The use of ultrasound to predict flexor tendinopathy after anterior locking plating of the distal radius.

This study compares ultrasound to clinical and radiographic measurements for assessing tendon pathology associated with distal radial anterior locking plates. A total of 46 patients undergoing removal of a distal radial plate had a preoperative clinical examination, radiographs and ultrasound evaluation to detect evidence of tendon irritation. Gross changes to the tendon were assessed during plate removal.

A National Survey to Assess LGBTQ+ Curricular Needs in Pediatrics Residency Programs.

Objective: Despite incremental increases in lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) health education, there are no uniform training requirements in graduate medical education and the extent to which pediatrics residency programs incorporate LGBTQ+ curricula remains unknown. We aimed to assess the current state of LGBTQ+ health education in pediatrics residency programs.

Methods: We surveyed all 202 Accreditation Council for Graduate Medical Education (ACGME)-accredited categorical pediatrics program directors (PDs) in the United States.

The role of competency based medical education in addressing health inequities and cultivating inclusive learning environments.

Pediatric health inequities are pervasive and reflect the confluence of social and structural determinants of health including racism in all its forms. Current approaches in graduate medical education that prepare trainees to address health inequities and improve population health are inadequate. Competency based medical education (CBME) can advance equity-oriented efforts to improve patient outcomes, optimize the learning environment and encourage lifelong learning.

Small Glove Size and Female Gender Are Associated with Greater Reported Difficulty Using Orthopaedic Instruments Among Residents.

Introduction: Smaller hand size has been shown to affect ease of instrument use and surgeon injury rates in multiple surgical subspecialties. Women have a smaller average hand size and are more often affected by this issue than men. The goal of this resident survey was to investigate whether hand size and gender impact self-reported difficulty with instrument use among orthopaedic surgery residents.

Understanding the Remplissage: History, Biomechanics, Outcomes, and Current Indications.

Purpose Of Review: Arthroscopic remplissage has continued to gain popularity as an adjunct to Bankart repair for patients with anterior shoulder instability. Although the original remplissage technique was described over 15 years ago, our understanding of when and how to use this procedure continues to evolve. This article provides a review of how remplissage affects shoulder biomechanics, compares clinical outcomes between remplissage and other procedures for shoulder instability, and discusses current indications for remplissage.

Radiographic Thigh Muscle Measurements Are a Reliable Predictor of Psoas Area and Sarcopenia.

Background: Sarcopenia is associated with falls, fractures, postoperative complications such as periprosthetic joint infections and dislocations, and early mortality. Although cross-sectional imaging is currently used to diagnose sarcopenia, inexpensive and widely available screening tests are needed. The goal of this study was to investigate whether measurements of thigh muscles made on radiographs can predict psoas muscle area and the presence of sarcopenia as determined on computed tomography (CT) scans.

Ambulation Distance Within 72 Hours after Surgical Management Is a Predictor of 90-Day Ambulatory Capacity in Elderly Patients with Hip Fracture.

Introduction: The inability to mobilize after surgical intervention for hip fractures in the elderly is established as a risk factor for greater morbidity and mortality. Previous studies have evaluated the association between the timing and distance of ambulation in the postoperative acute care phase with postoperative complications. The purpose of this study was to evaluate the association between ambulatory distance in the acute postoperative setting and ambulatory capacity at 3 months.

The Effect of Black Cohosh on Ki67 expression and Tumor Volume: A Pilot Study of Ductal Carcinoma in Situ Patients.

Background: Black cohosh (BC) () may prevent and treat breast cancer through anti-proliferative, pro-apoptotic, anti-estrogenic, and anti-inflammatory effects. This study sought to evaluate the effect of BC on tumor cellular proliferation, measured by Ki67 expression, in a pre-operative window trial of ductal carcinoma in situ (DCIS) patients.

Methods: Patients were treated pre-operatively for 2 to 6 weeks with BC extract.

Comparing Propofol With Fentanyl and Midazolam for Sedation in Closed Reductions of Traumatic Hip Dislocations.

Traumatic native hip dislocations require prompt reduction of the dislocation to limit the risk of avascular necrosis and resultant hip arthrosis. Although closed reduction under sedation is frequently attempted, there is minimal evidence about which sedative agent is most safe and effective. The goal of this study was to compare the efficacy of propofol vs combination fentanyl/midazolam for closed reduction under sedation of traumatic native hip dislocations.

Developing an Entrustable Professional Activity to Improve the Care of LGBTQ+ Youth.

Despite the multitude of health inequities often experienced by lesbian, gay, bisexual, transgender, and queer (LGBTQ)+ youth, few training programs consistently and comprehensively address these disparities through education and assessment of learners. Over the past decade, programs have begun to incrementally increase the number of hours dedicated to LGBTQ+ health training; however, the lack of standardization for curricula and assessment remains a significant barrier. As medical education shifts to a competency-based approach, focusing on patient outcomes and the competencies trainees must achieve to meet those outcomes, we must take this opportunity to develop curricula and assessment tools that emphasize inclusive, affirming, equitable, and culturally humble care for LGBTQ+ youth.

Selpercatinib Treatment of RET-Mutated Thyroid Cancers Is Associated With Gastrointestinal Adverse Effects.

Context: Metastatic medullary thyroid carcinoma (MTC) and radioactive iodine-refractory differentiated thyroid carcinoma (RAI-R DTC) have poor prognosis and limited treatment options. Selpercatinib (LOXO-292), a selective kinase inhibitor targeting the RET gene, has shown a 69% to 79% objective response rate in this cohort with benefits in other tumors including lung cancer harboring the same oncogenic driver. Published reports describe only 17% of patients experiencing gastrointestinal (GI) adverse effects (AEs), which is in contrast to our local experience.

