The performance of ChatGPT on orthopaedic in-service training exams: A comparative study of the GPT-3.5 turbo and GPT-4 models in orthopaedic education.

Introduction: The rapid advancement of artificial intelligence (AI), particularly the development of Large Language Models (LLMs) such as Generative Pretrained Transformers (GPTs), has revolutionized numerous fields. The purpose of this study is to investigate the application of LLMs within the realm of orthopaedic in training examinations. Methods: Questions from the 2020-2022 Orthopaedic In-Service Training Exams (OITEs) were given to OpenAI's GPT-3.5 Turbo and GPT-4 LLMs, using a zero-shot inference approach. Each model was given a multiple-choice question, without prior exposure to similar queries, and their generated responses were compared to the correct answer within each OITE. The models were evaluated on overall accuracy, performance on questions with and without media, and performance on first- and higher-order questions. Results: The GPT-4 model outperformed the GPT-3.5 Turbo model across all years and question categories (2022: 67.63% vs. 50.24%; 2021: 58.69% vs. 47.42%; 2020: 59.53% vs. 46.51%). Both models showcased better performance with questions devoid of associated media, with GPT-4 attaining accuracies of 68.80%, 65.14%, and 68.22% for 2022, 2021, and 2020, respectively. GPT-4 outscored GPT-3.5 Turbo on first-order questions across all years (2022: 63.83% vs. 38.30%; 2021: 57.45% vs. 50.00%; 2020: 65.74% vs. 53.70%). GPT-4 also outscored GPT-3.5 Turbo on higher-order questions across all years (2022: 68.75% vs. 53.75%; 2021: 59.66% vs. 45.38%; 2020: 53.27% vs. 39.25%). Discussion: GPT-4 showed improved performance compared to GPT-3.5 Turbo in all tested categories. The results reflect the potential and limitations of AI in orthopaedics. GPT-4's performance is comparable to a second-to-third-year resident and GPT-3.5 Turbo's performance is comparable to a first-year resident, suggesting the application of current LLMs can neither pass the OITE nor substitute orthopaedic training. This study sets a precedent for future endeavors integrating GPT models into orthopaedic education and underlines the necessity for specialized training of these models for specific medical domains.

Acute Batter's Shoulder With Concomitant Superior Labrum from Anterior to Posterior Injury in a Collegiate Baseball Player.

An 18-year-old collegiate baseball player sustained an acute batter's shoulder injury causing a posterior shoulder dislocation with type IX 360° superior labrum from anterior to posterior tear. To the authors' knowledge, this description of batter's shoulder is not within the literature. The patient ultimately underwent arthroscopic labral repair and has fully returned to sport. In understanding the complexity of the shoulder during the batter's swing, this case demonstrates an expansion to the previously described pathophysiology of batter's shoulder.

The Use of Blocking Wires in Fibular Intramedullary Nailing of an Ankle Fracture with Hardware Failure: A Case Report.

A 24-year-old male, with a body mass index (BMI) of 31.7 and a previous open reduction and internal fixation (ORIF) of the left ankle seven years ago, presented to the emergency department with a peri-implant, comminuted fibula fracture with broken hardware and syndesmotic injury. The nature of the revision surgery made proper guidewire placement during fibular nailing difficult. Blocking wires assisted in ensuring proper guidewire placement. The patient was successfully managed with revision ORIF, fibular nailing, and syndesmotic fixation. Blocking wires are a helpful tool for achieving proper fracture alignment and stability during intramedullary nailing procedures and may be considered in fibular nailing situations.

The Effects of Modified Game Schedules on Injury Rates in the National Hockey League (NHL).

