Search

Background This study assessed patient perceptions of the Physician Payments Sunshine Act and opinions toward physicians who receive gifts and/or payments from pharmaceutical or medical device companies. Methods During their office visit, patients attending different specialty clinics volunteered to complete our survey. The survey asks if the patient knows what the Sunshine Act is, then asks questions on 5-point response scales to assess the patient's opinions toward physicians who receive compensation from companies, their self-rated knowledge of physician compensation, and how they believe this compensation affects the cost of care. Results Over 13 months, 523 responses were collected: 8.6% of patients reported having knowledge of the Sunshine Act, 56.8% rated their knowledge of physician compensations as “poor,” and 67.1% agreed with the statement that patients should be aware of the compensation physicians receive. When asked how their opinion toward their physician would change if they learned the physician received free meals or gifts from companies, 58.9% replied “not at all,” and 36.11% of patients did not believe their cost of care would increase if their physician received compensation from companies. Conclusions Most patients were unfamiliar with the Sunshine Act, and believe their knowledge of physician compensation is poor. Over half of the respondents would not change their opinion of their physician based on knowledge of their physician receiving payments/gifts from companies, and over one-third of respondents did not believe such compensation increased the cost of care. The majority of respondents agreed that patients should be aware of payments/gifts to physicians.

Introduction: Women have historically been underrepresented in orthopaedics. This study analyzes the geographic distribution of female orthopaedic foot and ankle (OFA) surgeons, as well as geographic patterns between their training locations and current practices. Methods: American Orthopaedic Foot and Ankle Society (AOFAS) data regarding fellowship completion from 1988 to 2021 were analyzed. Internet searches were then performed to identify medical school, residency, and current practice locations of individual surgeons. States were categorized into regions and divisions based on US Census Bureau guidelines. Results: Of the 1088 OFA surgeons analyzed, 166 (15.26%) were women and 922 (84.74%) were men. The South has a higher number of female OFA surgeons; however, this region and the Midwest have the lowest percentages of female representation. The West and Northeast had significantly higher percentages of female representation and higher retention rates for women. There was high variability in the number and percentage of female OFA surgeons in divisions both within and between regions. Conclusion: Although the number of female OFA surgeons has increased, their representation remains low. Geographically, the East South Central division of the United States consistently had the least number of OFA surgeons, whereas the South Atlantic division had the highest. Level of Evidence: Not applicable.

Background: Female representation varies geographically among orthopaedic residency programs, with the southern region of the United States reported as having relatively lower rates of female orthopaedic surgeons. Purpose: To determine the gender and geographic distributions of US-based orthopaedic sports medicine surgeons and analyze geographic patterns between their training locations and present-day practices. Study Design: Cross-sectional study. Methods: American Orthopedic Society of Sports Medicine (AOSSM) fellowship completion data from the 2016-2021 academic years were analyzed with regard to gender and fellowship location. Medical school, residency, and current practice locations were obtained via internet searches for all individuals identified within the databases. Locations were categorized into regions based on the US Census Bureau definitions. Descriptive statistical analysis was performed on the data. Results: A total of 1268 sports orthopaedic surgeons who graduated fellowship from 2016 to 2021 were analyzed: 141 (11%) were female and 1127 (89%) were male. The percentage of female sports medicine surgeons in fellowship remained constant (11%-12%) from 2016 to 2021. On average, the annual percentage of female orthopaedic sports medicine fellows was 7.2% in the South, 10.4% in the West, 14.2% in the Midwest, and 14.7% in the Northeast. Based on the orthopaedic sports medicine fellowship graduates from 2016 to 2021, the mean percentage of current female orthopaedic sports medicine surgeons in practice was 7.4% in the South, 11.7% in the Northeast, 12.8% in the Midwest, and 14.4% in the West. Conclusion: Approximately 11% of our sample was female; however, this percentage varied heavily by region, with the southern region having significantly lower rates of gender diversity.

