Highly impacted bone allograft may allow immediate weight bearing in tibial plateau fractures: A case report.

INTRODUCTION: Proximal tibial fractures are common with an incidence of 10.2/100.000. Those displaced and involving the articular surface will often require surgical treatment. However, no consensus exists on whether to allow the patient early weight bearing or not. We developed a technique using structural bone chips, highly impacted under the articular surface, to permit immediate weight bearing after surgery. PATIENT: The patient was a 44-year old male who suffered a lateral tibial plateau fracture (AO type 41B2). INTERVENTION: We used an anterolateral approach with an S-shaped incision. A small window in the tibia was made using an awl, and the articular surface was reduced under radiographic imaging. The bone allograft was prepared by splitting the frozen femoral head in quarters and then taking large pieces of bone with a bone rongeur forceps avoiding the cartilage. The large pieces of bone were gathered in a small tray and thereafter compressed into the drill guide insert. The drill guide filled with bone graft was then inserted into the tibia window and directed in the appropriate position guided by radiography. Hereafter, the bone graft was impacted under the articular surface with force using the appropriate trocar and a hammer, and the fracture was finally reduced. Finally, the fracture was fixated utilizing an angular stable plate. OUTCOME: The patient was followed up one year postoperatively and allowed immediate weight bearing after surgery. No subsequent articular collapse occurred. DISCUSSION: In this case, we present a proximal tibial fracture with articular depression, which was surgically treated with a highly impacted bone allograft of large pieces and a locking plate. The patient was allowed immediate weight bearing and no subsequent articular collapse occurred.

[Can othopaedic surgeons accelerate time, or does the enthusiasm for alcohol rub just decrease by age?]

Senior surgeons can execute a full surgical hand antisepsis in no time. This could be due to a changed perception of time with age. This cross-sectional study secretly timed orthopaedic surgeons during alcohol rub, investigated their perception of 120 see and attitude towards hand antisepsis. Surgeons under 50 years of age used significantly longer time on alcohol rub. No significant difference in perception of neither time nor attitude towards surgical hand antisepsis were found between age groups. Surgeons are not affected by mental aging but seem to be able to accelerate time. Surgeons are aware of standard guidelines and follow them. This study presents new findings adding to the mythic nature of the orthopaedic surgeon.

[Orthopaedics' megalomania - myth or mobbing?]

INTRODUCTION: It is a general impression in the world of medicine that orthopaedic surgeons differ from doctors of other specialities in terms of intellect and self-confidence. The purpose of this study was to evaluate the self-confidence of orthopaedics. MATERIALS AND METHODS: We asked doctors from 30 different specialities to fill out a questionnaire. In addition to this, the participating orthopaedics were asked to rate their self-perceived surgical skills. RESULTS: In all, 120 orthopaedics and 416 non-orthopaedic doctors completed the questionnaire. There was no difference in GSE scores between orthopaedics and other doctors (p = 0.58). 98% of young orthopaedics estimated that their surgical talent was average or above average when compared with their colleagues on the same level of education. 72% believed that they were "equally talented", "more talented", or "far more talented" than their colleagues on a higher level of education. 76% believed that when assisting a senior surgeon the patients would "sometimes" (60%), "often" (14%) or "always" (2%) be better off if they were the ones performing the operation. More orthopaedics than non-orthopaedics believed that their speciality was regarded as one of the least important specialities in the world of medicine (p = 0.001). CONCLUSION: Orthopaedic surgeons in general are not more self-confident than other doctors or the average population, but young orthopaedic surgeons have a very high level of confidence in their own operation skills. FUNDING: none. TRIAL REGISTRATION: none.

Noticeable Variations in the Educational Exposure During Residency in Danish Orthopedic Departments.

OBJECTIVE: The objective of the study was to examine the educational exposure during residency in Danish orthopedic departments. DESIGN: Questionnaire-based cross-sectional study. SETTING: Data were gathered from January 1, 2014 to April 30, 2014 through a nationwide web-based questionnaire containing 15 questions within the areas of workload, surgical procedures, outpatient clinic, and research activities. The residents targeted worked at small-to-large hospitals and in tertiary care centers. PARTICIPANTS: Every resident in Denmark (n = 163) with at least 3 active months at a department was included. Questionnaires with less than 80% completion were excluded. In total, 152 entries were registered. Among those, 27 did not meet the inclusion criteria and 29 were excluded, leaving 96 participants, representing 22 of 26 departments, for further analysis. RESULTS: The average number of operative procedures as primary surgeon was 16 (range: 8-35) per month. In all, 18 of 22 (81%) departments offered the possibility to participate in research facilitated by the department and 38 of 96 (40%) worked for free (an average of 10h a month [range: 3-60]) to increase the amount of surgical procedures. CONCLUSIONS: A large variation in the educational exposure was found among the Danish orthopedic departments. Numbers indicate that Danish residents, compared with their US counterparts, operate considerably less during residency. Most residents work overtime and many of them work for free to participate in more surgical procedures.

[Lymphoma misinterpreted as osteomyelitis]. / Lymfom fejltolket som osteomyelitis

Patients are admitted based on a tentative diagnosis. If that is incorrect it may have negative consequences for the patient and the system. In this case we present an eight-month elucidation with several diagnostic procedures with a tentative diagnosis of osteomyelitis. This diagnosis was kept despite contradicting diagnostic results. Finally, the patient was diagnosed with peripheral T-cell lymphoma. Many cognitive diagnostic pitfalls are known to delay diagnosis. We recommend having them in mind and seeking quick interdisciplinary help when treatment is not successful.