Department Of Orthopaedics Research Articles

Comparing scissors and scalpels to a novel surgical instrument: a biomechanical sectioning study

BackgroundThis study introduces a novel surgical instrument to reduce iatrogenic nerve injuries during procedures such as carpal tunnel and ulnar nerve decompression surgery. These injuries often result from direct damage to surrounding tissues by surgical instruments, whose designs have remained largely unchanged over the past decades. The novel device is a modified surgical forceps that has a deployable surgical scalpel that runs along a groove on the forceps. This design protects important anatomical structures while allowing fast dissection and cutting of fascial layers.MethodsThe process used to develop a novel instrument included computer-aided design (CAD) modeling, 3D printing for prototyping, and the fabrication of an aluminum prototype. Biomechanical testing was performed with the novel device, iris scissors, bandage scissors, and a scalpel on an MTS Static Materials Test System. The peak force to slide-cut, number of cut attempts, and percentage cut on first attempt were compared between the prototype and traditional surgical tools. The materials cut in testing were Ace™ bandage, stockinette, and gauze. Statistical analyses were performed using Welch’s t-tests and Fisher’s exact tests.ResultsCompared to conventional bandage and iris scissors, the novel surgical instrument required significantly less force to cut through an Ace™ bandage, stockinette, and gauze (p < 0.01). The number of cuts required to transect those same materials with the novel device was comparable to that of the scalpel and bandage scissors. Additionally, while there were no differences between the novel device and the other devices for an Ace™ bandage and stockinette, the novel device tended to cut a greater percentage of gauze in one pass than did the iris scissors.ConclusionThe novel surgical instrument designed in this study required less force compared to conventional scissors, demonstrated cutting efficiency similar to that of a scalpel blade, and had more safety features than either instrument. This study highlights the value of collaboration between biomedical engineering and orthopedic surgery departments on innovation in medical technology, through which new technologies with improved design and functionality demonstrate the potential to reduce iatrogenic injuries.

Multivariate analysis of blood parameters for predicting mortality in patients with hip fractures.

The present retrospective cross-sectional study aimed to evaluate the predictive value of blood parameters and ratios for predicting mortality in patients with hip fractures. In total, 758 patients with hip fractures attending the Department of Orthopedics and Traumatology, Kütahya Health Sciences University Faculty of Medicine (Kütahya, Turkey) between January 2016 and January 2023 were included in the present study. Patients were then divided into two groups, namely the mortality (n=464; 61.2%) and survivor (n=294; 38.8%) groups. Patients in the mortality group were further sub-divided into the following three subgroups: i) Those who succumbed in <1 month (n=117; 25.2%); ii) those who succumbed between 1 and 12 months (n=185; 39.9%); and iii) those who succumbed >12 months later (n=162; 34.9%). In addition, the RDW coefficient of variation, mean platelet volume (MPV), MPV/platelet ratio, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio (PLR), mean platelet volume-to-lymphocyte ratio and monocyte-to-eosinophil ratio means were all found to be significantly higher in the mortality group (P<0.05). MPV (P<0.01), HGB (P<0.05), eosinophil, EOS (P<0.01), HRR (P<0.01), and PLR (P<0.05) were all revealed to exert significant effects on mortality. An age cut-off of 74.50 years had a sensitivity of 81.5% and specificity of 37.1%, whereas an MPV cut-off of 8.85 yielded a sensitivity of 73.5% and specificity of 36.1%. By contrast, an HGB cutoff of 11.05 had a sensitivity of 55.6% and specificity of 35.7%, an eosinophil cut-off of 0.065 had a sensitivity of 47.6% and specificity of 35.4%, whilst a HRR cut-off of 0.7587 had a sensitivity of 55.2% and specificity of 30.3%. Furthermore, a PLR cut-off of 152.620 had a sensitivity of 67.2% and specificity of 41.8% for hip fracture-associated mortality. An age cut-off of 79.50 years had a sensitivity of 70.9% and specificity of 41.5%, while an age cut-off of 83.50 years had a sensitivity of 46.2% and specificity of 64.0% for mortality occurring <1 month after hip fractures. To conclude, results from the present study suggested that HRR has potential predictive value for hip fracture-associated mortality and 30-day mortality, whereas the PLR could only predict hip fracture-associated mortality.

