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Light JJ, Davis JM, Dunahoe J, Stwalley D, Miller AN, Cannada LK. Evaluation of obesity and age as a predictive factor of lower extremity compartment syndrome: A national trauma data bank analysis. Am J Surg 2024:S0002-9610(24)00230-7. [PMID: 38653707 DOI: 10.1016/j.amjsurg.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/02/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Risk factors of acute compartment syndrome (ACS) of the leg include tibial fractures followed by soft tissue injuries. METHODS Data collected from the National Trauma Data Bank (NTDB) between 2017 and 2019 were analyzed for adult patients with lower extremity fractures, including proximal tibia, tibial shaft, and distal tibia. The primary outcome was a diagnosis of ACS. RESULTS There were 1052/220,868 patients with lower extremity fractures with a concomitant diagnosis of compartment syndrome. Our study has shown that patients with a BMI of ≥30 had a lower incidence of compartment syndrome when compared with patients with a BMI of 25-29 and controlled for fracture type. Increased age ≥55 in males, and females between 65 and 84, also demonstrated a decreased risk. Proximal tibial fractures (n = 54,696) were significantly associated with ACS compared to midshaft (n = 42,153) and distal (n = 100,432), p < 0.0001. CONCLUSION We found that being overweight decreases risk for development of compartment syndrome in patients with lower extremity fractures. This big data study aids in establishing risk factors for development of ACS in adult trauma patients.
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Affiliation(s)
| | - Jana M Davis
- Penn State College of Medicine, M.S. Hershey Medical Center, Hershey, PA, USA
| | - Jackie Dunahoe
- Washington University Department of Orthopaedic Surgery, St. Louis, MO, USA
| | - Dustin Stwalley
- Washington University Institute for Informatics, Data Sciences and Biostatistics, St. Louis, MO, USA
| | - Anna N Miller
- Washington University Department of Orthopaedic Surgery, St. Louis, MO, USA
| | - Lisa K Cannada
- Novant Health Orthopaedic Fracture Clinic, University of North Carolina School of Medicine, Charlotte Campus, Charlotte, NC, USA.
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2
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Sabesan VJ, Lavin A, Lama G, Daji AV, Fomunung CK, Fernandez CA, Jackson GR, Cannada LK. The Sex or Race of Program Directors May Not Play a Significant Role in Impacting Diversity Among Orthopaedic Surgery Residents. Arthroscopy 2024:S0749-8063(24)00259-7. [PMID: 38593927 DOI: 10.1016/j.arthro.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/18/2024] [Accepted: 03/23/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE To identify residency program characteristics, including the presence of underrepresented minority in medicine (URiM) and/or female Program Director's influence on the race and sex distribution of Orthopaedic Surgery Residency trainees. METHODS All active and ACGME-accredited orthopaedic surgery residency programs from 2017-2021 that reported usable information on the Residency Explorer Tool were included. Data collected included program characteristics, faculty and resident sex distribution, ethnicity, race, and demographic characteristics. The program director's (PDs) specific sex, ethnicity, race, and demographic characteristics were collected utilizing residency program websites. The prevalence of factors in programs with the top quartile of female and underrepresented residents were compared with the lower three quartiles. RESULTS Data were obtained from 148/200 ACGME-accredited programs (n=3,694 residents). The 52 excluded programs had no usable information on the Residency Explorer Tool or an identifiable program website. Overall, 15.9% of residents were female and 14% were underrepresented minorities in Orthopaedic surgery residency programs. Female PDs made up 12.4% and chairs 6.9% while URiM PDs and chairs were 8.3% and 4.6%, respectively. Programs with more female residents were not associated with a female PD (p=0.79) or with URiM PDs (p=0.48). Programs with a greater percentage of URiM residents were not associated with URiM PDs (p=0.16). No correlation was found with higher percentages of underrepresented residents and female PDs (p=0.76). Larger (p = 0.021) and university-based programs (p=0.048) had a greater percentage of female residents. Orthopaedic residency programs with Visa Sponsorship had a greater percentage of URiM residents (p = 0.017). CONCLUSION Programs with a higher percentage of female or URiM residents did not show a significant association with having female or URiM program directors. Larger programs and university-affiliated programs were more likely to have a larger percentage of female residents, while programs that offered visa sponsorship had a higher percentage of URiM residents.
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Affiliation(s)
- Vani J Sabesan
- JFK / University of Miami Orthopaedic Surgery Program, Palm Beach, FL; Palm Beach Shoulder Service at Atlantis Orthopaedics HCA Florida, Palm Beach, FL
| | - Alessia Lavin
- JFK / University of Miami Orthopaedic Surgery Program, Palm Beach, FL; Palm Beach Shoulder Service at Atlantis Orthopaedics HCA Florida, Palm Beach, FL
| | - Gabriel Lama
- Florida International University Herbert Wertheim College of Medicine, Miami, FL
| | - Akshay V Daji
- JFK / University of Miami Orthopaedic Surgery Program, Palm Beach, FL
| | - Clyde K Fomunung
- JFK / University of Miami Orthopaedic Surgery Program, Palm Beach, FL; Palm Beach Shoulder Service at Atlantis Orthopaedics HCA Florida, Palm Beach, FL
| | - Carlos A Fernandez
- JFK / University of Miami Orthopaedic Surgery Program, Palm Beach, FL; Palm Beach Shoulder Service at Atlantis Orthopaedics HCA Florida, Palm Beach, FL
| | - Garrett R Jackson
- JFK / University of Miami Orthopaedic Surgery Program, Palm Beach, FL; Palm Beach Shoulder Service at Atlantis Orthopaedics HCA Florida, Palm Beach, FL.
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Hopp M, Shao JM, Reyna C, Cannada LK, Nosanov LB. Beyond Grit and Resilience: It's okay to need help. Am J Surg 2024:S0002-9610(24)00195-8. [PMID: 38594143 DOI: 10.1016/j.amjsurg.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Morgan Hopp
- Creighton University School of Medicine, Phoenix, AZ, USA
| | - Jenny M Shao
- Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Chantal Reyna
- Department of Surgery, Loyola Medicine, Chicago, IL, USA
| | - Lisa K Cannada
- Novant Health Orthopedics, University of North Carolina SOM Charlotte Campus, Charlotte, NC, USA
| | - Lauren B Nosanov
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
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Davis ME, Ishmael C, Fram B, Light JJ, Obremskey WT, Cannada LK. Finding Your Job in Orthopaedic Trauma: A Survey Revealing the Cold Hard Facts. J Orthop Trauma 2024; 38:e120-e125. [PMID: 38117574 DOI: 10.1097/bot.0000000000002744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVES Finding a first job after fellowship can be stressful due to the uncertainty about which resources to use, including fellowship program directors, residency faculty, and other sources. There are more than 90 orthopaedic trauma fellows seeking jobs annually. We surveyed orthopaedic trauma fellows to determine the job search process. METHODS DESIGN An anonymous 37-question survey. SETTING Online Survey. PATIENT SELECTION CRITERIA Orthopaedic trauma fellows from the 5 fellowship-cycle years of 2016-2021. OUTCOME MEASURES AND COMPARISONS The primary questions were related to the job search process, current job, and work details. The secondary questions addressed job satisfaction. Data analysis was performed using STATA 17. RESULTS There were 159 responses (40%). Most of the respondents completed a fellowship at an academic program (84%). Many (50%) took an academic job and 24% were hospital employed. Sixteen percent had a job secured before fellowship and 49% went on 2-3 interviews. Word of mouth was the top resource for finding a job (53%) compared with fellowship program director (46%) and residency faculty (33%). While 82% reported ending up in their first-choice job, 34% of respondents felt they "settled." The number of trauma cases was important (62%), ranked above compensation (52%) as a factor affecting job choice. Surgeons who needed to supplement their practice (46%) did so with primary and revision total joints (37%). CONCLUSIONS Jobs were most often found by word of mouth. Most fellows landed their first job choice, but still a third of respondents reporting settling on a job. Case volume played a significant role in factors affecting job choice.
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Affiliation(s)
- Max E Davis
- Texas Tech University Health Sciences Center, Lubbock, TX
| | - Chad Ishmael
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Brianna Fram
- Department of Orthopaedics & Rehabilitation, Orthotrauma, Yale School of Medicine, New Haven, CT
| | - Jonathan J Light
- Eastern Virginia Medical School, School of Medicine, Norfolk, VA
| | - William T Obremskey
- Department of Orthopaedic Surgery, Vanderbilt University, Nashville, TN; and
| | - Lisa K Cannada
- Novant Health Orthopaedic Fracture Clinic, University of North Carolina School of Medicine, Charlotte Campus, Charlotte, NC
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Shao JM, Hopp M, Nosanov L, Reyna C, Cannada LK. Beyond grit and resilience: An association of Women Surgeon's series on surgical culture change. Am J Surg 2024:S0002-9610(24)00109-0. [PMID: 38365557 DOI: 10.1016/j.amjsurg.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/18/2024]
Affiliation(s)
- Jenny M Shao
- Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
| | - Morgan Hopp
- Creighton University School of Medicine, Phoenix, AZ, USA
| | - Lauren Nosanov
- Division of Acute Care and Regional Surgery, University of Wisconsin, Madison, WI, USA
| | - Chantal Reyna
- Department of Surgery, Loyola Medicine, Chicago, IL, USA
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Allen L, O'Toole RV, Bosse MJ, Obremskey WT, Archer KR, Cannada LK, Shores J, Reider LM, Frey KP, Carlini AR, Staguhn ED, Castillo RC. How many sites should an orthopedic trauma prospective multicenter trial have? A marginal analysis of the Major Extremity Trauma Research Consortium completed trials. Trials 2024; 25:107. [PMID: 38317256 PMCID: PMC10840249 DOI: 10.1186/s13063-024-07917-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Multicenter trials in orthopedic trauma are costly, yet crucial to advance the science behind clinical care. The number of sites is a key cost determinant. Each site has a fixed overhead cost, so more sites cost more to the study. However, more sites can reduce total costs by shortening the study duration. We propose to determine the optimal number of sites based on known costs and predictable site enrollment. METHODS This retrospective marginal analysis utilized administrative and financial data from 12 trials completed by the Major Extremity Trauma Research Consortium. The studies varied in size, design, and clinical focus. Enrollment across the studies ranged from 1054 to 33 patients. Design ranged from an observational study with light data collection to a placebo-controlled, double-blinded, randomized controlled trial. Initial modeling identified the optimal number of sites for each study and sensitivity analyses determined the sensitivity of the model to variation in fixed overhead costs. RESULTS No study was optimized in terms of the number of participating sites. Excess sites ranged from 2 to 39. Excess costs associated with extra sites ranged from $17K to $330K with a median excess cost of $96K. Excess costs were, on average, 7% of the total study budget. Sensitivity analyses demonstrated that studies with higher overhead costs require more sites to complete the study as quickly as possible. CONCLUSIONS Our data support that this model may be used by clinical researchers to achieve future study goals in a more cost-effective manner. TRIAL REGISTRATION Please see Table 1 for individual trial registration numbers and dates of registration.
