Frank C. Wilson

Dislocation of the acromioclavicular joint. An end-result study.

The cases of 127 patients who had an acute dislocation of the acromioclavicular joint were studied. Fifty-two patients, with an average follow-up of 10.8 years, were managed operatively, and seventy-five patients, with an average follow-up of 9.5 years, were managed non-operatively. Using a rating system that included subjective, objective, and roentgenographic criteria, it did not appear that reduction of the acromioclavicular joint was necessary to obtain consistently good results. Operative management, using either coracoclavicular or acromioclavicular fixation, was associated with a higher rate of complications than non-operative treatment. The use of a sling for four weeks without reduction of the joint, followed by a graduated exercise program, led to acceptable clinical results. In patients who had persistent pain and stiffness of the acromioclavicular joint, or in whom symptomatic post-traumatic arthritis developed, resection of the distal part of the clavicle reliably produced significant improvement.

Antibiotic prophylaxis in experimental bone infections.

The rationale for the use of prophylactic antibiotics in clean orthopaedic surgery was explored by means of an experimental model suited to the investigation of (1) antibiotic penetration and persistence in operative hematomas in bone and (2) the effect of cephaloridine administration on standard wound infections. Cephaloridine was found to penetrate hematomas in bone readily and to persist there in bacteriocidal concentrations. When cephaloridine was given preoperatively, all wounds were converted to bacteriological sterility and did not become clinically infected. When cephaloridine was begun six hours or later after contamination, infection occurred uniformly.

Progressive Diaphyseal Dysplasia

Seven cases of progressive diaphyseal dysplasia in three generations of one family were observed and data presented. The affected grandfather had six children, all but one of whom are described as documented cases, the other being probably affected. One of the grandchildren is documented as a definite case and three of thirteen other grandchildren probably were affected. The characteristic features of the dysplasia are the roentgenographic appearance of bilaterally symmetrical diaphyseal cortical thickening and autosomal dominant inheritance.

The use of bacitracin irrigation to prevent infection in postoperative skeletal wounds. An experimental study.

In dogs, irrigation of contaminated osseous wounds with bacitracin eliminated clinical evidence of infection and significantly reduced the number of positive cultures and pathological evidence of infection when compared with dogs that received no treatment or irrigation with normal saline solution. The inocula contained more organisms than are introduced into a wound during an elective orthopaedic operation. The use of bacitracin in the prevention of postoperative Staphylococcus aureus infection of bone in humans may be justified.

Results of knee replacement with the Walldius prosthesis.An interim report

Fourty-two knees replaced with the Walldius prosthesis have been followed for an average of almost 6 years. The rating of the average knee on a 100 point clinical scale improved 29 points as a result of the procedure. Complications were carefully documented and were numerous, although relatively few affected the end result.

Total replacement of the knee in rheumatoid arthritis. A prospective study of the results of treatment with the Walldius prosthesis.

This paper describes a prospective study of replacement of the knee joint with the Walldius endoprosthesis in patients disabled by rheumatoid arthritis. Thirty knees in nineteen patients were so treated and followed for an average of almost three years after operation. Evaluation before and after operation on a subjective, objective, and roentgenographic basis, showed that pain, the most disabling symptom, was eliminated or reduced to non-disabling levels in all patients. The total range of knee motion was not improved, but a more useful arc of motion was obtained. Significant instability did not occur. All patients who were in a bed-chair status preoperatively were able to walk postoperatively. Although settling and loosening of both components of the prosthesis was observed, they did not cause symptoms, and within the time limits of this study did not correlate with the duration of follow-up. A large number of cases, observed under standardized conditions over a long period of time, will be required before a definitive evaluation of this procedure can be made.

Antibiotic Penetration of Experimental Bone Hematomas

An experimental model for the study of antibiotic penetration and persistence in skeletal hematomas has been described. The highest levels of penicillin in the hematoma and the longest persistence of penicillin in the hematoma occurred when the drug was given before and after the operation. With this regimen, bacteriocidal levels of penicillin were maintained in the hematoma for ten to eleven hours after the last dose. While penetration of a hematoma with inhibitory levels of penicillin administered within four days of operation has been demonstrated, no conclusions concerning the value of antibiotics in the prophylaxis of operative wound infection are warranted from this study. Further studies on infected hematomas are being done to elucidate that question.

Credentialing in medicine

This article describes the history and process of credentialing: accreditation of programs and certification of individual practitioners. Under accreditation, general (institutional) and discipline-specific requirements, both for residencies and fellowships, are considered, along with possible outcomes and the appeals mechanism for an unfavorable review. Under certification, the relationship between individual specialty boards and the American Board of Medical Specialties is defined, followed by a consideration of the principles underlying subspecialty certification and recertification. It is concluded that enforced standards of learning are one of the pillars of accountability upon which a profession must rest; that if medicine abdicates its responsibility to impose credible standards on itself, its place will be taken by very interested, but less knowledgeable, others; and that we must, therefore, rededicate ourselves to the requirement of reasonable standards as a professional obligation and use the best means possible to meet that responsibility.

Development and use of a second-year musculoskeletal organ-system curriculum: A forty-year experience

The rationale for a preclinical musculoskeletal course lies in the prevalence of musculoskeletal diseases, injuries, and disorders. More than 30% of Americans have a musculoskeletal condition requiring medical attention, and workers in the United States miss nearly 440 million days of work annually because of musculoskeletal injuries1. Musculoskeletal disorders cost the United States nearly 850 billion dollars yearly and are the leading cause of disability in the United States1. The economic impact of musculoskeletal disorders is also considerable. Yelin et al. estimated that the economic impact was nearly

The accreditation of graduate educational programs in orthopedic surgery

200 billion per year, or approximately 2.5% of the annual U.S. gross domestic product2. Moreover, many studies have demonstrated a substantial deficit in musculoskeletal knowledge among recent medical school graduates and other practitioners3-5. There have been calls to reform the preclinical musculoskeletal medical school curriculum6, as well as proposals for a core set of standards for musculoskeletal content7. Two recent studies have described the development of a self-contained preclinical musculoskeletal course for either first or second-year students8,9. Another recent study described the process of curricular reform in the first and second years of medical school without a self-contained musculoskeletal course10. Both were designed with input from educators in several different medical and basic-science specialties, as was ours. The University of Minnesota course included seventeen hours of lecture content, similar to the amount in our course (twenty hours). The authors cited their small-group experience as essential to the success of the course8. The Louisiana State University course spanned six weeks and included forty-four hours of lecture and seventeen hours of small-group teaching9. Both studies emphasized anatomy and physical diagnosis and found substantial improvement in musculoskeletal knowledge and physical examination …