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Background: The American Academy of Orthopaedic Surgeons has adopted the strategic goal of evolving its culture and governance to become more strategic, innovative, and diverse. Given the charge to increase diversity, a focus on assessing and increasing diversity at the faculty level may help this cause. However, an analysis of gender and racial diversity among orthopaedic faculty has not been performed. The purpose of this study was to evaluate faculty appointments for underrepresented minority (URM) and female orthopaedic surgeons. We also aim to draw comparisons between orthopaedic surgery and other specialties. Methods: Data on gender, race, and faculty rank (clinical instructor, assistant professor, associate professor, and professor) of academic faculty for 18 specialties from 1997 to 2017 were obtained from the Association of American Medical Colleges (AAMC) Faculty Roster. Assistant professors were designated as junior faculty, whereas associate professor and professor were considered senior faculty. URMs were defined using the AAMC definition—groups having lower representation than in the general population. Regression analysis was used to evaluate and compare the change over time and to compare the change across different specialties. Results: Over the 20-year study period, the number of female faculty increased (8.8% pts) but represents a lower proportion than other specialties (13.9% pts) (p = 0.029). Female orthopaedic senior faculty grew slower (7.3% pts) than other specialties (14.7% pts) (p < 0.001). There was no difference in the growth of URM faculty positions (2.0% pts) compared with all other specialties (2.4% pts) (p = 0.165). The proportion of orthopaedic URM senior faculty increased less (0.5% pts) than other specialties (2.5% pts) (p < 0.001), whereas more orthopaedic URM junior faculty were added than other specialties (2.2% pts) (p = 0.012). Conclusions: Although orthopaedic surgery has increased the representation of female and URM faculty members, it continues to lag behind other specialties. In addition, fewer female and URM orthopaedic faculty members obtained senior faculty status than other specialties. To address the differences seen in faculty diversity, a concerted effort should be made to recruit and promote more diverse faculty, given similar qualifications and capabilities. Level of Evidence: Prognostic Level IV .

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Complex elbow instability consists of dislocation of the ulnohumeral joint with a concomitant fracture of one or several of the bony stabilizers of the elbow, including the radial head, proximal ulna, coronoid process, or distal humerus. Recurrent instability is not often associated with simple dislocation, but an improperly managed complex dislocation may be a prelude to chronic, recurrent elbow instability. Complex instability is significantly more demanding to manage than simple instability. Radial head, coronoid, and olecranon fracture associated with dislocation each must be assessed and often require surgery. Longterm outcome with surgical management of complex elbow injuries is unknown. A few published series examine combinations of different injury patterns managed with various methods. Recently, however, several well-designed prospective outcome studies have evaluated management of several different individual fracture-dislocation patterns with a unified treatment algorithm. Fixation or replacement of injured bony elements, ligamentous repair, and hinged fixation may be used to successfully manage complex elbow instability. E lbow instability may occur after any one of a large group of diverse injuries, such as a fall on an outstretched hand, motor vehicle accident, or direct trauma, resulting in fractures or dislocations. Instability may be categorized anatomically as simple (with no associated fracture) or complex (with associated fracture) or chronologically as acute, chronic, or recurrent. These categories are not mutually exclusive. The elbow is one of the most commonly dislocated joints in the body, with an average annual incidence of acute dislocation of 6 per 100,000 persons. 1 Simple dislocations, which are much more common than complex dislocations, are described by the direction of the dislocated ulna. Posterolateral dislocation is the most common simple dislocation. 2 Complex dislocations may include fracture of the radial head, coronoid process, olecranon, or distal humerus. The risk of recurrent or chronic instability and posttraumatic arthrosis is increased significantly with complex dislocation. 3,4 Chronic unreduced dislocations and recurrent instability in complex injuries are very difficult to manage. In addition to surgical intervention, they often require the use of a hinged external fixator to hold the elbow in a reduced position. 5,6 Early clinical series laid the groundwork for understanding the natural history of fractures of the coronoid process and radial head with and without associated dislocation. 1,3,4,7-9 Recent clinical research has focused on outcomes of

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Open release of the transverse carpal ligament (TCL) has been the gold standard surgical treatment for patients with carpal tunnel syndrome over the past 50 years. Transecting the TCL with a scalpel under direct vision produces reliable symptom relief in the vast majority of cases. However, despite the clinical success of this technique, transient post-operative "pillar pain," scar tenderness, or weakness are known to occur in some patients.

Background Although pneumatic tourniquets are widely used in upper extremity surgery, further evidence is needed to support their safe use. Excessive pressure and prolonged ischemic time can cause soft-tissue injury. The purpose of this study was to determine the safety of tourniquet use in a yearlong, consecutive series of patients. Methods A retrospective review of all patients who underwent upper extremity surgery by two board-certified hand surgeons over a 1-year period was performed. Demographic variables, comorbidities, and complications were noted along with tourniquet parameters, including application site, ischemic pressure, and time. Results A total 505 patients were included in the study because a tourniquet was used during their operation. Patients ranged in age from 3 months to 90 years old (mean 40.1 years). More than half of the population was overweight (mean body mass index (BMI) 27.1), and 77.1 % of adults had at least one cardiac risk factor. No immediate or delayed tourniquetrelated injuries were identified. The average operative time was 35.9 min, with an average tourniquet time of 33.1 min.Tourniquet inflation pressure of 250 or 225 mmHg was utilized in 78 and 21 % of adult patients, respectively; no patients had a pressure setting exceeding 275 mmHg. Conclusion In this series of more than 500 operations, there were no immediate or delayed tourniquet-related events using parameters determined perioperatively by the attending surgeon. Tourniquet pressures of 250 mmHg or less in adult patients with less than 2 h of ischemic time appear to be safe, even in the elderly and patients with multiple medical comorbidities.

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