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Orthopaedic surgery is the least diverse surgical subspecialty in medicine. However, to date, there is no literature that shows which medical schools have successfully contributed to improving orthopaedic surgeon diversity.The purpose of this study is to identify the top U.S. medical schools that have successfully matched black applicants into orthopaedic surgery residencies and juxtapose this ranking to the current top medical schools as ranked by the U.S. News and World Report (USNWR).The J. Robert Gladden Orthopaedic Society (JRGOS) database was queried for all orthopaedic surgeons, fellows, and residents who identified as black or multi-racial with black being one of the included races, yielding 938 physicians, of which 672 met our inclusion criteria. From this list, a ranking of the top 20 medical schools was generated.The top five medical schools ranked in the JRGOS database are Howard University College of Medicine (HUCOM), Meharry Medical College, Harvard Medical School (HMS), the University of Pennsylvania, and Morehouse School of Medicine (MSM). In addition, 10 (50%) of the medical schools ranked in the top 20 by the JRGOS database were also ranked by the USNWR. When ranking medical schools for black female applicants, HUCOM, MSM, HMS are the top three programs. Lastly, a ranking by region identified that the northeast contained the highest number of ranked medical schools.There are both historically black and non-historically black medical schools which have a proven track record of producing a significant number of future black orthopaedic surgery residents.

This article highlights the key topics that were presented at a symposium of the American Orthopaedic Association in May 2021, with the primary objectives of acknowledging the existence of systemic racism within the field of orthopaedic surgery, developing a plan for combating racism before it manifests within orthopaedic departments and practices, and understanding the benefit of pipeline programs in diversifying the orthopaedic surgeon workforce. When the word racism is mentioned among a group of orthopaedic surgeons, it may have the immediate effect of stifling honest conversations. Therefore, the crippling effects of racism within orthopaedic surgery are not addressed, and there are downstream effects that influence patient care by perpetuating disparities in health care. If orthopaedic departments want to fix the lack of diversity within the specialty, the magnitude of the problem must first be measured. Fortunately, through the efforts of the J. Robert Gladden Orthopaedic Society, data sets are being created that better measure the diversity of individual orthopaedic residency programs. In addition to hiring diverse faculty, orthopaedic departments and practices should focus on the mentorship, sponsorship, retention, and promotion of these faculty. Finally, pipeline programs such as Nth Dimensions have a proven track record for improving the diversity of the orthopaedic workforce and can serve as the primary mechanism employed by departments and practices in making their orthopaedic surgeon workforce look more like the demographics of the United States.

There are limited data to guide the use of venous thromboembolism disease (VTED) prophylaxis after foot and ankle surgery. Although there is general consensus that the overall risk is lower than after hip or knee replacement, subpopulations of patients may be at relatively heightened risk. Furthermore, existing data are often conflicting regarding the efficacy of prophylaxis, with little acknowledgment of the tradeoffs between VTED prophylaxis and potential complications associated with the use of such medications. This article provides an overview of currently available evidence to guide decision making regarding VTED prophylaxis in patients who undergo foot and ankle surgery.

Many of the small fractures below the knee are known by eponyms. Although some are well known such as the Maisonneuve and Lisfranc fractures, several are less well known, such as the Cedell and Tillaux fractures. Unfamiliarity with these small fractures may result in failure of detection at initial emergency department surveys or treated suboptimally by lack of experience. This ICL chapter consists of an overview of several common “small” fractures of the foot and ankle, not to be missed, not to be mistreated.

A 7-month-old male (neutered) Australian Shepherd canine presented with vomiting and an altered, depressed demeanour, about 20–60 minutes after ingesting 22–24, 200 mg ibuprofen tablets. This article describes the long-term nursing care provided to a dog with ibuprofen toxicity. Aspects of veterinary nursing include intravenous and urinary catheter maintenance, as well as monitoring of a patient on IV fluids. Proper care in these areas can lead to improved patient outcome, due to reduced secondary issues such as infection and fluid overload. This article focuses more on nursing care rather than how to diagnose and veterinary decisions.

Trimalleolar fractures are a common ankle fracture variant that has sparked controversy over whether or not to fix the posterior malleolus of these fractures. Recent literature has begun to support fixation of the posterior malleolus fragment to restore the contact force of the joint, as well as decrease the risk of posttraumatic osteoarthritis by increasing joint stability. This chapter focuses on fixation of the posterior malleolus using percutaneous screws.

A 73-year-old man with hemophilia was referred for evaluation of acute on chronic left hip and thigh pain. The patient had mild chronic discomfort in his proximal left thigh for several years, and although no prior records were available, he reported an MRI was performed 7 years earlier for evaluation of his pain and a soft tissue mass was identified. He did not recall any specific treatment given at that time. One month before his current presentation, he awoke with acute pain in his thigh, although he had no history of injury. His pain was exacerbated with weight-bearing and improved with rest. He was evaluated by his local physician, and the radiographs showed a bone abnormality with loss of lateral cortical bone in his femur. He was instructed to walk with crutches and was referred for further evaluation and treatment. His medical history revealed Type A hemophilia and a left TKA 23 years earlier that required perioperative clotting factor products. Physical examination revealed a soft tissue fullness in the proximal left thigh that was tender to palpation and a well-healed anterior left knee incision from his TKA. The skin was normal and range of motion in his lower extremity was satisfactory. The patient was intact from a neurovascular standpoint, but he had weakness and pain associated with left knee extension. Imaging studies were performed and included radiographs, MRI, and CT of the femur. The radiograph of the chest was unremarkable. Based on clinical history, physical examination, and imaging studies, what is the differential diagnosis?

Objectives. The purpose of this study was to determine from state and local health departments: ( 1) how they purchase, distribute, and fund influenza vaccine; ( 2) whether they experienced a shortage in 2003/04; ( 3) how the shortages were handled; and ( 4) how they prepared for distribution in 2004/05. Methods. A web-based survey was completed from June to August 2004 in eight Southeastern states. Results. Data were obtained from each state and 222 local health departments. Major differences between and within states were found with regard to purchasing, distributing, and funding influenza vaccine. Although the majority of health departments experienced periods of shortages in 2003/2004, surpluses of vaccine remained at the end of the season. There was little evidence of interaction between the public and private sectors to share vaccine resources in response to shortages. Tracking systems for redistribution of vaccine or follow-up were often not in place. Entering the 2004/05 season, 25% of states and 11% of counties were not developing any special procedures to deal with shortages beyond what was in place earlier. Conclusions. Better systems and funding are needed, especially for adult influenza vaccine delivery and for redistribution of influenza vaccine in response to shortages.