Postoperative Orthopedic Patients Research Articles

Prospective study of post-operative hyponatremia in patients undergoing lower-limb orthopedic surgery

Prospective study of post-operative hyponatremia in patients undergoing lower-limb orthopedic surgery

Remote Patient Monitoring for Postoperative Pediatric Patients with Peripheral Nerve Catheters

Background: Close follow up of postoperative orthopedic and pectus excavatum surgical patients discharged with a nerve catheter is required to ensure adequate pain management and recognize medication toxicity. Assessing ambulatory pediatric patients using a smartphone application is convenient and effective. Methods: A novel Remote Patient Monitoring (RPM) program was developed to improve follow-up and ability to assess postoperative pain management, analgesic toxicity, and catheter site. Adherence and successful graduation were measured to determine the success of the program. Additionally, patient and caregiver experience and opioid use were measured. Interventions: Patients were enrolled in RPM postoperatively for four days. The RPM nursing team reviewed patient reported data in real-time to address concerns and develop a plan of care. Pain management education was provided via video prior to removing the nerve catheter. Results: Adherence to RPM is over 90% for both populations, with 82% success rate in orthopedic patients and 93% success rate in pectus excavatum patients. Experience scores have been high, and opioid prescriptions have been reduced by half for the orthopedic population. Conclusions: RPM is an effective tool used to manage pediatric postoperative orthopedic and pectus excavatum surgical patients with significant patient and caregiver buy-in.

Massachusetts' opioid limit law associated with a reduction in postoperative opioid duration among orthopedic patients.

Postoperative orthopedic patients are a high-risk group for receiving long-duration, large-dosage opioid prescriptions. Rigorous evaluation of state opioid duration limit laws, enacted throughout the country in response to the opioid overdose epidemic, is lacking among this high-risk group. We took advantage of Massachusetts' early implementation of a 2016 7-day-limit law that occurred before other statewide or plan-wide policies took effect and used commercial insurance claims from 2014-2017 to study its association with postoperative opioid prescriptions greater than 7 days' duration among Massachusetts orthopedic patients relative to a New Hampshire control group. Our sample included 14 097 commercially insured, opioid-naive adults aged 18 years and older undergoing elective orthopedic procedures. We found that the Massachusetts 7-day limit was associated with an immediate 4.23 percentage point absolute reduction (95% CI, 8.12 to 0.33 percentage points) and a 33.27% relative reduction (95% CI, 55.36% to 11.19%) in the percentage of initial fills greater than 7 days in the Massachusetts relative to the control group. Seven-day-limit laws may be an important state-level tool to mitigate longer duration prescribing to high-risk postoperative populations.

Detroit Interventional Pain Assessment Scale: A Pain Score and Method for Measuring and Evaluating Post-Operative Pain Management-A Prospective Study.

Background and Objectives: Orthopedic surgeons commonly prescribe opioids, surpassing all medical specialties. Our objective was to develop a pain management scale that captures medication use, patient-reported pain scores, and helps orthopedic surgeons evaluate their post-operative prescribing practice. Materials and Methods: An IRB-approved prospective study followed 502 post-operative orthopedic surgery patients over a six-month period. All patients were surveyed in an orthopedic clinic at a Level 1 US Trauma Center, during a routine follow-up. Patient pain satisfaction was assessed using the validated Interventional Pain Assessment (IPA) scale, which uses three categories: 0 (no pain), 1 (tolerable pain), and 2 (intolerable pain). Daily narcotic use was translated to morphine milligram equivalents (MMEs) using the Michigan Automated Prescription System (MAPS) narcotics registry. When patient pain satisfaction and narcotic usage were combined, this scale was called the Detroit Interventional Pain Assessment (DIPA) scale. Results: The five classes based on common prescription and usage of narcotics in this cohort include the following: A (no pain medication), B (over-the-counter medication), C (occasional use of short-acting narcotics 1-30 MMEs), D (consistent/regular use of short-acting narcotics 31-79 MMEs), and E (long-duration or stronger short-acting narcotics 80+ MMEs). Patients were most satisfied with their pain management at six weeks (80.5%) and three months (75.65%), and least satisfied at two weeks (62.5%) and six months (60.9%). Additional information displayed on the DIPA graph revealed there was a significant decrease in the percentage of patients on narcotics at two weeks (65.2%) to six months (32.6%) at p < 0.001. Conclusions: The DIPA pain scale shows the relationship between patient pain perception and opioid prescription/usage, while also tracking prescriber tendencies. Providers were able to visualize their post-operative pain management progression at each designated clinic visit with corresponding alphabetical daily MME categories. In this study, results suggest that surgeons were not effective at managing the pain of patients at two weeks post-operative, which is attributed to an inadequate number of pain pills prescribed upon discharge. Overall, the DIPA graph signaled that better pain management interventions are necessitated in periods with lower efficiency scores.