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Affiliation(s)
- Lauren Allen
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21205, USA.
| | - Robert V O'Toole
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Michael J Bosse
- Atrium Health Carolinas Medical Center, Charlotte, NC, 28204, USA
| | - William T Obremskey
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Lisa K Cannada
- Novant Health Orthopedic Fracture Clinic, Charlotte, NC, 28211, USA
| | - Jaimie Shores
- School of Medicine, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Lisa M Reider
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21205, USA
| | - Katherine P Frey
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21205, USA
| | - Anthony R Carlini
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21205, USA
| | - Elena D Staguhn
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21205, USA
| | - Renan C Castillo
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 415 North Washington Street, Baltimore, MD, 21205, USA
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Weaver ML, Drudi LM, Adams AM, Faria I, Feldman HA, Gudmundsdottir H, Marmor H, Miles MVP, Ochoa B, Ruff SM, Sundland R, Tonelli C, Altieri MS, Cannada LK, Dewan K, Etkin Y, Marmor R, Plichta JK, Reyna C, Tatebe LC, Hicks CW. Implementation of a novel peer review academy by Surgery and the Association of Women Surgeons. Surgery 2024; 175:323-330. [PMID: 37953152 PMCID: PMC10842028 DOI: 10.1016/j.surg.2023.09.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/28/2023] [Accepted: 09/26/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND A novel Peer Review Academy was developed as a collaborative effort between the Association of Women Surgeons and the journal Surgery to provide formal training in peer review. We aimed to describe the outcomes of this initiative using a mixed methods approach. METHODS We developed a year-long curriculum with monthly online didactic sessions. Women surgical trainee mentees were paired 1:1 with rotating women surgical faculty mentors for 3 formal peer review opportunities. We analyzed pre-course and post-course surveys to evaluate mentee perceptions of the academy and assessed changes in mentee review quality over time with blinded scoring of unedited reviews. Semi-structured interviews were conducted upon course completion. RESULTS Ten women surgical faculty mentors and 10 women surgical trainees from across the United States and Canada successfully completed the Peer Review Academy. There were improvements in the mentees' confidence for all domains of peer review evaluated, including overall confidence in peer review, study novelty, study design, analytic approach, and review formatting (all, P ≤ .02). The mean score of peer review quality increased over time (59.2 ± 10.8 vs 76.5 ± 9.4; P = .02). In semi-structured interviews, important elements were emphasized across the Innovation, Implementation Process, and Individuals Domains, including the values of (1) a comprehensive approach to formal peer review education; (2) mentoring relationships between women faculty and resident surgeons; and (3) increasing diversity in the scientific peer review process. CONCLUSION Our novel Peer Review Academy was feasible on a national scale, resulting in significant qualitative and quantitative improvements in women surgical trainee skillsets, and has the potential to grow and diversify the existing peer review pool.
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Affiliation(s)
- M Libby Weaver
- Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, VA
| | - Laura M Drudi
- Division of Vascular Surgery, Centre Hospitalier de L'Universite de Montreal, Montreal, QC, Canada
| | - Alexandra M Adams
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX
| | - Isabella Faria
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA
| | - Hope A Feldman
- Department of General Surgery, Geisinger Medical Center, Danville, PA
| | | | - Hannah Marmor
- Department of Surgery, State University of New York Upstate Medical University, Syracuse, NY
| | - M Victoria P Miles
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Brielle Ochoa
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Samantha M Ruff
- Division of Surgical Oncology, The Ohio State University, Columbus, OH
| | | | - Celsa Tonelli
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Maria S Altieri
- Department of Surgery, University of Pennsylvania, Pennsylvania Hospital, Philadelphia, PA
| | - Lisa K Cannada
- Novant Health Fracture Clinic, University of North Carolina-Charlotte School of Medicine, Charlotte, NC
| | - Karuna Dewan
- Department of Otolaryngology, Head and Neck Surgery, Louisiana State University, New Orleans, LA
| | - Yana Etkin
- Division of Vascular Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Rebecca Marmor
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Chantal Reyna
- Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Leah C Tatebe
- Department of Surgery, Northwestern University, Chicago, IL
| | - Caitlin W Hicks
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
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8
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Davis CH, DiLalla GA, Perati SR, Lee JS, Oropallo AR, Reyna CR, Cannada LK. Future goals for professionalism in surgery: A My Thoughts piece from the Association of Women Surgeons. Am J Surg 2023; 226:393-394. [PMID: 37019809 DOI: 10.1016/j.amjsurg.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/01/2023] [Accepted: 03/23/2023] [Indexed: 04/05/2023]
Affiliation(s)
- Catherine H Davis
- Division of Surgical Oncology, Baylor University Medical Center, Dallas, TX, USA.
| | - Gayle A DiLalla
- Division of Surgical Oncology, Duke University School of Medicine, Duke Breast Surgery of Raleigh, Raleigh, NC, USA
| | - Shruthi R Perati
- Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Jenna S Lee
- Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | | | - Lisa K Cannada
- Department of Orthopaedics, University of North Carolina, Novant Health, Charlotte, NC, USA
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Chou LB, Johnson B, Shapiro LM, Pun S, Cannada LK, Chen AF, Valone LC, Van Nortwick SS, Ladd AL, Finlay AK. Reply to Letter to the Editor: Increased Prevalence of Breast and All-cause Cancer in Female Orthopaedic Surgeons. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202309000-00003. [PMID: 37678820 PMCID: PMC10484368 DOI: 10.5435/jaaosglobal-d-23-00130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/11/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Loretta B Chou
- From the Department of Orthopaedic Surgery (Dr. Chou, Dr. Johnson, Dr. Pun, Dr. Ladd), Stanford University (Dr. Chou, Dr. Johnson, Dr. Pun, and Dr. Ladd); the Department of Orthopaedic Surgery, University of California-San Francisco (Dr. Shapiro); the Department of Orthopaedic Surgery, Hughston Clinic (Dr. Cannada); the Department of Orthopaedic Surgery, Harvard Medical School (Dr. Chen); the Department of Orthopaedic Surgery, California Pacific Orthopaedics (Dr. Valone); the Department of Orthopaedic Surgery, Medical University of South Carolina (Dr. Van Nortwick); and the Department of Orthopaedic Surgery, Palo Alto Veterens Association (Dr. Finlay)
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Ghattas YS, Kyin C, Grise A, Glasser J, Johnson T, Druskovich K, Cannada LK, Service BC. Trends in Female Authorship in Orthopaedic Literature from 2002 to 2021: An Analysis of 168,451 Authors. J Bone Joint Surg Am 2023; 105:1285-1294. [PMID: 37155604 DOI: 10.2106/jbjs.22.01290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Significant gender disparity exists in orthopaedic surgery. While women have increasingly entered the field, we are short of the critical mass needed to drive change, including in authorship. This study aimed to characterize trends in authorship in peer-reviewed orthopaedic journals in the context of gender. METHODS This is a cross-sectional bibliometric study of orthopaedic journals in the United States. Articles that were indexed in the orthopaedic category of the Clarivate Journal Citation Report (JCR) and the Science Citation Index Expanded (SCIE) were analyzed (n = 82). Journals not originating from the U.S. (n = 43) or not considered primarily orthopaedic journals (n = 13) were excluded. The 2020 impact factors (IFs) of the remaining 26 journals were recorded. The articles underwent automated data collection from PubMed for January 2002 to December 2021 using R software to collect the title, the journal, the publication year, the first and senior author names, and the country of origin. Gender was determined by Gender API ( https://gender-api.com ). Names with <90% accuracy were excluded. RESULTS Overall, 168,451 names were studied, with 85,845 and 82,606 first and senior authors, respectively. Of the first and senior authors, 13.6% and 9.9%, respectively, were female. The proportion of female first authors was significantly greater than the proportion of female senior authors. The average IF was significantly higher for male authors compared with female authors (p < 0.005). Articles with female first authors were significantly more likely to have a female senior author. Orthopaedic subspecialty journals had a smaller proportion of manuscripts authored by female first and senior authors than general journals (p < 0.0001). There were 4,451 articles written by a single author, of which 92% (4,093) were written by a man and 8% (358) were written by a woman. Over the 20-year study period, the proportion of female first authorship exhibited a significant positive trend; however, there was a non-significant increase in female senior authorship. CONCLUSIONS Female representation in orthopaedics has been growing over the past decade. Increasing publication rates of female authors reveal steps toward positive gender equity in the field and present an opportunity for female leadership visibility, illustrating the capabilities of women in orthopaedics and encouraging more women to join the field.
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Affiliation(s)
| | - Cynthia Kyin
- University of Central Florida College of Medicine, Orlando, Florida
| | - Alison Grise
- University of Central Florida College of Medicine, Orlando, Florida
| | - Jillian Glasser
- University of Central Florida College of Medicine, Orlando, Florida
| | - Taylor Johnson
- Orlando Health Jewett Orthopedic Institute, Orlando, Florida
| | | | - Lisa K Cannada
- University of Central Florida College of Medicine, Orlando, Florida
- Novant Health Orthopedics, Charlotte, North Carolina
| | - Benjamin C Service
- University of Central Florida College of Medicine, Orlando, Florida
- Orlando Health Jewett Orthopedic Institute, Orlando, Florida
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11
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DiFiori MM, Gupta SS, Cannada LK, Pei KY, Stamm MA, Mulcahey MK. Bullying in Orthopaedic Surgery: A Survey of US Orthopaedic Trainees and Attending Surgeons. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202305000-00006. [PMID: 37141506 PMCID: PMC10155897 DOI: 10.5435/jaaosglobal-d-23-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/10/2023] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Bullying is a notable problem in surgery, creating a hostile environment for surgeons and trainees, and may negatively affect patient care. However, specific details regarding bullying in orthopaedic surgery are lacking. The primary aim of this study was to determine the prevalence and nature of bullying within orthopaedic surgery in the United States. METHODS A deidentified survey was developed using the survey created by the Royal College of Australasian Surgeons and the validated Negative Acts Questionnaire-Revised survey tool. This survey was distributed to orthopaedic trainees and attending surgeons in April 2021. RESULTS Of the 105 survey respondents, 60 (60.6%) were trainees and 39 (39.4%) were attending surgeons. Although 21 respondents (24.7%) stated they had been bullied, 16 victims (28.1%) did not seek to address this behavior. Perpetrators of bullying were most commonly male (49/71, 67.2%) and the victims' superior (36/82, 43.9%). Five bullying victims (8.8%) reported the behavior, despite 46 respondents (92.0%) stating that their institution has a specific policy against bullying. CONCLUSION Bullying behavior occurs in orthopaedic surgery, with perpetrators being most commonly male and the victims' superiors. Despite the fact that an overwhelming majority of institutions have policies against bullying, the reporting of such behavior is lacking.
