The case of 'A Rhino Horn': case report and proposal for modification to the Hetsroni and Kelly classification.

Subspine impingement syndrome by definition involves a prominent antero-inferior iliac spine (AIIS) which can lead to impingement on the femoral neck thereby causing symptoms. We present the case of a 22-year-old semi-professional athlete who presented with a Type III AIIS morphology leading to subspine impingement syndrome and was managed via a mini open anterior approach. Radiological examination revealed a fairly prominent left AIIS resembling the 'horn of a rhino' extending to the trochanteric region anteriorly. A mini-anterior surgical approach was utilized for the resection of the 'rhino horn' and the rectus femoris was reattached. The patient remained asymptomatic at the one-year follow-up and had resumed weightlifting. Following this case, we propose a new classification of the type III AIIS morphology in view of the clinical presentation. The AIIS type III-Standard represents an extension from the acetabular rim to less than 1 cm (type III-S) and type III-Large, with an extension from the acetabular rim beyond 1 cm (type III-L). The type III-L will further be divided into two groups based on its relation to the ilium, type III-Lr ('rib shape') and type III-Lrh ('rhino horn')

Level of clinical evidence presented at the open and closed American Shoulder and Elbow Surgeons annual meeting over 10 years (2005-2014)

© 2016 The Author(s). Background: The American Shoulder and Elbow Surgeons (ASES) annual scientific meetings are premier forums whereby orthopaedic surgeons are informed of the latest research advances in shoulder and elbow surgery. The purpose of the present study was to assess the Level of evidence (LOE) in the clinical papers presented at both the open and closed ASES annual scientific meetings from 2005 to 2014. Secondarily, the study evaluated whether there were any changes in the distribution of LOE over this period of time. Methods: Two reviewers independently evaluated the abstracts of 532 paper presentations at either the open or closed ASES annual meetings. The independent reviewers first screened the abstracts for clinical evidence and excluded cadaveric, biomechanical, technique, and review studies. The included abstracts were then independently graded for methodological quality using LOE from Level I (highest quality) to IV (lowest quality) based on the classification system created by The American Academy of Orthopaedic Surgeons (AAOS). Results: Overall, 421 presentations were included and graded for LOE. In general, 17% of the presentations were graded level I; 15% level II; 25% level III; and 43% assigned a LOE of IV. Chi-square analysis demonstrated a statistically significant improvement in the LOE of presentations at the open and closed ASES meetings combined (p = 0.028) between the years 2005 and 2014. In particular, the proportion of presentations graded as level IV significantly decreased over this period (p = \u3c0.001). Conclusions: While most presentations at the ASES annual scientific meetings were of lower LOEs the percentage of level I evidence is greater than that reported at other Orthopaedic meetings. There has been a significant improvement in the LOE of clinical research at open and closed ASES meetings from 2005 to 2014. Specifically, the proportion of level IV studies have dramatically decreased over time

Clinical Commentary: A Criteria-Based Testing Protocol for Return to Sport Post Hip Arthroscopy for Impingement

Overall, 84%-87% of athletes will return to sport following hip arthroscopy; however, some literature suggests that only 57% of athletes return to their preinjury level, and only 16.9% report optimal performance. This discrepancy may be due to a lack of consistency within the definition of return to sport as well as a lack of consistency within rehabilitation programs when determining return to sport readiness. Athletes who are returning to sport must demonstrate adequate range of motion, strength, and the ability to perform multi-directional movements without the risk of reinjury. There has yet to be a comprehensive, criteria-based, return to sport testing protocol that utilizes objective measures to ensure athletes are ready for return to sport. The goal of the authors was to create a criteria-based testing protocol for return to sport following hip arthroscopy utilizing components best supported in the literature. The following parameters were identified as key areas to assess for within a return to sport testing protocol: range of motion, strength, functional testing, self-reported outcomes including psychological readiness and time. The purpose of this clinical commentary is to propose a criteria-based testing protocol to be used following hip arthroscopy for impingement from early rehabilitation through return to previous level of sport. Criteria are presented clearly to promote objective progression through rehabilitation while still being mindful of the biological healing time required for safe and efficient progression. It is the authors' hope that in identifying and establishing a criteria-based testing protocol a higher percentage of athletes will be able to return to sport. # Level of Evidence

Low-dose prophylaxis protocol for heterotopic ossification after hip preservation surgery in a sport participants cohort

