The burden of orthopaedic disease presenting to a tertiary referral center in Moshi, Tanzania: a cross-sectional study.

Introduction: as road traffic crashes (RTCs) continue to rise in the developing world, the current growth rate and true burden of orthopaedic injuries are unknown. In 2015, we characterized the orthopaedic burden at Kilimanjaro Christian Medical Center (KCMC) in Tanzania. In this study, we re-evaluated the burden and growth-rate over three years in the absence of any system level changes. Additionally, we calculated the percentage of orthopaedic patients that received definitive fixation for their orthopaedic injury when surgery was indicated. Methods: we prospectively collected data for 190 patients admitted to the orthopaedic ward at KCMC during June/July 2018. We also retrospectively reviewed available records for patients presenting to the KCMC Emergency Department, Orthopaedic Outpatient Clinic and Orthopaedic Ward. Results: prospective data: 231 patients were admitted to the orthopaedic ward. Forty-one (17.7%) isolated spine patients were excluded, leaving 190 patients in the final study cohort. RTC (89, 46.8%) represented the most common mechanism of injury requiring orthopaedic ward admission, followed by falls (60, 31.6%) and infections (14, 7.4%). Femur fractures were the most common injury (62, 31.0%), followed by tibia fractures (27, 13.5%), isolated fibula fractures (23, 11.5%), and foot fractures (23, 11.5%). Almost 96% of admitted patients were indicated for surgical fixation, but only 44.5% received definitive fracture treatment. Retrospective data: KCMC treated an average of 15,117 orthopaedic patients per year, representing a 35.3% growth in the orthopaedic burden compared to 2015. Conclusion: the burden of orthopaedic surgical disease at KCMC is increasing. Without innovative strategies to address this situation, the discrepancy between the need for orthopaedic care and surgical care capacity at KCMC and in similar settings will continue to grow.

Preparation is the Only Shortcut You Need in Surgery: A Guide to Surgical Rehearsals for Hand and Upper Extremity Transplantation.

As upper extremity transplantation is becoming more accepted worldwide, the demand for a fresh tissue cadaveric training model for this procedure is increasing and necessary to assure surgical success. Surgical rehearsals can decrease operative time, improve technique, and reduce errors made on the actual day of surgery. The purpose of this article is to describe a method for surgical rehearsal of upper extremity transplantation using cadaveric specimens based on the clinical experience of an academic institution with an active transplantation program. The logistics of rehearsal setup, equipment, and modified version of procedural checklists are described.

"Is There An App For That?" Orthopaedic Patient Preferences For A Smartphone Application.

BACKGROUND: Patients are seeking out medical information on the Internet and utilizing smartphone health applications ("apps"). Smartphone use has exponentially increased among orthopaedic surgeons and patients. Despite this increase, patients are rarely directed to specific apps by physicians. No study exists querying patient preferences for a patient-centered, orthopaedic smartphone application. OBJECTIVES: The purpose of this study is to 1) determine Internet use patterns amongst orthopaedic patients; 2) ascertain access to and use of smartphones; and 3) elucidate what features orthopaedic patients find most important in a smartphone application. METHODS: We surveyed patients in an orthopaedic practice in an urban academic center to assess demographics, access to and patterns of Internet and Smartphone use, and preferences for features in a smartphone app. RESULTS: A total of 310 surveys were completed. Eighty percent of patients reported Internet access, and 62% used the Internet for health information. Seventy-seven percent owned smartphones, 45% used them for health information, and 28% owned health apps. Only 11% were referred to an app by a physician. The highest ranked features were appointment reminders, ability to view test results, communication with physicians, and discharge instructions. General orthopaedic information and pictures or videos explaining surgery were the 2 lowest ranked features. Seventy-one percent of patients felt an app with some of the described features would improve their healthcare experiences, and 40% would pay for the app. CONCLUSIONS: The smartphone is an under-utilized tool to enhance patient-physician communication, increase satisfaction, and improve quality of care. Patients were enthusiastic about app features that are often included in patient health portals, but ranked orthopaedic educational features lowest. Further study is required to elucidate how best to use orthopaedic apps as physician-directed educational opportunities to promote patient satisfaction and quality of care.

Management of medial-sided knee injuries, part 2: posteromedial corner.

Injury to the posteromedial corner (PMC) of the knee differs anatomically and biomechanically from isolated injury to the medial collateral ligament. Newer anatomic and biomechanical studies are refining the field's understanding of the medial side of the knee, as well as its role in multiple ligament injuries. Valgus instability places additional strain on a reconstructed anterior or posterior cruciate ligament, which can contribute to late graft failure. Injuries to the PMC may not heal without surgical repair or reconstruction, particularly when part of a multiple-ligament injury. Identification of PMC injury before cruciate reconstruction is important so that appropriate repair or reconstruction of the PMC and medial collateral ligament can be undertaken at the same time. This article reviews the relevant literature on the PMC, discusses reasons for selective operative management, and illustrates reconstructive strategies for PMC injuries occurring as part of a medial-sided or multiligament injury to the knee.

Management of medial-sided knee injuries, part 1: medial collateral ligament.

The medial collateral ligament complex is a primary stabilizer that combines static and dynamic resistance to direct valgus stress while contributing significant restraints to rotatory motion and anterior-posterior translation. Varying opinions exist among investigators regarding injury classification and treatment algorithms. Whereas most agree that the majority of isolated medial collateral ligament complex injuries can be treated nonoperatively, isolated injuries with chronic instability and multiligament injuries may require operative intervention. Substantial confounding factors are present within published reports, making comparative analyses and systematic review challenging. This review focuses on the anatomy and biomechanics of the medial structures of the knee; it discusses the clinical evaluation of complex injuries; and it reviews nonoperative and operative treatment methods.

Arthroscopic-assisted revision of telescopic rods in osteogenesis imperfecta.

Bailey-Dubow extensible nails are intramedullary stabilization devices designed to prevent deformities and recurrent long bone fractures in patients with osteogenesis imperfecta. The rods consist of a hollow outer sleeve and a solid inner obturator, allowing for telescoping of the rods and expansion of the device with longitudinal growth of the bone. Migration of the nail into the joint is a known complication of this procedure, which can lead to pain and loss of motion. This is a case report of the use of an arthroscopic approach to manipulate femoral and tibial Bailey-Dubow rods that migrated into the knee joint.