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Affiliation(s)
- Monica M DiFiori
- From the Department of Orthopaedic Surgery and Sports Medicine, Temple University Hospital, Philadelphia, PA, (Dr. DiFiori); Tulane University School of Medicine, New Orleans, LA (Ms. Gupta); Department of Orthopaedics, University of North Carolina and Novant Health Orthopaedic Fracture Clinic, Hughston Clinic, Jacksonville, FL (Dr. Cannada); Graduate Medical Education, Parkview Health, Fort Wayne, Indiana (Dr. Pei); Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA (Dr. Stamm and Dr. Mulcahey)
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12
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Sutton R, Wang WL, Abdelfadeel W, Sherman M, Cannada LK, Krueger CA. Are Orthopedic Fellowship Programs Giving Out Too Many Interviews? A Retrospective Analysis Suggests They Are. HSS J 2023; 19:210-216. [PMID: 37065095 PMCID: PMC10090836 DOI: 10.1177/15563316221103585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/22/2022] [Indexed: 04/18/2023]
Abstract
Background: The orthopedic surgery fellowship match process is associated with substantial stress and expense, yet the optimal number of interviews for fellowships to offer has not been evaluated. Purpose: We sought to evaluate the number of orthopedic surgery fellowship interviews given and construct a model to determine the appropriate number of interviews to offer based on specialty and program size. Methods: We conducted a retrospective study of 6 orthopedic fellowship specialties; data were obtained from San Francisco Match and covered the 5-year period from 2014 to 2018. The orthopedic fellowship subspecialties included adult reconstruction/oncology, foot and ankle, pediatrics, spine, sports medicine, and trauma. We excluded shoulder and elbow (less than 5 years of data) and hand and upper extremity (alternative matching process). Parameters included number of programs, number of spots per program, number of ranked applicants per program (mean ± SD), and difference in number of interviews offered and ranked applicants per program (mean ± SD). Multiple regression analysis was used to create an equation for determining the optimal number of interviews for the programs. Results: Of 1377 orthopedic fellowship programs analyzed, 1370 (99.50%) conducted interviews beyond the number of ranked applicants. Programs ranked an overall mean of 20.10 ± 10.17 applicants with an overall mean of 11.60 ± 8.62 additional interviews offered. Sports medicine had the highest mean ranked applicants (23.21 ± 9.77) and pediatrics had the lowest mean ranked applicants (15.74 ± 7.76). The most additional interviews were given in adult reconstruction (14.80 ± 9.92) and the least were given in pediatrics (8.32 ± 7.17). The predictive equation was reported as Y = β1x1 + β2x2 (Y = ranked applicants, x1 = spots open, and x2 = last rank). Conclusion: Programs in 6 orthopedic subspecialties in the fellowship match process appear to consistently offer more interviews than necessary. We have developed a model to help programs predict the optimal number of fellowship applicants to interview. Future studies need to validate the model, especially with anticipated increases of the virtual interview format.
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Affiliation(s)
- Ryan Sutton
- Rothman Orthopaedic Institute,
Philadelphia, PA, USA
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Doxey S, Only AJ, Milshteyn M, Cunningham BP, Cannada LK. Are Canadian orthopaedic surgeons and American orthopaedic surgeons on par? A Canadian practice survey of orthopaedic traumatologists. OTA Int 2023; 6:e272. [PMID: 37020569 PMCID: PMC10069860 DOI: 10.1097/oi9.0000000000000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 03/03/2023] [Indexed: 04/05/2023]
Abstract
Objectives: The purpose of this study was to obtain information on Canadian orthopaedic trauma surgeon practices and salary demographics. It was hypothesized that most of the practicing surgeons recognize specific practice aspects (compensation, call schedule, operating room availability, and provided support staff) as key factors in employment opportunity evaluation. Design: Cross-sectional survey study. Setting: Orthopaedic Trauma Association (OTA) practice surveys. Participants: All active Canadian members of the OTA were eligible to participate. Main Outcome Measurement: A 50-question survey was sent through email to OTA members assessing physician, practice, and compensation metrics of Canadian orthopaedic traumatologists. Results: Fifty-two of 113 Canadian OTA members participated giving a response rate of 46%. All surgeons worked in an academic practice, either for a university (83%) or community hospital (17%). Only 2% of surgeons have changed jobs in the last 5 years, and over 73% of surgeons maintain the same place of employment during their careers. Most had an available dedicated orthopaedic trauma operating room (73%). The majority indicated having residents (71%) and fellows (63%) as support staff. Many reported completing 300–500 cases per year (42%), which decreased during COVID-19 for 50% of surgeons. The most common reported compensation was between $400,000 and $600,000 US dollars (25%) with many working 4–6 call shifts a month (48%) and 51–70 hours a week (48%). Conclusion: This study demonstrated the varying practice and physician economic variables currently in Canada. The identification and continued surveillance of these employment variables will allow for transparency in job market evaluation by applicants. Level of Evidence: Level V.
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Affiliation(s)
- Stephen Doxey
- Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN
| | - Arthur J. Only
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - Michael Milshteyn
- Department of Orthopaedic Surgery, McLaren Macomb Orthopedics and Trauma, Mount Clemens, MI; and
| | | | - Lisa K. Cannada
- Department of Orthopaedic Surgery, Novant Health Orthopaedic Fracture Clinic, Charlotte, NC
- Corresponding author. Address: Orthopaedic Trauma Surgeon, Novant Health Orthopaedic Fracture Clinic, 449 N Wendover Rd # A, Charlotte, NC 28211. E-mail address: (Lisa K. Cannada)
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Kunes JA, Ulrich MN, Orr CE, Cannada LK, Russo CM. Intimate Partner Violence in the Orthopaedic Patient Population: What Surgeons Need to Know. JBJS Rev 2023; 11:01874474-202304000-00006. [PMID: 37079704 DOI: 10.2106/jbjs.rvw.22.00199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
» Intimate partner violence (IPV) is under-reported and pervasive in the orthopaedic surgical setting. » Screening programs that could increase reporting and assist in treatment and prevention are commonly underutilized. » There is little formalized education during orthopaedic surgery training for IPV. » The incidence of IPV continues to increase in the setting of recent stressors, such as COVID-19, and the orthopaedic surgeon should play a role in the screening and identification of patients presenting with IPV injuries and provide resources and referral.
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Affiliation(s)
- Jennifer A Kunes
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Marisa N Ulrich
- Department of Orthopedic Surgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Charlotte E Orr
- Department of Orthopedic Surgery, Miami Valley Hospital, Terre Haute Regional Hospital, Dayton, Ohio
| | - Lisa K Cannada
- Department of Orthopaedic Surgery, Novant Health Orthopaedics, Charlotte, North Carolina
| | - Christen M Russo
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
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Rodarte P, Kammire MS, Israel H, Poon SC, Cannada LK. The other side of conflict: Examining the challenges of female orthopaedic surgeons in the workplace. Am J Surg 2023; 225:46-52. [PMID: 36243560 DOI: 10.1016/j.amjsurg.2022.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/21/2022] [Accepted: 09/18/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND As more women begin to enter the traditionally male-dominated field of orthopaedics, it is critical to examine their experiences in navigating gender-based conflicts in the workplace. METHODS An anonymous survey was distributed via a web link to approximately 1,100 members of Ruth Jackson Orthopaedic Society (RJOS) and 1,600 members of Women in Orthopaedics (WIO) Facebook group, with an estimated response rate of 50% and 50% respectively and protocols to mitigate duplicate response. Questions included demographics and presented several workplace scenarios. RESULTS Of the 373 respondents, 72% described experiencing some type of workplace conflict self-attributed to being female. Additionally, 8% reported either being forced out or leaving their previous job due to workplace conflict, leading to depression, anxiety, and burnout. 17% of respondents would not choose the same career again if given the opportunity. CONCLUSIONS Workplace conflict diminishes a surgeon's career satisfaction and may ultimately contribute to burnout. Understanding the relationship between gender bias and orthopaedic surgery is essential in moving towards change, and addressing these issues will create a more positive working environment for female surgeons.
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Affiliation(s)
- Patricia Rodarte
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Maria S Kammire
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Selina C Poon
- Shriner's for Children Medical Center, Pasadena, CA, USA
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Czerwonka N, Russo CM, Cannada LK. Publication and Career Trends of Ruth Jackson Orthopaedic Society Grant Winners Over the Past Decade. Iowa Orthop J 2023; 43:7-13. [PMID: 37383854 PMCID: PMC10296483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Background The Ruth Jackson Orthopaedic Society awards the Jacquelin Perry, MD Resident Research Grant and RJOS/Zimmer Biomet Clinical/Basic Science Research Grant to female orthopedic surgeons, intending to aid women in the progression and completion of their orthopedic research and bolster their pursuit or current career in academic orthopedic surgery. The impact of these grants has not yet been studied. The purpose of this study is to determine the percentage of scholarship/grant-winners who went on to publish the findings of their research, pursue academic positions, and currently hold positions of leadership in the field of orthopedic surgery. Methods The titles of the winning research projects were searched in PubMed, Embase, and/or Web of Science to ascertain publication status. For each award recipient, the number of publications prior to the award year, number of publications after the award year, total number of publications, and H-index were calculated. Each award recipient was searched online through the websites of their employment and social media pages to determine their residency institution, whether they pursued a fellowship, the number of fellowships they pursued, their subspecialty within orthopedics, their current job, and whether they are in academic or private practice. Results Of the fifteen Jacquelin Perry, MD Resident Research Grant winners, 73.3% of awarded research projects have since been published. 76.9% of award winners currently work in an academic setting and are affiliated with a residency program, and 0% currently hold leadership positions in orthopedic surgery. Of the eight winners of the RJOS/Zimmer Biomet Clinical/Basic Science Research Grant, 25% have published the findings of their awarded grant. 87.5% of award winners currently work in academics, and 75% hold leadership positions in orthopedic surgery. Conclusion Our results show that many of the winners of the Jacquelin Perry, MD Resident Research Grant and RJOS/Zimmer Biomet Clinical/ Basic Science Research Grant have published their research findings, continued research within the field of orthopedic surgery, and pursued academic careers and leadership positions. Many of the barriers to career progression and entry into orthopedic surgery that women and underrepresented groups face could be overcome through more grant opportunities and mentorship. Level of Evidence: V.
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Affiliation(s)
- Natalia Czerwonka
- Columbia Irving Medical Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Christen M. Russo
- Columbia Irving Medical Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Lisa K. Cannada
- Novant Health Orthopedic Fracture Clinic, Charlotte, North Carolina, USA
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17
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Adams JE, Fitton L, Chen AF, Cannada LK. Optimizing Outcomes By Optimizing Bone Health. Instr Course Lect 2023; 72:111-123. [PMID: 36534851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Orthopaedic surgeons have long been aware of the importance of metabolic bone health for fracture healing; however, recent attention has focused on optimization of bone health before elective surgery and also regarding pathways to ensure patients have appropriate evaluation and treatment for bone health issues. It is important to describe issues of importance to fragility fracture care and prevention and optimization of outcomes before elective or fracture surgery. To address the challenge of who has the time, expertise, and appropriate patient contact to identify and treat patients at risk of bone metabolic issues, one model for a suggested pathway to ensure these patients are identified and treated is outlined.
