Intra-Articular Osteotomy for Distal Humerus Malunion

Intra-articular osteotomy is considered in the rare case of malunion after a fracture of the distal humerus to restore humeral alignment and gain a functional arc of elbow motion. Traumatic and iatrogenic disruption of the limited blood flow to the distal end of the humerus resulting in avascular necrosis of capitellum or trochlea is a major pitfall of the this technically challenging procedure. Two cases are presented which illustrate the potential problems of intra-articular osteotomy for malunion of the distal humerus

Osteotomy and Autograft Lengthening for Intra-Articular Malunion of the Proximal Ulna: A Case Report

An osteotomy with interposition of iliac crest bone graft and lengthening of the proximal ulna can be used to restore ulnohumeral congruency after a malunited comminuted olecranon fracture treated with figure-of-eight tension band wiring

Artificial intelligence in orthopaedics:false hope or not? A narrative review along the line of Gartner's hype cycle

Artificial Intelligence (AI) in general, and Machine Learn-ing (ML)-based applications in particular, have the potential to change the scope of healthcare, including orthopaedic surgery.The greatest benefit of ML is in its ability to learn from real world clinical use and experience, and thereby its capability to improve its own performance.Many successful applications are known in orthopaedics, but have yet to be adopted and evaluated for accuracy and efficacy in patients' care and doctors' workflows.The recent hype around AI triggered hope for development of better risk stratification tools to personalize orthopaedics in all subsequent steps of care, from diagnosis to treatment.Computer vision applications for fracture recognition show promising results to support decision-making, overcome bias, process high-volume workloads without fatigue, and hold the promise of even outperforming doctors in certain tasks.In the near future, AI-derived applications are very likely to assist orthopaedic surgeons rather than replace us. 'If the computer takes over the simple stuff, doctors will have more time again to practice the art of medicine'.(76)</p

Surgeon Personal Factors Associated with Care Strategies in Musculoskeletal Telehealth

Background: Most surgeons used, or are currently using telehealth during the SARS-CoV-2 (COVID-19) pandemic. We studied surgeon personal factors associated with relative use of telehealth during the worldwide height of the pandemic. Questions/Purposes: (1) Are there any personal factors/characteristics associated with use and utilization of telehealth? (2) What are surgeon’s perspectives/ opinions with regard to use of telehealth for five common upper extremity conditions in terms of future prospects and viability? Methods: Hand and upper extremity surgeons in the Science of Variation Group (SOVG) were invited to participate in a web-based survey. The first part of the survey focused on surgeon characteristics and work preferences. The second part focused on care strategies during the pandemic and utilization of telehealth. The final part of the survey addressed the care of five common upper extremity conditions during the pandemic. Results: Ninety percent of surgeons used telehealth during the first few months of the pandemic, but only 20% of visits were virtual. A greater percentage of telehealth visits compared to office visits was independently associated with a policy of only seeing people with emergencies in person (RC: 0.64; CI 95%: 0.21 to 1.1; P&lt;0.01). Surgeons found it difficult to reproduce most parts of the physical examination on video, but relatively easy to make a diagnosis, with both ratings associated with less belief that the physical exam is essential. Comfort in offering surgery by video visit was associated with having young children, preference for remote meetings, and less belief that the physical exam is essential. Conclusion: Utilization of, and comfort with, telehealth is related to personal factors and preferences, acceptance of a more limited physical examination in particular. Utilization of early adopters and training to increase comfort with the probabilistic aspects of medicine could facilitate incorporation of telehealth into standard practice.</p

The management of elbow trauma from a historical perspective

The origins of contemporary orthopedics can be traced all the way back to antiquity. Despite the absence of modern imaging techniques, a few bright minds were able to lay the groundwork for understanding these fractures. This historical review will cover the process behind the various treatments for elbow fractures, such as splinting and casting, mobilization, amputation, fracture fixation, arthroplasty, and arthroscopy.</p

Regional differences in the three-dimensional bone microstructure of the radial head:implications for observed fracture patterns

Introduction: A characterization of the internal bone microstructure of the radial head could provide a better understanding of commonly occurring fracture patterns frequently involving the (antero)lateral quadrant, for which a clear explanation is still lacking. The aim of this study is to describe the radial head bone microstructure using micro-computed tomography (micro-CT) and to relate it to gross morphology, function and possible fracture patterns. Materials and methods: Dry cadaveric human radii were scanned by micro-CT (17 μm/pixel, isotropic). The trabecular bone microstructure was quantified on axial image stacks in four quadrants: the anterolateral (AL), posterolateral (PL), posteromedial (PM) and anteromedial (AM) quadrant. Results: The AL and PL quadrants displayed the significantly lowest bone volume fraction and trabecular number (BV/TV range 12.3–25.1%, Tb.N range 0.73–1.16 mm−1) and highest trabecular separation (Tb.Sp range 0.59–0.82 mm), compared to the PM and AM quadrants (BV/TV range 19.9–36.9%, Tb.N range 0.96–1.61 mm−1, Tb.Sp range 0.45–0.74 mm) (p = 0.03). Conclusions: Our microstructural results suggest that the lateral side is the “weaker side”, exhibiting lower bone volume faction, less trabeculae and higher trabecular separation, compared to the medial side. As the forearm is pronated during most falls, the underlying bone microstructure could explain commonly observed fracture patterns of the radial head, particularly more often involving the AL quadrant. If screw fixation in radial head fractures is considered, surgeons should take advantage of the “stronger” bone microstructure of the medial side of the radial head, should the fracture line allow this