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  1. Article: Surgical Debridement for Acute and Chronic Osteomyelitis in Children.

    Ekunseitan, Ernest / Sabatini, Coleen S / Swarup, Ishaan

    JBJS essential surgical techniques

    2023  Volume 13, Issue 1

    Abstract: Background: Osteomyelitis is an infection of the bone that commonly occurs in pediatric populations. First-line treatment most often involves a course of antibiotics. In recent studies, surgical debridement, in addition to antibiotics, has been shown to ...

    Abstract Background: Osteomyelitis is an infection of the bone that commonly occurs in pediatric populations. First-line treatment most often involves a course of antibiotics. In recent studies, surgical debridement, in addition to antibiotics, has been shown to provide positive clinical and functional outcomes in children. Debridement is most often indicated in patients with an abscess or in those who do not respond to empiric antibiotic therapy; however, there are limited video resources describing this technique in pediatric patients.
    Description: The key steps of the procedure, which are demonstrated in the present video article, are (1) preoperative planning, (2) positioning, (3) subperiosteal exposure and debridement, (4) cortical window creation, (5) irrigation, (6) adjunctive treatment, (7) drain placement, (8) wound closure, (9) dressing and immobilization, and (10) wound check and drain removal.
    Alternatives: Nonoperative treatment is usually indicated for acute osteomyelitis in which patients present with little to no necrotic tissue or abscess formation. In these cases, a course of broad-spectrum antibiotics may be sufficient for a cure.
    Rationale: This procedure allows for the removal of necrotic bone and soft tissue, thus facilitating the recovery process. It also allows for the retrieval of tissue samples that may be used to guide selection of the appropriate antibiotic therapy. Surgical debridement is a safe and reliable technique that has been associated with positive long-term outcomes.
    Expected outcomes: We expect that some patients will require repeat surgical debridement procedures to decrease pathogen burden and prevent future complications. However, we expect that the majority of patients who undergo surgical debridement for uncomplicated osteomyelitis will recover full functionality of the affected limb with no associated long-term sequelae
    Important tips: Understand preoperative imaging to identify areas of infection, localize critical structures and the physis, and plan surgical approaches.Use extensile approaches and preserve vascularity during the approach.Perform subperiosteal dissection and create a cortical window to debride areas of infection, but avoid excessive periosteal stripping.Close the dead space and wound in a layered manner.
    Acronyms and abbreviations: MRI = magnetic resonance imagingK-wire = Kirschner wireMRSA = methicillin-resistant
    Language English
    Publishing date 2023-03-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2747088-X
    ISSN 2160-2204
    ISSN 2160-2204
    DOI 10.2106/JBJS.ST.21.00039
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Rate of Refracture After Removal of Hardware in Pediatric Femur Fractures.

    Siu, Jeremy W / Chan, Chloe / Swarup, Ishaan / Sabatini, Coleen S

    Journal of pediatric orthopedics

    2023  Volume 43, Issue 8, Page(s) e674–e679

    Abstract: Purpose: Both flexible intramedullary nails (FINs) and plate osteosynthesis are commonly used for the treatment of femoral shaft fractures in pediatric patients. The purpose of this study is to determine the refracture rate after hardware removal in ... ...

