Comparing diagnosis of midfacial fractures by radiologists and plastic surgeons

Emergency Radiology - Clinicians who manage facial fractures often rely on radiologist interpretations to help with assessment and management. Among treating physicians, facial fractures are...     

Taking medicine back: Dx and Rx for orthopedic surgeons

The present day practice of medicine is cause of considerable malaise for physicians. This article will invoke the ancient proverb, "Physician Treat Thyself". In other words this article addresses the problems from a diagnostic and therapeutic perspective, working toward a permanent cure. The history of medical practice groups, in-office surgery, and ancillary services is reviewed. The co-morbidity of health maintenance organizations, Evaluation and Management requirements, and cost shifting are mentioned. Finally a list of symptoms and the appropriate therapeutic measures are administered to control costs, increase income, and re-establish some form of authority in the practice of medicine.     

The Radiographic Union Score for Hip (RUSH): the use of a checklist to evaluate hip fracture healing improves agreement between radiologists and orthopedic surgeons

Objective

The assessment of fracture healing following intertrochanteric fracture fixation is highly variable with no validated standards. Agreement with respect to fracture healing following surgery is important for optimal patient management. The purpose of this study was to (1) assess reliability of intertrochanteric fracture healing assessment and (2) determine if a novel radiographic scoring system for hip fractures improves agreement between radiologists and orthopedic surgeons.

Materials and methods

A panel of three radiologists and three orthopedic surgeons assessed fracture healing in 150 cases of intertrochanteric fractures at two separate time points to determine inter-rater and intra-rater agreement. Reviewers, blinded to the time after injury, first subjectively assessed overall healing using frontal and lateral radiographs for each patient at a single time point. Reviewers then scored each fracture using a Radiographic Union Score for Hip (RUSH) form to determine whether this improves agreement regarding hip fracture healing.

Results

Inter-rater agreement for the overall subjective impression of fracture healing between reviewer groups was only fair (intraclass coefficient [ICC]?=?0.34, 95 % CI: 0.11–0.52. Use of the RUSH score improved overall agreement between groups to substantial (ICC?=?0.66, 95 % CI: 0.53–0.75). Across reviewers, healing of the medial cortex and overall RUSH score itself demonstrated high correlations with overall perceptions of healing (r?=?0.53 and r?=?0.72, respectively).

Conclusions

The RUSH score improves agreement of fracture healing assessment between orthopedic surgeons and radiologists, offers a systematic approach to evaluating intertrochanteric hip fracture radiographs, and may ultimately provide prognostic information that could predict healing outcomes in patients with femoral neck fractures.     

骨科医生职业病的认知现状及健康管理

分析骨科行业从业人员容易罹患的辐射损伤、颈腰椎疾病、消化道疾病等职业损伤类型,针对骨科医生对职业病存在的认知误区如认知程度不足、防治措施不清、重视程度不够等现状,提出休假制度保障、健康管理师授课、加强自我防护能力等方法进行骨科职业病的健康管理策略。     

Anatomy instruction by radiologists

Ninety-four academic radiology departments responded to a questionnaire concerning anatomy instruction by radiologists. Seventy-six departments reported that radiologists teach anatomy to medical students in courses sponsored by anatomy departments (63), radiology departments (7), or both (6). The most frequent format for teaching anatomy was classroom lectures alone (25) or a combination of classroom lectures and small group instruction (24). Eighty departments indicated that additional teaching aids would be helpful.     

Microfracture for knee chondral defects: a survey of surgical practice among Canadian orthopedic surgeons

Purpose

The purpose of this study was to describe the practice of microfracture surgery for knee chondral defects among Canadian orthopedic surgeons.

Methods

All orthopedic surgeon members of the Canadian Orthopaedic Association were invited to participate in a survey, designed to explore the microfracture technique used by orthopedic surgeons in the treatment for knee chondral defects The primary outcome measure was an emailed 26-item questionnaire, which explored indications for microfracture surgery, surgical techniques, types of postoperative rehabilitation regimes used and assessment of outcome. In addition, responses were compared between orthopedic surgeons with a sports medicine practice to surgeons with a non-sports medicine practice.

Results

The survey response rate was 24.6% (299/1,216), with 131 regularly performing microfracture. 41% of surgeons indicated that they had no upper limit for age at the time of surgery, and 87% indicated no upper limit for body mass index. The majority of respondents (97%) resected cartilage back to a stable margin, while 69% of respondents removed the calcified cartilage layer prior to creating holes. Only 11% of respondents used continuous passive motion (CPM) postoperatively, and 39% did not restrict weight bearing. Sports surgeons were more likely than non-sports surgeons to remove the calcified cartilage layer, use a 45° pick, use CPM and restrict weight bearing postoperatively (all P values?<?0.05).

Conclusions

This survey on microfracture for knee chondral defects revealed widespread variation among surgeons regarding the indications for surgery, surgical technique, postoperative rehabilitation and assessment of outcome. Sports surgeons demonstrate better evidence-based practice than non-sports surgeons for a few important parameters.

Level of evidence

Cross-sectional survey, Level II.