The rapid development of AI technology in recent years has led to its widespread use in daily life, where it plays an increasingly important role. In healthcare, AI has been integrated into the field to develop the new domain of smart healthcare. In smart healthcare, opportunities and challenges coexist. This article provides a comprehensive overview of past developments and recent progress in this area. First, we summarize the definition and characteristics of smart healthcare. Second, we explore the opportunities that AI technology brings to the smart healthcare field from a macro perspective. Third, we categorize specific AI applications in smart healthcare into ten domains and discuss their technological foundations individually. Finally, we identify ten key challenges these applications face and discuss the existing solutions for each. 

Artificial Intelligence Applications in Smart Healthcare: A Survey

Long-term follow-up after surgical correction of patients with radial polydactyly might reveal unexpected or undesired outcomes that are accentuated by growth. It should be stressed that assessment of outcomes differs considerably by the system used. Preoperative examination can elucidate the underlying pathological anatomy of these anomalies and consequently, these anatomical differences should be corrected as much as possible during the first operation to prevent worse outcomes at long-term follow-up. In various long-term studies, the reoperation rate was in the range of 7%–28%, with the most common reasons being deviation, instability, nail deformity and suboptimal appearance. Most unfavourable results occur during growth and are frequently revealed only at longer-term follow-up. Concentration of care to a few centres is advised since these malformations occur in small numbers and experienced surgeons tend to have better results. Consensus on the used assessment system and multicentred studies are essential in future to better understand how we can prevent reoperations.

Complications after radial polydactyly surgery: analysis, prevention and management.

Background: Fatty infiltration of the rotator cuff muscle is a critical prognostic factor associated with poor tendon healing and high retear rates after rotator cuff tear (RCT). Recent studies have identified fatty acid binding protein 4 (FABP4) as a hypoxia- and inflammation-responsive lipid chaperone that may drive adipogenic degeneration in injured muscle tissue. Purpose: To evaluate whether fenofibrate—a peroxisome proliferator-activated receptor alpha (PPARα) agonist approved for the treatment of hyperlipidemia—could prevent fatty infiltration by modulating FABP4 expression in vitro and in a RCT repair rat model. Study Design: Controlled laboratory study. Methods: The expression of FABP4 under hypoxic conditions was evaluated in C2C12 myoblasts treated with fenofibrate (10 and 100 μm) using quantitative real-time polymerase chain reaction (qRT-PCR). To investigate molecular mechanisms, the expression levels of upstream regulators and adipocyte differentiation–related genes were also measured by qRT-PCR after fenofibrate treatment in the same cell line. For the in vivo study, an RCT model was established by transection of the right supraspinatus tendon. Fenofibrate (20 mg/kg) was locally administered 3 times over 2 days after surgery. At 6 weeks, the supraspinatus muscle was harvested. Fatty infiltration was qualitatively and quantitatively assessed using histological analysis, and the expression of relevant metabolic and adipogenic genes was analyzed by qRT-PCR. Results: In vitro, fenofibrate significantly downregulated FABP4 expression in a dose-dependent manner under hypoxic conditions (fenofibrate, 10 µm: 0.86 ± 0.12 [ P &lt; .01]; 100 µm: 0.32 ± 0.06 [ P &lt; .01]; control: 1.12 ± 0.17). Expression of PPARα (fenofibrate, 10 µm: 2.46 ± 0.10 [ P &lt; .01]; 100 µm: 2.75 ± 0.13 [ P &lt; .01]; control: 1 ± 0.10), an upstream regulator of FABP4, was significantly upregulated after treatment in a similarly dose-dependent fashion. In vivo, fenofibrate-treated shoulders demonstrated marked suppression of fatty infiltration, as confirmed by both qualitative histological evaluation and quantitative fat area analysis (fenofibrate: 6.66% ± 10.38%; control: 46.38% ± 21.79% [ P &lt; .01]). Gene expression profiling revealed that PPARα was significantly upregulated (fenofibrate: 10.65 ± 7.02; control: 1 ± 0.62 [ P &lt; 005]), while FABP4 expression was significantly reduced (fenofibrate: 2.64 ± 0.91; control: 5.44 ± 2 [ P &lt; .05]) in the fenofibrate group compared with controls. Conclusion: Fenofibrate reduces muscle fatty infiltration by modulating the PPARα-FABP4 metabolic pathway in the setting of RCT. These findings support the potential of fenofibrate as a drug repositioning candidate to prevent muscle degeneration and enhance tissue quality in rotator cuff (RC) injuries. Clinical Relevance: Fenofibrate, with its established clinical safety profile, may represent a novel pharmacologic strategy to improve outcomes after RC repair by targeting fatty infiltration. 

