Attending Orthopedic Surgeon Research Articles

Less Pain, but no changes in maximal inclination angles during an overhead reach task following local anesthetic in patients with ongoing shoulder pain

This multicenter observational study aimed to assess how pain reduction, induced by local anesthesia, affects the relative angular contributions of the shoulder girdle and trunk to the maximal angular performance during a semi-constrained overhead reach task in patients with ongoing shoulder pain. Twenty-nine individuals (age 59.0 SD 12.8 years;16-male) with symptomatic shoulders were administered corticosteroid and lidocaine injections by their attending orthopedic surgeon. Immediately before and after the injections, participants reached for a target on the ceiling ten times as high as possible while their pain levels, shoulder, and trunk movements were recorded. The analysis revealed that there was a significant reduction in pain following the injections. However, there were no significant differences in maximum shoulder and trunk inclination angles between the pre- and post-injection conditions. Notably, there were slight but statistically significant alterations in humeroscapular kinematics during the initial phase of arm elevation following the injections. In conclusion, acute pain relief following local anesthetics is not associated with immediate alterations in maximum shoulder girdle and trunk inclination angles during a semi-constrained overhead reach task in patients with ongoing shoulder pain. However, there are signs of small alterations in humeroscapular kinematics during the initial phase of arm elevation.

Correlation of medial tibial slope and lateral tibial slope measured on radiographs and magnetic resonance imaging in patients with anterior cruciate ligament injury.

The study aimed to investigate the correlation between medial tibial slope (MTS) and lateral tibial slope (LTS) on magnetic resonance imaging (MRI), MTS measured by different imaging, and the intra- and interobserver reliability of measurements between reviewers with gaps of experience over 10 years. This retrospective study included 97 patients (93 males, 4 females; mean age: 30.8±8.3 years; range, 17 to 49 years) with anterior cruciate ligament (ACL) injuries who subsequently underwent double-bundle ACL reconstruction by a single surgeon between January 2005 and December 2014. The MTS was measured on lateral knee radiographs, and MTS and LTS were measured on MRIs. Three different reviewers, including a postgraduate year doctor, an orthopedic resident, and an attending orthopedic surgeon, performed the measurements. Each reviewer measured the slope of the same image three times. The correlations of MTS on radiographs and MTS/LTS on MRIs were calculated. Intra- and interobserver reliability were evaluated. The average MTS and LTS measured on MRI were not significantly different (6.4° and 6.9°, respectively; p=0.268) and exhibited a moderate positive correlation (r=0.544, p<0.001). The average MTS on radiographs was significantly greater than that on MRI (10.5° and 6.4°, respectively; p<0.001) with a low positive correlation (r=0.480, p<0.001). The intraobserver reliability of the postgraduate year doctor, the orthopedic resident, and the attending orthopedic surgeon were moderate to excellent. The interobserver reliability of MTS on radiographs was excellent (intraclass correlation coefficient [ICC]=0.925; p<0.001). The interobserver reliability of MTS on MRI as well as LTS on MRI was good (ICC=0.755 and 820, respectively; all p values <0.001). Average MTS and LTS measured on MRI in patients with ACL injury exhibited a moderate positive correlation. The average MTS measured on radiographs was significantly greater than that on MRI with a low positive correlation.

ChatGPT Is Moderately Accurate in Providing a General Overview of Orthopaedic Conditions.

