Publication Trends of Residents Accepted for Shoulder and Elbow Fellowships.

This study aims to evaluate the research productivity trends in orthopaedic residents who were selected for shoulder and elbow fellowships from 2010 to 2019. We hypothesize that residents matching into orthopaedic shoulder and elbow fellowships are increasing both their publication number and publication quality from 2010 to 2019. Fellows of orthopaedic shoulder and elbow programs from 2010 to 2019 were identified through publicly accessible information on fellowship programs. Each fellow's publication data during their residency was collected via publicly available search engines, and analyzed to include: fellowship year, residency years, fellowship program and location, total publications, number of publications in high-impact general orthopaedic and shoulder and elbow journals, and authorship position. A total of 176 orthopaedic shoulder and elbow fellows from 17 different programs were identified and included in the study. The fellows produced a total of 668 publications, published 172 articles in high impact journals, and had first authorship on 49% of the studies. On average, there were 3.8 publications per fellow per year from 2010 to 2019. There were 5.7 publications produced per fellow in 2018-2019, compared to just 2.92 publications per fellow in 2010-2011. Overall, there was an increasing trend in publications, publications in high impact journals, and first authorship publications per applicant matching into shoulder and elbow fellowship from 2010 to 2019. (Journal of Surgical Orthopaedic Advances 31(4):205-208, 2022).

Implementation of a Multidisciplinary "Code Hip" Protocol is Associated with Decreased Time to Surgery and Improved Patient Outcomes.

BACKGROUND: The purpose of this study is to report outcomes data based on the implementation of a "Code Hip" protocol, a multidisciplinary approach to the care of fragility hip fracture patients focussing on medical optimization and early operative intervention. We hypothesized that implementation of this protocol would decrease time from presentation to surgical intervention and improve outcomes based on short term post-operative data. METHODS: A retrospective chart review was performed on all patients aged greater than 65 years old with a fragility hip fracture from October 2015 through June 2018. In addition to demographic and patient factors, we recorded time to surgery, type of surgical interventions performed, ability to ambulate in the post-operative period, 90-day post-operative complications and overall hospital cost. RESULTS: There were 114 patients in the pre-Code Hip cohort and 132 patients in the post-Code Hip cohort. Demographic factors were not different between the 2 cohorts. Time from presentation to surgery in the post-Code Hip cohort was shorter at 23.1 ± 16.4 hours versus 33.2 ± 27.2 hours (p < 0.001). 30.3% of patients in the post-Code Hip cohort had at least one post-operative complication compared to 42.1% in the pre-Code Hip cohort (RR = 0.72, CI = 0.51 -1.01, p = 0.05). The post-Code Hip cohort had a significantly lower rate of hospital readmission (p = 0.04), unplanned reoperation (p = 0.02), surgical site infection (p = 0.03), and sepsis (p = 0.05). Total hospital cost per patient decreased from an average of $14,079 +/- $10,305 pre-Code Hip cohort to $11,744 +/- $4,174 per patient in the post-Code Hip cohort (p = 0.02). CONCLUSIONS: Implementation of our Code Hip protocol, which invokes a multidisciplinary approach to the elderly patient with a fragility hip fracture, is associated with shorter times from presentation to surgery, increased ability to ambulate post-operatively, decreased short term post-operative complication, and decreased hospital costs. LEVEL OF EVIDENCE: Therapeutic Level III.

Utility of 3-Dimensional Intraoperative Imaging in Pelvic and Acetabular Fractures: A Network Meta-Analysis.

