bluuebunny/crossref_metadata_2025 huggingface dataset:
Experience-Based Opioid-Sparing Orthopedic Surgical Protocols
Authors: Chin Cassie , Sigman Scott
Published: August 2023

Specific protocols have been established for each of the time windows involved in the perioperative surgical experience. We use a combination of medications, medical devices, local and regional anesthetics to minimize pain while trying to avoid Opioids.
Where are standardized and validated conservative treatment protocols for knee osteoarthritis?
Authors: Kirschenbaum Ira H.
Published: August 2023

An editorial calling for a discussion of actual protocol-sharing for the non-operative management of knee osteoarthritis.
Perceptions of Regional Anesthesia for Pediatric Supracondylar humerus fractures – a multispecialty survey
Authors: Mansour Alfred , Biaggi-Ondina Andrea , Crawford Lindsay , Younas Shiraz , Matuszczak Maria , Cameron Staci , Warth Ryan J. , Haidar Layla
Published: August 2023

Background

The purpose of this study was to compare the prior experiences, perceived risks, benefits, complications, and practice patterns in the use of regional anesthesia for pediatric supracondylar humerus fractures between orthopaedic surgeons and anesthesiologists to better understand the attitudes and experiences governing perioperative pain management in the opioid crisis.

Methods

An online survey consisting of 22 multiple-choice questions regarding usage of regional anesthesia for perioperative pain management of supracondylar humerus fractures was approved by the Evidence-based Practice committee of the Pediatric Orthopaedic Society of North America (POSNA) and distributed to the active members. The same survey was also distributed to anesthesiologists associated with pediatric anesthesiology teaching centers between January 2019-June 2019. The results were captured anonymously using a RedCAP database, after which the data was exported for analysis.

Results

Two hundred and seventy nine physicians participated in this survey (n=249 orthopaedic surgeons [89.2%]; n=30 anesthesiologists [10.8%]). In total, 162/279 (58.1%) reported at least 10 years of practice, 236/279 (84.6%) reported practicing in an academic setting, and 185/279 (66.3%) reported a minimum volume of 20 applicable cases per year.

69.9% of Orthopaedic surgeons were moderately or highly concerned regional anesthesia would mask a compartment syndrome compared to only 10% of anesthesiologist sharing that same level of concern (p<0.001), although similar numbers of respondents treated patients with volkman’s contracture after a supracondylar humerus fracture. 76.1% of orthopaedic surgeons did not believe the level of perioperative pain warranted regional anesthesia compared to only 6.7% of anesthesiologists (p=0.005).

Conclusion

This multidisciplinary survey highlights the distinct differences in perceptions of regional anesthesia for supracondylar humerus fractures. These perceptional differences frame our opinions and willingness to changes our practices. This survey suggests perceptions on pain, risks, and benefits of regional anesthesia vary greatly between two major stakeholders treating the same injury.
Stable intertrochanteric hip fracture fixation: Device choice does not impact cost of care
Authors: DeAngelis Ryan D. , Zelenski Nicole A. , Brock John Logan , Charette Ryan S. , Neuwirth Alexander L. , Mehta Samir
Published: August 2023

Introduction

There are over 300,000 hip fractures in the U.S. annually. Hip fractures create a substantial health and economic burden, with one-year mortality after a hip fracture approaching 30% and hip fractures creating healthcare costs of over $12 billion annually. Stable intertrochanteric hip fractures can be treated with either an extramedullary implant (sliding hip screw, SHS) or an intramedullary nail (IMN), which has a higher hardware cost. This study compared the cost of care between patients treated with IMN versus SHS after stable intertrochanteric hip fracture.

Methods

This was a retrospective cohort study of patients over age 55 with stable intertrochanteric hip fractures at a Level 1 trauma center over a 4-year period. We collected demographic information, fixation method, outcomes measures, and cost data. Statistical analysis compared patient characteristics, costs, and outcomes between SHS and IMN patients.

Results

83 patients were included, of whom 57 received an SHS and 26 received an IMN. There were no differences in age, gender, BMI, and ASA score between patients who received SHS vs. IMN (p>0.05 for all). There were no significant differences in mortality or readmission rates. SHS and IMN patients had no significant differences in length of stay (8.3 +/- 5.2 vs 8.0 +/- 3.5 days, p=0.76), direct costs ($22,324 +/- $10,603 vs $19,881 +/- $5,894, p=0.18), or health system profit (-$1,313 +/- $8,559 vs -$4,373 +/- $8,394, p=0.13).

Discussion

We compared the cost of care between patients treated with IMN versus SHS after stable intertrochanteric hip fracture. The use of IMN for the treatment of stable intertrochanteric hip fractures is controversial due to the significant cost of the implant. We found no differences in length of stay or care costs between patients treated with IMN versus SHS. Differences in implant cost were insignificant compared to the total cost of care.
Management of Prosthetic Joint Infection following Total Knee Arthroplasty with an Articulating Antibiotic Knee Spacer: An Early Experience
Authors: Alden Kris J.
Published: August 2023

Eradication of deep prosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a vexing problem to patients, surgeons, and the health care system. At present, two-stage exchange is a widely accepted method to treat and resolve PJI following TKA. Various spacers are available following resection arthroplasty and are designed for the local delivery of antibiotics and stability of the knee joint. We report our experience with management of PJI in TKA patients with a novel mobile knee spacer.

