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Vasireddi N, Vasireddi N, Shah AK, Moyal AJ, Gausden EB, Mclawhorn AS, Poelstra KA, Gould HP, Voos JE, Calcei JG. High Prevalence of Work-related Musculoskeletal Disorders and Limited Evidence-based Ergonomics in Orthopaedic Surgery: A Systematic Review. Clin Orthop Relat Res 2024; 482:659-671. [PMID: 37987688 PMCID: PMC10936985 DOI: 10.1097/corr.0000000000002904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/29/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The Centers for Disease Control defines work-related musculoskeletal disorders as disorders of the nerves, muscles, tendons, joints, spinal discs, and cartilage that are caused or exacerbated by the environment or nature of work. Previous meta-analyses have characterized work-related musculoskeletal disorders among interventionists, general surgeons, and other surgical subspecialties, but prevalence estimates, prognosis, and ergonomic considerations vary by study and surgical specialty. QUESTIONS/PURPOSES (1) What is the career prevalence of work-related musculoskeletal disorders in orthopaedic surgeons? (2) What is the treatment prevalence associated with work-related musculoskeletal disorders in orthopaedic surgeons? (3) What is the disability burden of work-related musculoskeletal disorders in orthopaedic surgeons? (4) What is the scope of orthopaedic surgical ergonomic assessments and interventions? METHODS A systematic review of English-language studies from PubMed, MEDLINE, Embase, and Scopus was performed in December 2022 and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that presented prevalence estimates of work-related musculoskeletal disorders or assessed surgical ergonomics in orthopaedic surgery were included. Reviews, case reports, gray literature (conference abstracts and preprints), and studies with mixed-surgeon (nonorthopaedic) populations were excluded. The search yielded 5603 abstracts; 24 survey-based studies with 4876 orthopaedic surgeons (mean age 48 years; 79% of surgeons were men) were included for an analysis of work-related musculoskeletal disorders, and 18 articles were included for a descriptive synthesis of ergonomic assessment. Quality assessment using the Joanna Briggs Institute Tool revealed that studies had a low to moderate risk of bias, largely because of self-reporting survey-based methodology. Because of considerable heterogeneity and risk of bias, prevalence outcomes were not pooled and instead are presented as ranges (mean I 2 = 91.3%). RESULTS The career prevalence of work-related musculoskeletal disorders in orthopaedic surgeons ranged from 37% to 97%. By anatomic location, the prevalence of work-related musculoskeletal disorders in the head and neck ranged from 4% to 74%; back ranged from 9% to 77%; forearm, wrist, and hand ranged from 12% to 54%; elbow ranged from 3% to 28%; shoulder ranged from 3% to 34%; hip and thigh ranged from 1% to 10%; knee and lower leg ranged from 1% to 31%; and foot and ankle ranged from 4% to 25%. Of orthopaedic surgeons reporting work-related musculoskeletal disorders, 9% to 33% had a leave of absence, practice restriction or modification, or early retirement, and 27% to 83% received some form of treatment. Orthopaedic surgeons experienced biomechanical, cardiovascular, neuromuscular, and metabolic stress during procedures. Interventions to improve orthopaedic surgical ergonomics have been limited, but have included robotic assistance, proper visualization aids, appropriate use of power tools, and safely minimizing lead apron use. In hip and knee arthroplasty, robotic assistance was the most effective in improving posture and reducing caloric expenditure. In spine surgery, proper use of surgical loupes was the most effective in improving posture. CONCLUSION Although the reported ranges of our main findings were wide, even on the low end of the reported ranges, work-related musculoskeletal disability among orthopaedic surgeons appears to be a substantial concern. We recommend that orthopaedic residency training programs incorporate surgical ergonomics or work injury lectures, workshops, and film review (alongside existing film review of surgical skills) into their curricula. We suggest hospitals engage in shared decision-making with surgeons through anonymous needs assessment surveys to implement wellness programs specific to surgeons' musculoskeletal needs. We urge institutions to assess surgeon ergonomics during routine quality assessment of novel surgical instruments and workflows. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Nikhil Vasireddi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- University Hospitals Drusinsky Sports Medicine Institute, South Euclid, OH, USA
| | | | - Aakash K. Shah
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Andrew J. Moyal
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- University Hospitals Drusinsky Sports Medicine Institute, South Euclid, OH, USA
| | | | | | - Kornelis A. Poelstra
- The Robotic Spine Institute of New Jersey, Jersey City, NJ, USA
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | | | - James E. Voos
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- University Hospitals Drusinsky Sports Medicine Institute, South Euclid, OH, USA
| | - Jacob G. Calcei
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- University Hospitals Drusinsky Sports Medicine Institute, South Euclid, OH, USA
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Clar C, Koutp A, Leithner A, Leitner L, Puchwein P, Vielgut I, Sadoghi P. Occupational injuries in orthopedic and trauma surgeons in Austria. Arch Orthop Trauma Surg 2024; 144:1171-1178. [PMID: 38265464 PMCID: PMC10896885 DOI: 10.1007/s00402-024-05200-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/31/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND The aim of this study was to investigate the frequency and type of injuries during the career of orthopedic and trauma surgeons in Austria. The hypothesis was that the percentage of occupational injuries among orthopedic and trauma surgeons aligns with the incidence reported in the United States, thus indicating the need for a workplace prevention program. METHODS A web-based survey was created to collect all necessary data and was sent to all orthopedic and trauma surgeons in Austria via e-mail. Relevant parameters included the surgeons' age, work experience, severity of pain, type of injury, and current pain. Descriptive and explorative statistical analysis was performed. RESULTS A web-based survey was sent to 1122 board-certified orthopedic surgeons and residents in Austria via e-mail. In total, the response rate was 135 (12%). Seventy-two surgeons (54%) had suffered from one or more occupational injuries during their career. We detected a significant raise of occupational injuries related to the work life duration in which operations were performed and the prevalence of injuries. Most injuries of surgeons were reported between 21 and 30 years of their professional life. According to the frequency at different locations, the distribution in descending order was 25% with injuries of the hand, 22% of finger(s), 12% of the foot, 10% of the spine, 2% of the neck, 3% of the head, and 2% of the abdomen. A causality of incapacity to work through injuries at the workplace was given as 4%. Four percent stated a sick leave of at least 3 weeks. In 7% of the facilities, there was no optimization of preventive measures following an occupational injury. We found no correlation of injuries and resident status. CONCLUSION Orthopedic surgeons in Austria show a high incidence of occupational injuries in line with the findings of colleagues from the United States. The impact on the health system consists of absenteeism in the workplace of highly specialized health service providers as well as the incapacity to work of a high quality, highly trained workforce of at least 4%. With more preventive measures and more attention and care in the rehabilitation phase after such injuries, a positive effect could be achieved. We believe that residents should be specifically trained on how to avoid such injuries.
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Affiliation(s)
- Clemens Clar
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Amir Koutp
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Paul Puchwein
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Ines Vielgut
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
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Asiri FA, Alqhtani AA, Assiri AH, Alqahtani MH, Motlag DS, Tedla JS, Alwadai SA. Shoulder Pain and Disability Scores and the Factors Influencing Them among Orthopedic Surgeons Working in the Kingdom of Saudi Arabia: A Cross-Sectional Study. J Pers Med 2023; 14:55. [PMID: 38248756 PMCID: PMC10820873 DOI: 10.3390/jpm14010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/16/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
(1) Background: Musculoskeletal pain is common among orthopedic surgeons. Their common musculoskeletal issues include shoulder pain and disability. Many associated factors could lead to this pain and disability; by identifying these, we can prevent orthopedic surgeons' pain and improve their functional capacity. (2) Methods: This study aimed to gather quantitative data regarding the shoulder pain and disability experienced by orthopedic surgeons. It also aimed to explore the potential correlations between demographic characteristics and work-related factors and their pain and disability. This study interviewed 150 orthopedic surgeons working in the Kingdom of Saudi Arabia, asking questions on the Shoulder Pain and Disability Index (SPADI) scale and about their demographic characteristics. (3) Results: All interviewed orthopedic surgeons were male, married, and nonsmokers. Their SPADI pain subsection score was 25.24%, their SPADI disability subsection score was 21.25%, and their total SPADI score was 22.79%. Among the examined demographic characteristics, total SPADI scores have a significant positive correlation with body weight (Spearman's ρ = 0.432; p < 0.05) and body mass index (BMI; ρ = 0.349; p < 0.05). (4) Conclusions: Our findings indicate that all orthopedic surgeons generally suffer from moderate shoulder pain and disability. Body weight and body mass index are important factors that may influence shoulder pain and disability among orthopedic surgeons.
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Affiliation(s)
- Faya Ali Asiri
- Department of Orthopedics, Ahad Rufaidah General Hospital, Abha 62242, Saudi Arabia;
| | - Abdulrhman Abdullh Alqhtani
- Department of Orthopedics, Aseer Central Hospital, Abha 62523, Saudi Arabia; (A.A.A.); (A.H.A.); (M.H.A.); (D.S.M.); (S.A.A.)
| | - Abdullah Hassan Assiri
- Department of Orthopedics, Aseer Central Hospital, Abha 62523, Saudi Arabia; (A.A.A.); (A.H.A.); (M.H.A.); (D.S.M.); (S.A.A.)
| | - Mohammed Hassan Alqahtani
- Department of Orthopedics, Aseer Central Hospital, Abha 62523, Saudi Arabia; (A.A.A.); (A.H.A.); (M.H.A.); (D.S.M.); (S.A.A.)
| | - Dhuha Saeed Motlag
- Department of Orthopedics, Aseer Central Hospital, Abha 62523, Saudi Arabia; (A.A.A.); (A.H.A.); (M.H.A.); (D.S.M.); (S.A.A.)
| | - Jaya Shanker Tedla
- Department of Medical Rehabilitation Science, College of Applied Medical Sciences, King Khalid University, Abha 62421, Saudi Arabia
| | - Saad Ali Alwadai
- Department of Orthopedics, Aseer Central Hospital, Abha 62523, Saudi Arabia; (A.A.A.); (A.H.A.); (M.H.A.); (D.S.M.); (S.A.A.)
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AlHussain A, Almagushi NA, Almosa MS, Alotaibi SN, AlHarbi K, Alharbi AM, Al Shabraqi H, Alowid F. Work-Related Shoulder Pain Among Saudi Orthopedic Surgeons: A Cross-Sectional Study. Cureus 2023; 15:e48023. [PMID: 38034212 PMCID: PMC10687659 DOI: 10.7759/cureus.48023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Shoulder pain is one of the most frequently reported musculoskeletal conditions that approximately 6.9 to 26% of people experience. Numerous etiologies have been linked to causing shoulder pain, with the most frequent one being rotator cuff tendinopathy. Work-related musculoskeletal pain is prevalent in the medical field in general, but orthopaedic surgeons account for the majority of cases overall. The pain experienced is usually caused by many attributing factors that all relate to either the long hours and physically intensive procedures or the unnatural positions orthopaedic surgeons are put in during their surgeries. This study seeks to shed light on the prevalence, contributing factors, and effect of the complications of shoulder pain among orthopaedic surgeons, a topic unexpectedly understudied, particularly in Saudi Arabia. METHODS A survey has been developed to ask orthopaedic surgeons at various levels of their careers. The study was conducted in Saudi Arabia, Riyadh. It was a multi-centered study that included both governmental and private hospitals in Riyadh. The collected data included age, gender, BMI, sub-specialty, position, number of surgeries performed per week, and the average time per surgery. In our survey, we used the Shoulder Pain and Disability Index (SPADI) to assess shoulder pain. Ethical approval was obtained for this study by the Institutional Review Board of King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia (IRB/1484/23). RESULTS Fifty orthopaedic surgeons participated in this study most of whom were male (88%) and fell within the age range of 31-40 years (36%). Regarding their positions, a significant proportion were consultants (54%). In terms of workload, approximately (38%) of the surgeons performed three to four surgeries per week. As for the duration of surgeries, almost half of the participants spent between three and five hours per surgery (48%). When it comes to experiencing pain or difficulties during shoulder activities, a considerable number reported occasional occurrences (36%). Moreover, a substantial majority did not have a history of specific shoulder-related disorders, as (88%) of the participants had none of the mentioned conditions, such as shoulder trauma or disorders like adhesive capsulitis and impingement. Most participants reported difficulties in performing daily activities due to their work-related shoulder pain. Mild pain was the most common reported severity level in all assessed activities. CONCLUSION The present study showed that orthopaedic surgeons in Riyadh, Saudi Arabia, occasionally experience shoulder pain from their jobs. Most of our sample stated that mild shoulder discomfort made it difficult to conduct daily tasks. This study is limited by a relatively low response rate, which may be attributed to the demanding nature of orthopaedic surgery. To promote health among caregivers throughout the kingdom, more studies should be conducted about shoulder pain.
