Early Exposure to Orthopaedic Surgery.

INTRODUCTION: Disparities in early orthopaedic experiences among medical students prompt a critical examination of factors influencing the availability and nature of these exposures. While the current body of literature underscores the significance of early surgical exposure and mentorship in medical education, a notable gap exists in investigating early orthopaedic exposure and its specific impact on students from diverse backgrounds. METHODS: A 16-item questionnaire, approved by our institutional review board, was administered to fourth-year medical students (MS4) and first-year orthopaedic residents (PGY-1) across U.S. orthopaedic surgery programs during the 2022-2023 application cycle. The questionnaire assessed participants' initial orthopaedic exposures and factors influencing interest in the field. Two-proportion Z-test analyses were conducted to analyze the data, and thematic analysis was used to assess qualitative data involving free-response questions. RESULTS: Out of 72 total respondents, the study revealed that 83% of respondents encountered orthopaedics before medical school, with initial exposures stemming from various sources such as familial connections (28%), athletics (17%), and high school or college exposures (15%), including shadowing, athletics participation, and occupation-related exposure. Disparities were observed in the availability of orthopaedic mentors and early exposure opportunities between demographic groups. Statistical analyses highlighted significant differences in access to mentors who reflected students' identities between male and non-male participants (70% vs. 39%, p=0.02) and between white and non-white participants (69% vs. 36%, p=0.02). White participants were also more likely to first interact with a surgeon who treated them or their family members than non-white participants (35% vs 7%, p=0.04). Non-white participants were more likely than white participants to come by their first orthopaedic opportunity by searching for it independently (21% vs. 4%, p=0.03). Family and friend connections in orthopaedics were found to be influential in motivating students to pursue orthopaedics, with 40% of respondents indicating personal connections in medicine and 12% reporting family members who are orthopaedic surgeons. Research experiences were identified as important contributors to students' initial interest and motivation to ultimately pursue orthopaedics, especially those with diverse backgrounds. CONCLUSION: The findings underscore the importance of early orthopaedic exposures in shaping students' interest in the field, highlighting the need for more immersive pre-clinical year opportunities and enhanced mentorship programs. Addressing disparities in mentorship access and early exposure opportunities requires systemic changes and increased support for underrepresented minorities in orthopaedics. Initiatives like mentorship programs and research opportunities can help bridge gaps in access to early orthopaedic experiences. Medical schools should prioritise targeted early access to orthopaedic exposures for all students, regardless of background. This initiative aims to promote inclusivity and cultivate a more diverse orthopaedic workforce capable of meeting the evolving healthcare needs of society.

Cluster analysis of COVID-19 recovery center patients at a clinic in Boston, MA 2021-2022: impact on strategies for access and personalized care.

BACKGROUND: There are known disparities in COVID-19 resource utilization that may persist during the recovery period for some patients. We sought to define subpopulations of patients seeking COVID-19 recovery care in terms of symptom reporting and care utilization to better personalize their care and to identify ways to improve access to subspecialty care. METHODS: Prospective study of adult patients with prior COVID-19 infection seen in an ambulatory COVID-19 recovery center (CRC) in Boston, Massachusetts from April 2021 to April 2022. Hierarchical clustering with complete linkage to differentiate subpopulations was done with four sociodemographic variables: sex, race, language, and insurance status. Outcomes included ICU admission, utilization of supplementary care, self-report of symptoms. RESULTS: We included 1285 COVID-19 patients referred to the CRC with a mean age of 47 years, of whom 71% were female and 78% White. We identified 3 unique clusters of patients. Cluster 1 and 3 patients were more likely to have had intensive care unit (ICU) admissions; Cluster 2 were more likely to be White with commercial insurance and a low percentage of ICU admission; Cluster 3 were more likely to be Black/African American or Latino/a and have commercial insurance. Compared to Cluster 2, Cluster 1 patients were more likely to report symptoms (ORs ranging 2.4-3.75) but less likely to use support groups, psychoeducation, or care coordination (all p < 0.05). Cluster 3 patients reported greater symptoms with similar levels of community resource utilization. CONCLUSIONS: Within a COVID-19 recovery center, there are distinct groups of patients with different clinical and socio-demographic profiles, which translates to differential resource utilization. These insights from different subpopulations of patients can inform targeted strategies which are tailored to specific patient needs.

Factors Associated With Humeral Avulsion of Glenohumeral Ligament Lesions in Patients With Anterior Shoulder Instability: An Analysis of the MOON Shoulder Instability Cohort.

Background: Humeral avulsion of the glenohumeral ligament (HAGL) lesions are an uncommon cause of anterior glenohumeral instability and may occur in isolation or combination with other pathologies. As HAGL lesions are difficult to detect via magnetic resonance imaging (MRI) and arthroscopy, they can remain unrecognized and result in continued glenohumeral instability. Purpose: To compare patients with anterior shoulder instability from a large multicenter cohort with and without a diagnosis of a HAGL lesion and identify preoperative physical examination findings, patient-reported outcomes, imaging findings, and surgical management trends associated with HAGL lesions. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients with anterior glenohumeral instability who underwent surgical management between 2012 and 2020 at 11 orthopaedic centers were enrolled. Patients with HAGL lesions identified intraoperatively were compared with patients without HAGL lesions. Preoperative characteristics, physical examinations, imaging findings, intraoperative findings, and surgical procedures were collected. The Student t test, Kruskal-Wallis H test, Fisher exact test, and chi-square test were used to compare groups. Results: A total of 21 HAGL lesions were identified in 915 (2.3%) patients; approximately one-third (28.6%) of all lesions were visualized intraoperatively but not identified on preoperative MRI. Baseline characteristics did not differ between study cohorts. Compared with non-HAGL patients, HAGL patients were less likely to have a Hill-Sachs lesion (54.7% vs 28.6%; P = .03) or an anterior labral tear (87.2% vs 66.7%; P = .01) on preoperative MRI and demonstrated increased external rotation when their affected arm was positioned at 90° of abduction (85° vs 90°; P = .03). Additionally, HAGL lesions were independently associated with an increased risk of undergoing an open stabilization surgery (odds ratio, 74.6 [95% CI, 25.2-221.1]; P < .001). Conclusion: Approximately one-third of HAGL lesions were missed on preoperative MRI. HAGL patients were less likely to exhibit preoperative imaging findings associated with anterior shoulder instability, such as Hill-Sachs lesions or anterior labral pathology. These patients underwent open procedures more frequently than patients without HAGL lesions.

Sports-Related Shoulder Injuries Among Female Athletes.

PURPOSE OF REVIEW: The objectives of this review are to explore the recent literature evaluating sports-related shoulder injuries among female athletes. RECENT FINDINGS: Recent literature has highlighted sex-related differences in injury trends and patterns among athletes. Increased participation of women in both recreational and professional sports has resulted in increased exposure to injury. While men experience greater rates of shoulder injury overall, women tend to experience more overuse-related injuries. Evidence also suggests women are more susceptible to shoulder laxity and rotator cuff tears. In comparison to their male counterparts, women note poorer function, increased pain, and decreased activity level following shoulder injuries. Women may also be more likely to experience worse outcomes following surgical intervention. Sex-related differences in injury patterns and outcomes results from a combination of molecular and environmental influences, including hormone pathways, shoulder morphology, and differing rates of participation in, and athletic regulations among, certain sports. Sex-related differences occur in how athletes sustain, experience, and recover from sports-related injuries. A comprehensive understanding of sex-related injuries enhances clinical decision making, treatment, and recovery. Further research is needed to clarify sex as an independent variable when evaluating sports-related shoulder injuries.