1
|
Stevens NM, Tyler AF, Boyce RH, Mitchell PM. Extra-articular Unstable Iliac Fractures: Associated Injuries, Fixation Strategies, and Outcomes. J Orthop Trauma 2022; 36:339-342. [PMID: 34873131 DOI: 10.1097/bot.0000000000002323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To characterize the associated injuries, fixation constructs, and outcomes of extra-articular unstable iliac fractures. DESIGN Retrospective cohort study. SETTING Level I trauma center. PATIENTS Thirty-three extra-articular unstable iliac fractures treated over a 20-year period. INTERVENTION Percutaneous or open fixation of iliac fractures at the pelvic brim AND/OR iliac crest. MAIN OUTCOME MEASURES Incidence of union, fixation failure, and angiography at the time of injury. RESULTS Twenty-five patients were treated operatively with appropriate follow-up. Four patients had fixation failure with displacement, all in the group with only brim OR crest fixation (4/8 patients, 50% rate). In patients with both crest AND brim fixation (n = 17), there were no cases of implant failure or late displacement. In displaced fractures (n = 22), 4 patients (18%) required embolization by interventional radiology. In all 4 cases, the superior gluteal artery was embolized. In patients with both crest AND brim fixation, all went on to uneventful union with an average Visual Analog Scale (VAS) pain score of 0.9 (range, 0-5) at final follow-up. CONCLUSIONS Extra-articular unstable iliac fractures are high-energy injuries that demonstrate a high rate of union when both pelvic brim AND iliac crest fixation is used. Approximately 1 in 5 patients with a displaced iliac fracture presented with a superior gluteal artery disruption requiring embolization. Pelvic brim OR iliac crest fixation used in isolation was associated with a fixation failure rate of 50%, supporting previous biomechanical work. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Nicole M Stevens
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | | | | | | |
Collapse
|
2
|
Castillo RC, Huang Y, Scharfstein D, Frey K, Bosse MJ, Pollak AN, Vallier HA, Archer KR, Hymes RA, Newcomb AB, MacKenzie EJ, Wegener S, Hsu JR, Karunakar MA, Seymour RB, Sims SH, Flores E, Churchill C, Hak DJ, Henderson CE, Mir HR, Chan DS, Shah AR, Steverson B, Westberg J, Gary JL, Achor TS, Choo A, Munz JW, Porrey M, Hendrickson S, Breslin MA, McKinley TO, Gaski GE, Kempton LB, Sorkin AT, Virkus WW, Hill LC, Jones CB, Sietsema DL, O'Toole RV, Ordonio K, Howe AL, Zerhusen TJ, Obremskey W, Boyce RH, Jahangir AA, Molina CS, Sethi MK, Vanston SW, Carroll EA, Drye DY, Holden MB, Collins SC, Wysocki E. Association Between 6-Week Postdischarge Risk Classification and 12-Month Outcomes After Orthopedic Trauma. JAMA Surg 2019; 154:e184824. [PMID: 30566192 DOI: 10.1001/jamasurg.2018.4824] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Numerous studies have demonstrated that long-term outcomes after orthopedic trauma are associated with psychosocial and behavioral health factors evident early in the patient's recovery. Little is known about how to identify clinically actionable subgroups within this population. Objectives To examine whether risk and protective factors measured at 6 weeks after injury could classify individuals into risk clusters and evaluate whether these clusters explain variations in 12-month outcomes. Design, Setting, and Participants A prospective observational study was conducted between July 16, 2013, and January 15, 2016, among 352 patients with severe orthopedic injuries at 6 US level I trauma centers. Statistical analysis was conducted from October 9, 2017, to July 13, 2018. Main Outcomes and Measures At 6 weeks after discharge, patients completed standardized measures for 5 risk factors (pain intensity, depression, posttraumatic stress disorder, alcohol abuse, and tobacco use) and 4 protective factors (resilience, social support, self-efficacy for return to usual activity, and self-efficacy for managing the financial demands of recovery). Latent class analysis was used to classify participants into clusters, which were evaluated against measures of function, depression, posttraumatic stress disorder, and self-rated health collected at 12 months. Results Among the 352 patients (121 women and 231 men; mean [SD] age, 37.6 [12.5] years), latent class analysis identified 6 distinct patient clusters as the optimal solution. For clinical use, these clusters can be collapsed into 4 groups, sorted from low risk and high protection (best) to high risk and low protection (worst). All outcomes worsened across the 4 clinical groupings. Bayesian analysis shows that the mean Short Musculoskeletal Function Assessment dysfunction scores at 12 months differed by 7.8 points (95% CI, 3.0-12.6) between the best and second groups, by 10.3 points (95% CI, 1.6-20.2) between the second and third groups, and by 18.4 points (95% CI, 7.7-28.0) between the third and worst groups. Conclusions and Relevance This study demonstrates that during early recovery, patients with orthopedic trauma can be classified into risk and protective clusters that account for a substantial amount of the variance in 12-month functional and health outcomes. Early screening and classification may allow a personalized approach to postsurgical care that conserves resources and targets appropriate levels of care to more patients.
