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Background: The ankle is one of the anatomic sites most frequently injured in National Football League (NFL) players. Ankle injuries have previously been shown to have long-lasting negative impacts, and have been associated with impaired athletic performance. The aim of this study was to use fantasy football points as a metric to evaluate the impact of ankle injuries on NFL offensive skill player performance., Methods: An open-access online database was used to identify NFL players who sustained ankle injuries from 2009 to 2020. Another public online database was used to determine fantasy points and other performance metrics for injured offensive skill players in the seasons before and after their ankle injury. Injured players were matched to a healthy control by position, age, and BMI. Paired T-tests were performed to evaluate performance metrics before and after the ankle injury. An ANCOVA was performed to assess the effect of return to play (RTP) time and injury type on fantasy performance., Results: 303 players with ankle injuries were included. Fantasy output, including average points per game (PPG) and total fantasy points accrued in one season, significantly decreased in the season following a player's ankle injury (p < 0.0001). In running backs, tight ends, and wide receivers, performance significantly decreased in every metric evaluated (p < 0.0001). In quarterbacks, there was no significant change in performance, except for a decrease in the number of games played (p = 0.0033) and in the number of interceptions thrown (p = 0.029)., Conclusion: Assessing fantasy football output revealed a decrease in player performance in the season following an ankle injury, especially in route-running players. These results can be used to inform injury prevention and rehabilitation practices in the NFL., (© 2024 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)

Background: Syndesmotic injuries are frequently stabilized using syndesmotic screws. Traditionally, these screws were routinely removed during the postoperative period, however recent literature has brought into question the necessity of routine removal, citing no change in functional outcomes and the inherent risks of a second surgery. Our study aimed to compare outcomes of patients undergoing routine syndesmotic screw removal versus those undergoing an on-demand approach to removal., Methods: A systematic search of studies comparing routine syndesmotic screw removal to on-demand screw removal following an acute ankle fracture, or an isolated syndesmotic injury was conducted across seven databases. Only Prospective randomized controlled trials were eligible for inclusion. Data reported on by at least 2 studies was pooled for analysis., Results: Three studies were identified that met inclusion and exclusion criteria. No significant difference in Olerud-Molander Ankle Score (MD -2.36, 95% CI -6.50 to 1.78, p = 0.26), American Orthopedic Foot and Ankle Hindfoot Score (MD -0.45, 95% CI -1.59 to .69, p = 0.44), or dorsiflexion (MD 2.20, 95% CI -0.50 to 4.89, p = 0.11) was found between the routine removal group and on-demand removal group at 1-year postoperatively. Routine removal was associated with a significantly higher rate of complications than on-demand removal (RR 3.02, 95% CI 1.64 to 5.54, p = 0.0004). None of the included studies found significant differences in pain scores or range of motion by 1-year postoperatively., Conclusion: Given the increased risk of complications with routine syndesmotic screw removal and the comparable outcomes when screws are retained, an as-needed approach to syndesmotic screw removal should be considered., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Daniel Acevedo reports was provided by Nova Southeastern University. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)

Background: This systematic review and meta-analysis investigated the treatment for Achilles tendon rupture (ATR) associated with the lowest risk of rerupture in older patients., Methods: Five databases were searched through September 2022 for studies published in the past 10 years analyzing operative and nonoperative ATR treatment. Studies were categorized as "nonelderly" if they reported only on patients aged 18-60 years. Studies that included at least 1 patient older than age 70 were categorized as "elderly inclusive." Of 212 studies identified, 28 were eligible for inclusion. Of 2965 patients, 1165 were treated operatively: 429 (37%) from elderly-inclusive studies and 736 (63%) from nonelderly studies. Of the 1800 nonoperative patients 553 (31%) were from nonelderly studies and 1247 (69%) were from elderly-inclusive studies., Results: For nonoperative treatment, the rate of rerupture was higher in nonelderly studies (83/1000 cases, 95% CI = 58, 113) than in elderly-inclusive studies (38/1000 cases, 95% CI = 22, 58; P <.001). For operative treatment no difference was found in the rate of rerupture between nonelderly studies (7/1000 cases, 95% CI = 0, 21) and elderly-inclusive studies (12/1000 cases, 95% CI = 0, 35; P <.78). Overall, operative treatment was associated with a rerupture rate of 1.5% (95% CI: 1.0%, 2.8%) ( P <.001), which was lower than the 5% rate reported by other studies for nonoperative management ( P <.001)., Conclusion: Older patients may benefit more than younger patients from nonoperative treatment of ATR. More studies are needed to determine the age at which rerupture rates decrease among nonoperatively treated patients., Level of Evidence: 3., Competing Interests: D Acevedo reports grants from the 10.13039/501100000026National Institute of Aging Medical Student Training in Aging Research Summer Program during the conduct of the study. AA Aiyer reports personal fees from Vilex and Smith & Nephew, outside the submitted work; is a board or committee member of the American Orthopaedic Foot and Ankle Society; receives publishing royalties, financial or material support from DeLee & Drez's Orthopaedic Sports Medicine (Elsevier) and Miller's Review of Orthopaedics (Elsevier); and is on the editorial or governing board of the Journal of Bone and Joint Surgery-British. The remaining authors have nothing to disclose., (© 2024 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)

Introduction: The aim of this study was to assess occupational injuries among female orthopaedic surgeons and compare these rates to their male counterparts., Methods: An electronic survey was developed to assess occupational injuries among female orthopaedic surgeons. Descriptive statistics were analyzed for all survey items, and chi-squared tests and paired t-tests were used when appropriate., Results: 169 female orthopaedic surgeons completed this survey, the average age was 50 years old. MSK Injuries: Among the 169 responding surgeons, there were a total of 320 work-related musculoskeletal injuries. Non-MSK Occupational Injuries: Female orthopaedic surgeons experience social isolation at much higher rates than their male counterparts (53.8 % and 32.9 % respectively, p < 0.0001) as well as psychological distress since beginning practice (61.5 % and 55.3 % respectively). Additionally, female orthopaedic surgeons report higher rates of burnout (72.2 %, p = 0.01) compared to male orthopaedic surgeons (63.4 %). Female orthopaedic surgeons also sought out counseling from mental health professionals at higher rates than their male counterparts since beginning training (37.3 % and 28.6 % respectively, p = 0.02). 13.1 % of female respondents reported having been diagnosed with cancer since starting practice. Additionally, 94.6 % of female orthopaedic surgeons have experienced a finger stick and 16.1 % of female orthopaedic surgeons have experienced hearing loss since beginning practice., Discussion: This study assesses the occupational injuries that affect female orthopaedic surgeons' physical and mental well-being. We found that in comparison to male orthopaedic surgeons, the major differences were found in the psychological and emotional domains. Women reported experiencing burnout and social isolation as well as seeking professional counseling at significantly higher rates than males; however, both genders reported concerningly high numbers. This could suggest that more resources need to be made available to help orthopaedic surgeons cope with the stresses of their demanding profession, with a specific emphasis on reducing work-related stress among female orthopaedic surgeons., Competing Interests: The authors, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. There are no relevant disclosures. We have no conflicts of interest. The Manuscript submitted does not contain information about medical device(s)/drug(s)., (© 2023 Published by Elsevier B.V. on behalf of Professor P K Surendran Memorial Education Foundation.)