JBJS Open Access最新文献

{"title":"Video-Based Assessment of Surgical Skill in Orthopaedic Surgery: A Technique Guide to Capturing Critical Surgical Detail.","authors":"Jillian McNally, David Wilson, Emma E Jones, Neyousha Shahisavandi, Caroline King, Chad Coles, Raymond Andrew Glennie","doi":"10.2106/JBJS.OA.24.00183","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00183","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical skills are critical to assess in residency programs. These observations often occur in the clinical settings, which are limited by patient safety and potential bias. High fidelity simulated cadaveric surgery can account for some of these shortcomings. Professional video offers a promising avenue to both anonymize and effectively evaluate surgical skill. The objective of this study were to describe the technique for professional video capture of simulated, open orthopaedic surgeries and to assess construct validity by comparing objective performance scores from the videos with the learner's stage of training.</p><p><strong>Methods: </strong>In 2022, one experienced surgeon and 3 trainees (post graduate year [PGY]-4, PGY-3, PGY-2) were recruited from a residency program to perform 2 moderately challenging surgeries (open reduction and internal fixation of both bone forearm and talus fractures), with fractures simulated using an osteotome. Videographers positioned cameras at various positions throughout a skills laboratory. Total costs were calculated. Statistical analysis was performed to compare evaluator scores of participants' actual level of training.</p><p><strong>Results: </strong>The simulated surgeries were recorded, edited for optimal viewing angles, and anonymized by blurring faces and voice over technology. Seventeen local teaching faculty were recruited to evaluate the videos. The videos were shortened on average 65 minutes for critical steps to be represented in the final production (i.e., Bone reduction, dissection of neurovascular structures, radiographic images, etc.) The full cost to produce the 8 surgical videos was $48,934.00 Canadian dollars. The final data set had 61 observations, with a range of 13 to 17 observations per participant. There was a 19.7% error rate, meaning the videos were generally 80% accurate in predicting the year of training.</p><p><strong>Conclusions: </strong>The discriminative ability of the videos was better at detecting true \"novice\" and \"expert\" surgeons but less accurate between the middle years of training. A larger, multicentered study with more participants is needed to draw any further conclusions.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048486","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":"Prevalence & Risk Factors of Post-traumatic Stress Disorder in Patients with Lower Limb Fractures in South Africa.","authors":"Gerald Tan, Maritz Laubscher, Sithombo Maqungo, Adam Truss, Kirsty Berry, Nando Ferreira, Simon Matthew Graham","doi":"10.2106/JBJS.OA.24.00124","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00124","url":null,"abstract":"<p><strong>Background: </strong>Fractures occur at disproportionately higher rates in low-income and middle-income countries (LMIC) and commonly occur following a traumatic event. The association between suffering from a fracture and the development of psychological symptoms is under-reported. The aim of this study was to investigate the prevalence and risk factors of developing post-traumatic stress disorder (PTSD) among patients following lower limb trauma in South Africa.</p><p><strong>Methods: </strong>The study was undertaken from September 2017 to December 2018 and included a cohort of 260 patients with lower limb long bone fractures. Patients were screened using the Primary Care PTSD (PC-PTSD-5) screening tool, which is a gold standard measure to identify patients at risk of PTSD in the civilian population. Within this cohort, high-risk patients were assessed with the PTSD checklist (PCL-C), which is a standardized questionnaire scale to indicate if an individual may have PTSD.</p><p><strong>Results: </strong>There were 254 patients in the final cohort analysis with ages ranging from 18 to 71 years, and 75.6% (192/254) of the cohort were male patients. Femoral fractures were found in 51.6% (131/254) of patients while tibial fractures were found in 48.4% (123/254). The rate of PTSD within the study population was found to be 7.1% (18/254), and the risk of developing PTSD was 13.4% (34/254). We did not identify any risk factors, including open fractures, high-injury severity, and complication such as nonunion, for the development of PTSD.