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In the 1950s, the concept of artificial intelligence emerged, suggesting that machines could possess the ability to think and learn. In the 21st century, with advancements in GPUs and CPUs, deep learning has become an integral part of human life.

Proximal femoral fractures are known to be one of the leading causes of mortality and injuries among the elderly population. This study aims to detect proximal femoral fractures in X-ray images and compare the success of using the YOLOv4 algorithm and provide decision support system within the diagnosis. To retrain the algorithm, more than 500 patients’ X-ray images were examined. Through data augmentation techniques, the initial set of 410 patients’ femur proximal fracture X-ray images was expanded to 820 images.

After retraining the YOLO algorithm, two different groups were included for comparing the algorithm’s performance: orthopedic specialists and general practitioners. The results from these three groups were evaluated using specific criteria. The YOLOv4 model demonstrated an accuracy of 90.33%. In comparison, orthopedic and traumatology resident doctors achieved an accuracy of 91.42%, while the general practitioner group achieved an accuracy of 81.30%.

Fluoroscopy is a commonly used tool in hand surgery. There have been recent advances in the technology and its clinical utilisation. Indications include assessment of joint and fracture fixation and stability, particularly when combined with minimally invasive techniques. Recent developments include surgeon operated mini C-arm image intensifiers. We present a review of the clinical utilisation of fluoroscopy in hand surgery including recent developments, Australian legislation, safety issues, strategies to reduce radiation exposure and clinical examples for imaging distal radius and scaphoid fracture fixation.

Background: The frictional properties between bone and uncemented orthopedic implants are important for initial stability. Accurate frictional data are used in computer modeling to improve implant design. Unfortunately, friction data derived from standardized testing methods is rare. We aimed to validate two testing methods and to provide friction data. Method: Two experimental designs for testing friction (Sled and Rotation) were investigated. One (Sled) employed a friction testing standard (ASTM D4518) while the other (Rotation) was a novel design. Both designs were initially validated using metal and polymer surfaces of known friction coefficients. The effect of variables, speed and normal force was evaluated. Finally trabecular bone from fresh frozen cadaveric femurs ($n=4$) was tested against four commonly used orthopedic surfaces. Porosity of each bone sample was obtained using micro-CT and we reviewed the correlation between porosity and friction coefficient. Results: Based on the validation experiments, the Rotation method delivered more accurate friction estimates, and was less affected by normal force and speed, than the Sled method. The testing of bone against implant surfaces produced a variety of different force displacement curves and a wide range of friction coefficients (range 0.19–0.78). Bone excised from the lateral femoral condyle produced a higher friction coefficient than bone from the medial femoral condyle (p-value $<0.05$). Trabecular bone samples yielded a range of porosities (91.30–79.03%) as determined by micro-CT. A weak positive correlation was observed between bone porosity and friction coefficient. Conclusion: This study demonstrated the importance of a validated testing method when determining frictional properties between bone and orthopedic implants. Specific testing standards should therefore be created, to ensure accurate and reproducible data. The data produced in this study will be utilized for further experimental studies and computer modeling.

Plantar Fasciitis (PF) is a disorder of connective tissue that supports the longitudinal arch of the foot. The fascia runs along the sole with insertion to the heads of the metatarsal bones and origin in the calcaneus. It is one of the most frequent diagnoses for patients in general and foot clinics, and one of the common causes for heel pain which may develop into chronic heel pain, change the way we walk and lead to foot, knee, hip or back problems. PF is the most common type of plantar fascia injury. The purpose of this study is to describe the natural history of PF, including the ethnicity, early and main symptoms, aggravating factors, comorbidities and treatments for PF, based on the patient-reported data from active PF community in an online crowdsourcing platform, StuffThatWorks. Analyses were made in order to discover characteristics which have a clinical importance. Totally 3835 patients were included in this retrospective observational study. The results show that crowdsourcing is a valid approach for data collection, as expected results with regard to clinical aspects such as age-of-onset, early and main symptoms were witnessed. Furthermore, the patient-reported data show three characteristics which have a very high clinical relevance: high level of physical activity, being overweight and age. In addition, leads for future studies were established.

