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Vaisman A, Guiloff R, Contreras M, Casas-Cordero JP, Calvo R, Figueroa D. Over 50% of self-reported burnout among Latin American orthopaedic surgeons: A cross-sectional survey on prevalence and risk factors. J ISAKOS 2024; 9:128-134. [PMID: 38036044 DOI: 10.1016/j.jisako.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/10/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Assess the prevalence of self-reported burnout and identify risk and protective factors based on demographic and life quality aspects, among Latin American orthopaedic surgeons. METHODS This study employed a cross-sectional analytical design. An original design survey was developed using multiple-choice and Likert-scale questions to gather self-reported burnout, demographic, work-related, social, personal, and mood-related data. The survey was electronically distributed to the Chilean Orthopaedic Surgery Society and the Latin American Society of Arthroscopy, Knee Surgery, and Sports Medicine members. Statistical analysis included Chi-square and Fisher's exact tests to determine associations between self-reported burnout and other variables. Subsequently, a multivariate logistic regression was carried out to identify key risk and protective factors (p < 0.05). RESULTS The survey's response rate was 20 % (n = 358) out of the 1779 invitations that were sent. The most representative age range was 41-60 years (50 %) and 94 % were men. Of those surveyed, 50 % reported a burnout episode more than once per year, 60 % depersonalization when treating patients at least yearly, 13 % anhedonia, 11 % a depressive mood more than half of the month or almost every day, and 61 % weariness at the end of a working day. Burnout was statistically associated with age under 40 years old (p = 0.012), fewer years as a specialist (p = 0.037), fear of lawsuits (p < 0.001), a non-healthy diet (p = 0.003), non-doing recreational activities (p = 0.004), depersonalization when treating their patients (p < 0.001), weariness (p < 0.001), anhedonia (p < 0.001), depressive mood (p < 0.001), and career dissatisfaction (p < 0.001). The logistic regression demonstrated that fear of lawsuits (p < 0.001), weariness at the end of a workday (p = 0.016), and anhedonia (p = 0.019) were those variables with stronger direct associations with self-reported burnout. A healthy diet was the strongest protective variable (p < 0.001). CONCLUSION Over 50 % of the Latin American orthopaedic surgeons who participated in the survey reported experiencing burnout episodes more than once a year, along with depersonalization when treating their patients at least once a year. Additionally, nearly 10 % of respondents experienced weekly depressive symptoms. Among the noteworthy risk factors for self-reported burnout were fear of lawsuits, weariness at the end of the workday, and anhedonia. Conversely, maintaining a healthy diet emerged as the most potent protective factor. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Alex Vaisman
- Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Departamento Traumatología, Av. Vitacura 5951, 7650568, Santiago, Chile
| | - Rodrigo Guiloff
- Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Departamento Traumatología, Av. Vitacura 5951, 7650568, Santiago, Chile.
| | - Martín Contreras
- Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Av. Plaza 680, 7610658, Las Condes, Santiago, Chile
| | - Juan Pablo Casas-Cordero
- Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Av. Plaza 680, 7610658, Las Condes, Santiago, Chile
| | - Rafael Calvo
- Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Departamento Traumatología, Av. Vitacura 5951, 7650568, Santiago, Chile
| | - David Figueroa
- Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Departamento Traumatología, Av. Vitacura 5951, 7650568, Santiago, Chile
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Khalifa AA, Khidr SS, Hassan AAA, Mohammed HM, El-Sharkawi M, Fadle AA. Can Orthopaedic Surgeons adequately assess an Electrocardiogram (ECG) trace paper? A cross sectional study. Heliyon 2023; 9:e22617. [PMID: 38046166 PMCID: PMC10686838 DOI: 10.1016/j.heliyon.2023.e22617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 12/05/2023] Open
Abstract
Objectives The primary objective was to evaluate the ECG trace paper evaluation current knowledge level in a group of Orthopaedic surgeons divided into juniors and seniors according to M.D. degree possession. Methods A cross sectional study through self-administered questionnaires at a university hospital Orthopaedic and Trauma Surgery Department. The questionnaire included five sections: 1-Basic participants' characteristics, 2-Participants' perception of their ECG evaluation current knowledge level, 3-The main body of the questionnaire was an ECG quiz (seven); the participant was asked to determine if it was normal and the possible diagnosis, 4-Participants' desired ECG evaluation knowledge level, and 5-Willingness to attend ECG evaluation workshops. Results Of the 121 actively working individuals in the department, 96 (97.3 %) finished the questionnaire, and 85 (77.3 %) were valid for final evaluation. The participants' mean age was 30.4 ± 6.92 years, 76.5 % juniors and 23.5 % seniors. 83.5 % of the participants perceived their current ECG evaluation knowledge as none or limited. For participants' ability to evaluate an ECG, higher scores were achieved when determining if the ECG was normal or abnormal, with a mean score percentage of 79.32 % ± 23.27. However, the scores were lower when trying to reach the diagnosis, with a mean score percentage of 43.02 % ± 27.48. There was a significant negative correlation between the participant's age and answering the normality question correctly (r = -0.277, p = 0.01); and a significant positive correlation between answering the diagnosis question correctly and the desired level of knowledge and the intention to attend a workshop about ECG evaluation, r = 0.355 (p = 0.001), and r = 0.223 (p = 0.04), respectively. Only 56.5 % of the participants desired to get more knowledge, and 81.2 % were interested in attending ECG evaluation workshops. Conclusion Orthopaedic surgeons showed sufficient knowledge when determining the normality of ECG trace papers; however, they could not reach the proper diagnosis, and Junior surgeons performed slightly better than their senior peers. Most surgeons are willing to attend ECG evaluation and interpretation workshops to improve their knowledge level.
