Patients Prefer Medical Facts and Educational Videos From Sports Medicine Surgeons on Social Media.

Purpose: To provide updated information on which sports medicine patients are most influenced by provider presence on social media, as well as their preferences in social media platforms and content. Methods: Between November 2021 and January 2022, an anonymous online, voluntary, self-administered questionnaire containing 13 questions was distributed to patients who had a clinic visit with 1 of 2 orthopaedic sports medicine surgeons at the same institution. Descriptive statistics were used to analyze the data. Results: A total of 159 responses were received for a response rate of 29.5%. The most common platforms used by patients were Facebook (110; 84%), YouTube (69; 53%), and Instagram (61; 47%). Most participants indicated that it did not make a difference if their sports medicine surgeon was on social media (N = 99, 62%), and they indicated they would not travel further to see a physician who was active on social media (N = 85, 54%). Compared with other age groups, significantly more respondents over the age of 50 years used Facebook to follow their physicians (47 of 60, 78%, P = .012). Seventy-eight (50%) patients noted that they were interested in seeing medical facts, whereas 72 (46%) were interested in seeing educational videos on their physician's social media page. Conclusions: In this study, we found that sports medicine patients prefer to see educational videos and medical facts from their surgeons on social media, most predominantly on Facebook. Clinical Relevance: Social media is a popular way to connect in our modern world. As the influence of sports medicine surgeons on social media grows, it is important to understand how this is perceived by patients.

Use of Wrist Denervation in the Treatment of SLAC and SNAC Wrist by ASSH Members.

Background Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are common patterns of wrist arthritis, and surgical treatment options include partial and total wrist arthrodesis and wrist denervation, which maintains the current anatomy while relieving pain. Introduction The purpose of this study is to elucidate current practices within the hand surgery community with respect to the use of anterior interosseous nerve/posterior interosseous nerve (AIN/PIN) denervation in the treatment of SLAC and SNAC wrists. Methods An anonymous survey was distributed to 3,915 orthopaedic surgeons via the American Society for Surgery of the Hand (ASSH) listserv. The survey collected information on conservative and operative management, indications, complications, diagnostic block, and coding of wrist denervation. Results In total, 298 answered the survey. 46.3% ( N = 138) of the respondents used denervation of AIN/PIN for every SNAC stage, and 47.7% ( N = 142) of the respondents used denervation of AIN/PIN for every SLAC wrist stage. AIN and PIN combined denervation was the most common standalone procedure ( N = 185, 62.1%). Surgeons were more likely to offer the procedure ( N = 133, 55.4%) if motion preservation had to be maximized ( N = 154, 64.4%). The majority of surgeons did not consider loss of proprioception ( N = 224, 84.2%) or diminished protective reflex ( N = 246, 92.1%) to be significant complications. 33.5%, 90 respondents reported never performing a diagnostic block prior to denervation. Conclusion Both SLAC and SNAC patterns of wrist arthritis can result in debilitating wrist pain. There is a wide range of treatment for different stages of disease. Further investigation is required to identify ideal candidates and evaluate long-term outcomes.

Traumatic orthopaedic motor vehicle injuries: Are there age and sex differences in pedestrian and cyclist accidents in a major urban center?

INTRODUCTION: Injuries caused by road traffic have become the leading cause of death in people aged 5 to 29 years, with pedestrians and cyclists being disproportionately affected. Research has demonstrated age and sex differences in road accidents in European populations. The purpose of this study was to determine age and sex-specific differences in pedestrian and cyclist accidents involving passenger cars at a single Level 1 Trauma Center in a major US metropolitan area. METHODS: We performed a retrospective chart review of 1,845 patients that presented to a single level 1 trauma center from January 1, 2016 - October 1st, 2021, and were involved in a motor vehicle vs. pedestrian or motor vehicle vs. cyclist accidents. Demographics, injury pattern, abbreviated injury scores (AIS), and hospital stay were analyzed, and the data was stratified by pedestrian vs. cyclist, biological sex, and race. Chi square analysis, t tests, and binomial logistic regression was used to examine sex and age-based differences. RESULTS: Pedestrian vs. motor vehicle collisions (N = 1359, 74%) occurred more frequently than cyclists (N = 475, 26%) with an overall mortality rate of 6%. The mean age of pedestrians and cyclists was 39 and 42 years of age, respectively. Overall, more female than male patients had hand (mean=0.05 vs. 0.02) (p = 0.03) and pelvis fractures (mean 0.28 vs. 0.19) (p = 0.007). Females had a 1.2 times higher likelihood of getting a pelvis fracture than males (95% CI, 1.06 to 1.43). Linear regression analysis found a statistically significant relationship between older age and increased AIS severity (p < .001). Half of our sample consisted of Black patients (49.6% Black vs. 42.1% white). CONCLUSION: Female pedestrians and cyclists are at increased risk of obtaining pelvis fractures when in a traumatic road accident than males, regardless of age stratification, and age is a predictor of injury severity. Our study also found that race-based differences exist, with Black patients being injured more frequently. Further research is needed to better understand demographics at risk for traumatic road accidents, as well as evaluation of city infrastructure for biking and walking.

