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Interviewing in the Wake of COVID-19: How Orthopaedic Residencies, Fellowships, and Applicants Should Prepare for Virtual Interviews
Hagedorn, John C. II; Chen, Jie; Weiss, William M.; Fredrickson, Saul W.; Faillace, John J
doi : 10.5435/JAAOS-D-20-01148
Journal of the American Academy of Orthopaedic Surgeons. 29(7):271-277, April 1, 2021.
On May 7, 2020, the Coalition for Physician Accountability's released “Medical Students in the Class of 2021: Moving Across Institutions for Post Graduate Training,” which comprises official recommendations on keeping programs and medical students safe during the upcoming match cycle with the challenges posed by COVID-19. In these recommendations, away rotations are discouraged, and all programs are compelled to commit to virtual interviews. Unlike employers and applicants in other industries, orthopaedic residency/fellowship programs and candidates seeking those positions have not routinely conducted virtual interviews. Without in-person interviews, applicants may perceive a limited ability to demonstrate their qualifications, judge program culture, and gauge ultimate program compatibility. Likewise, programs may perceive the inability to evaluate a candidate in real time, physically show program strengths, and ultimately judge applicant compatibility. Careful preparation and execution of a virtual interview can overcome these perceived limitations, whereas benefits, such as decreased cost for both programs and applicants, can make virtual interviews appealing. The purpose of this review was to help define a virtual interview, illustrate the benefits, and offer tips to both programs and applicants on how to prepare and perform optimally on an interview day.
Closed Pantalar Dislocations: Characteristics, Treatment Approaches, and Outcomes
Vosoughi, Amir Reza; Vallier, Heather A.
doi : 10.5435/JAAOS-D-20-00836
Journal of the American Academy of Orthopaedic Surgeons. 29(7):278-287, April 1, 2021.
Closed pantalar dislocation mainly occurs among male adults aged 20 to 45 years and is usually associated with high-energy trauma, mostly falls (50.0%). The talus dislocates anterolaterally in about 85% of cases. Pure pantalar dislocation is more common (54.7%) than cases with concomitant fractures (45.3%). Ankle fractures are the most common associated fractures, followed by fractures of the talar posterior process. Among 40 reported cases, 24 had successful closed reduction (60%), 11 had unsuccessful closed reduction (27.5%), and 5 underwent open reduction without attempting closed reduction (12.5%). The success rate for closed reduction of closed pantalar dislocation is 68.5% (24/35 cases). Post-traumatic arthrosis occurs in 32.3%. Osteonecrosis occurs less often than previously reported. Infection after closed reduction of pantalar dislocation is very rare except after open reduction and fixation for concomitant talar fractures. Conclusively, closed pantalar dislocations are very rare injuries and may portend a poor prognosis. Urgent talar relocation restores ankle and hindfoot anatomy and reduces pressure on surrounding soft tissues to optimize outcome. A closed reduction maneuver should be attempted initially, followed by urgent open reduction when the talus is not accurately reduced through closed means.
Targeted Muscle Reinnervation: A Paradigm Shift for Neuroma Management and Improved Prosthesis Control in Major Limb Amputees
Johnson, Christine C.; Loeffler, Bryan J.; Gaston, R. Glenn
doi : 10.5435/JAAOS-D-20-00044
Journal of the American Academy of Orthopaedic Surgeons. 29(7):288-296, April 1, 2021.
Targeted muscle reinnervation (TMR) is a procedure that redirects nerves severed by amputation to new muscle targets. In tandem with advances in myoelectric prosthetics, TMR surgery provides amputees with improved control of myoelectric prostheses and simultaneously prevents or treats painful neuromas. TMR also has an emerging role in the management of neuromas in a nonamputation setting, and it seems to be a powerful strategy to treat a wide variety of neuromas. Because the pattern of nerve transfers varies based on the availability of donor nerves and muscle targets, TMR is inherently nonprescriptive, and thus, an understanding of the principles of TMR is essential for its successful application. This review describes the rationale for and principles of TMR, and outlines techniques for TMR, which can be used at various amputation levels and for the management of neuromas in nonamputees.