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Affiliation(s)
- Ahmed A. Khalifa
- Orthopaedic Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Shimaa S. Khidr
- Cardiology Department, Assiut University Hospital, Assiut, Egypt
| | | | - Heba M. Mohammed
- Public Health and Community Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohammad El-Sharkawi
- Orthopaedic and Trauma Surgery Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Amr A. Fadle
- Orthopaedic and Trauma Surgery Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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MacDessi SJ, Oussedik S, Abdel MP, Victor J, Pagnano MW, Haddad FS. The language of knee alignment : updated definitions and considerations for reporting outcomes in total knee arthroplasty. Bone Joint J 2023; 105-B:102-108. [PMID: 36722056 DOI: 10.1302/0301-620x.105b2.bjj-2022-1345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Orthopaedic surgeons are currently faced with an overwhelming number of choices surrounding total knee arthroplasty (TKA), not only with the latest technologies and prostheses, but also fundamental decisions on alignment philosophies. From 'mechanical' to 'adjusted mechanical' to 'restricted kinematic' to 'unrestricted kinematic' - and how constitutional alignment relates to these - there is potential for ambiguity when thinking about and discussing such concepts. This annotation summarizes the various alignment strategies currently employed in TKA. It provides a clear framework and consistent language that will assist surgeons to compare confidently and contrast the concepts, while also discussing the latest opinions about alignment in TKA. Finally, it provides suggestions for applying consistent nomenclature to future research, especially as we explore the implications of 3D alignment patterns on patient outcomes.Cite this article: Bone Joint J 2023;105-B(2):102-108.
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Affiliation(s)
- Samuel J MacDessi
- Sydney Knee Specialists, Sydney, Australia.,The University of New South Wales, Sydney, Australia
| | | | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jan Victor
- Department of Orthopaedics, University Hospital of Ghent, Ghent, Belgium
| | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Fares S Haddad
- University College London Hospitals, London, UK.,The Bone & Joint Journal, London, UK
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Akhtar H, Lorimer J, Gray R, Potluri S, Bhati R, Williamson J, Doorgakant A. How reconfiguration of a minor injuries unit has affected service delivery during the COVID-19 pandemic: a retrospective analysis. Ann R Coll Surg Engl 2023; 105:178-182. [PMID: 35442111 PMCID: PMC9889175 DOI: 10.1308/rcsann.2021.0359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Redeployment of orthopaedic consultants to a minor injuries unit (MIU) during the COVID-19 pandemic provided a unique opportunity to assess the impact of early senior specialist input on patient management. METHODS Patient demographics, diagnosis, location of injury and disposal method were compared between three 7-day periods: during the April 2020 COVID-19 lockdown (period A), one month prior to period A (period B) and one year prior to period A (period C). Orthopaedic consultants staffed the MIU during period A, and emergency nurse practitioners staffed the MIU during periods B and C. RESULTS Period A witnessed higher injury severity either due to modified activities or altered healthcare-seeking behaviour during lockdown. For fractures, compared with periods B and C, period A saw a lower rate of referral to fracture clinic (41% vs 100% vs 86%, p<0.001) and higher rate of discharge (38% vs 0% vs 9%, p<0.001). The median time to fracture clinic was also longer (15 days vs 6 days vs 10 days, p<0.001), indicating earlier institution of definitive care. There were no other significant differences between periods with radiology alerts and complaints received remaining largely unchanged. CONCLUSION Early senior orthopaedic input in the patient journey from MIU had clear benefits, this being most true for fracture diagnoses. Earlier definitive management planning was observed as lower rates of fracture clinic referral, higher rates of discharge and deferred first fracture clinic reviews. This study highlights the benefits of greater partnership between MIU and orthopaedics. As the pandemic subsides and redeployed staff return to normal duties, a modification of this model could be utilised to ensure this partnership is sustainable.
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Affiliation(s)
- H Akhtar
- Warrington and Halton Teaching Hospitals NHS Foundation Trust, UK
| | - J Lorimer
- Warrington and Halton Teaching Hospitals NHS Foundation Trust, UK
| | - R Gray
- Warrington and Halton Teaching Hospitals NHS Foundation Trust, UK
| | - S Potluri
- Warrington and Halton Teaching Hospitals NHS Foundation Trust, UK
| | - R Bhati
- Warrington and Halton Teaching Hospitals NHS Foundation Trust, UK
| | - J Williamson
- Warrington and Halton Teaching Hospitals NHS Foundation Trust, UK
| | - A Doorgakant
- Warrington and Halton Teaching Hospitals NHS Foundation Trust, UK
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Farrow L, Clement ND, Smith D, Meek DRM, Ryan M, Gillies K, Anderson L, Ashcroft GP. Prioritization of THose aWaiting hip and knee ArthroplastY(PATHWAY): protocol for development of a stakeholder led clinical prioritization tool. Bone Jt Open 2022; 3:753-758. [PMID: 36193629 PMCID: PMC9626858 DOI: 10.1302/2633-1462.310.bjo-2022-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
AIMS The extended wait that most patients are now experiencing for hip and knee arthroplasty has raised questions about whether reliance on waiting time as the primary driver for prioritization is ethical, and if other additional factors should be included in determining surgical priority. Our Prioritization of THose aWaiting hip and knee ArthroplastY (PATHWAY) project will explore which perioperative factors are important to consider when prioritizing those on the waiting list for hip and knee arthroplasty, and how these factors should be weighted. The final product will include a weighted benefit score that can be used to aid in surgical prioritization for those awaiting elective primary hip and knee arthroplasty. METHODS There will be two linked work packages focusing on opinion from key stakeholders (patients and surgeons). First, an online modified Delphi process to determine a consensus set of factors that should be involved in patient prioritization. This will be performed using standard Delphi methodology consisting of multiple rounds where following initial individual rating there is feedback, discussion, and further recommendations undertaken towards eventual consensus. The second stage will then consist of a Discrete Choice Experiment (DCE) to allow for priority setting of the factors derived from the Delphi through elicitation of weighted benefit scores. The DCE consists of several choice tasks designed to elicit stakeholder preference regarding included attributes (factors). RESULTS The study is co-funded by the University of Aberdeen Knowledge Exchange Commission (Ref CF10693-29) and a Chief Scientist Office (CSO) Scotland Clinical Research Fellowship which runs from 08/2021 to 08/2024 (Grant ref: CAF/21/06). Approval from the University of Aberdeen Institute of Applied Health Sciences School Ethics Review Board was granted 22/03/2022 - Reference number SERB/2021/12/2210. CONCLUSION The PATHWAY project provides the first attempt to use patient and surgeon opinions to develop a unified approach to prioritization for those awaiting hip and knee arthroplasty. Development of such a tool will provide more equitable access to arthroplasty services, as well as providing a framework for developing similar approaches in other areas of healthcare delivery.Cite this article: Bone Jt Open 2022;3(10):753-758.
