Charlotte F. Wahle

Study Design: Scoping Review. Objective: Spine research is resource-intensive and thus often performed in high-income countries. Consequently, findings may not be generalizable to low-resource areas. This study aimed to assess the current state of primary clinical spine disease research in Sub-Saharan Africa. Methods: All spine studies published in English or French in Sub-Saharan Africa in the past 50 years with at least ten patients were included. A study quality variable was created that identified randomized studies, prospective studies, and studies that include a control group as having a higher level of scientific rigor. Results: A total of 154 spine studies have been published from at least 26 countries since 1975 (some included multiple). There was a significant increase in research productivity after 2005 (p<0.001). The highest number of publications came from Nigeria with 52 (34%), followed by Tanzania (25 papers, 16%) and Ethiopia (12 papers, 8%). Nearly half of studies involved collaborative partnerships. On univariate analysis, lower-income countries were more likely to engage in collaboration with other countries (OR 3.2, 95% CI: 1.2-9.8) and to receive external funding (OR 7.0, 95% CI: 2.3-20.4). Further, collaborative studies were found to produce higher quality academic publication (OR 2.0, 95% CI: 0.94-4.2). Conclusion: There is a relative paucity of spine literature from Sub-Saharan Africa. Higher research quality was associated with collaborative engagement. These results support the development of global health partnerships that may foster high-quality research aimed at addressing the burden of spine disease in Africa.

Objective: To determine if variation in the practice of open vs closed reduction of femoral neck fractures (FNFs) for nonelderly adults at the aggregate treatment center level can be explained by patient and fracture characteristics. Methods: Design: Multicenter retrospective cohort. Setting: Twenty-five North American Level 1 Trauma Centers. Patient Selection Criteria: Skeletally mature patients between the ages of 18 and 60 years with operative repair of FNFs. Outcome Measures and Comparisons: The propensity for treatment with open vs closed reduction was estimated given patient and fracture characteristics from all patients included in the study. Predicted probabilities of open reduction were averaged for each treatment center and used to assess variation in each centers' proportion of open reductions. Logistic models of treatment approach were fit with and without indicator variables for treatment centers to test the impact of exclusion of treatment center using a likelihood ratio test. Results: The sample included 818 patients with a mean age of 43.9 (SD 11.3), 56.7% of patients were male, and 37.0% presented with a Pauwels angle >50°. Open reduction was performed more frequently for 225/352 (63.9%) displaced FNFs compared with 131/466 (28.1%) nondisplaced FNFs ( P < 0.001). A likelihood ratio test showed significant deterioration of model fit with exclusion of treatment center for both groups ( P < 0.001). Conclusions: The decision to perform an open vs closed reduction differed significantly compared with that which would have been predicted based on patient characteristics and case-mix at several treatment centers. This suggests that external factors beyond case-mix may bias operative decision making at a treatment center level. Level of Evidence: Level III Therapeutic.

Introduction: Despite growing enthusiasm for artificial intelligence (AI) implementation in orthopaedic care, patient attitudes toward AI adoption remain unexplored. This study assesses patient perceptions of AI integration in diagnosis, treatment, and patient communication in orthopaedic surgery. Methods: A 28-question survey was administered to patients in hand surgery, orthopaedic oncology, and joint replacement surgery clinics. The survey queried patients' baseline comfort with AI and its perceived strengths, weaknesses, risks, and benefits. Results: Among 300 patients, the median age was 59 years. Most (55.2%) were comfortable with AI-assisted radiologic diagnosis, 58.3% with robot-assisted surgery, and 34.7% with AI-driven communication tools. Higher education and income correlated with greater AI acceptance ( P < 0.001). Patients with lower education levels perceived fewer benefits in daily AI use and a less positive impact of surgical outcomes ( P = 0.03, P = 0.05). Common concerns included loss of patient-surgeon relationships (70.0%), surgeon overreliance on AI (56.9%), and lack of individualized care (51.5%). Men were more accepting of AI use in diagnosis and surgery ( P < 0.03), whereas women were more concerned about AI perpetuating biases ( P = 0.05). Older patients were less comfortable with using AI for diagnostics ( P < 0.001). Conclusion: As AI implementation in orthopaedic care expands, women, older patients, and patients with lower education and household income levels may feel less comfortable with AI integration, threatening their quality of clinical care. Universal concerns about AI implementation include AI potentially weakening the patient-surgeon relationship. Targeted patient education efforts to address common concerns about AI adoption will enable orthopaedic surgeons to responsibly integrate these tools into practice.

