Does the polarity of radial head arthroplasty affect functional outcomes?: a systematic review and meta-analysis.

Background: Radial head arthroplasty allows a high degree of customizability, and implant polarity has emerged as an important variable. The purpose of this meta-analysis was to evaluate differences in functional and clinical outcomes between patients receiving monopolar and bipolar radial head prosthetic implants. Methods: A systematic review and meta-analysis were employed, and 65 articles were identified in three databases. Twelve articles contained non-English or insufficient text and were consequently excluded, and 20 others did not contain sufficient data or follow-up. The remaining 33 articles were qualitatively and quantitatively reviewed. Results: In total, 33 populations were identified, with 809 unduplicated patients: 565 with monopolar and 244 with bipolar implants. In these respective patients, the mean follow-up was 40.2 and 56.9 months. Average Mayo Elbow Performance Score were 86.7 and 87.4 (P=0.80), respectively; average Disability of the Arm, Shoulder, and Hand scores were 17.9 and 14.7 (P=0.47), and average final flexion/extension arcs were 119.4° and 118.7° (P=0.48). Revision rates were 4.07% and 6.56%, while complication rates were 19.65% and 20.08% in the respective monopolar and bipolar patients. These increased relative risks associated with bipolar implants were not significant. Conclusions: Radial head implant polarity does not appear to affect functional outcomes. While bipolar prosthetic design may increase the risks of revision and complications, the increases were not significant.

Return to Play After Hook of Hamate Fracture: A Systematic Review and Meta-Analysis.

In athletes, a hook of hamate fracture is concerning in terms of time to return to sport and effect on performance upon return. This study aims to analyze the treatment of hook of hamate fractures in athletes to determine their rates of return to play, timelines of recovery, and performance level upon return to play. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to perform this analysis. The PubMed database was queried to perform the literature search. Data were pooled and analyzed. P values <.05 were considered significant. Data were analyzed using the Comprehensive Meta-Analysis software to determine heterogeneity. Twenty studies with 823 patients sustaining hook of hamate fractures that reported any competitive level of play were included in the analysis. Of the 823 patients, 778 (94.5%) were able to return to play with 91.2% (506/555) of patients demonstrating similar or improved performance. The mean time to return to play was 45 days (range: 21-168 days). Treatment included surgical excision for 787 patients (95.6%), open reduction and internal fixation for 18 patients (2.2%), stress reduction/casting for 13 patients (1.6%), and loss to follow-up or surgery refusal for 5 patients (0.6%). A very high number of athletes return to play following a hook of hamate fracture at the same or improved level of performance. In our study, the majority of injuries were treated with surgical excision of the fractured hook of hamate fragment. Most athletes returned to their sport at an average of 45 days.

The Impact of the City of Miami's Decision to Revoke Electric Scooter Company Permits on Orthopedic Trauma at a Level I Trauma Center.

BACKGROUND: Since the introduction of electric-scooter (e-scooter) mobile applications, there has been a marked increase in e-scooter-related injury. On January 19, 2022, the City of Miami revoked permits to five major mobile applications for violation of safety protocols. OBJECTIVES: The purpose of our study was to assess the effects of this notice on the orthopedic patients seen at our corresponding Level I trauma center. METHODS: Institutional Review Board approval was obtained for this study. A retrospective chart review was performed including all patients with orthopedic injuries at our Level I trauma center between July 19, 2021 and July 19, 2022. These dates include 6 months prior to and after the major e-scooter operators ceased use in Miami. SPSS statistical software version 28.0.0 (SPSS, IBM, Armonk, NY) was utilized for all statistical analysis. RESULTS: There were 2558 patients in the prenotice cohort, and 2492 patients in the postnotice cohort. After the notice, there was a significant decrease in the number of patients that presented to our institution due to injuries caused by e-scooters (2.8% vs. 1.8% patients; p = 0.021). Patients with injuries caused by e-scooters had a significantly lower age (38 vs. 42, respectively; p = 0.034) and were more likely to be male (79.3% vs. 67.4% male, respectively; p = 0.007) than patients with other orthopedic injuries. CONCLUSION: This study demonstrates that the 2022 notice revoking the major mobile application operators from the City of Miami resulted in a significant decrease in the number of orthopedic cases due to e-scooter-related injury at the corresponding Level I trauma center.

