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Risk Factors for Leaving Against Medical Advice in Patients Admitted for Upper Extremity Orthopedic Procedures. 上肢矫形手术入院患者违抗医嘱离院的风险因素。
IF 1.5 Q3 Medicine Pub Date : 2024-06-06 eCollection Date: 2024-06-01 DOI: 10.5435/JAAOSGlobal-D-23-00063
David Momtaz, Umar Ghilzai, Shawn Okpara, Abdullah Ghali, Rishi Gonuguntla, Travis Kotzur, Kai Zhu, Ali Seifi, Ryan Rose

Introduction: Patients who leave against medical advice (AMA) face increased risks of negative health outcomes, presenting a challenge for healthcare systems. This study examines demographic and hospital course factors associated with patients leaving AMA after an upper extremity (UE) orthopaedic procedure.

Methods: We analyzed 262,912 patients who underwent UE orthopaedic procedures between 2011 and 2020, using the Healthcare Cost and Utilization Project database. We then compared demographic and hospital course factors between patients who left AMA and those who did not leave AMA.

Results: Of 262,912 UE orthopaedic patients, 0.45% (1,173) left AMA. Those more likely to leave AMA were aged 30 to 49 (OR, 5.953, P < 0.001), Black (OR, 1.708, P < 0.001), had Medicaid (OR, 3.436, P < 0.001), and were in the 1st to 25th income percentile (OR, 1.657, P < 0.001). Female patients were less likely to leave AMA than male patients (OR, 0.647, P < 0.001). Patients leaving AMA had longer stays (3.626 versus 2.363 days, P < 0.001) and longer recovery times (2.733 versus 1.977, P < 0.001).

Conclusion: We found that male, Black, younger than 49 years old, Medicaid-insured, and lowest income quartile patients are more likely to leave AMA after UE orthopaedic treatment.

导言:违背医嘱(AMA)离院的患者面临着更大的负面健康后果风险,这对医疗保健系统来说是一个挑战。本研究探讨了与上肢(UE)矫形手术后离开AMA的患者相关的人口统计学和住院过程因素:我们利用医疗成本与利用项目数据库分析了 2011 年至 2020 年间接受上肢矫形手术的 262,912 名患者。然后,我们比较了离开AMA和未离开AMA的患者的人口统计学和住院过程因素:在 262,912 名 UE 骨科患者中,0.45%(1,173 人)离开了 AMA。更有可能离开AMA的患者年龄在30至49岁之间(OR,5.953,P<0.001)、黑人(OR,1.708,P<0.001)、有医疗补助(OR,3.436,P<0.001)、收入在第1至25百分位数之间(OR,1.657,P<0.001)。女性患者比男性患者更不可能离开AMA(OR,0.647,P < 0.001)。离开AMA的患者住院时间更长(3.626天对2.363天,P < 0.001),康复时间更长(2.733天对1.977天,P < 0.001):我们发现,男性、黑人、49 岁以下、有医疗补助保险和最低收入四分位数的患者在接受 UE 骨科治疗后更有可能离开 AMA。
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引用次数: 0
Neglected Developmental Hip Dysplasia Treated With External Iliofemoral Distraction, Open Reduction, and Pelvic Osteotomy: Eleven-Year Follow-Up. 采用髂股骨外牵引、开放式还原和骨盆截骨术治疗被忽视的发育性髋关节发育不良:十一年随访。
IF 1.5 Q3 Medicine Pub Date : 2024-06-04 eCollection Date: 2024-06-01 DOI: 10.5435/JAAOSGlobal-D-23-00291
Omar A Amin, Shahad AlAmoudi, Bashir A Amin, Abdulhadi Alamoudi

Neglected untreated developmental hip dysplasia can result in severe deformities and functional disabilities. This report describes the treatment and 11-year follow-up of a patient who underwent the procedure in two stages. At the time of treatment, the patient was 7 years of age and was diagnosed with acetabular dysplasia and neglected right hip dysplasia. A stepwise treatment approach, including gradual distraction of the iliofemoral joint, open reduction, and pelvic osteotomy, was performed. Subsequent postoperative rehabilitation and regular follow-up assessments were performed over 11 years. The long-term results indicated notable improvements in hip joint congruency, functional range of motion, and overall quality of life. Early diagnosis and appropriate intervention are crucial for patients with developmental hip dysplasia, and the treatment methods described here are effective.

发育性髋关节发育不良如不及时治疗,可导致严重畸形和功能障碍。本报告介绍了一名患者分两个阶段接受手术的治疗和 11 年的随访情况。治疗时,患者7岁,被诊断为髋臼发育不良和被忽视的右髋关节发育不良。患者接受了分步治疗,包括逐步牵开髂股关节、切开复位和骨盆截骨术。随后进行了为期11年的术后康复和定期随访评估。长期结果表明,患者的髋关节一致性、功能活动范围和整体生活质量都有显著改善。早期诊断和适当干预对发育性髋关节发育不良患者至关重要,本文介绍的治疗方法非常有效。
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引用次数: 0
Differences in Intraoperative Fluoroscopic Radiation Exposure During Ankle Fracture Open Reduction and Internal Fixation Between Orthopaedic Surgery and Podiatry. 矫形外科和足病科在踝关节骨折切开复位和内固定术中术中透视辐射暴露的差异。
IF 1.5 Q3 Medicine Pub Date : 2024-05-30 eCollection Date: 2024-06-01 DOI: 10.5435/JAAOSGlobal-D-24-00131
Monica DiFiori, Kristofer Bires, Gavin Rallis, Eric Gokcen