It is well established that early diagnosis and subsequent intervention can result in significant benefits in infants with neurodevelopmental disorders such as cerebral palsy (CP). This scoping review aimed to assess the current state of the literature regarding the use of innovative and emerging technologies for early CP screening, diagnosis and phenotyping in pre-ambulatory children. Searches were performed across PubMed, Embase and Cochrane databases; articles were screened by four independent reviewers at the title/abstract and full-text levels. Forty-eight studies met the inclusion criteria. The most frequently used modalities included wearable sensors (e.g., accelerometers, inertial measurement units) and video-based motion analysis. These movement-tracking systems were used to screen for a variety of pediatric-onset neurodevelopmental disorders and have been useful in quantifying spontaneous infant movements, detecting the absence or abnormality of fidgety movement, or identifying atypical motor patterns. Although CP was our primary focus, several studies applied a similar pipeline to autism spectrum disorder (ASD) and spinal muscular atrophy (SMA), underscoring broader relevance for early neurodevelopmental screening, diagnosing and phenotyping. Overall, technology-assisted motor assessment demonstrated promising feasibility and diagnostic potential; however, most studies are limited by small sample sizes, short follow-up durations, and heterogeneous validation methods. Given the benefits of early intervention and the emerging capabilities of wearable and video-based analytics, larger multi-site and longitudinal datasets are needed to support early diagnosis, risk stratification, and functional phenotyping in CP.

Introduction: New patient visits in the orthopaedic oncology clinic are medically complex and emotionally nuanced. Previous orthopaedic literature has shown that clear communication of the diagnosis and plan can be difficult, resulting in worse outcomes. This study aimed to validate the use of a novel patient encounter card (PEC) to improve patient/physician postencounter satisfaction. Methods: All new patients who presented to the clinics of three fellowship-trained orthopaedic oncologists from September 2023 to March 2025 were included. In the preintervention phase, visits were conducted without modification. Patients were queried on satisfaction, whether concerns were addressed, understanding of the treatment plan, and perceived patient/physician connection. During the intervention phase, a PEC was implemented. The “patient” side was completed in the waiting room; the “physician” side during the visit. Patients then completed the same postvisit survey. Residents and fellows were surveyed at the end of each clinic. All statistical analysis was done using STATA V18. Results: A total of 245 patients were surveyed. During the intervention phase, patient scores improved across all 12 patient satisfaction and competency metrics. Following the intervention, 94% of patients strongly agreed that the doctor listened to what they had to say and 93% felt that their main concern had been addressed. Compared with the control group, markedly more patients reported being “very satisfied” with their visit ( P = 0.048) and “very confident” that they made the most of their visit ( P = 0.041). Markedly more patients also reported that they were involved in their treatment plan as much as they wanted to be ( P = 0.046). Finally, 100% of surveyed physicians believed that the intervention improved clinical efficiency. Conclusion: PECs improve patient experience and strengthen patient-physician communication while maintaining clinical efficiency in orthopaedic oncology consultations. This simple, low-cost intervention may be effective across a range of medical and surgical specialties.

