JBJS Open Access最新文献

{"title":"Reoperation Rate After Posterior Spinal Fusion Varies Significantly by Lenke Type.","authors":"Peter Boufadel, Daniel Badin, Amer F Samdani, Paul D Sponseller","doi":"10.2106/JBJS.OA.23.00179","DOIUrl":"10.2106/JBJS.OA.23.00179","url":null,"abstract":"<p><strong>Background: </strong>Lenke curve types can vary in their response to treatment. We explored potential differences in reoperation rates, causes, and risk factors among patients with different Lenke types who underwent posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).</p><p><strong>Methods: </strong>We studied a multicenter database of patients with AIS who underwent index PSF at ≤21 years of age and had a minimum 2-year follow-up. Baseline and surgical characteristics were collected. Reoperation rates, causes, and risk factors were analyzed by Lenke type.</p><p><strong>Results: </strong>A total of 3,165 patients were included. The mean age was 14.6 years, and most patients were female (81%) and Caucasian (68%). The mean follow-up period was 4.4 years. A total of 138 patients (4.4%) underwent reoperation. The reoperation rate varied by Lenke type (p = 0.02): patients with type-5 curves had the highest reoperation rate (7.2%), and those with type-1 curves had the lowest (3.0%). The most common cause of reoperation was an instrumentation complication. The rate of reoperation due to an instrumentation complication varied by Lenke type (p < 0.01). Compared with patients with type-1 curves, those with type-5 curves had significantly higher rates of reoperation due to implant prominence (odds ratio [OR], 11.7; p = 0.03), loss of fixation (OR, 3.9; p = 0.01), or a broken rod (OR, 7.8; p = 0.02) and those with type-3 curves had a significantly higher rate of reoperation due to loss of fixation (OR, 4.37; p = 0.01). Independent risk factors for reoperation were a major curve magnitude of ≥60° in patients with type-5 curves (adjusted OR [aOR], 4.18; p = 0.04), a major curve correction of ≥40° in patients with type-5 curves (aOR, 3.6; p = 0.04), and a lowest instrumented vertebra (LIV) at or above L1 in patients with type-1 curves (aOR, 2.8; p = 0.02).</p><p><strong>Conclusions: </strong>The reoperation rate for patients with AIS who underwent PSF varied by Lenke type. Patients with type-5 curves had the highest reoperation rate, whereas patients with type-1 curves had the lowest. Patients with Lenke type-5 curves had a higher rate of reoperation due to instrumentation complications.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683009","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":"Collagenase <i>Clostridium histolyticum</i> Versus Needle Fasciotomy for Primary Metacarpophalangeal Dupuytren Contracture: Five-Year Results from a Randomized Controlled Trial.","authors":"Ingi Thor Hauksson, Morten Beier Havdal, Jūratė Šaltytė Benth, Sigurd E Hoelsbrekken, Per-Henrik Randsborg","doi":"10.2106/JBJS.OA.24.00038","DOIUrl":"10.2106/JBJS.OA.24.00038","url":null,"abstract":"<p><strong>Background: </strong>Collagenase <i>Clostridium histolyticum</i> (CCH) and percutaneous needle fasciotomy (PNF) are 2 treatment options for Dupuytren disease. The purpose of this study was to compare these 2 methods in terms of clinical and patient-reported outcomes.</p><p><strong>Methods: </strong>Eighty patients (median age, 72 years; 83% male) with a single-digit primary metacarpophalangeal (MCP) joint contracture of ≥30° were randomized to either CCH or PNF and followed for 5 years. The primary outcome was the difference in flexion-contracture reduction at the MCP joint from baseline to 2 years, with additional analysis examining the effect of the primary endpoint variable up to 5 years. Secondary outcomes included complications, grip strength, scores on the visual analogue scale (VAS) for pain, the shortened version of the Disabilities of the Arm, Shoulder and Hand, the brief Michigan Hand Questionnaire, Unité Rhumatologique des Affections de la Main, and a VAS for treatment satisfaction as well as recurrence and retreatments.</p><p><strong>Results: </strong>The mean MCP joint contracture was 48° at baseline and 2° at 5 years in the CCH group, and 50° at baseline and 7° at 5 years in the PNF group. The reduction in MCP contracture at 2 years was larger in the CCH group than in the PNF group, with a mean difference between the groups of 12° (95% confidence interval [CI], 1.5° to 22.3°; p = 0.026). At 5 years, this mean difference was reduced to 6° (-1.5° to 12.8°; p = 0.1). There was no difference between the groups in any patient-reported outcome scores or grip strength beyond 4 weeks, with the exception of the brief Michigan Hand Questionnaire at 5 years. Ten (25%) of the patients in the PNF group compared with no patient in the CCH group had recurrence (contracture of ≥30°) at the MCP joint at 2 years. At 5 years, 17 (42.5%) of 40 patients in the PNF group had been retreated compared with 4 (10%) of 40 in the CCH group (p < 0.001). The CCH group experienced more transient complications (stiffness and hematoma) during the first week and were more satisfied (VAS satisfaction) from 1 year to the 5-year follow-up.