Hip fracture is a cause for concern in the geriatric population. It is one of the leading causes of traumatic injury in this demographic and correlates to a higher risk of all-cause morbidity and mortality. The Garden classification of femoral neck fractures (FNF) dictates treatment via internal fixation or hip replacement, including hemiarthroplasty or total hip arthroplasty. This review summarizes existing literature that has explored the difference in outcomes between internal fixation, hemiarthroplasty, and total hip arthroplasty for nondisplaced and displaced FNF in the geriatric population, and more specifically highlights the risks and benefits of a cemented vs. uncemented approach to hemiarthroplasty.

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Introduction: Scholarly impact has been used to measure faculty productivity and academic contribution throughout academia. Traditionally, the number of articles authored has been the primary metric for scholarly impact regarding academic promotion and reputation. We hypothesize that over time, the nature of authorship has evolved to include more authors per research article throughout the history of orthopaedic literature. Methods: Bibliometric data for all original research article abstracts were extracted from PubMED for the 10 highest rated H5-index orthopaedic clinical journals (“ American Journal of Sports Medicine ,” “ Journal of Bone and Joint Surgery American Volume ,” “ Clinical Orthopaedics and Related Research “ Spine ,” “ Knee Surgery, Sports Traumatology, Arthroscopy ,” “ Journal of Arthroplasty ,” “ Arthroscopy ,” “ The Spine Journal ,” “ European Spine Journal ,” and “ Journal of Bone and Joint Surgery British Volume/Bone & Joint Journal ”). The number of authors per article was then analyzed over time using the Cochran-Armitage trend test. Results: A total of 106,529 original articles were analyzed over a 70-year period. The number of authors increased significantly over time from a mean of 1.4 authors (SD: 0.62) in 1946 to 5.7 authors (SD: 3.1) in 2019, representing an average relative increase of 4.3% per year ( P < 0.05). The three oldest journals had the lowest average authors ( Journal of Bone and Joint Surgery Am Volume : 1946, mean 3.7 authors [SD: eight]; Journal of Bone and Joint Surgery Br Volume/Bone & Joint Journal : 1948, mean: 3.6 authors [SD: 7.5]; Clinical Orthopaedics and Related Research : 1963, mean 3.3 authors [SD: 2.9]). The three newest journals had the highest average authors ( European Spine Journal : 1992, mean 5.3 authors [SD: 3.3]; Knee Surgery, Sports Traumatology, Arthroscopy : 1993, mean 5.5 authors [SD: 6.7 authors; The Spine Journal : 2003, mean 5.2 authors [SD: 3.6]). Discussion: Original research articles published in orthopaedic academic journals have experienced an increase in authorship over time. Although our data cannot explain what has driven this change, increasing cooperation between collaborators may represent less contribution per author over time.

higher among those who failed TWOC (M[1.84, SD[0.76) than those who succeeded (M[1.29, SD[0.70; p <.001).CONCLUSIONS: 1 in 5 patients failed their initial TWOC. Higher pre-operative PVR is associated with an increased risk of failed TWOC following CWVTT.

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To explore the origins of circumcision and the use of anesthesia along the journey.METHODS: Literature review via PubMed journal articles, texts, and historical discussion detailing the evolution of circumcision and accompanying anesthesia throughout history.RESULTS: Earliest records of circumcision described religious rather than scientific rationale, marking a boy's ascension to manhood. Documentation of the earliest practices of anesthesiology are relevant to urology through these traditions. Circumcision is first noted in Egyptian temple hieroglyphics dated to 4000 BCE, depicting young men restrained with a priest performing the cut wielding a knife. As early as 2500 BCE, circumcision in ancient Egypt was the first known surgical procedure utilizing anesthesia. A mixture rendered from calcium carbonate and acetic acid formed carbon dioxide on the prepuce resulting in the first rendition of cryo-analgesia. Egypt was not the only African culture performing circumcision during this time period. Assyrian records dating back to 400 BCE describe a similar methodology, but also transcribed another primitive method of anesthesia. Assyrians utilized digital compression of the carotid arteries to produce anesthetic effects of both altered consciousness and decreased procedural pain. Carotid compression as anesthesia was commonplace enough that it influenced the language for which the carotid blood vessels are described in both Greek and Russian with translation as "The Artery of Sleep". As the practice was adopted by the Israelites, infant circumcision was acknowledged on the eighth day of life representative of the covenant between God and Abram. It is considered that this shift may have been related to a pubescent male's ability to refuse the religious covenant on the basis of the painful procedure, while an infant is unable to object. The Jewish tradition of brit milah utilizes a few drops of wine in the mouth of the infant, both as a form of analgesia and symbolic of the sealed covenant. It is hypothesized that the sugar interacts with the opiate receptors in the brain which is enhanced by the suckling action, providing comfort. Today, approximately 1 of 3 males worldwide are circumcised, with 55% of physicians performing infant circumcision choosing not to utilize any form of anesthesia, citing lack of necessity and anesthetic risk.CONCLUSIONS: Since their earliest documented history, anesthetic techniques have contributed to and been intertwined with the practices of circumcision.

