Orthopaedic Trauma Surgery Research Articles

Viscoelastic Hemostatic Assays for Orthopedic Trauma and Elective Procedures.

The application of viscoelastic hemostatic assays (VHAs) (e.g., thromboelastography (TEG) and rotational thromboelastometry (ROTEM)) in orthopedics is in its relative infancy when compared with other surgical fields. Fortunately, several recent studies describe the emerging use of VHAs to quickly and reliably analyze the real-time coagulation and fibrinolytic status in both orthopedic trauma and elective orthopedic surgery. Trauma-induced coagulopathy—a spectrum of abnormal coagulation phenotypes including clotting factor depletion, inadequate thrombin generation, platelet dysfunction, and dysregulated fibrinolysis—remains a potentially fatal complication in severely injured and/or hemorrhaging patients whose timely diagnosis and management are aided by the use of VHAs. Furthermore, VHAs are an invaluable compliment to common coagulation tests by facilitating the detection of hypercoagulable states commonly associated with orthopedic injury and postoperative status. The use of VHAs to identify hypercoagulability allows for an accurate venous thromboembolism (VTE) risk assessment and monitoring of VTE prophylaxis. Until now, the data have been insufficient to permit an individualized approach with regard to dosing and duration for VTE thromboprophylaxis. By incorporating VHAs into routine practice, orthopedic surgeons will be better equipped to diagnose and treat the complete spectrum of coagulation abnormalities faced by orthopedic patients. This work serves as an educational primer and up-to-date review of the current literature on the use of VHAs in orthopedic surgery.

Advances in osteosynthesis - a basic overview of modern fixation materials

The dynamic development of trauma-orthopedic surgery and accompanying material technology has led in recent years to the need for close cooperation between researchers in these fields. In a short time, thanks to the cooperation of engineers and doctors, the general approach to the method of bone anastomosis has changed significantly. The need to optimize the effects of treatment, i.e. to quickly recovery, reduce the number of postoperative complications, reduce the number of reoperations, and reduce the costs of procedures and treatment used has resulted in the development of many new technologies that have set trends in modern traumatology. The widespread use of LCP (Locking compression plate) and locking screws, the development of polymers and biopolymers with a modified chemical structure, a significant improvement in the biocompatibility and cytocompatibility of the materials used, and the implementation of products with significant micro-roughness that improve osseointegration are the well-known and commonly used effects of this cooperation today .
 Materials science related to orthopedics is an extremely complex and multi-threaded field. Its continuous development requires a periodic summary of the results and development directions provided, which allows faster evaluation and interpretation by researchers. The purpose of the following work is to summarize the latest research on materials and methods used in osteosynthesis in a legible way for potential recipients of this information from various fields.

How to assess applicability and methodological quality of comparative studies of operative interventions in orthopedic trauma surgery

PurposeIt is challenging to generate and subsequently implement high-quality evidence in surgical practice. A first step would be to grade the strengths and weaknesses of surgical evidence and appraise risk of bias and applicability. Here, we described items that are common to different risk-of-bias tools. We explained how these could be used to assess comparative operative intervention studies in orthopedic trauma surgery, and how these relate to applicability of results.MethodsWe extracted information from the Cochrane risk-of-bias-2 (RoB-2) tool, Risk Of Bias In Non-randomised Studies—of Interventions tool (ROBINS-I), and Methodological Index for Non-Randomized Studies (MINORS) criteria and derived a concisely formulated set of items with signaling questions tailored to operative interventions in orthopedic trauma surgery.ResultsThe established set contained nine items: population, intervention, comparator, outcome, confounding, missing data and selection bias, intervention status, outcome assessment, and pre-specification of analysis. Each item can be assessed using signaling questions and was explained using good practice examples of operative intervention studies in orthopedic trauma surgery.ConclusionThe set of items will be useful to form a first judgment on studies, for example when including them in a systematic review. Existing risk of bias tools can be used for further evaluation of methodological quality. Additionally, the proposed set of items and signaling questions might be a helpful starting point for peer reviewers and clinical readers.

