Hasil untuk "Orthopedic surgery"

Wenbo Li, Ziyao Ding, Shuo Feng et al.

Abstract Background Traditional lecture-based learning (LBL) faces limitations in teaching complex spinal anatomy and surgical procedures. This study aimed to evaluate the efficacy of a novel Problem-Based Learning (PBL) model integrated with three-dimensional (3D) anatomy software and software-assisted annotation in spinal surgery education. Methods A randomized controlled trial included 120 fifth-year clinical medicine undergraduates, starting in August 2024. Participants were divided into an experimental group (n = 60, receiving 3D + PBL + annotation-assisted teaching) and a control group (n = 60, receiving traditional LBL). Outcomes were assessed via written tests (objective/subjective questions) and standardized questionnaires evaluating knowledge mastery, learning motivation, academic atmosphere, teacher-student interaction, and knowledge retention. Results The experimental group scored significantly higher on subjective questions (case analysis) than the control group (39.33 ± 5.38 vs. 32.08 ± 4.79, P < 0.001). Questionnaire results indicated that the experimental group reported significantly higher self-rated mastery in spinal endoscopic procedures, anatomy, Michigan State University (MSU) classification of lumbar disc herniation (LDH), and differential diagnosis (all P < 0.05). In addition, students in the experimental group expressed greater satisfaction with learning motivation, academic atmosphere, teacher–student interaction, and knowledge retention (all P < 0.05). Conclusions Integrating 3D anatomy visualization, software-assisted annotation, and PBL significantly enhances clinical reasoning, spatial understanding, and student engagement in spinal surgery education. This multimodal approach addresses the limitations of traditional methods and is recommended for broader application in orthopedic training. Trial registration Chinese Clinical Trial Registry (ChiCTR), ChiCTR2400082568. Registered on 01 April 2024.

Santosh Borkar, Rajiv Munde, Shrirang Godbole et al.

Background. Intra-articular calcaneal fractures, particularly of the joint depression type, present significant surgical challenges. The traditional lateral extensile approach (LEA), although providing excellent exposure, is associated with notable soft tissue complications, such as wound necrosis and infection. The sinus tarsi approach (STA), a minimally invasive technique, aims to minimize these complications while maintaining comparable outcomes. This study aimed to compare the functional, radiological outcomes, and complications of STA with cannulated cancellous (CC) screw fixation versus LEA with plating in the management of joint depression-type intra-articular Sanders Type 2 and 3 calcaneal fractures. Methodology. A prospective, non-randomized comparative study was conducted at a tertiary care center (BSTRH and MIMER Medical College, Talegaon Dabhade), involving 56 adult patients (aged >18 years) with acute (<three weeks) intra-articular joint depression (Sanders Type 2 and 3) calcaneal fractures, diagnosed via radiographs and CT scan. All surgeries were performed by a senior orthopaedic trauma surgeon with more than 10 years of experience. Patients were allocated into two groups of 28 each: Group A underwent STA with CC screw fixation, while Group B received LEA with plate fixation. Surgical intervention was performed after soft tissue readiness, followed by standard postoperative care. Patients were evaluated at one, three, six, nine, and 12 months postoperatively using the American Orthopaedic Foot and Ankle Society hindfoot score (AOFAS), Visual Analogue Scale (VAS), and radiological parameters including Bohler’s angle, Gissane angle, and calcaneal height and width. Complication rates, operative time, and hospital stay were also analyzed. Results. STA resulted in significantly shorter operative times (59.1 vs. 98.4 minutes, p < 0.001) and hospital stays (4.7 vs. 7.42 days, p < 0.001). AOFAS scores at 12 months were comparable between STA (mean 80.57) and LEA (mean 77.33). Postoperative VAS scores were significantly better in the STA group (1.67 vs. 2.04; p = 0.044). Radiographic outcomes were similar between groups. STA demonstrated fewer complications, including superficial infection (3 vs. 5), deep infection (0 vs. 2), and sural nerve injury (0 vs. 1). Conclusion. The sinus tarsi approach with cannulated screw fixation offers equivalent functional and radiological outcomes to the lateral

Lei Gao, Zhipeng Tang, Zhijin Zhang et al.

