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Background: The purpose of this study is to characterize malpractice claims against orthopedic surgeons treating humeral fractures and determine factors associated with plaintiff verdicts and settlements., Methods: The Westlaw legal database was queried for all cases involving humeral fractures. Patient demographics, causes cited for litigation, case outcomes, and indemnity payments were collected to determine common factors that lead plaintiffs to pursue legal action., Results: Fifty-seven cases were identified that met inclusion criteria. The mean plaintiff age was 52.5 years with 61% female. The most common category of negligence was treatment error, which occurred in 29 claims (51%). The most common types of damages incurred were functional limitation (40%), nerve injury (32%), and malunion/nonunion (26%). Overall, 42 cases (74%) resulted in a defense verdict. Four cases (7%) resulted in settlements and 11 cases (19%) resulted in plaintiff verdicts. Cases that resulted in plaintiff verdicts or settlements were treated with intramedullary nails more often than those with defense verdicts (27% vs. 4.8%, p = 0.036)., Discussion: These findings highlight the importance of effective communication with patients regarding treatment modalities, risks and benefits, and prognosis of their injury., Level of Evidence: IV; Case Series using Large Database; Epidemiology Study., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Alberta is a paid consultant for Integra Life Sciences; receives royalties from Aevumed, Inc. and NewClip USA; is a paid presenter or speaker for Integra Life Sciences; and is a board or committee member for American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, New England Shoulder and Elbow Society, and New Jersey Orthopaedic Society., (© The Author(s) 2023.)

Background: Postoperative urinary retention (POUR), a known complication following total joint arthroplasty (TJA), remains inconsistent in its diagnostic criteria, prevalence, and risk factors. This study aims to quantify POUR rates, identify risk factors, and assess complications associated with catheterization in TJA., Methods: A single-center cohort undergoing TJA between January 2015 and December 2022 was retrospectively reviewed. POUR rates were quantified using 3 different diagnostic criteria. Variables analyzed included age, sex, alpha-blocker prescription, operative joint, body mass index, American Society of Anesthesiologists score, Charlson Comorbidity Index classification, and anesthesia type. Complication rates between POUR and non-POUR patients were compared. Among POUR patients, 90-day postoperative renal and infectious complications were evaluated based on catheterization type and frequency., Results: Among the 17,220 TJA patients identified, POUR incidence rates varied from 20% (catheterization), 25% (postoperative bladder scan > 500 mL), to 29% (catheterization and/or bladder scan). Advanced age, male gender, lower body mass index, moderate Charlson Comorbidity Index scores, total knee arthroplasty, spinal anesthesia, and alpha-blocker use were significantly more prevalent among POUR patients. The development of postoperative complications, including renal/infectious complications, was not significant between POUR and non-POUR patients. Among POUR patients, there was a significant increase in renal/infectious complications among patients who received 4+ catheters (odds ratio = 10.17, 2.75, 37.59)., Conclusions: Diagnostic variability in POUR after TJA persists. For POUR management, patients receiving 4+ catheters were at a 10-fold risk for renal/infectious complications compared to those without catheterization. Reducing catheterization frequency and employing risk stratification for susceptible patients may help mitigate these risks effectively., (© 2024 The Authors.)

Background: The objective of this study was to provide the poster and podium publication rates from the 2016 to 2019 American Association of Hip and Knee Surgeons (AAHKS) annual meetings and assess the quality of presentations ultimately published during this time., Methods: Posters and podiums from 2016 to 2019 were located through the AAHKS e-poster and meeting archives. Titles were queried on Google, Google Scholar, and PubMed. Presentation title, topic type, number of authors, degrees held by first author, and award status were collected. For each identified full-text publication, journal name, study type, dates of online and print publication, and journal impact factor (JIF) were also obtained., Results: A total of 1,274 abstracts were presented at the 2016 to 2019 AAHKS annual meetings with an overall publication rate of 67.8% (864 of 1,274). Podiums (4.0 months, 95% confidence interval [CI]: 3.0 to 4.0) were more likely to be published earlier than posters (7.0 months, 95% CI: 6.0 to 7.0) (P < .001). The median JIF of published abstracts was 3.3 (95% CI: 3.3 to 3.7) with no significant difference in mean JIF of published posters or podiums (3.3 ± 1.0 versus 3.3 ± 1.0, P = .554). The likelihood of publication was significantly higher for podiums (odds ratio [OR]: 3.41, 95% CI: 2.29 to 5.07, P < .001), award-winning presentations (OR: 4.78, 95% CI: 1.69 to 13.55, P = .003), and with more authors (OR: 1.09, 95% CI: 1.02 to 1.16, P = .014)., Discussion: This analysis demonstrates abstracts presented at the AAHKS annual meetings from 2016 to 2019 had an overall publication rate of 67.8%, with podiums (86.4%) 3 times as likely to be published as posters (63.6%). If selected to present at the AAHKS annual meeting, individuals can be confident that their work has a high chance of eventual publication., (Copyright © 2024. Published by Elsevier Inc.)