Use of Artificial Intelligence in Cobb Angle Measurement for Scoliosis: Retrospective Reliability and Accuracy Study of a Mobile App.

Scoliosis is a spinal deformity in which one or more spinal segments bend to the side or show vertebral rotation. Some artificial intelligence (AI) apps have already been developed for measuring the Cobb angle in patients with scoliosis. These apps still require doctors to perform certain measurements, which can lead to interobserver variability. The AI app (cobbAngle pro) in this study will eliminate the need for doctor measurements, achieving complete automation. We aimed to evaluate the reliability and accuracy of our new AI app that is based on deep learning to automatically measure the Cobb angle in patients with scoliosis. A retrospective analysis was conducted on the clinical data of children with scoliosis who were treated at the Pediatric Orthopedics Department of the Children's Hospital affiliated with Fudan University from July 2019 to July 2022. Three measurers used the Picture Archiving and Communication System (PACS) to measure the coronal main curve Cobb angle in 802 full-length anteroposterior and lateral spine X-rays of 601 children with scoliosis, and recorded the results of each measurement. After an interval of 2 weeks, the mobile AI app was used to remeasure the Cobb angle once. The Cobb angle measurements from the PACS were used as the reference standard, and the accuracy of the Cobb angle measurements by the app was analyzed through the Bland-Altman test. The intraclass correlation coefficient (ICC) was used to compare the repeatability within measurers and the consistency between measurers. Among 601 children with scoliosis, 89 were male and 512 were female (age range: 10-17 years), and 802 full-length spinal X-rays were analyzed. Two functionalities of the app (photography and photo upload) were compared with the PACS for measuring the Cobb angle. The consistency was found to be excellent. The average absolute errors of the Cobb angle measured by the photography and upload methods were 2.00 and 2.08, respectively. Using a clinical allowance maximum error of 5°, the 95% limits of agreement (LoAs) for Cobb angle measurements by the photography and upload methods were -4.7° to 4.9° and -4.9° to 4.9°, respectively. For the photography and upload methods, the 95% LoAs for measuring Cobb angles were -4.3° to 4.6° and -4.4° to 4.7°, respectively, in mild scoliosis patients; -4.9° to 5.2° and -5.1° to 5.1°, respectively, in moderate scoliosis patients; and -5.2° to 5.0° and -6.0° to 4.8°, respectively, in severe scoliosis patients. The Cobb angle measured by the 3 observers twice before and after using the photography method had good repeatability (P<.001). The consistency between the observers was excellent (P<.001). The new AI platform is accurate and repeatable in the automatic measurement of the Cobb angle of the main curvature in patients with scoliosis.

Interrelationships of cervical spine sagittal alignment and whole spinopelvic alignment under implications of musculoskeletal health among independent elderly women in Taiwan: A cross-sectional study.

Older women are at increased risk of spinal misalignment and its associated complications. This study investigated the influence of age, grip strength, and various sagittal spinal parameters on spinal alignment. The results indicate the need for comprehensive management strategies. This cross-sectional study included 200 older women who underwent bone health evaluations at the orthopedic department of a hospital. The study participants underwent dual-energy X-ray absorptiometry, grip strength measurement, and full-length spine radiography. Clinical and radiographic parameters were analyzed through Pearson correlation and linear regression analyses. Significant correlations were identified between grip strength and spinal parameters such as C7 slope and global tilt, indicating that muscle strength affects spinal alignment. Advanced age was associated with changes in sagittal spinal parameters, indicating that changes occur in body compensation over time. Furthermore, pelvic parameters such as pelvic tilt and sacral slope were significantly correlated with spinal curvature, indicating their critical roles in maintaining spinal stability. This study revealed the critical roles of muscle strength and pelvic alignment in the management of spinal health in older women with low bone mass. Targeted interventions for increasing muscle strength, correcting posture, and achieving hormonal balance can notably improve spinal stability and reduce the risk of associated complications. Longitudinal studies should be conducted to validate and refine the intervention strategies and to extend the study findings.