Ankle fractures are common injuries treated by orthopedists. Indications for operative repair of deltoid ligament (DL) injuries in ankle fracture patients are debated. The purpose of this review is to determine the indications for operative DL repair. Ovid MEDLINE, CINAHL, and Scopus were searched up to December 2019. Web of Science was searched up to August 2018. Search terms included "Deltoid" and "Ligament" or "Ligaments." Comparative studies assessing conservative vs operative DL repair were searched for. Articles meeting inclusion criteria were screened in two stages to determine eligibility. Out of 1,542 articles, nine were included in our qualitative synthesis. These nine studies included 449 patients, of which 233 were treated with open reduction internal fixation (ORIF) with or without trans-syndesmotic (TS) screw fixation, and 205 of which were treated with ORIF with DL repair. The remaining 21 patients were managed nonoperatively, had no evidence of DL injury, or were lost to follow-up. There is a lower rate of malreduction associated with DL repair compared to TS screw fixation. Moreover, DL repair may be useful in treating patients with Weber Type C fractures, concomitant DL-syndesmotic disruption, or residual valgus instability following ORIF in isolated lateral malleolar fractures.

Hallux valgus is one of the most common conditions treated by foot and ankle orthopedists; over 140 surgical procedures have been developed for management of the condition. A rare complication of hallux valgus repair is nonunion, and the literature regarding nonunion after hallux valgus repair is correspondingly sparse. We present a 39-year-old active duty male who underwent operative management after developing nonunion and transfer metatarsalgia following a proximal oblique metatarsal osteotomy. The patient underwent nonunion correction and metatarsal lengthening via bone allografting. No complications were observed during the intra- or perioperative periods. At 2.5-years postoperatively, the patient’s symptoms had largely resolved. He expressed high satisfaction with his outcome and was able to continue activity duty. Our findings indicate that nonunion repair can have excellent clinical outcomes with high patient satisfaction, even in an active military population.

Differentiating Charcot neuropathic osteoarthropathy (CN) from infection is challenging. The diagnosis of CN is often missed or delayed, resulting in inappropriate and delayed treatment. We hypothesized that the misdiagnosis of CN results in inappropriate antibiotic prescriptions and explore the sequelae of unnecessary antibiotic use.A retrospective review of patient electronic medical records from January 2010 to December 2017 was conducted for those diagnosed with CN after being referred to an orthopaedic foot and ankle specialist.Our review showed 58 of 103 (56%) patients received antibiotics on the date, or within the next 7 days, of referral to foot and ankle orthopaedic specialist. The antibiotic of choice given on referral were as follows: Sulfamethoxazole/Trimethoprim 18 of 58 (31%), doxycycline 13 of 58 (22%), clindamycin 13 of 58 (22%), cephalexin 9 of 58 (16%), minocycline 5 of 58 (9%).Missed diagnoses for CN are common and result in complications stemming from inappropriate treatment, delays in appropriate therapy, and may accelerate antibiotic resistance. Misdiagnosis of CN contributes to the inappropriate use of prescription antibiotics.

We present a unique case of chronic deltoid ligament disruption in a 34-year-old high-level military operator with a 12-month history of acute-onset medial ankle pain. Magnetic resonance imaging showed an isolated chronic disruption of the superficial and deep deltoid ligament. The patient was managed operatively with a semitendinosus allograft. No complications were observed during the intra- or perioperative periods. At 12-month follow-up, the patient reported near-complete pain resolution and was able to return to unrestricted active duty. Use of allograft ligamentous reconstruction of the deltoid ligament in a highly active soldier was successful, allowing return to unrestricted active duty.

We present a unique case of chronic peroneal tendon dislocation in a 47-year-old active duty military member with a 2-mo history of acute onset lateral ankle pain due to sports injury. Magnetic resonance imaging revealed superficial peroneal retinaculum (SPR) disruption, a flattened retrofibular groove, dislocation of the peroneus longus tendon, and a tear of the peroneus brevis tendon. The patient was managed operatively with fibular groove deepening, SPR reconstruction, peroneus brevis debridement, and peroneus longus tubulurization. No complications were observed during the intra- or perioperative periods. At their 3-mo follow-up, the patient reported near complete resolution of pain and the ability to ambulate without any brace or support. He returned to running and was able to deploy fit for full duty 4.5 mo from injury.

