搜索结果：The Journal of the American Academy of Orthopaedic Surgeons

Healthcare access varies dramatically across the United States, with rural and underserved populations facing notable barriers to timely, specialized care. The proximity of physician training affects the overall workforce distribution; however, this trend has not been assessed within orthopaedic surgery. This study investigates the impact birthplace and training location have on future practice location among US orthopaedic surgeons and characterizes the per-capita workforce distribution. Eight thousand, six hundred seventy-six orthopaedic surgeons who completed residency training between 2004 and 2017 were identified from the American Medical Association Physician Masterfile. Demographic and practice data were extracted, including birthplace, medical school, residency and attending practice as of January 1, 2023. Locations were stratified by state and census division. The cohort represented 94.84% of orthopaedic surgeons trained nationally during the study period. Attendings returning to their state of birth, medical school, or residency to practice were 21.7%, 31.8%, and 33.9%, respectively, with pronounced state-level variability (birthplace: 2.50% to 47.95%; medical school: 3.94% to 61.8%; residency: 11.71% to 63.95%). Indiana (pop:6,880,131) trained the fewest residents per capita (1:1.15 million), whereas neighboring Ohio (pop:11,824,034) ranked fifth nationally (1:191,000). Univariate logistic regression revealed notable associations (P < 0.01) between practice location by census division at all career stages. Attending distribution per capita showed strong correlations by state (R2 = 0.98) and census division (R2 = 0.99), whereas birthplace (R2 = 0.71), medical school (R2 = 0.53), and residency (R2 = 0.63) showed moderate association. This study demonstrates that birthplace and training location are strongly associated with practice location for US orthopaedic surgeons. Despite variation in trainee numbers by state, the distribution of practicing surgeons normalizes relative to state population, likely driven by economic incentives, local workforce demands, and market conditions. Given the strong statistical association for surgeons to practice near their training location, aligning local programs with underserved or high-need areas may offer a potential solution to reduce regional disparities and improve access to orthopaedic care.

The American College of Surgeons (ACS) created the National Surgical Quality Improvement Program (NSQIP) risk calculator and database for use across surgical subspecialties and is frequently cited in surgical subspecialty peer-reviewed journals. In addition, Medicare has endorsed clinically using this risk calculator. This risk calculator has not been formally evaluated for use in distal radius fracture surgery. This study aimed to assess the utility of the ACS-NSQIP risk calculator in hand surgery by comparing complication rates predicted by the ACS-NSQIP risk calculator against those observed from an institutional database. Retrospective cohort study between May 2000 and May 2020. Academic level 1 trauma center. Seven hundred sixty-seven patients who underwent of open reduction and internal fixation of 790 distal radius fractures were prospectively enrolled into an institutional database. Patients aged 18 years or older who underwent volar plate fixation within 2 weeks following a distal radius fracture. The primary study outcomes were the rate of "any" complications, as defined by ACS-NSQIP, and the rate of "hand-related" complications, as defined by a peer-reviewed journal publication. Overall, 767 patients were identified who sustained 790 distal radius fractures treated with volar plating to make up the cohort of the study. Mean age was 56.9 years, 77.0% were female, and 33.0% were type 23C1 distal radius fractures. ACS-NSQIP predicted an "any" complication rate of 1.85% (confidence interval [CI], 1.75 to 1.95). Institutional data observed "any" complication rate of 2.15% (CI, 1.01-2.91) within 30 days and 11.14% (CI, 8.99-13.42) for "long-term" any. Institutional data observed "hand-related" complication rate of 6.84% (CI, 5.18-8.83) within 30 days and 27.72% (CI, 24.56 to 30.89) for "long-term" any. ACS-NSQIP fails to accurately predict the number of "hand-related" complications from distal radius fracture surgery. From a health policy, quality control, and clinical standpoint, ACS-NSQIP should be used cautiously with distal radius fracture surgery.

