The use of computed tomography versus clinical acumen in diagnosing appendicitis in children: A two-institution international study.

Background: Appendicitis in children can be diagnosed utilizing clinical and laboratory findings, with the assistance of ultrasound (US) and/or computed tomography (CT). However, repeated exposure to ionizing radiation increases the lifetime risk of cancer. We compared the work-up of suspected appendicitis between a children's hospital in the United States (USA) and one in Spain to identify differences in imaging use and associated outcomes.

A predictive model for increased hospital length of stay following geriatric hip fracture.

Background: The purpose of this study was to identify the risk factors that are significantly associated with hospital length of stay (LOS) following geriatric hip fracture and to use these significant variables to develop a LOS calculator.

Materials And Methods: This was a retrospective study examining 614 patients treated for geriatric hip fracture between January 2000 and December 2009 at an urban, Level 1 trauma center. A negative binomial regression analysis was used to identify perioperative variables associated with hospital LOS.

Management of Femoral Defects Greater Than 5 cm Following Open Femur Fractures: A 12-Year Retrospective Review.

This study sought to evaluate the outcomes of patients with osseous defects exceeding 5 cm following open femur fractures. Size of the osseous defect, method of internal fixation (plate vs. intramedullary nail), patient demographics, medical comorbidities, and surgical complications were collected.

The risk of deep vein thrombosis in total joint patients compared to orthopaedic trauma patients: Need for new prevention guidelines.

Background: The development of Deep Vein Thrombosis (DVT) is a major concern following orthopaedic surgery. No study has yet to compare the rate and risk factors for DVT between total joint and orthopaedic trauma patients. To evaluate if DVT prophylaxis for trauma should differ from total joints, we explored the rate and risk factors for DVT between both cohorts.

Comparison of recidivism rates for a teenage trauma prevention program after the addition of high-fidelity patient simulation.

Objectives: We evaluated the benefits of adding high-fidelity simulation to a teenage trauma prevention program to decrease recidivism rates and encourage teens to discuss actionable steps toward safe driving.

Methods: A simulated pediatric trauma scenario was integrated into an established trauma prevention program. Participants were recruited because they were court-ordered to attend this program after misdemeanor convictions for moving violations.

Open treatment of ankle fracture as inpatient increases risk of complication.

Background: Ankle fracture is one of the most common injuries treated by orthopaedic surgeons, and its incidence is only expected to rise with an aging population. It is also associated with often costly complications, yet there is little literature on risk factors, especially modifiable ones, driving these complications. The aim of this study is to reveal whether inpatient treatment after ankle fracture is associated with higher incidence of postoperative complications.

Outcomes of Distal Femur Nonunions Treated With a Combined Nail/Plate Construct and Autogenous Bone Grafting.

In this study, we sought to retrospectively evaluate union and infection rates after treatment of distal femur nonunions using a combined nail/plate construct with autogenous bone grafting obtained from the ipsilateral femur using a reamer irrigator aspirator system. Ten (10) patients treated at a Level I trauma center for nonunion of a femoral fracture using a combined nail/plate construct from 2004 to 2014 were included in the study. Union rate and postoperative infection rates were recorded.

Predicting the post-operative length of stay for the orthopaedic trauma patient.

Purpose: Length of stay (LOS) is a major driver of cost and quality of care. A bundled payment system makes it essential for orthopaedic surgeons to understand factors that increase a patient's LOS. Yet, minimal data regarding predictors of LOS currently exist.

Outcomes of Distal Femur Nonunions Treated with a Combined Nail/Plate Construct and Autogenous Bone Grafting.

SummaryIn this study, we sought to retrospectively evaluate union and infection rates after treatment of distal femur nonunions using a combined nail/plate construct with autogenous bone grafting. 10 patients treated at a Level I Trauma Center for nonunion of a femoral fracture using a combined nail/plate construct from 2004 to 2014 were included in the study. Union rate and postoperative infection rate were recorded.

The impact of resident involvement on outcomes in orthopedic trauma: An analysis of 20,090 cases.