Surgical ankle fractures pose a unique situation because both podiatrists and orthopaedic surgeons manage these injuries. Intraoperative fluoroscopy is routinely used; however, excessive radiation can be harmful to both the patient and the surgical team. The primary goal of this study was to determine whether there is a difference in the amount of intraoperative radiation exposure during ankle fracture open reduction and internal fixation (ORIF) when performed by orthopaedic surgeons versus podiatrists. This is a retrospective review of patients who underwent ankle fracture ORIF at an urban level I trauma center between January 1st, 2018, and April 1st, 2023. The electronic health record was queried using International Classification of Diseases nine and 10 codes associated with ankle fractures. Patients aged older than 18 years with an ankle fracture managed surgically were included. Subjects were then stratified by procedure. The mean total radiation dose (mRad) and mean total fluoroscopic time (seconds) were then compared between those performed by orthopaedic surgeons and podiatrists. Of the 333 included procedures, 186 were done by orthopaedic surgeons and 147 were done by podiatrists. Using multiple linear regression analysis to control for age, sex, race, ethnicity, and body mass index, patients undergoing isolated malleolus ORIF with syndesmosis repair performed by orthopaedic surgery were found to have a significantly lower mean fluoroscopic time compared with those performed by podiatry (68.4 s versus 104.8 s; P = 0.028). In addition, trimalleolar ORIF with syndesmotic repair performed by orthopaedic surgery had a significantly lower mean total radiation dose compared with those performed by podiatry (244.6 mRad v 565.6 mRad; P = 0.009). Patients and surgical teams are exposed to markedly less radiation in isolated malleolar and trimalleolar fracture ORIF with syndesmosis repair when performed by an orthopaedic surgeon as compared with those performed by a podiatrist.

踝关节骨折手术的情况比较特殊,因为足病医生和矫形外科医生都会处理这些损伤。术中透视是常规的做法,但过量的辐射会对患者和手术团队造成伤害。本研究的主要目的是确定在踝关节骨折切开复位内固定术(ORIF)中,骨科医生与足病医生的术中辐射量是否存在差异。这是一项回顾性研究,研究对象是2018年1月1日至2023年4月1日期间在城市一级创伤中心接受踝关节骨折开放复位内固定术的患者。我们使用与踝关节骨折相关的《国际疾病分类》第 9 条和第 10 条代码查询了电子健康记录。纳入了年龄大于 18 岁、踝关节骨折经手术治疗的患者。然后按手术方法对受试者进行分层。然后比较骨科外科医生和足科医生的平均总辐射剂量(mRad)和平均总透视时间(秒)。在纳入的 333 例手术中,186 例由骨科医生完成,147 例由足病医生完成。使用多元线性回归分析控制年龄、性别、种族、民族和体重指数后发现,与足病医生相比,由骨科手术进行孤立踝关节ORIF并进行巩膜修补的患者的平均透视时间明显更短(68.4秒对104.8秒;P = 0.028)。此外,与足病治疗相比,由骨科手术进行的三极ORIF联合趾捻发音修补术的平均总辐射剂量明显更低(244.6 mRad对565.6 mRad;P = 0.009)。与足病医生的手术相比,由骨科医生实施的孤立踝关节和三踝关节骨折联合巩膜修复手术中,患者和手术团队受到的辐射明显更少。
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引用次数: 0
A Novel Bipedicular Dissociation Fracture Pattern of Vertebral Osteoporotic Fractures of the Elderly. 老年人椎体骨质疏松性骨折的新型双足分离骨折模式
IF 1.5 Q3 Medicine Pub Date : 2024-05-30 eCollection Date: 2024-06-01 DOI: 10.5435/JAAOSGlobal-D-23-00241
Raphael Lotan, Oded Hershkovich

Introduction: CVFs are common, with several classification systems available. We have encountered osteoporotic vertebral fractures (OVFs) with PDF, a never-described fracture pattern.This study evaluates this unique fracture's characteristics.

Methods: Retrospective study of surgically treated OVFs during 2016 to 2020.

Results: Of 105 patients, 85 had classifiable OVFs and 20 had uni-PDF (n = 10, 9.5%) or bi-PDF (n = 10, 9.5%). Both cohorts mainly had single vertebral fractures and upper end plate involvement with cleft sign found in 30% of PDFs versus 15.3% of OVFs (P < 0.001), higher incidence of burst fractures (40% vs. 25.9%; P < 0.001). Posterior vertebral body collapse was higher for PDFs (13.2 ± 9.3% vs. 18.3 ± 8.5%; P = 0.02). Most OVFs underwent balloon kyphoplasty (BKP) (94%). Most bi-PDFs were regarded unstable; six patients underwent PSF (2 short PSF, 1 PSF + BKP, and 3 BKP with intravertebral pedicular lag screws at the fractured vertebra). Half of the bi-PDFs underwent BKP-developed nonunion.

Conclusion: Our study is novel in describing an unrecognized OVF pattern disregarded in current classification systems. We found notable differences in fracture characteristics, prefracture functional status, and surgical results between OVF and PDF cohorts. We suggest adding this fracture pattern as a unique OF-4 subtype or a specific entity between OF-4 and 5, with uni-PDF as type A and bi-PDF as type B.