ChatGPT is an artificial intelligence chatbot capable of providing human-like responses for virtually every possible inquiry. This advancement has provoked public interest regarding the use of ChatGPT, including in health care. The purpose of the present study was to investigate the quantity and accuracy of ChatGPT outputs for general patient-focused inquiries regarding 40 orthopaedic conditions. For each of the 40 conditions, ChatGPT (GPT-3.5) was prompted with the text "I have been diagnosed with [condition]. Can you tell me more about it?" The numbers of treatment options, risk factors, and symptoms given for each condition were compared with the number in the corresponding American Academy of Orthopaedic Surgeons (AAOS) OrthoInfo website article for information quantity assessment. For accuracy assessment, an attending orthopaedic surgeon ranked the outputs in the categories of <50%, 50% to 74%, 75% to 99%, and 100% accurate. An orthopaedics sports medicine fellow also independently ranked output accuracy. Compared with the AAOS OrthoInfo website, ChatGPT provided significantly fewer treatment options (mean difference, -2.5; p < 0.001) and risk factors (mean difference, -1.1; p = 0.02) but did not differ in the number of symptoms given (mean difference, -0.5; p = 0.31). The surgical treatment options given by ChatGPT were often nondescript (n = 20 outputs), such as "surgery" as the only operative treatment option. Regarding accuracy, most conditions (26 of 40; 65%) were ranked as mostly (75% to 99%) accurate, with the others (14 of 40; 35%) ranked as moderately (50% to 74%) accurate, by an attending surgeon. Neither surgeon ranked any condition as mostly inaccurate (<50% accurate). Interobserver agreement between accuracy ratings was poor (κ = 0.03; p = 0.30). ChatGPT provides at least moderately accurate outputs for general inquiries of orthopaedic conditions but is lacking in the quantity of information it provides for risk factors and treatment options. Professional organizations, such as the AAOS, are the preferred source of musculoskeletal information when compared with ChatGPT. ChatGPT is an emerging technology with potential roles and limitations in patient education that are still being explored.

ChatGPT-4 generates orthopedic discharge documents faster than humans maintaining comparable quality: a pilot study of 6 cases.

Large language models like ChatGPT-4 have emerged. They hold the potential to reduce the administrative burden by generating everyday clinical documents, thus allowing the physician to spend more time with the patient. We aimed to assess both the quality and efficiency of discharge documents generated by ChatGPT-4 in comparison with those produced by physicians. To emulate real-world situations, the health records of 6 fictional orthopedic cases were created. Discharge documents for each case were generated by a junior attending orthopedic surgeon and an advanced orthopedic resident. ChatGPT-4 was then prompted to generate the discharge documents using the same health record information. The quality assessment was performed by an expert panel (n = 15) blinded to the source of the documents. As secondary outcome, the time required to generate the documents was compared, logging the duration of the creation of the discharge documents by the physician and by ChatGPT-4. Overall, both ChatGPT-4 and physician-generated notes were comparable in quality. Notably, ChatGPT-4 generated discharge documents 10 times faster than the traditional method. 4 events of hallucinations were found in the ChatGPT-4-generated content, compared with 6 events in the human/physician produced notes. ChatGPT-4 creates orthopedic discharge notes faster than physicians, with comparable quality. This shows it has great potential for making these documents more efficient in orthopedic care. ChatGPT-4 has the potential to significantly reduce the administrative burden on healthcare professionals.

Acetabular cup size trends in total hip arthroplasty.

Total hip arthroplasty (THA) is a common procedure for end stage osteoarthritis. The learning curve for THA is complex and challenging. One of the most difficult skills to master is acetabular reaming. We wish to identify if experience in arthroplasty leads to preservation of more bone stock. To investigate if increasing surgeon experience will predict an ever decreasing acetabular cup size. A retrospective case series of four attending orthopaedic surgeons was completed. All uncemented elective total hip arthroplasties since appointment were selected for inclusion. The size of acetabular cup used was noted and logistic regression was used to identify if a trend to smaller cups existed. A total of 1614 subjects were included with a mean age of 64 years. Overall cups were on average 0.18mm smaller per year (95% confidence interval -0.25 to -0.11, P < 0.001). Individual surgeon trends showed cup sizes to decrease 0.27 mm/year for surgeon A, 0.02 mm/year for surgeon B, 0.15 mm/year for surgeon C and 0.29 mm/year for surgeon D. Three of the four surgeons had a more pronounced trend to smaller cups for male subjects than their female counterparts. We found increasing surgeon experience to be associated with an ever-decreasing acetabular cup size. Smaller acetabular cup size may act as a surrogate marker of surgical proficiency by virtue of decreased acetabular reaming.

Surgeon‐Administered Ultrasound‐Guided Regional Anesthesia in Fixation of Distal Fibula Fracture

Distal fibula fracture is a common injury of the lower limb. Significantly displaced distal fibula fracture is treated with surgical fixation under general, spinal, or regional anesthesia. We present a case of displaced distal fibula fracture with both the regional anesthesia and operation performed by the same attending orthopedic surgeon. The patient underwent successful ultrasound‐guided regional anesthesia as well as open reduction and internal fixation. This case report highlights the technical detail for ultrasound‐guided regional anesthesia and surgical fixation by surgeon.

