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Macrodactyly is a rare and debilitating pediatric hand anomaly that has historically been treated with amputation. Recent advances in our understanding of macrodactyly have increasingly implicated the digital nerve as the underlying cause of the condition. In addition, much progress has been made toward digital salvage in treating macrodactyly. Modern techniques often advocate for digital nerve resection to prevent recurrence and treat the underlying etiology. However, little if any emphasis has been given to sensory reconstruction for purposes of protective sensation and acceptable 2-point discrimination at the volar digital pulp. We report 2 cases of macrodactyly treated with digital nerve resection and nerve allograft reconstruction of large sensory nerve gaps which show early promising sensory outcomes. There remain little if any data on the use of nerve allograft in pediatric populations, and its application in the treatment of macrodactyly. This technique permits digit salvage with the potential for improved sensory outcomes without the donor morbidity of autologous nerve harvest.

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INTRODUCTION: Although women now constitute approximately half of all graduating medical students, orthopaedic surgery continues to lag behind in its ability to recruit female applicants. One hypothesis for this discrepancy is the lack of female faculty mentors at academic institutions. The three objectives of this study were the following: (1) to quantify the proportion of female orthopaedic surgery residency applicants, (2) to quantify the proportion of female orthopaedic surgery faculty, and (3) to investigate the relationship between female orthopaedic surgery faculty at an academic institution and the corresponding number of female orthopaedic surgery residency applicants. METHODS: Data from the Association of American Medical Colleges from 2005 to 2014 were used to calculate the number of medical school graduates, the number of orthopaedic surgery residency applicants, and the number of orthopaedic full-time faculty in the United States. Institutions were excluded if they had incomplete data. A Spearman rank correlation was used to assess for a correlation between the 9-year total number of female orthopaedic surgery applicants and the average number of female orthopaedic surgery faculty members. RESULTS: A total of 101 U.S. medical schools were included in the final analysis. During the period examined, women accounted for 48.7% of medical school graduates, 14.9% of orthopaedic surgery applicants, and 13.2% of full-time orthopaedic surgery faculty. The percentage of female residency applicants increased from 13.91% in 2005 to 2006 to 16.02% in 2013 to 2014 while the percentage of female faculty increased from 12.26% in 2005 to 2006 to 15.79% in 2013 to 2014. No correlation was found between the average number of female orthopaedic surgery faculty at an institution and the total number of female orthopaedic surgery applicants from that institution during the study period examined (Rho, 0.0176; P = 0.5957). CONCLUSIONS: The data presented in this study failed to demonstrate a relationship between the number of female faculty and the number of women who apply into orthopaedic surgery, which highlights the complex nature of this issue. More research is needed to examine factors influencing the recruitment of female medical students.

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BACKGROUND: Fifth metacarpal fractures are often treated nonoperatively with serial radiographs; however, the utility of these radiographs in altering clinical management has not been investigated. We hypothesize that follow-up plain films will not alter clinical management and are therefore unnecessary for most patients. METHODS: Between 2007 and 2014, patients with a fifth metacarpal fracture at our level I trauma center were retrospectively reviewed. Patients with inadequate documentation or imaging, ipsilateral upper extremity injuries, or who underwent initial surgical fixation were excluded. Initial and postreduction radiographs were reviewed by 4 board-certified attending hand surgeons and 2 hand fellows who indicated their preferred management. At a later date, blinded to their initial management, the reviewers assessed follow-up films taken at least 2 weeks later and indicated their preferred management. RESULTS: In total, 60 patients met inclusion criteria, and of those, 30 were randomly selected. There were 9 base, 7 shaft, and 14 neck fractures. Initially, reviewers opted for nonoperative management in 72.2% of base, 71.4% of shaft, and 91.7% of neck fractures. After reviewing follow-up films, reviewers changed from nonoperative to operative management in 0.0% of base, 9.5% of shaft, and 1.2% of neck fractures. CONCLUSIONS: Follow-up radiographs may not be indicated for most fifth metacarpal base and neck fractures. Follow-up radiographs may change management in select fifth metacarpal shaft fractures as these fractures may displace. Follow-up radiographs should be performed at the discretion of the treating surgeon on an as-needed basis for fractures at risk for displacement.

