An analysis of osteopathic medical students applying to surgical residencies following transition to a single graduate medical education accreditation system.

CONTEXT: Upon requests from osteopathic medical schools, the National Resident Matching Program (NRMP) Charting Outcomes were redesigned to include osteopathic medical school seniors beginning in 2018 and one joint graduate medical education (GME) accreditation system, the Accreditation Council for Graduate Medical Education (ACGME), formed in 2020. OBJECTIVES: The goal of this study is to analyze the match outcomes and characteristics of osteopathic applicants applying to surgical specialties following the ACGME transition. METHODS: A retrospective analysis of osteopathic senior match outcomes in surgical specialties from the NRMP Main Residency Match data from 2020 to 2022 and the NRMP Charting Outcomes data from 2020 to 2022 was performed. RESULTS: For surgical specialties, results show matching increased as United States Medical Licensing Examination (USMLE) Step 2 CK (clinical knowledge) and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 2 CE (cognitive evaluation) scores increased along with the number of contiguous rankings (p<0.001). The greatest indication for matching looking at scores alone were those who scored greater than 230 on Step 2 CK compared to below (p<0.001) and above 650 on Level 2 CE (p<0.001). However, those who scored 240 (p=0.025) on Step 2 CK were just as likely to match as those who scored 250 (p=0.022) when compared to those who scored below those scores. Increasing research involvement had little to no significance with the likelihood of matching across most surgical subspecialties. CONCLUSIONS: Our study demonstrates that there are unique thresholds for Step 2 CK scores, Level 2 CE scores, and the number of contiguous ranks for each surgical specialty that, when reached, are significantly associated with match success. Although certain board score delineations are linked with higher match success rates, the rates level off after this point for most surgical specialties and do not significantly increase further with higher scores. In addition, thresholds within contiguous ranks for increasing match likelihood exist and vary across surgical specialties. Overall, this study highlights that the quantitative metrics utilized to assess applicants lack the correlation reported historically, and the data presently available need to be more substantiated.

A 25-Year Analysis of Diversity, Equity, and Inclusion Research in Orthopaedics Shows Majority Female Authorship and Increasing Gender Parity Research.

Introduction: Orthopaedic surgery is one of the least diverse fields in medicine. In recent decades, there has been a concerted effort to increase diversity, equity, and inclusion (DEI) in the specialty, in addition to the institution of several organizations to establish the pipeline and facilitate underrepresented minority students into orthopaedic surgery. The aim of this study was to examine trends in orthopaedic surgery DEI research. Methods: A search of DEI articles was conducted in orthopaedic surgery using PubMed, MEDLINE, EMBASE, Scopus, Cumulative Index to Nursing and Allied Health Literature, and Education Resources Information Center. The year of publication, article topic of focus, sex of the primary author, publishing journal, citation index, and primary contributing institution were recorded for each article. Sex of the primary author was predicted by the authors using an online image search of the author and institution. Articles were excluded if the research was conducted outside of the United States or if they were not specific to orthopaedic surgery. Results: A total of 143 articles met the inclusion criteria. A total of 52.4% of authors (n = 75) were women and 44.1% (n = 63) were men. A total of 42.7% of the articles were written about sex (n = 61), 39.9% about race/ethnicity and sex (n = 57), and 11.9% about race/ethnicity (n = 17). A total of 10 articles were affiliated with Washington University in St. Louis while 51 other institutions wrote the remaining articles, with none having more than 4. Information could not be confirmed for 5 articles. In 2018, 5 articles were published, followed by 17 in 2019, 25 in 2020, 34 in 2021, and 30 in 2022. Conclusion: DEI research in orthopaedic surgery is a relatively new venture within the specialty and has room to grow, specifically in the examination of race/ethnicity and inclusion strategies. Leading journals and academic institutions in orthopaedic surgery should incentivize productivity and authorship in DEI research. Level of Evidence: III.

