The clinical teacherO Rackham, M M Maitland, P Ahluwalia, O Murray, J E McKay
BACKGROUND: The transition from pre-clinical to clinical medicine is challenging, particularly in applying anatomical knowledge to patient care. Reductions in dedicated anatomy teaching time have compounded this. Near-peer teaching may help address this gap by reducing hierarchy and enhancing psychological safety, though few programmes have explicitly targeted the pre-clinical to clinical transition through the integration of anatomy with clinical cases. APPROACH: A prospective educational evaluation examined a near-peer, case-based orthopaedic anatomy programme delivered to Year 4 medical students by Year 5 facilitators across four sessions. Knowledge acquisition was assessed using parallel pre- and post-session multiple-choice question (MCQ) sets compared using Wilcoxon signed-rank test and Cohen's dz. Student experience was evaluated using purpose-designed questionnaires. EVALUATION: Thirty-two matched pairs were available for analysis. Baseline anatomical confidence (mean 2.76/5) and ratings of placement-based anatomy teaching (mean 2.26/5) indicated clear unmet need. MCQ scores improved significantly from 5.0 to 7.0 out of 8 (mean 5.00 vs. 6.69, p < 0.001, Cohen's dz = 1.12). Post-session confidence improved to 4.03/5, facilitators were rated highly (mean 4.59/5), and 97% of students felt comfortable engaging with peer facilitators. IMPLICATIONS: This programme provides preliminary support for near-peer, case-based anatomy teaching as a promising approach to supporting the pre-clinical to clinical transition, demonstrating short-term improvements in MCQ performance, confidence and student satisfaction.
Biomedical physics & engineering expressAamir Shehzad, Wang Yanen, Ghulam Hassan Askari, Sidra Aslam, Nasar Ali
Porous orthopedic implants are widely studied because they promote osseointegration and reduce stress shielding associated with dense, stiff implants. This review critically examines recent progress in the design and fabrication of additively manufactured porous orthopedic implants, with a focused emphasis on polylactic acid (PLA)-bioceramic systems, particularly hydroxyapatite-, tricalcium phosphate-, and bioactive glass-containing composites. We examine how porosity governs biological outcomes-cell attachment and proliferation, nutrient transport, and bone ingrowth-while simultaneously affecting stiffness, strength, and fatigue resistance. Rather than treating pore size, porosity, and material selection as universally optimal parameters, the review emphasizes that these variables must be interpreted according to implant location, loading environment, degradation profile, and the expected timeline of bone repair. Key structural variables, including pore size, morphology, interconnectivity, and graded architectures, are discussed in the context of meeting load-bearing requirements. Particular attention is given to balancing permeability with mechanical integrity, and to approaches such as ceramic-filled PLA composites and surface modifications that improve bioactivity. Additive manufacturing is presented as an enabling route to couple external geometry with internal architecture, and fused deposition modeling, Stereolithography, and binder jetting are compared with respect to material compatibility, attainable feature resolution, and post-processing needs. Building on these insights, we frame co-design as the joint optimization of material selection and porous structure to maximize overall implant function. Finally, we identify the main barriers to clinical translation, including degradation-healing mismatch, fatigue durability, sterilization, reproducibility of porous architectures, regulatory documentation, and the need for long-termin vivovalidation.
PloS oneMaria Hälleberg-Nyman, Erika Fjordkvist, Eva Joelsson-Alm, Madeleine Winberg, Ami Hommel, Joan Ostaszkiewicz, Lars Wallin, Ann Catrine Eldh
BACKGROUND AND OBJECTIVES: National clinical practice guidelines promote evidence-based practice, though are hardly implemented without local facilitation. While further research is needed as for what facilitation strategies work, in what context, and with what outcomes, the Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation (OPTION) trialled a tailored implementation intervention for evidence-based clinical practice guidelines in orthopaedic care. Informed by the principles of realism, this paper describes the evaluation of the context, mechanisms, and outcomes triad of locally assembled teams of nursing and rehabilitation staff and their managers offered monthly guideline implementation support for one year. METHODS: A process evaluation incorporating group interviews with designated teams across seven intervention sites, at the end of their programme and 12 months later. Individual facilitator logs, photos and educational material from the intervention, and external facilitators' notes were added. The data was thematically analysed, describing and contrasting the initial hypotheses with a refined understanding of the theoretical and practical features of the process and outcomes. RESULTS: With increased knowledge of the content and purpose of the guidelines and further recognition of their local context and implementation essentials, the intervention facilitated the local, designated teams to practise concurrent quality improvement procedures and skills. Having both staff and managers on the teams authorised modifications of their local context in favour of guideline implementation. The one-year support programme enabled primary implementation steps, though a comprehension of what could work and why required that the teams saw the intervention through. CONCLUSION: Learning about the implementation of a clinical practice guideline is a local effort. This requires dedicated teams with sustained roles, resources, and mandate, with external implementation and clinical support. Nevertheless, this is a slow process that requires repeated or prolonged follow-up to identify long-term implementation intervention outcomes. TRIAL REGISTRATION: US National Institutes of Health Clinical Trials Registry: NCT04700969. Registered 8 January 2021. https://clinicaltrials.gov/study/NCT04700969.
Operative Orthopadie und TraumatologieMartin C Jordan, Justus Bremer, Abdul Al Refai, Felix Wolff, Georgi I Wassilew, Janosch Schoon, Stefan Zwingenberger, Philipp Heilig
OBJECTIVE: Safe and complete removal of osteosynthesis materials while preserving the surrounding soft tissues. INDICATIONS: Indications include implant-related pain, soft-tissue irritation, infection, implant failure, pseudarthrosis, and risk to adjacent tendons, nerves, or vessels as well as implants in children. CONTRAINDICATIONS: Disproportionate procedural risk in patients with poor bone quality, extensive scarring, or high surgical morbidity. SURGICAL TECHNIQUE: Thorough preoperative planning, precise identification of the implant type and manufacturer, and the availability of the manufacturer's original extraction tools as well as alternative extraction instruments-such as special extractors, carbide drills, and hollow reamers-are essential. In this article, stepwise removal techniques are detailed for screws, plates, intramedullary nails, and spinal or pelvic implants, including strategies for managing stripped, cold-welded, or fractured implants. POSTOPERATIVE MANAGEMENT: Early functional rehabilitation is encouraged. Following removal of load-bearing implants, temporary activity restrictions and postoperative X‑rays to detect iatrogenic fractures are recommended. CLINICAL RELEVANCE: Implant removal is a frequent yet technically demanding procedure. Careful preparation, appropriate instrumentation, and meticulous technique reduce complications and enhance patient safety.
PloS oneAmeen Chaudry, Rishi Trikha, Thomas Olson, Samuel Clarkson, Chad Ishmael, Kristofer Jones, Alexandra Stavrakis, Rachel Thompson, Nicholas Bernthal
INTRODUCTION: Gender and racial diversity are key topics for discussion in medical education and, in particular, orthopaedic surgery. Studies have shown patient-physician concordance leads to improved healthcare outcomes. Despite this, the orthopaedic surgery workforce is amongst the least diverse. This study examined trends in gender and race amongst applicants to United States (U.S.) orthopaedic surgery programs to understand the future trajectory of the orthopaedic workforce. With an increasing emphasis on diversity, we hypothesize that gender and racial diversity among orthopaedic surgery applicants have increased. METHODS: Publicly available demographic data from the Electronic Residency Application Service (ERAS) for applicants to surgical residency programs between 2007 and 2019 were collected. Linear regression analysis by residency application year was performed for orthopaedic surgery and other surgical specialties. Z-tests were used to compare respective proportions. RESULTS: Over the 12-year study period, 18,542 applicants applied to U.S. orthopaedic programs. Of those, 14.9% were female and 28.2% were Black, Indigenous, or People of Color (BIPOC). The percentage of female applicants increased from 11.8% to 19.3% at a rate of 0.41% per year (R = 0.79). The percentage of BIPOC applicants between 2007-2019 ranged from 24.8 to 34.1% annually, trending upwards by 0.44% per year. Compared to other surgical specialties, orthopaedic surgery consistently demonstrated a paucity of female and BIPOC applicants. While African American and Hispanic representation in the orthopaedic surgery applicant pool were comparable to other surgical specialties (6.6% and 8.0%, respectively), Asian applicants were underrepresented at 15.4% compared to 19.3-22.6% for other specialties (p < 0.001). CONCLUSIONS: Application to orthopaedic training programs by female and BIPOC individuals is persistently lower than in other specialties. Despite efforts to increase diversity, diversification has not accelerated signficantly. It remains important for orthopaedic residencies to continue institutional programs and grassroots efforts to encourage a diverse applicant pool.