Surgical Opioid Stewardship for Orthopedic Surgery: A Quality Improvement Initiative.

The aim of this quality improvement initiative was to reduce unnecessary opioid prescribing by sharing data with prescribers on opioid use by patients. In our study, transition of care clinicians performed follow-up phone calls to select postoperative orthopedic patients to determine opioid use. We implemented a standardized postoperative 7-day opioid wean and designed a dashboard to track the information gathered. We calculated descriptive statistics for continuous and categorical variables. In the initial assessment of opioid use by orthopedic patients, the study consisted of 296 patients with a mean age of 64.8±11.4 years, 147 females (49.7%) and 149 males (50.3%), 59.1% joint replacements (hip, knee, shoulder), and 40.9% spine surgeries (lumbar decompression, cervical fusion, hemilaminectomy). Among those prescribed an opioid, 50% received a prescription for 30 pills or less and 52.4% reported taking more than 80% of the opioid pills, while 35.1% reported taking less than 60%. In the prescribing quality improvement assessment, there were a total of 1547 hospitalizations for joint replacement surgeries from June 2018 to June 2020: 774 (50.0%) hips and 773 (50.0%) knees. There was a significant difference in morphine milligram equivalents per day and quantity prescribed when comparing the preintervention period with the postintervention period without significant increases in opioid refill requests or return visit rates. In our study, sharing data around patient opioid use and provider-facing prescribing metrics reduced postoperative opioid prescribing without significantly increasing opioid refill or emergency department return visit rates. [Orthopedics. 2023;46(4):e230-e236.].

Effectiveness of melatonin treatment for sleep disturbance in orthopaedic trauma patients: A prospective, randomized control trial

ObjectivesExplore sleep disturbance in postoperative orthopedic trauma patients and determine the impact of melatonin supplementation on postoperative sleep, pain, and quality of life. Materials and MethodsIn this prospective, randomized controlled trial at a Level I trauma center, 84 adult orthopedic trauma patients with operative fracture management were randomized 2-weeks postoperatively to either the melatonin or placebo group. Patients randomized to the melatonin group (42 subjects, mean age 41.8 ± 15.5 years) received 5 mg melatonin supplements. Patients in the placebo group (42 subjects, mean age 41.3 ± 14.0 years) received identical glucose tablets. Both groups were instructed to take the tablets 30 minutes before bed for 4 weeks and received sleep hygiene education and access to the Cognitive Behavioral Therapy for Insomnia (CBT-I) Coach app. Main Outcome MeasuresOur primary outcome was sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes were pain measured by the Visual Analog Scale (VAS), quality of life measured by the 36-Item Short Form Survey (SF-36), and opioid use. ResultsPatients in both groups had significant sleep disturbance (PSQI ≥ 5) at 2-weeks (83%) and 6-weeks (67%) postoperatively. PSQI improved by 3.3 points (p<0.001) at follow-up, but there was no significant difference between groups (melatonin PSQI = 5.6, placebo PSQI = 6.1, P = 0.615). Compared to placebo, melatonin did not affect VAS, SF-36, or opioid use significantly. ConclusionSleep disturbance is prevalent in orthopedic trauma patients. Melatonin treatment did not significantly improve subjective sleep quality, pain, quality of life or opioid use. Level of evidenceTherapeutic Level I.

