ABSTRACT
BACKGROUND: Ring fixator techniques can precisely correct complex long bone deformities. In select patients, controlled shortening or intentional fracture deformation with delayed correction can also aid in complex wound coverage and limb salvage. METHODS: This retrospective cohort study analyzed all patients who underwent acute limb shortening or intentional temporary fracture deformation between 2005 and 2020. Patients were divided into three groups based on reason for acute shortening or intentional deformity: (1) skeletal indications alone, with traditional flap coverage; (2) skeletal and soft tissue indications, to augment traditional reconstructive measures; and (3) skeletal and soft tissue indications, to avoid microsurgery altogether. Comorbidities, orthopedic and reconstructive methods, and functional outcomes were recorded. RESULTS: Eighteen patients were identified: six in Group 1, five in Group 2, and seven in Group 3. Fractures were primarily in the distal third of the tibia. On initial assessment, all wounds would have required free tissue transfer. Group 1 patients were reconstructed with free flaps. Among Group 2, closure was accomplished by skin grafting (Nâ¯=â¯1), local flaps (Nâ¯=â¯1), pedicled muscle flaps (Nâ¯=â¯1), and free flaps (Nâ¯=â¯2). In Group 3, five wounds were closed primarily and two were skin grafted. All limbs were shortened, averaging 25.1â¯mm; seven were intentionally deformed, most commonly varus (10-20°). After skeletal correction, residual leg length discrepancy averaged 5.7â¯mm. No patients required amputation. CONCLUSIONS: Acute skeletal shortening with or without intentional temporary deformation in select IIIB/IIIC open tibial fractures can facilitate soft tissue coverage and limb salvage in patients who might otherwise require amputation.
Subject(s)
Fractures, Open/surgery , Leg Length Inequality/surgery , Limb Salvage/methods , Plastic Surgery Procedures/methods , Tibial Fractures/surgery , Adult , Female , Fracture Healing , Free Tissue Flaps , Humans , Male , Middle Aged , Retrospective Studies , Skin TransplantationSubject(s)
Ankle Fractures/surgery , Fracture Fixation/methods , Age Factors , Aged , Algorithms , Ankle Fractures/diagnostic imaging , Ankle Fractures/pathology , Bone Plates , Bone Screws , Clinical Decision-Making/methods , Fracture Fixation/instrumentation , Frail Elderly , Humans , Perioperative Care/methods , RadiographyABSTRACT
PURPOSE: Mini-Medical school programs have become an increasingly popular means of encouraging high-school students to consider medical professions. However, there is little research evaluating the long-term effect of these programs on influencing career choice. The purpose of our study was to determine the motivational factors for attending the Mini-Medical school programs at our institution, student satisfaction with their experience, and whether it impacts intended secondary education and career choices. METHODS: An online anonymous survey was distributed to Drexel University College of Medicine Mini-Medical school program graduates to determine factors influencing student participation and program satisfaction. RESULTS: The most influential factors in attending the program were to confirm an interest in medicine (n = 55, 95%) and parental advice (n = 29, 50%). Most maintained an interest in medicine: 57% (n = 33) pursued a pre-med degree, 55% (n = 32) planned to apply to medical school within 3 years; and 12% (n = 7) were either in medical school or matriculating in the fall of 2015. 91% (n = 53) participants noted the program's influence on choosing a pre-med undergraduate track. CONCLUSION: Our results suggest Mini-Medical school programs significantly impacted students' decision to pursue a medical career through fostering interest and effectively answering students' questions about the field.
