Pediatric Fractures

This reprint contains original research and review chapters concerning the latest advancements in various topics related to pediatric fractures. Topics include fractures of the face, clavicle, shoulder, elbow, forearm, wrist, pelvis, femur, and tibia; special considerations focus on osteogenesis imperfecta patients; and consideration is also given to general pediatric fracture topics, such as the influence of the COVID-19 pandemic, mortality after pediatric trauma, the effects of NSAID and electronic cigarette use, and chapters on epidemiology and physical activity

Medical Robotics

The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not

An evaluation of a checklist in Musculoskeletal (MSK) radiographic image interpretation when using Artificial Intelligence (AI)

Background: AI is being used increasingly in image interpretation tasks. There are challenges for its optimal use in reporting environments. Human reliance on technology and bias can cause decision errors. Trust issues exist amongst radiologists and radiographers in both over-reliance (automation bias) and reluctance in AI use for decision support. A checklist, used with the AI to mitigate against such biases, may optimise the use of AI technologies and promote good decision hygiene. Method: A checklist, to be used in image interpretation with AI assistance, was developed. Participants interpreted 20 examinations with AI assistance and then re- interpreted the 20 examinations with AI and a checklist. The MSK images were presented to radiographers as patient examinations to replicate the image interpretation task in clinical practice. Image diagnosis and confidence levels on the diagnosis provided were collected following each interpretation. The participant perception of the use of the checklist was investigated via a questionnaire.Results: Data collection and analysis are underway and will be completed at the European Congress of Radiology in Vienna, March 2023. The impact of the use of a checklist in image interpretation with AI will be evaluated. Changes in accuracy and confidence will be investigated and results will be presented. Participant feedback will be analysed to determine perceptions and impact of the checklist also. Conclusion: A novel checklist has been developed to aid the interpretation of images when using AI. The checklist has been tested for its use in assisting radiographers in MSK image interpretation when using AI.<br/

Selection of fusion levels in adolescent idiopathic scoliosis (AIS) using the fulcrum bending radiograph prediction: verification based on pedicle screw strategy

E-Poster - Adolescent Idiopathic Scoliosis: no. 297Utilizing the fulcrum bending radiographic technique to assess curve flexibility to aid in the selection of fusion levels, a prospective radiographic study was performed to assess the safety and effectiveness of pedicle screw fixation with alternate level screw strategy (ALSS) for thoracic AIS. This study suggests that ALSS obtains greater deformity correction than hook and hybrid systems, and improves balance without compromising fusion levels.postprin

'Clinical Triad' findings in Klippel-feil patients

E-Poster - Congenital Deformity: no. 530It has been propagated that Klippel-Feil Syndrome (KFS) is associated with the clinical triad findings (CTF) of short neck, low posterior hairline, and limited range of motion. This study noted that CTFs are not consistently noted in KFS patients. KFS patients with extensive congenitally fused cervical segments were more likely to exhibit one of the components of CTF.postprin

The integrated care model for the management of older patients with hip fracture in China

Introduction Hip fracture is a common and severe injury among older people and has become a significant public health issue with a huge burden on patients’ families and societies due to high mortality, disability, excess medical costs. The World Health Organisation advocates an integrated care for olde people framework to provide comprehensive care and management for older people. However, there is very limited evidence with respect to the care delivery and management of older patients with hip fracture in China. This thesis aims to generate an evidence base with respect to establishing and implementing an integrated model of care for older patients with hip fracture in China, facilitated by digital health technologies. Methods The thesis consists of five chapters, 1) a multicentre observational study to understand the characteristics of traumatic orthopaedic injuries in China; 2) a non-randomised controlled trial to evaluate an orthogeriatric co-managed model of care for older patients with hip fracture; 3) a qualitative study to identify the factors that influencing the implementation of the orthogeriatric co-managed model of care within acute hospitals and develop a conceptual framework that constitutes a series of determinants to facilitate the scale-up of this model of care; 4) a qualitative study to identify the barriers and enablers of the post-surgery care delivery of older patients with hip fracture and summarise recommendations for the implementation of an integrated post-surgery care of hip fracture; and 5) a scoping review to understand the role of digital health technologies to facilitate the post-surgery care delivery of older patients with hip fracture. Results The most common fracture is hip fracture and the access to fracture care, both acute and post-discharge, is underdeveloped in China. The orthogeriatric co-managed model of care for older patients with hip fracture can significantly increase the proportion of patients who receive surgery within 48 hours, in addition to reducing in-hospital and one-year cumulative mortality, compared with the conventional orthopaedist-led model of care. However, several challenges were identified during the delivery of the orthogeriatric co-managed care model within acute hospitals, and various factors were found to facilitate scale-up of the co-managed model of care, including hospital authority support, an enabling environment, adequate number of beds, sufficient and skilled health providers, use of digital health technology, regular quality supervision, evaluation, and feedback, and external collaborations. Moreover, several barriers and enablers were also identified during the delivery of post-surgery care of older patients with hip fracture, deriving from the macro, meso, and micro levels of the health systems. The recommendations to implement an integrated post-surgery care of hip fracture included the engagement of governments and private sectors, establishment of a case manager role and a community-based care model. Digital health technologies can have a potential to provide a concrete opportunity for the integration of medical resources to address the obstacles during the hip fracture care delivery across different health facilities. Conclusion Despite the challenges existing across the health systems during the hip fracture care delivery, an orthogeriatric co-managed model of care can improve the clinical and health outcomes of older patients with hip fracture in an integrated manner, and this integrated model of care should be expanded to the whole patient journey of hip fracture. Digital health technologies should be actively adopted to facilitate the hip fracture care in the future

