Orthopedics最新文献

{"title":"Bridging the Gender Pay Gap: Medicare Procedure Volume and Reimbursement Among Spine Surgeons.","authors":"Marine Coste, George A Beyer, Rehan R Khan, Rohith Ryali, Olivia T Zhou, Shahyan R Khan, Sarah G Stroud, Nader El-Hajj, Harleen Kaur, Qurratul-Ain Dar, Nicole R Vingan, Lara Passfall, Lana Kass-Gergi, Chadi Tannoury, Tony Tannoury, Carl B Paulino, Neil V Shah, Bassel G Diebo, Virginie Lafage","doi":"10.3928/01477447-20260819-01","DOIUrl":"10.3928/01477447-20260819-01","url":null,"abstract":"<p><strong>Background: </strong>Gender differences in physician compensation have been described in various medical specialties, although little is known about reimbursement patterns among spine surgeons. We sought to determine whether any differences exist in procedural volume, claims, and Medicare reimbursement between male and female spine surgeons performing fusion procedures.</p><p><strong>Materials and methods: </strong>This was a retrospective analysis of the Medicare Provider Utilization and Payment Public Use File (2017-2022). Spine surgeons performing fusion procedures were identified and stratified by sex. Procedural volume, claims, and reimbursement across fusion categories were collected. Multivariable log-linear regression models adjusted for procedural volume and year effects were constructed. Nonparametric bootstrap resampling (5,000 iterations) and propensity score overlap weighting were included as sensitivity analyses.</p><p><strong>Results: </strong>A total of 2,311 spine surgeons were identified, of whom 34 (1.5%) were female. Male and female surgeons performed comparable numbers of total fusions (10.44 ± 7.79 vs 7.97 ± 7.18; <i>P</i> = .0625). However, male surgeons received significantly greater Medicare and surgical reimbursement. Adjusted regression analyses demonstrated that female surgeons were independently associated with 21% lower fusion-related reimbursement (<i>P</i> = .028) and 30% lower Medicare reimbursement (<i>P</i> = .004). The findings' directionality was confirmed via bootstrap and propensity-weighted sensitivity analyses.</p><p><strong>Conclusion: </strong>Between 2017-2022, male spine surgeons had higher total Medicare reimbursements and per-procedure reimbursements for lower and posterior spinal fusions, despite similar procedural volumes among surgeons. These differences remained even after statistical adjustment for procedural volume and calendar year. Future work incorporating additional clinical- and practice-level variables may clarify drivers of these differences.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e399-e407"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of GLP-1 Agonists With Postoperative Complications Following Knee Extensor Mechanism Repair: An Analysis of 1,092 Patients.","authors":"Elliot Forst, Lindsey Tully, Thomas E Moran, Alyssa D Althoff","doi":"10.3928/01477447-20260811-01","DOIUrl":"10.3928/01477447-20260811-01","url":null,"abstract":"<p><strong>Background: </strong>Diabetes and obesity are recognized as risk factors for postoperative complications including increased surgical site infection (SSI) and reoperation in patients undergoing knee extensor mechanism repair. However, limited literature evaluates how preoperative glucagon-like peptide-1 (GLP-1) receptor agonist therapy may influence these outcomes. This study evaluated GLP-1 receptor agonist use as an independent risk factor for postoperative outcomes following knee extensor mechanism repair.</p><p><strong>Materials and methods: </strong>Patients who underwent quadriceps or patellar tendon repair from 2012 to 2025 were identified in the TriNetX database and stratified by GLP-1 agonist use within 1 year of surgery. One-to-one propensity score matching yielded 2 well-balanced cohorts (n = 546). Postoperative complications were assessed at 90 days, 1 year, and 2 years, and Kaplan-Meier survival analysis was performed.</p><p><strong>Results: </strong>No significant 90-day postoperative differences were observed. At 1 year, patients using GLP-1 agonists demonstrated significantly lower rates of SSI (2.38% vs 5.31%; odds ratio [OR] = 0.435; <i>P</i> = .0118) and wound complications (2.02% vs 5.31%; OR = 0.367; <i>P</i> = .0037). Differences persisted at 2 years, with lower rates of SSI (2.75% vs 6.04%; OR = 0.439; <i>P</i> = .0079), wound complications (2.38% vs 6.04%; OR = 0.379; <i>P</i> = .0026), and acute kidney injury (9.71% vs 13.55%; OR = 0.686; <i>P</i> = .0474). No significant differences in revision surgery were found. Kaplan-Meier analysis demonstrated significant separation for SSI and wound complications beginning at 1 year.</p><p><strong>Conclusion: </strong>Preoperative GLP-1 receptor agonist therapy was associated with reduced postoperative SSI and wound complications following knee extensor mechanism repair. These findings suggest potential for perioperative risk modulation as GLP-1 use becomes increasingly prevalent in patients undergoing knee extensor mechanism repair.