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1.
J Orthop Surg (Hong Kong) ; 28(2): 2309499020923499, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32406305

RESUMO

The coronavirus (COVID-19) pandemic has severely affected the medical community and stopped the world in its tracks. This review aims to provide the basic information necessary for us, orthopaedic surgeons to prepare ourselves to face this pandemic together. Herein, we cover the background of COVID-19, presentation, investigations, transmission, infection control and touch upon emerging treatments. It is of paramount importance that we should stay vigilant for our patients, our families and ourselves. Adequate infection control measures are necessary during day-to-day clinical work.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Controle de Infecções/métodos , Ortopedia/normas , Pandemias , Pneumonia Viral , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Humanos , Cirurgiões Ortopédicos , Ortopedia/educação , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia
3.
J Bone Joint Surg Am ; 102(10): 847-854, 2020 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-32271208

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) broke out in Wuhan, the People's Republic of China, in December 2019 and now is a pandemic all around the world. Some orthopaedic surgeons in Wuhan were infected with COVID-19. METHODS: We conducted a survey to identify the orthopaedic surgeons who were infected with COVID-19 in Wuhan. A self-administered questionnaire was distributed to collect information such as social demographic variables, clinical manifestations, exposure history, awareness of the outbreak, infection control training provided by hospitals, and individual protection practices. To further explore the possible risk factors at the individual level, a 1:2 matched case-control study was conducted. RESULTS: A total of 26 orthopaedic surgeons from 8 hospitals in Wuhan were identified as having COVID-19. The incidence in each hospital varied from 1.5% to 20.7%. The onset of symptoms was from January 13 to February 5, 2020, and peaked on January 23, 8 days prior to the peak of the public epidemic. The suspected sites of exposure were general wards (79.2%), public places at the hospital (20.8%), operating rooms (12.5%), the intensive care unit (4.2%), and the outpatient clinic (4.2%). There was transmission from these doctors to others in 25% of cases, including to family members (20.8%), to colleagues (4.2%), to patients (4.2%), and to friends (4.2%). Participation in real-time training on prevention measures was found to have a protective effect against COVID-19 (odds ratio [OR], 0.12). Not wearing an N95 respirator was found to be a risk factor (OR, 5.20 [95% confidence interval (CI), 1.09 to 25.00]). Wearing respirators or masks all of the time was found to be protective (OR, 0.15). Severe fatigue was found to be a risk factor (OR, 4 [95% CI, 1 to 16]) for infection with COVID-19. CONCLUSIONS: Orthopaedic surgeons are at risk during the COVID-19 pandemic. Common places of work could be contaminated. Orthopaedic surgeons have to be more vigilant and take more precautions to avoid infection with COVID-19. LEVEL OF EVIDENCE: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Cirurgiões Ortopédicos/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adulto , Estudos de Casos e Controles , China/epidemiologia , Infecções por Coronavirus/prevenção & controle , Fadiga/complicações , Feminino , Hospitais/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Cirurgiões Ortopédicos/educação , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Prevenção Primária/educação , Roupa de Proteção/estatística & dados numéricos , Fatores de Risco
4.
Medicine (Baltimore) ; 99(14): e19677, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243403

RESUMO

In the Graf method of hip ultrasonography, the diagnosis of the infantile hip with developmental dysplasia of the hip (DDH) is strictly dependent on the bony roof (alpha angle) and the cartilage roof (beta angle) measurements. In this study, we investigated whether the infant hip could be diagnosed with DDH solely by evaluating ultrasound images obtained in the standard plane, without bony roof and cartilage roof measurements, in respect to different professional experience levels.Two hundred ten hip ultrasounds were randomly selected from patients who presented to our hospital for DDH screening. A total of 6 ultrasound images were obtained for each hip. The hip morphology evaluations were made without the bony roof and the cartilage roof measurements by 2 orthopedic surgery residents; 2 orthopedic surgery specialists, trained in the diagnosis and the treatment of the DDH; and 2 pediatric orthopedic surgery professors, highly experienced in the diagnosis and treatment of DDH. After hip morphology evaluations, the bony roof and the cartilage roof measurements were obtained and hip type evaluations were made by the same raters, according to the Graf method of hip ultrasonography.The highest intraobserver agreements between the hip maturity evaluation before and the hip type evaluation after measurements were .676 (P < .001) and .577 (P < .001) in professors 2 and 1, respectively, and the lowest agreements were .185 (P < .01) and .289 (P < .001) in specialist 1 and resident 2, respectively.The diagnosis of the infant hip as DDH could not be made solely by evaluation of the ultrasound images obtained in the standard plane without the bony roof and the cartilage roof measurements. The bony roof and the cartilage roof measurements were obligatory for the diagnosis of the infant hip as DDH, even in the very experienced pediatric orthopedic surgeons.Level of evidence: 2.