The purpose of this study is to compare patient presentation characteristics and timeliness of pediatric supracondylar humerus fracture management from before and after the COVID-19 pandemic. These comparisons may lead to the identification of changes in emergency department (ED) flow or operating room availability since the pandemic. A retrospective review was done of patients seen for an isolated supracondylar humerus fracture at a single tertiary care pediatric hospital. The prepandemic group presented from January 1, 2018 to June 30, 2019, and the postpandemic group presented from March 1, 2022 to August 31, 2023. The two groups were directly compared. Three hundred eighty-eight patients were included in the prepandemic group, and 413 patients in the postpandemic group with a median age of 5.3 years. Of the patients who presented directly to our ED and were admitted, there was markedly longer time to admission (5.7 vs. 4.0 hours; P < 0.0001), time to surgical intervention (14.0 vs. 9.2 hours; P < 0.0001), and total length of stay (22.9 vs. 20.0 hours; P = 0.0004) in the postpandemic group. Similarly, of the patients who were transferred to our institution and were admitted, there was markedly longer time to surgical intervention (7.4 vs. 5.8 hours; P = 0.0029) and total length of stay (20.0 vs. 17.1 hours; P = 0.0002) in the postpandemic group. In the postpandemic group, patients who presented directly to our ED and did not require surgery had a markedly longer total length of stay (5.0 vs. 3.9 hours; P < 0.0001). Patients transferred to our ED in the postpandemic group were more likely to require nonsurgical care, although this did not reach significance (12% vs. 6%; P = 0.084). Since the pandemic, there have been notable delays in care for pediatric supracondylar humerus fractures. Identification of these delays provides support for the restructuring of hospital resources to help improve the patient experience and physician morale and decrease hospital costs. III.

The primary aim of this study was to identify and characterize medical malpractice lawsuits pertaining to pediatric orthopaedic surgery. The Westlaw research database was queried for all jury verdicts and settlements pertaining to pediatric orthopaedic medical malpractice from 1980 to 2024. Cases were only included if the primary basis of litigation rested on a malpractice claim related to pediatric orthopaedic surgery and were levied against an orthopaedic surgeon. Data collected included date and state of case filing, patient (plaintiff) and surgeon (defendant) demographics, jury verdict, monetary awards, alleged negligence, and patient complications. Of 5,031 cases screened for inclusion, a total of 100 cases met the inclusion and exclusion criteria and were subsequently included in the final analysis. Plaintiff favorable outcomes were more commonly seen than a defendant verdict (56% vs. 44%). Patients most commonly presented for fracture management (62%), and most commonly underwent casting (30%). Alleged failure to diagnose was the most frequent basis of litigation (30%) and was predictive of a plaintiff outcome. The most frequent complication was the presence of permanent deformity (22%). A pediatric orthopaedic surgeon was the primary defendant in 59% of cases and was more commonly named following closed reduction and percutaneous pinning. Adult orthopaedic surgeons (41%) were more commonly named following fracture casting. The majority of medical malpractice cases in pediatric orthopaedic surgery result in plaintiff-favorable outcomes. Pediatric orthopaedic medical malpractice cases most often arise in the setting of fracture care and allegations of missed diagnoses. Patients pursuing litigation most frequently sustain permanent deformity as a result of the alleged negligence. Both pediatric and adult orthopaedic surgeons primarily face litigation following call-related fracture cases.

Large language models (LLMs), such as ChatGPT, are becoming increasingly prevalent, particularly in medical education and clinical assessments. Previous LLMs were seen to perform at the level of a first-year resident on the 2022 Orthopaedic In-Training Examination (OITE). With exponential advances in LLMs over the past 3 years, the true capabilities of these models remain unexplored. In addition, the addition of image processing further increases their clinical applicability. The purpose of this study was to evaluate the performance of six LLMs on the 2024 OITE. Six LLMs were evaluated in this study: ChatGPT (GPT-4o), Gemini 2.0 Flash, Grok 3, Mistral Large 2.7, DeepSeek R1, and Llama. ChatGPT, Gemini, Grok, and Mistral could evaluate images and text while DeepSeek and Llama were limited to text. Accuracy, image interpretation, and logical consistency were assessed in 203 multiple-choice questions, stratified by difficulty and type of the question. Statistical analyses involved chi-square tests, Fisher exact tests, z-tests, and Cohen &#x3ba; tests. ChatGPT performed with the highest accuracy (74.9%), followed by DeepSeek, Llama, Grok, Mistral, and Gemini. ChatGPT also led in logical consistency (72.4%) and image interpretation (73.8%). Logical consistency strongly correlated with accuracy and correctness (P < 0.00001). As difficulty increased, performance declined across all models. ChatGPT consistently scored the highest in terms of accuracy across all metrics while also maintaining reasoning quality. Compared with resident averages, ChatGPT performed at a postgraduate year five level which indicates its potential for integration into orthopaedic clinics, electronic medical records, and surgical planning. Further development models would allow for better performance on difficult questions and creating orthopaedic focused models could enhance these results.

