JBJS Open Access最新文献

{"title":"Results of a Retrospective FDA Investigational Device Exemption Study for Anterior Vertebral Body Tethering in Adolescent Idiopathic Scoliosis with 3-Year to 10-Year Follow-Up.","authors":"Taemin Oh, Manan Patel, Emily Nice, Joshua M Pahys, Steven W Hwang, Amer F Samdani","doi":"10.2106/JBJS.OA.25.00171","DOIUrl":"10.2106/JBJS.OA.25.00171","url":null,"abstract":"<p><strong>Background: </strong>Vertebral body tethering (VBT) offers an alternative treatment for patients with idiopathic scoliosis. We present our finalized Food and Drug Administration Investigational Device Exemption (IDE) study results on VBT.</p><p><strong>Methods: </strong>We retrospectively reviewed patients with Lenke Type IA/B curves who underwent VBT between 2011 and 2015. Clinical, radiographic, perioperative, and complications data were prospectively collected.</p><p><strong>Results: </strong>Fifty-seven patients (mean age 12.4 ± 1.3 years) were enrolled and followed for 6.6 ± 1.6 years (range: 3.0-10.2 years). Thoracic Cobb angle measured 40.4 ± 6.8° preoperatively with correction to 14.5 ± 9.0° at 2 years and slight regression to 22.1 ± 12.4° at last follow-up. Median Sanders and Risser were 3 and 0, respectively. At last follow-up, 71% of patients (39/56) had curves ≤30° and 98% (55/56) had achieved skeletal maturity. There were no major neurologic or pulmonary complications. However, 10 patients required 13 revisions; 2 required conversion to fusion. Percent predicted forced expiratory volume and forced vital capacity dropped from 85% and 87%, respectively, to 80% and 82% at the final follow-up.</p><p><strong>Conclusion: </strong>These finalized IDE results highlight VBT as a safe, effective treatment for skeletally immature patients with idiopathic scoliosis. However, complication and revision rates remain concerning, and patients should be counseled appropriately.</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 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030850","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 Fallacy of Patient-Reported Outcome Measures: Why They Often Fail to Detect Clinically Important Differences.","authors":"Nathan N O'Hara, Dane J Brodke, Ashley E Levack, Robert V O'Toole, Gerard P Slobogean","doi":"10.2106/JBJS.OA.25.00172","DOIUrl":"10.2106/JBJS.OA.25.00172","url":null,"abstract":"<p><strong>Background: </strong>Patient-reported outcome measures are increasingly common in orthopaedic research yet routinely fail to detect clinically meaningful differences in clinical trials. We assessed if orthopaedic studies are more likely to detect clinically important differences with a binary outcome, such as nonunion surgery, or a continuous patient-reported outcome sensitive to important clinical differences.</p><p><strong>Methods: </strong>We constructed a hypothetical clinical trial comparing 2 treatments for tibial shaft fractures. We assumed the true nonunion rate was 10% in the treatment group and 20% in the control group. Based on recent publications, we assumed nonunion patients had a mean Patient-Reported Outcomes Measurement Information System (PROMIS) physical function score of 40 (standard deviation [SD], 10) and united patients had a mean score of 50 (SD, 10), a difference that is double the minimum clinically important difference. Based on these expected distributions, we simulated 10,000 trials with a sample size of 400 patients to assess the probability of detecting a significant difference between treatment groups at p < 0.05. The trial results were analyzed using the binary outcome of nonunion surgery and PROMIS physical function.</p><p><strong>Results: </strong>Of the 10,000 simulated trials with a 400-patient sample, the observed difference in nonunion surgery between the treatment groups was statistically significant 80.9% (95% confidence interval [CI], 79.2%- 82.6%) of the time. By contrast, the 400-patient sample detected a statistically significant difference between groups in PROMIS physical function only 4.2% (95% CI, 3.8%-4.6%) of the time (difference, 76.7%; 95% CI, 75.8%-77.6%; p < 0.001).</p><p><strong>Conclusion: </strong>Even if patient-reported outcome measures are sensitive to important clinical events, most studies will fail to detect statistically significant differences between the treatment groups when the important clinical outcome occurs in a minority of the overall sample. Orthopaedic surgeons and scientists should be aware of this limitation when designing and appraising studies that compare treatments with patient-reported outcomes.</p><p><strong>Level of evidence: </strong>Not applicable.