Bone & Joint Open最新文献

{"title":"Machine learning in shoulder arthroplasty : a systematic review of predictive analytics applications.","authors":"Tim Schneller, Moritz Kraus, Jan Schätz, Philipp Moroder, Markus Scheibel, Asimina Lazaridou","doi":"10.1302/2633-1462.62.BJO-2024-0234.R1","DOIUrl":"10.1302/2633-1462.62.BJO-2024-0234.R1","url":null,"abstract":"<p><strong>Aims: </strong>Machine learning (ML) holds significant promise in optimizing various aspects of total shoulder arthroplasty (TSA), potentially improving patient outcomes and enhancing surgical decision-making. The aim of this systematic review was to identify ML algorithms and evaluate their effectiveness, including those for predicting clinical outcomes and those used in image analysis.</p><p><strong>Methods: </strong>We searched the PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases for studies applying ML algorithms in TSA. The analysis focused on dataset characteristics, relevant subspecialties, specific ML algorithms used, and their performance outcomes.</p><p><strong>Results: </strong>Following the final screening process, 25 articles satisfied the eligibility criteria for our review. Of these, 60% focused on tabular data while the remaining 40% analyzed image data. Among them, 16 studies were dedicated to developing new models and nine used transfer learning to leverage existing pretrained models. Additionally, three of these models underwent external validation to confirm their reliability and effectiveness.</p><p><strong>Conclusion: </strong>ML algorithms used in TSA demonstrated fair to good performance, as evidenced by the reported metrics. Integrating these models into daily clinical practice could revolutionize TSA, enhancing both surgical precision and patient outcome predictions. Despite their potential, the lack of transparency and generalizability in many current models poses a significant challenge, limiting their clinical utility. Future research should prioritize addressing these limitations to truly propel the field forward and maximize the benefits of ML in enhancing patient care.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 2","pages":"126-134"},"PeriodicalIF":2.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-optimized cut-off values for pubofemoral distances in screening for hip dysplasia.","authors":"Hans-Christen Husum, Michel B Hellfritzsch, Rikke D Maimburg, Bjarne Møller-Madsen, Mads Henriksen, Natallia Lapitskaya, Søren Kold, Ole Rahbek","doi":"10.1302/2633-1462.62.BJO-2024-0181.R1","DOIUrl":"10.1302/2633-1462.62.BJO-2024-0181.R1","url":null,"abstract":"<p><strong>Aims: </strong>To establish cut-off values for lateral pubofemoral distance (PFD) measurements for detecting hip dysplasia in early (four days) and standard care (six weeks) screening for developmental dysplasia of the hip (DDH).</p><p><strong>Methods: </strong>All newborns, during a one-year period (October 2021 to October 2022), were offered a PFD ultrasound (US) examination in addition to the existing screening programme for DDH. Newborns who were referred for standard care hip US, suspected for DDH, received a secondary PFD US examination in conjunction with the standard care Graf/Harcke hip US examination. Receiver operating characteristic curves and empirically optimal cut-off values were calculated with a true positive defined as a Graf type ≥ IIc hip.</p><p><strong>Results: </strong>We included 2,735 newborns, of whom 758 received both early PFD hip US and standard care Graf/Harcke hip US. For early (four days) PFD screening, the optimal cut-off point was calculated to be 6.2 mm (95% CI 4.7 to 7.7) producing a sensitivity of 80% (95% CI 55% to 100%) and a specificity of 87% (86% to 89%). For PFD screening performed at standard care (six weeks) hip US, the optimal cut-off point was calculated to be 5.6 mm (95% CI 4.9 to 6.3) producing a sensitivity of 100% (95% CI 100% to 100%) and a specificity of 96% (95% CI 95% to 97%).</p><p><strong>Conclusion: </strong>PFD US screening produces a high degree of both sensitivity and specificity for detecting DDH. Age-specific cut-off values should be used to heighten the accuracy of PFD US screening.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 2","pages":"119-125"},"PeriodicalIF":2.8,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary malignant bone and soft-tissue tumours of the spine and appendicular sacrum.","authors":"Eleonora Schneider, Thomas M Tiefenboeck, Christoph Böhler, Iris-Melanie Noebauer-Huhmann, Susanna Lang, Petra Krepler, Philipp T Funovics, Reinhard Windhager","doi":"10.1302/2633-1462.62.BJO-2024-0169.R1","DOIUrl":"10.1302/2633-1462.62.BJO-2024-0169.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of the present study was to analyze the oncological and neurological outcome of patients undergoing interdisciplinary treatment for primary malignant bone and soft-tissue tumours of the spine within the last seven decades, and changes over time.