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Stephens AR, Potter JW, Tyser AR, Kazmers NH. Evaluating the impact of social deprivation on Press Ganey® Outpatient Medical Practice Survey Scores. Health Qual Life Outcomes 2021; 19:167. [PMID: 34147118 PMCID: PMC8214262 DOI: 10.1186/s12955-020-01639-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 12/07/2020] [Indexed: 11/20/2022] Open
Abstract
Background Social deprivation has been shown to affect access to health care services, and influences outcomes for a variety of physical and psychological conditions. However, the impact on patient satisfaction remains less clear. The objective of this study was to determine if social deprivation is an independent predictor of patient satisfaction, as measured by the Press Ganey® Outpatient Medical Practice Survey (PGOMPS). Methods We retrospectively reviewed unique new adult patient (≥ 18 years of age) seen at a tertiary academic hospital and rural/urban outreach hospitals/clinics between January 2014 and December 2017. Satisfaction was defined a priori as achieving a score above the 33rd percentile. The 2015 Area Deprivation Index (ADI) was used to determine social deprivation (lower score signifies less social deprivation). Univariate and multivariable binary logistic regression were used to determine the impact of ADI on PGOMPS total and provider sub-scores while controlling for variables previously shown to impact scores (wait time, patient age, sex, race, specialty type, provider type, and insurance status). Results Univariate analysis of PGOMPS total scores revealed a 4% decrease in odds of patient satisfaction per decile increase in ADI (p < 0.001). Patients within the most deprived quartile were significantly less likely to report satisfaction compared to the least deprived quartile (OR 0.79, p < 0.001). Multivariable analysis revealed that the odds of achieving satisfaction decreased 2% for each decile increase in ADI on the Total Score (p < 0.001), independent of other variables previously shown to impact scores. For PGOMPS Provider Sub-Score, univariate analysis showed that patients in the lowest ADI quartile were significantly less likely be satisfied, as compared to the least deprived quartile (OR 0.77; 95% CI 0.70–0.86; p < 0.001). A 5% decrease in a patient being satisfied was observed for each decile increase in ADI (OR 0.95; 95% CI 0.94–0.96; p < 0.001). Conclusions Social deprivation was an independent predictor of outpatient visit dissatisfaction, as measured by the Press Ganey® Outpatient Medical Practice Survey. These results necessitate consideration when developing health care delivery policies that serve to minimize inequalities between patients of differing socioeconomic groups.
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Affiliation(s)
- Andrew R Stephens
- School of Medicine, University of Utah, 30N 1900E, Salt Lake City, UT, 84132, USA.
| | - Jared W Potter
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Andrew R Tyser
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Nikolas H Kazmers
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
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The Impact of Social Deprivation on Orthopaedic Outpatient Satisfaction Using the Press Ganey Outpatient Medical Practice Survey. J Am Acad Orthop Surg 2020; 28:e1111-e1120. [PMID: 32235241 DOI: 10.5435/jaaos-d-19-00852] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION In orthopaedics, multiple factors (patient age, wait time, and depression) have been associated with lower Press Ganey Outpatient Medical Practice Survey (PGOMPS) patient satisfaction scores. We hypothesized that increased social deprivation is an independent predictor of lower patient satisfaction, as measured by the PGOMPS. METHODS We retrospectively reviewed unique new outpatient orthopaedic surgery visits between January 1, 2014, and December 31, 2016, at a single tertiary academic institution. Given the high ceiling effects, satisfaction was defined a priori as achieving a score above the 33rd percentile. Social deprivation was determined using the 2015 Area Deprivation Index (ADI). Univariate and multivariable binary logistic regressions were used to detect factors associated with patient satisfaction for both the PGOMPS Total Score and Provider Sub-Score. RESULTS Of the 4,881 included patients, the mean age was 53.3 ± 15.9 years, 59.3% were women, and mean ADI was 30.1 ± 19.2. Univariate analysis revealed a significantly decreased odds of achieving satisfaction on the Total Score for each decile increase in ADI (odds ratio [OR] 0.94; P < 0.001). Compared with the least deprived quartile, patients of the most deprived quartile were significantly less likely to report satisfaction for both the Total Score (OR 0.56; P = 0.001) and Provider Sub-Score (OR 0.63; P = 0.011). Multivariable analysis revealed that the odds of achieving satisfaction for each decile increase in ADI were 0.96 for the Total Score (P = 0.014) and 0.95 for the Provider Sub-Score (P = 0.004), independent of age, wait time, race, subspecialty, provider type, and the clinic setting. CONCLUSIONS Increased social deprivation was an independent predictor of orthopaedic outpatient dissatisfaction on the PGOMPS. These findings should be considered when interpreting patient satisfaction scores and lend further support in an effort to improve healthcare inequalities. LEVEL OF EVIDENCE Level III.
