Trends in Case Volume Reported by Musculoskeletal Oncology Fellows in Accreditation Council for Graduate Medical Education-Accredited Training Programs: 2017 to 2022.

Introduction: Increasingly, national accrediting bodies and professional societies for musculoskeletal oncology recognize the need for more standardized training. This study elucidates recent trends in reported case volume during Accreditation Council for Graduate Medical Education (ACGME)-accredited musculoskeletal oncology fellowship training relative to case minimum requirements.

Methods: We conducted a retrospective cross-sectional analysis of fellows at ACGME-accredited musculoskeletal oncology fellowships (2017 to 2022).

Does the Use of Negative Pressure Wound Therapy and Postoperative Drains Impact the Development of Surgical Site Infections?: A PARITY Trial Secondary Analysis.

Background: Surgical site infections (SSIs) represent a major complication following oncologic reconstructions. Our objectives were (1) to assess whether the use of postoperative drains and/or negative pressure wound therapy (NPWT) were associated with SSIs following lower-extremity oncologic reconstruction and (2) to identify factors associated with the duration of postoperative drains and with the duration of NPWT.

Methods: This is a secondary analysis of the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial, a multi-institution randomized controlled trial of lower-extremity oncologic reconstructions.

Metastatic mesenchymal chondrosarcoma of the spine managed with nonsurgical treatment: A case report and review of the literature.

In this report, we present a rare case of a 17-year-old male patient with metastatic mesenchymal chondrosarcoma (MCS) managed with nonsurgical treatment who subsequently demonstrated a favorable response to concurrent chemotherapy and radiation therapy, followed with pazopanib target therapy. Further study regarding nonoperative care for metastatic MCS of spine is warranted.

Stress-Mediated Attenuation of Translation Undermines T-cell Activity in Cancer.

Unlabelled: Protein synthesis supports robust immune responses. Nutrient competition and global cell stressors in the tumor microenvironment (TME) may impact protein translation in T cells and antitumor immunity. Using human and mouse tumors, we demonstrated here that protein translation in T cells is repressed in solid tumors.

The Use of Carbon Fiber Implants for Impending or Existing Pathologic Fractures.

Objectives: To evaluate the utility and complications of using carbon fiber implants (CFIs) compared with standard titanium alloy (TI) intramedullary implants for stabilization of impending or existing pathologic fractures.

Design: Retrospective comparison.

Patients/participants: Ninety-four patients undergoing intramedullary fixation of 100 impending or existing pathologic fractures between 2014-2019 were identified for inclusion.

Workplace Hazards in Orthopaedic Surgery Training: A Nationwide Resident Survey Involving Sharps-related Injuries.

Introduction: Surgical specialties are at an increased risk for occupational hazards, including sharps-related injuries. The objective of this study was to report the frequency of sharps injuries and evaluate which characteristics influence the number of injuries and reporting behaviors.

Methods: A web-based, anonymous survey was available for 10 weeks to 46 US orthopaedic surgery residency programs (1,207 potential residents) participating in an education research collaborative.

Resident Level Involvement Affects Operative Time and Surgical Complications in Lower Extremity Fracture Care.

Objective: The purpose of this study is to evaluate the effect of resident participation on operative time and surgical complications in isolated lower extremity fracture care.

Setting: Patients who were treated at teaching hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program database.

Participants: A total of 2,488 patients who underwent surgical fixation of isolated hip fractures, femoral or tibial shaft fractures, and ankle fractures.

Epithelioid Sarcoma Arising in a Long-Term Survivor of an Atypical Teratoid/Rhabdoid Tumor in a Patient With Rhabdoid Tumor Predisposition Syndrome.

Rhabdoid tumor predisposition syndrome (RTPS) is defined as the presence of a or genetic aberration in a patient with malignant rhabdoid tumor. Patients with RTPS are more likely to present with synchronous or metachronous rhabdoid tumors. Based on the current state of rhabdoid tumor taxonomy, these diagnoses are based largely on patient demographics, anatomic location of disease, and immunohistochemistry, despite their nearly identical histologic and immunohistochemical profiles.

