Becker's Spine Review

6 SPINE "When you have a majority of men in the specialty, it's really difficult to see yourself doing this very physical surgery," Linda Suleiman, MD, associate dean for diversity and inclusion and assistant professor of orthopedic surgery and medical education at Northwestern University Feinberg School of Medicine in Chicago, told Becker's. "Historically people would say, 'Women don't want to do this because it's a very physical surgery,' and for those of us who are women in orthopedics, we have figured out how to make this surgery doable." So what happens to the women who are able to jump over these hurdles and actually become orthopedic surgeons? e barriers don't end when they become MDs. In some settings, workplace culture issues have caused female orthopedic surgeons and students to face harassment, bullying, macro and microaggressions, and sexual harassment. "It's always challenging to be the only one or the only one of a few," Corinna Franklin, MD, chief of pediatric orthopedic surgery at New Haven, Conn.-based Yale School of Medicine, told Becker's. "I think one of the hardest things intellectually and emotionally is feeling like you represent all women. As a student or a resident you may think, 'If I don't know this or if I do this poorly, it reflects badly on everyone.' As one of the few, you do feel added pressure to be a good role model." ough female representation in orthopedics remains low, the women who are currently in the field are lighting the path for the next generation of orthopedic leaders. "We need to continue to chip away at an environment in which the world expects that orthopedic surgeons are going to be white men," Jennifer Weiss, MD, treasurer of RJOS and American Academy of Orthopaedic Surgeons communications chair, told Becker's. "As the world sees how beneficial it is to have people of different genders, races, ethnicities and economic backgrounds, our care is going to get better and our patients will appreciate having the option to be cared for by surgeons who get them a little bit better." n Spine surgeon performs spinal fusion on 95-year-old patient By Carly Behm V ijay Yanamadala, MD, of Hartford (Conn.) HealthCare spoke with Becker's about a recent spine case he performed on an older patient. Note: This conversation was lightly edited for clarity. Question: You recently performed a spinal fusion on a 95-year-old patient. How did that case go? Dr. Vijay Yanamadala: So this gentleman, unbeknownst to him, had ankylosing spondylitis. He unfortunately had a fall at home really just from standing and had developed a bad three-column fracture of the thoracic spine. He came to the emergency room, fortunately still neurologically intact, and we did the imaging. So I had to do a multilevel fusion for him to stabilize this in the setting of ankylosing spondylitis. This was not an awake surgery. However, I'd love to do these types of surgeries awake, but we haven't necessarily started doing multilevel fusions awake. The man was 95 years old, and [we] did extensive preoperative optimization and clearance for him with our medical teams before we took him to surgery. Q: What was the biggest challenge with this procedure? VY: This was an extensive conversation with him and his family. He was high functioning, he was active, and what we said is that without getting surgery, he would basically be bed-bound because of this unstable fracture. You know, what we know about ankylosing spondylitis is if the patient really gets up and walks without stabilization, that patient could become paralyzed due to movement of the fracture and injury to the spinal cord. So we basically had that conversation and the patient said, "I'm used to being mobile. I'm used to being independent and living alone." So we wanted to really get him back to that functional state. And the only way we could do that is through surgery, not through bracing or really any other means. Could we stabilize this adequately to get him walking? Q: How have the outcomes been? VY: He's doing very well. He's actually back home. He's independent. He has really had a remarkable recovery, especially given his age. So he's very, very happy with how things are going. n Rafael Nadal undergoes hip surgery By Carly Behm Tennis player Rafael Nadal had sugery on his hip, he said in a June 3 tweet. He had an arthroscopy on his left psoas tendon, the tweet, translated from Spanish, said. Mr. Nadal thanked Marc Philippon, MD; Dr. Jaume Vilaró and Dr. Angel Ruiz-Cotorro. Dr. Philippon, of the Steadman Clinic in Vail, Colo., was the primary surgeon, according to sports journalist Jon Wertheim. Mr. Nadal is expected to recover in five months. n

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