Orthopedic Surgical Intervention Research Articles

Impact of Orthopedic Surgical Intervention on Difficult-to-Treat Rheumatoid Arthritis: A Propensity Score Matched Study.

To elucidate the therapeutic effect of orthopedic surgical intervention (OSI) in difficult-to-treat rheumatoid arthritis (D2T RA) compared with non-D2T RA. A total of 534 recent surgeries were analyzed only in patients who had undergone OSI since 2016 and for whom a 12-month post-operative follow-up was available. D2T RA was determined according to the EULAR definition, and patients with D2T RA were matched to patients with non-D2T RA using propensity scores calculated by a logistic regression analysis. The Health Assessment Questionnaire-Disability Index (HAQ-DI), Disease Activity Index 28 (DAS28), face scale, and patient's assessment of general health (GH) were measured repeatedly at baseline and 6 and 12 months and were compared using a two-way analysis of variance. The HAQ-DI, DAS28, face scale, and GH showed significant post-operative improvements, and there were significant differences in the HAQ-DI and face scale scores between D2T RA and non-D2T RA. An additional analysis with DAS28 as a covariate showed no significant interaction for either, suggesting that these improvements in clinical assessment were due to OSI rather than improved disease activity. In the absence of an effective pharmacological treatment strategy, OSI may be an effective treatment modality for the management of D2T RA.

Artificial intelligence and orthopaedic

Artificial intelligence is the next big thing in human history. It is set to affect large and small industries, entertainment, agriculture, literature, research, and healthcare. The field of Artificial intelligence includes machine learning and deep learning, which denote an increased level of specialization. These changes are also set to influence orthopedic trauma, from diagnostics, clinical assessment, surgical intervention, rehabilitation, and outcome prediction. Some of these fields will be affected more than others. We carried out a narrative review of artificial intelligence and orthopaedic surgery to provide an updated overview of the current and future applications. AI is set to revolutionize radiological diagnostics, outcome measurement, and rehabilitation in orthopedic trauma. However, concerns about clinical decision-making and intervention remain. Ethical concerns, regulation, and superiority over traditional methods of treatment also need to be assessed. Until then, the role of AI in orthopaedic trauma remains in the realm of possibilities.

Kinematic Changes throughout Childhood in Youth with Cerebral Palsy: Influence of Age and Orthopaedic Surgery.

Abnormal gait kinematics are common in youth with cerebral palsy (CP), but prior studies have not analyzed their longitudinal change throughout childhood. This study examines how age and orthopaedic surgery influence gait kinematics throughout childhood in those with ambulatory CP. In this institutional review board-approved prospective cohort study, children with spastic CP (GMFCS I-III) were recruited at age 17-40 months. Instrumented gait analysis was performed at 3-year intervals from age 4 to 21 years, collecting longitudinal kinematic data in bare feet at a self-selected speed. The change in Gait Profile Score (ΔGPS) between each pair of gait analyses (intervals) was analyzed by age distribution (<10, 10-15, ≥15 years) and by presence/absence of orthopaedic surgery. The study included 31 children (GMFCS: I [13], II [14], III [4]). A baseline instrumented gait analysis was performed at age 5.8 ± 1.6 years with subsequent analysis at 2.5 ± 1.3-year intervals. Examining ΔGPS from baseline to final outcome, 87% of limbs were improved/unchanged; 298 intervals of ΔGPS were analyzed and classified as nonsurgical or surgical. Analysis revealed greater GPS improvement in intervals with surgery versus intervals without (p = 0.0004). Surgical intervals had significantly greater GPS improvement in the <10- vs. >15-year-old groups, p = 0.0063. Improvement in gait kinematics in children with CP is significantly influenced by age and timing of orthopaedic surgical intervention for gait correction, and was most pronounced for children <10 years old. Although surgery was associated with improved outcomes in all age groups, these improvements were significantly less for children >10 years old. These results reinforce the importance of considering the timing of orthopaedic surgery.

