Effectiveness of AI-powered Chatbots in responding to orthopaedic postgraduate exam questions-an observational study.

PURPOSE: This study analyses the performance and proficiency of the three Artificial Intelligence (AI) generative chatbots (ChatGPT-3.5, ChatGPT-4.0, Bard Google AI®) and in answering the Multiple Choice Questions (MCQs) of postgraduate (PG) level orthopaedic qualifying examinations. METHODS: A series of 120 mock Single Best Answer' (SBA) MCQs with four possible options named A, B, C and D as answers on various musculoskeletal (MSK) conditions covering Trauma and Orthopaedic curricula were compiled. A standardised text prompt was used to generate and feed ChatGPT (both 3.5 and 4.0 versions) and Google Bard programs, which were then statistically analysed. RESULTS: Significant differences were found between responses from Chat GPT 3.5 with Chat GPT 4.0 (Chi square = 27.2, P < 0.001) and on comparing both Chat GPT 3.5 (Chi square = 63.852, P < 0.001) with Chat GPT 4.0 (Chi square = 44.246, P < 0.001) with. Bard Google AI® had 100% efficiency and was significantly more efficient than both Chat GPT 3.5 with Chat GPT 4.0 (p < 0.0001). CONCLUSION: The results demonstrate the variable potential of the different AI generative chatbots (Chat GPT 3.5, Chat GPT 4.0 and Bard Google) in their ability to answer the MCQ of PG-level orthopaedic qualifying examinations. Bard Google AI® has shown superior performance than both ChatGPT versions, underlining the potential of such large language processing models in processing and applying orthopaedic subspecialty knowledge at a PG level.

Primary Versus Revision ACL Reconstruction Using Quadriceps Autograft: A Matched-Control Cohort Study.

Background: The incidence of anterior cruciate ligament (ACL) reconstruction is increasing, and quadriceps tendon (QT) autograft is gaining popularity for both primary and revision ACL reconstruction. Purpose: To evaluate the differences in the patient-reported functional outcomes, concomitant injuries, and graft failure in primary versus revision ACL surgery using QT autograft. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 376 patients with primary ACL reconstruction and 138 patients with revision ACL reconstruction were retrospectively retrieved from a prospectively collected ACL registry. A minimally invasive technique was used for QT autograft harvesting. The surgical procedure and rehabilitation protocol were identical in both groups. To maintain a homogeneous cohort for the study, the groups were matched by age, sex, and preinjury outcome scores (Lysholm knee score, Tegner activity level, and visual analog scale [VAS] for pain). Initial baseline assessments of outcome scores were compared with scores collected at the 2-year postoperative mark. Results: The mean age of the primary group and revision group was 32.9 ± 10.2 years (range, 18-55 years) and 32.3 ± 9.9 years (range, 19-55 years) respectively. Significant preinjury to postoperative improvements were noted in Lysholm (88.2 ± 16.4 vs 83.5 ± 15.0; P = .007) and VAS pain (0.9 ± 1.3 vs 1.5 ± 1.6; P = .001) scores after primary ACL reconstruction compared with revision reconstruction. However, no significant difference was found in Tegner activity level (6.7 ± 1.8 vs 5.9 ± 1.8; P > .430). Primary ACL injury was associated with significantly higher concomitant medial collateral ligament injuries (P = .019), while the revision group was associated with significantly higher concomitant cartilage (P = .001) and meniscal (P = .003) injuries. A significantly higher graft failure rate was noted in the revision group compared with the primary ACL reconstruction group (13.0% vs 5.6%; P = .005). Conclusion: Both primary and revision ACL reconstruction with QT autograft had acceptable functional outcomes. The primary group had better outcomes than the revision group, possibly due to the lower prevalence of meniscal and cartilage injuries in the primary group compared with the revision group. The revision group was associated with higher graft failure than the primary group. QT autograft is a viable graft choice for both primary and revision ACL reconstruction.

Total hip arthroplasty in active and advanced tubercular arthritis: a systematic review of the current evidence.

