Archives of Bone and Joint Surgery
Volume:13 Issue: 1, Jan 2025

This piece aims to explore the applications, implications, and drawbacks of utilizing artificial intelligence in medical publications. In order to use AI, we must first understand the extent to which it may affect medical publications as a whole. While AI can be used to generate a wealth of information faster than we as humans can, that data may contain gaps, such as a lack of representation of different groups of people, as well as access to medical records left in said database. The different applications, implications, and drawbacks of artificial intelligence in medical publications, afford us the ability to adapt to such a science and cultivate it in a way that benefits both the general public and the medical world.

Bennett's fracture, the most common intra-articular fracture occurring at the base of the thumb, accounts for less than 1% of all hand fractures. It typically results from specific traumatic mechanisms, deforming forces, and ligamentous injuries. To compare the functional outcomes and sequelae in patients with Bennett's fracture treated surgically using: Open reduction and internal screw fixation, closed reduction and percutaneous fixation, arthroscopy-assisted reduction and screw fixation.

A systematic literature review was conducted to identify studies on Bennett's fracture dislocations in patients over 18 years of age without additional injuries. Searches were performed in PubMed, Scopus, Cochrane Central, Web of Science, Scielo, Lilacs, Oneme, and Epistemonikos databases, with language restrictions in English, French, Spanish, Portuguese, Italian, and German, and no date restrictions. Primary outcome variables included measures of functionality and secondary outcomes such as pain, stiffness, and osteoarthritis.

A total of 18 studies met the selection criteria, with most being retrospective (94.45%). Pain measures were reported in 77.78% of the studies, predominantly using the VAS (min=0 and max=2). All techniques seemed to achieve similar functional outcomes. The main difference was the pain registered at follow-up, mainly by patients treated with open reduction. Osteoarthritis appeared as a common consequence of these fractures, regardless of the treatment type -excluding arthroscopy-assisted reduction as there was not enough data.

The three techniques had similar functional outcomes. Closed reduction and percutaneous fixation appear to result in less pain; however, both closed reduction with percutaneous fixation and open reduction with internal screw fixation have similar rates of osteoarthritis at follow-up. Unfortunately, there is insufficient data to evaluate arthroscopy-assisted reduction with screw fixation, suggesting the need for rigorous follow-up in patients undergoing this surgical intervention. Level of evidence: III

Artificial Intelligence (AI) is rapidly transforming healthcare, particularly in orthopedics, by enhancing diagnostic accuracy, surgical planning, and personalized treatment. This review explores current applications of AI in orthopedics, focusing on its contributions to diagnostics and surgical procedures. Key methodologies such as artificial neural networks (ANNs), convolutional neural networks (CNNs), support vector machines (SVMs), and ensemble learning have significantly improved diagnostic precision and patient care. For instance, CNN-based models excel in tasks like fracture detection and osteoarthritis grading, achieving high sensitivity and specificity. In surgical contexts, AI enhances procedures through robotic assistance and optimized preoperative planning, aiding in prosthetic sizing and minimizing complications. Additionally, predictive analytics during postoperative care enable tailored rehabilitation programs that improve recovery times. Despite these advancements, challenges such as data standardization and algorithm transparency hinder widespread adoption. Addressing these issues is crucial for maximizing AI's potential in orthopedic practice. This review emphasizes the synergistic relationship between AI and clinical expertise, highlighting opportunities to enhance diagnostics and streamline surgical procedures, ultimately driving patient-centric care.        Level of evidence: V

The purpose of this study is to evaluate the outcomes of a polyaxial locking plate utilizing locking-cap fixation for treatment of patients with displaced olecranon fractures.
A retrospective review was performed for all consecutive patients at two institutions with displaced olecranon fractures treated with a polyaxial locking plate. Patients were required to have at least 1-year follow up. Clinical outcomes including the Disabilities of the Arm, Shoulder, and Hand (DASH) score, Single Assessment Numeric Evaluation (SANE), along with a Likert-scaled satisfaction survey ranging between 1-5 (1= very unsatisfied and 5= very satisfied) were collected.
The plate osteosynthesis was performed on 24 patients with displaced olecranon fractures. Functional outcome scores were collected on 19 (79.2%) patients. The mean age at the time of surgery was 57.9 years (range, 23 to 78) and mean clinical follow-up was 21.0 ± 6.6 months (range, 12-34 months). All patients achieved osseous union in an acceptable position. Four (16.7%) patients complained of plate related pain and 6 (25%) patients complained of postoperative stiffness. Complications were found in 3 (12.5 %) patients, which included two neuropathies and one hardware failure in which a patient presented following a fall with a broken screw. No patients required revision surgery nor removal of hardware. A total of 16 (84%) patients were somewhat to very satisfied. The mean SANE score was 87.8 ± 14.6 (range: 45-100) and the mean DASH score was 13.8 + 17.5 (range: 0-55.8). Seventeen (89%) patients rated their elbows as 75% or better on SANE assessment and 16 (84%) patients achieved DASH scores of less than 30.
Polyaxial plate fixation utilizing locking-cap technology resulted in excellent short-term functional outcomes in patients with displaced olecranon fractures. Further follow-up is needed to determine the long-term outcomes of locking-cap constructs for olecranon fractures.
        Level of evidence: IV

