The opportunity cost of arthroplasty training in orthopaedic surgery.

INTRODUCTION: Training the next generation of surgeons is a crucial role fulfilled by consultant orthopaedic surgeons. However we are increasingly constrained by limited time and resources. We sought to compare operative time and length of stay (LOS) for total hip and total knee arthroplasties (THA, TKA) performed by a consultant orthopaedic surgeon with those performed by supervised trainees. MATERIALS AND METHODS: A prospective database of arthroplasty procedures performed from 2015 to 2018 was collated. Primary surgeon grade was recorded. Patient demographics, ASA grade, LOS and operative time were recorded. For THA both cemented and uncemented arthroplasties were used. SPSS version 23 was used for statistical analysis. RESULTS: 394 arthroplasty procedures were carried out during the study period. Trainee surgeons performed a high proportion of both THA (53.2%, n = 123) and TKA (44.8%, n = 73) surgeries. Trainees performed 57% of cemented THA procedures. LOS did not differ between consultant and trainee surgeons for THA (5.9 ± 4.8 days) or TKA (5.6 ± 4.1 days). Age had a significant effect on LOS (p < 0.001). For THA the mean operative time for trainees was 90.3 ± 19.23 min, 18.2 min longer than the consultant group. For TKA the mean operative time was 89.06 ± 18.87 min for trainees, 24.4 min longer than the consultant group. DISCUSSION: At our institution trainee surgeons can be expected to take between 18 and 24 min longer to perform arthroplasty procedures. This should be factored into resource planning, as the training of orthopaedic surgeons is crucial to sustaining and improving health service provision.

A Big HIIT: A Fracture Dislocation of the Hip in a Young Man Participating in Extreme Conditioning Exercise: A Case Report.

CASE: Hip dislocations with associated acetabular fracture are rare events usually associated with high-energy trauma. We describe an unusual case of low-energy acetabular fracture dislocation sustained by a 30-year-old athletic male athlete during a high-intensity training program. CONCLUSION: Correct execution of training programs is important. Healthcare professionals as well as participants and instructors of extreme conditioning programs should be aware of this serious complication. Avoidance of this injury may be possible with increased interval recovery and improved technique.

[Intestinal intussusception in children. Ultrasonic diagnosis]. / Invaginacija intestinuma kod dece. Dijagnostika ultrazvukom.

The aim of the paper is to demonstrate a successful use of ultrasound in the diagnosis of intestinal intussusception in children. Ultrasound decreases the number of irrigographic examinations and reduces diagnostic exposure of children to X-rays. In the last three years 35 children, aged from 3 months to 15 years (average 2 years), had a suspected clinical diagnosis of intussusception. The ultrasound studies revealed intestinal intussusception in 26 patients (74%). There were no false positive or false negative ultrasound findings. In four patients with secondary intussusception the main symptoms were identified (three solid lesions and two Meckel's diverticula). Intraluminal lesions at the apex of intussusception were confirmed by surgery. In 22 patients intussusception was idiopathic. In 15 of these patients (68%), hydrostatic desinvaginations, under combined ultrasound and radioscopic control, were successful. High grade unsuccessful hydrostatic reductions were associated with long persistence of symptoms (2 to 9 days). Ultrasound is reliable in diagnosis of intestinal intussusception and useful in control of hydrostatic reduction. In patients with expected intestinal perforation ultrasound should be combined with fluoroscopy.

True hermaphroditism: 10 years' experience.

True hermaphroditism (TH) is the rarest variant of intersex malformations. By definition, these patients have both ovarian and testicular tissue. Most present due to ambiguous genitalia and/or gynecomastia. From 1986 to 1996, we treated 97 patients with intersex disorders; there were 4 with TH. In all cases testicular and ovarian tissue was separate. In 3 patients the external genitalia were ambiguous and 1 had hypoplastic male genitalia. Three patients had a 46, XY and 1 a 46, XX karyotype. Three patients had been listed as males and 1 as a female. The number of operations required varied from 3 to 9 (mean 5.7 per patient). Two patients who had been raised as males finished puberty with hypogenitalism and hypoplastic testes. One married and could have erections, but no ejaculation. Two male patients have been on supplementary androgen therapy. The only patient who had been raised as a female after clitorovaginoplasty had a 6-cm-deep, blind-ending vagina that was deepened to 12 cm with bougienage, so that she was capable of having normal intercourse. It is felt at present that most patients with TH should be raised as females. This was confirmed in our patients as well, which underlines the significance of early diagnosis.

[Multicystic dysplastic kidney. Therapeutic dilemmas and personal experience]. / Multicisticni displazicni bubreg. Terapijske dileme i nase iskustvo.

A multicystic dysplastic kidney (MCDK) is one of the most frequent causes of abdominal mass in the neonate. Prenatal echography permits early and frequent diagnostics. It is a nonfamilial disease without associated cystic disease of the pancreas, liver or lungs. Indications for elective surgery are clear when there is a symptomatic disease. However, treatment of asymptomatic patients is controversial. A rising number of authors prefer nonsurgical approach, leaving MCDK intact with a close follow-up of patients for possible severe complications (malignancy, hypertension, infection, pain, rupture). We treated 15 patients with MCDK from 1984 to 1994. Diagnosis was passed antenatally in 7 (47%) patients, accidentally in 2, and based on the presence of abdominal mass in 6 patients. Two patients had renal failure due to the abnormal contralateral kidney. Nine patients were operated on and 6 were treated nonsurgically. The risk of complications associated with nonsurgical treatment, easiness of efficient surgery at the age of 3-6 months, avoiding stress in the child and family due to long-term follow-up, all suggest operative treatment. We suggest to parents both operative and nonoperative options, explaining the risk and danger of both. We believe that nephrectomy is the best solution in a child with MCDK who is growing, develops hypertension, with uncertain diagnosis or when adequate follow-up is impossible.

[Clinical heterogeneity in patients with ocular myopathies]. / Heterogenost klinickog ispoljavanja kod bolesnika s okularnom miopatijom.

We present the results of clinical, electrophysiological, and biopsy studies in patients with ocular myopathy. Nine patients (four women and five men) were included in these investigations. According to the biopsy findings the patients were divided into patients with oculocraniosomaltic syndrome (OCSS) and patients with oculopharyngeal muscular dystrophy (OPMD). The presented clinical features, especially in the OCSS groups was more variable. Associated neurological and multisystem disturbances were characteristic of OCSS. Biopsy findings were of essential significance in distinguish these two conditions, especially in cases of the late onset.