Statistical analysis of total hip arthroplasty at rural hospital in Maharashtra under MJPJAY: a prospective study

Background: Total hip arthroplasty (THA) is one of the most common orthopedic surgeries globally, particularly in Western countries. In India, its prevalence has increased over the last two decades. However, most data on THA are from Europe and the United States. This study analyzes the clinical and demographic characteristics of patients undergoing uncemented THA at a rural hospital in Maharashtra, India, under the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY). Methods: A prospective study was conducted in the Department of Orthopedics at Mahatma Gandhi Institute of Medical Sciences, Sevagram, from January 2020 to October 2022. A total of 123 patients (130 hips) who underwent uncemented THA, were included. Patients were categorized by age, gender, and primary indication for surgery. Preoperative evaluations, radiographic analysis, and postoperative follow-ups assessment of pain, range of motion, and complications were done. Results: The mean age of patients was 40.32±12.53 years, with males (85.36%) outnumbering females (14.64%). Bilateral hip involvement was seen in 56.9% of cases and osteonecrosis of the femoral head was the most common indication (89.23%), with 57.6% idiopathic, 12.3% alcohol-related and 6.1% steroid-induced. The complication rate was 3.8%, with dislocation being the most frequent (2.1%). Revision surgeries performed in 2.1% of cases. Conclusions: THA under MJPJAY demonstrates comparable clinical outcomes to international standards. Idiopathic osteonecrosis remains the leading cause, with a male predominance. Standardized protocols for the Indian population are needed.

Anthropometric predictors of hamstring graft size in anterior cruciate ligament reconstruction

Background: The anterior cruciate ligament (ACL) is commonly injured in the knee joint, necessitating surgical reconstruction where quadrupled hamstring tendon autografts are frequently utilized for their favourable outcomes. Predicting the appropriate dimensions of these grafts is essential for surgical success. This study aims to investigate whether simple anthropometric measurements-height, weight, body mass index (BMI), thigh length, and circumference-can predict the length and diameter of quadrupled hamstring tendons used in ACL reconstruction. Methods: This cross-sectional study included 45 patients undergoing ACL reconstruction with quadrupled hamstring autografts at department of orthopaedics, Renai Medicity Kerala, India. Preoperative anthropometric measurements were correlated with intraop graft dimensions using Pearson correlation and SPSS statistical software (version 22). Results: Taller patients exhibited a positive correlation with graft diameter (p=0.028). Height and thigh length correlated positively with both gracilis and semitendinosus tendon lengths (p&lt;0.001). Thigh circumference correlated positively with semitendinosus length (p=0.005), while weight, BMI, and other measures did not significantly correlate with graft dimensions. Conclusions: Anthropometric measurements, particularly height and thigh length, serve as valuable predictors for hamstring graft dimensions in ACL reconstruction. These findings may assist surgeons in selecting appropriate grafts and optimizing surgical outcomes.

Analysis of preoperative and postoperative depression and anxiety in patients with lumbar disc herniation with radiculopathy treated with percutaneous transforaminal endoscopic discectomy

ObjectiveThis study aims to examine the mental health of patients with lumbar disc herniation with radiculopathy (LDHR) and to evaluate the effects of percutaneous transforaminal endoscopic discectomy (PTED) on their mental well-being.MethodThis study included 114 LDHR patients who received PTED in the Spinal Orthopedics Department of Zhongshan Hospital of Traditional Chinese Medicine between May 2022 and May 2023. The study population was stratified into two groups according to the presence of preoperative anxiety and depression: Group A comprised patients with such symptoms, and Group B included the remainder. Patients were assessed using the Hospital Anxiety and Depression Scale (HADS), the Visual Analog Scale for Pain (VAS), and the Oswestry Disability Index (ODI) at preoperative and final follow-up visits. Evaluations were performed using the Hospital Anxiety and Depression Scale (HADS), the Visual Analog Scale, and the Oswestry Disability Index (ODI) at the time of preoperation and during the last follow-up.ResultsAmong the 114 LDHR patients who obtained complete follow-up, fifty-four had anxiety/depression symptoms before surgery, which accounted for a incidence of 47%. Both Group A and Group B patients showed significant improvement in all evaluation indicators after PTED, but the overall prognosis of Group A was worse than that of Group B.ConclusionPTED can effectively improve patients’ pain, functional activities and mental health, which has a positive impact on patients’ quality of life, and there is a significant correlation between patients’ preoperative mental health and prognosis.

