Concept of Artificial Intelligence (AI) and Its Use in Orthopaedic Practice: Applications and Pitfalls: A Narrative Review

Background: The growth and use of Artificial Intelligence (AI) in the medical field is rapidly rising. AI is exhibiting a practical tool in the healthcare industry in patient care. The objective of this current review is to assess and analyze the use of AI and its use in orthopedic practice, as well as its applications, limitations, and pitfalls. Methods: A review of all relevant databases such as EMBASE, Cochrane Database of Systematic Reviews, MEDLINE, Science Citation Index, Scopus, and Web of Science with keywords of AI, orthopedic surgery, applications, and drawbacks. All related articles on AI and orthopaedic practice were reviewed. A total of 3210 articles were included in the review. Results: The data from 351 studies were analyzed where in orthopedic surgery. AI is being used for diagnostic procedures, radiological diagnosis, models of clinical care, and utilization of hospital and bed resources. AI has also taken a chunk of share in assisted robotic orthopaedic surgery. Conclusions: AI has now become part of the orthopedic practice and will further increase its stake in the healthcare industry. Nonetheless, clinicians should remain aware of AI’s serious limitations and pitfalls and consider the drawbacks and errors in its use.

Artificial Intelligence for Global Health: Difficulties and Challenges: A Narrative Review

Global health (GH) aims to improve healthcare for all people on the planet and eradicate all avoidable diseases and deaths. The inception of Artificial Intelligence (AI) is innovating healthcare practices and improving patient outcomes by shuffling enormous volumes of health data—from health records and clinical studies to genetic information analyzing it much faster than humans. AI also helps in the improvement of medical imaging and medical diagnosis. There is an increased optimism regarding the use of applications of AI locally but can these facets be translated globally in the advancement and delivery of healthcare with the help of AI. At present majority of AI developments and applications in health care provide to the needs of developed countries and there is little effort to develop programs which could help to improve healthcare delivery globally. We performed this narrative review to assess the difficulties and discrepancies in implementing AI in global health delivery and find ways to improve.

Hospitalizations for Osteoporosis-Related Fractures: Analysis from Eastern Saudi Arabia

Background and Objectives: Osteoporosis causes fragility fractures which increase the morbidity and mortality in the elderly. Our objective was to look at the hospital admissions due to fragility fractures and site of fractures. Methods: This is a retrospective study of a 2-year period (2017-2018), in which we evaluated all the admissions of fragility fractures at King Fahd Hospital of the University, Al Khobar, Saudi Arabia. A Fragility Fracture is a fracture which occurs in patients with low bone mass due to a fall from a standing height. The data were gathered from the Quadru Med patient care system for patients over the age of 50 years: sex, site of fracture, previous fractures, and treatment meted out. The hospitalization rate for fragility fractures was calculated by taking into consideration of all the adult admissions to the orthopaedic department. Ethical approval was obtained from the Institutional Review Board of the Hospital and the Imam Abdul Rahman Bin Faisal University, Dammam. Results: During the study period 187 patients with fragility fractures were admitted. The mean age was 68.55 ± 12.43 years;fracture femur was the most common with 136 (72.7%), tibia 15 (8%) and spine 14 (7.5%). At the time of discharge based on the T score of spine 50 were osteopenic and 45 were osteoporotic. Overall adult admission for the study period was 1410 patients and 13.26% were patients with fragility fractures. There were 3 (1.6%) deaths within the first 30 days in the hospital. Conclusions: Fracture femur was the most common fragility fracture seen in our study. Orthopaedic surgeons should be ready to treat all fragility fractures and treat osteoporosis appropriately so that a second fracture is prevented.

