A Pilot Study for an Interactive Activity Educating First-Year Medical Students on How (Not What) to Prescribe.

Objective: Pharmacotherapy outcomes may be influenced as much by psychosocial factors as by medication. Comprehensive discussion of such factors may contribute to better patient outcomes and may counter aspects of a curriculum that prioritizes efficiency and that has the potential to undermine clinician empathy. This pilot study aimed to explore the benefits of teaching psychosocial aspects of prescribing and student acceptance of such teaching.

Disease Activity and Bone Microarchitectural Phenotype in Patients With Axial Spondyloarthritis.

Background: Axial spondyloarthritis (AxSpA) is a chronic rheumatic disease characterized by spine inflammation, abnormal bone growth, and paradoxically osteoporosis and vertebral fractures. The pathogenesis of skeletal deficits in this disease is poorly understood.

Purpose: We sought to evaluate volumetric bone mineral density (vBMD) and bone microarchitecture in patients with AxSpA and to identify disease-related factors associated with skeletal abnormalities.

Hindfoot Alignment in Pediatrics: The Relationship Between Hindfoot Moment Arm and Hindfoot Alignment Angle.

Background: Various measurements are used to evaluate hindfoot alignment and determine appropriate treatment, though the best tool is not known. Few studies have examined the relationship between these measurements in pediatric patients. This study sought to compare Hindfoot Moment Arm (HMA) and Hindfoot Alignment Angle (HAA) in evaluation of pediatric hindfoot deformity.

Location of medial collateral ligament tears: introduction to a magnetic resonance imaging-based classification.

Purpose: Despite established tear grade classifications, there is currently no radiological classification for sMCL tear locations. This study aims to establish a magnetic resonance imaging (MRI) tear location classification system for sMCL tears, to enhance understanding and guide treatment decisions by categorizing tear types.

Methods: A retrospective search in a single institution's MRI database identified patients with acute, Grade III sMCL tears (< 30 days between injury and MRI) from January to December 2022.

Fully automated determination of robotic pedicle screw accuracy and precision utilizing computer vision algorithms.

Historically, pedicle screw accuracy measurements have relied on CT and expert visual assessment of the position of pedicle screws relative to preoperative plans. Proper pedicle screw placement is necessary to avoid complications, cost and morbidity of revision procedures. The aim of this study was to determine accuracy and precision of pedicle screw insertion via a novel computer vision algorithm using preoperative and postoperative computed tomography (CT) scans.

The Longitudinal Effects of Posterior Spinal Fusion with Derotation on Axial Deformity in Adolescent Idiopathic Scoliosis.

Study Design: Retrospective case series.

Objective: To characterize the change in angle of trunk rotation (ATR), axial vertebral rotation (AVR), and body surface rotation (BSR) in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF) with en-bloc derotation across multiple postoperative visits.

Summary Of Background Data: Previous research has documented ATR, AVR, and BSR correction for AIS patients after surgery.

Vitamin B Supplementation in Psychiatric Practice.

Purpose Of Review: Vitamin B (B12, cobalamin) deficiency has been associated with neuropsychiatric symptoms, suggesting a role for B12 supplementation both as a treatment for psychiatric symptoms due to B12 deficiency and as an augmentation strategy for pharmacological treatments of psychiatric disorders. This critical review discusses the major causes of B12 deficiency, the range of psychiatric and non-psychiatric manifestations of B12 deficiency, the indications for testing B12 levels, and the evidence for B12 supplementation for major psychiatric disorders.

Recent Findings: We find that high-quality evidence shows no benefit to routine B12 supplementation for mild depressive symptoms or to prevent depression.

The role of the photographic arts in psychiatry.

Photography is a medium that has historical roots in psychiatry. It is an art form that shares some concepts with psychodynamic psychotherapy and can also provide psychotherapeutic value. In addition, it can provide a means of stress reduction for the burned-out clinician.

Measurement of TT-TG can change with sequential MRIs due to variations in tibiofemoral rotation in patellofemoral instability patients.

Purpose: There are various anatomic risk factors for patellofemoral instability (PFI) that help guide surgical treatment, including the tibial tubercle to trochlear groove (TT-TG) distance. However, no study has analysed the temporal changes in TT-TG prior to surgical intervention. This study sought to understand the variations in TT-TG over time for pediatric patients suffering from PFI prior to surgical intervention.

Association of Lateral Extra-Articular Tenodesis With Improved Graft Maturity on MRI 2 Years After ACL Reconstruction With Quadriceps Tendon Autograft in Skeletally Immature Athletes.

Background: Quadriceps tendon autograft (QTA) has recently gained popularity in the treatment of anterior cruciate ligament (ACL) ruptures in pediatric patients. The addition of lateral extra-articular tenodesis (LET) to an ACL reconstruction (ACLR) has been found to reduce the risk of ACL retear in high-risk patients.

Purpose: To (1) compare ACL graft maturity using signal intensity ratios (SIRs) on magnetic resonance imaging (MRI) scans in skeletally immature patients undergoing ACLR with QTA either with or without concomitant LET and (2) evaluate LET safety by calculating the physeal disturbance-related reoperation rate in the ACLR+LET group.

Exploring Correlations Between Pain and Deformity in Idiopathic Scoliosis With Validated Self-reported Pain Scores, Radiographic Measurements, and Trunk Surface Topographic Measurements.

Background: Up to 75% of patients with idiopathic scoliosis (IS) report back pain, but the exact contributors are unclear. This study seeks to assess how pain correlates with demographics, radiographic and surface topographic (ST) measurements, and patient-reported outcome measures (PROMs) in patients with IS.

