Publications by Year: 2026

PURPOSE: This study aims to evaluate indicators of continued research involvement and activity among hand fellowship faculty. Specifically, we assess the impact of research publication counts during different stages of medical training and geographic factors on the academic productivity of hand surgeons.

METHODS: A retrospective cross-sectional analysis was conducted using data from all fellowships listed on the American Society for Surgery of the Hand Fellowship Directory from June 2024 to July 2024. Faculty names were collected, and an algorithm was used to automate searches for research publication output across preresidency, residency, fellowship, and postfellowship periods. PubMed and Scopus databases were used to compile publication counts and H-indices. Data were categorized by geographic regions (Northeast, Midwest, South, West) and analyzed using descriptive statistics, Kruskal-Wallis tests, and negative binomial regression to determine the relationship between publication counts during training and total career publications.

RESULTS: The analysis included 94 hand fellowship programs and 645 physicians. Major regional differences were observed in publication counts during fellowship, postfellowship, and overall medical careers, with the Midwest showing the highest averages. A negative binomial regression revealed that publication counts during residency and fellowship, as well as the length of the medical career, independently predicted total career publications. Finally, Southern programs had the highest area deprivation index values, whereas Western programs had the highest Hirsch index to area deprivation index ratios, indicating increased productivity regardless of the area's socioeconomic status.

CONCLUSIONS: Research publication counts during hand surgeon training, particularly during fellowship, serve as key indicators of continued research leadership. Geographic variations suggest regional differences in research productivity and resource availability. These findings underscore the importance of early and sustained research involvement for academic success in hand surgery.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.

BACKGROUND: Optimal management of acetabular fractures remains controversial. Open reduction and internal fixation (ORIF) may be followed by post-traumatic degeneration and late conversion arthroplasty, whereas acute total hip arthroplasty (THA) may introduce implant-related risks. We compared short- and long-term outcomes after ORIF versus acute THA in a large, multicenter electronic health record cohort.

METHODS: We performed a retrospective cohort study using the TriNetX Network. Adults with isolated, closed, acute acetabular fractures treated with either ORIF or acute primary THA were identified. Patients were propensity score-matched (PSM) 1:1 on demographics and comorbidities. Outcomes were assessed at 90 days and at 1, 2, 5, and 10 years, including mortality, complications, health care utilization, and procedure-specific failures (for ORIF: nonunion, post-traumatic osteoarthritis, and conversion to THA; for THA: periprosthetic fracture, prosthetic joint infection [PJI], instability/dislocation, and mechanical complications).

RESULTS: After PSM, 3700 matched pairs comprised the early follow-up cohorts. At 90 days, ORIF was associated with higher mortality (5.2% vs 3.5%; OR 1.5; p < 0.0001) and higher rates of stroke, respiratory failure, venous thromboembolism, and ICU admission, whereas acute THA had higher emergency department visits (9.1% vs 5.3%; p < 0.0001) and hip pain (23.2% vs 13.2%; p < 0.0001). Over long-term follow-up, acute THA demonstrated higher implant-related complications at 2 years, including periprosthetic/implant fracture (3.0% vs 0.8%), PJI (6.8% vs 3.8%), instability (7.7% vs 3.0%), and mechanical complications (6.3% vs 3.5%) (all p < 0.0001), while overall reoperation rates were similar at 2 years (11.8% vs 11.2%; p = 0.53) and remained comparable through 10 years. In the ORIF cohort, nonunion reached 11.3%; conversion to THA increased from 4.3% at 2 years to 5.8% at 10 years; and post-traumatic osteoarthritis (PTOA) increased from 21.2% at 2 years to 27.2% at 10 years. Pre-index hip disease was markedly more common among acute THA patients (OA 51% vs 10%; AVN 14% vs 1%).

CONCLUSIONS: In this study, ORIF was associated with higher early mortality and systemic complications, whereas acute THA was associated with higher implant-related complications. Despite these differing complication profiles, cumulative reoperation rates were similar through long-term follow-up. Progressive PTOA and conversion to THA remain important sequelae after ORIF.