Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jul 2003
Clinical TrialSalvage of failed internal fixation of intertrochanteric hip fractures.
Most intertrochanteric hip fractures treated with internal fixation heal. If nonunion or early loss of fracture fixation occurs, treatment options include prosthetic replacement and revision internal fixation. The purpose of the current study was to evaluate the results of revision internal fixation and bone grafting for salvage of failed internal fixation of intertrochanteric hip fractures. ⋯ Sixteen of the 19 patients who achieved healing reported no pain and three had mild pain (related to retained hardware); all were ambulatory. Two patients had perioperative complications (10%): one wound dehiscence, and one severe hyponatremia. In properly selected patients, revision internal fixation with bone grafting for failed open reduction and internal fixation of intertrochanteric hip fractures can provide a high rate of union and good clinical results with a low rate of complications.
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Each year hundreds of accredited continuing medical education conferences and meetings receive industry support through unrestricted educational grants. Many of these programs might not occur without this funding support. With the explosive growth of continuing medical education on the Internet, industry again is being asked to provide assistance through unrestricted educational grants and in some instances educational content. ⋯ Education and information do not require continuing medical education accreditation to be valuable. Although some people in continuing medical education voice ethical concerns regarding the nature of industry's involvement in education, meeting the needs of orthopaedic surgeons remains the top priority. As demands on the orthopaedic surgeons' time continue to impact participation in educational meetings, industry will continue to play a critical role in helping educational organizations such as medical specialty societies develop new, innovative educational programs for presentation via the Internet.
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Clin. Orthop. Relat. Res. · Jul 2003
ReviewCurrent guidelines regarding industry-sponsored continuing medical education.
The importance of continuing medical education has been long recognized by the orthopaedic profession as vital in maintaining a current knowledge and skills base. There has been increasing concern over the expanding involvement of industry in sponsoring continuing medical education. Concomitant with rising costs of medical education is a decreasing source of funds from government and other sources; therefore industry has taken an active role in sponsoring continuing medical education, leading to a potential for serious conflict of interest. ⋯ The guidelines are intended to prevent bias, keep commercial displays separate from educational presentations, and clearly state that industry-sponsored events should be primarily educational in nature and directly benefit the patient. Because of the potential conflict inherent within industry-sponsored continuing medical education, a cooperative relationship between educators, industry, and attendees of educational activities must be achieved to prevent bias and to keep the patient's best interest as paramount. Each orthopaedic surgeon has an ethical obligation to resolve any conflicts of interest in the best interest of the patient.
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Clin. Orthop. Relat. Res. · Jul 2003
Comparative StudyBicondylar tibial plateau fractures: a biomechanical study.
The optimal treatment of bicondylar tibial plateau fractures remains controversial. The current study was designed to answer the following questions: (1) can a lateral fixed angle plate provide similar construct stability to dual plating techniques and (2) does the size of the medial buttress plate used in dual plating techniques have an effect on construct stability? Bicondylar tibial plateau fractures were created, reduced, and instrumented in a matched pair design using a cadaveric simulated bicondylar tibial plateau fracture model. ⋯ There was no significant difference measured between the two dual plating constructs and the lateral fixed angle plate for overall construct stiffness or with respect to medial condylar fragment displacement. A lateral fixed angle plate may have clinical applications in the treatment of bicondylar tibial plateau fractures.
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Clin. Orthop. Relat. Res. · Jul 2003
Review Case ReportsContinuing medical education: ethical collaboration between sponsor and industry.
The quandary is, "How can the very different fiduciary responsibilities of physicians and pharmaceutical companies ethically coexist in a society where its healthcare system is under increasing financial scrutiny?" It is paradoxical that the number of states requiring continuing medical education for medical licensure has increased to 39, in the face of reduced federal funding and the squeeze of managed care. Despite industry's providing more than half of the funding required to sustain the increasing need for continuing medical education, some physicians claim it is inappropriate for continuing medical education sponsors to collaborate with pharmaceutical companies because of their vested interest in selling prescription medications. Is the integrity of the physician-patient relationship at risk? I will show that there are ethical standards in place, for professionals and industry, that are effectively maintaining the continuing medical education system in balance. Eliminating the current opportunities for collaboration between sponsors and commercial supporters would severely compromise the continuing medical education enterprise in the United States, ultimately, a disservice to patients, who expect their physicians to continue their medical education lifelong.