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Yu Ren Department of Pharmacy, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China

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Hui Yu Department of Hematology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
Department of Hematology, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou, Zhejiang, China

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Zhangfu Wang Department of Orthopedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China

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Wenjun Pan Department of Orthopedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China

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Lin Chen Department of Orthopedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China

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Hua Luo Department of Orthopedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China

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Purpose

  • For many decades, patients recovering from wound closure have been instructed not to bathe. Although studies have shown that earlier postoperative bathing does not increase the risk of wound infection, it remains rare in practice for patients to be allowed earlier postoperative bathing. We performed this meta-analysis to determine how earlier bathing affected rates of wound infection, other complications, and patient satisfaction.

Methods

  • This systematic review conforms to PRISMA guidelines. The PubMed, EMBASE, Medline, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from their inception dates to December 31, 2022. We estimated pooled values for the efficacy of trial of earlier bathing versus delayed bathing using the odds ratio and their associated 95% CI, and we used the I 2 statistic to assess heterogeneity between studies contributing to these estimates.

Results

  • Of the 1813 articles identified by our search, 11 randomized controlled trials including 2964 patients were eligible for inclusion. The incidence of wound infection did not differ significantly between the earlier bathing and delayed bathing groups, nor did rates of other wound complications such as redness and swelling, or wound dehiscence. However, the incidence of hematoma in the delayed bathing group was higher than in the earlier bathing group. Reported patient satisfaction was significantly higher in the earlier bathing group.

Conclusion

  • The medical community, health authorities, and government should create and disseminate clinical practice guidelines to guide patients to evidence-based beneficial treatment.

Open access
Xiangji Dang Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, P.R. China
Department of Pharmaceutical, Lanzhou University Second Hospital, Lanzhou, Gansu province, P.R. China

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Mei Liu The First Clinical Medical School, Gansu University of Chinese Medicine, Gansu, P.R. China

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Qiang Yang Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, Gansu province, P.R. China

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Jin Jiang Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu province, P.R. China

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Yan Liu Gansu High Throughput Screening and Creation Center for Health Products, School of Pharmacy, Lanzhou University, Lanzhou, P.R. China

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Hui Sun Cuiying Biomedical Research Center, Lanzhou University Second Hospital, Lanzhou, Gansu province, P.R. China

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Jinhui Tian Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, P.R. China

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Purpose

  • This study sought to determine if the use of tranexamic acid (TXA) in preexisting thromboembolic risk patients undergoing total joint arthroplasty (TJA) was linked to an increased risk of death or postoperative complications.

Methods

  • We conducted a comprehensive search for studies up to May 2023 in PubMed, Web of Science, EMBASE, and the Cochrane Library. We included randomized clinical trials, cohort studies, and case–control studies examining the use of TXA during TJA surgeries on high-risk patients. The Cochrane Risk of Bias instrument was used to gauge the excellence of RCTs, while the MINORS index was implemented to evaluate cohort studies. We used mean difference (MD) and relative risk (RR) as effect size indices for continuous and binary data, respectively, along with 95% CIs.

Results

  • Our comprehensive study, incorporating data from 11 diverse studies involving 812 993 patients, conducted a meta-analysis demonstrating significant positive outcomes associated with TXA administration. The findings revealed substantial reductions in critical parameters, including overall blood loss (MD = −237.33; 95% CI (−425.44, −49.23)), transfusion rates (RR = 0.45; 95% CI (0.34, 0.60)), and 90-day unplanned readmission rates (RR = 0.86; 95% CI (0.76, 0.97)). Moreover, TXA administration exhibited a protective effect against adverse events, showing decreased risks of pulmonary embolism (RR = 0.73; 95% CI (0.61, 0.87)), myocardial infarction (RR = 0.47; 95% CI (0.40–0.56)), and stroke (RR = 0.73; 95% CI (0.59–0.90)). Importantly, no increased risk was observed for mortality (RR = 0.53; 95% CI (0.24, 1.13)), deep vein thrombosis (RR = 0.69; 95% CI (0.44, 1.09)), or any of the evaluated complications associated with TXA use.

