next Generation Sequencing (NGS), a DNA sequencing technology, was used to further identify the pathogens involved. Results Between 2021 to 2023, 48 patients underwent IPP revision surgery for either infectious or noninfectious reasons. During the operation, a section of the capsule tissue surrounding the implanted IPP pump was first taken and sent for cultures. NGS studies were also sent out. After the implant removal, all implant spaces were irrigated and washed out with CHG (two 450-mL bottles). A second tissue culture was then obtained post washout. Of the 48 patients, there were 4 positive bacterial cultures before washout and 13 positive NGS results. Results of the post CHG washout cultures were all negative. Conclusions It appears that irrigation with 0.05% Chlorhexidine Gluconate solution is an effective antiseptic that can decrease bacterial presence, and hopefully reduce IPP infections. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Microgen Dx, Irrisept.

Civilian Ballistic Arthrotomies: Infection Rates and Operative Versus Nonoperative Management.

The purpose of this study was to determine whether a significant difference existed in the rate of infection after ballistic traumatic arthrotomy managed operatively compared with those managed without surgery. Retrospective cohort study. Academic Level I Trauma Center. Patients with ballistic traumatic arthrotomies of the shoulder, elbow, wrist, hip, knee, or ankle who received operative or nonoperative management. The rates of infection and septic arthritis in those who received operative or nonoperative management. One hundred ninety-five patients were studied. Eighty patients were treated nonoperatively (Non-Op group), 16 patients were treated with formal irrigation and debridement in the operating room (I&D group), and 99 patients were treated with formal I&D and open reduction and internal fixation (ORIF) (I&D + ORIF group). Patients in all 3 groups received local wound care and systemic antibiotics. No patients in the Non-Op or I&D group developed an infection. Six patients in the I&D + ORIF group developed extra-articular postoperative infections requiring additional interventions. The infection rate in the I&D + ORIF group was consistent with the infection rates reported in orthopaedic literature after fixation alone. In addition, none of the infections were cases of septic arthritis. This suggests that traumatic arthrotomy does not increase the risk for infection beyond what is expected after fixation alone. Importantly, the Non-Op group represented a series of 80 patients who were treated nonoperatively without developing an infection, indicating that I&D may not be necessary to prevent infection after ballistic arthrotomy. The results suggest that septic arthritis after civilian ballistic arthrotomy is a rare complication regardless of the choice of treatment. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Positive outcome reporting in orthopaedic literature.

Perthes' disease (PD) is a relatively rare syndrome of idiopathic osteonecrosis of the proximal femoral epiphysis. Treatment for Perthes' disease is controversial due to the many options available, with no clear superiority of one treatment over another. Despite having few evidence-based approaches, many patients with Perthes' disease are managed surgically. Positive outcome reporting, defined as reporting a study variable producing statistically significant positive (beneficial) results, is a phenomenon that can be considered a proxy for the strength of science. This study aims to conduct a systematic literature review with the hypothesis that positive outcome reporting is frequent in studies on the treatment of Perthes' disease. We conducted a systematic review of all available abstracts associated with manuscripts in English or with English translation between January 2000 and December 2021, dealing with the treatment of Perthes' disease. Data collection included various study characteristics, surgical versus non-surgical management, treatment modality, mean follow-up time, analysis methods, and clinical recommendations. Our study included 130 manuscripts. Overall, 110 (85%) reported positive (beneficial) results, three (2%) reported negative results, and 17 (13%) reported no significant difference. Despite only 10/130 studies (8%) having a testable hypothesis, 71 (55%) recommended the use of their studied treatment methods for the patients, five (4%) made recommendations against the use of the studied treatment modality, and 54 (42%) did not make any recommendations. The overall rate for positive outcomes among included manuscripts regarding different treatment methods for Perthes' disease (85%) is higher than the 74% positive outcome rate found among studies for other surgically treated disorders and significantly higher than most scientific literature. Despite the lack of testable hypotheses, most manuscripts recommended their studied treatment method as a successful option for managing patients solely based on the reporting of retrospective data.

The gender role in the publishing of Authorships in high-impact orthopedic journals.

To evidence the existence of a gender gap in the orthopedic scientific literature by including also differences between some specific orthopedic surgery specialities, such as hands and feet. Then, we also considered gender role in the Authorship linked with the economic wealth of each country belonging to each Author. The gender of the first Authors of journals on orthopedics and sports medicine indexing in the Scopus database with the highest impact factor (IF) related to the year 2019, for the period from January 1, 2015, to December 31, 2020, were considered. A total of 11 journals were considered, including a total of 5474 articles, 1087 (19.86%) had a woman as the first Author and 4387 (80.14%) a man. During the studied period, the trend seems to be the same (p = 0.906): Men were significantly more producing than women in the orthopedic field both by considering the topic of the journal (p = .003), all the most impacted orthopedic journals (p < 0.001) and economies (p < 0.001). There was therefore a strong significance: In the orthopedic field, there were significantly more male researchers who presented their first name in scientific publications compared to females in all orthopedic subspecialties. The economically poorer countries published less and the role of women became almost absent.

