The 50 most influential papers pertaining to the Ilizarov method: A bibliometric analysis.

The Ilizarov method has become a widely recognised surgical technique. A bibliometric analysis of the 50 most-cited publications relating to the Ilizarov method was carried out. Cumulative number of citations was 4,918. Mean number of citations was 98. h-index was 50. Impact factor of these journals ranged from 0.5-5.082. Our study suggests that a highly cited and influential paper likely originated from an American journal with a high impact factor and was published in the 1990s/2000s. Our compilation of the 50 most influential papers on the Ilizarov method will prove invaluable to those in training and those involved in further advancing the technique.

Readability and quality of online information for patients pertaining to revision knee arthroplasty: An objective analysis.

BACKGROUND: Modern patients use the internet more frequently for their health information. Our aim was to assess the quality and readability of online patient education materials relating to revision knee arthroplasty. We hypothesised that this information would be too difficult to read for the average patient and of a lesser quality than desired. METHOD: A search of the top 50 results on 3 search engines (Google, Bing, Yahoo) was completed (MeSH "revision knee arthroplasty", "revision knee replacement"). Readability of these websites was calculated using a specialised website, www.readable.com to produce 3 scores (Gunning-Fog (GF), Flesch Reading Ease (FRE), Flesch-Kincaid Grade (FKG). Quality was assessed using the Journal of American Medical Association (JAMA) benchmark criteria and the Health On the Net (HON) code toolbar extension. RESULTS: 89 unique websites were identified. Mean FRE was 44.01 ± 11.05. The mean GF was 12.01 ± 2.94. The mean FKG level was 10.06 ± 1.95. As per the FRE score, no webpage was pitched at or below a sixth grade reading level. The GF index identified only 3 websites (3.4%) at 6th grade reading level. As per FKG score, most webpages (n = 58, 65.2%) found themselves in the 10th grade reading level and above. Four websites (4.5%) displayed a HONcode certificate. However, all had expired. Most websites (n = 34, 38.2%) didn't meet any of the JAMA criteria. CONCLUSION: The reading level of these materials is too high for the average patient and of a low quality. Given what we know about levels of health literacy and their relationship with patient outcomes, it is vital that we address these deficiencies promptly.

Trends in Irish hip fracture surgery over a 7-year period and international registry comparison.

BACKGROUND: Hip fractures are a significant cause of morbidity and mortality in elderly patients. Timely surgical fixation and early mobilisation are the cornerstone to successful outcomes. The Irish Hip Fracture Database (IHFD) was established in 2012 and publishes annual reports on hip fracture care. This paper describes the trends in surgical fixation in Ireland during a 7-year period (2013-2019), assesses for compliance with guidelines and compares the most recent published reports from ten international hip fracture registries. METHODS: All published IHFD reports were systematically reviewed and tabulated. Data corresponding to demographics, fracture type, surgical fixation and post-operative management was plotted and analysed. Ten international hip fracture registries were identified and reviewed. Data was extracted corresponding to the IHFD dataset. RESULTS: A total of 21,684 hip fractures were recorded during this period. The majority of patients were female (70.16%), >80 years old (58.26%), admitted from their own home (82.13%) and ASA grade 3 (53%). The majority of undisplaced and displaced intracapsular fractures were treated with hemiarthroplasty, 62% and 88% respectively. There has been a decline in the use of dynamic hip screw (DHS) for intertrochanteric fractures with intramedullary nails being favoured. CONCLUSION: Despite greater awareness of hip fracture care through the IHFD and the introduction of Best Practice Tariffs (BPT), further improvements are needed. Ireland compares well to international standards but has low rates of compliance to NICE guidelines for surgical fixation.

Scaphoid fractures: A bibliometric analysis of the most influential papers.

