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Background: Only a few cases of bilateral traumatic sternoclavicular dislocations have been reported in the literature. This injury is considered one of the rarest injuries of the human musculoskeletal system. Therefore, we present the first documented case of a cyclist with a third-degree open thoracic trauma (Gustilo–Anderson 3a) associated with a dislocated manubrium sterni fracture in the upper thoracic aperture, bilateral anterior dislocations of the sternoclavicular joints, rib fractures, and pleural ruptures. Case presentation: The patient, a 27-year-old Caucasian male, incurred this injury while participating in a professional cycling race at Nürburgring, Germany and received immediate interdisciplinary surgical treatment and has encountered no complications. We conducted a 1-year follow-up and present the clinical findings of this follow up. Additionally, we conducted a comprehensive review of the existing literature on this injury. Conclusions: Immediate interdisciplinary intervention, including surgical repair and meticulous postoperative care, facilitated successful patient recovery. This underscores the critical role of comprehensive trauma management in complex polytrauma cases. In conclusion, this case report highlights the rarity and complexity of a traumatic injury involving bilateral sternoclavicular dislocation, with this case being the first case reported with concomitant open thorax trauma. Our patient benefited greatly from immediate air-bound transportation to an interdisciplinary care provider, which houses both thoracic and trauma surgery departments. [ABSTRACT FROM AUTHOR]

Background: Surgical specialists experience significant musculoskeletal strain as a consequence of their profession, a domain within the healthcare system often recognized for the pronounced impact of such issues. The aim of this study is to calculate the risk of presenting musculoskeletal injuries in surgeons after surgical practice. Methods: Cross-sectional study carried out using an online form (12/2021–03/2022) aimed at members of the Spanish Association of Surgeons. Demographic variables on physical and professional activity were recorded, as well as musculoskeletal pain (MSP) associated with surgical activity. Univariate and multivariate analysis were conducted to identify risk factors associated with the development of MSP based on personalized surgical activity. To achieve this, a risk algorithm was computed and an online machine learning calculator was created to predict them. Physiotherapeutic recommendations were generated to address and alleviate each MSP. Results: A total of 651 surgeons (112 trainees, 539 specialists). 90.6% reported MSP related to surgical practice, 60% needed any therapeutic measure and 11.7% required a medical leave. In the long term, MSP was most common in the cervical and lumbar regions (52.4, 58.5%, respectively). Statistically significant risk factors (OR CI 95%) were for trunk pain, long interventions without breaks (3.02, 1.65–5.54). Obesity, indicated by BMI, to lumbar pain (4.36, 1.84–12.1), while an inappropriate laparoscopic screen location was associated with cervical and trunk pain (1.95, 1.28–2.98 and 2.16, 1.37–3.44, respectively). A predictive model and an online calculator were developed to assess MSP risk. Furthermore, a need for enhanced ergonomics training was identified by 89.6% of surgeons. Conclusions: The prevalence of MSP among surgeons is a prevalent but often overlooked health concern. Implementing a risk calculator could enable tailored prevention strategies, addressing modifiable factors like ergonomics. [ABSTRACT FROM AUTHOR]

The present study has two main goals: to conduct a systematic review of musculoskeletal injuries experienced by badminton players, and to examine the management of such injuries. Searches were conducted of the PROSPERO, PubMed, Scopus, and SPORTDiscus databases, from their inception until March 2023. The papers analysed were all based on a study population consisting of individuals aged 18 years or more, diagnosed with badminton-related injuries. The methodological quality assessments was using the Newcastle-Ottawa Scale and REVMAN. A total of 28 studies were included in the systematic review. In total, the analysis included 2435 participants. Of these athletes, 35.6% (1012) were female and 64.4% (1503) were male. By type of injury, sprains were the most commonly studied and the most prevalent, accounting for 36.06% of the sample. These were followed by muscle injuries, representing 23.86% of the total. Injuries to the joints were the least prevalent, accounting for 4.97% of the sample. Lower limb injuries accounted for 52.15% of the total. Of these, ankle injuries were the most common. Despite the generally low quality of the studies considered, the evidence suggests that musculoskeletal injuries, especially to the lower limb, most commonly affect badminton players of all levels. [ABSTRACT FROM AUTHOR]

The purpose of this scoping review was to identify existing strategies to reduce modifiable risk factors for musculoskeletal (MSK) injury in adaptive athletes. Medline, Embase, Web of Science, and CINAHL were searched. Inclusion criteria required studies written in English, samples of adaptive athletes, and evaluation of any injury prevention programs that would reduce risk factors associated with MSK injury. The literature search resulted in 785 unique articles. Thirty-two full text articles were screened for inclusion. Four studies of wheelchair basketball and wheelchair rugby injury prevention programs were included in the final analysis, and these studies demonstrated increase in shoulder range of motion, decreased shoulder pain, and decreased cumulative traumatic disorders; all of which was proposed to reduce risk of shoulder injury. However, these studies were small and did not include control groups. Future research is needed to implement programs that reduce risk factors of MSK injuries and reduce health disparities for adaptive athletes. [ABSTRACT FROM AUTHOR]

Orthopedic trauma results in the injury of bone joints and tendons of the body. A radiologist reviews and monitors large numbers of radiographs daily, which can lead to the diagnostic error. Therefore, there is a need to automate the detection of bone fractures in X-ray images, particularly humerus bone fractures. In this paper, we have proposed an ensemble model that can detect the fracture in an x-ray image. In this paper, we proposed an ensemble model designed for fracture detection in X-ray images. An ensemble model combines multiple diverse models to improve predictive accuracy and robustness by aggregating their individual predictions. The model leverages MobileNetV2, Vgg16, InceptionV3, and ResNet50, using histogram equalization for preprocessing and a Global Average Pooling layer for feature extraction. The entire humerus from the public Mura-v1.1 dataset is utilized for analysis, utilizing a single training-validation split. The dataset is divided into a ratio of 80:20 for experiments for the training and validation datasets. The proposed model outperformed the modified deep-learning models and achieved 92.96%, 91.62%, and 92.14% accuracy, recall, and F1 scores, respectively. The ensemble model presented effectively automates bone fracture detection in X-ray images of the humerus, demonstrating superior performance compared to modified deep-learning models. A comparison has been made between a novel ensemble model and state-of-the-art models, bench-marking their performance. These findings underscore its potential for enhancing diagnostic accuracy and efficiency in orthopedic radiology. • Novel technique using an ensemble model for humerus fracture detection in X-ray images. • Combines MobileNetV2, Vgg16, InceptionV3, and ResNet50 for enhanced predictive accuracy. • Uses histogram equalization before data augmentation and Global Average Pooling. • Achieved 92.96% accuracy, 91.62% recall, and 92.14% F1 score, outperforming other models. [ABSTRACT FROM AUTHOR]

The study of bone cement disintegration is important for advancing orthopedic and trauma surgery outcomes. Bone cement, commonly used in joint replacement procedures, plays a vital role in fixation implants. However, the long-term stability and integrity of bone cement are critical for the success of these procedures. This study focuses on the use of ultrasonic pulsating water jet technology for the selective removal of bone cement, aiming to provide a precise and efficient method for revision surgeries. The disintegration efficiency is measured in terms of depth, width and volume of the disintegrated bone cement as a result of variations in the nozzle geometry, supply pressure and traverse speed. Two different nozzle types, the standard nozzle insert and nozzle with an extension tube of 100 mm having a diameter of 0.3 mm, are used. Two supply pressure levels were taken as 10 and 20 MPa with five levels of traverse speeds as 0.5, 1, 1.5, 2 and 2.5 mm/s. The results showed an increased disintegration efficiency for all experimental conditions using an extension tube nozzle as compared to a standard nozzle (20 - 25% in terms of disintegration volume). Also, the disintegration efficiency increased with higher pressure level values (8.2 mm3 and 4.85 mm3 for p = 20 and 10 MPa, respectively) and lower traverse speed values. The results showed a promising direction in terms of the utilization of an ultrasonic pulsating jet with a modified nozzle type for higher bone cement disintegration efficiency. [ABSTRACT FROM AUTHOR]

Background: Moderate-severe traumatic brain injury (msTBI) stands as a prominent etiology of adult disability, with increased risk for cognitive impairment and dementia. Although some recovery often occurs within the first year postinjury, predicting long-term cognitive outcomes remains challenging, partly due to the significant pathophysiological heterogeneity of TBI, including acute cerebrovascular injury. The primary aim of our recently funded study, cerebral autoregulation, brain perfusion, and neurocognitive outcomes after traumatic brain injury (CAPCOG-TBI), is to determine if acute cerebrovascular dysfunction after msTBI measured using multimodal non-invasive neuromonitoring is associated with cognitive outcome at 1-year post-injury. Methods: This longitudinal observational study will be conducted at two Level 1 trauma centers in Texas, USA, and will include adult patients with msTBI, and/or mild TBI with neuroimaging abnormalities. Multimodal cerebral vascular assessment using transcranial Doppler and cerebral near-infrared spectroscopy (NIRS) will be conducted within 7-days of onset of TBI. Longitudinal outcomes, including cognitive/functional assessments (Glasgow Outcome Scale and Patient-Reported Outcomes Measurement Information System), cerebral vascular assessment, and imaging will be performed at follow-ups 3-, 6-, and 12-months post-injury. We aim to recruit 100 subjects with msTBI along with 30 orthopedic trauma controls (OTC). This study is funded by National Institute of Neurological Disease and Stroke (NINDS) and is registered on Clinicaltrial.org (NCT06480838). Expected results: We anticipate that msTBI patients will exhibit impaired cerebrovascular function in the acute phase compared to the OTC group. The severity of cerebrovascular dysfunction during this stage is expected to inversely correlate with cognitive and functional outcomes at 1-year postinjury. Additionally, recovery from cerebrovascular dysfunction is expected to be linked to cognitive recovery. Conclusion: The results of this study could help to understand the contribution of cerebrovascular dysfunction to cognitive outcomes after TBI and pave the way for innovative vascular-focused interventions aimed at enhancing cognitive recovery and mitigating neurodegeneration following msTB. In addition, its focus toward personalized medicine to aid in the management and prognosis of TBI patients. [ABSTRACT FROM AUTHOR]

