Browsing by Author "Wagner, Russell MD"
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Item Improving Communication Skills in Orthopedic Residents: Dale Carnegie Experience(2016-03-23) Wagner, Russell MD; Ogunyanki, Fadeke; Chambers, HeatherBackground: Professionalism and communication skills have often been described as essential to quality patient care. In 1999, the ACGME introduced six areas of residency competency, one of which was communication skills. There have been many different approaches to implementing and improving residents’ communication skills by residency programs since that time. In this study we propose another possible approach for improving Orthopedic surgery residents’ communication skills through the Dale Carnegie Training Course. Methods: Six Orthopedic Surgery residents were randomly selected over a four-year period to attend the Dale Carnegie interpersonal communication skills training course. 360-degree (based on Clinical/Nursing/Admin Staff) and Faculty evaluations were collected for all residents, including those that did not attend the course, before and after the course. The results of the evaluations were then compared using analysis of variance (ANOVA) and analysis of covariance (ANCOVA) statistical test for continuous variables. Regression analysis was also performed to identify independent outcome predictors. P values generated with P Results: There was a statistically significant improvement in the 360-degree evaluations of residents that attended the course as compared with those that did not, p = 0.0015. There was no statistically significant improvement in faculty evaluation scores of residents that attended the course over those that did not, p= 0.1583. However, it appears that some residents that attended improved more than others, p= 0.0097, and perhaps gained more from the experience. Conclusions: Communication skills and professionalism are essential components of quality patient care and should be emphasized during medical education. The Dale Carnegie course could be considered as a possible effective tool for improving residents’ communication skills. Our study revealed a statistically significant improvement in the residents evaluations completed by nursing staff, clinic staff and other departments. This course is a time tested program with expansion to multiple franchises around the world, with consistent and reliable results. It may not be financially reasonable for residency programs to send every resident for this training, however, it might be utilized as an alternative for residents identified as “at risk” or those with noted poor communication skills by their program directors.Item Resident Total Knee Arthroplasty Training: The Protective Benefits of an Osteotome during Cruciate Retaining TKA(2016-03-23) Rabbani, Tebyan; Wood, Addison; Wagner, Russell MD; Sheffer, BenjaminResident Total Knee Arthroplasty Training: The Protective Benefits of an Osteotome during Cruciate Retaining TKA INTRODUCTION: The central objective of this study is to evaluate the effectiveness of a simple surgical technique to prevent PCL damage during performance of a posterior cruciate retaining (CR) total knee arthroplasty (TKA) surgery. This technique involves placement of an osteotome to prevent iatrogenic injury to the PCL by the sagittal saw blade during tibial resection. This simple technique can be useful to faculty members instructing novice residents or to senior surgeons looking to perform a low volume of CR TKA as an adjunct to their private practices. METHODS: We randomized 60 cadaveric specimens into two groups: Group I and Group II. Group I, 30 specimens, received standard tibial resections as performed during CR-TKA using a standard Y shaped PCL retractor. Group II, 30 specimens, received standard tibial resections as performed during CR-TKA using a standard Y shaped PCL retractor with the additional placement of a ½ inch osteotome. A board certified adult reconstructive orthopaedic surgeon, aligned the extramedullary tibial resection guide and positioned the osteotome. Posterior cruciate ligaments were assessed after completion of the procedures and removal of all instrumentation by 3 separate individuals to assess PCL damage. There were two states defined: PCL intact and PCL damaged. RESULTS: A difference in PCL damage was noted in 73% (22/30) of group I and in 23% (7/30) of group II. Group I was found to be twice more likely to have an injured PCL than Group II which used an osteotome for PCL protection. DISCUSSION AND CONCLUSION: Placement of an osteotome anterior to the PCL during CR-TKA provides a protective benefit to the patient. We speculate that the protective benefit could be increased by ensuring osteotome penetration is deeper than resection depth. This study simulated 60 tibial resections and may be applied to novice resident training.Item Single-stage bilateral distal