JBJS Open Access最新文献

{"title":"Obstetric Demographics for Female Orthopaedic Surgeons Compared with the General Population and Peer Physicians.","authors":"Emily A Reeson, Gwen M Grimsby, Melissa Esparza, Heather Menzer","doi":"10.2106/JBJS.OA.24.00209","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00209","url":null,"abstract":"<p><strong>Background: </strong>Medical training occurs during optimal childbearing years. While unique family planning challenges for surgeons are becoming more widely reported, a gap in knowledge remains regarding fertility and pregnancy risks for each subspecialty. This study assessed reported experiences and opinions of orthopaedic surgeons compared with other physicians and the general population regarding pregnancy complications, infertility, and maternal support.</p><p><strong>Methods: </strong>An anonymous, voluntary survey was distributed to female physicians through private physician social media groups from June 2021-August 2021. The survey queried pregnancy demographics and complications, infertility diagnosis and treatment, workplace environment, and prior education on these topics. Results were compared between orthopaedic surgeons and the general population and other physicians.</p><p><strong>Results: </strong>Four thousand six hundred thirty-eight female physicians completed the survey, including 141 orthopaedic surgeons (3%). Compared with the general population, orthopaedic surgeons had children later in life (34.1 vs. 23.6 years; p < 0.0001), were more likely to have had a miscarriage (40% vs. 19.1%; p < 0.0001), undergone infertility evaluation (40.1% vs. 8.8%; p < 0.0001) or infertility treatment (31.9% vs. 12.7%; p < 0.0001), and had a preterm birth (19.9% vs. 10.2%; p < 0.0001). Forty-six percent of orthopaedic surgeons reported a pregnancy complication, and 6% received education on risks of delaying pregnancy. Compared with other physicians, orthopaedic surgeons were older at their first pregnancy (34.1 vs. 31.7, p < 0.0001), had fewer children (1.8 vs. 2.0, p = 0.0094), were more often discouraged from starting a family during training and practice (56% vs. 42%, p = 0.0007), and worked more hours per week while pregnant (59.1 vs. 54.1, p = 0.0002).</p><p><strong>Conclusions: </strong>Female orthopaedic surgeons may have increased risks of miscarriage, infertility, and preterm birth compared with the general population. In addition, orthopaedic surgeons report experiencing more negative workplace attitudes and longer working hours while pregnant compared with physician peers. The culture of orthopaedic surgery must continue to evolve to better support women physicians with pregnancy and family planning.</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":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052669","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":"Cephalomedullary Nail Breakages in a Multicenter Insertion vs. Retrieval Database Comparison: A Retrospective Cohort Study of 3,882 Patients.","authors":"Anton P Lambers, Bertram Rieger, Alan Kop, Moreica B Pabbruwe, Tom Briffa, Jessica Perring, Peter D'Alessandro, Piers J Yates","doi":"10.2106/JBJS.OA.24.00196","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00196","url":null,"abstract":"<p><strong>Background: </strong>Cephalomedullary nails are used for internal fixation of proximal femur fractures, pathological fractures, and for revision fixation in the case of failures. Nail breakages are rare, with published figures demonstrating a high variability with a previous benchmark set at less than 1.3%. The aim of this study was to use a large and geographically isolated patient cohort to better define and compare the proportion of implant breakages across a range of cephalomedullary nails.</p><p><strong>Methods: </strong>Implantation data were collected from electronic theater records at all tertiary public orthopaedic hospitals in the state of Western Australia between 1 January, 2001, and 5 July, 2017, to capture a consecutive series of implant insertions across all indications. This was linked to Western Australia's Centre for Implant Technology and Retrieval Analysis (CITRA) nail repository records to identify broken nails received for analysis in the subsequent years until data collection ceased on 5 July, 2024.</p><p><strong>Results: </strong>Three thousand eight hundred eighty-two cephalomedullary nails were implanted. There were 18 nail breakages in this cohort recovered by CITRA, giving an overall breakage proportion of 0.5%. While breakages were rare, the Trochanteric Fixation Nail-Advanced (TFNA) demonstrated a 7-fold higher proportion of reported breakages (6/393; 1.5%) compared with its predecessor the proximal femoral nail antirotation (PFNA; 6/2,621; 0.2%, p = 0.002). The proportions of reported breakages in the Gamma3 and PFN prostheses were 0.6% (2/320) and 0.7% (4/548), respectively.</p><p><strong>Conclusions: </strong>In this large consecutive sample of cephalomedullary nail patients, the TFNA appears to have a higher proportion of reported breakages than one of its predecessors, the PFNA, and this sits outside our previously defined benchmark. Breakages need to be considered in conjunction with other causes of failure and the index diagnosis when making decisions about implant choice in the management of proximal femur fractures. Further studies that are better able to deal with the many confounding variables of implant fatigue failure are required.