Scott C. Nelson

Introduction: Global orthopaedics includes collaborative efforts to improve clinical care, education, research, and capacity across international settings, with an emphasis on equitable, bidirectional, and sustainable partnerships. Interest in global orthopaedics among North American residents continues to grow, yet structured opportunities for clinical, educational, and research engagement in low- and middle-income countries (LMICs) remain limited. This study evaluated the availability of global orthopaedic opportunities within residency programs and assessed resident experiences, perceptions, and interest in expanding these initiatives. Methods: A cross-sectional survey was distributed to orthopaedic surgery residents in the United States and Canada through the Consortium of Orthopaedic Academic Traumatologists (COACT)-affiliated faculty and resident leads. Residents from postgraduate years 1 to 5 were eligible. Survey domains included prior global health experience, opportunities available at home institutions, resident satisfaction with existing resources, and interest in future global orthopaedic engagement. Descriptive statistics were performed. Results: Thirty of 35 residency programs (85.7%) participated, with 299 of 300 residents completing the survey (99.7%). Forty-six respondents (15.4%) reported prior or current participation in global orthopaedic activities, most commonly through organized teaching or clinical experiences (50.0%), research collaborations (41.3%), and elective international clinical rotations (37.0%). Nearly one third of residents (30.1%) reported that their residency program offered no global orthopaedic opportunities. Residents expressed dissatisfaction with the availability of mentorship, elective international rotations, and global outreach opportunities at their home institutions. Despite limited access, interest in expanding opportunities in LMICs was notable, particularly for mentorship and guidance (73.2%), elective international rotations (72.9%), and collaborative research (54.8%). Conclusions: North American orthopaedic residents demonstrate substantial interest in global orthopaedic engagement that exceeds the opportunities currently available. These findings support expanding structured mentorship, international partnerships, and centralized networks such as COACT to facilitate sustainable global clinical, educational, and research opportunities during residency.

Introduction: The use of magnetic resonance imaging (MRI) with a magnetic intramedullary lengthening nail in place is contraindicated per the manufacturer due to the concern of implant activation and migration. A prior in vitro study did not confirm these complications only noting that a 3.0 T MRI weakened the internal magnet. Therefore, a retrospective analysis of patients who underwent an MRI with a magnetic nail in place was performed to determine if any adverse effects occurred in the clinical setting. Materials and methods: A retrospective review of all patients who underwent an MRI with a magnetic lengthening nail in place was performed. The time spent being imaged in the MRI, number of times the patient entered the MRI suite, and the images obtained were recorded. Radiographs were performed before and after the MRI to determine if any hardware complications occurred. The patients were monitored for any adverse symptoms while they were in the suite. Results: A total of 12 patients with 13 nails were identified. Two patients underwent imaging with a 3.0 T MRI while the remaining 10 underwent imaging with a 1.5 T MRI. Each patient entered the MRI suite 2.1 times and spent an average of 84.7 min being imaged in the MRI (range 21–494). No patients noted any adverse symptoms related to the nail while in the suite and no hardware complications were identified. Conclusion: MRI appears to be safe with a magnetic nail in place and did not result in any complications. Given the manufacturer’s recommendations, informed consent should be obtained prior to an MRI being performed and a 3.0 T MRI should be avoided when possible if further activation of the nail is required.

Case: A 27-year-old woman with a Grade II chondrosarcoma in the right acetabulum underwent a Type II internal hemipelvectomy with an ischiofemoral fusion. She developed a 7.0-cm functional limb-length discrepancy with adduction of the hip at rest. Four years after surgery, she underwent a corrective osteotomy and limb lengthening with a magnetic lengthening nail. Eleven years after tumor resection and a successful pregnancy, she had symmetric leg lengths and ambulated without an assistive device. Conclusions: A magnetic lengthening nail is a viable option for correcting limb-length discrepancies after hemipelvectomy. If necessary, a simultaneous corrective proximal femoral osteotomy can be performed.

