Surgeon specialty effect on early outcomes of elective posterior spinal fusion for adolescent idiopathic scoliosis: a propensity-matched analysis of 965 patients.

BACKGROUND AND OBJECTIVE: Comparative effectiveness research plays a vital role in health care delivery. Specialty training is one of these variables; surgeons who are trained in different specialties may have different outcomes performing the same procedure. The objective of this study was to investigate the impact of spine surgeon specialty (neurosurgery vs orthopedic surgery) on early perioperative outcome measures of elective posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). METHODS: This is a retrospective, 1:4 propensity score-matched cohort study. 5520 AIS patients were reviewed from ACS-NSQIP pediatric database. Propensity score matching was utilized. RESULTS: Patients operated on by orthopedic surgeons were more likely to have shorter operation time (263 min vs 285 min), shorter total hospital stay (95 h vs 118 h), lower rate of return to operating room within the same admission (1.2% vs 3.8%), lower discharge rates after postoperative day 4 (23.8% vs 30.9%), and lower unplanned readmission rate (1.6% vs 4.1%), (p < 0.05). On the other hand, patients operated on by neurosurgeons had lower perioperative blood transfusion rate (62.1% vs 69.8%), (p < 0.05). Other outcome measures and mortality rates were not significantly different between the two cohorts. CONCLUSIONS: This retrospective study found significant differences in early perioperative outcomes of patients undergoing PSF for AIS by neurosurgeons and orthopedic surgeons. Further studies are recommended to corroborate this finding which may trigger changes in the educational curriculum for neurosurgery residents.

Repetitive Musculoskeletal Injuries: A Survey of Female Adult Reconstruction Surgeons.

BACKGROUND: Occupational injuries are a prevalent and costly problem for orthopedic surgeons, especially arthroplasty surgeons performing physically demanding and repetitive tasks. The purpose of this study was to characterize occupational musculoskeletal injuries in female adult reconstruction surgeons. METHODS: A prospective survey about workplace musculoskeletal injuries was distributed to female attending adult reconstruction surgeons in May 2020. Participants were identified using subspecialty membership data, social media, and personal contacts. Results were analyzed using descriptive statistics. RESULTS: Of the total 63 female arthroplasty surgeons who responded, 65.1% were 30-45 year old, and 42.9% were within 5 years of practice, 68.3% sustained an occupational musculoskeletal injury, most commonly forearm/wrist/hand (79.1%), shoulder (48.8%), and low back (44.2%); 10.0% of reported occupational injuries not related to pregnancy resulted in the surgeon requiring time off work, while 48.2% required temporary modifications of job performance, and 10.9% required surgical treatment. Of the injured surgeons who reported having been pregnant, 65.4% reported a workplace exacerbation of a pregnancy-related musculoskeletal condition, including low back pain (52.9%), pubic symphysis pain (35.3%), and carpal tunnel syndrome (29.4%). CONCLUSION: A total of 68.3% of female arthroplasty surgeons reported occupational musculoskeletal injuries, predominately forearm/wrist/hand, with a portion of those requiring modifications of job performance. Musculoskeletal injuries may be mitigated by performing repetitive tasks ergonomically, correcting posture, using appropriately sized instrumentation, and using automated or lighter instruments, to potentially avoid modifications to job performance, time off work, or even surgical procedures. Further studies should investigate factors that contribute to injuries in arthroplasty surgeons and how they can be prevented.

Current Trends in Knee Arthroplasty: Are Italian Surgeons Doing What Is Expected?