介绍:CVF很常见,有多种分类系统。本研究评估了这种独特骨折的特征:方法:对2016年至2020年间接受手术治疗的OVF进行回顾性研究:结果:在105名患者中,85人患有可分类的OVF,20人患有单PDF(10人,9.5%)或双PDF(10人,9.5%)。两组患者主要都有单椎体骨折和上椎体终板受累,其中 30% 的 PDF 患者出现裂隙征,而 15.3% 的 OVF 患者出现裂隙征(P < 0.001),爆裂性骨折的发生率更高(40% 对 25.9%;P < 0.001)。PDF椎体后方塌陷率较高(13.2 ± 9.3% vs. 18.3 ± 8.5%;P = 0.02)。大多数 OVF 接受了球囊椎体成形术 (BKP)(94%)。大多数双椎体后凸被认为是不稳定的;6 名患者接受了 PSF(2 例短 PSF,1 例 PSF + BKP,3 例 BKP,在骨折椎体处使用椎弓根内滞后螺钉)。半数接受 BKP 治疗的双椎体骨折患者出现了不愈合:结论:我们的研究是一项新颖的研究,它描述了一种在当前分类系统中被忽视的未被发现的 OVF 模式。我们发现 OVF 和 PDF 两组患者在骨折特征、骨折前功能状态和手术结果方面存在明显差异。我们建议将这种骨折模式作为一个独特的 OF-4 亚型或 OF-4 和 5 之间的一个特定实体,将单 PDF 作为 A 型,将双 PDF 作为 B 型。
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引用次数: 0
Fetal Scoliosis: Natural History and Outcomes. 胎儿脊柱侧凸:自然史和结果
IF 2 Q2 ORTHOPEDICS Pub Date : 2024-05-28 eCollection Date: 2024-06-01 DOI: 10.5435/JAAOSGlobal-D-24-00093
Samuel Walters, Ben Barkham, Tim Bishop, Jason Bernard, Christina Coroyannakis, Basky Thilaganathan, Darren F Lui

Introduction: Scoliosis can be detected on prenatal ultrasonography and may be associated with structural and syndromic abnormalities. Associations and pregnancy outcomes related to the prenatal diagnosis of scoliosis are poorly understood.

Methods: A retrospective cohort study was undertaken at a tertiary referral center in London. Referred cases with spinal deformities between 1997 and 2021 were identified from the prenatal ultrasonography database. Outcomes were ascertained from the database and electronic notes.

Results: One hundred twenty-three cases of fetal spinal deformities (scoliosis, kyphosis, or kyphoscoliosis) were identified from a referral population of 660,000 pregnancies, giving an incidence of approximately 0.2 per 1000 fetuses. Fifty-eight live births (47.2%) and 65 cases (52.8%) of fetal or neonatal demise or termination were observed. Most live births were isolated spinal deformities with a good postnatal outcome (n = 35, 60.3%). The commonest syndromic diagnosis in this group was VACTERL association (n = 7, 12.1%). Most cases of fetal loss were associated with severe malformations, most commonly spina bifida, body stalk anomaly and amniotic band sequence, or chromosomal abnormalities, except in 2 cases (3.1%).

Conclusions: This is the largest reported cases series to date of prenatally diagnosed fetal spinal deformity. This confirms that fetal scoliosis and associated vertebral abnormalities are underdiagnosed prenatally, with the reported incidence (0.2 per 1000) lower than the recognized incidence of congenital scoliosis (1 in 1,000). The concurrent finding of severe malformations was strongly associated with fetal loss. When an isolated finding, most fetal spinal deformities had a good postnatal outcome, while 1:8 live births were diagnosed with VACTERL association.