Conclusion

  • The results of this study indicate that the use of TXA in TJA patients with preexisting thromboembolic risk does not exacerbate complications, including reducing mortality, deep vein thrombosis, and pulmonary embolism. Existing evidence strongly supports the potential benefits of TXA in TJA patients with thromboembolic risk, including lowering blood loss, transfusion, and readmission rates.

Open access
Heiner Fangerau Department for the History, Philosophy and Ethics of Medicine, Medical Faculty, Heinrich-Heine University Duesseldorf Centre Health & Society, Moorenstraße 5, Düsseldorf, Germany

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  • The use of artificial intelligence (AI) in medicine and surgery is currently predicted to be very promising.

  • However, AI has the potential to change the doctor’s role and the doctor–patient relationship. It has the potential to support people’s desires for health, along with the potential to nudge or push people to behave in a certain way.

  • To understand these potentials, we must see AI in the light of social developments that have brought about changes in how medicine’s role, in a given society, is understood.

  • The trends of ‘privatisation of medicine’ and ‘public-healthisation of the private’ are proposed as a contextual backdrop to explain why AI raises ethical concerns different from those previously caused by new medical technologies, and which therefore need to be addressed specifically for AI.

Open access
Tristan Ferry Service de Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
Université Claude Bernard Lyon 1, Villeurbanne, France
Centre de Références des IOA Complexes de Lyon, CRIOAc Lyon, Lyon, France
StaPath team, Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
Education and Clinical Officer of the ESCMID Study Group for Non-traditional Antibacterial Therapy (ESGNTA)

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Jolien Onsea Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
Department of Development and Regeneration, KU Leuven, Oude Markt 13, Leuven, Belgium

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Tiphaine Roussel-Gaillard Institut des Agents Infectieux, Centre de Biologie et de Pathologie du Nord, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France

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Cécile Batailler Service de Chirurgie Orthopédique et de Médecine du Sport, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France

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Thomas Fintan Moriarty AO Research Institute Davos, Clavadelerstrasse 8, Davos Platz, Switzerland

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Willem-Jan Metsemakers Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
Department of Development and Regeneration, KU Leuven, Oude Markt 13, Leuven, Belgium

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  • The treatment of musculoskeletal infections (MSIs), including periprosthetic joint infection (PJI) and fracture-related infection (FRI), is often complicated by biofilm-related challenges necessitating multiple revision surgeries and incurring substantial costs.

  • The emergence of antimicrobial resistance (AMR) adds to the complexity of the problem, leading to increased morbidity and healthcare expenses.

  • There is an urgent need for novel antibacterial strategies, with the World Health Organization endorsing non-traditional approaches like bacteriophage (phage) therapy.

  • Phage therapy, involving the targeted application of lytic potent phages, shows promise in the treatment of MSIs.

  • Although historical clinical trials and recent case studies present significant milestones in the evolution of phage therapy over the past century, challenges persist, including variability in study designs, administration protocols and phage selection. Efforts to enhance treatment efficacy consist of personalized phage therapy and combination with antibiotics.

  • Future perspectives entail addressing regulatory barriers, standardizing treatment protocols, and conducting high-quality clinical trials to establish phage therapy’s efficacy for the treatment of MSIs.

  • Initiatives like the PHAGEFORCE study and the PHAGEinLYON Clinic programme aim to streamline phage therapy, facilitating personalized treatment approaches and systematic data collection to advance its clinical utility in these challenging infections.

Open access
Enrique Gómez-Barrena Department of Orthopaedic Surgery and Traumatology, Hospital La Paz-IdiPaz, Universidad Autónoma de Madrid, Madrid, Spain

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Christian Ehrnthaller Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Germany

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  • Long bone non-unions represent a serious clinical and socioeconomical problem due to the prolonged episodes, frequent sequelae, and variable treatment effectiveness.

  • Bone grafts, classically involving the autologous iliac crest graft as the ‘gold standard’ bone graft, enhance bone regeneration and fracture healing incorporating osteoconductive and/or osteoinductive/osteogenic capacity to the non-union under treatment.

