About

Alice Chu, MD, is a professor in the Department of Orthopaedics at Rutgers New Jersey Medical School. She holds a medical degree from UMDNJ New Jersey Medical School, earned in 2002, and a Bachelor of Arts from Drew University, obtained in 1998. Dr. Chu is certified by the American Board of Orthopaedic Surgery in Pediatric Orthopaedic Surgery and is licensed to practice medicine in New Jersey. Her professional focus is on orthopaedics, with a specialization in pediatric orthopaedic surgery, contributing to clinical practice and education within the department.

Research topics

• Computer Science
• Family medicine
• Surgery
• Medicine
• Political Science
• Economics
• Finance
• Medical education
• Demography
• World Wide Web
• Internal medicine
• Library science

Selected publications

• Are Routine Post–Cast Removal Radiographs and a Second Follow-up Appointment Necessary in the Management of Nondisplaced or Minimally Displaced Distal Radius Fractures?

  Journal of the Pediatric Orthopaedic Society of North America · 2025-03-08 · 2 citations

  articleOpen access

  Background: The effectiveness of routine follow-up radiographs and appointments after cast removal when managing minimally displaced pediatric distal radius fractures has not been conclusively proven. This study aims to assess how often follow-up appointments and radiographs taken after cast removal alter management of patients with minimally displaced distal radius fractures. Methods: A single-center retrospective chart review was conducted on patients under 18 years of age with minimally displaced distal radius fractures between 2017 and 2023. Demographic information, fracture characteristics, time to follow-up, and each appointment outcome were recorded. A change in patient management following post-cast removal radiographs was defined as a need for closed reduction, operative intervention, or prolonged immobilization. The second follow-up appointment was considered to modify management if it necessitated a physical therapy referral or an additional office visit. Unscheduled appointments and any changes in fracture alignment during follow-up visits were also noted. Results: Ninety-three patients met the inclusion criteria; 1.1% (1 of 93) of patients had their management changed following their post-cast removal radiographs according to our criteria. One patient was indicated for prolonged immobilization for a visible fracture line; no patients were indicated for surgery or closed reduction. Thirty-eight patients who underwent cast removal attended their 2nd follow-up appointment; 2.6% (1 of 38) of patients had their management changed according to our criteria. One patient required an additional follow-up appointment for a physeal check; no patient required a physical therapy referral. Two patients had an unscheduled appointment after discharge of care, due to parental desire of recovery confirmation before returning to gym play. No changes in fracture alignment were observed during any follow-up radiographs. Conclusions: This study suggests that post-cast removal radiographs and second follow-up appointments rarely alter management of minimally displaced distal radius fractures. Limiting unnecessary visits and imaging could reduce costs and ease the burden on patients and families. Key Concepts: 1) Post-cast removal radiographs rarely altered management for minimally displaced pediatric distal radius fractures.2) Only 1.1% of patients required prolonged immobilization, with no cases needing surgery or closed reduction.3) Second follow-up appointments infrequently changed management, with only 2.6% of patients requiring an additional visit.4) Unscheduled visits were primarily driven by parental concerns rather than clinical necessity.5) No changes in fracture alignment were observed in any follow-up radiographs. Level of Evidence: Level IV - case series.

  PublisherDOI

• Gender biases in surgical residency and their association with postoperative outcomes: A qualitative study of residents in general and orthopedic surgery

  Patient Education and Counseling · 2025-10-13 · 1 citations

  articleOpen access

  OBJECTIVES: Recent studies have shown gender-based disparities in surgical outcomes, with women physicians achieving better postoperative results. However, the mechanisms underlying these differences remain poorly understood. This complex, underexplored phenomenon lacks perspectives from key stakeholders such as patients, staff, and surgeons. Surgical residents inhabit a unique position, balancing the roles of learners and healthcare providers and offering valuable insights into these disparities. Our objective was to explore resident surgeons' perceptions of the mechanisms underlying the differences observed in postoperative outcomes through interviews. METHODS: We conducted a qualitative study using semi-structured interviews with men and women residents, analyzed through qualitative content analysis. Participants included 17 surgical residents from 10 ACGME-accredited orthopedic and general surgery programs across four U.S. regions. RESULTS: Key findings were: (1) Women surgical residents experienced gender biases during training; (2) Men and women surgeons differed in their approaches to patient care and surgical practice. Residents of both genders noted that women surgeons encounter biases stemming from prevailing norms, beliefs, and expectations related to gender. These biases manifest as double standards and pressure to conform to men-dominated environments. The absence of comparable pressure on men surgeons to adapt to interactions with women colleagues or patients may lead to challenges in meeting the expectations of women patients. Participants of both genders reported that women surgeons tend to adopt a more holistic approach to patient care. CONCLUSIONS: Our findings suggest that the unique challenges faced by women surgeons may contribute to the development of refined interpersonal and surgical skills, which could be associated with improved postoperative outcomes. Raising awareness of gender-based differences in surgical practice is essential to addressing the disparities observed in postoperative results. PRACTICAL IMPLICATIONS: Residency programs may benefit from incorporating gender-aware training to address implicit biases, foster equitable learning environments, and optimize skill development for all trainees.

