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.

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.

Scientific publications on orthopedic surgery from three major East Asian countries(2012-2021)

BACKGROUND East Asia is the most dynamic region in the world and includes three major countries:Japan,South Korea and China.Due to rapid economic growth,orthopedics research in East Asia has achieved great advances during the past 10 years.However,the current status of orthopedic research in Japan,South Korea and China is still unclear.AIM To understand the current status of orthopedic research in Japan,South Korea,and China.METHODS Journals listed in the“Orthopedics”category of Science Citation Index Expanded subject categories were included.The PubMed and Web of Knowledge electronic databases were searched to identify scientific publications from the selected journals written by researchers from Japan,South Korea and China.A systematic analysis was conducted to analyze orthopedic research articles published in the three countries based on the number of articles,study design,impact factors(IFs)and citations.Furthermore,we also ranked the top 10 countries worldwide with the highest publications in the past 10 years.Additionally,we ranked the top 10 countries with the highest number of publications in the world in the past 10 years.Statistical analyses were performed using SPSS 20.0 software(SPSS Inc.,Chicago,IL,United States),and statistical results are given in Tables and Figures.The Kruskal-Wallis test and the Mann-Whitney test were used to detect differences between countries.The tendency regarding the number of articles was analyzed by curvilinear regression.A two-tailed P<0.05 was considered significant.RESULTS From 2012-2021,a total of 144518 articles were published in the 86 selected orthopedic journals.During this period,the number of worldwide published orthopedic articles has shown an annual increasing trend.A total of 27164 orthopedic research articles were published by Japan,South Korea and China during the past 10 years;44.32%were from China,32.98%were from Japan,and 22.70%were from South Korea.From 2012 to 2021,the annual number of articles markedly increased in each of the three countries.Over time,the worldwide share of articles increased substantially in South Korea(3.37%to 6.53%,P<0.001)and China(5.29%to 9.61%,P<0.001).However,the worldwide share of articles significantly decreased in Japan(5.22%to 3.80%,P<0.001).The annual total IFs of articles from China were well above those of articles from Japan and South Korea(36597.69 vs 27244.48 vs 20657.83,P<0.05).There was no significant difference among the articles in the top 10 high-IF orthopedics journals published from those three countries[South Korea(800)>China(787)>Japan(646),P>0.05].CONCLUSION Over the past 10 years,China’s scientific publications in orthopedic journals have shown an increasing trend.Considering the relative scale of the populations,Japan and South Korea have outpaced China with respect to quality.

Acute hospital-community hospital care bundle for elderly orthopedic surgery patients:A propensity score-matched economic analysis

BACKGROUND While Singapore attains good health outcomes,Singapore’s healthcare system is confronted with bed shortages and prolonged stays for elderly people recovering from surgery in acute hospitals.An Acute Hospital-Community Hospital(AHCH)care bundle has been developed to assist patients in postoperative rehabilitation.The core concept is to transfer patients out of AHs when clinically recommended and into CHs,where they can receive more beneficial dedicated care to aid in their recovery,while freeing up bed capacities in AHs.AIM To analyze the AH length of stay(LOS),costs,and savings associated with the AH-CH care bundle intervention initiated and implemented in elderly patients aged 75 years and above undergoing elective orthopedic surgery.METHODS A total of 8621:1 propensity score-matched patients aged 75 years and above who underwent elective orthopedic surgery in Singapore General Hospital(SGH)before(2017-2018)and after(2019-2021)the care bundle intervention period was analyzed.Outcome measures were AH LOS,CH LOS,hospitalization metrics,postoperative 30-d mortality,and modified Barthel Index(MBI)scores.The costs of AH inpatient hospital stay in the matched cohorts were compared using cost data in Singapore dollars.RESULTS Of the 862 matched elderly patients undergoing elective orthopedic surgery before and after the care bundle intervention,the age distribution,sex,American Society of Anesthesiologists classification,Charlson Comorbidity Index,and surgical approach were comparable between both groups.Patients transferred to CHs after the surgery had a shorter median AH LOS(7 d vs 9 d,P<0.001).The mean total AH inpatient cost per patient was 14.9%less for the elderly group transferred to CHs(S$24497.3 vs S$28772.8,P<0.001).The overall AH U-turn rates for elderly patients within the care bundle were low,with a 0%mortality rate following orthopedic surgery.When elderly patients were discharged from CHs,their MBI scores increased significantly(50.9 vs 71.9,P<0.001).CONCLUSION The AH-CH care bundle initiated and implemented in the Department of Orthopedic Surgery appears to be effective and cost-saving for SGH.Our results indicate that transitioning care between acute and community hospitals using this care bundle effectively reduces AH LOS in elderly patients receiving orthopedic surgery.Collaboration between acute and community care providers can assist in closing the care delivery gap and enhancing service quality.