A type III internal hemipelvectomy includes resection of the pubic rami. Although bony reconstruction is not necessary, the integrity of the abdominal wall is deficient following resection. The aim of this study was to report the outcome of soft-tissue reconstruction following these resections. We retrospectively reviewed all isolated type III internal hemipelvectomies which were undertaken at the Mayo Clinic (Rochester, USA) between January 2002 and December 2022. The group included 25 patients, of whom 14 (56%) were male. Their median age was 45 years (IQR 61 to 31) at the time of surgery. Most patients (n = 18; 72%) underwent resection for a sarcoma. Soft-tissue flaps were used in 21 patients (84%) and nine also had a mesh reconstruction. The five-year disease-specific survival was 65% following surgery, with significantly worse survival in patients with locally advanced tumour (35% (95% CI 12 to 100) vs 76% (95% CI 59 to 99); p = 0.036). Complications were common, with 21 patients (84%) having at least one complication, and 12 (48%) having several complications. Most commonly, this included seroma or haematoma (44%), wound dehiscence (40%), and infection (40%). The use of a soft-tissue flap did not significantly reduce the risk of infection (hazard ratio (HR) 0.68 (95% CI 0.14 to 3.28); p = 0.638) or seroma or haematoma (HR 0.31 (95% CI 0.30 to 4.14); p = 0.088), but patients who did not have a soft-tissue flap were significantly more likely to develop a hernia (odds ratio 9.0 (95% CI 1.14 to 71.03); p = 0.027). A total of three of 21 patients (14%) whose reconstruction involved a flap had donor site complications. Soft-tissue reconstruction following a type III internal hemipelvectomy reduces the risk of postoperative hernia formation, with a low rate of donor site complications. This additional procedure should be considered for all patients undergoing this type of resection.

Lower extremity amputation (LEA) is performed by diverse specialties, including orthopaedic surgery and vascular surgery; whether outcomes differ by specialty remains uncertain. This study compared early postoperative outcomes after LEA performed by orthopaedic and vascular surgeons. Patients who underwent LEA surgeries were identified within the National Surgical Quality Improvement Program database. National Surgical Quality Improvement Program was queried for above-knee amputation, below-knee amputation, and foot amputations performed by orthopaedic or vascular surgeons. Patients were matched in a 1:1 ratio using propensity scores using a mixed exact/caliper approach. Primary outcomes were 30-day mortality, readmission, and revision surgery; secondary outcomes included cardiac, pulmonary, wound-related issues, and discharge disposition. A total of 26,925 LEA cases were identified. After propensity matching, 3,580 cases remained: orthopaedic surgery 1790 versus vascular surgery 1790, including 3,180 matched below-knee amputation, 806 matched above-knee amputation, and 334 matched foot amputations. Final cohorts had a similar distribution of demographic variables, indicating appropriate matching. Mortality of 4.0% versus 4.0%, readmission of 10.7% versus 11.7%, and revision surgery of 7.6 versus 8.3% were equivalent between orthopaedics and vascular surgery, respectively. The vascular cohort demonstrated higher rates of any postoperative complication: the sum of secondary outcomes (77.9% vs 70.4%; P < 0.001), driven primarily by increased non-home discharge (69.7% vs 60.8%) and transfusion within 72 hours (19.5% vs 16.3%). When non-home discharge was removed, there was no difference in early postoperative complication (32.2% vs 35.5%; P = 0.382). By contrast, the orthopaedic group had slightly higher rates of organ/space infection (4.1% vs 2.2%; P = 0.001) and postoperative pneumonia (3.8% vs 2.5%; P = 0.029), consistent with the higher proportion of contaminated/dirty wounds: 44.4% versus 36.0% and longer surgical duration: 79.5 &#xb1; 43.5 versus 68.3 &#xb1; 46.1 observed in this group. The present analysis represents the first matched comparison of LEA outcomes by surgical specialty. When baseline patient risk is balanced, orthopaedic and vascular surgeons achieve comparable 30-day major outcomes: mortality, readmission, and revision surgery following LEA. Residual differences in complication profiles appear driven by clinical context, such as wound class, transfusion exposure, and rehabilitation needs, rather than by specialty itself. Level III.

