RESUMEN

BACKGROUND: Medical malpractice represents a significant economic cost in healthcare. Increasingly large damage claims by professional athletes against physicians have raised concerns about the medicolegal challenges in caring for high-level athletes. METHODS: An online proprietary legal research database was queried for lawsuits related to malpractice in the care of professional and amateur athletes from 1992-2023. Demographics of plaintiffs and defendants, details of lawsuit filings and damages claimed were recorded for all cases, settlements, and jury verdicts. Descriptive statistics, linear regression, as well as univariate analysis of demographic factors and damage claims in inflation-adjusted 2023 dollars was performed. RESULTS: Eighty-eight lawsuits were recorded from 1992-2023. The sum of indemnities exceeded 186 million in 2023 inflation-adjusted United States Dollars. Football players were the most commonly represented athletes (n=26) and represented 49% of total financial awards. Fourteen cases (16%) involved treatment of the upper extremity. Professional and collegiate level of play was associated with higher damages in favor of plaintiffs when compared to other levels of play. No other demographic was associated with higher financial awards. Linear regression showed a significant positive trend with an increasing inflation-adjusted compensation for plaintiff verdicts in the last 30 years. CONCLUSIONS: There is an increasing medicolegal financial risk associated with the care of athletes. This is higher in collegiate and professional levels of play. As physicians, insurers and institutions adjust to these financial risks, care must be taken to avoid ramifications on the availability and quality of care provided to athletes. Shoulder and elbow surgeons may consider additional preoperative counseling, legal waiver forms regarding malpractice claims and advocacy for medical malpractice reforms in the care of athletes with high earning potential to mitigate these increasing financial risks.

RESUMEN

PURPOSE: Gastrocnemius flaps provide reliable reconstructive solutions to soft-tissue loss of the knee and proximal tibia following orthopedic procedures. While this technique has been used and studied, little is known about its prophylactic application. Single-stage and delayed approaches were compared with respect to the timing of débridement, complications, and relationship between microorganisms and complications. METHODS: Gastrocnemius flaps for soft-tissue defects of the knee joint were retrospectively reviewed. Success of the flap procedure was defined as a healed soft-tissue envelope, no evidence of infection, a good blood supply to the flap, and adherence of the flap to its bed. Independent sample t test was used to compare the corresponding parameters (level of statistical significance was 0.05). RESULTS: Of 43 flaps (43 patients), 18 were performed during a single-stage procedure along with the orthopedic procedure and 25 were delayed. Success of the single-stage (100%) and delayed flaps (88%) was not significantly different (p = 0.083). Complication rate did not differ significantly for single-stage (11%) and delayed flaps (24%) (p = 0.272). We were unable to establish a relationship between complications and microorganisms. CONCLUSION: Results indicate both approaches are reliable. Single-stage gastrocnemius flaps may eliminate the need for a second surgery. LEVEL OF EVIDENCE: Level III (Therapeutic, Retrospective cohort).

Asunto(s)

Procedimientos de Cirugía Plástica , Traumatismos de los Tejidos Blandos , Humanos , Rodilla/cirugía , Articulación de la Rodilla/cirugía , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/métodos , Estudios Retrospectivos , Traumatismos de los Tejidos Blandos/etiología , Traumatismos de los Tejidos Blandos/cirugía , Colgajos Quirúrgicos , Tibia/cirugía , Resultado del Tratamiento

RESUMEN

The development of a fluorescent probe for a specific metal has required exquisite design, synthesis, and optimization of fluorogenic molecules endowed with chelating moieties with heteroatoms. These probes are generally chelation- or reactivity-based. Catalysis-based fluorescent probes have the potential to be more sensitive; however, catalytic methods with a biocompatible fluorescence turn-on switch are rare. Here, we have exploited ligand-accelerated metal catalysis to repurpose known fluorescent probes for different metals, a new approach in probe development. We used the cleavage of allylic and propargylic ethers as platforms that were previously designed for palladium. After a single experiment that combinatorially examined >800 reactions with two variables (metal and ligand) for each ether, we discovered a platinum- or copper-selective method with the ligand effect of specific phosphines. Both metal-ligand systems were previously unknown and afforded strong signals owing to catalytic turnover. The fluorometric technologies were applied to geological, pharmaceutical, serum, and live cell samples and were used to discover that platinum accumulates in lysosomes in cisplatin-resistant cells in a manner that appears to be independent of copper distribution. The use of ligand-accelerated catalysis may present a new blueprint for engineering metal selectivity in probe development.