JBJS Open Access最新文献

{"title":"Analysis of Tumor and Tumor-Like Entities Tested on the Orthopaedic In-Training Examination From 2012 to 2023.","authors":"Sean Kelly, Braden Goldberg, Eli Bryk, Vincent Vigorita","doi":"10.2106/JBJS.OA.24.00250","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00250","url":null,"abstract":"<p><strong>Background: </strong>The Orthopaedic In-Training Examination (OITE) is used by orthopaedic residency training programs to evaluate the knowledge base of orthopaedic surgery trainees and to predict future performance on the American Board of Orthopaedic Surgery (ABOS) certifying exams. The pathology section of the OITE has changed over the years, both in terms of the content assessed and the format of the questions. This study aims to describe such trends.</p><p><strong>Methods: </strong>This study analyzed OITE questions from 2012 to 2023, focusing on tumors and tumor-like conditions of bone and soft tissue to guide resident preparation and core curriculum design. Questions were categorized by histologic photomicrographs, preferred responses, possible options, and implied entities. Additionally, questions were classified into four domains: diagnosis, treatment, next step, and multifactorial.</p><p><strong>Results: </strong>Tumor-related questions constituted 10-16% of each OITE, with an equal number of questions concerning benign and malignant entities. Bone tumor questions averaged nine per year, while soft tissue tumor questions averaged four. The most frequently tested bone tumors were osteosarcoma and giant cell tumor, while pleomorphic sarcoma and liposarcoma were the most frequently tested malignant soft tissue tumors. Metabolic bone diseases such as osteoporosis, osteomalacia, and osteonecrosis were also frequently tested. Histologic photomicrographs were included in 120 questions over the study period, with osteosarcoma being the most depicted. A shift in question focus was observed, with diagnosis questions declining in favor of treatment and next-step management questions in recent years.</p><p><strong>Conclusion: </strong>These findings provide a comprehensive overview of tumor-related content on the OITE, highlighting trends in question composition and format. This information can guide program directors in designing curricula that align with tested material, ensuring residents are well-prepared for both the OITE and ABOS exams. Emphasizing highyield topics and adapting to evolving question patterns can optimize educational outcomes and improve board pass rates.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050913","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":"Preoperative and Postoperative Residual Urine in 796 Men Older than 65 Years Undergoing Elective Orthopaedic Surgery in Denmark: A Single-Center Cohort Study.","authors":"Inger Markussen Gryet, Charlotte Graugaard-Jensen, Asger Roer Pedersen, Simon Toftgaard Skov","doi":"10.2106/JBJS.OA.24.00180","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00180","url":null,"abstract":"<p><strong>Background: </strong>Postvoid residual urine (PVR) can be an unknown chronic disorder, or it can occur after surgery. A pilot study led to development of a flowchart suggesting performing preoperative and postoperative bladder scans and recommending men with PVR further diagnostic work-up. This study aimed to determine the prevalence of preoperative and postoperative PVR in men older than 65 years undergoing major elective orthopaedic surgery and also to determine risk factors and possibility of prediction.</p><p><strong>Methods: </strong>This was a single-center cohort study. The patients were consecutively included for 1 year from April 2022. Data were extracted from the electronic patient files: age, lower urinary tract symptoms (LUTS), comorbidity, type of surgery and anesthesia, opioid use, and preoperative and postoperative PVR which was defined as ≥150 ml.</p><p><strong>Results: </strong>A total of 796 men were eligible for inclusion: 316 knee, 276 hip, and 26 shoulder arthroplasties and 178 lower back spinal surgeries. Preoperative bladder scans were acquired in 95% of the eligible patients, and PVR was found in 15% (confidence interval [CI] 12-18). There was a higher risk of preoperative PVR in men reporting LUTS, OR 1.97 (1.28-3.03); neurological disease, OR 3.09 (1.41-6.74); and the risk increased with higher age, OR 1.08 per year (1.04-1.12). PVR was found in 9% of the men without risk factors. A postoperative bladder scan was performed in 72% of the men. Among men without preoperative PVR, 15% (CI 12-19) had postoperative PVR de novo. The highest risk for PVR postoperative was PVR preoperatively.