Clinical orthopaedics and related research
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Pulled elbow and hypermobility of joints are frequently seen in young children, the latter occurring in 5% of the general population. A group of 100 children with pulled elbows, composed of 64 girls and 36 boys with a mean age of 25.5 months, and their parents were checked for joint hypermobility in a prospective study over a period of two years. Results were compared with a normal (non-pulled elbow) control group of 30 children. ⋯ In 48% of the cases of children with pulled elbows, at least one of the parents had hypermobility, whereas only in 10% of the control group were parents hypermobile. The association between pulled elbow and hypermobility indicates that pulled elbow can be considered one of the effects of this condition. Since not all patients with pulled elbows were hypermobile nor did they have parents with hypermobility, other factors may be relevant, such as variations in the anatomy of the radial head and surrounding structures in combination with the degree of violence involved.
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Clin. Orthop. Relat. Res. · Aug 1990
Comparative StudyThe relationship between residency programs and fellowships in the educational setting.
In 1981, the Advisory Council for Orthopaedic Education published a list of 175 orthopedic postgraduate fellowships. Since that time, several groups within orthopedics have discussed various methods for enhancing the educational nature of fellowships as they related to orthopedic residency programs. The orthopedic community as a whole has concurred about the concept of accrediting fellowships, ensuring a minimum standard educational quality, and keeping the growth of fellowships in some areas from adversely affecting the educational quality of a residency program. ⋯ Certification is the process of credentialing individual physicians as specialists and is the responsibility of a specialty board. Accreditation is the process of identifying residency and fellowship programs that meet published educational standards and is the responsibility of the Accreditation Council for Graduate Medical Education and the corresponding Residency Review Committee. There is little question that the educational process that occurs during a fellowship can have a beneficial effect on the learning process of residents and vice versa.
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Clin. Orthop. Relat. Res. · Aug 1990
Historical ArticleThe accreditation of graduate educational programs in orthopedic surgery.
The development and evaluation of graduate medical education in the United States from the late 19th century to the present are founded on the structure, role, and function of the accrediting bodies (the Accreditation Council for Graduate Medical Education and the Residency Review Committees). The general and specific requirements for accreditation of orthopedic programs, the processes for accreditation of existing and new residency programs, and the current status of fellowship accreditation are continuously under evaluation.
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Clin. Orthop. Relat. Res. · Aug 1990
Historical ArticleMedical specialty credentialing in the United States.
Specialty boards serve the function of defining qualifications and issuing credentials to assure the public of the specialist's preparation and skill. Over the past 72 years, 23 such boards have been approved and now issue 31 different types of general specialty certificates and 57 types of subspecialty credentials. For 50 years, the American Board of Medical Specialties has encouraged a system of recertification to demonstrate that the certified specialist has maintained skill and has incorporated the new knowledge associated with advancing medical science. ⋯ The numbers have increased dramatically during the past 20 years and reflect the advances in science as well as new styles of practice. As a consequence, some specialties are moving toward accreditation without certification to improve training, even if there is no authorized type of certification. Another consequence of subspecialty proliferation is concern about fragmentation of medical care and its effect on the costs of health care.
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Clin. Orthop. Relat. Res. · Jul 1990
Multicenter Study Comparative Study Clinical TrialLimb salvage versus amputation. Preliminary results of the Mangled Extremity Severity Score.
Objective criteria can predict amputation after lower-extremity trauma. The authors examined the hypothesis that objective data, available early in the evaluation of patients with severe skeletal/soft-tissue injuries of the lower extremity with vascular compromise, might discriminate the salvageable from the unsalvageable limbs. The Mangled Extremity Severity Score (MESS) was developed by reviewing 25 trauma victims with 26 severe lower-extremity open fractures with vascular compromise. ⋯ Again, there was a significant difference in the mean MESS scores; 4.00 for the 14 salvaged limbs and 8.83 for the 12 amputated limbs (p less than 0.01). In both the prospective and retrospective studies, a MESS score of greater than or equal to 7 had a 100% predictable value for amputation. This relatively simple, readily available scoring system of objective criteria was highly accurate in acutely discriminating between limbs that were salvageable and those that were unsalvageable and better managed by primary amputation.