JBJS Open Access最新文献

{"title":"Assessing Medical Student Preparedness for Orthopaedic Clinical Rotations: Insights from a Cross-Sectional Survey.","authors":"Mitchel Hawley, Anne Boeckmann, Emma Roccaforte, Winston Scambler, David Shau","doi":"10.2106/JBJS.OA.25.00129","DOIUrl":"https://doi.org/10.2106/JBJS.OA.25.00129","url":null,"abstract":"<p><strong>Introduction: </strong>Orthopedic surgery is highly competitive, requiring strong performance in research, exams, and clinical skills. Despite required competency on standardized exams, many students report low confidence in musculoskeletal (MSK) knowledge. These exams often fail to prepare students for the clinical demands of orthopedic rotations, which require a strong foundation in MSK anatomy and radiographic interpretation. This study aimed to assess medical student perceptions of preparedness and exposure to MSK anatomy and radiology during preclinical training.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted at a local orthopedic research conference to evaluate self-reported preparedness among medical students planning to apply for orthopedic residency. The 13-question survey used a 1-5 Likert scale (\"strongly disagree\" to \"strongly agree\"). Eligible participants were students who had completed preclinical training but had not begun orthopedic away rotations. The survey was voluntary, anonymous and distributed via QR code. 41 of 48 students responded (85%). Data was collected via Qualtrics and analyzed using descriptive statistics.</p><p><strong>Results: </strong>Responses were grouped into five categories: curriculum evaluation, self-driven preparation, resource access, x-ray interpretation, and supplemental course value. While 67.6% felt well-prepared in MSK anatomy, only 23.5% felt prepared to interpret MSK radiography, while 55% felt unprepared. Most students (79.4% and 85.3%) spent extracurricular time on MSK x-rays and anatomy, respectively, and 76.5% struggled to find high-quality resources. Only 35.3% of respondents reported feeling somewhat confident in their ability to interpret x-ray if they were to be placed in an orthopedic away rotation, with zero respondents strongly agreeing and 41.2% feeling unconfident. All students agreed that formal MSK x-ray instruction would benefit them, and 91% endorsed a dedicated anatomy course.</p><p><strong>Conclusion: </strong>Students report low confidence and insufficient preparation in MSK radiology and anatomy, despite its importance for orthopedic success. Unanimous support for supplemental instruction highlights the need for improved educational resources. Clinical Relevance: Enhancing MSK anatomy and radiology training may improve student confidence, clinical performance on orthopedic rotations, and match success in orthopedic residency.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259410","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":"Visceral Fat and Ossification of the Posterior Longitudinal Ligament: Insights From a Japanese Cohort.","authors":"Tomoya Sato, Tsutomu Endo, Yoshinao Koike, Hideki Sudo, M Alaa Terkawi, Huohuo Xue, Ryo Fujita, Soya Miura, Ryota Suzuki, Yukitoshi Shimamura, Masahiro Kanayama, Ken Kadoya, Katsuhisa Yamada, Daisuke Ukeba, Misaki Ishii, Norimasa Iwasaki","doi":"10.2106/JBJS.OA.25.00195","DOIUrl":"https://doi.org/10.2106/JBJS.OA.25.00195","url":null,"abstract":"<p><strong>Background: </strong>Ossification of the posterior longitudinal ligament (OPLL) is relatively common in East Asian populations, with a recently revealed link to obesity. However, evidence linking OPLL with visceral fat obesity, which is prevalent in the Asian population, is insufficient. We aimed to examine the association between visceral fat obesity and the development of OPLL.</p><p><strong>Methods: </strong>In a single-center case-control study, data were collected from 120 Japanese patients diagnosed with OPLL and 91 controls without spinal ligament ossification identified during health screenings. From 2020 to 2023, all participants underwent computed tomography to assess visceral fat content and spinal ligament ossification. OPLL was classified as localized (cervical spine) or diffuse (thoracic/lumbar spine). Multivariable logistic regression was conducted to assess the effect size (odds ratio [OR]) of body mass index on the incidence of OPLL and to compare outcomes between groups with a high and low visceral/subcutaneous fat area (V/S) ratio.