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Affiliation(s)
- Ahmed AlHussain
- Orthopaedic Surgery, King Abdulaziz Medical City, Riyadh, SAU
| | - Nouf A Almagushi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Mohammad S Almosa
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Sultan N Alotaibi
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | | | - Halah Al Shabraqi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Fay Alowid
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Buddle V, Nugent R, Jack RA, DeLuca P. Orthopedists Report High Prevalence of Work-Related Pain and Low Ergonomic Awareness. Orthopedics 2023; 46:280-284. [PMID: 36853949 DOI: 10.3928/01477447-20230224-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The purpose of this study was to determine the prevalence of work-related pain among practicing orthopedic surgeons, quantify knowledge of operating room (OR) and clinic ergonomics, and examine the use of occupational health resources. A survey was distributed, which included orthopedic surgeons from four states and five institutions. Data collected included years in practice, practice setting, orthopedic subspecialty, hours operating per week, days per week exercising, location and significance of pain, occupational health awareness, and use of OR/clinic ergonomics. One hundred ten of 194 surveys (56.7%) were completed, representing all orthopedic subspecialties. Eighty-three surgeons (75.5%) experienced pain because of occupational responsibilities. The lumbar spine, neck, and shoulders were the most affected areas. Seventeen (20.5%) identified this pain as significant. Ten (12.0%) stated that the pain did subjectively affect their OR performance. Hand surgeons had a statistically significant decreased risk of musculoskeletal pain (P=.007), whereas spine surgeons had a statistically significant increased risk of musculoskeletal pain (P=.028). Forty-nine (44.5%) were not aware of any institutional resources available if an injury was sustained at work. Forty-eight (43.6%) were aware of OR ergonomics, with 34 (30.9%) taking steps to make their OR more ergonomic. The vast majority of orthopedic surgeons experience pain as a result of occupational responsibilities. A clear lack of knowledge regarding institutional resources as well as OR ergonomics implementation was identified. Education in training, at the institutional and national levels, would expand surgeon knowledge and promote surgeon health. [Orthopedics. 2023;46(5):280-284.].
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Al Mulhim FA, AlSaif HE, Alatiyah MH, Alrashed MH, Balghunaim AA, Almajed AS. The Prevalence of Musculoskeletal Pain (MSP) Among Orthopedic Surgeons and Residents in Saudi Arabia's Eastern Area. Cureus 2023; 15:e39246. [PMID: 37342747 PMCID: PMC10277320 DOI: 10.7759/cureus.39246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Orthopedic surgery is a tiring specialty both physically and mentally. Surgeons tend to hold strenuous postures for long periods of time. Orthopedic surgery residents are affected just as much as their seniors by the difficult ergonomics. More care should be aimed toward healthcare professionals to improve patient outcomes and decrease the burden on our surgeons. The goal of this study is to pinpoint the areas of musculoskeletal pain among orthopedic surgery physicians and residents and its prevalence in the eastern province of Saudi Arabia. METHODS A cross-sectional study was conducted in the Eastern region of Saudi Arabia. A simple random selection of 103 male and female orthopedic surgery residents from Saudi Commission for Health Specialties accredited hospitals was enrolled in the study. Residents enrolled from the first to fifth year. Data were collected using a self-administered online questionnaire based on the musculoskeletal Nordic questionnaire activated in 2022-2023. RESULTS Out of 103, a total of 83 completed the survey. The majority (49.9%) were junior residents from residency year (R) 1-R3 and exactly 52 (62.7%) residents were males. The majority of the participants, which were 35 physicians (55.6%), perfume less than six operations as average operations per week, and duration stay in the operating room (OR) per operation there were 29 physicians (46%) stay in the OR for 3-6 h. The most reported sites of pain included lower back pain (46%), followed by neck pain (39.7%) and then upper back pain (30.2%). About 27% of the participants had the pain for more than 6 months, however, only 7 (11.1%) residents seek for medical help. Considering the associated factors with MSP, smoking, and residency year were significantly associated with having musculoskeletal pain (MSP). The presence of MSK pain among R1 residents represents 89.5%, in comparison with R2 residents Who reported 63.6% and 66.7% among R5 residents. This finding indicates a decrease in MSP among residents over the 5 years of residency programs. Additionally, the majority of the participants with MSP reported being smokers 24 (88.9%), controversy, only three of the participants represent (11.1%) without MSP and smokers. CONCLUSIONS Musculoskeletal pain is a serious issue that needs to be addressed. The results indicate that the most reported areas of MSP were the low back, neck, and upper back. Only a minority of the participants went to seek medical help. Residents from R1 experienced more MSP than their seniors and this could indicate an adaptive behavior from senior staff. More research should be done on the topic of MSP in order to promote health among caregivers across the kingdom.
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Affiliation(s)
| | - Hajer E AlSaif
- College of Medicine, King Faisal University, Al-Ahssa, SAU
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UKA with a handheld robotic device results in greater surgeon physiological stress than conventional instrumentation. Knee Surg Sports Traumatol Arthrosc 2023; 31:777-785. [PMID: 35188582 DOI: 10.1007/s00167-022-06908-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/23/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Poor ergonomics and acute stress can impair surgical performance and cause work-related injuries. Robotic assistance may optimize these psychophysiological factors during UKA. This study compared surgeon physiologic stress and ergonomics during robotic-assisted UKA (rUKA) and conventional UKA (cUKA). METHODS Cardiorespiratory and postural data from a single surgeon were recorded during 30 UKAs, (15 rUKAs, 15 cUKAs). Heart rate (HR), HR variability, respiratory rate (RR), minute ventilation and calorie expenditure were used to measure surgical strain. Intraoperative ergonomics were assessed by measuring flexion/extension/rotation of the neck and lumbar spine, and shoulder abduction/adduction. RESULTS Mean operative time was 32.0 ± 7 min for cUKA and 45.9 ± 9 min for rUKA (p < 0.001). Mean neck flexion was - 23.4° ± 13° for rUKA and - 49.1° ± 18 for cUKA (p < 0.001), while mean lumbar flexion was - 20.3° ± 30° for rUKA and - 0.4° ± 68° for cUKA (p = 0.313). Mean lumbar flexion was similar; however, a significantly greater percentage of time was spent in lumbar flexion > 20° during cUKA. Bilateral shoulder abduction was significantly higher for rUKA. Mean calorie expenditure was 154 cal for rUKA and 89.1 cal for cUKA (p < 0.001). Mean HR was also higher for rUKA (88.7 vs. 84.7, p = 0.019). HR variability was slightly lower for rUKA (12.4) than for cUKA (13.4), although this did not reach statistical significance (p = 0.056). No difference in RR or minute ventilation was observed. CONCLUSION rUKA resulted in less neck flexion but increased shoulder abduction, heart rate, and energy expenditure. The theoretical ergonomic and physiologic advantages of robotic assistance using a handheld sculpting device were not realized in this study. LEVEL OF EVIDENCE II.
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Moving beyond radiographic alignment: applying the Wald Principles in the adoption of robotic total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2023; 47:365-373. [PMID: 35532787 PMCID: PMC9877041 DOI: 10.1007/s00264-022-05411-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/18/2022] [Indexed: 01/29/2023]
Abstract
The use of robotics in total knee arthroplasty (TKA) is growing at an exponential rate. Despite the improved accuracy and reproducibility of robotic-assisted TKA, consistent clinical benefits have yet to be determined, with most studies showing comparable functional outcomes and survivorship between robotic and conventional techniques. Given the success and durability of conventional TKA, measurable improvements in these outcomes with robotic assistance may be difficult to prove. Efforts to optimize component alignment within two degrees of neutral may be an attainable but misguided goal. Applying the "Wald Principles" of rationalization, it is possible that robotic technology may still prove beneficial, even when equivalent clinical outcomes as conventional methods, if we look beyond the obvious surrogate measures of success. Robotic systems may help to reduce inventory, streamline surgical trays, enhance workflows and surgical efficiency, optimize soft tissue balancing, improve surgeon ergonomics, and integrate artificial intelligence and machine learning algorithms into a broader digital ecosystem. This article explores these less obvious alternative benefits of robotic surgery in the field of TKA.
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Yakkanti RR, Sedani AB, Syros A, Aiyer AA, D’Apuzzo MR, Hernandez VH. Prevalence and Spectrum of Occupational Injury Among Orthopaedic Surgeons: A Cross-Sectional Study. JB JS Open Access 2023; 8:JBJSOA-D-22-00083. [PMID: 36733707 PMCID: PMC9886518 DOI: 10.2106/jbjs.oa.22.00083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Orthopaedic surgeons are at increased risk for many occupational hazards, both physical and mental. The aim of this study was to evaluate a wide range of work-related injuries among orthopaedic surgeons in the United States. Methods An electronic survey was developed to assess both physical and mental occupational hazards among orthopaedic surgeons. Descriptive statistics were analyzed for all survey items and compared using chi-square and paired t tests, as appropriate. Results The 1,645 responding orthopaedic surgeons (7% response rate) reported a total of 2,702 work-related musculoskeletal injuries, 17.9% of which required surgical treatment. Of the 61 who filed a disability claim, only 66% returned to work and 34% retired early. Additionally, 17.4% of respondents reported having been diagnosed with cancer since starting practice, and 93.8% reported experiencing a finger stick at some point in their career. Over one-half (55.8%) had experienced feelings of psychological distress since beginning practice, and nearly two-thirds (64.4%) reported burnout from work. Conclusions This study captured a spectrum of occupational injuries that pose longitudinal risks to an orthopaedic surgeon's physical and mental well-being. Our hope is that this analysis of occupational hazards will help to raise awareness among the orthopaedic and medical communities and lead to efforts to reduce these risks. Level of Evidence Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ramakanth R. Yakkanti
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida
| | - Anil B. Sedani
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida
| | - Alina Syros
- Miller School of Medicine, University of Miami, Miami, Florida,Email for corresponding author:
| | - Amiethab A. Aiyer
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, Maryland
| | - Michele R. D’Apuzzo
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida
| | - Victor H. Hernandez
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida
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Xu AL, Covarrubias OG, Yakkanti RR, Sotsky RB, Aiyer AA. The Biomechanical Burden of Orthopaedic Procedures and Musculoskeletal Injuries Sustained by Orthopaedic Surgeons: A Systematic Review. JBJS Rev 2023; 11:01874474-202301000-00010. [PMID: 36722828 DOI: 10.2106/jbjs.rvw.22.00202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Orthopaedic surgeons are at high risk for experiencing work-related musculoskeletal (MSK) injuries and chronic pain due to repetitive large magnitude forces, altered posture from lead vests, and prolonged irregular body positions. We sought to synthesize available evidence regarding (1) the biomechanics of orthopaedic surgery and (2) MSK injuries sustained by orthopaedic surgeons with subsequent treatment and consequences. METHODS To conduct this systematic review, we queried 4 databases (PubMed, Embase, MEDLINE, and Web of Science) for original research studies presenting on the biomechanics of orthopaedic surgery or MSK injuries sustained by orthopaedic surgeons. Studies were excluded if they were not original research (i.e., reviews) or reported on non-MSK injuries and injuries in patients or nonorthopaedic specialists. The literature search yielded 3,202 publications, 34 of which were included in the final analysis. RESULTS Eight studies reported on the biomechanics of orthopaedic surgery. Surgeons spent an average 41.6% of operating time slouched. Head and whole spine angles were closest to natural standing position when using a microscope for visualization and with higher surgical field heights. Use of lead aprons resulted in a shifted weight distribution on the forefoot, gain in thoracic kyphosis, and increase in lateral deviation from postural loading. Twenty-six studies reported on MSK symptoms and injuries experienced by orthopaedic surgeons, with an overall prevalence from 44% to 97%. The most common body regions involved were lower back (15.2%-89.5%), hip/thigh (5.0%-86.6%), neck (2.4%-74%), hand/wrist (10.5%-54%), shoulder (7.1%-48.5%), elbow (3.1%-28.3%), knee/lower leg (7.9%-27.4%), and foot/ankle (7%-25.7%). Of surgeons with any reported MSK symptom or injury, 27% to 65.7% required nonoperative treatment, 3.2% to 34.3% surgery, and 4.5% to 31% time off work. Up to 59.3% of surgeons reported that their injuries would negatively influence their ability to perform surgical procedures in the future. CONCLUSIONS The orthopaedic surgeon population experiences a high prevalence of MSK symptoms and injuries, likely secondary to the biomechanical burdens of tasks required of them during strenuous operations. LEVEL OF EVIDENCE Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Amy L Xu
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Oscar G Covarrubias
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ramakanth R Yakkanti
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Rachel B Sotsky
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amiethab A Aiyer
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Suganthirababu P, Parveen A, Mohan Krishna P, Sivaram B, Kumaresan A, Srinivasan V, Vishnuram S, Alagesan J, Prathap L. Prevalence of work-related musculoskeletal disorders among health care professionals: A systematic review. Work 2022; 74:455-467. [PMID: 36530117 DOI: 10.3233/wor-211041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Work-related musculoskeletal disorders (WRMSDs) are one of the main causes of morbidity among healthcare professionals. It has various secondary consequences on productivity by diminishing the quantity and quality of work completed by the affected personnel, in addition to having a primary impact on the individual with pain and discomfort. OBJECTIVE The study aims to determine the overall prevalence rate of WRMSD among dentists, physiotherapists, and surgeons and also identify the commonly affected regions of the body about specific health care professions among each of the three professions, as recorded by the cross-sectional studies performed in various countries and regions of the world. METHODS A systematic search strategy was framed following the PRISMA guidelines based on the present inclusion and exclusion criteria. A critical search of articles was conducted during June 2020 in CINAHL (DOAJ), PubMed, Google Scholar Scopus, PEDro databases and SAGE journals. RESULTS Out of the 42 articles that met the eligibility criteria, there were 39 cross-sectional studies, 2 pilot cross-sectional surveys and 1 prospective cohort study with one-year follow-up. All studies included in this review used various survey tools for recording the demographic details and measuring the prevalence of WRMSDs and other outcome factors. CONCLUSION We conclude that all three health care professionals (dentists, physiotherapists and surgeons) are highly prone to develop WRMSDs with surgeons and dentists being more vulnerable when compared to physiotherapists. The lower back and neck are identified as the two most commonly affected regions among all three professionals.