Far Anterior Medial Portals in Complicated Elbow Arthroscopic Procedures: Safety Profile in a Cadaveric Model.

Purpose: The purpose of this study is to describe the placement and evaluate the safety of the far anterior proximal and distal anteromedial portals by comparing them to previously defined portal techniques in a cadaveric model of the elbow. Methods: Six paired (left and right) fresh, frozen cadaveric elbow joints were dissected. .62-mm Kirschner wires were placed at the literature-defined distal and proximal portal sites on right elbows. The proposed "far anterior" distal and proximal portals were established on the matched left elbows. The elbows were dissected to display the median and ulnar nerves. Digital calipers were used to measure distances from wires to nerves. Results: For the distal portal, the literature-defined portals were a significantly greater distance (P = .014) from the ulnar nerve (31.22 mm) compared to the far anterior portals (24.65 mm). For the proximal portal, the far anterior portals were a significantly greater distance (P = .026) from the ulnar nerve (26.98 mm) than the literature-defined portals (13.75 mm). There was no significant difference between the far anterior and literature-defined proximal and distal portal techniques in relation to the median nerve. Conclusions: Analysis of elbow arthroscopy anteromedial portal technique shows the far, anterior, proximal, and distal portals are a safe distance from the ulnar and median nerves. A portal modification that may address complicated elbow conditions is a more anterior placement of the medial portals to allow for better visualization and access. Clinical Relevance: The elbow is a difficult joint in which to perform arthroscopic surgery. One option our institution has used for safe portal modification to address complicated elbow conditions is a further anterior placement of the medial portals to allow better visualization and access.

Age and Female Sex Are Important Risk Factors for Stress Fractures: A Nationwide Database Analysis.

BACKGROUND: Stress fractures are caused by micro-trauma due to repetitive stress on bone, common in active individuals and athletes. Previous studies demonstrate that the weightbearing bones of the lower extremities incur stress fractures most often, especially in women and older adults. HYPOTHESIS: Prior literature does not quantify the difference in frequency of stress fractures among different genders, age groups, or body mass indices (BMIs). We hypothesized that older female patients would have higher rates of lower extremity stress fractures than male patients. STUDY DESIGN: Epidemiological research. LEVEL OF EVIDENCE: Level 3. METHODS: Records of female and male patients with lower extremity stress fractures from 2010 to 2018 were identified from the PearlDiver administrative claims database using the International Classification of Diseases (ICD)-9/ICD-10 codes. Stress fractures were classified by ICD-10 diagnosis codes to the tibial bone, proximal femur, phalanges, and other foot bones. Comorbidities were incorporated into a regression analysis. RESULTS: Of 41,257 stress fractures identified, 30,555 (70.1%) were in women and 10,702 (25.9%) were in men. Our sample was older (>60 years old) (37.3%) and not obese (BMI <30 kg/m2, 37.1%). A greater proportion of female patients with stress fracture were older (P < 0.001) and had foot stress fractures (P < 0.001), while a greater proportion of male patients with stress fracture were younger than 19 years (P < 0.001) and had metatarsal (P < 0.001), hip (P = 0.002), and tibia stress fractures (P < 0.001). CONCLUSION: Stress fractures commonly occur in women and older adults with low BMIs. Metatarsal and tibia stress fractures were the most common, and a greater proportion of women had foot stress fractures. CLINICAL RELEVANCE: Our study examined the large-scale prevalence of different lower extremity stress fractures among a wide patient population sample of varying ages and BMIs. These findings can help clinicians identify active populations at greater risk for stress fracture injuries.

Musculoskeletal Injuries and Conditions Among Homeless Patients.