</p><p><strong>Conclusions: </strong>Preoperatively, 15% had PVR. Neurological disease, LUTS, and higher age were identified as risk factors, but PVR was found in 9% of the men without risk factors. In men without preoperative PVR, 15% had postoperative PVR de novo. It is not possible to conclude whether PVR is transient or chronic, and it is unclear whether a PVR of 150 ml is associated with complications or if the threshold should be higher. This study highlights the importance of awareness regarding voiding issues before and after surgery.</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":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037638","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 Between Septic Arthritis Alone and Coexisting with Other Bone and Joint Infections in Pediatric Patients: A Retrospective Review.","authors":"Nicolas Makoto Favre, Giacomo De Marco, Oscar Vazquez, Amira Chargui, Anne Tabard-Fougère, Blaise Cochard, Christina Steiger, Romain Dayer, Dimitri Ceroni","doi":"10.2106/JBJS.OA.24.00200","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00200","url":null,"abstract":"<p><strong>Background: </strong>It is unclear whether coexisting septic arthritis and osteomyelitis (CSAO) differs from septic arthritis (SA) alone in terms of susceptible age groups, clinical and paraclinical presentations, and prevalence. This study aimed to compare patients with isolated SA with those presenting with CSAO, determine the efficacy of different parameters used to distinguish those diagnoses, and investigate the prevalence of CSAO due to <i>Kingella kingae</i>.</p><p><strong>Methods: </strong>The study retrospectively included all patients treated for SA over a 17-year period at Geneva University Hospitals. Clinical, biological, and bacteriological data were analyzed. Magnetic resonance imaging (MRI) was reviewed for all patients to identify those with coexisting osteomyelitis. Comparisons between patients with isolated SA and those with CSAO were performed using the unpaired Mann-Whitney <i>U</i> for continuous outcomes (reported with median [interquartile range]) and the Pearson χ² tests for dichotomous outcomes (reported with n [%]).</p><p><strong>Results: </strong>Of 247 patients with osteoarticular infections, 177 with SA fulfilled our inclusion criteria. Of these, 124 had SA alone, and 53 (29.9%) had a CSAO. There were no statistically significant differences between the 2 groups regarding sex, age, and clinical and paraclinical results. When coexisting osteomyelitis was present, 51% of cases were acute and 49% were subacute. Bone infection was found in the metaphyses of 21 patients (39.6%), the epiphyses of 11 (20.8%), and was transphyseal in 10 (18.9%). Whatever the infection location, <i>K. kingae</i> was the most common pathogen found in both groups (48% of SA, 43% of CSAO, p = 0.651).</p><p><strong>Conclusions: </strong>This study showed that CSAO is common in children, especially among those younger than 4 years, with an unexpectedly high prevalence of subacute osteomyelitis. This should encourage caregivers to use MRI more extensively in diagnostic processes. Clinical and paraclinical data did not contribute to differentiate CSAO from SA. The widespread presence of <i>K. kingae</i> as a pathogen in both groups supports the advice to systematically use polymerase chain reaction techniques in children younger than 4 years of age.</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":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999977","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":"Long-Term Outcomes Following Reverse Total Shoulder Arthroplasty: A Systematic Review with a Minimum Follow-Up of 10 Years.","authors":"Matthias Biner, Stafan Klotz, Octavian Andronic, Daniel C Karczewski, Lukas Zingg, Wieser Karl, Philipp Kriechling","doi":"10.2106/JBJS.OA.25.00025","DOIUrl":"https://doi.org/10.2106/JBJS.OA.25.00025","url":null,"abstract":"<p><strong>Background: </strong>Reverse total shoulder arthroplasty (rTSA) is a crucial intervention for restoring shoulder function and alleviating pain. The aim of this review was to evaluate long-term clinical and radiological outcomes of rTSA patients with a minimum follow-up of 10 years.</p><p><strong>Methods: </strong>A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across PubMed, Web of Science, Embase, and Cochrane databases until September 2024. Studies in English or German with a minimum 10-year follow-up were included. Risk of bias was assessed using the Methodological Index for Non-Randomized Studies criteria. The study was registered with PROSPERO (CRD42024558828).