Effectiveness of Passive Range-of-motion Exercises on Quality of Sleep among Postoperative Orthopedic Patients

Effectiveness of Passive Range-of-motion Exercises on Quality of Sleep among Postoperative Orthopedic Patients

Effectiveness of early mobilisation versus laxative use in reducing constipation in post-operative orthopaedic patients: an integrative review

Objective: To explore which nursing intervention: early mobilisation versus laxative use, is more effective in reducing constipation in post-operative orthopaedic patients who require strong analgesia. Background: The use of opioids to manage pain in orthopaedic patients causes post-operative constipation. Nursing interventions used to relieve constipation in patients post-operatively include encouraging patients to eat a high fibre diet, to increase their hydration, to mobilise and to use laxatives. However, varying results have been demonstrated on the effects of early mobilisation and laxative use, specifically in managing opioid-induced constipation. Study design and methods: An integrative literature review was used to identify articles from online databases between January 2000 and June 2020. Grey literature was also utilised. Data were quality appraised, extracted, and thematic analysis was used to synthesise the results. Results: The use of laxatives was effective in some studies, while some studies found laxatives to be either ineffective or partially effective. Most of the studies and grey literature recommended early mobilisation, however not in isolation, but in conjunction with other interventions including increased fibre, fluid intake and laxative use. Discussion: Although the benefits of early mobilisation have been identified, it is not advocated for independently and is usually advocated for in conjunction with other interventions such as a diet high in fibre, increased water intake along with laxative use. Laxatives used as the first line of constipation treatment are not always effective. Multiple doses are often required as they may not deal with the underlying cause of opioid-induced constipation. Conclusion: This study determined there is no clear evidence to support a singular course of action; early mobilisation or laxative use. Each intervention potentially contributes to preventing constipation therefore both interventions should be utilised concurrently. Implications for research, policy, and practice: Post-operative constipation is an ongoing problem in this subset of patients. However, there is always a need for reviewing current practices and re-educating and reminding patients and staff of the benefits of a multipronged approach. Practices recommended include discouraging bedpans, following protocols, documentation and having an open dialogue with patients. Further research is needed to examine the effectiveness of early mobilisation only in relieving constipation in post-operative orthopaedic patients and orthopaedic patients in general who require strong analgesia. What is already known about the topic? The continuous use of opioids to manage pain post-operatively in orthopaedic patients results in opioid-induced constipation. The advice given currently advocates a mix of pharmacological and non-pharmacological interventions to relieve constipation. What this paper adds: There is no evidence that either early mobilisation or laxatives are effective in preventing post-operative constipation. Both interventions should be utilised concurrently. Research addressing whether early mobilisation only can relieve constipation is needed.

C-reactive Protein Is a Diagnostic Tool for Postoperative Infection in Orthopaedics

BackgroundOrthopedic fracture-associated infection is a prevalent complication with a huge burden on the healthcare infrastructure. C-reactive protein (CRP) is a widely used serum inflammatory marker in patients with infections in orthopaedics. It could be difficult to distinguish between CRP elevation caused by surgical site infection and CRP elevation caused by surgery and trauma in orthopaedic procedures. In most situations, a clinical diagnosis of post-surgical infection is sufficient, however, the use of a biomarker with predictive value for acute post-op complications could prompt an earlier diagnosis. This study, therefore, aims at assessing CRP levels in post-operative orthopaedic trauma patients and determining the reliability of CRP as an early indicator of postoperative infection.Materials and methodsA prospective study was conducted between December 2020 and November 2021 in the department of orthopaedics in Sri Devaraj Urs medical college, Kolar. Patients with an open and closed fracture of the upper and lower extremities treated by osteosynthesis on an elective or emergency basis were included. The clinical parameters were studied on the day of trauma, postoperative days first, third and seventh. Blood samples for CRP were taken prior to the surgical procedure and on the same days as clinical monitoring. The CRP levels were compared between patients with postoperative infection and patients without postoperative infections using independent samples t-test. A p-value of < 0.05 was considered statistically significant.ResultsA total of 51 patients were included in the study meeting the inclusion criteria, of which mean standard deviation for age was 37.5 (15.7%), 44 were men (86.2%) and seven were women (13.7%), Patients according to Tscherene classification grade I were 10 (19.6%), grade II were eight (15.6%), grade III were 15 (29.4%) and grade IV was 18 (35.2%), type of fracture surgery diaphyseal were 27 (52.9%), proximal was 11 (21.5%) and distal were 13 (25.4%). 15 patients developed postoperative infection with CRP levels of 96 µg/mL in nine (17.6%), 48 µg/mL in four (7.8%) and 24 µg/mL in two (3.9%). Thirty-six patients who did not develop post-operative infection had CRP levels of 6 µg/mL in 31 (60.8%) and 12 µg/mL in five (9.8%). The p-value for the first postoperative day was 0.289 and statistically insignificant and on the third and seventh postoperative days was <0.001 and was found to be statistically significant.ConclusionC-reactive protein is a useful parameter to detect and monitor post-operative infections in orthopaedic trauma surgeries. The rise in C-reactive protein on the third and seventh postoperative days can be used as a reliable predictor of post-operative infections.