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18
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Golub IJ, Ng MK, Conway CA, Vakharia RM, Cannada LK, Kang KK. How does sleep apnea impact outcomes following primary total hip arthroplasty for femoral neck fractures: a matched-control analysis. Arch Orthop Trauma Surg 2023; 143:295-300. [PMID: 34287701 DOI: 10.1007/s00402-021-04070-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/11/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cross-sectional studies have demonstrated that the prevalence of sleep apnea (SA) to be increasing within the United States. While studies have shown the association of SA and its association on complications following elective orthopedic procedures, well-powered studies investigating its impact in a traumatic setting are limited. The purpose of this study was to determine whether SA patients undergoing primary total hip arthroplasty (THA) for femoral neck fractures have higher rates of: (1) hospital lengths of stay (LOS); (2) readmissions; (3) complications; and (4) healthcare expenditures. METHODS The 100% Medicare Standard Analytical Files was queried from 2005 to 2014 for patients who sustained femoral neck fractures and were treated with primary THA. The study group consisted of patients with concomitant diagnoses of SA, whereas patients without SA served as controls. Study group patients were matched to controls in a 1:5 ratio by age, sex, and various comorbid conditions. Demographics of the cohorts were compared using Pearson's chi-squared analyses, and multivariate logistic regression analyses were used to calculate the odds (OR) of the effects of SA on postoperative outcomes. A p value less than 0.006 was considered to be statistically significant. RESULTS The final query yielded 24,936 patients within the study (n = 4166) and control (n = 20,770) cohorts. SA patients had significantly longer in-hospital LOS (6 vs. 5 days, p < 0.0001) but similar readmission rates (24.12 vs. 20.50%; OR: 1.03, p = 0.476). SA patients had significantly higher frequency and odds of developing medical complications (72.66 vs. 43.85%; OR: 1.57, p < 0.0001), and higher healthcare costs ($22,743.79 vs. $21,572.89, p < 0.0001). CONCLUSION SA is associated with longer in-hospital LOS, higher rates of complications and healthcare expenditures. This study is vital as it can allow orthopaedists to educate patients with SA on the potential complications which may occur following their procedure. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ivan J Golub
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY, 11219, USA
| | - Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY, 11219, USA
| | - Charles A Conway
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY, 11219, USA
| | - Rushabh M Vakharia
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY, 11219, USA.
| | | | - Kevin K Kang
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY, 11219, USA
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Cannada LK. CORR Insights®: Functional Outcome After Nonoperative Management of Tibial Plateau Fractures in Skeletally Mature Patients: What Sizes of Gaps and Stepoffs Can be Accepted? Clin Orthop Relat Res 2022; 480:2296-2297. [PMID: 35901431 PMCID: PMC10538872 DOI: 10.1097/corr.0000000000002309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Lisa K Cannada
- Orthopaedic Trauma Surgeon, Novant Health Orthopaedics, Charlotte, NC, USA
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Golub IJ, Lam AW, Ciminero ML, Vakharia RM, Cannada LK, Kang KK. Comparison study of patient demographics and risk factors for infections following primary total hip arthroplasty for femoral neck fractures. Arch Orthop Trauma Surg 2022; 142:3779-3786. [PMID: 34748054 DOI: 10.1007/s00402-021-04237-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION While studies have shown favorable outcomes in the treatment of femoral neck fractures with the utilization of total hip arthroplasty (THA), adverse events, such as infections, can still occur. Therefore, the aims of this study were to 1) compare baseline demographics and 2) identify risk factors associated with developing either surgical site infections (SSIs) or peri-prosthetic joint infections (PJIs). MATERIALS AND METHODS A retrospective analysis of patients who underwent primary THA for femoral neck fractures were queried from the Medicare database. The inclusion criteria consisted of patients developing SSIs within 90 days or PJIs within 3 years following the index procedure. The query yielded 2502 patients who developed infections in the form of either SSIs (n = 987) or PJIs (n = 1515) out of 57,191 patients treated for femoral neck fractures with primary THA. Primary endpoints were to compare baseline demographic profiles and determine risk factors associated with developing infections. Multivariate binomial logistic regression analyses were performed to determine the odds (OR) of developing infections. A p value less than 0.001 was considered to be statistically significant. RESULTS Patients who developed either infections were found to be significantly different when compared to patients who did not develop infections. SSI (10 vs. 8, p < 0.0001) and PJI (9 vs. 5, p < 0.0001) patients both had significantly higher mean Elixhauser Comorbidity Index (ECI) scores compared to their counterparts. The regression model found the greatest risks for developing SSIs included hypertension (OR 1.63, p = 0.001), pathologic weight loss (OR 1.58, p < 0.0001), and iron deficiency anemia (IDA) (OR 1.48, p < 0.0001), whereas IDA (OR 2.14, p < 0.0001), pathologic weight loss (OR 1.75, p < 0.0001), and rheumatoid arthritis (OR 1.57, p < 0.0001) increased the odds for PJIs. CONCLUSION This study can be utilized by orthopedic surgeons and other healthcare professionals to adequately educate these patients of the complications which may occur following their surgery.
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Affiliation(s)
- Ivan J Golub
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY, 11219, USA
| | - Aaron W Lam
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY, 11219, USA
| | - Matthew L Ciminero
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY, 11219, USA
| | - Rushabh M Vakharia
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY, 11219, USA.
| | | | - Kevin K Kang
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY, 11219, USA
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Quan T, Gu A, Agarwal AR, Bernstein SA, Malyavko A, Levine WN, Cannada LK. The Impact of a Virtual Orthopaedic Surgery Symposium on Medical Students: Increasing Awareness and Knowledge of the Field. JB JS Open Access 2022; 7:JBJSOA-D-22-00077. [PMID: 36447497 PMCID: PMC9699640 DOI: 10.2106/jbjs.oa.22.00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
UNLABELLED Orthopaedic surgery has become an increasingly popular field of residency training for medical students. Many institutions offer elective time to explore areas of interest through clinical rotations and research; however, most of these opportunities are reserved for senior medical students. The purpose of this study was to evaluate the impact of a dedicated medical student orthopaedic surgery symposium to increase awareness about the field and to assess students' interest and knowledge of orthopaedic surgery before and after the symposium. METHODS Medical students were invited to submit orthopaedic surgery-related research to a free, 1-day virtual symposium held in April 2022. Abstracts were reviewed and selected from 9 different orthopaedic surgery subspecialty categories. Survey assessments were sent to medical students to complete before and after the symposium. The surveys included questions related to participant demographics as well as interest and knowledge about the field of orthopaedic surgery. Statistical analyses were completed to compare the participants' responses before and after the symposium. RESULTS In total, 962 medical students registered for the 4-hour symposium. Of these, 58.5% completed the presymposium survey and 48.0% completed the postsymposium survey. 13.3% of the respondents reported being "very knowledgeable" about the various orthopaedic surgery subspecialties before the symposium, which increased to 18.4% after the symposium. 46.9% of the participants stated that they were "knowledgeable" about the daily life of an orthopaedic surgery resident before the symposium, which increased to 67.3% after the symposium. Similarly, the percentage of respondents who reported that they were "very knowledgeable" about the residency match process increased from 12.2% presymposium to 22.4% postsymposium. CONCLUSIONS As interest in pursuing a career in orthopaedic surgery increases, medical students will continue to seek information, mentorship, and opportunities to present their research in preparation for residency applications. Our study demonstrated that a large-scale, national, virtual orthopaedic surgery symposium provided a platform to augment medical students' knowledge of the field, present their research, and interact with faculty members. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Theodore Quan
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Alex Gu
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia,E-mail for corresponding author:
| | - Amil R. Agarwal
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Simone A. Bernstein
- Department of Psychiatry, Washington University School of Medicine in St. Louis, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Alisa Malyavko
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - William N. Levine
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
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22
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Flanagan CD, Cannada LK. Results of a Nationwide Practice Survey of Orthopaedic Traumatologists. J Orthop Trauma 2022; 36:e431-e436. [PMID: 35616627 DOI: 10.1097/bot.0000000000002419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the current practice setting, clinical metrics, and reimbursements for orthopaedic traumatologists in the United States. DESIGN AND SETTING Nationwide survey of orthopaedic traumatologists. PARTICIPANTS Orthopaedic traumatologists with an active clinical practice. RESULTS Five-hundred three orthopaedic traumatologists responded to the survey request. A plurality of respondents practiced in an academic setting (48%), with a majority in practice 10 years or less (54%), and having achieved the untenured (89%) rank of assistant professor (37%). For those within private groups, 62% had achieved "partner" status, generally within 1-3 years (53%) of employment. Most surgeons (85%) reported access to a dedicated orthopaedic trauma room, providing nearly all surgeons (97%) with a first start case on weekdays, but only 55% with a first start on weekends. The greatest degree of ancillary support came from physician assistants (80%). Orthopaedic traumatologists most often reported working between 51 and 70 hours per week (66%), with 4-6 nights of call/month (43%), 1 clinic day/week (42%), and with the majority of clinical volume (>75%) related to managing traumatic injury. More than half (53%) of respondents received compensation for call. Annual case volumes and wRVU varied widely. Commonly, respondents had 100% of their salary guaranteed (48%), and most reported eligibility for additional revenue through production bonuses (70%). Three subgroup analyses by years in practice, practice setting, and physician sex provider further insight into clinical characteristics. CONCLUSIONS The results of this nationwide survey provide insight into the current clinical status of orthopaedic traumatology. Providers may find this information useful in job searches and contract negotiations.
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Affiliation(s)
- Christopher D Flanagan
- Department of Orthopaedic Surgery, University of South Florida, Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL; and
| | - Lisa K Cannada
- Department of Orthopaedic Surgery, Novant Health Fracture Clinic, Charlotte, NC
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23
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Marmor HN, Cannada LK. Does virtual negotiation training teach women to put their money where their mouth is? Am J Surg 2022. [DOI: 10.1016/j.amjsurg.2022.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Johnson KP, Lins LAB, Simske NM, Noonan KJ, Cannada LK, Whiting PS. Factors Considered in Ranking Pediatric Orthopedic Fellowship Applicants: A Survey of Program Directors. Orthopedics 2022; 45:e207-e210. [PMID: 35245134 DOI: 10.3928/01477447-20220225-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The field of orthopedic surgery continues to grow rapidly in popularity. Ninety percent of orthopedic residents pursue fellowship training after residency, representing the highest rate of subspecialty training among surgical specialties. The goal of this study was to determine the factors considered most important by pediatric orthopedic fellowship program directors (PDs) in evaluating applicants and determining a rank list. A web-based survey was sent to all 42 US pediatric orthopedic fellowship programs. The PDs were contacted through publicly accessible email addresses found on program websites or the Pediatric Orthopaedic Society of North America website. Respondents were asked to indicate the fellowship program size and the number of applicants interviewed and ranked each year. The PDs were then asked to rank a list of 12 factors to reflect the relative importance of these criteria in evaluating fellowship applicants. Three emails were sent: 1 at the initial survey release and 2 reminder emails at 2 and 4 weeks. Surveys were anonymous. The overall response rate was 69% (29 of 42). Of the responding PDs, 48% (14 of 29) indicated that the interview was the most important factor in ranking fellowship applicants, whereas 31% (9 of 29) considered the applicant's letters of recommendation most important. Personal connections to the applicant or letter writer and research experience were each considered most important by 10% of responding PDs. Nearly half (48%) of responding PDs considered in-person interviews the most important factor in ranking fellowship applicants. Our results provide useful information for medical students and orthopedic residents planning to pursue fellowship training in pediatric orthopedics. [Orthopedics. 2022;45(4):e207-210.].
