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Annually, orthopedic residency programs rank and recruit the best possible candidates. Little evidence exists identifying factors that potential candidates use to select their career paths. Recent literature from nonsurgical programs suggests hospital, social and program-based factors influence program selection. We sought to determine what factors influence the choice of an orthopedic career and a candidate's choice of orthopedic residency program.We surveyed medical student applicants to orthopedic programs and current Canadian orthopedic surgery residents (postgraduate year [PGY] 1-5). The confidential online survey focused on 3 broad categories of program selection: educational, program cohesion and noneducation factors. Questions were graded on a Likert Scale and tailed for mean scores.In total, 139 residents from 11 of 17 Canadian orthopedic programs (49% response rate) and 23 medical student applicants (88% response rate) completed our survey. Orthopedic electives and mandatory rotations were reported by 71% of participants as somewhat or very important to their career choice. Collegiality among residents (4.70 ± 0.6), program being the "right fit" (4.65 ± 0.53) and current resident satisfaction with their chosen program (4.63 ±0.66) were ranked with the highest mean scores on a 5-point Likert scale.There are several modifiable factors that residency programs may use to attract applicants, including early availability of clerkship rotations and a strong mentorship environment emphasizing both resident-resident and resident-staff cohesion. Desirable residency programs should develop early access to surgical and operative skills. These must be balanced with a continued emphasis on top-level orthopedic training.Chaque année, les programmes de résidence en orthopédie évaluent et recrutent les meilleurs candidats possibles. On dispose de peu de renseignements au sujet des critères sur lesquels les candidats fondent leur choix de parcours professionnel. Selon la littérature récente issue de programmes non chirurgicaux, les critères de sélection des programmes ont à voir avec les hôpitaux, les programmes eux-mêmes et certains facteurs sociaux. Nous avons voulu savoir quels sont les facteurs qui influent sur le choix d'une carrière en orthopédie et le choix d'un programme de résidence en orthopédie par les candidats.Nous avons interrogé les étudiants en médecine candidats aux programmes d'orthopédie et les médecins résidents actuels en chirurgie orthopédique au Canada (année de résidence [R] de 1 à 5). Le questionnaire en ligne confidentiel portait sur 3 grandes catégories de critères de choix d'un programme : facteurs didactiques, facteurs liés à la cohésion des programmes et facteurs non didactiques. Les questions ont été classées sur une échelle de Likert et les scores moyens ont été estimés.En tout, 139 candidats et médecins résidents actuels de 11 programmes d'orthopédie sur 17 au Canada ont répondu au questionnaire (taux de réponse 49 %). Soixante et onze pour cent des participants ont qualifié les stages électifs et obligatoires en orthopédie de relativement ou très importants pour leur choix de carrière. La collégialité entre les médecins résidents (4,70 ± 0,6), l'adéquation des programmes (4,65 ± 0,53) et la satisfaction actuelle des médecins résidents à l'endroit du programme choisi (4,63 ± 0,66) ont obtenu les scores moyens les plus élevés sur l'échelle de Likert en 5 points.Les programmes de résidence pourraient utiliser plusieurs facteurs modifiables pour attirer des candidats, y compris une offre de stage hâtive et un solide mentorat, mettant l'accent sur la cohésion résident-résident et résident-personnel. Les programmes de résidence attrayants devraient offrir un accès rapide aux compétences chirurgicales et opératoires. Et ces compétences devraient être en phase avec le maintien d'une formation orthopédique de haut niveau.

