Second Toe Osteochondral Bone Graft for Resurfacing the Articular Surface of the Proximal Phalanx Head of the Thumb: A Case Report.

The most widely accepted surgical management of a traumatized interphalangeal joint of the thumb is arthrodesis. However, in certain situations, specific functional and vocational demands require preserved movement at this joint. In the present case report, we describe harvesting the second toe proximal phalanx head as an osteochondral bone graft to recontour the proximal aspect of the thumb interphalangeal joint. The post-operative hand therapy regimen is described resulting in a pain-free functional range of motion. We conclude that when a motivated, healthy patient has specific functional goals, osteochondral bone grafting from the toe is a viable technique to maintain a functional range of motion.

Health trends in Canada 1990-2019: An analysis for the Global Burden of Disease Study.

OBJECTIVE: Monitoring trends in key population health indicators is important for informing health policies. The aim of this study was to examine population health trends in Canada over the past 30 years in relation to other countries. METHODS: We used data on disability-adjusted life years (DALYs), years of life lost (YLL), years lived with disability, life expectancy (LE), and child mortality for Canada and other countries between 1990 and 2019 provided by the Global Burden of Disease Study. RESULTS: Life expectancy, age-standardized YLL, and age-standardized DALYs all improved in Canada between 1990 and 2019, although the rate of improvement has leveled off since 2011. The top five causes of all-age DALYs in Canada in 2019 were neoplasms, cardiovascular diseases, musculoskeletal disorders, neurological disorders, and mental disorders. The greatest increases in all-age DALYs since 1990 were observed for substance use, diabetes and chronic kidney disease, and sense organ disorders. Age-standardized DALYs declined for most conditions, except for substance use, diabetes and chronic kidney disease, and musculoskeletal disorders, which increased by 94.6%, 14.6%, and 7.3% respectively since 1990. Canada's world ranking for age-standardized DALYs declined from 9th place in 1990 to 24th in 2019. CONCLUSION: Canadians are healthier today than in 1990, but progress has slowed in Canada in recent years in comparison with other high-income countries. The growing burden of substance abuse, diabetes/chronic kidney disease, and musculoskeletal diseases will require continued action to improve population health.

RéSUMé: OBJECTIF: La surveillance des tendances des indicateurs clés de la santé de la population est importante pour éclairer les politiques de santé. Dans cette étude, nous avons examiné les tendances de la santé de la population au Canada au cours des 30 dernières années par rapport à d'autres pays. MéTHODES: Nous avons utilisé des données sur les années de vie ajustées en fonction de l'incapacité (DALY), les années de vie perdues (YLL), les années vécues avec un handicap, l'espérance de vie (LE) et la mortalité infantile pour le Canada et d'autres pays entre 1990 et 2019, fournies par l'Étude mondiale sur le fardeau de la maladie. RéSULTATS: L'espérance de vie, les YLL ajustées selon l'âge et les DALY ajustées selon l'âge ont tous connu une amélioration au Canada entre 1990 et 2019, bien que le taux d'amélioration se soit stabilisé depuis 2011. Les cinq principales causes des DALY pour tous les âges au Canada en 2019 étaient les néoplasmes, les maladies cardiovasculaires, les affections musculosquelettiques, les affections neurologiques et les troubles mentaux. Les plus fortes augmentations des DALY pour tous les âges depuis 1990 ont été observées pour l'usage de substances, le diabète et les maladies rénales chroniques, ainsi que les troubles des organes sensoriels. Les DALY ajustées selon l'âge ont diminué pour la plupart des conditions, à l'exception de l'usage de substances, du diabète et des maladies rénales chroniques, ainsi que des troubles musculosquelettiques, qui ont augmenté de 94,6 %, 14,6 % et 7,3 % respectivement depuis 1990. Le classement mondial du Canada pour les DALY ajustées selon l'âge est diminué de la 9ième place en 1990 à la 24ième place en 2019. CONCLUSION: Les Canadiens sont en meilleure santé aujourd'hui qu'en 1990, mais les progrès se sont ralentis ces dernières années par rapport à d'autres pays à revenu élevé. La croissance du fardeau lié à l'abus de substances, au diabète/maladies rénales chroniques et aux affections musculosquelettiques exigera des actions continues pour améliorer la santé de la population.