Collapse
Affiliation(s)
- Renan C Castillo
- METRC Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yanjie Huang
- METRC Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel Scharfstein
- METRC Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Katherine Frey
- METRC Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Andrew N Pollak
- University of Maryland R Adams Cowley Shock Trauma Center, Baltimore
| | | | | | | | | | - Ellen J MacKenzie
- METRC Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Stephen Wegener
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Joseph R Hsu
- Carolinas Medical Center, Charlotte, North Carolina
| | | | | | | | | | | | - David J Hak
- Denver Health and Hospital Authority, Denver, Colorado
| | | | - Hassan R Mir
- Florida Orthopedic Institute/Tampa General Hospital, Tampa
| | - Daniel S Chan
- Florida Orthopedic Institute/Tampa General Hospital, Tampa
| | - Anjan R Shah
- Florida Orthopedic Institute/Tampa General Hospital, Tampa
| | | | - Jerald Westberg
- Hennepin County Medical Center/Regions Hospital, Minneapolis, Minnesota
| | - Joshua L Gary
- University of Texas Health Science Center at Houston
| | | | - Andrew Choo
- University of Texas Health Science Center at Houston
| | - John W Munz
- University of Texas Health Science Center at Houston
| | | | | | | | | | | | | | | | | | | | | | | | - Robert V O'Toole
- University of Maryland R Adams Cowley Shock Trauma Center, Baltimore
| | - Katherine Ordonio
- University of Maryland R Adams Cowley Shock Trauma Center, Baltimore
| | - Andrea L Howe
- University of Maryland R Adams Cowley Shock Trauma Center, Baltimore
| | | | | | - Robert H Boyce
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Cesar S Molina
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Manish K Sethi
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Eben A Carroll
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | | | - Martha B Holden
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Susan C Collins
- METRC Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Elizabeth Wysocki
- METRC Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
3
|
Thakore RV, Foxx AM, Lang MF, Sathiyakumar V, Obremskey WT, Boyce RH, Ehrenfeld JM, Sethi MK. Operative intervention for geriatric hip fracture: does type of surgery affect hospital length of stay? Am J Orthop (Belle Mead NJ) 2015; 44:228-232. [PMID: 25950538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hip fractures are the most costly fall-related fractures. Differences in hospital length of stay (LOS) based on type of surgery could have major financial implications in a potential bundled payment system in which all hip fractures are reimbursed a standard amount. We conducted a study to analyze differences in hospital LOS and costs for total hip arthroplasty (THA), hemiarthroplasty (HA), cephalomedullary nailing, open reduction and internal fixation (ORIF), and closed reduction and percutaneous pinning (CRPP). Through retrospective chart review, 615 patients over age 60 years across a 9-year period at an urban level I trauma center were identified. Mean LOS and costs for hip fracture repair were 6.91 days and $30,011.25, respectively. HA/THA was associated with the longest mean LOS (7.43 days) and highest costs ($33,657.90). After several patient factors were adjusted for, ORIF was associated with 0.84 fewer in-patient days and $3805.20 less in hospitalization costs compared with HA/THA (P=.042). CRPP was associated with 1.63 fewer days and $7383.90 less in costs than HA/THA (P=.0076). Our results provide insight into the financial implications of hip fracture fixation and identify targets for quality improvement initiatives to improve efficiency of resource utilization.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Manish K Sethi
- Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
| |
Collapse
|