介绍:产前超声波检查可发现脊柱侧弯,脊柱侧弯可能与结构和综合征异常有关。与产前诊断脊柱侧弯症相关的关联性和妊娠结局尚不清楚:伦敦一家三级转诊中心进行了一项回顾性队列研究。从产前超声波数据库中确定了1997年至2021年间转诊的脊柱畸形病例。研究结果通过数据库和电子记录得以确认:从转诊的66万名孕妇中发现了123例胎儿脊柱畸形(脊柱侧弯、脊柱后凸或脊柱后凸),发病率约为每1000个胎儿中0.2例。观察到 58 例活产(47.2%)和 65 例(52.8%)胎儿或新生儿死亡或终止妊娠。大多数活产儿为孤立脊柱畸形,产后结果良好(35 例,60.3%)。该组最常见的综合征诊断是 VACTERL 关联(7 例,12.1%)。除 2 例(3.1%)外,大多数胎儿丢失与严重畸形有关,最常见的是脊柱裂、体柄异常、羊膜带序列或染色体异常:结论:这是迄今为止报道的最大规模的产前诊断胎儿脊柱畸形病例系列。结论:这是迄今为止报道的最大规模的产前诊断胎儿脊柱畸形病例系列,证实了胎儿脊柱侧弯及相关脊椎畸形在产前诊断不足,报道的发病率(0.2‰)低于公认的先天性脊柱侧弯发病率(1‰)。同时发现严重畸形与胎儿夭折密切相关。如果是单独发现,大多数胎儿脊柱畸形在出生后都有良好的预后,而每 8 个活产婴儿中就有 1 个被诊断出与 VACTERL 有关。
{"title":"Fetal Scoliosis: Natural History and Outcomes.","authors":"Samuel Walters, Ben Barkham, Tim Bishop, Jason Bernard, Christina Coroyannakis, Basky Thilaganathan, Darren F Lui","doi":"10.5435/JAAOSGlobal-D-24-00093","DOIUrl":"10.5435/JAAOSGlobal-D-24-00093","url":null,"abstract":"<p><strong>Introduction: </strong>Scoliosis can be detected on prenatal ultrasonography and may be associated with structural and syndromic abnormalities. Associations and pregnancy outcomes related to the prenatal diagnosis of scoliosis are poorly understood.</p><p><strong>Methods: </strong>A retrospective cohort study was undertaken at a tertiary referral center in London. Referred cases with spinal deformities between 1997 and 2021 were identified from the prenatal ultrasonography database. Outcomes were ascertained from the database and electronic notes.</p><p><strong>Results: </strong>One hundred twenty-three cases of fetal spinal deformities (scoliosis, kyphosis, or kyphoscoliosis) were identified from a referral population of 660,000 pregnancies, giving an incidence of approximately 0.2 per 1000 fetuses. Fifty-eight live births (47.2%) and 65 cases (52.8%) of fetal or neonatal demise or termination were observed. Most live births were isolated spinal deformities with a good postnatal outcome (n = 35, 60.3%). The commonest syndromic diagnosis in this group was VACTERL association (n = 7, 12.1%). Most cases of fetal loss were associated with severe malformations, most commonly spina bifida, body stalk anomaly and amniotic band sequence, or chromosomal abnormalities, except in 2 cases (3.1%).</p><p><strong>Conclusions: </strong>This is the largest reported cases series to date of prenatally diagnosed fetal spinal deformity. This confirms that fetal scoliosis and associated vertebral abnormalities are underdiagnosed prenatally, with the reported incidence (0.2 per 1000) lower than the recognized incidence of congenital scoliosis (1 in 1,000). The concurrent finding of severe malformations was strongly associated with fetal loss. When an isolated finding, most fetal spinal deformities had a good postnatal outcome, while 1:8 live births were diagnosed with VACTERL association.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11132347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141601962","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}
引用次数: 0
Decade-long Trends in Incidence of Slipped Capital Femoral Epiphysis in the United States: A Nationwide Database Analysis of Over 33 Million Patients. 美国股骨头骺滑脱发病率的十年趋势:对3300多万名患者的全国性数据库分析。
IF 1.5 Q3 Medicine Pub Date : 2024-05-22 eCollection Date: 2024-05-01 DOI: 10.5435/JAAOSGlobal-D-24-00112
Aaron Singh, Travis Kotzur, Beltran Torres-Izquierdo, David Momtaz, Rishi Gonuguntla, Amir Human Hoveidaei, Ali Seifi, María Galán-Olleros, Pooya Hosseinzadeh

Purpose: Slipped capital femoral epiphysis (SCFE) is a prevalent pediatric hip disorder linked to severe complications, with childhood obesity as a crucial risk factor. Despite the rising obesity rates, contemporary data on SCFE's epidemiology remain scarce in the United States. This study examined SCFE incidence trends and demographic risk factors in the United States over a decade.

Methods: A decade-long (2011 to 2020) retrospective cohort study was undertaken using the Healthcare Cost and Utilization Project National Inpatient Sample. Patients aged younger than 18 years were identified and further analyzed if diagnosed with SCFE through ICD-9 or ICD-10 codes. Key metrics included demographics variables, with multivariate regression assessing demographic factors tied to SCFE, and yearly incidence calculated.

Results: Of 33,180,028 pediatric patients, 11,738 (0.04%) were diagnosed with SCFE. The incidence escalated from 2.46 to 5.96 per 10,000 children, from 2011 to 2020, mirroring childhood obesity trends. Lower socioeconomic status children were predominantly affected. Multivariate analysis revealed reduced SCFE risk in female patients, while Black and Hispanic ethnicities, alongside the Western geographic location, had an increased risk.

Conclusion: This study underscores a twofold increase in SCFE incidence over the past decade, aligning with childhood obesity upsurge. Moreover, SCFE disproportionately affects lower SES children, with male sex, Black and Hispanic ethnicities amplifying the risk. This calls for targeted interventions to mitigate SCFE's effect, especially amidst the vulnerable populations.