Methods: Patient-Reported Outcome Measurement Information System (PROMIS) Pain Interference (PI) and Scoliosis Research Society revised (SRS-22r) pain domain from an IRB approved prospectively collected registry containing patients 11 to 21 years old with IS were correlated (Spearman coefficients) with measurements from whole-body EOS radiography and ST scanning, PROMIS 1.

Posterior Cruciate Ligament Femoral Avulsion Fractures in Pediatric Patients: A Report of 2 Interesting Surgical Cases.

Case: This report describes 2 cases of femoral-sided posterior cruciate ligament (PCL) avulsion injuries. A 10-year-old male patient presented with a chronic nonunion of a bony PCL femoral avulsion. In addition, a 4-year-old boy presented with an acute, displaced PCL femoral avulsion off the medial femoral condyle.

Characterizing focal muscle signal on MRI in flexor-pronator muscles' status post ulnar collateral ligament reconstruction.

Objective: Focal high signal is commonly seen about the flexor pronator mass on MRI in some patients after ulnar collateral ligament (UCL) reconstruction of the elbow. The etiology of this high signal is unclear and not described in literature. The hypothesis is that the edema we see on post-operative MRI is related to palmaris longus graft harvest rather than secondary to other causes of muscle edema such as denervation or muscle strain.

Extension of Tibial Spine Fractures Beyond the Tibial Spine: An MRI Analysis of 54 Patients.

Background: To the authors' knowledge, no previous study has thoroughly described the anteroposterior dimensions of tibial spine fractures (TSFs) on 3-dimensional imaging. The extension of TSFs into weightbearing regions of the tibial plateau, posterior extension within the epiphysis, and potential association between fracture size and patient age may have implications for treatment strategies and clinical outcomes.

Hypothesis: TSF fragments would commonly involve weightbearing regions of the tibial plateau, would be larger in younger patients, and would extend more posteriorly than the anatomic footprint of the tibial spine.

The relationship between physical activity, structural deformity, and spinal mobility in adolescent idiopathic scoliosis patients.

Purpose: Adolescent idiopathic scoliosis (AIS) patients experience structural spinal deformity, but the impact of AIS on physical activity is not widely studied. Reports of physical activity levels between children with AIS and their peers are mixed. This study sought to characterize the relationship between spinal deformity, spinal range of motion, and self-reported physical activity in AIS patients.

Concomitant anterior medializing osteotomy and MPFL reconstruction improves patellar tilt when compared to MPFL reconstruction alone.

Purpose: Understanding how surgical procedures influence anatomic factors associated with patellofemoral instability can help guide surgeons when planning treatments for individual patients. This study sought to understand how patellar tilt is affected in adolescent patients with elevated pre-operative tibial tuberosity to trochlear groove (TT-TG) values undergoing medial patellofemoral ligament reconstruction (MPFLR) with or without an anterior medializing osteotomy (AMZ).

Methods: Utilizing a prospective database of 274 patellofemoral instability patients who underwent MPFLR ± AMZ by one of two orthopedic surgeons at a single institution, those who underwent MPFLR + AMZ were identified.

Assessment of Patellar Vascularity after Patellar Cartilage Restoration via Lateral Parapatellar Approach: Analysis Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging.

Objective: Patellofemoral cartilage restoration procedures, including osteochondral allograft, particulated juvenile cartilage, and matrix-induced autologous chondrocyte implantation, have been shown to be effective treatments for patellofemoral cartilage lesions. However, concerns exist regarding disruption of the patellar vascular supply and secondary stabilizers of the patellofemoral joint during medial parapatellar approaches, especially when combined with a lateral release. A lateral parapatellar approach affords the possibility of avoiding disruption of the medial blood supply to the patella, while also allowing laterally-based soft tissue stabilization procedures.

Correlation of femoral version measurements between computed tomography and magnetic resonance imaging studies in patients presenting with a femoroacetabular impingement-related complaint.

Computed tomography (CT) is considered the gold standard for femoral version measurement. However, recent data have shown magnetic resonance imaging (MRI) as another modality to measure femoral version. This study aimed to correlate MRI and CT femoral version measurements in patients presenting with a femoroacetabular impingement (FAI)-related complaint.

Age and Bone Bruise Patterns Predict Tear Location in the Anterior Cruciate Ligament.

Purpose: To assess the influence of demographic risk factors, anatomic risk factors, and injury mechanisms on anterior cruciate ligament (ACL) tear patterns.

Methods: All patients undergoing knee magnetic resonance imaging at our institution for acute ACL tears (within 1 month of injury) in 2019 were retrospectively analyzed. Patients with partial ACL tears and full-thickness posterior cruciate ligament injuries were excluded.

Swinging injuries in competitive baseball players.

Injuries are common in competitive baseball players and can occur in all facets of the game. The majority of the existing literature on injuries in baseball players has focused on injuries secondary to the overhead throw with very little attention given to injuries sustained while batting. The baseball swing is a complex, often violent, motion that predisposes batters to a variety of injuries affecting the spine, trunk, pelvis, and extremities.

The lateral femoral notch sign decreases in paediatric patients following anterior cruciate ligament reconstruction.

Introduction: Anterior cruciate ligament (ACL) ruptures are common amongst paediatric patients, especially those participating in competitive sports. While magnetic resonance imaging (MRI) is typically used to confirm the diagnosis, certain radiologic findings can be indicative of an ACL tear, including a lateral femoral notch sign (LFNS) > 1.5 mm (mm).

Prevalence of rapidly progressive osteoarthritis of the hip following intra-articular steroid injections.

Introduction: Numerous studies have indicated that intra-articular steroid injections to the hip are beneficial for short-term pain relief. However, recent studies have drawn concerns of rapidly progressive osteoarthritis of the hip (RPOH) following intra-articular steroid injections. The prevalence of RPOH following intra-articular steroid injections varies widely in the literature.