Predicting gait kinematics in youth with cerebral palsy using clinically informed machine learning algorithms.

The Emerging Roles for 3 Dimensional Printing in Orthopedics: Applications, Evidence, and Future Directions.

Although rare, stress-related gastrointestinal complications, such as perforated peptic ulcer (PPU) and upper gastrointestinal bleeding, can result in notable morbidity and mortality following orthopaedic surgery, particularly in elderly or critically ill patients. Despite widespread implementation of stress ulcer prophylaxis (SUP) in critical care, its role in orthopaedic surgical populations remains ill defined. A narrative review of the literature reveals a low incidence of PPU following orthopaedic procedures (0.054% after elective spine surgery); however, associated mortality may reach as high as 25% in cases of PPU. Identified risk factors include NSAID use, advanced age, notable comorbidities, and critical illness. SUP with proton pump inhibitors or histamine-2 receptor antagonists has been shown to reduce upper gastrointestinal bleeding in critically ill patients, leading to guideline-based recommendations for selective prophylaxis in high-risk individuals. Given the potential severity of these complications, orthopaedic surgeons should maintain vigilance and consider SUP in at-risk patients, while avoiding routine prophylaxis in low-risk cases. Tailoring prophylactic strategies to patient-specific risk factors aligns with best practices from critical care and may help mitigate preventable postoperative complications.

Periacetabular osteotomy, commonly performed for prearthritic hip dysplasia, was identified as a procedure that could benefit from an enhanced recovery after surgery pathway due to wide variation in multimodal pain management and regional anesthesia practices at our institution. The global aim of this project was to implement an enhanced recovery after surgery pathway for patients undergoing periacetabular osteotomy. Our SMART aim was to achieve greater than 70% compliance for the intraoperative medication bundle elements during the first PDSA cycle. A multidisciplinary pathway was designed and implemented with key stakeholders from the Departments of Evidence Based Practice, Anesthesiology, Orthopedic Surgery, and Perioperative Nursing. Patient data from all patients undergoing periacetabular osteotomy from 2018 to the present were analyzed, which included the baseline cohort as well as outcomes from two Plan-Do-Study-Act cycles. After ERAS implementation and two subsequent Plan-Do-Study-Act cycles, we observed a decrease in hospital length of stay from 3.34 days (95% CI [2.95, 3.72]) to 2.37 days (95% CI [2.00, 2.74]) and an intraoperative medication bundle compliance of 90%. These gains occurred with minimal change in average postoperative pain scores and no hospital readmissions within 30 days of surgery. Multidisciplinary enhanced recovery after surgery pathways continue to play a critical role in standardizing perioperative care, reducing unwarranted variation, and promoting faster recovery across paediatric populations.

The rapid expansion of glucagon-like peptide-1 receptor agonist (GLP-1 RA) use for weight management and diabetes has raised perioperative questions, particularly regarding delayed gastric emptying and infection risk. Emerging real-world data suggest a more nuanced perioperative profile. This scoping review synthesizes evidence on preoperative GLP-1 RA exposure and postoperative outcomes across orthopaedic procedures, with emphasis on soft-tissue sports medicine, and is intended to map associative perioperative outcomes rather than establish causality. Following Arksey-O'Malley and Joanna Briggs Institute methodology and PRISMA-ScR reporting, we searched PubMed, Scopus, Web of Science, CINAHL Ultimate, Academic Search Premier, and Ovid Emcare (2015 to 2025). Eligible studies evaluated adult orthopaedic patients with documented GLP-1 RA use and postoperative outcomes. Three reviewers independently screened and extracted study characteristics, exposure timing, perioperative management, and outcomes. Of 117 records screened, 35 studies met inclusion. Most were large retrospective cohorts spanning arthroplasty, spine fusion, trauma fixation, foot/ankle fusion, shoulder arthroplasty, and rotator cuff repair. Across hip, knee, and shoulder arthroplasty, GLP-1 RA use was generally associated with similar or lower 90-day complications, reduced periprosthetic joint infection, shorter length of stay, and fewer readmissions or revisions. Spine findings were mixed: Several cohorts showed lower infection and readmission, while others noted increased pneumonia, acute kidney injury, or pseudarthrosis in long-term semaglutide users. Trauma and ankle fracture cohorts showed no increase in short-term complications and in some cases lower mortality, with isolated signals for increased late fall-related injuries. Soft-tissue cohorts (rotator cuff repair and distal radius fixation) demonstrated fewer adverse events without increased aspiration or revision surgery risk. Functional outcomes (PROMIS) were rarely reported. Preoperative GLP-1 RA exposure is not broadly associated with increased postoperative risk and often correlates with lower infection, readmission, and mortality rates-particularly in arthroplasty, spine, and ankle fracture fixation cohorts. Findings in spine surgery are more mixed and warrant cautious interpretation, especially with prolonged semaglutide exposure. Outcomes in sports-medicine procedures seem reassuring, although prospective multicenter studies with standardized perioperative protocols and PROMIS-based outcomes are needed.

