➢ Argentine orthopaedics was shaped by the influence of Dr. Vittorio Putti (Rizzoli Institute, Bologna, Italy). Dr. Carlos E. Ottolenghi, one of Dr. Putti's most distinguished disciples, together with Dr. José Valls, founded the Instituto de Ortopedia y Traumatología at Hospital Italiano de Buenos Aires in 1926. Prof. Ottolenghi transformed the Orthopaedic Service into a leading academic center and pioneer of subspecialization, serving as a foundational driver of orthopaedic development in Argentina and Latin America, while establishing strong international academic connections and collaborations.➢ Major milestones include the establishment of one of the earliest institutional bone banks and the performance of one of the world's first reported massive bone allograft reconstructions (1948); the performance of the first Charnley total hip replacement in the Americas (1967) and the first total knee replacement in Argentina (1970); and the early adoption of intramedullary nailing (1972), knee arthroscopy (1976), and femoral bone impaction allografting (1987). These contributions helped to define modern orthopaedic practice across Latin America and influenced global reconstructive strategies.➢ Advances such as surgical navigation (2010) and augmented reality (2025) have strengthened its role as a regional and globally connected center of excellence, particularly in musculoskeletal oncology.➢ Over the past 25 years, 180 residents and 160 fellows have been trained in our institute, and more than 500 indexed publications have been produced in the last 10 years, with alumni holding leadership roles across major orthopaedic centers worldwide, amplifying our institute's global footprint.➢ A merit-based, highly selective system based on excellence determines who becomes a staff surgeon. Currently, 85% of the actual staff surgeons completed residency training in our department, fostering a unique sense of institutional identity and perceived belonging. This experience reinforces the concept that excellence in orthopaedics transcends geographic boundaries and can emerge as a global reference from any setting committed to innovation, mentorship, and academic rigor.
To report on findings from the most recent Orthopaedic Trauma Association (OTA) nationwide survey of orthopaedic trauma surgeons on current practice details. Cross-sectional survey. Orthopaedic Trauma Association approved quadrennial survey. Orthopaedic trauma surgeons practicing in the United States with one of the following OTA membership types: active, candidate, or clinical. A 47-question survey was emailed to OTA members assessing demographics, practice setting, and current compensation. A total of 785/1501 (52%) orthopaedic traumatologists responded. Slightly more than half of respondents practiced in academic settings (51%), with a majority in practice for ≤10 years (47%). For those in private groups, 65% had achieved "partner" status, which generally took 1-3 years (53%) of employment. The majority of surgeons (87%) reported access to a dedicated orthopaedic trauma operating room, providing many surgeons (78%) with access during the daytime on weekdays and weekends, but only 21% with 24-hour access. Surgeons most commonly reported working 51-70 hours per week (64%), with 4-6 nights of call per month (40%), 1 clinic day per week (44%). Seventy-two percent reported more than 75% of their clinical practice was devoted to trauma (72%). More than half of surgeons (59%) received compensation for call. Annual work relative value units (wRVU) and case volumes varied. Typically, respondents had $501,000-$900,000 of their annual base salary guaranteed (62%), and most were eligible for additional revenue via production bonuses (76%). Further insight into clinical characteristics were provided by three subgroup analyses: years in practice, practice setting, and reported gender of surgeon. These findings provide updated data into the current landscape of orthopaedic trauma practice in the United States. This information may be useful to guide contract discussions and inform institutional decision-making. V.
Patients with a hip fracture are treated by surgeons at various stages of training, under different levels of supervision. However, it is unclear whether their experience and the level of supervision are associated with patient outcomes. The aim of this study was to investigate the relationship between operating surgeon experience and level of supervision, and the patients' subsequent quality of life (QoL), mortality, and complications after surgery for a hip fracture. A multicentre, prospective cohort study of patients aged 60 years and older with a hip fracture in the UK. Primary exposure was operating surgeon grade and level of supervision. Outcomes were health-related quality of life (HRQoL; EuroQol five-dimension five-level questionnaire (EQ-5D-5L)), mortality, and complications at four months. Linear and Cox proportional hazards regression models were fitted to assess the relationship between operating surgeon grade and level of supervision, and HRQoL, mortality, and complications. Among 24,523 patients with a hip fracture, there were 12,702 consultant-performed and 11,365 resident-performed operations. Operations performed by supervised residents had better recovery of EQ-5D-5L (mean difference (MD) 0.02, 95% CI 0.01 to 0.03; p < 0.001), a similar risk of mortality (HR 0.92, 95% CI 0.84 to 1.01; p = 0.083), but higher risks of reoperation (HR 1.29, 95% CI 1.06 to 1.57; p = 0.009), blood transfusion (HR 1.44, 95% CI 1.28 to 1.62; p < 0.001), acute kidney injury (HR 1.72, 95% CI 1.46 to 2.04; p < 0.001), lower respiratory tract infection (HR 1.22, 95% CI 1.10 to 1.35; p < 0.001), cerebrovascular accident (HR 1.98, 95% CI 1.33 to 2.95, p < 0.001), and myocardial infarction (HR 1.91, 95% CI 1.33 to 2.74; p < 0.001), compared with operations performed by consultants. Operations performed by unsupervised residents had better recovery of EQ-5D-5L (MD 0.02, 95% CI 0.00 to 0.03; p = 0.008), a similar risk of mortality (HR 0.92, 95% CI 0.81 to 1.06; p = 0.260), but a higher risk of blood transfusion (HR 1.54, 95% CI 1.33 to 1.80; p < 0.001) compared with operations performed by consultants. Operations performed by residents were associated with a better recovery of QoL, similar mortality, but slightly more complications compared with consultants. This highlights the need for tailored supervision and structured training to optimize outcomes and ensure patient safety.
