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.

Can a Clinician-Scientist Training Program Develop Academic Orthopaedic Surgeons? One Program's Thirty-Year Experience.

BACKGROUND: Clinician-scientist numbers have been stagnant over the past few decades despite awareness of this trend. Interventions attempting to change this problem have been seemingly ineffective, but research residency positions have shown potential benefit. OBJECTIVE: We sought to evaluate the effectiveness of a clinician-scientist training program (CSTP) in an academic orthopedic residency in improving academic productivity and increasing interest in academic careers. METHODS: Resident training records were identified and reviewed for all residents who completed training between 1976 and 2014 (n = 329). There were no designated research residents prior to 1984 (pre-CSTP). Between 1984 and 2005, residents self-selected for the program (CSTP-SS). In 2005, residents were selected by program before residency (CSTP-PS). Residents were also grouped by program participation, research vs. clinical residents (RR vs. CR). Data were collected on academic positions and productivity through Internet-based and PubMed search, as well as direct e-mail or phone contact. Variables were then compared based on the time duration and designation. RESULTS: Comparing all RR with CR, RR residents were more likely to enter academic practice after training (RR, 34%; CR, 20%; p = 0.0001) and were 4 times more productive based on median publications (RR, 14; CR, 4; p < 0.0001). Furthermore, 42% of RR are still active in research compared to 29% of CR (p = 0.04), but no statistical difference in postgraduate academic productivity identified. CONCLUSIONS: The CSTP increased academic productivity during residency for the residents and the program. However, this program did not lead to a clear increase in academic productivity after residency and did not result in more trainees choosing a career as clinician-scientists.

Minimally Invasive Anterior Two-Incision Approach for Repair of a Chronic Neglected Distal Biceps Tendon Rupture.

INTRODUCTION: Rupture of the distal biceps brachii results in significant weakness and limitation of function in those affected. Acute ruptures of the biceps tendon are generally best treated with early repair, ideally within 3weeks of injury. The preferred treatment of chronic ruptures is still uncertain. CASE REPORT: We present a case of a chronic distal biceps tendon rupture repaired with a novel, two-incision, minimally invasive anterior approach utilizing an Achilles tendon allograft and cortical button fixation, in a patient with a high demand occupation as a cabinet maker. CONCLUSION: Numerous surgical techniques have been described for the repair or reconstruction of chronic distal biceps ruptures. Most described techniques have utilized an extensile anterior approach or an extensile anterior approach combined with another posterolateral incision. We believe that this minimally invasive approach allows for better cosmesis and quicker recovery and return to work in patients with high demand occupations.