INTRODUCTION: The purpose of this study was to analyze existing literature on musculoskeletal diseases that homeless populations face and provide recommendations on improving musculoskeletal outcomes for homeless individuals. METHODS: A comprehensive search of the literature was performed in March 2020 using the PubMed/MEDLINE (1966 to March 2020), Embase (1975 to April 2020), and CINHAL (1982 to 2020) databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for accuracy of reporting, and the Newcastle-Ottawa Scale was used for quality assessment. RESULTS: Twenty-nine articles met inclusion criteria. Seven studies observed an increased prevalence of musculoskeletal injuries among the homeless population, four observed increased susceptibility to bacterial soft-tissue infection, four observed increased fractures/traumatic injuries, three described increased chronic pain, and six focused on conditions specific to the foot and ankle region. DISCUSSION: Homeless individuals often have inadequate access to care and rely on the emergency department for traumatic injuries. These findings have important implications for surgeons and public health officials and highlight the need for evidence-based interventions and increased follow-up. Targeted efforts and better tracking of follow-up and emergency department usage could improve health outcomes for homeless individuals and reduce the need costly late-stage interventions by providing early and more consistent care.

Surgeon Decision-Making for Individuals With Obesity When Indicating Total Joint Arthroplasty.

BACKGROUND: Obesity is a risk factor for complications after total joint arthroplasty (TJA). This study analyzed the impact of individual surgeon demographics, financial concerns, and other factors in determining patient candidacy for TJA based on body mass index (BMI). METHODS: A 21-question survey was approved by the American Association of Hip and Knee Surgeons Research Committee for distribution to its membership. Objective questions asked about surgeon or hospital BMI thresholds for offering TJA. Subjective questions asked about physician comfort discussing topics including obesity, bariatric surgery, and weight loss before TJA, as well as insurance and age considerations. RESULTS: For TJA procedures, 49.9% of surgeons had a BMI cutoff at 40, 24.5% at 45, and 8.3% at 50. At a BMI cutoff of 40, 23.8% of surgeons felt their patient volume would be adversely affected, whereas at a BMI cutoff of 35, 50% of surgeons felt their patient volume would be adversely affected. Surgeons were more likely to not perform total hip arthroplasty on patients with morbid obesity than total knee arthroplasty (P = .037). Significantly more academic surgeons did not have cutoffs for total hip arthroplasty (P = .003) or total knee arthroplasty (P < .001) compared with all other practice settings. CONCLUSION: There are myriad factors that affect surgeon BMI thresholds for offering elective TJA including poor outcomes, hospital thresholds, financial considerations, and the well being of the patient. Further work should be performed to minimize the risks associated with TJA while providing the best possible care to patients with morbid obesity.

Variability of Cutting and Thermal Dynamics Between New and Used Acetabular Reamers During Total Hip Arthroplasty.

BACKGROUND: Aseptic loosening of the acetabular component remains one of the leading causes of early failure of total hip arthroplasty. Poor apposition of bone onto the implant surface can be due to inaccurate reaming and osteonecrosis of the acetabular bone due to the heat generated while reaming. METHODS: New and used acetabular reamers were tested on an MTS system using a clinically relevant force of 87.6 N. A thermal profile and depth achieved by the reamers were analyzed and compared between the 2 cohorts. Heat generated and force required for the community used reamers to achieve the same depth as the new reamers were subsequently analyzed. RESULTS: The new reamers achieved a depth 3.4 mm deeper than the community reamers (P < .001). The new reamers generated 4.1°C less heat than the community reamers (P = .007) under the same force and time. When programmed to ream to the average depth of the new reamers, the community reamers generated 16.8°C more heat (P = .002) and required forces 95-318% greater than the 87.6 N force used by the new reamers. CONCLUSIONS: Community use of reamers will cause variations in depth of penetration and increased temperatures at a clinically generated force vs new reamers. When community reamers were forced to the same depths the new reamers achieved, a significantly greater amount of heat was generated, and an increased amount of time was needed, both of which are known risk factors for osteonecrosis.

Sports Medicine Fellowship Training Significantly Increases Sports Case Volume: An Analysis of ACGME Case Log Data from 2006 to 2019.

