Advancing orthopaedic trauma care through WhatsApp:An analysis of clinical and non-clinical applications,challenges,and future directions

The integration of WhatsApp,a widely-used instant messaging application(IMA),into the realm of orthopaedics and trauma surgery has emerged as a significant development in recent years.This paper explores the multifaceted role of WhatsApp in orthopaedics,focusing on its clinical and non-clinical applications,advantages,disadvantages,and future prospects.The study synthesizes findings from various research papers,emphasizing the growing reliance on mobile technology in healthcare.WhatsApp’s role in orthopaedics is notable for its ease of use,real-time communication,and accessibility.Clinically,it facilitates triage,teleconsultation,diagnosis,treatment,patient advice,and post-operative monitoring.Non-clinically,it supports telemedicine,teleradiology,virtual frac-ture clinics,research,and education in orthopaedic surgery.The application has proven beneficial in enhancing communication among healthcare teams,providing quick responses,and motivating junior physicians.Its use in educational settings has been shown to improve learner’s understanding and patient care.However,the use of WhatsApp in orthopaedics is not without challenges.Risks include the potential spread of misleading information,privacy concerns,and issues with image quality affecting diagnosis and treatment decisions.The paper acknowledges the importance of maintaining professional boundaries and the need for oversight measures to ensure content accuracy.Looking forward,the potential of WhatsApp and similar IMAs in orthopaedics lies in their ability to streamline data collection and retrieval,improve doctor-patient communication,and address challenges like bureaucratic red tape and limited resources.The paper suggests that future orthopaedic practice,particularly in emergency departments,will increasingly rely on such technologies for efficient patient management.This shift,however,must be approached with an understanding of the ethical,legal,and practical implications of integrating social media and mobile technology in healthcare.

Damage control orthopaedics: State of the art

Damage control orthopaedics(DCO) originally consisted of the provisional immobilisation of long bone-mainly femur-fractures in order to achieve the advantages of early treatment and to minimise the risk of complications, such as major pain, fat embolism, clotting, pathological inflammatory response, severe haemorrhage triggering the lethal triad, and the traumatic effects of major surgery on a patient who is already traumatised(the "second hit" effect). In recent years, new locations have been added to the DCO concept, such as injuries to the pelvis, spine and upper limbs. Nonetheless, this concept has not yet been validated in well-designed prospective studies, and much controversy remains.Indeed, some researchers believe the indiscriminate application of DCO might be harmful and produce substantial and unnecessary expense. In this respect, too,normalised parameters associated with the acid-base system have been proposed,under a concept termed early appropriate care, in the view that this would enable patients to receive major surgical procedures in an approach offering the advantages of early total care together with the apparent safety of DCO. This paper discusses the diagnosis and treatment of severely traumatised patients managed in accordance with DCO and highlights the possible drawbacks of this treatment principle.

Evaluating learning and change in orthopaedics: What is the evidence-base?

Learning and change are key elements of clinical governance and are responsible for the progression of our specialty.Although orthopaedics has been slow to embrace quality improvement,recent years have seen global developments in surgical education,quality improvement,and patient outcome research.This review covers recent advances in the evaluation of learning and change and identifies the most important research questions that remain unanswered.Research into proxies of learning is improving but more work is required to identify the best proxy for a given procedure.Learning curves are becoming commonplace but are poorly integrated into postgraduate training curricula and there is little agreement over the most appropriate method to analyse learning curve data.With various organisations promoting centralisation of care,learning curve analysis is more important than ever before.The use of simulation in orthopaedics is developing but is yet to be formally mapped to resident training worldwide.Patient outcome research is rapidly changing,with an increased focus on quality of life measures.These are key to patients and their care.Costutility analysis is increasingly seen in orthopaedic manuscripts and this needs to continue to improve evidence-based care.Large-scale international,multi-centre randomised trials are gaining popularity and updated guidance on sample size estimation needs to become widespread.A global lack of surgeon equipoise will need to be addressed.Quality improvement projects frequently employ interrupted time-series analysis to evaluate change.This technique’s limitations must be acknowledged,and more work is required to improve the evaluation of change in a dynamic healthcare environment where multiple interventions frequently occur.Advances in the evaluation of learning and change are needed to drive improved international surgical education and increase the reliability,validity,and importance of the conclusions drawn from orthopaedic research.

