Bibliometric analysis of research on the effects of human immunodeficiency virus in orthopaedic and trauma surgery

BACKGROUND There is little research investigating how human immunodeficiency virus(HIV)affects outcomes in orthopaedic surgery.With advances in treatment,HIV has become a chronic health problem and the chance of orthopaedic surgeons encountering it in clinical practice is increasing.AIM To ascertain the quantity and quality of peer-reviewed publications in orthopaedic journals about HIV.METHODS A search of the Web of Science database was carried out,identifying any articles relating to HIV published in orthopaedic journals.These were assessed for geographic origin and level of evidence.RESULTS Of 48.7%of orthopaedic journals listed on the Web of Science database had published articles relating to HIV.There were 168 articles about HIV in orthopaedic journals with only 40.5%(n=68)published in the time frame we analysed(January 2007 to September 2017).Very few articles came from lowincome countries and any articles published from that setting were collaborations.All of the articles were low level of evidence.CONCLUSION There is a need for more high level orthopaedic and trauma research investigating the effects of HIV,particularly research from low-income countries,where higher level research will help to guide improvements in their treatment of its musculoskeletal manifestations and complications.

PFNA2 versus 95 Degree Condylar Blade Plate in the Management of Unstable Trochanteric Fractures

Purpose: The proximal femoral nail anti-rotation (PFNA) is known to have advantages in enhancing the anchorage ability of internal fixation in elderly unstable osteoporotic intertrochanteric fracture patients. However whether it is superior to condylar blade fixation is not clear. This study aimed to determine which treatment has better clinical outcomes in older patients. Materials and Methods: A total of 86 patients over the age of 60 with unstable trochanteric fractures within the past 3 weeks, were included in this prospective study conducted from June 1, 2018, to May 31, 2021. All the intertrochanteric fractures were classified according to AO/OTA classification. Among them, 44 cases were treated with the Proximal Femoral Nail (PFNA2) with or without an augmentation screw, and 42 cases were treated with the Condylar Blade Plate. In addition, the operative time, intraoperative blood loss, intraoperative and postoperative blood transfusion, postoperative weight-bearing time, hospitalization time, Harris score of hip function, Kyle’s criteria and postoperative complications were compared between the two groups. Results: The mean duration of surgery for the PFN group was 66.8 minutes (on average), whereas for the condylar blade plate group, it was 99.30 minutes (on average). The PFNA2 group experienced less blood loss (average of 80 mL) compared to the condylar blade plate group (average of 120 mL). Union and partial weight-bearing occurred earlier in the PFNA2 group (14.1 weeks and 10.6 weeks, respectively) compared to the Condylar blade plate group (18.7 weeks and 15.8 weeks). In two patients from the PFNA2 group, screw backing out and varus collapse complications were encountered;however, these patients remained asymptomatic and did not require revision surgery. In two other patients, screw cut out and breakage of the nail at the helical screw hole leading to non-union of the proximal femur were observed during the nine-month follow-up, necessitating revision surgery with prosthetic replacement. Among the condylar blade plate group, three patients experienced complications, including blade breakage at the blade and plate junction. In two cases, the fracture united in varus, and in one case, the blade cut through, resulting in non-union of the femoral head, which required revision surgery. According to the Harris hip score and Kyle’s criteria, a good-excellent outcome was observed in 92.85% of cases in the PFNA2 group and 90.90% of cases in the condylar blade plate group. Conclusion: Both the Proximal Femoral Nail A2 and Condylar blade plate are effective implants for the treatment of unstable trochanteric fractures. The intramedullary implant promotes biological healing and allows for early ambulation with minimal complications. Similarly satisfactory restoration of anatomy and favorable radiological and functional results can be achieved with the biological fixation provided by the 95-degree condylar blade plate. However, the use of PFNA2 internal fixation technique has the advantage of less trauma in elderly patients than the 95-degree condylar blade plate.

