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\"TRAUMA is Dr. Cole's harrowing account of his life spent in the ER and on the battlegrounds, fighting to save lives. In addition to his gripping stories of treating victims of gunshot wounds, stabbings, attempted suicides, flesh-eating bacteria, car crashes, industrial accidents, murder, and war, the book also covers the years during Cole's residency training when he was faced with 120-hour work weeks, excessive sleep deprivation, and the pressures of having to manage people dying of traumatic injury, often with little support. Unlike the authors of other medical memoirs, Cole trained to be a surgeon in the military and served as a physician member of a Marine Corps reconnaissance unit, United States Special Operations Command (USSOCOM), and on a Navy Reserve SEAL team. From treating war casualties in Afghanistan and Iraq to his experiences as a civilian trauma surgeon treating alcoholics, drug addicts, criminals, and the mentally deranged, TRAUMA is an intense look at one man's commitment to his country and to those most desperately in need of aid\"-- Provided by publisher.

Exercise is described as a preventive and therapeutic strategy against various diseases. However, competitive sports practice is associated with an increased risk of injuries, particularly with specialization and more intense training at younger ages. Given the importance of surveillance and epidemiological studies to protect athletes’ health, our study aimed to describe the prevalence of injuries among athletes at the 2022 Aerobic Gymnastics World Championship (WCH) and to understand the intrinsic and extrinsic risk factors that may contribute to these injuries. Athletes participating in WCH 2022 were invited to complete a retrospective injury questionnaire covering the past 12 months of their training schedule. Descriptive statistic data were used to analyze all variables in the study. Seventy-three percent of athletes reported sustaining injuries, with an average of 1.6 ± 1.5 injuries occurring one to three times in the past year. The most common injuries were muscle injuries, joint sprains, stress fractures, and contusions, with the lower limbs being the most affected, followed by the upper body and trunk. Regarding injury risk factors, a significant number of athletes reported experiencing psychological stress (p=0.043) and concerns about individual protection equipment (p=0.042). Given that the type of injury and affected body region seem to be related to sports-specific movements, the impact absorption of the floor and footwear should be studied further. Additionally, injury prevention measures should include coping strategies to manage stress effectively. Vadba je opisana kot preprečevalno in zdravilno sredstvo proti različnim boleznim. Vendar pa je tekmovalna športna vadba povezana s povečanim tveganjem za poškodbe, zlasti pri usmerjeni in zahtevnejših vadbah v mlajših letih. Glede na pomen nadzora in dosedanje raziskave za zaščito zdravja športnikov je bila naša raziskava namenjena opisovanju razširjenosti poškodb med telovadci na svetovnem prvenstvu (SP) v telovadnih plesih (»športni aerobiki«) leta 2022 in razumevanju notranjih in zunanjih dejavnikov tveganja, ki lahko prispevajo k tem poškodbam. Športniki, ki sodelujejo na SP 2022, so bili povabljeni, da izpolnijo vprašalnik o poškodbah, ki zajema zadnjih 12 mesecev njihove vadbe. Za razčlenitev vseh spremenljivk v raziskavi so bili uporabljeni opisni statistični podatki. Triinsedemdeset odstotkov športnikov je poročalo o poškodbah, s povprečno 1,6 ± 1,5 poškodbami, ki so se zgodile enkrat do trikrat v zadnjem letu. Najpogostejše poškodbe so bile poškodbe mišic, zvini sklepov, stresni zlomi in zmečkanine, pri čemer so bili najbolj prizadeti spodnji udi, sledita zgornji del telesa in trup. Kar zadeva dejavnike tveganja za poškodbe, je veliko število športnikov poročalo o duševnem stresu (p=0,043) in zaskrbljenosti glede osebne zaščitne opreme (p=0,042). Glede na to, da se zdi, da sta vrsta poškodbe in prizadeti del telesa povezana z gibi, značilnimi za dejavnost, je treba prenos udarca tal in obutve dodatno preučiti. Poleg tega morajo ukrepi za preprečevanje poškodb vključevati načrte za učinkovito obvladovanje stresa.