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Li X, Galvin JW, Li C, Agrawal R, Curry EJ. The Impact of Socioeconomic Status on Outcomes in Orthopaedic Surgery. J Bone Joint Surg Am 2020; 102:428-444. [PMID: 31833981 DOI: 10.2106/jbjs.19.00504] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Xinning Li
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Chris Li
- Northeastern University, Boston, Massachusetts
| | - Ravi Agrawal
- Boston University School of Medicine, Boston, Massachusetts
| | - Emily J Curry
- Boston University School of Public Health, Boston, Massachusetts
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Wolfstadt JI, Pincus D, Kreder HJ, Wasserstein D. Association between socioeconomic deprivation and surgical complications in adults undergoing ankle fracture fixation: a population-based analysis. Can J Surg 2019; 62:320-327. [PMID: 31550093 DOI: 10.1503/cjs.012018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background Few studies have investigated the outcomes of surgical fracture care among socially deprived patients despite the increased incidence of fractures and the inequality of care received in this group. We evaluated whether socioeconomic deprivation affected the complications and subsequent management of marginalized/homeless patients following surgery for ankle fracture. Methods In this retrospective, population-based cohort study involving 202 hospitals in Ontario, Canada, we evaluated 45 444 patients who underwent open reduction and internal fixation (ORIF) for ankle fracture performed by 710 different surgeons between Jan. 1, 1994, and Dec. 31, 2011. Multivariable logistic regression models were used to assess the association between deprivation and shorter-term outcomes within 1 year (implant removal, repeat ORIF, irrigation and débridement owing to infection, and amputation). Multivariable Cox proportional hazards models were used to assess longer-term outcomes up to 20 years (ankle fusion and ankle arthroplasty). Results A higher level of deprivation was associated with an increased risk of irrigation and débridement (quintile 5 v. quintile 1: odds ratio [OR] 2.14, 95% confidence interval [CI] 1.25–3.67, p = 0.0054) and amputation (quintile 4 v. quintile 1: OR 3.56, 95% CI 1.01–12.4, p = 0.0466). It was more common for less deprived patients to have their hardware removed (quintile 5 v. quintile 1: OR 0.822, 95% CI 0.76–0.888, p < 0.0001). There was no correlation between marginalization and subsequent revision ORIF, ankle fusion, or ankle arthroplasty. Conclusion Marginalized patients are at a significantly increased risk of infection and amputation following surgical treatment of ankle fractures. However, these complications are still extremely uncommon among this group. Socioeconomic deprivation should not prohibit marginalized patients from receiving surgery for unstable ankle fractures.
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Affiliation(s)
- Jesse Isaac Wolfstadt
- From the Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ont. (Wolfstadt); the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Wolfstadt, Pincus, Kreder, Wasserstein); the Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Pincus, Kreder, Wasserstein); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Pincus, Kreder); and ICES, Toronto, Ont. (Pincus, Kreder)
| | - Daniel Pincus
- From the Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ont. (Wolfstadt); the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Wolfstadt, Pincus, Kreder, Wasserstein); the Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Pincus, Kreder, Wasserstein); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Pincus, Kreder); and ICES, Toronto, Ont. (Pincus, Kreder)
| | - Hans J. Kreder
- From the Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ont. (Wolfstadt); the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Wolfstadt, Pincus, Kreder, Wasserstein); the Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Pincus, Kreder, Wasserstein); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Pincus, Kreder); and ICES, Toronto, Ont. (Pincus, Kreder)
| | - David Wasserstein
- From the Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ont. (Wolfstadt); the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont. (Wolfstadt, Pincus, Kreder, Wasserstein); the Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ont. (Pincus, Kreder, Wasserstein); the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Pincus, Kreder); and ICES, Toronto, Ont. (Pincus, Kreder)
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Morris R, Jones NC, Pallister I. The use of personalised patient information leaflets to improve patients' perceived understanding following open fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:537-543. [PMID: 30368617 DOI: 10.1007/s00590-018-2332-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/16/2018] [Indexed: 11/27/2022]
Abstract
Open tibial fractures can have devastating long-term effects. In our centre, these patients are followed up in a multidisciplinary Orthoplastic Research Clinic. To improve patient comprehension of information, we have developed personalised information leaflets. This study determines patients' views on these. The leaflet was completed during clinic visits and its role explained. At their next appointment, patients were given anonymised feedback forms, adapted from previously published questionnaires, to complete on their views and use of the leaflet. During the study period, 48 new patients attended clinic; 40 completed questionnaires and were analysed. A majority of patients (39) self-reported improved understanding of their condition, and 11 patients used the information leaflet to improve communication with other healthcare professionals. A majority of patients (34) wished to receive the information leaflet on discharge. The majority of patients in this study felt the leaflet improved their knowledge of their injuries and management.
