Orthopaedic Clinic Research Articles

Integrated analysis of bioinformatics, mendelian randomization, and experimental validation reveals novel diagnostic and therapeutic targets for osteoarthritis: progesterone as a potential therapeutic agent.

Osteoarthritis (OA), characterized by progressive degeneration of cartilage and reactive proliferation of subchondral bone, stands as a prevalent condition in orthopedic clinics. However, the precise mechanisms underlying OA pathogenesis remain inadequately explored. In this study, Random Forest (RF), Least Absolute Shrinkage and Selection Operator (LASSO), and Support Vector Machine-Recursive Feature Elimination (SVM-RFE) machine learning techniques were employed to identify hub genes. Based on these hub genes, an Artificial Neural Network (ANN) diagnostic model was constructed. The Drug Signatures Database (DSigDB) was utilized to screen small-molecule drugs targeting these hub genes, and molecular docking analyses and molecular dynamics simulations were employed to explore and validate the binding interactions between proteins and small-molecule drugs. Expression changes of the hub genes under inflammatory conditions were validated through in vitro experiments, including RT-qPCR and Western blotting, and the therapeutic effects of the identified small-molecule drug on chondrocytes under inflammatory conditions were further verified in vitro. Lastly, Mendelian randomization analysis was conducted to examine the causal association between progesterone levels and various OA phenotypes. In this study, we identified three hub genes: interleukin 1 receptor-associated kinase 3 (IRAK3), integrin subunit beta-like 1 (ITGBL1), and Ras homolog family member U (RHOU). An Artificial Neural Network (ANN) diagnostic model constructed based on these hub genes demonstrated excellent performance in both training and validation phases. Screening with the Drug Signatures Database (DSigDB) identified progesterone as a small-molecule drug targeting these key proteins. Molecular docking analysis using AutoDock Vina revealed that progesterone exhibited binding energies of ≤ -7kcal/mol with each of the key proteins, indicating strong binding affinity. Furthermore, molecular dynamics simulations validated the stability and strength of these interactions. RT-qPCR and Western blotting confirmed the downregulation of the hub genes in IL-1β-treated chondrocytes. Western blotting also demonstrated the potential therapeutic effects of progesterone on IL-1β-treated chondrocytes. Finally, Mendelian randomization analysis established a significant association between progesterone levels and multiple OA phenotypes. In our study, IRAK3, ITGBL1, and RHOU were identified as potential novel diagnostic and therapeutic targets for OA. Progesterone was preliminarily validated as a small-molecule drug with potential effects on OA. Further research is crucial to elucidate the pathogenesis of OA and the specific therapeutic mechanisms involved.

Diabetes mellitus and obesity: risk optimization before surgical interventions

The prevalence of obesity has increased significantly in recent years and is acausal risk factor for the development of type2 diabetes. Moreover, chronic degenerative joint diseases are also triggered by obesity. Both obesity-related secondary diseases-type2 diabetes and chronic degenerative joint disease-can be prevented or at least delayed by lifestyle intervention aimed at weight reduction. The progression of these diseases can also be favourably influenced by radical weight loss. Diets with areduction in carbohydrates-aso-called "low-carb" or ketogenic diet-appear to be superior to alow-fat diet. If joint replacement surgery is necessary, preoperative and perioperative interdisciplinary care by ateam of experienced therapists from the fields of orthopaedics and obesity/type2 diabetes is required. The Düsseldorf TeDia model in the network of Catholic hospitals in Düsseldorf takes these requirements into account by providing interdisciplinary care for such patients at the orthopaedic centre at St. Vinzenz Hospital Düsseldorf and the West German Diabetes and Health Centre (WDGZ). Patients with pronounced obesity or diabetes mellitus are presented preoperatively at the WDGZ on an outpatient basis, and weight reduction therapy or optimization of the diabetic metabolic situation is initiated. If joint problems persist despite weight reduction or pronounced degenerative changes that require surgery, the WDGZ provides inpatient diabetology care in the orthopaedic clinic with the option of further outpatient follow-up care.

Reasons for declining to participate in a trial of online cognitive behavioural therapy following orthopaedic trauma: A mixed methods study.