OBJECTIVES: The purpose of this study is to evaluate Italian surgeons' behavior during knee arthroplasty. MATERIALS AND METHODS: All orthopedic surgeons who specialized in knee replacement surgeries and were members of the Italian Society of Knee, Arthroscopy, Sport, Cartilage and Orthopedic Technologies (SIGASCOT) between January 2019 and August 2019 were asked to complete a survey on the management of knee arthroplasty. Data were collected, analyzed, and presented as frequencies and percentages. RESULTS: One-hundred and seventy-seven surgeons completed the survey and were included in the study. Ninety-five (53.7%) surgeons were under 40 years of age. Eighty-five surgeons (48%) worked in public hospitals and 112 (63.3%) were considered "high volume surgeons", with more than 100 knee implants per year. Postero-stabilized total knee arthroplasty was the most commonly used, implanted with a fully cemented technique by 162 (91.5%) surgeons. Unicompartmental knee arthroplasty (UKA) was a rarer procedure compared to TKA, with 77% of surgeons performing less than 30% of UKAs. Most common TKA pre-operative radiological planning included complete antero-posterior (AP) weight-bearing lower limb radiographs, lateral view and patellofemoral view (used by 91%, 98.9% and 70.6% of surgeons, respectively). Pre-operative UKA radiological images included Rosenberg or Schuss views, patellofemoral view and magnetic resonance imaging (66.1%, 71.8% and 46.3% of surgeons, respectively). One hundred and thirty-two surgeons (74.6%) included an AP weight-bearing lower limb X-ray one year after surgery in the post-operative radiological follow-up. Furthermore, 119 surgeons (67.2%) did not perform a post-operative patellofemoral view because it was not considered useful for radiological follow-up. There was no uniformity in the timing and features of post-operative follow-up, with 13 different combinations. CONCLUSIONS: Italian surgeons perform TKA more commonly than UKA. Pre-operative TKA planning is quite uniform rather than UKA planning. Despite literature evidence, there is no agreement on follow-up. It may be useful to create a uniform checklist, including correct timing and exams needed. This analysis is also part of a society surgical educational project for training doctor.

Physiotherapists' ability to diagnose and manage shoulder disorders in an outpatient orthopedic clinic: results from a concordance study.

BACKGROUND: Advanced practice physiotherapy has emerged as a promising solution to improve health care access because access to orthopedic care is limited in several countries. However, evidence supporting advanced practice physiotherapy models for the management of shoulder pain remains scarce. The purpose of this study was to establish diagnostic, surgical triage, and medical imaging agreement between advanced practice physiotherapists (APPs) and orthopedic surgeons (OSs) for the management of patients with shoulder disorders in an outpatient orthopedic clinic. METHODS: Patients referred to an OS for shoulder complaints were recruited and independently assessed by an OS and an APP. Each provider completed a standardized form indicating diagnosis, imaging test requests, and triage of surgical candidates. Patient satisfaction with care was recorded with the 9-item Visit-Specific Satisfaction Questionnaire (VSQ-9). Inter-rater concordance was calculated with the Cohen κ, prevalence-adjusted bias-adjusted κ, and associated 95% confidence interval (CI). We used χ2 tests to compare differences between providers in terms of treatment plan options and Student t tests to compare patient satisfaction between providers. RESULTS: Fifty participants were evaluated. Good diagnostic agreement was observed between providers (κ, 0.80; 95% CI, 0.67-0.93). Agreement for triage of surgical candidates was moderate (κ, 0.46; 95% CI, 0.21-0.71) as APPs tended to refer patients more often to OSs for further evaluation. Imaging test request agreement was moderate as well (κ, 0.42; 95% CI, 0.19-0.66). Patient satisfaction with care was high, with no significant differences found between providers (P = .70). CONCLUSION: APPs could improve access to orthopedic care for shoulder disorders by safely initiating patient care without compromising satisfaction. These results support further development and evaluation of APP care for orthopedic patients presenting with shoulder disorders.

Patient-Recorded Physician Ratings: What Can We Learn From 11,527 Online Reviews of Orthopedic Surgeons?

BACKGROUND: Physician rating websites have become an increasingly popular medium for patients to give feedback and to obtain information about physicians. Each physician rating website uses different criteria to evaluate physicians, with the option for patients to provide written reviews. Our goal is to identify factors that patients value when seeking an orthopedic surgeon. METHODS: The study design was observational. We analyzed 7 common physician rating websites (RateMDs.com, HealthGrades.com, Vitals.com, WebMD.com, CareDash.com, Wellness.com, and ZocDoc.com) to evaluate orthopedic surgeon ratings and examine the variables that influence these ratings. Numeric ratings were standardized on a scale from 0-100 (higher number = positive rating). Multilevel mixed-effect Poisson regression models were used where appropriate. RESULTS: A total of 11,527 online reviews of orthopedic surgeons in a single metropolitan area were evaluated in April 2019. The average overall rating was positive at 83.66 (±12.33) on our scale. The majority of surgeons amassed ≤20 reviews on each website. Higher ratings were correlated with staff friendliness (P = .010), punctuality (P = .009), and knowledge/expertise (P = .031). Analysis of written reviews showed that resolution of original patient complaints was associated with a high-scoring review. CONCLUSION: This study may impact the ability of orthopedic surgeons to improve patient satisfaction and experience. The online image of orthopedic surgeons is positive in general, with weight placed on timeliness, knowledge, and staff friendliness. Further study is needed to examine whether differences exist in patient-centric domains reviewing orthopedic subspecialties. Future multiple geographic area studies will help elucidate any regional variation in patient-recorded data, as well as the role of any participation bias.

