Ankle fracture surgery performed by orthopaedic residents without supervision has comparable outcomes to surgery performed by fellowship trained orthopaedic surgeons.

BACKGROUND: Unstable fractures often necessitate open reduction and internal fixation (ORIF), which generally yield favourable outcomes. However, the impact of surgical trainee autonomy on healthcare quality in these procedures remains uncertain. We hypothesized that surgery performed solely by residents, without supervision or participation of an attending surgeon, can provide similar outcomes to surgery performed by trauma or foot and ankle fellowship-trained orthopaedic surgeons. METHODS: A single-center cohort of an academic level-1 trauma center was retrospectively reviewed for all ankle ORIF between 2015 and 2019. Data were compared between surgery performed solely by post-graduate-year 4 to 6 residents, and surgery performed by trauma or foot and ankle fellowship-trained surgeons. Demographics, surgical parameters, preoperative and postoperative radiographs, and primary (mortality, complications, and revision surgery) and secondary outcome variables were collected and analyzed. Univariate analysis was performed to evaluate outcomes. RESULTS: A total of 460 ankle fractures were included in the study. Nonoperative cases and cases operated by senior orthopaedic surgeons who are not trauma or foot and ankle fellowship-trained orthopaedic surgeons were excluded. The average follow-up time was 58.4 months (SD ± 12.5). Univariate analysis of outcomes demonstrated no significant difference between residents and attendings in complications and reoperations rate (p = 0.690, p = 0.388). Sub-analysis by fracture pattern (Lauge-Hansen classification) and the number of malleoli involved and fixated demonstrated similar outcomes. surgery time was significantly longer in the resident group (p < 0.001). CONCLUSION: The current study demonstrates that ankle fracture surgery can be performed by trained orthopaedic surgery residents, with similar results and complication rates as surgery performed by fellowship-trained attendings. These findings provide valuable insights into surgical autonomy in residency and its role in modern clinical training and surgical education. LEVEL OF EVIDENCE: Level III - retrospective cohort study.

Anthropogenic or non-anthropogenic particulate matter: Which one is more dangerous and how to differentiate between the effects?

The authors have observed that the function linking health outcomes with exposure to particulate-matter (PM) follows a biphasic pattern. It peaks around levels of PM10≤100 µg/m3, then weakens and rises again at PM10 levels in the range of hundreds. This could be due to a different nature of PM, the first peak reflecting a stronger anthropogenic and the second - weaker non-anthropogenic particles' effect. The current analysis is focused at the biphasic pattern on the association between PM levels with BG and asthma exacerbations. Pollutants were assessed by local monitoring stations and a satellitebased model. Local weekends/holidays were used to define nonanthropogenic levels of pollutants featured by lower Nitrogen Dioxide, the proxy for anthropogeneity. The association of PM10 with health outcomes within 24-48h lag was explored using spline functions of generalized additive models. Analysis of 546,420 BG tests (43,569 subjects) showed an almost linear association of PM10 with asthma with BG during the days with anthropogenic activity and no trend on other days. Analysis of asthmatic exacerbations within 1576 children showed no heterogeneity in association with PM10 by anthropogeneity levels, possibly indicating a mechanical impact on alveolar as the main trigger for exacerbations rather than PM10 chemical composition.