Journal of orthopaedic trauma
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The interplay between law and medicine is a complex but necessary part of medical education and encompasses ethics, public policy, and professional liability. As one facet of the law, being "served" in this context can be an intimidating and confusing event for most orthopaedic surgeons. Having basic knowledge of the life of a lawsuit is critical to provide comfort during an often unfomfortable journey.
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Comparative Study
Determination of Radiographic Healing: An Assessment of Consistency Using RUST and Modified RUST in Metadiaphyseal Fractures.
To determine the reliability of the Radiographic Union Scale for Tibia (RUST) score and a new modified RUST score in quantifying healing and to define a value for radiographic union in a large series of metadiaphyseal fractures treated with plates or intramedullary nails. ⋯ The ICC for the modified RUST is slightly higher than the standard RUST in metadiaphyseal fractures and had substantial agreement. The ICC for the assessment of union was moderate agreement; however, definite union would be 10 and 13 with over 90% of reviewers assigning union. These are the first data-driven estimates of radiographic union for these scores.
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Comparative Study
A Comparison of the Charlson and Elixhauser Comorbidity Measures to Predict Inpatient Mortality After Proximal Humerus Fracture.
Proximal humerus fractures are very common in infirm elderly patients and are associated with appreciable inpatient mortality. We sought to compare the discriminative ability of the Charlson and Elixhauser comorbidity measures for predicting inpatient mortality after proximal humerus fractures. ⋯ Given that inadequate comorbidity risk adjustment can unfairly penalize hospitals and surgeons that care for a disproportionate share of infirm and sick patients, wider adoption of the Elixhauser measure for mortality prediction after proximal humerus fracture-and perhaps other musculoskeletal injuries-merits to be considered.
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To identify if preoperative cardiac consultations are made in accordance with the American College of Cardiology (ACC) Foundation and American Heart Association (AHA) guidelines and the delays in care after unnecessary consults. ⋯ Preoperative cardiac consults are frequently overused and lead to delays to surgical intervention and longer hospital length of stay while not revealing any further need for cardiac intervention or changing the rate of adverse events. Stricter adherence to the ACC/AHA guidelines will help decrease surgical delay and hospital length of stay.
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Treatment of greater tuberosity (GT) fractures occurring during anterior shoulder dislocation generally consists of initial closed reduction of the shoulder. Undisplaced fractures are treated conservatively, whereas displaced fractures generally undergo surgical management. Our hypothesis is that many well-reduced GT fractures will migrate. The primary goal of this study is to evaluate the outcomes of GT fractures associated with shoulder dislocation to optimize their management. ⋯ Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.