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Category: Ankle; Arthroscopy Introduction/Purpose: Ankle osteoarthritis, primarily posttraumatic, affects younger patients with extended life expectancies, significantly impacting their physical and mental quality of life. Surgical interventions, such as ankle fusion and ankle replacement, are crucial for managing end-stage ankle osteoarthritis. Ankle fusion has been the gold standard, providing consistent symptom relief, while total ankle arthroplasty (TAA) has evolved with improved designs and biomechanical properties. Studies indicate a notable increase in TAA rates compared to total knee and hip arthroplasty. However, the debate continues regarding the long-term outcomes and risk-benefit analysis of TAA versus ankle fusion, with individual patient characteristics and functional demands playing a significant role in treatment decisions. Methods: We conducted a study to analyze information related to total ankle replacement procedures. Using Google searches and the SEO minion Chrome extension, we collected and categorized 100 FAQs from reliable sources. We used the Rothwell classification for FAQ transparency, evaluated source transparency using the JAMA benchmark tool, and assessed source quality with Brief DISCERN. Statistical analysis was performed in R(4.3.1) and RStudio, including descriptive statistics, Fisher’s exact test for JAMA Benchmark item presence, and the Kruksal-Wallis test for website category differences in Brief Discern Scores. Dunn’s test was used for post-hoc analysis with Holm correction for multiple comparisons. Results: Our Google search returned 100 unique FAQs after removing duplicates and unrelated FAQs. The majority were classified as fact-based questions (47/100, 47%), followed by value (30/100, 30%) and policy questions (23/100, 23%). Overall, the most common topic searched was related to the timeline of recovery (17/47, 36.2%). The frequent answer sources were medical practice/hospital (44/100, 44%), followed by academic (27/100, 27%) and government (24/100, 24%). The Kruksal-Wallis test revealed a significant difference in mean quality scores among the 4 source types (H(3) = 8.7445, p = 0.03) with medical practices/hospitals averaging the worst score (16/30) compared to academic sources which were found to have the highest score (22/30). Conclusion: When seeking online information regarding total ankle replacement surgery, patients using Google most often searched fact-based questions pertaining to the timeline of recovery. Medical practices and hospitals were the most common sources for this information but scored the lowest in quality and transparency. When publishing online information, sources should refer to established criteria such as the JAMA benchmark tool and Brief DISCERN. Based on our results physicians should be informed of the fact that patients do not commonly encounter high-quality information. This emphasizes the importance of well-informed, evidence-based patient counseling prior to treatment.

Category: Other; Ankle Introduction/Purpose: The Accreditation Council for Graduate Medical Education (ACGME) Surgical Review Committee monitors the quantity of experiences through Current Procedural Terminology (CPT) codes logged by residents based on the procedures they perform. The ACGME currently requires a minimum of 20 specific foot and ankle procedures to be completed prior to graduation. These are defined as 15 'ankle fracture' cases and 5 'ankle, hindfoot, or midfoot arthroscopy' cases. The year 2020 marked a milestone change in residency training, as the Allopathic (MD) and Osteopathic (DO) residency accreditation merger resulted in unified graduate medical education training. The purpose of this study was to better understand the effect the merger had on the average number of cases, as well as the defined minimum cases for graduating orthopedic residents. Methods: A retrospective analysis of ACGME case logs examined the max and average number of adult orthopaedic cases related to both Leg/Ankle and Foot/Toes performed by graduating orthopaedic surgery residents from 2014 to 2023, spanning a 10-year period. Trends in case exposure were analyzed by assessing the average number of adult orthopaedic procedures during the study period. All data were sourced directly from the ACGME website.1 Descriptive statistics will be used along with unpaired t-tests to examine if there are statistical differences between pre and post merger averages (Microsoft Corporation, 2018. Microsoft Excel). Results: In 2014, 151 programs graduated 684 residents, compared to 197 programs in 2023 graduating 884 residents. The overall average of leg/ankle procedures prior to the merger was 176.74 (range 151.9-200.8, SD 18.9), which increased to 212.93 post-merger (range 206.5-219.9, SD 6.7; p = 0.006). Similarly, the total number of foot/toes procedures increased from a mean of 72.6 (range 62.5-83, SD 7.3) pre-merger to 82.9 post-merger (range 83.2-83.9, SD 1.1; p = 0.023). The average number of ankle fractures pre-merger was 58.3 (range 53-62.3, SD 3.7), which increased to 68.2 post-merger (range 66.6-69.7, SD 1.5; p < 0.01). Additionally, the average number of ankle arthroscopy procedures increased from 13.8 pre-merger (range 11.4-15.6, SD 1.7) to 15.3 post-merger (range 14.8-15.9, SD 0.5; p = 0.9). Conclusion: The merger between MD and DO residency programs in 2020 has led to a significant increase in the average number of orthopedic surgery procedures related to the foot and ankle performed by graduating residents. This indicates a positive impact on the training and exposure of orthopedic surgery residents in these areas. The findings suggest that the merger has helped to enhance the educational experience and preparedness of orthopedic surgery residents in foot and ankle procedures, meeting the ACGME requirements for graduation.