Initial response to the 2024 Noto earthquake by the university hospital closest to the disaster area

Major earthquakes have occurred frequently in Japan throughout history, and the 2024 Noto earthquake is no exception. However, such natural disasters differ in some respects, and specific problems related to these events have also become clear. Kanazawa Medical University Hospital, which was the closest university hospital to the disaster area of the 2024 Noto earthquake, played a crucial role in serving the local community in the wake of the earthquake. The first method used to identify disaster-related patients is to tag them when they are examined by a physician. After confirming that a patient was eligible at the disaster-related patient-determination meeting, patients’ medical information was extracted from the tag name. A total of 421 disaster-related patients were transported and hospitalized by day 31. Fifty-two (14.4%) and 48 (13.3%) patients were admitted for orthopedic surgery and respiratory medicine, respectively. Forty (11.1%) and 38 (10.5%) patients were admitted to cardiology and nephrology departments, respectively. These four departments account for 49.3% of the total. The number of hospitalized patients in the nephrology and orthopedic surgery departments was high immediately after the 2024 Noto Earthquake. We also describe new hospital-specific initiatives and recommendations to improve Kanazawa Medical University Hospital’s system while sharing another hospital experience.

Reevaluating Pediatric Osteomyelitis with Osteoarticular Tuberculosis: Addressing Diagnostic Delays and Improving Treatment Outcomes

Background: Pediatric osteoarticular tuberculosis (TB) remains a significant global health challenge, particularly in resource-limited settings, where delayed diagnosis and treatment frequently lead to severe long-term complications. Despite advancements in TB control, skeletal TB in children is often misdiagnosed due to its non-specific clinical presentation, contributing to poor outcomes such as joint deformities, growth disturbances, and chronic pain. The complexity of diagnosing osteoarticular TB is further exacerbated by the limited sensitivity of conventional diagnostic tools and the overlap with other musculoskeletal conditions. This study seeks to evaluate the impact of early detection and multidisciplinary management on treatment outcomes in pediatric patients with osteoarticular TB. Methods: A retrospective review was conducted at the Pediatric Orthopedics Department of the “Grigore Alexandrescu” Children’s Hospital in Romania from 2009 to 2023. Case data included clinical, imaging, and microbiological findings, and treatment outcomes in children aged 0–18 years diagnosed with tuberculous osteomyelitis. Results: The study identified varied clinical presentations, with delayed diagnosis often linked to misinterpretation of symptoms as non-TB infections. Multimodal diagnostic approaches combining imaging, microbiological testing, and histopathology improved diagnostic accuracy. Early surgical intervention alongside anti-TB therapy proved effective in reducing long-term complications. Conclusions: Timely, accurate diagnosis and multidisciplinary treatment are critical to improving outcomes in pediatric osteoarticular TB. Vaccination status and comprehensive diagnostic tools significantly influence disease progression and treatment success. The study underscores the need for enhanced screening and diagnostic methods to prevent delays in treatment.

Piperacillin-tazobactam fixed dose combination induced skin reaction in a patient with split thickness skin grafting: a case report

Piperacillin is a semi-synthetic ureido-penicillin. It has a broad spectrum against gram negative bacilli particularly P. aeruginosa. It is one of the most broadly active of the currently available penicillin with regard to other bacterial species like proteus, klebsiella, H. influenzae and gonococci. Tazobactam is β-lactamase inhibitor and combined with piperacillin to increase spectrum of the drug. Patient was 25 years old female, admitted in orthopaedic department for treatment of traumatic leg injury of left limb. Leg was amputated in the accident, so after 1-month split thickness skin grafting was done at plastic surgery department. For prophylaxis piperacillin-tazobactam IV 4.5 gm 8 hourly given, on 2nd post operative day patient reported rashes on neck, trunk, both upper and lower extremities, sparing the mucous membrane. Patient was prescribed anti pruritic and anti-allergic medication for ADR management. It is necessary to use such kind of drugs cautiously in patients whose health is deteriorated by this medication.

