Introduction: Accident compensation corporation (ACC) provides a no faults cover to the injured person in New Zealand. Since the introduction of “Treatment injury” in 2005, injuries sustained as a result of treatment from a registered health profession such as medical error and mishap, were covered. Aim: This study is an analysis of 335 cases of spinal conditions with complications for “treatment injury claims”. Materials: A single surgeon assessed 1200 cases meeting the criteria for orthopaedic treatment injury. 335 of these cases were claims for spine (Lumbar 61%, Thoracic 16%, Cervical 23%). Complications related to a pre-existing condition, refusal to give consent, no desired result obtained, and an ordinary consequence are not considered “treatment injury. Summary Treatment injuries for cervical, thoracic and lumbar spine have been discussed. Surgeons must appreciate that no matter how skilled they are the possibility of iatrogenic nerve or cord injury exists in every case. With a no blaming and shaming culture, health professions are gaining increasing confidence in reporting their complications in the “treatment injury system”. Nerve injury was the most common claim and 148 of 335 claims were related to neurological complications. If a nerve or cord is damaged intra-operatively, notify the patient as soon as feasible and maintain the physician-patient relationship. Other treatment complications were discussed. There is high rate of dissatisfaction after surgery on spinal condition compared hip or knee surgeries.

Introduction:
In the orthopedic and trauma surgery operating theatre staff are confronted daily with the risk of exposure to ionizing radiation. This exposure continues to increase with the development of radiosurgical techniques, making it possible to avoid open surgery . These techniques expose to X-rays with harmful effects on the health of patients and exposed personnel, which requires knowledge of the risks involved and the means of protection.
The objectives of this work were to assess the knowledge of exposed personnel of ionizing radiation and the means of protecting themselves.
Materials and methods :
This is a descriptive study, carried out among orthopedic department staff working in the operating room. The technique used was based on a self-administered questionnaire comprising 30 questions on knowledge of radiation protection. We included in this study any person exposed to ionizing radiation and working in the operating room. We excluded students.
Results:
We distributed 60 questionnaires. Respondents were 92% physician and 8% parmedical. The average number of years of exercise was 3 years, 23% of respondents were unaware of the risks of ionizing radiation, 98% of respondents were unaware of Algerian radiation protection regulations, 89% of respondents had no idea about the annual dose limit not to be exceeded for workers. 98% of staff would like to receive training in radiation protection.
Conclusion:
The knowledge of the personnel with regard to radiation protection is poor, the implementation of comprehensive training for operating room personnel on radioprection is necessary to minimize the risks incurred.

Objective: Osteochondral injuries are a recognised factor in the development of osteoarthritis (OA). Mesenchymal stromal cells (MSCs) represent a promising biological therapeutic option as an OA-modifying treatment, and they also secrete factors that may have an anticatabolic effect and/or encourage endogenous repair. We aim to study the effects of (i) intra-articular injection of human bone-marrow-derived MSCs and (ii) their secretome on recovery in a murine knee osteochondral injury model.

Methods: The MSC secretome was generated by stimulating human bone-marrow-derived MSCs with TNFα. Mice (n=48) were injected with i) MSC secretome, ii) MSCs or iii) cell culture medium (control). Pain was assessed by activity monitoring, and cartilage repair, subchondral bone volume and synovial inflammation were evaluated using histology and microCT.

Results: Both MSC- and MSC-secretome-injected mice showed significant pain reduction at day 7, but only the MSC-injected mice maintained a significant improvement over the controls at day 28. Cartilage repair was significantly improved in MSC-injected mice. No significant effects were observed with regards to synovial inflammation or subchondral bone volume.

Conclusion: The MSC secretome demonstrates regenerative effects but this does not appear to be as sustained as a MSC cell therapy. Further studies are required to investigate if this can be overcome using different dosing regimens. As we understand the regenerative properties of the MSC secretome, we may be able to enhance the clinical translatability of these therapies. Direct intra-articular injection of MSCs for the treatment of OA also appears promising as a potential future strategy for OA management.