Communication after cancellations in orthopaedics: The patient perspective

AIM: To examine patients' perceptions on communication surrounding the cancellation of orthopaedic operations and to identify areas for improvement in communication.METHODS: A prospective survey was undertaken at a university teaching hospital within the department of Trauma and Orthopaedics. Patients admitted to an acute orthopaedic unit, whose operations were cancelled, were surveyed to assess patient satisfaction and preferences for notification of cancellation of their operations. Patients with an abbreviated mental test score of < 9, patients unable to complete the survey independently, those under 16 years of age, and any patient notified of the cancellation by any of the authors were excluded from this study. Patients were surveyed themorning after their operation had been cancelled thus ensuring that every opportunity was given for the medical staff to discuss the cancellation with the patient. The survey included questions on whether or not patients were notified of the cancellation of their surgery, the qualifications of the person discussing the cancellation, and patient preferences on the process. Satisfaction was assessed via 5-point Likert scale questions.RESULTS: Sixty-five consecutive patients had their operations cancelled on 75 occasions. Fifty-four point seven percent of the patients who had cancellations were notified by a nurse and 32% by a doctor. No formal communication occurred for 13.3% cancellations and no explanation was provided for a further 16%. Patients reported that they were dissatisfied with the explanation provided for 36 of the 75(48%) cancellations. Of those patients who were dissatisfied, 25(69.4%) were notified by a nurse. Twenty-three of the 24(96%) patients notified by a doctor were satisfied with the explanation and that communication. Of those patients who were notified by a nurse 83% patients reported that they would have preferred it if a doctor had discussed the cancellation with them. There was a significant difference in satisfaction between those counselled by a nurse and those notified by a doctor(P < 0.0001).CONCLUSION: Communication surrounding cancellations does not meet patient expectations. Patients prefer to be notified by a doctor, illustrating the importance of communication in the doctor-patient relationship.

Use of bone marrow derived stem cells in trauma and orthopaedics: A review of current concepts

There is a considerable amount of interest in the futurerole of bone marrow-derived stem cells(BMDSCs) and tissue engineering techniques to manage conditions within the musculoskeletal system. Repair of soft tissue and bone defects, in the early stages of injury, may lead to a reduction in progression of symptoms. Furthermore, troublesome soft tissue injuries that are notoriously fraught with problems either in healing or function, could be augmented with such techniques. The aim of this review paper is to look at the advances in such strategies to tackle these problems and assess how BMDSCs, with the aid of growth factors and scaffolds, are being used in vitro, animal and even human models to treat problems within the field of trauma and orthopaedics. There is plenty of evidence that the results are encouraging and thus gaining momentum toward their use in human studies.

Prophylactic Wound Drainage in Orthopaedics: A Comparative Evaluation of Closed Suction Drainage versus No-Drainage in a Nigerian Teaching Hospital

Background: Surgical wound drainage is practiced routinely by many orthopaedic surgeons despite studies that challenge the practice. Among proponents, the advantages of drainage include prevention of haematoma and/or seroma formation which potentially reduces the chances for infection, prevention of wound swelling, prevention of compartment syndrome and improvement of the local wound environment. Opponents argue that prophylactic wound drainage confers no significant advantages, increases the risk of infection and the need for blood transfusion with the attendant risks of this therapy. Aim: To ascertain if prophylactic drainage of clean orthopaedic wounds confer any significant advantages by evaluating wound and systemic factors in two treatment groups. Patients and Methods: A prospective analysis of 62 patients was undergoing clean orthopaedic procedures. The patients were randomly assigned to a “No drain” (study) group and a “drain” (control) group. Each group had 31 patients. Surgeons were blinded to the randomization process and the evaluation of clinical outcomes. The parameters assessed included pain, superficial wound infection, the need for post-operative transfusion, wound leakage, dressing changes and the surgery-discharge interval. Data was analysed using SPSS statistics version 20 (IBM Corp., New York). Results: There were no significant differences in the demographic data. Femoral fractures were the commonest indication for surgery (43.55%), and plate and screw osteosynthesis was the commonest procedure (48.4% in the drain group and 67.7% in the no-drain group). There was a significantly higher need for post-operative transfusion in the drain group (22.6% against 0%) as well as a significantly prolonged capillary refill time (2.39 + 0.56 secs versus 2.03 + 0.41 secs). Although not statistically significant, there were four cases (12.8%) of superficial wound infection in the drain group and 1 case (3.2%) in the no-drain group. Conclusion: Prophylactic wound drainage confers no significant advantages over no drainage and may contribute to increased treatment costs through an increased post-operative transfusion requirements.

