Young Orthopaedic Surgeons Research Articles

Publication Productivity of Early-Career Orthopedic Trauma Surgeons

The goals of this study were to: (1) define the publication productivity of early-career orthopedic trauma surgeons over time; (2) compare the early-career publication productivity of recent orthopedic trauma fellowship graduates vs their more senior colleagues; and (3) determine the proportion of fellowship graduates who meet the Orthopaedic Trauma Association (OTA) publication criteria for active membership early in their careers. Orthopedic trauma fellowship graduates from 1982 to 2007 were analyzed. A literature search was performed for each fellow's publications for the 6-year period beginning the year of fellowship graduation. Publication productivity was compared between early and recent groups of graduates, 1987 to 1991 and 2003 to 2007, respectively. Fulfillment of OTA publication criteria was determined. Seventy-nine percent of graduates contributed to 1 or more publications. The recent group produced more total publications per graduate (4.06 vs 3.29, P=.01) and more coauthor publications (2.60 vs 2.04, P=.019) than the early group. The number of first-author publications did not differ between groups (1.46 vs 1.25, P=.26). A greater percentage of the recent group met current OTA publication criteria compared with the early group (51% vs 35%, P=.04). The findings showed that recent orthopedic trauma graduates had increased publication productivity compared with their more senior colleagues, although a proportion had not qualified for active OTA membership 6 years into their career. Overall, these data are encouraging and suggest that young orthopedic trauma surgeons remain committed to sustaining a high level of academic excellence.

The Mark Paterson Travelling Fellowship 2014

Each year The British Editorial Society of Bone & Joint Surgery sponsors The Mark Paterson Travelling Fellowship which allows three young orthopaedic consultants (usually senior trainees or new consultants) to travel round a number of centres in the run up to the EFORT congress in the country hosting the EFORT meeting. This year’s travelling fellowship was in the UK in the run up to the 2014 London meeting. The fellowship is entitled to Mr Mark Paterson, a well-known UK children’s orthopaedic surgeon, who died in 2013 at the age of 59. He was a Member of Council of The British Editorial Society of Bone & Joint Surgery, an Associate Editor of The Bone & Joint Journal ( BJJ ) and President of the Orthopaedic Section of the Royal Society of Medicine. The British Editorial Society of Bone & Joint Surgery Council and EFORT renamed the fellowship to honour Mark and to help inspire young orthopaedic surgeons. Travelling to the UK and visiting leading hospitals in the UK healthcare system has been a journey from tradition to the advances of the scientific community. There were three of us, Alberto Di Martino from Rome, Egemen Altan from Turkey and Michal Skowronek from Poland, representing an interesting mix of experiences from a cultural and professional perspective. We also had different surgical interests, Alberto is a Spinal and Oncology surgeon, Egemen is interested in Sports’ Medicine and upper limb surgery, and Michal in hip and trauma surgery. The fellowship consisted of visits to Hospitals and healthcare centres …

The 2013 American-British-Canadian Traveling Fellowship: innovation, accountability, and insight.

The American-British-Canadian (ABC) Exchange Fellowship was conceived by Dr. Robert I. Harris of the University of Toronto. In 1947, Dr. Harris, President of the American Orthopaedic Association (AOA), was concerned that “because of World War II and the accompanying post-war difficulties, young orthopaedic surgeons of Great Britain would find it difficult, if not impossible, to visit orthopaedic centres in the United States and Canada.”1 With the partnership of the Presidents of the Canadian Orthopaedic Association (COA, Edouard Samson) and the British Orthopaedic Association (BOA, S.A.S. Malkin), Dr. Harris designed a tour of North America and attracted funds. In the spring of 1948, thirteen orthopaedic surgeons from Great Britain sailed to North America on the RMS Queen Elizabeth and toured as the first ABC fellows. The following year, a reciprocal tour with fifteen North American orthopaedic surgeons took place in the United Kingdom. During the ensuing four years, debate raged within the orthopaedic associations regarding the future of the ABC Exchange Fellowship. While detractors were a vocal minority, the prevailing force was the persistence of individuals such as British fellows Philip Newman, Derick Strange, Sir Reginald Watson-Jones (President of the BOA), and Sir Henry Osmond-Clarke, who collectively extolled the significance of a face-to-face academic and cultural exchange. The ABC Exchange Fellowship resumed in 1954 with British fellows traveling to North America. The legacy of the ABC tour has continued without interruption since that time. The Fellowship was further acclaimed in 1958 when the fellows were received at the White House by President Dwight D. Eisenhower, who emphasized the value and importance of face-to-face exchanges. In 1964, the Ruth B. Lilly Fellowship Fund was created and ensured the continuation of the Fellowship in perpetuity. South Africa joined the tour in 1983, followed by Australia and New Zealand in 1985. During the …

