JBJS Open Access最新文献

{"title":"Long-Term Results After Hallux Valgus Correction with Distal Metatarsal Reversed-L (ReveL) Osteotomy: Factors That Influence Recurrence and the Clinical Outcome.","authors":"Lizzy Weigelt, Noah Davolio, Carlos Torrez, Florian Haug, Nathalie Kühne, Stephan H Wirth","doi":"10.2106/JBJS.OA.24.00042","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00042","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the long-term results of hallux valgus correction with a distal metatarsal reversed-L (ReveL) osteotomy.</p><p><strong>Methods: </strong>Eighty-eight patients (131 feet) were evaluated after a mean follow-up of 14.2 years (range, 10 to 18 years). Weight-bearing foot radiographs were analyzed preoperatively, at 6 weeks postoperatively, and at the final follow-up for the following parameters: hallux valgus angle (HVA), intermetatarsal angle (IMA), first metatarsophalangeal joint (MTPJ) congruence angle, sesamoid position, presence of the round sign, and first MTPJ arthritis. The visual analog scale (VAS) and the Foot and Ankle Outcome Score (FAOS) assessed postoperative pain and function. Univariate and multivariable logistic regression analyses identified risk factors for hallux valgus recurrence and an inferior clinical outcome.</p><p><strong>Results: </strong>All radiographic parameters significantly improved at the 6-week follow-up and the final follow-up (p < 0.001). The recurrence rate (HVA >20°) was 14%. A preoperative HVA of >28° (odds ratio [OR], 9.1; p = 0.02) and a 6-week postoperative HVA of >15° (OR, 4.6; p = 0.03) were independent risk factors for recurrence. At the final follow-up, all FAOS subscales resembled high postoperative function (median, 100 points [range of the interquartile range (IQR), 81 to 100 points]). A preoperative body mass index of >30 kg/m² was associated with lower FAOS quality of life (QOL) (p = 0.04), and postoperative hallux varus was associated with lower FAOS activities of daily living (p = 0.048). Patients with first MTPJ arthritis of grade 2 or higher at the final follow-up had significantly lower FAOS subscales (p < 0.01) except for QOL. Hallux valgus recurrence did not influence the long-term outcome. A symptomatic implant was the main cause of revision (15%). In 94% of cases, the patients were satisfied with the hallux appearance and, in 92% of cases, the patients were satisfied with postoperative pain reduction.</p><p><strong>Conclusions: </strong>Hallux valgus correction with a ReveL osteotomy led to high long-term satisfaction rates. A preoperative HVA of >28° and a 6-week postoperative HVA of >15° increased the risk of hallux valgus recurrence. First MTPJ arthritis was the leading cause of inferior clinical results, whereas radiographic hallux valgus recurrence had no impact on the clinical results. First MTPJ arthritis at the final follow-up was associated with an inferior clinical outcome, whereas radiographic hallux valgus recurrence had no impact on the long-term clinical results.</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":"9 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11392477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297444","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":"Trends in Orthopaedic Surgery Fellowship Match Among Female Residents: Discrepancies in Sex Diversity by Subspecialty.","authors":"Malini Anand, Kaitlyn R Julian, Mary K Mulcahey, Stephanie E Wong","doi":"10.2106/JBJS.OA.24.00057","DOIUrl":"https://doi.org/10.2106/JBJS.OA.24.00057","url":null,"abstract":"<p><strong>Introduction: </strong>There is a historic sex imbalance in the field of orthopaedic surgery in the United States, with female physicians being vastly underrepresented. In addition, this sex imbalance is particularly pronounced in certain subspecialties. As such, we sought to analyze the distribution of graduating female residents and their fellowship match trends from 2017 to 2022.</p><p><strong>Methods: </strong>The American Medical Association Fellowship and Residency Electronic Interactive Database was used to identify all orthopaedic surgery residency programs in the United States during the 2016 to 2017 and the 2021 to 2022 academic years. The data were supplemented with the Accreditation Council for Graduate Medical Education (ACGME) Data Book to include data on all ACGME-accredited programs in 2017 and 2022. The percentage of female orthopaedic surgery residents matching into each subspecialty was calculated. Continuous data were analyzed with independent <i>t</i> test, and significance was set at p < 0.05.