Ultrasonic scalpels (USs) have been widely used in various cancer surgeries due to their advantages of minimal thermal damage, effective vascular/lymphatic sealing, and reduced complications. However, robust evidence supporting their efficacy in soft-tissue sarcoma (STS) surgery remains limited, especially for large-size thigh STS (&#x2265;8 cm)-a subgroup characterized by high intraoperative bleeding risk and frequent wound healing issues. This study aimed to comprehensively evaluate the efficacy of USs in the surgical management of large thigh STS (&#x2265;8 cm). We conducted a retrospective study of patients who underwent surgical resection of large thigh STS (&#x2265;8 cm) between January 2019 and December 2024. Patients' clinical characteristics and treatment details were meticulously collected, and key metrics analyzed included intraoperative blood loss, hospital stays, and wound complications. To reduce selection biases, propensity score matching was applied. We defined the matched cases wherein US was used as the "using group" and the other matched cases as the "non-using group." Outcomes were compared between the groups. After propensity score matching, 36 patients were included in each group. The ultrasonic using group showed markedly reduced estimated intraoperative blood loss (204.2 vs. 505.6 mL; P = 0.041) and shorter hospital stay (6.9 vs. 11.4 days; P = 0.002). In addition, the incidence of major wound complications (Clavien-Dindo grade III or higher) was markedly lower (13.9% vs. 38.9%; P = 0.031). Multivariate logistic regression analysis confirmed that US use was independently associated with fewer major wound complications (odds ratio, 0.118; 95% confidence interval, 0.026 to 0.531; P = 0.005). The application of USs in the surgical resection of large thigh STS (&#x2265;8 cm) is associated with reduced intraoperative blood loss, shorter hospital stay, and lower rates of major postoperative wound complications. These findings support the potential value of US as a technical adjunct in complex STS surgery and warrant further validation in prospective randomized controlled trials.

The thoracic vertebrae, ribs, and sternum, provide structural and protective support for the upper body. The unique framework of the region suggests that fractures involving both the thoracic spine and sternum occur with notable spinal instability. Despite their clinical relevance, the short-term medical and surgical outcomes of combined sternal and thoracic spinal fractures remain poorly understood compared with thoracic fractures alone. This study aims to compare the 90-day complication rates and surgical intervention requirements in patients with concomitant sternal and thoracic vertebral fractures with those with isolated thoracic vertebral fractures. Patients presenting with acute sternal and thoracic spine fractures in the same admission were identified using the PearlDiver database. Patients with sternal and vertebral fractures were propensity matched in a 1:1 ratio with a control group by age and Elixhauser comorbidity index. Medical complications, rate of spinal cord injury, and rates of surgical intervention were assessed at 90 days. A total of 9,026 patients were identified in this study with 4,513 patients presenting with sternal and thoracic spine fractures and 4,513 patients in the control group. Sternal and vertebral fracture coinjury was associated with higher rates of spinal cord injury (P < 0.0001), higher rates for spinal decompression/fusion (odds ratio = 4.38, P < 0.0001), and higher rates of thoracic surgery (odds ratio = 3.0, P < 0.0001). These patients were also statistically markedly more likely to develop hemodynamic, respiratory, cardiac, and renal complications (P < 0.001) at 90 days. Patients with thoracic spine fractures who sustain simultaneous sternal fractures are markedly more likely to have concomitant spinal cord injury, require spinal stabilization or decompression, and develop medical complications. Our findings point toward the role of the sternum as a fourth column of stability in cases of thoracic spinal fractures, which mitigate complications, surgery, and neurologic injury in cases of trauma.