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OBJECTIVE: The purpose of this study was to assess first-year medical students' implicit perceptions of surgeons, focusing on the roles of gender and demeanor (communal = supportive, associated with women; agentic = assertive, associated with men). DESIGN: Survey study. Each survey had 1 of 8 possible scenarios; all began with a short description of a surgeon who was described as accomplished and well trained, then varied by surgeon gender (male/female), surgeon demeanor (agentic/communal), and type of surgery (breast cancer/lung cancer). Using a 0 to 5 scale, respondents rated their perception of the surgeon through 5 questions. These 5 items were averaged to create a composite perception score scaled from 0 to 5. SETTING: Surveys were administered at the University of California, San Francisco, and the University of California, Los Angeles. PARTICIPANTS: We administered surveys to 333 first-year medical students who could read English and voluntarily agreed to participate. RESULTS: A total of 238 students responded (71.5%). They preferred the communal vs agentic surgeon (4.2 ± 0.7 vs 3.9 ± 0.7, p = 0.002) and male medical students perceived surgeons more favorably than female medical students did (4.2 ± 0.6 vs 4.0 ± 0.8, p = 0.036). The preference score did not differ according to surgeon gender (female 4.12 vs male 3.98, p = 0.087). There were no significant interactions between the factors of student gender, surgeon gender, or demeanor. Students who reported an interest in surgery as a career did not perceive surgeons more favorably than the students interested in other fields (4.3 ± 0.7 vs 4.0 ± 0.7 respectively, p = 0.066). CONCLUSIONS: Based on our findings, surgeon educators would likely find success in teaching and recruiting medical students by employing a communal demeanor in their interactions with all students, regardless of the students' gender or stated interest in surgery.

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BACKGROUND: Optimizing the surgeon-nurse relationship to improve interprofessional communication is increasingly recognized as an essential component of patient care. The increasing number of women surgeons has altered the surgeon-nurse dynamic, which has traditionally been a male-female relationship. In particular, this shift has raised the issue of whether implicit perceptions regarding gender and demeanor influence the interactions between surgeons and nurses. Therefore, the purpose of this study was to understand nurses' implicit perceptions of surgeons, with a particular focus on gender and gender-normative demeanor. We defined two types of demeanor: communal, which is classically associated with women and includes being supportive and nurturing, and agentic, which is a male-associated trait that includes being direct and assertive. METHODS: We administered surveys to 1701 nurses at the main campus of our institution. Each survey had one of eight possible scenarios; all began with a short description of a surgeon who was described as accomplished and well-trained, then varied by surgeon gender (male/female), surgeon demeanor (agentic/communal) and type of surgery (breast cancer/lung cancer). Using a 0 to 5 scale, respondents rated their perception of the surgeon through five questions. These five items were averaged to create a composite perception score scaled from 0 to 5. RESULTS: We received 493 surveys. The overall average perception score was 3.8±0.99. Respondents had a statistically significant preference for the communal surgeon (4.1±0.91) versus the agentic surgeon (3.6±1.0, p<0.001). There were no significant main effects of surgeon gender or surgery type. CONCLUSION: Nurses demonstrated a significant preference for communal surgeons, regardless of surgeon gender.

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BACKGROUND: Perceptions underlie bias and drive behavior. This study assessed female surgeons' implicit perceptions of surgeons, with a focus on the roles of sex and demeanor (communal = supportive, associated with women; agentic = assertive, associated with men). METHODS: Electronic surveys were administered via the Association of Women Surgeons e-mail listserve to 550 post-training female surgeons. Each survey had one of the 4 possible scenarios that varied by surgeon sex (male/female) and surgeon demeanor (agentic/communal). Respondents rated their perception of the surgeon through 5 questions regarding preference and 5 questions regarding professional opinion (1 to 5 scale). RESULTS: We received 212 surveys. In both preference and professional scores, female surgeons were rated significantly higher compared with their male counterparts (4.7 vs 4.4 and 4.3 vs 4.0, respectively). Communal surgeons were rated significantly higher versus agentic surgeons in both scores (4.7 vs 4.4 and 4.6 vs 3.7). CONCLUSIONS: Female surgeons demonstrated a significant preference for female surgeons and for communal surgeons.

