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.

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.

Trends in leadership at orthopaedic surgery sports medicine fellowships

BACKGROUND Fellowship directors(FDs)in sports medicine influence the future of trainees in the field of orthopaedics.Understanding the characteristics these leaders share must be brought into focus.For all current sports medicine FDs,our group analyzed their demographic background,institutional training,and academic experience.AIM To serve as a framework for those aspiring to achieve this position in orthopaedics and also identify opportunities to improve the position.METHODS Fellowship programs were identified using both the American Orthopaedic Society for Sports Medicine and the Arthroscopy Association of North America Sports Medicine Fellowship Directories.The demographic and educational background data for each FD was gathered via author review of current curriculum vitae(CVs).Any information that was unavailable on CV review was gathered from institutional biographies,Scopus Web of Science,and emailed questionnaires.To ensure the collection of as many data points as possible,fellowship program coordinators,orthopaedic department offices and FDs were directly contacted via phone if there was no response via email.Demographic information of interest included:Age,gender,ethnicity,residency/fellowship training,residency/fellowship graduation year,year hired by current institution,time since training completion until FD appointment,length in FD role,status as a team physician and H-index.RESULTS Information was gathered for 82 FDs.Of these,97.5%(n=80)of the leadership were male;84.15%(n=69)were Caucasian,7.32%(n=6)were Asian-American,2.44%(n=2)were Hispanic and 2.44%(n=2)were African American,and 3.66%(n=3)were of another race or ethnicity.The mean age of current FDs was 56 years old(±9.00 years),and the mean Scopus H-index was 23.49(±16.57).The mean calendar years for completion of residency and fellowship training were 1996(±15 years)and 1997(±9.51 years),respectively.The time since fellowship training completion until FD appointment was 9.77 years.17.07%(n=14)of FDs currently work at the same institution where they completed residency training;21.95%(n=18)of FDs work at the same institution where they completed fellowship training;and 6.10%(n=5)work at the same institution where they completed both residency and fellowship training.Additionally,69.5%(n=57)are also team physicians at the professional and/or collegiate level.Of those that were found to currently serve as team physicians,56.14%(n=32)of them worked with professional sports teams,29.82%(n=17)with collegiate sports teams,and 14.04%(n=8)with both professional and collegiate sports teams.Seven residency programs produced the greatest number of future FDs,included programs produced at least three future FDs.Seven fellowship programs produced the greatest number of future FDs,included programs produced at least four future FDs.Eight FDs(9.75%)completed two fellowships and three FDs(3.66%)finished three fellowships.Three FDs(3.66%)did not graduate from any fellowship training program.The Scopus H-indices for FDs are displayed as ranges that include 1 to 15(31.71%,n=26),15 to 30(34.15%,n=28),30 to 45(20.73%,n=17),45 to 60(6.10%,n=5)and 60 to 80(3.66%,n=3).Specifically,the most impactful FD in research currently has a Scopus H-index value of 79.By comparison,the tenth most impactful FD in research had a Scopus H-index value of 43(accessed December 1,2019).CONCLUSION This study provides an overview of current sports medicine FDs within the United States and functions as a guide to direct initiatives to achieve diversity equality.

COVID-19 and its effects upon orthopaedic surgery: The Trinidad and Tobago experience

The World Health Organisation(WHO)declared coronavirus disease 2019(COVID-19)a pandemic on March 11,2020.COVID-19 is not the first infectious disease to affect Trinidad and Tobago.The country has faced outbreaks of both Chikungunya and Zika virus in 2014 and 2016 respectively.The viral pandemic is predicted to have a significant impact upon all countries,but the healthcare services in a developing country are especially vulnerable.The Government of Trinidad and Tobago swiftly established a parallel healthcare system to isolate and treat suspected and confirmed cases of COVID-19.Strick‘lockdown’orders,office closures,social distancing and face mask usage recommendation were implemented following advice from the WHO.This approach has seen Trinidad and Tobago emerge from the second wave of infections,with the most recent Oxford COVID-19 Government Response Tracker report indicating a favourable risk of openness index for the country.The effects of the pandemic on the orthopaedic services in the public and private healthcare systems show significant differences.Constrained by shortages in personal protective equipment and inadequate testing facilities,the public system moved into emergency mode prioritizing the care of urgent and critical cases.Private healthcare driven more by economic considerations,quickly instituted widespread safety measures to ensure that the clinics remained open and elective surgery was not interrupted.Orthopaedic teaching at The University of the West Indies was quickly migrated to an online platform to facilitate both medical students and residents.The Caribbean Association of Orthopedic Surgeons through its frequent virtual meetings provided a forum for continuing education and social interaction amongst colleagues.The pandemic has disrupted our daily routines leading to unparalleled changes to our lives and livelihoods.Many of these changes will remain long after the pandemic is over,permanently transforming the practice of orthopaedics.