Use of Telemedicine in a Sports Medicine Clinic: An Investigation of Patient Satisfaction

Objective: Compare patient satisfaction between telemedicine and in-office visits and between providers post-operatively in an orthopedics setting with athletic trainers and physicians. Design: Cross-sectional study Methods: Patients from a Sports Medicine Clinic that received an orthopedic surgical intervention from March 2020-September 2021, and engaged in telemedicine, or an in-office visit post-operatively. Provider type included full-time athletic trainers, resident athletic trainers, physician (MD) resident/fellows, and float athletic trainers. Press-Ganey Patient Experience Surveys were collected at the time of follow up visit, with focus on items, “likelihood to recommend” and “how well staff worked together.” Results: There was a total of 255 patients (age=50±17 years). Providers included the attending physician with full-time athletic trainers (n=134, 52.3%), resident athletic trainers (n=77, 30.1%), MD residents/fellows (n=38, 14.8%), or float athletic trainers (n=6, 2.3%). No significant difference was found with patient satisfaction between in-office (n=175, 68.4%), or telemedicine visits (n=80, 31.3%), (p&gt;.44). Patients were more satisfied with care provided by the full-time athletic trainers compared to MD residents/fellows (p.18). Conclusions: This study demonstrates no significant differences with patient satisfaction between in-office or telemedicine visits. Patients seeing full-time athletic trainers had the highest patient satisfaction, demonstrating the capability of athletic trainers to effectively use telemedicine in a physician practice.

Features of the formation of bone regenerate and metabolism of bone formation markers in a patient with type 1 diabetes mellitus and diabetic neuroosteoarthropathy (Charcot foot)

Background: Surgical treatment of diabetic neuroosteoarthropathy is a complex area in traumatology — orthopedics not only because of severe biomechanical disorders and gross deformations of the distal segment of the lower limb, but also because these phenomena are accompanied by many disorders of the somatic status. Of particular importance is a pronounced decrease in bone mineral density. This case is intended to illustrate the features of the treatment of this pathology. Clinical case description: A clinical case of treatment of a 34-year-old young female patient with type 1 diabetes mellitus, development of diabetic neuroosteoarthropathy (Charcot foot), and aseptic necrosis of the talus of the right foot is presented. From 2019–2020 conservative and surgical treatment was carried out aimed at stopping the active stage of Charcot foot, correcting deformity and stabilizing the distal segment of the limb (calcaneotibial arthrodesis). A satisfactory treatment result was achieved, complete activation 8 months after the operation. However, in 2021 The patient suffered a closed low-energy fracture of the distal metaphysis of the right tibia. Regarding this episode, the patient comes in at the stage of consolidation of a displaced fracture and complaints of recurrence of varus deformity, even greater shortening of the limb, and swelling of the ankle joint. The fact of injury is denied, which allows us to regard the existing fracture of the tibia as pathological. In this regard, an operation was performed: osteotomy of the fibula and tibia in the area of consolidation of the pathological fracture in order to correct the deformity and compensate for the existing shortening of the limb due to the formation of a distraction regenerate. During the treatment, malnutrition and delayed formation of bone regenerate were noted, which required prolonged use of an external fixation device and specific drug therapy aimed at stimulating osteogenesis and improving bone mineral density. At the end of the course, there was an increase in the mineral density of the tissue, the density of the regenerate radiologically and laboratory (control of bone formation markers) and a satisfactory functional result. CONCLUSION: A successful result in this clinical case was achieved by combining orthopedic surgical and conservative treatment with specific drug therapy in a comorbid patient with reduced bone mineral density and a high probability of complications in a multidisciplinary approach.

The genetic landscape of osteogenesis imperfecta: mutational mechanisms and therapeutic targets

Osteogenesis imperfecta is colloquially known as brittle bone disease because it is an inherited disease characterized by a connective tissue disorder that causes decreased bone mass, increased bone fragility and abnormalities in skeletal structure. This disease is caused by a mutation in the type I collagen genes, specifically COL1A1 and COL1A2, resulting in a variety of clinical manifestations ranging from mild to lethal. The impact on the quality of life of patients with OI can be complicated, which is why they need multidisciplinary management strategies including orthopedic care, physical therapy, pain management and surgical interventions.

Orthopedic Surgical Treatment of Patients with Tumor-induced Osteomalacia Located in the Hip Bones: A Retrospective Analysis of 10 Years in a Single Center.

