Deep Learning for Orthopedic Disease Based on Medical Image Analysis: Present and Future

Since its development, deep learning has been quickly incorporated into the field of medicine and has had a profound impact. Since 2017, many studies applying deep learning-based diagnostics in the field of orthopedics have demonstrated outstanding performance. However, most published papers have focused on disease detection or classification, leaving some unsatisfactory reports in areas such as segmentation and prediction. This review introduces research published in the field of orthopedics classified according to disease from the perspective of orthopedic surgeons, and areas of future research are discussed. This paper provides orthopedic surgeons with an overall understanding of artificial intelligence-based image analysis and the information that medical data should be treated with low prejudice, providing developers and researchers with insight into the real-world context in which clinicians are embracing medical artificial intelligence.

Treatment of chronic osteomyelitis with antibiotic-impregnated polymethyl methacrylate (PMMA) – the Cierny approach: is the second stage necessary?

Background Chronic osteomyelitis is a challenge for orthopedic surgeons. Most patients with osteomyelitis receive two-stage management according to Cierny-Mader. The first stage includes radical debridement and insertion of an antibiotic-impregnated cement spacer (ACS) (beads, rods, nails, or blocks) into the bone defect. The second stage is performed 6–8 weeks later, when the spacer is removed and a cancellous autograft is placed within the bone defect. The possibility of ACS as definitive management for osteomyelitis, avoiding the second stage, is presented. Methods Sixteen patients with osteomyelitis received radical debridement and insertion of an ACS in all forms into the bone defect as a definitive management. In 8 patients, the tibia was infected, 4 had femur infection, 2 humerus, 1 fibula, and 1 ankle. The mean age at the time of the first stage of reconstruction was 49 years (range, 13–71 years). According to the Cierny-Mader classification, 1 patient was C-M IA, another was IB, 7 IIIA, 6 IIIB, and 1 was 4A. All B hosts had systemic illnesses. The mean follow-up period was 6 years (1.5–16 years). Results No patient exhibited radiographic evidence of excessive bone loss. Signs of recurrence of osteomyelitis were not noted in any of the patients, and no fractures had occurred by the last follow-up. Conclusion Our study suggests that a proportion of patients with planned retention of ACS appear to function well without requiring further surgical intervention, especially in elderly or vulnerable patients.

Emerging zero-dimensional to four-dimensional biomaterials for bone regeneration

Bone is one of the most sophisticated and dynamic tissues in the human body, and is characterized by its remarkable potential for regeneration. In most cases, bone has the capacity to be restored to its original form with homeostatic functionality after injury without any remaining scarring. Throughout the fascinating processes of bone regeneration, a plethora of cell lineages and signaling molecules, together with the extracellular matrix, are precisely regulated at multiple length and time scales. However, conditions, such as delayed unions (or nonunion) and critical-sized bone defects, represent thorny challenges for orthopedic surgeons. During recent decades, a variety of novel biomaterials have been designed to mimic the organic and inorganic structure of the bone microenvironment, which have tremendously promoted and accelerated bone healing throughout different stages of bone regeneration. Advances in tissue engineering endowed bone scaffolds with phenomenal osteoconductivity, osteoinductivity, vascularization and neurotization effects as well as alluring properties, such as antibacterial effects. According to the dimensional structure and functional mechanism, these biomaterials are categorized as zero-dimensional, one-dimensional, two-dimensional, three-dimensional, and four-dimensional biomaterials. In this review, we comprehensively summarized the astounding advances in emerging biomaterials for bone regeneration by categorizing them as zero-dimensional to four-dimensional biomaterials, which were further elucidated by typical examples. Hopefully, this review will provide some inspiration for the future design of biomaterials for bone tissue engineering. Graphical abstract

Restoration of Hip Biomechanics after a Hemiarthroplasty for a Femoral Neck Fracture—Who Does It Better?

Introduction: The restoration of the preoperative biomechanics of the hip, in particular leg length and femoral offset, are critical in restoring normal function and diminishing the risk of dislocation following hip arthroplasty. This study compares the consistency of arthroplasty and non-arthroplasty orthopedic surgeons in restoring the normal biomechanics of the hip when performing a hemiarthroplasty for the treatment of a femoral neck fracture. Methods: We retrospectively reviewed the preoperative and postoperative digital radiographs of 175 hips that had a modular hemiarthroplasty for the treatment of a displaced femoral neck fracture at a Level 1 academic hospital. Fifty-two hips were treated by one of the three fellowship-trained arthroplasty surgeons (Group A), and 123 were treated by one of the nine non-arthroplasty fellowship-trained orthopedic surgeons (Group B). Results: Patients in Group A were more likely to have their femoral offset restored to normal than patients in Group B, both with respect to under correcting the offset (p = 0.031) and overcorrecting the offset (p = 0.010). Overall, there was no difference in restoration of leg lengths between the two groups (p = 0.869). Conclusions: Following a hemiarthroplasty for a displaced femoral neck fracture, the normal biomechanics of the hip are more likely to be restored by an arthroplasty-trained surgeon than by a non-arthroplasty-trained surgeon. Identifying the inconsistency of non-arthroplasty surgeons and, to a lesser degree, arthroplasty surgeons in restoring hip biomechanics is important for sensitizing surgeons to rectify this in the future with appropriate templating and femoral implant selection.

