Bin Majid et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background While female participation has improved in several surgical specialties over time globally, no such increase has been observed in orthopaedic surgery over the past decades. The potential barriers to female participation are likely present from the beginning of medical education. Therefore, this study assessed the apparent lag in equal representation among men and women in orthopaedic surgery in the Kingdom of Saudi Arabia. Methods This cross-sectional study used a questionnaire survey to investigate medical students’ and interns’ perceptions of women participating in orthopaedic surgery, their subspeciality preferences, and barriers preventing them from pursuing an orthopaedic career. The responses were analysed to understand general perceptions, gender-based differences, impact of clinical experiential learning, and exposure to orthopaedic surgery. Results Approximately 565 medical students (49% females, 51% males) participated in the survey. Only 17% of students (11% females, 23% males) considered orthopaedic surgery as their future career option. While 31% of female and 17% of male students disagreed with the concept of female-appropriate orthopaedic subspecialties, most of the remaining male and female students perceived paediatric orthopaedics as a female-appropriate subspecialty. Concerning equal representation of women, gender bias and lack of a strong physique were the most frequently selected barriers by female and male students, respectively. Patient preference for male orthopaedicians, gender discrimination, social and family commitments, and need for physical strength were all perceived as barriers for women in orthopaedics. Overall, clinical experience and orthopaedic exposure did not significantly improve the likelihood of female students in choosing orthopaedic surgery as a career. Conclusions The bias against women in orthopaedic careers is prevalent among medical students early in their academic years. Clinical experience and exposure to orthopaedic surgery should be improved to make a significant impact on female participation in orthopaedic careers. Career building efforts in terms of improved career opportunities, career counselling, flexible working hours, social and family related adjustments and implementation of mentorship/research/fellowship programmes for females are needed to reduce gender discrimination and improve female orthopaedic participation. Furthermore, process improvements may yield greater flexibility for women pursuing the challenging field while accommodating other barriers faced by women in orthopaedic surgery.
Management of bone fractures must achieve both reduction and stability. However, dermatological conditions such as dystrophic epidermolysis bullosa can lead to catastrophic events when operating on the patient’s bone fracture, possibly leading to wound infections and fracture nonunion. Here, we report the case of a 20-year-old female with dystrophic epidermolysis bullosa who had suffered from a femur fracture after a fall from the bed. The fracture management was challenging due to the severe condition; however, the use of the Nancy nail was efficient. Due to the rarity of the disease, modifications due to the challenges faced during the patient care approach were accomplished to prevent any harm to the patient. Even though the management was challenging, the outcome was good.
BackgroundThe management of bone fractures must achieve both the reduction and stability providence. However, dermatological conditions such as dystrophic epidermolysis bullosa (DEB) for instance can lead to catastrophic events when operating on the patient’s bone fracture. This can lead to wound infections and possible failure of bone healing leading to fracture nonunion. This dermatological disorder leads to heterogenous bullous dermatoses including cutaneous fragility leading to cutaneous bullous formation after exposure to any type of trauma. DEB is a rare inherited form of the disease characterized by the formation of cutaneous bullae. DEB is associated with a genetic mutation of COL7A1 gene that encodes collagen type VII. Due to the rarity and uniqueness of the disease, special modifications due to the challenges faced during the patient care approach were accomplished to prevent any possible harm to the patient. In this study, we propose a case report that is followed by the anesthetic and surgical challenges faced and how they were modified upon.Case PresentationA 20-year-old female presented to the emergency department with a spiral mid-diaphyseal fracture of the femur after an incidence of falling from bed. The patient was previously diagnosed with dystrophic epidermolysis bullosa which made this case unique and complex. As the patient was examined by the team, her skin was covered with old blisters and wounds that have developed with the consequence of the disease. Due to the sophisticated dermatological condition and the unique presentation, the established multidisciplinary team took a decision to treat the patient with flexible intramedullary nailing in an open versus closed reduction technique, and modifications of the treatment approach were done based on the challenges in this case. The goal was to provide the management while minimizing the risk of infections and complications that would have arisen. The proposed case will set a baseline for the management of similar cases.ConclusionsWe suggest that in order to manage femur shaft fracture in the setting of dystrophic epidermolysis bullosa, modifying the management to avoid the least possible skin harm at any expense while managing the bone fracture is the golden approach.
Introduction For Sprengel deformity, a variety of operations are available, with Woodward's procedure being a favorable option with good outcomes. This study aims to assess the outcomes of Woodward's procedure with brachial plexus monitoring to prevent the possible complications of nerve injury and consequent deficits. Methods In our study, we included 18 patients with Sprengel deformity treated with Woodward's procedure using intraoperative neuromonitoring for the brachial plexus from 2013 to 2019 at our institute. For each patient, we collected information about age, gender, follow-up duration, affected shoulder side, and presence of an omovertebral bar. Also, preoperative and postoperative degrees of shoulder abduction, Cavendish grade of cosmetic appearance, Rigaults grade, and difference in scapular elevation along with postoperative complications were all measured to evaluate the outcomes. Results The mean duration of follow-up was 12 months. The average preoperative Cavendish grade was 3.1, which decreased to 1.3 on the final follow-up. The average preoperative Rigault grade was 2.5, which has decreased to an average of 1.8. The average increase in the degree of shoulder abduction postoperatively was 48.3°. The average preoperative difference in scapular height (mm) was 26.9, which decreased to an average of 12.2. Furthermore, the final outcome was not impacted by the absence or the existence of the omovertebral bar. Conclusion Woodward's procedure using intraoperative neuromonitoring without clavicle osteotomy for Sprengel's deformity successfully corrects the deformity and decreases the risk of iatrogenic brachial plexus injury.
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