目的:股骨头骺滑脱(SCFE)是一种常见的小儿髋关节疾病,与严重的并发症有关,而儿童肥胖症是一个重要的风险因素。尽管肥胖率不断上升,但美国有关 SCFE 流行病学的当代数据仍然很少。本研究探讨了十年来美国 SCFE 的发病趋势和人口风险因素:方法:利用医疗成本与利用项目全国住院病人样本进行了一项长达十年(2011 年至 2020 年)的回顾性队列研究。通过ICD-9或ICD-10编码对年龄小于18岁的SCFE患者进行识别和进一步分析。关键指标包括人口统计学变量,多变量回归评估与 SCFE 相关的人口统计学因素,并计算每年的发病率:在33,180,028名儿科患者中,有11,738人(0.04%)被诊断为SCFE。从2011年到2020年,发病率从每万名儿童2.46例上升到5.96例,反映了儿童肥胖的趋势。受影响的主要是社会经济地位较低的儿童。多变量分析表明,女性患者患 SCFE 的风险降低,而黑人和西班牙裔以及西部地区的患者患 SCFE 的风险增加:这项研究强调,在过去十年中,SCFE 的发病率增加了两倍,这与儿童肥胖症的激增是一致的。此外,SCFE 对社会经济地位较低的儿童的影响尤为严重,男性、黑人和西班牙裔儿童患 SCFE 的风险更大。这就要求采取有针对性的干预措施,以减轻 SCFE 的影响,尤其是对弱势群体的影响。
{"title":"Decade-long Trends in Incidence of Slipped Capital Femoral Epiphysis in the United States: A Nationwide Database Analysis of Over 33 Million Patients.","authors":"Aaron Singh, Travis Kotzur, Beltran Torres-Izquierdo, David Momtaz, Rishi Gonuguntla, Amir Human Hoveidaei, Ali Seifi, María Galán-Olleros, Pooya Hosseinzadeh","doi":"10.5435/JAAOSGlobal-D-24-00112","DOIUrl":"10.5435/JAAOSGlobal-D-24-00112","url":null,"abstract":"<p><strong>Purpose: </strong>Slipped capital femoral epiphysis (SCFE) is a prevalent pediatric hip disorder linked to severe complications, with childhood obesity as a crucial risk factor. Despite the rising obesity rates, contemporary data on SCFE's epidemiology remain scarce in the United States. This study examined SCFE incidence trends and demographic risk factors in the United States over a decade.</p><p><strong>Methods: </strong>A decade-long (2011 to 2020) retrospective cohort study was undertaken using the Healthcare Cost and Utilization Project National Inpatient Sample. Patients aged younger than 18 years were identified and further analyzed if diagnosed with SCFE through ICD-9 or ICD-10 codes. Key metrics included demographics variables, with multivariate regression assessing demographic factors tied to SCFE, and yearly incidence calculated.</p><p><strong>Results: </strong>Of 33,180,028 pediatric patients, 11,738 (0.04%) were diagnosed with SCFE. The incidence escalated from 2.46 to 5.96 per 10,000 children, from 2011 to 2020, mirroring childhood obesity trends. Lower socioeconomic status children were predominantly affected. Multivariate analysis revealed reduced SCFE risk in female patients, while Black and Hispanic ethnicities, alongside the Western geographic location, had an increased risk.</p><p><strong>Conclusion: </strong>This study underscores a twofold increase in SCFE incidence over the past decade, aligning with childhood obesity upsurge. Moreover, SCFE disproportionately affects lower SES children, with male sex, Black and Hispanic ethnicities amplifying the risk. This calls for targeted interventions to mitigate SCFE's effect, especially amidst the vulnerable populations.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11111394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077165","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}
引用次数: 0
Women in Orthopaedics: 10-Year Trends of Fellowship Match Rate and Subspecialty. 矫形外科中的女性:研究员匹配率和亚专科的 10 年趋势。
IF 1.5 Q3 Medicine Pub Date : 2024-05-22 eCollection Date: 2024-05-01 DOI: 10.5435/JAAOSGlobal-D-23-00269
Emily Naclerio, Molly Sekar, Yasmine S Ghattas, Scott Steinmann, Lisa K Cannada, Niloofar Dehghan

Background: Orthopaedic surgery has consistently remained one of the least diverse specialties in medicine. There are limited data on the match rate by sex into orthopaedic fellowships.

Purpose: The goals of this study were to determine (1) how the percentage of women applying to orthopaedic fellowships has changed from 2011 to 2021, (2) whether there was a correlation between sex and the likelihood of a successful fellowship match, and (3) which subspecialties tend to have a greater proportion of female applicants and fellows.

Methods: The San Francisco (SF) Match service was used to obtain US orthopaedic fellowship applicant data from 2010 to 2021. San Francisco Match has run the match for the orthopaedic fellowship match since 2010. International medical graduates' applications, incomplete applications, or withdrawn applications were excluded. The following variables were collected and assessed: sex, subspecialty choice (except for hand because they do not use SF Match services), and match outcome. The number of female applicants and matches was recorded by year and compared with the number of male applicants and matches. Chi-square analysis was used to analyze categorical variables.

Results: A total of 6969 applicants to all orthopaedic specialties within SF Match were included during the study period. Overall, 859 were female (12.3%), and 6110 were male (87.7%). The number of female applicants had an increasing trend over the 10-year period from 65 applicants in 2011 to 111 in 2021. The overall proportion of female applicants was between 10.1% and 14.4%. The annual match rate for female applicants was 90.7% to 100% during the study period while the match rate for male applicants was 93.7% to 97.3%. Regarding successful matches, pediatrics had the highest proportion of women (range: 30.2% to 46.2%), followed by foot and ankle (range: 9.8% to 26.4%). Spine (range: 3.2 to 10.9%) and adult reconstruction (range: 3.9% to 9%) had the least number of women among matched applicants.

Discussion: This study found that the number of female applicants to orthopaedic fellowships has increased over the past 10 years. The difference in fellowship match rates among male versus female applicants did not statistically differ during this 10-year period; however, the proportion of female fellows is not equally distributed among subspecialties, with a higher proportion of women matching into pediatrics and foot and ankle and lower proportion in reconstruction and spine. These data can provide a benchmark for department chairs and society leadership to ensure they are recruiting, interviewing, and selecting candidates who are representative of the current sex demographics of orthopaedic fellowship graduates.