Identifying anatomic landmarks and median nerve characteristics for the analysis of persistent carpal tunnel syndrome using magnetic resonance imaging (MRI).

OBJECTIVE: Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy in the USA. In this study, we define anatomical landmarks to assess symptomatic and asymptomatic cohorts with persistent CTS using MRI imaging. MATERIALS AND METHODS: Distal vs proximal incomplete release was determined using the distal most aspect of the hook of hamate and the distal wrist crease. An incomplete release showed the transverse carpal ligament (TCL) intact at either boundary. Twenty-one patients with persistent CTS were analyzed for incomplete release, median nerve enlargement and T2 signal hyperintensity, and flattening ratio using postoperative wrist MRI. These findings were compared to a ten-patient asymptomatic persistent CTS control group. Fisher's exact and a Student's two-tailed t-tests were used to determine statistical significance. RESULTS: In the symptomatic persistent CTS group, 13 (61.9%) incomplete releases were identified, 5 (38.5%) incomplete distally, and 1 (7.7%) incomplete proximally. There was no statistical significance in the rate of incomplete releases when compared to the asymptomatic group (p = 1.00). T2 signal hyperintensity and enlargement at the site of release showed no statistical significance, (p = 0.319 and p = 0.999, respectively). The mean flattening ratio at the site of release in the symptomatic group (2.45 ± 0.7) was statistically significant compared to the asymptomatic group (1.48 ± 0.46), (p = 0.007). CONCLUSION: Utilizing the established landmarks, the full length of the TCL can be assessed via MRI. Additionally, evaluation of the median nerve flattening ratio at the level of the incomplete release may be utilized as an aid to the clinical management of persistent CTS.

The Impact of Florida Law HB21 on Opioid Prescribing Patterns After Outpatient Hand Surgery.

BACKGROUND: The purpose of this study is to evaluate the effects of Florida lae House Bill 21 (HB21) on opioid prescribing patterns by a single orthopedic hand surgeon after outpatient hand and upper extremity surgery. METHODS: The following variables were evaluated with retrospective chart review before and after implementation of HB21: type of opioid, number of pills, morphine milligram equivalents (MMEs), emergency department visits, and readmissions. In addition, the Florida Prescription Drug Monitoring Program (E-FORCSE [Electronic-Florida Online Reporting of Controlled Substance Evaluation]) was queried to determine the number of pills and MMEs prescribed and sold for the latter cohort. Student t tests, Fisher exact tests, and binary logistic regression were used for statistical analysis. P < .05 was considered significant. RESULTS: We reviewed 231 consecutive patients who underwent hand or upper extremity surgery from July 2017 to July 2018 and 207 consecutive patients from January 2020 to January 2021. The average age was significantly different between the cohorts (48.41 vs 44.98 years, P = .025); however, there were no significant differences across other demographic variables. After controlling for age, the average number of pills prescribed per patient decreased significantly after HB21 (25.11 vs 21.6 pills, P < .001). The number of MMEs prescribed per patient decreased as well, but the decrease was not statistically significant (167.8 vs 154.1 MMEs, P = .054). There was an association between preoperative opioid prescriptions filled and prolonged opioid use (odds ratio 6.438, P = .003). CONCLUSION: Florida law HB21 resulted in significantly fewer pills prescribed per patient, suggesting that legislation likely changed prescriber behavior and/or patient demand regarding postoperative opioid prescriptions after outpatient hand and upper extremity surgery.

Does Surgeon Level of Expertise Correlate with Patient Outcomes?

