Journal of Orthopaedic Experience & Innovation最新文献

{"title":"Preparedness for Matching into an Orthopaedic Surgery Residency: Student Perspectives as a Model for Institutional Progression","authors":"Dane M. Pizzo, Peter Filtes, A. Chandra, Matthew H. Nasra, Jomar N A Aryee, Stephen E. Adolfsen, Thomas G. McPartland, Brian M. Katt","doi":"10.60118/001c.36049","DOIUrl":"https://doi.org/10.60118/001c.36049","url":null,"abstract":"With the increasingly competitive nature of matching into an orthopaedic surgery residency, there is an opportunity for medical schools and orthopaedic faculty to enhance their students’ candidacy. In this study, we aim to evaluate medical students’ satisfaction with our institution’s provision of resources, identify areas of strengths and weaknesses within our department, and use these findings to implement action plans for institutional advancement. This is a prospective, cross-sectional survey study of alumni from our institution, an allopathic medical school affiliated with a tertiary-care university teaching-hospital, who successfully matched into an orthopaedic surgery residency program between 2006 and 2021. Robert Wood Johnson Medical School (RWJMS) Department of Orthopaedic Surgery, New Brunswick, NJ The survey was distributed to 83 matched alumni from our institution, 45 (54.2%) responded to the survey. Forty-four (97.8%) survey respondents successfully matched into a PGY-1 orthopaedic surgery residency position on their first attempt. Nearly 70.0% of survey respondents matched into their top 3 ranked residency program while ~90.0% matched into their top 5 ranked residency program. Survey respondents reported that board exam scores (33.3%), performance on away rotations (28.9%), and letters of recommendation (15.6%) were their greatest strengths, while research experience (53.3%), lack of inclusion in AOA (17.8%), and board exam scores (15.6%) were their greatest weaknesses. On survey responses evaluated using a 1-5 Likert scale, survey respondents reported that their sub-internship at our home institution adequately prepared them to excel on away rotations (4.38 ± 0.912). Conversely, survey respondents from our institution rated faculty and resident’s receptiveness to students seeking research opportunities the lowest (3.38 ± 1.007). An internal assessment of orthopaedic departments at medical institutions, utilizing student perspectives, can be a useful tool for identifying the strengths and weaknesses of a program’s ability to prepare students to successfully match into an orthopaedic residency. After identification, programs must be able to hone strengths and mitigate weaknesses by setting objectives for improvement and implementing action plans to ensure deficiencies are adequately addressed.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129228323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Displaced paediatric distal radius fractures with volar skin tenting following manipulation and reduction: a report of two cases and literature review","authors":"A. Chou, Darryl Chew, D. Chia, A. Mahadev, K. Wong","doi":"10.60118/001c.35699","DOIUrl":"https://doi.org/10.60118/001c.35699","url":null,"abstract":"Distal radius fractures are amongst the most common forearm fractures in children and can often be managed with closed reduction and casting for the majority of patients. While the thick periosteum sleeve can be used to guide reduction, it can also make the traction used in an adult patient counterproductive to closed reduction attempts. We report two unusual cases of distal radius fractures with displaced volar fragments in children that required urgent surgical intervention following manipulation and reduction due to concern for skin and neurovascular compromise. While one patient developed post-operative superficial skin necrosis managed conservatively, both children recovered well without long-term complications.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117239096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supine Elbow Arthroscopy: A decade of results with a vertical humerus and a free forearm","authors":"A. L. Hunter","doi":"10.60118/001c.37791","DOIUrl":"https://doi.org/10.60118/001c.37791","url":null,"abstract":"Elbow arthroscopy has been in existence for decades, but to date little innovation in elbow positioning for arthroscopy has occurred. After experiencing disadvantages with lateral decubitus, prone, and supine suspended positioning techniques, the author has changed to a supine positioning technique that stabilizes the humerus vertically while leaving the forearm free for all elbow arthroscopy procedures. A retrospective review was conducted for arthroscopic elbow surgeries performed by a single surgeon in a single surgery center in the supine elbow arthroscopy (SEA) position from 2011 to 2021. Efficiency, safety, and versatility of elbow arthroscopy performed in the SEA position were analyzed. In 298 relevant arthroscopic surgical procedures performed on 289 patients, the average total procedural time was 52.2 minutes, with an average arthroscopic (surgical) time of 31.2 minutes. No complications were found in the review of medical records. SEA promotes safe, technically easier, and more efficient elbow arthroscopy with improved surgical access, intraoperative flexibility, and accelerated procedural times compared with other current techniques.