OBJECTIVE: The aim of this study was to assess the stress level and depression among orthopaedic surgeons in Saudi Arabia. In addition, to evaluate orthopedic training programs related factors that might have a critical role in the development of depression among orthopaedic surgeons.
METHODS: The study adopted a cross-sectional study design. Two validated questionnaires were utilized, the Patient Health Questionnaire 9 (PHQ-9) and the Perceived Stress Scale (PSS-10) for assessing depressive symptoms and stress levels. Data was collected by sending the survey to the Saudi Commission for Health Specialties so they could be distributed throughout all registered orthopaedic surgeons.
RESULTS: The study sample consisted of 325 participants. The results revealed that the severity of depression varied across the different groups. As per the PHQ-9 criteria, 74 (22.8%) were initially diagnosed with major depression. Among assistant consultants, 39.5% reported severe depression, while 34.9% reported mild depression. Consultants predominantly reported moderate perceived stress (82.9%) with a notable proportion experiencing high perceived stress (12.4%). Assistant consultants showed a balanced distribution, with 93.0% reporting moderate perceived stress and 4.7% reporting high perceived stress. Demographic variables gender, relationship status and having children revealed statistically significant relationship with PHQ-9 scores (p-value < 0.05) but not with PSS-10 scores.
CONCLUSIONS: The study highlights pressing need to address mental health concerns within orthopaedic surgeons. To address these challenges, healthcare institutions should implement comprehensive mental health support programs offering resources for stress management, counseling services, and peer support groups.

OBJECTIVE: International English language publication activities in orthopaedic surgery comparing the years 2008/09 to 2018/19 were analyzed.
METHODS: 20 international journals listed on PubMed were examined. The impact factor (IF) for each journal was determined using the InCites Journal Citation Report.
RESULTS: 9,205 publications in 2008/09 and 15,549 in 2018/19 with 21,435 cumulative IF (CIF) in 2008/09 and 50,552 in 2018/19 were registered. Most publications consisted of narrative reviews (42.0%), followed by clinical studies (22.0%), experimental investigations (16.9%), randomized controlled trials (6.0%), and meta-analyses (5.6%). The highest increase in publications was observed for narrative reviews from 33.5% in 2008/09 to 41.1% in 2018/19. The USA had the highest number of publications (2,981 and 4,796), followed by UK (806 and 879) and Germany (606 and 922) in 2008/09 and 2018/19, resp. Per 1 Mio inhabitants, Switzerland (13.6 and 28.4), Sweden (10.9 and 18.1), the Netherlands (9.6 and 15.4), and Denmark (9.0 and 21.8) were the most productive countries in 2008/09 and 2018/19, resp.
CONCLUSIONS: International publishing activity in orthopaedic surgery has increased substantially over the last 10 years. The quality of the published articles has not increased in the same way, as evidenced by the disproportionate rise in narrative reviews. Over the entire period, the US were the leader with respect to number of publications and CIF. In terms of population, however, smaller countries such as Switzerland and Sweden were much more active.

UNASSIGNED: Non-attendance with scheduled postoperative follow-up visits remains a common issue in orthopaedic clinical research. The objective of this study was to identify the risk factors associated with loss to follow-up among elderly patients with hip-fracture postoperatively.
UNASSIGNED: A retrospective analysis of 1-year post-surgery was performed on patients aged over 60 years who underwent hip-fracture surgery from January 2017 to March 2019. Based on their completion of the appointed follow-up schedule, the patients were classified into 2 groups: the Loss to Follow-up (LTFU) Group and the Follow-up (FU) Group. Clinical outcomes were evaluated by Functional Recovery Score (FRS) questionnaires. Telephone interviews were conducted with patients lost to follow-up to determine the reasons for non-attendance. A comparative analysis of baseline characteristics between the 2 groups was implemented, with further exploration of statistical differences through logistic regression.
UNASSIGNED: A total of 992 patients met the inclusion criteria were included in this study, of which 189 patients, accounting for 19.1%, were lost to follow-up 1 year postoperatively. The mean age of the patients in the LTFU Group was 82.0 years, significantly higher than the 76.0 years observed in the FU Group (P < 0.001). The FRS for the LTFU Group was marginally higher than that of the FU group (84.0 vs 81.0), with no significant difference (P = 0.060). Logistic regression analysis identified several significant predictors of noncompliance, including advanced age at surgery, femoral neck fracture, hip arthroplasty, long distance from residence to hospital, and the reliance on urban-rural public transportation for reaching the hospital.
UNASSIGNED: Postoperative follow-up loss was prevalent among elderly patients with hip fractures. Our study indicated a constellation of risk factors contributing to noncompliance, including advanced age, transportation difficulties, long travel distance, femoral neck fracture and hip arthroplasty surgery.