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Affiliation(s)
- Prathap Suganthirababu
- Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamilnadu, India
| | - Ayesha Parveen
- Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamilnadu, India
| | - P Mohan Krishna
- Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamilnadu, India
| | - B Sivaram
- Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamilnadu, India
| | - A Kumaresan
- Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamilnadu, India
| | - Vignesh Srinivasan
- Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamilnadu, India
| | - Surya Vishnuram
- East Point College of Physiotherapy, East Point Group of Institutions, Bangalore, Karnataka, India
| | - Jagatheesan Alagesan
- Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamilnadu, India
| | - Lavanya Prathap
- Department of Anatomy, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamilnadu, India
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12
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Alaseem AM, Turcotte RE, Ste-Marie N, Alzahrani MM, Alqahtani SM, Goulding KA. Occupational injuries and burn out among orthopedic oncology surgeons. World J Orthop 2022; 13:1056-1063. [PMID: 36567863 PMCID: PMC9782546 DOI: 10.5312/wjo.v13.i12.1056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/12/2022] [Accepted: 11/29/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Orthopedic oncology surgeons commonly engage in prolonged and complex surgical procedures. These types of surgeries increase the risk of physical and psychological stressors, which may in turn make these physicians prone to work-related occupational injuries.
AIM The aim of this study was to explore in orthopedic oncologists, the prevalence of work-related physical injuries and psychological disturbances.
METHODS A modified version of the physical discomfort survey was developed to assess occupational injuries among orthopedic oncology surgeon members of the Musculoskeletal Tumor Society, the Canadian Orthopedic Oncology Society and European Musculoskeletal Oncology Societies. The survey was sent by email, and it explored musculoskeletal complaints, psychological disturbances, treatment required for these complaints and the requirement of time off work.
RESULTS A total of 67 surgeon responses were collected. A high number of orthopedic oncologists (84%) reported an occupational injury. Low back pain (39%) was the most prevalent musculoskeletal condition, followed by lumbar disk herniation (16%), shoulder tendinitis (15%) and lateral epicondylitis (13%). Of the cohort, 46% required surgery and 31% required time off work due to their injury. Thirty-three respondents reported a psychological disorder. Burnout (27%), anxiety (20%) and insomnia (20%) were the most commonly reported. Time required off work due to injury was associated with old age and years in practice.
CONCLUSION Orthopedic oncology surgeons report a high prevalence of work-related disorders. Lower back related injury and burnout were the most reported disorders. Improving operative room ergonomics and prevention of stress related to the work environment should be areas to explore in upcoming research.
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Affiliation(s)
- Abdulrahman M Alaseem
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
| | - Robert E Turcotte
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal H4A3J1, Canada
| | - Nathalie Ste-Marie
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal H4A3J1, Canada
| | - Mohammad M Alzahrani
- Department of Orthopedic Surgery, College of Medicine, Imam Abdulrahman Bin Faisal university, Dammam 34212, Saudi Arabia
| | - Saad M Alqahtani
- Department of Orthopedic Surgery, College of Medicine, Imam Abdulrahman Bin Faisal university, Dammam 34212, Saudi Arabia
| | - Krista A Goulding
- Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, Arizona 85054, USA
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13
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Employment-related musculoskeletal complications experienced by the physical therapists in Bangladesh: a comprehensive cross-sectional case study. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2022. [DOI: 10.1186/s43161-022-00096-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Dentists, nurses, and physical therapists have all been associated with an increased risk of work-related diseases. The findings of studies in these different occupations might aid in the development of preventative measures. In Bangladesh, however, no comparable evidence has been recorded among physical therapists. The study’s goal was to find out the prevalence of work-related physical problems at different anatomical locations, as well as the link between these disorders and treatment strategies across Bangladeshi physical therapists.
Methods
A physical and online survey of Bangladeshi physical therapists was done. A total of 300 questionnaires were given out, with work-related discomfort or pain detected in nine locations of the body: (1) neck, (2) shoulder, (3) elbow, (4) wrists, (5) upper back, (6) lumbar, (7) thighs, (8) knee, and (9) ankle.
Results
85.5% of Bangladeshi physical therapists suffer musculoskeletal problems, according to the results of this research. The neck (25.7%), lower back (15.2%), elbow (12.3%), ankle (8.6%), and shoulder (8.6%) were the most often affected locations (7.1%). Upper back (3.0%) and hips (2.2%) ailments had the lowest prevalence.
Conclusion
Work-related musculoskeletal illnesses were common among the Bangladeshi physical therapists, especially in their neck, lower back, elbow, and ankle regions.
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Cohen-Rosenblum AR, Varady NH, Leonovicz O, Chen AF. Repetitive Musculoskeletal Injuries: A Survey of Female Adult Reconstruction Surgeons. J Arthroplasty 2022; 37:1474-1477.e6. [PMID: 35026370 DOI: 10.1016/j.arth.2022.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Occupational injuries are a prevalent and costly problem for orthopedic surgeons, especially arthroplasty surgeons performing physically demanding and repetitive tasks. The purpose of this study was to characterize occupational musculoskeletal injuries in female adult reconstruction surgeons. METHODS A prospective survey about workplace musculoskeletal injuries was distributed to female attending adult reconstruction surgeons in May 2020. Participants were identified using subspecialty membership data, social media, and personal contacts. Results were analyzed using descriptive statistics. RESULTS Of the total 63 female arthroplasty surgeons who responded, 65.1% were 30-45 year old, and 42.9% were within 5 years of practice, 68.3% sustained an occupational musculoskeletal injury, most commonly forearm/wrist/hand (79.1%), shoulder (48.8%), and low back (44.2%); 10.0% of reported occupational injuries not related to pregnancy resulted in the surgeon requiring time off work, while 48.2% required temporary modifications of job performance, and 10.9% required surgical treatment. Of the injured surgeons who reported having been pregnant, 65.4% reported a workplace exacerbation of a pregnancy-related musculoskeletal condition, including low back pain (52.9%), pubic symphysis pain (35.3%), and carpal tunnel syndrome (29.4%). CONCLUSION A total of 68.3% of female arthroplasty surgeons reported occupational musculoskeletal injuries, predominately forearm/wrist/hand, with a portion of those requiring modifications of job performance. Musculoskeletal injuries may be mitigated by performing repetitive tasks ergonomically, correcting posture, using appropriately sized instrumentation, and using automated or lighter instruments, to potentially avoid modifications to job performance, time off work, or even surgical procedures. Further studies should investigate factors that contribute to injuries in arthroplasty surgeons and how they can be prevented.
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Affiliation(s)
- Anna R Cohen-Rosenblum
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Nathan H Varady
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Olivia Leonovicz
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Haffar A, Krueger CA, Goh GS, Lonner JH. Total Knee Arthroplasty With Robotic Surgical Assistance Results in Less Physician Stress and Strain Than Conventional Methods. J Arthroplasty 2022; 37:S193-S200. [PMID: 35184931 DOI: 10.1016/j.arth.2021.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/02/2021] [Accepted: 11/15/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Poor surgical ergonomics and physiological stress have been shown to impair surgical performance and cause injuries. The prevalence of musculoskeletal pain among arthroplasty surgeons is inordinately high. This study compared surgeon stress and strain during robotic-assisted total knee arthroplasty (rTKA) and conventional TKA (cTKA). METHODS Continuous cardiorespiratory and ergonomic data of a single surgeon were measured during 40 consecutive unilateral TKAs (20 rTKAs, 20 cTKAs) using a smart garment and wearable sensors. Heart rate (HR), HR variability, respiratory rate, minute ventilation, and calorie expenditure were used as surrogate measures for physiological stress. Intraoperative ergonomics were assessed by measuring cervical and lumbar flexion, extension and rotation, and shoulder abduction/adduction. RESULTS Mean operative time was longer for rTKA (48.2 ± 9 vs 31.8 ± 7 min, P < .001). Calories expended per minute was lower for rTKA (2.53 vs 3.50, P < .001). Total calorie expenditure in rTKA cases 11-20 was significantly lower than the first 10 (107.1 ± 27 vs 137.6 ± 24, P = .015), and lower than cTKA (112.3 ± 37). Mean HR was lower for rTKA (81.5 ± 4 vs 90.1 ± 5, P < .001). Minute ventilation was also lower for rTKA (14.9 ± 1 vs 17.0 ± 1.0 L/min, P < .001). Mean lumbar flexion as well as the percentage of time spent in a demanding flexion position >20° were significantly lower during rTKA (P < .001). CONCLUSION rTKA resulted in less surgeon physiologic stress, energy expenditure per minute, and postural strain compared to cTKA. Robotic assistance may help to increase surgical efficiency and reduce physician workload, but further studies are needed to determine whether these benefits will reduce musculoskeletal pain and injury among surgeons.