A comprehensive review on biocompatible Mg-based alloys as temporary orthopaedic implants:Current status,challenges,and future prospects

Mg and its alloys are drawing huge attention since the last two decades as a viable option for temporary implants applications.A commendable progress has already been made in the development of these alloys.The biodegradable nature of Mg,appreciable biocompatibility of elemental Mg,and its close resemblance to natural bone in terms of density and elastic modulus make them highly preferable option amongst other available alternatives in this field.This review article presents an overview covering the recent advancements made in the field of Mg-based biodegradable implants for orthopaedic implant applications.The paper focuses on alloy development and fabrication techniques,the state of the art of important Mg-based alloy systems in terms of their mechanical properties,in-vitro and in-vivo degradation behaviour and cytotoxicity.Further,the paper reviews the current progress achieved in the clinical transition of Mg-based alloys for orthopaedic fixtures.The review also includes the degradation mechanisms of the alloys in physiological environment and highlights the mismatch existing between the rate of bone healing and alloy degradation due to rapid corrosion of the alloys in such environment,which has still restricted their widespread application.Finally,the surface coating techniques available for the alloys as an effective way to reduce the degradation rate are reviewed,followed by a discussion on the future research prospects.

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.

Diabetes and its negative impact on outcomes in orthopaedic surgery

An estimated 285 million adults(aged 20-79 years)worldwide were diagnosed to have diabetes mellitus(DM)in 2010,and this number is projected to grow to 439million adults by the year 2030.Orthopaedic surgeons,regardless of their subspecialty interest,will encounter patients with DM during their career since this epidemic involves both developed and emerging countries.Diabetes results in complications affecting multiple organ systems,potentially resulting in adverse outcomes afterorthopaedic surgery.The purpose of this review is to discuss the pathophysiology of DM and its potential for impacting orthopaedic surgery patients.Diabetes adversely affects the outcome of all orthopaedic surgery subspecialties including foot and ankle,upper extremity,adult reconstructive,pediatrics,spine surgery and sports medicine.Poorly controlled diabetes negatively impacts bone,soft tissue,ligament and tendon healing.It is the complications of diabetes such as neuropathy,peripheral artery disease,and end stage renal disease which contributes to adverse outcomes.Well controlled diabetic patients without comorbidities have similar outcomes to patients without diabetes.Orthopaedic surgeons should utilize consultants who will assist in inpatient glycemic management as well as optimizing long term glycemic control.

Use of three-dimensional printing in preoperative planning in orthopaedic trauma surgery: A systematic review and meta-analysis

BACKGROUND With the increasing complexity of surgical interventions performed in orthopaedic trauma surgery and the improving technologies used in threedimensional(3D)printing,there has been an increased interest in the concept.It has been shown that 3D models allow surgeons to better visualise anatomy,aid in planning and performing complex surgery.It is however not clear how best to utilise the technique and whether this results in better outcomes.AIM To evaluate the effect of 3D printing used in pre-operative planning in orthopaedic trauma surgery on clinical outcomes.METHODS We performed a comprehensive systematic review of the literature and a metaanalysis.Medline,Ovid and Embase were searched from inception to February 8,2018.Randomised controlled trials,case-control studies,cohort studies and case series of five patients or more were included across any area of orthopaedic trauma.The primary outcomes were operation time,intra-operative blood loss and fluoroscopy used.RESULTS Seventeen studies(922 patients)met our inclusion criteria and were reviewed.The use of 3D printing across all specialties in orthopaedic trauma surgery demonstrated an overall reduction in operation time of 19.85%[95%confidence intervals(CI):(-22.99,-16.71)],intra-operative blood loss of 25.73%[95%CI:(-31.07,-20.40)],and number of times fluoroscopy was used by 23.80%[95%CI:(-38.49,-9.10)].CONCLUSION Our results suggest that the use of 3D printing in pre-operative planning in orthopaedic trauma reduces operative time,intraoperative blood loss and the number of times fluoroscopy is used.