PURPOSE: The purpose of this study was to determine the experiential benefit of completing a sports medicine fellowship for orthopaedic surgeons specializing in the treatment of sports injuries. METHODS: Accreditation Council for Graduate Medical Education case logs were examined for sports medicine cases performed by orthopaedic surgery residents from 2006 to 2019 and for orthopaedic sports medicine fellows from 2010 to 2019. The average number of arthroscopic cases was evaluated for residents and fellows according to each body group. Additional data based on subcategorization of arthroscopic cases was analyzed as well. A Student t-test was conducted to compare the means between the groups. RESULTS: Orthopaedic sports medicine fellows reported 274.9% more shoulder (260.6 ± 77.31 vs 94.8 ± 23.7, P < .0001), 685.6% more humerus/elbow (17.1 ± 6.14 vs 2.5 ± .508, P < .0001), 596.7% more pelvis/hip (41.4 ± 25.40 vs 6.9 ± 2.97, P < .0001), 188.1% more femur/knee (281.4 ± 57.85 vs 149.6 ± 34.09, P < .0001), and 264.1% more foot/ankle (16.9 ± 5.58 vs 6.4 ± .600, P < .0001) sports cases compared to orthopaedic surgery residents. Orthopaedic sports medicine fellows performed significantly more shoulder arthroscopy cases (126.8 ± 3.96 vs 86.0 ± 22.26, P = .032) and knee arthroscopy cases (179.4 ± 8.98 vs 101.75 ± 33.51, P = .015) than residents over a 5-year period. CONCLUSIONS: On average, orthopaedic sports medicine fellowships significantly increase sports case volume of orthopaedic trainees, especially in the upper extremity. Notable increases were in the shoulder, femur/knee, and pelvis/hip. We have demonstrated that orthopaedic sports medicine fellowships significantly increase exposure to sports medicine related cases. CLINICAL RELEVANCE: It is important for case volume to be evaluated across orthopaedic sports medicine fellowships because they must ensure that fellows receive adequate training in orthopaedic sports medicine.

How Did the Number and Type of Injuries in Patients Presenting to a Regional Level I Trauma Center Change During the COVID-19 Pandemic with a Stay-at-home Order?

BACKGROUND: During a pandemic, it is paramount to understand volume changes in Level I trauma so that with appropriate planning and reallocation of resources, these facilities can maintain and even improve life-saving capabilities. Evaluating nonaccidental and accidental trauma can highlight potential areas of improvement in societal behavior and hospital preparedness. These critical questions were proposed to better understand how healthcare leaders might adjust surgeon and team coverage of trauma services as well as prepare from a system standpoint what resources will be needed during a pandemic or similar crisis to maintain services. QUESTIONS/PURPOSES: (1) How did the total observed number of trauma activations, defined as patients who meet mechanism of injury requirements which trigger the notification and aggregation of the trauma team upon entering the emergency department, change during a pandemic and stay-at-home order? (2) How did the proportion of major mechanisms of traumatic injury change during this time period? (3) How did the proportion and absolute numbers of accidental versus nonaccidental traumatic injury in children and adults change during this time period? METHODS: This was a retrospective study of trauma activations at a Level I trauma center in New Orleans, LA, USA, using trauma registry data of all patients presenting to the trauma center from 2017 to 2020. The number of trauma activations during a government mandated coronavirus 2019 (COVID-19) stay-at-home order (from March 20, 2020 to May 14, 2020) was compared with the expected number of activations for the same time period from 2017 to 2019, called "predicted period". The expected number (predicted period) was assumed based on the linear trend of trauma activations seen in the prior 3 years (2017 to 2019) for the same date range (March 20, 2020 to May 14, 2020). To define the total number of traumatic injuries, account for proportion changes, and evaluate fluctuation in accidental verses nonaccidental trauma, variables including type of traumatic injury (blunt, penetrating, and thermal), and mechanism of injury (gunshot wound, fall, knife wound, motor vehicle collision, assault, burns) were collected for each patient. RESULTS: There were fewer total trauma activations during the stay-at-home period than during the predicted period (372 versus 532 [95% CI 77 to 122]; p = 0.016). The proportion of penetrating trauma among total activations was greater during the stay-at-home period than during the predicted period (35% [129 of 372] versus 26% [141 of 532]; p = 0.01), while the proportion of blunt trauma was lower during the stay-at-home period than during the predicted period (63 % [236 of 372] versus 71% [376 of 532]; p = 0.02). The proportion of gunshot wounds in relation to total activations was greater during the stay-at-home period than expected (26% [97 of 372] versus 18% [96 of 532]; p = 0.004). There were fewer motor vehicle collisions in relation to total activations during the stay-at-home period than expected (42% [156 of 372] versus 49% [263 of 532]; p = 0.03). Among total trauma activations, the stay-at-home period had a lower proportion of accidental injuries than the predicted period (55% [203 of 372] versus 61% [326 of 532]; p = 0.05), and there was a greater proportion of nonaccidental injuries than the predicted period (37% [137 of 372] versus 27% [143 of 532]; p < 0.001). In adults, the stay-at-home period had a greater proportion of nonaccidental injuries than the predicted period (38% [123 of 328] versus 26% [123 of 466]; p < 0.001). There was no difference between the stay-at-home period and predicted period in nonaccidental and accidental injuries among children. CONCLUSION: Data from the trauma registry at our region's only Level I trauma center indicate that a stay-at-home order during the COVID-19 pandemic was associated with a 70% reduction in the number of traumatic injuries, and the types of injuries shifted from more accidental blunt trauma to more nonaccidental penetrating trauma. Non-accidental trauma, including gunshot wounds, increased during this period, which suggest community awareness, crisis de-escalation strategies, and programs need to be created to address violence in the community. Understanding these changes allows for adjustments in staffing schedules. Surgeons and trauma teams could allow for longer shifts between changeover, decreasing viral exposure because the volume of work would be lower. Understanding the shift in injury could also lead to a change in specialists covering call. With the often limited availability of orthopaedic trauma-trained surgeons who can perform life-saving pelvis and acetabular surgery, this data may be used to mitigate exposure of these surgeons during pandemic situations. LEVEL OF EVIDENCE: Level III, therapeutic study.

