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Andrea Cina Spine Center, Schulthess Clinic, Zurich, Switzerland
Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland

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Fabio Galbusera Spine Center, Schulthess Clinic, Zurich, Switzerland

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  • Machine learning (ML), a subset of artificial intelligence, is crucial for spine care and research due to its ability to improve treatment selection and outcomes, leveraging the vast amounts of data generated in health care for more accurate diagnoses and decision support.

  • ML's potential in spine care is particularly notable in radiological image analysis, including the localization and labeling of anatomical structures, detection and classification of radiological findings, and prediction of clinical outcomes, thereby paving the way for personalized medicine.

  • The manuscript discusses ML's application in spine care, detailing supervised and unsupervised learning, regression, classification, and clustering, and highlights the importance of both internal and external validation in assessing ML model performance.

  • Several ML algorithms such as linear models, support vector machines, decision trees, neural networks, and deep convolutional neural networks, can be used in the spine domain to analyze diverse data types (visual, tabular, omics, and multimodal).

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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.

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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.

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Alp Paksoy Charité University Hospital, Center for Musculoskeletal Surgery, Augustenburger Platz 1, Berlin, Germany

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Doruk Akgün Charité University Hospital, Center for Musculoskeletal Surgery, Augustenburger Platz 1, Berlin, Germany

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Sebastian Lappen Schulthess Klinik, Lengghalde 2, Zurich, Switzerland

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Philipp Moroder Schulthess Klinik, Lengghalde 2, Zurich, Switzerland

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  • Posterior shoulder instability (PSI) is less common than anterior shoulder instability, accounting for 2–12% of total shoulder instability cases.

  • However, a much higher frequency of PSI has been recently indicated, suggesting that PSI accounts for up to 24% of all young and active patients who are surgically treated for shoulder instability.

  • This differentiation might be explained due to the frequent misinterpretation of vague symptoms, as PSI does not necessarily present as a recurrent posterior instability event, but often also as mere shoulder pain during exertion, limited range of motion, or even as yet asymptomatic concomitant finding.

  • In order to optimize current treatment, it is crucial to identify the various clinical presentations and often unspecific symptoms of PSI, ascertain the causal instability mechanism, and accurately diagnose the subgroup of PSI.

  • This review should guide the reader to correctly identify PSI, providing diagnostic criteria and treatment strategies.

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Marta Salom Department of Pediatric Orthopedic, La Fe University and Polytechnique Hospital, Valencia, Spain

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Inês Balacó Department of Pediatric Orthopedic, Hospital Pediátrico de Coimbra, Unidade Local de Saúde de Coimbra, Portugal

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  • Bone tumours are frequent in children but most of them are benign. Moreover, the incidence and type of tumours differ from those of adults.

  • As an orthopaedic surgeon, we will likely encounter a bone lesion in a child and we must be able to distinguish if it is a benign lesion or has malignant characteristics and it is necessary to refer it to a centre specialized in tumours.

  • We will discuss the key points we would have to ask in the medical history, look at the physical examination and the radiological characteristics that will allow us to distinguish between a benign and a malignant bone lesion in a child.

  • When there are doubts about the malignancy of a bone lesion or if the diagnosis is not clear, a biopsy should be performed following certain rules in a specialized centre.

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Francesco Pirato Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy

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Federica Rosso Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy

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Federico Dettoni Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy

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Davide Edoardo Bonasia Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy

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Matteo Bruzzone Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy

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Roberto Rossi Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy

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  • Knee stiffness is a widely known and worrying condition in several postoperative knees. Less is known about native stiff knee. The aim of this manuscript is to summarize the available literature on native stiff knee epidemiology, classification and treatment.

  • In 1989 stiff knee was defined as a knee with less than 50° of total range of motion. If range of motion is <30°, it is defined as an ankylosed knee. Knee stiffness can be divided into three main types: flexion contractures, extension contractures, and combined contractures. Different risk factors have been associated to native stiff knee and grouped into modifiable or not modifiable. Furthermore, risk factors can be divided into patients’ related no patients’-related.

  • Different treatment modalities can be indicated to treat knee stiffness, including manipulation under anesthesia (MUA), arthroscopic and open surgical release. When stiffness is associated with articular disruption TKA represent an option. TKA in native stiff knee can be challenging for the surgeon. Implant’s choice and knee exposure are the first steps. In some cases, additional release and extensive can be considered. A stepwise approach and careful preoperative planning are mandatory to obtain long-term satisfactory outcomes.

