Increasing Timely Follow-up with Pediatric Orthopaedic Fracture Care

2022 ◽  
Vol 10 (1) ◽  
Author(s):  
Courtney Bishop ◽  
Kevin Dolan ◽  
Julie Balch Samora
Keyword(s):  
Fracture Care ◽  
Pediatric Orthopaedic

Patient follow-up in pediatric orthopaedic retrospective call-back studies

2012 ◽  
Vol 23 (6) ◽  
pp. 590-594
Author(s):  
Benjamin J. Grear ◽  
Julie Neumann ◽  
William C. Warner ◽  
Jeffrey R. Sawyer ◽  
Derek M. Kelly
Keyword(s):  
Pediatric Orthopaedic

scholarly journals Effectiveness of reverse total shoulder arthroplasty for primary and secondary fracture care: mid-term outcomes in a single-centre experience

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
AM Schwarz ◽  
GM Hohenberger ◽  
M Sauerschnig ◽  
M Niks ◽  
G Lipnik ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Assessment Tools ◽  
Single Centre ◽  
Fracture Care ◽  
Operative Revision ◽  
Fracture Management ◽  
Reverse Total Shoulder

Abstract Background The introduction of reverse total shoulder arthroplasty (RSA) as a treatment option in complex proximal humeral fractures, has significantly extended the surgical armamentarium. The aim of this study was to investigate the mid-term outcome following fracture RSA in acute or sequelae, as well as salvage procedures. It was hypothesized that revision RSA (SRSA) leads to similar mid-term results as primary fracture treatment by RSA (PRSA). Methods This retrospective study describes the radiological and clinical mid-term outcomes in a standardized single-centre and Inlay design. Patients who underwent RSA in fracture care between 2008 and 2017 were included (minimum follow-up: 2 years, minimum age: 60 years). The assessment tools used for functional findings were range of motion (ROM), Visual Analogue Scale, absolute (CS) plus normative Constant Score, QuickDASH, and Subjective Shoulder Value. All adverse events as well as the radiological results and their clinical correlations were statistically analysed (using p < .05and 95% confidence intervals). Results Following fracture RSA, 68 patients were included (mean age: 72.5 years, mean follow-up: 46 months). Forty-two underwent primary RSA (PRSA), and 26 underwent revision RSA (SRSA). Adverse advents were observed in 13% (n = 9/68). No statistically significant results were found for the scores of the PRSA and SRSA groups, while the failed osteosynthesis SRSA subgroup obtained statistically significantly negative values for ROM subzones (flexion: p = .020, abduction: p = .020). Decreased instances of tubercle healing were observed for the in PRSA group relative to the SRSA group (p = .006). The absence of bony healing of the tubercles was related to significant negative clinical and subjective outcomes (all scores: p < .05, external rotation: p= .019). Significant postoperative improvements were evaluated in the SRSA group (CS: 23 to 56 at mean, p = .001), the time from index surgery to operative revision revealed no associations in functional findings. Conclusions RSA is an effective option in severe shoulder fracture management with predictable results for salvage as well as first-line treatment. Promising mid-term functional results, reasonable implant survival rates, and high patient satisfaction can be achieved. Level of evidence Level III.

Addressing Secondary Prevention of Osteoporosis in Fracture Care: Follow-up to “Own the Bone”

2011 ◽  
Vol 93 (15) ◽  
pp. e87(1)-e87(7) ◽  
Author(s):  
Beatrice J Edwards ◽  
Kenneth Koval ◽  
Andrew D Bunta ◽  
Kristy Genuario ◽  
Allison Hahr ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Fracture Care ◽  
Prevention Of Osteoporosis

scholarly journals Mobile Outreach: An Innovative Program for Older Orthopedic Patients in Care Facilities

2019 ◽  
Vol 10 ◽  
pp. 215145931982647 ◽  
Author(s):  
Julie A. Switzer ◽  
Lisa K. Schroder
Keyword(s):  
Nursing Care ◽  
Care Facility ◽  
Outreach Program ◽  
Full Time ◽  
Coordinated Care ◽  
Level Of Evidence ◽  
Fracture Care ◽  
Care Facilities ◽  
Postoperative Fracture