</p><p><strong>Conclusions: </strong>The main finding of this study is that CCH and PNF were equally effective in reducing MCP flexion contracture, but the correction of contracture lasted longer in the CCH group.</p><p><strong>Level of evidence: </strong>Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683008","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":"A Dedicated Research Rotation Increases Orthopaedic Residency Scholarly Activity.","authors":"Nathan Angerett, Christopher Ferguson, Matthew Kelly, Timothy Ackerman","doi":"10.2106/JBJS.OA.24.00075","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00075","url":null,"abstract":"<p><strong>Introduction: </strong>Although clinical research has traditionally been a part of orthopaedic residency, there are now certain core requirements created by the Accreditation Council for Graduate Medical Education (ACGME), which outline the type of research activities to be completed during residency. However, there are no specific details included in the ACGME guidelines regarding how these milestones are to be met. Nor is there specificity regarding expectations of scholarly activity to be completed by the time of graduation. There is a paucity of literature demonstrating the effectiveness of implementing a dedicated research block in an orthopaedic surgical residency, especially in the community setting where limited research-related resources are available.</p><p><strong>Methods: </strong>We implemented a dedicated research rotation along with a set of research milestones and guidelines at our single orthopaedic surgery community residency program. A search was performed through PubMed using residents' and faculty members' names to find publications included a 7-year period from 2015 to 2022 to determine number of publications by residents and faculty. Scholarly activity of faculty was analyzed and quantified using self-reported annual surveys.</p><p><strong>Results: </strong>The average annual number of resident publications (by all 25 residents) increased from 2 to 26 after implementation of a dedicated research rotation. Faculty's scholarly activity, as measured by the following criteria, increased as well: number of publications (from 22 to 55), conference presentations (from 51 to 83), and other presentations (from 43 to 72).</p><p><strong>Conclusion: </strong>Implementation of a dedicated research rotation in a community orthopaedic residency program is associated with an increased publication rate in major academic journals among residents and faculty. There is also an observed association with implementation of a dedicated resident research rotation and an increase in faculty scholarly activity satisfying ACGME faculty requirements.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629512","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":"Radiographic Assessment of Bone Union in Proximal Tibia and Distal Femur Osteotomies: A Systematic Review.","authors":"Eva A Bax, Netanja I Harlianto, Roel J H Custers, Nienke van Egmond, Wouter Foppen, Moyo C Kruyt","doi":"10.2106/JBJS.OA.24.00101","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00101","url":null,"abstract":"<p><strong>Background: </strong>Osteotomies around the knee are a well-established treatment option for early and moderate unicompartmental osteoarthritis combined with a lower extremity malalignment. Moreover, osteotomies are often combined with cartilage treatment. Current image-based bone union assessments lack an accepted definition despite widespread use in research and clinical settings. The aim of this systematic review was to identify definitions and classification systems for bone union on radiographs after a proximal tibia or distal femur osteotomy.</p><p><strong>Methods: </strong>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically searched MEDLINE and Embase database, applying specific inclusion and exclusion criteria. Two independent reviewers screened abstracts and full-texts. The modified Cochrane Risk of Bias Tool and Risk of Bias in Nonrandomized Studies of Interventions tool were used. Data extraction included study characteristics, imaging modality, bone union definition, classification systems, assessment of gap fillers, use of modifiers, and osteotomy type.</p><p><strong>Results: </strong>Of the 1,180 screened titles and abstracts, 105 studies were included, with the majority (69 studies [65.7%]) using a retrospective design. Fifty-five studies (52.4%) defined bone union based on one or more criteria, while 50 studies (47.6%) used a classification system. There were 13 different criteria for bone union and 9 different classification systems. Interestingly, none of the classification systems incorporated negative criteria, such as hardware failure. Notably, 137 studies (49.1%) described bone union as either a primary or secondary outcome but do not describe a system for assessing bone union.