Injury-International Journal of the Care of the Injured最新文献

{"title":"Management of rotational malalignment following operative treatment of fractures of the lower extremities. A scoping review","authors":"Mounir Cherkaoui ,&nbsp;Jolien Onsea ,&nbsp;Louis Thielman ,&nbsp;Michael H.J. Verhofstad ,&nbsp;William T. Obremskey ,&nbsp;Austin T. Fragomen ,&nbsp;Mitchell Bernstein ,&nbsp;Kevin Tetsworth ,&nbsp;Willem-Jan Metsemakers","doi":"10.1016/j.injury.2024.111903","DOIUrl":"10.1016/j.injury.2024.111903","url":null,"abstract":"<div><h3>Background</h3><div>Rotational malalignment after operative fracture treatment of the lower extremity may be associated with increased pain and functional impairment. Despite its clinical relevance, there are no uniform management guidelines. The aim of this scoping review is to provide an overview of all available evidence to diagnose and treat rotational deformities of the lower extremity following operative fracture treatment.</div></div><div><h3>Methods</h3><div>This scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A literature search was carried out on 22 August 2023 by two independent reviewers in the Pubmed (MEDLINE), Embase, Web of Science, and Cochrane library databases. The search strategy was developed with the assistance of a biomedical information specialist. The main search terms were tibial and femoral malrotations. Disagreements were resolved through discussion with a third reviewer.</div></div><div><h3>Results</h3><div>After screening and quality assessment of 3929 unique identified records, 50 articles were included for qualitative synthesis. Most studies were retrospective case reports or case series. Thirty studies focused on the femur, 11 on the tibia and nine included both femur and tibia. Most of the included studies presented cases where malrotation was associated with other limb deformities. Only 18 studies focused solely on the treatment of malrotation of the lower extremities after operative fracture treatment. Regarding diagnosis, bilateral CT-scans were used in 34 studies. Regarding treatment, external fixation was used in two studies, internal fixation (either intramedullary nail or plate) in 45 studies, and in three studies the authors used both. Overall, revision surgery resulted in good clinical outcomes with low complication rates.</div></div><div><h3>Conclusion</h3><div>This scoping review reveals that rotational malalignment following operative treatment of lower extremity fractures remains an important complication. Although it occurs frequently and is associated with severe disability for the patient, standardized guidelines regarding the terminology, diagnosis, indications for intervention and treatment are lacking. CT-scan is the most used diagnostic modality in daily clinical practice. Revision surgery, using diverse operative techniques, demonstrated positive results, significantly alleviating patient complaints with few complications. Nevertheless, an international consensus regarding the optimal management pathway is needed, and future prospective clinical studies seem therefore necessary.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 11","pages":"Article 111903"},"PeriodicalIF":2.2,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142327469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"There is no correlation between differences in adverse events and differences in patient-reported outcome measures in orthopaedic trauma randomized controlled trials: A systematic review","authors":"Joshua A. Parry,&nbsp;Maryam Salimi,&nbsp;Stephen C. Stacey,&nbsp;Cyril Mauffrey","doi":"10.1016/j.injury.2024.111909","DOIUrl":"10.1016/j.injury.2024.111909","url":null,"abstract":"<div><h3>Introduction</h3><div>A recovery without adverse events is a top priority of orthopaedic trauma patients, however many randomized controlled trials (RCTs) are only powered to detect a difference in patient-reported outcome measures (PROMs). While it may be assumed that differences in major adverse event rates between treatment groups will result in differences in PROMs, this has not been established. The purpose of this study was to perform a systematic review of RCTs to evaluate if differences in these outcomes were correlated.</div></div><div><h3>Methods</h3><div>A systematic search was conducted of online databases to identify RCTs in orthopaedic trauma fracture management that reported both major adverse events and PROMs. Adverse events included secondary surgeries or complications that could negatively affect long-term outcomes (nonunion, chronic regional pain syndrome, etc.). The correlation between a difference (<em>p</em> &lt; 0.05) in adverse events and a difference in PROMs was assessed.