Eenvoudige zuurstofingreep voor verbetering van motorische leerprocessen
Achtergrond De overdracht van zuurstof naar de weefsels in het menselijk lichaam hangt bijna volledig af van het niveau en de functie van hemoglobine in het bloed. Aangezien bijna alle zuurstof in het bloed gebonden is aan het hemoglobinemolecuul, is slechts een klein deel opgelost in plasma. Daarom leidt een verhoging van het zuurstofgehalte in […]


Botverlies bij postmenopauzale vrouwen
Osteoporose komt naar schatting bij één miljoen mensen in Nederland voor en wordt gekenmerkt door een lage botmineraaldichtheid (bone mineral densit...
Veel mensen met Parkinson zijn niet bekend met speciale loopstrategieën
Bewegen kan erg moeilijk zijn voor mensen met de ziekte van Parkinson. Onder andere loopstoornissen zijn veel voorkomend en erg hinderlijk voor deze p...

Orthopedie nieuws

Finding Your Job in Orthopaedic Trauma: A Survey Revealing the Cold Hard Facts
OBJECTIVES: Finding a first job after fellowship can be stressful due to the uncertainty about which resources to use, including fellowship program directors, residency faculty, and other sources. There are more than 90 orthopaedic trauma fellows seeking jobs annually. We surveyed orthopaedic trauma fellows to determine the job search process.METHODS: Design: An anonymous 37-question survey.Setting: Online Survey.Patient Selection Criteria: Orthopaedic trauma fellows from the 5 fellowship-cycle years of 2016–2021.Outcome Measures and Comparisons: The primary questions were related to the job search process, current job, and work details. The secondary questions addressed job satisfaction. Data analysis was performed using STATA 17.RESULTS: There were 159 responses (40%). Most of the respondents completed a fellowship at an academic program (84%). Many (50%) took an academic job and 24% were hospital employed. Sixteen percent had a job secured before fellowship and 49% went on 2–3 interviews. Word of mouth was the top resource for finding a job (53%) compared with fellowship program director (46%) and residency faculty (33%). While 82% reported ending up in their first-choice job, 34% of respondents felt they “settled.” The number of trauma cases was important (62%), ranked above compensation (52%) as a factor affecting job choice. Surgeons who needed to supplement their practice (46%) did so with primary and revision total joints (37%).CONCLUSIONS: Jobs were most often found by word of mouth. Most fellows landed their first job choice, but still a third of respondents reporting settling on a job. Case volume played a significant role in factors affecting job choice.
Outcomes of Humerus Nonunion Surgery in Patients With Initial Operative Fracture Fixation
OBJECTIVES: To describe outcomes following humerus aseptic nonunion surgery in patients whose initial fracture was treated operatively and to identify risk factors for nonunion surgery failure in the same population.METHODS: Design: Retrospective case series.Setting: Eight, academic, level 1 trauma centers.Patients Selection Criteria: Patients with aseptic humerus nonunion (OTA/AO 11 and 12) after the initial operative management between 1998 and 2019.Outcome Measures and Comparisons: Success rate of nonunion surgery.RESULTS: Ninety patients were included (56% female; median age 50 years; mean follow-up 21.2 months). Of 90 aseptic humerus nonunions, 71 (78.9%) united following nonunion surgery. Thirty patients (33.3%) experienced 1 or more postoperative complications, including infection, failure of fixation, and readmission. Multivariate analysis found that not performing revision internal fixation during nonunion surgery (n = 8; P = 0.002) and postoperative de novo infection (n = 9; P = 0.005) were associated with an increased risk of recalcitrant nonunion. Patient smoking status and the use of bone graft were not associated with differences in the nonunion repair success rate.CONCLUSIONS: This series of previously operated aseptic humerus nonunions found that more than 1 in 5 patients failed nonunion repair. De novo postoperative infection and failure to perform revision internal fixation during nonunion surgery were associated with recalcitrant nonunion. Smoking and use of bone graft did not influence the success rate of nonunion surgery. These findings can be used to give patients a realistic expectation of results and complications following humerus nonunion surgery.LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Pedicled Peroneus Brevis Muscle Flaps as an Alternative to Fasciocutaneous Rotational Flaps for Lower-Extremity Soft Tissue Defects
OBJECTIVES: To report our experience using a peroneus brevis flap (PBF) for soft tissue defects of the distal third of the tibia, ankle, and hindfoot in resource-challenged environments.METHODS: Design: Retrospective review.Setting: Rural outpatient surgical facility in Honduras.Patient Selection Criteria: Patients who sustained tibia, ankle, or hindfoot fractures or traumatic degloving, with critical-sized soft tissue defects treated with either a proximally based or distally based pedicled PBF to achieve coverage of the middle and distal third of the leg, ankle, and/or hindfoot.Outcome Measures and Comparisons: Flap healing, complications, and reoperations.RESULTS: Twenty-three patients, 4 with proximally based and 19 with distally based PBF flaps were included. The mean patient age was 37.3 (SD = 18.3; range 18–75 years). Duration of follow-up averaged 14.7 months (SD = 11.4; range 4–46). The PBF successfully covered the defect without the need for additional unplanned surgical flap coverage in all but 2 patients. Thirty percent of the PBFs received a split thickness skin graft, while the remainder granulated successfully without skin graft. Four flaps were partially debrided without additional flap mobilization, while 1 flap was lost completely. Ten patients had successful re-elevation of their flaps for secondary procedures such as implant removal, spacer exchange, deep debridements, and bone grafting. All donor site incisions healed without complication.CONCLUSIONS: The pedicled PBF allows coverage of distal leg, ankle, and hindfoot wounds using muscle in patients who may otherwise require free tissue flaps or transfer to another institution for coverage. PBFs can be learned and implemented without the use of microvascular techniques.LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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