Assuntos
Competência Clínica/estatística & dados numéricos , Luxação Congênita de Quadril/diagnóstico por imagem , Cirurgiões Ortopédicos/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos , Adulto , Cartilagem/diagnóstico por imagem , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Ossos Pélvicos/diagnóstico por imagem , Reprodutibilidade dos Testes , Ultrassonografia/métodos
5.
Trop Doct ; 50(2): 108-110, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32316857

RESUMO

The emergence of COVID-19 has impacted orthopaedic surgery worldwide. India, with its large population and limited health resources, will be overwrought over the coming days due to the number of cases of critically ill patients with COVID-19. It is important to understand the challenges for orthopaedic (and other) surgeons in India when dealing with patients during the COVID-19 pandemic. This article highlights the challenges in the triaging of patients, care in dealing with a patient with COVID-19 in orthopaedic surgery, and the effects on academics and research activities; it also suggests immediate measures and recommendations that also apply to other specialties.


Assuntos
Infecções por Coronavirus/epidemiologia , Procedimentos Ortopédicos , Cirurgiões Ortopédicos/psicologia , Pandemias , Pneumonia Viral/epidemiologia , Humanos , Índia/epidemiologia
6.
Instr Course Lect ; 69: 597-606, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017754

RESUMO

Low back pain is one of the most common reasons for physician visits, leading to high heath care costs and disability. Patients may present to primary care physicians, pain management physicians, chiropractors, physical therapists, or surgeons with these complaints. A thorough history and physical examination coupled with judicious use of advanced imaging studies will aid in determining the etiology of the pain. As most cases of low back pain are self-limited and will not develop into chronic pain, nonsurgical treatment is the mainstay. First-line treatment includes exercise, superficial heat, massage, acupuncture, or spinal manipulation. Pharmacologic treatment should be reserved for patients unresponsive to nonpharmacologic treatment and may include NSAIDs or muscle relaxants. Surgery is reserved for patients with pain nonresponsive to a full trial of nonsurgical interventions and with imaging studies which are concordant with physical examination findings.


Assuntos
Dor Lombar , Vértebras Lombares , Cirurgiões Ortopédicos , Adulto , Humanos , Exame Físico , Guias de Prática Clínica como Assunto , Cirurgiões
7.
Isr Med Assoc J ; 22(1): 5-7, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927797

RESUMO

BACKGROUND: Many procedures requiring sedation in the pediatric emergency department are performed by consultants from outside the department. This team usually includes orthopedic surgeons and general surgeons. As sedation is now a standard of care in such cases, we evaluated consultants' views on sedation. OBJECTIVES: To evaluate consultants' views on sedation. METHODS: A questionnaire with both open-ended questions and Likert-type scores was distributed to all orthopedic surgeons and general surgeons performing procedures during the study period. The questionnaire was presented at three medical centers. RESULTS: The questionnaire was completed by 31 orthopedic surgeons and 16 general surgeons. Although the vast majority (93-100%) considered sedation important, a high percentage (64-75%) would still perform such procedures without sedation if not readily available. CONCLUSIONS: Sedation is very important for patients and although consultants understand its importance, the emergency department staff must be vigilant in both being available and not allowing procedures to "escape" the use of sedation.


