JBJS Open Access最新文献

» 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.

Introduction: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Background: While rotator cuff tears are prevalent in the general population, the natural history of this disease is unclear. Understanding rotator cuff tear progression is crucial for refining surgical indications and evaluating the necessity of early interventions. This study presents an in-depth analysis of the existing literature on the definitions and progression rates of rotator cuff tears, aiming to enhance clinical decision making and patient outcomes.

Methods: A systematic literature search was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using Medline (PubMed), Embase (Elsevier), and Web of Science databases on January 12, 2023. Articles were identified as relevant to the natural history and progression of asymptomatic and symptomatic partial-thickness (PT) and full-thickness (FT) rotator cuff tears. Those written in English reporting rotator cuff progression rates of tears in adults, based on magnetic resonance imaging (MRI) or ultrasound, were included. After reviewing the articles, the data on the rates of tear progression and associated risk factors were extracted, compiled, and analyzed. The risk of bias was determined using the Newcastle-Ottawa Scale.

Results: Twenty-one articles met the inclusion criteria, with 1,831 tears included. The progression rate for all partial thickness tears was 26.7% ± 12.8% at an average follow-up of 2.2 ± 0.9 years, with 5 definitions for tear progression. For FT tears, the progression rate was 54.9% ± 18.6% at a follow-up time of 3.0 ± 2.0 years, with 8 definitions for tear enlargement. A significant difference (p < 0.0001) was found between the progression rates of PT and FT tears. Patients who were initially asymptomatic and became symptomatic had higher progression rates (33%-63%) than those who remained asymptomatic (4%-38%).

Conclusion: Further research would benefit by identifying a clinically relevant and standardized definition of rotator cuff tear progression, to describe the natural history of rotator cuff disease, making results more comparable and optimizing treatment planning.

Level of evidence: Level II. See Instructions for Authors for a complete description of levels of evidence.

Introduction: The American Board of Orthopaedic Surgery (ABOS) Knowledge, Skills, and Behavior (KSB) project sets up a framework for competency-based medical education for orthopaedic surgery residency training. The Behavior aspect of KSB includes use of the American Board of Orthopaedic Surgery Behavior Tool (ABOSBT) to assess 5 domains of professional behavior. The purpose of this study was to analyze the results of 2 years of ABOSBT assessments and to characterize the low score ratings.

Methods: All ABOSBT assessments from January 1, 2022, to December 31, 2023, were reviewed totaling 51,678 completed assessments with 48,648 (94%) assessments from a 360° process and 3,030 (6%) as end-of-rotation assessments.

Results: Distribution of 51,678 ABOSBT assessments with 258,390 scores demonstrated low scores (disagree or strongly disagree) in 0.9% of assessments. All 5 domains identified low scores in a small percentage at all years-in-training with the greatest number in second- and third-year residents. Comparison of scores from 360° vs. end-of-rotation requests demonstrated a higher percentage of low scores given during the 360° process (p < 0.0001). Three thousand seven hundred seven unique evaluators completed ABOSBT assessments, with attending physicians as the most frequent evaluator type (44%); inpatient nurses assessed residents with low ABOSBT scores more frequently (4.5%) than any other evaluator type. Residents with 2 or more low scores by 2 or more different evaluators were analyzed for each of the 5 domains; low scores were most frequently observed in the reliability domain.

Discussion: The ABOSBT was originally validated 5 years ago in 18 programs with 9,892 assessments; this article updates results using the ABOSBT across 95 programs assessing 2,397 residents with 3,707 evaluators. The ABOSBT demonstrates that most residents demonstrate professional behavior across 5 domains of assessment; the ABOSBT identifies residents with low scores. A strength of KSB is the ability to identify professionalism deficiencies while residents are in training and can focus on individualized educational improvement. Tracking residents with low scores on the ABOSBT assessment over time will help determine its effectiveness in identifying unprofessional behavior.

Introduction: African American, Hispanic, Asian, and Pacific Islanders are groups who are underrepresented in medicine (URM groups). Similarly, although women comprise more than 50% of medical students in the United States, women comprise a smaller percentage of all orthopaedic surgery trainees. Therefore, underrepresented in orthopaedics (URiO) represents the URM groups and women. The purpose of this study is to examine the impact of specific steps to recruit a qualified, diverse trainee complement within a single academic orthopaedic surgery residency program between 2000 and 2023. We aim to explore changes in the representation of URiO during this period as well as explore the strategies and programs implemented by the department that may have impacted recruitment of a diverse complement of trainees.

