Background Although women account for approximately half of the medical students in the United States, they represent only 13% of orthopaedic surgery residents and 4% of members of the American Academy of Orthopaedic Surgeons (AAOS). Furthermore, a smaller relative percentage of women pursue careers in orthopaedic surgery than in any other subspecialty. Formal investigations regarding the gender discrepancy in choice of orthopaedic surgery are lacking. Questions/purposes (1) What reasons do women orthopaedic surgeons cite for why they chose this specialty? (2) What perceptions do women orthopaedic surgeons think might deter other women from pursuing this field? (3) What role does early exposure to orthopaedics and mentorship play in this choice? (4) What professional and personal choices do women in orthopaedics make, and how might this inform students who are choosing a career path? Methods A 21-question survey was emailed to all active, candidate, and resident members of the Ruth Jackson Orthopaedic Society (RJOS, n = 556). RJOS is the oldest surgical women's organization incorporated in the United States. An independent orthopaedic specialty society, RJOS supports leadership training, mentorship, grant opportunities, and advocacy for its members and promotes sex-related musculoskeletal research. Although not all women in orthopaedic practice or training belong to RJOS, it is estimated that 42% of women AAOS fellows are RJOS members. Questions were formulated to determine demographics, practice patterns, and lifestyle choices of women who chose orthopaedic surgery as a specialty. Specifically, we evaluated the respondents' decisions about their careers and their opinions of why more women do not choose this field. For the purpose of this analysis, the influences and dissuaders were divided into three major categories: personal attributes, experience/exposure, and work/life considerations. Results The most common reasons cited for having chosen orthopaedic surgery were enjoyment of manual tasks (165 of

Objectives Prior studies of gender differences in AAA repair suggest there may be differences in presentation, suitability for EVAR, and outcomes between men and women. Methods We used the Vascular Study Group of New England database to identify all patients undergoing EVAR or open AAA repair (OAR). We analyzed demographics, comorbidities, and procedural, and perioperative data. Results were compared using Fisher’s exact test and student’s t-test. Multivariable logistic regression and Cox proportional hazards modeling was performed to identify predictors of mortality. Results We identified 4,026 patients who underwent AAA repair (78% male, 54% EVAR). Women were less likely than men to undergo EVAR for intact aneurysms (50% vs. 60% of intact AAA repairs of, P<.001) but not for ruptured aneurysms (26% vs. 20%, P=.23). Women were older (median age 75 vs. 72 years for intact, P<.001; 78 vs. 73 years for rupture, P<.001) with smaller aortic diameters (57 vs. 59mm for elective, P<.001; 71 vs. 79mm for rupture, P<.001). Arterial injury was more common in women (5.4% vs. 2.7%, P=0.013) among patients undergoing EVAR for intact aneurysms and women stayed in the hospital longer (4.3 vs. 2.7 days, P=.018) and had a lower odds of being discharged home, even after adjusting for age.. Among patients undergoing open repair for intact aneurysms, women more frequently experienced leg ischemia/emboli (4% vs. 1%, P=.001) and bowel ischemia (5% vs. 3%, P=.044). Women had higher 30-day mortality after OAR for both intact (4% vs. 2%, P=.03) and rupture (48% vs. 34%, P=.03) repairs. However, 30-day mortality after EVAR was similar for both intact (1% in men vs. 1% in women, P=.57) and rupture (29% in men vs. 27% in women, P=1.00) repairs. Late survival was worse in women than men only for patients undergoing open repair of ruptured aneurysms (HR 1.8, 95% CI 1.0–3.1, P=.04). After controlling for age, type of repair, urgency at presentation (i.e. elective/intact vs. ruptured), comorbidities, and other relevant risk factors, gender was not predictive of 30-day or 1-year mortality. Conclusion Women with AAA are being treated at older ages and smaller diameters, and undergoing rupture repair at smaller diameters than men. Women are more likely to experience perioperative complications as a result of less favorable vascular anatomy. Age >80 years, comorbidity, presentation, and type of repair are more important predictors of mortality than gender.

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BackgroundScaphoid fractures are commonly seen in orthopedic practice. An organized and thoughtful approach to diagnosis and treatment can facilitate good outcomes. However, despite optimal treatment, complications may ensue. In the setting of nonunion or an avascular proximal pole, vascularized bone grafting may be needed.Methods and resultsIn this article we review the literature regarding these injuries and describe an approach to diagnosis, treatment, and management of scaphoid fractures and nonunions.ConclusionScaphoid fractures and nonunions may present as challenging problems in practice, but a systematic and deliberate approach can facilitate optimal results.

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Atlantic herring (Clupea harengus) embryos were exposed to water accommodated fractions (WAFs; oil dissolved in water) and chemically enhanced water accommodated fractions (CEWAFs; oil dispersed in water with Corexit 9500A) of Medium South American (MESA) crude oil. The CEWAF was approximately 100-fold more toxic than WAF based on nominal loadings of test solutions (% v/v). In contrast, the ratio of WAF and CEWAF toxicity expressed as measured oil concentrations approximated 1.0, indicating that the higher toxicity of CEWAFs was caused by an increase in exposure to hydrocarbons with chemical dispersion. In a second experiment, the chronic toxicity of Corexit 9500A and chemically dispersed heavy fuel oil 7102 (HFO 7102) to rainbow trout (Oncorhynchus mykiss) embryos was compared to chemically dispersed Nujol, a nontoxic mineral oil. Dispersant alone was toxic, but caused different signs of toxicity than HFO 7102. Nujol at a dispersant-to-oil ratio of 1:20 was nontoxic, suggesting that dispersant was sequestered by oil and not present at toxic concentrations. In contrast, the same nominal loadings of dispersed HFO 7102 caused concentration-dependent increases in toxicity. Both experiments suggest that chemically dispersed oil was more toxic to fish embryos than solutions created by mechanical mixing due to the increased exposure of fish to petroleum hydrocarbons and not to changes in hydrocarbon toxicity. The Nujol control discriminated between the toxicity of oil and chemical dispersant and would be a practical addition to programs of dispersant testing.

The present study isolated and identified compounds in heavy fuel oil 7102 (HFO 7102) that are bioavailable and chronically toxic to rainbow trout embryos (Oncorhynchus mykiss). An effects-driven chemical fractionation combined the chemical separation of oil with toxicity testing and chemical analyses of each fraction to identify the major classes of compounds associated with embryo toxicity. Toxicity was assessed with 2 exposure methods, a high-energy chemical dispersion of oil in water, which included oil droplets in test solutions, and water accommodated fractions which were produced by oiled gravel desorption columns, and which did not contain visible oil droplets. Fractions of HFO with high concentrations of naphthalenes, alkanes, asphaltenes, and resins were nontoxic to embryos over the range of concentrations tested. In contrast, fractions enriched with 3- to 4-ringed alkyl polycyclic aromatic hydrocarbons (PAHs) were embryotoxic, consistent with published studies of crude oils and individual alkyl PAHs. The rank order of fraction toxicity did not vary between the exposure methods and was consistent with their PAH content; fractions with higher-molecular weight alkyl PAHs were the most toxic. Exposure of juvenile trout to most fractions of HFO induced higher activities of cytochrome P450 enzymes, with a rank order of potency that varied with exposure method and differed somewhat from that of embryotoxicity. Induction reflected the bioavailability of PAHs but did not accurately predict embryotoxicity.

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