BACKGROUND: The Vice-chair (VC) position is gaining popularity in academic orthopaedic surgery departments; however, there is a paucity of information regarding qualifications and career advancements associated with this role. The purpose of this study was to define the characteristics of current orthopaedic surgery department VCs.
METHODS: Descriptive study following a retrospective web-based search utilizing the Fellowship and Residency Electronic Interactive Database (FREIDA) database and orthopaedic surgery residency program websites.
METHODS: 200 ACGME-accredited orthopaedic surgery residency programs across the United States.
METHODS: Program name and hospital affiliations were collected from the FREIDA database to account for all ACGME-accredited programs. The following information was derived from publicly available program websites: title, role description, previously trained institutions, academic rank, and concurrent roles of VCs. Research productivity was measured using the H-index. The previous roles of current Department Chairs (DC) were also evaluated.
RESULTS: Of the 178 VCs identified, VC of Research (n = 36; 20%), Education (n = 25; 14%), and Clinical Operations/Affairs (n = 21; 12%) were the most common titles. Women made up 17% (n = 30) of the VCs. Trauma (n = 36; 20%) was the most common fellowship subspecialty among VCs. The average H-index for VCs was 25. Among VCs, 94 (53%) were professors, 78 were also Chiefs/Heads/Directors (44%), 7 (4%) were Fellowship Directors, and 18 (10%) were Residency Directors. Twenty-six of 95 (27%) current DC had VC experience.
CONCLUSIONS: The findings can facilitate effective leadership development, promotion of diversity and inclusion in these roles, and guidance for those who seek such leadership positions.

Introduction Tourniquets are vital devices in orthopaedic surgery that aid in creating a bloodless field. While they reduce operative time and outcomes, improper use can lead to severe complications. The British Orthopaedic Association Standards for Trauma (BOAST) offers guidelines for safe intraoperative tourniquet usage, emphasising proper application and accurate documentation. With the push for a paperless National Health Service (NHS), orthopaedic units across the UK are transitioning to electronic patient records (EPR). In this audit, we aim to evaluate the impact of electronic patient records (EPR) implementation on tourniquet documentation and subsequent interventions to enhance guideline adherence. Methods This closed-loop audit evaluated 159 emergency trauma cases at a single UK-based district general hospital across three different cycles. The first cycle (n=50) was collected before the trust-wide adoption of an EPR system (EPIC HIVE). Upon collecting the second cycle (n=59), local intraoperative tourniquet usage results compared to BOAST were presented at a departmental audit meeting. A specialised smart phrase template was subsequently shared with the department and the results were re-audited in the third cycle (n=50). Statistical analyses were performed to compare the cycles. Results Following the introduction of the EPR, compliance with documentation standards (fully and partially adhered to) initially declined from 38.0% to 17.0%. Post-intervention, compliance increased to 62.0% (p=0.0005). Individual aspects of documentation revealed notable improvements, including increases in skin assessment pre- and post-tourniquet application (0% to 56% and 0% to 60%, respectively, p<0.0001), isolation method (0% to 60%, p<0.0001), exsanguination method (2% to 24%, p=0.0003), tourniquet pressure (39% to 76%, p=0.0001) and tourniquet time (59% to 94%, p=0.0001). Lower limb tourniquet pressures significantly decreased between audit cycles (mean: 287.06 vs mean: 265.91, p=0.007) while upper limb pressures remained relatively stable (mean: 236.67 vs mean: 236.56, p=0.993). No tourniquet-related complications were reported across all audit cycles. Conclusion While the introduction of new EPR systems may initially present challenges in upholding accurate operative records, the incorporation of specialised electronic templates and active staff engagement has shown to be instrumental in improving tourniquet safety and enhancing care standards.