</p><p><strong>Level of evidence: </strong>Therapeutic Level III (Retrospective Cohort Study). See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040400","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":"Good Long-Term Clinical Outcome in 50% of Hips With Mild and Moderate Chronic Slipped Capital Femoral Epiphysis Treated With in Situ Fixation: 93 Hips With a Follow-up of 50 Years.","authors":"Terje Terjesen, Anders Wensaas","doi":"10.2106/JBJS.OA.24.00212","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00212","url":null,"abstract":"<p><strong>Background: </strong>There is no consensus regarding the initial treatment of slipped capital femoral epiphysis (SCFE). The aim of this study was to analyze the long-term outcome of in situ fixation (ISF) in chronic SCFE.</p><p><strong>Methods: </strong>The study consisted of 79 patients (93 hips), treated with ISF from 1955 to 1993. There were 47 male patients (59%) and 32 female patients with a mean age of 12.8 years (range, 8-16 years) at the time of diagnosis. The mean slip angle was 33.4° (range, 12°-80°). The slip was mild (<30°) in 46 hips (49%), moderate (30°-49°) in 33 (36%), and severe (≥50°) in 14 hips. Long-term clinical outcome was based on the rate of total hip arthroplasty (THA) and the modified Harris Hip Score (mHHS) analyzed by telephone (maximum score 91 points).</p><p><strong>Results: </strong>The mean follow-up time was 51.6 years (range, 30-68 years). Thirty-two hips (34%) had undergone THA at a mean patient age of 55.9 years (range, 21-75 years). The survival rate (percentage of hips that had not undergone THA) was 99% at 20 years of follow-up and fell to 69% (95% confidence interval, 58%-80%) at 50 years. The mean mHHS in 57 of the 61 hips that had not undergone THA was 80.7 points (range, 22-91 points). Good long-term outcome, defined as no THA and mHHS ≥76 points, occurred in 40 of 89 hips (45%). The outcome was worse in hips with severe slips compared with moderate and mild slips (p = 0.020), whereas there was no significant differences between moderate and mild slips (p = 0.817). The only independent risk factor of outcome was high alpha angle.</p><p><strong>Conclusions: </strong>At a mean follow-up of 50 years, the clinical outcome in hips with mild or moderate slipping was good in 50% of the hips, and 27% had been converted to THA. These results are well suited for comparison with future studies of more modern treatment concepts.</p><p><strong>Level of evidence: </strong>Therapeutic 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":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056932","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":"Diversity, Equity, and Inclusion Initiatives and Faculty Roles in Orthopaedic Sports Medicine Fellowships Are Associated With Increased Female Representation Among Faculty and Fellows.","authors":"Natasja J Lessiohadi, James Pai, William B Goodman, Deeya Patel, Nicholas E Ganek, Mia V Rumps, Mary K Mulcahey","doi":"10.2106/JBJS.OA.24.00198","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00198","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this study was to identify the prevalence of Diversity, Equity, and Inclusion (DEI) statements and DEI faculty roles in orthopaedic sports medicine fellowships and report any association with female representation among sports medicine fellows and faculty. We also sought to identify other potential trends in prevalence of DEI advocacy and fellow/faculty gender proportions, disparities in these variables among different geographic regions, and program types.</p><p><strong>Methods: </strong>Arthroscopy Association of North America and American Orthopaedic Society for Sports Medicine Fellowship Database review provided all accredited sports medicine fellowship programs. Data were collected (April 20, 2023-June 20, 2023) from 87 programs: location, full names of sports medicine faculty/fellows, and DEI statements/faculty. Physicians' gender was classified using pronouns from biographical webpages.</p><p><strong>Results: </strong>Of 87 fellowship websites, 74.7% (65/87) published DEI statements and 64.4% (56/87) listed DEI faculty (e.g., Diversity Dean, Diversity Officer, etc). Programs with DEI statements had significantly greater proportions of female sports medicine faculty than programs without (80/578, 13.8% ± 15.3% vs. 10/166, 6.0% ± 4.0%, p = 0.017). Programs with DEI statements also had more female sports medicine fellows (25/147, 17% ± 25.5% vs. 3/71, 4.2% ± 8.5%, p = 0.056). All University programs (32/32) included DEI statements and roles; fewer community programs included statements (9/24, 37.5%) or roles (5/24, 20.8%). Most Northeast programs included statements (20/22, 90.9%) and roles (16/22, 72.7%). Only 11 of 19 (57.9%) Western programs included statements, and 8 of 19 (42.1%) included roles.