The Effect of Underrepresented Minority Mentorship on Orthopaedic Spine Surgery Recruitment and Diversity: A 20-Year Analysis at a Single Institution.

INTRODUCTION: Despite national efforts to increase diversity and inclusion, underrepresented minority (URM) representation among orthopaedic spine surgery faculty remains low. Research has shown that URM trainees are more likely to pursue surgical careers when they have access to URM mentors. The purpose of this study was to explore the influence of URM representation among spine faculty on the rate of URM orthopaedic residents pursuing spine surgery fellowships. METHODS: From 2004 to 2023, data were collected from each residency class at our academic institution: residency year, number of residents per class (total and URM), and number of residents applying to spine surgery fellowships. These ethnicities were considered URM: Black or African American, Hispanic or Latino, and Native American. In 2018, two African American spine faculty were hired. Data were compared between Before and After their arrival. A subanalysis was done to include a period of increasing URM recruitment (2012 to 2018). Binary logistic regression analysis evaluated associations between appointment of URM faculty and fellowship choice of URM residents. RESULTS: Two hundred fifty-six residents were included. Thirty-one total URM residents were in the program during the study period (12.1%). Overall, URM representation in the program increased over time [OR: 1.1, 95% CI: 1.1 to 1.2], whereas residents applying to spine surgery fellowships did not change [OR: 1.0, 95% CI: 1.0 to 1.1]. Comparing Before-2012 and 2012 to 2018 groups with the After-2018 group demonstrated a significant difference in the proportion of URM residents applying to spine surgery fellowships after the hiring of URM spine faculty (0.0% versus 23.1% versus 74.1%; P = 0.001). CONCLUSION: This retrospective study provides empirical evidence of the importance of URM representation among orthopaedic spine surgery faculty and the potential effect on URMs pursuing orthopaedic fellowships. Institutions should consider prioritizing the representation of URM faculty in spine surgery to address the lack of current and future diversity in the field. LEVEL OF EVIDENCE: III.

Increasing Diversity in Orthopaedics: The Problem, Strategies, and Solutions.

It is important to educate and equip the orthopaedic community with tools to address health care disparities and improve orthopaedic specialty recruitment for racial minorities. How patients and providers are affected by systemic racism in healthcare and what that means in orthopaedic surgery, methods to identify bias and improve access to orthopaedic care for racial minorities, and how to structure a program and department environment to encourage and promote diversity are important topics of discussion.

Pediatric elbow injuries in athletes.

Elbow injuries in pediatric and adolescent population represent a spectrum of pathology that can range from medial tension injuries to posterior shear injuries. Elbow injuries in this population continue to rise in parallel with the increase in youth participation in sports both throughout the calendar year and across multiple sports. Many of these injuries are noncontact and are attributed to overuse. Evaluation and management of youth and adolescent athletic elbow injuries requires knowledge of developmental anatomy, injury pathophysiology, and established treatment algorithms. Furthermore, risk factors contributing to elbow injuries must be recognized, with education and recommendations for safe play continually advocated. This education--of parents, athletes, and coaches--is paramount in reducing the climbing incidence of elbow injuries in our youth athletes.

Optimal aspiration volume of vertebral bone marrow for use in spinal fusion.

BACKGROUND CONTEXT: Bone marrow aspirate (BMA) has shown promise as a bone graft option in spinal fusion. The vertebral body is a convenient source for marrow aspirate as it is accessed in routine course of pedicle screw instrumentation. Studies have relied on data from the iliac crest to determine optimal aspiration volume from the vertebral body. PURPOSE: This study is designed to determine the optimal aspiration volume for BMA taken from the vertebral body. STUDY DESIGN: Prospective clinical study. PATIENT SAMPLE: Data are drawn from 18 pedicles and 180 aspirations. The average age of the subjects was 50.3 years, and the subject pool comprised five men and seven women. OUTCOME MEASURES: Nucleated cell count and alkaline phosphatase staining colony forming units. METHODS: Ten 1 mL aliquots of BMA were incrementally aspirated through a cannulated pedicle tap for each instrumented vertebral body. The numbers of nucleated cells per mL of BMA were analyzed with a hemocytometer, and the percentage of osteoprogenitor cells per mL aspirate were estimated by an alk phos production assay. The study was funded through departmental funds, and none of the authors have any conflicts of interest to report related to the study. RESULTS: Nucleated cell count decreased with increasing aspirate number (p<.001). The average cell count for the first mL was 45.8 million cells. Cell counts did not differ by age or sex (p=.943 and p=.685, respectively). Likewise, osteoprogenitor cell percentage decreased with increasing aspirate number (p<.001). CONCLUSIONS: The 2 mL aspirate volume has been defined as ideal for the iliac crest, but there has been no analogous assessment of the effect of aspiration volume for other sources such as the vertebral body. This information is important for the clinical implementation of vertebral body aspirations if volume, cells, and presumably performance, of this potential bone graft option are to be optimized for spine cases. Our data show a direct relationship between increasing aspiration number and decreasing osteoprogenitor cellular concentration, with a drop to 50% of the original aspirate cell count by the 4th mL aspirate. The vertebral body is a potentially exciting source of osteoprogenitor cells that can be implemented for a variety of spinal uses.

Biomechanical comparison of endplate forces generated by uniaxial screws and monoaxial pedicle screws.