The timely enrollment of study participants is critical to the success of clinical trials. Understanding factors that contribute to patients' decision to participate in trials involving online cognitive behavioural therapy for pain management should prove helpful to optimize the design of study protocols. Fracture patients from an orthopaedic clinic who declined to participate in the Cognitive behavioural therapy to Optimize Post-operative rEcovery (COPE) trial were asked to complete a Research Participation Questionnaire that asked them about their previous experiences with clinical research and mental health therapy and their reasons for declining to participate in the COPE trial. At the end of the questionnaire, a subset of participants was offered the opportunity to participate in a telephone interview to further discuss why they declined to participate in the COPE trial. Sixty-four patients who declined to participate in the COPE trial completed the questionnaire and twenty of these participants agreed to take part in a telephone interview (31%). Twenty-two participants (34%) had previous experience with clinical research and six participants (9%) had received cognitive behavioural therapy (CBT) in the past. Excessive time commitment (41%) was the most commonly selected reason for not participating in the COPE trial, followed by a disinclination to participate in clinical research (19%). Four themes emerged from the interviews with participants: 1) belief that they could overcome mental health challenges after their fracture without external help; 2) belief that CBT might be helpful for some fracture patients, but not for themselves; 3) preference for online or in-person CBT; and 4) concerns regarding time commitment. To maximize enrollment, trials exploring the role of psychotherapy in recovery from orthopedic trauma should optimize time commitment of psychotherapy. Providing information in the patient consent process regarding evidence for psychotherapy and recovery from orthopedic trauma may also prove helpful in promoting patient enrollment.

Evaluating ChatGPT, Gemini and other Large Language Models (LLMs) in orthopaedic diagnostics: A prospective clinical study.

Large Language Models (LLMs) such as ChatGPT are gaining attention for their potential applications in healthcare. This study aimed to evaluate the diagnostic sensitivity of various LLMs in detecting hip or knee osteoarthritis (OA) using only patient-reported data collected via a structured questionnaire, without prior medical consultation. A prospective observational study was conducted at an orthopaedic outpatient clinic specialized in hip and knee OA treatment. A total of 115 patients completed a paper-based questionnaire covering symptoms, medical history, and demographic information. The diagnostic performance of five different LLMs-including four versions of ChatGPT, two of Gemini, Llama, Gemma 2, and Mistral-Nemo-was analysed. Model-generated diagnoses were compared against those provided by experienced orthopaedic clinicians, which served as the reference standard. GPT-4o achieved the highest diagnostic sensitivity at 92.3 %, significantly outperforming other LLMs. The completeness of patient responses to symptom-related questions was the strongest predictor of accuracy for GPT-4o (p < 0.001). Inter-model agreement was moderate among GPT-4 versions, whereas models such as Llama-3.1 demonstrated notably lower accuracy and concordance. GPT-4o demonstrated high accuracy and consistency in diagnosing OA based solely on patient-reported questionnaires, underscoring its potential as a supplementary diagnostic tool in clinical settings. Nevertheless, the reliance on patient-reported data without direct physician involvement highlights the critical need for medical oversight to ensure diagnostic accuracy. Further research is needed to refine LLM capabilities and expand their utility in broader diagnostic applications.

Case report FDAL causing bilateral tarsal tunnel syndrome

A 49 year old woman presented to orthopaedic clinic with a two year history of pain at the back of both of her heels She started doing a lot of walking during the Covid 19 lockdown

Estimating the Budget Impact and Joint Replacement Avoidance by Implementing a Standardized Education and Exercise Therapy Program for Hip and Knee Osteoarthritis in a Publicly Insured Healthcare System.

Estimate the budget impact of funding a standardized education and exercise therapy program (GLA:D®) for people with hip and knee OA waiting for total joint replacement (TJR) consultation in a universal publicly insured healthcare system in Canada. We built a budget impact analysis (BIA) model to estimate the annual cost of providing GLA:D® program to people waiting for TJR consultation and then forecasted a three-year budget cycle. The base case assumes 40% attend GLA:D®, 11% avoid surgery, uniform care delivery, training costs are incurred separately, and the healthcare system has enough trained staff to meet demand. The population of people with hip and knee OA waiting for TJR consultation was estimated with government statistics, peer-reviewed evidence and routinely collected data from five orthopaedic centralized intake clinics (serving 80% of people seeking TJR). Patient-level costs were collected prospectively. International published evidence-informed estimates of TJR avoidance. One-way sensitivity analysis of key parameters evaluated model robustness. Four scenarios were analysed: public-funding for everyone (base case), low-income, rural, or uninsured persons. Funding GLA:D® would cost $4.3 million, serve 12,500 people, and save $8.5 million by avoiding 1,300 TJRs in year one. Savings grow to $8.8 and $8.7 million in year two and three. The number of TJR's performed annually produced the most uncertainty in budget impact (-$15.3, -$1.8 million). The most cautious parameter estimates still produce cost-savings. Publicly funding standardized education and exercise therapy programs for everyone waiting for TJR consultation would avoid surgeries, improve access to evidence-based treatments and save more than the program costs.

TITLE: Patient Preferences for Carpal Tunnel Release Education: A Comparison of Education Materials from Popular Healthcare Websites and ChatGPT.

