Pediatric Orthopaedic Society Research Articles

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.

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.

Use of paralytic agents during the operative treatment of type III supracondylar humerus fractures in children: A single-center investigation and survey of Pediatric Orthopaedic Society of North America members

BackgroundParalytic agents are occasionally used during the surgical treatment of type III (OTA 13A2) supracondylar humerus fractures (SCHFx) in children depending on surgeon preference. Paralytic agents create a neuromuscular blockade and therefore may potentially help with ease of fracture reduction. Controversy regarding the use of a paralytic agent as an adjunct to anesthesia exists due to potential associated adverse drug reactions, including prolonged paralysis, cardiovascular effects, or electrolyte abnormalities.The purpose of this study was to investigate intraoperative paralytic use in pediatric type III SCHFx and to report survey responses of members of the Pediatric Orthopaedic Society of North America (POSNA) on paralytic use in SCHFx management. MethodsA retrospective chart review identified 319 type III SCHFx treated at our institution (January 2016-May 2019). Patients were assigned to three groups: Group 1, surgical treatment without a paralytic agent (n=240); Group 2, treatment with rocuronium (n=43); Group 3, treatment with succinylcholine (n=36). POSNA members were surveyed regarding paralytic use intraoperatively for type III SCHFx (November–December 2021) on paralytic use frequency, request for paralytics, reversal agent use, average time to surgery after injury and/or presentation, effect of time to surgery after injury and/or presentation on when to use a paralytic, annual number of SCHFx surgeries performed, awareness of paralytic complications, and years of surgeon experience. Statistical analysis was performed. ResultsAverage patient age was 5.2±2.2 years. Group 2 had significant increases in anesthesia duration, surgical duration, fluoroscopic time, and radiation exposure compared to Group 1. Group 2 had a higher conversion rate to open reduction than other groups. No statistically significant difference was found among groups in terms of sex, body mass index (BMI), laterality, radiographic measurements, or rates of open procedures or complications. Survey results indicated 32% (24/76) routinely use paralytics during closed reduction maneuvers; 71% (17/24) request administering paralytics at the beginning/before the case; and 33% (8/24) use paralytics in all type III SCHFx. ConclusionsSurgeons at our center reported paralytic use for closed reduction in 25% of patients; similarly, one-third of POSNA survey respondents reported paralytic use during operative management. Although paralytic agents are used during the treatment of supracondylar humerus fractures in children this study was unable to demonstrate an association of advantageous outcomes, such as shorter surgical times. Routine paralytic use to facilitate closed reduction of supracondylar humerus fractures in children warrants further study. Level of EvidenceLevel III, Retrospective chart review; Therapeutic study

The carbon footprint of American Academy of Orthopaedic Surgeons and Pediatric Orthopaedic Society of North America national meetings

BackgroundThe health care sector contributes substantially to carbon emissions. Estimating the carbon emissions of an event can help determine its climate impact. This study calculates the carbon footprints of the 2019 American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting and the 2019 Pediatric Orthopaedic Society of North America (POSNA) Annual Meeting. MethodsData regarding attendance volume, geographic origin of attendees and vendors, hotel room nights, event space, and duration of meetings were obtained from AAOS and POSNA. Data were entered into an online calculator designed to measure the carbon footprint of large events (www.terrapass.com). ResultsThe AAOS 2019 annual meeting was attended by 29 448 people, requiring 66 000 hotel room nights and 2 308 800 ft2 of convention center space for 5 days. We estimated 7179 short, 8374 medium, and 13 421 long-haul round-trip flights. The POSNA 2019 annual meeting was attended by 1103 people, requiring 1932 hotel room nights and 52 100 ft2 of convention center space for 4 days. We estimated 501 short, 280 medium, and 280 long-haul round-trip flights. The AAOS 2019 meeting emitted 26 075 metric tonnes of carbon dioxide equivalents (CO2e), while the POSNA 2019 meeting emitted 544 metric tonnes. Eighty-one percent of the carbon emissions from AAOS and 80% from POSNA came from flight travel alone. Carbon neutralization of in-person AAOS and POSNA annual meetings would require carbon-offset purchases of approximately $273 700 and $5700, respectively. ConclusionsAnnual orthopaedic meetings contribute to climate change through their large carbon footprint. Leaders in the field of orthopaedics should consider strategies to mitigate the impact of such meetings, examples of which include transitioning to hybrid formats when appropriate and by purchasing carbon offsets for essential in-person participation. Key Concepts1)Calculating the carbon footprint of an event estimates its total carbon dioxide emissions to help determine how to reduce its climate impact.2)The AAOS 2019 meeting emitted 26 075 metric tonnes (MT) of carbon dioxide equivalents (CO2e), while the POSNA 2019 meeting emitted 544MT, with ∼80% coming from air travel alone.3)Carbon neutralization of in-person AAOS and POSNA annual meetings would require carbon-offset purchases of approximately $273 700 and $5700, respectively. Level of EvidenceIV