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Cannada LK. CORR Insights®: Hip Fractures in Patients With Liver Cirrhosis: Worsening Liver Function is Associated with Increased Mortality. Clin Orthop Relat Res 2022; 480:1089-1090. [PMID: 35134015 PMCID: PMC9263454 DOI: 10.1097/corr.0000000000002140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/25/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Lisa K Cannada
- Orthopaedic Trauma Surgeon, Novant Health Orthopaedics, Charlotte, NC, USA
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26
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Chou LB, Johnson B, Shapiro LM, Pun S, Cannada LK, Chen AF, Valone LC, Van Nortwick SS, Ladd AL, Finlay AK. Increased Prevalence of Breast and All-cause Cancer in Female Orthopaedic Surgeons. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202205000-00010. [PMID: 35587823 PMCID: PMC9126513 DOI: 10.5435/jaaosglobal-d-22-00031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/03/2022] [Indexed: 04/18/2023]
Abstract
INTRODUCTION Cancer is the second leading cause of death among women in the United States. Previous studies demonstrate a higher prevalence of cancer among female orthopaedic surgeons. This study aimed to provide an updated prevalence of breast and all-cause cancer among female orthopaedic surgeons using a larger and more current study population. METHODS We distributed surveys to female orthopaedic surgeons in national orthopaedic specialty societies. Six hundred seventy-two survey responses were collected. We calculated standardized prevalence ratios (SPRs) and 95% confidence intervals (CIs) based on gender-specific, race-specific, and age-specific cancer prevalence statistics in the US population. We compared the distribution of breast cancer risk factors with that of women in the 2018 and 2009 California Health Interview Survey. RESULTS Fifty-one of the 672 surveyed surgeons reported a diagnosis of invasive cancer. Twenty reported breast cancer with a prevalence higher among female orthopaedic surgeons compared with the US female population (SPR: 2.89, 95% CI: 2.16 to 3.81, P < 0.001). The breast cancer prevalence was also higher among orthopaedic surgeons compared with the US female population (SPR: 3.97, 95% CI: 2.43 to 6.14, P = 0.003). DISCUSSION The increased prevalence of breast and all-cause cancer among a larger and more diverse cohort of female orthopaedic surgeons confirms previous studies and provides an update regarding a concerning public health issue within this specialty.
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Affiliation(s)
- Loretta B Chou
- From the Department of Orthopaedic Surgery, Stanford University, Stanford, CA (Dr. Chou, Dr. Pun, Dr. Ladd); Walter Reed National Military Medical Center, Bethesda, MD (Dr. Johnson); the Department of Orthopaedic Surgery, University of California - San Francisco San Francisco, CA (Dr. Shapiro); Novant Health Orthopaedic Fracture Clinic, Charlotte, NC (Dr. Cannada); the Department of Orthopaedic Surgery, Harvard Medical School Boston, MA (Dr. Chen); the Department of Orthopaedic Surgery, California Pacific Orthopaedics San Fransciso, CA (Dr. Valone); the Department of Orthopaedic Surgery, Medical University of South Carolina Charleston, SC (Dr. Van Nortwick); and the Department of Orthopaedic Surgery, Palo Alto Veterens Association Palo Alto, CA (Dr. Finlay)
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Cannada LK, Rao A, Saltzman BM. Clinical Faceoff: Management of Massive Rotator Cuff Tears in Patients Younger than 65 Years of Age. Clin Orthop Relat Res 2022; 480:672-676. [PMID: 35254327 PMCID: PMC8923571 DOI: 10.1097/corr.0000000000002154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Lisa K. Cannada
- Orthopaedic Trauma Surgeon, Novant Health Orthopedics, Charlotte, NC, USA
| | - Allison Rao
- Orthopaedic Surgeon, The Christ Hospital, Cincinnati, OH, USA
| | - Bryan M. Saltzman
- Assistant Professor, Atrium Health Musculoskeletal Institute (MSKI) Sports Medicine, Rock Hill, SC, USA
- Orthopaedic surgeon, The Sports Medicine Center, Charlotte, NC, USA
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Gianakos AL, Freischlag JA, Mercurio AM, Haring RS, LaPorte DM, Mulcahey MK, Cannada LK, Kennedy JG. Bullying, Discrimination, Harassment, Sexual Harassment, and the Fear of Retaliation During Surgical Residency Training: A Systematic Review. World J Surg 2022; 46:1587-1599. [PMID: 35006329 DOI: 10.1007/s00268-021-06432-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The negative effects of bullying, discrimination, harassment, and sexual harassment (BDHS) on well-being and productivity of surgical residents in training have been well documented. Despite this, little has changed over the past decade and these behaviors continue. The purpose of this study was to determine the prevalence of each abusive behavior experienced by residents, identify the perpetrators, and examine the reporting tendency. METHODS A systematic review of articles published between 2010 and 2020 in the MEDLINE, EMBASE, and Cochrane databases was performed following PRISMA guidelines. The following search terms were used: bullying, harassment, sexual harassment, discrimination, abuse, residency, surgery, orthopedic surgery, general surgery, otolaryngology, obstetrics, gynecology, urology, plastic surgery, and training. RESULTS Twenty-five studies with 29,980 surgical residents were included. Sixty-three percent, 43, 29, and 27% of surgical residents experienced BDHS, respectively. Female residents reported experiencing all BDHS behaviors more often. Thirty-seven percent of resident respondents reported burnout, and 33% reported anxiety/depression. Attending surgeons, followed by senior co-residents, were the most common perpetrators. Seventy-one percent did not report the behavior to their institution. Fifty-one percent stated this was due to fear of retaliation. Of those who reported their experiences, 56% stated they had a negative experience reporting. CONCLUSION Our review demonstrates high prevalence rates of BDHS experienced by residents during surgical training, which have been associated with burnout, anxiety, and depression. The majority of residents did not report BDHS due to fear of retaliation. Residency programs need to devise methods to have a platform for residents to safely voice their complaints.
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Affiliation(s)
- Arianna L Gianakos
- Department of Orthopaedic Surgery, Harvard-Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA.
| | | | | | | | - Dawn M LaPorte
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Lisa K Cannada
- Department of Orthopaedic Surgery, Novant Health Orthopaedics, Charlotte, NC, USA
| | - John G Kennedy
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
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Milner JE, Granger C, Cannada LK, Aiyer A. The Importance of Mentorship and Interest Group Involvement for the Orthopedic Surgery Applicant. Iowa Orthop J 2022; 42:1-7. [PMID: 36601229 PMCID: PMC9769350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Mentorship in medical education is important for students' professional development career planning. Orthopedic Surgery Interest Groups (OSIG) exist as formal organizations and serve as a conduit for undergraduate mentorship, though the role of mentorship via OSIGs within orthopedic medicine has not been thoroughly evaluated. Similarly, OSIGs within institutions are not standardized nor well defined. We sought to answer: (1) What offerings does OSIG provide for students interested in orthopaedic surgery? (2) How does OSIG involvement impact the orthopaedic surgery residency applicant? (3) Does OSIG involvement increase match rates for orthopaedic surgery residency applicants? Methods An online survey was distributed to faculty advisors at all allopathic US medical schools with available contact information. Results were analyzed using SPSS. Results Of the 28 respondent organizations, the majority (53.6%) have between 1-25 student members. On average, OSIGS offer 3.64 + 1.59 (mode = 4) executive positions. The most important initiative for OSIG groups was clinical/surgical shadowing, followed by faculty mentorship, and guidance for the residency application. OSIG involvement does impact the applicant, as all faculty mentors believed this to be an important component of the residency application. Leadership positions within OSIG was not perceived as being equally important. OSIG involvement did increase match rates; the match rate for all students at the schools surveyed (n=17) was 81.21% while the match rate for students within OSIG (n=17) was 82.39% (p<0.05). Of all students who applied to orthopedic surgery residency programs, 98.9% were members of OSIG, and of all students who successfully matched into orthopedic surgery residency programs in the 2019-2020 cycle, 100% (p<0.05) of students (n=17) were involved in OSIG. Conclusion This study indicates the importance of involvement in OSIG as a conduit for clinical exposure and mentorship throughout medical education, and is especially relevant for applicants given the impact of the COVID-19 pandemic on the residency application process. Data suggests that participation in an OSIG is a valuable experience for the medical student interested in orthopedics and that students involved in OSIGs are more likely to match into orthopedic residency programs. Level of Evidence: V.
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Affiliation(s)
- Jacob E Milner
- Leonard M. Miller School of Medicine, The University of Miami, Miami, FL, USA
| | - Caroline Granger
- Department of Orthopaedics Washington University, St. Louis, MO, USA
| | - Lisa K Cannada
- Orthopaedic Trauma, Hughston Clinic and Novant Health, Jacksonville, FL, USA
| | - Amiethab Aiyer
- Department of Orthopedics, Johns Hopkins University, Baltimore, MD, USA
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Cannada LK. CORR Insights®: The Charlson and Elixhauser Scores Outperform the American Society of Anesthesiologists Score in Assessing 1-year Mortality Risk After Hip Fracture Surgery. Clin Orthop Relat Res 2021; 479:1980-1981. [PMID: 33989232 PMCID: PMC8373568 DOI: 10.1097/corr.0000000000001826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/17/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Lisa K Cannada
- Orthopaedic Trauma Surgeon, Novant Health Orthopaedics, Charlotte, NC, USA
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31
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Cannada LK, O’Connor MI. Equity360: Gender, Race, and Ethnicity-Harassment in Orthopaedics and #SpeakUpOrtho. Clin Orthop Relat Res 2021; 479:1674-1676. [PMID: 34213502 PMCID: PMC8277278 DOI: 10.1097/corr.0000000000001884] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Lisa K. Cannada
- Orthopaedic Trauma Surgeon, Novant Health Orthopaedics, Charlotte, NC, USA
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Bernatz JT, Johnson KP, Stokman JJ, Cannada LK, Williams SK, Whiting PS. Factors Considered in Ranking Spine Surgery Fellowship Applicants: A Survey of Program Directors. Spine (Phila Pa 1976) 2021; 46:882-885. [PMID: 33428366 DOI: 10.1097/brs.0000000000003938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To determine which factors spine surgery fellowship program directors (PDs) consider most important when ranking applicants. SUMMARY OF BACKGROUND DATA Spine surgery is a popular orthopedic subspecialty. As such, the spine fellowship match process is highly competitive. Surveys of fellowship PDs in orthopedic sports medicine and hand surgery have demonstrated differing opinions regarding factors considered most important when ranking fellowship applicants. The factors considered important to spine surgery fellowship PDs have not been evaluated. METHODS A web-based questionnaire was sent to the PDs of all spine surgery fellowships participating in the San Francisco (SF) Match Program. The questions were designed to identify criteria considered most important in ranking spine surgery fellowship applicants. A list of 12 criteria was presented and PDs were asked to rank these in order of importance. A weighted score for each criterion was calculated using the following scale: 5 points for each criterion ranked 1st, 4 points for 2nd, 3 points for 3rd, 2 points for 4th, and 1 point for 5th. RESULTS Of the 73 PDs queried, 52 responded (71% response rate). The interview was the most important factor when ranking fellowship applicants. The other criteria deemed most important in order of weighted scoring were letters of recommendation and personal connections to the applicant and/or familiarity with the applicant's letter writer(s). CONCLUSION Spine surgery fellowship PDs consider the interview, letters of recommendation, and personal connections with the applicant/letter writers to be the most important factors when ranking candidates. These results may be valuable to orthopedic residents and mentors of those pursuing fellowship training in spine surgery.Level of Evidence: 4.
