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Background: Upper extremity injuries account for 36.5% of presentations to the emergency department in the United States. This study seeks to determine current rates of upper extremity injuries that present to the emergency department and the injury characteristics of patients requiring admission. Methods: National Electronic Injury Surveillance System was queried for a 10-year period for upper extremity injuries. Further analysis was done to evaluate specific patient demographics, injury characteristics, and mechanisms of injury of those patients who were admitted to the hospital. Results: Between 2012 and 2021, 39 160 365 persons are estimated to have presented to 100 United States emergency departments for managing upper extremity injuries, accounting for 28.8% of total presentations. A total of 12 662 041 upper extremity patients were pediatric (32.3%). Admissions occurred in 4.6% of presentations. The most common presenting diagnosis was laceration (24.9%), while the most common admission diagnosis was fracture (49.7%). The majority had injuries involving their forearms (19.9%). The most common injury-associated consumer product group was stairs, ramps, landings, and floors at 28.5%. Of the 445 644 patients, those estimated to have been injured by stairs, ramps, landings, and floors adults were 429 435 or 96.4%. The most common injury-associated product in pediatric populations was playground equipment (23.6%), of which 53.7% was from monkey bars and other climbing apparatuses. Conclusion: This study demonstrates an overall increase in admissions for upper extremity injuries in the setting of similar rates of overall upper extremity injuries with fractures and forearm being the most common diagnosis and body part involved, respectively. Level of Evidence: IV; Database [ABSTRACT FROM AUTHOR]

Background: Traumatic finger amputations are a common and well-known hand injury, yet there are few studies addressing long-term epidemiologic data and associated mechanisms of injury. This paper aims to use a large national database to identify the relationship of patient demographics and mechanism of injury in finger amputations. Methods: The National Electronic Injury Surveillance System (NEISS) was queried for finger amputations in the United States from 2010 to 2019. Patient demographic information was collected and analyzed by gender, race, age, and further statistical analysis was performed to determine correlations with consumer products. Results: Finger amputations accounted for an estimated 234,304 emergency department visits from 2010 to 2019. Most of the patients were male (79%) and identified as white (46.2%). The most commonly implicated products overall were power saws and related power tools, followed by doors and then lawn mowers. A bimodal age incidence was observed with the highest incidence rates occurring in children ages 0 to 4, followed by a second peak incidence rate in the adults ages 65 to 74. The most common mechanisms of injury were found to differ in patients less than 19 and those 20 and over. Conclusion: Traumatic finger amputations have a bimodal incidence with changing epidemiology and mechanism of injury with age. The first peak occurs from ages 0 to 4, involves predominantly doors, and has a male to female ratio of 1.30. The second peak occurs from ages 65 to 74, involves mostly power saws, and has a male to female ratio of 6.68. Level of Evidence: Prognostic, Level IV [ABSTRACT FROM AUTHOR]

Elbow fractures comprise 15% of all fractures in children. Our study identifies risk factors and consumer products that contribute to pediatric elbow fractures. The National Electronic Injury Surveillance System was used to collect demographic and consumer product information between 2010 and 2019 for patients younger than 17 years who presented to the emergency department with elbow fractures. Of the 458,433 elbow fractures, the average age of the patients was 7.4 ± 4.1 years and 55.6% were male children. The most common consumer product was sports and recreation equipment, followed by home furnishings. Male patients (P <.0001) and patients 8 years and older (79.2% vs 51.1%, P <.0001) experienced significantly greater rates of injury with sports and recreation equipment. This study evaluates the products associated with pediatric elbow fractures and highlights the importance of safe sports and recreation equipment use and the role of parental counseling in preventing falls from furniture. [ABSTRACT FROM AUTHOR]