Comparative evaluation of artificial intelligence systems'accuracy in providing medical drug dosages:A methodological study

BACKGROUND Medication errors,especially in dosage calculation,pose risks in healthcare.Artificial intelligence(AI)systems like ChatGPT and Google Bard may help reduce errors,but their accuracy in providing medication information remains to be evaluated.AIM To evaluate the accuracy of AI systems(ChatGPT 3.5,ChatGPT 4,Google Bard)in providing drug dosage information per Harrison's Principles of Internal Medicine.METHODS A set of natural language queries mimicking real-world medical dosage inquiries was presented to the AI systems.Responses were analyzed using a 3-point Likert scale.The analysis,conducted with Python and its libraries,focused on basic statistics,overall system accuracy,and disease-specific and organ system accuracies.RESULTS ChatGPT 4 outperformed the other systems,showing the highest rate of correct responses(83.77%)and the best overall weighted accuracy(0.6775).Disease-specific accuracy varied notably across systems,with some diseases being accurately recognized,while others demonstrated significant discrepancies.Organ system accuracy also showed variable results,underscoring system-specific strengths and weaknesses.CONCLUSION ChatGPT 4 demonstrates superior reliability in medical dosage information,yet variations across diseases emphasize the need for ongoing improvements.These results highlight AI's potential in aiding healthcare professionals,urging continuous development for dependable accuracy in critical medical situations.

Applications of finite element simulation in orthopedic and trauma surgery

Research in different areas of orthopedic and trauma surgery requires a methodology that allows both a more economic approach and the ability to reproduce different situations in an easy way. Simulation models have been introduced recently in bioengineering and could become an essential tool in the study of any physiological unity, regardless of its complexity. The main problem in modeling with finite elements simulation is to achieve an accurate reproduction of the anatomy and a perfect correlation of the different structures, in any region of the human body. Authors have developed a mixed technique, joining the use of a three-dimensional laser scanner Roland Picza captured together with computed tomography(CT) and 3D CT images, to achieve a perfect reproduction of the anatomy. Finite element(FE) simulation lets us know the biomechanical changes that take place after hipprostheses or osteosynthesis implantation and biological responses of bone to biomechanical changes. The simulation models are able to predict changes in bone stress distribution around the implant, so allowing preventing future pathologies. The development of a FE model of lumbar spine is another interesting application of the simulation. The model allows research on the lumbar spine, not only in physiological conditions but also simulating different load conditions, to assess the impact on biomechanics. Different degrees of disc degeneration can also be simulated to determine the impact on adjacent anatomical elements. Finally, FE models may be useful to test different fixation systems, i.e., pedicular screws, interbody devices or rigid fixations compared with the dynamic ones. We have also developed models of lumbar spine and hip joint to predict the occurrence of osteoporotic fractures, based on densitometric determinations and specific biomechanical models, including approaches from damage and fracture mechanics. FE simulations also allow us to predict the behavior of orthopedic splints applied to the correction of deformities, providing the recovering force-displacement and angle-moment curves that characterize the mechanical behavior of the splint in the overall range of movement.

Cost-analysis of inpatient and outpatient parenteral antimicrobial therapy in orthopaedics: A systematic literature review

BACKGROUND Increasing numbers of total joint arthroplasties and consecutive revision surgery are associated with the risk of periprosthetic joint infections (PPJI). Treatment of PPJI is complex and associated with immense socio-economic burden. One treatment aspect is parenteral antiinfective therapy, which usually requires an inpatient setting [Inpatient parenteral antibiotic therapy (IPAT)]. An alternative is outpatient parenteral treatment [Outpatient parenteral antibiotic therapy (OPAT)]. To conduct a health economic cost-benefit analysis of OPAT, a detailed cost analysis of IPAT and OPAT is required. So far, there is a lack of knowledge on the health economic effects of IPAT and OPAT for PPJI. AIM To review an economic comparison of IPAT and OPAT. METHODS A systematic literature review was performed through Medline following the PRISMA guidelines. RESULTS Of 619 identified studies, 174 included information of interest and 21 studies were included for quantitative analysis of OPAT and IPAT costs. Except for one study, all showed relevant cost savings for OPAT compared to IPAT. Costs for IPAT were between 1.10 to 17.34 times higher than those for OPAT. CONCLUSION There are only few reports on OPAT for PPJI. Detailed analyses to support economic or clinical guidelines are therefore limited. There is good clinical evidence supporting economic benefits of OPAT, but more high quality studies are needed for PPJI.