  • Structural alternatives to autologous bone grafts include allografts and bone substitutes, expanding the available stock but loosing biological properties associated with cells in the graft.

  • Biological alternatives to autologous bone grafts include bone marrow concentration from iliac crest aspiration, bone marrow aspiration from reaming of the diaphyseal medullary canal in the long bones, and isolated, expanded mesenchymal stem cells under investigation.

  • When the combination with natural and synthetic bone substitutes allows for larger volumes of structural grafts, the enhancement of the biological regenerative properties through the incorporation of cells and their secretoma permits to foresee new bone grafting solutions and techniques.

Open access
Guillermo Droppelmann Research Center on Medicine, Exercise, Sport and Health, MEDS Clinic, Santiago, RM, Chile
Health Sciences PhD Program, Universidad Católica de Murcia UCAM, Murcia, Spain
Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA

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Constanza Rodríguez Facultad de Medicina, Universidad Finis Terrae, Santiago, RM, Chile

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Carlos Jorquera Facultad de Ciencias, Escuela de Nutrición y Dietética, Universidad Mayor, Santiago, RM, Chile

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Felipe Feijoo School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile

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Purpose

  • The integration of artificial intelligence (AI) in radiology has revolutionized diagnostics, optimizing precision and decision-making. Specifically in musculoskeletal imaging, AI tools can improve accuracy for upper extremity pathologies. This study aimed to assess the diagnostic performance of AI models in detecting musculoskeletal pathologies of the upper extremity using different imaging modalities.

Methods

  • A meta-analysis was conducted, involving searches on MEDLINE/PubMed, SCOPUS, Cochrane Library, Lilacs, and SciELO. The quality of the studies was assessed using the QUADAS-2 tool. Diagnostic accuracy measures including sensitivity, specificity, diagnostic odds ratio (DOR), positive and negative likelihood ratios (PLR, NLR), area under the curve (AUC), and summary receiver operating characteristic were pooled using a random-effects model. Heterogeneity and subgroup analyses were also included. All statistical analyses and plots were performed using the R software package.

Results

  • Thirteen models from ten articles were analyzed. The sensitivity and specificity of the AI models to detect musculoskeletal conditions in the upper extremity were 0.926 (95% CI: 0.900; 0.945) and 0.908 (95% CI: 0.810; 0.958). The PLR, NLR, lnDOR, and the AUC estimates were found to be 19.18 (95% CI: 8.90; 29.34), 0.11 (95% CI: 0.18; 0.46), 4.62 (95% CI: 4.02; 5.22) with a (P < 0.001), and 95%, respectively.

Conclusion

  • The AI models exhibited strong univariate and bivariate performance in detecting both positive and negative cases within the analyzed dataset of musculoskeletal pathologies in the upper extremity.

Open access
Andrew Kailin Zhou Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
West Hertfordshire Hospitals NHS Trust, London, United Kingdom

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Eric Jou Kellogg College, University of Oxford, Oxford, United Kingdom

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Victor Lu Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, Norfolk, United Kingdom

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James Zhang Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, Essex, United Kingdom

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Shirom Chabra Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom

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Matija Krkovic Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom

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  • Compared to other techniques, poller screws with intramedullary nailing are technically simple, practical, and reproducible for the fixation of metaphyseal fractures.

  • In addition, poller screws do not require special instruments or hardware and are minimally invasive. This review takes a historical perspective to evaluate poller screws holistically.

  • A non-systematic search on PubMed was performed using ‘Poller screw’ or ‘Blocking screw’ to find early use of poller blocking screws. Relevant references from these primary studies were then followed up.

  • In 1999, Krettek et al. first coined the term poller screws after the small metal bollards that block and direct traffic.

  • Poller screws were introduced as an adjunct to aid the union of metaphyseal long bone fractures during intramedullary nailing.

  • However, as more evidence was published, the true effectiveness of poller screws was not appreciated, leading to split opinions.