Background It is difficult to evaluate the results of surgical techniques as there is inherent variability between surgeons in regard to experience, skill level, and knowledge. Tang suggested a classification system in 2009 in an attempt to standardize surgeon level of expertise, with categories ranging from nonspecialist (Level I) to expert (Level V). This epidemiological analysis of all articles citing Tang's original paper examines if a surgeon's self-reported level of expertise correlates with outcomes and evaluates whether the current definition of Tang level is sufficient to account for expertise bias. Methods In May 2021, all articles citing Tang level of expertise were identified ( N = 222). Articles were included if they described a novel technique and provided author(s)' levels ( n = 205). Statistical analysis was conducted, and p -values less than 0.05 were considered significant. Results The most common specialties reporting Tang level of expertise were orthopaedic surgery (82.9%) and plastic surgery (15.5%). The most common subspecialty was hand surgery. 2020 was the year with the most studies reporting level of expertise (31.7%), followed by 2021 (20.0%) and 2019 (17.1%). The majority of studies (80.5%) reported positive results with their technique, and of these, 63.3% were statistically significant. Level of expertise was not significantly associated with a doctoral degree, type of residency completed, fellowship completion, hand fellowship, author sex, study type, or result significance. Discussion The current Tang classification is both underreported and incomplete in its present state. To account for expertise bias, we recommend all authors report Tang level when describing surgical techniques. Studies with multiple authors should explicitly state the level of each author, as well as a weighted average accounting for the total contribution of each individual.

Angioleiomyoma in a 52-year-old female wrist: A case report.

Angioleiomyoma is a benign soft tissue tumor arising from vascular smooth muscle and most commonly presents in the lower extremities. We report a case of a 52-year-old right-hand dominant woman who presented with a 2-year history of intermittent, nonradiating left wrist pain, which she described as achy in nature without numbness or tingling. A focused physical examination revealed no edema, no obvious skin changes; there was tenderness over the volar-radial aspect of the left wrist, with an underlying firm, mobile, and palpable soft tissue mass. There was no prior history of trauma or surgery to the affected area. Ultrasound (US) examination demonstrated a 0.6 × 0.6 × 0.4 cm well-defined, oval, hypoechoic soft tissue mass within the volar radial soft tissues of the left wrist. The lesion abutted the radial artery without signs of calcification or necrosis. Color Doppler showed little to no vascularity within the mass nor radial artery thrombosis. Histological analysis revealed an angioleiomyoma arising from the radial artery wall. A case presentation like this would most commonly be due to a volar ganglion cyst; however, it is important to consider other soft tissue masses in differential diagnosis, such as angioleiomyoma, as treatment varies significantly.

Effects of the Covid-19 Pandemic on the Orthopaedic Surgery Residency Application Match Patterns.

Background: The COVID-19 pandemic and its effects on the orthopaedic match process are yet to be fully understood and should be explored. We hypothesize that the cancellation of away rotations due to the COVID-19 pandemic would decrease the variability of where students matched into orthopaedic residency compared to pre-pandemic years. Methods: Accredited orthopaedic programs were collected from the Accreditation Council for Graduate Medical Education (ACGME) database. Rosters of orthopaedic residency classes for the years 2019, 2020, and 2021 were compiled across all orthopaedic programs in the United States. Data collection for the incoming 2021 orthopaedic surgery residents was carried out by reviewing each program's website, Instagram, and Twitter. Results: Data for the incoming orthopaedic surgery residents from the 2021 National Residency Match Program (NRMP) were collected. 25.7% of incoming residents matched at their home institution. Data collection for the 2020 and 2019 orthopaedic residency classes yielded 19.2% and 19.5% home institution match rates, respectively. When examining likelihood to match into an orthopaedic residency program in ones own's state, we found that in the 2021 match cycle, 39.3% of applicants matched within their state, while 34.3% and 33.4% of incoming residents matched in 2020 and 2019, respectively. Conclusion: To keep our patients and staff safe, visiting externship rotations were suspended in the 2021 Match cycle. As we continue to navigate the shifting waters of the COVID-19 pandemic, it is important to understand how our choices affect the dynamics of applying into residency training and beyond. This study demonstrates that a higher percentage of applicants that matched into orthopaedic residency remained at their home program compared to the previous two years before the pandemic. This indicates that programs tended to rank their home applicants, and that applicants tended to rank their home programs, higher than those that were less familiar. Level of Evidence: IV.

A Regional Analysis of Hospital Readmissions Following Total Hip and Knee Arthroplasty and the Impact of Medicaid Expansion.

