Christopher J. Lama

Objectives: The aim of this study was to characterize the case volume dependence of both facilities and surgeons on morbidity and mortality after femoral shaft fracture (FSF) fixation. Methods: Adults who had an open or closed FSF between 2011 and 2015 were identified in the New York Statewide Planning and Research Cooperative System database. Claims were identified by International Classification of Disease-9, Clinical Modification diagnostic codes for a closed or open FSF and International Classification of Disease-9, Clinical Modification procedure codes for FSF fixation. Readmission, in-hospital mortality, and other adverse events were compared across surgeon and facility volumes using multivariable Cox proportional hazards regression, controlling for patient demographic and clinical factors. Surgeon and facility volumes were compared between the lowest and highest 20% to represent low-volume and high-volume surgeons/facilities. Results: Of 4,613 FSF patients identified, 2,824 patients were treated at a high or low-volume facility or by a high or low-volume surgeon. Most of the examined complications including readmission and in-hospital mortality showed no statistically significant differences. Low-volume facilities had a higher 1-month rate of pneumonia. Low-volume surgeons had a lower 3-month rate of pulmonary embolism. Conclusion: There is minimal difference in outcomes in relation to facility or surgeon case volume for FSF fixation. As a staple of orthopaedic trauma care, FSF fixation is a procedure that may not require specialized orthopaedic traumatologists at high-volume facilities.

Background: This study seeks to examine the reliability, quality, and content of YouTube videos on cubital tunnel syndrome, on which there is presently a paucity of information. Methods: The top 50 unique YouTube videos by relevance resulting from the Boolean search term “cubital tunnel + cubital tunnel syndrome” were identified, with video properties for analysis including source, upload date, duration, views, and comments. Content was assessed using the Journal of American Medical Association ( JAMA) criteria, the Global Quality Score (GQS), and a “Cubital Tunnel–Specific Score” (CTSS). Results: The average video saw 72 108 ± 199 362 views, with videos produced by allied (nonphysician) health professionals demonstrating the highest mean views (111 789 ± 294 471 views). Videos demonstrated low mean JAMA scores (2.4/4 ± 0.7), GQS (2.8/5 ± 1.3), and CTSS (7.5/21 ± 4.3), with academic and nonacademic physician videos demonstrating significantly greater mean GQS and CTSS scores when compared with videos by allied health professionals. Positive independent predictors for GQS included academic sources (β = 1.871), nonacademic physician sources (β = 1.651), and video duration (β = 0.102), which were likewise positive predictors for CTSS (β = 4.553, 4.639, 0.374). Content relating to surgical techniques or approaches for cubital tunnel decompression had the greatest CTSS scores (11.2 [4.2]). Conclusions: YouTube is a source of highly accessible information on cubital tunnel syndrome, although the average video presents generally poor and inadequate information. Directing patients toward higher quality video resources can be a meaningful component of patient education.

Orthopedic residency training overlaps with common childbearing ages. The purpose of this study was to describe factors affecting male and female residents' family-planning decisions and attitudes of program directors (PDs) toward parenthood during residency. In 2018, using an anonymous survey model, residents and PDs in Accreditation Council for Graduate Medical Education–accredited orthopedic surgery programs were asked about their perceptions of parenthood on training, the availability of family-oriented services at their programs, and the effect of residency culture and policies on their decision to have children. This survey occurred in 2018. Three hundred forty-nine (76.2%) of 458 resident respondents were male and 109 (23.8%) were female. Two hundred four (49.9%) of 409 residents were unsure of their program's parental leave policy. Male residents reported taking an average of 0.8 weeks (95% CI, 0.0–4.0 weeks) of parental leave and females an average of 4.6 weeks (95% CI, 2.0–6.5 weeks) ( P <.001). Female residents were more likely to report delaying having children during residency (56.73% vs 38.71%, P =.001) and were more likely to cite reputational concerns (57.63% vs 0.76%, P <.001) and effects on career opportunities (42.37% vs 7.57%, P <.001) as reasons for delaying parenthood. The most commonly cited negative effect of parenthood on residency training by PDs was reduction in off-duty educational time (15 of 29, 51.72%). Twenty-four (80%) of 30 PDs believe that training may need to be extended based on amount of maternity/paternity leave time taken off. Although parenthood during orthopedic training is common, both male and female residents reported delaying parenthood because of residency-related factors. Improved clarification of leave policies and establishment of clear guidelines for parenthood in residency may improve resident wellness. [ Orthopedics . 2021;44(2):98–104.]

Application of tibiofemoral compression force (TCF) has been shown to produce anterior cruciate ligament (ACL) injuries in a laboratory setting. A new robotic testing methodology was utilized to predict ACL forces generated by TCF without directly loading the ligament. We hypothesized that ACL force, directly recorded by a miniature load cell during an unconstrained test, could be predicted by measurements of anterior tibial restraining force (ARF) recorded during a constrained test. The knee was first flexed under load control with 25 N TCF (tibial displacements and rotations unconstrained) to record a baseline kinematic pathway. Tests were repeated with increasing levels of TCF, while recording ACL force and knee kinematics. Then tests with increasing TCF were performed under displacement control to reproduce the baseline kinematic pathway (tibia constrained), while recording ARF. This allowed testing to 1500 N TCF since the ACL was not loaded. TCF generated ACL force for all knees (n = 10) at 50 deg flexion, and for eight knees at 30 deg flexion (unconstrained test). ACL force (unconstrained test) and ARF (constrained test) had strong linear correlations with TCF at both flexion angles (R2 from 0.85 to 0.99), and ACL force was strongly correlated with ARF at both flexion angles (R2 from 0.76 to 0.99). Under 500 N TCF, the mean error between ACL force prediction from ARF regression and measured ACL force was 4.8±7.3 N at 30 deg and 8.8±27.5 N at 50 deg flexion. Our hypothesis was confirmed for TCF levels up to 500 N, and ARF had a strong linear correlation with TCF up to 1500 N TCF.