Novant Health Charlotte Orthopedic Hospital

Based on evidence suggesting anxiolytic properties of the atypical antipsychotic olanzapine, this study was conducted to evaluate whether olanzapine may be efficacious in treating social anxiety disorder (SAD). This study was an 8-week, double-blind, placebo-controlled evaluation of olanzapine as monotherapy in which 12 patients with the DSM-IV diagnosis of SAD were randomized to either olanzapine (n = 7) or placebo (n = 5). An initial dose of 5 mg/day was titrated to a maximum of 20 mg/day. Baseline to endpoint scores from the Brief Social Phobia Scale (BSPS), Social Phobia Inventory (SPIN), Liebowitz Social Anxiety Scale and Sheehan Disability Scale, as well as Clinical Global Impression-Improvement ratings, were compared for olanzapine versus placebo. Seven subjects completed all 8 weeks of the study, four in the olanzapine group and three in the placebo group. In the intent-to-treat analysis, olanzapine yielded greater improvement than placebo on the primary measures: BSPS (p = 0.02) and SPIN (p = 0.01). Both treatments were well tolerated, although the olanzapine group had more drowsiness and dry mouth. Olanzapine and placebo were both associated with negligible weight gain. Olanzapine was superior to placebo on the primary outcome measures in this preliminary study of SAD. Additional studies of olanzapine as a treatment for SAD are warranted.

There were 157 patients following major lower extremity amputation who were evaluated to determine functional prosthetic ambulation. Twenty-eight patients were evaluated in the amputee clinic and found not to be candidates for prosthetic fitting. Forty-one patients were fit with a prosthesis but did not become functional prosthetic ambulators. Eighty-eight patients became functional prosthetic ambulators. Of all above-the-knee amputees, 46% became functional prosthetic ambulators. Only 19% of bilateral lower extremity amputees became functional prosthetic ambulators. Of all below-the-knee amputees, 66% became functional ambulators. The presence of coronary artery disease decreased the ambulatory potential in above-the-knee or bilateral amputees but not in below-the-knee amputees. A screening method for elderly, dysvascular amputees should be instituted prior to prosthetic fitting.

Abstract Background Previous natural history studies have advanced the understanding of sickle cell disease (SCD), but generally have not included sufficient lifespan data or investigation of the role of genetics in clinical outcomes, and have often occurred before the widespread use of disease‐modifying therapies, such as hydroxyurea and chronic erythrocyte transfusions. To further advance knowledge of SCD, St. Jude Children's Research Hospital established the Sickle Cell Clinical Research and Intervention Program (SCCRIP), to conduct research in a clinically evaluated cohort of individuals with SCD across their lifetime. Procedures Initiated in 2014, the SCCRIP study prospectively recruits patients diagnosed with SCD and includes retrospective and longitudinal collection of clinical, neurocognitive, geospatial, psychosocial, and health outcomes data. Biological samples are banked for future genomics and proteomics studies. The organizational structure of SCCRIP is based upon organ/system‐specific working groups and is opened to the research community for partnerships. Results As of August 2017, 1,044 (92.3% of eligible) patients with SCD have enrolled in the study (860 children and 184 adults), with 11,915 person‐years of observation. Population demographics included mean age at last visit of 11.3 years (range 0.7–30.1), 49.8% females, 57.7% treated with hydroxyurea, 8.5% treated with monthly transfusions, and 62.9% hemoglobin (Hb) SS or HbSB 0 ‐thalassemia, 25.7% HbSC, 8.4% HbsB + ‐Thalassemia, 1.7% HbS/HPFH, and 1.2% other. Conclusions The SCCRIP cohort will provide a rich resource for the conduct of high impact multidisciplinary research in SCD.

