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James Kasser, M.D.
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Fourth Session
Moderator: James Kasser, M.D.
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| Renn J. Crichlow, MD |
Mitchel Harris, MD |
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Depression in Orthopedic Trauma Patients: Prevalence, Severity and Etiology
Renn J. Crichlow, MD
Advisor: Mark Vrahas, MD
Discussor: Mitchel Harris, MD
This study enrolled and interviewed 161 orthopedic trauma patients
at MGH and BWH, then followed them after hospital discharge. Their depression was
evaluated with the S-MFA and PF-10 validated instruments, and compared with their
injury type and severity. Results: Clinically significant depression approaches 45%
in a diverse cohort of orthopedic trauma patients. Global disability and presence
of an open fracture were found to correlate with highest rates of depression.
Dr. Harris asked how the rates of PTSD might relate to the rates
of depression. He wondered why the depression rate for minor injuries was similar
to that for much more serious ones, and proposed it might be related to pre-existing
marginal status within society, so that they had less "reserve" after injury. Dr.
Boland compared this to a similar rate of situational depression among injured
athletes. Dr. Nunley suggested that socioeconomic data would improve the paper,
and asked when should we refer trauma patients for treatment of their depression.
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| Sean O. Rassman, MD |
Peter Millett, MD |
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Prevalence of Associated Injuries in Pediatric Anterior Cruciate Ligament Tears.
Sean O. Rassman, MD
Advisor: Mininder Kocher, MD
Discussor: Peter Millett, MD
Ninety-nine pediatric patients undergoing ACL reconstruction
were examined arthroscopically. Fifty three meniscal tears, 6 articular
cartilage lesions and 1 posterior cruciate ligament tear were seen. This rate
of other lesions found at surgery is similar to the rate for adults.
Dr. Millett observed that the bottom line of the paper was
that, as is the case with adults, other injuries must be suspected and
investigated in a child with an ACL injury. This is difficult because children
are hard to examine, but it is important since the risk of not operating must
be weighed against operative risk, considering all the injuries that may be
unrecognized before surgery. Dr. Nunley asked whether a series of patients
with pre and post surgical MRs could help determine the true incidence of the
these associated lesions.
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| Jason Tavakolian, MD |
Mininder Kocher, MD |
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Decision Analysis for Complex Proximal Humerus Fractures
Jason Tavakolian, MD
Advisor: David Ring, MD
Discussor: Mininder Kocher, MD
Using best-available data on outcomes of different treatment
methods for three and four part proximal humerus fractures, a decision analysis
tree was constructed to determine appropriate evidence-based treatment strategy.
Factors considered were the rate of AVN, the rate of malunion, salvage after
failed fixation, and satisfactory results after hemiarthroplasty. The model was
found to favor operative fixation at baseline for both three and four part
fractures. In sensitivity analysis, the decision was found to vary most strongly
with the rate of satisfactory results after hemiarthroplasty.
Dr. Kocher praised the author's quick grasp of an analysis
technique that many have found challenging. After asking some clarifying
questions about the details of the model's construction, he asked how the
model fit into the concept of shared decision-making, and suggested that a
simplified version of it could be used for shared decision making with a
patient.
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