    Abstract Purpose: Both flexible intramedullary nails (FINs) and plate osteosynthesis are commonly used for the treatment of femoral shaft fractures in pediatric patients. The purpose of this study is to determine the refracture rate after hardware removal in pediatric femur fractures.
    Methods: This is a retrospective cohort study that utilized the Pediatric Health Information System database to determine the number of pediatric patients ages 4 to 10 who underwent surgical fixation of a femur fracture and subsequent hardware removal between the years 2015 and 2019. All patients had a minimum of a 2-year follow-up to assess for refracture. Patients with metabolic bone disease, neuromuscular conditions, bone fragility disorders, nutritional deficiencies, and pathologic fractures were excluded.
    Results: Of the total, 2805 pediatric patients with 2881 femoral shaft fractures who underwent FIN (48.4%), plate fixation (36.1%), splinting/casting (14.9%), or external fixation (0.6%) were included. The mean age of patients with index fracture was 7.2 years (SD, 2.1) and 69% were males. Eight hundred eighty patients (60%) in the FIN group had their hardware removed compared with 693 patients (68%) in the plate fixation group ( P = 0.07), at an average of 287 ± 191 days versus 320 ± 203 days ( P = 0.03). Refracture occurred in 13 patients (1.5%) who had their hardware retained and in 21 patients (1.4%) who had their hardware removed ( P = 0.732). Among 65% of patients who underwent hardware removal, refracture occurred in 7 patients with FIN (0.8%) and 14 patients with plate fixation (2.2%) ( P = 0.04). Refracture occurred within 365 days from hardware removal in 1 patient with FIN (0.1%) and 7 patients with plate fixation (1%) ( P = 0.01). In logistic regression, patients with FIN fixation had lower odds of refracture after hardware removal compared with plate fixation (adjusted odds ratio: 0.39; 95% CI: 0.15-0.97). Age and payor status did not reach statistical significance in multivariate analysis.
    Conclusions: The rate of refracture after hardware removal for pediatric patients with a femoral shaft fracture was similar between patients with hardware retained and removal. However, patients with FIN had a lower rate of refracture AFTER hardware removal compared with plate fixation. This information can be helpful for advising families regarding the risks of refracture after hardware removal.
    Level of evidence: Level IV-retrospective cohort study.
    MeSH term(s) Male ; Humans ; Child ; Female ; Retrospective Studies ; Femoral Fractures/surgery ; Fracture Fixation, Internal/adverse effects ; Fractures, Spontaneous ; Femur ; Bone Diseases ; Fracture Fixation, Intramedullary/adverse effects ; Treatment Outcome
    Language English
    Publishing date 2023-06-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 604642-3
    ISSN 1539-2570 ; 0271-6798
    ISSN (online) 1539-2570
    ISSN 0271-6798
    DOI 10.1097/BPO.0000000000002454
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    Zs.A 1681: Show issues Location:
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  3. Article ; Online: Epidemiology and treatment outcomes in pediatric patients with post-injection paralysis.

    Song, Siyou / Muhumuza, Moses Fisha / Penny, Norgrove / Sabatini, Coleen S

    BMC musculoskeletal disorders

    2022  Volume 23, Issue 1, Page(s) 754

    Abstract: Background: Post-injection paralysis (PIP) of the sciatic nerve is an iatrogenic paralysis that occurs after an intramuscular injection, with resultant foot deformity and disability. This study investigates the epidemiology and treatment of PIP in ... ...

    Abstract Background: Post-injection paralysis (PIP) of the sciatic nerve is an iatrogenic paralysis that occurs after an intramuscular injection, with resultant foot deformity and disability. This study investigates the epidemiology and treatment of PIP in Uganda.
    Methods: Health records of pediatric patients surgically treated for PIP at the CoRSU Rehabilitation Hospital from 2013 to 2018 were retrospectively reviewed. Pre-operative demographics, perioperative management, and outcomes were coded and analyzed with descriptive statistics, chi-square for categorical variables, and linear models for continuous variables.
    Results: Four-hundred and two pediatric patients underwent 491 total procedures. Eighty-three percent of reported injection indications were for febrile illness. Twenty-five percent of reported injections explicitly identified quinine as the agent. Although ten different procedures were performed, achilles tendon lengthening, triple arthrodesis, tibialis posterior and anterior tendon transfers composed 83% of all conducted surgeries. Amongst five different foot deformities, equinus and varus were most likely to undergo soft tissue and bony procedures, respectively (p=0.0223). Ninteen percent of patients received two or more surgeries. Sixty-seven percent of patients achieved a plantigrade outcome; 13.61% had not by the end of the study period; 19.3% had unreported outcomes. Those who lived further from the facility had longer times between the inciting injection and initial hospital presentation (p=0.0216) and were more likely to be lost to follow-up (p=0.0042).
    Conclusion: PIP is a serious iatrogenic disability. Prevention strategies are imperative, as over 400 children required 491 total surgical procedures within just six years at one hospital in Uganda.
    MeSH term(s) Child ; Foot Deformities/surgery ; Humans ; Iatrogenic Disease/epidemiology ; Injections, Intramuscular/adverse effects ; Paralysis/epidemiology ; Paralysis/etiology ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2022-08-05
    Publishing country England
    Document type Journal Article
    ZDB-ID 2041355-5
    ISSN 1471-2474 ; 1471-2474
    ISSN (online) 1471-2474
    ISSN 1471-2474
    DOI 10.1186/s12891-022-05664-4
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  4. Article ; Online: New Injury Patterns in Pediatric Supracondylar Fractures During COVID-19: Beds Are the New Monkey Bars.