Increased osteogenesis, both in fracture healing and heterotopically, occurs in a significant percentage of patients with traumatic brain injury. Periarticular heterotopic ossification, especially in the hip and elbow joint, can cause functional loss of motion in patients with traumatic brain injury and interfere with activities of daily living. Seventeen patients with traumatic brain injury had periarticular heterotopic ossification resected in 20 joints (13 hips and seven elbows). Each joint was ankylosed prior to surgical resection (Brooker IV). In the immediate postoperative period, the average arc of motion was 85 degrees in the hips and 65 degrees in the elbows. At the final follow-up observation (average, 23 months), 17 of the 20 heterotopic ossification resected joints had maintained functional range of motion. Three joints in two patients reankylosed. Two additional patients had significant complications. In summary, surgical excision of periarticular heterotopic ossification in patients with traumatic brain injury can give satisfactory results, provided appropriate preoperative selection is done.

Aims The aim of this study was to observe the implications of withholding total joint arthroplasty (TJA) in morbidly obese patients Patients and Methods A total of 289 morbidly obese patients with end-stage osteoarthritis were prospectively followed. There were 218 women and 71 men, with a mean age of 56.3 years (26.7 to 79.1). At initial visit, patients were given information about the risks of TJA in the morbidly obese and were given referral information to a bariatric clinic. Patients were contacted at six, 12, 18, and 24 months from initial visit. Results The median body mass index (BMI) at initial visit was 46.9 kg/m 2 (interquartile range (IQR) 44.6 to 51.3). A total of 82 patients (28.4%) refused to follow-up or answer phone surveys, and 149 of the remaining 207 (72.0%) did not have surgery. Initial median BMI of those 149 was 47.5 kg/m 2 (IQR 44.6 to 52.5) and at last follow-up was 46.7 kg/m 2 (IQR 43.4 to 51.2). Only 67 patients (23.2%) went to the bariatric clinic, of whom 14 (20.9%) had bariatric surgery. A total of 58 patients (20.1%) underwent TJA. For those 58, BMI at initial visit was 45.3 kg/m 2 (IQR 43.7 to 47.2), and at surgery was 42.3 kg/m 2 (IQR 38.1 to 46.5). Only 23 patients (39.7%) of those who had TJA successfully achieved BMI < 40 kg/m 2 at surgery. Conclusion Restricting TJA for morbidly obese patients does not incentivize weight loss prior to arthroplasty. Only 20.1% of patients ultimately underwent TJA and the majority of those remained morbidly obese. Better resources and coordinated care are required to optimize patients prior to surgery. Cite this article: Bone Joint J 2019;101-B(7 Supple C):28–32

