Abstract:
:Healthcare policy has changed drastically, and with the 50-year anniversary of the passage of Medicare approaching in 2015, the authors evaluate the development of the current healthcare system and its relationship to the development of modern orthopaedic trauma. With more changes in healthcare policy forthcoming, it is increasingly important for the orthopaedic traumatologist to understand how changes in policy will affect practice. Historically, the motivators for change have remained largely the same over the past 50 years. The development of diagnosis-related groups, the resource-based relative value scale, and the sustainable growth rate are 3 defining policies that were designed to control costs, but which had an unexpected effect on those caring for the trauma population. Healthcare reform has a unique effect on those systems where care is dictated by a defining event or injury. Evaluating the development of trauma systems, the authors find that legislation directed toward the trauma population has been driven by the study of patient outcomes, providing an opportunity for orthopaedic traumatologists to contribute to future changes in policy. As healthcare policy changes begin to take effect, having a thorough understanding of reform and its drivers will be increasingly important in taking an active role in advocating for the field of orthopaedic trauma and its patients.
journal_name
J Orthop Traumajournal_title
Journal of orthopaedic traumaauthors
Mitchell PM,Thakore R,Obremskey A,Sethi MKdoi
10.1097/BOT.0000000000000214subject
Has Abstractpub_date
2014-10-01 00:00:00pages
S2-4eissn
0890-5339issn
1531-2291pii
00005131-201410001-00002journal_volume
28 Suppl 10pub_type
杂志文章abstract::In physiologically young patients with displaced femoral neck fractures, surgical treatment is aimed at achieving fracture union while preserving native hip anatomy and biomechanics. The intracapsular environment, tenuous vascular supply, and unfavorable hip biomechanics contribute to the high complication rates seen ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/BOT.0000000000001368
更新日期:2019-01-01 00:00:00
abstract:OBJECTIVE:Evaluate the ability of osteogenic protein-1 to induce formation of de novo bone in the presence of bacterial infection and metal in an intramuscular osteoinduction model in the rat. DESIGN:Prospective experimental design with assessment time points of up to 4 weeks. SETTING:Intramuscular pocket surgically ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200408000-00008
更新日期:2004-08-01 00:00:00
abstract::An 80-year-old man sustained a T-shaped supracondylar fracture of the femur associated with distal one-third shaft comminution. Initial failure of a 95 degrees angle blade plate was followed by insertion of an intraarticular intramedullary nail stabilized with static locking-screw fixation. A second failure of the imp...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199308000-00004
更新日期:1993-01-01 00:00:00
abstract:OBJECTIVES:Long bone fractures that fail to heal or show a delay in healing can lead to increased morbidity. Bone marrow aspirate concentrate (BMAC) containing bone mesenchymal stem cells (BMSCs) has been suggested as an autologous biologic adjunct to aid long bone healing. The purpose of this study was to systematical...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/BOT.0000000000000453
更新日期:2016-01-01 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:OBJECTIVE:To determine the effectiveness of exchange reamed nails for treatment of aseptic femoral delayed unions and nonunions. DESIGN:Retrospective chart review. PATIENTS:Nineteen patients admitted to the Carolinas Medical Center Level I trauma center from 1990 to 1996 for repair of femoral shaft fracture nonunion ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200006000-00005
更新日期:2000-06-01 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: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 ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3181b18b89
更新日期:2010-06-01 00:00:00
abstract:OBJECTIVE:To determine whether stimulation with low-intensity ultrasound will reduce the radiologic healing time of fresh tibial shaft fractures fixed with a reamed and statically locked intramedullary rod. DESIGN:Prospective, randomized, double blinded, and placebo controlled. PATIENTS AND METHODS:Thirty-two adult p...
journal_title:Journal of orthopaedic trauma
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00005131-199905000-00005
更新日期:1999-05-01 00:00:00
abstract:OBJECTIVES:To propose a new fracture classification according to the direction of epiphysis displacement and to compare clinical findings and surgical outcomes between these subtypes. DESIGN:Retrospective study. SETTING:A tertiary referral hospital. PATIENTS:Twelve adolescents (mean age, 13.4 ± 1.3 years) who experi...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000060
更新日期:2014-08-01 00:00:00
abstract:OBJECTIVES:To document the high failure rate of a specific implant: the Synthes Variable Angle (VA) Locking Distal Femur Plate. DESIGN:Retrospective. SETTING:Urban University Level I Trauma Center. PATIENT/PARTICIPANTS:All distal femur fractures (OTA/AO 33-A, B, C) treated from March 2011 through August 2013 were re...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000391
更新日期:2016-01-01 00:00:00
abstract::We present a rare case of complete talar extrusion after trauma. Treatment of this severe injury remains controversial as a result of the lack of congruent evidence-based literature, associated high complication rate with primary repair, and difficulty in objectively assessing long-term outcomes. Recent small sampled ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e318210f236
更新日期:2011-11-01 00:00:00
abstract:OBJECTIVES:Hand dominance has been reported to be an important factor affecting outcomes after upper extremity trauma but remains unstudied after hemiarthroplasty for fracture. This study determined whether dominance affected outcomes after hemiarthroplasty for proximal humerus fractures. DESIGN:Retrospective cohort s...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000294
更新日期:2015-08-01 00:00:00
abstract:OBJECTIVES:To describe the surgical technique and clinical outcomes of high-energy proximal femur fractures treated with a 95-degree angled blade plate. DESIGN:Retrospective case series. SETTING:Single academic Level I trauma center. PATIENT/PARTICIPANTS:Forty-five consecutive patients from March 2012 to April 2017 ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001505