Methods: Match lists from a large, academic, orthopaedic surgery residency between 2000 and 2023 were collected and reviewed for racial and gender data. Match lists were then divided into 6-year quantiles to identify any trends in the recruitment of URiO students. Self-reported racial and gender data from Electronic Residency Application Service applicant reports and the Accreditation Council for Graduate Medical Education (ACGME) data books between 2018 and 2022 were collected and reviewed. In addition, the department's strategies implemented during the study period with the goal of enhancing URiO exposure to orthopaedic surgery were also explored.

Results: The department implemented proactive strategies to increase exposure to orthopaedic surgery for URiO students. An increase in URiO representation was noted between 2000 and 2023 with Hispanic, Black/African American, and Native Hawaiian/Pacific Islander resident representation increasing by 5%, 11%, and 1%, respectively. In addition, women representation increased by 27% between 2000 and 2023. The overall attrition rate among URiO residents was 1% with only one resident not completing the program. Self-reported racial and gender data from ACGME data books demonstrated that Black/African American, Hispanic, and Native Hawaiian/Pacific Islander residents comprised 5%, 4%, and 0.04%, respectively, of orthopaedic surgery residents between 2018 and 2022.

Conclusions: These results provide insight for other programs to use similar strategies to potentially improve recruitment, retain, and provide support to URiO residents.

Introduction: Assessing scholarly contributions in academic orthopaedic surgery remains challenging, despite the importance of publication productivity in evaluating academic leaders. The Hirsch (h)-index and its derivative, the m-index, offer objective measures to compare and evaluate publication productivity. The primary aims of this study were to compare h- and m-indices of department chairs and residency program directors of orthopaedic training programs in the United States and assess the association between h-index and program rank.

Methods: A publicly available Doximity report was used to identify and rank orthopaedic surgery residency programs in the United States. Internet-based searches of institution-specific websites were performed to confirm current department chairs and residency program directors as of January 2024. H-index data were collected from a publicly available database known as Scopus. The m-index was calculated as the quotient of h-index and years in practice. Gender and years in practice were obtained through available biographies on institution-specific websites.

Results: Department chairs had significantly higher h- and m-indices at both the career and 5-year time intervals compared with program directors. Upon subgroup analysis, department chairs and program directors at top-10 ranked programs had significantly higher h- and m-indices compared with the entire population of department chairs and program directors. Linear regression analyses demonstrated a direct linear association between department chair/program director h- and m-indices and program rank.

Conclusions: Publication productivity was higher for department chairs than residency program directors. Orthopaedic leaders at top-10 institutions had higher publication productivity compared with those at institutions outside of the top 10, per Doximity rankings. Finally, there is substantial variation in publication productivity of orthopaedic surgeons in leadership roles at academic institutions in the United States.

Clinical relevance: This study highlights the publication productivity of orthopaedic surgery department chairs and residency program directors and describes the linear association between publication productivity of academic orthopaedic leaders and program rank. This information can be utilized by those interested in learning more about the publication productivity among academic orthopaedic surgeons across different institutions and can assist those who are involved in the hiring and promotion process at these academic institutions.

Background: The interobserver and intraobserver reliability of various tibial plateau fracture (TPF) classifications has been examined in recent literature using radiography, computed tomography, and magnetic resonance imaging. The question remains as to which classification system provides the highest reliability. In this systematic review, we are going to evaluate the overall interobserver and intraobserver reliability of various TPF classifications in different imaging modalities.

Methods: We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In February 2023, predefined terms were used for database search (Embase, PubMed, Scopus, Cochrane, and Web of Science). Meta-analysis of intrarater and inter-rater kappa coefficients was performed for each of the classifications in each modality.

Results: Thirty-four studies were included in this review. Schatzker's classification was more frequently used than others. It had a better intrarater kappa coefficient than the Hohl and Moore and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) classifications in radiography (κ = 0.72, 95% confidence interval [CI] = 0.67-0.76, p < 0.01). The Schatzker and AO/OTA classifications had similar inter-rater reliability in the radiography modality (κ = 0.53, 95% CI = 0.51-0.54, p < 0.01; κ = 0.53, 95% CI = 0.5-0.55, p < 0.01; respectively). In 3-dimensional computed tomography, the Luo classification system showed the highest intrarater (κ = 0.85, 95% CI = 0.35-0.66) and inter-rater (κ = 0.77, 95% CI = 0.73-0.81) kappa coefficients.