Objectives To determine the incidence of positive diagnostic evaluations during the management of postoperatively febrile orthopaedic trauma patients. A secondary objective was to describe the incidence and risk factors for postoperative fever. Design Retrospective study. Setting The orthopaedic trauma service at a tertiary referral hospital. Patients Postoperatively febrile orthopaedic trauma patients admitted from 2005 to 2008. Main outcome measures In patients who developed postoperative fever (oral temperature ≥38.5oC), records were reviewed to determine whether urinalysis, urine cultures, blood cultures, chest radiographs, or wound cultures were performed and subsequent results were recorded. Patient demographics including sex, age, and medical comorbidities were also noted. Results A total of 106 subjects (18%) developed a postoperative fever, with a mean temperature of 38.8 ± 0.3oC (range, 38.5-40.0oC). Overall, 135 diagnostic tests were ordered with 14 being positive (10%). Yields per individual test were as follows: urinalyses, 7 of 34 (21%); urine cultures, 4 of 38 (11%); chest radiograph, 2 of 23 (9%); blood cultures, 1 of 38 (3%); and wound cultures, 0 of 2 (0%). Patients investigated on postoperative day 6 or later had a greater incidence of positive diagnostic evaluations (40%) than patients investigated on postoperative days 0-5 (16%). The single positive blood culture was found on postoperative day 16. Conclusions Postoperative fever is common among orthopaedic trauma patients. Diagnostic evaluations have a low-positive yield, particularly in the early postoperative period. In the later postoperative period, physicians should be more suspicious for an infective source of fever because a traumatic inflammatory etiology of fever is less likely.

Periprosthetic joint infection (PJI) remains a serious complication following a total knee replacement. Infections rates following arthroplasty range from 0.5% to 3%. The acutely infected knee replacement often presents to the on call Orthopaedic Surgeon who can often lack the expertise or resources for the definitive management. However, obtaining an early and accurate diagnosis and potentially performing an early treatment such as irrigation and debridement may be required by the on call surgeon. Management of these patients should include a team of specialists including Medical or Intensive Care, and Infectious Disease. Management of PJI is expensive, complicated and has a high morbidity. These patients should have their definitive care by specialist multidisciplinary teams on a regional basis.

Templating is an important aspect of preoperative planning for total hip arthroplasty and can help determine the size and positioning of the prosthesis. Historically, templating has been performed using acetate templates over printed radiographs. As a result of the increasing use of digital imaging, surgeons now either obtain additional printed radiographs solely for templating purposes or use specialized digital templating software, both of which carry additional cost.The purposes of this study was to compare acetate templating of digitally calibrated images on an LCD monitor to digital templating in terms of (1) accuracy; (2) reproducibility; and (3) time efficiency.Acetate onlay templating was performed directly over digital radiographs on an LCD monitor and was compared with digital templating. Five separate observers participated in this study templating on 52 total hip arthroplasties. For the acetate templating, the digital images were magnified to the scaled reference on the templates provided by the manufacturer (ratio 1.2:1) before templating using a 25-mm marker as a reference. Both the acetate and digital templating results were then compared with the actual implanted components to determine accuracy. Interobserver and intraobserver variability was determined by an intraclass correlation coefficient. Observers recorded time to complete templating from the time of complete upload of patients' imaging onto the system to completion of templating.Both acetate and digital templates demonstrated moderate accuracy in predicting within one size of the eventual implanted acetabular cup (77% [199 of 260]; 70% [181 of 260], respectively; p = 0.050; 95% confidence interval [CI], 0.058-0.32), whereas acetate templating was better at predicting the femoral stem compared to digital templating (75% [195 of 260]; 60% [155 of 260], respectively; p0.001; 95% CI, 0.084-0.32). Acetate templating showed moderate to substantial interobserver agreement (cup intraclass correlation coefficient [ICC] = 0.55; 95% CI, 0.14-0.86; femoral ICC = 0.75; 95% CI, 0.39-0.95) and both methods showed almost perfect intraobserver agreement in reproducibility (acetate cup ICC = 0.82; 95% CI, 0.66-0.97; acetate femoral ICC = 0.86; 95% CI, 0.74-0.97; digital cup ICC = 0.82; 95% CI, 0.68-0.97; digital femoral ICC = 0.88; 95% CI, 0.77-1.0). Acetate templating could be performed more quickly (acetate mean 119 seconds; range, 37-220 seconds versus 154 seconds; range, 73-343 seconds; p0.001).Acetate onlay templating on digitally calibrated images can be a reliable substitute for digital templating using specialized software. It is quicker to perform and much less expensive. Hospitals and practices need not purchase expensive software, particularly at lower volume centers.Level III, diagnostic study.