The Hospital Readmissions Reduction Program (HRRP) works to temper nationally rising readmission rates. Total knee arthroplasty (TKA) and total hip arthroplasty (THA) have a 30-day readmission cost burden of $889,300 and $689,400, respectively. No research has compared TKA and THA readmission rates by region and Medicaid expansion status. This study compares THA and TKA readmission rates in the United States by region, Medicaid status, and performance. One-way ANOVAs were conducted to determine the regions with the highest and lowest mean excess readmission ratios (ERRs). An independent t-test compared Medicaid versus non-Medicaid expansion states. Southern hospitals have the highest mean ERR, followed by northeastern, midwestern, and then western hospitals. Although Medicaid expansion states have significantly lower ERRs compared to non-expansion states, Medicaid status alone does not account for regional differences in ERRs after THA and TKA. Regional factors likely confound Medicaid status's effect on readmission rates. (Journal of Surgical Orthopaedic Advances 32(1):005-008, 2023).

Analysis of Questions in Sections of the Orthopaedic In-Training Examination: A Scoping Review.

PURPOSE: The purpose of this review was to assess all available studies that analyzed the types of questions in individual sections of the Orthopaedic In-Training Examination, which may be used as a reference for residents studying for their examination. METHODS: Following the Providing Innovative Service Models and Assessment extension for Scoping Reviews guidelines, a systematic review was conducted on studies that report on sections or question categories of the Orthopaedic In-Training Examination using PubMed, MEDLINE, and Web of Science databases. Two reviewers and an arbitrator reviewed and extracted relevant data from 20 included studies which made up the systematic review. RESULTS: All 20 studies in the review reported the mean number of questions per section, with the highest coming from musculoskeletal trauma (18.9% to 19.0%). 18 studies reported the Buckwalter taxonomic classification; 42.0% of questions were T1, 18.2% were T2, and 39.5% were T3 with a wide range from section to section. Primary sources were nearly three times more likely to be cited when compared with textbook sources. There were 12 journals that were commonly cited with the most being the Journal of Bone and Joint Surgery: American Volume (17/18). DISCUSSION: This study accurately portrays the characteristics of each section of the Orthopaedic In-Training Examination over the past 10 years. These data suggest that orthopaedic residents may be inclined to focus on musculoskeletal trauma, topics related to clinical management, and primary journal sources for studying. In addition, residency programs may choose to focus on higher yield sources or material to prepare their residents for the examination.

Leadership Trends at Hand Surgery Fellowships.

BACKGROUND: Fellowship directors (FDs) influence the future of trainees in the field of hand surgery. Currently, there are no studies that analyze the demographic background, institutional training, and academic experience of hand surgery FDs. This study aims to serve as a framework to understand the landscape of current leadership positions in hand surgery education and to identify opportunities to improve FD diversity. METHODS: The American Society for Surgery of the Hand Fellowship Directory was reviewed to include all hand surgery fellowships in the United States. Collected demographic information regarding FDs included age, sex, ethnicity, residency/fellowship training, residency/fellowship graduation year, year hired by current institution, time since training completion until FD appointment, length in FD role, and H-index. RESULTS: Of the 90 FDs included, 86.7% were men and 71.4% self-reported as Caucasian. The average H-index was 13.98 and significantly correlated with age and duration as FD; 71.1% of FDs were trained in orthopedic surgery. The most attended residency program was the University of Pennsylvania; Mayo Clinic and Harvard University were the most represented fellowship programs. CONCLUSION: This review reveals specific trends in demographic backgrounds, institutional training, and academic experiences among current FDs in hand surgery. Our observations, such as racial/ethnic and sex disparities, may offer opportunities to improve the representation of the communities these physicians serve. In addition, the trends described in this study provide objective data among current hand surgery FDs and could serve as a guide for individuals who desire academic leadership roles.

Radiographic Outcomes following K-Wire Augmentation of Dorsal Spanning Plate Fixation for Intra-Articular Fractures of the Distal Radius.

