BACKGROUND:Preoperative planning is a helpful tool for orthopaedic trauma cases, but clinical experience dictates that its use remains inconsistent. The primary aim of this cross-sectional survey study was to investigate practices and applications of preoperative planning for orthopaedic trauma cases and to identify factors influencing its use. METHODS:A cross-sectional 26-item survey was distributed to members of the Orthopaedic Trauma Association and The Netherlands Orthopaedic Trauma Association between April 2024 and August 2024. Four key areas of interest were assessed: (1) general preoperative planning practices; (2) features of the preoperative plan; (3) use of preoperative planning for resident training; and (4) factors influencing the decision to make a preoperative plan. General preoperative planning practices were compared between attendings and residents or fellows. RESULTS:Two-hundred-eleven orthopaedic surgeons, fellows, or residents completed the survey (84 % male, 74 % attending, 55 % of attendings trauma-fellowship-trained). Overall, 84 % of respondents considered preoperative planning very or extremely important. Formal preoperative planning was performed on average for 50 % of cases. Residents or fellows planned significantly more often than attendings (76 % vs. 30 %, p < 0.001) and used digital templating more often (59 % vs. 38 %, p= 0.006). The most common features of the plan were tactical, including positioning of implants and specific steps of approach and reduction. Residents reported that preoperative plans were discussed preoperatively in 75 % of cases and postoperatively evaluated in 40 %. Case complexity was the most influential factor in deciding to plan. CONCLUSION:Respondents considered preoperative planning to be very or extremely important for orthopaedic trauma cases but made a formal preoperative plan on average in only half of cases. Residents or fellows made a preoperative plan twice as often. Complexity of the case was the most important factor in deciding to make a preoperative plan. Benefits of preoperative planning such as improving resident teaching and learning, efficiency, and teamwork should be considered more often in the decision to make a preoperative plan.

OBJECTIVES:Accrediting bodies in orthopaedic trauma education are adopting case minimum requirements to enhance orthopaedic trauma fellowship training. This study defined case volume percentiles during Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic trauma fellowship training. METHODS:This was a retrospective cohort study of orthopaedic trauma fellows graduating from ACGME-accredited programs (2018-2023). Percentiles for reported case volumes were calculated across ACGME-defined case categories. Variability was defined as fold-differences between the 90th and 10th percentiles of orthopaedic trauma fellows by case volume. Annual trends in reported case volumes were analyzed with linear regression. Sensitivity analyses were performed to identify potential case minimum requirements. DESIGN:Retrospective cohort study of orthopaedic trauma fellows (2018-2023). SETTING:ACGME-accredited orthopaedic trauma fellowship programs. PATIENT SELECTION CRITERIA:N/A. OUTCOME MEASURES AND COMPARISONS:Case volumes at the 10th, 30th, 50th, 70th and 90th percentiles; and variability defined as fold-differences between the 90th and 10th percentiles. Annual trends were analyzed with linear regression. RESULTS:There were 117 orthopaedic trauma fellows included in this study, which represented all ACGME-accredited fellows from 2018 to 2023. Mean annual reported case volume did not change significantly over the study period (505 ± 126 to 558 ± 106, 10.5% increase, P = 0.176). Pediatric cases accounted for a minority of cases (1.2%). Reported cases were mostly in pelvis/hip (n = 123, 25%), femur/knee (n = 100, 20%), and leg/ankle (n = 86, 17%). Variability in reported case volumes between the 90th and 10th percentiles was greatest in fasciotomy (20.5-fold), debridement (8.4-fold), and external fixation (5.8-fold). The 10th and 30th percentiles of ACGME-accredited orthopaedic trauma fellows reported a total of 343 and 431 cases, respectively. CONCLUSIONS:Analysis of reported case volumes from ACGME-accredited orthopaedic trauma fellows suggest performance of 343 and 431 cases to achieve 10th and 30th percentiles, respectively. Understanding areas of case volume variability can assist future fellows and faculty improve operative training experiences during orthopaedic trauma fellowship training.

