Epidemiological studies show that burn victims often have extended hospital stays (LOS), affecting individuals and society significantly. Accurate LOS prediction is crucial for optimizing hospital management and reducing costs. This study introduces a machine learning approach to predict LOS for burn patients using diagnostic records, employing five algorithms: Logistic Regression, LightGBM, XGBoost, CatBoost, and random forest. The model predicts LOS across various timeframes and evaluates performance across different demographics. Logistic Regression achieved an F1-score of 0.72 and an AUROC of 0.84 for predicting stays over 14 days. Other predictions yielded an F1-score of 0.61 and RMSE of 0.93 and 6.11. A no-code training platform reduced model training time by 95%. The study demonstrates the effectiveness of machine learning and no-code AI platforms in predicting LOS, improving treatment outcomes, and optimizing hospital resources.
Peripheral nerve injuries are one of the most debilitating injuries of the upper limb. These injuries are most commonly secondary to trauma, which includes crush, lacerations, burning, traction, stretching, or ischemia. Early diagnosis and treatment are imperative for patients with such extremity injuries. We present a 46-year-old male sustaining a penetrating injury to his right forearm resulting in combined ulnar and median nerve palsy. Relevant surgical anatomy and clinical examination are discussed for this patient’s injury. Elicitation of clinical tests for diagnosing peripheral nerve injuries is a pivotal part in early recognition of the pathology, which allows for prompt treatment and favourable patient outcomes.
Background: Arthrogryposis Multiplex Congenita (AMC) is a rare musculoskeletal birth defect, our objective is to conduct an epidemiological characterization of the prevalence and risk factors associated with the presentation of AMC in newborns. Methods: A population-based case-control study was performed with the data from the Program for the Prevention and Surveillance of Birth Defects and Rare Diseases of Bogotá and Cali (PREVERDEC) from January 2002 to March 2020. Including 29 cases of AMC and 126 controls. Prevalence was calculated per 10,000 Live Births (LB) with a 95% confidence interval. Demographic factors were analyzed using Student’s [Formula: see text]-test, and risk factors for AMC were assessed through univariate regression. Results: The prevalence of AMC amounted to 0.52 cases per 10,000 LB (95% CI: 0.35–0.75). Increased association for AMC was found in cases with low birth weight (<2,500 g), low gestational age (<37 weeks), and presence of polyhydramnios. Decreased risk association was found in cases with paternal age >35 years, male newborns and folic acid consumption. Conclusion: This study explores the prevalence and risk factors of AMC in Bogotá and Cali, Colombia, aiming to mitigate morbidity in susceptible populations. Establishing surveillance systems for congenital abnormalities is crucial for enhancing AMC identification, diagnosis, and early treatment.
Desmoid tumors localized in the trapezius muscle are rare neoplasms characterized by their benign nature but local invasive capacity, associated with a significant rate of morbidity, a tendency for recurrence, and a propensity to infiltrate surrounding tissues. An unusual case was observed in a 39-year-old man with no history of trauma, pre-existing tumors, or familial diseases related to the head and neck region. This patient presented with a left postero-lateral cervical swelling evolving over eight months. Imaging studies, including CT scan and MRI, revealed a mass involving the trapezius muscle, later confirmed to be a desmoid tumor following a biopsy. Immunohistochemical analyses showed positive cytoplasmic staining with an anti-AML antibody and nuclear staining with an anti-beta-catenin antibody. A comprehensive evaluation of this case was conducted by a multidisciplinary team. The patient was closely monitored clinically and radiologically, with check-ups every six months for two years, followed by annual check-ups for five years. Throughout this period, the tumor size remained stable, without signs of infiltration into surrounding tissues or troublesome symptoms for the patient. Consequently, a decision for regular follow-up was made, without the need for medical or surgical treatment. Despite the benign nature of desmoid tumors, the risk of invading neighboring structures, recurrence, and mortality remains significant, emphasizing the critical importance of early diagnosis and appropriate management of these conditions.