Machine learning in orthopaedic surgery

Artificial intelligence and machine learning in orthopaedic surgery has gained mass interest over the last decade or so.In prior studies,researchers have demonstrated that machine learning in orthopaedics can be used for different applications such as fracture detection,bone tumor diagnosis,detecting hip implant mechanical loosening,and grading osteoarthritis.As time goes on,the utility of artificial intelligence and machine learning algorithms,such as deep learning,continues to grow and expand in orthopaedic surgery.The purpose of this review is to provide an understanding of the concepts of machine learning and a background of current and future orthopaedic applications of machine learning in risk assessment,outcomes assessment,imaging,and basic science fields.In most cases,machine learning has proven to be just as effective,if not more effective,than prior methods such as logistic regression in assessment and prediction.With the help of deep learning algorithms,such as artificial neural networks and convolutional neural networks,artificial intelligence in orthopaedics has been able to improve diagnostic accuracy and speed,flag the most critical and urgent patients for immediate attention,reduce the amount of human error,reduce the strain on medical professionals,and improve care.Because machine learning has shown diagnostic and prognostic uses in orthopaedic surgery,physicians should continue to research these techniques and be trained to use these methods effectively in order to improve orthopaedic treatment.

A Target-Orientated Marker Image Binarization Method for Orthopaedic Surgical Navigation System

Camera calibration is the key technique in a C-arm based orthopaedic surgical navigation system. The extraction of marker location information is a necessary step in the calibration process. Ideal marker images should possess uniform background and contain marker shadow only, but in fact marker images always possess nonuniform background and are contaminated by noise and unwanted anatomic information, making the extraction very difficult. A target-orientated marker shadow extraction method was proposed. With this method a proper threshold for marker image binarization can be determined.

Role of decision aids in orthopaedic surgery

Medical treatment of patients inherently entails the risk of undesired complication or side effects. It is essential to inform the patient about the expected outcomes, but also the possible undesired outcomes. The patients preference and values regarding the potential outcomes should be involved in the decision making process. Even though many orthopaedic surgeons are positive towards shared decision-making, it is minimally introduced in the orthopaedic daily practice and decision-making is still mostly physician based. Decision aids are designed to support the physician and patient in the shareddecision-making process. By using decision aids, patients can learn more about their condition and treatment options in advance to the decision-making. This will reduce decisional conflict and improve participation and satisfaction.

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.

Caring Behaviour of Nurses in Orthopaedic Wards of Selected Health Institutions as Perceived by Patients

Nurses are trained to provide hands-on care to patients in a variety of settings, which include physical care which can range from total care to helping a patient prevent illness. The health of a patient can significantly improve when they (patients) perceive caring nursing behaviours and are satisfied with the quality of care been received from their care giver. The aim of this study was to determine the caring behaviour of nurses as perceived by patients admitted to orthopaedic ward in some selected hospitals in Osogbo, Osun state, Nigeria. A descriptive comparative design was used. Convenient sample technique was used to select 616 respondents consisting of male and female patients admitted to orthopaedic wards of selected hospitals. The questionnaire on Caring Behaviour Assessment scale was adapted from CBI. The most highly ranked perceived nurses’ behaviour by patients rated “satisfactory” was the general perception of the patients and rendering of basic needs. The findings also revealed that patients rated nurses behaviour (care-giving) with respect to human needs assistance, the provision of safe environment, assisting in psychological care and giving physical comfort as average. Lastly, findings also revealed that patients rated perceived nurses behaviour (care-giving) as “not satisfactory” with regards to meeting their communication needs, nutritional needs and individualized care. In conclusion, care giving is an important branch of nursing and it depicts the quality of care received by a patient which in turn is capable of aiding speedy recovery.