</p><p><strong>Results: </strong>The proportion of patients with visceral fat obesity was significantly higher in both the localized and diffuse OPLL groups than in the controls (58.9% vs. 64.1% vs. 25.2%, p < 0.05). Patients with OPLL had a higher rate of comorbid visceral fat obesity than the propensity score-matched controls did (56.8% vs. 18.1%, p < 0.001). The effect of BMI on the development of diffuse OPLL was 2.6-fold greater in the high V/S ratio group (OR, 9.50; 95% confidence interval [CI], 2.11 to 42.71) than in the low V/S ratio group (OR, 3.56; 95% CI, 1.51-8.37).</p><p><strong>Conclusions: </strong>Visceral fat obesity was associated with the development of OPLL, particularly diffuse OPLL. The modifying effect of visceral fat accumulation with overweight status was more strongly associated with diffuse OPLL than was that of subcutaneous fat combined with an overweight status.</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 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259419","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":"High Reoperation Rate After Osteosynthesis of Proximal Periprosthetic Tibial Fractures Around Medial Unicompartmental Knee Arthroplasty.","authors":"Stefan Kastalag Risager, Anders Troelsen, Bjarke Viberg, Martin Lindberg-Larsen","doi":"10.2106/JBJS.OA.25.00204","DOIUrl":"https://doi.org/10.2106/JBJS.OA.25.00204","url":null,"abstract":"<p><strong>Background: </strong>A periprosthetic tibial fracture (PPTF) is a known complication of medial unicompartmental knee arthroplasty (mUKA). Treatment options include conversion to total knee arthroplasty (cTKA), open reduction internal fixation (ORIF), and nonoperative treatment. The risk of reoperation after initial treatment of PPTFs is not well examined. Given the rise of cementless mUKA and its association with early (≤4 months), likely surgery-related fractures, this group is particularly interesting. The aim of this study was to (1) report the 2-year risk of reoperation according to initial treatment and (2) report the need for delayed conversion to TKA (dcTKA) after ORIF or nonoperative treatment, or the need for revision TKA (rTKA) after cTKA.</p><p><strong>Methods: </strong>Using data from the Danish Knee Arthroplasty Register and the Danish National Patient Register, all PPTFs after mUKAs between 1997 and 2022 were included and stratified by treatment. Subsequent reoperations and need for dcTKA or rTKA within 2 years were outcomes.</p><p><strong>Results: </strong>We identified 177 PPTFs after mUKA with complete 2-year follow-up. When the treatment of the PPTF was cTKA (69 cases), 5 cases (7%) underwent reoperation and fewer than 5 required rTKA. For nonoperative treatment (46 cases), 13 cases (28%) underwent reoperation, with 10 cases requiring dcTKA. When treated with ORIF (62 cases), 25 cases (40%) underwent reoperation, with 19 cases requiring dcTKA. PPTFs after cemented mUKA were mostly late PPTFs (70%) and were often treated nonoperatively, where PPTFs after cementless mUKA were often early PPTFs (74-78%) and very rarely treated nonoperatively. Fixation of mUKA was not associated with the risk of reoperation within each treatment group. Among 74 early PPTFs after cementless mUKA, 35 cases were treated with cTKA with fewer than 5 reoperations within 2 years and 0 cases needing rTKA. In contrast after ORIF (39 cases), 16 cases (41%) underwent reoperation, with 12 cases requiring dcTKA.</p><p><strong>Conclusion: </strong>PPTFs treated with ORIF were associated with higher rates of reoperation and need for dcTKA compared with PPTFs treated with cTKA and nonoperative treatment. These data suggest that careful consideration is needed before using ORIF as treatment. However, the unknown fracture severity precludes definitive attribution of reoperation to the treatments.