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Affiliation(s)
- Amer Haffar
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Chad A Krueger
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Jess H Lonner
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Alqahtani SM, Alzahrani MM, Bicknell R, Pichora D. Prevalence and factors of work-related musculoskeletal disorders among hand surgeons. World J Orthop 2022; 13:465-471. [PMID: 35633751 PMCID: PMC9125005 DOI: 10.5312/wjo.v13.i5.465] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/12/2021] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The nature of tasks required by hand surgeons require both forceful and repetitive maneuvers, thus subjecting these surgeons to the risk of musculoskeletal (MSK) injuries during their years in practice.
AIM To assess the prevalence, characteristics and impact of MSK disorders among hand surgeons.
METHODS A modified version of the physical discomfort survey was sent to surgeons who were members of the American Society for Surgery of the Hand via e-mail. The collected data were analyzed using descriptive statistics, one-way analysis of variance, and Fisher's exact test. P values of < 0.05 were considered statistically significant.
RESULTS Of the 578 respondents, 60.4% reported that they had sustained a work-related MSK injury, of which the most common diagnoses were lateral elbow epicondylitis (18.7%), low back pain (17.1%) and carpal tunnel syndrome (15.6%). Among those that reported an injury, 73.1 % required treatment and 29.2 % needed time off work as a direct result of their injury. The number of work-related injuries incurred by a surgeon increased significantly with increasing age (P < 0.003), increasing years in practice (P < 0.001) and higher case load (P < 0.05).
CONCLUSION To our knowledge this study is the first of its kind to assess MSK injuries sustained by Hand surgeons with a high incidence. These results should increase awareness on this aspect and fuel future studies directed at preventing these types of work-related injuries, thus minimizing the financial and psychological burden on these surgeons and the healthcare system.
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Affiliation(s)
- Saad M Alqahtani
- Department of Orthopaedics, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Mohammad M Alzahrani
- Department of Orthopaedics, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Ryan Bicknell
- Department of Orthopaedics, Queens University, Kingston K7L 3N6, Ontario, Canada
| | - David Pichora
- Department of Orthopaedics, Queens University, Kingston K7L 3N6, Ontario, Canada
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A Survey of Musculoskeletal Disorders in the Orthopaedic Surgeon: Identifying Injuries, Exacerbating Workplace Factors, and Treatment Patterns in the Orthopaedic Community. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202205000-00012. [PMID: 35608969 PMCID: PMC9132526 DOI: 10.5435/jaaosglobal-d-20-00244] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/03/2022] [Indexed: 12/03/2022]
Abstract
Introduction: As demand for orthopaedic care increases, the orthopaedic community must preserve access to skilled physicians. Workplace hazards and related injuries or conditions contribute to musculoskeletal (MSK) stress on orthopaedic surgeons, which can lead to undesirable medical leaves of absence or early retirement. The purpose of this study was to identify and characterize work-related and non–work-related MSK conditions that affect orthopaedic surgeons and differential injury patterns among male and female surgeons. This study hypothesized that MSK conditions would be exacerbated by work, correlate with age, and show gender-based disparities. Identifying MSK conditions and associated workplace hazards may ultimately help guide preventive or protective efforts. Methods: Following IRB and society approvals, a modified 15-question physical discomfort survey was emailed to a randomized selection of American Academy of Orthopaedic Surgeons (AAOS) members and all Ruth Jackson Orthopaedic Society members. Data were deidentified and merged by AAOS; analyses were performed by the authors. Results: Most surgeons reported at least one MSK condition (86%; 95% male versus 82% female, P = 0.317), with an average of two conditions per surgeon. Low back pain (56%) and neck pain (42%) were the two most common conditions reported. Male surgeons were more likely to report medial epicondylitis (P = 0.040), lateral epicondylitis (P ≤ 0.001), low back pain (P = 0.001), and lumbar radiculopathy (P = 0.001); however, male respondents were significantly older than female respondents (57 versus 43 years, P ≤ 0.0001), and some conditions were age-correlated. Most respondents reported at least one work-attributed MSK condition (64%; 68% male versus 62% female, P = 0.806). Caseload was not associated with an increased number of work-related MSK conditions; yet, 60% of surgeons reported that work worsened symptoms. Surgical treatment was sought most often for lumbar radiculopathy (6%) and carpal tunnel syndrome (6%). Sixty-nine leaves of absence were reported; most less than 1 month (55%). Exacerbating workplace factors included positioning (patient/surgeon), instruments, and personal protective equipment. Discussion: Work-related MSK conditions are common among orthopaedic surgeons. Greater awareness of potential workplace-related hazards and conditions is needed to address and mitigate negative MSK health effects on orthopaedic surgeons.
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Park SR, Park JY, Ghani R, Ha J, Hester T. Visualising the Future of Orthopaedic Surgery: A Novel Application of Wireless Smart Glasses to Visualise Intraoperative Imaging. Cureus 2022; 14:e22004. [PMID: 35340507 PMCID: PMC8913437 DOI: 10.7759/cureus.22004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
Smart glasses can provide a heads-up display of advanced imaging intraoperatively. In recent years, growing attention has been drawn to the use of smart glasses as an assistive technology to improve both efficiency and ergonomics in a surgical setting. Previous studies have reported improved surgical accuracy, efficiency, and ergonomics with its usage, but its effectiveness as a form of intraoperative heads-up display remains elusive in the context of orthopaedics. This study provides a novel account of a wireless set-up of the Moverio BT-35E Smart Glasses (Suwa, Japan: Epson Inc.), incorporated in a complex orthopaedic procedure. Hind-foot nailing was performed on a patient with a complex open ankle fracture and multiple co-morbidities. Smart glasses were worn by the primary surgeon throughout the procedure to provide heads-up visualisation of the intraoperative fluoroscopy. In our surgical case, the surgeon experienced improved ergonomics and reduced disruption to focus with the use of smart glasses. The wireless set-up provided excellent signal transmission throughout the duration of the procedure. The wireless set-up of smart glasses is a potential solution for common occupational risks imposed on orthopaedic surgeons. Smart glasses minimise musculoskeletal strain from switching of vision from monitor to patient, whilst the wireless set-up allows for efficient use of space in an operating theatre and may potentially limit radiation exposure. Lastly, ergonomic benefits may increase the efficiency of movement for the surgeon, decreasing operative duration, and in turn minimising the risk of surgical complications for patients.
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Claeson AA, Schwab FJ, Gandhi AA, Skaggs DL. Power-assisted Pedicle Screw Technique Protects Against Risk of Surgeon Overuse Injury: A Comparative Electromyography Study of the Neck and Upper Extremity Muscle Groups in a Simulated Surgical Environment. Spine (Phila Pa 1976) 2022; 47:E86-E93. [PMID: 33973563 DOI: 10.1097/brs.0000000000004097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cadaveric. OBJECTIVE The aim of this study was to quantify the amplitude and duration of surgeons' muscle exertion from pedicle cannulation to screw placement using both manual and power-assisted tools in a simulated surgical environment using surface electromyography (EMG). SUMMARY OF BACKGROUND DATA A survey of Scoliosis Research Society members reported rates of neck pain, rotator cuff disease, lateral epicondylitis, and cervical radiculopathy at 3 ×, 5 ×, 10 ×, and 100 × greater than the general population. The use of power-assisted tools in spine surgery to facilitate pedicle cannulation through screw placement during open posterior fixation surgery may reduce torque on the upper limb and risk of overuse injury. METHODS Pedicle preparation and screw placement was performed from T4-L5 in four cadavers by two board-certified spine surgeons using both manual and power-assisted techniques. EMG recorded muscle activity from the flexor carpi radialis, extensor carpi radialis, biceps, triceps, deltoid, upper trapezius, and neck extensors. Muscle activity was reported as a percentage of the maximum voluntary exertion of each muscle group (%MVE) and muscle exertion was linked to low- (0-20% MVE), moderate- (20%-45% MVE), high- (45%-70% MVE) and highest- (70%-100% MVE) risk of overuse injury based on literature. RESULTS Use of power-assisted tools for pedicle cannulation through screw placement maintains average muscle exertion at low risk for overuse injury for every muscle group. Conversely with manual technique, the extensor carpi radialis, biceps, upper trapezius and neck extensors operate at levels of exertion that risk overuse injury for 50% to 92% of procedure time. Powerassisted tools reduce average muscle exertion of the biceps, triceps, and deltoid by upwards of 80%. CONCLUSION Power-assisted technique protects against risk of overuse injury. Elevated muscle exertion of the extensor carpi radialis, biceps, upper trapezius, and neck extensors during manual technique directly correlate with surgeons' self-reported diagnoses of lateral epicondylitis, rotator cuff disease, and cervical myelopathy.Level of Evidence: N/A.
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To Fix or Revise: Differences in Periprosthetic Distal Femur Fracture Management Between Trauma and Arthroplasty Surgeons. J Am Acad Orthop Surg 2022; 30:e17-e24. [PMID: 34288890 DOI: 10.5435/jaaos-d-20-00968] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 05/23/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION This study sought to determine the effect of trauma fellowship training on the surgical decision to fix or revise to distal femoral replacement in periprosthetic distal femur fractures. METHODS An anonymous online survey including nine cases of geriatric periprosthetic distal femur fractures was distributed through the Orthopaedic Trauma Association website. Respondents were asked whether they would recommend fixation or revision to distal femoral replacement. Fractures were classified by the location relative to the anterior flange (proximal or distal) and the presence or absence of comminution. Recommendations were compared between type of fellowship completed (trauma, arthroplasty, or both), practice setting, and number of periprosthetic distal femur fractures treated monthly. RESULTS One hundred fifty-one surgeon survey responses were included. Completion of a trauma fellowship was associated with a higher likelihood of recommending fixation for any periprosthetic distal femur fracture compared with arthroplasty training (odds ratio [OR] 2.55, 95% confidence interval [CI] 1.97 to 3.29; P < 0.0001). Disagreement was significant for comminuted proximal (OR 6.90, 95% CI 3.24 to 14.68; P < 0.0001), simple distal (OR 20.90, 95% CI 6.41 to 67.71; P < 0.001), and comminuted distal fractures (OR 2.47, 95% CI 1.66 to 3.68; P < 0.0001). Dual fellowship-trained surgeons were less likely to recommend fixation than surgeons who completed a trauma fellowship alone (OR 0.60, 95% CI 0.39 to 0.93; P = 0.027) and more likely to recommend fixation than surgeons who completed an arthroplasty fellowship alone (OR 1.70, 95% CI 1.13 to 2.63; P = 0.012). Surgeons who treat three or more periprosthetic distal femur fractures monthly showed a significant preference for fracture fixation compared with lower volume surgeons (OR 2.45, 95% CI 1.62 to 3.68; P < 0.0001). DISCUSSION Fellowship-trained trauma surgeons show a notable preference for fracture fixation over distal femoral replacement for periprosthetic distal femur fractures, as compared with arthroplasty-trained surgeons. Additional research is needed to clarify surgical indications that maximize outcomes for these injuries.
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Oladiran A, Imediegwu K, Ezeh F, Yakubu M, Igwe O. Awareness of hazard risks and prevention among orthopaedic surgery residents in South East Nigeria. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:11-16. [PMID: 36203929 PMCID: PMC9531746 DOI: 10.4103/jwas.jwas_85_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/28/2022] [Indexed: 11/04/2022]
Abstract
Background: Objectives: Materials and Methods: Results: Conclusion: Recommendation:
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22
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Alzahrani MM, Alqahtani SM, Pichora D, Bicknell R. Work-related musculoskeletal injuries among upper extremity surgeons: A web-based survey. World J Orthop 2021; 12:891-898. [PMID: 34888149 PMCID: PMC8613686 DOI: 10.5312/wjo.v12.i11.891] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/28/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Work-related injuries have gained recent attention, especially in the orthopaedic literature. As upper extremity orthopaedic surgical tasks require repetitive and constant maneuvers, these surgeons can be at increased risk of acquiring work-related musculoskeletal (MSK) disorders during their years in practice.
AIM To assess the prevalence, characteristics and impact of MSK disorders among upper extremity orthopaedic surgeons.
