Effects of Accreditation Council for Graduate Medical Education Duty Hour Regulations on Clinical Preparedness of First-Year Orthopaedic Attendings: A Survey of Senior Orthopaedic Surgeons.

It is unclear how the Accreditation Council for Graduate Medical Education (ACGME) resident duty hour restriction has affected attending orthopaedic surgeons in their first year of practice. The purpose of this study was to compare the clinical preparedness of first-year orthopaedic attending surgeons who trained with ACGME duty hour regulations versus those trained without regulations. Senior orthopaedic surgeons with greater than 10 years of experience were surveyed and results indicate that first-year attendings who trained with ACGME duty hour regulations required more supervision reviewing cases preoperatively, required more assistance completing operative cases, had inferior technical skills, had more major operative complications, had poorer physical exam skills, and delivered an inferior quality of care. Private attendings were most critical. In the postregulatory era, residency programs must optimize the resident's time to ensure competency on graduation. Strategies include increasing midlevel staff, focusing on competencies outlined by ACGMEmilestones, and increasing the role of simulation. (Journal of Surgical Orthopaedic Advances 27(1):42-46, 2018).

Determination of the Inter- and Intra-rater Reliability of Fusion Assessment in First Tarsometatarsal Joint Arthrodesis Using CT Scan: An Observational Study.

Background: First tarsometatarsal joint arthrodesis is a common procedure performed by podiatrists and orthopedic surgeons. There remains debate on how useful CT scans are in assessing fusion status in the post-operative patient. The purpose of our study was to determine the reliability among both orthopedic surgeons and radiologists in reviewing both postoperative radiographs and CT in order to determine if fusion had occurred in patients undergoing 1st tarsometatarsal arthrodesis. A secondary purpose of this study was to determine if CT offered improved inter- and intra-rater reliability when compared to plain radiographs. Methods: Patients who underwent 1st tarsometatarsal arthrodesis were retrospectively reviewed and those who underwent CT post-operatively for persistent pain were identified. Orthopedic surgeons and radiologists then analyzed the radiographs and CT of these patients for union with a threshold for union being set at 50% of the joint being fused. Imaging was then re-evaluated by the same provider 6 months later. Results: 24 patients were identified meeting inclusion criteria. Inter-rater reliability and intra-rater reliability for assessment of 1st tarsometatarsal arthrodesis were better with CT compared to radiographs; however, this association was not deemed reliable. Both imaging modalities were not able to assess union status confidently and reliably across reviewers, although CT scan had better intra-rater reliability. Conclusions: While CT is frequently used to assess fusion in patients who have underwent 1st tarsometatarsal arthrodesis, it was not found to be better than radiographs. Practitioners should reconsider the use CT as the gold standard when assessing fusion in this population.

Perceptions of social media utilization among orthopaedic foot and ankle surgeons.

BACKGROUND: The growing social media presence in healthcare has provided physicians with new ways to engage with patients. However, foot and ankle orthopaedic surgeons have been found to underuse social media platforms despite their known benefits for patients and surgeons. Thus, this study sought to investigate the reasons for this phenomenon and to identify potential barriers to social media utilization in clinical practice. METHODS: A 19-question survey was distributed to active attending physicians identified through the American Orthopaedic Foot & Ankle Society membership database. The survey included demographic, practice characteristics, and social media use questions assessed by a 5-point Likert scale. Logistic regression was used to identify predictors of positive attitudes toward social media. RESULTS: Fifty-eight surgeons were included. Most respondents were male (n = 43, 74.1%), in private practice (n = 31, 53.5%), and described their practice to be greater than 51% elective procedures (n = 46, 79.4%). The average years in practice was 14.8 years (standard deviation, SD: 10.0 years). A total of 32.8% (n = 19) of surgeons reported using social media as part of their clinical practice. Facebook (n = 19, 32.8%), a professional website or blog (n = 18, 31.0%), and LinkedIn (n = 15, 25.9%) were the most used platforms-primarily for practice marketing or brand development (n = 19, 32.8%). A total of 58.6% (n = 34) of surgeons reported they did not use social media. The primary reasons were the time commitment (n = 31, 53.5%), concerns about obscuring professional boundaries (n = 22, 37.9%), and concerns regarding confidentiality (n = 11, 19.0%). Many surgeons reported that social media positively influences foot and ankle surgery (n = 23, 39.7%), although no individual predictors for these views could be identified. CONCLUSIONS: Foot and ankle orthopaedic surgeons tended to view social media use positively, but the time investment and concerns over professionalism and confidentiality pose challenges to its use. Given the influence of a surgeon's social media identity on patient satisfaction and practice building, efforts should be made to streamline social media use for foot and ankle surgeons to establish their online presence. LEVEL OF EVIDENCE: Level IV, cross-sectional study.