Introduction: Lateral condyle fractures are the second most common pediatric elbow fracture. There exist multiple options for internal fixation including buried K-wires, unburied K-wires, and screw fixation. Our study aims to review the current literature and determine if fixation strategy affects outcomes to include fracture union, postoperative range of motion, and need subsequent surgery. Methods: A systematic review of Pubmed, MEDLINE, and EMBASE databases was performed. Included articles involve pediatric patients with displaced lateral condyle fractures treated with internal fixation that reported outcomes to include union rates and complications. Results: Thirteen studies met inclusion criteria for a total of 1299 patients (472 buried K-wires, 717 unburied K-wires, and 110 screws). The patients' average age was 5.8 ± 0.6 years, male (64%), and had 16.3 months of follow-up. No differences in union and infection rates were found. Unburied K-wires had the shortest time to union and the greatest elbow range of motion postoperatively. Conclusions: Our systematic review demonstrates similar outcomes with union and infection rates between all fixation techniques. Unburied K-wires demonstrated a shorter time to union and the greatest postoperative range of motion. Additionally, unburied K-wires may be removed in clinic, decreasing the cost on the healthcare system. Evidence: Level 3. [ABSTRACT FROM AUTHOR]

We firmly reaffirm that because orthopedic surgeons are unlikely to improve the mortality rate in a deployed setting, particularly one with air superiority allowing for rapid transport, orthopedic surgeons do not belong on a Forward Surgical Team (FST). We appreciate the continued discussion on the role of orthopedic surgeons in the immediate post-injury period in the deployed setting. [Extracted from the article]

Introduction: Bone and joint tumors are the third most common cause of pediatric cancer-related deaths in the United States. Although there have been improvements in survival rates among pediatric cancer patients over the past few decades, bone and joint cancers remain the exception. Considering current clinical trials involving novel targeted therapies, the establishment of updated mortality rates and predictors of survival for this cancer would be prudent. This investigation sought to determine updated 5-year survival rates and predictors of survival among pediatric Ewing sarcoma (ES) of bone treated within the United States., Methods: The National Cancer Database was retrospectively inquired for all pediatric ES cases within the most updated bone and joint public use file available in September 2022. The reported data were truncated to only include patients with reported 5-year vital (ie, survival) status. Cox proportional hazard regression was conducted on both the truncated data and the entire cohort to validate the findings. The patients were then separated into alive versus deceased cohorts, and univariate regression analysis was done followed by multivariable regression of notable variables of interest., Results: Overall, an aggregated 5-year survival rate of 74.5% was found in the included patient cohort. Patients with localized cancer had a comparatively improved 5-year survival rate of 84.70% as opposed to those with macrometastatic disease on presentation with a survival rate of 50.4%. Patient demographic-, tumor-, and treatment-specific variables all demonstrated an effect on survival. The multivariable predictors of worse mortality were found to include older age, larger tumor size (>8 cm), macrometastatic disease on presentation, and positive surgical margins., Conclusion: This analysis serves to establish updated survival rates of pediatric ES treated within the United States to set standards for comparison among future studies. Continued multi-institutional and international collaboration is needed to optimize current treatment results and develop novel targeted therapies., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Children with cerebral palsy (CP) and those with avascular necosis (AVN) after treatment of developmental hip dysplasia (DDH) are at risk of developing coxa valga. Proximal femur guided growth is a minimally invasive option to correct this deformity. A systematic review of articles that described treatment of coxa valga with proximal femur guided growth (PFGG) and reporting on primary radiographic outcomes, demographic variables, surgical variables and complications. One hundred and seventy-nine hips underwent PFGG (117 with CP and 62 with lateral overgrowth). Average age at surgery was 8.1 years; average follow-up was 52.5 months. Migration percentage improved from 11.2% (p < 0.0001). Neck-shaft angle improved by 11.9° (p < 0.0001). The most common complication was screw growth out of the physis (30% of cases). PFGG can correct coxa valga, improve radiographic parameters, and in children with CP prevent further subluxation. This technique modulates proximal femur growth, induces changes to the acetabulum and can correct valgus deformity. Evidence Level III. (Journal of Surgical Orthopaedic Advances 32(4):049-052, 2024).

