ABSTRACT
To evaluate the benefit of the Pacific Island Health Care Project (PIHCP) to our orthopedic graduate medical education program, we performed a retrospective review of our 8-year operative experience with patients referred through this program. Between July 1994 and June 2002, 69 patients underwent 79 orthopedic operative procedures. Patients were categorized by primary diagnosis, anatomic site involved, and surgical treatment rendered. Because many of the patients referred from the PIHCP with tumors were noted to have either unusually large lesions or advanced-stage disease, further analyses of tumor stage and pathologic grade were made. Seven of the 14 oncologic cases surgically treated in our department in the past 8 years were referrals from the PIHCP. Unique operative procedures performed for these tumor patients included one forequarter amputation, one hip disarticulation, one hemipelvectomy, two partial scapulectomies, and one distal ulna excision. We conclude that the PIHCP referrals provide an important and relatively unique contribution to the clinical and operative experience of our orthopedic residents. These patients from the Pacific basin also enhance our orthopedic graduate medical education program by exposing our residents to the special socioeconomic and cultural issues related to caring for people from developing insular countries.
Subject(s)
Hospitals, Military/statistics & numerical data , Internet , Military Medicine/education , Orthopedic Procedures/statistics & numerical data , Orthopedics/education , Referral and Consultation , Remote Consultation , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Education, Medical, Graduate , Female , Hawaii , Health Services Accessibility , Humans , Male , Middle Aged , Pacific Islands , Program Evaluation , Retrospective Studies , Transportation of PatientsABSTRACT
The two teams comprising the fiscal year 2001 Blast Resuscitation and Victim Assistance mission had the opportunity to learn from and practice mine injury treatment principles with experienced local and international war surgeons in Cambodia. Treatment principles were modifications of International Committee of the Red Cross recommendations. A total of 14 acute lower extremity mine injuries were treated. Surgery generally consisted of an open amputation or thorough irrigation and debridement using equipment readily available in any U.S. military field hospital. The surgical techniques will be described in detail. Delayed primary closure occurred 5 days later followed by prosthesis fitting (for amputees) in an International Committee of the Red Cross facility 12 weeks later. Other options and techniques will be discussed with an emphasis on applicability to U.S. military field surgery.
Subject(s)
Amputation, Surgical/methods , Blast Injuries/surgery , Leg Injuries/surgery , Medical Missions/organization & administration , Military Medicine/methods , Perioperative Care/methods , Resuscitation/methods , Warfare , Amputation, Surgical/education , Cambodia , Debridement/methods , Humans , International Educational Exchange , Military Medicine/education , Practice Guidelines as Topic , Red Cross , Relief Work , Resuscitation/education , Surgical Flaps , Therapeutic Irrigation/methods , Treatment Outcome , United StatesABSTRACT
We treated 16 delayed unions and 57 nonunions of the tibial diaphysis with a below-the-knee functional brace. In 48 cases, bracing was preceded by fibular ostectomy, and ten patients had an additional bone graft. We were able to follow 67 patients, of whom six (8.7%) failed to respond to treatment. In patients with nonunion, bony healing occurred with a median of 4 months. There was no difference in the speed of healing according to the level of the defect. Shortening of the limb following ostectomy of the fibula had a mean of 3 mm in the delayed-union group and 5 mm in the nonunion group.
