Innovating Flexor Tendon Repair Training with a Three-dimensional Printed Model.

Background: Flexor tendon repair is a technically demanding procedure, with functional outcome directly proportional to skillful execution. A repair must be strong to manage early mobilization and precise to allow for gliding through the tendon sheath. As a result, junior residents face a steep learning curve that may be mitigated by exposure to surgical simulators.

Comparison of Adult Female and Male PMHS Pelvis and Lumbar Response to Underbody Blast.

The goal of this study was to gather and compare kinematic response and injury data on both female and male whole-body Post-mortem Human Surrogates (PMHS) responses to Underbody Blast (UBB) loading. Midsized males (50th percentile, MM) have historically been most used in biomechanical testing and were the focus of the Warrior Injury Assessment Manikin (WIAMan) program, thus this population subgroup was selected to be the baseline for female comparison. Both small female (5th percentile, SF) and large female (75th percentile, LF) PMHS were included in the test series to attempt to discern whether differences between male and female responses were predominantly driven by sex or size.

A comparison of fracture response in female and male lumbar spine in simulated under body blast component tests.

Underbody blasts (UBB) from mines and improvised explosive devices in military combat can cause debilitating spine injuries to vehicle mounted soldiers. Due to the exclusion of females in combat roles in prior US Department of Defense policy, UBB exposure and injury have predominantly affected male soldiers. Recent policy changes have opened many combat roles to women serving in the US Military (Carter, 2015) and have increased the need to understand the injury potential for female Warfighters.

Up Front and Open? Shrouded in Secrecy? Or Somewhere in Between? A Meta-Research Systematic Review of Open Science Practices in Sport Medicine Research.

To investigate open science practices in research published in the top 5 sports medicine journals from May 1, 2022, and October 1, 2022. A meta-research systematic review. Open science practices were searched in MEDLINE.

Barriers and facilitators to implementation of musculoskeletal injury mitigation programmes for military service members around the world: a scoping review.

Introduction: Musculoskeletal injury (MSK-I) mitigation and prevention programmes (MSK-IMPPs) have been developed and implemented across militaries worldwide. Although programme efficacy is often reported, development and implementation details are often overlooked, limiting their scalability, sustainability and effectiveness. This scoping review aimed to identify the following in military populations: (1) barriers and facilitators to implementing and scaling MSK-IMPPs; (2) gaps in MSK-IMPP research and (3) future research priorities.

Patient-Reported Outcomes and Reoperation Rates Following Lumbar Tubular Microdecompression: Six-year Follow-Up.

Study Design: Prospective cohort study.

Objective: To report reoperation rates after lumbar tubular microdecompression (LTM) and to compare patient-reported outcomes (PROs) six years after surgery between those who did and did not need revision at the index level.

Summary Of Background Data: Long-term data describing PROs and reoperation rates after LTMs are lacking.

Distal Radius Fractures and Bone Health: A Survey of Hand Surgeons.

Following low-energy distal radius fractures (DRF) patients rarely receive a bone health evaluation. The purpose of this survey was to investigate the attitudes and practices of American Society for Surgery of the Hand (ASSH) members regarding osteoporosis and low-energy DRF. An electronic survey was sent to 4,125 members of the ASSH.

An Innovative Seven-year Physician Scientist Residency Training Program That Addresses the Shortage of Academic Surgeons.

Due to the declining number of scientifically trained physicians and increasing demand for high-quality literature, our institution pioneered a seven-year Physician Scientist Training Program (PSTP) to provide research-oriented residents the knowledge and skills for a successful academic career. The present study sought to identify orthopaedic surgeons with MD/PhD degrees, residency programs with dedicated research tracks, and to assess the effectiveness of the novel seven-year program in training prospective academic orthopaedic surgeons. Surgeons with MD/PhD degrees account for 2.

Orthopaedic Surgery Training in North Carolina: The Impact of The Flexner Report and The Sherman Antitrust Act.

The current medical schools and orthopaedic residency programs in the state of North Carolina have evolved based upon geopolitical, economic events, historical reports and regulations. The American Medical Association Committee on Medical Education, the Flexner Report and the Sherman Antitrust Act and their recommendations were codified by state regulatory agencies and state law. These important pressures created the programs as they are known today.