Scientific reportsPhilipp Zehnder, Frederik Aasen-Hartz, Michael Zyskowski, Conrad Ketzer, Tobias Resch, AG Digitalisierung der DGOU, Peter Biberthaler, Dominik Pförringer
Generative AI tools such as ChatGPT (OpenAI, San Francisco, CA, USA) are showing remarkable capabilities in generating qualitative text, displaying potential to revolutionize daily life and professional practices, including medical diagnostics and education. The use of ChatGPT in publishing, especially its legal and ethical implications, is subject of growing scientific interest and discussion. The underlying study aims to understand the current status, usage patterns, and future expectations of generative AI among healthcare professionals. An anonymous online survey among healthcare professionals was distributed to members of the German society for orthopedics and traumatology (February and March 2024). The questionnaire comprised 12 questions regarding individual use of and attitude towards artificial intelligence. The responses of two age-dependent groups (group 1 ≤ 45 years vs. group 2 > 45 years) were compared. A total of 375 of 504 invited participants completed the survey (response rate 74%); 177 respondents were aged ≤ 45 years. Awareness of ChatGPT was high in both groups, while prior self-reported use was more common in group 1 (73% vs. 62%, p = 0.03). Respondents aged ≤ 45 years more often reported that they could imagine using ChatGPT for manuscript-related tasks (59% vs. 44%, p = 0.001), whereas respondents aged > 45 years more frequently supported disclosure of ChatGPT use in manuscript preparation (86% vs. 77%, p = 0.001). The age groups differed significantly in professional role distribution. In an adjusted analysis including professional position, the association between age group and AI use remained similar but not significant (unadjusted OR 1.6, 95% CI 1.1-2.4; adjusted OR 1.6, 95% CI 1.0-2.6; p 0.053). In this cohort of DGOU members, awareness of generative AI was high and self-reported use was common. Younger respondents reported more frequent use of ChatGPT and related digital tools. However, these findings should be interpreted cautiously because they reflect self-reported cross-sectional data from one professional society and do not demonstrate actual integration of AI into clinical or academic workflows. The creation of an ethical framework is therefore essential and our participants want the use to be clearly identified.
Inquiry : a journal of medical care organization, provision and financingAhmet Aybar, Kemal Gokkus, Abdullah Sukun, Yakup Yildirim
IntroductionCreator-side analytics can characterize viewing behavior around surgical videos but cannot establish learning or educational quality. We compared advanced procedural and patient-facing videos from one orthopedic YouTube channel.MethodsWe performed a retrospective cross-sectional analysis of cumulative video-level YouTube Studio metrics extracted on February 5, 2026, for videos published from June 2018 through February 4, 2026. One author classified videos using predefined title and metadata criteria. Co-primary outcomes were average view duration and video-attributed net subscriber change per 1,000 engaged views. Mann-Whitney U tests and rank-biserial correlations were used.ResultsAmong 262 included videos (175 advanced procedural; 87 patient-facing), advanced procedural videos were longer (median, 357 vs 60 seconds), had longer average view duration (107 vs 32 seconds), and had higher net subscriber change per 1,000 engaged views (8.04 vs 2.57; both p< .001). Patient-facing videos had higher average percentage viewed (61.16% vs 30.30%; p< .001). Post hoc sensitivity analyses preserved the direction and statistical significance of the comparative findings.ConclusionWithin this single channel, content type corresponded to distinct and consistent within-channel engagement patterns: advanced procedural videos sustained longer absolute viewing and greater net subscriber change per 1,000 engaged views, whereas patient-facing videos were watched more completely. Because absolute and proportional engagement diverged, these dimensions should be interpreted separately. These creator-side metrics show how different orthopedic video formats are watched and how video-attributed net subscriber change varies relative to engagement across formats, providing a single-channel behavioral reference rather than a measure of educational effectiveness or learning.
Journal of the American Academy of Orthopaedic Surgeons. Global research & reviewsTerence L Thomas, Alexander P Zavitsanos, Claude J Regis, John Czarnicki, Harrison S Fellheimer, Gabriel Onor, William L Justice, Jalen Broome, Damon V Briggs,…
BACKGROUND: Despite growing attention to workforce diversity in orthopaedic surgery, limited data exist describing the demographic composition of academic sports medicine faculty. This study examines the diversity of sports medicine fellowship-trained orthopaedic surgery faculty across US orthopaedic surgery residency training programs. METHODS: A cross-sectional analysis of all ACGME-accredited orthopaedic surgery sports medicine faculty was conducted. Faculty data included sex, race, level of professorship, residency attended, year of residency graduation, and h-index. Underrepresented in Orthopaedics (URiO) was defined as non-White and non-Asian by race and all women. Descriptive statistics were performed. RESULTS: A total of 812 sports medicine-fellowship trained faculty were included in the analysis: 91% men and 9% women. Racial distribution of faculty was 83% White, 11% Asian, 4% African American, and 1% Hispanic. The region of the United States with the greatest percentage of URiO faculty was the South Atlantic (26%). Most URiO faculty graduated from residency in the last quarter century: 42% from 2012 to 2025 and 41% from 2001 to 2011. No differences were observed between URiO and non-URiO with regard to academic rank or H-Index. CONCLUSIONS: The present findings highlight persistent disparities in diversity among orthopaedic sports medicine faculty. Intentional efforts remain warranted to mitigate structural barriers in URiO recruitment to the sports medicine subspecialty and orthopaedic surgery as a whole.
Journal of the American Academy of Orthopaedic Surgeons. Global research & reviewsNicholas J Pettinelli, Michael Anderson, Madison Blackwell, Arjun K Reddy, Chad D Hanson
BACKGROUND: Highly cited articles in orthopaedic surgery are important in shaping practice and education. However, their accessibility through open access (OA) remains unclear despite increasing emphasis on equitable research dissemination. OBJECTIVE: The aim of this study was to evaluate the prevalence of open access among the 1000 most-cited publications pertinent to orthopaedic surgery and examine trends by journal, decade, and study design. It was hypothesized that access to most of the most-cited orthopaedic publications is behind paywalls. METHODS: We conducted a cross-sectional bibliometric analysis of the top 1000 most-cited orthopaedic surgery journal articles indexed in Scopus from 1980 to 2025. OA status was determined using the Unpaywall criteria adapted by Scopus, which categorizes publications as gold, green, bronze, hybrid, or closed. Descriptive statistics, chi-square tests, and nonparametric comparisons were used to evaluate OA prevalence across article types, journals, and decades. Citation density and OA status were compared using Mann-Whitney U tests and negative binomial regression. RESULTS: Among the top 1000 cited articles, 724 (72.4%) were not available through some form of OA. 276 (27.6%) were available through OA. Most open access was tagged as bronze (12.4%) or green (11.3%), while only 3.9% were published in fully OA journals. No hybrid OA articles were identified. OA prevalence varied among top journals, with Clinical Orthopaedics and Related Research showing the highest proportion (43.2%) and the American Journal of Sports Medicine the lowest (8.1%). OA availability differed significantly by article type (χ2 = 15.88, P = 0.0032); randomized controlled trials and preclinical studies were more likely to be open than cohort studies. OA prevalence increased significantly over time, from 0% in the 1980s to 63.6% after 2020s. OA articles had higher annual citation densities (28.0 vs. 23.9 citations/year; P < 0.0001), although OA status was not a notable predictor of total citations in multivariable models. CONCLUSION: Despite positive trends in open access, most influential knowledge in orthopaedic surgery remains closed access, representing a notable barrier to the global orthopaedic community.
Journal of the American Academy of Orthopaedic Surgeons. Global research & reviewsSara Alhomaidhi, Hamza M Alrabai, Laila Alsabbagh, Abdullah Addar
Musculoskeletal disorders (MSDs) are primarily characterized by joint, bone, and connective tissue involvement, but they can also present with ocular manifestations that carry diagnostic and clinical significance. These findings such as uveitis, blue sclera, lens subluxation, and scleritis may serve as early markers of systemic disease or indicate ongoing inflammation that affects orthopaedic decision making. Despite their relevance, ocular symptoms are frequently underrecognized in orthopaedic settings, potentially delaying comprehensive care. This narrative review aims to explore the spectrum of MSDs with documented ocular involvement, examining the underlying pathophysiological mechanisms, clinical implications for orthopaedic specialists, and current recommendations for interdisciplinary management and ophthalmology referral. A literature search was conducted using PubMed, Scopus, and Google Scholar, including peer-reviewed studies published between 2016 and 2025. High-risk conditions, such as osteogenesis imperfecta, Marfan syndrome, rheumatoid arthritis, and juvenile idiopathic arthritis, were emphasized because of their ocular complexity and orthopaedic relevance. Ophthalmologic evaluation in selected musculoskeletal populations can aid in early diagnosis, improve perioperative safety, and support holistic patient care. Incorporating structured identification of patients requiring ophthalmology referral into orthopaedic protocols, especially for syndromic, pediatric, and inflammatory conditions, represents a practical step toward more comprehensive musculoskeletal management.
