Small Glove Size and Female Gender Are Associated with Greater Reported Difficulty Using Orthopaedic Instruments Among Residents.

Introduction: Smaller hand size has been shown to affect ease of instrument use and surgeon injury rates in multiple surgical subspecialties. Women have a smaller average hand size and are more often affected by this issue than men. The goal of this resident survey was to investigate whether hand size and gender impact self-reported difficulty with instrument use among orthopaedic surgery residents. Methods: Residents were surveyed about how often they experience difficulty using common orthopaedic instruments. Self-reported difficulty using surgical instruments was compared between residents with small glove (SG, outer ≤7.0) vs. large glove (LG, ≥ 7.5) sizes and between male and female residents. Results: One hundred forty-five residents (118 males and 27 females) completed the survey for a response rate of 3.7%. The SG group contained 35 residents, with 26 females and 9 males. The LG group contained 110 residents, with 1 female and 109 males. The SG group reported more difficulty than the LG group when using 3/6 instruments: the wire-cutting pliers (71.4% vs. 25.5%), universal T-handle chuck (65.7% vs. 21.4%), and large wire driver (60.0% vs. 24.8%). Female residents reported more difficulty than males for 5/6 instruments. Within the SG group, however, there was no difference in self-reported difficulty between female SG and male SG residents for 4/6 instruments. Conclusions: The predominantly male LG group reported significantly less difficulty than the more gender mixed though still predominantly female SG group. A subanalysis comparing males and females within the SG group found that there was no difference between SG female and SG male residents for 4/6 of the instruments, suggesting that glove size might impact reported difficulty independently from gender. Although the effect of glove size vs. gender is difficult to differentiate in this study, the high rate of difficulty experienced by male and female residents in the SG group should be considered by residency programs, surgeon educators, and instrument manufacturers as the field of orthopaedic surgery continues to become more diverse. Level of Evidence: III.

Clinical and Radiographic Outcomes for Patients with Cervical Adjacent Segment Disease Treated with Anterior Cervical Discectomy and Fusion with Integrated Interbody Spacers.

INTRODUCTION: Anterior cervical discectomy and fusion (ACDF) is among the most common spine procedures. Adjacent segment disease (ASD), characterized by degenerative disease at an adjacent spinal level to a prior fusion, is a well-recognized and significant sequela following ACDF. Adjacent segment ACDF may be considered after the failure of non-surgical options for patients with symptomatic ASD. This study aimed to assess the incidence of dysphagia and other complications as well as radiographic outcomes in adult patients who have undergone ACDF with an integrated interbody spacer device for symptomatic ASD. METHODS: This was a retrospective review of patients who underwent ACDF for symptomatic ASD with commercially available integrated interbody spacers by three spine surgeons at an academic institution from March 2018 to April 2022. Demographic, radiographic, and postoperative data were collected, including dysphagia, device-related complications, and the need for revision surgery. RESULTS: There were 48 patients (26 male, 22 female) who met inclusion criteria (mean age 59.7 years, mean body mass index 19.5 kg/m2) who underwent ACDF for symptomatic ASD (1one-level, n = 44; 2-level, n = 4). Overall, 12 patients (25%) experienced dysphagia postoperatively before the first follow-up appointment. Nine of 44 (20.4%) of 1-level ACDF patients experienced dysphagia, and 3 of 4 (75%) of 2-level ACDF patients experienced dysphagia. Three patients had severe dysphagia which prompted an otolaryngology referral. Two of those patients remained symptomatic at 6 weeks postoperatively. Of 43 patients with prior plate cage systems, none required hardware removal at the time of surgery. Preoperative global and segmental lordosis were 9.07° ± 8.36° (P = 0.22) and 3.58° ± 4.57° (P = 0.14), respectively. At 6 weeks postoperatively, global and segmental lordosis were 11.44° ± 9.06° (P = 0.54) and 5.11° ± 4.44° (P = 0.44), respectively. This constitutes a change of +2.37° and +1.53° in global and segmental lordosis, respectively. The mean anterior disc height change between preoperative and immediate postoperative time points was 6.3 ± 3.1 mm. Between the immediate postoperative and 6-week postoperative time points, the mean anterior disc height change was -1.5 ± 2.7 mm. Between the immediate postoperative and 3-month postoperative time points, the mean anterior disc height change was -3.7 ± 5.0 mm. The posterior disc height changes at the same time points were 2.5 ± 1.7 mm, -0.4 ± 1.8. and -0.5 ± 1.4 mm, respectively. This fusion rate was 50% and 70% at 6 months and 1 year post-surgery, respectively. CONCLUSIONS: ACDF with integrated spacer is a viable alternative to traditional plate-cage systems for symptomatic ASD. An advantage over traditional plate-cage systems is that the removal of prior instrumentation is not needed in order to place implants. Based on a review of the literature, these standalone systems allowed for a shorter operative time and had less incidence of dysphagia than plate-cage systems for ASD after ACDF. The different standalone and plate-cage systems used in treating ASD after ACDF surgeries should be compared in prospective studies.