Practice Patterns for Subacromial Decompression and Rotator Cuff Repair

Recently there have been several evolving trends in the practice of shoulder surgery. Arthroscopic subacromial decompression has been performed with greater frequency by orthopaedic surgeons, and there has been considerable recent interest in arthroscopic rotator cuff repair. The purpose of this study was to identify trends in practice patterns for subacromial decompression and rotator cuff repair over time and in relation to the location of practice, fellowship training, and declared subspecialty of the surgeon. We reviewed the American Board of Orthopaedic Surgery Part II database to identify patterns in the utilization of open and arthroscopic subacromial decompression and rotator cuff repair among candidates for board certification. All procedures involving only arthroscopic or open subacromial decompression and/or rotator cuff repair from 2004 to 2009 were identified. The rates of arthroscopic and open subacromial decompression and/or rotator cuff repair were compared in terms of year, geographic region, fellowship training, and declared subspecialty of the surgeon. Between 2004 and 2009, 12,136 surgical procedures involving only arthroscopic or open subacromial decompression and/or rotator cuff repair were performed. There were significant differences in treatment with respect to year, geographic region of practice, declared subspecialty, and fellowship training (p < 0.001). There was a significant increase over time in the utilization of arthroscopy among all candidates (p < 0.001). Surgeons with sports medicine fellowship training or a sports-medicine-declared subspecialty performed significantly more subacromial decompressions and rotator cuff repairs arthroscopically than all other candidates (p < 0.001). During this time period, there was a significant decrease in the rate of arthroscopic subacromial decompression, both as an isolated procedure and combined with arthroscopic rotator cuff repair (p < 0.001). From 2004 to 2009, there was a significant shift throughout the United States toward arthroscopic rotator cuff repair and subacromial decompression among young orthopaedic surgeons, with sports medicine fellowship-trained surgeons performing more of their procedures arthroscopically than surgeons with other training. However, there was an increasing frequency of arthroscopic rotator cuff repair performed without subacromial decompression, and, overall, there was a decrease in the frequency of isolated arthroscopic subacromial decompression over time.

Superior Labrum Anterior and Posterior Lesions of the Shoulder

Background: Tears of the superior labrum (superior labrum anterior and posterior [SLAP] lesions) of the shoulder are uncommon injuries; however, the incidence of surgical correction seems to be increasing. Purpose: To report the findings of a review of a proprietary descriptive database that catalogs cases for the purpose of board certification on the demographics of SLAP lesion repair. It is the authors’ impression that the percentage of cases of SLAP lesion repairs reported by young orthopaedic surgeons is high and that complications associated with this are not insignificant. Study Design: Cohort study; Level of evidence, 3. Methods: We searched the American Board of Orthopedic Surgery (ABOS) Part II database to evaluate changes in treatment over time and to identify available outcomes and associated complications of arthroscopic repair of SLAP lesions. The database was searched for all SLAP lesions (ICD-9 code 840.7) and SLAP repairs (CPT code 29807) for the years 2003 through 2008. Utilization was analyzed by geographic region and was also obtained based on applicant subspecialty declaration. Results: There were 4975 SLAP repairs, representing 9.4% of all applicants’ shoulder cases. Mean follow-up was 8.9 weeks because of the time-limited case collection period. There were 78.4% who were men, and 21.6% of patients were women. The percentage of shoulder cases that were SLAP repairs increased over the study period from 9.4% to 10.1% by 2008 (P = .0163). Mean age of male patients was 36.4 ± 13.0 years, with a maximum of 85 years. Mean age of female patients was 40.9 ± 14.0 years, with a maximum of 88 years. Pain was reported as absent in only 26.3% of patients at follow-up and function as normal in only 13.1%. There were 40.1% of applicants who self-reported their patients to have an excellent result. The self-reported complication rate was 4.4%. Declared sports medicine specialists had a higher percentage of SLAP repairs than did general orthopaedic surgeons: 12.4% versus 9.2%. Conclusion: The percentage of shoulder cases that are SLAP repairs reported by the candidates is 3 times the published incidence supported by the current literature. The large number of repairs in middle-aged and elderly patients is concerning. Focusing on educating young orthopaedic surgeons to appropriately recognize and treat symptomatic SLAP lesions may bring the rate of SLAP repairs down.

When Things Don't Work Out: Finding Another Job

It is extremely common for young orthopaedic surgeons find themselves in unsatisfactory practice situations early in their careers. This article highlights several points to bear in mind when considering a change of employment in the first few years of practice. Many factors should be revisited from the candidate's initial job search to fully analyze the situation. If the problems are found to be irreconcilable, then the decision can be made to find a more suitable setting, but the relocation process should be handled judiciously. There are many resources available that can be helpful to make a successful transition.

Effectiveness of the AAOS Leadership Fellows Program for Orthopaedic Surgeons

Effective physician leadership is critical to the future success of healthcare organizations. The American Academy of Orthopaedic Surgeons (AAOS) Leadership Fellows Program is a one-year program designed to train young orthopaedic surgeons to become future leaders in orthopaedics. The purpose of this study was to evaluate the impact of the AAOS Leadership Fellows Program on the leadership skills and achievements of its participants. Graduates of the Leadership Fellows Program were compared with a control group of previous applicants who were not accepted to the program (applicants) in a retrospective cohort comparison study. A subjective survey of leadership skills was used to assess the confidence of the two cohorts in eight areas of leadership. In addition, an updated curriculum vitae from each of sixty leadership fellows from the classes of 2003 through 2009 and from each of forty-seven applicants was retrospectively reviewed for evidence of leadership. The updated curriculum vitae of the leadership fellows was evaluated for leadership activity attained prior to and following participation in the program, while the updated curriculum vitae of applicants was evaluated for leadership activity attained prior to and following the last year of application to the program. Curricula vitae were assessed for demonstration of national leadership, academic rank, hospital administrative rank, and research experience. On the leadership survey, the graduates of the Leadership Fellows Program scored higher than the applicants in seven of eight categories. The review of the curricula vitae demonstrated that, prior to the Leadership Fellows Program, the leadership fellows were more likely than the applicants to have an academic practice and hold an academic rank. The difference between the two cohorts in administrative rank and leadership of national committees was not significant. Following the program, the leadership fellows were more likely to chair national committees (p < 0.001) and hold leadership positions in their hospitals (p = 0.008). Furthermore, the leadership fellows were more likely to advance in their academic and administrative ranks compared with those who applied to the program and were not accepted. The AAOS Leadership Fellows Program seems to have a positive impact on the leadership competency of its participants. Graduates of the program are more likely to assume leadership positions in national organizations and within their own institutions.

Clinical analysis of 107 patients with foot and ankle deformities caused by spinal bifida

To analyze the incidence, clinical features, deformity categories and orthopedic treatment of foot and ankle deformities caused by spinal bifida. The charts of the patients received surgical treatment between January 1990 and July 2009 were studied retrospectively, and the data were analyzed. One hundred and seven cases of foot and ankle deformities caused by spinal bifida received surgical treatment and were included. There were 44 male and 63 female patients. The average age was 17.7 years (range, 1.3 - 52.0 years). And 50.5% (54/107) of cases were over 18 years old and had spinal bifida occulta, and the other 49.5% had spinal bifida manifesta. There was only one case of thoracic spinal bifida (T(3-8)), while the other 106 cases had lumbosacral vertebrae cleft (mainly L(3) to Sacrum). Among a total of 165 feet, unilateral involvement was found in 49 cases (22 cases on the left side, 27 cases on the right side), bilateral involvement in 58 cases. Combined ankle-foot deformities included 76 varus talipes, 23 talipes valgus, 15 flail feet, and 51 other foot deformities. Other site deformities, as a result of spinal bifida, included knee flexion or hyperextension deformity in 4 cases, hip deformity (hip adduction, flexion, or hip dislocation, pelvic tilt, lower extremity discrepancy, etc.) in 17 cases, and urinatory dysfunction and defecation in 30 cases. Twenty-nine of 54 cases with spinal bifida occulta failed to be diagnosed in other hospitals and the misdiagnosed rate reached 53.7% (29/54). Corrective surgery was performed in only 26 patients. And 50.5% (54/107) of patients (over 18 years old) had severe foot and ankle deformities due to a failure of prior surgical treatment. Spinal bifida is the most commonly found in the lumbosacral vertebrae. Although the main pathogenesis is developmental abnormalities of spinal cord and nerve, the secondary deformity is usually located on the foot and ankle. Some young orthopedic surgeons may not have enough awareness and treatment experience about this disease due to over-specialty of the orthopaedics, so the delay of early diagnosis and treatment is often found and many severe foot and ankle deformities occur.