</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 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259407","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":"Disparities in Patient-Reported Healthcare Affordability and Access Among Arthroplasty Patients in the All of Us Database.","authors":"Michael J Farias, Theodore Joaquin, Gabriel Gonzalez, Yuchen Hua, Manjot Singh, Joseph E Nassar, Lachlan Kirby, Zvipo M Chisango, Nicolas L Carayannopoulos, Catherine B Hurley, Bassel G Diebo, Alan H Daniels","doi":"10.2106/JBJS.OA.25.00203","DOIUrl":"https://doi.org/10.2106/JBJS.OA.25.00203","url":null,"abstract":"<p><strong>Background: </strong>While racial and ethnic disparities in postoperative outcomes for total hip and knee arthroplasty (THA/TKA) are well-documented, a significant gap remains in understanding patient-reported barriers to care. This study investigates racial and ethnic disparities in self-reported barriers to health care among THA/TKA patients.</p><p><strong>Methods: </strong>This cross-sectional study used data from the All of Us Research Program. Adult patients undergoing THA or TKA were identified using Current Procedural Terminology codes. Multivariable logistic regression was used to analyze 11 self-reported barriers across racial/ethnic groups (non-Hispanic White, Black, Hispanic, and Other). Odds ratios (ORs) were calculated from models after adjusting for age, sex, and/or neighborhood-level Community Deprivation Index (CDI).</p><p><strong>Results: </strong>A total of 4,419 patients were analyzed: 3,706 (83.9%) White, 325 (7.4%) Black, 235 (5.3%) Hispanic, and 153 (3.5%) Other. After adjusting for age, sex, and CDI, Black patients had significantly higher odds of delaying care because of cost of follow-up (OR 2.01, 95% confidence interval [CI] 1.26-3.21), general visits (OR 2.07, 95% CI 1.24-3.47), and co-pays (OR 2.31, 95% CI 1.44-3.71). Both Black (OR 1.99, 95% CI 1.32-2.98) and Hispanic (OR 1.79, 95% CI 1.13-2.82) patients had significantly higher odds of experiencing transportation-related delays.</p><p><strong>Conclusion: </strong>Significant racial and ethnic disparities in affordability and access persist among THA/TKA patients, even after controlling for neighborhood-level socioeconomic deprivation. Black and Hispanic patients experience multifaceted barriers, underscoring that interventions should address not only individual patient circumstances but also structural community-level factors to achieve equitable arthroplasty care.</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 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259452","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":"Short Versus Long Nails in Treating Subtrochanteric Hip Fractures: A Systematic Review and Meta-analysis of Complication Rates.","authors":"Amr Selim, Nikhil Ponugoti, Deepak Menon, Geraint Thomas","doi":"10.2106/JBJS.OA.25.00144","DOIUrl":"https://doi.org/10.2106/JBJS.OA.25.00144","url":null,"abstract":"<p><strong>Background: </strong>Subtrochanteric hip fractures present a treatment challenge due to their varied etiologies, complexity, and associated complications. While intramedullary nailing is the standard treatment, the choice between short and long nails remains controversial. The aim of this meta-analysis was to compare the complication rates of short versus long cephalomedullary nail fixation in the treatment of subtrochanteric hip fractures.</p><p><strong>Methods: </strong>A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Medline, Embase, and CINAHL databases were searched for relevant studies up to May 2025. Inclusion criteria comprised studies directly comparing short and long nails in treating subtrochanteric fractures, including randomized controlled trials and comparative studies. Data synthesis and statistical analysis were performed using RevMan 5.23.5 software.</p><p><strong>Results: </strong>After screening, 5 retrospective comparative studies met the inclusion criteria, encompassing a total of 4,384 subtrochanteric fracture subjects. The weighted mean age was 82 years, with women representing 70.7% of the sample. Implant failure (odds ratio [OR] 2.12; 95% confidence interval [CI] [1.15-3.92]; p = 0.02) and peri-implant fractures (OR 4.03; 95% CI [1.46-11.14]; p = 0.007) were significantly more common with short nails. The reoperation rate was higher with short nails but not statistically significant (OR 1.33; 95% CI [0.87-2.04]; p = 0.19). No significant differences were observed between groups for nonunion (OR 0.96; 95% CI [0.40-2.33]; p = 0.94), deep infection (OR 0.70; 95% CI [0.23-2.17]; p = 0.40), or 1-year mortality (OR 0.83; 95% CI [0.43-1.58]; p = 0.57).