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Intended Retained Surgical Item (RSI) Not a Problem? Think Again!

 

Intended Retained Surgical Item (RSI) – Not a Problem? Think Again!

As I was placing the last stitch of the skin closure on a total hip surgery, the tip of the needle broke off. To remove the 1-cm fragment, I would probably have to reopen part of the skin incision (which could increase the risk of prosthetic joint infection), would possibly have to convert from spinal to general anesthetic, and there would be additional radiation exposure for the patient. I had intended to leave the fragment, but the hospital where I practice informed me that I HAD to remove it prior to the patient leaving the OR. It made no difference to the hospital whether this was a broken drill bit, a needle fragment or any other RSI. I subsequently had to answer to the hospital’s Peer Review Committee.

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Opioid Counterpoint

 

Opioid Counterpoint

I read Dr. Ilahi’s recent Touch with interest and admiration and I applaud his efforts to reduce his patients’ need for strong opioids. With the recent attention focused on opioid abuse in America, reports like Dr. Ilahi’s are becoming more common, and there is a push for doctors to standardize their prescribing in order to reduce opioid usage. However, as an Orthopaedic Oncologist, I have some patients that require strong opioids. Do they require them because I have over-prescribed? No, they require them because they have a condition that results in severe pain. Should I try less potent drugs initially? Absolutely. But, I should also tailor a medical regimen on an individual, per patient basis.

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How I Avoid Prescribing Strong Opioids

 

How I Avoid Prescribing Strong Opioids

I haven’t prescribed any opiate stronger than codeine in over 3 years. Before that, my routine post-operative prescription was hydrocodone, which was fairly standard for U.S. orthopaedic surgeons. But after learning of the gross disparity in postoperative narcotic prescriptions here compared to other countries and given the changing attitudes in America regarding post injury/postoperative pain control, I was able to significantly reduce the strength of my opioid prescriptions.

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Spring Has Sprung!

 

Spring Has Sprung!

As the weather warms up, it is only natural that we all head outside for sunshine and fun, especially our kids. So, this seems like a good time to quickly review safety regarding a warm-weather favorite: trampolines.

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The Western Orthopaedic Foundation Announces Latest Resident Research Grant Recipient

 

The Western Orthopaedic Foundation Announces Latest Resident Research Grant Recipient

The Western Orthopaedic Foundation (WOF) is pleased to announce its first 2018 Resident Research Grant Recipient, Caitlin Rugg, MD of UC San Francisco. Dr. Rugg has been awarded a grant to study “The Impact of Early Sport Specialization on the Collegiate Athlete.” With young athletes participating in organized sports at an ever-increasing pace, there has been a growing number of injures as well as “specialization” in sports played year-round. This continuous activity may lead to injury patterns and biomechanical changes in the musculoskeletal system, warranting in-depth study of major clinical significance to orthopaedists.

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Maintenance of Certification - The Saga Continues

 

Maintenance of Certification – The Saga Continues

At the urging of state societies, such as the California Orthopaedic Association (COA), and regional societies, such as the Western Orthopaedic Association (WOA), the American Academy of Orthopaedic Surgeons (AAOS) has been working diligently with the American Board of Orthopaedic Surgery (ABOS) to push for changes to the unpopular Maintenance of Certification (MOC) program.

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Benefits of Membership: Through the Eyes of a Resident

 

Benefits of Membership: Through the Eyes of a Resident

As a fourth-year resident, there are many demands on my time. Nonetheless, when presented with an opportunity to serve the WOA, I wasted no time applying. I'm one of two residents currently serving on the WOA’s Board of Directors; I am in my second year on the Board.

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