First metatarsophalangeal hemiarthroplasty for hallux rigidus

There is a paucity of objective information in the literature about first metatarsophalangeal (MTP) hemiarthroplasty. The authors postulate that it is a reasonable treatment option for severe hallux rigidus in selected patients. Twenty-two elective first MTP hemiarthroplasties were performed on 20 patients that met the inclusion criteria. Pre- and postoperative evaluations were done using the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, visual analogue scale (VAS) pain score, range of motion (ROM) measurements, and radiographs. Average ROM and dorsiflexion improved by 15° and 8°, respectively. VAS pain scores improved from 5 to 2.5 after six weeks. Painless ambulation occurred after six weeks, with maximum improvement by six months. After 24 months, two patients had pain at the surgical site interfering with function, leading to an unsatisfactory result that required conversion to arthrodesis. First MTP hemiarthroplasty for severe hallux rigidus can be considered an alternative to fusion in properly selected patients who wish to maintain a functional range of motion

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

A QUEST for Intervention

Our team approaches drug and alcohol addiction through the lense of a holistic medical model and focuses on integrative healthcare and treatment at all points in an individual’s experience with substance abuse. Through a review of global and local research on addiction, we observed the benefits of integrative healthcare for individuals and society and noticed that the state of Montana is behind in implementing such programs. We propose the implementation of infrastructure that provides prevention, intervention, and treatment programs across multiple healthcare agencies and community organizations. This unification within the health organizations in Missoula, Montana will promote the integrative care of all individuals in need, as well as maximize the benefit and effect of existing addiction resources. Additionally, our team brings a variety of knowledge and professional experience in the field of psychology to the topic and we aim to also provide addiction intervention resources in areas of mental and behavioral health care, housing instability, and poverty. Both Community Health Centers and screening programs have a presence in Missoula but they are not as effective as they need to be at preventing and treating addiction. Our team will conduct research to examine where exactly the community needs assistance in unifying the care for those experiencing substance addiction. Our emphasis on the integrated treatment and prevention of drug and alcohol addiction is meant to ensure that each patient receives the care they need as quickly as possible. The coordination between services and programs is key to the success of integrated healthcare and the emphasis the medical model for drug and alcohol addiction reduces the punitive and recidivistic effects of the law enforcement model. Our team strives to increase outreach to these programs and increase the use of the Screening, Brief Intervention and Referral to Treatment (SBIRT) approach. This approach identifies those at risk for developing a SUD through effective screening methods and provides treatment for those with a SUD before detrimental results, such as comorbid health problems and legal troubles, occur

The World Wide Race for Artificial Intelligence: A Path Forward for U.S. Policy

The advent of an artificial intelligence (AI) revolution will result in massive transformation across all sectors of society. AI has the potential to redefine innovation, impacting global labor markets, improving military capabilities, and supporting smart cities. As a result of this incredible potential, countries worldwide are funneling resources towards the expansion of their AI capabilities and finding new ways to collect vast amounts of data to train AI systems. These landmark technologies bring cutting edge solutions to challenges previously out of reach. However, AI proliferation also comes with difficult ethical questions regarding data privacy and the use of autonomous weaponry

Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between Mar