</div></div><div><h3>Results</h3><div>The systematic review yielded 30 RCTs involving 6,769 patients. The primary outcome was a continuous PROM in 70.0 % (21/30). A difference in major adverse events was reported in 23.3 % (7/30) and a difference in PROMs was reported in 6.7 % (2/30). Studies reporting a difference in adverse events, compared to those that did not, were not more likely to report a difference in PROMs (14.3 % (1/7) vs. 4.3 % (1/23); <em>p</em> = 0.42).</div></div><div><h3>Conclusions</h3><div>There was no correlation between differences in adverse event rates and differences in PROMs in orthopaedic trauma RCTs. Investigators should consider powering studies to detect differences in the major adverse events that both patients and surgeons wish to avoid.</div></div><div><h3>Level of evidence</h3><div>Level I</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 11","pages":"Article 111909"},"PeriodicalIF":2.2,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimal intervention (removable splint or bandage) for the management of distal forearm fractures in children and adolescents: A scoping review","authors":"Peter J. Snelling ,&nbsp;Peter Goodwin ,&nbsp;Justin Clark ,&nbsp;David Bade ,&nbsp;Randy Bindra ,&nbsp;Robert S. Ware ,&nbsp;Gerben Keijzers","doi":"10.1016/j.injury.2024.111897","DOIUrl":"10.1016/j.injury.2024.111897","url":null,"abstract":"<div><h3>Introduction</h3><div>Distal forearm fractures are common in children and adolescents with a spectrum of severity. There are fracture patterns that are suitable for minimal interventions, such as a splint or bandage. The objective of this review was to identify which types of paediatric distal forearm fractures can be safely and effectively managed with a removable splint or bandage.</div></div><div><h3>Materials and methods</h3><div>A scoping review was performed. Databases searched were PubMed, Embase, The Cochrane Library and CINAHL; two trial registries were also searched. All primary study designs with children &lt;18 years of age with a distal forearm fracture that was managed in either a splint or bandage were included. Quality of evidence was determined using the GRADE tool.</div></div><div><h3>Results</h3><div>Twenty-two eligible articles were included from 20 unique studies: 12 randomised controlled trials, seven cohort studies and a case report. Twelve studies focused solely on buckle/torus fractures, with remaining studies including other fracture types, such as incomplete (‘greenstick’), complete (‘transverse’), or physeal (Salter-Harris). Twelve studies reported that participants with either bandage or splint had appropriate reduction in pain and recovery of function at completion of follow-up for all fracture types. All 20 studies reported minimal adverse events related to fracture management. One study reported worsening angulation with bandage immobilisation for complete fractures in two participants, which required manipulation under anaesthesia.</div></div><div><h3>Discussion</h3><div>There is high quality evidence to support the safety and effectiveness of a splint or bandage for treatment of distal radius buckle and non-displaced incomplete fractures. Several studies supported the use of minimal interventions for various distal radius cortical breach fracture types, with good outcomes, but were limited by heterogeneity (methodology, interventions, outcome measures, reference standard) and potential bias.</div></div><div><h3>Conclusions</h3><div>Included studies confirmed the inherent stability of buckle fractures. The current literature gap to support minimal interventions for a range of other paediatric distal forearm fracture types was highlighted. High-quality evidence with well-designed, large, multicentre randomised control trials in defined age groups is required to identify which paediatric distal forearm fractures can be safely and effectively managed with either a removable splint or bandage.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 11","pages":"Article 111897"},"PeriodicalIF":2.2,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0020138324006260/pdfft?md5=1832b30dc447ca45f5d63d85973f4b0f&pid=1-s2.0-S0020138324006260-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can limb length discrepancies be corrected with the Masquelet technique? A technical trick","authors":"Peter V. Giannoudis ,&nbsp;Eduardo Gonzalez Edery ,&nbsp;Nikolaos K. Kanakaris","doi":"10.1016/j.injury.2024.111881","DOIUrl":"10.1016/j.injury.2024.111881","url":null,"abstract":"<div><div>Masquelet technique is a well-established procedure for reconstruction of bone defects secondary to such causes as infections, non-unions, tumors or open fractures with bone loss. The management of limb length discrepancies following bone defects has been well established using bone transport and remains the preferred choice amongst reconstruction surgeons. One of the criticisms of the Masquelet technique has been its limitation to address limb length discrepancies. We describe a technique for the correction of limb length discrepancies using the Masquelet technique.