Department Of Orthopaedic Surgery Research Articles

A medium- and long-term comparative observation on volumetric changes of cervical disc herniation after symmetrically or asymmetrically decompression and conservative treatment for cervical spondylotic myelopathy

Objective: To compare the volumetric changes of cervical disc herniation (CDH) after cervical microendoscopic laminoplasty(CMEL),expansive open-door laminoplasty (EOLP) and conservative treatment. Methods: A retrospective study was conducted involving 101 patients with cervical spondylotic myelopathy(CSM),at the Department of Orthopaedic Surgery,the First Affiliated Hospital of Zhengzhou University from April 2012 to April 2021. The patients included 52 males and 49 females with an age of (54.7±11.8) years(range:25 to 86 years). Among them, 35 patients accepted CMEL treatment,33 patients accepted EOLP treatment,while 33 patients accepted conservative treatment. Volume data of CDH were measured by three-dimensional analysis of the initial and follow-up MRI images. The absorption rate and reprotrusion rate of CDH were calculated. The happening of resorption or reprotrusion was defined when the ratio was greater than 5%. The clinical outcomes and quality of life were evaluated by the Japanese Orthopaedic Association (JOA) score and the neck disability index (NDI).Quantitative data was analyzed by one-way ANOVA with post LSD-t test (multiple comparison) or Kruskal-Wallis test. Categorical data was analyzed by χ2 test. Results: The follow-up time of the CMEL group,EOLP group and the conservative treatment group were (27.6±18.8)months,(21.6±6.9)months and(24.9±16.3)months respectively with no significant difference(P>0.05). Changes of CDH volume in patients:(1) There were 96 CDH of 35 patients in the CMEL group,among which 78 showed absorption. The absorption frequency was 81.3%(78/96) and the absorption rate was ranged 5.9% to 90.9%;9 CDH showed reprotrusion,the reprotrusion frequency was 9.4% (9/96) and the reprotrusion rate was 5.9% to 13.3%;(2) There were 94 CDH of 33 patients in the EOLP group,of which 45 showed absorption. The absorption prevalence was 47.9% (45/94) and the absorption rate was 5.0% to 26.7%;20 CDH showed reprotruded,with the reprotrusion frequency of 21.3% (20/94) and the reprotrusion rate was 5.8% to 28.3%;(3) There were 102 CDH in 33 patients of the conservative group. Among them, 5 showed absorption. The absorption frequency was 4.9% (5/102),and the absorption rate was 7.2% to 14.3%;58 CDH showed reprotruded with the re-protrusion ratio of 56.9% (58/102) and the re-protrusion rate was 5.4% to 174.1%. The absorption ratio and reprotrusion ratio of the CMEL group were statistically different from EOLP group or the conservative group (P<0.01).The absorption ratio and reprotrusion ratio of the EOLP group was different from conservative group (all P<0.01). In terms of clinical outcomes, the excellent/good rate of the JOA score and NDI scores in the CMEL group were different from that of conservative group (all P<0.01) but not from that of the EOLP group(P>0.05). Conclusions: CMEL is an effective method for the treatment of CSM,making CDH easier to resorption compared to the EOLP or conservative treatment,thus making a better decompression effect on the nerves. This study enlightened on a new strategy for the clinical treatment of CSM.

Comparison of intra-articular steroid injection versus hydrodilatation with saline and corticosteroid for the treatment of refractory adhesive capsulitis of the shoulder.