STUDY DESIGN: Systematic review. INTRODUCTION: Total hip arthroplasty (THA) is a well-acknowledged surgical intervention to restore a painless and mobile joint in patients with osteoarticular tubercular arthritis of the hip joint. However, there is still substantial uncertainty about the ideal management, clinical and functional outcomes following THA undertaken in patients with acute Mycobacterium tuberculosis (TB) hip infections. AIM OF THE STUDY: To undertake a systematic review and evaluate existing literature on patients undergoing THA for acute mycobacterium tuberculosis arthritis of the hip. METHODS: A systematic review of electronic databases of PubMed, EMBASE, Scopus, Web of Science and Cochrane Library was performed on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search focused on "arthroplasty in cases with tuberculosis of hip joint" since inception of databases until July 2023. Data on patient demographics, clinical characteristics, treatment administered, surgical interventions and outcome, as reported in the included studies, were recorded. Median (range) and mean (standard deviation) were used to summarise the data for continuous variables (as reported in the original studies); and frequency/percentage was employed for categorical variables. Available data on Harris hip scores and complications were statistically pooled using random-effects meta-analysis or fixed-effect meta-analysis, as appropriate RESULTS: Among a total of 1695 articles, 15 papers were selected for qualitative summarisation and 12 reporting relevant data were included for proportional meta-analysis. A total of 303 patients (mean age: 34 to 52 years; mean follow-up: 2.5 to 10.5 years) were included in our systematic review. In a majority of included studies, postero-lateral approach and non-cemented prosthesis were employed. Fourteen studies described a single-staged procedure in the absence of sinus, abscess and tubercular infection syndrome (TIS). All surgeries were performed under cover of prolonged course of multi-drug anti-tubercular regimen. The mean Harris hip score (HHS) at final follow-up was 91.36 [95% confidence interval (CI): 89.56-93.16; I2:90.44%; p<0.001]. There were 30 complications amongst 174 (9.9%) patients (95% CI: 0.06-0.13; p=0.14; I2=0%). CONCLUSION: THA is a safe and effective surgical intervention in patients with active and advanced TB arthritis of hip. It is recommended that the surgery be performed under cover of multi-drug anti-tubercular regimen. In patients with active sinus tracts, abscesses and TIS, surgery may be accomplished in a multi-staged manner. The clinical (range of motion, deformity correction, walking ability and pain scores), radiological (evidence of radiological reactivation and implant incorporation) and function outcome (as assessed by HHS) significantly improve after THA in these patients.

An updated meta-analysis comparing complications, functional, clinically relevant and radiological outcomes of accelerometer based portable navigation and conventional technique of total knee arthroplasty.

Introduction: Since previous studies, including small-scale meta-analyses comparing accelerometer-based portable navigation (APN-TKA) and conventional techniqueof total knee arthroplasty (CONV-TKA), have reported divergent results, there is a need for an updated meta-analysis to compare complications, functional outcomes, clinically relevant outcomes and radiographic alignment of components. Methods: This meta-analysis was conducted as per PRISMA guidelines. Randomised controlled trials, and non-randomised comparative cohort studies in English language on primary TKA were included. The complications compared were Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), infection, manipulation under anaesthesia (MUA) for postoperative knee stiffness, re-operation and mortality. The functional outcomes compared were the Knee Society Knee Score, Knee Society Score function, Oxford Knee Score, Knee Injury and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Arthritis Index. The evaluated clinically relevant outcomes were surgical time, blood loss, drop in haematocrit, tourniquet time, postoperative knee flexion and complications). The number of radiological outliers; as well as the absolute values of the alignment of the overall prosthesis, femoral and tibial components in both coronal and sagittal planes, was assessed. Results: Twenty-five studies were included. Both the groups were comparable in terms of preoperative demographic features. There was no difference in complications and functional outcomes. Operation time was longer in APN-TKA (p < 0.00001) but there was no difference in rest of the clinically relevant outcomes. Restoration of the lower limb mechanical axis (p = 0.003) and coronal femoral alignment angle (p = 0.0002) was better with APN. APN also significantly reduced the risk of the odds of outliers of lower limb mechanical axis (p < 0.0001), coronal femoral alignment (p = 0.03), coronal tibial alignment (p < 0.0001) and sagittal tibial alignment (p = 0.0001). Conclusion: The improvement in the accuracy of implantation by the use of APN-TKA, as determined by the overall alignments of prosthesis, or femoral and tibial components, does not necessarily translate into lesser complications and better functional and clinical outcomes. Level of evidence: Therapeutic study, Level II.

Erratum: Author Correction: Telemedicine-Rehabilitation and Virtual Reality in Orthopaedics and Sports Medicine.