Assuntos
Sedação Consciente , Consultores/estatística & dados numéricos , Serviço Hospitalar de Emergência , Atitude do Pessoal de Saúde , Criança , Sedação Consciente/métodos , Sedação Consciente/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Cirurgiões Ortopédicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários
8.
Medicine (Baltimore) ; 99(2): e18508, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914022

RESUMO

This is a retrospective evaluated. The objective of this study was to test the interobserver reliability and intraobserver reproducibility of fracture classification with Arbeitsgemeinschaftfür Osteosynthesefragen (AO) system and Fernandez system used by 5 senior orthopedic surgeons.Anteroposterior and lateral radiographs of 160 patients hospitalized for displaced distal radius fracture were examined. Independently, 5 orthopedic surgeons evaluated the radiographs according to 2 different distal radius classification systems (3 types of results). Three statistical tools were used to measure interobserver reliability and intraobserver reproducibility. The intraclass correlation coefficient and kappa coefficient (k) were used to assess both interobserver and intraobserver agreement of AO and Fernandez. Kappa value indicated poor agreement (<0), slight (0-0.20), fair (0.21-0.40), moderate (0.41-0.60), good (0.61-0.80), and perfect (0.81-1.00).The intraobserver reproducibility of AO system (9 types) and Fernandez system were moderate with a value of 0.577 and 0.438. The intraobserver reproducibility of AO system (27 subtypes) was 0.286. The interobserver reliability of AO system (9 types) was moderate with a value of 0.469 and that of Fernandez was moderate with a value of 0.435. The interobserver reliability of AO system (27 subtypes) was 0.299.Neither of the 2 systems can give us a satisfactory agreement between interobserver reliability and intraobserver reproducibility. In AO system, the interobserver reliability and intraobserver reproducibility of the 9 types decreased with the increase of subgroups.


Assuntos
Fraturas do Rádio/classificação , Fraturas do Rádio/diagnóstico por imagem , Reprodutibilidade dos Testes , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Cirurgiões Ortopédicos , Radiografia/métodos , Estudos Retrospectivos , Adulto Jovem
9.
Sports Health ; 12(1): 94-98, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31665613

RESUMO

BACKGROUND: Mixed results exist regarding the benefit of orthobiologic injections. The purpose of this study was to assess the variability in costs for platelet-rich plasma (PRP) and stem cell (SC) injections and evaluate for variables that influence pricing. HYPOTHESIS: There will be significant variability in the cost of PRP and SC injections throughout the United States. STUDY DESIGN: Descriptive epidemiology study. LEVEL OF EVIDENCE: Level 3. METHODS: Calls were made to 1345 orthopaedic sports medicine practices across the United States inquiring into the availability of PRP or SC knee injections and associated costs. In addition to pricing, the practice type, number of providers, and population and income demographics were recorded. Univariate statistical analyses were used to identify differences in availability and cost between variables. RESULTS: Of the contacted offices that provided information on both PRP and SC availability (n = 1325), 268 (20.2%) offered both treatments, 550 (41.5%) offered only PRP injections, 20 (1.5%) offered only SC injections, and 487 (36.8%) did not offer either treatment. The mean ± SD cost of a PRP injection was $707 ± $388 (range, $175-$4973), and the mean cost of an SC injection was $2728 ± $1584 (range, $300-$12,000). Practices offering PRP and SC injections tended to be larger (PRP, 12.0 physicians per practice vs. 8.1 [P < 0.001]; SC, 13.6 vs 9.7 [P < 0.001]). Practices that offered PRP injections were located in areas with higher median household income (P = 0.047). Variables associated with higher cost of PRP injections included city population (P < 0.001) and median income of residents (P < 0.001). CONCLUSION: While the majority of sports medicine practices across the United States offer some type of orthobiologic injection, there exists significant variability in the cost of these injections. CLINICAL RELEVANCE: This study demonstrates the significant variability in costs of orthobiologic injections throughout the country, which will allow sports medicine physicians to appreciate the value of these injections when counseling patients on available treatment options.