The 5 Hallmarks of Biomaterials Success: An Emphasis on Orthopaedics

Over the past 200 years, there has been significant advancements in the fields of bioengineering and orthopaedics. Investigators, clinicians and manufactures are learning that the success of implant systems is not limited to a single factor, but a combination of variables that must work in unison to provide stability and high survivorship. Innovations continue to advance these fields and include: biomimetic alterations, three-dimensional, patient-specific reconstructions and novel coatings to mitigate aseptic loosening or other pathologies. However, implant systems continue to fail in clinical practice since they do not adhere to key fundamental principles. Therefore, this article is intended to highlight 5 hallmarks of biomaterials that should be considered during design, surgery, and post-operative rehabilitation.

Traditional Chinese Medicine in orthopaedics—Problems and future direction

Introduction: Orthopaedic surgery includes varieties of injuries and other pathologies. Treatments are complicated while healing and recovery take time. Rehabilitation needs planning and commitment. In the Chinese Communities, traditional medicine has been popular since hundreds of years ago and has remained so in spite of the current advances in medicine. The purpose of this review is to identify the techniques being used in current situations, the indications and problems. Varieties of Traditional Treatments: 1) Topical applications of herbs are very much welcome after joint sprains, inflammatory conditions and even fractures. 2) On the wide area of physical training, the Chinese Tai-chi and Qigong are excellent gentle exercises for personal pursues. These exercises emphasize on body-mind interactions and carry strong philosophical insights. 3) Acupuncture has become standard rehabilitation practice in some hospitals and is getting even more popular in pain control and rehabilitation training after nerve injuries. Problems: Topical agents for pain and inflammation are not totally safe because allergic adverse conditions could happen from time to time. The major concern could be the unawareness of non-unions or delayed unions in fracture cases after herbal applications because the traditional healers are using too little modern assessment tools. Physical trainings and acupunctures are on the whole safe, only that indications are not clearly defined. Future Direction: 1) Concerning the topical agents used for pain and swelling, the essential research requirements include demonstration on the topical agents’ anti inflammatory, angiogenic and cell regenerative effects. The capability of skin penetration needs to be confirmed and a final clinical trial will further confirm the efficacy. 2) Clinical researches trying to obtain evidence on the use of Tai-chi and Qigong on the neuromuscular recovery are plentiful, while their effects on cardiovascular and respiratory health are likewise encouraging. 3) Acupuncture has already become a standard treatment option for pain control, nausea/vomiting and neuromuscular recoveries.

Retraction note to four articles published in World Journal of Orthopaedics

Retraction Note to four articles published in World Journal of Orthopaedics:(1)Iwamoto J,Sato Y,Takeda T,Matsumoto H.Return to sports activity by athletes after treatment of spondylolysis.World J Orthop 2010;1(1):26-30 PMID:22474624 DOI:10.5312/wjo.v1.i1.26;(2)Iwamoto J,Sato Y,Takeda T,Matsumoto H.Effectiveness of exercise for osteoarthritis of the knee:A review of the literature.World J Orthop 2011;2(5):37-42 PMID:22474634 DOI:10.5312/wjo.v2.i5.37;(3)Iwamoto J,Sato Y,Takeda T,Matsumoto H.Analysis of stress fractures in athletes based on our clinical experience.World J Orthop 2011;2(1):7-12 PMID:22474626 DOI:10.5312/wjo.v2.i1.7;and(4)Iwamoto J,Takada T,Sato Y,Matsumoto H.Effect of risedronate on speed of sound in postmenopausal women with osteoporosis.World J Orthop 2013;4(4):316-322 PMID:24147269 DOI:10.5312/wjo.v4.i4.316.These articles[1-4]have been retracted at the request of the Editors-in-Chief as misconduct over authorship of the paper was detected and confirmed.