More than 20% of patients experience chronic lateral ligamentous instability of the ankle (CLLIOTA) following the appropriate management of an ankle sprain. The modified Broström-Gould (MBG) procedure has become the standard treatment for the anatomic repair of symptomatic CLLIOTA. ‪The present study aimed to evaluate the clinical and functional outcomes of the MBG technique ‪in patients with CLLIOTA and investigate factors affecting the outcome of surgery. This retrospective, single-group study included all patients with CLLIOTA who underwent surgery using the MBG technique in Shahid Kamyab Hospital, Mashhad, Iran, between July 2015 and August 2020. The American Orthopedic Foot and Ankle Score (AOFAS), Manchester-Oxford Foot Questionnaire (MOXFQ), and Pain Visual Analog Scale (VAS) were used to evaluate the outcome. The correlation between patient-related factors and each outcome measure was also analyzed. In total, 38 patients underwent the MBG procedure. The mean follow-up was 40.1 (18-67) months. Overall, 15 patients (39.47%) had a history of sports-related ankle sprains, and 15 (39.47%) had ankle osteochondral lesions. The AOFAS score improved significantly (51.23±13.49 to 91.92±12.077, P<0.001), while MOXFQ and VAS scores decreased significantly in the follow-up evaluation (50.28±9.33 to 27.5±13.35, P<0.001, and 6.2±1.47 to 2.18±1.86, P<0.001, respectively). No significant correlation was found between pre-operative ankle osteoarthritis, talus osteochondral lesion, duration of the follow-up, ankle sprain etiology (sports vs. non-sports), age, body mass index, gender, and the interval between the first sprain and surgery on the one hand, and post-operative outcomes, on the other hand. The more time passed after the surgery, the less painful the ankle of the patient was (P=0.038). No failure was observed among the patients. This study showed that the open MBG technique for CLLIOTA can improve clinical outcomes with no major complications following surgery in the Iranian population.         Level of evidence: III

The composition of department leadership, notably the Department Chair and Program Director, plays a pivotal role in “Match” decision making and further residency training. This study aims to examine the current landscape of subspecialties and other demographic characteristics of the Department Chairs and Program Directors of orthopaedic surgery residency programs across the United States. A list of Department Chairs and Program Directors of all 201 ACGME orthopaedic surgery residency programs was generated from the Orthopaedic Residency Information Network (ORIN) website. Demographic information, years of practice, research productivity (H-Index), and subspecialty for both Chairpersons and Program Directors were gathered. Information was available on 163/201 department chairs and 199/201 program directors. Among the 163 Department Chairs, Sports (24.5%), Adult Reconstruction (16.6%), and Trauma (13.5%) emerged as the most prevalent subspecialties, while Shoulder and Elbow (5.5%), Pediatrics (3.7%), and General Orthopedics (1.8%) were the least represented. Among the 199 Program Directors, Trauma (22.1%), Sports (17.1%), and Hand and Upper Extremity (14.1%) were the most common, while Shoulder and Elbow (6.0%), Foot and Ankle (5.5%), and General Orthopedics (1.0%) were the least represented. Chairpersons exhibited notably higher mean years of practice, mean H-index, and were more commonly male compared to Program Directors. However, in the multivariable regression model predicting leadership position, only years of practice and H-index were found to be significant predictors. Sports, trauma, joint reconstruction, and hand were the most common subspecialities among those in positions of leadership explained by their higher prevalence among American-board orthopedic surgeons. Furthermore, H-index and years of practice were both predictors of being a chairperson.        Level of evidence: III

The major emphasis of physical therapy in patient evaluation is the assessment of physical function, and the Patient-Specific Functional Scale (PSFS) is one of the most commonly used instruments for this purpose. Therefore, the present study aims to translate and cross-culturally adapt the PSFS into Persian and test its psychometric properties in patients with chronic low back pain (CLBP). The PSFS was translated from English to Persian and cross-culturally adapted in accordance with the study by Beaton et al.  Psychometric properties of 100 CLBP patients were assessed. Reliability (internal consistency and test-retest) was examined for 32 participants who completed the Persian version of the PSFS (PSFS-P) twice with one week interval. Construct validity was assessed against the Persian versions of the Oswestry Disability Index (ODI-P) and the Numerical Pain Rating Scale (NPRS-P). The PSFS-P showed excellent reliability (Cronbach’s alpha=0.88, intraclass correlation coefficient [ICC 3, 1] =0.95, 95% CI [0.87 to 0.98]). The construct validity analysis revealed a moderate negative correlation between PSFS-P and NPRS-P (r=-0.47) and a high negative correlation between PSFS-P and ODI-P (r=-0.61). The PSFS-P showed no floor and ceiling effects. The PSFS-P has adequate psychometric properties and is applicable in both clinical settings and research involving the Iranian population with CLBP.        Level of evidence: IV

The purpose of this in brief article was to determine the current role of intraarticular injections of hyaluronic acid (HA) and platelet-rich plasma (PRP) for the treatment of painful KOA. It has been reported that the average duration of effectiveness (pain relief) of one injection of extended-release HA is around one year. Kellgren-Lawrence grade (I-II versus III-IV), male gender, and older age are associated with a longer duration of effectiveness. Cartilage degeneration might be improved with a higher number of injections of HA. Intraarticular injections of HA alleviate pain, function, and diminish non-steroidal anti-inflammatory drugs (NSAIDs) consumption. In addition, several studies have indicated that the combination of HA and PRP is more effective than HA alone. Finally, other studies seemed to demonstrate that PRP was more effective than HA.        Level of evidence: III