Calcific tendinitis of gluteus maximus insertion.

Calcific tendinitis, classified as enthesopathy, is a self-limiting disease that rarely involves the tendons of the gluteus maximus. We discuss a 52-year-old woman with a 1-year history of localized, reproducible posterolateral pain of her left hip, which was previously treated with steroid injection to her left greater trochanteric bursa without significant pain relief. Plain radiography and magnetic resonance imaging of the left hip revealed abnormal edema and calcifications at the insertion of the gluteus maximus tendon to the gluteal tuberosity, corresponding to the area of maximal tenderness on examination. This case report contributes to the growing medical literature for the rare presentation of calcific tendinitis of gluteus maximus insertion and reinforces the importance of the patient history, focused physical examination with special testing, and pertinent imaging for proper diagnosis and management.

General skin and nasal decolonization with octenisan® set before and after elective orthopedic surgery in selected patients at elevated risk for revision surgery and surgical site infections-a single-center, unblinded, superiority, randomized controlled trial (BALGDEC trial).

BACKGROUND: The preoperative body surface and nasal decolonization may reduce the risk of surgical site infections (SSI) but yields conflicting results in the current orthopedic literature. METHODS: We perform a single-center, randomized-controlled, superiority trial in favor of the preoperative decolonization using a commercial product (octenidine® set). We will randomize a total number of 1000 adult elective orthopedic patients with a high risk for SSI and/or wound complications (age ≥ 80 years, chronic immune-suppression, American Society of Anesthesiologists score 3-4 points) between a decolonization (octenisan® wash lotion 1 × per day and octenisan® md nasal gel 2-3 × per day; during 5 days) and no decolonization. Decolonized patients will additionally fill a questionnaire regarding the practical difficulties, the completeness, and the adverse events of decolonization. The primary outcomes are SSI and revision surgeries for postoperative wound problems until 6 weeks postoperatively (or 1 year for surgeries with implants or bone). Secondary outcomes are unplanned revision surgeries for non-infectious problems and all adverse events. With 95% event-free surgeries in the decolonization arm versus 90% in the control arm, we formally need 2 × 474 elective orthopedic surgeries included during 2 years. DISCUSSION: In selected adult orthopedic patients with a high risk for SSI, the presurgical decolonization may reduce postoperative wound problems, including SSI. TRIAL REGISTRATION: ClinicalTrial.gov NCT05647252. Registered on 9 December 2022. PROTOCOL VERSION: 2 (5 December 2022).

Can Generative Artificial Intelligence Enhance Health Literacy About Lateral Epicondylitis?

INTRODUCTION: Health literacy is a critical determinant of a patient's overall health status, and studies have demonstrated a consistent link between poor health literacy and negative health outcomes. The Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) advise that patient educational materials (PEMs) should be written at an eighth-grade reading level or lower, matching the average reading level of adult Americans. The purpose of this study was to investigate the ability of generative artificial intelligence (AI) to edit PEMs from orthopaedic institutions to meet the CDC and NIH guidelines. METHODS: PEMs about lateral epicondylitis (LE) from the top 25 ranked orthopaedic institutions from the 2022 U.S. News & World Report Best Hospitals Specialty Ranking were gathered. ChatGPT Plus (version 4.0) was then instructed to rewrite PEMs on LE from these institutions to comply with CDC and NIH-recommended guidelines. Readability scores were calculated for the original and rewritten PEMs, and paired t-tests were used to determine statistical significance. RESULTS: Analysis of the original and edited PEMs about LE revealed significant reductions in reading grade level and word count of 3.70 ± 1.84 (p<0.001) and 346.72 ± 364.63 (p<0.001), respectively. CONCLUSION: Our study demonstrated generative AI's ability to rewrite PEM about LE at a reading comprehension level that conforms to the CDC and NIH guidelines. Hospital administrators and orthopaedic surgeons should consider the findings of this study and the potential utility of artificial intelligence when crafting PEMs of their own.

Lower Extremity Peripheral Nerve Blocks for Post-operative Pain Control in a Multi-trauma Patient With Brugada Syndrome: A Literature Review and Case Report.

