Objective: To assess the impact of an open fracture intervention bundle on clinical management and patient outcomes of adults in Malawi with open tibia fractures.
Methods: We conducted a before-and-after implementation study in Malawi in 2021 and 2022 to assess the impact of an open fracture intervention bundle, including a national education course for clinical officers and management guidelines for open fractures. We recruited 287 patients with open tibia fractures. The primary outcome was a before-and-after comparison of the self-reported short musculoskeletal function assessment score, a measure of patient function. Secondary outcomes included clinical management; and clinician knowledge and implementation evaluation outcomes of 57 health-care providers attending the course. We also constructed multilevel regression models to investigate associations between clinical knowledge, patient function, and implementation evaluation before and after the intervention.
Findings: The median patient function score at 1 year was 6.8 (interquartile range, IQR: 1.5 to 14.5) before intervention and 8.4 (IQR: 3.8 to 23.2) after intervention. Compared with baseline scores, we found clinicians' open fracture knowledge scores improved 1 year after the intervention was implemented (mean posterior difference: 1.6, 95% highest density interval: 0.9 to 2.4). However, we found no difference in most aspects of clinicians' open fracture management practice.
Conclusion: Despite possible improvement in clinician knowledge and positive evaluation of the intervention implementation, our study showed that there was no overall improvement in clinical management, and weak evidence of worsening patient function 1 year after injury, after implementation of the open fracture intervention bundle.
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http://dx.doi.org/10.2471/BLT.23.290755 | DOI Listing |
Medicine (Baltimore)
January 2025
Hebei Province Tangshan Second Hospital Trauma Five, Hebei, China.
Ankle fractures are among the most common bone injuries, which are often accompanied by soft tissue injuries. Proper management of these fractures is crucial to promote healing and minimize complications. This study explores the effects of 2 treatment methods for ankle fractures: open reduction and internal fixation and manual reduction followed by plaster external fixation.
View Article and Find Full Text PDFJ Orthop Trauma
January 2025
Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.
Objectives: The 22-modifier in the Current Procedural Terminology (CPT) system indicates increased surgical procedure complexity, aiming to secure greater reimbursement for surgeons. This study investigated the 22-modifier on reimbursement amounts after acetabular fracture fixation.
Methods: Design: Retrospective cohort study.
J Orthop Trauma
January 2025
Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA.
Objectives: To describe and enumerate surgeries for patients who underwent reconstruction or amputation after severe distal tibia, ankle, and mid to hindfoot injuries.
Methods: Design: Secondary analysis of a multicenter prospective observational study.
Setting: 31 U.
Cureus
December 2024
Department of Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA.
Subtrochanteric fractures in older patients are typically due to low-energy falls. The standard of care is intramedullary nailing. The Smith & Nephew Trigen Intertan (Memphis, TN, US) is an intramedullary nail with a novel design that incorporates two integrated compression screws.
View Article and Find Full Text PDFCureus
December 2024
Faculty of Medicine, King Khalid University, Abha, SAU.
Introduction Neck manipulations, including massages and self-cracking, are common practices, yet public awareness of their potential risks is poorly understood. This study explores public knowledge and awareness of the risks associated with neck manipulations in the Southern region of Saudi Arabia. Methods The study employed a descriptive cross-sectional design from May 2024 to July 2024, distributing a questionnaire to the adult population in the Southern Region.
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