</p><p><strong>Conclusion: </strong>This systematic review highlights the lack of consensus in the literature in defining bone union after a proximal tibia or distal femur osteotomy, revealing many criteria and different classifications. None of the classification systems were applicable to osteotomies with and without gap filler. This systematic review shows the need for a straightforward, reproducible, and accurate method to assess bone union after a proximal tibia or distal femur osteotomy.</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":"9 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629513","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 Effect of a Flipped Classroom Didactic Curriculum on Orthopaedic In-Training Examination Scores for a Resident Cohort.","authors":"Steven M Cherney, C Lowry Barnes, R Dale Blasier, John W Bracey, Corey O Montgomery","doi":"10.2106/JBJS.OA.24.00107","DOIUrl":"10.2106/JBJS.OA.24.00107","url":null,"abstract":"<p><strong>Introduction: </strong>There is little research on the efficacy of flipped classroom (FC) models of learning in formal orthopaedic didactic curricula. The primary aim of this study was to compare resident Orthopaedic In-Training Examination (OITE) scores before and after implementation of an FC curriculum at a single academic institution.</p><p><strong>Methods: </strong>An FC didactic model consisting of 3 hour-long weekly sessions focusing on highly tested topics was implemented for the start of the 2021 to 2022 academic year. The curriculum was based on the Orthobullets PASS curriculum. The OITE scores were measured 3 years before and 3 years after the implementation of the novel curriculum.</p><p><strong>Results: </strong>Mean in-training scores as a program against national peers increased from the 29th percentile precurriculum implementation to 75th percentile postcurriculum implementation (p < 0.001).</p><p><strong>Conclusion: </strong>At a single academic institution, average OITE scores increased significantly after implementation of an FC model. Consideration should be given to changing traditional lecture-based curricula to models that more effectively engage resident learners.</p><p><strong>Level of evidence: </strong>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":"9 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11519402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548088","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":"Clinical and Radiographic Outcomes in Kienbock Disease Following Radial Closing Wedge Osteotomy: An Age Comparative Study and Literature Review.","authors":"Takeru Yokota, Soichi Ejiri, Nobuyuki Sasaki, Yuto Akiyama, Narihiro Toshiki, Takuya Kameda, Yoshihiro Matsumoto","doi":"10.2106/JBJS.OA.24.00066","DOIUrl":"10.2106/JBJS.OA.24.00066","url":null,"abstract":"<p><strong>Background: </strong>Age is a preoperative prognostic factor for radial closing wedge osteotomy (RCWO) in Kienbock disease. Specifically, for cases classified as Lichtman stage III, clear criteria for selecting RCWO have not been established. We believe that age can provide vital information for determining the appropriate surgical procedure for Kienbock disease. The aim of this study was to investigate RCWO outcomes for Lichtman stage III by examining different age groups from clinical and radiological perspectives.</p><p><strong>Methods: </strong>Sixteen patients with Lichtman stage III Kienbock disease underwent RCWO. The median age was 59 years, and the median follow-up period was 2.9 years. We determined the age cutoffs for clinical and radiological outcomes using a receiver operating characteristic curve. Subsequently, we conducted intergroup comparisons of postoperative outcomes between the younger and older age groups.</p><p><strong>Results: </strong>Age cutoffs were established at 52.5 and 30 years for clinical and radiological outcomes, respectively. In the comparative analysis, the younger age group (≤52 years; n = 7) demonstrated significantly superior clinical results, including improved range of motion and pain relief, higher postoperative Mayo Wrist Score, and lower Disability of the Arm, Shoulder, and Hand scores. From a radiological perspective, the younger age group (≤30 years; n = 3) experienced segmented lunate bone fragments healing, indicating an improved disease stage compared with the older group.</p><p><strong>Conclusion: </strong>Based on previous literature and our research findings, it is reasonable to conclude that RCWO results in improved clinical outcomes for patients up to their mid-50s and enhanced radiological outcomes for those up to approximately at the age of 30 years. Further studies on these age cutoffs will contribute to refining the surgical selection criteria for RCWO.