Objective: To compare the outcome of intra-articular steroid injection versus hydrodilatation with saline and corticosteroid for the treatment of refractory adhesive capsulitis of the shoulder. Study Design: Randomized Controlled Trial. Setting: Department of Orthopaedic Surgery, Sahiwal Teaching Hospital Sahiwal. Period: February 2021 to January 2022. Material &amp; Methods: A total of 156 patients with refractory adhesive capsulitis were randomized. In Group-A, patients were treated with intra articular steroid injection alone and in Group-B, patients were treated with hydrodilatation using corticosteroid and saline. The patients were followed up at 3rd, 6th and 12th week and their functional outcomes was assessed in terms of pain and range of motion (disability) using “Shoulder Pain and Disability Index (SPADI)” scoring system. Results: In a total of 156 patients, 81 (51.9%) were females. The mean age was 51.4±10.6 years (ranged between 33 to 68 years). History of steroid intake was reported in 30 (19%) patients. The mean pain scores on the basis of SPADI scoring at 3-week (p=0.0001), 6-week (p=0.0001) and 12-week (p&lt;0.0001) were significantly less in Group-B when compared to Group-A. The disability scores on the basis of SPADI scoring at 3-week (p&lt;0.0001), 6-week (p&lt;0.0001) and 12-week (p&lt;0.0001) were significantly less in Group-B when compared to Group-A. In comparison to Group-A, functional outcomes were significantly better among patients of Group-B at 6-week (p&lt;0.0001) and 12-week (p&lt;0.0001) intervals. Conclusion: Hydrodilatation along with corticosteroid injection were better treatment options when compared to intra-articular steroid injection alone for reduction in pain and improvement in range of motion among patients with refractory frozen shoulder.

Effect of single versus multiple prophylactic antibiotic doses on prosthetic joint infections following primary total hip arthroplasty in patients with osteoarthritis at public and private hospitals in Denmark: protocol for a nationwide cross-over, cluster randomised, non-inferiority trial [The Pro-Hip-Quality Trial]

IntroductionA feared complication after total hip arthroplasty (THA) is prosthetic joint infection (PJI), associated with high morbidity and mortality. Prophylactic antibiotics can reduce the risk of PJI. However, there is...

Evaluation of radial nerve palsy treatment: tendon transfer with the flexor carpi radialis combination

Introduction: Radial nerve palsy, a common peripheral nerve injury, significantly impacts the quality of life of affected individuals. The standard treatment is tendon transfer, but the optimal choice of tendon transfers remains a subject of ongoing debate. This study aimed to evaluate the treatment of radial nerve palsy through tendon transfer with the flexor carpi radialis combination in a Bangladeshi population. Methods: This observational study was conducted over 18 weeks at the Department of Orthopedic Surgery of 3 medical college hospitals in Bangladesh. Forty adult patients with radial nerve palsy were selected based on specific inclusion criteria. Participants were evaluated preoperatively and postoperatively using the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Complications were also recorded. Results: The majority of participants were male (77.5%) and had right-sided injuries (72.5%). The most common cause of injury was humerus shaft injury (55.0%). The most common site of injury was middle third of the humerus shaft (67.50%). Postoperatively, 85.0% achieved an "Excellent" grade. Complications were minimal, with 90% of participants experiencing no complications. Conclusions: Tendon transfer with the flexor carpi radialis combination appears to be an effective treatment for radial nerve palsy, with significant improvements in DASH scores postoperatively and minimal complications. Further research is needed to confirm these findings and compare the effectiveness of this treatment with other tendon transfer combinations.

Pattern of Aerobic Bacterial Pathogens Causing Wound Infection at a Tertiary Teaching Hospital in Bangladesh with Special Reference to Methicillin Resistant Staphylococcus aureus and Extended Spectrum Beta Lactamases

Background: Wound infection gaining utmost importance day by day because of emergence of drug resistant bacteria. Objective: This study was carried out to see the pattern of aerobic bacterial pathogens along with MRSA and ESBL producing strains causing wound infection. Methodology: This cross sectional study was conducted from May 2010 to April 2011. Wound swabs were taken from the patients suffering from wound infections admitted in the different surgical wards of Rajshahi Medical College Hospital, Rajshahi, Bangladesh. The study place was the department of Microbiology of Rajshahi Medical College, Rajshahi and department of General Surgery, Orthopedic Surgery and Gynaecology &amp; Obstetrics of Rajshahi Medical College Hospital, Rajshahi. Two wound samples were collected from each patient with, one for microscopy and other for culture. Gram staining and culture of collected wound swab were done for isolation and identification of MRSA and ESBL Bacteria. Antimicrobial susceptibility testing of the isolates were performed by using modified Kirby-Bauer technique using Mueller-Hinton agar and commercially available antimicrobial discs manufactured by Oxoid Diagnostic. Results: A total of 300 samples were collected. Culture yielded growth of 175(58.33%) cases, of which 138 (78.86%) were gram negative. From total 138 of gram negative bacteria 52(37.68%) were ESBL positive and they were distributed as K. pneumoniae 05(55.56%), E. coli 35(54.68%), Pr. mirabilis 05(20.83%) and Ps. aeruginosa 05(17.00%). All the ESBL producers were 100.0% resistant against ampicillin, cotrimoxazole, ceftriaxone and ceftazidime. Ciprofloxacin was 80.0 to 88.6%, gentamicin was 40.0 to 60.0%, aztreonam was 60.0 to 100.0% and netilmycin was 20.0 to 60% resistant. All the MRSA were 100.0% resistant against ampicillin, co-trimoxazole and cloxacillin. None showed resistance against vancomycin. Conclusion: Drug resistant ESBL producing bacteria and MRSA are quite high among the isolated pathogens with resistant to most of the antimicrobial agent. Bangladesh Journal of Infectious Diseases, June 2022;9(1):15-24