Purpose With the COVID-19 crisis, recommendations for personal protective equipment (PPE) are necessary for protection in orthopaedics and traumatology. The primary purpose of this study is to review and present current evidence and recommendations for personal protective equipment and safety recommendations for orthopaedic surgeons and trauma surgeons. Methods A systematic review of the available literature was performed using the keyword terms “COVID-19”, “Coronavirus”, “surgeon”, “health-care workers”, “protection”, “masks”, “gloves”, “gowns”, “helmets”, and “aerosol” in several combinations. The following databases were assessed: Pubmed, Cochrane Reviews, Google Scholar. Due to the paucity of available data, it was decided to present it in a narrative manner. In addition, participating doctors were asked to provide their guidelines for PPE in their countries (Austria, Luxembourg, Switzerland, Germany, UK) for consideration in the presented practice recommendations. Results World Health Organization guidance for respiratory aerosol-generating procedures (AGPs) such as intubation in a COVID19 environment was clear and included the use of an FFP3 (filtering face piece level 3) mask and face protection. However, the recommendation for surgical AGPs, such as the use of high-speed power tools in the operating theatre, was not clear until the UK Public Health England (PHE) guidance of 27 March 2020. This guidance included FFP3 masks and face protection, which UK surgeons quickly adopted. The recommended PPE for orthopaedic surgeons, working in a COVID19 environment, should consist of level 4 surgical gowns, face shields or goggles, double gloves, FFP2-3 or N95-99 respirator masks. An alternative to the mask, face shield and goggles is a powered air-purifying respirator, particularly if the surgeons fail the mask fit test or are required to undertake a long procedure. However, there is a high cost and limited availabilty of these devices at present. Currently available surgical helmets and toga systems may not be the solution due to a permeable top for air intake. During the current COVID-19 crisis, it appeared that telemedicine can be considered as an electronic personal protective equipment by reducing the number of physical contacts and risk contamination. Conclusion Orthopaedic and trauma surgery using power tools, pulsatile lavage and electrocautery are surgical aerosol-generating procedures and all body fluids contain virus particles. Raising awareness of these issues will help avoid occupational transmission of COVID-19 to the surgical team by aerosolization of blood or other body fluids and hence adequate PPE should be available and used during orthopaedic surgery. In addition, efforts have to be made to improve the current evidence in this regard. Level of evidence IV.

Purpose To assess research directions of the Mesenchymal stem cells (MSCs) injections in traumatology and orthopaedics. Methods The study monitored the protocols of randomised controlled trials (RCTs) and systematic reviews (SRs) investigating mesenchymal stem cell (MSC) injections for various traumatological and orthopaedic conditions. Relevant RCT protocols were identified through searches of ClinicalTrials.gov, International Clinical Trials Registry Platform, EU Clinical Trials Register databases for RCTs and SRs were obtained from PROSPERO. The databases were searched from their inception to December 2023. Results A total of 449 clinical trials were identified. At the time of the study, 159 (35.4%) trials had been completed, and only 56 (12.5%) had published results in peer-reviewed journals. Data on clinical trial completion were normally distributed ( p  = 0.145). The duration for trial completion was 40.6 ± 26.5 months (range: 1 to 153 months). The most commonly investigated indications for MSCs injections were osteoarthritis of the hip and knee (37.6%) and spinal cord injuries (10.5%). The most frequent sources of MSCs were bone marrow (26.5%), adipose-derived (20.5%) and umbilical cord (15.4%). Reported MSCs concentrations varied widely, ranging from 0.5 × 10⁶ to 9.7 × 10⁸ cells. The most frequently used concentrations were 1 × 10⁷ (8.2%), 2 × 10⁷ (8.0%), 5 × 10⁷ (5.8%), and 10 × 10⁷ (5.8%) cells, while 59 other dosing schemes were each used in fewer than 1% of trials. Furthermore, 55.5% of protocols did not specify the cell concentration. A search in PROSPERO identified 114 systematic review protocols. By the time of the study, 32 studies (28.10%) had been completed, with the results of 30 (26.32%) published in peer-reviewed journals. Conclusion MSC injections represent a growing area of research in traumatology and orthopaedics. However, the results of only a small proportion of clinical trials and systematic reviews are published in peer-reviewed journals, which most likely does not allow practitioners to form a full judgement on the efficacy and safety of this treatment.

Trauma care has improved owing to interventions first used on the battlefield. Recent advances include the use of tourniquets, permissive hypotension, tranexamic acid, high-ratio massive transfusion, FAST examination, and resuscitative endovascular balloon occlusion of the aorta.

Gender and sex disparities persist in orthopaedic and traumatology surgery, making it one of the least diverse medical specialties worldwide. Despite growing women representation in medical education, women continue to be significantly underrepresented in orthopaedics, occupying only 6–8% of surgical roles. This underrepresentation extends to academic leadership, research, and public speaking opportunities, ultimately limiting innovation and the quality of patient care. Systemic barriers—such as gender bias, lack of mentorship, and misperceptions about physical demands—discourage women from entering and advancing in the field. This manuscript explores the current landscape of gender inequality in orthopaedics and identifies strategic interventions to promote equity. Solutions include enhancing recruitment through early exposure, fostering inclusive institutional cultures, expanding mentorship and sponsorship opportunities, and implementing supportive policies for work-life integration. In patient care, disparities in diagnosis, pain management, surgical decision-making, and rehabilitation access disproportionately impact women. We advocate for the development of gender-inclusive clinical guidelines, equitable research funding, and standardized assessment tools. Additionally, the role of public awareness is examined, emphasizing the need to highlight success stories, engage male allies, and conduct outreach through educational and community initiatives. Programs such as the Perry Initiative, Nth Dimensions, and campaigns like HeForShe are shown to play pivotal roles in shifting perceptions and increasing diversity. Addressing these disparities is not only a matter of justice but also essential to achieving excellence in clinical outcomes. This article offers a comprehensive framework for fostering gender and sex equality in orthopaedic and traumatology surgery through systemic, cultural, and policy-level change.