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Affiliation(s)
- Rhys Morris
- Department of Trauma and Orthopaedic Surgery, Nevill Hall Hospital, Abergavenny, NP7 7EG, UK.
| | - Nia Catrin Jones
- Department of Trauma and Orthopaedic Surgery, Morriston Hospital, Swansea, SA6 6NL, UK
| | - Ian Pallister
- Department of Trauma and Orthopaedic Surgery, Morriston Hospital, Swansea, SA6 6NL, UK
- Swansea University Medical School, Swansea, SA2 8PP, UK
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Does socioeconomic status influence the epidemiology and outcome of distal radial fractures in adults? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017. [PMID: 28638948 DOI: 10.1007/s00590-017-2003-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study in adult patients with a distal radial fracture was to determine whether socioeconomic status influenced the epidemiology, mechanism of injury, fracture severity, or the outcome according to function, radiographic assessment, and rate of associated complications. METHODS We identified 3983 distal radial fractures over a 7-year period. Socioeconomic status was assigned using the Carstairs score, and the population was divided into quintiles depending on deprivation. Patient demographics, mechanism of injury, fracture severity, and radiographic assessment at time of injury were assessed for epidemiological differences according to social quintile. Functional outcome was assessed using grip strength, Moberg pickup test, return to normal use of the hand, and range of movement. Radiographs were assessed at 1 week, 6 weeks, and 1 year. Complications were defined as malunion, carpal tunnel syndrome, complex regional pain syndrome (CRPS), persistent pain, and subjective cosmetic deformity of the wrist. RESULTS Socioeconomically deprived patients were significantly younger (p < 0.001) and more likely to be male (p = 0.017); after adjusting for confounding factors, deprived patients were 3.1 (95% CI 1.4-4.7) years younger than the most affluent patients (p < 0.001). Deprived patients were more likely to sustain their fracture by a high-energy mechanism (p = 0.004). There were no significant differences between quintiles in outcome. There was a significantly greater prevalence of CRPS in more affluent patients (p = 0.004). CONCLUSIONS Socioeconomically deprived patients sustaining a distal radial fracture are more likely to be younger and male. Outcome is not influenced by socioeconomic status, but the prevalence of CRPS is greater in more affluent patients.
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Abstract
OBJECTIVES The aim of our study was to identify the risk factors associated with the development of acute compartment syndrome (ACS) after a fracture of the tibia. DESIGN Retrospective cohort study. SETTING Orthopaedic trauma unit, university teaching hospital. PATIENTS From our trauma database, we identified all patients who sustained an acute tibial diaphyseal fracture over a 13-year period. A retrospective analysis of 1407 patients was performed to record and analyze the OTA fracture classification, open fracture grade according to Gustilo, soft tissue injury classification according to Tscherne, treatment, development of ACS, and other patient demographics including smoking, occupation, and socioeconomic deprivation. MAIN OUTCOME MEASURE A diagnosis of ACS was made using clinical signs, compartment pressure monitoring, or a combination of the 2. RESULTS One thousand three hundred eighty-eight patients were included with a mean age of 39 (12-98) years, and 957 (69%) were male. One hundred sixty patients (11.5%) were diagnosed with ACS. On initial analysis, age, male gender, blue-collar occupation, sporting injury, fracture classification, and treatment with intramedullary nails were predictive of ACS (all P < 0.05). Age was the strongest predictor of developing ACS (P < 0.001), with the highest prevalence between 12-19 years and 20-29 years. Occupation (P = 0.01) and implant type (P = 0.004) were the only factors that remained significant after adjusting for age. On further subanalysis, implant type was not predictive when stratified by Tscherne class (P = 0.11). CONCLUSIONS We have documented the risk factors for the development of ACS after an acute tibial diaphyseal fracture, with youth the strongest predictor. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Ramaesh R, Clement ND, Rennie L, Court-Brown C, Gaston MS. Social deprivation as a risk factor for fractures in childhood. Bone Joint J 2015; 97-B:240-5. [PMID: 25628289 DOI: 10.1302/0301-620x.97b2.34057] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Paediatric fractures are common and can cause significant morbidity. Socioeconomic deprivation is associated with an increased incidence of fractures in both adults and children, but little is known about the epidemiology of paediatric fractures. In this study we investigated the effect of social deprivation on the epidemiology of paediatric fractures. We compiled a prospective database of all fractures in children aged < 16 years presenting to the study centre. Demographics, type of fracture, mode of injury and postcode were recorded. Socioeconomic status quintiles were assigned for each child using the Scottish Index for Multiple Deprivation (SIMD). We found a correlation between increasing deprivation and the incidence of fractures (r = 1.00, p < 0.001). In the most deprived group the incidence was 2420/100 000/yr, which diminished to 1775/100 000/yr in the least deprived group. The most deprived children were more likely to suffer a fracture as a result of a fall (odds ratio (OR) = 1.5, p < 0.0001), blunt trauma (OR = 1.5, p = 0.026) or a road traffic accident (OR = 2.7, p < 0.0001) than the least deprived. These findings have important implications for public health and preventative measures.
