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1.
Hand Clin ; 39(1): 111-118, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36402521

RESUMO

Hand surgery encompasses a diaspora of pathology and patients, but the surgeons treating this population are not commensurately diverse. A physician population that reflects the population it treats consistently leads to improved patient outcomes. Despite increasing diversity amongst surgeons entering into pipeline specialties such as General Surgery, Plastic Surgery, and Orthopaedic Surgery, the overall makeup of practicing hand surgeons remains largely homogenous. This article outlines organizations, such as the Perry Initiative, which have increased recruitment of women and underrepresented minorities into pipeline programs. Techniques of minimizing bias and increasing opportunities for underrepresented groups are also discussed.


Assuntos
Ortopedia , Cirurgiões , Humanos , Feminino , Grupos Minoritários
2.
Hand Clin ; 39(1): 73-78, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36402528

RESUMO

Hand surgery is a subspecialty that requires additional fellowship training after a primary residency; a long and competitive journey to achieve success. An underrepresented in medicine (UIM) student's journey to becoming a hand surgeon in the United States adds another level of challenge given several defined obstacles. Despite the lack of representation, the chances of becoming a hand surgeon are difficult but not impossible. A comprehensive strategy for an UIM student to become a hand surgeon is outlined in detail.


Assuntos
Mãos , Ortopedia , Humanos , Estados Unidos , Mãos/cirurgia , Bolsas de Estudo , Ortopedia/educação
3.
J Biomater Appl ; 36(7): 1213-1230, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34939515

RESUMO

Locking compression plate (LCP) has conventionally been the most extensively employed plate in internal fixation bone implants used in orthopaedic applications. LCP is usually made up of non-biodegradable materials that have a higher mechanical capability. Biodegradable materials, by and large, have less mechanical strength at the point of implantation and lose strength even more after a few months of continuous degradation in the physiological environment. To attain the adequate mechanical capability of a biodegradable bone implant plate, LCP has been modified by adding laddered - type semicircular filleted embossed structure. This improved design may be named as laddered embossed locking compression plate (LELCP). It is likely to provide additional mechanical strength with the most eligible biodegradable material, namely, Mg-alloy, even after continuous degradation that results in diminished thickness. For mechanical validation and comparison of LELCP made up of Mg-alloy, four-point bending test (4PBT) and axial compressive test (ACT) have been performed on LELCP, LCP and continuously degraded LELCP (CD-LELCP) with the aid of finite element method (FEM) for the assembly of bone segments, plate and screw segments. LELCP, when subjected to the above mentioned two tests, has been observed to provide 26% and 10.4% lower equivalent stress, respectively, than LCP without degradation. It is also observed mechanically safe and capable of up to 2 and 6 months of continuous degradation (uniform reduction in thickness) for 4PBT and ACT, respectively. These results have also been found reasonably accurate through real-time surgical simulations by approaching the most optimal mesh. According to these improved mechanical performance parameters, LELCP may be used or considered as a viable biodegradable implant plate option in the future after real life or in vivo validation.


Assuntos
Ortopedia , Implantes Absorvíveis , Fenômenos Biomecânicos , Placas Ósseas , Parafusos Ósseos , Fixação Interna de Fraturas/métodos
4.
J Orthop Trauma ; 36(12): 615-622, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36399673

