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PubMed1976

[Disinfection of medical orthopedic articles made of polymer materials].

In traumatological hospitals the medical orthopedic articles made of polymer materials are contaminated by different microorganisms including pathogenic staphylococci, therefore they can serve as a factor of transmission of hospital-associated staphylococcal infections. Polymer materials used for medical orthopedic articles are not bactericidal. Mechanical cleaning with detergents does not provide sufficient elimination of microorganisms from orthopedic articles. This can be obtained by means of the treatment (immersion, wiping) with solutions of bactericidal preparations of various chemical orogin (chloramine, lithium hypochloride, chlorine, sulphochlorantine, hydrogen peroxide, peracetic acid, nitran). Medical orthopedic articles must be decontaminated before use. In the hospitals, disinfection of orthopedic articles should be performed at least once a day. Immersion of the articles made of porous materials into solutions of disinfectans with surface-active additives or into solutions of surface-active bactericides is a simple, readily available and effective method of treatment. Drawback of this method is that disinfectant solution partly remains in the pores and can be eliminated only by means of drying of the article in thermostate. Orthopedic articles of polyurethane foam can be decontaminated only by use of solutions of hydrogen peroxide and nirtan out of all the tested disinfectants. Medical orthopedic articles made of polymer materials have endured repeated treatment with disinfectant solutions without any change of their physical and mechanical properties. The usability of these articles did not deteriorate.

Cross Infection↗
PubMed2003

[The importance of isolating septic patients in an autonomous unit in orthopedic surgery and traumatology].

UNLABELLED: To examine whether Sepsis Containment Units are presently in use by French Orthopedic surgeons in a number of hospitals and the subsequent efficacy of these measures in the prevention of risks linked to methicillin resistant Staphylococcus aureus (MRSA), MRSA was used as an example because it is the bacteria most frequently associated with infection in orthopedics. The transient carriage of MRSA on the hands of hospital personnel is the most common mechanism of patient to patient transmission. Consequently, the incidence of nosocomial MRSA in patients can be used to assess the quality of infection control. SETTING: The orthopaedic surgery department (104 beds) of a 1. 228 bed, university affiliated public hospital located in eastern France (Besançon). METHODS: First: a questionnaire was sent out to 71 French university orthopedic departments to investigate the practice in place. Second: to establish whether a significant correlation exists between the colonisation pressure exerted by real imported MRSA, and the number of cases of real acquired MRSA since we know that colonisation pressure of bacteria is a major factor in the prognosis of clinical infection. Third: our orthopedic surgery department was redesigned to study the risks of colonisation pressure with or without Sepsis Containment Units. RESULTS: First: among the 71 orthopedic departments studied, only 11 used a Sepsis Containment Unit. Second: there is a definite, linear relationship between the colonisation pressure exerted in a unit by real imported MRSA and the number of cases of real acquired clinical infection. Third: in the absence of Sepsis Containment Units, the risk of MRSA infections is increased by 160%. Debat: the classical clinical arguments concerning the dangers of hand or aerobic MRSA transmission are confirmed by our figures. The strict use of Sepsis Containment Units prevents contamination of septics by septics. Inversely, the rigorous concentration of means in the Sepsis Containment Units also prevents cross contamination of septics. At question are the psychological and financial inconveniences of Sepsis Containment Units. The results of this experiment, performed in orthopedic surgery, show that the use of Sepsis Containment Units is just as critical in other surgical units: vascular, thoracic, etc., nor should they be overlooked in outpatient and emergency care--often the first step in orthopedic surgery. CONCLUSION: Sepsis Containment Units are essential and merit further development.

Containment of Biohazards↗
PubMed2005

Are orthopedic surgeons prone to burnout?