The management of the long head of the biceps in rotator cuff repair:A comparative study of high vs.subpectoral tenodesis

Background:Tenodesis of the long head of the biceps(LHB)is commonly undertaken during arthroscopic rotator cuff repair.We assessed the clinical and structural outcomes after high arthroscopic tenodesis(HAT)or mini-open subpectoral tenodesis(ST).We hypothesized that the clinical and structural results after HAT and ST are similar.Methods:We included 40 patients with rotator cuff tear and LHB tendinopathy.Twenty patients(7 women and 13 men;mean age:57.9 years;range:56-63 years)were treated using HAT,and 20 patients(8 women and 12 men;mean age:58.5 years;range:55-64 years)were treated using ST.Functional evaluation was performed preoperatively and at 6 weeks,6 months,and 1 year after surgery,using the Constant Murley Score and Simple Shoulder Test scores;the LHB was evaluated using the LHB score.A Visual Analogue Scale was administered to all patients preoperatively and 2 days after surgery.Results:The postoperative total and pain subscale’s Constant scores were significantly higher in the ST group.Moreover,2 LHB score values were significantly different between the groups.The postoperative LHB total score in the ST and HAT groups averaged 86.9±4.1(mean±SD)points and 73.3±6.4 points,respectively.The Pain/Cramps subscale in the ST and HAT groups averaged 47.1±5.9 and 33.2±4.6 points,respectively.The 2 groups showed no difference in Visual Analogue Scale values(5.5 in the HAT group;5.8 in the ST group)postoperatively.One patient in the HAT group reported a secondary onset of Popeye deformity.Conclusion:Both high arthroscopic and mini-open ST of the LHB tendon produced reliably good functional results,but the ST group was associated with better postoperative clinical outcomes.

Long noncoding RNA protein-disulfide isomerase-associated 3 regulated high glucose-induced podocyte apoptosis in diabetic nephropathy through targeting miR-139-3p

BACKGROUND Podocyte apoptosis plays a vital role in proteinuria pathogenesis in diabetic nephropathy(DN).The regulatory relationship between long noncoding RNAs(lncRNAs)and podocyte apoptosis has recently become another research hot spot in the DN field.AIM To investigate whether lncRNA protein-disulfide isomerase-associated 3(Pdia3)could regulate podocyte apoptosis through miR-139-3p and revealed the underlying mechanism.METHODS Using normal glucose or high glucose(HG)-cultured podocytes,the cellular functions and exact mechanisms underlying the regulatory effects of lncRNA Pdia3 on podocyte apoptosis and endoplasmic reticulum stress(ERS)were explored.LncRNA Pdia3 and miR-139-3p expression were measured through quantitative real-time polymerase chain reaction.Relative cell viability was detected through the cell counting kit-8 colorimetric assay.The podocyte apoptosis rate in each group was measured through flow cytometry.The interaction between lncRNA Pdia3 and miR-139-3p was examined through the dual luciferase reporter assay.Finally,western blotting was performed to detect the effect of lncRNA Pdia3 on podocyte apoptosis and ERS via miR-139-3p.RESULTS The expression of lncRNA Pdia3 was significantly downregulated in HG-cultured podocytes.Next,lncRNA Pdia3 was involved in HG-induced podocyte apoptosis.Furthermore,the dual luciferase reporter assay confirmed the direct interaction between lncRNA Pdia3 and miR-139-3p.LncRNA Pdia3 overexpression attenuated podocyte apoptosis and ERS through miR-139-3p in HG-cultured podocytes.CONCLUSION Taken together,this study demonstrated that lncRNA Pdia3 overexpression could attenuate HG-induced podocyte apoptosis and ERS by acting as a competing endogenous RNA of miR-139-3p,which might provide a potential therapeutic target for DN.