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Affiliation(s)
- R Ramaesh
- The Royal Hospital for Sick Children, 18/5 Sciennes Road, Edinburgh, EH16 5PN, UK
| | - N D Clement
- The Royal Hospital for Sick Children, 18/5 Sciennes Road, Edinburgh, EH16 5PN, UK
| | - L Rennie
- The Royal Hospital for Sick Children, 18/5 Sciennes Road, Edinburgh, EH16 5PN, UK
| | - C Court-Brown
- Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - M S Gaston
- The Royal Hospital for Sick Children, 18/5 Sciennes Road, Edinburgh, EH16 5PN, UK
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Brennan SL, Yan L, Lix LM, Morin SN, Majumdar SR, Leslie WD. Sex- and age-specific associations between income and incident major osteoporotic fractures in Canadian men and women: a population-based analysis. Osteoporos Int 2015; 26:59-65. [PMID: 25278299 DOI: 10.1007/s00198-014-2914-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED We investigated sex- and age-specific associations between income and fractures at the hip, humerus, spine, and forearm in adults aged ≥50 years. Compared to men with the highest income, men with the lowest income had an increased fracture risk at all skeletal sites. These associations were attenuated in women. INTRODUCTION Associations between income and hip fractures are contested, even less is known about other fracture sites. We investigated sex- and age-specific associations between income and major osteoporotic fractures (MOF) at the hip, humerus, spine, and forearm. METHODS Incident fractures were identified from administrative health data for adults aged ≥50 years in Manitoba, Canada, 2000-2007. Mean neighborhood (postal code area) annual household incomes were extracted from 2006 census files and categorized into quintiles. We calculated age-adjusted and age-specific sex-stratified fracture incidence across income quintiles. We estimated relative risks (RR) and 95% CI for income quintile 1 (Q1, lowest income) vs. income quintile 5 (Q5) and tested the linear trend across quintiles. RESULTS We identified 15,094 incident fractures (4736 hip, 3012 humerus, 1979 spine, and 5367 forearm) in 2718 men and 6786 women. For males, the RR of fracture for the lowest vs. highest income quintile was 1.63 (95% CI 1.42-1.87) and the negative trend was statistically significant (p < 0.0001); individual skeletal sites showed similar associations. For females, the RR of fracture for the lowest vs. highest income quintile was 1.14 (95% CI 1.01-1.28), with a statistically significant negative trend (p = 0.0291); however, the only skeletal site associated with income in women was the forearm (Q1 vs. Q5 RR 1.09, 95% CI 1.01-1.28). CONCLUSIONS Compared to men with the highest income, men with the lowest income had an increased fracture risk at all skeletal sites. These associations were attenuated in women. For men, these effect sizes seem large enough to warrant public health concern.