Background: Prompt identification of fracture healing is crucial for medical decision-making and clinical research. This study aims to assess the effectiveness of the Radiographic Union Score for Hip (RUSH) in subtrochanteric fractures and determine the optimal scoring threshold for fracture healing. Methods: We obtained 94 sets of X-ray films from the postoperative follow-up of 35 patients who underwent intramedullary nail fixation for subtrochanteric fractures. Six orthopedic trauma surgeons evaluated the imaging data and determined fracture healing based on subjective judgment. They then scored the X-ray images using the RUSH form. After four weeks, the same observers re-evaluated 47 randomly selected sets of radiographs. Subsequently, the observers and study designer conducted a consensus meeting where they agreed on whether the fractures had healed. We used Fleiss kappa to evaluate agreement among observers based on subjective impressions, and the intraclass correlation coefficient assessed RUSH score consistency. Regression analysis examined the relationship between scores and fracture healing consensus using a receiver operator characteristic (ROC) curve. Results: Based on overall impressions, the agreement level among orthopedic trauma surgeons for determining the healing status of subtrochanteric fractures was moderate (Kappa = 0.564, 95% CI: 0.511–0.616). However, utilizing the RUSH scoring system can improve the consistency to a substantial level of agreement (ICC = 0.748, 95% CI: 0.663–0.817). Regarding intraobserver reliability, there were significant differences among orthopedic trauma surgeons in judging fracture healing based on overall impressions. However, using the RUSH scoring form, the attending group achieved better intraobserver consistency than the resident group. Regression analysis and ROC curve analysis revealed a strong correlation between the RUSH total score, cortical bone score, cancellous bone score, and consensus on fracture healing. The AUC values are 0.769 (95% CI: 0.670–0.868), 0.779 (95% CI: 0.681–0.876), and 0.771 (95% CI: 0.674–0.867), respectively. Conclusions: Our study highlights the effectiveness of the RUSH scoring system in enhancing interobserver agreement and intraobserver consistency when evaluating subtrochanteric fracture healing in orthopedic trauma surgeons. We propose setting 21 points as the threshold for the simplified RUSH scoring system to determine fracture healing. This system includes only eight items related to cortical bone, with a total score of 24 points. [ABSTRACT FROM AUTHOR]

This paper explores the use of biomechanics in identifying the mechanistic causes of musculoskeletal tissue injury and degeneration. It appraises how biomechanics has been used to develop training programmes aiming to maintain or recover tissue health. Tissue health depends on the functional mechanical environment experienced by tissues during daily and rehabilitation activities. These environments are the result of the interactions between tissue motion, loading, biology, and morphology. Maintaining health of and/or repairing musculoskeletal tissues requires targeting the "ideal" in vivo tissue mechanics (i.e., loading and deformation), which may be enabled by appropriate real-time biofeedback. Recent research shows that biofeedback technologies may increase their quality and effectiveness by integrating a personalised neuromusculoskeletal modelling driven by real-time motion capture and medical imaging. Model personalisation is crucial in obtaining physically and physiologically valid predictions of tissue biomechanics. Model real-time execution is crucial and achieved by code optimisation and artificial intelligence methods. Furthermore, recent work has also shown that laboratory-based motion capture biomechanical measurements and modelling can be performed outside the laboratory with wearable sensors and artificial intelligence. The next stage is to combine these technologies into well-designed easy to use products to guide training to maintain or recover tissue health in the real-world. [ABSTRACT FROM AUTHOR]

Purpose: Electrotherapies are commonly used to treat adult musculoskeletal pathologies. However, there is insufficient evidence supporting the use of electrotherapies for lower limb conditions in children. Currently, it is unknown how electrotherapies are used in paediatric clinical practice. This study aimed to investigate if practitioners use electrotherapy to treat children's lower limb conditions, frequency and why. Materials and methods: A custom-built online survey was disseminated via social media targeting international medical and healthcare practitioners who treat children with lower limb conditions using electrotherapy. Practitioners were asked if they did or did not use electrotherapies, and their reasons. Responses were described in frequencies and with thematic analysis. Results: There were 445 practitioners who responded. From these, 301(68%) indicated they used electrotherapy, with the most frequently used being Transcutaneous Electrical Nerve Stimulation (n = 110). The most common reason cited for using electrotherapy was practitioner preference due to the alleged effectiveness of the chosen modality. The remaining 144 (32%) practitioners reported not using electrotherapy, the most common reason being lack of evidence. Conclusions: We found that a majority of practitioners used electrotherapies on children. The reasons for using or not using electrotherapy were practitioner centred. IMPLICATIONS FOR REHABILITATION: Electrotherapy modalities are commonly used to treat musculoskeletal injuries in adults The management of children differs from adults due to physiological and psychological differences. The use of electrotherapy to treat musculoskeletal lower limb pathologies children is currently not supported by evidence, and the frequency of use of these modalities in children is not known. This study found that despite that, a majority of medical and health practitioners surveyed in this study routinely use electrotherapy to treat paediatric musculoskeletal injuries. [ABSTRACT FROM AUTHOR]

A lateral ankle sprain is the most common musculoskeletal injury in the physically active population. However, it is unclear how the clinical condition evolves during the period after the injury and what proportion of patients develops chronic symptoms. Therefore, the purpose of this study is to assess the evolution of patient-reported outcome measures after a first time lateral ankle sprain. A prospective clinical study assessed the patient-reported outcome measures (PROMs) of a consecutive group of 100 patients during 1 year after a first lateral ankle sprain. The Karlsson score and Foot and Ankle Outcome Score (FAOS) were assessed at 6 weeks, 3 months, 6 months, 9 months and 1 year. The Cumberland Ankle Instability Tool (CAIT)-score was assessed at 6 months, 9 months and 1 year. The difference between the time points of all scores was analysed using the positive change over time (binomial test versus 50%) and the difference in score (signed rank test). The time to sustained excellent level was also assessed overall and in several subgroups: age, gender, degree of injury (2 or 3), avulsion fracture, use of crutches, use of cast. Differences between subgroups were assessed by a generalized log-rank test. All clinical scores demonstrated an improvement up to 12 months after the sprain. The median Karlsson score (interquartile range) improved from 62 (50−80) at 6 weeks to 90 (72−100) at 3 months, to 97 (82−100) at 6 months to 100 (90−100) at 9 months, to 100 (100−100) at 1 year. The analysis of positive change over time demonstrated a significant positive change (P-value <.0005) between all time points except between 6 weeks and 12 weeks when using the FAOS quality score. The difference in score demonstrated a significant change (P-value <.01) between all time points except between 36 weeks and 48 weeks when using the FAOS pain and FAOS sports score. Age and presence of an avulsion fracture were correlated with a slower recovery and worse results. At 1 year, in total 13 patients (13%) had a worse outcome corresponding to a Karlsson score < 81 or CAIT score < 24. The clinical condition after a first ankle sprain demonstrated a significant improvement in PROMs between the different time points in the first year. Twelve months after a first lateral ankle sprain 13% had a fair or poor outcome. Higher age and presence of an avulsion fracture were correlated with a slower recovery and worse results. This information is useful in clinical practice to predict further progression and inform patients. Moreover, it is valuable to improve treatment strategies. Level II (prospective cohort study) • The clinical condition after a first ankle sprain demonstrated a significant improvement in PROMs up to 12 months. • At 1 year, in total 13 patients (13%) had a worse outcome corresponding to a Karlsson score < 81 or CAIT score < 24. • Higher age and presence of an avulsion fracture were correlated with a slower recovery and worse results. [ABSTRACT FROM AUTHOR]

Bilateral communication between bones and muscles is essential for healing composite bone–muscle injuries from orthopedic surgeries and trauma. However, these injuries are often characterized by exaggerated inflammation, which can disrupt bone–muscle crosstalk, thereby seriously delaying the healing of either tissue. Existing approaches are largely effective at healing single tissues. However, simultaneous healing of multiple tissues remains challenging, with little research conducted to date. Here we introduce collagen patches that overcome this overlooked issue by harnessing the plasticity of macrophage phenotypes. Phosphatidylserine liposomes (PSLs) capable of shifting the macrophage phenotype from inflammatory M1 into anti-inflammatory/prohealing M2 were coated on collagen patches via a layer-by-layer method. Original collagen patches failed to improve tissue healing under inflammatory conditions coordinated by M1 macrophages. In contrast, PSL-coated collagen patches succeeded in accelerating bone and muscle healing by inducing a microenvironment dominated by M2 macrophages. In cell experiments, differentiation of preosteoblasts and myoblasts was completely inhibited by secretions of M1 macrophages but unaffected by those of M2 macrophages. RNA-seq analysis revealed that type I interferon and interleukin-6 signaling pathways were commonly upregulated in preosteoblasts and myoblasts upon stimulation with M1 macrophage secretions, thereby compromising their differentiation. This study demonstrates the benefit of PSL-mediated M1-to-M2 macrophage polarization for simultaneous bone and muscle healing, offering a potential strategy toward simultaneous regeneration of multiple tissues. Existing approaches for tissue regeneration, which primarily utilize growth factors, have been largely effective at healing single tissues. However, simultaneous healing of multiple tissues remains challenging and has been little studied. Here we demonstrate that collagen patches releasing phosphatidylserine liposomes (PSLs) promote M1-to-M2 macrophage polarization and are effective for simultaneous healing of bone and muscle. Transcriptome analysis using next-generation sequencing reveals that differentiation of preosteoblasts and myoblasts is inhibited by the secretions of M1 macrophages but promoted by those of M2 macrophages, highlighting the importance of timely regulation of M1-to-M2 polarization in tissue regeneration. These findings provide new insight to tissue healing of multiple tissues. [Display omitted] [ABSTRACT FROM AUTHOR]