Background Restoration of articular surface alignment is critical in treating intra-articular distal radius fractures. Dorsal spanning plate fixation functions as an internal distraction mechanism and can be advantageous in the setting of highly comminuted fracture patterns, polytrauma patients, and patients with radiocarpal instability. The addition of K-wires to support articular surface reduction potentially augments fracture repair stability. Questions/Purposes We examined the radiographic outcomes and maintenance of reduction in patients with comminuted intra-articular distal radius fractures treated with K-wire fixation of articular fragments followed by dorsal spanning plate application. Patients and Methods We reviewed 35 consecutive patients with complex intra-articular distal radius fractures treated with dorsal spanning plate and K-wire fixation between April 2016 and October 2019. AO classification was recorded: B1 (3), B3 (2), C2 (2), C3 (28). A two-tailed paired t -test was used to compare findings immediately post-dorsal spanning plate surgery and at final follow-up after dorsal spanning plate removal. Results Mean patient age was 43.3 years (19-78 years). Mean follow-up was 7.8 months (SD 4.3 months) from surgery and 2.5 months from pin removal (SD 2.6 months). All patients achieved radiographic union. Radial height (mean interval change (MIC) 0.2 mm, SD 2.2, p = 0.63), articular step-off (MIC 0.1 mm, SD 0.6 mm, p = 0.88), and radial inclination (MIC -1.1 degrees, SD 3.7 degrees, p = 0.10) did not change from post-surgery to final follow-up. Ulnar variance (MIC -0.9 mm, SD 2.0 mm, p = 0.02) and volar tilt (MIC -1.5 degrees, SD 4.4 degrees, p = 0.05) were found to have decreased. Conclusion Dorsal spanning plate augmented with K-wire fixation for comminuted intra-articular distal radius fractures in polytrauma patients allows for immediate weightbearing and maintains articular surface alignment at radiographic union and may provide better articular restoration than treatment with dorsal spanning plate alone. Level of Evidence This is a Level IV , therapeutic study.

The Effects of Face Masks on the Doctor-Patient Relationship in Orthopaedics.

Background: Since the onset of the COVID-19 pandemic, the widespread use of face masks has grown exponentially. There is limited data highlighting the patient perception of face mask use during this pandemic, specifically in orthopaedic clinics. The purpose of this study was to determine the patient's perception of the implementation of face masks in the orthopaedic clinic during a period of mask mandates and if this change impacted the success of their interactions with physicians. The secondary aim includes measures of patient satisfaction such as the ability to understand conversation and communicate effectively with the physician. Methods: Participants were recruited on the day of their appointment at our institution's orthopaedic clinic and provided with instructions via email. The online, anonymous survey included the CARE questionnaire - a tool to examine patient satisfaction by assessing perception of empathy and was conducted using Qualtrics. Results: Does patient preference to have their physician wear a face mask impact the success of their interactions with physicians? Overall, the use of face masks by physicians did not negatively impact patient encounters. CARE scores for patients who preferred masks (37.2) were similar to those who preferred their physician did not wear a mask (37.5). Is patient satisfaction affected by the use of face masks in the orthopaedic clinic? Patients who preferred that their doctor wear a face mask stated that it had no negative impact on the effect of communication or conversation with the physician. Other factors such as how well the patients knew the physician and patient gender had a greater impact on the CARE score than masks did. Conclusion: Our study determined that the preference of face masks by patients does not impact the success of their interactions with physicians using the CARE score. The findings of this study are valuable in informing orthopaedic physicians about patient attitudes towards mask use and could influence decision making for not only the COVID-19 pandemic, but also future infectious outbreaks that may arise. Level of Evidence: III.

Electric scooters as a source of orthopedic injuries at a Level-I trauma center.

Introduction: Electric scooter rentals are offered by major ridesharing companies as a new and alternative method for urban travel in major metropolitan areas. The correlation between motorized electric scooter rental services and orthopedic injuries has not been well scrutinized. The purpose of our study is to evaluate orthopedic injuries sustained by motorized scooter riders and their potential correlation with patient demographics and associated injuries. Methods: We retrospectively reviewed level 1 trauma center patients with orthopedic injuries sustained while riding motorized electric scooters from 4/2019-11/2019. Demographics, fracture characteristics, and patient management were examined. Results: Sixty-two patients sustained 86 orthopedic injuries. There were 56 (65.1%) upper extremity and 29 (33.7%) lower extremity injuries. Six patients (9.7%) suffered open injuries and 30 (48.4%) sustained injuries that required surgery. Anatomic location of the injury was associated with both the presence of open fracture and needing surgery (P = 0.016 and P less than 0.001, respectively). Also, the presence of multiple orthopedic injuries was associated with the need for surgery (P less than 0.001). Scooter collision events were significantly associated with multiple orthopedic and the presence of non-orthopedic injuries (P less than 0.01 and P less than 0.01). Conclusion: Electric scooter accidents can result in orthopedic injuries, many of which require surgery. Caution should be exercised when riding electric scooters, and special attention should be given by trauma centers and emergency departments to patients who present after electric scooter injury as the potential for orthopedic injury is high with this mechanism of injury.

