Physician health is a global concern, with increasing research efforts directed towards the challenge. Australia has limited published specialty-specific well-being data for trainees and consultants in medicine and surgery. We measured distress in Australian Orthopaedic trainees using the Physician Well-Being Index (PWBI, MedEd Web Solutions) using an online anonymous survey sent by the Australian Orthopaedic Association. The survey response rate was 38% (88/230). Forty-four percent of survey respondents met criteria for distress. Self-reported burnout in the 30 days prior was reported by 63% of respondents. Fifty-eight percent of females and 41% of males met criteria for distress. Of the 19% or respondents identifying as an ethnic minority, 53% were distressed compared to 42% of those identifying as non-ethnic minority. Trainees without a mentor had a 50% distress rate compared to those with a mentor (37% distress rate). Twenty-five percent of all trainees wished they had picked a career outside of medicine and 16% wished they had pursued a medical career other than Orthopaedic Surgery. Of those trainees who had already passed the fellowship exam, 17% wished they had pursued a career outside of medicine and 21% wished they had pursued a medical career in an area other than Orthopaedic Surgery. These findings suggest concerning rates of career regret and gender-related trends in distress in Australian Orthopaedic trainees. Females may be over-represented in our results as 17% of the source population was female compared to 22% of respondents. Further research is required across all Australian specialties to gain further understanding of factors contributing to distress and to assist in the development of strategy to protect against physician burnout.
A new technique of trapeziometacarpal suspension arthroplasty is described. Suspension arthroplasty as a treatment for trape-ziometacarpal arthritis has been studied extensively in the literature, but only using relatively weak forms of tendon-bone fixation. Interference screw fixation for tendon grafts has been proven in other areas of the body such as the knee and shoulder. Our technique involves trapeziectomy and suspension arthroplasty using one half of the flexor carpi radialis tendon, left attached distally. A short segment (approximately 2 cm) is harvested and passed through a 4 mm drill hole in the proximal thumb metacarpal. This is accurately positioned using an initial K-wire and then a cannulated drill. Fixation is achieved with a 4 mm Bio-tenodesis screw (Arthrex) and enhanced using a 4/0 Fibrewire (Arthrex) Krackow suture weave. Due to the strength of fixation, no supplemental fixation is required and immobilisation is only used in the initial postoperative period. There is no need for additional support in the form of tendon interposition. Although these are preliminary results, this technique shows promise for an improvement in outcome for the surgical treatment of thumb carpometacarpal arthritis, compared to current methods