Acta orthopaedica et traumatologica turcicaYakup Kahve, Tahsin Aydın, Utku Gürhan
OBJECTIVE: Pediatric fractures are among the most common traumas in childhood and constitute an important public health issue. Although bibliometric studies in this field have recently appeared in the international literature, a comprehensive national-level evaluation is lacking in Türkiye. The aim of this study is to perform a bibliometric analysis of pediatric fracture research published in journals indexed in the ULAKBİM TR Index, and to examine publication characteristics, thematic trends, and interdisciplinary collaboration patterns within this indexing system. METHODS: A search was conducted in ULAKBİM TR Index database on August 15, 2025, using the keywords "çocuk" (child) "pediatrik" (pediatric), "kırık" (fracture), and "fracture." All publications containing these terms in their title or abstract were included. Bibliographic data such as year of publication, journal, authors, institutions, keywords, and citation counts were analyzed. In addition, keyword cooccurrence networks and interdisciplinary collaboration networks were generated. RESULTS: A total of 166 articles were evaluated. The highest number of publications appeared in Acta Orthopaedica et Traumatologica Turcica (17.5%) and Turkish Journal of Trauma and Emergency Surgery (10.2%). Institutional contributions predominantly originated from training and research hospitals affiliated with the Ministry of Health (59.6%). In keyword analysis, "child" (50), "surgery" (37), "method" (14), and "radiography" (11) were the most frequently used terms. In the interdisciplinary collaboration network, the strongest connections were observed between Orthopedics and Traumatology and Emergency Medicine, while contributions from fields such as Pediatrics, Radiology, and Public Health remained more limited. CONCLUSION: Pediatric fracture research published in journals indexed in the ULAKBİM TR Index suggests a gradual increase in publication activity over time, with a concentration in specific journals and institutions and a predominant focus on surgical approaches. Contributions related to rehabilitation, psychosocial effects, and long-term functional outcomes were relatively limited in the national literature. Cite this article as: Kahve Y, Aydın T, Gürhan U. A bibliometric analysis of pediatric fracture research published in journals indexed in the ULAKBİM TR index. Acta Orthop Traumatol Turc., 2026; 60(5), 0680, doi: 10.5152/j.aott.2026.25680.
Australian health review : a publication of the Australian Hospital AssociationDarryn Marks, James Todd, Michael Thomas, Steven Stern, Sharon Mickan, Wayne Hing
OBJECTIVE: Effective general practitioner (GP) referral and timely orthopaedic surgical decisions are essential for health service productivity and quality patient care, yet efficiency in this pathway is not well understood. This study evaluated GP public orthopaedic referrals up to the point of surgical determination. Aims were to estimate GP-level variability in referral volumes, types, orthopaedic resource usage, surgical conversion rates and the time and costs of orthopaedic care, up to surgical decision. METHODS: This study involved a retrospective observational cohort with cost and outcomes analysis. The 2-year cohort included all GP orthopaedic referrals to a large regional Australian public health service, orthopaedic-led care provision and costs incurred up to surgical determination (or discharge). Survival analysis used the Kaplan-Meier estimator for right censored data, with inverse probability censoring for inflation adjusted costs, expressed in Australian dollars from the health service perspective. RESULTS: A total of 18,901 referrals were identified. Referral volume was highly variable, ranging from 1 to 238 per GP. Time to surgical decision was often lengthy (mean = 520 days) and highly variable (1 week-4 years). Mean pre-surgical health service costs per referral were $785 (s.e. 11.89) and the surgical conversion rate was low (25%). Longer time periods and surgical listings were associated with greater costs. CONCLUSIONS: This large, single-centre evaluation revealed high GP referral variability, prolonged non-surgical orthopaedic care, low surgical conversion and high drop-out rates. Further research is needed to better understand the reasons behind variation in GP referral parameters and to explore ways to more efficiently align referral goals and non-surgical care across primary care and orthopaedics.
The Journal of the American Academy of Orthopaedic SurgeonsJaquelyn Kakalecik, Emily K Krisanda, Marissa N Pazik, Diana V Rijo, Jennifer E Hagen, Michael T Talerico
BACKGROUND: Although female representation at national orthopaedic society meetings has increased in recent years, women remain disproportionately more likely to deliver nontechnical presentations. Examining patterns in speaker roles provides a measurable way to assess progress toward equitable representation by sex in academic orthopaedic settings. QUESTIONS/PURPOSES: This study aimed to (1) evaluate trends in female speaker representation at the Orthopaedic Trauma Association (OTA) Annual Meeting from 2014 to 2024 and (2) assess sex-based differences in speaker roles, including the likelihood of delivering technical versus nontechnical presentations. PATIENTS AND METHODS: Speaker names, session titles, and roles (speaker, moderator, or committee member) were extracted from OTA Annual Meeting programs spanning 2014 to 2024. Sessions were classified as technical or nontechnical, and speaker sex was determined through publicly available information. A total of 514 sessions were analyzed, including 390 technical and 124 nontechnical sessions. Trends in speaker roles by sex were assessed over time, and odds ratios (ORs) were calculated to evaluate the likelihood of men versus women delivering technical presentations. RESULTS: Female representation increased across all roles over the study period. The proportion of female speakers rose from 8.85% in 2014 to 22.22% in 2024, and the proportion of female moderators increased from 4.84% to 12.99%. Four women served as committee members since 2021, with one serving as cochair. Men were significantly more likely to give technical talks in 2024 (OR 2.8, 95% CI, 1.47-5.41, P = 0.0018) and 2021 (OR 3.0, 95% CI, 1.59-5.87, P = 0.0009). CONCLUSION: Female representation at the OTA Annual Meeting has increased substantially over the past decade, mirroring trends observed in other orthopaedic subspecialty societies. However, sex-based differences in the distribution of technical versus nontechnical presentations were observed in multiple years. Continued efforts are needed to promote equitable access to academic and leadership roles for women in orthopaedic trauma. LEVEL OF EVIDENCE: Level III (retrospective observational study).
Academic emergency medicine : official journal of the Society for Academic Emergency MedicineSpencer M Tomberg, Stacy A Trent, Kathleen M Joseph
OBJECTIVES: Musculoskeletal injuries account for approximately 20% of presentations to emergency departments (ED) in the United States. While many patients can be treated exclusively by an emergency medicine (EM) clinician, others require consultation with an orthopedic surgeon. The objective of this quality improvement initiative was to develop and evaluate the effect of institutional orthopedic consultation guidelines on ED length of stay (LOS), the percentage of patients with fractures who receive an orthopedic consultation in the ED and orthopedic clinic referrals without an ED orthopedics consultation. METHODS: A multidisciplinary team of EM and orthopedic clinicians developed injury-based guidelines for ED patients defining when orthopedic consultation was required, when a phone consultation was required, and when EM clinicians should provide exclusive care. The guidelines were implemented at our institution on June 15, 2022. We performed a retrospective before-after study of all ED patients with orthopedic extremity or pelvis injuries between August 2021 and June 2023 and analyzed changes in ED metrics using multivariable difference-in-differences analysis and quantile regression. RESULTS: A total of 4013 patient visits with fractures of an extremity or the pelvis were included. After adjusting for covariates and temporal trends, ED LOS decreased by a median of 71 min (p < 0.001) after implementation of the guidelines in difference-in-differences analyses. After implementation of the guidelines, orthopedic consultation decreased by 5.5% (95% CI: -10.2, -0.8), and outpatient referrals to orthopedics without an in-person consultation in the ED increased by 11.2% (95% CI: 7.8, 14.5). CONCLUSION: Institutional guidelines for ED orthopedic consultations increased the number of patients managed exclusively by the EM service, decreased total consultations placed to the orthopedic service and decreased the ED LOS for patients at a large urban Level-1 trauma center.
Anticancer researchFlorian Lenze, Lilian Engemann, Sebastian Breden, Sara Consalvo, Carolin Knebel, Andreas Dinkel, Dietmar Dammerer, Rüdiger VON Eisenhart-Rothe, Ulrich Lenze
BACKGROUND/AIM: A substantial proportion of patients with cancer experience clinically relevant psycho-oncological distress. In addition to clinic-based screening, mobile approaches are receiving increasing attention for standardized assessment. However, evidence in patients with musculoskeletal sarcoma remains limited. PATIENTS AND METHODS: Forty-five patients with sarcoma underwent smartphone-based distress screening using a cancer-specific questionnaire (QSC-R10) at two time points (T1 and T2). At T1, patients also completed the System Usability Scale (SUS) and additional acceptability items. RESULTS: Mean QSC-R10 scores decreased significantly from T1 to T2 (p=0.034). Patients with recurrent disease showed significantly higher distress at follow-up (p=0.012). Usability was high (SUS: 83.78±12.68), and overall acceptance was high. CONCLUSION: Smartphone-based distress screening is feasible and well accepted in patients with musculoskeletal sarcoma and may improve the identification of psycho-oncological needs through repeated, real-world assessments.