Physical therapist-led (PT-led) orthopedic triage is a care model designed to improve access to specialist care for patients with musculoskeletal disorders (MSK), including osteoarthritis (OA). Results from a previous RCT comparing PT-led triage with standard care (orthopedic surgeon assessment) showed that patients perceived the received care to be of good quality, however also showed (i) lower levels of participation in decision-making and that (ii) their expectations on the assessment were fulfilled to a lesser extent. Therefore, the aim of this study was to explore the expectations of the assessment and experiences of patients with hip or knee OA regarding PT-led triage in an Swedish orthopedic clinic. An explorative qualitative research design with an inductive approach was used. Patients who had undergone PT-led triage for their hip/knee OA at a hospital based orthopedic clinic were invited to participate. A purposive sampling was used to get a variation in gender and assessment outcome. Semi-structured, one-to-one interviews were conducted in Swedish. The interviews were audio recorded, transcribed verbatim and analyzed with content analysis according to Graneheim and Lundman. Thereafter the results were translated into English. Twelve patients were included in the study. The patients' expectations and experiences about PT-led triage were classified into 2 themes; In safe hands and A care model in progress, with a total of 6 categories: Highly skilled and professional PT, Sense of involvement and empowerment, Feeling validated, An innovative and effective care model, Expectations on the meeting and Opportunities for Improvements. The main findings of this study are that patients felt they were meeting an expert, experienced a sense of involvement in their care, and viewed PT-led triage as a valuable model of care although some patients reported a lack of information regarding the care process. The results from this study of patients' expectations and experiences may be used to further refine and improve this model of care, thereby supporting its implementation on a broader scale. The study was prospectively registered in Clinical Trials Gov NCT04665908, registered 07/12/2020.
Implant selection in primary total knee arthroplasty (TKA) remains a critical yet variable aspect of surgical decision-making, associated with both patient characteristics and surgeon-related factors. With the increasing integration of surgical innovations such as robotic-assisted techniques, understanding contemporary determinants of implant choice has become essential. This study aimed to evaluate implant selection patterns and identify independent factors associated with the use of cruciate-retaining (CR) vs. posterior-stabilized (PS) implants in a modern clinical setting. This study was designed as a retrospective observational analytical study, with data analyzed within a cross-sectional framework. A cross-sectional study was conducted on 280 patients undergoing primary TKA at a high-volume tertiary care center between May 2024 and April 2025. Data on patient demographics, clinical characteristics, and implant-related variables were collected. Surgeon-level factors, including fellowship training, years in practice, and use of robotic or navigation systems, were also analyzed. Multivariate logistic regression was performed to identify independent factors associated with the CR implant selection. CR implants were used in 60.0% of cases, whereas PS implants were used in 40.0% (p = 0.017). Cemented fixation predominated (75.0%, p = 0.004). Fellowship-trained surgeons and those with fewer years in practice demonstrated higher CR utilization (p = 0.019 and p = 0.041, respectively). Multivariable analysis identified fellowship training (OR 2.14, p = 0.002), ≥10 years in practice (OR 1.45, p = 0.027), and robotic assistance (OR 1.61, p = 0.012) as independent factors associated with CR selection. Increasing age (OR 1.02, p = 0.045) and male sex (OR 1.35, p = 0.042) were also associated with CR use, whereas BMI, ASA class, and navigation were not. Implant selection in primary TKA is influenced by a combination of surgeon training and experience, patient characteristics, and the adoption of surgical technologies such as robotic assistance. These findings highlight the impact of surgical innovation on decision-making in modern arthroplasty practice and underscore the need for standardized, evidence-based approaches to reduce variability in implant selection.
