Orthopedic Surgery - Science topic

How many of us think that an academic society or organisation helps us, like AOTrauma helps us in professional growth, academic growth and helps us move up the ladder in our career. Does it really remove the obstacles. If yes please mention the name of such organization ( like Indian Orthopaedic association, AOTrauma, OTA, BOA, Arthroplasty, Arthroscopic or trauma societies of different countries states etc) which really help you. Please write your thoughts if you have a different point of view.

There are contradictory recommendations in this regard. Any authentic guidelines please?

Hello there!

I am performing a systematic review regarding the effect of a specific surgical procedure on a common orthopaedic condition. All identified studies are case-series with no control group.

For these studies the outcome is pre- vs post-surgery change in Visual Analogue Scale (VAS).

Is it possible to perform a meta-analysis of pre- vs post-surgery change in VAS given there is no control group?

Any thoughts would be greatly appreciated!

Accidents involving motorcycles are responsible for over 50% of open fractures of the tibia and can be associated with other lesions and the victims, in the vast majority, are youth and young adult (Brazil epidemiological data). What preventive measures could be taken to reduce this type of accident?

As there are greater advances in the field of orthopaedics, how important a role has commercialisation to play ? Are the implant companies and big organisations influencing clinical practice ? What are the pros and cons on this route the modern orthopaedics is on?

For my dissertation I'm validating the method of sonication culture for prosthetic joint Infections and orthopaedic implant infection. Hopefully this method can be used in our lab since this has been repeatedly proved to be more specific than tissue culture. I want to investigate if this sonication method will also be beneficial for detecting osteomyelitis. In the literature there is not much to find on this subject, maybe researchers here can help me with the question if this is possible or maybe there are labs who already use this method?

Respected Fellows,

First and foremost, wish you all, all the very best for the year 2021!.

I was formerly a faculty member in Canada (2006-2011, Assistant Prof.), then came back to my mother-land. What I've seen in the past 10 yrs, in regard to publishing our papers, was that politics was GREATLY involved in numerous journals' decision on our manuscripts.

My question for you is as follows:

Do you agree that politics is involved in science these days?, and if so, should we, researchers, be indifferent with respect to unfair behavior of some of our fellows with respect to some others who are working in some countries, like my mother-land?.

Most recently, a manuscript from my research team, which was submitted to a Japanese journal, and it was 100% theoretical work, with no experiments involved at all, was rejected since one of the reviewers has criticized our work and mentioned why different steps of the experiment done in our work were not clearly explained (?!!!!!!). We immediately prepared a rebuttal and appealed their decision, but EIC has responded and mentioned we only accept about 10% of the manuscripts we receive (!!!!).

Thanks for your thoughts in advance,

PS1: I am working on Biomechanics related projects, mostly on Orthopaedic and Dental Implants Biomechanics, so no threat to other nations (?!)- please correct me if I am wrong.

PS2: I am Iranian-Canadian, but now am living in Iran, and working from here. If there is anything wrong with this, please educate me.

Does the term "contrast bath" imply any random time-temperature combination of hot and cold water or it is a specific combination of repetitive alternate spells of dipping the affected body part in cold water at a specific temperature for a specified duration followed by dipping in hot water at a specific temperature for a specified duration?

After the ORIF surgery of right hand wrist fracture, the fingers are stiffened - the finger segments getting as hard as stones (hardened edema) - making the bending of fingers to close the palm as fist almost impossible as the stone hard lower segment of the finger doesn't allow the finger to be bent downwards. The physiotherapist tries mobiisation applying his full might to bend the fingers downwards causing extreme pain to the patient, still the fingers do not bend beyond 90 degrees from their fully stretched position. Is this physiontherapy (extreme torture to the patient) - extending to 2 / 3 / 4 weeks or even more - the only way to restore the fingure movement or there are some easier / painless patient-friendly ways (such as some medication etc.) of treating the stiffened fingers without subjecting the patient to ubearable tortures?

