bluuebunny/crossref_metadata_2025_split huggingface dataset:
EXPLORING EXPERIENCES OF GENDER BIAS IN ORTHOPAEDIC TRAINING IN NEW ZEALAND
Authors: Scherf E. 
Published: February 2023

This qualitative study aims to explore and highlight the experiences of trainees in the Orthopaedic Surgical Education Training (SET) program in New Zealand, with a focus on identifying gender-specific biases which may impact professional development.Orthopaedic SET trainees in New Zealand were invited to complete a qualitative, semi-structured questionnaire exploring their experiences in the Orthopaedic SET program. A broad range of topics were covered, addressing culture, belonging, learning styles and role modelling. Recurrent themes were identified using inductive methods.Analysis of questionnaire responses identified several key themes for women in the Orthopaedic SET program, compared to their male counterparts, including (1) role incredulity, (2) confidence vs. competence, (3) adaptation, (4) interdisciplinary relationships and (5) role modelling. Female participants described experiencing gender bias or discrimination by both patients and interdisciplinary colleagues at a higher rate than their male counterparts. The majority of female participants described feeling as competent as their male counterparts at the same SET level, however, identified that they do not typically exhibit the same confidence in their surgical abilities. Whilst similar numbers of female and male participants described experiencing barriers to career progression, female participants described having to adapt both physically and socially to overcome additional gender-specific barriers. Positive influences on training experience included role modelling and supportive relationships amongst trainee groups.This study highlighted gender-specific biases experienced by trainees in the Orthopaedic SET program in New Zealand. Further investigation is warranted to determine how these experiences affect professional development, and how they may be addressed to foster increased gender equity in the surgical profession. This will likely require system-level interventions to create meaningful and sustainable culture change.
REMOTE EVALUATION OF POSTOPERATIVE OUTCOMES USING WEARABLE SENSORS COMPARING ROBOTIC-ASSISTED AND CONVENTIONAL KNEE ARTHROPLASTY
Authors: Zaidi F. , Bolam S.M. , Yeung T.C. , Besier T.F. , Hanlon M. , Munro J.T. , Monk A.P. 
Published: February 2023

Patient-reported outcome measures (PROMs) have failed to highlight differences in function or outcome when comparing knee replacement designs and implantation techniques. Ankle-worn inertial measurement units (IMUs) can be used to remotely measure and monitor the bi-lateral impact load of patients, augmenting traditional PROMs with objective data. The aim of this study was to compare IMU-based impact loads with PROMs in patients who had undergone conventional total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), and robotic-assisted TKA (RA-TKA).77 patients undergoing primary knee arthroplasty (29 RA-TKA, 37 TKA, and 11 UKA) for osteoarthritis were prospectively enrolled. Remote patient monitoring was performed pre-operatively, then weekly from post-operative weeks two to six using ankle-worn IMUs and PROMs. IMU-based outcomes included: cumulative impact load, bone stimulus, and impact load asymmetry. PROMs scores included: Oxford Knee Score (OKS), EuroQol Five-dimension with EuroQol visual analogue scale, and the Forgotten Joint Score.On average, patients showed improved impact load asymmetry by 67% (p=0.001), bone stimulus by 41% (p<0.001), and cumulative impact load by 121% (p=0.035) between post-operative week two and six. Differences in IMU-based outcomes were observed in the initial six weeks post-operatively between surgical procedures. The mean change scores for OKS were 7.5 (RA-TKA), 11.4 (TKA), and 11.2 (UKA) over the early post-operative period (p=0.144). Improvements in OKS were consistent with IMU outcomes in the RA-TKA group, however, conventional TKA and UKA groups did not reflect the same trend in improvement as OKS, demonstrating a functional decline.Our data illustrate that PROMs do not necessarily align with patient function, with some patients reporting good PROMs, yet show a decline in cumulative impact load or load asymmetry. These data also provide evidence for a difference in the functional outcome of TKA and UKA patients that might be overlooked by using PROMs alone.
SHOULDER ARTHROPLASTY IN ANTICOAGULATED PATIENTS: A COHORT STUDY
Authors: Faulkner H. , Levy G. , Hermans D. , Duckworth D. 
Published: February 2023