</p><p><strong>Conclusions: </strong>Most orthopaedic surgery sports medicine fellowship programs include DEI statements and DEI-related faculty positions, although these roles generally exist outside the orthopaedic department. Programs with DEI statements and/or faculty roles are associated with higher female representation among sports medicine faculty and fellows. Programs without DEI initiatives should develop public-facing DEI statements and create DEI roles within the orthopaedic department. These initiatives can shape program culture, signal inclusivity, and provide mentorship opportunities. Tracking outcomes such as changes in demographics can demonstrate the impact of these efforts and guide continuous improvement.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033126","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":"Let Us Agree to Disagree on Operative Versus Nonoperative Treatment for Proximal Humerus Fractures: A Multicenter International Prospective Cohort Study of Gray-Zone, Clinical Equipoise Fractures.","authors":"Ruben J Hoepelman, Frank J P Beeres, Bryan J M van de Wall, Christian Michelitsch, Isabelle R Bünter, Reto Babst, Christoph Sommer, Egbert-Jan M M Verleisdonk, Detlef van der Velde, Roderick M Houwert, Rolf H H Groenwold, Mark van Heijl","doi":"10.2106/JBJS.OA.24.00170","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00170","url":null,"abstract":"<p><strong>Background: </strong>Internationally, the optimal treatment strategy of proximal humerus fractures remains much debated.</p><p><strong>Methods: </strong>To investigate whether operative treatment of displaced proximal humerus fractures is superior to nonoperative treatment, this international multicenter prospective natural experiment based on clinical equipoise was performed. Two hundred twenty-six patients with acute proximal humerus fractures presenting from July 2020 to March 2022 were included after expert panel evaluation, consisting of Dutch and Swiss surgeons with diverse ideas on optimal treatment. Patients were included when no consensus on optimal treatment was reached i.e., clinical equipoise. Follow-up was completed after 1 year (n = 191 [84%]). The primary outcome was Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) after 1 year. Secondary outcomes included QuickDASH at 6 weeks and EQ5D, Subjective Shoulder Value (SSV), Numeric Rating Scale (NRS) for pain at 6 weeks and 1 year.</p><p><strong>Results: </strong>No difference in QuickDASH score after 1 year (12.8 vs. 16.2, p = 0.73) was found. At 6 weeks, operative treatment resulted in lower NRS (4.3 vs. 3.0, p < 0.001), higher EQ5D (0.59 vs. 0.67, p = 0.011), and higher SSV (40.9 vs. 51.4, p = 0.005). At 1 year, operative treatment resulted in higher SSV (72.1 vs. 83.7, p = 0.002), while EQ5D was comparable (0.87 vs. 0.85, p = 0.95).</p><p><strong>Conclusion: </strong>No difference between treatments was observed in the primary outcome. Patient-tailored care may still include counseling operative treatment to patients to reduce short-term pain and/or facilitate early return to sport/work in young active patients.</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":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11981393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038546","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":"Perceptions of Orthopaedics and the Effect of Stereotypes on Medical Students.","authors":"Nazihah S Bhatti, Alexandra Sheldon, In Young Nah, Hania Shahzad, Kanu Goyal, Elizabeth Yu","doi":"10.2106/JBJS.OA.24.00177","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00177","url":null,"abstract":"<p><strong>Introduction: </strong>Orthopaedic surgery is the least diverse of all medical specialties. While the overall medical student population has shifted to a female majority, orthopaedics has not made the same progress. Are stereotypes of the specialty influencing medical students?</p><p><strong>Methods: </strong>A survey was distributed to incoming and current medical students at a singular institution's medical school. The survey examined opinions on the field of orthopaedics and how social media plays a part in perpetuating stereotypes of orthopaedics.</p><p><strong>Results: </strong>There were a total of 261 completed survey responses, for a response rate of approximately 32.6%. Eighty-eight percent of students have seen a social media portrayal of orthopaedics. These portrayals negatively affected the opinions of 56% of the medical students. Students with no previous exposure to orthopaedics were more likely to have an unfavorable opinion of the field.</p><p><strong>Conclusions: </strong>Previous exposure to the field, whether before or during medical school, was associated with a more favorable opinion. Most medical students surveyed have seen social media portrayals that have negatively affected their outlook on the field of orthopaedics. Those with some first-hand orthopaedic experience before or during medical school were more likely to have a favorable opinion on the field. Female students were more likely to be deterred from orthopaedic surgery due to these stereotypes.</p><p><strong>Level of evidence: </strong>Level V. 