The American journal of orthopedics
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The content and adequacy of orthopedic surgery residency training can be evaluated by several means. The Accreditation Council for Graduate Medical Education and the Residency Review Committee set standards with which residency programs must comply in order to be accredited. Residents' perceptions of the content and adequacy of their training is another means of evaluating orthopedic residency training. ⋯ The most common fellowships taken included sports medicine (20.5% of all respondents), hand (12.1%), and spine (9.5%). Younger graduating residents, those from larger programs (more residents per year), and those from the Mideast (U. S.), and New England regions were most likely to enter a fellowship after graduation.
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A 46-year-old man sustained a crush injury, including several phalangeal fractures and vascular disruption, when his left foot was run over by a forklift truck. Although the skin was not broken, the middle and distal phalanges of his second toe were displaced, appearing absent on radiography. This was a closed degloving injury, a rare form of trauma involving tissue separation without skin disruption. Closed degloving injuries, which can occur in conjunction with bone displacement in the toes, can produce a striking radiographic appearance, referred to in this report as the "empty toe."
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Twenty cadaveric posterior gluteal regions were dissected to quantitatively determine the location and dimensions of the superior gluteal artery and its branches on the posterior gluteal region. Two reference lines were defined: one (transverse) was drawn from the posterior inferior iliac spine (PIIS) across the ilium to the anterior superior iliac spine (ASIS), and another (vertical) was drawn orthogonal to the transverse line at a point 8 cm from the PIIS. Results showed that the average distances from the posterior superior iliac spine (PSIS) and PIIS to the superior gluteal artery origin at the sciatic notch were 60 mm and 42 mm, respectively. ⋯ The deep inferior branch traveled an average of 23 mm below the transverse line along the vertical line and penetrated the minimus or medius 36 mm from the ASIS, while providing 3 to 8 perforators to the medius and 1 to 3 to the minimus. The average distance from the deep inferior branch to the superior edge of the acetabulum along the vertical line was 25 mm. These data may be helpful in preventing the injury of the superior gluteal artery during the posterior gluteal approach.
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Total hip arthroplasty is an operative procedure in which the diseased and destroyed hip joint is resected and replaced with a new bearing surface. Since its introduction into the surgical management of the arthritic hip in the early 1960s, total hip arthroplasty has helped alleviate the suffering of millions of patients throughout the world. ⋯ While the operation has been successful over the years, problems have manifested themselves as the length of follow-up has increased. As total hip arthroplasty approaches its fourth decade of use, we outline these problems and the proposed solutions.
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In the United States, train-related accidents account for more than 18,000 injuries and 1,200 fatalities annually, yet there is a paucity of literature pertaining to this unique injury. We reviewed the medical records of 98 of 135 cases of train-related trauma treated at Ben Taub General Hospital, Baylor College of Medicine, Houston, Texas, from 1990 to 1995. There were 50 train-pedestrian accidents, 47 train-automobile accidents, and 1 train-motorcycle accident, with a mean patient age of 30.1 years (range, 2 to 66 years). ⋯ However, when serious injury is sustained, it is often of high morbidity (amputation) and mortality, which appears to correlate well with the initial MESS and ISS. Extrapolating our cost data to include all train-related accident injuries and deaths indicates that the direct costs to society may exceed 300 million dollars annually. Greater public awareness and preventive measures may reduce the tremendous human and financial costs of train-related accidents.