Opioid-Induced Constipation and Associated Symptoms After Orthopedic Trauma.

Purpose: Opioid-induced constipation is an adverse effect often experienced among patients taking prescription opioid medication. Despite frequent opioid prescribing after orthopedic injury, there is a dearth of research examining opioid-induced constipation presentations in this population. This analysis examines the frequency of opioid-induced constipation manifestations and association with patient-reported outcomes among participants prescribed opioid medication following orthopedic injury.

Emergency department encounters and opioid prescribing following orthopaedic trauma among Black and White patients with substance use disorders.

Introduction: Patients living with substance use disorder (SUD) have complex pain management needs, which may be mismanaged during hospital admission. Ineffectively managed pain following orthopaedic trauma, influenced by clinician biases related to race or SUD diagnosis, may subject patients to worse pain outcomes and subsequent emergency department (ED) encounters. This study examined ED encounters and opioid prescribing for pain-related complaints following orthopaedic trauma, among patients with SUD who identify as Black or African American relative to White patients.

Patient-reported barriers for adherence to prophylactic enoxaparin after orthopedic trauma surgery.

Introduction: Venous thromboembolism following orthopedic trauma surgery remains prevalent despite prophylaxis being a standard of care. Enoxaparin injection is a commonly utilized prophylaxis regimen among high-risk patients. Patient-reported rates of nonadherence and barriers to enoxaparin use are not described in the literature.

Opioid utilization after orthopaedic trauma hospitalization among Medicaid-insured adults.

Opioids are vital to pain management and sedation after trauma-related hospitalization. However, there are many confounding clinical, social, and environmental factors that exacerbate pain, post-injury care needs, and receipt of opioid prescriptions following orthopaedic trauma. This retrospective study sought to characterize differences in opioid prescribing and dosing in a national Medicaid eligible sample from 2010-2018.

A Shadow of Doubt: Is There Implicit Bias Among Orthopaedic Surgery Faculty and Residents Regarding Race and Gender?

Background: Orthopaedic surgery continues to be one of the least diverse medical specialties. Recently, increasing emphasis has been placed on improving diversity in the medical field, which includes the need to better understand existing biases. Despite this, only about 6% of orthopaedic surgeons are women and 0.

A systematic review of patient-centered interventions for improving pain outcomes and reducing opioid-related risks in acute care settings.

Objectives: This systematic review evaluates the literature for patient-oriented opioid and pain educational interventions that aim to optimize pain management using opioid-sparing approaches in the orthopaedic trauma population. The study protocol was registered with PROSPERO (CRD42021234006).

Data Sources: A review of English-language publications in CINAHL (EBSCO), MEDLINE through PubMed, Embase.

Early Identification of Post-Traumatic Stress Disorder in Trauma Patients: Development of a Multivariable Risk Prediction Model.

Background: The purpose of this study was to build a risk prediction model to identify trauma patients at the time of injury who are at high risk for post-traumatic stress disorder (PTSD) 1 year later.

Methods: Patients 18+ with operative orthopedic trauma injuries were enrolled in prospective social determinants of health cohort. Data were collected through initial surveys, medical records at time of injury, and 1-year follow-up phone screenings.

Racial Disparities in the Operative Management of Orthopedic Trauma: A Systematic Review and Meta-Analysis.

Objective: The objective of this study was to investigate if race is associated with the likelihood of operative management of acute fractures.

Methods: A systematic review of the literature was performed using the PubMed, EMBASE, and Cochrane databases to identify studies associated with social disparities and acute orthopedic trauma. Peer-reviewed studies commenting on social disparities and the decision to pursue operative or non-operative management of acute fractures were identified for detailed review.

High Altitude as a Risk Factor for Venous Thromboembolism in Tibial Plateau Fractures.

Background Tibial plateau fractures are often significant injuries that can require complex surgical interventions with prolonged perioperative immobilization, thereby increasing the risk of developing venous thromboembolic (VTE) events, specifically, deep vein thrombosis (DVT) and pulmonary embolism (PE). Risk stratification is paramount for guiding VTE prophylaxis. Although high altitude has been suggested to create a prothrombotic state, virtually no studies have explored its clinical effects in lower extremity trauma.

Opioid Prescribing Behavior in the Emergency Department During Routine Orthopedic Manipulations.

Background: The emergency department (ED) often represents the first exposure orthopedic trauma patients have to prescription opioids and thus a critical opportunity for prevention of potential long-term opioid use. This study will analyze the impact of opioid prescribing patterns among both ED providers and orthopedic surgery residents on the utilization of opioids during routine orthopedic trauma manipulations.

Materials And Methods: This retrospective study reviewed opioid utilization among patients with an ankle or distal radius fracture at a large, urban, level 1 trauma center.

The Potential Impact of Food Insecurity in an Urban Trauma Population.

Background: Food insecurity (FI) has been defined as a lack of consistent access to enough food for a healthy active lifestyle. As of 12.7% of the United States are suffering from FI, which has been correlated with increased hospital costs and poorer health outcomes.

Integration of Life Care Specialists Into Orthopaedic Trauma Care to Improve Postoperative Outcomes: A Pilot Study.