Limb Lengthening and Reconstruction Society orthopedic surgeons in the United States: An analysis of geographical distribution, academic, leadership, and demographic characteristics.

BACKGROUND: The Limb Lengthening and Reconstruction Society (LLRS) is a premier orthopedic specialty organization that promotes limb reconstruction for all ages. LLRS membership characteristics, however, are poorly reported. This study delineates orthopedic surgeon LLRS members' demographic traits, academic achievement, leadership attainment, and geographical distribution across the United States. AIM: To inform aspiring orthopedic professionals, as well as to promote growth and diversity in both the LLRS organization and overarching field. METHODS: This cross-sectional study examined United States LLRS members' academic, leadership, demographic, and geographical attributes. After reviewing the 2023 LLRS member directory, Google search results were matched to the listings and appended to the compiled data. Sex and ethnicity were evaluated visually utilizing retrieved images. The Hirsch index (H-index) of academic activity, residency and fellowship training, other graduate degrees, leadership positions, practice type (academic or non-academic), and spoken languages were categorized. LLRS members per state and capita determined geographic distribution. The Mann-Whitney U test was applied to compare H-index between males and females, as well as to assess member differences pertaining to affiliation with academic vs non-academic practice facilities. RESULTS: The study included 101 orthopedic surgeons, 78 (77.23%) Caucasian and 23 (22.77%) non-Caucasian, 79 (78.22%) male and 22 (21.78%) female. Surgeons with DO degrees comprised only 3.96% (4) of the cohort, while the vast majority held MDs [96.04% (97)]. Mean H-index was 10.55, with male surgeons having a significantly higher score (P = 0.002). Most orthopedic surgeons (88.12%,) practiced in academic centers. Of those professionals who occupied leadership positions, 14% were women, while 86% were men. Additionally, 19 (37.25%) United States regions and the District of Columbia lacked an LLRS-member orthopedic surgeon. Total per capita rate across the United States was 0.30 LLRS orthopedic surgeons per 1 million people. CONCLUSION: Over 21% of LLRS members are women, surpassing prior benchmarks noted in orthopedic faculty reporting. LLRS members' high research productivity scores imply field dedication that can refine expertise in the limb lengthening and reconstruction space. Gender disparities in leadership remain, however, necessitating greater equity efforts. A low rate of LLRS representation per capita must be addressed geographically as well, to affect improvements in regional care access. This study can serve to support aspiring orthopedic professionals, inform diversity, leadership, and field advancement strategies, and maintain the continued goal of enhanced patient care worldwide.

Gender Disparities in Endowed Professorships Within Orthopaedic Surgery.

Background Orthopaedic surgery has the lowest number of full-time faculty positions held by women, at 19%, with endowed chairs among the most coveted and advantageous. We examined the characteristics of endowed professors from the US top 100 orthopaedic academic centers and highest-funded musculoskeletal (MSK) researchers to determine if gender is associated with endowed professorship. Additionally, we sought to determine if gender is associated with increased NIH funding for top-performing musculoskeletal researchers.  Methods Our primary study group included the top 100 orthopaedic academic centers defined by US News World Report and Doximity's rankings. Our secondary study group examined the top MSK researchers, defined as principal investigators, who received >$400,000 in annual NIH funding from 2018 to 2021. Orthopaedic departments included MSK researchers and subspecialties within orthopaedics and medicine. Publicly available sources were used to compile institutional, gender, H-index, citation number, and subspecialty data on endowed professors; statistical comparisons were calculated. Results Within the top 100 orthopaedic academic departments, 4674 faculty were identified. Seven hundred and thirty-three (15.68%) were identified as women, 3941 as men (84.32%). One hundred and ninety-four held endowed professorships; 13 were awarded to women (6.7%), and 185 (95.3%) were awarded to men, with a significant odds ratio (OR) of 2.95, favoring men. For MSK researchers, the OR increases to 11.4. Arthroplasty and sports had the highest numbers of endowments. Significant differences in H-index, publications, and graduation year were identified between men and women for top MSK researchers and orthopaedic-trained surgeons; however, these differences disappeared when considering heterogenous orthopaedic departments that included medicine subspecialties, plastic surgery, hand surgery, and neurosurgery. Additional gender differences were observed in endowment names, with awards commemorating 51.5% men, 7.2% women, and 34% families or groups. Conclusion Gender inequities at the endowment level are substantial, and there are very few women in musculoskeletal medicine to achieve endowments. Differences in H-index, publications, and graduation year between men and women MSK researchers and orthopaedic-trained surgeons, but not combined orthopaedic, PM&R, and medical subspecialty departments, suggest unique challenges in orthopaedic surgery environments and histories that may contribute to endowment disparity. Gender was not found to be associated with funding bias for top-performing musculoskeletal researchers.

