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Orthopaedic surgery residency applicants submit more applications than ever before. While this issue is multifactorial, increased information and transparency regarding residency programs are important. This study aimed to evaluate the completeness and variability of the information that is currently available regarding orthopaedic residency programs on two publicly available databases, the Fellowship and Residency Electronic Interactive Database (FREIDA) and the newly created Orthopaedic Residency Information Network (ORIN).Orthopaedic surgery residency programs were identified and evaluated using FREIDA and ORIN on September 11, 2021. Information on the FRIEDA and ORIN databases were evaluated in the following categories: program overview, the residency application, and education information. Univariate statistical analysis was performed on the data.Of the 194 programs that participated in the FREIDA database, over 48% failed to include basic program information including resident demographics and key application information including USMLE Step requirements. Of the 141 programs that participated in the ORIN database, most the programs did not report USMLE Step median and cutoff scores and clerkship grades. Depending on the database and type of information, factors including the program's National Institutes of Health funding, reputation, size, and type were associated with the availability of information.This study showed that while most orthopaedic surgery residency programs participate in FREIDA and ORIN, the information included was highly variable and incomplete for nearly all programs. Improving the completeness of information in these databases has the potential to allow students to make more informed application decisions.

Background The surgical burden in low- and middle-income countries (LMICs) as reported by the number of surgical cases per capita is great. To improve global health and help address this burden, there has been a rise in surgical outreach to LMICs. In high-income countries, an electronic health record (EHR) is used to document and communicate data critical to the quality of care and patient safety. Despite this, there is little guidance or precedence on the data elements or processes for utilizing an EHR on outreach trips. We validated data elements and process steps for utilizing an EHR for hand surgery outreach trips. Methods We conducted a literature review to identify data elements collected during surgical outreach trips. A future-state process map for the collection and documentation of data elements within an EHR was developed through literature review and semistructured interviews with experts in global outreach. An expert consortium completed a modified RAND/University of California at Los Angeles Delphi process to evaluate the importance and feasibility of each data element and process step. Results In total, 65 data elements (e.g., date of birth) and 24 process steps (e.g., surgical site marking) were validated for use in an EHR for hand surgery outreach trips to LMICs. Conclusion This validated portfolio of data elements/process steps can serve as the foundation for pilot testing of an EHR to document and communicate critical patient data on hand surgery outreach trips. Utilization of an EHR during outreach trips to LMICs may serve to improve the safety and quality of care provided. The validated data elements/process steps can serve as a guide for EHR development and implementation of other surgical specialties.

Background Despite interest among North American orthopaedic residents to pursue rotations in resource-limited settings, little is known regarding resident motivations and impact on host surgeons. Methods Surveys were distributed to North American orthopaedic surgeons and trainees who participated in international rotations during residency to assess motivations for participation and to orthopaedic surgeons at partnering low- and middle-income country (LMIC) institutions to assess impact of visiting trainees. Results Responses were received from 136 North American resident rotators and 51 LMIC host surgeons and trainees. North American respondents were motivated by a desire to increase surgical capacity at the LMIC while host surgeons reported a greater impact from learning from residents than on surgical capacity. Negative aspects reported by hosts included selfishness, lack of reciprocity, racial discrimination, competition for surgical experience, and resource burdens. Conclusions The motivations and impact of orthopaedic resident rotations in LMICs need to be aligned. Host perceptions and bidirectional educational exchange should be incorporated into partnership guidelines.

