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Background Medical education in this era has been disturbed by coronavirus disease. Our faculty has quickly adapted the curricula to online formats. The online format seems to be more advantageous in terms of content material and virtual activities, but the results of these adjustments will require subsequent evaluation. The aim of this study was to evaluate medical student expectations of online orthopedics learning that was created based on social constructivism theory. Materials and methods A cross-sectional survey was carried out to assess the fifth-year medical student expectations of our newly developed online orthopedics course during the outbreak. Constructivist Online Learning Environment Survey (COLLES) was applied for evaluating the expectations during orthopedic rotation. The survey contains six aspects based on social constructivist principles: relevance, reflection, interactivity, tutor support, peer support, and interpretation. All students responded to the preferred COLLES before starting the online course, and the actual COLLES was filled out when the online course was completed. Before and after attending the online course, the scores were compared and interpreted to assess student expectations. Results A total of 126 fifth-year medical students studied the online orthopedic course. The preferred COLLES were completed by 125 students, while 120 students replied to the actual COLLES. The overall scores from the post-course survey in all aspects were significantly higher than scores from the pre-course with P -value < 0.01. The comparison between the preferred and actual scores showed this online course fulfilled student expectations. Conclusion The outbreak of coronavirus disease 19 has disrupted medical student education. The online orthopedic learning course in our department has been developed to deal with the current situation. Using the various activities based on social constructivism theory in the online platform was able to fulfill medical student expectations.

The COVID-19 pandemic adversely affected the functional outcomes of fragility hip fracture patients. This study revealed a higher in-hospital complication rate and lower postoperative function at 3 months among patients treated during the pandemic. Therefore, modified in-hospital and post-discharge protocols should be developed for implementation during pandemic crisis periods. Introduction This study aims to investigate the in-hospital complication rate and short-term postoperative functional outcomes of fragility hip fracture (FHF) patients compared between during the COVID-19 pandemic and the same 14-month time period 1 year prior to the pandemic. Methods Using data from the Siriraj Fracture Liaison Service registry, FHF patients treated during the COVID-19 pandemic (1 March 2020 to 30 April 2021) were time-matched with FHF patients treated during the pre-pandemic period (1 March 2018 to 30 April 2019). We collected the rate of in-hospital postoperative complications and the postoperative functional outcomes at discharge and 3 months as measured by the Barthel Index (BI) and EuroQol visual analog scale (EQ-VAS). Functional outcome measures were compared between the pre-pandemic and pandemic periods. Results There were 197 and 287 patients in the pre-pandemic and pandemic groups, respectively. At the 3-month postoperative follow-up, the mean postoperative BI score and change in BI score were both significantly lower in the pandemic group indicating poorer postoperative function. Moreover, FHF patients treated during the pandemic had significantly more inhospital complications (36.6% vs. 22.8%, p = 0.002). There was no significant difference in the 3-month EQ-VAS or change in the EQ-VAS between groups. ConclusionThe results of this study revealed a higher in-hospital complication rate and lower postoperative function at 3 months among FHF patients treated during the COVID-19 pandemic compared to the pre-pandemic period. Therefore, modified in-hospital and post-discharge protocols should be developed for implementation during pandemic crisis periods.

Summary Fragility hip fracture (FHF) is a serious complication of osteoporosis. A fracture liaison service (FLS) is crucial in preventing FHF. Our retrospective data of 489 patients with FHF and 3-year follow-ups demonstrated that the FLS improved functional outcomes. Our study’s mortality rates were lower than in other published series. Purpose This study assessed the 3-year outcomes after fragility hip fracture (FHF) treatment by a multidisciplinary team from the Siriraj Fracture Liaison Service (Si–FLS). The review investigated the administration rates of anti-osteoporosis medication, refracture, and mortality; activities of daily living; mobility; and health-related quality of life. Methods A retrospective review was performed of the records of Si-FLS patients given FHF treatment between June 2016 and October 2018. The outcomes were evaluated at 3 time points: before discharge, and 1 and 3 years after treatment. Results The study enrolled 489 patients (average age, 78). The mortality and refracture rates at 1 year after hip fracture were 13.9% and 1.6%, respectively. At the 3-year follow-up, both rates were higher (20.4% and 5.7%, respectively). The Barthel Index and EuroQoL Visual Analogue Scale had risen to a plateau at the 1-year follow-up and remained stable to the 3-year follow-up. One year after treatment, approximately 60% of the patients could ambulate outdoors, and the proportion remained steady until the 3-year follow-up. There was no difference in the 1- and 3-year follow-up anti-osteoporosis medication administration rates (approximately 40%). Conclusions This study confirms the benefits of having a multidisciplinary FLS care team to manage older people with FHF. An FLS improves the care of patients with FHF and the social support of caregivers and relatives. The FLS maintained the functional outcomes of the patients through 3 years of postfracture treatment.

