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Biomedical subjects

Kenneth J Koval

Publications and source records attributed to Kenneth J Koval.

At least 19 recordsLinked to original sources
PubMed2006

Stress radiographs after ankle fracture: the effect of ankle position and deltoid ligament status on medial clear space measurements.

OBJECTIVE: This study was designed to determine 1) how ankle position affects the medial clear space by using stress radiographs, 2) which medial clear space measurement, overall width or increase in width, better predicts deep deltoid ligament disruption after Weber type-B distal fibular fracture, and 3) what value of medial clear space is most predictive of deep deltoid ligament disruption after Weber type-B distal fibular fracture. DESIGN: Cadaveric fracture model. SETTING: Biomechanics laboratory. INTERVENTION: Fluoroscopic mortise views were taken of 6 fresh cadaveric ankles mounted in a fixture permitting both positioning in neutral flexion, dorsiflexion, and plantarflexion, and the application of internal and external rotational forces. After destabilizing the ankles according to the supination-external rotation mechanism of Lauge-Hansen, repeat radiographs were taken with the same combination of flexion and applied rotational stress. MAIN OUTCOME MEASURE: Radiographic measurements of medial clear space width and changes in medial clear space were made. RESULTS: A medial clear space of > or =5 mm on radiographs taken in dorsiflexion with an external rotational stress was most predictive of deep deltoid ligament transection after distal fibular fracture. In dorsiflexion-external rotation, medial clear spaces of > or =4 mm yielded lower specificity and positive predictive value, whereas > or =6 mm yielded lower sensitivity and negative predictive value. All other stress conditions and increases in medial clear space of 2 or 3 mm were less predictive. CONCLUSIONS: Ankle stress radiographs taken in dorsiflexion-external rotation were most predictive of deep deltoid ligament disruption after distal fibular fracture. Under this stress condition, a medial clear space of > or =5 mm was the most reliable predictor of deep deltoid ligament status.

Aged↗
PubMed2006

Does fibular plating improve alignment after intramedullary nailing of distal metaphyseal tibia fractures?

OBJECTIVE: Evaluate whether supplementary fibular fixation helped maintain axial alignment in distal metaphyseal tibia-fibula fractures treated by locked intramedullary nailing. DESIGN: Retrospective chart and radiographic review. SETTING: Three, level 1, trauma centers. PATIENTS: Distal metaphyseal tibia-fibula fractures were separated into 2 groups based on the presence of adjunctive fibular plating. Group 1 consisted of fractures treated with small fragment plate fixation of the fibula and intramedullary (IM) nailing of the tibia, whereas group 2 consisted of fractures treated with IM nailing of the tibia without fibular fixation. OUTCOME MEASURES: Malalignment of the tibial shaft was defined as 1) >5 degrees of varus/valgus angulation, or 2) >10 degrees anterior/posterior angulation. Measures of angulation were obtained from radiographs taken immediately after the surgery, a second time 3 months later, and at 6-month follow-up. Leg length and rotational deformity were not examined. RESULTS: Seventy-two fractures were studied. In 25 cases, the associated fibula fracture was stabilized, and in 47 cases the associated fibula fracture was not stabilized. Cases were more likely to have the associated fibula fracture stabilized where the tibia fracture was very distal. In multivariate adjusted analysis, plating of the fibula fracture was significantly associated with maintenance of reduction 12 weeks or later after surgery (odds ratio = 0.03; P = 0.036). The use of 2 medial-lateral distal locking bolts also was protective against loss of reduction; however, this association was not statistically significant (odds ratio = 0.29; P = 0.275). CONCLUSIONS: In this study, the proportion of fractures that lost alignment was smaller among those receiving stabilization of the fibula in conjunction with IM nailing compared with those receiving IM nailing alone. Adjunctive fibular stabilization was associated significantly with the ability to maintain fracture reduction beyond 12 weeks. At the present time, the authors recommend fibular plating whenever IM nailing is contemplated in the unstable distal tibia-fibular fracture.

Adolescent↗
PubMed2006

The consistency between scientific papers presented at the Orthopaedic Trauma Association and their subsequent full-text publication.

