Orthopaedic Society Research Articles

Rates of Reporting and Analyzing Race and Ethnicity in Athlete-Specific Sports Medicine Research: A Systematic Review.

Race- and ethnicity-based differences in treatment access and outcomes have been reported in the orthopaedic sports medicine literature. However, the rate at which race and ethnicity are reported and incorporated into the statistical analysis of sports medicine studies remains unclear. To determine the rate at which race and ethnicity are reported and analyzed in athlete-specific sports medicine literature. Systematic review; Level of evidence, 4. Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, articles published by the 3 journals of the American Orthopaedic Society for Sports Medicine between 2017 and 2021 were considered for inclusion. Original sports medicine research studies that focused on athletes were included. Outcome measures included reporting and analysis of patient demographics (age, sex, race, ethnicity). Studies that included demographic variables in a multivariate analysis or that performed a race-/ethnicity-based stratified analyses were considered to have analyzed that variable. Studies that reported and/or analyzed patient demographics were examined. Chi-square tests were performed to determine statistical significance. A total of 5140 publications were screened, and 842 met the inclusion criteria. Age and sex were well reported (84.1% and 87.0%, respectively), while race (3.8%) and ethnicity (2.0%) were poorly reported. There was no difference in rates of reporting age, sex, race, or ethnicity between the American Journal of Sports Medicine (AJSM), the Orthopaedic Journal of Sports Medicine (OJSM), or Sports Health: A Multidisciplinary Approach (Sports Health). The rate of analysis was also calculated as a percentage of the studies that reported that variable. Of the studies that reported age, 38.5% analyzed age. Using this method, 26.2% of studies analyzed sex, 40.6% analyzed race, and 17.6% analyzed ethnicity. Although there was no difference in the overall rate at which studies from the 3 journals analyzed ethnicity, Sports Health studies analyzed age (P = .044), sex (P = .001), and race (P = .027) more frequently than studies published in AJSM and OJSM. Of the studies that analyzed race, most of those studies (8/13, 61.5%) found significant race-based differences in reported outcomes. This systematic review demonstrated that race and ethnicity are poorly reported and analyzed in athlete-specific sports medicine literature, despite the fact that a majority of studies analyzing race found significant differences between racial groups. Improved reporting of race and ethnicity can determine whether race- and ethnicity-based differences exist in patient interventions to ameliorate disparities in patient outcomes.

Advocacy: a reflection on my 30 years of orthopedic practice

As orthopedic surgeons, we have the responsibility for advocating for our patients and our profession, on the local, state, and federal levels. The American Academy of Orthopaedic Surgeons (AAOS) created the American Association of Orthopaedic Surgeons to allow for political advocacy. The Association Political Action Committee, OrthoPAC, was created in 1999 and has become an effective tool in our advocacy committee. The American Shoulder and Elbow Surgeons (ASES), along with many orthopedic subspecialty societies, has established an advocacy effort and works with the AAOS through the OrthoPAC as a member of the Advisor’s Circle, which is designed to provide AAOS Members’ group practices and specialty societies with a leadership role within the Political Action Committee of the American Association of Orthopaedic Surgeons (Orthopaedic PAC). If we are to preserve individual patient access to specialized musculoskeletal care, we must support state and federal advocacy efforts. This can be in the form of financial support or personal involvement in relationship building. I encourage all members of ASES, especially the younger ones, to support your state orthopedic societies, the ASES, and the AAOS in their advocacy efforts. The well-being of our patients and the future of our profession depend on you.

Abstracts accepted for the 2021–2023 French Orthopaedic and Traumatology Society meetings: Proportion of women submitters

BackgroundWomen are underrepresented in orthopaedic and trauma surgery worldwide, with proportions of 4% to 17% across countries and 9.1% in France. The annual meeting of the French Society for Orthopaedic and Trauma Surgery (SOFCOT) provides opportunities for quantifying the representation of women, which has not yet been accurately evaluated. The objectives of this retrospective study were: 1) to evaluate the proportion of women relative to men who submitted abstracts accepted for presentation at annual SOFCOT meetings, 2) to analyse this proportion in each abstract category, and 3) to compare the professional profiles of submitting authors. HypothesisAmong authors with abstracts accepted for presentation at annual SOFCOT meetings, only a minority were women. MethodsThis retrospective study evaluated all abstracts accepted for presentation at the annual SOFCOT meetings held in 2021, 2022, and 2023. For each accepted abstract, the gender and professional profile of the submitting author were assessed. The female/male ratio was determined for each abstract category and professional profile for each of the three years. ResultsThe female/male ratio among authors of abstracts accepted in 2021, 2022, and 2023 was 161/923 (14.9% women), 128/541 (19.1%), and 120/550 (17.9%). The proportion of women was significantly less than the proportion of men for abstracts on the knee (41/333, 11% women (p = 0.0008)), hip (23/209, 9.9% (p = 0.002)), trauma (53 /358, 12,9% (p = 0.017)), and tumours (14/119, 10.5% (p = 0.04)). The proportion of women was also significantly smaller than the proportion of men among residents/fellows (154/491, 23.5% (p < 0.0001)), senior surgeons in non-university institutions (42/400, 11.5% (p < 0.0001)), and senior surgeons in university hospitals (23/164, 12.3% (p = 0.009)). DiscussionThe representation of women compared to men remains low at annual SOFCOT meetings despite being greater than the overall representation of women among orthopaedic surgeons in France. These results highlight the appeal of research and growing interest for orthopaedic surgery among women. Scientific societies and surgical teams must continue to encourage this dynamic. Level of evidenceIII; retrospective case-control study.

Management of Syndesmotic Ankle Injuries: Results of a Survey of POSNA Members

BackgroundAlthough utilization of dynamic suture-button fixation for adult syndesmotic injuries has shown improved outcomes over static screw fixation, data in pediatric populations is limited. This study evaluated trends in management and identified factors influencing surgeon choice of implant for pediatric syndesmotic injuries. MethodsPediatric Orthopaedic Society of North America (POSNA) members were surveyed regarding syndesmotic injury implant preferences between October 2021 and May 2022. Respondents that opted out, treated <1 syndesmotic ankle injury in the past year, or had conflicting financial obligations were excluded. Results were summarized and analyzed using logistic regression to assess for significance between years post-training and technique preference. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for significance (P-values<0.05). ResultsAmong 103 respondents to the survey (with 102 complete responses), 25% were <5 years post-training, 24% between 5-10 years, 21% between 11-15 years, and 28% >15 years post-training. Twenty-four percent (24/102) preferred screw versus 76% (78/102) preferring suture-button implants for syndesmotic injuries. Members >15 years post-training were 4.7 times more likely to prefer screw implants compared to members <5 years post-training (OR=4.7; 95% CI, 1.14-19.34; p=0.03). Since starting their clinical practice, 62 respondents (60%) reported an implant preference change, with avoidance of secondary surgery (46/62; 74%) and extrapolation from adult outcomes (39/62; 63%) cited as primary motivating factors. Of the 40 members with no preference change, comfort with the procedure was the primary cited reason (33/40; 83%). Among those choosing operative intervention, radiograph-based cases showed preference for suture-button in 70-79% of respondents for skeletally mature patients versus 71-81% for skeletally immature patients. ConclusionOur data shows that the shift over time from screw to suture-button implant fixation for pediatric and adolescent syndesmotic ankle injuries is largely due to interest in avoiding implant removal and extrapolation from superior outcomes seen with suture-button use in adults. Larger comparative studies of pediatric and adolescent patients treated with suture-button versus screw fixation are needed to establish standards of care for these challenging injuries. Levels of EvidenceLevel V: Expert opinion

Post-Surgical Dental Precautions/Prophylaxis in Pediatric Patients: Results of a 2023 Survey of the Membership of the Pediatric Orthopaedic Society of North America (POSNA)

IntroductionGuidelines regarding post-surgical dental care have been common in adult total joint arthroplasty patients, despite limited supporting evidence in the literature. There is anecdotal evidence that similar precautions are implemented frequently in post-operative pediatric orthopaedic patients without any published evidence to guide clinicians. Material and MethodsA survey of the Active Members of the Pediatric Orthopaedic Society of North America (POSNA) was performed to assess the use of post-surgical guidelines regarding dental care (procedures and prohylaxis) in pediatric patients. A 20-question survey regarding this subject was developed with the input of, and approved by, the Evidence-Based Practice Committee of POSNA, and a link to participate was distributed to the Active Membership. ResultsOne hundred and seventy-three POSNA members opened the link to the survey. 163 respondents self-identified as Active, for a response rate of 19.8%. One hundred and fifty-seven (96.3%) reported direct involvement in surgical and post-surgical care of pediatric orthopaedic patients. Sixty-two (39.4%) indicated use of a post-operative protocol regarding dental interventions. Forty percent of those indicating use of guidelines were uncertain of the specifics of the protocol(s) used at their institution. Eighty-five percent of those utilizing protocols felt that the use of guidelines was a valuable topic for investigation. ConclusionsThese results demonstrate that many of the active members of POSNA utilize post-surgical guidelines for dental care, particularly for those patients who have undergone spinal surgery with permanent implants. This is despite the fact that there is limited evidence to support their use in adult total joint patients, and no literature regarding use of such guidelines in pediatric orthopaedic patients. Level of EvidenceLevel V

Do ChatGPT and Gemini Provide Appropriate Recommendations for Pediatric Orthopaedic Conditions?

Artificial intelligence (AI), and in particular large language models (LLMs) such as Chat Generative Pre-Trained Transformer (ChatGPT) and Gemini have provided additional resources for patients to research the management of healthcare conditions, for their own edification and the advocacy in the care of their children. The accuracy of these models, however, and the sources from which they draw conclusions, have been largely unstudied in pediatric orthopaedics. This research aimed to assess the reliability of machine learning tools in providing appropriate recommendations for the care of common pediatric orthopaedic conditions. ChatGPT and Gemini were queried using plain language generated from the American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guidelines (CPGs) listed on the Pediatric Orthopedic Society of North America (POSNA) web page. Two independent reviewers assessed the accuracy of the responses, and chi-square analyses were used to compare the 2 LLMs. Inter-rater reliability was calculated via Cohen's Kappa coefficient. If research studies were cited, attempts were made to assess their legitimacy by searching the PubMed and Google Scholar databases. ChatGPT and Gemini performed similarly, agreeing with the AAOS CPGs at a rate of 67% and 69%. No significant differences were observed in the performance between the 2 LLMs. ChatGPT did not reference specific studies in any response, whereas Gemini referenced a total of 16 research papers in 6 of 24 responses. 12 of the 16 studies referenced contained errors and either were unable to be identified (7) or contained discrepancies (5) regarding publication year, journal, or proper accreditation of authorship. The LLMs investigated were frequently aligned with the AAOS CPGs; however, the rate of neutral statements or disagreement with consensus recommendations was substantial and frequently contained errors with citations of sources. These findings suggest there remains room for growth and transparency in the development of the models which power AI, and they may not yet represent the best source of up-to-date healthcare information for patients or providers.

Attitude of aspiring orthopaedic surgeons towards artificial intelligence: a multinational cross-sectional survey study

IntroductionThe purpose of this study was to evaluate the perspectives of aspiring orthopaedic surgeons on artificial intelligence (AI), analysing how gender, AI knowledge, and technical inclination influence views on AI. Additionally, the extent to which recent AI advancements sway career decisions was assessed.Materials and methodsA digital survey was distributed to student members of orthopaedic societies across Germany, Switzerland, and Austria. Subgroup analyses explored how gender, AI knowledge, and technical inclination shape attitudes towards AI.ResultsOf 174 total respondents, 86.2% (n = 150) intended to pursue a career in orthopaedic surgery and were included in the analysis. The majority (74.5%) reported ‘basic’ or ‘no’ knowledge about AI. Approximately 29.3% believed AI would significantly impact orthopaedics within 5 years, with another 35.3% projecting 5–10 years. AI was predominantly seen as an assistive tool (77.8%), without significant fear of job displacement. The most valued AI applications were identified as preoperative implant planning (85.3%), administrative tasks (84%), and image analysis (81.3%). Concerns arose regarding skill atrophy due to overreliance (69.3%), liability (68%), and diminished patient interaction (56%). The majority maintained a ‘neutral’ view on AI (53%), though 32.9% were ‘enthusiastic’. A stronger focus on AI in medical education was requested by 81.9%. Most participants (72.8%) felt recent AI advancements did not alter their career decisions towards or away from the orthopaedic specialty. Statistical analysis revealed a significant association between AI literacy (p = 0.015) and technical inclination (p = 0.003). AI literacy did not increase significantly during medical education (p = 0.091).ConclusionsFuture orthopaedic surgeons exhibit a favourable outlook on AI, foreseeing its significant influence in the near future. AI literacy remains relatively low and showed no improvement during medical school. There is notable demand for improved AI-related education. The choice of orthopaedics as a specialty appears to be robust against the sway of recent AI advancements.Level of evidenceCross-sectional survey study; level IV.

Changes and clinical significance of NLRP3 inflammasomes and related factors in patients with spinal fracture complicated with acute spinal cord injury

To investigate the changes and clinical significance of NOD like receptor protein 3 (NLRP3) inflammasomes and related factors in patients with spinal fractures complicated with acute spinal cord injury (SCI). Eighty-six spinal fracture patients complicated with acute SCI admitted to hospital from June 2019 to March 2022 were selected as SCI group, There were 48 males and 38 females, with an average age of (43.48±6.58) years old. And 100 healthy volunteers who underwent physical examination during the same time were selected as control group, including 56 males patients and 44 females patients, with an average age of (45.13±6.43) years old. Peripheral blood mononuclear cell (PBMC) were collected, and the mRNA expressions of NLRP3 and Caspase-1 were detected. Serum was collected and the levels of interleukin (IL)- 1β, IL-18 were detected. According to Frankel's grade, the SCI group was divided into complete injury patients and incomplete injury patients, and according to the Japanese Orthopedic Society (JOA) grade, the SCI group was divided into good prognosis group and poor prognosis group. The difference of NLRP3, Caspase-1, IL-1β, IL-18 among groups were compared, the influencing factors for poor prognosis in SCI patients was analyzed by Logistic regression. The mRNA expression levels of NLRP3 (1.41±0.33) and Caspase-1 (1.44±0.35) in PBMC and the levels of IL-1β(45.34±13.22) pg·ml-1, IL-18(40.95±8.77) pg·ml-1 in serum of SCI group were higher than those of the control group[(1.00±0.19), (1.00±0.16), (16.58±4.24) pg·ml-1, (12.57±3.68) pg·ml-1] (P<0.05). The mRNA expression levels of NLRP3(1.63±0.34) and Caspase-1 (1.67±0.27) in PBMC and the levels of IL-1β(51.09±11.10) pg·ml-1, IL-18 (47.65±7.93) pg·ml-1 in serum of patients with complete injury in the SCI group were higher than those of patients with incomplete injury [(1.31±0.27), (1.34±0.33), (42.85±13.36) pg·ml-1, (38.05±7.48) pg·ml-1](P<0.05). The mRNA expression levels of NLRP3 (1.66±0.31) and Caspase-1 (1.72±0.31)in PBMC and the levels of IL-1β(51.21±11.31) pg·ml-1, IL-18 (45.70±7.25) pg·ml-1 in serum, the proportion of complete injury(21 patients), and the proportion of spinal cord edema or bleeding of patients(15 patients) with poor prognosis in the SCI group were higher than those of patients with good prognosis[(1.28±0.26), (1.37±0.36), (42.79±13.25) pg·ml-1、(38.90±8.63) pg·ml-1, 5、20 cases](P<0.05). Complete injury and the mRNA expression of NLRP3 in PBMC were the influencing factors for poor prognosis in the SCI group (P<0.05). The activation of NLRP3 inflammasomes in patients with spinal fractures complicated with acute SCI is associated with worsening injury and poor prognosis, and NLRP3 expression can serve as a marker for evaluating prognosis.

Medical advisability of softball youth pitching recommendations on the internet

ABSTRACT Objective Developing softball pitchers are prone to injury due to the repetitive throwing motion. Many children and parents use the internet as a source of medical advice, but this information may not always be aligned with medical guidelines. The purpose of this study was to assess the medical advisability of injury prevention guidelines for developing softball pitchers on websites using Google as the primary search engine. Methods The first 100 websites populated from a Google search using the term softball youth pitching recommendations were evaluated. Each website was categorized as discussing baseball, softball, or both, and as athletic, commercial, or educational. For every website, 16 recommendations described by the American Orthopaedic Society for Sports Medicine (AOSSM) Stop Sports Injuries softball injury prevention guidelines (Table 1) were scored as in agreement (+1), different guideline mentioned (0.5), no mention (0), or discordant (−1). Table 1. Websites with guidelines identical to AOSSM by type of website, by sport, and by order of appearance in google search, AOSSM = American orthopaedic society for sports medicine. ‘*’ indicates p value < 0.05. Results Of the 98 qualifying websites, 57 advised only about softball, while 19 advised about both baseball and softball. Fifty websites had no mention of any recommendation outlined by AOSSM. Websites that were mostly in agreement with AOSSM were educational websites (mean score = 3.9, p = 0.02), websites discussing only softball (mean score = 2.0, p = 0.02), and the first 50 websites (mean score = 2.2, p = 0.04). The most common discordant guideline was differing opinions in pitch count (13 websites). Conclusion The most common category in disagreement with AOSSM was different pitch count guidelines, highlighting a need for websites to provide more consistent information using high-quality resources. Educational websites, websites discussing only softball, and the first 50 websites had the highest scores, indicating that these types of websites are most likely to have the highest amount of medically advisable information. We recommend users conduct targeted Google searches on reliable websites for information on pitching softball recommendations to maximize the validity of Google search results.

Knowledge and Utilization of Sex-Specific Lead Aprons Among Pediatric Orthopaedic Surgeons.

Orthopaedic surgeons routinely face exposure to ionizing radiation during intraoperative use of fluoroscopy. Lead personal protective equipment reduces occupational radiation exposure. Female-specific lead aprons are designed with expanded lateral coverage to improve protection of breast tissue against radiation beams. The purpose of this study was to identify current trends in knowledge and utilization of female-specific lead aprons as well as any barriers to utilization. An anonymous electronic survey including 20 multiple choice and multiple selection responses was distributed to all members of the Pediatric Orthopaedic Society of North America (POSNA). Respondents who reported the use of intraoperative fluoroscopy in their practice were included in the study. Most respondents were attending surgeons (91%) and practiced in an academic setting (85%) in an urban environment (75%). Most respondents reported using a lead apron for every case (76%) and a thyroid shield for every case (75%), while most respondents reported they do not wear lead glasses (73%). Fifty-one percent of respondents were aware of female-specific lead aprons. The majority of respondents reported female-specific lead is unavailable (45%) or available in insufficient quantities (5.5%) at their institution. Ninety percent of females reported they do not wear female-specific lead with the common reasons being lack of availability and discomfort. Knowledge of female-specific lead is low with lack of availability as a common barrier to utilization. As female presence in the field of orthopaedic surgery expands, efforts should be made to improve education and availability of sex-specific lead aprons.

The Year Publication Rate of Presentations from the Inaugural Medical Student Orthopedic Society Research Symposium

Introduction Orthopaedic surgery is one of the most competitive residencies to match in medicine, the match rate has decreased to 63.1% in 2023.&lt;sup&gt;1,13&lt;/sup&gt; Aspects of the application that are most in the control of applicants are their personal and research experiences in the field and their choice of acting internships. The Medical Student Orthopaedic Society (MSOS) hosted the first national, and virtual orthopaedic research symposium for medical students. This study aimed to examine the short-term publication rate of the research presented at the 2022 MSOS Research Symposium. Methods The titles of the articles and the names of the presenters from the MSOS program were used to search for publications via PubMed and Google Scholar search engines. If no matching result was found, the article was considered not published. If the presentation was published in a journal within our study period, the updated title, name and gender of the medical student and senior author, name of the journal, and date of publication were recorded. Demographic variables among presenters included gender, and current training status. These were determined via a Google search. Impact factors were extracted from the Web of Science (WoS) database for the year of 2023. Results For the 2022 MSOS Symposium, a total of 300 presentations were given. Nineteen publications had to be excluded. Of the 281 presentations included in this study, 129 were published in a peer-reviewed journal within 18-months after the symposium (45%). Presentations were published on average 165 days (~5.5 months) after the symposium. Of the journals that had an impact factor score, the average was 2.18. Categories with over 60% publication rate were Practice Management and Health Disparities, shoulder and elbow, and medical education. Among presenters whose projects were published, 74% identified as men and 26% as women. The papers’ senior authors were 85% men and 15% women. Of those that participated and published in the 18-month period, 22% of individuals matched into orthopedics the following year, 9% matched into another residency, 38% were still medical students, 30% statuses were unknown or could not be determined. Of those schools represented, 20 schools (35 participants) did not have a home program at their institution, also known as orphan programs. The presenter was the first author in 53% (69) of the published works. Discussion The Medical Student Orthopaedic Society (MSOS) touted a publication rate of 45% which is comparable to the rates of publication in less time than numerous other meetings (~5.5 months). This may be due to medical students’ finite amount of time to gain the experience necessary to apply, suggesting there is a higher motivation to get research out and published. However, further research into the participation levels of presenters would need to be studied directly to give a definitive understanding as to why first authorship was not provided to the presenter. Participants that published were majority male and attended allopathic schools. Most were still in medical school, while 21% have matched into an Orthopaedics program, 9% matched into another program and 30% could not be determined at this time. Conclusion As the goal for a medical student is to successfully match it is highly important that opportunities are not only accessible but allow for URiM and orphan medical schools to engage in a meaningful way.&lt;sup&gt;11&lt;/sup&gt; The MSOS is hopeful that this virtual symposium can be beneficial in expanding exposure to orthopaedics through research opportunities and experiences. &lt;sup&gt;1&lt;/sup&gt;

Paper 44: In-Person Versus Virtual Interviews for Orthopaedic Surgery Sports Medicine Fellowship: Applicant Perspectives

Objectives: Virtual fellowship interviews were widely utilized during the COVID-19 pandemic. Little is published at this time about the preferences of applicants of orthopaedic surgery sports medicine fellowship positions regarding in-person versus virtual interviews. The purpose of this study is to determine the applicant cost-benefit willingness for both in-person and virtual interviews, assess the ability to learn about a program in a virtual setting, and to gauge the opinions of applicants on their preferences for in-person or virtual interviews. Methods: An online survey was distributed to all orthopaedic sports medicine applicants for the 2022-2023 match cycle through the American Orthopaedic Society for Sports Medicine (AOSSM). Statistical analysis was performed using descriptive statistics. Results: Forty-five surveys were completed. Respondents had a mean age of 31.49 years (±2.49) with 38 (84.4%) identifying as male and 7 (15.6%) as female. Most applicants applied to between 31-40 (26.7%) or 21-30 programs (22.2%), while attending between 11-15 interviews (44.4%). 51.1% of applicants stated that ~25% of their interviews were virtual format, with 15.6% of all applicants attending over 50% of interviews in the virtual format. Most applicants spent between $2,500-$5,000 (35.7%) or $5,000-$7,500 (26.7%) on interviews. Applicants stated they would feel most comfortable spending between $2,500-$5,000 (46.7%) or $5,000-$7,500 (26.7%). 36.4% of applicants stated they completed less in-person interviews due to cost, and 52.3% said they would have completed less interviews overall if there was no virtual option. 68.2% of applicants stated distance traveled was irrelevant when electing to attend an interview virtually. When comparing in-person vs virtual interviews, applicants either strongly agreed or agreed that in-person interviews allowed them to better represent themselves (95.6% vs 44.4%), assess right “fit” (95.6% vs 28.9%) and sufficiently formulate a rank list (93.2% vs 40%) compared to virtual interviews. Conclusions: Fellowship applicants had strong preferences for in-person interviews in the orthopaedic surgery sports medicine fellowship match. Cost was a limiting factor in declining in-person interviews and most applicants attended more interviews due to virtual formats. Applicants did not feel that virtual interviews were sufficient for creating accurate rank lists.