Risk stratification of indeterminate thyroid nodules using ultrasound and machine learning algorithms.

Background: Indeterminate thyroid nodules (Bethesda III) are challenging to characterize without diagnostic surgery. Auxiliary strategies including molecular analysis, machine learning models, and ultrasound grading with Thyroid Imaging, Reporting and Data System (TI-RADS) can help to triage accordingly, but further refinement is needed to prevent unnecessary surgeries and increase positive predictive values.

Design: Retrospective review of 88 patients with Bethesda III nodules who had diagnostic surgery with final pathological diagnosis.

Functional outcomes of unstable ankle fractures with and without syndesmotic fixation in the adolescent population.

Purpose: The purpose of this study was to compare functional outcomes of adolescents with and without ankle syndesmotic injuries and identify predictors of functional outcome after operative ankle fractures.

Methods: A retrospective review was conducted on operative adolescent ankle fractures treated between 2009 and 2019 with a minimum of one-year follow-up (mean 4.35 years).

Teaching Sexual Orientation and Gender Identity in Pediatric Clinical Settings: A Training Workshop for Faculty and Residents.

Introduction: Health disparities for the lesbian, gay, bisexual, transgender, queer, intersex, asexual, all other genders, sexes, and sexualities (LGBTQIA+) population are striking. Yet, deliberate efforts to integrate sexual orientation and gender identity in pediatric education settings remain lacking. The type of formal training that pediatric educators currently have for teaching of sexual orientation and gender identity is unclear and limited, which led to the development and implementation of this curriculum.

Suture-button Versus Screw Fixation in Adolescent Syndesmotic Injuries: Functional Outcomes and Maintenance of Reduction.

Background: Fixation of the tibiofibular syndesmosis is often performed with a trans-syndesmotic screw (SS) or suture-button (SB). SB fixation has been shown to have lower rates of postoperative syndesmotic malreduction, late diastasis, and implant removal, though some studies have found complications related to infection and implant subsidence. The purpose of this study was to compare maintenance of reduction, complications, implant removal and functional outcomes of SB versus SS fixation in adolescents.

Predicting Trainee Clinical Success From Performance at Simulated Endotracheal Intubation.

Introduction: Multiple attempts and failure at endotracheal intubation (ETI) are common for inexperienced practitioners and can cause patient morbidity. A test to predict a provider's likelihood of success at patient ETI could assist decisions about training. This project investigated whether trainees' performance at laryngoscopy on airway mannequins predicted their laryngoscopy outcomes in patients.

Plate Versus Lag Screw Only Fixation of Unstable Ankle Fractures Involving the Fibula in Adolescent Patients.

Background: Plate fixation has been the traditional technique for fracture repair of unstable ankle injuries with an associated lateral malleolus fracture. Recently, biomechanical and clinical data have demonstrated lag screw only fixation to be an effective alternative to plate fixation in the adult population. This comparison has yet to be studied in the adolescent or pediatric population.

Compensatory motion scaling for time-delayed robotic surgery.

Background: Round trip signal latency, or time delay, is an unavoidable constraint that currently stands as a major barrier to safe and efficient remote telesurgery. While there have been significant technological advancements aimed at reducing the time delay, studies evaluating methods of mitigating the negative effects of time delay are needed. Herein, we explored instrument motion scaling as a method to improve performance in time-delayed robotic surgery.

Functional Outcomes of Tillaux and Triplane Fractures with 2 to 5 Millimeters of Intra-Articular Gap.

Background: The treatment of transitional ankle fractures (Tillaux and triplane) is often dictated by the amount of displacement at the articular surface. Although >2 mm is a common indication for operative management, this practice has not been strongly supported by either the pediatric or adult literature. The purpose of this study was to determine whether operative treatment of transitional fractures with 2 to 5 mm of intra-articular gap leads to superior functional outcomes compared with cast management.

Functional Outcomes of Unstable Ankle Fractures in Adolescents.

Background: The purpose of this study was to describe the functional outcomes and complications of unstable supination external rotation (SER) and pronation external rotation (PER) ankle fractures in adolescents. A secondary outcome was to compare functional outcomes of SER stage IV injuries that were treated definitively with closed reduction and cast application to a similar group of minimally displaced fractures treated with open reduction and internal fixation (ORIF).

Methods: A retrospective review of adolescents aged 10 to 18 years with unstable ankle fractures treated at a single institution between 2009 and 2017 was conducted.

Comprehensive Analysis of a Recalled Modular Total Hip System and Recommendations for Management.

Background: Recent total hip arthroplasty designs have introduced modularity at the neck-stem junction. There are reports of failure of this class of designs due to corrosion at the modular junction. The purpose of this study was to evaluate patients implanted with a recently recalled modular total hip arthroplasty system.

MR Imaging of Knee Arthroplasty Implants.

Primary total knee arthroplasty is a highly effective treatment that relieves pain and improves joint function in a large percentage of patients. Despite an initially satisfactory surgical outcome, pain, dysfunction, and implant failure can occur over time. Identifying the etiology of complications is vital for appropriate management and proper timing of revision.

MR Imaging of Adverse Local Tissue Reactions around Rejuvenate Modular Dual-Taper Stems.

Purpose: To describe the magnetic resonance (MR) imaging characteristics associated with adverse local tissue reactions and tissue damage around hip arthroplasties in which the recalled Rejuvenate modular dual-taper stem was used.

Materials And Methods: The institutional review board of the Hospital for Special Surgery approved the study. All study patients provided informed consent.