Abstract:
OBJECTIVE:The objective of this study was to analyze the appropriateness of transfer of patients with orthopaedic injuries to a Level I trauma center from surrounding Level II to IV centers. DESIGN:A prospective study was conducted over a 5-month period by collecting data on all orthopaedic patients being transferred to our facility. All transfer diagnoses were designated as appropriate or inappropriate. Patient demographics were calculated. SETTING:The transfer of patients occurred from 23 Level II to IV hospitals to a Level I trauma center. These hospitals service 1 to 1.5 million people a year. PATIENTS/PARTICIPANTS MAIN OUTCOME MEASUREMENTS: All patients transferred with orthopaedic injuries were recorded. Patient variables such as transfer diagnosis, age, gender, insurance status, time of arrival, day of transfer, transferring and accepting physicians, previous imaging studies, and patient disposition were recorded. Outcome measurements included chi tests to determine variation in demographics based on insurance and appropriateness of transfer. Multivariate regression analysis was also performed to determine influence of individual patient variables on the main outcome variable: appropriateness of transfer. RESULTS:Two hundred sixteen patients were transferred of which we considered 52% inappropriate. Sixty-eight percent of transfers occurred between 6:00 pm and 5:59 am and 60% of all transfers were over the weekend. Also, 69% of inappropriate transfers were discharged directly from the emergency department. Insurance was an independent factor affecting appropriateness of transfer. A larger percentage of inappropriate patients transferred were uninsured. The inappropriate patient who was transferred had more likelihood of being uninsured than insured. Moreover, there was a significantly higher percentage of inappropriate uninsured patients transferred after hours and over the weekend as compared with insured patients. More than 97% of inappropriate transfers were accepted by the emergency department physician without communication with the on-call orthopaedist at our facility. CONCLUSIONS:There is a trend among community hospitals to transfer uninsured patients with benign orthopaedic injuries inappropriately to a Level I trauma center. This effect is magnified on weekends and at night. Strict regulation of the Emergency Labor Act and better communication between Level II to IV hospitals and Level I orthopaedic surgeons can decrease the inappropriate transfer of patients and reduce the burden on our healthcare system.
journal_name
J Orthop Traumajournal_title
Journal of orthopaedic traumaauthors
Thakur NA,Plante MJ,Kayiaros S,Reinert SE,Ehrlich MGdoi
10.1097/BOT.0b013e3181b18b89subject
Has Abstractpub_date
2010-06-01 00:00:00pages
336-9issue
6eissn
0890-5339issn
1531-2291pii
00005131-201006000-00002journal_volume
24pub_type
杂志文章abstract:OBJECTIVE:The aim of the current study was to see how different interlocking mechanisms would affect construct stability and overall failure in the treatment of two-part surgical neck fractures in the proximal humerus in vitro. METHODS:Left and right bones of eight pairs of fresh-frozen human cadaveric humeri were ass...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3181ffdf9a
更新日期:2011-07-01 00:00:00
abstract:OBJECTIVE:The purpose of this prospective cohort study was to determine if a new patella fracture fixation construct resulted in improved outcomes compared with traditional tension band techniques. DESIGN:Comparative cohort study. SETTING:Academic level I trauma center. PATIENTS/PARTICIPANTS:Patients with isolated, ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000787
更新日期:2017-05-01 00:00:00
abstract:OBJECTIVE:To determine whether multiple approaches pose an increased risk to fracture healing when compared with a standard single approach in the treatment of pilon (OTA 43C) fractures. DESIGN:Retrospective review of a prospective database. SETTING:Level I academic trauma center and level II community trauma center....