Background Due to the COVID-19 pandemic, many professional sports leagues such as the National Hockey League (NHL) made significant changes to their schedules and operating procedures. Changes included a modified 2019-2020 playoff format, the removal of the 2020-2021 preseason, and condensed game schedules. Though these modifications were made in an effort to protect players from COVID-19, they resulted in decreased training time and preparation. The purpose of this study was to assess the impact of these changes on the rate of player injuries in the NHL both after the resumption of the midseason stoppage and during the subsequent seasons. Hypothesis/purpose Changes to the NHL schedule amid the COVID-19 pandemic resulted in a significant increase in player injury rates. Methods NHL injuries were obtained from an NHL injury database for the 2018-2019 through the 2021-2022 seasons. The date of injury, date of return, injury description, player age, and player position were recorded. Injury rates were calculated as the number of total athlete injuries per 1000 game exposures (GEs). The primary outcome was the injury proportion ratio (IPR) when comparing the injury rates of the post-COVID-19 season with baseline seasons. Secondary measures analyzed injuries based on age, anatomic location, month in the season, position, length of injury, season-ending injuries, and recurring injuries. Results A total of 4604 injuries were recorded between 2018 and 2022. The modified 2019-2020 playoffs had significantly higher rates of injury (IPR = 1.84, 95% confidence interval {CI} = 1.36-2.49) with more game exposures per week. The 2020-2021 season had significantly higher rates of overall player injury compared to baseline seasons (IPR = 1.19, 95% CI = 1.09-1.30) and also had a higher rate of season-ending injuries (IPR = 1.71, 95% CI = 1.38-2.11). Most injuries occurred in the first few months of the 2020-2021 season. There was no significant difference in injury rate based on age group and no significant difference in the average length of injury between seasons. Conclusion Increases in injury rates could be due to decreased offseason training between seasons, the elimination of preseason games, and increased game density. Decreasing typical training timelines and eliminating the preseason to rapidly return to normal competition after unexpected events (pandemics, lockdowns, etc.) may pose a risk to player safety in the NHL. These findings should be considered before future schedule changes in professional hockey.

Compartment Syndrome Due to Reperfusion Injury from an Axillary Artery Occlusion: A Case Report and Review of the Literature.

Introduction: While commonly caused by traumatic injury and fracture, compartment syndrome can also result from reperfusion injury. Very few cases of prophylactic fasciotomy are mentioned when considering time to revascularization after prolonged vascular ischemia. We present a case of a patient who underwent multiple compartment prophylactic fasciotomies following reperfusion injury in the upper extremity. Case Report: We report a 72-year-old male that suffered from an anterior shoulder dislocation after a ground-level fall. After reduction, pulses were not measurable, and angiography indicated an axillary artery occlusion. Immediately after operative reperfusion, compartments became tense. Orthopedic surgeons subsequently performed arm anterior, posterior, and forearm volar and mobile wad compartment fasciotomies, after 13 h of ischemia. The patient tolerated the procedure, and at the latest follow-up, was working to improve strength in the extremity. Conclusion: Even when the circumstances of injury seem to be less traumatic as in this case of a ground-level fall, we document the importance of prompt recognition and intervention of suspected compartment syndrome following prolonged ischemia and revascularization of the upper extremity.

Technology-assisted behavioral intervention to encourage prehabilitation in frail older adults undergoing surgery: Development and design of the BeFitMe™ Apple Watch app.

Objective: Increasing the physical activity of frail, older patients before surgery through prehabilitation (prehab) can hasten return to autonomy and reduce complications postoperatively. However, prehab participation is low in the clinical setting. In this study, we re-design an existing prehab smartphone application (BeFitMe™) using a novel standalone Apple Watch platform to increase accessibility and usability for vulnerable patients. Methods: Design Science Research Methodology was used to (1) develop an approach to clinical research using standalone Apple Watches, (2) re-design BeFitMe™ for the Apple Watch platform, and (3) incorporate user feedback into app design. In phase 3, beta and user testers gave feedback via a follow-up phone call. Exercise data was extracted from the watch after testing. Descriptive statistics were used to summarize accessibility and usability. Results: BeFitMe™ was redesigned for the Apple Watch with full functionality without requiring patients to have an iPhone or internet connectivity and the ability to passively collect exercise data without patient interaction. Three study staff participated in beta testing over 3 weeks. Six randomly chosen thoracic surgery patients participated in user testing over 12 weeks. Feedback from beta and user testers was addressed with updated software (versions 1.0-1.10), improved interface and notification schemes, and the development of educational materials used during enrollment. The majority of users (5/6, 83%) participated by responding to at least one notification and data was able to be collected for 54/82 (68%) of the days users had the watches. The amount of data collected in BeFitMe™ Watch app increased from 2/11 (16%) days with the first patient tester to 13/13 (100%) days with the final patient tester. Conclusions: The BeFitMe™ Watch app is accessible and usable. The BeFitMe™ Watch app may help older patients, particularly those from vulnerable backgrounds with fewer resources, participate in prehab prior to surgery.

