ABSTRACT
Perilunate injuries most commonly occur in high energy trauma situations; however, they are rare and frequently missed. Familiarity with the complex bony and ligamentous anatomy is required to fully understand these complex injury patterns. Careful orthogonal imaging and evaluation is required to ensure timely diagnosis of a perilunate injury. Early recognition and management of acute perilunate injuries has been demonstrated to correlate with better patient outcomes. Delayed treatment of chronic injuries can result in post-traumatic osteoarthritis and carpal collapse requiring salvage interventions. Here, we review the anatomy, basic evaluation, and management of this frequently missed injury.
Subject(s)
Fracture Dislocation , Joint Dislocations , Orthopedic Procedures , Wrist Injuries , Wrist Joint , Biomechanical Phenomena , Fracture Dislocation/diagnostic imaging , Fracture Dislocation/etiology , Fracture Dislocation/physiopathology , Fracture Dislocation/surgery , Fracture Healing , Humans , Joint Dislocations/diagnostic imaging , Joint Dislocations/etiology , Joint Dislocations/physiopathology , Joint Dislocations/surgery , Orthopedic Procedures/adverse effects , Orthopedic Procedures/methods , Recovery of Function , Risk Factors , Treatment Outcome , Wrist Injuries/diagnostic imaging , Wrist Injuries/etiology , Wrist Injuries/physiopathology , Wrist Injuries/surgery , Wrist Joint/diagnostic imaging , Wrist Joint/physiopathology , Wrist Joint/surgeryABSTRACT
The relationship between pharmaceutical and biomedical technology companies (industry) and medical practitioners has been a topic of discussion and concern for several decades. The large monetary payments and extravagant gifts to physicians from these companies have been regulated and largely stopped; however, there still exists an active rapport between physicians and industry. Little formal instruction is given to medical students and residents on what constitutes a conflict of interest when entering these business partnerships. In this study, we presented a set of scenarios depicting industry-physician interactions to medical students, orthopaedic surgery residents, and attending physicians and asked them to decide whether a conflict of interest is depicted. Our goal was to determine whether a disparity exists in the ability to identify conflicts of interest across the levels of training. Of 200 potential participants, 70 provided responses to the survey (35%). Thirty-five (50%) were attending physicians, 18 (25.7%) residents, 12 (17.1%) medical students, and 8 (11.4%) declined to provide level of training. There was no significant difference in the ability to identify a conflict of interest across seniority level for the 13 questions. Our results suggest that both medical students and resident physicians are able to identify which interactions with industry pose a possible conflict of interest as accurately as attending physicians can.
