JBJS Open Access最新文献

{"title":"Visual Feedback-Based Rehabilitation Improves Gait Recovery After Total Hip Arthroplasty: A Randomized Controlled Clinical Trial.","authors":"Riccardo Spanò, Antonio Ammendolia, Nicola Marotta, Alessandro de Sire, Maria Girolama Raso, Simone Carozzo","doi":"10.2106/JBJS.OA.26.00065","DOIUrl":"10.2106/JBJS.OA.26.00065","url":null,"abstract":"<p><strong>Background: </strong>This randomized controlled trial investigated whether adding a visual feedback-based (VFB) rehabilitation program to standard care could enhance gait performance and pelvic kinematics in patients recovering from total hip arthroplasty (THA).</p><p><strong>Methods: </strong>Inpatients aged 55 to 80 years who underwent unilateral THA by a lateral approach were randomized to either a VFB group or a control group. The VFB group received 30 minutes of technology-assisted visual feedback training using TecnoBody systems plus 30 minutes of conventional physiotherapy daily, while the control group received one hour of conventional therapy alone, both 5 days per week for 6 weeks. Gait and pelvic kinematics were assessed using the G-WALK inertial sensor at baseline and after 6 weeks, alongside clinical measures for pain, functional independence, and ambulation capacity.</p><p><strong>Results: </strong>Both groups showed significant improvements on clinical scales, with no meaningful differences between them. However, the VFB group demonstrated significantly greater gains in key gait and kinematic parameters, including cadence, speed, symmetry, pelvic tilt, and pelvic obliquity, with multivariate analysis confirming a distinct and more favorable post-treatment kinematic profile.</p><p><strong>Conclusion: </strong>Incorporating visual feedback-based training into postoperative rehabilitation after THA leads to superior improvements in gait quality and pelvic control compared with conventional therapy alone, supporting its clinical integration in standard physiotherapy programs.</p><p><strong>Level of evidence: </strong>Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 4","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168377","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":"Private Equity in Orthopaedics: An Analysis of Practice Acquisitions, 2016 to 2023.","authors":"Kathryn R Segal, Stephen Wendolowski, Megha Reddy, Phillip Schmitt, Raymond Y Hsu, Yashaswini Singh","doi":"10.2106/JBJS.OA.26.00128","DOIUrl":"10.2106/JBJS.OA.26.00128","url":null,"abstract":"<p><strong>Introduction: </strong>Private equity (PE) has had an increasing influence in health care, including procedural subspecialties such as orthopaedic surgery. No studies yet have characterized the orthopaedic practices that are acquired by PE firms.</p><p><strong>Methods: </strong>This cross-sectional study analyzed PE acquisitions of orthopaedic practices in the United States between January 1, 2016, and December 31, 2023. A combination of PitchBook and manual web searches was used to identify PE acquisitions. The Medicare Data on Provider Practice and Specialty were used to identify Tax Identification Numbers of practices and the unique providers of each practice at time of affiliation.</p><p><strong>Results: </strong>Eighty-nine orthopaedic practices were identified from 2016 to 2023, accounting for 4.8% of orthopaedists by 2023. More than three-quarters of acquisitions took place from 2021 to 2023 (77.5%). Nearly half of acquisitions were in the South (47.2%). At time of acquisition, 36.6% of providers in the practices were surgeons, 10.0% were nonsurgical physicians, and 53.4% were ancillary providers, such as advanced practice providers and therapists. The most represented subspecialties included sports (24.8%) and arthroplasty (18.2%), and the least represented were pediatrics (0.7%) and tumor (0.3%).</p><p><strong>Conclusion: </strong>PE involvement in orthopaedics skyrocketed in 2021. Practices targeted by PE firms typically included a multidisciplinary mix of providers, more than half of whom were nonphysician adjuncts, with a geographic predilection for the South. Orthopaedic subspecialties with historically higher reimbursements and outpatient volumes were overrepresented in PE-acquired practices. Future work should examine the resulting influence of PE in orthopaedics, including provider turnover, practice patterns, and clinical outcomes.