Introduction. The recent introduction of Chatbots has provided an interactive medium to answer patient questions. The accuracy of responses with these programs in limb lengthening and reconstruction surgery has not previously been determined. Therefore, the purpose of this study was to assess the accuracy of answers from 3 free AI chatbot platforms to 23 common questions regarding treatment for limb lengthening and reconstruction. Method. We generated a list of 23 common questions asked by parents before their child's limb lengthening and reconstruction surgery. Each question was posed to three different AI chatbots (ChatGPT 3.5 [OpenAI], Google Bard, and Microsoft Copilot [Bing!]) by three different answer retrievers on separate computers between November 17 and November 18, 2023. Responses were only asked one time to each chatbot by each answer retriever. Nine answers (3 answer retrievers × 3 chatbots) were randomized and platform-blinded prior to rating by three orthopedic surgeons. The 4-point rating system reported by Mika et al. was used to grade all responses. Result. ChatGPT had the best response accuracy score (RAS) with a mean score of 1.73 ± 0.88 across all three raters (range of means for all three raters – 1.62 – 1.81) and a median score of 2. The mean response accuracy scores for Google Bard and Microsoft Copilot were 2.32 ± 0.97 and 3.14 ± 0.82, respectively. This ranged from 2.10 – 2.48 and 2.86 – 3.54 for Google Bard and Microsoft Copilot, respectively. The differences between the mean RAS scores were statistically significant (p < 0.0001). The median scores for Google Bard and Microsoft Copilot were 2 and 3, respectively. Conclusion. Using the Response Accuracy Score, the responses from ChatGPT were determined to be satisfactory, requiring minimal clarification, while the responses from Microsoft Copilot were either satisfactory, requiring moderate clarification, or unsatisfactory, requiring substantial clarification

Introduction. Previous studies have shown the potential for virtual reality (VR) immersion as a promising technique for pain and anxiety management. The aim of our study was to evaluate the feasibility of VR in the management of pain and anxiety during post-op external fixator care procedures. Method. This study involved patients aged 5-21 years following limb lengthening/reconstruction surgery with an external fixator. Aqua VR application from the KindVR® was utilized for this study. Subjects were seen during the first four postoperative visits and assigned to a ‘VR-first’ or ‘no-VR-first’ group. Visits alternated between VR immersion and no VR immersion during care procedures. The study endpoints (pain and anxiety levels) were assessed before, during, and after procedures using the Wong-Baker Faces (FACES) and Children's Fear Scale, respectively. Proxy scores for pain and anxiety were also obtained from parents or legal guardians and providers. Result. A total of 29 patients (16 male and 13 female) were evaluated. The mean age at enrollment was 14.4 ± 2.2 years for group 1 and 14.7 ± 4.0 years for group 2. The median number of pin sites was 7. Anxiety scores were consistently higher during the non-VR immersion experience compared to the VR immersion visits. The pain and anxiety scores were significantly lower in the ‘VR-first’ group during the non-VR immersion study visits compared to patients in the ‘no-VR-first’ group. This observation was also consistent with survey findings among the parent proxies and providers. Conclusion. VR immersion is associated with lower anxiety scores for pin-site care procedures. VR immersion at the first post-operative visit following limb reconstruction surgery was also associated with lower pain and anxiety scores during subsequent non-VR immersion visits

Insufficiency of the lateral collateral ligamentous complex causes posterolateral rotatory instability (PLRI). During reconstruction surgery the joint capsule is repaired, but its biomechanical influence on elbow stability has not been described. We hypothesized that capsular repair reduces ROM and varus angle after reconstruction of the lateral collateral complex. Six fresh frozen cadaveric elbow specimens were used. Varus laxity in supination, pronation and neutral forearm rotation with 1 Nm load and forearm rotaitonal range of motion (ROM) with 0.3 Nm torque were measured using a Microscribe 3DLX digitizing system (Revware Inc, Raleigh, NC). Each specimen was tested under four different conditions: Intact, Complete Tear with LUCL, RCL and capsule tear, LUCL/RCL reconstruction + capsule repair and LUCL/RCL reconstruction only. Reconstruction was performed according to the docking technique (Jones, JSES, 2013) and the capsule was repaired with mattress sutures. Each condition was tested in 30°, 60° and 90° elbow flexion. A two-way ANOVA with Tukey's post-hoc test was used to detect statistical differences between the conditions. Total ROM of the forearm significantly increased in all flexion angles from intact to Complete tear (p<0.001). ROM was restored to normal in 30° and 60° elbow flexion in both reconstruction conditions (p>0.05). LUCL/RCL Reconstruction + capsule repair in 90° elbow flexion was associated with a significantly lower ROM compared to intact (p=0.0003) and reconstruction without capsule repair (p=0.015). Varus angle increased significantly from intact to complete tear (p<0.0001) and restored to normal in both reconstruction conditions (p>0.05) in 30° and 60° elbow flexion. In contrast varus angle was significantly lower in 90° elbow flexion in both reconstruction conditions compared to intact (both p<0.0001). Reconstruction of the lateral collateral complex restores elbow stability, ROM and varus laxity independent of capsular repair. Over tightening of the elbow joint occurred in 90° elbow flexion, which was aggravated by capsular repair. Over all capsular repair can be performed without negatively affecting elbow joint mobility

Objectives. Fracture non-union poses a significant challenge to treating orthopaedic surgeons. These patients often require multiple surgical procedures. The incidence of complications after Autologous Bone Graft (ABG) harvesting has been reported up to 44%. These complications include persistent severe donor site pain, infection, heterotopic ossification and antalgic gait. We retrospectively compared the use of BMP-7 alone in long bone fracture Non-union, with patients in whom BMP-7 was used in combination with the Autologous Bone Graft (ABG). Material and Methods. The databases of our dedicated Limb Reconstruction Unit were searched for patient with three common long bone fractures Non-unions (Tibia, Femur and Humerus). The patients who had intra-operative use of Bone Morphogenetic Protein (BMP-7) alone and in combination with ABG were evaluated. 53 Patients had combined use of ABG and BMP-7, and 65 patients had BMP-7 alone. Results. In the ABG and BMP-7 group, the union rate for femoral (n=18) Non-unions was 83%, for humeral (n=16) Non-unions 81%, and for tibia (n=19) Non-unions it was 47%. In the BMP-7 alone group, 83% of the femoral (n=12) Non-unions, 87% of the humeral (n=16) and 56% of the tibial (n=37) Non-unions healed. The common risk factors for Non-union were comparable in both the groups and included location and nature (open vs closed) of fracture, infection, smoking and NSAIDs use. The average time to union in ABG+BMP-7 group was 8.1 months (range 3-30 months) and in BMP-7 alone group it was 7.2 months (range 3-24 months). Conclusion. Autologous Bone Grafting has a pivotal role in limb reconstruction surgery but its indication should be carefully evaluated in view of considerable morbidity associated with graft donor site. Our study did not show any significant difference in the union rates of common long bone fracture Non-unions treated with BMP-7 alone or with a combination of Autologous Bone Graft and BMP-7