Midterm Follow-up of a Novel Algorithm for Nonoperative Weber B Ankle Fractures.

BACKGROUND: Stable Weber B ankle fractures are routinely treated nonoperatively. Our group previously presented a novel algorithm that provides radiographic parameters guiding when Weber B ankle fractures can be treated nonoperatively.2 The purpose of this study is to evaluate the durability of those results with a minimum 5-year follow-up. METHODS: All 51 patients who were included in the initial study were contacted by telephone and asked to return to clinic for repeat evaluation where American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot, Olerud-Molander Ankle (OMA), and visual analog scale (VAS) scores were collected. Bilateral standing ankle radiographs were obtained and evaluated using the Kellgren-Lawrence grading scale for ankle arthritis. RESULTS: Twenty-nine of 51 patients (56%) participated in this follow-up study with a mean follow-up of 6.8 (range 5.6-8) years. Average functional score results were as follows: AOFAS, 98.43; OMA score, 94.11; and VAS, 0.46. AOFAS scores improved by an average of 5 points between 1 year and 5 years (P = .002); OMA and VAS scores were stable. All patients achieved union of their fracture on follow-up radiographs. CONCLUSION: Our findings demonstrate the durability of the previous study results conducted by Holmes et al,2 and support that appropriately selected patients can be treated nonoperatively using the study's novel algorithm. This reinforces our theory that medial clear space widening on weightbearing radiographs up to 7 mm should be considered for nonoperative management. LEVEL OF EVIDENCE: Level IV, case series.

Pregnancy in Orthopaedic Residents: Peripartum Barriers Identified.

While there are multiple barriers that may discourage women from choosing a career in orthopaedic surgery, one area of concern is pursuing pregnancy during residency training. This study's primary purpose was to determine the most prominent barriers to pursuing pregnancy during orthopaedic surgery residency. Methods: A 63-item survey designed to evaluate multiple aspects of childbearing during orthopaedic surgery residency was distributed through email and a targeted Facebook platform to female orthopaedic surgeons and orthopaedic trainees in the United States. Given the study design, statistics were largely descriptive in nature. Multivariate logistic regression was also used to determine independent factors associated with professional dissatisfaction as it related to pregnancy during orthopaedic residency. Results: A total of 328 women responded to the survey. The 3 most prominent barriers to pursuing pregnancy during orthopaedic residency were concerns about the ability to balance clinical and maternal duties (67%), fear of how the resident would be viewed by those in the program (60%), and being unable to ensure optimal prenatal and postpartum care for the mother and child given an unpredictable schedule (38%). On univariate analysis of those who reported ≥1 pregnancy during residency (n = 71), maternity leave ≤6 weeks was statistically associated with "revisiting career choice" (p = 0.02) and "lack of resources and support" (p = 0.01). Conclusion: The results raise concern that qualified female applicants may be deterred from the field of orthopaedics given perceived difficulties associated with pregnancy as a resident. If policies are created to support women who desire to have children during residency, more women may be encouraged to pursue a career in orthopaedic surgery. Level of Evidence: V.