Augmented Reality for Perioperative Anxiety in Patients Undergoing Surgery: A Randomized Clinical Trial.

Importance: Both augmented reality (AR) and virtual reality (VR) have had increasing applications in medicine, including medical training, psychology, physical medicine, rehabilitation, and surgical specialties, such as neurosurgery and orthopedic surgery. There are little data on AR's effect on patients' anxiety and experiences. Objective: To determine whether the use of an AR walkthrough effects patient perioperative anxiety. Design, Setting, and Participants: This randomized clinical trial was conducted at an outpatient surgery center in 2021 to 2022. All patients undergoing elective orthopedic surgery with the senior author were randomized to the treatment or control group. Analyses were conducted per protocol. Data analysis was performed in November 2022. Intervention: AR experience explaining to patients what to expect on their day of surgery and walking them through the surgery space. The control group received the standard educational packet. Main Outcomes and Measures: The main outcome was change in State-Trait Anxiety Inventory (STAI) from the screening survey to the preoperative survey. Results: A total of 140 patients were eligible, and 45 patients either declined or were excluded. Therefore, 95 patients (63 [66.3%] male; mean [SD] age, 38 [16] years) were recruited for the study and included in the final analysis; 46 patients received the AR intervention, and 49 patients received standard instructions. The AR group experienced a decrease in anxiety from the screening to preoperative survey (mean score change, -2.4 [95% CI, -4.6 to -0.3]), while the standard care group experienced an increase (mean score change, 2.6 [95% CI, 0.2 to 4.9]; P = .01). All patients postoperatively experienced a mean decrease in anxiety score compared with both the screening survey (mean change: AR, -5.4 [95% CI, -7.9 to -2.9]; standard care, -6.9 [95% CI, -11.5 to -2.2]; P = .32) and preoperative survey (mean change: AR, -8.0 [95% CI, -10.3 to -5.7]; standard care, -4.2 [95% CI, -8.6 to 0.2]; P = .19). Of 42 patients in the AR group who completed the postoperative follow-up survey, 30 (71.4%) agreed or strongly agreed that they enjoyed the experience, 29 (69.0%) agreed or strongly agreed that they would recommend the experience, and 28 (66.7%) agreed or strongly agreed that they would use the experience again. No differences were observed in postoperative pain levels or narcotic use. Conclusions and Relevance: In this randomized clinical trial, the use of AR decreased preoperative anxiety compared with traditional perioperative education and handouts, but there was no significant effect on postoperative anxiety, pain levels, or narcotic use. These findings suggest that AR may serve as an effective means of decreasing preoperative patient anxiety. Trial Registration: ClinicalTrials.gov Identifier: NCT04727697.

Therapeutic Perspectives for Inflammation and Senescence in Osteoarthritis Using Mesenchymal Stem Cells, Mesenchymal Stem Cell-Derived Extracellular Vesicles and Senolytic Agents.