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Affiliation(s)
- S L Brennan
- School of Medicine, Deakin University, Geelong, Australia
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Duckworth AD, Wickramasinghe NR, Clement ND, Court-Brown CM, McQueen MM. Long-term outcomes of isolated stable radial head fractures. J Bone Joint Surg Am 2014; 96:1716-23. [PMID: 25320198 DOI: 10.2106/jbjs.m.01354] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is evidence to support primary nonoperative management of isolated stable fractures of the radial head, although minimal data exist regarding long-term outcomes. The aim of this study was to report subjective long-term outcomes of isolated stable fractures of the radial head and neck following primary nonoperative management. METHODS From a prospective database of proximal radial fractures, we identified all skeletally mature patients who sustained an isolated stable Mason type-1 or type-2 fracture of the radial head or neck during an eighteen-month period. Inclusion criteria were a confirmed isolated stable fracture of the proximal aspect of the radius, primarily managed nonoperatively. The primary long-term outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS The study cohort comprised 100 patients with a mean age of forty-six years (range, seventeen to seventy-nine years). A fall from a standing height accounted for 69% of all injuries. Thirty-five percent of the patients had one or more comorbidities. There were fifty-seven Mason type-1 fractures and forty-three Mason type-2 fractures. At a mean of ten years post injury (range, 8.8 to 10.2 years), the mean DASH score was 5.8 (range, 0 to 67.2) and the mean Oxford Elbow Score (OES) was 46 (range, 14 to 48). Fourteen (14%) of the patients reported stiffness and twenty-four (24%) reported some degree of pain. A worse DASH score was associated with older age (p = 0.002), one or more comorbidities (p = 0.008), increasing socioeconomic deprivation by Index of Multiple Deprivation quintile (p = 0.026), increasing amount of fracture displacement (p = 0.041), and involvement in compensation proceedings (p = 0.006). CONCLUSIONS Long-term patient-reported outcomes were excellent following the nonoperative management of isolated stable fractures of the radial head or neck. We suggest that routine primary nonoperative management of these fractures provides a satisfactory outcome for the majority of patients, with few patients in our study requiring further intervention for persisting complaints. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Andrew D Duckworth
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Neil R Wickramasinghe
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Nicholas D Clement
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Charles M Court-Brown
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Margaret M McQueen
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
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Clement ND, McQueen MM, Court-Brown CM. Social deprivation influences the epidemiology and outcome of proximal humeral fractures in adults for a defined urban population of Scotland. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:1039-46. [DOI: 10.1007/s00590-013-1301-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 08/17/2013] [Indexed: 11/28/2022]
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12
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Court-Brown CM, Aitken SA, Duckworth AD, Clement ND, McQueen MM. The relationship between social deprivation and the incidence of adult fractures. J Bone Joint Surg Am 2013; 95:e321-7. [PMID: 23515993 DOI: 10.2106/jbjs.k.00631] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Social deprivation is associated with many diseases. To our knowledge, there has been no previous investigation of its role in the epidemiology and incidence of fractures in adults. METHODS We analyzed 6872 consecutive fractures in patients fifteen years of age or older over a one-year period. Social deprivation was analyzed using the Carstairs score, which is derived from patients' postal codes and accurately defines social deprivation in our population. RESULTS Social deprivation is associated with an increasing fracture incidence. The effect is not linear, and the most deprived 10% of society are affected. The odds ratios of the most deprived 10% of society having an increased incidence of fractures are 3.7 in males and 3.1 in females. CONCLUSIONS Social deprivation is associated with a significant increase in the incidence of fractures in the most deprived 10% of the population. Most fracture types are affected.
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Affiliation(s)
- Charles M Court-Brown
- Royal Infirmary of Edinburgh, Little France, Old Dalkeith Road, Edinburgh EH16 4SU, Scotland.
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13
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Griffin M, Malahias M, Khan W, Hindocha S. Update on the management of open lower limb fractures. Open Orthop J 2012; 6:571-7. [PMID: 23248730 PMCID: PMC3522114 DOI: 10.2174/1874325001206010571] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 08/31/2012] [Accepted: 09/19/2012] [Indexed: 01/29/2023] Open
Abstract
Open lower limb fractures pose a significant challenging pathology for orthopaedic and plastic surgeons to manage due to the combined soft tissue damage, bone loss and potential vascular compromise. These fracture require extensive team-work and expertise between several surgical specialties and the advice of non-surgical specialties to ensure good clinical outcomes. Extensive research has improved the outcomes of open lower limb fractures and current recommendation on the optimal management is always being updated to enhance patient outcomes. This review serves to provide an overview of the management of open tibial fractures using current evidence and recently updated UK guidelines. The optimal time for surgical debridement, surgical intervention, providing antibiotics and soft tissue coverage will be outlined as well as the indications for amputation.
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Affiliation(s)
- M Griffin
- Department of Surgery, St. Georges Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - M Malahias
- Department of Plastic Surgery, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
| | - W Khan
- Royal National Orthopaedics Hospital, Stanmore, London, HA7 4LP, UK
| | - S Hindocha
- Department of Plastic Surgery, Whiston Hospital, Liverpool, L35 5DR, UK
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Griffin M, Malahias M, Hindocha S, Khan W. Update on the management of compound lower limb fractures. Open Orthop J 2012; 6:518-24. [PMID: 23251301 PMCID: PMC3524792 DOI: 10.2174/1874325001206010518] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 08/31/2012] [Accepted: 09/04/2012] [Indexed: 02/08/2023] Open
Abstract
Compound lower limb fractures pose a significant challenging pathology for orthopaedic and plastic surgeons to manage due to the combined soft tissue damage, bone injury and potential vascular compromise. These fractures require extensive team-work and expertise between several surgical specialties and the advice of non-surgical specialties, to ensure good clinical outcomes. Extensive research has improved the outcomes of compound lower limb fractures and current recommendation on the optimal management is always being updated to enhance patient outcomes. This review serves to provide an overview of the management of compound tibial fractures using current evidence and recently updated UK guidelines. The optimal time for surgical debridement, surgical intervention, antibiotic regime and soft tissue coverage will be outlined as well as the indications for amputation.