Introduction: The worldwide incidence of fragility fractures is increasing and the greatest burden is borne by the oldest population. Mobile Outreach, an innovative orthopedic-based program providing on-site musculoskeletal care for individuals in nursing care facilities, was implemented as part of our Geriatric Orthopaedic Trauma Program. The objectives of this report are to describe characteristics of patients cared for through Mobile Outreach and to report specific services provided. Program Description: Based from a nonprofit, private hospital that serves as the community’s level 1 trauma center and teaching hospital, the Mobile Outreach Program is directed by an orthopedic surgeon with geriatric subspecialization and staffed by a full-time geriatric nurse practitioner. Patients receive care for musculoskeletal concerns and fracture assessments at their nursing care facilities by a Mobile Outreach care provider. Referral for care is from nursing care facilities or as scheduled postoperative follow-up. Results: In 2016, the program treated 458 patients (76% female) in the patients’ care settings for a total of 689 visits. The mean age was 81 years (standard deviation = 14; range 25-107). Care of patients included nonoperative fracture care in 100 (22%), postoperative fracture follow-up in 149 (33%), injections for pain management in 184 (40%), and other orthopedic care in 25 (5%). Visits occurred at 88 facilities, mean 7 visits per site (range 1-57). Conclusions: Mobile Outreach was implemented to improve postoperative fracture care in the elderly patients. The program also provides on-site nonoperative fracture care and care of frail elderly individuals with chronic musculoskeletal conditions. This report aims to establish the feasibility of a program focused on the provision of appropriate, coordinated care for older fracture patients in their care facility. Level of Evidence: Level V.

scholarly journals Effectiveness of Reverse Total Shoulder Arthroplasty for Primary and Secondary Fracture Care: Mid-Term Outcomes in a Single-Centre Experience

2020 ◽  
Author(s):  
Angelika Schwarz ◽  
Gloria Hohenberger ◽  
Martin Sauerschnig ◽  
Milan Niks ◽  
Georg Lipnik ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Assessment Tools ◽  
Single Centre ◽  
Fracture Care ◽  
Operative Revision ◽  
Fracture Management ◽  
Reverse Total Shoulder

Abstract Background The introduction of reverse total shoulder arthroplasty (RSA) as a treatment option in complex proximal humeral fractures, has significantly extended the surgical armamentarium.The aim of this study was to investigate the mid-term outcome following fracture RSA in acute or sequelae, as well as salvage procedures. It was hypothesized that revision RSA (SRSA) leads to similar mid-term results as primary fracture treatment by RSA (PRSA).Methods This retrospective study describes the radiological and clinical mid-term outcomes in a standardized single-centre and Inlay design. Patients who underwent RSA in fracture care between 2008 and 2017 were included (minimum follow-up: two years, minimum age: 60 years).The assessment tools used for functional findings were range of motion (ROM), Visual Analogue Scale, absolute (CS) plus normative Constant Score, QuickDASH, and Subjective Shoulder Value. All adverse events as well as the radiological results and their clinical correlations were statistically analysed (using p < .05 and 95% confidence intervals).Results Following fracture RSA, 68 patients were included (mean age: 72.5 years, mean follow-up: 46 months). Forty-two underwent primary RSA (PRSA), and 26 underwent revision RSA (SRSA). Adverse advents were observed in 13% (n = 9/68).No statistically significant results were found for the scores of the PRSA and SRSA groups, while the failed osteosynthesis SRSA subgroup obtained statistically significantly negative values for ROM subzones (flexion: p = .020, abduction: p = .020). Decreased instances of tubercle healing were observed for the in PRSA group relative to the SRSA group (p = .006). The absence of bony healing of the tubercles was related to significant negative clinical and subjective outcomes (all scores: p < .05, external rotation: p = .019). Significant postoperative improvements were evaluated in the SRSA group (CS: 23 to 56 at mean, p = .001), the time from index surgery to operative revision revealed no associations in functional findings.Conclusions RSA is an effective option in severe shoulder fracture management with predictable results for salvage as well as first-line treatment. Promising mid-term functional results, reasonable implant survival rates, and high patient satisfaction can be achieved.Trial RegistrationNot applicable, level of evidence III.

