Use of Social Media in Orthopaedic Surgery Training and Practice: A Systematic Review

Background

Social media use has grown across healthcare delivery and practice, with dramatic changes occurring in response to the coronavirus (COVID-19) pandemic. The purpose of this study was to conduct a comprehensive systematic review to determine the current landscape of social media use by (1) orthopaedic surgery residencies/fellowship training programs and (2) individual orthopaedic surgeons and the change in use over time.

Methods

We searched 3 electronic databases (PubMed, MEDLINE, and Embase) from their inception to April 2022 for all studies that analyzed the use of social media in orthopaedic surgery. Two reviewers independently determined study eligibility, rated study quality, and extracted data. Methodology was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results

Twenty-eight studies were included, of which 11 analyzed social media use by orthopaedic surgery residency and fellowship training programs and 17 examined its use by individual orthopaedic surgeons. Among residency and fellowship programs, Instagram was identified as the most common platform used, with 42% to 88% of programs reporting program-specific Instagram accounts, followed by Twitter/X (20%-52%) and Facebook (10%-38%). Social media was most commonly used by programs for recruitment and information dissemination to prospective residency applicants (82% and 73% of included studies, respectively). After the start of the COVID-19 pandemic, there was a 620% and 177% increase in the number of training programs with Instagram and Twitter/X accounts, respectively. Individual use of social media ranged from 1.7% to 76% (Twitter/X), 10% to 73% (Facebook), 0% to 61% (Instagram), 22% to 61% (LinkedIn), and 6.5% to 56% (YouTube).

Conclusions

Instagram, Twitter/X, and Facebook are the premier platforms that patients, residency applicants, and institutions frequent. With the continued growth of social media use anticipated, it will be critical for institutions and individuals to create and abide by guidelines outlining respectful and professional integration of social media into practice.

Level of Evidence

Level IV.

Autograft patellar bone-tendon-bone use does not increase operative time in anterior cruciate ligament reconstruction

Background

Anterior cruciate ligament reconstruction (ACLR) is a common procedure that has been shown to have relatively good outcomes amongst various graft types. Operative time in ACLR has been found to influence outcomes and cost. The purpose of this study was to evaluate the association of operative time in primary arthroscopically performed anterior cruciate ligament reconstruction (ACLR) and graft type while controlling for confounders that influence time.

Methods

All patients who received ACLR between 2018 and 2022 were included in this retrospective cohort study. Exclusion criteria consisted of age (≤16 years), revisions, concomitant ligament reconstruction or tendon repairs, or other simultaneously performed procedures that could potentially add substantial variation in operative time. The primary outcome was operative time. Graft types included allograft, bone-tendon-bone (BTB) autograft, hamstring tendon (HS) autograft and quadriceps tendon (QT) autograft.

Results

A total of 1813 primary ACLRs were included. The average operative time was 98.9 ± 33.0 min. Graft utilization varies considerably among surgeons. The most used graft type was BTB autograft (42.6%) followed by HS autograft (32.3%) and allograft (21.4%). Only 68 cases (3.8%) used a QT autograft. Seven of the 15 included surgeons primarily used BTB autograft. One surgeon predominately used QT autograft. No difference in operative time was observed among the autograft types (p = 0.342). Allograft ACLR was significantly faster by 27-33 min compared to using BTB autograft, HS autograft, or QT autograft (p < 0.001).

Conclusion

Operative time did not vary by type of autograft selected. Allograft ACLR was performed approximately 30 min faster than autograft ACLR. Further studies examining the effect on patient outcomes of reduced operative time and minimizing graft harvest morbidity in ACLR is important to more accurately determine the cost-effectiveness of allograft ACLR.

Predicting performance on the Royal College of Physicians and Surgeons of Canada internal medicine written examination

BACKGROUND

Although the written component of the Royal College of Physicians and Surgeons of Canada (RCPSC)internal medicine examination is important for obtaining licensure and certification as a specialist, no methods exist to predict a candidate's performance on the examination.

METHOD

We obtained data from 5 Canadian universities from 1988 to 1998 in order to compare raw scores from the American Internal Medicine In-Training Examination (AIMI-TE) with raw scores and outcomes (pass or fail) of the written component of the RCPSC internal medicine examination.

RESULTS

Mean scores on the AIMI-TE correlated well with scores on the RCPSC internal medicine written examination for all postgraduate years (r = 0.62, r = 0.55 and r = 0.65 for postgraduate years 1, 2 and 3 respectively). Scores above the 50th percentile on the AIMI-TE w/ere predictive of a low failure rate (< 1.5%) on the RCPSC internal medicine written examination, whereas scores at or below the 10th percentile were associated with a high failure rate (about 24%).

INTERPRETATION

Candidates who are eligible to take the written component of the RCPSC certification examination in internal medicine can use the AIMI-TE to predict their performance on the Canadian examination. The AIMI-TE is a useful test for residents in all levels of training, because the examination scores have a strong relation to expected performance on the Canadian examination for each year of postgraduate training.