OBJECTIVES: To determine the consistency of conclusions/statements made in podium presentations at the annual meeting of the Orthopaedic Trauma Association (OTA) with those in subsequent full-text publications. Also, to evaluate the nature and consistency of study design, methods, sample sizes, results and assign a corresponding level of evidence. DATA SOURCES: Abstracts of the scientific programs of the OTA from 1994 to 1997 (N = 254) were queried by using the PubMed database to identify those studies resulting in a peer-reviewed, full-text publication. STUDY SELECTION: Of the 169 articles retrieved, 137 studies were the basis of our study after the exclusion criteria were applied: non-English language, basic science studies, anatomic dissection studies, and articles published in non-peer-reviewed journals. DATA EXTRACTION/SYNTHESIS: Information was abstracted onto a data form: first from the abstract published in the final meeting program, and then from the published journal article. Information was recorded regarding study issues, including the study design, primary objective, sample size, and statistical methods. We provided descriptive statistics about the frequency of consistent results between abstracts and full-text publications. The results were recorded as percentages and a 95% confidence interval was applied to each value. Study results were recorded for the abstract and full-text publication comparing results and the overall conclusion. A level of scientific-based evidence was assigned to each full-text publication. RESULTS: The final conclusion of the study remained the same 93.4% of the time. The method of study was an observational case series 52% of the time and a statement regarding the rate of patient follow-up was reported 42% of the time. Of the studies published, 18.2% consisted of a sample size smaller than the previously presented abstract. When the published papers had their level of evidence graded, 11% were level I, 16% level II, 17% level III, and 56% level IV. CONCLUSIONS: Authors conclusions were consistent with those in full-text publications. Most studies were observational, less than half reported on the rate of patient follow-up. Many abstracts followed by publication had a smaller sample size in the published paper. Half of all studies were graded level IV evidence.

Abstracting and Indexing↗
PubMed2006

Treatment of distal tibia fractures without articular involvement: a systematic review of 1125 fractures.

BACKGROUND: The management of unstable distal tibia fractures remains challenging. The mechanism of injury and the prognosis of these fractures are different from pilon fractures, but their proximity to the ankle makes the surgical treatment more complicated than the treatment tibial midshaft fractures. A variety of treatment methods have been suggested for these injuries, including nonoperative treatment, external fixation, intramedullary nailing, and plate fixation. However, each of these treatment options is associated with certain challenges. Nonoperative treatment may be complicated by loss of reduction and subsequent malunion. Similarly, external fixation of distal tibia fractures may result in insufficient reduction, malunion, and pin tract infection. Intramedullary nailing can be considered the "gold standard" for the treatment of tibial midshaft fractures, but there are concerns about their use in distal tibia fractures. This is because of technical difficulties with distal nail fixation, the risk of nail propagation into the ankle joint, and the discrepancy between the diaphyseal and metaphyseal diameter of the intramedullary canal. Open reduction and internal plate fixation results in extensive soft tissue dissection and may be associated with wound complications and infections. The optimal treatment of unstable distal tibia without articular involvement remains controversial. OBJECTIVES: This study was designed to review the outcomes of different treatment methods for extra-articular distal tibia fractures. The English literature was systematically reviewed and the rates of malunion, nonunion, infection, fixation failure, and secondary surgical procedures were extracted.

Bone Plates↗
PubMed2006

Blisters associated with lower-extremity fracture: results of a prospective treatment protocol.

