Fertility and pregnancy complications in female orthopaedic surgeons.

BACKGROUND: While the number of female medical graduates continues to increase, only a few pursue an orthopaedic career. This is related to challenges regarding pregnancy and the peripartum period during orthopaedic training. AIMS: To evaluate fertility, pregnancy-related complications and attitudes towards female orthopaedic surgeons in Israel. METHODS: An electronic anonymous 34-question electronic web-based survey was sent to all Israeli female orthopaedic surgeons. Participation was voluntary. Questions were formulated to determine demographics, obstetrics medical history, teratogenic exposure, medical leave and breastfeeding parameters along with attitude towards pregnancy. RESULTS: Twenty-six orthopaedic surgeons complied with the survey, 68% of all registered female orthopaedic surgeons. Participants age was 39.5 (±8.8). The average number of children for a female orthopaedic surgeon was 2.2 (±1.4), with an average of 1.3 (±1.1) deliveries during residency. The average age for a first child was 31.1 (±3.7) years. Four surgeons required fertility treatments and six had abortions. Thirty-eight per cent experienced pregnancy complications. Most surgeons were exposed to radiation and bone cement during pregnancy. The average duration of maternity leave was 19.4 (±9.9) weeks and return to work was associated with cessation of breastfeeding. Seventy-six per cent of surgeons felt that pregnancy had negatively influenced their training, and 12% reported negative attitudes from colleagues and supervisors. CONCLUSIONS: Orthopaedic surgeons in Israel experience a delay in childbirth and higher rates of pregnancy complications. Most feel that their training is harmed by pregnancy. Programme directors should design a personalized support programme for female surgeons during pregnancy and the peripartum period.

Reducing fracture incidence in children with osteogenesis imperfecta: contribution of orthotics to bisphosphonates treatment.

PURPOSE: To determine whether there was a reduction in fracture incidence amongst children with OI who were treated with both bisphosphonates and orthoses. OBJECTIVE: Was there an additional reduction in fracture incidence amongst children with Osteogenesis Imperfecta (OI) treated with both bisphosphonates and Hip-Knee-Ankle-Foot-Orthosis (HKAFO)? MATERIALS AND METHODS: Of the 129 OI patients treated from 1990 to 2017, retrospective data from 48 patients who participated in the bisphosphonates-orthosis regime were analyzed including the incidence of fractures and modalities of fracture treatment. RESULTS: Bisphosphonates usage was more frequent than bracing and there were more positive changes (smaller or equal number of fractures each year) than negative changes (more fractures each year); negative changes were scarce, explained by non-compliance with the use of bracing. Poisson regression models were significant for positive changes, whereas the interaction between them was borderline significant. The main finding is that the association between bisphosphonates usage and the number of positive changes was stronger among the patients who used braces more frequently and weaker among patients who used bracing less frequently. CONCLUSIONS: Bracing of OI patients has an additive effect on bisphosphonate treatment in fracture prevention which should lead to the reconsideration of a hybrid approach to OI management.

Two key goals of treatment of Osteogenesis Imperfecta (OI) patients include decreasing fracture incidence and improving function and independence as supported by a multi-disciplinary approach that combines medical, orthopaedic and rehabilitation treatments.Although the literature provides evidence that bisphosphonates reduce the frequency of fractures, there have not been reports of its effect when used with orthoses.Orthoses for OI patients have an additive effect on bisphosphonate treatment in fracture prevention.These results contribute to making an informed decision regarding this hybrid approach to OI management.

Correction of knee and ankle valgus in hereditary multiple exostoses using the Ilizarov apparatus.

BACKGROUND: Hereditary multiple exostoses (HME) is a genetic disorder that causes limb deformities due to disturbance at the growth plates. MATERIALS AND METHODS: Six adolescents, whith symptomatic valgus deformity at the ankle and knee (seven affected legs) underwent correction procedures using the Ilizarov apparatus. In 5 legs, a bifocal Ilizarov apparatus was used, whereas in 2 legs the use of a monofocal apparatus was sufficient. RESULTS: Correction of the mechanical axis was achieved in all cases, and limb length discrepancy was equalized in the 3 cases that underwent limb elogation. The average knee and ankle corrections were 15 degrees and 18 degrees , respectively. The average time from application to removal of the Ilizarove apparatus was 4.6 months. No major complication occurred. CONCLUSIONS: The use of the Ilizarov method in adolescents with HME enables successful simultaneous correction of multiplanar, multifocal complex limb deformities.