The orthopedic surgical treatment strategies for patients with tumor-induced osteomalacia (TIO) require improvement, especially for patients where the causative tumors are located in surgically challenging areas, requiring a greater degree of in-depth investigation. This work aims to summarize and investigate clinical features and orthopedic surgical treatment effects of patients with tumor-induced osteomalacia (TIO), whose causative tumors are located in the hip bones. A retrospective analysis was conducted on the clinical data of all patients diagnosed with culprit tumors located in the hip bones who underwent surgical treatment at the orthopedic bone and soft tissue tumor sub-professional group of Peking Union Medical College Hospital from January 2013 to January 2023. This retrospective study summarized the clinical data, preoperative laboratory test results, imaging findings, surgery-related data, perioperative changes in blood phosphorus levels, and postoperative follow-up data of all patients who met the inclusion criteria. Normally distributed data are presented as mean and standard deviation, while non-normally distributed data are shown as the means and 25th and 75th interquartile ranges. The clinical diagnostic criteria for TIO were met by all 16 patients, as confirmed by pathology after surgery. Among the 16 patients, we obtained varying degrees of bone pain and limited mobility (16/16), often accompanied by difficulties in sitting up, walking, and fatigue. An estimated 62.5% (10/16) of patients had significantly shorter heights during the disease stages. All 16 patients underwent surgical treatment for tumors in the hip bones, totaling 21 surgeries. In the pathogenic tumor, there were 16 cases of skeletal involvement and none of pure soft tissue involvement. Out of the 16 patients, 13 cases had a gradual increase in blood phosphorus levels following the latest orthopedic surgery, which was followed up for 12 months to 10 years. Due to unresolved conditions after the original surgery, four patients received reoperation intervention. Two cases of refractory TIO did not improve in their disease course. In summary, the location of the causative tumor in the hip bone is hidden and diverse, and there is no defined orthopedic surgical intervention method for this case in clinical practice. For patients with TIO where the tumors are located in the hip bones, surgical treatment is difficult and the risk of postoperative recurrence is high. Careful identification of the tumor edge using precise preoperative positioning and qualitative diagnosis is crucial to ensure adequate boundaries for surgical resection to reduce the likelihood of disease recurrence and improve prognosis.

Pathological Fractures in Patients Affected by Pycnodysostosis: A Case Series.

Background/Objectives: Pycnodysostosis is a rare genetic disorder causing skeletal dysplasia. It is determined by a gene mutation leading to cathepsin K deficiency and predisposes a patient to osteosclerosis, resulting in increased bone fragility. The altered bone quality typical of this disease is responsible for an increased risk of fractures. The purpose of our study was to evaluate the orthopedic manifestations and potential pitfalls in the surgical treatments of pathological fractures in a series of patients treated in our institution who were affected by pycnodysostosis. Methods: We retrospectively evaluated clinical and radiographic characteristics of five patients with pycnodysostosis treated for pathological fractures at our hospital in the past 5 years. Results: Two male and three female patients were included in this study. Four patients had a family history of pycnodysostosis. All the patients were of short stature, but only two underwent growth hormone treatment. All the patients experienced fractures, mostly in their lower limbs and occurring as a result of low-energy trauma. Most of the patients experienced either consolidation delay or nonunion. Conclusions: The orthopedic management of fractures in patients with pycnodysostosis poses an ongoing challenge for orthopedic surgeons. The fact that the bone is simultaneously sclerotic and brittle makes any orthopedic surgical treatment challenging and at a high risk of nonunion in any case.

Timing of venous thromboembolism prophylaxis initiation and complications in polytrauma patients with high-risk bleeding orthopedic interventions: A nationwide analysis.