Cement Pulmonary Embolism during Cemented Total Hip Arthroplasty: A Case Report and Review of Literature

Fractures of the femoral neck are the most frequent in elderly patients. They represent the most prevalent pathology in traumatology. Their incidence increases with age due to osteoporosis and the tendency to fall. Treatment is by cemented or uncemented arthroplasty. The use of polymethylmetacrylate cement provides primary stabilization of the implant and compensates for the poor bone quality in the elderly. However, the use of cement is not without complications and cement pulmonary embolism is one of the most serious complications. We report the case of a 64- year-old patient admitted to the Department of Orthopaedic and Traumatologic Surgery for a femoral neck fracture classified as Garden 2 and who underwent cemented arthroplasty complicated by cement pulmonary embolism and death.

Distal femur stress fracture: A unique case presentation in a youth rower

Department of Emergency Medicine, Department of Orthopaedic Surgery and Sports Medicine, University of Florida College of Medicine, Gainesville, FL Financial Disclosures: The author reports no conflicts of interest. Correspondence to Joshua Altman, MD, CAQSM, University of Florida College of Medicine, Department of Emergency Medicine, Department of Orthopaedic Surgery and Sports Medicine, Gainesville 32610, FL Tel: +352-265-5911; fax: +352-265-5606; e-mail: [email protected].

Limited number of spine surgeons among recipients of National Institutes of Health grants awarded for degenerative spine disease research.

Surgeon scientists remain underrepresented among recipients of National Institutes of Health (NIH) grants despite their unique ability to perform translational research. This study elucidates the portfolio of NIH grants awarded for degenerative spine diseases and the role of spine surgeons in this portfolio. The most common diagnoses and surgical procedures for degenerative spine diseases were queried on the NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) database (2011-2021). Total NIH funding was extracted for 20 additional clinical areas and compound annual growth rates (CAGRs) were calculated. A retrospective cohort study of principal investigators (PIs) was conducted. NIH grants and funding totals were extracted and compared to those from other clinical areas. The total NIH research budget increased from $31 to $43 billion over the 10-year period (CAGR 3.4%). A total of 273 unique grants equaling $91 million (CAGR 0%) were awarded for degenerative spine diseases. Diabetes ($11.8 billion, CAGR 0%), obesity ($10.6 billion, CAGR 3%), and chronic pain ($5.6 billion, CAGR 7%) received the most funding. Most NIH funding for degenerative spine disease research was awarded through the R01 (66%) and R44 (8%) grant mechanisms. The National Institute of Arthritis and Musculoskeletal and Skin Diseases awarded the most NIH funding (64%). Departments of orthopedic surgery were awarded the most funding (32%). NIH funding supported clinical (28%), translational (37%), and basic science (35%) research. Disease mechanisms (58%), imaging modalities (20%), and emerging technologies (16%) received the most funding. Nineteen spine surgeons were identified as PIs (16%). There were no significant differences in NIH funding totals by PI demographic and academic characteristics (p > 0.05)-except for full professors, who had the most NIH funding (p = 0.007) and highest h-index values (p < 0.001). Few spine surgeons receive NIH grants for degenerative spine disease research. Future opportunities may exist for spine surgeons to collaborate in identified areas of clinical interest. Additional strategies are needed to increase NIH funding in spine surgery.