Safety of a Novel Obstructive Sleep Apnea Triage Tool for Postoperative Orthopedic Surgery Patients

PurposeThe purpose of this quality improvement project is to provide a tool for effective and safe triage of postoperative patients in the postanesthesia care unit with known or suspected obstructive sleep apnea (OSA) at an academic orthopedic hospital in New York City. DesignThe structure of this project was observational after implementation of a novel OSA triage tool. MethodsResults were reported from a single center experience in a hospital where there was no existing standard assessment tool consistently used to triage patients with either known or suspected OSA in the postoperative period. Adult patients who underwent orthopedic surgery between October 2018 and February 2020 and who had a known or suspected history of OSA were included. After admission to the postanesthesia care unit (PACU) and upon meeting their modified Aldrete criteria or after 2 hours had elapsed, the PACU primary provider used the OSA triage tool to assess whether the patient had a high or low risk of respiratory deterioration after discharge from the PACU related to OSA. Patients without high-risk criteria were discharged from the PACU to a medical/surgical unit. For patients with high-risk criteria, the PACU provider requested critical care consultation to determine each patient's appropriate hospital disposition upon PACU discharge. FindingsOver the course of the study period, 216 patients were evaluated using the OSA triage tool: 53.2% of the cohort was male, median BMI was 36.3 kg/m2, and 80.1% had a prior diagnosis of obstructive sleep apnea. Patients underwent a variety of orthopedic surgeries with 23.6% having undergone hip surgery, 51.4% knee surgery, 13.4% spine surgery, 9.7% shoulder surgery, and 1.9% foot or ankle surgery. Notably, with the use of this tool, only 12.5% of patients met criteria for critical care consult and 91.7% were admitted to the floor from the PACU. Rapid response for respiratory complications were not observed in any of the patients. There were only three patients who required critical care evaluation after PACU discharge. An anonymous survey completed by PACU nurse practitioners and anesthesiologists revealed a 96.8% self-reported satisfaction with OSA triage tool. ConclusionWe demonstrated that use of a OSA triage tool in the single-center orthopedic PACU at NYULH is potentially a safe and effective method of triaging patients with known or suspected OSA to acute care beds versus higher levels of care.

Effectiveness of Art Therapy on Pain Perception among Post-Operative Patients in Orthopedic wards of Selected Hospitals, UAE

Art therapy the essence of psychotherapy enables to reduce patient’s suffering from pain sensation by focusing the way the patient perceives the current situation; pain relieved as well along the way. The aim of the study was to assess the effectiveness of art therapy on pain perception among postoperative orthopedic patients and to find association between pain perception scores of postoperative patient with their selected demographic and clinical variables.Pre-experimental research design among 50 orthopedic post-operative selected using consecutive sampling technique. Demographic data, clinical data and pain scores assessed using numeric pain scale before and after the art therapy for three consecutive days. Majority (70%) of the participants were males. About 62% were married and 42% had primary level of education. Majority (32%) had road traffic accident and 28% meet with work site injuries. On day-1 pre-art most of the patients (52%) experienced moderate to severe pain (28%), on day-2 and day-3, they experienced mild (44%) to moderate (42%) level of pain. After an hour of the art therapy, pain assessment on day-1, the patients had mild (38%) to moderate (34%), while on day-2, majority (72%) experienced mild pain and 26% had moderate pain. On day-3, the pain was verbalized to be with mild (78%) to moderate (22%). Art therapy was effective in reducing pain (p=0.000) Variables like age, gender, educational level and nationality were noted to be significantly associated with the pain scores along with diabetes, hypertension, and type of injury. Art therapy is beneficial hence be utilized effectively by nurses to help alleviate pain among post- operative orthopedic patients.