Following institutional changes that reduced access to cadaveric dissection, Paris-Saclay University developed a two-year elective anatomy pathway serving as a longitudinal progression toward near-peer tutoring (NPT). Designed as a complement to the core curriculum, the program preserves engagement with human dissection while promoting professional development under resource constraints. The fourth-year tutoring phase represents the final stage of this pathway, with guided autonomy under structured faculty supervision. The objective of the study was to evaluate tutors' motivations, perceived gains in anatomical knowledge and teaching skills, and professional development during the NPT module. A cross-sectional, mixed-methods survey was administered to three consecutive cohorts (2020-2021, 2021-2022, 2022-2023). The questionnaire included multiple-choice items, five-point Likert scales, and open-ended questions. Quantitative data were analyzed using descriptive statistics, χ2 tests, Kruskal-Wallis tests, and Spearman correlations. Qualitative data underwent post hoc semantic grouping and reflexive thematic analysis. Among 40 eligible tutors, 34 completed the survey (85% response rate). Motivations included deepening anatomical knowledge (38%) and teaching others (35%). Perceived gains were high across all cohorts: increased anatomical proficiency (mean 4.6-4.7), motivation to teach (3.2-4.4), and reduced fear of surgical tools (3.7-4.4), with no significant intercohort differences. Strong correlations linked improved anatomy knowledge with motivation for anatomy (ρ = 0.65) and teaching (ρ = 0.52-0.64). Thematic analysis identified four benefit domains: anatomy proficiency, surgical/technical confidence, pedagogical skills, and ethical awareness. Negative feedback highlighted needs for better supervision and organization. The NPT module consolidates learning through teaching responsibility, and ethical engagement. Embedding NPT longitudinally offers a scalable strategy to sustain dissection-based anatomy education under faculty constraints while fostering teaching confidence and professional identity.
Digital technologies increasingly shape postgraduate medical education, yet orthopedic and trauma training face unique challenges because of the tactile, procedurally focused skills involved. Digital tools partially address these needs, but gaps remain, particularly across diverse European contexts. Our primary aim was to quantitatively assess predictors of digital learning technology acceptance (e-learning, distance education, and virtual reality [VR] and augmented reality [AR]) among European orthopedic and trauma trainees, drawing on the technology acceptance model (TAM) and the unified theory of acceptance and use of technology (UTAUT) as conceptual guides. Specifically, we examined how perceived usefulness and perceived ease of use (TAM), alongside performance expectancy, effort expectancy, social influence, and facilitating conditions (UTAUT), related to trainees' acceptance of digital technologies. These constructs guided variable selection and grouping, attitudinal scale design, and interpretation of how individual and contextual factors shape acceptance of digital learning tools in orthopedic training. Secondary aims were to describe adoption and attitude patterns, identify attitudinal trainee profiles, and examine contextual associations (eg, workplace type and national gross domestic product [GDP]). We distributed a multinational survey via European trainee federations and used validated scales to assess digital competence and attitudes and gathered demographic data (n=217 across 29 European countries). We administered the questionnaire in English; however, respondents who self-reported English proficiency below the intermediate level were excluded from the analyses to minimize potential comprehension-related bias. The survey assessed digital experience, self-reported digital competence, and attitudes toward e-learning, distance education, and VR/AR, and collected detailed demographic and workplace data. Expert review, cognitive pretesting, and pilot testing ensured validity and clarity. Analytical methods included Wilcoxon tests, ANOVA, clustering, multinomial logistic regression, and factor analysis to ensure the reliability and validity of attitudinal measures. e-Learning technologies were the most widely adopted, whereas VR/AR tools were less frequently used despite high average attitude ratings (mean 4.07, SD 0.88). Cluster analysis identified 3 distinctive groups-enthusiastic, supportive, and hesitant-that differed significantly in digital competence and acceptance profiles. Digital competence and national GDP emerged as significant predictors of group membership, consistent with TAM/UTAUT expectations that perceived capability and contextual facilitating conditions shape acceptance. Variation in attitudes was further associated with workplace type and regional resource disparities, underscoring the influence of contextual factors on technology adoption. European orthopedic trainees show broad support for digital innovations, preferring VR/AR despite low use. Preliminary evidence supports digital competence as a key mediator of acceptance, with GDP and workplace disparities predicting profiles (hesitant vs enthusiastic). Competence-first strategies and targeted resource equity (eg, low-GDP subsidies), together with policy adjustments, may address regional disparities. Future longitudinal and multimethod studies are needed to test causal pathways implied by TAM and UTAUT and to evaluate the generalizability of these findings across specialties and educational contexts.
