Orthopaedic Examination Research Articles

A modified approach to portal placement for arthroscopic management of osteochondritis dissecans lesions of the tarsocrural joint in 15 dogs (19 tarsi).

To describe the surgical technique and outcomes of arthroscopic treatment for talar osteochondritis dissecans (OCD) in dogs, using scope and instrument portals placed on the same side of the joint as the lesion. Retrospective case series. Fifteen client-owned dogs (19 tarsi). The records of dogs with talar OCD lesions managed by arthroscopy using this modified approach to portal placement were reviewed. Signalment, owner-completed questionnaires-the Canine Brief Pain Inventory (CBPI) and a visual analog scale (VAS)-together with clinical and imaging data, surgical techniques, and postoperative complications were recorded. Mid- to long-term outcomes (over 6 months) were assessed using orthopedic examinations, osteoarthritis radiographic scores, and owner-completed questionnaires. Visualization of the affected articular structures was adequate in all cases. The multiple OCD fragments identified on CT scans were removed without intraoperative complication in 17 tarsi. Mini-arthrotomy was performed in one dog and mini-tenotomy of the deep digital flexor sheath was performed in another. Minor postoperative complications (synovial cysts) were reported in four cases. Mid- to long-term outcomes were good to excellent in 11 of the 14 dogs with substantial improvement in lameness, CBPI, and VAS scores compared with preoperative results. Degenerative joint disease progression was observed in 10 of the 14 cases. The modified arthroscopic technique resulted in few complications, rapid clinical improvement, and full or acceptable function in most cases. This modified approach to portal placement is an appealing and suitable alternative to the approach described previously for managing tarsal OCD lesions.

Long‐term outcome of a canine longitudinal patellar fracture treated with lag screw and pin

AbstractWe report a rare case of a 4‐year‐old, female, mixed‐breed dog with a longitudinal patellar fracture of the left hindlimb. Orthopaedic examination revealed pain, swelling and crepitus in the patella. Stifle radiography and computed tomography confirmed a longitudinal patellar fracture with lateral displacement of the fragment. A lateral parapatellar approach was chosen to assess the stifle joint. Intraoperative findings were consistent with the diagnostic imaging findings, with an additional partial tear of the quadriceps tendon at the fracture location. The fracture was treated using a 2 mm lag screw combined with a 1.25 mm K‐wire, and the partial quadriceps tendon tear was repaired with a locking‐loop suture. Despite a soft tissue injury due to temporary external coaptation treated conservatively, recovery was uneventful, and lameness gradually decreased, remaining lameness‐free from postoperative Week 7. The dog finally returned to full activity without recurrence of lameness during long‐term follow‐up (422 days).

Long-Term Orthopaedic and Radiological Outcomes of Symphysis Approximation without Osteotomy in Primary Bladder Exstrophy Repair.

Previous assumptions suggested that the technique of approximation without osteotomy in primary exstrophy repair (PER) could only be applied in newborns and anticipated poorer outcomes. Recent studies indicated that this technique can be successfully executed not only in immediate PER but also yields favorable long-term results. Therefore, we evaluated and compared the orthopaedic and radiological long-term outcomes after pubic symphysis approximation without osteotomy in immediate and delayed PER. From March 2018 to December 2020, individuals with PER and approximation of the symphysis without osteotomy were recruited. Patients <12 years and with a history of orthopaedic surgery of the bony pelvis were excluded. Orthopaedic examinations and magnetic resonance imaging (MRI) of the bony pelvis including the hip joints were performed and pubic diastasis, the acetabulum angle (ACA), and the center-edge angle (CEA) were evaluated. Twenty-nine patients were included, 11 of them had an immediate and 18 had a delayed PER. Between the two groups, no significant differences could be observed concerning hip pain (p = 0.419), mobility impairment (p = 0.543), sports impairment (p = 0.543), hip impingement (p = 1.000), leg length discrepancy (p = 0.505), and width of the pubic diastasis as measured by MRI (p = 0.401). There were also no significant differences with regard to CEA right (median 30 degrees, p = 0.976), CEA left (median 31.5 degrees, p = 0.420), ACA right (median 19 degrees, p = 0.382), and ACA left (median 17 degrees, p = 0.880). There were no significant differences in clinical orthopaedic or radiological long-term outcomes between bladder exstrophy patients after immediate and delayed bladder closure with symphysis approximation without osteotomy. Establishing core outcome sets is essential to get robust and comparable results, further advancing and substantiating our initial insights.