Introduction:Midline skin incision is the standard surgical approach during total knee arthroplasty(TKA). Infrapatellar branch of saphenous nerve(IBSN) is at risk of injured during TKA. The aim of the study is to assess the anatomical course of IBSN in relation to midline skin incision during TKA among Asian population. Methods:Eight male Asian cadaver knees were dissected. Terminal branches of IBSN were identified and tranced in relation to midline skin incision during TKA. Results:Majority of the cadavers(75%) consist of all three terminal branches, namely superior, middle and inferior branch, and findings are consistent between both knees. The branches branching at the distance between 2.0cm to 5.8cm from the medial border of the patella. All terminal branches cross the midline skin incision at the level between inferior pole of patella and tibial tuberosity and ended at lateral aspect of the knee. Discussion:IBSN is located superficially at subcutaneous layer and easily missed or hardly avoidable during midline skin incision during TKA. Hence, IBSN and its terminal branches are likely injured during TKA. Thus, it is postulated that injury of IBSN could contribute to the causes of anterior knee pain post TKA, as a result of neuropathic pain from neuroma formation and often under reported. Conclusion:This study shows IBSN with its terminal branches are likely being injured during standard midline skin incision during TKA due to the nature of its anatomical locations and variations. Therefore, it is important that patient is well informed regarding the possible complications preoperatively.

Acromioclavicular joint (ACJ) Radiographic anatomy is essential knowledge help on diagnosing wide range of ACJ pathologies. Knowing normal morphometric measurement of joint space will support decision-making in choosing management modality, emphasize practicing surgeries and arthroscopes in the shoulder region. This a descriptive retrospective analytic study aims to investigate the radiological morphology of normal ACJ anatomy among the Sudanese population. Two hundred normal acromioclavicular joints Xray belong to one hundred subjects, 55 were male and 45 were female, with an average age of 43 ranged from 18 to 70 were studied, the joint type was classified observing acromial and clavicular ends of the joint, the proximal, middle, distal and longitudinal distances were measured, and integral joint space was calculated. The present study had classified the morphology of ACJ into nine types depending on articular surfaces shape. (acromial/clavicular) namely Flat/Flat, Flat/Curved, Flat/Oblique, Oblique/Oblique, Oblique/Flat, Oblique/Curved, Curved/Curved, Curved/Flat and Curved/ Oblique type, the most common type was flat/ curved type in both male and female. There was no significant difference in types and distances associated with right and left sides. The normal proximal distance was 5.09 mm (1.9 – 8.00), the distal distance was 4.08 mm (1- 7.20), whereas middle point distance was 3.68 mm (1.10 – 7.20). The integral acromioclavicular joint space using this three-point was 4.28 mm (1.33 – 7.47). The spaces were found to be wider in male than female, consequentially decreased with advance in age except longitudinal length distance which increases with rise in age.

BACKGROUND: Femoral shaft fractures are common in Malawi, with annual incidence of 44/100,000 people. Inadequate treatment and delayed presentation often result in functional, biopsychosocial, and financial challenges for patients. We examined the socioeconomic consequences of femoral shaft fractures for patients in Malawi. METHODS: This study of 42 patients was part of a larger study that prospectively examined quality of life. Questionnaires were distributed to patients at 1-year follow-up following femoral shaft fracture treatment. Patients reported standard of living and financial well-being pre-and post-injury. RESULTS: Patients reported relatively high transportation costs to and from hospital. One year after injury, 17 patients (40%) had not returned to work. Of the 25 (60%) who had returned, 5 (20%) changed jobs due to their injury, and all reported decreased productivity. Household income decreased for 29% of patients. 45% of patients reported ongoing food insecurity. Many patients changed their residence, borrowed money, sold personal property, and unenrolled children from school due to financial hardship after injury. CONCLUSION: While Malawian public healthcare is free at the point of care, it lacks financial risk protection that is essential to universal health coverage. We found that indirect costs of care due to femoral fractures have substantial socioeconomic consequences on patients and their families. Increased investment of financial and human capital should be made into capacity building and preventative measures to decrease the burden of injury, increase access to care, improve care delivery, and provide financial risk protection for trauma patients in Malawi.

Introduction: Pedicle screws fixation in patients with dysplastic and fully corticalized pedicles poses potential challenges, difficulties, and risks. Methods: All scoliotic patients with major (curve with largest Cobb angle) main thoracic curves who had CT scans prior to corrective spine surgery from 2015 to 2020 were retrospectively included in this study. Exclusion criteria were: (1) non-idiopathic scoliosis, (2) thoracolumbar and lumbar major curves (3) patients with previous spinal surgery or trauma, (4) reverse curves. Pedicles were classified as Type A: cancellous channel >4 mm; Type B: cancellous channel 2 to 4 mm; Type C: cancellous channel <2 mm or corticalized pedicle >4 mm; Type D: corticalized pedicle ≤4 mm. Type B, C and D were dysplastic pedicles. Type C and D were narrow dysplastic pedicles. Results: A total of 6494 pedicles from 191 patients were measured and evaluated. Smallest pedicles were located at right T4, T3 and T5 (2.3±1.0mm, 2.6±1.1mm, and 2.8±1.2mm) followed by left T7, T8 and T6 (3.1±1.1mm, 3.2±1.2mm, and 3.3±1.1mm). Prevalence of narrow dysplastic pedicles followed the similar pattern with majority located at right T3-T5 (71.2-83.7%) and left T7-T9 (51.3-61.2%). The prevalence of fully corticalized pedicles were the highest at right T3-T5 (20.9-34.0%) and left T7-T8 (11.0-12.0%). These regions corresponded to the concavity of the proximal thoracic (PT) curves and the main thoracic (MT) curves. Conclusion: The concave pedicles of the PT and MT curves had the narrowest transverse pedicle diameter and showed high prevalence of narrow dysplastic and fully corticalized pedicles.