The objective of this case report is to emphasize the fact that the intramuscular hemangiomas (IMH) in infants present a significant challenge for the orthopedic surgeon. Due to their rapid growth, IMH can easily be misinterpreted as malignancies. In such cases, MRI is a valuable diagnostic tool. We report a case of a six-month-old female infant with a large, oval-shaped swelling, localized on the dorsal aspect of the left forearm. In addition, the inability to fully extend the wrist and fingers of the left hand was evident. MRI, magnetic angiography and Doppler flow ultrasonography were used as diagnostic tools, revealing a large lobulated lesion with well-defined edges on the dorsal aspect of the forearm between the extensors of the wrist and fingers, with extension in the interosseous membrane between radius and ulna. A surgical resection of the tumor was performed. Histologic findings were consistent with those of an infantile hemangioma. Six weeks after surgery, full recovery of wrist and finger extension was evident. Finally, at five years of follow-up, there was no recurrence of the vascular tumor and normal upper limb function was maintained. Surgical resection of the IMHs in the upper limbs must be cautious and meticulous. The loss of an adjacent muscle or nerve injury from aggressive surgical resection can result in functional impairment of the limb.
With advancing age, women experience changes in body posture, with thoracic hyperkyphosis being one of the most common. Although the etiology associated with the abnormal increase in curvature of the thoracic region of the spine is not yet completely understood, several risk factors appear to contribute to its manifestation, including advanced age, osteoporosis, vertebral fractures, sarcopenia, and limited physical activity levels. Understanding these factors is crucial for developing effective strategies to prevent and manage this condition, with physical exercise emerging as a particularly promising intervention. Recognizing the potential complications associated with this condition, such as chronic pain, functional limitations, increased risk of falls and fractures, and the negative impact on women’s quality of life, also highlights the importance of delaying this condition. This review aims to analyze the prevalence of thoracic hyperkyphosis in postmenopausal women and identify the risk factors and possible adverse health impacts associated with it. It is also intended to identify the methods used to assess the thoracic kyphosis angle and evaluate its progression and the effectiveness of interventions, with a focus on exploring the effect of physical exercise in this condition.
Agility is characterized by quick whole-body motions and direction changes. It is dependent on speed, balance, and coordination. During these movements, the diaphragm, which is normally associated with breathing, also helps to maintain balance and postural stability. The present study aimed to determine the relationship between respiratory muscle strength and agility in competitive soccer players. This cross-sectional study recruited a hundred and twenty male soccer players (age 20.68 ± 2.75 years). Maximal inspiratory and expiratory pressure (MIP-MEP) for respiratory muscle strength was recorded using micro-respiratory pressure device. Agility was assessed using Illinois agility test. The results of the current study showed that MIP and MEP were negatively correlated with agility ([Formula: see text] [Formula: see text]-0.310; [Formula: see text] [Formula: see text] [Formula: see text] 0.001 and [Formula: see text] [Formula: see text] –0.433; [Formula: see text] [Formula: see text] [Formula: see text] 0.001; respectively). The study concluded that the increase in muscle strength results in reducing the time taken for completing the agility task. Hence incorporating inspiratory muscle training as an adjunct to regular skill training in footballers can improve their agility performance.
Introduction: Triple pelvic osteotomies can reduce hip subluxation, medialize the hip joint center, and redistribute the contact stresses over the whole articular surface and can be performed regardless of whether the triradiate cartilage is open or closed. Methods: In this case series, patients’ radiographs and data who underwent triple pelvic osteotomy were sought retrospectively, and those aged 8-18 years who had proven acetabular dysplasia and an adequate hip range of motion were included. Over the follow-up period, complications were recorded, as were radiographic outcomes. Results: Twenty-two patients with 29 hips were included. Patients were aging on average 14.5 ± 3 years, with 65.5% females and an average of 78 months (58–102) follow-up. Harris Hip Score (HHS) was used to evaluate hip function, which was excellent in 13 hips (44.8%), good in 15 (51.7%), and fair in 1 hip (3.5%). Complications were encountered in 6 cases, including an anterior column fracture, hip, lateral femoral cutaneous nerve, sciatic nerve injury, and superficial wound infection. Conclusion: Triple pelvic osteotomies in adolescents for correction of acetabular dysplasia show good functional and radiological short-term outcomes.