Background: AIM: This pilot study assessed the feasibility and impact of integrating a Life Care Specialist (LCS) into orthopaedic trauma care.

Design: This was a prospective feasibility single group pilot study at a level 1 trauma center.

Method: The LCS is a paraprofessional behavior-based "pain coach" and delivered patient-centered opioid safety education, trained participants on nonpharmacologic pain management approaches, conducted opioid risk assessments, and coordinated care.

The effect of a Life Care Specialist on pain management and opioid-related outcomes among patients with orthopedic trauma: study protocol for a randomized controlled trial.

Background: Orthopedic trauma patients face complex pain management needs and are frequently prescribed opioids, leaving them at-risk for prolonged opioid use. To date, post-trauma pain management research has placed little emphasis on individualized risk assessments for misuse and systematically implementing non-pharmacologic pain management strategies. Therefore, a community-academic partnership was formed to design a novel position in the healthcare field (Life Care Specialist (LCS)), who will educate patients on the risks of opioids, tapering usage, safe disposal practices, and harm reduction strategies.

Development of systemic immune dysregulation in a rat trauma model of biomaterial-associated infection.

Orthopedic biomaterial-associated infections remain a major clinical challenge, with Staphylococcus aureus being the most common pathogen. S. aureus biofilm formation enhances immune evasion and antibiotic resistance, resulting in a local, indolent infection that can persist long-term without symptoms before eventual hardware failure, bone non-union, or sepsis.

Impact of Frailty and Malnutrition on Outcomes After Surgical Fixation of Lower Extremity Fractures in Young Patients.

Objectives: Evaluate the relationship of nutrition parameters and the modified frailty index (mFI) on postsurgical complications within a young patient population sustaining lower extremity orthopaedic trauma.

Design: Retrospective observational cohort study.

Setting: Urban, American College of Surgeons-Verified, Level-1, Trauma Center.

The 11-Item Modified Frailty Index as a Tool to Predict Unplanned Events in Traumatic Brain Injury.

Background: Frailty has been studied extensively in trauma, but there is minimal research detailing its impact on traumatic brain injury (TBI). We hypothesized that the 11-item modified frailty index (mFI-11) would predict complications and discharge outcomes in patients with TBI.

Methods: A retrospective review of our trauma quality improvement program (TQIP) registry was conducted for all patients with TBI.

High acuity polytrauma centers in orthopaedic trauma: Decreasing patient mortality with effective resource utilization.

Background: There is a select number of massive-volume, high-acuity trauma centers (HACs) in the United States. Expertise in polytrauma care has been associated with improved mortality in general surgery trauma, though has not been investigated in orthopaedic trauma. With complex polytrauma proficiency comes the inherent risk of intensive care, complications, and prolonged inpatient stays, without a commensurate increase in allocated resources.

The 5 and 11 Factor Modified Frailty Indices are Equally Effective at Outcome Prediction Using TQIP.

Background: The 5-factor modified frailty index (mFI-5) and the 11-factor modified frailty index (mFI-11) are equally effective in predicting adverse outcomes in the American College of Surgeons National Surgical Quality Improvement Program database. The similarly structured American College of Surgeons Trauma Quality Improvement Program (TQIP) database has not been studied with these two frailty indices. We hypothesized that the mFI-5 and mFI-11 could similarly predict adverse outcomes with TQIP data.

The 5-Item Modified Frailty Index Predicts Adverse Outcomes in Trauma.

Background: The 5-item modified frailty index (mFI-5) has been shown to predict adverse outcomes in surgery; yet, its role in trauma patients is unclear. We hypothesized that increasing frailty, as indicated by increasing mFI-5 scores, would correlate with worse outcomes and greater mortality in trauma patients.

Methods: We performed a retrospective review of patients captured by our 2018 Spring and Fall Trauma Quality Improvement Program registry.

Metabolic Syndrome: Major Risk Factor for Morbidity and Mortality in Severely Injured Trauma Patients.

Background: Metabolic syndrome (MetS) increases cardiovascular risk and is associated with poor patient outcomes. We hypothesized that MetS confers an increased risk of morbidity and mortality in severely injured trauma patients.

Study Design: We performed a retrospective review of trauma patients from 2014 through 2018, excluding patients younger than 16 years, with Injury Severity Score <16, and with incomplete height and/or weight documentation.

Is Operative Debridement Greater Than 24 Hours Post-admission Associated With Increased Likelihood of Post-operative Infection?

Background: The historical "six-hour rule" as a golden hour for timing to debridement has been refuted in modern literature. Current standards prompt a timely debridement; however, in the setting of polytrauma, patients are often resuscitated for periods >24 h, with delayed orthopedic intervention. Therefore, we sought to determine the association between prolonged time to operative debridement (>24 h) and infection.

Minimizing Posttraumatic Osteoarthritis After High-Energy Intra-Articular Fracture.

This article serves to provide an overview of molecular and surgical interventions to minimize the progression of posttraumatic arthritis following high-energy intra-articular fractures. The roles of cartilage and the microcellular environment are discussed, as well as the response of the joint and cartilage to injury. Molecular therapies, such as glucocorticoids, mesenchymal stem cells, and bisphosphonates, are presented as potential treatments to prevent progression to posttraumatic arthritis.