Subsequent ipsi- and contralateral femoral fractures after intramedullary nailing of a trochanteric or subtrochanteric fracture: a cohort study on 2012 patients

Background: The literature is inconclusive as to whether an intramedullary nail changes the distribution of a subsequent ipsi- or contralateral fracture of the femur. We have compared the incidence, localisation, and fracture pattern of subsequent femoral fractures after intramedullary nailing of trochanteric or subtrochanteric fractures in patients without previous implants in either femur at the time of surgery. Methods: Retrospective analysis was performed of a two-centre cohort of 2012 patients treated with a short or long intramedullary nail for the management of trochanteric or subtrochanteric fracture between January 2005 and December 2018. Subsequent presentations with ipsi- and contralateral femoral fractures were documented. Only patients with no previous femoral surgery performed, other than the index nailing were followed. Odds ratios (ORs) for subsequent femoral fracture were calculated using robust variance estimates in logistic regression. Results: The mean age of the cohort was 82.4 years and 72.1% were female. The total number of patients presenting with subsequent femoral fractures was 299 (14.9%). The number of patients presenting with subsequent ipsilateral and contralateral femoral fractures was 51 (2.5%) and 248 (12.3%) respectively (OR 5.0; CI 3.7–6.9). Twenty-six (8.7%) of all subsequent femoral fractures occured in the ipsilateral shaft, 14 (4.7%) in the ipsilateral metaphyseal area, one (0.33%) in the contralateral shaft, and three (1.0%) in the contralateral metaphysis (OR 10; CI 3.6–29). Conclusion: An intramedullary nail significantly changes the fracture pattern in the event of a second low-energy trauma, reducing the risk of subsequent proximal ipsilateral femoral fractures and increasing the risk of subsequent ipsilateral femoral fractures in the shaft and distal metaphyseal area compared with the native contralateral femur.publishedVersio

‘I was young, I wanted to return to sport, and re-ruptured my ACL’ – young active female patients’ voices on the experience of sustaining an ACL re-rupture, a qualitative study

publishedVersio

Exploring the potential of ChatGPT as a supplementary tool for providing orthopaedic information

Purpose: To investigate the potential use of large language models (LLMs) in orthopaedics by presenting queries pertinent to anterior cruciate ligament (ACL) surgery to generative pre-trained transformer (ChatGPT, specifically using its GPT-4 model of March 14th 2023). Additionally, this study aimed to evaluate the depth of the LLM’s knowledge and investigate its adaptability to different user groups. It was hypothesized that the ChatGPT would be able to adapt to different target groups due to its strong language understanding and processing capabilities. Methods: ChatGPT was presented with 20 questions and response was requested for two distinct target audiences: patients and non-orthopaedic medical doctors. Two board-certified orthopaedic sports medicine surgeons and two expert orthopaedic sports medicine surgeons independently evaluated the responses generated by ChatGPT. Mean correctness, completeness, and adaptability to the target audiences (patients and non-orthopaedic medical doctors) were determined. A three-point response scale facilitated nuanced assessment. Results: ChatGPT exhibited fair accuracy, with average correctness scores of 1.69 and 1.66 (on a scale from 0, incorrect, 1, partially correct, to 2, correct) for patients and medical doctors, respectively. Three of the 20 questions (15.0%) were deemed incorrect by any of the four orthopaedic sports medicine surgeon assessors. Moreover, overall completeness was calculated to be 1.51 and 1.64 for patients and medical doctors, respectively, while overall adaptiveness was determined to be 1.75 and 1.73 for patients and doctors, respectively. Conclusion: Overall, ChatGPT was successful in generating correct responses in approximately 65% of the cases related to ACL surgery. The findings of this study imply that LLMs offer potential as a supplementary tool for acquiring orthopaedic knowledge. However, although ChatGPT can provide guidance and effectively adapt to diverse target audiences, it cannot supplant the expertise of orthopaedic sports medicine surgeons in diagnostic and treatment planning endeavours due to its limited understanding of orthopaedic domains and its potential for erroneous responses. Level of evidence: V

Immigrant patients in brief meetings with anaesthetist nurses - experiences from perioperative meetings in the orthopaedic setting

Aim To explore the experience of anaesthetist nurses in brief meetings with immigrant patients in the perioperative setting. Methods The study was conducted through open individualised interviews using open-ended questions. Eighteen anaesthetist nurses (six men and twelve women) participated in the interviews. Their age varied between 35 and 65 and they had worked as anaesthetist nurses for a period between six and twenty eight years. The text was analysed using qualitative content analysis. Results Meetings with immigrant patients made nurses with less experience to prepare more, to study behaviour of these patients and to ask their older colleagues for advice. More experienced nurses acted on the basis of their previous experience and treated the patients in the same way as before. They also emphasised the great responsibility and wider scope of assistance needed by these patients than those born in Sweden. The majority of nurses begin the meetings with these patients by requesting an interpreter, while some nurses begin the meeting directly with the patient and, if they see it is not going well, they request an interpreter. Conclusion Nurses need better guidelines and education in how to deal with the legislation relating to immigrant patients in order to handle the situation more effectively. Training in cross-cultural care should be improved to help nurses deal with stress through co-operation with the Migration Board and others. In order to provide for good communication and patient safety professional interpreters should be used