OBJECTIVES: To evaluate patient outcomes after treatment of lower-extremity fractures associated with blister formation and to assess complications after soft-tissue treatment using a prospective protocol. DESIGN: Retrospective evaluation of prospectively collected data. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Between September 1999 and September 2003, 47 patients who had sustained a closed lower-extremity fracture with early development of fracture blisters in the zone of injury were followed. Blisters were characterized as either avoidable or unavoidable with respect to surgical incisions, and characteristics such as number, size, blood filled or clear filled, and the presence of an intact roof were documented. INTERVENTION: All blisters were unroofed, and antibiotic cream (silver sulfadiazine, Silvadene, King Pharmaceuticals Inc.) was applied twice daily until the blister bed had re-epithelialized. MAIN OUTCOME MEASUREMENTS: Fracture union and the development of wound or skin complications. Patient satisfaction with the cosmetic outcome of the treatment regimen was assessed through telephone survey at 23-month minimum follow-up. RESULTS: Twenty-eight patients presented with a single blister, and 19 had multiple blisters. Blister size averaged 9.7 cm. Twenty-two patients had blood-filled blisters, 20 had clear-filled blisters, and five had a combination of the two. Fracture patterns included 17 ankle fractures (OTA 44), 13 tibial plateau fractures (OTA 41), five tibial-shaft fractures (OTA 42), eight calcaneus fractures (OTA 45), and four pilon fractures (OTA 43). Mean delay in definitive surgical care was 7.7 days (range 0 to 20 days). The average delay of surgery for ankle fractures was 6 days (range 0 to 18 days), which was significantly less than the delay for calcaneus fractures (12 days, range 4 to 19 days, P < 0.02) and tibial plateau fractures (11 days, range 0 to 20 days, P < 0.02). Thirty-seven of the 45 patients (82.3%) available for follow-up at a mean of 27 weeks (range 14 to 35) had an uncomplicated postoperative course, and fracture union was achieved in 43 of 45 cases (95.6%). The soft-tissue complication rate associated with the standardized treatment regimen was 13.3% (6/45 cases), with three cases of minor soft-tissue breakdown, one superficial infection, and two major complications directly related to the presence of fracture blisters. Both major complications involved full-thickness skin breakdown occurring directly at the base of fracture blisters in patients with diabetes. The skin breakdown required further surgery in both cases. Including the two patients who developed nonunion, the overall complication rate for the treatment cohort was 17.7% (8/45 cases). At a mean follow-up of 51.9 months (range 23 to 73), three patients in the cohort had expired. Of the 42 patients available for evaluation, 28 patients (67%) were reachable for a telephone survey to assess satisfaction with the outcome of the fracture and soft-tissue management. Patients rated their satisfaction with the cosmetic appearance of their lower extremities after the standardized treatment regimen on a scale of 1 to 10 (with 10 representing very satisfied), with a mean of 9.07 (range 5 to 10). Six patients reported scarring at the sites of previous fracture blisters, all of which occurred after blistering of the blood-filled subtype. The presence of scarring significantly decreased patient satisfaction with cosmesis and overall treatment (P < 0.0001 and P < 0.01, respectively). CONCLUSIONS: Treatment of fracture blisters with a silver sulfadiazine (Silvadene) regimen proved to be successful in minimizing soft-tissue complications by promoting re-epithelialization in all nondiabetic patients. At long-term follow-up, patients were generally satisfied with the cosmetic outcome of the treatment regimen. Postoperative scarring, which was more common with blood-filled blisters, significantly impacted patient satisfaction. We urge caution when planning to make a surgical incision around an area of both full-thickness (blood-filled) and partial-thickness (clear-filled) fracture blisters in diabetic patients because the zone of injury might extend beyond the borders of the fracture blister.

Adult↗
PubMed2006

Fixation of diaphyseal fractures with a segmental defect: a biomechanical comparison of locked and conventional plating techniques.

BACKGROUND: Locking plates are an alternative to conventional compression plate fixation for diaphyseal fractures. The objective of this study was to compare the stability of various plating with locked screw constructs to conventional nonlocked screws for fixation of a comminuted diaphyseal fracture model using a uniform, synthetic ulna. Locked screw construct variables were the use of unicortical or bicortical screws, and increasing bone to plate distance. METHODS: This biomechanical study compared various construct groups after cyclic axial loading and three-point bending. Results were analyzed via one-way analysis of variance. Displacements after cyclical axial loading and number of cycles to failure in cyclic bending were used to assess construct stability. RESULTS: The constructs fixed by plates with bicortical locked screws withstood significantly more cycles to failure than the other constructs (p < 0.001). Significantly less displacement occurred after axial loading with bicortical locked screws than with bicortical nonlocked screws. Increased distance of the plate from the bone surface, and use of unicortical locked screws led to early failure with cyclic loading for constructs with locked screws. CONCLUSIONS: These results support the use of plating with bicortical locked screws as an alternative to conventional plating for comminuted diaphyseal fractures in osteoporotic bone. Bicortical locked screws with minimal displacement from the bone surface provide the most stable construct in the tested synthetic comminuted diaphyseal fracture model. The results of this study suggest use of plates with unicortical screws for the described fracture is not recommended.