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Affiliation(s)
- Luke Farrow
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK,Grampian Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, UK,Correspondence should be sent to Luke Farrow. E-mail:
| | - Nick D. Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | - Mandy Ryan
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Katie Gillies
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Lesley Anderson
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - G. P. Ashcroft
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK,Grampian Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, UK
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Bagaria V, Tiwari A, Kini A, Lobo Gajiwala A, Bhagunde P, Dave A. It's the Biology Orthopods! Heralding a Reconstructive Revolution Through Musculoskeletal Tissue Banks (MSTB) in India. Indian J Orthop 2022; 56:1533-46. [PMID: 36052382 DOI: 10.1007/s43465-022-00661-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND A tissue bank is an establishment that aids in retrieval, processing, storage, and distribution of human tissue for transplantation. For many years, such banks have been dispensing tissue to orthopaedic surgeons, performing reconstructive surgeries. METHODOLOGY The retrieval, preparation, and delivery of musculoskeletal tissue used for transplantation is an intricate process involving varying practices among different musculoskeletal tissue banks. RESULTS Musculoskeletal allografts are used in various orthopaedic surgeries ranging from primary bone defects, trauma, and carcinoma to congenital disabilities. Every decade brings in paradigm shifts and new hope for treating challenging cases with the aid of newer devices and materials. CONCLUSION This review article outlines various technical, regulatory and quality enhancement steps involved in tissue banking. Also, it discusses the road ahead and the research avenues for developing novel allograft products with the synergy of tissue banks and clinicians. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-022-00661-0.
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7
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Chandra AA, Batko BD, Portilla GM, Galdi B, Beebe K. Assessing the recognition of female orthopaedic surgeons in Castle Connolly's "America's Top Doctors" from 2000 to 2020. J Clin Orthop Trauma 2021; 23:101641. [PMID: 34745875 PMCID: PMC8554527 DOI: 10.1016/j.jcot.2021.101641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/27/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The field of orthopaedic surgery has one of the lowest percentages of practicing female physicians. Studies have shown disparities in various academic societies' award recipients by sex. Given the recent increased use of physician rating platforms by patients and focus on consumer-driven healthcare, our aim was to assess the recognition of female orthopaedic surgeons. METHODS A twenty-year quantitative analysis was performed comparing the rate of top female orthopaedic surgeons listed on Castle Connolly's "America's Top Doctors" to the percentage of practicing female orthopaedic surgeons as reported by the American Academy of Orthopaedic Surgeons. RESULTS From 2000 to 2020, there was a statistically significant increase in the percentage of top female orthopaedic surgeons listed on Castle Connolly (1.3%-5.3%), as well as an increase in overall practicing AAOS female members (2.7%-5.8%). When comparing the rate of top female orthopaedic surgeons listed on Castle Connolly to the proportion of practicing female AAOS members from 2000 to 2020, there were no statistically significant differences. CONCLUSIONS The increase in the rate of top female orthopaedic surgeons recognized by Castle Connolly was proportionate to the increase in percentage of practicing female AAOS members over the past 20 years. This study highlights the persistence of a gender discrepancy in the academic sector of orthopaedic surgery.
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Affiliation(s)
- Akhil A. Chandra
- Rutgers Robert Wood Johnson Medical School, 675 Hoes Lane West, Piscataway, NJ, 08854, Piscataway, New Jersey, USA
| | - Brian D. Batko
- Department of Orthopaedics, Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07103, Newark, NJ, USA
| | - Gabriela M. Portilla
- Rutgers Robert Wood Johnson Medical School, 675 Hoes Lane West, Piscataway, NJ, 08854, Piscataway, New Jersey, USA
| | - Balazs Galdi
- Department of Orthopaedics, Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07103, Newark, NJ, USA
| | - Kathleen Beebe
- Department of Orthopaedics, Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07103, Newark, NJ, USA
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Abstract
AIMS Current National Institute for Health and Clinical Excellence (NICE) guidance advises that MRI direct from the emergency department (ED) should be considered for suspected scaphoid fractures. This study reports the current management of suspected scaphoid fractures in the UK and assesses adherence with NICE guidance. METHODS This national cross-sectional study was carried out at 87 NHS centres in the UK involving 122 EDs and 184 minor injuries units (MIUs). The primary outcome was availability of MRI imaging direct from the ED. We also report the specifics of patient management pathways for suspected scaphoid fractures in EDs, MIUs, and orthopaedic services. Overall, 62 of 87 centres (71%) had a guideline for the management of suspected scaphoid fractures. RESULTS A total of 11 of 87 centres (13%) had MRI directly available from the ED. Overall, 14 centres (17%) used cross-sectional imaging direct from the ED: MRI in 11 (13%), CT in three (3%), and a mixture of MRI/CT in one (1%). Four centres (6%) used cross-sectional imaging direct from the MIU: MRI in three (4%) and CT in two (2%). Of 87 centres' orthopaedic specialist services, 74 (85%) obtained repeat radiographs, while the most common form of definitive imaging used was MRI in 55 (63%), CT in 16 (19%), mixture of MRI/CT in three (3%), and radiographs in 11 (13%). CONCLUSION Only a small minority of centres currently offer MRI directly from the ED for patients with a suspected scaphoid fracture. Further research is needed to investigate the facilitators and barriers to the implementation of NICE guidance. Cite this article: Bone Jt Open 2021;2(11):997-1003.