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024370","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 Utility of Cervical Vertebral Maturation Method for Staging Skeletal Growth and Curve Progression in Patients with Adolescent Idiopathic Scoliosis.","authors":"Samuel Tin Yan Cheung, Garvin Chi Chun Cheung, Jason Pui Yin Cheung, Prudence Wing Hang Cheung","doi":"10.2106/JBJS.OA.25.00184","DOIUrl":"10.2106/JBJS.OA.25.00184","url":null,"abstract":"<p><strong>Background: </strong>Cervical vertebral maturation (CVM) is a skeletal maturity method that can be assessed routinely on whole spine radiographs to minimize radiation exposure. Originally used in orthodontics, its role in staging adolescent growth spurt and curve progression in adolescent idiopathic scoliosis (AIS) remains unclear. The aim of this study was to investigate growth rates across CVM stages, its cutoff for indicating peak growth (PG) versus growth cessation (GC), and its relationship with coronal curve progression.</p><p><strong>Methods: </strong>One hundred forty-two AIS patients were prospectively followed from Risser stage 0, until growth completion. Longitudinal data collected included arm span (AS), body height (BH), sitting height (SH), coronal Cobb angle, and maturity assessments. CVM was evaluated through its relationship with growth rates and curve progression rates. A total of 1107 spine radiographs corresponding to longitudinal growth rates were analyzed to detect PG and GC in each patient, with predictive accuracy assessed using receiver operating characteristic curve analysis. Curve progression rate of each CVM stage in treatment-naïve patients was plotted against timing to peak curve progression.</p><p><strong>Results: </strong>CVM correlated most with Proximal Femur Maturity Index (PFMI) (τ_b = 0.662, p < 0.001). CVM stage 3 and 6 showed the respective highest and lowest mean growth rates in SH and AS. CVM stage 3 predicted PG with an area under the curve (AUC) of 0.711 to 0.720. CVM stage 5 predicted GC with AUC of 0.840 to 0.850. CVM stage 3 had the highest curve progression rate (0.45° per month). Peak curve progression occurred 5.8 months after CVM 3 and 9.1 months before CVM 4, lagging behind PG by 6.5 months.</p><p><strong>Conclusions: </strong>CVM stage 3 indicates peak growth, while stage 6 marks growth cessation. In this cohort of AIS patients, GC is more accurately predicted than PG by CVM. Peak curve progression occurred between CVM stage 3 and CVM stage 4.</p><p><strong>Clinical relevance: </strong>This study highlights CVM method's ability in indicating timing of growth cessation. CVM can be used to indicate curve progression beyond peak growth, especially until the point of growth cessation.</p><p><strong>Level of evidence: </strong>Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024402","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":"Cast Versus Surgery for Displaced Intra-Articular Distal Radius Fractures in the Elderly a Randomized Clinical Noninferiority Trial (the DART Study).","authors":"Dirk P Ter Meulen, Caroline A Selles, Esther J Kret, Anouk A Kruiswijk, Malou E Slichter, Joost W Colaris, Anne Vochteloo, Hanna C Willems, Gerald A Kraan, J Carel Goslings, Ydo V Kleinlugtenbelt, Nienke W Willigenburg, Niels W L Schep, Rudolf W Poolman","doi":"10.2106/JBJS.OA.25.00060","DOIUrl":"10.2106/JBJS.OA.25.00060","url":null,"abstract":"<p><strong>Background: </strong>Evidence supporting surgery in elderly patients with distal radius fractures is limited, but displaced fractures may benefit from surgery. This study aimed to determine whether casting is noninferior to surgery for patients aged 65 years or older with substantially displaced intra-articular (AO type C) distal radius fractures.</p><p><strong>Methods: </strong>This multicenter randomized controlled noninferiority trial included 138 patients (mean age 76 years, SD 6.0) in 19 Dutch hospitals. 138 patients were randomized with a mean age of 76 years (SD 6.0). After 12 months, 126 patients (91%) completed the trial. All patients had a nonacceptable fracture position according to the guideline after reduction. Patients were randomized between casting and open reduction internal fixation (ORIF). The primary outcome was the Patient Rated Wrist Evaluation (PRWE) at the 1-year follow-up. Secondary outcomes included the Disability of the Arm, Shoulder, and Hand questionnaire; quality of life (measured by the EQ-5D-3L); range of motion; grip strength; and complications. Primary analyses were linear mixed models with an intention-to-treat approach.</p><p><strong>Results: </strong>The mean PRWE score at 1-year follow-up for the casting group was 20.4 (95% CI, 15.3-25.6) and in the surgical group was 14.5 (95% CI, 9.9-19.0). The primary intention-to-treat crude analysis was inconclusive regarding noninferiority, with a between-group difference of 6.0 points (95% CI, -2.1 to 14.1) in favor of surgery. However, noninferiority was demonstrated after correction for baseline covariates and in both as-treated analyses. The surgical group had better grip strength but significantly more reoperations (i.e., hardware removal). Subgroup analysis showed greater benefits of surgery in physiologically younger patients, while more frail patients had no advantage.