We describe the case of a 28-year-old man with Brugada syndrome who received single-shot adductor canal and sciatic nerve blocks for the management of post-operative pain related to extensive orthopedic injuries. Low-dose ropivacaine with glucocorticoid additives was administered without any EKG changes, arrhythmias, or syncopal sensations. The patient experienced pain relief for over 24 h and was monitored on telemetry with defibrillator pads as a cardiac precaution. This case adds a valuable data point in the limited canon of information on the safety and efficacy of regional anesthesia in Brugada syndrome for the perioperative physician.

Revision Rotator Cuff Repair Versus Primary Repair: An Assessment of Longitudinal Outcomes Outcomes in Revision Rotator Cuff Repair.

BACKGROUND: Information about outcomes after revision rotator cuff repair (RCR) is limited. A more thorough investigation of pain, range of motion (ROM), strength, and functional outcomes is needed. Comparing outcomes between primary and revision rotator cuff repair patients can help surgeons guide patient expectations of the revision procedure. The aim of this study was to compare the outcomes of a revision repair group to a control group of primary RCR patients. We expect revision RCR patients to have worse clinical outcomes than primary RCR patients. METHODS: A retrospective review of patients who underwent primary or revision RCR between 2012 to 2020 was performed. The case group included 104 revision patients, and the control group included 414 primary RCR patients. Patient visual analog score (VAS) for pain, ROM, strength, Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), and Constant-Murley scores were collected at baseline, 12 months, 24 months, and final follow-up. RESULTS: The average final follow-up was 43.9 months for primary patients and 63.8 months for revision patients. 352 primary patients and 55 revision patients had a final follow-up of 2 or more years. By final follow-up, primary patients had less pain than revision patients (Δ of 2.11, P < .0001), but both groups improved overall. Primary patients had significant improvements in forward flexion, external rotation, internal rotation, and abduction at 2 years that were lost by final follow-up, but revision patients did not experience any long-term improvement in ROM. These differences in ROM between groups were not significant. Supraspinatus strength in the revision group did not improve nor decline by final follow-up. By final follow-up, both primary and revision patients had improved SST and ASES scores from baseline. Primary patient ASES scores were 17.9 points higher (P < .0001) than revision patients by final follow-up, and there was no difference between groups in SST scores at this time. CONCLUSION: Revision RCR significantly improves patient pain, SST score, and ASES score at 4 years. Revision patients should not expect to see the improvements in range of motion that may occur after primary repair.

Glenoid Fracture Fixation Using an Acu-Loc Distal Radius Plate.

Displaced fractures of the glenoid require surgical fixation. This poses multiple problems, including a difficult approach and achieving adequate reduction with current implants. We provide a surgical technical tip for fixing scapula neck and glenoid rim fractures with an Acu-Loc distal radius plate (Acumed, Weyhill, UK), illustrated with two recent case reports. Here, we present two cases of a 58-year-old female and a 51-year-old male presenting to a hospital following a fall, both sustaining an isolated right glenoid intra-articular fracture evident on plain radiographs. CT scans revealed a displaced and fragmented glenoid surface. A reverse Judet posterior approach facilitated exposure to enable the reduction of the glenoid, an uncommon approach. Current plate designs provide surgeons with limited options to fix complex fractures of the scapula and were not suitable here. The lateral scapula border and inferior glenoid have a similar anatomical shape to the distal radius. An Acu-Loc locking distal radius plate with a radial styloid plate was trialled and provided a good reduction to the fragmented glenoid. A distal radius plate can be a useful option to consider in complex scapula neck and glenoid rim fractures. A better understanding of glenoid shape will facilitate the further development of orthopaedic implants. Familiarity with various surgical approaches is needed to operate on these complex fractures.

Pillar Pain After Minimally Invasive and Standard Open Carpal Tunnel Release: A Systematic Review and Meta-analysis.

