Israel Medical Association Journal

Background: Pain following arthroscopic partial meniscectomy (APM) varies considerably among patients. Previous studies have suggested that gender and ethnicity may influence postoperative pain after orthopedic procedures. However, limited evidence exists regarding pain differences between Arab and Jewish patients after APM.

Objectives: To evaluate the association of gender and ethnicity with postoperative pain and analgesic consumption during the first month after APM.

Methods: Patients who underwent primary APM between 2018 and 2019 were retrospectively identified and stratified by gender and ethnicity. Intraoperative findings, including meniscal tear type and cartilage injury, were recorded. Postoperative pain was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS), analgesic consumption was quantified in grams, and pain sensitivity was evaluated with the Pain Sensitivity Questionnaire (PSQ). Outcomes were analyzed weekly during the first postoperative month.

Results: In total, 99 patients were included (65 men, 34 women; 39 Arabs, 60 Jews), comprising 22 Arab men, 43 Jewish men, 17 Arab women, and 17 Jewish women. Women reported lower KOOS scores and consumed more analgesics during weeks 3 and 4. Arab patients also demonstrated lower KOOS scores, higher PSQ scores, and greater analgesic consumption at selected postoperative intervals. Combined analysis showed an additive effect of gender and ethnicity, with Arab women reporting the poorest pain outcomes.

Conclusions: Female gender and Arab ethnicity were associated with greater postoperative pain and increased analgesic requirements after APM. These factors should be considered when tailoring postoperative pain management, although baseline differences and cultural influences may partially explain the associations.

Background: Data on how the coronavirus disease 2019 (COVID-19) affected consultations in ophthalmic departments are sparse.

Objectives: To examine the epidemiology of ophthalmic consultations in a large pediatric emergency medicine department (PED) during the first nationwide COVID-19 lockdown in Israel.

Methods: The database of a tertiary pediatric medical center was retrospectively reviewed for patients aged < 18 years who attended the PED from 17 March to 30 April 2020 (first COVID-19 lockdown) and the corresponding period in 2019. Background, clinical, and disease-related data were collected from the medical charts and compared between groups.

Results: The study included 757 PED visits. There were no significant differences in demographics between the groups. The 2020 period was characterized by a decrease in PED visits (by 52%), increase in arrivals during late afternoon and evening (P = 0.013), decrease in visits of older children (age 5–10 year), and proportional increase in younger children (age 1–5 years) (P = 0.011). The most common diagnoses overall and during each period was trauma followed by conjunctivitis and eyelid inflammation. The mechanisms of trauma differed (P = 0.002), with an increase in sharp trauma and decrease in blunt trauma in 2020 (P < 0.001 for both). In 2020, 95% of traumatic events occurred in the home compared to 54% in 2019 (P < 0.001).

Conclusions: Parents need to learn appropriate preventive and treatment measures to prevent serious and long-term ophthalmic injury while minimizing their exposure to the COVID-19. PEDs and ophthalmic pediatric clinics should consider increasing use of telemedicine and the availability of more senior physicians as consultants during such times.

Background: A clavicular fracture accounts for 2.6%–5% of adult fractures. Fractures in the middle-third (OTA 15-B) represent 69%–82% of all clavicular fractures. There is no consensus among orthopedic surgeons regarding treatment for these fractures; many support conservative treatment even for displaced middle-third clavicular fractures, while others choose operative treatment.

Objectives: To assess the attitudes of orthopedic surgeons regarding treatment of displaced mid-shaft clavicular fractures.

Methods: We conducted a survey in which we interviewed orthopedic surgeons from various countries during the 2012 EFORT meeting in Berlin. The questionnaire included an X-ray of a displaced middle-third clavicular fracture, as well as questions regarding the surgeon’s proposed treatment plan.

Results: A total of 177 orthopedic surgeons completed the questionnaire; 49% preferred operative treatment for a displaced middle-third clavicular fracture. Among the orthopedic trauma specialists, 58% suggested operative treatment, as did 82% of shoulder specialists. Most surgeons preferred a locking plate for fixation.

Conclusions: The treatment approach for a displaced middle-third clavicular fracture seems to be evenly split between conservative and operative approaches. The tendency toward operative treatment was even more remarkable among orthopedic trauma specialists and shoulder specialists who completed the questionnaire. Most surgeons prefer a locking plate as a fixation system for this type of fracture.