Estimated Incidence of Pediatric Distal Radius Buckle Fractures in the United States

BackgroundDistal radius buckle fracture care has been extensively studied, yet the incidence in the United States is unknown. This study aims to determine the incidence of pediatric buckle fractures using geospatial analysis. MethodsPediatric distal radius buckle fractures (patients aged <18) from 2018 to 2022 were identified via a retrospective chart review from a single health care organization. The catchment area was defined as all of the home ZIP codes of verified buckle fracture patients. Corrections were made for buckle fractures treated at institutions with overlaying catchment areas. Adjusted incidence was then used to calculate annual buckle fractures nationally. Pediatric Orthopaedic Society of North America member rolls were used to identify and locate pediatric orthopaedic surgeons. It was assumed that each pediatric orthopaedic surgeon would treat up to 20 buckle fractures annually from a 25-mile radius of the primary office. Based on this, the percentage of buckle fractures nationally that are able to be treated by pediatric Orthopaedic surgeons was estimated. ResultsA total of 594 distal radius buckle fractures over 5 years were confirmed in an estimated catchment area of 866,238 population. With adjustments for overlapping institutions, the estimated annual incidence was 17.3 per 100,000 people (95% CI [14.5, 20.1]). In the United States, there are an estimated 66,513 buckle fractures annually, with 1,182 pediatric orthopaedic surgeons potentially able to treat 26.5% of these cases. ConclusionsThis investigation estimates the incidence of pediatric buckle fractures in the United States, allowing for estimates of expected volumes and implications for care. Based on the geographic distribution of pediatric orthopaedic surgeons and estimated incidence, it is impractical for buckle fracture care to be delivered exclusively by pediatric orthopaedic surgeons. Key Concepts(1)The estimated annual incidence of distal radius buckle fracture is 17.3 per 100,000 people.(2)Pediatric orthopaedic surgeons are able to treat up to 26.5% of these cases.(3)Buckle fractures cannot be the exclusive domain of pediatric orthopaedic surgeons, as the number of pediatric Orthopaedic surgeons is too small for them to be the sole providers of care. Level of EvidenceIII

Barriers to Health Care Communication: Patient Education Resource Readability and Spanish Translation for Slipped Capital Femoral Epiphysis

BackgroundThe American Medical Association (AMA) and the National Institutes of Health (NIH) recommend that patient education resources be written at 6th and 8th grade reading levels, respectively. However, many existing resources are written above this level. In addition, the majority of patient education resources are only available in English, despite the significant Spanish-speaking population in the United States. The purpose of this study was to determine the availability and readability of online patient education resources for Slipped Capital Femoral Epiphysis (SCFE) provided by the top-ranked pediatric orthopaedic hospitals and major pediatric orthopedic professional societies. MethodsWe performed a cross-sectional analysis to determine the availability of English and Spanish language resources for SCFE provided by the top pediatric orthopaedic hospitals and major professional societies. We then assessed the readability of available patient education materials via three measures of readability. Statistical analysis was performed using descriptive, univariate, and correlation analyses. ResultsIn total, 79.6% (39/49) of hospitals and 66.7% (2/3) of professional societies provided English language resources for SCFE. In contrast, Spanish language resources were provided by 34.7% (17/49) and 33% (1/3) hospitals and professional societies. English language resources scored significantly lower than Spanish language resources using the Flesch-Kincaid and Fernandez-Huerta reading ease scales, respectively (60.32 vs. 65.89, p<0.05). There was no difference in grade level calculated by Fry Graph/Gilliam-Peña-Mountain (9.5 vs. 8.5, p>0.05), but English language resources had a significantly higher grade level calculated by SMOG/SOL (11.9 vs. 10.4, p<0.01). There was greater availability of Spanish language resources in states with >20% primary Spanish- speakers (p<0.05). ConclusionThe majority of top-ranked hospitals and professional societies provide online educational materials on SCFE in English; however, only a third provide similar materials in Spanish. Additionally, the average reading level of English and Spanish language resources is above the recommendations from the AMA and NIH. Additional effort and resources should be allocated toward improving SCFE patient education materials to increase accessibility to broader patient and caregiver populations. LEVEL OF EVIDENCELevel III KEY CONCEPTS(1)Online patient education resources for Slipped Capital Femoral Epiphysis (SCFE) are written above the recommended reading grade level for both English and Spanish.(2)There is limited availability of Spanish-language patient education recourses for SCFE, despite a significant Spanish-speaking population in the United States.(3)There is greater availability of Spanish-language resources for SCFE in states with a primary Spanish-speaking population greater than 20%.

