Analysis of the Sports Medicine Section of the Orthopaedic In-Training Examination: Improvements in Levels of Evidence and Question Taxonomy Over a 12-Year Period.

There has been a recent shift within the orthopedic literature to publish articles with higher levels of evidence. In this investigation, the trends in question taxonomy and the levels of evidence of the references for sports medicine questions on the Orthopaedic In-Training Examination (OITE) during a 12-year period were evaluated. Sports medicine questions were obtained from the OITEs administered between 2005 and 2007 and between 2014 and 2016. The taxonomy of each question was characterized, and levels of evidence for all references were assigned using American Academy of Orthopaedic Surgeons guidelines. Question taxonomy and article levels of evidence from 2005 to 2007 were compared with those from 2014 to 2016. Sports medicine questions comprised 8% of the OITEs in both examination groups. The questions from 2014 to 2016 had a higher mean taxonomic level (2.26 vs 1.52, P=.0001) and a greater proportion of studies with high levels of evidence (levels 1 and 2) (21% vs 10%, P=.027). However, references with low levels of evidence or nonprimary resources made up 82.2% and 68.5% of the total references on the older and more recent examinations, respectively. References from 2014 to 2016 were, on average, 2 years older than those from earlier examinations. This study indicated that sports medicine questions on recent OITEs cite references of higher levels of evidence and contain higher taxonomic question structure than examinations 10 to 12 years ago. However, the majority of questions still cite articles with low levels of evidence or nonprimary sources. These findings can be used to guide resident education and continue improvements in the selection of references for questions on the Sports Medicine section of the OITE. [Orthopedics. 2020;43(5):e460-e464.].

Complications of Hand Infections.

Although most hand infections can be eradicated by appropriate management with return to normal function, complications are frequently encountered. Common complications include stiffness, osteomyelitis, and large soft tissue defects that require complex wound management. Risk factors for hand infections include an immunocompromised host state, as is the case in patients with diabetes mellitus or human immunodeficiency virus/AIDS, as well as those on immunosuppressive medications for autoimmune disorders or following organ transplantation. Patients at risk for complications secondary to hand infections should be monitored closely during the treatment process so that complications may be identified and treated early.