[This corrects the article DOI: 10.1007/s43465-022-00766-6.].

Isolated Tuberculosis of Spinous Process of C5 Vertebra: A Rare Case Report of Reformation of Destroyed Spinous Process.

Introduction: Tuberculosis of posterior spinal elements or neural arch tuberculosis is a rare clinical entity. We report a patient with isolated tuberculosis of the C5 spinous process and reformation of destroyed spinous process in response to antitubercular therapy (ATT). This is first case report of the kind to the best of our knowledge. Case Report: A young male aged 22 years presented to us with a slow-growing, painful lump for the past 3 months accompanied by a discharging sinus at the back of his neck. Plain radiograph and computed tomography scan showed destruction of the C5 spinous process. Magnetic resonance imaging cervical spine showed presence of abscess in addition to the above finding. The patient underwent incision and drainage of abscess followed by local injection of streptomycin. CB-NAAT (Gene Xpert) and histopathological examination confirmed the diagnosis of tuberculosis. The patient responded to ATT very well. The C5 spinous process which was destroyed by the disease process was seen to have gradually reformed on serial radiographs. Conclusion: Isolated posterior spinal tuberculosis is rare, but it must be thought of as a differential diagnosis in suitable cases. Diseased tissue in tuberculosis has high healing potential in response to medical therapy, thus avoiding the need of radical debridement.

Does intraoperative patellar eversion affect clinical and functional outcomes in patients undergoing primary total knee arthroplasty? An evidence-based meta-analysis.

PURPOSE: This meta-analysis aims to compare the early postoperative recovery, complications encountered, length of hospital stay, and initial functional scores between patellar eversion and non-eversion manoeuvres in patients undergoing during primary total knee arthroplasty (TKA) based on clinical studies available in the literature. METHODS: A systematic literature search was conducted using PubMed, Embase, Web of Science, and the Cochrane Library databases between January 1, 2000 and August 12, 2022. Prospective trials comparing clinical, radiological, and functional outcomes in patients undergoing TKA with and without patellar eversion manoeuvre were included. The meta-analysis was performed using Rev-Man version 5.41 (Cochrane Collaboration). Pooled-odds ratios (for categorical data) and mean differences with 95% confidence intervals (for continuous data) were calculated (p < 0.05 was regarded as statistically significant). RESULTS: Ten (out of the 298 publications identified in this subject) were included for the meta-analysis. The patellar eversion group (PEG) had a significantly shorter tourniquet time [mean difference (MD) - 8.91 min; p = 0.002], although the overall intraoperative blood loss was higher (IOBL; MD 93.02 ml; p = 0.0003). The patellar retraction group (PRG), on the other hand, revealed statistically better early clinical outcomes in terms of shorter time necessary to perform active straight leg raising (MD 0.66, p = 0.0001), shorter time to achieve 90° knee-flexion (MD 0.29, p = 0.03), higher degree of knee flexion achieved at 90 days (MD - 1.90, p = 0.03), and reduced length of hospital stay (MD 0.65, p = 0.03). There was no statistically significant difference in the early complication rates, 36-item short-form health survey (1 year), visual analogue scores (1 year), and Insall-Salvati index at follow-up between the groups. CONCLUSION: The implications from the evaluated studies suggest that in comparison with patellar eversion, patellar retraction manoeuvre during surgery provides significantly faster recovery of quadriceps function, earlier attainment of functional knee range of motion (ROM), and shorter length of hospital stay in patients undergoing TKA.

Telemedicine-Rehabilitation and Virtual Reality in Orthopaedics and Sports Medicine.

Introduction: Tele-rehabilitation is a method of delivering rehabilitation services using information, technology and communication to everyone, irrespective of their geographic location. National zeal for competitive sports and COVID pandemic has led to an increase in its demand and popularity worldwide. The athletes need immediate treatment and correct rehabilitation to keep them in their game. This review aims to bring into perspective the importance of telemedicine and telerehabilitation in orthopaedics and sports medicine with a focus on virtual reality. Methods: Articles were searched based on suitable keywords 'telemedicine', 'telerehabilitation' 'orthopedics', 'orthopaedics', 'sports' and 'India*' which were combined using suitable boolean operators in PubMed, Scopus and Web of Science. Government guidelines and laws were also reviewed in view of telehealth and telemedicine. Conclusion: Tele-rehabilitation and virtual physical therapy are innovative and cost-effective ways to provide the best rehabilitative services to the patients at their doorstep. Virtual reality should be incorporated into the Indian telehealth delivering system with a special focus on the remote athlete population.