BACKGROUND: Staphylococcus aureus is the most commonly isolated organism in periprosthetic joint infection (PJI). Resistant strains such as methicillin-resistant S aureus (MRSA) are on the rise, and many programs have instituted decolonization protocols. There are limited data on the success of S aureus nasal decolonization programs and their impact on PJI. QUESTIONS/PURPOSES: The purposes of this study were to (1) determine the proportion of patients successfully decolonized using a 2-week protocol; (2) compare infection risks between our surveillance and decolonization protocol group against a historical control cohort to evaluate changes in proportions of S aureus infections; and (3) assess infection risk based on carrier type, comparing S aureus carriers with noncarrier controls. METHODS: We retrospectively evaluated a group of 3434 patients who underwent elective primary and revision hip and knee arthroplasty over a 2-year period; each patient in the treatment group underwent a surveillance protocol, and a therapeutic regimen of mupurocin and chlorhexidine was instituted when colonization criteria were met. A 2009 to 2010 comparative historical cohort was chosen as the control group. We compared risks of infection between our treatment group and the historical control cohort. Furthermore, in patients who developed surgical site infections (SSIs), we compared the proportions of each S aureus type between the two cohorts. Finally, we compared infection rates based on carrier status. Surveillance for infection was carried out by the hospital infection control coordinator using the Centers for Disease Control and Prevention (CDC) criteria. During the time period of this study, the CDC defined hospital-acquired infection related to a surgical procedure as any infection diagnosed within 1 year of the procedure. With the numbers available, we had 41% power to detect a difference of 0.3% in infection rate between the treatment and control groups. To achieve 80% power, a total of 72,033 patients would be needed. RESULTS: Despite the protocol, 22% (26 of 121) of patients remained colonized with MRSA. With the numbers available, there were no differences in infection risk between the protocoled group (27 of 3434 [0.8%]) and the historical control group (33 of 3080 [1.1%]; relative risk [RR], 0.74; 95% confidence interval [CI], 0.44-1.22; p = 0.28). In terms of infecting organism in those who developed SSI, S aureus risk decreased slightly (treatment: 13 of 3434 patients [0.38%]; control: 21 of 3080 patients [0.68%]; RR, 0.56; CI, 0.28-1.11; p = 0.11). Within the protocoled group, carriers had a slightly higher risk of developing SSI (carrier: seven of 644 [1.1%]; noncarrier: 18 of 2763 [0.65%]; RR, 1.77; CI, 0.74-4.24; p = 0.20). CONCLUSIONS: The screening and decolonization protocol enabled a substantial reduction in nasal carriage of MRSA, but some patients remained colonized. However, our nasal decolonization protocol before elective total joint arthroplasty did not demonstrate a decrease in the proportion of patients developing SSI. Future meta-analyses and systematic reviews will be needed to pool the results of studies like these to ascertain whether small improvements in infection risk are achieved by protocols like ours and to determine whether any such improvements warrant the costs and potential risks of surveillance and intervention. LEVEL OF EVIDENCE: Level III, therapeutic study.

INTRODUCTION: Hepatic artery infusion pump (HAIP) chemotherapy is a specialized therapy for patients with unresectable colorectal liver metastases (uCRLM). Its effectiveness was demonstrated from a high volume center, with uncertainty regarding the feasibility and safety at other centers. Therefore, we sought to assess the safety and feasibility of HAIP for the management of uCRLM at other centers. METHODS: We conducted a multicenter retrospective cohort study of patients with uCRLM treated with HAIP from January 2003 to December 2017 at six North American centers initiating the HAIP program. Outcomes included the safety and feasibility of HAIP chemotherapy. RESULTS: We identified 154 patients with HAIP insertion and the median age of 54 (48-61) years. The burden of disease was >10 intra-hepatic metastatic foci in 59 (38.3%) patients. Patients received at least one cycle of systemic chemotherapy before HAIP insertion. Major complications occurred in 7 (4.6%) patients during their hospitalization and 13 (8.4%) patients developed biliary sclerosis during follow-up. A total of 148 patients (96.1%) received at least one-dose of HAIP chemotherapy with a median of 5 (4-7) cycles. 78 patients (56.5%) had a complete or partial response and 12 (7.8%) received a curative liver resection. CONCLUSION: HAIP programs can be safely and effectively initiated in previously inexperienced centers with good response.

BACKGROUND: Primary malignant liver tumors are rare, accounting for 1% to 2% of all childhood cancers. When chemotherapy fails, transarterial radioembolization with yttrium-90 (TARE-Y90) may offer an alternative therapy as a bridge to surgical resection or liver transplant or for palliation. METHODS: We conducted a retrospective review of 10 pediatric patients with histologically confirmed primary liver malignancy who received treatment with TARE-Y90. RESULTS: The median age at treatment was 5.5 years (range, 2-18 years). Median patient survival from initial diagnosis was 12.5 months (range, 10-28 months), and median patient survival after TARE-Y90 was 4 months (range, 2-20 months). Retreatment was well tolerated in three of 10 patients, with these patients demonstrating the longest survival times (range, 17-20 months). One patient was transplanted 6 weeks after TARE-Y90. By RECIST 1.1 criteria of all target lesions, eight of nine patients had stable disease, and one of nine had progressive disease. By mRECIST criteria (requiring postcontrast arterial phase imaging), two of seven patients had a partial response, four of seven had stable disease, and one of seven had progressive disease. CONCLUSION: TARE-Y90 of unresectable primary liver malignancy is both technically feasible and demonstrates an anticancer effect, and retreatment is well tolerated. TARE-Y90 could be considered as adjunctive therapy in pediatric patients with unresectable hepatic malignancies and could be used as a bridge to surgical resection or liver transplant. More research is required to determine the efficacy of this treatment in children and to define the clinical scenarios where benefit is likely to be optimized.