Assuntos
Custos de Cuidados de Saúde , Traumatismos do Joelho/economia , Traumatismos do Joelho/terapia , Plasma Rico em Plaquetas , Células-Tronco , Mão de Obra em Saúde , Humanos , Renda , Injeções Intra-Articulares , Traumatismos do Joelho/epidemiologia , Cirurgiões Ortopédicos/estatística & dados numéricos , Estados Unidos/epidemiologia
11.
Rev Med Suisse ; 15(670): 2021-2026, 2019 Nov 06.
Artigo em Francês | MEDLINE | ID: mdl-31696676

RESUMO

Proximal femur fractures in the elderly are still a major event in the functional trajectory of patients. In order to optimize their care, a pilot orthogeriatric unit was created in 2018 at the Valais Hospital. This innovative unit, managed by the internist-geriatrician within the orthopedic department, allows the early and standardized management of geriatric syndromes and postoperative complications. This article describes the practical operation of the unit, presents the preliminary results, and develops suggestions for improvement.


Assuntos
Fraturas Ósseas/cirurgia , Geriatras , Cirurgiões Ortopédicos , Idoso , Fêmur/cirurgia , Humanos , Complicações Pós-Operatórias/terapia
12.
J Bone Joint Surg Am ; 101(18): e95, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31567810

RESUMO

BACKGROUND: Communication is the foundation of any patient-doctor relationship. Patients who are unable to communicate effectively with physicians because of language barriers may face disparities in accessing orthopaedic care and in the evaluation and treatment of musculoskeletal symptoms. We evaluated whether Spanish-speaking patients face disparities scheduling appointments with orthopaedists via the telephone. METHODS: From the American Academy of Orthopaedic Surgeons (AAOS) web site, we randomly selected 50 orthopaedic surgeons' offices in California specializing in knee surgery. The investigator called eligible offices using a script to request an appointment for a hypothetical Spanish-speaking or English-speaking 65-year-old man with knee pain. The caller randomly selected the patient's primary language for this first call. A second call was placed a week later requesting an appointment for an identical patient who spoke the alternate language. RESULTS: There was no significant difference between Spanish-speaking and English-speaking patients' access to appointments with an orthopaedic surgeon (p = 0.8256). Thirty-six English-speaking patients and 35 Spanish-speaking patients were offered an appointment. Twenty-eight Spanish-speaking patients were instructed to bring a friend or family member who could translate for them, 3 were told that the provider spoke sufficient Spanish to communicate without the need for an interpreter, and 4 were told that an interpreter would be made available. CONCLUSIONS: We did not detect a disparity between Spanish-speaking and English-speaking patients' access to appointments with an orthopaedic surgeon. However, 80% of Spanish-speaking patients were asked to rely on nonqualified interpreters for their orthopaedic appointment. This study suggests that orthopaedic offices in California depend heavily on ad hoc interpreters rather than professional interpretation services. It also highlights potential barriers to the provision of qualified interpreters. Additional study is warranted to assess how this lack of adequate utilization of medical interpreters affects the patient-doctor relationship, the quality of care received, and the financial burden on the health system. CLINICAL RELEVANCE: Optimizing the care that we provide to our patients is a goal of every orthopaedic surgeon. We highlight the importance of utilizing professional interpreters as a means to reduce health-care disparities and overall health-care costs, as well as the importance of improving reimbursement and infrastructure for physicians to utilize qualified interpreters in caring for their limited-English-proficient patients.


Assuntos
Agendamento de Consultas , Barreiras de Comunicação , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Idioma , Cirurgiões Ortopédicos , Relações Médico-Paciente , Idoso , California , Disparidades em Assistência à Saúde/etnologia , Hispano-Americanos , Humanos , Masculino , Procedimentos Ortopédicos , Telefone , Tradução
13.
J Bone Joint Surg Am ; 101(19): 1713-1723, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31577676