Osteoarthritis (OA) is the most common cause of disability worldwide among the elderly. Alarmingly, the incidence of OA in individuals less than 40 years of age is rising, likely due to the increase in obesity and post-traumatic osteoarthritis (PTOA). In recent years, due to a better understanding of the underlying pathophysiology of OA, several potential therapeutic approaches targeting specific molecular pathways have been identified. In particular, the role of inflammation and the immune system has been increasingly recognized as important in a variety of musculoskeletal diseases, including OA. Similarly, higher levels of host cellular senescence, characterized by cessation of cell division and the secretion of a senescence-associated secretory phenotype (SASP) within the local tissue microenvironments, have also been linked to OA and its progression. New advances in the field, including stem cell therapies and senolytics, are emerging with the goal of slowing disease progression. Mesenchymal stem/stromal cells (MSCs) are a subset of multipotent adult stem cells that have demonstrated the potential to modulate unchecked inflammation, reverse fibrosis, attenuate pain, and potentially treat patients with OA. Numerous studies have demonstrated the potential of MSC extracellular vesicles (EVs) as cell-free treatments that comply with FDA regulations. EVs, including exosomes and microvesicles, are released by numerous cell types and are increasingly recognized as playing a critical role in cell-cell communication in age-related diseases, including OA. Treatment strategies for OA are being developed that target senescent cells and the paracrine and autocrine secretions of SASP. This article highlights the encouraging potential for MSC or MSC-derived products alone or in combination with senolytics to control patient symptoms and potentially mitigate the progression of OA. We will also explore the application of genomic principles to the study of OA and the potential for the discovery of OA phenotypes that can motivate more precise patient-driven treatments.

Effect of Trainee Level on Surgical Time and Postoperative Complications of Anterior Cruciate Ligament Reconstruction.

PURPOSE: The objective of this study was to investigate the association between trainee level and surgical time and postoperative complications of anterior cruciate ligament reconstruction (ACLR). METHODS: A retrospective chart review of patients who underwent ACLR at an academic orthopaedic ambulatory surgery center collected demographic and clinical information, including the number of trainees present and trainee level. Unadjusted and adjusted regression analyses assessed the association between trainee number and level with surgical time (time from skin incision to closure) and postoperative complications. RESULTS: Of 799 patients in this study operated on by one of five academic sports surgeons, 87% had at least one trainee involved. The average surgical time overall was 93 ± 21 minutes and by trainee level was 99.7 (junior resident), 88.5 (senior residents), 96.6 (fellows), and 95.6 (no trainees). Trainee level was significantly associated with surgical time (P = 0.0008), with increased surgical time in cases involving fellows (0.0011). Fifteen complications (1.9%) were observed within 90 days of surgery. No notable risk factors of postoperative complications were identified. CONCLUSION: Resident trainee level does not have a notable effect on surgical time or postoperative complications for ACLR at an ambulatory surgery center, although cases involving fellows had longer surgical times. Trainee level was not associated with risk of postoperative complications.

A Regional Analysis of Hospital Readmissions Following Total Hip and Knee Arthroplasty and the Impact of Medicaid Expansion.

The Hospital Readmissions Reduction Program (HRRP) works to temper nationally rising readmission rates. Total knee arthroplasty (TKA) and total hip arthroplasty (THA) have a 30-day readmission cost burden of $889,300 and $689,400, respectively. No research has compared TKA and THA readmission rates by region and Medicaid expansion status. This study compares THA and TKA readmission rates in the United States by region, Medicaid status, and performance. One-way ANOVAs were conducted to determine the regions with the highest and lowest mean excess readmission ratios (ERRs). An independent t-test compared Medicaid versus non-Medicaid expansion states. Southern hospitals have the highest mean ERR, followed by northeastern, midwestern, and then western hospitals. Although Medicaid expansion states have significantly lower ERRs compared to non-expansion states, Medicaid status alone does not account for regional differences in ERRs after THA and TKA. Regional factors likely confound Medicaid status's effect on readmission rates. (Journal of Surgical Orthopaedic Advances 32(1):005-008, 2023).

The 50 most influential publications in clavicle fractures.