Enhanced microfracture techniques in cartilage knee surgery: Fact or fiction?

The limited intrinsic healing potential of human articular cartilage is a well-known problem in orthopedic surgery. Thus a variety of surgical techniques have been developed to reduce joint pain, improve joint function and delay the onset of osteoarthritis. Microfractures as a bone marrow stimulation technique present the most common applied articular cartilage repair procedure today. Unfortunately the deficiencies of fibrocartilaginous repair tissue inevitably lead to breakdown under normal joint loading and clinical results deteriorate with time. To overcome the shortcomings of microfracture, an enhanced microfracture technique was developed with an additional collagen Ⅰ/Ⅲ membrane(Autologous, Matrix-Induced Chondrogenesis, AMIC). This article reviews the pre-clinical rationale of microfractures and AMIC, presents clinical studies and shows the advantages and disadvantages of these widely usedtechniques. PubM ed and the Cochrane database were searched to identify relevant studies. We used a comprehensive search strategy with no date or language restrictions to locate studies that examined the AMIC technique and microfracture. Search keywords included cartilage, microfracture, AMIC, knee, ChondroGide. Besides this, we included our own experiences and study authors were contacted if more and non published data were needed. Both cartilage repair techniques represent an effective and safe method of treating full-thickness chondral defects of the knee in selected cases. While results after microfracture deteriorate with time, mid-term results after AMIC seem to be enduring. Randomized studies with long-term followup are needed whether the grafted area will maintain functional improvement and structural integrity over time.

Two-stage revision arthroplasty for coagulase-negative staphylococcal periprosthetic joint infection of the hip and knee

BACKGROUND Periprosthetic joint infections(PJIs)are frequently caused by coagulase-negative Staphylococci(CoNS),which is known to be a hard-to-treat microorganism.Antibiotic resistance among causative pathogens of PJI is increasing.Two-stage revision is the favoured treatment for chronic CoNS infection of a hip or knee prosthesis.We hypothesised that the infection eradication rate of our treatment protocol for two-stage revision surgery for CoNS PJI of the hip and knee would be comparable to eradication rates described in the literature.AIM To evaluate the infection eradication rate of two-stage revision arthroplasty for PJI caused by CoNS.METHODS All patients treated with two-stage revision of a hip or knee prosthesis were retrospectively included.Patients with CoNS infection were included in the study,including polymicrobial cases.Primary outcome was infection eradication at final follow-up.RESULTS Forty-four patients were included in the study.Twenty-nine patients were treated for PJI of the hip and fifteen for PJI of the knee.At final follow-up after a mean of 37 mo,recurrent or persistent infection was present in eleven patients.CONCLUSION PJI with CoNS can be a difficult to treat infection due to increasing antibiotic resistance.Infection eradication rate of 70%-80%may be achieved.

Improved patient reported outcomes with functional articulating spacers in two-stage revision of the infected hip