Dorsal Spanning Plate for Perilunate Dislocations.

Purpose The purpose of this study was to compare radiographic outcomes in patients treated with the traditional method of open reduction, internal fixation (ORIF) and casting as compared with those treated with ORIF and dorsal spanning plate (DSP) fixation. We hypothesized that the application of a DSP to augment the repair of perilunate dislocations would maintain carpal stability while also allowing early loadbearing through the carpus. Materials and Methods This is a retrospective radiographic review of patients with a perilunate dislocation, who were treated with ORIF and casting or ORIF with a dorsal spanning plate between 2012-2018. Scapholunate (SL) and lunotriquetral (LT) intervals were measured immediately after the index surgery and after scheduled hardware removal. A total of 28 patients met inclusion criteria, including 13 cases with traditional treatment and 15 cases with dorsal spanning plate fixation. Results Comparison of the change in SL interval and LT interval between the 13 patients in the traditional treatment group and the 15 patients in the DSP group did not yield any clinically relevant variation after statistical analysis. Both groups demonstrated minimal change in the radiographic markers of carpal stability from postoperative radiographs obtained immediately after the index repair and after the removal of hardware. Conclusion DSP fixation placed at the index surgery with early loadbearing for the treatment of perilunate dislocation is not inferior to the current mainstay of treatment consisting of cast immobilization without loadbearing and does not confer any increased carpal instability in comparison to ORIF and casting.

Expertise of Surgeons Publishing Novel Techniques in the Journal of Wrist Surgery.

Introduction Recent efforts to standardize reporting of surgeon experience in novel technique publications have recommended reporting of Tang level of expertise (LOE). Question/Purpose The aim of this study was to document trends in LOE reporting for novel technique articles published in the Journal of Wrist Surgery and evaluate whether author experience affects novel research outcomes. Methods A total of 261 articles published from 2018 to 2020 were reviewed. Articles describing novel surgical techniques were included and examined for Tang LOE. Author variables were collected online. Results Eight percent (21/261) of articles discussed novel surgical techniques and one reported LOE. Nearly half (47.6%) of articles did not conduct statistical analysis. Four (19.0%) reported insignificant statistical results and 7 (33.3%) reported significant findings. All significant statistical findings were positive. Number of prior related publications by the senior author did not affect new technique result significance ( p = 0.34). Discussion From 2018 to 2020, only one article documented LOE. Authors' variables, including number of prior related publications, were not correlated with significant results in their new publications. This may suggest that an author's established experience in a novel technique, quantified by prior publications on the topic, does not make one more likely to achieve significantly better or worse outcomes in their reviewed Journal of Wrist Surgery study. Conclusions Tang LOE is an important way for readers to classify expertise and should be reported, and potentially modified to better define contributing variables.

Virtual Versus In-person Grand Rounds in Orthopaedics: A Framework for Implementation and Participant-reported Outcomes.

