Background Health literacy is the single best predictor of an individual's health status. It is important to customize health-related education material to the individual patient's level of reading skills. Readability of a given text is the objective measurement of the reading skills one should possess to understand the written material. Questions/purposes In this article, some of the commonly used readability assessment tools are discussed and guidelines to improve the comprehension of patient education handouts are provided. Where are we now? Several healthcare organizations have recommended the readability of patient education materials be no higher than sixth-to eighth-grade level. However, most of the patient education materials currently available on major orthopaedic Web sites are written at a reading level that may be too advanced for comprehension by a substantial proportion of the population. Where do we need to go? There are several readily available and validated tools for assessing the readability of written materials. While use of audiovisual aids such as video clips, line drawings, models, and charts can enhance the comprehension of a health-related topic, standard readability tools cannot construe such enhancements. How do we get there? Given the variability in the capacity to comprehend health-related materials among individuals seeking orthopaedic care, stratifying the contents of patient education materials at different levels of complexity will likely improve health literacy and enhance patient-centered communication.

The use of accurate and reliable clinical and imaging modalities for quantifying leg-length discrepancy (LLD) is vital for planning appropriate treatment. While there are several methods for assessing LLD, we questioned how these compared. We therefore evaluated the reliability and accuracy of the different methods and explored the advantages and limitations of each method. Based on a systematic literature search, we identified 42 articles dealing with various assessment tools for measuring LLD. Clinical methods such as use of a tape measure and standing blocks were noted as useful screening tools, but not as accurate as imaging modalities. While several studies noted that the scanogram provided reliable measurements with minimal magnification, a full-length standing AP computed radiograph (teleoroentgenogram) is a more comprehensive assessment technique, with similar costs at less radiation exposure. We recommend use of a CT scanogram, especially the lateral scout view in patients with flexion deformities at the knee. Newer modalities such as MRI are promising but need further investigation before being routinely employed for assessment of LLD.

Background: Antegrade intramedullary (IM) nailing for skeletally immature femur fractures can damage the capital femoral epiphysis blood supply, leading to avascular necrosis (AVN) of the femoral head. Reported AVN rates are 2% for piriformis entry and 1.4% for trochanteric entry. None of previous reports described IM lengthening nails for limb lengthening procedures. We have used self-lengthening telescopic nails with a proximal Herzog bend and standard trochanteric entry for femoral lengthening in children. The purpose of this study is to determine whether trochanteric entry IM lengthening nails can be used safely (no AVN or proximal femoral deformity) in the skeletally immature femur. Methods: A retrospective review was performed between 2004 and 2014 to determine all skeletally immature patients younger than 18 years of age who had a reamed IM lengthening nail inserted through the greater trochanter, with at least 1-year follow-up. Results: Thirty-one femurs were lengthened in 28 patients (17 males and 11 females). The etiology was congenital femoral deficiency (10), achondroplasia (6), post-traumatic (5), hemihypertrophy (3), Ollier disease (2), and miscellaneous (5). An attending surgeon was present for all procedures. Mean age at time of surgery was 12.9 years (range, 7 to 17 y). Mean follow-up was 3.5 years (range, 1.4 to 9 y). The average amount of lengthening was 5.4 cm (range, 3 to 6.7 cm). Twenty-four nails were 10.7 mm in diameter. Seven nails were 12.5 mm in diameter. Intramedullary skeletal kinetic distractor was used in 18 femurs and PRECICE in 13 femurs. Ten segments (7 intra-medullary skeletal kinetic distractor; 3 PRECICE) experienced 13 complications. None of the patients developed AVN or proximal femoral deformity. Conclusions: IM lengthening nails inserted through the greater trochanter may be utilized in skeletally immature patients without increased risk of AVN of the femoral head or proximal femoral deformity. Larger trials would be helpful to confirm our hypothesis. We recommend careful surgical technique with liberal use of the image intensifier to avoid trauma to the femoral head blood supply. Level of Evidence: Level IV-therapeutic.