Robotic-Assisted Minimally Invasive Spinopelvic Fixation for Traumatic Sacral Fractures: Case Series Investigating Early Safety and Efficacy.

BACKGROUND: High-energy traumatic sacral fractures, particularly U-type or AOSpine classification type C fractures, may lead to significant functional deficits. Traditionally, spinopelvic fixation for unstable sacral fractures was performed with open reduction and fixation, but robotic-assisted minimally invasive surgical methods now present new, less invasive approaches. The objective here was to present a series of patients with traumatic sacral fractures treated with robotic-assisted minimally invasive spinopelvic fixation and discuss early experience, considerations, and technical challenges. METHODS: Between June 2022 and January 2023, 7 consecutive patients met the inclusion criteria. Intraoperative fluoroscopic images were merged with intraoperative computed tomography images using a robotic system to plan the trajectories for placement of bilateral lumbar pedicle and iliac screws. Intraoperative computed tomography was performed after pedicle and pelvic screw insertion to confirm appropriate placement before insertion of rods percutaneously without the need for a side connector. RESULTS: The cohort consisted of 7 patients (4 female, 3 male) with ages ranging from 20 to 74. Intraoperatively, the mean blood loss was 85.7 ± 84.0 mL, and mean operative time was 178.4 ± 63.9 minutes. There were no complications in 6 patients; 1 patient experienced both a medially breached pelvic screw and a complicated rod pullout. All patients were safely discharged to their homes or an acute rehabilitation facility. CONCLUSIONS: Our early experience reveals that robotic-assisted minimally invasive spinopelvic fixation for traumatic sacral fractures is a safe and feasible treatment option with the potential to improve outcomes and reduce complications.

Minority Resident Physicians' Perspectives on the Role of Race/Ethnicity, Culture, and Gender in Their Surgical Training Experiences.

BACKGROUND: Female and racial/ethnic minority representation in surgical programs continues to trail behind other medical specialties. Various structural and perceived obstacles which contribute to a difficult path for underrepresented minority (URM) trainees have been identified, and efforts to reduce these hurdles are underway. Gaining perspective and insight from current surgical minority trainees may add valuable insight to aid with improving and innovating strategies to recruit and retain URM surgeons. OBJECTIVE: To characterize how race/ethnicity, cultural background, and gender affect the surgical training experience of URM surgical residents in all areas of surgery a focus on the field of Orthopedic Surgery, given its particularly poor rates of diversity. METHODS: Authors conducted semi-structured video interviews on current surgical residents or fellows who were members of underrepresented populations including Female, African-American/Black, Latino, Asian, Native American, and First or Second-generation immigrant status. Recruitment was achieved through a combination of voluntary, convenience, and snowball sampling procedures. Interview transcripts were then coded using conventional thematic analysis. Themes were iteratively expanded into subthemes and subsequently categorized utilizing a pile-sorting methodology. RESULTS: Among 23 surgical trainees 12 self-identified as Black (60.9%), 5 as Asian (17.4%), 1 as Hispanic (4.4%), and 5 as Caucasian (17.4%). Twelve residents identified as male (52%) and 11 as female (48%). Six surgical specialties were represented with the majority of participants (83%) being trainees in surgical subspecialties, among those orthopedic surgery was most strongly represented (57%). Analysis of their responses revealed 4 major themes: positive experiences, problems related to minority status, coping strategies, and participant suggested interventions. Themes were distilled further to sub-themes. Positive experiences' sub-themes included finding a supportive community, pride in minority status, and being able to better relate to patients. Negative experiences related to minority status' subthemes included perceived microaggressions and additional pressures, such as greater scrutiny and harsher punishments relative to their nonminority counterparts, which negatively impacted their surgical training. Most respondents did not feel there were dedicated resources to help alleviate these additional burdens, so some sought help outside of their training programs while others tried to assimilate, and others felt isolated. Recommended proposed interventions included validating the URM resident experience, providing education/training, and creating opportunities for mentorship. IMPLICATIONS/CONCLUSIONS: URM surgical trainees face numerous challenges related to their minority status. Recruitment and retention of URM in medicine would benefit from individual early and longitudinal mentorship, mitigating imposter syndrome, acknowledging the challenges faced by residents, and seeking feedback from both past and current residents.

Spontaneous pneumomediastinum: A rare complication of methamphetamine use.

OBJECTIVE: To present an unusual case of spontaneous pneumomediastinum subsequent to recreational amphetamine use. CASE REPORT: A young African American adult male was admitted to internal medicine service for treatment of rhabdomyolysis secondary to methamphetamine use. On admission, he was complaining of chest pain in addition to nausea and generalized muscle aches. By his second hospital day, chest pain had resolved yet physical exam demonstrated crepitation of the anterior chest and left axilla. Portable chest x-ray revealed subcutaneous emphysema in addition to pneumomediastinum. CONCLUSION: Spontaneous pneumomediastinum is a rare complication of amphetamine use that is often associated with subcutaneous emphysema and can be diagnosed with chest x-ray. Management is conservative, with observation, pain control, and supplemental oxygen as needed.