  PublisherDOI

• Cognitive frameworks for intraoperative surgical decision making: a systematic scoping review

  British journal of surgery · 2025-08-01

  articleOpen access

  Abstract Introduction Surgical outcomes are heavily influenced by intraoperative decisions, yet the cognitive processes underlying these decisions remain incompletely understood. This scoping review aims to map existing cognitive frameworks in the literature and identify gaps in our understanding of intraoperative decision-making. Method A systematic search of six databases, including PubMed, Embase, Scopus, Cochrane, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) identified studies examining cognitive processes in surgical decision-making across all surgical subspecialties and training levels. Articles focused on procedure-specific decisions or teaching of intraoperative decision making were excluded. Key themes were identified to highlight the most relevant concepts, and a final selection of studies were analyzed. Result In total, 5,501 articles were screened, 190 studies underwent full-text review, and 19 papers were chosen for final analysis. Five major themes emerged: (1) cognitive processing models, outlining how surgeons acquire and act on information; (2) essential skills and competencies; (3) balancing internal and external factors; (4) context-dependent decision-making; and (5) limitations of existing models. Decision-making was commonly described as a continuum between intuitive (experience-based, rapid) and analytical (deliberate, rule-based) strategies, with surgeons dynamically shifting between these approaches based on case complexity and time constraints. Discussion Intraoperative decision-making is a complex, dynamic process requiring surgeons to balance multiple factors while managing cognitive load. Enhancing awareness of these processes— through structured reflection, metacognition, and adaptability—may improve decision-making and surgical education.

  PublisherOA PDFDOI

• Cognitive frameworks for intraoperative surgical decision-making: A systematic scoping review

  Surgery · 2025-12-11 · 1 citations

  articleOpen access

  Introduction: Traditionally, surgical outcomes have been attributed to individual surgeon factors such as experience, training, and gender, as well as contextual elements like case volume and complexity. More recently, the importance of nontechnical skills such as situational awareness, teamwork, and decision-making has been increasingly recognized. Although factors like cognitive load and time pressure1 have been studied, the specific cognitive processes that underlie and connect these elements—how surgeons synthesize information, weigh risks, and adapt in real time—remain poorly defined. A deeper understanding of these mental mechanisms is essential to advancing surgical care. This scoping review synthesizes existing cognitive frameworks in surgical decision-making to inform interventions aimed at improving surgical education and intraoperative performance. Methods: This scoping review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews guidelines.

  PublisherDOI

• Evaluating the Readability of Patient-Reported Outcome Measures in Pediatric Orthopaedic Registries: Alignment With National Institutes of Health and American Medical Association Standards