Performance of Melatonin as Prophylaxis in Geriatric Patients with Multifactorial Risk for Postoperative Delirium Development: A Randomized Comparative Study.

Objective:Postoperative delirium is the worst patient outcome. Elderly patients undergoing orthopaedic procedures under general anaesthesia are highly liable to experience delirium. Several studies supported melatonin use for the prevention of delirium. This work evaluated the prophylactic efficiency of melatonin for postoperative delirium in patients with multifactorial risk for developing delirium as elderly undergoing orthopaedic trauma surgery under general anaesthesia.Methods:This double-blinded prospective randomized comparative study was conducted on 80 elderly patients subjected to orthopaedic interventions under general anaesthesia. Patients were randomized into group M (Melatonin group) and group NM (Non-melatonin group). Group M received 5 mg melatonin while group NM received placebo. The study drugs were given preoperatively and for the first 3 postoperative days. For the incidence of delirium, patients were evaluated using the Abbreviated Mental Test. The Pain Assessment in Advanced Dementia, sedation scores, and changes in hemodynamics were recorded.Results:The incidence of delirium was significantly lower postoperatively in M group (25%) relative to NM group (52.5%) (P < .001, OR = 2.3. 95% CI = −0.44, + 1.23). Abbreviated Mental Test scores at postanaesthesia care unit and day 0 showed a highly significant differences. However, Abbreviated Mental Test scores had no significant difference within the 3 postoperative days. Heart rate was significantly lower in M group after 50 minutes from the start of surgery. Mean blood pressure, Pain Assessment in Advanced Dementia, and sedation scores showed insignificant differences.Conclusion:Perioperative melatonin treatment could reduce the incidence of postoperative delirium in the studied population, and it could be considered a prophylactic medication.

National Evaluation of Social Determinants of Health in Orthopedic Fracture Care: Decreased Social Determinants of Health Is Associated With Increased Adverse Complications After Surgery.

To assess the individual impact of social determinants of health disparities (SDHD) on surgical outcomes following orthopaedic trauma surgery. Retrospective Cohort Study. Mariner Claims Database. Inclusion criteria were patients 18-85 years of age, undergoing surgery for hip fractures or ankle fractures from 2010 to 2018. Patients were divided based on SDHD using International Classification of Diseases 9 and International Classification of Diseases 10 codes. Those with SDHD were propensity-score matched with those who did not have any disparities with respect to age, gender, Charlson comorbidity index, tobacco use, and obesity (body mass index >30 kg/m2). Ninety-day major medical complications, infection, readmission, and revisions within 1 year. Patients with educational deficiencies had increased rates of readmission and major complications compared with those without disparities following hip and ankle fracture management. Moreover, economic disparities were associated with an increased risk of readmission and revision following hip fracture surgery and infection and readmission following ankle fracture surgery. This study emphasizes the large impact of SDHD on patients' outcomes following surgery and the importance of proper follow-up interventions to optimize patient care. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Malpractice lawsuits in orthopedic trauma surgery: a meta-analysis of the literature.

The objectives for this study were to identify whether diagnostic or procedural errors more commonly resulted in lawsuit, as well as to elucidate how specific variables affected mean indemnity. Systematic review of English-language articles in the PubMed and Google Scholar databases (through 2020) using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analysis was performed to estimate measures of proportions and differences in mean indemnity. The estimated probability of lawsuits related to orthopedic trauma in overall studies was 23.3%. There were no significant rate differences between main causes of claims (diagnostic vs procedural errors) and areas of injury (upper vs lower). There was no significant difference of mean indemnity between the probabilities of trauma-related claims, diagnostic error, and procedural error. Non-trauma cases were more likely to result in lawsuit than trauma cases. Procedural errors accounted for most malpractice claims. The average indemnity increased according to the higher diagnostic errors, while the indemnity was lower with a relatively higher proportion of procedural errors. The most common cause of litigation varied between studies; however, among the most cited reasons were missed diagnosis/error in diagnosis, improper/substandard surgical performance, and, though not specifically studied in this analysis, errors of informed consent. Economic and Decision Analyses Level VI.