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 11","pages":"Article 111881"},"PeriodicalIF":2.2,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of deep vein thrombosis and pulmonary embolism in closed foot and ankle fractures treated with conservative versus surgical management: A nationwide analysis","authors":"Meera Kohli ,&nbsp;Kuldeepsinh P. Atodaria ,&nbsp;Rajeshkumar Patel ,&nbsp;Shyam Brahmabhatt ,&nbsp;Aakash R. Goyal ,&nbsp;Neha Raval","doi":"10.1016/j.injury.2024.111859","DOIUrl":"10.1016/j.injury.2024.111859","url":null,"abstract":"<div><h3>Objectives</h3><div>Though there is extensive research on recovery and outcomes of proximal joint fractures, such as hip and knee, there is a paucity of such research in foot and ankle fractures and a lack of uniform data on the incidence of venous thromboembolism (VTE). This is a retrospective cohort study that seeks to investigate the incidence of VTE following surgically versus conservatively treated foot and ankle fractures</div></div><div><h3>Methods</h3><div>This study included all adult-patient hospitalizations with International Classification of Disease 10th Revision diagnosis codes related to closed foot and ankle fractures as a primary diagnosis in the National Inpatient Sample, an administrative database part of the Healthcare Cost and Utilization Project, for a total of 209,595 cases. Multivariate binary logistic regression was performed to determine the effect of age, gender, past medical history of venous thromboembolism (PMHVTE), Charlson Comorbidity Index, race, surgery, and transfusion of red cell products on the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE).</div></div><div><h3>Results</h3><div>Our study found an overall incidence of DVT and PE to be 0.4 % and 0.3 %, respectively, following foot or ankle fracture. Conservative management was found to have an increased relative risk of DVT and PE of 2.02 and 1.15, respectively. This difference persisted on performing inverse probability treatment weighting (IPTW) analysis to account for confounders. PMHVTE and requirement of blood transfusion was associated with an increased odds ratio (OR) of 3.41 and 3.217, respectively. Cases identified as Black and Asian/Pacific Islander also had an increased OR of DVT.</div></div><div><h3>Conclusions</h3><div>The results of this study demonstrate that surgical management of foot and ankle fractures is associated with a lower relative risk of VTE compared to medical management. PMHVTE and transfusion of red cell products increase the odds of VTE following either form of intervention.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 111859"},"PeriodicalIF":2.2,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142444744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interprofessional interventions that impact collaboration and quality of care across inpatient trauma care continuum: A scoping review","authors":"Alexandra Lapierre ,&nbsp;Mélanie Bérubé ,&nbsp;Marianne Giroux ,&nbsp;Pier-Alexandre Tardif ,&nbsp;Valérie Turcotte ,&nbsp;Éric Mercier ,&nbsp;Andréane Richard-Denis ,&nbsp;David Williamson ,&nbsp;Lynne Moore","doi":"10.1016/j.injury.2024.111873","DOIUrl":"10.1016/j.injury.2024.111873","url":null,"abstract":"<div><h3>Introduction</h3><p>Despite the recognized importance of interprofessional collaboration (IPC) in trauma care, healthcare professionals often work in silos. Interprofessional (IP) interventions are crucial for optimizing IPC and delivering high-quality care across clinical contexts, yet their effectiveness throughout the inpatient trauma care continuum is not well understood. Thus, this review aimed to examine the literature on the effectiveness of IP interventions on collaboration processes and related outcomes in inpatient trauma care.</p></div><div><h3>Methods</h3><p>We conducted a scoping review following Joanna Briggs Institute's methodology. We searched six databases for studies from the last decade on IP interventions in inpatient trauma care. Two independent reviewers categorized IP interventions (education, practice, organization) and extracted their impact on IPC processes and related outcomes (team performance, patient, organization).