ChatGPT: A useful tool for teaching orthopedic trauma to residents

As a practicing orthopedic surgeon and educational deputy in the orthopedic ward, I have witnessed challenges teaching complex surgical procedures and managing orthopedic trauma patients to residents in real-time. However, the advancement of technology has dramatically accelerated the learning process. During Covid-19, we have benefited from online teaching and case discussions using WhatsApp and received many positive feedbacks from residents and faculties. Speaking of the new technological assets, one particular tool that has proven to be very effective for educational purposes is ChatGPT

Pro ultra-Mesh Augmentation in the Rotator Cuff Repair: A Randomized, Single-Blind, Controlled Trial

Background: Rotator cuff tears present in about 20% of the population. This has prompted surgeons to look for techniques to augment the rotator cuff tear repair. This study aimed to assess the results of Ultrapro mesh augmentation in patients with massive and large rotator cuff tears as a clinical trial.   Methods: The study was a single-blind randomized controlled trial in which patients were randomly divided into two groups. Both groups underwent surgery. In one, Ultrapro mesh was used to augment the repair. Therapeutic outcome was assessed by using a joint range of motion, Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), and visual analogue scale (VAS).   Results: 60 patients were included, of whom 47 were men. Forward flexion (FF), abduction, external rotation (ER), and internal rotation (IR) degree increased significantly in both groups (P 0.05). During the study period and in both groups, the OSS score decreased, and the SST score increased. The pain in both groups decreased until the sixth month and increased after that up to the twelfth month.   Conclusion: Although the use of Ultrapro mesh augmentation in the rotator cuff tear has been associated with better long-term results in the abduction and ER of patients, the effect on the patients’ clinical results is not significant. Further studies are needed to make a more accurate judgment

Orthopedic oncology residency education, how broad and how deep?

Orthopedic residency training has long been an area of active research and discussion, and as the knowledge and concepts in subspecialties evolve, it is crucial to investigate the implications of these advancements in the musculoskeletal oncology field. It is important to note that the acquisition of surgical skills and scientific knowledge from orthopedic texts alone is not sufficient in this area. Orthopedic residents must also acquire multidisciplinary communication and leadership skills, as well as the mental capacity to make sound clinical decisions. Therefore, this commentary highlights the importance of assessing whether the current curriculum provides adequate preparation for residents’ future careers, despite the fact that the expansion of subspecialties in orthopedic education has undoubtedly enhanced the depth of knowledge and concepts in the field. In addition, orthopedic residents must adopt an open-minded and scientific approach toward orthopedic oncology, which has unique principles. Moreover, it is crucial that general orthopedic surgeons have the necessary skills to manage patients and know when to refer them. By exploring these issues, we hope to continually contribute to ongoing discussions about how to improve orthopedic residencyeducation

Evaluation of the Inter and Intra-Observer Reliability of the AO Classification of Intertrochanteric Fractures and the Device Choice (DHS, PFNA, and DCS) of Fixations

BACKGROUND:ArbeitsgemeinschaftfürOsteosynthesefragen (AO) classification is the most frequently used tool to classify intertrochanteric fractures. However, there is limited evidence regarding its reliability. Therefore, this study was designed to evaluate inter-observer and intra-observer reliability of the AO-2018 intertrochanteric fracture classification.METHOD: A retrospective study was conducted in Imam Khomeini Hospital Complex, on radiography of patients who came with intertrochanteric fractures from March 21, 2018, to March 19, 2019. Four orthopedic trauma surgeons assessed 96 anteroposterior pelvic radiographs of intertrochanteric fractures and classified using an AO intertrochanteric fracture classification of 2018. The reading and review of radiography were performed in 2 separate occasions in a 1-month interval. The inter-observer and intra-observer reliability was assessed using kappa statistics.RESULT: The level of both mean inter-observer (K =0.322; 95%CI: 0.321-0.323) and intra-observer agreement (K =0.317; 95%CI: 0.314-0.320) in AO intertrochanteric fracture classification subgrouping were not satisfactory. The inter-observer (K =0.61; 95%CI: 0.608-0.611) and intra-observers’ (K=0.560;95%CI: 0.544-0.566) reliability in AO main groupings showed moderate agreement.CONCLUSION: The AO classification does not show adequate and acceptable inter-observer and intra-observer reliability and reproducibility. Therefore, it will be hard to base on the AO classification for treatment protocols

Tribocorrosion behavior of NiTi biomedical alloy processed by an additive manufacturing laser beam directed energy deposition technique

The purpose of the present study was to experimentally assess the synergistic effects of wear and corrosion on NiTi alloy in comparison with Ti-6Al-4V alloy, the most extensively used titanium alloy in biomedical applications. Both alloys were processed by an additive manufacturing laser beam directed energy deposition (LB-DED) technique, namely laser engineered net shaping (LENS), and analyzed via tribocorrosion tests by using the ball-on-plate configuration. The tests were carried out in phosphate buffered saline solution at 37 °C under open circuit potential (OCP) to simulate the body environment and temperature. The synergistic effect of wear and corrosion was found to result in an improved wear resistance in both materials. It was also observed that, for the process parameters used, the LB-DED NiTi alloy exhibits a lower tendency to corrosion as compared to the LB-DED Ti-6Al-4V alloy. It is expected that, during the service life as an implant, the NiTi alloy is less susceptible to the metallic ions release when compared with the Ti-6Al-4V alloy.This work was partially funded by FCT (Fundação para a Ciência e Tecnologia) through the grant SFRH/BD/112280/2015 and the reference projects UID/EEA/04436/2019, COMPETE 2020 with the code POCI-01-0145-FEDER-006941; NORTE-01-0145-FEDER-000018-HAMaBICo and POCI-01-0145-FEDER-031035_LaserMULTICER. Also, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES-Brazil) and Alexander von Humboldt Foundation are acknowledged for the partial support of this work. This work was also partially supported by the Project “EXPERT”, Contract no. 14PFE/17.10.2018 and Auburn University’s Presidential Award for Interdisciplinary Research (PAIR)

Violence against Nurses: A Neglected and Health-threatening Epidemic in the University Affiliated Public Hospitals in Shiraz, Iran.

BACKGROUND: Nurses are more likely to be exposed to violence at their workplace in comparison with other employees. OBJECTIVE: To determine various aspects of violence against nurses in Shiraz public hospitals. METHODS: This cross-sectional study was conducted from 2017 to 2018, using a multistage random sampling method. Violence including verbal threats, verbal abuse, physical and sexual abuse as well as ethnical types, violence from patients, patients' companions and coworkers, and causes of violence were investigated using a checklist. RESULTS: 405 nurses with a mean age of 30.2 (SD 7.1) years and female to male ratio of 4.2 were interviewed. 363 (89.6%) nurses had experienced at least one kind of violence; 68.4% suffered from more than one type of violence. Verbal abuse (83.9%), verbal threats (27.6%), physical violence (21.4%), sexual abuse (10.8%), and ethnical harassment (6.1%) were the most common types of violence experienced by the nurses. Patients' companions, patients, and physicians were reported as the sources of violence in 70.6%, 43.1%, and 4.1% of cases, respectively. Nurses with non-official employment status and non-Farsi ethnicity, having a disease, with non-evening shift work, and those with short or long employment period were more affected. Unrealistic expectations by patients' companions and long working hours were the most common attributing factors. CONCLUSION: Violence against nurses, as a strenuous and health-threatening crisis, has become epidemic in public hospitals in our region. Effective interventions are warranted to sort out these problems. KEYWORDS: Hospitals; Nurses; Patients; Physicians; Violenc