</p><p><strong>Conclusions: </strong>This study found the rate of PTSD to be lower compared with that in high-income countries, but still higher than the general population in South Africa. Our study indicates that screening for PTSD in patients with lower limb trauma in LMICs could be beneficial. Early identification of patients at risk of developing PTSD would enable appropriate resources, support, and treatment to be provided.</p><p><strong>Level of evidence: </strong>Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031877","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":"Unadjusted Unplanned 30-Day Hospital Readmission Rates are Not a Useful Quality Measure for Planned or Urgent Orthopaedic Inpatient Care: A Retrospective Cohort Study.","authors":"Samuel F Turner, Vijay Badial, Reece Barter, Edward Hayter, Raymond E Anakwe","doi":"10.2106/JBJS.OA.24.00237","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00237","url":null,"abstract":"<p><strong>Background: </strong>We examined the number of patients who experienced an unplanned hospital readmission following an episode of inpatient care in a tertiary level trauma and orthopaedic service, the reasons for readmission and whether these reasons related to lapses in care, care and service delivery problems, and missed healthcare intervention opportunities and whether they were or should have been prevented and anticipated. We hypothesized that most 30-day readmissions would be unrelated to the original complaint and admission, and the reasons for readmission would not be truly avoidable or attributable to the index hospital admission. We further hypothesized that socioeconomic factors would be predictive of the likelihood of unplanned hospital readmission within 30 days of hospital discharge.</p><p><strong>Methods: </strong>Over a 5-year study period, we identified all adult patients discharged from our unit and those who had an unplanned readmission within 30 days of discharge. We evaluated the reasons for readmission and assessed the impact of socioeconomic deprivation and social determinants of health on the likelihood of unplanned 30-day readmission using multivariable logistic regression.</p><p><strong>Results: </strong>Fifteen thousand three hundred thirteen patients were discharged from our unit over the study period. 690 patients (4.5%) were readmitted within 30 days of discharge as an unplanned episode of care. 58.4% of unplanned readmissions were directly related to the index admission, but only 9% of readmissions were preventable. The single most frequent reason for readmission was an unrelated noninfective medical complaint, 244 patients (35.4%). Social determinants of health influenced the risk of an unplanned readmission, particularly the Index of Multiple Deprivation and the subdomains related to housing, the living environment, social services, and support.</p><p><strong>Conclusions: </strong>The 30-day readmission rate as a marker of quality for inpatient care should be questioned. It is not useful as an unadjusted metric and can be misleading. Adjusting for socioeconomic influences, preventability of readmissions, and missed opportunities to improve whole health may improve its usefulness.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052670","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":"Does Replication of Native Acetabular Anatomy Satisfy Recommended Hip-Spine Targets for Cup Orientation?","authors":"Johnathan Sevick, Christopher Plaskos, Andrew Speirs, Jim Pierrepont, George Grammatopoulos","doi":"10.2106/JBJS.OA.24.00169","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00169","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to assess whether replication of native acetabular anatomy would satisfy cup orientation targets using 3 commonly described hip-spine algorithms. Whether spinopelvic characteristics influence ability to achieve cup orientation targets when replicating native anatomy and the agreement between algorithm recommendations was tested.</p><p><strong>Methods: </strong>A prospective database was queried to identify patients with adverse (n = 70) spinopelvic characteristics. These were matched for age and sex with patients without adverse characteristics (n = 70). Spinopelvic characteristics were obtained from radiographs and computed tomography (CT) scans. CT scans were segmented to determine native acetabular anatomy, particularly anteversion. Three hip-spine planning algorithms were evaluated for each patient (Optimized Positioning System [OPS], Combined-Sagittal Index [CSI], Hip-Spine Classification). Differences between target orientations and native anatomy were determined. Agreement between algorithms was tested.