The July Effect in Podiatric Medicine and Surgery Residency.

The period when medical students begin residency in teaching hospitals throughout the United States heralds a period known in the medical community as the "July Effect." Though several sentinel studies associated this timeframe with an increase in medical errors, residencies since demystified this phenomenon within their respective specialty. This study aims to evaluate the presence of the July Effect in a podiatric medicine and surgery residency program. A retrospective chart review was conducted, comparing patient demographics and surgical outcomes including length of stay, operative time and readmission rate between the first (July, August, September) and fourth (April, May June) quarters of the academic year from 2014-2019. A total of 206 patients met the inclusion criteria, where 99 received care in the first, resident-naïve, quarter and 107 received care in the fourth, resident-experienced, quarter. No difference in patient demographics including sex, body mass index, or comorbidity index was appreciated between both quarters (p<0.05). Those patients who underwent soft tissue and bone debridements, digital, forefoot, midfoot and rearfoot amputations experienced no statistically significant difference in length of stay, operative time, or readmission rate between both quarters (p<0.05). The results of this study did not support the presence of the July Effect in our foot and ankle surgery residency. Future studies can further explore this phenomenon by examining patients admitted following traumatic injury or elective procedures. Moreover, this study shows the curriculum employed at our program provides sufficient support, guidance, and resources to limit errors attributed to the July Effect.

Anatomic Description of the Fourth and Fifth Tarsometatarsal Articulation: A Cadaveric Study.

The fourth and fifth tarsometatarsal joint, consisting of the fourth and fifth metatarsal and the cuboid, imparts a significant amount of motion to the foot during ambulation. Injury to this joint complex, through chronic deformation or acute trauma, often necessitates arthroplasty, arthrodesis, or fusion. Currently, there exists no studies that investigate the anatomy of this articulation. The purpose of this study is to describe the medial and lateral anterior cuboid articulations which allows for surgical planning and the advancement of hardware design. Twenty fresh-frozen below-the-knee cadaver legs were thawed and the cuboids were excised. The width and height of the entire joint complex were measured as the longest span across the total articular surface of the anterior cuboid. The width and height of each articular facet were recorded as the span across the geometric bisection of each individual surface. The mean anterior cuboid articulation width and height was 25.62 mm and 16.74 mm, respectively. The mean medial cuboid articulation width and height was 11.7mm and 13.65 mm, respectively. The mean lateral cuboid width and height was 16.74 mm and 12.78 mm, respectively. The medial articulation maintained a larger mean height and narrower mean width than the lateral facet (p < .05). The unique anatomy of the lateral tarsometatarsal joint complex plays an important functional role and requires attention when deciding between arthrodesis or arthroplasty. Increasing the understanding of the clinical anatomy of this joint will better prepare surgeons and product designers to anticipate hardware needs.

Early Experience With the CADENCE Total Ankle Prosthesis.

A number of 2-component, fourth-generation total ankle arthroplasty prostheses have been introduced to the market. The purpose of the present study was to present early experience with the CADENCE total ankle prosthesis. All patients who underwent primary total ankle arthroplasty using the prosthesis between August 2016 and June 2018 at a single institution and who were at least 1 year postoperative were included. A total of 32 ankles with a mean follow-up of 24 (range, 12-33) months met the criteria. Weightbearing radiographs were assessed using coronal and sagittal alignment parameters preoperatively, at 6 weeks postoperative, and at the most recent follow-up. Medical records and charts were reviewed and revisions, reoperations, and complications were classified according to the criteria established by Vander Griend et al and Glazebrook et el, respectively. Coronal and sagittal tibiotalar alignment significantly improved after surgery (p < .001, p < .005), and was maintained during the latest follow-up (p = .44, p = .30). Two (6.3%) ankles underwent early revision for aseptic loosening; while 6 (18.8%) underwent a nonrevisional reoperation. Nine (28.1%) ankles presented a total of 13 (4 high grade, 2 intermediate, and 7 low) complications according to the Glazebrook classification. The most common was intraoperative periprosthetic medial malleolar fracture (5 ankles, 15.6%), a low-grade complication. The present study is the first to report early outcomes and experience with the CADENCE total ankle. Overall, survivorship was 94% at short-term follow-up of 2 years. As with all arthroplasty devices, surgeons new to the prosthesis should be cognizant of the potential learning curve. Intraoperative medial malleolar fracture was found to be the most common complication.

Safety Profile Associated With Calcaneal Autograft Harvesting Using a Reaming Graft Harvester.