PURPOSE: Clavicle fractures are among the most common orthopedic fractures, and treatment methods, operative versus nonoperative, have been a point of contention. The purpose of this study was to evaluate the 50 most influential articles regarding clavicle fractures to better understand past focuses of research and to identify any gaps in knowledge. METHODS: A review of the most cited articles related to clavicle fractures was conducted using Web of Science database. A search was conducted in April 2022 by one trained researcher. Two independent researchers evaluated each article based on relevance to clavicle fracture. RESULTS: The mean number of citations was 179.1, ranging from 576 to 81 citations, and collectively cited 8954 times. The decade from 2000 to 2009 contributed the greatest portion of articles, with only a small portion coming from before 1980. The Journal of Bone and Joint Surgery-American Volume contributed the greatest number of articles (20%). The majority of the articles were therapeutic (n = 37) and focused on treatment and outcome (n = 32). Most of the clinically focused articles had a level of evidence of IV (n = 26). CONCLUSION: There is an increased influence of recent articles focused on clavicle fracture and management, due to the idea that conventional nonoperative treatment has a high rate of nonunion. Many of the most influential studies evaluate the outcomes of various treatments. Many of these studies, however, are lower levels of evidence, leaving a paucity of high level of evidence articles to support these conclusions. LEVEL OF EVIDENCE: V.

The 50 Most Cited Articles in Knee Medial Collateral Ligament Injury Research.

Background: Medial collateral ligament (MCL) injury is a common orthopaedic knee injury with a plethora of published articles regarding evaluation, treatment, and outcome. Purpose: To perform a comprehensive bibliometric analysis of the 50 most cited articles in MCL research. Study Design: Cross-sectional study. Methods: We performed a keyword search of the Institute for Scientific Information's Web of Knowledge database for the identification of articles published before September 2021 encompassing the MCL. The conducted search yielded 9534 articles. The results were then filtered using predetermined guidelines and criteria, and the 50 most cited articles were selected for analysis. Extracted data included title, authors, citation count, year of publication, topic, journal, article type, country of origin, and level of evidence. Results: The selected 50 articles ranged from 1976 to 2013. The largest proportion was classified as having level 4 evidence (n = 12; 24%). The majority of the articles were published in the decade from 2000 to 2009 (n = 17; 34%), followed by 1990 to 1999 (n = 16; 32%). The mean raw citation score per article was 133 (range, 74-422). The most popular topic discussed was surgical technique and outcome (n = 14; 28%), followed by anatomy and biomechanics (n = 13; 26%). Conclusion: This study provides a comprehensive and objective measure of the most cited articles on MCL research. Knowledge of the characteristics of these most influential articles improves the understanding of MCL injury and can guide discussion for future research.

Social media growth of orthopaedic surgery residency programs in response to the COVID-19 pandemic.