To determine whether pre-operative cessation of anticoagulant or antiplatelet medication is necessary for patients undergoing total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA).A prospectively maintained database was used to identify 213 consecutive patients treated with TSA or RTSA performed by a single surgeon across 3 centres. This cohort included 24 patients on an anticoagulant agent (warfarin, apixaban, rivaroxaban, dabigatran), 52 patients on an antiplatelet agent (aspirin, clopidogrel), and a control group of 137 patients not on anticoagulant or antiplatelet medication. Patients on anticoagulant or antiplatelet medications continued these agents peri-operatively. Outcomes included haemoglobin drop, intra-operative blood loss, operative time, transfusion requirements and post-operative complications.The mean age of the cohort was 74.3 years (range 47 – 93) and 75 (35.2%) of the patients were male. TSA was performed in 63 cases and RTSA in 150 cases. The mean haemoglobin drop in the control group was 17.3 g/L, compared to 19.3 g/L in the anticoagulant group (p = 0.20) and 15.6 g/L in the anti-platelet group (p = 0.14). The mean intra-operative blood loss in the control group was 107.8 mL, compared to 143.0 mL in the anticoagulant group (p = 0.03) and 134.3 mL in the anti-platelet group (0.02). The mean operative time in the control group was 49.3 minutes, compared to 47.1 minutes in the anticoagulant group (p = 0.56) and 50.3 minutes in the anti-platelet group (p = 0.78). Post-operatively no patients developed a wound infection or haematoma requiring intervention. Three patients not on anticoagulant or antiplatelet medication developed pulmonary embolism.Continuing anticoagulant or antiplatelet medication was associated with higher intra-operative blood loss, but produced no statistically significant differences in haemoglobin drop, operative time, transfusion requirements or post-operative complications. We now do not routinely stop any anticoagulant or antiplatelet medication for patients undergoing total shoulder arthroplasty.
OSSEOINTEGRATION OUTCOMES FOLLOWING AMPUTEE LENGTHENING
Authors: Hoellwarth J. , Chavan A. , Oomatia A. , Lu W. , Al Muderis M. , Preda V. 
Published: February 2023

Percutaneous EndoProsthetic Osseointegration for Limbs (PEPOL) facilitates improved quality of life (QOL) and objective mobility for most amputee's discontent with their traditional socket prosthesis (TSP) experience. Some amputees desiring PEPOL have residual bone much shorter than the currently marketed press-fit implant lengths of 14-16 cm, potentially a risk for failure to integrate. We report on the techniques used, complications experienced, the management of those complications, and the overall mobility outcomes of seven patients who had femur distraction osteogenesis (DO) with a Freedom nail followed by PEPOL.Retrospective evaluation of a prospectively maintained database identified nine patients (5 females) who had transfemoral DO in preparation for PEPOL with two years of follow-up after PEPOL. Six patients had traumatic causes of amputation, one had perinatal complications, one was performed to manage necrotizing fasciitis and one was performed as a result of osteosarcoma.The residual femurs on average started at 102.2±39.7 mm and were lengthened 58.1±20.7 mm, 98±45% of goal (99±161% of the original bone length). Five patients (56%) had a complication requiring additional surgery. At a mean of 3.4±0.6 (2.6-4.4) years following osseointegration six patients had K-level >2. The 6 Minute Walk Test remained unchanged (267±56 vs 308 ± 117 meters). Patient self-rating of prosthesis function, problems, and amputee situation did not significantly change from before DO to after osseointegration. Six patients required additional surgery following osseointegration: six to remove fixation plates placed to maintain distraction osteogenesis length at osseointegration; two required irritation and debridement for infection.Extremely short residual femurs which make TSP use troublesome can be lengthening with externally controlled telescoping nails, and successfully achieve osseointegration. However, it is imperative to counsel patients that additional surgery to address inadequate regenerate or to remove painful hardware used to maintain fixation may be necessary. This may improve the amputee's expectations before beginning on a potentially arduous process.
DISTAL RADIUS FRACTURE CLASSIFICATION USING DEEP LEARNING ALGORITHMS
Authors: White J. , Wadhawan A. , Min H. , Rabi Y. , Schmutz B. , Dowling J. , Tchernegovski A. , Bourgeat P. , Tetsworth K. , Fripp J. , Mitchell G. , Hacking C. , Williamson F. , Schuetz M. 
Published: February 2023