TRANSPOSIÇÃO LATERAL E DISTAL DA TUBEROSIDADE TIBIAL NO TRATAMENTO DA LUXAÇÃO MEDIAL DE PATELA GRAU II ASSOCIADA À PATELA ALTA EM CÃO – RELATO DE CASO

The objective was to report the diagnosis and treatment of a mixed breed dog, 3 years old, with high patella and grade II medial patellar dislocation in the right pelvic limb. The patient was seen complaining of lameness in the affected limb and, after orthopedic examination, a grade II medial dislocation of the patella was diagnosed, possibly associated with patella alta. Patellar chondropathy and osteoarthrosis were also suggested due to the presence of crepitus in the joint on examination. Radiographs confirmed the diagnosis and enabled surgical planning. Surgery included trochleoplasty, medial desmotomy, lateral imbrication, lateral and distal transposition of the tibial tuberosity and tenotomy of the rectus femoris muscle. Two weeks after the procedure, there was an improvement in patellar stability and locomotion, with slight residual lameness. Upon return after 30 days, no lameness, patellar dislocation and joint pain were observed. One year after the procedure, a virtual reassessment was carried out with videos sent by the tutor, demonstrating the absence of lameness and the patient's good general condition. It is concluded that the recommended surgical treatment was effective in correcting patellar dislocation and patella alta, resulting in an improvement in the patient's quality of life due to the good clinical results presented.

A successful outcome in four puppies sustained swimmer puppy syndrome.

Swimmer puppy syndrome (SPS) is a rare condition that affects neonatal animals. The affected puppies are unable to stand, remain in sternal recumbency with their legs splayed laterally and ambulate with typical swimmer-like movements. This study reports the clinical findings and discusses the treatments and outcomes in four puppies of various breeds with clinical signs of SPS. Previous medical records of the animals were reviewed for history, clinical features, radiographic findings and choice of treatment. Treatment follow-up was evaluated at 15, 30, 45 days and 6 months. In three puppies all limbs were affected. In one case only the forelimbs were affected, while the hind limbs remained normal. Clinical, orthopaedic and neurological examinations, routine laboratory findings and tidal breathing flow-volume loop measurements were normal. Concurrent problems occurred in two animals and included slightly deformed chest and ventrodorsal flattening of the thorax with a slight right displacement of the heart. For the management of SPS, chest and hobble bandages were used, as well as physiotherapy and environmental management. Three puppies recovered completely after 45 days of treatment. In one case the therapy was discontinued after 2 weeks. In this case, the puppy could stand, but mild abduction of the forelimbs and lameness were obvious after 6 months. Intensive physiotherapy contributed to positive outcomes even in older puppies. Also, to the authors' knowledge, this is the first report of tidal breathing flow-volume loop measurement for dogs with pectus excavatum.

Arthroscopic removal of the fragmented medial coronoid process in dogs - Evaluation of treatment results with special reference to postoperative computed tomography and residual particles

The aim of this study was to assess the treatment success of dogs with medial coronoid disease (here: Fragmented Coronoid Process [FCP]) following arthroscopically performed subtotal coronoidectomy by the use of subjective and objective gait analysis and the evaluation of osteoarthritis progression in addition to their correlation with the findings from postoperative computed tomography. In particular, the clinical relevance of residual particles remaining postoperatively was to be evaluated. Thirty elbows from 24 dogs of different breeds were examined clinically, orthopedically, using gait analysis as well as radiographically at least 6 months after unilateral or bilateral subtotal coronoidectomy. The results were compared with the preoperative findings of the corresponding examinations and postoperative computed tomography. 79.2% (19/24) of the patients improved by at least one degree of lameness in the orthopedic examination, 66.7% (16/24) were free of lameness. 60% (18/30 joints) showed an increase in the degree of arthrosis. Postoperative computed tomography revealed small residual bone particles (<1 mm) in the joint space or soft tissue in 56.7% (17/30) of the joints. No significant association was evident between residual lameness and residual particles remaining within the joint postoperatively. An association between persistent lameness and progression of arthrosis was also not be demonstrable. No evidence was apparent supporting a link between residues of small bone particles after arthroscopic subtotal coronoidectomy and postoperative lameness. The progression of osteoarthritis could not be interrupted despite the surgical intervention. When small residual particles (<1 mm) remain after subtotal coronoidectomy, these do not appear to have any influence on the clinical outcome.