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INTRODUCTION: Diastolic dysfunction contributes significantly to diastolic heart failure. We examined the use of cardiac magnetic resonance imaging (CMR) using midwall longitudinal fractional shortening (MLFS) in the evaluation of transthoracic echocardiogram (TTE)-evidenced diastolic dysfunction. METHODS: A total of 80 patients with CMR within 6 months of TTE and normal ejection fraction were identified. MLFS was calculated as percentage change in distance from the anterior mitral leaflet base to the apical endocardium in systole and diastole. RESULTS: MLFS of grade II/III [0.14 (0.12-0.16)] was significantly lower than that of grade 0/I [0.20 (0.19-0.21)], P=.001. MLFS detected age-related changes with grade 0 [0.22 (0.21-0.23)] significantly lower than grade I [0.18 (0.16-0.20)], P=.001. CONCLUSION: TTE-evidenced diastolic dysfunction can be reliably identified by CMR using MLFS.

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BACKGROUND: As more women become surgeons, knowledge of patient perceptions is necessary to educate this new pool of surgeons on how to maximize patient trust and foster the optimal surgeon-patient relationship. MATERIALS AND METHODS: Patients in a general medicine clinic in San Francisco were surveyed. Study respondents read one of the eight short scenarios that differed by surgeon gender, surgery type (lung cancer versus breast cancer), and surgeon demeanor (more masculine--agentic versus more feminine--communal). In all scenarios, the surgeon was described as accomplished and well trained. After reading the short description, respondents rated five items from 0-5, which were averaged to create a measure of preference. RESULTS: Based on the 476 completed surveys, respondents did not have a significant preference for either female or male surgeons (P = 0.76). We found a significant interaction in respondent choice between the surgeon demeanor and the type of surgery (P < 0.05). Respondents preferred an agentic surgeon for lung cancer surgery and a communal surgeon for breast cancer surgery regardless of surgeon or respondent gender. No other interactions or main effects were statistically significant. CONCLUSIONS: Our respondents did not overtly prefer a surgeon based on gender, which suggests that patients may not contribute to the traditional gender biases reported by female surgeons. Further work needs to be done to determine if our results can be replicated in different geographic regions and if there is gender stereotyping within the field of surgery.

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Understanding mechanisms causing pulmonary vascular disease (PVD) frequently requires a thorough understanding of the underlying structural changes in the pulmonary circulation. Animal models have been used extensively to study different forms of PVD but conventional experimental techniques are limited in their ability to allow the study of the whole pulmonary vasculature at once. In this study, we introduce novel techniques of arterial casting, high-resolution imaging and tree analysis to study the pulmonary circulation in rodent models. Male Sprague-Dawley rats were used at 20, 36, 52, 100 and 160 days of age. A technique involving arterial casting with Microfil silicone polymer, high-resolution micro-computed tomography (micro-CT) at 12.5 µm resolution and image data analysis involving segmentation and skeletonization was developed to both qualitatively and quantitatively describe the changes in the pulmonary vasculature with increasing age. Parameters identified to affect the quality of pulmonary arterial casting included polymer flow rate, total injected volume, polymer viscosity and polymerization time. By optimizing these parameters, we successfully created arterial casts of the pulmonary circulation in rats of different ages and demonstrated the feasibility of quantitatively characterizing the changes in the number of vessels with postnatal growth. These preliminary data suggest that the number of vessels with lumen diameters of 50-200 µm increases rapidly in both lungs between 52 and 100 days of age. With this new technique, the pulmonary vasculature can now be studied in a whole lung animal model to better understand the global effects of disease on vascular structure.

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