Study Characteristics and Impact of Pediatric Orthopaedic Society of North America Annual Meeting's "Best Papers" From 2009 to 2019.

Award-winning abstracts are selected every year at the Pediatric Orthopaedic Society of North America (POSNA) annual meeting as "best paper" or poster. It is unknown how many achieve publication in peer-reviewed journals and the impact they have. We sought to determine the characteristics, including the level of evidence (LoE), publication rates, and the impact of award-winning abstracts on pediatric orthopaedic surgery practice from 2009 to 2019. Award-winning abstracts or "best papers" from 2009 to 2019 were retrospectively reviewed from the POSNA website from abstract publication to manuscript publication. A search across Pubmed was used to match abstracts to their publications by comparing author names, titles, study design and methodology, results, and conclusions. Area of focus, abstract authors, institutions, publication status, LoE, time to publication, authors of publication, journals of publication, and the journal's latest Hirsch Index and impact factor were recorded. There have been 54 "best papers" at the POSNA annual meeting from 2009 to 2019. Of those, 39 have been published across 17 different journals for a publication rate of 72%. The average time from abstract presentation to publication was 21.2 months with a range of 0 to 121 months. Of the published award-winning abstracts, 64% (25) were published within 2 years, 87% (34) within 3 years, and 95% (37) within 4 years. Out of the published abstracts, 26% (10) were in the Journal of Pediatric Orthopaedics , 23% (9) were in the Journal of Bone and Joint Surgery , and 10% (4) were in the Journal of Child Orthopaedics . The median number of abstract authors was 4 and increased to a median of 6 authors once published. Most award-winning abstracts had a LoE of 3. The average journal impact factor for all publications was 4; the average Hirsch Index for the corresponding author was 29.9, and the average number of citations for a publication was 41 with a range of 0 to 270. The majority of the "best papers" presented at POSNA annual meetings from 2009 to 2019 were published in peer-reviewed journals within 2 years of presentation, with approximately half being published in the Journal of Pediatric Orthopaedics or Journal of Bone and Joint Surgery . The publication rate of "best papers" at the POSNA annual meeting was found to be higher than rates reported for abstracts presented at the annual meetings of POSNA, American Society for Surgery of the Hand and European Pediatric Orthopaedic Society, but similar to the rates observed for American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, and Orthopaedic Trauma Association. Most of the selected "best papers" at the POSNA annual meeting are published and have a substantial impact on pediatric orthopaedic surgery practice. Level IV.

Academic and Demographic Characteristics of Pediatric Orthopaedic Division Chiefs in the United States.