Intraoperative fluoroscopy has become essential in orthopaedic surgery, particularly with the rise of minimally invasive surgery (MIS) techniques. As MIS techniques depend more on intraoperative imaging, MIS techniques may necessitate increased fluoroscopy use compared with open procedures. Despite the advantages of minimally invasive foot and ankle surgery, MIS techniques raise concerns about radiation exposure to both patients and surgical staff. The purpose of this study was to evaluate fluoroscopy time and radiation dose (cumulative air kerma) associated with open versus MIS bunion correction, comparing the open modified Lapidus procedure and the minimally invasive distal first metatarsal transverse osteotomy and akin osteotomy (META). It was hypothesized that the META procedure would be associated with increased radiation dose and fluoroscopy time compared with the open modified Lapidus procedure. A retrospective review was conducted for patients who underwent bunion surgery between January 2021 and June 2025 by two fellowship-trained orthopaedic foot and ankle surgeons at a single academic institution. A total of 294 patients met inclusion criteria. Of these, 258 patients underwent a META procedure and 36 underwent an open modified Lapidus procedure. Fluoroscopy time (minutes) and radiation dose (mGy) were compared between the groups. A mean fluoroscopy time of 2.13 &#xb1; 1.27 (range, 0.06 to 7.05) minutes and a radiation dose of 2.02 &#xb1; 1.30 (range, 0.05 to 7.52) mGy were observed in the META cohort. An average fluoroscopy time of 1.63 &#xb1; 1.83 (range, 0.08 to 7.70) minutes and a radiation dose of 1.31 &#xb1; 1.43 (range, 0.07 to 5.98) mGy were observed in the open modified Lapidus cohort. Fluoroscopy time between the cohorts did not differ markedly ( P = 0.123); however, the META group demonstrated a higher radiation dose than the open modified Lapidus group ( P = 0.007). The META procedure had a markedly higher radiation dose compared with the open modified Lapidus procedure, although both remain substantially below the International Commission on Radiological Protection recommended occupational exposure of less than 20.00 mSv per year. Despite the META procedure generating an average radiation dose of 2.02 mGy per case, surgeons receive only 0.50% of the dose; thus, nearly 1,980 procedures would be required to exceed the 20.00 mSv annual occupational limit. These findings suggest that concerns about radiation exposure should not necessarily deter providers from performing the META technique for bunion correction. III (Retrospective Comparative Study).

Treatment of nondisplaced scaphoid fractures with either nonsurgical or surgical methods ideally involves shared decision making. To date, no meta-analysis has explicitly reported differences in healing rates between fracture locations and treatment choices, making this conversation challenging. We aimed to report the nonunion risk in nondisplaced scaphoid fractures when stratified by both treatment type and fracture location. We searched PubMed, SCOPUS, CINAHL, SportsDiscus, HAND, Journal of Hand Surgery, and Plastic and Reconstructive Surgery for outcome studies of nonsurgical or surgical treatment of acute, nondisplaced scaphoid fractures. Meta-analyses were conducted for the pooled proportion of fracture nonunion of each fracture location and treatment modality. We screened 2019 articles, and 29 were included in the final data analysis. The pooled proportion of scaphoid fracture nonunions was higher among those treated nonsurgically than surgically, although prediction intervals were overlapping and significance was not established. We found that, regardless of the treatment method, proximal fragment fractures have the highest rate of nonunion. When evaluating only proximal scaphoid fractures, the proportions of nonunion were similar between nonsurgical and surgical subgroups. Our review indicates that surgical treatment results in overall fewer nonunions than nonsurgical treatment, but with overlapping prediction intervals. However, when analyzing subgroups, we found that this association is less clear for proximal scaphoid fractures. Our review highlights a distinct lack of literature on scaphoid fractures of the distal pole. The results of this study can be used to inform shared decision making when discussing treatment for a nondisplaced scaphoid fracture.