New copper(II) µ-alkoxo-µ-carboxylato double-bridged complexes as models for the active site of catechol oxidase: synthesis, spectral characterization and DFT calculations.

A series of four copper(II) µ-Alkoxo-µ-carboxylato double bridged complexes, [{Cu2(L)}2][(µ-O2C-CO2] 1, [{Cu2(L)}2(µ-O2C-(CH2)CO2] 2, [{Cu2(L)}2(µ-O2C-CH2-CO2] 3 and [{Cu2(L)}2(µ-O2C-C6H4-CO2] 4 (H3L = 4-bromo-2-((E)-((3-(((E)-5-chloro-2-hydroxybenzylidene) amino)-2-hydroxypropyl) imino) methyl)-6-methoxyphenol and µ-dicarboxylate ions = oxalate, malonate, succinate and terephthalate) have been synthesized and characterized using several physicochemical techniques. The tridentate nature of H3L is interpreted from IR spectra. The Epr spectra of these complexes are characteristic of the quintet state (S = 2) in central features and the triplet state (S = 1) of these tetranuclear complexes. The electrochemical potential of these complexes was investigated using CV (cyclic voltammetry) and DPV (differential pulse voltammetry). All complexes showed quasi reversible reduction peaks in the cathodic region. To explore the stability of these complexes, quantum chemical parameters like electronegativity, ionization potential, electron affinity, global hardness and softness, and electrophilicity were estimated and discussed. The synthesized complexes have been designed as structural and functional models of the catechol oxidase enzymes to investigate the catecholase activity. Additionally, superoxide dismutase activity data of all complexes have also been evaluated and compared with known SOD mimics.

Plate Alone Versus Plate and Lag Screw for Lapidus Arthrodesis: A Biomechanical Comparison of Compression.

Background. Arthrodesis of the first tarsal metatarsal joint can be accomplished in many ways. The compressive force attained between various constructs remains unclear. This study compares compression achieved through a locking/compression Lapidus plate both with and without the addition of a lag screw. Methods: A dorsal medial Lapidus/locking compression plate (Total Compression Plate System, OrthoPro, Salt Lake City, UT, now Wright Medical) was applied to one cadaveric limb, while the same plate with the addition of a 4.0-mm cannulated lag screw was applied to the contralateral limb for a total of 5 matched pairs of cadaveric specimens. Compressive force was recorded over time and compared between the constructs using a compression sensor (8" FlexiForce Resistive Force Sensor, Phidgets Inc, Calgary, Alberta, Canada). Results: Compression was maintained for 45.4 minutes in the plate only construct, and 317 minutes with the addition of the lag screw (P = .010). The mean time to 50% peak compression for the plate only construct was 4.90 minutes compared with 15.11 minutes for plate with lag screw construct (P = .012). Conclusion: The addition of a lag screw is recommended for extending the length of compression and possibly reducing nonweightbearing time and the risk of nonunion. Levels of Evidence: Level V.

A locking compression plate versus the gold-standard non-locking plate with lag screw for first metatarsophalangeal fusion: A biomechanical comparison.

INTRODUCTION: The treatment of end-stage first metatarso-phalangeal joint (MTP) arthritis has been arthrodesis. A dorsal non-locking plate with a lag screw has been the standard traditional fixation method. This study compares the biomechanical strength of a locking compression plate (LCP) with and without internal compression versus this known gold standard. METHODS: In group 1, six matched pairs of cadaver great toes were used to compare the standard non-locking dorsal plate and 3.5mm lag screw to an anatomic locking compression plate in which a lag screw was utilized rather than the internal compression features of the plate. In group 2, another six matched pairs of cadaver great toes were used to compare the gold standard to the locking compression plate, utilizing the plate's internal compression feature instead of a lag screw. A material testing system (MTS) machine applied loads to the MTP joints and measured displacement and stiffness of the constructs. The stiffness of the constructs (Young's modulus) was calculated from the force-displacement curves, and the displacement was measured. RESULTS: The locking compression plate group that used the compression features of the plate, without the lag screw, had less joint displacement and higher stiffness than control (p<0.05). The same plating construct in which a lag screw was used rather than internal compression of the plate was found to be stiffer than the control (p<0.05), but displacement was not statistically significant. DISCUSSION: The results suggest that a locking compression plate alone provides the stiffest construct for a first MTP joint fusion.