Harms Reporting in the RCTs Underpinning the AAOS Clinical Practice Guidelines for Clavicle Fractures

Background: The American Academy of Orthopaedic Surgeons (AAOS) publishes clinical practice guidelines (CPGs) for various pathologies. An extension to the Consolidated Standards for Reporting (CONSORT) checklist provides authors with a framework for reporting harms in randomized controlled trials (RCTs). Objectives: The purpose of this study was to measure harms reporting among RCTs cited as supporting evidence for the AAOS CPG on the treatment of clavicle fractures. This study also sought to determine whether these reporting rates changed over time. Methods: Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we used the AAOS CPG for clavicle fractures and conducted a linear regression analysis to model the relationship between the year of publication and the total CONSORT checklist percentage adherence over time. Results: There were 28 RCTs cited as supporting evidence for the clavicle fractures CPG included in the final sample. The average number of the 18 CONSORT Extension for Harms items appropriately reported across all included RCTs was 9.32 (51.8%). Nine checklist items had more than 50% compliance (50%), 3 items had between 20% and 50% compliance (16.7%), and 6 items had less than 20% compliance (33.3%). The linear regression model demonstrated no significant improvement in CONSORT Harms reporting over time. Conclusions: Adverse events are inadequately reported in RCTs cited as supporting evidence for the AAOS Treatment of Clavicle Fractures CPGs. We recommend the utilization of standardized adverse event reporting tools specific to orthopedic trauma literature to facilitate ease in adverse event reporting among RCTs.

Patient Self-Reported Allergies and Their Correlation with Thoracic Outlet Syndrome Outcomes.

Thoracic outlet syndrome (TOS) is an uncommon neurovascular disorder that presents as neck and upper extremity pain secondary to brachial plexus trunk or subclavian vasculature compression. The orthopedic literature has correlated patient-reported allergies to postoperative patient-reported outcome (PRO) scores for a variety of surgical procedures. We sought to evaluate patient-reported allergies and PROs following surgical decompression for TOS. A chart review was conducted after identifying patients who underwent surgical thoracic outlet decompression by a single surgeon. Patients were contacted and administered five PRO questionnaires via telephone: the QuickDASH Outcome Measure questionnaire (disabilities of the arm, shoulder, and hand [DASH]), the Cervical Brachial Symptom Questionnaire, the Single Assessment Numeric Evaluation, the 12-Item Short Form Survey, and the Numeric Rating Scale (a visual analogue scale). A bivariate analysis of Pearson's correlation coefficient (r) was used to determine the associations of allergies with questionnaires and demographic variables. Of the 393 patients (128 males and 265 females) identified in the study, 75 (24%) responded and completed all of the questionnaires, 18 (24%) males and 57 (76%) females. A significant correlation was found between the number of allergies reported and the QuickDASH Outcome Measure questionnaire (r = 0.375, P < 0.001), the Cervical Brachial Symptom Questionnaire (r = 0.295, P = 0.01), change in the Single Assessment Numeric Evaluation score (r = -0.310, P < 0.01), change in the visual analogue scale (r = 0.244, P = 0.035), sex (r = 0.245, P = 0.034), and the number of medications (r = 0.642, P < 0.001). The increased frequency of patient-reported allergies is significantly associated with worse PRO scores for women undergoing TOS surgical decompression. Better understanding this association can help physicians counsel patients on expected outcomes.

Utility of Artificial Intelligence in Orthopedic Surgery Literature Review: A Comparative Pilot Study.