</p><p><strong>Results: </strong>OPS plan had significantly reduced inclination compared with native (39° vs. 52°, p < 0.001). No significant difference between OPS and native anteversions was seen (18° vs. 18°, p = 0.1) for the adverse group. OPS-planned anteversion was greater than native (23° vs. 16°, p < 0.001) in the nonadverse group. Most native orientations met published CSI targets (90% nonadverse, 59% adverse). Most native acetabular orientations (61% adverse and 58% nonadverse) failed to meet Hip-Spine Classification targets. Overall, in 88% of cases, replication of native acetabular version and 40° of inclination satisfied at least one suggested target. Agreement of all 3 algorithms was 31%; greater agreement was seen between Hip-Spine Classification and OPS (64%).</p><p><strong>Conclusions: </strong>Native acetabular anteversion and radiographic inclination of 40° are reliable targets, satisfying at least one hip-spine algorithm and thus justifying such practice, when advanced hip-spine analysis is not performed. The discrepancy between suggested orientations by the various published techniques, despite their validated low dislocation rates, emphasizes that although achieving a target cup orientation is important, the nature of hip stability is multifactorial and merits a holistic approach.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047576","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":"Erratum: Effective Compression and a Minimally Invasive Rail Plate to Optimize Bone Transport in Distraction Osteogenesis.","authors":"E López-Carreño, E P López Avendaño, L Padilla Rojas, A Y Martínez-Castellanos, I Arámbula Rodríguez, C García López, H Campos Reyes, L Flores Huerta","doi":"10.2106/JBJS.OA.ER.23.00144","DOIUrl":"https://doi.org/10.2106/JBJS.OA.ER.23.00144","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2106/JBJS.OA.23.00144.].</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047615","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 Real Match Rate? US DO Students Match Into Orthopaedic Surgery at Significantly Lower Rates than US MD Students Despite Single Accreditation.","authors":"Mark S Katsma, Jett B Murray, George C Balazs, Mark R Speicher, Aaron A Olsen","doi":"10.2106/JBJS.OA.24.00002","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00002","url":null,"abstract":"<p><strong>Background: </strong>Orthopaedic surgery remains one of the most competitive residency matches for both senior allopathic (MD) and senior osteopathic (DO) medical students. Despite the completion of a transition to single accreditation of residency programs accredited by the American Osteopathic Association and the Accreditation Council for Graduate Medical Education in 2020, little is known about the subsequent impact of this new environment for DO and MD orthopaedic applicants. The purpose of this study was to evaluate the differences between MD and DO match rates using both Electronic Residency Application Service (ERAS) and National Residency Matching Program (NRMP) data.</p><p><strong>Methods: </strong>ERAS applicant data from 2020 to 2023 specific to orthopaedic surgery were obtained from the Association of American Medical Colleges. NRMP data were queried for the same years. Both NRMP (unadjusted) and ERAS (adjusted) match rates were calculated and compared for each year and cumulatively. In addition, the proportion of ERAS applicants that failed to rank orthopaedic surgery in the NRMP was calculated and compared between senior MD and senior DO applicant groups.</p><p><strong>Results: </strong>From 2020 to 2023, the unadjusted match rate dropped for MDs (79% vs 73%, p = 0.002) and DOs (63% vs 50%, p = 0.009). Adjusted match rates over this time were not different for MDs (59% vs 57%, p = 0.22) or DOs (39% vs 37%, p = 0.67). Overall, the unadjusted and adjusted match rate for DO applicants was lower than MD across all years (p < 0.05). For every year except 2023 (p = 0.15), a larger proportion of US DO senior students with ERAS applications did not submit a final NRMP rank list for orthopaedics (p < 0.05).</p><p><strong>Conclusions: </strong>Aspiring DO orthopaedic surgeons have lower match rates and higher rates of abandoning plans to apply for orthopaedic surgery between ERAS application and NRMP compared with their US MD peers despite single accreditation. Active identification of bias, orthopaedic mentorship, and focused advising may help prepare qualified applicants for competitive specialty matches.