Antibiotic use for prophylaxis and empirical therapy of fracture-related infections in Germany : Asurvey of 44hospitals

Antibiotics play an important role in the prophylaxis and treatment of infections in orthopedic trauma surgery; however, there seems to be remarkable differences in the clinical antibiotic practice between hospitals, particularly for open fractures and for the empirical therapy of fracture-related infections (FRI). Therefore, we intended to evaluate the current clinical praxis in university and workers' compensation hospitals in Germany with aquestionnaire on prophylaxis and empirical treatment of FRI. The results were compared with the resistance profile of 86FRI patients in order to analyze the hypothetical effectiveness of the empirical treatment. A total of 44hospitals (62.0%) responded. Ahomogeneous antibiotic prophylaxis (95.5% of all hospitals) with cephalosporins was reported for perioperative prophylaxis of internal fixation of closed fractures. For open fractures, eight different monotherapy and combination treatment concepts were reported. In empirical treatment of FRI, 12different therapeutic concepts were reported, including aminopenicillins/beta lactamase inhibitors (BLI) (31.8%), cephalosporins (31.8%), and ampicillin/sulbactam + vancomycin (9.1%). In terms of the hypothetical effectiveness of these antibiotic regimes, low sensitivity rates of 65.1% and 74.4% for cephalosporins and aminopenicillins/BLI, respectively, were found. For the combination vancomycin + meropenem, the highest hypothetical sensitivity (91.9%) was detected. Based on the existing, institution-specific pathogen spectrum, the combination therapy including meropenem and vancomycin seems to be of value but should be restricted to patients with multiple revision procedures or aseptic course of infection in order to prevent the selection of highly resistant pathogens.

"My Surgical Success": Feasibility and Impact of a Single-Session Digital Behavioral Pain Medicine Intervention on Pain Intensity, Pain Catastrophizing, and Time to Opioid Cessation After Orthopedic Trauma Surgery-A Randomized Trial.

BACKGROUND:Behavioral pain treatments may improve postsurgical analgesia and recovery; however, effective and scalable options are not widely available. This study tested a digital perioperative behavioral medicine intervention in orthopedic trauma surgery patients for feasibility and efficacy for reducing pain intensity, pain catastrophizing, and opioid cessation up to 3 months after surgery.METHODS:A randomized controlled clinical trial was conducted at an orthopedic trauma surgery unit at a major academic hospital to compare a digital behavioral pain management intervention (“My Surgical Success” [MSS]) to a digital general health education (HE) intervention (HE; no pain management skills). The enrolled sample included 133 patients; 84 patients were randomized (MSS, n = 37; HE, n = 47) and completed study procedures. Most patients received their assigned intervention within 3 days of surgery (85%). The sample was predominantly male (61.5%), White (61.9%), and partnered (65.5%), with at least a bachelor’s degree (69.0%). Outcomes were collected at 1–3 months after intervention through self-report e-surveys and electronic medical record review; an intention-to-treat analytic framework was applied. Feasibility was dually determined by the proportion of patients engaging in their assigned treatment and an application of an 80% threshold for patient-reported acceptability. We hypothesized that MSS would result in greater reductions in pain intensity and pain catastrophizing after surgery and earlier opioid cessation compared to the digital HE control group.RESULTS:The engagement rate with assigned interventions was 63% and exceeded commonly reported rates for fully automated Internet-based e-health interventions. Feasibility was demonstrated for the MSS engagers, with >80% reporting treatment acceptability. Overall, both groups improved in the postsurgical months across all study variables. A significant interaction effect was found for treatment group over time on pain intensity, such that the MSS group evidenced greater absolute reductions in pain intensity after surgery and up to 3 months later (treatment × time fixed effects; F[215] = 5.23; P = .024). No statistically significant between-group differences were observed for time to opioid cessation or for reductions in pain catastrophizing (F[215] = 0.20; P = .653), although the study sample notably had subclinical baseline pain catastrophizing scores (M = 14.10; 95% confidence interval, 11.70–16.49).CONCLUSIONS:Study findings revealed that a fully automated behavioral pain management skills intervention (MSS) may be useful for motivated orthopedic trauma surgery patients and reduce postsurgical pain up to 3 months. MSS was not associated with reduced time to opioid cessation compared to the HE control intervention.

