Buddhist monk Lin Daoren,specialist of traumatology and orthopedics

Buddhist monk Lin Daoren(790-850,from Xi'an,Shaanxi Province)was a specialist of traumatology and orthopedics of the Tang Dynasty.Secrets of Treating Wounds and Rejoining Fractures(Li Shang Xu Duan Fang)written by him is the first extant monography on traumatology and orthopedics in China.According to the preface of the book,he had profound medical knowledge especially about the theory,diagnosis and treatment for wounds and fractures.

An Approach to Modern Schools of Orthopedics and Traumatology of TCM

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Factors for Postponement or Cancellation of Operating Programs Set in the Orthopedics-Traumatology Department of Yalgado Ouédraogo University Teaching Hospital in Ouagadougou (Burkina Faso)

Objective: The purpose of this work was to study the factors of cancellations or postponement of regulated operating programs of the Orthopedic-Traumatology unit of Yalgado Ouédraogo University Teaching Hospital. Materials and Methods: This was a prospective descriptive study over a period of six months. All interventions postponed or canceled during the study period were included. Patients who died or were lost to follow-up before surgery were not included. Results and Comments: the postponement/ cancellation rate was 24.5%. Out of 83 operations cancelled, 72.3% of patients were under 50 years old [extreme 15 and 88 years old]. ASA classes I and II were dominant with 57% and 37% of patients canceled, respectively. There were more postponed interventions (67.5%) than definitive cancellations (32.5%). The causes found were avoidable in 68.7% of cases. The most common was the unavailability of labile blood products (57%), the lack of financial means (36%) and the absence of the patient (28%). The results of our study show that 53% of the causes of cancellations were related to the organization of the hospital. Conclusion: the cancellation rate of orthopedic surgeries remains high at Yalgado Ouédraogo University Teaching Hospital. Most of the causes of cancellations are potentially preventable and the vast majority of them are related to the organization of the hospital. Financial accessibility to care plays an important role in cancellations.

Application of artificial intelligence in trauma orthopedics: Limitation and prospects

The varieties and capabilities of artificial intelligence and machine learning in orthopedic surgery are extensively expanding.One promising method is neural networks,emphasizing big data and computer-based learning systems to develop a statistical fracture-detecting model.It derives patterns and rules from outstanding amounts of data to analyze the probabilities of different outcomes using new sets of similar data.The sensitivity and specificity of machine learning in detecting fractures vary from previous studies.AI may be most promising in the diagnosis of less-obvious fractures that are more commonly missed.Future studies are necessary to develop more accurate and effective detection models that can be used clinically.

Limb Lengthening and Reconstruction Society orthopedic surgeons in the United States:An analysis of geographical distribution,academic,leadership,and demographic characteristics

BACKGROUND The Limb Lengthening and Reconstruction Society(LLRS)is a premier orthopedic specialty organization that promotes limb reconstruction for all ages.LLRS membership characteristics,however,are poorly reported.This study delineates orthopedic surgeon LLRS members’demographic traits,academic achievement,leadership attainment,and geographical distribution across the United States.AIM To inform aspiring orthopedic professionals,as well as to promote growth and diversity in both the LLRS organization and overarching field.METHODS This cross-sectional study examined United States LLRS members’academic,leadership,demographic,and geographical attributes.After reviewing the 2023 LLRS member directory,Google search results were matched to the listings and appended to the compiled data.Sex and ethnicity were evaluated visually utilizing retrieved images.The Hirsch index(H-index)of academic activity,residency and fellowship training,other graduate degrees,leadership positions,practice type(academic or non-academic),and spoken languages were categorized.LLRS members per state and capita determined geographic distribution.The Mann Whitney U test was applied to compare H-index between males and females,as well as to assess member differences pertaining to affiliation with academic vs non-academic practice facilities.RESULTS The study included 101 orthopedic surgeons,78(77.23%)Caucasian and 23(22.77%)non-Caucasian,79(78.22%)male and 22(21.78%)female.Surgeons with DO degrees comprised only 3.96%(4)of the cohort,while the vast majority held MDs[96.04%(97)].Mean H-index was 10.55,with male surgeons having a significantly higher score(P=0.002).Most orthopedic surgeons(88.12%,)practiced in academic centers.Of those professionals who occupied leadership positions,14%were women,while 86%were men.Additionally,19(37.25%)United States regions and the District of Columbia lacked an LLRS-member orthopedic surgeon.Total per capita rate across the United States was 0.30 LLRS orthopedic surgeons per 1 million people.CONCLUSION Over 21%of LLRS members are women,surpassing prior benchmarks noted in orthopedic faculty reporting.LLRS members’high research productivity scores imply field dedication that can refine expertise in the limb lengthening and reconstruction space.Gender disparities in leadership remain,however,necessitating greater equity efforts.A low rate of LLRS representation per capita must be addressed geographically as well,to affect improvements in regional care access.This study can serve to support aspiring orthopedic professionals,inform diversity,leadership,and field advancement strategies,and maintain the continued goal of enhanced patient care worldwide.

