Common Orthopaedic Injuries in CrossFit Athletes.

CrossFit is a high-intensity exercise program that has gained popularity over the past few decades. CrossFit combines movements from Olympic weight lifting, gymnastics, powerlifting, and high-intensity interval training. As CrossFit continues to expand, knowledge of the associated orthopaedic injuries to aid providers in diagnosis, treatment, and prevention will be increasingly important. The most common CrossFit injuries occur in the shoulder (25% of all injuries), spine (14%), and knee (13%). Male athletes are markedly more likely to experience injuries than female athletes, and injuries occur markedly less when there is supervised coaching of the athletes. The most common causes of injury in CrossFit include improper form and exacerbation of a prior injury. The purpose of this article was to review the literature to aid clinicians in identifying and treating common orthopaedic injuries in CrossFit athletes. Understanding the injury patterns, treatment, and prevention options is important for a successful recovery and return to sport.

Combined Supracondylar Humerus Fracture, Monteggia Injury, and Radial/Ulnar Shaft Fractures in a 3-Year-Old Child.

Ipsilateral pediatric elbow and forearm injuries are uncommon, particularly those comprising a supracondylar humerus fracture, radiocapitellar joint dislocation, proximal ulna fracture, and distal forearm fracture. We present the case of a boy who was 3 years, 6 months old and sustained this constellation of injuries. He underwent urgent treatment with closed reduction and percutaneous fixation of the humerus and flexible intramedullary nail fixation of the ulna. He presented with an ulnar sensory and motor neuropraxia that resolved, and he had full radiographic union and upper extremity range of motion by 3 months postoperatively. [Orthopedics. 2022;45(2):e107-e109.].

Economic Impact of Unused Surgical Instruments in an Orthopaedic Surgery Department at an Academic Medical Center: A Prospective Cross-sectional Study.

Orthopaedic surgical trays contain unused instruments, but we do not know which specific instruments go unused nor do we know the savings from eliminating them from a given tray. This was a single-site, observational study conducted at an academic medical center. The primary outcome was type of unused instruments and percentage of instruments used in two commonly used surgical trays. The secondary outcome was cost savings in United States dollars (USD) that could be attained by eliminating these instruments. In the first tray, five instruments (10.6%) were unused in any of 37 observed cases. In the second tray, nineteen instruments (19.6%) were unused in 37 observed cases. The total annual savings from replacement cost analysis and reprocessing cost analysis was $6,597.00 USD. Unused instruments are common in surgical trays. Eliminating unused instruments can result in immediate cost savings. (Journal of Surgical Orthopaedic Advances 30(3):131-135, 2021).

A novel clinical test for partial tears of the distal biceps brachii tendon: The TILT sign.

Partial tears of the distal biceps brachii tendon are rare. A complete tear of the distal biceps brachii tendon is readily diagnosed on the basis of history and physical examination and has a well-described clinical presentation of acute pain in the antecubital fossa, localized tenderness, swelling, palpable defect, positive hook test, and weakness in forearm supination and elbow flexion. Partial tears, on the other hand, can present more subtly and remain a diagnostic challenge. We present a novel physical examination technique that utilizes the rotational anatomy of the radius. The patient's forearm is passively supinated and pronated with the elbow flexed to 90° while the examiner firmly palpates the dorsal forearm overlying the radial tuberosity. The tuberosity presents itself beneath the examining fingers only in full forearm pronation. A positive test is indicated by tenderness over the radial (or lateral) aspect of the tuberosity (TILT sign) only in full forearm pronation, and not in supination. We have found this diagnostic test to be 100% sensitive for diagnosing partial distal biceps brachii tendon tears over the last five years during which it has been in use. Representative example cases are presented. A positive TILT sign indicates a diagnosis of partial tear of the distal biceps brachii tendon. This simple diagnostic maneuver could facilitate earlier detection of these injuries. Clin. Anat. 31:301-303, 2018. © 2017 Wiley Periodicals, Inc.

Analysis of Orthopedic Resident Ability to Apply Levels of Evidence Criteria to Scientific Articles.