Upper Extremity Infection Related to Intravenous Drug Use: Considering the True Cost of the COVID-19 Pandemic and Lockdown.

BACKGROUND: The COVID-19 pandemic caused significant morbidity and mortality in people who inject drugs (PWID). Upper extremity soft tissue infections are frequently associated with intravenous drug use (IVDU) due to poor compliance with aseptic technique. In Canada, multiple safe injection sites providing clean injection supplies closed, leaving many PWID with no alternatives to inject safely. It was hypothesized that these closures will correspond with increased morbidity and mortality among PWID. The main objective of this study was to determine the effect of the COVID-19 pandemic on the incidence of upper extremity infections in PWID. METHODS: This was a retrospective chart review study. The primary outcome of interest was the frequency of upper extremity infections in PWID. Data were filtered to include only those patients presenting to the emergency department between March to June of 2019 and 2020. Chi-squared analysis was used to compare the number of IVDU patients among patients with upper extremity skin infections between these time periods. RESULTS: The number of IVDU patients treated for upper extremity infections in Hamilton significantly increased during the pandemic, relative risk = 2.0 (95% confidence interval [CI]: 1.3-2.9, P = .0012,) while total upper extremity infections numbers have decreased overall. During the pandemic, PWID made up a larger proportion of upper extremity infections (χ2 = 10.444, P = .00123). Demographic data such as age and sex of IVDU patients presenting with upper extremity infection was not significantly affected by the pandemic. CONCLUSIONS: The effect of the pandemic on accessing harm reduction services has led to evident increases in morbidity as described by this study. Further research on the impact of closures in PWID is needed to quantify these harms and work toward mitigation strategies.

Dr Patricia Clugston-A Spirit of Determination.

Dr Patricia Clugston was a British Columbia native who completed her plastic surgery residency training in Vancouver in 1993 before pursuing a fellowship in Nashville with Dr Patrick Maxwell in 1994. When Dr Clugston returned to Vancouver, she helped to establish a comprehensive and renowned breast reconstruction program. She spent her career advocating for and working towards better treatment options for women seeking breast reconstruction. As a determined surgeon and accomplished athlete, Dr Clugston was truly a tour de force in all aspects of her life. Patty, as she was affectionately known by her colleagues, loved her job. Dr Clugston was an avid advocate for medical education and an outstanding clinical researcher and speaker that established her as a shining star in Canadian plastic surgery. Patty had always lived life to the fullest and was determined that scleroderma would not change this. Her sharp wit, intellectual curiosity, and pragmatism masked an incredible courage as she fought bravely against a cruel disease. Dr Clugston died on March 1, 2005, at the age of 46 surrounded by the loving company of her husband, friends, and family at the Vancouver General Hospital. The Dr Patricia Clugston Chair in Breast Reconstruction was established in her name to honour her legacy and continue to improve the care of patients with breast cancer.

Originaire de la Colombie-Britannique, la docteure Patricia Clugston a terminé sa résidence en plasturgie à Vancouver en 1993 avant d'effectuer des études postdoctorales à Nashville avec le docteur Patrick Maxwell en 1994. À son retour à Vancouver, elle a contribué à mettre sur pied un programme de reconstruction mammaire complet et réputé. Elle a consacré sa carrière à préconiser et à rechercher de meilleures possibilités thérapeutiques pour les femmes qui veulent une reconstruction mammaire. Chirurgienne déterminée et athlète accomplie, elle dominait dans tous les aspects de sa vie. Patty, comme l'appelaient affectueusement ses collègues, adorait son travail. Cette défenseure passionnée de l'enseignement de la médecine était une chercheuse clinicienne et une conférencière remarquable, ce qui l'a établie comme une tête d'affiche de la plasturgie au Canada. Elle a toujours vécu sa vie au maximum et était déterminée à ne pas laisser la sclérodermie y changer quelque chose. Sa vivacité d'esprit, sa curiosité intellectuelle et son pragmatisme cachaient un courage incroyable, car elle luttait contre une maladie cruelle. Elle est décédée le 1er mars 2005 au Vancouver General Hospital à l'âge de 46 ans, entourée de l'amour de son mari, de ses amis et de sa famille. La chaire Dre Patricia Clugston en reconstruction mammaire a été créée en son nom pour commémorer sa mémoire et continuer d'améliorer les soins aux patientes atteintes du cancer du sein.

