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Representation Matters: A Higher Percentage of Women Orthopaedic Surgery Faculty Is Associated With an Increased Number of Women Residents
No full textIntroduction: Orthopaedic surgery has been recognized as one of the least diverse surgical specialties. Previous studies have demonstrated that women are heavily underrepresented within orthopaedic surgery. The purpose of this study was to determine whether orthopaedic surgery residency programs with a higher presence of women faculty had a higher proportion of women residents.
Methods: The Fellowship and Residency Electronic Interactive Database was used to identify all orthopaedic surgery residency programs in the United States. Resident and faculty\u27s sex and degree were recorded in addition to faculty administrative title (eg, program director, chair) and academic rank (clinician, professor, etc). Pearson correlation coefficients were used to compare the number of women residents with the number of women faculty.
Results: A total of 192 orthopaedic surgery programs were analyzed. Of the 5,747 faculty members and 4,268 residents identified, 13.1% (n = 752) and 22.6% (n = 963) were women, respectively. The number of women residents markedly correlated with the number of women faculty in leadership positions (r = 0.516, P \u3c 0.001), such as chief or chair. The most significant correlations were among women with the academic role of professor (r = 0.575, P \u3c 0.001), assistant professor (r = 0.555, P \u3c 0.001), and women who held faculty positions but held no higher academic appointment (r = 0.509, P \u3c 0.001). Program directors and assistant program directors were not found to have significant correlations with the number of women residents.
Conclusion: This study demonstrates a positive correlation between women faculty and residents at orthopaedic surgery residencies. Some academic positions, such as division chief, held more significant associations, whereas other positions, such as professor emeritus, were not held by any women, thereby limiting statistical analysis. Further investigation into minority representation in orthopaedic surgery and initiatives to address the observed disparities is paramount
Achilles Allograft Fiber Track Graft Preparation Technique for Anterior Cruciate Ligament Reconstruction
Get PDFAnterior cruciate ligament rupture is a common orthopaedic injury, with reconstruction the treatment of choice for active individuals. Graft selection is an important consideration for surgical planning. Achilles tendon allograft is a graft choice most likely used in cases of revision anterior cruciate ligament reconstruction. This technical note discusses an approach to Achilles tendon allograft preparation that respects and follows the rotation of the fibers of the Achilles tendon. Key considerations in the use of this technique include (1) identifying the rotational fiber tracks, (2) performing careful dissection along the identified tracks of the fibers, and (3) ensuring an appropriate graft width based on patient size, all of which are crucial for the success of this unique technique. The preservation of the rotational fibers provided by this technique may have the potential to result in increased tensile strength and better clinical outcomes
Danger Zone for Paramedian Forehead Flap Elevation: Maximizing Flap Length and Viability
Get PDFThe supratrochlear artery (STA) demonstrates anatomical variability that impacts facial reconstruction with a paramedian forehead flap. STA branching patterns and the distance to the midline have been reported, but the STA pedicle has not been characterized. Our aim was to triangulate the STA pedicle relative to known anatomical landmarks and identify a danger zone to aid surgeons in creating viable tissue flaps. The upper facial region was dissected bilaterally on 38 cadaveric donors. Measurements from the supraorbital neurovascular bundle, orbital rim, and medial canthus to the STA pedicle were collected. Data were tallied and statistically analyzed. Measurement means, range, and standard deviations were calculated; no significant differences were found in the laterality of the measurements (p \u3e 0.05). Statistically significant, sex-based differences were identified for all measurements collected among male and female donors. This study characterizes a surgical danger zone for the STA pedicle specific to a paramedian forehead flap and identifies important differences within this danger zone among male versus female donors that surgeons should consider to prevent pedicle violation and enhance surgical success while maximizing flap length and mobility
Integrative Effects of Transcutaneous Auricular Vagus Nerve Stimulation on Esophageal Motility and Pharyngeal Symptoms Via Vagal Mechanisms in Patients With Laryngopharyngeal Reflux Disease
Get PDFBackground and aim: Laryngopharyngeal reflux disease (LPRD) is primarily characterized by discomfort in the pharynx and has limited treatment options. This research aimed to assess the efficacy of transcutaneous auricular vagus nerve stimulation (tVNS) in patients with LPRD and delve into the potential underlying mechanisms.
Methods: A total of 44 participants, diagnosed with LPRD were divided into two groups randomly. Twice-daily stimulation was delivered for 2 weeks for patients in experimental group, with stimulation ranging from 1.0 mA to 1.5 mA (n = 22), while the control group underwent sham tVNS (n = 22) with the same stimulation parameters and different anatomical location. The severity of symptoms and levels of anxiety and depression were monitored using questionnaires. High-resolution esophageal manometry data were collected, and the patients’ autonomic function was assessed through heart rate variability analysis.
Results: There was a positive correlation between reflux symptom index (RSI) scores and low frequency/high frequency (LF/HF) ratio (r = 0.619; p \u3c 0.001), Hamilton anxiety scale (HAMA) scores (r = 0.623; p \u3c 0.001), and Hamilton depression scale (HAMD) scores (r = 0.593; p \u3c 0.001). Compared to the pre-tVNS phase, RSI (p \u3c 0.001), HAMA (p \u3c 0.001), and HAMD (p \u3c 0.001) scores were significantly reduced after 2 weeks of treatment. Additionally, the resting pressure of the upper esophageal sphincter (UESP; p \u3c 0.05) and lower esophageal sphincter (LESP; p \u3c 0.05) showed significant enhancement. Notably, tVNS led to an increase in root mean square of successive differences (RMSSD; p \u3c 0.05) and high frequency (HF; p \u3c 0.05) within heart rate variability compared to the pre-treatment baseline. Compared to the control group, RSI (p \u3c 0.001), HAMA (p \u3c 0.001), and HAMD (p \u3c 0.001) scores in tVNS group were significantly lower at the end of treatment. Similarly, the resting pressure of UESP (p \u3c 0.05) and LESP (p \u3c 0.05) in tVNS group were significantly higher than that of control group. Notably, RMSSD (p \u3c 0.05) and HF (p \u3c 0.05) in tVNS group were significantly higher than that of control group.
