» Wearable technologies (wearables), including smartphones, smartwatches, and sensors, such as accelerometers and inertial measurement units, enable continuous, real-time, and objective data collection on physical function, health behaviors, and patient perceptions. » Wearables can track mobility metrics such as step count, activity duration, and joint range of motion, providing valuable longitudinal insights into recovery trajectories. » In orthopaedic surgery, wearables support timely, personalized patient education and improve communication between patients and surgical teams, contributing to better functional outcomes and patient satisfaction. » Smart implants and virtual/augmented reality systems are emerging as innovative approaches to enhancing engagement and adherence during postoperative rehabilitation. » Key challenges to implementation include concerns about data privacy, accessibility, and integration into clinical workflows.

The anterior cruciate ligament (ACL) is the most commonly injured ligament of the knee, with most patients undergoing surgical reconstruction. Of these patients, 6.5-27.6% require a second operation to treat loss of motion, which can cause substantial delays in patient recovery and return to sport. Currently, there is a paucity of comprehensive data regarding loss of motion following anterior cruciate ligament reconstruction (ACLR) surgery, resulting in variable measures of incidence and uncertainty about risk factors. The primary objective of this study is to identify the incidence and risk factors for repeat surgical intervention for loss of motion following primary ACLR. Two independent reviewers conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The EMBASE, MEDLINE, and PubMed databases were searched, along with the reference lists of included articles and related systematic reviews. Studies were included if they met the following criteria: (1) included adult patients with primary ACL ruptures treated surgically, (2) had a follow-up period of at least 3 months postoperative, (3) provided an objective definition of stiffness, arthrofibrosis, or cyclops lesions, and (4) reported the incidence and/or risk factors for loss of motion. A random-effects meta-analysis was conducted to estimate the pooled incidence of loss of motion across studies. A total of 48 studies were included in the final analysis. Of these studies, 46 reported the incidence of loss of motion requiring surgery, with a mean pooled incidence of 4% (95% CI: 3-5 ​%). The incidence decreased over time from 10% (95% CI: 7-13%) in 1991-1999 to 4% (95% CI: 3-5%) in 2000-2023. There were 29 studies that reported statistically significant risk factors for loss of motion requiring surgery. The most common risk factors were female sex, acute repair, concomitant meniscus repair, delayed postoperative range of motion, and preoperative range of motion deficit. The incidence of loss of motion requiring surgery after ACLR is 4%, with a variety of risk factors related to the patient, injury, surgery, and recovery. The incidence has decreased over time, but arthrofibrosis remains a devastating surgical complication that is important to discuss with patients. III.

Objective: Prediction models are increasingly being sought in epilepsy surgery to predict postoperative outcomes and support clinical decision‐making. Studies summarizing the evidence in this area can provide insight into the type of surgical prediction models, their methodology, and their performance and inform areas for future research. Our aim was to address these knowledge gaps through a comprehensive systematic review of prediction models in epilepsy surgery. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines using four databases. Papers were included if they were primary research studies, human‐based, studied adult or pediatric populations, studied people with epilepsy undergoing surgical management, and developed or validated a multivariable tool to predict epilepsy surgery outcomes. Data extraction was reviewed in triplicate, and the quality of evidence in each paper was assessed using the Prediction Model Risk of Bias Assessment Tool. Results: The literature search yielded a total of 11 614 papers, with 42 papers and 113 prediction models included in the final analysis. The median area under the curve and accuracy for all models were .75 (interquartile range = .68–.83) and .76 (interquartile range = .69–.83), respectively. Overall, 54.0% of models underwent internal validation, and 20.4% underwent external validation. Models of cognitive–language outcomes seemed to perform better than those for other outcomes. Overall risk of bias was high in 81% of models, with weakest performance in outcomes and analyses, but trended toward improvement over time. Concerns for applicability were low in 89% of the models. Significance: Prediction models in epilepsy surgery are rapidly proliferating, but most lack external validation, and many still exhibit a high risk of bias. Therefore, caution is needed when interpreting and applying these predictive tools. Evidence of improvement in methodological quality holds promise for enhancing patient care, if coupled with improved model performance.