</p><p><strong>Results: </strong>From 2017 to 2022, there has been a significant increase in the percentage of female residents matching in orthopaedic surgery fellowships (14.6% vs. 19.5%, p < 0.001). In the orthopaedic hand subspecialty, 24 (15.8%) female residents matched into a hand fellowship in 2017 vs. 56 (35.2%) in 2022 (p < 0.001). Spine, trauma, adult reconstruction, oncology, pediatrics, foot and ankle, shoulder and elbow, and sports medicine fellowships have not seen a significant change in the distribution of female residents matching over the past 5 years.</p><p><strong>Conclusion: </strong>Between 2017 and 2022, the total number of female orthopaedic surgery fellows increased, and there was significant growth in the percentage of matched female fellows in the subspecialty of hand. Other orthopaedic subspecialties including spine, trauma, adult reconstruction, oncology, pediatrics, foot and ankle, shoulder and elbow, and sports medicine have seen no significant change in the distribution of women fellows over the past 5 years. Further investigation is warranted to determine factors leading to growth in certain fellowships among female residents to encourage sex diversity among all subspecialties in orthopaedic surgery.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11392489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297447","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":"Robots on the Stage: A Snapshot of the American Robotic Total Knee Arthroplasty Market.","authors":"Avinash Inabathula, Dimitar I Semerdzhiev, Anand Srinivasan, Farid Amirouche, Lalit Puri, Hristo Piponov","doi":"10.2106/JBJS.OA.24.00063","DOIUrl":"10.2106/JBJS.OA.24.00063","url":null,"abstract":"<p><p>» Computer-assisted robots aid orthopaedic surgeons in implant positioning and bony resection. Surgeons selecting a robot for their practice are faced with numerous options. This study aims to make the choice less daunting by reviewing the most commonly used Food and Drug Administration-approved robotic total knee arthroplasty platforms in the American arthroplasty market.» Modern total knee arthroplasty (TKA) robots use computer guidance to create a virtual knee model that serves as the surgeon's canvas for resection planning.» Most available robotic TKA (rTKA) systems are closed semiactive systems that restrict implant use to those of the manufacturer.» Each system has distinct imaging requirements, safety features, resection methods, and operating room footprints that will affect a surgeon's technique and practice.» Robots carry different purchase, maintenance, and equipment costs that will influence patient access across different socioeconomic groups.» Some studies show improved early patient-reported outcomes with rTKA, but long-term studies have yet to show clinical superiority over manual TKA.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141302","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":"ChatGPT-4 Knows Its A B C D E but Cannot Cite Its Source.","authors":"Diane Ghanem, Alexander R Zhu, Whitney Kagabo, Greg Osgood, Babar Shafiq","doi":"10.2106/JBJS.OA.24.00099","DOIUrl":"10.2106/JBJS.OA.24.00099","url":null,"abstract":"<p><strong>Introduction: </strong>The artificial intelligence language model Chat Generative Pretrained Transformer (ChatGPT) has shown potential as a reliable and accessible educational resource in orthopaedic surgery. Yet, the accuracy of the references behind the provided information remains elusive, which poses a concern for maintaining the integrity of medical content. This study aims to examine the accuracy of the references provided by ChatGPT-4 concerning the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach in trauma surgery.</p><p><strong>Methods: </strong>Two independent reviewers critically assessed 30 ChatGPT-4-generated references supporting the well-established ABCDE approach to trauma protocol, grading them as 0 (nonexistent), 1 (inaccurate), or 2 (accurate). All discrepancies between the ChatGPT-4 and PubMed references were carefully reviewed and bolded. Cohen's Kappa coefficient was used to examine the agreement of the accuracy scores of the ChatGPT-4-generated references between reviewers. Descriptive statistics were used to summarize the mean reference accuracy scores. To compare the variance of the means across the 5 categories, one-way analysis of variance was used.