OBJECTIVES:To determine (1) if early routine radiographic follow-up at 2-3 weeks for patients with operatively treated tibia, fibula or ankle fractures identified complications (i.e., complications only visible on radiographs and not associated with symptoms on history taking or clinical examination) and (2) if these complications were clinically relevant (i.e., led to treatment change). METHODS:All adult patients who underwent operative treatment for a tibia, fibula or ankle fracture between January 2021 and January 2023 and who received early routine radiographic follow-up between 10 and 30 days postoperatively were included in this retrospective case series. Routine radiographs were defined as radiographs that were scheduled and obtained as part of the institution's standardized follow-up protocol. The primary outcome was the rate of complications detected on early routine radiographs, stratified by the presence of associated symptoms based on history taking or findings on physical examination. The secondary outcome was any documented treatment change for complications. RESULTS:Six hundred and twenty-eight patients (median age of 47 years, 42 % male) were included. A total of 5 complications in 628 patients (0.8 %) were seen on early routine radiographs, of which 3 complications (0.5 %) were exclusively identified on radiographs (i.e., not associated with symptoms). None of these 3 complications led to a change in treatment strategy. The remaining 2 complications were visible on radiographs but were accompanied by symptoms on history taking or physical examination. CONCLUSION:The results of the current study suggest that radiographs at 2-3 weeks following operative treatment of tibia, fibula or ankle fractures may not need to be ordered routinely. Obtaining radiographs should be guided by clinical indication or by patient and surgeon preference (e.g., for reasons beyond complications). These findings should be considered in light of increasing healthcare expenditures and the time investment required of patients and healthcare professionals.

INTRODUCTION:The purpose of this study was to determine the rate of conversion to total elbow arthroplasty (TEA) following open reduction and internal fixation (ORIF) with olecranon osteotomy for intraarticular distal humerus fractures. METHODS:This retrospective case series included adult patients who underwent ORIF with olecranon osteotomy for AO/OTA 13C distal humerus fractures between January 2010 and April 2024 at two academic level 1 trauma centers. The primary outcome was the rate of conversion to TEA. Secondary outcomes included indications for conversion, TEA complications associated with the osteotomy, osteotomy revision surgery rates (for nonunion, fixation failure, symptomatic implant, and infection), and the rate of osteotomy union. RESULTS:A total of 148 patients were included, with a median age of 58 years (interquartile ranges: 42 to 69) and 78 (53%) were female. Three patients (2.0%) required conversion to TEA at 2, 4, and 21 months post-ORIF because of fixation failure, distal humerus nonunion, and posttraumatic osteoarthritis, respectively. Among geriatric patients, two of 51 (3.9%) required conversion to TEA. One conversion involved complications with ulnar component insertion because of the osteotomy. Regarding osteotomy revision surgeries, four patients (2.7%) underwent revision surgery for nonunion, three (2.0%) for fixation failure, 14 (9.5%) for symptomatic implant, and eight (5.4%) for infection. Osteotomy union was achieved in 145 patients (98%). CONCLUSIONS:Approximately one in 50 patients required conversion to TEA, with only one case involving a TEA complication associated with the prior olecranon osteotomy. When stratified by age, approximately one in 100 patients younger than 65 years and one in 25 geriatric patients required conversion. Revision surgery rates for osteotomy nonunion and fixation failure were similarly low, with 98% of osteotomies achieving union. These findings suggest that ORIF with olecranon osteotomy can be performed for 13C distal humerus fractures with minimal concern for subsequent TEA, osteotomy revision surgery, or nonunion. LEVEL OF EVIDENCE:Therapeutic level IV.