PeerJMotaz Alaqeel, Abdulrahman Alaseem, Waleed Albishi, Zyad A Aldosari, Mohammed N Alhuqbani, Omar A Aldosari, Badr F Alshehri, Bandar I Aljammaz, Ibrahim S Alsha…
BACKGROUND AND AIM: Poor surgical ergonomics may be associated with an increased risk of musculoskeletal pain (MSP) and injuries among surgeons in the workplace. We aimed to assess the knowledge, attitudes, and practices regarding surgical ergonomics and to determine the prevalence of MSP among orthopedic residents in Saudi Arabia. Methods: This research employed a cross-sectional design using a modified, validated tool distributed among orthopedic surgery residents. We performed tests of association between knowledge, attitude, and practice of surgical ergonomics and demographic and clinical characteristics, as well as their impact on the prevalence of MSP. RESULTS: Among 158 orthopedic residents, 77.8% were male, with most in their first or second year of training. MSP was reported by 75.9%, predominantly affecting the lower back, feet, and neck. Trauma surgery was the most discomfort-provoking subspecialty (69%). MSP influenced fellowship decisions, mobility, and frustration tolerance. Changing posture during procedures was the most frequently used coping strategy. Greater knowledge of surgical ergonomics was associated with significantly lower odds of reporting moderate-to-severe MSP (odds ratio (OR) = 0.324, 95% CI [0.132-0.794], p = 0.014). A positive attitude toward surgical ergonomics was similarly associated with significantly lower odds of experiencing moderate-to-severe MSP (OR = 0.304, 95% confidence interval (CI) [0.108-0.855], p = 0.024). CONCLUSION: MSP was widespread among orthopedic residents and influenced both performance and career choices. Procedure-related pain impaired mobility and operative efficiency, while most residents relied on personal coping strategies in the absence of structured ergonomic support. Greater ergonomic knowledge and more positive attitudes were associated with lower odds of moderate-to-severe MSP, whereas reported practices showed no clear association. Despite broad support for formal ergonomics training, institutional provision remains limited. These cross-sectional study findings reflect associations rather than causality, underscoring the need for longitudinal research to better understand how ergonomic education and practice influence MSP over time.
International journal of medical informaticsNadav Graif, Gil Rachevsky, Alexis Sandler, David Zeltser, Amal Khoury, Roy Gigi
BACKGROUND: Although artificial intelligence-assisted radiographic fracture detection tools (AI-RFDT) have demonstrated high diagnostic accuracy in adult limb radiography, real-world evidence regarding their operational impact in the adult emergency department (ED) remains limited. METHODS: We evaluated whether deploying an AI-RFDT reduced ED length of stay (LOS) and revisit rates in fracture-excluded (F-E) patients undergoing limb radiography, using fracture-confirmed (F-C) patients as a disease-specific internal control. This retrospective controlled before-after cohort study, with complementary interrupted time-series analysis, was conducted in a tertiary Ambulatory Orthopedic ED. We included 8253F-E and 6864F-C visits between January 2021 and February 2026. Fracture status was assigned from the treating physician's ICD-coded discharge diagnosis, without study-level re-adjudication against imaging. The primary outcome was ED LOS before versus after deployment on 1 October 2023; secondary outcomes were 24-hour, 7-day and 30-day revisits. Subgroup analyses were exploratory. RESULTS: Mean F-E LOS decreased from 135.6 to 127.5 min (Δ -8.13 min; 95% CI -11.52 to -4.70; p < 0.001) and median LOS from 114.0 to 109.8 min (p < 0.001); the F-C control was unchanged (Δ + 0.37 min; 95% CI -3.95 to +4.74; p = 0.87); the cohort-by-period interaction was -7.99 min (95% CI -13.36 to -2.62; p = 0.004). The reduction was concentrated at the upper tail: no change at the 25th percentile and -24.0 min at the 90th (90th-25th difference -24.0 min; 95% CI -35.4 to -15.1); stays over four hours decreased from 11.3% to 8.2%. Interrupted time-series analysis showed a 19.2-min level decrease at deployment against a flat pre-existing trend, with no significant control change. Early revisits did not increase. CONCLUSIONS: AI-RFDT deployment was associated with decreased ED LOS in F-E patients, concentrated in the distribution's slow tail. The unchanged F-C control is consistent with an F-E-specific mechanism, with no increase in early revisits. These associations do not establish causation.
Journal of medical Internet researchEdward Lee Major Iii, Vivek P Shah, Amber N Carroll, James R Goetz, Chaitu Malempati, Sameer Badarudeen
BACKGROUND: Patient visit summaries (PVS) are patient-facing documents intended to reinforce communication and promote patient education after clinical encounters. Despite national recommendations that patient education materials be written at or below a sixth-grade reading level, most orthopedic materials substantially exceed this threshold. Current visit summaries are also time-consuming to generate, lack personalization, and often fail to meet patient literacy needs. AI-based scribes can generate personalized PVS in real time directly from patient-provider conversations, offering a potential solution. OBJECTIVE: This study aimed to evaluate the readability of AI-generated PVS produced by a commercial AI scribe platform in an orthopedic surgery setting and determine their alignment with established literacy standards for patient-facing materials. METHODS: A total of 1007 consecutive AI-generated PVS from an academic orthopedic surgery outpatient clinic between December 2023 and May 2024 were reviewed. Following standardized preprocessing, including restoration of original section headings and removal of diagnosis label headers, summaries identified as incomplete were excluded (n=25), yielding a final study cohort of 982 summaries. Readability was assessed using 5 validated indices: the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), and Simple Measure of Gobbledygook (SMOG) Index. The proportions of PVS meeting the sixth- and eighth-grade benchmarks were calculated. Spearman's rank correlation (ρ) assessed associations between word count and readability metrics. The Kendall Coefficient of Concordance (W) was used to evaluate agreement among indices after reverse-coding FRES for directional alignment. Statistical significance was set at P<.05. RESULTS: Among 982 analyzed PVS, the mean FKGL was 9.3 (SD 1.2, 95% CI 9.2-9.4) and the mean FRES was 57.6 (SD 7.9, 95% CI 57.1-58.1), corresponding to "fairly difficult." Mean scores for secondary indices were 12.4 (SD 1.6) for GFI, 11.0 (SD 1.5) for CLI, and 12.4 (SD 1.2) for SMOG. Only 0.4% (4/982) of PVS met the sixth-grade benchmark and 14.2% (139/982) met the eighth-grade threshold. Word count was not significantly correlated with FKGL (ρ=0.012, P=.70), suggesting that sentence structure and vocabulary rather than document length drive reading complexity. Readability indices demonstrated strong agreement across all 5 metrics (W=0.882, P<.001). CONCLUSIONS: In this orthopedic outpatient setting, AI-generated PVS consistently exceeded recommended patient literacy thresholds, with a mean ninth-grade reading level and only 14.2% of summaries meeting the eighth-grade standard. In the absence of a concurrent comparison group, the present study was not designed to evaluate improvement over traditional methods. These findings establish a quantitative readability baseline for AI scribe output in orthopedic surgery and highlight the need for algorithmic refinement, plain language optimization, and prospective patient comprehension testing to improve health communication.
OrthopedicsApurva S Choubey, Peter Chebi, Brett Drake, Deepa Dhillon, Sean Cooke, Majd Mzeihem, Alfonso Mejia, Mark H Gonzalez
BACKGROUND: Orthopedic surgery fellowships have evolved from optional to nearly mandatory since accreditation in 1981, yet factors influencing subspecialty selection remain incompletely defined. We evaluated orthopedic residency program director (PD) and department chair demographics and training backgrounds, resident fellowship match patterns, fellowship availability, and concordance between leadership training and resident subspecialty selection. MATERIALS AND METHODS: Using programs accredited by the Accreditation Council for Graduate Medical Education, we analyzed available PD and department chair demographics and fellowship training. Five years of alumni fellowship data and fellowship availability at each institution were collected from program websites. Descriptive statistics, chi-squared tests, and crude odds ratios (ORs) were used, with P < .05 considered significant. RESULTS: Among 109 residency programs and 5,443 recent graduates, residents most often matched into sports medicine (24.44%), arthroplasty (17.86%), and hand surgery (16.57%). PDs were most commonly trained in trauma, sports medicine, and hand surgery; chairs were most commonly trained in sports medicine, trauma, and spine surgery. Leadership was predominantly male and White (PDs: 87.16% male, 78.90% White; chairs: 93.58% male, 88.07% White). Programs offering spine, hand, or orthopedic oncology fellowships had higher match rates into those specialties than programs without them (OR: 1.20, 1.42, and 1.94; all P < .05). Residents were also more likely to enter arthroplasty when their PD was arthroplasty trained and to enter hand surgery or orthopedic oncology when their chair had concordant training. CONCLUSION: Fellowship availability and leadership training background were each associated with resident subspecialty selection. Applicants with subspecialty interests should consider both factors when evaluating residency programs.