Purpose: Pillar pain is a recognized postoperative complication of carpal tunnel release (CTR). Minimally invasive and alternative surgical techniques can theoretically prevent pillar pain, and the aim of this review was to compare the incidence of pillar pain after standard open CTR and alternative surgical techniques. Methods: MEDLINE, Embase, and Scopus databases were thoroughly searched. Randomized controlled trials comparing minimally invasive surgical techniques to standard open CTR were identified. Data, including surgical technique, number of hands, incidence of pillar pain, and follow-up intervals, were extracted. Odds ratios (OR) were expressed as pillar pain incidence in the intervention group relative to standard open CTR. Results: There were 12 studies included. No statistically significant differences were noted among endoscopic (OR = 0.53, P = .20), flexor retinaculum lengthening (OR = 1.00, P = 1.00), short incision (OR = 0.41, P = .07) or illuminated knife techniques (OR = 0.18, P = .16). There was a statistically significant decrease in pillar pain after minimally invasive CTR (OR = 0.41, 95% confidence interval 0.20-0.86, I2 = 0%, P = .02) between 3- and 6-months follow-up; however, analyses at all other follow-up periods failed to reach statistical significance. Conclusions: Although our findings suggest that standard open CTR may be associated with an increased duration of pillar pain between 3 and 6 months postoperatively, our results suggest that minimally invasive CTR techniques do not affect either the initial development or persistence of pillar pain. Clinical relevance: Our results illustrate the natural history of pillar pain with the majority of cases resolving after 6 months, highlighting the utility of symptomatic and conservative treatments and patient education in the management of pillar pain.

Orthopedic Surgical Treatment of Patients with Tumor-induced Osteomalacia Located in the Hip Bones: A Retrospective Analysis of 10 Years in a Single Center.

OBJECTIVE: The orthopedic surgical treatment strategies for patients with tumor-induced osteomalacia (TIO) require improvement, especially for patients where the causative tumors are located in surgically challenging areas, requiring a greater degree of in-depth investigation. This work aims to summarize and investigate clinical features and orthopedic surgical treatment effects of patients with tumor-induced osteomalacia (TIO), whose causative tumors are located in the hip bones. METHODS: A retrospective analysis was conducted on the clinical data of all patients diagnosed with culprit tumors located in the hip bones who underwent surgical treatment at the orthopedic bone and soft tissue tumor sub-professional group of Peking Union Medical College Hospital from January 2013 to January 2023. This retrospective study summarized the clinical data, preoperative laboratory test results, imaging findings, surgery-related data, perioperative changes in blood phosphorus levels, and postoperative follow-up data of all patients who met the inclusion criteria. Normally distributed data are presented as mean and standard deviation, while non-normally distributed data are shown as the means and 25th and 75th interquartile ranges. RESULTS: The clinical diagnostic criteria for TIO were met by all 16 patients, as confirmed by pathology after surgery. Among the 16 patients, we obtained varying degrees of bone pain and limited mobility (16/16), often accompanied by difficulties in sitting up, walking, and fatigue. An estimated 62.5% (10/16) of patients had significantly shorter heights during the disease stages. All 16 patients underwent surgical treatment for tumors in the hip bones, totaling 21 surgeries. In the pathogenic tumor, there were 16 cases of skeletal involvement and none of pure soft tissue involvement. Out of the 16 patients, 13 cases had a gradual increase in blood phosphorus levels following the latest orthopedic surgery, which was followed up for 12 months to 10 years. Due to unresolved conditions after the original surgery, four patients received reoperation intervention. Two cases of refractory TIO did not improve in their disease course. CONCLUSION: In summary, the location of the causative tumor in the hip bone is hidden and diverse, and there is no defined orthopedic surgical intervention method for this case in clinical practice. For patients with TIO where the tumors are located in the hip bones, surgical treatment is difficult and the risk of postoperative recurrence is high. Careful identification of the tumor edge using precise preoperative positioning and qualitative diagnosis is crucial to ensure adequate boundaries for surgical resection to reduce the likelihood of disease recurrence and improve prognosis.

Wearable Sensors in Other Medical Domains with Application Potential for Orthopedic Trauma Surgery-A Narrative Review.