Purpose:Bicondylar tibial plateau (BTP) fracture-dislocations with an intact anterolateral (AL) cortical rim present a unique treatment challenge due to posterolateral joint impaction. The purpose of this study was to determine the prevalence of this pattern within a large cohort of bicondylar tibial plateau fractures and describe fracture characteristics and complication rates. Methods:Patients undergoing open reduction and internal fixation of a BTP fracture at two Level 1 trauma centers between 2010 and 2023 were identified. Radiographs and CT scans were reviewed to identify medial fracture-dislocations with an intact anterolateral cortical rim. Posterior shearing injuries were excluded. Demographic, surgical, and outcome variables were collected. Results:In total, 46/455 patients (10 %) met inclusion criteria (average age 53 years, 52 % female, 71 % high-energy). The average posterolateral depression was 9 mm and 40 % of fractures had >50 % lateral plateau involvement. Twenty-seven (59 %) patients were treated with single medial plating and 9 (20 %) with dual medial plating. One (2.2 %) lateral meniscal tear was repaired. A single-incision approach was used in 34 cases (74 %), most commonly medial-only (63 %). Eight (17 %) patients required reoperation, including 2 (4.3 %) for deep infection. The post-operative medial proximal tibial and posterior proximal tibial angles were 88° (IQR: 86-89) and 9° (IQR: 7-11), respectively. The post-operative articular stepoff or gap was <5 mm for 89 % of cases. Conclusion:In this series, 1 in 10 bicondylar tibial plateau fracture-dislocations presented with an intact anterolateral cortical rim. The dominant surgical strategy of medial-only plating with low rates of meniscal repair in this series resulted in good restoration of condylar width and relatively low infection rates. Long-term studies are needed to determine the degree to which a separate lateral approach or lateral plating may influence functional outcomes, but a medial-only strategy can be utilized when soft tissue swelling precludes an additional lateral incision.

ABSTRACT:Medical slang is commonly used in the orthopaedic community to improve communication, enhance team cohesion, and provide humor in intense work environments. However, when used carelessly, inappropriate terminology can alienate certain groups of physicians. When encountered in clinical settings, these terms can create uncomfortable environments, reduce trust, and discourage trainees from pursuing orthopaedics. To create more inclusive and effective clinical teams, it is important to regularly reassess medical slang and develop alternative terms that are respectful, practical, and consistent. This contemporary article highlights 8 examples of inappropriate terminology that are used in the orthopaedic community, explores their history of use, and suggests more appropriate alternatives.

INTRODUCTION:A separate tibial tubercle fragment (TF) is found in up to half of all bicondylar tibial plateau (BTP) fractures. Adequate healing of the TF is required to reconstitute the extensor mechanism of the knee. The purpose of this study was to compare outcomes after surgical fixation of BTP fractures with and without a TF. MATERIALS AND METHODS:Retrospective comparative study of adult patients undergoing open reduction internal fixation (ORIF) of a Schatzker V/VI BTP fracture at two Level 1 trauma centers. Primary outcomes were patient-reported outcomes as assessed by the PROMIS Physical Function (PF) score and EQ-5D-3L. Secondary outcomes included rates of infection, reoperation, and nonunion. Patient demographics, fracture characteristics, and outcomes were compared for patients with and without a TF. RESULTS:189 patients (mean follow-up 8.1 yrs) were included. 55 patients (29%) had a separate TF. There was no significant difference in PROMIS PF (48.1 vs 47.5, p = 0.45) or EQ-5D-3L scores (0.82 vs 0.83, p = 0.32) between patients with and without a separate tubercle fragment.Patients with a TF had more open fractures (16% vs 5%, p = 0.02) and high energy injuries (66% vs 49%, p = 0.03).There was no significant difference in the rates of deep infection (15% vs 8%, p = 0.19) or unplanned reoperation (23% vs 13%, p = 0.09). There were more nonunions in the TF group (11% vs 2%, p = 0.02) but only two involved the tubercle fragment. CONCLUSION:In this comparative study, the presence of a TF did not portend a worse functional outcome for patients with a healed fracture. Rates of open fracture and high energy mechanism of injury were significantly higher in the TF group.. Surgeons should be aware that a separate TF may indicate a more severe injury. More studies are needed to determine whether the presence of a TF is associated with higher complication rates.