Unprecedented tetranuclear complexes with "weighing balance shaped" topology: single crystal structures, unusual EPR spectra, magnetic properties and antioxidant activity.

Using the 2-hydroxy-N'-[(E)-phenyl(pyridin-2-yl)methylidene]benzohydrazide ligand and dicarboxylate anions (succinate and malonate), two new copper(ii) complexes of formula [Cu4(µ-L)4(µ-CH2(COO)2)(H2O)3](NO3)2·4H2O (1) and [Cu4(µ-L)4(µ-CH2-CH2(COO)2)(H2O)](NO3)2] (2) have been synthesized and characterized by single crystal X-ray diffraction. Complexes 1 and 2 contain a dicarboxylate bridged tetranuclear Cu(ii) cationic unit with "weighing balance shaped" topology. These compounds have also been studied by variable temperature magnetic susceptibility measurements, X-band EPR spectroscopy and electrochemistry. The unprecedented tetranuclear copper complexes 1 and 2 exhibit antiferromagnetic interactions between adjacent copper(ii) centers with magnetic exchange coupling constants (J) of J1 = -6.8 cm-1, J2 = -20.6 cm-1 and g = 2.03 for 1 and J1 = -3.1 cm-1, J2 = -13.9 cm-1 and g = 2.02 for 2. The goal for our research work is to understand the factors that govern the stability of the Cu-O(-O-C-O-) bond towards reactive oxygen species (ROS) in Cu-containing mimics utilizing a systematic approach. The antioxidant superoxide dismutase measurements indicate that these complexes behave as superoxide dismutase mimics.

In-Patient Trends and Complications After Total Ankle Arthroplasty in the United States.

The number of total ankle arthroplasties (TAAs) performed annually in the United States has increased. The purpose of this study was to evaluate the in-patient demographics, complications, and readmission rates of patients after TAA at academic medical centers in the United States. The University HealthSystems Consortium administrative database was searched for patients who underwent TAA in 2007 to 2011. A descriptive analysis of demographics was performed, followed by a similar analysis of clinical benchmarks, including hospital length of stay, hospital direct cost, in-hospital mortality, and 30-day readmission rates. The study included 2340 adult patients with a mean age of 62 years (47% men and 53% women) who underwent TAA. The majority of patients were Caucasian (2073; 88.5%). Average hospital length of stay was 2.2±1.26 days. Average total direct cost for the hospital was $16,212±7000 per case, with 49.7% of patients having private insurance. In-hospital mortality was less than 1%, and overall complications were 1.4%. Complications after discharge included deep venous thrombosis (2.3%), reoperation (0.7%), and infection (3.2%). A readmission rate of 2.7% within the first 30 days from the time of discharge occurred. Total ankle arthroplasty in the United States is a relatively safe procedure with low overall complication rates. Patients who are male, have a history of community-acquired pneumonia, and have a larger number of preoperative comorbidities had a significant increased risk of developing 1 complication within 30 days of surgery.

Open Reduction Internal Fixation of Posterior Malleolus Fractures and Iatrogenic Injuries: A Cadaveric Study.

Open reduction internal fixation of posterior malleolus fractures from a posterior approach is gaining popularity. One concern that has not been studied is the risk of iatrogenic injury to anatomical structures on the anterior ankle. The purpose of this study is to determine the proximity of these anterior structures with relation to K-wires advanced through the anterior cortex. A total of 10 cadaver ankles were utilized in the study. A posterolateral approach to the ankle was used. K-wires were advanced at varying levels above the articular surface, and then, the proximity of the wires to the following structures was determined: the neurovascular bundle, tibialis anterior (TA), and extensor hallucis longus. Overall, the structure most in danger of being injured was the TA (P < .001). This tendon was injured by 52% of all K-wires. These data suggest that K-wires should be advanced under direct fluoroscopic visualization to minimize the risk of iatrogenic injury. LEVELS OF EVIDENCE: Level IV.

Peroneal nerve compression secondary to an anomalous biceps femoris muscle in an adolescent athlete.

Common peroneal nerve compression is a well-recognized entity that can cause severe debilitating clinical manifestations. The current literature describes numerous locations and mechanisms of compression, including both structural and systemic causes. Anatomical variants should be considered part of the differential diagnosis in peroneal nerve impingement. We present the case of a 14-year-old basketball player with footdrop secondary to compression of the common peroneal nerve from an accessory biceps femoris muscle, which was treated by neurolysis. In addition, we review the systematic workup of patients with nerve compression.