Impact of Program Region and Prestige on Industry Supplemental Earnings for Pediatric Orthopedic Surgery Fellowships in the United States: A Retrospective Analysis

Introduction: With the passage of the Physician Payment Sunshine Act, there has been increased transparency regarding the industrial financial relations that physicians have. Orthopedic surgeons have been highly studied in this domain with approximately 50% of all orthopedic surgeons engaging in industrial financial relationships. Furthermore, an increasing number of orthopedic surgeons are seeking fellowship training with pediatric fellowship programs gaining popularity in recent years. The purpose of this study is to evaluate the impact various pediatric orthopedic fellowship programs have on industry earnings and academic productivity. Methods: Pediatric orthopedic fellowship programs were identified via the Orthopedic Society of North America (POSNA) website. Information on individual fellowship programs was obtained from their respective websites. Academic productivity was measured via an aggregate of all employed physicians’ H-index at a specific fellowship as found on the Scopus website. The Open Payments Database (OPD) website was used to assess lifetime industry earnings. Other variables such as Newsweek or Doximity ranking were taken directly from relevant websites. Statistical analysis was performed using a Kruskal–Wallis test with Bonferroni correction and Mann–Whitney U-test. Results: A total of 43 pediatric orthopedic surgery fellowships in the United States were identified with a total of 392 physicians as fellowship faculty. Complete OPD and H-index information were available for 336 of those physicians (85.7%). On average, there were 7.81 ± 5.18 physicians and 1.56 ± 0.93 fellows per program. The mean combined physician H-index was 117.23 ± 122.51, and the mean combined physician lifetime supplemental earnings in dollars was $646,684.37 ± $1,159,507.17. There was no significant relationship between region of pediatric orthopedic fellowship, Newsweek ranking of affiliated hospital, Doximity ranking of affiliated hospital, presence of MBA program, type of program (public, private, mixed), and the lifetime industry earnings or academic productivity of program graduates. Conclusions: Despite the observed lack of statistical significance, there were clear trends observed with fellowship programs in the northeast and west coast regions being the highest earning and fellowship programs with top 10 Newsweek ranking of affiliated hospital having by far the greatest industry earnings. Sample size limitations likely prevented the detection of statistical significance. Future studies should examine if any relation exists when accounting for type of industry payment received and case volume per fellowship program.

Implants removal in children: results of a survey among Italian orthopaedic surgeons.

In the treatment of paediatric limb disorders, the use of metal implants has been increasing over the last decades. Recent studies have addressed the decision of orthopaedic surgeons regarding the removal of implants after the treatment of fracture, and there is a growing consensus within the scientific community supporting the choice of not removing implants in children. This survey aimed to investigate the rationale behind the Italian orthopaedic community's decision regarding metal implant removal in paediatric patients. An electronic questionnaire was sent to all members of the Italian Paediatric Orthopaedic and Traumatology Society, Italian Orthopaedic and Traumatology Society, Italian Club of Osteosynthesis, and South Italy Society of Orthopaedic and Traumatology. The survey comprised 34 questions about hardware removal after the treatment of long bone fractures, epiphyseal growth plate injuries, slipped capital femoral epiphysis (SCFE), and flat foot. Of the 3500 orthopaedic surgeons who received the questionnaire, 5.5% responded. The leading indications for implant removal were the patient's intolerance, pain, ROM limitations, and hardware breakage. Removal of elastic nails for long bone fractures, cannulated screws for growth plate injuries, and SCFE and screws for arthroereisis for flat foot correction were analysed in detail. The consensus among Italian Orthopaedic Surgeons is to remove elastic nails and cannulated screws in cases of pain, intolerance, or breakage and to reduce further risks during patient growth. An increasing number of physicians, however, are endorsing and advocating the growing trend in the literature of not routinely removing the hardware.

Gabapentinoid prescriptions for neuropathic and musculoskeletal pain in Lebanon.

Aim: The purpose of this study is to analyze the different characteristics of gabapentinoids prescription by Lebanese orthopedics surgeons. Methods: This is an observational, cross-sectional study using a survey which was carried out in collaboration with the Lebanese Orthopedic Society over a 3-month period. Results: Forty-two orthopedic surgeons responded, most of them prescribing gabapentinoids in their daily practice with only half of the patients feeling relief after taking them. Furthermore, most of the surgeons prescribed these drugs for patients above 18 years old and for both acute and chronic pain. Conclusion: Even though almost half of the patients do not experience relief after taking gabapentinoids, these drugs are becoming more and more prescribed.

Adolescent Idiopathic Scoliosis Minimum Data Set: Towards Standardization of Data Elements in History and Physical Examination.

Nonoperative care represents a cornerstone of adolescent idiopathic scoliosis (AIS) management, although no consensus exists for a minimal data set. We aimed to determine a consensus in critical data points to obtain during clinical AIS visits. A REDCap-based survey was distributed to Pediatric Orthopedic Society of America (POSNA), Pediatric Spine Study Group (PSSG), and International Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT). Respondents ranked the importance of data points in history, physical examination, and bracing during AIS visits. Results: One hundred eighty-one responses were received (26% response rate), of which 86% were physicians and 14% were allied health professionals. About 80% of respondents worked at pediatric hospitals or pediatric spaces within adult hospitals, and 82% were academic, with the majority (57%) seeing 150+ unique AIS patients annually. Most respondents recommended six-month follow-up for patients under observation (60%) and bracing (54%). Most respondents (75%) considered family history and pain important (69%), with the majority (69%) asking about pain at every visit. Across all time points, Adam's forward bend test, shoulder level, sagittal contour, trunk shift, and curve stiffness were all considered critically important (>60%). At the first visit, scapular prominence, leg lengths, motor and neurological examination, gait, and iliac crest height were also viewed as critical. At the preoperative visit, motor strength and scapular prominence should also be documented. About 39% of respondents use heat sensors to monitor bracing compliance, and average brace wear since the prior visit was considered the most important (85%) compliance data point. This study establishes recommendations for a 19-item minimum data set for clinical AIS evaluation, including history, physical exam, and bracing, to allow for future multicenter registry-based studies.

