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1.
JBJS Rev ; 8(5): e0211, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32427775

RESUMO

¼ Orthopaedic surgery reports one of the lowest proportions of female residents among all medical specialties. While the number of female medical students has increased, our field has been particularly slow to respond to the gender gap. ¼ There are several barriers to increased female representation in orthopaedics, including "jock" culture and male dominance, the residency application process, pregnancy and lifestyle concerns, a limited number of mentors and role models, and lack of early exposure to the field. ¼ Organizations such as the American Academy of Orthopaedic Surgeons (AAOS), the Ruth Jackson Orthopaedic Society, The Perry Initiative, Nth Dimensions, and the J. Robert Gladden Society, as well as social media channels, are working to close the gender gap, but there is still more that needs to be done. ¼ By acknowledging and addressing these barriers, both at an individual and institutional level, we can hopefully bring more women into the field. This will ultimately benefit not only ourselves, but our patients as well.


Assuntos
Equidade de Gênero , Internato e Residência , Cirurgiões Ortopédicos/educação , Feminino , Humanos , Gravidez
2.
J Bone Joint Surg Am ; 101(5): e18, 2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30845044

RESUMO

BACKGROUND: Evaluation of surgical skill competency is necessary as graduate medical education moves toward a competency-based curriculum. This study by the American Board of Orthopaedic Surgery (ABOS) and the Council of Orthopaedic Residency Directors (CORD) compares 2 web-based evaluation tools that assess the level of autonomy that is demonstrated by residents during surgical procedures in the operating room as measured by faculty. METHODS: Two hundred and ninety-four residents from 16 orthopaedic surgery residency programs were evaluated by 370 faculty using 2 web-based evaluation tools in a crossover design in which residents requested faculty review of their surgical skills before starting a case. One thousand, one hundred and fifty Ottawa Surgical Competency Operating Room Evaluation (O-Score) assessments, which included a 9-question evaluation of 8 steps of the surgical procedure, were compared with 1,186 P-score evaluations, which included a single-question summative evaluation. Twenty-five different surgical procedures were evaluated. RESULTS: There were no significant differences in rates of resident requests or faculty completion of the 2 scores. The most common surgical procedures that were assessed were total knee arthroplasty (n = 254, 11%), carpal tunnel release (n = 191, 8%), open reduction and internal fixation (ORIF) of stable hip fractures (n = 170, 7%), ORIF of simple ankle fractures (n = 169, 7%), and total hip arthroplasty (n = 166, 7%). Both instruments disclosed significant differences in competency among entry, intermediate, and advanced-level residents. The findings support the construct validity of the evaluation method. The survey results indicated that >70% of the faculty were confident that use of either the P-score or the O-score allowed them to distinguish a resident who can perform the surgery independently from one who needs additional training. CONCLUSIONS: This research has led to the modification of the O-score and the P-score into a combined OP-score instrument. The ABOS envisions that the OP-score instrument can be used with an expanded number of surgical procedures as a required element of residency training in the near future. CLINICAL RELEVANCE: This study allows the profession of orthopaedic surgery education to take a leadership role in the measurement of competence for surgical skills for orthopaedic surgeons in residency training, an important clinically relevant topic to the practice of orthopaedic surgery.


Assuntos
Competência Clínica/normas , Internato e Residência/normas , Procedimentos Ortopédicos/normas , Ortopedia/educação , Análise de Variância , Educação Baseada em Competências/métodos , Estudos de Viabilidade , Humanos , Internet , Internato e Residência/métodos , Ortopedia/normas , Estados Unidos
4.
J Am Acad Orthop Surg ; 20(3): 160-6, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22382288

RESUMO

The benefits of spinal surgery for relief of low back and leg pain in patients with degenerative spinal disorders have long been debated. The Spine Patient Outcomes Research Trial (SPORT) was designed to address the need for high-quality, prospectively collected data in support of such interventions. SPORT was intended to provide an evidential basis for spinal surgery in appropriate patients, as well as comparative and cost-effectiveness data. The trial studied the outcomes of the surgical and nonsurgical management of three conditions: intervertebral disk herniation, degenerative spondylolisthesis, and lumbar spinal stenosis. Both surgical and nonsurgical care of intervertebral disk herniation resulted in significant improvement in symptoms of low back and leg pain. Still, the treatment effect of surgery for intervertebral disk herniation was less than that seen in patients who underwent surgical versus nonsurgical treatment of degenerative spondylolisthesis and lumbar spinal stenosis. Across SPORT, more significant degrees of improvement with surgery were noted in chronic conditions of lumbar spinal stenosis and lumbar spinal stenosis with spondylolisthesis. In addition, no catastrophic progressions to neurologic deficit occurred as a result of watchful waiting.