The Effect of a Flipped Classroom Didactic Curriculum on Orthopaedic In-Training Examination Scores for a Resident Cohort.

There is little research on the efficacy of flipped classroom (FC) models of learning in formal orthopaedic didactic curricula. The primary aim of this study was to compare resident Orthopaedic In-Training Examination (OITE) scores before and after implementation of an FC curriculum at a single academic institution. An FC didactic model consisting of 3 hour-long weekly sessions focusing on highly tested topics was implemented for the start of the 2021 to 2022 academic year. The curriculum was based on the Orthobullets PASS curriculum. The OITE scores were measured 3 years before and 3 years after the implementation of the novel curriculum. Mean in-training scores as a program against national peers increased from the 29th percentile precurriculum implementation to 75th percentile postcurriculum implementation (p < 0.001). At a single academic institution, average OITE scores increased significantly after implementation of an FC model. Consideration should be given to changing traditional lecture-based curricula to models that more effectively engage resident learners. Level III: Retrospective Cohort Study. See Instructions for Authors for a complete description of levels of evidence.

Pain related syndrome of inappropriate antidiuretic hormone secretion in a kitten

A 2-month-old domestic shorthair kitten was presented for evaluation of weakness, gait abnormalities, and signs of pain after trauma. On admission, the patient was found laterally recumbent with obvious gait abnormalities: difficulty rising from sitting and marked unilateral left hind limb lameness. On orthopedic examination, severe pain, crepitations, and swelling of the left hind limb were detected. Results of the first diagnostic work-up were all consistent with hyponatremia, hypochloremia and a Salter-Harris type I fracture.The kitten initially received isotonic fluids, analgesia, and antiemetic treatment. Twelve hours after admission, the analgesic plan was considered insufficient, and the general patient's condition worsened, showing severe mental depression. Blood and urine samples were collected for a more in-depth diagnostic evaluation; the patient showed worsening hyponatremia (113 mmol/L; [RR: 146,2-156,2]), severe plasma hypoosmolality (218.2 mOsm/kg; [RR: 287-307 mOsm/kg]), high natriuresis (Na: 74.9 mmol/L; [RR: <40 mmol/L]), and urinary hyperosmolality (630 mOsm/kg; [RR: <150 mOsm/kg]). Based on these new clinical findings syndrome of inappropriate antidiuretic hormone (SIADH) secretion was diagnosed.Emergency treatment with hypertonic saline was then instituted, a constant rate infusion of 3% hypertonic saline infusion to increase plasma sodium was initiated and a loop diuretic, furosemide (1 mg/kg/IV), was administered at 12-hour intervals to induce diuresis. Discharge occurred 4 days after admission as the patient was clinically stable and the hyponatremia progressively resolved. To the author's knowledge this is the first report of a kitten developing pain related SIADH associated to orthopedic trauma.

Assessment of radiation dose values in common orthopaedic trauma examinations performed under X-ray fluoroscopy guidance.

This study aims to provide radiation reference levels in orthopaedic surgery. A total of 753 procedures were collected within 1y. Categories containing several similar procedures were created based on four criteria: same anatomical area, same level of complexity, only single procedures, and at least 10 cases per category. Exposure was defined in terms of air kerma-area product, fluoroscopy time, and air kerma at the patient entrance reference point. For common procedures, median effective doses to patient were calculated using the Monte Carlo Software PCXMC. Most irradiating procedure in this study i.e. intramedullary nailing of the proximal femur was equivalent to an air kerma at the patient entrance reference point of 37.1mGy, which is ~50 times lower than the threshold for acute deterministic effects of radiation. Optimization remains a must to reduce the dose while maintaining the image quality and reducing the likelihood of stochastic effects.