</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":"11 4","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166671","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":"Efficacy and Safety of Intraosseous Regional Versus Intravenous Tranexamic Acid in Total Knee Arthroplasty: A Randomized Controlled Trial.","authors":"Shuaifei Tian, Baochao Ji, Yicheng Li, Xiaogang Zhang, Guoqing Li, Boyong Xu, Li Cao","doi":"10.2106/JBJS.OA.26.00282","DOIUrl":"10.2106/JBJS.OA.26.00282","url":null,"abstract":"<p><strong>Background: </strong>Tranexamic acid (TXA) reduces perioperative blood loss in total knee arthroplasty (TKA); however, evidence for intraosseous regional administration (IORA) remains limited. We evaluated the efficacy and safety of IORA-TXA versus intravenous TXA (IV-TXA) in TKA.</p><p><strong>Methods: </strong>In this prospective, randomized, single-center trial, 98 patients undergoing primary TKA were randomized 1:1 to IORA-TXA or IV-TXA (49 per group) at a uniform dose of 20 mg/kg. The primary outcome was calculated perioperative blood loss. Secondary efficacy outcomes included calculated hidden blood loss, postoperative hemoglobin (Hb) levels, and transfusion rate. Safety outcomes included deep vein thrombosis (DVT), muscular calf vein thrombosis, pulmonary embolism (PE), and wound-related complications.</p><p><strong>Results: </strong>Compared with IV-TXA, IORA-TXA reduced calculated perioperative blood loss (674.8 ± 335.0 vs. 817.5 ± 357.2 mL; mean difference, 142.6 mL; 95% CI, 7.4-277.8; p = 0.038) and calculated hidden blood loss (644.8 ± 335.5 vs. 790.9 ± 339.0 mL; mean difference, 146.1 mL; 95% CI, 10.9-281.3; p = 0.035). Postoperative Hb was similar on POD1 (134.0 ± 9.8 vs. 130.1 ± 11.1 g/L; p = 0.067) but was higher with IORA-TXA on POD2 (119.8 ± 8.3 vs. 113.8 ± 11.5 g/L; mean difference 6.0 g/L; 95% CI 2.0-10.0; p = 0.005) and POD3 (114.8 ± 7.9 vs. 109.8 ± 12.6 g/L; mean difference 5.0 g/L; 95% CI 0.8-9.2; p = 0.020). No patient required blood transfusion. DVT detected by routine postoperative Doppler occurred numerically more often with IORA-TXA than with IV-TXA: 10.2% (95% CI, 3.4%-22.2%) versus 0.0% (95% CI, 0.0%-7.3%); p = 0.056.</p><p><strong>Conclusions: </strong>IORA-TXA reduced calculated perioperative and hidden blood loss and improved early postoperative Hb preservation compared with IV-TXA. However, DVT incidence was numerically higher with IORA-TXA, indicating a potential thromboembolic safety signal that warrants confirmation in larger, adequately powered trials.</p><p><strong>Level of evidence: </strong>Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 4","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168335","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":"The Future of Rural Orthopaedic Practice: A Resident Survey Study.","authors":"Andrew Moore, Isaiah Roepe, Damon Mar, James Barber, Kimberly Templeton","doi":"10.2106/JBJS.OA.26.00155","DOIUrl":"10.2106/JBJS.OA.26.00155","url":null,"abstract":"<p><strong>Background: </strong>Those who live in rural areas generally exhibit higher prevalence of musculoskeletal conditions than urban populations. Already limited access to local orthopaedic care is becoming more challenging, as orthopaedic surgeons in these areas tend to be older and nearing retirement, while few graduating residents are selecting rural practice. However, little data exist on why orthopaedic residents are not choosing rural practice despite the clear need.</p><p><strong>Methods: </strong>A 22-question survey was created in REDCap. A letter of invitation to participate was sent to interested program directors through the AOA Collaborative Orthopaedic Education Research Group (COERG). Questions included those related to community of origin, level of interest in rural practice, and areas in which more information is needed.</p><p><strong>Results: </strong>One hundred seven orthopaedic surgery residents from 16 programs completed the survey. Only 6 respondents plan to practice in rural areas. Thirty-two reported no interest in rural practice. Sixty-nine respondents were unsure about rural practice. No significant differences in rural interest were found based on gender or parental status. The only demographic factor impacting interest in rural practice was coming from a rural background. Factors leading to interest or disinterest in rural practice were similar. Those indicating that they were unsure wanted more information regarding impact on families, call, compensation, and case volume and complexity.