Effects of γ-aminobutyric acid (GABA) intake in combination with exercise on muscle strength in humans with decreased mobility: a randomized, double-blind, placebo-controlled, parallel-group study

Background: Aging-related declines in skeletal muscle mass, muscle strength, and physical function are related to instability, falls, and frailty in older people, resulting in the need for nursing care. Objective: To investigate the effect of oral γ-aminobutyric acid (GABA) intake and exercise on muscle parameters in healthy subjects whose muscle strength is beginning to decline with age. Methods: A randomized, double-blind, placebo-controlled, parallel-group comparative study was conducted. Fifty subjects (over 40 years old) were randomly divided into the GABA (100 mg/day) or placebo food intake group. Subjects orally consumed the respective study substance every day for 12 weeks. They performed daily “locomotion training” as devised by the Japanese Orthopedic Society. Muscle mass, fat mass, and knee extension muscle strength were measured. Results: The two groups had no significant differences in muscle and fat mass. Compared with the placebo food group, the GABA group showed a significant improvement in knee extension muscle strength in the left and right legs at pre-dose Week 0 (at Week 6, p = 0.02). In post hoc subgroup analysis by sex, when compared with the placebo food intake group, the GABA food intake group showed significant improvement in knee extension muscle strength of the right leg at Weeks 6 (p = 0.001) and 12 (p = 0.007), the left leg at Week 6 (p = 0.02), the stronger of the left and right legs at pre-dose Week 0 (at Week 6, p = 0.001), and the weaker of the left and right legs at pre-dose Week 0 (at Week 12, p = 0.013) in males. Conclusions: These results suggest that GABA intake combined with daily exercise is effective for maintaining knee extension muscle strength, which decreases with age. Furthermore, there were no safety issues with the intake of GABA-containing food during this study. Trial registration: UMIN-CTR: UMIN000050152. Keywords: γ-Aminobutyric acid, GABA, Muscle mass, Knee extension muscle strength, Aging

Reassessing the minimum 2-year follow-up standard after lumbar decompression surgery: a 2-month follow-up seems to be an acceptable minimum

BACKGROUND CONTEXTAcademic orthopedic journals and specialty societies emphasize the importance of two-year follow-up for patient-reported outcome measures (PROMS) after spine surgery, but there are limited data evaluating the appropriate length of follow-up. PURPOSETo determine whether PROMs, as measured by the Oswestry Disability Index (ODI), would change significantly after 2-months postoperatively after lumbar decompression surgery for disc herniation or spinal stenosis. STUDY DESIGNRetrospective analysis of prospectively and consecutively enrolled patients undergoing lumbar decompression surgery between 2020 and 2021 from a single surgeon spine registry. PATIENT SAMPLEOne hundred sixty-nine patients. OUTCOME MEASURESODI, achievement of minimum clinically important difference (MCID), revisions. METHODSPatients without a preoperative baseline score were excluded. Completion of the ODI questionnaire was assessed at the follow-up points. The median ODI was compared at time baseline, 2-month, 1-year and 2-year follow-up. Risk of reoperation was assessed with receiver operating characteristic (ROC) analysis to identify at-risk ODI thresholds of requiring reoperation. RESULTSMedian ODI significantly improved at all time points compared to baseline (median baseline ODI: 40; 2-month ODI: 16, p=.001; 1-year ODI: 11.1, p=.001; 2-year ODI: 8, p=.001). Posthoc analysis demonstrated no difference between 2-months, 1-year and 2-year postoperative ODI (p=.9, p=.468, p=.606). The MCID was met in 87.9% of patients at 2 months, 80.7% at 1 year, and 87.3% at 2 years postoperatively. Twelve patients (7.7%) underwent revision surgery between 2 months and 2 years after the index surgery (median time to revision: 5.6 months). ROC curve analysis demonstrated that an ODI score ≥24 points at 2-months yielded a sensitivity of 85.7% and a specificity of 71.8% for predicting revision after lumbar decompression (AUC=0.758; 95% CI: 0.613–0.903). The Youden optimal threshold value of ≥24 points at 2-month postop ODI yielded an odd ratio (OR) for revision of 15.3 (CI: 1.8–131.8; p=.004). The positive predictive value (PPV) and negative predictive value (NPV) were 15.4% and 98.8%, respectively. CONCLUSIONTwo-year clinical follow-up may not be necessary for future peer-reviewed lumbar decompression surgery studies given that ODI plateaus at 8 weeks. Patients with a score ≥24 points at 2-months postoperatively have a higher risk of requiring a second surgery within the first 2 years and warrant continued follow-up.