ChatGPT has been increasingly utilized to create, simplify, and revise hand surgery patient education materials. While significant research has examined the quality and readability of ChatGPT-derived hand surgery patient education, the patient perspective has not previously been evaluated. This study compared patient reported clarity and readability grades as well as patient preferences for carpal tunnel surgery educational information from medical education websites and ChatGPT. Patients without a history of carpal tunnel release surgery at two orthopaedic hand surgery outpatient clinics were asked to complete an anonymous survey which gathered demographic information and included a blinded educational passage on carpal tunnel release surgery from ChatGPT, WebMD, or Mayo Clinic. Patients graded the blinded passages regarding clarity, readability, length, likeliness to recommend to others, and overall satisfaction with the education material. There were no significant differences in clarity (p = 0.682),readability (p = 0.328), or likeliness to recommend to others (p = 0.106) between the different educational sources. When stratified by age, younger patients (under 55) were more likely to recommend Mayo Clinic over other resources (p = 0.002). When further stratified to include only those who reported previously using websites for healthcare information, patients tended to have a higher likelihood of recommending Mayo Clinic compared to other sources, but this was not a statistically significant difference. There were no differences in clarity, readability, or preference ratings between patient education materials that were produced by ChatGPT, WebMD and Mayo Clinic. However, while ChatGPT-generated materials are comparable in quality based on patient ratings, younger patients may still favor well-established sources for medical education. This information regarding patient preferences provides valuable insights for hand surgeons when selecting suitable educational resources for their patients.

Telemedicine in Orthopedic Oncology: An Opportunity for Cost Savings Without Compromising Clinical Outcomes.

Prior work has demonstrated that telemedicine in orthopedic surgery is cost-effective and can yield good clinical outcomes with high patient satisfaction. However, few studies have investigated the use of telemedicine in orthopedic oncology. In this study, we assessed the effect of telemedicine on (1) potential cost savings for orthopedic oncologic patients and (2) clinical outcomes as measured by unexpected in-person clinic visits and missed complications. A total of 308 patients who had 528 telemedicine visits in the orthopedic oncology clinic from May 2020 to August 2023 were identified. Demographic and clinical information, travel distance/time to clinic, complications, and instances where a telemedicine visit prompted an in-person evaluation were collected and reported with descriptive statistics. Cost savings were calculated based on travel distance and lost productivity. Patients with and without a complication or an unexpected in-person clinic visit were compared to identify risk factors for these clinical outcomes. Cost analysis demonstrated that telemedicine offers patients a potential cost savings of up to $475.2±$242.9 per visit. For 4.5% of the patients, a telehealth visit prompted an in-person evaluation. A complication was experienced by 5.5% of the patients. No complications were missed because of telemedicine. A diagnosis of a malignant tumor was associated with a higher rate of complications (P=.01) and unexpected in-person clinic visits (P=.03). Telemedicine can reduce the financial burden of treatment for orthopedic oncologic patients without negatively impacting clinical outcomes. Care should be taken when considering telehealth for patients with malignant tumors given their higher risk for adverse outcomes. [Orthopedics. 202x;4x(x):xx-xx.].

USING THERMOPLASTIC BASE MATERIALS IN THE CLINIC OF ORTHOPEDIC DENTISTRY IN THE TREATMENT OF PATIENTS WITH COMPLETE TOOTH LOSS

Background. Fabrication of high-quality removable orthopedic structures is one of the most important and still unsolved problems in the clinic of prosthetic dentistry. In order to solve this problem, in recent years, new basic dental materials have been developed and researched. Nowadays, orthopedic dentists are increasingly using acrylic-free thermoplastic base materials. They provide opportunities for the treatment of patients, contributing to the improvement of comfort, functionality and aesthetics of complete dentures. The aim of the study is to examine the effectiveness of using basic thermoplastic materials «Vertex ThermoSens» and «Deflex Acrylato» in an orthopedic dentistry clinic in patients with complete absence of teeth. Materials and methods. The base materials used in the study were polyamide (nylon) by «Vertex ThermoSens» (Netherlands) and thermoplastic material based on polymethyl methacrylate by «Deflex Acrylato» (Argentina). We treated 30 patients with complete absence of teeth who had been wearing complete removable dentures made of acrylic base dental materials for the past 4-5 years. New complete dentures were made of thermoplastic dental base materials «Vertex ThermoSens» and «Deflex Acrylato». The effectiveness of prosthetics was evaluated using electromyography of the masticatory muscles (immediately after prosthetics and in certain long-term periods). Results. When analyzing and statistically processing the electromyograms of patients of the first and second groups before prosthetics, the amplitude of compression during the «voluntary compression» test decreased to 188.91±5.16 μV and to 201.13±6.03 μV during the «voluntary chewing» test, which is significantly different from the norm. As for the assessment of the coefficient «K», which in patients with intact dentition is as close to one as possible, its value has almost doubled and is 2.32±0.07. After the orthopedic treatment, the clenching amplitude increases significantly, and the coefficient «K» approaches one. Quantitative indicators of electromyographic studies in patients of the first and second clinical groups after a month and a year of use of complete removable dentures almost do not differ from each other and are close to normal. Conclusions. Based on the research conducted in the clinic of prosthetic dentistry, we noted that in the manufacture of complete dentures from the base thermoplastic materials «Vertex ThermoSens» and «Deflex Acrylato», better fixation and stabilization of these structures is achieved due to a more accurate reflection of the relief of the mucous membrane of the prosthetic bed. Such prostheses are very well processed and polished, which significantly improves their quality and reduces the risk of inflammation of the prosthetic bed mucosa. Based on this, it can be concluded that adaptation to such prostheses takes place in a shorter time and almost without corrections.