A Review of the Application of Artificial Intelligence in Orthopedic Diseases

In recent years,Artificial Intelligence(AI)has revolutionized people’s lives.AI has long made breakthrough progress in the field of surgery.However,the research on the application of AI in orthopedics is still in the exploratory stage.The paper first introduces the background of AI and orthopedic diseases,addresses the shortcomings of traditional methods in the detection of fractures and orthopedic diseases,draws out the advantages of deep learning and machine learning in image detection,and reviews the latest results of deep learning and machine learning applied to orthopedic image detection in recent years,describing the contributions,strengths and weaknesses,and the direction of the future improvements that can be made in each study.Next,the paper also introduces the difficulties of traditional orthopedic surgery and the roles played by AI in preoperative,intraoperative,and postoperative orthopedic surgery,scientifically discussing the advantages and prospects of AI in orthopedic surgery.Finally,the article discusses the limitations of current research and technology in clinical applications,proposes solutions to the problems,and summarizes and outlines possible future research directions.The main objective of this review is to inform future research and development of AI in orthopedics.

Burden of routine orthopedic implant removal a single center retrospective study

BACKGROUND Open reduction and internal fixation represent prevalent orthopedic procedures,sparking ongoing discourse over whether to retain or remove asymptomatic implants.Achieving consensus on this matter is paramount for orthopedic surgeons.This study aims to quantify the impact of routine implant removal on patients and healthcare facilities.A retrospective analysis of implant removal cases from 2016 to 2022 at King Fahad Hospital of the University(KFHU)was conducted and subjected to statistical scrutiny.Among these cases,44%necessitated hospitalization exceeding one day,while 56%required only a single day.Adults exhibited a 55%need for extended hospital stays,contrasting with 22.8%among the pediatric cohort.The complication rate was 6%,with all patients experiencing at least one complication.Notably,34.1%required sick leave and 4.8%exceeded 14 d.General anesthesia was predominant(88%).Routine implant removal introduces unwarranted complications,particularly in adults,potentially prolonging hospitalization.This procedure strains hospital resources,tying up the operating room that could otherwise accommodate critical surgeries.Clearly defined institutional guidelines are imperative to regulate this practice.AIM To measure the burden of routine implant removal on the patients and hospital.METHODS This is a retrospective analysis study of 167 routine implant removal cases treated at KFHU,a tertiary hospital in Saudi Arabia.Data were collected in the orthopedic department at KFHU from February 2016 to August 2022,which includes routine asymptomatic implant removal cases across all age categories.Nonroutine indications such as infection,pain,implant failure,malunion,nonunion,restricted range of motion,and prominent hardware were excluded.Patients who had external fixators removed or joints replaced were also excluded.RESULTS Between February 2016 and August 2022,360 implants were retrieved;however,only 167 of those who met the inclusion criteria were included in this study.The remaining implants were rejected due to exclusion criteria.Among the cases,44%required more than one day in the hospital,whereas 56%required only one day.55%of adults required more than one day of hospitalization,while 22.8%of pediatric patients required more than one day of inpatient care.The complication rate was 6%,with each patient experiencing at least one complication.Sick leave was required in 34.1%of cases,with 4.8%requiring more than 14 d.The most common type of anesthesia used in the surgeries was general anesthesia(88%),and the mean(SD)surgery duration was 77.1(54.7)min.CONCLUSION Routine implant removal causes unnecessary complications,prolongs hospital stays,depletes resources and monopolizing operating rooms that could serve more critical procedures.