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127642529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Customized Individually-Made and Conventional Total Knee Implants are associated with Similar Improvements in Patient-Reported Outcomes","authors":"Carl L. Herndon, Jeremy S. Frederick, Omar K. Farah, Walkania Santos, R. Shah, H. Cooper","doi":"10.60118/001c.37881","DOIUrl":"https://doi.org/10.60118/001c.37881","url":null,"abstract":"Customized individually-made (CIM) implants aim to reproduce knee kinematics by restoring patient-specific anatomy. There is sparse data comparing outcomes of CIM implants with conventional implants. The purpose of this study was to compare short-term outcomes of total knee arthroplasty (TKA) performed with CIM versus off-the-shelf (OTS) implants. We retrospectively compared clinical outcomes of 123 CIM TKAs with 282 concurrent, matched OTS TKAs performed at a single academic medical center by two high-volume arthroplasty surgeons. All CIM TKA were included. Perioperative outcomes evaluated included hospital length-of-stay (LOS), discharge disposition, and patient-reported outcome measures (PROMs) at baseline, 3 months, and 1 year. Student’s t-tests were used for continuous variables, and chi-squared tests were used for categorical variables. Baseline demographics were statistically similar between groups. CIM Baseline WOMAC Pain and Physical Function scores were statistically, but not clinically, better. There were no differences in LOS (CIM 2.19d vs. OTS 2.35d; p=0.30) or proportion discharged home (78.7% vs. 83.5%, p=0.26). There were no differences in WOMAC subscores or the KSS Functional Score at 3-month and 1-year follow-up. The CIM cohort had a statistically significant, but not clinically significant, higher KSS-Function score at 1-year (79.4 vs. 72.6, p=0.02), but the change from preoperative baseline was not significant between groups. Compared to traditional TKA implants, CIM implants offered similar improvements and patient-reported outcome scores through the first postoperative year. Longer-term outcomes as well as cost-effectiveness of CIM implants should be studied.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121753736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"For Your Consideration: Bridge Enhanced ACL Restoration (BEAR): Why, How, and When","authors":"Sean McMillan, Scott Sigman, Chris Dougherty, Elizabeth Ford","doi":"10.60118/001c.38392","DOIUrl":"https://doi.org/10.60118/001c.38392","url":null,"abstract":"Reconstruction of the anterior cruciate ligament (ACL) has been the gold standard for complete rupture for nearly 40 years. During this journey, variations on technique, rehab, and graft selection have been points of discussion. With the explosion of biologic augments currently seen in orthopedics, a paradigm shift of reconstruction to potential repair and/or restoration has begun. The bridge enhanced ACL restoration (BEAR) procedure provides the ability to perform primary repair of the acutely torn ACL’s via utilization of a proprietary protein based scaffold. Many promising benefits have been shown from early clinical data, including potentially decreasing risk of osteoarthritis, decreased donor site morbidity, and higher success rates in the subset of patients that fail ACL restoration verses those that fail ACL reconstruction. Nevertheless, restoration has potential drawbacks and requires proper patient identification. As the implant has moved from research to commercialization, many questions still exist regarding why, how, and when to use the BEAR implant for injured patients. This manuscript aims to provide a broad overview of these questions and provide clarity based upon initial experiences.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122284295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Bisphosphonates and Prostaglandins for the Treatment of Subchondral Insufficiency Fractures of the Knee: An Evidenced-Based Opinion","authors":"Zachary S Aman, Nicholas N. DePhillipo, D. R. Lind, T. Dekker, R. LaPrade","doi":"10.60118/001c.34672","DOIUrl":"https://doi.org/10.60118/001c.34672","url":null,"abstract":"Subchondral Insufficiency Fractures of the Knee (SIFK) can result in accelerated cartilage degeneration and poor outcomes. The presence of SIFK is difficult to manage and can cause persistent knee swelling, pain, and prolonged disability. Pharmacologic agents to suppress extensive bone remodeling, improve blood supply, and reduce pain have been suggested as treatment for these lesions. Nonoperative management with prostaglandins and bisphosphonates has emerged as a potentially efficacious intervention for symptom reduction and resolution of knee bone marrow edema. However, previous reports of potential serious adverse effects including atypical femoral fractures of the proximal femur raise concerns for clinical safety. This evidence-based opinion article demonstrates the potential clinical efficacy of various pharmacologic therapies, including prostaglandins and bisphosphonates, for the treatment of SIFK. The overall rate of reporting adverse effects in the literature is high (47.3%), while significant clinical improvements have been identified in 66% to 100% of the patient population. This collective information may help guide physicians during prescription drug therapy for the treatment of SIFK.