Bone Substitutes in Management of Benign Bone Tumors, Review of Literature

Intralesional excision or curettage is commonly used to treat benign and low-grade malignant bone tumors. The resulting defect can be treated with a variety of materials, such as autologous bone grafts, allografts, or synthetic materials like polymethylmethacrylate or composite alternatives. Because it is osteogenic, osteoinductive, and osteoconductive, autologous cancellous bone is often considered the gold standard of transplant material. However, issues including transplant size limitations, wound-related complications, and prolonged donor site pain have limited its usage in clinical practice. Concerns about immunogenicity and infection have also hampered the use of demineralized freeze-dried allografts and xenografts.  As a result, synthetic materials have sparked substantial interest in orthopedics, and a variety of bone graft alternatives are now commercially accessible

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries