bluuebunny/crossref_metadata_2025_split huggingface dataset:
Device Profile of SonoVision™ Ultrasound System: Efficacy and Safety for Lateral Approach Spinal Surgery
Authors: Singh Kern , Cha Elliot D.K. , Lynch Conor P. , Jacob Kevin C. , Patel Madhav R. , Prabhu Michael C. , Vanjani Nisheka N. , Pawlowski Hanna 
Published: August 2023

Introduction Minimally invasive spinal surgeries rely heavily on imaging for localization of key anatomical structures. Current established modalities either do not provide adequate visualization of soft-tissue structures or do so in an indirect manner. Real-time integrated soft-tissue imaging will allow surgeons to accurately differentiate nerves, muscle, vasculature, and bone while simultaneously preventing excessive dissection of tissue and risk to patients. Areas Covered SonoVision™ is a novel imaging device able to meet the needs of intraoperative anatomical visualization. This review explains the mechanism of the device and summarizes the empirical support for its use. Multiple animal, cadaver, and human studies have been used to compile machine-learning training data and validate the system’s accuracy and usability through actual and simulated surgical scenarios. Expert Opinion SonoVision™ represents a significant improvement over current intraoperative imaging technology in terms of accuracy, efficiency, and ease of use. This system provides vital anatomical information that would otherwise be unavailable in an intuitive, real-time format. SonoVision™ may play an important role in improving outcomes in lateral approach spine surgery as well as making minimally invasive techniques more accessible to a wider range of surgeons. Article Highlights • The direct lateral transpsoas approach for lumbar fusion has distinct advantages, but is associated with various complications, many of which are related to inadequate intraoperative imaging. • There is a significant unmet need for real-time intraoperative soft-tissue imaging in spine surgery. • The SonoVision™ ultrasound system utilizes machine-learning algorithms to provide real-time soft tissue imaging and differentiation for use during spine procedures. • Early trials are promising with regard to SonoVision’s™ ability to meet needs for intraoperative soft-tissue imaging in lateral approach spine surgery.
One Year Analysis of Financial and Clinical impacts of COVID-19 on an Orthopedic Surgery Department, Analysis of Recovery Timeline and Assessment of Implemented Telehealth Initiatives
Authors: Amato Chad , Kantzos Andrew , Matullo Kristofer 
Published: August 2023

Introduction To evaluate the effects that pandemic restrictions had on our practice, evaluate initiatives to increase care options to patients, and assess the rate of return to normal operations. Methods Surgical volumes, clinic volumes, telehealth utilization, RVU generation, Fee for Service Charges (FFS) during the period of COVID-19 restrictions from mid-March 2020 through May 2020, were compared to data from the preceding months of the fiscal year as well as the months following the lifting of COVID restrictions. Results April 2020 saw the largest impact to each area compared to preceding averages of the fiscal year. Pre-COVID office visits averaged 2,256 per week compared to the COVID period average of 1,048 or 46% from baseline. Pre-COVID surgical cases averaged 169 per week, compared to 71 or 42%. Pre-COVID work RVU generation averaged 26,130 compared to April with 9,722 or 37% of baseline average. Pre-COVID FFS charges averaged $5,214,925 per month compared to April with charges of $1,753,992 or 33% of the pre-COVID average. Office visits, surgical cases, FFS charges, and RVU generation saw overall increases of 28%, 6%, 17.6%, and 15% respectively in the period following the lifting of restrictions. Conclusion The COVID-19 pandemic and the associated restrictions on elective case and clinic volumes have shown significant reductions in case volumes, clinic volumes, RVU, and FFS generation. Going forward this analysis may serve as a framework to estimate the impact from possible future restrictions on an orthopedic practice should a similar event take place in the future.
Interpreting the Knee Osteoarthritis Outcome Score Joint Replacement: Minimum clinically important difference values vary over time within the same patient population
Authors: Only Arthur J. , Albright Patrick , Guenthner Guy , Parikh Harsh R. , Kelly Brandon , Huyke Fernando A. , Horst Patrick K. , Cunningham Brian 
Published: August 2023