Heel pad injuries present a difficult reconstructive challenge due to the unique nature of the heel pad skin and soft tissues. These injuries pose wound healing challenges for many and are particularly difficult in patients with limb ischemia. This is a case report of a 66-year-old male who presented a heel degloving injury after a forklift accident who had a prolonged clinical course after initial primary closure. After delayed healing, skin flap ischemia, and infection, vascular studies were obtained which revealed ischemic toe pressures. Identification and treatment of this patient’s severe vascular disease resulted in complete healing of the wound and full recovery. We recommend consideration of vascular studies in initial workup of every patient with a heel pad injury.
Rotational dislocations of the patella are uncommon injuries where the patella rotates and dislocates along its horizontal or vertical axis. The occurrence of this injury along with a fracture of the distal femur is rarer. Attempts to reduce this dislocation without identifying the fracture, such as a Hoffa fracture, compromise the prognosis of this injury. Here, we report the case of a 27-year-old male who presented with a rotational dislocation of the patella in the vertical axis with a concurrently occurring lateral condyle fracture of the femur with the patella sandwiched between the fracture. The possible mechanism of injury and the modality of treatment used have also been discussed here.
Introduction: Several complications have been attributed to the operative management such as infection, compartment syndrome, non-union, malunion, refracture, synostosis, and nerve injuries. Here we describe a rare complication termed as Pseudo–Volkmann’s contracture (PVC) following the fixation of both bone forearm fractures. Contrary to Volkmann’s contracture, wherein ischemia is the cause for contracture, PVC results from mechanical entrapment of the flexor group, resulting in contractures. Case Scenario: A 21-year-old male presented with complaints of inability to extend the left thumb for two years. He had a history of trauma two years back and sustained both bone fractures of the left forearm. He was further managed by open reduction and internal fixation with dynamic compression plating. The patient noticed he was unable to extend his left thumb from postoperative day 1. The fracture showed good clinical union, intraoperatively. The flexor pollicis longus (FPL) musculo-tendinous junction was entrapped under the plate at the fracture site and adhered to the periosteum. Muscles showed good signs of viability, without any indication of previous ischemia. A linear bone trough was noted along the radial margin, entrapping the FPL. Implant removal with fractional tendon release, myo-tenolysis of FPL, and median nerve neurolysis. The adherent tissue of the FPL was released in a subperiosteal fashion. Following the release of adhesions around the FPL, complete passive movements of the thumb were noted. Results: Sollerman hand function test score improved from 10 at the presentation to 80 at the six-month follow-up. Three years of follow-up showed excellent clinical outcomes with no deficits. Discussion: PVC, despite being a rare phenomenon, is now gaining traction due to higher reporting of the condition [Deeney VF, Kaye JJ, Geary SP, Cole WG. Pseudo–Volkmann’s contracture due to tethering of flexor digitorum profundus to fractures of the ulna in children. J Pediatr Orthop 18(4): 437–440, 1998; Geissler J, Westberg J, Stevanovic M. Pseudo–Volkmann contracture: A case report and review of the current literature. J Am Acad Orthop Surg Glob Res Rev 2(11): e031, 2018, doi:10.5435/JAAOSGlobal-D-18-00031; Shaw B, Murphy K. Flexor tendon entrapment in ulnar shaft fractures. Clin Orthop Relat Res 330: 181–184, 1996; Song DJ, Kennebrew GJ Jr, Jex JW. Isolated ring finger flexor digitorum profundus entrapment after closed reduction and intramedullary fixation of both-bone forearm fracture. Orthopedics 35(8): e1283–e1285, 2012, doi:10.3928/01477447-20120725-36]. Clinically both active and passive extensions of the thumb are lost with the wrist in extension. However, the same are present with the wrist in flexion. This presentation greatly overlaps that of Volkmann’s contracture but can be differentiated with an extensive history, the lack of ischaemic clinical findings, and intraoperative assessment of the viable muscular tissue [Geissler J, Westberg J, Stevanovic M. Pseudo–Volkmann contracture: A case report and review of the current literature. J Am Acad Orthop Surg Glob Res Rev 2(11): e031, 2018, doi:10.5435/JAAOSGlobal-D-18-00031]. Often, the identification of digital contractures is delayed 4–6 weeks following the onset. Established contactures do not respond well to physical therapy [Prabhu RKR, Swaminathan N, Harvey LA. Passive movements for the treatment and prevention of contractures. Cochrane Database Syst Rev 12: CD009331, 2013, doi:10.1002/14651858.CD009331.pub2]. Early diagnosis in the postoperative period warrants an attempt at manipulation. Further, if manipulation does not provide an adequate range of movements, surgical exploration, and release have to be undertaken. Fractional tendon release and myotenolysis are only needed in chronic established cases. Occasionally, in chronic cases, lengthening might be needed to gain complete motion. Conclusion: PVC is a rare complication following both bone forearm fracture fixation with very limited reported literature, especially in the adult population. The clinical picture may overlap with Volkmann’s contracture and must be differentiated to properly manage the condition. Prompt diagnosis and treatment of PVC can result in excellent clinical outcomes.