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125039200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Blockchain: Why Physicians Should Care","authors":"A. Rondon, J. Abboud","doi":"10.60118/001c.35657","DOIUrl":"https://doi.org/10.60118/001c.35657","url":null,"abstract":"Blockchain has emerged as a foundational technology primed to change how our world functions. There are multiple avenues for blockchain application from smart contracts, surgical billing, managing inventories, disease tracking real time, and health insurance claims. The value of blockchain is that anything and everything can have a unique identifier, be recorded, and tracked. Blockchain can unlock future growth and value with unmet efficiency and transparency by providing the foundation to be a system of record for all transactions. While full implementation remains years from realization, this article will define blockchain and discuss why orthopaedic surgeons and physicians should learn about blockchain along with future applications of this technology. The primary aim of this article is to highlight how this technology can be utilized to improve our understanding of surgical billing, supply chain in medical care, and introduce smart contracts.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience & Innovation","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131382431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screw Thread Configuration Has No Effect on Operative Outcomes of Slipped Capital Femoral Epiphysis","authors":"G. Via, David A. Brueggeman, Joseph G. Lyons, Derrek Edukugho, A. Froehle, Melissa Martinek, M. Albert","doi":"10.60118/001c.37402","DOIUrl":"https://doi.org/10.60118/001c.37402","url":null,"abstract":"The current “gold standard” treatment for slipped capital femoral epiphysis (SCFE) is insertion of a single cannulated screw down the epiphyseal center. Debate remains as to whether partially- (PTCS) or fully-threaded (FTCS) cannulated screws, and what number, are optimal. The present retrospective cohort study compares such constructs in a clinical model. IRB approval was obtained. Patients (N=158) presenting to a level-one pediatric trauma center for in situ pinning of SCFE between January 2005 and April 2018 were included. Covariates analyzed were sex, race, BMI, history of endocrinopathy, and preoperative designation of unstable SCFE. Outcomes included return to the operating room (OR), avascular necrosis (AVN), hardware failure/removal, and the sequelae of femoroacetabular impingement (FAI). Multivariable logistic regression models included covariates with significant univariate effects, as well as thread configuration, number of screws, preoperative instability, and the screw*thread and screw*instability interactions. Average patient age at surgery was 12.3±1.9 years; 63% of patients were male; 68% of patients were White/Caucasian and the remaining 32% were Black/African American. Mean BMI was 28.4±6.4 kg∙m-2. PTCS were utilized in 81.0% of constructs and 1 screw was placed in 83.5% of hips. Outcome rates were as follows: return to OR=15.8%, AVN=7.6%, FAI=7.0%, hardware failure/removal=9.5%. Univariate modeling demonstrated no significant covariate effects on return to OR (each P≥0.181) or AVN (each P≥0.099). Sex had a significant effect on FAI (P=0.012). Age and bilateral SCFE were significantly related to hardware failure/removal (P=0.039 and P=0.015, respectively). Multivariable models found that 2 screw constructs were associated with increased odds of return to OR [P=0.027; OR=3.01 (1.13-7.98)]. Odds of AVN were increased by older age (P=0.024; OR=1.45 [1.03-2.03]) and 2 screw constructs in stable SCFE [screws*stability interaction: P<0.001; OR=60.5 (5.60-652.31)]. Female sex increased odds of FAI (P=0.012; OR=5.17 [1.31-20.36]). Finally, odds of hardware failure/removal were increased by 2 screw constructs [P=0.038; OR=3.64 (1.13-11.70)] and bilateral SCFE [P=0.027; OR=3.51 (1.15-10.74)]. A single, PTCS comprises the majority of SCFE constructs, and this construct carries the least risk for negative outcomes in cases of stable SCFE. These data demonstrate no significant effects of thread configuration on outcomes. The authors caution orthopaedic surgery providers against using more than one screw in cases of stable SCFE, as well as to monitor older, female, and/or bilateral SCFE patients more closely due to an increased risk for complications.