Socratic Artificial Intelligence Learning (SAIL): The Role of a Virtual Voice Assistant in Learning Orthopedic Knowledge.

OBJECTIVE: We hypothesized that learning through multiple sensory modalities would improve knowledge recall and recognition in orthopedic surgery residents and medical students. DESIGN: We developed a virtual study assistant, named Socratic Artificial Intelligence Learning (SAIL), based on a custom-built natural language processing algorithm. SAIL draws from practice questions approved by the American Board of Orthopaedic Surgery and quizzes users through a conversational, voice-enabled Web interface. We performed a randomized controlled study using a within-subjects, repeated measures design. SETTING: Participants first took a pretest to assess their baseline knowledge. They then underwent 10 days of spaced repetition training with practice questions using 3 modalities: oral response, typed response, and multiple-choice. Recall and recognition of the practiced knowledge were assessed via a post-test administered on the first day, first week, and 2 months after the training period. PARTICIPANTS: Twenty-four volunteers, who were medical students and orthopedic surgery residents at multiple US medical institutions. RESULTS: The oral, typed, and multiple-choice modalities produced similar recall and recognition rates. Although participants preferred using the traditional multiple-choice modality to study for standardized examinations, many were interested in supplementing their study routine with SAIL and believe that SAIL may improve their performance on written and oral examinations. CONCLUSIONS: SAIL is not inferior to the multiple-choice modality for learning orthopedic core knowledge. These results indicate that SAIL can be used to supplement traditional study methods. COMPETENCIES: medical knowledge; practice-based learning and improvement.

International medical graduates (IMGs) matching into US orthopaedic surgery residency: a fifteen year analysis of trends in applications and geographical distribution.

PURPOSE: International Medical Graduates (IMGs) face challenges in securing orthopaedic surgery residencies in the U.S. This study examines residency matching trends and geographic distribution for U.S. and non-U.S. citizen IMGs. METHODS: The National Resident Matching Program (NRMP) data from 2008 to 2022 were analyzed for USMLE scores, publication counts, and match rates, using linear regression. The proportion of non-US IMGs in orthopaedic surgery residency was compared with the foreign-born population of each region based on the 2021 American Community Survey. RESULTS: The overall IMG fill rate decreased significantly from 2.04% in 2008 to 1.26% in 2022 (P = 0.002). The number of publications for matched US IMGs was at least three times that of matched MD seniors and about two times that of unmatched US IMGs. Matched non-US IMGs had approximately five and three times the number of publications as matched MD seniors and unmatched non-US IMGs, respectively. Mississippi had the highest IMG-to-all-filled-position ratio (6.7%) and New York matched the most IMGs (36 residents). Although the foreign-born population comprises approximately 13.72% of the US population, non-US IMGs accounted for less than 1% of total matched residents. When compared to the foreign-born population, non-US IMGs were underrepresented in the US. This underrepresentation was observed in all nine geographic divisions, particularly in the West South Central and Pacific regions. CONCLUSIONS: While IMGs constitute a low percentage of matched MDs in orthopaedic surgery, they show three to five times more publications than MD seniors. IMGs should recognize the importance of higher publication numbers in the matching process as well as states with higher IMG matching rates.

Endoscopic Versus Open Treatment of Carpal Tunnel Syndrome: Postoperative Complications in Patients With Diabetes Mellitus.

Purpose: Patients with type 2 diabetes mellitus (T2DM) often face higher postoperative complication rates. Limited data exist regarding outcomes in T2DM patients undergoing carpal tunnel release (CTR). This study compares complication rates between endoscopic CTR (ECTR) and open CTR (OCTR) in patients with T2DM. Methods: The TriNetX database was used to perform a retrospective cohort study of 67,225 patients with T2DM who underwent ECTR (n = 17,792) or OCTR (n = 49,433). Demographic data, medical comorbidities, and complication rates were analyzed. A 1:1 propensity score match was performed to calculate risk ratios and 95% confidence intervals of postoperative median nerve injury, 6-week wound dehiscence, and 6-week wound infection. Results: After matching, a significantly greater number of ECTR patients had liver disease (P = <.001) and a body mass index > 40 (P = .001) compared to the OCTR group. These patients also had a lower incidence of fluid and electrolyte disorders (P = .003). Patients with T2DM who underwent ECTR had a significantly lower relative risk of 6-week wound infection, 6-week wound dehiscence, and median nerve injury (all P < .001) compared to patients who underwent OCTR. Conclusions: In our analysis of T2DM patients undergoing CTR, ECTR yielded significantly lower rates of wound infection, wound dehiscence, and nerve injury within 6-weeks post-surgery, reducing the risk by 43%, 52%, and 58%, respectively. These findings suggest that ECTR may result in a lower complication rate in this patient population. Type of study/level of evidence: III.