RESUMO

BACKGROUND: Implant malalignment may predispose patients to prosthetic failure following total knee arthroplasty (TKA). A more thorough understanding of the surgeon-specific factors that contribute to implant malalignment following TKA may uncover actionable strategies for improving implant survival. The purpose of this study was to determine the impact of surgeon volume and training status on malalignment. METHODS: In this retrospective multicenter study, we performed a radiographic analysis of 1,570 primary TKAs performed at 4 private academic and state-funded centers in the U.S. and U.K. Surgeons were categorized as high-volume (≥50 TKAs/year) or low-volume (<50 TKAs/year), and as a trainee (fellow/resident under the supervision of an attending surgeon) or a non-trainee (attending surgeon). On the basis of these designations, 3 groups were defined: high-volume non-trainee, low-volume non-trainee, and trainee. The postoperative medial distal femoral angle (DFA), medial proximal tibial angle (PTA), and posterior tibial slope angle (PSA) were radiographically measured. Outlier measurements were defined as follows: DFA, outside of 5° ± 3° of valgus; PTA, >±3° deviation from the neutral axis; and PSA, <0° or >7° of flexion for cruciate-retaining or <0° or >5° of flexion for posterior-stabilized TKAs. "Far outliers" were defined as measurements falling >± 2° outside of these ranges. The proportions of outliers were compared between the groups using univariate and multivariate analyses. RESULTS: When comparing the high and low-volume non-trainee groups using univariate analysis, the proportions of knees with outlier measurements for the PTA (5.3% versus 17.4%) and PSA (17.4% versus 28.3%) and the proportion of total outliers (11.8% versus 20.7%) were significantly lower in the high-volume group (all p < 0.001). The proportions of DFA (1.9% versus 6.5%), PTA (1.8% versus 5.7%), PSA (5.5% versus 12.6%), and total far outliers (3.1% versus 8.3%) were also significantly lower in the high-volume non-trainee group (all p < 0.001). Compared with the trainee group, the high-volume non-trainee group had significantly lower proportions of DFA (12.6% versus 21.6%), PTA (5.3% versus 12.0%), PSA (17.4% versus 33.3%), and total outliers (11.8% versus 22.3%) (all p < 0.001) as well as DFA (1.9% versus 3.9%; p = 0.027), PSA (5.5% versus 12.6%; p < 0.001), and total far outliers (3.1% versus 6.4%; p = 0.004). No significant differences were identified when comparing the low-volume non-trainee group and the trainee group, with the exception of PTA outliers (17.4% versus 12.0%; p = 0.041) and PTA far outliers (5.7% versus 2.6%; p = 0.033). Findings from multivariate analysis accounting for the effects of patient age, body mass index, and individual surgeon demonstrated similar results. CONCLUSIONS: Low surgical volume and trainee status were risk factors for outlier and far-outlier malalignment in primary TKA, even when accounting for differences in individual surgeon and patient characteristics. Trainee surgeons performed similarly, and certainly not inferiorly, to low-volume non-trainee surgeons. Even among high-volume non-trainees, the best-performing cohort in our study, the proportion of TKA alignment outliers was still high. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Artroplastia do Joelho/estatística & dados numéricos , Artroplastia do Joelho/normas , Mau Alinhamento Ósseo/prevenção & controle , Cirurgiões Ortopédicos/estatística & dados numéricos , Ortopedia/educação , Idoso , Competência Clínica/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ortopedia/normas , Estudos Retrospectivos , Centros Cirúrgicos/estatística & dados numéricos
15.
J Bone Joint Surg Am ; 101(19): e102, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31577687