Notable Variability in Opioid-prescribing Practices After Common Orthopaedic Procedures.

Introduction: The purpose of this study was to evaluate nationwide trends and regional variability in opioid prescriptions after common orthopaedic procedures.

Methods: A retrospective analysis of privately insured subjects from the MarketScan database between 2015 and 2016 was conducted. Median oral morphine equivalents and interquartile ranges were analyzed by region for the initial post-op prescriptions and 90-day total prescriptions for opioid-naive patients undergoing the following: carpal tunnel release; anterior cruciate ligament reconstruction; arthroscopic meniscectomy; bimalleolar ankle fracture open reduction and internal fixation; distal radius fracture open reduction and internal fixation; arthroscopic rotator cuff repair; single-level anterior cervical discectomy and fusion; and total shoulder, hip, and knee arthroplasties.

Murine Aseptic Surgical Model of Femoral Atrophic Nonunion.

Although bone repair is typically an efficient process, an inadequate healing response can occur, with approximately 5-20% of fractures developing nonunion. Even with improved healing strategies and external fixation devices, overall rate of nonunion has not been significantly reduced, particularly for atrophic nonunion. Atrophic nonunion is characterized by sparse or no callus formation and is difficult to treat clinically, resulting in long-term pain and functional limitation.

Notable Racial and Ethnic Disparities Persist in Lower Extremity Amputations for Critical Limb Ischemia and Infection.

Introduction: The purpose of this study is to investigate the current disparities for major lower extremity amputation in patients with critical limb ischemia (CLI) and infection.

Methods: A retrospective analysis of the National Surgical Quality Improvement Program's database for the years 2011 to 2017 was conducted. Multivariate models were used to isolate the effect of race and ethnicity on the likelihood of a below-knee or above-knee amputation (BKA and AKA, respectively) for CLI secondary to type 2 diabetes mellitus, atherosclerosis, peripheral vascular disease, chronic osteomyelitis, and deep soft-tissue infections.

A propensity-score matched analysis of limb salvage vs amputation for osteosarcoma.

Background And Objectives: With recent advances in chemotherapy and surgical techniques, the trend in the treatment of osteosarcoma continues to progress towards limb salvage. However, studies comparing limb salvage with amputation continue to be limited by selection bias and small sample sizes. This study utilized propensity-score matching to minimize potential confounders and selection bias to compare the survival rates in patients with osteosarcoma that were treated with amputation vs limb salvage surgery.

Teaching Surgical Model Development in Research by Using Situated Learning and Instructional Scaffolding.

Resources detailing the scope, details, and duration for teaching and learning surgical model development in research are poorly described. Situated learning and instructional scaffolding are useful skill-building tools. Herein, we discuss educational theory in the context of a training paradigm for surgical researchers, using our experience with a nonunion femoral fracture model as an example.

Endoplasmic Reticulum Stress Contributes to Mitochondrial Exhaustion of CD8 T Cells.

Tumor antigen-specific T cells rapidly lose energy and effector function in tumors. The cellular mechanisms by which energy loss and inhibition of effector function occur in tumor-infiltrating lymphocytes (TILs) are ill-defined, and methods to identify tumor antigen-specific TILs that experience such stress are unknown. Processes upstream of the mitochondria guide cell-intrinsic energy depletion.

Smoking is associated with increased complications and readmission following extensor mechanism repair.

Purpose: Extensor mechanism injuries are disabling injuries that require prompt evaluation and treatment and complications are often devastating. While smoking has been shown to increase complications following total joint arthroplasty, this relationship has not yet been established in those undergoing extensor mechanism repair. The purpose of this study was to evaluate the risk of smoking on postoperative complications following extensor mechanism repair.