Surgical Management of Paediatric Thoracolumbar Tuberculosis by a Combination of Anterior and Posterior Versus Posterior Only Approach: A Systematic Review and Meta-Analysis.

STUDY DESIGN: Systematic Review and Meta-analysis. OBJECTIVES: This systematic review and meta-analysis is aimed to assess effectiveness, safety, clinical, functional and radiological outcome of either combined anteroposterior or posterior-only approach in the surgical management of active tubercular disease of paediatric thoracolumbar spine. METHODS: A systematic literature search through PubMed, Scopus, Web of Science and Cochrane Library database was performed. Data extraction was undertaken following methodological quality assessment. RESULTS: 9 out of the 182 publications identified, were included for analysis. A total of 247 patients were analysed. Two amongst the 9 studies were retrospective comparative studies evaluating posterior approach with combined anteroposterior approach and were considered for comparative meta-analysis. Blood loss and duration of surgery was significantly higher in the anteroposterior group, as compared to the posterior-only group. There was no significant difference between the 2 groups in terms of post-operative kyphosis angles, final kyphosis angles, number of complications, functional outcome and spinal fusion time. However, all the included studies were non-randomised and retrospective. Only 2 of them had a control group with a high heterogeneity amongst these 2 studies. CONCLUSION: The inference from the studies included in this review suggests that equivalent results can be achieved with posterior-only approach for thoracolumbar tuberculosis in children as compared to anteroposterior approach, with much lower complexity, reduced blood loss and shorter surgical time. However, due to the high risk of bias and considerable heterogeneity among the studies included, we cannot conclude whether one approach is better than the other.

Bone defect classifications in revision total knee arthroplasty, their reliability and utility: a systematic review.

BACKGROUND: There are various classification systems described in the literature for managing bone defects in revision knee arthroplasty (RTKA). We analysed the reliability and usefulness of these classification systems. QUESTIONS/PURPOSES: (1) To review and critique the various classification systems proposed for bone loss in RTKA. (2) Among all the proposed classifications which one is the most commonly used by surgeons to report their results. (3) What is the reliability of various bone defect classification systems for RTKA. In this review, we have assessed the studies validating those classifications with a detailed description of the limitations and the proposed modifications. METHODS: This systematic review was conducted following PRISMA guidelines. Pubmed/Medline, CINAHL, EMBASE, Scopus, Cochrane databases and Web of Science databases were searched using multiple search terms and MeSH terms where possible. Studies meeting inclusion criteria were assessed for statistical parameters of reliability of a classification system. RESULTS: We found 16 classification systems for bone defects in RTKA. Six studies were found evaluating a classification system with reporting their reliability parameters. Fifty-four studies were found which classified bone loss using AORI classification in their series. AORI classification is most commonly reported for classifying bone defects. Type T2B and F2B are the most common bone defects in RTKA. The average kappa value for AORI classification for femoral bone loss was 0.38 (0.27-0.50) and 0.76 (0.63-1) for tibial bone loss assessment. CONCLUSION: None of the available classification systems is reliably established in determining the bone loss and treatment plans in RTKA. Among all, AORI classification is the most widely used system in clinical practice. The reliability of AORI Classification is fair for femoral bone loss and substantial for tibial bone loss.

No difference in sports participation and patient-reported functional outcomes between total knee arthroplasty and unicompartmental knee arthroplasty at minimum 2-year follow-up in a matched control study.