Primary Care Physicians' Knowledge, Perceptions, and Comfort Level in Managing Patients Fasting in Ramadan.

Background: Once a year, Muslims fast from dawn to sunset during the month of Ramadan. While fasting has many positive health implications, it may pose risks to individuals with underlying health issues. Despite the exemption from fasting for those who are ill, many Muslims with chronic conditions choose to fast. It is unclear how many Muslim patients receive counseling on fasting. As such, the purpose of this pilot project was to assess the knowledge, perception, and comfort level of primary care physicians (PCPs) at Dalhousie University's Department of Family Medicine in managing patients choosing to fast during Ramadan. Methods: A 16-item anonymous, self-administered, structured online survey was distributed to PCPs with an academic affiliation with the Department of Family Medicine at Dalhousie University. Participants rated their level of comfort, objective knowledge, and perceptions of managing patients fasting in Ramadan. Results: Many PCPs perceived the importance of understanding Ramadan fasting and its relevance to their patients' health, however, they did not have adequate knowledge about the matter. The majority of PCPs felt they received inadequate training in this area and did not feel comfortable counseling and managing the health of these patients. Conclusions: The findings of this study have outlined a knowledge gap that exists within our PCP community and will help inform and prioritize educational needs and direct efforts to ensure safe patient management during Ramadan.

Shaping Plastic Surgery in British Columbia-The Courtemanche Legacy.

Dr Albert Douglas Courtemanche was born in Gravenhurst, Ontario on November 16, 1929. In 1949, he was accepted to the University of Toronto Medical School, graduating in 1955. After completing his internship at the Toronto General Hospital and at the Hospital for Sick Children, he completed his surgical training in Vancouver and in the United Kingdom. When Dr Courtemanche returned from his training in 1962, he joined Dr Cowan on the surgical staff at the Vancouver General Hospital. He was responsible for establishing a new plastic surgery ward, a dedicated operating room (OR), an integrated burn unit and also starting the UBC plastic surgery training program. Dr Courtemanche became involved in working with the Royal College, first as an examiner and then as the Chairman of the Plastic Surgery Exam Board in 1981. He eventually became the first and only plastic surgeon to ever hold the position as President of the Royal College. Dr Courtemanche emphasized throughout his career the importance of teaching and role modeling. A very proud moment in Dr Courtemanche's career was when his son Douglas became a pediatric plastic surgeon. After retiring Dr Courtemanche became a volunteer at the VanDusen Botanical Garden and completed their Master Gardeners Program.

Le docteur Albert Douglas Courtemanche est né à Gravenhurst, en Ontario, le 16 novembre 1929. En 1949, il est accepté à l'école de médecine de l'Université de Toronto, où il est promu en 1955. Après avoir terminé son internat au Toronto General Hospital et au Hospital for Sick Children, il se spécialise en chirurgie à Vancouver et au Royaume-Uni. À son retour en 1962, il complète l'unité de chirurgie du Vancouver General Hospital avec le docteur Cowan. Il met sur pied un nouveau service de chirurgie plastique, une salle d'opération réservée, une unité intégrée des grands brûlés et le programme de formation en chirurgie plastique de l'université de la Colombie-Britannique. Le docteur Courtemanche s'investit au sein du Collège royal, d'abord comme examinateur, puis comme président du comité d'examen en chirurgie plastique en 1981. Il devient enfin le premier et le seul chirurgien plasticien à occuper la présidence du Collège royal. Tout au long de sa carrière, le docteur Courtemanche a souligné l'importance de l'enseignement et de la formation par l'exemple. Il a d'ailleurs ressenti une grande fierté lorsque son fils Douglas est devenu chirurgien plasticien en pédiatrie. Après avoir pris sa retraite, le docteur Courtemanche est devenu bénévole au jardin botanique VanDusen, où il a suivi le programme de maître jardinier.

