Variability in Exposure to Subspecialty Rotations During Orthopaedic Residency: A Website-based Review of Orthopaedic Residency Programs.

IntroductionThe variability in exposure to various subspecialty rotations during orthopaedic residency across the United States has not been well studied.MethodsData regarding program size, resident's sex, department leadership, university-based status of the program, outsourcing of subspecialty rotation, and geographic location were collected from websites of 151 US allopathic orthopaedic residency programs. The relationship of these factors with the time allotted for various clinical rotations was analyzed.ResultsThe number of residents in a program correlated positively with time allocated for elective rotations (r = 0.57, P = 0.0003). Residents in programs where the program director was a general orthopaedic surgeon spent more time on general orthopaedic rotations (22 versus 9.9 months, P = 0.001). Programs where the program director or chairman was an orthopaedic oncologist spent more time on oncology rotations ([3.8 versus 3 months, P = 0.01] and [3.5 versus 2.7 months, P = 0.01], respectively). Residents in community programs spent more time on adult reconstruction than university-based programs (6.6 versus 5.5 months, P = 0.014). Based on multiple linear regression analysis, time allotted for adult reconstruction (t = 2.29, P = 0.02) and elective rotations (t = 2.43, P = 0.017) was positively associated with the number of residents in the program.ConclusionsSubstantial variability exists in the time allocated to various clinical rotations during orthopaedic residency. The effect of this variability on clinical competence, trainees' career choices, and quality of patient care needs further study

Predictors for Nonaccidental Trauma in a Child With a Fracture-A National Inpatient Database Study.

BackgroundDespite heightened awareness and multidisciplinary efforts, a predictive model to help the clinician quantify the likelihood of nonaccidental trauma (NAT) in a child presenting with a fracture does not exist. The purpose of this study was to develop an evidence-based likelihood of NAT in a child presenting with a fracture.MethodsUsing the 2012 Kids' Inpatient Database, we identified all available pediatric inpatients admitted with an extremity or spine fracture. Children with a fracture were subcategorized based on the diagnosis of NAT. Multivariate analysis using multiple logistic regression was used to generate odds ratios and create a predictive model for the probability of NAT in a child with a fracture.ResultsOf the 57,183 pediatric fracture cases, 881 (1.54%) had a concurrent diagnosis of NAT. Of these children, those presenting with multiple fractures had the highest rate of NAT (2.8%). The overall mortality rate in patients presenting with fractures and abuse was 1.8%, which was twice as high as patients without abuse (odds ratio [OR] = 2.0). Based on multivariate analysis, younger age (OR = 0.5), black race (OR = 1.7), intracranial injury (OR = 3.7), concomitant rib fracture (OR = 7.2), and burns (OR = 8.3) were positive predictors of NAT in a child with a fracture. A weighted equation using regression coefficients was generated and plotted on a receiver operative characteristic curve, demonstrating excellent correlation and probability of NAT (area under curve = 0.962). (Equation - ln (P/(1 - P)) = -1.79 - 0.65 (age in years) + 0.51 (black race) + 1.97 (rib fracture) + 1.31 (intracranial injury) + 2.12 (burn)).ConclusionUsing a large, national inpatient database, we identified an overall prevalence of 1.54% of NAT in children admitted to the hospital with a fracture. Based on five independent predictors of NAT, we generated an estimated probability chart that can be used in the clinical workup of a child with a fracture and possible NAT. This evidence-based algorithm needs to be validated in clinical practice.Level of evidencePrognostic study, Level III (case-control study)

A statistical method (cross-validation) for bone loss region detection after spaceflight.

Astronauts experience bone loss after the long spaceflight missions. Identifying specific regions that undergo the greatest losses (e.g. the proximal femur) could reveal information about the processes of bone loss in disuse and disease. Methods for detecting such regions, however, remains an open problem. This paper focuses on statistical methods to detect such regions. We perform statistical parametric mapping to get t-maps of changes in images, and propose a new cross-validation method to select an optimum suprathreshold for forming clusters of pixels. Once these candidate clusters are formed, we use permutation testing of longitudinal labels to derive significant changes

Study of bone metabolism in second and third trimesters of pregnancy and puerperal period in re-pregnant women

Objective To investigate the changes of bone metabolism in the second and third trimesters of pregnancy and puerperal period in re-pregnant women， aiming to provide reference for calcium supplementation during pregnancy and lactation in re-pregnant women. Methods Pregnant women who underwent regular obstetric examination were enrolled and divided into the re-pregnant group （n=100） and first pregnant group （n=100） according to their self-reported birth frequency. Patients in each group were divided into three subgroups according to age （25-30 years old， 31-35 years old and 36-40 years old）. Bone metabolism indexes in the second and third trimesters of pregnancy and puerperal period were compared between two groups. Bone metabolism in pregnant women of different ages was also compared. Bone mineral density （BMD） was measured in the puerperal period， and the pregnancy complications of pregnant women with different bone metabolism were compared. Results The β-collagen degradation product （β-CTX） level in the second and third trimesters of pregnancy and puerperal period in the re-pregnant group was higher， whereas the level of carboxy-terminal propeptide （PICP） of type I procollagen was lower than those in the first pregnant group （both P < 0.05）. There were no significant differences in the serum parathyroid hormone （PTH）， N-terminal fragment of osteocalcin （N-MID）， β-CTX and PICP levels in pregnant women of different ages during the second and third trimesters of pregnancy and puerperal period （all P >0.05）. The levels of 25-hydroxyvitamin D3（25（OH）D3） in the second and third trimesters of pregnancy and puerperal period were the highest in re-pregnant women aged 25-30 years （all P < 0.05）. The incidence of hypothyroidism and gestational diabetes mellitus in patients with abnormal bone mass during pregnancy was higher than that in those with normal bone mass （both P < 0.05）. Conclusions The β-CTX levels in the second and third trimesters and puerperal period of re-pregnant women are higher， whereas the PICP levels are lower compared with those in first pregnant women. Age and parity can affect partial bone metabolism indexes， and women with abnormal bone mass have a higher incidence of pregnancy complications