Background:Mental health conditions affect tens of millions of Americans. In recent years, particularly with the advent of the coronavirus disease 2019 pandemic, there has been a burst of interest in mental health and mental illness among orthopaedic surgical patients. The mental health of orthopaedic surgeons themselves has also come into focus, with high reported rates of burnout and depression. The aim of this article was to evaluate trends in publication on mental health and mental illness in orthopaedic surgery.Methods:Web of Science and PubMed were queried to conduct a systematic review. Studies that discussed orthopaedic surgery and mental illnesses or mental health topics over 2001 to 2022 were included. Publications were analyzed by article-, author-, and topic-level characteristics.Results:A total of 416 studies were analyzed after application of inclusion and exclusion criteria. Publication volume increased dramatically, demonstrating quadratic growth over 2001 to 2022 (p < 0.001). Eighty-eight percent of studies focused on patients and 10% on surgeons, with studies about patients more likely to focus on mental illness and those about surgeons more likely to focus on mental health (p < 0.001). Twenty percent of publications had a female senior author, and 5 authors collectively accounted for 10% of all publications. Eight journals published more than 10 publications, accounting for 35% of all publications. The most productive subspecialties were arthroplasty (135, 30%), general orthopaedics (87, 21%), and spine (69, 17%). Mental illnesses that were least represented included schizophrenia, bipolar disorder, eating disorders, attention-deficit/hyperactivity disorder, and personality disorders (1% or less of total publications each).Conclusion:This analysis showed a dramatically increasing trend in publications on mental health and mental illness in orthopaedic surgery. A high concentration of publications came from a subset of journals and senior authors, and women were overrepresented as senior authors relative to their representation in the field. The results of this analysis identified gaps in the literature, including underrepresented subspecialties, understudied mental illnesses, and study of orthopaedic surgeon mental health, and thus highlighted areas for future investigation.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Category: Other; Ankle; Hindfoot; Midfoot/Forefoot Introduction/Purpose: The Orthopaedic In-Training Examination (OITE) was first administered in 1963 by the American Academy of Orthopaedic Surgeons to evaluate and monitor the training and knowledge of orthopaedic surgery residents. After various iterations of the exam, the current OITE consists of 275 questions covering foot and ankle, hip and knee, shoulder, and elbow, spine, sports medicine, trauma, and basic science. The most recent investigation of the foot and ankle OITE questions evaluated content, references, and treatment methods included on the exams from 2006-2010. This study evaluates OITE test questions over a 10-year period from 2012-2021 for topic, taxonomy, treatment tested, imaging modality, and references cited. The goal of this analysis is to inform and optimize foot and ankle education among orthopaedic residency and fellowship programs. Methods: OITE questions between 2012 and 2021 were obtained through the AAOS 'ResStudy' online question bank. Each question was manually evaluated by each author for foot and ankle content. The total number of questions pertaining to foot and ankle were recorded for each year and the topic of each question was classified under broader topic areas: trauma, deformity, tendon disorder, diabetic foot, sports, great toe, lesser toe, pediatric foot, heel pain, arthritis, and tumor. Imaging techniques were classified as radiographs, magnetic resonance imaging (MRI), computerized tomography, and clinical photo or video. Question taxonomy was classified using criteria in a previous OITE question analysis with three groups2. Taxonomy 1 (T1): knowledge (requires recall of orthopaedic practice or literature); T2: comprehension (interpretation of information and/or diagnosis); T3: application (formulation of a treatment plan from provided information). References provided by AAOS were identified by journal title and publication date or textbook title and editors. Results: Overall, foot and ankle questions comprised of 11.5% (308/2679) of all the graded OITE questions. In recent years, the proportion of foot and ankle questions has decreased. From 2012-2017 the average proportion of foot and ankle questions was 12.6% per test, and from 2018-2021, the average proportion was 9.8%. The most common question taxonomy from 2012-2017 was T3 (application) comprising 60.9% of the question, however, from 2018-2021, T3 questions made up only 29.4% of foot and ankle questions. In total, 59.1% (182/308) of the questions required knowledge of treatment modalities, most commonly open reduction internal fixation and arthrodesis procedures. Imaging modalities were tested 67.9% (209/308) of the time, with radiographs appearing in 47.4% (146/308) of all questions. The most common journals cited were Foot and Ankle International, Journal of the American Academy of Orthopaedic Surgeons, and the Journal of Bone and Joint Surgery American Volume. Conclusion: The proportion of foot and ankle questions on the OITE has decreased over the past 10 years and there has been a reduced emphasis on application questions with a more balanced distribution among knowledge, comprehension and application questions recently. Residents and residency programs should ensure proficiency in interpreting radiographs, which are tested on almost half of all foot and ankle OITE questions.