Use of cast index and three-point index in paediatric both bone forearm fractures: a prospective study

Introduction The majority of paediatric both bone forearm fractures are treated with manipulative reductions and casting; loss of reduction is one of the most commonly reported complications. We aimed to assess the role of cast index and 3-point index as predictor of outcome of a successful closed reduction in distal both bones forearm fractures.Materials and methods This prospective observational study was conducted at the Department of Orthopedics, Kalpana Chawala Government Medical College in Karnal to assess the role of cast index and 3-point index as predictor of outcome of a successful closed reduction in distal both bones forearm fractures. In the present study, 55 patients 16 years old were included irrespective of sex with distal both bones forearm fractures, managed by closed reduction and casting were included.Results Fracture reduction failure was observed in 32.7 % of the patients. Both three-point index and cast index were found to be significantly higher in patients with reduction failure. It was observed that at 2 weeks Area under curve (ROC Curve) for Cast index and Three point index was 0.72 and 0.85 respectively. At 4 weeks, Area under curve for Cast index and Three point index was 0.77 and 0.84 respectively and at 6 weeks 0.74 and 0.86 respectively. Thus, in the present study, CI and 3PI had similar predictability for fracture reduction failure.Discussion There are a few limitations of our study: We could not observe the patients for a longer period of time to know re-modelling in the long term. We did not take in to consideration the severity of fracture, type of anesthesia used (conscious sedation versus General Anesthesia) and the fracture configuration while assessing the outcomes. We also did not collect information about anthropometric parameters like child weight and diameter of the forearm.Conclusion The three-point index and cast index are clinically useful tools to assess the quality of cast molding following closed reduction of pediatric forearm fractures and to predict re-displacement in distal forearm fractures.

Clinical, functional and neuropsychological status of joint replacement patients

Introduction The number of hip and knee replacement surgeries is increasing annually in Russia and worldwide. The majority of patients receiving joint arthroplasties are elderly women.The objective was to assess the clinical, functional and neuropsychological status of patients undergoing total knee or hip replacement.Material and methods The study included 448 patients admitted for elective surgery of total knee or hip replacement at the Department of Traumatology and Orthopedics of the Federal Center for High Medical Technologies (CHMT, Kaliningrad Region). Anthropometric parameters of the patients were measured, the medical history and concomitant diseases recorded. Common blood count and biochemistry test were evaluated preoperatively. Neuropsychological examination included assessment of cognitive and executive functions, levels of distress, depression, anxiety and somatization.Results Almost all patients studied were found to have varying degrees of obesity. A typical combination of concomitant pathology in volunteers was stage 2 hypertension, risk degree 2–3, and chronic gastritis in remission. Half of the volunteers showed moderate and high levels of distress, depression, anxiety and somatization. A significant number of volunteers showed moderate to high levels of cognitive decline. Age- and sex-related blood counts were slightly different from the normal ranges for a CBC and biochemistry. Changes in leukocyte count were detected.Discussion Leukocyte counts indicated the osteoarthritis induced inflammatory process in most patients. Mitochondrial dysfunction and aging of the immune system contributed to the “proinflammatory status.” The high rate of cognitive impairment in volunteers was associated with age and comorbidity, cardiovascular conditions, in particular. Distress and anxiety were associated with emotional reactions to surgery.Conclusion The factors reported can affect the duration and course of rehabilitation. The “pro-inflammatory status” of patients can complicate the healing of a postoperative wound. Neuropsychological disorders noted during postoperative rehabilitation can have a significant impact on physical recovery, social and professional adaptation.