Nature and characteristics of orthopaedic medical emergency team (MET) events: a retrospective study of 263 MET calls

Background: Medical emergency teams (MET) are globally recognized strategies to improve outcomes of deteriorating patients. This study aimed to compare characteristics of hypotension and nonhypotension MET calls by characterizing triggers, timings, risk factors, management strategies, and outcomes of postoperative orthopaedic MET calls and provide information in identifying patients who require further perioperative assessment to facilitate better patient care. Methods: A retrospective, single-center review of postoperative orthopaedic MET calls between October 2017 and April 2019 was performed. MET calls were categorized into three groups depending on MET triggers and analyzed by preoperative, intraoperative, and postoperative parameters. Results: Comparing hypotension-only MET events (Group 1) with other triggers (Group 3), Group 1 showed patients who were younger (71.9 yr vs. 75.8 yr, P=0.012), had elective procedures (52.0% vs. 37.1%, P=0.032), and had non-neck of femoral fracture (71.0% vs. 53.0%, P=0.007). They had fewer comorbidities (Charlson Comorbidity Index: 2.7 vs. 3.6, P=0.011), fewer imaging investigations (12.0% vs. 50.8%, P&lt;0.05), larger volume fluid boluses (0.36L vs. 0.09L, P&lt;0.05), and fewer medication changes (27.0% vs. 43.2%, P=0.013) or additions (18.0% vs. 56.8%, P&lt;0.05). Conclusions: Older age, emergency surgery, higher Charlson Comorbidity Index, preoperative delirium or dementia, and non-neck of femoral fracture orthopaedic patients were at higher risk of nonhypotension METs. In postoperative orthopaedic patients, hypotension-only METs were managed with an average crystalloid fluid bolus of 0.36L. Nonhypotension METs were more likely to be discharged to high level care nursing homes (HLCNH) and less likely to have an ICU admission. These findings have clinical implications for better patient identification and resource allocation of hospital systems. Level of Evidence: Level III.

Music Intervention to Orthopedic Patients: A Possible Alternative Solution to Control Pain.

Aims and Objective. Pain is a common problem associated with postoperative orthopedic patients; the current study is aimed at evaluating music intervention as an alternative method to control pain. Methodology. The experimental design of the current study was comparative, descriptive, and quasi-experimental. 38 postoperative orthopedic patients were equipped with pocket-size MP3 players with prerecorded music tracks (instrumental and lyrical) in Hindi, English, and Urdu. After that, pre-post-pain scores were recorded with the help of designed brief patient logs. Ultimately, a satisfactory survey was completed at discharge. Major Findings. It was found that during the intervention of music, the pain was significantly reduced from 5.40 to 2.98. There was a slight relationship between listening time and pain relief. It was also found that the feedback was extremely positive and each patient suggested the use of music to others with 96.6% recommendation. Conclusion. From the current study, it was found that music intervention can be beneficial to postoperative patient pain control. Further, it is hoped that the findings of the current experimental work will lead to improvements in the care of postoperative patients.

Effect of Music Therapy on Pain, Anxiety, and Use of Opioids Among Patients Underwent Orthopedic Surgery: A Systematic Review and Meta-Analysis.

Background of the topic revealed that orthopedic surgery is one of the most painful surgeries in which music therapy is found to be effective for reducing pain and anxiety. This study aimed to examine the effect of music therapy on pain, anxiety, and the use of opioids among patients who underwent orthopedic surgery. Methods include a comprehensive search was conducted in PubMed/MEDLINE, Embase, Ovid, Clinical Key, and Google Scholar for relevant randomized controlled trials (RCTs) and quasi-experimental studies published until December 2020 in the English language regarding music therapy in comparison to standard care on pain, anxiety, and opioid use among postoperative orthopedic patients. Results of the study included 13 studies, having a total of 778 patients included in a systematic review comprising ten RCTs and three quasi-experimental studies. Meta-analysis was performed on ten RCTs. The results showed a significant difference between the two groups regarding the use of music therapy in reducing the pain [standard mean difference (SMD) = −0.27; p = 0.002] and anxiety (SMD = −0.40; p = 0.0009). No statistically significant difference was found in the use of opioids and physiological variables between the two groups. Conclusion of the current evidence demonstrated that music therapy significantly reduces pain and anxiety among postoperative orthopedic patients. Researchers recommended using it in the routine care of orthopedic patients for managing their subjective feelings like pain and anxiety. Musical intervention timing, duration, and type of music can be changed according to specific clinical settings and medical teams.