    Soriano, Kylen K J / Sabatini, Coleen S / Brar, Ravinder K / Jagodzinski, Jason E / Livingston, Kristin S

    Journal of pediatric orthopedics

    2023  Volume 43, Issue 4, Page(s) 198–203

    Abstract: Background: The coronavirus disease 2019 (COVID-19) pandemic drastically altered children's activity patterns. Our goal was to investigate how COVID-19 affected demographics, injury characteristics, treatment patterns, follow-up, and outcomes in ... ...

    Abstract Background: The coronavirus disease 2019 (COVID-19) pandemic drastically altered children's activity patterns. Our goal was to investigate how COVID-19 affected demographics, injury characteristics, treatment patterns, follow-up, and outcomes in pediatric supracondylar humerus (SCH) fractures.
    Methods: This was an Institutional Review Board-approved retrospective analysis of patients undergoing surgery for a SCH fracture from May to November 2019 (pre-COVID-19) and from May to November 2020 (during COVID-19) at 2 tertiary children's hospitals. Demographic information, injury characteristics, hospital course, and follow-up data were collected and compared.
    Results: SCH fractures decreased by >50% from 2019 (149) to 2020 (72). Children in the 2020 cohort were younger (mean 5.2 y old) compared with 2019 (6.0 y old) ( P =0.019). Mechanism of injury was significantly different in 2020 ( P <0.001), as the proportion of trampoline and furniture fractures increased from 8% and 17% to 15% and 33%, respectively. The proportion of playground and monkey bar fractures decreased from 20% and 17% to 3% and 4%, respectively. Distribution of Gartland type and neurovascular injury rates were similar in 2019 and 2020 ( P =0.411 and 0.538). Time from emergency department admission to the operating room and duration of hospital admission were both unchanged from 2019 to 2020 ( P =0.864 and 0.363). The duration of postoperative follow-up in 2019 was 94.5 days compared with 72.8 days in 2020 ( P =0.122), as more pandemic patients were lost to follow up (22.5% vs. 35.2%, P =0.049).
    Conclusions: The demographics, mechanism of injury, and follow-up practices of pediatric SCH fractures changed significantly during the pandemic, likely because of school closures and lock-downs changing activity patterns. Different mechanisms of injury affected younger patients and reflected the new ways children played. Trampoline-related and furniture-related injuries overtook the classic playground falls as primary mechanism of injury. Despite the need for COVID-19 testing, there was no delay in time to the operating room. Hospitalization duration did not change, yet postoperative follow-up was shorter, and more patients were lost to follow up. Despite these stressors, outcomes remained excellent in most children.
    Level of evidence: Level III-Retrospective comparative study.
    MeSH term(s) Humans ; Retrospective Studies ; COVID-19 Testing ; COVID-19/epidemiology ; Communicable Disease Control ; Humeral Fractures/surgery
    Language English
    Publishing date 2023-01-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 604642-3
    ISSN 1539-2570 ; 0271-6798
    ISSN (online) 1539-2570
    ISSN 0271-6798
    DOI 10.1097/BPO.0000000000002350
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    Zs.A 1681: Show issues Location:
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  5. Article: Vertical patellar dislocation: A pediatric case report and review of the literature.

    Udogwu, Ugochukwu N / Sabatini, Coleen S

    Orthopedic reviews

    2018  Volume 10, Issue 3, Page(s) 7688

    Abstract: Vertical patellar dislocations (VPDs) are a rare event, and even more so among pediatric female patients. There have been less than 30 vertical patellar dislocations reported in the literature since the first in 1844. In this type of dislocation, the ... ...