Psychosocial impact of scars following total hip arthroplasty: a comparative study of traumatic vs. non-traumatic etiologies

Background. This study aims to assess the psychosocial impact of the scars resulting from total hip arthroplasties (THA) in terms of internalization and adaptation related to the etiology of the joint damage (traumatic versus non-traumatic) and the specific surgical procedure, by using a modern approach. Methods. A prospective study was carried out between October 2020 and September 2022, at the Orthopedics department, Bihor Emergency County Clinical Hospital in Oradea, located in North-west of Romania. Depending on diagnosis, the participants were divided into two relatively homogeneous groups: non-traumatic group with 113 subjects (55.66%) diagnosed with degenerative hip osteoarthritis and traumatic group with 90 (44.33%) patients who underwent total hip arthroplasty (THA) following a trauma. Results. The highest internalization score was noted in uncemented THA cases performed as a consequence of traumatic coxarthrosis. The ANOVA coefficients of intergroup comparisons for the participants with traumatic coxarthrosis indicate that surgical procedures have a significant influence on scar internalization [F (2, 90) = 10.046; p&lt;0.001; ƞ2=0.188]. Scheffe’s post hoc test indicated that patients with non-traumatic coxarthrosis who underwent uncemented THA procedures presented a higher level of psychosocial internalization compared to those who underwent cemented (Mdf = 3.87; p&lt;0.02) and revision THA (Mdf = 4.60; p&lt;0.004), but without surprising differences compared to revision of the soft tissue (Mdf = 3.31; p&lt;0.08). Conclusions. The relevance of the coxarthrosis etiology for subsequent surgical interventions was emphasized in this study. Coxarthrosis has a strong impact on the psychosocial internalization of postoperative scars, which indicates a change in the perception of social support as well as the perception of the quality of life.

Effectiveness of Soleus Muscle Flap for The Coverage of Wound in Open Tibia Fracture in The Mid Shaft

Introduction: An open fracture of the tibia has been one of the most common long bone injuries. Soleus muscle flap supply can be a remedy for this kind of soft tissue difficulties. The soleus muscle flap’s blood supply may help in the construction of a longer, safer, and more functional flap. When the incision is clinically fit for covering, the flaps from the same leg are elevated between 0 and 14 days following the damage. In the majority of these cases, the flaps are covered with a split-thickness skin graft taken from the anterior aspect of the thigh in the same sitting. This can be a great solution. Aim of the study: The study aimed to assess the effectiveness of soleus muscle flap for the coverage of wound in open tibia fracture in the mid shaft. Methods: This prospective interventional study aimed to evaluate the outcomes of early coverage using the soleus muscle flap in the management of Gustilo type-IIIB fractures of the mid-shaft tibia. The study followed a quasi-experimental design and was conducted over an 18-month period from January 1, 2010, to June 30, 2011. The research took place in the Department of Orthopaedics and Traumatology at Dhaka Medical College Hospital (DMCH) and the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) in Dhaka. The study population included all 15 patients admitted to the hospitals with clinical and radiological evidence of open Gustilo type-IIIB fractures of the mid-shaft tibia followed by the inclusion and exclusion criteria. Informed written consent was taken before data collection and confidentiality was maintained. The analysis was done by SPSS version 15. Result: Among 15 patients most (12) were male, 3 were female. Mean age was 38 ± 12 years. Majority were in 31-45 years. Male female ratio was 4:1. The selected study subjects were predominantly motor driver (26.66%), followed by day labor, housewife, service holder, farmer, and businessman (each was-13.33%), and student was 6.66%. ...

Complications following total wrist replacement: A single-center retrospective review

Background/Purpose: Total wrist replacement (TWR) is an alternative to wrist fusion in advance wrist arthritis with the advantage of preserving the wrist motion. TWR is, however, infrequently performed in Asia-Pacific region. This study aimed to describe our institution's experience in managing complications following TWR. Methods: This study represents a single-center retrospective review of all patients who underwent TWR at the Department of Orthopedics and Traumatology, Prince of Wales Hospital in Hong Kong. The study period spans from 1 January 2004 to 1 March 2023. Recorded demographic parameters include gender, age upon surgery, pathology, types of implants, and follow-up period. Outcomes focused particularly on postoperative complications and need for revision surgery. Results: Twelve TWR from 10 Chinese-Asian patients were reviewed with a mean follow-up duration of 97.4 months. The incidence of complications in our study was as follows: loosening (16.67%), metallosis (8.3%), infection (8.3%), and stiffness (8.3%). One patient required conversion to total wrist arthrodesis due to metallosis and stiffness. Conclusion: TWR offers promising solutions for managing painful arthritic wrists. However, it's crucial to recognize that complications can arise, necessitating further surgical intervention. Surgeons must thoroughly comprehend these risks to provide informed counseling to patients and explore alternative treatment approaches.