  • Native stiff knee is a rare but invalidating condition. Different treatment modalities have been proposed as treatment. However, considering that it is frequently associated to sever arthritis, TKA can be an option in painful stiff knees. Nature of knee stiffness necessitates a customized approach to ensure successful management and achieve satisfying outcomes.

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Juan Ramón Cano Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, University of Málaga, Malaga, Spain

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José Manuel Bogallo Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, University of Málaga, Malaga, Spain

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Alicia Ramirez Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, University of Málaga, Malaga, Spain

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Enrique Guerado Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, University of Málaga, Malaga, Spain

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  • The diagnosis of a traumatic unstable pelvis in a stable patient is a temporary concept depending on when we see the patient, as all patients presenting with hemorrhagic shock have hemodynamic stability until they become unstable. As a rule, the more unstable the pelvic fracture is, the higher the risk of bleeding and hemodynamic instability it has. Therefore, in unstable pelvic fractures, hemodynamic stability should be a diagnosis by exclusion.

  • For bleeding detection in stable patients, an immediate one-stage contrast-enhanced CT scan is the appropriate diagnosis test; however, since CT scan radiation is always an issue, X-rays should be considered in those cases of hemodynamically stable patients in whom there is a reasonable suspicion that no unsafe bleeding is going on. Pelvic fracture classification is essential as usually there is an association between the injury mechanism, the fracture displacement, and the hemodynamic stability. Anteroposterior and, particularly, vertical traumatisms have much more proclivity to provoke major pelvic displacement and bleeding.

  • The use of a pelvic binder, as early as possible including pre-hospital management, should be standard in high-impact blunt trauma patients independently of the trauma mechanisms. External fixation is the preferred method of stabilization in case of open fractures, and, in closed ones, when the schedule for definite osteosynthesis prolongs because of the patient’s general condition. If possible, immediate percutaneous sacroiliac screw insertion for unstable pelvic fractures produce excellent results even in open fractures.

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Thorsten Gehrke Department of Orthopaedic Surgery, Helios ENDO-Klinik, Hamburg, Germany

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Mustafa Citak Department of Orthopaedic Surgery, Helios ENDO-Klinik, Hamburg, Germany

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Mustafa Akkaya Department of Orthopaedic Surgery, Helios ENDO-Klinik, Hamburg, Germany

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  • Acetabular revision arthroplasty, a demanding field of reconstructive hip surgery, calls for innovative strategies to deal with challenging bone defects and implant failure seen in revision cases.

  • Conventional implant solutions might fall short of adequately addressing severe bone loss and ensuring stable fixation, highlighting the necessity of customized strategies.

  • Personalized megaimplants, distinguished by their tailor-made design and large-scale construction, present a viable option to overcome these challenges.

  • The present article provides an elaborate analysis of custom-made megaimplants in acetabular revision arthroplasty, shedding light on the underlying principles, design complexities, manufacturing methods, applications in the clinical setting, and outcome assessment.

  • The aim of this review is to present a comprehensive insight into personalized megaimplants and their contribution to the advancement of orthopedic surgery.

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Andrea Pratobevera Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy

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Romain Seil Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d’Eich, Luxembourg, Luxembourg
Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science (LIROMS), Luxembourg, Luxembourg
Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d’Eich, Luxembourg, Luxembourg

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Jacques Menetrey Centre de Medecine du Sport et de l’Exercice - Swiss Olympic Medical Center, Hirslanden Clinique La Colline, Geneva, Switzerland
Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland

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  • This review explores the intricate relationship between knee osteotomy and frontal plane joint line orientation, emphasizing the dynamic nature of the joint line’s influence on knee forces and kinematics.

  • Consideration of coronal alignments, knee phenotypes, and associated angles (medial proximal tibial angle (MTPA), lateral distal femoral angle (LDFA), joint line convergence angle (JLCA)) becomes crucial in surgical planning to avoid joint line deformities.

  • The double-level osteotomy is to be considered a valid option, especially for severe deformities; however, the target patient cannot be selected solely based on high predicted postoperative joint line obliquity (JLO) and MPTA.

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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.

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