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Affiliation(s)
- Benjamin J F Dean
- NDORMS, University of Oxford Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford, UK
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Affiliation(s)
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,Nuffield Orthopaedic Centre, Oxford, UK
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Realpe AX, Blackstone J, Griffin DR, Bing AJF, Karski M, Milner SA, Siddique M, Goldberg A. Barriers to recruitment to an orthopaedic randomized controlled trial comparing two surgical procedures for ankle arthritis : a qualitative study. Bone Jt Open 2021; 2:631-637. [PMID: 34378406 PMCID: PMC8384444 DOI: 10.1302/2633-1462.28.bjo-2021-0074.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aims A multicentre, randomized, clinician-led, pragmatic, parallel-group orthopaedic trial of two surgical procedures was set up to obtain high-quality evidence of effectiveness. However, the trial faced recruitment challenges and struggled to maintain recruitment rates over 30%, although this is not unusual for surgical trials. We conducted a qualitative study with the aim of gathering information about recruitment practices to identify barriers to patient consent and participation to an orthopaedic trial. Methods We collected 11 audio recordings of recruitment appointments and interviews of research team members (principal investigators and research nurses) from five hospitals involved in recruitment to an orthopaedic trial. We analyzed the qualitative data sets thematically with the aim of identifying aspects of informed consent and information provision that was either unclear, disrupted, or hindered trial recruitment. Results Recruiters faced four common obstacles when recruiting to a surgical orthopaedic trial: patient preferences for an intervention; a complex recruitment pathway; various logistical issues; and conflicting views on equipoise. Clinicians expressed concerns that the trial may not show significant differences in the treatments, validating their equipoise. However, they experienced role conflicts due to their own preference and perceived patient preference for an intervention arm. Conclusion This study provided initial information about barriers to recruitment to an orthopaedic randomized controlled trial. We shared these findings in an all-site investigators’ meeting and encouraged researchers to find solutions to identified barriers; this led to the successful completion of recruitment. Complex trials may benefit for using of a mixed-methods approach to mitigate against recruitment failure, and to improve patient participation and informed consent. Cite this article: Bone Jt Open 2021;2(8):631–637.
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Affiliation(s)
- Alba X Realpe
- Bristol Medical School, University of Bristol, Bristol, UK
| | - James Blackstone
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | | | - Andrew J F Bing
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, Shropshire, UK
| | - Michael Karski
- Foot and Ankle Surgery, Wrightington Hospital, Wigan, UK
| | - Stephen A Milner
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Malik Siddique
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, Newcastle upon Tyne, UK
| | - Andrew Goldberg
- The Wellington Hospital, London, UK.,Imperial College London, London, UK.,UCL Institute of Orthopaedics and Musculoskeletal Science, Stanmore, UK
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Yokoe T, Tajima T, Yamaguchi N, Morita Y, Chosa E. The current clinical practice of general orthopaedic surgeons in the treatment of lateral ankle sprain: a questionnaire survey in Miyazaki, Japan. BMC Musculoskelet Disord 2021; 22:636. [PMID: 34303350 DOI: 10.1186/s12891-021-04527-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lateral ankle sprain (LAS) is one of the most common musculoskeletal injuries. Numerous studies regarding LAS have been performed. However, there are few studies evaluating the current clinical practice of orthopaedic surgeons regarding LAS. The purpose of this study was to evaluate the current clinical practice of general orthopaedic surgeons in the treatment of LAS. METHODS A questionnaire survey was conducted from September 2020 to December 2020 in Miyazaki, Japan, to evaluate the clinical practice of general orthopaedic surgeons in the treatment of LAS. The survey was composed of 12 questions that were developed with consideration of the recommendations in the current clinical practice guidelines (CPGs) published by the Dutch orthopaedic society. The questions in this study were focused on the diagnosis, conservative treatment, rehabilitation, and the criteria for return to sports (RTS). RESULTS The survey response rate was 82.7% (129/156). Among the respondents, 95.3% did not consider the Ottawa Ankle Rules in the decision to perform plain radiography for patients. Rehabilitation following LAS was performed in 58.9% of patients. Eighty-five (65.9%) of the surgeons used only one factor as the criterion for RTS. The absence of pain was the most frequently used criterion (45.7%). No objective criteria were used for the RTS decision in athletes with LAS. CONCLUSIONS The present study suggested that most general orthopaedic surgeons do not provide the care for patients with LAS recommended by the current CPGs. No objective criteria for the RTS decision are used for athletes with LAS.