Given high patient expectations in the setting of complex surgeries, orthopedic surgeons are at risk of being subject to malpractice claims which can impose significant economic and psychological burden. This study investigates malpractice claims against orthopedic surgeons and podiatrists performing hindfoot arthrodesis and determine factors associated with plaintiff verdicts and settlements using the Westlaw legal database. The database was queried for all cases involving hindfoot arthrodesis using the terms "malpractice" and either "ankle fusion," "arthrodesis," "subtalar fusion," "tibiotalar fusion," "tibiotalocalcaneal fusion," "TTC fusion," or "tibiofibular fusion" from 1987 to 2023. Data regarding patient demographics, causes cited for litigation, case outcomes, and indemnity settlements were collected. Cases were excluded if the defendant was not an orthopedic surgeon or a podiatrist, the procedure involved was not a hindfoot arthrodesis, or if the patient was a minor. Forty-five cases of hindfoot arthrodesis met the inclusion criteria. The mean plaintiff age was 51.5 ± 13.8 years with 51.1% male. Thirty-three cases (73%) were in favor of the defendant, with an average inflation-adjusted payout of $853,863 (±456,179). The most alleged category of negligence was procedural/intraoperative error (75%) followed by postsurgical error (38%) and failure to inform (31%). The most common specific damages included functional/ROM limitation (49%), need for additional surgery (47%), continuing/worsened pain (27%), and nonunion/malunion (29%). Given the frequency of hindfoot arthrodesis performed, this study highlights the importance of effective communication with patients concerning potential postoperative complications, prognosis of their injury, and risks and benefits associated with each treatment modality., (Copyright © 2024 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the differences in frequently asked questions (FAQs) and responses related to rotator cuff surgery between Google and ChatGPT., Methods: Both Google and ChatGPT (version 3.5) were queried for the top 10 FAQs using the search term "rotator cuff repair." Questions were categorized according to Rothwell's classification. In addition to questions and answers for each website, the source that the answer was pulled from was noted and assigned a category (academic, medical practice, etc). Responses were also graded as "excellent response not requiring clarification" (1), "satisfactory requiring minimal clarification" (2), "satisfactory requiring moderate clarification" (3), or "unsatisfactory requiring substantial clarification" (4)., Results: Overall, 30% of questions were similar between what Google and ChatGPT deemed to be the most FAQs. For questions from Google web search, most answers came from medical practices (40%). For ChatGPT, most answers were provided by academic sources (90%). For numerical questions, ChatGPT and Google provided similar responses for 30% of questions. For most of the questions, both Google and ChatGPT responses were either "excellent" or "satisfactory requiring minimal clarification." Google had 1 response rated as satisfactory requiring moderate clarification, whereas ChatGPT had 2 responses rated as unsatisfactory., Conclusions: Both Google and ChatGPT offer mostly excellent or satisfactory responses to the most FAQs regarding rotator cuff repair. However, ChatGPT may provide inaccurate or even fabricated answers and associated citations., Clinical Relevance: In general, the quality of online medical content is low. As artificial intelligence develops and becomes more widely used, it is important to assess the quality of the information patients are receiving from this technology., Competing Interests: The authors that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Case: We present a 64-year-old woman with loss of lumbar lordosis with a preoperative computed tomography scan demonstrating the presence of an intrapelvic kidney with aberrant vasculature. A 2-level anterior lumbar interbody fusion with a 2-level oblique interbody fusion was planned. An anterior approach was successfully used to access the anterior spine without damaging the pelvic kidney., Conclusion: Anatomic variations, both congenital and acquired, can pose significant challenges to surgeons during their dissection. We present a case where multilevel anterior interbody cage placement can be safely performed, even in a patient whose anatomy is complicated by an intrapelvic kidney., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C365)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: The American Shoulder and Elbow Surgeons (ASES) society has advanced the practice of shoulder and elbow care through the exhibition of research at academic meetings. The ASES annual meeting is a closed (member-only) conference annually held in October, while the specialty day is an open (non-members included) event that takes place during the American Academy of Orthopaedic Surgeons (AAOS) meeting week in March. This study aims to compare the rate of publication for abstracts presented at