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Anterior shoulder instability represents one of the most common causes of shoulder dysfunction, particularly among young active individuals. Its prevalence is markedly elevated in the United States military, where incidence rates are up to 18 times higher than in the general population. Over the past 25 years, military orthopaedic surgeons have leveraged this unique population to advance the understanding, diagnosis, and treatment of shoulder instability through a systematic, translational research framework spanning epidemiology, biomechanics, imaging, and surgical innovation. Early studies identified the dramatically increased risk of recurrence after nonoperative management and established evidence-based guidelines for first-time dislocators, shifting global treatment paradigms toward early surgical intervention for high-risk patients. Subsequent investigations defined the critical and subcritical thresholds of glenoid bone loss, demonstrating that even modest loss (>13.5%) compromises outcomes after soft-tissue stabilization. Through extensive biomechanical and imaging research, this team validated the glenoid track concept, developed the Glenoid Track Instability Management Score (GTIMS), and demonstrated that bipolar bone loss involving both the glenoid and humeral head is additive and functionally significant. Advances in imaging led to the validation of three-dimensional MRI as a radiation-free alternative to CT for quantifying glenoid bone loss. To address the limitations of existing reconstructive options, the group developed the distal tibia allograft (DTA) as a novel osteochondral solution for glenoid bone loss, achieving comparable outcomes to the Latarjet with lower complication and revision rates. These clinical and translational advances were supported by the Military Orthopaedic Tracking Injuries and Outcomes Network (MOTION). Collectively, this body of work has transformed the management of anterior shoulder instability, establishing new diagnostic standards, surgical techniques, and treatment algorithms that emphasize the right surgery for the right patient, done right the first time, benefiting both military service members and the broader orthopaedic community.
Up to 30% of the global burden of disease is secondary to surgical conditions, most of which falls on those in low- and middle-income countries (LMICs). Ensuring that the quality of care delivered during outreach trips to address these conditions is foundational. Limited work has been done to develop and implement tools to assess and improve the quality of care for these trips. The purpose of this study was to identify candidate quality measures that address orthopaedic surgery outreach trips in LMICs. We conducted a systematic review of MEDLINE/PubMed, EMBASE, Web of Science, Google Scholar, and other databases to identify candidate quality measures relevant to orthopaedic surgery outreach to LMICs. Quality measures were then categorized by system management, sustainability, or both system management and sustainability according to the framework and structures, processes, and outcomes of Bido et al according to the Donabedian domains. Our initial search yielded 3,891 articles, 22 of which met the inclusion criteria. Seventy-nine candidate quality measures were identified. Regarding the framework of Bido et al, 55 of 79 (70%) were related to system management, 8 (10%) were related to sustainability, and 16 (20%) were related to both system management and sustainability. According to Donabedian domains, 43 of 79 (54%) were structure measures, 25 (32%) were process measures, and 11 (14%) were outcome measures. Quality measures addressing orthopaedic surgery outreach trips are lacking in quantity and breadth, limiting the ability to assess and improve the safety and quality of care provided. The candidate quality measures identified disproportionately focus on systems management and structures, with few related to sustainability and few addressing outcomes. Patients receiving care on outreach trips would benefit from the implementation of the measures identified in this review and from the development of quality measures that capture all domains of care and emphasize outcomes. Level III.
Climate change has been increasingly recognized in the healthcare sector over recent years, with global implications in infrastructure, economics, and public health. As a result, a growing field of study examines the role of healthcare in contributing to environmental sustainability. These analyses commonly focus on the environmental impact of the operating room, due to extensive energy and resource utilization in surgery. While much of this literature has arisen from other surgical specialties, several environmental sustainability studies have begun appearing in the field of orthopaedic surgery, consisting mostly of waste audits and, less frequently, more comprehensive environmental life cycle assessments. The present study aims to review this limited evidence. The results suggest that methods to reduce the environmental impact of the operating room include proper selection of anesthetic techniques that have a smaller carbon footprint, minimization of single use instruments, use of minimalist custom-design surgical packs, proper separation of waste, and continuation or implementation of recycling protocols. Future directions of research include higher-level studies, such as comprehensive life cycle assessments, to identify more opportunities to decrease the environmental impact of orthopaedic surgery.
Computational models represent more than just finite element analysis, a term that many clinicians may know and globally apply. Over the past 30 years, many published studies have addressed clinically relevant orthopaedic questions with speed and precision by using a wide variety of computational approaches. Given such a wide spectrum of techniques, clinicians often do not have a full understanding of the methods used to create models and therefore do not appreciate the strengths, weaknesses, and potential pitfalls of published results. The short, nonnumeric summaries of the methodologies employed for various computational approaches presented here can help address this issue.
Since popularized by Native Hawaiian Olympian, Duke Kahanamoku, in the early 20th century, surfing has grown into a globally popular sport. Because the prevalence of surfing continues to grow, physicians should be familiar with traumatic and atraumatic surfing injuries to guide treatment and prevention. The unique biomechanics of paddling prone on the surfboard and maneuvering the surfboard with the lower extremities make the injury profile for surfers different than that of other aquatic or overhead sports. This review provides a comprehensive guide on surfing biomechanics, orthopaedic injury profiles, injury prevention, return to surfing, and the future direction of orthopaedic-related surfing research.