Accessibility and Characterization of Parental Leave Policies for Orthopaedic Surgery Residency Training in the United States.

INTRODUCTION: This study assesses the accessibility and nature of parental leave policies during orthopaedic surgery residency training after implementation of the Accreditation Council for Graduate Medical Education (GME) mandate for 6 weeks of paid parental leave effective July of 2022. MATERIALS AND METHODS: An audit of orthopaedic surgery residency and affiliated GME websites was conducted to assess the accessibility of parental leave policies during the 2023-2024 academic year. Details on length of leave and nature of renumeration during the leave were recorded. Bivariate analyses were conducted to determine residency program characteristics associated with the accessibility of a parental leave policy. Results were compared with a previous analysis during the 2017-2018 academic year. RESULTS: A total of 200 residency programs were evaluated, and 152 had parental leave policies (76.0%). Compared with 2017 to 2018, a similar percentage of parental leave policies were accessible on residency program websites (3.0% vs. 2.0%, P = 0.777) but fewer were accessible on GME websites (55.5% vs. 80.7%, P < 0.001). More contemporary policies were obtained from program coordinators (18.5% vs. 7.2%, P = 0.003), and more were not available (24.0% vs. 9.0%, P < 0.001). Most policies offered renumeration (86.7%) and leave for 6 weeks in length (75.0%). A higher prevalence of parental leave policy accessibility was found among orthopaedic residency programs with university affiliation (P < 0.001), more faculty members (P = 0.008) and residents (P = 0.017), a higher percentage of female faculty (P = 0.008), affiliation with a top 50 ranked National Institutes of Health-funded orthopaedic surgery department, and accreditation achieved before 2017 to 2018 (P = 0.004). DISCUSSION: Most orthopaedic surgery residency programs do not have accessible parental leave policies on their websites. The new Accreditation Council for GME mandate will require orthopaedic residency programs to provide residents with 6 weeks of paid parental leave during residency training. Accessible policies may be useful to applicants interested in child rearing during orthopaedic residency training.

The Impact of Surgical Training on Residents' Relationships and Life Choices.

OBJECTIVE: Our study investigated the effects of surgical training on residents' personal relationships. It aimed to address the gaps in understanding of how the surgical training commitment can influence relationship stability, decision-making, and life planning within this unique professional group. DESIGN: We used cross-sectional survey methodology to gather data on the intricacies of relationship dynamics amid the rigors of surgical training. The survey focused on marital status, relationship dynamics, personal life choices, the challenges and rewards of dual-healthcare relationships, and the support networks that individuals and couples rely on. SETTING: All surgical departments at The Johns Hopkins Hospital. PARTICIPANTS: The study comprised 111 participants, including residents, fellows, and attending surgeons. Of those reporting sex, 56/105 (53%) were female, and the predominant age category was 25 to 34 years, making up 61/104 (59%) of respondents. RESULTS: The majority (73/105, 70%) of respondents were or had been married, and 50/96 (52%) had partners in the medical field. Among those in a dual-healthcare relationship, 38/46 (83%) reported that their relationship was strengthened through understanding and empathy, yet 37/46 (80%) acknowledged complications in work-life balance. However, women were significantly more likely than men to report at least one negative effect of a dual-healthcare relationship (84% [16/19] versus 22% [6/27], p = .003). Among those with partners outside medicine, 39/46 (85%) acknowledged that their partner had to adjust their lifestyle significantly. A considerable number (73/92, 79%) postponed life events such as starting a family, and 57/85 (67%) experienced relationship strain due to long working hours. CONCLUSIONS: Residents in dual-healthcare couples derived support from their relationships, but surgical training placed a significant strain on residents' personal relationships and often prompted residents to postpone major life events such as starting a family. Enhanced support systems and targeted interventions are needed to assist surgical professionals in navigating the complexities of balancing a demanding career with personal life.

Sex Diversity and Equity Among Fellows of the American Orthopaedic Association.

