JBJS Open Access最新文献

{"title":"Cannabidiol Perceptions and Use in the Orthopaedic Patient Population.","authors":"Bradley Lambert, Karen L Hernandez, Haley Goble, Erin Orozco, Patrick C McCulloch","doi":"10.2106/JBJS.OA.24.00141","DOIUrl":"10.2106/JBJS.OA.24.00141","url":null,"abstract":"<p><strong>Background: </strong>Although explored in other medical fields, cannabidiol (CBD) use for pain management remains understudied in orthopaedics. The purpose of this study was to evaluate the frequency of CBD use and perceptions among an orthopaedic population. We hypothesized that most patients would be aware of CBD, that the prevalence of CBD use would at least be comparable with the general population (∼15%), and that the overall perception of CBD use for pain relief would be favorable.</p><p><strong>Methods: </strong>Five hundred adult orthopaedic patients (♂249/♀247; 4 = undisclosed, 54 ± 16 years, 18-86 years) seeking treatment for a wide range of conditions were recruited from a single hospital system before undergoing surgery. Patients were sent an email with a REDCap link for an anonymous survey that included questions about the following: demographics, procedure type, current pain levels, previous knowledge of and/or use of CBD, and indication of favorability regarding CBD use for pain management.</p><p><strong>Results: </strong>Among all patients, >80% reported having heard of CBD and 41.8% reported having used CBD. Among patients reporting previous CBD use, \"pain management\" (79.43%) and \"seeking alternative pain treatment\" (58.81%) were the most common reasons. Among patients reporting no use, the most common reasons were \"unsure of how to obtain\" (42.76%) or \"lack of familiarity\" (37.24%); although the same patients indicated they would consider using if prescription CBD was available (61.22%) along with more evidence regarding safety/efficacy (44.90%). Over 80% of the surveyed patients agreed that CBD might be effective for pain management (p < 0.05).</p><p><strong>Conclusion: </strong>A large proportion of orthopaedic patients have used, or are aware of, CBD for pain management. Presently, barriers to use appear to be most associated with the need for more evidence regarding efficacy/safety and the availability of physician-prescribed pharmaceutical-grade CBD. These results highlight an important need for large-scale randomized trials that may support pharmaceutical-grade CBD use for pain management.</p><p><strong>Level of evidence: </strong>Level III, Descriptive Survey Study. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804337","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":"Rethinking the Paradigm of Using Ps for Diagnosing Compartment Syndrome.","authors":"Yasser Bouklouch, July Agel, William T Obremskey, Andrew H Schmidt, Kathy Liu, Jerald R Westberg, Matthew Zakariah, Eli Bunzel, Greer Henry, Andres Fidel Diaz, Thierry Bégué, Mitchell Bernstein, Edward J Harvey","doi":"10.2106/JBJS.OA.24.00065","DOIUrl":"10.2106/JBJS.OA.24.00065","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the predictive power of 7 clinical signs and symptoms associated with acute compartment syndrome (ACS) of the leg, namely pain, paresthesia, paralysis, pallor, poikilothermia, pulselessness, and pressure on palpation (7P's).</p><p><strong>Methods: </strong>Retrospective data of 357 patients were obtained from the databases of 5-level one trauma centers in Canada, the United States, and France. Inclusion criteria were patients with tibia injuries that received fasciotomies in adults with documented serial clinical assessments. All possible combinations of signs/symptoms used were generated. The combinations were tested for predictive power using 2 machine learning algorithms.</p><p><strong>Results: </strong>Pressure on palpation was the strongest clinical predictor of ACS while pain was the weakest. Using any single P to assess for ACS yields a poor prediction. Increasing the number of Ps improves the performance up to 4Ps, regardless of the composition of the combination. None of the combinations had a perfect predictive power which means that the use of single or multiple Ps does not guarantee diagnosis. Predictive performance indicated that poikilothermia, pallor, and paralysis are not significantly informative.