Operative Techniques in Orthopaedics最新文献

Healthcare disparities have become a notable topic of research in the last decade. Within orthopedics, minority patients experience these disparities via increased lengths of stay, higher 30-day hospital readmission rates, and poor patient reported outcomes. One possible cause for these disparities is implicit bias held by providers. The aims of this study were to assess the current state of implicit racial biases among orthopedic surgeons at various stages of training and to review the current literature involving effects of implicit bias on healthcare and patient outcomes. Orthopedic surgery medical student subinterns, residents, and attendings at an urban academic medical center were provided an anonymous, voluntary survey to document the results of an online Implicit Association Test (IAT) specifically focusing on race. These results were compared among the three groups and to that of the general population. Our results demonstrated that medical students and residents mirror the general population with an inherent preference for White over Black people. Attendings differed significantly from the general population with the most common result being little to no preference for either race. This small pilot study demonstrated varied IAT results, with both medical students and residents showing a preference for White over Black people, as compared to attendings who showed no preference for either race. Given the small cohort, it is difficult to generalize this data. Regardless, implicit racial biases are prevalent and can lead to poor patient interactions and worse clinical outcomes. The IAT provides a reliable assessment tool for implicit bias and can help guide interventions. Initiating this discussion is invaluable within orthopedics, but more research with larger cohorts is needed to evaluate feasibility of assessing bias and identify successful methods of reducing it.

Partial hand amputations are very common in the United States. Amputations distal to the wrist account for the majority of all traumatic amputations of the upper extremity. These amputations lead to functional limitations, decreased quality of life, and disability. Treatment options include replantation or revision amputation.

Amputation surgery is a life-altering experience, profoundly impacting an individual's ability to perform daily tasks and engage in their chosen activities. Upper extremity prostheses have advanced remarkably, offering diverse solutions to restore functionality and enhance the quality of life for amputees. This article provides a comprehensive examination of the various types of upper extremity prostheses available today, highlighting their unique features, advantages, and limitations. This article categorizes upper extremity prostheses into three main types: body-powered prostheses, myoelectric prostheses, and advanced prosthetic technologies. Passive prostheses are generally designed to replicate the appearance of the missing limb. Body-powered prostheses rely on cables and harnesses for control, offering affordability and durability. Myoelectric prostheses employ electromyography (EMG) signals from residual muscles for intuitive and precise control. Advanced prosthetic technologies, including neural interfaces and 3D printing, are pushing the boundaries of what is possible in terms of functionality and customization. This article aims to serve as a valuable resource for upper extremity surgeons to help guide options and even optimize surgical plans to allow individuals to maximize the use of upper extremity prostheses.

This article serves as a guide to approaching pain management related to limb loss. The following points may serve as a framework by which to address common pain experiences of patients prior to and following amputation. The guidelines provided will allow surgeons and clinicians to better understand the varieties of pain associated with limb loss and assist in devising treatment plans for pain related to amputation.

Shoulder-level amputations, including forequarter amputation and shoulder disarticulation, are very uncommon but can be incredibly devastating. Unlike other levels of upper extremity amputation, these procedures are indicated based on etiology, namely trauma, tumor, or infection. Depending on the emergent need for the procedure and if time allows, physical examination and advanced imaging modalities can be utilized for perioperative planning. Most likely, however, there will be a significant need for revision surgeries, such as targeted muscle reinnervation (TMR), following index amputation. These surgeries can dramatically improve a patient's quality of life, by allowing them to function through a myoelectric prosthesis or to enable them to live without the burden of phantom limb or neuroma pain.

The loss of a limb is a life-altering event that profoundly affects an individual's capacity to engage in their daily routines. Therapy can play a vital role in maximizing their participation and overall independence. The rehabilitation process begins with a comprehensive evaluation of the patient's current functional level and should also include a detailed report of their occupational profile.

Transradial amputations represent the most common level of amputation in the upper extremity proximal to the fingers. While patients following forearm-level amputations have a high rate of phantom limb pain and utilization of neuropathic medications, they are also the most likely upper extremity amputees to utilize a prosthesis and remain in the work-force. The advent and evolution of active nerve management strategies such as targeted muscle reinnervation (TMR) and regenerative peripheral nerve interfaces (RPNI) have revolutionized amputation surgery. Initially developed to facilitate prosthetic control, TMR and by extension, RPNI have been shown to significantly mitigate neuroma pain and phantom limb pain. The use of these techniques should be considered in most patients undergoing major limb amputation. The continuous development of improved prosthetic technologies has led to a refinement of paradigms for amputation throughout the body, and forearm-level amputation is no different. In this chapter, we will outline the conceptual framework for TMR/RPNI, discuss its role in forearm-level amputations, review pearls and pitfalls for the surgeon performing these procedures, and outline our algorithm and approach in performing transradial amputation and wrist disarticulation.