Computerised Hexapod-Assisted Orthopaedic Surgery (CHAOS) in the Treatment of Long Bone Malunion (Tibia and Femur) - A Comprehensive Review.

The Value of Specific Special Questions on Case Lists Submitted for ABOS Certification: Commentary on an article by Gregory P. Guyton, MD, et al.: " Insights into Evolving Trends and Controversies in Orthopaedic Surgery from the ABOS Case Collection System. Data from Current Procedural Terminology-Specific Special Questions, 2022 to 2024 ".

Large joint arthroplasty is among the most frequently performed procedures in orthopaedic surgery. One of the most common and challenging causes of prosthetic failure is periprosthetic joint infection (PJI). Periprosthetic soft tissue damage is often a critical yet underestimated factor influencing surgical outcomes. The aim of our meta-analysis is to evaluate the clinical efficacy, complications, failure rates, and the overall reliability of free flaps as a reconstructive solution. PubMed, Embase, and Google Scholar were searched, according to PRISMA guidelines. Studies were included if they reported healing rate, complications, type of free flaps, and pathogen characteristics. A quality evaluation was performed. The overall effect size was reported as survival rate of the free flaps, and the secondary effect sizes were determined as the rate of reinfection or persistent infection after coverage with free flaps and the amputation rate because of non-controlled infection. The statistical analysis was carried out using the software 'R', version 4.5.0 (2025-04-11). Fourteen papers were included, with a total of 185 observations and 161 events (free flap survived). All papers were retrospective studies. The pooled survival rate was 93% (I 2 = 66.7%). The pooled rate of reinfection or persistent infection after the index surgery was 16% (I 2 = 77.6%). The amputation rate was 8%. Free flaps are a reliable solution to manage tissue loss in patients with periprosthetic infection, but the results could be affected by technical errors and non-skilled intra- and post-operative management. Orthoplastic and microsurgical skills are mandatory to be successful.

➢ The American Board of Orthopaedic Surgery (ABOS) collects sequential Current Procedural Terminology (CPT)-coded surgical case lists both from Candidates for initial certification and from Diplomates participating in Maintenance of Certification (MOC). Collectively, these case lists represent a unique and extensive sampling of orthopaedic surgical practices across the United States. ➢ Because revisions or additions to the CPT system often take many years to reflect changes in surgical practice, in 2022 the ABOS began adding special questions for recorded cases in which the CPT codes alone do not identify potentially new or controversial surgical choices. ➢ The responses are used primarily for the ABOS internal case selection process for oral examination, but the ABOS recognizes that these previously unreported data are also of broad interest to the orthopaedic community. ➢ The data from the ABOS CPT-specific special questions from 2022 to 2024 were collected and analyzed. Responses from both early-career Candidates for initial certification and mid-career MOC Diplomates are compared in this report. They provide insight into both established orthopaedic practices across the United States and evolving trends in surgical choices and education across multiple subspecialties.

Recent Innovations and Applications of Custom 3D Printed Cages for Critical Bone Defects in Foot and Ankle Surgery.