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Affiliation(s)
| | - M Malahias
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - S Hindocha
- Whiston Teaching Hospital, Liverpool, UK
| | - W Khan
- Royal National Orthopaedic Hospital, London, UK
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Duckworth AD, Clement ND, Jenkins PJ, Will EM, Court-Brown CM, McQueen MM. Socioeconomic deprivation predicts outcome following radial head and neck fractures. Injury 2012; 43:1102-6. [PMID: 22440531 DOI: 10.1016/j.injury.2012.02.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 02/05/2012] [Accepted: 02/19/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is increasing evidence demonstrating an association between fracture epidemiology and socioeconomic status. However, the influence of socioeconomic deprivation on fracture outcome has not been documented before. The aim of this study was to determine if socioeconomic deprivation influenced the short-term outcome following a fracture of the radial head or neck. METHODS We identified from a prospective database all patients who sustained a radial head or neck fracture over an 18-month period. The primary outcome measure for this study was the patient-reported short musculoskeletal function assessment (SMFA). The Index of Multiple Deprivation (IMD) was used to quantify deprivation, and any correlation with functional outcome was determined. Multivariate regression analysis was used to determine the influence of deprivation on outcome once other significant demographic and fracture characteristics had been accounted for. RESULTS There were 200 patients in the study cohort, of which 107 (53.5%) were female and the mean age was 44 years (16-83). At a mean follow-up of 6 months the median SMFA score was 0.54 (0-55.4). The SMFA was found to be influenced by the IMD, with increasing deprivation associated with a poorer outcome (p=0.006). On multivariate analysis, the AO fracture classification, compensation and increasing deprivation were the only independent predictors of outcome (all p<0.05). CONCLUSIONS We have a shown a clear correlation between functional outcome and socioeconomic status, with the most deprived patients reporting a poorer outcome. Future work should be aimed at determining which aspects of deprivation influence patient outcome, with modifiable factors targeted in future health-care planning.
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Affiliation(s)
- Andrew D Duckworth
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SU, UK.
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Duckworth AD, Clement ND, Jenkins PJ, Aitken SA, Court-Brown CM, McQueen MM. The epidemiology of radial head and neck fractures. J Hand Surg Am 2012; 37:112-9. [PMID: 22119600 DOI: 10.1016/j.jhsa.2011.09.034] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 09/24/2011] [Accepted: 09/27/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to define the epidemiological characteristics of proximal radial fractures. METHODS Using a prospective trauma database of 6,872 patients, we identified all patients who sustained a fracture of the radial head or neck over a 1-year period. Age, sex, socioeconomic status, mechanism of injury, fracture classification, and associated injuries were recorded and analyzed. RESULTS We identified 285 radial head (n = 199) and neck (n = 86) fractures, with a patient median age of 43 years (range, 13-94 y). The mean age of male patients was younger when compared to female patients for radial head and neck fractures, with no gender predominance seen. Gender did influence the mechanism of injury, with female patients commonly sustaining their fracture following a low-energy fall. Radial head fractures were associated more commonly with complex injuries according to the Mason classification, while associated injuries were related to age, the mechanism of injury, and increasing fracture complexity. CONCLUSIONS Radial head and neck fractures have distinct epidemiological characteristics, and consideration for osteoporosis in a subset of patients is recommended. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Andrew D Duckworth
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK.