INTRODUCTION:This study assessed geographic disparities in orthopaedic surgery workforce adequacy relative to other musculoskeletal medicine specialties. METHODS:This was a cross-sectional study of physicians in orthopaedic surgery, physical medicine and rehabilitation, and rheumatology using data from the Health Workforce Simulation Model. Supply was defined as the projected number of full-time equivalent physicians. Demand was defined as the number of full-time equivalent physicians required to meet United States healthcare needs under status quo and improved access scenarios. Adequacy was defined as the ratio of supply and demand. Trends were analyzed with linear regression and comparisons were made with chi squared tests. RESULTS:From 2024 to 2037, the supply of orthopaedic surgeons was projected to decrease from 32,310 to 30,620 (5.2% decrease, P < 0.001), whereas demand was projected to increase from 33,460 to 35,850 (7.1% increase, P < 0.001). As a result, orthopaedic surgery workforce adequacy was projected to decrease under status quo (96.6% to 85.4%, P < 0.001) and improved access (82.1% to 71.0%, P < 0.001) scenarios. Rheumatology workforce adequacy was projected to increase under status quo (87.0% to 89.5%, P < 0.001) and improved access (82.5% to 84.7%, P < 0.001) scenarios. No notable changes were projected for physical medicine and rehabilitation workforce adequacy under the status quo (91.2% to 92.8%, P = 0.059) and improved access (71.1% to 71.0%, P = 0.305) scenarios. Nonmetropolitan areas had markedly less workforce adequacy than metropolitan areas for all three specialties. In 2024, states with the lowest projected orthopaedic surgery workforce adequacy were West Virginia (60.9%), Arkansas (69.7%), and Alabama (74.1%). By 2037, states with the lowest projected orthopaedic surgery workforce adequacy will be Delaware West Virginia (54.5%), Arkansas (60.0%), and Delaware (61.5%). DISCUSSION:There are anticipated shortages in the orthopaedic surgery workforce, which are greatest in nonmetropolitan areas and certain identified states. Future work is needed to improve the adequacy of the orthopaedic surgery workforce in the Unitde States.

INTRODUCTION:The impact of social determinants on clinical outcomes following surgeries for orthopaedic injuries are well-documented. In this study, we sought to quantify the representation of women, racial, and ethnic minorities in US-based clinical trials for hip fracture surgery. METHODS:This was a cross-sectional analysis of patients enrolled in US-based, interventional clinical trials for hip fractures registered on ClinicalTrials.gov (2000-2022). Participation-to-prevalence ratios (PPRs) were calculated for demographic groups in clinical trials relative to their prevalence among patients receiving hip fracture surgery in the National Inpatient Sample (2006-2015). PPRs between 0.8-1.2 were considered equitable representation. PPRs<0.8 were considered underrepresentation and PPRs>1.2 were considered overrepresentation. Temporal trends were analyzed between previous (2000-2010) and contemporary (2011-2022) periods. RESULTS:There were thirty-eight hip fracture clinical trials involving 6937 participants included in this study. All clinical trials reported sex, but only sixteen trials (42 %) reported race and ten trials (26 %) reported ethnicity. In total, trial participants were predominately White (89.3 %) and female (68.0 %). Few patients were non-White including Asian (7.2 %), Black (2.1 %), and Hispanic (0.8 %). Female (PPR=0.97) and male (PPR=1.07) patients had equitable representation. However, Hispanic (PPR=0.22), and African American (PPR=0.51) patients were underrepresented. White patients (PPR=1.00) had equitable representation while Asian patients were overrepresented (PPR=4.50). The rate of race (P < 0.001) and ethnicity (P = 0.010) reporting increased between previous and contemporary periods. CONCLUSION:Recruitment of racial and ethnic minorities into hip fracture clinical trials remains limited. The impact of social determinants on outcomes after trauma surgery requires equitable representation of all groups in clinical trials to ensure translatability of results. Stakeholders across healthcare, industry, and government must work to address these disparities.