Biomechanical Phenomena↗
PubMed2006

A biomechanical comparison of two volar locked plates in a dorsally unstable distal radius fracture model.

BACKGROUND: This study compares the biomechanical stability of two volar locked plate systems for fixation of unstable, extra-articular distal radius fractures. METHODS: In six matched pairs of fresh frozen cadaveric specimens, a simulated unstable, extra-articular distal radius fracture was created. The fractures were stabilized with one of two types of volar locked plates. Specimens were axially loaded at five different positions: central, volar, dorsal, radial, and ulnar. Initial (precyclic loading) stiffness of each locked plate system was calculated. Each specimen was then loaded for 5,000 cycles with an 80 N central load. Finally, specimens were axially loaded at the same five positions to calculate the postcyclic loading stiffness of each volar locked plate system. Main outcome measurements were precyclic loading stiffness, postcyclic loading stiffness, maintenance of stiffness after cyclic loading, and amount of fracture displacement between the two volar locked plate systems. RESULTS: There were no differences in maintenance of stiffness and fracture displacement following cyclical loading between the two volar plate systems. After cyclic loading, the distal volar radius (DVR) locked plate was significantly stiffer than the Synthes volar locked plate in volar loading only (p < 0.01). CONCLUSION: Materials properties and design differences between these systems did not provide enough biomechanical difference to support use of either implant over the other. With this in vitro model, both implants provided adequate stability to resist physiologic loads expected during therapy in the initial postoperative period.

Adult↗
PubMed2006

Treatment of external fixation pins about the wrist: a prospective, randomized trial.

BACKGROUND: Pin-track infection remains one of the most troublesome complications of external fixation, in some cases compromising otherwise successful fracture treatment. METHODS: One hundred and eighteen patients (120 wrists) who had been managed with the placement of an external fixation device for the treatment of a displaced, unstable, distal radial fracture were randomized into one of three treatment groups: (1) weekly dry dressing changes without pin-site care; (2) daily pin-site care with a solution of one-half normal saline solution and one-half hydrogen peroxide; and (3) treatment with the placement of chlorhexidine-impregnated discs (Biopatch) around the pins, with weekly changes of the discs by the treating surgeon. The patients were followed at weekly intervals until the external fixator was removed. Radiographs were made biweekly. The patients were evaluated with regard to (1) erythema, (2) cellulitis, (3) drainage, (4) clinical or radiographic evidence of pin-loosening, (5) the need for antibiotics, and (6) the need for pin removal before fracture-healing due to infection. Differences in complication rates among the three groups, with adjustment for patient age, gender, and the performance of an associated open procedure, were evaluated. RESULTS: The average age of the patients was fifty-four years. Forty-seven wrists had an open procedure (either bone-grafting or open reduction and internal fixation) in addition to treatment with the external fixator. The fixators remained in place for an average of 5.9 weeks. Twenty-three patients (19%) had a complication related to the pin track, with twelve of these patients requiring oral antibiotics for the treatment of a pin-track infection. There were no significant differences among the three groups with regard to the prevalence of pin-site complications. The age of the patient was found to be significantly associated with an increased risk of postoperative pin-track complications (p = 0.04). CONCLUSIONS: We found a high rate of local wound complications around external fixation pin sites; however, most complications were minor and could be observed or treated with oral antibiotics. The prevalence of these complications was not decreased in association with the use of hydrogen peroxide wound care or chlorhexidine-impregnated dressings. On the basis of these results, we do not recommend additional wound care beyond the use of dry, sterile dressings for pin-track care after external fixation for the treatment of distal radial fractures.