Dr Henry Shimizu: The Journey of a Canadian Plastic Surgeon, Advocate, and Artist.

Dr Henry Shimizu was a dedicated Canadian plastic surgeon with Japanese roots who spent his career practicing in Edmonton at the University of Alberta Hospital. He relished the opportunity to share his expertise by training residents and medical students. Dr Shimizu completed his plastic surgery training in the United States and was central to establishing the plastic surgery training program in Edmonton. Beyond clinical practice, Dr Shimizu was a prominent advocate in his community, serving as the Chairman of the Redress committee for Japanese internment. As a talented painter, he had produced magnificent oil paintings based on childhood recollections as an internee in the Slocan Valley. Dr Shimizu has made significant contributions to Canadian plastic surgery serving as president of the Canadian Society of Plastic Surgeons in 1978. His clinic work and dedication to the community at large were recognized with the Order of Canada in 2004 and more recently an honorary degree from the University of Victoria. Dr Shimizu continues to golf, paint, and travel in his retirement. He is happily married to his wife Joan and is the proud father of 4 children and 6 grandchildren.

Le docteur Henry Shimizu, un plasticien canadien dévoué d'origine japonaise, a exercé pendant toute sa carrière à l'University of Alberta Hospital d'Edmonton. Il adorait partager ses compétences par l'enseignement aux résidents et aux étudiants en médecine. Il a terminé sa formation en chirurgie plastique aux États-Unis et a joué un rôle essentiel dans la création du programme de chirurgie plastique à Edmonton. Au-delà de la pratique clinique, le docteur Shimizu était un militant réputé dans sa communauté : il a présidé le comité de redressement pour l'internement des Japonais. Peintre talentueux, il a produit de magnifiques peintures à l'huile sur ses souvenirs d'enfance alors qu'il était interné dans la vallée de Slocan. Le docteur Shimizu a contribué largement à la chirurgie plastique au Canada et a présidé la Société canadienne des chirurgiens plasticiens en 1978. Il a été nommé membre de l'Ordre du Canada en 2004 pour son travail clinique et son dévouement envers l'ensemble de la communauté, et plus récemment, a reçu un doctorat honorifique de l'université de Victoria. Maintenant à la retraite, le docteur Shimizu continue de jouer au golf, de peindre et de voyager. Il vit un mariage heureux avec sa femme, Joan, et est le fier père de quatre enfants et de six petits-enfants.

Dr Michael Bell: A Surgeon With Boundless Ingenuity.

Dr Michael Bell was born in Kingston, Ontario, on October 14, 1944. He was always a curious child who exhibited a tendency toward innovation and experimentation. Dr Bell was accepted into the MD program at the University of Toronto graduating in 1969 before completing his plastic surgery residency there. Dr Bell accepted a position bringing hand and microsurgery expertise to the University of Ottawa in 1976. He pioneered the widespread use of local anesthetic for surgery and developed an innovative relationship with Leonard Lee of Lee Valley tools. Canica Design created several surgical products, including an enhanced design on the traditional scalpel handle and wound closure devices. Dr Bell had a passion for making improvements to enable surgeons to advance patient care. He encourages a philosophy of critical thinking that contributes to continued design in plastic surgery. Dr Bell continues to design and craft new devices with alumni of the Lee Valley Tools team.

