Allograft Reconstruction of the Lisfranc Ligament.

UNLABELLED: For Lisfranc injuries, screw fixation of the medial and middle columns is currently the standard of treatment. The purpose of this study was to biomechanically evaluate the use of allograft for a severed Lisfranc ligament compared to standard screw fixation and the intact condition. Six pairs of fresh-frozen cadaveric lower extremities were prepared with reflective marker arrays and cyclically loaded to simulate partial weight bearing under 4 sequential testing conditions: (1) intact ligament, (2) disrupted ligament, (3) tendon allograft reconstructed ligament, and (4) rigid screw fixation. The relative displacement between the medial cuneiform and the second metatarsal was assessed via motion analysis. A mixed model analysis of variance was used to determine the significance (α = .05) of displacement differences. Mean displacements and 95% confidence intervals for each condition were as follows: (1) intact 9.1 (7.1-11.2) mm, (2) cut ligament 9.4 (7.4-11.5) mm, (3) allograft fixation 8.8 (6.8-10.9) mm, and (4) screw fixation 8.2 (6.2-10.3) mm. There were no significant differences among the specimens according to condition. Allograft fixation provided adequate strength and stability and did not differ significantly compared to intact or screw fixation. LEVELS OF EVIDENCE: Level V: Bench testing.

Impact of a weekly reading program on orthopedic surgery residents' in-training examination.

In response to a decline in individual residents' performance and overall program performance on the Orthopaedic In-Training Examination (OITE), the authors' department initiated a daily literature reading program coupled with weekly tests on the assigned material. The goal of this study was to assess the effect of the reading program on individual residents' scores and the training program's OITE scores. The reading program consisted of daily review articles from the Journal of the American Academy of Orthopaedic Surgeons, followed by a weekly written examination consisting of multiple-choice or fill-in-the-blank questions. All articles were selected and all questions were written by the departmental chair. A questionnaire was given to assess residents' perceptions of the weekly tests. As a result of implementing the reading program for a 10-month period, residents' subsequent performance on the OITE significantly improved (mean score increase, 4, P<.0001; percentile score increase, 11, P=.0007). The difference in mean score was significant for residents in postgraduate years 3, 4, and 5. A statistically significant correlation was found between weekly test scores and performance on the OITE, with a significant correlation between weekly test scores and OITE percentile ranking. The study results also showed a positive correlation between reading test attendance and weekly test scores. Residents' anonymous questionnaire responses also demonstrated the reading program to be a valuable addition to the residency training curriculum. In conclusion, the study strongly supports the benefits of a weekly reading and examination program in enhancing the core knowledge of orthopedic surgery residents.

The free condom initiative: promoting condom availability and use in New York City.

In 2005, the New York City Department of Health and Mental Hygiene (DOHMH) made free condoms available to organizations through a Web-based ordering system. In 2006, we interviewed managers and patrons about free condom availability, acquisition, and use in venues where people at high risk for human immunodeficiency virus congregate. DOHMH condom distribution increased from 5.8 million in 2004 to 17.3 million in 2006. Overall, managers reported making condoms available at 76% (309/409) of high-priority venues, but only at 40% of gay bars. Among patrons who saw free condoms, 80% (280/351) reported taking them; 73% (205/280) of those who reported taking them also reported using them. A simple, Web-based ordering system dramatically increased condom distribution. In the venues we sampled, the majority of patrons acquired and used free condoms when available and visible, suggesting that increasing free condom availability may increase use. Special efforts are needed to ensure availability at gay bars.