OBJECTIVE: Burnout syndrome (BOS) is a state of physical, and emotional or mental exhaustion, depersonalization, and low personal accomplishment. Health care givers are most prone to suffer from BOS. There are no studies to date on BOS among trained orthopedic, and trauma surgeons. The objective of this study, was to assess the prevalence of BOS among the orthopedic surgeons in the Eastern province of Saudi Arabia. METHODS: This study was conducted among the orthopedic surgeons of the Eastern province of Saudi Arabia between September 2003 and October 2004. One hundred and two questionnaires of the Maslach Burnout Inventory (MBI) were sent to the qualified orthopedic surgeons with a self-addressed stamped envelope, from the Department of Orthopedic Surgery, King Fahd Hospital of the University, Al-Khobar. Three factors of MBI, which were assessed, were emotional exhaustion, depersonalization, and personal accomplishment. The data were entered in the database, and analyzed using Statistical Package for Social Science. RESULTS: Sixty-nine (67.6%) of the orthopedic surgeons completed the questionnaire. The average age was 45.72 +/- 6.82 (33-57) years. Thirty-five (50.7%) were found to be in a state of emotional exhaustion, 59.4% depersonalized, and 17% had low state of personal accomplishment. Doctors working in the government hospitals fared better than those in the private sector. CONCLUSION: Burnout syndrome is common among orthopedic surgeons working in the Eastern province Saudi Arabia. It is emphasized that awareness of the problem should be highlighted; programs need to be put in place to reduce the prevalence of burnout syndrome.

Adult↗
PubMed1983

Quantitative analysis of the orthodontic and orthopedic effects of maxillary traction.

This article analyzes differences in displacement of ANS and of the upper first molar when different vectors of force are delivered to the maxilla in non-full-banded Phase I mixed-dentition treatment of Class II malocclusion. The sample is identical to that for which we have previously reported differences in change in several key measures of mandibular and facial shape. It includes a cervical-traction group, a high-pull-to-upper-molar group, a modified-activator group, and an untreated Class II control group. Using newly developed computer-conducted procedures, which are described, we have been able to partition the orthodontic and orthopedic components of upper molar displacement and also to isolate treatment effects from those attributable to spontaneous growth and development. In the region of ANS, small but statistically significant and clinically meaningful differences were noted between treatments. When the intercurrent effects of growth and development had been factored out (Table III), orthopedic distal displacement of ANS was significantly greater in the high-pull and cervical groups than in the activator group. Orthopedic downward displacement of ANS was seen to be significantly greater in the cervical group than in the high-pull and activator groups. In the region of the first molar cusp, mean distal displacement of the tooth as an orthopedic effect was found to be almost identical in the cervical and high-pull groups (although variability was greater in the cervical group), but the mean orthodontic effect was significantly greater in the high-pull group than in the cervical group. In the cervical group, where relatively light forces were used for relatively long treatment periods on average, more of the total distal displacement of the upper molar was of an orthopedic character than of an orthodontic character. Conversely, in the high-pull group, in which relatively heavier forces tended to be used for briefer treatment periods, most of the distal displacement at the upper molar was of an orthodontic character. These observations are contrary to expectations from conventional orthodontic theory. In the activator-treated group, roughly equal components of the treatment-associated distal displacement of the upper molar were of the orthodontic and orthopedic types. As concerns changes in the vertical direction in the region of the molar cusp, significant intrusion of both the orthopedic and orthodontic types was seen in the high-pull sample as compared to each of the other groups examined.(ABSTRACT TRUNCATED AT 400 WORDS)

Activator Appliances↗
PubMed2000

Orthopedic surgery in Estonia.

We did a survey on the development of orthopedic surgery in Estonia, especially during the past 10 years, including education, hospital-based orthopedic surgery and orthopedic research. The main types of orthopedic operations were analyzed, on the basis of data from the Estonian Social Ministry, Bureau of Medical Statistics and several departments of orthopedic. On the average, 11,831 orthopedic operations were performed yearly during the years 1996-1998 in hospital departments.

Education, Medical↗
PubMed2002

The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost.

OBJECTIVE: To measure the impact of orthopedic surgical-site infections (SSIs) on quality of life, length of hospitalization, and cost. DESIGN: A pairwise-matched (1:1) case-control study within a cohort. SETTING: A tertiary-care university medical center and a community hospital. PATIENTS: Cases of orthopedic SSIs were prospectively identified by infection control professionals. Matched controls were selected from the entire cohort of patients undergoing orthopedic surgery who did not have an SSI. Matching variables included type of surgical procedure, National Nosocomial Infections Surveillance risk index, age, date of surgery, and surgeon. MAIN OUTCOME MEASURES: Quality of life, duration of postoperative hospital stay, frequency of hospital readmission, overall direct medical costs, and mortality rate. RESULTS: Fifty-nine SSIs were identified. Each orthopedic SSI accounted for a median of 1 extra day of stay during the initial hospitalization (P = .001) and a median of 14 extra days of hospitalization during the follow-up period (P = .0001). Patients with SSI required more rehospitalizations (median, 2 vs 1; P = .0001) and more total surgical procedures (median, 2 vs 1; P = .0001). The median total direct cost of hospitalizations per infected patient was $24,344, compared with $6,636 per uninfected patient (P = .0001). Mortality rates were similar for cases and controls. Quality of life was adversely affected for patients with SSI. The largest decrements in scores on the Medical Outcome Study Short Form 36 questionnaire were seen in the physical functioning and role-physical domains. CONCLUSIONS: Orthopedic SSIs prolong total hospital stays by a median of 2 weeks per patient, approximately double rehospitalization rates, and increase healthcare costs by more than 300%. Moreover, patients with orthopedic SSIs have substantially greater physical limitations and significant reductions in their health-related quality of life.