Le docteur Michael Bell est né le 14 octobre 1944 à Kingston, en Ontario. Il a toujours été un enfant curieux, qui affichait une tendance vers l'innovation et l'expérimentation. Accepté au programme de médecine à l'université de Toronto, il a obtenu son diplôme en 1969 avant d'y effectuer sa résidence en chirurgie plastique. Il a accepté un poste à l'Université d'Ottawa en 1976, où il a mis en valeur ses compétences en chirurgie de la main et en microchirurgie. Ce pionnier de l'utilisation généralisée des anesthésiques locaux pour la chirurgie, a noué une relation novatrice avec Leonard Lee de Lee Valley Tools. Canica Design® a créé plusieurs produits chirurgicaux, y compris la conception améliorée du manche habituel de scalpel et des dispositifs de fermeture des plaies. Le docteur Bell se passionnait pour les améliorations afin que les chirurgiens puissent faire progresser les soins aux patients. Il favorise une philosophie de pensée critique qui contribue à poursuivre les concepts en chirurgie plastique et continue de concevoir et d'inventer de nouveaux dispositifs avec les anciens de l'équipe de Lee Valley Tools.

Long term follow-up demonstrating stability and patient satisfaction of minimally invasive punch technique for percutaneous bone anchored hearing devices.

OBJECTIVE: Minimally Invasive Ponto Surgery (MIPS) was recently described to facilitate the placement of percutaneous bone anchored hearing devices. As early adopters of this new procedure, we sought to perform a quality assurance project using our own small prospective cohort to justify this change in practice. We chose to examine device stability and to gauge our patients' perspective of the surgery and their overall satisfaction with the process. METHODS: A total of 12 adult patients who underwent MIPS between 2016 and 2017 with a minimum post-operative follow-up of 12 months were included in this study. A prospective MIPS research clinic was used to follow patients, assess the implant site soft tissue status and gather qualitative information through patient interviews and surveys. RESULTS: The mean (SD) soft tissue status score averages using the IPS Scale were low for inflammation 0.1 (0.1), pain 0.1 (0.1), skin height 0.2 (0.1) and total IPS score 0.4 (0.3) indicating minimal soft tissue changes. Patient experiences with MIPS were overwhelmingly positive in reports through the MIPS modified SSQ-8. All patients reported speedy recoveries and no long-term complications. There were zero device losses. CONCLUSION: The series presented in this paper represents the first MIPS cohort with long term follow-up to be published to date in North America. Our findings conclude both device stability and patient satisfaction with no loss of fixtures. Consequently, we have adopted MIPS as our procedure of choice for the placement of all percutaneous BAHDs.

Direct cost comparison of minimally invasive punch technique versus traditional approaches for percutaneous bone anchored hearing devices.

BACKGROUND: Minimally Invasive Ponto Surgery (MIPS) was recently described as a new technique to facilitate the placement of percutaneous bone anchored hearing devices. The procedure has resulted in a simplification of the surgical steps and a dramatic reduction in surgical time while maintaining excellent patient outcomes. Given these developments, our group sought to move the procedure from the main operating suite where they have traditionally been performed. This study aims to test the null hypothesis that MIPS and open approaches have the same direct costs for the implantation of percutaneous bone anchored hearing devices in a Canadian public hospital setting. METHODS: A retrospective direct cost comparison of MIPS and open approaches for the implantation of bone conduction implants was conducted. Indirect and future costs were not included in the fiscal analysis. A simple cost comparison of the two approaches was made considering time, staff and equipment needs. All 12 operations were performed on adult patients from 2013 to 2016 by the same surgeon at a single hospital site. RESULTS: MIPS has a total mean reduction in cost of CAD$456.83 per operation from the hospital perspective when compared to open approaches. The average duration of the MIPS operation was 7 min, which is on average 61 min shorter compared with open approaches. CONCLUSION: The MIPS technique was more cost effective than traditional open approaches. This primarily reflects a direct consequence of a reduction in surgical time, with further contributions from reduced staffing and equipment costs. This simple, quick intervention proved to be feasible when performed outside the main operating room. A blister pack of required equipment could prove convenient and further reduce costs.