Introduction: The purpose of this study was to determine the most common allegations for malpractice litigation brought against orthopaedic surgeons for oncologic matters and the resulting verdicts., Methods: The Westlaw Legal research database was queried for malpractice cases filed against orthopaedic surgeons for oncologic matters in the United States after 1980. Plaintiff demographics, state of filing, allegations, and outcomes of lawsuits were recorded and reported accordingly., Results: A total of 36 cases met the inclusion and exclusion criteria and were subsequently included in the final analysis. The overall rate of cases filed remained consistent through the past four decades and was primarily related to a primary sarcoma diagnosis in adult women. The primary reason for litigation was failure to diagnose a primary malignant sarcoma (42%) followed by failure to diagnose unrelated carcinoma (19%). The most common states of filing were primarily located in the Northeast (47%), where a plaintiff verdict was also more commonly encountered as compared with other regions. Damages awarded averaged $1,672,500 with a range of $134, 231 to $6,250,000 and a median of $918,750., Conclusion: Failure to diagnose primary malignant sarcoma and unrelated carcinoma was the most common reason for oncologic litigation brought against orthopaedic surgeons. Although most of the cases ruled in favor of the defendant surgeon, it is important for orthopaedic surgeons to be aware of the potential errors that not only prevent litigation but also improve patient care.

Treatment of medial epicondyle fractures is controversial in pediatric orthopaedics with a recent trend towards operative fixation in overhead athletes. We performed a systematic review to compare outcomes in operative and non-operatively overhead athletes. A systematic review of the literature was performed. Articles investing pediatric athletes with medial epicondyle fractures treated operatively and non-operatively that reported functional and radiographic outcomes were compiled. We identified 6 studies with a total of 99 patients (52 treated operatively and 47 treated non-operatively). We found a significantly higher union rate with operative treatment (100%) compared to non-operative treatment (76%, p = 0.0025), with equivalent return to sport time and rate. Non-operative treatment had a lower complication and repeat surgery rates (p = 0.009). This study demonstrates lower complication rates and equivalent functional outcomes between operative and non-operatively treated medial epicondyle fractures in athletes. Non-operative treatment is a valid option in these patients. (Journal of Surgical Orthopaedic Advances 32(1):009-013, 2023).

Development of malignancy is a multifactorial process, and there are multitude of conditions of bone that may predispose patients to malignancy. Etiologies of malignancy include benign osseous conditions, genetic predisposition, and extrinsic conditions. New-onset pain or growth in a previously stable lesion is that should concern for malignant change and should prompt a diagnostic workup for malignancy., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Pectoralis major tendon injuries are an uncommon injury. They can be treated with primary repair, however, when the tendon becomes retracted it necessitates tendon reconstruction. We performed a systematic review to evaluate patient characteristics, surgical techniques, and outcomes associated with pectoralis major reconstruction. A review was performed for studies published between 1990 and 2019. Peer-reviewed studies with a minimum 1-year follow-up were included. Return to activity, range of motion, complications, and functional outcome scores were primary outcomes. Fourteen primary studies with 88 total patients met inclusion criteria. All patients were male with the average age of 34.6 years-old. Hamstring autograft represented the most frequently used graft type (35). Functional outcomes demonstrated good to excellent results in the majority of patients. Pectoralis major tendon reconstruction is a viable option for tears not amenable to primary repair. We found good to excellent outcomes, and 94.2% return to sport for patients undergoing reconstruction. (Journal of Surgical Orthopaedic Advances 31(2):123-126, 2022).

Military orthopaedic surgeons are faced with hardship and decreased morale. Surgeons have frequent deployments and practice inefficiencies resulting in poor retention rates. The purpose of this analysis is to report demographics and factors effecting military retention. A survey was sent to all members of the Society of Military Orthopedic Surgeons. The survey obtained demographic information, as well as factors affecting retention and termination of service. Data was compared between subset groups within the total respondent population. Of active-duty personnel, 38.5% plan on staying in the military until retirement. Most surgeons entered into the military due to a desire to serve their country, while most people leave service due to higher pay as a civilian. A minority of military orthopaedic surgeons achieve military retirement; however, increased pay, increased control over practice, and decreased frequency of deployments are factors that could improve retention rates. (Journal of Surgical Orthopaedic Advances 30(2):116-119, 2021).