Conclusion: Three-column classification proposed by Luo et al. was able to reach the highest degree and was the only classification with near-excellent inter-rater reliability.

Introduction: International medical graduates (IMGs) continue to play an important role in the US health care system, but little is known about their trends of matching into highly competitive residencies such as orthopedic surgery. The purpose of this study was to analyze temporal trends of IMG applicants matching into US orthopedic residency programs between 2008 and 2024 and compare them with US allopathic (MD) and osteopathic (DO) graduates.

Methods: Orthopedic residency specific data for years 2008 to 2024 was obtained from the National Resident Match Program and Electronic Residency Application Service. Variables collected included total number of programs, total positions offered, number of applicants (MD, DO, and IMG), positions filled, and fill rate for each group. Trends were examined using simple linear regression modeling.

Results: The number of orthopedic residency programs increased from 160 (2008) to 218 (2024), with total positions increasing from 636 (2008) to 916 (2024). The IMG fill rate decreased from 2.99% in 2008 to 0.87% in 2024 (p < 0.01 for linear trend; β -0.069). This corresponds to an absolute number decrease of 19 IMGs in 2008 to 8 in 2024. More specifically, the proportion of US IMGs decreased from 0.94% to 0.66%, and the proportion of non-US IMGs decreased from 2.04% to 0.21%. Over the 17-year study period, a total of 105 US IMGs and 110 non-US IMGs matched into orthopedic surgery. The US MD applicant fill rate decreased significantly from 96.5% to 85.0% (p < 0.001; β -0.944). The DO applicant fill rate increased significantly from 0.31% to 13.97% (p < 0.0001; β 0.990).

Conclusion: The declining rate of IMGs matching into orthopedic residency programs in the United States underscores the growing challenges faced by IMGs in accessing training in this competitive specialty. The notable increase in DO graduates securing orthopedic residency positions likely reflects the integration of a unified accreditation system for MD and DO residency programs established in 2020.

Level of evidence: Retrospective Cohort Study; IV.

➤ The COVID-19 pandemic created a persistent surgical backlog in elective orthopedic surgeries. ➤ Artificial intelligence (AI) uses computer algorithms to solve problems and has potential as a powerful tool in health care. ➤ AI can help improve current and future orthopedic backlogs through enhancing surgical schedules, optimizing preoperative planning, and predicting postsurgical outcomes. ➤ AI may help manage existing waitlists and increase efficiency in orthopedic workflows.

Background: Orthopaedic academic partnerships between high-income countries (HICs) and low and middle-income countries (LMICs) are an effective method to increase research and scholarly support. The purpose of this study was to perform a systematic literature review of the current state of partnerships worldwide and assess the quality, quantity, and content of their research output.

Methods: A systematic review was conducted using 4 academic databases: PubMed, MEDLINE, Embase, and CENTRAL. Article eligibility criteria included articles published between January 2017 and 2022, with orthopaedic authors from at least 1 HIC and LMIC. Articles related to global orthopaedic surgery with exclusively HIC or LMIC authors were excluded.

Results: The database search yielded 25,928 articles, and after deduplication, 21,145 articles were included in the screening. After title and abstract screening, 408 articles underwent full-text review for eligibility. The final list of eligible articles for extraction included 310 publications in 127 journals. Published articles increased over time (46 in 2017 to 88 in 2021) and were most commonly published in the Journal of Bone and Joint Surgery (20, 6.5%). Open-access articles (203, 65.5%) had a significantly greater Journal Citation Indicator (p = 0.024) than non-open-access articles. Most studies (40.7%) were observational, with few (3.6%) randomized controlled trials. Orthopaedic trauma (38.1%) was the most common subspecialty, followed by spine (14.8%) and pediatrics (14.2%). Most partnerships were sponsored by North American authors in 65 LMICs, primarily China, India, and the sub-Saharan African region.

Conclusion: This study identified 310 articles published by orthopaedic international academic partnerships in 106 countries over the past 5 years, demonstrating that collaborations between LMIC/HIC partners nearly doubled over the study period. Sixty-five percent of the articles were published in open-access journals.