Scaphoid fractures are commonly seen following a fall on an outstretched hand and often missed on initial presentation. An untreated scaphoid fracture may result in avascular necrosis of the scaphoid due to its retrograde blood supply. Published articles guide our investigation and management of these injuries. A citation analysis was performed on the top 30 articles relating to scaphoid fractures ranked by citation number. The 30 articles have been cited a total of 4595 times originating from 9 different countries. The leading article was cited 443 times with an average of 12.66 citations/year. Although this may not directly correlate with study quality, it does provide an insight to the influence which a paper has had on the scientific community. This list may prove invaluable to clinicians involved in the treatment of patients with scaphoid fractures and those actively furthering the development of the field.

Ankle conFUSION: The quality and readability of information on the internet relating to ankle arthrodesis.

BACKGROUND: The internet is an important source of information for patients undergoing surgery. Multiple studies have identified inappropriately high reading levels of patient information online. The average reading level in the United States is 7-8th grade. Multiple organisations have recommended that patient information not exceed 6th grade level. This study aims to evaluate the reading levels and quality of information regarding ankle fusion surgery online. METHODS: Google, Bing and Yahoo were searched (MeSH "ankle fusion", "ankle arthrodesis") and the top 30 URLs analysed. Readability was assessed using an online readability calculator to produce 3 scores (Gunning FOG, Flesch Kincaid Grade and Flesch Reading Ease). Quality was assessed using a HONcode detection web-extension and the JAMA benchmark criteria. RESULTS: Ninety-eight webpages were identified. The mean Flesch Kincaid Grade level was 9.24 ± 2.33 (95% CI 8.78-9.71). The mean Gunning FOG grade was 10.88 ± 3.1 (95% CI 10.26-11.5). The mean Flesch Reading Ease score was 49.88 ± 14.46 (95% CI 46.98-52.78). 7 webpages were at or below the 6th grade reading level. The mean JAMA score was 1.34 ± 1.32 out of 4 (95% CI 1.07-1.6). 14 websites were HONcode accredited. CONCLUSION: The overall readability of medical information online is too high for the average patient. Given the important role that health literacy provides in patient reported outcomes, improving the readability and quality of these materials is imperative. Awareness by the general public is essential for them to critically appraise the information they receive online.

Assessing the Attitudes, Awareness, and Behavioral Alterations of Patients Awaiting Total Hip Arthroplasty During the COVID-19 Crisis.

BACKGROUND: COVID-19 has placed a huge burden on healthcare systems which has led to widespread cancellation elective surgical care. Ireland is recovering from the first wave of COVID-19 and as such the expeditious return of elective surgical care is important. This is the first study to examine the attitudes of patients to undergoing total joint arthroplasty during the COVID-19 crisis. METHODS: A prospective qualitative study was undertaken in our institution during the week 13/05/2020-20/05/2020. 65 patients completed a questionnaire assessing attitudes, awareness, and behavioral changes associated with COVID-19, a Charlson Comorbidity Index, modified-Harris Hip Score, and a Short Form-12 score. RESULTS: 86% of patients felt that they were at little to no risk of COVID-19 infection. The majority of patients were happy to proceed with surgery at the current level of COVID-19 related threat (86%). Patients with higher mHHS were more likely to postpone their operation than those with lower mHHS scores. Our cohort had low patient reported outcome measures in both mHHS and SF-12, indicating the significant burden of hip osteoarthritis on both physical and mental health. CONCLUSION: Patients reported a significant disease-related impairment of physical function and subsequent deterioration in mental health as a result of hip osteoarthritis. Patients with worse hip function, as measured by the mHHS are more willing to proceed with surgery than those with superior hip function. This offers a potential mechanism by which to triage patients once elective surgical pathways reopen in the coming months.

Gastro-cholecysto-colic fistula. Case report of an idiopathic case, and management approach.

A 71-year-old lady presented with a 4-week-history of epigastric pain, feculent vomiting, diarrhoea and weight-loss. On subsequent investigations, she was found to have a complex gastro-cholecysto-colic fistula with no clear underlying aetiology. The only abnormality both macroscopically and microscopically was ulceration and inflammation in the colon. However, this was not pathognomonic of inflammatory bowel disease, and (gastric) acid-induced inflammation is an alternative explanation. Herein we present her case, her comprehensive evaluation, her successful surgical management and a review of the relevant literature.