Purpose To evaluate the tibiofemoral contact mechanics of an all‐inside posterior medial meniscal root repair technique via suture fixation to the posterior cruciate ligament (PCL) and to compare with that of the intact knee and the knee with a root tear. Methods Tibiofemoral contact mechanics were recorded in 8 human cadaveric knee specimens using pressure sensors. Each knee underwent 3 testing conditions related to the posterior medial meniscal root: (1) intact knee; (2) root tear; and (3) all‐inside repair via suture fixation to the PCL. Knees were loaded with a 1000‐N axial compressive force at 4 knee flexion angles (0°, 30°, 60°, 90°). Calculations were performed for contact area, mean contact pressure, and peak contact pressure. A generalized linear model with a Tukey adjusted least square means test was used to determine differences between testing conditions. Results Across all knee flexion angles, there was an overall mean 26.3% reduction in contact area with root tear (211.34 mm 2 vs intact 286.64 mm 2 , P = .0002), and a 31.6% increase from root tear to repair (277.61 mm 2 , P = .0297). Across all knee flexion angles, there was an overall mean 24.3% increase in contact pressure with root tear (1849.12 N/mm 2 vs. intact 1487.52 N/mm 2 , P < .0001), and a 31.1% decrease from root tear to repair (1410.7 N/mm 2 , P = .0037). Across all knee flexion angles, there was an overall mean 10.6% increase in peak contact pressure with root tear (4083.55 N/mm 2 vs. intact 3693.68 N/mm 2 , P < .0001), and a 12.4% decrease from root tear to repair (3632.13 N/mm 2 , P = .531). Conclusions In most testing conditions and with overall averaging across knee flexion angles, the all‐inside posterior medial meniscal root repair with suture fixation to the adjacent PCL fibers restored contact area (from 26.3% reduction with root tear to 31.6% increase with repair), contact pressures (from 24.3% increase with root tear to 31.1% decrease with repair), and peak contact pressures (from 10.6% increase with root tear to 12.4% decrease with repair) to that of the intact knee This may be a future potential technique to limit complications associated with the traditional transtibial pull‐out method of repair. Clinical Relevance This technique may provide a posterior medial meniscal root repair construct that restores most tibiofemoral contact mechanics and offers theoretical benefits of technical ease and potential for an acceptable, less “anatomic” repair location.

INTRODUCTION: At present there is no curriculum to guide physician lifelong learning in a prescribed, deliberate manner. The Conjoint Committee on Continuing Medical Education, a group representing 16 major stakeholder organizations in continuing medical education, recommends that each specialty society and corresponding board reach consensus on the competencies expected of physicians in that specialty. Experts in a specialty will define content-based core competencies in the areas of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. These competencies, when cross-referenced with expertise, comprise a framework for specialty curricula and board maintenance of certification programs. The American Academy of Ophthalmology and the American Board of Ophthalmology already have implemented this recommendation. Their work is reported as a model for further development. A competency-based curriculum framework offers a foundation for continuing medical education in diverse practice settings and provider organizations.