Background Underrepresented in medicine (UIM) visiting student clerkship scholarships provide an opportunity for supporting diversity. Although these scholarships have become a popular initiative to recruit diverse surgical applicants, they have not been thoroughly analyzed regarding which programs offer scholarships and the characteristics of the scholarships. UIM scholarship opportunity disparities may exist depending on location, funding, reputation, and program size among different specialties. Objective To describe the characteristics and prevalence of UIM visiting student scholarships by examining institutional and program websites for the surgical specialties. Methods Using the Accreditation Council for Graduate Medical Education (ACGME) Accreditation Data System for 2021, residency training and diversity websites were identified and evaluated for the availability of UIM visiting student scholarships in July 2021. Eight surgical specialties were examined. Scholarships were categorized by how UIM was defined, the funding amount provided, and scholarship application requirements. We analyzed the association of the program's National Institutes of Health funding, size, type, region, reputation, and population density of the program's area via Doximity on scholarship availability using chi-square and multivariate analysis. Results Of the 1058 analyzed programs, 314 (29.7%) had a UIM visiting student scholarship. There were 4 different definitions of UIM used among the analyzed programs. The average scholarship amount offered was $1,852.25 ($500-$4,000). Depending on the specialty, different variables were associated with whether a program had a UIM scholarship. Conclusions Currently, UIM scholarship offerings were variable between programs and surgical specialties.

Background The surgical technique of radius distraction for stabilization of distal radioulnar joint (DRUJ) if intraoperative DRUJ instability was found after the fixation of distal radius fracture has been previously described, but this surgical technique lacks clinical and radiographic effect in minimal 3 years follow-up. We therefore evaluated the clinical outcome and radiographic results of radius distraction in minimal 3 years follow-up as long-term evaluation. Methods We reviewed the case series of distal radius fracture with concomitant DRUJ instability receiving radius distraction from the senior author over a 5-year period (January 1st, 2013, to June 30th, 2017) retrospectively. Radius distraction during volar plating was performed by moving the volar plate distally via compression screw loosening/fastening to achieve firm endpoint on the dorsopalmar stress test. The evaluations of radiographic, including bone union time and ulnar variance, and clinical outcomes, including grading of DRUJ instability, NRS of wrist pain, DASH score, MMWS score, and range of motion of operated wrist at final follow-up, were performed at clinic as minimum 3-year follow-up; a total 34 patients had been evaluated. Results At minimal post-operative 36 months follow-up, all cases demonstrated acceptable wrist range of motion with stable DRUJs, low NRS of wrist pain (0.6, SD 0.7), and satisfactory DASH score (mean 9.1, SD 6.2) and MMWS score (mean 87, SD 10). There were no cases suffering from nonunion of distal radius. The mean ulnar variance of injured wrist and uninjured wrist were -1.2 mm and 0.2 mm, respectively (SD 1.0 and 0.6) with significant statistical difference. Conclusions Radius distraction during volar fixation of distal radius fracture should be considered if DRUJ instability was found by the dorsopalmar stress test intraoperatively, and the long-term DRUJ stability could be achieved by maintenance of normal-to-negative ulnar variance, with decreased wrist pain and satisfactory function outcome. Level of Evidence Therapeutic Level IV

Characterize the appearance of digital nerve injuries in different ultrasound planes and correlate the presence and size of neuromas with time from injury.Surgically confirmed nerve injuries were retrospectively evaluated. Appearances of the nerve injury in the available imaging planes were reviewed by two readers. Associations between presence and size of neuroma with time from injury were analyzed.Injuries of 29 digital nerves (3 incomplete lacerations, 17 complete lacerations, 6 with 7 stump neuromas, 3 neuromas-in-continuity) noted on ultrasound were surgically confirmed. Among the 20 lacerations, long-axis images were obtained in 15, of which 10 depicted the injury and 4 did not. Among the 10 depicting the injury in long axis, 2 showed a discrete gap, and 7 showed the nerve obscured by laceration tissue without a gap. In short axis, the nerve injury was visible in all 20, and nerve laceration was seen as a discrete gap in 2, and obscuration by laceration tissue in 14. Neuromas were hypoechoic and well-defined. There was a positive association between time and presence of neuroma (OR = 1.3, p = 0.002). Correlations between time and cross-sectional area (rUltrasound long axis may be less useful, and those short axis may be more reliable for assessing digital nerve injuries than previously reported. Neuromas are hypoechoic and well-defined, and their size can vary based on time from injury.