➢ Risk stratification in orthopaedic surgery is complex and depends on the outcome of interest and multiple interdependent factors. Effective risk stratification has uses for limiting and predicting adverse events in patients undergoing discretionary surgery, avoiding the penalization of surgeons for operating on candidates whose health is situated in more difficult circumstances, and ensuring that inordinate attention is not placed on discrete musculoskeletal pathophysiology when there are other pressing health priorities.➢ For individual patient decision-making, no comprehensive risk-stratification tool currently exists, in part due to the heterogeneity of orthopaedic procedures performed and the diverse patient population treated. The Elixhauser Comorbidity Measure and the Risk Stratification Index 3.0 appear to be most promising.➢ At a population level, risk stratification may be useful in alternative payment models to ensure that hospitals that treat a disproportionate number of high-risk patients are not penalized and that cherry-picking (preferentially selecting only healthier patients with a lower risk of complications) does not occur. Any attempt to risk-stratify may have unintended consequences.➢ Orthopaedic surgeons must be aware of the tools available, their strengths, and their limitations in order to be included in decision-making as payment models and public health policies are implemented.

Background: It is unclear whether the current North Atlantic Treaty Organization (NATO) trauma system will be effective in the setting of Large-Scale Combat Operations (LSCO). We sought to model the efficacy of the NATO trauma system in the setting of LSCO. We also intended to model novel scenarios that could better adapt the current system to LSCO. Methods: We developed a discrete-event simulation model for patients with combat musculoskeletal injuries treated within the standard NATO system. The primary outcome of the model was survival. The model's health states were characterized as stable, hypovolemia, sepsis, shock, or death. The model simulated combat intensity by increasing the number of casualties up to 192 casualties per 24 hours. We explored how an augmented system (FC) and Field Hospital (FH) moved closer to the battlefront would change performance. Results: Mortality rates rose precipitously from a 10% baseline to 61% at 12 casualties per 24 hours in the base model. This performance was not significantly different from that of the FC model at any casualty rate. Successful evacuation of casualties was significantly more for the FH model versus the base model at 12 casualties/24 hours (47.5% vs. 39%; p = 0.046), 48 casualties/24 hours (45.5% vs. 33%; p = 0.008), and 192 casualties/24 hours (25% vs. 15.5%; p = 0.02). Conclusions: The current NATO model experiences high rates of mortality in LSCO. The most effective modification entails situating Field Hospitals within one-hour of ground transport from the battlefront.

INTRODUCTION:There are limited studies on the financial implications of promotion for orthopaedic faculty at academic institutions in the United States. This study quantifies the association between academic promotion and financial compensation for orthopaedic faculty. METHODS:Annual salary benchmarks were analyzed from the 2022 Association of American Medical Colleges Faculty Salary Report for faculty at departments of orthopaedic surgery in US medical schools. Primary outcomes were annual and lifetime salary compensation. Financial models for lifetime salary compensation were created using benchmarks for time to promotion in academic surgical careers. Nonparametric tests were used to compare median annual compensation and salary compensation across academic ranks. RESULTS:Of 752 academic orthopaedic faculty, 350 sports medicine surgeons (47%), 144 hand surgeons (19%), 143 trauma surgeons (19%), and 115 spine surgeons (15%) were included in this study. Most were assistant professors (47%), associate professors (28%), and professors (24%). Across each orthopaedic subspecialty, median annual salary increased at higher academic ranks ( P < 0.05). The greatest increase in lifetime salary compensation occurred during the promotion from assistant professor to associate professor (median = $2,265,444, 13% increase), while the lowest impact was observed in the promotion from associate professor to full professor (median = $179,028, 1% increase; P = 0.040). The greatest increase in lifetime salary compensation from assistant professor to associate professor occurred in sports medicine (18% increase, $3,040,752). Spine surgery had the greatest increase in lifetime salary compensation from associate professor to full professor (22% increase, $4,329,198). DISCUSSION:There is notable financial benefit associated with academic promotion in orthopaedic surgery. This financial benefit is greatest from assistant to associate professor. Departmental leaders must be cognizant of these trends to recruit quality talent.