A fracture-related infection (FRI) is a severe complication of an orthopedic trauma, often leading to challenging treatments and poor outcomes. The surgical strategies are typically categorized into one-stage or two-stage procedures, with the use of systemic and local antibiotics being crucial for infection management. This study assessed the efficacy of an antibiotic-loaded hydrogel (ALH) applied over the internal fixation devices for treating FRIs, comparing the outcomes between the one-stage (OS) and two-stage (TS) reconstructions. This retrospective study included 17 patients with an FRI treated using the ALH at a single center. The patients were divided into OS and TS reconstruction groups. The data on demographics, surgical procedures, antibiotic regimens, and outcomes were collected. The primary and secondary outcomes included the infection cure rate, bone union, complications, and reoperation rates. Among the 17 patients (mean age 48.5 years, 16 males), infections were predominantly in the tibia, with 12 chronic and 5 acute cases. Seven patients had monomicrobial infections, and nine had multidrug-resistant pathogens. No significant differences were found between the OS and TS groups in terms of the infection cure rate, bone union, or complications. One patient in the OS group experienced an infection recurrence, and bone healing was achieved in all but one case. Additional complications included delayed wound closure in two cases and implant failure in one case, requiring a reoperation. The ALH demonstrated potential as an effective local antibiotic treatment for FRIs, particularly in the one-stage reconstructions, allowing for a safe application of internal fixation devices. However, further research with larger sample sizes and longer follow-ups is needed to validate these findings. [ABSTRACT FROM AUTHOR]

The rate of proximal femur fractures (PFF) in the structure of musculoskeletal system injuries among all fractures of long bones ranges from 3.9 to 18%. According to Russian Ministry of Health 2020 data, the incidence of femoral fractures in Russia was up to 61 cases per 100,000 population (90,000 per year); and femoral neck fractures incidence was 4 times higher among people over 75 years of age. The choice of surgical technique and the fixator used depend on many factors, such as fracture location and its nature, the age of the patient, comorbidities, and the quality of bone tissue. Internal osteosynthesis, is the current treatment method of choice for extra-articular proximal femur fracture, but every treatment method has its limitations. a significant number of complications caused by technical errors, vicious union or nonunion with the subsequent development of false joints, the development of femoral head aseptic necrosis, which leads to coxarthrosis and persistent pain syndrome. To solve the above-described problems, it is necessary to use a conversion surgery - total hip replacement. long-term analysis of the results of total hip replacement in patients with proximal femur pseudarthrosis. The study was based on clinical and laboratory data analysis and on the results of total hip arthroplasty (THA) in 45 patients aged 56–84 years (mean age 68.3), including 32 (71.1%) women and 13 (26.1%) men. 12 patients initially received conservative treatment, and 33 patients received initial surgical treatment using various metal osteosynthesis procedures. The time from osteosynthesis or from the moment of injury to admission to the hospital for hip arthroplasty ranged from 12 to 30 months. All patients, before conversion arthroplasty and after discharge, were repeatedly invited to the clinical diagnostic department for a clinical examination and for assessment using rating scales. 3, 6 and 12 months after the surgery, pain syndrome and patient quality of life were assessed using the following questionnaire scales: Harris Hip Score, MOS SF-36, VAS. The maximum follow-up period ranged from 12 to 60 months. Based on the results obtained, patients of all 4 groups after conversion arthroplasty noted a significant quality of life improvement, a decrease in pain severity and functional results improvement. This was probably due to the presence of a severe limitation of range of movements in the joint, intense pain, absence of support ability of the extremity, as well as low operative efficacy expectations. In 1 (2%) patient, acute PJI was diagnosed in the early postoperative period, followed by sepsis and death. In 4 patients (9%) the result was considered unsatisfactory. At 1 year of follow-up after surgery, they complained of pain and claudication in the operated joint. 3 (6%) patients underwent reduction of dislocation. Strict adherence to the recommended treatment algorithm for patients with proximal femur pseudarthrosis made it possible to achieve good treatment results in 90% of surgically treated patients. An important step in the treatment of this patients is a careful preoperative planning with thorough assessment of bone tissue quality and muscles condition in the proximal femur area, allowing to choose the optimal endoprosthesis components. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal issues at work have an influence on daily life, productivity, and quality of life. Musculoskeletal issues that go untreated can result in severe damage and function loss, which can limit participation, cause financial loss, and add to the rising burden of illness in the world. Objective: The purpose of this study was to find the effect of occupational therapy rehabilitation program in occupational therapy students with work related musculoskeletal disorder. Study Design: Quasi-experimental, pilot study design was chosen for the research Methods: The study employed a quasi-experimental study design. Thirty occupational therapy students aged 20-25 years were recruited through convenience sampling after a prevalence check where 30 students reported 54 musculoskeletal problems. A total number of participants (n= 30) received occupational therapy rehabilitation program. Standardised Nordic musculoskeletal questionnaire (SNMQ) and Numeric pain rating scale (NPRS) were administered to Pain and work related musculoskeletal disorder for all the participants. Result: It revealed that there was a statistically significant difference in pre-test and post-test with numeric pain rating scale (t=10.625, p=0.000). There was a significant difference in percentage in 7 days component of SNMQ. There was no statistical difference with post-test of score of 12 months component of SNMQ. Conclusion: Occupational therapy rehabilitation program is effective for reducing Musculoskeletal disorder or discomfort in occupational therapy students. [ABSTRACT FROM AUTHOR]

High-energy impacts, like vehicle crashes or falls, can lead to pelvic ring injuries. Rapid diagnosis and treatment are crucial due to the risks of severe bleeding and organ damage. Pelvic radiography promptly assesses fracture extent and location, but struggles to diagnose bleeding. The AO/OTA classification system grades pelvic instability, but its complexity limits its use in emergency settings. This study develops and evaluates a deep learning algorithm to classify pelvic fractures on radiographs per the AO/OTA system. Pelvic radiographs of 773 patients with pelvic fractures and 167 patients without pelvic fractures were retrospectively analyzed at a single center. Pelvic fractures were classified into types A, B, and C using medical records categorized by an orthopedic surgeon according to the AO/OTA classification system. Accuracy, Dice Similarity Coefficient (DSC), and F1 score were measured to evaluate the diagnostic performance of the deep learning algorithms. The segmentation model showed high performance with 0.98 accuracy and 0.96–0.97 DSC. The AO/OTA classification model demonstrated effective performance with a 0.47–0.80 F1 score and 0.69–0.88 accuracy. Additionally, the classification model had a macro average of 0.77–0.94. Performance evaluation of the models showed relatively favorable results, which can aid in early classification of pelvic fractures. [ABSTRACT FROM AUTHOR]

Objective: Describe and evaluate methodological improvements in AMAGuides to the Evaluation of Permanent Impairment (Guides) Sixth Edition 2024, including an updated sequential method and enhanced diagnosis-based impairment tables, compared to the Guides Sixth 2008. Methods: Three physician experts and 3 premedical students, respectively, completed 2 rounds of impairment ratings using the AMA Guides Sixth 2008 versus 2024 methods. Impairment values and completion times using eachmethodwere compared for both groups. Results: Time to complete an impairment rating by experts averaged 3.5 minutes using Guides 2024 compared with 13.9 minutes using Guides 2008, with 100% accuracy and reliability for both. Students' time averaged 5.3 and 15.9 minutes, respectively, with increased accuracy and reliability with Guides 2024. Conclusions: The Guides Sixth 2024 allowed more efficient impairment ratings while retaining accuracy, consistency, reliability, and reproducibility. [ABSTRACT FROM AUTHOR]

The aim of this work was to synthesize, characterize and apply advanced antimicrobial biocompatible electrospun polymers suitable for medical implants for surgical repairs. Injuries to the musculoskeletal system often necessitate surgical repair, but current treatments can still lead to high failure rates, such as 40% for the repair of rotator cuff tears. Therefore, there is an urgent need for the development of new biocompatible materials that can effectively support the repair of damaged tissues. Additionally, infections acquired during hospitalization, particularly those caused by antibiotic-resistant bacteria, result in more fatalities than AIDS, tuberculosis, and viral hepatitis combined. This underscores the critical necessity for the advancement of antimicrobial implants with specialized coatings capable of combating Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-sensitive Staphylococcus aureus (MSSA), two strains notoriously known for their antibiotic resistance. Therefore, we developed an antimicrobial coating incorporating nanoparticle mixtures using the sol-gel process and applied it to electrospun polycaprolactone (PCL) filaments, followed by thorough characterization by using spectroscopic (FTIR, Raman, NMR) microscopic (SEM and SEM-EDX), and tensile test. The results have shown that the integration of electro-spinning technology for yarn production, coupled with surface modification techniques, holds significant potential for creating antimicrobial materials suitable for medical implants for surgical repairs. [ABSTRACT FROM AUTHOR]

