A survey of the ethnic and racial distribution in orthopedic residency programs in the United States.

This study examined the racial and ethnic composition of orthopedic training programs in the United States. A questionnaire was mailed in January 1995 to chairpersons at 159 orthopedic programs in the United States. Eighty-nine (56%) responses were received. The distribution of orthopedic residents and fellows was as follows: white non-Hispanic, 84.2%; Asian, 6.6%; African American, 3.6%; Native American, 2.2%; Puerto Rican, 1.2%; Mexican American, 0.8%; and other Hispanic, 1%. African Americans and Hispanics were under-represented in orthopedic training programs compared with their numbers in the general population. The percentage of residents in these two minority groups also were below goals established by the Council on Graduate Medical Education and the US Government's Healthy People 2000 report. In contrast, Native Americans and Asians were overrepresented. If racial balance is to be achieved in orthopedics, new incentives must be created to encourage more African Americans and Hispanics to enter orthopedic residency training programs.

Cost effectiveness of low-molecular weight heparin versus warfarin following hip replacement surgery.

Little information is available on the efficacy of low-molecular-weight heparin (enoxaparin) versus warfarin for treatment of deep vein thrombosis and pulmonary embolism following hip replacement surgery. Still less is known of the comparative cost effectiveness of these two therapies. A retrospective study was done on 56 patients who underwent elective hip surgery at an urban medical center between 1991 and 1996. All patients received enoxaparin or warfarin for purposes of thromboprophylaxis. An analysis of medication cost, therapy, laboratory monitoring, and bleeding events of the two antithrombolytic agents was undertaken. Total savings with enoxaparin averaged $1253 per patient, or $137,886 over the study period. The incidence of deep vein thrombosis or pulmonary embolism was 0% with enoxaparin and 3% with warfarin. These data indicate that enoxaparin is a more cost-effective and efficacious regimen for thromboprophylaxis following hip replacement surgery than warfarin.

Total hip reconstruction in a woman with Cornelia de Lange syndrome: a case report.

More than 250 cases of Cornelia de Lange syndrome have been reported in the medical literature, but not have described the use of hip reconstruction to correct the congenital dysplasia that may be associated with this condition. This article reports the application of a bipolar hemiarthroplasty and acetabular allograft reconstruction for a 32-year old woman with congenital dysplasia and degenerative joint disease of the hip secondary to de Lange's syndrome. On admission, she was in considerable pain and unable to bear weight on the affected extremity. Her Harris hip score was 25. Following surgical intervention and a well-designed plan of rehabilitation, the patient's functional status improved markedly. Her Harris hip score was 72, and her pain was alleviated.

Perioperative complications in patients with sickle cell disease. An orthopedic perspective.

Osteonecrosis of the femoral head has been reported to occur in 19% to 31% of patients with sickle cell disease, with the condition often being bilateral. Current surgical options for these patients include various forms of arthrodesis, resection arthroplasty, osteotomy, and uncemented hip arthroplasty. Poor surgical outcome, coupled with frequent perioperative medical complications, makes the treatment of these patients very challenging. A case report of a 33-year-old black woman with a 21-year history of sickle cell disease who underwent hip arthroplasty and developed sickle chest syndrome is presented.

Fibular strut grafting for fibrous dysplasia of the femoral neck.

When fibrous dysplasia affects the femoral neck, normal bone is replaced by fibro-osseous dysplastic bone that is both mechanically weakened and biomechanically abnormal. Surgical management is recommended for persistent pain, progressive deformity, or impending fracture. Surgical options include curettage and cancellous bone grafting, osteotomy and nail-plate fixation, intramedullary rodding, and cortical bone grafting. We present the case of a patient with a painful, dysplastic lesion of the femoral neck who underwent cortical bone grafting using dual fibular strut grafts. To ensure long-term graft incorporation, the fibular cortical grafts bridged the lesion in the femoral neck and were securely anchored to the normal bone of the lateral femoral cortex and a head of the femur. No supplemental internal fixation was required. The biological basis for success of the fibular strut grafting procedure is that creeping substitution of the cortical graft necrotic bone does not replace the interstitial lamellae, which persist to lend structural support. Fibular strut grafting is an excellent procedure for fibrous dysplasia of the femoral neck.

Pedicle screw fixation in the management of unstable thoracolumbar spine injuries.

Pedicle screw fixation provides rigid segmental stabilization of the thoracolumbar spine. A wide range of conditions that can cause instability of the thoracolumbar spine can be treated using this technique. The increasing popularity of pedicle screw fixation has resulted in new knowledge concerning pedicle anatomy and the biomechanics of this method of fixation. The preliminary results have clarified both the indications and the limitations of this procedure. Successful results using pedicle screws require prudent patient selection, thorough preoperative preparation, and a high level of surgical expertise.

Congenital bowing of the ulna and aggressive fibromatosis.

The association of skeletal anomalies and aggressive fibromatosis has been documented. Isolated bowing of the ulna is rare, yet its occurrence, particularly in conjunction with congenital dislocation of the radial head, has been documented. This article presents two cases of ulnar bowing in which the patients subsequently developed aggressive fibromatosis. We feel that aggressive fibromatosis may be a latent manifestation of congenital bowing of the ulna. The course of the disease appears to be of an aggressive nature, and patients who present with bowing of the ulna should be followed for the potential development of this disease.

A permian productoid brachiopod: life history.

Spine arrangements on silicified specimens of Waagenoconcha abichi (Waagen) from the Khisor Range of West Pakistan suggest that the juvenile shell attached itself to a foreign object, and that the adult shell lay on its ventral valve in the substrate, anchored and stabilized by a dense corona of long slender spines around the ventral visceral disc.