</p><p><strong>Methods: </strong>We retrospectively analyzed our single-centre experience of prospectively collected data by querying our tumour registry (Medical University of Vienna). Therapeutic, pathological, and demographic variables were examined. Descriptive data are reported for the entire cohort. Kaplan-Meier analysis and multivariate Cox regression analysis were applied to evaluate survival rates and the influence of potential risk factors.</p><p><strong>Results: </strong>A total of 119 consecutive patients (mean age 38 years (SD 37; 1 to 83), mean follow-up 66 months (SD 26; 0 to 505) were investigated. Histological entities included Ewing's sarcoma (EWS; 33), chondrosarcoma (CSA; 20), osteosarcoma (OSA; 22), and soft-tissue sarcoma (STS; 44). Surgery was performed in 88 patients (74%). Neurological parameters improved in 18 patients (20%) after surgery. Overall, 32 patients (36%) suffered from surgical complications requiring revision. The median survival was 42 months (IQR 10 to 204). The one-, five-, and ten-year survival rates were 73%, 47%, and 39%, respectively. Corresponding five-year survival rates for EWS, CSA, OSA, and STS were 63%, 61%, 40%, and 32%, respectively. The decade of diagnosis, histological entity, surgical intervention, resection margin, and the presence of metastases had significant influence on survival. (Neo-)adjuvant therapies alone had no significant influence on overall survival.</p><p><strong>Conclusion: </strong>Our study clearly demonstrates the positive impact of improved surgical techniques, as well as refined imaging methods and evolved adjuvant therapy options, on survival rate in all tumour entities. However, despite a multimodal treatment plan, the long-term mortality of these tumours remains high.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 2","pages":"109-118"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11785419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"STEP 1: The Scottish Trauma & Orthopaedics Equality Project : demographics and working patterns of a national workforce.","authors":"Monu Jabbal, Jennifer Cherry, Deborah Eastwood, Chloe E H Scott, Phil Walmsley, Emily Baird","doi":"10.1302/2633-1462.61.BJO-2024-0014.R1","DOIUrl":"https://doi.org/10.1302/2633-1462.61.BJO-2024-0014.R1","url":null,"abstract":"<p><strong>Aims: </strong>Trauma & Orthopaedic (T&O) surgery has come under scrutiny for lagging behind other medical specialties in promoting gender and cultural equity and diversity within their workforce. The proportions of female, ethnic minority, and sexual and gender minority individuals within orthopaedic membership bodies are disproportionate to the populations they serve. The aim of this study is to report the findings of a national workforce survey of demographics and working patterns within T&O in Scotland.</p><p><strong>Methods: </strong>A questionnaire devised by a working group was delivered by the Client Analyst and Relationship Development (CARD) group. Utilizing a secure third party ensured anonymity for all respondents. Data were recorded and analyzed by the CARD group.</p><p><strong>Results: </strong>A total of 353 responses were recorded, representing 71% of the known workforce. Overall, 261 respondents (74%) identified as male, 85 (24%) female, and seven (2%) preferred not to say. For specialist trainee (ST)3 to ST6, 148 (42%) were female, and for ST7 to ST8, 131 (37%) were female. In total, 226 of all respondents (64%) were white-British, 35 (10%) were white-European, and 92 (26%) were of an ethnic minority background. A total of 321 of respondents (91%) identified as heterosexual, 14 (4%) preferred not to say, and 18 (5%) identified as LGBTQ+ or preferred to self-describe.</p><p><strong>Conclusion: </strong>This is the largest national workforce survey in contemporary surgical literature. The findings demonstrate a greater proportion of female surgeons overall compared to other studies in T&O. This proportion of females was highest among more junior trainees. The Scottish T&O workforce is more ethnically diverse than the demographics of the population it serves. This study suggests that T&O in Scotland is an evolving speciality in terms of equality and diversity, and is making positive progress.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 1","pages":"103-108"},"PeriodicalIF":2.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"STEP 1: The Scottish Trauma & Orthopaedics Equality Project.","authors":"Monu Jabbal, Jennifer Cherry, Deborah Eastwood, Chloe E H Scott, Phil Walmsley, Emily Baird","doi":"10.1302/2633-1462.61.BJO-2024-0014.R1","DOIUrl":"10.1302/2633-1462.61.BJO-2024-0014.R1","url":null,"abstract":"<p><strong>Aims: </strong>Trauma & Orthopaedic (T&O) surgery has come under scrutiny for lagging behind other medical specialties in promoting gender and cultural equity and diversity within their workforce. The proportions of female, ethnic minority, and sexual and gender minority individuals within orthopaedic membership bodies are disproportionate to the populations they serve. The aim of this study is to report the findings of a national workforce survey of demographics and working patterns within T&O in Scotland.