Orthopedic Provider Gender Preference Among Patients in an Orthopedic Surgery Residency Program of a Hispanic American Community.

Background: There are limited data regarding the gender preferences of Hispanic Americans when selecting their orthopedic surgeon. This study aimed to evaluate the gender preferences of Hispanic Americans when choosing a physician as their orthopedic provider. Materials and Methods: A cross-sectional survey was administered to all consecutive Hispanic American patients treated at the outpatient orthopedic clinics of a tertiary medical center in Puerto Rico between October 4, 2019 and March 4, 2020. Sociodemographic status and opinion of gender preference in orthopedic surgery were assessed and analyzed between female and male respondents. Results: A total of 628 surveys were completed. There were 343 (54.6%) females and 285 (45.4%) males with an average age of 51.0 ± 13.0 years. A significantly higher portion of female respondents was widowed (p = 0.01), had a higher educational level (p = 0.02), were unemployed (p = 0.01), and had a lower individual annual income salary (p = 0.04); when compared with males. Most of the respondents had no gender preference (91.1% = 572/628) for an orthopedic provider. Among those with a gender preference, 5.1% (32/628) preferred a male surgeon, and 3.8% (24/628) preferred a female surgeon. No significant difference was found between male and female respondents in the opinion of an orthopedic provider. Conclusions: This study illustrates that Hispanic Americans have no gender preference when choosing an orthopedic provider. Therefore, patient preference should not be considered a factor contributing to women's under-representation in our orthopedic surgery training program. Our findings may also assist future studies in search of other indications attributed to the under-representation of females in this field.

Post-traumatic tenosynovial chondromatosis following a triquetrum fracture: a case report.

Tenosynovial chondromatosis (TC) is a rare progressive benign tumor from the synovial lining of tendon sheath. The TC mostly affects males between the ages 30 to 50 years old at the ventral side of wrist. There are two different forms of TC that have been proposed in previous studies: an idiopathic cause (primary TC) and a joint related diseases cause (secondary TC). Even though trauma has been written to be a common reason for TC, a case of a secondary TC affecting the dorsal wrist following a triquetrum fracture has never been written before. The aim of this report is to present a rare case of a solitary post-traumatic TC at the dorsal wrist following a triquetrum fracture. We describe the clinical presentation, imaging modalities, histopathological and treatment challenges to manage this difficult lesion.

Microvascular Free Tissue Transfer for Complex Soft Tissue Injuries in Lower Extremities: Brief Report of a Hispanic Population.

OBJECTIVE: Microvascular free-tissue transfer (M-FTT) is a surgical technique for traumatic injuries that allows tissue reconstruction based on donor tissue composition. The aim of this study is to describe the surgical experiences of M-FTT for reconstruction of complex soft tissue injuries in the lower extremities of a Hispanic population. METHODS: This is a descriptive study of all M-FTT procedures performed by a single plastic surgeon from 2012 to 2016 at Puerto Rico Medical Center. Demographics, admission diagnosis, mechanism of trauma, type of free flap, co-morbidities, length of stay, donor site and complications were evaluated. RESULTS: Eight patients who underwent single M-FTT procedures at lower extremity were enrolled in the study. The average age at time of surgical reconstruction was 36.9+13.2 years with six males and two females. The transfer procedures were performed using donor sites of six rectus abdominis flaps and 2 radial forearm flaps. Posterior tibial artery was used in 62.5% and popliteal artery were used in 37.5% as recipient arteries. Average surgical time was 4.4+0.7 hours with an average length of hospital stay of 22.9+20.1 days. Post-operative complications were reported in three M-FTT procedures: two cases who suffered venous thrombosis and one case who suffered partial necrosis. CONCLUSION: The M-FTT offers an adequate surgical option for patients who present with complex soft tissue traumatic injuries at the lower extremities.

The Effect of Total Hip Arthroplasty on the Sciatic Nerve: an Electrodiagnostic Evidence Study.

OBJECTIVE: Objectively evaluate the incidence of sciatic nerve injury after a total hip arthroplasty (THA) performed through a posterolateral approach. METHODS: Patients scheduled to undergo THA were evaluated preoperatively and postoperatively with electrophysiologic studies, the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) questionnaire and other methods described in the study. Patients older than 21 years with any of the following preoperative diagnoses: primary or secondary osteoarthritis, aseptic avascular necrosis, rheumatoid arthritis, and posttraumatic arthritis were included. Variables used for analysis were sex, age, and body mass index (BMI). The Mann-Whitney U and Wilcoxon tests and, Pearson and Spearman correlation statistics were used for analysis of categorical and continuous data respectively. RESULTS: Electrodiagnostic data showed alterations in 17 patients (70.8%). No signs of sciatic nerve injury. The mean preoperative and postoperative WOMAC scores were 40 and 74, respectively (p = 0.0001). Statistical differences were noted in sural sensory amplitude (SSA) and distal amplitude of the tibialis motor nerve in the female group (p=0.007; p=0.036, respectively). The SSA also demonstrated differences in the obese group (p=0.008). In terms of age, both the SSA (Pearson p=0.010 and Spearman p=0.024) and the proximal latency of the peroneal motor nerve (Pearson p=0.026 and Spearman p=0.046) demonstrated a decrease in amplitude and an increase in latency that was inversely related with age. CONCLUSION: According to our subclinical electrophysiological findings, surgeons that use the posterolateral approach in THA procedures must be conscious of the sciatic nerve's vulnerability to reduce possible clinical complications.

Extraskeletal presentation of Ewing's Sarcoma.

The case of a 27-year-old Hispanic female who presented with an occipito-parietal tumor after suffering trauma to the area. A physical examination revealed no tenderness to palpation and with evidence of healing ulcerations. The biopsy was consistent with a synovial sarcoma. A wide excision of the mass (15cm x 14cm x 6cm) followed by a pericranial flap was performed. A follow-up CT showed recurrence involving the parietal sagittal sinus. After a second biopsy the mass was determined to be a small-cell sarcoma, consistent with Ewing's sarcoma. Chemotherapy included 8 cycles of doxorubicin, vincristine, and cyclophosphamide, with alternating cycles of etoposide and ifosfamide. A year later, a second wide excision of the mass was performed, followed by bilaminate skin substitute and skin graft placement for reconstruction of the soft-tissue defect. After chemotherapy, a follow-up PET scan showed no signs of re-uptake in any soft tissue or skeletal structures. After 2 years, the patient remains in complete remission.