Differences in Intraoperative Fluoroscopic Radiation Exposure During Ankle Fracture Open Reduction and Internal Fixation Between Orthopaedic Surgery and Podiatry.

Surgical ankle fractures pose a unique situation because both podiatrists and orthopaedic surgeons manage these injuries. Intraoperative fluoroscopy is routinely used; however, excessive radiation can be harmful to both the patient and the surgical team. The primary goal of this study was to determine whether there is a difference in the amount of intraoperative radiation exposure during ankle fracture open reduction and internal fixation (ORIF) when performed by orthopaedic surgeons versus podiatrists. This is a retrospective review of patients who underwent ankle fracture ORIF at an urban level I trauma center between January 1st, 2018, and April 1st, 2023. The electronic health record was queried using International Classification of Diseases nine and 10 codes associated with ankle fractures. Patients aged older than 18 years with an ankle fracture managed surgically were included. Subjects were then stratified by procedure. The mean total radiation dose (mRad) and mean total fluoroscopic time (seconds) were then compared between those performed by orthopaedic surgeons and podiatrists. Of the 333 included procedures, 186 were done by orthopaedic surgeons and 147 were done by podiatrists. Using multiple linear regression analysis to control for age, sex, race, ethnicity, and body mass index, patients undergoing isolated malleolus ORIF with syndesmosis repair performed by orthopaedic surgery were found to have a significantly lower mean fluoroscopic time compared with those performed by podiatry (68.4 s versus 104.8 s; P = 0.028). In addition, trimalleolar ORIF with syndesmotic repair performed by orthopaedic surgery had a significantly lower mean total radiation dose compared with those performed by podiatry (244.6 mRad v 565.6 mRad; P = 0.009). Patients and surgical teams are exposed to markedly less radiation in isolated malleolar and trimalleolar fracture ORIF with syndesmosis repair when performed by an orthopaedic surgeon as compared with those performed by a podiatrist.

Patient Safety Issues From Information Overload in Electronic Medical Records.

BACKGROUND AND OBJECTIVE: Electronic health records (EHRs) have become ubiquitous in medicine and continue to grow in informational content. Little has been documented regarding patient safety from the resultant information overload. The objective of this literature review is to better understand how information overload in EHR affects patient safety. METHODS: A literature search was performed using the Transparent Reporting of Systematic Reviews and Meta-Analyses standards for literature review. PubMed and Web of Science were searched and articles selected that were relevant to EHR information overload based on keywords. RESULTS: The literature search yielded 28 articles meeting the criteria for the study. Information overload was found to increase physician cognitive load and error rates in clinical simulations. Overabundance of clinically irrelevant information, poor data display, and excessive alerting were consistently identified as issues that may lead to information overload. CONCLUSIONS: Information overload in EHRs may result in higher error rates and negatively impact patient safety. Further studies are necessary to define the role of EHR in adverse patient safety events and to determine methods to mitigate these errors. Changes focused on the usability of EHR should be considered with the end user (physician) in mind. Federal agencies have a role to play in encouraging faster adoption of improved EHR interfaces.

COVID-19 and Orthopaedic International Humanitarianism.

As the world continues to adjust to life with COVID-19, one topic that requires further thought and discussion is whether elective international medical volunteerism can continue, and, if so, what challenges will need to be addressed. During a pandemic, the medical community is attentive to controlling the disease outbreak, and most of the literature regarding physician involvement during a pandemic focuses primarily on physicians traveling to areas of need to help treat the disease. As a result, little has been written about medical volunteerism that focuses on medical treatment unrelated to the disease outbreak. In a world-wide pandemic, many factors are to be considered in determining whether, and when, a physician should travel to another region to provide care and training for medical issues not directly related to the pandemic. Leaders of humanitarian committees of orthopaedic surgery subspecialties engaged with one another and host orthopaedic surgeons and a sponsoring organization to provide thoughtful insight and expert opinion on the challenges faced and possible pathways to provide continued orthopaedic support around the globe. Although this discussion focuses on international orthopaedic care, these suggestions may have a much broader application to the international medical community as a whole.

Tarsal Coalition of the Cuneiforms in a Young Athlete: A Case Report.

CASE: Tarsal coalitions are relatively common, but there are no reports of cuneiform-to cuneiform coalition in the English language literature. The authors present a case of medial-to-intermediate cuneiform coalition in a young female track athlete. Previous nonoperative treatments had been unsuccessful. Coalition release and medial-intermediate cuneiform arthrodesis enabled her to return initially to full athletic participation without pain, but she had return of pain that persists despite removal of hardware. CONCLUSION: Medial-intermediate cuneiform coalition is rare. Surgery in this patient provided a short period of pain-free athletic participation, but long-term outcomes are not proven, and further research is needed.

Sustainable Orthopaedic Surgery Residency Training in East Africa: A 10-Year Experience in Kenya.

Low- and middle-income countries (LMICs) have continued to lag behind high-income countries in all measurable outcomes of health care. As concluded by the World Health Organization during the 2013 Global Forum on Human Resources for Health, an adequate healthcare workforce is mandatory to provide universal health coverage. Despite efforts to increase the numbers of healthcare workers, an extreme deficit in highly trained surgeons remains. Several options exist to provide training for surgeons in LMICs, including local training by local surgeons, sending local surgeons abroad for training, or local training by short-term or long-term visiting surgeons from high-income countries. This article further discusses the benefits and challenges of each option and reviews the 10-year outcomes of the Orthopaedic Surgery Residency Program at the CURE Kenya Hospital in Kijabe, Kenya. The program has graduated nine orthopaedic surgeons who are all practicing in Africa, five of which are full-time attending consultants in residency training programs. An additional eight residents are currently in the program. Sustainable orthopaedic training can be accomplished in LMICs as demonstrated by the ongoing success of the CURE Kenya Orthopaedic Surgery Residency Program. Additional efforts to expand and replicate this model may assist in providing improved access to high-quality universal healthcare in LMICs.

Delayed presentation of a heteropagus (parasitic) twin: a case report of a 17-year-old patient.

Conjoined twins are rare, but well-described, anomalies. The heteropagus (parasitic) variant, in which there is a fully functioning autosite and a partially formed parasite, is even more rare. Typically, patients with this condition are discovered and treated as neonates or infants. We present an unusual case of an ischiopagus patient presenting at 17 years of age, which appears to be the oldest recorded presentation for surgery of a heteropagus twin in the English literature. The patient had two additional developed lower extremities along with two additional rudimentary upper extremities. The challenges and lessons learned from this rare and complex surgery are discussed.

Adamantinoma of tibia in Ethiopia: the first bone transplant in Ethiopia.

UNLABELLED: Adamantinoma of long bones is an extremely rare tumor with no report, to authors' knowledge from neither Ethiopia nor Africa. We are reporting a 25 year old female college student with one and half years history of right mid leg pain and swelling with radiologically and histologically proven adamantinoma of right tibia. At CURE Hospital, she had undergone complete excision of the tumor with histologically documented clean margins. The limb was salvaged by reconstructing with a fresh frozen tibial allograft obtained from the USA and an interlocking intramedullary nail (SIGN nail). Such insertion and incorporation of huge allograft using SIGN nail and saving a limb is the first surgery in Ethiopia. The gradual incorporation of the allograft at different months during follow-up is elucidated with clinical signs of healing. CONCLUSION: At times, limb salvage surgery and technology should be offered to selected patients with a chosen type of bone tumor.