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Background: Orthopaedic academic partnerships between high-income countries (HICs) and low and middle-income countries (LMICs) are an effective method to increase research and scholarly support. The purpose of this study was to perform a systematic literature review of the current state of partnerships worldwide and assess the quality, quantity, and content of their research output.

Methods: A systematic review was conducted using 4 academic databases: PubMed, MEDLINE, Embase, and CENTRAL. Article eligibility criteria included articles published between January 2017 and 2022, with orthopaedic authors from at least 1 HIC and LMIC. Articles related to global orthopaedic surgery with exclusively HIC or LMIC authors were excluded.

Results: The database search yielded 25,928 articles, and after deduplication, 21,145 articles were included in the screening. After title and abstract screening, 408 articles underwent full-text review for eligibility. The final list of eligible articles for extraction included 310 publications in 127 journals. Published articles increased over time (46 in 2017 to 88 in 2021) and were most commonly published in the Journal of Bone and Joint Surgery (20, 6.5%). Open-access articles (203, 65.5%) had a significantly greater Journal Citation Indicator (p = 0.024) than non-open-access articles. Most studies (40.7%) were observational, with few (3.6%) randomized controlled trials. Orthopaedic trauma (38.1%) was the most common subspecialty, followed by spine (14.8%) and pediatrics (14.2%). Most partnerships were sponsored by North American authors in 65 LMICs, primarily China, India, and the sub-Saharan African region.

Conclusion: This study identified 310 articles published by orthopaedic international academic partnerships in 106 countries over the past 5 years, demonstrating that collaborations between LMIC/HIC partners nearly doubled over the study period. Sixty-five percent of the articles were published in open-access journals.

Background: The stabilization of metastatic lesions in the periacetabular region can be successfully performed using percutaneous techniques. Photodynamic nails (PDNs) are among the available tools for stabilization. Data on postoperative complications and functional outcomes are, however, scarce.

Methods: Patients undergoing percutaneous stabilization using PDNs (IlluminOss Medical) for impending or actual minimally displaced pathological fractures of the pelvis from metastatic bone disease, multiple myeloma, or primary bone lymphoma were enrolled prospectively. Outcomes were assessed preoperatively and postoperatively at the 2-day, 2-week, 6-week, 3-month, 6-month, and 1-year time points. Functional outcomes assessed included the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, PROMIS Pain Interference, Combined Pain and Ambulatory Function (CPAF), EuroQol-Visual Analogue Scale (EQ-VAS), and Musculoskeletal Tumor Society (MSTS) scores. Pain was assessed using a VAS.

Results: A total of 30 patients treated with PDNs were included. The median VAS pain score dropped from 60 points preoperatively to 30 at 6 weeks postoperatively (p = 0.004). The median CPAF score improved from 6 preoperatively to 7 postoperatively at the 6-week mark. The median EQ-VAS score showed significant improvement at 6 weeks (70 versus 50; p = 0.006). The median 2-week PROMIS Pain Interference score was significantly lower than preoperatively (64.1 versus 66.9; p = 0.03). An improvement in the median PROMIS Physical Function score was seen at 6 weeks following surgery compared with preoperatively (37 versus 30.1; p = 0.001). A significant improvement in the MSTS score was seen as soon as 2 days after surgery (77% versus 40%; p < 0.0001).

Conclusions: Among patients with pelvic bone metastases, multiple myeloma, or primary bone lymphoma, we found that treatment using PDNs resulted in immediate return to ambulation and rapid functional outcome improvement, with low complication rates. In this population, this technique represents a safe alternative to open surgery.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Background: Reverse total shoulder arthroplasty (RTSA) offers satisfactory mid-term outcomes for a variety of pathologies, but long-term follow-up data are limited. This study demonstrates the long-term clinical and radiographic outcomes as well as the predictive factors for an inferior outcome following RTSA.

Methods: Using the prospective database of a single, tertiary referral center, we included all primary RTSAs that were performed during the study period and had a minimum 10-year follow-up. Clinical outcomes included the absolute Constant-Murley score (CS), relative CS, Subjective Shoulder Value (SSV), range of motion, pain, complication rate, and reintervention rate. Radiographic measurements included the critical shoulder angle (CSA), lateralization shoulder angle (LSA), distalization shoulder angle (DSA), reverse shoulder angle (RSA), acromiohumeral distance (ACHD), center of rotation, glenoid component height, notching, radiolucent lines, heterotopic ossification, and tuberosity resorption.