Efficacy of Red Cell Salvage Systems in Open Acetabular Surgery.

Over the past 50 years, treatment of displaced acetabular fractures has moved away from conservative treatment with bedrest to operative intervention to achieve anatomic reduction, stable fixation, and allow early range of motion of the hip. However, operative fixation is not without complications. Internal fixation of traumatic acetabular fractures has been coupled with large volume of blood loss both at the time of injury and surgery. This often results in the need for allogenic blood products, which has been linked to increase morbidity (Vamvakas and Blajchman, 2009). In an attempt to avoid the risk associated with allogenic blood transfusion numerous techniques and methods have been devised. Red blood cell salvage (CS) is an intraoperative blood salvage tool where blood is harvested from the operative field. It is washed to remove the plasma, white blood cells, and platelets. The red cells are resuspended in a crystalloid solution. If the hematocrit of the resuspended red blood cells is sufficient, it is transfused to the patient intravenously. The benefits of CS in major spine surgery, bilateral knee replacement, and revision hip surgery are well established (Goulet et al. 1989, Gee et al. 2011, Canan et al. 2013). However, literature reviewing the use of cell saver in orthopedic trauma surgery, specifically acetabular surgery is limited. Our institute performed a retrospective review of 63 consecutive operative acetabular fractures at a level one trauma center. Our study revealed that patients with blood loss of less than 400 mL were 13 times less likely to receive autologous blood, and patients with hemoglobin less than 10.5 were 5 times less likely to receive autologous transfusion (p < 0.05). We also found that no patients with a hemoglobin level less than 10.5 and EBL less than 400 mL received autologous blood return. Autologous blood transfusion had no effect on volume or rate of allogenic blood transfusion. We believed that if a patient's preoperative hemoglobin is less than 10.5 or expected blood loss is less than 400 mL, then CS should have a very limited role, if any, in the preoperative blood conservation strategy. We found ASA greater than 2, BMI greater than 24 and associated fracture type to be a risk factor for high blood loss.

Methods of Quantifying Intraoperative Blood Loss in Orthopaedic Trauma Surgery: A Systematic Review.

To collect and present the recently published methods of quantifying blood loss (BL) in orthopaedic trauma. A systematic review of English-language literature in PubMed, Cochrane Library, and Scopus databases was conducted according to the PRISMA guidelines on articles describing the methods of determining BL in orthopaedic trauma published since 2010. English, full-text, peer-reviewed articles documenting intraoperative BL in an adult patient population undergoing orthopaedic trauma surgery were eligible for inclusion. Two authors independently extracted data from the included studies. Articles were assessed for quality and risk of bias using the Cochrane Collaboration's tool for assessing risk of bias and ROBINS-I. The included studies proved to be heterogeneous in nature with insufficient data to make data pooling and analysis feasible. Eleven methods were identified: 6 unique formulas with multiple variations, changes in hemoglobin and hematocrit levels, measured suction volume and weighed surgical gauze, transfusion quantification, cell salvage volumes, and hematoma evacuation frequency. Formulas included those of Gross, Mercuriali, Lisander, Sehat, Foss, and Stahl, with Gross being the most common (25%). All formulas used blood volume estimation, determined by equations from Nadler (94%) or Moore (6%), and measure change in preoperative and postoperative blood counts. This systematic review highlights the variability in BL estimation methods published in current orthopaedic trauma literature. Methods of quantifying BL should be taken into consideration when designing and evaluating research.

The management of orthopedic trauma surgery during the COVID-19 pandemic in Turkey.

