This research paper builds on previous literature and documents general changes in the labor market for Native American women that occurred during the Great Recession using extracts of data from the Current Population Survey Annual Earnings file, known as the Merged Outgoing Rotation Groups (MORG). Wages, unemployment, and other labor market variables for Native American women are contrasted with those of Native American men and white women to determine the relative change in labor market inequality that occurred during the Great Recession.

This case report presents the failure of retrograde intramedullary (IM) nailing in a supracondylar distal femur fracture in a 72-year-old female after a fall from standing. Multiple medical comorbidities are a known risk factor for fracture nonunion. With the rising incidence of patients having osteoporosis and multiple medical comorbidities, orthopedic surgeons need to be prepared for the treatment of hardware complications.The patient is a 72-year-old severely obese female with multiple medical comorbidities including cardiac valvular disease, hypertension, type II diabetes mellitus, hypothyroidism, acute on chronic blood loss anemia, rheumatoid arthritis, and lupus arthritis. She presented after a fall from standing where she sustained a closed displaced left supracondylar distal femur fracture with intercondylar extension.Open reduction and internal fixation (ORIF) was performed on the left distal femur intercondylar split and retrograde intramedullary nailing for the left supracondylar distal femur fracture. Three-month follow-up Xrays revealed no osseous formation of the supracondylar distal femur fracture and catastrophic failure of the implants with two broken screws and a broken condylar bolt consistent with hardware failure.Treatment options included either non-weight-bearing for three months to evaluate for callus formation, which would require her to be in a wheelchair, or surgical referral for implant removal and distal femur replacement. The patient elected to undergo revision surgery consisting of distal femoral replacement. Following revision surgery, the patient was discharged with physical therapy referral. She disclosed a decrease in pain and increased range of motion (ROM) compared to the preoperative state. This case demonstrates an elderly, obese patient with multiple comorbidities including type II diabetes mellitus and autoimmune conditions that placed the patient at high risk for hardware failure following surgery. Due to pain and quality of life concerns, patients with such injuries may be forced into a situation with limited options. This case highlights the need for optimal surgeon-to-patient communication to ensure that patients and all members of their healthcare team are knowledgeable when certain clinical situations are considered high risk for failure. Moving forward, risk factor consideration and medication adjustments are preoperative topics of discussion that should be discussed at length with the patient in order to provide the best opportunity for a successful surgery.

We use the Theil index and data from the 2012–2016, American Community Survey 5-Year Sample to document and analyze gender wage inequality for American Indian and Alaska Native (AIAN) women across single, multiracial and ethnic identity groups. Mean differences in hourly wages by gender contribute little to measured wage inequality when individuals are separated based upon their proximity to tribal homeland areas. Instead, we find between-group wage inequality is a function of glass-ceiling effects that differ by AIAN identification and homeland area. Differences in glass-ceiling effects across AIAN identity groups suggest the need to disaggregate data by AIAN ethnic identity. Furthermore, under certain circumstances, it may be appropriate to combine some racial AIAN identity groups into a single population even if the focus is to study policy impacts on citizens of federally recognized AIAN nations for those using government survey data.

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