Background: Over the past two decades, increasing numbers of women have served in the military, with women now comprising 17.3% of active-duty personnel and 21.4% of National Guard and reserves. During military service, women often incur painful musculoskeletal (MSK) injuries related to carrying heavy loads and wearing ill-fitting gear. While women may receive initial care for these injuries under the auspices of the Department of Defense (DoD), these injuries often linger and further treatment in required as women transition to Department of Veterans Affairs (VA) care. However, little is known about this transition process, and whether women are given adequate information and support regarding how to access VA care after their military service has ended. Research Design: To better understand these issues, we interviewed 65 women veterans with military service-related MSK injuries about their transition from DoD to VA care. Results: Six major themes emerged from the interviews. Those themes were: (1) Military injuries are often related to ill-fitting gear or carrying heavy loads; (2) Stigma/discrimination related to military injuries; (3) Limited assistance with transition between DoD and VA to manage ongoing injuries and pain; (4) Women have a difficult time managing perceptions and expectations of their weight after military service; (5) Childcare is a substantial burden for veterans in self-care; and (6) veterans desire peer-support services to help them stay healthy. Conclusions: Based on these findings, DoD and VA should continue to work together to develop programs to educate and support women as they transition from military to VA care. Furthermore, VA should consider developing peer support programs for women Veterans who may require additional support to maintain health, especially among Veteran mothers who have complex family responsibilities that may limit their ability to focus on their own health. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to externally validate a predictive score for fracture-related infections, establishing generalizability for absolute and relative risk of infection in the setting of orthopedic fracture surgery. Materials and Methods: This was a retrospective, case-control study performed at a level I academic trauma center that included 147 patients with fracture-related infection in the study group and 300 control patients. We analyzed the same 8 independent predictors of fracture-related infection cited by a previous study. We then used the area under the receiver operating characteristics curve (AUC) to compare the derivation and validation cohorts. The validation and derivation cohorts were then compared by grouping patients into 4 strata of Wise score groups. This allowed for comparison of AUC and risk of fracture-related infection in our institution with those in the previously studied institution. Results: The resulting data yielded an AUC (0.74) nearly identical to that of the previously studied institution. It was also found that the relative risk of infection correlated with the Wise score in the same way the initial model did with the absolute risks being similar. Conclusion: The previous predictive model was externally validated and shown to be generalizable to a different patient population. The relative risk of a fracture-related infection can be determined using this scoring model preoperatively with the goal of aiding in patient counseling and surgical decision-making, giving a quantitative value to patient risk factors. [Orthopedics. 2024;47(5):e268–e272.] [ABSTRACT FROM AUTHOR]

Background: Disparities in orthopedic trauma care have been reported for racial-ethnic minority and socially disadvantaged patients. We examined differences in perioperative metrics by patient race and ethnicity and insurance after pelvic fracture in a national sample in the United States. Materials and Methods: The 2016–2019 National Inpatient Sample was queried for White, Black, and Hispanic patients 18 to 64 years old with private, Medicaid, or self-pay insurance who underwent non-elective pelvic fracture surgery. Associations between combined race and ethnicity and insurance subgroups and perioperative metrics (time to surgery, length of stay, inhospital complications, institutional discharge) were assessed using multivariable generalized linear and logistic regression models. Adjusted percent differences or odds ratios (ORs) were reported. Results: A weighted total of 14,375 surgeries were included (68.8% in White patients, 16.1% in Black patients, and 15.1% in Hispanic patients; 60.0% private insurance, 26.3% Medicaid, and 13.7% self-pay). Compared with White patients with private insurance, all Black insurance subgroups had longer length of stay (+15.38% to +38.78%, P≤.001), as did Hispanic patients with Medicaid (+28.03%, P<.001), White patients with Medicaid (+13.08%, P<.001), and White patients with self-pay (+9.47%, P=.04). Additionally, compared with White patients with private insurance, decreased odds of institutional discharge were observed for all patients with self-pay (OR, 0.24–0.37, P<.001) as well as White patients with Medicaid (OR, 0.70, P=.003) and Hispanic patients with Medicaid (OR, 0.57, P=.002). There were no significant adjusted associations between race and ethnicity and insurance subgroups and in-hospital complications or time to surgery. Conclusion: These differences in perioperative metrics, primarily for Black patients and patients with self-pay insurance, warrant further examination to identify whether they reflect disparities that should be addressed to promote equitable orthopedic trauma care. [Orthopedics. 2024;47(5):e233–e240.] [ABSTRACT FROM AUTHOR]

Context: The Disablement in the Physically Active Scale (DPAS) was recently developed to evaluate the disability process and health-related quality of life. The aim of this study was to investigate the validity and reliability of the Turkish version of the DPAS in physically active individuals with musculoskeletal injury. Methods: The study sample comprised 64 physically active individuals with musculoskeletal injury aged 16–40 years. The DPAS was translated into Turkish according to the guidelines for cross-cultural adaptation. Short Form-36 was used concurrently to test the construct validity. The test–retest reliability of the Turkish version of the scale assessed by intraclass correlation coefficient and Cronbach α was calculated for internal consistency. Results: Confirmatory factor analysis carried out on the Turkish version of the DPAS was confirmed. Cronbach α was calculated to be.946. The intraclass correlation coefficients ranged between.593 and.924 (P <.001). The Turkish version of the scale showed significant correlations with domains of the Short Form-36 (P <.05). When the sensitivity of the study was evaluated, the highest correlation was found between DPAS total score and impairments (r =.906, P =.001), and the lowest correlation was between DPAS total score and quality of life (r =.637, P =.001). Conclusion: The Turkish version of the DPAS is a reliable, valid, and practical tool. The Turkish version of the DPAS can be used by health professionals to understand quality of life, the disability process, and activity limitations in Turkish-speaking physically active people after musculoskeletal injuries. [ABSTRACT FROM AUTHOR]

Musculoskeletal (MSK) injuries are the most common and debilitating work-related injuries among healthcare providers. These injuries often occur due to a lack of awareness and insufficient guidance during the early years of medical training. Recognizing the need to address this issue, the Comprehensive Cleft Care Workshop (CCCW) has taken steps to integrate an ergonomics session into its curriculum. The goal of this initiative is to enhance awareness on ergonomics, improve the integration of ergonomics into daily routine, and ultimately reduce the occurrence of MSK injuries among healthcare professionals. [ABSTRACT FROM AUTHOR]

Context: Collegiate tenpin bowling participation is increasing. Accordingly, the experience level of athletes participating, factors related to performance, as well as training workload and sport specialization are likely evolving. However, literature regarding injury rates remains extremely limited. The purpose of this study was to characterize injuries in collegiate tenpin bowlers. Design: Retrospective cohort survey study. Methods: Tenpin bowling athletes of top-ranked collegiate programs in the United States were invited to participate. Each participant completed an online survey to report on their injury history and additional factors of interest. Descriptive statistics were generated for participant characteristics, injury counts, and overall injury prevalence and recurrence. Chi-square tests were used to determine if overall injury prevalence and recurrence occurred by chance, and to evaluate the influence of gender and conditioning program participation on injury frequencies. Results: The response rate was 40.6% (101/249; N = 101). The sample was 20.02 (1.43) years old and 54.5% female. There were a total of 235 singular and recurrent injuries reported across all body parts. Upper-extremity injuries were the most common (n = 112). Injury prevalence (87%) and recurrence (75%) were more likely than chance (χ² > 21.3, both P < .001) and not different based on gender (χ² ≤ 1.1, both P ≥ .33). Injuries were more frequent in the absence of a conditioning program (χ² = 50.6, P < .001). Conclusions: Injuries and injury recurrence in elite tenpin bowlers were frequent, most common in the upper-extremity, not different based on gender, and more frequent in those without conditioning programs. Findings may serve as foundational knowledge for developing sport-specific rehabilitation and conditioning programs. [ABSTRACT FROM AUTHOR]

Context: Although occupational injuries for police officers cannot be prevented, factors that contribute to musculoskeletal injury risk could be better identified to inform preventative interventions. Previous research has supported screening tools such as the functional movement screen (FMS) and Y-Balance Test (YBT) as possible indicators of musculoskeletal injury risk. The purposes of this study are to (1) examine the relationships between age, dynamic balance, and functional movement in police officers and (2) determine how much variance in functional movement is predicted by age and dynamic balance. Methods : This study was conducted in a university research laboratory as part of an ongoing collaboration with a local police department. All data for the current study were collected across 2 separate laboratory visits within a 14-day period. Participants: Thirty- five active-duty police officers (31 men and 4 women; mean [SD], age 33.4 [9.4] y, height 177.4 [8.0] cm, body mass 88.4 [15.3] kg) volunteered to participate in this study . Main Outcome Measures : Functional movement was assessed using the FMS, and FMS overall scores were calculated. Dynamic balance was assessed via the YBT, and lower quarter Y-Balance Test scores (LQYBT%) were calculated. Results : There was a significant negative correlation between FMS overall score and age ( r = -.641, P <.001 ) Correlations between FMS overall score and LQYBT% and between LQYBT% and age were not statistically significant. Age and LQYBT% scores significantly predicted FMS overall scores (F2,32 = 11.162, P < .001), accounting for 41.1% of the variance in FMS overall scores (R²= All ) with age being the only significant predictor . Conclusions : This study confirms that age and FMS overall score have a strong, negative relationship, suggesting that age may be a contributing factor to movement quality and may lead to an increased risk of musculoskeletal injury within this unique population. [ABSTRACT FROM AUTHOR]