</p><p><strong>Conclusion: </strong>Addressing the gap in rural orthopaedic care is complex, but there are opportunities such as outreach to rural students to encourage them to consider medicine and then orthopaedic surgery as a career, as well as education sessions and rotations during residency training to expand rural interest.</p><p><strong>Clinical relevance: </strong>Understanding the factors that lead to orthopaedic residents pursuing (or not) practice in rural areas is important in addressing access to musculoskeletal care in these areas.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 4","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166271","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":"Hormone Replacement Therapy Is Associated with Increased Risk of Anterior Cruciate Ligament Tear in Midlife Women in the United States.","authors":"Katharine P Playter, Olivia L Gordon, Elizabeth G Matzkin","doi":"10.2106/JBJS.OA.26.00279","DOIUrl":"10.2106/JBJS.OA.26.00279","url":null,"abstract":"<p><strong>Background: </strong>Across the female lifespan, the incidence of anterior cruciate ligament (ACL) tears has demonstrated a bimodal age distribution, and this may be related to fluctuating lifetime estrogen. However, this relationship-and the role of hormone replacement therapy (HRT) and its potentially modifying effect on ACL tear risk-has been underreported. The purpose of this study was to (1) characterize the ACL tear risk pattern in women compared with men in a national database and (2) assess the relationship between HRT and the risk of ACL tear among midlife women.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the Merative^© MarketScan Commercial database. The data set was queried for women 40 to 55 years of age with insurance claims between January 1, 2019, and December 31, 2023. The exposure of interest was any systemic supplemental estrogen. The primary outcome was any ACL tear following the index date. The nearest neighbor 5:1 propensity score was used to generate matched groups with and without exposure to supplemental estrogen.</p><p><strong>Results: </strong>Of 384,582 included individuals, 16,751 were taking HRT. Analysis of aggregate ACL tear events, normalized by person-time, demonstrated a bimodal distribution in women, with peaks during adolescence (16-20 years old) and midlife (40-50 years old). Conditional logistic regression analysis demonstrated that women in the supplemental estrogen-exposed group had a significantly higher risk of any ACL tear (OR: 1.26, 95% CI: 1.02-1.55) and ACL reconstruction (OR: 1.5, 95% CI: 1.07-2.11) compared with the control group.</p><p><strong>Conclusions: </strong>Estrogen-containing HRT was associated with significantly increased risk of ACL tear when controlling for age, comorbidities, and perimenopausal or menopausal status. The relationship between HRT and ACL tear risk is likely multifactorial, and these findings support the need for further prospective studies to better characterize this relationship.</p><p><strong>Level of evidence: </strong>Level III-Retrospective, observational cohort. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 4","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169046","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":"Lack of Curricular Responsiveness to Regional Musculoskeletal Disease Burden in U.S. Medical Education.","authors":"Erica Olfson, Lachlan Anderson, Carl Berghult, Nathaniel Bridge, David Shau","doi":"10.2106/JBJS.OA.26.00018","DOIUrl":"10.2106/JBJS.OA.26.00018","url":null,"abstract":"<p><strong>Introduction: </strong>Musculoskeletal (MSK) disorders are among the leading causes of disability worldwide and account for a substantial proportion of U.S. healthcare visits. Despite this burden, undergraduate medical education devotes limited time to MSK instruction. This study evaluates whether medical school priorities or regional MSK disease burden influence MSK curriculum duration.