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018273","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":"Picture Perfect: An Analysis of Diversity, Equity, and Inclusion in Orthopaedic Sports Medicine Website Imagery and Language.","authors":"Katarina Nilsson, Kevin M Posner, Cassandra Bakus, Mallery Zieman, Daniel Thiemann, Thomas Gunning, Dante Implicito","doi":"10.2106/JBJS.OA.24.00181","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00181","url":null,"abstract":"<p><strong>Background: </strong>Diversity, equity, and inclusion (DEI) is important on patient-facing orthopaedic websites for patients to connect with healthcare providers. Image representation and language availability on websites allow for improved patient outcomes. The purpose of this study was to investigate DEI in orthopaedics through the critical evaluation of patient-facing imagery and language present on orthopaedic sports medicine websites.</p><p><strong>Methods: </strong>Using the US News and World Rankings, the top 50 orthopaedic departments were compiled. The orthopaedic sports medicine websites with images (N = 36) were analyzed for representation of skin color/sex in images and language availability. The data were then compared with demographic information.</p><p><strong>Results: </strong>There was an increase in the proportion of White (19.11%, p = 0.003) and male patients (16.17%, p = 0.047) in website images compared with demographics. There was a decrease in the proportion of patients of color (16.17%, p = 0.012) and female patients (12.27%, p = 0.047) in website images compared with demographics. Of the 36 websites, 50% did not mention the availability of translated materials.</p><p><strong>Conclusion: </strong>The images found on orthopaedic webpages overrepresent White and male patients while underrepresenting patients of color and female patients compared with local demographics. In addition, half of the orthopaedic sports medicine webpages lacked translated resources for non-English speaking patients, limiting their language accessibility. Orthopaedic programs could better use patient-facing websites to incorporate DEI for their patients, which could improve patient satisfaction and outcomes.</p><p><strong>Level of evidence: </strong>Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019456","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":"Orthopaedic Fellowship Match: How Do Degree and Gender Type Affect Match Success?","authors":"Kenneth B Choy, Lisa K Cannada, Scott Steinmann, Randy M Cohn, Adam Bitterman","doi":"10.2106/JBJS.OA.24.00207","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00207","url":null,"abstract":"<p><strong>Introduction: </strong>Discrepancies have previously been identified in terms of gender and medical degree throughout orthopaedic education. The purpose of this study was to evaluate trends in the degree type and gender of applicants to orthopaedic trauma, sports medicine, adult reconstruction, foot and ankle, shoulder and elbow, and pediatric fellowships.</p><p><strong>Methods: </strong>Official San Francisco match data from 2012 to 2023 were obtained. Data regarding the number of applicants, match rates, and rank list position based on applicant degree and gender were evaluated.</p><p><strong>Results: </strong>The match rate for female applicants increased from a low of 81% (45/56) in 2013 to a high of 99% (94/95) in 2021 (mean 90% ± 6%), with a significant increase over the study period (<i>r</i> = 0.59, p = 0.02). For male applicants, the match rate ranged from a low of 85% (416/488) in 2013 to a high of 96% (515/536) in 2021 (mean 90% ± 4%), with a significant increase (<i>r</i> = 0.91, p = 0.000007). The match rate for osteopathic applicants increased from 63% (46/73) in 2013 to 94% (84/89) in 2021 (mean 82% ± 8%). There was a statistically significant increase in the match rate of osteopathic applicants over the study period (<i>r</i> = 0.75, p = 0.002). The match rate for allopathic applicants ranged from a low of 86% (405/471) in 2013 to a high of 96% (522/542) in 2021 (mean 91% ± 3%). There was a statistically significant increase in the match rate of allopathic applicants over the study period (<i>r</i> = 0.72, p = 0.003).</p><p><strong>Conclusions: </strong>Overall, male and female applicants match at equal rates for the orthopaedic fellowship. Osteopathic graduates are less likely to match than allopathic graduates.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001463","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 Trend to Use the Word \"Trend\" to Describe Nonsignificant Results in Orthopaedic Literature.","authors":"Patrick A Massey, Ryan Taylor, Robert W Rutz, Joshua Harris, Carver Montgomery, Mohammad Alfrad Nobel Bhuiyan","doi":"10.2106/JBJS.OA.24.00211","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00211","url":null,"abstract":"<p><strong>Introduction: </strong>Use of the word \"trend\" for statistical judgment with no statistical significance has been recognized in multiple fields of medical literature. \"Trend\" is sometimes used to describe \"nearly significant\" findings when they are not statistically significant. The purpose of this study was to characterize the use of the word \"trend\" to describe nonsignificant findings in orthopaedic publications.