</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":"9 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11519403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548087","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":"Research Fellowships for Unmatched Orthopaedic Applicants: What Can They Expect?","authors":"Robert B Ponce, Ridge Maxson, Sean P Wrenn, Cade Morris, Craig Louer, Phillip M Mitchell","doi":"10.2106/JBJS.OA.24.00131","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00131","url":null,"abstract":"<p><strong>Introduction: </strong>Unmatched orthopaedic surgery applicants often pursue research fellowships to strengthen their residency applications. The aims of this study were to (1) report the trend of the number of orthopaedic research fellowships offered online between 2019 and 2024, (2) describe the characteristics of research fellowships available to unmatched applicants, and (3) assess the quality of support received by unmatched applicants who complete research fellowships.</p><p><strong>Methods: </strong>An online orthopaedic forum was retrospectively reviewed to identify job postings for medical student research fellowships in the 2019 to 2020 and 2024 to 2025 academic years. Information regarding expected mentorship and funding described in these postings was collected. Surveys were administered electronically to assess the funding received and perceived levels of mentor advocacy among unmatched orthopaedic applicants who had completed research fellowships between 2022 and 2024.</p><p><strong>Results: </strong>The number of orthopaedic research fellowships offered online increased by 165% (54-143) between 2019 and 2024, corresponding with a rate of 18 new fellowships offered per year. For the 2024 to 2025 academic year, 80 fellowships (56%) were available to unmatched applicants. The minority of online postings for these positions described support in the match (49%), the specific amount of funding offered (36%), a successful match track record for prior fellows (20%), and contact information of current or prior fellows (11%). The average amount of publicly offered funding was $32,537 (range, $18,000 to $65,000). Among 31 unmatched applicants who responded, the average amount of funding received was $38,180 ± 11,719. Most respondents rated advocacy from research fellowship mentors as high (53%) or moderate (40%), met with their mentors weekly or biweekly (63%), and received feedback on their residency applications (83%).</p><p><strong>Conclusion: </strong>Over the past 5 years, the number of orthopaedic research fellowships available to unmatched applicants has more than doubled. Although perceived advocacy was rated highly by most unmatched research fellows, fewer than half of the online postings for these positions provided details regarding financial compensation and support during the match cycle. Improvements in transparency related to fellowship characteristics are warranted to assist unmatched orthopaedic applicants in making informed decisions when pursuing research years between match cycles.</p><p><strong>Level of evidence: </strong>N/A.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11498923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509697","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":"Can Artificial Intelligence Fool Residency Selection Committees? Analysis of Personal Statements by Real Applicants and Generative AI, a Randomized, Single-Blind Multicenter Study.","authors":"Zachary C Lum, Lohitha Guntupalli, Augustine M Saiz, Holly Leshikar, Hai V Le, John P Meehan, Eric G Huish","doi":"10.2106/JBJS.OA.24.00028","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00028","url":null,"abstract":"<p><strong>Introduction: </strong>The potential capabilities of generative artificial intelligence (AI) tools have been relatively unexplored, particularly in the realm of creating personalized statements for medical students applying to residencies. This study aimed to investigate the ability of generative AI, specifically ChatGPT and Google BARD, to generate personal statements and assess whether faculty on residency selection committees could (1) evaluate differences between real and AI statements and (2) determine differences based on 13 defined and specific metrics of a personal statement.</p><p><strong>Methods: </strong>Fifteen real personal statements were used to generate 15 unique and distinct personal statements from ChatGPT and BARD each, resulting in a total of 45 statements. Statements were then randomized, blinded, and presented to a group of faculty reviewers on residency selection committees. Reviewers assessed the statements by 14 metrics including if the personal statement was AI-generated or real. Comparison of all metrics was performed.