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This “What’s Your Diagnosis?” radiograph (December 2011) generated reader response on its position and degree of wear.


Published 2/1/2012

Catching Up with What You Think

About being sued…
The article
“Avoiding a Lawsuit: Lessons from the Never Sued” (AAOS Now, October 2011) includes several suggestions on how to practice medicine (“be nice, be competent, be communicators, use check lists”). I believe these are excellent points on how to practice good medicine, but have little bearing on the chance of being sued.

As mentioned in another article in that same issue (“How Likely Are You to Be Sued?”), orthopaedic surgeons have a 99 percent chance of being sued by age 65. Many of these lawsuits are not directed at the “mean” doctors, but rather are from emergency department patients who never had a chance to build rapport with a doctor. Trauma patients often meet their doctor for the first time while intubated and unconscious.

It is also clear that the court system does a poor job of weeding out incompetent doctors. We can minimize our risk by following the examples of the “never-sued” doctors; after all, risk management would not exist if it had no benefit. The difference between the sued and the never-sued, however, is luck.
Craig Reigel, MD

Culpeper, Va.

About treating fractures…
The November 2011 front-page article (“
New Pediatric Supracondylar Humerus Fractures CPG”), prompted me to write. The simple fact is that Dr. Stanley Chung, as chief of orthopaedics at the old Children’s Hospital in Philadelphia, strongly proposed treating humeral fractures in precisely the same manner that is recommended in the new clinical practice guidelines—and that was 37 years ago!

I am stunned to see how slowly we learn—and that we not only learn at a tortoise-pace, but disseminate information at the same rate, even with wonderful organizations such as the AAOS and multiple others.
Walter J. Finnegan, MD, JD

Allentown, Pa.

About orthopaedic apps…
The AAOS Now app is excellent. I read most of my journals online. An app for each journal would be ideal. It allows me to utilize time between cases by accessing the articles on my smartphone ortablet PC. I thought some positive feedback would be nice.

Devin K. Datta, MD
Melbourne, Fla.

About physician and presidential payments…
I believe that if the increase in the payments to physicians is 1 percent, then the limit on all federal employees—including members of Congress (House and Senate) and the president—for all their office spending and wages should be limited to 1 percent as well. This should also include curtailing the president from using Air Force One for vacations, politicking, and running around and holding him to the same limitations placed on personal use of corporate jets. If he is not working 80 hours a week on the citizen affairs of this country, he needs to be more than just “present.”
Robert H. Horne, MD

Sandy, Utah

About “What’s Your Diagnosis?”…
Congratulations to Stuart J. Fischer, MD, on the case featured in
“What’s Your Diagnosis?” (AAOS Now, December 2011). The amount of polyethylene wear noted in the pictured liner is reflective of the wear associated with the polyethylene used at the time this total hip replacement was performed (18 years earlier according to Dr. Fischer), and not the highly crosslinked variety available and used today.

It would have been interesting to know the temporal relationship between the two radiographs shown. My guess is that they were taken several years apart. A radiograph of this hip made even a year before the patient was seen in the emergency department would quite likely have shown much more “poly” wear than can be seen in the earlier radiograph.
E. Anthony Rankin, MD

Washington, D.C.

I noticed that the second radiograph was read as stable position, but I measure 3 mm superior migration of the femoral head, which means excessive wear of the insert. That explains the cause of the fracture of the insert.
James J. Kim, MD

Buckhannon, W.Va.

Setting Now Straight

If you want to set AAOS Now straight, send your letters to the Editor, AAOS Now, 6300 N. River Rd., Rosemont, IL 60018; fax them to 847-823-8033; or email them to aaoscomm@aaos.org