ChatGPT, Bard, and Bing Chat are large language processing models that answered OITE questions with a similar accuracy to first-year orthopaedic surgery residents.

PurposeTo assess ChatGPT, Bard, and BingChat’s ability to generate accurate orthopaedic diagnosis or corresponding treatments by comparing their performance on the Orthopaedic In-Training Examination (OITE) to orthopaedic trainees. MethodsOITE question sets from 2021 and 2022 were compiled to form a large set of 420 questions. ChatGPT (GPT3.5), Bard, and BingChat were instructed to select one of the provided responses to each question. The accuracy of composite questions was recorded and comparatively analyzed to human cohorts including medical students and orthopaedic residents, stratified by post-graduate year. ResultsChatGPT correctly answered 46.3% of composite questions whereas BingChat correctly answered 52.4% and Bard correctly answered 51.4% of questions on the OITE. Upon excluding image-associated questions, ChatGPT, BingChat, and Bard’s overall accuracies improved to 49.1%, 53.5%, and 56.8%, respectively. Medical students and orthopaedic residents (PGY1-5) correctly answered 30.8%, 53.1%, 60.4%, 66.6%, 70.0%, and 71.9%, respectively. ConclusionChatGPT, Bard, and BingChat are AI models that answered OITE questions with an accuracy similar to that of first-year orthopaedic surgery residents. ChatGPT, Bard, and BingChat achieved this result without using images or other supplementary media that human test takers are provided.

Structure and function of the foot in the context of Achilles tendon rupture – cause-effect analysis

Introduction and objective: Achilles tendon rupture is the most common sports injury. The aim of the study was to analyse the cause-effect correlation between the occurrence of foot dysfunction and Achilles tendon rupture in male athletes. Materials and methods: The study included 41 men who were treated for Achilles tendon rupture, and a control group of 40 men who met the same criteria, but had no history of Achilles tendon rupture. Each participant underwent the following examinations: orthopaedic examination, plain standing foot radiographs, and foot examination on the gait platform. The final stage was an experimental study in the field of biomechanics of the musculoskeletal system of the lower limbs, with an assessment of forces arising in the Achilles tendon and statistical analyses of all obtained results. Results: Plain foot radiographs and examination on the gait platform showed that the feet in the study group had significantly more abnormalities compared to the control group. Planovalgus foot deformity was far more frequent in the study group on plain radiographs. The forefoot was overloaded much more often in the study group, and the foot was placed in excessive abduction, which is characteristic of planovalgus foot. The experimental study shows that the force in the Achilles tendon increases with increasing load on the forefoot. Conclusions: Planovalgus foot deformity in male athletes with a history of ruptured Achilles tendon is the most common foot pathology, significantly increasing the forces transmitted by the Achilles tendon.

Long-Term Effect of Intra-Articular Adipose-Derived Stromal Vascular Fraction and Platelet-Rich Plasma in Dogs with Elbow Joint Disease-A Pilot Study.

(1) Background: The aim of the current pilot study was to describe the long-term effects of a single intra-articular injection of autologous stromal vascular fraction (SVF) with platelet-rich plasma (PRP) in dogs with confirmed elbow OA, using orthopedic lameness scoring and kinetic and kinematic gait analysis. For comparison of normal long-term variation of gait over time, a group of healthy control dogs (CDs) was also evaluated. (2) Methods: A prospective longitudinal clinical pilot study investigating 19 client-owned dogs with elbow OA (OADs) treated with SVF and PRP and eight CDs not receiving treatment. The OAD and CD groups were evaluated before and after 6 and at least 12 months following treatment with SVF and PRP (OAD group) and twice with a six-month interval (CD group), respectively, through orthopedic examinations, goniometry, and kinetic and kinematic analyses (seven variables). (3) Results: The OAD had an increase in fore-hind peak force symmetry ≥12 months after treatment (p < 0.05), but no other objective variables changed over time. Orthopedic consensus scores had improved at ≥six months follow-up evaluation (p < 0.05). None of the investigated gait variables had changed at ≥six months follow-up evaluation in the CD group. (4) Conclusions: The current study could not confirm a significant benefit from SVF and PRP treatment in OADs, but future studies should be conducted in order to fully evaluate the potential of the treatment. The improvement seen in fore-hindlimb symmetry may represent an improvement in gait or an incidental finding.