There are no clear recommendations for the perioperative timing and initiation of venous thromboembolism pharmacologic prophylaxis (VTEp) among polytrauma patients undergoing high-risk bleeding orthopedic operative intervention, leading to variations in VTEp administration. Our study examined the association between the timing of VTEp and VTE complications in polytrauma patients undergoing high-risk operative orthopedic interventions nationwide. We performed a retrospective cohort study of trauma patients 18 years or older who underwent high-risk bleeding operative orthopedic interventions for pelvic, hip, and femur fractures within 24 hours of admission at American College of Surgeons-verified trauma centers using the 2019-2020 American College of Surgeons Trauma Quality Improvement Program databank. We excluded patients with a competing risk of nonorthopedic surgical bleeding. We assessed operative orthopedic polytrauma patients who received VTEp within 12 hours of orthopedic surgical intervention compared with VTEp received beyond 12 hours of intervention. The primary outcome assessed was overall VTE events. Secondary outcomes were orthopedic reinterventions within 72 hours after primary orthopedic surgery, deep venous thromboembolism, and pulmonary embolism rates. The study included 2,229 patients who underwent high-risk orthopedic operative intervention. The median time to VTEp initiation was 30 hours (interquartile range, 18-44 hours). After adjustment for baseline patient, injury, and hospital characteristics, VTEp initiated more than 12 hours from primary orthopedic surgery was associated with increased odds of VTE (adjusted odds ratio, 2.02; 95% confidence interval, 1.08-3.77). Earlier initiation of prophylaxis was not associated with an increased risk for surgical reintervention (hazard ratio, 0.90; 95% confidence interval, 0.62-1.34). Administering VTEp within 24 hours of admission and within 12 hours of major orthopedic surgery involving the femur, pelvis, or hip demonstrated an associated decreased risk of in-hospital VTE without an accompanying elevated risk of bleeding-related orthopedic reintervention. Clinicians should reconsider delays in initiating or withholding perioperative VTEp for stable polytrauma patients needing major orthopedic intervention. Therapeutic/Care Management; Level III.

The economic and resource burden of e-scooter-related orthopaedic injuries: A district general hospital's experience

PurposeElectric scooters (e-scooters) are an increasingly popular method of transportation worldwide. However, there are concerns regarding their safety, specifically with regards to orthopaedic injuries. We aimed to investigate the overall burden and financial impact on orthopaedic services as a result of e-scooter-related orthopaedic injuries. MethodsWe retrospectively identified all e-scooter-related injuries requiring orthopaedic admission or surgical intervention in a large District General Hospital in England over a 16-month period between September 2020 and December 2021. Injuries sustained, surgical management, inpatient stay and resources used were calculated. ResultsSeventy-nine patients presented with orthopaedic injuries as a result of e-scooter transportation with a mean age of 30.1 years (SD 11.6), of which 62 were males and 17 were females. A total of 86 individual orthopaedic injuries were sustained, with fractures being the most common type of injury. Of these, 23 patients required 28 individual surgical procedures. The combined theatre and recovery time of these procedures was 5500 min, while isolated operating time was 2088 min. The total cost of theatre running time for these patients was estimated at £77,000. A total of 17 patients required hospital admission under Trauma and Orthopaedics, which accounted for total combined stay of 99 days with a mean length of stay of 5.8 days. ConclusionWhile there are potential environmental benefits to e-scooters, we demonstrate the risks of injury associated with their use and the associated increased burden to the healthcare system through additional emergency attendances, frequent outpatient clinic appointments, surgical procedures, and hospital inpatient admissions.

Health Care Professionals' Perspectives Before and After Use of eDialogue for Team-Based Digital Communication Across Settings: Qualitative Study.

Orthopedic surgical treatment is a transversal task that requires the active involvement of patients, relatives, and health care professionals (HCPs) across various settings. However, after hospital discharge, communication is challenged and undertaken primarily by phone. New digital communication solutions have the potential to create a space for seamless and patient-centered dialogue across discipline and sector boundaries. When evaluating new communication solutions, knowledge about HCPs' needs and perspectives of use must be explored, as it is they who are responsible for implementing changes in practice. This study aimed to (1) investigate HCPs' perceptions of current communication pathways (phase 1) and (2) explore their experiences of using a simple messenger-like solution (eDialogue) for team-based digital communication across settings (phase 2). We used a triangulation of qualitative data collection techniques, including document analysis, observations, focus groups, and individual interviews of HCPs before (n=28) and after (n=12) their use of eDialogue. Data collection and analysis were inspired by the Consolidated Framework for Implementation Research (CFIR) to specifically understand facilitators and barriers to implementation as perceived by HCPs. HCPs perceive current communication pathways as insufficient for both patients and themselves. Phone calls are disruptive, and there is a lack of direct communication modalities when communication crosses sector boundaries. HCPs experienced the use of eDialogue as a quick and easy way for timely interdisciplinary interaction with patients and other HCPs across settings; however, concerns were raised about time consumption. eDialogue can provide needed support for interdisciplinary and cross-sectoral patient-centered communication. However, future studies of this solution should address its impact and the use of resources.

Silver carboxylate-TiO2/polydimethyl siloxane is a safe and effective antimicrobial with significant wound care potential.

