Can using emergent technology incur liability?

There are numerous areas of potential liability for the practicing surgeon attempting to upgrade skills and introduce emergent technology into his or her practice. The College understands that graduate medical education in a teaching institution, continuing medical education at our College-sponsored venues, and all other sponsored or co-sponsored educational activities each carry risks and benefits. Current College activities are directed toward enhancing translation of emergent surgical technology into clinical practice as effectively, productively, safely, and as free of risk as possible.

A joint protocol for home skeletal traction.

Cost-effective delivery of quality patient care is a major focus of the orthopaedic advanced practice nurse's practice. Long-term skeletal traction therapy for select fractures of the pelvis remains a treatment option for certain patients. The purposes of this article are to describe the development of a joint proposal for home skeletal traction therapy and to analyze the cost savings involved by reviewing a case study of a home traction patient.

Syndesmotic screw placement: a biomechanical analysis.

At the present time, syndesmotic screw fixation is recommended when there is a tibiofibular diastasis, a Maisonneuve fracture, or syndesmotic instability after fixation of distal tibia-fibula fractures. The aim/purpose of this study was to demonstrate the optimal level of syndesmotic screw placement before creation of a Maisonneuve fracture. Legs of 17 embalmed cadavers underwent knee disarticulation. The legs were then dissected to expose the syndesmosis/interosseous membrane. The paired cadaver legs were tested in two groups. In group I (10 pairs), the left legs were tested without any syndesmotic fixation and the right legs were tested with the syndesmosis fixed at 2.0 cm above the tibiotalar joint. In group II (7 pairs), the syndesmosis in each left leg was fixed at 3.5 cm above the tibiotalar joint and the right leg syndesmosis was fixed at 2.0 cm above the tibiotalar joint. After ligament section and syndesmosis fixation, each leg was then jig mounted with transfixing wires through the proximal tibia and calcaneus. The ankle was placed in neutral with 15 degrees of pronation and a load of 150 pounds and a strain gauge anchored medially and laterally. The proximal tibia was internally rotated while the ankle was held fixed until syndesmotic, bony, or hardware failure occurred. Torsional force, the degree of rotation and the amount of syndesmotic widening were quantitated. Two-tailed t-test comparing no fixation with fixation at 2.0 cm indicated less syndesmotic widening with screw placed at 2.0 cm (P = 0.04). Two-tailed t-test comparing screw fixation at 2.0 cm and 3.5 cm indicated less syndesmotic widening with screw placed at 2.0 cm (P = 0.07). It would seem reasonable to place a syndesmotic screw at 2.0 cm above tibiotalar joint.

Autogenous bone grafting of hallux sesamoid nonunions.

We first performed autogenous bone grafting for lesions of the hallux sesamoid in 1984. During the next 9 years, 21 patients (11 men and 10 women with an average age of 34 and 32 years, respectively) underwent this surgical procedure for symptomatic tibial hallux sesamoid non-unions. Successful bony union was achieved in all but two patients. The majority of patients obtained concomitant relief of preoperative symptomatology and returned to their preinjury level of activity. We believe that this procedure serves as an alternative to hallux sesamoid excision in selected cases.

Ultrasonography in the management of painful hips in children.

The decision to aspirate a painful hip joint is often based on history, physical, and laboratory findings. The purpose of this study is to determine whether ultrasound is helpful in making decisions to aspirate a painful hip joint in children. The anterior capsular distance was determined in 10 children with painful or irritable hips. This anterior capsular distance is 2 to 4 mm in most hips. A side difference of 2 mm or more is considered a significant capsular distension. Based on these criteria and clinical parameters, 3 hips were aspirated, and 7 were observed without aspiration. None of the 7 hips subsequently required further diagnostic workup or treatment and all have had a satisfactory outcome. Ultrasound is a reliable method to detect capsular distension or joint effusion. It helps significantly in making the decision as to "when to aspirate" a painful or irritable hip joint.

Posterior ankle impingement.

Thirty cases of posterior ankle impingement in 28 patients were treated over a 10-year period (1982-1992). All conditions were caused by forced plantar flexion. An os trigonum or posterior process fracture was demonstrated radiographically in 63% of these cases, and an intact posterior process was demonstrated in 33%. Ten cases were lost to follow-up. Of the remaining 20 cases, in 18 patients 12 (60%) improved with nonoperative treatment; 8 (40%) required operative excision. The results were good to excellent in 7 patients and fair in 1 patient. Operative excision for the treatment of recalcitrant posterior ankle impingement can relieve symptoms and allow a return to full preinjury activities.

Sesamoid foot problems in the athlete.

Problems of the sesamoid bones of the metatarsophalangeal joint of the great toe are critical in maintaining full ability to compete or to engage in recreation--in athletes of any age. The sesamoids are subject to the same post-traumatic, acute, and chronic changes as any other bone. These unique and deceptively important injuries demand a high index of suspicion, a thorough diagnostic effort, and a guided long-range treatment program, including follow-up to normalized athletics, particularly in the running-based sports.

Stress fractures in runners.

As the running community as well as the primary care medical community become more sophisticated in their knowledge of and treatment of repetitive stress injuries, only the more difficult problems will arrive at the orthopedist's office. As a result, injuries such as stress fracture will constitute a larger percentage of running and other repetitive stress injuries. The universal occurrence of stress fracture and its possible at-risk nature for serious injury if undertreated underscores the need to observe good treatment principles. With these principles in mind, the physician can usually treat stress fracture without major interruption of the recreational or competitive athlete's sport style.

Plantar fasciitis.

Plantar fasciitis is a typical repetitive-stress running injury and a difficult problem to treat. A full, nonoperative treatment program requires unusual patient cooperation and motivation. Surgical treatment is necessary in a small number of intractable cases.

The floating knee: Ipsilateral fractures of the tibia and femur.

Fifty-one extremities with ipsilateral tibial and femoral fractures are reviewed. Some children are included in the study. Most of the 47 patients are young men who have multiple injuries with high velocity trauma. The involved extremities are classified according to the injury site: Type 1 fractures involve both shafts; type 2-A fractures involve the knee joint; type 2-B fractures involve hip or ankle joints. Complications are frequent. Delayed union or nonunion occurred in 44.6% of the total number of bones involved. Sixty to seventy percent of the adult patients showed significant permanent functional disability.