Introduction Total knee arthroplasty (TKA) is the preferred treatment for end-stage osteoarthritis. Minimal clinical important difference (MCID) quantifies if a patient achieves a successful outcome following TKA. This study aims to determine the MCID for Knee Injury Osteoarthritis Outcome Score Joint Replacement (KOOS JR) at two designated time intervals and to compare methodologies for calculating MCID. Methods Patient-Reported Outcome Measures (PROM) were prospectively evaluated for 956 patients undergoing TKA between 2017 and 2018 at a single health care system. Patients who completed baseline, 3-month and 1-year post-operative PROM surveys at clinical follow-up were included in the study. MCID was calculated from baseline to 3-months and baseline to 1-year using anchoring and distribution-based methods. Results Average KOOS JR scores at baseline, 3-month, and 1-year follow-up were 51.7 ± 11.7, 69.2 ± 12.0, and 76.3 ± 14.5. The KOOS JR MCID determined by the PROMIS10 physical health anchoring method was 21.5 ± 14.9 and 27.9 ± 16.0 for the 3-month and 1-year intervals. The KOOS JR MCID determined by the PROMIS10 quality-of-life anchoring method was 21.2 ± 14.9 and 28.9 ± 15.8 for the 3-month and 1-year intervals. The MCID calculated by the distribution method was 7.4 and 8.2 for the 3-month and 1-year intervals. Conclusion KOOS JR MCID varies as a function of time and is variable within the same population depending on MCID calculation methodology. Improved strategy for calculating or standardizing MCID is required to better guide use of KOOS JR and other PROMs in clinical decision-making.
Interpreting the Hip Osteoarthritis Outcome Score Joint Replacement: Minimum clinically important difference values vary over time within the same patient population
Authors: Guenthner Guy , Albright Patrick , Only Arthur J. , Parikh Harsh R. , Kelly Brandon , Huyke Fernando , Horst Patrick K. , Cunningham Brian 
Published: August 2023

Introduction Total hip arthroplasty (THA) results in outstanding outcomes and long-term implant survivorship, but there continues to be a need for tools to identify surgical candidates and assist with shared decision-making. This study aims to determine the Hip Osteoarthritis Outcome Score Joint Replacement (HOOS JR) Minimum Clinical Important Difference (MCID) at two time intervals and to evaluate different methods for calculating the HOOS JR MCID for patients undergoing THA. Methods A patient reported outcome measure (PROM) database was prospectively queried at a single outpatient ambulatory surgery center for patients treated with THA between 2017 and 2018. All patients completed PROM surveys at preoperative baseline, 3-month, and 1-year follow-up. MCID was calculated at two different intervals, baseline to 3-months and baseline to 1-year, using anchoring and distribution-based methods. Anchor-based calculations were anchored to the Patient-Reported Outcomes Measure Information System (PROMIS10) quality-of-life and physical health instruments. Results 514 patients were statistically analyzed. Average HOOS JR scores were 52.5, 79.3, and 86.1 at preoperative baseline, 3-month follow-up and 1-year follow-up, respectively. The HOOS JR MCID determined by the PROMIS10 physical health anchoring method was 30.1 and 35.5 for the 3-month and 1-year time intervals. The HOOS JR MCID determined by the PROMIS10 quality-of-life anchoring method was 31.1 and 34.8 for the 3-month and 1-year time intervals. The distribution method MCID was 8.2 for the 3-month interval and 8.4 for the 1-year interval. Conclusions MCID values vary by time and by calculation method. THA patients may require individualized and time-point specific MCID formulas to better guide clinical decision-making.
Comparative Analysis of Racial and Gender Diversity in Orthopedic Surgery Applicants and Residents from 2007 and 2019
Authors: Onuoha Anointing C. , Meadows Austin M. , Faraj Majd T. , Skinner Madelyn M. , Day Charles , Ravi Karthik 
Published: August 2023