BACKGROUND Two-stage revision arthroplasty with an antibiotic-loaded spacer is the treatment of choice in chronically infected total hip arthroplasties.Interval spacers can be functional articulating or prefabricated.Functional results of these spacers have scarcely been reported.AIM To compare retrospectively the patient reported outcome and infection eradication rate after two-stage revision arthroplasty of the hip with the use of a functional articulating or prefabricated spacer.METHODS All patients with two-stage revision of a hip prosthesis at our hospital between 2003 and 2016 were included in this retrospective cohort study.Patients were divided into two groups;patients treated with a functional articulating spacer or with a prefabricated spacer.Patients completed the Hip Osteoarthritis Outcome Score and the EQ-5D-3L(EQ-5D)and the EQ-5D quality of life thermometer(EQVAS)scores.Primary outcomes were patient reported outcome and infection eradication after two-stage revision.The results of both groups were compared to the patient acceptable symptom state for primary arthroplasty of the hip.Secondary outcomes were complications during spacer treatment and at final follow-up.Descriptive statistics,mean and range are used to represent the demographics of the patients.For numerical variables,students’t-tests were used to assess the level of significance for differences between the groups,with 95%confidence intervals;for binary outcome,we used Fisher’s exact test.RESULTS We consecutively treated 55 patients with a prefabricated spacer and 15 patients with a functional articulating spacer of the hip.The infection eradication rates for functional articulating and prefabricated spacers were 93%and 78%,respectively(P>0.05).With respect to the functional outcome,the Hip Osteoarthritis Outcome Score(HOOS)and its subscores(all P<0.01),the EQ-5D(P<0.01)and the EQVAS scores(P<0.05)were all significantly better for patients successfully treated with a functional articulating spacer.More patients in the functional articulating spacer group reached the patient acceptable symptom state for the HOOS pain,HOOS quality of life and EQ-VAS.The number of patients with a spacer dislocation was not significantly different for the functional articulating or prefabricated spacer group(P>0.05).However,the number of dislocations per patient experiencing a dislocation was significantly higher for patients with a prefabricated spacer(P<0.01).CONCLUSION Functional articulating spacers lead to improved patient reported functional outcome and less perioperative complications after two-stage revision arthroplasty of an infected total hip prosthesis,while maintaining a similar infection eradication rate compared to prefabricated spacers.

Content of blood cell components,inflammatory cytokines and growth factors in autologous platelet-rich plasma obtained by various methods

BACKGROUND The evaluation of the efficacy of platelet-rich plasma(PRP) in clinical practice yields conflicting results and raises numerous controversies. This may be due to different concentrations of biologically active components in PRP obtained with the use of different methods of gravity separation.AIM To compare the content, repeatability and correlations between biologically active components in PRP obtained with four different commercial systems.METHODS From a whole blood sample of each of 12 healthy male volunteers, 4 PRP samples were prepared using 4 different commercial kits [Arthrex Autologous Conditioned Plasma(ACP), Mini GPS Ⅲ, Xerthra, Dr. PRP] in accordance with the instructions provided by the manufacturers. A comparative analysis of blood cell components-13 selected inflammatory cytokines and 7 growth factors-in the obtained PRP samples was performed using the Kruskal-Wallis test by ranks. The repeatability of results in each method was evaluated by the estimation of the coefficient of variation. The Spearman correlation was used to estimate the relationship between blood cell content and cytokines.RESULTS Significantly higher concentrations of platelets(PLT), white blood cells(WBC) and red blood cells(RBC) were found in PRP obtained with the use of Mini GPS Ⅲ than in PRP obtained using other systems. Significant differences in the content of growth factors and cytokines in PRP were found. A positive correlation of the amount of PLT, RBC and WBC with the concentration of most of the growth factors was found but in only three inflammatory cytokines. The obtained correlations between blood cell components and cytokines differed between the systems in terms of statistical significance, which may be due to insufficient sample size. The repeatability of the obtained PLT concentration also varied between protocols with the lowest in Xerthra and the highest in Arthrex ACP.CONCLUSION Significant differences in the content of biologically active components and their repeatability were found in PRP obtained by various methods, providing new data for further research.

Wrist joint moments of walker-assisted gait:a study of biomechanics and instrumentation

While walkers are commonly prescribed to improve patient stability and ambulatory ability,quantitative study of the biomechanical and functional requirements for effective walker use is limited.To investigate the changes in wrist joint moments that occur with the use of a standard walker,a strain gauge-based walker instrumentation sys- tem was developed for the measurement of wrist joint moments.This walker dynamometer was integrated with an up- per extremity biomechanical model.Preliminary system data were collected for twelve healthy,right-handed young a- dults following informed consent.Bilateral upper extremity kinematic data were acquired with a six-camera motion a- nalysis system.Internal joint moments at the wrist were determined in the three clinical planes using the inverse dy- namics method.Results showed that during a walker-assisted gait there were several typical demands of wrist abduc- tor,adductor,flexor and external rotator.An interesting'bare phase'of wrist joint moments was also found in phase angle[-30°,30°]of gait cycle.Complete description of wrist joint moments during walker-assisted gait may pro- vide insight into walker use parameters and rehabilitative strategies.

Consensus Delphi study on guidelines for the assessment of anterior cruciate ligament injuries in children

Background:Knee examination guidelines in minors are intended to aid decisionmaking in the management of knee instability.Clinical question:A Delphi study was conducted with a formal consensus process using a validated methodology with sufficient scientific evidence.A group consensus meeting was held to develop recommendations and practical guidelines for use in the assessment of instability injuries in children.Key findings:there is a lack of evidence to analyse anterior cruciate ligament injuries in children and their subsequent surgical management if necessary.Diagnostic guidelines and clinical assessment of the patient based on a thorough examination of the knee are performed and a guide to anterior cruciate ligament exploration in children is developed.Clinical application:In the absence of a strong evidence base,these established guidelines are intended to assist in that decision-making process to help the clinician decide on the most optimal treatment with the aim of benefiting the patient as much as possible.Following this expert consensus,surgical treatment is advised when the patient has a subjective sensation of instability accompanied by a pivot shift test++,and may include an anterior drawer test+and a Lachman test+.If these conditions are not present,the conservative approach should be chosen,as the anatomical and functional development of children,together with a physiotherapy programme,may improve the evolution of the injury.

Therapeutic Aspects of Chronic Bone Infections and Management Challenges

This study aims to investigate various aspects of the treatment of chronic bone infections and the challenges in their management. The characterization of treatment of 73 patients with chronic bone infection was reported. The four management challenges including consultation delay, immune depression, extreme variety of clinical manifestations and non-use of CT or MRI were discussed in this study. We conducted a retrospective study at Aristide Le Dantec Hospital on 90 cases of chronic bone infection in 73 patients. The mean duration of symptoms before consultation was 36 months. More than half of the patients had a productive fistula at the first consultation. Sickle cell anemia was found in 6 patients. Multiple lesions were found in 10 patients;and long bones were affected in 90% of cases. The bacterial culture was positive in 93.15%. Staphylococcus aureus was the most isolated germ (68.35%). Seventy-two out of seventy-three patients were operated on. The procedure depended on anatomical and radiological lesions. Surgical treatment was associated with antibiotherapy which was firstly probabilistic and secondarily adapted to the results of bacterial culture. A favorable trend was found in 41 patients (56.16%). 32 cases of adverse effects were noted (43.83%), and 27 patients had recurrence after a favorable outcome. Several complications and sequelae were observed demonstrating the tenacity of these chronic infections.

Tibialization of Fibula in Treatment of Major Bone Gap Defect of the Tibia: A Case Report

Gap bone defect is a major challenge. Its treatment has evolved over the years from amputation to limb reconstruction through vascularised graft, distraction osteogenesis and use of customised implants. Availability and affordability of these innovative techniques have always been an additional challenge in the developing resource poor countries. We report the use of Tibialization of Ipsilateral fibula first suggested by Hahns in 1884 to bridge a gap of 12 cm in an 8 year old male, with segmental tibia loss from chronic osteomyelitis. We did an end to end transposition of the ipsilateral fibular into the tibia gap defect in a one stage procedure. This was after eradication of the infective process of osteomyelitis. He commenced partial weight bearing ambulation in cast at 3 months and out of cast ambulation at 18 months post surgery. The transposed fibula was 75% tibialized at 18 months post surgery. Conclusion: Fibular is a useful armamentarium in filling segmental bone defect.

Return to sport following scaphoid fractures:A systematic review and meta-analysis

BACKGROUND Scaphoid fracture is the most commonly fractured carpal bone in the athletic patient, accounting for over 85% of all sport-related carpal bone fractures, and is particularly common in sports involving high impact injuries to the wrist. The management of such injuries comprises both conservative and surgical techniques, as guided by fracture location and type. Athletes demonstrate a unique challenge with regards to the management of scaphoid fractures due to their requirement to return to sport, as soon as able.AIM To review systemically all studies recording return to sport following scaphoid fractures, to collate information on return rates to sport(RRS) and mean return times(RTS) to sport and to determine differences in sporting outcome for the various treatment methods.METHODS A systematic search of MEDLINE, EMBASE, CINAHAL, Cochrane, Google Scholar, Physiotherapy Evidence Database, SPORTDiscus, Web of Science and Scopus was performed in August 2018 using the keywords "scaphoid","fracture", "acute", "carpal", "athletes", "sports", "non-operative","conservative", "operative" and "return to sport". All studies that recorded RRS and RTS following scaphoid fractures were included. RTS was recorded as the length of time from commencement of either primary conservative management or primary surgical procedure to return to sport.RESULTS Eleven studies were included: Two randomised controlled trials, six retrospective cohort studies and three case series. Seven studies reported on conservative management(n = 77), and eight studies reported on surgical management(n =83). For conservative management, RRS was 90%(69/77), and the mean RTS was9.6 wk. Three studies allowed to return to sport in cast [RRS 89%(25/28); RTS 1.9 wk], and four studies required completion of cast treatment prior to returning to sport [RRS 90%(44/49); RTS 13.9 wk]. Four studies recorded fracture union data:Union rate 85%(47/55); mean time to union 14.0 wk. For surgical management,RRS was 98%(81/83), and RTS was 7.3 wk. Three studies reported on Percutaneous Screw Fixation [RRS 97%(32/33); RTS 6.5 wk], and five studies reported on Open Reduction Internal Fixation [RRS 98%(49/50); RTS 7.9 wk]. Six studies recorded fracture union data: Union rate 97%(69/71); mean time to union9.8 wk. On meta-analysis, RRS(RR = 1.09; 95% confidence interval(CI): 1.00-1.18;P < 0.045), RTS(MD 2.3 wk; 95%CI: 0.79-3.87; P < 0.002), union rates(RR = 1.14;95%CI: 1.01-1.28; P < 0.030) and mean times to union(MD 4.2 wk; 95%CI: 3.94-4.36; P < 0.001) were all significantly better for the surgical cohort compared to the conservative cohort.CONCLUSION Surgical management of scaphoid fractures can provide significantly improved RRS and RTS to sport compared to conservative management. Both treatments,however, remain acceptable options, and athletes should be fully informed of the benefits and risks of both prior to deciding treatment plans. Immediate return to sport in a cast should be avoided due to the significant risk of non-union.

Lumbar and cervical viscoelastic disc replacement:Concepts and current experience

The ideal lumbar and cervical discs should provide six degrees of freedom andtri-planar (three-dimensional) motion. Although all artificial discs are intended toachieve the same goals, there is considerable heterogeneity in the design oflumbar and cervical implants. The “second generation total disc replacements”are non-articulating viscoelastic implants aiming at the reconstruction ofphysiologic levels of shock absorption and flexural stiffness. This review aims togive an overview of the available implants detailing the concepts and thefunctional results experimentally and clinically. These monobloc prostheses raisenew challenges concerning the choice of materials for the constitution of theviscoelastic cushion, the connection between the components of the internalstructure and the metal endplates and even the bone anchoring mode. Newobjectives concerning the quality of movement and mobility control must bedefined.