Medical Students' Perceptions and Retention of Skills From Active Resilience Training.

Background And Objectives: Medical students face difficult transitions throughout their training that increase their risk of burnout. Resiliency training may prepare students to better face the demands of their medical careers. This project is an initial investigation into medical students' long-term utilization of learned resiliency skills.

Lumbopelvic postural differences in adolescent idiopathic scoliosis: A pilot study.

Background: A primary etiology of adolescent idiopathic scoliosis (AIS) is currently unknown, but poor postural control of the spinal extensor musculature has been identified as an AIS risk factor. Identifiable postural differences would aid in advancing the precise postural behaviors that should be modified during Physiotherapy Scoliosis Specific Exercise (PSSE) to help limit the progression of AIS.

Research Question: Are there any determinable differences in lumbopelvic posture or range of motion between subjects with AIS and controls?

Methods: This prospective cohort pilot study consisted of 53 subjects (27 AIS and 26 control) aged 11-17 years.

Contributions of Pubic Rami Fracture Morphology and Fixation to Pelvic Ring Stability in Type 1 Lateral Compression Injuries: A Biomechanical Cadaveric Study.

Background: Treatment of lateral compression type 1 (LC-1) injuries has historically been nonoperative with immediate weight-bearing. However, management of these injuries remains controversial, with reports of displacement at follow-up for nonoperatively managed LC-1 fractures. The goal of our study was to determine the effect of superior pubic ramus fracture morphology and fixation construct on pelvic stability.

Verification of High-Rate Vertical Loading Laboratory Skeletal Fractures by Comparison with Theater Injury Patterns.

For the current study, an existing theater injury data set was compared to component and whole body experiments meant to replicate the theater high rate vertical loading environment. The theater injury data set was derived from real world events that were within the design range of the Warrior Injury Assessment Manikin. A qualitative and quantitative assessment of the whole body fracture patterns was developed to determine whether the laboratory loading was correctly representing the resulting injuries seen in theater Underbody Blast (UBB) events.

Lower Extremity Impact and Injury Responses of Male and Female PMHS to High-Rate Vertical Loading.

Whole-body PMHS (Post Mortem Human Surrogate) testing was conducted on the Accelerative Loading Fixture (ALF), which is designed to generate floor and seat loading conditions at the level, rate, location, direction, and extent seen in UBB (Underbody Blast). The overarching goal of this research effort was to examine potential differences in the lower extremity response of females and males under UBB conditions. The ALF consists of an occupant platform that is driven upward by the detonation of an explosive charge.

Methodology for Evaluation of WIAMan Injury Assessment Reference Curves Using Whole Body Match-Paired Data.

Development of the Warrior Injury Assessment Manikin (WIAMan) capability has included the creation of injury assessment reference curves (IARCs) specific to under-body blast (UBB) loading mechanisms and injuries. The WIAMan IARCs were created from high-rate vertical loading tests of component post-mortem human surrogates (PMHS) and analogous components of the WIAMan anthropomorphic test device (ATD). Validation of the WIAMan IARCs is required prior to the WIAMan ATD being utilized for injury assessment in live-fire vehicle test events.

Improved osseointegration using porcine xenograft compared to demineralized bone matrix for the treatment of critical defects in a small animal model.

Background: Autograft (AG) is the gold standard bone graft due to biocompatibility, osteoconductivity, osteogenicity, and osteoinductivity. Alternatives include allografts and xenografts (XG).

Methods: We investigated the osseointegration and biocompatibility of a decellularized porcine XG within a critical defect animal model.

Forward Surgical Teams as a Model for Humanitarian Orthopedic Surgical Care: A Review of Current Literature.

Introduction: Orthopedic trauma is a significant portion of global burden of disease in low- and middle-income countries (LMICs). This has led the World Health Organization to advocate for increased surgical intervention in LMICs. The two largest barriers to orthopedic surgical care for LMICs are cost of procedure and geographic access to centers with appropriate surgical capabilities.

