The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Sep 2006
Ulnar shortening osteotomy in idiopathic ulnar impaction syndrome. Surgical technique.
Idiopathic ulnar impaction syndrome can be defined as a degenerative condition of the ulnar aspect of the wrist in patients with congenital or dynamic positive ulnar variance without a history of fracture or premature physeal arrest. The purpose of this study was to evaluate the clinical features of idiopathic ulnar impaction syndrome and the outcomes of ulnar shortening osteotomy for this group of patients. ⋯ Ulnar shortening osteotomy improved wrist function in patients with idiopathic ulnar impaction syndrome and reduced the subluxation of the distal radioulnar joint, which is commonly found in these patients. Degenerative cystic changes of the ulnar carpal bones appear to resolve following the shortening osteotomy.
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J Bone Joint Surg Am · Sep 2006
Multicenter StudyPhysician incentives for academic productivity. An analysis of orthopaedic department compensation strategies.
Changes in the health-care industry have led to increasing demand for physician-driven clinical volume. This environment has altered the traditional balance among teaching, research, and service responsibilities for faculty in residency training programs. As economic pressures mount and budgets shrink, academic departments are exploring ways of paying faculty that would help to maintain the global mission of the organization. The purpose of this study was to examine the compensation strategy for faculty in academic orthopaedic surgery departments in the United States with a focus on compensation methods for academic productivity. ⋯ Most, but not all, departments accounted for academic productivity in their compensation system. Most programs used the chair's discretion to determine academic bonuses, but several departments had developed point systems. There are common themes with regard to this issue, including the importance of the academic mission, the need for clinical revenues, the value of flexibility and transparency, and the importance of culture and leadership.
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J Bone Joint Surg Am · Sep 2006
Temporary internal distraction as an aid to correction of severe scoliosis.
Halo traction is a well-recognized adjunct for correcting severe complex rigid scoliotic curves, but it is associated with complications and is contraindicated in the presence of fixed cervical instability, kyphosis, or stenosis. In addition, halo traction often requires prolonged hospital stays and is not welcomed by all families. These limitations led to consideration of temporary internal distraction as an alternative. ⋯ Therapeutic Level IV.
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J Bone Joint Surg Am · Sep 2006
Corrective osteotomy for intra-articular malunion of the distal part of the radius. Surgical technique.
Corrective osteotomy is an appealing treatment for malunited articular fractures of the distal part of the radius since articular incongruity may be the factor most strongly associated with arthrosis and diminished function after such fractures. Enthusiasm for osteotomy has been limited by concerns regarding the difficulty of the technique and the potential for additional injury, osteonecrosis, and nonunion. ⋯ The results of corrective osteotomy for the treatment of intraarticular malunion are comparable with those of osteotomy for the treatment of extra-articular malunion. Intra-articular osteotomy can be performed with acceptable safety and efficacy, it improves wrist function, and it may help to limit the need for salvage procedures such as partial or total wrist arthrodesis.