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e383-e390"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distractor-assisted Reduction for Volar Shear Distal Radius Fractures: A Retrospective Case Series.","authors":"Jialiu Fang, Tingjun Li, Jinhao Cheng, Jun Li, Jisen Zhang, Yanfang Yang","doi":"10.3928/01477447-20260817-01","DOIUrl":"10.3928/01477447-20260817-01","url":null,"abstract":"<p><strong>Background: </strong>Volar shear distal radius fractures are technically challenging due to the difficulty in controlling small volar fragments. This study aimed to evaluate the clinical and radiographic outcomes of a distractor-assisted reduction technique in the surgical management of these fractures.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed 23 consecutive patients treated with distractor-assisted reduction and volar plating between January 2024 and March 2025. Radiographic outcomes (ie, radial height, inclination, volar tilt) and functional outcomes, including wrist range of motion, grip strength, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Modified Mayo Wrist Score (MMWS), were assessed.</p><p><strong>Results: </strong>A total of 23 patients completed follow-up at a mean of 13.4 months. Radiographic alignment was well restored, with a mean radial height of 11.6 ± 1.8 mm, radial inclination of 22.4° ± 3.1°, and volar tilt of 11.2° ± 3.6°. Wrist motion recovered satisfactorily, with mean wrist extension of 64° ± 11° and flexion of 71° ± 12°. The mean DASH score was 12.8 ± 7.4. According to the MMWS, outcomes were rated as excellent in 15 patients, good in 7, and fair in 1. Grip strength recovered to 83% ± 9% of the contralateral side. No major complications were observed.</p><p><strong>Conclusion: </strong>Distractor-assisted reduction appears to be a useful adjunct in the surgical treatment of volar shear distal radius fractures.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e426-e430"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GsMTx4 Alleviates Knee Osteoarthritis by Inhibiting PIEZO1/2-mediated Chondrocyte Apoptosis.","authors":"Bin Chang, Yongjun Hu, Liangliang Fan, Qichang Tao, Wei Wei, Qian Chen, Zhenhua Sun","doi":"10.3928/01477447-20260916-01","DOIUrl":"https://doi.org/10.3928/01477447-20260916-01","url":null,"abstract":"<p><strong>Background: </strong>Knee osteoarthritis (KOA) is a prevalent, disabling degenerative joint disorder featuring progressive articular cartilage loss, persistent chronic pain, and compromised knee mobility. This work aimed to characterize the expression pattern of mechanosensitive ion channels PIEZO1/2 in KOA and explore their potential regulatory roles, as well as preliminarily evaluate whether non-selective PIEZO inhibitor GsMTx4 could slow KOA-related pathological changes.</p><p><strong>Materials and methods: </strong>Cartilage tissues and matched clinical data were collected from 54 KOA patients undergoing knee arthroplasty, and 20 trauma patients with intact cartilage served as controls. Correlations between PIEZO1/2 abundance, clinical pain severity, and radiographic grades were analyzed. A rat posttraumatic KOA model was established via anterior cruciate ligament, medial collateral ligament, and partial medial meniscus resection, followed by weekly intra-articular GsMTx4 injection for 8 weeks. Pain behaviors and cartilage histology were assessed. Transcriptomic profiling and bioinformatic analysis were carried out, and core differentially expressed genes were further verified via immunohistochemistry.</p><p><strong>Results: </strong>PIEZO1/2 expression was markedly increased in KOA cartilage, and their upregulation showed positive correlations with aggravated pain and higher Kellgren-Lawrence grades. In animal assays, GsMTx4 treatment appeared to alleviate hyperalgesia, attenuate chondrocyte apoptosis and cartilage damage, and partially rescue KOA-associated fibrotic remodeling, lipid metabolic imbalance, and inflammatory dysregulation.</p><p><strong>Conclusion: </strong>Aberrant PIEZO1/2 upregulation and activation may be linked to chondrocyte apoptosis, cartilage degeneration, and pain hypersensitivity in KOA. Blocking PIEZO channels with GsMTx4 might mitigate pathological joint remodeling, suggesting PIEZO channels could represent potential therapeutic targets for KOA intervention.