METHODS A modified version of the physical discomfort survey was sent to surgeons who were members of the American Shoulder and Elbow Surgeons and the Canadian shoulder and elbow society via e-mail. The collected data were analyzed using descriptive statistics, one-way analysis of variance, and Fisher's exact test. P values of < 0.05 were considered statistically significant.
RESULTS Of the 142 respondents, 90.8% were males and the majority were younger than 55 years old (65.5%). A work-related MSK injury was reported by 89.4% of respondents, of which the most common diagnoses were low back pain (26.1%) and lateral elbow epicondylitis (18.3%). Among those that reported an injury, 82.7% required treatment and 26% required time off work as a direct result of their injury. The need to undergo treatment due to the injury was associated with increased number of injuries (P < 0.01). Moreover, surgeons were more likely to require time off work when they had been in practice for > 21 years (P < 0.05).
CONCLUSION A high proportion of surgeons in our survey reported MSK injuries, with more than one quarter of surgeons reported requiring time off work due to an MSK injury. The high incidence of these disorders may place a financial and psychological burden on surgeons and affect their ability to provide patient care. Awareness of operative ergonomics, irrespective of surgical specialty may help to decrease or possibly prevent the occurrence of these disorders.
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Affiliation(s)
- Mohammad M Alzahrani
- Department of Orthopaedics, Imam Adulrahman Bin Faisal University, Dammam, KSA 34212, Saudi Arabia
| | - Saad M Alqahtani
- Department of Orthopaedics, Imam Adulrahman Bin Faisal University, Dammam, KSA 34212, Saudi Arabia
| | - David Pichora
- Department of Orthopaedics, Queens University, Kingston K7L 3N6, Canada
| | - Ryan Bicknell
- Department of Orthopaedics, Queens University, Kingston K7L 3N6, Canada
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Neal-Smith G, Butler K, Patel B, Huntley D, Wood A. 'Ergopaedics': the future of ergonomics in orthopaedics. Br J Hosp Med (Lond) 2021; 82:1-4. [PMID: 34817257 DOI: 10.12968/hmed.2021.0581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ergonomics is the scientific study of people and their working conditions, aiming to improve effectiveness. Improved ergonomics of orthopaedic theatres and equipment would reduce the risk of occupational injury and help to encourage more women into an underrepresented specialty.
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Affiliation(s)
- Gregory Neal-Smith
- Department of Trauma and Orthopaedic Surgery, Royal Cornwall Hospital, UK
| | - Katherine Butler
- Department of Trauma and Orthopaedic Surgery, John Radcliffe Hospital, Oxford, UK
| | - Bhavi Patel
- Department of Trauma and Orthopaedic Surgery, Wexham Park Hospital, Slough, UK
| | - Daniel Huntley
- Department of Trauma and Orthopaedic Surgery, Royal Devon and Exeter Hospital, Exeter, UK
| | - Alexander Wood
- Department of Trauma and Orthopaedic Surgery, John Radcliffe Hospital, Oxford, UK
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McQuivey KS, Christopher ZK, Deckey DG, Mi L, Bingham JS, Spangehl MJ. Surgical Ergonomics and Musculoskeletal Pain in Arthroplasty Surgeons. J Arthroplasty 2021; 36:3781-3787.e7. [PMID: 34303581 DOI: 10.1016/j.arth.2021.06.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND One occupational hazard inherent to total joint replacement surgeons is procedural-related musculoskeletal pain (MSP). The purpose of this study is to identify the prevalence of work-related MSP among arthroplasty surgeons and analyze associated behaviors, attitudes, and beliefs toward surgical ergonomics. METHODS A survey was sent to members of the American Association of Hip and Knee Surgeons. The survey included 3 main sections: demographics, symptoms by body part, and attitudes/beliefs/behaviors regarding surgical ergonomics. Pain was reported using the Numeric Rating Scale (0 = no pain, 10 = maximum pain), and well-being was assessed using the Maslach Burnout Inventory. RESULTS In total, 586 surgeons completed the survey: 96.1% male and 3.9% female. Most surgeons (96.5%) experience procedural-related MSP. Collectively, surgeons reported an average pain score of 3.7/10 (standard deviation ±1.95). Significant levels of MSP (≥5/10) were most common in the lower back (34.2%), hands (24.8%), and the neck (21.2%). There was a positive association among higher MSP and burnout (P < .001), callousness toward others (P = .005), and decreased overall happiness (P < .001). MSP was also found to have a significant impact on surgeon behavior including the degree of irritability (P < .001), alcohol intake (P < .001), and poor sleep patterns (P < .001). CONCLUSION The prevalence of MSP among arthroplasty surgeons is extremely high. This study demonstrates that MSP has a significant impact on career attitudes, lifestyle, and overall surgeon well-being. This study may also contribute to future work to prevent cumulative chronic ailments, disability, and lost productivity of arthroplasty surgeons through promotion of improved ergonomics and risk-reduction strategies. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kade S McQuivey
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | | | - David G Deckey
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Lanyu Mi
- Division of Biomedical Statistics and Informations, Mayo Clinic Arizona, Scottsdale, AZ
| | - Joshua S Bingham
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Mark J Spangehl
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ
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Sarwal G, Tobias G, Taylor DC, Misskey JD, Hsiang YN. Survey of Canadian vascular surgeons and trainees finds work-related musculoskeletal pain and discomfort is common. J Vasc Surg 2021; 75:1431-1436. [PMID: 34718100 DOI: 10.1016/j.jvs.2021.09.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Occupational injuries and disability are a source of surgeon morbidity. The purpose of this study was to assess the physical toll of working in operating rooms by Canadian vascular surgeons. OBJECTIVE To assess work-place musculoskeletal (MSK) complaints and challenges faced by Canadian vascular surgeons and trainees and its implications on surgical practice and occupational longevity. METHODS An online survey was distributed to resident and surgeon members of the Canadian Society of Vascular Surgery. The survey collected data on demographics, operative volume, and work-related MSK symptoms. RESULTS The survey was distributed to 188 surgeons and trainees. After three e-mailings, 109 surveys were returned (58% response rate). Of the responders, 87% were male, 51% were 45 years or older, and 56% had been in practice for ten or more years. Workplace MSK symptoms was reported by 83% of the responders. The most common locations were the low back (78%), neck (74%), and shoulder (30%). Most responders (83%) believed that these symptoms were related to their operative environment. Almost half (48%) sought medical care. As a result of these MSK symptoms, 25% experience chronic pain with 8% reporting time off work as a consequence. Another 11% reported an impact on their operative performance with 14% considering early retirement. A lack of operating room system changes to prevent workplace injury and disability was noted by 85% of the responders although only 3% reported their disability to their department. CONCLUSION Occupational MSK symptoms and disability is common amongst Canadian vascular surgeons. Further research is needed to create programs to improve surgeon morbidity.
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Affiliation(s)
- Gautamn Sarwal
- Division of Vascular Surgery, University of British Columbia, Vancouver, B.C
| | - Gabriel Tobias
- Division of Vascular Surgery, University of British Columbia, Vancouver, B.C
| | - David C Taylor
- Division of Vascular Surgery, University of British Columbia, Vancouver, B.C
| | - Jonathan D Misskey
- Division of Vascular Surgery, University of British Columbia, Vancouver, B.C
| | - York N Hsiang
- Division of Vascular Surgery, University of British Columbia, Vancouver, B.C..
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Skaggs DL, Compton E, Vitale MG, Garg S, Stone J, Fletcher ND, Illingworth KD, Kim HJ, Ball J, Kim EB, Keil L, Harris H, Shah SP, Andras LM. Power versus manual pedicle tract preparation: a multi-center study of early adopters. Spine Deform 2021; 9:1395-1402. [PMID: 33891296 DOI: 10.1007/s43390-021-00347-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
STUDY DESIGN Retrospective cohort, multicenter. A single surgeon study demonstrated that pedicle tract preparation with power tools was associated with lower fluoroscopy times and revision rates compared to manual tools, while maintaining patient safety. OBJECTIVE Our purpose was to determine the safety of power-assisted pedicle tract preparation by early adopters of this technology. METHODS Retrospective review comparing patients that underwent posterior spinal fusion by seven pediatric spine surgeons at six institutions between January 1, 2008 and August 31, 2019. The manual pedicle tract preparation used a pedicle awl. Power tract preparation used a flexible 2.0-2.4 mm drill bit, followed by a larger drill bit or a reamer. All screws were inserted with power technique. RESULTS In the manual tract preparation group, 9424 screws were placed in 585 cases. In the power tract preparation group, 22,209 screws were placed in 1367 cases. Seven patients (7/1952; 0.36%; 95% CI: 0.14-0.74%) had 11 mal-positioned screws (11/31,633; 0.03%; 95% CI: 0.017-0.062%). Seven screws (7/9424; 0.07%; 95% CI: 0.030-0.15%) were in the manual cohort and four (4/22,209; 0.02%; 95% CI: 0.0049-0.046%) were in the power cohort. There were significantly more revisions per screw in the manual cohort (p = 0.02). However, there were not significantly more revisions per patient in the manual cohort (manual: 0.5%, 3/585 vs. power: 0.3%, 4/1,367; p = 0.43). Of these seven, three patients (3/585; 0.5%; 95% CI: 0.1-1.5%) experienced neurologic injury or neuro-monitoring changes requiring screw removal in the manual cohort, and 1 patient (1/1,367, 0.07%; 95% CI: 0.002-0.4%) in the power cohort (p = 0.08). Three additional patients underwent revision in the power cohort: 1 for an asymptomatic lateral breech, 1 for a spinal headache/medial breech that developed after an MVA, and 1 for an iliac vein injury during pedicle tract preparation. CONCLUSION This is the first multi-center study examining power pedicle preparation. Overall, 99.9% of pedicle screws placed with power pedicle preparation did not have complications or revision. Equivalent patient safety was demonstrated compared to manual technique. LEVEL OF EVIDENCE III.
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Affiliation(s)
- David L Skaggs
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA. .,Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
| | - Edward Compton
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Sumeet Garg
- Children's Hospital Colorado, Aurora, CO, USA
| | - Joseph Stone
- Department of Orthopaedics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | | | - Kenneth D Illingworth
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Jacob Ball
- Columbia University Medical Center, New York, NY, USA
| | - Eun Bi Kim
- Children's Hospital Colorado, Aurora, CO, USA
| | - Lukas Keil
- Department of Orthopaedics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Hilary Harris
- Emory Orthopedics and Spine Center, Atlanta, GA, USA
| | - Sachin P Shah
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Lindsay M Andras
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA
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Vajapey SP, Li M, Glassman AH. Occupational hazards of orthopaedic surgery and adult reconstruction: A cross-sectional study. J Orthop 2021; 25:23-30. [PMID: 33897136 DOI: 10.1016/j.jor.2021.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/28/2021] [Indexed: 12/16/2022] Open
Abstract
Background Occupational injuries and hazards related to orthopaedic surgery are not well studied, and what is published on this topic is largely based on in vitro or in vivo animal studies. Objectives To evaluate the self-reported prevalence of musculoskeletal (MSK) overuse disorders and other conditions among orthopaedic surgeons, especially those performing total hip (THA) or total knee arthroplasty (TKA), and report the factors placing these surgeons at higher risk for occupational health hazards. Methods This was a cross-sectional study of 66 currently practicing orthopaedic surgeons in the Midwestern United States. An online survey was sent to the participants, and all responses were collected anonymously. The survey consisted of 18 multiple-choice questions. Results Almost 82% of surgeons surveyed had either a musculoskeletal (MSK) overuse disorder, kidney stones, cataracts, infertility, deafness, or a combination of the above. Fifty-three percent of these respondents believed their medical conditions arose due to their job demands or exposure. A majority of the orthopaedic surgeons surveyed wanted to retire at either 60-65 years of age (31.8%) or 66-70 years of age (47%). Nearly 88% of the survey respondents believed they will be able to meet the demands of their job until their intended retirement age. The prevalence of an overuse disorder was highest for those who have been in practice for 21-30 years (100%). There was a trend toward higher rate of surgery for overuse condition in Adult Reconstruction (AR) surgeons. Rotator cuff disease was the most common MSK disorder affecting AR surgeons. Conclusion A majority (>80%) of orthopaedic surgeons suffer from a musculoskeletal overuse disorder, kidney stones, cataracts, infertility, deafness, or a combination of these. A significant proportion (53%) of surgeons believe one or more of their medical conditions developed due to occupational exposure.
