Eric G. Huish

Background: In 2023, Major League Baseball (MLB) implemented a pitch clock (PC) to reduce game duration. Concerns have emerged regarding its effect on injury rates, particularly ulnar collateral ligament (UCL) tears, by reducing recovery time between pitches. Purpose: To assess the correlation between the MLB PC and UCL injury. Study Design: Cohort study; Level of evidence, 3. Methods: UCL tear incidence was compared between pre-PC (PPC) (2021-2022) and PC (2023-2024) eras. Data on UCL injuries were collected from publicly available databases. Variables collected included player demographics, advanced pitching metrics, total pitches, innings pitched, and games played. The primary outcome was UCL tear incidence per 1000 innings pitched. Secondary outcomes included UCL tears per innings pitched in the season of injury (preinjury workload innings [PIWi]) and UCL tears per pitches thrown in the season of injury (preinjury workload pitches [PIWp]), pitch count per season, fastball velocity, and pitch selection. Results: There was no significant difference in UCL tear incidence between PPC (0.63) and PC (0.67) eras ( P = .73). However, PIWp was significantly higher in the PC era (n = 721) compared with the PPC era (n = 442) ( P = .009), and PIWi was significantly higher in the PC (45.7) era compared with the PPC era (26.5) ( P = .003). Pitchers in the PC group were significantly younger (28.4 vs 31.0) ( P = .0002), threw more pitches per season (710 vs 441) ( P = .02), and averaged more pitches per game (54.9 vs 35.5) ( P = .0005). Conclusion: The PC had no observed effect on overall UCL tear incidence but was associated with a higher preinjury workload. These findings challenge fatigue-related injury theories and suggest potential protective effects of the PC.

Purpose To investigate the relationship between urinary toxicology screen and traumatic femoral shaft fractures treated with intramedullary fixation, as well as assessing their impacts on morphine milligram equivalents (MME) and hospital length of stay (LOS). Methods Design: Retrospective Chart Review; Setting: Single center, non-academic community level II trauma center; Patient Selection Criteria: All patients who were 16 years or older, and admitted to the hospital following a trauma activation for a femoral shaft fracture were included in the study. Exclusion criteria included patients without a urine toxicology screen, with low energy mechanisms or pathologic fractures, or those with miscoded charts. Outcome Measures and Comparisons: The primary outcomes of this study were MME and hospital LOS. Patients were grouped based on whether or not they had a positive or negative urinary drug screen. Results A total of 144 patients met inclusion criteria having sustained femoral shaft fractures treated with intramedullary fixation. 34 patients were excluded from the study for not meeting one or more inclusion criteria. A total of 110 patients met the criteria for analysis. No positive UDS was found to correlate significantly with hospital LOS, and amongst all drugs screened for, only opiates were found to have a statistically significant increase in morphine milligram equivalents per day. Additionally, a negative UDS for opiates showed statistically significant correlation with ICU admission (p value 0.0273). Conclusions Trauma patients with a positive UDS for opioid use, and a femoral shaft fracture treated with intramedullary nail, are at an increased risk for higher MME requirements during their hospitalization, independent of ISS.

Background The digital mid-axial incision is commonly used in hand surgery. When correctly placed, the proper digital nerves should lie protected in the volar skin flap. The purpose of this study was to evaluate the distance of the digital neurovascular (NV) bundle from a mid-axial incision. Methods A standardized mid-axial incision along both sides of each digit was made on five fresh-frozen cadaver hands. The distance from the margin of the incision to the NV bundle was measured at the proximal interphalangeal joint (PIP) and the distal interphalangeal joint (DIP) levels on radial and ulnar sides. The same protocol was performed at the interphalangeal joint (IP) of each thumb. Results A total of 90 measurements were taken on five cadaveric hands. In the fingers, the average distance was 3.96 mm from the mid axial incision, with no measurement less than 2.97 mm. This distance was an average of 6.58 mm in the thumb, with no measurement less than 5.98 mm. The NV bundle on the radial side of the fingers was found to be farther from the mid axial incision than those on the ulnar side. The thumb displayed the opposite relationship, with the ulnar side having larger measurements. Conclusions The digital nerves of the fingers and thumb are safe during a mid-axial approach, with a safe zone of approximately 3mm in the fingers and 6mm in the thumb. Knowing these anatomic relationships will aid surgeons in safely approaching the digits while minimizing the risk of NV injury.