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Court-Brown CM, Aitken SA, Ralston SH, McQueen MM. The relationship of fall-related fractures to social deprivation. Osteoporos Int 2011; 22:1211-8. [PMID: 20552329 DOI: 10.1007/s00198-010-1315-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 04/26/2010] [Indexed: 11/30/2022]
Abstract
UNLABELLED The relationship between fall-related fractures and social deprivation was studied in 3,843 patients. The incidence of fractures correlated with deprivation in all age groups although the spectrum of fractures was not affected by deprivation. The average age and the prevalence of hip fractures decreased with increasing deprivation. INTRODUCTION This study examines the relationship between social deprivation and fall-related fractures. Social deprivation has been shown to be a predisposing factor in a number of diseases. There is evidence that it is implicated in fractures in children and young adults, but the evidence that it is associated with fragility fractures in older adults is weak. As fragility fractures are becoming progressively more common and increasingly expensive to treat, the association between social deprivation and fractures is important to define. METHODS All out-patient and in-patient fractures presenting to the Royal Infirmary of Edinburgh over a 1-year period were prospectively recorded. The fractures caused by falls from a standing height were analysed in all patients of at least 15 years of age. Social deprivation was assessed using the Carstairs score and social deprivation deciles, and the 2001 census was used to calculate fracture incidence. The data were used to analyse the relationship between social deprivation and fall-related fractures in all age groups. RESULTS The incidence of fall-related fractures correlated with social deprivation in all age groups including fragility fractures in the elderly. The overall spectrum of fractures was not affected by social deprivation although the prevalence of proximal femoral fractures decreased with increasing deprivation. The average age of patients with fall-related fractures also decreased with increasing social deprivation as did the requirement for in-patient treatment. CONCLUSIONS This is the first study to show the relationship between fall-related fractures and social deprivation in older patients. We believe that the decreased incidence of proximal femoral fractures, and the lower average age of patients with fall-related fractures, in the socially deprived relates to the relative life expectancies in the different deprivation deciles.
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Affiliation(s)
- C M Court-Brown
- Royal Infirmary of Edinburgh, University of Edinburgh, EH16 4SU Edinburgh, UK.
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Anakwe RE, Aitken SA, Cowie JG, Middleton SD, Court-Brown CM. The epidemiology of fractures of the hand and the influence of social deprivation. J Hand Surg Eur Vol 2011; 36:62-5. [PMID: 20709710 DOI: 10.1177/1753193410381823] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study investigates the relationship between the epidemiology of hand fractures and social deprivation. Data were collected prospectively in a single trauma unit serving a well-defined population. The 1382 patients treated for 1569 fractures of the metacarpals or phalanges represented an incidence of hand fracture of 3.7 per 1000 per year for men and 1.3 per 1000 per year for women. Deprivation was not directly associated with the incidence of hand fracture. Common mechanisms of injury are gender specific. Fractures of the little finger metacarpal were common (27% of the total) and were associated with social deprivation in men (P = 0.017). For women, fractures where the mechanism of injury was unclear or the patient was intoxicated and could not recall the mechanism showed a clear association with deprivation. Affluent patients were more likely to receive operative treatment. Social deprivation influences both the pattern and management of hand fractures.
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Affiliation(s)
- R E Anakwe
- Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
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Tzioupis C, Cox G, Giannoudis PV. Acute compartment syndrome of the lower extremity: an update. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.mporth.2009.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Factors affecting infection after calcaneal fracture fixation. Injury 2009; 40:1313-5. [PMID: 19524907 DOI: 10.1016/j.injury.2009.03.044] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 02/25/2009] [Accepted: 03/25/2009] [Indexed: 02/02/2023]
Abstract
A retrospective study of 178 operatively managed intra-articular calcaneal fractures was undertaken. The primary purpose of the study was to investigate whether delay prior to surgery was related to the prevalence of post-operative deep infection although other factors related to infection were also examined. The deep infection rate was 5.6% but there was no statistical correlation between surgical delay and deep infection. However analysis of the results showed that surgical experience did correlate with deep infection. The infection rate for a group of inexperienced surgeons was 14.3% compared with 2.8% for the most experienced surgeon in the study. Analysis also indicated a trend towards more socially deprived patients having a higher rate of infection but it was only in drug addicts where there was a significantly increased rate of deep infection. Other factors such as smoking, fracture severity and wound closure did not affect the rate of deep infection. Our study shows that delay prior to calcaneal fracture surgery is not associated with a lower infection rate but it is does indicate that surgical experience is important and we believe that these difficult fractures should be treated in specialised centres.
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Faschingbauer M, Meiners J, Schulz AP, Rudolf KD, Kienast B. Operative Treatment and Soft Tissue Management of Open Distal Tibial Fractures - Pitfalls and Results. Eur J Trauma Emerg Surg 2009; 35:527-31. [PMID: 26815375 DOI: 10.1007/s00068-009-9170-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Accepted: 09/03/2009] [Indexed: 10/20/2022]
Abstract
Open tibial fractures usually result from high-energy trauma. Severe soft-tissue injuries are often combined with open fractures of the distal tibia. A consecutive series of 42 patients with open extraarticular distal tibial fractures (Gustilo I-IIIc) operated on between July 2006 and February 2009 were included in the study reported here. We performed open reduction and internal fixation for the Gustilo I cases. Soft tissue was closed directly after antibiotic beads had been temporarily applied. For the Gustilo II and III cases, our treatment protocol included soft-tissue debridement of all devitalized soft tissue and bone fragments, pulsatile jet irrigation, and external stabilization. Soft tissue was temporarily closed with Epigard_ after the application of antibiotic beads. A second-look operation was scheduled after 3-5 days. Gustilo II patients needed an average of 1.1 (0-3) revisions until wound closure, compared to the average of 2.1 revisions necessary for the Gustilo III patients. It took 5.6 (0-16) days to obtain definitive wound closure in the Gustilo II patients and 9.9 (3-28) days in the Gustilo III patients. Skin grafting was sufficient for definitive softtissue closure in ten cases, local flaps in eight cases, and free musculocutaneous flaps were needed in six cases. Gustilo II patients with primary wound closure remained hospitalized for 11 days, while patients with secondary wound closure stayed in hospital for an average of 20 days. Our early results concerning infection rate, number of reoperations, and time to bony consolidation can be compared with other studies. Functional results will have to be evaluated at clinical follow-up.