背景:矫形外科一直是医学领域中最缺乏多样性的专业之一。目的:本研究旨在确定(1)从 2011 年到 2021 年,申请骨科研究金的女性比例发生了怎样的变化;(2)性别与成功匹配研究金的可能性之间是否存在相关性;以及(3)哪些亚专科的女性申请者和研究员比例较高:方法:利用旧金山(SF)匹配服务获取 2010 年至 2021 年的美国骨科研究金申请人数据。旧金山匹配服务从 2010 年开始为骨科研究员匹配服务。国际医学毕业生的申请、不完整的申请或撤回的申请均被排除在外。收集并评估了以下变量:性别、亚专科选择(手部除外,因为他们不使用旧金山匹配服务)和匹配结果。按年份记录女性申请者和匹配者的数量,并与男性申请者和匹配者的数量进行比较。采用卡方分析法对分类变量进行分析:在研究期间,共有 6969 人申请 SF Match 的所有骨科专业。总体而言,其中 859 人为女性(占 12.3%),6110 人为男性(占 87.7%)。女性申请人的人数在 10 年间呈上升趋势,从 2011 年的 65 人上升到 2021 年的 111 人。女性申请人的总体比例介于 10.1%和 14.4%之间。在研究期间,女性申请者的年度匹配率为 90.7% 至 100%,而男性申请者的匹配率为 93.7% 至 97.3%。就成功匹配率而言,儿科的女性比例最高(范围:30.2% 至 46.2%),其次是足踝科(范围:9.8% 至 26.4%)。脊柱(范围:3.2% 至 10.9%)和成人重建(范围:3.9% 至 9%)的配对申请人中女性人数最少:讨论:本研究发现,在过去 10 年中,申请骨科研究金的女性人数有所增加。然而,女性研究员的比例在各亚专科中的分布并不均衡,匹配到儿科和足踝科的女性比例较高,而匹配到重建科和脊柱科的女性比例较低。这些数据可以为科室主任和学会领导提供一个基准,以确保他们在招聘、面试和选拔候选人时能够代表当前骨科研究员毕业生的性别比例。
{"title":"Women in Orthopaedics: 10-Year Trends of Fellowship Match Rate and Subspecialty.","authors":"Emily Naclerio, Molly Sekar, Yasmine S Ghattas, Scott Steinmann, Lisa K Cannada, Niloofar Dehghan","doi":"10.5435/JAAOSGlobal-D-23-00269","DOIUrl":"10.5435/JAAOSGlobal-D-23-00269","url":null,"abstract":"<p><strong>Background: </strong>Orthopaedic surgery has consistently remained one of the least diverse specialties in medicine. There are limited data on the match rate by sex into orthopaedic fellowships.</p><p><strong>Purpose: </strong>The goals of this study were to determine (1) how the percentage of women applying to orthopaedic fellowships has changed from 2011 to 2021, (2) whether there was a correlation between sex and the likelihood of a successful fellowship match, and (3) which subspecialties tend to have a greater proportion of female applicants and fellows.</p><p><strong>Methods: </strong>The San Francisco (SF) Match service was used to obtain US orthopaedic fellowship applicant data from 2010 to 2021. San Francisco Match has run the match for the orthopaedic fellowship match since 2010. International medical graduates' applications, incomplete applications, or withdrawn applications were excluded. The following variables were collected and assessed: sex, subspecialty choice (except for hand because they do not use SF Match services), and match outcome. The number of female applicants and matches was recorded by year and compared with the number of male applicants and matches. Chi-square analysis was used to analyze categorical variables.</p><p><strong>Results: </strong>A total of 6969 applicants to all orthopaedic specialties within SF Match were included during the study period. Overall, 859 were female (12.3%), and 6110 were male (87.7%). The number of female applicants had an increasing trend over the 10-year period from 65 applicants in 2011 to 111 in 2021. The overall proportion of female applicants was between 10.1% and 14.4%. The annual match rate for female applicants was 90.7% to 100% during the study period while the match rate for male applicants was 93.7% to 97.3%. Regarding successful matches, pediatrics had the highest proportion of women (range: 30.2% to 46.2%), followed by foot and ankle (range: 9.8% to 26.4%). Spine (range: 3.2 to 10.9%) and adult reconstruction (range: 3.9% to 9%) had the least number of women among matched applicants.</p><p><strong>Discussion: </strong>This study found that the number of female applicants to orthopaedic fellowships has increased over the past 10 years. The difference in fellowship match rates among male versus female applicants did not statistically differ during this 10-year period; however, the proportion of female fellows is not equally distributed among subspecialties, with a higher proportion of women matching into pediatrics and foot and ankle and lower proportion in reconstruction and spine. These data can provide a benchmark for department chairs and society leadership to ensure they are recruiting, interviewing, and selecting candidates who are representative of the current sex demographics of orthopaedic fellowship graduates.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11111387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141074542","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}
引用次数: 0
Increasing Use of Promotional Language in Orthopaedic Surgery Abstracts-An Analysis of 112,916 Abstracts 1985 to 2020. 骨科手术摘要中越来越多地使用促销语言--1985 年至 2020 年对 112,916 篇摘要的分析。
IF 1.5 Q3 Medicine Pub Date : 2024-05-22 eCollection Date: 2024-05-01 DOI: 10.5435/JAAOSGlobal-D-24-00109
Ryan T Halvorson, Liam H Wong, Brian T Feeley

Background: Increasing use of "hype" language (eg, language overstating research impact) has been documented in the scientific community. Evaluating language in abstracts is important because readers may use abstracts to extrapolate findings to entire publications. Our purpose was to assess the frequency of hype language within orthopaedic surgery.