Distal radius fractures (DRFs) are one of the most common types of fracture and one which is often treated surgically. Standard X-rays are obtained for DRFs, and in most cases that have an intra-articular component, a routine CT is also performed. However, it is estimated that CT is only required in 20% of cases and therefore routine CT's results in the overutilisation of resources burdening radiology and emergency departments. In this study, we explore the feasibility of using deep learning to differentiate intra- and extra-articular DRFs automatically and help streamline which fractures require a CT.Retrospectively x-ray images were retrieved from 615 DRF patients who were treated with an ORIF at the Royal Brisbane and Women's Hospital. The images were classified into AO Type A, B or C fractures by three training registrars supervised by a consultant. Deep learning was utilised in a two-stage process: 1) localise and focus the region of interest around the wrist using the YOLOv5 object detection network and 2) classify the fracture using a EfficientNet-B3 network to differentiate intra- and extra-articular fractures.The distal radius region of interest (ROI) detection stage using the ensemble model of YOLO networks detected all ROIs on the test set with no false positives. The average intersection over union between the YOLO detections and the ROI ground truth was Error! Digit expected.. The DRF classification stage using the EfficientNet-B3 ensemble achieved an area under the receiver operating characteristic curve of 0.82 for differentiating intra-articular fractures.The proposed DRF classification framework using ensemble models of YOLO and EfficientNet achieved satisfactory performance in intra- and extra-articular fracture classification. This work demonstrates the potential in automatic fracture characterization using deep learning and can serve to streamline decision making for axial imaging helping to reduce unnecessary CT scans.
SMARTPHONE-BASED STEP-COUNT MEASURES CORRELATE WITH KOOS-12 FUNCTION AND UCLA ACTIVITY PROMS DURING EARLY TKA RECOVERY
Authors: McMahon S. , Coffey S. , Sullivan J. , Petterwood J. , Ponder C. , Slotkin E. , Wakelin E.A. , Orsi A.D. , Plaskos C. 
Published: February 2023

Passive smartphone-based apps are becoming more common for measuring patient progress after total knee arthroplasty (TKA). Optimum activity levels during early TKA recovery haven't been well documented. This study investigated correlations between step-count and patient reported outcome measures (PROMs) and how demographics impact step-count preoperatively and during early post-operative recovery.Smartphone capture step-count data from 357 TKA patients was retrospectively reviewed. Mean age was 68±8years. 61% were female. Mean BMI was 31±6kg/m2. Mean daily step count was calculated over three time-windows: 60 days prior to surgery (preop), 5-6 weeks postop (6wk), and 11-12 weeks postop (12wk).Linear correlations between step-count and KOOS12-function and UCLA activity scores were performed. Patients were separated into three step-count levels: low (<1500steps/day), medium (1500-4000steps/day), and high (>4000steps/day). Age >65years, BMI >30kg/m2, and sex were used for demographic comparisons.Student's t-tests determined significant differences in mean step-counts between demographic groups, and in mean PROMs between step-count groups.UCLA correlated with step-count at all time-windows (p<0.01). KOOS12-Function correlated with step-count at 6wk and 12wk (p<0.05). High step-count individuals had improved PROMs compared to low step-count individuals preoperatively (UCLA: ∆1.4 [p<0.001], KOOS12-Function: ∆7.3 [p<0.05]), at 6wk (UCLA: ∆1 [p<0.01], KOOS12-Function: ∆7 [p<0.05]), and at 12wk (UCLA: ∆0.8 [p<0.05], KOOS12-Function: ∆6.5 [p<0.05]).Younger patients had greater step-count preoperatively (3.8±3.0k vs. 2.5±2.3k, p<0.01), at 6wk (3.1±2.9k vs. 2.2±2.3k, p<0.05) and at 12wk (3.9±2.6k vs. 2.8±2.6k, p<0.01). Males had greater step-count preoperatively (3.7±2.6k vs. 2.5±2.6k, p<0.001), at 6wk (3.6±2.6k vs. 1.9±2.4k, p<0.001), and at 12wk (3.9±2.3 vs. 2.8±2.8k, p<0.01). No differences in step-count were observed between low and high BMI patients at any timepoint.High step count led to improved PROMs scores compared to low step-count. Early post-operative step-count was significantly impacted by age and sex. Generic recovery profiles may not be appropriate across a diverse population.
THE UTILITY OF 3D PRINTING FOR PREOPERATIVE CREATION OF PATIENT-SPECIFIC IMPLANTS FOR SHOULDER ARTHRODESIS
Authors: Sun J. , Tan SL E. , Sevao J. 
Published: February 2023

