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PubMed1975

[Dentofacial orthopedics and orthopedic surgery].

The authors describe five cases of surgical correction of dysmorphisms of the maxillaries requiring orthodontic treatment before surgery. Pre-operative orthodontic treatment of the adult has the advantage of enabling the arches to be aligned, facilitating the operation when the osteotomized fragments are positioned and resulting in immobilisation in a good position.

Adolescent↗
PubMed2004

Robot-assisted orthopedic surgery.

The main advantages of robot-assisted orthopedic surgery over conventional orthopedic techniques are improved accuracy and precision in the preparation of bone surfaces, more reliable and reproducible outcomes, and greater spatial accuracy. Orthopedic surgery is ideally suited for the application of robotic systems. The ability to isolate and rigidly fix bones in known positions allows robotic devices to be securely fixed to the bone. As such, the bone is treated as a fixed object, simplifying the computer control of the robotic system. Commercially available robotic systems can be categorized as either passive or active devices, or can be categorized as positioning or milling/cutting devices. Computer assisted orthopedic surgery is a related area of technological development in orthopedics; however, robot-assisted orthopedic surgery can achieve levels of accuracy, precision, and safety not capable with computer assisted orthopedic surgery. Applications of robot-assisted orthopedic surgery currently under investigation include total hip and knee replacement, tunnel placement for reconstruction of knee ligaments, and trauma and spinal procedures. Several short-term studies demonstrate the feasibility of robotic applications in orthopedics, however, there are no published long-term data defining the efficacy of robot-assisted orthopedic surgery. Issues of cost, training, and safety must be addressed before robot-assisted orthopedic surgery becomes widely available. Robot-assisted orthopedic surgery is still very much in its infancy but it has the potential to transform the way orthopedic procedures are done in the future.

Humans↗
PubMedDate not supplied

[The history of orthopedics in Freiburg].

During the 19th century orthopedic medicine in Germany developed uniformly. The starting point was almost always the foundation of a private institute, which was then taken over by state/communal or confessional/charitable bodies, and in some cases universities. In Freiburg, however, orthopedics developed very differently. From the very beginning it was a clinical and academic discipline within the university. Orthopedic medicine was practised systematically at Freiburg Surgical Clinic from about 1835 on, and it was at this time that the first lectures in Orthopedics were given. Freiburg also has one of the oldest university orthopedic institutes. The founding of an Extraordinary Chair of Orthopedic Medicine is due to the efforts of the pathologist Aschoff and the surgeon Kraske. Besides Carl Friedrich Hecker, the special development of orthopedics in Freiburg may be attributed to the work of Georg Friedrich Louis Stromeyer. It is to him that orthopedics--in Freiburg and elsewhere--owes a debt not only for introducing surgical procedures, but first and foremost for its establishment as a scientific discipline. The remarkably early rise of orthopedics in Freiburg was followed, after World War I, by a decline brought about by economic conditions and university policy. Its consequences were so far-reaching that the Chair of Orthopedic Medicine in Freiburg was not refounded until 1970- the last in Germany. Until that time orthopedics remained dependent on the judgment or indulgence of the directors of the surgical clinic, who regarded orthopedics as a conservative discipline, or at best as a branch of limb surgery.

Germany↗
PubMed2006

Confidence in spine training among senior neurosurgical and orthopedic residents.