    Abstract Vertical patellar dislocations (VPDs) are a rare event, and even more so among pediatric female patients. There have been less than 30 vertical patellar dislocations reported in the literature since the first in 1844. In this type of dislocation, the patella rotates about its vertical axis with the articular surface facing either medially or laterally. The mechanism of injury for a VPD can be broadly divided into two themes: a twisting injury or direct impact to the medial or lateral edge of the patella. We present a 10-year-old girl with a VPD after experiencing a twisting injury when descending a playground slide. The purpose of this study is to present a case report and review of the literature on vertical patella dislocations, including mechanisms of injury and suggested methods of treatment. We aim to provide a comprehensive understanding of the various categories of patella dislocations to alleviate confusion when classifying patellar dislocations. Furthermore, we provide clear suggestions for reduction methods and techniques with regards to vertical patellar dislocations, including a suggested protocol for an irreducible patella.
    Language English
    Publishing date 2018-09-05
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2508171-8
    ISSN 2035-8164 ; 2035-8237
    ISSN (online) 2035-8164
    ISSN 2035-8237
    DOI 10.4081/or.2018.7688
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  6. Article ; Online: Gluteal Fibrosis and Its Surgical Treatment.

    Alves, Kristin / Katz, Jeffrey N / Sabatini, Coleen S

    The Journal of bone and joint surgery. American volume

    2019  Volume 101, Issue 4, Page(s) 361–368

    Abstract: Background: The objective of this study was to analyze the literature regarding the diagnosis, pathogenesis, and prevalence of gluteal fibrosis (GF) and the outcomes of treatment.: Methods: We searched PubMed, Embase, and Cochrane literature ... ...

    Abstract Background: The objective of this study was to analyze the literature regarding the diagnosis, pathogenesis, and prevalence of gluteal fibrosis (GF) and the outcomes of treatment.
    Methods: We searched PubMed, Embase, and Cochrane literature databases, from database inception to December 15, 2016. We used the following search terms including variants: "contracture," "fibrosis," "injections," "injections, adverse reactions,' "gluteal," and "hip." All titles and abstracts of potentially relevant studies were scanned to determine whether the subject matter was potentially related to GF, using predefined inclusion and exclusion criteria. If the abstract had subject matter involving GF, the paper was selected for review if full text was available. Only papers including ≥10 subjects who underwent surgical treatment were included in the systematic analysis. Data abstracted included the number of patients, patient age and sex, the type of surgical treatment, the method of outcome measurement, and outcomes and complications.
    Results: The literature search yielded 2,512 titles. Of these, 82 had a focus on GF, with 50 papers meeting the inclusion criteria. Of the 50 papers reviewed, 18 addressed surgical outcomes. The surgical techniques in these papers included open, minimally invasive, and arthroscopic release and radiofrequency ablation. Of 3,733 operatively treated patients in 6 reports who were evaluated on the basis of the criteria of Liu et al., 83% were found to have excellent results. Few papers focused on the incidence, prevalence, and natural history of GF, precluding quantitative synthesis of the evidence in these domains.
    Conclusions: This study provided a systematic review of surgical outcomes and a summary of what has been reported on the prevalence, diagnosis, prognosis, and pathogenesis of GF. Although GF has been reported throughout the world, it requires further study to determine the exact etiology, pathogenesis, and appropriate treatment. Surgical outcomes appear satisfactory.
    Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    MeSH term(s) Adolescent ; Buttocks/pathology ; Buttocks/surgery ; Child ; Child, Preschool ; Female ; Fibrosis/surgery ; Hip Contracture/pathology ; Hip Contracture/surgery ; Humans ; Male ; Muscle, Skeletal/pathology ; Muscle, Skeletal/surgery ; Postoperative Complications/etiology ; Treatment Outcome
    Language English
    Publishing date 2019-02-23
    Publishing country United States
    Document type Journal Article ; Systematic Review
    ZDB-ID 220625-0
    ISSN 1535-1386 ; 0021-9355
    ISSN (online) 1535-1386
    ISSN 0021-9355
    DOI 10.2106/JBJS.17.01670
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  7. Article ; Online: An Analysis of Online Ratings of Pediatric Orthopaedic Surgeons.