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Abstract
BACKGROUND COVID-19 was declared a global emergency in the first quarter of 2020. It is has resulted in and continues in over a million deaths worldwide and halted medical systems and particularly elective surgeries worldwide. The aim of this study was to identify the effect of the initial COVID-19 pandemic months on orthopaedic surgeons in British Columbia. METHODS The study surveyed (June until August 2020) 187 orthopaedic surgeons in British Columbia affiliated with the University of British Columbia or the British Columbia Orthopaedic Association using an online survey to help identify the impact of COVID-19 on patient care, work and personal life. RESULTS Eighty-seven out of 187 (46.5%) orthopaedic surgeons participated in the online survey. All types of surgeries were completely cancelled for 23 respondents. Elective surgeries were cancelled for most respondents (in-hospital n = 38 and/or ambulatory n = 32). Trauma cases were reduced according to 35 respondents. Outpatient clinics were stopped initially and transferred in virtual clinics (telemedicine). Approximately 40% of respondents were afraid of infecting others (patients, family) and 25% admitted to drink more heavily. Ninety percent of respondents reported an income loss of > 15% (range 0-100%). CONCLUSION Orthopaedic surgeons and their patients have been significantly affected by the COVID-19 pandemic. Cancellation of surgeries has created an increased backlog of 32,400 orthopaedic surgeries in British Columbia. However, the COVID-19 pandemic has expedited the implementation of telemedicine, which will be a long-lasting benefit in providing healthcare.
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Affiliation(s)
- Maciej J K Simon
- Department of Orthopaedics, Chan Gunn Pavilion, Allen McGavin Sports Medicine Clinic, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T1Z3, Canada
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - William D Regan
- Department of Orthopaedics, Chan Gunn Pavilion, Allen McGavin Sports Medicine Clinic, University of British Columbia, 2553 Wesbrook Mall, Vancouver, BC, V6T1Z3, Canada.
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Brindisino F, Ristori D, Lorusso M, Miele S, Pellicciari L, Rossettini G, Bonetti F, Heick JD, Testa M. Subacromial impingement syndrome: a survey of Italian physiotherapists and orthopaedics on diagnostic strategies and management modalities. Arch Physiother 2020; 10:16. [PMID: 32905154 PMCID: PMC7465722 DOI: 10.1186/s40945-020-00087-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/29/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIM The subacromial impingement syndrome (SIS) represents a common cause of disability in approximately 74% of patients with Shoulder Pain (SP). Even if contemporary research suggests that this mechanism is not (always) the dominant driver in SP, SIS is still a source of debate among scholars and clinicians. From a clinical point of view, evidence has suggested that clinicians can use both medical and physiotherapy approaches as effective methods to treat SIS.This survey aims to investigate models of management of patients with SIS in a sample of Italian physiotherapist specialists (Orthopaedic Manipulative Physical Therapists, -OMPTs-) and orthopaedic surgeons. MATERIALS AND METHODS An online survey with 29-item questionnaire was administered to assess the knowledge of OMPTs and orthopaedic surgeons about: a) strategies of clinical examination; b) the role of imaging in the diagnostic process; c) the physiotherapy management; and d) the pharmacological and surgical management in patients with SIS. RESULTS Six-hundred and twenty-nine respondents completed the survey (511 OMPTs (79.97%) and 128 orthopaedic surgeons (20.03%)). Ninety-two percent (n = 470) of the OMPTs and 80.5% (n = 103) of orthopaedic surgeons stated that in patients with SIS, a combination of diagnostic tests produced better accuracy (p = < 0.001). Twenty point seven % of OMPTs (n = 106) and 4.7% of orthopaedic surgeon (n = 6) stated that the Lift off was the most specific test (p = < 0.001). Four-hundred-and-twenty-four OMPTs (83%) and 40 orthopaedic surgeons (31.3%) answered that the gold standard for diagnosis of a patient with SIS are history and clinical examination (p < 0.001). CONCLUSION OMPTs and orthopaedic surgeons approach patients with SIS differently during both the assessment and the treatment. OMPTs appear to be appropriate in planning and managing clinical examination and therapeutic strategies to use with patients with SIS.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise C/da Tappino c/o Cardarelli Hospital, 86100 Campobasso, Italy
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Diego Ristori
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health – University of Genova – Campus of Savona, Savona, Italy
| | - Mariangela Lorusso
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Simone Miele
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health – University of Genova – Campus of Savona, Savona, Italy
| | | | - Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health – University of Genova – Campus of Savona, Savona, Italy
| | - Francesca Bonetti
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - John Duane Heick
- Department of Physical Therapy and Athletic Training, Northern Arizona University Flagstaff, Flagstaff, AZ USA
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health – University of Genova – Campus of Savona, Savona, Italy
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Hua W, Zhang Y, Wu X, Gao Y, Yang C. Work characteristics of orthopaedic surgeons during the COVID-19 pandemic: A single center analysis. ACTA ACUST UNITED AC 2020; 20:100127. [PMID: 32835118 DOI: 10.1016/j.pcorm.2020.100127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/29/2020] [Accepted: 08/08/2020] [Indexed: 01/08/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in widespread cancellation of elective orthopaedic surgeries. During the pandemic period, many orthopaedic surgeons had been working at the front line to fight against COVID-19 in China, and the number of orthopaedic surgeries performed in our hospital decreased sharply. Methods The work characteristics of orthopaedic surgeons was evaluated by the workplaces of orthopaedic surgeons, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rate of orthopaedic surgeons and the number of orthopaedic surgeries performed. January 23–April 7 in 2020, January 23–April 8 in 2019, and April 8–June 22 in 2020 was defined as the pandemic period, non-pandemic period and post-pandemic period, respectively. The number and types of orthopaedic surgeons during the pandemic period, non-pandemic period, and post-pandemic period was compared and summarized. Results During the pandemic period, 65.56% of the orthopaedic surgeons had been working at the front line to fight against COVID-19. The SARS-CoV-2 infection rate of the orthopaedic surgeons who worked at the front line in January and since February was 18.18% and 0.00%, respectively (P=0.003). The number of orthopaedic surgeries performed per day during the pandemic period decreased 95.74% compared with the same period in the past year (P<0.001). The number of orthopaedic surgeries performed during the post-pandemic period was 13.10 times that of the pandemic period (P<0.001), and 55.71% of the non-pandemic period (P<0.001). Conclusions The work characteristics of orthopaedic surgeons greatly changed during the COVID-19 pandemic.