</p><p><strong>Conclusion: </strong>The use of short nails in the management of subtrochanteric hip fractures is associated with higher rates of implant failure and peri-implant fractures, with equivalent rates of nonunion, infection, 1-year mortality, and reoperation. These findings highlight the need for a well-conducted trial to assess the overall benefits and to determine the lowest level of subtrochanteric fracture that can be safely treated with short nails.</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 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259386","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":"Patient-Defined Outcomes in Adults with Hip Dysplasia: What Activities Do Patients Hope to Improve with Treatment?","authors":"John M Gaddis, Martin Salgado-Flores, Seunghoon Lee, Syed Ghazi, Hunter Butler, Edward P Mulligan, Charles South, Joel E Wells","doi":"10.2106/JBJS.OA.25.00051","DOIUrl":"10.2106/JBJS.OA.25.00051","url":null,"abstract":"<p><strong>Introduction: </strong>Patient-reported outcome measures have widely been used in the field of orthopaedics to determine treatment outcomes; however, they may not always align with the patient's goals for improvement following treatment. Therefore, we introduced the concept of patient-defined outcomes (PDOs): pretreatment goals or activities patients wish to improve following treatment, along with the patient-perceived difficulty and importance of these activities. This study aimed to evaluate PDOs in adults with hip dysplasia across 3 age groups while assessing patient variables for potential associations with choosing specific categories of activities.</p><p><strong>Methods: </strong>We analyzed PDOs in 180 adults diagnosed with hip dysplasia, stratified into age groups: young adults (18-39 years), older adults (40-59 years), and senior adults (60 years or older). Patients listed at least 1 activity into the PDO questionnaire, followed by rating the difficulty and importance of the activity on a scale from zero to 10. PDOs were grouped into 6 thematic categories: sports, exercise, hobbies, activities of daily living (ADLs), work, and social engagement.</p><p><strong>Results: </strong>ADLs were the most common PDO reported across all age groups, increasing from 47.2% of young adults to 68.2% of seniors, while exercise-related goals were the second most common reported PDO. Age and body mass index significantly positively related with choosing an ADL as a PDO (p = 0.017). Age (p = 0.041) and Pain Catastrophizing Score (p = 0.042) significantly negatively related, while University of California Activity Score (p = 0.020) showed a significant positive relationship, with reporting an exercise as a PDO. Almost all patients reported patient-perceived importance at the highest levels.</p><p><strong>Conclusion: </strong>These findings underscore the impact hip dysplasia has on function, as most patients, regardless of age, expressed a desire to improve in basic ADLs. In addition, the importance levels of activities were consistently high across all age groups, highlighting the significance of aligning treatment goals with patient-centered outcomes.</p><p><strong>Level of evidence: </strong>Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12494044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233452","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 Missing Revision Burden: Total Hip and Knee Replacement Revision Rates in the United States, 1996 to 2020.","authors":"Timothy Bhattacharyya, Gourinandan Saravanan, Suhyeon Yoon, Subrata Paul","doi":"10.2106/JBJS.OA.25.00192","DOIUrl":"10.2106/JBJS.OA.25.00192","url":null,"abstract":"<p><strong>Background: </strong>Rising volumes of primary hip and knee replacements, coupled with longer lifespans, have led to projections of revision surgeries becoming a significant cost and healthcare burden. However, techniques and technology have improved. The purpose of this study was to determine whether revision hip and knee arthroplasty incidence has risen as previously predicted in the United States.</p><p><strong>Methods: </strong>This retrospective serial cross-sectional study analyzed data on primary and revision hip and knee replacements from the National Inpatient Sample, a comprehensive US hospitalization database, from 1996 to 2020. Primary outcome was the incidence of primary and revision arthroplasty. Secondary outcomes were comparisons between observed revision volumes and predictions, as well as trends in indications for revision surgery.