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Affiliation(s)
- Sravya P Vajapey
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mengnai Li
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Andrew H Glassman
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Assessing Risks Awareness in Operating Rooms among Post-Graduate Students: A Pilot Study. SUSTAINABILITY 2021. [DOI: 10.3390/su13073860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: In this study, we promote a global approach to occupational risk perception in order to improve occupational health and safety training programs. The study investigates the occupational risk perception of operating room healthcare workers using an Analytic Hierarchy Process approach. Methods: A pilot study was carried out through a cross-sectional survey in a university hospital in Southern Italy. An ad hoc questionnaire was administered to enrolled medical post-graduate students working in the operating room. Results: Fifty medical specialists from seven fields (anaesthetists, digestive system surgeons, general surgeons, maxillofacial surgeons, thoracic surgeons, urologists, and gynaecologists) were questioned about perceived occupational risk by themselves. Biological, ionizing radiation, and chemical risks were the most commonly perceived in order of priority (w = 0.300, 0.219, 0.210). Concerning the biological risk, gynaecologists unexpected perceived this risk as less critical (w = 0.2820) than anaesthesiologists (w = 0.3354), which have the lowest perception of the risk of ionizing radiation (w = 0.1657). Conclusions: Prioritization methods could improve risk perception in healthcare settings and help detect training needs and perform sustainable training programs.
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Surgical Ergonomics and Musculoskeletal Pain in Orthopaedic Surgery Residents: A Multicenter Survey Study. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202103000-00006. [PMID: 33720100 PMCID: PMC7960490 DOI: 10.5435/jaaosglobal-d-20-00119] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 01/17/2021] [Indexed: 12/23/2022]
Abstract
Owing to the nature of orthopaedic surgery, occupational hazards and musculoskeletal pain (MSP) are inherent. These hazards have been well-documented among practicing orthopaedic surgeons, but there remains a paucity of data regarding MSP among orthopaedic surgery residents. The purpose of this study was to identify the prevalence and quantify the extent of work-related MSP among orthopaedic surgical residents. We also sought to analyze resident attitudes, beliefs, and behaviors regarding surgical ergonomics.
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Abstract
INTRODUCTION Musculoskeletal injury can substantially affect orthopaedic surgeons and productivity. The objective of this study was to assess occupation-related neck pain and cervical radiculopathy/myelopathy among orthopaedic surgeons and to identify the potential risk factors for injury. METHODS An online survey was sent to orthopaedic surgeons via their state orthopaedic society. The survey consisted of items related to orthopaedic practices, such as the number of arthroscopic procedures done and the use of microscopes/loupes. The prevalence, potential causes, and reporting practices of neck pain and cervical radiculopathy/myelopathy among orthopaedic surgeons were also assessed. RESULTS There were 685 responses from surgeons representing 27 states. A total of 59.3% of respondents reported neck pain and 22.8% reported cervical radiculopathy. After adjusting for age and sex, surgeons performing arthroscopy had an odds ratio of 3.3 (95% confidence interval: 1.4 to 8.3, P = 0.007) for neck pain. Only five of the surgeons with neck pain and one of the surgeons with cervical radiculopathy/myelopathy had ergonomic evaluations. CONCLUSION Neck pain and cervical radiculopathy/myelopathy are common among orthopaedic surgeons. Associated factors included older age, higher stress levels, and performing arthroscopy. Cervical injuries are rarely reported, and ergonomic workplace evaluations are infrequent.
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Aikawa L, Yoshizumi AM, Shirassu MM, Koike MK. Rapid acupuncture for musculoskeletal pain in the emergency room of the Hospital Servidor Publico Estadual, Brazil: A quasi-experimental study. JOURNAL OF INTEGRATIVE MEDICINE 2020; 18:313-318. [PMID: 32553560 DOI: 10.1016/j.joim.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To compare differences in self-reported musculoskeletal pain before and after receiving rapid acupuncture for pain at an outpatient emergency department. METHODS Exactly 102 patients presenting to the emergency room of the Hospital Servidor Publico Estadual in Sao Paulo, Brazil, participated in this before-and-after study. All participants had musculoskeletal pain and were treated with the technique proposed by Marques Filho. This emergency acupuncture involved inserting a needle at a point defined by traditional Chinese medicine and applying intense stimulation for 10 s; no more than two points were used on any individual patient. Pain was measured using a numerical visual scale before and immediately after the procedure. RESULTS Participants in this study were mostly women (78%), had a college degree (47%) and were below the age of 60 (56%). The most common region of pain was the lower back (31%), and the most common type of pain was acute and exacerbated chronic pain. The meridians most commonly involved were the eight extra meridians (40%), and the points most often used for treatment were Houxi (SI3), Shenmai (BL62) and Zulinqi (GB41). Almost all participants reported a decrease in pain intensity, independent of sex, education level, pain site and pain type (acute/chronic; P < 0.05). At the end of the session, only 4% of the participants reported a desire for allopathic medication. CONCLUSION This emergency acupuncture technique for analgesia appears to reduce musculoskeletal pain. TRIAL REGISTRATION Brazilian Registry of Clinical Trials (http://www.ensaiosclinicos.gov.br/) with No. RBR-8dmfjf.
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Affiliation(s)
- Luciana Aikawa
- Programa de Pós-Graduação em Ciências da Saúde, Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), Vila Clementino, São Paulo, SP 04029-000, Brazil
| | | | - Mirian Matsura Shirassu
- Programa de Pós-Graduação em Ciências da Saúde, Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), Vila Clementino, São Paulo, SP 04029-000, Brazil
| | - Marcia Kiyomi Koike
- Programa de Pós-Graduação em Ciências da Saúde, Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), Vila Clementino, São Paulo, SP 04029-000, Brazil.
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Alaqeel M, Tanzer M. Improving ergonomics in the operating room for orthopaedic surgeons in order to reduce work-related musculoskeletal injuries. Ann Med Surg (Lond) 2020; 56:133-138. [PMID: 32637088 PMCID: PMC7327029 DOI: 10.1016/j.amsu.2020.06.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/13/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction Orthopaedic surgery is characterized by surgical tasks that are physical, repetitive and require some degree of stamina from the surgeon. Occupational injuries are alarmingly common in orthopaedic surgery with two-thirds of all surgeons reporting a work-related musculoskeletal (MSK) injury during their career. One of the leading causes of the high level of MSK injuries among orthopaedic surgeon is lack of ergonomics of the operating room. Implementing an ergonomic process has been shown to be effective in reducing the risk of developing MSK disorders in other high-risk industries. We reviewed well-established and effective ergonomic guidelines from the industrial workplace and determined the pertinent principles that could be transferred to the operating room to help reduce the number and severity of common orthopaedic work-related MSK injuries. Methods We reviewed the ergonomic guidelines, primarily from the Occupational Safety and Health Administration (OSHA), that specifically address minimizing the risk of these work-related injuries and that are transferable to the operating room. In addition, the ergonomic guidelines from the Canadian Center for Occupational Health and Safety (CCOHS), the National Institute for Occupational Safety and Health (NIOSH) and the Centers for Disease Control and Prevention (CDC) were reviewed. Results Many of the guidelines to avoid work-related injuries in industry are transferable to the operating room. The pertinent guidelines clearly indicated how to adjust the height of the operating table, the proper design of hand and power tools and the modifications to the operating room environment that can help prevent injury. These guidelines from industry include maintaining a neutral posture and joint alignment, working with the appropriate hand tools and minimizing the lower extremity fatigue by using the proper footwear and floor mats. Discussion Optimizing the occupational environment and utilizing well-established ergonomic principle from industry is both feasible and practical in the operating room to decrease the incidence of musculoskeletal injuries among this high-risk profession. These guidelines are simple, effective and are easy to implement by orthopaedic surgeons in order to minimize their risk of sustaining a work-related injury.
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Affiliation(s)
- Motaz Alaqeel
- Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada
| | - Michael Tanzer
- Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada
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Dale L, Fiedler J. Risk factors for musculoskeletal disorders in an obstetrician-gynecologist and orthopedic surgeon. Work 2020; 65:749-761. [PMID: 32310206 DOI: 10.3233/wor-203128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Orthopedic and obstetrician-gynecologist (OB/GYN) surgeons have risks for musculoskeletal disorders (MSD) during work in the operating room (OR). Risks for MSD have not been identified as a result of work outside the OR or during non-work tasks. OBJECTIVE The purpose of the study was to determine risk factors for MSD in an orthopedic and OB/GYN surgeon. METHODS A case study format and mixed method design were used to gather data by using the Rapid Upper Limb Assessment (RULA) to measure MSD risks in the OR; the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) to measure surgeons' upper extremity disability; observation of surgeon office hours; and semi-structured interviews to gather qualitative data. RESULTS Both surgeons had risks for MSD during occupational performance outside of work, with some risks similar to those experienced at work. Both surgeons had MSD risks during work inside and outside the OR. Both surgeons experienced MSD symptoms exacerbated by work and non-work tasks. CONCLUSIONS Identifying and reducing MSD risk should include a comprehensive analysis of occupational performance for orthopedic and OB/GYN surgeons.
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Affiliation(s)
- Lucinda Dale
- School of Occupational Therapy, University of Indianapolis Indianapolis, IN, USA
| | - Jordan Fiedler
- School of Occupational Therapy, University of Indianapolis Indianapolis, IN, USA
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Al-Mohrej OA, Elshaer AK, Al-Dakhil SS, Sayed AI, Aljohar S, AlFattani AA, Alhussainan TS. Work-related musculoskeletal disorders among Saudi orthopedic surgeons: a cross-sectional study. Bone Jt Open 2020; 1:47-54. [PMID: 33215107 PMCID: PMC7659643 DOI: 10.1302/2633-1462.14.bjo-2020-0005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Studies have addressed the issue of increasing prevalence of work-related musculoskeletal (MSK) pain among different occupations. However, contributing factors to MSK pain have not been fully investigated among orthopaedic surgeons. Thus, this study aimed to approximate the prevalence and predictors of MSK pain among Saudi orthopaedic surgeons working in Riyadh, Saudi Arabia. METHODS A cross-sectional study using an electronic survey was conducted in Riyadh. The questionnaire was distributed through email among orthopaedic surgeons in Riyadh hospitals. Standardized Nordic questionnaires for the analysis of musculoskeletal symptoms were used. Descriptive measures for categorical and numerical variables were presented. Student's t-test and Pearson's χ2 test were used. The level of statistical significance was set at p ≤ 0.05. RESULTS The response rate was 80.3%, with a total number of 179 of Saudi orthopaedic surgeons (173 males and six females). Of our sample, 67.0% of the respondents complained of having MSK pain. The most commonly reported MSK pain was lower back (74.0%), followed by neck (58.2%). Age and body mass index were implicated in the development of more than one type of MSK pain. Increased years of experience (≥ 6 years) was linked to shoulder/elbow, lower back, and hip/thigh pain. Smoking is widely associated with lower back pain development, whereas physicians who do not smoke and exercise regularly reported fewer pain incidences. Excessive bending and twisting during daily practice have been correlated with increased neck pain. CONCLUSION MSK pain was found to be common among Saudi orthopaedic surgeons. Further extensive research should be conducted to understand and analyze the risk factors involved and search for possible improvements to avoid further complications. However, ergonomics education during surgical training could be effective at modifying behaviors and reducing MSK pain manifestations.