Cross Infection↗
PubMed2005

Patient-focused measures of functional health status and health-related quality of life in pediatric orthopedics: a case study in measurement selection.

The objectives of this report are to review the assessment of patient-focused outcomes in pediatric orthopedic surgery, to describe a framework for identifying appropriate sets of measures, and to illustrate an application of the framework to a challenging orthopedic problem.A detailed framework of study design and measurement factors is described. The factors are important for selecting appropriate instruments to measure health status and health-related quality of life (HRQL) in a particular context. A study to evaluate treatment alternatives for patients with neurofibromatosis type 1 and congenital tibial dysplasia (NF1-CTD) provides a rich illustration of the application of the framework. The application involves great variability in the instrument selection factors. Furthermore, these patients and their supportive caregivers face numerous complex health challenges with long-term implications for HRQL. Detailed summaries of important generic preference-based multi-attribute measurement systems, pediatric health profile instruments, and pediatric orthopedic-specific instruments are presented. Age-appropriate generic and specific measures are identified for study of NF1-CTD patients. Selected measures include the Activities Scale for Children, Gillette Functional Assessment Questionnaire Walking Scale, Health Utilities Index, and Pediatric Inventory of Quality of Life. Reliable and valid measures for application to pediatric orthopedics are available. There are important differences among measures. The selected measures complement each other. The framework in this report provides a guide for selecting appropriate measures. Application of appropriate sets of measures will enhance the ability to describe the morbidity of pediatric orthopedic patients and to assess the effectiveness of alternative clinical interventions. The framework for measurement of health status and HRQL from a patient perspective has relevance to many other areas of orthopedic practice.

Activities of Daily Living↗
PubMed2001

Access to orthopedic care for children with medicaid versus private insurance in California.

OBJECTIVE: To compare the availability of timely orthopedic care to a child with a fractured arm insured by Medi-Cal (California state Medicaid) and by private insurance. STUDY DESIGN: Fifty randomly chosen offices of orthopedic surgeons were telephoned with the following scenario: "My 10-year-old son broke his arm last week during a vacation" followed by a request for an appointment that week. Each office was called twice with an identical script except for insurance status: once with Medi-Cal and once with private insurance. RESULTS: All 50 offices offered an appointment to see the child with private insurance within 7 days. Only 1 of the same 50 offices offered an appointment to see the child with Medi-Cal within 7 days. Of the offices that would not see a child with Medi-Cal, 87% were unable to recommend an orthopedic office that accepted Medi-Cal. CONCLUSIONS: Timely access to orthopedic care was available in 100% of offices polled to a child with private insurance versus in 2% of offices to a child with Medi-Cal. This is a significant difference. Lack of timely orthopedic care may result in poor outcome, ie, if a fracture is not properly aligned in the first few weeks, a permanent deformity may result. Although causation cannot be established from this study, we suspect that Medi-Cal reimbursement rates below the cost of office overhead may be of significance. Although federal guidelines require that payments must be sufficient to enlist enough providers so that services to Medi-Cal recipients are available to the same extent as those available to the general population, this study finds that that children with Medi-Cal insurance have significantly less access to timely orthopedic care.

Appointments and Schedules↗
PubMed2006

A review of orthopedic surgeries after selective dorsal rhizotomy.