RESUMO

BACKGROUND: Resident burnout-the state of exhaustion, maladaptive detachment, and low sense of accomplishment-is a widely documented phenomenon that affects between 27% and 75% of residents in the United States. To our knowledge, no previous study has examined the relationship between resident burnout and performance on the Orthopaedic In-Training Examination (OITE). The current investigation sought to evaluate whether an association exists between indices of orthopaedic surgery resident burnout as assessed by the Maslach Burnout Inventory (MBI) and performance on the OITE. METHODS: In a cross-sectional study of the orthopaedic surgery residents at a single large academic institution, the MBI was completed by all trainees in May 2016. The results of the 2016 OITE were documented for each resident, including the percentage of correctly answered questions and OITE percentile ranking. To control for individual test-taking skills, United States Medical Licensing Examination (USMLE) Step-1 and Step-2 scores also were documented for each resident. The relationship between the MBI subscale scores and OITE performance was evaluated. RESULTS: The analysis included 100% of the 62 orthopaedic surgery residents in training at our institution. Sixteen (25.8%) of the residents experienced at least moderate emotional exhaustion, while 32 (51.6%) of the residents experienced at least moderate depersonalization and 8 (12.9%) of the residents experienced a moderate sense of impaired personal accomplishment. Postgraduate year (PGY)-2 residents had the highest emotional exhaustion and depersonalization scores compared with residents in other years of training. Each of the 3 MBI indices of burnout was associated with worse OITE performance when controlling for general test-taking ability. CONCLUSIONS: In this study of orthopaedic surgery residents at a large academic training program, burnout was present among residents in all PGYs of training; it was most prevalent during the second year of training. Increased levels of the 3 components of burnout were associated with worse performance on the OITE. While there is a lack of consensus in the existing literature, this study provides additional evidence that burnout is negatively associated with 1 aspect of overall resident performance. CLINICAL RELEVANCE: Orthopaedic surgery residency training is challenging; residents are tasked to acquire a considerable amount of knowledge, develop complex surgical skills, and hone critical clinical thinking in a relatively short period of time. Identifying modifiable contributors to resident burnout and the development of strategies to promote resident wellness during training are important as we strive toward developing the next generation of capable, competent, and well-balanced orthopaedic surgeons.


Assuntos
Esgotamento Profissional/psicologia , Competência Clínica/normas , Internato e Residência/normas , Ortopedia/educação , Sucesso Acadêmico , Estudos Transversais , Avaliação Educacional , Humanos , Cirurgiões Ortopédicos/educação , Cirurgiões Ortopédicos/psicologia , Cirurgiões Ortopédicos/normas , Inquéritos e Questionários , Estados Unidos
16.
Hand Surg Rehabil ; 38(6): 358-363, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31550553

RESUMO

Microsurgery is an unusual procedure in the theatres of military operations. We sought to analyze the state of microsurgical practices in the French medical treatment facilities (MTFs) deployed around the world in the 21st century. A retrospective study was conducted among all patients who were operated on in French forward surgical facilities between 2003 and 2015. Those who underwent microsurgical procedures for nerve injury, vascular injury, or extremity reconstruction were included. Only early vascular results were assessed. Among the 2589 patients operated on for an extremity injury during the study period, 56 (2.1%) were included, with the group composed of 29 patients with isolated nerve injuries, 28 patients with nerve and arterial injuries, and two patients with isolated arterial injuries, mostly at the hand level. Nerve procedures predominantly consisted of direct suturing, although autografting and nerve transfers were also performed. Thirteen microvascular repairs were carried out, including nine cases of proximal or digital revascularization; revascularization was successful in six of the nine cases. These procedures were completed by orthopedic surgeons trained in microsurgery, mostly under loupes magnification. Routine nerve repair in the field seems to be specific to French MTFs. Salvage of amputated or devascularized fingers in the combat zone had never been reported before. Such emphasizes the need to train deployed orthopedic surgeons to perform microsurgical procedures and to equip all MTFs with basic microsurgical sets and magnification means.


Assuntos
Extremidades/cirurgia , Microcirurgia/estatística & dados numéricos , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Procedimentos Ortopédicos/estatística & dados numéricos , Adulto , Artérias/lesões , Artérias/cirurgia , Extremidades/lesões , Feminino , Fraturas Ósseas/cirurgia , França , Hospitais Militares , Humanos , Masculino , Unidades Móveis de Saúde , Cirurgiões Ortopédicos/estatística & dados numéricos , Traumatismos dos Nervos Periféricos/cirurgia , Reimplante , Estudos Retrospectivos
17.
J Bone Joint Surg Am ; 101(17): e87, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31483407