The use of wearable technology is steadily increasing. In orthopedic trauma surgery, where the musculoskeletal system is directly affected, focus has been directed towards assessing aspects of physical functioning, activity behavior, and mobility/disability. This includes sensors and algorithms to monitor real-world walking speed, daily step counts, ground reaction forces, or range of motion. Several specific reviews have focused on this domain. In other medical fields, wearable sensors and algorithms to monitor digital biometrics have been used with a focus on domain-specific health aspects such as heart rate, sleep, blood oxygen saturation, or fall risk. This review explores the most common clinical and research use cases of wearable sensors in other medical domains and, from it, derives suggestions for the meaningful transfer and application in an orthopedic trauma context.

Efficacy of Continuous Lumbar Plexus Blockade in Managing Post-Operative Pain after Hip or Femur Orthopedic Surgeries: A Systematic Review and Meta-Analysis.

Background: Post-operative pain management is essential for optimizing recovery, patient comfort, and satisfaction. Peripheral nerve blockade, or lumbar plexus block (LPB), has been widely used for analgesia and regional anesthesia. This study explored the existing literature to determine the efficacy of continuous lumbar plexus blockade in managing post-operative pain following hip or femur surgery. Methods: Reviewers comprehensively searched electronic databases to identify peer-reviewed scholarly articles reporting the efficacy of lumbar plexus block in managing post-operative pain after orthopedic surgery. The potential articles were carefully selected and assessed for the risk of bias using the Cochrane Collaboration Risk of Bias assessment tool. Data were systematically extracted and analyzed. Results: The literature search yielded 206 articles, 20 of which were randomized controlled trials. Lumbar plexus block demonstrated superior pain relief compared to conventional pain management approaches like general anesthetics. In addition, LPB reduced patients' overall opioid consumption compared to controls, reduced adverse effects, and enhanced functional recovery, which underlines the broader positive impact of meticulous pain management. More patients could walk more than 40 feet after the second day post-operatively among the lumbar plexus group (14.7%) compared to the continuous femoral group (1.3%). Other parameters, including cortisol levels and hemodynamic stability, were evaluated, showing comparable outcomes. Conclusions: Lumbar plexus block is effective in pain management after orthopedic surgery, as shown by the lower pain scores and less opioid consumption. Additionally, patient satisfaction was relatively higher in LPB-treated patients compared to other approaches like general anesthesia.

Anatomic Reversal of Shoulder Joint After Neck of Humerus Fracture.

We report on a singular case of a unique form of post-traumatic reversal of the humeral head after humeral neck fracture, in which the pattern of collapse resulted in the formation of a native reverse polarity shoulder. In essence, the humeral head became a socket, and the glenoid rounded to become a head with well-preserved shoulder function. To our knowledge, this is the first case of an acquired shoulder deformity that bears a remarkable functional similarity to a prosthetic reverse polarity shoulder replacement.

Trends in Medicare Reimbursement for Common Pediatric Orthopedic Procedures: From 2000 to 2022.

Objective We aimed to evaluate trends in government monetary reimbursement (Medicare) for 10 of the most commonly performed pediatric orthopedic procedures from 2000 to 2020. Methods Utilizing the Centers for Medicare and Medicaid Services website, we collected data for 10 of the most commonly performed pediatric orthopedic surgical procedures and their variations. The reimbursement data for each procedure was taken from the Current Procedural Terminology (CPT) code, which was collected from the Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services (Baltimore County, MD). The reimbursement values were adjusted for inflation to the 2022 US dollar (USD) using the changes to the Consumer Price Index. The compound annual growth rates (CAGRs) and total percentage changes in reimbursement were calculated for all the procedures and put into relative value units. Results Reimbursement for 20 of the 22 total procedures decreased by 32.65% from 2000 to 2022 after adjusting for inflation. Achilles tenotomy with local anesthesia saw the greatest decrease (-54.38%), whereas the procedure revision of spinal fusion saw the highest increase (26.00%) in mean adjusted reimbursement during this study period. Adjusted reimbursement decreased by an average of 2.08% on a yearly basis. Conclusion This study is the first to take an in-depth view and evaluate trends in procedural Medicare reimbursement for pediatric orthopedic surgery. When adjusted for inflation, Medicare reimbursement for 20 of 22 included procedures has steadily decreased from 2000 to 2022. There needs to be an increased awareness and consideration of these trends as they will be important for policymakers, hospitals, and surgeons to ensure continued access to meaningful surgical pediatric orthopedic care in the United States.