Purpose: Minimally invasive plate osteosynthesis (MIPO) is used for the treatment of distal tibial fractures, especially in cases of intra-articular fractures. There are many advantages of MIPO, including preservation of blood supply to the fracture site and enhanced bone healing, however, it is not without complication. The study aimed to elaborate the benefits of MIPO technique in managing distal tibia fractures and to describe the necessities for good union and functional outcome. Methods: A total of 38 patients with distal tibia comminuted and spiral fractures, having closed distal tibia AO/OTA 43-A, B or C fractures with or without fibular fractures, were included. All the cases were assessed for union time, complications and functional outcomes. Binomial regression using $R$ v3.6.0 was used to assess the success of MIPO based on four-cortex alignment. $P$ value $<0.05$ was considered statistically significant. Results: The mean operative time was 70min. All 38 tibial fractures united and the mean union time was found to be 18 weeks. Five cases were noted to have complications (four superficial infections and one implant failure). Out of 38 patients, 28 (majority) showed excellent functional outcomes as assessed by the American Orthopaedic Foot and Ankle Society score, i.e. a score of $\ge$90. Conclusion: MIPO is a good method for the management of tibial fractures with extra-articular and intra-articular involvement, with good union even when absolute four cortical contact is not achieved.

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Background: To date, little is known about the characteristics of highly cited studies in hand surgery compared with other orthopaedic subspecialties. We aimed to assess the position of hand surgery within the orthopedic surgery literature.

Methods: We conducted a bibliographic analysis using the Web of Science database to review 1,568 articles published between January 2012 and December 2012 in 4 relevant general orthopedic and 2 hand surgery journals. We used the number of citations within 3 years of publication to measure the impact of each paper. To analyze prognostic factors using logistic regression analysis, we extracted data on orthopedic subspecialty, published journal, location of authorship, and type of study for all articles. For clinical studies, we also recorded details on study design and sample size.

Results: Of eligible hand surgery articles (n = 307), the majority (62%) were case reports/series. Only 19% were comparative studies, comprising a significantly smaller proportion of comparative studies from other subspecialties in general orthopedic journals. Systematic reviews/meta-analyses generated a significantly higher number of average citations, whereas educational reviews were consistently cited less frequently than other study types (14.9 and 6.1 average citations, respectively). Being published in the Journal of Bone and Joint Surgery, American volume, having authorship in North America or Europe and Australia, focusing on subspecialties like hip & knee, sports, or shoulder, utilizing a comparative or randomized clinical trial study design, and having a larger sample size increased the odds of receiving more citations.

Conclusions: Clinical studies related to hand surgery published in general orthopedic journals are most often of lower quality study design. Having a larger sample size or using a comparative study or randomized clinical trial design can improve the quality of study and may ultimately increase the impact factor of hand surgery journals.

Bone drilling is widely performed in orthopedics for fixation and reconstruction of bone. In bone drilling, a hard metallic drill penetrates into the bone tissue which may cause trauma. Shear deformation of the bone material and friction between the drill and bone may induce elevated temperature in bone tissue. Temperature above a certain level may seriously harm the tissue, leading to several postoperative complications. The purpose of the current study is to measure and compare temperature in bone drilling using sharp and worn drill. Drilling tests were performed on cortical bone obtained from femoral shaft of a cow. A parametric study was conducted to quantify bone temperature using a range of drilling speeds and feed rates using drills having sharp and worn cutting edges with and without cooling environment. The temperature was measured using thermocouples, and wear of the cutting edges of the drill was measured using a scanning profilometer. Experimental results demonstrated lower temperature in bone using a sharp drill compared with a worn drill for similar drilling conditions. The bone temperature was found to rise with drill rotational speed, rate of penetration and size of the drill with and without cooling. Blunt drills were found more crucial for inducing thermal necrosis in bone.