BACKGROUND: We hypothesized that women are underrepresented among fellows of the American Orthopaedic Association (AOA) relative to their prevalence among faculty at departments of orthopaedic surgery. METHODS: Clinical faculty at departments of orthopaedic surgery that are affiliated with residency training programs were analyzed for AOA membership. Participation-to-prevalence ratios (PPRs) were calculated for men and women with AOA membership relative to their prevalence among orthopaedic surgeon faculty. A PPR of <0.8 or >1.2 indicated under- or overrepresentation, respectively. PPR values between 0.8 and 1.2 indicated equivalent representation. Sex disparities in AOA membership were explored by academic rank and orthopaedic subspecialty. RESULTS: There were 4,310 orthopaedic surgery faculty, and 998 (23.2%) had AOA membership. Overall, women formed the minority of members in the AOA study cohort (11.4%), but they had equivalent representation relative to their prevalence among faculty (10.0%, PPR = 1.14, p = 0.210). In the AOA study cohort, women were the minority at each academic rank, including assistant professor (20.2% versus 79.8%, p < 0.001), associate professor (16.8% versus 83.2%, p < 0.001), and full professor (7.0% versus 93.0%, p < 0.001). However, women had greater representation in the AOA study cohort at each academic rank than would be expected based on their prevalence among faculty, including the assistant (PPR = 1.45), associate (PPR = 1.56), and full (PPR = 1.27) professor levels. Similarly, in the AOA study cohort, women were the minority in each orthopaedic subspecialty, but were only underrepresented in pediatric orthopaedics (PPR = 0.74). Women had greater representation in the AOA study cohort than would be expected by their prevalence among faculty in hand surgery (PPR = 1.51) and orthopaedic sports medicine (PPR = 1.33). In contrast, men had equivalent representation in each orthopaedic subspecialty. CONCLUSIONS: Women form a minority group in the AOA, but they exhibit greater representation in the AOA than would be expected based on their prevalence among faculty at each academic rank, and they have greater representation than men, who exhibit equivalent representation across all academic ranks. Collectively, these results disproved our hypothesis, and suggest that women are participating in the AOA at rates that are greater than their prevalence among faculty. CLINICAL RELEVANCE: Equitable participation of women in orthopaedic surgery is necessary to promote diversity and inclusion in the specialty. The AOA may be an important catalyst for future positive diversity and inclusion efforts within orthopaedic surgery.

Identification of Factors Associated with Orthopaedic Surgery Residency Programs That Preferentially Match Students Who Performed an Elective Rotation Before the Interview Process.

Introduction: The role of elective rotations in the orthopaedic residency selection process varies between programs. Our study aims to identify factors associated with residency programs that interview and match a greater proportion of applicants who have completed an elective rotation with their program. Methods: Data were collected through the American Orthopaedic Association's Orthopaedic Residency Information Network database. Bivariate correlations and multivariate regression models were used to identify independent predictors of programs with a greater proportion of interviewees or residents who completed an elective rotation at the respective program. Results: One hundred seventy-eight of the 218 existing residency programs were included in this study. Programs that offered fewer interviews and more away rotation positions per year were associated with a greater odds of its interviewees (OR = 0.36, p = 0.01; OR = 4.55, p < 0.001, respectively) and residents (OR = 0.44, p = 0.04; OR = 4.23, p < 0.001, respectively) having completed an elective rotation with the program. In addition, programs with fewer attendings (OR = 0.39, p = 0.03) and in-person interviews (OR = 3.04, p = 0.04) matched a greater proportion of their rotators. However, programs that interviewed applicants during the elective rotation were less likely to match their rotators (OR = 0.35, p = 0.04). Conclusion: Certain program characteristics independently predict the likelihood of a program interviewing and matching their rotators. These findings may provide information for applicants and programs regarding the rotation process. Level of Evidence: III.

Sex Disparities Among Fellowship Program Directors in Orthopaedic Surgery.