Journal of the American Academy of Orthopaedic Surgeons. Global research & reviewsVidushan Nadarajah, Miranda Barnes, Jonathan Belding, Basilia O Nwankwo, Susan E Stephens, A Bobby Chhabra, Matthew J Deasey
BACKGROUND: Political action committees (PACs) play a crucial role in the US political landscape, supporting legislative agendas for various professional groups. The Orthopaedic PAC, established by the American Association of Orthopaedic Surgeons, exemplifies this model by directing funds to influence healthcare policy in alignment with orthopaedic interests. However, more research is needed on the correlation between PAC contributions and legislative outcomes, specifically within health care. OBJECTIVE: This study analyzed the Orthopaedic PAC's financial contributions over time, focusing on spending trends, geographic distribution, and partisan alignment to understand potential associations with healthcare legislative activity. METHODS: We conducted a retrospective quantitative analysis of Orthopaedic PAC contributions using publicly available data from the Federal Election Commission from 1999 to 2022. Contributions exceeding $200 were analyzed to assess spending patterns by party affiliation, geographic distribution, and temporal trends. Descriptive statistics contextualized Orthopaedic PAC activity within the broader healthcare PAC landscape. Geographic information systems (GIS) mapping visualized regional variations, and JMP Pro statistical software was used for all analyses. RESULTS: The Orthopaedic PAC's financial contributions have generally increased over time, with notable peaks during critical legislative cycles, such as the 2010 Affordable Care Act. Contributions generally favored Republican candidates, particularly in Texas, Alabama, and California. Geographic trends indicated concentrated support in the Southeast and Midwest regions. Comparative analyses showed that the Orthopaedic PAC outspent many other healthcare PACs, highlighting its strong financial engagement. However, no direct causative link between contributions and specific legislative outcomes could be established. CONCLUSION: This study highlights the Orthopaedic PAC's financial strategies and political alignment, underscoring its sustained engagement in healthcare policy advocacy. Although spending trends suggest a strategic response to legislative events, further research is needed to evaluate the direct impact of PAC contributions on policy outcomes.
Journal of the American Academy of Orthopaedic Surgeons. Global research & reviewsMia S Hagen, Jacquelyn Dunahoe, Kate M Parker, Christopher Y Kweon, Stephen A Kennedy
INTRODUCTION: Orthopaedic skills modules have been validated in the short term, but their effect on longitudinal development is unknown. The objective of this study was to assess whether orthopaedic surgery interns with access to a home module set had improved Objective Structured Assessment of Technical Skill (OSATS) scores at the end of the academic year compared with the start of the year and with a control class who did not have access to the modules. METHODS: In this prospective cohort study, eight incoming postgraduate year one residents ("PGY1") and eight outgoing PGY1 residents ("control") were tested on five skills modules. The PGY1 cohort had home access to modules over the year and was retested at the end of the academic year. Grading was conducted by two faculty using the OSATS Global Rating Score (GRS). Objective measures of efficiency (time) and accuracy were recorded. The performances of PGY1 at the beginning of the year versus the end of the year and PGY1 at the end of the year versus control group were compared. RESULTS: A significant improvement was observed in GRS across all modules for PGY1, and the end-of-year PGY1 performed better than the control cohort across all modules (all P < 0.05). For the PGY1 cohort, beginning-of-year versus end-of-year accuracy improved in drill plunge from 13.7 ± 8.6 to 5.7 ± 2.1 millimeters (P = 0.034) and efficiency improved in angled drilling from 37.6 ± 22.5 to 12.0 ± 3.6 seconds (P = 0.017). The end-of-year PGY1 demonstrated greater efficiency in drill plunge, depth gauge, and angled drilling compared with the control cohort (all P < 0.05), with no significant differences in task accuracy. CONCLUSION: The 1-year implementation of low-cost orthopaedic skills modules was associated with improved skill performance among the PGY1 residents relative to their performance at the beginning of the year and relative to a class of control residents who did not have access to the modules.
Archives of orthopaedic and trauma surgeryBartosz Maciąg, Krzysztof Bujak, Dawid Jegierski, Artur Stolarczyk
INTRODUCTION: Artificial intelligence (AI) has evolved rapidly in recent years and is becoming increasingly integrated into many areas of medicine. In the medical field, these systems have attracted considerable attention because of their potential applications in clinical decision support, medical education, scientific communication, and postgraduate training. The aim of the present study was to evaluate whether ChatGPT could achieve a passing score on the Polish National Medical Specialization Examination (Panstwowy Egzamin Specjalizacyjny, PES) in orthopedics and traumatology and to determine how different prompting strategies influenced its performance. MATERIALS AND METHODS: Authors systematically assessed the performance of ChatGPT-4 across five consecutive official PES exams (from Autumn 2023 to Spring 2025) in orthopedics and traumatology. Each exam was administered using three distinct prompting strategies: Professor prompt, Specialist prompt, Resident prompt. For each exam session (e.g., Spring 2024, Autumn 2023), the prompts were submitted to ChatGPT sequentially. The model's responses were evaluated against the official answer key published by the Polish Center of Medical Exams (Centrum Egzaminów Medycznych, CEM). RESULTS: The results were averaged across all prompts. The overall accuracy was 81% (range: 68.33%-85.83%). The highest score (85.83%) was recorded multiple times across different prompt types, indicating that the model could approach or exceed the minimum passing threshold depending on prompt structure. Agreement between prompting strategies was moderate to substantial (Cohen's κ 0.518-0.632; Fleiss' κ = 0.571). Radiology-related questions demonstrated the highest error rate among all question categories. CONCLUSIONS: Large language models such as ChatGPT can perform well on knowledge-based orthopedic examinations and may serve as useful tools for examination preparation and educational support. However, examination success should not be interpreted as evidence of clinical competence or readiness for independent surgical practice. Specialist certification and patient care remain dependent on human expertise, practical skills, and professional responsibility.
Journal of orthopaedic surgery (Hong Kong)Raghu Yelavarthi, Ravi Chandra Vattipalli
Urban orthopaedic practice in India is undergoing profound organisational change driven by population ageing, an increasing burden of musculoskeletal disease, expanding subspecialisation, technological advances, and growing regulatory and quality-reporting requirements. These developments have renewed interest in organisational models capable of supporting coordinated, high-quality musculoskeletal care while maintaining clinical efficiency and professional sustainability. This structured narrative review evaluates contemporary organisational models of orthopaedic practice, with particular emphasis on structured group practice, within the Indian healthcare context. A structured narrative review was undertaken using PubMed as the primary database, supplemented by targeted Google Scholar searches and manual reference screening. Forty-five publications meeting predefined eligibility criteria were included in the final narrative synthesis. Evidence relating to orthopaedic practice organisation, subspecialisation, volume-outcome relationships, multidisciplinary care, clinical governance, registry participation, workforce wellbeing, health-system organisation, and practice sustainability was synthesised. The available literature suggests that structured group practice may facilitate subspecialty-focused care, multidisciplinary collaboration, standardisation of perioperative pathways, registry participation, continuous quality improvement, and equitable workload distribution. However, direct comparative evidence demonstrating superiority over well-organised solo or small-group practice remains limited, particularly in India. Many reported advantages appear to arise from effective evidence-based organisational processes rather than organisational size alone. The available evidence suggests that organisational models capable of supporting multidisciplinary care, clinical governance, and evidence-based organisational processes are increasingly important for contemporary orthopaedic practice. Structured group practice represents one context-dependent organisational approach that may be particularly relevant to urban India. The review identifies important evidence gaps, particularly the lack of comparative Indian studies, and highlights priorities for future research.
Acta orthopaedica BelgicaA Sidhu, S Bharadwaj, C Ravichandran, K Swaminathan, V Pannirselvam, S Srinivasan
Ethical, legal, and economic considerations, alongside working-hour restrictions, have reduced opportunities for surgical training in the operating theatre, prompting the adoption of hands-on workshops as an alternative approach. These workshops provide trainees with a controlled environment to develop technical skills, decision- making, and confidence using a variety of simulation modalities, including synthetic models, cadaveric specimens, and virtual reality platforms. This scoping review aimed to map the existing literature on hands-on workshops in orthopaedic surgical training and examine how their educational design and outcomes are reported. A systematic search of PubMed, Cochrane Library, Embase, and Google Scholar was conducted for English-language studies published within the past 10 years, focusing on trauma and orthopaedic training for medical students and healthcare professionals. Review articles, letters, and non-English publications were excluded. Forty-five studies met inclusion criteria, most reporting improvements in performance-based outcomes following participation in hands-on workshops. Commonly used modalities included synthetic simulators, arthroscopy trainers, and virtual reality, with fewer studies incorporating cadaveric specimens. Reported outcomes included technical performance, procedural efficiency, and trainee confidence, primarily assessed in simulated or cadaveric settings. Findings were heterogeneous, and evidence linking workshop participation to direct clinical outcomes was limited. Resource considerations, including cost and accessibility, were frequently noted as challenges. Overall, the literature suggests that hands-on workshops and simulation-based interventions are widely employed in orthopaedic training and are associated with improvements in educational outcomes. These findings highlight the potential role of hands-on workshops in surgical education while underscoring the need for further research to clarify their translati.