A Decade's Perspective on the Orthopedic Workforce in Saudi Arabia.

Background The orthopedic surgery workforce constitutes a vital role in the healthcare system, with data being scarce. Therefore, through this study, we share an overview of the orthopedic workforce distribution, demographic trends, and changes over the past decade in Saudi Arabia. Methods All practicing orthopedic surgeons in Saudi Arabia from January 1, 2010, to December 31, 2021, were included in the study. Data regarding orthopedic surgeons' demographics and numbers were obtained from the Saudi Commission for Health Specialties (SCFHS), whereas the data related to the geographical distribution of orthopedic surgeons was obtained from the Ministry of Health Statistical Yearbook of 2020. Results The ratio of orthopedic surgeons per 100,000 people was 5.42 in 2010, which grew subsequently to 12.29 in 2021. The number of Saudi orthopedic surgeons has been noticeably rising through the years, while a slowly growing pattern can be seen among non-Saudi orthopedic surgeons. In addition, the highest ratios of orthopedic surgeons per 100,000 were in Makkah (1.72), Riyadh (1.26), and the Eastern Region (1.06). Conclusion In this study, we demonstrate the progress of the orthopedic workforce in Saudi Arabia over a period of 12 years. The number of orthopedic surgeons per 100,000 people showed a significant rise due to several factors, one of which is road traffic accidents. Also, although the number of female orthopedic surgeons has been rising lately, they are still much fewer than males in this field. In addition, Saudi Arabia has been developing a new healthcare system via the privatization of some of the governmental hospitals, which will lead to changes in the future workforce and its accommodations.

A Multi-Disciplinary MRI Assessment May Optimize the Evaluation of Chondral Lesions in Acute Ankle Fractures: A Prospective Study.

Chondral lesions (CL) in the ankle following acute fractures are frequently overlooked immediately after the injury or diagnosed at a later stage, leading to persistent symptoms despite successful surgery. The literature presents a wide range of discrepancies in the reported incidence of CLs in acute ankle fractures. The objective of this prospective study is to provide a precise assessment of the occurrence of chondral lesions (CLs) in acute ankle fractures through MRI scans conducted immediately after the trauma and prior to scheduled surgery. Furthermore, the study aims to highlight the disparities in the interpretation of these MRI scans, particularly concerning the size and extent of chondral damage, between radiologists and orthopedic surgeons. Over the period of three years, all patients presenting with an unstable ankle fracture that underwent operative treatment were consecutively included in this single-center prospective study. Preoperative MRIs were obtained for all included patients within 10 days of the trauma and were evaluated by a trauma surgeon and a radiologist specialized in musculoskeletal MRI blinded to each other's results. The location of the lesions was documented, as well as their size and ICRS classification. Correlations and kappa coefficients as well as the p-values were calculated. A total of 65 patients were included, with a mean age of 41 years. The evaluation of the orthopedic surgeon showed CLs in 52.3% of patients. CLs occurred mainly on the tibial articular surface (70.6%). Most talar lesions were located laterally (11.2%). The observed CLs were mainly ICRS grade 4. According to the radiologist, 69.2% of the patients presented with CLs. The most common location was the talar dome (48.9%), especially laterally. Most detected CLs were graded ICRS 3a. The correlation between the two observers was weak/fair regarding the detection and classification of CLs and moderate regarding the size of the detected CLs. To enhance the planning of surgical treatment for ankle chondral lesions (CLs), it may be beneficial to conduct an interdisciplinary preoperative assessment of the performed scans. This collaborative approach can optimize the evaluation of ankle CLs and improve overall treatment strategies.