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":"49 5","pages":"e443-e450"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Octogenarians Face Higher 90-day Medical Risk but Lower 1-year Revision Rates After Primary Total Knee Arthroplasty.","authors":"Gerald Y Liao, Howard Chansky, Paul A Manner, Navin D Fernando, Ermyas A Kahsai, Nicholas M Hernandez","doi":"10.3928/01477447-20260820-01","DOIUrl":"10.3928/01477447-20260820-01","url":null,"abstract":"<p><strong>Background: </strong>Prior studies evaluating age-related outcomes after total knee arthroplasty (TKA) have examined medical complications and revision risk separately. We asked whether octogenarians have higher rates of 90-day medical complications, 30- and 90-day readmissions, and all-cause and etiology-specific revision after primary TKA.</p><p><strong>Materials and methods: </strong>PearlDiver all-payer claims (2010 to 2022) identified isolated, first-instance unilateral primary TKA, excluding index revision, fracture/malignancy, concomitant other-joint arthroplasty, staged/simultaneous bilateral TKA within 30 days, and prior arthroplasty within 1 year. Patients were stratified by age (<65, 65 to 79, 80 to 89 years). Outcomes included 90-day medical complications, 30- and 90-day readmissions, and 1-year all-cause and etiology-specific revision (ie, prosthetic joint infection, mechanical loosening, instability/dislocation, periprosthetic fracture). Multivariable logistic and Cox regression adjusted for sex, Elixhauser Comorbidity Index, and body mass index.</p><p><strong>Results: </strong>Among 376,914 TKAs with complete covariate data, octogenarians had higher adjusted odds of 90-day medical complications and 30- and 90-day readmissions (<i>P</i> < .0001). Patients <65 years had the highest 1-year all-cause revision and higher adjusted odds of all-cause revision, prosthetic joint infection, and mechanical loosening or instability/dislocation revision, whereas octogenarians had a higher hazard of revision for periprosthetic fracture (<i>P</i> < .05).</p><p><strong>Conclusion: </strong>Octogenarians experienced greater early medical morbidity but lower observed 1-year revision hazards than did younger patients. These findings support age-calibrated counseling emphasizing perioperative optimization in older patients while informing younger patients of their greater early revision risk. Because mortality was unavailable as a competing event, lower revision hazards in octogenarians should be interpreted cautiously and not assumed to reflect superior implant durability. Future studies incorporating competing-risk methodology, frailty measures, and patient-reported outcomes are needed.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e415-e425"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterization of Infrapatellar Fat Pad-derived Cell Concentrates Obtained During Knee Arthroscopy: Nonenzymatic Versus Enzymatic Processing.","authors":"Haobo Li, Lei Zhang, Jing Ma, Jun Zhu, Yi Chen, Qiwei Fu, Shu Chen, Jiahua Shao, Yiqin Zhou, Qirong Qian","doi":"10.3928/01477447-20260910-01","DOIUrl":"10.3928/01477447-20260910-01","url":null,"abstract":"<p><strong>Background: </strong>This exploratory laboratory study compared infrapatellar fat pad (IPFP)-derived cell concentrates obtained by non-enzymatic and collagenase-based processing with respect to cell yield, an adherent/proliferative fraction, selected mesenchymal stromal cell-associated markers, clonogenicity, and qualitative differentiation.</p><p><strong>Materials and methods: </strong>Sixty independent patients were randomized to non-enzymatic or enzymatic processing (30 per group). Fresh concentrates were assessed for nucleated cell yield, attachment/proliferation, colony formation, and selected markers. Archived group-level summaries were reassessed with two-sided Welch <i>t</i> tests; marker comparisons were adjusted by the Benjamini-Hochberg procedure. Non-enzymatically isolated cells were culture-expanded for descriptive marker assessment and qualitative adipogenic, osteogenic, and chondrogenic staining.</p><p><strong>Results: </strong>Enzymatic processing produced a higher nucleated cell yield than non-enzymatic processing (8.86 ± 2.50 × 10⁵ vs 1.19 ± 1.17 × 105 cells/g; <i>P</i> < .001) and a higher adherent/proliferative fraction (9.85% ± 2.36% vs 3.25% ± 1.23%; <i>P</i> < .001). This fraction was not a live/dead viability measurement. Seven of 8 marker-positive populations were higher after enzymatic processing following false-discovery-rate adjustment; CD105⁺ did not differ. Culture-stage marker findings and trilineage staining were descriptive and qualitative, respectively.</p><p><strong>Conclusion: </strong>Non-enzymatic processing yielded heterogeneous IPFP-derived cell concentrates that could be culture expanded, but enzymatic processing produced higher cell yield and higher proportions of most measured marker-positive populations. The findings do not establish equivalence, clinical efficacy, complete International Society for Cell and Gene Therapy characterization, or quantitative viability.