Abstract Background Osteomyelitis (OM) is a bone disease that can leave people disabled. Eukaryotic translation initiation factor (EIF5A) is involved in cell proliferation, apoptosis, differentiation, and inflammation, but the role of EIF5A in staphylococcus aureus (S. aureus)-infected OM remains unclear. Methods The mRNA and proteins were detected by qRT-PCR and western blot. Cell viability was examined by CCK8 assay. The reactive oxygen species (ROS), malondialdehyde (MDA), ferrous iron (Fe2+), and glutathione (GSH) levels were analyzed using the ROS, MDA, GSH, and Fe2+ detection kits. The levels of tumor necrosis factor-alpha (TNF-α), interleukin-1β (IL-1β), and Interleukin-6 (IL-6) were examined using Enzyme-linked immunosorbent (ELISA) kits. The binding between FOS and promoter of EIF5A was detected by chromatin immunoprecipitation (CHIP) assay. The interaction between EIF5A and Fos proto-oncogene (FOS) was detected by dual-luciferase reporter assay. The diagnostic values of EIF5A and FOS were analyzed with blood of S. aureus-infected OM patients and healthy volunteers by ROC curve. Results The EIF5A was up-regulated in S. aureus-infected OM. EIF5A knockdown promoted cell viability in S. aureus-infected MG-63 cells and reduced ROS, MDA, and Fe2+ levels, and increased GSH levels. Meanwhile, silencing EIF5A could increase expression of glutathione peroxidase 4 (GPX4), and ferritin heavy chain1 (FTH1) and reduce acyl-CoA synthetase long-chain family member 4 (ACSL4) expression, and silencing EIF5A could reduce immune factors (TNF-α, IL-1β, and IL-6) levels. FOS could bind to EIF5A. Silencing FOS promoted cell viability, and increased GSH levels in S. aureus-infected MG-63 cells, but reduced ROS, MDA, and Fe2+ levels. Meanwhile, promoted GPX4 and FTH1 expression, inhibited ACSL4 expression, and reduced immune factor levels in S. aureus-infected MG-63 cells. Interestingly, EIF5A overexpression could weaken the actions. FOS promotes ferroptosis and inflammation via EIF5A in S. aureus-infected MG-63 cells. Besides, the EIF5A and FOS might be potential molecular diagnostic markers in the progression of OM. Conclusion FOS promotes ferroptosis and inflammation via EIF5A in S. aureus-infected OM. This study is first to report the role of FOS and EIF5A in S. aureus-infected OM, but we found that there are still some limitations in our work, such as not covering all possible types of infection, which is the focus of future research.

Xuanyu Chen, Zhangfu Li, Chao Zheng et al.

Abstract Objective This study aims to investigate changes in matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) levels in the intervertebral discs of New Zealand white rabbits under simulated overload and microgravity conditions, focusing on the expression of MMP1, MMP3, and TIMP1. The findings aim to provide a theoretical foundation for preventing and delaying lumbar disc degeneration in these environments. Methods Overload was simulated using an animal centrifuge, and microgravity was mimicked through tail suspension. A randomized single-blind method was applied to divide 120 age- and weight-matched New Zealand white rabbits into six groups: control groups (30 d, 60 d, 90 d) and overload/microgravity groups (30 d, 60 d, 90 d), with 20 rabbits per group. The expression of MMP1, MMP3, and TIMP1 in the lumbar intervertebral discs was measured and analyzed using statistical methods, including chi-square tests and t-tests, across different exposure times. Results In the experimental groups, MMP1 and MMP3 expression levels were significantly higher than those in the corresponding control groups at all time points (P < 0.01). MMP1 and MMP3 levels progressively increased with longer exposure durations, showing statistically significant differences (P < 0.01). TIMP1 expression was significantly higher in the 30-day and 60-day experimental groups than in the control group (P < 0.01), but decreased in the 90-day group, indicating a late-stage imbalance in the MMP/TIMP1 ratio. Conclusion Simulated overload and microgravity conditions lead to elevated MMP1, MMP3, and TIMP1 expression in lumbar intervertebral discs, promoting accelerated disc degeneration.