As the number of total elbow arthroplasty (TEA) continues to increase worldwide, one might predict the number of revision TEA would rise as well. The most common indications for revision TEA include (a) loosening, (b) infection, and (c) periprosthetic fracture. Although the rate of revision TEA procedures continues to rise due to the infrequency in which they are performed compared to other arthroplasty surgeries, no gold standard algorithm or procedure for managing severe ulnar bone loss in revision TEA has been determined. Various surgical techniques and strategies including allograft-prosthesis composite, custom long prosthesis with or without allograft, and resection arthroplasty have all been employed in attempting to address severe ulnar bone loss in revision TEA. Though the reported outcomes are mixed at best between each treatment strategy with similar complication rates. Another option is implanting the ulnar component into the radius. In those patients with severe ulnar bone loss, a humeroradial TEA revision can provide stability, restore range of motion, and provide pain relief.

Abstract Purpose To our knowledge, no study has quantified the rate of discontinuation and nonpublication of randomized controlled trials (RCTs) regarding upper and lower extremity fractures. Methods We searched ClinicalTrials.gov on September 9th, 2020, for phase 3 and 4 RCTs pertaining to upper and lower extremity fractures. Trial completion status was determined using records available on ClinicalTrials.gov. Publication status was determined using records on ClinicalTrials.gov and by searching PubMed (MEDLINE), Embase, and Google Scholar. We queried corresponding authors on trial status if a peer-reviewed publication was not identified. Results Our final analysis included 142 RCTs, of which 57 (40.1%) were discontinued and 71 (50%) were unpublished. Thirty-six (of 57, 63.2%) discontinued trials failed to provide a reason for discontinuation, the most commonly identified reason for discontinuation was due to inadequate recruitment (13/21, 61.9%). Completed trials were more likely to reach publication (59/85; 69.4%; X 2 = 32.92; P ≤ 0.001) than discontinued trials. Trials with more than 80 participants were less likely not to reach publication (AOR: 0.12; 95% CI 0.15–0.66). Conclusion Our analysis of 142 upper and lower extremity fracture RCTs demonstrated one-half failed to reach publication and two-fifths were discontinued prior to trial completion. These findings indicate the need for increased guidance in developing, completing, and publishing RCTs in upper and lower extremity fractures. Discontinuation and nonpublication of orthopaedic RCTs hinder the public’s access to collected data and negate the valued contribution from study participants. Discontinuation and non-publication of clinical trials may subject participants to potentially harmful interventions, limit the advancement of clinical research, and contribute to research waste. Level of Evidence: III.