Reliability and Reproducibility of Sacro-Femoro-Pubic Angle Measurements on Anteroposterior Pelvis Radiographs.

BackgroundThe sacro-femoro-pubic (SFP) angle is a surrogate measurement for pelvic tilt obtained on anteroposterior (AP) pelvis radiographs. It is unknown whether the SFP angle can be measured reliably by senior surgeons and trainees alike.MethodsWe conducted an intrareader and interreader reliability study using preoperative AP pelvis radiographs. Using our hospital electronic database, we randomly selected 31 subjects undergoing primary total hip arthroplasty. An attending orthopedic surgeon and two orthopedic surgery residents performed two separate SFP angle measurements for each subject. Intrareader and interreader agreement were measured using intraclass correlation coefficients (ICC).ResultsPairwise intrareader and interreader ICCs ranged from 0.91 to 0.99. Overall ICC was 0.94. Interreader ICCs between the attending surgeon and each orthopedic resident were 0.93 and 0.98, and the ICC between orthopedic residents was 0.91. Interreader mean differences for SFP angle measurements were 2.32 degrees or less: -2.03 (standard deviation: 2.23) and 0.29 (1.64) between the attending surgeon and each orthopedic resident, and 2.32 (2.44) between orthopedic residents.ConclusionSFP angle may be measured reliably on AP pelvis radiographs by senior clinicians and trainees. SFP angle measurement may prove helpful as an alternative to pelvic tilt measurements when lateral pelvic radiographs are not available.

Sclerotherapy for Aneurysmal Bone Cysts: Scale for Response.

The objective of this study was to develop a response scale for aneurysmal bone cysts (ABCs) treated with sclerotherapy and determine its inter-rater reproducibility. Patients treated with sclerotherapy for an ABC between 1993 and 2014 were identified. An attending orthopaedic surgeon and an attending interventional radiologist independently reviewed the radiographic series for each patient and determined response to treatment using a novel grading system. Pain scores were collected from each visit. Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). General estimating equations analysis was used to evaluate the relationship between radiographic and pain scores and outcome, to develop an algorithm for the study patient population. A receiver operating characteristic curve was constructed to evaluate the diagnostic performance of the radiographic and pain scores in identifying the necessity of further treatment. To quantify the diagnostic utility, the area under the receiver operating characteristic curve was estimated along with a 95% confidence interval (CI). The inter-rater reliability was excellent for magnetic resonance imaging (ICC=0.83; 95% CI=0.74-0.89) and good for computed tomography/x-ray (ICC=0.69; 95% CI=0.51-0.81). The radiographic and pain scores proved to be independent predictors of treatment (P<0.001 and 0.004, respectively). An algorithm to determine the predictive probability for treatment versus observation in the study population was developed and tested based on these assessments. The area under the receiver operating characteristic curve of 0.85 (95% CI=0.79-0.92) indicated the good diagnostic performance of the algorithm. This novel grading system for radiographic response to sclerotherapy treatment demonstrates excellent to good inter-rater reliability giving providers a platform for discussion among themselves and with patients/parents. When incorporated with an assessment of pain, a predictive algorithm shows how this information could be used to determine the next steps after sclerotherapy treatment. Level IV-case series.

Disparities Among Leading Publishers of Arthroplasty Research

BackgroundDespite the importance of diversity in advancing scientific progress, diversity among leading authors in arthroplasty has not been examined. This study aimed to identify, characterize, and assess disparities among leading authors in arthroplasty literature from 2002 to 2019. MethodsArticles published between 2002 and 2019 from 12 academic journals that publish orthopedic and arthroplasty research were extracted from PubMed. Original articles containing keywords related to arthroplasty were analyzed. Author gender was assigned using the Genderize algorithm. Gender and characterization of the top 100 male and female authors utilized available information on academic profiles. ResultsFrom the 14,692 articles that met inclusion criteria, the genders of 23,626 unique authors were identified. Women were less likely than men to publish 5 years after beginning their publishing careers (adjusted odds ratio 0.51, 95% confidence interval 0.45-0.57, P < .001). Of the top 100 authors, 96 were men, while only 4 were women. Orthopedic surgeons made up 93 of 100 top authors, of which 92 were men and 1 was a woman. Among the top 10 publishing female and male authors, 10 of 10 men were orthopedic surgeons, only 2 of 10 women were physicians, and only one was an attending orthopedic surgeon. ConclusionWhile the majority of authors with high arthroplasty publication volume were orthopedic surgeons, there were significant gender disparities among the leading researchers. We should continue working to increase gender representation and supporting the research careers of women in arthroplasty.