Junaid Aamir MBChB MRes MRCS, Chijioke Orji MBBS, MRCS, Lyndon Mason BMBS MRCS FRCS

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Occult posterior malleolar fractures (PMFs) are reported commonly in tibial shaft fractures. Presurgical identification is necessary to negate possible complications during tibial fracture surgical treatment (e.g. PMF fracture displacement. The aims of this study was to determine the most relevant factors predicting PM fractures by applying the AI "Minimum Redundancy Maximum Relevance" (mRMR) feature selection method to investigate the predictive power of various clinical and demographic factors. Methods: This was a historic cohort study, employing the mRMR method to identify the most relevant features associated with occult PMF in tibial shaft fractures . The inclusion criteria for this study were any patient who had sustained a diaphyseal tibial fracture who had undergone surgery during the study period who had also undergone a CT scan in addition to plain radiographs. The selected features were then used to train a machine learning model for identifying occult PMF. The model's performance was evaluated by measuring classification accuracy across different combinations of features. Results: Out of 764 diaphyseal fractures identified 442 met the inclusion criteria. A total of 107 patients had PMF extensions (24.21%). The analysis revealed that tibia the most relevant fractures were tibia fracture type, fibular fracture morphology, tibia fracture level, fibular fracture level and mechanism. On further analysis, tibial spiral fracture was the most significant predictor, with a classification accuracy of 0.78 with other factor clusters not reaching the same significance. Low energy mechanisms and tibial fracture comminution were the best predictors of no occult PMF. Conclusion: This study demonstrates that AI can effectively be used to identify prediction factors of occult PMF in tibial fractures. Spiral tibia fractures being the most relevant predictor. The findings highlight the potential of using AI-driven methods, such as mRMR, to enhance the accuracy of injury prediction, and these findings are in keeping with results from traditional statistics.

Ziming Cai, Gongpeng Xiong, Jintao Wu et al.

ABSTRACT Introduction Spinal cord injury (SCI), acknowledged as the most severe complication arising from spinal trauma, pertains to the dysfunction of the spinal cord due to traumatic events or other pathological conditions. Extensive research has elucidated a substantial correlation between SCI and inflammatory processes, highlighting the critical involvement of microglia in orchestrating neuroinflammatory responses. Moreover, a growing body of evidence has demonstrated a strong connection between microglial activation and both the pathogenesis and progression of SCI. Objective We chose bibliometric analysis to comprehensively summarize the research progress of microglia in SCI, aiming to provide researchers with current trends and future research directions. Methods All articles and reviews addressing microglia in SCI were systematically retrieved from the Web of Science Core Collection database, spanning publications from 2000 to 2024. Subsequent bibliometric analysis was conducted utilizing four analytical tools: VOSviewer (version 1.6.20), R software (package bibliometrix), the Biblioshiny web interface, and CiteSpace (version 6.2.R4), ensuring comprehensive examination of publication patterns and research trends. Results A total of 2428 publications were ultimately included in this bibliometric analysis. The annual publication count demonstrated a consistent upward trajectory. China is the country with the most published articles, and Ohio State University ranks first in institutional publications. Experimental Neurology is the journal with the most published articles, while Journal of Neuroscience is the journal with the most cited articles. Popovich Pg is the author with the highest productivity and co‐citation. Cluster analysis yielded a total of 15 different co‐citation clusters. Time analysis shows explosive citation outbreaks in 2006, 2009, and 2011. Keyword analysis revealed inflammation, expression, activation, and central nervous system as the most frequently occurring terms. Recent keyword trends feature emerging terms like exosomes, extracellular vesicles, and nanoparticles. Keyword bursts revealed promotes, extracellular vesicle, recovery, neuroinflammation, therapy, polarization, and pathway are the hotspots of research at the present stage and are likely to continue. These findings provide critical insights for developing microglia‐targeted therapeutic strategies and prioritizing research directions in neuroinflammatory modulation to improve functional recovery after SCI. Conclusion Emerging research frontiers prominently feature exosomes, gut microbiota, and nanoparticles. The interplay between microglia‐mediated neuroinflammation and SCI has emerged as a critical focal point in current scientific investigations and is anticipated to remain central to forthcoming scientific inquiries.