Background: Approximately 1 in 4 adults will develop hallux valgus (HV). Up to 80% of adult Internet users reference online sources for health-related information. Overall, with the high prevalence of HV combined with the numerous treatment options, we believe patients are likely turning to Internet search engines for questions relevant to HV. Using Google’s people also ask (PAA) or frequently asked questions (FAQs) feature, we sought to classify these questions, categorize the sources, as well as assess their levels of quality and transparency. Methods: On October 9, 2022, we searched Google using these 4 phrases: “hallux valgus treatment,” “hallux valgus surgery,” “bunion treatment,” and “bunion surgery.” The FAQs were classified in accordance with the Rothwell Classification schema and each source was categorized. Lastly, transparency and quality of the sources’ information were evaluated with the Journal of the American Medical Association ’s (JAMA) Benchmark tool and Brief DISCERN, respectively. Results: Once duplicates and FAQs unrelated to HV were removed, our search returned 299 unique FAQs. The most common question in our sample was related to the evaluation of treatment options (79/299, 26.4%). The most common source type was medical practices (158/299, 52.8%). Nearly two-thirds of the answer sources (184/299; 61.5%) were lacking in transparency. One-way analysis of variance revealed a significant difference in mean Brief DISCERN scores among the 5 source types, F (4) = 54.49 ( P

Objective To quantify conflicts of interest, assess the accuracy of authors self-reporting them, and examine the association between conflicts of interest and favourability of results and discussions in addiction medicine systematic reviews.Design A search was performed on Medline (Ovid) from January 2016 to 25 April 2020 to locate systematic reviews and meta-analyses focused on treatments of addiction disorders using a systematic search strategy. Data were extracted from each systematic review, including conflict of interest statements, authorship characteristics and the favourability of the results/conclusion sections. A search algorithm was used to identify any undisclosed conflicts of interest on the Open Payments Database (Dollars for Docs), Dollars for Profs, Google Patents/United States Patent and Trade Office, and prior conflict of interest statements in other published works from these authors.Results The search identified 127 systematic reviews, representing 665 unique authors. Of the 127 studies, 81 reported no authors with conflicts of interest, 28 with 1 or more conflict, and 18 had no conflict of interest statement. Additional non-disclosed conflicts of interest were found for 34 authors. There were 69 reviews that had at least one author with a conflict of interest. Of the 69 reviews, 14 (20.3%) reported favourable results and 26 (37.7%) reported favourable discussion/conclusions with no statistically significant association. A subanalysis was performed on publications with only US authors (51) with 35 (68.9%) having at least 1 conflict of interest. US authored studies that had a conflict of interest favoured the results (p =

BackgroundThe emergency authorization of COVID-19 vaccines has offered the first means of long-term protection against COVID-19–related illness since the pandemic began. It is important for health care professionals to understand commonly held COVID-19 vaccine concerns and to be equipped with quality information that can be used to assist in medical decision-making. ObjectiveUsing Google’s RankBrain machine learning algorithm, we sought to characterize the content of the most frequently asked questions (FAQs) about COVID-19 vaccines evidenced by internet searches. Secondarily, we sought to examine the information transparency and quality of sources used by Google to answer FAQs on COVID-19 vaccines. MethodsWe searched COVID-19 vaccine terms on Google and used the “People also ask” box to obtain FAQs generated by Google’s machine learning algorithms. FAQs are assigned an “answer” source by Google. We extracted FAQs and answer sources related to COVID-19 vaccines. We used the Rothwell Classification of Questions to categorize questions on the basis of content. We classified answer sources as either academic, commercial, government, media outlet, or medical practice. We used the Journal of the American Medical Association’s (JAMA’s) benchmark criteria to assess information transparency and Brief DISCERN to assess information quality for answer sources. FAQ and answer source type frequencies were calculated. Chi-square tests were used to determine associations between information transparency by source type. One-way analysis of variance was used to assess differences in mean Brief DISCERN scores by source type. ResultsOur search yielded 28 unique FAQs about COVID-19 vaccines. Most COVID-19 vaccine–related FAQs were seeking factual information (22/28, 78.6%), specifically about safety and efficacy (9/22, 40.9%). The most common source type was media outlets (12/28, 42.9%), followed by government sources (11/28, 39.3%). Nineteen sources met 3 or more JAMA benchmark criteria with government sources as the majority (10/19, 52.6%). JAMA benchmark criteria performance did not significantly differ among source types (χ24=7.40; P=.12). One-way analysis of variance revealed a significant difference in mean Brief DISCERN scores by source type (F4,23=10.27; P