Current surgical treatment of idiopathic scoliosis involves the use of various segmental instrumentation. Various pedicle screws have allowed for improved correction. Although monoaxial screws have improved rotational control compared with polyaxial screws, their use may increase screw-bone interface or vertebral endplate forces if not inserted in an exactly straight trajectory. Uniaxial screws potentially decrease these forces while retaining the advantages of monoaxial screws with respect to better rotational control. The purpose of this study was to compare the vertebral endplate forces with monoaxial or uniaxial screws when being reduced to a rod. Thirty-two plastic, surrogate T11 vertebrae were prepared with monoaxial (n=16) or uniaxial (n=16) screws. Screw angles relative to inferior vertebral endplates were assessed with lateral radiographs. The vertebrae were fixed to a load cell, and loads were measured as the screw was reduced to a rod. Monoaxial screws demonstrated a linear progression of endplate force with increasing screw angle. Uniaxial screws demonstrated minimal endplate force until approximately 20°, coinciding with screwhead excursion angle. As this maximum excursion angle was passed, uniaxial screws demonstrated a force slope similar to the monoaxial screws.The measured endplate forces should be equivalent to forces at the screw-bone interface. The reduced force with uniaxial screws is expected to have less cranial-caudal plow potential as the screw is coupled to a rod for deformity correction. This could have potential implications for screw failure, especially in less dense bone.

The effect of rigid cervical collar height on full, active, and functional range of motion during fifteen activities of daily living.

STUDY DESIGN: Laboratory biomechanical experiment. OBJECTIVE: To evaluate how different anterior cervical collar heights restrict full, active range of motion (ROM), and functional ROM during 15 activities of daily living. SUMMARY OF BACKGROUND DATA: Hard cervical collars are commonly used in the clinical setting. Collar fit is presumed to affect immobilization, making neck height an important variable. No prior study has evaluated how different collar heights affect full, active and functional ROM. METHODS: A previously validated electrogoniometer device was employed to quantify both full, active, and functional ROM. For each of 10 subjects, these ROM measurements were repeated without a collar and with an adjustable, hard collar (Aspen Vista) at each of 6 collar neck height settings. RESULTS: For each increase in collar height, there was a corresponding decrease in mean full, active ROM of 3.7% (3°) in the sagittal plane (R2 = 0.91, P = 0.003), 3.9% (3°) in the coronal plane (R2 = 0.88, P = 0.005), and 2.8% (4°) in the rotational plane (R2 = 0.86, P = 0.006). For each increase in collar height, there was a corresponding decrease in mean functional ROM across all of the tested activities of daily living of 1.1% (1°) in the sagittal plane (R2 = 0.90, P = 0.004), 0.4% (0.4°) in the coronal plane (R2 = 0.86, P = 0.007), and 0.6% (0.5°) in the rotational plane (R2 = 0.81, P = 0.014). For each increase in collar height, there was a 1.7° increase in mean neck extension while in the neutral position (R2 = 0.99, P < 0.001). CONCLUSION: This study suggests that greater cervical collar height for hard cervical collars will better restrict full, active, and functional cervical ROM. However, the change in functional ROM was only about one quarter to that of full active ROM and the clinical significance of this may be questioned. This must be balanced by the fact that this increased collar height forces the neck into greater extension which may not be the most clinical desired or functional position and may cause skin-related issues at the jaw or chest.

Soft and rigid collars provide similar restriction in cervical range of motion during fifteen activities of daily living.

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To evaluate the relative efficacies of soft and rigid collars for restricting both the full, active and functional ranges of motion (ROM) of the cervical spine during 15 activities of daily living (ADLs). SUMMARY OF BACKGROUND DATA: Cervical collars are frequently used for the purpose of limiting cervical motion after surgical procedures or as a treatment for certain injuries. Rigid collars are generally believed to reduce cervical motion to a greater extent than soft collars but the latter are often preferred by patients because of their greater comfort. Although there are some data to suggest that soft collars restrict full, active ROM (i.e., the extremes of motion) to a lesser degree than rigid braces, there are currently no comparative studies that have assessed the effects of these 2 types of cervical collars on the functional ROM that is required to perform multiple ADLs. METHODS: In this investigation, a previously validated electrogoniometer device was used to quantify both the full, active ROM of 10 subjects as well as the functional ROM they exhibited during a series of 15 ADLs. For each individual, these ROM measurements were repeated after the application of both a soft collar and a rigid orthosis. RESULTS: The soft collar limited flexion/extension, lateral bending, and rotation by 27.1%+/-9.9% (mean+/-standard deviation), 26.1%+/-4.8%, and 29.3%+/-10.3%, respectively. The corresponding reductions in ROM with a rigid collar were 53.7%+/-7.2%, 34.9%+/-6%, and 59.2%+/-5.3%, respectively. The rigid collar resulted in significantly lower full, active ROM in both the sagittal and axial planes but not in the lateral bending plane. Compared with the soft collar, the rigid collar afforded no difference in motion during 13 of the 15 simulated ADLs. Greater motion was only noted with backing up a car and sitting from a standing position. CONCLUSION: Although subjects exhibited less full, active ROM of the cervical spine when immobilized in a rigid collar than when they were placed in a soft collar, the motion recorded during various functional tasks was not significantly different for nearly all of the ADLs in this study, regardless of which cervical device was applied. One potential explanation for this finding is that both collars may serve as proprioceptive guides, which allow patients to regulate their own cervical motion based on their level of comfort. Given the paucity of data supporting the use of postoperative bracing, especially after procedures which incorporate internal fixation, this study indicates that a rigid orthosis may be unnecessary in many cases because even a soft collar seems to be sufficient for restricting motion during routine activities until the normal, physiologic ROM of the cervical spine has been restored.