BACKGROUND: Women are underrepresented in the orthopaedic surgery workforce in the U.S. The purpose of this study was to elucidate the representation of women among fellowship program directors (PDs) in orthopaedic surgery. METHODS: This was a retrospective cohort study of fellowship PDs in orthopaedic surgery during the 2022 to 2023 academic year. Academic, training, and demographic characteristics were collected from internet-based resources. Participation-to-prevalence ratios (PPRs) were calculated for both men and women. A PPR of <0.8 indicated underrepresentation and a PPR of >1.2 indicated overrepresentation. Bivariate analyses were utilized to assess the correlation between sex diversity and geographic region and between sex diversity and Accreditation Council for Graduate Medical Education (ACGME)-accreditation status. The relationship between the median annual salary and the sex diversity of each orthopaedic subspecialty was analyzed with use of the Pearson correlation coefficient. RESULTS: This study included 600 fellowship PDs, 40 (6.7%) of whom were women. In total, 24.5% of the fellowship PDs were assistant professors (8.8% women versus 91.2% men, p < 0.001); 26.2% were associate professors (9.6% women versus 90.4% men, p < 0.001); 36.8% were full professors (4.5% women versus 95.5% men, p < 0.001); and 12.5% were unranked (2.7% women versus 97.3% men, p < 0.001). The representation of women increased with academic rank, as reflected in their prevalence at the assistant (PPR = 0.67), associate (PPR = 0.77), and full professor (PPR = 0.80) levels. Among the orthopaedic subspecialties, musculoskeletal oncology (19.0%), pediatric orthopaedics (14.6%), and hand surgery (12.6%) had the highest proportions of women fellowship PDs. PPRs were lowest for orthopaedic sports medicine (PPR = 0.35), shoulder and elbow (PPR = 0.45), and adult reconstruction (PPR = 0.52). Women PDs had equitable representation in musculoskeletal oncology (PPR = 1.17), hand surgery (PPR = 1.02), foot and ankle (PPR = 0.84), and orthopaedic trauma (PPR = 0.80). Median subspecialty compensation was negatively correlated with the prevalence of women among fellowship PDs (r = -0.70, p = 0.036). Geographic region was not associated with sex diversity (p = 0.434), but programs with ACGME accreditation had significantly more women fellowship PDs than those without (11.0% versus 3.9%, p < 0.001). CONCLUSIONS: Women are underrepresented among orthopaedic fellowship PDs, especially in certain subspecialties (orthopaedic sports medicine, shoulder and elbow, and adult reconstruction). More research is needed to understand the barriers that impact the representation of women among leadership positions in orthopaedic surgery. CLINICAL RELEVANCE: Greater sex diversity among fellowship PDs may help to increase the recruitment of women into orthopaedic subspecialties. The equitable consideration of orthopaedic surgeons from all backgrounds for leadership positions can increase workforce diversity, which may improve the vitality of the orthopaedic community.

Preference Signaling Survey of Program Directors-After the Match.

INTRODUCTION: The 2022 to 2023 orthopaedic residency cycle implemented a preference signaling program (PSP), allowing applicants to send "signals" to up to 30 programs to demonstrate their genuine interest. With the conclusion of the 2022 to 2023 cycle, the primary purpose of this study was to analyze program director (PD) perceptions of the PSP after the match cycle and provide a retrospective evaluation of the effects of the PSP on the orthopaedic resident selection process. METHODS: A 21-question survey was distributed to 98 PDs (32.7% response rate). Contact information was obtained from a national database. RESULTS: Most respondents (96.9%) participated in the American Orthopaedic Association's PSP. The majority (93.7%) view preference signaling as a positive change. Most PDs (56.2%) reported a decreased number in applications received compared with previous years. Receiving a preference signal was ranked among the most important factors in resident selection, and most PDs agreed that preference signaling should be used to screen applicants (84.4%) and differentiate similar applicants (96.8%). Moreover, 65.6% of PDs indicated that they would not rank or invite applicants to interview without a signal or completion of a formal away rotation. PDs report that in the 2022 to 2023 cycle, 98.5% of applicants who matched at their program had sent a preference signal. DISCUSSION: Preference signaling was one of the most important factors assessed during its inaugural application cycle and is anticipated to remain a key tool for screening and differentiating candidates. Applicants should strategically select signal recipients to enhance their success in the match.

Using a Modern Linked Research Database to Examine Gender Disparities in Orthopaedic Grant Funding from 2010 to 2022.

BACKGROUND: Gender disparities in research grant funding persist in many disciplines. With use of the Dimensions database, we sought to examine the extent of gender disparities in U.S. orthopaedic grant funding from 2010 onward. Our aim was to provide insights into the extent of gender disparities in the field of orthopaedic research and to highlight the potential need for future action to address these disparities. METHODS: Using orthopaedic-related search terms, we queried all U.S. grants awarded for orthopaedic research from 2010 to 2022. A total of 22,326 results were then manually screened to exclude those without a direct focus on orthopaedic research. The amounts received per principal investigator were reported in U.S. dollars and adjusted for inflation. Author gender was predicted with use of the Genderize.io algorithm application programming interface. The iCite Relative Citation Ratio (RCR) was utilized to assess the impact of the publications linked to each grant. RESULTS: A total of 1,723 grants were included. Men principal investigators received significantly higher median funding per grant in 2011, 2012, and 2013; however, this trend reversed with women receiving nonsignificantly higher funding in 2015, 2017, 2018, 2021, and 2022. In 2020, women received significantly higher median funding per grant than men ($166,234 versus $121,384; p = 0.04). Throughout the 13-year period, men principal investigators accounted for approximately 71% of grants, with a very weak increasing trend in the percent of grants attributed to women (R 2 = 0.16; p < 0.001). Grants with men principal investigators resulted in more publications than those with women principal investigators (mean publications, 11.1 versus 6.6; p = 0.001). Publications resulting from grants awarded to men had a significantly higher mean RCR than those resulting from grants awarded to women (2.42 versus 2.09; p = 0.04). CONCLUSIONS: There was no significant difference in the median amounts of funding per grant awarded to men and to women in 7 of the past 8 years, despite significantly greater funding per grant having been awarded to men from 2011 to 2013. Men principal investigators accounted for the majority of grants received during the study period, although this proportion was lower than the proportion of men among orthopaedic surgeons in 2022. This study could inform initiatives aimed at promoting equity in grant funding for orthopaedic research.