PURPOSE: The purpose of this study was to compare (1) sports participation and type of sports activity between TKA and UKA patients; (2) functional outcome and activity level between TKA and UKA; and (3) survivorship of the prosthesis in both the groups. METHODS: Prospectively collected data were obtained from an arthroplasty database to identify patients who underwent primary TKA and UKA. Both the cohorts of TKA and UKA were matched, controlling for age, sex, BMI and preoperative patient-reported outcomes, which include Oxford Knee Score (OKS), Tegner activity level, and visual analog scale (VAS) for pain score. After matching the two groups, 287 TKA and 69 UKA cases were available to be included in the study. Patients were evaluated pre- and postoperatively at 2 years for sports participation and sports preference, patient-reported outcomes, activity levels, and improvement in knee pain. RESULTS: The mean age of the TKA and UKA groups were 75.7 ± 8.1 and 74.2 ± 8.8, respectively. There was no significant difference between the two groups concerning the demographic variables. Significant improvement was noted in the weekly sports participation at the final follow-up compared to preoperative sports participation in both the TKA and UKA groups (p < 0.05). All patients were able to return to their desired sporting activity. No significant difference was noted between the two groups in sports participation preoperatively and postoperatively (p > 0.05). OKS, Tegner activity level and VAS for pain demonstrated a significant improvement from preoperative to 2 years postoperatively (p < 0.05). However, preoperative and postoperative patient-reported outcomes did not differ significantly between the TKA and UKA groups (p > 0.05). No case of revision surgery was found at a 2-year follow-up in both groups. CONCLUSION: Traditionally, in isolated medial compartment osteoarthritis, UKA has been considered to be the procedure with better functional outcomes, but the current study demonstrates that when confounding factors are controlled, both TKA and UKA are effective, and offer similar functional outcomes and result in similar improvement in sports participation. These findings will be helpful to counsel the patients to choose the best suitable operative procedure between UKA and TKA. LEVEL OF EVIDENCE: Level 3.

Femoral neck system reduces surgical time and complications in adults with femoral neck fractures: A systematic review and meta-analysis.

Purpose: Femoral neck fractures (FNF) in adults are conventionally managed with surgical options. This paper is aimed to assess the safety, and functional outcomes of the novel Femoral neck system (FNS) for FNF treatment in adult population. Methods: An organized quest of four literature databases (PubMed, Scopus, Web of Science, and Cochrane Library) was performed on March 1, 2022 using the term "femoral neck system". Fixed or random-effect meta-analysis was used to analyse the outcome measures after selecting relevant studies and assessing their quality. Heterogeneity was considered when calculating pooled effect sizes and 95% confidence ranges. Results: On comparing FNS with cannulated cancellous screws (CCS) or other methods, in a total of 762 patients (351 FNS and 411 CCS) in the 11 comparative studies considered for meta-analysis, blood loss was pointedly higher overall in the FNS group, mean difference 115.77 ml; 95% CI 3.11 ml, 28.42 ml; test of overall effect: z = 1.68, p = 0.09); with considerable heterogeneity. However, in the FNS group the operative time was substantially lower (Mean difference -7.91 min; 95% CI -15.01, -0.80; test of overall effect: z = 2.18, p = 0.03, with marked heterogeneity). Moreover, complications such as infections, non-union, osteonecrosis, implant cut-out were significantly lower in the FNS group with a Mantel Haenszel Odds ratio of 0.20 (95% CI 0.12, 0.34: Z = 6.01, p < 0.0001). Conclusion: Keeping in mind the heterogenicity of the studies, -management of adult patients with FNF with FNS can provide results comparable to traditional fixation methods with significantly lower rate of complications.

Tibial periprosthetic fractures in Total Knee Arthroplasty - A scoping review.

Background: Periprosthetic tibial fractures in Total Knee Arthroplasty are much less commonly seen than femoral fractures, and there is a paucity of available literature and management recommendation for these fractures. We aimed to identify the relevant and up-to-date literature on this subject to analyse the incidence, risk factors, and management recommendations. Methods: A literature search was done on the databases of PubMed and SCOPUS using appropriate keywords. All the published literature in the English language was included for this review. Results: We included 21 studies comprising 260 tibial periprosthetic fractures (91 intra-operative (35%) and 169 (65%) post-operative or delayed fractures). Only 5.9% of these fractures were managed conservatively. Whereas 98 cases (58%) were managed with open reduction and internal fixation (ORIF) with plating, 19 (11.2%) were managed with revision TKA. Seventeen cases (10%) were managed with minimally invasive percutaneous plate osteosynthesis (MIPPO), and 8 (4.7%) were managed with intramedullary nailing. Less than 6% of cases were managed with other means, viz. megaprosthesis (n = 4), arthrodesis (n = 5), amputation (n = 1), and external fixator (n = 1). Conclusion: Intraoperative fractures accounted for one-third of the fractures in our review. A majority of the delayed periprosthetic fractures were treated with surgical intervention. The most preferred surgical treatment method was ORIF of fractures using locking plates (either open or MIPPO). Revision TKA or megaprosthesis was used in cases with the loosened implants in association with the fracture. Level of evidence: IV.