Poster 335: Increased Body Mass Index is Associated with Increased time to Imaging and Surgery in Young Athletes with Anterior Cruciate Ligament Injury

Objectives: For young athletes with anterior cruciate ligament (ACL) injury, ACL reconstruction is usually recommended to restore stability to the knee. Previous studies have shown that increased time from ACL injury to ACL reconstruction can lead to the accrual of new injuries over time, specifically medial meniscus tears. In addition, increased time from magnetic resonance imaging (MRI) to ACL reconstruction in these patients decreases the predictive value of MRI imaging as a diagnostic tool for concomitant injuries. However, risk factors for delay in care for ACL injuries remain undetermined. To our knowledge, no prior study has examined the impact of social determinants of health on the timing of MRI and ACL reconstruction after ACL injury in young athletic patients. The goal of this study is to investigate what social determinants of health may impact timing of care in young athletes with ACL injury. Methods: We retrospectively reviewed the electronic medical records of all patients aged 13-25 years at a single orthopaedic surgery department who underwent isolated primary ACL reconstruction from January 2017 to June 2020. We excluded patients who were not self-reported athletes or charts without MRI, operative report, or date of initial injury. We documented the time from injury to MRI, MRI to surgery, and injury to surgery. Demographics were recorded including age, gender, body mass index (BMI), race/ethnicity, and insurance type (public versus private). Multivariable analysis was used to determine if any demographic factor had a significant association with increased time to MRI or surgery after initial injury. Results: A total of 432 patients met inclusion and exclusion criteria (mean age 17.9, 46% male). On multivariable analysis, there were significant associations between BMI and timing of care while holding all other predictors constant. There were 249 patients with normal BMI, 106 overweight (BMI 25 – 29.9), 60 obese (BMI &gt;= 30), and 17 underweight (BMI &lt; 18.5). Patients with obese BMI had an injury to MRI time that was on average 77.6 (95% CI: 20.7–193.4; p = 0.015) days longer than those with normal BMI, and an increased time from injury to surgery that was on average 107.2 [95% CI 11.3–203.1; p &lt; 0.029] days longer than those with normal BMI. Patients with overweight BMI had an MRI to surgery time that was on average 34.3 [95% CI: 9.2–59.4; p &lt; 0.007] days longer than those with normal BMI and an injury to surgery time that was on average 74.6 [95% CI: 2.3–147; p &lt; 0.043] days longer than those with a normal BMI. No other demographic factors had a statistically significant association with the timing of care, although public insurance and minority race/ethnicity trended toward delays in care. Conclusions: This multivariable analysis of over 400 patients from a single institution demonstrates that athletes with ACL injuries that have higher BMI experience increased time to MRI and surgical care compared to patients with normal BMI when controlling for other variables. While the cause of the delay for this group may be multifactorial, understanding this disparity in health care and using it to uncover our hidden biases may help us provide better patient care to all.

Poster 388: Gender Diversity of Orthopaedic Sports Medicine Fellowship Trainees, Faculty and Leadership

Objectives: Orthopaedic surgery has remained the most male-dominated field in medicine, despite recent efforts to recruit and retain more women. The objective of this study was to determine the gender composition of fellows, faculty, and leaders within orthopaedic sports medicine fellowship programs to provide a more complete analysis of gender diversity within this subspecialty. Methods: Official program websites of orthopaedic sports medicine fellowships listed on the Arthroscopy Association of North America (AANA) fellowship directory were examined. Data collected for analysis included the gender of program directors, fellowship faculty, orthopaedic surgery department faculty, current sports medicine fellows and fellows who graduated within the last five years. Results: In the academic year 2021-2022, 132 sports medicine fellows were in fellowship training in the United States within 97 programs. Of these, 113 (85.6%) were men and 19 (14.4%) were women (p&lt;0.001). Within the past five years, 419 fellows were listed as completing a sports medicine fellowship, with 375 (89.5%) being men, and 44 (10.5%) being women (p&lt;0.001). There is no significant difference in the gender composition of current fellows compared to the composition of fellows within the last 5 years (p=0.74). When examining gender trends in sports medicine faculty, 639 (86.6%) were men and 99 (13.4%) were women (p&lt;0.001). There are 14 women (14.4%) orthopaedic sports medicine faculty in leadership positions (i.e., program directors or assistant program directors) compared to 83 men in such positions (85.6%) (p&lt;0.001). Conclusions: Orthopaedic sports medicine fellowships remain heavily male-dominated in their trainees, faculty, and leadership. There was no significant difference in the gender composition of current fellows when compared to those who graduated in the last five years, suggesting further and novel initiatives are needed to enhance gender diversity in sports medicine. [Table: see text][Table: see text]