</p><p><strong>Results: </strong>ChatGPT-4 had an average reference accuracy score of 66.7%. Of the 30 references, only 43.3% were accurate and deemed \"true\" while 56.7% were categorized as \"false\" (43.3% inaccurate and 13.3% nonexistent). The accuracy was consistent across the 5 trauma protocol categories, with no significant statistical difference (p = 0.437).</p><p><strong>Discussion: </strong>With 57% of references being inaccurate or nonexistent, ChatGPT-4 has fallen short in providing reliable and reproducible references-a concerning finding for the safety of using ChatGPT-4 for professional medical decision making without thorough verification. Only if used cautiously, with cross-referencing, can this language model act as an adjunct learning tool that can enhance comprehensiveness as well as knowledge rehearsal and manipulation.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141301","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":"Predicting the Occurrence of New Vertebral Fractures Using the Vertebral Bone Quality Score: A Prospective Cohort Study Using 11-Year MRI Follow-up Data from the Minami-Aizu Study.","authors":"Takeru Yokota, Koji Otani, Yuji Endo, Ryoji Tominaga, Takuya Kameda, Kenji Kobayashi, Takehiro Watanabe, Miho Sekiguchi, Shin-Ichi Konno, Yoshihiro Matsumoto","doi":"10.2106/JBJS.OA.23.00161","DOIUrl":"10.2106/JBJS.OA.23.00161","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have recognized the potential of the Vertebral Bone Quality (VBQ) score for predicting fractures. However, these studies often have lacked longitudinal perspectives and have not focused on community populations. Our study aimed to enhance the predictive capacity of the VBQ score by investigating its correlation with new vertebral fractures (NVFs) that were detected 11 years later in a community-based cohort and by developing a comprehensive prediction model.</p><p><strong>Methods: </strong>This study was a population-based study conducted in the Minami-Aizu area in Fukushima Prefecture, Japan. One hundred and thirty participants voluntarily underwent T1-weighted magnetic resonance imaging (MRI) of the lumbar spine in 2004 and 2015. VBQ scores were ascertained from the 2004 scans. NVFs that occurred between 2004 and 2015 were detected based on a ≥20% reduction in vertebral height on the midsagittal sections of the MRI. Other predictors that were considered included age, sex, body mass index, smoking history, heart disease, cerebrovascular disease, respiratory disease, and existing vertebral fractures (EVFs). A logistic regression analysis was conducted.</p><p><strong>Results: </strong>The logistic regression analysis indicated that the VBQ score, age, sex, and EVFs were significant predictors of NVFs. The prediction model showed an area under the curve of 0.84, suggesting excellent discriminatory power. The calibration capacity was confirmed using the Hosmer-Lemeshow test.</p><p><strong>Conclusions: </strong>The VBQ score was significantly correlated with the long-term incidence of NVFs in a community population. The prediction model exhibited satisfactory discrimination and calibration capacities, highlighting the use of the VBQ score as a potential tool for long-term prediction of NVFs.</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":"9 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11335329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056783","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 Comparison of PROMIS Scores of Metatarsophalangeal Joint Arthrodesis and Polyvinyl Alcohol Hydrogel Implant Hemiarthroplasty for Hallux Rigidus.","authors":"Seif El Masry, Allison L Boden, Grace M DiGiovanni, Agnes D Cororaton, Scott J Ellis","doi":"10.2106/JBJS.OA.23.00158","DOIUrl":"10.2106/JBJS.OA.23.00158","url":null,"abstract":"<p><strong>Background: </strong>The current literature shows similar clinical outcomes between first metatarsophalangeal (MTP) joint arthrodesis and synthetic cartilage implant (SCI) hemiarthroplasty in the treatment of hallux rigidus; however, prior studies have not reported validated patient-reported outcome measures (PROMs). To our knowledge, this is the first study to compare PROMs using 6 domains of the validated Patient-Reported Outcomes Measurement Information System (PROMIS) in patients treated for hallux rigidus with MTP joint arthrodesis and with SCI hemiarthroplasty. In addition, this novel study provides comparative data on the complication and revision rates for each procedure.