RESUMO

OBJECTIVES: To determine whether there is a difference in orthopaedic trauma patient medication satisfaction and adherence using an oral versus subcutaneous injectable anticoagulant for venous thromboembolism chemoprophylaxis. DESIGN: Randomized controlled trial. SETTING: Single academic Level 1 trauma center. PARTICIPANTS: One hundred twenty adult orthopaedic trauma patients with operative pelvic or lower extremity fractures were randomized and completed the study. INTERVENTION: Three weeks of either the service standard 40 mg once daily enoxaparin versus trial medication 10 mg once daily rivaroxaban postoperatively. MAIN OUTCOME MEASURES: Patient satisfaction as measured by the Treatment Satisfaction Questionnaire for Medication (TSQM-9). Medication adherence as measured by the Morisky Medication Adherence Scale (MMAS-8). RESULTS: Medication adherence was similar in both groups. Medication satisfaction was significantly higher in the oral rivaroxaban group based on the TSQM-9 and patient-reported data. Secondary outcomes found no significant difference in the incidence of bleeding events or clinically relevant venous thromboembolism. The enoxaparin group experienced more adverse medication-related events. The rivaroxaban medication regimen costs 7.5-10× less out of pocket for uninsured patients. CONCLUSION: The results of this randomized controlled trial demonstrate that patients with surgical orthopaedic trauma prefer an oral anticoagulant for postoperative venous thromboembolism chemoprophylaxis and suggest that rivaroxaban may be a viable option. Furthermore, large-scale studies are needed to confirm safety and efficacy for rivaroxaban in this population as a potential alternative to enoxaparin and aspirin. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Ortopedia , Tromboembolia Venosa , Humanos , Adulto , Enoxaparina/uso terapêutico , Rivaroxabana/uso terapêutico , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle , Tromboembolia Venosa/epidemiologia , Estudos Prospectivos , Anticoagulantes/uso terapêutico
5.
J Orthop Trauma ; 36(12): 665-673, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36399680

RESUMO

OBJECTIVES: To understand prevalence and factors associated with concurrent mental illness and financial barriers to mental health care after orthopaedic trauma. DESIGN: This is a retrospective, cross-sectional study. SETTING: Interview-based survey was conducted across representative sample of 30,000 US households. PATIENTS/PARTICIPANTS: The study included 2,309 survey respondents reporting a fracture over the past 3 months, between 2004 and 2017. INTERVENTION: Screening for financial barriers to mental health care. MAIN OUTCOME MEASUREMENTS: Prevalence and factors associated with concurrent mental illness and financial barriers to mental health care based on sociodemographic and injury characteristics were the main outcome measurements. RESULTS: Of the 2309 orthopaedic trauma survivors included in our analysis, 203 patients [7.8%, 95% confidence interval (CI): 6.4%-9.2%] were determined to experience severe mental illness, of whom 54 (25.3%, 95% CI: 18.0%-32.6%) and 86 (40.9%, 95% CI: 31.5%-50.2%) reported financial barriers to counseling and pharmacotherapy, respectively. Factors associated with concurrent severe mental illness and cost barriers to care were 45 to 64 years of age [adjusted odds ratios (AOR) 5.1, 95% CI: 1.7-15, P = 0.004], income below 200% of the Federal Poverty Threshold (AOR 2.5, 95% CI: 1.2-5.3, P = 0.012), and unemployment at the time of injury (AOR 3.9, 95% CI: 1.4-11, P = 0.009). CONCLUSIONS: Approximately one half of orthopaedic trauma survivors with severe mental illness face financial barriers to some form of mental health services. Younger, minority, and low socioeconomic status patients are most affected. These data suggest the presence of postdiagnosis disparities in mental health access that may be improved through direct provision and subsidization of integrated mental health support services for high-risk populations. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Transtornos Mentais , Ortopedia , Humanos , Saúde Mental , Estudos Transversais , Estudos Retrospectivos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Transtornos Mentais/psicologia , Sobreviventes
6.
J Am Acad Orthop Surg ; 30(23): e1495-e1503, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36400059

RESUMO

Neurofibromatosis type 1 (NF1) is a congenital disease which is caused by mutations in the NF1 gene on chromosome 17, resulting in an altered function of the neurofibromin protein. Owing to the ubiquitous expression of this protein, this syndrome is associated with pathology in many organ systems of the body, especially the central and peripheral nervous, musculoskeletal, and integumentary systems. This review outlines the common sequelae related to a diagnosis of NF1 and the common treatment approach to each.


Assuntos
Neurofibromatose 1 , Ortopedia , Humanos , Neurofibromatose 1/complicações , Neurofibromatose 1/diagnóstico , Neurofibromatose 1/genética , Neurofibromina 1/genética , Neurofibromina 1/metabolismo , Mutação
8.
J Surg Orthop Adv ; 31(3): 169-176, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36413164

RESUMO

Despite improved surgical techniques and prophylactic procedures, orthopaedic implant-associated infections remain high with complications that can lead to devastating outcomes for the patient. Implant coatings and associated surface modification techniques represent a promising means to prevent infections. Various approaches have emerged to address the challenges associated with implant infections, such as antibacterial resistance, biofilm prevention, and appropriate efficacy kinetics. Methods including antibiotic and antimicrobial peptide surface tethering, use of osteo-conductive and -inductive materials, and altering hydrophobicity and hydrophilicity of the implant surface, have all demonstrated efficacy toward diminished infection risk. Though many of these techniques have shown great potential in in vitro and in vivo studies, clinical translation remains limited with very few commercially available implant coatings globally. This review summarizes recent advancements in orthopaedic implant coatings, pre-clinical studies, and clinical translation, as well as potential future marketed products. (Journal of Surgical Orthopaedic Advances 31(3):169-176, 2022).