</p><p><strong>Methods: </strong>Publicly available data from 157 U.S. allopathic medical schools were reviewed; 78 schools with identifiable MSK curriculum duration were included. Schools were categorized by primary care emphasis and geographic region using Association of American Medical Colleges classifications. Regional MSK disease burden was obtained from the Burden of Musculoskeletal Diseases in the United States (BMUS) database. Descriptive statistics, independent t-tests, chi-squared testing, and analysis of variance (ANOVA) were used.</p><p><strong>Results: </strong>Among the 78 U.S. allopathic medical schools with available curriculum data, the mean MSK curriculum duration was 5.97 weeks (SD 2.72; median 6; range 2-14). Thirty-nine schools (50%) emphasized primary care. MSK curriculum duration did not differ between schools with and without a primary care emphasis (5.79 vs. 6.15 weeks, p = 0.561). No significant differences were observed across geographic regions using either the 4-region (p = 0.500) or 9-division (p = 0.920) classifications. Despite substantial regional variation in MSK disease burden, MSK curriculum duration remained relatively uniform.</p><p><strong>Conclusion: </strong>MSK curriculum duration was similar across medical schools, averaging around 6 weeks, regardless of institutional mission or regional disease burden. This suggests that curriculum duration does not vary according to these institutional characteristics and may help inform future discussions regarding undergraduate musculoskeletal curriculum design.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 4","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167457","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":"Femoral-Canal Administration of Tranexamic Acid in Tourniquet-Assisted Total Knee Arthroplasty: A Prospective Randomized Trial.","authors":"Muyang Yu, Mingwei Hu, Te Liu, Yiming Xu, Xingdong Yang, Huiming Peng, Xisheng Weng, Bin Feng","doi":"10.2106/JBJS.OA.26.00161","DOIUrl":"10.2106/JBJS.OA.26.00161","url":null,"abstract":"<p><strong>Background: </strong>This study compared femoral-canal administration of tranexamic acid (TXA), which is a modified intraosseous regional administration (IORA) technique, with intravenous (IV) TXA and combined IORA+IV-TXA across prosthesis designs in tourniquet-assisted, manual total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>This single-center study comprised 2 consecutive prospective, randomized, placebo-controlled, triple-blind cohorts: a previously reported cruciate-retaining (CR) cohort followed by a posterior-stabilized (PS) cohort. Within each cohort, patients undergoing primary, unilateral, manual TKA were randomized to IORA-TXA, IV-TXA, or IORA+IV-TXA. The primary outcome was total blood loss (TBL). Secondary outcomes included transfusion, inflammatory and coagulation markers, pain, knee function, and complications. Pooled and prosthesis-stratified analyses were performed, including treatment-by-prosthesis interaction testing.</p><p><strong>Results: </strong>Among 202 randomized participants (mean age, 69.1 years [SD, 6.5]; 162 women [80%]; CR, 97; PS, 105), TBL differed significantly among groups. Compared with IV-TXA (578.7 ± ±277.4 mL), TBL was lower with IORA-TXA (429.2 ± 293.9 mL, p = 0.010) and IORA+IV-TXA (354.3 ± 252.1 mL, p < 0.001). The treatment-by-prosthesis interaction for TBL was not significant (p = 0.289). Transfusion occurred in 1 participant in the IV-TXA group and none in the IORA-TXA or IORA+IV groups. Statistically significant differences were observed in the selected early inflammatory and clinical outcomes, primarily involving the combined regimen; however, these differences did not translate into clinically meaningful differences in pain scores, range of motion, or KOOS-JR scores by 90 days. No statistically detectable differences in complications were observed.</p><p><strong>Conclusions: </strong>In tourniquet-assisted manual TKA, femoral-canal IORA-TXA reduced TBL compared with IV-TXA, and IORA+IV-TXA showed the lowest mean TBL. These findings should be interpreted within the pre-tourniquet-release IV-TXA protocol; evidence was insufficient to establish corresponding reductions in transfusion or clinically meaningful functional benefits by 90 days.