There is limited evidence to guide treatment strategies for native and periprosthetic distal femoral nonunions. The aim was to determine factors associated with failure of distal femoral nonunion repair. All adult patients undergoing operative repair for a distal femoral nonunion from 2004 to 2023 at two Level 1 Trauma Centers with ≥ 6 months follow-up were identified. The primary outcome was additional nonunion surgery. Univariate logistic regression was performed to determine associations of patient, initial fracture, nonunion, and treatment characteristics with additional nonunion surgery. Eighty-six patients (median age 63 years, 63% female) were included. Definitive fixation was most often a non-augmented lateral locking plate (LLP, 52%), 95-degree-blade-plate (BP, 29%), or augmented LLP (15%). Augmented fixation was defined as the addition of a medial or endosteal plate or intramedullary nail. Fourteen patients (16%) required additional nonunion surgery. In univariate logistic regression analysis, initial high-energy injuries (OR: 4.18, p = 0.044), increasing number of previous surgeries (OR: 1.94, p = 0.007), and treatment with retention of previous implants (OR: 5.25, p = 0.010) or bone morphogenetic protein use (OR: 5.82, p = 0.005) were associated with increased odds of additional nonunion surgery; whereas treatment with BP constructs (vs. non-augmented LLPs, OR: 0.11, p = 0.044) reduced odds. Rates of additional nonunion surgery were 12/45 (27%) for non-augmented LLP, 1/13 (7.7%) for augmented LLP, and 1/25 (4.0%) for BP constructs. When excluding patients treated with retention of previous implants, rates were 7/35 (20%) for non-augmented LLP, 0/8 (0%) for augmented LLP, and 1/25 (4%) for BP constructs. There were differences across constructs, including for rates of initial intra-articular fractures (49% vs. 0% vs. 13%), and use of autograft (51% vs. 62% vs. 16%) and bone morphogenetic protein (44% vs. 31% vs. 8.0%). Approximately 1 in 6 patients required additional nonunion surgery. In unadjusted analyses, initial high-energy injuries and more prior surgeries were associated with increased odds for additional nonunion surgery, suggesting that the severity of the initial injury is associated with subsequent nonunion treatment outcomes. The current study findings suggest that distal femoral nonunion repair should be based on revision fixation using augmented lateral locking plate (dual-plate or nail-plate) or blade plate constructs. However, these findings are based on unadjusted comparisons. Larger studies with sufficient power to correct or stratify for confounding are needed to further define optimal treatment.

BACKGROUND:This study evaluated secondary displacement rates for nonsurgically managed greater tuberosity (GT) fractures using a validated radiographic measurement method. METHODS:This retrospective study included adults with GT fractures (AO/OTA 11A1.1) managed nonsurgically between 2010 and 2023 with a minimum radiographic follow-up of 6 weeks at two level 1 trauma centers. The primary outcome was the rate of secondary displacement, defined as a superior GT position (GT ratio ≥ 0.5) at the final follow-up for fractures initially positioned inferiorly or intermediately (GT ratio < 0.5). GT positioning was measured radiographically and categorized according to the GT ratio described by Mutch et al. Secondary objectives were to compare secondary displacement rates between isolated GT fractures and GT fracture-dislocations, identify risk factors for secondary displacement, and compare active range of motion between patients with and without secondary displacement. RESULTS:A total of 115 patients (median age 57 years, 70% female) with a median follow-up of 104 days were included. Isolated GT fractures accounted for 81 cases (70%), whereas 34 (30%) were GT fracture-dislocations. Among 104 initially inferiorly or intermediately positioned GT fractures, 11 (11%) experienced secondary displacement. Secondary displacement rates were similar between isolated GT fractures (n = 7, 9.2%) and GT fracture-dislocations (n = 4, 14%; P = 0.482). A greater initial injury GT ratio was predictive for secondary displacement ( P = 0.028). Patients with secondary displacement showed a negligible trend toward reduced active forward flexion ( P = 0.156), although abduction and external rotation were not markedly different ( P = 0.941 and P = 0.392, respectively). CONCLUSION:Approximately 10% of nonsurgically managed GT fractures undergo secondary displacement. Secondary displacement rates were similar between isolated and GT fracture-dislocations. A more superior GT position at the initial injury was predictive of secondary displacement. No differences were found in active range of motion between patients with and without secondary displacement. These findings can help surgeons determine appropriate follow-up strategies for nonsurgically managed GT fractures. LEVEL OF EVIDENCE:Diagnostic Level IV.