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":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11981248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042412","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":"What Sets Indexed Orthopaedic Journals Apart? A Comparative Analysis of Quality Metrics Between Indexed Orthopaedic Journals and Nonindexed Orthopaedic Journals.","authors":"Alex P Percle, Austin Hansen, Aaron Sheppard, Landon Tujague, Robert W Rutz, Patrick A Massey","doi":"10.2106/JBJS.OA.24.00166","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00166","url":null,"abstract":"<p><strong>Introduction: </strong>The PubMed database is used by many organizations as the benchmark for quality publications. This study aimed to identify quality metrics distinguishing orthopaedic journals indexed in PubMed from nonindexed journals. A second aim was to compare metrics of orthopaedic journals indexed in other major databases vs. nonindexed journals. We hypothesized that indexed orthopaedic journals would have several measurable attributes differentiating them from nonindexed journals.</p><p><strong>Methods: </strong>A list of all current orthopaedic journals in publication in 2021 was compiled. The journals were characterized based on their index status in PubMed, Master Journal List, Journal Citation Reports (JCR), MEDLINE, or Directory of Open Access Journals. Various journal attributes were collected and compared by indexed status. Each variable's association with indexed journals was determined through statistical analysis.</p><p><strong>Results: </strong>Of 478 evaluated journals, 271 were indexed by PubMed. Univariate analysis demonstrated significant associations between PubMed indexing and society affiliation, physician editorial leadership, print version availability, subscription availability, impact factor (IF) listed in JCR, use of Creative Commons licenses, Committee on Publication Ethics (COPE) membership, journals that require an article processing charge (APC), and earlier year of first issue (all with p < 0.001). Logistic regression of journals listed in any index demonstrates that COPE membership had the highest impact on indexed status (odds ratio = 34.19; 95% confidence interval 5.69-105.59; p < 0.001). The regression model also demonstrated that society affiliation, subscription availability, MD designation on website for editors, year of first issue, and number of physician editors have significant associations with indexed journals.</p><p><strong>Conclusion: </strong>COPE membership was the most distinguishing characteristic of indexed orthopaedic journals. Physician editorial leadership and society affiliation were also strong predictors of a journal having an indexed status. In addition, having a print version and/or subscription available, use of Creative Commons licenses, higher IF, longer publication history, and higher APC charge were associated more frequently with indexed journals. Authors should consider these factors when submitting articles to a journal and use caution submitting to journals which do not meet these quality metrics.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11981467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027706","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":"Inclusion of Medical Students in the Operating Room, Are Patients at Risk? A Retrospective Comparison of Short-Term Patient Outcomes Following Total Knee Arthroplasty.","authors":"Brendan Sweeney, Shaan Sadhwani, Michael Marcinko, Timothy Edwards, Michael Brown, Timothy Maurer, Timothy Ackerman","doi":"10.2106/JBJS.OA.24.00163","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00163","url":null,"abstract":"<p><strong>Introduction: </strong>With the advent of virtual clerkships, the ability of medical students to be involved in direct patient care continues to be scrutinized. One such area that has come under scrutiny is the role medical students should play in the operating room. The major critiques brought up by OR staff and surgeons are potential increases in contamination rates and operative times. In this study, we hope to reveal that medical students do not significantly increase postoperative infections or operative times for total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>TKA cases were collected from 3 separate surgeons between 2021 and 2022. Operative times for TKA were compared when medical students were present and when students were not. The same was then done to compare the 2 groups for 30-day and 90-day emergency department (ED) visits and readmissions as well as 1-year deep/superficial infection rates.</p><p><strong>Results: </strong>Five hundred eighty-five cases met inclusion criteria. When averaging the operative times of the 3 surgeons with and without medical students, we found that medical student-assisted cases took 84.6 minutes and without students took 80.1 minutes (p value = 0.0056). Complication rates were higher in the student group (3.73% vs 11.67%, p-value = 0.004). When comparing infection rates, we found that there was a slight reduction in infection rate, 0.37% vs 0.63% with students present (student vs no student; p-value = 1.00).</p><p><strong>Discussion: </strong>This study appears to reassure hospital systems and operating room staff that medical students do not significantly alter infection rates in TKA. In addition, while they do extend operative times, on average, it was less than 5 minutes per case, which seems to be a reasonable amount of time to sacrifice in light of no increase to aggregate complications within 1 year.