Methods

We retrospectively reviewed 31 consecutive infected knee arthroplasties, (primary TKA, 26) and (revision TKA, 5) performed between 2014 and 2016 treated with two-stage exchanges. The outcome of the spacer cohort and subsequent reimplantation procedure was examined to determine spacer range of motion, postoperative range of motion, and reinfection rate following two-stage exchange.

Results

Minimal spacer-related complications are reported and a stable knee spacer with flexion up to 95° were observed in most patients. The overall mean ± SD time of interim spacer placement for all patients was 25.7± 21.9 weeks (range, 8-109 weeks). The mean ± SD postoperative follow-up (following reimplantation surgery) was 3.52 ± 1.36 years (range, 1.29-6.03 years). Two patients re-infected and required a second two-stage exchange procedure. Following post second stage reimplantation surgery, all patients demonstrated no evidence of recurrence of infection.

Conclusions

This customized and modular articulating knee spacer has the potential to significantly reduce spacer-related complications following PJI in both primary and revision TKA and provide enhanced stability and improved knee range of motion.

Level of Evidence

Prognostic Level IV.
OrthoSummit 2020 Resident & Fellow Competition Abstracts
Authors: Authors Multiple
Published: August 2023

This is the compendium of the Resident & Fellow abstracts that were accepted for presentation for the OrthoSummit 2020 meeting that was presented virtually. Congratulations to all these presenters.
The Effectiveness of Bedside Low Pressure Irrigation on Pistol Caliber Gun Shot Wounds Bacterial Contamination
Authors: Colen Alexander , Lindeman Katherine , Ablove Robert
Published: August 2023

Controversy exists regarding the benefit of low-pressure irrigation of pistol caliber gunshot wounds. Our study set to examine the effect of low-pressure irrigation on bacteria quantity in a simulated gunshot wound.
Risk Factors for Physician Burnout in Early Career Arthroplasty Surgeons
Authors: Arguelles William , Salami Joseph , Patel Shaun P. , Courtney P. Maxwell , Lange Jeffrey K. , Suarez Juan P. , Martin J. Ryan
Published: August 2023

Introduction

We sought to identify the prevalence and risk factors for physician burnout and job satisfaction among arthroplasty surgeons within their first five years of practice.

Methods

The American Association of Hip and Knee Surgeons (AAHKS) Young Arthroplasty Group was surveyed for this study. The survey collected data regarding surgeon demographics, extracurricular activities, and job satisfaction. The abbreviated Maslach Burnout Inventory (aMBI) was utilized to evaluate emotional exhaustion, depersonalization, and personal accomplishment. Demographic and practice variables were analyzed to identify any association with aMBI scores.

Results

82 surgeons (35%) responded to the survey with 78% satisfied with their current job. Surgeons who were satisfied with their current job were more likely to have hobbies outside of orthopedics (OR = 7.50, p = 0.005), be younger (OR = 11.11, p = 0.047), and to be employed in a physician-owned practice type (OR = 9.09, practice, p = 0.019). The median personal accomplishment score was higher for those reporting hobbies outside of orthopedics (16 vs. 13.5, p = 0.040), performing research (16.5 vs. 16, p = 0.006), and having less call (17 vs. 14.5, p = 0.001). Depersonalization and emotional exhaustion scores were not related to any characteristic measured.

Conclusion

Emotional exhaustion, depersonalization, and sense of personal accomplishment varied greatly amongst early career arthroplasty surgeons. Having hobbies outside of orthopedics was most strongly associated with a sense of greater personal accomplishment and job satisfaction. Understanding risk factors related to burnout may help improve identification and prevention of this potential cause of job dissatisfaction and turnover.
Direct to Employer Contracting in Orthopedics
Authors: Kurtz William
Published: August 2023

Direct to employer contracting for MSK services is popular now that large employers are self-funded for their healthcare benefits. These self-funded employers can use their TPA (third party administer) for their non-orthopedic claims and contract with sophisticated orthopedic provider groups for value based MSK services.
Three-Dimensional Gait Analysis in a Healthy Geriatric Cohort
Authors: Johnson Jeremiah D. , Rozumalski Adam , Thomas Avis J. , Huyke Fernando A. , Schroder Lisa K. , Switzer Julie A.
Published: August 2023

Introduction

Three-dimensional gait analysis assesses multiple parameters of lower extremity motion. Neither normative gait patterns nor an understanding of how health and demographic factors impact gait have been established for the geriatric population.

Methods

A single time-point observational study from October 2013 to February 2015 recruited 25 healthy geriatric participants within three cohorts: 60-69, 70-79, and 80 years-old and older. Participants underwent static lower extremity range of motion assessment and gait analysis to collect lower extremity joint kinematics, joint kinetics, and spatiotemporal data. Questionnaires and tools included: FRAX, SF-12, and Fried Frailty Index. Data was compared with non-geriatric controls with mature gait patterns.