Increasing Burden of Upper-Extremity Fractures in the Middle East and North Africa (MENA): A 30-Year Analysis of the Epidemiology and Causes of Injuries.

BACKGROUND: Upper-extremity fractures (UEFs) account for a large proportion of bone fractures and are costly to both health and the economy. The fracture burden in the Middle East and North Africa (MENA) is influenced by the region's diverse cultural, economic, and political status. This study examined UEF epidemiology and causes across the MENA region and within the 21 MENA countries as categorized by the Global Burden of Disease (GBD) data set. METHODS: On the basis of GBD data, this study evaluated the epidemiology of UEFs from 1990 to 2019. The causes of injuries, incidence, number of years of healthy life lost due to disability (YLD), and their association with the Socio-demographic Index (SDI) were obtained and calculated for males and females in all age groups. RESULTS: From 1990 to 2019, the age-standardized incidence rate (ASIR) of UEFs in the MENA region increased by 2.33%, to 1,086.39 per 100,000 people, and the YLD rate increased 15.69%, to 9.17 per 100,000, opposing the global decreasing trends. Fractures of the radius and/or ulna had the highest ASIR (505.32 per 100,000) of all UEF types in 2019. The clavicle, scapula, and humerus had the highest increasing trend among the fracture sites. In 2019, Saudi Arabia had the highest ASIR of UEFs (2,296.93 per 100,000). Afghanistan had the highest age-standardized YLD rate due to UEFs (19.6 per 100,000) in 2019, with Syria (153.32%) and Iran (37.04%) experiencing the greatest increase and decrease, respectively, from 1990 to 2019. Falling was the leading cause of UEFs, accounting for 45.05% of incidence and 41.19% of YLD overall. CONCLUSIONS: Contrary to global trends, UEFs increased in the MENA region during the study period. Countries with higher fracture incidence and YLD should consider preventive and rehabilitation strategies.

Epidemiologic trends in hand injuries in the National Football League from 2009-2010 to 2019-2020.

OBJECTIVES: In American football, hand injuries have been shown to negatively impact performance. The purpose of this study is to characterize the prevalence and severity of hand injuries in National Football League (NFL) players. METHODS: A public online database was utilized to identify hand injuries in NFL players from 2009-2010 to 2019-2020. The primary outcome was to analyze the overall incidence of hand injuries (including wrist, metacarpus, finger, and thumb), injury type by each aforementioned anatomic location, and player position. Injury severity was evaluated based on percentage of injuries in which players returned to play (RTP), number of games missed before RTP, and the percentage of injuries resulting in the player being placed on injured reserve (IR). RESULTS: Of the 6,127 players included, 847 (13.8%) players sustained a hand injury, of which 24.8%, 34.3%, 17.9%, and 22.9% occurred at the wrist, metacarpus, finger, and thumb, respectively. Of the injured players, 97.4% returned to play following their injury, 14.8% were put on IR, and an average of 1.7 (SD 3.3) games were missed. Quarterbacks were the most likely to sustain hand injuries at all anatomic locations. Wrist injuries were associated with the lowest RTP rate (93.3%), the most players placed on injured reserve (28.6%), and the greatest number of games missed (mean 2.5, SD 4.2). CONCLUSION: Hand injuries decreased in prevalence by 65.6% over the 11 NFL seasons evaluated. This trend coincides with the implementation of several safety rules that relate to components of play involving the hands. Quarterbacks experienced the greatest prevalence and severity for all hand injuries. Wrist injuries represent the anatomic location associated with the greatest severity. These findings may be able to inform tailored injury prevention practices by position, and advocate for the further adoption of safety rules to protect players from further injury.

Trends in Distal Radius Fixation Reimbursement, Charge, and Utilization in the Medicare Population.