Adolescent↗
PubMed2006

Predictors of short-term functional outcome following ankle fracture surgery.

BACKGROUND: Ankle fractures are among the most common injuries treated by orthopaedic surgeons. However, very few investigators have examined the functional recovery following ankle fracture surgery and, to our knowledge, none have analyzed factors that may predict functional recovery. In this study, we evaluated predictors of short-term functional outcome following surgical stabilization of ankle fractures. METHODS: Over three years, 232 patients who sustained a fracture of the ankle and were treated surgically were followed prospectively, for a minimum of one year. Trained interviewers recorded baseline characteristics, including patient demographics, medical comorbidities, and functional status according to the Short Musculoskeletal Function Assessment (SMFA). Laboratory findings, the American Society of Anesthesiologists (ASA) class, and operative findings were recorded from the chart during hospitalization. Follow-up information included the occurrence of complications or additional surgery, weight-bearing status, functional status according to the SMFA, and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. The data were analyzed to determine predictors of functional recovery at three months, six months, and one year postoperatively. RESULTS: Complete follow-up data were available for 198 patients (85%). At one year, 174 (88%) of the patients had either no or mild ankle pain and 178 (90%) had either no limitations or limitations only in recreational activities. According to the AOFAS ankle-hindfoot score, 178 (90%) of the patients had > or = 90% functional recovery. A patient age of less than forty years was a predictor of recovery, as measured with the SMFA subscores, at six months after the ankle fracture. At one year, however, age was no longer a predictor of recovery. Patients who were younger than forty were more likely to recover > or = 90% of function (p = 0.004), and men were more likely than women to recover function (p = 0.02). ASA Class 1 or 2 (p = 0.03) and an absence of diabetes (p = 0.02) were also predictors of better functional recovery at one year. SMFA subscores were below average at baseline, indicating a healthy population. At three and six months postoperatively, all SMFA subscores were significantly higher than the baseline subscores (p < 0.001); however, at one year, the SMFA subscores were almost back to the baseline, normal level. CONCLUSIONS: One year after ankle fracture surgery, patients are generally doing well, with most experiencing little or mild pain and few restrictions in functional activities. They have a significant improvement in function compared with six months after the surgery. Younger age, male sex, absence of diabetes, and a lower ASA class are predictive of functional recovery at one year following ankle fracture surgery. It is important to counsel patients and their families regarding the expected functional recovery after an ankle injury.

Adolescent↗
PubMed2006

Are patients being transferred to level-I trauma centers for reasons other than medical necessity?

BACKGROUND: In the United States, the Emergency Medical Treatment and Active Labor Act defines broad guidelines regarding interhospital transfer of patients who have sought care in the emergency department. However, patient transfers for nonmedical reasons are still considered a common practice. The purpose of this study was to evaluate the possible risk factors for hospital transfer in a population of patients unlikely to require transfer to a level-I center for medical reasons. METHODS: A retrospective case-control national database study was performed with use of data from the National Trauma Data Bank (version 4.3). The study group consisted of patients with low Injury Severity Scores (< or =9) who were transferred to a level-I trauma center from another hospital. The controls were patients with low Injury Severity Scores who were treated at any hospital that was lower than a level-I trauma center and were not transferred. Hypothesized risk factors for hospital transfer were the age, gender, race, and insurance status of the patient; the time of day the transfer was received; and the number and type of comorbidities. RESULTS: The total sample included 97,393 patients, 21% of whom were transferred to a level-I trauma center. The odds ratios adjusted for all risk factors indicated that transfer rates were higher for male patients compared with female patients (adjusted odds ratio = 1.46), children compared with seniors (3.54), blacks compared with whites (1.28), evening or night transfers compared with morning or afternoon transfers (2.25), patients with Medicaid compared with those with other types of insurance (2.02), and for those with one or more comorbidities compared with those with no comorbidity (2.79). CONCLUSIONS: These results suggest the need for prospective studies to further investigate the relationships between hospital transfer and medical and nonmedical factors.

Adolescent↗
PubMed2006

Preoperative assessment of tibial nail length: accuracy using digital radiography.