</p><p><strong>Methods: </strong>A single-center, retrospective registry search identified all patients with preoperative PROMIS scores who underwent MTP joint arthrodesis or SCI hemiarthroplasty for hallux rigidus between February 2016 and June 2021. The study aimed to determine if the 2 procedures showed statistically or clinically equivalent PROMIS scores in 6 domains: physical function, pain interference, pain intensity, global physical health, global mental health, and depression. A multivariable linear regression analysis was performed to compare adjusted 1-year postoperative PROMIS scores between the 2 cohorts. Complication and revision rates were also compared.</p><p><strong>Results: </strong>The study included 82 patients who underwent SCI hemiarthroplasty and 101 who underwent MTP joint arthrodesis. Demographic data and preoperative hallux rigidus severity showed no significant differences between the cohorts. PROMIS scores were mostly comparable between the 2 groups, except for the pain intensity domain. The patients who underwent MTP joint arthrodesis exhibited significantly better pain relief at 1 and 2 years postoperatively, which was supported by adjusted postoperative PROMIS scores. At 2 years, the SCI group had worse pain intensity scores and lower global physical health scores. There were no differences between the cohorts in additional PROMIS scores or complication data.</p><p><strong>Conclusions: </strong>While outcomes in most of the domains were similar, MTP joint arthrodesis was more effective at mitigating pain intensity compared with SCI hemiarthroplasty. This information can guide patient counseling and decision-making when considering surgical intervention for hallux rigidus.</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 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11328988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005491","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 Pelvic Inlet and Outlet View Angles in the Ethiopian Population.","authors":"Solomon Melkamu, Gabriel Alemayehu, Samuel Hailu","doi":"10.2106/JBJS.OA.24.00015","DOIUrl":"10.2106/JBJS.OA.24.00015","url":null,"abstract":"<p><strong>Background: </strong>Accurate radiographic assessment is pivotal in evaluating trauma patients with suspected pelvic ring disruptions. The conventional approach of using anteroposterior, 45° inlet, and 45° outlet radiographs for the evaluation of pelvic injury may not consistently align with varying lumbopelvic anatomy. This study aimed to determine the ideal pelvic inlet and outlet radiographic angles when there is limited access to advanced imaging (e.g., computed tomography [CT]) for assessing clinically relevant pelvic osseous landmarks and to investigate variations based on age, sex, and sacral dysmorphism.</p><p><strong>Methods: </strong>This cross-sectional study investigated patients who were ≥18 years of age who had no traumatic injuries or pelvic ring pathology; we reviewed abdominopelvic CT scans that were obtained between January 1, 2023, and June 30, 2023. Midsagittal reconstruction and 3D rendering of 148 CT scans facilitated the measurement of pelvic inlet and outlet angles. Standard techniques that were based on previous studies were used to determine the ideal angles. Statistical analyses investigated mean pelvic inlet and outlet angles as well as correlations with age, sex, and sacral dysmorphism.</p><p><strong>Results: </strong>The mean pelvic inlet angle was 23.8° ± 8.4° (95% confidence interval [CI]: 22.4° to 25.2°), and the mean outlet angle was 40.1° ± 5.9° (95% CI: 39.2° to 41.1°). Male patients exhibited greater inlet angles (27° versus 20°), whereas female patients had greater outlet angles (41° versus 39°). Pelves with dysmorphism showed a 3.6° increase in outlet angles when compared with those with normal sacral anatomy. An inverse relationship between age and inlet angle was observed.