JBJS Open Access最新文献

{"title":"Risk of Fracture at External Fixator Pin Hole After Lateral Tibial Plateau Fracture Plating: A Biomechanical Comparison of Different Screw Configurations.","authors":"Patrick A Massey, Wayne Scalisi, Chloe Duval, Michael Lowery, Brad Chauvin, Giovanni F Solitro","doi":"10.2106/JBJS.OA.24.00094","DOIUrl":"10.2106/JBJS.OA.24.00094","url":null,"abstract":"<p><strong>Background: </strong>External fixation of tibial plateau fractures commonly provides temporary stabilization before definitive fixation with plate and screws. The purpose of this study was to determine if an external fixator pin hole distal to a tibial plate in a synthetic fracture model would increase the risk of fracture after fixation. Another objective was to determine the ideal configuration when placing tibial plate screws near an external fixator pin hole.</p><p><strong>Methods: </strong>Thirty synthetic tibiae were tested and evenly divided into 5 groups. Tibial plateau plates were placed with 4 different screw configurations for the distal-most screw near the external fixator pin hole. The 5 groups tested were control (fixation with no external fixator hole), unicortical (distal fixation with a unicortical locking screw), bicortical (distal fixation with a bicortical locking screw), oblique (distal fixation with an oblique cortical screw angled 30° proximally from the external fixator hole), and hole-bridging (hole-bridging fixation in which the plate was placed bridging the external fixator hole). The bone surrogates were potted and tested using an Instron 8874 Testing System.</p><p><strong>Results: </strong>There was a significant difference in failure load among the 5 groups (p = 0.005). The mean peak loads were 1,259 N (control), 835 N (unicortical), 831 N (bicortical), 943 N (oblique), and 993 N (hole-bridging). There was a higher failure load in the control group compared with the bicortical group (p = 0.007) and the unicortical group (p = 0.007). There was no difference in failure load between the control group and the hole-bridging group (p = 0.16) and the oblique group (p = 0.067).</p><p><strong>Conclusions: </strong>External fixator pin holes distal to a tibial plateau plate may increase the risk of tibial fracture through the pin hole. This risk may be mitigated by placing the distal screw oblique and angled proximally away from the external fixator pin hole or by placing the external fixator pin proximally with subsequent bridging of the external fixator pin hole with the plate.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11778079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Resident Gender or Race/Ethnicity Affect Orthopaedic Surgery Case Volume During Residency Training?","authors":"Parisun Shoga, Ann Van Heest, S Elizabeth Ames, Sean O Hogan, Eric Holmboe, Mary Klingensmith, Yoon Soo Park, Corey Parker, Erik Solberg, Kimberly Templeton","doi":"10.2106/JBJS.OA.24.00146","DOIUrl":"10.2106/JBJS.OA.24.00146","url":null,"abstract":"<p><strong>Introduction: </strong>Disparities in case volumes have been reported in some surgical specialties. The objective of this study was to evaluate whether gender or racial/ethnicity disparities exist during orthopaedic surgery residency surgical case log volume.</p><p><strong>Methods: </strong>Accreditation Council for Graduate Medical Education Case Log Database for orthopaedic surgery residents for 9 years of cohorts graduating in academic years 2013-2014 to 2021-2022 were analyzed to compare case logs between men and women, as well as race/ethnicity, defined by Association of American Medical Colleges as underrepresented in medicine (URiM) and non-URiM groups.</p><p><strong>Results: </strong>Longitudinal analyses of total required minimum type cases indicate significant gender differences among the initial graduating cohorts with women trainees reporting 33 cases fewer than men; in the most recent years of this study period, women trainees reported 5 cases fewer than men per year. URiM trainees reported 29 cases fewer at baseline, while in the most recent years, there were no significant differences. Significant differences exist for 8 of the 15 case minimum types with fewer women cases at baseline; in the most recent years, women had fewer cases in anterior cruciate ligament Reconstruction, Ankle Fracture Fixation, Closed Reduction Forearm Fracture, Total Hip Arthroplasty, and Total Knee Arthroplasty. There were significant differences for 3 of 15 case minimum types at baseline for URiM trainees with no significant differences in most recent years. Hand was the only anatomic area with women reporting significantly more cases than men, both initially and over the 9 years of study period.