What is the course of action in an arthroplasty which is infected clinically but is culture negative? I find this a difficult situation in many orthopaedic infections not only arthroplasty where the clinical features from a weeping wound to local signs cry infection and even the deeper swabs grow nothing. How does one tailor the antibiotics in such situations?

What are pros and cons of it vis-a-vis the gold standard two stage revision surgery?

15 y old male normal xrays no other symptoms normal uric acid level bilateral lesions no history of trauma

The COVID pandemic has been a blessing for most journals, including our Journal of Clinical Orthopaedics and Trauma. Currently, we are getting around 6 new manuscripts daily and the number of submissions in the last 4 months has risen to 280%, compared to the last year. I do not know when this curve is likely to flatten to come to normalcy.

This trend has over-burdened the editors and their editorial team members, especially as the number of journal staff has not risen but has actually decreased to lockdown and some staff getting sick.

What are the likely reasons for such an exponential rise?

We are currently conducting a study on the influence of collars in metadiaphyseal uncemented stems and I am curious what the orthopedic community at RG thinks about this topic.

Do you think collared stems have advantages or disadvantages? Do you use collared stems in you daily practice?

International Orthopaedics

June 2018, Volume 42, Issue 6, pp 1297–1306| Cite as

Trimorphic extreme clubfoot deformities and their management by triple surgical skin expanders- DOLAR, DOLARZ and DOLARZ-E(evidence based mega-corrections without arthrodesis)

In my experience outpatient review for orthopaedic patients unless part of a dedicated trial is non standardized and often vague such as pain has improved or back to work and function. Should all patients have a standardized set of reviews recommended by specialist societies to facilitate consistent review, assessment between units and research projects that are multi centre.

Is there any selective advantage to the brachial plexus being a network instead of independent nerves? Same question for the lumbosacral plexus.

I am very interested in scaphoid fracture non-union but have found there is, despite the significant need clinically to improve our understanding, very little interest in the aetiology and histology from the basic science point of view. I would like to find someone or institution who may be interested in this and who I can collaborate with. In preference, this is within the UK because of specimen sharing logistics. Jon Compson. Consultant Orthopaedic Surgeon, Kings College Hospital London, UK

Whilst we are awaiting evidence of all types, what is the best current evidence for orthopaedic robots?

In the future, there are many possible study designs and outcome measures. Medical device research is confounded by the inability to blind the surgeon and the varied surgical technique. Registry data may give the answer in the long term but is likely to be confounded by experienced surgeons using the robot and fit patients selecting the robot.

Is the best outcome measure 3D CT measured implant position of robotic vs human ?

Thanks for the answers...

I did orthopedic surgery on my mouse yesterday and for surgical prophylaxis, I had 10 mg of intraperitoneal cefazolin injection 30min before surgery, then once every day for 5 days 10mg of cefazolin will be injected intraperitoneally, today when I checked my mouse, I saw sth around the patella that swelled outward, I want to know if it's ok and it's sth normal like inflammation or its sth serious like infection or abscess, and what should I do with that, if it's the inflammation should I use NSAIDs or if it's infection, should I change or add another antibiotics?

In today's era of orthopaedics, PSI helps in performing the replacement surgery more accurately with reproducible results. The literature supports the usage of PSI with numerous benefits.

Market has numerous options of PSI - few being MRI based, while others CT based. What is your take on this technology and which one do you prefer, if any?

In your previous discussions corrosion is mentioned as one reason of failures. Is it possible to detect corrosion or microfractures before mechanical failure of implants

This questionnaire was developed in 2001 by Kirsi Johannson and used again in 2016

Eloranta, S., Katajisto, J. and Leino-Kilpi, H., 2016. Orthopaedic patient education practice. International journal of orthopaedic and trauma nursing, 21, pp.39-48.

I have emailed the researchers in Finland but I have had no reply

I am in need of your expertise. What does your experience say?