Single-cell RNA sequencing in orthopedic research

Although previous RNA sequencing methods have been widely used in orthopedic research and have provided ideas for therapeutic strategies,the specific mechanisms of some orthopedic disorders,including osteoarthritis,lumbar disc herniation,rheumatoid arthritis,fractures,tendon injuries,spinal cord injury,heterotopic ossification,and osteosarcoma,require further elucidation.The emergence of the single-cell RNA sequencing(sc RNA-seq)technique has introduced a new era of research on these topics,as this method provides information regarding cellular heterogeneity,new cell subtypes,functions of novel subclusters,potential molecular mechanisms,cell-fate transitions,and cell-cell interactions that are involved in the development of orthopedic diseases.Here,we summarize the cell subpopulations,genes,and underlying mechanisms involved in the development of orthopedic diseases identified by sc RNA-seq,improving our understanding of the pathology of these diseases and providing new insights into therapeutic approaches.

Fighting age-related orthopedic diseases: focusing on ferroptosis

Ferroptosis, a unique type of cell death, is characterized by iron-dependent accumulation and lipid peroxidation. It is closely related to multiple biological processes, including iron metabolism, polyunsaturated fatty acid metabolism, and the biosynthesis of compounds with antioxidant activities, including glutathione. In the past 10 years, increasing evidence has indicated a potentially strong relationship between ferroptosis and the onset and progression of age-related orthopedic diseases, such as osteoporosis and osteoarthritis. Therefore, in-depth knowledge of the regulatory mechanisms of ferroptosis in age-related orthopedic diseases may help improve disease treatment and prevention. This review provides an overview of recent research on ferroptosis and its influences on bone and cartilage homeostasis. It begins with a brief overview of systemic iron metabolism and ferroptosis,particularly the potential mechanisms of ferroptosis. It presents a discussion on the role of ferroptosis in age-related orthopedic diseases, including promotion of bone loss and cartilage degradation and the inhibition of osteogenesis. Finally, it focuses on the future of targeting ferroptosis to treat age-related orthopedic diseases with the intention of inspiring further clinical research and the development of therapeutic strategies.

Knowledge and attitudes of orthopedic surgeons regarding prosthesis joint infection

BACKGROUND Periprosthetic joint infection(PJI)is a critical complication after joint arthroplasty and is accompanied by increasing rates of morbidity and mortality.Several studies have aimed at preventing PJI.AIM To research the knowledge level and attitudes of orthopedic surgeons,who play a key role in both preventing and managing PJI.METHODS We conducted a web-based survey to evaluate orthopedic surgeons'knowledge level and attitudes regarding PJI.The Likert scale survey utilized consisted of 30 questions which were prepared based on the"Proceedings of the International Consensus on Periprosthetic Joint Infection".RESULTS A total of 264 surgeons participated in the survey.Their average age was 44.8,and 173 participants(65.5%)had more than 10 years of experience.No statistically significant relationship was found between the PJI knowledge of the surgeons and their years of experience.However,participants who worked in training and research hospitals demonstrated higher levels of knowledge than the ones in the state hospitals.It was also noticed that surgeons'knowledge concerning the duration of antibiotic therapy and urinary infections was not consistent with their attitudes.CONCLUSION Even though orthopedic surgeons have adequate knowledge about preventing and managing PJI,their attitudes might contradict their knowledge.Future studies are required to examine the causes and solutions of the contradictions between orthopedic surgeons'knowledge and attitudes.