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000728
更新日期:2017-02-01 00:00:00
abstract::We report an isolated anterior dislocation of the radial head in an adult after sustaining a fall on the outstretched arm. Based on history and presentation, we speculate that the injury occurred in a position of hyperextension and supination. Reduction was achieved by a pronation maneuver. ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199505000-00014
更新日期:1995-01-01 00:00:00
abstract:OBJECTIVES:To determine if distal femoral traction pins result in knee dysfunction in patients with femoral or pelvic fracture, and to determine if skeletal traction relieves pain more effectively than splinting for femoral shaft fractures. DESIGN:Prospective cohort trial. SETTING:Level I urban trauma center. PATIEN...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000202
更新日期:2015-02-01 00:00:00
abstract::Use of cephalomedullary nails is an option for treatment of subtrochanteric femur fractures. However, the magnitude of bending forces in this area of the femur often can lead to implant failure before union. We report on a case of hardware failure of a specific device (Synthes spiral blade) and a method for removal. ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199803000-00010
更新日期:1998-03-01 00:00:00
abstract::This report presents a case demonstrating the nonunion of a capital femoral physeal fracture with a large metaphyseal fragment in a 10-year-old boy. To our knowledge, there is no previously reported case of this type of nonunion. The treatment of this nonunion presented a potential risk of premature physeal closure an...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3181c83a3b
更新日期:2010-08-01 00:00:00
abstract:OBJECTIVE:To observe and report the clinical results of indirect plating techniques in the treatment of femoral shaft nonunions originally treated with intramedullary nailing. DESIGN:Prospective consecutive. SETTING:Regional trauma center. PATIENTS:A consecutive series of twenty-three patients with nonunion of femor...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200105000-00004
更新日期:2001-05-01 00:00:00
abstract:OBJECTIVES:This study compared the acute treatment effects of systemic analgesics with (celecoxib) and without anti-inflammatory activity (acetaminophen) on bone fracture healing. STUDY DESIGN:Longitudinal time study of fracture healing in rats. METHODS:Closed, mid diaphyseal femur fractures were produced in female S...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/01.bot.0000184144.98071.5d
更新日期:2005-11-01 00:00:00
abstract:OBJECTIVE:To observe the results and describe the technique of closed reduction and placement of a two-pin supra-acetabular external fixator, followed by immediate weight bearing, in the treatment of displaced vertically stable lateral compression pelvic fractures. DESIGN:Prospective, consecutive. SETTING:Regional tr...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:
更新日期:2006-01-01 00:00:00
abstract::Tubular poly(L-lactide) membranes with a pore size of 5-15 microns and a molecular weight of 70,000 Daltons were implanted into 24 New Zealand skeletally mature rabbits to cover 10-mm mid-diaphyseal defects of the radius of the forelimb. An identical defect on the contralateral limb was not treated with the membrane a...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199604000-00006
更新日期:1996-01-01 00:00:00
abstract:BACKGROUND:Calcaneal fractures comprise 1 to 2 percent of all fractures. Approximately 75% of calcaneal fractures are intra-articular. The management of intra-articular calcaneal fractures remains controversial. Nonoperative treatment options include elevation, ice, early mobilization, and cyclic compression of the pla...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:
更新日期:2005-05-01 00:00:00
abstract::Antegrade intramedullary nails are an established, effective method of fixation for humeral shaft fractures. One significant limitation of this technique is chronic postoperative shoulder pain, which is likely related to the standard approach that involves splitting the rotator cuff to gain access to the nail starting...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000684
更新日期:2017-02-01 00:00:00
abstract::Marginal impaction of the acetabulum is typically accessible through fracture planes specific to the nature of the injury. Infrequently, however, incarcerated marginal impaction or free osteochondral fragments are not accessible through these existing fracture planes. As such, alternative methods to access these artic...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000759
更新日期:2017-05-01 00:00:00
abstract::Severe crush injuries to the midfoot often involve comminuted cuneiform or tarsal navicular fractures. Treatment principles for the bony injury of the crushed midfoot include maintenance of the medial column length and alignment, as well as appropriate stable fixation after open or closed fracture reductions. This is ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/00005131-200308000-00007
更新日期:2003-08-01 00:00:00
abstract:OBJECTIVES:To investigate the incidence of concomitant posterior malleolar fractures (PMFs) in operative, distal-third, spiral tibia fractures. DESIGN:Prospective protocol with retrospective review of data. SETTING:Single, Level 1 trauma center. PATIENTS/PARTICIPANTS:One hundred ninety-three consecutive, skeletally ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001307
更新日期:2018-11-01 00:00:00
abstract::A case of a complex distal humeral fracture is presented. The patient lacked sufficient bony architecture to allow for conventional reconstruction. A technique is described using an intramedullary plate to obtain bony stabilization and permit early range of motion exercises. ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200205000-00011
