Occupational injuries—such as carpal tunnel syndrome, back sprains, and torn ligaments—are a common complaint of patients who seek orthopaedic care. Many of the orthopaedic surgeons who provide that care may also sustain on-the-job injuries, according to a study recently published in The Journal of Bone & Joint Surgery.

To assess occupational injuries among orthopaedic surgeons, the study used an electronic survey that was sent to all of the orthopaedists in the state of Tennessee. Researchers found that nearly half of respondents had sustained one or more injuries at the workplace at some point in their careers. Among all respondents, 10 percent missed work due to workplace injuries, and 23 percent of those injured reported not having access to any institutional resources to support their recovery.

AAOS Now: Why did you conduct this study?

Dr. Sethi: Much of the impetus for the study came from the experience of my mentor here at Vanderbilt University, William T. Obremskey, MD, MPH, who is also one of the coauthors of the study.

Dr. Obremskey was stuck in the hand with an electrocautery knife while performing an amputation on a patient with necrotizing fasciitis. Dr. Obremskey later became critically ill with the same DNA strain of bacterial infection, which caused necrotizing fasciitis and toxic shock syndrome. He was in the intensive care unit for a week and almost died from this occupational injury.

After talking with him about his experience, I began to wonder whether on-the-job injuries occur more frequently in orthopaedics than we think. For example, I know three orthopaedic surgeons who have contracted hepatitis C from needlestick injuries that occurred while they were treating patients. One died of associated liver cancer. The other two eventually could return to the operating room only after prolonged antiviral therapy. And yet, if you look at the literature, there have been very few studies done on occupational injuries in physicians and no studies on orthopaedics. So, this is the first contribution to the literature on injuries in orthopaedists, which is an area that needs greater awareness.

AAOS Now: What did you keep in mind as you designed the electronic survey?

Dr. Sethi: We wanted to capture information about things such as the respondent’s subspecialty, practice setting, and length of time in practice, as well as some basic information about injuries sustained, such as the anatomic area (hand, back) that was injured. We also gathered some information about how the injury affected the surgeon in terms of days of work lost, as well as whether any institutional resources were available during recovery.

We wanted to strike the right balance between gathering detailed information and making sure the survey was an appropriate length for facilitating a good response rate. The longer the survey, the lower the response rate is likely to be. So, we asked respondents to identify the anatomic area of the injury, but did not collect information about the specific type of injury.

AAOS Now: What did you find? Were you surprised by any of the results?

Dr. Sethi: Of the 495 surveys we sent out, 140 surveys were returned, for a 28 percent response rate. Sixty-one of the surveys (44 percent) indicated that the surgeon had sustained at least one injury at the workplace. The anatomic areas associated with the greatest percentage of injuries were the hand (25 percent), the lower back (19 percent), and the neck (10 percent).

I expected a fair number of back and hand injuries, but I was surprised that 38 percent of injured respondents reported no institutional resources available to support them as they recovered. In addition, only about 25 percent of injured respondents said they had reported their injury to their institution. Based on this information, it seems that many orthopaedists have occupational injuries, but may not report them because they believe no reporting mechanism exists. That is quite shocking, considering how many systems are in place for other workers injured on the job, such as Workers’ Compensation.

These data showed that some of these injuries were significant, having an impact on operating room performance (Table 1) and causing the surgeon to lose 3 or 4 weeks of work. These results would suggest that we need to think about the resources available to orthopaedic surgeons, given that this volume of missed work may have economic implications for both the surgeons and their healthcare systems.

The likelihood of injury increased with the length of time in practice. So, surgeons who had practiced from 11 to 20 years or from 21 to 30 years were more likely to be injured than those in practice for 10 years or less.

AAOS Now: Based on your findings, what do you think needs to change regarding occupational injuries and orthopaedists?

Dr. Sethi: We need more awareness of this issue, as well as of the steps an orthopaedist can take to avoid occupational injuries. For example, because the hand and the back were the two anatomic areas with the most reported injuries, perhaps hospitals and training programs could educate orthopaedists about these injuries and provide strategies for preventing them.

We also need to address the problems of insufficient institutional resources for orthopaedic surgeons with occupational injuries. For example, large academic medical centers may have policies and procedures covering workplace injuries, but that may not be the case in smaller, private hospitals. As the shift to hiring physicians through hospitals and treating them as individual contractors continues, this may become an issue.

Orthopaedic surgeons also need to be aware of occupational risks so they can obtain appropriate insurance for short-or long-term disability. Surgeons also need to report any injuries, especially needlesticks or sharp sticks and obtain appropriate testing of patients and themselves.

Another reason to pay attention to occupational injuries among orthopaedists is that the number of patients needing care is increasing faster than the number of orthopaedists to treat them. That ratio will continue to get worse over time, as the population ages. So, it’s important to keep the orthopaedic workforce healthy.

AAOS Now: Are you planning additional research on this topic?

Dr. Sethi: Yes, we would like to go back to this group of respondents and collect specific data on their injuries. We are also considering doing a national survey on this issue.

As we move forward, we as orthopaedic surgeons need to stop and think about our own health. After all, if we are not in good health, we cannot care for patients.

Dr. Sethi’s co-authors for “Occupational Injury Among Orthopaedic Surgeons” include William T. Davis, BS; Vasanth Sathiyakumar, BA; A. Alex Jahangir, MD; and William T. Obremskey, MD, MPH.

Disclosure information: Dr. Sethi, Mr. Davis, Mr. Sathiyakumar, and Dr. Obremskey—no conflicts. Dr. Jahangir—Springer, Orthopaedic Trauma Association.

To read more about Dr. Obremskey’s illness, see “To the Edge and Back” in the October 2011 issue of AAOS Now.

Jennie McKee is a senior science writer for AAOS Now. She can be reached at mckee@aaos.org

Bottom Line

• A survey of orthopaedic surgeons in Tennessee found that 44 percent of respondents had sustained at least one injury at the workplace at some time in their career.
• The anatomic areas associated with the greatest number of injuries were the hand (25 percent) and the lower back (19 percent).
• More than a third of injured respondents reported that there were no institutional resources available to support them as they recovered from injury.
• The researchers call for greater awareness and institutional resources related to occupational injuries, geared to finding ways to prevent these injuries and supporting surgeons who sustain them.

Additional Information
Occupational Injury Among Orthopaedic Surgeons