</p><p><strong>Conclusions: </strong>The primary analysis did not demonstrate noninferiority of casting compared with surgery at 1-year follow-up in patients aged 65 years or older with substantially displaced intra-articular distal radius fractures. The benefit of surgery was consistent across multiple outcomes, most notably in the short term and for physiologically younger patients.</p><p><strong>Level of evidence: </strong>RCT. Level I evidence. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024386","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":"Effect of Femoral Component Flexion in Robotic-Assisted Total Knee Arthroplasty on Retrograde Intramedullary Nail Sagittal Trajectory Angulation.","authors":"Jason Brant, Michael Roberts, Nathaniel Nelms, Patrick Schottel, Mark Haimes, Michael Blankstein","doi":"10.2106/JBJS.OA.25.00182","DOIUrl":"10.2106/JBJS.OA.25.00182","url":null,"abstract":"<p><strong>Background: </strong>In robotic-assisted total knee arthroplasty (RA-TKA), the femoral prosthesis is positioned independent of the intramedullary canal and frequently in flexion for function optimization. Femoral prosthesis flexion displaces retrograde intramedullary nail (rIMN) start point posteriorly potentially exacerbating hyperextension deformity in periprosthetic fracture (PPFx) fixation. The aim of this study was to determine the relationship between RA-TKA femoral component flexion with rIMN sagittal trajectory angulation. We hypothesized flexion of the femoral component increases nail sagittal angle.</p><p><strong>Methods: </strong>This is a single-center academic observational study including adult patients undergoing primary RA-TKA by 3 fellowship-trained arthroplasty surgeons between August 2023 and February 2024. Final femoral implant characteristics after knee gap balancing were obtained from intraoperative computerized tomography screenshots. Sagittal angle measurements of rIMN trajectory based on distal femoral nail start point and center of femoral shaft were measured using ImageJ software and compared with several variables with a focus on femoral component flexion for 10-mm and 12-mm nail sizes.</p><p><strong>Results: </strong>A total of 111 patients (61 female and 50 male) with a mean age of 67 years (SD 10) and height 168 cm (SD 11) were included. The mean femoral component flexion was 5.87° (SD 2.13), and the mean nail sagittal trajectory angle was 9.83° (SD 2.79) and 11.43° (SD 2.88) for the 10-mm and 12-mm nails, respectively. There was a significant linear correlation of a 0.50° increase in the mean sagittal angle for every 1.0° increase in femoral component flexion for both nail sizes (p < 0.001).</p><p><strong>Conclusions: </strong>There is a linear correlation between femoral component flexion and rIMN sagittal trajectory angle. The mean sagittal angulation was approximately 10°, and the mean component flexion was 6°. As number of RA-TKAs performed nationally is expected to increase, a rIMN with a distal bend designed to compensate for femoral component flexion could be considered to limit hyperextension deformity in distal femur PPFx fixation.</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 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024407","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":"Three-Dimensional Lower Extremity Alignment During the Stance Phase of Gait Using Anteroposterior Fluoroscopic Imaging and Image-Matching Technique: A Comparison with the Standing Position in Advanced Knee Osteoarthritis.","authors":"Tatsuya Soeno, Takashi Sato, Koichi Kobayashi, Ryota Katsumi, Kazutaka Otani, Hiroyuki Kawashima","doi":"10.2106/JBJS.OA.25.00168","DOIUrl":"10.2106/JBJS.OA.25.00168","url":null,"abstract":"<p><strong>Background: </strong>Lower extremity alignment in knee osteoarthritis (OA) is conventionally assessed using standing radiographs. However, symptoms often manifest during gait. Understanding dynamic alignment during gait may help characterize disease progression and inform treatment strategies.</p><p><strong>Methods: </strong>Twenty patients (40 knees) with advanced medial knee OA scheduled for arthroplasty were analyzed. Lower extremity alignment in standing (LEA-Standing) and during the midstance phase of gait (LEA-Gait) was evaluated using 3D-2D image matching technique with a ground-referenced and gravity-referenced coordinate system. Alignment parameters included femoral and tibial inclinations (coronal and sagittal), rotation angles, hip-knee-ankle angle (HKA), and tibial joint line angle (TJLA). Parameters were compared between gait and standing. ΔLEA (gait minus standing) was analyzed in relation with patient background and standing alignment. Medial joint space closure was evaluated on static radiographs and during gait.