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e437-e442"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Copper-to-Zinc Ratio and Postoperative Delirium After Hip Fracture Surgery: A Propensity Score-matched Cohort Study.","authors":"Cheol Lee, Young Jean Ahn, Kwangjin Lee, Jina Kim","doi":"10.3928/01477447-20260604-01","DOIUrl":"10.3928/01477447-20260604-01","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium (POD) is frequent after hip fracture surgery, yet objective biomarkers that improve risk stratification beyond age, dementia, and frailty are limited. The serum copper-to-zinc (Cu/Zn) ratio reflects combined inflammatory and nutritional vulnerability, but its association with POD after hip fracture surgery is uncertain.</p><p><strong>Materials and methods: </strong>We performed a single-center retrospective cohort study of 420 consecutive patients aged ≥65 years undergoing surgery for low-energy hip fracture. The preoperative Cu/Zn ratio, measured within 48 hours before surgery, was the exposure (prespecified high ratio >2.0). The primary outcome was POD within 7 postoperative days or before discharge. Secondary outcomes were numeric rating scale pain scores, 24-hour morphine-equivalent opioid consumption, and hospital length of stay (LOS).</p><p><strong>Results: </strong>In the matched cohort, POD occurred in 23/124 (18.5%) patients with low Cu/Zn ratios and 56/124 (45.2%) with high ratios (odds ratio [OR], 3.62; 95% confidence interval [CI], 2.04-6.42; <i>P</i> < .001). In the full cohort, high Cu/Zn remained associated with POD after adjustment (adjusted OR, 3.35; 95% CI, 2.00-5.59; <i>P</i> < .001). After matching, early postoperative pain and 24-hour opioid consumption were not significantly different, whereas LOS was modestly longer in the high Cu/Zn group (mean difference = 1.0 day).</p><p><strong>Conclusion: </strong>A high preoperative Cu/Zn ratio (>2.0) was independently associated with increased odds of POD and slightly longer hospital LOS after hip fracture surgery in older adults, with minimal impact on early pain-related outcomes.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e301-e309"},"PeriodicalIF":1.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148318384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supracondylar Distal Femur Fracture Fixation: Early Experiences Comparing the Retrograde Nail With Locking Attachment Washer (LAW) Plate to Traditional Fixation Techniques.","authors":"Peter Bishara, Ereny Bishara, Samira Perez, Sharon Hill, Damayanti Samanta, Nancy M Duvall","doi":"10.3928/01477447-20260605-01","DOIUrl":"10.3928/01477447-20260605-01","url":null,"abstract":"<p><strong>Background: </strong>The locking attachment washer (LAW) plate offers an advancement in fixation techniques for supracondylar distal femur fractures. This study compared fixation outcomes for supracondylar distal femur fractures managed with traditional fixation techniques (ie, retrograde intramedullary nail, locking plate) versus DePuy Synthes RFN-ADVANCED Retrograde Femoral Nailing System incorporating the LAW plate.</p><p><strong>Materials and methods: </strong>A retrospective single-center comparative analysis was conducted of adult patients with supracondylar distal femur fractures treated between December 2022 and December 2024. Patients were divided into two groups: (1) traditional fixation and (2) nail plate construct using retrograde femoral nail with LAW plate. Outcomes focused on surgical parameters, functional recovery, and clinical implications.</p><p><strong>Results: </strong>Forty-five patients met inclusion criteria: 17 treated with traditional fixation, 28 with the LAW construct. Patients in the LAW group were significantly more likely to have an estimated 76.43-minute reduction in operative time compared to patients in the traditional group (<i>P</i> = .009). Hospital length of stay trended shorter with LAW (7.5 vs 15.2 days) but failed to achieve statistical significance in both univariate and multivariate analyses. Postoperative weight bearing was significantly more common with LAW (67.8% vs 23.6%, <i>P</i> = .032), and the rate of radiographic union trended lower with LAW but did not achieve statistical significance.</p><p><strong>Conclusion: </strong>The LAW construct demonstrated shorter operative times and earlier advancement in weight-bearing protocols, despite use in an older cohort. Radiographic union and complication rates were comparable. Potential advantages of the LAW construct lend to clinical and research opportunities for these complex injuries.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e293-e300"},"PeriodicalIF":1.