BackgroundColorectal cancer (CRC) has the third highest cancer mortality rate in the United States. Enhanced screening has reduced mortality rates; however, certain populations remain at high risk, notably African Americans. Raising awareness among at-risk populations may lead to improved CRC outcomes. The influence of celebrity death and illness is an important driver of public awareness. As such, the death of actor Chadwick Boseman from CRC may have influenced CRC awareness. ObjectiveWe sought to assess the influence of Chadwick Boseman’s death on public interest in CRC in the United States, evidenced by internet searches, website traffic, and donations to prominent cancer organizations. MethodsWe used an auto-regressive integrated moving average model to forecast Google searching trends for the topic “Colorectal cancer” in the United States. We performed bivariate and multivariable regressions on state-wise CRC incidence rate and percent Black population. We obtained data from the American Cancer Society (ACS) and the Colon Cancer Foundation (CCF) for information regarding changes in website traffic and donations. ResultsThe expected national relative search volume (RSV) for colorectal cancer was 2.71 (95% CI 1.76-3.66), reflecting a 3590% (95% CI 2632%-5582%) increase compared to the expected values. With multivariable regression, the statewise RSV increased for each percent Black population by 1.09 (SE 0.18, P

Objective: To assess the influence of industry sponsorship and authors’ conflicts of interest on the favorability of results and conclusions of systematic reviews regarding osteoarthritis of the knee. Design: We searched MEDLINE, Embase, and the Cochrane Database of Systematic Reviews on June 26, 2020 for systematic reviews with or without meta-analyses focusing on treatment of osteoarthritis of the knee. Author COI were collected from the systematic review’s COI disclosure statement, the CMS Open Payments Database, Dollars for Profs, Google Patents, the United States Patent and Trademark Office (USPTO), as well as previously published COI disclosure statements. Study sponsorship was determined using information provided in each systematic review’s funding statement. Results: Our study included 53 systematic reviews conducted by a total of 279 authors. Thirty-one authors (of 279; 11.1%) had one or more COI. Fourteen systematic reviews (of 53; 26.4%) had one or more conflicted authors. Of these reviews, only two (of 14; 14.3%) reported narrative results favoring the treatment group, whereas five (of 14; 35.7%) reported conclusions favoring the treatment group. Our results showed no statistically significant association between the presence of COI and the favorability of results (P= 0.11) and conclusions (P= 0.73). Because our sample only included one industry-sponsored systematic review, we were unable to adequately assess for a relationship between industry-sponsorship and favorability of results and conclusions. Conclusion: We found no association between the favorability of systematic review results and conclusions with either the presence of author’s conflicts of interest or industry-sponsorship.

In mammals a considerable 92% of genes contain introns, with hundreds and hundreds of these introns reaching the incredible size of over 50,000 nucleotides. These "large introns" must be spliced out of the pre-mRNA in a timely fashion, which involves bringing together distant 5' and 3' acceptor and donor splice sites. In invertebrates, especially Drosophila, it has been shown that larger introns can be spliced efficiently through a process known as recursive splicing-a consecutive splicing from the 5'-end at a series of combined donor-acceptor splice sites called RP-sites. Using a computational analysis of the genomic sequences, we show that vertebrates lack the proper enrichment of RP-sites in their large introns, and, therefore, require some other method to aid splicing. We analyzed over 15,000 non-redundant, large introns from six mammals, 1,600 from chicken and zebrafish, and 560 non-redundant large introns from five invertebrates. Our bioinformatic investigation demonstrates that, unlike the studied invertebrates, the studied vertebrate genomes contain consistently abundant amounts of direct and complementary strand interspersed repetitive elements (mainly SINEs and LINEs) that may form stems with each other in large introns. This examination showed that predicted stems are indeed abundant and stable in the large introns of mammals. We hypothesize that such stems with long loops within large introns allow intron splice sites to find each other more quickly by folding the intronic RNA upon itself at smaller intervals and, thus, reducing the distance between donor and acceptor sites.