Introduction: The potential capabilities of generative artificial intelligence (AI) tools have been relatively unexplored, particularly in the realm of creating personalized statements for medical students applying to residencies. This study aimed to investigate the ability of generative AI, specifically ChatGPT and Google BARD, to generate personal statements and assess whether faculty on residency selection committees could (1) evaluate differences between real and AI statements and (2) determine differences based on 13 defined and specific metrics of a personal statement. Methods: Fifteen real personal statements were used to generate 15 unique and distinct personal statements from ChatGPT and BARD each, resulting in a total of 45 statements. Statements were then randomized, blinded, and presented to a group of faculty reviewers on residency selection committees. Reviewers assessed the statements by 14 metrics including if the personal statement was AI-generated or real. Comparison of all metrics was performed. Results: Faculty correctly identified 88% (79/90) real statements, 90% (81/90) BARD, and 44% (40/90) ChatGPT statements. Accuracy of identifying real and BARD statements was 89%, but this dropped to 74% when including ChatGPT. In addition, the accuracy did not increase as faculty members reviewed more personal statements (area under the curve [AUC] 0.498, p = 0.966). BARD performed poorer than both real and ChatGPT across all metrics (p < 0.001). Comparing real with ChatGPT, there was no difference in most metrics, except for Personal Interests, Reasons for Choosing Residency, Career Goals, Compelling Nature and Originality, and all favoring the real personal statements (p = 0.001, p = 0.002, p < 0.001, p < 0.001, and p < 0.001, respectively). Conclusion: Faculty members accurately identified real and BARD statements, but ChatGPT deceived them 56% of the time. Although AI can craft convincing statements that are sometimes indistinguishable from real ones, replicating the humanistic experience, personal nuances, and individualistic elements found in real personal statements is difficult. Residency selection committees might want to prioritize these particular metrics while assessing personal statements, given the growing capabilities of AI in this arena. Clinical Relevance: Residency selection committees may want to prioritize certain metrics unique to the human element such as personal interests, reasons for choosing residency, career goals, compelling nature, and originality when evaluating personal statements.

Glenohumeral instability is frequently encountered by surgeons due to the relatively high frequency of traumatic shoulder dislocations. Recurrent anterior instability is common and increasingly seen in young active male patients while recurrent posterior instability is less frequently seen. Surgery is often indicated in cases of recurrent instability or after an initial dislocation event with high risk of recurrence. The goal of treatment is to prevent future instability events and their sequelae. Advanced imaging is typically required to determine the extent of injury. Selection of appropriate surgical treatment is dependent on the degree of soft tissue and bony injury and is necessary to avoid failure and additional instability episodes. While some cases are relatively straightforward, there remains controversy in management of more complex cases.

Background: There are many surgical techniques when repairing pectoralis major tears. However, there is no clear consensus on which repair technique is biomechanically superior. Our purpose was to perform a systematic review and meta-regression to evaluate the most biomechanically superior pectoralis major repair technique. Methods: We performed a systematic review and meta-regression of six human cadaveric biomechanical studies evaluating fixation techniques for pectoralis major repairs. The primary outcome was the ultimate failure load. Covariates included cadaveric age, bone mineral density, implants, suture, and stitch method. Meta-regression accounted for differences in variables. Results: Compared with Krackow/Bunnell stitch method, the modified Mason–Allen stitch demonstrated a decrease in ultimate failure load by 220.6 N (95% CI, −273.0 to −168.2; p = <0.001). No differences were found between Krackow/Bunnell and whipstitch. There was an increase in ultimate failure load when utilizing suture tape by 206.6 N (95% CI, 139.5–273.7, p < 0.001). Suture anchors had a decrease in ultimate failure load by 88.1 N (95% CI, −153.4 to −22.8, p = 0.008) when compared to transosseous sutures. No differences were found between transosseous sutures and unicortical buttons. Discussion: We found the combination of suture tape in a whipstitch or Krackow/Bunnell stitch utilizing transosseous sutures or unicortical buttons is the most biomechanically superior construct for pectoralis major repairs.