Objective: There is a growing body of clinical evidence to support coccygectomy as an effective treatment for chronic coccygodynia. To date, the authors identified no other studies that describe and evaluate the paramedian surgical approach to coccygectomy and post-operative outcomes. Methods: A case report of 36 patients who underwent coccygectomy with a paramedian or midline approach. All patients had chronic coccydynia that was refractory to conservative treatment. Three patients were excluded from the study due to additional lumbar surgery (2) or missing data (1). Outcomes assessed were Visual Analog Scale (VAS), operative and post-operative complications, use of post-operative pain medication, and surgery time. Results: Included in the study were 24 females and 9 males with a mean age of 46 years (range 18-74 years). The most common etiologies were trauma (26) and idiopathic (7). Twenty seven patients underwent coccygectomy with a paramedian approach and 6 had the same procedure with the midline incision. There was a significantly lower infection rate in the paramedian group (p-value=0.00871). Conclusion: The paramedian and midline approach to coccygectomy are both viable treatments for coccygodynia. The two methods offer low complication rates and high patient satisfaction. Surgeon and patient preference should be taken into account when choosing a surgical approach for coccygectomy. Further examination comparing traditional midline vs. paramedian approach are needed to assess superiority.

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Introduction:The American Academy of Orthopaedic Surgeons (AAOS) created an evidence-based clinical practice guideline for the care of pediatric diaphyseal femur fractures in 2010. Our institution implemented checklists based off these guidelines embedded in a standardized EMR order. The purpose of this study was to describe compliance with checklist completion and to assess safety improvement in a large urban pediatric hospital.Methods: Retrospective and prospective data were collected from 2 years before and 5 years after checklist implementation. This included the patient safety checklists from August 2011 through August 2016. Patients aged 0 to 18 years with a diaphyseal femur fracture were queried from the EMR and included in this study. Patient charts were reviewed for complications, including nerve injury, pressure sore, leg length discrepancy, loss of reduction, failure of fixation, nonunion, delayed union, and infection. Compliance rates were reported based on the AAOS clinical practice guidelines.Results: A total of 313 patients for the postchecklist period were reviewed in this study. Of 219 patients eligible for inclusion, 198 had checklists completed (group B). This group was compared with 100 patients with diaphyseal femur fractures from the period before implementation of the checklist (group A). We found no statistical difference in the number of patients with complications between groups (12% in both groups, P = 0.988). Postoperative checklists demonstrated that 89.9% of patients (178/198) received ageappropriate treatment consistent with the AAOS guideline recommendations after implementation of the checklist. Before the checklist implementation (group A), 94% (94/100) adhered to the guidelines. Conclusion:This study reveals high compliance rates with the AAOS evidence-based clinical practice guideline for the management of

The emergence of Coronavirus Disease 2019 (COVID-19) has dramatically changed the landscape of medical education. The global pandemic highlighted advantages of specific curricular frameworks.  Longitudinal, integrated approaches may avoid some of the educational consequences seen in traditional models. This viewpoint highlights the advantages of a longitudinal integrated clerkship during the COVID-19 outbreak. These advantages include a relatively even exposure to multiple specialties, discipline specific assessment information despite an early truncation of clinical activity, and a seamless transition to ongoing integrated online learning, as a single integrated virtual clerkship model for an entire class. Notably, the longitudinal integrated clerkship avoided consequences seen in traditional clerkships such as missing entire rotations positioned in March-June 2020 and therefore, clerkship grades. The longitudinal clerkship allowed for students to receive discipline specific grades in all core specialties based on assessment of individual skills (direct observation and assessment of skills such as physical exam and history) versus discipline specific knowledge (subject exams). In addition, there are advantages of pre-existing relationships with preceptors and patients that could facilitate engagement in ongoing contact during virtual clerkships and opportunistic clinical experiences when it is safe for students to re-engage in clinical activities.