Advancing care for congenital pseudoarthrosis: A case series highlighting the combined use of an intramedullary device with either Ilizarov’s fixators or plating for the treatment of congenital pseudoarthrosis

Congenital pseudarthrosis of the tibia (CPT) is a bone defect in which non-union occurs in a dysplastic segment of the tibial diaphysis following a fracture at the same site. Once a fracture occurs through a susceptible bone and pseudoarthrosis is formed, spontaneous healing is unexpected. Therefore, surgical intervention is essential for healing. This study aimed to compare the outcomes of using intramedullary nailing with either Ilizarove’s fixator or plating as a treatment method for CPT to other treatment methods described in the literature. This case series study included nine patients who presented to the Pediatric Orthopedic clinic with CPT from 2018 to 2021. All patients were previously diagnosed with Neurofibromatosis-1 by pediatric genetics and presented with unilateral CPT. The minimum follow-up duration was 12 months. Nine patients were diagnosed with neurofibromatosis. Of the nine patients, fixation was supplemented with an Ilizarov external fixator in 5 patients, and the plate was used in 4 patients. Most patients (88.9%) achieved union, except for one patient with an infection requiring multiple surgical debridement. The type of fixation was not significantly associated with the union rate. In conclusion, patients who underwent intramedullary nailing in conjugation with Ilizarov’s fixator or plating for the treatment of CPT and cross-union have achieved excellent union rates with no refracture in early outcomes.

IMPLANTATION OF CHONDROFILLER LIQUID® AS A SCAFFOLD MATERIAL FOR THE TREATMENT OF CHONDRAL LESIONS OF THE KNEE JOINT

Introduction: Trauma, sports, or the normal aging degenerative process may damage the articular cartilage. Surgical methods that are most often used to manage cartilage defects include autologous chondrocyte implantation, mosaicplasty, microfractures, perforations, and joint arthroplasty in cases of severe damage. Another approach is to use collagen gel for cartilage defect reconstruction. Its biocompatibility, high tensile strength, and minimal invasiveness make it an attractive solution. ChondroFiller gel is a two-component collagen implant that could be used in the treatment of traumatic or degenerative chondral lesions. After application, it forms a protective cover for the damaged chondral area and provides structural support for the stem cells that migrate to its collagen matrix. Thus, with ChondroFiller, we aim to restore articular cartilage, prevent further degenerative processes, and return to normal joint function. In this research, we have investigated the application of ChondroFiller during knee arthroscopy to treat knee articular cartilage lesions. Methods: The clinical study was conducted at the University Hospital - Pleven Clinic of Orthopedics and Traumatology between 2012 and 2023. Seventeen patients (ten males and seven females) with a mean age of 31 years underwent knee chondroplasty with ChondroFiller gel, and their data was analyzed. Knee function was assessed using the Lysholm scale and IKDC score. The follow-up period was twelve months. Results: Statistical analysis has shown a significant difference between pre-operative Lysholm and pre-operative IKDC score and 3rd month, 6th and 12 months. Significant difference is detected between the 3rd month and 6th and 12th months Lysholm and IKDC scores (p &lt; 0.05). No statistical difference was found between 6 and 12 month (p &gt; 0.05). Conclusion: Restoring joint congruity is challenging. Overall, we have found encouraging results by employing ChondroFiller to restore articular cartilage. We believe that Chondrofiller provides an excellent surgical solution to younger patients with chondral defects less than 2cm2. In our opinion, further research in the field of collagen implants is needed to discover long-term effect.

Translation and Validation of the Spanish Version of the Banff Patellofemoral Instability Instrument 2.0.