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Affiliation(s)
- Omar A. Al-Mohrej
- Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | | | - Sahar S. Al-Dakhil
- Department of Orthopedic Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - AlBraa I. Sayed
- Department of Orthopedic Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Seham Aljohar
- Biostatistics Unit, Epidemiology and Scientific computing Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Areej A. AlFattani
- Biostatistics Unit, Epidemiology and Scientific computing Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Thamer S. Alhussainan
- Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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Abstract
Introduction Orthopaedic surgeons are significantly predisposed to musculoskeletal injury, and these injuries can have negative effects on surgeon function and patient outcomes. While this phenomenon has been studied in the non-Asian population of surgeons, no study has been carried out in the local or regional Asian setting. The aim of this study was to determine the prevalence, characteristics and associations of occupational injuries in orthopaedic surgeons and residents, and to assess its functional impact. Materials and Methods The Nordic Musculoskeletal Questionnaire was sent out to all orthopaedic consultants and residents at two institutions in Singapore, via an email link to an online survey. Separately, further questions on symptom description, severity and treatment were surveyed. Additional information like age, gender, height and weight were obtained as well. Results A total of 87.5% respondents have at least one injury. Neck symptoms (66.1%) were the most prevalent, and back symptoms had the highest median severity score (4.5/10). The 74.1% of these injuries were reported as directly attributable to work. Age was found to be associated with an increase in the total number of anatomical areas affected (p = 0.016). A seated operating position was associated with more severe back pain (p = 0.040). Conclusion There is a high prevalence of occupational injuries sustained in our population of orthopaedic surgeons. Neck symptoms, followed by back and wrist symptoms, were the predominant symptoms in our population. Targeted ergonomic interventions may be considered to prevent specific musculoskeletal injuries in our population of orthopaedic surgeons.
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Affiliation(s)
- Ksk Tan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Ebk Kwek
- Department of Orthopaedic Surgery, Woodlands Health Campus, Singapore
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Ergonomics in Dermatologic Surgery: Lessons Learned Across Related Specialties and Opportunities for Improvement. Dermatol Surg 2019; 46:763-772. [PMID: 31876576 DOI: 10.1097/dss.0000000000002295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND As the practice of dermatology becomes increasingly procedurally based, there is a concordant rise in musculoskeletal injury (MSI) risk. Dermatologic surgeons are most susceptible and, although the majority suffer from MSI, few have received any formal ergonomics training. This stems from a lack of awareness of this troubling trend and a paucity of research and education on the ergonomics of dermatologic surgery. OBJECTIVE To highlight pertinent ergonomics principles and strategies from other specialties that could be translated into dermatology, and to synthesize general recommendations aimed at reducing MSI among dermatologic surgeons. MATERIALS AND METHODS A comprehensive search of the PubMed and Cochrane Reviews databases from 1975 to 2019 was conducted, using a combination of ergonomics-related search terms, generating 6 publications from the dermatology literature and 58 from the fields of dentistry, medicine, and select surgical subspecialties. RESULTS This multidisciplinary approach yielded multiple interventions that could be applied directly (i.e., adequate lighting, adjustable operating tables, and surgical seat heights) or indirectly pending further investigation into their feasibility (i.e., video displays of the surgical field to allow neutral head and neck postures). CONCLUSION Although much can be learned from decades of prior ergonomics research from other specialties, considerations that are unique to dermatology remain and must be addressed with specialty-specific research.
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Work-Related Musculoskeletal Discomfort and Injury in Craniofacial and Maxillofacial Surgeons. J Craniofac Surg 2019; 30:1982-1985. [PMID: 31369503 DOI: 10.1097/scs.0000000000005631] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Long, complex surgical procedures with non-ergonomic postures, headlights, loupe magnification, and microscope use may put craniofacial and maxillofacial surgeons at an increased risk of work-related musculoskeletal discomfort (WRMD). Identifying the prevalence and impact of WRMD may guide preventive strategies to prolong well-being, job satisfaction, and career duration. METHODS A 31-question survey was designed to evaluate WRMD. The survey was sent to American Society of Craniofacial Surgeons and American Society of Maxillofacial Surgeons members. The survey was created and distributed electronically through a private survey research center (Qualtrics Survey Software). RESULTS There were 95 respondents (23.75% response rate): 75% male, 56% aged 31 to 50 years old, and 73% in academic practice. On a scale of 0 to 10 (0 no pain, 10 worst pain), WRMD for surgery without loupes/microscope had a median of 3, with loupes 4, and with microscope 5. Pain was most common in the neck. Pain within 4 hours of surgery was present in 55% and 38% feared pain would influence future surgical performance. Surgeon discomfort affects posture (72%), stamina (32%), sleep (28%), surgical speed (24%), relationships (18%), and concentration (17%). Medical treatment for discomfort was sought by 22%. Time off work for treatment occurred in 9%. CONCLUSION The WRMD can affect many aspects of a craniofacial or maxillofacial surgeon's life and has the potential to shorten or end a career. Occupational health and surgical ergonomics should be emphasized during surgical training and in surgical practice.
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Changing practice patterns: flexed versus semi-extended positioning for tibial nailing. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Berlusconi M, Moretti B, Vicenti G. Management of severe bone and soft-tissue loss: A series of case reports from AO Trauma-Italy. Injury 2018; 49 Suppl 4:S1. [PMID: 30526945 DOI: 10.1016/j.injury.2018.11.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Marco Berlusconi
- University of Bari, Department of Orthopedics and Trauma, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Biagio Moretti
- University of Bari, Department of Orthopedics and Trauma, Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Giovanni Vicenti
- University of Bari, Department of Orthopedics and Trauma, Piazza G. Cesare 11, 70124 Bari, Italy
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Patient Positioning During In-Office Otologic Procedures Impacts Physician Ergonomics. Otol Neurotol 2018; 39:e883-e888. [DOI: 10.1097/mao.0000000000001961] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wartski M, Williams CM, Broughton NS, Bowles KA. Quantifying the lumbar spine movements of surgeons during surgical lists in a teaching hospital. ANZ J Surg 2018; 89:153-158. [DOI: 10.1111/ans.14812] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/27/2018] [Accepted: 07/17/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Michelle Wartski
- Department of Surgery; Peninsula Health; Melbourne Victoria Australia
| | - Cylie M. Williams
- Department of Allied Health; Peninsula Health; Melbourne Victoria Australia
- Department of Physiotherapy; Monash University; Melbourne Victoria Australia
| | - Nigel S. Broughton
- Department of Surgery; Peninsula Health; Melbourne Victoria Australia
- Department of Surgery, Central Clinical School; Monash University; Melbourne Victoria Australia
| | - Kelly-Ann Bowles
- Department of Community Emergency Health and Paramedic Practice; Monash University; Melbourne Victoria Australia
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Thamyongkit S, Bachabi M, Thompson JM, Shafiq B, Hasenboehler EA. Use of reprocessed external fixators in orthopaedic surgery: a survey of 243 orthopaedic trauma surgeons. Patient Saf Surg 2018; 12:10. [PMID: 29930708 PMCID: PMC5991444 DOI: 10.1186/s13037-018-0156-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background The increasing financial burden of orthopaedic implants on our health care system has prompted cost-control measures, such as implant reprocessing. The purpose of this study was to describe the current usage by orthopaedic trauma surgeons of reprocessed external fixators (EFs) for treatment of complex fractures. Methods A 16-question survey about use and perceptions of reprocessed EFs was distributed to 894 Orthopaedic Trauma Association members between August 2016 and June 2017 using a web-based survey system. Results The authors received 243 responses (27%). Thirty-seven percent of respondents reported using reprocessed EFs. Nonprofit hospitals used reprocessed EFs more commonly than did for-profit hospitals (41% vs 15%, P = .0004). Eighty-seven percent of respondents believed reprocessing could be cost-effective. The most common reason (32%) for not using reprocessed EFs was coordination/logistics of reprocessing. Concern about litigation was also reported as a main reason for not using (20%) or having recently stopped using (21%) reprocessed EFs. Conclusions Many orthopaedic traumatologists are interested in the reprocessing of EF components but few have reprocessing systems in place at their institutions. A major barrier to implementation is concern about litigation, which is likely unwarranted on the basis of Food and Drug Administration approval and a lack of previous litigation. Reprocessing by the original device manufacturers has yielded substantial savings at our institution and is an example of the cost savings that can be expected when implementing an EF reprocessing system.
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Affiliation(s)
- Sorawut Thamyongkit
- 1Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., Baltimore, MD 21224 USA.,2Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchatewi, Bangkok, 10400 Thailand
| | - Malick Bachabi
- 1Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., Baltimore, MD 21224 USA
| | - John M Thompson
- 1Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., Baltimore, MD 21224 USA
| | - Babar Shafiq
- 1Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., Baltimore, MD 21224 USA
| | - Erik A Hasenboehler
- 1Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., Baltimore, MD 21224 USA
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Grozdanovic D, Grozdanovic M. Research on Key Indicators in Modern Surgical Practice Assessment: Ergonomic Approach. Surg Innov 2018; 25:323-332. [PMID: 29726307 DOI: 10.1177/1553350618772720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
It is undeniable that fundamental requirements in surgery refer to the adequate use of medical knowledge (eg, clinical knowledge and technical skills). However, this knowledge and skills of surgeons should be supplemented with synergetic research of capabilities of surgeons, operating rooms (ORs), and nontechnical skills. In this article, by using expert research, we presented 15 key indicators in surgical practice assessment. Communication efficiency in the OR has been ranked as the first and most important among indicators using the fuzzy analytic hierarchy process method. Within the analysis of this indicator, we have shown a new method that provided us with the results describing the extent of communication, the correlation in the communication system, surgeon workload uniformity, and isolation of individual surgeons in the OR. The goal of this research is aimed at the increase of operator efficiency in the OR. It is necessary that results of this kind of research find their practical use and become an obligatory element in the construction of new ORs as well as reconstruction of old ORs.
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Does the Full Power-Assisted Technique Used in Pedical Screw Placement Affect the Safety and Efficacy of Adolescent Idiopathic Scoliosis Surgery? World Neurosurg 2018; 116:e79-e85. [PMID: 29684515 DOI: 10.1016/j.wneu.2018.04.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/06/2018] [Accepted: 04/07/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND The new full power-assisted (FPA) technique used in pedicle screw placement during adolescent idiopathic scoliosis (AIS) surgery streamlines the surgical procedure and reduces repetitive surgeon tasks. However, the use of the FPA technique may also negatively affect the surgical safety and efficacy of patients with AIS. OBJECTIVE The purpose of this study was to investigate the effect of the FPA technique on the accuracy of pedicle screw placement, as well as on operating time, blood loss, and clinical outcomes. METHODS A total of 105 patients with AIS with major thoracic curves treated with posterior instrumentation and fusion were randomized into 2 groups. With the new FPA technique, 427 pedicle screws were implanted in the thoracic region in 35 patients (the FPA group), and using the conventional freehand (FH) technique, 896 screws were implanted in 70 patients (the FH group). The primary end point screw position was assessed using postoperative computed tomography. Secondary end points, such as operative time, blood loss, and clinical outcomes, were also assessed. RESULTS The FPA technique did not significantly affect the accuracy rate of the pedicle screw placement, scoliosis correction, total operating time, or total blood loss. However, the surgical times for the screw insertion phase and for each screw placement were significantly shorter for the FPA group compared with the FH group (P < 0.001). CONCLUSIONS Compared with the conventional manual tools, use of the FPA technique seemed to be superior and had relatively shorter pedicle screw placement times, with comparable surgical safety and efficacy for patients with AIS.