Pregnancy and live birth after focused ultrasound surgery for symptomatic focal adenomyosis: a case report.

Adenomyosis is a benign disease whose symptoms mimic those of uterine leiomyoma. Hysterectomy is the treatment of choice; conservative surgery is difficult to perform and can damage the uterine structural integrity. We report the case of a 36-year-old woman who had difficulty conceiving because of profuse menometrorrhagia. An 84 cm3 uterine tumour was diagnosed on ultrasonography as leiomyoma, and conservative myomectomy was planned. Magnetic resonance imaging (MRI) corrected the diagnosis to focal adenomyosis. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) destroyed a significant part of the tumour. Following an uncomplicated MRgFUS treatment, a non-perfused volume of 33 cm3 was measured. At 6 weeks, the patient experienced a significant reduction in menometrorrhagia and a marked decrease in tumour size (about 50%). She conceived spontaneously and, after an uneventful pregnancy, gave birth at term to a healthy infant via normal vaginal delivery. No structural uterine abnormality was detected after her delivery. This report highlights the difficult diagnosis and new therapeutic considerations of adenomyosis. MRgFUS seems to have the potential to precisely and effectively treat focal adenomyosis without damage to surrounding healthy myometrium, allowing for normal reproduction. Further studies are needed to assess the overall safety and long-term effectiveness of MRgFUS for the non-invasive treatment of adenomyosis.

Drift compression of an intense neutralized ion beam.

Longitudinal compression of a velocity-tailored, intense neutralized beam at 300 keV, 25 mA has been demonstrated. The compression takes place in a 1-2 m drift section filled with plasma to provide space-charge neutralization. An induction cell produces a head-to-tail velocity ramp that longitudinally compresses the neutralized beam, enhancing the beam peak current by a factor of 50 and producing a pulse duration of about 3 ns. This measurement has been confirmed independently with two different diagnostic systems.

Delayed reaction to shrapnel retained in soft tissue.

BACKGROUND: Treatment of penetrating injuries to soft tissues does not require surgical excision of shrapnel. Metals usually remain inert and do not cause damage and are therefore left in soft tissue. OBJECTIVE: Characterization of delayed reaction to shrapnel retained for many years in soft tissue. PATIENTS: Four patients sustained penetrating injuries to the limbs with embedded shrapnel. Many years later, they experienced delayed reaction to the metals that required surgery, with very unusual findings. CONCLUSIONS: Although nonsurgical treatment of shrapnel in soft tissues is the treatment of choice in most cases, we need to be aware of the possibility of late complications requiring surgical treatment.

Effect of microwave oven induced mild hyperthermia on bone viability and strength.

Extracorporeal hyperthermia treatment of bone followed by reimplantation may be an option for treating bone tumors. However, intensive heat treatment, such as autoclaving, causes a decline of mechanical and biologic functions of bone tissue. In the current study, a microwave oven was used for minimal hyperthermic treatment, and it was found that complete eradication of all viable cells in rat bone could be achieved with minimal reduction in mechanical function. When the cells were evaluated histologically by special lactate dehydrogenase activity staining, complete bone cell death occurred after 60 seconds of heating in an empty Petri dish and after 30 seconds when heated in a Petri dish containing normal saline. Mechanical stiffness and strength of the bones, tested in three-point bending, showed no decrease after this heating. Microwave oven induced hyperthermia eradication of viable cells without significant damage to the mechanical properties may have clinical relevance in limb salvage tumor surgery.

Expandable flash x-ray tube (FXT) having a 0.5-mm source size.

An inexpensive, expandable, continuously pumped, all-metal flash x-ray tube (FXT) was developed. It was coaxialy integrated at the end of a 70-Omega flexible coaxial transmission line. The tube, which has a small, 0.5-mm, x-ray source size when operated at 200 kV, produces a dose rate of 5x10(7) R/s (at exit port). The produced x-ray pulse has a duration of 20 ns, thus permitting the radiography of high-speed transient phenomena.