Assuntos
Deslocamento do Disco Intervertebral/cirurgia , Estenose Espinal/cirurgia , Espondilolistese/cirurgia , Humanos , Deslocamento do Disco Intervertebral/terapia , Vértebras Lombares , Ensaios Clínicos Controlados Aleatórios como Assunto , Estenose Espinal/terapia , Espondilolistese/terapia
6.
J Am Acad Orthop Surg ; 18(11): 657-67, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21041800

RESUMO

External orthoses are used in the management of a variety of spinal disorders. Many types of brace are available to support the cervical, thoracic, and lumbar spine as well as junctional regions, which have special mechanical considerations. Many prefabricated and custom-made devices are available, made by a variety of manufacturers in this unregulated area of medical practice. Despite the widespread use of spinal orthoses, evidence of their efficacy in managing many spinal conditions is lacking. The most compelling indication for their use is in the management of traumatic spine injury. However, studies evaluating the efficacy of spinal orthoses have several shortcomings; many have evaluated orthoses that are no longer used. Recent data provide general guidelines to help the clinician choose the appropriate device.


Assuntos
Aparelhos Ortopédicos , Doenças da Coluna Vertebral/terapia , Coluna Vertebral , Dor nas Costas/prevenção & controle , Fenômenos Biomecânicos , Braquetes , Desenho de Equipamento , Fraturas por Compressão/terapia , Humanos , Imobilização/instrumentação , Cervicalgia/prevenção & controle , Aparelhos Ortopédicos/efeitos adversos , Amplitude de Movimento Articular , Traumatismos da Coluna Vertebral/fisiopatologia , Traumatismos da Coluna Vertebral/terapia
7.
Orthop Clin North Am ; 35(4): 463-72, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15363921

RESUMO

Femoral head fractures occur with a reported incidence of 6%-16% after hip dislocation. Even the largest series have evaluated only a few dozen patients, often collecting experience from multiple centers. This article provides the clinician with current information to guide the diagnosis and treatment of this uncommon condition.


Assuntos
Cabeça do Fêmur/lesões , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/reabilitação , Consolidação da Fratura/fisiologia , Fraturas Ósseas/reabilitação , Humanos , Escala de Gravidade do Ferimento , Masculino , Complicações Pós-Operatórias , Prognóstico , Radiografia , Recuperação de Função Fisiológica , Medição de Risco , Resultado do Tratamento
8.
J Spinal Disord Tech ; 17(4): 272-6, 2004 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15280754

RESUMO

BACKGROUND: We tested the hypothesis that a pedicle screw construct's height is an important factor in strengthening a screw-rod system. METHODS: Six corpectomy constructs were made, each using two ultra-high-molecular-weight polyethylene blocks, 6.5-mm pedicle screws, and two 6.35-mm rods. Pedicle screws were placed at +10-, +5-, 0-, and -5-mm depths in relation to the dorsal surface of the corpectomy model. Nondestructive testing was performed in flexion/extension and in torsion. RESULTS: For all modes tested, the screw-rod constructs continued to increase in stiffness as the height of the construct was lowered, and this was statistically significant at all heights tested (P < 0.001). The stiffness increased 232% when comparing flexion at +10 and -5 mm and increased 231% in extension from +10 to -5 mm. The torsional stiffness increased 171% when comparing +10 and -5 mm. CONCLUSIONS: Thus, lower-profile instrumentation systems should be used to take advantage of this by decreasing the size and bulkiness of the implants while increasing the strength of the construct.


Assuntos
Parafusos Ósseos , Vértebras Lombares/fisiologia , Vértebras Lombares/cirurgia , Fusão Vertebral/instrumentação , Fenômenos Biomecânicos , Humanos , Técnicas In Vitro , Teste de Materiais , Anormalidade Torcional
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