Prosthetic joint infections (PJIs) following total joint arthroplasty are a significant and costly complication. To address fragmented care typically seen with separate management, we established a combined infectious disease and orthopaedic surgery clinic at Duke Health in July 2020. This clinic focuses on patients experiencing acute deterioration or multiple PJI episodes, often at the stage where amputation is the only option offered. From July 2021 to March 2024, the clinic completed 974 visits with 319 unique patients. The clinic maintained a low no-show rate of 5.0%. Treatment plans included procedures such as debridement, antibiotics and implant retention (38%), as well as implant explantation and one-stage exchange (32% each), with amputation required in only 4% of cases. The integrated clinic model facilitated real-time, multidisciplinary care, improving patient outcomes and operational efficiency. This approach offers a promising model for managing complex infections.

UNASSIGNED: Despite the recent emphasis on promoting international collaborations within orthopaedic surgery, criteria for determining the strengths of such partnerships has not been established. The purpose of this study was to evaluate orthopaedic experts\' perceptions of the most valuable characteristics of international academic partnerships.
UNASSIGNED: This study was conducted using a modified Delphi methodology. Experts were identified through the Consortium of Orthopaedic Academic Traumatologists (COACT). Responses were collected from February to September 2022. Three rounds of surveys listing possible topics on a 5-point Likert scale were used to develop consensus among a group of experts. Consensus criteria for topic inclusion in the final scale was determined as a rating of \"strongly agree\" or \"agree\" by ≥70% of the participants in the third survey.
UNASSIGNED: The Round 1 survey was distributed to 96 invited participants within the COACT network, of which 50 experts (52.1%) completed the first survey. Consensus was reached on 54 topics organized into the following 5 categories: Research, Advocacy/Leadership, Training/Surgical Skills, Education/Knowledge Exchange, and Sustainability and Safety (RATES Criteria).
UNASSIGNED: Determining the most valuable characteristics of successful international academic partnerships can lead to more sustainable, mutually beneficial collaborations. The criteria identified in this study can provide the foundation for developing new partnerships and assessing existing ones.

OBJECTIVE: Adolescent idiopathic scoliosis (AIS) is a common spinal deformity with varying progression, complicating treatment decisions. Artificial intelligence (AI) and machine learning (ML) are increasingly prominent in orthopedic care, aiding in diagnosis, risk-stratification, and treatment guidance. This scoping review outlines AI applications in AIS.
METHODS: This study followed PRISMA-ScR guidelines and included articles that reported the development, use, or validation of AI models for treating, diagnosing, or predicting clinical outcomes in AIS.
RESULTS: 40 full-text articles were included, with most studies published in the last 5 years (77.5%). Common ML techniques were convolutional neural networks (55%), decision trees and random forests (15%), and artificial neural networks (15%). Most AI applications in AIS were for imaging analysis (25/40; 62.5%), focusing on automatic measurement of Cobb angle, and axial vertebral rotation (13/25; 52%) and curve classification/severity (13/25; 52%). Prediction was the second most common application (15/40; 37.5%), with studies predicting curve progression (9/15; 60%), and Cobb angles (9/15; 60%). Only 15 studies (37.5%) reported clinical implementation guidelines for AI in AIS management. 52.5% of studies reported model accuracy, with an average of 85.4%.
CONCLUSIONS: This review highlights the applications of AI in AIS care, notably including automatic radiographic analysis, curve type classification, prediction of curve progression, and AIS diagnosis. However, the current lack of clear clinical implementation guidelines, model transparency, and external validation of studied models limits clinician trust and the generalizability and applicability of AI in AIS management.