STUDY DESIGN: A cross-sectional survey of senior neurosurgical and orthopedic residents. OBJECTIVE: To evaluate the confidence of senior orthopedic and neurosurgery residents in performing spinal surgical procedures and their need for further training. The content and exposure to spine training as well as anticipated practice profile were characterized. SUMMARY OF BACKGROUND DATA: Spinal surgery is performed by specialists with backgrounds in orthopedic surgery and neurosurgery. As this subspecialty evolves, the need to modify training programs to keep up with technological and medical advances becomes increasingly clear. The primary objective of this study was to evaluate the self-assessed confidence and perceived need for further training of senior orthopedic and neurosurgical residents in performing a number of spinal surgical procedures. METHODS: An evaluation of self-assessed surgical competence of senior orthopedic and neurosurgery residents in Canada was undertaken by mail-out questionnaire. A follow-up questionnaire was mailed to nonresponders 3 months later. Survey results were summarized using SPSS statistical software, and descriptive and comparative analyses were performed. RESULTS: Significant differences in time and exposure to spine training differentiated the neurosurgical and orthopedic residencies (37% and 16% of total residency time devoted to spine, respectively). Neurosurgical residents reported significantly higher levels of confidence for all 25 surgical procedures. Of those residents anticipating incorporating spine into their practice, 29% of neurosurgery residents planned on entering a spine fellowship compared with 17% of their orthopedic colleagues. CONCLUSIONS: Training in spine surgery constitutes a considerably larger proportion of neurosurgery residency than orthopedic residency. Neurosurgery residents graduate with significantly higher levels of confidence to perform spine surgery, while orthopedic residents report significantly higher need for additional training in spine surgery. The majority of neurosurgery graduates report that they will include spine in their clinical practice, while most orthopedic graduates will exclude it.

Cross-Sectional Studies↗
PubMed2000

Outcomes of care and resource utilization among patients with knee or shoulder disorders treated by general internists, rheumatologists, or orthopedic surgeons.

PURPOSE: Previous studies have suggested that specialists may achieve better clinical outcomes for patients, albeit often at greater cost. We sought to compare outcomes of care and resource utilization among patients with shoulder or knee problems who were treated by general internists, rheumatologists, and orthopedic surgeons. SUBJECTS AND METHODS: Outpatients with knee or shoulder complaints who were seen by general internists, rheumatologists, or orthopedic surgeons at an academic medical center were administered questionnaires at enrollment in the study and again 3 months later. The questionnaires included validated measures of satisfaction, functional status, and pain severity, as well as resource utilization. We compared baseline clinical characteristics, satisfaction with care, resource utilization, and changes in function and symptoms during 3 months of follow-up among patients who were cared for by the three different types of providers. RESULTS: A total of 534 patients responded to the baseline survey and 436 (82%) to the 3-month follow-up survey. About 60% (n = 323) had knee pain. Orthopedists cared for 40% (n = 211) of the patients, with the remainder treated in approximately equal numbers by general internists or rheumatologists. At baseline, patients of internists had less severe pain (differences of 0.3 to 0.6 points on a 1 to 5 scale, P <0.05) and functional limitations (differences of 0.4 to 0.6 points on a 1 to 5 scale, P <0.0006) than patients of rheumatologists and orthopedic surgeons. Adjusting for baseline differences, there were no significant differences among provider groups in pain relief or functional improvement during follow-up. However, in adjusted analyses, patients with shoulder pain who were cared for by orthopedic surgeons were least satisfied with the office environment [adjusted mean (+/- SD) satisfaction score of 1.6 +/- 0.8 on a 1 to 4 scale for orthopedic surgeons vs 1.3 +/- 0.8 for rheumatologists and 1.4 +/- 0.8 for internists, P = 0.004]. Among patients with knee pain, those treated by rheumatologists and orthopedic surgeons were more satisfied with the doctor-patient interaction (adjusted mean satisfaction scores of 1.1 +/- 0.9 for rheumatologists and 1.2 +/- 0.7 for orthopedic surgeons on a 1 to 4 scale vs 1.4 +/- 0.8 for general internists, P = 0.003). Orthopedic surgeons obtained significantly more radiographs of the knee or shoulder and more magnetic resonance imaging scans of the knee. Rheumatologists performed significantly more aspirations or injection procedures. Among all patients, those treated by rheumatologists were most satisfied with the physician interaction, and those treated by orthopedic surgeons were most satisfied with treatment results. CONCLUSION: The relative benefits of specialist compared with generalist care for patients with knee or shoulder pain depend on the importance attached to resource utilization, patient satisfaction, and health outcomes.

Academic Medical Centers↗
PubMed2003

Misrepresentation of research publications among orthopedic surgery fellowship applicants: a comparison with documented misrepresentations in other fields.

