Point of Care Ultrasound (POCUS) is used to evaluate the injured pediatric elbow. Standard of care, however, remains radiography. POCUS performed in the setting of normal radiographs have been obtained may demonstrate radiologic occult lipohemarthrosis indicative of occult fracture. We reviewed our pediatric emergency department (PED) POCUS archive for lipohemarthrosis, and then isolated those cases with normal elbow radiography. Radiography was deemed to be normal per the interpretation of the treating PED physician, and was reviewed for this series by an experienced ABR board certified pediatric radiologist. Fracture on POCUS was defined as fracture line or lipohemarthrosis in a posterior sagittal or transverse view of the distal humerus. Fracture was confirmed by signs of cortical healing on follow‐up radiography, or clinical course consistent with fracture as documented by an orthopedist. We identified four children with elbow fractures who had no fracture line or elevated posterior fat pad on radiography but demonstrated lipohemarthrosis on POCUS. POCUS may elicit evidence of fracture even after normal radiography, and POCUS findings suggesting occult fracture may allow for more effective guidance on discharge.
Background:Gender diversity in medicine can improve physician-patient interactions. Although the number of female medical students has risen to almost 50%, the relative number of female orthopaedic residents remains low. The reason for so few female applicants to orthopaedic programs remains in question.
Methods:A web survey was distributed to medical students and interns in Israel in 2015 and again in 2018. The survey included demographic data and a questionnaire. The questionnaire explored reasons for not choosing orthopaedics as a specialty and exposure to musculoskeletal medicine in medical school.
Results:A total of 371 responses were received, 143 in 2015 and 228 in 2018. The distribution of gender, marital status, student status, and medical schools were similar. Men were more inclined to choose orthopaedics in both years (P = 0.004, P = 0.044). The major reason for not choosing orthopaedics was "it's just not interesting." However, in 2018, there were a significant number of male responders who wanted a more balanced work-life profession (P = 0.047).
Conclusions:Women have given many possible reasons for not choosing orthopaedic surgery, such as wanting a better work-life balance, perceptions of physical strength needed, a closed "boy's club," not enough exposure, and lack of female role models, yet most of them replied the field is "just not interesting." The authors suggest in concordance to the literature that having more opportunity for exposure and more female role models would increase gender diversity in orthopaedics.
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