Chronic hip abductor insufficiency remains a challenging problem to treat and can result in notable disability in some patients. The use of allograft has become an increasingly common option for surgical reconstruction. The purpose of this systematic review was to analyze the clinical outcomes, complications, and revisions rates of patients who underwent allograft reconstruction for irreparable hip abductor tears. PubMed (MEDLINE), Scopus (EMBASE, MEDLINE, COMPENDEX), and Cochrane databases were used to conduct a systematic review. A total of five studies were included, comprising three that used a dermal allograft, one that used an Achilles tendon allograft with a calcaneal bone block, and one that used an extensor mechanism of the knee allograft. Demographics, hip setting (native hip, primary total hip arthroplasty [THA], revision THA), patient-reported outcome measures, presence of Trendelenburg sign, use of walking aids, abduction strength, complication rates, and revision rates were analyzed. A total of 76 patients (76 hips) underwent hip abductor reconstruction with allograft. The mean age was 63.2 years with 84.2% being female. The mean follow-up was 23.6 months. Four studies reported changes in preoperative to postoperative patient-reported outcome measures, all of which demonstrated an improvement in outcomes. The mean preoperative reported abduction strength was 2.7/5, which improved to 3.9/5 postoperatively (P < 0.001). Two studies demonstrated a persistent postoperative Trendeleburg sign in more than one third of patients. The complication and revision rates were 5.3% (4/76) and 1.3% (1/76), respectively. Allograft reconstruction is a salvage procedure for a challenging problem that provides satisfactory clinical outcomes in patients with chronic hip abductor insufficiency not amendable to primary repair. Complication and revision rates were notably low. Future research should compare the clinical outcomes of allograft reconstruction with other muscle transfer techniques to determine the optimal surgical treatment for chronic hip abductor deficiency.

Existing literature lacks clarity on how geography may affect gender disparities among pediatric orthopaedic surgeons. This study compares the academic productivity of pediatric orthopaedic attendings based on their sex and region. Faculty lists from the 45 Pediatric Orthopaedic Society of North America fellowship programs were accessed in February 2024. Data on sex, training history, fellowship director status, institution, publication counts, and H-indices were collected from program websites and Scopus. The attending publication rate was calculated by dividing the total number of publications completed as an attending by the number of years in practice. Results were displayed using (mean &#xb1; SD). Categorical variables were analyzed using Pearson chi square. Mann-Whitney U and one-way analysis of variance were used for nonparametric and parametric data, respectively. Analyses were done using GraphPad Prism 10, with significance set at P < 0.05. Four hundred one pediatric orthopaedic surgeons (302 male, 99 female) from 45 fellowship programs were analyzed. Female surgeons had fewer publications, lower H-indices, and lower publication rates than male surgeons. In the Northeast, male attendings had higher publication counts, rates, and H-indices. Men also had higher H-indices than women in the Midwest and Southwest. Among male pediatric orthopaedic attendings, those in the Northeast exhibited the highest publication counts, rates, and H-indices. However, no regional differences were observed among female pediatric orthopaedic surgeons. Notable gender disparities persist among pediatric orthopaedic surgeons in the United States, reflecting systemic barriers that limit women's research opportunities. Male faculty outnumber female faculty across fellowship programs and have higher publication counts, rates, and H-indices. Regional differences were most notable in the Northeast, where male attendings had markedly higher publication counts, rates, and H-indices. H-index disparities were also present in the Midwest and Southwest. Targeted strategies are needed to improve research access and support for women trainees and faculty.

Clubfoot is a common orthopaedic birth defect and is affected by both clinical and psychosocial risk factors. The purpose of this study was to evaluate the effect of transportation barriers on the risk of relapse in patients undergoing treatment for idiopathic clubfoot. Patients diagnosed with idiopathic clubfoot were enrolled in a prospective registry at a single tertiary care center between May 2019 and August 2022. A prospective survey was administered regarding demographics and transportation, and a retrospective chart review was conducted. Zip codes were also used to query a health needs database. A total of 97 patients who met inclusion criteria underwent the Ponseti treatment method, with a median of eight serial casts. Eighty patients (83.3%) underwent an Achilles tenotomy. A total of 46 patients (47.4%) experienced a relapse, and 27 patients (27.8%) experienced multiple relapses. For the first episode of relapse, 27 of 46 patients (58.7%) underwent repeat casting, 15 of 46 (32.6%) underwent a surgical procedure, and 4 of 46 (8.7%) underwent both.Patients with a longer commute to our clinic were significantly more likely to experience relapse (median 38 versus 52.5 minutes; P = 0.031). In addition, patients from areas with higher rates of households without vehicles and patients from areas with more households below the federal poverty level were more likely to experience relapse (P = 0.008 and P = 0.037, respectively). Transportation barriers correlate with higher relapse rates in patients with clubfoot. These findings underscore the importance of addressing social determinants of health, particularly transportation access, to optimize treatment outcomes for patients with idiopathic clubfoot. III.

