BACKGROUND: Medical supervisors struggle to find meaningful ways to evaluate the preparedness of trainees to independently perform patient care tasks. The aim of this study was to describe the factors that influence how attending and resident physician perceptions of trust impact decision making.

From 2003 to 2013, the percentage of fellowship-trained applicants taking the American Board of Orthopaedic Surgery Part II examination gradually increased to 90%. In the same time period, fellowship-trained surgeons performed an increasing proportion of procedures within their area of subspecialty training. Orthopaedic graduates have become increasingly subspecialized over the past decade.

Tibial plateau fractures are common orthopedic injuries and represent a spectrum of injury severity defined by the fracture morphology and the associated soft tissue injury. The management of tibial plateau fractures is challenging, and patients are at risk for adverse outcomes including infection, malunion, nonunion, and stiffness. Accurate diagnosis and early management can mitigate the impact of these complications. When complications do occur, a principle-based approach outlined in this review can minimize the burden to patients in their return to function.

T he role of irrigation and debridement, modular exchange, and implant retention for the treatment of periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) remains controversial. The proposed benefits of debridement, antibiotics, and implant retention, often referred to as DAIR, include reduced economic cost and morbidity of 2-stage reimplantation 1. The primary disadvantage of this approach is a higher rate of failure and infection recurrence 2,3. Furthermore, several authors have demonstrated inferior outcomes of 2-stage exchange revision arthroplasty after a failed attempt at limited debridement with implant retention 4-6. Because of study heterogeneity, the outcomes of acute PJI treatment with irrigation and debridement and implant retention have been variable in the literature, with reported success rates ranging from 16% to 100%; overall, the success rate is around 50% 3,7,8. Recently, studies evaluating outcomes of DAIR have indicated that host factors, organism type, the timing of intervention, and the duration of symptoms can influence the likelihood of success with this approach 7,9-12. DAIR may be considered for all patients with early postoperative PJI or an acute hematogenous infection in the context of well-fixed implants and a healthy soft-tissue envelope. Chronic PJI should be considered an absolute contraindication to DAIR 13. The patient's health status, comorbidities, and immune status also should be considered. Caution should be exercised when considering DAIR for a patient in whom preoperative cultures demonstrate a drug-resistant or highly virulent organism, because of a higher risk of failure 1,9,14,15. With careful patient selection and meticulous surgical technique, it is possible to achieve success with this treatment strategy. The surgical procedure begins with a medial parapatellar approach and arthrotomy. A complete synovectomy is then performed, and remaining Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work and "yes" to indicate that the