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Affiliation(s)
- James T Bernatz
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Kristina P Johnson
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - James J Stokman
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Lisa K Cannada
- Department of Orthopaedic Surgery and Rehabilitation, University of Florida College of Medicine - Jacksonville, Jacksonville, FL
| | - Seth K Williams
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Paul S Whiting
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Cannada LK, Dart B, Dehghan N, Jeray K, Miller AN. Allies in Orthopaedic Trauma Surgery. OTA Int 2021; 4:e098. [PMID: 34746652 PMCID: PMC8568467 DOI: 10.1097/oi9.0000000000000098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
From the casting couch to the board room, the media, and beyond, the topic of sexual harassment and bullying can no longer be ignored. Sexual harassment and bullying in medicine has the potential to be the next big headline on these topics. The culture in medicine and especially the hierarchy in surgery often permit this behavior. To improve the culture in orthopaedic surgery regarding sexual harassment and bullying, education must occur. With education, comes acknowledgment and recognition. This permits an ability to act on and improve the culture. This paper will start the dialogue of this difficult topic and provide a call to action for sexual harassment and bullying to become "Never events".
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Affiliation(s)
| | | | - Niloofar Dehghan
- The CORE Institute
- Department of Orthopaedic Surgery, University of Arizona College of Medicine Phoenix, Phoenix, AZ
| | - Kyle Jeray
- Department of Orthopaedic Surgery, University of South Carolina, Prisma Health, Greenville, SC
| | - Anna N Miller
- Washington University Department of Orthopaedic Surgery, St. Louis, MO
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Erickson JG, Johnson KP, Grogan BF, Cannada LK, Whiting PS. Factors considered in ranking orthopedic shoulder and elbow fellowship applicants: a survey of program directors. JSES Rev Rep Tech 2021; 1:151-154. [PMID: 37588149 PMCID: PMC10426661 DOI: 10.1016/j.xrrt.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Orthopedic fellowship positions continue to be increasingly competitive, with most orthopedic residency graduates pursuing fellowship after completion of residency. Shoulder and elbow fellowship training represents an increasingly competitive and relatively smaller cohort of applicants than other subspecialties; there are only 29 programs with a total of 40 offered positions. The purpose of this survey is to identify and rank factors considered most important by shoulder and elbow fellowship directors when identifying potential fellowship candidates. Methods A web-based survey was emailed to all 29 orthopedic shoulder and elbow fellowship directors recognized by American Shoulder and Elbow Surgeons. Demographic information was collected regarding program size, total number of applicants interviewed, and total number of applicants subsequently ranked. The survey also included a list of twelve applicant characteristics which each program director was asked to rank in a sequential order (most important to least). The median score of each factor was calculated, and a weighted score was applied to the top five (of twelve) categories selected by each program. Five points were given to the top-ranked factor. Four points were given to factors ranked 2nd, three points to factors ranked 3rd, two points to factors ranked 4th, and one point to factors ranked 5th. The weighted scores were then used to determine the most highly desired applicant characteristics. Results Twenty-two of 29 (76%) orthopedic shoulder and elbow fellowship programs responded to the survey. Fourteen of 22 (64%) programs interview 20 or fewer applicants each year. No programs ranked more than 25 applicants. Twelve of 22 (55%) of program directors rated the interview as the most important factor, whereas 6 of 22 (27%) selected letters of recommendation. Based on the weighted score calculation, interviews, letters of recommendation, and personal connections to the applicant/letter writers comprised the top three categories, respectively, and captured 193 of 330 (58%) of the total available points in the weighted score. Strength of shoulder/elbow experience in residency, ties to the geographical area, and comments made regarding technical competence scored among the lowest factors. Conclusion Orthopedic shoulder and elbow fellowship directors consistently ranked interviews, letters of recommendation, and personal connection to applicant/letter writer higher than other factors when ranking applicants. This information provides both program directors as well as applicants with important information to consider when navigating the shoulder and elbow fellowship application process.
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Affiliation(s)
- Jonathan G. Erickson
- Department of Orthopedics and Rehabilitation, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Kristina P. Johnson
- Department of Orthopedics and Rehabilitation, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Brian F. Grogan
- Department of Orthopedics and Rehabilitation, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | | | - Paul S. Whiting
- Department of Orthopedics and Rehabilitation, University of Wisconsin Hospital and Clinics, Madison, WI, USA
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35
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Cannada LK, Freibott CE, Strauch RJ, Weber K. Top Tips for an Orthopaedic Surgeon's Practice. Instr Course Lect 2021; 70:577-586. [PMID: 33438937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
As orthopaedic surgeons become more specialized, it is important that they remain up to date in the diagnosis and management of common orthopaedic problems. These can include conditions encountered in the clinic and/or on call. It is important that practicing surgeons stay abreast of recognition and management of problems, not only for the patients, but also to avoid commonly missed conditions or less-than-optimal treatment. The orthopaedic surgeon should be aware of the top tips in multiple disciplines, including orthopaedic oncology, hand, and trauma.
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Hill BW, Cannada LK, Nelson L, Tornetta P, Hymes R, Jones CB, Obremskey W, Carroll E, Mullis B, Tucker M, Teague D, Marcantonio A, Ostrum R, Core MD, Israel H. Is There a Critical Radiographic Angle That Portends Poor Functional Outcome Scores in Nonoperative Treatment of Isolated Humeral Shaft Fractures? J Surg Orthop Adv 2021; 30:73-77. [PMID: 34181520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Our purpose was to evaluate radiographic alignment of nonoperatively treated humerus fractures and determine if there is a critical angle associated with worse outcomes. All patients with humeral shaft fractures that were prospectively followed as part of a larger multicenter trial were reviewed. These patients were selected for nonoperative management based on shared decision making. There were 80 patients that healed with adequate data. The receiver operating characteristic (ROC) had best fit with a sagittal radiographic angle of 10° (AUC: 0.731) and coronal angle of 15° (AUC: 0.580) at 1-year follow-up. We found increased or worse disabilities of the arm, shoulder and hand (DASH) scores with > 10° sagittal alignment or > 15° of coronal alignment. Poor DASH scores were observed at angles lower than previously accepted for nonoperative treatment. These findings are useful in decision making and patient guidance. (Journal of Surgical Orthopaedic Advances 30(2):073-077, 2021).
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Affiliation(s)
| | | | | | - Paul Tornetta
- Boston University Medical Center, Boston, Massachusetts
| | - Robert Hymes
- Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Clifford B Jones
- Dignity Health Medical Group, St. Joseph's Orthopaedic Surgery, Creighton Medical School, Phoenix Arizona
| | | | | | - Brian Mullis
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | | | - Robert Ostrum
- University of North Carolina, Chapel Hill, North Carolina
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Burkes J, Cannada LK, Olson SA, Schemitsch EH, Kyle RF. New Developments in Hip Fracture Treatment to Reduce Morbidity and Mortality. Instr Course Lect 2021; 70:85-100. [PMID: 33438906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
There have been major changes in the treatment of various hip fracture patterns in the proximal femur. The orthopaedic surgeon should be up to date on device management, current guidelines, and techniques in the care of hip fracture patterns.
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Krueger CA, Helms JR, Bell AJ, Israel H, Cannada LK. An Applicant's Residency Program Region May Influence Where They Complete Fellowship. J Surg Orthop Adv 2021; 30:30-35. [PMID: 33851911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The primary goal of this study was to determine if an applicant's geographic region of residency was associated with where they matched for fellowship. San Francisco Match (SF Match) provided results regarding applicant data and match results from 2014-2018 for orthopaedic subspecialties except hand and shoulder and elbow. Residency programs were divided into five regions: (Northeast [NE], Southeast [SE], Midwest [MW], Southwest [SW] and West [W]). The MW region had the fewest number of fellowship positions per applicant (0.62), the W region had the most (1.7). Applicants from each region were significantly (p < 0.0001) more likely to complete fellowship in the same region where they completed residency, and there were significant (p < 0.05) differences between regions for specific subspecialties. There are imbalances in terms of the number of applicants and specific fellowship spots available in each region. This imbalance seems important considering the strong associations found between the region in which an applicant completes residency and fellowship. Level of Evidence: Level 3. (Journal of Surgical Orthopaedic Advances 30(1):030-035, 2021).
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Cannada LK, Nelson L, Tornetta P, Hymes R, Jones CB, Obremskey W, Carroll E, Mullis B, Tucker M, Teague D, Marcantonio A, Ostrum R, Core MD, Israel H. Operative vs. Nonoperative Treatment of Isolated Humeral Shaft Fractures: A Prospective Cohort Study. J Surg Orthop Adv 2021; 30:67-72. [PMID: 34181519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The purpose was to compare plate and screw fixation (open reduction internal fixation [ORIF]) and functional bracing (FB) of isolated humeral shaft fractures with treatment and patient-based outcomes. We performed a prospective trial of ORIF v. FB at 12 centers. Surgeons counseled patients on treatment options and a patient centered decision was made. We enrolled 179 patients, of which 6-month data was analyzed for 102 (39 female; 63 male). Forty-five were treated with ORIF and 57 with FB. We found no difference in the disability of the arm, shoulder and hand (DASH) score, visual analogue score (VAS) or elbow range of motion (ROM) at 6 months. However, 11% of the FB group developed nonunion. Complications in the ORIF group included a 2% infection and nonunion rate and 13% iatrogenic radial nerve dysfunction (RND). ORIF can be expected to result in higher union rates with the inherent risks of infection and RND. Finally, at 6 months, both groups demonstrated higher DASH scores than population norms, indicating a lack of full recovery. (Journal of Surgical Orthopaedic Advances 30(2):067-072, 2021).