RESUMO

BACKGROUND: Several studies have identified discrepancies in salary between male and female surgeons. Our aim was to investigate the impact of sex on an orthopaedic surgeon's yearly earnings by evaluating stratified income and specialty data from a large sample survey of orthopaedic surgeons. METHODS: Self-reported data were obtained from the 2014 and 2008 American Academy of Orthopaedic Surgeons (AAOS) biennial censuses. Responses were received from 6,805 (24.26%) of those who were surveyed. The census form is a 19-question survey that includes information regarding work status (full time versus part time), sex, years in practice, practice type (private versus academic), specialty, hours worked, case volume, and income. The main outcome evaluated was self-reported income, and a multivariate regression model was used to control for confounding variables. RESULTS: Male surgeons reported higher incomes than female colleagues working equivalent hours ($802,474 versus $560,618; p = 0.016); however, male surgeons reported a greater case volume for the same number of hours. Among surgeons who performed ≥26 procedures per month, male and female surgeons reported comparable incomes ($949,508 versus $872,903; p = 0.649). Incomes of those in practice for >20 years also were comparable. Regression analysis controlling for subspecialty choice, hours worked, work status, case volume, years in practice, and practice setting revealed that income was $62,032.51 less for women than men (p < 0.001). CONCLUSIONS: Income disparity between male and female orthopaedic surgeons remains significant, and the gap increased from 2008 to 2014. Although subspecialty choice, practice setting, years in practice, and amount and distribution of procedures performed can partially explain salary differences, our regression analysis suggests persistence of an income gap based on sex in orthopaedic surgery.


Assuntos
Renda/estatística & dados numéricos , Cirurgiões Ortopédicos/economia , Médicas/economia , Escolha da Profissão , Feminino , Humanos , Masculino , Cirurgiões Ortopédicos/estatística & dados numéricos , Médicas/estatística & dados numéricos , Salários e Benefícios , Fatores Sexuais , Estados Unidos
18.
Bull Hosp Jt Dis (2013) ; 77(3): 171-177, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31487481

RESUMO

INTRODUCTION: Medical vocabulary that conveys different meanings to different groups of readers can lead to confusion and potential misinterpretation of diagnoses. This article reviews words used by radiologists that convey information to the orthopedic surgeon and patient that is different from what the radiologist intended. These terms include meniscal tears, ligament sprains, partial tendon tears, bone bruises, bone contusions, articular cartilage injury, disc bulges, disc herniations, and joint subluxation. These words can, for example, suggest a traumatic etiology when in fact the condition is atraumatic, and they can imply a surgical treatment where none is indicated. This problem is further magnified in the arena of personal injury litigation. MATERIALS AND METHODS: The terms tear, bruise, contusion, injury, sprain, bulge, herniation, and subluxation are defined and analyzed for their ambiguous use, i.e., their actual versus intended meaning or other interpretation. RESULTS: Abnormalities and variations observed on musculoskeletal magnetic resonance (MR) images are often multi-factorial and may not be the source of any given patient's symptoms. The same MR image findings can have a congenital, traumatic, or degenerative source. CONCLUSIONS: Radiology vocabulary that invokes a singular traumatic event as a cause of an MRI finding can significantly mislead patients (as well as judges and juries). We propose that some terms be either avoided entirely when the findings are of uncertain etiology. At the very least, the various meanings of the terms need to be spelled out. Greater cooperation between orthopedic surgeons and radiologists on this matter would be beneficial to patient care.


Assuntos
Current Procedural Terminology , Erros de Diagnóstico/prevenção & controle , Imagem por Ressonância Magnética , Doenças Musculoesqueléticas/diagnóstico , Cirurgiões Ortopédicos/normas , Radiologistas/normas , Terminologia como Assunto , Ferimentos e Lesões/diagnóstico , Competência Clínica , Humanos , Colaboração Intersetorial , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/normas , Melhoria de Qualidade , Estados Unidos
19.
Ghana Med J ; 53(2): 126-134, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31481808

