Search

Background: The Orthopaedic Surgery Match is highly competitive, with more applicants than residency spots. With the Step 1 Exam moving to a pass/fail result, residency programs and applicants have fewer objective data to determine applicants' relative competitiveness. Through this study, we sought to provide the mean number of accepted publications on PubMed a successfully matched orthopedic surgery applicant has by the time of submission of their application. Materials and Methods: Orthopedic surgery residency programs participating in the National Resident Matching Program were identified by their ranking on the Doximity Residency Navigator. Each program's intern class and their medical schools were identified. Their names were searched in PubMed and Scopus and articles with their name and affiliations were recorded. Results: In total, 877 orthopedic surgery interns published a mean of 3.30±5.27 articles each on PubMed. They were first or second author on 1.44±2.58, and 1.96±3.89 publications were related to orthopedic surgery. There were no statistical differences between degree, sex, or residency program rank from the Doximity Residency Navigator. The mean number of publications from a successful applicant was approximately 3. There was a great range in the number of publications, and 27.3% of successful applicants did not have a single publication. Conclusion: Future applicants and programs can use this number to gauge relative research output. [Orthopedics. 2024;47(6):355–358.] [ABSTRACT FROM AUTHOR]

In this review paper, we present the common etiology, presentation, diagnosis, and management of the following three common bunion formations: dorsal bunion, tailor's bunion, and hallux valgus (HV). Bunions are common pathologies that present to a variety of clinics, so it is important for providers to have a base understanding of these in order to provide the best care to patients. Many of these bunion formations have a variety of causes which allow providers to manage them before surgical intervention is required. The aim of this review paper is to bring attention and expanded insight on these common bunion presentations in order to minimize morbidity early on. The information provided in this review will allow both primary care and subspecialty physicians with the knowledge to accurately diagnose and optimally manage these bony deformities of the lower extremity. [ABSTRACT FROM AUTHOR]

The purpose of this study is to determine if arthrodesis, compared with open reduction and internal fixation (ORIF), produces favorable American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores, and to determine if differences in complication, revision surgery, and secondary arthrodesis rates exist for patients with Lisfranc fracture/dislocation injuries. Searches were performed in PubMed using the keywords "Lisfranc fracture," "metatarsal fracture," "ORIF," "open reduction internal fixation," "arthrodesis," and "fusion." These criteria left 183 articles for review. Exclusions left 21 articles and 2 translations of Chinese abstracts. Data analysis was performed using Student's 2-sample t test for samples of equal variance, and chi-square test for goodness of fit. The t test revealed a significant difference (P = .03) between the average AOFAS score for patients who underwent primary arthrodesis (84.7 ± 6.14) compared with those who were treated with ORIF (78.9 ± 5.09). There was no significant difference for the average VAS scores (P = .33) of the arthrodesis and ORIF groups. The complication rate of arthrodesis patients was significantly lower than ORIF patients (P = .04), and the rates of revision surgery (P = .22) and secondary arthrodesis (P = .53) were not significant between the groups. The results of this study indicate that arthrodesis may be a better surgical option than ORIF, due to the higher functional scores and the lower complication rate.Levels of Evidence: Level III: A meta-analysis. [ABSTRACT FROM AUTHOR]

Background: Many syndesmosis screw fixations do not achieve success at the first attempt. Currently, there are no data available to evaluate revision of syndesmosis screw failure. Methods: A total of 160 consecutive patients who underwent syndesmosis screw fixation from 2014 to 2016 were reviewed. The current study focuses on 13 of 160 patients who underwent revision surgery and analyzes reasons, methods, and outcomes of syndesmotic screw revisions. Results: Thirteen out of 160 patients had revision surgeries. Incidence of recurrent diastasis was 92.3%. Seven out of 19 screws had broken. Two patients had screw loosening, 9 patients underwent early weightbearing, 1 patient developed osteomyelitis, 1 patient developed osteoarthritis, and 1 patient had fibular nonunion. Eleven patients underwent removal, 3 patients underwent clamp reduction, and 4 patients underwent fibular osteotomy. Six patients experienced good reduction with 0/10 pain, 3 patients experienced good reduction with some pain, 1 patient experienced poor reduction; 1 patient developed osteomyelitis and subsequent 7/10 pain; 1 patient underwent fusion with 5/10 pain, and 1 patient experienced medial malleolar mal-union with 3/10 pain. Conclusion: It was found that the main reason for syndesmosis revision was reoccurring diastasis. Most patients ultimately experienced good reduction and were able to ambulate, despite some residual pain. Levels of Evidence: Level IV: Case series. [ABSTRACT FROM AUTHOR]