    Jay, Jordan H / Runge, Nicholas E / Vergara, Franz H / Sabatini, Coleen S / Oni, Julius K

    Journal of pediatric orthopedics

    2021  Volume 41, Issue 9, Page(s) 576–579

    Abstract: Background: Patients continue to utilize physician review websites (PRWs) to assist in their selection of a health care provider. Studies on PRWs and how they affect patient care have recently become popular in the literature. This study analyzes PRW ... ...

    Abstract Background: Patients continue to utilize physician review websites (PRWs) to assist in their selection of a health care provider. Studies on PRWs and how they affect patient care have recently become popular in the literature. This study analyzes PRW ratings of a previously unexamined subspecialty, pediatric orthopaedic surgeons.
    Methods: Three hundred ninety-nine randomly selected Pediatric Orthopaedic Society of North America member's PRW ratings were examined from May 4, 2020 to July 18, 2020. Healthgrades.com, Vitals.com, RateMDs.com, and Google.com were reviewed. Number of ratings and average ratings (0 to 5.0) were recorded. Provider sex, years in practice (0 to 10, 11 to 20, and 21+), practice type (academic, private), geographic location (Northeast, Southeast, Midwest, Southwest, West), degree (Medical Doctor, Doctor of Osteopathic Medicine), and fellowship training (yes, no) were recorded. Kruskal-Wallis testing was performed to determine factors affecting positive surgeon ratings.
    Results: 98.5% (393) of Pediatric Orthopaedic Society of North America surgeons were rated on a PRW at least once and were highly rated with an average rating of 4.14 of 5.0. Surgeons in practice 1 to 10 years had higher ratings than those in practice 11 to 20 and 21+ years, on Healthgrades.com (P=0.049) and RateMDs.com (P=0.011). Academic surgeons were found to have higher ratings than those in private practice on Google.com (P=0.007). Sex, region of practice, degree type, and fellowship training status did not have an effect on online ratings across all PRWs.
    Conclusions: Pediatric orthopaedic surgeons are frequently and highly rated, similar to other orthopaedic subspecialties. Surgeons in practice 1 to 10 years were found to have statistically higher ratings on some websites. Academic surgeons were found to have statistically higher ratings on some websites.
    MeSH term(s) Child ; Fellowships and Scholarships ; Humans ; Internet ; Orthopedic Surgeons ; Orthopedics ; Patient Satisfaction ; Surgeons
    Language English
    Publishing date 2021-08-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 604642-3
    ISSN 1539-2570 ; 0271-6798
    ISSN (online) 1539-2570
    ISSN 0271-6798
    DOI 10.1097/BPO.0000000000001932
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    Zs.A 1681: Show issues Location:
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    ab Jg. 2022: Lesesaal (EG)

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  8. Article ; Online: Implicit Racial Bias in Pediatric Orthopaedic Surgery.

    Guzek, Ryan / Goodbody, Christine M / Jia, Lori / Sabatini, Coleen S / Sankar, Wudbhav N / Williams, Brendan A / Shah, Apurva S

    Journal of pediatric orthopedics

    2022  Volume 42, Issue 7, Page(s) 393–399

    Abstract: Introduction: Racial and ethnic minority patients continue to experience disparities in health care. It is important to understand provider-level factors that may contribute to these inequities. This study aims to evaluate the presence of implicit ... ...