Literature reviews are essential to the scientific process and allow clinician researchers to advance general knowledge. The purpose of this study was to evaluate if the artificial intelligence (AI) programs ChatGPT and Perplexity.AI can perform an orthopedic surgery literature review. Five different search topics of varying specificity within orthopedic surgery were chosen for each search arm to investigate. A consolidated list of unique articles for each search topic was recorded for the experimental AI search arms and compared with the results of the control arm of two independent reviewers. Articles in the experimental arms were examined by the two independent reviewers for relevancy and validity. ChatGPT was able to identify a total of 61 unique articles. Four articles were not relevant to the search topic and 51 articles were deemed to be fraudulent, resulting in 6 valid articles. Perplexity.AI was able to identify a total of 43 unique articles. Nineteen were not relevant to the search topic but all articles were able to be verified, resulting in 24 valid articles. The control arm was able to identify 132 articles. Success rates for ChatGPT and Perplexity. AI were 4.6% (6 of 132) and 18.2% (24 of 132), respectively. The current iteration of ChatGPT cannot perform a reliable literature review, and Perplexity.AI is only able to perform a limited review of the medical literature. Any utilization of these open AI programs should be done with caution and human quality assurance to promote responsible use and avoid the risk of using fabricated search results. [Orthopedics. 2024;47(3):e125-e130.].

Total Knee Arthroplasty in Patients with Ipsilateral Hip Fusion: Technical Notes and Literature Review.

Numerous studies report the success and outcomes of the total knee arthroplasty (TKA); however, few papers present patients with knee osteoarthritis and ipsilateral hip fusion. One controversy when treating patients requiring a TKA with prior ipsilateral hip fusion is whether to first perform a total hip arthroplasty (THA) of the fused hip, followed by the ipsilateral TKA, or to proceed with the TKA without replacing the hip; studies suggest that the position of the fused hip is a key factor when making this therapeutical decision. In addition, performing a TKA in patients with an ipsilateral fused hip may require modifications to the surgical technique generated by the lack of joint mobility in the hip. We identified 12 studies encompassing 30 patients with hip fusion and ipsilateral TKA in current orthopedic literature, but only six offered insights on patient positioning on the operating table during surgery. This study aims to review the current literature on patients with knee osteoarthritis and prior ipsilateral hip fusion and to present some technical considerations when performing a TKA on a 75-year-old patient with hip ankylosis who underwent a total ipsilateral knee arthroplasty in our clinic.

Determining the follow-up rates for shoulder arthroplasty: a retrospective review of a multicenter study of 4700 shoulders

BackgroundPostoperative follow-up is a routine component of the surgical care of a patient undergoing shoulder arthroplasty. Orthopedic journals require a high follow-up percentage in prospective studies to ensure reproducibility, generalizability of the data, and to limit bias. This study’s primary aim was to report the true follow-up rates after total shoulder arthroplasty among a multicenter cohort at 1, 2, 5, and 10 years and to explore various demographic factors associated with follow-up rates. MethodsA retrospective review of patients undergoing anatomic and reverse total shoulder arthroplasties at five U.S. centers from 2000 to 2020 was performed. The presence or absence of follow-up at 1-, 2-, 5-, and 10-year follow-up intervals was recorded as well as associated patient demographics and history variables. Univariate and multivariable logistic regression models were employed to examine the factors associated with patient follow-up. Results4700 shoulder arthroplasties were identified across five centers for review. Eligible follow-up rates were 66% at 1 year, 47% at 2 years, 26% at 5 years, and 9% at 10 years. When compared with the majority baseline groups at 1 year in multivariable analysis, the follow-up rate was significantly less for male patients (odds ratio [OR] = 0.83, P = .004), those over age 80 (OR = 0.66; P < .001), black patients (OR = 0.76, P = .035), Hispanic patients (OR = 0.54, P = .041), self-paying patients (OR = 0.5, P < .001), disabled patients (OR = 0.69, P = .021), those with psychiatric history (OR = 0.76, P < .001), and those with preoperative opioid use (OR = 0.81, P = .016). At 2 years, significantly lower follow-up rates were identified with patients ages 35 to 49.9 years (OR = 0.62, P = .013), over age 80 (OR = 0.67, P < .001), Hispanic (OR = 0.42, P = .010), unemployed (OR = 0.65, P = .014), psychiatric history (OR = 0.82, P = .017), and smoking history (OR = 0.71, P = .010). ConclusionTrue clinical follow-up rates following shoulder arthroplasty are much lower than the 80% 2-year follow-up rate expected by most orthopedic journals. Many factors contribute to differences among follow-up rates. Promoting follow-up at all time points would limit bias in orthopedic literature and potentially allow for early intervention of complications, but would need to be balanced with the additional burden and resources needed from patients and providers.