Results

Mean age was 72(SD 8); 44% women. Significant kinematic differences between the geriatric volunteers and controls were observed. Minimum hip flexion was 1.6°(SD 11.9) versus -6.0°(SD 6.9) in controls. Minimum to maximum ankle dorsiflexion was -13.1°(SD 6.3) to 15.8°(SD 3.1) and -21.6°(SD 9.0) to -13.1°(SD 6.3) in controls. Maximum ankle dorsiflexion was significantly different across age cohorts (60-69, 70-79, 80+ respectively): 15.8°(SD 2.9), 13.9°(SD 3.1), 18.0°(SD 1.6). Minimum hip flexion and minimum knee flexion were significantly higher at older ages: 5.7°(SD 7.7) and 9.4°(SD 2.2) respectively in the age 80+ cohort versus -3.2°(SD 13.9) and 5.9°(SD 3.1) in the 60-69 year-olds.

Conclusion

Significant kinematic gait differences were observed between geriatric volunteers and controls. Age-related gait differences were found within the geriatric study population. These findings have clinical implications for understanding fall predisposition, directing rehabilitation, and guiding medical and surgical approaches to lessen the impact on gait changes. The study identifies significant declines in geriatric gait and serves as a useful reference for future studies in the geriatric population.

Level of Evidence

Prognostic Cohort Study, Level III
The Anatomy of an Innovation- Ziptek for Tissue Repair
Authors: Bennett William , Galaz Ramses , Mangone Peter , Schacter Aaron , Ruiz-Suarez, MD Michell
Published: August 2023

All of the existing devices are load-sharing and stress shielded. If you have a tissue repair system that never releases the pressure on that tissue, then the tissue never experiences normal stress, i.e., compressive, tensile and sheer forces that are needed to create a normal tendon or ligament through remodeling. Our system, which is revolutionary not evolutionary, works such that the loop suture technology is not utilized. Resorbable button tissue repair technology is a technology whose biomechanics is completely different than suture loop technology.
Understanding Blockchain: Why Physicians Should Care
Authors: Rondon Alexander J , Abboud Joseph A
Published: August 2023

Blockchain has emerged as a foundational technology primed to change how our world functions. There are multiple avenues for blockchain application from smart contracts, surgical billing, managing inventories, disease tracking real time, and health insurance claims. The value of blockchain is that anything and everything can have a unique identifier, be recorded, and tracked. Blockchain can unlock future growth and value with unmet efficiency and transparency by providing the foundation to be a system of record for all transactions. While full implementation remains years from realization, this article will define blockchain and discuss why orthopaedic surgeons and physicians should learn about blockchain along with future applications of this technology. The primary aim of this article is to highlight how this technology can be utilized to improve our understanding of surgical billing, supply chain in medical care, and introduce smart contracts.
Displaced paediatric distal radius fractures with volar skin tenting following manipulation and reduction: a report of two cases and literature review
Authors: Chou Andrew , Chew Darryl , Chia Dawn , Mahadev Arjandas , Wong Kenneth
Published: August 2023

Distal radius fractures are amongst the most common forearm fractures in children and can often be managed with closed reduction and casting for the majority of patients. While the thick periosteum sleeve can be used to guide reduction, it can also make the traction used in an adult patient counterproductive to closed reduction attempts. We report two unusual cases of distal radius fractures with displaced volar fragments in children that required urgent surgical intervention following manipulation and reduction due to concern for skin and neurovascular compromise. While one patient developed post-operative superficial skin necrosis managed conservatively, both children recovered well without long-term complications.
The Effects of the COVID-19 Pandemic on Orthopaedic Surgery Residency Match Results, a Cohort Study
Authors: Furman Andrew A , Linton Alexander A , Lanzetta Nicholas J , Hsu Wellington K
Published: August 2023

Background

The COVID-19 pandemic disrupted the 2021 Orthopaedic residency recruitment process by eliminating visiting rotations and in-person interviews. In the fields of Plastic Surgery and Urology, this led to a significant increase in the rate at which residency applicants matched into residency at the same institution (“home match”) as their medical school. This study sought to investigate the effects the pandemic had on the outcomes of the 2021 Orthopaedic Surgery Match compared to the preceding four cycles 2017-2020.

Methods

A list of all Orthopaedic Surgery residency programs with an affiliated medical school was obtained using ORINTM and Doximity. Program websites and official social media accounts were used to gather resident information including class year, medical school, and medical school state. Outcomes of interest were home matches and matches within the same region or state as one’s medical school.

Results

The rate of home matches increased by 41% from 22% in 2017-2020 to 31% in 2021 (p<0.001). This increased rate was consistent across medical school regions and sub-regions, as well as across program sizes and reputation rankings. Southern programs had a higher rate of home matches than all other regions both at baseline in 2017-2020 28% v. 20% (p<0.001) and in 2021 36% v. 28% (p<0.001).

Conclusions

In 2021, the first residency match affected by the COVID-19 pandemic, the proportion of home matches increased compared to the prior four cycles. This may be a result of the inability of prospective residents to visit programs in-person during an away rotation or interview, resulting in programs preferring individuals they already knew via their affiliated medical school. Many pandemic-related changes such as virtual rotations and virtual interviews might stay for the long term; it will be interesting to see how these impact Orthopaedic Residency recruitment and resulting Match characteristics in subsequent cycles.
Screw Thread Configuration Has No Effect on Operative Outcomes of Slipped Capital Femoral Epiphysis
Authors: Via Garrhett Glenn , Brueggeman David , Lyons Joseph G , Edukugho Derrek , Froehle Andrew W , Martinek Melissa A , Albert Michael C
Published: August 2023

INTRODUCTION

The current “gold standard” treatment for slipped capital femoral epiphysis (SCFE) is insertion of a single cannulated screw down the epiphyseal center. Debate remains as to whether partially- (PTCS) or fully-threaded (FTCS) cannulated screws, and what number, are optimal. The present retrospective cohort study compares such constructs in a clinical model.

