Background:Musculoskeletal (MSK) disorders are one of the most common causes of disability and emergency department and physician visits in the United States. However, there is very little consistency in how physicians in training are prepared to treat MSK disorders. On the basis of published reports, medical school graduates have a relative lack of cognitive mastery in MSK medicine, even with the recent increase in instruction. This study sought to compare MSK education at an allopathic medical school with that at an osteopathic medical school.Methods:An anonymous survey of students in medical school graduate years 2, 3, and 4 at Michigan State University College of Human Medicine (allopathic) and College of Osteopathic Medicine (osteopathic) was conducted. Questions were structured into three main categories: demographic information, content of the current MSK curriculum, and opinions regarding importance, instruction, and assessment of MSK education.Results:As of 2010, 83% of medical schools require MSK courses because of the United States Bone and Joint Initiative to incorporate such coursework into core curriculum. Yet only 54% of surveyed students thought that their MSK education was adequate. A greater portion of osteopathic students (57.1%) compared with allopathic students (26.8%) thought that their MSK curriculum is adequate, and as a consequence, 36.6% of allopathic students thought that they were inadequately prepared for the MSK content of US medical licensing examinations compared with 8.1% of osteopathic students. Further curriculum development and improvement is needed to advance physicians' abilities to address and treat MSK disorders. Medical students surveyed feel that this goal can be accomplished by emphasizing MSK education in third and fourth years of medical school.Conclusion:These findings highlight differences in MSK education between an allopathic and osteopathic medical school. Further standardization of the curriculum in medical schools may help improve the quality of teaching student comfort levels of new physicians.Level of Evidence:Level III

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Introduction: Reverse shoulder arthroplasty (RSA) has seen exponential growth over the past 2 decades. In addition, the recent focus on opioid usage and dependence has led to an increased understanding of the risk factors that lead to dependence. The purpose of this study was to examine associations between diagnosis and opioid consumption and dependence in RSA. Methods: A retrospective review was performed of 441 patients who had undergone a primary RSA from 2012 to 2016. Demographics were collected and patients were categorized based on top 4 diagnoses: glenohumeral osteoarthritis (n ¼ 129), irreparable rotator cuff tear (n ¼ 85), rotator cuff arthropathy (RCA) (n ¼ 184), and proximal humerus fracture (n ¼ 69). Opioid consumption within 90 days surrounding surgery was recorded from Prescription Drug Monitoring Programs. Logistic regression was performed. Results: Baseline characteristics for sex (P ¼ .0001), ethnicity (P ¼ .04), age (P ¼ .01), and preoperative opioid use (P ¼ .029) were significantly different. Patients with osteoarthritis had the lowest preoperative total morphine equivalents (TMEs) at 22.82 compared with fractures (53.36, P ¼ .02) and RCA (46.54, P ¼ .02). There was no significant difference in preoperative opioid dependence based on diagnosis (P ¼ .16); however, postoperatively, the RCA group had the highest dependence at 40.3% (P ¼ .03). In addition, there were no significant differences postoperatively in TMEs prescribed (P ¼ .197). The preoperatively dependent patients were 8 times more likely to remain dependent regardless of diagnosis. Conclusion: Patients with fractures consume the highest amounts of opioids surrounding surgery. Surgeons should tailor their preoperative education and pain management protocols accordingly based on diagnoses for RSA. In addition, increased awareness and protocols need to be implemented for preoperative opioid-dependent patients regardless of diagnosis.

Histoplasma capsulatum periprosthetic knee infection has rarely been reported in the literature due to its low frequency. Notwithstanding, it is important to keep it among the differential diagnoses to avoid delays in treatment. The current report presents the case of infectious knee monoarthritis in an immunocompetent patient after unicompartmental knee arthroplasty. The joint infection was accompanied by disseminated histoplasmosis, which initiated an autoimmune reaction, ensuing a systemic inflammatory response syndrome. The management protocol used in this case was successful and included staged arthroplasty reconstruction combined with chronic antifungal and steroid pharmacotherapy. Approximately 4 years after total knee arthroplasty revision, there were no clinical signs of localized or systemic infection.

Introduction: Hospital readmissions after elective shoulder arthroplasty represent a costly burden to the health-care system due to the rising demand for this procedure. Nevertheless, the reasons for readmissions remain inconclusive. Therefore, the main purposes of the current investigation were to determine (1) the readmission rates within 90 days after shoulder arthroplasty, (2) the reasons behind those readmissions, and (3) the characteristics of readmitted patients. Methods: A retrospective review was performed on 184 patients who underwent total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA) performed by a single surgeon at a single institution between 2010 and 2016. The readmissions that occurred within 90 days after surgery and their reasons were noted. Patient characteristics were compared between readmitted and non-readmitted patients. Results: Overall, 7.1% of patients were readmitted within 90 days after shoulder arthroplasty. However, patients with a previous surgery on the same shoulder of the TSA or RSA had a higher rate (13.5%) than patients without a previous surgery (5.4%). Readmission rates for TSA and RSA were virtually identical. Most readmissions were due to surgical (69.2%) rather than medical complications (30.8%). The most common reasons for readmission were surgical-site infection and deep vein thrombosis. There were no statistically significant differences between the baseline patient characteristics of readmitted and non-readmitted patients. However, the proportion of males (69.2%) was more than twice the one of females (30.8%) among readmitted patients. Conclusion: The readmission rate within 90 days after surgery was relatively low among patients who underwent either a TSA or RSA at our institution. Surgically related causes were largely responsible for readmissions.