Methods: One hundred thirty-nine hype adjectives were previously identified using a linguistics approach. All publicly available abstracts from 18 orthopaedic surgery journals between 1985 and 2020 were obtained, and hype adjectives were tabulated. Change in frequency of these adjectives was calculated.

Results: A total of 112,916 abstracts were identified. 67.0% (948/1414) of abstracts in 1985 contained hype adjectives, compared with 92.5% (5287/5714) in 2020. The average number of hype adjectives per abstract increased by 136% (1.1 to 2.6). Of the 139 adjectives, 87 (62.5%) increased in frequency and 40 (28.7%) decreased in frequency while 12 (9%) were not used. The hype adjectives with the largest absolute increases in frequency were quality (+324wpm), significant (+320wpm), systematic (+246wpm), top (+239wpm), and international (+201wpm). The five hype adjectives with the largest relative increases in frequency were novel (+10500%), international (+2850%), urgent (+2600%), robust (+2300%), and emerging (+1400%).

Conclusion: Promotional language is increasing in orthopaedic surgery abstracts. Authors, editors, and reviewers should seek to minimize the usage of nonobjective language.

背景:据记录,科学界越来越多地使用 "炒作 "语言(如夸大研究影响的语言)。评估摘要中的语言非常重要,因为读者可能会通过摘要来推断整篇出版物的研究结果。我们的目的是评估骨科手术中炒作语言的频率:方法:我们之前使用语言学方法识别了 139 个炒作形容词。我们获得了 1985 年至 2020 年间 18 种矫形外科期刊的所有公开摘要,并将炒作形容词制成表格。结果:结果:共识别出 112,916 篇摘要。1985年67.0%(948/1414)的摘要包含炒作形容词,而2020年为92.5%(5287/5714)。每篇摘要的平均炒作形容词数量增加了 136%(从 1.1 个增加到 2.6 个)。在 139 个形容词中,87 个(62.5%)的使用频率增加,40 个(28.7%)减少,12 个(9%)未使用。绝对频率增幅最大的炒作形容词是质量(+324wpm)、显著(+320wpm)、系统(+246wpm)、顶级(+239wpm)和国际(+201wpm)。频率相对增长最大的五个炒作形容词是新颖(+10500%)、国际(+2850%)、紧急(+2600%)、稳健(+2300%)和新兴(+1400%):结论:骨科手术摘要中的宣传用语越来越多。作者、编辑和审稿人应尽量减少使用非客观性语言。
{"title":"Increasing Use of Promotional Language in Orthopaedic Surgery Abstracts-An Analysis of 112,916 Abstracts 1985 to 2020.","authors":"Ryan T Halvorson, Liam H Wong, Brian T Feeley","doi":"10.5435/JAAOSGlobal-D-24-00109","DOIUrl":"10.5435/JAAOSGlobal-D-24-00109","url":null,"abstract":"<p><strong>Background: </strong>Increasing use of \"hype\" language (eg, language overstating research impact) has been documented in the scientific community. Evaluating language in abstracts is important because readers may use abstracts to extrapolate findings to entire publications. Our purpose was to assess the frequency of hype language within orthopaedic surgery.</p><p><strong>Methods: </strong>One hundred thirty-nine hype adjectives were previously identified using a linguistics approach. All publicly available abstracts from 18 orthopaedic surgery journals between 1985 and 2020 were obtained, and hype adjectives were tabulated. Change in frequency of these adjectives was calculated.</p><p><strong>Results: </strong>A total of 112,916 abstracts were identified. 67.0% (948/1414) of abstracts in 1985 contained hype adjectives, compared with 92.5% (5287/5714) in 2020. The average number of hype adjectives per abstract increased by 136% (1.1 to 2.6). Of the 139 adjectives, 87 (62.5%) increased in frequency and 40 (28.7%) decreased in frequency while 12 (9%) were not used. The hype adjectives with the largest absolute increases in frequency were quality (+324wpm), significant (+320wpm), systematic (+246wpm), top (+239wpm), and international (+201wpm). The five hype adjectives with the largest relative increases in frequency were novel (+10500%), international (+2850%), urgent (+2600%), robust (+2300%), and emerging (+1400%).</p><p><strong>Conclusion: </strong>Promotional language is increasing in orthopaedic surgery abstracts. Authors, editors, and reviewers should seek to minimize the usage of nonobjective language.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11111393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077170","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}
引用次数: 0
Effects of Surgeon-Preferred Staff and Staff Turnover on Operating Time and Complication Rates in Reverse and Anatomic Total Shoulder Arthroplasty. 外科医生首选员工和员工流动对反向和解剖全肩关节置换术手术时间和并发症发生率的影响
IF 1.5 Q3 Medicine Pub Date : 2024-05-16 eCollection Date: 2024-05-01 DOI: 10.5435/JAAOSGlobal-D-24-00104
Sarah C Kurkowski, Samuel K Gerak, Michael J Thimmesch, Henry A Kuechly, K Schuyler Nissen, Adam C Valenti, Rahul D Patel, Brian M Grawe

Background: This study focuses on investigating the risk factors of increased operating room time and patient complication rates after total shoulder arthroplasty cases (both reverse and anatomic). We hypothesize that the use of surgeon-preferred staff will improve operating room efficiency and reduce complication rates while increased staff turnover will decrease efficiency and increase complications.

