Search

Background: Heterotopic ossification in the elbow, often caused by trauma or neurogenic factors, can lead to limited range of motion and physical impairment, while severe cases may result in debilitating loss of function. Complete bony ankylosis of the elbow, though rare, presents challenges in treatment due to complex anatomy and high recurrence rates, with limited literature on management and outcomes. This study retrospectively investigates cases of elbow ankylosis secondary to heterotopic ossification, assessing long-term functional outcomes following operative intervention and standardized rehabilitation. Methods: A retrospective case series was performed on patients who underwent surgical excision of heterotopic ossification of the elbow at our institution. Outcomes of interest were intraoperative flexion-extension arc, flexion-extension arc at the final long-term postoperative follow-up, visual analog scale pain scores at long-term follow-up, and Mayo Elbow Performance scores at long-term follow-up. The Wilcoxon signed-rank test was performed to identify a statistically significant difference between arc of motion achieved intraoperatively and the arc of motion maintained at the final long-term postoperative follow-up. Results: Between September 1999 and July 2021, 107 patients underwent operative resection for heterotopic ossification around the elbow, with 13 patients (16 elbows) exhibiting complete ankylosis at time of surgery. Patients were followed up for a minimum of 2 years. Long-term outcomes demonstrated an average visual analog scale pain score of 1.4 +/− 1.7, and an average Mayo Elbow Performance score of 85.9 +/−12.8, with 75% of cases maintaining at least 100 degrees of flexion-extension arc at the final long-term postoperative follow-up. On average, the flexion-extension arc of motion at the final follow-up was preserved at 95% of intraoperative levels. Patients did have an average residual flexion contracture of 18 +/− 9 degrees at the final follow-up. Conclusion: Surgical excision for complete elbow ankylosis secondary to heterotopic ossification presents challenges due to potential complications. Our study shows favorable long-term outcomes in pain scores, range of motion, and Mayo Elbow Performance scores. Despite reported complications in the literature, our series exhibited no adverse events, supporting operative excision as a standard treatment with overall fair to excellent outcomes. Further research, particularly involving multicenter, randomized, prospective studies, is warranted to refine protocols and understand predictors for improved outcomes in this patient population.

Introduction:. Assessing scholarly contributions in academic orthopaedic surgery remains challenging, despite the importance of publication productivity in evaluating academic leaders. The Hirsch (h)-index and its derivative, the m-index, offer objective measures to compare and evaluate publication productivity. The primary aims of this study were to compare h- and m-indices of department chairs and residency program directors of orthopaedic training programs in the United States and assess the association between h-index and program rank. Methods:. A publicly available Doximity report was used to identify and rank orthopaedic surgery residency programs in the United States. Internet-based searches of institution-specific websites were performed to confirm current department chairs and residency program directors as of January 2024. H-index data were collected from a publicly available database known as Scopus. The m-index was calculated as the quotient of h-index and years in practice. Gender and years in practice were obtained through available biographies on institution-specific websites. Results:. Department chairs had significantly higher h- and m-indices at both the career and 5-year time intervals compared with program directors. Upon subgroup analysis, department chairs and program directors at top-10 ranked programs had significantly higher h- and m-indices compared with the entire population of department chairs and program directors. Linear regression analyses demonstrated a direct linear association between department chair/program director h- and m-indices and program rank. Conclusions:. Publication productivity was higher for department chairs than residency program directors. Orthopaedic leaders at top-10 institutions had higher publication productivity compared with those at institutions outside of the top 10, per Doximity rankings. Finally, there is substantial variation in publication productivity of orthopaedic surgeons in leadership roles at academic institutions in the United States. Clinical Relevance:. This study highlights the publication productivity of orthopaedic surgery department chairs and residency program directors and describes the linear association between publication productivity of academic orthopaedic leaders and program rank. This information can be utilized by those interested in learning more about the publication productivity among academic orthopaedic surgeons across different institutions and can assist those who are involved in the hiring and promotion process at these academic institutions.