Introduction Since 1999, orthopedic surgery has noted significant gaps in racial and gender diversity. A 2007 study demonstrated that diversity in orthopedic surgery lagged behind other specialties. Our study’s purpose was to evaluate changes in orthopedic surgery applicant and resident diversity from 2007 to 2019 and to compare current levels of diversity between applicants and residents alongside 7 other specialties. Methods Using public demographic data, our study evaluated racial and gender demographics of medical school graduates, residency applicants, and residents from 2007 to 2019 for orthopedic surgery and 7 additional specialties. Furthermore, diversity metrics between orthopedic surgery applicants and residents were compared. Results From 2007 to 2019, the proportion of minority applicants increased by 26%, while the proportion of female applicants increased by 64% (p<0.001). Orthopedic surgery experienced a 10% decrease in minority resident representation, despite individual increases in some areas (p=0.004). Meanwhile, female representation increased 24% among orthopedic residents (p<0.001). When compared to other specialties in 2019, orthopedic surgery had the lowest proportions of minority and female residents (p<0.001*). Discussion Since 2007, orthopedic surgery experienced growths in minority and female applicant representation. However, additional efforts are needed to address the gaps in minority and female representation in orthopedic residencies compared to other specialties.
Mini-Open Carpal Tunnel Release with a Pediatric Nasal Speculum: A 10-Year Retrospective Case Series
Authors: Lung Brandon , Grossman Lauren , Kim Matthew , Komatsu David , Yang Jie , Wang Edward 
Published: August 2023

Background Nasal speculum assisted carpal tunnel release (CTR) is performed using smaller incisions than are normally achieved with open procedures. We performed a retrospective case series analysis to evaluate short and long-term symptom and functional outcomes of a single surgeon’s results with this technique. Methods During the period of 2005-2011, 678 cases met the inclusion criteria. Of these, 198 cases representing 152 unique individuals were contacted and consented to participate in the study. A chart review was performed to identify demographics, pre-operative questionnaire results, and post-operative characteristics. Post-operative Symptom Severity Scale and Functional Status Scale results from the Carpal Tunnel Questionnaire were then obtained via telephone interviews. Results The mean (StDev) time to follow up was 4.08 (2.1) years with the mean age at follow up 61.94 (14) years. More females (56%) were included than males (44%). Using linear mixed models, patients with nasal speculum assisted CTR had significant improvements in both Symptom Severity and Functional Status Scales following surgery. In addition, 97.7% of patients reported their incisions were aesthetically pleasing and only 78.7% reported their incisions were still visible. Several pre-operative factors had a significant association with good surgical outcomes, including: Positive Compression Test/Durkin’s; Severe/very severe difficulties on the Functional Status Scale; High scores on the Symptom Severity and Functional Status Scales. Conclusions This surgeon’s experience with nasal speculum assisted CTR shows that this technique results in not only aesthetically pleasing results, but also excellent symptomatic and functional outcomes. Level of Evidence Level IV Case Series
How a VR Surgical Training Company Came About: Osso VR
Authors: Barad Justin , Mednick Thompson Rachel 
Published: August 2023

An example of the valaue of VR Training: ““We’ve already started to see the benefits of our technology. For example, one fellowship trained orthopedic surgeon who was trying to transition from doing posterior to anterior hips did a case that took three hours and 30 minutes. He then did a 2-week Osso VR training involving 91 sessions and remote coaching. Following this, he did the same patient’s other hip, and that case only took one hour and 45 minutes!”
The Differing Effects of Ethnicity on Mental Health Outcomes Among Patients Undergoing Lumbar Fusion Surgery
Authors: Jadczak Caroline N. , Mohan Shruthi , Lynch Conor P. , Cha Elliot D.K. , Jacob Kevin C. , Patel Madhav R. , Prabhu Michael C. , Vanjani Nisheka N. , Pawlowski Hanna , Singh Kern 
Published: August 2023