Introduction: We retrospectively summarized all orthopedic surgeries performed on patients diagnosed with osteogenesis imperfecta (OI) in our hospital from 2013 to 2021. Results: The data consisted of 496 surgeries in 223 OI patients (95 female, 128 male). The patients’ ages ranged from 0.5 to 38 years (interquartile-range [IQR], 5.7 ~ 14.4). Between 1 and 9 (IQR, 1 ~ 3) surgeries were performed per patient. Osteotomies were involved in 341 surgeries (68.8%), while non-osteotomies were involved in 155 surgeries (31.2%). The non-osteotomies involved one or multiple of these: casting adjustment or fixation (n=56), revision (n=48), fracture (n=38), removal of internal fixation (n=22), debridement (n=9), cranial traction (n=4) and spine surgeries (n=4). Among the osteotomies, 178, 135, 23 and 5 surgeries involved one, two, three and four bone segments, respectively. About half (47.8%) of osteotomies involved two segments or more. The most common sites are femur and tibia, being involved in 241 and 148 surgeries respectively. Only 27 surgeries were performed on the upper limbs. Seventy-five of the osteotomies (22.0%) were followed by some unplanned surgeries (n=118; average 1.6). On average, the patients enjoyed 1,079 days of event-free post-operative life. Locking plates were used in 48 osteotomies, and their use did not seem to incur additional events or unplanned surgeries. Conclusion: A large number of orthopedic surgeries were reviewed. Unplanned surgeries account for less than one quarter of all surgeries and at least three years lapsed before further interventions were needed. Locking plates can be used safely to improve stabilization where necessary.

Self-renewal and differentiation into diverse cells are two main characteristics of stem cells. These cells have important roles in development and homeostasis of different tissues and are supposed to facilitate tissue regeneration. Function of stem cells is regulated by dynamic interactions between external signaling, epigenetic factors, and molecules that regulate expression of genes. Among the highly appreciated regulators of function of stem cells are long non-coding RNAs (lncRNAs) and microRNAs (miRNAs). Impact of miR-342-5p, miR-145, miR-1297, miR-204-5p, miR-132, miR-128-3p, hsa-miR-302, miR-26b-5p and miR-10a are among miRNAs that regulate function of stem cells. Among lncRNAs, AK141205, ANCR, MEG3, Pnky, H19, TINCR, HULC, EPB41L4A-AS1 and SNHG7 have important roles in the regulation of stem cells. In the current paper, we aimed at reviewing the importance of miRNAs and lncRNAs in differentiation of stem cells both in normal and diseased conditions. For this purpose, we searched PubMed/Medline and google scholar databases using “stem cell” AND “lncRNA”, or “long non-coding RNA”, or “microRNA” or “miRNA”.

Introduction: Traditionally face-to-face hospital induction has been documented to lead to information overload with poor knowledge retention. This along with the COVID-19 pandemic has provided an opportunity to redesign induction, taking it into the digital age, with medical student needs in mind.
Methods: A virtual induction video to the Trauma and Orthopaedic department was created for medical students. iPhone was used for filming and iMovie programme for editing. It was shared with students prior to starting their hospital placement. It included a walk-through of the hospital, highlighting key areas and explaining educational opportunities. Eight students were the first amongst their cohort to return to hospital placements since the COVID -19 pandemic. Data was collected from these students in the form of pre and post placement questionnaires and focus groups.
Results: Students strongly preferred virtual induction to traditional face-to-face induction. 80% of students felt more confident about where to go, 75% knew who to contact on day one of their placement. 75% felt that being able to re-watch the video on their personal devices at their convenience was invaluable, and more time-efficient.
Discussion: COVID-19 has brought about rapid digitalization of services of which hospital induction should be no exception. Using easily accessible equipment, we produced a virtual induction video which can be easily recreated by other departments and save departmental time and costs in the long run. Our feedback shows that virtual induction allows for more efficient orientation, navigation, learning and can lead to improved wellbeing of students during their placement.