Doximity Orthopaedic Surgery Program Rankings Are Associated with Academic Productivity.

Doximity residency rankings are used to compare training programs. Reputation is a component of Doximity rankings and is based on physician surveys. Outcomes-based measures allow for objective program comparison and may be more appropriate when assessing programs. This study evaluated how Doximity rankings of orthopaedic surgery residency programs compare with an outcomes-based ranking of programs based on academic productivity. This study also evaluated whether program size and type were associated with academic productivity. Methods: Orthopaedic program rankings, size, type, and research productivity were recorded from Doximity. An academic productivity score was calculated by averaging the mean percentage of alumni clinical trials and alumni publications. Analysis of variance and post hoc analyses were performed to determine whether academic productivity was associated with program reputation, size, and type. Results: One hundred seventy-five orthopaedic residency programs were included. Program rankings, size, and type had a statistically significant association with academic productivity (p < 0.0001). The 44 orthopaedic programs in the top quartile had an academic productivity score of 79.1 ± 13 in comparison with programs in the bottom quartile, who had a score of 38.3 ± 12.1 (p < 0.0001). Of the programs in the top quartile of reputation rankings, 32 (73%) were also in the top quartile for academic productivity. Programs with more residents demonstrated greater academic productivity than smaller programs. Twenty-three programs (13%) had more than 30 residents and a mean academic productivity of 76.2 ± 14.8. In comparison, 13 programs (7.5%) had 10 or fewer residents with an academic productivity score of 40.6 ± 16.3 (p < 0.0001). An academic productivity score differed significantly based on program type: university (63.9 ± 14.8), military (54.7 ± 16.9), university/community (46.3 ± 15.6), and community (38.7 ± 15) (p < 0.0001). Conclusions: Academic productivity among orthopaedic residency programs is associated with Doximity ranking, program size, and type. This information can be used by medical students, residents, and physicians to understand the Doximity rankings and how they correlate with this objective measure. Level of Evidence: III.

Use of calcium phosphate cement after removal of a cephalomedullary nail: A case report.

Femoral neck fracture in the absence of trauma is a rare, but known complication after hardware removal. This complication may be due to the boney defect created by the hardware removal itself, or the increase in femoral neck strain that occurs after removal of the hardware. Previous biomechanical studies have suggested that filling the defect with calcium phosphate cement after removal of hardware may prevent the development of a femoral neck fracture. However, there are no reports on the use of calcium phosphate cement after removal of hardware in the clinical setting. The purpose of this case discussion is to present the first reported case, to our knowledge, of the use of calcium phosphate cement augmentation of the boney defect after lag screw removal, and the subsequent failure resulting in atraumatic femoral neck fracture.

Acute Correction of Leg Length Discrepancy and Severe Femoral Malalignment: A Case Report.

Introduction: Approximately 70% of the population have a leg length discrepancy, with 2 cm being the threshold for surgical treatment. Although there are reports of patient outcomes after incremental leg-lengthening, there is a paucity of data regarding acute lengthening procedures. We present a unique case of acute leg lengthening and correction of severe malalignment in an adult patient after femoral malunion treated with multiple modified Sofield-Millar osteotomies and intramedullary nailing, a technique that has only previously been performed in pediatric long bone deformities. To the author's knowledge, there have been no previous reports of acute lengthening in an adult patient to correct for such a severe deformity in a single operation. Case Report: A 48-year-old woman with a 35-year history of a right femur fracture malunion presented with a 5 cm leg length discrepancy and severe malalignment associated with pain and ambulatory dysfunction. Multiple modified Sofield-Millar osteotomies followed by placement of an intramedullary nail were performed and resulted in successful acute correction of limb length discrepancy and anatomical alignment. There was a complete union of bone with callus formation at osteotomy sites at 9 months postoperatively, and the patient reported minimal pain and improved ambulation. The patient was followed for 2 years postoperatively and experienced an improvement in ambulatory function with no pain. No post-operative complications were observed. Conclusion: Multiple modified Sofield-Millar osteotomies with intramedullary nailing were utilized for successful acute correction of limb length discrepancy and severe malalignment with improvement in pain and ambulatory function in this case of femoral leg length discrepancy in an adult patient.

Outcomes after antibiotic megaspacer implantation in patients with severe chronic periprosthetic infections.