WHAT DRIVES INNOVATION AND CHANGE IN ACL SURGERY? AN ANALYSIS OF 14,352 PATIENTS

IntroductionAnterior cruciate ligament reconstruction (ACLr) is the most widely published operation in the orthopaedic literature. Over recent years there has been increased interest in the surgical technique and role of concomitant procedures performed during ACLr. The National Ligament Registry (NLR) collects robust data on ACLr performed in the UK. In this registry analysis we explore trends in ACLr surgery and how they relate to published literature and the growing industry portfolio available to surgeons.MethodsUsing data from the NLR, 14,352 ACLr performed between 2013–2021 were analysed. High impact papers on ACLr were then cross referenced against this data to see if surgical practice was influenced by literature or whether surgical practice dictated publication. Common trends were also compared to key surgical industry portfolios (Arthrex, Smith and Nephew) to see how new technology influenced surgical practice.ResultsThe number of ACLr performed in isolation is decreasing. The number of ACL reconstructions involving meniscal surgery shows an increasing trend since 2013, with 57% of ACLr in 2021 now involving meniscus surgery. The number of ACLr with lateral extra-articular tenodesis (LET) has increased sharply since 2018, preceding the stability trial publication in 2020. Graft preference and size has remained static despite the introduction of new graft harvest and fixation devices. Additional procedures such as other ligament reconstruction and additional cartilage surgery have also remained static over time.ConclusionIn this analysis we looked at surgical trends in ACLr and their relation to literature and industry. Meniscal intervention is increasing, in keeping with the growing level of literature in this area. In the setting of LET, a high impact level 1 study appears to have significantly changed the practice of UK surgeons with a sharp increase in the number of LET procedures being performed. Industry appears to have little influence on the change in surgical trends, suggesting high quality evidence is what drives innovation in ACLr while industry supports rather than influences innovation. It will be interesting to see the impact of the stability 2 study, recent work on the medial structures of the knee and the commissioning of cartilage centres on future trends.

A proposed paradigm shift in the management of distal radius fractures

Background and objectiveDistal radius fractures represent a remarkable orthopaedic entity. Most distal radius fractures can be treated conservatively with closed reduction and immobilisation with satisfactory results, while open reduction and internal fixation is reserved for displaced fractures. Our objective was to propose a paradigm shift in the management of distal radius fractures. MethodsA literature search of management of distal radius fractures was conducted. PubMed and Cochrane databases were used for the search. English articles with open access or institutional subscription availability were included. Key content and findingCurrent literature supports operative management for younger active patients with defined radiographic inclusion parameters, but among the elderly there is little evidence of benefit. Most orthopaedic literature defines “elderly” as patients above 65 years of age. Non-surgical treatment for fractures of the distal radius tends to yield satisfactory functional results, and these favourable outcomes do not necessarily align with normal radiological parameters. For the minority of patients that have symptomatic malunion, corrective osteotomy is a good option to improve the function provided the symptoms can be clearly attributed to the malalignment. ConclusionThe vast majority of distal radius fractures can be managed conservatively. Further studies are recommended to explore the feasibility of advocating for universal conservative treatment for patients with less functional demands while still having the option of staged surgery in the form of corrective osteotomy where there is symptomatic malunion amenable to anatomical correction. Future research should also aim to identify patients who would benefit most from surgical intervention by considering the type of functional recovery needed, rather than relying predominantly on the patient's chronological age as the determining factor in the decision-making process.

Trends in Osteopathic Authorship in Orthopedic Publications and Its Impact on Adult Reconstruction Match Rates

BackgroundDoctors of osteopathy (D.O.) have historically been underrepresented in the orthopedic literature. As adult reconstruction (AR) continues to rank among the most competitive orthopedic fellowships, participation in research likely serves a key role for successfully matching. This study sought to identify trends in D.O. orthopedic publications and assess for correlations between these trends and osteopathic AR match results. MethodsThe top 10 orthopedic surgery journals based on impact factor were selected for analysis. Articles published between 2010 and 2021 were screened to assess for publications with a D.O. author, as well as authorship position. A total of 29,499 articles were available for final analysis. Data from the San Francisco Residency and Fellowship Match Services were also reviewed to evaluate the number of osteopathic applicants and their match rates during the same study period. Trends in D.O. publications and osteopathic AR match rates were then assessed for any correlations. ResultsFrom 2010 to 2021, there was a significant increase in orthopedic and arthroplasty-related publications with a D.O. author (P < .0001), as well as D.O. first (P = .0006) and senior authorship positions (P = .009). Osteopathic match rate significantly increased during the study period (P = .003). There was a strong correlation between the increase in osteopathic match rate and arthroplasty-related publications with a D.O. author (r = 0.76). ConclusionsFrom 2010 to 2021, there was an upward trend of osteopathic orthopedic publications. This increase is strongly correlated with an increase in osteopathic AR match rate. Our findings suggest that authorship in publications may play a key role in successfully matching into an AR fellowship.