</p><p><strong>Conclusion: </strong>Significant differences exist in case volume and case types during orthopaedic surgery residency based on gender for the initial cohort, albeit lessening in most recent years. Although initial differences in cases volumes based on race/ethnicity exist, no significant differences persist in most recent years of the study period.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11778099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-Assisted Retrograde Elastic Intramedullary Nailing Versus ORIF with a Plate for Displaced Midshaft Clavicular Fractures.","authors":"Yufu Zhang, Jie Tan, Xigong Zhang, Xiao Han, Yanchao Li, Maoqi Gong, Qiang Huang, Junqiang Wang, Xieyuan Jiang","doi":"10.2106/JBJS.OA.24.00071","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00071","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study was to compare the clinical outcomes of robot-assisted retrograde elastic intramedullary nailing and open reduction and internal fixation (ORIF) with a plate for displaced midshaft clavicular fractures.</p><p><strong>Methods: </strong>All patients diagnosed with displaced midshaft clavicular fractures between November 1, 2022, and June 30, 2023, in our level-III hospital (most advanced level) were enrolled in this retrospective study; a total of 116 patients met the inclusion criteria. Patients were divided into 2 groups on the basis of treatment: robot-assisted retrograde elastic intramedullary nailing (RAN group) and ORIF with a plate (plate group). Operations in the RAN group were carried out using the novel TIANJI Robot system (TINAVI Medical Technologies) for navigation and planning of the optimal retrograde intramedullary nailing trajectory. Patient demographics, perioperative parameters, and complications were documented. Patients were followed at the trauma clinic for clinical and radiographic assessment.</p><p><strong>Results: </strong>There were 74 patients in the RAN group and 42 patients in the plate group. The RAN group exhibited a significantly shorter total operative time (mean, 52.20 ± 20.76 versus 86.83 ± 27.42 minutes), less blood loss (mean, 7.38 ± 5.54 versus 59.05 ± 30.11 mL), shorter incision length (mean, 1.28 ± 0.85 versus 9.79 ± 1.63 cm), and shorter duration of hospital stay (mean, 3.38 ± 0.73 versus 5.50 ± 1.99 days) (all p < 0.05). Nail treatment was also associated with a significantly shorter time to bone union (mean, 7.92 ± 2.46 versus 16.79 ± 5.18 weeks), a higher SCAR score (mean, 9.77 ± 0.51 versus 5.74 ± 1.15), a shorter time to return to sports (mean, 12.70 ± 2.35 versus 20.10 ± 4.10 weeks), and a shorter time to regain full range of shoulder motion (mean, 9.46 ± 2.35 versus 12.05 ± 2.95 weeks) (all p < 0.05). At the final follow-up, the Constant-Murley shoulder score was significantly higher in the RAN group (mean, 97.57 ± 2.77 versus 93.29 ± 7.63) (p < 0.05). Compared with the RAN group, the plate group had more complications (p < 0.05).</p><p><strong>Conclusions: </strong>Robot-assisted retrograde elastic intramedullary nailing is a safe and minimally invasive treatment option for displaced midshaft clavicular fractures that promotes rapid healing, good cosmesis, excellent functional outcomes, and fewer complications compared with ORIF with a plate.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Improvements by Controlled Suture Tension in Arthroscopic Rotator Cuff Repair.","authors":"Shinji Imai","doi":"10.2106/JBJS.OA.24.00031","DOIUrl":"10.2106/JBJS.OA.24.00031","url":null,"abstract":"<p><strong>Background: </strong>Although a certain degree of tension in bridging sutures is required for proper tendon healing following suture-bridge rotator cuff repair, excessive suture tension may be detrimental to tendon healing. This study aimed to investigate the effects of bridging suture tension on clinical outcomes and tendon healing. We hypothesized that fixed, low tension of the bridging sutures would improve the tendon healing rate and clinical outcomes compared with maximum manual tensioning.</p><p><strong>Methods: </strong>A group of 39 patients with a rotator cuff tear were treated with arthroscopic suture-bridge rotator cuff repair, in which the bridging sutures were uniformly tensioned to 20 N (group A). A separate group of 37 patients was treated with the same suture construct, but the sutures were tensioned by maximum manual pulling (mean tension, 36.1 N; group B). The visual analog scale (VAS) score for pain, active anterior elevation, external and internal rotation, and Constant score were compared between the groups preoperatively and at 1, 3, and 6 months and 1 and 2 years postoperatively. Anatomical healing was evaluated using magnetic resonance imaging (MRI) at 1 year after surgery.