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVE:Comparison between a Less Invasive Stabilization System (LISS) using monocortical screws with angular stability and two conventional plate systems Condylar Buttress Plate (CBP) and Dynamic Condylar Screw (DCS) for the treatment of distal femoral fractures with respect to biomechanical properties. DESIGN:Biom...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200109000-00004
更新日期:2001-09-01 00:00:00
abstract:OBJECTIVES:No studies have assessed the effects of parameters associated with insertion temperature in modern self-drilling external fixation pins. The current study assessed how varying the presence of irrigation, insertion speed, and force impacted the insertion temperatures of 2 types of standard and self-drilling e...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000859
更新日期:2017-08-01 00:00:00
abstract:SUMMARY:We present the previously unreported complication of symptomatic heterotopic ossification of the quadriceps following placement of a large-diameter Steinmann pin for the purpose of temporary skeletal traction. Following the development of distal quadriceps heterotopic bone formation in three patients, we conduc...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/00005131-200404000-00010
更新日期:2004-04-01 00:00:00
abstract::Our purpose was to determine the incidence of deep-vein thrombosis (DVT) in patients who have had early operative fixation of fractures of the lower extremity distal to the hip. There is a high incidence of distal thrombosis in patients who have undergone early operative fixation of lower-extremity fractures. The inci...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199605000-00002
更新日期:1996-01-01 00:00:00
abstract::Two unusual cases of symptomatic partial rupture of the extensor carpi ulnaris tendon associated with ulnar-styloid nonunion are described. Intraoperative findings suggested that the jagged surface of the distal ulna was the cause of flaying. In one case, debridement of the frayed extensor carpi ulnaris tendon and fix...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/00005131-200210000-00011
更新日期:2002-10-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to report the efficacy of the Kapandji technique performed in the prone position for humeral supracondylar fractures in children. DESIGN:Retrospective. SETTING:Level I trauma center. PATIENTS/PARTICIPANTS:We retrospectively reviewed 34 children with Gartland type III supracond...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000015
更新日期:2014-06-01 00:00:00
abstract::The surgical treatment of pelvic and acetabular fractures can be technically challenging. Various techniques are available for the reconstruction of pelvic and acetabular fractures. Less invasive percutaneous fracture stabilization techniques, with closed reduction or limited open reduction, have been developed and ar...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/BOT.0b013e318288c0c3
更新日期:2014-01-01 00:00:00
abstract:OBJECTIVES:To investigate the clinical utility of additional axillary or Velpeau views in evaluating potential shoulder trauma after a standard radiograph series of anteroposterior, Grashey, and/or trans-scapular views. DESIGN:Retrospective study. SETTING:Level I academic medical center. PATIENTS:All patients in a 1...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001760
更新日期:2020-08-01 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:BACKGROUND:To determine whether the cost of nonoperative treatment, including those who require delayed operative treatment, is less than those receiving initial operative management. METHODS:We identified 4 recent randomized controlled trials comparing operative and nonoperative treatment of displaced midshaft clavic...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,meta分析,评审
doi:10.1097/BOT.0000000000000225
更新日期:2015-04-01 00:00:00
abstract:OBJECTIVES:This study was designed to evaluate the frequency of intraoperative problems and complications involved with Less Invasive Stabilization System (LISS) plate removal. DESIGN:Retrospective study. SETTING:Single academic level I trauma center. METHODS:Medical records were reviewed for demographics, surgical ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3181c29bf5
更新日期:2010-06-01 00:00:00
abstract::Traumatic spinal cord injuries have a tremendous impact on individuals, families, and society as a whole. Substantial heterogeneity in the patient population, their presentation and underlying pathophysiology has sparked debates along the care spectrum from initial assessment to definitive treatment. This article revi...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/BOT.0000000000000943
更新日期:2017-09-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to compare the relative stiffness of four common external fixation (XF) configurations used to span and stabilize the knee after knee dislocation. METHODS:Synthetic composite femora and tibiae connected with cords were used to simulate a knee. Four configurations of external fix...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3181e3cd4b
更新日期:2010-11-01 00:00:00
abstract::Forty-three patients with 43 comminuted femoral shaft fractures treated with the Brooker-Wills interlocking nail were followed through bony union to determine the device's ability to maintain length and rotational control of these difficult injuries. Only severely comminuted fractures, types III and IV, were included....
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-198702010-00002
更新日期:1987-01-01 00:00:00
abstract:OBJECTIVES:To compare radiographic and clinical outcomes of supination external rotation type IV equivalent (SER IV E) ankle fractures (AO/OTA classification 44-B2.1) treated with transsyndesmotic screw fixation with those treated with deltoid and posterior inferior tibiofibular ligament (PITFL) repair. DESIGN:Case se...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000318
更新日期:2015-05-01 00:00:00
abstract:OBJECTIVES:To compare the outcomes of two different surgical treatments for the management of isolated closed Mason Type 2 radial head fractures. DESIGN:Retrospective study. The Student t test and McPearson chi-square test were used to evaluate whether there was a significance difference between the groups. PATIENTS:...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e318220a227
更新日期:2012-04-01 00:00:00