</p><p><strong>Results: </strong>Faculty correctly identified 88% (79/90) real statements, 90% (81/90) BARD, and 44% (40/90) ChatGPT statements. Accuracy of identifying real and BARD statements was 89%, but this dropped to 74% when including ChatGPT. In addition, the accuracy did not increase as faculty members reviewed more personal statements (area under the curve [AUC] 0.498, p = 0.966). BARD performed poorer than both real and ChatGPT across all metrics (p < 0.001). Comparing real with ChatGPT, there was no difference in most metrics, except for Personal Interests, Reasons for Choosing Residency, Career Goals, Compelling Nature and Originality, and all favoring the real personal statements (p = 0.001, p = 0.002, p < 0.001, p < 0.001, and p < 0.001, respectively).</p><p><strong>Conclusion: </strong>Faculty members accurately identified real and BARD statements, but ChatGPT deceived them 56% of the time. Although AI can craft convincing statements that are sometimes indistinguishable from real ones, replicating the humanistic experience, personal nuances, and individualistic elements found in real personal statements is difficult. Residency selection committees might want to prioritize these particular metrics while assessing personal statements, given the growing capabilities of AI in this arena.</p><p><strong>Clinical relevance: </strong>Residency selection committees may want to prioritize certain metrics unique to the human element such as personal interests, reasons for choosing residency, career goals, compelling nature, and originality when evaluating personal statements.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11498924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509692","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":"Operative First Web Contracture Management: Current Strategies.","authors":"Doyle R Wallace, Waldo E Floyd","doi":"10.2106/JBJS.OA.24.00025","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00025","url":null,"abstract":"<p><p>» First web contractures can be due to nonthermal trauma, burns, congenital differences, and Dupuytren contracture.» Mild cases are managed with contracture release and full-thickness skin graft or when surrounding skin is pliable, Z-plasty.» Release of severe contractures creates a tetrahedral void that may require local or distant flap coverage. Reconstructive options include dorsal transposition flaps, regional rotation flaps, free tissue transfer, first metacarpal distraction osteogenesis with web deepening, or pollicization.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509695","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":"Musculoskeletal Learning and Knowledge Retention Among Postgraduate Physicians: Evaluating the Long-Term Impact of a New Preclerkship Curriculum at a Nationally Accredited Medical Program.","authors":"Taylor Orchard, Alexa Hryniuk, Jason Peeler","doi":"10.2106/JBJS.OA.24.00117","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00117","url":null,"abstract":"<p><strong>Introduction: </strong>Musculoskeletal (MSK) injuries and disorders are exceptionally prevalent in the clinical setting. Despite this, physician training in MSK medicine has been historically inadequate contributing to a lack of MSK knowledge, confidence, and clinical skills among postgraduate physicians. The goal of this investigation was to examine the long-term impact of a new preclerkship MSK curriculum implemented by a nationally accredited medical program on postgraduate physician's learning and knowledge retention in the area of MSK medicine.</p><p><strong>Methods: </strong>Five hundred sixty-eight postgraduate physicians (years 1-6) who had previously completed the new curriculum over a 6-year period were recruited to complete a standardized and validated MSK examination that consisted of 30 multiple-choice questions on core or must-know topics in MSK medicine that could be directly mapped to learning objectives within the new preclerkship MSK curriculum.</p><p><strong>Results: </strong>Ninety postgraduate physicians completed the examination, obtaining an average score of 75.0% (±10.2; range 57.0-100.0). Physicians who completed MSK-related electives during clerkship training or specialized in fields related to MSK medicine (i.e., orthopaedics, PM&R, sports medicine, and rheumatology) performed significantly better on the MSK examination (p ≤ 0.01).</p><p><strong>Conclusion: </strong>Data indicated that the program's new preclerkship curriculum supports high levels of MSK learning and knowledge retention among postgraduate physicians. These findings are expected to assist with the establishment of minimum curriculum standards and can be used to guide MSK curricular reform at other medical programs.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509694","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}