the open and closed ASES meetings from 2013 to 2019., Methods: The ASES website was searched to obtain the annual meeting and specialty day program agendas from 2013 to 2019. A standardized search protocol was employed to identify conference abstracts that went on to be published. Publications associated with an ASES abstract were analyzed through several variables including the time to publication, journal impact factor (JIF), and level of evidence., Results: There was no difference between the rates of publication of the open (76.5%, 121/158) and closed (75.3%, 223/296) meetings (P = .904). The median time to publication significantly differed between the open (7 months, 95% confidence interval [CI]: 5.0-10.0) and closed (11 months, 95% CI: 9.0-13.0) meetings (P = .02). There was no difference between the median JIF between the open (2.69, 95% CI: 2.41-2.81) and closed (2.73, 95% CI: 2.41-2.81) meetings. The distribution of the level of evidence in published articles comparing the open and closed meetings did not differ significantly (P = .446)., Discussion: The overall quality of academic research presented at orthopedic subspecialty conferences can be objectively evaluated through abstract publication rates. Our analysis demonstrates that there is not a single significant difference among the publication rates, median JIF, and level of evidence distribution between the ASES open and closed meetings from 2013 to 2019. Impactful research is showcased at both the open and closed meetings. Societies that limit submissions from members only at annual meetings can consider soliciting research from non-members. While the quality of research would not decline if non-ASES members were invited to participate, the presence of a closed annual meeting may be a valuable tool for societies to expand their reach through member-exclusive benefits., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Introduction: Orthopedic surgery is one of the most common subspecialties subject to medical malpractice claims. Although total shoulder arthroplasty (TSA) is associated with favorable patient outcomes and relatively low complication rates, surgeons performing this procedure may be subject to malpractice litigation leading to significant economic and psychological burden on the provider. The purpose of this study is to characterize and describe malpractice claims against orthopedic surgeons performing TSA using the Westlaw legal database., Methods: The Westlaw legal database was queried for all cases related to TSA using the terms "malpractice" AND "shoulder replacement" OR "shoulder arthroplasty." Cases were excluded if the defendant was not an orthopedic surgeon, the procedure involved was not a TSA, or if the patient was a minor. Patient demographics, causes cited for litigation, case outcomes, and indemnity payments were analyzed to determine common factors that lead plaintiffs to pursue legal action., Results: Thirty-five TSA cases were identified that met inclusion criteria. The mean plaintiff age was 55 years with 63.6% female. The most common category of negligence alleged was intraoperative error, which occurred in 25 claims (71%). The most common types of damages incurred were nerve injury (23%), functional limitation (20%), and infection (17%). Overall, 27 cases (77%) resulted in a defense verdict. Four cases (11%) resulted in settlements and 4 cases (11%) resulted in plaintiff verdicts. The average inflation-adjusted monetary award in these cases was $1,619,919 (standard deviation, $1,689,452)., Discussion: This study provides a comprehensive summary of malpractice claims and associated outcomes in TSA. Given the rapidly increasing rate of TSA in the United States and the burden of associated malpractice claims, understanding potential legal implications of TSA is of great value to orthopedic surgeons. Intraoperative error was the category of negligence cited most commonly in TSA malpractice claims. Nerve injury, functional limitation, and infection were the most commonly cited specific damages. These findings highlight the need for orthopedic surgeons to educate patients regarding potential postoperative complications while continuing to focus on minimizing their occurrence., (Copyright © 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Case: The pudendal nerve lies near the origin of the hamstring muscles, placing it at increased risk of injury during proximal hamstring tendon repair. In this study, we report on a 56-year old man who experienced intermittent unilateral testicular pain after a proximal hamstring tendon repair presumably due to pudendal nerve neurapraxia. At the 1-year follow-up, he continued to experience discomfort in the pudendal nerve distribution but reported significant improvement in symptoms and complete resolution of hamstring pain., Conclusion: Although the risk of pudendal nerve injury during proximal hamstring tendon repair is rare, surgeons should be aware of this potential complication., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B999)., (Copyright © 2022 by The Journal of Bone and Joint Surgery, Incorporated.)