    Abstract Introduction: Racial and ethnic minority patients continue to experience disparities in health care. It is important to understand provider-level factors that may contribute to these inequities. This study aims to evaluate the presence of implicit racial bias among pediatric orthopaedic surgeons and determine the relationship between bias and clinical decision making.
    Methods: A web-based survey was distributed to 415 pediatric orthopaedic surgeons. One section measured for potential implicit racial bias using a child-race implicit association test (IAT). IAT scores were compared with US physicians and the US general population using publicly available data. Another section consisted of clinical vignettes with associated questions. For each vignette, surgeons were randomly assigned a single race-version, White or Black. Vignette questions were grouped into an opioid recommendation, management decision, or patient perception category for analysis based on subject tested. Vignette answers from surgeons with IAT scores that were concordant with their randomized vignette race-version (ie, surgeon with pro-White score assigned White vignette version) were compared with those that were discordant.
    Results: IAT results were obtained from 119 surveyed surgeons (29% response rate). Overall, respondents showed a minor pro-White implicit bias ( P <0.001). Implicit bias of any strength toward either race was present among 103/119 (87%) surgeons. The proportion of pediatric orthopaedic surgeons with a strong pro-White implicit bias (29%) was greater than that of US physicians overall (21%, P =0.032) and the US general population (19%, P =0.004). No differences were found in overall opioid recommendations, management decisions, or patient perceptions between concordant and discordant groups.
    Conclusion: Most of the pediatric orthopaedic surgeons surveyed demonstrated implicit racial bias on IAT testing, with a large proportion demonstrating strong pro-White bias. Despite an association between implicit bias and clinical decision making in the literature, this study observed no evidence that implicit racial bias affected the management of pediatric fractures.
    Level of evidence: Level IV.
    MeSH term(s) Analgesics, Opioid ; Attitude of Health Personnel ; Child ; Ethnicity ; Humans ; Minority Groups ; Orthopedic Procedures ; Racism
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2022-05-09
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 604642-3
    ISSN 1539-2570 ; 0271-6798
    ISSN (online) 1539-2570
    ISSN 0271-6798
    DOI 10.1097/BPO.0000000000002170
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    ab Jg. 2022: Lesesaal (EG)

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  9. Article ; Online: Treatment of Severely Shortened or Comminuted Clavicular Fractures in Older Adolescent Athletes.

    Spence, David D / Wilson, Philip L / Pennock, Andrew T / Nepple, Jeffrey J / Pandya, Nirav K / Perkins, Crystal A / Li, Ying / Ellis, Henry B / Sabatini, Coleen S / Edmonds, Eric W / Willimon, S Clifton / Bae, Donald S / Busch, Michael T / Kocher, Mininder / Heyworth, Benton E

    The American journal of sports medicine

    2024  Volume 52, Issue 2, Page(s) 423–430

    Abstract: Background: Recent evidence suggests that for completely displaced midshaft clavicular fractures, surgery offers no clear benefit over nonoperative treatment in a general adolescent population from 10 to 18 years of age. However, the comparative ... ...

    Abstract Background: Recent evidence suggests that for completely displaced midshaft clavicular fractures, surgery offers no clear benefit over nonoperative treatment in a general adolescent population from 10 to 18 years of age. However, the comparative outcomes of comminuted and/or severely shortened clavicular fractures specifically in older adolescent athletes have not been explored in a focused, methodologically rigorous fashion.
    Hypothesis: The study hypothesis was that outcomes would be superior in older adolescent athletes who underwent operative treatment compared with nonoperative treatment for comminuted and/or severely shortened clavicular fractures.
    Study design: Cohort study; Level of evidence, 2.
    Methods: A level 2, multicenter, prospective cohort study investigating the outcomes of midshaft fractures in adolescents between 2013 and 2017 was filtered to analyze the subcohorts of athletes 14 to 18 years of age with either fracture comminution or fracture shortening of ≥25 mm or both. Patient characteristics, injury mechanisms, fracture characteristics, and treatments were compared. Complications, rates, timing of return to sports (RTS), and patient-reported outcomes (PROs) were analyzed.
    Results: The 2 treatment groups, which included 136 older adolescent athletes (69 nonoperative, 67 operative), showed similar distributions of primary sport type, competition level, comminution, shortening, and 2-year PRO response rate (n = 99; 73%). The operative group demonstrated 3 mm-greater mean superior displacement, which was therefore statistically controlled for as a confounder in the comparative PRO analysis. No 2-year differences in nonunion, delayed union, symptomatic malunion, refracture, clinically significant complications, or rates of RTS were detected between treatment groups. The difference in timing of RTS (operative, 10.3 weeks; nonoperative, 13.5 weeks) was statistically significant. After controlling for the minor difference in superior displacement, regression analysis and matched comparison cohorts demonstrated no differences between the nonoperative and operative groups in mean or dichotomized PRO scores.
    Conclusion: In this prospective, multicenter cohort study investigating older adolescent athletes with comminuted and/or severely shortened clavicular fractures, contrary to the study hypothesis, there were no differences in complications, RTS, or PROs between nonoperatively and operatively treated patients at 2 years. Comparably excellent outcomes of severe clavicular fractures in adolescent athletes can be achieved with nonoperative treatment.
    MeSH term(s) Humans ; Adolescent ; Aged ; Prospective Studies ; Cohort Studies ; Fracture Healing/physiology ; Treatment Outcome ; Fractures, Bone/surgery ; Fracture Fixation, Internal/adverse effects ; Athletes ; Clavicle/diagnostic imaging ; Clavicle/surgery ; Clavicle/injuries
    Language English
    Publishing date 2024-01-18
    Publishing country United States
    Document type Multicenter Study ; Journal Article
    ZDB-ID 197482-8
    ISSN 1552-3365 ; 0363-5465
    ISSN (online) 1552-3365
    ISSN 0363-5465
    DOI 10.1177/03635465231219248
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  10. Article ; Online: Access to Orthopaedic Care for Spanish-Speaking Patients in California.