Application of aspirin and low molecular weight heparin in major orthopedic surgery:Meta analysis of a randomized controlled trial

Objective:The perioperative period of major orthopedic surgery is associated with a high risk of thrombosis,but the best chemopreventive agent for thrombosis prophylaxis is still inconclusive.For this reason,this paper evaluated the efficacy and safety of aspirin versus low-molecular heparin using a Meta-analysis.Methods:Ten randomized controlled studies on the application of aspirin and low-molecular heparin for the prevention of deep vein thrombosis in orthopedic major surgery were retrieved by computer searches of PubMed,CochraneLibrary,WebofScience,China Knowledge Network,Wanfang,and Vipul databases according to inclusion and exclusion criteria,and the literature was managed using Endnote software,and the data were analyzed using Revman 5.3 software was used to perform Meta-analysis of the extracted data,focusing on the effects of these two drugs on pulmonary embolism,deep vein thrombosis,major bleeding events,minor bleeding events,wound complications,mortality and blood loss within 90 days after major orthopedic surgery.Results:(1)Ten randomized controlled trials of high quality were included,with a total of 12,974 patients,7,026 in the aspirin group and 5,948 in the low-molecular heparin group;(2)Meta-analysis showed that aspirin had a higher incidence of pulmonary embolism(OR=1.59,95%CI:1.02 to 2.49,P=0.04)and deep vein thrombosis(OR=1.60,95%CI:1.26 to 2.02,P=0.0001)than low molecular heparin;(3)The incidence of major bleeding events(OR=0.85,95%CI:0.47 to 1.55,P=0.60),minor bleeding events(OR=0.79,95%CI:0.55 to 1.12,P=0.18),adverse wound reactions(OR=0.79,95%CI:0.48 to 1.31,P=0.36),mortality within 90 days(OR=0.69,95%CI:0.20 to 2.31,P=0.55)and perioperative blood loss(MD=0.69,95%CI:0.20 to 2.31,P=0.55)in both drug groups,mortality within 90 days(OR=0.69,95%CI:0.20 to 2.31,P=0.55)and perioperative blood loss(MD=0.69,95%CI:0.20 to 2.31,P=0.55)were not statistically significant.Conclusion:Low-molecular heparin was superior to aspirin in the prevention of pulmonary embolism and lower extremity deep vein thrombosis after major orthopedic surgery,but the safety and adverse drug reactions of both groups were basically similar.Based on this,the authors recommend that low-molecular heparin should be preferred for the prevention of deep vein thrombosis in major orthopaedic surgery;however,the inclusion of randomized controlled trials remains limited,necessitating high-quality,large-sample,long-term follow-up clinical studies.

Ultrasound in the diagnosis of clinical orthopedics:The orthopedic stethoscope

Ultrasonography has advantages over other imaging modalities in terms of availability and comfort,safety,and diagnostic potential.Operating costs are low compared with both computed tomography(CT)and magnetic resonance imaging(MRI).The portable equipment is accessible at locations distant from medical centers.Importantly,ultrasonography is performed while patients lie in a comfortable position,without pain or claustrophobia.Ultrasonography is a totally safe noninvasive imaging technique.In contrast to CT and X-rays,it does not emit ionizing radiation.Unlike MRI,it is safe for all patients,including those with cardiac pacemakers and metal implants,without any contraindications.Of the many indications for musculoskeletal ultrasonography,the evaluation of soft tissue pathology is particularly common.In addition,ultrasonography is useful for the detection of fluid collection,and for visualization of cartilage and bone surfaces.Color or power Doppler provides important physiological information,including that relating to the vascular system.The capability of ultrasonography in delineating structures according to their echotextures results in excellent pictorial representation.This imaging principle is based on physical changes in composition,as compared to imaging with MRI,which is based on changes in chemical composition.This article reviews the contribution of sonography to the evaluation of the musculoskeletal system.

Three-dimensional printing for the accurate orthopedics:clinical cases analysis

As an emerging technology to promote the combination of medicine and industry,the three-dimensional(3D)printing has developed rapidly in the fields of orthopedics,while its unique advantages in improving precise treatment still need to be further popularized.In this report,our team have exhibited several classic cases of integrating 3D printing into orthopedic clinical application,thereby further elaborating thoughts and opinions on the significance of 3D printing in the orthopedic clinical application,technical advantages,existing main problems and coping strategies.