Effects of a System-Wide Fracture Care Program to Enhance Access and Follow-Up for Orthopedics

2012 ◽  
Vol 28 (7) ◽  
pp. 680-683 ◽  
Author(s):  
Michael W. Sauer ◽  
Daniel A. Hirsh ◽  
Harold K. Simon ◽  
Michael L. Schmitz ◽  
Jesse J. Sturm
Keyword(s):  
Care Program ◽  
Fracture Care

scholarly journals VARIABILITY IN EVALUATION AND TREATMENT OF PEDIATRIC TIBIAL TUBERCLE FRACTURES AMONGST PEDIATRIC ORTHOPAEDIC SURGEONS

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0005
Author(s):  
Michael W. Fields ◽  
Neil K. Kaushal ◽  
Neeraj M. Patel ◽  
Sekinat K. McCormick ◽  
Craig P. Eberson ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Practice Guidelines ◽  
Nonoperative Treatment ◽  
Post Treatment ◽  
Tibial Tubercle ◽  
Orthopaedic Surgeons ◽  
Moderate Agreement ◽  
Pediatric Orthopaedic ◽  
Work Up

Introduction: Tibial tubercle fractures are uncommon injuries typically seen in adolescents approaching skeletal maturity. No evidence based clinical practice guidelines currently exist regarding clinical management of both operative and nonoperative fractures. Purpose: To determine the variability in clinical management of tibial tubercle fractures among a group of pediatric orthopaedic surgeons. Methods: Nine fellowship trained academic pediatric orthopaedic surgeons reviewed 51 anteroposterior and lateral knee radiographs with associated case age (mean: 13.6yrs, range: 9-16yrs) and gender (86%male). Respondents were asked to describe each fracture using the Ogden classification (Type 1-5 with A/B modifiers), desired radiographic workup, operative vs. nonoperative treatment strategy, and plans for post treatment follow-up. Interrater reliability was determined among the surgeons using Fleiss Kappa analysis. Results: Fair agreement was reached when classifying the fracture type using the Ogden classification (k=0.39,p<0.001). There was slight agreement when determining if CT (k=0.10,p<0.001) should be ordered and when rating concern for compartment syndrome (k=0.17,p<0.001). Overall, surgeons had moderate agreement on whether to treat the fractures operatively vs. nonoperatively (k=0.51,p<0.001). Nonoperative management was selected for 80.4%(45/56) of Type 1A fractures. Respondents selected operative treatment for 75% (30/40) of Type 1B, 58.3% (14/24) of Type 2A, 97.4%(74/76) of Type 2B, 90.7%(39/43) of Type 3A, 96.3%(79/82) of Type 3B, 71.9%(87/121) of Type 4, and 94.1%(16/17) of Type 5 fractures. Regarding operative treatment, moderate agreement was reached when evaluating the emergent nature of the fracture (k=0.44,p<0.001) and surgical technique (k=0.44, p<0.001). However, only fair/slight agreement was reached when selecting the specifics of operative treatment including surgical fixation technique (k=0.25,p<0.001), screw type (k=0.26, p<0.001), screw size (k=0.08,p<0.001), use of washers (k=0.21,p<0.001), and performing a prophylactic anterior compartment fasciotomy (k=0.20,p<0.001). There was moderate agreement on radiographic work up at first (k=0.5,p<0.0011) and final (k=0.49,p<0.001) follow up visits. Surgeons had moderate agreement on plans to remove hardware (k=0.39,p<0.001). Non-operative treatment of fractures was observed to have only fair agreement (k=0.29,p<0.001). Furthermore, surgeons had fair/moderate agreement regarding the specifics of nonoperative treatment including degree of knee extension during immobilization (k=0.46,p<0.001), length of immobilization (k=0.34,p<0.001), post treatment weight bearing status (k=0.30,p<0.001), and post treatment rehabilitation (k=0.34,p<0.001). Finally, there was moderate agreement on radiographic work up at first (k=0.51,p<0.001) and final follow up (k=0.46,p<0.001). Conclusion: Significant variability exists between surgeons when evaluating and treating pediatric tibial tubercle fractures. Future studies should aim to create best practice guidelines for pediatric orthopaedic surgeons to reference when treating these fractures. [Table: see text]

Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

2019 ◽  
Vol 42 ◽  
Author(s):  
John P. A. Ioannidis
Keyword(s):  
Mental Health ◽  
Mental Disease ◽  
Brain Disorders ◽  
Social Stressors ◽  
Labor Education ◽  
Mental Diseases ◽  
Long Term Follow Up ◽  
Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

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