Background: Heterotopic ossification (HO) is a well-known complication of arthroscopic and open surgical treatment of femoroacetabular impingement (FAI). Incidence of heterotopic ossification has been reported in the literature between 0% and 44% after hip arthroscopy and between 18.2% and 25% after anterior mini-open surgery. Currently, pharmacological prophylaxis with NSAIDs and selective COX-2 inhibitors are commonly used and their effectiveness is well documented in literature. Hypothesis: We hypothesized that the low-dose prophylaxis protocol with selective cox-2 inhibitors decreases the risk of heterotopic ossification in open or arthroscopic hip preservation surgery in athletes. Methods: This study is an analysis of prospectively gathered data on 98 sport participant patients who underwent arthroscopic or anterior mini-open treatment for FAI between April 2008 and April 2018. All the patients received postoperative oral prophylaxis with 60 mg etoricoxib once daily for two weeks. Post-operative X-rays were performed at 1, 3, and 12 months after surgery and reviewed by two orthopedic surgeons blinded to the type and side of surgery. HO were graded according to the Brooker classification. Descriptive statistics was used to analyze demographic data. Bivariate analysis was performed to analyze the association of HO with each of the following variables: type of surgery, physical activity, time of evolution of symptoms, age at surgery, and sex. Finally, a regression model analysis was performed to determine the presence of confounding effects between variables. Results: The study cohort was composed of 54 patients in the arthroscopic treatment group and 44 patients in the anterior mini-open group. HO was identified in 6 (13.6%) patients in the mini-open group. No HO was identified in the arthroscopic group. In the bivariate analysis, “type of surgery” was the only variable that showed a statistically significant association with HO (p = 0.007). Conclusion: Results of this study suggest that anterior mini-open treatment was characterized by a higher risk of HO development compared to hip arthroscopy for femoroacetabular impingement treatment regardless of pharmacological prophylaxis. The treatment regimen of 60 mg etoricoxib daily for two weeks was an effective prophylaxis for HO formation in sport participant patients compared with data available in the literature

Communal Conflict and Post-Conflict Developmental Challenges in Nigeria

Communal conflicts stand as a recurrent and significant issue plaguing the socio-political landscape of Africa, posing a major obstacle to Nigeria's security and development. The aftermath of such conflicts often entails extensive destruction, leaving behind a daunting task of reconstruction. In the case of the Modakeke community, their longstanding communal conflicts with Ife community have resulted in property damage and loss of lives over centuries. Despite efforts towards reconstruction and development, progress has been slow. This study aims to delve into the challenges faced by the community in the post-conflict phase. Employing a mixed-method design, data was collected and analyzed using a multi-stage sampling technique. A well-structured questionnaire and semi-structured key informant interviews were utilized to gather data. The analysis encompassed descriptive and inferential statistics, as well as content analysis. The findings shed light on several post-conflict developmental challenges confronted by the community. The destruction of farmlands and disputes over farm settlements have led to reduced agricultural yields and income for farmers. Additionally, the lingering fear of conflict recurrence has deterred new investments in the area. The study proposes crucial recommendations to address these challenges. Increased government involvement in community development, particularly in bolstering the farming and cocoa economy, is essential. Ensuring robust security measures is imperative to attract investors and prevent future conflicts. Moreover, reconstructing and revitalizing abandoned areas along the conflict's buffer zone is vital to fostering peace and progress. In conclusion, this research uncovers the pressing post-conflict developmental issues faced by the Modakeke community. By implementing the proposed recommendations, the community can strive towards sustainable development and foster a more secure and prosperous futur

Accelerated evidence synthesis in orthopaedics—the roles of natural language processing, expert annotation and large language models

peer reviewedIn an era of electronical medical records, rapidly expanding publication rates of medical knowledge, and large-scale registries, orthopaedics is in a dire need of innovative approaches to facilitate the adoption of the latest knowledge in clinical practice. While machine learning (ML) has been heralded as one solution to many research tasks hampered by previous technological limitations [12], there is an increasing need to direct our attention towards subdomains of ML that are convenient for the extraction of meaningful clinical information stored in medical records. We believe natural language processing (NLP) to be one such domain of ML, with an immense future potential to catalyse rate-limiting steps in orthopaedic research

Patients' values and preferences of the expected efficacy of hip arthroscopy for osteoarthritis : a protocol for a multinational structured interview-based study combined with a randomised survey on the optimal amount of information to elicit preferences

Peer reviewe