Division Chiefs (DCs) and department leadership play an integral role within the service. The goal of this study is to assess the demographics and scholarly work of the leadership in pediatric orthopaedics services across the United States and comment on the role of diversity within leadership positions. Academic medical centers and pediatric hospitals were identified using the Electronic Residency Application Service website, the Pediatric Orthopaedic Society of North America website, and the Children's Hospital Association website. Leadership was identified using the hospitals' respective websites where data such as sex, race/ethnicity, fellowship institution, time since graduating fellowship, and academic rank were collected. Scopus database was used to determine h-indices and PubMed was used to determine the number of publications. Of 196 academic centers and 223 pediatric hospitals identified, 98 had a designated DC of the pediatric orthopaedics division. The majority of the DCs were male (85.7%), and leadership positions at hospitals with academic affiliations had a higher proportion of female DCs than nonacademic centers ( P =0.0317). DCs were mostly white (83.7%), followed by Asian (12.2%), and African American (2.0%). The average time since fellowship was 21.1 years and the average h-index was 15.7. The average age of the DCs was 56.8 years old. Of those in academic settings, 48.5% held the rank of professor. The fellowship programs that trained the most DCs were Boston Children's Hospital (16.3%) and Texas Scottish Rite for Children (14.3%). There is a paucity of available research on leadership characteristics in pediatric orthopaedic surgery. While progress has been made, there is still a lack of diversity that exists among leadership in pediatric orthopaedics, both within the academic setting as well as the private sector. The position of DC is held predominately by white males with a rank of either professor or no academic association. Intentional efforts are needed to continue to increase diversity in leadership positions within pediatric orthopaedic programs in the United States. IV.

Trigger thumb treatment approach: Results of a survey of EPOS members.

The aim of this study is to analyze the clinical reality of pediatric trigger thumb among members of the European Paediatric Orthopaedic Society. A 35-question survey was sent to all European Paediatric Orthopaedic Society members, focusing on surgeon's profile and experience, trigger thumb diagnostic and trigger thumb treatment approach. Descriptive statistics were performed. A total of 99 responses were analyzed. Most important factor considered in the therapeutic approach was the presence of a locked interphalangeal joint (52%). Regarding treatment, 41.4% opt for conservative approach as the first line of treatment, while 30.3% consider surgery and 28.3% just observe. Nevertheless, 76% mention to treat conservatively their patients and 99% to consider surgery at some stage. Regarding surgical technique, 96% do it open and 56% consider 2 years as the minimum age for procedure. Most surgeons perform this procedure in out-patient care (87%), don't administer prophylactic antibiotherapy (80%), use a tourniquet (75%), don't use any postoperative immobilization (64%), and report complications related to surgery (64%), mainly recurrence/incomplete division (59%) and superficial wound infection (30%). Our study shows a significant variability in the initial management of pediatric trigger thumb with a predominance of conservative management, followed by surgery and observation without treatment. The disparity in treatment options and timing, or waiting times before moving on to different therapeutic options, shows us that this is a controversial issue and that the development of prospective randomized controlled studies is needed to analyze the different treatment methods and determine which ones give the best outcomes.

An Analysis of Negative One-star Patient Reviews and Complaints for Pediatric Orthopaedic Surgeons throughout the United States: A Retrospective Study.

Patients commonly use physician review websites when choosing a surgeon for an elective procedure. Although data exist regarding other orthopaedic specialties, no study has investigated one-star reviews for pediatric orthopaedic surgeons. The goal of this retrospective study was to classify the factors contributing to one-star reviews of pediatric orthopaedic surgeons to identify which areas contribute to lower patient satisfaction. Patient ratings on a 5-star system and comments about pediatric orthopaedic surgeons were collected from the state with the most physicians registered in the "Pediatric Orthopaedic Society of North American" database for each of the 9 geographical regions of the United States as defined by the Association of American Medical Colleges. One-star reviews that included comments were classified as either surgical or nonsurgical. These comments were then further classified based on their content. Three hundred fifty-four one-star reviews with 700 complaints were included in this study. Of these complaints, 481 (68.7%) were from nonsurgical patients and 219 (31.3%) were from surgical patients. Nonsurgical patients were significantly more likely to reference the amount of time spent with the physician (12.9% to 6.6%, P = 0.026), wait time (11.9% to 0.0%, P < 0.001), and bedside manner (41.2% to 22.8%, P < 0.001). Patients who said they had undergone a surgical procedure in their one-star review were significantly more likely to reference a disagreement with the physician's decision or plan (35.3% to 17.5%, P < 0.001), and uncontrolled pain (21.6% to 5.2%, P < 0.001). There was no significant difference in the comments that referenced medical staff or institutional complaints between surgical and nonsurgical patients (13.8% to 11.4%, P = 0.424). Most one-star reviews of pediatric orthopaedic surgeons referenced interpersonal skills and other nonclinical aspects of a clinical encounter, with bedside manner being the most frequent complaint. Patients who had undergone surgical procedures were less likely to leave a one-star review, but if they did, their comment was usually about a disagreement with the physician's plan. Prognostic studies III.