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Affiliation(s)
- Maximilian Faschingbauer
- Department of Traumatology, Orthopedics and Sports Medicine, BG Trauma Centre, Hamburg, Germany. .,Department of Traumatology, Orthopedics and Sports Medicine, BG Trauma Centre, Bergedorfer Straße 10, 21033, Hamburg, Germany.
| | - Jan Meiners
- Department of Traumatology, Orthopedics and Sports Medicine, BG Trauma Centre, Hamburg, Germany
| | - Arndt Peter Schulz
- Department of Trauma and Orthopedics, University of Lübeck, Lübeck, Germany
| | - Klaus-Dieter Rudolf
- Department of Hand, Plastic and Microsurgery, BG Trauma Centre, Hamburg, Germany
| | - Benjamin Kienast
- Department of Traumatology, Orthopedics and Sports Medicine, BG Trauma Centre, Hamburg, Germany
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Modin M, Ramos T, Stomberg MW. Postoperative impact of daily life after primary treatment of proximal/distal tibiafracture with Ilizarov external fixation. J Clin Nurs 2009; 18:3498-506. [PMID: 19732246 DOI: 10.1111/j.1365-2702.2009.02859.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe patients' experience of the impact of their health-related life situation on their daily life two and four weeks after primary fracture treatment with Ilizarov external fixation. BACKGROUND A few studies have been conducted postoperatively focussing on fracture treatment with Ilizarov fixation. DESIGN A prospective descriptive research design. METHOD Patients who had been treated for a proximal/distal tibial fracture were invited to participate in the study. Data were collected with a semi-structured questionnaire where 20 patients described in their own words their situation at home two and four weeks postoperatively. The process used when analysing the data was similar to content analysis. RESULTS Four key themes were identified: 'limitations in the home environment', 'limitations outside the home', 'limitations to social relations' and 'experience of having an Ilizarov fixation'. The patient's life situation was strongly affected during the first postoperative month. This took the form of clear limitations on activities outside the home and a degree of limitation on coping with household chores and personal hygiene. These limitations became less severe after between 2-4 weeks and were very much a consequence of using crutches. CONCLUSION This study points to limitations in the patient's daily life situation in the home. The results from the study make it obvious that the information given to patients prior to discharge, concerning the value of putting weight on the leg, had not been clear or that the patients had not understood it. This had a negative impact on the patient's daily life after discharge. Further data are needed to uncover the extent of the issue to be able to optimise patient outcomes. RELEVANCE TO CLINICAL PRACTICE There is a need for clearer and more active information from the nurse before discharge but also a need to follow up how the information given is understood.
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Affiliation(s)
- Marina Modin
- Department of Surgery, Central Hospital, Skövde, Sweden.
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Menon MRG, Walker JL, Court-Brown CM. The epidemiology of fractures in adolescents with reference to social deprivation. ACTA ACUST UNITED AC 2008; 90:1482-6. [PMID: 18978270 DOI: 10.1302/0301-620x.90b11.21163] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A relationship between social deprivation and the incidence of fracture in adolescents has not previously been shown. We have used a complete fracture database to identify adolescents who sustained fractures in 2000. The 2001 Scottish census was used to obtain age-specific population and deprivation data according to the Carstairs score. Regression analysis determined the relationship between the incidence of fractures and social deprivation. We analysed 1574 adolescents with fractures (1083 male, 491 female). The incidence of fractures in this group was 21.8 per thousand (31.0 male, 13.1 female). Social deprivation predicted the incidence in adolescent males and females. The incidence of fractures of the proximal upper limb and distal radius in females was overwhelmingly influenced by socioeconomic factors. Males of 15 to 20 years of age were more likely to sustain fractures of the hand and carpus if they lived in economically depressed neighbourhoods.
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Affiliation(s)
- M R G Menon
- Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SU, UK
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