A Surgical Skills Rotation for Mid-Level Residents.

The University of Iowa orthopaedic residency previously designed a month-long surgical skill rotation for postgraduate year (PGY)-1 residents. This successful initiative has become a model of interest for other teaching institutions. In addition to the intern year, an important phase in residency occurs during the transition from PGY2 to PGY3, when residents assume greater responsibility and autonomy in leading surgical procedures. To directly address this transition and assess residents' readiness, our residency program established a week-long PGY2 surgical skills rotation. This rotation serves as a training checkpoint and focuses on both training and evaluation of level-appropriate skills in joint arthroplasty, trauma, arthroscopy, and wire navigation. The primary objective of the PGY2 surgical skills rotation is to enhance orthopaedic residents' operative skills and experience by providing increased exposure and practice of requisite technical skills. Similar to the Orthopedic In-Training Examinations that assess residents' knowledge, this week-long program, aimed at assessing residents' proficiency in fundamental orthopaedic technical skills, occurs before their PGY3 year. Faculty-led training and assessment sessions in each area offer residents many opportunities for dedicated practice and improvement. Transferring these acquired skills from the laboratory to the operating room is essential for a training program. To confirm improvement, the final day of the surgical skills rotation was exclusively dedicated to structured performance evaluations, with a specific emphasis on establishing proficiency benchmarks. We herein describe the University of Iowa's PGY2 surgical skills rotation, providing insights into its development, implementation, and outcomes. By sharing our experience, we offer a framework for other academic departments seeking to optimize surgical skills education and ensure the successful transition of mid-level residents.

Evaluation of Symmetry of Ventrodorsal Pelvic Radiographs in Dogs; A Retrospective Study

Pelvic radiographs in dogs have been used for assessments of pelvic bone, hip joint, and sacral bone in orthopaedic examinations. Thus, symmetric radiographs must be a goal to minimise medical errors. Despite the importance of symmetric radiographs, ventrodorsally pelvic radiographs are routinely evaluated using the symmetric appearance of the obturator foramen and wing of the ilium. This retrospective study was performed to evaluate the symmetry of pelvic radiographs in dogs. For this purpose, 100 pelvic radiographs were reevaluated by linear, area, and circumference measurements. The differences in percentages were remarkable for width and area values for both the ilium and obturator foramen between the left and right sides. In terms of the difference in the percentage of iliac wing width, two-thirds of radiographs showed asymmetry up to 20% and higher in the remaining one-third of radiographs. The findings of this research indicate that completely symmetrical positioning on pelvic radiographs is often not obtained.

Congenital variants of the ventral laminae of the sixth and seventh cervical vertebrae are not associated with clinical signs or other radiological abnormalities of the cervicothoracic region in Warmblood horses

AbstractBackgroundThere is controversy about the clinical relevance of congenital variants of the ventral laminae of the sixth (C6) and seventh (C7) cervical vertebrae and their relationship with other radiological abnormalities.ObjectivesTo document the prevalence of congenital variants of C6 and C7 and that of other radiological abnormalities from C6 to the second thoracic vertebra (T2).Study designCross‐sectional.MethodsThe study included Warmblood horses ≥3 years of age undergoing clinical assessment at two referral institutions: 127 control horses and 96 cases (neurologic, neck pain or stiffness, or neck‐related forelimb lameness). All horses underwent a standardised orthopaedic and neurologic examination. Lateral–lateral and lateral 45°–55° ventral–lateral dorsal (left to right and right to left) radiographic views of C5 to T2 were acquired and assessed blinded to the horse's clinical category using a predetermined grading system.ResultsThe ventral profile of C7 was abnormal in 54 horses (24.2%). Cases were less likely to have congenital variants than control horses, p = 0.0002, relative risk (RR): 0.63 (95% confidence intervals [CIs]: 0.4, 1.0). There was no association between the presence of a congenital variant of C7 and the presence of modelling of the articular processes (APs) of C6–C7, C7–T1 or T1–T2. Cases were more likely to have severe modelling of the APs at C6–C7, p = 0.01, RR: 1.94, CI: 1.1, 3.5 and C7–T1, p = 0.04, RR: 1.97, CI: 1.2, 3.2 compared with control horses.Main limitationsRadiographs were read by one assessor independently at each institution.ConclusionsThere was no association between the presence of congenital variants of C7 and any other radiological findings. Congenital variants occurred less frequently in cases compared with control horses. There was no association between the presence or absence of a congenital variant and the type of case.