Concomitant spine and calcaneum fractures: a possible indication of less extensive injury.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To study the incidence of concomitant calcaneum fractures in participants with traumatic spine fractures and to study the association of calcaneum injury with the mode of trauma, morphology and level of vertebral fracture and neurological status in participants with concomitant spine and calcaneum fracture. SETTING: Central Institute of Orthopaedics, Safdarjung Hospital, New Delhi, India. METHODS: Records of participants with traumatic spine fractures were analyzed. Participants who had calcaneum fracture confirmed on radiographs were considered to have concomitant spine and calcaneum fracture. In these participants, variables noted were age, gender, mode of trauma, level and morphology of vertebral fracture and neurological status. RESULTS: Concomitant calcaneum fracture was present in 43 participants out of a total of 358. The lumbar spine was involved in 72.09% of participants. 46.51% of participants had complete burst type of vertebral fractures. Neurology was found to be intact in 58.13% of participants. The association of concomitant calcaneum injury with the level of spine fracture and type of fracture were found to be statistically significant (p < 0.05). In particular, the association of concomitant calcaneal fracture with intact neurology and incomplete paraplegia (ASIA B, C or D) as compared to spinal injury cases without calcaneal fractures was statistically significant (p < 0.001). CONCLUSION: Calcaneum fractures co-exist with spine fractures in 12.01% participants. Concomitant calcaneal fracture(s) with spine trauma indicate a greater chance of incomplete injury or intact neurology possibly due to dispersion of force vectors.

Bibliometric analysis of COVID-19 related publications in Indian orthopaedic journals.

BACKGROUND: The COVID-19 pandemic has resulted in an infodemic about the novel coronavirus SARS-CoV-2 outbreak to build knowledge and develop mitigation strategies. In addition, scientific journals across the world have studied the impact of COVID-19 on trauma and orthopaedics. METHODS: A cross-sectional, bibliometric analysis of the literature was undertaken on COVID-19 related articles from three Pubmed and Scopus indexed orthopaedic journals from India, namely, Indian Journal of Orthopaedics(IJO),Journal of Clinical Orthopaedics and Trauma(JCOT), and Journal of Orthopaedics (JOO), in May 2021. All the article types and study designs were included for this review. The authors, institutions, countries, keywords, and co-authorship mapping were studied. RESULTS: A total of 112 COVID-19 related documents were retrieved. Period of these publications was from 2nd April 2020 to 31st May 2021. Vaishya R. (n = 16) was the most cited author, and Indraprastha Apollo Hospitals (n = 16) was the most cited research Institution. India led the list of countries in academic publication output. On keyword mapping, telemedicine was the most prominent Medical Subject Headings (MeSH) search word. CONCLUSION: The Indian orthopedic journals have addressed the impact of COVID-19 on orthopaedic practice in India and aborad whilst continuing to publish knowledge about basic science and clinical orthopaedic research studies. The JCOT has outperformed and become the most leading orthopaedic journal from India during the pandemic. COVID -19 articles have been fast tracked, open accessed and attracted more citations in reduced duration of time compared to non-COVID-19 papers.

Bibliometric analysis of the top 50 most cited publications of the Journal of Clinical Orthopaedics and Trauma.

BACKGROUND: The Journal of Clinical Orthopaedics and Trauma (JCOT) is one of the top three orthopaedic journals from India. We set out to analyse the top 50 cited articles from JCOT since indexing in PubMed and Scopus. METHODS: We looked into the bibliometrics of the top 50 cited articles and compared citations from PubMed and Scopus, and depicted outputs from VOS viewer analysis on co-authorship and keywords. RESULTS: Total citations for top-cited articles were 1076 in numbers, with a maximum of 103.2016 and 2018 were the most productive years. The major contribution was from India with 74%, followed by the USA. New Delhi published maximally at 72%. Clinical topics and narrative reviews were the most common types of studies. Trauma and Adult reconstruction was the most common sub-specialities, and Level 4 was the most frequent level of study. The basic science and COVID-19 related articles received the maximum citations. The authors from Indraprastha Apollo Hospitals published the maximum number of top-50 cited articles in the JCOT. CONCLUSIONS: There is a steady increase in the number of publications in the JCOT, with an increasing number of citation counts. Both the Indian and foreign authors have been publishing in this journal at a comparative rate. Although the citation counts in Scopus are more than those in PubMed for given articles, more than 80% of articles are listed in both databases as top 50 cited articles. The majority of top-cited articles belonged to trauma and adult reconstruction, level III studies, and narrative reviews.

