No abstract

Introduction The U.S. Navy offers an attractive opportunity for residency training in orthopedic surgery. The factors that Navy orthopedic residency program leadership finds important in applicant selection for training have not been reported. Additionally, data regarding the academic competitiveness of recently matched applicants have not been previously published. This study presents the results of two surveys administered to all navy orthopedic program directors and department chairmen, as well as data for United States Medical Licensing Examination (USMLE) Steps 1 and 2, medical school class percentile, leadership responsibilities, research endeavors, and letters of recommendation of both matched and unmatched applicants. Materials and Methods Two anonymous surveys were administered to all program directors and department chairmen at Navy orthopedic residency training programs with questions designed to gauge perceived importance of various application factors when selecting for the match. The results were compiled, and mean levels of importance were reported. Deidentified data were collected on all applicants to Navy orthopedic residency programs from 2015 to 2019. Data points specific to USMLE Step 1 and 2 board scores, medical school class percentile, research, leadership, and letters of recommendation were analyzed using single and multiple logistic regression analyses, and odds ratios for each variable were calculated. Results Navy leadership unanimously expressed that clerkship performance at the individual program director’s institution was most important, followed by Steps 1 and 2 licensing examination scores. Single logistic regression analyses showed that Step 1 score and clinical, leadership, and recommendation scores were statistically significant. When controlled for Step 1 score, only academic performance and leadership scores maintained statistical significance. Conclusions Applicants to Navy orthopedic surgery residency programs should strive to be competitive in all aspects of their application, with specific emphasis placed on outstanding performance during orthopedic clerkships, demonstration of leadership characteristics, and academic excellence. With transition to a pass/fail grading system for Step 1, there will be more emphasis on other measures of academic success, such as Step 2 scores and clinical clerkship grades.

Clavicle fractures are common orthopedic injuries that occur in a young active population and are even more common in the military. Military fitness test data presents the unique opportunity to analyze functional ability with regard to military-specific activities. The primary goal of this study was to compare functional outcomes using military fitness test data between operative and non-operative treatment of midshaft clavicle fractures. We performed a retrospective review of active-duty U.S. Navy and Marine patients with midshaft clavicle fractures treated at our institution over a seven-year period. There were 94 and 153 patients in our operative and non-operative cohorts, respectively. Average follow-up time from the date of injury or surgery was 28 months. The rate of infection in the operative group (4%) was significantly greater than in the nonoperative group (0%, p = 0.023). The rate of non-union in the operative group (3%) was significantly lower than in the non-operative group (14.5%, p = 0.004). The rate of symptomatic malunion in the operative group (0%) was significantly different from that in the non-operative group (4.6%, p = 0.036). There was no significant difference in the rate of revision surgery between the operative (9.2%) and non-operative (13.2%) groups (p = 0.105). A total of 51 marines met inclusion criteria for our functional outcome analysis using Marine Corps Physical Fitness Test (PFT) data. Of those who underwent operative fixation, 68% were able to meet or surpass their pre-injury average amount of pull-ups in their first PFT after surgery and 88% by the next PFT at least one year after surgery. While 69% of non-operative patients met their pre-injury average in their first PFT, only 57% maintained this level at least one year after surgery. This difference was statistically significant.

Anterior cruciate ligament repairs are performed over 100,000 times annually in the US. A common surgical method is a bone‐patellar tendon‐bone graft, which requires the placement of a tibial tunnel through the proximal tibia. Mismatches between the length of the tibial tunnel and the length of the graft have been reported to occur 26% of the time or more, and require procedural modifications during surgery. Most methods for placing the tibial tunnel rely on consideration of patient height and/or angle of placement. Little is known about the variables that affect mismatches. Better understanding how the shape of the proximal tibia impacts the length of the tibial tunnel will allow for improved surgical technique and could lower the number of mismatches, and perhaps even graft failures. We examined 33 right proximal tibiae from donor cadavers (15 females, 18 males) via three‐dimensional scans that allowed us to take 6 linear measurements to describe the dimensions of the proximal tibia. We also used the directions for a popular tibial tunnel guide to simulate a tibial tunnel length on all individuals. Our analysis found the length of the tibial tunnel is influenced by multiple shape components that vary by sex. Specifically, male tibial measurements were always significantly larger than female measurements (p<0.05), there were a greater number of significant correlations among measurements in the male tibia than the female tibia, and the length of the tibial tunnel is more closely correlated to anterior‐posterior measurements in females in contrast to males, where it is more closely correlated to mediolateral measurements. These findings suggest there are sex‐based differences in the shape of the proximal tibia that may confound tibial tunnel placement. The development of surgical techniques should incorporate knowledge of shape‐based variables, and future research should continue to explore sex‐specific foundations of variable outcomes in clinical treatments.Support or Funding InformationThis project was funded by the Basic Sciences Department, College of Osteopathic Medicine, Touro University NevadaThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.