</p><p><strong>Results: </strong>Of 673 studies, 7 retrospective case series with Level IV evidence met the inclusion criteria, totaling 469 rTSA procedures in 460 patients. The weighted mean age was 71 years, with 63% female patients. The mean follow-up was 12 years, with a 63% lost to follow-up. Four studies conducted all follow-ups in a clinical setting, while 3 used either outpatient visits (20 to 41%) or phone/mail interviews. The weighted mean reported revision-free implant survivorship reported in 5 studies was 88% at 10 years. Overall, the complication rate was 36% with need for further revision in 23% of patients. The revisions were primarily due to infection (8%), instability (7%), and glenoidal complications (3%). Significant functional improvements were noted across all studies. The absolute Constant score (CS) improved from 27 to 62 across 5 studies, and the relative CS improved from 37% preoperatively to 81% across 3 studies. The American Shoulder and Elbow Surgeons Score improved from 35 to 74 (p < 0.001) and the Single Assessment Numeric Evaluation from 23 to 73 (p < 0.001), in 1 study each. The Subjective Shoulder Value increased from 28% to 79% (p = 0.001) in 2 studies. Weighted mean range of motion improvements included active abduction of 54°, active anterior elevation of 52°, and active external rotation of 8°. Longitudinal outcomes were reported to be stable in the due course in 5 studies and deteriorated in 1. Scapular notching varied widely, with Nerot-Sirveaux grades I and II in 15% to 59% of cases, and grades III and IV in 7% to 47%.</p><p><strong>Conclusion: </strong>RTSA appears to provide substantial long-term improvements in shoulder function, clinical outcomes, and pain relief, albeit with significant complication and revision rates. However, caution is warranted when interpreting the data due to high lost-to-follow-up rates and limited data quality in the contemporary literature. Long-term registry data will be essential.</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 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064833","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":"Glenoid Bone Grafting During Primary Reverse Shoulder Arthroplasty: A Learning-Curve Analysis.","authors":"Zaamin B Hussain, Sameer R Khawaja, Musab Gulzar, Hayden L Cooke, Krishna N Chopra, Robert S Roundy, Michael B Gottschalk, Eric R Wagner","doi":"10.2106/JBJS.OA.24.00125","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00125","url":null,"abstract":"<p><strong>Background: </strong>Reverse shoulder arthroplasty (RSA) with structural bone grafting of the glenoid utilizing an autograft from the resected humeral head is an effective strategy to address severe glenoid bone loss. Although learning curves have been established for RSA, RSA with bone grafting is more technically challenging, with relatively higher complication rates. The number of cases needed for proficiency and the optimal learning strategies have yet to be defined for RSA with bone grafting.</p><p><strong>Methods: </strong>All patients who underwent primary, single-stage RSA with bone grafting for severe glenoid bone loss at our institution between November 2018 and February 2022 were identified. Perioperative data, including imaging, operative time, complications, revisions, postoperative functional data, and patient-reported outcomes, were recorded and analyzed. The learning curve for a fellowship-trained shoulder and elbow surgeon was analyzed using linear regression and cumulative sum (CUSUM) analysis. CUSUM analysis objectively evaluated differences in operative time over the course of the surgeon's practice and elucidated the completion of the learning curve.</p><p><strong>Results: </strong>A total of 32 patients (53% male and 47% female; mean age, 68 years) were included in the analysis. The mean follow-up was 28 months. The mean operative time was 127 minutes, and there was a linear decrease in operative time throughout the study. CUSUM analysis using operative times demonstrated that the surgeon's learning curve was 14 patients. When comparing patients among the first 14 cases and the last 18 cases, there was no difference in shoulder range of motion, American Shoulder and Elbow Surgeons (ASES) scores, and Subjective Shoulder Value (SSV), while visual analog scale (VAS) pain scores at the time of final follow-up were better for patients in the surgeon's proficiency phase compared with the learning phase.