Chronic pain and disability are closely related. Evidence supporting the role of the central nervous system (cortical and limbic system), as opposed to peripheral, nociceptive processes, in the development and maintenance of chronic pain is reviewed. This includes the phenomenon of central sensitization, relevant limbic-cortical processes, and psychiatric diagnoses often co-morbid with chronic pain. Psychological and socioeconomic 'red flags' for a poor return to work prognosis are delineated. The critical importance of cognitive beliefs and, therefore, physician statements to patients concerning their medical condition, resulting restrictions, and limitations is emphasized. The relationship between motivation, performance, and patients' beliefs about what they can do (self-efficacy) and what will happen when they return to work is discussed. The need for a comprehensive interdisciplinary approach oriented towards functional restoration to enable patients with chronic pain to reach maximum medical improvement (MMI) is reviewed. It is argued that psychiatry, with a bio-psychosocial perspective is uniquely qualified to evaluate and treat chronic pain.

Approximately 50% of female carriers of hemophilia A have factor VIII (FVIII) levels below 0.5 IU/dL and may be categorized as having mild hemophilia. Females with hemophilia may go undiagnosed for years because the most common symptoms - menorrhagia and bleeding after childbirth - also occur in females without hemophilia. Females with hemophilia can exhibit increased bleeding tendencies despite current guidelines of expected, adequate FVIII levels. The cases described illustrate the clinical variability and presentation of hemophilia in females and highlight the importance of a timely diagnosis, effective management, and monitoring. Prophylactic factor replacement therapy is recommended in females with hemophilia, particularly those with joint disease or gynecologic complications. Affected individuals should receive infusion training and education on treatment options, physical activities, the importance of treatment adherence, and recognizing bleeding symptoms warranting treatment. Further study is needed to increase awareness of hemophilia in females and reassess current guidelines for their management and monitoring.

Although collegiate athletes underutilize mental health programming, investigators have rarely examined factors that may influence their participation in such programs. The current study examined how structured interviews and demographic factors influence collegiate athletes to use psychological programming. Two-hundred and eighty-nine collegiate athletes were referred to the study. They were screened for mental health and randomly assigned to one of two semi-structured interviews based on experimental phase. Participants in Phase I received standard engagement (SE; N = 35) or SE+discussion of mental health (DMH; N = 44). Phase II participants received SE+DMH (N = 82) or SE+DMH + discussion of personal ambitions (DPA; N = 66). Phase III participants received SE+DMH+discussion about their culture of choice (DCC) (N = 25) or SE+DMH+discussion of sport culture (DSC) (N = 37). After receiving the respective interview participants were offered psychological assessment and intervention. Chi squared analyses revealed class standing, mental health symptom severity, referral type, and type of engagement interview influenced program commitment/utilization. Logistic regression analyses indicated SE+DMH+DPA and SE+DMH+DSC uniquely improved assessment attendance whereas referrals from the athletic department and coaches/teammates, participation in sport performance workshops, and senior status uniquely improved assessment and intervention attendance.

OBJECTIVE: To perform a review of the collective experience of all hospital-based helicopter ambulances in the state of North Carolina for compliance with utilization review criteria. DESIGN: Flight records of the six members of the North Carolina Aeromedical Affiliation for the months of November and December 1989 were compared with utilization review criteria by an independent reviewer. A secondary review was performed by a staff member for each service. Scene responses and patients flown to a hospital other than the sponsor were evaluated. SETTING: All six hospital-based helicopter services in North Carolina. TYPE OF PARTICIPANTS: All available flight records for November and December 1989. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 756 transports, 747 flight records were available for review. Initial review demonstrated compliance with the criteria for 713 (95.4%) patients; secondary review showed compliance for 18 of 34 flights not meeting initial review, for an overall compliance rate of 97.9%. Compliance rates for scene responses and transports taken to a hospital other than the sponsoring facility were 96.6% and 94.1%, respectively. CONCLUSIONS: Review of all flights over a period of two-months by all six hospital-based helicopter services in North Carolina using utilization review criteria demonstrated a very high rate of compliance with the established criteria.