</p><p><strong>Level of evidence: </strong>Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 4","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171245","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":"Abaloparatide Increases Distal Femur Bone Mineral Density Post-Total Knee Arthroplasty.","authors":"Brian Nickel, Diane Krueger, Gretta Borchardt, Samuel Mosiman, Paul A Anderson, Neil Binkley","doi":"10.2106/JBJS.OA.26.00176","DOIUrl":"10.2106/JBJS.OA.26.00176","url":null,"abstract":"<p><strong>Background: </strong>Osteoporosis is common in joint replacement patients and increases adverse outcome risk. Data indicate that total knee arthroplasty (TKA) causes distal femur bone loss. We hypothesized that abaloparatide (ABL) would mitigate this loss. The study's purpose was to evaluate the effect of ABL initiated before TKA on distal femur bone mineral density (BMD) in osteoporotic patients.</p><p><strong>Methods: </strong>TKA candidates age ≥55 years were enrolled in this open-label, prospective, observational 18-month study. Those with clinical osteoporosis, defined as lowest <i>T</i>-score ≤ -2.5 or < -1.0 if prior low-trauma fracture, received daily ABL. TKA patients with osteopenia without fracture comprised an untreated control group. BMD was measured by dual energy x-ray absorptiometry at the L-spine, hip, radius and 2 distal femur regions of interest (ROIs) placed at 15% and 25% of femur length at screening (∼3 months pre-TKA), 1 week pre-TKA, and 6 months and 15 months post-TKA. Patient-reported outcomes were obtained at the same time points. Groups were compared at screening by t-test. Between group outcomes over time were evaluated by repeated measures mixed modelling.</p><p><strong>Results: </strong>At screening (n = 58; 29 ABL/29 control) sex, mean age and mean BMI did not differ between groups. ABL group screening BMD was lower (p ≤ 0.05) at all sites except the L-spine. ABL was dosed for a mean (SD) of 96 (60) days before TKA. Control group distal femur BMD was statistically unchanged, -1.0% and -2.4% at the 15% and 25% ROIs, respectively, at 15 months post-TKA, (p ≥ 0.34). ABL group distal femur BMD increased at the 15% and 25% ROIs and differed from control by 4.6% to 7.6% (all p < 0.01) at 6 and 15 months post-TKA. Knee injury and Osteoarthritis Outcome Score for Joint Replacement demonstrated significantly worse (<0.05) function at baseline in the osteoporotic group and greater improvement over time compared with controls.</p><p><strong>Conclusion: </strong>ABL increases distal femur BMD in osteoporotic patients undergoing TKA. Unlike prior reports distal femur BMD did not decrease after TKA among controls; further study to clarify the effect of TKA on distal femur BMD is needed.</p><p><strong>Trial registration: </strong>Clinical trial status-open-label prospective trial registered at ClinicalTrials.gov: NCT04167163.</p><p><strong>Level of evidence: </strong>Level II, Therapeutic. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041097","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":"Preinjury Smartphone-Derived Mobility Metrics Are Associated With Discharge Location After Lower Extremity Fracture.","authors":"Ian P Marshall, Patrick J McGlone, Janse T Schermerhorn, Brian M Shear, Dane J Brodke, Robert V O'Toole, Gerard P Slobogean, Nathan N O'Hara","doi":"10.2106/JBJS.OA.26.00214","DOIUrl":"10.2106/JBJS.OA.26.00214","url":null,"abstract":"<p><strong>Background: </strong>Early prediction of nonhome discharge after lower extremity fracture treatment may improve care coordination and reduce costs. While preinjury functional status is an established predictor, it is commonly assessed subjectively. We hypothesized that preinjury Apple Health mobility metrics, including step count, walking speed, step length, walking asymmetry, and double support time, would be associated with discharge disposition after fracture management.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adults with lower extremity fractures. Preinjury Apple Health mobility data within 26 weeks of injury were analyzed. The primary outcome was discharge home vs. nonhome. Multivariable logistic regression assessed associations between mobility metrics and discharge location, adjusting for age (<65 vs. ≥65 years) and isolated vs. nonisolated fractures.