</p><p><strong>Conclusions: </strong>In this study, we found a significant linear decrease in operative time with the number of cases completed, without associated detriment to the postoperative outcome or complication rate. Our findings suggest that at least 14 cases may be required before proficiency is obtained with RSA using humeral head bone graft.</p><p><strong>Level of evidence: </strong>Prognostic Level IV. 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":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999985","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":"Comparative Diagnostic Value of Serological and Synovial Tests for Periprosthetic Joint Infections: A Comprehensive Analysis.","authors":"Mars Yixing Zhao, Samuel Girgis, Thomas Goldade, Evan Parchomchuk, Michaela Nickol, Johannes M van der Merwe","doi":"10.2106/JBJS.OA.24.00206","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00206","url":null,"abstract":"<p><strong>Background: </strong>Prompt diagnosis of periprosthetic joint infections (PJIs) is crucial for providing optimal care. Currently, there are no gold-standard tests available. An ideal test would be simple to implement, cost-effective, and readily available. We aimed to determine the best single or combined serological or synovial markers for diagnosing PJIs.</p><p><strong>Methods: </strong>There were 177 of 313 patients who had PJIs between April 2012 and March 2023 and a control group of 60 patients who were included in this retrospective review. The PJIs were diagnosed using Musculoskeletal Infection Society (MSIS) and European Bone and Joint Infection Society (EBJIS) criteria. Serum (C-reactive protein [CRP], white blood-cell [WBC] count, neutrophil-lymphocyte ratio [NLR], polymorphonuclear neutrophil percentage [PMN%]), and synovial fluid (WBC, NLR, PMN%) parameters were compared between the 2 groups. We determined the sensitivity, specificity, area under the curve (AUC), and cutoff values (COV) for each marker. We determined the best combination of markers to diagnose PJIs. There was no statistical significance between the demographic data of the control and treatment groups.</p><p><strong>Results: </strong>The S-CRP had the highest AUC of 0.912 with a COV of 16.15 mg/dL (Sensitivity 79.6%, Specificity 97.8%). The combination of tests, S-CRP, synovial fluid (SF-WBC), and S-NLR demonstrated the highest AUC of 0.946 (Sensitivity 93%, Specificity 90.9%). The COV for SF-WBC was 5.75 cells/μL (AUC 0.803; Sensitivity 70.3%, Specificity 97.1%); S-NLR COV was 3.659 (AUC 0.803; Sensitivity 67.3%, Specificity 88%).</p><p><strong>Conclusion: </strong>We found the combination of S-CRP, SF-WBC, and S-NLR to be valuable in diagnosing PJI with high sensitivities and specificities. It can be easily implemented by clinicians without additional cost or equipment. It is important to use this with a thorough clinical and physical examination as well as other modalities (i.e., MSIS/EBJIS criteria).</p><p><strong>Level of evidence: </strong>Retrospective Comparative Study-Level III evidence. 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":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031010","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":"Prevalence & Risk Factors of Post-traumatic Stress Disorder in Patients with Lower Limb Fractures in South Africa.","authors":"Gerald Tan, Maritz Laubscher, Sithombo Maqungo, Adam Truss, Kirsty Berry, Nando Ferreira, Simon Matthew Graham","doi":"10.2106/JBJS.OA.24.00124","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00124","url":null,"abstract":"<p><strong>Background: </strong>Fractures occur at disproportionately higher rates in low-income and middle-income countries (LMIC) and commonly occur following a traumatic event. The association between suffering from a fracture and the development of psychological symptoms is under-reported. The aim of this study was to investigate the prevalence and risk factors of developing post-traumatic stress disorder (PTSD) among patients following lower limb trauma in South Africa.</p><p><strong>Methods: </strong>The study was undertaken from September 2017 to December 2018 and included a cohort of 260 patients with lower limb long bone fractures. Patients were screened using the Primary Care PTSD (PC-PTSD-5) screening tool, which is a gold standard measure to identify patients at risk of PTSD in the civilian population. Within this cohort, high-risk patients were assessed with the PTSD checklist (PCL-C), which is a standardized questionnaire scale to indicate if an individual may have PTSD.