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148318442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rising Incidence of Group A Streptococcal Musculoskeletal Infections in Pediatric Patients.","authors":"Sarah Bradley, Cody Ashy, Henry Baird, Joshua Abrams, Jonathan Pire, Ryan McFadden, Stephen Thacker, Sara Van Nortwick, Matthew Dow, Robert Murphy","doi":"10.3928/01477447-20260619-01","DOIUrl":"10.3928/01477447-20260619-01","url":null,"abstract":"<p><strong>Background: </strong>Group A streptococcal (GAS) musculoskeletal infections (MSKI) are an increasingly recognized cause of pediatric morbidity alongside methicillin-sensitive and methicillin-resistant <i>Staphylococcus aureus</i> (MSSA, MRSA). Seasonal variation in these infections remains poorly defined. This study evaluated epidemiologic trends and seasonal patterns of pediatric MSKI at a single institution over 9 years.</p><p><strong>Materials and methods: </strong>We performed a retrospective review of pediatric patients surgically treated for MSKI from 2015 to 2023. Demographics, clinical presentation, laboratory and imaging findings, operative reports, and culture results were collected. Seasonal variation was analyzed using odds ratios with 95% confidence intervals and Fisher's exact tests (<i>P</i> ≤ .05).</p><p><strong>Results: </strong>Fifty-three patients requiring surgical intervention were identified (median age, 5 years [IQR 1.8 to 9.0]; 49.1% female). Culture-positive infections occurred in 70% of cases, including 13 MSSA, 8 MRSA, and 9 GAS. Eight of 9 GAS infections (89%) occurred from 2019 to 2023, representing a nearly 3-fold increase, while <i>S. aureus</i> infections declined 1.4-fold. Most (78%) GAS cases presented in January to May, 6 with a viral prodrome; 2 developed osteomyelitis. Seasonally, GAS infections were most frequent in fall (37.5%) compared with winter (15.4%), spring (20.0%), and summer (0%). Fall carried higher risk versus winter (odds ratio, 3.30) and spring (odds ratio, 2.40). In contrast, <i>S. aureus</i> infections peaked in summer (64.3%), exceeding winter (30.8%), spring (40.0%), and fall (37.5%).</p><p><strong>Conclusion: </strong>GAS MSKI increased nearly 3-fold over the study period, with a 6.7-fold greater risk after 2019. These findings highlight the rising incidence and distinct seasonal patterns of pediatric GAS MSKI.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e330-e336"},"PeriodicalIF":1.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148397257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Residency to Specialization: A Critical Analysis of Residency Leadership and Impact on Specialty Selection.","authors":"Apurva S Choubey, Peter Chebi, Brett Drake, Deepa Dhillon, Sean Cooke, Majd Mzeihem, Alfonso Mejia, Mark H Gonzalez","doi":"10.3928/01477447-20260722-01","DOIUrl":"https://doi.org/10.3928/01477447-20260722-01","url":null,"abstract":"<p><strong>Background: </strong>Orthopedic surgery fellowships have evolved from optional to nearly mandatory since accreditation in 1981, yet factors influencing subspecialty selection remain incompletely defined. We evaluated orthopedic residency program director (PD) and department chair demographics and training backgrounds, resident fellowship match patterns, fellowship availability, and concordance between leadership training and resident subspecialty selection.</p><p><strong>Materials and methods: </strong>Using programs accredited by the Accreditation Council for Graduate Medical Education, we analyzed available PD and department chair demographics and fellowship training. Five years of alumni fellowship data and fellowship availability at each institution were collected from program websites. Descriptive statistics, chi-squared tests, and crude odds ratios (ORs) were used, with <i>P</i> < .05 considered significant.</p><p><strong>Results: </strong>Among 109 residency programs and 5,443 recent graduates, residents most often matched into sports medicine (24.44%), arthroplasty (17.86%), and hand surgery (16.57%). PDs were most commonly trained in trauma, sports medicine, and hand surgery; chairs were most commonly trained in sports medicine, trauma, and spine surgery. Leadership was predominantly male and White (PDs: 87.16% male, 78.90% White; chairs: 93.58% male, 88.07% White). Programs offering spine, hand, or orthopedic oncology fellowships had higher match rates into those specialties than programs without them (OR: 1.20, 1.42, and 1.94; all <i>P</i> < .05). Residents were also more likely to enter arthroplasty when their PD was arthroplasty trained and to enter hand surgery or orthopedic oncology when their chair had concordant training.</p><p><strong>Conclusion: </strong>Fellowship availability and leadership training background were each associated with resident subspecialty selection. Applicants with subspecialty interests should consider both factors when evaluating residency programs.</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":"49 4","pages":"e368-e375"},"PeriodicalIF":1.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}