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A recent study published in Clinical Orthopaedics and Related Research® examined the mortality, infection, and nonunion rates after periprosthetic femoral fractures in the United States. Periprosthetic fractures are complex injuries that have high morbidity, mortality, and economic costs. The study found that the incidence rate of proximal periprosthetic femur fractures more than doubled from 2010 to 2019, while the incidence rate of distal fractures more than tripled over the same time period. The 1-year and 5-year mortality rates after periprosthetic femur fractures were high, ranging from 21% to 27% and 57% to 63%, respectively. The study highlights the need for better understanding and management of periprosthetic fractures, as well as the importance of preventing these injuries and improving treatment outcomes. [Extracted from the article]

Background: The long incubation period and asymptomatic spread of COVID-19 present considerable challenges for health-care institutions. The identification of infected individuals is vital to prevent the spread of illness to staff and other patients as well as to identify those who may be at risk for disease-related complications. This is particularly relevant with the resumption of elective orthopaedic surgery around the world. We report the results of a universal testing protocol for COVID-19 in patients undergoing orthopaedic surgery during the coronavirus pandemic and to describe the postoperative course of asymptomatic patients who were positive for COVID-19.Methods: A retrospective review of adult operative cases between March 25, 2020, and April 24, 2020, at an orthopaedic specialty hospital in New York City was performed. Initially, a screening questionnaire consisting of relevant signs and symptoms (e.g., fever, cough, shortness of breath) or exposure dictated the need for nasopharyngeal swab real-time quantitative polymerase chain reaction (RT-PCR) testing for all admitted patients. An institutional policy change occurred on April 5, 2020, that indicated nasopharyngeal swab RT-PCR testing for all orthopaedic admissions. Screening and testing data for COVID-19 as well as relevant imaging, laboratory values, and postoperative complications were reviewed for all patients.Results: From April 5, 2020, to April 24, 2020, 99 patients underwent routine nasopharyngeal swab testing for COVID-19 prior to their planned orthopaedic surgical procedure. Of the 12.1% of patients who tested positive for COVID-19, 58.3% were asymptomatic. Three asymptomatic patients developed postoperative hypoxia, with 2 requiring intubation. The negative predictive value of using the signs and symptoms of disease to predict a negative test result was 91.4% (95% confidence interval [CI], 81.0% to 97.1%). Including a positive chest radiographic finding as a screening criterion did not improve the negative predictive value of screening (92.5% [95% CI, 81.8% to 97.9%]).Conclusions: A protocol for universal testing of all orthopaedic surgery admissions at 1 hospital in New York City during a 3-week period revealed a high rate of COVID-19 infections. Importantly, the majority of these patients were asymptomatic. Using chest radiography did not significantly improve the negative predictive value of screening. These results have important implications as hospitals anticipate the resumption of elective surgical procedures.Level Of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

It brought me back to three years ago, when I too would walk with Anna to the hospital before a night shift. Currently, that list includes preparing for tomorrow's cases, watching ~50 boards prep lectures, submitting a couple abstracts, and packing a hospital bag for my wife Anna's delivery (she's due this month). Writing these diary entries has given me a sense of peace about residency. [Extracted from the article]