</p><p><strong>Results: </strong>The cohort included 249 patients (median age, 39 years; 58% male). Overall, 179 (72%) were discharged home, and 70 (28%) to nonhome facilities. Patients discharged home were younger and more likely to have isolated fractures (p < 0.001 for both). In the adjusted model (area under the receiver operating characteristic curve, 0.80; 95% confidence interval [CI], 0.74-0.86), higher preinjury step count was strongly associated with discharge disposition. Compared with <2,500 steps/day, 2,500 to 5,000 steps/day (OR, 2.73; p = 0.03) and >5,000 steps/day (OR, 4.21; p = 0.001) were associated with increased odds of home discharge. Walking asymmetry <10% (OR, 3.21; p = 0.01) and faster walking speed (OR per 0.1 m/s, 1.31; p = 0.01) were also associated with higher odds of home discharge. Patients <65 years with isolated injuries and >5,000 steps/day had a 94% probability of home discharge (95% CI, 90%-98%) compared with 8% (95% CI, 1%-16%; p < 0.001) among those ≥65 years with nonisolated injuries and <2,500 steps/day.</p><p><strong>Conclusions: </strong>Preinjury smartphone mobility data were independently associated with discharge disposition after lower extremity fracture treatment. These objective measures may improve perioperative risk stratification and discharge planning in orthopaedic trauma populations.</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":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991754","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":"Reading the Writing on the Wall: Resident Evaluation Measures as Predictors of Performance in Practice.","authors":"Austin M Beason, Nicole K Roberts, Youssef El Bitar, Margaret L Boehler, Cathy J Schwind, D Gordon Allan","doi":"10.2106/JBJS.OA.25.00119","DOIUrl":"10.2106/JBJS.OA.25.00119","url":null,"abstract":"<p><strong>Background: </strong>Identifying orthopaedic surgery residents at risk of future professional or practice-related difficulties remains challenging. While knowledge-based assessments such as the Orthopaedic In-Training Examination (OITE) are widely used, they incompletely capture behavioral and professionalism concerns that often underlie significant problems during residency and subsequent practice.</p><p><strong>Methods: </strong>We conducted a retrospective, single-institution cohort study of 119 orthopaedic surgery residents who entered training between 1978 and 2013. Institutional resident files were reviewed for documented performance problems in academic, clinical, and professionalism domains, OITE scores, and American Board of Orthopaedic Surgery (ABOS) Part I and Part II examination outcomes. Adverse postresidency indicators were assessed using publicly available data, including board examination failure, licensure status, practice continuity, and persistent negative online presence. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive utility of cumulative documented performance problems and OITE scores.</p><p><strong>Results: </strong>Forty-two residents (35%) had at least 1 documented performance problem during residency (mean 4.98, range 1-13). Residents with documented problems were significantly more likely to fail ABOS Part I (33% vs. 8%; relative risk [RR] 4.28, p = 0.002) and Part II (24% vs. 4%; RR 6.11, p = 0.004) and to demonstrate persistent negative online presence (19% vs. 5%; RR 3.67, p = 0.026). Having more than 1 adverse postresidency indicator was also more common among residents with documented problems (31% vs. 6%; RR 4.77, p = 0.001). On ROC analysis, 4 or more documented problems predicted failure on ABOS Part I (AUC 0.787) and the presence of adverse postresidency indicators (AUC 0.772), while 3 or more problems best predicted ABOS Part II failure (AUC 0.784). OITE scores demonstrated lower predictive accuracy (AUC 0.696) and lacked a clearly actionable threshold.</p><p><strong>Conclusions: </strong>Cumulative documented performance problems during residency-particularly behavioral and professionalism-related concerns-are associated with increased risk of board examination failure and adverse practice outcomes after graduation. Aggregated longitudinal documentation may provide an early, complementary signal of risk beyond knowledge-based testing.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"11 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991719","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}