Background Distal radius fractures (DRF) are the second most common fragility fracture experienced by the elderly, and surgical management constitutes an appreciable sum of Medicare expenditure for upper extremity surgery. Using Medicare data from 2012 to 2017, our primary aim was to describe temporal changes in surgical treatment, physician payment, and patient charges for DRF fixation. Methods We examined surgical volumes and retrospective patient charge (services billed by surgeon) and surgeon payment (professional fee) data from 2012 to 2017 for four DRF surgeries: closed reduction percutaneous pinning (CRPP), open reduction internal fixation (ORIF) of extra-articular fractures, ORIF of intra-articular (IA) (2-fragment) fractures, and ORIF of IA (> 3 fragments) fractures. The reimbursement ratio was defined and calculated as the ratio of charges to payment. Rates were adjusted for inflation using the annual consumer-price index. Results For these four surgeries from 2012 to 2017, total patient charges grew by 64% from $117 to 193 million, while surgeon payment grew by 42% from $30 to 42 million. CRPP cases fell by 47%, while ORIF increased by 17, 14, and 45% for extra-articular, IA (2-fragment), and IA (> 3 fragments) surgeries, respectively. After adjusting for inflation, payment to physicians increased by more than or equal to 16% for all procedures except for CRPP, which fell by 2%. Charges during this same period increased from 13 to 38%. Reimbursement ratios declined from -9.2% to -13% for each procedure. Conclusion From 2012 to 2017, while charges have outpaced surgeon payment, payment has outpaced inflation for all forms of distal radius ORIF, aside from CRPP. There has been a continued sharp decline of CRPP. Level of Evidence is III, economic.

What Factors Are Associated With Arterial Line-Related Limb Ischemia in Patients on Extracorporeal Membrane Oxygenation? A Single-Center Retrospective Cohort Study.

OBJECTIVES: The primary purpose of this study was to identify factors associated with the development of arterial line-related limb ischemia in patients on extracorporeal membrane oxygenation (ECMO). The authors also sought to characterize and report the outcomes of patients who developed arterial line-related limb ischemia. DESIGN: Retrospective cohort study. SETTING: A single academic tertiary referral ECMO center. PARTICIPANTS: Consecutive patients who were treated with ECMO over 6 years. INTERVENTIONS: Use of arterial line. MEASUREMENTS AND MAIN RESULTS: A total of 278 consecutive ECMO patients were included, with 19 (7%) patients developing arterial line-related limb ischemia during the ECMO run. Postcannulation Sequential Organ Failure Assessment (SOFA) (adjusted odds ratio [aOR] 1.20, 95% CI 1.08-1.32), Acute Physiology and Chronic Health Evaluation-II (aOR 0.84, 95% CI 0.74-0.95), and adjusted Vasopressor Dose Equivalence (aOR 1.03, 95% CI 1.01-1.05) scores were independently associated with the development of arterial line-associated limb ischemia. A SOFA score of ≥17 at the time of ECMO cannulation had an 80% sensitivity and 87% specificity for predicting arterial line-related limb ischemia. CONCLUSIONS: Arterial line-related limb ischemia is much more common in ECMO patients than in the typical intensive care unit setting. The SOFA score may be useful in identifying which patients may be at risk for arterial line-related limb ischemia. As this was a single-center retrospective study, these results are inherently exploratory, and prospective multicenter studies are necessary to validate these results.

Selective Thumb Carpometacarpal Joint Denervation Versus Trapeziectomy and Ligament Reconstruction With Tendon Interposition for Painful Arthritis: A Prospective Study With 2 Years of Follow-Up.

PURPOSE: Thumb carpometacarpal (CMC) joint denervation is a relatively novel method for the management of osteoarthritis-associated pain by selective transection of articular nerve branches of the CMC joint. This study compared functional/patient-reported outcomes after CMC denervation with those after trapeziectomy and ligament reconstruction with tendon interposition (T + LRTI) over a 2-year follow-up period. We hypothesized that the outcomes of denervation and T + LRTI would be similar over the course of the study and at the final 2-year follow-up. METHODS: Adults with Eaton stage 2-4 disease, no evidence of CMC subluxation, and no history of thumb injury/surgery were included. Pain scores, brief Michigan Hand Questionnaire (bMHQ), Kapandji score, 2-point discrimination, and grip/key/3-point pinch strength were measured at 3-, 6-, 12-, and 24-months after surgery. On average, T + LRTI patients underwent 7 weeks of splinting, with release to full activity at 3 months; denervation patients were placed in a soft postoperative dressing for 2 weeks, with release to full activity as tolerated at 3 weeks. RESULTS: Thirty-three denervation and 20 T + LRTI patients were included. Preoperative characteristics were similar between both groups. Two denervation patients underwent secondary T + LRTI during the study period; one denervation patient underwent fat grafting to the CMC joint at an outside institution. Data prior to secondary surgeries were included in the analysis. The average tourniquet times (minutes) for denervation and T + LRTI were 43.5 ± 11.8 and 82.7 ± 14.2 minutes, respectively. For denervation and T + LRTI, the postoperative bMHQ scores were significantly higher than those at baseline at all time points. No significant differences were found between both groups for bMHQ, sensation, or strength measures. CONCLUSIONS: Carpometacarpal denervation is well tolerated, with shorter tourniquet times and faster return to full activity than T + LRTI. For the study cohort, the conversion rate to T + LRTI at 2 years was 9%. Both procedures demonstrated durable improvement in bMHQ compared with the preoperative state with similar long-term outcomes over 2 years of follow-up. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