In-Hospital Mortality Risk and Discharge Disposition Following Hip Fractures: An Analysis of the Texas Trauma Registry.

Background: In-hospital mortality and discharge disposition following traumatic hip fractures previously reported in the literature, has mainly focused on a nationwide scale, which may not be reflective of unique populations. Objective: Our aim was to characterize demographics, hospital disposition, and associated outcomes for patients with the most common hip fractures. Methods: A retrospective study utilizing the Trauma Registry from the Texas Department of State Health Services. Patient demographics, injury characteristics, and outcomes, such as in-hospital mortality, and discharge dispositions, were collected. The data were analyzed via univariate analysis and multivariate regressions. Results: There were 17,104 included patients, composed of 45% femoral neck fractures (FN) and 55% intertrochanteric fractures (IT). There were no differences in injury severity score (ISS) (9 ± 1.8) or age (77.4 ± 8 years old) between fracture types. In-hospital mortality risk was low but different among fracture types (intertrochanteric, 1.9% vs femoral neck, 1.3%, P = .004). However, when controlling for age, and ISS, intertrochanteric fractures and Hispanic patients were associated with higher mortality (P < .001, OR 1.5, 95% CI 1.1-2.0). Uninsured, and Black/African American (P = .05, OR 1.2, 95% CI 1.1-1.3) and Hispanic (P < .001, OR 1.2, 95% CI 1.1-1.3) patients were more likely to be discharged home after adjusting for age, ISS, and payment method. Conclusion: Regardless of age, severity of the injury or admission hemodynamics, intertrochanteric fractures and Hispanic/Latino patients had an increased risk of in-hospital mortality. Patients who were uninsured, Hispanic, or Black were discharged home rather than to rehabilitation, regardless of age, ISS, or payment method.

The Most Popular YouTube Videos About Shoulder Replacement Are of Poor Quality for Patient Education.

Purpose: To characterize the quality of YouTube total shoulder arthroplasty videos as a source of patient information using the DISCERN instrument. Methods: An analysis of the YouTube video library was performed, using a string of 6 search terms related to "total shoulder replacement" and "total shoulder arthroplasty" in the YouTube search engine. The first 20 videos from each search (n = 120) were selected. The top 25 most viewed videos were compiled, screened, and evaluated with the DISCERN score in the final analysis. Pearson's correlation coefficients were used to assess the correlation of DISCERN scores and video characteristics. Inter-rater reliability was calculated with the conger kappa score for multiple raters. Results: Twenty-five videos met inclusion criteria, 13 (52%) were produced by academic institutions, 7 (28%) by physicians, and 5 (20%) by commercial entities. Median total DISCERN score was 33 out of 80 (IQR: 28-44). The overall total DISCERN scores, showed no correlation with video likes or views and was negatively correlated with video power index (r = -0.75, P = .001). No association between total shoulder arthroscopy video source and DISCERN score could be demonstrated. All videos analyzed scored poorly by the DISCERN instrument. Conclusions: The current most popular shoulder replacement videos on YouTube are low-quality patient education resources. Furthermore, our study found no correlation between video popularity, as measured by the number of views and the DISCERN score. Clinical Relevance: Successful outcomes following total shoulder arthroplasty may be influenced by the quality of information patients receive.

Documented Contact Allergy Impacts Risk for Surgical Adhesive-Associated Contact Dermatitis after Shoulder Arthroplasty.