Job satisfaction, Career Burnout, and Work-Related Well-Being Prevalence among Orthopedic Surgeons: A Nationwide Study.

Background: Burnout is a well-known consequence of chronic stress. Orthopedic surgery is among the most desired specialty among Iranian medical students. The nature of the job, the income, and the ability to deal with stress can all be stressful factors for orthopedic surgeons. Nonetheless, little is known about how these medical doctors work and live in Iran. The present study aimed to assess job satisfaction, engagement, and burnout among Iranian orthopedists. Methods: A nationwide online survey was conducted in Iran. Job satisfaction, engagement, and burnout were evaluated using the job description index (JDI), Utrecht Work Engagement Scale, and Maslach Burnout Scale. They were also asked some additional questions related to career choice. Results: A total of 456 questionnaires (41% response rate) were retrieved. Overall, 56.8% of the participants experienced burnout. The burnout levels significantly differed based on age, years from graduation, working in public hospitals, operating more than 10 patients in a week, monthly income, having less than two children, and being single (P<0.05). They scored higher on work questions on the present job and jobs in general but lower scores on pay and opportunities for promotion. Conclusion: In a national study of orthopedic surgeons, their primary concern in JDI was "pay and promotion." Burnout was substantially associated with respondents' characteristics, such as younger age and having fewer children. This will lead to impaired performance, increased patient complaints, and the tendency to immigrate.

Time to Look for Ergonomically Viable Designs of Radiation Protection Aprons and Thyroid Shields in Orthopedic Surgery: A Survey of 416 Orthopedic Surgeons.

Introduction The advent of minimally invasive surgery has increased the use of C-arm among orthopedic surgeons. Their views on the ergonomicity of radiation protection aprons and thyroid shields need elucidation. To investigate, we deliberated a question-based survey. The primary aim of the survey was to find out the percentage of those not using these devices, the prevalence of back pain, and its relationship with the type of radiation protection aprons. Materials and methods This was a cross-sectional survey. A five-section Google Forms survey (Google, Inc., Mountain View, CA) was filled out, and responses from 416 orthopedic surgeons were included. Analysis was carried out using Statistical Package for the Social Sciences (SPSS) version 14.0 (SPSS Inc., Chicago, IL). Results Of the total number of orthopedic surgeons, 36.8% felt that apart from radiation exposure, wearing a radiation protection apron was the biggest problem in C-arm usage. Furthermore, 20.4% wore thyroid shields the majority of the time. The 31-40 years age group was the most comfortable wearing these devices, wore them more often, and suffered more often from back pain (all p<0.01). Conclusion The study concluded that the majority of orthopedic surgeons were not comfortable with the current designs of radiation protection aprons and thyroid shields. Thyroid shields are worn less than aprons. Lead apron weight and thyroid shield ergonomicity were the number one reason for being bare-bodied. Among those who regularly wore aprons, a large proportion suffered from back pain.

Work-Related Shoulder Pain Among Saudi Orthopedic Surgeons: A Cross-Sectional Study.

INTRODUCTION: Shoulder pain is one of the most frequently reported musculoskeletal conditions that approximately 6.9 to 26% of people experience. Numerous etiologies have been linked to causing shoulder pain, with the most frequent one being rotator cuff tendinopathy. Work-related musculoskeletal pain is prevalent in the medical field in general, but orthopaedic surgeons account for the majority of cases overall. The pain experienced is usually caused by many attributing factors that all relate to either the long hours and physically intensive procedures or the unnatural positions orthopaedic surgeons are put in during their surgeries. This study seeks to shed light on the prevalence, contributing factors, and effect of the complications of shoulder pain among orthopaedic surgeons, a topic unexpectedly understudied, particularly in Saudi Arabia. METHODS: A survey has been developed to ask orthopaedic surgeons at various levels of their careers. The study was conducted in Saudi Arabia, Riyadh. It was a multi-centered study that included both governmental and private hospitals in Riyadh. The collected data included age, gender, BMI, sub-specialty, position, number of surgeries performed per week, and the average time per surgery. In our survey, we used the Shoulder Pain and Disability Index (SPADI) to assess shoulder pain. Ethical approval was obtained for this study by the Institutional Review Board of King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia (IRB/1484/23). RESULTS: Fifty orthopaedic surgeons participated in this study most of whom were male (88%) and fell within the age range of 31-40 years (36%). Regarding their positions, a significant proportion were consultants (54%). In terms of workload, approximately (38%) of the surgeons performed three to four surgeries per week. As for the duration of surgeries, almost half of the participants spent between three and five hours per surgery (48%). When it comes to experiencing pain or difficulties during shoulder activities, a considerable number reported occasional occurrences (36%). Moreover, a substantial majority did not have a history of specific shoulder-related disorders, as (88%) of the participants had none of the mentioned conditions, such as shoulder trauma or disorders like adhesive capsulitis and impingement. Most participants reported difficulties in performing daily activities due to their work-related shoulder pain. Mild pain was the most common reported severity level in all assessed activities. CONCLUSION: The present study showed that orthopaedic surgeons in Riyadh, Saudi Arabia, occasionally experience shoulder pain from their jobs. Most of our sample stated that mild shoulder discomfort made it difficult to conduct daily tasks. This study is limited by a relatively low response rate, which may be attributed to the demanding nature of orthopaedic surgery. To promote health among caregivers throughout the kingdom, more studies should be conducted about shoulder pain.