</p></div><div><h3>Results</h3><p>Of the 17,397 studies screened, 148 met the inclusion criteria. Most were cohort designs (72%), conducted in level I trauma centers (57%) and emergency departments (51%), and involved surgeons (56%) and nurses (53%). Studies focused on IP organization interventions (51%), such as clinical pathways; IP practice interventions (35%), such as trauma team activation protocols; and IP education interventions (14%) including multi-method education. IP practice interventions most effectively improved team performance results, while IP education interventions primarily improved IPC processes. Positive patient outcomes were limited, with few studies examining organizational effects.</p></div><div><h3>Conclusions</h3><p>Significant advancements are still required in IP interventions and trauma care research. Future studies should rigorously explore the effectiveness of interventions throughout the inpatient trauma care continuum and focus on developing robust measures for patient and organizational outcomes.</p></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 11","pages":"Article 111873"},"PeriodicalIF":2.2,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0020138324006028/pdfft?md5=b80c445b664976d2e3a2227f0bf32a62&pid=1-s2.0-S0020138324006028-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142272113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early external fixation of tibial plateau fractures is associated with an increased risk of compartment syndrome","authors":"Julian Wier,&nbsp;Andrew M. Duong,&nbsp;Joshua L. Gary,&nbsp;Joseph T. Patterson","doi":"10.1016/j.injury.2024.111879","DOIUrl":"10.1016/j.injury.2024.111879","url":null,"abstract":"<div><h3>Introduction</h3><p>Tibial plateau fractures are often associated with high-energy trauma necessitating external fixation as a means of temporization. There is evidence that pin placement and fracture distraction may result in transient increases in compartment pressures, and the optimal timing of external fixator placement is unknown. This study sought to determine the effect of early versus late external fixator placement on the risk of compartment syndrome after a tibial plateau fracture.</p></div><div><h3>Methods</h3><p>The Trauma Quality Improvement Program was retrospectively queried between 2015 and 2019 for adult patients with a tibial plateau fracture who underwent external fixator placement. Patients with concomitant tibial shaft and/or distal femur fractures, requiring lower extremity fasciotomy before external fixation, or external fixation &gt;7 days after admission were excluded. The primary study outcome was inpatient compartment syndrome. Secondary outcomes were inpatient acute respiratory failure/unplanned intubation, surgical site infection, and venous thromboembolism (VTE). A time threshold of delayed external fixation was identified at which the odds of compartment syndrome no longer significantly decreased with increasing time using a Markov Chain Monte Carlo simulation of a restricted cubic spline model. The odds of each outcome were compared between patients who underwent early versus delayed external fixation on or after the time threshold, adjusting for potential confounding by patients, injury, and hospital characteristics. Significance was defined as <em>p</em> &lt; 0.05.</p></div><div><h3>Results</h3><p>A threshold for delayed external fixation was identified at 28.8 h from admission. Of the 3,185 eligible patients, 2,656 (83.4 %) were classified as early external fixation and 529 (16.6 %) were classified as delayed external fixation. Delayed external fixation was associated with lower adjusted odds (aOR) of compartment syndrome (aOR: 0.31, 95 % Confidence Interval (CI): 0.13–0.74, <em>p</em> = 0.008) and higher aOR of acute respiratory failure/unplanned intubation (aOR: 2.13, 95 % CI: 1.13–4.0.2, <em>p</em> = 0.019), however no significant differences in adjusted odds of surgical site infection or VTE were observed.</p></div><div><h3>Conclusion</h3><p>Patients with tibial plateau fractures who underwent closed reduction and external fixation within 28.8 h of admission were associated with greater odds of compartment syndrome than those undergoing external fixation after this time threshold.</p></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 11","pages":"Article 111879"},"PeriodicalIF":2.2,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142272116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroplasty treatment options for femoral neck fractures in the elderly: A network meta-analysis of randomized control trials","authors":"Arhum Saleem ,&nbsp;Charles C. Lin ,&nbsp;Utkarsh Anil ,&nbsp;Steven M. Rivero","doi":"10.1016/j.injury.2024.111875","DOIUrl":"10.1016/j.injury.2024.111875","url":null,"abstract":"<div><h3>Introduction</h3><p>Treatment options for displaced intracapsular femoral neck fractures in elderly patients include unipolar hemiarthroplasty (UHA), bipolar hemiarthroplasty (BHA), unipolar total hip arthroplasty (UTHA), and dual-mobility total hip arthroplasty (DMTHA). This network meta-analysis (NMA) of randomized controlled trials (RCTs) quantitatively compares these treatments to identify the optimal surgical technique.