Surgical Treatment of Recent Traumatic Epiphyseal Detachments of the Distal Femur in the Orthopedic and Traumatological Surgery Department of the CHU Bocar Sidy Sall de Kati: About 20 Cases

Introduction: To our knowledge, no scientific study has been conducted at the university hospital of Kati on recent traumatic epiphyseal detachment fractures of the distal femur. However, every day, children present in consultation for knee trauma. Conjugal plate fractures are by definition single to children. Any break in any solution of continuity of this plate is called an epiphyseal fracture or detachment. Objectives: To evaluate the results of surgical treatment of traumatic epiphyseal in detachments of the distal femur recent in children and adolescents. Patients and Method: This was a 13-month prospectively collected longitudinal descriptive study from September 1, 2016 to September 30, 2017. We identified and reviewed 20 medical records of recent traumatic epiphyseal detachments of the distal femur. The parameters studied were sociodemographic, lesion, surgical technique and evolutionary. Results: During the study period, the most affected group age was 12 to 17 years (85%) with an average of 14.65 ± 1.61 years (6 and 20 years). The victims were male (95%). The most frequent etiology was road traffic accident (95%), with a mean time to care of 26.42 ± 10.21 hours and Type II was frequently encountered (85%) with 35% of immediate complications. Cross-bracketing was the most commonly used surgical technique (85%). The result was good (65%). Conclusion: This study allowed us to observe a significant hospital incidence of epiphyseal detachment fractures of the distal femur. Cross pinning was the most commonly used surgical technique with fewer complications (35%) and a satisfactory result in 90% of cases.

Evaluation of Intraoperative Iatrogenic Lesions and Postoperative Complications in 1140 Patients Treated for Carpal Tunnel Syndrome in the Orthopedic Surgery and Traumatology Department of the Moulins-Yzeure Hospital Center in France

Introduction: Carpal tunnel syndrome is a more common form of upper limb canal syndrome, resulting from compression of the median nerve in the carpal tunnel, but is particularly troublesome. Medical treatment is often unsuccessful, and surgical treatment usually involves transection of the annular ligament. The aim of this study was to assess iatrogenic intraoperative and postoperative complications, as well as patient outcomes following the use of conventional and endoscopic surgery in the surgical management of carpal tunnel syndrome. Hypothesis: Are nerve, vascular and tendon injuries of iatrogenic origin always present in the surgical management of carpal tunnel syndrome, even though this surgery is performed on an outpatient basis? Patients and methods: This retrospective series is composed of 1140 patients, 230 men and 910 women, mean age 58.6 ± 16.4 years, operated on between 2010 and 2020 for carpal tunnel syndrome by conventional surgery and under endoscopy. Medical records, operative reports and consultation letters were consulted. All patients were reviewed regularly at one month post-op until recovery. Results: No nerve, vascular or tendon damage was noted, and at a maximum follow-up of 2 years, 20 patients had recurred, i.e. a 2.51% failure rate. Scar disunion was observed in 0.9%, wound infection in 0.9% and scar fibrosis in 0.9%. 92.98% of patients underwent outpatient surgery, irrespective of the type of anesthesia or surgical technique used. Patients who stayed in hospital for a short time were suffering from carpal tunnel syndrome associated with compression of the ulnar nerve in Guyon’s canal, for which both the median and ulnar nerves were freed during the same operation, under general anaesthetic. All patients were able to return to their previous activity within 30 days of surgery. Conclusion: Intraoperative iatrogenic complications, notably nerve, vascular and tendon lesions, were not identified despite the large sample size. On the other hand, postoperative skin complications related to scarring, such as wound disunion, fibrosis and recurrence, were present despite low rates.