  • Through our research, we have built upon our understanding of poller screws, and we present a novel classification of poller screws over the years while exploring our novel technique and what we believe to be the fourth generation of poller screws.

  • Currently, there is a paucity of research focussing on poller screws.

  • However, studying the original evidence regarding poller screws through the most recent articles has demonstrated a confusion of research in this field. Therefore, we suggest a more organised approach to classify the use of poller screws.

Open access
Ahmed Halloum Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej, Aalborg, Denmark

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Søren Kold Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej, Aalborg, Denmark

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Jan Duedal Rölfing Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard, Aarhus, Denmark

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Ahmed A Abood Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej, Aalborg, Denmark
Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard, Aarhus, Denmark

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Ole Rahbek Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej, Aalborg, Denmark

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Purpose

  • The objective of this scoping review was to describe the extent and type of evidence of using guided growth to correct rotational deformities of long bones in children.

Methods

  • This scoping review was conducted in accordance with the JBI methodology for scoping reviews. All published and unpublished studies investigating surgical methods using guided growth to perform gradual rotation of long bones were included.

Results

  • Fourteen studies were included: one review, three clinical studies, and ten preclinical studies. In the three clinical studies, three different surgical methods were used on 21 children. Some degree of rotation was achieved in all but two children. Adverse effects reported included limb length discrepancy (LLD), knee stiffness and rebound of rotation after removal of tethers. Of the ten preclinical studies, two were ex vivo and eight were in vivo. Rotation was achieved in all preclinical studies. Adverse effects reported included implant extrusions, LLD, articular deformities, joint stiffness and rebound of rotation after removal of tethers. Two of the studies reported on histological changes.

Conclusions

  • All studies conclude that guided growth is a potential treatment for rotational deformities of long bones. There is great variation in animal models and surgical methods used and in reported adverse effects. More research is needed to shed light on the best surgical guided growth method, its effectiveness as well as the involved risks and complications. Based on current evidence the procedure is still to be considered experimental.

Level of evidence

  • 4

Open access
Yvet Mooiweer Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

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Lina Roling School of Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany

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Margaret Vugrin Preston Smith Library, Texas Tech University Health Sciences Center, Lobbock, Texas, USA

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Lena Ansmann Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
Chair of Medical Sociology, Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR) Faculty of Medicine, University of Cologne, Oldenburg, Germany

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Martin Stevens Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

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Gesine H Seeber Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
University Hospital of Orthopedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany

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Purpose

  • The association between preoperative expectations and treatment outcomes in total hip arthroplasty (THA) or total knee arthroplasty (TKA) is still unclear. Therefore the aim is to examine the association between preoperative outcome expectations, process expectations, and self-efficacy, and the postoperative outcomes overall outcome, pain, function, stiffness, satisfaction, and quality of life following THA/TKA.

Methods

  • A systematic review with narrative synthesis was conducted. PubMed, EMBASE, PsycINFO, CINAHL and Cochrane Library were searched from inception to October 17, 2022. Included were prospective longitudinal cohort studies published in English, German, or Dutch, with an adult population undergoing THA/TKA, and including at least one measure of preoperative expectations and the postoperative outcomes mentioned earlier. Two independent reviewers screened the retrieved articles for eligibility, a third solved disagreements. Risk of bias (RoB) was assessed using the QUIPS tool.

Results

  • Of the 50 included studies, 38 had high RoB and 12 moderate RoB. Unadjusted results suggest a positive association between preoperative outcome expectations and overall outcome in the medium and long term, and between self-efficacy and change in ‘overall outcome’ in the long term. Adjusted results suggest positive associations between outcome expectations and function and between self-efficacy and overall outcome in the medium term, and for outcome expectations with pain and change in pain, respectively, and self-efficacy and stiffness in the long term.

Conclusions

  • Preoperative expectations show a possible positive association with specific outcome measures, such as pain or function. For future research, it is advised to link matching specific expectations with specific outcomes.

Open access
Pierre Hoffmeyer University Hospitals of Geneva, Switzerland

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Open access