With the rise in antibiotic resistance, new methodologies are needed to combat musculoskeletal infections. Silver is an antimicrobial that can be synthesized in different forms, but its pharmacokinetics are difficult to control. This study details the antibacterial efficacy and cellular cytotoxicity of a formulation consisting of silver carboxylate (AgCar) released through a titanium dioxide/polydimethylsiloxane matrix with a predictable release profile on Pseudomonas aeruginosa, Acinetobacterium baumannii, and human-derived primary osteoblasts. Through an Institutional Animal Care and Use Committee and IRB-approved protocol, AgCar was applied to live Yucatan porcine skin and histologically analyzed for skin penetration. Graphite Furnace Atomic Absorption Spectroscopy (GFAAS) was used to measure elution of AgCar. Dose-response curves were generated through optical density to assess potency. Finally, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was used to quantify the cellular cytotoxicity of the novel formulation. The results were subject to statistical analysis using analysis of variance and post hoc Tukey tests. The silver carboxylate coating demonstrated deep penetration into the epithelium at the level of the deep pilosebaceous glands in animal models. GFAAS testing demonstrated the extended elution profile of silver carboxylate over 96 hours, while 100% silver with no titanium dioxide-polydimethylsiloxane matrix fully eluted within 48 hours. 10x silver carboxylate demonstrated superior antimicrobial activity to antibiotics and other silver formulations and showed minimal cytotoxicity compared with other silver formulations. Current antimicrobial therapies in wound care and surgical antisepsis, such as chlorhexidine gluconate, have pitfalls including poor skin penetration and short duration of efficacy. The broad antimicrobial activity, extended elution, and deep skin penetration of this AgCar formulation show great promise for surgical site infection and wound care treatment. Novel technology to fight the growing threat of microbial resistance should be at the forefront of orthopaedic surgical site infection prevention and treatment.

Multiple Diagnoses of Nutritional Rickets in An Inner-City Pediatric Population: A Case Series

This case series details seven pediatric cases of nutritional rickets in an inner-city population of New Jersey. Eighty six percent of these patients were exclusively breast fed, and all self-identified as black or African American. Patients ranged in age from 8 months to 3 years at the time of initial diagnosis. All seven patients were male. Five patients were presented in an office setting, while two were found to have nutritional rickets in an emergency setting. Patients demonstrated classic pathognomonic findings of rickets, including three patients with rachitic rosary. The aim of this case series is to emphasize the importance of surveillance and high clinical suspicion for nutritional rickets, particularly in children with darker skin complexions and who were exclusively breast-fed during infancy. Rapid diagnosis and intervention may delay or negate the need for orthopedic surgical intervention.

Outcomes in very elderly ICU patients surgically treated for proximal femur fractures.

Proximal femur fractures (PFF) are a common injury in elderly patients that significantly impact mobility and daily living activities. Mortality rates in this population are also high, making effective treatment essential. Recent advances in intensive and geriatric care have enabled complex surgical interventions that were previously not feasible. However, there is a lack of studies focusing on outcome parameters in very elderly patients (≥ 90years) who receive intensive care treatment following PFFs. In this retrospective study, we analyzed multi-layered data of 148 patients who were 90years or older and received intensive care after trauma and orthopedic surgical treatment for PFFs or periprosthetic fractures between 2009 and 2019. All patients received a 365-day follow-up. To identify potential predictors of mortality, all deceased and surviving patients were subjected to multiple logistic regression analyses. We found that 22% of patients deceased during in-hospital care, and one-year survival was 44%. Independent predictors of one-year all-cause mortality included higher CCI and SOFA scores at ICU admission. Overall, 53% of patients who resided in private dwellings prior to admission were able to return home. Our study highlights the utility of using CCI and SOFA scores at ICU admission as prognostic indicators in critically ill very elderly patients who undergo surgical treatment for PFFs. These scores can provide valuable insight into the severity of illness and potential outcomes, which can inform resource allocation, prioritize endangered patients, and aid in end-of-life discussions and planning with patients and their families. Our findings can help improve the management of PFFs in very elderly patients and contribute to optimized patient care.