</p><p><strong>Methods: </strong>Orthopaedic journals indexed in MEDLINE were identified using the terms: orthopedics OR orthopaedics OR sports medicine OR orthopedic OR orthopaedic. Abstracts from these journals that contained the word \"trend\" from 1985 to 2022 were identified. Journals containing literature on nonhuman orthopaedics were excluded. \"Trend\" used for statistical judgment without a p-value or with a nonsignificant p-value was labeled \"NS Trend\". Use of \"trend\" not in the context of statistical tests was labeled as \"dictionary usage\" of the word.</p><p><strong>Results: </strong>A total of 59,839 article abstracts were identified, with \"trend\" being used in 1,029 abstracts (1.7%). \"NS Trend\" was used in 617 abstracts (60%) to describe significant results when the p-value was not given or not actually significant. There was a strong correlation over time with increasing use of the word \"trend\" in orthopaedic abstracts (r = 0.956). An exponential rise in \"NS Trend\" usage was found (r = 0.924; R² = 0.853; p < 0.001). An exponential fit was confirmed using a Kolmogorov-Smirnov test (p = 0.283).</p><p><strong>Conclusion: </strong>The word \"trend\" is increasingly being used in orthopaedic literature, including suggesting statistical significance when absent. Misinterpretation of statistical analyses can lead to research conclusions that push readers toward inappropriate treatments. It is imperative that we clearly communicate our statistical findings and not use ambiguous language. The word \"trend\" should only be used to describe an actual trend analysis and not to imply statistical significance when none is present.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020127","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":"Virtual Reality as an Adjunct to Pediatric Cast Removal: A Randomized Controlled Trial.","authors":"Andrew G Georgiadis, Peter E Schavee, Trever M Koester, William T DeBruin, Chantel C Burkitt, Walter H Truong, Jennifer C Laine","doi":"10.2106/JBJS.OA.24.00244","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00244","url":null,"abstract":"<p><strong>Background: </strong>Cast removal may produce pain or anxiety in children. Virtual reality (VR) has been studied in other pediatric settings, but little evidence exists for its use during pediatric cast removal.</p><p><strong>Methods: </strong>A randomized controlled trial was performed in children aged 4 to 12 years, assessing the effect of VR compared with standard of care (SOC) on pain and anxiety during first-time cast removal. Children were randomized to SOC earmuffs or a VR headset. VR was hypothesized to produce less sympathetic response, lower pain, and less anxiety. Metrics were assessed by a standardized protocol. <i>Primary aim</i>: sympathetic response as measured by continuous heart rate (HR) before, during, and after cast removal. <i>Secondary aims</i>: pain as assessed using the FACES (0-10) and Visual Analog Scale (VAS; 0-100) score, and anxiety as assessed by the VAS score (0-100).</p><p><strong>Results: </strong>Ninety patients were analyzed in each of the SOC and VR groups for the primary outcome. The average age was 7.84 years (range 4-12). There were no differences in sympathetic response by baseline, removal, or change in HR between groups (+11.23 bpm for SOC vs. + 7.84 bpm for VR, p = 0.113). There were no differences in baseline, removal, or change in pain (FACES +0.86 for SOC vs. + 0.40 for VR, p = 0.220). Most patients and caregivers reported no pain, and average FACES scores were low (1.45 for SOC and 1.00 for VR). VR improved child anxiety (-4.31 ± 22.6 for VR vs. 9.96 ± 33.94 for SOC, p = 0.001) and caregiver anxiety (-17.12 ± 25.78 for VR vs. -4.99 ± 29.03 for SOC). There was high caregiver satisfaction with the removal experience in both groups (95.34 ± 15.39 in SOC vs. 95.40 ± 15.48 in VR, on a VAS 0-100).</p><p><strong>Conclusions: </strong>Use of VR did not improve sympathetic response or self-reported pain during pediatric cast removal compared with SOC. Pain during pediatric cast removal was uniformly low. Child and caregiver anxiety was improved by the use of VR.</p><p><strong>Level of evidence: </strong>Level I-randomized controlled trial. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037061","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}