Does Bone Loss Imaging Modality, Measurement Methodology, and Interobserver Reliability Alter Treatment in Glenohumeral Instability?

To determine, in the context of measuring bone loss in shoulder instability, whether measurement differences between magnetic resonance imaging (MRI) and computed tomography (CT), linear-based and area-based methods, and observers altered the proposed treatment when a standardized algorithm was applied. This was a retrospective, comparative imaging study of preoperative patients with anterior shoulder instability with both an MRI and CT scan within 1year of one another. On parasagittal images reoriented en face to the glenoid, 2 attending orthopaedic surgeons measured glenoid width, glenoid area, glenoid defect width, and glenoid defect area. On axial images maximal Hill-Sachs width was measured. From these, linear percent glenoid bone loss (%GBL) and area %GBL were calculated, and on-versus off-track was determined. With these results, a recommended treatment was determined by applying a standardized algorithm, in which the Latarjet procedure was selected for %GBL >20%, arthroscopic labral repair and remplissage for off-track lesions with %GBL <20%, and arthroscopic labral repair on-track shoulders with %GBL <20%. In total, 53 patients with mean ± standard deviation 45 ± 83days between scans were include with a CT linear %GBL of 23.5 ± 9.6% (range 0%-47%). CT lead to larger measurements of %GBL than MRI (linear P= .008, area P=.003), and fewer shoulders being considered on-track (33.0% vs 40.5%), which would alter treatment in 25% to 34%. Linear measurements produced larger values for %GBL (CT, P < .001; MRI, P < .001), which would alter treatment in 25%. For %GBL, inter-rater reliability was good, with intraclass correlation coefficients varying from 0.727 to 0.832 and Kappa varying from 0.57 to 0.62, but these inter-rater differences would alter treatment in 31%. The significant differences in bone loss measurement between imaging modality, measurement method, and observers may lead to differences in treatment in up to 34% of cases. Linear CT measurements resulted in the most aggressive treatment recommendations. Retrospective Comparative Study: Diagnostic, Level III.

Real-Time Monitoring with a Controlled Advancement Drill May Decrease Plunge Depth.

Although drill use is fundamental to orthopaedic surgery, the risk of plunging past the far cortex and potentially damaging the surrounding soft tissues remains unavoidable with conventional drilling methods. A dual motor drill may decrease that risk by providing controlled drill-bit advancement and real-time monitoring of depth and energy expenditure. We hypothesized that using the dual motor drill would decrease plunge depth regardless of the user's level of experience. Sixty-six subjects of varying operative experience (20 attending orthopaedic surgeons, 20 orthopaedic surgery residents, and 26 senior medical students) drilled 3 holes with a conventional drill and 3 holes with a dual motor drill in a bicortical Sawbones block set in ballistic gel. The depth of drill penetration into the ballistic gel was measured for each hole using a digital caliper. Overall, subjects plunged less with the dual motor drill (0.9 mm) than with the conventional drill (4.2 mm) (p < 0.001). This finding was consistent within each group: attending surgeons (0.9 compared with 3.2 mm; p = 0.02), residents (1.0 compared with 3.0 mm; p < 0.001), and students (0.7 compared with 6.0 mm; p < 0.001). Plunge depths were also stratified into 3 categories: 0 to <2 mm, 2 to 5 mm, and >5 mm. Using the dual motor drill, subjects were more likely to plunge <2 mm (97% plunged, on average, 0 to <2 mm and 3% plunged, on average, 2 to 5 mm), whereas subjects were more likely to plunge deeper with the conventional drill (27% plunged, on average, 0 to <2 mm, 45% plunged, on average, 2 to 5 mm, and 27% plunged, on average, >5 mm). Notably, no subject plunged ≥2 mm on the third attempt with the dual motor drill. Attending surgeons (p = 0.02) and residents (p = 0.01) plunged less than students with the conventional drill. There was no significant difference between attending surgeons and residents with the conventional drill (p = 0.96). There was no significant difference in plunge depth between groups using the dual motor drill. The dual motor drill significantly decreased plunge depth for both surgically experienced and inexperienced subjects. Although inexperienced subjects performed worse with the conventional drill than those with experience, there was no difference in their performance with the dual motor drill. Use of a controlled advancement drill may decrease the chance of plunge-related neurovascular injury during in vivo drilling.