Opioid Prescription Trends for Isolated Diaphyseal Femur Fractures in Pediatric Patients

Purpose: Despite the ongoing opioid epidemic, there is a lack of research on narcotic prescribing in the pediatric orthopaedic population. The Pediatric Orthopaedic Society of North America (POSNA) therefore published a survey on pain management to provide recommendations for opioid dosing. The goal of this study was to characterize opioid prescribing patterns for pediatric femur fractures in the context of the opioid epidemic and emerging national studies/guidelines.Methods: A retrospective review of 128 pediatric patients (age < 16) with isolated diaphyseal femur fractures was conducted between 2003-2019 at a level I pediatric trauma center. Comparison groups included before distribution of the POSNA survey (pre-POSNA = 01/01/2016 or earlier, N = 85) and after the survey (post-POSNA, N = 43).Results: Median total hospital postoperative opioids prescribed was 27.2 morphine milligram equivalents (MME). The two groups differed in age (pre-POSNA = 9.0 years, post-POSNA = 3.7 years, P = 0.0381), hospital length of stay (LOS) (pre-POSNA = 2 days, post-POSNA = 1 day, P < 0.0001), and procedural incision required for fracture reduction (pre-POSNA = 28.3%, post-POSNA = 58.1%, P = 0.0019). Adjusted postoperative opioid dosing was significantly lower post-POSNA (median reduction of 18.351 MME per year, P = 0.0408).Conclusions: The period following the POSNA survey was associated with a significant decline in postoperative narcotic prescriptions for pediatric femur fractures. The timing of the survey likely represents an increased concern for pediatric opioid use and a shift in clinical practice. Further work is needed to optimize injury and patient-specific narcotic prescribing.Level of Evidence: Therapeutic Level III Key Concepts•The 2016 POSNA survey identified a lack of consensus on opioid prescribing practices for common orthopaedic procedures in the United States.•The 2016 POSNA survey and subsequent 2019 published narcotic prescription recommendations represent a shift in the specialty of orthopaedic surgery regarding opioid usage in the pediatric population.•Postoperative morphine milligram equivalents significantly decreased for the treatment of pediatric diaphyseal femur fractures at a single-level I pediatric trauma center following administration of the 2016 POSNA survey.

Decreased Case Volumes for Pediatric Orthopaedic Surgery Fellows during the Early Stages of the Coronavirus-19 Pandemic

Background: In the early months of the coronavirus disease 2019 (COVID-19) pandemic, elective procedures were suspended to reallocate resources, notably impacting 1-year surgical fellowship programs. The purpose of this study is to compare the case volume of pediatric orthopaedic surgery fellows during the pandemic's peak year to the years before and after.Materials and Methods: Accreditation Council for Graduate Medical Education (ACGME) case log reports of key procedures in pediatric orthopaedic surgery were compared between the fellowship classes of 2018-2019 (pre-pandemic), 2019-2020 (peak pandemic), and 2020-2021 (post-peak pandemic). Both overall case volume and individual key procedures were analyzed for significant differences between each of the three class years.Results: There was a significant decrease (−43.7 cases, −15.5%) in the overall number of key procedures completed by the fellowship class of 2020 compared to 2019 (p=0.014), with similar significant decreases in various individual key procedures (foot and ankle deformity, limb deformity, and soft tissue: transfer, lengthening, and release). In the subsequent year, there was a significant increase (+98.8 cases, +41.5%) in the average case volume for the class of 2021 (p<0.001), with significant increases in procedures for foot and ankle deformity, clubfoot, limb deformity, hip, and soft tissue: transfer, lengthening, and release. Additionally, the rebound in overall case volume for the class of 2021 surpassed the pre-pandemic caseload completed by the class of 2019 (p=0.008).Conclusion: During the peak of the pandemic when elective cases were suspended, pediatric orthopaedic surgery fellows logged fewer surgical cases compared to the pre-pandemic class of 2019. While the case volume rebounded in the subsequent year, further research is needed to quantify the overall impact of the decreased caseload for the pediatric orthopaedic fellowship class of 2020.Level of Evidence: Level IVKey Concepts•With the onset of the unprecedented COVID-19 pandemic, the ensuing shutdowns' effects on the training and case volumes of pediatric orthopaedic fellows remain unclear.•This study quantified the change in case volume of pediatric orthopaedic fellows during the first year of the COVID-19 pandemic and identified a significant decrease of nearly 44 total cases (15.5%) performed by fellows of the graduating class of 2020 when compared to those who graduated in 2019.•This study quantified the rebound in case volume for the fellows of the 2021 graduating class when compared to the graduates of the 2020 fellowship class.

American Academy of Orthopaedic Surgeons Clinical Practice Guideline Case Study: Management of Anterior Cruciate Ligament Injuries.

Considering the frequency of anterior cruciate ligament (ACL) tears, optimal management of these injuries was the subject of a 2022 clinical practice guideline update from The American Academy of Orthopaedic Surgeons (AAOS) with input from representatives from the American Orthopaedic Society for Sports Medicine, the Pediatric Orthopaedic Society of North America, the American Orthopaedic Society for Sports Medicine, the American Medical Society for Sports Medicine, the American Academy of Physical Medicine and Rehabilitation, and the American College of Emergency Physicians. The eight recommendations and seven options to guide orthopaedic surgeons and other physicians managing patients with these anterior cruciate ligament injuries are based on the best current available evidence. The cases presented in this article are examples designed to demonstrate the clinical application of these guidelines.

Policies, Practices, and Attitudes Related to Parental Leave for Practicing Pediatric Orthopaedic Surgeons.

Parental leave impacts family engagement, bonding, stress, and happiness. Because parental leave benefits are important to all surgeons regardless of sex, understanding parental leave practices in pediatric orthopaedic surgery is critical to promote equity within the profession and supporting balance in work and family life. The aim of this study was to survey pediatric orthopaedic surgeons about their knowledge of parental leave policies, attitudes towards parental leave, and their individual experiences taking leave. A 34-question anonymous survey was distributed to the Pediatric Orthopaedic Society of North America membership. Eligible respondents were attending pediatric orthopaedic surgeons practicing in the United States or Canada. The survey gathered information about employer parental leave policies, perceptions about and experiences with parental leave while practicing as a surgeon, and demographic information about respondents. A total of 77 responses were completed and used for analysis. Most respondents were men (59.7%), <50 years old (67.5%), married (90.9%), and in urban communities (75.3%). A large majority were practicing in the United States (97.4%). Most respondents were unfamiliar with employer parental leave policies (maternity: 53.3%; paternity: 67.5%; and adoption: 85.7%). Those familiar with policies reported that employers offered 7 to 12 weeks for maternity leave (45.7%) and <1 week for paternity leave (50%) and adoption leave (45.5%). Most respondents believed 7 to 12 weeks should be offered for maternity leave (66.2%), 1 to 6 weeks for paternity leave (54.6%), and 7 to 12 weeks for adoption leave (46.8%). Many respondents reported taking 1 to 6 weeks of parental leave as a surgeon (53.3%) and that their colleagues were supportive of their parental leave (40.3%). Most pediatric orthopaedic surgeons were unfamiliar with parental leave benefits provided by employers. Respondents who were familiar with these policies believed that more parental leave should be provided, especially for men who may feel social pressure to take less time for leave. Although respondents reported that their work environments were supportive, this study identified opportunities for improvement to support surgeons who wish to balance parental experiences with work responsibilities. Level V.

Current Clubfoot Practices: POSNA Membership Survey

Clubfoot management has advanced in the 21st century with increases in formal training, practitioner experience, and improved casting/bracing constructs. The Ponseti method is the gold standard, yet variations in application persist. This survey aims to identify current treatment practices among clubfoot practitioners within the Pediatric Orthopaedic Society of North America (POSNA). A 23-question online survey of members was conducted between June and August 2021. Eighty-nine respondents self-identified as clubfoot providers. Of these, 93.1% had an MD degree, 23.6% possessed >30 years' experience, and the majority (65.6%) worked in a teaching hospital associated with a medical school. Most responders (92.0%) were pediatric fellowship trained. A total of 51.7% had participated in a clubfoot training course. More than half (57.5%) noted changes to clubfoot management practices throughout their training. A majority used between four and seven (88.7%) long leg casts (98.4%), changed at seven-day intervals (93.4%). Plaster (69.4%) was most commonly used. The most common bracing device was Mitchell-Ponseti (72.9%). A mean 84.8% of clubfeet required tenotomy. The most common anesthetic agent was numbing gel (43.0%). Tenotomies mostly occurred in patients aged <6 months (63.1%). Tenotomy locations were operating room (46.5%), clinic (45.4%) and procedure room (8.1%). Cast removal was primarily performed with saws (54.7%). The mean incidence of observed cast burns was 5.5%. Most providers did not use a device to prevent cast burns (76.6%). Reported cast complications included slippage (85.9%), skin irritation (75.8%), and saw-related injuries (35.9%). Clubfoot management variations exist in orthotics, tenotomy indications and practices, and cast material. Casting complications continue to be a problem. Further studies are warranted to determine if certain practices predispose patients to specific complications.

What's New in Hand and Wrist Surgery.

What's New in Hand and Wrist Surgery.

Variability in Pain Management Practices for Pediatric Anterior Cruciate Ligament Reconstruction.

The opioid epidemic in the United States is a public health crisis. Pediatric orthopaedic surgeons must balance adequate pain management with minimizing the risk of opioid misuse or dependence. There is limited data available to guide pain management for anterior cruciate ligament reconstruction (ACLR) in the pediatric population. The purpose of this study was to survey current pain management practices for ACLR among pediatric orthopaedic surgeons. A cross-sectional survey study was conducted, in which orthopaedic surgeons were asked about their pain management practices for pediatric ACLR. The voluntary survey was sent to members of the Pediatric Orthopaedic Society of North America. Inclusion criteria required that the surgeon perform anterior cruciate ligament repair or reconstruction on patients under age 18. Responses were anonymous and consisted of surgeon demographics, training, practice, and pain management strategies. Survey data were assessed using descriptive statistics. Of 64 included responses, the average age of the survey respondent was 48.9 years, 84.4% were males, and 31.3% practiced in the southern region of the United States. Preoperative analgesia was utilized by 39.1%, 90.6% utilized perioperative blocks, and 89.1% prescribed opioid medication postoperatively. For scheduled non-narcotic medications postoperatively 82.8% routinely advocated and 93.8% recommended cryotherapy postoperatively.Acetaminophen was the most used preoperative medication (31.3%), the most common perioperative block was an adductor canal block (81.0%), and the most common postoperative analgesic medication was ibuprofen (60.9%). Prior training or experience was more frequently reported than published research as a primary factor influencing pain management protocols. Substantial variability exists in pain management practices in pediatric ACLR. There is a need for more evidence-based practice guidelines regarding pain management. Level V.

Gender Representation in Major Orthopaedic Surgery Meetings: A Quantitative Analysis.