Clinical management of rare bone diseases (RBDs) is challenged by low prevalence, delayed diagnosis, and complex multidisciplinary needs. This survey aimed to map current clinical practices in RBDs, identify unmet needs, and generate foundational data to guide the development of minimum standards for patient assessment. An anonymous online survey was distributed to members of the European Paediatric Orthopaedic Society (EPOS) and the European Reference Network on Rare Bone Diseases (ERN BOND) in September 2025. Questions addressed diagnostic work-up, interdisciplinary care, transition practices, and future perspectives. Quantitative data were analysed descriptively, and free-text responses thematically. A total of 119 respondents (35 countries), mostly orthopaedic surgeons (74%), completed the survey. Almost all (118/119) provided direct care, and 63% had >10 years' experience treating RBDs. Over 80% routinely used anthropometric, posture, and alignment measures, whereas the use of advanced tools varied. Interdisciplinary care is widely applied at varying frequencies, with a high consideration for shared decision-making and quality of life. Most lacked registry access (>80%) and formal transition protocols (~70%). Respondents prioritised clinical frameworks over technological advances and anticipated increasing future relevance for technological innovations. This survey highlights considerable variability in clinical decision-making for RBDs. The findings underscore the importance and need of standardised interdisciplinary care, registry data, and structured protocols and frameworks. This is the first systematic survey of clinical practice and decision-making process in RBD care among EPOS and ERN BOND members. The findings may guide future recommendations and standards, supporting more harmonised care for individuals with RBDs, especially ultra-rare conditions.
Myelomeningocele (MMC) is a severe neural tube defect resulting from incomplete closure of the spinal column during early embryogenesis, often leading to lifelong neurological, urological, and orthopedic impairments. The "two-hit hypothesis" describes both the primary embryologic malformation and progressive in-utero neural injury as contributors to clinical severity. While postnatal repair prevents further exposure of neural tissue, it does not reverse the intrauterine damage already sustained. This manuscript provides a comprehensive review of the historical evolution, surgical techniques, and institutional experience of in-utero MMC repair, with particular emphasis on the pioneering role of Vanderbilt University Medical Center. Key operative advancements-such as the use of bipedicled fasciocutaneous flaps, refined hysterotomy techniques, and multidisciplinary coordination-are discussed alongside postoperative maternal-fetal management and long-term outcomes. The manuscript also examines comparative outcomes between open and fetoscopic approaches, highlighting the challenges, safety profiles, and global expansion of fetal MMC programs. Detailing both historical context and modern innovations, this work aims to underscore the important reconstructive challenges presented by in-utero repair of MMC, and the critical role played by plastic surgery in optimizing fetal MMC repair and advancing care for this complex condition.
To determine if axial computerized tomography (CT) images compared with radiographs of minimally displaced femoral neck fractures in older adults change surgeons' estimates of posterior tilt or treatment preference for internal fixation versus arthroplasty. A survey was developed from the clinical vignettes, injury radiographs of anteroposterior (AP) pelvis and lateral hip, and CT pelvis axial images of 10 patients randomly selected from 50 patients with minimally displaced femoral neck fractures enrolled in a clinical trial. Survey respondents estimated femoral neck fracture posterior tilt angle (0-90 degrees) and stated their treatment preference on a scale of 100% for internal fixation to 100% for arthroplasty based on the radiographs, then again after viewing the CT images of the same patient. The survey was administered electronically using REDCap and distributed by email between 15 June and 15 July 2025. The survey was distributed to a convenience sample of attending orthopaedic surgeons with hip fracture call experience nonrandomly selected from email contacts of colleagues, acquaintances, and extramural research collaborators located in North America, South America, and Europe. Neither fellowship training nor practice setting were requirements for participation. The mean differences in posterior tilt estimates and treatment preferences between radiographs and CT were estimated using linear mixed-effects models. Complete survey responses were received from 69 of 98 participants (70.4% response rate). Posterior tilt estimates were 6 degrees greater based on CT versus radiographs (95% confidence interval [CI], 4-7 degrees; P < 0.0001). CT images significantly changed treatment preferences by 20% more in favor of arthroplasty (95% CI, 14%-26%; P < 0.0001). Axial CT images significantly changed orthopaedic surgeons' estimates of posterior tilt and treatment preferences in favor of arthroplasty for minimally displaced femoral neck fractures compared with radiographs. Prognostic Level V. See Instructions for Authors for a complete description of levels of evidence.