Introduction: The menisci are a pair of fibrocartilaginous structures important for the normal biomechanical function of the knees. Tears are common, and multiple approaches have been used to repair meniscal tears. Of the approaches, the all-inside approach has historically been avoided for tears to the posterior aspect of the lateral meniscus (LM) due to the risk of popliteal and common peroneal neurovascular injury., Case Report: We reviewed the electronic medical records of all patients who underwent all-inside LM repair by our senior author from August 2022 through August 2023. Demographic, injury, and surgical data were collected to characterize surgical success and any complications attributed to the surgical approach. A literature review of MEDLINE was performed to investigate the current data regarding the all-inside approach and identify methods for improving safety and efficacy. Two cases were identified (one male and one female) who underwent all inside repair of the LM. No surgical complications were attributed to suture selection or placement, and no damage to the popliteal neurovascular structures was identified., Conclusion: The all-inside approach is a safe arthroscopic approach for the repair of the LM. The current literature demonstrates multiple considerations and guidelines to mitigate the risk of neurovascular injury and supports the efficacy of the all-inside approach when compared to other surgical approaches., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Introduction: Bacteria can enter the bloodstream through simple actions such as brushing teeth, flossing, and even chewing food, increasing the chance of hematogenous seeding of prosthetic joints. Antibiotics before dental work in patients with orthopedic hardware is a topic of debate because of concerns for antibiotic resistance. Patients with dentures theoretically avoid this risk due to the lack of teeth and their maintenance. Most periprosthetic joint infections (PJIs) that occur in the first six months after surgery are due to wound infection, whereas late PJIs are more commonly caused by hematogenous seeding., Materials and Methods: Charts from patients who received primary total joint arthroplasty were interrogated for the condition of their teeth at the time of operation. If the patient had a PJI, the time from surgery and the organism responsible were noted. Multivariate linear regressions were performed for statistical analysis to compare rates of dental status, infection, comorbidities, and demographics., Results: From the 1,500 charts reviewed, patients with teeth and edentulous had similar rates of comorbidities. PJI patients had higher rates of chronic kidney disease than patients who did not have the infection. The overall rate of infections in patients with teeth was 2.14%, close to the national average. The rate of infection in patients without teeth was 0.78%. Patients with teeth have a higher rate of infection one month or longer from surgery than edentulous patients., Conclusions: There was an increased infection rate in patients with teeth at six months and greater since the primary total joint arthroplasty. The organisms responsible for many of the PJIs are commonly found in the mouth of humans. Having teeth is a potential risk factor for late PJI., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The University of Toledo issued approval 301280-UT. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Brenner et al.)

The meniscus is an essential component of the knee joint, acting as a shock absorber as well as assisting in the transmission of forces. Due to the meniscus importance of the knee, much of the current literature focuses on treatment techniques that can spare and repair the meniscus when it is torn. The unique vasculature of the meniscus often makes repair difficult or, in many cases, impossible. A current focus within orthopedics has been on meniscal allograft transplantation to fill this gap. The lack of a universal surgical technique for graft fixation, along with the current failure rates, demonstrates the need for further improvements. The senior author proposes a novel technique for meniscal allograft transplantation that has shown decreased blood loss and surgical time, while also reducing intra-operative trauma to the knee. This case reports a 16-year-old patient who underwent a right lateral meniscal allograft transplant following a large segmental defect tear of the lateral meniscus. The patient initially underwent arthroscopy and meniscectomy with screw fixation of the lateral femoral condyle lesion. After physical therapy, the patient experienced increased pain and swelling, with magnetic resonance imaging (MRI) demonstrating a meniscal defect unamenable to repair. The patient met indications for meniscal allograft transplantation given the failed meniscectomy, absence of cartilage loss and significant osteoarthritis, and the patient's age of less than 50 years old., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Yatsonsky et al.)