BACKGROUND: In the Spring of 2020, residency programs across the country experienced rapid and drastic changes to their application process as a result of the coronavirus disease 2019 (COVID-19) pandemic. In response, residency programs shifted to virtual events and began harnessing social media to communicate with applicants. AIM: To analyze the changes in social media usage by orthopaedic surgery programs in response to the COVID-19 pandemic. METHODS: Based on the 2019 residency and fellowship electronic database, accredited US orthopaedic surgery programs were reviewed for social media presence on Instagram and Twitter. Approximately 47000 tweets from 2011-2021 were extracted through the Twitter application programming interface. We extracted: Total number of followers, accounts following, tweets, likes, date of account creation, hashtags, and mentions. Natural language processing was utilized for tweet sentiment analysis and classified as positive, neutral, or negative. Instagram data was collected and deemed current as of August 11, 2021. The account foundation date analysis was based on the date recognized as the start of the COVID-19 outbreak in the United States, before or after March 1, 2020. RESULTS: A total of 85 (42.3%) orthopaedic surgery residency program Twitter handles were identified. Thirty-five (41.2%) programs joined Twitter in the nine months after the 2020 covid outbreak. In 2020, there was a 126.6% increase in volume of tweets by orthopaedic surgery residency accounts as compared to 2019. The median number of followers was 474.5 (interquartile range 205.0-796.5). The account with the highest number of tweets was Hospital for Special Surgery (@HSpecialSurgery) with 13776 tweets followed by University of Virginia (@UVA_Ortho) with 5063 and Yale (@OrthoAtYale) with 899. Sentiment analysis before 2020 revealed 30.4% positive, 60.8% neutral, and 8.8% negative sentiments across tweets. Interestingly, the positive sentiment percentage increased in 2020 from 30.4% to 34.5%. Of the 201 ACGME-accredited orthopaedic residency programs on Fellowship and Residency Electronic Interactive Database, 115 (57.2%) participate on Instagram, with 101 (87.8%) identified as "resident"-managed vs 14 (12.2%) identified as "department"-managed. Over three quarters (77.4%) of Instagram accounts were created after March 1, 2020. The average number of followers per account was 1089.5 with an average of 58.9 total posts. CONCLUSION: Our study demonstrates a substantial growth of Instagram and Twitter presence by orthopaedic surgery residency programs during the COVID-19 pandemic. These data suggest that orthopaedic residency programs have utilized social media as a new way to communicate with applicants and showcase their programs in light of the challenges presented by the pandemic.

Effects of immunocompromised status on diagnostic criteria in septic arthritis.

Introduction: Septic arthritis is an orthopaedic emergency, with permanent cartilage damage possible within hours of the onset of symptoms. Diagnostic criteria for septic arthritis in immunocompetent patients are well established, however, there is a paucity of literature evaluating diagnostic criteria in immunocompromised patients. The purpose of this retrospective case-control study was to evaluate the laboratory and clinical information of immunocompromised patients with septic arthritis and compare them to immunocompetent patients with septic arthritis to enable physicians to diagnose septic arthritis more accurately in this population. Methods: All patients at our institution, a level I trauma center, with a clinical diagnosis of septic arthritis between January 1, 2006 and November 1, 2021 were identified and reviewed retrospectively. Patients 18 years old or older were screened for immunocompromised status and those meeting criteria were included for review. The control cohort was matched by the joint affected and age. Data were analyzed using the Shapiro-Wilk test, Turkey's test, Mann-Whitney U test, independent sample t-test, and chi-square analysis. A p-value of <0.05 was considered significant. Results: A total of 36 patients with positive joint aspirate cultures were compared (18 immunocompetent and 18 immunocompromised). The immunocompromised group had a significantly longer length of hospital stay than the immunocompetent group (p = 0.044). There was no significant difference in erythrocyte sedimentation rate (ESR) (p = 0.852), peripheral white blood cell count (pWBC) (p = 0.696), joint aspirate white blood cell count (aWBC) (p = 0.901), polymorphonuclear cell percentage (PMN%) (p = 0.325), or total operations performed per patient (p = 0.365). Conclusion: At our institution, immunocompromised patients with septic arthritis did not have significantly different diagnostic laboratory values when compared to immunocompetent patients. This suggests that immunocompromised patients with suspicion of septic arthritis can be assessed with similar diagnostic criteria as immunocompetent individuals; however, a larger cohort study is needed to assess the difference more precisely in laboratory values.

Epidemiology and Outcomes of Ankle Injuries in the National Football League.