Anatomically specific fixation devices have become mainstream, yet there are anatomical regions and clinical conditions where no pre-contoured plates are available, such as for glenohumeral arthrodesis. In a case series of 4 glenohumeral arthrodesis patients, a consultant orthopaedic surgeon at GCUH implemented 3D printing technology to create reconstructions of each patient's shoulder girdle to pre-contour arthrodesis plates. Our aim was to quantify the cost-benefit & intra-operative time savings of this technique in glenohumeral arthrodesis.We hypothesized that the use of 3D printing for creating patient specific implants through pre-operative contouring of plates will lead to intra-operative time and cost savings by minimising time spent bending plates during surgery.This study analysed 4 patients who underwent shoulder arthrodesis by a single consultant orthopaedic surgeon at GCUH between 2017-2021. A CT-based life-size model of each patient's shoulder girdle was 3D printed using freely available computer software programs: 3D Slicer, Blender, Mesh Mixer & Cura.Once the patient's 3D model was created, plate benders were used to contour the plate pre-op, which was then sterilised prior to surgery. Arthrodesis was performed according to AO principles of fixation. The time spent pre-bending the plate using the 3D model was calculated to analyse the intra-op time and cost-saving benefits.For the 4 cases, the plate pre-bending times were 45, 40, 45 & 20 minutes (average 38.8 mins). The intra-op correction time to make small adjustments to the plate was 2 min/ case. 3 plates needed minor (3 degree) adjustment to fine-tune scapula spine contouring. 1 plate needed a 5 degree correction to fine-tune hand position. On average, the pre-bending of the plate saved approximately 38.8 mins intra-op/ case. These shorter anaesthetic and operating times equate to approximately $2586 saving/ case, given an estimate of $4000/hour of theatre costs.We conclude that pre-bending plates around 3D-printed life-size models of an individual's shoulder girdle prior to surgery results in approximately 38.8 mins time saving intra-op when used in shoulder arthrodesis. This is a viable and effective technique that will ultimately result in significant operative time and financial savings.
IMPACT OF COVID-19 RESTRICTIONS ON UPPER LIMB TRAUMA IN A TERTIARY TRAUMA CENTRE: 2021 SECOND WAVE
Authors: Lai S. , Zhang X. , Xue K. , Bubra P. , Baba M. 
Published: February 2023

The second wave of COVID-19 infections in 2021 resulting from the delta strain had a significantly larger impact on the state of New South Wales, Australia and with it the government implemented harsher restrictions.This retrospective cohort study aims to explore how the increased restrictions affected hand trauma presentations and their treatment. Retrospective analysis was performed on patients who underwent hand surgery from the period of June 23 – August 31 in 2020 and 2021 at a level one trauma centre in Western Sydney.During the second-wave lockdown there was an 18.9% decrease in all hand trauma presentations. Despite widespread restrictions placed on the manufacturing, wholesale, retail and construction industries, there was an insignificant difference in work injuries.Stay-at-home orders and reduced availability of professional tradespersons likely contributed to an increase in DIY injuries. Significant reductions in metacarpal and phalangeal fractures coincided with significantly curtailed sporting seasons. The findings from this study can assist in predicting the case-mix of hand trauma presentations and resource allocation in the setting of future waves of COVID-19 and other infectious diseases.
CHOOSING WISELY: THE LACK OF VALIDITY OF ULTRASOUND SCANS IN THE INVESTIGATION OF SHOULDER INSTABILITY
Authors: Mohammed K. , Oorschot C. , Austen M. , O'Loiughlin E. 
Published: February 2023