</p><p><strong>Methods: </strong>A questionnaire devised by a working group was delivered by the Client Analyst and Relationship Development (CARD) group. Utilizing a secure third party ensured anonymity for all respondents. Data were recorded and analyzed by the CARD group.</p><p><strong>Results: </strong>A total of 353 responses were recorded, representing 71% of the known workforce. Overall, 261 respondents (74%) identified as male, 85 (24%) female, and seven (2%) preferred not to say. For specialist trainee (ST)3 to ST6, 148 (42%) were female, and for ST7 to ST8, 131 (37%) were female. In total, 226 of all respondents (64%) were white-British, 35 (10%) were white-European, and 92 (26%) were of an ethnic minority background. A total of 321 of respondents (91%) identified as heterosexual, 14 (4%) preferred not to say, and 18 (5%) identified as LGBTQ+ or preferred to self-describe.</p><p><strong>Conclusion: </strong>This is the largest national workforce survey in contemporary surgical literature. The findings demonstrate a greater proportion of female surgeons overall compared to other studies in T&O. This proportion of females was highest among more junior trainees. The Scottish T&O workforce is more ethnically diverse than the demographics of the population it serves. This study suggests that T&O in Scotland is an evolving speciality in terms of equality and diversity, and is making positive progress.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 1","pages":"103-108"},"PeriodicalIF":2.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between acetabular coverage over femoral head and rate of joint space narrowing in non-arthritic hips.","authors":"Toshiyuki Kawai, Kohei Nishitani, Yaichiro Okuzu, Koji Goto, Yutaka Kuroda, Shinichi Kuriyama, Shinichiro Nakamura, Shuichi Matsuda","doi":"10.1302/2633-1462.61.BJO-2024-0143.R1","DOIUrl":"10.1302/2633-1462.61.BJO-2024-0143.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study was performed to investigate the association between the acetabular morphology and the joint space narrowing rate (JSNR) in the non-arthritic hip.</p><p><strong>Methods: </strong>We retrospectively reviewed standing whole-leg radiographs of patients who underwent knee arthroplasty from February 2012 to March 2020 at our institute. Patients with a history of hip surgery, Kellgren-Lawrence grade ≥ II hip osteoarthritis, or rheumatoid arthritis were excluded. The hip JSNR was measured, and the normalized JSNR (nJSNR) was calculated by calibrating the joint space width with the size of the femoral head in 395 patients (790 hips) with a mean age of 73.7 years (SD 8.6). The effects of the lateral centre-edge angle (CEA) and acetabular roof obliquity (ARO) in the standing and supine positions were examined using a multivariate regression model.</p><p><strong>Results: </strong>The mean JSNR and nJSNR were 0.115 mm/year (SD 0.181) and 2.451 mm/year (SD 3.956), respectively. Multivariate regressions showed that older age was associated with a larger nJSNR (p = 0.010, standardized coefficient (SC) 0.096). The quadratic curve approximation showed that the joint space narrowing was smallest when the CEA was approximately 31.9°. This optimal CEA was the same in the standing and supine positions. Multivariate regressions were separately performed for joints with a CEA of < 31.9° and > 31.9°. When the CEA was < 31.9°, a smaller CEA was associated with a larger nJSNR (p < 0.001, SC 0.282). When the CEA was > 31.9°, a larger CEA was associated with a larger nJSNR (p = 0.012, SC 0.152). The ARO was not associated with the nJSNR.</p><p><strong>Conclusion: </strong>Both insufficient coverage and over-coverage of the acetabulum over the femoral head were associated with increased joint space narrowing in hips that were non-arthritic at baseline. The effects of insufficient coverage were stronger than those of overcoverage.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 1","pages":"93-102"},"PeriodicalIF":2.8,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Convertible metal-backed glenoid in total shoulder arthroplasty.","authors":"Riccardo Ranieri, Mario Borroni, Giacomo Delle Rose, Marco Conti, Raffaele Garofalo, Alessandro Castagna","doi":"10.1302/2633-1462.61.BJO-2024-0118.R1","DOIUrl":"10.1302/2633-1462.61.BJO-2024-0118.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to report long-term clinical outcomes of a modern convertible metal-backed glenoid (MBG) in total shoulder arthroplasty (TSA).