COVID-19 has now alarmed the whole world, putting many countries' health systems in trouble. We aimed to evaluate the affect of the new treatment strategy that shortens hospital stay in orthopedic trauma patients in pandemic.Trauma patients who underwent surgical treatment between March 15th-May 1st 2019 and 2020 were examined about time interval from admission to surgery, period from surgery to discharge and total hospital stay time. This cohort was compared to a retrospective cohort of patients admitted for the same reasons in the same period of the previous year. During COVID pandemia, 51 trauma patients operated with the mean period from admission to operation 1.45 days, faster than the previous year's same period (3.76 days). From operation day to discharge time was 1.6 days in pandemic period and 4.3 days last year. The total hospitalization period (3,05 days) was significantly shorter in pandemic than the same period of the last year (8,06 days). (p<0.05). No complications and mortality were observed in any of our patients with faster trauma treatment strategy in pandemic. The operation of orthopedic trauma patients requiring surgery during a pandemic in a shorter time than normal time will not increase the complication and mortality, but will also help to use the bed more effectively by reducing the hospital stay.

Consent for orthopaedic trauma surgery during the COVID-19 pandemic

IntroductionThe COVID-19 pandemic has brought a series of new challenges to the management of surgical patients. The consent process relies on a foundation of open and non-coerced discussion between clinician...

Outcome oriented clinical research and quality measurement in fracture care

Abstract Objective The paradigm shift according to the principles of Value-Based Healthcare is receiving growing attention. In Orthopedic Trauma care, there are no defined standards to provide an incentive system to recompensate for quality instead of quantity. The definitions of quality from the patient's view have to be validated and included in the reimbursement cycle. In our Department, we now have fully standardized and structured documentation and outcome measurement workflow from the clinical point of view. Methods We set up a Fracture Registry with a REDCap® Database to document every patient with surgical treatment. Included are all surgically treated fractures of the extremities, excluding the hand. Furthermore pelvic, acetabular, and periprosthetic fractures, joint dislocations, and tendon ruptures. With interfaces to our Clinical Documentation Systems, the administrative effort became very efficient. The interfaces provide a possibility to identify every patient with inclusion criteria and implement reminder feedback for Surgeons. We collect PROMs with the heartbeat-Software, and document CROMs with REDCap®. We merged these data using the software ‘R’. The documentation of each patient is completed with a database for Adverse Events. Results Data-entry rates were less than 50% in 2018 and have reached 99.1% for 2020 and 99.5% for 2021 for surgically treated fracture patients. Until the submission of this abstract, 2382 surgical procedures have been performed at our Department on 2073 hospitalized patients. 972 patients were included in the Fracture Registry (47%). In a feasibility study, we have merged clinical data with the PROMs of patients treated for distal radius (DR) and proximal humerus (PH) fractures. The baseline values for DR of the quality-of-life questionnaire EQ5D was 0.83 (n=144), after 3months 0.9 (n=58) and 0.97 one year after treatment (n=6). Although not more than a trend, we realized the same pattern for PH-patients with an EQ5D-Baseline of 0.75 (n=63), three months values of 0.75 (n=58), and one-year results of 0.87 (n=6). Conclusion Collecting structured data allows combining routine clinical data with PROMs and CROMs. This information is of inestimable value to define the quality of care for Orthopedic Trauma Surgery. Our combination of Databases to collect diagnosis, subjective and objective outcome measures has been proven feasible and showed high data quality.

What's New in Orthopaedic Trauma.

What's New in Orthopaedic Trauma.

A Review on Biomaterials for Orthopaedic Surgery and Traumatology: From Past to Present.

The principal features essential for the success of an orthopaedic implant are its shape, dimensional accuracy, and adequate mechanical properties. Unlike other manufactured products, chemical stability and toxicity are of increased importance due to the need for biocompatibility over an implants life which could span several years. Thus, the combination of mechanical and biological properties determines the clinical usefulness of biomaterials in orthopaedic and musculoskeletal trauma surgery. Materials commonly used for these applications include stainless steel, cobalt-chromium and titanium alloys, ceramics, polyethylene, and poly(methyl methacrylate) (PMMA) bone cement. This study reviews the properties of commonly used materials and the advantages and disadvantages of each, with special emphasis on the sensitivity, toxicity, irritancy, and possible mutagenic and teratogenic capabilities. In addition, the production and final finishing processes of implants are discussed. Finally, potential directions for future implant development are discussed, with an emphasis on developing advanced personalised implants, according to a patient’s stature and physical requirements.