On March 14, 2020, the Surgeon General of the United States urged a widespread cessation of all elective surgery across the country. The suddenness of this mandate and the concomitant spread of the COVID-19 virus left many hospital systems, orthopaedic practices, and patients with notable anxiety and confusion as to the near, intermediate, and long-term future of our healthcare system. As with most businesses in the United States during this time, many orthopaedic practices have been emotionally and fiscally devastated because of this crisis. Furthermore, this pandemic is occurring at a time where small and midsized orthopaedic groups are already struggling to cover practice overhead and to maintain autonomy from larger health systems. It is anticipated that many groups will experience financial demise, leading to substantial global consolidation. Because the authors represent some of the larger musculoskeletal multispecialty groups in the country, we are uniquely positioned to provide a framework with recommendations to best weather the ensuing months. We think these recommendations will allow providers and their staff to return to an infrastructure that can adjust immediately to the pent-up healthcare demand that may occur after the COVID-19 pandemic. In this editorial, we address practice finances, staffing, telehealth, operational plans after the crisis, and ethical considerations.
Extremity wounds compose the burden of injury in the global war on terrorism, and there is a great need for research to improve the treatment of soldiers who incur these devastating injuries. The mission of the United States Army Institute of Surgical Research is to conduct combat casualty care research in several areas, including explosive injury mechanisms, field tourniquet use, external fixator pin coating, wound irrigation optimization, antibiotic-impregnated bone graft substitutes, segmental muscle defects, and outcomes research. Future research directions include development of bone and soft-tissue regenerative technologies, prevention and treatment of heterotopic ossification, and bacteriology of unique pathogens.
The Coronavirus disease 2019 pandemic has been an unprecedented challenge to healthcare systems and clinicians around the globe. As the virus has spread, critical questions arose about how to best deliver health care in emergency situations where material and personnel resources become scarce. Clinicians who excel at caring for the individual patient at the bedside are now being reoriented into a system where they are being asked to see the collective public as their responsibility. As such, the clinical ethics that clinicians are accustomed to practicing are being modified by a framework of public health ethics defined by the presence of a global pandemic. There are many unknowns about Coronavirus disease 2019, which makes it difficult to provide consistent recommendations and guidelines that uniformly apply to all situations. This lack of consensus leads to the clinicians' confusion and distress. Real-life dilemmas about how to allocate resources and provide care in hotspot cities make explicit the need for careful ethical analysis, but the need runs far deeper than that; even when not trading some lives against others, the responsibilities of both individual clinicians and the broader healthcare system are changing in the face of this crisis.
Outcomes measures have long been used in the assessment of knee injuries and management protocols. In the past decade, there has been a shift from clinician-based outcomes tools to the development and validation of patient-reported outcomes measures. General health as well as disease- and medical condition-specific outcomes measures have been so modified. The Medical Outcomes Study 36-Item Short Form is the most commonly used general health measure in orthopaedics. Joint-specific measures include the Western Ontario and McMaster Universities Osteoarthritis Index, the Knee Injury and Osteoarthritis Outcome Score, and the International Knee Documentation Committee Subjective Form. The Lysholm Knee Scale and the Cincinnati Knee Rating Scale continue to be popular, especially for the assessment of ligamentous injuries. The ACL Quality of Life score is a disease-specific, patient-reported outcomes measure of anterior cruciate ligament deficiency. The historically used Tegner activity level scale and the recently developed Marx activity level scale are used in conjunction with these outcomes measures to make possible a global assessment of recovery from knee injuries and clinician interventions.
Extensor mechanism disruption is a rare and potentially devastating complication associated with total knee arthroplasty. Disruption can occur at the quadriceps or patellar tendons or, in the setting of a fracture, at the patella. Recognition of the risk factors for disruption and prevention via meticulous surgical technique are critical to avoid this complication. Various management techniques and the challenges associated with treatment have been described. Nonsurgical management consists of the use of walking aids and/or knee braces, which may not be acceptable for the active patient. Surgical options include primary repair and reconstructive techniques using allograft, autograft, synthetic material, and gastrocnemius rotational flaps. However, no single method has reliably demonstrated satisfactory outcomes. Although research on reconstructive procedures with synthetic materials has been promising, further study is need to assess the use of these materials.
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Thoracolumbar spine trauma is an important cause of morbidity and mortality in pediatric patients. Special attention to this population is necessary because several unique features of the growing pediatric spine separate these patients from adult patients. These injuries are frequently associated with high-energy trauma and concurrent thoracic or abdominal injuries that require coordinated multidisciplinary care. Thoracolumbar spine trauma in pediatric patients may lead to compression fractures, burst fractures, flexion-distraction injuries (ie, Chance fracture), fracture-dislocation injuries, apophyseal fractures/herniations, and spinous process and transverse process fractures. Depending on the nature of the injury and the patient's level of skeletal maturity, thoracolumbar spinal injuries may have substantial ability to heal and remodel. Because the impact of thoracolumbar spinal injury on pediatric patients can be devastating, appropriate early diagnosis and management, as well as long-term follow-up, are imperative.