</p><p><strong>Methods: </strong>After a minimum of 15 years, a previously studied cohort of 35 patients who received a modern convertible MBG during the period 1996 to 2005 was contacted for clinical and radiological follow-up. At last follow-up, patients were evaluated radiologically and clinically according to the Constant Score, Simple Shoulder Test, and visual analogue scale for pain. Complications and revisions were recorded, and survival analysis was performed.</p><p><strong>Results: </strong>At the last follow-up, 20 patients were contacted. Of these, 15 patients had experienced at least one complication, and ten underwent revision surgery. The mean time to revision was 13.8 years (7 to 20). Cuff failure was the most common complication. Conversion to reverse shoulder arthroplasty, while maintaining the baseplate, was possible in five cases, with good results. In patients in whom the baseplate was removed, revision was performed significantly later (18.4 vs 11.1 years; p = 0.016). The general revision-free survival was 73% (95% CI 49.5 to 87.3) at 15 years and 38% (95% CI 11.8% to 64.3%) at 20 years, while MBG revision-free survival was 96.0% (95% CI 74.8% to 99.4%) at 15 years and 54% (95% CI 16.2% to 80.8%) at 20 years. Clinical scores showed a negative trend over time, although not statistically significant. Radiologically, polyethylene wear was observed in all cases and was complete in 12 out of 19 cases, and five glenoids were 'at risk' for loosening.</p><p><strong>Conclusion: </strong>At long-term follow-up, convertible MBG-TSA revealed a high rate of complications and revision surgery, mainly due to soft-tissue failure and polyethylene wear occurring with time. Prompt conversion to RSA maintaining the baseplate provided good results and a low complication rate. Radiological follow-up at about ten years is strictly recommended and, if metal-to-metal contact is observed, conversion to RSA is advisable. These results emphasize the need for continued research into improving TSA outcomes, especially in cases of MBG usage.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 1","pages":"82-92"},"PeriodicalIF":2.8,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How many people in the Netherlands live with a hip, knee, or shoulder replacement?","authors":"Mirthe H W van Veghel, Liza N van Steenbergen, Maaike G J Gademan, Wilbert B van den Hout, B W Schreurs, Gerjon Hannink","doi":"10.1302/2633-1462.61.BJO-2024-0162.R1","DOIUrl":"10.1302/2633-1462.61.BJO-2024-0162.R1","url":null,"abstract":"<p><strong>Aims: </strong>We estimated the prevalence of people living with at least one hip, knee, or shoulder arthroplasty in the Netherlands.</p><p><strong>Methods: </strong>We included the first hip (n = 416,333), knee (n = 314,569), or shoulder (n = 23,751) arthroplasty of each patient aged ≥ 40 years between 2007 and 2022 (hip/knee) or 2014 and 2022 (shoulder) from the Dutch Arthroplasty Register (LROI). Data on the size of the Dutch population were obtained from Statistics Netherlands. Annual incidences and deaths from hip and knee arthroplasty since 2010, and shoulder arthroplasty since 2015, were observed from the LROI. Annual incidences and deaths before those years were estimated using Poisson regression analyses and parametric survival models based on a Gompertz distribution. Non-parametric percentile bootstrapping with resampling was used to estimate 95% CIs.</p><p><strong>Results: </strong>Annual incidences per 100,000 Dutch inhabitants aged ≥ 40 years increased for hip arthroplasties from 221 (95% CI 214 to 229) in 1990 to 360 in 2022, for knee arthroplasties from 181 (95% CI 174 to 188) to 272, and for shoulder arthroplasties from 11 (95% CI 8.0 to 16) to 34. In 2022, 791,000 (95% CI 787,000 to 794,000) people in the Netherlands were living with at least one joint replacement, representing 8.4% (95% CI 8.4 to 8.5) of the Dutch population aged ≥ 40 years. For hip, knee, and shoulder arthroplasties, these were 436,000 (95% CI 433,000 to 438,000), 383,000 (95% CI 380,000 to 386,000), and 34,000 (95% CI 33,000 to 36,000) people, corresponding to 4.7% (95% CI 4.6 to 4.7), 4.1% (95% CI 4.1 to 4.1), and 0.4% (95% CI 0.3 to 0.4) of the Dutch population, respectively. The most common age group living with at least one joint replacement was the ≥ 80-year age group, representing 38% (95% CI 37 to 38) of the Dutch population aged ≥ 80 years.</p><p><strong>Conclusion: </strong>Approximately 800,000 people in the Netherlands were living with at least one hip, knee, or shoulder replacement in 2022, representing one in 12 Dutch inhabitants aged ≥ 40 years.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 1","pages":"74-81"},"PeriodicalIF":2.8,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The correlation between trainee gender and operative autonomy during trauma and orthopaedic training in Ireland and the UK.","authors":"Rosie Mc Colgan, Fiona Boland, Gerard A Sheridan, Grainne Colgan, Deepa Bose, Deborah M Eastwood, David M Dalton","doi":"10.1302/2633-1462.61.BJO-2024-0176.R1","DOIUrl":"10.1302/2633-1462.61.BJO-2024-0176.