SCI收录的Journal of Pediatric Orthopaedics(《儿科矫形外科学》杂志)介绍

英文刊名：Journal of Pediatric Orthopaedics中文刊名：《儿科矫形外科学》

The Effects of Pre-Surgical Education on Patient Expectations in Total Knee Arthroplasties

As patients prepare for total-knee arthroplasty surgery, they have many expectations related to their long-term recovery and function. This research examined whether the use of a pre-surgical patient education class with an additional long-term expectation module addressing recovery during the first 12 months after surgery was more effective in modifying participant’s pre-surgical expectations than participants receiving the standard pre-surgical education class alone. Prior to the class each participant completed one disease-specific instrument, a general-health survey, and a total-knee replacement expectation survey. After the class, each participant once again completed the total-knee replacement survey. Included in the study were 42 participants who were enrolled in a pre-surgical education course that was randomized. The participants in the control group received the standard pre-surgical education addressing pre-surgical topics. The participants in the intervention group received the standard pre-surgical education plus an additional module that specifically addressed long-term recovery and function up to 12 months post surgery. The primary outcome of the data revealed that participants’ who received the standard pre-surgical education with the additional module and who had an educational level higher than highschool, had expectations that were able to be modified to coincide with the surgeons’ expectations.

Localizing the Language Network with fMRI and Functional Connectivity: Implications for Pre-Surgical Planning

Object: Functional MRI is frequently applied to lateralize language in pre-surgical planning, with potential to localize functionally important cortex too. Here we present BOLD signal activation maps and related functional connectivity, in response to three commonly administered fMRI language tasks. Methods: Datasets from 55 pre-surgical fMRI studies were analyzed. Verbal response naming, covert word generation and passive listening tasks were administered in all studies. Single-subject analyses, group analyses and region-of-interest analyses were conducted, and a multi-subject functional connectivity analysis was performed. Results: Single-subject analyses revealed that clinically important language regions were activated in all but three patients using the panel of tasks. Group analyses revealed significant bilateral BOLD signal increases in anterior and posterior language regions in response to verbal response naming and bilateral signal increase in posterior language regions only in response to passive listening. Covert word generation activated anterior language regions bilaterally and posterior language cortex in the dominant hemisphere. Functional connectivity analyses confirmed that activated regions were significantly correlated in all tasks. Conclusion: The findings of single-subject and group analyses add to the evidence supporting the use of a panel of fMRI tasks to map the language network for pre-surgical planning. Our findings support the additional use of functional connectivity analysis in routine language mapping to add to the localization value to fMRI. In addition, the results of our investigation demonstrate these three commonly applied tasks reliably activate unique aspects of the language network, which advocates closer individual inspection, guided by the surgical intervention planned.

Advances of biodegradable magnesium-based implants for orthopaedics

Stainless steel,titanium alloys,cobalt-chromium alloys and other metal materials are the most widely used orthopaedic implants.However,there are still some problems in clinical application,including a mechanical mismatch between metal and bone,inflammation and secondary operation.As a new generation of medical metal materials,magnesium(Mg)and its alloys have attracted much attention due to their excellent biodegradability.Biodegradable Mg-based metals have good mechanical and osteogenic properties,and are expected to become implant materials to treat challenging orthopaedic diseases.However,the rapid corrosion rate is still one of the main challenges restricting its clinical application.Alloy and surface modification are effective methods to control the corrosion rate of Mg alloys.This paper reviews the mechanical and biological properties of biodegradable Mg alloys and the problems when they are applied clinically,emphasizing the latest progress of Mg-based metals in alloying and surface modification.The status of the application of Mg-based implants in orthopaedics are also described.

Silver nanoparticle technology in orthopaedic infections

The irrational and prolonged use of antibiotics in orthopaedic infections poses a major threat to the development of antimicrobial resistance.To combat antimi-crobial resistance,researchers have implemented various novel and innovative modalities to curb infections.Nanotechnology involves doping ions/metals onto the scaffolds to reach the target site to eradicate the infective foci.In this conno-tation,we reviewed silver nanoparticle technology in terms of mechanism of action,clinical applications,toxicity,and regulatory guidelines to treat ortho-paedic infections.