The journal impact factor (JIF) is the average of the number of citations of the papers published in a journal, calculated according to a specific formula; it is extensively used for the evaluation of research and researchers. The method assumes that all papers in a journal have the same scientific merit, which is measured by the JIF of the publishing journal. This implies that the number of citations measures scientific merits but the JIF does not evaluate each individual paper by its own number of citations. Therefore, in the comparative evaluation of two papers, the use of the JIF implies a risk of failure, which occurs when a paper in the journal with the lower JIF is compared to another with fewer citations in the journal with the higher JIF. To quantify this risk of failure, this study calculates the failure probabilities, taking advantage of the lognormal distribution of citations. In two journals whose JIFs are ten-fold different, the failure probability is low. However, in most cases when two papers are compared, the JIFs of the journals are not so different. Then, the failure probability can be close to 0.5, which is equivalent to evaluating by coin flipping.
Webology is an international peer-reviewed journal in English devoted to the field of the World Wide Web and serves as a forum for discussion and experimentation. It serves as a forum for new research in information dissemination and communication processes in general, and in the context of the World Wide Web in particular. This paper presents a Scientometric analysis of the Webology Journal. The paper analyses the pattern of growth of the research output published in the journal, pattern of authorship, author productivity, and subjects covered to the papers over the period (2013-2017). It is found that 62 papers were published during the period of study (2013-2017). The maximum numbers of articles were collaborative in nature. The subject concentration of the journal noted was Social Networking/Web 2.0/Library 2.0 and Scientometrics or Bibliometrics. Iranian researchers contributed the maximum number of articles (37.10%). The study applied standard formula and statistical tools to bring out the factual result.
Using the Scopus dataset (1996-2007) a grand matrix of aggregated journal-journal citations was constructed. This matrix can be compared in terms of the network structures with the matrix contained in the Journal Citation Reports (JCR) of the Institute of Scientific Information (ISI). Since the Scopus database contains a larger number of journals and covers also the humanities, one would expect richer maps. However, the matrix is in this case sparser than in the case of the ISI data. This is due to (i) the larger number of journals covered by Scopus and (ii) the historical record of citations older than ten years contained in the ISI database. When the data is highly structured, as in the case of large journals, the maps are comparable, although one may have to vary a threshold (because of the differences in densities). In the case of interdisciplinary journals and journals in the social sciences and humanities, the new database does not add a lot to what is possible with the ISI databases.
Clinical tools involving immersive virtual reality (VR) may bring several advantages to cognitive neuroscience and neuropsychology. However, there are some technical and methodological pitfalls. The American Academy of Clinical Neuropsychology (AACN) and the National Academy of Neuropsychology (NAN) raised 8 key issues pertaining to Computerized Neuropsychological Assessment Devices. These issues pertain to: (1) the safety and effectivity; (2) the identity of the end-user; (3) the technical hardware and software features; (4) privacy and data security; (5) the psychometric properties; (6) examinee issues; (7) the use of reporting services; and (8) the reliability of the responses and results. The VR Everyday Assessment Lab (VR-EAL) is the first immersive VR neuropsychological battery with enhanced ecological validity for the assessment of everyday cognitive functions by offering a pleasant testing experience without inducing cybersickness. The VR-EAL meets the criteria of the NAN and AACN, addresses the methodological pitfalls, and brings advantages for neuropsychological testing. However, there are still shortcomings of the VR-EAL, which should be addressed. Future iterations shou
This scientometric study analyzes Avian Influenza research from 2014 to 2023 using bibliographic data from the Web of Science database. We examined publication trends, sources, authorship, collaborative networks, document types, and geographical distribution to gain insights into the global research landscape. Results reveal a steady increase in publications, with high contributions from Chinese and American institutions. Journals such as PLoS One and the Journal of Virology published the highest number of studies, indicating their influence in this field. The most prolific institutions include the Chinese Academy of Sciences and the University of Hong Kong, while the College of Veterinary Medicine at South China Agricultural University emerged as the most productive department. China and the USA lead in publication volume, though developed nations like the United Kingdom and Germany exhibit a higher rate of international collaboration. "Articles" are the most common document type, constituting 84.6% of the total, while "Reviews" account for 7.6%. This study provides a comprehensive view of global trends in Avian Influenza research, emphasizing the need for collaborative efforts ac
Ageing of publications, percentage of self-citations, and impact vary from journal to journal within fields of science. The assumption that citation and publication practices are homogenous within specialties and fields of science is invalid. Furthermore, the delineation of fields and among specialties is fuzzy. Institutional units of analysis and persons may move between fields or span different specialties. The match between the citation index and institutional profiles varies among institutional units and nations. The respective matches may heavily affect the representation of the units. Non-ISI journals are increasingly cornered into "transdisciplinary" Mode-2 functions with the exception of specialist journals publishing in languages other than English. An "externally cited impact factor" can be calculated for these journals. The citation impact of non-ISI journals will be demonstrated using Science and Public Policy as the example.