Introduction: Diagnosis and treatment of acute stroke depends upon imaging, namely non-contrast CT (NCCT), CT angiography (CTA), CT perfusion (CTP), and MRI. We sought to i) examine available data from around the world on six categories related to acute stroke imaging: utilization, time to imaging, radiation exposure, contrast dose, availability, and cost, and ii) compare that information with similar data from our province (Alberta). Methods: Using a scoping review methodology, six categories related to acute stroke diagnostic imaging were examined: utilization, time to imaging, radiation exposure, contrast dose, availability, and cost. Metadata for these categories in Alberta were collected from Alberta Health Services administrative records for comparison. Results: A total of 6693 articles/documents were initially identified through database searches, of which 83 were included for analysis. CT (range = 55-100%) was used more frequently than MRI (range = 23.6-94.0%) in acute stroke, with high CTA use in Alberta (55.7%) compared to other centres (range = 8.6-36.0%; Table 1). CT time to imaging was < 25 min (target time) in most centres, but not in Alberta (mean = 3.2 hr, median = 2.0 hr). MRI was not used urgently in most centres (mean = 0.4-21.0 hr), including Alberta (mean = 15.4 hr, median = 13.0 hr). CTA radiation exposure was greater in Alberta compared to other centres (5.7 mSv vs 2.8-5.4 mSv) whereas it was similar for NCCT and CTP. Contrast doses for CTA and CTP were similar between Alberta (CTA = 50-70 mL, CTP = 45 mL) and other centres (CTA = 40-150 mL, CTP = 30-60 mL). Lastly, the number of CT and MRI scanners per million population and cost of operating them was similar worldwide. Conclusions: In conclusion, no studies were identified that provide a comprehensive overview of all six factors relevant to diagnostic imaging in acute stroke. The Alberta metadata fills in this literature gap, specifically in the context of Canadian stroke care. Download figure

Distal humerus fractures can be difficult to manage in older patients with poor bone quality and those with risk factors for failure of open reduction internal fixation. When nonunion occurs, there are limited repeat fixation options and conversion to total elbow arthroplasty (TEA) can be considered. The objective of this descriptive, retrospective case series is to compare the outcomes of TEA for aseptic vs. septic nonunion of distal humerus fractures. Seven cases were identified by 2 orthopedic surgeons that specialize in TEA. The inclusion criteria were as follows: (a) adult patients (≥18 years of age), (b) underwent TEA after distal humerus open reduction internal fixation complicated by aseptic or septic nonunion, (c) had clinical follow-up data ≥1 year after TEA, and (d) completed patient-reported outcome surveys ≥1 year after TEA. Charts were reviewed to extract the relevant data, and outcomes between aseptic and septic nonunion groups compared using range of motion, grip strength, x-rays, and patient-reported outcome measures. After TEA, all average patient-reported outcome scores were better in the aseptic nonunion group compared to the septic nonunion group, indicating a more favorable recovery trajectory (Disabilities of the Arm, Shoulder and Hand score: 39.5 ± 9.3 vs. 58.4 ± 21.9; visual analog pain scale: 3.1 ± 2.1 vs. 4.4 ± 2.4). In addition, range of motion was better in the aseptic nonunion group compared to the septic nonunion group for most parameters (flexion: 127.3 ± 17.3 vs. 106.7 ± 18.8; supination: 73.3 ± 20.5 vs. 58.3 ± 28.4; pronation: 80.5 ± 9.9 vs. 69.0 ± 21.5), except elbow extension (27.5 ± 43.7 vs. −2.3 ± 8.7). Two patients in the aseptic nonunion group developed post-operative complications (ulnar neuropathy and periprosthetic fracture with osteolysis) compared to one patient in the septic nonunion group (periprosthetic infection). TEA is a viable treatment option for patients with aseptic and septic nonunion of distal humerus fractures, although patient outcomes in septic nonunion tend to be worse. Conversion to TEA is best done in 2 stages to ensure infection is identified and treated appropriately.