Baishideng’s Reference Citation Analysis database announces the first Journal Article Influence Index of 104 core journals and a list of high-quality academic journals in orthopedics

After three rounds of rigorous evaluation of core journals in orthopedics conducted by the Reference Citation Analysis(RCA)editorial team of Baishideng Publishing Group(Baishideng),the RCA database of Baishideng officially released the 2022 Journal Article Influence Index(2022 JAII)of 104 core journals and a list of high-quality academic journals in orthopedics,for the first time on August 9,2022.The list of 104 core journals can be found at:https://www.referencecitationanalysis.com/SearchJournal.Among them,the highest 2022 JAII is 55.015 and the lowest is 3.076.This article introduces the 21 high-quality academic journals and describes the calculation method for the 2022 JAII,the evaluation process,and the inclusion principles for journals in the RCA.These steps are the underpinning of the RCA’s empirical journal academic evaluation service by which the digital platform addresses the needs of authors to select reliable journals for submission,readers to select high-quality literature for reading,and editors to track their own journal citation performance.As such,the RCA core journal list will serve as a useful Find-a-Journal tool.Any interested party is welcome to use this journal list and recommend it to their peers.

Impact of three dimensional printing in orthopedics

The primary objective of this article is to explore effects of latest development in the area of three dimensional(3D)printing&to assess its abilities,and further undertake helpful reporting.Here the focus is to assess ad vantages of 3D printing in orthopedics and analyze how 3D printed models help solve complex 3D orthopedics distortions.This study identified that 3D models manufactured by 3D printing models reduce medical parts de velopment cost and surgical planning time.Integrating 3D printing with orthopaedics helps in understanding the conditions of problems and achieving the operation succssfully.This technology can enable doctors/surgeons to design,produce,recreate and plan operations more accurately,carefully,and economicaly.3D models can assist specialists with a visual comprehension of the patient-particular pathology and life structures.Innovation in 3D printing initiated a scaffold for the virtual outline and execution of medical procedures.This research proposes the utilisation of 3D printers as an elective procedure for the fabrication of parts.It empowers surgeons/patients for better raining,education and research.In the future,there is a foreseeable expansion of additive manufacturing in orthopedics.

Influence of different anesthesia methods on stress reaction and hemodynamics for elderly orthopedics patients during operations

Objective:To study the influence of general anesthesia, epidural anesthesia and combined spinal and epidural anesthesia method on stress reaction and hemodynamics for elderly orthopedics patients during operations.Methods: A total of 90 cases of elder patients who received orthopedic operations were randomly divided to group A, B and C, with 30 cases per group. Three groups of patients were separately given by general anesthesia, epidural anesthesia and combined spinal and epidural anesthesia for operations;The variations of adrenocorticotrophic hormone (ACTH), Cortisol (Cor),β-endorphin (β-EP), Angiotensin-Ⅱ(Ang-Ⅱ), heart rate (HR) and blood pressure (SBP, DBP) on patients in three groups before anesthesia (T0), during skin incision (T1), after skin incision (T2) and extubation after operation (T3) were compared and analyzed.Results:During T1, T2, ACTH, Cor,β-EP and Ang-Ⅱlevels in 3 groups of patients were significantly higher than those during T0;SBP and DBP were significantly lower than that during T0;HR during T2 was significantly lower than that during T0;During T3, every index in 3 groups were recovered to levels close to that during T0;During T1, T2, ACTH, Cor,β-EP, Ang-Ⅱlevels in group B and C were significantly lower than that in group A. And levels in C was lower than that in B;SBP and DBP in group B and C were significantly higher than A. No HR statistical significance appeared between each group.Conclusions: During clinical anesthesia, we should choose suitable anesthesia method combined with actual situations of patients. Combined spinal and epidural anesthesia had a slight influence on hemodynamics of elder orthopedics patients during operation, and it could effectively alleviate stress reaction during operation.

Normal Variants of the Lower Limbs in Pediatric Orthopedics

Normal variants of lower limb development such as in-toeing, out-toeing, flat feet, bow-legs and knock knees are a common cause for parental concern and also a common source of referral to pediatric clinics. A thorough history and clinical examination is usually all that is required to make the diagnosis of a normal variant. They also help to exclude pathological conditions that may present in a similar fashion. Radiological and other investigations are not routinely required in children with normal variants of the lower limb except to exclude pathological conditions. Shoe inserts, orthoses and physical therapy are not to be encouraged as they provide no benefit. In the majority of cases the natural history is one of spontaneous resolution of the deformity. Surgery may, however, be required in a small number of patients greater than eight years in whom severe in or out-toeing is present. Parental education and reassurance is an important part of the treatment and must be re-emphasized.

What is the purpose of launching World Journal of Orthopedics?