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Affiliation(s)
| | | | - Paul Tornetta
- Boston University Medical Center, Boston, Massachusetts
| | - Robert Hymes
- Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Clifford B Jones
- Dignity Health Medical Group, St. Joseph's Orthopaedic Surgery, Creighton Medical School, Phoenix Arizona
| | | | | | - Brian Mullis
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | | | - Robert Ostrum
- University of North Carolina, Chapel Hill, North Carolina
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Cannada LK, Mears SC, Quatman C. Clinical Faceoff: When Should Patients 65 Years of Age and Older Have Surgery for Hip Fractures, and When is it a Bad Idea? Clin Orthop Relat Res 2021; 479:24-27. [PMID: 33315622 PMCID: PMC7899710 DOI: 10.1097/corr.0000000000001596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 10/05/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Lisa K Cannada
- L. K. Cannada, Orthopaedic Trauma Surgeon, Novant Health Orthopedics, Charlotte, NC, USA
- S. C. Mears, Professor, Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- C. Quatman, Associate Professor, Department of Orthopaedic Surgery, The Ohio State University, Columbus, OH, USA
| | - Simon C Mears
- L. K. Cannada, Orthopaedic Trauma Surgeon, Novant Health Orthopedics, Charlotte, NC, USA
- S. C. Mears, Professor, Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- C. Quatman, Associate Professor, Department of Orthopaedic Surgery, The Ohio State University, Columbus, OH, USA
| | - Carmen Quatman
- L. K. Cannada, Orthopaedic Trauma Surgeon, Novant Health Orthopedics, Charlotte, NC, USA
- S. C. Mears, Professor, Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- C. Quatman, Associate Professor, Department of Orthopaedic Surgery, The Ohio State University, Columbus, OH, USA
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Cotter EJ, Rasmussen LH, Johnson KP, Hennessy DW, Cannada LK, Whiting PS. Factors Considered in Ranking Hip and Knee Arthroplasty Fellowship Applicants: A Survey of Program Directors. Arthroplast Today 2020; 6:623-627.e1. [PMID: 32995411 PMCID: PMC7502560 DOI: 10.1016/j.artd.2020.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 11/30/2022] Open
Abstract
Background Variables considered by hip and knee arthroplasty fellowship program directors (PDs) to select fellowship candidates are not well known. Methods A web-based questionnaire containing 5 questions was developed and sent to all 92 adult reconstruction fellowship PDs via email. Three questions collected program information including the number of positions available, the number of candidates interviewed, and ranked annually. PDs were then given a list of 12 factors and asked to rank them in the order of importance. A weighted score for each factor was calculated using the following scale: 5 points each time a factor was ranked 1st, 4 points each time a factor was ranked 2nd, 3 points for each 3rd place rank, 2 points for each 4th place rank, and 1 point for each 5th place rank. PDs were also allowed to write in other factors they considered important when ranking fellowship candidates. Results The overall response rate was 34.8% (32/92). Seventy-five percent of responding programs indicated that they interview between 21 and 40 applicants per year for their fellowship position(s). The interview was ranked as the most important variable in selecting applicants by 53.1% of responding PDs, followed by letters of recommendation (ranked first by 25% of PDs) and personal connections to the applicant and/or letter writer(s) (ranked first by 9% of PDs). A positive correlation was identified between the program size and an applicant’s geographical ties to the city/town of the fellowship program (rs = 0.472; P = .006). Conclusions According to hip and knee arthroplasty fellowship PDs, the interview, letters of recommendation, and personal connections to the applicant and/or letter writers are the most important factors considered in selecting arthroplasty fellowship candidates.
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Affiliation(s)
- Eric J Cotter
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI, USA
| | - Luke H Rasmussen
- Department of Orthopaedic Surgery & Rehabilitation, University of Florida-Jacksonville, Jacksonville, FL, USA
| | - Kristina P Johnson
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI, USA
| | - David W Hennessy
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI, USA
| | - Lisa K Cannada
- Department of Orthopaedic Surgery & Rehabilitation, University of Florida-Jacksonville, Jacksonville, FL, USA
| | - Paul S Whiting
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI, USA
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Abstract
PURPOSE OF REVIEW The purpose is to review current literature on pain management strategies from initial presentation to postoperative care on common fracture types. RECENT FINDINGS - Hip fractures benefit from use of multimodal pain control for early mobility and decreased narcotic requirement. - Distal radius fracture pain during reduction can be managed with hematoma block. Postoperatively, a soft dressing is adequate, and use of a compression glove may improve pain control and edema. - Ankle fractures can be reduced with hematoma block, though use of procedural sedation may reduce reduction attempts for fracture dislocations. - Long bone fracture pain management is trending toward multimodal pain control. Though there is no high-quality evidence, concern that regional anesthesia may mask compartment syndrome has limited its use in high-risk fractures. - The effect of NSAIDs on bone healing has not been conclusively demonstrated. The literature is still inconclusive regarding superiority of either spinal or general anesthesia during operative treatment. Fracture pain control is complex and multifactorial, requiring nuanced clinical judgment in the face of mixed clinical findings.
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Affiliation(s)
- Hannah Elsevier
- Department of Orthopaedic Surgery, Icahn School of Medicine, New York, NY, USA
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Krueger CA, Helms JR, Bell AJ, Israel H, Cannada LK. How the Reputation of Orthopaedic Residency Programs Is Associated with Orthopaedic Fellowship Match Results. J Bone Joint Surg Am 2020; 102:e28. [PMID: 31913867 DOI: 10.2106/jbjs.19.00750] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The primary goal of the present study was to determine if applicants from higher-ranking U.S. orthopaedic surgery residency programs match at a more desired position on their fellowship match-rank list compared with those applicants from lower-ranked residency programs. METHODS San Francisco Match provided results regarding applicant data and match results from 2014 to 2018 for all orthopaedic subspecialties except the hand and the shoulder and elbow. Unmatched applicants and international medical graduates were excluded. Residency programs were divided into 5 tiers (with tier 1 being the highest-ranked residency programs and tier 5 being the lowest-ranked programs) on the basis of 2018 Doximity rankings of orthopaedic residency programs. Statistical analysis consisted of descriptive statistics, chi-square tests, and analysis of variance. RESULTS Two thousand eight hundred and eleven applicants met inclusion criteria. Applicants from residency programs in tiers 1 and 2 applied to significantly fewer programs than those from tiers 3, 4, or 5 (p < 0.0001). Applicants from each tier were significantly more likely to attain interviews than applicants from all tiers below them (p < 0.01). Applicants from tier-1 residency programs matched at a significantly higher position on their rank list (p < 0.001) and were more desirably ranked by fellowship programs (p = 0.003) compared with all other tiers. CONCLUSIONS Applicants from the highest-ranking residency programs apply to fewer programs, interview at a greater percentage of these programs, and are more likely to match to 1 of their top-ranking programs than applicants from lower-ranking programs. However, the association of the applicant match position with the program ranking appears to be most pronounced when it comes to fellowships selecting which applicants to interview. These findings may help future applicants when determining which programs to apply to during the match.
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Affiliation(s)
| | | | - Anthony J Bell
- University of Florida-Jacksonville, Jacksonville, Florida
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Dashe J, Murray B, Tornetta P, Grott KM, Mullis B, Bellevue KD, Firoozabadi R, Kempegowda H, Horwitz DS, Patel S, Fontenot PB, Mir HR, Ruder JA, Bosse MJ, Westberg J, Sandberg B, Bramlett KJ, Marcantonio AJ, Sadauskas AJ, Cannada LK, Goodwin A, Miller AN, Fox MP, Klatman SH. Henry Versus Thompson Approach for Fixation of Proximal Third Radial Shaft Fractures: A Multicenter Study. J Orthop Trauma 2020. [PMID: 31809416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the volar Henry and dorsal Thompson approaches with respect to outcomes and complications for proximal third radial shaft fractures. DESIGN Multicenter retrospective cohort study. PATIENTS/PARTICIPANTS Patients with proximal third radial shaft fractures ± associated ulna fractures (OTA/AO 2R1 ± 2U1) treated operatively at 11 trauma centers were included. INTERVENTION Patient demographics and injury, fracture, and surgical data were recorded. Final range of motion and complications of infection, neurologic injury, compartment syndrome, and malunion/nonunion were compared for volar versus dorsal approaches. MAIN OUTCOME The main outcome was difference in complications between patients treated with volar versus dorsal approach. RESULTS At an average follow-up of 292 days, 202 patients (range, 18-84 years) with proximal third radial shaft fractures were followed through union or nonunion. One hundred fifty-five patients were fixed via volar and 47 via dorsal approach. Patients treated via dorsal approach had fractures that were on average 16 mm more proximal than those approached volarly, which did not translate to more screw fixation proximal to the fracture. Complications occurred in 11% of volar and 21% of dorsal approaches with no statistical difference. CONCLUSIONS There was no statistical difference in complication rates between volar and dorsal approaches. Specifically, fixation to the level of the tuberosity is safely accomplished via the volar approach. This series demonstrates the safety of the volar Henry approach for proximal third radial shaft fractures. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jesse Dashe
- Department of Orthopaedics, Boston Medical Center, Boston, MA
| | - Brett Murray
- Department of Orthopaedics, Boston Medical Center, Boston, MA
| | - Paul Tornetta
- Department of Orthopaedics, Boston Medical Center, Boston, MA
| | - Kelly M Grott
- Department of Orthopaedics, Indiana University, Indianapolis, IN
| | - Brian Mullis
- Department of Orthopaedics, Indiana University, Indianapolis, IN
| | - Kate D Bellevue
- Department of Orthopaedics, University of Washington, Seattle, WA
| | - Reza Firoozabadi
- Department of Orthopaedics, University of Washington, Seattle, WA
| | | | - Daniel S Horwitz
- Department of Orthopaedics, Geisinger Medical Center, Danville, PA
| | - Shaan Patel
- Orthopaedic Trauma Service, Florida Orthopaedic Institute and Department of Orthopaedics University of South Florida, Tampa, FL
| | - Philip B Fontenot
- Orthopaedic Trauma Service, Florida Orthopaedic Institute and Department of Orthopaedics University of South Florida, Tampa, FL
| | - Hassan R Mir
- Orthopaedic Trauma Service, Florida Orthopaedic Institute and Department of Orthopaedics University of South Florida, Tampa, FL
| | - John A Ruder
- Department of Orthopaedics, Carolinas Medical Center, Charlotte, NC
| | - Michael J Bosse
- Department of Orthopaedics, Carolinas Medical Center, Charlotte, NC
| | - Jerald Westberg
- Department of Orthopaedics, Hennepin County Medical, Minneapolis, MN
| | - Benjamin Sandberg
- Department of Orthopaedics, Hennepin County Medical, Minneapolis, MN
| | | | | | - Alex J Sadauskas
- Department of Orthopaedics, Saint Louis University, St. Louis, MO
| | - Lisa K Cannada
- Department of Orthopaedics, Saint Louis University, St. Louis, MO
| | | | - Anna N Miller
- Department of Orthopaedics, Wake Forest, Winston-Salem, NC; and
| | | | - Samuel H Klatman
- Department of Orthopaedics, Louisiana State University, Kenner, LA
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Arvesen J, Burnett Z, Bush AN, Israel H, Mullis B, Cannada LK. High Energy Midfoot Fracture-Dislocations: Does Staged Treatment with External Fixation Help? J Surg Orthop Adv 2020; 29:154-158. [PMID: 33044155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study analyzes the outcomes of patients treated for high energy midfoot injuries with temporary stabilization (TS) prior to definitive operative fixation compared to a control group (C) treated initially with splint only. Three Level 1 trauma centers reduced and temporized high energy Lisfranc injuries. A matched control group was compared with the intervention group. Clinical parameters, complications and need for additional surgery were evaluated. There were 15 patients in group C and 29 patients with temporary stabilization (TS). Both the TS and C groups demonstrated no significant difference in the number of additional operations, infection rate, incidence of deep vein thrombosis (DVT), nonunion and need for orthotics postoperatively (p > 0.05). Staged treatment of high energy Lisfranc injuries in the TS group led to a delay in definitive fixation or arthrodesis while having a similar minimal complication rate relative to the controls. This is a Level III, Retrospective Case Control Study. (Journal of Surgical Orthopaedic Advances 29(3):154-158, 2020).