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Rui M, Lee JE, Vauthey JN, Conrad C. Enhancing surgical performance by adopting expert musicians' practice and performance strategies. Surgery 2018; 163:894-900. [DOI: 10.1016/j.surg.2017.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/14/2017] [Accepted: 09/25/2017] [Indexed: 01/26/2023]
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Epstein S, Sparer EH, Tran BN, Ruan QZ, Dennerlein JT, Singhal D, Lee BT. Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists: A Systematic Review and Meta-analysis. JAMA Surg 2018; 153:e174947. [PMID: 29282463 DOI: 10.1001/jamasurg.2017.4947] [Citation(s) in RCA: 226] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Importance Physicians in procedural specialties are at high risk for work-related musculoskeletal disorders (MSDs). This has been called "an impending epidemic" in the context of the looming workforce shortage; however, prevalence estimates vary by study. Objectives To estimate the prevalence of work-related MSDs among at-risk physicians and to evaluate the scope of preventive efforts. Data Sources and Study Selection Systematic search in MEDLINE (Ovid), Embase (Elsevier), Web of Science, PubMed (National Center for Biotechnology Information), and 2 clinical trial registries, without language restriction, for studies reporting on the prevalence and prevention of work-related MSDs among at-risk physicians published until December 2016. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines for meta-analyses and systematic reviews of observational studies were used. At-risk physicians were defined as surgeons and medical interventionalists. Studies reporting on specific disorders or pain assessed with validated instruments were included. Data Extraction and Synthesis Study characteristics; disease prevalence for the neck, shoulder, back, and upper extremity; and measures of resulting disability were recorded. Study estimates were pooled using random-effects meta-analytic models. Main Outcomes and Measures Career prevalence of injuries and 12-month prevalence of pain. Results Among 21 articles (5828 physicians [mean age, 46.0 years; 78.5% male; 12.8 years in practice; 14.4 hours performing procedures per week]) included in this systematic review and meta-analysis, pooled crude prevalence estimates of the most common work-related MSDs were degenerative cervical spine disease in 17% (457 of 2406 physicians) (95% CI, 12%-25%), rotator cuff pathology in 18% (300 of 1513 physicians) (95% CI, 13%-25%), degenerative lumbar spine disease in 19% (544 of 2449 physicians) (95% CI, 5%-16%), and carpal tunnel syndrome in 9% (256 of 2449 physicians) (95% CI, 5%-16%). From 1997 to 2015, the prevalence of degenerative cervical spine disease and degenerative lumbar spine disease increased by 18.3% and 27%, respectively. Pooled prevalence estimates for pain ranged from 35% to 60% and differed by assessment instrument. Of those with a work-related MSD, 12% (277 of 2319 physicians) (95% CI, 7%-18%) required a leave of absence, practice restriction or modification, or early retirement. Heterogeneity was considerable for all crude analyses (mean I2 = 93.5%) but was lower for sensitivity analyses (mean I2 = 72.3%). Interventions focused on products and behaviors. Twelve at-risk specialties described a gross lack of awareness and an unmet need for ergonomics education. Conclusions and Relevance Prevalence estimates of work-related MSDs among at-risk physicians appear to be high. Further research is needed to develop and validate an evidence-based applied ergonomics program aimed at preventing these disorders in this population.
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Affiliation(s)
- Sherise Epstein
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Division of Plastic Surgery and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Emily H Sparer
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Bao N Tran
- Division of Plastic Surgery and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Qing Z Ruan
- Division of Plastic Surgery and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jack T Dennerlein
- Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Dhruv Singhal
- Division of Plastic Surgery and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Bernard T Lee
- Division of Plastic Surgery and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Dianat I, Bazazan A, Souraki Azad MA, Salimi SS. Work-related physical, psychosocial and individual factors associated with musculoskeletal symptoms among surgeons: Implications for ergonomic interventions. APPLIED ERGONOMICS 2018; 67:115-124. [PMID: 29122182 DOI: 10.1016/j.apergo.2017.09.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 06/07/2023]
Abstract
This study evaluated the effect of physical, psychosocial and individual factors on the presence of musculoskeletal symptoms (MSS) among surgeons (n = 312) in Iran. Data were collected using questionnaires and analysed by multivariate logistic regression. The prevalence of MSS, particularly in the knees (48.7%), neck (45.8%), low back (42.3%) and shoulders (40.1%) was relatively high. Work-related factors including time spent on surgeries each week (>25 h/week), number of hours working in standing position per day (>4 h/day), moderate to high levels of work-family conflict, duration of each surgery (>3 h), number of years worked as a surgeon (>10 years) and surgical specialty (particularly cardiothoracic and obstetric/gynecologic surgeries) were independently associated with the presence of MSS in different body regions. Individual factors including gender (being female) and little or no involvement in sport and physical activity were also independently associated with the occurrence of complaints. Implications of the findings for further research and development work for improving the working conditions and consequently reducing MSS among this working group are discussed.
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Affiliation(s)
- Iman Dianat
- Department of Occupational Health and Ergonomics, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ahmad Bazazan
- Department of Occupational Health and Ergonomics, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran.
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Norheim EP, Black MH, Ngor EW, Shi JM, Safran MR, Navarro RA. Cervical spine disease in surgeons performing arthroscopy or laparoscopy. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2017; 74:206-214. [PMID: 29035681 DOI: 10.1080/19338244.2017.1392277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/06/2017] [Indexed: 06/07/2023]
Abstract
Minimal research exists regarding cervical spine disorders in surgeons who perform endoscopy. A confidential on-line survey regarding neck pain (NP), spine disease (SD), and radiculopathy/myelopathy (R/M) was sent to 722 surgeons from a managed, group-based health care system. 415 responded. 361 had endoscopy experience, of whom 24.4% had NP, 20.8% SD, and 3.9% R/M. Most respondents were less than 50 years of age (62.3%), and male (65.7%). Significant risk factors for NP included older age and female, whereas OB/Gyn specialty, increased age and job stress were for SD. After adjusting for age and gender, significant risk factors for NP and SD included greater surgeon experience. After also adjusting for job stress, significant risk factors for SD included increased surgeon experience and higher frequency of endoscopies. No association was found between use of digital OR. Endoscopy appears to place surgeons at higher risk of cervical disease. Level of Evidence: Level 3.
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Affiliation(s)
- Elizabeth P Norheim
- a Southern California Permanente Medical Group, Kaiser Permanente, Downey Medical Center, Spine Surgery , Downey , California , USA
| | | | - Eunis W Ngor
- b Kaiser Foundation Health Plan , Pasadena , California , USA
| | - Jiaxiao M Shi
- b Kaiser Foundation Health Plan , Pasadena , California , USA
| | - Marc R Safran
- c Stanford Hospital and Clinics , Stanford , California , USA
| | - Ronald A Navarro
- d Southern California Permanente Medical Group, Kaiser Permanente, South Bay Medical Center , Harbor City , California , USA
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Gans I, Jain A, Sirisreetreerux N, Haut ER, Hasenboehler EA. Current practice of antibiotic prophylaxis for surgical fixation of closed long bone fractures: a survey of 297 members of the Orthopaedic Trauma Association. Patient Saf Surg 2017; 11:2. [PMID: 28105080 PMCID: PMC5240258 DOI: 10.1186/s13037-016-0118-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 12/28/2016] [Indexed: 01/31/2023] Open
Abstract
Background The risk of postoperative surgical site infection after long bone fracture fixation can be decreased with appropriate antibiotic use. However, there is no agreement on the superiority of a single- or multiple-dose perioperative regimen of antibiotic prophylaxis. The purpose of this study is to determine the following: 1) What are the current practice patterns of orthopaedic trauma surgeons in using perioperative antibiotics for closed long bone fractures? 2) What is the current knowledge of published antibiotic prophylaxis guidelines among orthopaedic trauma surgeons? 3) Are orthopaedic surgeons willing to change their current practices? Methods A questionnaire was distributed via email between September and December 2015 to 955 Orthopaedic Trauma Association members, of whom 297 (31%) responded. Results Most surgeons (96%) use cefazolin as first-line infection prophylaxis. Fifty-nine percent used a multiple-dose antibiotic regimen, 39% used a single-dose regimen, and 2% varied this decision according to patient factors. Thirty-six percent said they were unfamiliar with Centers for Disease Control and Prevention (CDC) antibiotic prophylaxis guidelines; only 30% were able to select the correct CDC recommendation from a multiple-choice list. However, 44% of surgeons said they followed CDC recommendations. Fifty-six percent answered that a single-dose antibiotic prophylaxis regimen was not inferior to a multiple-dose regimen. If a level-I study comparing a single preoperative dose versus multiple perioperative antibiotic dosing regimen for treatment of closed long bone fractures were published, most respondents (64%) said they would fully follow these guidelines, and 22% said they would partially change their practice to follow these guidelines. Conclusion There is heterogeneity in the use of single- versus multiple-dose antibiotic prophylaxis for surgical repair of closed long bone fractures. Many surgeons were unsure of current evidence-based recommendations regarding perioperative antibiotic use. Most respondents indicated they would be receptive to high-level evidence regarding the single- versus multiple-dose perioperative prophylactic antibiotics for the treatment of closed long bone fractures. Electronic supplementary material The online version of this article (doi:10.1186/s13037-016-0118-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Itai Gans
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline Street, Baltimore, MD 21287 USA
| | - Amit Jain
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline Street, Baltimore, MD 21287 USA
| | - Norachart Sirisreetreerux
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline Street, Baltimore, MD 21287 USA
| | - Elliott R Haut
- Department of Surgery, Division of Acute Care Surgery, The Johns Hopkins Hospital, 600 N Wolfe Street, Baltimore, MD 21287 USA
| | - Erik A Hasenboehler
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline Street, Baltimore, MD 21287 USA
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Alzahrani MM, Alqahtani SM, Tanzer M, Hamdy RC. Musculoskeletal disorders among orthopedic pediatric surgeons: an overlooked entity. J Child Orthop 2016; 10:461-466. [PMID: 27538942 PMCID: PMC5033786 DOI: 10.1007/s11832-016-0767-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 08/05/2016] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Forceful and repetitive maneuvers constitute the majority of pediatric orthopedic surgical tasks, thus subjecting surgeons to the risk of musculoskeletal (MSK) injuries during their years in practice. The aim of this study was to assess the prevalence, characteristics and impact of MSK disorders among pediatric orthopedic surgeons. METHODS A modified version of the physical discomfort survey was sent to surgeons who were members of the Pediatric Orthopedic Society of North America (POSNA) via e-mail. The collected data were analyzed using descriptive statistics, one-way analysis of variance, and Fisher's exact test. p values of <0.05 were considered statistically significant. RESULTS Of the 402 respondents, 67 % reported that they had sustained a work-related MSK injury, of which the most common diagnoses were low back pain (28.6 %) and lateral elbow epicondylitis (15.4 %). Among those which reported an injury, 26 % required surgical treatment and 31 % needed time off work as a direct result of their injury. The number of work-related injuries incurred by a surgeon increased significantly with increasing age (p < 0.001), working in a non-academic institute (p < 0.05), working in more than one institute (p < 0.05), and being in active practice for >21 years (p < 0.05). The need to undergo treatment or take time off due to the injury was associated with increased number of injuries (p < 0.001). In addition, surgeons were more likely to require time off work when they were >56 years of age (p < 0.001), had been in practice for >21 years (p < 0.001), required surgical management of their disorder (p < 0.001), and had experienced an exacerbation of a previous disorder (p < 0.001). DISCUSSION AND CONCLUSION This study is the first of its kind to assess MSK injuries sustained by pediatric orthopedic surgeons. The high incidence of these disorders may place a financial and psychological burden on these surgeons and thus the healthcare system. These results should shed a light on awareness and the need for further studies to prevent and help decrease the incidence of these disorders not only in orthopedic surgeons but also in the surgical population in general.
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Affiliation(s)
- Mohammad M. Alzahrani
- Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, 2000 Drummond, Apt.1203, Montreal, QC H3G 2X1 Canada ,Division of Orthopaedic Surgery, McGill University, Montreal, QC Canada ,Department of Orthopaedic Surgery, University of Dammam, Dammam, Saudi Arabia
| | - Saad M. Alqahtani
- Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, 2000 Drummond, Apt.1203, Montreal, QC H3G 2X1 Canada ,Division of Orthopaedic Surgery, McGill University, Montreal, QC Canada ,Department of Orthopaedic Surgery, University of Dammam, Dammam, Saudi Arabia
| | - Michael Tanzer
- Division of Orthopaedic Surgery, McGill University, Montreal, QC Canada
| | - Reggie C. Hamdy
- Division of Orthopaedic Surgery, Shriners Hospital for Children, Montreal Children Hospital, McGill University, 2000 Drummond, Apt.1203, Montreal, QC H3G 2X1 Canada ,Division of Orthopaedic Surgery, McGill University, Montreal, QC Canada
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