As the world continues to adjust to life with COVID-19, one topic that requires further thought and discussion is whether elective international medical volunteerism can continue, and, if so, what challenges will need to be addressed. During a pandemic, the medical community is attentive to controlling the disease outbreak, and most of the literature regarding physician involvement during a pandemic focuses primarily on physicians traveling to areas of need to help treat the disease. As a result, little has been written about medical volunteerism that focuses on medical treatment unrelated to the disease outbreak. In a world-wide pandemic, many factors are to be considered in determining whether, and when, a physician should travel to another region to provide care and training for medical issues not directly related to the pandemic. Leaders of humanitarian committees of orthopaedic surgery subspecialties engaged with one another and host orthopaedic surgeons and a sponsoring organization to provide thoughtful insight and expert opinion on the challenges faced and possible pathways to provide continued orthopaedic support around the globe. Although this discussion focuses on international orthopaedic care, these suggestions may have a much broader application to the international medical community as a whole.

Purpose: Langenskiöld described a reconstructive soft-tissue procedure for irreducible lateral congenital patellar dislocations. Paley further detailed the technique in the surgical management of congenital femoral deficiency. The aim of this study was to evaluate the outcomes of patients with congenital, chronic and recurrent patellar dislocations treated with the modified Langenskiöld procedure. Methods: This is a retrospective case series. Between 2011 and 2018, 18 knees in 13 patients (mean age 15.8 years (sd 4.4; 12 to 29.9), nine female) with diagnoses of recurrent (six patients, eight knees), chronic (four patients, six knees) and congenital (three patients, four knees) patellar dislocations were treated with the modified Langenskiöld procedure. Results: There were no recurrent lateral dislocations in the congenital or recurrent groups. One of the patients in the congenital group had an overcorrection with some medial patellar maltracking but until this time has not required any further surgery. In the chronic group two of the six knees developed further dislocations; these were both on the same patient, who had no dislocations until one year after surgery. Mean Kujala score was 83.7 (sd 17; 47 to 100) for all groups. In spite of preoperative knee flexion contractures of up to 30° in three patients (six knees), all patients had full extension postoperatively. Eight patients reported being satisfied with their outcome, one was somewhat satisfied, two were very dissatisfied, and two did not respond. Conclusion: The modified Langenskiöld reconstruction provides a powerful correction for challenging cases of congenital and recurrent patellar dislocations. Re-dislocation as well as overcorrection can occasionally occur. Level of Evidence: Level IV

The purpose of our study was to assess the relationship between amount of blood loss and surgical stage in pediatric patients undergoing posterior spinal fusion for deformity correction to determine: (1) when the highest rate of blood loss occurred; (2) what percentage of total blood loss occurred during deformity correction and closure; and (3) how to predict remaining blood loss during a procedure. Blood loss following exposure and placement of the final pedicle screw is often underestimated, which may result in lack of sufficient blood product availability. Knowledge of the rate of blood loss plays an important role in intraoperative decision making, facilitating communication with the anesthesia team, and improving patient safety. Clinical records were reviewed for all patients 9 to 18 years of age who underwent index spinal fusion surgery with pedicle screw constructs for deformity correction of greater than 4 levels by a single surgeon from April 2013 to July 2015. All patients received tranexamic acid prophylactically. Exclusion criteria included vertebral column resections, cell saver use, cases complicated by signal loss on monitoring, and incomplete records. Sixty-two of 99 patients met criteria and were included in data analysis. The surgery was divided into four stages: exposure, screw/anchor placement, corrective procedures (reduction, osteotomies), and closure. Normalized blood loss (NBL) was calculated by adjusting actual blood loss for patient weight and number of levels fused. Demographic factors of age, sex, weight/BMI, diagnosis, preoperative Cobb angle, and number of levels fused were accounted for and autoregressive moving average was used to assess whether NBL varied significantly at different stages of the procedure. NBL during reduction and closure (1.69) was significantly greater than NBL during exposure and screw placement (1.49) (p < .040). The rate of blood loss was also highest during reduction/deformity correction procedures than exposure (p < .001), anchor placement (p = .010), and closure (p < .010). At the time of placement of the final pedicle screw, 47% of the total blood loss for the case had occurred. Rate of blood loss varies during pediatric posterior spinal deformity correction surgery, with the highest rates occurring during the reduction portion of the operation. Just over half of the total EBL occurs during the reduction and closure stages of surgery requiring the surgical team to plan accordingly. Additional studies investigating modifiable factors affecting blood loss during the later stages of scoliosis surgery are warranted.