Fever and hyponatremia in the post-operative period are a frequent observation. Drug-induced etiopathogenesis is a possibility that is often overlooked in such situations. Drug-induced pyrexia with hyponatremia in the post-operative period is often a diagnosis of exclusion. We present a 53-year-old male who was admitted to our hospital with an open tibia fracture and intravenous heparin was started for thrombophylaxis. The patient developed fever and hyponatremia. Usual causes of fever and hyponatremia were ruled out by clinical and laboratory evaluation. Upon discontinuation of heparin, the hyperthermia ceased, and serum sodium levels returned to baseline. Heparin is an anticoagulant widely used in clinical health practices for the prevention and treatment of thromboembolic disorders. Despite its efficacy, heparin is associated with several adverse drug reactions, most common being bleeding and heparin-induced thrombocytopenia (HIT). Heparin can also lead to osteoporosis, which is quite risky, particularly in women. Moreover, heparin-induced skin necrosis is a serious complication and manifests as necrotic lesions at the injection site. The rare adverse drug reactions to heparin, though serious, do not represent a prevalent health problem in the general population. This report aims to bring to the notice of practising clinicians two of the rare adverse effects of heparin, which are fever and hyponatremia in the postoperative period. This background sets a stage for further exploration into the mechanism, incidence and management of these adverse drug reactions with the goal of optimizing patient outcomes while minimizing risks.
Angiofibrolipomas belong to a subtype of lipomas that contain mature fat cells, blood vessels, and collagen. These are extremely rare growths with previous case reports having documented these tumors in various body locations. We report what appears to be the first case arising from the flexor tendon sheath at the wrist causing carpal tunnel syndrome.
Endoscopic spine surgery is expected to advance as endoscopic instruments become fully developed and navigable by robotic-assisted systems. This combination promises to revolutionize spine surgery, making procedures less invasive and more precise. Adopting these technologies can improve patient outcomes. A 70-year-old man was referred to our clinic presenting with right leg pain, clamping, and numbness along the right lateral aspect of the lower leg. Upon physical examination, manual muscle power testing confirmed a grade 5 strength, decreased pinprick, and light touch sensation along the L4 dermatome area of the right leg. The initial diagnosis was right L4/5 neural foramen stenosis. The procedure utilized the Excelsius GPS robotic guidance system for a robotic-assisted right L45 lateral recess and foraminal decompression via a left contralateral approach. His symptoms, particularly the right leg pain and cramping, showed significant improvement. The ongoing development and integration of robotic systems in spine surgery present substantial benefits, including increased accuracy of surgical incisions and instrument placement, reduced operative time, and decreased radiation exposure. The new electromagnetic tracking navigation system used with robotic systems may offer a better solution than the optical navigation system for reducing pin site pain and radiation exposure. However, challenges such as the suitability of robotic instruments for endoscopic spine surgery and the associated learning curve must be addressed.