The Hospital for the Ruptured and Crippled Eugene H. Pool, Fourth Surgeon-in-Chief 1933–1935 Followed by Philip D. Wilson, Fifth Surgeon-in-Chief 1935

In 1933, for the second time in the history of the Hospital for the Ruptured and Crippled (R & C), a general surgeon, Eugene Hillhouse Pool, MD, was appointed Surgeon-in-Chief by the Board of Managers of the New York Society for the Relief of the Ruptured and Crippled. R & C (whose name was changed to the Hospital for Special Surgery in 1940), then the oldest orthopaedic hospital in the country, was losing ground as the leading orthopaedic center in the nation. The R & C Board charged Dr. Pool with the task of recruiting the nation's best orthopaedic surgeon to become the next Surgeon-in-Chief. Phillip D. Wilson, MD, from the Massachusetts General Hospital in Boston and the Harvard Medical School was selected and agreed to accept this challenge. He joined the staff of the Hospital for the Ruptured and Crippled in the spring of 1934 as Director of Surgery and replaced Dr. Pool as Surgeon-in-Chief the next year. It was the time of the Great Depression, which added a heavy financial toll to the daily operations of the hospital. With a clear and courageous vision, Dr. Wilson reorganized the hospital, its staff responsibilities, professional education and care of patients. He established orthopaedic fellowships to support young orthopaedic surgeons interested in conducting research and assisted them with the initiation of their new practices. Recognizing that the treatment of crippling conditions and hernia were becoming separate specialties, one of his first decisions was to restructure the Hernia Department to become the General Surgery Department. His World War I experiences in Europe helped develop his expertise in the fields of fractures, war trauma and amputations, providing a broad foundation in musculoskeletal diseases that was to be beneficial to him in his future role as the leader of R & C.

Nail or Plate Fixation of Intertrochanteric Hip Fractures: Changing Pattern of Practice

A new method of fixation for intertrochanteric hip fractures that involves the use of an intramedullary nail that interlocks proximally into the femoral head was introduced in the early 1990s. Anecdotal observation of practice patterns during the Part II (oral) American Board of Orthopaedic Surgery examination suggested that the use of this method had increased substantially in recent years in comparison with the more traditional sliding compression screw technique. A study of the Part II database was undertaken to detect changing patterns of care for intertrochanteric fractures. During the process of Board certification, candidates for the Part II (oral) examination submit a six-month surgical case list and patient data into a secure database. The database was searched for all intertrochanteric fractures (International Classification of Diseases, Ninth Revision, code 820.20 or 820.21) over a seven-year period (1999 through 2006). The cases were categorized by intramedullary nail or plate fixation on the basis of surgeon-reported Current Procedural Terminology codes. Relative utilization of the two devices was analyzed according to year and region, and the devices were compared in terms of complications and outcomes. A dramatic change in practice was demonstrated, with the intramedullary nail fixation rate increasing from 3% in 1999 to 67% in 2006. Regional variation was substantial. The highest rate of utilization of intramedullary nail fixation was recorded by candidates from the South, Southeast, and Southwest, who converted to the new technology faster than those in the Northeast, Northwest, and Midwest. Overall, patients managed with plate fixation had slightly less pain and deformity in comparison with those managed with intramedullary nailing, with no significant differences being identified in terms of function or satisfaction. Patients managed with intramedullary nailing had more procedure-related complications, particularly bone fracture. From 1999 to 2006, a dramatic change in surgeon preference for the fixation device used for the treatment of intertrochanteric fractures has occurred among young orthopaedic surgeons. This change has occurred despite a lack of evidence in the literature supporting the change and in the face of the potential for more complications.

