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.

Bad to the bone. Not all bone tumors are cancer: Case of long bone osteomyelitis.

Long bone osteomyelitis could mimic bony tumor in clinical presentation and imaging studies. We present a case of a 47-year man who presented with leg pain, weight loss and night sweats that initially was thought to be related to osteosarcoma, later suffered a pathologic fracture from osteomyelitis. This case highlights the importance of source control of infection and careful clinical evaluation including radiographic and pathologic findings that can help physicians to differentiate between competing diagnoses.

Improving the Patient Experience During Care in the Orthopedic Cast Room.

Patients regularly have casts, splints, and wounds that require attention in the clinic. Patients commonly experience anxiety and pain during such visits. We hypothesized that aromatherapy and music would improve these patients' pain and anxiety when compared with no exposure.

Motorized Intramedullary Nail Lengthening in the Older Population.

Limb lengthening has not been widely employed in the elderly population due to concerns that outcomes will be inferior. The purpose of this multicenter, retrospective case-control series was to report the bone healing outcomes and complications of lower limb lengthening in older patients (≥60 years) using magnetic intramedullary lengthening nail (MILN). Our hypothesis was that healing parameters including consolidation days, the consolidation index, maturation days, and the maturation index, as well as the number of adverse events reported in the older population, would be no different to those of the general adult population.

Musculoskeletal Conditions and Secondary Cardiovascular Morbidity Increase Veterans' Rehabilitation and Orthopaedic Service Utilization.

Background Musculoskeletal conditions often affect patients' mobility and ability to participate in health behaviors such as exercise, potentially affecting their systemic health. The purpose of this research is to determine how frequently cardiac-related comorbidities present in a veteran population with musculoskeletal service-connected disability and how this affects musculoskeletal health care utilization.  Methodology A retrospective cohort of Iraq and Afghanistan Veterans who received a Veterans Affairs (VA) disability determination for service-connected musculoskeletal disability were categorized according to the diagnosis of cardiac comorbidity including diabetes mellitus, hyperlipidemia, hypertension, and obesity, and atherosclerosis disease documented by ICD-9 codes in the VA administrative data.

Intramedullary Canal Injection of Vancomycin- and Tobramycin-loaded Calcium Sulfate: A Novel Technique for the Treatment of Chronic Intramedullary Osteomyelitis.

Aim: In this study, we present a detailed surgical technique for treating chronic osteomyelitis (COM) of the intramedullary canal with injectable tobramycin and vancomycin-loaded calcium sulfate (CS).

Background: Chronic osteomyelitis of the long bones has been treated using antibiotic-impregnated polymethyl methacrylate (PMMA), which typically requires a second procedure for removal.

Technique: Removal of the infected intramedullary nail (if any), copious irrigation, canal reaming, and intramedullary canal injection of vancomycin- and tobramycin-loaded calcium sulfate as a single-stage procedure for the treatment of COM of long bones.

Using the articularis genu to test peri-articular muscle health during knee osteoarthritis.

Knee osteoarthritis (OA) involves peri-articular sarcopenia. The infrapatellar articularis genu (AG) links to the quadriceps femoris (QF) and can be sampled from discarded tissue during arthroplasty. We predict disuse-mediated changes in AG myofiber type ratio and atrophy similar to reports on the QF during OA.

Early Advanced Weight-Bearing After Periarticular Fractures: A Randomized Trial Comparing Antigravity Treadmill Therapy Versus Standard of Care.

In current clinical practice, weight-bearing is typically restricted for up to 12 weeks after definitive fixation of lower extremity periarticular fractures. However, muscle atrophy resulting from restricting weight-bearing has a deleterious effect on bone healing and overall limb function. Antigravity treadmill therapy may improve recovery by allowing patients to safely load the limb during therapy, thereby reducing the negative consequences of prolonged non-weight-bearing while avoiding complications associated with premature return to full weight-bearing.

Cognitive-Behavioral-Based Physical Therapy for Improving Recovery After Traumatic Orthopaedic Lower Extremity Injury (CBPT-Trauma).

Physical and psychological impairment resulting from traumatic injuries is often significant and affects employment and functional independence. Extremity trauma has been shown to negatively affect long-term self-reported physical function, the ability to work, and participation in recreational activities and contributes to increased rates of anxiety and/or depression. High pain levels early in the recovery process and psychosocial factors play a prominent role in recovery after traumatic lower extremity injury.

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.

What Is a Cytokine Storm and Should It Matter to Me?

The recent COVID-19 pandemic has brought attention to cytokines and the phenomenon of cytokine storm into mainstream discussions. In this disease specifically, a cytokine storm overwhelming immune response contributes to the pathophysiology and mortality of the COVID-19 infection. Analogous perturbed immune reactions are experienced in polytrauma patients, compromising local tissue healing while threatening multiple organ systems.