The Centers for MedicareMedicaid Services (CMS) Open Payments public database, resulting from the Physician Payments Sunshine Act of 2010, was designed to increase transparency of physicians' financial relationships with pharmaceutical manufacturers. We compared physician-reported conflict-of-interest (COI) disclosures in journal articles with this database to determine any discrepancies in physician-reported disclosures.COIs reported by authors from 2014 through 2016 were analyzed in 3 journals: FootAnkle International (FAI), The Journal of BoneJoint Surgery (JBJS), and The Journal of Arthroplasty (JOA). Payment information in the CMS Open Payments database was cross-referenced with each author's disclosure statement to determine if a disclosure discrepancy was present.We reviewed 3,465 authorship positions (1,932 unique authors) in 1,770 articles. Within this sample, 7.1% of authorships had a recorded undisclosed COI (disclosure discrepancy), and 13.2% of articles had first and/or last authors with a disclosure discrepancy. Additionally, we saw a great variation in the percentage of authorships with disclosure discrepancies among the journals (JBJS, 2.3%; JOA, 3.6%; and FAI, 23.7%).Discrepancies exist between payment disclosures made by authors and those published in the CMS Open Payments database. Although the percentage of articles with these discrepancies varies widely among the journals that were analyzed in this study, no trend was found when analyzing the number of discrepancies over the 3-year period.COI disclosures are important for the interpretation of study results and need to be accurately reported. However, COI disclosure criteria vary among orthopaedic journals, causing uncertainty regarding which conflicts should be disclosed.

Category: Ankle; Sports Introduction/Purpose: Suture anchors provide an optimal way of fixating injured soft tissue to bone while promoting healing and structural integrity. With recent innovations, the development of biodegradable ultrasonic liquifying suture anchors has been of particular interest. These devices utilize ultrasound energy to liquify a polylactide anchor tip, which is inserted into cancellous bone, at which point it solidifies and fixates within seconds. Mechanical performance testing in comparison to current mainstream devices suggests this method as more suitable for rapid tissue repair and healing. Initial studies have, however, been limited to artificial bone. The current study aims to evaluate surgical and patient-reported outcomes in the use of bio-absorbable suture anchors used for Broström-Gould lateral ankle ligament reconstruction. Methods: This study consisted of a single-surgeon, retrospective analysis with Institutional Review Board approval (University of Texas Medical Branch (UTMB), August 2 2019). A database search was conducted for patients who underwent primary or secondary Broström-Gould repair indicated for chronic laxity of the anterior talofibular ligament (ATFL) with bioabsorbable suture anchors between May 2017 and May 2019 at UTMB. Exclusion criteria were patient age under 18, incarcerated patient, and patient being a pharmaceutical company employee. Using patient charts, operative and progress notes were reviewed to assess surgical outcomes, concurrent repairs, and complications. Thereafter, patients were contacted via telephone to obtain Patient- Reported Outcomes Measurement Information System (PROMIS) scores through a series of survey questions concerning their physical health and physical function. Results: Twenty-six patients (20 females, 6 males) met inclusion and exclusion criteria. One patient had both ankles repaired separately, therefore 27 ankles were analyzed. Mean age at the time of surgery was 43 years (range 22-63). Preliminary analysis examined the period between surgery and last clinic visit, with a mean of 3.9 months. Mean concurrent repairs was 2.0. There were no intraoperative complications. All patients were compliant with weightbearing protocol. Complications unrelated to device function totaled 29.6% and included cellulitis (18.5%), suture granuloma (7.4%), and tarsal tunnel syndrome (3.7%), which all resolved after proper intervention. Functional complications included recurrent instability in 1 patient (3.7%) at 8.4 months. PROMIS scores are currently being collected and will be compiled by the end of February 2020. Conclusion: Preliminary analysis showed a relatively high overall complication rate at 33.3% (n=7), although recurrent instability was reported by 1 patient only (3.7%). The addition of PROMIS scores will be critical in examining longer term functional outcomes in ATFL repair with bioabsorbable suture anchors.