</p><p><strong>Conclusion: </strong>The presence of specific patterns of clinical signs/symptoms associated with ACS seems to influence a surgeon's decision to perform fasciotomy. These data question the gold standard of clinical signs for diagnosis of ACS. The reliance on the Ps classically taught in medical school does not seem to be sufficient for accurate diagnosis. Objective measures such as continuous pressure or a physiologic marker of ischemia may be better indications for compartment syndrome.</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 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804365","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":"Developing a Quality Improvement Curriculum in a Community-Based Orthopaedic Surgery Residency.","authors":"Bernard F Hearon, Matthew G Van Engen, Vafa Behzadpour, Seth A Tarrant, Bradley R Dart","doi":"10.2106/JBJS.OA.24.00248","DOIUrl":"10.2106/JBJS.OA.24.00248","url":null,"abstract":"<p><strong>Background: </strong>In response to Accreditation Council of Graduate Medical Education (ACGME) directives, a resident-led quality improvement (QI) curriculum was implemented in our orthopaedic residency program. This study describes the evolution of this curriculum, the QI projects resulting from our program, and resident perceptions of the curriculum as an educational tool and a means to improve patient care and the residency experience.</p><p><strong>Methods: </strong>QI teams consisted of one resident from each post-graduate year group filling the hierarchical roles of team leader, project coordinator, team recorder, and topic researcher. QI projects proposed by residents and approved by the program director were approached using Six Sigma methodology to Define, Measure, Analyze, Improve, and Control (DMAIC) the quality issue. In 6-8 conferences during the academic year, residents studied QI concepts and applied the principles learned to their selected topics. Current residents and recent graduates were surveyed regarding their experience with the curriculum.</p><p><strong>Results: </strong>Since 2016, residents conducted 22 QI projects of which 6 which were published in our university medical journal. Ten studies focused on improving patient care or community health, 10 augmented professional education, and 2 enhanced resident wellness. When surveyed, most current residents and recent graduates opined that our curriculum was an effective educational tool for the QI program. Among graduates, 89% of respondents indicated they have applied QI concepts learned during residency to improve patient care in their own practice.</p><p><strong>Conclusions: </strong>Our curriculum, based on the DMAIC process, enabled residents to design and conduct effective QI projects thereby elevating the quality of our residency training program. The curriculum fulfilled the ACGME requirements and core competencies for orthopaedic residents in the QI domain and, more importantly, prepared graduates to champion QI initiatives for their own patients.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804339","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":"Imposter Syndrome Among Orthopaedic Surgery Residents is Extremely Common and Disproportionately Affects Female Residents.","authors":"Harsh Wadhwa, Harmon S Khela, Monty S Khela, Noelle Van Rysselberghe, Anastasia A Hunt, Laura Lu, Julius Bishop","doi":"10.2106/JBJS.OA.24.00132","DOIUrl":"10.2106/JBJS.OA.24.00132","url":null,"abstract":"<p><strong>Introduction: </strong>Imposter syndrome is a psychological phenomenon in which individuals experience persistent self-doubt and feelings of inadequacy despite achieving objective measures of success. This phenomenon is associated with lower job satisfaction, increased rates of burnout, and reduced productivity. Therefore, the purpose of this study was to determine the prevalence of imposter syndrome among orthopaedic surgery residents and determine whether specific individual or residency characteristics predict higher rates of imposter syndrome.</p><p><strong>Methods: </strong>An anonymous survey was distributed to residents at 7 ACGME-accredited orthopaedic surgery residencies. Respondents provided deidentified demographic data and completed the Clance Imposter Phenomenon Scale (CIPS) assessment. CIPS scores were used to categorize imposter syndrome severity as none to mild, moderate, significant, or intense. Differences were calculated and compared using t-test and χ² analyses. Multivariable regression analysis was used to identify predictors of increased symptom severity.