Fractographic analysis of two different plate designs used for orthopaedic trauma surgery

Two different orthopaedic implant designs of straight reconstruction and pancarpal arthrodesis plates with oval radiocarpal hole – both associated with clinically negative results – were initially subjected to laboratory cyclic fatigue testing in two independent biomechanical studies and presented with a fracture.Fractographic analysis was performed of each one randomly selected sample – Reco-Frac and OH-Frac.Reco-Frac fracture surface was characterized by three different plateau-like zones, distinguishing from each other by different topographies and fracture features. Complexity of the fracture was associated with a complex loading protocol. OH-Frac fracture surface revealed distinct radial marks originating at the bone-oriented side and was characterized with smeared metal and cleavage-like patterns. The fracture surface was more uniform, which can be ascribed to a simpler loading protocol.Clinically, fractures of the investigated two plate designs can be attributed to bone fracture healing disturbances, leading to prolonged cyclic loading of the plates and ultimately to their fatigue failure.

Feasibility and acceptability of intranasal povidone iodine decolonization among orthopedic trauma surgery patients

Background: Nasal decolonization significantly decreases the incidence of Staphylococcus aureus surgical-site infections (SSIs). Patient adherence with self-administration of a decolonization ointment (ie, mupirocin) is low, especially among patients having urgent surgery. Povidone-iodine decolonization may overcome patient adherence challenges because povidone-iodine needs to be applied only on the day of surgery. We assessed the effectiveness and acceptability of povidone-iodine decolonization given on the day of surgery among patients having orthopedic trauma surgery. Methods: Adult patients who underwent operative fixation of traumatic lower extremity fractures were consented to receive 10% intranasal povidone-iodine solution. Povidone-iodine was applied ~1 hour before surgical incision and was reapplied the evening after surgery. Patients were tested for S. aureus nasal colonization before surgery, the evening after surgery (before povidone-iodine reapplication), and the day after surgery. Swabs were inoculated into Dey-Engley neutralizer and processed in a vortexer. A series of dilutions were performed and plated on mannitol salt agar plates. S. aureus cultures were quantitatively assessed to determine the reduction in S. aureus after povidone-iodine use. Reductions in S. aureus nasal growth were evaluated using the Skillings-Mack test. SSIs manifesting within 30 and 90 days of surgery were identified using NHSN definitions. A survey was administered the morning after surgery to determine the acceptability of intranasal povidone-iodine. Results: In total, 51 patients participated in this pilot study between February 2020 and June 2021. Nasal samples from 12 participants (23.5%) grew S. aureus. The S. aureus concentration decreased significantly across the time points (P = .03) (Fig. 1). No SSIs were identified within 30 days of surgery. One SSI occurred within 90 days of surgery; this patient did not carry S. aureus, and cultures from the infected site were negative. Also, 31% of patients reported at least 1 mild side effect while using povidone-iodine: dripping (n = 7), itching (n = 6), dryness (n = 4), stinging (n = 4), staining (n = 3), unpleasant taste (n = 3), runny nose (n = 2), burning (n = 1), sneezing (n = 1), sore throat (n = 1), tickling (n = 1), and/or cough (n = 1). Also, 86% of patients stated that povidone-iodine felt neutral, pleasant, or very pleasant, and only 14% stated that it felt unpleasant or very unpleasant. Discussion: In this pilot study, 2 applications of nasal povidone-iodine on the day of surgery were acceptable for patients, and this protocol significantly reduced S. aureus concentration in nares of patients. Future large clinical trials should evaluate whether this 2-application regimen of povidone-iodine significantly decreases rates of SSI among orthopedic trauma surgery patients.Funding: PDI HealthcareDisclosures: None

A systemic review and a meta-analysis on the influences of closed incisions in orthopaedic trauma surgery by negative pressure wound treatment compared with conventional dressings.