The fracture is fixated with two metal plates and additional screws.

Four weeks post surgery there is still pain (on a scale from 1 to 10 = 7 to 8) in the region of the metal plates and swelling, total numbness in the antebrachium region and sporadic moments of control over the hand. Is this normal?

Is it possible to reach a total recovery? If not, what factors play a role in this?

What does your experience say in regards of removal of metal plates and screws, does this occur in most cases?

If anyone can refer to scientific papers on the matter I would be so grateful.

This is of personal interest. Feel free to answer here or contact me in my inbox.

Thank you so much for your time.

Kind Regards Sabina

Tibial fractures are the most common long bone fractures.The aim of treatment for tibial shaft fractures is function with lower complication rates. Several methods have been used for treatment of this fracture, including compression plating, reamed or unreamed intramedullary nailing and external fixation. Among them, intramedullary nail fixation has been shown to be an effective method for treating both open and closed tibial fractures . However, the choice between two alternative intramedullary nailing approaches, reamed or unreamed, is an ongoing controversy. Reamed intramedullary nailing has the advantage of providing optimal biomechanical stability; however, reaming of the medullary canal may also lead to endosteal blood flow damage, bone necrosis, compartment syndrome and infection . In theory, unreamed intramedullary nailing does not have the above-mentioned problems associated with reaming, but the mechanical stability may limit its application. Both of them have strong rationales; which is better?

The tibia is the most commonly broken major bone in the leg. Displaced distal tibia shaft fractures are effectively treated with standard plates or intramedullary nails. which one is more preferable?

Intramedullary nailing has revolutionized the treatment of fractures. It is important to be aware of the biological and mechanical effects of reaming and nailing on bone. Intramedullary devices commonly are termed rods or nails.

I am trying to start a research basing on free published online dataset. My field of research is Orthopaedics. Thank you for any help!

In today's era of sub specialisation in all surgical Fields specially orthopaedics, hands on surgical training in specialty of choice is a must. Considering the steep learning curve for most technically demanding surgeries, are cadaveric courses helpful for the young trainee ?

Some argue that it's the way forward to hone one's surgical skills while others are of the opinion that it's more of a commercialised driven industry activity.

Do such courses equip a young surgeon enough to operate independently on a real patient ?

With increasing dependency on technology in pre op planning and execution of orthopaedic surgeries, how much importance would robotics hold in the future of orthopaedics? Can the skills, experience and judgement of a seasoned senior orthopaedician be replaced by an automated machine programmed to follow commands? What are the risks and would it increase or decrease the surgical complication rate?

Is any research points toward female prediction with suggestive pathogenesis for the same.

The knowledge of SRD, or Complex Regional Pain Syndrome, is improving over the years, however, evidence-based management of this condition, as well as I know, seems to be lacking in the physiotherapy practice.

Some orthopedic screws are hollow. In some orthopedic surgeries, such screws are used, for example Herbert and

Cannold Why are these screws and their advantages over other screws?

Arthroscopic Partial Meniscectomy (APM) is one of the most popular orthopaedic procedures, but recent publications stated that non-operative treatments have similar results to arthroscopic surgery.

The Meniscus Consensus Project in which more than 80 physicians from 21 european countries have been involved was set up to try to standardize an uniform the treatment algorithm of degenerative meniscus lesions (DML).

Skeletal trauma leads to pain and discomforting positioning often with cumbersome braces/splints/plaster etc. How it affects sleep quality. That might also be contributing to various I'll effects in future.

Dear collegues 

In our practices we often see patients with neurological complaints. At those moments it is important to test the neurological system as good as possible. And we do so by using the techniques we were taught. When it comes to neurological tests in the upper limb we all know the tests of which Wilhelm Heinrich Erb was the founder. They state that when you test nervus ulnaris, nervus radialis and nervus medianus, the patient is in a supine position and the therapist induces the respective movements to create a maximal tension on the nerve. Now I am wondering: ‘Why is it in a supine position and not in a sitting position?’ Is there a specific reason why the test is developed and taught like this? Because personally I think it is possible to test in a sitting position. Is there any known research on this topic? Or does anyone of you have advice in this area? Are there other approaches, or only variations of the technique above?

