Posttraumatic Amputations Epidemiology and Outcomes Within the National Trauma Data Bank: Improved Survival Over Time Results in Increased Population in Need of Rehabilitation Support.

Objective: Acute trauma care has significantly reduced mortality over the last two decades. The last study to examine the epidemiology of traumatic amputees predates these gains. The majority of those who sustain traumatic amputation are male; therefore, limited data exist on female amputees.

Resident Perceptions of Virtual Reality Versus Dry Lab Simulation for Advanced Shoulder Arthroscopy Resident Training.

Introduction: Surgical training using simulation can fill gaps in traditional surgical residency learning. We hypothesize that arthroscopy training conducted on a virtual reality simulator will be preferred by orthopaedic surgery residents over a traditional dry lab simulation model.

Methods: 38 orthopaedic surgery residents at a single U.

Diversity and Inclusion in Orthopaedic Surgery from Medical School to Practice: AOA Critical Issues.

Orthopaedic surgery has historically been one of the least diverse fields in medicine in the U.S. Despite having been declared a critical issue by the American Orthopaedic Association, a lack of diversity and inclusion across all metrics remains a persistent problem.

Sexual Dimorphisms in Anterior Cruciate Ligament Injury: A Current Concepts Review.

Background: Although most anterior cruciate ligament (ACL) injuries occur in male athletes, female athletes are consistently observed to be at a higher risk for sports-specific ACL injury.

Purpose: To provide a thorough review of what is known about the sexual dimorphisms in ACL injury to guide treatment and prevention strategies and future research.

Study Design: Narrative review.

Shoulder Arthroscopy Simulator Training Improves Surgical Procedure Performance: A Controlled Laboratory Study.

Background: Previous simulation studies evaluated either dry lab (DL) or virtual reality (VR) simulation, correlating simulator training with the performance of arthroscopic tasks. However, these studies did not compare simulation training with specific surgical procedures.

Purpose/hypothesis: To determine the effectiveness of a shoulder arthroscopy simulator program in improving performance during arthroscopic anterior labral repair.

How Common Are Civilian Blast Injuries in the National Trauma Databank, and What Are the Most Common Mechanisms and Characteristics of Associated Injuries?

Background: Recent military conflicts have produced substantial improvements in the care of service members who experience blast injuries. As conflicts draw down, it is important to preserve and improve skills gained in combat. It is unknown whether civilian blast injuries can serve as a surrogate for military blast trauma.

Sex differences in neuromuscular control of quadriceps.

Purpose: Patellofemoral pain syndrome (PFPS) is twice as prevalent in females as males, yet a few studies have evaluated differences in quadriceps muscle control between sexes or across force levels. This study investigated sex differences in quadriceps EMG onset times and amplitude at different force levels during isometric knee extension in asymptomatic males and females and in females with PFPS.

Methods: Thirteen healthy males, 12 healthy females, and 10 females with PFPS performed isometric knee extension ramp contractions at 25%, 50%, and 75% of maximal voluntary contraction (MVC).

Sexual Dimorphic Features Associated with Femoroacetabular Impingement.

Sexual dimorphism describes differences in biologic response between males and females due to inherent chromosomal differences. These differences similarly affect orthopaedic-related injuries and treatment outcomes as seen with femoroacetabular impingement, an abnormal hip morphology where females have shown worse hip function scores than male counterparts before and after surgery. Potential dimorphic factors that increase susceptibility of females to injury and/or worse outcomes may include joint laxity, hip morphology, and osseous biology.

Acute Extremity Compartment Syndrome and the Role of Fasciotomy in Extremity War Wounds.

Acute compartment syndrome (CS) is a frequent and potentially devastating complication of blunt and penetrating extremity injuries. Extremity war injuries are particularly susceptible to CS due to associated vascular injuries; high Injury Severity Score; extensive bone and soft tissue injury; and frequent transportation that may limit close monitoring of the injured extremity. Treatment consists of prompt fasciotomy of all compartments in the involved segment, over their full length.

Pelvic Fracture Care.

While combat-related pelvis fractures are more commonly open, higher energy, and complex in pattern than those seen in the civilian setting, the principles of management are similar. The primary differences are related to the austere setting in which the initial management takes place, and the lack of resources typically available. Initial management consists of cessation of hemorrhage, along with the multi-disciplinary prioritized management of associated injuries, and skeletal stabilization.

Hydration Strategies for the Female Tactical Athlete.