Assessment of Functional Pain Score by Comparing to Traditional Pain Scores.

Background: Pain assessments, such as the Numerical Pain Scale (NPS) and Wong-Baker FACEs (FACEs), offer methods to quantify pain with simplistic descriptions on a scale of 0-10 or facial expressions. These tools have limitations and deliver insufficient information to the provider developing a pain management plan. A new Functional Pain Scale (FPS) assesses other scopes of pain, including the loss of function in activities of daily living, sleep habits, and communication. Although NPS and FACEs are traditionally used in clinical practice, FPS provides a functional assessment to help patients self-report their pain to their providers. Aim: Our study attempts to show a comparative data analysis of the FPS to NPS and FACEs. The purpose of our study is not to demonstrate FPS's superiority over NPS and FACEs but to fill the gaps of information necessary to communicate the type of pain a patient has to their provider. Due to its descriptive nature and clear scores, FPS should be implemented within electronic medical records (EMR) to help providers assess patients’ pain and evaluate the efficacy of interventions selected based on that pain.Design: A prospective, observational, single-center, cohort study was performed, with simultaneously administered surveys to compare pains scores on a new FPS to the common NPS and FACEs. The target sample was postoperative orthopedic patients above 18 years of age who can read and speak English. Patients were surveyed on all three pain scales: FPS, NPS, and FACEs and were asked to rate their pain perioperatively after their respective orthopedic procedures.Methods: Spearman correlation method was used to test for correlation between the three pain scales and Wilcoxon rank-sum test was used to compare means between FPS and NPS.Results: FPS has a strong correlation with FACEs (r = 0.647, p<0.05) and with NPS (r = 0.634, p<0.05). There is a significant difference in mean scores between FPS and NPS.Conclusion and study implications: The most reliable marker of pain is patient self-reporting. In routine assessment, because pain is one-dimensional, we as providers need to better define the range of 0-10. This can only be done via an algorithm regarding which functions are lost as pain intensities increase. FPS fits those requirements by offering suitable descriptions with each pain score. The implications of the study include a chance to remedy the opioid crisis that plagues healthcare. We need tools that assess and educate patients about their pain level and appropriately convey that information to providers. Furthermore, this study is a chance for innovative tools to be implemented to better change healthcare practice. If FPS gains traction, it can improve pain communication between patients and providers.

The impact of a standard pain assessment protocol on pain levels and consumption of analgesia among postoperative orthopaedic patients

BackgroundPain is a leading concern in post-surgical orthopaedic settings; andeffective pain assessment tools are important aspects of pain management. ObjectiveThis study assessed the effect of using standard pain assessment protocols (SPAP) on pain levels, pain management, and analgesia consumption among patients in the first 24 h following orthopaedic surgery. MethodsIn total, 101 patients were recruited and assigned to the comparison group (n = 50) and experimental group (n = 51). SPAP was used in the experimental group while the comparison group received routine care. Pain levels at rest and during movement and analgesic consumption were compared between the two groups. FindingsThere were significant differences in pain levels between the comparison and experimental groups. The experimental group consumed significantly less pain medication at 8–11 h of opioid medications and 12–15 h of non-opioid medications (P < .001). The use of non-pharmacological modalities was significantly higher in the experimental group compared to the comparison group (P < .001). ConclusionsRegular pain assessment and management using SPAP can promote pain management and reduce pain levels as well as reduce analgesia administration and promote the use of non-pharmacologic approaches. These outcomes can result in fewer side effects for patients. ImplicationsThe findings suggest that using SPAP can result in improved outcomes as well as the use of non-pharmacologic approaches to pain management. This approach can result in better outcomes and increased communication between the nurse and the patient.

