Women and the orthopaedic surgeon. Changing the relationship

Studying gender and injuries: a comparative analysis of the literatures on women's injuries in sport and work

This article provides a review and analysis of the literatures on the gendering of injuries in sport and in work. It argues that, while research on women's work-related injuries has considered the interaction of biological and social bases of risk, research on women's injuries in sport has concentrated to a greater extent on biological risk factors alone. The difference in emphasis between these two literatures has, in turn, provoked contrasting responses to these sets of research. While bringing women into the discussion of work-related injuries is seen as an advance, the profiling of women's sport-related injuries has been viewed with alarm by critics, who see this as a return to historical notions of women's frailty. The analysis suggests that contrasts between these bodies of research derive from differences in the social organisation of sport and work and the broader literatures on health and safety in each setting. The article highlights the importance of conceptualisations of gender in research agenda devoted to understanding health-related concerns.

PRACTITIONER SUMMARY

The analysis presented here has important relevance to ergonomics because of the need to better understand how gender is implicated in ergonomics research and practice.

Spinal deformity and athletics

Exercise and athletic competition for the young individual has become increasingly more important in society. Scoliosis and Scheurmann kyphosis are spinal deformities prevalent in up to 2% to 3% and 7% of the population respectively, requiring nonoperative and occasionally operative treatment. Curve progression and patient physiologic age dictate treatment regimens. Bracing and physical therapy is the mainstay for nonoperative treatment, whereas soft tissue releases and fusion with instrumentation are used for operative correction. Athletic activity and sports participation is usually allowed for patients undergoing nonoperative treatment. Return to sport after surgical correction is variable, often decided by the treating surgeon, and based on the level of fusion and sporting activity. Although most treating surgeons promote some form of activity regardless of treatment modality chosen, caution should be taken when deciding on participation in collision activities such as football and wrestling.

The importance of communication in secondary fragility fracture treatment and prevention

INTRODUCTION

We report on a Canadian longitudinal qualitative case study of midlife women with fragility fractures, their treating orthopaedic surgeons and family physicians.

METHODS

Women and their treating physicians were followed for an average of one year post fracture to investigate the health outcomes and what, if any, follow-up occurred aimed at secondary fracture prevention. The final dataset includes 223 interviews gathered from women aged 40 to 65 with fragility fractures, orthopaedic surgeons and family physicians.

RESULTS

The circle of care for those with fragility fractures is disrupted at vital communication junctures: (1) the inconsistent flow of information between acute care institutions and family physicians; (2) unidirectional and inconsistent communication from orthopaedic surgeons to family physicians; and (3) competing demands of the cast clinic environment and patient expectations. It is not the lack of will that is undermining the consistent and detailed communication among patients, physicians and institutions. It is the episodic nature of fracture care that makes communication among involved parties difficult, if not impossible.

CONCLUSIONS

Communication about events, acuity and clear expectations around roles and follow-up is urgently needed to improve communication throughout the circle of care to support secondary fracture prevention. Fractures from a standing height or similar trauma in women aged 40 to 65 should be treated as suspicious fractures and followed-up to investigate the underlying bone condition. This article reports on challenges and barriers to clear communication among women, their orthopaedic surgeons and family physicians that is necessary for follow-up and prevention of future fractures.

Common athletic injuries in adolescent girls

Teenaged girls constitute the fastest growing segment of children and adolescents participating in organized athletics. Adolescent girls appear to have similar injury rates as boys in comparable activities but different injury patterns. To properly diagnose and manage athletic injuries in adolescent girls, pediatric health care providers must be aware of these differences, especially as the literature and their knowledge base may be skewed to the traditional predominance of males in sport. This review identifies athletic injuries that are unique to or especially common in adolescent girls, including apophyseal injuries; breast and pelvic injuries; scoliosis and spondylolysis; multidirectional shoulder instability and "gymnast's wrist"; anterior cruciate ligament injuries and patellofemoral pain syndrome; chronic exertional lower-leg compartment syndrome, ankle sprains, and reflex sympathetic dystrophy; and stress fractures. It also briefly discusses possible risk factors for these injuries, emphasizing the female athlete triad.