Study Design: Delphi study. Objective: Optimal spine trauma care requires extensive resource availability and training. In LMICs, where resources and training are scarcer, spine trauma represents a major source of disability and public health burden. This study aimed to evaluate the highest priority resource needs for spine surgeons in sub-Saharan Africa in order to provide safe, high-quality spine trauma care. Methods: This study utilized a Delphi methodology with three electronic surveys. Participants were identified through the Continental Association of African Neurosurgical Societies (CAANS) and College of Surgeons of East, Central, and Southern Africa (COSECSA) networks. Response collection lasted from August 2024 to May 2025. The initial survey was an open-ended collection of all spine trauma resource priorities. In each subsequent round, participants rated topics on a Likert scale from 1 (most important) to 9 (least important). Consensus was defined as topics ranked 1, 2 or 3 (highly important) by >70% of participants. Results: Invitations were sent to 75 potential participants, with 36 participating in round one. Thirty-four participants (94.4%) and thirty-five (97.2%) completed the second and third consensus rounds respectively. Fifty-one items reached consensus. The most highly rated items included braces/c-collars, spine training/education of emergency room physicians and surgeons, and access to implants. Items not reaching consensus included microscopes, endoscopes, navigation and specialized auxiliary personnel. Conclusion: Given the high burden of traumatic spine injury and resource needs in these regions, efforts should be focused on providing essential resources related to timely stabilization of the spine over advanced tools and technologies.

Purpose: Leadership skills are critical for success as a surgical trainee and attending. However, the prevalence of structured leadership training curricula in surgical residency training programs is unknown. The objective of this study was to assess the current state of the literature in terms of reporting on formal leadership curricula in surgical residency programs in the United States. Methods: A systematic literature search was performed per PRISMA guidelines. Inclusion criteria consisted of all original research articles that discussed the implementation of a formal surgical leadership curriculum in ACGME-accredited residency programs. Exclusion criteria included non-surgical residencies, leadership training for medical students or faculty and non-U.S.-based residency programs. Results: A total of 199 studies underwent screening. Ten studies (5.0%) met final inclusion criteria, published from 2004 to 2024. A total of 252 residents were included across eight studies (2/10 studies did not disclose how many residents participated). The most common forms of curricular intervention were formal leadership lectures (including free-standing lectures and leadership-focused grand rounds speakers), journal clubs, and individualized leadership mentoring/coaching. Seven of the 10 formal leadership programs (70%) were modelled according to literature, programs, or experts in other industries. Curricular impact was measured via faculty feedback, rates of attrition, and surveys/feedback from the residents following the intervention. Conclusions: The prevalence of literature describing formal leadership curricula in U.S. residency programs is sparse. However, those surgical residencies that have described the implementation of such programming have largely reported success and positive reactions from participants.

Technological advancements in orthopaedic oncology continue to augment our approach to surgical interventions. However, the impact on patient outcomes following lower extremity bone tumor resections remains under‐characterized. This systematic review identifies the impact of various technological advancements on post‐operative outcomes. A systematic search of PubMed, Embase, and Cochrane Library databases (2014–2024) identified studies on lower extremity bone tumor resections involving 3D prostheses/patient‐specific instruments (3D PSI), intraoperative navigation, and control conventional surgeries. Individual case reports, cadaveric, and animal studies were excluded. Two reviewers independently screened abstracts and extracted Musculoskeletal Tumor Society (MSTS) scores and data on complications (infections, fractures, revisions). Interventions were segmented by use of technology in surgery between 3D patient‐specific instrumentation (PSI), intraoperative navigation and conventional approaches. Descriptive analysis was employed to calculate the weighted means, frequencies, and proportions of complications across technology subgroups. Out of 2841 studies screened, 40 studies with 606 patients met inclusion criteria. Average patient age was 30.7 ± 14.3 years with mean follow‐up period of 32.9 ± 20.5 months. Overall complication rates were 11.9 ± 12.9 for 3D PSI, 16.4 ± 16.7% for intraoperative navigation, and 32.7 ± 2.8% for conventional. Weighted mean infection rates were 3.3 ± 6.2% for 3D PSI, 3.4 ± 4.3% for intraoperative navigation, and 7.2 ± 7.8% for conventional. Mean revision rates were 1.6 ± 5.4% for 3D PSI, 2.5 ± 5.6% for intraoperative navigation, and 7.2 ± 3.1% for conventional. Weighted mean MSTS scores were similar between groups (26.4 ± 4.4 3D PSI, 25.4 ± 2.8 intraoperative navigation, 26.2 ± 6.2 conventional). This Level III Evidence study's results suggest that application of technological advances to operative management of musculoskeletal tumors may decrease complication rates while maintaining MSTS scores.