Abstract There is a broad differential diagnosis of infantile hepatosplenomegaly, with some etiologies being debilitating and treatable. A structured approach to history, examination, and laboratory and radiographic findings is important in diagnosis. Herein, we present a case of Wolman disease presenting as hepatosplenomegaly in an infant. This case details important learning points to help distinguish the diagnosis of Wolman disease from other conditions with overlapping clinical features, such as hemophagocytic lymphohistiocytosis (HLH). The advent of enzyme replacement therapy has dramatically changed the natural history of Wolman disease, and this child showed remarkable improvement with treatment. This child was later found to have extensive adenopathy with retroperitoneal lymph node biopsy demonstrating diffuse infiltration by lipid‐laden macrophages, fatty deposits, cholesterol crystals, and calcifications. Similar to the collection of characteristic cells in other lysosomal storage disorders, we postulate that this is characteristic of underlying Wolman disease. We conclude with a summary of learning points from this presentation on infantile hepatosplenomegaly, pertinent to the geneticist, pediatrician, and pediatric subspecialists.

Background: Exagamglogene autotemcel (exa-cel) is a non-viral cell therapy that reactivates fetal hemoglobin (HbF) via ex vivo CRISPR-Cas9 editing of autologous CD34+ hematopoietic stem and progenitor cells at the erythroid-specific enhancer region of BCL11A. Exa-cel is approved as a one-time treatment for patients aged ≥12 years with severe sickle cell disease (SCD). We report long-term efficacy and safety for participants with SCD in the ongoing phase 3 CLIMB SCD-121 and CLIMB-131 studies. Methods: CLIMB SCD-121 is a 2-year, phase 3 study of a single-infusion of exa-cel in participants aged 12 through 35 years with SCD and a history of ≥2 vaso-occlusive crises (VOCs)/year for 2 years before screening. Enrollment and dosing are complete; the study is ongoing. The primary efficacy endpoint is the proportion of participants free of severe VOCs for ≥12 consecutive months (VF12); the key secondary efficacy endpoint is the proportion of participants free from inpatient hospitalization for severe VOCs for ≥12 consecutive months (HF12). Evaluation of VF12 and HF12 began 60 days after the last red blood cell (RBC) transfusion for post-transplant support or SCD management. Participants evaluable for the primary and key secondary endpoints had ≥16 months of follow-up after exa-cel infusion. Participants who complete CLIMB-121 may enroll in the 13-year long-term extension study, CLIMB-131, where they will be followed for a total of 15 years. Results: As of May 2024, a total of 46 participants (mean age of all participants: 21.4 years, range: 12, 34; mean age of adolescents 12 through 18 years of age [N=12]: 14.5 years, range: 12, 17) with mean 4.2 VOCs/year at baseline received exa-cel after myeloablative busulfan conditioning and had a median follow-up of 29.9 months (range: 8.9, 58.9). Of these participants, 31 completed 2 years of follow-up in CLIMB SCD-121 and transitioned to CLIMB-131. After exa-cel infusion, all 46 participants engrafted neutrophils and platelets at a median of 27 days (range: 15, 40) and 34.5 days (range: 23, 126), respectively. Of the 46 participants, 40 were evaluable for the primary and key secondary endpoints of which 36 (90.0%) achieved VF12 (95% CI: 76.3%, 97.2%) and 38 (95.0%) achieved HF12 (95% CI: 83.1%, 99.4%). In participants achieving VF12, mean VOC-free duration was 29.3 months (range: 14.0, 56.3). All participants, including those who did not achieve VF12, maintained increased levels of hemoglobin (Hb) and HbF and stable allelic editing, supporting that the effects from exa-cel are durable over time in all patients. For all participants, mean total Hb was 11.9 g/dL from Month 3 and was maintained at normal or near normal levels of ≥12 g/dL from Month 6 onward; mean HbF was 37.4% at Month 3 and generally ≥40% from Month 6 onward with pancellular distribution (≥95% RBCs express HbF). Proportion of edited BCL11A alleles was stable in bone marrow CD34+ and peripheral blood nucleated cells. Clinically meaningful improvements in hemolysis markers (lactate dehydrogenase, haptoglobin, reticulocyte count, indirect bilirubin) were observed and maintained over time. Quality of life (QOL) measures showed clinically meaningful improvements compared to baseline. Most common adverse events (AEs) were nausea (69.6%), stomatitis (63%), vomiting (58.7%), febrile neutropenia (54.3%), headache (54.3%), abdominal pain (52.2%), and pruritis (50%). Most AEs and serious AEs (SAEs) occurred within first 6 months after exa-cel infusion. No participants had SAEs considered related to exa-cel; there were no study discontinuations or malignancies. As previously reported, there was 1 death from respiratory failure due to COVID-19 infection unrelated to exa-cel. Conclusion: Exa-cel demonstrated elimination of VOCs in 90% of participants that was maintained for up to 4.7 years. All participants had durable increases in Hb and HbF levels and stable allelic editing; clinically meaningful improvements were also seen in hemolysis markers and QOL measures. The safety profile of exa-cel remains consistent with myeloablative busulfan conditioning and autologous transplantation. These results confirm the potential for exa-cel to provide a one-time functional cure to patients with severe SCD.