We test the clinical validity and financial implications of the proposed Choosing Wisely statement: “Using ultrasound as a screening test for shoulder instability is inappropriate in people under 30 years of age, unless there is clinical suspicion of a rotator cuff tear.”A retrospective chart review from a specialist shoulder surgeon's practice over a two-year period recorded 124 patients under the age of 30 referred with shoulder instability. Of these, forty-one had already had ultrasound scans performed prior to specialist review. The scan results and patient files were reviewed to determine the reported findings on the scans and whether these findings were clinically relevant to diagnosis and decision-making. Comparison was made with subsequent MRI scan results. The data, obtained from the Accident Compensation Corporation (ACC), recorded the number of cases and costs incurred for ultrasound scans of the shoulder in patients under 30 years old over a 10-year period.There were no cases where the ultrasound scan was considered useful in decision-making. No patient had a full thickness rotator cuff tear. Thirty-nine of the 41 patients subsequently had MRI scans. The cost to the ACC for funding ultrasound scans in patients under 30 has increased over the last decade and exceeded one million dollars in the 2020/2021 financial year. In addition, patients pay a surcharge for this test.The proposed Choosing Wisely statement is valid. This evidence supports that ultrasound is an unnecessary investigation for patients with shoulder instability unless there is clinical suspicion of a rotator cuff tear. Ultrasound also incurs costs to the insurer (ACC) and the patient. We recommend x-rays and, if further imaging is indicated, High Tech Imaging with MRI and sometimes CT scans in these patients
Seguimiento otológico en niños con Síndrome de Down
Authors: Losada-Campa Juan , Benito-Orejas José Ignacio , Álvarez-Álvarez María , González-Sosto Mariana , Santos-Pérez Jaime , Muñoz-Moreno Maria Fe 
Published: February 2023

Introducción y objetivo: La trisomía 21 es la alteración cromosómica más frecuente. Los avances terapéuticos han conducido a un incremento de la esperanza de vida, que implica unos cuidados más especializados.
Las manifestaciones de la esfera ORL son un foco dominante de morbilidad en los niños con Síndrome de Down (SD). Los problemas auditivos son más habituales que en el resto de población, pudiendo mediatizar la evolución educativa y social, afectando su calidad de vida.
El objetivo de este trabajo consiste en analizar los resultados del seguimiento otológico de los niños con SD estudiados en nuestro Servicio de ORL, durante los últimos 29 años.
Método: Estudio prospectivo/retrospectivo del registro que realizamos en el Servicio ORL del HCU de Valladolid, de los 83 niños con SD que acudieron a consulta desde 1993 a 2021 y de los datos introducidos tras una revisión actual de sus historiales.
Resultados: El 63% de los niños estudiados con SD fueron varones, 77% con menos de 5 años de edad y procedentes en el 88% de Valladolid y provincia. El 19% nacieron en nuestro hospital y un 29% se perdió durante el seguimiento.
Detectamos un 66% de malformaciones de oído externo. La patología de oído medio estuvo presente en el 92%. Realizamos pruebas auditivas al 93% y un 60% tenía hipoacusia, bilateral en un 78% y de grado leve/moderado en el 87% (8% profunda). Un 39% de las hipoacusias fue de tipo neurosensorial. La adaptación protésica con audífonos se llevó a cabo en el 48% de los niños con hipoacusia; recibiendo un 11% una prótesis osteointegrada y un 4% un implante coclear. Se realizó cirugía ORL al 62%, destacando en frecuencia, la adenoidectomía y la colocación de drenajes transtimpánicos.
Discusión y conclusiones: El seguimiento ORL recomendado para los niños con SD resulta una tarea difícil de organizar. Se suman además otros obstáculos inherentes al SD, como la discapacidad intelectual, las dificultades en la exploración, el carácter fluctuante de la hipoacusia, unos peores resultados en el tratamiento médico/quirúrgico, que se acompaña de mayor morbilidad y con unas indicaciones en ocasiones, enfrentadas en la literatura… y unos padres que se cansan de tantas visitas y de la cronicidad de los procesos.
Dada la frecuencia de patología ORL en el niño con SD y de las repercusiones que puede tener en su evolución, consideramos necesario este seguimiento, pero se impone el reto de desarrollar una planificación específica, que lo haga posible en nuestro sistema público de salud.