BACKGROUND: Successful surgical management of pelvic ring and acetabular fractures requires technical expertise to achieve an accurate reduction and stable fixation. The use of 3-dimensional (3D) intraoperative imaging (3DIOI) as an assessment tool has led to improved reduction and placement of implants. The purpose of this study was to assess the utility of using 3DIOI in the management of acetabular and pelvic fractures on the basis of outcomes reported in the literature. METHODS: A literature search was performed using PubMed, the Cochrane Database of Systematic Reviews (CDSR), and Google Scholar using key terms. A network meta-analysis conducted using the frequentist approach allowed for statistical analysis of reported outcomes regarding screw position (in mm), fracture reduction (in mm), and complications. RESULTS: A total of 9 studies were included in this analysis. When compared with conventional radiography, the mean radiation dose (in cGy·cm2) was significantly higher in 3DIOI (mean difference, 82.72; 95% confidence interval [CI], 21.83 to 143.61; p = 0.007). Use of 3DIOI yielded a 93% lower risk of developing medical complications (odds ratio [OR], 0.07; 95% CI, 0.02 to 0.35; p = 0.014). Use of 3DIOI yielded higher odds of achieving accurate screw placement (OR, 4.21; 95% CI, 1.44 to 12.32; p = 0.008) and perfect reduction (OR, 2.60; 95% CI, 1.19 to 5.68; p = 0.016). In ranking the imaging modalities, 12 of the 13 parameters analyzed were in favor of 3DIOI over conventional fluoroscopy and 2D navigation imaging. CONCLUSIONS: Current literature supports the use of 3DIOI because of the decreased rates of misplaced implants, malreduced fractures, complications, and subsequent revision operations. The use of 3DIOI allows for improved visualization of pelvic anatomy when repairing pelvic and acetabular fractures, and helps surgeons to achieve favorable surgical outcomes. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Assessment of caregiver willingness to vaccinate their children against COVID-19 in Saudi Arabia: a cross-sectional study.

BACKGROUND: Vaccination against COVID-19 is the key to controlling the pandemic. Parents are the decision makers in the case of children vaccination as they are responsible for them. This study aims to investigate the acceptability of COVID-19 vaccination for children among parents in Saudi Arabia. METHODS: This cross-sectional study used an online self-administered questionnaire. A 35-items questionnaire was distributed via social media platforms between June 6 and July 9-2021. Descriptive statistics were used to describe the participants' characteristics. Categorical variables were reported as frequencies and percentages. Predictors of vaccination acceptance were identified using binary logistic regression. RESULTS: A total of 581 parents were involved in this study. A majority of parents 63.9% reported that they will vaccinate their children if the vaccine becomes available. Around 40% of them confirmed that they want their child to be among the first to receive the COVID-19 vaccine. Nearly a quarter, 23.9%, reported that they will vaccinate their child against influenza this year. The most commonly reported reason for hesitancy was poor awareness about the vaccine's effectiveness on children. Adequate information about the COVID-19 vaccine was the most agreed cause to accept the vaccine. Having five or more children was a significant predictor for poor vaccination acceptance (OR: 0.42 (95%CI: 0.21-0.86), p < .05). CONCLUSION: An appropriate proportion of parents are willing to vaccinate their children if the vaccine becomes available for children in Saudi Arabia. Public health awareness must be raised to gain public trust in the vaccination and the healthcare system.

Missed positional gluteal compartment syndrome in an obese patient after foot surgery: a case report.

BACKGROUND: Gluteal compartment syndrome is an uncommon condition and can be difficult to diagnose. It has been diagnosed after trauma, vascular injury, infection, surgical positioning, and prolonged immobilization from drug or alcohol intoxication. The diagnosis is based on clinical findings and, in most cases, recognizing these symptoms and making a diagnosis early is critical to a complete recovery. CASE PRESENTATION: A 53-year-old male who underwent left foot surgery had severe pain to his contralateral hip and posterior gluteal compartment radiating to the right lower extremity immediately postoperative. He was positioned supine with a "bump" placed under his right hip to externally rotate his operative leg during the surgery. Due to the patient's complex past medical history, a presumptive diagnosis of a herniated disc and/or compression of the sciatic nerve was made as a cause for the patient's pain. This resulted in a misdiagnosis period of 36 h until the patient was diagnosed with unilateral gluteal compartment syndrome. Performing a fasciotomy was decided against due to the increased risk of complications. The patient was treated with administration of IV fluids and closely monitored. On post-op day 6, the patient was discharged. At three months post-op, the patient was walking without a limp and he had no changes in his peripheral neurologic examination compared to his preoperative baseline. CONCLUSION: Gluteal compartment syndrome is a surgical emergency that must be considered postoperatively especially in obese patients with prolonged operation times who experience acute buttock pain. The use of positional bars or "bumps" in the gluteal area should be used with caution and raise awareness of this complication after orthopedic surgeries.