</p><p><strong>Results: </strong>From 1996 to 2019, the incidence of primary hip replacements increased by 156%, from 128 to 328 per 100,000 person-years. The incidence of revision hip replacements increased by 41%, from 24 to 34 per 100,000 person-years. The incidence of primary knee replacements increased 136% from 220 to 520 per 100,000 person-years, while the incidence of revision knee replacements rose by 147%, from 19 to 47 per 100,000 person-years. Modeling a 10% failure rate at 10 years, revision hip replacement volumes were 41% lower than expected. Modelling a 7% failure rate at 10 years, revision knee replacement volumes were 33% lower than expected. The proportion of revisions due to loosening and implant wear decreased significantly over the last decade: for hip replacements, from 34.3% to 20.7% (p < 0.001), and for knee replacements, from 49.2% to 28.5% (p < 0.001).</p><p><strong>Conclusion: </strong>The burden of revision surgeries, especially due to implant wear, is significantly lower than anticipated. These data suggest improving longevity, which may support surgeon and patient confidence in arthroplasty durability.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12494052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233479","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 Standardized Care Protocols on Hip Fracture Outcomes: Mitigating Socioeconomic and Racial Disparities in a Universal Healthcare System: A Retrospective Cohort Study.","authors":"Vijay Badial, Samuel F Turner, Harry Hodgson, Reece Barter, George Lee, Thomas S Mackinnon, Edward Hayter, Raymond E Anakwe","doi":"10.2106/JBJS.OA.25.00053","DOIUrl":"10.2106/JBJS.OA.25.00053","url":null,"abstract":"<p><strong>Background: </strong>Socioeconomic deprivation and race and ethnic background are established predictors of poorer health outcomes and mortality after a hip fracture. The extent to which standardized, evidence-based treatment protocols can address these disparities remains unclear.</p><p><strong>Methods: </strong>We analyzed data from 637 patients treated for hip fractures at a level 1 trauma center over 5 years. All patients received care according to a standardized protocol aligned with national best practice standards.</p><p><strong>Results: </strong>Four hundred eleven (65%) patients underwent surgery within 36 hours of diagnosis. The mortality was 34.7% over 5 years. Factors significantly associated with mortality included delayed surgery (p < 0.05), American Society of Anesthesiologists grade (p = 0.003), and frailty (p = 0.001). Ethnicity (p = 0.381) and socioeconomic class (p = 0.678) were not significant predictors of mortality. There was no difference in the pattern of hip fractures, the treatment given, the timeliness of surgery, or patient mortality when patients of different ethnic background and socioeconomic status were compared.</p><p><strong>Conclusions: </strong>Standardized, evidence-based protocols and treatment pathways within healthcare systems have the potential to enhance clinical outcomes and minimize the influence of socioeconomic and racial disparities on postoperative mortality. These findings highlight the crucial role of equitable access to care and the implementation of structured treatment protocols and standards in addressing health inequities.</p><p><strong>Level of evidence: </strong>Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12494043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233499","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":"Comparison of Short and Long Intramedullary Nails in the Treatment of Trochanteric and Subtrochanteric Fractures: An Observational Study of 17,606 Fractures in the Norwegian Hip Fracture Register.","authors":"Peter Sverre Frønsdal, Eva Dybvik, Torbjørn Berge Kristensen, Jan-Erik Gjertsen","doi":"10.2106/JBJS.OA.25.00015","DOIUrl":"10.2106/JBJS.OA.25.00015","url":null,"abstract":"<p><strong>Background: </strong>There is no consensus of whether to use a short or long intramedullary nail (IMN) in the treatment of trochanteric and subtrochanteric fractures.