    Greene, Nattaly E / Fuentes-Juárez, Berenice N / Sabatini, Coleen S

    The Journal of bone and joint surgery. American volume

    2019  Volume 101, Issue 18, Page(s) e95

    Abstract: Background: Communication is the foundation of any patient-doctor relationship. Patients who are unable to communicate effectively with physicians because of language barriers may face disparities in accessing orthopaedic care and in the evaluation and ... ...

    Abstract Background: Communication is the foundation of any patient-doctor relationship. Patients who are unable to communicate effectively with physicians because of language barriers may face disparities in accessing orthopaedic care and in the evaluation and treatment of musculoskeletal symptoms. We evaluated whether Spanish-speaking patients face disparities scheduling appointments with orthopaedists via the telephone.
    Methods: From the American Academy of Orthopaedic Surgeons (AAOS) web site, we randomly selected 50 orthopaedic surgeons' offices in California specializing in knee surgery. The investigator called eligible offices using a script to request an appointment for a hypothetical Spanish-speaking or English-speaking 65-year-old man with knee pain. The caller randomly selected the patient's primary language for this first call. A second call was placed a week later requesting an appointment for an identical patient who spoke the alternate language.
    Results: There was no significant difference between Spanish-speaking and English-speaking patients' access to appointments with an orthopaedic surgeon (p = 0.8256). Thirty-six English-speaking patients and 35 Spanish-speaking patients were offered an appointment. Twenty-eight Spanish-speaking patients were instructed to bring a friend or family member who could translate for them, 3 were told that the provider spoke sufficient Spanish to communicate without the need for an interpreter, and 4 were told that an interpreter would be made available.
    Conclusions: We did not detect a disparity between Spanish-speaking and English-speaking patients' access to appointments with an orthopaedic surgeon. However, 80% of Spanish-speaking patients were asked to rely on nonqualified interpreters for their orthopaedic appointment. This study suggests that orthopaedic offices in California depend heavily on ad hoc interpreters rather than professional interpretation services. It also highlights potential barriers to the provision of qualified interpreters. Additional study is warranted to assess how this lack of adequate utilization of medical interpreters affects the patient-doctor relationship, the quality of care received, and the financial burden on the health system.
    Clinical relevance: Optimizing the care that we provide to our patients is a goal of every orthopaedic surgeon. We highlight the importance of utilizing professional interpreters as a means to reduce health-care disparities and overall health-care costs, as well as the importance of improving reimbursement and infrastructure for physicians to utilize qualified interpreters in caring for their limited-English-proficient patients.
    MeSH term(s) Aged ; Appointments and Schedules ; California ; Communication Barriers ; Health Services Accessibility/statistics & numerical data ; Healthcare Disparities/ethnology ; Healthcare Disparities/statistics & numerical data ; Hispanic Americans ; Humans ; Language ; Male ; Orthopedic Procedures ; Orthopedic Surgeons ; Physician-Patient Relations ; Telephone ; Translating
    Language English
    Publishing date 2019-10-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 220625-0
    ISSN 1535-1386 ; 0021-9355
    ISSN (online) 1535-1386
    ISSN 0021-9355
    DOI 10.2106/JBJS.18.01080
    Database MEDical Literature Analysis and Retrieval System OnLINE

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