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15
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Ranade AS, Oka GA, Daxini A, Ardawatia G, Majumder D, Bhaskaran S. Radiation Safety Knowledge and Practices: Is the Indian Orthopaedic Community Well-informed? Indian J Orthop 2020; 54:158-164. [PMID: 32952924 PMCID: PMC7474027 DOI: 10.1007/s43465-020-00212-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/23/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND In spite of frequent exposure to radiation, orthopaedic surgeons lack knowledge about radiation safety and do not comply with safety practices. We surveyed orthopaedic trainees and consultants in India to determine their knowledge and practices regarding radiation safety. METHODS A questionnaire with 16 multiple choice questions was sent out using Google forms. We included practicing orthopaedic surgeons (consultants), fellows and trainees pursuing DNB, MS and D. Ortho courses across India. RESULTS We received 439/700 responses (62.7% response rate) from 233 (53.1%) consultants and 206 (46.9%) trainees. Only 71 (16.2%) were aware of the ALARA (As Low As Reasonably Achievable) principle. While lead aprons were always used by 379 (86.3%), thyroid shields were never used by 302 (68.8%) respondents. Knowledge about the ALARA principle was significantly associated with radiation safety practices. A significantly greater proportion of participants who were aware about the ALARA principle always used lead aprons (OR 1.15; 95% CI 1.0 to 1.2, p = 0.001) and thyroid shields (OR 2.00; 95% CI 1.0 to 3.7, p = 0.029) and had their dosimeters checked within the last 1 year (OR 1.69; 95% CI 1.0 to 2.8, p = 0.039) when compared to those who were not aware of the ALARA principle. Almost 99% respondents expressed interest in participating in a radiation safety training program. CONCLUSION A majority of the respondents were keen to obtain training in radiation safety. We believe that professional organizations and hospitals could initiate training programs for the orthopaedic community in India to improve their radiation safety knowledge and practices.
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Affiliation(s)
- Ashish S. Ranade
- Blooming Buds Centre for Pediatric Orthopaedics, Deenanath, Mangeshkar Hospital and Research Center, Erandwane, Pune 411004 India
| | - Gauri A. Oka
- Department of Research, Deenanath Mangeshkar Hospital and Research Center, Erandwane, Pune 411004 India
| | - Anurag Daxini
- Department of Orthopaedics Government Medical College, Nagpur, 440003 India
| | - Gaurav Ardawatia
- Department of Orthopaedics, Deenanath Mangeshkar Hospital and Research Center, Erandwane, Pune 411004 India
| | - Debkumar Majumder
- Department of Orthopaedics, Deenanath Mangeshkar Hospital and Research Center, Erandwane, Pune 411004 India
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Purohit S, Srivastava S, Shankarkumar A, Raj A, Dalal B, Marathe N, Shende C. Prevalence of Vitamin D Deficiency Amongst Indian Orthopaedic Surgeons. Indian J Orthop 2020; 54:183-187. [PMID: 32952928 PMCID: PMC7474029 DOI: 10.1007/s43465-020-00134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/02/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Vitamin D deficiency is a widely prevalent condition with patients in both symptomatic and asymptomatic spectrum. With the lack of routine screening there exists an unknown population of Indian Orthopaedic surgeons who are deficient in Vitamin D and lead to an unexplained loss of quality of work and increased susceptibility to various other diseases. The easiest access to resources for supplementation is available to this group of treating physicians however its use for their personal cure is rarely recognised. This study aims to highlight this endemic disease and to find out its correlation with other parameters. METHODS It is a prospective observational study including 150 practicing orthopaedic surgeons from entire India who visited our centre during 3 months duration for various educational meetings. Venous sample was collected after due informed consent and analysed at a single laboratory for 25-OH Cholecalciferol levels by a chemiluminescent assay. All the samples were analysed and a questionnaire was sent to the participants via google forms regarding various parameters under study. RESULTS The mean serum Vitamin D levels were 18.6 ± 9.67 ng/ml in the sample studied. 17 out of 150 participants (11.3%) were found to have sufficient serum levels of 25(OH) Cholecalciferol. 105 participants (70%) were having deficient levels and 28 (18.7%) had insufficient levels of Vitamin D. Overall 88.7% participants had Vitamin D deficiency among the sample studied. CONCLUSION This widespread prevalence of Vitamin D deficiency warrants frequent screening and routine supplementation of Vitamin D in orthopaedic surgeons thereby providing a low cost solution to improve the troublesome situation among healthcare providers.
