Mentoring as a Means to Achieving Workforce Diversification in Orthopaedic Surgery.

Orthopaedic surgery is no stranger to health care disparities and the American Academy of Orthopaedic Surgeons (AAOS) has expressed a commitment to a culturally competent and diverse workforce. Addressing workforce diversification is critical to recruiting a more diverse orthopaedic workforce and engaging the community to improve patient care and ensure equitable care for all. Unfortunately, these concerns were acknowledged by the AAOS almost 2 decades ago, without much significant progress. This article discusses mentoring as a means to address workforce diversification in orthopaedics and provides recommendations on how orthopaedics can enhance its efforts.

Optimizing the Orientation of a Suture Button to Stabilize the Distal Radioulnar Joint in a Sawbones Model.

Purpose: When left untreated, distal radioulnar joint (DRUJ) instability leads to prolonged wrist pain and weakness during pronosupination. Current treatment options are technically demanding and result in mixed outcomes. This study used a synthetic bone model to evaluate the potential of using a suture button to stabilize the DRUJ and find its optimal configuration. Methods: A suture button was placed between the radius and ulna of a synthetic bone model with DRUJ instability. The suture button was placed straight across or in an oblique orientation while the forearm was in 60° of pronation, neutral, or 60° of supination for 6 configurations. The range of motion, dislocation events, dorsal translation, volar translation, and gaps between the radius and ulna were measured and compared among these 6 configurations. Results: Full range of motion (ROM) was achieved in all configurations except for suture buttons placed while the forearm was in 60 ° pronation. Obliquely placed suture buttons led to more dislocations than straight across suture buttons. The 2 configurations that offered full ROM with the greatest stability were straight across 60° supination and straight across neutral configuration, with the supinated configuration slightly improving stability. Conclusions: In this model, suture buttons restored DRUJ stability while maintaining full ROM, indicating that suture buttons have the potential to be used as a treatment option for stabilization of DRUJ. The optimal configuration of a suture button is likely in the straight across 60° supinated configuration, as it provides the greatest stability without sacrificing ROM compared with the other suture button configurations. Clinical relevance: Additional treatment options for the stabilization of DRUJ are needed. Suture buttons may be of use.

An Online Learning Tool to Obtain, Optimize, and Interpret Radiographs During Total Hip Arthroplasty.

Total hip arthroplasty (THA) is a common orthopedic procedure which has been growing in popularity with the elderly population. With more surgeons completing anterior THAs, intraoperative radiographs have become commonplace. Unfortunately, there is a lack of education in regard to obtaining, optimizing, and interpreting these radiographs. The purpose of this study was to develop and test the efficacy of an online learning tool that medical students, residents, and C-arm technicians could use to improve their understanding of THA radiography. The learning tool taught users how to obtain an optimal AP pelvis radiograph and how to interpret radiographs so THA components could be placed in their optimal position. This learning tool was sent to medical students, orthopedic surgery residents, and C-arm technicians along with a pre-test, post-test, and feedback survey. Twenty users (eleven medical students and nine orthopedic surgery residents) completed the learning tool. Post-test scores (M=96.4%, SD=2.9%) were significantly greater than pre-test scores (M=68.3%, SD=23.9%) for all users (t=5.5069, P<.0001). The user's level of training was positively correlated with pre-test scores. Surveys from the users revealed that the learning tool provided significant learning opportunities, was relatively easy to understand, but was slightly too long. Users felt that this learning tool would be best suited for senior medical students, junior orthopedic surgery residents, and C-arm technicians. With the positive results of this study, the authors hope to further develop this learning tool for widespread adoption and to develop similar learning tools in the future.

Short Communication: Carotid Artery Plaque Burden in HIV Is Associated with Soluble Mediators and Monocytes.

Maximum carotid plaque thickness (MCPT) measures the largest plaque thickness in the carotid artery and reflects atherosclerosis plaque burden. MCPT may be a better predictor of cardiovascular disease than carotid artery intima-media thickness (cIMT) because it identifies potential unstable arterial atherosclerosis plaques. We assessed the relationships of monocyte and T cell populations and plasma soluble mediators with MCPT measures. We performed a cross-sectional and small follow-up analysis in people living with HIV (PLWH) aged >40 years on stable antiretroviral therapy (ART) >6 months. MCPT was acquired by high-resolution B-mode ultrasound. Existing monocyte subsets and T cell activation frequencies were determined by flow cytometry and plasma mediators of inflammation and apolipoproteins were measured by Luminex assay. One hundred twenty-five ART-treated PLWH, 88% male, 55% Caucasian, with a median age of 51 years, median CD4 count of 477 cells/µL (Q1: 325, Q3: 612), 84% undetectable plasma HIV RNA (<50 copies/mL). Twenty-five PLWH had detectable carotid plaque. MCPT correlated with monocyte chemoattractant protein-1 (MCP-1; r = 0.487, p = .016), tumor necrosis factor-α (TNF-α; r = 0.474 p = .019), soluble vascular cell adhesion molecule-1 (sVCAM-1; r = 0.472, p = .020), apolipoprotein B6 (ApoB6; r = -0.473, p = .019), and interleukin-6 (IL-6; r = 0.455, p = .025). In a multivariable regression model, MCP-1, TNF-α, and sVCAM-1 remained significant after adjustment for age. Carotid plaque burden was associated with increased inflammatory, monocyte, and endothelial measures, including MCP-1, TNF-α, and sVCAM-1 levels. Further investigation on the evolution or severity of plaque burden in this population is warranted.