</p><p><strong>Conclusions: </strong>This study highlights that the recommended 45° angle for pelvic inlet and outlet views may not optimally align with the anatomy of the Ethiopian population. The findings suggest that the ideal inlet and outlet angles for this population are 25° and 40°, respectively. Understanding these variations is crucial for optimizing pelvic radiographic views in trauma evaluation, potentially leading to more accurate assessments and improved patient care in this demographic.</p><p><strong>Level of evidence: </strong>Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11328984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005493","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":"Intra-Articular Corrective Osteotomy for Distal Radial Intra-Articular Malunion Using Patient-Matched Instruments: A Prospective, Multicenter, Open-Label, Single-Arm Trial.","authors":"Kunihiro Oka, Satoshi Miyamura, Ryoya Shiode, Hiroyuki Tanaka, Norimasa Iwasaki, Daisuke Kawamura, Kazuki Sato, Takuji Iwamoto, Michiro Yamamoto, Keiichiro Nishida, Yasunori Shimamura, Tomomi Yamada, Seiji Okada, Tsuyoshi Murase","doi":"10.2106/JBJS.OA.24.00026","DOIUrl":"10.2106/JBJS.OA.24.00026","url":null,"abstract":"<p><strong>Background: </strong>Corrective osteotomy for intra-articular malunion is a challenging procedure. However, recent advancements, including patient-matched instruments created on the basis of preoperative computer simulation, enable accurate intra-articular correction. We hypothesized that intra-articular corrective osteotomy using patient-matched instruments for the treatment of distal radial intra-articular malunion would reduce intra-articular deformity and restore wrist function at 12 months of follow-up.</p><p><strong>Methods: </strong>This prospective study included 12 patients with distal radial intra-articular malunion who underwent intra-articular corrective osteotomy external to the joint using patient-matched instruments. The primary end point was the maximum step-off on the articular surface of the distal radius, measured with use of computed tomography (CT), with an expected postoperative value of ≤1.5 mm. The secondary end points included the gap of the articular surface; range of motion; grip strength; pain evaluated using a visual analog scale (VAS); patient satisfaction; Disabilities of the Arm, Shoulder and Hand (DASH) score; and Patient-Rated Wrist Evaluation (PRWE) score. A mean postoperative step-off of ≤1.5 mm for the primary end point was assessed with use of the 1-sample t test. The secondary end points were assessed with use of the Dunnett multiple comparison test.</p><p><strong>Results: </strong>The average step-off significantly improved from 3.75 ± 1.04 mm preoperatively to 0.51 ± 0.40 mm at the 52-week postoperative follow-up and was maintained within 1.5 mm. The average wrist and forearm range of motion, VAS score, grip strength, DASH score, and PRWE score significantly improved. Eleven patients were either very satisfied or satisfied with their outcomes.</p><p><strong>Conclusions: </strong>The use of patient-matched instruments could contribute to improving postoperative outcomes of intra-articular corrective osteotomy procedures involving the distal radius.</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":"9 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11328987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005492","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":"Predictors Associated with the Need for Open Reduction of Pediatric Supracondylar Humerus Fractures: A Meta-analysis of the Recent Literature.","authors":"M Bryant Transtrum, Diego Sanchez, Shauna Griffith, Brianna Godinez, Vishwajeet Singh, Kyle J Klahs, Amr Abdelgawad, Ahmed M Thabet","doi":"10.2106/JBJS.OA.24.00011","DOIUrl":"10.2106/JBJS.OA.24.00011","url":null,"abstract":"<p><strong>Background: </strong>Supracondylar humerus (SCH) fractures are some of the most common fractures in pediatric patients with surgery typically consisting of either open or closed reduction with internal fixation. The aim of this meta-analysis was to identify patient, injury, and administrative factors that are associated with treating pediatric SCH fractures with open techniques.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed and CINAHL database searches were conducted for studies from 2010 to 2023 that made direct comparisons between open reduction and internal fixation (ORIF) and closed reduction and percutaneous pinning (CRPP) for treating SCH fractures in the pediatric population. The search terms used were \"pediatric\" AND \"SCH fracture\" OR \"distal humerus fracture.