OBJECTIVE: In the era of evidence-based medicine, understanding study design and levels of evidence (LoE) criteria is an important component of resident education and aids practicing surgeons in making informed clinical decisions. The purpose of this study is to analyze the ability of orthopedic residents to accurately determine LoE criteria for published articles compared with medical students. DESIGN: Basic science article. SETTING: Geisinger Medical Center (Danville, PA), tertiary referral center. PARTICIPANTS: Overall, 25 U.S. orthopedic residents and 15 4th year medical students interviewing for a residency position in orthopedic surgery voluntarily participated and provided baseline demographic information. A total of 15 articles from the American Volume of Journal of Bone and Joint Surgery were identified. Study participants were provided with the article title, the abstract, and the complete methods section. The assigned LoE designation was withheld and access to the LoE criteria used by Journal of Bone and Joint Surgery was provided. Each participant was assigned a study type and LoE designation for each article. RESULTS: There were more correct responses regarding the article type (67%) than for LoE designation (39%). For LoE, the intraclass correlation coefficient was 0.30. The percentage of correct responses for article type and LoE increased with more years of training (p = 0.005 and p = 0.002). Although residents had a higher proportion of correct LoE responses overall than medical students, this difference did not reach statistical significance (42% vs. 35%, p = 0.07). CONCLUSIONS: Although improvements in accurately determining both article type and LoE were seen among residents with increasing years of training, residents were unable to demonstrate a statistically significant improvement for determining LoE or article type when compared with medical students. Strategies to improve resident understanding of LoE guidelines need to be incorporated into orthopedic residencies, especially when considering the increased emphasis on evidence-based medicine.

Levels of Evidence for Hand Questions on the Orthopaedic In-Training Examination.

Background: Although analyses of the Orthopaedic In-Training Examination (OITE) subspecialty content domains have been performed, few studies have analyzed the levels of evidence (LoEs) for journal articles used as references to create OITE questions. We present an analysis of reference characteristics and question taxonomy for the hand surgery content domain on the OITE. We aim to determine whether level of evidence (LoE) for hand surgery questions have increased over a 15-year period. Methods: All questions and references in the hand surgery content domain on the OITE from 1995-1997 and 2010-2012 were reviewed. The taxonomic classification was determined for each question. Publication characteristics were defined for each reference, and each primary journal article was assigned a LoE. Results: A total of 129 questions containing 222 references met inclusion criteria: 76 questions from 1995-1997 and 53 from 2010-2012. The Journal of Hand Surgery American and European Volumes, Journal of Bone and Joint Surgery American and British Volumes, and the Journal of the American Academy of Orthopaedic Surgeons were the most frequently cited journals overall. Recent examinations were more likely to have Buckwalter T3 complex clinical management questions. There was a statically significant increase in the LoE used to create hand questions on the 2010-2012 compared with the 1995-1997 OITE. Conclusions: Primary journal articles cited on the hand surgery content domain of the OITE frequently included recent publications from both general and subspecialty journals. More recent examination questions appear to test clinical management scenarios. LoE for hand questions has increased over a 15-year period. Our results can be used as a guide to help prepare orthopedic residents for the OITE.

Levels of evidence have increased for musculoskeletal trauma questions on the orthopaedic in-training examination.

OBJECTIVE: The purpose of this study was to determine if the levels of evidence for primary journal articles used as references for musculoskeletal trauma questions on the Orthopaedic In-Training Examination (OITE) have increased over a 15-year period. DESIGN: Basic science article. SETTING: Geisinger Medical Center (Danville, PA), tertiary referral center. PARTICIPANTS: All 329 questions in the musculoskeletal trauma content domain on the OITE from 1995 to 1997 and 2010 to 2012 were reviewed. Baseline characteristics for each question and each reference were recorded. References were categorized as a textbook, a journal review article, an instructional course lecture, or a primary journal article. For each primary journal article, the level of evidence for the article was determined in accordance with the American Academy of Orthopaedic Surgeons Levels of Evidence Guidelines. RESULTS: The level of evidence used for primary journal articles demonstrated a statistically significant increase from 1995 to 1997 to 2010 to 2012. Overall, 27% of primary journal articles cited on the 1995 to 1997 OITEs were level I, II, or III studies, increasing to 43% during the 2010 to 2012 period (p = 0.04). The Buckwalter classification for the OITE questions changed significantly between the 2 periods, with questions from 2010 to 2012 including more T1 questions (25% vs 39%) and fewer T3 questions (46% vs 39%, p = 0.016). The Journal of Bone and Joint Surgery and the Journal of Orthopaedic Trauma were the most frequently cited journals overall. CONCLUSIONS: The levels of evidence for primary journal articles cited on the OITE for questions within the musculoskeletal trauma content domain have increased between 1995 and 2012. Our analysis can be used as a guide to help examinees prepare for musculoskeletal trauma questions on the OITE and as an aid in core curriculum development.