Background: Traumatic ankle injuries are commonly complicated by persistent symptoms and the development of chronic ankle instability. Purpose: To describe the epidemiology of ankle injuries in the National Football League (NFL) and investigate the effects that ankle injuries have on performance metrics in the years after injury. Study Design: Descriptive epidemiologic study. Methods: Ankle injuries sustained by NFL players during the 2015-2016, 2016-2017, and 2017-2018 seasons were identified using the Pro Football Reference database. Cumulative incidence was calculated, and demographic identifiers were collected for each injury. The return-to-play (RTP) rate was also recorded. For each player who met inclusion for the performance analysis, power rating (PR) was calculated for the preinjury season (Y-1) and 2 postinjury seasons (Y+1 and Y+2) as follows: PR = (offensive yards/10) + (total touchdowns × 6) + (combined tackles) + (sacks × 2) + (interceptions × 2). Mean PRs were calculated for each season as well as the percentage change and mean difference in PR between Y-1 and Y+1 (ΔPR1%, ΔPR1) and between Y-1 and Y+2 (ΔPR2%, ΔPR2). Subgroup analyses of PR were performed by player position, injury type, and years of experience. Results: Overall, 668 ankle injuries were identified, with an average cumulative incidence across the 3 seasons of 11.2% and RTP rate of 91%. Of those injuries, 159 met inclusion criteria for the PR analysis. The mean overall PR (96.95 in Y-1) declined 22% in Y+1 to 76.10 (-20.85 [95% CI, -13.82 to -27.89]; P < .001) and 27% in Y+2 to 70.93 (-26.02 [95% CI, -18.04 to -34.00]; P < .001). The mean PR per game played (6.70 in Y-1) decreased 14% in Y+1 to 5.75 (-0.95 [95% CI, -0.56 to -1.34]; P < .001) and 17% in Y+2 to 5.54 (-1.16 [95% CI, -0.63 to -1.62]; P < .001). Conclusion: It was found that ankle injuries hampered the performance of NFL players, even multiple years after the injury occurred, despite a relatively high RTP rate. There was a decrease in total games played after ankle injuries as well as a decreased performance output per game played.

Watercraft propellers as a mechanism of orthopaedic injuries: injury patterns, management, and complications.

INTRODUCTION AND PURPOSE: Recreational watercraft use is popular across the United States, and there is a high rate of injury associated with the use and misuse of these vehicles. Watercraft propeller injuries represent a particularly devastating mechanism of injury. We aim to describe and analyze the range of orthopaedic injuries sustained from a watercraft propeller with a particular focus on the mechanism, injury pattern, management, and complications associated with these unique, high-energy injuries. MATERIALS AND METHODS: A retrospective review of 42 patients who sustained injuries from watercraft propeller that presented to a level 1 trauma center was performed. Data collected included patient demographics, mechanism of injury, surgical management, antibiotic use, and complications. RESULTS: Forty-two patients sustained 96 fractures. Ninety-one fractures (94.8%) were open and 5(5.2%) were closed. Twenty (20.8%) were of the upper extremity, 70(72.9%) were of the lower extremity, and 6(6.3%) were of the pelvic ring. The majority of open fractures were Gustilo-Anderson Type IIIA or greater (54, 59.3%). There were 9 total infections affecting 8 of 96 fracture sites (cumulative risk of 8.3%), and other complications included stiffness (3), heterotopic ossification (1), non-union (1), flap failure (1), DVT (2), PE (1), and systemic infection (1) for a total of 19 complications. CONCLUSIONS: Watercraft propellers often result in devastating injuries with high rates of morbidity. The high rate of open fractures and neurovascular injury, necessity for multiple surgeries, and extended length of hospital stay show the need for continued awareness about boat safety and the danger of propellers.

Performance Outcomes After Surgical Repair of Achilles Tendon Rupture in the Women's National Basketball Association.