Successful Treatment of Olecranon Fracture with Tie-in External Fixator in a Cat

In this case report, A 4-months-old, male, British shorthair cat was presented with lameness and swelling in the forelimb and loss of appetite after a fall from a height. On the orthopedic examination, pain, lameness, abnormal mobility, local sensitivity, crepitation, and deformation findings were observed in the forelimb. Clinical and radiological examinations revealed an avulsion fracture of the left olecranon. The fracture was treated with an external fixator. Clinical and radiological controls were performed on the 10th, 21st, 30th, and 45th postoperative days. The external fixator was removed on the 62nd postoperative day under sedation. This case report aimed to contribute to the literature on the successful treatment of fracture of the olecranon with an external fixator in a 4-months-old young cat.

Inadequate Performance of ChatGPT on Orthopedic Board-Style Written Exams.

Chat Generative Pre-Trained Transformer (ChatGPT) is an artificial intelligence (AI) chatbot capable of delivering human-like responses to a seemingly infinite number of inquiries. For the technology to perform certain healthcare-related tasks or act as a study aid, the technology should have up-to-date knowledge and the ability to reason through medical information. The purpose of this study was to assess the orthopedic knowledge and reasoning ability of ChatGPT by querying it with orthopedic board-style questions. We queried ChatGPT (GPT-3.5) with a total of 472 questions from the Orthobullets dataset (n = 239), the 2022 Orthopaedic In-Training Examination (OITE) (n = 124), and the 2021 OITE (n = 109). The importance, difficulty, and category were recorded for questions from the Orthobullets question bank. Responses were assessed for answer choice correctness if the explanation given matched that of the dataset, answer integrity, and reason for incorrectness. ChatGPT correctly answered 55.9% (264/472) of questions and, of those answered correctly, gave an explanation that matched that of the dataset for 92.8% (245/264) of the questions. The chatbot used information internal to the question in all responses (100%) and used information external to the question (98.3%) as well as logical reasoning (96.4%) in most responses. There was no significant difference in the proportion of questions answered correctly between the datasets (P = 0.62). There was no significant difference in the proportion of questions answered correctly by question category (P = 0.67), importance (P = 0.95), or difficulty (P = 0.87) within the Orthobullets dataset questions. ChatGPT mostly got questions incorrect due to information error (i.e., failure to identify theinformation required to answer the question) (81.7% of incorrect responses). ChatGPT performs below a threshold likely to pass the American Board of Orthopedic Surgery (ABOS) Part I written exam. The chatbot's performance on the 2022 and 2021 OITEs was between the average performance of an intern and to second-year resident. A major limitation of the current model is the failure to identify the information required to correctly answer the questions.

Analysis of Hip Preservation Questions on the Orthopaedic In-Training Examination Over the Past 20 Years.

