Orthopedics
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In recent years, there has been an increasing trend toward subspecialization in orthopedic surgery via fellowships. This study sought to characterize sex, ethnic, and racial representation within each fellowship program and to examine their changes over time to identify trends and/or gaps. Demographic data were obtained from the National Graduate Medical Education Census. ⋯ Asian and female fellows preferred specific subspecialties over others. These data are presented as an initial step in determining factors that attract minority groups to different orthopedic subspecialties. Further research should define specific factors and identify ways to increase minority distribution among fellowship programs. [Orthopedics. 2018; 41(5):282-288.].
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Although total hip arthroplasty and total knee arthroplasty commonly overlap, there are concerns about the safety and quality of this scenario. The objectives of this study were to (1) compare the operative time and the incidence of 90-day complications between overlapping and nonoverlapping total joint arthroplasties; and (2) evaluate the effect of the duration of overlap on operative time and the incidence of 90-day complications. A total of 9192 patients who underwent primary total hip arthroplasty or total knee arthroplasty at a large academic hospital from 2005 to 2014 were identified. ⋯ Operative times increased with increasing duration of overlap (P<.001); however, there was no association between duration of overlap and 90-day complications (P>.05 for all). Although overlapping surgeries had increased operative times, they did not appear to increase the risk of perioperative complications. This information may be helpful for scheduling overlapping procedures and counseling patients. [Orthopedics. 2018; 41(5):e695-e700.].
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A recent study that evaluated the risk of facing a malpractice claim by physician specialty found that orthopedic surgeons were at a significantly greater risk of being sued than other medical specialists. To date, no studies have characterized trends in orthopedic surgery malpractice claims. The Westlaw legal database was used to locate state and federal jury verdicts and settlements related to medical malpractice and orthopedic surgery from 2010 to 2016. ⋯ The jury found in favor of the defendant orthopedic surgeon in most cases. Procedural error and/or negligence were cited most commonly by the plaintiffs as the bases for the claims. Verdicts in favor of the plaintiffs resulted in payouts nearly double those of settlements. [Orthopedics. 2018; 41(5):e615-e620.].
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Comparative Study
A Biomechanical Study of an Alternative Internal Fixation Method for Transverse Patella Fractures.
Pain and reoperation after fixation using tension band wiring and K-wires is not uncommon. A novel hook plate was designed to improve the treatment of patella fractures. The aim of this study was to compare the stability of the hook plate with that of tension band wiring and K-wires in a simulated patellar transverse fracture model (AO/OTA classification 34-C1.1). ⋯ Six of 8 specimens in the tension band wiring and K-wires group met the failure criterion of fracture gap greater than 2 mm vs 1 in the hook plate group (P=.041). From a biomechanical point of view, the hook plate is a valid alternative to tension band wiring and K-wires for fixing patella transverse fractures. Compared with tension band wiring and K-wires, the hook plate may have superior ability in sustaining a reduced transverse patella fracture. [Orthopedics. 2018; 41(5):e643-e648.].
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Randomized Controlled Trial Comparative Study
A Comparison of Clinical and Radiological Outcomes of Minimally Invasive and Conventional Plate Osteosynthesis for Midshaft Clavicle Fractures.
Thirty patients with displaced midshaft clavicle fractures were prospectively enrolled in this study. Fifteen were randomly assigned to the minimally invasive plate osteosynthesis group and 15 to the conventional plate osteosynthesis group. Constant score, visual analog scale satisfaction score, operative time, scar length, and complications, including hypoesthesia, were evaluated at least 1 year postoperatively to determine functional outcomes and time to bone union as a radiological outcome. ⋯ In the minimally invasive plate osteosynthesis group, time to bone union was significantly correlated with the gap interval (P=.004) and the number of fracture fragments (P=.002). Minimally invasive plate osteosynthesis showed some superiority over conventional plate fixation for midshaft clavicle fractures, having a shorter operative time and scar length. The time to bone union was influenced by the reduction status and the number of fracture fragments in the minimally invasive plate osteosynthesis group. [Orthopedics. 2018; 41(5):e649-e654.].