No abstract

No abstract

Background: Technological innovation is a key component of orthopaedic surgery. With the integration of powerful technologies in surgery and clinical practice, artificial intelligence (AI) may become an important tool for orthopaedic surgeons in the future. Through adaptive learning and problem solving that serve to constantly increase accuracy, machine learning algorithms show great promise in orthopaedics. Purpose: To investigate the current and potential uses of AI in the management of anterior cruciate ligament (ACL) injury. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review of the PubMed, MEDLINE, Embase, Web of Science, and SPORTDiscus databases between their start and August 12, 2020, was performed by 2 independent reviewers. Inclusion criteria included application of AI anywhere along the spectrum of predicting, diagnosing, and managing ACL injuries. Exclusion criteria included non-English publications, conference abstracts, review articles, and meta-analyses. Statistical analysis could not be performed because of data heterogeneity; therefore, a descriptive analysis was undertaken. Results: A total of 19 publications were included after screening. Applications were divided based on the different stages of the clinical course in ACL injury: prediction (n = 2), diagnosis (n = 12), intraoperative application (n = 1), and postoperative care and rehabilitation (n = 4). AI-based technologies were used in a wide variety of applications, including image interpretation, automated chart review, assistance in the physical examination via optical tracking using infrared cameras or electromagnetic sensors, generation of predictive models, and optimization of postoperative care and rehabilitation. Conclusion: There is an increasing interest in AI among orthopaedic surgeons, as reflected by the applications for ACL injury presented in this review. Although some studies showed similar or better outcomes using AI compared with traditional techniques, many challenges need to be addressed before this technology is ready for widespread use.

Implication Statement: Medical students have a wide range of opinions and expectations about research and face many challenges when pursuing it. Online research webinars have the potential to teach medical students about the value of research for various competitive and non-competitive specialties, while also providing them with the opportunity to network with recent medical graduates. When hosted virtually, these events have the potential to reach medical student across multiple provinces and provide them with insight on the different facets of research.

Objective: To evaluate whether published studies support basing the diagnosis of compartment syndrome of the lower leg on clinical findings, intracompartmental pressure (ICP) monitoring, or both. Data Sources: A PubMed/MEDLINE, Web of Science, and Embase search of the English literature from 1966 to February 2022 was performed. This used “lower extremity” or “leg” or “tibia” and “compartment syndrome” and “pressure” as the subjects. A manual search of the bibliographies was performed and cross-referenced with those used to formulate the American Academy of Orthopaedic Surgeons clinical practice guidelines. Study Selection and Extraction: Inclusion criteria were traumatic tibia injuries, presence of data to calculate the sensitivity, specificity, positive and negative predictive values of clinical findings and/or pressure monitoring, and the presence or absence of compartment syndrome as the outcome. A total of 2906 full articles were found, of which 63 were deemed relevant for a detailed review. Seven studies met all eligibility criteria. Data Synthesis: The likelihood ratio form of Bayes theorem was used to assess the discriminatory ability of the clinical findings and ICP monitoring as tests for compartment syndrome. The predictive value for diagnosing acute compartment syndrome was 21% and 29% for the clinical signs and ICP, respectively. When combining both, the probability reached 68%. Conclusions: The use of ICP monitoring may be helpful when combined with a clinical assessment to increase the sensitivity and specificity of the overall diagnosis. Previously accepted individual inference values should be revisited with new prospective studies to further characterize the statistical value of each clinical finding. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Case:A 32-year-old patient was diagnosed with a vertical patella fracture nonunion after a bone–patellar tendon–bone (BTB) anterior cruciate ligament reconstruction. In addition, a 1 × 2 × 1 cm patellar bone defect was noticed at the graft harvesting site. The patient was treated surgically with open reduction and internal fixation and iliac crest bone autograft which resulted in fracture union.Conclusion:Many intraoperative and postoperative risk factors for iatrogenic patella fracture when harvesting BTB autograft were identified. Surgeons should be aware of technical skills needed to prevent this complication and should treat the fracture appropriately to avoid nonunion and optimize the outcome.

Background: In the past decade, distal femur anterior hemiepiphysiodesis for fixed knee flexion deformity has gained popularity. In this study, we aim to systematically review the literature on this technique as a treatment for fixed knee flexion deformity in patients with neuromuscular disorders.Methods: A systematic review was performed in the following databases: PubMed, Embase, and Medline. The inclusion criteria included anterior hemiepiphysiodesis of the distal femur for patients with neuromuscular disorders and fixed knee flexion deformities.Results: Our search yielded 419 titles. A total of 12 articles were qualified for final review based on the inclusion and exclusion criteria. The total number of patients was 279, with 483 knees corrected. The male to female ratio was 2.1:1, and the mean age of the patients was 11.3 6 1.4 years (range 4-17 years). The mean preoperative flexion deformity was 23.1°6 10.0°(range 10°-90°). The mean residual flexion deformity at the final follow-up was 8.6°6 9.0°(range 0°-32.5°), which corresponds to a statistically significant decrease compared with the preoperative deformity (p , 0.05). Conclusion:Anterior hemiepiphysiodesis for fixed knee flexion deformity provides favourable outcomes with low complication rates in patients with neuromuscular disorders. Future studies should focus on comparing the long-term outcomes of the different metal implants used for these operations.

A bstract Aim In the past decade, internal limb lengthening nails have gained popularity. In this study, we aim to systematically review the literature on humerus limb lengthening with a motorized intramedullary nail (MIN). We intend to assess the outcome and complications of this technique. Materials and methods A systematic review was performed in the following databases: PubMed, Embase, Web of Science, and the Journal of Limb Lengthening and Reconstruction . The inclusion criteria included limb lengthening of the humerus using an intramedullary nail, clinical studies, all levels of evidence, and no restriction to the date of publication. Results Our search yielded 239 journal articles. A total of nine articles remained relevant based on the inclusion and exclusion criteria. The total number of patients was 20, with 22 segments lengthened. The mean age of the patients was 20.8-year-old [standard deviation (SD), 12.0; range, 13–51]. The mean gained length was 5.7 cm (SD, 0.9; range, 5–7.5) with a mean distraction protocol of 0.82 mm/day (SD, 0.2; range, 0.6–1). The average duration of lengthening was 71.6 days (SD, 12.8; range, 50–93), and the mean duration of consolidation was 192.3 days (SD, 40.5; range, 120–228). Reported complications included a range of motion (ROM) limitation, hardware failure, and hypertrophic bone regeneration. Conclusion Humeral lengthening with an MIN provides favourable outcomes with low complication rates. Future high-level studies should focus on comparing long-term outcomes of humeral lengthening utilising internal and external fixation techniques. Clinical significance Humeral lengthening using MIN can be used safely. Each surgical approach and type of nail have different risks and benefits. These should be carefully discussed when planning the surgery. How to cite this article Lorange JP, Alamiri N, Marwan Y, et al . Humerus Lengthening with a Motorized Intramedullary Nail: A Systematic Review of Outcomes and Complications. Strategies Trauma Limb Reconstr 2022;17(3):165–171.