Orthopedic Team Surgeons in Major Professional Sports: An Analysis of Affiliation With the Top 10 Sports Medicine Fellowship Programs and Implications for Leadership and Diversity.

This paper examines the correlation between orthopedic team surgeons in major professional sports and their affiliation with the top 10 sports medicine fellowship programs. With a growing trend in post-residency fellowship training, particularly in sports medicine, the study focuses on the implications of fellowship program choice for aspiring major professional sports team physicians. By analyzing data from Major League Baseball (MLB), the National Basketball Association (NBA), the National Football League (NFL), and the National Hockey League (NHL), the research reveals that 61 of 124 (49.19%) team surgeons graduated from the top 10 sports medicine fellowship programs. The results identify a noticeable pipeline effect in professional sports, where teams often hire graduates from a select number of esteemed fellowship programs. The study suggests that choosing a fellowship program from the top 10 list may enhance the prospects of becoming a major league team surgeon. Additionally, our results found a significant gender disparity among team surgeons, with only two (1.6%) of all major professional team physicians being women. This emphasizes the imperative for diversity improvement in orthopedic sports medicine. In conclusion, the research underscores the impact of top-tier fellowship programs on professional team surgeons, with implications for aspiring sports medicine physicians and a call for addressing gender disparities.

Retrograde Intramedullary Nailing Hardware Failure of a Supracondylar Distal Femur Fracture With Intercondylar Extension.

This case report presents the failure of retrograde intramedullary (IM) nailing in a supracondylar distal femur fracture in a 72-year-old female after a fall from standing. Multiple medical comorbidities are a known risk factor for fracture nonunion. With the rising incidence of patients having osteoporosis and multiple medical comorbidities, orthopedic surgeons need to be prepared for the treatment of hardware complications. The patient is a 72-year-old severely obese female with multiple medical comorbidities including cardiac valvular disease, hypertension, type II diabetes mellitus, hypothyroidism, acute on chronic blood loss anemia, rheumatoid arthritis, and lupus arthritis. She presented after a fall from standing where she sustained a closed displaced left supracondylar distal femur fracture with intercondylar extension. Open reduction and internal fixation (ORIF) was performed on the left distal femur intercondylar split and retrograde intramedullary nailing for the left supracondylar distal femur fracture. Three-month follow-up X-rays revealed no osseous formation of the supracondylar distal femur fracture and catastrophic failure of the implants with two broken screws and a broken condylar bolt consistent with hardware failure. Treatment options included either non-weight-bearing for three months to evaluate for callus formation, which would require her to be in a wheelchair, or surgical referral for implant removal and distal femur replacement. The patient elected to undergo revision surgery consisting of distal femoral replacement. Following revision surgery, the patient was discharged with physical therapy referral. She disclosed a decrease in pain and increased range of motion (ROM) compared to the preoperative state. This case demonstrates an elderly, obese patient with multiple comorbidities including type II diabetes mellitus and autoimmune conditions that placed the patient at high risk for hardware failure following surgery. Due to pain and quality of life concerns, patients with such injuries may be forced into a situation with limited options. This case highlights the need for optimal surgeon-to-patient communication to ensure that patients and all members of their healthcare team are knowledgeable when certain clinical situations are considered high risk for failure. Moving forward, risk factor consideration and medication adjustments are preoperative topics of discussion that should be discussed at length with the patient in order to provide the best opportunity for a successful surgery.

Case Report Demonstrating Multifactorial Risks of Anterior Cruciate Ligament Re-tear Injuries and Appropriate Response Among Those With High Chance of Recurrence.

We present the case of a collegiate football player with an extensive bilateral ligamentous knee injury history to elucidate the mechanisms and possible explanations behind why some athletes sustain recurrent injuries. We hope to initiate thought on altering rehabilitation schedules for athletes who are at an increased risk of re-injury. A 21-year-old collegiate American football player presented with a re-tear of his left anterior cruciate ligament (ACL) and medial meniscus following reconstructive surgery. The initial injury occurred to the patient when he was 15 and suffered a right ACL, lateral collateral ligament, and lateral meniscus tear in a non-contact injury. At the age of 19, he suffered his second injury, a contact-associated left ACL tear. Upon return to play six months following the left ACL tear, the patient sustained a non-contact bucket handle tear of the right medial meniscus. One year later, he presented with a re-tear of his left ACL. His initial left and right ACLs were repaired with hamstring autografts, and his current left ACL was repaired with a bone-patellar tendon-bone graft. This case illustrates an all too common situation plaguing the modern orthopedic sports medicine surgeon. At what point should a surgeon diverge from the standard rehabilitation schedule of ACL surgery due to a patient being at too high of a risk for a re-tear? We propose further investigations into risk factors as well as rehabilitation protocols to help surgeons identify and optimize treatment for these patients.

Empleo en ferti-irrigacion de los efluentes industriales cachaza y vinaza descargados por el ingenio y la destileria de alcoholes de la compañia azucarera Concepcion S.A

Se analiza la posibilidad de irrigar los cultivos con los efluentes de la industria azucarera, que son la cachaza y vinaza. De esta manera, dichos efluentes podrian ser utilizados como fertilizantes en lugar de ser arrojados a los rios, donde provocan la contaminacion de las aguas

Información general sobre vinazas originadas en procesos industriales amilaceo-azucarero

Informa de la composición de vinazas de la industria del azucar. Estudia sus efectos sobre el medio ambiente donde sera evacuado el efluente. Fija una determinación del grado de contaminación y riesgos ecológicos que genera. Plantea el empleo de vinaza como fertilizante y la producción de biomasa fungica a partir de la vinaza. Explica el proceso de digestión anaeróbica, tratamiento, concentración y combustión de las vinazas

Información general sobre vinazas originadas en procesos industriales amilaceo-azucarero

Informa de la composición de vinazas de la industria del azucar. Estudia sus efectos sobre el medio ambiente donde sera evacuado el efluente. Fija una determinación del grado de contaminación y riesgos ecológicos que genera. Plantea el empleo de vinaza como fertilizante y la producción de biomasa fungica a partir de la vinaza. Explica el proceso de digestión anaeróbica, tratamiento, concentración y combustión de las vinazas