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Purpose To predict whether a patient has osteoporosis/osteopenia using the attenuation of trabecular bone obtained from knee computed tomography (CT) scans. Methods Retrospective analysis of 273 patients who underwent contemporaneous knee CT scans and dual-energy X-ray absorptiometry (DXA) within 1 year. Volumetric segmentation of the trabecular bone of the distal femur, proximal tibia, patella, and proximal fibula was performed to obtain the bone CT attenuation. The data was randomly split into training/validation (78%) and test (22%) datasets and the performance in the test dataset were evaluated. The predictive properties of the CT attenuation of each bone to predict osteoporosis/osteopenia were assessed. Multivariable support vector machines (SVM) and random forest classifiers (RF) were used to predict osteoporosis/osteopenia. Results Patients with a mean age (range) of 67.9 (50–87) years, 85% female were evaluated. Seventy-seven (28.2%) of patients had normal bone mineral density (BMD), 140 (51.3%) had osteopenia, and 56 (20.5%) had osteoporosis. The proximal tibia had the best predictive ability of all bones and a CT attenuation threshold of 96.0 Hounsfield Units (HU) had a sensitivity of .791, specificity of .706, and area under the curve (AUC) of .748. The AUC for the SVM with cubic kernel classifier (AUC = .912) was better than the RF classifier (AUC = .683, P < .001) and better than using the CT attenuation threshold of 96.0 HU at the proximal tibia (AUC = .748, P = .025). Conclusions Opportunistic screening for osteoporosis/osteopenia can be performed using knee CT scans. Multivariable machine learning models are more predictive than the CT attenuation of a single bone.

Background: While there has been much interest in the increased dislocation rate in total hip arthroplasty (THA) patients with a lumbar spine fusion (LSF), there is minimal literature comparing the risk based on surgical approach. The purpose of this study was to determine if a direct anterior (DA) approach was protective against dislocation when compared to the anterolateral and posterior approaches in this high-risk patient population. Methods: A retrospective review was performed of 6554 THAs performed at our institution from January 2011 to May 2021. 294 (4.5%) patients had a prior LSF and were included in the analysis. The surgical approach, timing of LSF in relation to THA, vertebral levels fused, timing of THA dislocation, and the need for revision surgery were recorded for statistical analysis. Results: In total, 39.7.3% of patients underwent a DA approach (n = 117), 25.9% underwent an anterolateral approach ( n = 76), and 34.3% underwent a posterior approach ( n = 101). There was no difference in number of vertebral levels fused between groups (mean 2.5, all p > 0.05). There was a total of 13 (4.4%) THA dislocation events, with an average time from surgery to dislocation of 5.6 months (0.3–30.5 months). There were fewer dislocations in the DA cohort (0.9%) in comparison to both the anterolateral (6.6%, p = 0.036) and posterior groups (6.9%, p = 0.026). Conclusions: The DA approach demonstrated a significantly lower THA dislocation rate compared to both the anterolateral and posterior approaches in patients with a concomitant LSF.

Objectives Differences in National Institutes of Health (NIH) funding between specialties may affect research and patient outcomes in specialties that are less well funded.The aim of this study is to evaluate how NIH funding has been awarded by medical specialty. This study assesses differences and trends in the amount of funding, by medical specialty, for the years 2011–2020, via a retrospective analysis of data from the NIH RePORTER (Research Portfolio Online Reporting Tools Expenditures and Results). Study design Longitudinal cross-sectional study Setting NIH RePORTER data from 2011 to 2020 for awarded NIH grants (F32, T32, K01, K08, K23, R01, R03, R21, U01, P30) in the following medical specialties: anaesthesiology, dermatology, emergency medicine, family medicine, internal medicine, neurology, neurosurgery, obstetrics and gynaecology, ophthalmology, orthopaedic surgery, otolaryngology, pathology, paediatrics, physical medicine and rehabilitation, plastic surgery, psychiatry, radiation-diagnostic/oncology, surgery, and urology. Participants NIH grant awardees for the years 2011-2020 Intervention None Primary and secondary outcome measures The following measures were studied: (1) number of grants by specialty, (2) number of grants per active physician in each specialty, (3) total dollar amount of grants by specialty, (4) total dollar amount of grants per active physician in each specialty and (5) mean dollar amount awarded by specialty for each grant type. We investigated whether any of these measures varied between medical specialties. Results In general, internal medicine/medicine, psychiatry, paediatrics, pathology and neurology received the most grants per year, had the highest number of grants per active physician, had the highest total amount of funding and had the highest amount of funding per active physician, whereas fields like emergency medicine, plastic surgery, orthopaedics, and obstetrics and gynaecology had the lowest. The mean dollar amount awarded by grant type differed significantly between specialties (p value less than the Bonferroni-corrected alpha=0.00029). Conclusions NIH funding varies significantly between medical specialties. This may affect research progress and the careers of scientists and may affect patient outcomes in less well funded specialties.

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Background: Stress-view radiographs are frequently obtained to evaluate supination-external rotation (SER) variant ankle fractures. Measurement of the ankle medial clear space (MCS) is a surrogate of medial structure integrity as part of overall ankle stability. Measurement of the lateral talus displacement with respect to the incisura may be a sensitive and specific method to assess joint subluxation. Methods: Retrospective review of acute SER-variant isolated lateral malleolar fractures with gravity stress views (GSVs) were performed for 103 patients. GSV analysis was performed with standardized measurements of the MCS, superior clear space (SCS), and 2 new novel measurements of lateral talus subluxation (LTS). Decision for surgery was obtained by surgeons who reviewed masked injury radiographs for predictive performance analysis of the LTS vs MCS. Results: MCS, SCS, and LTS measurements were performed on 103 patients. Mean MCS, SCS, and LTS within the operative group was increased. MCS ≥5 mm and LTS >4 mm had equal sensitivity (95%), with higher specificity for LTS (75% vs 60%). Receiver operating characteristic analysis demonstrates an area under the curve of 0.786 for MCS ≥5 mm vs 0.918 for LTS >4 mm. Conclusion: We found LTS to be superior to MCS for medial ankle structure stability on gravity stress views of SER-variant ankle fractures. We propose this as a useful tool for clinicians to consider when evaluating SER-variant ankle fractures. Level of Evidence: Level II, prospective comparative study of radiographs.

AbstractThe inclusion of ancestrally diverse participants in genetic studies can lead to new discoveries and is important to ensure equitable health care benefit from research advances. Here, members of the Ethical, Legal, Social, Implications (ELSI) committee of the International Genetic Epidemiology Society (IGES) offer perspectives on methods and analysis tools for the conduct of inclusive genetic epidemiology research, with a focus on admixed and ancestrally diverse populations in support of reproducible research practices. We emphasize the importance of distinguishing socially defined population categorizations from genetic ancestry in the design, analysis, reporting, and interpretation of genetic epidemiology research findings. Finally, we discuss the current state of genomic resources used in genetic association studies, functional interpretation, and clinical and public health translation of genomic findings with respect to diverse populations.