Analysis of authors of Chinese Journal of Orthopaedics from 2005 to 2009

Objective To investigate the authors,the institution and endemic distribution of these authors of Chinese Journal of Orthopaedics,and understand the current situation and problems in the field of Orthopaedics.Methods The authors,the

The citation analysis of Chinese Journal of Orthopaedics from 2005 to 2009

Objective To evaluate the academic level and the popularity of Chinese Journal of Orthopaedics from the point view of citation.Methods According to the information of Chinese Medical Citation Index(CMCI),the amount and distribution of

情景模拟联合PBL教学法在脊柱侧弯住培教学中的应用研究

目的 探究情景模拟联合以问题为导向的教学法(problem-based learning,PBL)在脊柱侧弯住培教学中的应用效果。方法 将2020年1月—2021年12月在南通大学附属医院骨科参加住培的40名学员作为研究对象,并随机分为对照组(n=20,给予PBL教学法),观察组(n=20,给予情景模拟联合PBL教学法)。比较分析2组学员考核成绩、满意度及综合能力评价情况。结果在考核成绩方面,住培前2组学员考核成绩差异无统计学意义(P> 0.05),住培后观察组学员理论与实践的成绩分别是(91.04±3.14)分、(92.33±3.57)分,均高于对照组学员的(81.75±2.97)分、(82.64±2.69)分,且观察组综合得分(91.47±3.26)分高于对照组学员的(82.01±2.54)分,差异均有统计学意义(P<0.05)。观察组与对照组对住培教学的满意度(95.00%vs. 70.00%)的差异有统计学意义(P <0.05)。在综合能力评价方面,观察组学员综合评价总分(89.46±1.17)分,高于对照组学员的(70.27±1.22)分,差异有统计学意义(P <0.05)。结论 在脊柱侧弯住培教学中实施情景模拟联合PBL教学法可以有效提高学员的理论知识水平以及实践操作能力,并且学员的综合能力显著提高。

BOPPPS联合互联网+在骨科手术临床护理教学中的应用

目的探讨BOPPPS[导入(bridge)、目标(objective)、预评价(pre-assessment)、参与式学习(participation)、后评价(post-assessment)、总结(summary)]联合互联网+在骨科手术临床护理教学的应用。方法 选取汕头大学医学院2019年7月—2023年5月四年制护理学专业70名学生为研究对象。将2019-2021年度34名学生为对照组,2021-2023年度的36名学生为干预组。2组学生均由同一名骨科手术组医生进行手术演示,由同一名高年资主管护师进行临床带教。干预组采用BOPPPS联合互联网+教学,对照组采用传统教学模式,教学结束后分别对2组学生理论知识和临床技能进行评估,并采用问卷调查的方法,收集授课教师和2组学生对教学的反馈。结果 干预组理论知识成绩、临床技能整体评分均高于对照组,差异有统计学意义(P <0.05)。干预组教学满意度评分高于对照组,差异有统计学意义(P <0.05)。干预组教学效果评价均优于对照组,差异有统计学意义(P <0.05)。干预组学生对BOPPPS联合互联网+教学方法满意度100%。干预组临床思维能力评分均优于对照组,差异有统计学意义(P <0.05)。结论BOPPPS联合互联网+有助于提高学生理论和技能成绩、提高学生临床思维能力和增强教师教学技能,达到教学相长。

直接床位管理在骨科实习教学中的作用研究

目的探索实习医生在带教老师的协助下直接管床对提高实习教学质量的作用。方法选择2020年9—12月重庆医科大学附属第一医院骨科实习的30名临床医学专业实习生作为研究对象;随机分为对照组及管床组,每组15名,对照组进行常规带教,管床组除常规带教外由实习生直接管床。进行为期4周的实习教学,实习结束后分析2组的出科考核成绩以及对实习教学的满意度情况。结果出科考核成绩中管床组的成绩普遍好于对照组,尤其是技能考核成绩高于对照组,差异有统计学意义(P<0.05);对照组总体满意率为80.0%,管床组的整体满意率则高达93.3%,管床组总体满意率高于对照组,差异无统计学意义(P>0.05);后一个实习科室对2组实习生总体评价上,对照组中优良率为73.3%,管床组中的优良率达到了93.3%,差异无统计学意义(P>0.05)。结论直接床位管理能够提升实习教学质量,提高实习生对实习教学的满意度。