Background: Case-control studies are a common method of analyzing associations between clinical outcomes and potential risk factors. Matching cases to controls based on known confounding variables can decrease bias and allow investigators to assess the association of interest with increased precision. However, the analysis of matched data generally requires matched statistical methods, and failure to use these methods can lead to imprecise or biased results. The appropriate use of matched statistical methods in orthopaedic case-control studies has not been documented.Questions/purposes: (1) What proportion of matched orthopaedic case-control studies use the appropriate matched statistical analyses? (2) What study factors are associated with the use of appropriate matched statistical tests?Methods: All matched case-control studies published in the top 10 orthopaedic journals according to impact factor from 2007 to 2016 were identified by literature review. Studies using appropriate statistical techniques were identified by two independent evaluators; discrepancies were settled by a third evaluator, all with advanced training in biostatistics. The number of studies using appropriate matched statistical methods was compared with the number of studies reviewed. Logistic regression was used to identify key study factors (including journal, publication year, rank according to impact factor, number of matching factors, number of controls per case, and the inclusion of a biostatistician coauthor) associated with the use of appropriate statistical methods. Three hundred nineteen articles that were initially classified as case-control studies were screened, yielding 83 matched case-control studies. One hundred two of the excluded articles were cohort or cross-sectional studies that were misclassified as case-control studies. The median number of matching factors was 3.0 (range, 1-10) and the median number of controls per case was 1.0 (range, 0.5-6.0). Thirty studies (36%) had a statistician coauthor.Results: Thirty of the 83 included studies (36%) used appropriately matched methods throughout, 11 (13%) used matched methods for multivariable but not univariable analyses, and 42 (51%) used only unmatched methods, which we considered inappropriate. After controlling for the number of controls per case and publication year, we found that the inclusion of a statistician coauthor (70% versus 38%; odds ratio, 3.6; 95% confidence interval, 1.4-20.3; p = 0.01) and journal were associated with the use of appropriate methods.Conclusions: Although matched case-control studies can be statistically more efficient study designs, in that they are capable of generating more precise effect size estimates than other kinds of retrospective research, most orthopaedic case-control studies use inappropriate statistical methods in their analyses. Additionally, the high degree of study misclassification indicates a need to more rigorously define differences among case-control, cohort, and cross-sectional study designs.Clinical Relevance: Failing to use matched statistical tests may lead to imprecise and/or biased effect estimates, which may lead to a tendency to overestimate or underestimate associations between possible risk factors and clinically relevant outcomes. Orthopaedic researchers should be cognizant of the risks and benefits of matching and should consult individuals with biostatistical expertise as needed to ensure that their statistical methods are appropriate and methodologically rigorous. [ABSTRACT FROM AUTHOR]

Background: Cerebral palsy (CP) comprises a heterogeneous group of disorders whose clinical manifestations and epidemiologic characteristics vary across socioeconomic and geographic contexts. The functional severity of untreated CP in low-income countries has been insufficiently studied; a better understanding of how these children present for care in resource-constrained environments is important because it will better characterize the natural history of CP, guide clinical decision-making, and aid in the prognostication of children with untreated CP.Questions/purposes: The purposes of this study were (1) to determine the etiologies, motor subtypes, topographic distributions, and functional classifications of a large cohort of Nepali children with untreated CP presenting to a large pediatric rehabilitation center in Nepal; and (2) to compare the Gross Motor Function Classification System (GMFCS), the Manual Ability Classification System (MACS), and the Communication Function Classification System (CFCS) scores of a subset of patients with spastic CP in the Nepali cohort with control subjects from high-income countries.Methods: A cross-sectional study was conducted at the Hospital and Rehabilitation Centre for Disabled Children in Nepal. Two hundred six consecutive Nepali children (76 girls; median age 4.0 years [interquartile range {IQR}, 2.5-9.0 years]) were evaluated to determine the demographic, clinical, and functional characteristics of a cohort of Nepali children with untreated CP. A systematic review of the Medline and Cochrane databases was then performed to obtain reference classification scores from high-income countries. Cross-sectional, noninterventional studies reporting at least one functional classification system with a sample size of at least 50 participants were included. Only studies of patients with spastic CP were included to allow for compatible comparisons with a subset of our study sample with spastic CP. A random-effects analysis was used to pool functional scores from participants in the included studies. Among the 206 children in our sample, 102 had spastic CP (35 girls; median age 5.5 years [IQR, 3.5-9.0 years]). Functional scores from these children were compared with pooled scores obtained from the systematic review by assessing the proportions of children in each sample with GMFCS, MACS, and CFCS score categories of I or II versus III to V.Results: Children with spastic hemiplegia from high-income countries were more likely to have a GMFCS score of I or II (96% [95% confidence interval {CI}, 92%-99%] versus 78% [95% CI, 62%-89%]) and a MACS score of I or II (83% [95% CI, 77%-88%] versus 50% [95% CI, 32%-68%]) relative to those from Nepal, but they were less likely to have a CFCS score of I or II (67% [95% CI, 51%-80%] versus 97% [95% CI, 87%-99%]). No differences were seen in children with spastic diplegia or quadriplegia.Conclusions: Children in Nepal with hemiplegic CP display less difficulty in communicating and social engagement (CFCS) despite more-severe upper- and lower-extremity impairments in gross motor function (GMFCS) and manual ability (MACS) than do children with hemiplegic CP from high-income countries. Targeted interventions, including perhaps simple orthopaedic interventions to treat soft-tissue contractures, may therefore provide more-substantial improvements in function and quality of life to Nepali children than could be achieved for the same deployment of resources in more-affluent settings.Level Of Evidence: Level II, prognostic study. [ABSTRACT FROM AUTHOR]