Social Media Use Among Orthopedic and Trauma Surgeons in Germany: Cross-Sectional Survey Study.

BACKGROUND: Social media (SM) has gained importance in the health care sector as a means of communication and a source of information for physicians and patients. However, the scope of professional SM use by orthopedic and trauma surgeons remains largely unknown. OBJECTIVE: This study presents an overview of professional SM use among orthopedic and trauma surgeons in Germany in terms of the platforms used, frequency of use, and SM content management. METHODS: We developed a web-based questionnaire with 33 variables and 2 separate sections based on a review of current literature. This study analyzed the first section of the questionnaire and included questions on demographics, type of SM used, frequency of use, and SM content management. Statistical analysis was performed using SPSS (version 26.0). Subgroup analysis was performed for sex, age groups (<60 years vs ≥60 years), and type of workplace (practice vs hospital). Differences between groups were assessed with a chi-square test for categorical data. RESULTS: A total of 208 participants answered the questionnaire (166/208, 79.8% male), of whom 70.2% (146/208) were younger than 60 years and 77.4% (161/208) worked in a practice. All participants stated that they use SM for private and professional purposes. On average, participants used 1.6 SM platforms for professional purposes. More than half had separate SM accounts for private and professional use. The most frequently used SM platforms were messenger apps (119/200, 59.5%), employment-oriented SM (60/200, 30%), and YouTube (54/200, 27%). All other SM, including Facebook and Instagram, were only used by a minority of the participants. Women and younger participants were more likely to use Instagram (P<.001 and P=.03, respectively). The participants working in a hospital were more likely to use employment-oriented SM (P=.02) and messenger apps (P=.009) than participants working in a practice. In a professional context, 20.2% (39/193) of the participants produced their own content on SM, 24.9% (48/193) used SM daily, 39.9% (77/193) used SM during work, and 13.8% (26/188) stated that they checked the number of followers they had. Younger participants were more likely to have participated in professional SM training and to have separate private and professional accounts (P=.04 and P=.02, respectively). Younger participants tended toward increased production of their own content (P=.06). CONCLUSIONS: SM is commonly used for professional purposes by orthopedic and trauma surgeons in Germany. However, it seems that professional SM use is not exploited to its full potential, and a structured implementation into daily professional work routines is still lacking. SM can have a profound impact on medical practices and communication, so orthopedic and trauma surgeons in Germany should consider increasing their SM presence by actively contributing to SM.

Knowledge, attitudes, and behaviors regarding the use of clinical practice guidelines among spine surgeons in Latin America.

Background: Clinical Practice Guidelines (CPGs) are invaluable tools to assure evidence-based spine surgery care. In this study, we aimed to identify perceptions, barriers, and potential determinants for the use of CPG among Latin American spine surgeons. Methods: A 28-item questionnaire regarding the use of CPGs was sent to the members of AO Spine Latin America. The questionnaire was subdivided into three sections: (1) demographic data; (2) perceptions and awareness of CPGs; (3) and potential barriers to CPG use. Multivariate logistic regression was performed to assess potential associations with CPG use. Results: A total of 304 spine surgeons answered the questionnaire. Most of the participants were male (91.8%) and orthopedic spine surgeons (52.3%) who averaged 45-65 years of age. Most respondents were aware of some CPGs for spine care (68.8%) and reported using them (70.4%); lack of awareness about CPGs was the most frequent barrier to their use (65.1%). Conclusion: Awareness of CPGs in spine surgery is of paramount importance for their use. Educational programs explaining the importance and benefits of spine care CPG surgical and clinical practice would increase the adherence of physicians to the guidelines.