The first issue of World Journal of Orthopedics(WJO),whose preparatory work was initiated on March 11,2010,will be published on November 18,2010.The WJO Editorial Board has now been established and consists of 114 distinguished experts from 26 countries.Our purpose of launching WJO is to publish peer-reviewed,high-quality articles via an open-access online publishing model,thereby acting as a platform for communication between peers and the wider public,and maximizing the benefits to editorial board members,authors and readers.

New Year's greeting and overview of World Journal of Orthopedics in 2021

On behalf of the Editorial Office of World Journal of Orthopedics(WJO),we extend our sincere gratitude to our authors,subscribers,readers,Editorial Board members,and peer reviewers,thanking each and every one for their contributions to WJO in 2020 and with wishes for a Happy New Year.It was the support of all our Editorial Board members and peer reviewers that allowed the Baishideng Publishing Group Inc to successfully carry out the complete peer review,editing and publishing processes for WJO in 2020.We have analyzed the data of WJO's manuscript submissions and article publications in 2020,the invited manuscripts for 2021,manuscript peer review,composition of Editorial Board,and citation of WJO's articles,and present the findings here.We expect to be even more productive and to further raise the academic rank of WJO in 2021.

Development and prospects of digital orthopedics in Hubei province

Based on the development and application of new technology,as a new interdisciplinary subject,digital orthopedics becomes an important development direction of modern medicine in the past years.Using digital orthopedics technology,such as 3D digital printing technology,mixed reality technology,provides new impetus of orthopedic surgery and indicates its great potential of precision medicine and personalized therapy for orthopedic disorders.In 2017,Hubei Branch of China Digital Orthopaedic Society of SociétéInternationale de Chirurgie Orthopédique et de Traumatologie(SICOT)was founded.It is an important milestone and academic event for the development of digital orthopedics in Hubei.After that,Hubei's digital orthopedics professionals have made great progress in clinical,scientific research,conference and social activities.The development of 5G technologies in China will provide more opportunities and challenges for global digital orthopedics in the near future.

Study on the Effect of the Intervention on Traditional Chinese Medicine Negative Heel Shoes in Geriatric Orthopedics Patients

In the clinical practice of orthopedics,geriatric patients are prone to form and exhibit complex and diverse clinical complications during long-term bedridden treatment.This can result in poor survival rate and adverse final clinical outcomes.Hence,it is essential to select appropriate methods for nursing intervention and health-care support for long-term bedridden geriatric orthopedic patients.It is of great significance to support and guarantee patients to obtain the best clinical results.This article focuses on the topic of interventional health effects of traditional Chinese medicine negative-heeled shoes in orthopedic bedridden patients,and two specific aspects were selected for a brief explanation.

Analgesic Efficacy of Intrathecal Bupivacaine with or without Morphine in Lower Limb Orthopedic Surgery. A Comparative Study

Background: Lower limb orthopaedic surgeries are commonly associated with moderate to severe postoperative pain. Adequate pain relief is essential for patients undergoing such procedures, as uncontrolled pain can lead to delayed recovery, prolonged hospitalization, and increased morbidity. Intrathecal administration of bupivacaine, a long-acting local anesthetic, has been shown to provide effective analgesia after lower limb orthopaedic surgery. However, the duration of analgesia with bupivacaine alone is limited, and the addition of an opioid, such as morphine, can prolong the duration of analgesia. Objective: The objective of this study was to document the comparative effect of adding morphine to intrathecal bupivacaine or only intrathecal bupivacaine for lower limb trauma orthopedic surgeries in terms of onset of action, duration of analgesia, pain severity, and side effects. Methods: This was a comparative longitudinal study design conducted at the Orthopaedic Unit of the Tamale Teaching Hospital. A simple random sampling technique was used to recruit 60 patients. A standard structured questionnaire was also used to collect data on the socio-demographics, and clinical features of patients, drug used,side effects and severity of pain at 24,48 and 72 hrs after surgery. Results: Co-administration of intrathecal bupivacaine with morphine produced good and long-lasting postoperative analgesia with a mean time of 1004.25 ± 310.43 minutes, whiles using only bupivacaine produced shorter postoperative analgesia with a mean time of 294.75 ± 195.53 minutes. The p-value p values of p = 0.635 and p = 0.689 respectively. Conclusion: The study revealed that co-administration of intrathecal bupivacaine with morphine emerged as a better option for postoperative pain management after lower limb orthopedic surgeries as compared to administering only bupivacaine regarding the duration of analgesia. Milder side effects like pruritus, nausea, and vomiting were seen in group B than in group A and were promptly well managed to the patient’s satisfaction.