Background: Involvement in patient care is critical in training orthopedic surgery residents for independent practice. As the focus on outcomes and quality measures intensifies, the impact of resident intraoperative involvement on patient outcomes will be increasingly scrutinized. We sought to determine the impact of residents' intraoperative participation on 30-day post-operative outcomes in the orthopedic trauma population.

Incidence and predictive risk factors of postoperative sepsis in orthopedic trauma patients.

Background: Postoperative sepsis is associated with high mortality and the national costs of septicemia exceed those of any other diagnosis. While numerous studies in the basic orthopedic science literature suggest that traumatic injuries facilitate the development of sepsis, it is currently unclear whether orthopedic trauma patients are at increased risk. The purpose of this study was thus to assess the incidence of sepsis and determine the risk factors that significantly predicted septicemia following orthopedic trauma surgery.

Higher Charlson Comorbidity Index Scores Are Associated With Increased Hospital Length of Stay After Lower Extremity Orthopaedic Trauma.

Objectives: The purpose of this study was to explore the relationship between preoperative Charlson Comorbidity Index (CCI) and postoperative length of stay (LOS) for lower extremity and hip/pelvis orthopaedic trauma patients.

Design: Retrospective.

Setting: Urban level 1 trauma center.

Geographic variations in orthopedic trauma billing and reimbursements for hip and pelvis fractures in the Medicare population.

We investigated geographic variations in Medicare spending for DRG 536 (hip and pelvis fracture). We identified 22,728 patients. The median number of charges, discharges, and payments were recorded.

Adverse cardiac events in 56,000 orthopaedic trauma patients: Does anatomic area make a difference?

Purpose: Postoperative cardiac events in orthopaedic trauma patients constitute severe morbidity and mortality. It is therefore increasingly important to determine patient risk factors that are predictive of postoperative myocardial infarctions and cardiac arrests. This study sought to assess if there is an association between anatomic area and cardiac complications in the orthopaedic trauma patient.

Increased risk of adverse events in management of femur and tibial shaft fractures with plating: An analysis of NSQIP data.

Background: The management of femoral and tibial shaft fractures has long been among the simplest in orthopaedic trauma. Little data exist on the predictors of complications associated with these fractures. The evolving healthcare system is creating a focus on quality metrics and changing payment models.

Predictors of Adverse Events for Ankle Fractures: An Analysis of 6800 Patients.

Ankle fractures are one of the most common injuries seen by orthopedic surgeons. It is therefore essential to understand the risks associated with their treatment. Using the American College of Surgeons National Surgical Quality Improvement Program(®) database from 2006 to 2013, the patient demographics, comorbidities, and 30-day complications were collected for 5 types of ankle fractures.

Pre-operative labs: Wasted dollars or predictors of post-operative cardiac and septic events in orthopaedic trauma patients?

Purpose: As US healthcare expenditures continue to rise, there is significant pressure to reduce the cost of inpatient medical services. Studies have estimated that over 70% of routine labs may not yield clinical benefits while adding over $300 in costs per day for every inpatient. Although orthopaedic trauma patients tend to have longer inpatient stays and hip fractures have been associated with significant morbidity, there is a dearth of data examining pre-operative labs in predicting post-operative adverse events in these populations.

Risk factors for discharge to rehabilitation among hip fracture patients.

Length of stay (LOS) drives costs for hip fracture patients. One factor that affects LOS is delayed transfer of patients to rehabilitation centers. It is therefore imperative that orthopedists have a mechanism for identifying which patients require rehabilitation services after surgery.

Editorial on "Comprehensive geriatric care for patients with hip fractures: a prospective, randomized, controlled trial" published in The Lancet on April 25(th), 2015.

A third of elderly adults fall every year, many leading to hip fractures with a 24% mortality rate just within the first year. As a growing number of the US population approaches old age, these hip fractures are expected to cost the US over 25 billion annually. In the near future, physicians will need to not only improve the treatment for a larger patient population but also reduce the medical costs associated.