The Banff Patellofemoral Instability Instrument (BPII) 2.0 is a patient-reported outcome measure (PROM) tailored specifically for patellofemoral instability. The BPII 2.0 was developed in English and has been validated for adolescents and translated into several languages, but not into Spanish. This investigation involved translating the BPII 2.0 into Spanish and evaluating and validating its psychometric properties. It was hypothesized that there would be a moderate correlation between the Spanish BPII 2.0 and the Spanish version of the Kujala score. Cohort study (diagnosis); Level of evidence, 3. The BPII 2.0 underwent forward and backward translations into Colombian Spanish according to the Consensus-Based Standards for the Selection of Health Measurement Instrument guidelines. Colombian patients aged 9 to 18 years who experienced knee symptoms after a primary or recurrent patellar dislocation were recruited from a hospital-based orthopaedic clinic. Participants completed the Spanish BPII 2.0 and the Kujala score during their initial visit (t0) and the Spanish BPII 2.0 again 1 week later (t1). Internal consistency and test-retest reliability were assessed using the intraclass correlation coefficient (ICC). Concurrent validity of the Spanish BPII 2.0 with the Kujala score was explored through Pearson correlation analysis. A total of 46 participants (31 [67%] female; mean age, 15.1 ± 2.0 years) were included. The mean time since first patellofemoral dislocation was 22 ± 28 months. Of the 4 participants who received operative treatment for patellar instability, the mean time since surgery was 12 months (range, 7-18 months). All patients completed the BPII 2.0 at t0 and at t1, a mean of 7 days later (range, 6-7 days), and 45 (98%) participants completed the Kujala score at t0. Five Spanish BPII 2.0 items exhibited floor or ceiling effects, however no subscales demonstrated these effects. Th Spanish BPII 2.0 demonstrated excellent internal consistency at both t0 (ICC, 0.94; 95% CI, 0.92-0.96) and t1 (ICC, 0.96; 95% CI, 0.93-0.97), along with excellent test-retest reliability (ICC, 0.98; 95% CI, 0.97-0.99). Concurrent validity of the Spanish BPII 2.0 with the Spanish Kujala score was good to strong (r = 0.74; 95% CI, 0.57-0.85). The Spanish BPII 2.0 had excellent internal consistency and test-retest reliability, suggesting this PROM is a reliable and valid questionnaire.

Endocrinologic Abnormalities Observed Among Total Joint Arthroplasty Patients Using "Artri King" and Related Over-the-Counter Supplements: A Cautionary Tale from a Safety Net Hospital.

Background/Objectives: Artri King is an over-the-counter supplement previously marketed to treat joint pain and arthritis. In 2022, the Food and Drug Administration (FDA) issued a product warning after it discovered Artri King contained hidden ingredients including dexamethasone, diclofenac, and methocarbamol. Given the risk of adrenal insufficiency in the context of long-term dexamethasone use, we sought to report on adverse endocrinologic outcomes observed among patients endorsing the use of these supplements who presented to an orthopedic surgery clinic at a county safety net hospital. Methods: Preoperative patients presenting from November 2023 to June 2024 were screened for supplement use. Data were collected including patient demographics and comorbidities. Serum cortisol, adrenocorticotropic hormone (ACTH), and C-reactive protein (CRP) were obtained to assess adrenal function. Recommendations from Endocrinology regarding perioperative stress dose corticosteroids were also recorded. Standard descriptive statistics were employed to report our results. Results: In total, 13 patients (6 female and 7 male) were identified with a mean age of 62.8 years (range of 47-79 years) and an average BMI of 32.03 kg/m2 (range of 22.93-45.81 kg/m2). The average duration of use was 10.2 months (range of 1-36 months). One patient developed new-onset diabetes mellitus while taking supplements. Nine patients had low cortisol levels (<6.7 mcg/dL), necessitating referral to Endocrinology, and two were found to have concomitantly low ACTH levels (<5 pg/mL). Endocrinology recommended perioperative stress dose corticosteroids for all nine patients with low cortisol. Conclusions: Artri King and similar supplements may lead to severe endocrinological consequences. We recommend routine screening and continued management of patients who endorse supplement use.

Increase in Strength After Multimodal Pain Management Concept in Patients with Cervical Radiculopathy-A Non-Randomized, Uncontrolled Clinical Trial.