The Fracture Risk Assessment Tool (FRAX), widely used for predicting the 10-year likelihood of hip fractures, does not incorporate factors like prior falls and sociodemographic characteristics, notably the Social Vulnerability Index (SVI). Recognizing these limitations, we aim to evaluate the predictive accuracy of FRAX by integrating fall frequency, fall energy, and SVI into the model for assessing the risk of fall-induced hip fractures. A retrospective case-control study was conducted, and patients aged ≥ 40 years with a documented diagnosis of a fall-induced hip fracture were age-matched with controls with a history of falls without an associated hip fracture. Basic demographic data, along with information about the number of prior falls and the energy of the current falls, were collected. The FRAX and SVI were calculated accordingly. Logistic regression analysis was employed to identify significant predictors. The performance of the models was evaluated and reported using appropriate metrics. Baseline characteristics of the dataset were presented as medians with interquartile ranges (IQR) or as percentages, where applicable. The significance of the identified variables was quantified using Odds Ratio (OR) along with their 95% Confidence Interval (CI). A p-value threshold of 0.05 was set for statistical significance. A total of 261 patients per group were included with a median age of 74 (IQR 67-80) and 72 (IQR 62-83) years. The FRAX score was significantly associated with the likelihood of experiencing a fall-induced hip fracture, as indicated by an OR of 1.06 (CI: 1.03-1.09). Participants with a one-time history of falls had an OR of 1.58 (CI: 1.02-2.37), compared to 1.84 (CI: 1.09-3.1) for those with multiple falls. The White participants, along with the Housing Type and Transportation domain of the SVI, also demonstrated to play a role (OR = 2.85 (CI: 1.56-5.2) and OR = 0.3 (CI: 0.12-0.8), respectively). This study underscored the significance of factors such as fall frequency, SVI, and race in predicting fall-induced hip fractures. It also highlighted the need for further refinement of the FRAX tool. We recommend that future research should be focused on validating the impact of these sociodemographic and fall characteristics on a broader scale, along with exploring the implications of clinical surrogates related to falls.

Supplemental Digital Content is Available in the Text. OBJECTIVES:To report on adverse events during magnetic resonance imaging (MRI) in patients with external fixators.Design:Retrospective case series.Setting:Two Level 1 trauma centers.Patient Selection Criteria:Patients with external fixators on the appendicular skeleton or pelvis undergoing MRI between January 2005 and September 2023.Outcome Measures and Comparisons:Adverse events, defined as any undesirable event associated with the external fixator being inside or outside the MRI bore during imaging, including (subjective) heating, displacement or pullout of the external fixator, or early MRI termination for any reason.RESULTS:A total of 97 patients with 110 external fixators underwent at least one MRI scan with an external fixator inside or outside of the MRI bore. The median age was 51 years (interquartile range: 39-63) and 56 (58%) were male. The most common external fixator locations were the ankle (24%), knee (21%), femur (21%), and pelvis (19%). The median duration of the MRI was 40 minutes (interquartile range: 26-58), 86% was performed using 1.5-Tesla MRI, and 14% was performed using 3.0-Tesla MRI. Ninety-five percent of MRI was performed for the cervical spine/head. Two MRI scans (1.6%), one of the shoulder and one of the head and cervical spine, with the external fixator outside of the bore were terminated early because of patient discomfort. There were no documented events of displacement or pullout of the external fixator.CONCLUSIONS:These findings suggest that MRI scans of the (cervical) spine and head can be safely obtained in patients with external fixators on the appendicular skeleton or pelvis. Given the low numbers of MRI scans performed with the external fixator inside the bore, additional studies are necessitated to determine the safety of this procedure. The results from this study can aid orthopaedic surgeons, radiologists, and other stakeholders in developing local institutional guidelines on MRI scanning with external fixators in situ.LEVEL OF EVIDENCE:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