</p><p><strong>Results: </strong>There were 254 patients in the final cohort analysis with ages ranging from 18 to 71 years, and 75.6% (192/254) of the cohort were male patients. Femoral fractures were found in 51.6% (131/254) of patients while tibial fractures were found in 48.4% (123/254). The rate of PTSD within the study population was found to be 7.1% (18/254), and the risk of developing PTSD was 13.4% (34/254). We did not identify any risk factors, including open fractures, high-injury severity, and complication such as nonunion, for the development of PTSD.</p><p><strong>Conclusions: </strong>This study found the rate of PTSD to be lower compared with that in high-income countries, but still higher than the general population in South Africa. Our study indicates that screening for PTSD in patients with lower limb trauma in LMICs could be beneficial. Early identification of patients at risk of developing PTSD would enable appropriate resources, support, and treatment to be provided.</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 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031877","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":"Video-Based Assessment of Surgical Skill in Orthopaedic Surgery: A Technique Guide to Capturing Critical Surgical Detail.","authors":"Jillian McNally, David Wilson, Emma E Jones, Neyousha Shahisavandi, Caroline King, Chad Coles, Raymond Andrew Glennie","doi":"10.2106/JBJS.OA.24.00183","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00183","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical skills are critical to assess in residency programs. These observations often occur in the clinical settings, which are limited by patient safety and potential bias. High fidelity simulated cadaveric surgery can account for some of these shortcomings. Professional video offers a promising avenue to both anonymize and effectively evaluate surgical skill. The objective of this study were to describe the technique for professional video capture of simulated, open orthopaedic surgeries and to assess construct validity by comparing objective performance scores from the videos with the learner's stage of training.</p><p><strong>Methods: </strong>In 2022, one experienced surgeon and 3 trainees (post graduate year [PGY]-4, PGY-3, PGY-2) were recruited from a residency program to perform 2 moderately challenging surgeries (open reduction and internal fixation of both bone forearm and talus fractures), with fractures simulated using an osteotome. Videographers positioned cameras at various positions throughout a skills laboratory. Total costs were calculated. Statistical analysis was performed to compare evaluator scores of participants' actual level of training.</p><p><strong>Results: </strong>The simulated surgeries were recorded, edited for optimal viewing angles, and anonymized by blurring faces and voice over technology. Seventeen local teaching faculty were recruited to evaluate the videos. The videos were shortened on average 65 minutes for critical steps to be represented in the final production (i.e., Bone reduction, dissection of neurovascular structures, radiographic images, etc.) The full cost to produce the 8 surgical videos was $48,934.00 Canadian dollars. The final data set had 61 observations, with a range of 13 to 17 observations per participant. There was a 19.7% error rate, meaning the videos were generally 80% accurate in predicting the year of training.</p><p><strong>Conclusions: </strong>The discriminative ability of the videos was better at detecting true \"novice\" and \"expert\" surgeons but less accurate between the middle years of training. A larger, multicentered study with more participants is needed to draw any further conclusions.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048486","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":"Unadjusted Unplanned 30-Day Hospital Readmission Rates are Not a Useful Quality Measure for Planned or Urgent Orthopaedic Inpatient Care: A Retrospective Cohort Study.","authors":"Samuel F Turner, Vijay Badial, Reece Barter, Edward Hayter, Raymond E Anakwe","doi":"10.2106/JBJS.OA.24.00237","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00237","url":null,"abstract":"<p><strong>Background: </strong>We examined the number of patients who experienced an unplanned hospital readmission following an episode of inpatient care in a tertiary level trauma and orthopaedic service, the reasons for readmission and whether these reasons related to lapses in care, care and service delivery problems, and missed healthcare intervention opportunities and whether they were or should have been prevented and anticipated. We hypothesized that most 30-day readmissions would be unrelated to the original complaint and admission, and the reasons for readmission would not be truly avoidable or attributable to the index hospital admission. We further hypothesized that socioeconomic factors would be predictive of the likelihood of unplanned hospital readmission within 30 days of hospital discharge.