Assuntos
Ortopedia , Humanos , Próteses e Implantes , Biofilmes , Antibacterianos/uso terapêutico
9.
J Surg Orthop Adv ; 31(3): 144-149, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36413159

RESUMO

Due to the declining number of scientifically trained physicians and increasing demand for high-quality literature, our institution pioneered a seven-year Physician Scientist Training Program (PSTP) to provide research-oriented residents the knowledge and skills for a successful academic career. The present study sought to identify orthopaedic surgeons with MD/PhD degrees, residency programs with dedicated research tracks, and to assess the effectiveness of the novel seven-year program in training prospective academic orthopaedic surgeons. Surgeons with MD/PhD degrees account for 2.3% of all 3,408 orthopaedic faculty positions in U.S. residency programs. During the last 23 years, our PSTP residents produced 752 peer-reviewed publications and received $349,354 from 23 resident-authored extramural grants. Eleven of our seven-year alumni practice orthopaedic surgery in an academic setting. The seven-year PSTP successfully develops clinically trained surgeon scientists with refined skills in basic science and clinical experimental design, grant proposals, scientific presentations, and manuscript preparation. (Journal of Surgical Orthopaedic Advances 31(3):144-149, 2022).


Assuntos
Internato e Residência , Ortopedia , Cirurgiões , Humanos , Estudos Prospectivos , Ortopedia/educação , Educação de Pós-Graduação em Medicina
10.
J Surg Orthop Adv ; 31(3): 139-143, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36413158

RESUMO

The current medical schools and orthopaedic residency programs in the state of North Carolina have evolved based upon geopolitical, economic events, historical reports and regulations. The American Medical Association Committee on Medical Education, the Flexner Report and the Sherman Antitrust Act and their recommendations were codified by state regulatory agencies and state law. These important pressures created the programs as they are known today. The result was the forced closure of most early medical institutions in the state of North Carolina in the early 1900s. Industrial resource consolidation by monopolies was the motivation for the Sherman antitrust act. Enforced by Theodore Roosevelt, this legislation disbanded major monopolies and encouraged philanthropy. This manuscript details the evolution of modern medical education and highlights the impact of historical social, economic and political events on the development of Duke, Wake Forest, University of North Carolina and Charlotte/ Atrium Health orthopedic programs in North Carolina. (Journal of Surgical Orthopaedic Advances 31(3):139-143, 2022).


Assuntos
Procedimentos Ortopédicos , Ortopedia , Estados Unidos , Humanos , Leis Antitruste , North Carolina
11.
J Surg Orthop Adv ; 31(3): 187-192, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36413167

RESUMO

This study assessed the effect of preoperative planning using a 3D-printed periarticular fracture model on operative performance. A complex pilon fracture was 3D-printed, and a preoperative plan was developed. Orthopaedic surgery residents (n = 20) were randomized into two groups. Group 1 performed routine preoperative planning, while Group 2 was also practiced using a 3D-printed construct before performing fixation of the 3D-printed model. Resident performance was assessed using a video motion capture system and evaluated by blinded reviewers. Three residents (3D group) completed fixation within the allotted 45 minutes. The 3D group had less hand distance traveled for step 1 (89 m vs. 162 m, p = 0.04). The 3D group had better performance on three of the four components and more acceptable reductions (6 vs. 0, p = 0.009). Average global rating scale was higher in the 3D group (3.0 vs. 1.7, p = 0.0095). Use of 3D-printed models for preoperative planning improved resident performance. (Journal of Surgical Orthopaedic Advances 31(3):187-192, 2022).