This study was performed to determine if picture archiving communication systems can provide a more accurate method of determining implant length for intramedullary tibial nailing. Postoperative radiographs of 40 patients who underwent intramedullary nailing of their tibial shaft fractures using picture archiving communication systems were retrieved. In phase one and two of this investigation, tibial nail lengths were measured using "measuring distance" and "measure calibration" tools displayed on the respective digital systems. Phase 3 of this study involved 5 tibial Sawbones (Pacific Research Laboratories, Vashon, Wash) radiographically captured on the picture archiving communication systems with a radiograph marker of known length. Using the "measuring distance" and "measure calibration" tools in phases one and two did not result in accurate measurements. Of 40 digital radiographic images measured and calibrated with the on-screen ruler and using the digital system tools, 100% of our measurements were inaccurate. An average of 19.4-mm and 10.6-mm difference was noted in uncorrected measurements on anteroposterior (AP) and lateral views, respectively. An average 25.8 mm and 15.7 mm was noted in calibrated (corrected) measurements on AP and lateral views respectively. Digitally measured and calibrated lengths were an average 22 mm and 25 mm greater from the actual known length of the tibial nail, respectively. Phase 3 of our study presented the most accurate results in length determination of tibial nail length.

Body Weights and Measures↗
PubMed2006

The geographic incidence and treatment variation of common fractures of elderly patients.

Fractures of the hip, wrist, proximal humerus, and ankle frequently are observed among the elderly patient population in the United States. The Medicare patient population has shown dramatic geographic variation in the rates of these common fractures, with an increased incidence observed throughout the Southeast. Treatment (surgical versus nonsurgical) is also highly variable and dependent on the geographic location but not necessarily on the type of injury. Whereas regional variation in medical treatment may be attributed to variations in practice patterns, the etiology behind the dramatic variations in fractures is less well-defined and is likely multifactorial, related to environmental, occupational, genetic, or nutritional factors.

Aged↗
PubMed2006

Predictive value of preoperative arterial blood gas evaluation for geriatric patients with hip fractures.

The high incidence of preoperative silent pulmonary embolisms (PEs) among elderly patients with hip fractures has led some authors to recommend making acquisition of arterial blood gas (ABG) levels a routine part of the preoperative workup. In the study reported here, we retrospectively reviewed 254 patients in our hip-fracture database and determined that ABG levels have poor positive predictive value for PEs and add little to the positive predictive value or negative predictive value of careful clinical examination. Therefore, we do not recommend making acquisition of ABG levels a routine part of the preoperative evaluation.

Aged↗
PubMed2006

Increasingly conflicted: an analysis of conflicts of interest reported at the annual meetings of the Orthopaedic Trauma Association.

PURPOSE: To identify trends in industry sponsorship of orthopaedic trauma research presented at the annual meetings of the Orthopaedic Trauma Association since the establishment of conflict of interest (COI) reporting policies in 1993. BACKGROUND: Industry plays a large role in funding orthopaedic basic science and clinical research. The purpose of this study was to analyze the role of industrial support in orthopaedic research as documented in the final programs of the annual meetings of the Orthopaedic Trauma Association (OTA), determine the incidence and nature of COI in the papers and posters accepted for OTA presentation, and report any changes in the frequency of reporting since disclosure policies were enacted in 1993. METHODS: This paper analyzes COI for all years since the adoption of the reporting policies 1993-2002. From 1993-1998, presenters of posters and papers presented at the Orthopaedic Trauma Association annual meetings were required to disclose COI greater than dollar 500, the type of monetary distribution was not recorded. From 1999-2002, presenters of posters and papers were required to acknowledge the type of COI: 1. research grant, 2. miscellaneous non-income support, 3. royalties, 4. stock, and 5. consultant fees. All COI categories were recorded for each year Linear regression was used to determine significance of trends in the pooled data. RESULTS: There was an increase in the percentage of papers accepted and presented at the OTA between 1993 and 2002 with COI. The number of papers reporting COI rose from 7.6% in 1993 to 12.6% in 2002 (p = 0.0129). There was no significant increase in posters with COI over that same time period. No changes were observed in the nature of industrial involvement since the change in reporting enacted in 1999. There were no observed trends in NIH or OTA grant distribution between 1993 and 2002. DISCUSSION AND CONCLUSION: Industry is playing an increasing role in the funding oforthopaedic research. The majority of industrial support is in the form of research grants. The increasing industrial support of scientific research in the public sector is to be applauded as long as it does not lead to the sequestering and suppression of information that may be disadvantageous to the industrial sponsor.

