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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The purpose of this study was to determine the efficacy of nonopioid pain management following arthroscopic partial meniscectomy and/or chondroplasty and to assess patients' attitudes regarding their need for opioid pain medication following these procedures. Patients who underwent a knee arthroscopy procedure for either partial meniscectomy and/or chondroplasty from July 2016 to January 2017 by a single surgeon at a single institution were included. Medical records were reviewed, and demographics were recorded. ⋯ Three of 6 patients requiring opioids were unable to take nonsteroidal anti-inflammatory drugs. All 6 patients who took opioids felt that they needed them for adequate pain control. This study provides initial encouragement that it is largely possible to remove opioids from the postoperative pain regimen of knee arthroscopy patients and maintain adequate pain control and patient satisfaction. [Orthopedics. 2018; 41(4):209-214.].
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The purpose of this study was to determine the proportion of questions used by online physician rating scales to directly rate physicians themselves. A systematic review was performed of online, patient-reported physician rating scales. ⋯ Overall, 28% directly rated the physician, 48% rated both the physician and the office, and 24% rated the office alone. There is great variation in the questions used, and most fail to directly rate physicians themselves. [Orthopedics. 2018; 41(4):e445-e456.].
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Using Ceramic-on-Ceramic Bearings in Total Hip Arthroplasty Necessitating 44- or 46-mm Metal Shells.
Ceramic-on-ceramic articulation shows the lowest wear, with a low incidence of osteolysis. A small cup limits options regarding liner thickness and femoral implant size. The purpose of this study was to evaluate the safety of a 4-mm-thick ceramic liner and the outcomes of cementless total hip arthroplasty using a 44- or 46-mm metal shell and a ceramic-on-ceramic bearing at mid- to long-term follow-up. ⋯ Two hips underwent revision because of periprosthetic fractures. The survival rates of the acetabular cups and the femoral stems were 100% and 97.4%, respectively. The thin (4 mm) ceramic liner did not increase the risk of ceramic fracture and did not affect the mid- to long-term results and survival of cementless total hip arthroplasty using 44- or 46-mm metal shells. [Orthopedics. 2018; 41(3):e354-e359.].
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Comparative Study
Mini-Fragment Fixation Is Equivalent to Bicortical Screw Fixation for Horizontal Medial Malleolus Fractures.
Horizontal fractures of the medial malleolus occur through application of valgus or abduction force through the ankle that creates a tension failure of the medial malleolus. The authors hypothesize that mini-fragment T-plates may offer improved fixation, but the optimal fixation construct for these fractures remains unclear. Forty synthetic distal tibiae with identical osteotomies were randomized into 4 fixation constructs: (1) two parallel unicortical cancellous screws; (2) two parallel bicortical cortical screws; (3) a contoured mini-fragment T-plate with 2 unicortical screws in the fragment and 2 bicortical screws in the shaft; and (4) a contoured mini-fragment T-plate with 2 bicortical screws in the fragment and 2 unicortical screws in the shaft. ⋯ The mean stiffness values of both mini-fragment T-plate constructs and the bicortical screw construct were higher than that of a parallel unicortical screw construct (102±20 N/mm). Contoured T-plate constructs provide stiffer initial fixation than a unicortical cancellous screw construct. The T-plate is biomechanically equivalent to a bicortical screw construct, but may be superior in capturing small fragments of bone. [Orthopedics. 2018; 41(3):e395-e399.].