Objective: To perform a review evaluating management of and complications stemming from dog bite trauma sustained to the head and neck over the past decade., Data Sources: PubMed and Cochrane Library., Methods: The authors searched the PubMed and Cochrane Library databases for relevant published literature. A total of 12 peer-reviewed canine-exclusive series inclusive of 1384 patient cases describing facial dog bite trauma met inclusion criteria. Wounds including fractures, lacerations, contusions, and other soft-tissue injuries were evaluated. Demographics related to clinical course and management, operating room requirements, and antibiotic usage were compiled and analyzed. Initial trauma and surgical management complications were also assessed., Results: 75.5% of patients sustaining dog bites required surgical intervention. Of these patients, 7.8% suffered from postsurgical complications, including hypertrophic scarring (4.3%), postoperative infection (0.8%), or nerve deficits and persistent paresthesias (0.8%). Prophylactic antibiotics were administered to 44.3% of patients treated for facial dog bites and the overall infection rate was 5.6%. Concomitant fracture was present in 1.0% of patients., Conclusion: Primary closure, often in the OR may be necessary, with few cases requiring grafts or flaps. Surgeons should be aware that the most common complication is hypertrophic scarring. Further research is needed to elucidate the role of prophylactic antibiotics., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors. World Journal of Otorhinolaryngology ‐ Head and Neck Surgery published by John Wiley & Sons Ltd on behalf of Chinese Medical Association.)

Introduction:  The innovative iCite tool applies the relative citation ratio (RCR) to gauge the time and field-adjusted scientific influence of a publication. This study examines scholarly effects on spine surgery to distinguish the impact made by orthopedic surgeons, neurosurgeons, and several other specialists., Materials and Methods:  From 2013 to 2017, 100 of the highest RCR-rated articles were gathered for each of the following terms: cervical disc herniation (CDH), lumbar disc herniation (LDH), lumbar spinal stenosis (LSS), neurogenic claudication (NC), radiculopathy (RAD), and sciatica (SC). The first, second, and last authors were queried for background and academic qualifications and placed into the following specialty categories: orthopedic surgery, neurosurgery, pain management, medicine, and others. To provide an alternative degree of influence, the Scopus database was employed to classify the h-index associated with each author., Results:  Across the six search terms, there were 526 orthopedic surgeons among 1,730 authors (30.4%), with the highest representation in LSS (118/290, 40.7%), and the lowest in SC (45/286, 15.7%). Orthopedics was the most influential specialty across all six research terms by median RCR (p = 0.012). Compared to their neurosurgical counterparts, orthopedic authors had a greater influence in CDH (3.93 vs. 2.63, p = 0.0492), LDH (5.10 vs. 4.99, p = 1.0000), NC (2.16 vs. 1.40, p = 0.2370), and SC (3.35 vs. 3.04, p = 0.5285), but had a lower influence in LSS (5.13 vs. 5.32, p = 0.7736) and RAD (5.03 vs. 6.05, p = 0.3938)., Conclusion:  Orthopedic surgeons lead other specialties when determining scholarly influence through RCR across six of the pre-designated research domains within spine surgery. For orthopedics, a modest influence in LSS and RAD may suggest potential areas of future focus. The use of bibliometrics to analyze available literature enables us to identify other specialties that have contributed to our field and promote interdisciplinary collaboration., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2022, Grace et al.)

Introduction The iCite database, developed by the National Institute of Health (NIH), utilizes a bibliometric known as the relative citation ratio (RCR) to gauge scholarly impact. The goal of this study was to use the RCR to evaluate the influence of orthopedic journals in regard to knee arthritis treatment literature, as no such studies exist to date. Materials and methods The 100 highest RCR-rated articles published between 2007 and 2017 were obtained in the following categories: physical therapy (PT), viscosupplementation (VS), nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injection (CSI), results of total knee arthroplasty (TKA), platelet-rich plasma (PRP), and meniscectomy (MS). Journals were categorized with respect to the following specialties: general orthopedics (GO), orthopedic subspecialty (OSS), nonsurgical musculoskeletal (NSMSK), general medicine (GM), and basic science/nonclinical (BS/NC). Results Across the seven domains, GO journals held the highest median RCR, while OSS ranked fourth (RCR, 6.60 versus 3.95; p=0.0027). GO journals were considered the most influential specialty in CSI (RCR, 2.99), while OSS journals held the highest median RCR in PRP (RCR, 4.10). OSS and GO journals ranked third (RCR, 4.79) and fourth (RCR, 4.21), respectively, in NSAIDs, lagging behind NSMSK and GM journals. Conclusions Bibliometric tools, such as the RCR, can inform the orthopedic field of current and future research trends and help guide further research efforts. Currently, publications in GO journals hold a strong influence in CSI but less so in PT and NSAIDs. The use of bibliometrics allows the identification of highly influential non-orthopedic articles and journals to read while identifying influential non-orthopedic researchers to promote interdisciplinary collaboration., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2022, Megalla et al.)