Effect of Supination vs Pronation in Non-operative Treatment of Pediatric Supracondylar Fracture Humerus

Objective: to compare modes of the forearm (supination and pronation) in terms of elbow deformity after closed reduction and casting of supracondylar fracture humerus. Methodology: Prospective study was conducted at orthopedic surgery department of Nishtar Hospital Multan from January 2023 to February 2024. One hundred patients were included in study 45 treated in pronation position and 55 in supination position. Supracondylar fracture was managed with closed reduction and immobilization procedure. Outcomes were assessed through clinical and radiographic examination. Follow up was done till 8 months. SPSS version 23 was used for data analysis and p vale ≤0.05 was considered as significant. Results: In pronation, the type of fracture (I &amp; III) was noted as n=32 (71.1%) and n=13 (28.9%), respectively. While in supination, type of fracture (I &amp; III) was noted as n=40 (72.7%) and n=15 (27.3%), respectively. Conclusion: there is a definite difference between two groups of management supination and pronation in the closed treatment of supracondylar humerus fracture regarding elbow malunion deformity.

Outcome of Long Segment Posterior Spinal Stabilization Incorporating the Fractured Vertebra for Unstable Thoraco-Lumbar Junctional Brust Fracture

Objectives: To evaluate the outcome of long segment posterior spinal stabilization incorporating the fractured vertebra with posterolateral fusion for unstable thoraco-lumbar junctional brust fracture. Background: Thoracolumbar junction is the commonest site of traumatic spinal injury. Now a days, it is managed surgically most of the time because it is often associated with the spinal cord injury. Its mode of surgical management is a field of controversy. Huge debate is still going on between the superiority of long &amp; short segment stabilization. In this study, we evaluated the outcome of long segment posterior spinal stabilization incorporating the fractured vertebra Materials &amp; Method: This prospective interventonal study included 30 case of thoraco-lumbar junctional unstable brust fractures was carried out in the Spine unit of Orthopaedic surgery department of Bangabandhu Sheikh Mujib Medical University, Dhaka and other private hospital in Dhaka City, Bangladesh, from January 2016 to July 2022. All the patients with positive clinical findings, X-ray, MRI &amp; CT scan findings and underwent long segment posterior spinal stabilization incorporating the fractured vertevra with posterolateral fusion. Average follow-up period was 12 months. Pre &amp; Post-operatively, neurological assessment was done by the ASIA Impairment Score, improvement of pain control by VAS score, fusion rate by Bridwell’s criteria, Kyphotic angle was measured by Cobb’s angle measurement method &amp; Overall functional assessment by modified Odom’s score. Results: Total number of patients was 30. Average age was 34 years (range 21- 47). ASIA score improved from B to C in 5 patients, B to D in 5 patients, C to D in 8 patients , C to E in 3 patients, patients, D to E in 7 patients. 2 patient did not improved following surgery. Fusion was achieved in 29 patients &amp; 1 patient developed pseudoarthrosis. Pre &amp; Post- operative VAS score was 7.30±1.9 &amp; 3.3±1.8 respectively. The average kyphotic correction was 15 ∞. In our series, we have no bedridden patients after surgery. There was no radiographic progression after surgery. Conclusion: Early treatment within 21 days of injury with long segment posterior spinal stabilization incorporating the fractured vertevra with posterolateral fusion is a very effective surgical procedure with preservation of the motion segment to treat unstable thoracolumbar junctional brust fracture.