Evaluation and Management of Common Accessory Ossicles of the Foot and Ankle in Children and Adolescents
Murphy, Robert F.; Van Nortwick, Sara S.; Jones, Richard; Mooney, James F. III
doi : 10.5435/JAAOS-D-20-00218
Journal of the American Academy of Orthopaedic Surgeons. 29(7):e312-e321, April 1, 2021.
Accessory ossicles are a common radiographic finding about the foot and ankle in children and adolescents. They are often noted incidentally during evaluation of foot and ankle injuries, and most can be managed nonsurgically. Although over 20 accessory ossicles have been described around the foot and ankle, five specific structures generate the most concern in pediatric patients. An accessory navicular presents commonly with medial midfoot pain and may require surgical intervention after failure of nonsurgical treatment. Although an accessory navicular can be treated surgically with simple excision, there is some recent evidence that supports concomitant reconstruction of associated flatfoot deformities. Os trigonum, an ossicle posterior to the talus, is also commonly asymptomatic. However, os trigonum may be associated with persistent posterior ankle pain, and open and endoscopic resection techniques are successful. Os subfibulare is an uncommon ossicle that may be associated with recurrent ankle sprains. Recent literature reports successful return to activities after ossicle excision and ligament reconstruction. Os subtibiale may be confused with a medial malleolar fracture in skeletally immature patients. Os peroneum may contribute to lateral midfoot pain.
The Psychological Effects of Musculoskeletal Trauma
Kang, Kevin K.; Ciminero, Matthew L.; Parry, Joshua A.; Mauffrey, Cyril
doi : 10.5435/JAAOS-D-20-00637
Journal of the American Academy of Orthopaedic Surgeons. 29(7):e322-e329, April 1, 2021.
Musculoskeletal injuries comprise a large percentage of hospital admissions for adults and often contribute to persistent daily pain as an illness; opioid dependence; disability; and complaints of increased depression, anxiety, and symptoms of post-traumatic stress disorder. The prevalence of depression and post-traumatic stress disorder after orthopaedic trauma has been found to be considerably greater than the general adult cohort. Soon after sustaining a fracture, psychological factors can predict pain and disability many months after injury, even after controlling for injury severity. Thus, early in the care of orthopaedic trauma, there exists an opportunity to improve overall health by attending to psychological and social concerns, along with physical health. Recent literature has identified clinically actionable subgroups within the orthopaedic trauma cohort that are at psychological risk after an injury. Improving positive factors such as resilience, social support, and self-efficacy via validated interventions such as Cognitive-Behavioral Therapy, mindfulness training, and other types of mindset training has helped people return to their daily routine. Raising awareness of the psychological effects of trauma among the orthopaedic community could improve post-treatment planning, increase referrals to appropriate nonmedical professionals, and implement earlier effective interventions.
What Is a Cytokine Storm and Should It Matter to Me?
Simkin, Jennifer; Strange, Tierra; Leblanc, Nicholas; Rivera, Jessica C. Less
doi : 10.5435/JAAOS-D-20-00805
Journal of the American Academy of Orthopaedic Surgeons. 29(7):297-299, April 1, 2021.
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. The expanding field of osteoimmunology should contribute to the orthopaedic community's understanding of how the immune system response, whether normal or pathologic, affects the whole body outcome of our patients.
Patient Perception of Pain Control (Not Opiate Amount) Affects Hospital Consumer Assessment of Healthcare Providers and Systems and Press Ganey Satisfaction Scores After Orthopaedic Trauma
Ahmed, Adil S.; Kim, Ryan L.; Ramsamooj, Harry; Roberts, Michael; Downes, Katheryne; Mir, Hassan R
doi : 10.5435/JAAOS-D-20-00069
Journal of the American Academy of Orthopaedic Surgeons. 29(7):301-309, April 1, 2021.
Opiate abuse is a public health issue linked to prescribing. Prescribing increased partly in response to adopting pain as the fifth vital sign. Assessing pain control on patient satisfaction surveys, including government-mandated Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and optional private surveys (Press Ganey) administered on hospital discharge, may contribute. This study evaluates whether opiate amounts affect orthopaedic trauma patient perception of pain control and overall hospital rating on HCAHPS and Press Ganey surveys.