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Affiliation(s)
- Shaligram Purohit
- Department of Orthopedics, MS (ORTHO), 6th Floor, Multistorey Building, Seth G.S Medical College and King Edward Memorial Hospital, Parel, Mumbai, 400012 India
| | - Sudhir Srivastava
- Department of Orthopedics, MS (ORTHO), 6th Floor, Multistorey Building, Seth G.S Medical College and King Edward Memorial Hospital, Parel, Mumbai, 400012 India
| | | | - Aditya Raj
- Department of Orthopedics, MS (ORTHO), 6th Floor, Multistorey Building, Seth G.S Medical College and King Edward Memorial Hospital, Parel, Mumbai, 400012 India
| | - Bhavik Dalal
- ICMR, King Edward Memorial Hospital, Parel, Mumbai, 400012 India
| | - Nandan Marathe
- Department of Orthopedics, MS (ORTHO), 6th Floor, Multistorey Building, Seth G.S Medical College and King Edward Memorial Hospital, Parel, Mumbai, 400012 India
| | - Chetan Shende
- Department of Orthopedics, MS (ORTHO), 6th Floor, Multistorey Building, Seth G.S Medical College and King Edward Memorial Hospital, Parel, Mumbai, 400012 India
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17
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Onyemaechi NO, Itanyi IU, Ossai PO, Ezeanolue EE. Can traditional bonesetters become trained technicians? Feasibility study among a cohort of Nigerian traditional bonesetters. Hum Resour Health 2020; 18:24. [PMID: 32197617 PMCID: PMC7085192 DOI: 10.1186/s12960-020-00468-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 03/13/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Traditional bonesetters (TBS) provide the majority of primary fracture care in Nigeria and other low- and middle-income countries (LMICs). They are widely patronized and their services are commonly associated with complications. The aim of the study was to establish the feasibility of formal training of TBS and subsequent integration into the healthcare system. METHODS Two focus group discussions were conducted involving five TBS and eight orthopaedic surgeons in Enugu Nigeria. Audio-recordings made during the focus groups were transcribed verbatim and analysed using a thematic analysis method. RESULTS Four themes were identified: Training of TBS, their experiences and challenges; perception of traditional bonesetting by orthopaedic surgeons; need for formal training TBS and willingness to offer and accept formal training to improve TBS practice. Participants (TBS group) acquired their skills through informal training by apprenticeship from relatives and family members. They recognized the need to formalize their training and were willing to accept training support from orthopaedists. The orthopaedists recognized that the TBS play a vital role in filling the gap created by shortage of orthopaedic surgeons and are willing to provide training support to them. CONCLUSION This study demonstrates the feasibility of providing formal training to TBS by orthopaedic surgeons to improve the quality of services and outcomes of TBS treatment. This is critical for integration of TBS into the primary healthcare system as orthopaedic technicians. Undoubtedly, this will transform the trauma system in Nigeria and other LMICs where TBS are widely patronized.
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Affiliation(s)
- Ndubuisi Onu Onyemaechi
- Department of Surgery, College of Medicine, University of Nigeria Ituku-Ozalla, Enugu, P.M.B. 01129, Nigeria.
| | - Ijeoma Uchenna Itanyi
- Department of Community Medicine and Institute of Public Health, College of Medicine, University of Nigeria Ituku-Ozalla, Enugu, Nigeria
| | | | - Echezona Edozie Ezeanolue
- Institute of Maternal and Child Health, College of Medicine, University of Nigeria Ituku-Ozalla, Enugu, Nigeria
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Jarvis S, Orlando A, Blondeau B, Banton K, Reynolds C, Berg GM, Patel N, Meinig R, Carrick M, Bar-Or D. The effect of orthopaedic surgeons' and interventional radiologists' availability on the priority treatment sequence for hemodynamically unstable pelvic fractures: a survey of US Level I trauma centers. J Orthop Surg Res 2019; 14:411. [PMID: 31801568 PMCID: PMC6894122 DOI: 10.1186/s13018-019-1417-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/15/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Most guidelines recommend both pelvic packing (PP) and angioembolization for hemodynamically unstable pelvic fractures, however their sequence varies. Some argue to use PP first because orthopaedic surgeons are more available than interventional radiologists; however, there is no data confirming this. METHODS This cross-sectional survey of 158 trauma medical directors at US Level I trauma centers collected the availability of orthopaedic surgeons and interventional radiologists, the number of orthopaedic trauma surgeons trained to manage pelvic fractures, and priority treatment sequence for hemodynamically unstable pelvic fractures. The study objective was to compare the availability of orthopaedic surgeons to interventional radiologists and describe how the availability of orthopaedic surgeons and interventional radiologists affects the treatment sequence for hemodynamically unstable pelvic fractures. Fisher's exact, chi-squared, and Kruskal-Wallis tests were used, alpha = 0.05. RESULTS The response rate was 25% (40/158). Orthopaedic surgeons (86%) were on-site more often than interventional radiologists (54%), p = 0.003. Orthopaedic surgeons were faster to arrive 39% of the time, and interventional radiologists were faster to arrive 6% of the time. There was a higher proportion of participants who prioritized PP before angioembolization at centers with above the average number (> 3) of orthopaedic trauma surgeons trained to manage pelvic fractures, as among centers with equal to or below average, p = 0.02. Arrival times for orthopaedic surgeons did not significantly predict prioritization of angioembolization or PP. CONCLUSIONS Our results provide evidence that orthopaedic surgeons typically are more available than interventional radiologists but contrary to anecdotal evidence most participants used angioembolization first. Familiarity with the availability of orthopaedic surgeons and interventional radiologists may contribute to individual trauma center's treatment sequence.