Selective dorsal rhizotomy (SDR) is an evidence-based treatment for cerebral palsy (CP) spasticity. During their lifetime, patients with CP spasticity may require orthopedic surgery for muscles and joints to correct physical deformities and provide a better quality of life. In this review, the authors discuss the timing of such orthopedic surgery, its necessity, and whether it is influenced by the performance of SDR. A review of findings from the authors' 19 years of experience yields the following conclusions: 1) that SDR reduces orthopedic surgery requirements when compared with historical controls; 2) that SDR performed in patients at a young age (2-4 years) can reduce future orthopedic surgery requirements; 3) that independent walkers and diplegic patients will have the smallest amount of orthopedic surgery post-SDR; and 4) that patients who need assistance walking and those with quadriplegia will have the greatest amount, although the frequency of orthopedic surgery for quadriplegic patients is not as high as popularly believed.

Cerebral Palsy↗
PubMed2004

Effect of selective dorsal rhizotomy on need for orthopedic surgery for spastic quadriplegic cerebral palsy: long-term outcome analysis in relation to age.

OBJECT: The authors performed a long-term evaluation of gait status to determine the frequency with which orthopedic operations for cerebral palsy are conducted before and after selective dorsal rhizotomy (SDR) and the relation between pre- and post-SDR orthopedic surgery and age. METHODS: Fifty-two patients with spastic quadriplegia were prospectively followed for 5 to 9 years. All children were evaluated and underwent SDR at St. Louis Children's Hospital. Preoperative scores for gait function and details of previous orthopedic procedures were recorded for two age groups: those 2 to 5 (Group 1) and those 6 to 14 years of age (Group 2). Data were collected from parents who completed a questionnaire a mean of 7.5 years after SDR. Relations between gait status and the number/type of pre- and post-SDR orthopedic procedures, rate of improvement after SDR, benefit of operation according to parents, and return of spasticity were analyzed. Forty-nine percent of patients in Group 1 and 25% of those in Group 2 had improved gait scores. The interaction between pre- or post-SDR time frame and walking mode was statistically significant (p = 0.004). Among those children who had not undergone orthopedic surgery before SDR, the incidence of surgery post-SDR was higher in the older children (Group 2) than the younger children (Group 1 [70% compared with 34%]). Parents of 75% of the Group 1 patients and 88% of the Group 2 patients felt that their children benefited from SDR. CONCLUSIONS: The results of this study highlight the effect of SDR on gait status in children with spastic quadriplegic cerebral palsy. The percentage of patients needing orthopedic operations was not as high as reported previously. Parents indicated that SDR was beneficial to their children.

Adolescent↗
PubMed1990

Economies of scale, physician volume for orthopedic surgical patients, and the DRG prospective payment system.

American hospitals face increasing constraints due to a variety of factors. Federal and state diagnostic-related group (DRG) prospective hospital pricing has caused tremendous fiscal pressure on hospitals; many face substantial financial deficits. We analyzed the volume of orthopedic surgical procedures performed by an individual orthopedic surgeon for all patients (N = 2,134) treated for a 3-year period at a large academic medical center; these surgeons were arbitrarily divided into low volume or high volume. Patients of low volume surgeons had a longer hospital length of stay and hospital cost (after correction for DRG case mix and severity of illness), greater financial risk under DRGs, and a poorer outcome, compared with patients of higher volume orthopedic surgeons. Pearson correlation showed an inverse relationship between cost per patient and physician volume for nonemergency patients -0.201 (P less than .0001), and emergency patients, -0.321 (P less than .0001). Although the reasons for these findings appeared multifactoral, they raise important issues related to orthopedic surgical hospital costs, access, and quality of care. In addition, they suggest that hospital cost for these patients (and perhaps outcome) may be related to orthopedic surgical volume, and that DRG hospital payment (on the margin) may affect future orthopedic surgical practice opportunities.

Academic Medical Centers↗
PubMed1999

A survey of the ethnic and racial distribution in orthopedic residency programs in the United States.

This study examined the racial and ethnic composition of orthopedic training programs in the United States. A questionnaire was mailed in January 1995 to chairpersons at 159 orthopedic programs in the United States. Eighty-nine (56%) responses were received. The distribution of orthopedic residents and fellows was as follows: white non-Hispanic, 84.2%; Asian, 6.6%; African American, 3.6%; Native American, 2.2%; Puerto Rican, 1.2%; Mexican American, 0.8%; and other Hispanic, 1%. African Americans and Hispanics were under-represented in orthopedic training programs compared with their numbers in the general population. The percentage of residents in these two minority groups also were below goals established by the Council on Graduate Medical Education and the US Government's Healthy People 2000 report. In contrast, Native Americans and Asians were overrepresented. If racial balance is to be achieved in orthopedics, new incentives must be created to encourage more African Americans and Hispanics to enter orthopedic residency training programs.