Prior research has revealed gender disparities in the financial relationships between industry and orthopaedic surgeons. Despite attempts to level the playing field, it remains unclear whether these efforts have reduced or eliminated gender disparities in financial relationships between industry and orthopaedic surgeons. The Centers for Medicare and Medicaid Services (CMS) Open Payments database was queried from January 1, 2024, to December 31, 2024 for orthopaedic surgeons receiving "consulting fee" or "royalty or license" payments of $1,000 or more. Surgeon characteristics were recorded from the CMS database and public sources. Total payment amounts and number of payments were calculated. Characteristics were compared by gender between those receiving any industry payment, consulting payment, and royalty payment. Multivariable linear regression analyses were used to identify factors associated with payment amount and number of payments. Results were compared with a study using similar data from 2016 to 2017. A total of 3,714 surgeons received industry payments, with 3,514 (95%) being men. Of those receiving royalty payments (n = 1,374), 1.5% (n = 21) were women. Of those receiving consulting payments (n = 3,122), 6.2% (n = 194) were women. Men (β = 1.57 [95% confidence interval [CI]: 0.41-2.73, p = 0.008), years of experience (β = 0.09 [95% CI: 0.07-0.12], p < 0.001), and adult reconstruction (β = 1.77 [95% CI: 0.76-2.79], p = 0.001) were associated with a greater total number of payments. Hand surgery (β = -2.57 [95% CI: 3.97 to -1.17], p < 0.001), pediatrics (β = -2.62 [95% CI: 4.60 to -0.64], p = 0.01), and sports (β = -1.12 [95% CI: 2.08 to -0.16], p = 0.02) were associated with the fewer total number of payments. Men (β = 0.34 [95% CI: 0.10-0.57], p = 0.004), years of experience (β = 0.051 [95% CI: 0.046-0.056], p < 0.001), and adult reconstruction (β = 0.47 [95% CI: 0.27-0.68], p < 0.001) were associated with greater payment amounts, while hand (β = -0.96 [95% CI: 1.24 to -0.68], p < 0.001) and pediatrics (β = -0.79 [95% CI: 1.18 to -0.39], p < 0.001) were associated with lower payment amounts. When examining trends over time, men received 1.57 (2024) vs. 5.17 (2016-2017) additional payments and 40% (2024) vs. 197% (2016-2017) larger payments compared with women. Gender disparities in financial relationships (i.e., number of payments and payment amounts) between industry and orthopaedic surgeons persist, though are improved compared with prior research from about a decade ago.
Innovations in reverse total shoulder arthroplasty (rTSA) have improved outcomes and mitigated complications through improvements in implant design, surgical techniques, and enabling technologies. The purpose of this study was to evaluate the association between technologic evolutions in rTSA and the incidence of acromion and scapular spine fracture (ASF). The authors hypothesize that ASF incidence has decreased over time and that this decrease is temporally associated with successive changes in implant design, surgical technique, and enabling technology within a single-design platform. A retrospective case series from January 2007 to December 2024 was conducted. All patients undergoing rTSA by a single-implant manufacturer with a constant implant design philosophy (Enovis) were included. Patient-specific and surgical variables were collected. Five cohorts were formed based on major technologic advances focused on implant design, surgical technique, and virtual planning. Descriptive statistics were used to compare cohorts, while regression and moving average statistics assessed longitudinal trends. In total, 2,380 patients met inclusion criteria, including 2,068 primary rTSA and 312 revision rTSA cases. The overall incidence of ASF was 5.4% with no notable difference between primary and revision procedures. A higher incidence of ASF was observed for patients with rotator cuff deficiency when compared with rotator cuff-intact patients (7.39% vs. 2.8%; P < 0.001). A significant decrease in ASF incidence was observed across the study period (P < 0.001), with reductions between successive technologic cohorts. Regression analysis of the data revealed a logarithmic best-fit with r2 = 0.765. Year-to-year variability in ASF incidence was significantly lower during periods of routine preoperative planning compared with earlier periods (0.45% vs. 5.33%; P = 0.008). In 2014, the difference between the rates of cuff-intact and cuff-deficient cases disappeared (P = 0.025). Advancements in implant design and surgical technique within a single rTSA implant design philosophy were temporally associated with lower observed ASF incidence. Routine use of preoperative virtual planning coincided with the lowest ASF rates and reduced year-to-year variability. These findings should be interpreted in the context of time-related confounding, including surgeon experience and practice evolution. III.