  Journal of Pediatric Orthopaedics · 2025-07-11 · 1 citations

  article

  BACKGROUND: Patient-reported outcome measures (PROMs) are essential tools for assessing surgical effectiveness and capturing patient perspectives on functionality, symptoms, and quality of life. However, readability is critical for ensuring patients can understand and accurately complete them. The National Institutes of Health (NIH) and American Medical Association (AMA) recommend that patient materials be written at or below a sixth-grade reading level. In pediatric orthopaedic surgery, the Pediatric Outcomes Data Collection Instrument (PODCI), Pediatric Quality of Life Inventory (PedsQL), and Patient-Reported Outcomes Measurement Information System (PROMIS) instruments are among the most commonly utilized PROMs. This study evaluates whether PROMs used in pediatric orthopaedic registries meet NIH and AMA readability standards. METHODS: A readability analysis was performed on 59 PROMs reported in pediatric orthopaedic registries. PROMs were categorized as validated or not validated for patients under 18 years of age. Primary readability metrics were the Flesch Reading Ease Score (FRES) and the Simple Measure of Gobbledygook (SMOG) Index. Scores were obtained using an online calculator and compared against NIH and AMA guidelines. A FRES ≥80 or SMOG <7 was considered reflective of a sixth-grade or lower reading level. RESULTS: The average FRES and SMOG Index for all PROMs were 69 ± 14 and 8 ± 1, respectively, corresponding to an eighth to ninth-grade reading level. Only 4 PROMs met both FRES and SMOG readability thresholds: Hospital Anxiety and Depression Scale, Knee Society-Function, Children's Revised Impact of Event Scale, and PedsQL. PROMs such as the International Knee Documentation Committee, Lower Extremity Functional Scale, Single Assessment Numeric Evaluation, University of California Los Angeles Activity Scale, and Kujala Score were among the least readable. Although PedsQL met both readability thresholds, PODCI and PROMIS instruments were written above the recommended sixth-grade reading level. CONCLUSIONS: Most PROMs used in pediatric orthopaedic surgery are written above the recommended sixth-grade reading level, potentially impacting patient comprehension and the reliability of collected data. LEVEL OF EVIDENCE: Level IV-observational study.

  PublisherDOI

• Global trends in surgical approach to neonatal brachial plexus palsy: a systematic review

  Frontiers in Surgery · 2025-01-06 · 4 citations

  reviewOpen accessCorresponding

  Background We analyzed trends in age at surgery and surgical approach over time and geography. Methods We performed a systematic review according to PRISMA-IPD guidelines to include individual patient data. Collected data included age at surgery, location of surgery, and surgical approach. The surgical approach was independently categorized as the exploration of the brachial plexus (EBP) or nerve transfer without root exploration (NTwoRE). EBP was defined as exploring the brachial plexus in the supraclavicular fossa and applying a choice of coaptation procedures. NTwoRE included those sourcing donor nerves from, or entirely occurring outside of the plexus without exploring the root of the brachial plexus. Results Regression analysis of age at surgery 1985–2020 showed that age at BPBI surgery is rising ( p &amp;lt; 0.05). Surgery was performed at a younger age in patients from Europe (7.06 ± 7.77 months) and Asia (7.58 ± 5.33 months) than those from North America (10.44 ± 5.01 months) and South America (14.71 ± 4.53 months) ( p &amp;lt; 0.05). NTwoRE was more common in North America (37%) and least common in Europe (12%). Age at EBP was 7.2 ± 5.77 months, and age at NTwoRE was 15.85 ± 13.18 months ( p &amp;lt; 0.05). The incidence of NTwoRE is increasing time. Conclusions Age at NBPP surgery is increasing over time. Regional differences exist in age at NBPP surgery. Approaches to NBPP surgery that avoid exploration of BP roots are becoming more popular. Age at EBP is lower than age at NTwoRE.

  PublisherDOI

• Gender Bias During Residency Drive Improved Postoperative Outcomes of Women Surgeons- a Qualitative Interview Study of Men and Women Residents in General and Orthopedic Surgery

  SSRN Electronic Journal · 2025-01-01

  preprintOpen access
  PublisherDOI

• Survey of the POSNA Membership Reveals Variability in Use of Tibialis Anterior Tendon Transfer for Recurrent Clubfoot.

  PubMed · 2024-09-01 · 1 citations

  articleSenior author

  PURPOSE: The aim of this project was to survey members of the Pediatric Orthopaedic Society of North America (POSNA) regarding the use of tibialis anterior tendon transfer (TATT) in the management of recurrent clubfoot with dynamic supination and no deformity. We aimed to assess which techniques for TATT are most utilized by pediatric orthopedists. As there has been no general consensus in the literature regarding best methods, we hypothesized that treatment methods would vary widely among POSNA members. METHODS: The online survey, designed using Research Electronic Data Capture (REDCap) survey software, consisted of 15 initial questions, some of which had conditional follow-up questions that appeared if the respondent selected a specific answer choice, with a potential total of 22 questions. The survey was approved by the Evidence Based Practice Committee of POSNA and distributed to their 1,370 members. RESULTS: Only the responses of POSNA members who treated clubfoot and performed TATT were included in the analysis. The 228 survey respondents reached a consensus (75% agreement) on a small number of topics: use of the Ponseti treatment method for clubfoot (94%), transfer of the tibialis anterior tendon to the lateral cuneiform (77%), transfer of only the whole tibialis anterior tendon (79%), and the use of an ankle foot orthoses (94%) among those who reported using postoperative braces. However, the remaining survey questions revealed a marked amount of variability in the performance of TATT. CONCLUSIONS: Many of the questions garnered varied responses, which suggests differing opinions of POSNA members regarding how and when TATT should be performed for recurrent clubfoot with dynamic supination and no deformity. This is one of the first compilations of information about the treatment variations for TATT and may lead to further studies examining ways to standardize and optimize its use.