Background and Objective: Although multimodal pain therapy (MPT) is widely used in pain management for chronic cervical radiculopathy, its effect on increasing muscle strength in patients with cervical radiculopathy is not well documented. This study aimed to evaluate the impact of a structured multimodal pain management program on muscle strength in these patients, using objective strength measurements as indicators of therapeutic success. Materials and Methods: This non-randomized, uncontrolled, prospective clinical study initially included 35 patients, but 10 were excluded due to incomplete data, resulting in a final sample of 25 patients (14 women and 11 men, aged 42 to 84 years) with cervical radiculopathy who underwent a multimodal pain management program at a specialized orthopedic clinic. Muscle strength was measured at admission and discharge using a hand-held dynamometer. Pain levels were assessed with the Numeric Rating Scale. An uncontrolled study design was chosen for ethical reasons, as it was deemed inappropriate to form a control group that would be deprived of necessary anti-inflammatory or analgesic medications. Result: Significant improvements were observed in overall muscle strength, with an 11% increase from 114.78 kg to 127.41 kg (p = 0.003). The strongest increase in strength was observed in the proximal cervical muscle groups, with a notable 22.9% (p < 0.001)improvement in the muscles involved in cervical inclination. However, no significant strength gains were detected in the peripheral muscle groups of the upper arm. Pain scores on the NRS decreased by 54.2% (p < 0.001). Conclusions: This study demonstrates that a multimodal pain management approach leads to significant improvements in muscle strength and pain reduction in patients with cervical radiculopathy. The increase in cervical muscle strength is closely associated with pain relief and improved functional outcomes, highlighting the value of conservative pain management strategies for these patients.

Does Discussing Patient-reported Outcome Measures Increase Pain Self-efficacy at an Orthopaedic Visit? A Prospective, Sequential, Comparative Series.

Pain self-efficacy, or the ability to carry out desired activities in the presence of pain, can affect a patient's ability to function before and after orthopaedic surgery. Previous studies suggest that shared decision-making practices such as discussing patient-reported outcome measures (PROMs) can activate patients and improve their pain self-efficacy. However, the ability of PROMs to influence pain self-efficacy in patients who have undergone orthopaedic surgery has yet to be investigated. (1) Is immediately discussing the results of a PROM associated with an increase pain self-efficacy in new patients presenting to the orthopaedic surgery clinic? (2) Is there a correlation between patient resilience or patient involvement in decision-making in changes in pain self-efficacy? This was a prospective, sequential, comparative series completed between February to October 2023 at a single large tertiary referral center at a multispecialty orthopaedic clinic. Orthopaedic subspecialties included total joint arthroplasty, spine, hand, sports, and trauma. The first 64 patients underwent standard care, and the following 64 had a conversation with their orthopaedic surgeon about their PROMs during the initial intake visit. We collected scores from the Pain Self-Efficacy Questionnaire (PSEQ), Brief Resilience Scale (BRS), and Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function form (PF-SF10a) and data on demographic characteristics before the visit. The PSEQ is a validated PROM used to measure pain self-efficacy, while the BRS measures the ability of patients to recover from stress, and the PROMIS PF-SF10a is used to assess overall physical function. PROMs have been utilized frequently for their ability to report the real-time physical and psychological well-being of patients. In the standard care group, the PROMIS PF-SF10a score was not discussed with the patient. In the PROMs group, the physician discussed the PROMIS PF-SF10a score using a script that gave context to the patient's score. Additional conversation about the patient's score was permitted but not required for all patients. Scores from the Observing Patient Involvement in Decision Making (OPTION-5) instrument were recorded during the visit as a measure of patient involvement in clinical decision-making. After the visit, both groups completed the PSEQ. The primary outcome was change in the PSEQ. Change in pain self-efficacy was recorded as greater or less than the minimum clinically important difference, previously defined at 8.5 points for the PSEQ [10]. The secondary outcomes were correlation between PSEQ change and the BRS or OPTION-5. Between the PROMs and standard care groups, there was no difference in the change in PSEQ scores from before the visit to after (mean ± SD change in control 4 ± 10 versus change in PROMs group 3 ± 7, mean difference 1 [95% confidence interval (CI) -2.0 to 4.0]; p = 0.29). Fifty-six percent (36 of 64) of patients in the standard care group demonstrated an increase in pain self-efficacy (of whom 22% [14 of 64] had clinically important improvements), and 59% (38 of 64) of patients in the PROMs group demonstrated an increase in pain self-efficacy (of whom 19% [12 of 64] had clinically important improvements). In the control group, there was no correlation between the change in PSEQ score and resiliency (BRS score r = -0.13 [95% CI -0.36 to 0.12]; p = 0.30) or patient involvement in decision-making (OPTION-5 r = 0.003 [95% CI -0.24 to 0.25]; p = 0.98). Similarly, in the PROMs group, there was no correlation between the change in PSEQ score and resiliency (BRS score r = -0.10 [95% CI -0.33 to 0.16]; p = 0.45) or patient involvement in decision-making (OPTION-5 r = -0.02 [95% CI -0.26 to 0.23]; p = 0.88). Discussing PROMs results (PROMIS PF-SF10a) at the point of care did not increase pain self-efficacy during one visit. Therefore, surgeons do not need to discuss pain self-efficacy PROM scores in order to influence patient pain self-efficacy. While PROMs remain valuable tools for assessing patient outcomes, further work may assess whether the collection of PROMs itself may increase pain self-efficacy or whether longitudinal discussion of PROMs with patients changes pain self-efficacy. Level II, therapeutic study.