Dutton, M. (2012). Dutton's Orthopaedic Examination Evaluation and Intervention. 3rd ed. McGraw-Hill Medical, pp.415-417.

Thanks in advance!

This is the conventional view (from MedlinePlus):

Some Risk Factors, but no other causes were listed, only germs. However, there is an alternative theory that deserves critical scrutiny, especially with the present antibiotic crisis, namely:

The prime cause is a failure to heal any of the usual fluid leaks that occur with surgery. The prime example of this is in the middle ear where fistulas through bone are hard to seal, resulting in persistent attempts to do so, leading to cholesteatomas. In orthopedic surgery, the most likely causes of persistent fistulae are bone fragments in the wrong place. Germs will only be a secondary problem if pools of fluid form instead of draining away, or if these occur in parts of the body outside the influence of the immune system,

In leg amputation the remained bone is rasped to make the edges smoother to avoid tissue injuries. but still there is an unusual structure underneath the skin. 

Why don’t we use an implantable structure to avoid abnormal structure like sharp edges and damp the undue pressure and shocks underneath bones, the same way heel fat pad*(HFP) protects the underlying structures in the heel?

From my point of view, using such implants might also ease the use of prosthetic legs and decrease the possible pain in leg- prosthetic interfaces.

Are there any specific reasons not to use such implants during the leg amputation?

*The heel fat pad (HFP) is a highly specialized adipose-based structure that protects the rear foot and the lower extremities from the stress generated during the heel-strike and the initial support phase of locomotion. HFP cushioning efficiency is the result of its structure, shape and thickness.

since the drill are made of plastic,it is possible for them to be completely sterilized? and they are packed in bags that are also plastic.

Dear Experts,

Am aware, 400 series of steel possess high strength, high wear and acceptable corrosion resistance. Also, it has been extensively used as Cutting tools for Medical surgeries but why not as an Implant (orthopaedic or stents).

I looked for papers which relates the Bio-response of the cell or platelet adhesion over Martensitic steel ( ex. 420 or 440 ) but i couldn't see any published work explaining the same.

It would be great if someone could help me to understand better or to suggest some more research articles ?

Thank you in advance.

I wonder how much of an effect does ankle biomechanics have on the knee.

Hello I am orthopaedic surgeon interested on spinal cord injury cases and studies! I was just wondering if  we can be involved in this study 

Please, what can you say about the precision of 3D-printed patient-specific orthopedic surgical guides?

How is its precision impacted during these processes:

- Imaging of the bone model

- Preoperative planning with the imaging

- Manufacturing of the guides

- During surgical operation

- Other processes

Thank you. 

65 yo patient, previously healthy.

Medial pain since 1 month ago with no trauma history. 

Physical examination: range of movement complete, no effusion, no meniscal signs, no instability, pain after palpatio of anterior part of medial condyle, slight limping.

MRI with a small cartilage depression, bone marrow edema in medial condyle.

----

Do you have experience with this cases? What treatment would you recommend? 

What is right ? To continue with pharmaceutical prophylaxis for fearing DVT or stop (reduce) it to avoid wound complications ?

Some hospital care standards require pharmacologic DVT prophylaxis for orthopedic operations (even minor surgeries) in pediatric patients. Is it necessary  indeed or this a hypermeasure taken to insure against eventual litigation problems ? 

56yo pt needs a unilateral hip replacement due to Osteoarthritis. No significant Past medical history. Pt is active and would like to continue activities such as basketball, snow and waterskiing. What type of replacement will allow hip to continue such activities for as long as possible, with as few revisions as possible. 

