The Effect of an Orthopaedic Surgeon's Attire on Patient Perceptions of Surgeon Traits and Identity: A Cross-Sectional Survey.

INTRODUCTION: In orthopaedic surgery, limited research is available addressing how attire, including white coats (WC) and feminine attire such as skirts, affects patient perceptions. It is unknown how surgeon appearance is associated with identification as a surgeon and perception of clinical skills, nor whether this differs between male and female surgeons. METHODS: An image-based survey was offered to all adult patients in four orthopaedic surgeons' sport medicine or foot and ankle clinics. Respondents viewed 10 photos of male and female models in varying attire and identified that individual's most likely role on the healthcare team. Then, in 10 photos pairs, respondents selected which surgeon showed more competence, ability to excel in performing the physical components of surgery, likelihood to provide a good surgical outcome, and trustworthiness. RESULTS: Two hundred thirty-eight patients participated in the survey. Men were identified as surgeons significantly more frequently than women in similar clothing (P < 0.05) for all attire except a business attire without a WC (men: 18.2% vs women: 11.2%; P = 0.252). Patients ranked physicians wearing a WC with any attire as more competent and more likely to give a good surgical outcome than those without (all P < 0.005). Patients found women in feminine attire significantly less likely to excel in performing the physical parts of surgery than women in scrubs (P = 0.001). DISCUSSION: Women surgeons who wear feminine business attire instead of scrubs may be perceived less able to perform the physical work of operating, but are otherwise rated comparably with their peers, both male and female. Surgeons wearing WC are generally perceived more favorably than those without WC, an effect that is magnified for perceptions of competence for female surgeons. Men are more readily identified as surgeons than women when wearing a similar attire, except for a business attire without WC. There are continuing differences in how patients perceive male and female orthopaedic surgeons based on their attire.

Midtarsal arthrodesis in the treatment of Charcot midfoot arthropathy. Surgical technique.

BACKGROUND: Fracture-dislocation of the midfoot with collapse of the longitudinal arch is common in patients with neuropathic arthropathy of the foot. In this study, we describe a technique of midfoot arthrodesis with use of intramedullary axial screw fixation and review the results and complications following use of this technique. METHODS: A retrospective study of twenty-two patients who had undergone surgical reconstruction and arthrodesis to treat Charcot midfoot deformity was performed. Bone resection and/or osteotomy were required to reduce deformity. Axially placed intramedullary screws, inserted either antegrade or retrograde across the arthrodesis sites, were used to restore the longitudinal arch. Radiographic measurements were recorded preoperatively, immediately postoperatively, and at the time of the last follow-up and were analyzed in order to assess the amount and maintenance of correction. RESULTS: Patients were evaluated clinically and radiographically at an average of fifty-two months. Complete osseous union was achieved in sixteen of the twenty-two patients, at an average of 5.8 months. There were five partial unions in which a single joint did not unite in an otherwise stable foot. There was one nonunion, with recurrence of deformity. All patients returned to an independent functional ambulatory status within 9.5 months. Weight-bearing radiographs showed the talar-first metatarsal angle, the talar declination angle, and the calcaneal-fifth metatarsal angle to have improved significantly and to have been corrected to nearly normal values by the surgery. All measurements remained significantly improved, as compared with the preoperative values, at the time of final follow-up. There were no recurrent dislocations. Three patients had a recurrent plantar ulcer at the metatarsophalangeal joint that required additional surgery. There were eight cases of hardware failure. CONCLUSIONS: Open reduction and arthrodesis with use of multiple axially placed intramedullary screws for the surgical correction of neuropathic midfoot collapse provides a reliable stable construct to achieve and maintain correction of the deformity.

Midtarsal arthrodesis in the treatment of Charcot midfoot arthropathy.

BACKGROUND: Fracture-dislocation of the midfoot with collapse of the longitudinal arch is common in patients with neuropathic arthropathy of the foot. In this study, we describe a technique of midfoot arthrodesis with use of intramedullary axial screw fixation and review the results and complications following use of this technique. METHODS: A retrospective study of twenty-two patients who had undergone surgical reconstruction and arthrodesis to treat Charcot midfoot deformity was performed. Bone resection and/or osteotomy were required to reduce deformity. Axially placed intramedullary screws, inserted either antegrade or retrograde across the arthrodesis sites, were used to restore the longitudinal arch. Radiographic measurements were recorded preoperatively, immediately postoperatively, and at the time of the last follow-up and were analyzed in order to assess the amount and maintenance of correction. RESULTS: Patients were evaluated clinically and radiographically at an average of fifty-two months. Complete osseous union was achieved in sixteen of the twenty-two patients, at an average of 5.8 months. There were five partial unions in which a single joint did not unite in an otherwise stable foot. There was one nonunion, with recurrence of deformity. All patients returned to an independent functional ambulatory status within 9.5 months. Weight-bearing radiographs showed the talar-first metatarsal angle, the talar declination angle, and the calcaneal-fifth metatarsal angle to have improved significantly and to have been corrected to nearly normal values by the surgery. All measurements remained significantly improved, as compared with the preoperative values, at the time of final follow-up. There were no recurrent dislocations. Three patients had a recurrent plantar ulcer at the metatarsophalangeal joint that required additional surgery. There were eight cases of hardware failure. CONCLUSIONS: Open reduction and arthrodesis with use of multiple axially placed intramedullary screws for the surgical correction of neuropathic midfoot collapse provides a reliable stable construct to achieve and maintain correction of the deformity.