Influence of palmar tilt on wrist palmar flexion range-of-motion limitation after conservative treatment of distal radial fractures

Background Distal radial fractures are common forearm injuries. A key rehabilitation objective is achieving adequate wrist palmar and dorsal flexion range-of-motion (ROM). However, few studies have explored this relationship, with even lesser number of studies investigating the impact of distal radius alignment on wrist ROM limitation due to fractures. We aimed to determine the effect of radial alignment on wrist palmar and dorsal flexion ROM after conservative treatment for distal radial fractures. Patients and methods This retrospective, cohort study, included 82 patients with distal radial fractures (11 men, 71 women, mean age: 65.9 ± 16.6 years) who underwent examination at an orthopedic clinic. Wrist ROM limitation was defined as ˂60° of dorsal flexion and ˂55° of palmar flexion. The palmar tilt (PT), radial length (RL), and radial inclination (RI) were radiographically measured. The patient’s age, residual symptoms, and rehabilitation period were extracted from medical records. Univariate and multivariate analyses were conducted with the presence/absence of wrist ROM limitation as the objective variable, with the PT, RL, and RI as explanatory variables. A comparison of age, and rehabilitation period between the groups with and without wrist ROM limitation was performed using the Mann–Whitney U test. The presence/absence of residual symptoms were compared between two groups using the chi-squared test. Results Univariate analysis revealed that PT, RL and RI were associated with palmar flexion ROM limitation. Multivariate analysis showed that PT was the only factor associated with palmar flexion ROM limitation (odds ratio: 0.85, 95% confidence interval: 0.78–0.91, p < 0.001), while dorsal flexion ROM limitation was not associated with any of the three measurements. The group with palmar flexion ROM limitation presented older age (73.1 vs. 59.6 years), higher residual symptom frequency (23 vs. 12 patients), and longer rehabilitation period (159.2 vs. 73.9 days) compared to the group without the limitation (p < 0.01). Conclusion Dorsal displacement of the distal radius induces alterations in the wrist joint motion axis, potentially affecting limitation in palmar flexion ROM. Patients with palmar flexion ROM limitation had more residual symptoms and longer rehabilitation period than those without. These findings may contribute to the development of evidence-based joint ROM exercises, risk management, goal setting, and rehabilitation programs for patients with distal radial fractures.

Percutaneous ultrasound-guided A1 pulley release utilizing a modified 20-gauge spinal needle.

Trigger finger is a common cause of hand pain. Though multiple techniques for percutaneous A1 pulley release have been described in the literature, there is a continued need for safe and effective techniques using inexpensive, familiar, and commonly found instruments. This study evaluated outcomes of percutaneous A1 pulley release performed using a novel technique with a modified 20-gauge spinal needle and ultrasound guidance, with follow-up outcomes at least 6 months after the procedure. To evaluate the efficacy and safety of a novel percutaneous A1-pulley release technique in individuals with trigger finger. Retrospective observational study. Private practice outpatient orthopedics clinic. Forty digits from 30 unique patients with trigger finger who underwent percutaneous A1 pulley release. Percutaneous ultrasound-guided A1 pulley release performed with a modified 20-gauge spinal needle. The primary outcome measure was cessation of triggering. Secondary measures examined intraoperative and postoperative pain, postprocedural duration of activity limiting pain, and time to perform the procedure. Immediate cessation of triggering was achieved in all 40 digits following the procedure, with no recurrence reported at any time at an average follow-up of 11 months (range 6-32). Patients reported returning to normal activity in 2.75 days. Only one minor complication was reported, tenosynovitis, which resolved with a corticosteroid injection. Percutaneous, ultrasound-guided A1 pulley release performed with a modified 20-gauge spinal needle can be safely performed with good outcomes and a rapid return to normal activity.