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11981300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031086","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":"Mechanical Axis Deviation Shift in Limb Lengthening Over the Anatomical Axis, a Retrospective Analysis.","authors":"Akram Al Ramlawi, Philip K McClure, John E Herzenberg, Michael Assayag","doi":"10.2106/JBJS.OA.24.00168","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00168","url":null,"abstract":"<p><strong>Background: </strong>Recently, limb lengthening devices have shifted from external fixators to telescoping magnetic intramedullary lengthening nails (MILNs), which lengthen strictly along the bone's anatomic axis. Baumgart proposed the reverse planning method, overcorrecting lateral shift with a distal osteotomy and slight varus angulation. The untested assumption that antegrade lengthening along the anatomic axis causes lateral mechanical axis deviation (MAD) prompted our study, which examines MILNs' effect on lower limb alignment.</p><p><strong>Methods: </strong>We retrospectively evaluated records for 154 femoral antegrade MILNs inserted in 122 adult patients for limb lengthening. We excluded patients who underwent concomitant corrective osteotomies or tibial lengthening, or who had malunion, nonunion, mechanical failure, or revision surgery for any reason. Long-leg standing radiographs were taken preoperatively, at the end of lengthening, around 3 months postoperatively, and at the culmination of consolidation (approximately 6 months postoperatively). MAD and anatomic mechanical angle (AMA) were assessed as primary outcomes at each radiographic time point for sequential comparison. The predicted MAD was derived from the trigonometric formula (Predicted MAD = lengthening × sin [AMA]).</p><p><strong>Results: </strong>Average preoperative MAD was 2.4 mm medial (SD = 10.6), diminishing to 1.9 mm medial (SD = 13.2) by the end of lengthening. On assessment at consolidation, average MAD had equilibrated back to 2.6 mm medial. Our results showed a net shift of 0.18 mm, whereas the predicted shift was 5.4 mm. The mean preoperative AMA was 5.9 mm (SD = 1.49). At the end of lengthening, the average AMA had decreased to 4.8 mm (SD = 1.4).</p><p><strong>Conclusion: </strong>Our data indicated minimal to no impact on the mechanical axis or joint alignment of the lower limb after antegrade lengthening using a telescoping femoral MILN in a deformity-free femur. Study results suggested that the femur typically realigned in a way that minimized mechanical deviation while preserving joint alignment.</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":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11981364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048649","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":"Cannabidiol Perceptions and Use in the Orthopaedic Patient Population.","authors":"Bradley Lambert, Karen L Hernandez, Haley Goble, Erin Orozco, Patrick C McCulloch","doi":"10.2106/JBJS.OA.24.00141","DOIUrl":"10.2106/JBJS.OA.24.00141","url":null,"abstract":"<p><strong>Background: </strong>Although explored in other medical fields, cannabidiol (CBD) use for pain management remains understudied in orthopaedics. The purpose of this study was to evaluate the frequency of CBD use and perceptions among an orthopaedic population. We hypothesized that most patients would be aware of CBD, that the prevalence of CBD use would at least be comparable with the general population (∼15%), and that the overall perception of CBD use for pain relief would be favorable.</p><p><strong>Methods: </strong>Five hundred adult orthopaedic patients (♂249/♀247; 4 = undisclosed, 54 ± 16 years, 18-86 years) seeking treatment for a wide range of conditions were recruited from a single hospital system before undergoing surgery. Patients were sent an email with a REDCap link for an anonymous survey that included questions about the following: demographics, procedure type, current pain levels, previous knowledge of and/or use of CBD, and indication of favorability regarding CBD use for pain management.</p><p><strong>Results: </strong>Among all patients, >80% reported having heard of CBD and 41.8% reported having used CBD. Among patients reporting previous CBD use, \"pain management\" (79.43%) and \"seeking alternative pain treatment\" (58.81%) were the most common reasons. Among patients reporting no use, the most common reasons were \"unsure of how to obtain\" (42.76%) or \"lack of familiarity\" (37.24%); although the same patients indicated they would consider using if prescription CBD was available (61.22%) along with more evidence regarding safety/efficacy (44.90%). Over 80% of the surveyed patients agreed that CBD might be effective for pain management (p < 0.05).</p><p><strong>Conclusion: </strong>A large proportion of orthopaedic patients have used, or are aware of, CBD for pain management. Presently, barriers to use appear to be most associated with the need for more evidence regarding efficacy/safety and the availability of physician-prescribed pharmaceutical-grade CBD. These results highlight an important need for large-scale randomized trials that may support pharmaceutical-grade CBD use for pain management.</p><p><strong>Level of evidence: </strong>Level III, Descriptive Survey Study. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 2","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}