Total Hip Arthroplasty: Direct Anterior Approach Versus Posterior Approach in the First Year of Practice.

Background: The direct anterior approach (DAA) for total hip arthroplasty (THA) has been popularized as a less invasive technique, however outcomes within the first year of practice after fellowship have not been investigated. The primary aim was to determine differences in complications and outcomes between DAA and posterior approach (PA) in the first year of practice. The secondary aim was to determine if there was a learning curve factor in DAA and PA after fellowship training. Methods: THA cases performed by two surgeons during their first year of practice were reviewed. Overall, 181 THAs (91 DAA, 90 PA) in 168 patients, were performed. Intraoperative differences (blood loss, operative time), hospital stay, complications, reoperations, and revisions were compared. Results: Overall surgical complications were similar between DAA and PA (11% vs. 9%, p=0.64), but complication profiles were different: dislocation (1% vs. 4%, p=0.17), intraoperative femoral fracture (2% vs. 1%, p=0.32), postoperative periprosthetic fractures (2% vs. 3%, p=0.64). neuropraxia (3% vs. 0%, p=0.08). There was no difference in rate of reoperation (1% vs. 3%, p=0.31). There was a difference in rate of revision at final follow-up (0% vs. 6%, p=0.02). DAA consisted of longer operative time (111 vs. 99 minutes; p<0.001), however was only significant in the first 50 cases (p<0.001), while the subsequent cases were similar (p=0.31). There was no difference in the first 50 cases compared to the subsequent cases for either approach regarding blood loss, complications, reoperations, or revisions. Conclusion: DAA and PA for THA performed within the first year of practice exhibit similarly low complication rates, but complication profiles are different. In our series, PA did demonstrate a higher risk of revision at final follow-up. A learning curve is not unique to the DAA. Both DAA and PA THA exhibited a learning curve in the first 50 cases performed at the start of a surgeon's practice. Level of Evidence: III.

Role of Laser Pointer in Budgeting Fluoroscopy-Time and Radiation Exposure.

BACKGROUND: Literature on radiation exposure with use of the mini C-arm and value of having built-in laser guidance is limited. The purpose of this study was to determine whether laser guidance use on a mini C-arm fluoroscopy unit can reduce radiation exposure. METHODS: Surgeons (N = 25) performed the same simulated surgical task, which involved obtaining "perfect circle" views of 2 cannulated screws placed into a cadaveric wrist, done with and without C-arm laser guidance. The testing order was randomized. Main outcomes were time to complete the task, number of shots required to complete the task, number of blank shots taken, radiation exposure, total dose area product (DAP), and total exposure time. RESULTS: Laser guidance significantly reduced the percentage of surgeons who took blank shots, from 88% of the group without the laser to 12% of the group with the laser, and decreased the total average blank shots in the group from 3.5 to 0.1. While we found laser guidance led to shorter time to complete the task, decreased shots taken, and decreased exposure time and DAP, these findings only approached significance. CONCLUSION: While debate continues regarding whether mini or standard C-arm is safest, it is clear that decreasing the overall number of exposures limits potential adverse effects. Our study demonstrated that when using a mini C-arm, laser guidance decreases the number of exposures required to capture an image. These findings warrant a larger study to define the specific exposure savings and indicate potential benefit of mini C-arm use with laser guidance.

Ultrasound-guided interscalene block anesthesia performed by an orthopedic surgeon: a study of 1322 cases of shoulder surgery.