Developmental Dysplasia of the Hip (DDH) in Saudi Arabia: Time to Wake up. A Systematic Review (1980-2018)

The objective of this systematic literature review was to assess the incidence of DDH among the Saudi Arabian population. Methods: A systematic review was performed for all the published articles in the English language literature on DDH in Saudi Arabia. Data sources were PubMed Medline (1980-2018) (http://www.ncbi.nlm.nih.gov/pubmed/), Ovid Medline (1980-2018), EMBASE MEDLINE (1980 to May 2018), EMBASE (1991 to May 2018), the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, the Science Citation Index (1966 to May 2018), published data from the Saudi Medical Journal (1985-2018) and Annals of Saudi Medicine (1985-2018). The author independently reviewed articles and abstracted the data. The key words used were Saudi Arabia developmental dysplasia of the hip ORDDH, congenital hip dislocation or congenital subluxation of the hip, and congenital dysplasia of the hip. Results: The authors identified 18 potentially relevant articles published in the last 38 years, and 10 met the inclusion criteria. The 10 studies analyzed included 2037 studies of infants diagnosed with DDH;and they gave an average incidence of 10.46/1000. Two studies (303 subjects) did not report the affected gender;in the remaining 338 were boys and 1396 were girls and one study did not report the side of affection. The majority presented after 12 months of age. The right side was affected in 532 (27.2%) affected, 734 (37.6%) were left side and 687 (35.2%) infants were affected bilaterally. Consanguinity, breech presentation, and family history were found to be the risk factors in 32.9%, 17.3%, and 23.6% of the patients, respectively. Conclusions: There is paucity of available literature on DDH in Saudi Arabia. New strategies have to be developed that include mandatory screening programs in all hospitals (private and public) so that more children can be treated by nonsurgical methods.

Do osteoporosis-related vertebral fractures precede hip fractures?

AIM:To evaluate the relationship between a vertebral fracture and a hip fracture in Saudi Arabians with osteoporosis.METHODS:In this retrospective study,154 Saudi Arabian patients with osteoporosis-related hip fractures were analyzed for the presence of a vertebral fracture.Radiographs were retrieved from the IPAC(Image Picture Archiving and Computing)System,an imaging retrieval system,and were reviewed independently by two of the authors,Abid Hussain Gullenpet,and Mir Sadat-Ali,and later reviewed jointly.Patients admitted with proximal hip fracture who were≥50 years and had undergone Thoraco-lumber imaging and a dual energy X-ray absorptiometry(DEXA)scan were included in the study.Patients with a history of significant trauma to the spine and those with a malignancy or connective tissue disorder were excluded from the analysis.RESULTS:Out of 154 patients with hip fractures,78had a fracture of the femoral neck while 76 had an intertrochanteric hip fracture.Of the 111 patients whowere finally included in the study,after applying inclusion and exclusion criteria,76 patients with an average age of 67.28±12 years had no fractures of the spine.Thirty-five patients with an average age of 76.9±14.5years(31.53%)had a total of 49 vertebral fractures.Patients with vertebral fractures were significantly older than those without fractures P<0.001.Overall,24.7%of these patients had an asymptomatic vertebral fracture.Further analysis showed that 11 males(18.96%)and 24 females(45.28%)had suffered a previous asymptomatic vertebral fracture.Interestingly,all women who participated in this study and who presented with a femoral neck fracture had experienced a prior asymptomatic vertebral fracture.CONCLUSION:We recommend that all elderly patients who go to the radiology department for a chest X-ray also have a DEXA scan and a lateral thoracic spine radiograph.

Can we suppress excessive post-surgical scar formation:A case report

BACKGROUND Hypertrophic scars(HSs)formation is a complication that occurs after wounds heal with secondary intention and sometimes after clean surgical incisions.Many treatments are in vogue now with varying successes.Although the mechanism or mechanisms that cause a HS to form are not clearly understood,one thing that is clear is that once scar tissue matures,any intervention will not be successful.In this paper,we report on a case where a patient who was known to develop HS was treated with a new combination of ingredients(Phyto-chemicals+Silicone JUMI)to suppress HS formation.CASE SUMMARY A 68-year-old female of African descent presented a severe HS post total knee replacement(TKR),which the patient describes as itchy and painful.Due to complications caused by the scar,she was apprehensive about undergoing TKR on her other knee.However,after the TKR of the contralateral side post-removal of skin clips,JUMI anti-scar cream(JASC)was used to suppress excessive scar formation.CONCLUSION JASC appears potent and efficacious at suppressing excessive scar formation.We believe that this warrants further studies on larger patient groups and on different surgical sites.