There is a controversy over the medical treatment of unresectable spinal giant cell tumour (GCT) regarding dosing and duration. We studied a spinal GCT case that had expanded to the thoracic spinal canal and mediastinum and was successfully treated by surgical decompression and denosumab. A woman in her 30s presented with weakness in both the lower extremities. MRI revealed a large tumour in the posterior mediastinum expanding from the thoracic vertebrae (T3–6), which compressed the spinal cord. The patient underwent urgent spinal decompression with instrumentation and her tissue was sent for a pathology study. Histologically and immunohistochemistry confirmed the diagnosis of GCT. Since it was an unresectable tumour, this patient was treated with denosumab. Her neurological problem resolved after 6 months of treatment. After 4 years of follow-up, the patient displayed no further progression and no side effects from long-term denosumab usage.

Background Postoperative adverse events after intramedullary nailing have been reported in patients with metastatic pathological and non-pathological femoral fractures. Other consequences to be considered are readmission and reoperation. Few studies have compared the risks of postoperative adverse events, reoperation, and readmission after intramedullary nailing of pathological and non-pathological femur fractures. This study was designed to test the hypothesis that patients with pathological femoral fractures had more adverse events, readmission, and reoperation following surgical fixation than non-pathological femoral fractures. Methods This was a retrospective observational cohort study, conducted at an academic medical center in Thailand. The data from patients with femoral shaft fractures undergoing long intramedullary nailing, from June 1, 2006, to June 30, 2020, were included. Patients who had a pathological fracture from a primary bone tumor, metabolic bone disease, or inadequate/missing information were excluded. Patients with pathological fractures from metastatic bone disease were assigned to be the pathological group whereas those with traumatic fractures were assigned to be the non-pathological group. The primary outcome was the risk of inpatient adverse events as compared between the two groups. The secondary outcome was the risk of consequences after discharge as compared between the two groups. Outcomes were analyzed by using multivariate logistic regression analysis. Results The total number of patients was 48 in the pathological fracture group and 185 in the non-pathological group. There were significantly higher rates of surgical and medical adverse events in patients with pathological fractures compared to patients with non-pathological fractures. After adjusting for potential confounding factors in multivariate regression analysis, patients with pathological fractures had higher odds of both adverse surgical (adjusted OR 2.43, 95 % CI 1.15–5.13) and medical adverse events (adjusted OR 2.81, 95 % CI 1.13–7.03). Conclusions Patients with metastatic pathological femoral shaft fractures undergoing intramedullary nailing were more likely to experience postoperative adverse events than patients with non-pathological fractures.

Objectives:We aimed to explore the relationship between web-based orthopedic illness scripts and medical students' performance as assessed through examination results. Methods: This was a retrospective cohort study with 83 fifthyear medical students in an academic hospital. During a onemonth placement, they were instructed to do web-based illness scripts. Their performances were assessed by examination in the last week. All recorded data about illness scripts and examination results were retrieved. The students were separated into high and low response groups based on completed illness scripts. The characteristics of the students between the two groups were compared. Pearson correlation coefficients and regression analysis were used to identify the relationship between illness scripts and examination results. Results: There were 56 students in the high-response and 27 in the low-response groups. The characteristics and examination scores were not significantly different between the groups, while there was a significant difference in script completion (t(27)=13.72, p<0.001). Using Pearson correlation, we found weak correlations without significance between completed scripts, illness script scores, and examination scores. We found no relationship between illness script scores and examination scores, even in the high response group, by regression analysis. Conclusions: The use of web-based orthopedic illness scripts did not correlate to the examination performance of medical students. A high number of scripts without variety and limited time for practicing may have obscured potential positive relationships. Illness scripts should be adjusted as appropriate for each school before being assigned. A further multicenter, prospective study is suggested to identify the correlations and investigate the influencing factors.

Background The ongoing Covid-19 pandemic is driving medical schools to replace substantial parts of the traditional lecture method with online formats to maintain social distancing guidelines, and reduce face-to-face contact in the classroom. To our knowledge, there were a few studies comparing the effectiveness of traditional teaching and blended teaching based on the students’ final grades which the efficacy of online learning is still controversy. This study aims to compare the efficacy of blended teaching and conventional teaching in an orthopedics course. Methods This study was a retrospective cohort study which collected from fifth-year medical students between April 2019 and March 2021. The students were divided into two groups which based on years of education. The summative assessment was based on summing the MCQs plus KFs, the MEQ plus oral exam, OSCE, simulated-chart of patients, and OPD. All students were subjected to the same end of course quizzes with no difference between the groups regarding the kinds of knowledge tested. The results of these quizzes were used to compare the effectiveness of the conventional teaching in 2019 and the blended teaching in 2020. The paired t-test was used to analyze the data. Results A total of 252 students were enrolled in this study, of whom 128 and 124 patients were in traditional teaching group or blended teaching, respectively. The grade point averages of the students were 3.2 ± 0.4 and 3.3 ± 0.4 in 2019–2020 and 2020–2021, respectively, without significant difference (p = 0.06). The scores in blended learning group were higher than in the traditional learning group in all assessment tools (MCQ, KF, Oral, and OSCE scores) except the MEQ. Conclusions Blended learning was as effective as traditional learning for teaching medical students. However, well-designed, randomized controlled trials are needed to further analyze the educational structure and investigate the factors related to the effectiveness of this type of learning.