Preoperative Ankle Swelling and the Effect on Postoperative Wound Complications Following Ankle Fracture Surgery

Category: Trauma Introduction/Purpose: It is widely perceived that swelling in the first 24-48 hours following an ankle fracture precludes fixation, delaying operative treatment by 10-14 days to allow swelling to reduce. Such soft tissue management is assumed to be associated with better immediate soft tissue outcomes (wound closure) and mitigation of medium to long-term soft tissue problems. The aim of this study is to identify whether pre-operative ankle swelling has an independent effect on post-operative wound complications following ankle fracture surgery. The hypothesis of this study is that operative intervention at any point in time after the fracture of the ankle, irrespective of swelling, will show no better or worse soft tissue outcomes than those fixations delayed for swelling. The primary outcome measure will be wound complication. Methods: This is a prospective cohort study of patients presenting to a tertiary referral centre that were operatively managed for malleolar ankle fractures. Skeletally mature patients with closed, isolated ankle fractures were included in the study. Patients who were multiply-injured, had open fractures, and/or had known pre-existing limb oedema were excluded. Time to surgery was determined by the on-call attending orthopaedic surgeon. Ankle swelling of both the operative and non-operative limb was measured using the validated ‘Figure-of-eight’ measurement around the foot and ankle to quantify swelling of the affected ankle. A ratio of the patient’s 2 ankles was used as the measure of swelling to eliminate any bias between operators and standardise measurements between patients. Visual assessment of swelling was also recorded. Follow up was at 2, 6, and 12 weeks. Wound complications, patient co-morbidities, operative time, surgeon experience, and hospital stay duration were recorded Results: A total of 50 patients met inclusion criteria. Demographics were a 69% female predominance, a mean age of 45, and age range of 17- 69 years. A complication rate of 4% (n=2) was identified with both complications being superficial wound infections requiring oral antibiotics and wound episodes for treatment. Time to surgery had a mean of 6 days (range 0- 20). There was no significant difference in ankle swelling or time to surgery between patients with wound complications and those without. There were no significant differences identified between these groups when considering BMI, smoking status, diabetes, or peripheral vascular disease. Level of operating surgeon, operative time, tourniquet time, and closure material were also not significantly different between patients with and without wound complications. Conclusion: Our results show little post-operative soft tissue complications. If anything, our results are consistent with or show fewer soft tissue problems than the reported literature, despite a range of time to intervention. While we acknowledge that there may be a bias between surgeons in their preference in soft tissue management; we perceive that our study was sufficiently pragmatic to level this effect. Pre-operative swelling and time to operative intervention in ankle fracture surgery were not shown to correlate with change in soft tissue outcomes following ankle fracture surgery.

The Effectiveness of Bioskills Training for Simulated Lumbar Pedicle Screw Placement.

Study Design:Prospective randomized study.Objectives:To define the impact of an inexpensive, user-friendly, and reproducible lumbar pedicle screw instrumentation bioskills training module and evaluation protocol.Methods:Participants were randomized to control (n = 9) or intervention (n = 10) groups controlling for level of experience (medical students, junior resident, or senior resident). The intervention group underwent a 20-minute bioskills training module while the control group spent the same time with self-directed study. Pre- and posttest performance was self-reported (Physician Performance Diagnostic Inventory Scale [PPDIS]). Objective outcome scores were obtained from a blinded fellowship-trained attending orthopedic spine surgeon using Objective Structured Assessment of Technical Skills (OSATS) and Objective Pedicle Instrumentation Score metrics. In addition, identification of pedicle breach and breach anatomic location was measured pre- and posttest in lumbar spine models.Results:The intervention group showed a 30.8% improvement in PPDIS scores, compared with 13.4% for the control group (P = .01). The intervention group demonstrated statistically significant 66% decrease in breaches (P = .001) compared with 28% decrease in the control group (P = .06). Breach identification demonstrated no change in accuracy of the control group (incorrect identification from 32.2% pre- to posttest 35%; P = .71), whereas the intervention group’s improvement was statistically significant (42% pre- to posttest 36.5%; P = .0047).Conclusions:We conclude that a concise lumbar pedicle screw instrumentation bioskills training session can be a useful educational tool to augment clinical education.