Previous research has clearly shown that surgeon case volume is directly correlated with surgical outcomes in arthroscopic surgery. This study aimed to evaluate the exposure to wrist and elbow arthroscopy that graduating orthopedic surgery residents and fellows receive. Accreditation Council for Graduate Medical Education (ACGME) case log data from 2014 to 2024 was reviewed for graduating orthopedic residents, hand surgery fellows, and orthopedic sports medicine fellows in the United States. Mean and median numbers of wrist and elbow arthroscopy cases logged per resident or fellow were compared to assess procedure volume. The 10th and 90th percentiles of case volumes were analyzed to assess variability. Trends were evaluated over time to determine changes in case exposure. Wrist arthroscopy volume reported by orthopedic residents decreased from 4.6±5 (median 3, range 0-46) to 3.0±3 (1, 0-23) cases per resident (p<0.001). Elbow arthroscopy volume decreased from 2.1±2 (2, 0-18) to 1.8±3 (1, 0-38) cases per resident (p<0.001). Among hand surgery fellows, wrist arthroscopy volume decreased from 18.5±13 (15, 3-102) to 14.4±8 (13, 5-65) cases per fellow (p<0.001), and elbow arthroscopy volume from 5.2±7 (4, 0-35) to 2.6±3 (1, 0-20) cases per fellow (p<0.001). Sports medicine fellow elbow arthroscopy volume decreased from 6.6±8 (4, 0-48) to 3.1±4 (2, 0-23) cases per fellow (p<0.001). Wrist arthroscopy volume was not reported for sports medicine fellows. Despite the established role of wrist arthroscopy in upper extremity orthopedic surgery, resident exposure is limited and has declined over recent years. Fellowship training has not offset this decline, with wrist and elbow arthroscopy volume decreasing significantly in hand and sports medicine fellowships. These trends raise concerns over preparedness to safely and independently perform these technically demanding procedures in practice after training. IV.

Pediatric emergency department (ED) transfers have increased even among hospitals with pediatric admitting capability. We sought to determine whether pediatric subspecialty capability or pediatric intensive care unit (PICU) capability was associated with ED transfers among hospitals with pediatric admitting capability. This retrospective cross-sectional study included all pediatric ED visits from the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample database resulting in admission or transfer at hospitals with pediatric admitting capability. We compared EDs with and without pediatric subspecialty or PICU capabilities. Pediatric subspecialties included general surgery, orthopedic surgery, and neurology. Transfer rates were calculated as the number of patients transferred among those not discharged. We used logistic regression to evaluate the association of pediatric subspecialty and PICU capabilities with transfer. We analyzed 4 468 922 weighted ED visits. The transfer rate was 42.4% for EDs without pediatric subspecialty capability (adjusted odds ratio [aOR], 12.9; 95% CI, 8.5-19.6 compared with EDs with all 3 subspecialties), 12.8% for those with 1 subspecialty (aOR, 3.7; 95% CI, 2.4-5.6), 4.1% for those with 2 (aOR, 1.3; 95% CI, 0.9-2.1), and 2.6% for those with all 3. There was a 41.7% transfer rate for EDs without PICU capability (aOR, 1.6; 95% CI, 1.3-2.0) compared with 7.0% for those with PICU capability. Among hospitals with pediatric admitting capability, both the need for pediatric subspecialty care and intensive care were associated with increased transfers, and subspecialty capability had a larger association. Interventions to mitigate rising pediatric transfers may consider expanding subspecialty access.

Healthcare access varies dramatically across the United States, with rural and underserved populations facing notable barriers to timely, specialized care. The proximity of physician training affects the overall workforce distribution; however, this trend has not been assessed within orthopaedic surgery. This study investigates the impact birthplace and training location have on future practice location among US orthopaedic surgeons and characterizes the per-capita workforce distribution. Eight thousand, six hundred seventy-six orthopaedic surgeons who completed residency training between 2004 and 2017 were identified from the American Medical Association Physician Masterfile. Demographic and practice data were extracted, including birthplace, medical school, residency and attending practice as of January 1, 2023. Locations were stratified by state and census division. The cohort represented 94.84% of orthopaedic surgeons trained nationally during the study period. Attendings returning to their state of birth, medical school, or residency to practice were 21.7%, 31.8%, and 33.9%, respectively, with pronounced state-level variability (birthplace: 2.50% to 47.95%; medical school: 3.94% to 61.8%; residency: 11.71% to 63.95%). Indiana (pop:6,880,131) trained the fewest residents per capita (1:1.15 million), whereas neighboring Ohio (pop:11,824,034) ranked fifth nationally (1:191,000). Univariate logistic regression revealed notable associations ( P < 0.01) between practice location by census division at all career stages. Attending distribution per capita showed strong correlations by state (R 2 = 0.98) and census division (R 2 = 0.99), whereas birthplace (R 2 = 0.71), medical school (R 2 = 0.53), and residency (R 2 = 0.63) showed moderate association. This study demonstrates that birthplace and training location are strongly associated with practice location for US orthopaedic surgeons. Despite variation in trainee numbers by state, the distribution of practicing surgeons normalizes relative to state population, likely driven by economic incentives, local workforce demands, and market conditions. Given the strong statistical association for surgeons to practice near their training location, aligning local programs with underserved or high-need areas may offer a potential solution to reduce regional disparities and improve access to orthopaedic care.

