Patient Perception of Social Media Use by Orthopaedic Surgeons: A Pilot Study.

Background: Social media (SM) use by orthopaedic surgeons is becoming increasingly common; nonetheless, it needs to be clarified how patients perceive the content posted by physicians. Purpose: To characterize SM content posted by orthopaedic surgeons while investigating patient perceptions of this content and how it may influence their health care decisions. Study Design: Cross-sectional study. Methods: Posts on SM outlets by orthopaedic surgeons were reviewed and categorized. A survey to assess patient perception of these categories was administered between December 2021 and February 2022 in the clinics of 3 orthopaedic surgeons. Survey results were analyzed for differences in patient SM use and perception of SM content types. Results: There were 250 completed surveys. SM use was high among all age groups; however, the 18 to 24 years (87.1%) and 25 to 34 years (86.4%) age groups were more likely than older age groups to report daily use (P = .002). Overall, 17% of patients reported using SM to see information about their health care at least once per month, 21% reported reviewing the SM account of a physician at least once per month, 19% reported that they were likely or very likely to view the SM account of their physician, and 23% reported that SM content was likely or very likely to influence which physician they see. Patients held the most consistently positive view of posts that educated patients, discussed sports team coverage, and provided patient testimonials. Patients had consistently neutral views of posts educating colleagues, discussing presentations at national meetings, displaying aspects of surgeons' personal lives, and supporting marginalized groups. Several post categories elicited highly polarized responses-including those discussing research publications and showing surgical techniques or pictures/videos taken during surgery. Respondents had a consistently negative response to posts making political statements. Conclusion: SM is likely a useful tool to help physicians interact with patients. Physicians who wish to interact with patients should consider posting content viewed most positively-including posts educating patients, discussing sports team coverage, and providing patient testimonials. Content that is viewed less favorably should be posted sparingly or with a sensitive tag.

Use of Injections and Biologics for the Nonoperative Treatment of Rotator Cuff Pathology.

Symptomatic rotator cuff pathology is a common musculoskeletal issue with evolving surgical indications. Most of the patients undergo some form of nonoperative treatment before considering surgical intervention. Understanding and optimizing nonoperative treatment modalities is an essential key to successful treatment. This article contains a review of the current literature regarding the risks, benefits, and alternatives of the most common injections used in the treatment of rotator cuff pathology. Injection options covered include corticosteroids, biologics including platelet-rich plasma and stem cells, hyaluronic acid, and nonsteroidal anti-inflammatory drugs.

Tarsal Coalition of the Cuneiforms in a Young Athlete: A Case Report.

CASE: Tarsal coalitions are relatively common, but there are no reports of cuneiform-to cuneiform coalition in the English language literature. The authors present a case of medial-to-intermediate cuneiform coalition in a young female track athlete. Previous nonoperative treatments had been unsuccessful. Coalition release and medial-intermediate cuneiform arthrodesis enabled her to return initially to full athletic participation without pain, but she had return of pain that persists despite removal of hardware. CONCLUSION: Medial-intermediate cuneiform coalition is rare. Surgery in this patient provided a short period of pain-free athletic participation, but long-term outcomes are not proven, and further research is needed.

Endocytosis of BRASSINOSTEROID INSENSITIVE1 Is Partly Driven by a Canonical Tyr-Based Motif.

Clathrin-mediated endocytosis (CME) and its core endocytic machinery are evolutionarily conserved across all eukaryotes. In mammals, the heterotetrameric adaptor protein complex-2 (AP-2) sorts plasma membrane (PM) cargoes into vesicles via the recognition of motifs based on Tyr or di-Leu in their cytoplasmic tails. However, in plants, very little is known about how PM proteins are sorted for CME and whether similar motifs are required. In Arabidopsis (Arabidopsis thaliana), the brassinosteroid (BR) receptor BR INSENSITIVE1 (BRI1) undergoes endocytosis, which depends on clathrin and AP-2. Here, we demonstrate that BRI1 binds directly to the medium AP-2 subunit (AP2M). The cytoplasmic domain of BRI1 contains five putative canonical surface-exposed Tyr-based endocytic motifs. The Tyr-to-Phe substitution in Y898KAI reduced BRI1 internalization without affecting its kinase activity. Consistently, plants carrying the BRI1Y898F mutation were hypersensitive to BRs. Our study demonstrates that AP-2-dependent internalization of PM proteins via the recognition of functional Tyr motifs also operates in plants.

Complete Traumatic Trifocal Failure of the Extensor Mechanism of the Knee: A Case Report and Review of the Literature.

The unique case of a rare 3-level extensor mechanism failure in a 28-year-old male, involving a tibial tubercle avulsion fracture, a patellar tendon avulsion off the tibial tubercle fragment, and a severely comminuted patella fracture, and the surgical technique required to repair such an injury is presented. Focus is spent on the unique repair of a tendon injury when both proximal and distal bony attachments are damaged. Trifocal knee extensor mechanism is a rare clinical entity with minimal literature available-to date, this injury has only been reported in a retrospective review of combat-related injuries in military personnel. It is important to maintain an understanding of knee extensor mechanism anatomy and perform thorough investigation of high-energy knee injuries to ensure adequate treatment of all injuries. The outcome presented in this case shows that positive results after complex extensor mechanism injuries may be achieved, but limited data exists to elucidate optimum treatment. It is essential for surgeons to have firm grasp of techniques used to treat each segment of the extensor mechanism so that they may be combined when a patient presents with complex, multifocal injury.

Nonoperative Management of Proximal Tibiofibular Joint Synostosis after Tibial Intramedullary Nailing.

We report the case of a 28-year-old male semiprofessional basketball player who presented to an outside hospital with nonhealing stress fractures for which he underwent tibial intramedullary nailing (IMN). Two weeks after surgery, he developed pain proximal and lateral to the knee. As he returned to play, the pain worsened with jumping and lateral movement and improved with rest. He presented to our hospital one year after the operation with the same unresolved pain. Imaging one year after the surgery revealed proximal tibiofibular joint (TFJ) synostosis aligned with the drill path. Literature review showed that rare noncongenital cases of proximal TFJ synostosis cases were most often treated nonoperatively. However, two cases involved the removal of excessively protruding screws and two cases involved bone resection that resolved painful disruption of other joints, such as the ankle. The current patient had proper implant positioning and no other impacted joints, so he was managed without operative intervention. By the final 16-month postoperative follow-up, his symptoms had resolved completely. Although an unusual occurrence with limited data, we recommend nonoperative management for proximal TFJ synostosis caused by tibial nailing if implants are properly positioned and no other joints are affected.