Intramedullary Nail Fixation of Atypical Femur Fractures With Bone Marrow Aspirate Concentrate Leads to Faster Union: A Case-Control Study.

To evaluate bone marrow aspirate concentrate (BMAC) use in the treatment of AFF. Retrospective case control. Level 1 trauma center. Complete AFF, defined according to American Society of Bone and Mineral Research (ASBMR) criteria, from September 2009 to April 2015 with minimum 1-year follow-up. Operative treatment with antegrade intramedullary nails. Beginning June 2014, BMAC from the ipsilateral iliac crest was added to all AFFs. Time to union as determined by a blinded panel of 3 attending orthopaedic surgeons, union rates, complications. Thirty-five patients with 36 AFFs were reviewed, of which 33 AFFs were included and 11 received BMAC. Alendronate was the most commonly prescribed bisphosphonate, with a similar mean duration of use in controls and BMAC cases (5.6 versus 6 years, P = 0.79). BMAC use significantly decreased time to union (3.5 versus 6.8 months, P = 0.004). Varus malreduction was associated with a significant delay in union (9.7 versus 4.7 months, P = 0.04). Overall, 1 year union rate was 86.2% and nonsignificantly higher in BMAC compared with controls (100.0% versus 77.3%, P = 0.11). Multivariate analysis revealed BMAC and varus malreduction as independent predictors of time to union. There were no complications related to BMAC use. Our findings support intramedullary nailing of AFFs as an effective treatment option with a low surgical complication rate and highlight the importance of avoiding varus malreduction. BMAC use significantly reduced time to fracture union without an increase in surgical complication rates. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Increased Glenoid Index is a Risk Factor for Pediatric Anterior Glenohumeral Dislocation: An MRI-Based Case-Control Study

Objectives:In the adult population, anterior glenohumeral instability has been associated with a tall and narrow glenoid morphology, assessed using glenoid index (GI). This morphological association has not been assessed in children and adolescents. This study was designed to examine the association of GI with anterior glenohumeral dislocation in patients 19 years old and younger using a case-control study design.Methods:An institutional radiology database was queried over a 10-year period to identify patients 19 years old and younger who underwent glenohumeral MRI arthrography and were diagnosed with anterior shoulder dislocation (cases) and those without dislocation and normal shoulder arthrogram studies (controls). Those with bony Bankart lesions were excluded. Glenoid index (glenoid height-to-width ratio) was measured by an attending pediatric musculoskeletal radiologist and a fellowship-trained attending orthopedic surgeon. Comparative analysis between the two groups was performed using Student’s t-test for each variable, followed by receiver-operating-characteristic (ROC) analysis to determine discriminative ability when statistically significant.Results:Thirty-three males and 22 females (mean age: 15.4±2.1 years old) meeting inclusion and exclusion criteria were identified. Mean glenoid index in the dislocator group was significantly greater than the control group (1.55±0.14 vs. 1.38±0.08, P<0.001). ROC analysis revealed adequate discrimination of glenoid index in predicting glenohumeral dislocation (area under the curve [AUC] = 0.88). A glenoid index ≥1.45 was 83% sensitive and 79% specific for predicting dislocation in the study cohort.Conclusion:Patients with anterior glenohumeral dislocation were noted to have increased glenoid index (taller and narrower glenoid morphology) than controls. Glenoid index may help identify patients at risk for primary or recurrent anterior glenohumeral instability events, and can help guide treatment and anticipatory guidance.

The Effectiveness of Bioskills Training for Simulated Open Lumbar Laminectomy.