METHODS

IRB approval was obtained. Patients (N=158) presenting to a level-one pediatric trauma center for in situ pinning of SCFE between January 2005 and April 2018 were included. Covariates analyzed were sex, race, BMI, history of endocrinopathy, and preoperative designation of unstable SCFE. Outcomes included return to the operating room (OR), avascular necrosis (AVN), hardware failure/removal, and the sequelae of femoroacetabular impingement (FAI). Multivariable logistic regression models included covariates with significant univariate effects, as well as thread configuration, number of screws, preoperative instability, and the screw*thread and screw*instability interactions.

RESULTS

Average patient age at surgery was 12.3±1.9 years; 63% of patients were male; 68% of patients were White/Caucasian and the remaining 32% were Black/African American. Mean BMI was 28.4±6.4 kg∙m-2. PTCS were utilized in 81.0% of constructs and 1 screw was placed in 83.5% of hips. Outcome rates were as follows: return to OR=15.8%, AVN=7.6%, FAI=7.0%, hardware failure/removal=9.5%. Univariate modeling demonstrated no significant covariate effects on return to OR (each P≥0.181) or AVN (each P≥0.099). Sex had a significant effect on FAI (P=0.012). Age and bilateral SCFE were significantly related to hardware failure/removal (P=0.039 and P=0.015, respectively). Multivariable models found that 2 screw constructs were associated with increased odds of return to OR [P=0.027; OR=3.01 (1.13-7.98)]. Odds of AVN were increased by older age (P=0.024; OR=1.45 [1.03-2.03]) and 2 screw constructs in stable SCFE [screws*stability interaction: P<0.001; OR=60.5 (5.60-652.31)]. Female sex increased odds of FAI (P=0.012; OR=5.17 [1.31-20.36]). Finally, odds of hardware failure/removal were increased by 2 screw constructs [P=0.038; OR=3.64 (1.13-11.70)] and bilateral SCFE [P=0.027; OR=3.51 (1.15-10.74)].

DISCUSSION AND CONCLUSION

A single, PTCS comprises the majority of SCFE constructs, and this construct carries the least risk for negative outcomes in cases of stable SCFE. These data demonstrate no significant effects of thread configuration on outcomes. The authors caution orthopaedic surgery providers against using more than one screw in cases of stable SCFE, as well as to monitor older, female, and/or bilateral SCFE patients more closely due to an increased risk for complications.
Number of Stairs at Home Does Not Influence Discharge Disposition following Elective Total Hip Arthroplasty
Authors: Murtaugh Taylor , Held Michael B , Levitsky Matthew M , Iorio Richard , Neuwirth Alexander L , Geller Jeffrey A , Cooper H. John , Shah Roshan P
Published: August 2023

Background

Pragmatic challenges of the patient’s home environment, specifically the number of stairs (NOS) required to enter or navigate a patient’s home may influence discharge destination (DD) and length of stay (LOS) following primary Total Hip Arthroplasty (THA).

Questions/purposes

This study investigates whether the NOS at home predicts discharge to a post-acute-care-facility (PACF) following THA.

Methods

548 consecutive THA patients at a single urban arthroplasty center between 2011-2014 were reviewed. Patient factors including age, sex, BMI, length of stay, operative time, Anesthesia Score Assessment (ASA), the Risk-Assessment-and-Prediction-Tool (RAPT) and NOS stairs were analyzed. Logistic regression was performed to identify predictors for disposition to PACF. Groups were cohorted by number of stairs, and incidence of PACF discharge was determined.

Results

238 (43.4%) patients were discharged to PACF. The NOS at home had no impact on discharge to PACF (OR 1.02, 95% CI .993-1.04, p=0.209). Older age (OR 1.09, 95% 1.07-1.10, p<0.0001), LOS (OR 1.23, 95% 1.08-1.39, p=0.001), higher ASA (OR 1.74, 95% 1.19-2.53, p=0.004), and lower RAPT score (OR 0.0.865, 95% 0.781-0.958, p=0.005) were significant predictors for disposition to PACF (p<0.005). Female sex was protective in discharge to PACF (OR 0.391, 95% 0.260-0.587, p<0.0001). The incidence of PACF discharge was similar between groups of unavoidable stairs at home.

Conclusion

The NOS at home did not influence discharge destination following THA. This retrospective study helps discharge planning and in setting expectations for patients undergoing THA by supporting a home discharge in the setting of unavoidable stairs.
Surgical Repair and Augmentation of a Large Type-2 Re-tear of the Rotator Cuff with a Novel Biocomposite Scaffold: A Case Report
Authors: Mc Millan Sean , Ford Elizabeth , Sigman Scott
Published: August 2023

Case

A 55-year-old female presented with pain and weakness in her right shoulder after a new traumatic event occurred. She had undergone a rotator cuff repair to this right shoulder 4 months earlier with dermal strip augmentation secondary to poor tissue quality at the time of index surgery. For historical context, her contralateral shoulder had undergone a previous primary rotator cuff repair with xenograft, which failed, and was ultimately revised to a full thickness repair 2 years prior.