Vancomycin flushing syndrome in orthopaedic practice:A case report

BACKGROUND Vancomycin flushing syndrome(VFS),also known as red man syndrome,is an allergic reaction to vancomycin.It typically presents as a rash on the face,neck,and upper torso after intravenous administration of vancomycin.VFS is blamed on rapid intravenous infusion of vancomycin during management and rarely happens after local use.A review of the literature showed that in the last 23 years,4 such cases have been reported.Here,we add another case of VFS developed after slow local absorption of vancomycin in cement beads.CASE SUMMARY A 44-year-old male with a known case of hypertension,no history of allergies to medications,and a history of chronic osteomyelitis of the right tibia with discharging sinus over the anterolateral aspect of the leg.The pus culture grew Staphylococcus aureus,which was sensitive to clindamycin and vancomycin.The patient underwent irrigation and debridement with the placement of vancomycin cement beads made from 4 g of vancomycin powder and 40 g of polymethyl methacrylate.Three hours postoperatively,the patient developed a pruritic,erythematous,macular rash predominantly on his face,neck,chest,and lower extremities and to a lesser extent his upper extremities.A diagnosis of VFS was made and was successfully treated with cetirizine(10 mg,oral)and methylprednisolone sodium succinate(125 mg,intravenous).The patient continued to have itching with a facial rash for 12 h with gradual improvement.A decision was made to not remove the beads as the patient continued to improve.Gradually,the rash disappeared after 96 h with no further sequela.CONCLUSION VFS can occur not only after rapid intravenous injection of vancomycin but also with local release,as in our case.As orthopaedic surgeons routinely use vancomycin with polymethyl methacrylate in chronic osteomyelitis and revision arthroplasty,they should be aware of such a complication occurring.

Spinal cord injury regeneration using autologous bone marrowderived neurocytes and rat embryonic stem cells:A comparative study in rats

BACKGROUND Spinal cord injury(SCI)is an important cause of traumatic paralysis and is mainly due to motor vehicle accidents.However,there is no definite treatment for spinal cord damage.AIM To assess the outcome of rat embryonic stem cells(rESC)and autologous bone marrow-derived neurocytes(ABMDN)treatment in iatrogenic SCI created in rats,and to compare the efficacy of the two different cell types.METHODS The study comprised 45 male Wistar rats weighing between 250 and 300 g,which were divided into three groups,the control,rESC and ABMDN groups.The anesthetized animals underwent exposure of the thoracic 8th to lumbar 1st vertebrae.A T10-thoracic 12th vertebrae laminectomy was performed to expose the spinal cord.A drop-weight injury using a 10 g weight from a height of 25 cm onto the exposed spinal cord was conducted.The wound was closed in layers.The urinary bladder was manually evacuated twice daily and after each evacuation Ringer lactate 5 mL/100 g was administered,twice daily after each bladder evacuation for the first 7 postoperative days.On the 10th day,the rats underwent nerve conduction studies and behavioral assessment[Basso,Beattie,Brenham(BBB)]to confirm paraplegia.Rat embryonic stem cells,ABMDN and saline were injected on the 10th day.The animals were euthanized after 8 wk and the spinal cord was isolated,removed and placed in 2%formalin for histopathological analysis to assess the healing of neural tissues at the axonal level.RESULTS All the animals tolerated the procedure well.The BBB scale scoring showed that at the end of the first week no recovery was observed in the groups.Post-injection,there was a strong and significant improvement in rats receiving rESC and ABMDN as compared to the control group based on the BBB scale,and the Trainof-four-Watch SX acceleromyography device exhibited statistically significant(P<0.0001)regeneration of neural tissue after SCI.Histological evaluation of the spinal cord showed maximum vacuolization and least gliosis in the control group compared to the rESC and ABMDN treated animals.In the ABMDN group,limited vacuolization and more prominent gliosis were observed in all specimens as compared to the control and rESC groups.CONCLUSION This study provided strong evidence to support that transplantation of rESC and ABMDN can improve functional recovery after iatrogenic SCI.The transplanted cells showed a beneficial therapeutic effect when compared to the control group.