A recently developed parametric geometrical finite element model (p-FEM) was adapted to the specific hip geometric measurements of a group of patients with slipped capital femoral epiphysis (SCFE). The objective was to analyze the stress distribution in the growth plate of these patients and to evaluate differences for those patients who developed bilateral disease.

Different geometric parameters were measured in the healthy proximal femur of 18 adolescents (mean age, 12,1 yr) with unilateral SCFE and in 23 adolescents matched in age without hip disease (control group). Five patients developed SCFE in the contralateral side during follow-up. Different geometric measurements were taken from hip conventional X-ray studies. The p-FEM of the proximal femur permits modifications of different geometrical parameters, therefore the X-ray measurements taken from each patient were applied to the model obtaining a subject-specific model for each case. In each model, different mechanical situations such as walking, stairs climbing and sitting were simulated by applying loads on the femoral head corresponding to each own weight. The risk for growth plate failure was estimated by the Tresca, von Misses and Rankine stresses.

In summary, the models shows important differences between the stresses computed at the healthy femurs of patients with unilateral SCFE and femurs that further underwent bilateral SCFE. So, the 95% confidence interval of the percentage of volume of the growth plate subjected to stresses higher than 2MPa was almost similar for the control group and patients with unilateral SCFE. However, those patients who developed bilateral disease had statistically significant large physeal areas with more than 2.0 MPa (p< 0.005). Stresses were also strongly dependent on the geometry of the proximal femur, especially on the posterior sloping angle of the physis and the physeal sloping angle.

In spite of simplifications of the developed p-FEM, this tool has been able to show the influence of femur geometry in growth plate stresses and to predict the sites where growth plate starts to fail.

Purpose: To determine the degree of burnout among resident physicians in orthopaedic surgery and traumatology departments in Spanish hospitals and the influence of various factors.

Materials and methods: Descriptive crossover study. The study population included all the resident physicians in orthopaedic surgery and traumatology departments in Spain. We sent an anonymous self-administered questionnaire, the Maslach Burnout Inventory, which assesses emotional exhaustion, depersonalisation and personal accomplishment, in addition to a number of sociodemographic, occupational and personal variables by means of a questionnaire.

Results: Replies were received from 63 orthopaedic surgery and traumatology resident physicians (8%). 47.6% of the participants presented a high degree of emotional exhaustion, 66.6% a high degree of depersonalisation and 38.1% a low degree of personal accomplishment. Among the variables studied we found a high degree of burnout related, among others, to female sex, poor department organisation, little appreciation of the resident’s work and little free time for family. 32.8% of the respondents would choose the same medical specialisation but in a different hospital, as compared to 62.3% who would choose the same specialisation and the same hospital.

Conclusions: The levels of burnout among resident physicians in orthopaedic surgery and traumatology departments in Spain are higher than among associate physicians in the same departments in Spain and than those found in two earlier studies among primary care physicians in Spain and among several medical specialisations internationally. Training activities are needed to alleviate this problem.

Introduction and Objectives: Orthopaedic surgery is associated with significant pain in the immediate postoperative period. Management of this pain often requires the administration of opiates. The goal of this study is to evaluate the efficacy of analgaesic treatment with intravenous morphine hydrochloride in a nurse-controlled analgaesia (NCA) system during the first day postoperative in children in general hospital wards.

Materials and Methods: The study included 69 consecutive patients, all under 6 years of age, who underwent scheduled orthopedic surgery. All patients were treated postoperatively using intravenous morphine hydrochloride using the NCA system according to the following protocol: loading dose: 50–100 μg/kg; continuous infusion: 10–20 μg/kg/h; bolus dosage: 4- μg/kg: closure time: 20”; maximum dose: 400 μg/kg/4h. The following variables were evaluated: 1). Intensity of pain: none = 0 / mild = 1 / moderate = 2 / very intense = 3; 2). Side effects: a) nausea and vomiting: none =0 / 1 episode in 4 hours = 1 / more than 1 episode in 4 hours = 2. b) Urinary retention: none = 0 / spontaneous micturition after less than 8 h = 1/ draining catheter required = 2; 3). Average morphine chloride dose/kg of weight.

Results: Average age was 24.3 months (range: 4 months – 6 years). Average weight: 12.7 kg. Results showed no case of excessive sedation or respiratory depression. Average morphine hydrochloride dosage per kg body weight was 365.5 μg (± 402.5 μg).

Discussion and Conclusions: The guidelines of our I.V. morphine hydrochloride protocol for NCA yielded satisfactory control of post-operative pain after trauma surgery in children under 6 years old. No major side effects were noted in our patients, and the protocol may be safely used.