A repeat MRI demonstrated a recurrent large type-II rotator cuff tear with grade 3 Goutallier fatty infiltration. A novel biocomposite scaffold (BioBrace™) was used to augment a revision double row bridge repair with margin convergence. MRI at three and eight months after surgery suggested functional remodeling and growth of new tissue. At 10 months, arthroscopy was performed to evaluate bicipital pain and arthroscopic images demonstrated full incorporation of the biocomposite scaffold within the underlying native tendon and an intact repair. The source of bicipital pain was unrelated to the implant and a biceps tenodesis was performed to resolve the pain. Clinical outcomes were assessed preoperatively and at 1 year postoperatively using the Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES) Shoulder Score, and Single Assessment Numeric Evaluation (SANE).

Conclusion

The use of a novel biocomposite scaffold augmentation for revision rotator cuff repair demonstrated evidence of healing, incorporation, and remodeling at 10 months post-procedure. VAS, ASES, and SANE pre- and post-operative outcome scores were analyzed at 1 year demonstrating significant improvement across all metrics. This case report suggests the use of a novel biocomposite rotator cuff augment can provide a via option for revision rotator cuff repair.
Cryoanalgesia in Knee Replacement Surgery
Authors: Dasa Vinod
Published: August 2023

This is cryoanalgesia, a new technology where we can effectively create an ice cube under the skin, which shuts the nerve off. If we target some of the sensory nerves around the knee and then the femoral cutaneous nerves and then the branches of the saphenous nerve, then we can shut those nerves down and that pain goes away until those nerves regrow.
Revision Total Hip Arthroplasty using a Direct Anterior Approach in a Patient with Arthrogryposis Multiplex Congenita: A Case Report
Authors: Fang Christopher , Coden Gloria , Niu Ruijia , Aghazadeh Ryan , Mattingly David , Smith Eric
Published: August 2023

We review the case of a 48-year-old male with Arthrogryposis Multiplex Congenita (AMC), who presented with chronic right hip pain after a previous total hip arthroplasty (THA) in 1988 and revision THA (rTHA) in 2013. Routine radiographs demonstrated failure of his right acetabulum component with debonding of the bone implant interface and a well-fixed femoral component. The patient underwent a rTHA using a direct anterior approach (DAA) that resulted in a successful recovery without complication at one year. We report the successful result of the first case of a rTHA using a DAA in a patient with AMC.
Factors Influencing the Decision to Pursue Multiple Fellowships Following Graduation from Orthopaedic Surgery Residency
Authors: Antes Andrew W , Ierulli Victoria K , Cannada Lisa K , Mulcahey Mary K
Published: August 2023

Among practicing orthopaedic surgeons, the population that self-identify as generalists has been declining for the past three decades, while sub-specialization has become more prevalent. As more residents are pursuing fellowship training, some elect to complete multiple fellowships, but due to a lack of research, there is a lack of insight into the reasons behind these decisions. The purpose of this study was to determine factors influencing the decision of orthopaedic surgery residents to pursue more than one fellowship following graduation from residency. An anonymous survey was distributed via email to all PGY-4 and PGY-5 orthopaedic surgery residents who had matched into one or more fellowships in the spring of 2021 and 2022. Responses were analyzed to determine the prevalence of different specialties, reasons for pursuing fellowship, and among those pursuing more than one fellowship, the reasons they chose to do so. 259 responses were collected from residents entering a fellowship, with 74 (28.6%) entering fellowships in the Midwest, 54 (20.8%) in the Southwest, 51 (19.7%) in the Northeast, 42 (16.2%) in the Southwest, and 32 (12.4%) in the West. 19 (7.3%) respondents reported matching into two or more fellowships. Among the fellowships pursued, sports medicine was most popular with 10 (52.6%) respondents; followed by shoulder/elbow (5; 26.3%). Out of all 259 respondents, 252 (97.3%) indicated their fellowship choices were based on interest, and 192 (74.1%) were also affected by marketability. Mentorship played a role for 173 (66.8%) and training in an area of deficiency was important for 149 (57.5%). Among those pursuing multiple fellowships, many combinations seem to have been made to decrease the time to breaking even on the financial investment involved in pursuing fellowships after residency. Most orthopaedic surgery residents elect to pursue fellowship training due to personal interest in the field, as well as to increase their marketability, and shorten the time to breaking even in comparison to the loss of compensation required for pursuing fellowship. Our results indicate that residents pursuing multiple fellowships are those interested in less marketable specialties, who then pursue a second fellowship with higher returns on investment, such as completing fellowships in pediatrics and sports medicine.
Robotic Assisted Total Knee Arthroplasty in Arthrofibrosis or the Preoperatively Stiff Knee: A Case Report
Authors: Passano Brandon , Becker Jacob , Koenig Jan A.
Published: August 2023

Total knee arthroplasty (TKA) for arthrofibrosis or preoperatively stiff knees can present a set of difficult problems that challenge both the patient and surgeon. Patients with limited preoperative range of motion (ROM) are inherently at risk for worse outcomes. Prior literature has demonstrated the utility of robotic-assisted TKA (raTKA) regarding gap balancing and coronal deformity, however it has not been previously described in context of the preoperatively stiff knee.

