Lauren Bracey

OBJECTIVES: To compare 1-year revision rates among left-sided and right-sided intertrochanteric femur fractures. DESIGN: Retrospective. SETTING: 120+ contributing centers to multicentered database. PATIENT SELECTION CRITERIA: Patients who sustained intertrochanteric femur fracture (ITFF) and had a cephalomedullary nail (CMN) from 2015 to 2022 were identified. Patients were then stratified based on left-sided or right-sided fracture. Patients were excluded if younger than 18 years with <1-year follow-up. The intervention investigated was CMN on left or right side. OUTCOME MEASURES AND COMPARISONS: One-year revision surgery, comparing CMN performed on left or right side for ITFFs. RESULTS: In total, 113,626 patients met inclusion criteria, with 55,295 in the right-sided cohort and 58,331 in the left-sided cohort. There was no difference between cohorts with respect to age, gender, diabetes, osteoporosis, chronic kidney disease, or congestive heart failure (P > 0.05 for all). Patients who sustained a left ITFF and treated with a CMN were more likely to have revision surgery at 1 year (Left: 1.24%, Right: 0.90%; OR: 1.24; 95% confidence interval [CI], 1.15-1.1.33) or develop a nonunion or malunion (Left: 1.30%, Right: 0.98%; OR: 1.31; 95% CI, 1.14-1.52). The most common revision surgery conducted for both cohorts was conversion total hip arthroplasty (Left: 70.4% and Right: 70.0%). CONCLUSIONS: Patients who sustained a left intertrochanteric femur fracture and were treated with a CMN were more likely to undergo revision at 1 year due to nonunion. There were no differences in demographics and comorbidities between cohorts. Though left-sided versus right-sided confounding variables may exist, the difference in nonunion rate may be explained by clockwise torque of the lag screw used in most implants. Increased awareness, implant design, and improved technique during fracture reduction and fixation may help lower this disproportionate nonunion rate and its associated morbidity and financial impact. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Hand surgery is a competitive fellowship that draws applicants from orthopedic, plastic, and general surgery. In 2010, recommendations from the American Academy of Orthopaedic Surgeons (AAOS) Board of Specialty Societies Match Oversight Committee and the American Society of Plastic Surgeons (ASPS) Plastic Surgery Workforce Task Force led to significant reforms to their respective workforces and training. This study characterizes trends in hand fellowship applicants and programs since these recommendations (2010-2023). We queried hand fellowship applicant and program data from the American Society for Surgery of the Hand (ASSH), the National Resident Matching Program (NRMP), and the Accreditation Council for Graduate Medical Education (ACGME). From 2010 to 2023, the number of ACGME-accredited hand fellowship programs increased across specialties (orthopedic surgery, 58 to 74 (27.6% increase, R=0.97, p<0.001); plastic surgery, 14 to 19 (35.7% increase, R=0.91, p<0.001); general surgery, 1 to 2 (50% increase, R=0.71, p=0.004). The number of available fellowship positions commensurately increased by 38.8% over the same time period. The number of applicants did not significantly change between 2010 (155 applicants) and 2023 (198 applicants) (R=0.32, p=0.27). The ratio of applicants-to-positions significantly decreased from 2010 (1.12 applicants per position) to 2023 (1.04 applicants per position) (R=-0.74, p=0.003). Yet, applicants ranked nearly twice as many programs in 2023 (14.9 programs per applicant) compared to in 2010 (7.5 programs per applicant) (R=0.98, p<0.001). In light of the American Orthopaedic Association endorsing signal preferencing in the 2022-2023 residency Match, strategies to optimize rank lists in the fellowship application process should be further explored.

INTRODUCTION: Limited access to resources and stereotypes about orthopaedic surgeons may contribute to the low percentage of women and people of underrepresented in medicine (URiM) backgrounds in orthopaedic surgery. Several organizations have created resources to address these barriers, but medical students are unlikely to be exposed to the initiatives through traditional curricula. The purpose of this study was to (1) evaluate the ability of a 1-day virtual Diversity, Equity, Inclusion, and Accessibility (DEIA) summit to effectively reach URiM medical students, (2) increase medical students' knowledge of DEIA resources, and (3) augment the perception of diverse backgrounds in orthopaedic surgery. METHODS: A 1-day nationwide virtual summit was convened in October 2023. The summit invited residents and faculty leaders of diversity-focused orthopaedic organizations to speak with students in panel discussions and topic-focused breakout rooms. Pre- and postsummit surveys were used to determine whether the summit met the three goals. RESULTS: One hundred ninety-six medical students attended the summit. One hundred seventy-four surveys were received presummit, 106 surveys were received postsummit, and 60 students completed both. Most of the participants were female (n = 109, 63.0%), and many represented URiM backgrounds (n = 70, 41.7%). Postsummit, a notable number of survey respondents increased their knowledge about diversity-related opportunities (3.3% to 40%, P < 0.001). Participants who felt that their identity was welcome in orthopaedics nearly quadrupled from presummit (16.7%) to postsummit (63.3%) ( P < 0.001), and the likelihood of recommending orthopaedic surgery to another medical student from an URiM demographic increased by 58.6% ( P < 0.001). Among the 135 students who did not initially feel that their identity was welcome in the field of orthopaedic surgery, 124 (91.9%) rated changing stereotypes of the field as important to their decision to pursue a career in orthopaedics. CONCLUSIONS: This study supports the ability for virtual summits to reach URiM students, increase their knowledge of DEIA resources, and augment their perceptions of diversity in orthopaedics. LEVEL OF EVIDENCE: IV.