Childerssmed4521

beyond the Callanan safe zone. LEVEL OF EVIDENCE Level III.INTRODUCTION The time spent applying and interviewing for an orthopaedic fellowship has notable financial, educational, and workflow consequences on both residents and their respective residency programs. The purpose of this study was to assess the perceptions regarding the fellowship interview process to suggest changes that could be implemented. METHODS Mixed-response questionnaires were sent to orthopaedic surgery residency program directors (PDs) and PGY-4 to PGY-6 residents at the 164 accredited allopathic orthopaedic surgery residency programs in the United States (August 2017). RESULTS Significantly more PDs believed that time away for fellowship interviews negatively affected resident education compared with residents (68% versus 25%, 48 of 65 versus 28 of 113; P less then 0.001). About half of all PDs and residents noted a specific amount of time granted for interviews (range, 3 to 20 days). Seventy-one percent of residents included in this study would favor regionally coordinated interview dates. CONCLUSIONS Orthopaedic surgery residents and PDs perceive differences in the impact of the fellowship interview process on resident education and means for improvement of the process. Two-tiered or regionally coordinated interviews are favored as changes that could be implemented.Keloid and hypertrophic scar formation after orthopaedic surgical closure is a complex issue. The nature and location of procedures maximize wound tension, leave foreign bodies, and diminish dermal supply, all potentiating keloid formation. click here There is little discussion regarding the pathophysiology and management of this recurrent problem in orthopaedic literature. Keloid formation is a fibroproliferative disorder resulting in extensive production of extracellular matrix and collagen, but prevention and treatment is poorly understood. Patient and surgical factors contributing to the development of this condition are discussed. The treatments include both medical and surgical therapies that work at a biologic level and attempt to produce a cosmetic and complication-free management strategy. Medical options that have been investigated include combinations of intralesional steroid therapy, laser therapy, and biologics. Preventive surgical closure and excision remain mainstays of treatment. Radiation therapy has also been used in refractory cases with mixed results. Despite medical therapies and surgical excision aimed at treating the resulting scar, recurrence rate is very high for all modalities that have been studied to this point. Future work is being done to better understand the pathophysiology leading to keloid and hypertrophic scar formation in an effort to find preventive methods as compared to treatment strategies.BACKGROUND Total hip and knee arthroplasty (THA and TKA) are performed more commonly than total ankle arthroplasty (TAA), so patients and the orthopaedic community are more familiar with the likelihood of complications after THA and TKA than after TAA. The present study places early complication rates after TAA in the context of those after THA and TKA. METHODS Patients who underwent TAA, THA, or TKA during 2006 to 2016 as part of the National Surgical Quality Improvement Program were identified. Multivariate regression was used to compare procedures with adjustment for baseline and anesthesia characteristics. RESULTS One hundred thirty-eight thousand three hundred twenty-five patients underwent THA, 223,587 TKA, and 839 TAA. The total complication rate was lower for TAA (2.98%) compared with THA (4.92%, P = 0.011) and TKA (4.56%, P = 0.049). Similarly, the rate of blood transfusion was lower for TAA (0.48%) compared with THA (9.66%) and TKA (6.44%, P less then 0.001 for each). The rate of additional surgery was lower for TAA compared with THA (0.48% versus 1.79%, P = 0.007). Finally, the rate of readmission was lower for TAA (1.45%) compared with THA (3.66%, P = 0.002) and TKA (3.40%, P = 0.005). DISCUSSION Patients can be counseled that relative to THA and TKA, TAA is safer in the perioperative period, with lower rates of adverse events, blood transfusion, additional surgery, and hospital readmission.Injuries to the tibio-fibular syndesmotic ligaments are different than ankle collateral ligament injuries and occur in isolation or combination with malleolar fractures. Syndesmotic ligament injury can lead to prolonged functional limitations and ultimately long-term ankle dysfunction if not identified and treated appropriately. The syndesmosis complex is a relatively simple construct of well-documented ligaments, but the dynamic kinematics and the effects of disruption have been a point of contention in diagnosis and treatment. Syndesmotic ligament injuries are sometimes referred to as "high ankle sprains" because the syndesmotic ligaments are more proximal than the collateral ligaments of the ankle joint. Rotational injuries to the ankle often result in malleolar fractures, which can be combined with ankle joint or syndesmotic ligament injuries. Most of the orthopaedic literature to this point has addressed syndesmosis ligament injuries in combination with fractures and not isolated syndesmotic ligament injuries. Thus, we propose a simplified general video guide to do the diagnostic examinations and arthroscopic-assisted reduction based on current evidence-based medicine.BACKGROUND Patients seeking second opinions are a challenge for the colorectal cancer provider due to complexity, failed therapeutic relationship with another provider, need for reassurance, and desire for exploration of treatment options. OBJECTIVE To describe the patient and treatment characteristics of patients seeking initial and second opinions in colorectal cancer care at a multidisciplinary colorectal cancer clinic. DESIGN Retrospective cohort study SETTINGS Prospectively collected clinical registry of a multidisciplinary colorectal cancer clinic. PATIENTS Patients with colon or rectal cancer seen from 2012-2017. MAIN OUTCOME MEASURES Data were analyzed for initial vs. second opinion and demographic and clinical characteristics. RESULTS Of 1711 colorectal cancer patients, 1008 (58.9%) sought an initial opinion, 700 (40.9%) sought a second opinion. As compared to initial opinion patients, second opinion patients were more likely to have Stage IV disease (OR 1.94, 95% CI 1.47-2.58), recurrent disease (OR 1.