Objective: To compare clinical outcomes of patients treated by female surgeons versus those treated by male surgeons. Background: It remains unclear as to whether surgical performance and outcomes differ between female and male surgeons. Methods: We conducted a meta-analysis to compare patients’ clinical outcomes—including patients’ postoperative mortality, readmission, and complication rates—between female versus male surgeons. MEDLINE, Embase, CENTRAL, ICTRP, and ClinicalTrials.gov were searched from inception to September 8, 2022. The update search was conducted on July 19, 2023. We used random-effects models to synthesize data and GRADE to evaluate the certainty. Results: A total of 15 retrospective cohort studies provided data on 5,448,121 participants. We found that patients treated by female surgeons experienced a lower postoperative mortality compared with patients treated by male surgeons [8 studies; adjusted odds ratio (aOR), 0.93; 95% CI, 0.88–0.97; I ²=27%; moderate certainty of the evidence]. We found a similar pattern for both elective and nonelective (emergent or urgent) surgeries, although the difference was larger for elective surgeries (test for subgroup difference P=0.003). We found no evidence that female and male surgeons differed for patient readmission (3 studies; aOR, 1.20; 95% CI, 0.83–1.74; I ²=92%; very low certainty of the evidence) or complication rates (8 studies; aOR, 0.94; 95% CI, 0.88–1.01; I ²=38%; very low certainty of the evidence). Conclusion: This systematic review and meta-analysis suggests that patients treated by female surgeons have a lower mortality compared with those treated by male surgeons.

Aims: To clarify the effectiveness of the induced membrane technique (IMT) using beta-tricalcium phosphate (β-TCP) for reconstruction of segmental bone defects by evaluating clinical and radiological outcomes, and the effect of defect size and operated site on surgical outcomes. Methods: A review of the medical records was conducted of consecutive 35 lower limbs (30 males and five females; median age 46 years (interquartile range (IQR) 40 to 61)) treated with IMT using β-TCP between 2014 and 2018. Lower Extremity Functional Score (LEFS) was examined preoperatively and at final follow-up to clarify patient-centered outcomes. Bone healing was assessed radiologically, and time from the second stage to bone healing was also evaluated. Patients were divided into ≥ 50 mm and < 50 mm defect groups and into femoral reconstruction, tibial reconstruction, and ankle arthrodesis groups. Results: There were ten and 25 defects in the femur and tibia, respectively. Median LEFS improved significantly from 8 (IQR 1.5 to 19.3) preoperatively to 63.5 (IQR 57 to 73.3) at final follow-up (p < 0.001). Bone healing was achieved in all limbs, and median time from the second stage to bone healing was six months (IQR 5 to 10). Median time to bone healing, preoperative LEFS, or postoperative LEFS did not differ significantly between the defect size groups or among the treatment groups. Conclusion: IMT using β-TCP provided satisfactory clinical and radiological outcomes for segmental bone defects in the lower limbs; surgical outcomes were not influenced by bone defect size or operated part. Cite this article: Bone Joint J 2021;103-B(3):456–461.

Evidence has been mixed regarding the effect of topical vancomycin (VCM) powder in reducing surgical site infection (SSI). To clarify the effect of topical VCM powder for the prevention of SSI in major orthopaedic surgeries. The MEDLINE, Embase, CENTRAL, ICTRP, and ClinicalTrials.gov databases were searched from their inception to September 25^th, 2023. Randomized controlled trials comparing topical VCM powder and controls for the prevention of SSI in major orthopaedic surgeries were included. Two reviewers independently screened the title and abstract and extracted relevant data, followed by the assessment of the risk of bias and the certainty of the evidence. Main outcome measures were overall SSI, reoperation, and adverse events. Summary results were obtained using random-effects meta-analysis. Trial sequential analysis (TSA) was performed. Eight randomized controlled trials yielded data on 4307 participants. VCM powder showed no difference in reducing overall SSI. The cumulative number of patients did not exceed the required information size of 19,233 in our TSA, and the Z-curves did not cross the trial sequential monitoring or futility boundary, suggesting an inconclusive result of the meta-analysis. No difference was found for reoperation. Among SSIs, VCM powder showed a statistically significant difference in reducing Gram-positive cocci SSI. However, the certainty of this evidence was very low. This systematic review and meta-analysis suggests inconclusive results regarding the effect of VCM powder in reducing SSI in major orthopaedic surgeries. Further trials using rigorous methodologies are required to elucidate the effect of this intervention.

Surgery has historically been a male-dominated field; however, the representation of female surgeons has steadily increased, necessitating a comprehensive review of comparative performance. This narrative review synthesises recent literature to evaluate male and female surgeons across several key domains: technical skills, non-technical abilities, patient outcomes, and academic contributions. In terms of technical skills, research presents nuanced findings. While some studies suggest a potential male advantage in visuospatial skills, other evidence indicates that these initial differences can be mitigated or eliminated through dedicated training and prior experience with activities such as video games. Conversely, female surgeons consistently demonstrate superior manual dexterity. In non-technical areas, female surgeons consistently receive higher patient scores for communication, including providing clear explanations, listening attentively, and dedicating sufficient time during consultations. The literature on patient outcomes is complex and sometimes contradictory. Several large-scale observational studies and meta-analyses have reported a small but statistically significant reduction in mortality for patients treated by female surgeons, whereas other research has found no such association. Despite these findings, female surgeons remain underrepresented in senior academic and organisational leadership roles, with persistent disparities in departmental chair positions and grant funding. This gap is not necessarily attributable to a lack of productivity but rather to insufficient mentorship and institutional support. The evidence highlights that individual qualities and training are more significant than gender, although persistent systemic biases continue to pose challenges to female surgeons' career advancement and patient trust. Addressing these prejudices is essential to fostering a safe and equitable environment for all.

We report a case of volar fourth and fifth carpometacarpal (CMC) joint dislocation complicated by a hamate hook fracture. The CMC joint was reduced in a closed fashion and temporally fixed with Kirschner wires. Using intraoperative computed tomography, the displaced fracture of the hamate hook was reduced by open reduction and internal fixation and fixed with a screw. We suggest that this rare injury was caused by the over contraction of the flexor carpi ulnaris and avulsion force from the ligamentous structure around the pisiform, hamate, and metacarpal bones.