Study Design:Randomized, prospective study within an orthopedic surgery resident program at a large urban academic medical center.Objectives:To develop an inexpensive, user-friendly, and reproducible lumbar laminectomy bioskills training module and evaluation protocol that can be readily implemented into residency training programs to augment the clinical education of orthopedic and neurosurgical physicians-in-training.Methods:Twenty participants comprising senior medical students and orthopedic surgical residents. Participants were randomized to control (n = 9) or intervention (n = 11) groups controlling for level of experience (medical students, junior resident, or senior resident). The intervention group underwent a 40-minute bioskills training module, while the control group spent the same time with self-directed study. Pre- and posttest performance was self-reported by each participant (Physician Performance Diagnostic Inventory Scale [PPDIS]). Objective outcome scores were obtained from a blinded fellowship-trained attending orthopedic spine surgeon using Objective Structured Assessment of Technical Skills (OSATS) and Objective Decompression Score metrics.Results:When compared with the control group, the intervention group yielded a significant mean improvement in OSATS (P = .022) and PPDIS (P = .0001) scores. The Objective Decompression Scores improved in the intervention group with a trend toward significance (P = .058).Conclusions:We conclude that a concise lumbar laminectomy bioskills training session can be a useful educational tool for to augment clinical education. Although no direct clinical correlation can be concluded from this study, the improvement in trainee’s technical and procedural skills suggests that Sawbones training modules can be an efficient and effective tool for teaching fundamental spine surgical skills outside of the operating room.

Editorial: Upper Extremity Special Focus Section 2017

MedStar Union Memorial Hospital, Department of Orthopaedics and Sports Medicine Financial Disclosure: The author reports no conflicts of interest. Correspondence to Anand M. Murthi, MD, Chief, Shoulder and Elbow Surgery, Attending Orthopaedic Surgeon, Director, Shoulder and Elbow Fellowship and Research, MedStar Union Memorial Hospital, Department of Orthopaedics and Sports Medicine, 201 E. University Pkwy, Baltimore, MD 21218 Tel: +410-554-4382; e-mail: [email protected].

Obituary: Alexander Garcia MD (1919-2012)

Obituary: Alexander Garcia MD (1919-2012)

Impact of specialty and level of training on CT measurement of femoral version: an interobserver agreement analysis

BackgroundTo determine the interobserver agreement on femoral version measurements between an orthopedic attending, orthopedic senior and junior residents, and an attending radiologist.Materials and methodsPostoperative computed tomography (CT) scanograms of 267 patients who underwent femoral intramedullary (IM) nailing with corresponding radiology attending reads for femoral version were collected and de-identified. Femoral version measurements performed by a trauma fellowship-trained attending orthopedic surgeon (ORTHO), a senior orthopedic resident (PGY4), a junior orthopedic resident (PGY1), and a musculoskeletal fellowship-trained attending radiologist (RADS) were compared via Pearson’s interclass correlation coefficient to assess interobserver level of agreement.ResultsVersion measurements provided by the two attending physicians exhibited the highest level of agreement (r = 0.661, p < 0.01). The orthopedic attending and the senior resident had the next highest level of agreement (r = 0.543, p < 0.01). The first-year orthopedic resident had the weakest agreement across the board: with the orthopedic attending, the radiology attending, and the senior resident.ConclusionRegardless of specialty, experience and higher levels of training produce stronger agreement when measuring femoral version. Residents in training, especially those who are junior, produce weak agreement when compared to their senior colleagues.Level of evidenceLevel III, diagnostic study.

Upper Extremity

Chief, Shoulder and Elbow Surgery, Attending Orthopaedic Surgeon, Director, Shoulder and Elbow Fellowship and Research, MedsStar Union Memorial Hospital Department of Orthopaedics and Sports Medicine, Baltimore, MD Financial Disclosure: Dr. Murthi is a paid consultant for Zimmer and has received a grant from Integra. The author reports no conflicts of interest. Correspondence to Anand M. Murthi, MD, Chief, Shoulder and Elbow Surgery, Attending Orthopaedic Surgeon, Director, Shoulder and Elbow Fellowship and Research, MedsStar Union Memorial Hospital Department of Orthopaedics and Sports Medicine, Baltimore, MD 21228 Tel: +410 554 4382; fax: +410 554 2084; e-mail: [email protected]