Background: If reduction images of fractures can be provided in advance with artificial-intelligence (AI)-based technology, it can assist with preoperative surgical planning. Recently, we developed the AI-based preoperative virtual reduction model for orthopedic trauma, which can provide an automatic segmentation and reduction of fractured fragments. The purpose of this study was to validate a quality of reduction model of Neer 3- or 4-part proximal humerus fractures established by AI-based technology. Methods: To develop the AI-based preoperative virtual reduction model, deep learning performed the segmentation of fracture fragments, and a Monte Carlo simulation completed the virtual reduction to determine the best model. A total of 20 pre/postoperative three-dimensional computed tomography (CT) scans of proximal humerus fracture were prepared. The preoperative CT scans were employed as the input of AI-based automated reduction (AI-R) to deduce the reduction models of fracture fragments, meanwhile, the manual reduction (MR) was conducted using the same CT images. Dice similarity coefficient (DSC) and intersection over union (IoU) between the reduction model from the AI-R/MR and postoperative CT scans were evaluated. Working times were compared between the two groups. Clinical validity agreement (CVA) and reduction quality score (RQS) were investigated for clinical validation outcomes by 20 orthopedic surgeons. Results: The mean DSC and IoU were better when using AI-R that when using MR (0.78 ± 0.13 vs. 0.69 ± 0.16, p < 0.001 and 0.65 ± 0.16 vs. 0.55 ± 0.18, p < 0.001, respectively). The working time of AI-R was, on average, 1.41% of that of MR. The mean CVA of all cases was 81%±14.7% (AI-R, 82.25%±14.27%; MR, 76.75%±14.17%, p = 0.06). The mean RQS was significantly higher when AI-R compared with MR was used (91.47 ± 1.12 vs. 89.30 ± 1.62, p = 0.045). Conclusion: The AI-based preoperative virtual reduction model showed good performance in the reduction model in proximal humerus fractures with faster working times. Beyond diagnosis, classification, and outcome prediction, the AI-based technology can change the paradigm of preoperative surgical planning in orthopedic surgery. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

Background/Objectives: Integrated orthogeriatric care has demonstrated benefits in hip fracture management for older patients. Comprehensive care pathways are essential for effective integrated care delivery, yet local variability in care pathways persists. We assessed the current hip fracture care pathways in the Netherlands, focusing on the variability between these care pathways and the degree of implementation of orthogeriatric care. Methods: A nationwide inventory study was conducted. A survey was sent to all hospitals in the Netherlands to collect the care pathways or local protocols for hip fracture care. All care elements reported in the care pathways and protocols were systematically analyzed by two independent researchers. Furthermore, an assessment was performed to determine which model of orthogeriatric care was applied. Results: All 71 Dutch hospitals were contacted, and 56 hospitals responded (79%), of which 46 (82%) provided a care pathway or protocol. Forty-one care elements were identified in total. In the care pathways and protocols, the variability in the description of these individual care elements ranged from 7% to 87%. Twenty-one hospitals had an integrated care model with shared responsibility, while an equal number followed an orthopedic trauma surgeon-led care model. Conclusions: These findings provide a detailed description of the hip fracture care pathways in the Netherlands. Variations were observed concerning the care elements described in the care pathways, the structure of the care pathway, and the specification of several elements. The implementation of integrated care with shared responsibilities, as recommended by the international literature, has not been achieved nationwide. The clinical implications of the variability between care pathways, such as the influence on the quality of care, need to be further investigated. [ABSTRACT FROM AUTHOR]

Background: People with chronic musculoskeletal pain (CMSP) often have low physical activity. Various factors can influence the activity level. The aim of this study was to monitor physical activity, assessed by the number of steps per day, over time in people with CMSP and identify factors that could be associated with this activity feature. Methods: This prospective study involved people undergoing rehabilitation following an orthopedic trauma that had led to CMSP. At entry, participants completed self-reported questionnaires assessing pain, anxiety, depression, catastrophyzing, kinesiophobia, and behavioural activity patterns (avoidance, pacing and overdoing). They also underwent functional tests, assessing walking endurance and physical fitness. To determine daily step counts, participants wore an accelerometer for 1 week during rehabilitation and 3 months post-rehabilitation. The number of steps per day was compared among three time points: weekend of rehabilitation (an estimate of pre-rehabilitation activity; T1), weekdays of rehabilitation (T2), and post-rehabilitation (T3). Linear regression models were used to analyze the association between daily steps at T2 and at T3 and self-reported and performance-based parameters. Results: Data from 145 participants were analyzed. The mean number of steps was significantly higher during T2 than T1 and T3 (7323 [3047] vs. 4782 [2689], p < 0.001, Cohen's d = 0.769, and 4757 [2680], p < 0.001, Cohen's d = 0.693), whereas T1 and T3 results were similar (p = 0.92, Cohen's d = 0.008). Correlations of number of steps per day among time points were low (r ≤ 0.4). Multivariable regression models revealed an association between daily steps at T2 and pain interfering with walking, anxiety and overdoing behaviour. Daily steps at T3 were associated with overdoing behaviour and physical fitness. Conclusions: Despite chronic pain, people in rehabilitation after an orthopedic trauma increased their physical activity if they were given incentives to do so. When these incentives disappeared, most people returned to their previous activity levels. A multimodal follow-up approach could include both therapeutic and environmental incentives to help maintain physical activity in this population. [ABSTRACT FROM AUTHOR]

Background: Facial trauma, often accompanied by orthopedic injuries, presents a significant challenge in trauma care. This study aimed to evaluate the impact of early intervention on the recovery of patients with facial trauma and concomitant orthopedic injuries. Methods: A prospective observational study was conducted on 80 patients with facial trauma and orthopedic injuries. Patients were divided into early (n=42) and delayed (n=38) intervention groups. Outcome measures included the Facial Disability Index (FDI), Glasgow Outcome Scale (GOS), Visual Analog Scale (VAS) for pain, and Patient and Observer Scar Assessment Scale (POSAS) at 6 months post-injury. Results: The early intervention group had significantly better outcomes compared to the delayed intervention group, with higher FDI scores (85.4 ± 10.2 vs. 72.6 ± 14.8, p<0.001), higher GOS scores (median 5 vs. 4, p=0.02), lower VAS pain scores (2.1 ± 1.4 vs. 3.5 ± 1.9, p=0.001), and lower POSAS scores (12.3 ± 4.6 vs. 18.7 ± 6.2, p<0.001). Early intervention was an independent predictor of improved outcomes (OR 4.2, 95% CI 1.8- 9.7, p=0.001). Conclusion: Early intervention is associated with significantly better outcomes in patients with facial trauma and concomitant orthopedic injuries. The findings highlight the importance of timely, comprehensive, and individualized management in optimizing patient recovery and reducing the risk of complications. [ABSTRACT FROM AUTHOR]

Objective: To assess the clinical impact of diagnostic musculoskeletal (MSK) injections on treatment decision-making in adolescent and adult patients at a children's hospital. Materials and methods: Retrospective study in patients who underwent diagnostic MSK injections by fluoroscopy or ultrasound (US) between 8/2020 and 3/2023 at a children's hospital. Patients received ropivacaine and triamcinolone acetonide at pain site, reporting quantitative FACES pain score prior to, immediately following, and 2–3 days following injection. Impact on patient care was subsequently assessed. Results: A total of 109 diagnostic fluoroscopic or US MSK injection referrals (mean: 17.6 years old) were included, most commonly hip (76.2%), ankle (9.2%), and iliopsoas tendon sheath (8.3%). Pain improvement occurred in 89.0% immediately and 67.9% 2–3 days after MSK injection, with net 84.4% exhibiting improvement based on pain scores and clinical exams. When there was pain improvement at the site of injection, there was a statistically higher incidence of operative intervention or additional therapeutic injections compared with the cohort that did not have symptom improvement (88% versus 35.3%, P < 0.0001). For the 15.6% (N = 17) of referrals that did not have pain improvement, 17.6% (n = 3) ultimately had an operative intervention at a separate site from the diagnostic injection, as an alternative etiology for the pain was found. Conclusion: Image-guided MSK injections play an important role in the management of musculoskeletal disorders. 84.4% of referrals experienced symptom relief, improving confidence for treatment decision-making. Importantly, 15.6% of patients were found to have an alternative etiology for symptoms, altering management altogether. [ABSTRACT FROM AUTHOR]

Historically musculoskeletal injury has substantially affected United States (US) service members. Lumbosacral spine injuries are among the most common sites of injury for service members across all US military branches and usually presents with pain in the lower back and extremities. The aim of this study is to identify and describe the 50 most-cited articles relevant to military medicine on the subject of the spine. In April 2020 Web of Science was used to search the key words: spinal cord injury, spine, thoracic spine, lumbar spine, cervical spine, sacrum, sacral, cervical fusion, lumbar fusion, sacral fracture, combat, back pain, neck pain, and military. Articles published from 1900 to 2020 were evaluated for relevance to military spine orthopaedics and ranked based on citation number. The 50 most-cited articles were characterized based on country of origin, journal of publication, affiliated institution, topic, military branch, and conflict. 1900 articles met search criteria. The 50 most-cited articles were cited 24 to 119 times and published between 1993 and 2017. 30 articles (60%) originated in the United States. Aviation, Space, and Environmental Medicine accounted for the most frequent (n = 10) destination journal followed by Spine (n = 8). 37 institutions contributed to the top 50 most-cited articles. The most common article type was clinically focused retrospective analysis 36% (n = 18), clinically focused cohort study 10% (n = 5), and clinically focused cohort questionnaire, cross-sectional analysis, and randomized study 8% each (n = 4). 90% of articles were non-surgical (n = 45). The US Army had the greatest number of associated articles. Operation Iraqi Freedom and Operation Enduring Freedom were the most-cited conflicts. The 50 most-cited articles relevant to military spine orthopaedics are predominantly clinically focused, arising from the US, and published in Aviation, Space, and Environmental Medicine , Spine , and The Spine Journal. [ABSTRACT FROM AUTHOR]