Among practicing orthopaedic surgeons, the population that self-identify as generalists has been declining for the past three decades, while sub-specialization has become more prevalent. As more residents are pursuing fellowship training, some elect to complete multiple fellowships, but due to a lack of research, there is a lack of insight into the reasons behind these decisions. The purpose of this study was to determine factors influencing the decision of orthopaedic surgery residents to pursue more than one fellowship following graduation from residency. An anonymous survey was distributed via email to all PGY-4 and PGY-5 orthopaedic surgery residents who had matched into one or more fellowships in the spring of 2021 and 2022. Responses were analyzed to determine the prevalence of different specialties, reasons for pursuing fellowship, and among those pursuing more than one fellowship, the reasons they chose to do so. 259 responses were collected from residents entering a fellowship, with 74 (28.6%) entering fellowships in the Midwest, 54 (20.8%) in the Southwest, 51 (19.7%) in the Northeast, 42 (16.2%) in the Southwest, and 32 (12.4%) in the West. 19 (7.3%) respondents reported matching into two or more fellowships. Among the fellowships pursued, sports medicine was most popular with 10 (52.6%) respondents; followed by shoulder/elbow (5; 26.3%). Out of all 259 respondents, 252 (97.3%) indicated their fellowship choices were based on interest, and 192 (74.1%) were also affected by marketability. Mentorship played a role for 173 (66.8%) and training in an area of deficiency was important for 149 (57.5%). Among those pursuing multiple fellowships, many combinations seem to have been made to decrease the time to breaking even on the financial investment involved in pursuing fellowships after residency. Most orthopaedic surgery residents elect to pursue fellowship training due to personal interest in the field, as well as to increase their marketability, and shorten the time to breaking even in comparison to the loss of compensation required for pursuing fellowship. Our results indicate that residents pursuing multiple fellowships are those interested in less marketable specialties, who then pursue a second fellowship with higher returns on investment, such as completing fellowships in pediatrics and sports medicine.

As hospitals and healthcare have become specialized, so has nursing. Orthopaedic nurse certification is an example of this specialization. The purpose of this article is to describe the outcomes of one specialty hospital's implemented plan designed to encourage and support nurses seeking to demonstrate expertise in orthopaedic nursing practice. A review course was developed with attention to potential barriers and concerns that were identified in the review of literature. Successful resolution of problems encountered with staff nurses becoming orthopaedic nurse certified are described. Participants in the first 2 sessions passed the examination on the first attempt at a rate of 100% and 88%, which exceeds the national rate of 86.5% (Orthopaedic Nurse Certification Board, 2011, retrieved from http://oncb.org/certification-statistics). Since initiation of the program, the number of "orthopaedic nurse certification" nurses has nearly tripled in this orthopaedic specialty hospital.

