Faculty Bibliography

A fundamental pillar of science is the estimation of the effect size of associations. However, this task is sometimes difficult and error-prone. To facilitate this process, the R package metaConvert automatically calculates and flexibly converts multiple effect size measures. It applies more than 120 formulas to convert any relevant input data into Cohen's d, Hedges' g, mean difference, odds ratio, risk ratio, incidence rate ratio, correlation coefficient, Fisher's r-to-z transformed correlation coefficient, variability ratio, coefficient of variation ratio, or number needed to treat. Researchers unfamiliar with R can use this software through a browser-based graphical interface (https://metaconvert.org/). We hope this suite will help researchers in the life sciences and other disciplines estimate and convert effect sizes more easily and accurately.

As orthopedic surgeons navigate the complexities of selecting their first positions, or established surgeons seek changes in employment, understanding the evolving financial and structural landscape of surgical practices is crucial. The rising influence of private equity (PE) in health care has added another dimension to this decision, as investment firms increasingly acquire stakes in practices to drive consolidation and profitability. Between 2015 and 2022, PE transactions in health care surged dramatically, reflecting the growing trend of practice consolidation in response to declining reimbursements, rising operational costs, and regulatory burdens. PE firms use leveraged buyouts to acquire and restructure practices, often forming management services organizations to streamline operations. Although PE partnerships offer benefits, including access to capital and corporate expertise, they also raise concerns about reduced autonomy, increased procedural volumes, and potential impacts on care quality and costs. This article provides an overview of PE's role in orthopedic practices, including its history, investment strategies, and the anatomy of typical deals. It explores the implications of PE partnerships on financial and clinical outcomes and highlights the importance of physicians staying informed about these developments. By understanding the benefits and risks, orthopedic surgeons can make more informed decisions in the context of a rapidly changing health care environment.

Despite bone's robust regenerative capacity, complications such as delayed union and nonunion affect 5-10% of fractures, with significant clinical and economic burdens. The rising incidence of fractures, particularly in an aging population, highlights the importance of optimizing fracture healing strategies. This review explores current therapies aimed at enhancing bone regeneration, focusing on 2 main categories: local biologic therapies and mechanical therapies. Local biologic treatments, including concentrated bone marrow aspirate, platelet-rich plasma, bone morphogenetic proteins, and platelet-derived growth factor, aim to stimulate osteogenesis at the fracture site. Therapies, such as electrical stimulation, low-intensity pulsed ultrasound, and extracorporeal shockwave therapy, are theorized to modify the mechanical environment to promote healing. Although these therapies show promise, variability in clinical outcomes emphasizes the need for further research to standardize protocols and refine treatment strategies. Overall, advancing our understanding of bone healing mechanisms will continue to drive innovation in fracture management, improving patient outcomes and reducing health care costs.

The aim of this study was to provide a review for orthopedic surgeons on the care of para athletes. The article focuses on common patient populations that present to orthopedic surgeons, including individuals with spinal cord injuries and related disorders, limb deficiencies, and neuromuscular conditions. The most common types of injuries affecting these para athletes will be discussed, as well as strategies for injury prevention and treatment. This review article also dives into the historical origins of para sports and discusses how treatment can potentially influence classification levels for para athletes. Orthopedic surgeons should encourage their patients with disabilities to participate in para sports, understand the types of injuries they may be at risk of based on disability and sports-specific factors, and work to help keep para athletes successfully competing in the sports they love.

Limb reconstruction has been an evolving process beginning in the 20th Century with the introduction of modern surgical equipment and materials, to permit the repair of small vessels and nerves. Surgical techniques have also evolved and include vascularized composite allografts that have an important place in current limb reconstruction. The concept was actually conceived centuries ago and has been referred to as the "Miracle of the black leg," an important event in Christian iconography.