An Orthopedic Approach to a Child with a Limp: A Step-by-Step Review Article

This article explains the orthopedic approach to limping in children. This is a review article including a selected collection of new articles extracted from PubMed and Google Scholar searched for clinical points and beneficial approaches to limping children. In this paper, limping is divided into two categories, painful and painless. After stating the important points in the patient’s medical history and explaining specific examinations in this area, different gait types in children are explained and the best evaluation method for them is presented. Then, paraclinical examinations and imaging are described in a practical evaluation, high-risk etiologies of limping such as infections, tumors, and fractures are explained in detail and red flags are considered at each step. The algorithms and the list of differential diagnoses for each age group are included, which can provide physicians with a more comprehensive approach to limping in children.

Urinary Tract Infections in a Tunisian Orthopedic Institute: Major Strain Microbiological Profile

Background: Urinary Tract Infection (UTI) detected in the hospital and in the community is one of the most common reasons for consultation in everyday practice;it represents a major source of antibiotic consumption. This study’s objectives were to outline the microbiological profile of Tunisian patients with UTI and assess antibiotic resistance over the course of three years at the Orthopedic Institute. Methods: All strains identified in urine samples between January 1st, 2019, and December 31st, 2021, were included. Standard laboratory procedures were used to identify the bacterium. The Microscan Walkway 40 Plus was used to do biochemical assays and antibiotic susceptibility testing. The EUCAST criteria were used to interpret the findings. Results: A total of 1313 strains were isolated. The bacteriological study showed the predominance of enterobacteria (96.8%), especially E. coli (52.2%) and K. pneumoniae (19.3%). Overall resistance rates to antimicrobial agents were as follows: for hospital, E. coli strains were in descending order amoxicillin (73.05%), trimeth/sulfamethoxazole (46.9%), ofloxacin (40.3%), amoxicillin/clavulanic acid (35.05%) and gentamicin (20.5%). Our results showed low resistance to fosfomycin for E. coli 2.6% in hospitals while ≥12.1% for K. pneumoniae. Amikacin resistance remains medium-low for E. coli being ≥20% and 10% for K. pneumonia. Nitrofuran resistance has affected 1.06% of E. coli strains in hospital settings and 21.5% of K. pneumoniae. Extended Spectrum Beta-Lactamases (ESBLs) production was present in a number of enterobacteria (19.3% of K. pneumoniae and 14.4% of E. coli). Conclusion: The prevalence of E. coli and K. pneumoniae producers ESBLs in UTI is increasing. Rigorous surveillance of resistance rate is necessary to determine appropriate empirical treatment and limit the spread of multiresistant strains.

Prolotherapy in Musculoskeletal Disorders, Guideline for Orthopedic Application

Purpose: Prolotherapy is a therapeutic method that involves injecting an irritant substance into injured areas of tendons, ligaments, and articular spaces. It has a wide application in orthopedic fields, including arthritis, tendinopathies, and back pain. Protocol of injection varies extensively based on the pathological condition. This review aims to discuss orthopedic applications of prolotherapy and its related outcomes, intending to introduce more specific injection protocols in each field. Methods: In a narrative review of literature, various musculoskeletal indications and contraindications of prolotherapy, as well as the method and location of injection, solution type, procedure intervals and frequencies, outcomes and side effects are investigated to reveal all aspects of the current knowledge about this new approach. Results: Chronic back pain, osteoarthritis, and tendinopathies are considered the most common indications for prolotherapy. Protocol of injection varies from one condition to another. The actual concentration of administered dextrose ranges from 12.5% to 25%. Results of the different studies indicate that prolotherapy could have a pleasing effect on improving patient’s pain and functional outcomes. No severe complication has been mentioned in previous investigations. Conclusion: Prolotherapy is a new therapeutic option that can be suggested as an effective method in recalcitrant musculoskeletal conditions.