AOA 2005 John J. Fahey, MD, Memorial North American Traveling Fellowship: Fellowsʼ Travel Diary

In 1960, the American Orthopaedic Association (AOA) established the North American Traveling Fellowship (NATF). Inspired by John Fahey, MD, the AOA NATF has served as a mechanism to stimulate an intellectual exchange of ideas and leadership in the field of orthopaedics. The NATF has since evolved into a venue whereby young orthopaedic surgeons who are commencing a potential career in academics may learn by sharing ideas regarding the current leadership and research challenges in orthopaedics. Although it has been held more frequently, the current NATF model is one in which five fellows (four American and one Canadian) are selected every odd year to travel to the East Coast, Midwest, or West Coast of the United States and Canada. Our 2005 tour was organized by Kristy L. Weber, MD (Chief, Division of Orthopaedic Oncology, Johns Hopkins University), who coordinated all of our visits on the West Coast. The five traveling fellows were Kevin J. Bozic, a joint replacement surgeon from the University of California San Francisco; Johnny Lau, a foot and ankle surgeon from Toronto, Canada; Rex Haydon, an orthopaedic oncology surgeon from the University of Chicago; Matthew T. Provencher, a shoulder and sports medicine surgeon from the Naval Medical Center in San Diego; and Heather Vallier, an orthopaedic trauma surgeon from Case Western Reserve University in Cleveland. The fellows were first met in Canada by Dr. Kevin Hildebrand, Chief of Research at the Calgary Orthopaedic Program. As is the tradition of the NATF, a busy social and academic program awaited us at each institution and we were immediately indoctrinated into the demanding schedule we would maintain for the next thirty-one days. On the first morning, the group was treated to orthopaedic grand rounds at the Calgary hospital. Dr. Hildebrand shared his thoughts on posttraumatic elbow contractures, and then the fellows …

Professor Frantz Langlais (1942 – 2007)

![Figure][1] The accidental death of Frantz Langlais on June 15, 2007, as he was driving home from a postgraduate teaching session for young orthopaedic surgeons in La Baule, West France, came as a shock to the European orthopaedic community, which was left to mourn for one of its most

The Hospital for the Ruptured and Crippled, Entering the Twentieth Century, ca. 1900 to 1912

The continuing story of Hospital for Special Surgery (HSS) from its origin in 1863 as the Hospital for the Ruptured and Crippled (R&C) on lower Second Avenue in New York saw expansion at its second site. A new 200-bed hospital was constructed and opened in 1870 on the corner of 42nd street and Lexington Avenue. Converted by the second surgeon-in-chief, Virgil P. Gibney, M.D., from a 28-bed home for the incurables to a modern orthopedic and surgical hospital with outstanding professional staff, the R&C emerged into the 20th Century as a unique treatment center for disabled children and adults and a foremost training center for young orthopedic surgeons. The interaction of the New York Central Railroad and support of a very influential and philanthropic Board of Managers helped promote the growth and development of this institution. In 1912, it relocated for the third time in its history to 321 East 42nd Street, just east of Second Avenue. That same year the HSS Alumni Association was founded as the Alumni Association of the R&C.

Innovative Procedures

As this is being transcribed New Year's has just past. And if any of us had watched the various cable TV news shows, we would have heard the various authorities prognosticating about what the New Year will hold. The problem about prognostication is that there isn't an insignificant risk that you will be wrong. People will always remember when you are wrong rather than right. That being said, I will prognosticate. The future of bone radiology is bright. The field has rapidly evolved and progressed and has become a much closer collaborative adjunct to clinicians. In fact, one thing that has recently impressed me is how much young orthopedic surgeons in practice, having gotten used to working with good bone radiologists in the universities, desire that contact in a private practice setting. This is unique and relatively new to the field of musculoskeletal imaging.

Book Review

A lot of young orthopaedic surgeons embark on research projects with little guidance. This book is especially directed towards young investigators in the Southeast Asian region. It is a great effort as it encompasses a wide spectrum of orthopaedic research, both experimented and clinical.

Orthopaedic trauma education: visions for the future through the OTA. Orthopaedic Trauma Association.

As the trauma center system continues to expand, not only will the requirement for more and better trained trauma surgeons increase, but the means of educating them will need to become more standardized. The general surgeons recognized this many years ago, but orthopaedic trauma has lagged in its efforts to present a coordinated academic and clinical program to residents and fellows. The Orthopaedic Trauma Association has made a move to develop guidelines which may be used by training programs in an effort to improve the educational standards of this subspecialty. The recruitment and retention of young orthopaedic trauma surgeons remains an issue.