</p><p><strong>Results: </strong>At 6 months postoperatively, all clinical values had improved in both groups. The Constant score (p < 0.001), VAS pain score (p < 0.001), and anterior elevation (p = 0.004) were significantly better in group A than in group B. Two years postoperatively, there was no significant difference between groups A and B in the Constant score (p = 0.847), VAS pain score (p = 0.991), and anterior elevation (p = 0.855). Group A demonstrated a significantly lower retear rate (3 of 39, 7.7%) than group B (9 of 37, 24.3%) (p = 0.0467).</p><p><strong>Conclusions: </strong>Double-row suture-bridge repairs with fixed, low tension led to superior clinical outcomes at 6 months and a superior tendon healing rate at 1 year compared with repairs with higher suture tension. However, the clinical outcomes did not differ significantly at 2 years between the 2 tensioning methods.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Expanding the Pipeline: Exposure and Female Mentorship Increase Interest in Orthopaedic Surgery Among Female Premedical Undergraduate Students: Erratum.","authors":"Victoria E Bergstein, Jessica Schmerler, Alexandra H Seidenstein, Dawn M LaPorte","doi":"10.2106/JBJS.OA.ER.24.00142","DOIUrl":"10.2106/JBJS.OA.ER.24.00142","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2106/JBJS.OA.24.00142.].</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11737502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Updated Demographic Profile of Orthopaedic Surgery Using a New ABOS Data Set.","authors":"Lindsey S Caldwell, Natalie Glass, Gregory P Guyton, David W Elstein, Charles L Nelson","doi":"10.2106/JBJS.OA.24.00122","DOIUrl":"10.2106/JBJS.OA.24.00122","url":null,"abstract":"<p><strong>Introduction: </strong>The orthopaedic surgery physician workforce is predominately White and male and has been identified as the least diverse medical specialty. Increasing efforts toward diversification within orthopaedic surgery are underway. Evaluating the effectiveness of these programs requires a thorough understanding of the current demographic profile of the profession.</p><p><strong>Methods: </strong>The American Board of Orthopaedic Surgery (ABOS) is the leading board certification organization for orthopaedic surgeons in the United States. The ABOS began collecting self-reported race/ethnicity and sex/gender data of its examinees and diplomates in 2017. This new data set of ABOS was analyzed to describe both the current demographic profile of orthopaedic surgery and trends over time. Underrepresented minority (URM) was defined as a group that is less well represented in orthopaedic surgery than in US census data and includes female, American Indian or Alaska Native, Black or African American, Hispanic/Latino, and Native Hawaiian or Other Pacific Islander categories.</p><p><strong>Results: </strong>Of the 21,025 currently practicing ABOS diplomates with time-limited ABOS certificates (issued since 1986), 19,912 (94.7%) provided sex/gender data, and 19,876 (94.5%) provided race/ethnicity data. Approximately 84.78% selected male and 8.43% female. The majority identified as White (73.67%), whereas 16.35% selected a URM race/ethnicity category. There have been significant increases in the proportions of female (odds ratio [OR] = 4.72, 95% confidence interval [CI] = 3.64-6.11, p < 0.001) and URM (OR = 2.31, 95% CI = 1.80-2.96, p < 0.0001). Diplomates among orthopaedic surgeons attaining ABOS board Diplomates from 1989 to present. Among the subspecialties, pediatric orthopaedics reported the highest percentage of females (30.4%). Spine had both the lowest percentage of females (2.63%) and the highest percentage of URMs (8.97%). Sports had the lowest percentage of URMs at 5.63%.</p><p><strong>Conclusion: </strong>Orthopaedic surgery in 2023 remains largely White and male. However, there have been promising trends toward diversification of orthopaedic surgery both in terms of gender and race/ethnicity. Specialties within orthopaedics have a wide variety of demographic profiles.</p><p><strong>Level of evidence: </strong>Level IV Retrospective Cohort Study. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11737504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASA Class Is a Stronger Predictor of Early Revision Risk Following Primary Total Knee Arthroplasty than BMI.","authors":"Christopher J Wall, Richard N de Steiger, Christopher J Vertullo, Dylan Harries, Srinivas Kondalsamy-Chennakesavan","doi":"10.2106/JBJS.OA.24.00064","DOIUrl":"10.2106/JBJS.OA.24.00064","url":null,"abstract":"<p><strong>Background: </strong>Although there is a known correlation between obesity and revision risk following total knee arthroplasty (TKA), there is an ongoing debate regarding the appropriateness of denying TKA solely based on the body mass index (BMI) of a patient. Our aim was to determine whether a patient's American Society of Anesthesiologists (ASA) class predicts their risks of early all-cause revision and revision for periprosthetic joint infection (PJI) following primary TKA, independent of their BMI.