BACKGROUND: The rise in popularity of ride share e-scooters has led to an increase in the number of e-scooter injuries, with existing literature reporting increases in rates of admission by more than 350%. In April 2023, the Broome Shire signed a contract to provide 300 e-scooters as part of a shared micro mobility platform. This study aimed to describe the demographics, clinical presentation and health system utilization of patients presenting with e-scooter-related injuries at Broome Regional Hospital (BRH).
METHODS: A retrospective cohort study examined all e-scooter-related injuries presenting to BRH between April 1st 2023 and April 30th 2024. Patients with e-scooter injuries described in their Emergency Department (ED) electronic triage records were included. Data was collected from chart review.
RESULTS: A total of 190 patients were identified as having sustained an e-scooter injuries over the 12-month trial period. The median age was 26 years with equal numbers of males and females. Most injuries occurred between 6 pm and 12 am (28%) with 53% of patients reporting being intoxicated, while 75% were not wearing a helmet. Almost all patients (80%) were managed in the emergency department because of the low severity of their injuries. Of the remaining patients, 22 were admitted, with 16 transferred for tertiary-level operative management.
CONCLUSIONS: The introduction of e-scooters for shared micromobility represents a new cause of trauma related presentations to BRH. Our study\'s results have raised awareness regarding the incidence and severity of electric scooter injuries in Broome.

BACKGROUND: Surgical site infection (SSI) is an important cause of disease burden and healthcare costs. Fully manual surveillance is time-consuming and prone to subjectivity and inter-individual variability, which can be partly overcome by semi-automated surveillance. Algorithms used in orthopaedic SSI semi-automated surveillance have reported high sensitivity and important workload reduction. This study aimed to design and validate different algorithms to identify patients at high risk of SSI after hip or knee arthroplasty.
METHODS: Retrospective data from manual SSI surveillance between May 2015 and December 2017 were used as gold standard for validation. Knee and hip arthroplasty were included, patients were followed up for 90 days and European Centre for Disease Prevention and Control SSI classification was applied. Electronic health records data was used to generate different algorithms, considering combinations of the following variables: ≥1 positive culture, ≥ 3 microbiological requests, antimicrobial therapy ≥ 7 days, length of hospital stay ≥ 14 days, orthopaedics readmission, orthopaedics surgery and emergency department attendance. Sensitivity, specificity, negative and predictive value, and workload reduction were calculated.
RESULTS: In total 1631 surgical procedures were included, of which 67.5% (n = 1101) in women; patients\' median age was 69 years (IQR 62 to 77) and median Charlson index 2 (IQR 1 to 3). Most surgeries were elective (92.5%; n = 1508) and half were hip arthroplasty (52.8%; n = 861). SSI incidence was 3.8% (n = 62), of which 64.5% were deep or organ/space infections. Positive culture was the single variable with highest sensitivity (64.5%), followed by orthopaedic reintervention (59.7%). Twenty-four algorithms presented 90.3% sensitivity for all SSI types and 100% for deep and organ/space SSI. Workload reduction ranged from 59.7 to 67.7%. The algorithm including ≥ 3 microbiological requests, length of hospital stay ≥ 14 days and emergency department attendance, was one of the best options in terms of sensitivity, workload reduction and feasibility for implementation.
CONCLUSIONS: Different algorithms with high sensitivity to detect all types of SSI can be used in real life, tailored to clinical practice and data availability. Emergency department attendance can be an important variable to identify superficial SSI in semi-automated surveillance.