Unplanned reoperation is common following intramedullary nailing of open femoral shaft fractures: A retrospective review.

Background: The objective of this study is to investigate the incidence of unplanned reoperation, nonunion and infection following open femoral shaft fractures treated with an intramedullary nail and correlate these occurrences with patient variables and injury characteristics. Methods: A retrospective review of open femur fractures from a level 1 trauma center between 2012 and 2020 was performed. Ninety-five patients who sustained an open femur fracture, were treated definitively with an intramedullary nail, and had at least 3 months of follow-up were included in the analysis for surgical site infection. Seventy-three of these patients had at least one year of follow-up. After excluding planned bone grafting for segmental defects, 67 patients were included in the analysis of unplanned reoperation. Results: The rate of unplanned reoperation was 31.3 %, with 57 % of these operations occurring to address nonunion. The overall nonunion rate was 18 %. In patients who did not require reoperation to obtain union, the median time to union for the cohort was 6 months, with an interquartile range of 3-7.5 months. Post-operative surgical site infection occurred in 11.6 % of patients. Conclusions: In conclusion, unplanned reoperation following intramedullary nailing of open femur fractures occurs in nearly 1/3rd of patients and the rates of nonunion and surgical site infection may be higher than previously reported in the literature. Reoperation most closely correlates with the OTA Open Fracture Classification System. Patients with open femur fractures should be counseled that reoperation is often required to obtain fracture union, with soft tissue and fracture injury severity predicting complications.

Appropriateness and Reliability of an Online Artificial Intelligence Platform's Responses to Common Questions Regarding Distal Radius Fractures.

PURPOSE: Chat Generative Pre-Trained Transformer (ChatGPT) is a novel artificial intelligence chatbot that is changing the way humans gather information online. The purpose of this study was to investigate ChatGPT's ability to appropriately and reliably answer common questions regarding distal radius fractures. METHODS: Thirty common questions regarding distal radius fractures were presented in an identical manner to the online ChatGPT-3.5 interface three separate times, yielding 90 unique responses because ChatGPT produces an original answer with each query. All responses were graded as "appropriate," "appropriate but incomplete," or "inappropriate" by a consensus discussion among three hand surgeon reviewers. The questions were additionally subcategorized into one of four domains based on Bloom's cognitive learning taxonomy, and descriptive statistics were reported. RESULTS: Seventy of the 90 total responses (78%) produced by ChatGPT were "appropriate," and 29 of the 30 questions (97%) had at least one response considered appropriate (of the three possible). However, only 17 of the 30 questions (57%) were answered appropriately on all three iterations. The test-retest reliability of ChatGPT was poor with an intraclass correlation coefficient of 0.12. Finally, ChatGPT performed best answering questions requiring lower-order thinking skills (Bloom's levels 1-3) and less well on level 4 questions. CONCLUSIONS: This study found that although ChatGPT has the capability to answer common questions regarding distal radius fractures, caution should be taken before implementing its use, given ChatGPT's inconsistency in providing a complete and accurate response to the same question every time. CLINICAL RELEVANCE: As the popularity and technology of ChatGPT continue to grow, it is important to understand the potential and limitations of this platform to determine how it may be best implemented to improve patient care.

Differences in Lower Extremity Coordination Patterns as a Function of Sports Specialization.

The practice of early sport specialization, defined as intense year-round training in a single sport at the exclusion of others, is increasing in youth athletics. Despite potential benefits, sport specialization may be detrimental to the health of young athletes, as specialization may increase the risk of musculoskeletal injuries-particularly overuse injuries. However, there remains limited knowledge about how sports specialization uniquely alters underlying sports-related motor behavior. The purpose of this study was to compare the variability of movement patterns exhibited by highly sports specialized youth athletes to that of nonspecialized athletes during performance of a sport-specific, virtual reality based cutting task. It was hypothesized that highly specialized athletes would display different patterns of movement coordination compared to nonspecialized athletes during both the run-up phase and cut-and-decelerate phase. In support of the hypothesis, specialized athletes exhibited both intra- and inter-limb coordination that were significantly different than unspecialized athletes. Overall, the results indicate that the highly specialized athletes tended to exhibit greater degrees of coordination but also the ability to break the coordinated patterns of joint angle changes to execute a cutting maneuver, which requires asymmetric demands on the lower extremities while planting on one leg and changing direction.