Faucets and keyboards as a major reservoir of gram-negative bacilli in a regional hospital in Northeast Brazil

Infections related to healthcare assistance represent a major public health problem worldwide, and the main etiological agents associated with these infections are microorganisms also found on inanimate hospital surfaces. Therefore, understanding the dynamics of bacterial contamination of hospital surfaces is essential for professionals working in these services. Objective: To evaluate the contamination of inanimate surfaces by Gram-negative bacilli (GNB) in a Regional Hospital in Northeast Brazil. Methods: This is an observational and cross-sectional study. Samples were collected from different hospital wards using a sterile swab soaked in saline solution. They were then plated on MacConkey agar and incubated at 36°C for 48 hours. The bacterial isolates were counted and identified using the Gram staining method, TSI agar, and oxidase test. Results: Out of the 150 samples collected, 71 showed no microbiological growth, 11 showed growth of filamentous fungi, and 66 showed growth of Colony Forming Units (CFU). A total of 132 morphologically distinct colonies were identified, with 55 identified as yeasts and 77 as GNB. In the evaluation of hospital wards, the Adult Emergency Room and the Orthopedic Surgical Clinic showed the highest growth of GNB. Regarding the surfaces studied, the most contaminated were faucets, computer keyboards, mattresses, and beds. Conclusions: Hospital areas with higher human traffic are the most contaminated, particularly on frequently handled objects. Therefore, it is necessary to focus on disinfecting these surfaces to break the transmission chain of these etiological agents.

Comparison of ultrasound-guided fascia iliaca compartment block versus the combined obturator nerve and adductor canal block application in postoperative analgesia for patients undergoing arthroscopic knee surgery

Background: Arthroscopic knee surgery is a surgical intervention that is frequently performed by orthopedic clinics and new studies are constantly carried out by anesthetists to ensure effective pain control. This study aimed to compare the efficacy of ultrasound-guided suprainguinal fascia iliaca compartment block (FICB) versus the combined adductor canal and obturator nerve block application in terms of postoperative analgesia in patients undergoing arthroscopic knee surgery under spinal anesthesia.Materials and Method: Sixty patients, who underwent arthroscopic knee surgery under elective conditions were included in the study. They were randomly divided into two groups, Group 1 (n=30) and Group 2 (n=30), using a lottery method. Patients operated under spinal anesthesia received ultrasound-guided suprainguinal fascia iliaca compartment block (FICB) for Group 1. The combined adductor canal and obturator nerve block for Group 2 at the end of the surgery. Intravenous patient-controlled analgesia (PCA) device containing tramadol was connected to all patients in both groups, and they were evaluated for Visual Analog Scale (VAS) scores at 0, 2, 4, 12, and 24 hours of ward follow-up. The amount of PCA used at 24 hours, additional analgesic use, development of side effects, mobilization capabilities, and satisfaction levels were assessed at the end of 24 hours.Results: There were no significant differences between the groups in terms of demographic characteristics and the type of surgery performed (p&gt;0.05). In Group 1, where fascia iliaca block was applied the block administration time was observed to be significantly shorter compared to Group 2 (p&lt;0.05). No significant differences were observed between the two groups in terms of postoperative VAS scores, PCA usage amounts, incidence of side effects, postoperative mobilization abilities, and satisfaction measures (p&gt;0.05).Conclusions: Ultrasound-guided fascia iliaca compartment block alone can be effectively applied for postoperative analgesia in patients undergoing arthroscopic knee surgery, instead of combined adductor canal and obturator nerve block.

Orthobiologic Products: Preservation Options for Orthopedic Research and Clinical Applications.

The biological products used in orthopedics include musculoskeletal allografts-such as bones, tendons, ligaments, and cartilage-as well as biological therapies. Musculoskeletal allografts support the body's healing process by utilizing preserved and sterilized donor tissue. These allografts are becoming increasingly common in surgical practice, allowing patients to avoid more invasive procedures and the risks associated with donor site morbidity. Bone grafting is one of the most frequently used procedures in orthopedics and traumatology. Biologic approaches aim to improve clinical outcomes by enhancing the body's natural healing capacity and reducing inflammation. They serve as an alternative to surgical interventions. While preliminary results from animal studies and small-scale clinical trials have been promising, the field of biologics still lacks robust clinical evidence supporting their efficacy. Biological therapies include PRP (platelet-rich plasma), mesenchymal stem cells (MSCs)/stromal cells/progenitor cells, bone marrow stem/stromal cells (BMSCs), adipose stem/stromal cells/progenitor cells (ASCs), cord blood (CB), and extracellular vesicles (EVs), including exosomes. The proper preservation and storage of these cellular therapies are essential for future use. Preservation techniques include cryopreservation, vitrification, lyophilization, and the use of cryoprotective agents (CPAs). The most commonly used CPA is DMSO (dimethyl sulfoxide). The highest success rates and post-thaw viability have been achieved by preserving PRP with a rate-controlled freezer using 6% DMSO and storing other cellular treatments using a rate-controlled freezer with 5% or 10% DMSO as the CPA. Extracellular vesicles (EVs) have shown the best results when lyophilized with 50 mM or 4% trehalose to prevent aggregation and stored at room temperature.