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Purpose Clubfoot is the most common congenital foot deformity in children. Caregivers often seek medical information on the internet. The aim of the study was to characterize how social media is used by caregivers to access medical information. Methods A search was performed on Facebook, Twitter and YouTube platforms. Information was quantitatively assessed. Comments were qualitatively assessed, and the Kruskal-Wallis test was used to study thematic comment distribution. Results In total, 58 Facebook groups and pages, 109 YouTube accounts and ten Twitter accounts related to clubfoot were discovered from 2007 to 2019. Facebook groups and pages had a collective 56 123 members and 80 544 total likes, respectively. YouTube had a collective 3 280 454 views, with 54 969 total comments throughout the accounts. Comment themes most commonly included sharing information and advice (38.7%), appreciation and success stories (12.8%), emotional support (12.7%) and social media as a second opinion (11.9%). Facebook groups contained a significantly higher number of comments related to ‘social media as a second opinion’ compared with Facebook pages (p = 0.001), Twitter (p = 0.016) and YouTube (p < 0.0001) while YouTube contained a significantly lower number of comments related to ‘sharing information’ compared with Facebook groups, pages and Twitter (p < 0.0001). Conclusion Social media continues to be a growing tool for information sharing and the findings of this study highlight the importance placed by caregivers on the advice of their peers. The online presence of caregivers may represent an opportunity for orthopaedic surgeons to communicate with patients and help them make informed decisions. Level of evidence IV

Osteosarcoma (OS), the most common primary cancer of bone, exhibits a high propensity for local invasion and distant metastasis. This study sought to elucidate the role of S phase kinase-associated protein (Skp2) in osteosarcoma invasion and metastasis and to explore flavokawain A (FKA), a natural chalcone from kava extract, as a potential Skp2 targeting agent for preventing osteosarcoma progression. Skp2 was found to be overexpressed in multiple osteosarcoma cell lines, including 5 standard and 8 primary patient-derived cell lines. Patients whose tumors expressed high levels of Skp2 sustained a significantly worse metastasis-free (p = 0.0095) and overall survival (p = 0.0013) than those with low Skp2. Skp2 knockdown markedly reduced in vitro cellular invasion and in vivo lung metastasis in an orthotopic mouse model of osteosarcoma. Similar to Skp2 knockdown, treatment with FKA also reduced Skp2 expression in osteosarcoma cell lines and blocked the invasion of osteosarcoma cells in vitro and lung metastasis in vivo . Together, our findings suggest that Skp2 is a promising therapeutic target in osteosarcoma, and that FKA may be an effective Skp2-targeted therapy to reduce osteosarcoma metastasis.

In contrast to the well-described Tillaux fracture of the distal tibia, transitional fractures of the distal radius are exceedingly rare and have yet to be well described. Thus far, their presence in the literature has been limited to case reports and a singular series. None have involved a Salter-Harris III fracture pattern. We present the case of a 16-year-old male who sustained a Salter-Harris III transitional fracture of the distal radius with an associated ulnar styloid avulsion fracture secondary to a fall that was treated nonoperatively. Similar to the Tillaux fracture, examination of the distal radius transitional fracture should include computed tomography scan to better illustrate the pattern of injury and guide treatment.

Although several studies now support the use of aspirin for venous thromboembolism (VTE) prophylaxis in primary total hip arthroplasty (THA) and total knee arthroplasty (TKA), the optimal chemoprophylactic agent in revision THA and TKA is not clear. The purpose of this study was to determine if the type of chemoprophylaxis has an effect on the VTE rate in patients undergoing revision total joint arthroplasty (TJA). The second aim was to compare differences in rates of wound drainage in primary and revision TJA stratified by the postoperative chemoprophylaxis used. The authors retrospectively reviewed 1917 consecutive patients undergoing primary and revision TJA. Individual records were reviewed for patient demographics, medical comorbidities, type of chemoprophylaxis, VTE risk factors, intraoperative data, and postoperative complications. Outcomes, including VTE rate and wound complications, were compared between types of anticoagulant therapy used postoperatively. Of the 1917 patients, there were 742 (38.7%) primary TKAs, 326 (17%) revision TKAs, 608 (31.7%) primary THAs, and 241 (12.6%) revision THAs. The most common prophylactic agent used was rivaroxaban (40.6%), followed by warfarin (28.5%) and aspirin (27.6%). Type of chemoprophylaxis was not associated with postoperative VTE or wound drainage ( P >.05). Although revision surgery was an independent risk factor for wound drainage (odds ratio, 3.201; 95% confidence interval, 1.594–6.426; P= .001), it was not a risk factor for VTE (odds ratio, 1.847; 95% confidence interval, 0.423–8.053; P =.414). Revision arthroplasty alone was not associated with an increased rate of VTE. Aspirin is as effective as other chemoprophylactic agents without the increased risk of bleeding in low-risk patients. [ Orthopedics . 2019; 42(6):323–329.]