\" Screening, quality assessment, and data extraction were performed by 4 reviewers. After testing for heterogeneity between studies, data were aggregated using random-effects model analysis.</p><p><strong>Results: </strong>Forty-nine clinical studies were included in the meta-analysis. Summated, there were 94,415 patients: 11,329 treated with ORIF and 83,086 treated with CRPP. Factors that were significantly associated with greater rates of ORIF included obesity (p = 0.001), Gartland type IV fractures (p < 0.001), general neurological deficits (p = 0.019), and ulnar nerve deficits (p = 0.003). Gartland type II (p = 0.033) and medially displaced fractures (p = 0.011) were significantly associated with lower rates of ORIF. Secondary analysis showed cross-pinning constructs (p = 0.033) and longer hospital stays (p = 0.005) are more likely to be observed in patients undergoing ORIF compared with CRPP.</p><p><strong>Conclusion: </strong>This meta-analysis demonstrates that factors such as obesity, fracture displacement, and concomitant nerve deficits are more likely to require ORIF as opposed to CRPP.</p><p><strong>Level of evidence: </strong>Therapeutic Level III.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11299990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898534","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":"Revisiting Differences in Fourth-Year Orthopaedic Away Rotation Opportunities and Fees Among Allopathic and Osteopathic Medical Students.","authors":"Anthony Modica, Adam Kazimierczak, Brandon J Klein, Peter B White, Adam D Bitterman, Randy M Cohn","doi":"10.2106/JBJS.OA.24.00041","DOIUrl":"10.2106/JBJS.OA.24.00041","url":null,"abstract":"<p><strong>Introduction: </strong>Fourth-year away rotations are an important modifiable variable proven to increase students' opportunities to match into orthopaedic surgery. The purpose of this study was to determine differences in away rotation eligibility requirements and cost of rotation between allopathic and osteopathic students during the 2023 application cycle. Eligibility requirements and fees were then compared with the 2021 application cycle.</p><p><strong>Methods: </strong>A cross-sectional study was performed during the 2023 application cycle of all nonmilitary, Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic surgery residency programs (n = 194). Each program's website, affiliated school of medicine's website, visiting student application service portal, and Residency Explorer tool were searched for eligibility criteria, associated rotation fees, and other rotation requirements. Two-sample Z tests for proportions were utilized to compare differences in programs with differing requirements for students based on academic degree type. Data were compared statistically with previously reported data from the 2021 application cycle.</p><p><strong>Results: </strong>In 2023, there were more programs that restricted osteopathic medical students from away rotations than programs that restricted allopathic medical students (12/194, 6.2% vs. 0/194, 0.0%; p < 0.001). All 12 programs were formerly ACGME-accredited before the integration into a single accreditation system. There was a decrease in the number of programs restricting osteopathic medical students from away rotations compared with the 2021 application cycle (18/194, 9.3% vs. 12/194, 6.2%; p = 0.254). Fees associated with away rotations ranged from $25 to $4,000 for both allopathic and osteopathic students. The number of programs that charged osteopathic medical students higher rotation fees than programs that charged allopathic students when compared with the 2021 application cycles decreased (1/194, 0.5% vs. 5/194, 2.6%; p = 0.049).</p><p><strong>Conclusions: </strong>While some programs continue to have away rotation eligibility requirements that prohibit osteopathic medical students from rotating, only one residency program currently charges osteopathic medical students a higher fee to rotate than allopathic medical students.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11296481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894519","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}