</p><p><strong>Methods: </strong>Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) were obtained regarding all patients who underwent primary TKA for osteoarthritis in Australia from January 1, 2015, to December 31, 2022. Estimated hazard ratios of all-cause revision and revision for PJI, as well as predicted risks of revision within 3 months, 1 year, and 2 years, as a function of patient ASA class and BMI, were calculated with use of multivariable Cox proportional hazards models.</p><p><strong>Results: </strong>A total of 274,786 primary TKAs (54.5% female; mean age, 68.3 years) were included in the study, of which 5,401 were revised during the study period. Compared with BMI, ASA class was a stronger predictor of the risks of all-cause revision and revision for PJI following primary TKA. Patients with an ASA class of 3 to 4 had higher risks of all-cause revision and revision for PJI at multiple time points after TKA compared with patients with an ASA class of 1 to 2, regardless of BMI.</p><p><strong>Conclusions: </strong>Although ASA class and BMI are theoretically interrelated variables, we found that a patient's ASA class was more strongly associated with their risks of early all-cause revision and revision for PJI following primary TKA than their BMI. Employing a BMI threshold in isolation when assessing fitness for TKA may be inappropriate, and surgeons should give greater weight to the other medical comorbidities and general perioperative fitness of the patient. Patients with poorly controlled comorbidities should be referred for medical optimization prior to TKA.</p><p><strong>Level of evidence: </strong>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11737488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fetal Cartilage Progenitor Cells in the Repair of Osteochondral Defects.","authors":"Bruno C Menarim, Chan Hee Mok, Kirsten E Scoggin, Alexis Gornik, Emma N Adam, Shavahn C Loux, James N MacLeod","doi":"10.2106/JBJS.OA.24.00043","DOIUrl":"10.2106/JBJS.OA.24.00043","url":null,"abstract":"<p><strong>Background: </strong>Therapies for cartilage restoration are of great interest, but current options provide limited results. In salamanders, interzone (IZN) tissue can regenerate large joint lesions. The mammalian homolog to this tissue exists during fetal development and exhibits remarkable chondrogenesis in vitro. This study analyzed the potential of equine IZN and adjacent anlagen (ANL) cells to regenerate osteochondral defects.</p><p><strong>Methods: </strong>Osteochondral defects were created in the knee of immunosuppressed rats and were grafted with cell pellets from either equine fetal IZN, equine fetal ANL, adult fibroblasts, or adult chondrocytes, or they were left untreated. Osteochondral repair was assessed after 2, 6, and 16 weeks.</p><p><strong>Results: </strong>Untreated lesions unexpectedly failed to represent critical-sized defects and at 2 weeks exhibited new subchondral bone covered by a fibrocartilage layer that thinned over time. Fibroblast-treated defects filled with soft fibrous tissue. Chondrocyte-treated repair tissue exhibited strong proteoglycan and COL2 staining but poor integration to the adjacent bone. Defects treated with IZN, ANL, or chondrocyte pellets developed hyaline cartilage with increasing safranin-O and collagen II staining over time. IZN and ANL repair tissues exhibited some evidence of zonal architecture such as native cartilage and the best bone integration; nonetheless, they developed exuberant growth, often causing patellar instability and osteoarthritis.</p><p><strong>Conclusions: </strong>IZN or ANL cells exhibited some potential to recapitulate developmental features during cartilage repair. However, identifying regulatory determinants of IZN and ANL-derived overgrowths is necessary.</p><p><strong>Clinical relevance: </strong>Studies grafting IZN or ANL tissues in larger animal models with regular immune functions may provide additional insights into improving osteochondral regeneration.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Source Characteristics Influence AI-Enabled Orthopaedic Text Simplification: Recommendations for the Future.","authors":"Saman Andalib, Sean S Solomon, Bryce G Picton, Aidin C Spina, John A Scolaro, Ariana M Nelson","doi":"10.2106/JBJS.OA.24.00007","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00007","url":null,"abstract":"<p><strong>Background: </strong>This study assesses the effectiveness of large language models (LLMs) in simplifying complex language within orthopaedic patient education materials (PEMs) and identifies predictive factors for successful text transformation.