A Comparison of Match Rates to Orthopaedic Surgery Residency Programs Between First-Time Versus Repeat Applicants: An Analysis of the National Resident Matching Program Data from 2018 to 2022.

Orthopaedic surgery has become one of the most competitive specialties to match into among medical students applying to residency. The purpose of this study was to compare match rates to orthopaedic surgery residency programs among first-time vs. repeat applicants. Methods: Data were obtained from the National Resident Matching Program from 2018 to 2022. For each year, the total number of applicants to orthopaedic surgery residency programs was obtained, as well as the number of applicants who successfully matched into orthopaedics. The match rate was compared between first-time vs repeat applicants. A subanalysis was performed on allopathic graduates (MDs) and osteopathic graduates (DOs)/international medical graduates (IMGs). In addition, the match rate for first-time applicants and reapplicants was compared between MD and DO/IMG applicants. Results: Overall, there was a significantly higher match rate among first-time applicants (89.8%) vs. repeat applicants (22.5%, p < 0.0001). When substratified by MD and DO/IMG applicants, first-time applicants still matched at a significantly higher rate than reapplicants within each group (p < 0.0001 for each). Among first-time applicants, MDs (93.1%) matched at a significantly higher rate than DOs/IMGs (68.6%, p < 0.0001). Among reapplicants, DOs/IMGs (25.3%) matched at a significantly higher rate than MDs (20.1%, p < 0.01). Conclusion: First-time applicants to orthopaedic surgery residency programs have a significantly higher rate of matching compared with reapplicants, irrespective of degree. In recent years, first-time MD applicants have matched at a significantly higher rate than first-time DO/IMG applicants.

Women Are Underrepresented Among Principal Investigators of Hip and Knee Arthroplasty Clinical Trials in the United States.

BACKGROUND: Leadership of clinical trials confers national recognition and promotes academic advancement. We hypothesized that women would be underrepresented among principal investigators (PIs) of hip and knee arthroplasty clinical trials in the United States. METHODS: A query of hip and knee arthroplasty clinical trials from 2015 to 2021 was performed on ClinicalTrials.gov. Clinical trials were included if they involved a U.S.-based orthopaedic-surgeon PI. We analyzed the sex representation of arthroplasty PIs among junior-level (assistant professor) and senior-level (associate or full professor) faculty. Participation-to-prevalence ratios (PPRs) were calculated by comparing the sex representation among arthroplasty PIs with that among academic arthroplasty faculty at institutions conducting hip and knee arthroplasty clinical trials. A PPR of <0.8 indicated underrepresentation and a PPR of >1.2 indicated overrepresentation. RESULTS: A total of 157 clinical trials involving 192 arthroplasty PIs were included. Of these PIs, only 2 (1.0%) were women. PIs were mostly funded by academic institutions (66%) and industry (33%). U.S. federal sources funded a minority (1%) of PIs. Of the 243 male arthroplasty faculty who were eligible, 190 men (78.2%) served as PIs. In contrast, of the 17 female arthroplasty faculty who were eligible, only 2 women (11.8%) served as PIs (p < 0.001). Across the entire cohort of arthroplasty PIs, women were underrepresented (PPR = 0.16), whereas men were equitably represented (PPR = 1.06). Women were underrepresented at the assistant professor (PPR = 0.0), associate professor (PPR = 0.52), and full professor (PPR = 0.58) levels. CONCLUSIONS: Women were underrepresented among PIs of hip and knee arthroplasty clinical trials, which may lead to disparities in academic promotion and advancement. More research is needed to understand the potential barriers to female leadership of clinical trials. Greater awareness and engagement are needed to create sex equity in clinical trial leadership for hip and knee arthroplasty research. CLINICAL RELEVANCE: The underrepresentation of women among arthroplasty PIs may lead to fewer options in surgical providers for patients and may limit access to musculoskeletal care for certain patient populations. A diverse arthroplasty workforce can promote attention to issues that disproportionately affect historically underrepresented and vulnerable patient populations.