Spondilolysthesis L5-S1: An Original Article

Objectives: To assess the clinical, functional and radiological outcome of Posterior Lumbar Interbody Fusion (PLIF) by Banana cage with bone graft. Material and Methods: This retrospective analytical study was carried out in unit of Orthopaedic surgery department from January 2010 to December 2020. We did PLIF by Banana cage with bone graft for High-grade Lumbar Spondylolisthesis at L5-S1. The follow up period ranges from 1 year to 2 years (average 18 months). Within these follow up period we have assessed the patients clinically, functionally and radiologically. All patients were assessed by Visual Analogue Score (VAS), Oswestry Disability Index (ODI), Waddell Disability Index (WDI), Spino-pelvic parameters, Modified Macnab’s Criteria to find out overall outcome and Hackenberge ctriteria for radiological fusion. Results and Conclusions: Total 40 patients were included among them 16were male and 24 were female. The average age of the patients was 52.45±10.1 years. Maximum (60.0%) patients were housewife followed by 20.0%, 10.0%, 10% were day laborer, farmer and service holder respectively. Average pelvic tilt was 26.05±6.27° preoperatively and 24.10±6.26° at the final follow-up, average PI was 66.07±7.39° preoperatively and 61.19±7.08° at the final follow-up. Preoperative lumbar lordosis was 45.55±6.71° with postoperatively 37.29±6.19°at final follow-up. VAS score and ODI scales were improved significantly from preoperative 6.90±6.16 and 57.60±15.66, respectively, to postoperatively and final follow-up 2.0±0.8 and 7.60±2.40, respectively. Pre-operative Translation ratio, slip angle and disc height ratio were 21.96±10.25, -18.87±8.28, 11.03±4.36 respectively and postoperatively 13.17±6.57, -18.44±7.12, 19.60±3.36 respectively. Fusion was achieved in 36 cases (90%), 3 cases (7.5%) were fragmented and pseudoarthrosis showed only 1 case (2.5%). Most of the study population according to post operative clinical outcome showed excellent outcome (95%), 1 (2.5%) case had good and 1 (2.5%) case had fair outcome. Conclusion: It can be concluded that, Posterior Lumbar Interbody Fusion (PLIF) by Banana cage with bone graft can be a very good option for the treatment of High-grade Lumbar Spondylolisthesis at L5-S1 levels.

Outcome of Surgical Treatment of Developmental Dysplasia of the Hip in Aden, Yemen

Background: Developmental dysplasia of hip is a common condition presenting to a pediatric orthopedic surgeon. Objective: To evaluate the outcome of surgical treatment of developmental dysplasia of the hip. Materials and Method: This retrospective study conducted at the Department of Orthopedic Surgery in Alnaqeeb private hospital in Aden. The study children were 52 who were operated in the period from January 2016 to December 2018. Patient charts were reviewed and the collected data were sex, age, side, avascular necrosis, stiffness, re-dislocations, persistent acetabular dysplasia, and infection. The operations were open reduction and Pemberton's osteotomy plus minus femoral osteotomy without rotation. Statistical analyses were performed using SPSS version 22. We expressed distribution of variables using means and standard deviation (SD). Fisher test was used and p-value ≤ 0.05 was considered as statistically significant. Results: The majority of study children were females (80.8%). The age of the children ranged between 18 – 72 months. The mean age of children at surgery was 37 ± 17.5 months. The mean age of females was 37.2 ± 18.9 months while the mean age of males was 37.5 ± 10.7 months. The most common side was in the left side (51.9%). The mean time of follow-up was 34.7 ± 6.4 (range 24-48) months. Avascular necrosis found in (5.8%) children and stiffness found in (3.8%) children. Re-dysplasia of the hip were found in (5.8%) children. Persistent acetabular dysplasia was found in (3.8%) children. Additionally, we found superficial infection in (5.8%) children. Conclusion: The open reduction approach produces a better clinical outcome. The outcome of treatment in our study was comparable to published studies. Keywords: Developmental Dysplasia, hip, surgical treatment, outcome.