Optimizing Surgical Management of Tibial Plateau Fractures: A Comparative Study of Minimally Invasive Versus Open Reduction Techniques.

BACKGROUND: Tibial plateau fractures pose a significant challenge to orthopedic surgeons due to their complex nature and potential for long-term morbidity. Surgical intervention is often necessary to restore anatomical alignment and optimize functional outcomes. This study aimed to evaluate the efficacy of minimally invasive percutaneous plate osteosynthesis (MIPPO) compared to open reduction and internal fixation (ORIF) in the management of tibial plateau fractures. MATERIALS AND METHODS: The present hospital-based observational study was conducted at Agartala Government Medical College for two years. Seventy adult patients with tibial plateau fractures were included, with surgical interventions performed based on fracture characteristics. Postoperative outcomes, including knee range of movements, functional recovery, and complication rates, were assessed at six months. RESULTS: MIPPO demonstrated superior outcomes compared to ORIF, with a higher proportion of participants achieving knee range of movements > 120 degrees (66.7% versus 36%; p = 0.030), excellent functional outcomes (66.7% versus 36%; p = 0.046), and lower postoperative complication rates (2.2% versus 28%; p = 0.001). Fracture union times were significantly shorter in MIPPO (12.49 weeks) when compared to ORIF (14 weeks) (p = 0.009). CONCLUSION: MIPPO offers advantages over conventional ORIF in terms of functional recovery and complication rates while demonstrating comparable fracture union times. These findings advocate for the adoption of MIPPO as a preferred surgical technique for tibial plateau fractures.

Orthopedic Surgery Residents: How Much Do They Know About Occupational Therapy?

Background Orthopedic hand surgeons rely on occupational therapy (OT) as a crucial part of rehabilitation following injury or surgery. Therefore, orthopedic surgeons should understand the full range of OT services. There is limited prior research on orthopedic residents' understanding of OT in the United States. The main goal of this study is to examine how well orthopedic surgery residents grasp and perceive the role of OT, particularly in hand surgery, as integrated into their educational curriculum. Methods The study included all orthopedic surgery residents from a single institution (Columbia University, New York) during 2022-2023. We obtained permission from the Institutional Review Board, Department Chair, and Program Director to recruit participants. Eligible residents who agreed to participate completed questionnaires regarding their understanding of the role of OT in orthopedic surgery. Results Thirty subjects met the inclusion criteria. The total response rate from the residents was 14/30 (47%). The residents reported a mediocre level of familiarity with OT while also rating 4.5/5 the importance of OT in hand surgery without significant difference between postgraduate year groups. 11/14 residents reported no formal training concerning the role of OT in hand surgery. 12/14 residents reported that it would be helpful to spend time with an occupational therapist. Conclusions This study revealed the lack of confidence residents expressed regarding occupational therapists' roles. All residents recognized the importance of OT in hand surgery and expressed interest in shadowing occupational therapists. Residents of all levels acknowledge the crucial partnership between orthopedists and occupational therapists but lack formal education about the therapist's scope and role.

Association between operative duration and adverse outcomes after hip fracture surgery: A NSQIP matched cohort study.

