The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Sep 2006
Multicenter StudyPhysician incentives for academic productivity. An analysis of orthopaedic department compensation strategies.
Changes in the health-care industry have led to increasing demand for physician-driven clinical volume. This environment has altered the traditional balance among teaching, research, and service responsibilities for faculty in residency training programs. As economic pressures mount and budgets shrink, academic departments are exploring ways of paying faculty that would help to maintain the global mission of the organization. The purpose of this study was to examine the compensation strategy for faculty in academic orthopaedic surgery departments in the United States with a focus on compensation methods for academic productivity. ⋯ Most, but not all, departments accounted for academic productivity in their compensation system. Most programs used the chair's discretion to determine academic bonuses, but several departments had developed point systems. There are common themes with regard to this issue, including the importance of the academic mission, the need for clinical revenues, the value of flexibility and transparency, and the importance of culture and leadership.
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J Bone Joint Surg Am · Sep 2006
Early complications of primary total hip replacement performed with a two-incision minimally invasive technique. Surgical technique.
Total hip replacement performed through a small incision theoretically results in less trauma to the underlying structures, reduced blood loss, less pain, and a shorter hospital stay, but it may result in increased complications, particularly early in a surgeon's experience with a new technique. In the present study, we reviewed the early results of two techniques involving the use of smaller incisions; specifically, we evaluated one series of primary total hip replacements that had been performed through two small incisions and another series of total hip replacements that had been performed through a single small incision. ⋯ Although total hip arthroplasty with use of the two-incision technique was performed by a surgeon who was experienced in the performance of total hip replacement surgery with use of a single small incision, the rates of complications and repeat surgery associated with the two-incision technique initially were very high. While the rate diminished with increasing experience, total hip replacement with use of two incisions and fluoroscopic guidance is a technically demanding procedure that may be associated, especially initially, with higher rates of complications and repeat surgery.
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J Bone Joint Surg Am · Sep 2006
Primary nonoperative treatment of moderately displaced two-part fractures of the radial head.
Moderately displaced two-fragment fractures of the radial head have been treated predominantly nonoperatively. Recently, however, open reduction and internal fixation has gradually gained interest, without clear evidence that initial nonoperative treatment leads to an unfavorable outcome. As a consequence, the purpose of the present study was to evaluate the long-term outcome after the initial nonoperative treatment of this type of fracture. ⋯ Therapeutic Level IV.
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J Bone Joint Surg Am · Sep 2006
Effect of impact on chondrocyte viability during insertion of human osteochondral grafts.
Osteochondral grafts, used to treat chondral and osteochondral defects, require high insertional forces that may affect the viability of chondrocytes in the graft. The objectives of this study were to (1) measure the loading impact during insertion of osteochondral grafts, (2) evaluate the effect of insertional loading on chondrocyte viability, and (3) assess this effect on chondrocyte apoptosis and activation of caspase-3. ⋯ Chondrocyte death that occurs during impact insertion of osteochondral grafts may lead to compromised function. Understanding the mechanisms and consequences of such impact loading may provide insights into potential therapeutic interventions, or lead to changes in the insertion technique, to decrease the cell injury associated with impact loading.