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.

Four-corner arthrodesis using two headless compression screws.

We present the outcome of four-corner wrist arthrodesis using two headless compression screws for fixation. The study group consisted of 27 patients who underwent arthrodesis from 1998 through 2007. Data on demographic parameters, diagnosis, range of motion, pain and complications were collected from the medical files. A total of 77 series of anteroposterior, oblique, and lateral x-rays were reviewed by three independent interpreters ; consensus of at least two was required for the bones to be considered fused. Fusion was achieved in 24/27 wrists. Overall, inter-observer agreement in identifying radiographic bony fusion was fair (κ = 0.41). At the critical timing, 86 (SD 68) days postoperatively, when the decision regarding -fusion was made, inter-observer agreement was poor (κ = 0.07). Our rates of fusion are consistent with -reports in the literature. Radiographs performed at 3 months after four-corner arthrodesis are not -reliable for the diagnosis of fusion.

A comprehensive computerized critical laboratory results alerting system for ambulatory and hospitalized patients.

Automatic alerting systems for key events in medical practice have been proven effective in improving the clinician's response to the event. Most of the systems described in current literature are hospital based, some in intensive care units. We designed a clinical alerting system that screens laboratory results of both hospitalized patients and most of Israel's Southern region ambulatory patients for critical results, using an integrative CDR and its interfaces to the hospital's laboratory information systems. New alerts can be defined and activated using a rule editor. Alerts are generated by screening all new laboratory results that are entered in to the CDR, by a decision engine. The alerts are dispatched to clinicians through a customizable preferred alerting device that can be either e-mail, fax or cellular phone SMS, and enables additional alerting devices as they become available. Clinicians may customize both the alerting method and the critical levels for alert generation, according to individual specific needs. We hope that this versatile and customizable alerting system will suite the needs of both the hospital and the community clinical staff. The system will be implemented and tested in the near future.

[Vacuum phenomenon in the hip joint: diagnostic value].

Vacuum phenomenon is well known in degenerative spinal disease in the elderly, but is seldom seen in other joints, especially in children. The phenomenon does not represent a pathological finding, and can be used for imaging of the articular facets, mainly in the hip and knee joints. We report a patient with this phenomenon in the hip joint.