Implant-implant impingement in total hip arthroplasty remains a primarily clinical diagnosis, with little technology available to demonstrate impingement radiographically. The purpose of this study was to determine the effectiveness of external rotation stress CT scans in evaluating for posterior impingement in patients with painful total hip prostheses. Sixty-seven patients presenting with CT IMA (implant movement analysis) scans previously used for evaluation of potential aseptic loosening were identified between May 2021 and May 2024. Plain radiographs were evaluated to assess for acetabular cup abduction. CT IMA scans in external rotation IMA protocol position were evaluated to measure acetabular implant version and the distance between the femoral and acetabular components. Patients were separated into impingement and nonimpingement groups based on whether a clinical or intraoperative diagnosis of impingement had been made. Cup version, abduction, and implant-implant distances on the external rotation CT were compared between the groups. A receiver operating characteristic curve was created, and the area under the curve was calculated to determine an optimal implant-implant distance for diagnosing impingement. Overall, 29 patients were diagnosed with impingement and 38 patients were diagnosed with other sources of hip pain. Linear regression showed a notable negative correlation (P = 0.004) of measured cup version versus implant-implant distance. Implant-implant distance was markedly smaller in the impingement group versus the non-impingement group (P < 0.0001). The receiver operating characteristic curve demonstrated 100% sensitivity and 89% specificity impingement when the implant-implant distance was <5 mm, with an area under the curve of 0.98 &#xb1; 0.02. External rotation stress CT scans used by the IMA protocol were 100% sensitive and 89% specific in identifying patients with posterior impingement when an implant-implant distance of <5 mm was considered. This technology may help clinicians objectively define a diagnosis of impingement in total hip prostheses in the absence of other clinically identifiable sources of pain.

Gender disparities persist across surgical specialties including orthopaedic surgery and neurosurgery, which may limit workforce diversity and potentially influence care delivery. Understanding representation among spine surgeons performing common procedures such as anterior cervical diskectomy and fusion (ACDF) may identify opportunities to enhance equity. This was a retrospective cross-sectional study of spine surgeons performing ACDF using Medicare Provider Utilization and Payment Data from 2013 to 2021. The total representation of female spine surgeons performing ACDF, including their case volumes, practice characteristics, and payments, was compared with that of male spine surgeons. A total of 2,492 spine surgeons who performed 139,456 ACDF cases were included in the sample. Of these, 58 female spine surgeons (2.3%) performed 2,733 cases (2.0%). The percentage of female surgeons increased from 0% (0/1,124) in 2013 to 1.8% (12/651) in 2021 (&#x3b2; = 0.163, R2 = 0.263, P < 0.001). The average annual volume of ACDF procedures was similar between female and male surgeons (16.8 &#xb1; 3.6 vs. 17.2 &#xb1; 7.6, P = 0.712). No difference was observed in academic teaching hospital affiliation between female and male surgeons (13.9% vs. 11.8%, P = 0.697). No difference was found in mean standardized Medicare reimbursement for ACDF procedures over the study period (P = 0.145). In 2021, female surgeons treated a higher proportion of female patients (56.8% vs 55.0%, P = 0.043). Although representation of female spine surgeons increased modestly, gender disparities remain pronounced within the Medicare workforce. Strategies are needed to increase the number of female trainees interested in a career in spine surgery.

The prognostic value of initial tendon gap distance following acute Achilles tendon rupture (ATR) remains unclear. The present systematic review and meta-analysis aimed to investigate the effect of tendon gap distance on clinical outcomes following nonsurgical management of acute ATR. Our review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and used PubMed, EMBASE, and Cochrane Library databases for studies investigating the influence of tendon gap distance on functional outcomes following nonsurgical management of acute ATR. Data investigated included patient demographics, functional scores, including the Achilles Tendon Rupture Score (ATRS), gap size, and rupture location. The association between tendon gap distance and functional outcomes was investigated. Additional analyses examined secondary associations among age, sex, and rupture location and functional outcomes. A total of eight studies comprising 288 patients with acute ATRs were included in our review. Of these, four studies met criteria for quantitative synthesis and were included in the meta-analysis. With a cutoff of 10-mm gap distance, the pooled analysis demonstrated a markedly lower ATRS in patients with a larger gap size (>10 mm versus &#x2264;10 mm; Cohen d = -0.39; 95% CI = -0.76 to -0.02; P = 0.04). Secondary analyses revealed lower ATRS in patients older than 50 years (d = -0.70; P < 0.001) and female patients (d = -0.58; P = 0.01), whereas rupture location had no notable effect (P = 0.85). Our review demonstrated that a larger initial tendon gap is associated with lower functional outcomes following nonsurgical management of acute ATR, particularly with a cutoff of 10 mm. Furthermore, factors such as age and sex may also influence clinical outcomes. However, the result should be interpreted with caution due to heterogeneity across studies. Level 3, systematic review and meta-analysis.

Anterior cruciate ligament (ACL) tears are one of the most common orthopaedic injuries, and ACL reconstruction is often considered the standard of care for the active individual. Recently, attention-deficit/hyperactivity disorder (ADHD) has been shown to be a risk factor for adverse postoperative outcomes in patients undergoing ACL reconstruction. However, no studies have looked at the effect of stimulant medications on ACL reconstruction outcomes in patients with ADHD. This study aimed to compare postoperative outcomes between ADHD patients using stimulant medications and those not using stimulants following ACL reconstruction at 3- and 6-month follow-up. This retrospective cohort study used the TriNetX database to identify patients with ADHD who underwent ACL reconstruction surgery and divided them into cohorts based on the presence or absence of stimulant medication usage. Patient cohorts were 1:1 propensity score matched on age, sex, obesity, mood disorders, anxiety disorders, and nicotine dependence. Postoperative complications were analyzed within 3 and 6 months postoperatively, evaluating arthrofibrosis, infection, wound disruption, revision surgery, emergency department (ED) visits, hospital readmission, and deep vein thrombosis. Within 3 and 6 months postoperatively, ADHD patients not taking stimulants were markedly more likely to return to the ED and be readmitted to a hospital compared with those who were taking stimulants. In addition, at the 6-month time point, a statistically significant increase in arthrofibrosis was seen in nonstimulant users compared with stimulant users in patients with ADHD. This study found that patients with ADHD not taking stimulant medications are at an increased risk of returning to the ED, being readmitted to the hospital, and developing arthrofibrosis compared with those patients taking stimulants following ACL reconstruction. The results display the importance of identifying modifiable risk factors for ACL reconstruction surgery so that physicians can adequately adjust treatment regimens to each patient.

Physical therapy (PT) after anterior cruciate ligament (ACL) reconstruction is critical for recovery. Despite this, adherence to PT protocols remains inconsistent, and although socioeconomic barriers are thought to influence PT attendance, there are a paucity of data quantifying compliance rates and the influence of these proposed barriers. A total of 128 consecutive patients who underwent ACL reconstructions between January 2023 and December 2024 at a single urban academic medical center were studied. Three months postoperatively, patients completed a questionnaire regarding their PT compliance. Demographic, socioeconomic, and behavioral factors were collected. 35.9% of patients missed >15% of sessions. Reported barriers included time commitments (58.6% of respondents), transportation (50%), appointment availability (46.1%), cost (36.7%), and insurance issues (21.9%). Despite difficulties, 93.0% of patients thought PT was necessary. Government-sponsored insurance was associated with poor PT adherence (P = 0.006). By contrast, historically described barriers to healthcare access, including Area Deprivation Index (ADI) (P = 0.195), primary language other than English (P = 1.0), and lack of car ownership (P = 0.690), were not associated with poor attendance. Having state-sponsored/government-sponsored insurance is an independent risk factor for poor PT adherence, despite near unanimous strong desire of patients to attend therapy. Previously described barriers including higher ADI, primary language other than English, and not owning a car were not notable risk factors.