BACKGROUND: Prolonged operative duration is an independent risk factor for surgical complications in numerous subspecialties. However, associations between adverse events and operative duration of hip fracture fixation in older adults have not been well-quantified. This study aims to determine if prolonged operative duration of hip fracture surgery is related to adverse outcomes. We hypothesized that patients with high operative durations experience greater rates of 30-day complications. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was retrospectively reviewed to identify older adults (55 years and above) who underwent hip fracture fixation between 2015-2019. Prolonged operative duration was defined as >75th percentile, and cases were matched using propensity scores based on demographic, surgical, and comorbidity factors. Univariate differences in adverse events (including readmission, reoperation, mortality, and organ-system complications) were analyzed. Multivariable mixed-effects logistic regression analyses were completed for statistically significant events. RESULTS: A total of 8827 case-control pairs were identified for comparison. Rates of superficial surgical site infection (SSI) (p= 0.022), any SSI (p= 0.032), and any complication (p < 0.001) were elevated in those with prolonged surgical duration in univariate analyses. In multivariable models, prolonged operative time was associated with superficial SSI (OR 1.50, p= 0.019), any SSI (OR 1.35; p= 0.029) and any complication (OR 1.58; p < 0.001). In subgroup analyses, all findings persisted for IMN with operative time associated with superficial SSI (OR 1.98, p= 0.012), any SSI (OR 1.71; p= 0.019), and any complication (OR 1.84; p < 0.001). Operative time was associated only with any complication for hemiarthroplasty/internal fixation and sliding hip screw (OR 1.27 and 1.89, respectively; p < 0.001). CONCLUSION: Our study demonstrates that duration of surgery is an independent risk factor for superficial SSI, any SSI, and any complication. Notably, our findings suggest that high operative durations may be most concerning for SSIs in IMN fixation, which is currently the most common choice for hip fracture fixation in the US. However, the rate of any complication is significantly elevated when surgical duration is prolonged, regardless of surgery type.

Association of Timing With Postoperative Complications in the Management of Open Distal Radius Fractures.

BACKGROUND: This study investigates whether open distal radius fractures (ODRFs) treated after 24 hours from time of injury have an increased risk of infection or overall complication profile compared with those treated within 24 hours. METHODS: Retrospective review was performed of all patients treated for ODRF over a 6-year period at a single large academic institution. Postoperative complications included surgical site infections, need for revision irrigation and debridement, delayed soft tissue healing, loss of reduction, nonunion, and malunion. RESULTS: One-hundred twenty patients were treated for ODRF. Mean (SD) age at time of injury was 59.92 (17.68) years. Twenty patients (16.7%) had postoperative complications. Regarding mechanism of injury, 78 (65.0%) had a low-energy and 42 (35.0%) had a high-energy injury. Age and fracture grade were not significant factors. Mean (SD) open wound size was 1.18 (1.57) cm. Mean (SD) time from injury presentation to the emergency department (ED) and first dose of intravenous antibiotics was 3.07 (4.05) hours and mean (SD) time from presentation to the ED and operative treatment was 11.90 (6.59) hours, which did not show a significant association with postoperative complications. Twenty-four patients (20.0%) were treated greater than 24 hours after presentation to the ED, which was not significantly distinct from those treated within 24 hours. CONCLUSION: Patients with ODRFs treated after 24 hours were not associated with a greater risk of postoperative complications. Factors including age, energy and mechanism of injury, and fracture grade did not alter outcome in any statistically significant manner. LEVEL OF EVIDENCE: Level IV.

Surgical treatment of injection-induced rectus femoris muscle contracture in a child: A case report.

INTRODUCTION AND IMPORTANCE: Quadriceps contracture, characterized by the shortening of the quadriceps muscle and reduced knee flexion, poses challenges in daily activities. The etiology of this condition includes congenital, traumatic, infective, or iatrogenic factors.Treatment typically involves surgical intervention, with various techniques described in the literature. Differentiating between isolated rectus femoris contracture and combined rectus and quadriceps contractures is crucial for appropriate management. CASE PRESENTATION: A 14-year-old female presented with gait disturbance and limitations in sitting and squatting due to rectus femoris contracture secondary to repetitive intramuscular injections. Physical examination revealed restricted knee flexion and positive Ely's test. The patient underwent rectus femoris lengthening (RFL) surgery, resulting in improved knee flexion and hip extension. Postoperatively, early mobilization and physiotherapy were initiated, leading to complete recovery with no complications during a three-year follow-up. CLINICAL DISCUSSION: Quadriceps femoris muscle contracture in childhood can result from congenital factors or acquired causes such as injections, trauma, infections, or ischemia. In Syria, injection-induced contractures are prevalent due to widespread intramuscular drug administration. Differentiating between isolated rectus femoris contracture and combined quadriceps contracture is crucial for treatment selection. Surgical intervention, such as rectus femoris lengthening using the Z-plasty procedure, yields favorable outcomes. Postoperative physiotherapy is essential. Incision necrosis is a common complication, mitigated by careful incision placement. CONCLUSION: Injection-induced rectus femoris contracture is common in children due to repeated thigh injections. Healthcare providers should consider alternative administration sites and routes to prevent contractures.