»: Enchondromas are benign cartilaginous lesions that rarely require surgical intervention., »: Atypical cartilaginous tumors (ACTs), also referred to as grade-1 chondrosarcomas, may be managed without any intervention or with extended intralesional curettage and bone-void filling., »: High-grade chondrosarcomas, or grade-2 and 3 chondrosarcomas, should be managed aggressively with wide resection., »: Chemotherapy and radiation do not currently play a role in the treatment of chondrosarcomas., »: Differentiating an enchondroma from an ACT and an ACT from a high-grade chondrosarcoma can be difficult and requires clinical experience, radiographic and advanced imaging, and possibly a biopsy. Ultimately, a multidisciplinary team that includes a musculoskeletal oncologist, a radiologist, and a pathologist is needed to make the most appropriate diagnosis and treatment plan for each patient., Competing Interests: Disclosure: The authors indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A691)., (Copyright © 2021 Written work prepared by employees of the Federal Government as part of their official duties is, under the United States Copyright Act, a ‘work of the United States Government’ for which copyright protection under that Act is not available. As such, copyright protection does not extend to the contributions of employees of the Federal Government prepared as part of their employment.)

Introduction: Musculoskeletal oncology is a subspecialty of orthopaedics with few fellowship-training locations. Although orthopaedic oncologists comprise a minority within the field of orthopaedic surgery, most work at academic centers and serve in leadership roles with notable impact on patients and the training of residents. This article investigates the objective impact orthopaedic oncologists have regarding resident operative case volume and performance on in-training examinations., Methods: The William Beaumont Army Medical Center and Texas Tech University Health Sciences Center of El Paso combined orthopaedic residency program's case logs and Orthopaedic In-Training Examination (OITE) scores between 2013 and 2018 were reviewed. This provided 3 academic years of data before and after an orthopaedic oncology faculty member arrived in 2016. The case volume and OITE examination performance before and after the addition of the orthopaedic oncology faculty member were compared., Results: After the addition of an orthopaedic oncology faculty member, a significant increase was observed in the program's OITE overall correctly answered questions (171.30 versus 181.03, P = 0.004) and oncology subsection percentile (56th to the 66th percentile, P = 0.038). An increase was also observed in resident oncology case volume from 29 oncology cases per year to 138 cases on average (P = 0.022)., Discussion: The addition of a fellowship-trained orthopaedic oncologist results in increased exposure to orthopaedic oncology cases and improved resident performance on the OITE. This may correlate to improved American Board of Orthopaedic Surgeons Part I pass rates and improved overall resident satisfaction.

Pectoralis major rupture is an uncommon injury often treated surgically, requiring anatomic knowledge of the tendon insertion. This study defines the pectoralis major tendon insertion footprint and a novel anatomic relationship. Twelve cadaver shoulders were evaluated andmeasured using a standard surgical ruler to demonstrate the normal anatomic footprint. Measurements were taken from the anterior medial margin of the articular surface of the humeral head to the superior margin of the pectoralis major insertion and its relation to the latissimus dorsi tendon insertion. The average length and width of the pectoralis major insertion were 73.3 ± 10.0 mm and 3.3 ± 0.54 mm, respectively, consistent with previous publications. On average, the superior margin of the pectoralis tendon was within 1 mm of the latissimus dorsi insertion and 41.2 ± 9.27 mm from the articular margin. These points form a new anatomic reference of the latissimus dorsi, providing an intraoperative reference point when performing pectoralis major muscle tendon repair. (Journal of Surgical Orthopaedic Advances 27(1):39-41, 2018).