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Background: D-dimer is used as a clinical indicator to predict venous thromboembolism, and some hospitals have included it in the critical value project. We aimed to evaluate whether the setting of a D-dimer critical value is helpful in the diagnosis of deep vein thrombosis in patients with bone trauma and to explore the rationality of setting a D-dimer critical value limit. Methods: The clinical data of 4,897 bone trauma patients, hospitalized from April 1, 2022, to March 31, 2023, were retrospectively analyzed. Our hospital set the critical value limit for when the D-dimer value was greater than 15.0 mg/L, and Bayesian model was used to evaluate the relationship between deep vein thrombosis and the Ddimer limit. Results: During this period, 199 times the D-dimer detection value was greater than 15.0 mg/L, and the critical value was reported and accounted for 4.06%. The predicted probability of lower limb venous thrombosis in patients who triggered the critical value of D-dimer was 40.21%, and the actual incidence was 34.67%. There were 376 patients with lower limb venous thrombosis during hospitalization, and 81.38% of the D-dimer value did not reach the critical value limit. Conclusions: The role of D-dimer as a critical value item in predicting DVT in patients with orthopedic trauma is small. Whether to list D-dimer as a critical value item can be comprehensively considered according to the own situation of medical institutions and the recommendations of clinicians. The same can be applied for the setting of critical value boundaries. [ABSTRACT FROM AUTHOR]

Introduction Injury epidemiology research with military populations typically utilizes data obtained through medical chart review (MCR) or injury self-reports (ISRs). MCR data will not capture musculoskeletal injury (MSKI) data for which medical care was not sought, which is common during military recruit training. Injury self-report is affected by issues with recall, especially for MSKIs perceived as less severe. U.S. Marine Corps (USMC) recruits participate in an intense 13-week recruit training program during which they are susceptible to MSKIs. The purpose of the current analysis was to utilize a novel statistical method, the capture-recapture (CRC) technique, to account for the undercounting inherent in MSKI data sources and estimate the ascertainment-corrected cumulative incidence of MSKIs during USMC recruit training. Materials and Methods Data for the current study were derived from a larger study, the USMC Gender-Integrated Recruit Training Study, which was initiated to provide data-driven recommendations to increase gender integration in USMC recruit training. The estimated cumulative incidence of MSKIs during 13-weeks of USMC recruit training was calculated from the 2 sources of MSKI data (MCR, ISR) and using CRC analysis. Medical charts were reviewed to extract data about MSKIs that occurred during recruit training. Self-reported MSKI data for the same period were obtained from recruits at the end of recruit training. MSKIs were classified according to their anatomical location and type. The Chapman modification of the Lincoln-Peterson estimator was utilized to conduct the CRC analysis. Results Medical chart review and ISR MSKI data were available for 464 USMC recruits (age: 19.1 ± 1.9 years; gender: men 70.0%). The observed 13-week cumulative incidence of MSKI in the sample was 21.8% in the MCR and 28.4% in the ISR, while the CRC incidence was much higher (62.0%). The MCR and ISR ascertainment were 35.1% and 45.9%, respectively, while the overall ascertainment or completeness of MSKI data when 2 sources were used was moderate (65.0%). When stratified by MSKI anatomical location, the overall ascertainment varied by anatomical location of the MSKI. It was highest for lower extremity MSKIs (64.8%), but lower for upper extremity (38.9%) and spine (33.3%) MSKIs. The overall ascertainment also varied by MSKI type; it was highest for sprain (55.1%), followed by strain (54.8%), and the pain/spasm/ache (43.3%). Conclusions This was the first study to utilize the CRC technique to access the ascertainment-corrected incidence of MSKIs among USMC recruits. There was significant undercounting in both sources of the data analyzed, and the extent of undercounting varied by both MSKI anatomical location and type. When 2 sources of data were utilized simultaneously, the percent of CRC-estimated MSKIs observed from 2 sources of data was more complete. There is a need for further application of the CRC technique to MSKI data in military populations to provide a more complete assessment of MSKIs. Identification of modifiable factors that influence completeness of MSKI data obtained during military recruit training is also warranted. [ABSTRACT FROM AUTHOR]

Objective: In orthopedic trauma, identification of extremity trauma combined with vascular injury is challenging. Missed diagnosis may result in amputation or even death. The purpose of this study was to investigate whether physical examination combined with handheld vascular ultrasound Doppler examination could be an effective method of screening for peripheral vascular injury and to explore the characteristics of vascular injuries in orthopedic trauma patients. Methods: Retrospective analysis of patients in the emergency department of orthopedic trauma in our hospital from January 2022 to October 2023. Physical examination combined with handheld vascular ultrasound Doppler examination was used as a screening method for suspected vascular injuries. Patients with suspected vascular injury would undergo further angiography and receive multidisciplinary treatment. Angiography was used as the gold standard for diagnosing vascular injuries. Patient demographics, mechanism of injury, location and type of injury, angiographic results, surgical notes, and early treatment outcome data were recorded. Results: A total of 55 cases (58 limb injuries) with suspected vascular injury were ultimately included. Angiography revealed that 53 cases (55 limbs, positive rate 94.8%) were considered to have confirmed vascular injuries. Forty‐three were male (81.1%) and 10 were female (18.9%), with mean age 44.1 ± 16.6 years. The main mechanism of injury was traffic accident (30, 56.7%). Most common site of vascular injuries was knee joint (30/55, 54.5%), and popliteal artery (23, 47.9%) was the most commonly injured blood vessel. After multidisciplinary collaborative treatment, overall patient mortality was 3.8% (2/53), and limb survival rate among surviving patients was 81.1% (43/53) in our study. Conclusion: In orthopedic trauma, "Hard signs" and "soft signs" combined with handheld vascular ultrasound Doppler examination were effective ways to screen for suspected vascular injuries. Most limbs had associated fractures or dislocations at the site of vascular injury. Collaboration of vascular surgery, microsurgery and orthopedic trauma may help improve patients' prognosis. [ABSTRACT FROM AUTHOR]

Introduction Soldiers must be able to perform a multitude of physically demanding tasks as part of their regular duty, but their physical readiness is often degraded due to pain and musculoskeletal injury (MSKI). The presence of pain with movement has been associated with increased MSKI risk in Soldiers. Improved awareness of the prevalence of painful movements in uninjured Soldiers could help inform Army injury mitigation efforts. The purpose of this study was to identify the prevalence of pain with movement in a population of healthy active duty Soldiers. Materials and Methods The Selective Functional Movement Assessment—Top Tier Movements (SFMA-TTM), active range of motion (AROM) of the hips and shoulders, and the elicitation of pain with movement were measured in 268 healthy US Army Soldiers. Descriptive statistics were generated for the number of painful movements for each measure and inferential statistics; independent t -test and one-way independent analysis of variance (ANOVA) were used for analysis of the other measures. Results Greater than half (59%) of the participants reported pain with at least 1 movement and more than 41% reported pain with 2 or more movements. Soldiers reported a mean of 1.35 painful movements on the SFMA-TTM assessment and a mean of 1.54 painful AROM movements. Conclusions Pain with functional movement patterns was common across a sample of uninjured Soldiers. The presence of pain with movement warrants further evaluation as it may impact a Soldier's physical performance, risk for future injury, and overall quality of life. [ABSTRACT FROM AUTHOR]

Background: Trauma can be categorized based on the characteristics of its cause into penetrating, blunt, thermal, or compressive trauma. Another type of classification is based on anatomical location, as trauma may occur at any anatomical site of the body. Objectives: This study aimed to determine the epidemiology of neurosurgical and orthopedic trauma among children in the city of Ilam. Methods: In this retrospective study, the health records of all patients aged 6 to 18 years with orthopedic and neurosurgical trauma who were referred to the hospital in Ilam were investigated. Since Imam Khomeini Hospital is the only public hospital for trauma patients in this city, only the records of patients who were referred to this hospital were reviewed. Results: Results showed that in the neurosurgical trauma group, out of 145 reviewed cases, 96 (66.2%) patients were male and 49 (33.8%) were female. In relation to orthopedic traumas, out of 570 investigated cases, 386 (67.7%) were male and 184 (32.2%) were female. Additionally, results showed that 224 (39.3%) patients had fractures in the right hand, 255 (44.7%) had fractures in the left hand, and 91 (16%) had fractures in both hands. Furthermore, 21 (14.5%) patients had cervical spine injuries, 35 (24.1%) had thoracic spine injuries, 54 (37.2%) had lumbar spine injuries, and 35 (24.1%) had brain trauma. Conclusions: In the present study, the epidemiology of neurosurgical and orthopedic trauma in children was investigated. Given the prevalence of these types of trauma in Ilam, it is necessary to provide essential training to prevent or reduce their occurrence in the future. [ABSTRACT FROM AUTHOR]