INTRODUCTION:This study quantifies the state of sex diversity in orthopaedic trauma training and analyzes fellowship program characteristics associated with greater sex diversity among trainees. We hypothesized that greater sex diversity among orthopaedic trauma fellows would be associated with the presence of female faculty. METHODS:This was a retrospective, cross-sectional study of orthopaedic trauma faculty (2023 to 2024) and fellows (2009 to 2024). A trainee analysis for orthopaedic trauma fellows was done relative to orthopaedic surgery residents and allopathic medical students. Fellowship program characteristics associated with increased sex diversity among fellows were elucidated with chi square tests. Temporal analyses were done with linear regression. RESULTS:Overall, 1,266 orthopaedic trauma fellows and 200 were female (15.8%). Sex diversity in orthopaedic trauma fellowships was similar to orthopaedic surgery residency programs (14.2%, P = 0.135) but less than allopathic medical schools (47.5%, P < 0.001). Female representation in orthopaedic trauma fellowship training increased over the study period (9.1% vs. 31.5%, P < 0.001); 349 orthopaedic trauma faculty at 65 orthopaedic trauma fellowships and 41 were female (11.7%). Of the 65 fellowship program directors, only four were female (6.2%). The presence of female faculty was associated with greater sex diversity among orthopaedic trauma fellows ( P = 0.017). Additional program characteristics, like geographic region, accreditation status, and number of faculty, were not associated with greater sex diversity. DISCUSSION:Sex diversity is increasing in orthopaedic trauma fellowship training and is associated with the presence of female faculty. Efforts to mentor and recruit female trainees in orthopaedic trauma fellowship training may lead to greater workforce diversity in orthopaedic trauma.

Introduction: Case volumes of trauma centers and surgeons influence clinical outcomes following orthopaedic trauma surgery. This study quantifies surgical volume benchmarks for Orthopaedic Trauma Association (OTA)accredited fellowship training in the United States. Methods: This was a retrospective cross-sectional study of orthopaedic trauma fellows graduating between 2018 and 2019 to 2022-2023. Case volume percentiles were calculated across categories and variability defined as the fold-difference between 90th and 10th percentiles. Temporal trends were assessed with linear regression. Results: 446 orthopaedic trauma fellows were included in this study. Mean reported case volume increased from 898 +/- 245 in 2018-2019 to 974 +/- 329 in 2022-2023 (P = 0.066). Mean case volume was 924 over the study period and mostly consisted of other (418 cases, 45 %), subtrochanteric/intertrochanteric femoral neck (84 cases, 9 %), open fracture debridement (72 cases, 8 %), pelvic ring disruption / fracture (55 cases, 6 %), acetabular fracture (41 cases, 4 %), tibial shaft fracture (39 cases, 4 %), and femoral shaft fracture (38 cases, 4 %) cases. Overall variability in total reported case volume was 2.0. Variability was greatest in distal radius fracture (14.8), amputation (9.5), fasciotomy (8.0), and proximal humerus repair (5.0). Conclusion: Graduates from OTA-accredited fellowship training perform 924 cases on average, which exceeds the current minimum requirement of 600 cases. Case volume benchmarks can assist trainees and faculty align training goals with fellowship program strengths. More research is needed to determine evidence-based case minimum requirements for core competency training in orthopaedic trauma surgery.