Intramedullary Antibiotic Depot Does Not Preclude Successful Intramedullary Lengthening or Compression.

The challenging problem of long bone infection and limb length difference cannot be addressed using only an antibiotic-coated nonmagnetic static nail. The combined use of resorbable calcium sulfate and magnetic lengthening nails offers a possible solution to this dilemma, as well as for infected nonunions that require compression. We present a combined technique to treat or prevent infection using femoral or tibial intramedullary antibiotic delivery with an absorbable calcium sulfate depot and concomitant internal lengthening or compression using a nail.

Early Fasciotomy and Limb Salvage and Complications in Military Lower Extremity Vascular Injury.

Background: Military guidelines endorse early fasciotomy after revascularization of lower extremity injuries to prevent compartment syndrome, but the real-world impact is unknown. We assessed the association between fasciotomy and amputation and limb complications among lower extremitys with vascular injury.

Methods: A retrospectively collected lower extremity injury database was queried for limbs undergoing attempted salvage with vascular procedure (2004-2012).

The Military Orthopedics Tracking Injuries and Outcomes Network: A Solution for Improving Musculoskeletal Care in the Military Health System.

Introduction: Musculoskeletal injuries are an endemic amongst U.S. Military Service Members and significantly strain the Department of Defense's Military Health System.

Prescriptions for opioids and opioid-included polypharmacy: An analysis of the National Hospital Ambulatory Medical Care Survey.

Objective: Opioid-associated complications are compounded by other concomitant drugs that affect the central nervous system (CNS). This analysis aims to describe opioid and CNS polypharmacy from a representative sample of emergency department (ED) encounters to identify patient- and facility-level characteristics associated with these prescription outcomes.

Design: Generalized linear regression multivariable modeling was used to test for associations between the prescrip-tion outcomes and individual and group level predictors.

Developing a Novel Scoring System to Objectively Track Orthopaedic Resident Educational Performance and Progression.

Objective: Objectively determining orthopedic resident competence remains difficult and lacks standardization across residency programs. We sought to develop a scoring system to measure resident educational activity to stratify participation and performance in particular aspects of training and the effect of these measures on board certification.

Design: A weighted scoring system (Average Resident Score, ARS) was developed using the number of logged cases, clinic notes dictated, OITE PGY percentile, case minimums met, and scholarly activity completed each academic year (AY), with clinical activity being more heavily weighted.

Pharmacological Mitigation of Fibrosis in a Porcine Model of Volumetric Muscle Loss Injury.

Volumetric muscle loss (VML) resulting from extremity trauma presents functional deficits and fibrosis, ultimately manifesting disability. The extensive fibrotic accumulation is expected to interfere with neural, trophic, vascular, and mechanical connectivity of any possible regenerative medicine approaches. Our objective was to quantify the muscle properties and stiffness following injury and investigate if the fibrotic deposition could be mitigated using an antifibrotic agent; we hypothesized that antifibrotic treatment would prevent the overwhelming fibrotic response.

Infection Precedes Heterotopic Ossification in Combat Wounded.

Heterotopic ossification is the formation of ossified bone in soft tissue, particularly after soft tissue trauma. Heterotopic ossification is known cause of pain, prosthetic/orthotic malfit, and reoperation following combat extremity injury. The purpose of this research was to examine injury and treatment characteristics that are associated with heterotopic ossification in a broader population of deployment-injured subjects.

Analysis of References Used in Orthopaedic Self-Assessment Exams.

Orthopaedic surgery board certification and maintenance of certification requires success on standardized tests and ongoing continuing medical education. This study aims to identify the most impactful resources for preparation for and maintenance of board certification. Questions included in the Orthopaedic Self-Assessment Exams (SAEs) from 2009 to 2014 were examined with the type and age of reference materials cited for each question.

Orthopaedic Resident Surgical Case Log Disparities Observed in the Next Accreditation System.

Introduction: With the institution of the Next Accreditation System (NAS), case log procedures fundamentally changed. Unless multiple entries are made, only one procedure per case is credited for procedure counts. We hypothesized that the NAS caused notable changes in national procedure data.

Distraction arthroplasty compared to other cartilage preservation procedures in patients with post-traumatic arthritis: a systematic review.

Unlabelled: Post-traumatic arthritis (PTA) is characterized by the deterioration of articular cartilage temporally associated with an articular injury. With a paucity of literature comparing joint preservation techniques, we performed a systematic review of the literature intending to describe and summarize the results of ankle distraction arthroplasty as it compares with studies on tibio-talar microfracture, allograft, and autograft for ankle joint preservation in the post-traumatic population under 50 years of age. Research databases were searched and abstracts screened for relevance on our topic of interest.