The outcome of titanium elastic nail fixation of pediatric long bone fractures – a retrospective analysis

Background and Objectives Titanium Elastic Nails (TENs) in the surgical management of pediatric long bone fractures (LBF) have emerged as a pivotal technique. This study aimed to report experience with this technique for managing pediatric LBF at the Orthopaedic Department of Samtah General Hospital. Material and Methods A retrospective analysis was conducted using the pediatric LBF patients treated with TENs at the hospital from January 2021 to December 2023. Data regarding demographics, mechanism of injury, fracture patterns, time to achieve union, and functional outcome was extracted from their medical charts. Functional outcome was evaluated using the Flynn et al. criteria. Results A total of 26 patients, four females and 22 males, were included in the study, and the mean age was 9.6 years (6-16 years). Fractures analyzed were radius and ulna (n=12), femur (n=8), tibia (n=5), and isolated ulna (n=1). The most frequent cause was self-fall (n=17). The average time to achieve fracture consolidation (grade 3 callus) was 11.5±2.9 (6-16 weeks) for all fractures. The outcomes were excellent in 19 patients (73.1%) and satisfactory in 7 (26.9%). There were no poor results; only minor complications, such as skin irritation, were recorded in the study. Conclusion TENs fixation for Pediatrics LBF is an efficient and safe method with satisfactory outcomes.

A study on pathogenic aerobic bacteria of surgical site infection and their antimicrobial susceptibility pattern in patients attending a hospital in Bhubaneswar, Odisha

Abstract: Introduction: Identification of bacterial pathogens and their antibiotic susceptibility testing are vital for the effective treatment of surgical site infection (SSI). Objective: The objective of the study was to study the bacterial pathogens in patients with SSI and their antibiotic susceptibility pattern. Methods: Pus samples were collected using sterilized swab stick, and then, the samples were cultured in MacConkey and Blood agar and incubated for 24 h in bacterial incubator. The identification was done by using colony morphology, Gram staining technique, and biochemical tests. After identification, the antibiogram of organisms was done using Mueller–Hinton agar. Results: A total of 76 pus samples were collected from different specialties from SSIs. Out of which 53 samples were culture positive. The number of male patients who had SSI was higher than females. Maximum SSIs were observed in the orthopedics department followed by the surgery department and gynecology department. SSIs in surgery and orthopedics department were commonly seen in the age group 41–60 years. In the obstetrics and gynecology department, SSIs were seen mostly in the age group 21–40 years. In the surgery and orthopedics department, Staphylococcus aureus was the predominant organism and Klebsiella spp was the most common Gram-negative isolate. In the gynecology department, S. aureus was the predominant organism followed by Acinetobacter spp. Maximum sensitivity to Vancomycin and Linezolid was seen as the only Gram-positive isolate in all specialties. Gram-negative isolates from the Enterobacteriaceae family of all specialties were sensitive to tigecycline followed by imipenem and meropenem. Nonfermenters were mostly sensitive to polymyxin b/colistin, imipenem, and meropenem. Conclusion: The study gives an insight into aerobic bacterial pathogens and their antibiotic-sensitivity patterns isolated from SSI and there should be surveillance of SSI which helps to reduce the rate of SSI as well as appropriate use of antibiotics.

Exploring Impact and Variability of Research Productivity Among Academic Orthopaedic Leaders.