BACKGROUND: Foot and ankle surgery often requires bone healing, whether in elective arthrodesis or trauma. While primary bone healing is possible, the rate of nonunion in foot and ankle surgery remains variable. The addition of autogenous bone graft can allow for higher union rates by adding to the biology at the site of bone healing. Harvesting autogenous bone graft from the calcaneus for foot and ankle surgery can be done quickly and efficiently and allow for an adequate amount of graft. METHODS: A retrospective chart and radiographic review was performed for 1438 patients at a single center between August 1, 2015, and December 15, 2018, who underwent calcaneal autograft harvesting using a power-driven reaming graft harvester. RESULTS: In total, 966 patients were included and evaluated for the safety and complication rate associated with the procedure. Only 1 patient (0.1%) had a major complication, and there were 14 minor complications (1.4%). CONCLUSION: The safety profile and low complication rate of this case series demonstrate that this simple and efficient calcaneal autograft harvest technique can be considered when a small to moderate amount of autogenous bone graft is required to augment bone healing. LEVEL OF EVIDENCE: Therapeutic level IV, case series.

Podiatric Medicine and Surgery Resident-Authored Publications in The Journal of Foot and Ankle Surgery: A Systematic Review.

Since its introduction into the medical community, the Podiatric Medicine and Surgery residency has strived to graduate the most advanced and learned foot and ankle surgeons. From increasing length of training, to assuring didactics and education are sufficiently incorporated into the residency, the Council on Podiatric Medical Education has overseen this transition. One area of interest, podiatric medicine and research, remains central to this training and contributes to the field of foot and ankle surgery through journal publications. The purpose of this review was to identify Podiatric Medicine and Surgery resident-authored publication rates, trends, and geographic distribution. All published case reports, original research articles, review articles, and tips, quips, and pearls in The Journal of Foot and Ankle Surgery from January 2009 to December 2018 were reviewed. Podiatric Medicine and Surgery residents comprised 8% of all authors. Residents contributed to and published as first authors in 22% and 11% of all manuscripts, respectively. An increasing trend in resident authors, resident-authored manuscripts, and resident-first-authored manuscripts was observed. From before the mandated 3-year residency to after, the proportion of resident-authored manuscripts to all manuscripts declined from 9.99% to 7.21%; however, among these resident-authored publications, the rate of first-authorship increased from 45.32% to 51.36%. To the best of our knowledge, this is the first and only study to examine publication rates among foot and ankle surgery residents.

Effectiveness of the Cadaver Lab in Podiatric Surgery Residency Programs.

Since the inception of the first surgical training system by Sir William Stewart Halsted, resident surgical skill development has been promulgated in teaching hospitals. Currently, the Council on Podiatric Medical Education does not mandate the availability of a cadaver lab as a residency curriculum requirement. The purpose of the present study is to assess the structure of the cadaver lab and availability in the current podiatric surgical training programs. A survey was sent electronically to 229 American Association of Colleges of Podiatric Medicine-approved residency programs, excluding OhioHealth, across all residency programs. A total of 173 (6.9%) residents from 74 (32.3%) residency programs completed the survey. This survey analyzed the characteristics and perception of the current state of cadaver lab in podiatric residency. The most reported type of cadaver labs available were medical company sponsored and hospital sponsored. Other hands-on training, including inanimate simulators (n = 24) and animal models (n = 5), was also reported. Overall, 87.9% of the surveyed residents found that cadaver lab is either extremely beneficial (57.8%) or somewhat beneficial (30.1%). The most important factors perceived in a successful cadaver lab were faculty instruction (n = 78), accessibility of lab (n = 46), and availability of instrumentation/hardware (n = 26). This qualitative survey is the first study to address the uniformity, perception, and potential value of the cadaver lab in a podiatric surgical residency.

Involvement of a Jumonji-C domain-containing histone demethylase in DRM2-mediated maintenance of DNA methylation.

Histone demethylases-both lysine-specific demethylase 1 (LSD1) and Jumonji-C (JmjC) domain-containing proteins-are broadly implicated in the regulation of chromatin-dependent processes. In Arabidopsis thaliana, histone marks directly affect DNA methylation, and mutations in LSD1 homologues show reduced DNA methylation at some loci. We screened transfer DNA mutations in genes encoding JmjC domains for defects in DNA methylation. Mutations in jmj14 result in reduced DNA methylation in non-CG contexts at targets of DRM2 (domains rearranged methyltransferase 2)-mediated RNA-directed DNA methylation (RdDM), which is associated with an increase in H3K4m3. Unlike other components of RdDM, JMJ14 is not required for de novo methylation of a transgene, suggesting that JMJ14 is specifically involved in the maintenance phase of DRM2-mediated RdDM.