The unsolved problem of musculoskeletal hydatid disease: two case reports

BackgroundHydatidosis is a parasitic infection caused by Echinococcus granulosus and humans are usually an accidental intermediate host. Involvement of the musculoskeletal system is reported to occur in 0.5% to 4% of the cases.Case presentationWe present our experience with two cases of musculoskeletal hydatidosis in black African patients that required orthopaedic surgical intervention. A 51-year-old black African female presented with right hip hydatid disease and a 37-year-old black African female presented with the disease affecting the left shoulder. Both patients presented with joint pain and reduced range of motion. The patient with involvement of the shoulder had a background history of human immunodeficiency virus, this was not present with the other patient. Diagnostic work-up confirmed peri-articular hydatid disease and both patients were surgically managed with arthroplasty. Post-operative complications encountered include hardware loosening from bone lysis and hardware failure.DiscussionThe medical literature describes a limited number of cases of peri-articular musculoskeletal hydatid disease. Patients are often subjected to many investigations, prolonged treatment periods and multiple surgeries. Concurrent use of medical and surgical treatment is advocated however, the choice of surgery is individualised.ConclusionHydatid disease must always feature in the differential diagnosis of multiple lytic bone lesions and radical surgical intervention may be required from the outset.

The impact of conduction anesthesia at the hemostastic system in the limb reperfusion syndrome in pediatric traumatology-orthopedic practice

Introduction. Activation of the hemostatic system in the ischemia-reperfusion syndrome is a risk factor for thromboembolic complications during orthopedic surgical interventions associated with arterial tourniquet application. Therefore, it is relevant to find ways to mitigate reperfusion effects during such surgeries.&#x0D; Purpose. To find out character and effects of conduction anesthesia at the thromboelastogram parameters in the ischemic limb reperfusion after removing a tourniquet during orthopedic surgeries in children.&#x0D; Material and methods. The surgery which was performed in 20 patients from the traumatologic department in the City Children’s Clinical Emergency Hospital (Novosibirsk) required arterial tourniquet application. So, these patients were enrolled in the observational pilot study. The patients who had tourniquet application were distributed into two groups by the block randomization: Group 1 (n=10) – peripheric blockage; Group 2 (n=10) – no peripheric blockage. The basic technique used in the study was thromboelastography (TEG) with TEG5000 thromboelastograph (Haemonetics Corporation, USA). All patients had thromboelastography before tourniquet application (stage 1) and 5 minutes after its removal (stage 2). Main thromboelastogram parameters were assessed: R, measuring pathways for coagulation phases I and II; K – time, characterizing coagulation phase III; angle α, duplicating the information of “K” indicator; MA is the maximum amplitude of TEG branch divergence, characterizing the clot density which, in turn, depends on the function of platelet activity and on the amount of fibrinogen; LY30 is the percentage of clot lysed in 30 minutes.&#x0D; Results. In the group with regional anesthesia, indicators R, K, angle α, MA did not change at stage II; LY30 index decreased at stage 2. In the group without regional anesthesia, but with powerful central analgesic, indicators R, K, MA decreased, and angle α and LY30 increased at stage 2.&#x0D; Conclusion. In pediatric orthopedic surgeries with arterial tourniquet application , local anesthetic (Ropivacaine) in the conduction anesthesia technique prevented activation of the hemostastic system.

Functional Outcome of Vojta Therapy as A Postoperative Protocol for Surgically Treated Patients with Cerebral Palsy

Purpose: To evaluate the efficacy of postoperative Vojta therapy in children with cerebral palsy (CP) who have undergone orthopedic surgical interventions for lower limb deformities. Methods: We conducted a prospective case series on children with ambulatory CP aged 3 to 15, indicated for orthopedic surgical interventions (contracture release and deformity correction) between January 2020 and December 2022. One month following these interventions, all patients were scheduled for Vojta therapy sessions. Ambulation capability was evaluated using video gait analysis, an expanded timed get-up-and-go (ETGUG) test, and a 6-minute walk test (6MWT) at 2, 4, and 6 months postoperatively. A multivariable multilevel linear regression analysis was employed to demonstrate the adjusted effect of Vojta therapy during the postoperative period. Results: A total of eleven eligible children with CP were included. Of these, seven were boys (63.6%) with a mean age of 6.3 ± 3.1. The majority of patients were classified as gross motor function classification system (GMFCS) level I (45.4%). We observed a significant improvement in ETGUG (-14.1 sec, p = 0.011), 6MWT (6.3 m, p = 0.014), cadence (2.1 step/min, p = 0.033), and stride time (-0.1 sec, p = 0.027) after being adjusted by baseline function, age, and GMFCS level during the follow-up period. Sub-group analyses revealed no significant difference between patients with GMFCS I and those with GMFCS II to III. Conclusions: This study demonstrated a significant ambulation capability improvement in surgically treated patients with CP who underwent postoperative Vojta therapy.

