Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 3 de 3
Filtrar
Mais filtros











Base de dados
Intervalo de ano de publicação
1.
Orthop J Sports Med ; 8(6): 2325967120925019, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32577421

RESUMO

BACKGROUND: Pectoralis major (PM) tendon tears are common injuries in athletic patient populations, where operative repair is largely recommended for maximum functional recovery. The repair varies in difficulty and technique based on the location of the tear within the muscle-tendon unit. Magnetic resonance imagining (MRI) has been reported to be sensitive and specific for identifying the tear location, but the effect of injury mechanism on tear pattern has not been previously investigated. PURPOSE: To examine PM tears in a military patient population and assess the effect of injury mechanism (weightlifting vs high-energy trauma) on the tear pattern and accuracy of MRI interpretation. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Active duty military servicemembers undergoing operative repair of PM tendon tears with corresponding preoperative MRIs from 2 medical centers were identified. Two musculoskeletal fellowship-trained radiologists reviewed imaging studies, reporting the location of the tear within the muscle-tendon unit and the severity of the tear (sternal head vs clavicular head vs both). Radiographic findings were compared against intraoperative findings. Mechanism of injury and timing from injury to imaging and surgery were assessed to determine whether they affected the accuracy of MRI interpretations. RESULTS: A total of 72 patients were included (mean ± SD age, 33.7 ± 7.0 years; 100% male). Mechanisms of injury consisted of 46 weightlifting injuries and 26 high-energy injuries. Interrater reliability was poor for tear location (kappa, 0.162; P = .003) but substantial for extent of tear (kappa, 0.637; P < .0001). MRI had a 51.3% sensitivity and 63.6% specificity for identifying complete tears. MRI had a sensitivity of 73.9% and specificity of 72.2% for avulsion injuries and sensitivity of 75% and specificity of 79.3% for musculotendinous injuries. Mechanism of injury had no effect on extent of the tear but did affect the location of the tear, with a higher rate of avulsion injuries in the high-energy mechanism cohort (81% vs 40%; P = .02). CONCLUSION: The mechanism of injury was found to significantly affect the location of tendon tears. A higher rate of avulsion injuries was found in high-energy injuries than weightlifting injuries. MRI appeared to be less sensitive and specific than previous reports for traumatic PM tendon injuries.

2.
J Am Acad Orthop Surg ; 28(21): 885-892, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31934928

RESUMO

INTRODUCTION: The purpose of this study is to investigate the current disparities for major lower extremity amputation in patients with critical limb ischemia (CLI) and infection. METHODS: A retrospective analysis of the National Surgical Quality Improvement Program's database for the years 2011 to 2017 was conducted. Multivariate models were used to isolate the effect of race and ethnicity on the likelihood of a below-knee or above-knee amputation (BKA and AKA, respectively) for CLI secondary to type 2 diabetes mellitus, atherosclerosis, peripheral vascular disease, chronic osteomyelitis, and deep soft-tissue infections. RESULTS: For all diagnoses, blacks were 93.3%, and Hispanics were 61.9% more likely to undergo a BKA than white patients (P < 0.001). In addition, black patients had a 133.0% higher risk of an AKA than white patients (P < 0.001). Disparities were greatest with blacks undergoing surgery for CLI secondary to atherosclerosis (BKA odds ratio 2.093; AKA: odds ratio 2.625). Black patients also had an elevated risk of amputation secondary to diabetes, peripheral vascular disease, and deep soft-tissue infections (P < 0.001). DISCUSSION: This nationally representative, cohort-based study demonstrates that notable racial and ethnic disparities for lower extremity amputations persist, with a higher proportion of black and Hispanic patients undergoing amputation compared with limb salvage procedures for atraumatic CLI and infection. LEVEL OF EVIDENCE: Level III prognostic.


Assuntos
Amputação Cirúrgica/métodos , Amputação Cirúrgica/estatística & dados numéricos , Disparidades em Assistência à Saúde , Infecções/cirurgia , Isquemia/cirurgia , Salvamento de Membro/estatística & dados numéricos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Grupos Raciais , Infecções dos Tecidos Moles/complicações , Adolescente , Adulto , Idoso , Aterosclerose/complicações , Estudos de Coortes , Conjuntos de Dados como Assunto , Diabetes Mellitus Tipo 2/complicações , Feminino , Disparidades em Assistência à Saúde/etnologia , Humanos , Isquemia/etiologia , Masculino , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/complicações , Estudos Retrospectivos , Risco , Adulto Jovem
3.
J Surg Educ ; 76(1): 286-293, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30097349

RESUMO

OBJECTIVE: Previously published studies have evaluated Orthopedic In-Training Examination sports medicine questions, but none have evaluated whether question difficulty has changed over time. DESIGN: Sports medicine subsection questions between 2012 and 2016 were evaluated and compared with previously published data on Orthopedic In-Training Examination from 2004 to 2009. Question categories were classified into 1 of 3 taxonomy levels-basic recall, diagnosis, and advanced problem solving. SETTING: Medical University of South Carolina; Charleston, SC, 29425; Institution. PARTICIPANTS: Two residents evaluated the Sports Subsection questions separately. Then an attending physician evaluated the questions to resolve discrepancies. A statistician was used for analysis. RESULTS: Utilization of imaging modalities averaged 37%, with 28% (11/39) of the questions containing 2 or more imaging modalities. There were increases in utilization of advanced problem-solving questions (45% vs. 27%, p = 0.002) and decreases in basic recall questions (49% vs. 67%, p = 0.008) compared with previously published data. CONCLUSIONS: While the percentage of the Orthopedic In-Training Examination represented by sports medicine has remained relatively unchanged, there were fewer questions requiring residents to demonstrate simple recall and diagnosis, and increased demand to perform advanced problem solving while utilizing multiple imaging modalities.


Assuntos
Competência Clínica , Ortopedia/educação , Medicina Esportiva/educação , Avaliação Educacional/métodos , South Carolina
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA