Diaphyseal Both-Bone Forearm Fracture Due to a Grip Lock Injury in a Female Pediatric Gymnast: A Case Report.

CASE: A 13-year-old female gymnast sustained a diaphyseal both-bone forearm fracture due to a grip lock injury. CONCLUSION: This is a report of a diaphyseal both-bone forearm fracture due to a grip lock injury in a female pediatric gymnast, successfully treated with closed reduction and cast immobilization. The rare mechanism of injury, education, and treatment have been discussed.

Bilateral Posterior-Stabilized Total Knee Arthroplasty in a Patient With Osteopetrosis and Literature Review.

We present a case report of a patient with osteopetrosis and refractory bilateral knees osteoarthritis who underwent bilateral total knee arthroplasties (TKAs). After conservative management has failed, surgical treatment with arthroplasty is an excellent alternative with satisfactory outcomes. TKA in patients with osteopetrosis has only been described in 6 other case studies, none of which underwent bilateral TKA. To perform this procedure, additional attention should be directed toward the presurgical planning because of the amplified difficulty of the procedure and the altered bone biology that increases the risks of intraoperative fractures and markedly extends the time of surgery. This report describes a case of osteopetrosis with refractory osteoarthritis managed with bilateral TKA, the surgical technique and special considerations, complications, and future recommendations.

The Effect of Total Hip Arthroplasty on the Sciatic Nerve: an Electrodiagnostic Evidence Study.

OBJECTIVE: Objectively evaluate the incidence of sciatic nerve injury after a total hip arthroplasty (THA) performed through a posterolateral approach. METHODS: Patients scheduled to undergo THA were evaluated preoperatively and postoperatively with electrophysiologic studies, the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) questionnaire and other methods described in the study. Patients older than 21 years with any of the following preoperative diagnoses: primary or secondary osteoarthritis, aseptic avascular necrosis, rheumatoid arthritis, and posttraumatic arthritis were included. Variables used for analysis were sex, age, and body mass index (BMI). The Mann-Whitney U and Wilcoxon tests and, Pearson and Spearman correlation statistics were used for analysis of categorical and continuous data respectively. RESULTS: Electrodiagnostic data showed alterations in 17 patients (70.8%). No signs of sciatic nerve injury. The mean preoperative and postoperative WOMAC scores were 40 and 74, respectively (p = 0.0001). Statistical differences were noted in sural sensory amplitude (SSA) and distal amplitude of the tibialis motor nerve in the female group (p=0.007; p=0.036, respectively). The SSA also demonstrated differences in the obese group (p=0.008). In terms of age, both the SSA (Pearson p=0.010 and Spearman p=0.024) and the proximal latency of the peroneal motor nerve (Pearson p=0.026 and Spearman p=0.046) demonstrated a decrease in amplitude and an increase in latency that was inversely related with age. CONCLUSION: According to our subclinical electrophysiological findings, surgeons that use the posterolateral approach in THA procedures must be conscious of the sciatic nerve's vulnerability to reduce possible clinical complications.

Orthopaedic Surgeon Communication Skills: Perception of Empathy and Patient Satisfaction Through the Use of Anatomic Models.

INTRODUCTION: Patient satisfaction is an increasingly emphasized measure of patient-centered care and important component of reimbursement programs. Orthopaedic surgeons are regarded as low-empathy surgeons. Our goals were to understand the role of anatomic models during the orthopaedic appointment and how their use can affect patient satisfaction and perceived empathy. METHODS: New patients at an outpatient clinic were asked to participate in a postencounter questionnaire to asses empathy perception (n = 304). Clinic days were randomly assigned to use anatomic models during the encounter to assist with clinical information transmission. The instrument provided contained Consultation and Relational Empathy questionnaire (ie, a person-centered process that was developed to measure empathy in the context of the therapeutic relationship during a one-on-one consultation between a clinician and a patient). RESULTS: A total of 304 participants were included in the study. Analyses of the sociodemographic characteristics did not reveal any significant difference between the control and experimental groups. Consultation and Relational Empathy scores for the nonanatomic group (46.0 ± 9.0) and anatomic group (48.0 ± 7.7) were not statistically different (P = 0.482). The encounter time was significantly increased with the use of anatomic models (P < 0.005). DISCUSSION: The use of anatomic models during initial orthopaedic encounter did not improve perceived empathy and satisfaction scores in our study. Longer encounter time in the orthopaedic appointment does not mean higher empathy perception. CONCLUSION: Orthopaedic surgeons have the duty to find new strategies to improve communication with the patient. Better communication has been associated with better patient satisfaction. Further investigation should be considered to use other strategies to provide better care for our patients.

Diagnosis of an Occult Hip Fracture by Point-of-Care Ultrasound.

BACKGROUND: Hip fractures are common injuries, particularly among elderly patients. Although plain radiographs are the initial imaging modality of choice, approximately 10% of hip fractures are not radiographically evident. Failure to diagnose a hip fracture in the emergency department may result in delayed diagnosis and potentially devastating consequences. CASE REPORT: We report the case of an 81-year-old woman with right hip pain after a fall. Although plain radiographs of the right hip and femur were negative for fracture, point-of-care ultrasound of the right hip demonstrated a cortical disruption in the femur consistent with a fracture. Given the clinical and ultrasound findings, computed tomography of the bony pelvis and proximal femurs was performed, which confirmed an oblique complex fracture of the right femur through the greater and lesser trochanters. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Point-of-care ultrasound, in conjunction with clinical suspicion, may help identify patients who require more advanced imaging to identify occult hip fractures.

Web-based teaching in point-of-care ultrasound: an alternative to the classroom?

OBJECTIVES: To evaluate two educational methods for point-of-care ultrasound (POC US) in order to: 1) determine participant test performance and attitudes in using POC US and 2) compare cost and preparation time to run the courses. METHODS: This was a pilot study conducted at a county teaching hospital. Subjects were assigned to participate in either a large group course with live classroom lectures (Group A) or a group asked to watch 4.5 hours of online prerecorded lectures (Group B). Both groups participated in small-group hands-on training after watching the lectures. Both groups took a pre- and post-course exam, and completed course surveys. Cost and time spent running the courses were also compared. RESULTS: Forty-seven physicians participated in the study. The pre-test and post-test scores between the two groups did not differ significantly. Of those with prior ultrasound experience, the majority of both groups preferred to continue classroom-based teaching for future courses. Interestingly, in the groups who had no ultrasound experience prior to their course participation, there was a higher percentage who preferred web-based teaching. Lastly, Group B was shown to have the potential to take less preparatory time when compared to Group A. CONCLUSION: A web-based curriculum in POC US appears to be a promising and potentially time saving alternative to live classroom lectures and seems to offer similar educational benefits for the postgraduate learner.

Critical urologic skills and procedures in the emergency department.

The evaluation and management of genitourinary emergencies is a fundamental component of the training and practice of emergency physicians. Urologic procedures are common in the emergency room. Emergency physicians play a vital role in the initial evaluation and treatment because delays in management can lead to permanent damage. This article discusses the most common urologic procedures in which emergency physicians must be proficient for rapid intervention to preserve function and avoid complications. An overview of each procedure is discussed as well as indications, contraindications, equipment, technique, and potential complications.

The role of cardiovascular screening in headache patients.

There have been associations demonstrated between migraine and ischemic stroke and heart disease. Additionally, headache patients have increased cardiovascular risk factors. This article reviews available data supporting these concerns and answers the following questions: 1) Does the association between migraine and cardiovascular disease warrant cardiovascular screening tests in migraine sufferers? There is enough observational data to conclude that migraine with aura is a risk factor for cardiovascular disease. With the available data, we cannot recommend any additional cardiovascular screening tests for migraine patients. 2) Are there specific risk modification approaches for headache patients? As there is no data to suggest that migraine is a modifiable risk factor, no additional cardiovascular interventions beyond the standard practice of treating modifiable risk factors are suggested for migraine sufferers. 3) What is the appropriate screening for patients who may be candidates for triptans or tricyclic antidepressants? We support screening headache patients by obtaining a history of prior cardiovascular disease and traditional cardiovascular disease risk factors. We have found no data to suggest that any non-invasive cardiovascular screening test will identify a population of migraine sufferers at high risk for cardiovascular events following triptan use. Due to the increased risk of cardiovascular toxicity, ECGs should be considered prior to initiating tricyclic antidepressants in patients with preexisting cardiovascular disease.