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In this article the author comments on the article "Is 'Build On Your Strengths' The Best Advice?" by Bob Eichinger which appears elsewhere in this edition of the journal. Eichinger's article discussed the best path to career development for rising executives. The author of this critique notes that organizational leadership tends to possess exceptional ability when dealing with business strategy, finance, operations and marketing but do not have superior ability at personnel management or making the right hiring decisions.

Abstract: This research investigates predictors of job search activity among high-level European managers. We examined the role of personality in predicting job search over and above the effects of situational and demographic variables. Results found that the personality traits extraversion and neuroticism predicted job search, and the effects were found in the presence of situational and demographic variables shown in prior research as particularly important determinants of job search activity. [Copyright &y& Elsevier]

Objectives: Performing an examination under general anesthesia (EUA) using dynamic stress fluoroscopy of patients with posterior wall acetabular fractures has been used as a tool to determine hip stability and the need for surgical intervention. The purpose of this study was to further evaluate the effectiveness of this technique, from a source other than its primary advocates, in patients with posterior wall acetabular fractures less than or equal to 50% who were stable on EUA and treated nonoperatively., Design: Retrospective case series., Setting: University Level 1 Trauma Center., Participants: Seventeen patients with a posterior wall acetabular fracture stable on EUA treated nonoperatively., Intervention: The patients were treated nonoperatively as guided by an EUA negative for instability. Patient follow-up averaged 30 months (range, 6-64 months)., Main Outcome Measurements: Outcome evaluation included the modified Merle d'Aubigné clinical score and the Short Musculoskeletal Function Assessment Questionnaire. Radiographic evaluation for subluxation or arthritis consisted of the 3 standard pelvic radiographs., Results: Radiographic evaluation showed all hips to be congruent with a normal joint space. Sixteen of the 17 patients had radiographic outcomes rated as "excellent"; 1 patient was rated "good." The modified Merle d'Aubigné score (obtained in 12 patients) averaged very good, with only 1 having less than a good (graded as fair) clinical outcome. The Short Musculoskeletal Function Assessment Questionnaire scores (from 11 patients) were not significantly different from normal and were within the normal reported values for all indices and categories. There was no correlation between fracture fragment size and outcome., Conclusions: This study further supports the contention that a stable hip joint, as determined by EUA, after posterior wall acetabular fracture treated nonoperatively is predictive of continued joint congruity, an excellent radiographic outcome, and good-to-excellent early clinical and functional outcomes., Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: B. R. Moed has received royalties from Biomet and is a board member for AO North America. The remaining authors report no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Compare intraoperative "on end" fluoroscopy lag screw position to postoperative computer tomography., Design: Retrospective review., Clinical Setting: Level 1 trauma center., Patients: One hundred sixteen patients sustaining operative acetabular fractures with posterior wall components., Intervention: Posterior wall lag screws placed using "on end" fluoroscopic imaging., Main Outcome Measurements: The primary outcome was determining correlation between lag screw position, in relation to the acetabular articular margin, using intraoperative fluoroscopy and postoperative computer tomography. Analysis was performed based on location around the acetabulum, including posterior (P), superoposterior (SP), and superior (S) regions, and screws 0-5, 5-10, and >10 mm from the joint., Results: Two hundred forty-four lag screws were identified as follows: 51.6% in the P group, 25.4% in SP, and 23.0% in the S group with excellent correlation noted in all groups. For screws pooled based on fluoroscopic distance from the joint, 28.3% were 0-5 mm, 52.9% 5.01-10 mm, and 18.4% >10 mm. Correlation coefficients were 0.60 for 0-5 mm and 0.68 for both groups >5 mm. Subdividing screws based on anatomic region and fluoroscopic location found increasing correlation as screws moved further from the joint in the P region. In the SP group, excellent correlation was noted for screws 0-5 mm with decreasing correlation further from the joint. Within the S group, correlation for screws 0-5 mm did not reach significance, but good correlation was noted for screws >5 mm. Overall incidence of intraarticular screws was 1.2%., Conclusions: Intraoperative axial fluoroscopy for posterior wall lag screw placement correlates closely with postoperative computer tomography allowing for reliable posterior wall lag screw placement in all regions around the acetabulum. Care should be taken while placing lag screws within 5 mm of the articular surface, particularly within the posterior region., Competing Interests: The authors report no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

There are no data-supported recommendations on how proximal is too proximal for retrograde nailing (RGN). At six level 1 trauma centers, patients with femur fractures within the proximal one-third of the femur treated with RGN were included. This article describes a proximal segment capture ratio (PSCR) and nail segment capture ratio to evaluate RGN of proximal fractures. The study included 107 patients. The average follow-up was 44 weeks. There were two nonunions and three malunions. There was no significant difference between PSCR of 0.3 or less and need for secondary procedures or time to full weight bearing (p>.05). In this study, a smaller (< 0.3) PSCR was not associated with an increased number of complications. A higher Orthopaedic Trauma Association classification was predictive of malunion and increased time to union. These data demonstrate that retrograde nailing is safe and effective for the treatment of supraisthmal femur fractures.