Conclusion: This study demonstrated that tVNS as a therapeutic approach is effective in alleviating LPRD symptoms. Furthermore, it suggests that improvements in esophageal motility could be associated with vagus nerve-dependent mechanisms
Corynebacterium minutissimum as a Rare Cause of Tibial Osteomyelitis: A Case Report and Literature Review
Get PDFOsteomyelitis is commonly caused by pathogens like Staphylococcus aureus, but rare organisms such as Corynebacterium minutissimum, typically associated with superficial skin infections, can also be implicated. Recognizing these atypical pathogens presents diagnostic and therapeutic challenges, especially in the presence of orthopedic hardware. We conducted a literature review yielding 25 studies and encompassing 797 patient cases, which highlights the emerging role of Corynebacterium species in osteomyelitis, particularly following trauma or surgical interventions. A 72-year-old man with a history of chronic right tibia and fibula fractures from a motor vehicle accident presented with progressively worsening leg pain over six months. Imaging revealed hardware failure and new fractures. Surgical intervention involved hardware removal, osteotomy, and placement of an external fixator. Intraoperative cultures eventually grew C. minutissimum which was resistant to ceftriaxone but sensitive to doxycycline. His antibiotic regimen was switched from intravenous cefazolin to oral doxycycline, leading to gradual pain improvement and stable clinical status. This case adds to the growing body of literature on C. minutissimum as a rare but significant cause of osteomyelitis, particularly in patients with orthopedic hardware. Our literature review emphasizes the need for clinicians to be vigilant for Corynebacterium species in cases of osteomyelitis unresponsive to standard treatments. Early recognition and targeted antimicrobial therapy guided by susceptibility testing are crucial for successful outcomes in managing atypical bone infections
Use of Virtual Reality in Physical Therapy as an Intervention and Diagnostic Tool
No full textWithin the past decade, the integration of computer-generated virtual realities (VRs) has witnessed a significant rise in the field of healthcare, particularly in diagnosis and treatment applications. These VR systems have found extensive use in physical therapy, rehabilitation, research, and assessment. This narrative review article is aimed at providing a comprehensive overview of the literature regarding the implementation of VR in the physical therapy profession. The primary objective of this review is to provide information to clinicians about the diverse applications of VR and its potential advantages in intervening across various patient populations and diagnoses during rehabilitation therapy. Through in-depth discussions with experts and a thorough review of pertinent literature, several significant aspects of the topic were identified. Subsequently, we carried out an online search to investigate the prevalent utilization of VR systems within healthcare, both as assessment tools and for therapeutic interventions. Our examination encompassed a total of 56 articles, with supplementary references incorporated as required
Forensic Evidence Preservation Following an Incident of Rape: The Role of the Victim
No full textBackground: Rape has a high prevalence in South Africa. The collection of credible and valid forensic evidence is a key legal factor that impacts case trial outcomes. Victim behaviour around the time of the rape can impact the collection and the integrity of forensic evidence, and can have a direct effect on case progression and conviction. Despite the importance of victim behaviour, few studies have been done on the role of victims in preserving forensic evidence. This article discusses how common personal hygiene practices undertaken by rape victims after being raped can impact the quality and validity of forensic evidence. This investigation was done with the aim of elucidating the role of victims in preserving forensic evidence post rape.
Methods: This was a descriptive, retrospective clinical audit of all rape victims managed at Robert Mangaliso Sobukwe Hospital forensic unit in South Africa from 01 January 2020 to 31 March 2022.
Results: A total of 192 rape cases over the study period were included in this review. The median age of rape victims was 20 years (minimum 2 years; maximum 76 years). The majority (n = 178; 92.7%) of the victims were female. About 44.8% (n = 86) of the victims reported that they had urinated post-rape and prior to forensic examination, 20.8% (n = 40) had changed their clothing, 8.3% (n = 16) had showered, 6.8% (n = 13) had bathed, 4.2% (n = 8) had douched, and only 1.0% (n = 2) had defecated. Only 44 (22.9%) of the victims reported to have ingested alcohol or spiked drinks before the rape.
Conclusion: These findings suggest that some rape victims engaged in personal hygiene practices that could militate against forensic evidence preservation. This finding, therefore, indicates the need for public awareness about ways to preserve evidence to the greatest extent possible after an incident of rape.Contribution: We provide simple guidelines for victims on the preservation of forensic evidence following rape and before detailed forensic medical examination and evidence collection
Successful Robot-Assisted Simple Prostatectomy Years After a Prostate Artery Embolization: A Case Report and Review of the Literature
No full textSimple prostatectomy (SP) can be utilized for patients with large prostates with lower urinary tract symptoms. Prostate artery embolization (PAE) does not have robust clinical evidence to support its use in treating urinary symptoms; however, it is an effective treatment for refractory hematuria from a prostatic source. There have been limited papers regarding preoperative PAE prior to SP. However, there are no papers regarding the feasibility of delayed SP after PAE. We present, to our knowledge, the first paper demonstrating a successful robot-assisted SP years after a PAE in a patient with a 380g prostate with recurrent refractory gross hematuria