Individuals Reporting Past 3-month Smoked Stimulant Use Are Placed at Risk for Infection and Injury Amid COVID-19.

OBJECTIVES: Smoking stimulants, such as methamphetamine and "crack" cocaine, can spread infections, including hepatitis C and COVID-19, and lead to injuries, particularly when individuals share or use makeshift pipes. The purpose of the study was to assess the practices of people who inhale ("smoke") stimulants to guide future clinical harm reduction efforts. METHODS: Anonymous surveys were administered to participants reporting inhalation of crack cocaine and/or methamphetamine in the past 3 months. Participants were eligible if they sought services from an outreach team staffed by a municipal syringe service program (SSP) or if they were patients at a low-threshold substance use disorder treatment program, the Massachusetts General Hospital Bridge Clinic. RESULTS: The survey was administered to 68 total participants, 30% of whom were recruited in the Massachusetts General Hospital Bridge Clinic and 70% through SSP outreach. Unsafe smoking practices were reported by 93% of participants. Among the 46% of participants surveyed who both smoked and injected stimulants, 61% of those participants stated that they injected instead of smoked stimulants because of lack of access to pipes. Amid COVID-19, 35% of participants adopted safer smoking practices. Most participants reported that they would be more likely to attend an SSP or health center if pipes were provided. CONCLUSIONS: Inhalational practices that place participants at risk of injury and illness are common. Providing safer smoking equipment may promote health and engage individuals in care.

YouTube Is a Poor-Quality Source for Patient Information on Rehabilitation and Return to Sports After Hip Arthroscopy.

PURPOSE: To investigate the information quality on YouTube regarding rehabilitation and return to sport (RTS) after hip arthroscopy. METHODS: By use of private browsing and predefined search terms, 217 unique videos regarding RTS and rehabilitation after hip arthroscopy were included and systematically reviewed. A total of 164 videos were included in the final analysis. Videos were scored using 4 scoring systems: (1) Journal of the American Medical Association benchmark criteria, (2) the Global Quality Score, (3) a score for RTS after hip arthroscopy, and (4) a score for rehabilitation after hip arthroscopy. RESULTS: A large majority of the included videos provided substandard information quality, dependability, and precision. RTS videos that were uploaded by physicians had a significantly higher Journal of the American Medical Association score, Global Quality Score, and RTS score compared with commercial and personal testimony videos (P = .0003, P = .0021, and P = .0005, respectively). Physician videos pertaining to RTS were also significantly longer than videos in other categories (P = .0397). CONCLUSIONS: The quality and reliability of video content on YouTube pertaining to rehabilitation and RTS after hip arthroscopy are generally poor. The educational content of YouTube videos produced by physicians is of significantly higher quality as compared with non-physicians, patient testimonials, and commercials. CLINICAL RELEVANCE: The quality of the information patients receive on rehabilitation and RTS after hip arthroscopy is important for successful outcomes.

Social Media Use Continues to Increase Among Orthopaedic Residency Programs in the United States.

PURPOSE: To evaluate the social media usage of orthopaedic residency programs, program directors (PDs), and department chairs across Instagram, Facebook, and Twitter and to determine which types of social media posts are indicative of increased user following. METHODS: A systematic online search strategy was performed in October 2020 to identify all allopathic orthopaedic surgery residency program accounts on Instagram, Facebook, and Twitter. Instagram posts were further analyzed to evaluate the type of post that significantly correlated with increased follower counts. RESULTS: Of 158 orthopaedic surgery programs, 69 (43.7%) had Instagram accounts, 52 (32.9%) had Facebook accounts, and 54 (34.2%) had Twitter accounts. Program presence on Instagram and Twitter continued to grow exponentially (R 2 = 0.99 and R 2 = 0.95, respectively). Regarding program leadership, a total of 151 PDs and 156 chairs were identified. Of these, 21 PDs (14%) and 8 chairs (5.1%) had Instagram accounts. The number of posts and the numbers of educational, social, program information, and operative posts (P < .01) significantly correlated with increased followers on Instagram. CONCLUSIONS: Fewer than one-half of orthopaedic surgery residency programs and fewer than one-quarter of PDs and department chairs have a social media presence. However, the number of residency programs on social media continues to rise year-over-year. The total number of posts; the amount of educational, social, and program information; and the number of operative posts significantly correlated with increased followers on Instagram. CLINICAL RELEVANCE: With the growing prevalence of social media, orthopaedic surgery residency programs have the opportunity to connect with future applicants and disseminate informational content regarding their programs.

Tumor-induced rickets: usefulness of MR gradient echo recall imaging for tumor localization.

An 11-year-old boy presented with a femur fracture, bone hypomineralization, and hypophosphatemia, suggesting tumor-induced rickets. Conventional radiologic techniques including magnetic resonance skeletal survey did not identify a tumor. Magnetic resonance gradient echo recall imaging demonstrated a 3-cm iliac tumor, the resection of which rapidly reversed metabolic abnormalities. This technique may be useful in identifying elusive tumors associated with tumor-induced rickets.