What Leads to Lead: Results of a Nationwide Survey Exploring Attitudes and Practices of Orthopaedic Surgery Residents Regarding Radiation Safety.

Background: Excessive radiation to health-care providers has been linked to risks of cancer and cataracts, but its negative effects can be substantially reduced by lead aprons, thyroid shields, and leaded glasses. Hospitals are required to provide education and proper personal protective equipment, yet discrepancies exist between recommendations and compliance. This article presents the results of a survey of U.

Pedicled Rotational Medial and Lateral Gastrocnemius Flaps: Surgical Technique.

Gastrocnemius flaps have been used for decades to reconstruct defects of the proximal tibia and knee. They have proven to be useful in the soft-tissue reconstruction of defects caused by trauma, tumors, and infections about the knee, and the reconstruction of extensor mechanism discontinuity with and without total joint arthroplasty. The flaps have low failure rates and a distinct proximally based blood supply that allows them to be elevated and rotated up to 15 cm above the level of the knee joint.

The impact of race on the development of severe heterotopic ossification following acetabular fracture surgery.

Objectives: To determine the association between race on severe heterotopic ossification (HO) following acetabular fracture surgery.

Design: Retrospective case control study.

Setting: Level I university trauma centre.

Bronchogenic squamous cell carcinoma with soft-tissue metastasis to the hand: an unusual case presentation and review of the literature.

Carcinoma of the lung is the most common lethal form of cancer in both men and women worldwide. Orthopedic manifestations of lung cancer frequently include bony metastasis, most commonly the vertebrae (42%), ribs (20%), and pelvis (18%). Acral metastatic disease is defined as metastasis distal to the elbow or the knee.

How much tumor surgery do early-career orthopaedic oncologists perform?

Background: There are few data on the types of procedures orthopaedic oncologists perform in their first years of practice. Because fellowships are graduating fellows each year and the number of tumor patients is limited, defining the practice patterns of early-career orthopaedic oncologists may help diminish early employment discontent and enhance workforce discussions.

Questions/purposes: The aim of the study was to use the objective case log volumes of a cross-section of early career orthopaedic oncologists to describe (1) the number of operations performed annually; (2) the proportion of tumor, trauma, adult reconstruction, and other operations for individual participants, (3) individual practice characteristics that were associated with the number of tumor procedures; and (4) the sources of satisfaction and challenges in each individual's career and surgical practice.

Chondrosarcoma of bone.

Chondrosarcoma is a cartilage forming neoplasm, which is the second most common primary malignancy of bone. Clinicians who treat chondrosarcoma patients must determine the grade of the tumor, and must ascertain the likelihood of metastasis. Acral lesions are unlikely to metastasize, regardless of grade, whereas axial, or more proximal lesions are much more likely to metastasize than tumors found in the distal extremities with equivalent histology.

What is the use of imaging before referral to an orthopaedic oncologist? A prospective, multicenter investigation.

Background: Patients often receive advanced imaging before referral to an orthopaedic oncologist. The few studies that have evaluated the value of these tests have been single-center studies, and there were large discrepancies in the estimated frequencies of unnecessary use of diagnostic tests.

Questions/purposes: (1) Is there regional variation in the use of advanced imaging before referral to an orthopaedic oncologist? (2) Are these prereferral studies helpful to the treating orthopaedic oncologist in making a diagnosis or treatment plan? (3) Are orthopaedic surgeons less likely to order unhelpful studies than other specialties? (4) Are there any tumor or patient characteristics that are associated with the ordering of an unhelpful study?

Methods: We performed an eight-center prospective analysis of patients referred for evaluation by a fellowship-trained orthopaedic oncologist.

Complications of hip and knee joint replacement in solid-organ transplant patients.

This study investigated complication rates for 68 solid-organ transplant patients who had undergone 94 primary hip or knee joint replacements at a single institution from 1995 to 2008. There was a deep infection rate of 6.8% in the transplant patients compared to a 1.