Taking Family Call: Understanding How Orthopaedic Surgeons Manage Home, Family, and Life Responsibilities.

INTRODUCTION: Although women account for more than half of matriculating US medical students, they remain underrepresented in orthopaedic surgery, especially in leadership positions. This may, in part, be due to the disproportionate time spent on household responsibilities by women as compared to men. Understanding whether household responsibilities differ between female and male orthopaedic surgeons is critical to better understand how the demands of family life impacts their careers. METHODS: A 28-question multiple-choice anonymous online survey was sent via e-mail to 2,107 orthopaedic surgeons practicing at academic institutions in the United States. Survey questions related to the demographics of respondents, respondents' household responsibilities, and childcare methods. RESULTS: The survey was distributed to 2,043 orthopaedic surgeons, and 377 responded (response rate: 18.4%). Both female surgeons with and without children reported performing most household tasks, including grocery shopping, laundry, and meal preparation (P < 0.05). There was not a statistically significant difference between male and female surgeons without children who performed household repairs/maintenance in their homes (P = 0.186) and household finances (P = 1.00). Among surgeons with children, significantly more male surgeons completed financial tasks in the home (182 of 252 [72.2%] and 27 of 61 [44.3%]; M versus F, P < 0.0005) and completed household repairs (158 of 260 [60.8%] and 12 of 61 [19.7%]; M versus F, P < 0.0005). CONCLUSION: This study provides a quantitative breakdown of the hours of unwaged household work of male and female orthopaedic surgeons with and without children and asserts that although both male and female orthopaedic surgeons perform unwaged household work, women do substantially more than their male counterparts. Additional household responsibilities, or "family call," create an environment of competing priorities for female orthopaedic surgeons, which may reduce the time they have to devote to clinical duties and professional advancement.

The Effect of COVID-19 on Orthopedic Practices and Surgeons in Louisiana.

This study was performed to analyze the effect that coronavirus 2019 (COVID-19) has had on orthopedic surgeons' practices, their patients, and orthopedic surgeons themselves through a survey distributed to members of the Louisiana Orthopaedic Association (LOA). An anonymous 22-question online survey was created and distributed to 323 LOA members. Of the 323 recipients of the survey, 99 (30.7%) responded. As a part of a multiple response set, in which respondents could choose more than one answer, the majority reported delayed care for routine orthopedic injuries (81 of 97, 83.5%). Almost every surgeon (n=95, 96.0%) reported stopping or delaying elective surgery because of COVID-19 and an increase in pain/disability/deformity in patients due to delay in elective procedures (73 of 97, 75.3%) and delay in seeking care (66 of 97, 68.0%). The majority reported an increased use of telehealth visits (68 of 97, 70.1%), a decrease in patient volume (88 of 97, 90.7%), and a reduction in income (79 of 98, 80.6%) during the past 6 months. A majority of surgeons (58 of 98, 59.2%) reported that they had applied for government assistance or took out loans. Via a multiple response set, respondents indicated that as a result of the pandemic, telehealth will become more widespread (64 of 98, 65.3%) and hospitals will exert a stronger influence over health care (64 of 98, 65.3%). The COVID-19 pandemic has had lasting effects on orthopedic surgeons in Louisiana and their practices, with a substantial decrease in the number of patients treated (90.5%), surgical volume, and revenue (80.6%). Orthopedic surgeons affected by the pandemic could use these data to further understand future challenges with patient care and changing orthopedic practice dynamics during this unique time. [Orthopedics. 2020;43(6):351-355.].