</p><p><strong>Results: </strong>One hundred orthopaedic surgery residents completed the survey. Forty percent of respondents were female, and the mean age was 30.6 ± 2.8 years. The prevalence of significant or intense imposter syndrome was 73%. CIPS scores and significant or intense imposter syndrome did not vary by age, gender, sexual orientation, race/ethnicity, level of training, program region, research year, non-MD degrees, and Step 1, Step 2, or Orthopaedic In-Training Examination (OITE) scores on univariable analyses. On multivariable analysis, female residents were 5.64 (OR = 5.64 [1.04-30.63]) times more likely to have significant or intense imposter syndrome (p = 0.045). Residents at western programs were 0.13 (OR = 0.13 [0.02-0.90]) times as likely to experience significant or intense imposter syndrome (p = 0.039). In addition, women (estimate = 8.72 [1.41-16.04]; p = 0.0201) and those with OITE scores in the 0 to 25th (estimate = 11.92 [0.29-23.54]; p = 0.0446) and 51st-75th (estimate = 12.73 [2.79-22.67]; p = 0.0128) percentiles had higher CIPS scores.</p><p><strong>Conclusions: </strong>Imposter syndrome is common among orthopaedic surgery residents, with 73% experiencing significant or intense symptoms. Female gender, lower OITE scores, and training in nonwestern regions predicted increased imposter syndrome severity. Targeted programs may help reduce burnout and improve career satisfaction and advancement.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804341","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":"Knee Lyme Arthritis in Pediatric and Adolescent Patients May Be Associated With Meniscal Changes on MRI.","authors":"Matthew D Milewski, Kirsten Ecklund, Sang Won Lee, Ryan P Coene, Ryan M Sanborn, Emma C Gossman, Patricia E Miller, Benton E Heyworth, Yi-Meng Yen","doi":"10.2106/JBJS.OA.24.00080","DOIUrl":"10.2106/JBJS.OA.24.00080","url":null,"abstract":"<p><strong>Background: </strong>Lyme arthritis is a common manifestation of late-stage Lyme disease in pediatric and adolescent patients. Patients with Lyme arthritis typically present with atraumatic knee effusion and may undergo magnetic resonance imaging (MRI) to aid in diagnosis. The incidence of meniscal pathology on MRI in association with Lyme arthritis is unknown. This study aims to evaluate the incidence of meniscal pathology on MRI in young patients with Lyme arthritis.</p><p><strong>Methods: </strong>Patients (<18 years old) presenting with a unilateral knee effusion from 2009 to 2019 with a positive Lyme antibody serologic test, MRI within 2 weeks of the positive test, and ultimate diagnosis of Lyme arthritis were included in the study. MRI, which was performed to distinguish Lyme arthritis from other causes of knee effusion, underwent analysis by a pediatric musculoskeletal radiologist. Meniscal signal abnormality was graded as follows: grade 1 = globular, grade 2 = linear nonsurfacing, and grade 3 = surfacing tear.</p><p><strong>Results: </strong>Eighty-seven patients (10.6 ± 3.9 years, 71.3% male, 67.8% White) were included. Fourteen (16%) patients had meniscal changes (grade 1: n = 4 [5%]; grade 2: n = 3 [3%]; grade 3: n = 7 [8%]). Thirteen of the 14 patients (93%) with meniscal changes on MRI were treated only with oral antibiotics, with resolution of knee symptoms and return to sports, whereas 1 patient (7%) underwent arthroscopic partial meniscectomy.</p><p><strong>Conclusions: </strong>Of the 87 pediatric patients with serologically confirmed Lyme arthritis and MRI of their affected knee, 16% had a coexistent meniscal abnormality on MRI, but only 1 patient overall required surgical treatment related to the meniscus. Physicians should be aware of potential MRI meniscal changes in pediatric and adolescent patients who present with symptomatic knee effusion because of Lyme arthritis. Future research to evaluate the physiologic effects of Lyme arthritis on meniscal tissue is needed.</p><p><strong>Level of evidence: </strong>Level IV Case Series. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804342","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":"Impact of Flatback Deformity and Stiff Spinopelvic Mobility on 3-Dimensional Pelvic and Hip Kinematics After Total Hip Arthroplasty.","authors":"Toshiki Konishi, Satoshi Hamai, Hidehiko Higaki, Daisuke Hara, Shinya Kawahara, Ryosuke Yamaguchi, Goro Motomura, Taishi Sato, Takeshi Utsunomiya, Satoshi Yamate, Satoru Ikebe, Yuki Nakao, Takahiro Inoue, Yasuhiko Kokubu, Yasuharu Nakashima","doi":"10.2106/JBJS.OA.24.00151","DOIUrl":"10.2106/JBJS.OA.24.00151","url":null,"abstract":"<p><strong>Background: </strong>Spinopelvic abnormalities have been reported to be a risk factor for dislocation after total hip arthroplasty (THA). This study aimed to compare the kinematics of the pelvis and hip joints in patients with and without spinopelvic abnormalities after THA and to elucidate dynamic forward-leaning movement during chair-rising, which are not detectable through static radiographs.</p><p><strong>Methods: </strong>This case series included 108 hips that underwent dynamic anteroposterior radiographic imaging of the sit-to-stand motion after THA. The average age at surgery was 68 ± 10 years, with 95 hips (88%) in women (average body mass index, 23.5 ± 3.2 kg/m²). Kinematic analysis was performed to measure the anterior pelvic plane angle (APPa) and hip flexion/extension angles from seated to standing positions using model-image registration techniques. Pelvic incidence (PI) and lumbar lordosis (LL) were measured to calculate PI-LL.</p><p><strong>Results: </strong>Flatback deformity was present in 45 hips (42%) and stiff spinopelvic mobility (SPM) in 35 hips (32%), with both deformities present in 21 hips (19%). The pelvis was consistently significantly posteriorly tilted in the flatback deformity group throughout the movement compared with the normal group, with the greatest difference observed in the standing position. The hip flexion angles in the flatback deformity group showed significant extension in the standing position (7° greater than that in the normal group). For stiff SPM, a significant posterior tilt in the standing position was observed. Accordingly, the range between the maximum hip flexion and extension was 13° greater. There was no significant difference between the maximal flexion and extension centers.</p><p><strong>Conclusions: </strong>Patients with flatback deformities consistently exhibited posterior APPa, especially when standing. In stiff SPM, a large range of hip flexion and extension while chair-rising increased the risk of impingement, indicating the necessity for a wider range of motion without changing the target orientation. These findings highlight the importance of considering spinopelvic alignment when planning cup positioning in THA to minimize the risk of dislocation.</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":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11918609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692999","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":"Accuracy of Acetabular Component Positioning Using a Mixed Reality-Guided Navigation System During Total Hip Arthroplasty.","authors":"Alexander F Heimann, William S Murphy, Daniel C Sun, Stephen B Murphy","doi":"10.2106/JBJS.OA.24.00144","DOIUrl":"10.2106/JBJS.OA.24.00144","url":null,"abstract":"<p><strong>Background: </strong>Surgeons increasingly recognize the importance of patient-specific considerations in determining ideal cup alignments. In addition, various surgical navigation systems have been reported to improve cup placement accuracy during total hip arthroplasty (THA). Recently, a novel computed tomography (CT)-based planning and mixed-reality (MR) guidance system was developed to enable patient-specific 3-dimensional planning of the ideal cup position and further improve intraoperative achievement of the planned orientation.</p><p><strong>Methods: </strong>This is retrospective, observational study of 40 patients (40 hips) who underwent MR-guided THA. Patient-specific CT-based surgical planning with definition of target operative anteversion and inclination of the acetabular cup in relation to the anterior pelvic plane was performed. 3D holograms of the cup and cup impactor in the selected target position were created and exported. Intraoperatively, automatic holographic registration was performed using a smart tool-based linked-paired-point matching method. Patient-specific content was displayed on a head-mounted display, and the acetabular component was inserted by matching the spatial position of the cup impactor with the hologram of the cup impactor in the target position. Postoperatively, patients underwent biplane simultaneous imaging for measurement of achieved cup alignment using a validated measurement method.