Introduction: Cryptococccus neoformans is a fungus which typically presents in immunocompromised hosts, commonly presenting as meningoencephalitis. There have been very few documented incidents of intramuscular manifestations of this pathogen., Case Report: We report on a case of a 45-year-old caucasian male with disseminated Cryptococcus neoformans who developed cryptococcal intramuscular abscesses of all extremities and osteomyelitis of the left upper limb. Clinical treatment and surgical debridement of the forearm was performed. Persistent infection resulted in a left humeral amputation and ultimately the patient's death. This is one of the few documented intramuscular abscesses of Cryptococcus neoformans., Conclusion: Orthopedic manifestations of cryptococcal infections are rare; however, awareness and prompt diagnosis may improve outcomes., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Modular dual mobility total hip arthroplasty (THA) can be associated with complications if the liner is malseated, which can be unappreciated intraoperatively. A meticulous surgical technique is needed to ensure that the liner is perfectly seated. In addition, a malseated liner can be missed if the postoperative films are not carefully reviewed by the surgeon. We present three cases of THA associated with a malseated modular dual mobility liner. In one case, the malpositioned liner was appreciated intraoperatively, but it was wedged in place and could not be removed. The entire shell needed to be revised. In two other cases, malseating was not detected intra-operatively. Both were appreciated postoperatively, and early revision surgery was needed., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Gerber et al.)

Introduction: The association between rhabdomyolysis secondary to traumatic crush injuries and the resultant acute kidney injury has been well described . The pathway of opioid overdose and acute kidney injury (AKI) has been documented but not fully elucidated. This process is believed to be multifactorial in its pathophysiology, but it remains obscure. Acidosis, systemic hypoxia, hypothermia, muscle compression, immunologic, or direct toxic effects have been identified as contributing factors to opioid-induced AKI. Musculoskeletal crush injuries account for one of the most common causes of rhabdomyolysis leading to AKI. However, the vast majority of crush injuries documented involve large regions of the body and most commonly involve the lower extremity. This is hypothesized to be due to the need for a considerable amount of muscle necrosis and sufficient myoglobinuria to cause AKI. There is a paucity of literature describing isolated upper extremity crush injuries severe enough to cause AKI. The case described herein outlines a patient who developed isolated right upper extremity compartment syndrome and resultant rhabdomyolysis leading to AKI in the setting of an opioid overdose., Case Report: Rhabdomyolysis may be caused by a variety of metabolic events. The pathophysiology of rhabdomyolysis secondary to acute crush injuries with resultant AKI is well documented. However, the literature describing cases of acute kidney injury caused by upper extremity compartment syndrome-induced rhabdomyolysis is limited. We present the case of a 33-year-old male who developed right upper extremity compartment syndrome after being incapacitated following an opioid overdose. He subsequently underwent emergent fasciotomies and was found to have an AKI secondary to rhabdomyolysis in the acute post-operative period., Conclusion: This case describes a patient who was found to have isolated right upper extremity compartment syndrome and subsequent rhabdomyolysis, which resulted in AKI following an opioid overdose. This case highlights that an isolated incidence of upper extremity rhabdomyolysis is sufficient to cause acute kidney injury. The literature describing this pathology in isolated upper extremity injuries is limited as this phenomenon is typically encountered in the setting of lower extremity compartment syndrome.The pathophysiology and mechanism of this pathology are of particular importance to the fields of orthopedic surgery, nephrology, and internal medicine. This case highlights the need for early and adequate fluid resuscitation in patients with isolated upper extremity injuries to minimize the risk of subsequent AKI., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)