The first case study of spinal cord stimulation (SCS) for pain treatment, published in 1967, catalyzed decades of research to improve and optimize this therapy. This article provides an overview of the history of SCS technology, including advances made by industrial and academic innovators in lead designs, neurostimulator features, and battery chemistry. Foundational randomized controlled trials (RCTs) and a timeline of key product releases from the early 1970s are highlighted. The second half of the article discusses SCS technology advancements from a manufacturer's perspective and how they relate to improving the overall patient therapy experience. Specific SCS technology advancements that have focused on the patient's needs include: The development of patient programmers, enhanced rechargeable battery technology, position-adaptive neurostimulators, full-body magnetic resonance imaging (MRI) conditionality, and sensing-based closed-loop features.
Endoscopic spine surgery (ESS) is increasingly recognized for its clinical efficacy and patient-centered advantages, including reduced morbidity and faster recovery. However, despite growing global interest, its adoption remains highly variable, shaped more by systemic, economic, and institutional forces than by technical limitations. To evaluate global adoption barriers to ESS using psychometrically validated tools and identify region-specific structural disparities through Rasch analysis and differential item functioning (DIF). A cross-sectional global survey was conducted among 1834 spine surgeons. Of the 1040 individuals who began the survey, 438 (42.6%) from 46 countries completed the survey. A 27-item instrument assessed access, reimbursement, training infrastructure, and institutional support for ESS. Rasch rating scale modeling was used to test internal validity, unidimensionality, and item fit. DIF analysis and 1-way analysis of variance were performed to detect region-specific biases in item responses. Respondents were stratified by country and region, including China, India, Brazil, the United States, Latin America, and Europe. Collectively, the responding surgeons reported an extrapolated cumulative experience of 1,286,496 endoscopic spine procedures, suggesting that responses were anchored in substantial clinical experience. Rasch analysis confirmed acceptable model fit. DIF analysis revealed strong regional disparities. Surgeons in China and India reported high institutional support, better training access, and fewer reimbursement obstacles, suggesting high system adaptability. Conversely, respondents from the United States and Latin America cited limited training integration, poor reimbursement, and institutional inertia. Europe exhibited a structural stalemate driven by low surgeon compensation and excessive bureaucratic gatekeeping. Despite these differences, surgeon and patient interest in ESS remained uniformly high across regions, identifying shared global momentum for minimally invasive innovation. The global diffusion of ESS is hindered less by clinical limitations than by systemic inertia and fragmented policy frameworks. Countries with flexible, market-responsive systems (eg, China and India) are emerging as innovation leaders, while historically dominant regions (eg, United States and Europe) risk stagnation without structural reform. ESS serves as a diagnostic lens for broader health system adaptability, highlighting the urgent need for investment in training, reimbursement reform, and institutional endorsement. This study provides level II evidence that endoscopic lumbar decompression is a surgical work comparable to open techniques and should be valued accordingly. Grounded in more than 1.2 million cases and expert consensus, this study supports policy recommendations to retire Current Procedural Terminology 62380 and to adopt reimbursement frameworks based on surgical work rather than visualization method. While this study cannot be reclassified in the strict Oxford Centre for Evidence-Based Medicine hierarchy, the authors employ the following analogy: Rasch/DIF methods filter bias in the same way randomization filters bias in clinical trials. While it relies on self-reported surgeon data rather than direct clinical outcomes, the application of Rasch modeling and DIF analysis strengthens internal validity and minimizes measurement bias. Importantly, surgeon responses were anchored in an extrapolated cumulative experience of more than 1.28 million endoscopic spine procedures, reflecting deeply internalized clinical judgment rather than anecdotal opinion. These methodological features distinguish the study from unvalidated descriptive surveys and support its classification as higher-level clinical evidence-offering a filtered and reliable lens into global surgical practice patterns and systemic barriers to ESS adoption. Based on its cross-sectional observational design enhanced by validated psychometric methodology, the authors consider this survey study a psychometrically validated, high-quality observational survey study. This study identifies structural and systemic barriers that limit global adoption of ESS and highlights key targets-such as training, reimbursement, and institutional support-for improving access and accelerating safe implementation.