Distribution of interleukin-1 receptors in term human fetal membranes and decidua

Interleukin-1 (IL-1) is a dimorphic cytokine that acts on target cells through high-affinity receptors, type I and type II. It has been implicated in the onset of term and preterm labour with associated intrauterine infection. To define better the potential action of this cytokine in the human fetal membranes and decidua, the objective of this study was to define the type(s) of IL-1 receptors present in the tissues at term, examine the tissue and cellular distribution of the receptor(s) and determine if there were any changes in their expression or distribution with the onset of labour. Tissues were obtained following elective caesarean section (n=12) or normal labour delivery (n=11). Paraffin embedded and frozen sections were examined by immunohistochemistry and in situ hybridization for evidence of the type I and type II receptors and their corresponding mRNAs. In all tissues studied the type I receptor was localized mainly to the decidua and the type II receptor was localized to the decidua and scattered cells in the amnion-chorion mesenchymal layer. In situ hybridization localized type I receptor mRNAs and type II receptor mRNAs to the decidua. The type I and type II receptor protein in the decidua showed a similar pattern of staining as that found for CD-68, a macrophage marker. The pattern of receptor expression and distribution was unrelated to the mode of delivery. No evidence for the presence of the type I or type II receptor or their mRNAs in the amnion epithelial cells or chorion laeve trophoblast was found.

Concentrations of doxorubicin and its metabolites in human autopsy heart and other tissues

PURPOSE

Since doxorubicin causes cardiotoxicity, we wished to assess relative concentrations of doxorubicin and its metabolites in cardiac tissues of patients who had been treated antemortem. We also wished to determine factors that correlate with human cardiac doxorubicin and doxorubicinol concentrations.

PATIENTS AND METHODS

Autopsy tissues were collected from 35 patients who had received doxorubicin at any time antemortem, and were assayed by high pressure liquid chromatography.

RESULTS

The major species found in human autopsy cardiac tissues were doxorubicinol (median concentration 92 ng/g, range 0 to 484 ng/g), and doxorubicin (median 58 ng/g, range 0-1665 ng/g). Other doxorubicin metabolites were detected in cardiac tissues in < half the patients. Of ten organs studied, heart ranked fifth with respect to median doxorubicin concentration and ranked fourth with respect to median doxorubicinol concentration. By multiple stepwise regression analysis, factors most closely associated with cardiac doxorubicin concentrations were time from last treatment divided by dose intensity, serum total protein, albumin, and hemoglobin (negative correlations). Factors most closely associated with cardiac doxorubicinol concentrations were cumulative doxorubicin dose, total protein, hemoglobin, and uric acid (positive associations), and respiratory rate (negative association). The physiologic significance of these associations (if any) is uncertain. By paired t-tests, cardiac doxorubicin and doxorubicinol concentrations were significantly (p < 0.05) higher than concentrations in skeletal muscle and smooth muscle organs.

CONCLUSIONS

Overall, the results suggest that the much greater tendency to develop doxorubicin toxicity in heart than in other types of muscle may be due to a propensity of cardiac muscle to accumulate doxorubicin. The results also suggest that doxorubicinol may play a role in doxorubicin cardiac toxicity, and that doxorubicin may be gradually converted to doxorubicinol in human tissues.

Human autopsy-tissue distribution of menogaril and its metabolites

Autopsy-tissues were obtained from eight patients who had last received menogaril (total cumulative dose, 175-1080 mg/m2) intravenously (one patient) or orally (seven patients) from 1 to 285 days prior to death. Tissue samples were assayed for menogaril and its metabolities by high-pressure liquid chromatography. Unchanged menogaril was found only in a single lung-tissue sample from a patient who had died < 24 h after receiving his last treatment. N-Demethylmenogaril was found in two lung-tissue samples and in single samples of the thyroid, lymph node, pancreas, cerebellum, and tumor. The major menogaril metabolite found in human autopsy-tissues was 7-deoxynogarol. The highest 7-deoxynogarol concentrations were found in the large bowel (median, 201 ng/g), liver (median, 183 ng/g), and lung (median, 177 ng/g). The heart ranked as the 9th of 18 organs in median 7-deoxynogarol concentration, after the large bowel, liver, lung, tumor, thyroid, skeletal muscle, adrenal gland, and kidney. The lowest concentrations were detected in brain tissue. Our results suggest that the low degree of cardiac toxicity and the possible pulmonary toxicity of menogaril may be related to relative tissue concentrations of menogaril metabolites. Tumor 7-deoxynogarol concentrations were comparable with those in normal tissues, except that concentrations in intracerebral tumors were higher than those in the normal brain. Tissue 7-deoxynogarol concentrations appeared to be directly related to the cumulative dose and inversely related to the time from the last treatment to death; the value obtained by dividing dose by time correlated (P < 0.05) with tissue 7-deoxynogarol concentrations.

A simple procedure for obtaining high-quality NMR spectra of semiquantitative value from small tissue specimens: cervical biopsies

The handling of small tissue biopsy samples (< 100 microliters) for NMR investigations poses special problems. Optimal and stable positioning of the samples within the sensitive volume of the radiofrequency coil can be achieved by inserting the sample in a capillary. Methods for quantitation of the spectral information from samples requiring histological evaluation after the NMR experiment are discussed, in particular with respect to cervical biopsies.