Purpose: The purpose of this study is to report on the incidence and risk factors for allergic contact dermatitis (ACD) in patients who received Prineo after total shoulder arthroplasty (SA). Methods: A retrospective case-control study was conducted to investigate patients who experienced ACD after having SA by a single surgeon during a defined period when Prineo was routinely used as an adjunct to wound closure. Known risk factors for ACD (e.g., history of contact dermatitis, smoking) were analyzed for association development of Prineo-associated ACD using Fisher exact and Wilcoxon rank sum tests. Results: From June 2019 through July 2021, 236 consecutive patients were identified as having Prineo applied after SA. Nine cases of Prineo-ACD (3.8%) were documented, whereas 227 patients were unaffected. In all 9 affected patients, the complication was identified and treated without compromising the outcome of the SA. Previous allergy to medical adhesives was a statistically significant risk factor for Prineo-associated ACD in this series (P = .01). The odds of having Prineo-associated ACD among those with adhesive or contact allergy was 38.5 times that of their nonallergic counterparts in a multivariate model. Conclusions: Prineo adhesive ACD had an incidence of 3.8% in this study, and a history of adhesive or contact allergy was highly associated with its development. Level of Evidence: Level III, case-control study.

Education Research in Orthopaedic Surgery: A 6-Year Analysis.

With the ever-changing dynamics of surgical training, it is essential for the content of educational research to evolve simultaneously. This study aimed to assess the current state of scholarly work in orthopaedic training education and to identify particular educational topics that are trending in the literature. Methods: A PubMed search string was used to identify literature on orthopaedic surgery education from 2016 to 2021. Publications on orthopaedic surgery education were divided into 8 education-based categories: (1) operative training and simulation, (2) curriculum and career development, (3) diversity, (4) wellness and burnout, (5) program evaluation and match data, (6) trainee assessments, (7) social media, and (8) other. Univariate analysis and linear regression were used to determine trends. Results: A total of 383 orthopaedic surgery education publications met inclusion criteria. Orthopaedic surgery education publications accounted for 0.47% of the total publications from all 54 journals. Fifteen journals provided 85% of all orthopaedic education publications (N = 325). The Journal of Bone and Joint Surgery produced the most orthopaedic surgery education publications (76, 20%), followed by the Journal of Surgical Education (62, 16%) and the Journal of the American Academy of Orthopaedic Surgeons (58, 15%). Publications on curriculum and career development were the most common (21.9%). The following most frequent topics were program evaluation and match data (20.9%) and operative training and simulation (18%), respectively. Over the study period, the total amount of orthopaedic surgery education articles increased significantly (R2 = 0.86, p = 0.008). Articles included all levels of training, with resident education accounting for the majority, with 269 articles (70.2%). Conclusion: Recent trends in orthopaedic literature indicate an increased emphasis on education as the number of publications has increased, but are still sparse in orthopaedic literature. As the field of orthopaedics continues to advance, we recommend that academic institutions and organizations continue to evaluate and promote evidence-based educational research to ensure that orthopaedic education meets the ever-increasing demands that residents and practicing surgeons will face in the present and future. Level of Evidence: III.

[Bone cement implant as an alternative for orbital floor reconstruction: A case report]. / Implante de cemento óseo como alternativa para la reconstrucción de piso orbitario: reporte de caso.

BACKGROUND: The management of orbitary fractures is one of the most challenging in facial trauma; the variety of reconstruction materials for its treatment is broad and is constantly improving, but despite this there is no consensus for its use or literature that sustains it. OBJECTIVE: To present the use and design of a preformed bone implant as an alternative for the reconstruction of orbital floor fractures in the pediatric age group. CLINICAL CASE: A 7-year old male who suffered a right hemifacial contusion trauma with clinical and tomographic diagnosis of right pure blowout type orbital floor fracture with inferior rectus muscle entrapment and right post-traumatic palpebral ptosis. Successful surgical reconstruction was performed 7 days later with a pre-constructed bone cement implant. Eight weeks after surgery the patient presented with mild residual palpebral ptosis, no ocular movement limitations and no diplopia. CONCLUSIONS: The use of a bone cement implant can be considered appropriate for the reconstruction of these fractures, as another alternative to be used by the ophthalmologist among the variety of all the other materials used for this purpose. We consider that our optimism based on the results obtained in this case obligates us to increase the number of patients treated in order to gather more evidence and do larger follow up.