Purpose: Excessive rearfoot eversion during gait increases the risk of musculoskeletal dysfunction. This study examined the effect of postural changes on rearfoot kinematics during gait. Methods: Fifteen healthy men conducted gait trials under three postural conditions: neutral posture (NP), sway back posture (SBP) and forward leaning posture (FLP). An examiner visually assessed posture maintenance during trials based on a previous study. Kinematic data, including peak foot-ankle complex dorsiflexion, peak rearfoot eversion, and trunk-pelvis tilt angles, were collected using a three-dimensional motion capture system. Results: Trunk-pelvis tilt angles were significantly more posteriorly tilted in SBP (3.7[Formula: see text] and 6.3[Formula: see text]) and more anteriorly tilted in FLP (− 12.6[Formula: see text] and − 4.9[Formula: see text]) compared to NP (− 4.9[Formula: see text] and 3.3[Formula: see text]) ([Formula: see text] < 0.01), confirming appropriate postural control. The peak dorsiflexion angle of the foot-ankle complex significantly increased under the SBP (10.1[Formula: see text]) ([Formula: see text] < 0.01) compared to NP (8.5[Formula: see text]) and significantly decreased under the FLP (7.4[Formula: see text]) ([Formula: see text] < 0.05). Similarly, the peak rearfoot eversion angle significantly increased under the SBP (9.7[Formula: see text]) ([Formula: see text] < 0.05) and significantly decreased under the FLP (8.1[Formula: see text]) ([Formula: see text] < 0.05), compared to NP. Conclusions: Postural changes altered peak foot-ankle complex dorsiflexion during gait, corresponding with rearfoot eversion, which may increase under higher foot-ankle dorsiflexion demands.
Background: The Oxford Hip and Knee Scores (OHS/OKS) are validated tools for measuring outcomes in joint arthroplasty. There is inconclusive evidence to support their use to predict clinical success. The aim of this study was to assess whether pre- and early post-operative scores are predictive of outcome at one year. Method: A retrospective cohort study collecting pre-operative, and four-week and one-year post-operative OKS/OHS. Linear regression analysis was used to establish the predictive capacity of these scores on outcomes at one year. Results: In both samples, the scores significantly increased over time ([Formula: see text] < 0.001). Lower pre-operative scores had a greater overall improvement ([Formula: see text] < 0.001) but achieved significantly lower scores at 1-year than those with higher pre-operative scores. Greater four-week OKS/OHS are predictive of higher scores, and change in scores, at one year. Older patients ([Formula: see text] = 0.018) with higher pre-operative scores ([Formula: see text] = 0.002) were more likely to have poor outcomes, with failure to meet the minimally important change (MIC) at four weeks 7x, and 8x more likely to do poorly at one year in the OKS and OHS samples, respectively. Conclusion: PROMs can be used as predictors of post-operative outcomes; however, further research is indicated in defining the thresholds for intervention success. Failing to meet the MIC in the early post-operative period results in significantly higher risk of poor outcomes at one year.
Background: Adhesive capsulitis is a state of fibrosis with a decreased active and passive range of movements in two or more planes. Manipulation under anesthesia is an effective procedure that can remove the adhesions of the shoulder joint and girdle and relieve symptoms, thus improving the range of movements. There is a lack of a clear protocol for orthopedic surgeons to follow while treating adhesive capsulitis. We assume that manipulation under anesthesia with intraarticular steroid injection is a well-tolerated procedure and can yield satisfactory outcomes with a faster recovery of function than a conservative approach. Patient and Methods: We retrospectively reviewed the medical records of 63 patients in our hospital with adhesive capsulitis having unilateral involvement who were treated with manipulation under anesthesia between January 2020 and January 2023. Pain severity was evaluated by the shoulder pain and disability index (SPADI) and numerical pain rating scale (NPRS). Shoulder function was assessed by passive shoulder range of movements, which were measured by flexion, abduction and external rotation movements preoperatively; immediately after surgery; and at two weeks, one month, three months and 12 months. Results: Abduction improved from 83.40 ± 23.97[Formula: see text] to 149.23 ± 2.34[Formula: see text] at 12 months. Forward flexion improved from 77.60 ± 20.16[Formula: see text] to 153.78 ± 1.42[Formula: see text] at 12 months. The degree of external rotation improved from 22.60 ± 7.79[Formula: see text] to 78.13 ± 5.24[Formula: see text] at 12 months. The NRS score improved from 5.56 ± 0.58 to 1.00 ± 0.76 at 12 months. The SPADI score improved from 73.20 ± 9.00 to 26.40 ± 13.50 at 12 months. Forty-three (86%) patients reported reaching their preinjury status of functioning within 12 months. None of the patients experienced any perioperative complications. One patient experienced symptom recurrence at three months but improved with a short course of analgesics and physiotherapy. Conclusion: Manipulation under anesthesia is a short and easy technique for treating frozen shoulders refractory to conservative management. It is effective in patients secondary to diabetes, and 86% of patients reach their preinjury level of functioning. Level of Evidence: Level 3.