Is an Orthopaedic Surgery Resident's Previous Case Experience Associated with Success of Initial Treatment of Pediatric Forearm Fractures?

Redisplacement and subsequent intervention are common for pediatric forearm fractures. We investigated associations between the success of closed reduction and the treating provider's experience. We identified patients aged 4-16 years with forearm fractures treated by closed reduction and cast immobilization. Clinical data and radiographs of 130 patients treated by 30 residents were reviewed to determine the treating resident's pediatric forearm fracture reduction experience and the incidence of initial treatment failure (ITF). ITF was defined as subsequent intervention before union or malunion. ITF occurred in 32 of 130 patients (25%), comprising 12 of 23 patients (52%) treated by residents with no previous experience and 20 of 107 patients (19%) treated by residents who had logged ≥ 1 previous reduction (odds ratio, 4.7). ITF was more likely to occur in pediatric forearm fractures treated by residents with no previous forearm reduction experience compared with those performed by residents who had such experience. Level of Evidence: Level III, therapeutic. (Journal of Surgical Orthopaedic Advances 32(1):032-035, 2023).

Burden of Hand Osteoarthritis in the Middle East and North Africa (MENA): An Epidemiological Analysis From 1990 to 2019.

PURPOSE: Hand osteoarthritis (OA) is a common cause of disability in older people. Although often underemphasized, it may affect quality of life and imposes a considerable burden on the health system. This study evaluated the epidemiology of hand OA in the Middle East and North Africa (MENA) region. METHODS: This epidemiological study was performed based on the Global Burden of Disease study from 1990 to 2019. The incidence, prevalence, and years lived with disability (YLD) in all 21 MENA countries during the study period were reported in rate, age-standardized, and percentage. RESULTS: Hand osteoarthritis in MENA increased 2.7-fold, from 1.6 million cases to 4.3 million from 1990 to 2019 with an age-standardized incidence rate of 50.2 (95% CI, 38.2-66.4) per 100,000 people in 2019. Saudi Arabia had the highest age-standardized prevalence in both 1990 (2.3%) and 2019 (2.3%), whereas Turkey had the lowest (0.3%) in both years. Total YLDs due to hand osteoarthritis increased by more than 2.7-fold, from 50,335 to 135,336 during the study period. The highest rate of increase in YLD rate from 1990 to 2019 was in Iran (3.3) and the largest decrease was in Qatar (-11.5). CONCLUSIONS: In contrast to the global trend, MENA hand OA prevalence and YLDs did not decrease between 1990 and 2019 and remained constant over time. Aging and increasing obesity rates, particularly among women, might be the contributing factors. Hand OA epidemiology varies by country, possibly due to genetic, ethnic, and environmental factors. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

Effect of Faculty Diversity on Minority Student Populations Matching into Orthopaedic Surgery Residency Programs.

Greater faculty diversity within orthopaedic residency programs has been associated with an increased application rate from students of similarly diverse demographic backgrounds. It is unknown whether these underrepresented student populations have an equitable likelihood of being highly ranked and matching at these programs. Thus, we sought to evaluate the relationship between faculty and resident diversity, with a specific focus on sex, racial/ethnic groups that are underrepresented in medicine (URiM), and international medical graduates (IMGs). Methods: The American Orthopaedic Association's Orthopaedic Residency Information Network database was used to collect demographic data on 172 US residency programs. Linear regression analyses were performed to determine the relationship between the proportion of female or URiM attendings at a program and the proportion of female, URiM, or IMG residents or top-ranked applicants (≥25 rank). URiM was defined as "racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population." Results: A mean of 13.55% of attendings were female and 14.14% were URiM. A larger fraction of female attendings was a positive predictor of female residents (p < 0.001). Similarly, a larger percentage of URiM attendings was a positive predictor of URiM residents (p < 0.001), as well as of URiM (p < 0.001) and IMG (p < 0.01) students being ranked highly. There was no significant association between URiM attendings and female residents/overall top-ranked applicants, or vice versa. Conclusions: Residency programs with more female attendings were more likely to match female residents, and programs with more URiM attendings were more likely to highly rank URiM and IMG applicants as well as match URiM residents. Our findings indicate that orthopaedic surgery residencies may be more likely to rank and match female or URiM students at similar proportions to that of their faculty. This may reflect minority students preferentially applying to programs with more diverse faculty because they feel a better sense of fit and are likely to benefit from a stronger support system. Level of Evidence: III.