Acta orthopaedica BelgicaA I Al Alawi, S Al Kalbani, A M Al Barwani, R S Al Weshahi
Cobb angle measurement is essential for diagnosing and monitoring scoliosis; however, its accuracy varies with observer experience. In many healthcare systems, including Oman, initial measurements are commonly performed by residents and influence referral urgency, follow-up intervals, and bracing decisions, where even small inaccuracies may alter clinical pathways. This study evaluated the inter- and intra-observer reliability of Cobb angle measurement among orthopaedic residents and spine specialists. A prospective comparative reliability study was conducted including 18 OMSB orthopaedic residents (PGY2-5) and five spine specialists. Each participant measured Cobb angles on five standardised standing scoliosis radiographs on two occasions, four weeks apart. Inter- and intra-observer reliability were assessed using the intraclass correlation coefficient (ICC) with a two-way random-effects, single-measurement, absolute-agreement model [ICC(2,1)], and Bland-Altman plots were used to assess intra-observer reproducibility. Mean Cobb angles ranged from 45° to 56°. Inter-observer reliability was poor among residents (ICC = -0.219; 95% CI -1.41 to 0.485) and remained low among specialists (ICC = 0.120; 95% CI -2.28 to 0.898). Intra-observer variation averaged approximately 5°, with a Bland-Altman mean bias close to zero and limits of agreement of ±5%. Negative ICC values indicated that between-observer variability exceeded within- observer consistency. Residents demonstrated markedly poorer inter-observer reliability compared to specialists, highlighting the impact of clinical experience on accurate end-vertebra selection and angle measurement. Targeted training modules and structured exposure during residency may improve measurement consistency, referral accuracy, and overall scoliosis management pathways.
The bone & joint journalLuke Farrow, Scott Purdie, Jonathan T Evans, Tom Krause, Marion Campbell
There is increasing global recognition of the importance of sustainability in the design and delivery of healthcare, including trauma and orthopaedics. There has, however, to date been little focus on providing high-quality research which includes environmental outcomes to guide clinical practice. This annotation explores the importance of including sustainability outcomes using three key carbon-related domains, and highlights the urgent need for the incorporation of sustainability outcomes into future clinical trials.
Journal of the American Academy of Orthopaedic Surgeons. Global research & reviewsFatumastar O Adan, Kehinde S Agoro, Venkat Rao, Brian P Cunningham, Allison J Rao
INTRODUCTION: The growing applications of artificial intelligence (AI) is transforming the healthcare landscape by reshaping diagnostics, workflow operations, and clinical decision making. Among its most promising application in surgery is the development of AI scribes designed to reduce the burden of documentation. This review examines standard and emerging documentation tools with a focus on orthopaedic surgery. METHODS: A narrative review of the applications of AI and AI scribes in orthopaedic surgery was done. Literature searches were conducted using PubMed and Google Scholar through July 2025. Keywords included AI, documentation, scribes, AI scribes, and electronic health record. Articles were included if they focused on clinical documentation with particular relevance to orthopaedic surgery. In addition, a targeted review of commercially available AI scribe platforms was conducted, extracting advertised features including orthopaedic note tailoring, EHR integration, security policies, cost, strengths, and potential areas of consideration. RESULTS: The standard documentation approaches, including human transcription services, medical scribes, and frontend speech recognition software, provide partial relief from documentation burden but remain limited by cost, scalability, and workflow integration. Although human transcription services and medical scribes can capture nuanced clinical information and provide real-time support, they are constrained by turnaround time, financial burden, and scalability challenges. By contrast, emerging AI scribe platforms offer EHR-integrated, ambient documentation solutions but vary widely in cost, scalability, and orthopaedic-specific customization, highlighting ongoing challenges in addressing the unique documentation demands of orthopaedic practice. DISCUSSION: AI scribes represent a promising evolution in clinical documentation for orthopaedic surgery. Although early results are encouraging, further specialty-specific validation is needed to address orthopaedic workflows, ensure accuracy, and define optimal implementation strategies; however, ethical considerations and patient privacy protections remain essential to safe and responsible implementation.
Journal of the American Academy of Orthopaedic Surgeons. Global research & reviewsPhilip M Lee, Sasha Rovinsky, Mason J A Caldwell, Andrew T Nguyen, Eli M Snyder, Desmond Soares, Tu'uau S Mauiliu, Areta Samuelu, Seioh Ezaki, Kelly Withy, Rob…
Pacific Island countries face persistent and profound gaps in access to essential orthopaedic care driven by geographic dispersion, fragile infrastructure, and workforce shortages. Reliance on overseas medical referral schemes, often politically influenced and consuming substantial portions of limited health budgets, can improve access for individual patients but fails to build local capacity or ensure timely intervention for trauma and infection. Evidence from low- and middle-income settings demonstrates that "train-in-place" education models can expand the workforce, improve care processes, and reduce preventable disability. The Pacific Islands Orthopaedic Association exemplifies a regionally tailored approach through a tuition-free curriculum that retains trainees within their home health systems, reintegrates graduates as educators, and progressively reduces dependence on expatriate teams. To translate this model into durable system-level gains, parallel investments in procurement, supply chains, biomedical maintenance, and enabling policy are essential. Standardized capacity assessments encompassing workforce, case mix, infrastructure, readiness, and overseas medical referral utilization, coupled with regional train-in-place orthopaedic education, offer a scalable pathway to timely, high-quality care across the Pacific. The purpose of this article was to evaluate the current literature on strategies to increase access to musculoskeletal care in the Pacific, with a focus on home-training programs in the Pacific and their cost effectiveness.
Journal of the American Academy of Orthopaedic Surgeons. Global research & reviewsSamantha N Olson, Marisa N Ulrich, Cody C Wyles, Derek F Amanatullah
Artificial intelligence (AI) has rapidly integrated into multiple facets of society, specifically within the realm of orthopaedics. To understand its effects, we provide an overview of AI models, their presence in health care over time, current integrations, and regulations regarding AI. This overview highlights different perspectives, the variety of influences that AI currently has, and the implications for the future of orthopaedics. AI is agnostic to the outcome and will have both a positive and negative effect on the next generation of trainees, educators, practitioners, consumers, and leaders, necessitating proactive discussions about AI.
Journal of the American Academy of Orthopaedic Surgeons. Global research & reviewsFiras Moussa, Thomas Leonard, Mitchell J Christiansen, Mary K Mulcahey
INTRODUCTION: Digital promotion of orthopaedic research is increasingly associated with scholarly visibility yet the influence of specific social media posting characteristics on online attention remains unclear. The Altmetric Attention Score (AAS) is a weighted score that measures the amount of attention a study has received. The score is based on three factors: the volume of mentions, the medium the mention came from, and the author of the mention. In orthopaedic research, a higher AAS is correlated with higher citation rates. The purpose of this study was to examine the relationship between AAS and the presence of various types of multimedia in posts on X by orthopaedic surgery journals and the time posts were made. METHODS: Data were collected from the X accounts of the British Journal of Sports Medicine (BJSM), Journal of Bone and Joint Surgery (JBJS), Arthroscopy, Journal of Arthroplasty, American Orthopedic Society for Sports Medicine Journals (AOSSM), and Journal of the American Academy of Orthopaedic Surgeons (JAAOS) over two separate periods, January 1, 2023, to June 31, 2023, and July 1, 2024, to December 31, 2024. Media types were classified into the following categories: no media, text only, simple media, infographics, and videos. To analyze the effect of post time on AAS score, posts were grouped into three different time groups: 10 pm to 5:59 am, 6 am to 1:59 pm, and 2 pm to 9:59 pm. Statistical analysis for data sets with three or more groups was done with an Analysis of Variance (ANOVA) with post hoc t-tests performed when statistical significance was found. For data sets with only two groups, t-tests were done. RESULTS: One-way ANOVA results showed a significant difference in the average AAS between media types for the Journal of Bone and Joint Surgery (JBJS) in the 2024 period (P < 0.01) and in Arthroscopy for both the 2023 and 2024 periods (P < 0.0001 and P < 0.05, respectively). Post hoc t-tests showed a significant difference in average AAS between simple media and infographics for JBJS in 2024 with average AAS scores of 2.81 and 11, respectively (P < 0.001). In 2023, Arthroscopy showed significant differences in the average AAS of simple media vs infographics, simple media vs text only, and infographics vs no media (P < 0.0001, 0.0001, and 0.05, respectively). In 2024, Arthroscopy showed significant differences in average AAS for simple media vs infographics, videos vs infographics, and videos vs text only with P < 0.05, 0.005, and 0.05, respectively. For the American Orthopaedic Society for Sports Medicine (AOSSM) journals, t-tests showed a statistically significant difference in average AAS between posts made from 6 am to 1:59 pm and posts made from 2 pm to 9:59 pm with a P < 0.05 and average AAS of 12.9 and 74.5, respectively. CONCLUSION: Although results were not consistent across all journals, one trend was the increased AAS of infographics. This repeated success suggests a promising avenue for orthopaedic journals to improve the reach of their studies by increasing the utilization of infographics. Time posted did not seem to have a notable effect on AAS, but for the AOSSM Sports Medicine journals, the time frame of 2 pm to 9:59 pm may be an optimal time to maximize reach. Future studies with larger data sets and the development of an objective media classification system may provide an avenue toward strengthening the findings of this study and developing more precise strategies for orthopaedic journals to optimize their social media presence.