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to explore differences in operative autonomy by trainee gender during orthopaedic training in Ireland and the UK, and to explore differences in operative autonomy by trainee gender with regard to training year, case complexity, index procedures, and speciality area.</p><p><strong>Methods: </strong>This retrospective cohort study examined all operations recorded by orthopaedic trainees in Ireland and the UK between July 2012 and July 2022. The primary outcome was operative autonomy, which was defined as the trainee performing the case without the supervising trainer scrubbed.</p><p><strong>Results: </strong>A total of 3,533,223 operations were included for analysis. Overall, male trainees performed 5% more operations with autonomy than female trainees (30.5% vs 25.5%; 95% CI 4.85 to 5.09). Female trainees assisted for 3% more operations (35% vs 32%; 95% CI 2.91 to 3.17) and performed 2% more operations with a supervising trainer scrubbed (39% vs 37%; 95% CI 1.79 to 2.06). Male trainees performed more operations with autonomy than female trainees in every year of training, in each category of case complexity, for each orthopaedic speciality area, and for every index procedure except nerve decompression. When adjusting for year, training level, case complexity, speciality area, and urgency, male trainees had 145% (95% CI 2.18 to 2.76) increased odds of performing an operation with autonomy and 35% (95% CI 1.25 to 1.45) increased odds of performing an operation under trainer supervision, than assisting, compared to female trainees.</p><p><strong>Conclusion: </strong>Male trainees perform more operations with autonomy during orthopaedic training than female trainees. Female orthopaedic trainees assist for a greater proportion of cases than their male counterparts. A comprehensive review of trauma and orthopaedic training is needed to identify any additional differences in training opportunities between female and male trainees, particularly with regard to progression through training.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 1","pages":"62-73"},"PeriodicalIF":2.8,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11723784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the Rate of Early mobilization in Hip fracture patients using Alfentanil Better than standard opioid analgesia (REHAB)? A protocol for a prospective cohort study.","authors":"Nikhil Agarwal, Alasdair M J MacLullich, Nick D Clement","doi":"10.1302/2633-1462.61.BJO-2024-0076.R1","DOIUrl":"10.1302/2633-1462.61.BJO-2024-0076.R1","url":null,"abstract":"<p><strong>Aims: </strong>The primary aim of this study is to compare mobility status of patients receiving oral oxycodone with those receiving subcutaneous alfentanil as analgesic methods prior to mobilization to help physiotherapy compliance after hip fracture surgery. The secondary aims are to assess postoperative pain, health-related quality of life, in-hospital length of stay, total use of analgesia over postoperative days 1 and 2 (POD 1 and POD 2), complication rates within 30 days, and 30-day mortality rates.</p><p><strong>Methods: </strong>A single-centre, prospective cohort study of 64 patients will be undertaken. Patients undergoing surgery for femoral neck fractures at the study centre will be recruited. Patients with a hip fracture meeting the inclusion/exclusion criteria will be enrolled on admission. Patients who have been administered oral oxycodone will be compared to those prescribed alfentanil for pain prior to mobilization with physiotherapists on POD 1 and POD 2. Which drug a patient receives is reliant of the prescriptions given by the medical team, and in current practice this varies at approximately 50:50. Mobilization will be defined as the ability to stand on and weightbear both feet with or without assistance.</p><p><strong>Results: </strong>Visual analogue scale pain scores, mobility status, and total analgesia use will be assessed on POD 1 and POD 2. EuroQol five-dimension health questionnaire scores, complication rates, and mortality rates will be assessed up to 30 days following surgery (POD 1, 2, 7, and 30).</p><p><strong>Conclusion: </strong>This study will help to build a wider protocol aiming to improve early mobilization after hip fracture surgery. The results of this study will provide pain scores and mobility status which will either support use of subcutaneous alfentanil as the standard analgesic modality prior to physiotherapy sessions, or highlight its limitations compared to the standard oral oxycodone. Secondary outcomes will also help to assess if early mobilization improves outcomes compared to delayed mobilization.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 1","pages":"53-61"},"PeriodicalIF":2.8,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}