A mortality odds ratio analysis of cause of death among 347 White female members of the American Chemical Society (ACS) revealed a five-fold excess of suicide, notably by cyanide poisoning. Risk was also elevated for all cancers combined and for cancers of the breast, ovary, stomach, pancreas, and lymphatic and hematopoietic system. The excess breast and ovary cancer deaths were limited to unmarried women. (Am J Public Health 1985; 75:883-884.)

Background: Over 90% of graduating orthopaedic residents now pursue fellowship training, and only 15% of practicing orthopaedic surgeons now characterize themselves as generalists. Fellowship training has significant financial effects due to both opportunity cost of that year of training and changes in compensation throughout one's career. The purpose of this study was to estimate the financial return on investment by pursuing additional training in an orthopaedic fellowship versus general practice. Methods: Using described techniques of financial analysis, net present value (NPV), internal rate of return (IRR), and break-even point were estimated over the average working career length of an orthopaedic surgeon. Compensation data were drawn from the American Medical Group Association physician compensation surveys. Seven fellowships were studied and referenced to a career in general orthopaedic practice. Results: Fellowship training in spine surgery yields the highest return on investment with a break-even point of 5 years. Adult reconstruction has a positive NPV and IRR, but when corrected for number of hours worked per week offers no productivity advantage to general practice. Sports medicine and trauma offer neutral returns, but when corrected for work hours, NPV and IRR both become negative. Hand, pediatrics, and foot and ankle never break even following the loss of compensation realized during fellowship year. Discussion: The recent trend across all medical specialties has been for increased fellowship training and subspecialization. There are numerous reasons to pursue fellowship training, both personal and financial. This study presents an updated estimate of the financial impact of fellowship training in orthopaedics. This analysis demonstrates that selecting different fellowships can generate positive, negative, or neutral financial returns. This study has the potential to influence residents' decisions to pursue general practice versus fellowship training and identifies economic drivers, which may lead to preferential pursuit of certain subspecialties.

This study evaluated the effect of pre-bending dynamic compression plates on fracture site compression. Recommendations of 1 to 2 mm of pre-bend have been proposed, but there does not appear to be experimental data to confirm the optimal pre-bend magnitude. Dynamic compression plating was performed on the lateral convex surface of 18 femoral analogs to fixate a simulated mid-shaft fracture. Plates with 0 mm (flat plate), 1 mm, and 2 mm of pre-bend were evaluated for their production of compression by determining the strain magnitudes for 10 equal-sized zones across the anterior cortex at the osteotomy site using digital imaging correlation. The 0 and 1 mm plates produced significantly more compression at the near cortex (p = 0.001 and p = 0.003, respectively) than the 2 mm plate. However, the 0 and 1 mm plates also created visible diastasis at the far cortex, while the 2 mm plate exhibited compression across all zones. The strain magnitudes for the 0 mm (R2 = 0.62) and 1 mm (R2 = 0.86) plates linearly and significantly decreased from the region adjacent to the plate until a region 50%–60% across the analog diameter. In contrast, the 2 mm plate exhibited uniform strains across the osteotomy site. This study demonstrates that pre-bending a dynamic compression plate 2 mm prior to fixation on a convex lateral femur provides the most compression at the far cortex. It also produces more uniform compression across the fracture when compared to 0 and 1 mm of pre-bend.

No abstract