The safety and efficacy of a remotely distractible, magnetic controlled growing rod (MCGR) for the treatment of scoliosis in children: a prospective case series with minimum two year follow-up

Concurrent Session 2B - Early Onset Scoliosis: paper no. 26SUMMARY: The growing rod has been the gold standard for the treatment of scoliosis in young children. However, such management requires multiple open surgeries under general anesthesia for rod distraction and is associated with numerous postoperative complications. To avoid such pitfalls, we utilized a magnetically-controlled growing rod (MCGR) implant. Our study found that the MCGR was safe and effective, allowing for distractions on a non-invasive out-patient basis at monthly intervals, eliminating the need for surgeries and their associated complications. Introduction: Traditionally, growing rods are the standard of treatment for young children with severe spinal deformities and significant residual growth potential. However, this requires repeated open distractions under general anesthesia and is associated with numerous post-operative complications. This report addresses the safety and efficacy of the MCGR implant for non-invasive out-patient distractions for scoliosis correction in young children. METHODS: This was a prospective, patient series of the MCGR procedure. From November 2009 to March 2011, five patients (n=3 female; n=2 male) were treated with the MCGR. In this study, we report the first three patients (2 females and 1 male) with minimum 2 years follow-up. All cases were non-invasively distracted using an external magnet on a monthly basis. Pre and post distraction radiographs were carried out to assess the Cobb’s angle, predicted versus achieved rod distraction length and spinal length. Clinical outcome assessment was performed with the pain score (Visual Analogue Scale) and the SRS-30 questionnaire. All procedural or rod related complications were recorded. RESULTS: The main correction of the Cobb’s angle was obtained in the initial surgery and was maintained. The mean monthly increase in T1-T12, T1-S1 and instrumented segment length was 1.6mm, 2.5mm and 1.2mm, respectively. Predicted versus actual length gain per distraction were similar. One case had a superficial wound infection and there was one event of loss of distraction. On last follow-up, no pain was noted and SRS-30 scores remained unchanged to baseline. CONCLUSION: The MCGR is a safe and effective procedure for the surgical treatment of scoliosis in children. The MCGR provides external distractions on an out-patient basis without the need for sedation or anesthesia, and that remote distraction allows more frequent lengthening of the rod that may more closely mimic physiologic growth.postprin

Characterization of alar ligament on 3.0T MRI: a cross-sectional study in IIUM Medical Centre, Kuantan

INTRODUCTION: The main purpose of the study is to compare the normal anatomy of alar ligament on MRI between male and female. The specific objectives are to assess the prevalence of alar ligament visualized on MRI, to describe its characteristics in term of its course, shape and signal homogeneity and to find differences in alar ligament signal intensity between male and female. This study also aims to determine the association between the heights of respondents with alar ligament signal intensity and dimensions. MATERIALS & METHODS: 50 healthy volunteers were studied on 3.0T MR scanner Siemens Magnetom Spectra using 2-mm proton density, T2 and fat-suppression sequences. Alar ligament is depicted in 3 planes and the visualization and variability of the ligament courses, shapes and signal intensity characteristics were determined. The alar ligament dimensions were also measured. RESULTS: Alar ligament was best depicted in coronal plane, followed by sagittal and axial planes. The orientations were laterally ascending in most of the subjects (60%), predominantly oval in shaped (54%) and 67% showed inhomogenous signal. No significant difference of alar ligament signal intensity between male and female respondents. No significant association was found between the heights of the respondents with alar ligament signal intensity and dimensions. CONCLUSION: Employing a 3.0T MR scanner, the alar ligament is best portrayed on coronal plane, followed by sagittal and axial planes. However, tremendous variability of alar ligament as depicted in our data shows that caution needs to be exercised when evaluating alar ligament, especially during circumstances of injury