We performed a meta-analysis to evaluate the influences of closed incisions in orthopaedic trauma surgery (OTS) by negative pressure wound treatment (NPWT) compared with conventional dressings. A systematic literature search up to March 2022 was done and 14 studies included 3935 subjects with OTS at the start of the study; 2023 of them used NPWT and 1912 were conventional dressings. They were reporting relationships between the influences of closed incisions in OTS by NPWT compared with conventional dressings. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to assess the influences of closed incisions in OTS by NPWT compared with conventional dressings using the dichotomous methods with a random or fixed-effect model. NPWT had significantly lower deep surgical site infections (SSIs) (OR, 0.65; 95% CI, 0.48-0.87, P= .004), superficial SSIs (OR, 0.34; 95% CI, 0.19-0.61, P< .001), and wound dehiscence (OR, 0.41; 95% CI, 0.21-0.80, P= .009) compared with conventional dressings in subjects with closed incisions in OTS. NPWT showed a beneficial effect on deep SSIs, superficial SSIs, and wound dehiscence compared with conventional dressings in subjects with closed incisions in OTS. Further studies are required to validate these findings.

Automatic plane adjustment of orthopedic intraoperative flat panel detector CT-volumes.

Purpose: To assess the result in orthopedic trauma surgery, usually three-dimensional volume data of the treated region is acquired. With mobile C-arm systems, these acquisitions can be performed intraoperatively, reducing the number of required revision surgeries. However, the acquired volumes are typically not aligned to the anatomical regions. Thus, the multiplanar reconstructed (MPR) planes need to be adjusted manually during the review of the volume. To speed up and ease the workflow, an automatic parameterization of these planes is needed. Approach: We present a detailed study of multitask learning (MTL) regression networks to estimate the parameters of the MPR planes. First, various mathematical descriptions for rotation, including Euler angle, quaternion, and matrix representation, are revised. Then, two different MTL network architectures based on the PoseNet are compared with a single task learning network. Results: Using a matrix description rather than the Euler angle description, the accuracy of the regressed normals improves from 7.7deg to 7.3deg in the mean value for single anatomies. The multihead approach improves the regression of the plane position from 7.4 to 6.1mm, whereas the orientation does not benefit from this approach. Thus, the achieved accuracy meets the reported interrater variance in similarly complex body regions of up to 6.3deg for the normals and up to 9.3mm for the plane position. Conclusions: The use of a multihead approach with shared features leads to more accurate plane regression compared with the use of individual networks for each task. It also improves the angle estimation for the ankle region. The reported results are in the same range as manual plane adjustments. The use of a combined network with shared parameters requires less memory, which is a great benefit for the implementation of an application for the surgical environment.

Adaptation of the Centers for Disease Control Surgical Wound Classification System for Orthopaedic Trauma Surgery.

To evaluate a proposed orthopaedic-specific surgical wound classification system (SWCS) and the current Centers for Disease Control (CDC) system in a series of detailed clinical vignettes and to identify the degree of satisfaction with CDC SWCS and desire for institution of an orthopaedic-specific SWCS. Forty-five clinical vignettes and a 5-question survey were distributed to current and past members of the Orthopaedic Trauma Association's Classification Committee. Respondents were asked to provide wound class for each vignette using the CDC system and orthopaedic-specific SWCS. The orthopaedic-specific and CDC SWCS had interclass correlations of 0.95 and 0.91, respectively. When the systems were compared, in 34% of cases, there was no grade change; in 63% of cases, the wound was graded higher using the orthopaedic-specific SWCS. When only the procedure was changed between vignettes, wound classification was infrequently affected. There was near universal dissatisfaction with the CDC SWCS and desire for an orthopaedic-specific system. Both the CDC SWCS and orthopaedic-specific SWCS have excellent interobserver reliability. Incorporation of orthopaedic-specific language affects wound classification. There is low satisfaction with the current CDC SWCS and a desire exists for further development and validation of an orthopaedic-specific SWCS.