Fenofibrate Attenuates Rotator Cuff Muscle Fatty Infiltration via Modulation of the PPARα-FABP4 Pathway

Purpose Older patient population with acetabular fractures is increasing rapidly, requiring enhanced recovery. Acute total hip arthroplasty (THA) is a good option for these patients, and it is becoming increasing popular. However, acute THA has different indications in different studies. Therefore, a systematic review is needed to assess and comprehend the indications for acute THA in older patients. Methods A systematic literature review was conducted to identify a retrospective series or prospective studies in older patients (>60 years) with acetabular fractures. The search timeline was from database construction till December 2021; PubMed, Embase, and Cochrane Library databases were searched. Two trained professional reviewers independently read the full text of documents that met the inclusion criteria and extracted information on the specific methods used and indication information based on the research design. Results In total, there were 601 patients with acetabular fractures aged >60 years from 33 studies were obtained. Twenty-eight studies reported that THA was a feasible treatment option for acetabular fractures in geriatric patients with good outcome. The primary indications were dome impaction, irreducible articular comminution, femoral head injury, and pre-existing osteoarthritis or avascular necrosis. The most common patterns were anterior column and posterior hemitransverse, posterior wall, both columns, and T-type. Conclusion Acute THA is an effective treatment strategy for older patients with acetabular fractures and should be considered when the abovementioned indications are observed on preoperative images. (PROSPERO: CRD42022329555).

/pdf/current-indications-for-acute-total-hip-arthroplasty-in-1ef5egs5.pdf

Current indications for acute total hip arthroplasty in older patients with acetabular fracture: Evidence in 601 patients from 2002 to 2021

Case: Nontraumatic dorsal thumb snapping involving the extensor pollicis longus (EPL) is rare. We report 2 cases: a 44-year-old man with EPL snapping and metacarpophalangeal instability associated with chronic radial artery thrombosis and a 26-year-old woman with EPL snapping from extensor hood laxity. Both underwent surgery tailored to the pathology, achieving resolution of snapping and restored joint stability at 1 year. Conclusion: These cases emphasize the importance of individualized surgical management. Ultrasound, as an accessible and reproducible tool, supports diagnosis. Such strategies are especially relevant in young, active patients, ensuring functional recovery and long-term joint preservation. Level of Evidence: Level IV. 

Nontraumatic Extensor Pollicis Longus Snapping

Background: Over the last few decades, shoulder surgery has undergone rapid advancements, with ongoing exploration and the development of innovative technological approaches. In the coming years, technologies such as robot-assisted surgeries, virtual reality, artificial intelligence, patient-specific instrumentation, and different innovative perioperative and preoperative planning tools will continue to fuel a revolution in the medical field, thereby pushing it toward new frontiers and unprecedented advancements. In relation to this, shoulder surgery will experience significant breakthroughs. Main body: Recent advancements and technological innovations in the field were comprehensively analyzed. We aimed to provide a detailed overview of the current landscape, emphasizing the roles of technologies. Computer-assisted surgery utilizing robotic- or image-guided technologies is widely adopted in various orthopedic specialties. The most advanced components of computer-assisted surgery are navigation and robotic systems, with functions and applications that are continuously expanding. Surgical navigation requires a visual system that presents real-time positional data on surgical instruments or implants in relation to the target bone, displayed on a computer monitor. There are three primary categories of surgical planning that utilize navigation systems. The initial category involves volumetric images, such as ultrasound echogram, computed tomography, and magnetic resonance images. The second type is based on intraoperative fluoroscopic images, and the third type incorporates kinetic information about joints or morphometric data about the target bones acquired intraoperatively. Conclusion: The rapid integration of artificial intelligence and deep learning into the medical domain has a significant and transformative influence. Numerous studies utilizing deep learning-based diagnostics in orthopedics have remarkable achievements and performance.

Artificial intelligence- and computer-assisted navigation for shoulder surgery.

Current concepts in arthroscopic rotator cuff repair

Surgical outcome of locked facet in distractive flexion injury of the subaxial cervical spine: Single institution retrospective study

Purpose: Although closed reduction and extension block pinning have been widely used for acute mallet finger fracture, the problem of reduction remains a concern. We describe a tip for the reduction technique using a towel clamp, which provides a longitudinal traction force to the distal phalanx, and report the results of the technique.Methods: The medical records of 14 consecutive cases from 12 patients with acute mallet fractures were retrospectively reviewed. Reduction was achieved using the towel clamp reduction technique. The radiologic results were evaluated by simple radiographs, the functional results were analyzed in terms of range of motion, and remaining pain was assessed using Crawford criteria.Results: The mean follow-up period was 8.4 months. The mean union duration was 6 weeks. The mean range of motion was 73°. Eight cases had excellent outcomes, one had good outcomes, four had fair outcomes, and one had poor outcomes. One case of superficial infection and one case of skin necrosis developed, and three cases showed arthritic changes in the distal interphalangeal joint. Conclusion: The towel clamp technique can provide good reduction during surgery, with favorable radiologic and clinical results.

/pdf/extension-block-pinning-combined-with-traction-using-towel-29yo1a3h.pdf

Extension block pinning combined with traction using towel clamps for effective reduction of mallet fracture: a technical tip

Hyperlipidemia and Rotator Cuff Tears: Exploring Mechanisms and Effective Treatment

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