Novel Walking Stability-Based Gait Recognition Method for Functional Electrical Stimulation System Control

Gait recognition is the key question of functional electrical stimulation (FES) system control for paraplegic walking. A new risk-tendency-graph (RTG) method was proposed to recognize the stability information in FES-assisted walking gait. The main instrument was a specialized walker dynamometer system based on a multi-channel strain-gauge bridge network fixed on the walker frame. During walking process, this system collected the reaction forces between patient's upper extremities and walker and converted them into RTG morphologic curves of dynamic gait stability in temporal and spatial domains. To demonstrate the potential usefulness of RTG, preliminary clinical trials were done with paraplegic patients. The gait stability levels of two walking cases with 4- and 12-week FES training from one subject were quantified (0.43 and 0.19) from the results of temporal and spatial RTG. Relevant instable phases in gait cycle and dangerous inclinations of patient's body during walking process were also brought forward. In conclusion, the new RTG method is practical for distinguishing more useful gait stability information for FES system control.

Periprosthetic joint infections in femoral neck fracture patients treated with hemiarthroplasty–should we use antibiotic-loaded bone cement?

BACKGROUND Hemiarthroplasty is the most common treatment in elderly patients with displaced intra-capsular femoral neck fracture(FNF).Prosthetic joint infection(PJI)is one of the most feared and frequent complications post-surgery because of the frail health status of these patients and the need for fast track surgery.Therefore,priorities should lie in effective preventive strategies to mitigate this burden.AIM To determine how much the implementation of the routine use of antibioticloaded bone cement(ALBC)as a relatively easy-to-apply amendment to the surgical practice reduces the infection rate in our hemiarthroplasty cohort.METHODS We retrospectively assessed all demographic,health status and treatment-related data of our FNF patients undergoing cemented hemiarthroplasty in the period from 2011 to 2017;241 patients were further analyzed after exclusion of patients with cancer-related sequelae and those who died before the end of the 1-year observation period.The PJI rate as diagnosed on basis of the Musculoskeletal Infection Society(MSIS)criteria 2011 was determined for each included patient and compared in function of the bone cement used for hip stem fixation.Patients were split into a group receiving a plain bone cement in the period from January 2011 to June 2013(non-ALBC group)and into a group receiving an ALBC in the period July 2013 to December 2017(ALBC group).Data analysis was performed with statistical software.We further calculated the cost-efficacy of the implementation of routine use of ALBC in the second group balancing the inhospital infection related treatment costs with the extra costs of use of ALBC.RESULTS In total 241 FNF patients who received cemented hemiarthroplasty in the period from January 2011 to January 2017 were eligible for inclusion in this retrospective study.There were 8 PJI cases identified in the ALBC group among n=94 patients,whereas 28 PJI cases were observed in the non-ALBC group among n=147 patients.The statistical analysis showed an infection risk reduction of 55.3%(in particular due to the avoidance of chronic delayed infections)in the ALBC group(95%CI:6.2%-78.7%;P=0.0025).The cost-evaluation analysis demonstrated a considerable cost saving of 3.500€per patient,related to the implementation of routine use of ALBC in this group.CONCLUSION Use of ALBC is a potent infection preventive factor in FNF patients receiving cemented hemiarthroplasties.It was further found to be highly cost-effective.

Treatment options for irreparable postero-superior cuff tears in young patients

Rotator cuff tears(RCTs) occur more commonly with advanced age,with most rotator cuff abnormalities in patients less than 30 years old being painful tendinoses or partial-thickness RCTs.Irreparable postero-superior cuff tears has been reported as frequent as 7% to 10% in the general population,and the incidence of irreparable RCTs in young patients is still unknown.Several surgical procedures have been proposed for young patients with irreparable postero-superior RCTs,such as rotator cuff debridement,partial rotator cuff repair,biceps tenotomy/tenodesis,rotator cuff grafting,latissimus dorsi tendon transfer,and reverse shoulder arthroplasty.After being thoroughly investigated in open surgery,arthroscopic techniques for latissimus dorsi tendon transfer have been recently described.They have been shown to be an adequate option to open surgery for managing irreparable postero-superior RCTs refractory to conservative management.