Assessing scholarly contributions in academic orthopaedic surgery remains challenging, despite the importance of publication productivity in evaluating academic leaders. The Hirsch (h)-index and its derivative, the m-index, offer objective measures to compare and evaluate publication productivity. The primary aims of this study were to compare h- and m-indices of department chairs and residency program directors of orthopaedic training programs in the United States and assess the association between h-index and program rank. A publicly available Doximity report was used to identify and rank orthopaedic surgery residency programs in the United States. Internet-based searches of institution-specific websites were performed to confirm current department chairs and residency program directors as of January 2024. H-index data were collected from a publicly available database known as Scopus. The m-index was calculated as the quotient of h-index and years in practice. Gender and years in practice were obtained through available biographies on institution-specific websites. Department chairs had significantly higher h- and m-indices at both the career and 5-year time intervals compared with program directors. Upon subgroup analysis, department chairs and program directors at top-10 ranked programs had significantly higher h- and m-indices compared with the entire population of department chairs and program directors. Linear regression analyses demonstrated a direct linear association between department chair/program director h- and m-indices and program rank. Publication productivity was higher for department chairs than residency program directors. Orthopaedic leaders at top-10 institutions had higher publication productivity compared with those at institutions outside of the top 10, per Doximity rankings. Finally, there is substantial variation in publication productivity of orthopaedic surgeons in leadership roles at academic institutions in the United States. This study highlights the publication productivity of orthopaedic surgery department chairs and residency program directors and describes the linear association between publication productivity of academic orthopaedic leaders and program rank. This information can be utilized by those interested in learning more about the publication productivity among academic orthopaedic surgeons across different institutions and can assist those who are involved in the hiring and promotion process at these academic institutions.

Reliability of the Lever Sign Test in the Diagnosis of Anterior Cruciate Ligament Injuries: A Cross-Sectional Study with Interobserver Analysis

Introduction: Anterior cruciate ligament (ACL) injuries are known to have a high rate of occurrence among athletes. The growing prevalence of these injuries demands research in this field to determine clinically reliable diagnostic techniques. Aims: The goal of this study was to compare the diagnostic accuracy of the lever sign test with other frequently used manual tests, such as the anterior drawer and Lachman test, and to evaluate the sensitivity and specificity of the lever sign test in the diagnosis of ACL injuries. Study Design: The study was conducted for a period of 1 year, from November 2021 to November 2022, among 100 patients presenting to orthopedic outpatient department in a tertiary care center with complaints of acute knee pain after a trauma to the knee. Materials and Methods: A thorough history, physical examination, and three manual tests for diagnosing an ACL tear were performed by an intern, orthopedic resident, and consultant after obtaining consent. Arthroscopy of the injured knee was taken as the reference standard. Results: Of 100 patients, 53 were surgical and 67 were nonsurgical; the mean patient age was 33 years (range, 16 + 6.38 years). The overall accuracy of the lever sign test was 83% (85% sensitivity and 81% specificity); the accuracy was almost similar at arrival and under anesthesia (at arrival 86%, under anesthesia 80%), when performed by interns, postgraduates, and consultants. Conclusion: The lever sign test is easier to perform, equally efficacious, and reliable in diagnosing ACL injuries when compared to the other conventionally used manual tests.

Outcomes for centenarian patients admitted with orthopaedic trauma

IntroductionThe United Kingdom (UK) and world's population is aging with patients living longer, often with many co-morbidities. It is expected that patients of extreme old age would have poor outcomes following trauma; however, this assumption is not clearly evidenced. This study aims to present the outcomes of patients aged 100 or older admitted to a single hospital trust following admission for orthopaedic trauma. MethodA prospective cohort of patients aged 100 years and over admitted to the trauma and orthopaedic departments of two hospitals within the same trust between 2008 and 2022 was reviewed. Age was median 101 years (100–106 years). Outcome measures were length of stay, survival, complications and change in accommodation. Results80 patients met the inclusion criteria (71female, 9 male). Mean age at discharge was 102.5 years with survival mean 4.2 years. 2 patients with peri-prosthetic fracture survived a further 5 years. Mean length of stay was 17 days. 57 patients returned to their original place of residence. 72 patients (90 %) survived the acute hospital admission. ConclusionSurvival rates for patients aged over 100 years were high and most returned to the previous place of residence. This study supports the surgical management of trauma and helps inform patients and families expectations for mortality risk.