Here, we report a case of a patient undergoing primary TKA for severe osteoarthritis with significant preoperative stiffness resulting in severely limited ROM of only 5 degrees. This was performed with the use of a navigated raTKA system in conjunction with dynamic predictive balancing technology. With this method, the knee was balanced through bony cuts without the need for extensive soft tissue releases.

This patient had excellent improvement in ROM and KOOS Scores at 3-month follow up. This patient’s early post-operative results demonstrate the potential benefits of utilizing raTKA for preoperative stiff knees and may lay groundwork for future literature.
New reconstructive option in chronic distal biceps ruptures. A case report.
Authors: Tovar-Bazaga Miguel , Pérez-Cuesta Llaneras Maria , Badia Alejandro
Published: August 2023

Introduction

Distal biceps ruptures usually present as an acute injury. Difficulties in treatment happen when the presentation is delayed, becoming a real challenge.

Description of the issue

We present a case report of a young bodybuilder who suffered a distal biceps rupture with 35 days of treatment’s delay.

Treatment

A surgical distal biceps reconstruction was performed. Due to prolonged chronology, a surgical repair was not possible. An acellular dermal matrix was used as a graft in order to reconstruct the retracted and frayed tendon. Intraoperative and one year follow-up clinical photos are presented showing full range of motion.

Discussion

Chronic distal biceps rupture is a challenging issue. A sterile acellular dermal matrix, used with a meticulous surgical technique, has shown a strong reconstruction with promising functional outcomes.
Work-Family Enrichment in Orthopaedic Surgery
Authors: Thomas Nicholas D
Published: August 2023

The phenomenon of work-family enrichment (WFE) is increasingly studied in medical professions, but has yet to be investigated in orthopaedic surgery. While much of the literature in this field has acknoweldged high levels of stress and burnout among orthopaedic surgeons, some studies have suggested that WFE may be an important factor in promoting positive outcomes in both personal and professional domains. Future research should aim to explore the benefits of WFE for orthopaedic surgeons, as well as the factors that contribute to job satisfaction and overall well-being. By supporting work-family enrichment, hospitals and healthcare centers may be able to create a more supportive work environment for orthopaedic surgeons, which could lead to higher levels of job satisfaction and better patient care.
ASPECTOS DA ALIENAÇÃO PARENTAL E DA IMPLANTAÇÃO DAS FALSAS MEMÓRIAS E DENÚNCIAS INVERÍDICAS DE ABUSO SEXUAL COMO FATORES DE VIOLAÇÃO DOS DIREITOS DA PERSONALIDADE
Authors: Fontana Lucas Henrique , Oliveira José sebastião de
Published: August 2023

o presente artigo tem por objetivo analisar aspectos da alienação parental, em especial nos casos da prática da implantação das falsas memórias e das denúncias inverídicas de abuso sexual intrafamiliar. Desse modo, realiza-se um estudo acerca da evolução da família, do conceito de alienação parental, das práticas caracterizadoras, da diferenciação das falsas memórias e das denúncias falsas de abuso sexual, das consequências e das possíveis violações decorrentes destes atos. A este propósito, a problemática do presente artigo refere-se em discutir como os atos de alienação parental podem interferir na formação do indivíduo e na violação de direitos consagrados pelo ordenamento jurídico, em especial os direitos personalíssimos. Para tanto, a metodologia utilizada foi a revisão de literatura relacionada ao tema, através da leitura de obras consagradas, bem como a análise de diversos artigos científicos e legislações vigentes.
Design and Development of Information Systems for Data Collection and Monitoring of Children's Growth and Development as an Effort to Prevent Stunting in Kotapari Village
Authors: Muttaqin Muhammad Muttaqin , Mayasari Nova , Pratama Siswa
Published: August 2023

Stunting is one of the problems being faced by Kotapari Village. The absence of an information system about stunting that is easily accessible to the public is one of the aspects that has slowed down the resolution of the stunting problem. To accelerate the resolution of the stunting problem, it is considered necessary to have an information system that can help the community easily and quickly. Methods of data collection is done by interviews and observation. In this study the system development method used is waterfall with the supporting software used are PHP and MySQL. Seeing the reality above, it is deemed necessary to build a website-based information system that is useful to facilitate Kotapari Village and the Community in working to resolve the stunting problem in Serdang Bedagai Regency. Apart from being able to provide stunting information to the community, this application also has a child health check menu related to child growth and a discussion menu that can be used by the community to communicate with Kotapari Village.
Implementation of the A Star Heuristic Search Algorithm in Determining the Shortest Path
Authors: Aswandi  , Leni Marlina
Published: August 2023