  Publisher

• “Top 20” residency‐trained academic orthopaedic surgeons have higher academic productivity and funding in their careers

  Journal of Orthopaedic Research® · 2024-03-03

  articleOpen accessSenior author

  "Top 20" status on Doximity, an online networking service for medical professionals, is an indicator of the reputation of a residency program. The study assesses how training at a Top 20 (T20) orthopaedic residency program impacts career productivity and funding. Fellowship and Residency Electronic Interactive Database was used in 2022 to identify active orthopaedic residency programs. Demographic and training data was collected for each orthopaedic surgeon using institutional websites and Doximity. The Residency Navigator feature on Doximity was used to rank residency programs by "reputation." Programs were categorized as either T20 or non-T20. The relative citation ratio (RCR) was calculated using the NIH iCite tool and Hirsch index (h-index) was calculated using Scopus. Industry funding was collected from the Centers for Medicare & Medicaid Services Open Payments Program (CMS) for all available years (2014-2020). A total of 2812 academic orthopaedic surgeons were included in the study. Among academic orthopaedic surgeons in the United States, T20 trained orthopedists had more publications and citations (p < 0.001), along with higher h-indices (p < 0.001), RCR (p < 0.001), and industry funding (p = 0.043). Additionally, T20 trained orthopedists were 1.375 times more likely to obtain professor status (95% confidence interval: 1.150-1.645, p < 0.001). Even after propensity-matched analysis, T20 trained orthopedists maintained these differences. Training at a T20 residency program is associated with promotion, productivity, and funding. These findings are especially of concern to medical students who must consider the importance of a residency program's reputation when deciding where to apply for residency.

  PublisherOA PDFDOI

• A RANDOMIZED PROSPECTIVE DOUBLE-BLIND TRIAL COMPARING CROSS-LINKED WITH CONVENTIONAL POLYETHYLENE IN TOTAL HIP ARTHROPLASTY: MINIMUM 20-YEAR RESULTS

  Orthopaedic Proceedings · 2024-08-19

  articleSenior author

  We present minimum 20 year results of a randomized, prospective double blinded trial (RCT) of cross-linked versus conventional polyethylene (PE), using a computer assisted method of PE wear measurement. After Ethics Committee approval, 122 patients were enrolled into an RCT comparing Enduron (non cross-linked PE) and highly cross-linked Marathon PE (DePuy, Leeds, UK). Other than the PE liners, identical components were used, a Duraloc 300 metal shell with one screw, a 28mm CoCr femoral head and a cemented Charnley Elite femoral stem. All patients were followed with anteroposterior (A∼P) and lateral radiographs at 3 days, 6 weeks, 3 months, 6 months, 1, 2, 3, 4, 5, 10 and 20 years. PE wear was measured with PolyMig, which has a phantom validated accuracy of ± 0.09mm. At minimum 20 year follow-up, 47 patients had died, 5 of which had been revised prior to their death. Another 32 patients were revised and alive, leaving 43 patients unrevised and alive (15 Enduron, 28 Marathon). No patients were lost to follow-up, but 2 were not able to be radiographed (dementia), leaving 41 patients (15 Enduron, 26 Marathon) available for PE wear measurement. After the bedding-in period, Enduron liners had a wear rate of 0.182 mm/year, and Marathon liners had a wear rate of 0.028 mm/year. At 20 years follow-up, 37 patients had required revision. Patients with conventional PE had three times the revision rate (28/37) of those who received XLPE (9/37). This is the longest term RCT showing substantially improved clinical and radiological results when XLPE is used as the bearing surface.

  PublisherDOI

Frequent coauthors

• Lynn Ann Forrester

  42 shared

• Caixia Zhao

  40 shared

• Debra A. Sala

  IS practice

  38 shared

• Lauren Seo

  36 shared

• Leah J. Gonzalez

  36 shared

• Scott Friedlander

  Hinge Health

  36 shared

• Wallace B. Lehman

  36 shared

• Aleksandra McGrath

  Umeå University

  35 shared

Education

• M.D.

  UMDNJ New Jersey Medical School

  2002

• B.A.

  Drew University

  1998