</p><p><strong>Results: </strong>Mean planned operative anteversion and inclination angles were 28.4° ± 1.6° (95% confidence interval [CI], 27.9°-28.8°) and 39.9° ± 0.3° (95% CI, 39.8°-40.0°), respectively. The mean absolute target error between preoperative target operative anteversion and the achieved operative anteversion was 0.7° ± 1.1° (95% CI, 0.3°-1.0°; range, 0°-4°). The mean absolute target error between preoperative target operative inclination and the achieved operative inclination was 1.1° ± 1.2° (95% CI, 0.7°-1.4°; range, 0°-4°).</p><p><strong>Conclusion: </strong>Acetabular component positioning using a mixed reality guidance system during THA was highly accurate and well within the accuracy reported for other navigation systems.</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":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11918603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692996","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":"Surgical Treatment of Sprengel's Deformity in Adolescents and Adults.","authors":"Abdulaziz F Ahmed, Ryan S Lohre, Bassem T Elhassan","doi":"10.2106/JBJS.OA.24.00108","DOIUrl":"10.2106/JBJS.OA.24.00108","url":null,"abstract":"<p><strong>Background: </strong>Most patients with congenital shoulder girdle abnormalities receive treatment in childhood, with limited treatment reports in older populations. The aim of this study was to describe the surgical treatment and outcomes for adolescents and adults with Sprengel's deformity (SD).</p><p><strong>Methods: </strong>A retrospective review was conducted on patients treated for SD, a congenital shoulder girdle abnormality, by a single surgeon between 2011 and 2018. Patient demographics, surgical findings, procedures, complications, active range of motion, visual analog scale (VAS) pain scores, Single Assessment Numeric Evaluation (SANE), and 5-point Likert scale satisfaction were recorded. Univariate statistics were used to compare preoperative and postoperative outcomes.</p><p><strong>Results: </strong>Fourteen patients with an average age of 23.9 ± 10.1 years and a mean follow-up of 5.4 years (range 1-9 years) were included for analysis. All patients had unilateral pathology. Mean VAS pain scores improved from 6.3 ± 2.6 to 1.2 ± 0.9 (p < 0.001). The SANE score improved from 36.8% ± 9.6% to 77.5% ± 6% (p < 0.001). Average postoperative satisfaction was 4.8 ± 0.4. Forward elevation improved from 97° ± 18.1° to 137° ± 14° (p < 0.001), while abduction, external rotation, and internal rotation remained similar. Surgical treatments included reattachment of the lower trapezius to its anatomical insertion (N = 13), latissimus dorsi transfer to the medial scapular spine (N = 13), medial scapular border resection (N = 12), split pectoralis major transfer (N = 12), rhomboid and/or levator scapulae advancement (N = 12), anlage excision (N = 6), excision of a coracoclavicular ligament bony bridge (N = 1), and upper serratus advancement to the superomedial scapular border (N = 1). Only 1 patient underwent scapulothoracic fusion.</p><p><strong>Conclusion: </strong>In children, treatment of SD focuses on scapular distalization due to greater soft-tissue plasticity, while in older individuals, this was unfeasible due to stiffer soft-tissue and multiple periscapular muscular deficiencies. This series demonstrates treatment strategies in older patients, involving osseous resections and tendon transfers, resulting in significant improvements over a mean 5.4-year follow-up. Given the rarity of SD in older populations, multicenter studies are warranted to further validate this approach.</p><p><strong>Level of evidence: </strong>Case Series; Level IV. 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":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11918768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693387","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":"Away Rotations Have Increased Importance for Matching in Orthopaedic Surgery.","authors":"Dana H Tran, Randy M Cohn, Adam P Schiff, Shreya M Saraf, Mia V Rumps, Mary K Mulcahey","doi":"10.2106/JBJS.OA.24.00182","DOIUrl":"10.2106/JBJS.OA.24.00182","url":null,"abstract":"<p><strong>Introduction: </strong>Orthopaedic surgery is one of the most competitive specialties. In 2024, 1,492 medical students applied to 916 orthopaedic surgery first-year training positions. There are no recent data examining trends in the number of away rotations performed by medical students interested in orthopaedic surgery. The purpose of this study was to enhance understanding about the significance of away rotations and home rotations for successfully matching into orthopaedic surgery.