The orthopaedic in-training examination (OITE) is a 275-question test for orthopaedic residents administered annually. As the field of orthopaedics changes, the OITE evolves its content. The incidence of hip preservation-related procedures has increased substantially over the past decade; nonetheless, an analysis of the trends of hip preservation questions on the OITE has not yet been performed. The purpose of the study was to evaluate the number and type of questions on the OITE related to hip preservation to determine whether trends over time paralleled the increases in hip-related care in clinical practice. It was hypothesized that the frequency of hip preservation questions on the OITE would increase with time. Cross-sectional study. Each OITE between 2002 and 2021 was reviewed for questions related to hip preservation. The types of questions included under "hip preservation" were those related to femoroacetabular impingement (FAI), athletic soft tissue injuries of the hip, acetabular labral tears, hip arthroscopy, and surgical management of adult hip dysplasia-excluding arthroplasty. Questions were quantified and categorized by topic, taxonomy level, associated imaging, and cited sources. There were 30 hip preservation-related questions between 2002 and 2021. Of these, 77% occurred within the past 10 years. Also, 14 questions (47%) had associated images in the question stem-the most common being radiographs (n = 8 questions). The most commonly tested subcategories were FAI (n = 11 questions [37%]), athletic injuries (n = 7 questions [23%]), and anatomy (n = 7 questions [23%]). Over the last 10 years, 97.9% of citations were from journal articles-the most common being the Journal of the American Academy of Orthopaedic Surgeons, Clinical Orthopedics and Related Research, and the American Journal of Sports Medicine. The frequency of hip preservation-related questions on the OITE has increased with time, reflecting trends in clinical practice.

Outcome of surgical correction of medial patellar luxation in dogs weighing less than 10 kg.

Varioustrochleoplasty techniques, including trochlear wedge recession (TWR) and trochlear block recession (TBR), are used to treat dogs with medial patellar luxation (MPL). However, the objective outcomes of these surgical proceduresare underreported. Medical records were obtained for dogs weighing less than 10kg that underwent either TWR or TBR and tibial tuberosity transposition to address grade I-III MPL. Long-term (at least 1 year after the last procedure) follow-up included orthopaedic and radiographic examinations, such as osteoarthritis score (OAS), ground reaction force (GRF) analysis and canine brief pain inventory (CBPI). Overall, 20 dogs (26 stifles) were followed up in the long term. Minor postoperative complications, medial patellar reluxation (MPR) and intermittent lameness occurred in 46.15%, 19.23% and 15% of the dogs, respectively. MPR occurred only in TWR-treated stifles, while mean OAS increased in all groups. Using the CBPI, the owners perceived an excellent or very good outcomein 95% of dogs. The limitations of the study include its retrospective observational nature, a lack of randomisation and a small sample size. Surgical treatment resulted in a favourable outcome. GRF analysis could detect subtle differences in weight bearing in dogs treated for MPL, which might not be apparent clinically. There might be a higher risk for reluxation for TWR. However, a larger-scale prospective study would be required to find which treatment is superior.

Effectiveness of AI-powered Chatbots in responding to orthopaedic postgraduate exam questions-an observational study.

This study analyses the performance and proficiency of the three Artificial Intelligence (AI) generative chatbots (ChatGPT-3.5, ChatGPT-4.0, Bard Google AI®) and in answering the Multiple Choice Questions (MCQs) of postgraduate (PG) level orthopaedic qualifying examinations. A series of 120 mock Single Best Answer' (SBA) MCQs with four possible options named A, B, C and D as answers on various musculoskeletal (MSK) conditions covering Trauma and Orthopaedic curricula were compiled. A standardised text prompt was used to generate and feed ChatGPT (both 3.5 and 4.0 versions) and Google Bard programs, which were then statistically analysed. Significant differences were found between responses from Chat GPT 3.5 with Chat GPT 4.0 (Chi square = 27.2, P < 0.001) and on comparing both Chat GPT 3.5 (Chi square = 63.852, P < 0.001) with Chat GPT 4.0 (Chi square = 44.246, P < 0.001) with. Bard Google AI® had 100% efficiency and was significantly more efficient than both Chat GPT 3.5 with Chat GPT 4.0 (p < 0.0001). The results demonstrate the variable potential of the different AI generative chatbots (Chat GPT 3.5, Chat GPT 4.0 and Bard Google) in their ability to answer the MCQ of PG-level orthopaedic qualifying examinations. Bard Google AI® has shown superior performance than both ChatGPT versions, underlining the potential of such large language processing models in processing and applying orthopaedic subspecialty knowledge at a PG level.