Kenneth L. Baker, Marc Kegel, Duncan McCoy

In this article, we explore phenomena relating to quasi-alternating surgeries on knots, where a quasi-alternating surgery on a knot is a Dehn surgery yielding the double branched cover of a quasi-alternating link. Since the double branched cover of a quasi-alternating link is an L-space, quasi-alternating surgeries are special examples of L-space surgeries. We show that all SnapPy census L-space knots admit quasi-alternating surgeries except for the knots t09847 and o9_30634, neither of which have any quasi-alternating surgeries. In particular, this finishes Dunfield's classification of the L-space knots among all SnapPy census knots. In addition, we show that all asymmetric census L-space knots have exactly two quasi-alternating slopes and that these are consecutive integers. Similar behavior is observed for some of the Baker-Luecke asymmetric L-space knots. We also classify the quasi-alternating surgeries on torus knots and show that the set of formal L-space slopes is either empty or infinite This allows us to give examples of asymmetric formal L-spaces.

Soham Chanda

We construct a new surgery type operation by switching between two exact fillings of Legendrians which we call a BSP surgery. In certain cases, this surgery can preserve monotonicity of Lagrangians. We prove a wall-crossing type formula for the change of the disk-potential under surgery with Bohr-Sommerfeld profiles. As an application, we show that Biran's circle-bundle lifts admit a Bohr-Sommerfeld type surgery. We use the wall-crossing theorem about disk-potentials to construct exotic monotone Lagrangian tori in $\bP^n$.

Alexander Cowtan

We present Safe Surgery by Identifying Pushouts (SSIP), an open-source lightweight Python package for automating surgery between qubit CSS codes. SSIP is flexible: it is capable of performing both external surgery, that is surgery between two codeblocks, and internal surgery, that is surgery within the same codeblock. Under the hood, it performs linear algebra over $\mathbb{F}_2$ governed by universal constructions in the category of chain complexes. We demonstrate on quantum Low-Density Parity Check (qLDPC) codes, which are not topological codes in general, and are of interest for near-term fault-tolerant quantum computing. Such qLDPC codes include lift-connected surface codes, generalised bicycle codes and bivariate bicycle codes. We show that various logical measurements can be performed cheaply by surgery without sacrificing the high code distance. For example, half of the single-qubit logical measurements in the $Z$ or $X$ basis on the $[[ 144 ,12, 12 ]]$ gross code require only 30 total additional qubits each, assuming the upper bound on distance given by QDistRnd is tight. This is two orders of magnitude lower than the additional qubit count of 1380 initially predicted by Bravyi et al.

Haochen Qiu

We prove a surgery formula for the ordinary Seiberg-Witten invariants, and surgery formulas for the families Seiberg-Witten invariants of families of $4$-manifolds obtained through fibrewise surgery. Our formula expresses the Seiberg-Witten invariants of the manifold after the surgery, in terms of the original Seiberg-Witten moduli space cut down by a cohomology class in the configuration space. We use these surgery formulas to study how a surgery can preserve or produce exotic phenomena.

Joo Han Oh, Jaewon Choi, Dong Ho Lee et al.

Brent R. DeGeorge, Jr, MD, PhD

Lihui ZHANG, Shuo XIE, Mingfa LUO et al.