Higher workload is associated with burnout and lower performance. Therefore, we aim to assess shift-related factors associated with higher workload on EGS, ICU, and trauma surgery services. In this prospective cohort study, faculty surgeons and surgery residents completed a survey after each EGS, ICU, or trauma shift, including shift details and a modified NASA-TLX. Seventeen faculty and 12 residents completed 174 and 48 surveys after working scheduled 12-h and 24-h shifts, respectively (response rates: faculty – 62%, residents – 42%). NASA-TLX was significantly increased with a higher physician subjective fatigue level. Further, seeing more consults or performing more operations than average significantly increased workload. Finally, NASA-TLX was significantly higher for faculty when they felt their shift was more difficult than expected. Higher volume clinical responsibilities and higher subjective fatigue levels are independently associated with higher workload. Designing shift coverage to expand on busier days may decrease workload, impacting burnout and shift performance. •Faculty physician workload was increased when shifts were more difficult than expected.•Physician workload was increased after shifts with a higher patient care volume.•Subjective fatigue level was associated with increased physician workload.

Background Standardized training for orthopedic and traumatology residents is a crucial component of postgraduate medical education. Traditional teaching methods, such as Lecture-Based Learning (LBL), often fail to stimulate student initiative and clinical thinking. To address this, our study aimed to explore the effectiveness of a combined Problem-Based Learning (PBL) and Standardized Patients (SP) teaching method in enhancing the clinical skills and self-learning abilities of orthopedic residents. Methods A randomized controlled trial was conducted with 59 orthopedic residents from three medical institutions in China. The participants were randomly divided into a control group ( n  = 29) receiving traditional LBL combined with SP and a study group ( n  = 30) receiving PBL combined with SP. Both groups were instructed on common orthopedic diseases for 21 h. Teaching effectiveness was assessed through self-designed electronic questionnaires, classroom performance metrics, and final exams. Results Compared with the control group, the study group demonstrated significantly greater levels of self-study initiative, teamwork ability, classroom learning efficiency, learning interest, and clinical processing ability ( P  < 0.05). The study group also showed greater improvement in their ability to handle clinical problems and had higher postclass knowledge retention and learning interest scores ( P  < 0.05). Practical exam scores and overall scores were significantly higher in the study group ( P  < 0.05), although written exam scores did not differ significantly. Conclusions The combined PBL and SP teaching method was found to be superior to traditional LBL in improving the clinical skills and self-learning abilities of orthopedic residents. This approach enhances student engagement, clinical thinking, and overall educational outcomes, suggesting that it is a valuable addition to orthopedic resident training programs.

Purpose This article aims to share northern Italy’s experience in hospital re-organization and management of clinical pathways for traumatic and orthopaedic patients in the early stages of the COVID-19 pandemic. Methods Authors collected regional recommendations to re-organize the healthcare system during the initial weeks of the COVID-19 pandemic in March, 2020. The specific protocols implemented in an orthopaedic hospital, selected as a regional hub for minor trauma, are analyzed and described in this article. Results Two referral centres were identified as the hubs for minor trauma to reduce the risk of overload in general hospitals. These two centres have specific features: an emergency room, specialized orthopaedic surgeons for joint diseases and trauma surgeons on-call 24/7. Patients with trauma without the need for a multi-disciplinary approach or needing non-deferrable elective orthopaedic surgery were moved to these hospitals. Authors report the internal protocols of one of these centres. All elective surgery was stopped, outpatient clinics limited to emergencies and specific pathways, ward and operating theatre dedicated to COVID-19-positive patients were implemented. An oropharyngeal swab was performed in the emergency room for all patients needing to be admitted, and patients were moved to a specific ward with single rooms to wait for the results. Specific courses were organized to demonstrate the correct use of personal protection equipment (PPE). Conclusion The structure of the orthopaedic hubs, and the internal protocols proposed, could help to improve the quality of assistance for patients with musculoskeletal disorders and reduce the risk of overload in general hospitals during the COVID-19 pandemic.