</p><p><strong>Methods: </strong>In this retrospective cohort study, we analyzed 17,606 trochanteric and subtrochanteric fractures treated with an IMN registered in the Norwegian Hip Fracture Register from 2008 to 2022. The primary outcome was overall 1-year reoperation risk, and secondary outcomes were reoperation risk for specific causes and 1-year mortality for short IMNs (SIMNs) and long IMNs (LIMNs) and to compare 1-year reoperation risk for short and long versions of the 2 most used brands (Gamma3 and TRIGEN INTERTAN). Cox regression analyses adjusted for age, sex, and ASA class and instrument variable (IV) analyses with operation year and hospital as instrument were performed to calculate hazard rate ratios (HRRs).</p><p><strong>Results: </strong>LIMNs had a statistically significant higher reoperation risk than SIMNs in A1 fractures in the IV analysis. No other statistically significant differences in overall 1-year reoperation risk or 1-year mortality between SIMNs and LIMNs were found for any of the fracture types. Infection was a more frequent cause of reoperation after LIMNs (HRR, 2.82 [95% confidence interval [CI], 1.53-5.20]) while peri-implant fractures were less common for LIMNs (HRR, 0.38 [95% CI, 0.20-0.75]) compared with SIMNs. No statistically significant differences were found in reoperation risk between short and long Gamma3 nails or TRIGEN INTERTAN nails.</p><p><strong>Conclusion: </strong>SIMNs performed equal or better than LIMNs for all types of trochanteric and subtrochanteric fractures.</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 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12494041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233518","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 Evolving Effects of Preference Signaling in the Orthopaedic Residency Match: Outcomes After the Second Year of Preference Signaling Implementation.","authors":"Tanios Dagher, Stuart Trent Guthrie, Jodi Essey-Stapleton, Tessa Balach","doi":"10.2106/JBJS.OA.25.00098","DOIUrl":"10.2106/JBJS.OA.25.00098","url":null,"abstract":"<p><strong>Background: </strong>In the inaugural year of preference signaling in the orthopaedic match, our team surveyed applicants and program leaders (program directors, assistant program directors, and program coordinators), with results demonstrating reduced application volume and signal concentration compared with specialties with fewer signals. However, it remained unclear how trends would evolve as both parties became aware of each other's behavior. This study evaluates the evolving effects of preference signaling in its second year.</p><p><strong>Methods: </strong>Mixed-method surveys were adapted from our initial study and distributed to American Orthopaedic Association/Council of Orthopaedic Residency Directors member program leaders and applicants registered for the Electronic Standardized Letter of Recommendation following Universal Interview Offer Day 2023 (Fall Survey) and Match Day 2024 (Spring Survey).</p><p><strong>Results: </strong>Ninety-five program leaders (49%) and 311 applicants (28%) completed the Fall Survey, and 119 program leaders (61%) and 365 applicants (30%) completed the Spring Survey. While response rates are aligned with other similar survey studies, results are subject to nonresponder bias. Applicants submitted an average of 61 applications for Match 2024, significantly lower than 84 for Match 2023 (p < 0.001). The number of interviews received per applicant dropped to 10.8 from 11.7 for Match 2023 (p = 0.27). Only 3% of interviews went to nonsignaling, nonrotating students, down from 14% for Match 2023 (p < 0.001). A total of 96% of applicants matched at a signaled institution. There was a decrease in the variance in the number of interview invitations reported by applicants (p = 0.001) and in signal concentration, with 50% of signals concentrated among 32% of programs, compared with 27% for Match 2023.</p><p><strong>Conclusion: </strong>In the second year of signaling, application volume continued to decrease, with modest improvements in signal and interview concentration. Signals are being increasingly used as screening tools, and applicants predominantly interview and match at signaled programs.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12494038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233471","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}