Introduction Few studies have explored the effect of ethnicity on postoperative mental health outcomes. This study aims to evaluate the effect of ethnicity on changes in mental health outcomes following lumbar fusion (LF). Methods A surgical database was retrospectively reviewed for primary, single, or multilevel, lumbar fusion with posterior instrumentation procedures. Patients were propensity score matched to account for differences in demographics. 12-Item Short Form and Veterans RAND (SF-12 and VR-12) Mental Composite Score (MCS), 9-Item Patient Health Questionnaire (PHQ-9), Visual Analogue Scale (VAS) back, VAS leg, and Oswestry Disability Index (ODI) were recorded. A minimum clinically important difference (MCID) was calculated. Patients were grouped according to ethnicity: African-American, Hispanic, Asian/Other, and Caucasian. Differences between groups in baseline characteristics and mean outcome scores were evaluated. Ethnicity was assessed as a predictor of mental health outcomes and achievement of MCID was evaluated using regression analysis. Results The study included 224 patients, 43 African-American, 40 Hispanic, 22 Asian/Other, and 119 Caucasian. Groups differed in age, comorbidity score, and insurance collected (p<0.05). African-Americans had the longest postoperative stay (47.3 hours; p=0.032). Groups differed in preoperative SF-12 and VR-12 MCS, but not PHQ-9 (p<0.001, both). Groups demonstrated differences in postoperative SF-12 MCS (p≤0.021), VR-12 MCS (p≤0.028), PHQ-9 (p=0.009). VAS back, VAS leg, and ODI demonstrated significantly different scores (p≤0.041, all). Ethnicity was not a predictor of mental health outcomes at any timepoint and did not demonstrate an impact on achievement of MCID. Majority of individuals achieved an MCID by 1-year for all outcomes. Discussion Preoperative mental health scores demonstrated significant differences based on a patient’s ethnicity but was resolved by 2-years. Ethnicity did not demonstrate significant effects on the ability to achieve an MCID for mental health outcomes. These results suggest that patients of differing backgrounds may require alternative preoperative counseling.
Surgery avoidance rates among total knee replacement candidates following a non-invasive biomechanical intervention: A retrospective cohort study
Authors: Greene Andrew , Miles Christopher 
Published: August 2023

Background Nearly twenty million people are affected by osteoarthritis (OA) across the UK. For end-stage knee OA, total knee replacement (TKR) is considered as the standard of care, but this major surgery carries high costs, long waiting lists, and risk for further revision surgeries. Health systems are therefore looking for effective alternatives to treat these cohorts, significantly delaying, and potentially avoiding joint replacement surgery altogether. The purpose of this study was to examine the 2-year surgery avoidance rate amongst TKR candidates that received a non-invasive biomechanical intervention. Methods A retrospective clinical audit was conducted on 365 NHS patients with end-stage knee OA patients eligible for TKR. Each patient was individually fitted with a non-invasive, shoe-like, biomechanical device, that alters the foot center of pressure, minimizes reported symptoms, and promotes neuromuscular control training using convex pods under the sole. Patients used the device for short periods during activities of daily living and were followed for two years. The primary outcome was surgery status after 2 years. Secondary outcomes were evaluated using the generalized linear mixed-models procedure and included changes in pain, function (WOMAC and Oxford Knee Score (OKS), and spatiotemporal gait measured at 3, 6, 12, and 24 months from baseline. Results Of the 365 candidates for TKR, 305 (84%) avoided surgery at 2 years. Patients displayed significant clinical improvements over time. Six months after starting treatment, average pain decreased by 42%, average function improved by 39%, and average OKS increased by 7.6 points. These continued to improve over the 2 years. All spatial-temporal gait measures improved over time (p<0.001). Conclusions The current results suggest that a non-invasive biomechanical treatment may help end-stage knee OA patients delay knee replacement surgery for at least 2 years or avoid it altogether. This treatment may provide an effective non-surgical alternative for managing these patients in the community, alleviating pain, and improving gait and function.
An innovative technique - Axial Loading and Compression Fixation (ALCF Technique) of scaphoid fracture by percutaneous K-wire
Authors: Rao M Rajeev , P K Navaneeth , Shelin Mohammed , Raj Ranju 
Published: August 2023