Treatment of osteoarthritis hip is mainly surgical.Attempts to look at treatment options and traditional medication has not been well cited or published.

Do outline treatment options seeked by your patients in dealing with hip osteoarthritic pain and its success rate

We would like to get a way to predict the need for glenoid bone-grafting in a reverse shoulder replacement planning

I have limited experience in nonunion treatment by autogenous bone marrow aspirates (ABMA)

I published 2009 an article on(tretment of  infected nonunion by autogenous Bone marrow aspirates in Yemen) in the egyptian journal of Orthopedic surgery.

there is a research work on bone marrow aspirates for treatment of bone defect.

bone marrow injection for treatment of aneurysmal bone cyst published in 2016.

Plano-valgus foot deformity, children, teenage, adults

Gives h/o bilateral K-nailing for femoral shaft #s in 1988 (asymptomatic now) and Right patellectomy for comminuted patellar # subsequently in 1997. 

I wonder how many of you encountered a discoid meniscus during knee alloplasty? Was it injured, degenerated or connected with greater/lower rate of degeneration of the condyles facing it?

Tissue valve has a tendency to degenerate early but can be dilated or a valve in valve replacement may be tried by intervention, mechanical valves are durable but needs lifelong anticoagulant therapy with its inherent complications. So, a controversy remains in making a choice.

On the Czech Republic there are realised about 13500 surgeires with THA, there are in Central Health Statistic to find about 32 types of typical product set THA from cca 28 various producers ....but there are no statistic about median Patient durabilities implanting in years, there are no evidence about risks by "easy safety implanting with minimum preoperational complications - technical, postoperational infects, anesthesy complication, Crashes of sets by implanting, luxation of implanting in durace 5 month since Hall surgery, there sre no computer testing of efficiency locomotion ability of patients in timing - 1, 3 , 6, 12, 24 month after usrgeries"...ther are no advice to buy the best types of sets THA for Hospital in respects to realtion Costs/durability of perfect patient functional years, able to reoperability, etc". There are no summary evidences about State views, about local views for safety implantation in identified Clinics with yearly implanting about 850 cases of prime iámplanting THA....there are no advice to patient agreement with surgery THA - as well informed about patients risks....there ar no internal software controlling "Non of Hall surgeries THA could be legal beginning - without Clinic preliminary Plan of individual surgery"...there are absency to preference the computer supervised processing of implanting set THA by the well educated firm Videorecording with describeing the most important describeing mandatory activites of Orthopaeds, Radiologists ...by the Technician Requirements of Laws and with respecitng the firm implanting instruments, Firm implanting Measurements, Firm processing to respects the firm assembling technical and functional accuracy and ability......There are no "bands of acceptable tolerances of medical processing activites" with guaraces of Technical Quality, sequential processing...excluded absency or false partial Results step by steps...Immediately with immediastely to solve medical mistakes in time with substitutional supervising and certificated reoperational processing....substitutional controlling rescued medical processing, etc. There are most patients with stroke or Heart infarct in surgery hall or in the one week after surgery set THA, etc. The Orthopaeds - which are engaged 25 years on this fields of useres medica Tasks have no identity views on Patients risk with such standard operation....they habe no similar routine to carefully implanting set THA as it is standard by finished Clinics testing of New Medical Devices with respects Technicians so as Medical Aspects with rational balancies by repeated Medical strategic decision making...there are interrupting Interface between Research and Developement on the One side - and with User praxis in Hospital Clinis in daily medical workfllow on the Second side - despite the Implanting Technician Laws are the same....but adequated controlling supervised Technician similar system - NO! I saw the thousands of Statistic Analyses - which all prefered the Physicians, Ecopnomics aspects strongly - and undertaken the respensibilities to Patients risks and Technician Requirements Laws systematically!  

What is probable mechanism of such medial malleolar # and the line of management of this 78M.