No Effect of Return to Sport Test Batteries with and without Psychological PROs on the Risk of a Second ACL Injury: A Critical Assessment of Four Different Test Batteries

# Background Patients report psychological barriers as important when returning to sport, however, psychological outcome measures are seldom included in return to sport (RTS) assessment. There is a need for clinical trials to integrate psychological patient-reported outcomes (PROs) in return to sport batteries assessing patients treated with ACL reconstruction. # Objective The aim of this study was to determine the association between passing clinical tests of muscle function and psychological PROs and sustaining a second ACL injury in patients who RTS after primary ACL reconstruction. # Design Retrospective Cohort study # Methods Patients' sex, age, height and weight, and the results of strength and hop tests, as well as answers to PRO's (including Tegner activity scale, the ACL Return to Sport after Injury scale (ACL-RSI) as well as the Quality of Life (QoL) subscale of the Knee injury and Osteoarthritis Outcome Score $$KOOS$$), were extracted from a rehabilitation-specific registry. Four different test batteries comprising muscle function tests and PROs were created to assess whether patients were ready to RTS. Passing each of the test batteries (yes/no) was used as an independent variable. A multivariable Cox proportional hazard model analysis was performed, with sustaining a second ACL injury (either ipsi- or contralateral; yes/no) within two years of RTS as the dependent variable. # Results A total of 419 patients (male, n=214; 51%) were included, of which 51 (12.2%) suffered a second ACL injury within the first two years after RTS. There were no differences in passing rates in the different RTS test batteries comprising muscle function tests and PROs for patients who suffered a second ACL injury compared to patients who did not. # Conclusion No association between passing the RTS clinical tests batteries comprising muscle function and psychological PROs used, and the risk of a second ACL injury could be found. # Level of Evidence 3 ©The Author(s

Ethnic differences in the perception of pain: a systematic review of qualitative and quantitative research

Aim To investigate existence of scientific support for linking differences in the experience of pain to ethnicity. Methods The study was designed as a systematic literature review of qualitative and quantitative studies. The inclusion criteria were scientific studies published in scientific journals and written in English. Studies that described children’s experiences and animals were excluded. There were 10 studies, one qualitative and nine quantitative. Results The result was divided into two main sections. The first section presents the results of investigated material regarding different ethnic groups, the groups’ different experiences with regard to pain and its treatment focusing entirely on the patients’ perspective. Several studies have revealed major differences in the way individuals perceive their pain, using various pain evaluation tools. The second section explained different coping strategies depending on ethnicity and showed that different ethnic groups handle their pain in different ways. Conclusion Healthcare professionals have a duty to pay attention to and understand the patients’ experience of their disease and suffering and, as far as possible, mitigate this using appropriate measures. For this purpose, ethnic, cultural and religious differences between different patients need to be understood. It is necessary to continue to study ethnic differences in reporting and predicting pain and its consequences, including the assessment of variables associated with pain, as well as examining the use of prayer as a form of dealing with pain, with an evaluation of various effects of such different influences

The HARMONIE–AROME Model Configuration in the ALADIN–HIRLAM NWP System

The aim of this article is to describe the reference configuration of the convection-permitting numerical weather prediction (NWP) model HARMONIE-AROME, which is used for operational short-range weather forecasts in Denmark, Estonia, Finland, Iceland, Ireland, Lithuania, the Netherlands, Norway, Spain, and Sweden. It is developed, maintained, and validated as part of the shared ALADIN–HIRLAM system by a collaboration of 26 countries in Europe and northern Africa on short-range mesoscale NWP. HARMONIE–AROME is based on the model AROME developed within the ALADIN consortium. Along with the joint modeling framework, AROME was implemented and utilized in both northern and southern European conditions by the above listed countries, and this activity has led to extensive updates to themodel’s physical parameterizations. In this paper the authors present the differences inmodel dynamics and physical parameterizations compared with AROME, as well as important configuration choices of the reference, such as lateral boundary conditions, model levels, horizontal resolution, model time step, as well as topography, physiography, and aerosol databases used. Separate documentation will be provided for the atmospheric and surface data-assimilation algorithms and observation types used, as well as a separate description of the ensemble prediction system based on HARMONIE–AROME, which is called HarmonEPS

Satellite and in situ observations for advancing global Earth surface modelling: a review

In this paper, we review the use of satellite-based remote sensing in combination with in situ data to inform Earth surface modelling. This involves verification and optimization methods that can handle both random and systematic errors and result in effective model improvement for both surface monitoring and prediction applications. The reasons for diverse remote sensing data and products include (i) their complementary areal and temporal coverage, (ii) their diverse and covariant information content, and (iii) their ability to complement in situ observations, which are often sparse and only locally representative. To improve our understanding of the complex behavior of the Earth system at the surface and sub-surface, we need large volumes of data from high-resolution modelling and remote sensing, since the Earth surface exhibits a high degree of heterogeneity and discontinuities in space and time. The spatial and temporal variability of the biosphere, hydrosphere, cryosphere and anthroposphere calls for an increased use of Earth observation (EO) data attaining volumes previously considered prohibitive. We review data availability and discuss recent examples where satellite remote sensing is used to infer observable surface quantities directly or indirectly, with particular emphasis on key parameters necessary for weather and climate prediction. Coordinated high-resolution remote-sensing and modelling/assimilation capabilities for the Earth surface are required to support an international application-focused effort