CIVILIAN GUNSHOT FRACTURES OF THE ACETABULUM

Acetabulum fractures caused by civilian firearms represent a unique challenge for orthopaedic surgeons. Treatment strategies should include the assessment of infection risk due to frequently associated abdominal injuries and maintenance of joint function. Still, internationally accepted treatment algorithms are not available. The aim of the study was to increase knowledge about civilian gunshot fractures of the acetabulum by describing their characteristics and management at a high-volume tertiary hospital.All adult patients admitted to our hospital between January 2009 and December 2022 with civilian gunshot fractures of the acetabulum were included in this descriptive retrospective study.In total our institution treated 301 patients with civilian gunshot fractures of the hip joint and pelvis during the observation period, of which 54 involved the acetabulum. Most patients were young males (88,9%) with a mean age of 29 years. Thirty patients (55,6%) had associated intraabdominal or urological injuries. Fracture patterns were mostly stable fractures with minor joint destruction amenable to conservative fracture treatment (n=48, 88,9%). Orthopaedic surgical interventions were performed in 21 patients (38,9%) with removal of bullets in contact with the hip joint via arthrotomy or surgical hip dislocation as most frequent procedures. Most patients received antibiotics on admission (n=49, 90,7%). Fracture related infections of the acetabulum were noted in six patients (11,1%) while the mortality in the study population was low with one demised patient (1,9%) due to the trauma burden.Most civilian acetabulum gunshot fractures are associated with intraabdominal or urological injuries. In comparison to the literature on extremity gunshot fractures, there is an increased risk of infection in our study population. The decision for surgical wash-out and bullet removal should be based on contamination and anticipated joint destruction, while osteosynthesis or primary arthroplasty are rarely necessary for these injuries.

The experience of a tertiary level hospital in the 2023 Turkey double earthquake zone; management of 1,092 musculoskeletal injuries in the first week.

The double earthquakes that occurred on February 6, 2023, are currently called the disaster of the century, in Turkey. This study is the first to report the experiences in the treatment of orthopedic emergency patients hospitalized in Adana City Training and Research Hospital (ACH), the largest tertiary hospital in the region. The study included the retrospective analysis of the files of the victims of the earthquakes admitted to the ACH between February 6, 2023, and February 13, 2023. The age, gender, time of admission, types and localization of injuries, treatment modalities of earthquake victims, and orthopedic surgical treatment data were recorded. In the first week of the quakes, 3,699 patients were admitted to the ER with earthquake-related injuries. A total of 1,092 patients with musculoskeletal injuries were hospitalized, and 827 (75.7%) received orthopedic surgery. Surgical procedures included wound debridement under anesthesia (n=392, 47.4%), large bone fractures and/or pelvic ring fractures (n=224, 27.1%), fasciotomies (n=327, 69.1%), and amputations (n=121, 14.6%). Although Orthopedics and Traumatology Clinic staff have the highest workload, all hospital personnel should be equipped with basic orthopedic approaches related to the disaster. We believe that taking a more active role in the follow-up of orthopedic patients will help improve the management of the chaotic processes and increase overall treatment success.

The Classic Three-Month Post-Operative Adaptation Phase in Foot and Ankle Surgery-An Expert Perspective.

Foot and ankle disorders are a common reason for orthopedic surgical intervention. After surgery, specific precautions such as partial weight bearing or complete unloading, and the use of walking aids, coupled with a period of rest, are usually implemented to ensure the surgical outcome. However, when these aids are discontinued and the patients resume load increase and normal daily activities, they may enter a transitional phase characterized by inflammation, swelling, and pain. We call this phenomenon the "classic three-month post-operative adaptation phase" (POAP). It is essential to differentiate this physiological transition phase from other conditions, such as from the immediate post-surgical inflammation, complex pain regional syndrome, or an infection. The objective of this expert opinion is to describe and raise medical awareness of this evidence-based phenomenon, which we commonly observe in our daily practice.