Preoperative Opioid Use Increases the Cost of Care in Total Joint Arthroplasty
Bell, Kerri L.; Detweiler, Maxwell; Yayac, Michael; Penna, Sreeram; Chen, Antonia F
doi : 10.5435/JAAOS-D-20-00316
Journal of the American Academy of Orthopaedic Surgeons. 29(7):310-316, April 1, 2021.
Predictors of financial costs related to total joint arthroplasty (TJA) have become increasingly important becuase payment methods have shifted from fee for service to bundled payments. The purpose of this study was to assess the relationship between preoperative opioid use and cost of care in primary TJA.
Patient-reported Outcomes Associated With Preoperative Opioid Use in Revision Total Hip Arthroplasty: A Propensity Score-Matched Cohort Study
Smith, Evan; Klemt, Christian; Sabeh, Karim; Tirumala, Venkatsaiakhil; Kwon, Young-Min
doi : 10.5435/JAAOS-D-20-00823
Journal of the American Academy of Orthopaedic Surgeons. 29(7):e330-e336, April 1, 2021.
Opioid use is a public health crisis in the United States and an area of increased focus within the arthroplasty literature. The aim of this study was to investigate the effect of preoperative opioid use on patient-reported outcome measures (PROMs) before and after revision total hip arthroplasty (THA).
Addressing National Opioid Prescribing Practices for Knee Osteoarthritis: An Analysis of an Estimated 41,389,332 Patients With Knee Arthritis
Gwam, Chukwuweike U.; Emara, Ahmed K.; Ogbonnaya, Ivuoma A.; Zuskov, Andrey; Luo, T. David; Plate, Johannes F
doi : 10.5435/JAAOS-D-20-00924
Journal of the American Academy of Orthopaedic Surgeons. 29(7):e337-e344, April 1, 2021.
Knee osteoarthritis (OA) is a chronic pathology that is treated across multiple specialties. Opioid prescribing practices for knee OA have not been described on a national level. The purpose of this study was to (1) investigate the trends in opioid prescriptions for knee OA, (2) characterize and identify predominant opioid based medications prescribed for knee OA, and (3) identify patient- and provider-related factors influencing opioid prescribing patterns in the treatment of knee OA in the outpatient setting.
Patient Opioid Requirements Are Often Far Less Than Their Discharge Prescription After Orthopaedic Surgery: the Results of a Prospective Multicenter Survey
Wyles, Cody C.; Thiels, Cornelius A.; Hevesi, Mario; Ubl, Daniel S.; Gazelka, Halena M.; Turner, Norman S. III; Trousdale, Robert T.; Pagnano, Mark W.; Mabry, Tad M.; Habermann, Elizabeth B
doi : 10.5435/JAAOS-D-19-00415
Journal of the American Academy of Orthopaedic Surgeons. 29(7):e345-e353, April 1, 2021.
Evidence-based, procedure-specific guidelines for opioid prescribing after orthopaedic surgery are urgently needed to standardize care and minimize excess opioids.
The Impact of Mental Health and Substance Use on Opioid Demand After Hip Fracture Surgery
Cunningham, Daniel J.; LaRose, Micaela A.; Gage, Mark J.
doi : 10.5435/JAAOS-D-20-00146
Journal of the American Academy of Orthopaedic Surgeons. 29(7):e354-e362, April 1, 2021.
Mental health and substance use and abuse disorders have been associated with poor patient-reported outcomes. Despite the prevalence of hip fractures in the United States, the relationship between opioid demand and these factors in hip fracture surgery is not well understood. The purpose of this study is to describe opioid filling volume and rates after hip fracture surgery and to identify mental health risk factors for increased demand. The study hypothesis is that psychiatric comorbidities such as depression and psychoses as well as substance use and abuse indicators such as pre-op opioid dependence, drug, alcohol, and tobacco abuse would be associated with increased perioperative opioid demand.