To evaluate the association between Berger-Sanai topography and achievable extent of resection in patients with insular gliomas. This retrospective single-center study from Ukraine included 167 consecutive patients with insular gliomas treated surgically between 2017 and 2024. Tumors were classified according to the Berger-Sanai system. Extent of resection (EOR) was categorized as total/subtotal or partial. Persistent postoperative neurological deficits were assessed at 90 days. Univariable and multivariable logistic regression analyses were performed to identify factors associated with partial resection. Significant differences in EOR were observed among Berger-Sanai zones (p<0.001). Total or subtotal resection was achieved in 76% of zone I tumors compared with 39% in zone II, 51% in zone III, and 28% in zone IV. Persistent neurological deficits occurred in 13% of patients and were more frequent in zones II-IV. Tumor size and World Health Organization (WHO) grade differed significantly among topographic groups (both p<0.001). In univariable analysis, zones II, III, and IV were associated with partial resection. After adjustment for tumor size and WHO grade, zone II (odds ratio 2.88, 95% confidence interval 1.06-7.84; p=0.037) and zone IV (odds ratio 4.42, 95% confidence interval 1.30-15.10; p=0.017) remained independently associated with partial resection. Because only 22 patients experienced persistent neurological deficits, multivariable analysis was not performed. Berger-Sanai topography was associated with achievable EOR in insular glioma surgery. Zones II and IV demonstrated lower resectability independent of tumor size and WHO grade. These findings should be interpreted within the context of local surgical strategy and available technologies.
Nonpharmacological strategies are advocated as evidence-based treatment options for pain, yet these are rarely offered within the emergency department (ED) setting. Understanding how ED providers perceive these strategies can guide implementation efforts. The objective of this study was to qualitatively examine ED provider perceptions of conventional and complementary nonpharmacological pain strategies. Nine ED physicians from a single academic medical center completed a semi-structured interview conducted by a trained qualitative researcher. The interview focused on the provider's current pain management approach and perceived benefits, barriers, and facilitators of nonpharmacological pain treatments. Each interview was audio-recorded, transcribed verbatim, and analyzed using an iterative deductive-inductive approach. Findings were organized into themes and subthemes to inform a conceptual model of nonpharmacological intervention implementation. Six major themes emerged: 1) institutional context around intervention implementation, 2) professional beliefs about nonpharmacological pain interventions, 3) patient characteristics as a modifying factor, 4) intervention characteristics as a modifying factor, 5) process of implementation, and 6) engagement. Providers acknowledged benefits of nonpharmacological strategies, particularly for patients with chronic pain or history of opioid use. However, perceived barriers included negative patient perceptions of mind-body therapies, minimal ED provider training or education, limited time or care coordination support, and lack of physical space. Possible facilitators for integration included provider education, leadership support, and intervention tailoring. ED providers recognize the potential value of nonpharmacological pain treatment strategies. However, both broad healthcare and ED-specific barriers to implementation may limit routine use in the ED. Future efforts for improving pain management in the ED should identify strategies to address implementation barriers of evidence-based nonpharmacological interventions.
Musculoskeletal tumour imaging utilises a multimodality approach to obtain valuable diagnostic information about the bone tumour and plan appropriate management strategies for their resection. Conventional radiography has been the workhorse for bone tumours evaluation. However, with rapid evolution and advancements in cross-sectional imaging modalities such as CT, MRI, and PET CT, additional insights on tumour imaging have been made possible, for accurate staging and optimal surgical planning. Recent innovations in image fusion further enhance the precision of tumoral assessment. Additionally, imaging has also proven crucial in guiding treatment planning, evaluating surgical resectability, and optimising the selection and placement of allografts. They also play a role during intra-operative guidance and post-operative assessment. The advancements in 3D printing technology have changed the challenging domain of musculoskeletal oncology by paving the way for computer-generated customised tools like Patient Specific Cutting Guides (PSCG) for primary bone tumour resections. This breakthrough has improved surgical precision and patient outcomes. This article highlights and discusses how imaging enhances the accuracy and effectiveness of allograft assessment and explores the application of 3D CT reconstruction in evaluating allografts, guiding surgical resections, and complex musculoskeletal reconstructions while achieving consistent tumour-free margins for limb salvage surgery.
Community pharmacists provide direct patient care that requires patient health information. There is no standardized approach to obtaining health information and few studies in community pharmacy have assessed the feasibility and patient acceptability of the process for collecting medical and medication histories (MMH) through patient-completed electronic or paper formats. Describe the development, implementation, and assessment of the feasibility and identification and follow-up of drug-related problems (DRPs) with the integration of a patient-completed electronic or paper MMH form in community pharmacy. Patient acceptability of a self-completed MMH was additionally assessed. Four independent community pharmacies that serve urban communities and provide standard-of-care services collaborated with Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences in Detroit (EACPHS). A patient-completed MMH form was created at EACPHS. Student pharmacists/pharmacists integrated the electronic or paper patient-completed MMH forms into community practice. This prospective Phase I and retrospective Phase II study conducted from 2019-2022 included patients over 18 years old. Phase I evaluated the time required for patients to complete the MMH and for student pharmacist/pharmacist review of the completed MMH with patients. Phase II incorporated the MMH in identifying DRPs and interventions. Post-surveys were conducted to assess patient acceptance. A total of 163 patients participated (50 in Phase I; 113 in Phase II). In Phase I, the mean time for patient completion of the MMH was 7.92 minutes (SD± 3.6 minutes). The median time for student pharmacist/pharmacist review was 4.46 minutes (IQR ± 3.9 minutes). In Phase II, 319 DRPs (n=113 patients) were identified through review of the MMH. Ninety-six percent (n=157) of patients participated in the survey with 92.4% agreeing to update the form on future visits. Integrating a patient-completed MMH form within community practice is feasible and supports pharmacists in providing patient care.
