Amr Turkmani

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.

Bacterial biofilms on orthopedic implants are resistant to the host immune response and to traditional systemic antibiotics. Novel therapies are needed to improve patient outcomes. TRL1068 is a human monoclonal antibody (mAb) against a biofilm anchoring protein. For assessment of this agent in an orthopedic implant infection model, efficacy was measured by reduction in bacterial burden of Staphylococcus aureus, the most common pathogen for prosthetic joint infections (PJI). Systemic treatment with the biofilm disrupting mAb TRL1068 in conjunction with vancomycin eradicated S. aureus from steel pins implanted in the spine for 26 of 27 mice, significantly more than for vancomycin alone. The mechanism of action was elucidated by two microscopy studies. First, TRL1068 was localized to biofilm using a fluorescent antibody tag. Second, a qualitative effect on biofilm structure was observed using scanning electron microscopy (SEM) to examine steel pins that had been treated in vivo. SEM images of implants retrieved from control mice showed abundant three-dimensional biofilms, whereas those from mice treated with TRL1068 did not. Clinical Significance: TRL1068 binds at high affinity to S. aureus biofilms, thereby disrupting the three-dimensional structure and significantly reducing implant CFUs in a well-characterized orthopedic model for which prior tested agents have shown only partial efficacy. TRL1068 represents a promising systemic treatment for orthopedic implant infection.