Periprosthetic joint infection (PJI) is a rare postoperative complication that is treated with antibiotic spacers. Some patients develop severe, treatment-resistant, chronic PJI despite multiple attempts at salvaging the joint. Permanent resection of the joint or amputation may be the only definitive treatment. The purpose of this study is to describe the outcomes, infection resolution rate, and complications of two-stage revision, utilizing extensive resection of the affected bone and application of antibiotic megaspacers as a modality for limb-salvage. A review of 12 patients, initially referred for amputation due to chronically failed PJI, was conducted. All patients underwent extensive resection of the bone and surgical implantation of a custom-made antibiotic megaspacer between December 2016 and June 2019. Thirteen megaspacers were placed in 13 infected joints in 12 patients with a history of chronic PJI. Six patients (50%) had a diagnosis of osteomyelitis. Eradication of the infection leading to limb-salvage was successful in nine patients. Visual Analog Scale pain scores improved by 3.5, or 50%, after two-stage revision with megaprosthesis reimplantation (p = .008), and six patients (54.5%) had improvement in ambulation. Complication rates, not including reinfection or recurrence, following megaspacer and megaprosthesis reimplantation were 58.3% and 27.3%, respectively. One patient underwent amputation due to a life-threatening infection while two other patients underwent amputation due to debilitating complications following limb-salvage surgery. Statement of Clinical Significance: In patients whose PJI becomes treatment-resistant after multiple failed attempts at traditional two-stage exchange, performing extensive boney resection with placement of an antibiotic-laden megaspacer can be an effective method of achieving limb-salvage.

Management of long bone fractures in patients with cerebral fat embolism syndrome.

Fat embolism syndrome (FES) is a rare complication associated with long bone fractures. Intramedullary nailing is the gold standard for treating patients with these injuries and early surgical intervention can prevent FES. However, there is a paucity of data on managing these patients once FES has developed. The purpose of this study is to present 3 unique cases of polytrauma patients with long bone fractures who underwent fixation with Taylor Spatial Frame, open reduction and internal fixation, or submuscular plating for treatment of these injuries. All 3 patients had complete cognitive and physical recovery.

Team Approach: Rehabilitation Strategies for Patients After Osteosarcoma Reconstructive Surgery.

The multimodal treatment of osteosarcoma with chemotherapy, surgical resection, and reconstruction has improved outcomes after a limb-salvage surgical procedure. Physical rehabilitation considerations after surgical resection vary, depending on the location of the tumor. Physical medicine and rehabilitation physicians incorporate lymphedema specialists, orthotists, and prosthetists to help to improve limb function. Beyond physical rehabilitation, psychological or behavioral interventions and nutritional rehabilitation are necessary to maximize a patient's return to function.

Disparities and the American Health Care System.

The United States' health care system is often compared with those of other industrialized countries, and consistently ranks poorly in terms of health care delivery, efficiency, and quality. However, there are several considerations unique to the United States that are often distorted in these analyses, and when considered in the context of the convoluted ethnic and social disparities that persist in the United States, the successes of the American health care system become more apparent.

Delayed Exercise Is Ineffective at Reversing Aberrant Nociceptive Afferent Plasticity or Neuropathic Pain After Spinal Cord Injury in Rats.

Neuropathic pain is a debilitating consequence of spinal cord injury (SCI) that correlates with sensory fiber sprouting. Recent data indicate that exercise initiated early after SCI prevents the development of allodynia and modulated nociceptive afferent plasticity. This study determined if delaying exercise intervention until pain is detected would similarly ameliorate established SCI-induced pain. Adult, female Sprague-Dawley rats with a C5 unilateral contusion were separated into SCI allodynic and SCI non-allodynic cohorts at 14 or 28 days postinjury when half of each group began exercising on automated running wheels. Allodynia, assessed by von Frey testing, was not ameliorated by exercise. Furthermore, rats that began exercise with no allodynia developed paw hypersensitivity within 2 weeks. At the initiation of exercise, the SCI Allodynia group displayed marked overlap of peptidergic and non-peptidergic nociceptive afferents in the C7 and L5 dorsal horn, while the SCI No Allodynia group had scant overlap. At the end of 5 weeks of exercise both the SCI Allodynia and SCI No Allodynia groups had extensive overlap of the 2 c-fiber types. Our findings show that exercise therapy initiated at early stages of allodynia is ineffective at attenuating neuropathic pain, but rather that it induces allodynia-aberrant afferent plasticity in previously pain-free rats. These data, combined with our previous results, suggest that there is a critical therapeutic window when exercise therapy may be effective at treating SCI-induced allodynia and that there are postinjury periods when exercise can be deleterious.