Assuntos
Ortopedia , Fraturas da Tíbia , Humanos , Impressão Tridimensional , Fraturas da Tíbia/cirurgia
12.
Orthop Nurs ; 41(6): 385-386, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36413660
14.
Orthop Nurs ; 41(6): 387-390, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36413661

RESUMO

Hourly rounding impacts multiple patient care outcomes. The task of rounding has several obstacles and is made more time-consuming by donning and doffing protective personal equipment kits, especially in the setting of the COVID-19 pandemic. To improve the frequency of hourly rounding performance on the unit, nurses and unlicensed assistive personnel on an orthopaedic/trauma unit at an academic hospital in the Midwest United States were introduced to potential interventions in several PDSA (Plan-Do-Study-Act) cycles using quality improvement methodology. Methods included chart auditing, repetitive interventions designed by evaluating previous iterations, creation of educational material, and changing unit policy by communication during unit huddle. Results found a 10-percentage point improvement of hourly rounding compliance, from 77.3% to 87.3%, with use of a "redline" policy for isolation precautions. The policy implementation was a success. Future research may consider the expansion of this policy to other units.


Assuntos
COVID-19 , Ortopedia , Humanos , Estados Unidos , Centros de Traumatologia , Pandemias/prevenção & controle , COVID-19/prevenção & controle , Melhoria de Qualidade
16.
Artigo em Inglês | MEDLINE | ID: mdl-36360830

RESUMO

Few studies have reported injuries and physical characteristics in adolescent weightlifters. The purpose of this study was to report the results of orthopaedic medical examinations in adolescent amateur weightlifters that were performed cross-sectionally from 2012 to 2019. The orthopaedic medical examination included physical examinations, generalized joint laxity, muscle and joint tightness, static alignment, muscle volume of the lower extremities, and medial longitudinal arch of the foot (the height from the tip of the navicular tubercle to the ground surface). A questionnaire survey regarding pain in the spine and lower extremities was also performed. A total of 99 adolescent weightlifters were included (male/female, 71/28; mean age, 16.2 ± 0.2 years). A total of 9.1% had received orthopaedic treatments, with spine injuries being the most prevalent. Of those who had not received orthopaedic treatments, 31.1% had pain in the spine or lower extremities (for >4 weeks). There were no significant gender differences in the incidence of pain or positive findings of physical examinations. Female weightlifters had a more reduced dorsiflexion of the ankle joint than male weightlifters (p = 0.02). Male weightlifters had a lower flexibility of the quadriceps than female weightlifters. The results of orthopaedic medical examinations in this study may help clinicians and young weightlifters to prevent injuries in competitive weightlifting.


Assuntos
Ortopedia , Adolescente , Feminino , Masculino , Humanos , Levantamento de Peso/fisiologia , Atletas , Exercício Físico/fisiologia , Dor
17.
Artigo em Inglês | MEDLINE | ID: mdl-36360606

RESUMO

BACKGROUND: Following the introduction of administrative federalism in the Italian National Health Service, inter-regional patients' mobility has become increasingly relevant because, in addition to being an indirect index of the quality of care, it has important economic and financial implications. This study aimed to evaluate the fulfillment of the need for hospital orthopedic intensive rehabilitation on site and care-seeking patients' migration to other regions. METHODS: From 2011 to 2019, the data of intensive orthopedic rehabilitation extracts from the Hospital Discharge Cards provided by Italian Ministry of Health were analyzed. We studied the hospital networks of every Italian region (catchment areas). The epidemiological flows of inter-regional mobility were analyzed with Gandy's Nomogram, while the financial flows were analyzed through Attraction Absorption and Escape Production Indexes. RESULTS: Gandy's Nomogram showed that only Piedmont, Lombardy, A.P. of Trento, E. Romagna, Umbria and Abruzzo had good public hospital planning for intensive orthopedic rehabilitation, with a positive balance for all studied periods. Lombardy, E. Romagna, Piedmont, Veneto and Latium have absorbed approximately 70% of all financial flows (about EUR 60.5 million). CONCLUSIONS: Only six regions appear to be able to satisfy the care needs of their residents, with a positive epidemiological and financial balance for all studied periods.


