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Objectives The policies regarding resident physician work hours are constantly being evaluated and changed. However, the results of randomised control trials (RCTs) are mixed. This systematic review of RCTs aims to synthesise the evidence associated with resident duty hour restrictions and its impact on resident‐ and patient‐based outcomes. Methods A comprehensive search of the Cochrane Library, EMBASE and PubMed was conducted from inception until 31 July 2020. Any RCT evaluating the impact of longer resident physician work hours compared to shorter resident physician work hours on resident‐ and patient‐based outcomes was eligible for inclusion. Two reviewers extracted data independently. The primary outcome was the impact of resident duty hour restrictions on emotional exhaustion, depersonalisation and personal accomplishment, as defined by the Maslach Burnout Inventory. The secondary patient‐related outcomes were patient hospital length of stay, serious medical errors and preventable adverse events. Data were pooled using a random‐effects model. Results Of the 873 references, nine RCTs met the inclusion criteria. A shorter shift length compared with longer shift length was associated with significantly less emotional exhaustion (standardised mean difference [SMD] = −0.11, 95% CI = −0.21, −0.00) and less dissatisfaction with overall well‐being (OR = 0.61, 95% CI 0.38, 0.99) but not with hospital length of stay (SMD = −0.01, 95% CI = −0.05, 0.02, p = 0.45) and serious medical errors per 1000 patient hours (OR = 1.07, 95% CI = 0.52, 2.21; p = 0.86). Conclusions Shorter resident duty hours is possibly associated with improvement in resident‐based outcomes, specifically, emotional exhaustion, dissatisfaction with overall well‐being, sleep duration and sleepiness. These findings may inform the policy change in support of reduced shift hours resulting in overall well‐being for the residents with possible reduction in burnout without adverse impact on patient‐based outcomes.

Pectoralis major (PM) tears are a rare injury, that commonly occurs at the sternocostal head and has a greater incidence in men, with only two previously reported cases in young and middle-aged women. The authors report a complete PM tear that occurred in a 23-year-old woman, that presented after performing a ‘muscle-up’. MRI revealed PM rupture at the humeral insertion. Surgical management was performed, and patient returned to high-intensity interval training at 11 months postoperatively and reported great satisfaction. This is the first case in literature that reports a complete tear of the PM in a young woman through an atraumatic mechanism of injury with no previous alteration to the PM. With a cultural increase in wellness, atraumatic PM tear in young women should be expected and remain on the differential for any athlete that participates in high-intensity interval training.

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Objectives: Orthopedic surgery residency is considered one of the most competitive specialties in which to match. Studies examining the factors associated with a successful match have neglected whether participation in an orthopedic interest group (OIG) improves the chances of orthopedic residency match. The goal of this study was to test the hypothesis that participation in the OIG would improve matching into an orthopedic surgery residency. Methods:We performed a retrospective cohort study between May 2017 and 2019 at one state-funded medical school. All of the applicants in orthopedic surgery from 2004 to 2019 were identified and contacted for OIG membership status. The Office of Student Affairs provided academic performance data (US Medical Licensing Examination scores and third-year clinical clerkship grades), Alpha Omega Alpha and Gold Humanism Honor Society status, and demographics (race and sex) of applicants.Results: Between 2004 and 2019, 67 students (56 OIG and 11 non-OIG) applied for orthopedic surgery residency match. The match rate for the OIG was 86% compared with 64% for the non-OIG group, resulting in an adjusted odds ratio (adjusted for academic performance) of 10.23 (95% confidence interval 1.14-92.3, P = 0.038).Conclusions: OIG membership was associated with a significantly higher rate of orthopedic surgery residency matches. The higher rate of match associated with OIG membership may be the result of opportunities to diversify a residency application. Future studies are needed to further evaluate the potential association between OIG involvement and orthopedic surgery match.

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Background: Metacarpal factures are common, comprising up to 50% of hand fractures. More work is needed to further our understanding of metacarpal anatomy to improve fixation techniques and reduce postoperative complications following surgical implants. The purpose of this anatomic study was to evaluate the length, midshaft metaphyseal width, and area of the articular surface of the head (AH) and base (AB) of metacarpals 1 to 5. Methods: This prospective study assessed measures from 17 cadavers at 1 institution’s anatomy lab. The anatomic dimensions of the metacarpals in both the right and left hands were measured. Epidemiological data including sex and age at death were also collected. Results: In all, 29 hands were dissected for metacarpal anatomic measurements, for a total of 145 metacarpals. The second metacarpal was longest, at 69.58 mm. Multivariate analysis of variance revealed a significant effect of sex overall, with greater metacarpal dimensions in men. Increasing age was associated with decreasing dimensions, except for AH of metacarpal 1 ( F = 3.43, P = .02) and AB of metacarpal 1 ( F = 11.54, P < .001) and 4 ( F = 4.21, P = .01). Multiple metacarpal dimensions were also significantly correlated with each other. Conclusion: Our data reveal further information regarding metacarpal dimensions of length, midshaft width, and AH and AB. The results allow for potential to improve surgical management through improving metacarpal implants, developing an optimal plate and screw design, techniques to better accommodate anatomical differences based on age and sex, reducing postoperative complications and improving the standard of care.

Sarcomas are connective tissue tumors accounting for only 1% of all adult malignancies. Leiomyosarcoma (LMS) is a sarcoma arising from smooth muscle cells, and accounts for 10-20% of all sarcomas. A subtype of LMS are those originating from the smooth muscle of blood vessels. Leiomyosarcoma of the inferior vena cava is a sarcomatous tumor, with less than 350 cases described in the literature. It carries a poor prognosis, with 5- and 10-year survival rates of 31.4% and 7.4%, respectively. We present a case of a 46-year-old female with no significant past medical history presented to the emergency department with mild abdominal pain and distention, early satiety, and weight loss for three weeks, found to have unresectable metastatic leiomyosarcoma of the inferior vena cava.