Dorsal Radiocarpal Joint Fracture-Dislocation: A Case Report.

CASE: A 19-year-old right-hand-dominant man sustained a right dorsal radiocarpal dislocation. He presented with instability secondary to displacement of the volar ligamentous structures and an avulsed fragment of the distal aspect of the radius within the radiocarpal articulation. The patient was treated with open reduction and internal fixation, as well as a capsuloligamentous repair. At the 18-month follow-up, he had no pain and excellent functional recovery. CONCLUSION: Our experience emphasizes the importance of looking critically at the radiographs when there is an irreducible radiocarpal fracture-dislocation. A volar distal radial fragment and attached ligamentous structures can be the main blocks to closed reduction.

Academic Influence and Its Relationship to Industry Payments in Orthopaedic Surgery.

BACKGROUND: The Hirsch index (h-index) quantifies research publication productivity for an individual, and has widely been considered a valuable measure of academic influence. In 2010, the Physician Payments Sunshine Act (PPSA) was introduced as a way to increase transparency regarding U.S. physician-industry relationships. The purpose of this study was to investigate the relationship between industry payments and academic influence as measured by the h-index and number of publications among orthopaedic surgeons. We also examined the relationship of the h-index to National Institutes of Health (NIH) funding. METHODS: The h-indices of faculty members at academic orthopaedic surgery residency programs were obtained using the Scopus database. The PPSA web site was used to abstract their 2014 industry payments. NIH funding data were obtained from the NIH web site. Mann-Whitney U testing and Spearman correlations were used to explore the relationships. RESULTS: Of 3,501 surgeons, 78.3% received nonresearch payments, 9.2% received research payments, and 0.9% received NIH support. Nonresearch payments ranged from $6 to $4,538,501, whereas research payments ranged from $16 to $517,007. Surgeons receiving NIH or industry research funding had a significantly higher mean h-index and number of publications than those not receiving such funding. Surgeons receiving nonresearch industry payments had a slightly higher mean h-index and number of publications than those not receiving these kinds of payments. Both the h-index and the number of publications had weak positive correlations with industry nonresearch payment amount, industry research payment amount, and total number of industry payments. CONCLUSIONS: There are large differences in industry payment size and distribution among academic surgeons. The small percentage of academic surgeons who receive industry research support or NIH funding tend to have higher h-indices. For the overall population of orthopaedic surgery faculty, the h-index correlates poorly with the dollar amount and the total number of industry research payments. Regarding nonresearch industry payments, the h-index also appears to correlate poorly with the number and the dollar amount of payments. These results are encouraging because they suggest that industry bias may play a smaller role in the orthopaedic literature than previously thought.

Academic productivity among fellowship associated adult total joint reconstruction surgeons.

BACKGROUND: The Hirsch index (h-index) is a measure that evaluates both research volume and quality-taking into consideration both publications and citations of a single author. No prior work has evaluated academic productivity and contributions to the literature of adult total joint replacement surgeons. This study uses h-index to benchmark the academic impact and identify characteristics associated with productivity of faculty members at joint replacement fellowships. METHODS: Adult reconstruction fellowship programs were obtained via the American Association of Hip and Knee Surgeons website. Via the San Francisco match and program-specific websites, program characteristics (Accreditation Council for Graduate Medical Education approval, academic affiliation, region, number of fellows, fellow research requirement), associated faculty members, and faculty-specific characteristics (gender, academic title, formal fellowship training, years in practice) were obtained. H-index and total faculty publications served as primary outcome measures. Multivariable linear regression determined statistical significance. RESULTS: Sixty-six adult total joint reconstruction fellowship programs were identified: 30% were Accreditation Council for Graduate Medical Education approved and 73% had an academic affiliation. At these institutions, 375 adult reconstruction surgeons were identified; 98.1% were men and 85.3% had formal arthroplasty fellowship training. Average number of publications per faculty member was 50.1 (standard deviation 76.8; range 0-588); mean h-index was 12.8 (standard deviation 13.8; range 0-67). Number of fellows, faculty academic title, years in practice, and formal fellowship training had a significant (P < .05) positive correlation with both h-index and total publications. CONCLUSIONS: The statistical overview presented in this work can help total joint surgeons quantitatively benchmark their academic performance against that of their peers.

The role of chairman and research director in influencing scholarly productivity and research funding in academic orthopaedic surgery.

The purpose of this study was to determine what orthopaedic surgery department leadership characteristics are most closely correlated with securing NIH funding and increasing scholarly productivity. Scopus database was used to identify number of publications/h-index for 4,328 faculty, department chairs (DC), and research directors (RD), listed on departmental websites from 138 academic orthopaedic departments in the United States. NIH funding data was obtained for the 2013 fiscal year. While all programs had a DC, only 46% had a RD. Of $54,925,833 in NIH funding allocated to orthopaedic surgery faculty in 2013, 3% of faculty and 31% of departments were funded. 16% of funded institutions had a funded DC whereas 65% had a funded RD. Department productivity and funding were highly correlated to leadership productivity and funding(p< 0.05). Mean funding was $1,700,000 for departments with a NIH-funded RD, $104,000 for departments with an unfunded RD, and $72,000 for departments with no RD. These findings suggest that orthopaedic department academic success is directly associated with scholarly productivity and funding of both DC and RD. The findings further highlight the correlation between a funded RD and a well-funded department. This does not hold for an unfunded RD.