Patient-reported allergies are associated with increased rate of postoperative stiffness after arthroscopic rotator cuff repair

Several risk factors have been identified for the development of postoperative shoulder stiffness, and there has been increasing interest in orthopedic literature regarding patient-reported allergy (PRA) as an identifiable risk factor for adverse outcomes. The purpose of this study is to determine whether PRAs are associated with subsequent rates of diagnosis of adhesive capsulitis (AC) or return to the operating room for postoperative shoulder stiffness within two years following arthroscopic rotator cuff repair (ARCR). Patients were retrospectively identified using Current Procedural Terminology surgical billing codes to identify patients who underwent ARCR at a single urban academic institution from January 2012 to December 2020 with minimum 2-year follow-up. Lysis of adhesions (LOA), MUA, and adhesive capsulitis of the shoulder were further queried within two years postoperatively for the ipsilateral shoulder. Patients were excluded if they had undergone ipsilateral MUA/LOA or received a diagnosis of AC prior to the index procedure. Demographic characteristics and medical comorbidities (hypertension, diabetes, hyperlipidemia, hypothyroidism) were extracted from electronic medical records. Baseline characteristics were compared between patients with and without PRAs. Multivariate logistic regression analyses were performed to determine the association of the presence of PRAs overall, as well as presence one, two, or three or more PRAs, with subsequent MUA/LOA or diagnosis of AC within two years postoperatively. Of 7,057 patients identified in the study period, 6,583 patients were eligible for the final analysis. The mean age was 56.6±11.7 years and the mean BMI was 29.1±5.6. Overall, 19.3% of patients (n=1,271) reported at least one allergy and 7.1% (n=469) had >1 PRA. 44 patients (0.7%) underwent subsequent ipsilateral MUA/LOA within two years postoperatively, while 93 patients (1.4%) received a diagnosis of ipsilateral AC in the same time frame. PRAs were significantly associated with subsequent diagnosis of AC (OR 2.39; 95% CI [1.45-3.92]; p<.001), but not MUA/LOA (OR 1.97, 95% CI [1.26-3.61]; p=0.133). Patients with two PRAs had greater odds of being diagnosed with AC than patients with one PRA (OR: 2.74; 95% CI [1.14-5.99]; p=0.012). While this association was non-significant for MUA/LOA, patients with 2 PRAs (OR: 2.67; 95% CI [0.96-8.80]; p=0.059) demonstrated a similar statistical trend. Patient-reported allergies are associated with increased odds of receiving a diagnosis of adhesive capsulitis within two years following arthroscopic rotator cuff repair, but were not found to be associated with return to the operating room for postoperative stiffness.

Using Machine Learning to Predict Nonachievement of Clinically Significant Outcomes After Rotator Cuff Repair.

Although some evidence suggests that machine learning algorithms may outperform classical statistical methods in prognosis prediction for several orthopaedic surgeries, to our knowledge, no study has yet used machine learning to predict patient-reported outcome measures after rotator cuff repair. To determine whether machine learning algorithms using preoperative data can predict the nonachievement of the minimal clinically important difference (MCID) of disability at 2 years after rotator cuff surgical repair with a similar performance to that of other machine learning studies in the orthopaedic surgery literature. Case-control study; Level of evidence, 3. We evaluated 474 patients (n = 500 shoulders) with rotator cuff tears who underwent arthroscopic rotator cuff repair between January 2013 and April 2019. The study outcome was the difference between the preoperative and 24-month postoperative American Shoulder and Elbow Surgeons (ASES) score. A cutoff score was calculated based on the established MCID of 15.2 points to separate success (higher than the cutoff) from failure (lower than the cutoff). Routinely collected imaging, clinical, and demographic data were used to train 8 machine learning algorithms (random forest classifier; light gradient boosting machine [LightGBM]; decision tree classifier; extra trees classifier; logistic regression; extreme gradient boosting [XGBoost]; k-nearest neighbors [KNN] classifier; and CatBoost classifier). We used a random sample of 70% of patients to train the algorithms, and 30% were left for performance assessment, simulating new data. The performance of the models was evaluated with the area under the receiver operating characteristic curve (AUC). The AUCs for all algorithms ranged from 0.58 to 0.68. The random forest classifier and LightGBM presented the highest AUC values (0.68 [95% CI, 0.48-0.79] and 0.67 [95% CI, 0.43-0.75], respectively) of the 8 machine learning algorithms. Most of the machine learning algorithms outperformed logistic regression (AUC, 0.59 [95% CI, 0.48-0.81]); nonetheless, their performance was lower than that of other machine learning studies in the orthopaedic surgery literature. Machine learning algorithms demonstrated some ability to predict the nonachievement of the MCID on the ASES 2 years after rotator cuff repair surgery.