</p><p><strong>Results: </strong>LEA-Gait showed greater lateral inclination of the tibia and TJLA compared with standing, which resulted in increased varus HKA (all p < 0.01). No significant differences were observed in femoral or tibial rotation. Greater ΔTMA (tibial mechanical axis) and ΔTJLA were observed in knees with milder malalignment in standing. Medial joint space appeared open in 13 knees on standing and 5 on Rosenberg views but was closed in all 40 knees during gait.</p><p><strong>Conclusions: </strong>LEA-Gait differed significantly from LEA-Standing, revealing medial joint space closure and alignment abnormalities not captured by static evaluations including standing radiographs and Rosenberg views. These findings highlight the importance of considering the possibility of cartilage wear that may not be apparent on static radiographs.</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 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024415","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":"Simulation-Based Training of Surgical and Nonsurgical Skills in Orthopaedic Residency (Symposium Presented at the 2024 Summer CORD Conference).","authors":"Steven Long, Donald D Anderson, Gregg Nicandri, Robert A Gallo, J Lawrence Marsh, Matthew Karam","doi":"10.2106/JBJS.OA.25.00109","DOIUrl":"10.2106/JBJS.OA.25.00109","url":null,"abstract":"<p><strong>Introduction: </strong>Modern orthopaedic residency training increasingly integrates knowledge, skills, and behavior (KSB), in line with updated American Board of Orthopaedic Surgery (ABOS) and Accreditation Council for Graduate Medical Education (ACGME) guidelines. Developments in simulation technology-including high-fidelity simulators, virtual reality, and data-driven assessment tools-enable programs to target both technical and non-technical competencies. This paper examines how innovations in simulation, curriculum design, and performance assessment are shaping the future of orthopaedic education.</p><p><strong>Methods: </strong>This work synthesizes institutional practices, peer-reviewed literature, and consensus discussions from a 2024 Summer CORD Conference symposium to outline simulation-based training (SBT) and performance assessment strategies in orthopaedic residency.</p><p><strong>Results: </strong>A structured, PGY-level curriculum leverages a range of simulation tools-from low-fidelity models to virtual reality (VR)-to develop foundational and advanced technical skills. Programs like FAST and CROWNS, supported by data-driven feedback, improve arthroscopy and wire navigation proficiency without patient risk. Traditional cadaveric and sawbones training further reinforces skills in realistic settings. Objective and subjective assessments, such as procedure time, fluoroscopy use, OSATS, and the ABOS-mandated OP Score, offer complementary insight into resident progression. Benchmark testing, as seen in the University of Iowa's CROWNS program, may enhance competency before affording clinical autonomy. Non-surgical (clinical) skill is enhanced through assessment exercises like OSCEs, 360 evaluations, and video assessments. These tools assess communication, professionalism, and decision-making in reproducible, structured scenarios. OSCEs offer real-time feedback in simulated patient interactions, while video review promotes resident self-reflection and faculty-guided learning.</p><p><strong>Conclusion: </strong>Despite challenges-particularly cost, faculty time, and integration of advanced technologies-simulation-based and competency-driven training models demonstrate potential to reduce reliance on live cases for skill acquisition, improve patient safety, and provide a framework for resident evaluation. Aligning simulation, assessment, and educational innovation prepares orthopaedic residents to meet the demands of surgical practice with technical excellence and sound clinical judgment.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024350","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":"Correlation Between the \"Big Five\" Personality Traits and Burnout in Orthopaedic Surgery Residents.","authors":"Ryley Zastrow, Nainisha Chintalapudi, Rebecca Pool, Patrick Rosopa, Brian Scannell, Brandi Hartley, Adam S Levin, Gabriella Ode","doi":"10.2106/JBJS.OA.25.00059","DOIUrl":"10.2106/JBJS.OA.25.00059","url":null,"abstract":"<p><strong>Background: </strong>Burnout is prevalent among orthopaedic surgeons, but the intrinsic factors that predispose surgeons to it are unknown. Recent studies have demonstrated that personality traits correlate with the risk of burnout, but orthopaedic-specific data are lacking. This study examined the relationship between the \"Big Five\" personality traits and burnout among orthopaedic residents. We hypothesized that high neuroticism and low agreeableness scores would be associated with significantly higher rates of stress and burnout.