BACKGROUND: Interscalene blocks are becoming increasingly common for shoulder surgeries. This study primarily aimed to demonstrate the efficacy and complications and the secondarily to investigate the anesthesia-related time and patient satisfaction of an ultrasound-guided interscalene block performed by an orthopedic surgeon. METHODS: We retrospectively reviewed the medical records of 1322 consecutive patients (arthroscopic, 1225 cases; open, 97 cases) with a mean age of 64.2 years, who underwent shoulder surgery (arthroscopic or opensurgery) under an ultrasound-guided interscalene block performed by an orthopedic surgeon at a single institution between December 2012 and December 2019. We investigated patient satisfaction, block success rates, and complications and also compared the anesthesia-related time of an interscalene block with that of general anesthesia (428 cases, arthroscopic, 257 cases; open, 171 cases) for shoulder surgery with patients in the beach chair position during the same period. Difference between total anesthesia time and surgical time was defined as anesthesia-related time. RESULTS: Approximately 98.3% of patients were satisfied with an interscalene block, and the block success rate on the first attempt was 99.9%. Total complication incidence was 2.3%, with no recorded life-threatening complications. Anesthesia-related times were significantly shorter in the interscalene block group than those in the general anesthesia group (45 ± 14 min vs. 100 ± 26 min, P < .001). CONCLUSION: An ultrasound-guided interscalene block performed by an orthopedic surgeon for shoulder surgery is effective and safe, requires less time, and has a high patient acceptance rate, making it a feasible and alternative to the block performed by anesthesiologists.

Orthopedic surgeon's awareness can improve osteoporosis treatment following hip fracture: a prospective cohort study.

Through retrospective Jeju-cohort study at 2005, we found low rates of detection of osteoporosis (20.1%) and medication for osteoporosis (15.5%) in those who experienced hip fracture. This study was to determine the orthopedic surgeons' awareness could increase the osteoporosis treatment rate after a hip fracture and the patient barriers to osteoporosis management. We prospectively followed 208 patients older than 50 yr who were enrolled for hip fractures during 2007 in Jeju-cohort. Thirty four fractures in men and 174 in women were treated at the eight hospitals. During the study period, orthopedic surgeons who worked at these hospitals attended two education sessions and were provided with posters and brochures. Patients were interviewed 6 months after discharge using an evaluation questionnaire regarding their perceptions of barriers to osteoporosis treatment. The patients were followed for a minimum of one year. Ninety-four patients (45.2%) underwent detection of osteoporosis by dual energy x-ray absorptiometry and 67 (32.2%) were prescribed medication for osteoporosis at the time of discharge. According to the questionnaire, the most common barrier to treatment for osteoporosis after a hip fracture was patients reluctance. The detection and medication rate for osteoporosis after hip fracture increased twofold after orthopedic surgeons had attended the intervention program. Nevertheless, the osteoporosis treatment rate remains inadequate.

A Rare Case of Penile Strangulation Managed by Orthopedic Jumbo Cutter.

Penile strangulation is not commonly encountered in orthopedic practice. Quick decision and immediate removal of the metallic ring with readily available instruments is the key to a successful outcome. Jumbo cutter is a commonly available instrument. It can be used with ease without causing any thermal or soft tissue damage, giving satisfactory results.

Comparison of pediatric sports fracture outcomes based on provider type.

Objective: Pediatric primary care sports medicine physicians and pediatric sports medicine orthopedic surgeons, in conjunction with physician assistants (PAs), often manage patients with fractures. We sought to determine if pediatric patients with fractures seen by primary care sports medicine physicians had similar outcomes and satisfaction as those seen by orthopedic surgeons. Methods: We performed a retrospective chart review of four to 18-year-old patients who were treated by a sports medicine provider (primary care or orthopedic surgeon/PA) for a fracture of the radius, ulna, tibia, or fibula. Patients or their parents completed a patient satisfaction survey (Short Assessment of Patient Satisfaction [SAPS]) and an injury location-specific patient-reported functional outcome tool: the Foot and Ankle Ability Measure (FAAM) or the Disabilities of the Arm, Shoulder, and Hand (DASH) Scale. Results: Fifty-seven (70%) of the 82 patients were treated by pediatric primary care sports medicine physicians and 25 (30%) were treated by a pediatric sports medicine orthopedic surgeon or surgical PA. The median time from injury to clinically confirmed healing was similar between the two groups (47 vs 60.5 days; p = 0.54), as was the patient satisfaction (SAPS median score = 26 [range = 19-28] vs 24 [range = 9-28]; p = 0.12). Patient-reported outcomes did not differ significantly between groups for the functional outcome tools. Conclusions: Patients seen by pediatric primary care sports medicine physicians and sports medicine orthopedic surgeons have similar patient-reported fracture outcomes and similar satisfaction with care. Pediatric patients with fractures will likely have favorable outcomes when cared for by either of these subspecialty providers.