Objectives: Bone tissue grinding is one of the common and basic applications in orthopedic surgery clinics. The grinding process is energy-intensive and generates a lot of grinding heat. The accumulation of this heat may cause thermal damage to biological tissues. This paper presents experimental research to investigate the bone-grinding heat and the cooling method. Methods: The combined influence of nozzle position and feed direction on the cooling effect of bone grinding under cryogenic spray cooling conditions is experimentally investigated. A bone grinding platform with three-dimensional motion, as well as a cryogenic spray generation device, is designed and constructed. A spherical diamond grinding head with a diameter of 4 mm and a grit size of #150 is utilized. Fresh bovine cortical bone is used as the processing sample. The temperature at the nozzle outlet is 13 ℃, and the flow rate valve regulates the coolant flow rate to 400 mL/h. A three-dimensional force transducer (DJSW-40, China) is connected to a data acquisition system, which captures the forces applied to the bone sample along the X, Y, and Z directions at a frequency of 100 Hz. Simultaneously, a 0.1 mm diameter type K thermocouple (Omega Inc., TT-K-36) is embedded inside the bone sample to measure the grinding temperature in real-time. Three different nozzle arrangements were designed: above, in front of, and to the side of the abrasive tool, with the nozzles 10 mm away from the spray surface. Six sets of experiments (3×2) were designed using three nozzle orientations and two feeding directions. Each set of experiments was repeated three times to study the cooling effect of the spray under the combined influence of nozzle orientation and feed direction. Results: (1) During bone grinding, the abrasive tool is subjected to three orthogonal directional forces, namely FX (the tangential grinding force used for removing material), FY (the axial grinding force, representing the resistance of the abrasive tool during its feed), and FZ (the normal grinding force, which serves as the support force of the workpiece on the abrasive tool). For forward feed, the average values of the individual forces are: FX = 0.37 N, FY = -0.72 N, FZ = 1.38 N. For backward feed, FX = 0.46 N, FY = 0.78 N, FZ = 1.67 N. Since the grinding tool remains in the same rotational direction, the tangential force FX is consistently positive. For forward/backward feed, the axial force FY is in the -Y and +Y directions respectively, thus the sign of the FY value changes. When feeding forward/backward, the tangential force (FX) is 0.37 N and 0.46 N, respectively, which are relatively similar to each other, in accordance with the grinding theory. The power consumed for grinding is approximately 1.6 W and 1.9 W for forward and backward feed, respectively. (2) The nerve tissue is more heat-sensitive than bone tissue. Taking the human body's 37 ℃ as the base temperature, the threshold for the occurrence of thermal injury is 43 ℃, so the temperature rise threshold for thermal injury of nerve tissue is 6 ℃. In our experiment, the maximum temperature rise of bone under low-temperature spray cooling was lower than 4 ℃, indicating that the cooling method is effective. The effect of the nozzle arrangement was investigated under a fixed forward or backward feeding direction. When the abrasive tool is fed forward, the cooling of the thermocouple under the front nozzle is obvious. This is because, in addition to the contact arc area between the abrasive tool and the bone sample, a portion of the coolant from the front nozzle is sprayed onto the bone sample surface, resulting in a pre-cooling effect within the bone. When the abrasive tool is fed backward, the grinding temperature is lowest when the nozzle is placed above. For the different nozzle orientations, the side nozzles are in a perpendicular plane to the feed direction (Y-direction) of the grinding tool, so the feed direction has the least influence on the grinding temperature. The upper and front nozzles are in the same plane as the feed direction of the abrasive tool, so the influence of the feed direction is more significant. Conclusions: (1) The average tangential grinding force is 0.42 N, axial grinding force is 0.75 N, normal grinding force is 1.53 N, and the average power consumed by grinding is approximately 1.75 W when bone grinding is performed at a depth of 0.5 mm using a spherical diamond abrasive tool with a diameter of 4 mm. (2) Under the cooling effect of the cryogenic spray, the maximum temperature rise of grinding is less than 4 ℃, which can effectively prevent the occurrence of thermal damage in biological tissues. The temperatures of the two thermocouples in the same set of experiments were more consistent when the nozzle was placed above or side, while there was a significant difference in the temperatures of the two thermocouples when the nozzle was placed in front. This indicates that the cooling effect is more uniform when the nozzle is placed above and to the side. (3) The coupling of the nozzle arrangement and the feeding mode has a greater impact on the grinding temperature. When the nozzle is placed on top, it is favorable to backward feeding; when the nozzle is placed in front, it is conducive to forward feeding; and when the nozzle is placed on the side, there is no significant difference in the temperature between forward and backward feeding.

