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Convolutional neural networks (CNNs) are increasingly being developed for automated fracture detection in orthopaedic trauma surgery. Studies to date, however, are limited to providing classification based on the entire image-and only produce heatmaps for approximate fracture localization instead of delineating exact fracture morphology. Therefore, we aimed to answer (1) what is the performance of a CNN that detects, classifies, localizes, and segments an ankle fracture, and (2) would this be externally valid?

The training set included 326 isolated fibula fractures and 423 non-fracture radiographs. The Detectron2 implementation of the Mask R-CNN was trained with labelled and annotated radiographs. The internal validation (or 'test set') and external validation sets consisted of 300 and 334 radiographs, respectively. Consensus agreement between three experienced fellowship-trained trauma surgeons was defined as the ground truth label. Diagnostic accuracy and area under the receiver operator characteristic n (segmentation) of fracture lines on (ankle) radiographs. The AUC values presented in this paper indicate good discriminatory capability of the CNN and substantiate further study of CNNs in detecting and classifying ankle fractures.

II, Diagnostic imaging study.

II, Diagnostic imaging study.

The aim of this systematic review and meta-analysis was to gather epidemiological information on selected musculoskeletal injuries and to provide pooled injury-specific incidence rates.

PubMed (National Library of Medicine) and Scopus (Elsevier) databases were searched. Articles were eligible for inclusion if they reported incidence rate (or count with population at risk), contained data on adult population, and were written in English language. The number of cases and population at risk were collected, and the pooled incidence rates (per 100,000 person-years) with 95% confidence intervals (CIs) were calculated by using either a fixed or random effects model.

The screening of titles yielded 206 articles eligible for inclusion in the study. Of these, 173 (84%) articles provided sufficient information to be included in the pooled incidence rates. Incidences of fractures were investigated in 154 studies, and the most common fractures in the whole adult population based on the pooled incidence rates were distal radius fractures (212.0, 95% CI 178.1 to 252.4 per 100,000 person-years), finger fractures (117.1, 95% CI 105.3 to 130.2 per 100,000 person-years), and hip fractures (112.9, 95% CI 82.2 to 154.9 per 100,000 person-years). The most common sprains and dislocations were ankle sprains (429.4, 95% CI 243.0 to 759.0 per 100,000 person-years) and first-time patellar dislocations (32.8, 95% CI 21.6 to 49.7 per 100,000 person-years). The most common injuries were anterior cruciate ligament (17.5, 95% CI 6.0 to 50.2 per 100,000 person-years) and Achilles (13.7, 95% CI 9.6 to 19.5 per 100,000 person-years) ruptures.

The presented pooled incidence estimates serve as important references in assessing the global economic and social burden of musculoskeletal injuries.Cite this article

2022;11(11)814-825.

The presented pooled incidence estimates serve as important references in assessing the global economic and social burden of musculoskeletal injuries.Cite this article Bone Joint Res 2022;11(11)814-825.Transverse colon interposition for oesophageal replacement following oesophagectomy is a rarely seen entity; interposition of the colon exterior to the thoracic cage is rarer still. Here, we report the case of a patient presenting with a large bowel obstruction in a transverse colon interposition located subcutaneously anterior to the sternum, with the diaphragm fully intact, following chest compressions for multiple cardiac arrests. The need for specialty input was highlighted early on, and the large bowel decompressed via nasogastric tube insertion into the interpositioned colon. The patient was then transferred to the acute coronary unit for further observation and management.

Workplace-based assessments (WBAs) are intended to maximise learning opportunities in surgical training. There is speculation as to whether mandatory assessments in this form contribute to a tick-box culture. The objective of this review was to investigate surgical trainees' attitudes towards WBAs.

This systematic review of qualitative studies was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement. The literature was searched on the Medline

, Embase™, PubMed and Web of Science™ databases on 22 March 2022.

Sixteen studies were included in the review, mostly carried out on users of the Intercollegiate Surgical Curriculum Programme portfolio in the UK. Trainees felt that WBAs were educationally useful, providing opportunity for feedback, but this was overshadowed by a pressure to reach a set annual quota for WBAs and achieve high scores. Other themes included inaccurate recording of WBAs, the role of WBAs as formative or summative assessments, engagement and accessibility of trainers, and lack of time to complete WBAs.

Negative perceptions about WBAs were widespread among surgical trainees despite a recognition of their capacity to facilitate learning. This review supports the recent removal of the annual quota for WBAs in UK surgical training programmes.