Smart Drill for a Streamlined Estimation of the Drilling Angle and Channel Length in Orthopedic Surgical Procedures.

The estimation of distances and angles is a routine part of an orthopedic surgical procedure. However, despite their prevalence, these steps are most often performed manually, heavily relying on the surgeon's skill and experience. To address these issues, this study presents a sensor-equipped drill system which enables automatic estimation of the drilling angle and channel length. The angular accuracy and precision of the system were tested over a range of inclination angles and proved to be superior to the manual approach, with mean absolute errors ranging from 1.9 to 4.5 degrees for the manual approach, and from 0.6 to 1.3 degrees with the guided approach. When sensors were used for simultaneous estimation of both the inclination and anteversion angles, the obtained mean absolute errors were 0.35 ± 0.25 and 2 ± 1.33 degrees for the inclination and anteversion angles, respectively. Regarding channel length estimation, using measurements obtained with a Vernier caliper as a reference, the mean absolute error was 0.33 mm and the standard deviation of errors was 0.41 mm. The obtained results indicate a high potential of smart drill systems for improvement of accuracy and precision in orthopedic surgical procedures, enabling better patient clinical outcomes.

Results of the Surgical Approach of Idiopathic Scoliosis in Adolescents and Postoperative Quality of Life: Systematic Literature Review.

Adolescent idiopathic scoliosis is considered the most severe and common spinal deformity, affecting children and adolescents still in the neuropsychomotor development phase before they reach skeletal maturity. This study aimed to evaluate the surgical approach to adolescent idiopathic scoliosis (AIS), considering the results associated with the reduction of pathological curvature, pulmonary function, and repercussions on the quality of life of adolescents undergoing such treatment. Systematic literature review, with a quantitative and qualitative approach to the data collected, structured according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), carried out in the databases linked to the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Latin American and Caribbean Health Sciences Literature (LILACS). The total sample of the studies was 638 adolescents with AIS, with a mean age of 14.93 years ± 1.24. The mean correction of the main pathological curvature in the studies was 55.06% ± 12.24. In all of the selected studies using posterior spinal fusion to correct AIS, there was a significant reduction in pathological curvatures (> 49%), and the recurrence of curvature in none of the studies exceeded a pathological gain of more than 5%. As for lung function, the studies showed significant increases in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) in patients with severe AIS, and no pulmonary function losses were reported after surgery to correct AIS.

Eighteen-Year Follow-up After Autologous Chondrocyte Implantation on Medial and Lateral Femoral Condyles: A Case Report.

Articular cartilage defects are common injuries of the knee. The defects often progress in size and produce significant clinical symptoms due to the lack of intrinsic repair or regenerative capacity of articular cartilage. With the failure of nonoperative treatment options, surgical treatment is indicated and includes palliative, reparative, and regenerative options. For large defects of the femoral condyles, trochlea, or patella, autologous chondrocyte implantation can provide successful and long-lasting results. Presented is the case of a 37-year-old male with an 18-year follow-up to autologous chondrocyte implantation for extensive left knee articular cartilage defects of the medial and lateral femoral condyles. Recovery from articular cartilage defects is shown through both clinical improvement of the patient and arthroscopic photographs of robust autologous articular cartilage on the medial femoral condyle. This case supports the long-term benefits of autologous chondrocyte implantation as a surgical intervention for large, full-thickness articular cartilage defects of the knee.