Ying Li, Yabin Guo, Peipei Zhao et al.

Abstract Objectives This study aims to identify predictors of knee osteoarthritis (KOA) risk in middle-aged population, construct and validate a nomogram for KOA in this demographic. Methods From June to December 2020, we conducted a cross-sectional survey on 5,527 middle-aged individuals from Changsha and Zhangjiajie cities in Hunan Province, selected using a stratified multi-stage random sampling method. Data collection involved a structured questionnaire encompassing general demographic, physical condition, and lifestyle behaviors dimensions. The dataset was randomly split into a training set (n = 3868) and a validation set (n = 1659) at a 7:3 ratio via computerized randomization. We analyzed the prevalence of self-reported KOA and identified its influencing factors using logistic regression. A nomogram was constructed based on these "three-dimensional" factors. Subsequent validation was conducted, and the nomogram's performance was further evaluated through ROC curves, C-index, Hosmer–Lemeshow test, and calibration curves. Results The self-reported prevalence of KOA in the middle-aged population was 11.4% (632/5527). The risk factor with the greatest impact is: diagnosed with osteoporosis(95% CI 2.269–3.568, OR = 2.845), followed by age between 51 to 60 years (95% CI 2.176–3.151, OR = 2.619), diagnosed with hypertension(95% CI 1.633–2.499, OR = 2.02), diagnosed with diabetes (OR = 1.689), ethnic Han Chinese (OR = 1.673), exercise according to physical condition (OR = 1.643), pay attention to keeping the knee joint warm (OR = 1.535), eating habits are mainly light vegetables (OR = 1.374), male gender (OR = 1.343), drink occasionally in small amounts (OR = 1.286); a higher level of education (OR = 0.477) and frequently or always apply an external or plaster to relieve symptoms after knee discomfort (OR = 0.377; OR = 0.385) are protective factors. The C-index of the training set model was 0.8107 (95% CI: 0.8102–0.8111), with a statistically significant area under the ROC curve (AUC = 0.818), and the calibration curve showed a good fit. The C-index for the validation set was 0.8124 (95% CI: 0.8109–0.8140), with an AUC of 0.812. The Hosmer–Lemeshow test resulted in a P-value of 0.46 (P ≥ 0.05)indicating good calibration of the model. Conclusion The three dimensions nomogram generated in this study was a valid and easy-to-use tool for assessing the risk of KOA in middle-aged population, and helped healthcare professionals to screen the high-risk population.

Thomas Mark, Bülent Tosun

We consider the question of when the operation of contact surgery with positive surgery coefficient, along a knot $K$ in a contact 3-manifold $Y$, gives rise to a weakly fillable contact structure. We show that this happens if and only if $Y$ itself is weakly fillable, and $K$ is isotopic to the boundary of a properly embedded symplectic disk inside a filling of $Y$. Moreover, if $Y'$ is a contact manifold arising from positive contact surgery along $K$, then any filling of $Y'$ is symplectomorphic to the complement of a suitable neighborhood of such a disk in a filling of $Y$. Using this result we deduce several necessary conditions for a knot in the standard 3-sphere to admit a fillable positive surgery, such as quasipositivity and equality between the slice genus and the 4-dimensional clasp number, and we give a characterization of such knots in terms of a quasipositive braid expression. We show that knots arising as the closure of a positive braid always admit a fillable positive surgery, as do knots that have lens space surgeries, and suitable satellites of such knots. In fact the majority of quasipositive knots with up to 10 crossings admit a fillable positive surgery. On the other hand, in general (strong) quasipositivity, positivity, or Lagrangian fillability need not imply a knot admits a fillable positive contact surgery.

Yanbing Wang, Yanbing Wang, Zhenkui Sun et al.