Finding the shortest path in a graph can be applied to various fields of shortest distance costs in routes, computer games, robotics or navigation. This study implements the A star heuristic search algorithm in determining the shortest path using the Visual Basic programming language and MySQL database. A star heuristic algorithm is implemented to find the shortest path between two vertices in a two-way weighted graph. We use a heuristic method to estimate the remaining cost from the start node to the destination point. This condition gives the A star algorithm the opportunity to choose the next closest node and optimize the search for the shortest route. Various experiments have been carried out with various graph conditions and with different complicated graphs to test the A star algorithm. The experimental results show that this algorithm succeeds in finding the shortest path efficiently in various situations. Our findings confirm that the A star algorithm has great potential in solving the shortest path search problem with an advantage in combining various information and remaining cost estimates, thereby minimizing the number of explored nodes and producing the shortest path efficiently.
Perancangan Website Profil Program Studi Menggunakan Content Management System Wordpress
Authors: Khaliq Abdul
Published: August 2023

This article discusses designing a study program profile website using the WordPress Content Management System (CMS). Higher education has a need to present relevant and up-to-date information to prospective students, students, lecturers, and the general public. A study program profile website can be an effective tool to meet these needs. The design method used in this study involves the stages of needs analysis, interface design, selecting the appropriate WordPress theme, developing special features relevant to the study program, and testing functionality. Using the WordPress CMS as a content management platform makes it easy to manage and update content independently without requiring advanced programming skills. The result of this research is a responsive, attractive, and easy to navigate study program profile website. The features implemented include information about study programs, curriculum, lecturers, facilities, and the latest news. In addition, it is equipped with a search feature to make it easier for users to find the specific information they want. Implementing the WordPress CMS as a content management platform provides time and cost efficiency benefits in managing websites. In addition, the flexibility and ease of adding or changing content ensures that the information presented is always up-to-date relevant. In conclusion, designing a study program profile website using the WordPress CMS is an effective solution for presenting up-to-date and relevant information to stakeholders in the academic environment. This research contributes to the field of information technology, especially in the use of CMS platforms for efficient content management in the context of higher education.
Penggunaan Framework Codeigniter Dalam Pembuatan Web Profil Program Studi Teknik Elektro Universitas Pembangunan Panca Budi Medan
Authors: Suheri
Published: August 2023

The need for a website is very important in an institution in the current digital era, including the Electrical Engineering Study Program at the University of Panca Budi Medan. Through the Merdeka Learning Campus Merdeka (MBKM) program, students can apply their ideas and creativity in developing a website. With the help of the Codeigniter PHP programming framework, creating dynamic websites is easier to use because the CodeIgniter framework implements the Model, View and Controller methods. In developing a website application, a design method is also needed and in this study the author uses the Waterfall method in designing the system.
Sistem Informasi Rental Mobil Pada Regulator Rent Car
Authors: Satmoto Bambang , Wulan Rayung , Saputra Aswin
Published: August 2023

Car rental is an activity of renting a vehicle in the form of a car with the terms and conditions determined by the rental party. Every time a rental transaction is made, the Car Rent Regulator always records data on each customer and transactions made in writing. In addition, the rental party also cannot determine the choice of the best available car. This study aims to build an information system that can be applied to Car Rent Regulators, so that the transaction process can be carried out more quickly and reduce the risk of data damage. This system will apply the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method to determine the choice of the best car available at the rental. System information is created using the Java programming language and MySQL as a database. In designing the system, the Unified Modeling Language (UML) model is used to determine the structure and processes that occur in the system. The results of this study can facilitate and improve admin performance in conducting rental transactions, and calculations using the TOPSIS information system method can determine the choice of the best available car by entering values in the specified criteria. The results of calculations using the TOPSIS method show that the Avanza car is the best car choice available for rental.
Digitalisasi Pengelolaan Data Review Bisnis Pada Divisi GrabFood Berbasis Aplikasi Web
Authors: Fredy Rafles jhon , Hariyanto Eko , Mayang Sari Rahayu
Published: August 2023

Divisi GrabFood memiliki kewajiban untuk melakukan review pada merchant yang telah bekerja sama untuk mempertahankan atau meningkatkan performa penjualan dalam mendapatkan keuntungan. Pengelolaan data review ini belum terkomputerisasi dengan pola pengelolaan data terpusat atau menggunakan basis data. Tujuan penelitian ini adalah mengembangkan aplikasi pengelolaan data review bisnis dengan metode waterfall dan menggunakan basis data agar pengelolaannya menjadi lebih mudah. Perancangan aplikasi ini menggunakan unified modelling language yaitu use case diagram dan activity diagram. Hasil perancangan didapatkan antarmuka yang efisien dan mudah untuk digunakan dalam mengelola data review bisnis mitra Grabfood. Aplikasi yang dihasilkan mampu menangani keterkaitan data pada bagian yang satu dengan bagian yang lainnya sehingga dapat mengurangi terjadinya kesalahan dalam penginputan data.
Mega-Cecum with Short Intraperitoneal Ascending Colon and Retrocecal Terminal Ileum: A Short Review and Case Report
Authors:   Department of Biomedical Sciences, School of Medicine and Health Sciences, University of North Dakota, USA, Bahru Tessema Chernet
Published: August 2023