Results: A total of 135 shoulders (133 patients) were available for analysis at a mean follow-up of 10.9 ± 1.6 years. The mean age was 69 ± 8 years, and 76 shoulders (76 patients; 56%) were female. For most of the clinical outcomes, initial improvements were observed in the short term and were sustained in the long term without notable deterioration, with >10-year follow-up values of 64 ± 16 for the absolute CS, 79% ± 18% for the relative CS, 79% ± 21% for the SSV, and 14 ± 3 for the CS for pain. However, after initial improvement, deterioration was seen for flexion and external rotation, with values of 117° ± 26° and 25° ± 18°, respectively, at the final follow-up. Scapular notching, heterotopic ossification, and radiolucent lines of <2 mm progressed during the study period. Younger age (p = 0.040), grade-II notching (p = 0.048), tuberosity resorption (p = 0.015), and radiolucent lines of <2 mm around the glenoid (p = 0.015) were predictive of an inferior outcome. The complication rate was 28%, with a reintervention rate of 11%.

Conclusions: RTSA provided improved long-term results that did not significantly deteriorate over time for most of the clinical parameters. Negative clinical outcome predictors were younger age, grade-II notching, tuberosity resorption, and radiolucent lines of <2 mm around the glenoid.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Background: This study aimed to evaluate the long-term results of hallux valgus correction with a distal metatarsal reversed-L (ReveL) osteotomy.

Methods: Eighty-eight patients (131 feet) were evaluated after a mean follow-up of 14.2 years (range, 10 to 18 years). Weight-bearing foot radiographs were analyzed preoperatively, at 6 weeks postoperatively, and at the final follow-up for the following parameters: hallux valgus angle (HVA), intermetatarsal angle (IMA), first metatarsophalangeal joint (MTPJ) congruence angle, sesamoid position, presence of the round sign, and first MTPJ arthritis. The visual analog scale (VAS) and the Foot and Ankle Outcome Score (FAOS) assessed postoperative pain and function. Univariate and multivariable logistic regression analyses identified risk factors for hallux valgus recurrence and an inferior clinical outcome.

Results: All radiographic parameters significantly improved at the 6-week follow-up and the final follow-up (p < 0.001). The recurrence rate (HVA >20°) was 14%. A preoperative HVA of >28° (odds ratio [OR], 9.1; p = 0.02) and a 6-week postoperative HVA of >15° (OR, 4.6; p = 0.03) were independent risk factors for recurrence. At the final follow-up, all FAOS subscales resembled high postoperative function (median, 100 points [range of the interquartile range (IQR), 81 to 100 points]). A preoperative body mass index of >30 kg/m² was associated with lower FAOS quality of life (QOL) (p = 0.04), and postoperative hallux varus was associated with lower FAOS activities of daily living (p = 0.048). Patients with first MTPJ arthritis of grade 2 or higher at the final follow-up had significantly lower FAOS subscales (p < 0.01) except for QOL. Hallux valgus recurrence did not influence the long-term outcome. A symptomatic implant was the main cause of revision (15%). In 94% of cases, the patients were satisfied with the hallux appearance and, in 92% of cases, the patients were satisfied with postoperative pain reduction.

Conclusions: Hallux valgus correction with a ReveL osteotomy led to high long-term satisfaction rates. A preoperative HVA of >28° and a 6-week postoperative HVA of >15° increased the risk of hallux valgus recurrence. First MTPJ arthritis was the leading cause of inferior clinical results, whereas radiographic hallux valgus recurrence had no impact on the clinical results. First MTPJ arthritis at the final follow-up was associated with an inferior clinical outcome, whereas radiographic hallux valgus recurrence had no impact on the long-term clinical results.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Introduction: There is a historic sex imbalance in the field of orthopaedic surgery in the United States, with female physicians being vastly underrepresented. In addition, this sex imbalance is particularly pronounced in certain subspecialties. As such, we sought to analyze the distribution of graduating female residents and their fellowship match trends from 2017 to 2022.

Methods: The American Medical Association Fellowship and Residency Electronic Interactive Database was used to identify all orthopaedic surgery residency programs in the United States during the 2016 to 2017 and the 2021 to 2022 academic years. The data were supplemented with the Accreditation Council for Graduate Medical Education (ACGME) Data Book to include data on all ACGME-accredited programs in 2017 and 2022. The percentage of female orthopaedic surgery residents matching into each subspecialty was calculated. Continuous data were analyzed with independent t test, and significance was set at p < 0.05.