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Affiliation(s)
- John Arvesen
- Department of Orthopaedic Surgery, Saint Louis University, Saint Louis, Missouri
| | | | | | - Heidi Israel
- Department of Orthopaedic Surgery, Saint Louis University, Saint Louis, Missouri
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Zhang Y, Wright B, D'Amore P, Hightower C, Stang T, Israel H, Tucker M, Zura R, Cannada LK. Gunshot Wounds to the Hip: Doomed to Failure? J Surg Orthop Adv 2020; 29:135-140. [PMID: 33044152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The purpose is to evaluate hip fractures due to gunshot wounds (GSW) to the hip, which are treated surgically, and the complications. Patients who sustained a low velocity GSW with fracture to the femoral head/neck and intertrochanteric/peritrochantric region at three Level 1 Trauma Centers were eligible. There were 69 patients (63 males-91%), with an average age of 29 (18-60). Nine patients had orthopaedic surgical site infections. There were 6 nonunions, 4 patients with hardware failure, 2 cases of avascular necrosis (AVN), 3 patients with post traumatic arthritis (PTA) and 20 patients with heterotopic ossification (HO). There was no significant difference found regarding fracture site or type of fixation with regards to complications. This represents the largest study of surgically treated GSW to the hip. Of patients studied, 61% sustained additional GSW. These injuries are not benign; the main complications being infection and heterotopic ossification. (Journal of Surgical Orthopaedic Advances 29(3):135-140, 2020).
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Affiliation(s)
- Yiyi Zhang
- Saint Louis University School of Medicine, St. Louis, Missouri
| | - Breydan Wright
- Saint Louis University School of Medicine, St. Louis, Missouri
| | - Peter D'Amore
- Louisiana State University Department of Orthopaedic Surgery, New Orleans, Louisiana
| | | | - Thomas Stang
- Louisiana State University Department of Orthopaedic Surgery, New Orleans, Louisiana
| | - Heidi Israel
- Saint Louis University School of Medicine, St. Louis, Missouri
| | | | - Robert Zura
- Louisiana State University Department of Orthopaedic Surgery, New Orleans, Louisiana
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Lai CH, Finlay A, Cannada LK, Chen AF, Chou LB. Radiation Exposure and Case Characteristics in National Sample of Female Orthopaedic Trauma and Arthroplasty Surgeons. Iowa Orthop J 2020; 40:5-11. [PMID: 32742202 PMCID: PMC7368516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The risks of radiation exposure in orthopaedic surgery have become a topic of increasing interest in the setting of widespread fluoroscopy use and concern for an increased prevalence of breast cancer among female orthopaedic surgeons. The aim of this national study of 31 female orthopaedic surgeons was to achieve a deeper understanding of fluoroscopic use in the OR and its associated exposure to radiation, by comparing female orthopaedic trauma and arthroplasty surgeons. METHODS A total of 31 surgeons wore dosimeters for 10 operating days each to track cumulative radiation exposure. Surgeons were not asked to modify their practice in any way, with no requirement that the operating days had to be chosen with the knowledge that fluoroscopy would be used. Participants were also asked to fill out a form at the end of each day, detailing the number of cases that day, the number of hours spent in the OR, and the total amount of time using fluoroscopy. RESULTS Trauma surgeons received significantly higher radiation doses in the OR (p=0.01) and reported longer use of fluoroscopy (p<0.001). Trauma surgeons also spent more time per day in the OR and had more cases per day compared to arthroplasty surgeons, but this difference was not significant. Radiation dose penetrating through protective equipment remained minimal. CONCLUSION Although the female trauma surgeons in the study operated longer and performed more procedures per day, the higher radiation exposure was best explained by the amount of time fluoroscopy is used in the OR. The fluoroscopic times in this study therefore may be a useful self-assessment tool for attending trauma and arthroplasty surgeons. Awareness of these differences will hopefully increase an individual surgeon's mindfulness toward the length of fluoroscopy use in each case, regardless of orthopaedic subspecialty.Level of Evidence: IV.
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Affiliation(s)
- Cara H. Lai
- Stanford University School of Medicine, Stanford, CA
| | - Andrea Finlay
- Stanford University School of Medicine, Department of Orthopaedic Surgery, Stanford, CA
| | - Lisa K. Cannada
- Saint Louis University School of Medicine, Department of Orthopaedic Surgery, Saint Louis, MO
| | - Antonia F. Chen
- Harvard Medical School, Department of Orthopaedic Surgery, Cambridge, MA
| | - Loretta B. Chou
- Stanford University School of Medicine, Department of Orthopaedic Surgery, Stanford, CA
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Jurenovich KM, Cannada LK. Women in Orthopedics and their Fellowship Choice: What Influenced their Specialty Choice? Iowa Orthop J 2020; 40:13-17. [PMID: 32742203 PMCID: PMC7368530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Female orthopedic surgeons have different life choices, experiences, and influences that may alter their decisions when choosing a fellowship. There is no data that describes why women choose their specialty and if it is related to their mentorship, athletic background, family, family planning, physical attributes needed, location, practice setting, or discrimination.After a five year orthopedic residency, what influences their specialty choice to work in a specific field?Questions/ purposes: To understand why women in orthopedics chose a certain fellowship and if they are influenced by any specific factor. METHODS A 28 question survey created through SurveyMonkey was emailed to all members of the Ruth Jackson Orthopedic Society (RJOS) in July 2019. After six weeks the survey was closed and data was analyzed through SurveyMonkey. RESULTS 252 members of RJOS completed the 28 question survey. 94% of the women who responded did a fellowship after their orthopedic residency. 62% chose their fellowship specialty based on pure enjoyment. 79% were not influenced by a female role model, 92% were not influenced by a significant other, 85% were not influenced by wanting children or a family, and 96% were not influenced by being pregnant or planning on being pregnant. 64% were not influenced by physical attributes or perception of strength needed for the specialty. CONCLUSIONS 94% of the women who responded did a fellowship after their orthopedic residency and 62% chose their fellowship specialty based on pure enjoyment. It was not found that female mentorship, family, pregnancy, significant other, or physical attributes contributed to their fellowship choice.Level of Evidence: V.
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Arvesen JE, Burnett Z, Israel H, Watson JT, Cannada LK. High-Energy Midfoot Fracture-Dislocations: Staged Treatment With an External Fixator. J Surg Orthop Adv 2019; 28:24-30. [PMID: 31074733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to analyze the clinical outcomes of patients treated for high-energy midfoot (Lisfranc) injuries with initial temporization of an external fixator before definitive fixation. A retrospective chart review at two level 1 trauma centers was completed. Clinical parameters including demographics and comorbidities were evaluated in addition to hospital and clinical data. Time to full weight bearing took an average of 4.4 months, and with the numbers available no significant difference (p < .05) was found between the open reduction and internal fixation (ORIF) group and the arthrodesis group in regard to length of stay, days from initial reduction with an external fixator to definitive fixation, time to full weight bearing, or return to work. Staged treatment of high-energy Lisfranc injuries with external fixation demonstrated minimal soft tissue complications similar to other series reported in the literature. Definitive stabilization with either ORIF or arthrodesis produced similar results in staged treatment of these injuries. (Journal of Surgical Orthopaedic Advances 28(1):24-30, 2019).
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Affiliation(s)
- John E Arvesen
- Department of Orthopaedic Surgery, Saint Louis University, Saint Louis, Missouri; e-mail:
| | - Zachary Burnett
- Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Heidi Israel
- Department of Orthopaedic Surgery, Saint Louis University, Saint Louis, Missouri
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Corey RM, Cannada LK, Bledsoe G, Israel H. Biomechanical evaluation of medial malleolus fractures treated with headless compression screws. J Clin Orthop Trauma 2019; 10:310-314. [PMID: 30828200 PMCID: PMC6383165 DOI: 10.1016/j.jcot.2018.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/15/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022] Open
Abstract
PURPOSE The gold standard for fixation of medial malleolus fractures has yet to be determined. Most agree the best results of displaced unstable ankle fractures are with open reduction and internal fixation. Hardware irritation necessitating screw removal is a known complication. An alternative fixation method of medial malleolar fractures has been described using headless compression screws. There are currently no biomechanical studies that assess the stability of this method. The purpose of the study is to complete a biomechanical evaluation of partially threaded cancellous screws (PT) and headless compression screws (HC) in an external rotation ankle fracture model. METHODS Composite polyurethane sawbone models of tibia were obtained. A custom jig was created to ensure identical osteotomies. The models were fixed with either two partially threaded cancellous screws or two headless compression screws. The models were fitted into the Material Test System (MTS) machine and the force transducer was programed to apply axial offset. The two constructs were loaded until 5 mm of displacement occurred, our defined point of failure. The amount of force (Newtons) necessary to create fracture line displacement was recorded for each model. RESULTS The axial rotational force to create facture displacement between 1 mm and 3 mm, between 1 mm and 5 mm, and between 3 mm and 5 mm were statistically significant (p < 0.05) for both models. The mean axial rotational force measured in Newtons at 1 mm, 3 mm, and 5 mm of displacement for the PT was 149.32, 244.19 and 477.76 respectively. The mean axial rotational force measured in Newtons at 1 mm, 3 mm, and 5 mm of displacement for the HC was 152.05, 224.07, and 498.31 respectively. CONCLUSION No statistically significant difference was found between the biomechanical properties of partially threaded cancellous screws and headless compression screws used in the fixation of medial malleolus fractures. These results support HC screws as a viable alternative in a biomechanical model of medial malleolus fractures.
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Affiliation(s)
- Robert M. Corey
- Department of Orthopaedics, Saint Louis University, United States
| | - Lisa K. Cannada
- Department of Orthopaedics, Saint Louis University, United States,Corresponding author at: Department of Orthopaedic Surgery, Saint Louis University School of Medicine, 3635 Vista Avenue, 7th Floor Desloge Towers, St. Louis, MO, 63110, United States.
| | - Gary Bledsoe
- Parks College of Engineering, Saint Louis University, United States
| | - Heidi Israel
- Department of Orthopaedics, Saint Louis University, United States
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