femur replacement for traumatic distal femur fractures(2019-03-05) Sambhariya, Varun MD; Tran, Apollo; Rahman, Shawn; Dean, Thad DO; Wagner, Russell MD; Sanchez, Hugo MD, PhD; Neal, David MDBackground. Treatment of periprosthetic distal femur fractures and comminuted intraarticular distal femur fractures remains a difficult challenge for orthopedic surgeons. Previous case series have shown distal femur replacement (DFR) can effectively compensate for bone loss, relieve knee pain, and provide stability. However, bilateral injury treated with single stage DFR is rarely encountered and to our knowledge, there are no case reports in the literature. We present a patient with traumatic open left Su III/Rorabeck III periprosthetic distal femur fracture and closed right comminuted intraarticular distal femur fracture with end-stage arthrosis treated with bilateral DFR. We suggest that in elderly patients with similar injuries bilateral DFR can be a viable treatment option. Case Information. An 80-year-old female with past surgical history of left TKA in 2005 presented to our hospital after being involved in a motor vehicle collision resulting in open left periprosthetic distal femur fracture and a closed comminuted right intraarticular distal femur fracture with end-stage arthrosis. She also had a history of anemia and end-stage right knee arthritis for which she was planning a TKA in 2017. She was admitted by our geriatric trauma service for medical optimization prior to surgery. The on-call operative team planned open reduction internal fixation of the open left periprosthetic distal femur fracture after obtaining XR and CT. After making a lateral approach to the femur her fracture was found to be more comminuted than anticipated and the bone-prosthesis interface was not intact. An intraoperative decision was made to place an external fixator with referral to the arthroplasty service for evaluation for possible DFR. For the right distal femur fracture, closed reduction was performed with placement of a knee immobilizer. The patient was taken to the operating room on the 7th day post-admission for bilateral DFR. Postoperatively the patient was made weight bearing as tolerated to both lower extremities and worked with physical therapy daily. She is driving, maintaining her home, and living independently. On exam, her surgical incisions are well healed without evidence of infection. Knee range of motion is from 0-110 degrees bilaterally. One-year postoperative radiographs were obtained demonstrating unchanged alignment of her previously placed prostheses with no signs of loosening Conclusion. Bilateral DFR is a viable treatment option for Su III periprosthetic distal femur fractures and comminuted intraarticular distal femur fractures with previous arthritis. We suggest that in elderly patients with similar injuries, bilateral DFR can effectively compensate for bone loss, relieve knee pain, provide stability, and allow for earlier mobilization resulting in satisfactory patient outcomes.Item The Radiographic Prepatellar Fat Thickness Ratio Correlates with Infection Risk Following Total Knee Arthroplasty(2016-03-23) Wagner, Russell MD; McElroy, John; Burge, Ross; Mendez, SalvadorObesity is a known risk factor for surgical site infections (SSI) following total knee arthroplasty (TKA). Current methods use body mass index (BMI) to predict infection risk in patients. However, BMI may not be the most accurate predictor because it does not account for fat distribution and muscle mass is included in the calculation. We sought to assess the impact of subcutaneous fat at the surgical site on risk of infection following a TKA. It has been shown that fat tissue thickness expands without a complementary increase in blood flow, leaving subcutaneous tissue with reduced oxygenation. This wound hypoxia impairs healing by multiple mechanisms; healing wounds have high oxygen demands and leukocytes need oxygen to create reactive oxygen species against infection. We conducted a retrospective study of 530 patients who had TKAs at John Peter Smith Hospital (JPS) from 2006-2010. Pre-operative lateral knee radiographs for each patient were reviewed and measured. Both patellar thickness and prepatellar fat thickness were obtained. Soft tissue thickness was divided by the thickness of the patella to create the prepatellar fat thickness ratio (PFTR). Additionally, diabetes status, smoking status, gender, and BMI were obtained. The infection criteria used was 2 (+) cultures, or 1 (+) culture plus one of the following: gross purulence or [greater than] 10 PMNs/hfp. We expect the PFTR to be a significant predictor of SSI and more accurate than BMI in this regard. It may be beneficial to assess the PFTR in the preoperative evaluation to properly inform the patient of infection risk and allow the physician to take additional precautions to reduce the risk of infection.