PurposeThe imaging diagnosis of fracture-related infection is often challenging. The aim of this study was to evaluate the value of 18F-FDG PET/CT for the diagnosis of fracture-related infection (FRI) with internal fixation after orthopedic surgery in lower extremities.MethodsA total of 254 consecutive patients who underwent 18F-FDG PET/CT scans with suspected FRI with internal fixation in lower extremities were retrospectively investigated 18F-FDG PET/CT images were semiquantitatively evaluated with multiple metabolic parameters. Additionally, morphological information of the inguinal draining lymph nodes (DLN) with the highest SUV value was also collected and analyzed.ResultsPatients were divided into two groups according to final diagnosis: the infected (N=197) and the non-infected group (N=57). The differences in the inguinal DLN-related parameters, including the long diameter, short diameter, maximum cross-sectional area, maximum standardized uptake value (SUVmax), metabolic volume (MV) 60%, MV70%, MV80%, total lesional glycolysis (TLG) 60%, TLG70%, TLG80%, and the infection suspected area related parameters, including SUVmax, MV25%, MV30%, MV35%, MV40%, MV50%, and TLG70%, between the two groups were statistically significant. We then compared the highest area under the curves (AUCs) among the morphological parameters of DLN, metabolic parameters of DLN, and metabolic parameters of the suspected infection area. The result demonstrated that SUVmax of the inguinal DLN showed the best diagnostic performance with an AUC of 0.939 (P&lt;0.05).ConclusionSemiquantitative analysis (especially SUVmax) of the inguinal DLN in 18F-FDG PET/CT images could be a promising method for the diagnosis of suspected FRI with internal fixation after orthopedic surgery in lower extremities.

Simon Hwang, MD, Javier Ardebol, MD, Kassem Ghayyad, MD et al.

Background: Surgeon visual estimation of shoulder range of motion (ROM) is commonplace in the outpatient office setting and routinely reported in clinical research, but the reliability and accuracy of this practice remain unclear. The purpose of this study is to establish the reliability and accuracy of remote visual estimation of shoulder ROM in healthy volunteers and symptomatic patients among a large group of shoulder surgeons. Our hypothesis is that remote visual estimation would be reliable and accurate compared with the digital goniometer method. Methods: Fifty shoulder surgeon members of the PacWest Shoulder and Elbow Society independently determined the active shoulder forward flexion (FF), internal rotation at 90° abduction (IR90), external rotation at 90° abduction, external rotation at the side , and maximal spinal level reached with internal rotation (IRspine) through visual estimation of video recordings taken from 10 healthy volunteers and 10 symptomatic patients. Variations in measurements were quantified using the interobserver reliability through calculation of the intraclass correlation coefficient. Accuracy was determined through comparison with digital goniometer measurements obtained with an on-screen protractor application using Bland–Altman mean differences and 95% limits of agreement. Results: The interobserver reliability among examiners showed moderate to excellent correlation, with intraclass correlation coefficient ranging from 0.768 to 0.928 for the healthy volunteers and 0.739 to 0.878 for the symptomatic patients. Accuracy was limited, with upper limits of agreement exceeding the established minimal clinically important differences (MCIDs) for FF (20° vs. MCID of 14°) and IR90 (25° vs. 18°) in the healthy volunteers and for FF (33° vs. 16°), external rotation at 90° abduction (21° vs. 18°), and IR90 (31° vs. 20°) in the symptomatic patients. Conclusion: Despite generally high intersurgeon reliability in the visual estimation of shoulder ROM, there was questionable accuracy when compared to digital goniometer measurements,with measurement errors often exceeding established MCID values. Given the potential implications for the clinical response to treatment and the significance of research findings, the adoption of validated instruments to measure ROM and the standardization of examination procedures should be considered.

Hee Eun Choi, Tae Hoon Kim, Ji Hoon Jang et al.