What are the most disruptive publications in shoulder surgery?

Patient Blood Management in Orthopedic Surgery.

Ayushman card (PM-JAY) as a tool for financial risk protection in orthopaedic trauma care: Evidence from a Level-1 trauma centre.

Evolution of the Lower Extremity Reconstruction: From Limb Salvage to Functional Reconstruction.

Implant-associated-infections against the background of multi-drug-resistance cause severe complications in orthopedic and trauma surgery and burden global healthcare. Equipment of implants with antibacterial coatings loaded by lytic bacteriophages (PHAG) are seen promising in this respect. Here, we report antibacterial polyelectrolyte multilayer (PEM) coatings functionalized by PHAG, which were deposited at model substrates and metallic implants by consecutive adsorption from solutions of poly-l-lactide-modified hyaluronic acid (DAC), ethylenediamino-cellulose (EDAC) or poly(ethyleneimine) (PEI) according to layer-by-layer technique. PHAG against Staphylococcus aureus (S. aureus) bacteria were bound at five- and six-layered PEM coatings of PEI/DAC or EDAC/DAC, respectively. PEM deposition and PHAG interaction were studied by FTIR and SFM. In-vivo antibacterial properties of PHAG/PEM coatings against S. aureus bacteria were evaluated using Galleria mellonella (G. mellonella) larvae infection model. PEM coatings of EDAC/DAC revealed far higher deposited polymer amounts compared to PEI/DAC and far more PHAG were bound at thicker EDAC/DAC compared to thinner PEI/DAC coatings. Higher relative released PHAG amount (40-80%) was found for thinner PEI/DAC coatings, while lower one (10-20%) for thicker EDAC/DAC coatings. In-vivo studies revealed survival rates >80% of uninfected G. mellonella larvae treated with uncoated and PEM/PHAG coated metallic implants, indicating biocompatibility of the used materials. Infected G. mellonella larvae showed survival rates of 33%-43% for metallic implants with PEM/PHAG coatings of EDAC/DAC, which were higher with statistical significance compared to uncoated controls (13%), indicating excellent antibacterial properties.

Ultrasonic scalpels (USs) have been widely used in various cancer surgeries due to their advantages of minimal thermal damage, effective vascular/lymphatic sealing, and reduced complications. However, robust evidence supporting their efficacy in soft-tissue sarcoma (STS) surgery remains limited, especially for large-size thigh STS (≥8 cm)-a subgroup characterized by high intraoperative bleeding risk and frequent wound healing issues. This study aimed to comprehensively evaluate the efficacy of USs in the surgical management of large thigh STS (≥8 cm). We conducted a retrospective study of patients who underwent surgical resection of large thigh STS (≥8 cm) between January 2019 and December 2024. Patients' clinical characteristics and treatment details were meticulously collected, and key metrics analyzed included intraoperative blood loss, hospital stays, and wound complications. To reduce selection biases, propensity score matching was applied. We defined the matched cases wherein US was used as the "using group" and the other matched cases as the "non-using group." Outcomes were compared between the groups. After propensity score matching, 36 patients were included in each group. The ultrasonic using group showed markedly reduced estimated intraoperative blood loss (204.2 vs. 505.6 mL; P = 0.041) and shorter hospital stay (6.9 vs. 11.4 days; P = 0.002). In addition, the incidence of major wound complications (Clavien-Dindo grade III or higher) was markedly lower (13.9% vs. 38.9%; P = 0.031). Multivariate logistic regression analysis confirmed that US use was independently associated with fewer major wound complications (odds ratio, 0.118; 95% confidence interval, 0.026 to 0.531; P = 0.005). The application of USs in the surgical resection of large thigh STS (≥8 cm) is associated with reduced intraoperative blood loss, shorter hospital stay, and lower rates of major postoperative wound complications. These findings support the potential value of US as a technical adjunct in complex STS surgery and warrant further validation in prospective randomized controlled trials.

Cefazolin versus Alternative Antibiotics for Surgical Prophylaxis in Children With a Reported Penicillin Allergy.