Foot Plantar Pressure Measurement System for Static and Dynamic Condition

The purpose of this paper is to measure human foot pressure at various important points and to provide the proper diagnosis for treating the post-operative orthopedic patients. Measurement of the human foot pressure distribution can provide vital information and is of great value for medical diagnostics. The distribution of human plantar pressure data depends on the conditions of the foot such as foot structure, function, the posture control of the entire body and gait. This device data will contribute greatly to the diagnosis, estimation of surgery and a better understanding of the pathogenesis of diseased foot with abnormal pressure distribution. The device will measure the foot pressure with the help of FSR, force sensitive resistor sensors which are placed on the upside of the sole of shoe. These sensors are connected to the Arduino Mega 2560. A custom-made software is created using LabVIEW. The patient’s details can be fed in and are saved in this software and when executed, the pressure data values collected is converted into digital pattern and a pedobarography is generated. This pedobarography image is displayed and saved in a word document and thus, enables the doctors to examine the foot pressure based on the deduced results.

COVID-19-related healthcare closures negatively affect patient health and postoperative recovery

ObjectiveTo determine how COVID-19-related healthcare closures affect the health, recovery and access to resources of preoperative and postoperative orthopaedic sport medicine patients.MethodsPatients whose orthopaedic restorative surgeries were postponed as well as those within 3 months postoperative completed electronic questionnaires assessing physical health, emotional health, virtual care and access to resources. The EuroQoL-five-dimensional-three level (EQ-5D-3L) was included as a quantitative and standardised measure of general health status. Data were descriptively analysed using means, SD and qualitative measures.ResultsA total of 115 patients whose surgeries were postponed completed the survey. Notable findings included that 41.7% of patients reported an increase in their symptoms during the COVID-19-related closures, and 68.7% described a negative impact on their physical health. Furthermore, 62.6% of patients reported that the postponement of their surgery would negatively affect their ability to return to work. A substantial percentage of patients (71.3%) reported that postponement of their surgery had an overall negative impact on their physical and/or emotional health. The mean health state on the EQ-5D-3L visual analogue scale (VAS) scale was 69.9 (SD=18.7). A total of 198 patients within 3 months postoperative completed the survey. A majority of patients (69.7%) indicated that COVID-19-related healthcare closures had an overall negative affect on their recovery. One-third of patients (35.4%) stated that they experienced increased symptoms as a direct result of limited postoperative follow-up. Less than half (41.4%) of patients accessed virtual physiotherapy, and only 42.9% of those that did found it to be helpful in some way. Virtual orthopaedic follow-up was deemed helpful by 61.3% of patients but many commented that it did not replace inperson visits. The mean health state reported on the EQ-5D-3L VAS scale was 76.9 (SD=15.6).ConclusionThis study highlighted the significant impact of COVID-19-related healthcare closures on preoperative and postoperative orthopaedic sport medicine patients. It revealed that restorative procedures play an important role in maintaining physical and emotional health, as well as returning individuals to work and leisure activities. It also showed that virtual care did not adequately replace the hands-on assessments of allied care and orthopaedic specialists.Level of EvidenceV.

One-third of postoperative pediatric orthopedic patients pursue a career path in the healthcare field: a multicenter study.

One-third of postoperative pediatric orthopedic patients pursue a career path in the healthcare field: a multicenter study.

Comparison of Postoperative Pain in Two Groups of Children with Bone Fractures Receiving Pethidine and Paracetamol in Kerman Bahonar Hospital: A Clinical Trial Study

Background Paracetamol and Pethidine are two prevailing analgesics prescribed for postoperative orthopedic patients, each having different side effects and impacts on fracture healing. The present study was conducted to compare the impacts of Paracetamol and Pethidine on postoperative pain relief of children with bone fractures. Materials and Methods: Fifty children with orthopedic bone fracture surgery candidates were selected in a double-blinded clinical trial study. A random number table was utilized to classify children into two groups of Paracetamol or pethidine treatment. First, the pain intensity of each group was checked using the Visual Analog Scale (VAS). Six hours after the surgery, the first group received Pethidine (1mg/kg of body weight), and the second group received Paracetamol (1gr). Moreover, the VAS scales were checked for both groups 6, 12, and 24 hours later. Afterward, the pain intensity of both groups was assessed according to the VAS scale. Results: Independent t-test results revealed a significant difference between the pain intensity of paracetamol (44.24 ± 6.44), and Pethidine (52.68 ± 10.47) groups 6 hours after the surgery (p=0.03). Moreover, there was also a significant statistical difference between the pain intensity of two groups 12 and 24 hours after the surgery. Conclusion Given the effectiveness of Paracetamol and Pethidine on postoperative pain, both medications can be used for children with bone fractures.