Magnets are found commonly in children's toys and pose a risk of ingestion. Rare earth-transition metal magnets, such as ironneodymium, have a much greater coercivity than normal magnets. 1 Hence their ingestion is more likely to cause bowel injury. There have been a few case studies describing magnetic attraction between adjacent loops of bowel leading to pressure necrosis and perforation. [2][3][4][5][6][7] There is limited information on surgical technique and precautions in such cases. We report a case of bowel perforation following neodymium magnet ingestion and the operative approach.A 10-year-old boy presented to the emergency department with 24 h of colicky central abdominal pain with associated nausea. His abdomen was soft and non-tender without signs of peritonism. The blood results were normal. The impression was gastroenteritis.He represented 5 days later with persistent colicky abdominal pain. On further questioning he admitted to swallowing seven neodymium magnetic ball-bearings, on two separate occasions, 7 days ago. His abdomen was mildly distended with peri-umbilical tenderness. A plain abdominal radiograph showed metallic foreign bodies in the upper central abdomen (Fig. 1). He was observed overnight, but the abdominal pain progressed and there was evidence of peritonism. Repeat abdominal X-ray showed the magnets to be in the same position. There was concern that the magnets in adjacent loops of small bowel had united together causing pressure necrosis of the bowel wall.He came forward for an emergency laparotomy. This revealed fistulization of three magnetic balls between the proximal jejunum and the transverse colon (Fig. 2). The magnets were adherent and had necrotized and perforated through the bowel wall. The magnets were removed to find seven perforations in total, all of which were oversewn. The extracted magnets were then placed in the cut end of a glove and run over the bowel (Fig. 3). There was resistance over the second part of the duodenum and a further four magnetic balls were removed via an enterotomy. The duodenum was then oversewn. An intraoperative radiograph was performed and this did not show any further foreign bodies. The patient had a good recovery and was discharged on day 5 post operation.A recent systematic review found 98 cases of magnet ingestion in 17 countries. Ninety-six of these had resulted in bowel injury requiring bowel resection or fistula repair. In all such cases there were varying degrees of delay in diagnosis and treatment. 2 Direct questioning about foreign body ingestion may help in early diagnosis, however the history maybe unreliable in children because of their age and unwillingness to admit to foreign body ingestion. 8 Appropriate and timely imaging may be the only way of identifying magnet ingestion. 4 There is a high risk of bowel injury if more than one magnet has been ingested; hence early surgical intervention is indicated. 2,4-7 Fig. 1. Radiograph of ingested magnetic balls. Fig. 2. Fistulization of a magnet through the transverse colon.

Objectives: Patients now have longer life expectancies and more active lifestyles which is driving the growth and use of regenerative medicine. Definitions of regenerative medicine (RM) vary, with much of the public having an incomplete understanding of what regenerative medicine means or the science behind these therapies. The purpose of this study was to assess patient perceptions and understanding of the role of regenerative medicine in treating musculoskeletal problems. Methods:This cross-sectional study consisted of an anonymous self-administered survey designed to assess patient perceptions, knowledge and attitudes toward regenerative medicine and its application in sports medicine of 150 participants. The demographic information and participant's knowledge and conceptions of regenerative medicine were surveyed from patients in an orthopedic surgery department at a single institution. Descriptive statistics were used to report survey data. Analyses were performed based on demographic variables using independent t-test and an analysis of variance (ANOVA).Results: Of the survey takers, 70% viewed RM therapies positively. Participants with a positive view scored significantly higher in all aspects of the survey including effectiveness in the clinical setting (p<0.05) and the likelihood to use or recommend RM therapies (p<0.05). Older Participants (over 54years) scored higher for basic knowledge on RM (3.63; p=0.02). Participants with personal experience with RM had a more positive response when asked if it helps their condition (3.87 vs. 3.38; p=0.01) and were more comfortable recommending it to others (3.83 vs. 3.41; p=0.04). Conclusion:Overall, participants had a moderate level of understanding and positive perception of the effectiveness of RM therapies. Our results showed participants had a positive view of these treatment modalities despite the literature not supporting the effectiveness of these therapies. More research should be dedicated to this area of medicine given the public interest and desire for RM treatments.