RESUMO

CASE: A 13-year-old female gymnast sustained a diaphyseal both-bone forearm fracture due to a grip lock injury. CONCLUSION: This is a report of a diaphyseal both-bone forearm fracture due to a grip lock injury in a female pediatric gymnast, successfully treated with closed reduction and cast immobilization. The rare mechanism of injury, education, and treatment have been discussed.

Assuntos

Traumatismos do Antebraço , Fraturas do Rádio , Fraturas da Ulna , Adolescente , Criança , Feminino , Antebraço , Traumatismos do Antebraço/complicações , Força da Mão , Humanos , Fraturas do Rádio/complicações , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/terapia , Fraturas da Ulna/complicações , Fraturas da Ulna/terapia

RESUMO

OBJECTIVE: Objectively evaluate the incidence of sciatic nerve injury after a total hip arthroplasty (THA) performed through a posterolateral approach. METHODS: Patients scheduled to undergo THA were evaluated preoperatively and postoperatively with electrophysiologic studies, the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) questionnaire and other methods described in the study. Patients older than 21 years with any of the following preoperative diagnoses: primary or secondary osteoarthritis, aseptic avascular necrosis, rheumatoid arthritis, and posttraumatic arthritis were included. Variables used for analysis were sex, age, and body mass index (BMI). The Mann-Whitney U and Wilcoxon tests and, Pearson and Spearman correlation statistics were used for analysis of categorical and continuous data respectively. RESULTS: Electrodiagnostic data showed alterations in 17 patients (70.8%). No signs of sciatic nerve injury. The mean preoperative and postoperative WOMAC scores were 40 and 74, respectively (p = 0.0001). Statistical differences were noted in sural sensory amplitude (SSA) and distal amplitude of the tibialis motor nerve in the female group (p=0.007; p=0.036, respectively). The SSA also demonstrated differences in the obese group (p=0.008). In terms of age, both the SSA (Pearson p=0.010 and Spearman p=0.024) and the proximal latency of the peroneal motor nerve (Pearson p=0.026 and Spearman p=0.046) demonstrated a decrease in amplitude and an increase in latency that was inversely related with age. CONCLUSION: According to our subclinical electrophysiological findings, surgeons that use the posterolateral approach in THA procedures must be conscious of the sciatic nerve's vulnerability to reduce possible clinical complications.

Assuntos

Artroplastia de Quadril/efeitos adversos , Eletrodiagnóstico , Complicações Pós-Operatórias/diagnóstico , Nervo Isquiático/lesões , Neuropatia Ciática/diagnóstico , Adulto , Fatores Etários , Idoso , Artroplastia de Quadril/métodos , Índice de Massa Corporal , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Neuropatia Ciática/epidemiologia , Neuropatia Ciática/etiologia , Nervo Sural/fisiopatologia , Inquéritos e Questionários , Nervo Tibial/fisiopatologia

RESUMO

INTRODUCTION: Patient satisfaction is an increasingly emphasized measure of patient-centered care and important component of reimbursement programs. Orthopaedic surgeons are regarded as low-empathy surgeons. Our goals were to understand the role of anatomic models during the orthopaedic appointment and how their use can affect patient satisfaction and perceived empathy. METHODS: New patients at an outpatient clinic were asked to participate in a postencounter questionnaire to asses empathy perception (n = 304). Clinic days were randomly assigned to use anatomic models during the encounter to assist with clinical information transmission. The instrument provided contained Consultation and Relational Empathy questionnaire (ie, a person-centered process that was developed to measure empathy in the context of the therapeutic relationship during a one-on-one consultation between a clinician and a patient). RESULTS: A total of 304 participants were included in the study. Analyses of the sociodemographic characteristics did not reveal any significant difference between the control and experimental groups. Consultation and Relational Empathy scores for the nonanatomic group (46.0 ± 9.0) and anatomic group (48.0 ± 7.7) were not statistically different (P = 0.482). The encounter time was significantly increased with the use of anatomic models (P < 0.005). DISCUSSION: The use of anatomic models during initial orthopaedic encounter did not improve perceived empathy and satisfaction scores in our study. Longer encounter time in the orthopaedic appointment does not mean higher empathy perception. CONCLUSION: Orthopaedic surgeons have the duty to find new strategies to improve communication with the patient. Better communication has been associated with better patient satisfaction. Further investigation should be considered to use other strategies to provide better care for our patients.