The dissection of the abdominal cavity of an 81-year-old male donor revealed an unusually large cecum, filling the right iliac fossa and most part of the right side of the peritoneal cavity up to the fundus of the gall bladder. It was attached to the parietal peritoneum of the posterior abdominal wall by a short mesocecum. The ileocecal junction was shifted posterolaterally, closer to the posterolateral abdominal wall and the terminal ileum was found running from medial to lateral dorsal to the cecum (retrocecal) to reach the ileocecal junction. The cecum continued into a short intraperitoneal ascending colon with a long ascending mesocolon. The transitional area between the cecum and ascending colon was displaced medially close to the lumbar vertebral column. Since the ileocecal region is one of the common sites of different kinds of gastrointestinal diseases, such a complex variation can cause diagnostic and therapeutic difficulty that could result in failure of treatment as well as iatrogenic injuries during various procedures. Therefore, gastroenterologists, gastrointestinal surgeons and radiologists must be aware of such coexisting variations of the cecum, ileum and ascending colon.
Bilateral Common Origin of Obturator and Inferior epigastric Arteries from the External Iliac Arteries, Accompanied by Venous Corona Mortis Duplicated on the Left Hemi-Pelvis
Authors:   Department of Biomedical Sciences, School of Medicine and Health Sciences, University of North Dakota, USA, Tessema Chernet Bahru ,
Published: August 2023

During the dissection of the pelvis of a 93-year-old female donor, aberrant obturator artery and inferior epigastric artery were found to arise by a common trunk from the external iliac arteries bilaterally. Both right and left AOAs descended into the lesser pelvis with a venous corona mortis and entered the obturator canal on its anterolateral wall where each artery is joined by two (superior and inferior) obturator veins (OVs) and the obturator nerve on the respective side. The bilateral venous corona mortis connected the superior obturator veins with inferior epigastric veins, while on left hemi-pelvis, a second venous corona mortis additionally connected the inferior obturator vein with external iliac vein. These variant pelvic vessels are prone to injuries by trauma during accidents, iatrogenic injuries during inguinal and femoral hernia operations, and other orthopedic, gynecologic and urologic procedures. Such injuries have high morbidity and mortality rate due to hemorrhagic shock, therefore, caution must be exercised to avoid excessive hemorrhage and other complications.
The Role Of Instagram Social Media As A Public Communication Media At Puskesmas Cilengkrang Kabupaten Bandung
Authors: Putri Astiti  , Raharja Duane Masaji
Published: August 2023

Social media used by government agency can act as a medium of communication with the masses, not only by verbal means. Nowdays, government agency on various level have used social media to spread information to the people. They are certainly cannot be detach from Public Communication. Public Communication is a process of delivering messages or interaction with the public where the message can be in a form of education, instruction, or information. Puskesmas is a government agency as a center for development, construction, and service. Also function as vanguard post for developmentof community healthcare services. Therefore, Puskesmas Cilengkrang utilize social mediaas a channelto deliver various information about healthcare. In this case they used Instagram. The role of @pkm_cilengkrang_kabbandung Instagram is to convey information about various government programs and all event held by Puskesmas Cilengkrang Kabupaten Bandung. This research shows that type of information conveyed by Puskesmas Cilengkrang Kabupaten Bandungon Instagram is about government program to support people healthcare, training or workshop event held there, education regarding community healthcare, and also schedule of immunizations or regular vaccinations.
Krise: Beretning fra energisektorens maskinrum
Authors: Hansen Martin
Published: August 2023

Hvilke redskaber fra værktøjskassen griber man fat i, når de røde lamper blinker, ogbekymringsbarometeret går fra 0-100? Med Ruslands invasion af Ukraine lød startskuddettil den største energikrise i godt og vel 50 år. Og 2022 skulle vise sig at blive den perfektestorm for energisektoren. I orkanens øje stod Energistyrelsen med myndighedsansvaret forDanmarks beredskab og forsyningssikkerhed for gas-, olie- og elforsyning. Tre grundsten var,og er stadig, helt essentielle for krisestyringen: et velfunderet beredskab, scenariebaseretdialog med branchen og konkrete spareråd kommunikeret direkte til danskerne.
Hvor er de lavthængende grønne teknologier?
Authors: Ladenburg Jacob , Soytas Ugur
Published: August 2023

En efficient og smidig grøn energiopstilling kræver borgernes accept af de anvendte teknologier. Baseret på svarene fra en repræsentativ landsdækkende spørgeskemaundersøgelse med svar fra 1.589-1.593 respondenter1 finder vi størst accept af solceller på industritage, fjernvarme, energibesparelser og havvindmølleparker. Måske fordi det er en ny teknologi, er opbakningen til CO2-fangst og -lagring på land og kystnært lille. Der er også lille opbakning til atomkraft. Undersøgelsen viser også, at accepten af specifikke teknologier er afhængige af deres geografiske placering, og der er forskelle i teknologiaccept på tværs af aldersgrupper.
Energy Poverty During the Energy Crisis
Authors: Sari Ramazan , Zhang Professor Xiaobing
Published: August 2023

The energy crisis in the post-pandemic era seems to add new dimensions to energy policy in many developed countries. The spectrum of factors determining energy poverty ranges from sociological to psychological issues, far beyond economics. Ukraine- Russia war proved that even international relations could determine the number of households with difficulty accessing energy services properly. Thus, Denmark seems to be among those countries facing energy poverty because of the nondomestic economic factors but escalating global energy prices. This paper elaborates on this issue and develops policy suggestions to tackle Denmark’s energy poverty.