BACKGROUND:The objective of this study was to survey a cross-section of US female orthopaedic surgeons evaluating their education and attitudes on radiation safety and adherence to safety recommendations. METHODS:An online survey was distributed to female orthopaedic surgery faculty through the Forum, a society for women in orthopaedic surgery, and through internal institutional education networks (residency and fellowship programs). The first component of the survey gathered demographic information including practice setting, US state, and years in practice. The second component was a 10-question knowledge assessment. The third component captured personal experiences among respondents including satisfaction with radiation safety training, radiation safety practices, and level of concern regarding exposure risk. Responses from 66 participants from differing geographic locations were collected using Research Electronic Data Capture. RESULTS:Sixty-six female orthopaedic surgeons from 21 states completed the survey. Regular dosimeter usage was reported by 24.2% of respondents, and 36.4% of respondents reported always having well-fitted radiation protective equipment provided. The majority (56.1%) stated that they worry about the risks of radiation to their health. Regarding their radiation safety training, 60.6% of respondents rated their training as unsatisfactory or extremely unsatisfactory, and 90.9% of respondents stated that they think training efforts for radiation safety can improve. CONCLUSIONS:Female orthopaedic surgeons demonstrated an inadequate knowledge of adherence to radiation safety protocols and the majority expressed concern with long-term radiation exposure, particularly regarding health and pregnancy risk. To enhance radiation safety awareness and adherence among female orthopaedic surgeons, strategies should be tailored to this demographic, fostering confidence in their knowledge of radiation exposure and bolstering safety measures.

Management of first-time shoulder dislocations in young active patients presents a significant challenge due to the high likelihood of recurrent anterior shoulder instability. Repeated instability events can result in poor outcomes because each dislocation contributes dose-dependent damage to the glenohumeral joint. Various validated techniques are available for reducing glenohumeral dislocations. For in-season athletes sustaining a shoulder dislocation, management requires balancing a rapid return to play with the heightened risk of recurrent instability. In-season surgical management is typically reserved for athletes experiencing recurrent instability or substantial osseous deficits. When surgical intervention is necessary, the approach is guided by the extent of critical glenoid bone loss and whether the humeral head bone defect engages with the glenoid.

Parkinson disease (PD) is the second most common neurodegenerative disorder in the United States. Despite its rapid increase in prevalence over recent years, there remains a paucity of literature examining the optimal orthopedic management of populations affected by PD and the risk of complications. In this review, we provide insight into the pathophysiology, etiology, manifestations, and orthopedic management of PD, with an emphasis on adult reconstruction. Although limited outcome studies suggest that joint replacement may consistently offer improvement in pain, there is an increased risk of complications and reoperation, with significant functional improvement often being unpredictable.

Since the beginning of documented medical history, amputation procedures, limb loss, and the myriad creative solutions attempted to care for these individuals have been reported. With the coalescence of multiple World Wars resulting in an ever-increasing number of individuals with limb loss and advancing medical technology, a need to innovate in this field has always been present. The complexity of the hand and upper extremity in self-care, communication, vocation, and exercise results in more demands of prostheses to mimic or replace these functions as opposed to the lower extremity, which is focused mostly on weight bearing and ambulation. As such, this need has pushed technological advances past the simpler passive or body-powered prostheses alone, now with externally powered and hybrid devices revolutionizing the way these appliances were implemented in everyday life. Despite the ever-advancing field of prosthetic technology, upper and lower extremity amputees alike still battle common challenges of pain, phantom limb sensation, and lack of prosthetic control and sensation. Targeted muscle reinnervation and regenerative peripheral nerve interface offer new surgical solutions to some of these challenges and are proving invaluable. As technology and surgical options continue to advance at an ever-rapid pace, a more thoughtful and individualized approach to the care of upper extremity limb loss is available. In this study, we review the history and evolution of upper extremity prostheses and discuss considerations in making optimal surgical and prosthetic decisions for upper extremity amputees.

Genetics is a burgeoning field within adult reconstructive surgery. Genome-wide sequencing has identified genetic variants found to be associated with not only the development of osteoarthritis but also arthroplasty-related complications, such as aseptic loosening, prosthetic joint infection, arthrofibrosis, and postoperative pain. Examples include newer technology, such as next-generation sequencing, in diagnosing culture-negative prosthetic joint infection. Genetics drives new therapeutic technologies, such as gene therapy, gene-editing, and bacteriophage treatment. Although still rare, a handful of phase 3 clinical trials of gene therapy for osteoarthritis have begun to demonstrate efficacy with low-risk profiles. As the field continues to grow, public and professional buy-in as well as cost present challenges.