Introduction: Circumcision is the oldest known recorded surgical procedure dating to at least 4000 BCE and held religious, cultural, and military significance. Preputial resection connoted contrasting meanings among different cultures; in some, circumcision was and remains an important transtion into infancy and then adulthood. In Bronze Age and early Egyptian cultures, however, circumcision was performed on vanquished enemies and improved upon the morbidity and mortality of phallic resectoin as a war trophy. The circumcision of Jesus was a significant subject for many Medieval and Renaissance artists who often portrated the event as an allegroical commentary on contemporary socio-political events. While there has been much literature, anthropological analysis, and art on circumcision, little is known about the anesthesia provided to those undergoing the procedure, especially those for whom the act was not a punitive militaristic procedure. We aimed to identify descriptions of the anesthesia provided to patients or victims undergoing circumcision and how the anesthesia may have evolved into the modern techniques used in the modern era. Sources and Methods: We performed a literature review via PubMed journal articles, texts, and historical discussions detailing the evolution of circumcision and accompanying anesthesia throughout history. Results: Earliest records of circumcision described religious rather than scientific rationale, marking a boy’s ascension to manhood. Documentation of the earliest practices of anesthesiology are relevant to urology through these traditions. Circumcision is first noted in Egyptian temple hieroglyphics dated to 4000 BCE, depicting young men restrained with a priest performing the cut wielding a knife. As early as 2500 BCE, circumcision in ancient Egypt was the first known surgical procedure utilizing anesthesia. A mixture rendered from calcium carbonate and acetic acid formed carbon dioxide on the prepuce resulting in the first rendition of cryo-analgesia. Egypt was not the only culture performing circumcision during this time period. Assyrian records dating back to 400 BCE describe a similar methodology, but also transcribed another primitive method of anesthesia. Assyrians utilized digital compression of the carotid arteries to produce anesthetic effects of both altered consciousness and decreased procedural pain. Carotid compression was commonplace enough that it influenced the language for which the carotid blood vessels are described in both Greek and Russian with translation as “The Artery of Sleep.” The Jewish tradition of brit milah utilizes a few drops of wine in the mouth of the infant, both as a form of analgesia and symbolic of the sealed covenant. It is hypothesized that the sugar interacts with the opiate receptors in the brain which is enhanced by the suckling action, providing comfort. Conclusions: Since their earliest documented history, anesthetic techniques have contributed to and been intertwined with the practices of circumcision.

Introduction The reported rate of urethral fistulas after female to male gender affirming surgeries (GAS) ranges from 10% to 68%. There remains a paucity of evidence addressing the widely accepted hypothesis that colpectomy reduces the risk of fistula formation. Objective We aim to use a meta-analysis to describe the correlation between colpectomy and the rate of urethral complications, including fistula and stricture after GAS in transgender men. Methods PRISMA guidelines were used to conduct a literature search of PubMed, Embase, Web of Science, and MEDLINE databases was conducted for studies containing words or synonyms for “trans-male”, “phalloplasty” or “metoidioplasty”, and “complications”. Inclusion criteria was specific for studies reporting postoperative incidence of urethral fistula and urethral stenosis or stricture. For those that met criteria, surgical technique, urethral complications, and outcomes were collected and analyzed using the random-effects model due to the heterogeneity of included study populations. Review Manager (Version 5.4.1) was used to perform subgroup meta-analysis between those GAS with prior or concurrent colpectomy or vaginectomy and those without. A p-value of &lt;0.05 was considered statistically significant. Results 43 full-text articles meet inclusion criteria with a total of 3,929 patients. 542 (14%) of patients underwent GAS without a prior or concurrent colpectomy and 3387 (86%) underwent GAS with a colpectomy. 637 (16%) underwent metoidioplasty and 2291 (68%) underwent phalloplasty; the rest were unable to be grouped. The pooled odds ratio (OR) for urethral fistula was 0.12 (95% CI [0.06-0.21], I2 =96%, p &lt;0.00001) and 0.07 for urethral stenosis (95% CI [0.03-0.15], I2 =96%, p &lt;0.00001). Fistula event rate of 23.7% (930/3929) was slightly larger than the urethral stenosis event rate at 21.3% (585/2751). The OR of urethral fistula was 0.06 for GAS associated with colpectomy, compared to 1.01 with no associated colpectomy (p &lt;0.00001, I2 =97%). The OR of urethral stenosis was 0.06 for GAS associated with colpectomy, compared to 0.16 with no associated colpectomy (p &lt;0.41). Further subgroup analysis by procedure, showed similar findings in those who underwent phalloplasty, however no difference in the OR of fistula formation in those who underwent metoidioplasty (p &lt;0.00001, p=0.33 respectively). There was no significance in the OR of urethral stricture after GAS with or without colpectomy. 5 studies showed a 100% success rate in ability to void while standing, all of which had associated colpectomy. No studies without colpectomy were available for comparison. Two studies reported a success rate of 71% and 16% showing the variability in success amongst institutions. Conclusions GAS in transgender men, including phalloplasty and metoidioplasty, with prior or concurrent colpectomy were associated with lesser odds of developing urethral fistula compared to GAS without colpectomy. There was no significant difference between the odds of urethral stricture formation in GAS with or without colpectomy. Disclosure No