Results: From 2017 to 2022, there has been a significant increase in the percentage of female residents matching in orthopaedic surgery fellowships (14.6% vs. 19.5%, p < 0.001). In the orthopaedic hand subspecialty, 24 (15.8%) female residents matched into a hand fellowship in 2017 vs. 56 (35.2%) in 2022 (p < 0.001). Spine, trauma, adult reconstruction, oncology, pediatrics, foot and ankle, shoulder and elbow, and sports medicine fellowships have not seen a significant change in the distribution of female residents matching over the past 5 years.

Conclusion: Between 2017 and 2022, the total number of female orthopaedic surgery fellows increased, and there was significant growth in the percentage of matched female fellows in the subspecialty of hand. Other orthopaedic subspecialties including spine, trauma, adult reconstruction, oncology, pediatrics, foot and ankle, shoulder and elbow, and sports medicine have seen no significant change in the distribution of women fellows over the past 5 years. Further investigation is warranted to determine factors leading to growth in certain fellowships among female residents to encourage sex diversity among all subspecialties in orthopaedic surgery.

» Computer-assisted robots aid orthopaedic surgeons in implant positioning and bony resection. Surgeons selecting a robot for their practice are faced with numerous options. This study aims to make the choice less daunting by reviewing the most commonly used Food and Drug Administration-approved robotic total knee arthroplasty platforms in the American arthroplasty market.» Modern total knee arthroplasty (TKA) robots use computer guidance to create a virtual knee model that serves as the surgeon's canvas for resection planning.» Most available robotic TKA (rTKA) systems are closed semiactive systems that restrict implant use to those of the manufacturer.» Each system has distinct imaging requirements, safety features, resection methods, and operating room footprints that will affect a surgeon's technique and practice.» Robots carry different purchase, maintenance, and equipment costs that will influence patient access across different socioeconomic groups.» Some studies show improved early patient-reported outcomes with rTKA, but long-term studies have yet to show clinical superiority over manual TKA.

Introduction: The artificial intelligence language model Chat Generative Pretrained Transformer (ChatGPT) has shown potential as a reliable and accessible educational resource in orthopaedic surgery. Yet, the accuracy of the references behind the provided information remains elusive, which poses a concern for maintaining the integrity of medical content. This study aims to examine the accuracy of the references provided by ChatGPT-4 concerning the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach in trauma surgery.

Methods: Two independent reviewers critically assessed 30 ChatGPT-4-generated references supporting the well-established ABCDE approach to trauma protocol, grading them as 0 (nonexistent), 1 (inaccurate), or 2 (accurate). All discrepancies between the ChatGPT-4 and PubMed references were carefully reviewed and bolded. Cohen's Kappa coefficient was used to examine the agreement of the accuracy scores of the ChatGPT-4-generated references between reviewers. Descriptive statistics were used to summarize the mean reference accuracy scores. To compare the variance of the means across the 5 categories, one-way analysis of variance was used.

Results: ChatGPT-4 had an average reference accuracy score of 66.7%. Of the 30 references, only 43.3% were accurate and deemed "true" while 56.7% were categorized as "false" (43.3% inaccurate and 13.3% nonexistent). The accuracy was consistent across the 5 trauma protocol categories, with no significant statistical difference (p = 0.437).

Discussion: With 57% of references being inaccurate or nonexistent, ChatGPT-4 has fallen short in providing reliable and reproducible references-a concerning finding for the safety of using ChatGPT-4 for professional medical decision making without thorough verification. Only if used cautiously, with cross-referencing, can this language model act as an adjunct learning tool that can enhance comprehensiveness as well as knowledge rehearsal and manipulation.

Background: Previous studies have recognized the potential of the Vertebral Bone Quality (VBQ) score for predicting fractures. However, these studies often have lacked longitudinal perspectives and have not focused on community populations. Our study aimed to enhance the predictive capacity of the VBQ score by investigating its correlation with new vertebral fractures (NVFs) that were detected 11 years later in a community-based cohort and by developing a comprehensive prediction model.

Methods: This study was a population-based study conducted in the Minami-Aizu area in Fukushima Prefecture, Japan. One hundred and thirty participants voluntarily underwent T1-weighted magnetic resonance imaging (MRI) of the lumbar spine in 2004 and 2015. VBQ scores were ascertained from the 2004 scans. NVFs that occurred between 2004 and 2015 were detected based on a ≥20% reduction in vertebral height on the midsagittal sections of the MRI. Other predictors that were considered included age, sex, body mass index, smoking history, heart disease, cerebrovascular disease, respiratory disease, and existing vertebral fractures (EVFs). A logistic regression analysis was conducted.