</p><p><strong>Methods: </strong>We transformed 48 orthopaedic PEMs using GPT-4, GPT-3.5, Claude 2, and Llama 2. The readability, quantified by the Flesch-Kincaid Reading Ease (FKRE) and Flesch-Kincaid Grade Level (FKGL) scores, was measured before and after transformation. Analysis included text characteristics such as syllable count, word length, and sentence length. Statistical and machine learning methods evaluated the correlations and predictive capacity of these features for transformation success.</p><p><strong>Results: </strong>All LLMs improved FKRE and FKGL scores (p < 0.01). GPT-4 showed superior performance, transforming PEMs to a seventh-grade reading level (mean FKGL, 6.72 ± 0.99), with higher FKRE and lower FKGL than other models. GPT-3.5, Claude 2, and Llama 2 significantly shortened sentences and overall text length (p < 0.01). Importantly, correlation analysis revealed that transformation success varied substantially with the model used, depending on original text factors such as word length and sentence complexity.</p><p><strong>Conclusions: </strong>LLMs successfully simplify orthopaedic PEMs, with GPT-4 leading in readability improvement. This study highlights the importance of initial text characteristics in determining the effectiveness of LLM transformations, offering insights for optimizing orthopaedic health literacy initiatives using artificial intelligence (AI).</p><p><strong>Clinical relevance: </strong>This study provides critical insights into the ability of LLMs to simplify complex orthopaedic PEMs, enhancing their readability without compromising informational integrity. By identifying predictive factors for successful text transformation, this research supports the application of AI in improving health literacy, potentially leading to better patient comprehension and outcomes in orthopaedic care.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perception of Residency Program Diversity Is Associated With Vulnerability to Race and Gender Stereotype Threat Among Minority and Female Orthopaedic Trainees.","authors":"Risa T Reid, Susan M Odum, Patrick J Rosopa, Jaysson T Brooks, Brian P Scannell, Selina Poon, Tyler Williams, Joshua C Patt, Gabriella E Ode","doi":"10.2106/JBJS.OA.24.00084","DOIUrl":"10.2106/JBJS.OA.24.00084","url":null,"abstract":"<p><strong>Introduction: </strong>Stereotype threat (ST) is a psychological phenomenon in which perceived fear of confirming negative stereotypes about one's identity group leads to impaired performance. Gender and racial ST has been described in various academic settings. However, it is prevalence in orthopaedic surgery, where women and minorities are underrepresented, has not been examined. This study analyzes the prevalence of ST among orthopaedic surgery residents and fellows.</p><p><strong>Methods: </strong>US orthopaedic trainees completed a voluntary anonymous survey, which included demographics, perceived program diversity based on percentage of racial-ethnic and gender-diverse faculty and trainees, and a validated, modified version of the Stereotype Vulnerability Scale (SVS). Higher scores indicate greater ST vulnerability. ST prevalence was analyzed with descriptive statistics, and associations between program diversity, resident demographics, and ST vulnerability were compared using nonparametric tests.</p><p><strong>Results: </strong>Of 1,127 orthopaedic trainees at 40 programs, 322 responded (response rate 28.6%). Twenty-five percent identified as female, and 26% identified as an underrepresented minority in medicine (i.e., Asian, Black, or Hispanic). Asian (12 points), Black (12.5 points), and Hispanic (13.5 points) trainees had significantly higher SVS scores than White trainees (9 points) (p = 0.0003; p < 0.0001; p = 0.0028, respectively). Black trainees at perceived racially nondiverse residencies had the highest mean SVS scores (16.4 ± 1.03 points), while White trainees at perceived racially nondiverse residencies had the lowest SVS scores (9.3 ± 0.3 points), p = 0.011. Women had significantly higher gender stereotype vulnerability than men (p < 0.0001) in both gender-diverse (17.9 ± 0.2 vs. 9.0 ± 0.3 points) and gender nondiverse residencies (16.4 ± 0.4 vs. 9.6 ± 0.2 points).</p><p><strong>Conclusion: </strong>Minority and female orthopaedic trainees had higher ST vulnerability, especially in programs perceived as lacking racial or gender diversity. While perceived program diversity may offer some protection for minority and women trainees, women trainees still met the threshold for high vulnerability regardless of program gender diversity. Future strategies to mitigate ST should be explored in orthopaedic training.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11692954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}