This means:

- are there generalized surgical procedure specifications (e. g. common steps of a gal bladder resection or knee endoprosthetic - independently of those routines high variety level)

- are there furthermore general terms for the single steps or particular sequences (e.g. in general a total knee replacement is divided into certain steps like (1) incisioin (2) preparation of tibia (3) prep of femur (4) trial bearing (5) original implant (6) closure of  wound/suture)

40 y.o. female with breast cancer, known metastases in ribs, spine, pelvis and right femur suffered pathological pertrohanteric fracture without severe trauma. She is in generally good condition, obese, treated for breast cancer for 1,5 mths (hormonal treatment), hip pain for about 6mths. As we see in the x-ray there is also a methastasis in the middle of the femur shaft, no visible methastases below this one as well as clear femoral head and acetabulum (based on CT). Would you prefer IM-nailing with/without cement use or hip prosthesis? Any other ideas?

I have made a mini-review about CMI and I want to interact with someone who have knowledge in this area. Be free to contact me; )

Needed an article which describes ACR criteria in detail?

Literature suggest that capsulorrhaphy will take care of it but I have normally seen otherwise in few cases. What may be the evidence for going for bony surgery at this age?

Whats your take on this modality of fixation? Is it rationale or just a fad?

What's the name of distal phalanx pseudarthrosis, due to interposition of ungueal matrix?

Please send me a publication as an evidence for it too.

A few books say that it is 30-35 degree, whereas others say its around 15-20 degree.

When should the weight bearing be allowed in these cases with uncemented arthroplasty?

 Patient of 64 Year old, with Olecranon fracture, Elbow dislocation, and radial head fracture cephalad displaced about 2 cm. 

An orthopaedic expert stated in his report  that as regards to an inguinal hernia,  spinal belts are often used as part treatment of hernias. Would any surgeons care to comment on this?

It is mentioned in literature that using patient-specific instruments 3D-printed patient-specific orthopedic surgical guides (e.g MySpine by Medacta and OtisMed by OtisKneeTM) for surgery is expensive. High CT imaging cost is a factor. 

Please, what other factors drive the cost of these surgical instruments?

Thank you.

We have been practicing the Local Injection of Gentamicin for Prophylaxis Against Infection in Open Fractures and Intravenous Cephalosporins for prophylaxis of Surgical wound infection.

But, Does anyone has the experience/ evidence of using Local injection of Gentamicin for prophylaxis of Surgical wound infection???

I need to know what is the taper(conical) angle in pedicle screw of vertebra.

What is the best treatment for the medial meniscus posterior root tear?

To my knowledge, there are several surgical options; pull-out suture, all-inside suture with meniscus fixator (e.g.FasT-Fix) and debridement only.

The pull-out suture technique seems to be the best biomechanical stability. However, difficulty, iatrogenic cartilage injury and relatively long operation time of this procedure make me to hesitate to choose this technique.

I prefer to treat the medial meniscus posterior root tear using meniscus fixator only. One suture in the posterior cruciate ligament and posterior capsule, another suture in the meniscus root. This repair technique does not provide sufficient strength and anatomic reduction of the medial meniscus. Furthermore, pain in the flexed knee after this procedure is frequently found.

If there is varus alignment with the medial meniscus posterior root tear, I do only debride the degenerative portion of the medial meniscus with concomitant high tibial osteotomy and do not repair it. Spontaneous healing of the medial meniscus posterior root lesion was reported in several studies.

I would like to know what the best surgical option for the medial meniscus posterior root tear is. Especially in older patient without deformed knee and osteoarthritis.

Sometimes, It is difficult to differentiate between postoperative hematoma and imminent deep infection the first postoperative days after THA. Early debridement is reported to be very effective if it is done after 4-7 days of wound drainage. We need a biomarker to make the exact diagnosis and to act adequately.

Hi,

Is there anyone involved in stem cell application and research in Pediatric Orthopaedics?

nonunion of fractures, simple bone cyst (SBC), and osteonecrosis, pediatric osteoarticular disorders etc..