A New Computer Assisted Orthopaedic Surgery System:WATO

Background:The traditional manual orthopaedic technology heavily relies on a surgeon's experience,so it certainly increases the instability of the surgery.Therefore,computer assisted orthopaedic surgery(CAOS) is becoming a hot research topic for its high accuracy and stability.We developed a new CAOS system WATO,which is mainly designed for total knee replacement(TKR).Methods:WATO system provides the interactive software for a surgeon's preoperative planning.Based on its two infrared cameras,infrared markers and infrared probe,WATO system gives a simple surgical positioning procedure of femur and tibia without additional surgery for the placement of fiducial markers.According to the reference alignment axis from positioning procedure,a surgeon can move the robot of WATO system to do accurate bone resection.Safety checking is also considered in WATO system.Results:Extensive experiments were conducted on phantoms and cadaver bones to verify the accuracy and stability of WATO system.Experimental results showed that TKR using WATO system had better performance compared with traditional and navigated TKR.Conclusion:WATO system shows its superiority in TKR,and has a broad application prospect in the future.We will develop its new functions for other orthopaedic surgery such as total hip replacement(THR).Current disadvantages such as bigger skin incision have to be resolved in the future.

Orthopaedic education in the era of surgical simulation: Still at the crawling stage

Surgical skills education is in the process of a crucial transformation from a master-apprenticeship model to simulation-based training. Orthopaedic surgery is one of the surgical specialties where simulation-based skills training needs to be integrated into the curriculum efficiently and urgently. The reason for this strong and pressing need is that orthopaedic surgery covers broad human anatomy and pathologies and requires learning enormously diverse surgical procedures including basic and advanced skills. Although the need for a simulationbased curriculum in orthopaedic surgery is clear, several obstacles need to be overcome for a smooth transformation. The main issues to be addressed can be summarized as defining the skills and procedures so that simulation-based training will be most effective; choosing the right time period during the course of orthopaedic training for exposure to simulators; the right amount of such exposure; using objective, valid and reliable metrics to measure the impact of simulation-based training on the development and progress of surgical skills; and standardization of the simulation-based curriculum nationwide and internationally. In the new era of surgical education, successful integration of simulation-based surgical skills training into the orthopaedic curriculum will depend on efficacious solutions to these obstacles in moving forward.

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.

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》

Patients' preferred mode of travel to the orthopaedic theatre

AIM: To determine the preferred mode of travel to the operating theatre for elective orthopaedic patients. METHODS: Data was collected prospectively over a 2-wk period at an elective Orthopaedic Treatment Centre. Patients were asked to complete a patient satisfaction questionnaire following their surgery on their experience and subsequent preferred mode of transport to theatre. The data was then recorded in a tabulated format and analysed with percentages. Fisher's exact test was used to determine if there was any statistical association between patients' preference to walk and various groups; in-patient or day case procedures, and whether patients were < 60 years or > 60 years of age.RESULTS: Seventy patients(40 females and 30 males) fully completed the questionnaire. In total there were 33 d-cases and 37 in-patients. The spectrum of orthopaedic sub-specialties included was knee(41%), hip(17%), foot and ankle(24%), spine(13%) and upper limb(4%). Patient satisfaction for overall experience of travelling to theatre was either excellent(77%) or good(23%). Following their experience of travelling to theatre, 87%(95%CI: 79%-95%) of the total cohort would have preferred to walk to the operating theatre. There was a statistically significant association(P = 0.003) between patients' preference to walk and whether they were daycase or in-patients. Similarly, there was a statistically significance association(P = 0.028) between patients' preference to walk and whether they were < 60 years or > 60 years of age.CONCLUSION: This study confirms the majority of Orthopaedic elective patients would prefer to walk to theatre, when given the choice and if practically possible.

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.