Orthopaedic surgery suffers from gender disparity, and annual conferences are visible opportunities to quantify gender representation within a field. Therefore, the purpose of this manuscript was to investigate the prevalence of female speakers and moderators, and male-only panel sessions, at 10 major Orthopaedic Surgery meetings. Conference programs and details of faculty moderating or presenting in 10 Orthopaedic Surgery annual meetings in 2021 were retrieved. Conferences were selected with the aim of size and diversity in subspecialty topics and included American Association of Hip and Knee Surgeons, American Association for Hand Surgery, American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Canadian Orthopaedic Association (COA), European Federation of National Associations of Orthopaedics and Traumatology, North American Spine Society, Orthopaedic Research Society (ORS), Orthopaedic Trauma Association, and Pediatric Orthopaedic Society of North America (POSNA). Primary outcomes included percentage of female chairs and speakers and percentage of male-only panels, while secondary outcomes included number of publications, number of citations, and H-indexes of faculty. Further subgroup comparisons were performed between male-only panels and non-male-only panels and female members and male members. Of 207 included sessions, 121 (58.5%) were male-only panels and 150 (12.6%) of 1,188 faculty members were women. Conferences organized by the COA, ORS, and POSNA had higher percentages of female representation, while spine surgery and adult hip/knee reconstruction sessions had more than 70% male-only panels and fewer than 10% female members. There were no significant differences between male members and female members regarding years of practice; however, male members were more likely to hold the title of professor (p < 0.001). Male members and female members stratified by quartiles of publications, citations, and H-indexes, moderated or participated in similar numbers of sessions, indicating an absence of selection bias. There is a high prevalence of male-only panels (58.5%) and an overall lack of female representation (12.6%) in 10 major Orthopaedic Surgery meetings. Male members and female members from these conferences were found to have similar qualifications academically. Specific strategies such as the elimination of male-only panels, selecting diverse conference organizers, and forming conference equity, diversity, and inclusion committees can help achieve cultural change. Level V.

Medical conferences and medical practice

Medical conferences and medical practice

Publication Rates of Podium Presentations from the Orthopedic Summit: Fellow Resident and Medical Student Annual Meeting 2019-2021

Purpose To determine the publication rate of presentations presented at the Orthopaedic Summit and Evolving Techniques (OSET) Fellow Resident and Medical Student Annual Meeting 2019-2021 Methods All presentations from the OSET annual meeting between 2019 -2021 were identified from the OSET’s official website and confirmed through review of the OSET Official Programs. The 2019 and 2021 meeting were in person and the 2020 meeting was virtual due to the COVID pandemic. This information was then used to direct a search on PubMed and Google Scholar database to determine if the presentation was associated with a publication since the meeting. Publishing information was entered into the database. Results For 2019-2021 there were a total of 227 presentations with 101 associated publications (45%). The highest rate of publications was 63% of presentations published in 2019, followed by 49% rate of publications in 2020, and 27% rate of publications in 2021. The presentations were published at an average of 8.1 months after presentation. Conclusion Our research demonstrated a 45% publication rate over a 3-year period of presentations presented at the OSET annual meetings. Our results are comparable to other publication rates for podium presentations in other societies (e.g. American Academy of Orthopaedic Surgeons, Annual Meeting of the Pediatric Orthopedic Society of North America, Orthopedic Trauma Association Annual Meeting, American Academy for Surgery of the Hand, Annual Meetings of the North American Spine Society, and American Orthopedic Society for Sports Medicine Annual Meeting). This validates the quality of research presented in podium presentations format at the OSET Annual Meeting.