95th Anniversary of the First Russian Society of Orthopedic Surgeons

95 years ago, namely on October 12, 1926, through the efforts of 27 founders, including professors G.I. Turner, A.L. Polenov, R.R. Vreden and G.A. Albrecht, the first scientific society of orthopedic surgeons of Leningrad and the Leningrad region was created in our country, which continues to be an indispensable platform for the training of scientific personnel, the exchange of practical experience and research results directed by authoritative figures of domestic traumatology and orthopedics, the successors of the Leningrad school of orthopedic surgeons. The article summarizes the results of the societys work during four periods of its activity: the first period of formation (19261933), the second period work in the pre-war, war and post-war years (19341950), the third period the intensive development of traumatology and orthopedics (19501990) and the fourth period the modern rapid development of the specialty (since 1990). The main aim of the current activity and new areas of work are formulated.

Editorial Comment on the Article by Mushkin M.A. et al. “Effect of Prehospital Pause on the Outcomes of Emergency Decompression and Stabilization Procedures in Patients with Tumor and Infectious Spine Diseases”

The editorial comment evaluates the current state of issue of medical care at urgent states caused by pathological vertebral fractures and spinal cord compression in patients with spine destructive diseases. The rare occurrence of pathology and the deficiency of objective data determine the lack of consensus on the medical care for this category of patients. The article by M.A. Mushkin et al helps to understand how the prehospital pause affects the outcomes of emergency decompression and stabilization procedures in patients with tumor and infectious diseases of the spine, as well as to determine how much time the surgeon has at his disposal. The author of the comment believes that close cooperation of orthopedic surgeons, neurosurgeons, oncologists is necessary to solve this problem. Even despite the absence of oncologists in the staff of emergency hospitals, telemedicine allows to receive methodological support in a timely manner for making a correct decision for each patient. Interaction between clinicians, radiologists and pathologists is equally important. An important aspect is continuity in patient care. An urgently performed spinal cord decompression is only a stage of the complex treatment. Such patients should be provided with accurate routing depending on the diagnosis and the treatment early outcome.

Healthcare Delivery among Yoruba Bonesetters in Southwest Nigeria and the Need for Collaboration with Orthodox Orthopedic Healthcare Services: A Mixed Method Study

This study covers three purposively chosen states; Ogun, Ondo, and Oyo, in southwestern Nigeria. Primary data were collected using three sets of questionnaires. The respondent-driven sampling (RDS) technique was employed in selecting the respondents for the study. A total of 69 traditional bonesetters (TBS), 130 TBS patients, and 15 orthopedic surgeons were interviewed. The study reveals that majority (91.2%) of the TBS in the study area claimed that they had received an average of 11 patients from orthodox hospitals in the year preceding the survey while about 9.0% of the respondents reported that 78 Soladoye S. Asa, Matthew O. Ilori, and Lawrence A. Akinyoola they had on the average advised 6 patients per year to relocate to orthodox hospitals. The study also reveals the views of TBS areas of need from government to include recognition (93.7%) and integration into the country’s health system (63.5%). A majority (93.3%) of the orthopedic surgeons reported having received patients from TBS, and each surgeon had received, on average, 37 patients per year. All the orthopedic surgeons surveyed believed that TBS lacked knowledge in the management of bone injuries, apart from setting bones. Other issues considered critical by the doctors in the management of fractures by TBS included lack of training in the biology of bones (86.7%) and inability to refer cases to modern health facilities (73.3%). The proportion of orthopedic surgeons who had ever thought of a possible interaction between TBS and orthopedic surgeons was 80.0% while 86.7% would advise the establishment of such interaction. Furthermore, the study reveals that more than half (54.6%) of TBS patients made a TBS clinic their first choice for treatment. The paper concludes that integration will go a long way to improving the health of the population, thereby significantly reducing deaths or disability-adjusted life years (DALYs) lost.