Background. Physician review websites (PRWs) are increasing in usage and popularity. Our purpose is to characterize one-star reviews of orthopedic oncology surgeons to understand factors in healthcare that contribute to patient satisfaction. Methods. Orthopedic oncology surgeons were randomly selected from the Musculoskeletal Tumor Society. A search for one-star reviews was performed on Google Reviews, Healthgrades, and Vitals.com. Reviews were classified as clinical or nonclinical. Statistical analyses were performed regarding the frequency of reviews and complaints for each category. Results. Of the 7,733 reviews discovered, 908 (11.7) were identified as one-star reviews. Of 907 usable complaints, 362 (40.8) were clinical and 545 (59.2) were nonclinical. The most common nonclinical complaints included bedside manner (65) and limited time with providers (19). The most common clinical complaints included complications (26) and disagreements with the treatment plan (26). There were 120 surgical and 221 nonsurgical reviews. Surgical patients had a higher rate of clinical complaints. Nonsurgical patients had a higher rate of total complaints. Conclusion. To the best of our knowledge, this is the first study examining PRWs regarding orthopedic oncology surgeons. Most one-star reviews were due to nonclinical complaints from nonsurgical patients. The most common factors are bedside manner, limited time with provider, phone communication issues, and rude/unprofessional conduct.

Hypophosphatasia (HPP) is a rare genetic condition that can manifest from the prenatal period to adulthood. Clinical presentation is characterized by six major forms. HPP can be complex and debilitating. A two-year-old male with a past medical history of HPP presented to our emergency room with a non-displaced supracondylar fracture after minor trauma. Non-accidental trauma was considered in addition to inadequate medical control of his HPP. He was referred to our multidisciplinary clinic and asfotase alfa was increased to an appropriate dose. A multidisciplinary approach is the standard of care for the management of children with HPP, allowing for routine evaluation by tertiary specialists. This includes medication dosing surveillance with serum studies and imaging. Enzyme replacement therapy, appropriately dosed by considering weight and laboratory values, may reduce orthopedic complications. A multidisciplinary team's surveillance of patients with HPP ensures proper medication management, decreases the likelihood of bony injury and encourages continued patient follow-up.

Constriction band syndrome (CBS) is a rare condition where fibrous bands constrict one or more parts of the fetus with varying manifestations such as autoamputation, acrosyndactyly, and neuropathy. However, isolated extremity fractures in the setting of constriction band syndrome are even more rare, with only two reported cases in the literature. There are few guidelines on the management of CBS due to small case numbers, the variability of presentation between patients, and the lack of consensus on etiology and pathogenesis. In this small case series, we describe the presentation and management of three patients at our institution with extremity fractures at the site of severe constriction bands with neurologic injuries or vascular compromise. We also review the literature on this topic to provide further context. Intramedullary stabilization of the fracture with a k-wire allowed for soft tissue healing in two of our patients.

In this report, we present a rare case of a 17‐year‐old male patient with metastatic mesenchymal chondrosarcoma (MCS) managed with nonsurgical treatment who subsequently demonstrated a favorable response to concurrent chemotherapy and radiation therapy, followed with pazopanib target therapy. Further study regarding nonoperative care for metastatic MCS of spine is warranted.

This study evaluates how the start point of a third-generation humeral intramedullary nail (IMN) for proximal humerus fractures (PHFs) affects radiographic fracture alignment and whether surgeon experience improves radiographic alignment over time. Retrospective review of patients over 18 years old with PHFs treated with IMNs by a single surgeon between March 2021 and October 2023. The senior author reduced the fracture before fixation with a third-generation short proximal humeral nail with a lateral Herzog bend (Stryker). On the anterior-posterior (AP) view, we measured the distance from the start point to the lateral articular margin and the lateral edge of the head in millimeters (mm) and as a ratio relative to the width of the head. On the lateral view, we measured the distance from the start point to the anterior edge of the head in mm and as a ratio relative to the width of the head. We measured angulation and translation relative to the shaft on the AP and lateral views. "Acceptable" reductions were defined as neck shaft angle (NSA) > 130° and translation <20% on the AP view, and angulation from -5° to 5° and translation 20% (OR: 0.57; P = .017). Receiver operating characteristic curve analysis revealed that a start point at least 4.2 mm medial to the lateral articular margin resulted in NSA >130 with 80% sensitivity and 75% specificity (area under curve [AUC] 0.76). On the lateral view, a start point at least 18.2 mm posteriorly would result in <20% translation with 81% sensitivity and 86% specificity (AUC: 0.85). Reductions improved over time, with a lower rate of varus alignment after 12 cases. When treating PHFs with IMN, a start point that is more medial and posterior improves angulation and translation. There is a learning curve with a lower rate of varus alignment after 12 cases.