The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Dec 2014
A survey of resident perspectives on surgical case minimums and the impact on milestones, graduation, credentialing, and preparation for practice: AOA critical issues.
Residency education continues to evolve. Several major changes have occurred in the past several years, including emphasis on core competencies, duty-hour restrictions, and call. The Accreditation Council for Graduate Medical Education (ACGME) Next Accreditation System (NAS) implemented educational milestones in orthopaedic surgery in July 2013. ⋯ The development of the milestones to assess competency should continue, but, as surgical skill is not a specific core competency, perhaps other methods for assessing surgical proficiency need to be developed rather than case minimums. Surgical skills laboratories and proctoring residents independently performing procedures may help to assess surgical proficiency, in addition to traditional faculty and 360° evaluations. Combining these types of assessments with surgical case logs documenting the residents' educational experience seems to be the best path going forward in assessing the development of young surgeons.
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J Bone Joint Surg Am · Dec 2014
Randomized Controlled Trial Comparative StudyComparative study of the treatment outcomes of osteoporotic compression fractures without neurologic injury using a rigid brace, a soft brace, and no brace: a prospective randomized controlled non-inferiority trial.
The efficacy of brace application for the treatment of osteoporotic compression fractures remains unclear. The purpose of this study was to compare the treatment outcomes in patients with osteoporotic compression fractures with regard to whether the patients had no braces, rigid braces, or soft braces. ⋯ Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Dec 2014
Eccentric rotational acetabular osteotomy for acetabular dysplasia and osteoarthritis: follow-up at a mean duration of twenty years.
The aim of the eccentric rotational acetabular osteotomy is to correct the deficient acetabular coverage in the dysplastic hip in order to limit the development of secondary osteoarthritis. The purpose of this study was to investigate the results in patients managed with an eccentric rotational acetabular osteotomy after a mean of twenty years. ⋯ Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Dec 2014
Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates.
The aim of this study was to analyze NSQIP (National Surgical Quality Improvement Program) data to better understand the incidence, risk factors, and thirty-day complication rates associated with transfusions in primary total hip and knee arthroplasty. ⋯ Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Dec 2014
Variability in spine surgery procedures performed during orthopaedic and neurological surgery residency training: an analysis of ACGME case log data.
Current spine surgeon training in the United States consists of either an orthopaedic or neurological surgery residency, followed by an optional spine surgery fellowship. Resident spine surgery procedure volume may vary between and within specialties. ⋯ Spine surgery procedure volumes in orthopaedic and neurosurgery residency training programs vary greatly both within and between specialties. Although orthopaedic surgery residents had an increase in the number of spine procedures that they performed from 2009 to 2012, they averaged less than half of the number of spine procedures performed by neurological surgery residents. However, orthopaedic surgery residents appear to have greater exposure to spinal deformity than neurosurgery residents. Furthermore, orthopaedic spine fellowship training provides additional spine surgery case exposure of approximately 300 to 500 procedures; thus, before entering independent practice, when compared with neurosurgery residents, most orthopaedic spine surgeons complete as many spinal procedures or more. Although case volume is not the sole determinant of surgical skills or clinical decision making, variability in spine surgery procedure volume does exist among residency programs in the United States.