INTRODUCTION: This study examines trends in applicant characteristics for orthopedic surgery residency from 2016 to 2024, focusing on changes in match rates, academic performance, and research productivity. It highlights the impact of key shifts such as the transition to pass/fail grading for USMLE Step 1 and the MD-DO residency merger. The study aims to provide insights into how selection criteria have evolved and what future applicants, medical schools, and residency programs should consider when navigating the competitive field of orthopedic surgery. The purpose of this study is to examine the landscape of orthopedic surgery residency applications from 2016 to 2024, and analyze key trends in applicant characteristics, academic performance, and match rates. METHODS: This was a retrospective review of objective characteristics of both matched and unmatched applicants to orthopedic surgery. Data was sourced from NRMP, Charting Outcomes in the Match and was inclusive of years 2016 to 2024 with every other application cycle. All collected data was separated based on applicant type, divided between U.S. allopathic and U.S osteopathic. RESULTS: Between 2016 and 2024, U.S. allopathic seniors consistently had the highest match rates for orthopedic surgery residency, with 74.3% matching in 2024, though unmatched applicants also increased over time, reflecting growing competition. U.S. osteopathic seniors showed improvements in their match rates, rising from just 4 matches in 2018 to 93 in 2024, while unmatched applicants also grew. Academic performance metrics, including USMLE Step 1 and Step 2 CK scores, revealed a rising emphasis on Step 2 CK after Step 1's transition to pass/fail reporting. Research productivity notably increased across applicant groups, but was not the sole determinant of success in matching. Applicants with AOA membership and those from Top 40 NIH-funded medical schools had higher match rates, with AOA membership providing a particularly significant advantage. CONCLUSION: This analysis of orthopedic surgery residency match data from 2016 to 2024 reveals increasing competitiveness, with a shift in focus from Step 1 scores to Step 2 CK and research productivity. U.S. osteopathic applicants continue to face challenges, but with strong academic performance and strategic applications, success remains attainable, prompting the need for further research into selection criteria and long-term outcomes.

ABSTRACT Objective The optimal treatment for neurosarcoidosis myelitis is uncertain. We characterize incident neurosarcoidosis myelitis and assess treatment response by MRI and clinical scales. Methods Incident probable or definite neurosarcoidosis myelitis in adults was retrospectively identified from 13 academic medical centers. Cases were analyzed by initial treatment. The primary outcome was T1 post‐contrast gadolinium enhancement resolution at 6 months post‐treatment. Secondary outcomes were changes in modified Rankin scale (mRS) and Expanded Disability Status Scale (EDSS) from nadir to final follow‐up. Results Two hundred two patients were identified (median diagnosis age: 47 years (IQR 39–55); male: female 1.3:1). Median nadir mRS and EDSS were 2 (IQR 2–3) and 4 (IQR 2.5–6). At initial treatment, 129 (63.9%) received prolonged corticosteroids ≥ 4 weeks (group A 1 ), 36 (17.8%) received corticosteroids < 4 weeks (B 1 ), 21 (10.4%) received corticosteroids plus sarcoidosis‐directed immunosuppressant (E), and 16 (7.9%) received corticosteroids plus non‐sarcoidosis‐directed agents (F). In 167 cases with sufficient imaging, there were no significant differences in contrast enhancement resolution at 6 months (A 1 27/106 (25.5%), B 1 9/28 (32.1%), E 5/19 (26.3%), F 5/14 (35.7%); Fisher's exact p = 0.76). There were no significant differences in changes in mRS or EDSS among treatment groups (Kruskal–Wallis p = 0.69 and 0.63, respectively) after median follow‐up of 46.5 months (IQR 18–91.3). Interpretation Different initial immunosuppression strategies did not correlate with MRI contrast enhancement resolution at 6 months or clinical scales (mRS, EDSS). However, conclusions are limited by retrospective design, imbalanced cohorts, and insensitivity of binary MRI outcomes and available clinical scales for treatment response in neurosarcoidosis.