Backgrounds Surgical fixation techniques used for the treatment of scaphoid fracture is still a topic of discussion among hand surgeons especially in terms of approach, implants and surgical techniques. We present an innovative technique of scaphoid fracture fixation by K-wire, which we accidentally encountered when the guide wire broke while doing a cannulated screw for the scaphoid. This technique of axial aligning, compression loading over a bent tip of K-wire across the fracture fragments of scaphoid is innovative. Materials The study included 16 patients operated for Scaphoid fracture between January-2017 to January-2020 by ALCF Technique. the patient age ranged from 18 to 69 years,M:F12:4, 13 fractures on dominant hand,10 fracture presented within 2 weeks, 7 were trans-scaphoid displaced fractures sustained in RTA, 3 proximal pole fractures sustained after a fall, 6 were delayed presentation more than 3 months. Method The technique used to pass a K wire from dorsally in ante grade fashion to align the fracture fragments along the anatomical axis of the scaphoid then bend the K wire at the proximal end so as to hook the proximal fragment. The distal end of the K wire is then applied manual traction load with gentle rotation to achieve compression at the fracture ends with rotational alignment on the distal fragment. The distal fragment is anvil on the proximal fragment by a K-wire binder before distally binding to achieve compression & relative stable fixation. Conclusion It is a simple, easy to reproduce, economic method to achieve reduction, compression using axial traction and union in all types of scaphoid fractures.
Publication Rates of Podium Presentations from the Orthopedic Summit: Fellow Resident and Medical Student Annual Meeting 2019-2021
Authors: Gupta Sanchita , Cannada Lisa 
Published: August 2023

Purpose To determine the publication rate of presentations presented at the Orthopaedic Summit and Evolving Techniques (OSET) Fellow Resident and Medical Student Annual Meeting 2019-2021 Methods All presentations from the OSET annual meeting between 2019 -2021 were identified from the OSET’s official website and confirmed through review of the OSET Official Programs. The 2019 and 2021 meeting were in person and the 2020 meeting was virtual due to the COVID pandemic. This information was then used to direct a search on PubMed and Google Scholar database to determine if the presentation was associated with a publication since the meeting. Publishing information was entered into the database. Results For 2019-2021 there were a total of 227 presentations with 101 associated publications (45%). The highest rate of publications was 63% of presentations published in 2019, followed by 49% rate of publications in 2020, and 27% rate of publications in 2021. The presentations were published at an average of 8.1 months after presentation. Conclusion Our research demonstrated a 45% publication rate over a 3-year period of presentations presented at the OSET annual meetings. Our results are comparable to other publication rates for podium presentations in other societies (e.g. American Academy of Orthopaedic Surgeons, Annual Meeting of the Pediatric Orthopedic Society of North America, Orthopedic Trauma Association Annual Meeting, American Academy for Surgery of the Hand, Annual Meetings of the North American Spine Society, and American Orthopedic Society for Sports Medicine Annual Meeting). This validates the quality of research presented in podium presentations format at the OSET Annual Meeting.
The Drive for Health Equity - The Need to Use Technology to Reduce Healthcare Disparities in Orthopedics
Authors: Spira Bronwyn 
Published: August 2023

Health and healthcare disparities occur across a range of dimensions—including socioeconomic status, age, geographical location, language, and gender—and are reflected in variable rates of disease, disability, and death, as well as life expectancy. Members of disadvantaged groups are more likely to have poor health status in addition to more limited means and ability to access healthcare services. Within orthopedic care, existing literature has long identified various health and healthcare disparities, including significantly lower rates of total hip arthroplasty (THA) and total knee arthroplasty (TKA) among Black and Hispanic patients, as well as higher amputation rates among Black and Mexican American diabetic patients. While such studies have for decades identified the presence and impact of healthcare disparities among minority and disadvantaged populations, action to improve health equity in orthopedics has been scarce. To make meaningful progress on health equity, health systems and Ambulatory Surgery Centers will first need to identify existing barriers to care that impact their own patient populations, particularly as new legislation will require organizations to document how they screen patients for social determinants of health, analyze patient data, and address healthcare disparities. Digital care management, remote monitoring, and messaging platforms can help health systems and ASCs improve the quality, consistency, and availability of the care they deliver. As orthopedic care can potentially improve the health and well-being of so many Americans, it is crucial that we commit to resolving disparities in orthopedic care access, utilization, and outcomes for disadvantaged populations. With greater knowledge of each patient’s challenges, risks, and motivations, providers can more easily address barriers to care and support the best possible outcomes for each and every patient.