STUDY DESIGN: A retrospective study was used to review fellowship applications over 3 years. OBJECTIVES: To assess the prevalence of research misrepresentation in orthopedic fellowship applications, and to compare such activity between subspecialties (e.g., spine, sports, hand). SUMMARY OF BACKGROUND DATA: Competition for orthopedic surgery fellowships is intense. The applicant pool includes orthopedic, plastic, and general surgeons, as well as neurosurgeons. Residency and fellowship training programs in other disciplines have documented shocking levels of misrepresentation in the curriculum vitae of prospective applicants. However, no study has looked at orthopedic residents applying for subspecialty fellowship programs. METHODS: A retrospective analysis investigated 280 applications for fellowship positions in the department of orthopedic surgery at the authors' academic institution from 1996 to 1998 inclusively. To allow for press and publication delays, a minimum 24-month follow-up period was instituted. The listings of applicants' research publications were analyzed for evidence of misrepresentation through an exhaustive literature search. Only the most obvious confirmable discrepancies were labeled as misrepresentations. The results then were compared with those found in studies conducted in other fields: gastroenterology fellowship, emergency medicine residency, pediatric residency, dermatology residency, orthopedic residency, and medical faculty applications. RESULTS: Among 280 (54%) applicants for orthopedic surgery fellowships, 151 claimed journal publications. It was found that 16 (10.6%) of these 151 applicants had misrepresented their citations. This rate was highest in spine fellowship applicants (20%). However, considering the numbers available, this was not significantly different among the various subspecialty fellowship applicants (P > 0.1). In addition, various demographic data did not correlate with the rate of misrepresentation (P > 0.1). These results are comparable with those reported in other medical fields (P > 0.1). CONCLUSIONS: Misrepresentation occurs in orthopedic fellowship applications at a rate comparable with that observed in other fields. This rate is not different among the various subspecialties in orthopedics. Policies that may lessen the incidence of falsification on curriculum vitae should be instituted in an attempt to curb such activity.

Fellowships and Scholarships↗
PubMed2004

Referral patterns to a pediatric orthopedic clinic: implications for education and practice.

OBJECTIVE: Musculoskeletal medicine is becoming an increasingly essential part of primary care medicine. The American Academy of Pediatrics (AAP) Surgical Advisory Panel recently published voluntary guidelines to establish diagnoses that should be referred to a pediatric specialist rather than a general specialist (pediatric orthopedic surgery vs general orthopedic surgery). Given the crisis in pediatric orthopedic surgery manpower and resources, we believe that these guidelines are useful in defining appropriate referrals. The purpose of this study was to compare diagnoses that primary care pediatric providers believe commonly need referral to the AAP Guidelines for Referral to Pediatric Specialists recommendations for referral to pediatric orthopedic specialists. METHODS: A chart review of successive new referrals (n = 286) to the pediatric orthopedic clinic during a 12-month period was conducted. The following information was collected: 1) diagnosis from referring provider, 2) diagnosis and treatment plan by the pediatric orthopedic surgeon, 3) type of referring provider (eg, pediatrician, family practitioner, resident physician, physician assistant), and 4) patient age. The referring diagnosis, final orthopedic diagnosis, and treatment plan for each patient was compared against the AAP Guidelines for Referral to Pediatric Specialists. The terms "appropriate" and "inappropriate" were used to differentiate those diagnoses that matched versus those that did not match the AAP Guidelines, respectively. RESULTS: This analysis shows that a significant percentage (64.7%) of definitive diagnoses of referred cases were not consistent with the new AAP recommended guidelines for referral to pediatric orthopedic surgeons. In addition, a 23.8% (68 of 286) false-positive rate of referring diagnoses is noted. Cases that required no treatment or follow-up to monitor demonstrated a 32.8% (60 of 183) [(40 no treatment + 20 monitor inappropriate)/(116 no treatment + 67 monitor total)] false-positive rate. CONCLUSIONS: Inappropriate referrals create a large use of pediatric orthopedic resources, which delays care of other, more appropriate patients. A large proportion of referrals indicated either a lack of basic textbook knowledge or lack of examination skills and appropriate diagnostic tools as demonstrated by a high number of definitive diagnosis indicating normal variants.

Adolescent↗