ObjectiveThis study evaluates the performance of large language models (LLMs)-ChatGPT-4.0, Gemini 2.0 Pro, o3-mini, Doctor GPT and DeepSeek-V3-in a national orthopaedic proficiency examination and explores their implications for health informatics and medical education. The responses of these models were analysed to assess accuracy rates and differences between models.MethodA total of 100 multiple-choice questions from the 2024 TOTEK examination were administered to each AI model under identical conditions. Correct and incorrect responses were recorded, and differences in performance were evaluated using chi-square testing and frequency analysis. Question categories were also compared to identify domain-specific variations.Resultso3-mini achieved the highest accuracy rate (79%), while Gemini 2.0 showed the lowest (68%); all models exceeded the 60% pass threshold. A statistically significant difference between models was identified in the Surgical Procedures category, in which Gemini 2.0 answered fewer questions correctly (23/36) than the other models (30-32/36) (χ2 = 9.87, df = 4, p = 0.043). No significant differences were observed in the remaining categories (all p > 0.05), and the overall difference in accuracy between models did not reach statistical significance (χ2 = 4.01, df = 4, p = 0.405). Clinical decision-making and visual content-based questions were the most challenging for all models.ConclusionAI models demonstrate generally high accuracy in medical examinations; however, they struggle with interpreting clinical context, recognising atypical medical scenarios and answering questions involving visual content.
Journal of robotic surgeryZibo Gao, Yang Liu, Honglin Liu, Meiping Yang, Fangzheng Lin, Dingkun Lin, Yongjin Li
Extended reality (XR) technologies have made remarkable progress and been widely applied in orthopedic surgical education, offering a valuable and innovative pathway for traditional surgical training paradigms. Current reviews have not yet systematically synthesized the multimodal XR application landscape and emerging artificial intelligence (AI)-enabled adaptive tutoring technologies, making a comprehensive bibliometric analysis necessary to delineate the global research status and evolutionary trajectory of this field. Based on the Web of Science Core Collection, this study retrieved relevant literature published from 2000 to 2025 and screened 420 eligible publications following the PRISMA 2020 Guidelines. Multiple analytical tools were employed to investigate publication trends, geographical distribution, collaboration networks, research hotspots, and citation bursts. The field has undergone three developmental stages: initial exploration, steady growth, and explosive expansion. The USA, the UK, and China dominate the global research output with noticeable regional disparities, and McGill University ranks first in publication volume. Research foci have shifted from conventional virtual reality and augmented reality simulators toward the integration of AI with XR technologies, with AI demonstrating the strongest citation burst from 2020 to 2025. Technological advancement and post-pandemic demand for remote education have jointly driven the rapid growth of this field, and global research presents distinct developmental patterns between developed and emerging economies. Future research may further deepen the integrated application of AI and XR technologies, and expand cross-border academic collaboration to facilitate the inclusive and high-quality development of technological outcomes in this domain.
Journal of surgical educationJordan Tanyi, Samantha Little, Chinenye O Ogbonnah, Jeremiah Ageh, Melvyn Harrington
OBJECTIVE: Visiting student scholarships are increasingly offered by orthopedic surgery residency programs to reduce financial barriers to away rotations. We sought to determine the prevalence of these scholarships, characterize programs offering them, and evaluate whether scholarship availability is associated with underrepresented in medicine (URiM) resident representation after accounting for program size and state-level anti-DEI legislation. DESIGN: Cross-sectional observational study using publicly available program-level data from the 2024 to 2025 application cycle. Associations were evaluated using multivariable logistic regression, negative binomial regression, and binomial generalized linear models. SETTING: U.S. Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopedic surgery residency programs. PARTICIPANTS: Of 210 orthopedic surgery residency programs listed on the AAMC Residency Explorer™ tool, 187 programs with complete demographic and program characteristic data were included. RESULTS: Seventy-four programs (39.6%) offered visiting student scholarships, with availability concentrated in larger, university-based programs. After adjustment, scholarship availability was not independently associated with the presence of ≥1 URiM resident (OR 1.01; 95% CI, 0.28-3.62; p = 0.985) or with URiM resident count (IRR 1.13; 95% CI, 0.78-1.64; p = 0.527) or proportion (OR 1.14; 95% CI, 0.95-1.36; p = 0.156). Program size was consistently associated with both scholarship availability and URiM representation across all models. State-level anti-DEI legislation was not independently associated with URiM outcomes. CONCLUSIONS: Although visiting student scholarships may reduce financial barriers to away rotations, they were not independently associated with URiM representation after accounting for structural program characteristics. Program size, used as a proxy for institutional capacity, was the strongest predictor of URiM representation across all models. These findings suggest that scholarships may be a necessary but insufficient component of a comprehensive diversity recruitment strategy, and that surgical educators should consider embedding financial access mechanisms within broader institutional efforts that include mentorship, holistic review, and inclusive training environments.
Journal of medical Internet researchTusheng Li, Ziqian Ma, Baodong Wang, Ning Fan, Aobo Wang, Lei Zang
BACKGROUND: Orthopedic-related rare diseases are difficult to diagnose because of their low prevalence, heterogeneous phenotypes, and fragmented knowledge. Large language models (LLMs) can serve as dynamic knowledge-support tools, but their diagnostic performance and effect on physicians' decision-making remain unclear. OBJECTIVE: This study aims to compare the diagnostic performance of advanced LLMs for orthopedic-related rare diseases and to evaluate the effect of a 2-stage LLM-assisted diagnostic workflow on physicians' diagnostic accuracy and subjective acceptance. METHODS: We selected 40 orthopedic-related rare diseases from the Chinese Rare Disease Catalog. A total of 4 general-purpose LLMs each generated 1 primary diagnosis and 5 differential diagnoses per case. Diagnostic accuracy, defined as a correct primary diagnosis, was compared using the Cochran Q test and pairwise McNemar tests with Bonferroni correction. A representative LLM was integrated into a 2-stage workflow involving 27 intermediate and 15 senior orthopedic physicians. Physicians first diagnosed all cases independently and then rediagnosed the same cases after reviewing nonauthoritative LLM suggestions. Physician diagnostic data were primarily analyzed using mixed-effects logistic regression at the individual-diagnosis level. Case-level group accuracy was additionally assessed using >50% and ≥2/3 accurate-physician thresholds. After both rounds, physicians completed an 8-item Likert-scale questionnaire assessing subjective acceptance and workflow perceptions. RESULTS: Claude Sonnet 4.5, ChatGPT-5.0, and Gemini 2.5 Pro each achieved 90% (36/40) primary-diagnosis accuracy, whereas DeepSeek-V3.2 achieved 67.5% (27/40; Cochran Q P<.001). Before LLM assistance, mean physician-level accuracy was 42.22% for intermediate physicians and 58.67% for senior physicians; after assistance, it increased to 68.80% and 83.33%, respectively. In the primary mixed-effects logistic regression analysis, physician seniority group and LLM assistance stage were significantly associated with diagnostic correctness (both P<.001), whereas the group-by-stage interaction was not significant (P=.10). Secondary case-level analyses using the >50% threshold showed improvement from 40% (16/40) to 67.5% (27/40) for intermediate physicians and from 57.5% (23/40) to 82.5% (33/40) for senior physicians, with similar findings using the ≥2/3 threshold. Cases accurately diagnosed by all 3 agents increased from 16 to 27. The questionnaire showed high internal consistency (Cronbach α=0.902) and generally positive attitudes, with no significant differences between physician groups (P=.11 to P=.78). CONCLUSIONS: LLMs achieved high diagnostic accuracy for orthopedic-related rare diseases. In the 2-stage LLM-assisted workflow, LLM assistance was associated with higher diagnostic correctness in both physician groups, although seniority-related differences in the magnitude of benefit require evaluation in larger studies. Senior physicians retained higher diagnostic correctness than intermediate physicians. Secondary case-level analyses suggested attenuation of group-level gaps in case-recognition patterns. Physicians reported broadly positive workflow perceptions. Given the same-day repeated-case design and potential short-term recall bias, these exploratory findings should be interpreted cautiously and warrant prospective randomized, crossover, washout-period, independent-case, or real-world evaluations of LLM-assisted diagnostic workflows in orthopedics.
Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and TraumatologyFilippo Migliorini, Raju Vaishya, Nicola Maffulli, Jörg Eschweiler, Philipp Kobbe, Marcel Betsch, Luise Schäfer, Francesco Oliva, Fabrizio Rivera
BACKGROUND: Orthopaedics, as a surgical speciality with a structurally narrower citing audience and lower citation density than general medicine, is systematically disadvantaged in any cross-disciplinary comparison relying on absolute citation counts. Whether this disadvantage is stable or has changed over time has not been previously quantified. METHODS: The 100 most-cited articles indexed in the Web of Science Core Collection were identified for medicine and orthopaedics in 2014 and 2024. Citation data were extracted from a single snapshot taken on 19 January 2026. Total citations and citation velocity, defined as citations per year since publication, were compared between fields and across time points using Mann-Whitney U tests. Ratio-based analyses and distributional characteristics were also assessed. RESULTS: Median citation counts were substantially higher in medicine than in orthopaedics in both years, reaching 5055 versus 288 in 2014 and 720.5 versus 34.0 in 2024, corresponding to 17.6- and 21.2-fold differences, respectively. Citation velocity followed the same pattern, with medicine maintaining an approximately 17- to 21-fold advantage at both time points. Within-field temporal analysis showed that citation velocity remained broadly stable in medicine between cohorts, whilst orthopaedics demonstrated reduced early citation accrual in the more recent cohort. Citation distributions were more right-skewed in medicine, with a small number of articles accounting for a disproportionate share of total citations, whereas orthopaedic citations were more evenly distributed across the top 100. CONCLUSIONS: Orthopaedics demonstrated substantially lower citation performance than general medicine articles, and this gap appeared to persist over time.
Journal of surgical educationSarah Bergren, Julian Wier, Hannah Shelby, Fergui Hernandez, Jacob R Ball, Hyunwoo P Kang, Jay R Lieberman
OBJECTIVE: Orthopedic surgery remains one of the most competitive specialties in the United States residency match processes. Many factors are considered when evaluating applicants, including the Standardized Letters of Recommendation (SLORs). Away rotations play another instrumental role in the match. As both SLORs and away rotation play an important role in the orthopedic surgery match process, it is important to understand how home versus away SLOR writers influence match rates. SETTING: An individual, academic orthopedic surgery residency program accredited by the Accreditation Council for Graduate Medical Education in the United States. PARTICIPANTS: Individual applications submitted to the residency program for the 2023 to 2024 orthopedic surgery residency application cycle were reviewed. After identifying 8.9 as the 50th percentile of SLOR scores, SLORs were divided into "high" scores (>8.9) and "low" scores (≤8.9) (50th percentile) and match rates to orthopedic surgery programs between high and low scoring SLORs were compared using an adjusted odds ratio, while accounting for demographic and academic variables. RESULTS: About 350 SLORs were identified from 200 unique applications with an average score of 8.7 ± 1.2, without differences between scores from home versus away institutions. The unadjusted match rate for applicants with a high home SLOR score was 88.5%, while those with a high away SLOR score only demonstrated a 66.0% match rate. After adjusting for confounding variables, applicants with a high scoring home SLOR were 4 times more likely to match than applicants with a high scoring away SLOR (p = 0.017). There was no difference in match success of applicants with low scoring SLORs from home versus away institutions. CONCLUSIONS: Applicants with high-scoring home SLORs were associated with significantly improved match rates than those received from away rotations only, despite no significant difference in actual SLOR score.
Journal of the American Academy of Orthopaedic Surgeons. Global research & reviewsLogan M Good, Matthew R Magro, Jeremy M Adelstein, Margaret A Sinkler, Abigail M Braden, John M Apostolakos
Artificial intelligence (AI) has a broad impact on health care across orthopaedic surgery and numerous other subspecialties through various applications, including the enhancement of diagnostic imaging, robotic assisted surgeries, and rehabilitation protocols. More recently, AI-powered electronic medical record integration with platforms, such as DeepScribe, Augmedix, Suki, Abridge, Nuance Dragon Ambient eXperience, and Clinical Notes AI, have enabled hospital systems to enhance their operational value while streamlining patient care and reducing burnout for clinicians. Although these systems can notably reduce clinician workload while accurately and efficiently transcribing clinical encounters, concerns exist regarding patient confidentiality and data encryption, cost, and ease of integration within healthcare systems. Further studies are needed to elucidate the long-term impact and outlook of AI healthcare integration, particularly within the electronic medical record system.
Biomedical materials (Bristol, England)Nikhil Anand, Kaushik Pal
The selection of biomaterial is crucial for the long-term success of implants. Materials that perform an adequate function and reduce negative biological responses should be taken. Due to their good mechanical strength, stainless steel, titanium, and Co-based alloys have been utilized for implant purposes; however, their permanent nature and very low corrosion rates may lead to long-term clinical complications. Researchers are looking for biomaterials that combine suitable mechanical properties with controlled and uniform degradation behaviour. In the last decade, magnesium and iron-based alloys have been seen as a good alternative and examined as promising biodegradable metals for implant applications. However, their excessively rapid corrosion (Mg) or extremely slow degradation (Fe) imposes significant limitations on their clinical applicability. In recent times, zinc-based alloys have been seen as new materials that will challenge magnesium and iron-based alloys. Zn2+ions released from zinc metal corrosion play a crucial role in bone metabolism, enzymatic activity, and cellular proliferation. However, the low mechanical strength and limited ductility of pure zinc restrict its direct utilization in load-bearing implants. Therefore, the fabrication of high-strength and ductile zinc-based alloys while maintaining biocompatibility and suitable corrosion rate remains a main research challenge. This article critically assesses and compares the mechanical properties, corrosion behaviour, and biocompatibility of magnesium-, zinc-, and titanium-based alloys, and inspects the impact of advanced fabrication methods, particularly additive manufacturing, on microstructure evolution and implant performance.
PloS oneUtku Murat Kalafat, Hüseyin Mutlu, Ramiz Yazıcı, Murat Genç, Bensu Bulut, Medine Akkan Öz, Ayşenur Gür, Mehmet Yortanlı, Uğur Şakar
BACKGROUND: Supracondylar humeral fractures constitute 10-16% of pediatric skeletal injuries, requiring timely diagnosis to prevent neurovascular complications. Developmental variations in pediatric bone structures pose diagnostic challenges for clinicians. This study evaluated three next-generation large language models (LLMs) (ChatGPT-4o, Gemini 2.0, Claude 3.5) for detecting pediatric supracondylar humeral fractures and their classification according to the Gartland system. METHODS: This retrospective observational study included 300 pediatric patients (150 with supracondylar humeral fractures confirmed by expert consensus, 150 without fractures) aged 2-10 years presenting to the Emergency Department of the Bilkent City Hospital (October 2022-January 2025). Two-view elbow radiographs were presented to each LLM three times on different days. Diagnostic accuracy was evaluated using overall accuracy (all three responses correct), strict accuracy (≥2 correct responses), and ideal accuracy (≥1 correct response). Response consistency was assessed using Fleiss' Kappa coefficient. Fractures were classified according to modified Gartland criteria. RESULTS: Gemini 2.0 demonstrated highest sensitivity (68.4%) followed by Claude 3.5 (58.7%) and ChatGPT-4o (19.3%) for fracture detection (p < 0.001). Ideal accuracy rates were 83.3%, 78.7%, and 27.3% respectively. Although ideal accuracy rates exceeded 91% in non-fracture cases, specificity remained low (33.1-36.0%), indicating a high rate of false-positive classifications. Response consistency was very good for ChatGPT-4o (κ = 0.69) and Gemini 2.0 (κ = 0.61), good for Claude 3.5 (κ = 0.44). For Gartland classification, Gemini 2.0 achieved highest accuracy: Type I (83.3%), Type II (62.4%), Type III (68.7%). CONCLUSION: Current LLMs demonstrate limited capability as independent diagnostic tools for pediatric supracondylar humeral fractures. Gemini 2.0's 68.4% sensitivity indicates these technologies require specialized pediatric training before clinical implementation. However, their potential as assistive tools for triage and assessment warrants further development of pediatric-specific models.