Newer generation of proximal tibia locking plates demonstrate large variability in their ability to capture the posteromedial fragment in bicondylar tibial plateau fractures.

Introduction: The early generations of proximal tibial locking plates demonstrated inferior results when compared to dual plating in bicondylar tibial plateau fractures with posteromedial fragments (PMF). Modern plates have multiple rows of locking screws and variable angle technology -which tote the ability to capture the PMF. The purpose of this study was to determine if the modern plates could capture the PMF in a large series of bicondylar tibial plateau fractures.

The Effect of the Strengthen Opioid Misuse Prevention Act on Opiate Prescription Practices Within the Orthopaedic Surgery Department of an Academic Medical Center.

Unlabelled: In 2017, the Department of Health and Human Service declared a public health emergency known as the opioid crisis. In North Carolina, the "Strengthen Opioid Misuse Prevention Act of 2017" (STOP Act) went into effect on January 1, 2018, seeking to strengthen oversight over opioid prescriptions. Among other mandates, this legislation limited the duration of the initial prescription to 5 or 7 days.

Comparing the Efficiency, Radiation Exposure, and Accuracy Using C-Arm versus O-Arm With 3D Navigation in Placement of Transiliac-Transsacral and Iliosacral Screws: A Cadaveric Study Evaluating an Early Career Surgeon.

Objectives: To compare the efficiency, radiation exposure to surgeon and patient, and accuracy of C-arm versus O-arm with navigation in the placement of transiliac-transsacral and iliosacral screws by an orthopaedic trauma fellow, for a surgeon early in practice.

Methods: Twelve fresh frozen cadavers were obtained. Preoperative computed tomography scans were reviewed to assess for safe corridors in the S1 and S2 segments.

Optimizing the Double-Row Construct: An Untied Medial Row Demonstrates Equivalent Mean Contact Pressures in a Rotator Cuff Model.

Background: The merits of a double-row rotator cuff repair (RCR) construct are well-established for restoration of the footprint and lateral-row security. The theoretical benefit of leaving the medial row untied is to prevent damage to the rotator cuff by tissue strangulation, and the benefit of suture tape is a more even distribution of force across the repair site. These benefits, to our knowledge, have not been evaluated in the laboratory.

Investigating the Osteoinductive Potential of a Decellularized Xenograft Bone Substitute.

Bone grafting is the second most common tissue transplantation procedure worldwide. One of the alternative methods for bone repair under investigation is a tissue-engineered bone substitute. An ideal property of tissue-engineered bone substitutes is osteoinductivity, defined as the ability to stimulate primitive cells to differentiate into a bone-forming lineage.

Effects of tissue culture on the biomechanical properties of porcine meniscus explants.

Background: The meniscus is critical for the normal functioning of the knee joint. The specific aim of this study was to validate an in vitro culture model of meniscus explants for testing the impact of culture conditions on meniscus biomechanical properties. We hypothesized that culturing menisci in the presence of intermediate and high concentration of serum would have a positive effect on the compressive stiffness of the meniscus.

Development of a Homemade Spinal Model for Simulation to Teach Ultrasound Guidance for Lumbar Puncture.

Background: Spinal procedures such as lumbar punctures (LPs), epidurals, and spinal blocks are essential components to clinical practice but are challenging to teach, learn, or practice on real patients due to patient safety and comfort limiting the number of attempts. Resident physicians traditionally learn these spinal procedural skills through observation of a more senior physician before attempting the procedure. Simulation using models can improve providers' competency without introducing an added risk to patients.

A Military Case Review Method to Determine and Record the Mechanism of Injury (BioTab) from In-Theater Attacks.

A recent study of all mounted vehicle underbody blast attacks found that 21% of Abbreviated Injury Scale Severity 2+ injuries in the Joint Trauma Analysis and Prevention of Injury in Combat network were injuries to the leg and ankle. To develop effective countermeasure systems for these attacks, the epidemiology and mechanisms of injury from this loading environment need to be quantified. The goal of this study was to develop a military correlate of an existing civilian case review framework, the Crash Injury Research and Engineering Network (CIREN), to consider the differences in military event types and the amount of available vehicle/attack information.