Black or African American↗
PubMed2000

A review of orthopedic injuries in three recent U.S. military conflicts.

We conducted a retrospective review of all patients with orthopedic injuries evacuated to a single medical center to evaluate the treatment and outcome of these injuries in three recent U.S. military conflicts: Operation Urgent Fury (Grenada), Operation Desert Shield/Storm (southwest Asia), and Operation Restore Hope (Somalia). Sixteen orthopedic casualties were originally treated at the medical detachment in Grenada before evacuation to the medical center. Most of these injuries were gunshot wounds to the extremities (11), with three known open fractures. Two patients (three extremities) sustained traumatic amputation (19% amputation rate). One hundred eighty-one patients with orthopedic injuries were medically evacuated from southeast Asia to the medical center for definitive treatment. Of these injuries, there were 143 fractures in 69 patients. One hundred of these fractures were open fractures, and 60% of these injuries were blast injuries. Furthermore, there were 26 amputations (14%). Twenty-two patients with orthopedic injuries were treated in Somalia and evacuated to the medical center. Thirteen of the 22 patients (59%) sustained gunshot wounds, and 2 (9%) sustained blast injuries. There were eight open fractures (36%) and three amputations in two patients (14%). Three of the 22 patients underwent successful limb salvage when ablation was the only other surgical alternative. It appears that a large percentage of medical center evacuations from military conflicts are for orthopedic injuries. Many of these injuries are the result of high-velocity weapons or blast injuries. Regardless of the size and/or purpose of the intervention, similar injury patterns and severity can be expected, because 51% of orthopedic patients had open fractures. Similarly, the rate of amputation associated with extremity trauma has not varied significantly since the Vietnam War.

Amputation, Surgical↗
PubMedDate not supplied

A survey of occupational blood contact and HIV infection among orthopedic surgeons. The American Academy of Orthopaedic Surgeons Serosurvey Study Committee.

OBJECTIVE: To study the seroprevalence of human immunodeficiency virus (HIV) among orthopedic surgeons, and correlate the results with occupational and nonoccupational risk factors. Orthopedic surgeons are one of several groups of health care workers at risk for occupationally acquired HIV infection; however, few HIV seroprevalence studies in health care workers, and none in surgeons, have been performed to assist in estimating the extent of occupational risk. DESIGN: A voluntary, anonymous HIV serosurvey at an annual meeting. To assess the representativeness of participants, a mail survey of orthopedic surgeons was conducted 5 months prior to the annual meeting. SETTING: The 1991 annual meeting of the American Academy of Orthopaedic Surgeons held in Anaheim, Calif. PARTICIPANTS: United States or Canadian orthopedic surgeons in training, in practice, or retired from practice who attended the annual meeting. MAIN OUTCOME MEASURES: Participants' HIV serostatus and reporting of occupational and nonoccupational risk factors for HIV infection. RESULTS: Of 7147 eligible orthopedists at the annual meeting, 3420 (47.9%) participated. Compared with the 10,411 orthopedic surgeons responding to the mail survey, serosurvey participants had at least as many opportunities for occupational contact with blood and with HIV-infected patients. Among participants, 87.4% reported a blood-skin contact and 39.2% reported a percutaneous blood contact in the previous month. Among 3267 participants without reported nonoccupational risk factors for HIV infection, none was positive for HIV antibody (0%; upper limit of the 95% confidence interval [CI] = 0.09%); among 108 participants with reported nonoccupational HIV risk factors, two were positive for HIV antibody (1.9%; upper limit of the 95% CI = 5.7%). CONCLUSION: Although these findings may not be generalizable to all orthopedic surgeons, we found no evidence of HIV infection among serosurvey participants without nonoccupational risk factors. The high rates of self-reported blood contact underscore the importance of compliance with infection control precautions and of development of new techniques and equipment to minimize the risk of exposures to blood during surgical procedures.

Adult↗
PubMed1982

A family practice orthopedic trauma clinic.

