Background: Organism identification and their antibiotic sensitivity profile are critical for the successful treatment of upper extremity infections. Although many infections resolve with antibiotics alone, some require 1 or more surgical procedures in which culture data are obtained. The purpose of this study was to determine whether repeat cultures taken at subsequent irrigation and debridement of upper extremity infections changed antibiotic treatment. Methods: A retrospective review was performed using International Classification of Diseases, Ninth Revision codes to identify all adult patients with an upper extremity infection treated with 2 irrigation and debridement procedures with 2 separate culture data sets over a period of 5 years. Culture organisms and antibiotic sensitivity profiles were compared from each procedure, and changes in antibiotic treatment based on repeat culture information were identified. Results: In all, 183 patients who underwent 2 irrigation and debridement procedures with repeat culture data were identified. Organisms identified with repeat culture were the same or there was no growth in 153 patients and were different in 30 patients. The antibiotic treatment did not require a change in 170 (92.9%) of 183 patients. Of the 30 patients with different repeat cultures, antibiotic treatment changed in only 13 patients (43.3%). Patients who had a change in antibiotic treatment were more likely to have hepatitis C ( P = .005). Conclusions: Repeat culture data changed antibiotic treatment in only 7.1% of patients from our cohort. Patients with hepatitis C were more likely to require a change in antibiotic management after obtaining repeat cultures.
Extensor pollicis longus tendon pathology is a recognised complication following non-surgical treatment of non-displaced distal radius fractures. Tendon entrapment typically presents with pain, but preservation of thumb retropulsion during complete rupture results in loss of active thumb retropulsion and tenodesis effect. We present the case of a 52-year-old woman who developed extensor pollicis longus tendon entrapment with full active thumb extension following a non-displaced distal radius fracture. During her elective third dorsal compartment release, the extensor pollicis longus tendon was found to be completely ruptured and a rare supernumerary extensor pollicis longus tendon was found emerging from the fourth dorsal compartment. Gentle traction of this tendon resulted in thumb interphalangeal joint extension and simultaneous index finger metacarpophalangeal joint extension. An extensor indicis proprius to extensor pollicis longus tendon transfer was performed. At her final 6-month follow-up, she had painless full active thumb motion comparable to her contralateral side.
Paediatric lateral condyle fractures of the distal humerus are common but a concomitant elbow dislocation is rare. Typically, paediatric orthopaedic surgeons will treat lateral condyle fractures with pin or metaphyseal single-screw fixation and supplementary immobilisation for several weeks. These techniques sacrifice the early stability and mobilisation necessary to avoid stiffness after a complex elbow fracture-dislocation. We present an 11-year-old boy who sustained a traumatic posterolateral elbow dislocation with lateral condyle and coronoid fractures. Due to advanced skeletal age, both paediatric and adult treatment principles were applied to this rare injury. After initial closed reduction, open reduction and internal fixation of the distal humerus lateral condyle with divergent partially threaded compression screws was performed. Motion was initiated in 2 weeks and the patient regained almost full motion by 3 months. At 1.5-year follow-up, the affected limb carrying angle was unaffected and the patient had no functional limitations.
Background: Physician burnout has garnered increased attention in recent studies. It is attributed to the intrinsic stresses of medical practice and affects the quality of patient care. Previous studies have reported roughly half of orthopedic surgery and anesthesiology faculty and residents suffer symptoms of burnout. Objective: The purpose of this study is to determine if there is a significant difference in burnout rates among orthopedic surgeons and anesthesiologists, between faculty and residents in both specialties, and possible associated factors that may predispose participants to experience burnout. Methods: Data was gathered using the Maslach Burnout inventory survey (42 questions), which was distributed during the spring/summer of 2017 to orthopaedic surgery and anesthesiology residents and attending physicians, anesthesiology residents, orthopedic surgery faculty, and orthopedic surgery residents from various programs in the northeastern United States. Results: Survey Response rate was 238/666 = 38% response. As compared to attendings, residents scored: worse on Emotional Exhaustion; worse on Depersonalization and worse on Personal Accomplishment. When comparing specialties; for Emotional Exhaustion, Orthopaedic surgery scored better as compared with Anesthesiology. On Personal Accomplishment, Orthopaedic surgery scored better as compared with Anesthesiology. Residents had higher levels of burnout compared to attendings. Regarding specialty, Orthopaedic surgery scored significantly lower with regard to Emotional Exhaustion and Personal Accomplishment. It was also discovered that Orthopaedic surgeons overall have more social events, and more residents have mentors. Conclusion: Residents consistently demonstrated higher levels of burnout than attendings in both anesthesiology and orthopaedic surgery. Having a mentor and more interdepartmental social events may protect against burnout.
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