INTRODUCTION: Grand rounds have been weekly gatherings at academic orthopaedic surgery programs across the country for decades. During the 50th year of grand rounds at our institution, the COVID-19 pandemic prompted the transformation of this in-person forum into a virtual setting. The purpose of this study was to detail this initiative and to report survey data providing participant-reported perceptions and satisfaction of virtual versus in-person grand rounds. MATERIALS AND METHODS: Once in-person meetings were discontinued, virtual grand rounds commenced using the Zoom video application. At the conclusion of the 2020 to 2021 academic year, a 30-item online survey was sent to all residents, faculty, and visiting faculty to assess their perspective and satisfaction. A five-point Likert scale ranging from 1 to 5, with 5 being extremely effective, was used. A 21-item follow-up survey was sent to all speakers as well. RESULTS: Thirty-six virtual grand rounds were successfully hosted. The response rate for the survey was excellent-80 of 86 (93.0%) surveys returned completed. Respondents found that virtual grand rounds were more convenient to attend, were more convenient to obtain Continuing Medical Education, and were more satisfied with virtual grand rounds. Respondents reported that in-person grand rounds were more effective for stimulating social collegiality and networking. Speakers found that virtual grand rounds were more effective for uploading the presentation and overall convenience, whereas they were less effective at retaining audience attention and receiving audience feedback. Improved faculty attendance after the switch to virtual grand rounds was also noted. CONCLUSION: This study found that respondents across all groups appreciated the convenience of attending and obtaining Continuing Medical Educations at virtual grand rounds while also noting the merits of in-person grand rounds for promoting peer interaction, camaraderie, and departmental identity. All respondents strongly recommended continuation of this program in a hybrid format. Virtual orthopaedic grand rounds are viable, readily implemented and demonstrate improved participant satisfaction.

Watercraft propellers as a mechanism of orthopaedic injuries: injury patterns, management, and complications.

INTRODUCTION AND PURPOSE: Recreational watercraft use is popular across the United States, and there is a high rate of injury associated with the use and misuse of these vehicles. Watercraft propeller injuries represent a particularly devastating mechanism of injury. We aim to describe and analyze the range of orthopaedic injuries sustained from a watercraft propeller with a particular focus on the mechanism, injury pattern, management, and complications associated with these unique, high-energy injuries. MATERIALS AND METHODS: A retrospective review of 42 patients who sustained injuries from watercraft propeller that presented to a level 1 trauma center was performed. Data collected included patient demographics, mechanism of injury, surgical management, antibiotic use, and complications. RESULTS: Forty-two patients sustained 96 fractures. Ninety-one fractures (94.8%) were open and 5(5.2%) were closed. Twenty (20.8%) were of the upper extremity, 70(72.9%) were of the lower extremity, and 6(6.3%) were of the pelvic ring. The majority of open fractures were Gustilo-Anderson Type IIIA or greater (54, 59.3%). There were 9 total infections affecting 8 of 96 fracture sites (cumulative risk of 8.3%), and other complications included stiffness (3), heterotopic ossification (1), non-union (1), flap failure (1), DVT (2), PE (1), and systemic infection (1) for a total of 19 complications. CONCLUSIONS: Watercraft propellers often result in devastating injuries with high rates of morbidity. The high rate of open fractures and neurovascular injury, necessity for multiple surgeries, and extended length of hospital stay show the need for continued awareness about boat safety and the danger of propellers.

Pediatric injuries related to electric scooter use: a national database review.

Electric scooter (e-scooter) use and resulting injuries have grown exponentially since expansion into ridesharing in 2017. No study has described pediatric e-scooter injuries and focused on their impact in an adolescent cohort. Our primary purpose was to describe the epidemiology of admitted pediatric e-scooter injuries and compare them with existing literature on adults. We queried the National Electronic Injury Surveillance System for e-scooter injuries between 2015 and 2019 in patients 0-18 years old. Injuries caused by an e-scooter to a nonrider were removed. Patients admitted to the hospital were analyzed and weighted national estimates were calculated. A P value of <0.05 was considered significant. Nine hundred and two pediatric patients were treated for an e-scooter injury at an emergency department (ED) between 2015 and 2019. Among those admitted (n = 47), 72.3% were men, and the average age at injury was 11.3 years. Among all injuries (n = 56), the most common diagnosis was fracture (24/56, 42.9%). The 19% (9/47) of patients that experienced polytrauma were significantly older than those with single injuries (P < 0.001). ED admissions grew by 616% from 2017 to 2018. Children experience a greater rate of fractures and polytrauma from e-scooters compared to adults, but fewer facial injuries despite a similar rate of head trauma. The incidence of pediatric head injuries indicates a lack of helmet use similar to adults. Lawmakers should consider bolstering e-scooter regulations to decrease pediatric injuries.