RESUMO

Background: Low Back Pain (LBP) is the leading cause of disability globally. Standardized outcome measures for measuring LBP disability exist but none was developed with consideration for the Nigerian culture and environment. Objective: This study was aimed to develop a Nigerian culture- and environment-friendly LBP scale, the Ibadan Low Back Pain Disability Questionnaire (ILBPDQ). Methods: Items on ILBPDQ were devised from literature review, interview of patients (231 consecutively-sampled patients with chronic non-specific LBP) and 12 professionals experienced in LBP management and were contentvalidated. The first draft of the questionnaire underwent pretesting twice among individuals with chronic non-specific LBP (n=35 and 114 respectively), factor analysis and experts' reviews to produce the final version. Results: The final scale comprised 18 items with a two-factor structure (common Activity of Daily Living [ADL] and culture-specific ADL). It has eigen value ≥ 1 and explained 60% of variance. Items on ILBPDQ covered important constructs relevant to an average Nigerian patient with LBP. Conclusion: A scale for assessing disability in LBP is made available for use in Nigeria and similar populations. Funding: None declared.


Assuntos
Atividades Cotidianas , Cultura , Dor Lombar/fisiopatologia , Medidas de Resultados Relatados pelo Paciente , Análise Fatorial , Humanos , Nigéria , Cirurgiões Ortopédicos , Fisioterapeutas , Reprodutibilidade dos Testes , Inquéritos e Questionários
20.
BMC Musculoskelet Disord ; 20(1): 389, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31470828

RESUMO

BACKGROUND: Lithium, an established psychiatric medication, has recently been shown to enhance new bone formation in preclinical fracture models. Current research is focused on evaluating the efficacy of low-dose, short-term lithium treatment to improve long bone fracture healing through a Phase II randomized clinical trial (LiFT NCT02999022). In working towards future applications of lithium for fracture management, this study aimed to understand the current perceptions of lithium as a psychiatric drug and the potential barriers to its orthopaedic adoption. METHODS: Three questionnaires, evaluating knowledge about lithium and willingness to embrace its use in fracture healing were disseminated among the general population, fracture patients eligible for the LiFT (Lithium for Fracture Treatment) trial and orthopaedic surgeons across Canada. RESULTS: Of the 768 public respondents, 84% were willing to take a medication that would aid fracture healing but only 62.6% if the medication was lithium. Willingness dropped to 44.6% among the 168 respondents who knew about the psychiatric use of lithium. Lack of sufficient knowledge (n = 50) and concerns about side effects including effects on the brain (n = 74) were the main reasons cited by those who were unwilling to use lithium. Of the 29 fracture patients, only 20 patients had previously heard of lithium. Of these, 40% were willing to take lithium for fracture healing with an additional 10% if the dose was low or if the intake duration was short. Only 50% knew that lithium has side effects. Of the 43 orthopaedic surgeons, 38 surgeons knew about clinical use of lithium. Of these, 68% knew that lithium has side effects and 29% knew that it interacts with other drugs. While most agreed that new strategies are needed to improve fracture management, only 68% were willing to prescribe lithium for fractures with an additional 16% if there is scientific evidence and/or a standard dosing protocol. CONCLUSIONS: This study identified a lack of knowledge about uses and side effects of lithium among all three cohorts. A robust educational framework for orthopaedic surgeons, their patients and the members of their clinical care teams will be essential to widespread repurposing of lithium for fracture care.


Assuntos
Competência Clínica/estatística & dados numéricos , Consolidação da Fratura/efeitos dos fármacos , Fraturas Ósseas/terapia , Conhecimentos, Atitudes e Prática em Saúde , Carbonato de Lítio/administração & dosagem , Adolescente , Adulto , Encéfalo/efeitos dos fármacos , Canadá , Relação Dose-Resposta a Droga , Esquema de Medicação , Reposicionamento de Medicamentos , Feminino , Fixação de Fratura , Humanos , Carbonato de Lítio/efeitos adversos , Masculino , Pessoa de Meia-Idade , Cirurgiões Ortopédicos/psicologia , Cirurgiões Ortopédicos/estatística & dados numéricos , Percepção , Placebos/administração & dosagem , Placebos/efeitos adversos , Inquéritos e Questionários/estatística & dados numéricos , Fatores de Tempo , Adulto Jovem
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