</p></div><div><h3>Methods</h3><p>Following PRISMA guidelines, a comprehensive literature search in Medline (PubMed), Cochrane, and EMBASE databases was conducted. RCTs comparing UHA, BHA, UTHA, or DMTHA were included. Interventions were ranked using the SUCRA score.</p></div><div><h3>Results</h3><p>Among 5,542 studies, 12 RCTs met inclusion criteria, involving 1,490 patients. Procedures were ranked by prosthetic dislocation, mortality, operating time, intraoperative blood loss, revision rate, Harris Hip Score (HHS). BHA ranked the best in dislocation rate, intraoperative blood loss and mortality. UHA had the shortest operating time. DMTHA had the greatest ranking for HHS. However, the differences between these treatment modalities were rarely statistically significantly different.</p></div><div><h3>Conclusion</h3><p>A variety of arthroplasty procedures can be used to treat displaced intracapsular femoral neck fractures. Our results indicate that while BHA resulted in the best post-operative ranking amongst the compared treatment strategies in terms of dislocation rates, blood loss and mortality, the differences between the treatment options does not clearly favor a specific treatment option.</p></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 11","pages":"Article 111875"},"PeriodicalIF":2.2,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142272114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of sociodemographic characteristics with the timeliness of surgery for patients with open tibial fractures","authors":"Ami Hayashi ,&nbsp;Brendan Shi ,&nbsp;Catherine Juillard ,&nbsp;Christopher Lee ,&nbsp;Vickie M. Mays ,&nbsp;Jordan M. Rook","doi":"10.1016/j.injury.2024.111878","DOIUrl":"10.1016/j.injury.2024.111878","url":null,"abstract":"<div><h3>Background</h3><div>The American College of Surgeons recommends operative debridement of open tibial fractures within 24 h of presentation. It is unknown what the compliance rates are with this recommendation and what factors contribute to delays to operation.</div></div><div><h3>Methods</h3><div>To determine the characteristics associated with delays to operation for open tibial fractures, we conducted a retrospective cohort study utilizing American College of Surgeons Trauma Quality Improvement Program data from 2017 to 2021. Individuals aged 18 and older presenting to a trauma center with an open tibial fracture were included. Associations were determined with a hierarchal regression model nesting patients within facilities.</div></div><div><h3>Results</h3><div>Of the 24,102 patients presenting to 491 trauma centers, 66.3 % identified as White, 21.7 % as Black, 1.5 % as Asian, 1.1 % as American Indian, and 10.6 % as Other race. In total, 15.8 % identified as Hispanic. Patients were most often men (75.9 %) and privately insured (47.6 %). The median time to OR was 10.2 h (IQR 4.4–17.7) with 84.6 % receiving surgery within 24 h. In adjusted analyses, Black and American Indian patients had 5.5 % (CI 1.3 %-9.9 %) and 17.8 % (CI 2.2 %-35.8 %) longer wait times, respectively, and a decreased odds of receiving surgery within 24 h (AOR 0.85, CI 0.8–0.9; AOR 0.69, CI 0.5–0.9) when compared to White patients. Female patients had 6.5 % (CI 3.0 %-10.2 %) longer wait times than men. Patients with Medicaid had 5.5 % (CI 1.2 %-9.9 %) longer wait times than those with private insurance. Greater time to OR was associated with increasing age (<em>p</em> &lt; 0.001), increasing injury severity (<em>p</em> &lt; 0.001), and the presence of altered mentation (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>We identified longer wait times to operative irrigation and debridement of open tibial fractures for Black and American Indian patients, women, and those with Medicaid. The implementation of health equity focused quality metrics may be necessary to achieve equity in trauma care.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 11","pages":"Article 111878"},"PeriodicalIF":2.2,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0020138324006077/pdfft?md5=bc095bb9b0e9bd892ffb4190d606a369&pid=1-s2.0-S0020138324006077-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142304841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is it true that most intra-articular glenoid fractures should have surgery?","authors":"Scott Willms ,&nbsp;Andrew Caines ,&nbsp;Richard Buckley","doi":"10.1016/j.injury.2024.111880","DOIUrl":"10.1016/j.injury.2024.111880","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 11","pages":"Article 111880"},"PeriodicalIF":2.2,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142240612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}