</p><p><strong>Methods: </strong>In January 2024, the survey was distributed to orthopaedic surgery postgraduate year 1 (PGY-1) students at programs participating in the Collaborative Orthopaedic Education Research Group (COERG). The survey was distributed in March 2024 to 4th-year medical students who rotated at participating COERG residency programs. Data were collected on away rotations completed, motivations for participating, barriers encountered, and if the respondent matched at a program where they rotated.</p><p><strong>Results: </strong>Survey responses were collected from 37 of 90 PGY-1 students (41.1%) and 62 of 325 4th-year medical students (19.1%). The study cohort consisted of 99 applicants from the 2023 and 2024 orthopaedic surgery residency match cycles. PGY-1 students and 4th-year medical students completed an average of 3.4 away rotations and applied to an average of 4.4. Eight of 62 4th-year medical students (12.9%) did not match, with their average number of away rotations being 3.75. Of the 91 respondents who matched, 50 (54.9%) matched at an outside program where they rotated during 4th year. Fifteen (16.5%) matched at their home program. Fifteen (16.5%) matched at a program they had no prior exposure to before the residency interview. Six (6.6%) matched at a program with prior exposure and no away rotation. Five (5.5%) matched at a program with geographical ties and no away rotation.</p><p><strong>Conclusion: </strong>Medical students applying to orthopaedic surgery residency are completing more away rotations than noted in previous studies. Most medical students match at programs where they complete away rotations or their home program, which subsequently increases the importance of where students decide to do rotations and the number they complete.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658985","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 Epidemiology of Traumatic Brachial Plexus Injuries in England and Wales-A 32-Year Review.","authors":"Abbey Boyle, Chiraag Karia, Ryckie G Wade, Fiona Lecky, David Yates, Tom J Quick, Grainne Bourke","doi":"10.2106/JBJS.OA.24.00105","DOIUrl":"10.2106/JBJS.OA.24.00105","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brachial plexus injuries (TBPI) are often devastating and life-changing and are thought to be becoming more prevalent. Several studies have investigated the epidemiology of TBPI in other countries (e.g., United States, Brazil); however, a similar analysis is yet to be undertaken in England and Wales. The aim of this cohort study was to determine the incidence and epidemiology of TBPI in England and Wales.</p><p><strong>Methods: </strong>The Trauma Audit and Research Network database was reviewed to identify 1,297 eligible patients admitted with TBPI between 1990 and 2022. Patient demographics, injury mechanism, associated injuries, and outcomes were analyzed.</p><p><strong>Results: </strong>The median age of patients with TBPI was 41 years, and 77% (n = 997) were male. There was a significant difference in age between male patients and female patients, with male patients aged younger than 18 years (confidence interval 14.4-21.3) at the time of injury. The predominant injury mechanism was vehicle collision (65%), with 62% riding motorcycle or quad bikes. The majority of other injuries resulted from falls less than 2 m (19%). Falls less than 2 m were particularly prevalent in patients aged older than 65 years, who represented 19% of the cohort. TBPI was commonly associated with other injuries (94%), predominately bony injuries including dislocations and fractures.</p><p><strong>Conclusion: </strong>This is the first epidemiological study of TBPI within England and Wales. Vehicle incidents, particularly involving motorcycles, are the commonest cause of TBPI; however, there is a substantial cohort of elderly patients sustaining TBPI, often from falls. These findings may aid improved and earlier recognition of TBPI, enabling timely management.</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":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658993","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}