</p><p><strong>Methods: </strong>Over a 5-year study period, we identified all adult patients discharged from our unit and those who had an unplanned readmission within 30 days of discharge. We evaluated the reasons for readmission and assessed the impact of socioeconomic deprivation and social determinants of health on the likelihood of unplanned 30-day readmission using multivariable logistic regression.</p><p><strong>Results: </strong>Fifteen thousand three hundred thirteen patients were discharged from our unit over the study period. 690 patients (4.5%) were readmitted within 30 days of discharge as an unplanned episode of care. 58.4% of unplanned readmissions were directly related to the index admission, but only 9% of readmissions were preventable. The single most frequent reason for readmission was an unrelated noninfective medical complaint, 244 patients (35.4%). Social determinants of health influenced the risk of an unplanned readmission, particularly the Index of Multiple Deprivation and the subdomains related to housing, the living environment, social services, and support.</p><p><strong>Conclusions: </strong>The 30-day readmission rate as a marker of quality for inpatient care should be questioned. It is not useful as an unadjusted metric and can be misleading. Adjusting for socioeconomic influences, preventability of readmissions, and missed opportunities to improve whole health may improve its usefulness.</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":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Replication of Native Acetabular Anatomy Satisfy Recommended Hip-Spine Targets for Cup Orientation?","authors":"Johnathan Sevick, Christopher Plaskos, Andrew Speirs, Jim Pierrepont, George Grammatopoulos","doi":"10.2106/JBJS.OA.24.00169","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00169","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to assess whether replication of native acetabular anatomy would satisfy cup orientation targets using 3 commonly described hip-spine algorithms. Whether spinopelvic characteristics influence ability to achieve cup orientation targets when replicating native anatomy and the agreement between algorithm recommendations was tested.</p><p><strong>Methods: </strong>A prospective database was queried to identify patients with adverse (n = 70) spinopelvic characteristics. These were matched for age and sex with patients without adverse characteristics (n = 70). Spinopelvic characteristics were obtained from radiographs and computed tomography (CT) scans. CT scans were segmented to determine native acetabular anatomy, particularly anteversion. Three hip-spine planning algorithms were evaluated for each patient (Optimized Positioning System [OPS], Combined-Sagittal Index [CSI], Hip-Spine Classification). Differences between target orientations and native anatomy were determined. Agreement between algorithms was tested.</p><p><strong>Results: </strong>OPS plan had significantly reduced inclination compared with native (39° vs. 52°, p < 0.001). No significant difference between OPS and native anteversions was seen (18° vs. 18°, p = 0.1) for the adverse group. OPS-planned anteversion was greater than native (23° vs. 16°, p < 0.001) in the nonadverse group. Most native orientations met published CSI targets (90% nonadverse, 59% adverse). Most native acetabular orientations (61% adverse and 58% nonadverse) failed to meet Hip-Spine Classification targets. Overall, in 88% of cases, replication of native acetabular version and 40° of inclination satisfied at least one suggested target. Agreement of all 3 algorithms was 31%; greater agreement was seen between Hip-Spine Classification and OPS (64%).</p><p><strong>Conclusions: </strong>Native acetabular anteversion and radiographic inclination of 40° are reliable targets, satisfying at least one hip-spine algorithm and thus justifying such practice, when advanced hip-spine analysis is not performed. The discrepancy between suggested orientations by the various published techniques, despite their validated low dislocation rates, emphasizes that although achieving a target cup orientation is important, the nature of hip stability is multifactorial and merits a holistic approach.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047576","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}