A primary goal of rehabilitation is to produce optimal health-related quality of life outcomes, which includes returning patients to their desired level of activity. Injury-related fear, kinesiophobia, and fear-avoidance beliefs are psychological factors that negatively impact health-related quality of life and are associated with decreased levels of physical activity. Conversely, increased levels of self-efficacy have been linked to favorable rehabilitation outcomes. To promote full recovery and optimal health-related quality of life, the rehabilitation process should consider addressing self-efficacy and injury-related fear (e.g., kinesiophobia, fear-avoidance beliefs). Therefore, the purpose of this paper is to introduce a theoretical framework which integrates self-efficacy theory and the Fear-Avoidance Model to mitigate injury-related fear and optimize patient outcomes following musculoskeletal injury. The intention of this theoretical framework is to provide clinicians with psychosocial interventions to improve self-efficacy and prevent the progression of injury-related fear at varying times throughout the rehabilitation process. [ABSTRACT FROM AUTHOR]

Background: Improved survival following major trauma has resulted in an increased number of patients with complex physical, functional and psychosocial needs requiring specialist multidisciplinary rehabilitation. A key challenge in modern trauma care is to deliver rehabilitation interventions that translate into improved outcomes. This study aimed to synthesise patient perceptions of recovery following major musculoskeletal trauma. Methods: A pre-planned literature search (CINAHL, Medline, Embase, PsychInfo, and other sources) was performed 28/02/22–03/03/22 (updated 29/3/23–17/4/23 prior to submission) to capture all available qualitative or mixed methods studies describing major musculoskeletal trauma recovery from the patient perspective. Quality assessment was performed using the Joanna Briggs evaluation tool and the mixed methods appraisal tool. The qualitative data was thematically analysed. Findings: Of 5648 distinct studies, 18 studies met the criteria for inclusion totalling 637 participants. Thematic analysis of the qualitative data found that recovery following major musculoskeletal trauma has physical, psychological and socio-functional dimensions. Successful recovery involves 'crafting a new normal' and is both a process and an outcome. Three major themes were identified: vulnerability; learning to manage; adaptation and adjustment. Patients do not experience each theme in a linear way; instead, they move through the recovery process in an individualised and cyclical manner. Conclusion: This review highlights the individual experience of recovery, which requires flexible and holistic care to facilitate an occupational (or socio-functional) perspective on major musculoskeletal trauma recovery. Therefore, organisationally, an effective multi-disciplinary team model of care is essential to support survival as a long-term condition. [ABSTRACT FROM AUTHOR]

Background: Patients with limited health literacy have difficulty understanding their injuries and postoperative treatment, which can negatively affect their outcomes. Materials and Methods: This cross-sectional questionnaire-based study of 103 adult patients sought to quantify patients' health literacy at a single county hospital's orthopedic trauma clinic and to examine their ability to understand injuries and treatment plans. Demographics, Newest Vital Sign (NVS) health literacy assessment, and knowledge scores were used to assess patients' comprehension of their injuries and treatment plan. Patients were grouped by NVS score (NVS <4: limited health literacy). Fisher's exact tests and t tests were used to compare demographic and comprehension scores. Multivariate logistic regression analysis was used to examine the association among low health literacy, sociodemographic variables, and knowledge scores. Results: Of the 103 patients, 75% were determined to have limited health literacy. Patients younger than 30 years were more likely to have adequate literacy (50% vs 23%, P=.01). Patients who spoke Spanish as their primary language were 8.77 times more likely to have limited health literacy with respect to sociodemographic factors (odds ratio, 8.77; 95% CI, 1.03–76.92; P=.04). Low health literacy was 3.52 and 4.14 times more likely to predict discordance in answers to specific bone fractures and the narcotics prescribed (P=.04 and P=.02, respectively). Conclusion: Spanish-speaking patients have demonstrated limited health literacy and difficulty understanding their injuries and postoperative treatment plans compared with English-speaking patients. Patients with low health literacy are more likely to be unsure regarding which bone they fractured or their prescribed opiates. [Orthopedics. 2024;47(4):249–255.] [ABSTRACT FROM AUTHOR]

Objectives: To determine the national burden of working time lost to occupational injury and disease in Australia compensable by workers' compensation schemes; to characterise the distribution of time lost by age, sex, and injury and disease type. Study design: Retrospective population‐based study; analysis of National Dataset for Compensation‐based Statistics (NDS) data. Setting, participants: Granted workers' compensation claims by people aged 15–100 years including payment of wage replacement benefits for time off work lodged in Australia, 1 July 2012 – 30 June 2017. Main outcome measures: Working years lost (WYL) per annum (total number of years of wage replacement benefits paid to injured and ill workers), overall and by sex, age, and injury and disease type; WYL per 10 000 fulltime equivalent (FTE) years worked. Results: A total of 755 330 eligible claims with complete data for analysis variables by people aged 15–100 years were identified, for compensable injuries and disease that led to 41 194 (95% confidence interval [CI], 41 020–41 368) WYL/year. The annual WYL number and rate were each higher for men (25 367 [95% CI, 25 230–25 503] WYL/year; 42.6 [95% CI, 42.1–43.1] WYL/10 000 FTE years) than for women (15 827 [95% CI, 15 720–15 935] WYL/year; 38.8 [95% CI, 38.2–39.4] WYL/10 000 FTE years). Workers aged 45–100 years made 66 742 claims per year (44.1% of all claims) but incurred 21 763 WYL/year (52.8% of all WYL). Traumatic joint and muscle injuries led to 16 494 WYL/year (40.0% of all WYL), musculoskeletal disorders to 8547 WYL/year (20.7%), mental health conditions to 5361 WYL/year (13.0%), fractures to 4276 WYL/year (10.4%), and wounds and lacerations to 3449 WYL/year (8.4%). Conclusions: Occupational injury and disease covered by workers' compensation result in lost working time in Australia equivalent to more than 41 000 fulltime jobs. Distribution of the burden reflects the greater labour force participation of men, slower recovery of older workers, and the impact of common occupational injuries and diseases. Population‐based monitoring of lost working time could support effective occupational health surveillance and allocation of resources for protecting the health of Australian workers. [ABSTRACT FROM AUTHOR]

Aims: This study aims to compare the outcomes of immediate (followed by closed-incision negative-pressure therapy use) versus delayed ORIF in patients with Schatzker type IV–VI TPFs. Patients and Methods: A prospective study of patients undergoing ORIF between January 2018 and December 2019 was performed. The inclusion criteria were patients (>18 years) with a closed fracture sent to the emergency room (ER) within 24 h of injury. All the patients underwent preoperative image evaluation. Two senior orthopedic trauma surgeons evaluated the soft tissue condition in the ER by 5P's of the compartment syndrome, judging the timing of the operation of definitive ORIF. Group 1 (n = 16) received delayed ORIF. Group 2 (n = 16) received immediate ORIF and ciNPT use. Patient follow-up occurred after 2 and 6 weeks and 3, 6, and 12 months after surgery. The assessments included the time to definitive fixation, the length of hospital stay, the time to bone union, surgical site complications, and reoperation within 12 months. A universal goniometer was used to measure the postoperative 3 m, 6 m, and 12 m ROM. Results: The patient demographics were similar between the groups (p > 0.05). Group 2 displayed significantly a shorter time to definitive fixation (5.94 ± 2.02 vs. 0.61 ± 0.28, p < 0.0001) and hospital stay (14.90 ± 8/78 vs. 10.30 ± 6.78, p = 0.0016). No significant difference was observed in the time to bone union, surgical site complication incidence, and reoperation rates (p > 0.05). Flexion and flexion–extension knee ROM were demonstrated to be significantly improved in Group 2, 3, 6, and 12 months postoperatively (p < 0.0001). Conclusions: In this study, early ORIF and ciNPT use resulted in a shorter hospital length of stay, a reduced time to early active motion of the knee, and improved knee ROM. These results suggest that early ORIF with ciNPT for Schatzker type IV–VI TPFs is safe and effective in some patients. However, further research to confirm these findings across larger and more diverse populations is needed. [ABSTRACT FROM AUTHOR]

Objective: We hypothesised that the orientation of the fracture line in the cervical vertebral arch depends on the traumatic mechanism, specifically focusing on frontal oblique spino-laminar fractures to determine if this pattern can serve as an indicator of a hyperextension mechanism of injury of the cervical spine. Materials and methods: We reviewed the imaging records of 114 adult patients admitted to the emergency department of the Strasbourg University Hospital for severe polytrauma between January 2016 and December 2021 and who presented with a fracture of the posterior vertebral arch of the lower cervical spine on the whole-body CT scan. A radiology resident (R1) and a musculoskeletal radiologist (R2) independently read the CT scans to determine the type of vertebral arch fracture; inter- and intra-observer agreements were calculated using Cohen's Kappa test. Two musculoskeletal radiologists (R2 and R3) then reviewed the CT scans and possible MRIs to identify specific hyperextension injuries of the cervical spine. The association between frontal oblique spino-laminar fracture and hyperextension injuries was assessed using chi2 test. Results: Thirty-five patients had frontal oblique spino-laminar fractures of the cervical spine. These fractures were significantly associated (p = 0.001) with hyperextension injuries of the cervical spine. The inter- and intra-observer agreements for the identification of these spino-laminar fractures were very good (0.86 (0.75–0.96) and 0.90 (0.81–0.99)). Conclusion: Frontal oblique spino-laminar fractures are easily recognisable on CT scans and significantly associated with other traumatic injuries known as resulting from hyperextension. Their identification should lead to a search for potential associated unstable vertebral disco-ligamentous injuries with MRI. [ABSTRACT FROM AUTHOR]