Orthopedic disorders of the knee in hemophilia:A current concept review

The knee is frequently affected by severe orthopedic changes known as hemophilic arthropathy(HA) in patients with deficiency of coagulation factor Ⅷ or Ⅸ and thus this manuscript seeks to present a current perspective of the role of the orthopedic surgeon in the management of these problems.Lifelong factor replacement therapy(FRT) is optimal to prevent HA,however adherence to this regerous treatment is challenging leading to breakthrough bleeding.In patients with chronic hemophilic synovitis,the prelude to HA,radiosynovectomy(RS) is the optimal to ameliorate bleeding.Surgery in people with hemophilia(PWH) is associated with a high risk of bleeding and infection,and must be performed with FRT.A coordinated effort including orthopedic surgeons,hematologists,physical medicine and rehabilitation physicians,physiotherapists and other team members is key to optimal outcomes.Ideally,orthopedic procedures should be performed in specialized hospitals with experienced teams.Until we are able to prevent orthopedic problems of the knee in PWH will have to continue performing orthopedic procedures(arthrocentesis,RS,arthroscopic synovectomy,hamstring release,arthroscopic debridement,alignment osteotomy,and total knee arthroplasty).By using the aforementioned procedures,the quality of life of PWH will be improved.

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.

Mixed reality for visualization of orthopedic surgical anatomy

In the modern era,preoperative planning is substantially facilitated by artificial reality technologies,which permit a better understanding of patient anatomy,thus increasing the safety and accuracy of surgical interventions.In the field of orthopedic surgery,the increase in safety and accuracy improves treatment quality and orthopedic patient outcomes.Artificial reality technologies,which include virtual reality(VR),augmented reality(AR),and mixed reality(MR),use digital images obtained from computed tomography or magnetic resonance imaging.VR replaces the user’s physical environment with one that is computer generated.AR and MR have been defined as technologies that permit the fusing of the physical with the virtual environment,enabling the user to interact with both physical and virtual objects.MR has been defined as a technology that,in contrast to AR,enables users to visualize the depth and perspective of the virtual models.We aimed to shed light on the role that MR can play in the visualization of orthopedic surgical anatomy.The literature suggests that MR could be a valuable tool in orthopedic surgeon’s hands for visualization of the anatomy.However,we remark that confusion exists in the literature concerning the characteristics of MR.Thus,a more clear description of MR is needed in orthopedic research,so that the potential of this technology can be more deeply understood.

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.

Mobile phones in the orthopedic operating room: Microbial colonization and antimicrobial resistance

BACKGROUND Surgical site infections are a major cause of morbidity and mortality following orthopedic surgery.Recent efforts to identify sources of contamination in the operating rooms have implicated mobile phones.AIM To investigate microbial colonization on the mobile phones of health care professionals in the orthopedic operating room.METHODS We conducted a cross-sectional study involving culture and sensitivity analysis of swabs taken from the mobile phones of orthopedic and anesthesia attendings,residents,technicians and nurses working in the orthopedic operating rooms over a period of two months.Demographic and cell phone related factors were recorded using a questionnaire and the factors associated with contamination were analyzed.RESULTS Ninety-three of 100 mobile phones were contaminated.Species isolated were Coagulase-negative Staphylococcus(62%),Micrococcus(41%)and Bacillus(26%).The risk of contamination was increased with mobile covers and cracked screens and decreased by cell phone cleaning.CONCLUSION Mobile phones belonging to health care workers are frequently contaminated with pathogenic bacteria with the potential of transferring drug resistance to nosocomial pathogens.Studies investigating the relationship to surgical site infections need to be conducted.The concept of"mobile hygiene"involving the change of mobile covers,replacement of cracked screens or even wiping the phone with an alcohol swab could yield the cost-effective balance that contaminated cell phones deserve until they are established as a direct cause of surgical site infections.

Prevalence of depression and anxiety and associated factors among geriatric orthopedic trauma inpatients:A cross-sectional study