BACKGROUND: Achilles tendon ruptures are devastating in elite athletes. There are currently no studies examining the effects of Achilles tendon rupture on performance outcomes in the Women's National Basketball Association (WNBA). HYPOTHESIS: Athletes in the WNBA who sustained an Achilles tendon rupture and underwent subsequent surgical repair will sustain declines in performance metrics when compared with their preinjury statistics and matched controls. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Seventeen WNBA players who sustained an Achilles tendon rupture from 2000 to 2019 were identified through publicly available injury reports and player profiles. Athlete information collected included age, body mass index, position, and service in the WNBA when the tear occurred. Statistics were collected for 1 season before and 2 seasons after the injury, and the player efficiency rating (PER) was calculated. Players were matched to uninjured controls by service in the WNBA, position, and performance statistics. RESULTS: On average, players were 28 years of age at the time of Achilles tendon rupture, with a service time in the WNBA of 6.5 years. Four players never returned to play in the WNBA, while 7 players failed to play more than 1 season. Players who did return played significantly fewer minutes per game compared with preinjury in both postinjury seasons 1 and 2 (mean difference, -6.11 and -6.54 min/game, respectively; P < .01 for both) and had a significantly decreased PER in postinjury season 2 (mean difference, -2.53; P = .024). After returning to play, the injured players experienced significant decreases when compared with controls in field goals (-0.85 vs +0.20; P = .047), free throws (-1.04 vs +0.12; P < .01), steals (-0.48 vs +0.24; P = .018), and points scored (-2.89 vs +0.58; P = .014). CONCLUSION: WNBA players experienced significant decreases in performance metrics after Achilles tendon rupture compared with their preinjury levels and compared with uninjured controls. Overall, 23.5% of players failed to return to the WNBA, while 41.2% failed to play for more than 1 season.

The 50 Most Cited Articles in Meniscal Injury Research.

BACKGROUND: Meniscal injuries are among the most common orthopaedic injuries, with a significant volume of published literature. PURPOSE: To perform a comprehensive bibliometric analysis that appropriately evaluates the 50 most cited articles in meniscal research. STUDY DESIGN: Cross-sectional study. METHODS: We performed a keyword search of the ISI Web of Knowledge database and then pared the results down to the 50 most cited articles using specific inclusion and exclusion criteria. Data extracted included title, first author, citation count, year of publication, topic, journal, article type, country of origin, and level of evidence. Correlation coefficients were calculated between publication date and citation density and between publication date and raw citation count. RESULTS: The 50 most cited articles were published from 1975 to 2013. The mean number of citations was 258.24 (range, 163-926; median, 225). The majority of articles were published in The American Journal of Sports Medicine (19%), the Journal of Bone and Joint Surgery (12%), and Arthritis & Rheumatology (14%). Most articles focused on either the anatomy and biomechanics of meniscal injury or on prevention and physical rehabilitation (12 papers each). CONCLUSION: The most popular fields of meniscal research involved anatomy/biomechanics and prevention/rehabilitation, and both are areas that will likely increase the probability of an article's being highly cited in the future. This study provided a quality selection of the most cited articles on meniscal injury and may provide a foundation for both beginner and senior clinician readers for further discussion and research.

High-Viscosity Versus a Lower-Viscosity Cement Penetration at Dough Phase In Vivo in Primary Total Knee Arthroplasty.

BACKGROUND: Previous studies have shown that the depth of cement penetration and the presence of radiolucent lines (RLLs) correspond with the risk of aseptic loosening in total knee arthroplasty, while others have found a correlation between the viscosity of the cement and the depth of cement penetration. We compared cement marketed as high-viscosity cement (HVC) with one marketed by the same manufacturer as low-viscosity cement (LVC). We hypothesized that no significant difference would be found in depth of penetration or presence of RLLs between the two cohorts. METHODS: The HVC (n = 50) and LVC cohorts (n = 50) were gathered from two sequential series of primary total knee arthroplasties using the same implants and cementing techniques. Depth of cement penetration and presence of RLL were measured in four tibial zones and were compared between cohorts. RESULTS: There were no cases of aseptic loosening in either cohort at a mean of 29 months. Mean maximum cement penetration in 3 of the 4 zones was >3 mm with both cements. There was no significant difference in maximum penetration in any zone between the two cements. There were fewer tibial radiolucencies with HVC than LVC. CONCLUSION: These findings suggest that the marketing description of HVC or LVC is not necessarily a factor in cement penetration. The term high viscosity should not be used as a descriptor of cement that reaches dough phase more quickly, but rather cement that has a higher viscosity at its dough phase when it is typically applied.