</p><p><strong>Methods: </strong>The Profiling of Orthopaedic Surgery Trainees (POST) study is a prospective cohort study that collected cross-sectional cognitive assessments of orthopaedic residents at 12 institutions from 2020 to 2022. Participants completed a demographic survey, \"Big Five\" personality assessment, Perceived Stress Scale (PSS), and Abbreviated Maslach Burnout Inventory (aMBI) at study enrollment and 6 or 12 months later. Linear regressions assessed correlations between each \"Big Five\" personality trait and PSS and aMBI scores.</p><p><strong>Results: </strong>Overall, 83 of 129 (64%) eligible orthopaedic residents participated (mean age: 29 years, 12% women). Stress and burnout affected 63% to 66% and 48% to 49% of residents over the study period, respectively. Collectively, mean percentiles on the \"Big Five\" were highest for conscientiousness (69%), followed by extraversion (63%), openness (62%), agreeableness (58%), and neuroticism (36%). Neuroticism was positively correlated with stress (r = 0.26; p = 0.01), emotional exhaustion (r = 0.43; p < 0.01), and depersonalization (r = 0.26; p = 0.01) but negatively correlated with personal accomplishment (r = -0.30; p = 0.01). Conversely, agreeableness was negatively correlated with depersonalization (r = -0.23; p = 0.01) and positively correlated with personal accomplishment (r = 0.29; p = 0.01).</p><p><strong>Conclusions: </strong>Personality traits, particularly high neuroticism and low agreeableness, were associated with stress and burnout among orthopaedic residents. These findings suggest that personality assessments may identify residents at highest risk of burnout and provide an opportunity for proactive interventions to mitigate intrinsic drivers of burnout.</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 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12373080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972552","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":"H-Index Predicts Academic Rank Among Orthopaedic Surgery Faculty.","authors":"Ramon A Arza, Alexander W Richards, Ajay S Potluri, Matthew J Hadad, Glenn D Wera","doi":"10.2106/JBJS.OA.25.00149","DOIUrl":"10.2106/JBJS.OA.25.00149","url":null,"abstract":"<p><strong>Background: </strong>Research productivity, education, and clinical performance have become increasingly central to faculty promotion decisions in orthopaedic surgery. The Hirsch index (h-index) has emerged as an objective tool for quantifying academic impact, but its relationship with academic rank in orthopaedic surgery remains incompletely understood.</p><p><strong>Methods: </strong>We analyzed faculty data from the top 50 academic orthopaedic surgery programs ranked by Doximity. We identified faculty members from institutional websites and collected academic metrics from Scopus, including h-index, publication counts, first-author publications, last-author publications, career length, and m-index (h-index divided by the career length). We used a multivariate analysis and recursive partitioning to identify predictors of senior academic rank (associate or full professor).</p><p><strong>Results: </strong>Of 2,744 faculty reviewed, 1,520 academic orthopaedic surgeons met the inclusion criteria. The median h-index was 15 (interquartile range [IQR]: 7-27), and the median career length was 19 years (IQR: 13-28). In multivariate analysis, h-index and career duration emerged as the strongest predictors of senior academic rank. Multivariate recursive partitioning identified the h-index, number of publications, first-author publications, and career length as influential predictors. Faculty at institutions ranked 1 to 25 demonstrated significantly higher academic productivity across all metrics than those ranked 26 to 50 (p < 0.001). The trajectory of research productivity shows a consistent increase with career duration, with the m-index plateauing mid-career.</p><p><strong>Conclusions: </strong>Our findings indicate that the h-index and career length are significant predictors of senior academic rank. Academic productivity was higher at programs ranked 1 to 25 by Doximity compared with those ranked 26 to 50. While productivity metrics generally increase with career duration, the m-index plateaus in mid-career.</p><p><strong>Level of evidence: </strong>Level III, Prognostic Study. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12373081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Orthopaedic Representation in Medical School Leadership: Implications for Musculoskeletal Education.","authors":"Winston Scambler, Mitchel Hawley, Anne Boeckmann, Robert Schmidt, David Shau","doi":"10.2106/JBJS.OA.ER.25.00047","DOIUrl":"10.2106/JBJS.OA.ER.25.00047","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2106/JBJS.OA.25.00047.].</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972605","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}