In order to help provide care for acute orthopedic injuries to a portion of a military patient population and to add simultaneously a new aspect to the orthopedic rotation of family practice residents, a family practice orthopedic trauma clinic, staffed solely by family physicians, was initiated, and the records for six months were examined and summarized. A total of 540 patient visits, 286 (52.9 percent) of whom were adults during 45 sessions of this clinic were noted. Fractures accounted for 79.2 percent of the injuries, while sprains and contusions accounted for 17.7 and 3.1 percent, respectively. The most frequent injuries were fractures of the radius, fractures of hand phalanges, and ankle sprains. Orthopedic consultation was obtained at 88 (16.2 percent) of the patient visits. The results of this study indicate that family physicians can effectively manage the majority of nonsurgical, acute orthopedic injuries and that a clinic of this type may be a valuable addition to the orthopedic rotation of a family practice residencies.

Adolescent↗
PubMed1977

Orthopedic practice and training of family physicians: a survey of 302 North Carolina practitioners.

A mailed survey questionnaire was distributed to the North Carolina Academy of Family Physicians to assess their orthopedic training and their opinions of the orthopedic training of resident physicians in family practice. Approximately 300 questionnaires were analyzed and the spectrum of orthopedic activities in office, hospital, and community were tabulated. There was no significant geographic variation in practice within the state for these variables, but there were statistis in their management and referral practice of several patient problems. Seventy percent of respondents thought that their training in orthopedics was appropriate to their present practice, but half felt that their training was inadequate. Most of the respondents (57 percent) had less than one month of postgraduate training in orthopedics. The majority (68 percent) recommended some postgraduate training in orthopedics, with about 50 percent recommending one to three months of postgraduate training. The mail survey questionnaire is proposed as a useful aid in curricular design in family practice.

Education, Medical↗
PubMed1997

Evaluation of critical postoperative situations in orthopedic patients.

Most orthopedic surgery is elective. Even in the severely traumatized patient, orthopedic surgery is carried out after the patient's general condition stabilizes. Critical postoperative situations are still problems in orthopedic surgery. From November 1992 through May 1995, 7,325 patients were admitted to the orthopedic ward at the National Taiwan University Hospital and underwent surgery. We present a retrospective study of 78 postoperative orthopedic patients who were admitted to a surgical intensive care unit (ICU) during this period. Fourteen of these became vegetative or died. The patients admitted to an ICU were categorized into four groups, based on the type of surgery: arthroplasty (13 patients), spinal surgery (50), fracture other than spine (13), and others (2). The causes of ICU admission in each group were analyzed. The following operations were found to carry a high risk of postoperative complications: revisional total hip arthroplasty (one of four ICU-admitted patients died); debridement for infected total hip arthroplasty (two of two died); bilateral total knee arthroplasty (two of four died); and debridement of spinal infection (three of five died). The associated risk factors for ICU admission were: old age, underlying medical disease, pulmonary embolism in multiple fracture, respiratory compromise in spinal surgery, and massive blood loss. Great care should be taken when performing orthopedic surgery on patients with these risk factors.

Adult↗
PubMed1998

Orthopedic residents' perceptions of the content and adequacy of their residency training.

The content and adequacy of orthopedic surgery residency training can be evaluated by several means. The Accreditation Council for Graduate Medical Education and the Residency Review Committee set standards with which residency programs must comply in order to be accredited. Residents' perceptions of the content and adequacy of their training is another means of evaluating orthopedic residency training. A questionnaire was sent to all graduating orthopedic residents in the United States, Canada, and Puerto Rico. The questionnaire provided program and individual resident demographics, as well as the residents' rating of specific areas of residency training on a 5-point scale (1=superior, 2=above average, 3=average, 4=below average, 5=inadequate). Completed surveys were received from 454 of the 698 graduating orthopedic surgery residents listed by the American Academy of Orthopaedic Surgeons; the response rate was therefore 65.0%. Our respondents were representative of the entire population in terms of geographic and sex distribution. Respondents rated their general orthopedic training at 1.9. The areas of training that had the best ratings included trauma/fracture (1.8), adult reconstruction (1.9), and pediatrics (1.9). The worst rating was reported for training in foot and ankle (2.7). Factors related to better ratings for general orthopedic training included male sex of residents, programs with more full-time faculty, programs with more hours of weekly teaching conferences, programs with one or more faculty present at all teaching conferences and programs in which residents first operate independently at or before postgraduate year 4. Sixty-six percent of all respondents were planning to hold a fellowship immediately after graduation. The most common fellowships taken included sports medicine (20.5% of all respondents), hand (12.1%), and spine (9.5%). Younger graduating residents, those from larger programs (more residents per year), and those from the Mideast (U.S.), and New England regions were most likely to enter a fellowship after graduation.

Adult↗