Spondylodiscitis is a infective processes of the spinal column, that can affect the vertebrae in isolation (spondylitis), the discs (discitis) or both (spondylodiscitis). Three infection pathways are described from a pathogenetic perspective: endogenous, exogenous, and per continuitatem. The hematogenic form is the most common (about 60%), but cases of direct inoculation following surgical procedures on the spine (15%) or contamination by contiguity (12%) are not rare. Diagnosis is based on clinical, laboratory, radiological, microbiological and histopathological data, where the magnetic resonance imaging is the technique of choice for the diagnosis. Treatment may be medical using antibiotics to eliminate the infection or surgery using spinal fixation to prevent spinal instability and ample debridement of infected tissue. We report on a patient who had spondylodiscitis due to a sigmo-rettal fistula caused by a intrarectal penetration of a toothpick which was accidentally swallowed by the patient; which was successfully treated with targeted antibiotic therapy and immobilization.
Introduction: Tendon sheath fibroma is a rare and slowly growing benign tumor commonly seen in the upper extremity (80%). It is frequently seen in the third to fifth decades of life and is more common in males. Tendon sheath fibroma has been reported to occur most likely after trivial trauma and more commonly in the plantar aspect of the region. The tumor size usually seen is <3 cm in diameter. To our knowledge, only twelve such cases have been reported around the foot and ankle. Case report: We describe a unique case of a benign, locally aggressive fibroma of the tendon sheath affecting the left foot in an adolescent — a 13-year-old girl presented with slow-growing swelling on her left foot for a year. Physical examination revealed a 7 × 5 cm swelling on the plantar aspect of the foot. MRI showed a well-defined mass seen in the flexor compartment around the 2nd and 3rd metatarsals abutting the flexor tendon sheath with iso signal intensity to muscle on T1-weighted images and homogeneously low signal intensity to muscle on T2-weighted images. After the biopsy, we went ahead with complete tumor excision. The histopathological specimen was composed of spindle cells arranged in bundles, fascicles, and a swirling pattern, and areas with varying cell density and abnormal hyaline degeneration confirming tendon sheath fibroma. The atypical features seen in our case were that this was found in an adolescent girl, with a size of 7 × 5 cm, which did not follow the usual pattern as seen in other patients. There were no signs of recurrence or any disability seen at 2 years of follow-up. Given the foot’s susceptibility to various lytic lesions and the overlapping clinical presentations, accurate diagnosis can be challenging. The foot’s complex anatomy can further obscure the condition, underscoring the need for heightened clinical suspicion when evaluating foot lesions. Conclusion: Looking at the nature of the histopathological diagnosis which has quite distinct features from usual tendon sheath fibroma we conclude that tumors may present with atypical characteristics leading to difficulty in histopathological diagnosis.
The objective of this case report is to emphasize the importance of the identification of all the causative factors responsible for the creation of the congenital clasped thumb, as their detection will perform a critical part in the choice of the proper surgical treatment. This study presents the case of a four-year-old boy with a congenital clasped thumb of the right hand. A short Flexor Pollicis Longus (FPL), an absent Abductor Pollicis Longus (APL), a hypoplastic Extensor Pollicis Brevis (EPB), and palmar displacement of the Extensor Pollicis Longus (EPL) were detected. The surgical treatment included Z-lengthening of the short FPL and augmentation of the insufficient EPL and EPB by tendons transfer. Postoperatively, the thumb was halted in a place of full radial abduction and [Formula: see text] of palmar flexion with scotchcast plaster for four weeks. In his last follow-up three years after surgery, he was able to do full abduction and extension of the thumb. He was able to open a door or grasp and hold various objects. He was fully satisfied with the result of the operation. Treatment should be adjusted to address all causative issues of clasped thumb effectively, reduce deforming forces, and increase the activity of insufficient muscles.