BACKGROUND Common mental disorders such as anxiety and depression in geriatric orthopedic trauma patients have received little attention in research.AIM To investigate the prevalence of emotional disorders among geriatric orthopedic trauma patients and identify demographic,social and clinical risk factors.METHODS This cross-sectional study was performed in geriatric patients(aged≥60 years,both sexes)with orthopedic trauma admitted to a level I trauma center between May 2015 and December 2017.Demographic,social,and clinical characteristics were described.Huaxi Emotional-Distress Index(HEI)was used to evaluate the severity of anxiety and depression status.Differences in continuous variables were tested using the t-test,and differences in categorical variables were assessed using the Pearsonχ2 test.Binary logistic regression analyses were used to identify the factors associated with a HEI score>8.RESULTS Among the 966 patients,487 were male and 479 were female,with a mean age of 70.2±7.1 years.The age ranged from 60 to 90 years.Seventy-five patients had an HEI score>8,accounting for about 7.8%of all patients.A higher Injury Severity Score(4.17±3.10 vs 7.96±6.68,P<0.001),higher Visual Analog Score(5.05±1.09 vs 6.89±1.23,P<0.001),number of chronic diseases(P<0.001),injury type(P=0.038),and education level(P=0.001)were significantly associated with HEI score>8.On logistic regression,a higher education level was a protective factor for emotional disorders(P=0.047),whereas Injury Severity Score(P=0.024),Visual Analog Score(P<0.001),two or more chronic diseases(P<0.001)were the related independent risk factors.CONCLUSION Emotional disorders are common in geriatric patients with orthopedic trauma.Clinicians should remain vigilant of emotional disorders in geriatric patients and screen for anxiety and depression in higher risk groups.

What factors are important to new patients when selecting an orthopedic oncologist?

BACKGROUND Understanding how patients choose a provider may improve the overall experience by identifying ways to tailor a clinical practice.AIM To identify factors that patients consider important when choosing an orthopedic oncologist.METHODS New patients presenting to an orthopedic oncology clinic within a tertiary academic medical center from January 2019 to August 2020 were invited to complete an anonymous survey.The questionnaire consisted of 27 items including a Likert-type assessment of the importance of selection factors.RESULTS A total of 101 new patients with a median age of 66 years(range,14 years to 91 years)responded.Most were referred by another doctor(n=63,62.4%),and of the referring providers,the most frequent specialty was orthopedic surgery(n=32,51%).Using a Likert-type scale with 1 representing‘least important’and 5 representing‘most important’,the most important factor was the hospital reputation(mean,4.65;SD,0.85).Additional factors of importance were the number of years in practice(3.87±1.3)and a primary care provider referral(3.71±1.6).Patients younger than 40 years old found social media(P=0.016)and internet presence(P=0.035)of their surgeon to be more important than older patients.In contrast,older patients considered care within an academic center to be of greater importance than younger patients(P=0.014).CONCLUSION This investigation suggests a primary care referral,as well as hospital and physician reputation,are among the most important factors when selecting an orthopedic oncologist.Furthermore,social media utilization appears to be more important for younger patients.

Occupational injuries and burn out among orthopedic oncology surgeons

BACKGROUND Orthopedic oncology surgeons commonly engage in prolonged and complex surgical procedures.These types of surgeries increase the risk of physical and psychological stressors,which may in turn make these physicians prone to workrelated occupational injuries.AIM The aim of this study was to explore in orthopedic oncologists,the prevalence of work-related physical injuries and psychological disturbances.METHODS A modified version of the physical discomfort survey was developed to assess occupational injuries among orthopedic oncology surgeon members of the Musculoskeletal Tumor Society,the Canadian Orthopedic Oncology Society and European Musculoskeletal Oncology Societies.The survey was sent by email,and it explored musculoskeletal complaints,psychological disturbances,treatment required for these complaints and the requirement of time off work.RESULTS A total of 67 surgeon responses were collected.A high number of orthopedic oncologists(84%)reported an occupational injury.Low back pain(39%)was the most prevalent musculoskeletal condition,followed by lumbar disk herniation(16%),shoulder tendinitis(15%)and lateral epicondylitis(13%).Of the cohort,46%required surgery and 31%required time off work due to their injury.Thirty-three respondents reported a psychological disorder.Burnout(27%),anxiety(20%)and insomnia(20%)were the most commonly reported.Time required off work due to injury was associated with old age and years in practice.CONCLUSION Orthopedic oncology surgeons report a high prevalence of work-related disorders.Lower back related injury and burnout were the most reported disorders.Improving operative room ergonomics and prevention of stress related to the work environment should be areas to explore in upcoming research.