Assuntos
Ortopedia , Reabilitação , Medicina Estatal , Humanos , Hospitais , Itália
18.
Sci Rep ; 12(1): 20076, 2022 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-36418373

RESUMO

Orthopaedic screws insertion can be trivialised as a simple procedure, however it is frequently performed poorly. Limited work exists defining how well surgeons insert screws or whether augmented screwdrivers can aid surgeons to reduce stripping rates and optimise tightness. We aimed to establish the performance of surgeons inserting screws and whether this be improved with screwdriver augmentation. 302 orthopaedic surgeons tightened 10 non-locking screws to what they determined to be optimum tightness into artificial bone sheets. The confidence in the screw purchase was given (1-10). A further 10 screws were tightened, using an augmented screwdriver that indicated when a predetermined optimum tightness was reached. The tightness for unstripped insertions under normal conditions and with the augmented screwdriver were 81% (95% CI 79-82%)(n = 1275) and 70% (95% CI 69-72%)(n = 2577) (p < 0.001). The stripping rates were 58% (95% CI 54-61%) and 15% (95% CI 12-17%) respectively (p < 0.001). The confidences when using the normal and augmented screwdrivers respectively were 7.2 and 7.1 in unstripped insertions and 6.2 and 6.5 in stripped insertions. Performance improved with an augmented screwdriver, both in reduced stripping rates and greater accuracy in detecting stripping. Augmenting screwdrivers to indicate optimum tightness offer potentially enormous clinical benefits by improving screw fixation.


Assuntos
Cirurgiões Ortopédicos , Ortopedia , Cirurgiões , Humanos , Fixadores Internos , Parafusos Ósseos
19.
J Craniofac Surg ; 33(8): 2522-2528, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36409871

RESUMO

Presurgical infant orthopedic (PSIO) therapy has evolved in both its popularity and focus of treatment since its advent. Nasoalveolar molding, nasal elevators, the Latham appliance, lip taping, and passive plates are the modern treatment options offered by cleft teams. Many cleft surgeons also employ postsurgical nasal stenting (PSNS) after the primary lip repair procedure. The purpose of this study is to examine trends in current PSIO care as well as PSNS for the management of patients with cleft lip and palate. An electronic survey was distributed to cleft team coordinators listed by the American Cleft Palate Association. The survey reported on team setting, provider availability, PSIO offerings, contraindications, and use of PSNS. Descriptive statistics and analyses were performed using MS Excel and SPSS. A total of 102 survey responses were received. The majority of settings were children's specialty hospitals (66%) or university hospitals (27%). Presurgical infant orthopedics was offered by 86% of cleft teams, and the majority of those (68%) provided nasoalveolar molding. Nasal elevators and lip taping are offered at 44% and 53% of centers, respectively. Latham and passive plates are both offered at 5.5% of centers. Most centers had an orthodontist providing treatment. The majority of centers use PSNS (86%). Nasoalveolar molding is the most popular PSIO technique in North American cleft centers followed by the nasal elevator, suggesting that the nasal molding component of PSIO is of critical influence on current treatment practices.


Assuntos
Fenda Labial , Fissura Palatina , Procedimentos Ortopédicos , Ortopedia , Lactente , Criança , Humanos , Estados Unidos , Fissura Palatina/cirurgia , Fenda Labial/cirurgia , Procedimentos Ortopédicos/métodos , América do Norte
20.
Artigo em Inglês | MEDLINE | ID: mdl-36346841

RESUMO

Gout is characterized by the deposition of monosodium urate crystals in patients with chronically elevated blood levels of uric acid. It is the most common form of inflammatory arthritis in the United States and is often comorbid with hypertension, obesity, and chronic kidney disease. Initial presentation is usually an acutely warm, swollen joint, most commonly the first metatarsophalangeal joint, but a variety of locations may be affected. The main treatment for gout is medical management of acute inflammation and chronic uric acid levels, but surgical treatment may be indicated in cases of damage to the surrounding soft tissue, concomitant septic arthritis, symptomatic cartilage loss, or neurologic deficits. Based on the literature to date, gout does not seem to independently affect outcomes after total hip, knee, and ankle arthroplasty, but associated comorbidities affecting outcomes in these patients should be considered.


Assuntos
Gota , Ortopedia , Humanos , Ácido Úrico , Gota/complicações , Gota/cirurgia , Articulação do Joelho , Cartilagem
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