Venous Thromboembolism Chemical Prophylaxis in Patients Undergoing Shoulder Arthroscopy.

¼ Venous thromboembolism (VTE) after shoulder arthroscopy is rare (0.01%-0.38%) but impacts a significant number of patients because of the high procedure volume.¼ Studies found no significant benefit in reducing VTE risk with aspirin or low-molecular-weight heparins.¼ Current guidelines for thromboprophylaxis in shoulder arthroscopy lack consensus and need patient-specific considerations.¼ Further research is required to develop evidence-based thromboprophylaxis guidelines for shoulder arthroscopy.

Examining the Healthcare and Economic Burden of Gun Violence in a Major US Metropolitan City.

INTRODUCTION: The highest rates of fatal and nonfatal injury due to firearms occur in the Southern United States. This study examined the epidemiology of gunshot wound (GSW) injuries and the association of injury severity with mortality. METHODS: This is a retrospective cross-sectional analysis of 2016 to 2019 data from a mandatory reporting system for all licensed hospitals in Louisiana. Patients aged 18 years and older at the time of hospitalization for GSW were included. Injury severity was measured by the New Injury Severity Score (NISS). Primary outcomes assessed included mortality, length of stay, and total hospital charges. RESULTS: There were 1,709 firearm injuries identified. The patient sample was 83.2% Black and 87.4% male, with a mean age of 34 years. Orthopaedics was the most frequently consulted surgical service. Total hospital visit charges for all GSW-associated care were $262.4 million. The multivariable adjusted odds ratio and 95% confidence interval for mortality associated with a high NISS was 16.32 (8.96, 29.72). CONCLUSION: This study demonstrated the utility of NISS as a predictor of total hospital charges and length of stay, in addition to its well-established role as a predictor of mortality. Epidemiologic trends in GSW pathologies and associated procedures at a major urban trauma center were also reported. LEVEL OF EVIDENCE: Level III, prognostic study.

A Modified Technique of Percutaneous Fixation of Displaced Pediatric Lateral Humeral Condyle Elbow Fractures (aka the Martini Technique): A Brief Case Series.

Displaced lateral humeral condyle (LHC) fractures have routinely been treated with open reduction, which has known postoperative complications. Recent reports show that closed reduction and percutaneous pinning (CRPP) is a valid treatment. Five pediatric patients with displaced LHC fractures were included in a retrospective case series. Closed reductions (CRs) were facilitated by Kirschner wire placement into the capitellum through a toothed drill guide. The Kirschner wire and drill guide were used like a joystick to manipulate the fragment and maintain reduction for placement of additional Kirschner wires. Patient records were used to determine the number of patients diagnosed with LHC fractures between 2011 to 2022 among six pediatric orthopaedic surgeons at one institution along with the treatment and associated complications. Satisfactory reduction of displaced LHC fractures was achieved with CRPP in all patients with no complications using the "martini" modification. Of 26 LHC fractures, 16 were treated with CRPP/CRPS and 10 with open reduction and percutaneous pinning/open reduction and internal fixation, with four converted from CR to OR. Complications included one superficial infection in the CR group and four stiff elbows and one nonunion in the OR group option for LHC fractures. CRPP is an effective treatment option with a decreased risk of complications. Our modified reduction technique may help improve the success and results of closed treatment of LHC fractures.

Concussion Education for Athletes: Symptom Reporting and Safe Return to Sport.

¼ Educational programs on concussion have been demonstrated to improve knowledge for athletes, families, athletic trainers, and coaches about concussion, with the goal of reducing concussion incidence, duration, severity, and complications.¼ Despite the widespread availability and often mandatory concussion education provided to high school and collegiate athletes, there has not been an adequate change in knowledge, attitudes, and self-reporting behavior in this population.¼ Recently published studies suggest improving concussion education by emphasizing athletes' symptom reporting behavior, to contrast with current emphasis on knowledge-based outcomes.¼ Future educational programs about concussions for athletes, families, athletic trainers, and coaches should aim to emphasize cultural and behavioral changes that demonstrate outcome changes rather than solely evaluating knowledge improvements to determine effective programming.

The Top 50 Articles on Knee Posterolateral Corner Injuries.

Purpose: To identify and characterize the most cited publications in orthopaedic research related to posterolateral corner (PLC) injuries of the knee. Methods: The Science Citation Index Expanded was queried for PLC injury articles. The 50 most-cited studies from 1976 to 2021 were selected. Article characteristics, including number of citations, citation density, year of publication, source journal, country of origin, article type, article subtype, and level of evidence, were analyzed. Results: The number of citations for individual articles ranged from 47 to 205. The 50 most cited articles were published in 16 journals. Eleven of the 50 articles (22%) were published in Arthroscopy-The Journal of Arthroscopic and Related Surgery. The largest proportion of the articles (n = 22, 44%) were classified as clinical, with the rest classified as reviews (n = 15, 30%), and basic science research (n = 13, 26%). The most common level of evidence for clinical articles was IV (14/22, 63.6%). Nine countries contributed to the top 50 articles, with the majority published in the United States (n = 35, 70%). Conclusions: In the last 20 years, papers published on the diagnosis and surgical management of PLC injuries have a high citation frequency. Future high-quality research is needed to establish best-practice guidelines for the management of PLC injuries due to the low overall level of evidence of existing clinical studies. Clinical Relevance: This research provides a comprehensive list for practitioners and may help educators identify articles to include in the curriculum for residents and fellows.

Women in Leadership in State and Regional Orthopaedic Societies.

INTRODUCTION: Female representation in orthopaedics remains low compared with other specialties. Recently, several studies have examined the membership composition and leadership roles of women in orthopaedic societies. However, there is a paucity of information on the possible connection between the number of women within state and regional orthopaedic societies and women who serve in leadership roles within these societies. METHODS: Authors invited executive directors of 51 state and four regional orthopaedic societies to participate in an anonymous 14-question web-based survey about female members and women in leadership positions within these societies. The survey asked about female membership composition, the percentage of male and female practicing orthopaedic surgeons in the state/region (if available), and female representation on the Board of Directors of these societies. Data were analyzed for relationships between ordinal variables. RESULTS: Forty-nine executive directors (89.1%) responded to the survey. Among respondents, there was a statistically significant positive correlation between the percentage of female members and women leaders (P = 0.015). Thirty-two executive directors (68.1%) reported between 1% and 10% female members, 7 (14.9%) had between 11% and 20% female members, and 2 (4.3%) had no female members. Twenty-five societies (52.1%) have never had a female president. Of 17 societies (32.7%) that had female presidents, 15 (75.0%) reported having just one female president. In addition, of these 17 societies, 12 (70.6%) reported having at least one acting female president within the past 10 years. DISCUSSION: Our study demonstrates a positive correlation between female members and women on the Board of Directors in regional and state orthopaedic societies. Twelve societies had female presidents within the past 10 years. Female representation in leadership positions may help with the recruitment of female orthopaedic surgeons and improve diversity in orthopaedics. Future studies should evaluate different methods of increasing female membership and leadership positions in state and regional orthopaedic societies.