更新日期:2002-05-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to compare rates of surgical site infection (SSI) in patients with type 3 open fractures who had received cefazolin plus gentamicin versus piperacillin/tazobactam for antibiotic prophylaxis. DESIGN:Retrospective cohort study. SETTING:Level 1 trauma center. PATIENTS:Seven hund...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000554
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:To describe in utero radiation exposures in pregnant patients undergoing acetabular fracture repair. DESIGN:Retrospective case series. SETTING:University-affiliated regional trauma center. PATIENT/PARTICIPANTS:Eight pregnant patients with acetabular fractures treated over a 6-year period. There were an add...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3181847a42
更新日期:2008-09-01 00:00:00
abstract::The distribution of clindamycin in tibial cortical bone, administered via direct local infusion with an implantable pump, is described. Clindamycin concentrations in cortical bone were measured after 3, 7, and 21 days of intraosseous infusion. The tibia were divided into four quadrants relative to the outflow infusion...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199410000-00003
更新日期:1994-10-01 00:00:00
abstract:OBJECTIVES:To determine the effects of tubular resorbable polymer membranes on the healing of a segmental diaphyseal bone defect. DESIGN:A randomized prospective study using the minipig model. Animals were evaluated with in vivo roentgenograms on a biweekly basis until explanted at twelve weeks. SETTING:After surgery...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199711000-00002
更新日期:1997-11-01 00:00:00
abstract::This video demonstrates a displaced radial shaft fracture repaired through a dorsal (Thompson) approach to the forearm. The patient is an 18-year-old man who sustained a left elbow dislocation and ipsilateral radial shaft fracture (OTA/AO: 22-B2) while playing basketball. The patient underwent a closed reduction of th...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001827
更新日期:2020-08-01 00:00:00
abstract::The application of a pelvic clamp for provisional stability of unstable pelvic fractures has been advocated in the orthopaedic literature. Although the technique has gained some supporters, problems with placement and associated complications have prevented widespread acceptance. We have modified the pelvic clamp (ACE...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/01.bot.0000175156.92743.db
更新日期:2006-01-01 00:00:00
abstract::Posterior wall (PW) fractures are the most common fractures requiring surgical fixation in acetabular surgery. Extra-articular screw placement must be confirmed intraoperatively. Herein we describe the use of the inlet and obturator oblique view (the Leeds view) for screw placement in elementary PW and in associated b...
journal_title:Journal of orthopaedic trauma
pub_type: 临床试验,杂志文章
doi:10.1097/BOT.0000000000000724
更新日期:2017-04-01 00:00:00
abstract::The extraosseous tissue contribution to diaphyseal fracture callus has been investigated using a rabbit tibial fracture model and osteocalcin immunocytochemistry. The extraosseous tissues were isolated for study by reaming and nailing an osteotomy and excising 2 cm of periosteum on either side of the osteotomy. Specim...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199206000-00010
更新日期:1992-01-01 00:00:00
abstract::Successful management of intramedullary long bone osteomyelitis remains a challenge for both surgeons and patients. Patients are often immune compromised and have endured multiple surgeries. Treatment principles include antibiotic administration (systemically ± locally), surgical debridement of the infection site, and...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/BOT.0000000000000587
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:To determine the biomechanical characteristics of four different fixation constructs for split depression fractures of the lateral tibial plateau (OTA classification 41B3.1). DESIGN:Laboratory investigation using a cadaveric simulated split depression tibial plateau fracture model. SETTING:Split depression ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200203000-00006
更新日期:2002-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the cost-effectiveness of screw fixation versus hemiarthroplasty for nondisplaced femoral neck fractures in low-demand elderly patients. METHODS:We constructed a Markov decision model using a low-demand, 80-year-old patient as the base case. Costs, health-state utilities, mortality rates, and tra...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001747
更新日期:2020-07-01 00:00:00
abstract:OBJECTIVES:Fellowship-trained orthopaedic traumatologists are presumably taught skill sets leading to "best practice" outcomes and more efficient use of hospital resources. This should result in more favorable economic opportunities when compared with general orthopaedic surgeons (GOSs) providing similar clinical servi...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3182a59d6b
更新日期:2014-05-01 00:00:00
abstract:OBJECTIVE:To report the results from functional bracing of isolated ulnar shaft fractures. DESIGN:Retrospective review. SETTING:Two university hospitals. PATIENTS:Isolated ulnar shaft fractures in 444 patients were stabilized in functional braces that permitted full range of motion of all joints. INTERVENTION:Prefa...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199808000-00009
更新日期:1998-08-01 00:00:00