The American journal of orthopedics
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Encounters with racist patients can be distressing, damage the physician-patient relationship, and threaten the collegial environment of the health care setting. Although policies guiding physician interactions may exist, providers may be uncomfortable and left vulnerable in racially charged interactions. ⋯ Unsuccessful attempts at relationship salvage should be further guided by ethics teams, and in cases of a continued impasse, physicians should absolve themselves of medical duties provided that an appropriate alternative provider is available. Although racism in the health care setting can present a reasonable window to generate productive dialogue to improve race relations, a deeply entrenched and pervasive mindset can be difficult to reverse and should not impede the primary goal of providing timely patient care.
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We conducted a study to determine differences in knee pain in patients who underwent either traditional infrapatellar nailing or suprapatellar nailing. From a single institution, we identified patients who had an isolated tibial shaft fracture (Orthopaedic Trauma Association type 42 A-C) surgically fixed with an intramedullary nail between 2009 and 2012. Each patient was contacted by telephone by an investigator blinded to surgical exposure, and the Oxford Knee Score (OKS) questionnaire was administered. ⋯ Compared with the infrapatellar approach, suprapatellar nailing improved radiographic reduction in the sagittal plane (2.90° vs 4.58°; P = .044) and required less operative fluoroscopy time (81 vs 122 s; P = .003). We found no difference in OKS between the infrapatellar and suprapatellar approaches. Although further study is needed, the suprapatellar entry portal appears to be a safe alternative for tibial nailing with use of appropriate instrumentation.