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Affiliation(s)
- S. Jarvis
- Clinical Epidemiologist, ION Research, 383 Corona St. #319, Denver, CO 80218 USA
| | - A. Orlando
- Clinical Epidemiologist, ION Research, 383 Corona St. #319, Denver, CO 80218 USA
| | - B. Blondeau
- Research Medical Center, 2316 East Meyer Blvd., Kansas City, MO 64132 USA
- University of Connecticut Hartford Hospital, Hartford, CT 06106 USA
| | - K. Banton
- Swedish Medical Center, 501 E Hampden Ave., Englewood, CO 80113 USA
| | - C. Reynolds
- Swedish Medical Center, 501 E Hampden Ave., Englewood, CO 80113 USA
| | - G. M. Berg
- Wesley Medical Center, 550 N. Hillside St., Wichita, KS 67214 USA
| | - N. Patel
- Orthopaedic Trauma Surgeon, St. Anthony’s Hospital, 11600 West 2nd Place, Lakewood, CO 80228 USA
| | - R. Meinig
- Orthopaedic Trauma Surgeon, Penrose Hospital, 2222 North Nevada Ave., Colorado Springs, CO 80907 USA
| | - M. Carrick
- Medical City Plano, 3901 West 15th Street, Plano, TX 75075 USA
| | - D. Bar-Or
- Swedish Medical Center, 501 E Hampden Ave., Englewood, CO 80113 USA
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Zhang G, Yu Z, Chen X, Chen X, Wu C, Lin Y, Huang W, Lin H. Accurate placement of cervical pedicle screws using 3D-printed navigational templates : An improved technique with continuous image registration. Orthopade 2019; 47:428-436. [PMID: 29387914 DOI: 10.1007/s00132-017-3515-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Accurate placement of cervical pedicle screws remains a surgical challenge. This study aimed to test the feasibility of using a novel three-dimensional (3D-)printed navigational template to overcome this challenge. METHODS Cervical spines were scanned using computed tomography (CT). A 3D model of the cervical spines was created. The screw trajectory was designed to pass through the central axis of the pedicle. Thereafter, a navigational template was designed by removing the soft tissue from the bony surface in the 3D model. A 3D printer was used to print the navigational template. The screws were then placed in the cadavers following CT scanning. The 3D model of the designed trajectory and the placed screws were registered. The coordinates of the entry and exit points of the designed trajectory and the actual trajectory were recorded. The numbers of qualified points that met the different degrees of accuracy were compared using a χ2 test. RESULTS A total of 158 screws were placed. Five screws breached the pedicle cortex with a distance <2 mm. There was no significant difference between the pre- and postoperative entry points with a degree of accuracy ≥1.7 mm (P = 0.131). Meanwhile, there was no significant difference between the pre- and postoperative exit points with degrees of accuracy ≥6.4 mm (P = 0.071). CONCLUSION A navigational template can be designed by removing the soft tissue from the bony surface in a CT-generated 3D model. This guiding tool may effectively prevent intraoperative drifting and accurately places cervical pedicle screws.
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Affiliation(s)
- Guodong Zhang
- Department of Orthopedics, Affiliated Hospital of Putian University Teaching Hospital of Fujian Medical University, Affiliated Putian Hospital of Southern Medical University, Affiliated Hospital of Putian University, 351100, Putian, Fujian, China.,Department of Human Anatomy, Southern Medical University School of Basic Medical Sciences, 510515, Guangzhou, China
| | - Zhengxi Yu
- Department of Orthopedics, Affiliated Hospital of Putian University Teaching Hospital of Fujian Medical University, Affiliated Putian Hospital of Southern Medical University, Affiliated Hospital of Putian University, 351100, Putian, Fujian, China
| | - Xuanhuang Chen
- Department of Orthopedics, Affiliated Hospital of Putian University Teaching Hospital of Fujian Medical University, Affiliated Putian Hospital of Southern Medical University, Affiliated Hospital of Putian University, 351100, Putian, Fujian, China
| | - Xu Chen
- Department of Orthopedics, Affiliated Hospital of Putian University Teaching Hospital of Fujian Medical University, Affiliated Putian Hospital of Southern Medical University, Affiliated Hospital of Putian University, 351100, Putian, Fujian, China
| | - Changfu Wu
- Department of Orthopedics, Affiliated Hospital of Putian University Teaching Hospital of Fujian Medical University, Affiliated Putian Hospital of Southern Medical University, Affiliated Hospital of Putian University, 351100, Putian, Fujian, China
| | - Yijun Lin
- Department of Orthopedics, Affiliated Hospital of Putian University Teaching Hospital of Fujian Medical University, Affiliated Putian Hospital of Southern Medical University, Affiliated Hospital of Putian University, 351100, Putian, Fujian, China
| | - Wenhua Huang
- Department of Human Anatomy, Southern Medical University School of Basic Medical Sciences, 510515, Guangzhou, China.
| | - Haibin Lin
- Department of Orthopedics, Affiliated Hospital of Putian University Teaching Hospital of Fujian Medical University, Affiliated Putian Hospital of Southern Medical University, Affiliated Hospital of Putian University, 351100, Putian, Fujian, China.
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Vachhani K, Whyne CM, Schaffer A, Nam D. Perceptions of using lithium in fracture management: a survey of orthopaedic surgeons, fracture patients and the general public. BMC Musculoskelet Disord 2019; 20:389. [PMID: 31470828 PMCID: PMC6717343 DOI: 10.1186/s12891-019-2772-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/21/2019] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Kathak Vachhani
- Sunnybrook Research Institute, 2075 Bayview Avenue, MG301, Toronto, ON, M4N 3M5, Canada
| | - Cari M Whyne
- Sunnybrook Research Institute, 2075 Bayview Avenue, MG301, Toronto, ON, M4N 3M5, Canada.,Department of Surgery, University of Toronto, Toronto, Canada.,Institute for Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Ayal Schaffer
- Sunnybrook Research Institute, 2075 Bayview Avenue, MG301, Toronto, ON, M4N 3M5, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Diane Nam
- Sunnybrook Research Institute, 2075 Bayview Avenue, MG301, Toronto, ON, M4N 3M5, Canada. .,Department of Surgery, University of Toronto, Toronto, Canada.
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