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience &amp; Innovation","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114147107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Differing Effects of Ethnicity on Mental Health Outcomes Among Patients Undergoing Lumbar Fusion Surgery","authors":"Caroline N. Jadczak, Shruthi Mohan, Conor P. Lynch, Elliot D. K. Cha, Kevin C. Jacob, Madhav R. Patel, Michael C. Prabhu, N. Vanjani, Hanna Pawlowski, Kern Singh","doi":"10.60118/001c.33876","DOIUrl":"https://doi.org/10.60118/001c.33876","url":null,"abstract":"Few studies have explored the effect of ethnicity on postoperative mental health outcomes. This study aims to evaluate the effect of ethnicity on changes in mental health outcomes following lumbar fusion (LF). A surgical database was retrospectively reviewed for primary, single, or multilevel, lumbar fusion with posterior instrumentation procedures. Patients were propensity score matched to account for differences in demographics. 12-Item Short Form and Veterans RAND (SF-12 and VR-12) Mental Composite Score (MCS), 9-Item Patient Health Questionnaire (PHQ-9), Visual Analogue Scale (VAS) back, VAS leg, and Oswestry Disability Index (ODI) were recorded. A minimum clinically important difference (MCID) was calculated. Patients were grouped according to ethnicity: African-American, Hispanic, Asian/Other, and Caucasian. Differences between groups in baseline characteristics and mean outcome scores were evaluated. Ethnicity was assessed as a predictor of mental health outcomes and achievement of MCID was evaluated using regression analysis. The study included 224 patients, 43 African-American, 40 Hispanic, 22 Asian/Other, and 119 Caucasian. Groups differed in age, comorbidity score, and insurance collected (p<0.05). African-Americans had the longest postoperative stay (47.3 hours; p=0.032). Groups differed in preoperative SF-12 and VR-12 MCS, but not PHQ-9 (p<0.001, both). Groups demonstrated differences in postoperative SF-12 MCS (p≤0.021), VR-12 MCS (p≤0.028), PHQ-9 (p=0.009). VAS back, VAS leg, and ODI demonstrated significantly different scores (p≤0.041, all). Ethnicity was not a predictor of mental health outcomes at any timepoint and did not demonstrate an impact on achievement of MCID. Majority of individuals achieved an MCID by 1-year for all outcomes. Preoperative mental health scores demonstrated significant differences based on a patient’s ethnicity but was resolved by 2-years. Ethnicity did not demonstrate significant effects on the ability to achieve an MCID for mental health outcomes. These results suggest that patients of differing backgrounds may require alternative preoperative counseling.","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience &amp; Innovation","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124809049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interprosthetic Femur Fractures: Systematic Review","authors":"Ivan J. Golub, Mitchell K. Ng, R. Vakharia, K. Kang, Lisa K. Cannada","doi":"10.60118/001c.37198","DOIUrl":"https://doi.org/10.60118/001c.37198","url":null,"abstract":"Interprosthetic femur fractures (IFF) present unique challenges to orthopaedic surgeons due to the preexisting implants in place, oftentimes advanced age and poor bone quality. Through the development of specific implants and improvement of fixation principles, management of this rare—yet growing—fracture pattern has progressed in recent decades to improve patient outcomes. This study’s aim was to identify patient-related outcomes after undergoing ORIF of interprosthetic femur fractures, including time to union, change in pre-operative ambulatory status, malunion/nonunion, surgical site infections, and revisions. A systematic review of published literature was conducted on Pubmed/MEDLINE and Cochrane Library databases for English language papers published with 12 studies meeting inclusion/exclusion criteria. Studies providing quantitative data comparing time to union, change in ambulatory status, surgical site infections, malunion/nonunion, revisions, and one-year mortality were used in the analysis. Studies lacking quantitative data were excluded. 12 studies were included in this systematic review and graded by MINOR to identify potential biases. The aforementioned patient outcomes were calculated as mean values, ranges, and percentages. Time to union averaged 20.2 (range 6-28) weeks with roughly 18% of patients experiencing a decline in pre-operative ambulatory status. It was found 1.3% of patients experienced surgical site infections that were treated successfully either operatively or nonoperatively. Malunions and nonunions occurred in 1.63% and 6.12% of cases, respectively. Revisions were necessary in 12.6% of cases due to malunion, nonunion, and hardware failure. The one-year mortality rate was 12.8%. Our review demonstrates that interprosthetic femur fractures continue to pose significant challenges in their treatment to both patients and orthopaedic surgeons. With the expected continued growth in the number of primary total hip and total knee arthroplasty performed annually, the incidence of interprosthetic femur fractures will continue to rise. Full femur spanning locked plating is currently the standard of care in fracture patterns with stable prostheses. Therapeutic Level III","PeriodicalId":298624,"journal":{"name":"Journal of Orthopaedic Experience &amp; Innovation","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133873662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}