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Health literacy is the extent to which patients are able to understand and act upon health information. This concept is important for surgeons as their patients have to comprehend the nature, risks and benefits of surgical procedures, adhere to perioperative instructions, and make complex care decisions about interventions. Our review aimed to determine the prevalence of limited health literacy of the surgical patient population. A search of MEDLINE and EMBASE was performed from inception until January 14th 2017 for experimental and observational studies reporting surgical patients' health literacy measurement. Overall pooled proportion of surgical patients with limited health literacy was calculated using a random-effects model and methodologic quality was assessed. A total of 40 studies representing 18,895 surgical patients were included in our quantitative synthesis. Pooled estimate of limited health literacy was 31.7% (95%CI 24.7-39.2%, I 99.0%). There was low risk of bias among the majority of the 51 studies included in the qualitative synthesis. Statistical heterogeneity could not be fully accounted for by methodologic quality or patient and surgical characteristics. However, some of the heterogeneity was accounted by measurement tool [combined proportions with the REALM and NVS of 35.6 (95%CI 31.5-39.9, I 73.0%)]. A number of different health literacy measurement tools were used (19 overall). Our review demonstrates a high prevalence of limited health literacy among surgical patients with considerable heterogeneity. Our findings suggest the importance of recognizing and addressing surgical patients with limited health literacy and the need for standardization in measurement tools.

IM fixation may have a role in the treatment of certain metacarpal fractures. No conclusive recommendations can be made based on the available studies included in this literature search. Further study of this technique and its applications using high level evidence is warranted.

Background: Unilateral coronal craniosynostosis is a challenging condition in craniofacial surgery. Frontoorbital advancement by single-stage resorbable remodeling and distraction osteogenesis (DO) techniques have known intraoperative differences, but their comparative outcomes are less well characterized. Methods: A systematic literature search of the MEDLINE, EMBASE, LILACS, and Web of Science databases was conducted. The search was performed using terms related to craniosynostosis and its operative management. The primary outcome of interest was the Whitaker classification. Secondary outcomes included cranial volume or cranial index change, and infection and reoperation rates. Results: A total of 6978 eligible articles were identified of which 26 met inclusion criteria. A total of 292 patients were included in the studies, with 223 undergoing a single-stage remodeling procedure (76.4%) and 69 DO procedures (23.6%). There was a trend toward patients with DO having better Whitaker aesthetic outcomes. Only 2 studies reported volumetric changes. There was a substantial difference in planned and unplanned reoperation rates but not in infection rates. Conclusion: The results of this systematic review suggest that the techniques have similar outcomes and complications, although there was a trend toward better Whitaker outcomes with DO procedures. Inherent to the DO technique is the need for multiple operations to both insert and remove internal hardware which may affect the overall cost effectiveness.