The impact of musculoskeletal (MSK) injury on athlete health and performance has been studied extensively in youth sport and elite sport. Current research examining the relationship between training load, injury, and fatigue in university athletes is sparse. Furthermore, a range of contextual factors that influence the training load-fatigue-injury relationship exist, necessitating an integrative biopsychosocial model to address primary and secondary injury prevention research. The objectives of this review were (a) to review the scientific literature examining the relationship between training load, fatigue, and MSK injury in university athletes and (b) to use this review in conjunction with a transdisciplinary research team to identify biopsychosocial factors that influence MSK injury and develop an updated, holistic biopsychosocial model to inform injury prevention research and practice in university sport. Ten articles were identified for inclusion in this review. Key findings were an absence of injury surveillance methodology and contextual factors that can influence the training load-fatigue-MSK injury relationship. We highlight the inclusion of academic load, social load, and mental health load as key variables contributing to a multifactorial, gendered environmental, scientific inquiry on sport injury and reinjury in university sport. An integrative biopsychosocial model for MSK injury in university sport is presented that can be used to study the biological, psychological, and social factors that modulate injury and reinjury risk in university athletes. Finally, we provide an example of how causal inference can be used to maximize the utility of longitudinally collected observational data that is characteristic of sport performance research in university sport. [ABSTRACT FROM AUTHOR]

Objective: Musculoskeletal injuries mainly occur in tendons and ligaments and their aetiology is tightly connected with genetic and environmental influences. This review and meta-analysis identifies and evaluates the potential association of the COL5A1 rs12722 polymorphism with lower limb musculoskeletal injuries in adults (18-60 years). Methods: Literature database searching (SCOPUS, Web of Science and PubMed) and screening provided nine studies for analysis. Data was extracted and interpreted by main injury types focusing on the genotype distribution (CC, CT, TT) of the rs12722 polymorphism. Meta-analysis was carried out using different modes of inheritance and injury sub-groups. Results: Many individual studies indicated no significant difference between cases and controls (p>0.05), but pooled data showed significant association of COL5A1 rs12722 polymorphism with lower limb musculoskeletal risk of injury (p=0.009). The meta-analysis showed a significant effect for the total sample for the recessive model of inheritance (OR =1.28 (CI 1.03-1.57, p=0.021) and ACLI (OR=1.31 (CI 1.03-1.67, p=0.026). Conclusions: The systematic review and meta-analyses confirm that T allele carriers (TT, CT) were more susceptible to injury, while the C allele is protective, decreasing the risk of injury. Keywords: Col5A1 Gene, Meta-analysis, rs12722 Polymorphism, Musculoskeletal Injuries, Systematic reviewObjective: Musculoskeletal injuries mainly occur in tendons and ligaments and their aetiology is tightly connected with genetic and environmental influences. This review and meta-analysis identifies and evaluates the potential association of the COL5A1 rs12722 polymorphism with lower limb musculoskeletal injuries in adults (18-60 years). Methods: Literature database searching (SCOPUS, Web of Science and PubMed) and screening provided nine studies for analysis. Data was extracted and interpreted by main injury types focusing on the genotype distribution (CC, CT, TT) of the rs12722 polymorphism. Meta-analysis was carried out using different modes of inheritance and injury sub-groups. Results: Many individual studies indicated no significant difference between cases and controls (p>0.05), but pooled data showed significant association of COL5A1 rs12722 polymorphism with lower limb musculoskeletal risk of injury (p=0.009). The meta-analysis showed a significant effect for the total sample for the recessive model of inheritance (OR =1.28 (CI 1.03-1.57, p=0.021) and ACLI (OR=1.31 (CI 1.03-1.67, p=0.026). Conclusions: The systematic review and meta-analyses confirm that T allele carriers (TT, CT) were more susceptible to injury, while the C allele is protective, decreasing the risk of injury. [ABSTRACT FROM AUTHOR]

Currently, the prevalence of musculoskeletal injuries in high-level competitive athletes is high, and the injuries mainly appear in the neck and lower back. Long training years, looking down during training, and engaging in real-time combat sports are the main risk factors for the occurrence of neck disorders, and therefore, a scientific method is needed to identify signs of musculoskeletal injuries in athletes' MRI scans for early prevention and early intervention. Therefore, in this paper, a network model based on the lightweight network MobilenetV2 is proposed based on the transfer learning method, which ensures high classification accuracy while completing the recognition task with less number of parameters and computation. To address the problem that deep learning models require a large amount of data for training and patient images are difficult to obtain, this paper proposes the RS algorithm, which masks the local features of the 2DMRI images, augments the dataset, and combines it with the two proposed deep migratory learning classification models, TLV2 and TLV2C, in which TLV2 is the MobileNetV2 that fixes the shallow layer and initializes the deep layer after training on the Image Net dataset. network, initialize the deep network and re-train it under MRI dataset. TLV2C redesigns the classifier on the basis of TLV2. The experimental results show that the algorithm proposed in this paper solves the problem of insufficient MRI data, and at the same time is able to identify the signs of musculoskeletal injuries in MRI scans of athletes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Industrial workers often have musculoskeletal disorders due to the nature of their work. OBJECTIVE: The goal was to investigate the scientific use of polyherbal gel in relieving pain and stiffness due to musculoskeletal injuries and improving activities of daily living (ADLs) in industrial workers. METHODS: A pragmatic, single-blinded, randomized control study divided 200 musculoskeletal injury patients into four parallel groups (n = 50). Groups 1 and 2 were applied polyherbal gel via phonophoresis with therapeutic ultrasound and superficial massage. Groups 3 and 4 received diclofenac diethyl-ammonium 1% gel by phonophoresis and superficial massage. The Global Pain Relief Scale, Numeric Pain Rating Scale (NPRS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were used to measure pain, stiffness, and ADLs. Data was analyzed using one-way analysis of variance (ANOVA) and paired t-test to compare mean±SD of four independent groups before and after gel application. The confidence interval was 95%, with p < 0.05 considered significant. RESULTS: The results revealed that polyherbal gel reduced pain (NPRS, WOMAC and Global pain relief scales) more efficiently (p≤0.000) when applied with phonophoresis as compared to applied with massage and standard diclofenac (p≤0.005), furthermore, polyherbal gel when applied with phonophoresis showed more efficient results. CONCLUSION: Industrial workers with musculoskeletal injuries benefited from the use of polyherbal gel for pain and inflammation relief. The polyherbal gel is natural, cost-effective, and easy to formulate. [ABSTRACT FROM AUTHOR]

The fire service suffers from high rates of cardiovascular disease and poor overall health, and firefighters often suffer fatal and non-fatal injuries while on the job. Most fatal injuries result from sudden cardiac death, while non-fatal injuries are to the musculoskeletal system. Previous works suggest a mechanistic link between several health and performance variables and injury risk. In addition, studies have suggested physical activity and nutrition can improve overall health and occupational performance. This review offers practical applications for exercise via feasible training modalities as well as nutritional recommendations that can positively impact performance on the job. Time-efficient training modalities like high-intensity interval training and feasible modalities such as resistance training offer numerous benefits for firefighters. Also, modifying and supplementing the diet and can be advantageous for health and body composition in the fire service. Firefighters have various schedules, making it difficult for planned exercise and eating while on shift. The practical training and nutritional aspects discussed in this review can be implemented on-shift to improve the overall health and performance in firefighters. [ABSTRACT FROM AUTHOR]

Objective: To describe the health characteristics, condition-specific measures, chronic disease risk factors, and healthcare and medication use over time of individuals with musculoskeletal conditions awaiting orthopaedic surgical consultation. Study importance: Musculoskeletal conditions are highly prevalent in the general population and often coexist with chronic diseases. However, little is documented about the overall health of this group. This study describes the health of these individuals, with particular emphasis on modifiable risk factors of chronic disease. Study type: A repeated measures longitudinal cohort study of individuals referred for orthopaedic consultation across three time points (2014, 2015 and 2016). Methods: This study was undertaken in the orthopaedic outpatient service of a public tertiary referral hospital in New South Wales, Australia. Participants were aged 18 years and older and were referred for and awaiting orthopaedic surgical consultation for a musculoskeletal condition (back, neck, hand or wrist pain, or hip or knee osteoarthritis). Measures included patient demographics, condition-specific indicators (e.g. pain, disability, quality of life [QoL]) and chronic disease risk factors (e.g., excess weight, smoking). Results: The mean age of participants was 57.7 years, and 7.3% identified as Aboriginal and/or Torres Strait Islander. Back (43.1%) and knee (35.0%) pain were the most prevalent conditions. At baseline (N = 1052), participants reported moderate pain (mean numerical pain rating scale score of 6.4, standard deviation [SD] 2.4) and QoL (Physical Component Score of 32.7, SD 10.7; Mental Component Score of 46.6, SD 13.3). Chronic disease risk factors were highly prevalent, with 74.6% of participants having three or more. For most measures, there were only small changes over time. Conclusion: Individuals with musculoskeletal conditions who are awaiting orthopaedic surgical consultation have a complex clinical picture and numerous chronic disease risk factors. Given the modifiable nature of many of these risk factors, identifying and addressing them before or while awaiting consultation may improve the health of these individuals. [ABSTRACT FROM AUTHOR]

A continuing education quiz on human kinetics and athletic therapy and training is presented, with topics including regimented corrective exercise program, stroboscopic vision's impairment of postural control, and auditory and visual reaction times across the menstrual cycle.