The PGY2 grappling to reduce a midshaft humerus fracture with a coaptation splint? It's my last day as fracture chief. As the fracture chief, I oversaw a team of junior residents, managed everything from bread-and-butter trauma to geriatric trauma to complex polytrauma, and monitored interactions within the fracture team and between other teams in the hospital. [Extracted from the article]

I was recently at my brother's law school graduation listening to the commencement address by the author Chimamanda Ngozi Adichie. One consult was an ankle fracture-dislocation with a good ankle reduction, but the foot was in too much plantarflexion. Residency Diary: Fourth Year - Feedback Is Not Easy. [Extracted from the article]

On my first day in the operating room, I scrub a complete scapular and proximal humeral resection with a scapular allograft and reverse shoulder arthroplasty. Halfway through my fourth year, I begin a tumor rotation at Memorial Sloan Kettering Cancer Center. In my second week on the rotation, I am with my attending in clinic when we see a college senior returning for her 5-year follow-up appointment after a distal humeral resection and allograft for chondrosarcoma. [Extracted from the article]

Helping with the bedtime routine is also my only chance to offload Anna who has been home all day with Clara. Anna and I are watching Clara change on what seems like an hourly basis. More importantly, Anna reminds me, Clara will probably wake up at 3 am, in which case the diaper change duties are all mine. [Extracted from the article]

Having gone through the first COVID-19 wave, working in the ICU and covering trauma at a community hospital full of COVID-19 patients, these residual COVID-19 policies seem like a minor inconvenience, a welcome relief from the peak just a couple months back. The trauma attending uses these repetitive injuries as teaching moments. Downloaded from http://journals.lww.com/clinorthop by BhDMf5ePHKbH4TTImqenVA+lpWIIBvonhQl60EtgtdlLYrLzSPu+hQedJnbNaXBf on 04/05/2021 Downloaded from http://journals.lww.com/clinorthop by BhDMf5ePHKbH4TTImqenVA+lpWIIBvonhQl60EtgtdlLYrLzSPu+hQedJnbNaXBf on 04/05/2021 Clin Orthop Relat Res (2021) 479:461-462 DOI 10.1097/CORR.0000000000001667 Residency Diary Published online: 4 February 2021 Copyright © 2021 by the Association of Bone and Joint Surgeons Residency Diary: Third Year - New Year, Different Story DrakeG. [Extracted from the article]

Downloaded from http://journals.lww.com/clinorthop by BhDMf5ePHKbH4TTImqenVA+lpWIIBvonhQl60EtgtdlLYrLzSPu+hUapVK5dvms8 on 12/02/2020 Downloaded from http://journals.lww.com/clinorthop by BhDMf5ePHKbH4TTImqenVA+lpWIIBvonhQl60EtgtdlLYrLzSPu+hUapVK5dvms8 on 12/02/2020 Clin Orthop Relat Res (2020) 478:2436-2437 DOI 10.1097/CORR.0000000000001511 Residency Diary Published online: 6 October 2020 Copyright © 2020 by the Association of Bone and Joint Surgeons Residency Diary: Second Year - COVID-19 in New York DrakeG. D. G. LeBrun, Resident, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY USA Copyright © 2020 by the Association of Bone and Joint Surgeons. It is in these ORs, where I saw my first ACL reconstruction 1 year prior, that our orthopaedic specialty hospital is now caring for patients with COVID-19 on ventilators. [Extracted from the article]

In this article the author discussed his major transitions during January to March as his study habits, transition from medical school to intern on February 2019, and relearning of time management on March 2019. It mentions his role in patient care as student intern and his experience of being on the orthopaedic trauma service.

Errors in the article "Socioeconomic Status Influences Functional Severity of Untreated Cerebral Palsy in Nepal: A Prospective Analysis and Systematic Review" are presented.