With unprecedented expansion of the roles of women in the military and the longest period of continuous active combat in US history, it is time that research expanded, including the nutritional and hydration requirements of the female tactical athlete. Dehydration has a negative effect on athletic performance, most significantly in high intensity, aerobic endurance activities. There is evidence female athletes may be more prone to the potentially lethal effects of over hydration.

Sex-based Differences in Common Sports Injuries.

The patient's sex plays an important role in mediating the risk for, and experience of, disease. Injuries of the musculoskeletal system are no exception to this phenomenon. Increasing evidence shows that the incidence, clinical presentation, and treatment outcomes for male and female patients with common sports injuries may vary widely.

An Impaled Potential Unexploded Device in the Civilian Trauma Setting: A Case Report and Review of the Literature.

Background: The management of patients with impaled unexploded devices is rare in the civilian setting. However, as the lines of the traditional battlefield are blurred by modern warfare and terrorist activity, emergency providers should be familiar with facility protocols, plans, and contact information of their local resources for unexploded devices.

Case Report: A 44-year-old male sustained a close-proximity blast injury to his lower extremities while manipulating a mortar-type firework.

A randomized controlled trial evaluating methylsulfonylmethane versus placebo to prevent knee pain in military initial entry trainees.

Background: Methylsulfonylmethane (MSM) is a naturally occurring sulfur containing substance that has been shown to have anti-inflammatory and antioxidative properties. Previous studies using MSM as an oral supplement to improve pain in those patients with knee osteoarthritis have shown superiority compared to placebo. However, these studies are not translatable to active individuals performing high impact activities and have not evaluated MSM as a preventative measure.

Characteristics of US combat veterans (2001-2011) who remain on active duty after upper extremity amputations.

Objectives: Return to duty following traumatic amputations has been extensively studied in those with lower extremity amputation. As upper extremity amputations occur less frequently, the issue of return to duty for those with upper extremity amputations has received relatively little research. The purpose of this study was to determine the rate at which service members remain on active duty at least one year after having sustained traumatic upper extremity amputations during Operation Iraqi Freedom, Operation Enduring Freedom, and other overseas contingency operations of the Global War on Terrorism.

Multimedia Campaign Enhances Orthopaedic Patient Perceptions of Health Care Quality: A Prospective Analysis of Effect at a Military Treatment Facility.

Background: The importance of patient satisfaction as a measure of quality has grown with initiatives intended to enhance demand for services, refocus reimbursement paradigms, encourage health care efficiencies, and ultimately improve clinical outcomes. The purpose of our performance improvement project was to (1) characterize the effect of a two-pronged multimedia initiative on patient perceptions of health care quality and satisfaction as assessed by the Army Provider Level Satisfaction Survey (APLSS) and (2) assess for differences in APLSS scores between the surgeons that did and did not participate in the program.

Methods: Baseline APLSS data for our Department of Orthopaedic Surgery were collected and subsequently compared to APLSS results 3 months after the implementation of a department-wide multimedia campaign.

A Process Improvement Evaluation of Sequential Compression Device Compliance and Effects of Provider Intervention.

This process improvement study sought to evaluate the compliance in orthopaedic patients with sequential compression devices and to monitor any improvement in compliance following an educational intervention. All non-intensive care unit orthopaedic primary patients were evaluated at random times and their compliance with sequential compression devices was monitored and recorded. Following a 2-week period of data collection, an educational flyer was displayed in every patient's room and nursing staff held an in-service training event focusing on the importance of sequential compression device use in the surgical patient.

Cost Savings and Patient Experiences of a Clinic-Based, Wide-Awake Hand Surgery Program at a Military Medical Center: A Critical Analysis of the First 100 Procedures.

Purpose: Wide-awake, local anesthesia, no tourniquet (WALANT) hand surgery was developed to improve access to hand surgery care while optimizing medical resources. Hand surgery in the clinic setting may result in substantial cost savings for the United States Military Health Care System (MHS) and provide a safe alternative to performing similar procedures in the operating room.

Methods: A prospective cohort study was performed on the first 100 consecutive clinic-based WALANT hand surgery procedures performed at a military medical center from January 2014 to September 2015 by a single hand surgeon.

Reliability of Casting Indices Among Members of an Orthopaedic Surgery Residency.

Background: Multiple casting indices have been described to evaluate the adequacy of cast placement in pediatric distal forearm fractures. The aim of this study was to determine the intrarater and interrater reliability of the measurements of 5 common casting indices among members of an orthopaedic surgery residency program. The cast index, 3-point index, gap index, padding index, and Canterbury index were evaluated.