Objectives: Performing an examination under general anesthesia (EUA) using dynamic stress fluoroscopy of patients with posterior wall acetabular fractures has been used as a tool to determine hip stability and the need for surgical intervention. The purpose of this study was to further evaluate the effectiveness of this technique, from a source other than its primary advocates, in patients with posterior wall acetabular fractures less than or equal to 50% who were stable on EUA and treated nonoperatively., Design: Retrospective case series., Setting: University Level 1 Trauma Center., Participants: Seventeen patients with a posterior wall acetabular fracture stable on EUA treated nonoperatively., Intervention: The patients were treated nonoperatively as guided by an EUA negative for instability. Patient follow-up averaged 30 months (range, 6-64 months)., Main Outcome Measurements: Outcome evaluation included the modified Merle d'Aubigné clinical score and the Short Musculoskeletal Function Assessment Questionnaire. Radiographic evaluation for subluxation or arthritis consisted of the 3 standard pelvic radiographs., Results: Radiographic evaluation showed all hips to be congruent with a normal joint space. Sixteen of the 17 patients had radiographic outcomes rated as "excellent"; 1 patient was rated "good." The modified Merle d'Aubigné score (obtained in 12 patients) averaged very good, with only 1 having less than a good (graded as fair) clinical outcome. The Short Musculoskeletal Function Assessment Questionnaire scores (from 11 patients) were not significantly different from normal and were within the normal reported values for all indices and categories. There was no correlation between fracture fragment size and outcome., Conclusions: This study further supports the contention that a stable hip joint, as determined by EUA, after posterior wall acetabular fracture treated nonoperatively is predictive of continued joint congruity, an excellent radiographic outcome, and good-to-excellent early clinical and functional outcomes., Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Background: Recent publications have shown an infection rate of 5-7 % for acetabular fractures treated with the Kocher-Langenbeck (K-L) approach. Using metallic staples to close hip skin incisions has been considered the gold standard. The purpose of this study was to answer the following: (1) will closure of a K-L incision after acetabular fracture surgery with a running subcuticular monocryl suture, then sealing the wound with 2-octyl cyanoacrylate (OCA), result in a lower infection rate compared to metallic staple closure? (2) Do incisions closed with subcuticular monocryl and OCA exhibit decreased drainage? (3) Is there a cost difference between these two methods?, Materials and Methods: In a prospective clinical study, 103 patients with acetabular fractures treated using the K-L approach were randomized into two groups: skin closure with metallic staples (n = 52) versus subcuticular running monocryl suture sealed with OCA (n = 51)., Results: Two postoperative deep infections (4 %) in the staples group required multiple debridements; no infections developed in the OCA group. However, there was no statistical difference between the groups, (p = 0.495). There was a statistically significant difference (p = 0.032) comparing days from surgery to a dry incision favoring OCA (4.2 versus 5.85 days). The patient charge was approximately $900 greater on average in the OCA group due to the increased time in the operating room required for the subcuticular closure., Conclusions: Closure with OCA and subcuticular monocryl showed no clinical disadvantages and appears to have a clinical advantage when compared to standard metallic staple skin closure in acetabular fracture surgery. However, additional patient costs may be incurred., Level of Evidence: II.

The purpose of this study is to retrospectively review the results of proximal third femur fractures treated with retrograde nailing (RGN) and compare those results to a cohort from the same period treated with antegrade nailing (AGN). Adult patients with femur fractures within 10 cm of the lesser trochanter who were treated with intramedullary nails were reviewed. Two groups, patients treated with AGN (n = 35) and RGN (n = 34), were compiled. Demographic information, comorbidities, associated injuries, radiographic outcomes, complications, and secondary procedures were compared. There were two malunions in the AGN group and three in the RGN group. The AGN group had two nonunions while the RGN group had one. Subgroup analysis demonstrated that a higher body mass index (BMI) (p = .011) and a higher AO/OTA fracture classification (p = .019) were the only factors predictive of malunion. Regardless of starting point, there were no differences between groups in the number of secondary procedures, nonunions, malunions, or time until union.

Acetabular fracture-dislocations are severe injuries that require urgent closed reduction of the hip and often require surgery to restore hip stability. Other authors have described acetabular fracture-dislocations associated with femoral neck fractures, but to our knowledge, this case report is the first to describe an acetabular fracture-dislocation in association with an ipsilateral pertrochanteric fracture and subtrochanteric extension. The polytraumatized patient initially was not stable enough for prolonged surgery. Through a 3-cm anterolateral hip incision, a 5-mm Schanz screw was introduced percutaneously into the femoral head through the primary fracture site under fluoroscopic guidance. With inline traction on the leg, the Schanz screw was used to manipulate the femoral head back into the acetabular fossa. The Schanz screw was removed, the head remained reduced, and a skeletal traction pin was placed to maintain length and alignment of the pertrochanteric fracture until definitive stabilization was possible. We propose a staged treatment strategy consisting of early closed reduction of the hip, and after the patient has been stabilized, reduction and fixation of the fractures. This strategy may be useful in managing an unstable polytraumatized patient or a patient who requires prolonged transfer to receive definitive care.

Recent research suggests that the turnover process is not fully captured by the traditional sequential model relating job dissatisfaction to subsequent turnover. The present study contributes to this research by modeling within-individual job satisfaction as a function of job change patterns to determine if individual work attitudes change systematically with the temporal turnover process. Specifically, the authors hypothesized that low satisfaction would precede a voluntary job change, with an increase in job satisfaction immediately following a job change (the honeymoon effect), followed by a decline in job satisfaction (the hangover effect). Though this pattern is suggested in the literature, no prior research has integrated and tested this complete temporal model within individuals. Findings based on a sample of managers supported the proposed honeymoon-hangover effect., (Copyright 2005 APA, all rights reserved.)

The authors investigate a previously overlooked yet important objective for employee job search--seeking leverage against the current employer. They explore the outcomes and correlates of leverage-seeking search and how it may differ from the more traditional objective for engaging in job search--to change jobs. Results show that leverage-seeking and separation-seeking search objectives associate with different outcomes. The authors also find that characteristics of the work situation and individual differences associate with leverage-seeking search and relate differently with the 2 job search objectives. Implications for practice and the advancement of job search research are discussed., (2004 APA, all rights reserved)