Developmental dysplasia of the hip (DDH) is a common orthopaedic condition affecting newborns. The rapid and vast adoption of social media has changed how we access medical information. The aim of this study was to deepen the understanding of the impact of social media as a tool used by caregivers. A search was performed on the Facebook (FB), Twitter (TW), and YouTube (YT) platforms. Information was quantitatively assessed by category, and number of posts and users. Comments and posts from the social medial platforms were then qualitatively assessed by using a thematic analysis. 16 Facebook pages and groups, 135 YouTube videos, and 5 Twitter accounts related to DDH were identified across 15 countries. A total of 25,471 comments/tweets were recorded. Across the social media platforms, the most common comments theme was “information sharing” (36.1%). Facebook groups had a significantly greater number of comments that were characterized as “social media as a second opinion” in comparison to YouTube videos (p < 0.001), whereas YouTube videos had significantly fewer comments characterized as “sharing information” in comparison to Facebook groups and Facebook pages (p < 0.0001). Orthopaedic surgeons may utilize caregiver presence on social media as an opportunity to help share accurate information and facilitate informed decision-making.

Background: In the modern digital age, patients are increasingly consulting online physician reviews prior to making healthcare decisions. Physician review websites are being used in many medical fields including orthopaedic surgery. The purpose of this study is to investigate trends in online physician reviews and determine which factors are most strongly correlated with the likelihood that an orthopaedic surgeon is to be recommended by patients. Methods: Healthgrades.com, the most comprehensive physician rating and comparison database, was queried for “orthopaedic surgery” in the state of New Jersey. Demographic information, fellowship training status, years of experience, malpractice/disciplinary actions, physician ratings and the likelihood to recommend score (LTRS) was collected for all physicians. Quantitative analysis was conducted using descriptive statistics, student t-test, and one-way ANOVA. Qualitative analysis of randomly selected positive comments and all negative comments was conducted. Common themes were identified using frequency-based word cloud generator. Results: 834 board certified orthopaedic surgeons (800 Males, 34 Females), with a mean age of 55.7±12.5 years and an average LTRS of 4.1±0.84 were included for analysis. Compared with non-fellowship trained orthopaedic surgeons, fellowship trained surgeons were more likely to be recommend by patients [3.8 vs. 4.3; P< 0.0001]. Physicians with waiting time <10min were more likely to be recommended compared with their counterparts with waiting time >10min (P< 0.0001). No differences were observed in LTRS between male and female orthopaedic surgeons (P= 0.79) or based on malpractice status (P= 0.61). Qualitative analysis of a randomly selected sample of 4,151 out of a total of 12,168 positive comments and 1,113 total negative comments revealed that positive comments centered on surgeon competence and professionalism, while negative comments centered on surgeon personality and waiting time. Conclusion: Orthopaedic surgeons have generally favorable ratings and mostly positive comments. Fellowship status and waiting time are important factors that impact LTRS. Patients were more likely to write positive comments about surgeon competence and professionalism, and negative comments pertaining to surgeon personality and waiting time. Knowledge of surgeon specific attributes that are important to patients may help educate orthopaedic surgeons to improve patient care, patient satisfaction and online ratings. Tables and Figures Figure 1. Word cloud of randomly selected positive comments with most frequent words centered around professionalism and surgeon competency; larger size indicates more frequent words.