Results: The logistic regression analysis indicated that the VBQ score, age, sex, and EVFs were significant predictors of NVFs. The prediction model showed an area under the curve of 0.84, suggesting excellent discriminatory power. The calibration capacity was confirmed using the Hosmer-Lemeshow test.

Conclusions: The VBQ score was significantly correlated with the long-term incidence of NVFs in a community population. The prediction model exhibited satisfactory discrimination and calibration capacities, highlighting the use of the VBQ score as a potential tool for long-term prediction of NVFs.

Level of evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Background: The current literature shows similar clinical outcomes between first metatarsophalangeal (MTP) joint arthrodesis and synthetic cartilage implant (SCI) hemiarthroplasty in the treatment of hallux rigidus; however, prior studies have not reported validated patient-reported outcome measures (PROMs). To our knowledge, this is the first study to compare PROMs using 6 domains of the validated Patient-Reported Outcomes Measurement Information System (PROMIS) in patients treated for hallux rigidus with MTP joint arthrodesis and with SCI hemiarthroplasty. In addition, this novel study provides comparative data on the complication and revision rates for each procedure.

Methods: A single-center, retrospective registry search identified all patients with preoperative PROMIS scores who underwent MTP joint arthrodesis or SCI hemiarthroplasty for hallux rigidus between February 2016 and June 2021. The study aimed to determine if the 2 procedures showed statistically or clinically equivalent PROMIS scores in 6 domains: physical function, pain interference, pain intensity, global physical health, global mental health, and depression. A multivariable linear regression analysis was performed to compare adjusted 1-year postoperative PROMIS scores between the 2 cohorts. Complication and revision rates were also compared.

Results: The study included 82 patients who underwent SCI hemiarthroplasty and 101 who underwent MTP joint arthrodesis. Demographic data and preoperative hallux rigidus severity showed no significant differences between the cohorts. PROMIS scores were mostly comparable between the 2 groups, except for the pain intensity domain. The patients who underwent MTP joint arthrodesis exhibited significantly better pain relief at 1 and 2 years postoperatively, which was supported by adjusted postoperative PROMIS scores. At 2 years, the SCI group had worse pain intensity scores and lower global physical health scores. There were no differences between the cohorts in additional PROMIS scores or complication data.

Conclusions: While outcomes in most of the domains were similar, MTP joint arthrodesis was more effective at mitigating pain intensity compared with SCI hemiarthroplasty. This information can guide patient counseling and decision-making when considering surgical intervention for hallux rigidus.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Background: Accurate radiographic assessment is pivotal in evaluating trauma patients with suspected pelvic ring disruptions. The conventional approach of using anteroposterior, 45° inlet, and 45° outlet radiographs for the evaluation of pelvic injury may not consistently align with varying lumbopelvic anatomy. This study aimed to determine the ideal pelvic inlet and outlet radiographic angles when there is limited access to advanced imaging (e.g., computed tomography [CT]) for assessing clinically relevant pelvic osseous landmarks and to investigate variations based on age, sex, and sacral dysmorphism.

Methods: This cross-sectional study investigated patients who were ≥18 years of age who had no traumatic injuries or pelvic ring pathology; we reviewed abdominopelvic CT scans that were obtained between January 1, 2023, and June 30, 2023. Midsagittal reconstruction and 3D rendering of 148 CT scans facilitated the measurement of pelvic inlet and outlet angles. Standard techniques that were based on previous studies were used to determine the ideal angles. Statistical analyses investigated mean pelvic inlet and outlet angles as well as correlations with age, sex, and sacral dysmorphism.

Results: The mean pelvic inlet angle was 23.8° ± 8.4° (95% confidence interval [CI]: 22.4° to 25.2°), and the mean outlet angle was 40.1° ± 5.9° (95% CI: 39.2° to 41.1°). Male patients exhibited greater inlet angles (27° versus 20°), whereas female patients had greater outlet angles (41° versus 39°). Pelves with dysmorphism showed a 3.6° increase in outlet angles when compared with those with normal sacral anatomy. An inverse relationship between age and inlet angle was observed.

Conclusions: This study highlights that the recommended 45° angle for pelvic inlet and outlet views may not optimally align with the anatomy of the Ethiopian population. The findings suggest that the ideal inlet and outlet angles for this population are 25° and 40°, respectively. Understanding these variations is crucial for optimizing pelvic radiographic views in trauma evaluation, potentially leading to more accurate assessments and improved patient care in this demographic.

Level of evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.