Comparison of Dynamic Hip Screw and Proximal Femoral Nail in Cases of Unstable Intertrochanteric Fractures of the Femur, in Terms of Blood Loss and Operative Time: Experience in a Tertiary Care Hospital

Objective: To compare Dynamic Hip Screw with Proximal Femoral Nail in unstable Inter Trochanteric femur fractures.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Department of Orthopaedic Surgery, Combined Military Hospital, Malir Pakistan, from Dec 2020 to Aug 2021.&#x0D; Methodology: This study comprised patients aged 40 to 80 years with unstable inter Trochanteric proximal femoral fractures (AO Classification 31A2, 31A3). These patients were randomised into two Groups. Group-A patients underwent Dynamic hip screw fixation, and Group-B patients were subjected to Proximal Femoral Nailing. Follow-up was done at 2,6,12 weeks postoperatively. Two variables, namely operative time and blood loss, were evaluated. &#x0D; Result: Thirty patients were recruited in this study, with 18 patients in each Group. The average blood loss for Group-A Dynamic Hip Screw was measured to be 193.3±29.10 ml, and for Group-B Proximal Femoral Nail was 79.44±17.98 ml (p&lt; 0.001). Group-A (DHS) scored an average operative time of 51.56±7.76 min, and Group-B Proximal Femoral Nail was 36.89±3.66 min (p&lt;0.001).&#x0D; Conclusion: Proximal femoral nailing is a better choice in unstable proximal femoral fractures regarding operative time and blood loss.Keywords: Blood loss, Dynamic hip screw, Intertrochanteric fractures, Operative time, Proximal femoral nail.

CORR Insights®: What is the Prosthetic Survival After Resection and Intercalary Endoprosthetic Reconstruction for Diaphyseal Bone Metastases of the Humerus and Femur?

1Associate Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA A. S. Levin, The Johns Hopkins University, Department of Orthopaedic Surgery, 601 North Caroline Street, Baltimore, MD 21287, USA, Email: [email protected] This CORR Insights® is a commentary on the article “What is the Prosthetic Survival After Resection and Intercalary Endoprosthetic Reconstruction for Diaphyseal Bone Metastases of the Humerus and Femur?” by Johnson and colleagues available at: DOI: 10.1097/CORR.0000000000002669. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

CORR Insights®: Does the SORG Machine-learning Algorithm for Extremity Metastases Generalize to a Contemporary Cohort of Patients? Temporal Validation From 2016 to 2020.

1Professor of Orthopedic Surgery, VA Palo Alto Health Care System and Stanford University, Palo Alto, CA, USA N. J. Giori, VA Palo Alto Healthcare System, Department of Orthopaedic Surgery, Surgical Service (112), 3801 Miranda Avenue, Palo Alto, CA 94304, USA, Email: [email protected] This CORR Insights® is a commentary on the article “Does the SORG Machine-learning Algorithm for Extremity Metastases Generalize to a Contemporary Cohort of Patients? Temporal Validation From 2016 to 2020” by de Groot and colleagues available at: DOI: 10.1097/CORR.0000000000002698. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

CORR Insights®: Is Bone Marrow Aspiration and Biopsy of Clinical Importance in the Initial Staging of Extraskeletal Ewing Sarcoma?

1Professor and Chair, Department of Orthopedic Surgery, School of Medicine, National & Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece P. J. Papagelopoulos, National & Kapodistrian University of Athens, School of Medicine, Attikon University General Hospital, First Department of Orthopaedic Surgery, Neapoleos 15, Amarousion, Athens, 15123, Greece, Email: [email protected] This CORR Insights® is a commentary on the article “Is Bone Marrow Aspiration and Biopsy of Clinical Importance in the Initial Staging of Extraskeletal Ewing Sarcoma?” by Wahlig and colleagues available at: DOI: 10.1097/CORR.0000000000002661. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

CORR Insights®: What Changes Have Occurred in Opioid Prescriptions and the Prescribers of Opioids Before TKA and THA? A Large National Registry Study.

1Resident Physician, Long Island Jewish Medical Center, Northwell Health, Department of Orthopaedic Surgery, New York, NY, USA N. Sodhi, Department of Orthopaedic Surgery, Long Island Jewish Medical Center, Northwell Health, 270-05 76th Avenue, New York, NY 11040, USA, Email: [email protected] This CORR Insights® is a commentary on the article “What Changes Have Occurred in Opioid Prescriptions and the Prescribers of Opioids Before TKA and THA? A Large National Registry Study” by van Brug and colleagues available at: DOI: 10.1097/CORR.0000000000002653. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.

Lost in implementation: risk stratified care for musculoskeletal pain.

Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, NC, United States Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.