<b>Background:</b> This study evaluated the efficacy and safety of pulmonary rehabilitation (PR) on functional performance, exercise-related oxygen saturation, and health-related quality of life among patients with idiopathic pulmonary fibrosis (IPF). <b>Methods:</b> A total of 25 patients with IPF (13 in the PR group and 12 in the non-PR group) were enrolled between August 2019 and October 2021 at Haeundae-Paik Hospital in the Republic of Korea. A cardiopulmonary exercise test (CPET), six-minute walk test (6MWT), pulmonary function test (PFT), Saint George’s Respiratory Questionnaire (SGRQ), muscle strength test, and bioelectrical impedance analysis were performed in each group at baseline and after eight weeks of PR. <b>Results:</b> The mean age was 68 years of age and most subjects were male. Baseline characteristics were similar between the two groups. The distance during 6MWT after PR was significantly improved in the PR group (inter-group <i>p</i>-value = 0.002). VO₂max and VE/VCO₂ slopes showed a significant difference after eight weeks only in the PR group, but the rate of change did not differ significantly from the non-PR group. Total skeletal muscle mass, PFT variables, and SGRQ scores did not differ significantly between the groups. <b>Conclusions:</b> PR improved exercise capacity, as measured using CPET and 6 MWT. Further studies in larger samples are needed to evaluate the long-term efficacy of PR in IPF patients.

José Negrillo-Cárdenas, J. Jiménez-Pérez, F. Feito-Higueruela

Virtual and augmented reality have been used to assist and improve human capabilities in many fields. Most recent advances allow the usage of these technologies for personal and professional purposes. In particular, they have been progressively introduced in many medical procedures since the last century. Thanks to immersive training systems and a better comprehension of the ongoing procedure, their main objectives are to increase patient safety and decrease recovery time. The current and future possibilities of virtual and augmented reality in the context of bone fracture reduction are the main focus of this review. This medical procedure requires meticulous planning and a complex intervention in many cases, hence becoming a promising candidate to be benefited from this kind of technology. In this paper, we exhaustively analyze the impact of virtual and augmented reality to bone fracture healing, detailing each task from diagnosis to rehabilitation. Our primary goal is to introduce novel researchers to current trends applied to orthopedic trauma surgery, proposing new lines of research. To that end, we propose and evaluate a set of qualitative metrics to highlight the most promising challenges of virtual and augmented reality technologies in this context.

J. Pastora-Bernal, Rocío Martín-Valero, F. J. Barón-López et al.

Background In addition to traditional physiotherapy, studies based on telerehabilitation programs have published the results of effectiveness, validity, noninferiority, and important advantages in some neurological, cognitive, and musculoskeletal disorders, providing an opportunity to define new social policies and interventions. Objectives The aim of this systematic review is to investigate the effects of telerehabilitation after surgical procedures on orthopedic conditions as well as to describe how interventions are designed and to determine whether telerehabilitation is comparable with conventional methods of delivery. This systematic review summarizes the levels of evidence and grades of recommendation regarding telerehabilitation intervention (synchronous or asynchronous provided via the telerehabilitation medium, either in conjunction with, or in isolation of, other treatment interventions) after surgical procedures on orthopedic conditions. Methods Study quality was assessed using the Physiotherapy Evidence Database (PEDro) scores and grade of recommendation following the recommendation of the Oxford Centre for Evidence-Based Medicine. Results We found 3 studies with PEDro scores between 6 and 8, which is considered as level 1 evidence (good; 20% [3/15]), 4 studies with a score of 5, which is considered as level 2 evidence (acceptable; 27% [4/15]), and the remaining 8 studies had scores of 4 or less, which is considered (poor; 53% [8/15]). A total of 1316 participants received telerehabilitation intervention in the selected studies, where knee and hip replacement were 75% of all the studies. Strong and moderate grades of evidence (grade of recommendation A–B) were found in knee and hip replacement interventions. Studies on the upper limb were 25% of the studies, but only 1 study presented a moderate grade of evidence (grade of recommendation B) and the rest were of poor methodological quality with weak evidence (grade of recommendation C). Conclusions Conclusive evidence on the efficacy of telerehabilitation for treatment after an orthopedic surgery, regardless of pathology, was not obtained. We found strong evidence in favor of telerehabilitation in patients following total knee and hip arthroplasty and limited evidence in the upper limb interventions (moderate and weak evidence). Future research needs to be more extensive and conclusive. To the best of the authors’ knowledge, this is the first attempt at evaluating the quality of telerehabilitation intervention research after surgical procedures on orthopedic conditions in a systematic review. Clinical messages and future research recommendations are included in the review.