The reverse shoulder arthroplasty (RSA) angle quantifies inclination of the inferior glenoid and, thus the correction required during reverse total shoulder arthroplasty. There are no data on the effect of two-dimensional (2D) radiographic projection on the RSA angle or on the relationships between 2D true anterior-posterior (AP) views and their three-dimensional (3D) counterparts. Digitally reconstructed radiographs of the 2D true AP view of N = 68 scapulae, a subset in controlled ante-/retroversion and extension/flexion views, and their corresponding 3D anatomic models were analyzed. The RSA angle was measured on true AP images with the glenoid in profile at the intersection of lines defined by the supraspinatus fossa and inferior glenoid rim. On altered viewing perspectives, the glenoid face was visible, and thus the anterior and posterior rims. Since it was often unclear which was anterior and posterior, for consistency the RSA angle was measured at the most medial and lateral rims, and glenoid midpoint to determine the influence of measurement location. The 3D RSA angle was measured on 3D models using semi-automated techniques. Data were analyzed to determine the effects of viewing perspective and measurement location on the RSA angle and to compare 2D true AP to 3D measures. The 2D RSA angle was 18.1 ± 7.1° (range: 1.1° to 35.3°), while the 3D RSA angle was 10.1 ± 7.3° (-8.1° to 25.7°) (P < .001). Ante-/retroversion views had large effects on the RSA angle. The lateral rim was the most susceptible to error (up to 25.8 ± 6.6°) and the glenoid midpoint was least susceptible (less than 5.6 ± 6.5°). Extension/flexion was also influential, but the magnitudes were generally much less than ante/retroversion. Trends due to viewing perspective differed between the medial rim, lateral rim, and glenoid midpoint. The glenoid midpoint maintained the flattest distribution with the smallest errors across the views. Inter- and intra-rater reliability in measuring RSA angles was good to excellent (≥ 0.754). The 2D RSA angle experiences viewing perspective errors when not measured on a true AP radiograph. The glenoid midpoint provided the most consistent and smallest maximum error, with good to excellent reliability. The 3D underestimated the 2D RSA angle on true AP images by an average of -8.0°, with similar variability. When using 2D imaging, a true AP image is desirable; otherwise, use the glenoid midpoint to minimize viewing perspective errors. Comparisons between radiographic measures and 3D preoperative planning should consider the bias between the two techniques, and 3D measures should be evaluated for their measurement techniques within the respective preoperative planning softwares to ensure consistency and reliability among manufacturers. Basic Science Study; Cadaveric Study.
Surgery on the posterior cervical spine involves bilateral exposure and removal of midline structures, which may lead to chronic neck pain, dropped head syndrome, and an ugly scar. We present our experience of an innovative technique of posterior cervical approach using spinous process osteotomy with preservation of midline structures. A total of 25 consecutive myelopathic patients underwent 1- to 4-level posterior cervical decompression with or without fusion and were followed up prospectively for 6 to 24 months. Left-sided exposure was done through a midline skin incision, and bilateral exposure of the spine was achieved through spinous process osteotomy. Laminectomy with or without instrumented fusion was performed, and the wound was closed over a drain. All patients were mobilized without orthoses. There were 15 men and 10 women with a mean age of 68 years; mean blood loss was 150 mL; mean operating time was 150 minutes; mean follow-up was 12 months. The mean improvement in Neck Disability Index at final follow-up was 26% with a 2-point improvement in visual analog scale. Japanese Orthopaedic Association score improved from a mean of 12 to 16, and using Odom's criteria, the final outcome was good in 19 patients and excellent in 6. Nurick grade improved from 3 to 1, and all patients reported significant relief of myelopathic symptoms without chronic neck pain. Two patients had postoperative superficial wound infections, and 1 patient underwent reoperation for hematoma. In this cohort study, the spinous process osteotomy technique was easy to perform, was safe with a low complication rate, and had positive outcomes. However, more studies are required to compare its efficacy with other techniques.