Analysis of physician characteristics and factors influencing the online recommendation of pediatric orthopaedic surgeons: a cross-sectional study

Background: Physician online reviews are a growing resource that patients use to choose healthcare providers. The authors investigated the factors involved in the recommendation of pediatric orthopaedic surgeons on a popular online physician-rating website. Methods: A cross-sectional study was conducted using the 2020-2021 Pediatric Orthopedic Society of North America directory to identify United States active board-certified pediatric orthopaedic surgeons. Healthgrades.com was used to gather data including geographic location, years of experience, type of ratings, age, sex, and likelihood to recommend score (LTRS). Quantitative analysis was conducted using descriptive statistics, Student t-test, Analysis of Variance (ANOVA), Pearson correlation, and multiple linear regression models. Results: Seven hundred and one POSNA members (566 men, 135 women) were identified. A higher likelihood to recommend score (LTRS) was associated with short waiting times (P&lt;0.0001), reports of “appointment not being rushed” (P=0.001), and more total ratings (P=0.130). Male physicians were positively associated with LTRS (P=0.01). Surgeons with fewer years of experience had fewer negative reviews (P=0.02) and were more favorably rated (P&lt;0.05). Patients gave more positive (mean=3.37) then negative (mean=0.73) reviews and selected more “what went well” factors (mean=72) rather than “what could be improved” factors (mean=13). The South had more total, positive, and 5-star ratings (P&lt;0.01). Conclusions: Patients are more likely to rate pediatric orthopaedic surgeons on the two extremes when using online reviews. Physicians with the fewer years practicing received higher LTRS, suggesting satisfaction is not related to experience. Factors such as reducing waiting times and not rushing appointments may help improve the likelihood of physicians being recommended in the future. Level of Evidence: Level IV.

Pediatric Orthopaedic Surgery Research Quality: A Decade of Change at POSNA Annual Meetings from 2011-2020

Background: The Pediatric Orthopaedic Society of North America (POSNA) is a leading organization focused on disseminating research and promoting high-quality pediatric orthopaedic care. The purpose of our study was to understand how research quality in pediatric orthopaedic surgery has evolved over time by evaluating trends in clinical evidence and study design in podium presentations given at POSNA annual meetings from 2011-2020.Methods: Podium presentation abstracts for all POSNA meetings from 2011-2020 were independently reviewed for number of study patients, single center versus multicenter, randomized vs. non-randomized design, and abstract focus/topic. The level of evidence (LOE) assigned in the abstract program was also recorded. Chi-squared and Mann-Whitney U tests were used to compare differences in abstract characteristics between 2011-2015 and 2016-2020. Linear regressions were performed to analyze changes in level of evidence and the proportion of multicenter studies over time.Results: A total of 1589 podium presentations were reviewed including 679 from 2011-2015 and 910 from 2016-2020, representing a 34% increase in the total number of presentations. The median number of patients per abstract was higher in 2016-2020 compared to 2011-2015 (81.5 vs. 49, p<0.001). An increased proportion of presentations from 2016-2020 were multicenter (14.1% vs. 9.7%, p=0.009), with spine abstracts having the highest proportion of multicenter collaboration (23.9%, p=0.002). The subspecialty focus of podium presentations has remained consistent over time with the exception of spine-related abstracts (19.5% vs. 14.9%, p=0.018). Overall, 4.9% of the presentations were categorized as level 1 evidence, 18.5% level 2, 41.8% level 3, and 34.8% level 4. Between 2011-2020, the proportion of LOE 3 studies increased significantly (p=0.039). The proportion of LOE 4 studies decreased, but not significantly (p=0.060). There was no change in the proportion of level 1 and 2 studies (p=0.416).Conclusions: POSNA podium presentations have increased in number over the past decade, in large part due to the development of subspecialty day programs. This appears to have resulted in greater diversity in the academic program, with a lower proportion of spine abstracts over time. The LOE of POSNA presentations has improved with a higher proportion of level 3 studies compared to earlier years. More recent abstracts have evaluated higher numbers of patients and there has been a significant increase in multicenter study designs, suggesting improved collaboration.Level of Evidence: IVKey Concepts•POSNA podium presentations have increased in number over the past decade due to subspecialty day programming.•A decrease in the proportion of studies focused on spine-related topics has been observed.•Improved level of evidence has been observed with a higher proportion of level 3 evidence.•More recent podium presentations have evaluated higher numbers of patients and more commonly utilized multicenter study designs, suggesting improved collaboration.•Further work focusing on fostering and promoting multicenter collaboration across all pediatric subspecialties should be promoted.