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Medical Student Mentorship in Orthopaedic Surgery
Aiyer, Amiethab A. MD; Mody, Kush S. BS; Dib, Aseel G. BS; Kaplan, Jonathan R. MD; Varacallo, Matthew A. MD; LaPorte, Dawn M. MD; Levine, William N. MD
doi : 10.5435/JAAOS-D-20-01274
Volume 29(16), 15 August 2021, p 681-690
Mentorship is a key aspect of medical education, but the availability and quality of mentorship varies considerably between institutions. The lack of standardization results in information asymmetry and creates notable inequities. This disparity is particularly important for students interested in pursuing competitive specialties, such as orthopaedic surgery. The purpose of this study was to (1) demonstrate the importance of mentorship in orthopaedics, (2) provide a framework for orthopaedic surgeon mentors, and (3) guide medical students interested in activating and expanding their networks.
Management of Anterior Tibialis Tendon Ruptures
Chen, Jie MD, MPH; Kadakia, Rishin MD; Akoh, Craig Chike MD; Schweitzer, Karl Martin Jr MD
doi : 10.5435/JAAOS-D-20-00802
Volume 29(16), 15 August 2021, p 691-701
Anterior tibialis tendon ruptures, while relatively infrequent ruptures, are commonly identified in delayed fashion, which can lead to significant impairments in patient gait and function. Surgical treatment is typically required to restore ankle dorsiflexion function and proper gait. Depending on various patient-specific factors, tendon quality and excursion, and chronicity, a range of treatment options are available to manage these patients, from nonsurgical care to surgical treatment. Surgical options include direct repair, local tendon transfer, autograft tendon reconstruction, and allograft tendon reconstruction. Additional procedures may need to be considered. Despite the variety of described surgical procedures, limited evidence-based guidelines are available to direct surgeons in the most optimal treatment for their patients. In addition to the relevant anatomy, biomechanics, and pathoanatomy, the reconstructive armamentarium is detailed and reviewed here, along with outcomes and potential complications, to guide surgeons in the most appropriate treatment for their patients.
Structures Endangered During Minimally Invasive Plate Osteosynthesis of the Upper Extremity
Hill, Brian W. MD; Thomas, Claire N. BS; Schroder, Lisa K. BS, MBA; Cole, Peter A. MD
doi : 10.5435/JAAOS-D-20-00799
Volume 29(16), 15 August 2021, p e782-e793
Minimally invasive plate osteosynthesis is a surgical technique that is becoming increasingly common because radiographic images and implant technologies advance in capabilities. It is imperative for surgeons to enhance their understanding of the surgical anatomy related to new approaches for fracture fixation. While performing minimally invasive plate osteosynthesis, there is a danger of injuring structures in the common percutaneous and submuscular pathways. We describe the critical anatomical structures in these pathways and tips for injury avoidance when operating on the clavicle, scapula, humerus, and wrist.
A Comprehensive Primer for Quality Assessment in Orthopaedic Surgery: Quality Measures, Payment Programs, and Registries
Hunt, Kenneth J. MD; Hamati, Mary C. MD; Tuffiash, Michael I. MS
doi : 10.5435/JAAOS-D-20-01311
Volume 29(16), 15 August 2021, p e794-e804
Practicing orthopaedic surgeons are subject to both the requirement and the opportunity to participate in individual or group quality assessment, quality-based payment programs, and clinical data registries. An important limitation to participating in and receiving the benefits of quality measuring activities and programs is the lack of a current resource outlining quality assessment models, current quality metrics, and the presence and function of current quality programs, payment models, and active orthopaedic registries. This article is intended as a primer for the practicing orthopaedic surgeon and orthopaedic groups. We provide a detailed overview of current quality metric databases, their categorization and use, and orthopaedic surgeon's role in creating and shaping the definition of quality care and outcomes assessment in the future.
Musculoskeletal Considerations for Exercise and Sport: Before, During, and After Pregnancy
Borowski, Lauren E. MD; Barchi, Elizabeth I. MD; Han, Julie S. MD; Friedman, David A. MD; Carter, Cordelia W. MD
doi : 10.5435/JAAOS-D-21-00044
Volume 29(16), 15 August 2021, p e805-e814
There is little written in the orthopaedic literature regarding common musculoskeletal problems that women encounter in relation to pregnancy and their clinical and surgical management. Exercise and other physical activity are generally recommended for most women before, during, and after pregnancy. Unfortunately, a variety of musculoskeletal issues may keep women from starting, continuing, or resuming a healthy exercise regimen throughout a notable portion of their reproductive years. Untreated and undertreated orthopaedic conditions in female athletes may therefore have further unintended negative effects on maternal and fetal health. This article reviews the existing literature on musculoskeletal health considerations before, during, and after pregnancy to provide practical information to orthopaedic surgeons who treat women of all ages and athletic abilities.
Acetabular Bone Marrow Aspiration During Total Hip Arthroplasty
Ruoss, Severin PhD; Ball, Scott T. MD; Dorn, Shanelle N. BS; Parekh, Jesal N. PhD; Whitehead, Alexander J. BS; Engler, Adam J. PhD; Ward, Samuel R. PT, PhD
doi : 10.5435/JAAOS-D-21-00085
Volume 29(16), 15 August 2021, p e815-e819
Biologically augmented surgical treatments of orthopaedic conditions are increasingly popular. Bone marrow aspirate concentrate is a key orthobiologic tissue source, and the field is moving from the standard iliac crest marrow aspiration toward local aspirations of marrow depots that are accessible during the standard-of-care procedures in an attempt to reduce morbidity, surgery time, and cost. Here, we present the aspiration of the standard iliac marrow depot, but through a novel acetabular approach during total hip arthroplasty. This procedure markedly simplifies biologic augmentation with bone marrow aspirate concentrate in this large patient cohort.
Medial Ankle Stability Evaluation With Dynamic Ultrasound: Establishing Natural Variations in the Healthy Cohort
Saengsin, Jirawat MD; Hagemeijer, Noortje C. MD, PhD; Ho Chang, Song MD, PhD; Lubberts, Bart MD, PhD; Waryasz, Gregory MD; Guss, Daniel MD, MBA; DiGiovanni, Christopher W. MD
doi : 10.5435/JAAOS-D-20-00597
Volume 29(16), 15 August 2021, p 703-713
Destabilizing injuries to the deltoid ligament have relied on radiographic stress examination for diagnosis, with a focus on medial clear space (MCS) widening. Recently, studies have demonstrated the use of ultrasonography to assess deltoid ligament injury, but not the medial ankle stability. The purpose of this study was to assess the MCS via ultrasonography while weight-bearing and with a gravity stress test (GST) in the uninjured ankle as a means of establishing normative values for future comparison.
Association of Depression and Anxiety With Expectations and Satisfaction in Foot and Ankle Surgery
Henry, Jensen K. MD; Barth, Kathryn MD; Cororaton, Agnes MS; Hummel, Amelia BA; Cody, Elizabeth A. MD; Mancuso, Carol A. MD; Ellis, Scott MD
doi : 10.5435/JAAOS-D-20-01394
Volume 29(16), 15 August 2021, p 714-722
Mental health diagnoses involving depression or anxiety are common and can have a dramatic effect on patients with musculoskeletal pathologies. In orthopaedics, depression/anxiety (D/A) is associated with worse postoperative patient-reported outcomes. However, few studies have assessed the effect of D/A on expectations and satisfaction in foot and ankle patients.
New Persistent Opioid Use After Orthopaedic Foot and Ankle Surgery: A Study of 348 Patients
Hejna, Emily E. MPH; Mehraban, Nasima MD; Holmes, George B. Jr MD; Lin, Johnny L. MD; Lee, Simon MD; Hamid, Kamran S. MD, MPH; Bohl, Daniel D. MD, MPH
doi : 10.5435/JAAOS-D-21-00187
Volume 29(16), 15 August 2021, p e820-e825
The opioid epidemic is a devastating public health issue to which orthopaedic surgery is inextricably linked. The purpose of this study was to identify risk factors for new persistent opioid use after orthopaedic foot and ankle surgery among patients who were opioid naive preoperatively.
Utilization of a Standardized Care Pathway to Decrease Costs of Ankle Fracture Management
Duckworth, Elizabeth A. MD, MBA; Stevenson, Kimberly L. MD; Mehta, Samir N. MD; Donegan, Derek J. MD, MBA
doi : 10.5435/JAAOS-D-20-00022
Volume 29(16), 15 August 2021, p e826-e833
Ankle fractures are the most common fracture of the foot and ankle treated at trauma hospitals in the United States, costing millions of dollars yearly. The purpose of this study was to determine whether a standardized care pathway led to a difference in the direct and indirect costs of surgical fixation of ankle fractures at one Level I Trauma Center and tertiary care medical center.