Data for orthopaedic surgeons - A review.

As we step into a technology powered era, where information is available everywhere, managing data forms an important part of professional and everyday life. With developments like online databases, high definition videos and images, social media, robotics, explosion of academic publications, telecommunication, artificial intelligence and internet of things, there is a variable amount of data that the orthopaedic surgeon is exposed to and has to deal with on a regular basis. It is imperative that the surgeon has a basic working knowledge on data and its applications in relation to the field of orthopaedic surgery. This review introduces the surgeon to data and its types, its sources, collection, Electronic Medical Records (EMR), management after collection, Big data and legal issues related to data. Data generators from megabytes to yottabytes are discussed along with options for their storage and analysis. Knowledge on the types of data is important to decide on the type of statistical tests that may be used on them, for the options available for storage, analysis and legal issues. We discuss the different types of data, computer and cloud-based systems of Electronic Medical Records (EMRs) with their advantages and disadvantages as well as the differences between conventional and EMRs. Management of data after collection is discussed including storage and backup, archiving and sharing, organizing, tracking changes and analysis. High resolution images, videos, robotics and analytics are powering demand and production of data in Trauma and Orthopaedics. Issues like copyright, Privacy, security, encryption and legal issues related to data are highlighted as these are important as more and more data is being used online and involve issues of privacy and security. We also take a look into the future of data in orthopaedics as digitization of the world is occurring at a rapid pace.

Clinico-Radio-Histopathological Correlation by C-Arm Image-Guided Biopsy in Spinal Tuberculosis.

BACKGROUND/PURPOSE OF THE STUDY: C-arm-guided biopsy is a safe and effective technique for evaluating TB spine and is useful in planning therapy. The purpose of this study was to find a correlation between clinically and radiologically suspected TB spine and C-arm image-guided biopsy-proven cases and to study the complications encountered. METHODS: After evaluating the clinical, laboratory, X-ray and MRI findings, 92 patients with provisionally diagnosed tubercular spine were subjected to C-arm image-guided biopsy. RESULTS: Among our 92 cases, histopathology was positive in 55 cases (59.78%). Out of these 55 histologically positive cases, CBNAAT was positive in 42 cases and negative in the rest 13 cases. Overall, among the 92 cases, CBNAAT was positive in 51(55.43%) of cases, and out of these, histopathology turned out to be positive in 42 of cases. Out of 41 cases with negative CBNAAT, histopathology was suggestive of tuberculosis in 13. The strength of agreement between CBNAAT and histopathology was statistically significant (p < 0.0001; kappa = 0.511). No complication such as bleeding, nerve/cord injury, infection, injury to aorta or pneumothorax was encountered during and after the C-arm biopsy in any case. CONCLUSION: C-arm image-guided biopsy is reasonably accurate and should be used as a tool for diagnosis of TB spine. We recommend histopathological examination as a key component for the diagnosis of TB spine, as it is precise and consumes relatively shorter time. CBNAAT is more rapid but is not a substitute for histopathology for spine TB diagnosis.

Top 50 cited articles on Covid-19 after the first year of the pandemic: A bibliometric analysis.

BACKGROUND & AIMS: It has been just over a year since the Covid-19 pandemic started. The top 50 cited articles on this subject would help identify trends and focus on the research efforts. METHODS: We utilised e-utilities in PubMed to find publications on Covid-19 until the date of search on 7/2/21. The iCite website was used to find the top 50 citations of the output from the search strategy. We looked into their full text for the editorial dates, type of study, level of evidence, focus of the article and country of origin. We also counted the errata and comments on each of them. RESULTS: The total number of citations of all 50 articles was 123,960, the highest being 10, 754 for a single article. Huang C was the most cited first author. They were published from week 4-17, with February being the month with most citations. Lancet was the most cited journal, having published 9 of the 50 articles. Majority belonged to level 3 of the evidence ladder and were retrospective studies. Thirty percent of them had an errata published and an average of 7 comments per article. CONCLUSION: The top 50 most cited articles identify the most impactful studies on Covid-19, providing a resource to educators while identifying trends to guide research and publishing efforts. There has been an explosion of publications and an unprecedented rate and number of citations within the first year for any single condition in the literature.