Negative perceptions about WBAs were widespread among surgical trainees despite a recognition of their capacity to facilitate learning. This review supports the recent removal of the annual quota for WBAs in UK surgical training programmes.Failure mode and effect analysis (FMEA) is a leading tool for risk management in health care. The term "blanket" approach FMEA describes a comprehensive simultaneous look at the variety of interrelated factors that may directly and indirectly affect patient safety. Applying FMEA with the "blanket" approach is not common, due to FMEA's limitations. Algorithmic prediction of failure modes in health care (APFMH) is leaner and enables the application of the "blanket" approach, but, like FMEA, it lacks formal validation. The authors set out to validate the APFMH method while applying a "blanket" approach. They analyzed the sterile supply handling at a 1900-bed academic medical center. The study's first step took place in the operating room (OR) aspect of the process. An APFMH analysis was performed using the "blanket" approach, to identify the hazards and define the common root causes for predicted hazards. The second step took place a year later at the sterile supply and equipment department (SSED) and aimed to validate these root causes, thus validating the reliability of APFMH. The "blanket" approach analysis with the APFMH method consisted of categorization into 3 risk-dimensions patient safety, equipment damage, and time management. Root causes were defined for 8 high-ranking hazards. All the root causes for failures, identified by APFMH at the OR department, were revealed as actual hazards in the processes of the SSED. The independent findings at the SSED level validated the list of identified hazards that was formed at the target department (ie, the OR). APFMH methodology is a lean in time and human resources process that ensures comprehensive hazard analysis, which can include the "blanket" approach, and which was validated in this study. The authors suggest using the APFMH methodology for any organizational analysis method that requires the inclusion of "blanket" approaches.

Numerous studies have deemed the virtual fracture clinic (VFC) model to be both cost and clinically effective. However, very few of these studies have analysed the type of injuries seen in the VFC. The objectives of this study were to assess the clinical effectiveness of the VFC and analyse the types of injuries that lead to patients re-presenting in the face-to-face fracture clinic after being discharged virtually.

This is a retrospective study analysing 17,269 patients referred to the VFC between September 2017 and February 2020. Data regarding the type of presenting injury were collected to understand which injuries required further management after being discharged virtually. Patient clinic letters provided data regarding the purpose and outcomes of VFC referrals as well as face-to-face appointments. Theatre lists were cross-referenced to extract data regarding surgical management.

In total, 57.37% (9,908) patients were discharged virtually. Of these patients, 92.52% were discharged successfully and 7.48% re-presented to the fracture clinic 98.11% were managed conservatively and 1.88% required surgery. The highest number of failed discharges were for distal radius fractures (109, 14.69%). Face-to-face follow-up in fracture clinic was requested for 37.06% (6,400) of patients; 4.98% of them required surgical intervention. Some 5.56% (961) of referrals were removed from our analysis 807 were inappropriate referrals and 154 were deemed suitable for multidisciplinary team discussion. The trust has saved an average of £702,205 annually since introduction of the VFC.

The VFC model delivers as promised in terms of clinical efficacy and cost management. Injury types showing higher numbers of unsuccessful discharges could benefit from having modified management pathways.

The VFC model delivers as promised in terms of clinical efficacy and cost management. Injury types showing higher numbers of unsuccessful discharges could benefit from having modified management pathways.The placenta plays an essential role at the beginning of life, nourishing and supporting the fetus, but its life span is limited. In late pregnancy, the placenta develops signs of aging, including inflammation and impaired function, which may complicate pregnancy. Placentas also show another sign of aging - cells with extra or missing chromosomes. Chromosomally abnormal cells could gather in the placenta if they get stranded there and/or if the cells do not separate normally. Chromosome separation goes wrong in aging cells when the DNA sequences, which protect the ends of the chromosomes, erode. When chromosomes lose their protective caps, they fuse which leads to abnormal numbers of chromosomes. In this pilot study, for the first time, we found fusions between the caps in a human placenta when it reaches full term. More studies are needed to decide whether this has an influence on how the placenta works and outcomes of pregnancy.This is the first study to empirically evaluate the mortality of Amblyomma mixtum larvae caused by native entomopathogenic fungi (EPF) from cattle farm soils and the impact of the physicochemical conditions of those soils on the ability of EPF to kill ticks. Sovilnesib in vitro The efficacy of 25 EPF strains isolated from cattle farms soils in Veracruz, Mexico, against A. mixtum ticks was evaluated using a larval immersion test. Physicochemical analyses of the soils where the EPF were isolated were carried out, and the results were correlated with the obtained mortality. The MaV25 strain showed a mortality of 36.55% (P less then 0.05), followed by MaV57 with 27.30%, MaV08 with 26.21%, and MaV31 with 24.32% (P less then 0.05). Nitrogen and potassium are nutritional components of soils that seem to be associated with mortality caused by the evaluated fungal strains. This is the first study in Mexico where the effect of EPF against A. mixtum is evaluated and also is the first study in the world that uses native strains from livestock soils against larvae of this tick.