Authorship↗
PubMed2006

Outcome after femoral shaft fractures in the elderly: the effects of altitude.

BACKGROUND: A paucity of knowledge currently exists surrounding the effects of altitude on femur fracture outcomes. The purpose of this study was to determine if altitude plays a significant role in determining the outcome of femoral shaft fractures in the elderly. The authors hypothesized that the additional cardiopulmonary stress of altitude would promote poorer outcomes of those individuals treated at high altitude, especially those individuals whose home residence was located at low altitude. METHODS: Medicare part A claims data between 1996 and 2000 were searched and patients with open or closed femoral shaft fractures were identified for the study. The treatment altitude and home residence altitude for each patient was recorded by cross-matching Zip Code information provided in the Medicare part A database with a database providing altitude data by Zip Code. The patients were grouped both by the altitude of treatment and by the difference between the altitude of residence and the altitude of treatment. The data was analyzed for outcome measurements. RESULTS: The claims data search identified 30,168 patients for the study. For the entire sample, the in-hospital mortality was 4.2%, 30-day mortality was 8.3%, 1-year mortality was 26.3%, and complication rate was 5.7%. Length of stay results demonstrated that patients treated at medium or high altitude had statistically shorter lengths of stay than those treated at low altitude (p < 0.01). Mortality rates and complications were not statistically different for those treated at high, medium, or low altitude with the exception of a slightly lower in-hospital mortality in the medium treatment altitude group (p = 0.04). Additionally, those patients who resided more than 1000 ft below the treatment altitude had shorter lengths of stay than those who resided more than 1000 ft above the treatment altitude (p < 0.01). Those patients who lived within 1000 ft of the treatment hospital or more than 1000 ft below the treatment hospital had fewer days in the intensive care unit (p < 0.01, p = 0.01; respectively). CONCLUSIONS: Femoral shaft fractures treated at altitude were not associated with increased morbidity and mortality as compared to femoral shaft fractures treated at low altitude. Additionally, patients residing at low altitude and treated at high altitude did not suffer increased morbidity or mortality.

Aged↗
PubMed2006

Orthopedic management of decubitus ulcers around the proximal femur.

Decubitus ulcers, commonly known as pressure ulcers or sores, represent localized areas of tissue necrosis. Despite increased awareness and use of preventive measures, these ulcers remain a major concern in the hospitalized and immobile patient population. When the hip joint becomes infected or the wound remains refractory to nonsurgical treatments, the orthopedic surgeon becomes involved in patient care. In this review, a brief overview of decubitus ulcers and their nonsurgical management is given, followed by a discussion of various flaps used in more extensive repairs. The major orthopedic procedures presented include proximal femoral resection (Girdlestone procedure), hip disarticulation, and hemipelvectomy. These surgeries retain an important position in managing complicated decubitus ulcers around the proximal femur.

Disarticulation↗
PubMed2006

Demographics of high-energy mechanisms of injury in the Kids Inpatient Database.

The purpose of this study was to review the relationship of patient demographics to mechanism of injury (MOI). The 2000 Kids Inpatient Database (KID) was used. Logistic regression was used to evaluate the relationship between each MOI relative to other MOIs for each of five identified predictors (age, gender, race, socioeconomic status, geographic region). The KID had 87,795 children with a MOI coded and complete data for all predictors. For motor vehicle accidents, 16- to 20-year-olds were up to 3.72 times more likely to be involved than any other age group, and males were 40% less likely compared with females. For firearm hospitalizations, 16- to 20-year-old black males have significantly higher risk compared with all other identified groups.

Accidents, Traffic↗