Methods: This is a single-center, retrospective study focused on determining the effects of staffing on operating room time and efficiency in total shoulder arthroplasty. The study included patients who underwent total shoulder arthroplasty by a single fellowship-trained orthopaedic surgeon from 2018 to 2023.

Results: Four hundred twenty-three patients were included in the study from August 2018 to April 2023, 264 of which were reverse total shoulder arthroplasty (rTSA) and 159 were anatomic total shoulder arthroplasty (aTSA). In both rTSA and aTSA, the presence of surgeon-preferred staff markedly decreased operating room time. In rTSA, staff turnover increased risk of 90-day complications.

Conclusion: Because the presence of surgeon-preferred staff affects operating room time and efficiency, orthopaedic surgeons should train multiple surgical teams so that efficiency is not affected by the loss of personnel during a case. To reduce 90-day complication rates in rTSA, staff breaks and turnover should be minimized as much as possible because this has a direct effect on patient outcomes. Effort from hospital administration and management should be put toward reducing turnover to improve patient outcomes.

背景:本研究主要调查全肩关节置换术(反向和解剖)后手术室时间和患者并发症发生率增加的风险因素。我们假设,使用外科医生首选的员工将提高手术室效率并降低并发症发生率,而员工流动性增加将降低效率并增加并发症:这是一项单中心回顾性研究,重点是确定人员配置对全肩关节置换术手术室时间和效率的影响。研究纳入了 2018 年至 2023 年期间由一名接受过研究员培训的骨科医生进行全肩关节置换术的患者:研究纳入了2018年8月至2023年4月期间的423例患者,其中264例为反向全肩关节置换术(rTSA),159例为解剖型全肩关节置换术(aTSA)。在反向全肩关节置换术(rTSA)和解剖型全肩关节置换术(aTSA)中,外科医生首选员工的存在明显减少了手术室时间。在rTSA中,人员流动增加了90天并发症的风险:结论:由于外科医生首选人员的存在会影响手术室的时间和效率,骨科医生应培训多个手术团队,这样就不会因病例中人员流失而影响效率。为降低 rTSA 的 90 天并发症发生率,应尽可能减少人员休息和流动,因为这会直接影响患者的治疗效果。医院行政和管理层应努力减少人员流动,以改善患者的治疗效果。
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引用次数: 0
Probability of Occult Ankle Fracture Based on Radiograph-Measured Swelling. 根据 X 光片测量的肿胀情况判断踝关节隐性骨折的概率。
IF 1.5 Q3 Medicine Pub Date : 2024-05-15 eCollection Date: 2024-05-01 DOI: 10.5435/JAAOSGlobal-D-23-00271
Christian Kenneth Kerut, Srikanth Mudiganty, Denise Goodfellow Kerut, Ronald L Horswell, Reagan Williams, Melanie Valencia, Joseph Gonzales

Introduction: Pediatric ankle injuries are a common presentation in the emergency department (ED). A quarter of pediatric ankle fractures show no radiographic evidence of a fracture. Physicians often correlate non-weight bearing and tenderness with an occult fracture. We present this study to predict the probability of an occult fracture using radiographic soft-tissue swelling on initial ED radiographs.

Methods: This is a retrospective study at a Level 1 pediatric trauma center from 2021 to 22. Soft-tissue swelling between the lateral malleolus and skin was measured on radiographs, and weight-bearing status was documented. Statistical analysis was conducted using Stata software.

Discussion: The study period involved 32 patients with an occult fracture, with 8 (25%) diagnosed with a fracture on follow-up radiographs. The probability of an occult fracture was calculated as a function of the ankle swelling in millimeters (mm) using a computer-generated predictive model. False-negative and false-positive rates were plotted as a function of the degree of ankle swelling.

Conclusion: Magnitude of ankle soft-tissue swelling as measured on initial ED radiographs is predictive of an occult fracture. Although weight-bearing status was not a sign of occult fracture, it improves the predictive accuracy of soft-tissue swelling.

简介:小儿踝关节损伤是急诊科(ED)的常见病。四分之一的小儿踝关节骨折没有影像学证据显示骨折。医生通常将不负重和触痛与隐匿性骨折联系起来。我们通过这项研究,利用急诊室初诊X光片上的软组织肿胀来预测隐匿性骨折的可能性:本研究是一项回顾性研究,研究对象是 2021 年至 22 年间的一级儿科创伤中心。在X光片上测量外侧踝骨和皮肤之间的软组织肿胀,并记录负重状态。使用Stata软件进行统计分析:研究期间有 32 名患者出现隐匿性骨折,其中 8 人(25%)在随访拍片时被确诊为骨折。使用计算机生成的预测模型计算了隐匿性骨折的概率与踝关节肿胀(毫米)的函数关系。假阴性率和假阳性率与踝关节肿胀程度呈函数关系:结论:在急诊室最初的 X 光片上测量的踝关节软组织肿胀程度可预测隐性骨折。虽然负重状态不是隐性骨折的征兆,但它能提高软组织肿胀的预测准确性。
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引用次数: 0
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Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews
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