Disparities in follow-up care for ballistic and non-ballistic long bone lower extremity fractures

Arceo, S. Rafael; Runner, Robert P.; Huynh, Tony; Gottschalk, Michael B.; Schenker, Mara L.; Moore, Thomas J.

doi:10.1016/j.injury.2018.09.053

Cited by 20 publications

(11 citation statements)

References 8 publications

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“…The ED was often unable to meet the surgical needs of these patients in the same way that outpatient services could. Rafael Arceo et al 40 also found that homeless individuals experience ballistic lower extremity fractures that were treated in the ED than nonhomeless individuals.…”

Section: Discussionmentioning

confidence: 97%

Musculoskeletal Injuries and Conditions Among Homeless Patients

Kale

Marsh²,

Kale³

et al. 2021

JAAOS Glob Res Rev

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Introduction: The purpose of this study was to analyze existing literature on musculoskeletal diseases that homeless populations face and provide recommendations on improving musculoskeletal outcomes for homeless individuals. Methods: A comprehensive search of the literature was performed in March 2020 using the PubMed/MEDLINE (1966 to March 2020), Embase (1975 to April 2020), and CINHAL (1982 to 2020) databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for accuracy of reporting, and the Newcastle-Ottawa Scale was used for quality assessment. Results: Twenty-nine articles met inclusion criteria. Seven studies observed an increased prevalence of musculoskeletal injuries among the homeless population, four observed increased susceptibility to bacterial soft-tissue infection, four observed increased fractures/traumatic injuries, three described increased chronic pain, and six focused on conditions specific to the foot and ankle region. Discussion: Homeless individuals often have inadequate access to care and rely on the emergency department for traumatic injuries. These findings have important implications for surgeons and public health officials and highlight the need for evidence-based interventions and increased follow-up. Targeted efforts and better tracking of follow-up and emergency department usage could improve health outcomes for homeless individuals and reduce the need costly late-stage interventions by providing early and more consistent care.

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Section: Discussionmentioning

confidence: 97%

Musculoskeletal Injuries and Conditions Among Homeless Patients

Kale

Marsh²,

Kale³

et al. 2021

JAAOS Glob Res Rev

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“…Homeless patients face unique challenges throughout the surgical care continuum. 16 , 17 The few studies that have explored surgery in the homeless population highlight higher rates of postoperative emergency department usage and hospital readmission, 14 , 18 , 19 increased length of stay and costs of admission, 20 , 21 and lower rates of follow-up. 14 However, the impact of homelessness on surgical outcomes, including for patients with orthopedic trauma, remains largely understudied.…”

Section: Discussionmentioning

confidence: 99%

Ankle fracture surgery in patients experiencing homelessness: a national evaluation of one-year rates of reoperation

Fischer,

Shahzad,

Khan

et al. 2024

OTA International

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Objectives: To evaluate the impact of homelessness on surgical outcomes following ankle fracture surgery. Design: Retrospective cohort study. Setting: Mariner claims database. Patients/Participants: Patients older than 18 years who underwent open reduction and internal fixation (ORIF) of ankle fractures between 2010 and 2021. A total of 345,759 patients were included in the study. Intervention: Study patients were divided into two cohorts (homeless and nonhomeless) based on whether their patient record contained International Classification of Disease (ICD)-9 or ICD-10 codes for homelessness/inadequate housing. Main Outcome Measures: One-year rates of reoperation for amputation, irrigation and debridement, repeat ORIF, repair of nonunion/malunion, and implant removal in isolation. Results: Homeless patients had significantly higher odds of undergoing amputation (adjusted odds ratio [aOR] 1.59, 95% confidence interval [CI] 1.08–2.27, P = 0.014), irrigation and debridement (aOR 1.22, 95% CI 1.08–1.37, P < 0.001), and repeat ORIF (aOR 1.16, 95% CI 1.00–1.35, P = 0.045). Implant removal was less common in homeless patients (aOR 0.65, 95% CI 0.59–0.72, P < 0.001). There was no significant difference between homeless and nonhomeless patients in the rate of nonunion/malunion repair (aOR 0.87, 95% CI 0.63–1.18, P = 0.41). Conclusions: Homelessness is a significant risk factor for worse surgical outcomes following ankle fracture surgery. The findings of this study warrant future research to identify gaps in surgical fracture care for patients with housing insecurity and underscore the importance of developing interventions to advance health equity for this vulnerable patient population. Level of Evidence: Prognostic Level III.

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“…GSW injuries and their sequelae are costly and are associated with significant socioeconomic burden; the United States Government Accountability Office estimates that the indirect cost of firearm injuries is over $2.5 billion in the first year alone. [1][2][3][4][5] One clinically important complication of firearmrelated injuries is infection. Nonfatal firearm injuries tend to be localized to the extremities, which may result in ballistic traumatic arthrotomy and introduce the risk for joint infection.…”

Section: Introductionmentioning

confidence: 99%

Civilian Ballistic Arthrotomies: Infection Rates and Operative vs. Non-operative Management

Liu,

Kumar,

Liu

et al. 2023

Journal of Orthopaedic Trauma

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OBJECTIVES: The purpose of this study was to determine if a significant difference existed in the rate of infection following ballistic traumatic arthrotomy managed operatively compared to those managed without surgery. METHODS: Design: Retrospective cohort study. Setting: Academic Level I Trauma Center. Patient Selection Criteria: Patients with ballistic traumatic arthrotomies of the shoulder, elbow, wrist, hip, knee, or ankle that received operative or non-operative management. Outcome Measures and Comparisons: The rates of infection and septic arthritis in those who received operative or non-operative management. RESULTS: One hundred ninety-five patients were studied. Eighty patients were treated non-operatively (Non-Op group), sixteen patients were treated with formal irrigation and debridement in the operating room (I&D group), and ninety-nine patients were treated with formal irrigation and debridement and open reduction and internal fixation (I&D + ORIF group). Patients in all three groups received local wound care and systemic antibiotics. No patients in the Non-Op or I&D groups developed an infection. Six patients in the I&D + ORIF group developed extra-articular post-operative infections requiring additional interventions. CONCLUSIONS: The infection rate in the I&D + ORIF group was consistent with the infection rates reported in orthopedic literature following fixation alone. Additionally, none of the infections were cases of septic arthritis. This suggests that traumatic arthrotomy does not increase the risk for infection beyond what is expected following fixation alone. Importantly, the Non-Op group represented a series of 80 patients that were treated non-operatively without developing an infection, indicating that I&D may not be necessary to prevent infection after ballistic arthrotomy. The results suggest that septic arthritis after civilian ballistic arthrotomy is a rare complication regardless of the choice of treatment. Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Disparities in follow-up care for ballistic and non-ballistic long bone lower extremity fractures

Cited by 20 publications

References 8 publications

Musculoskeletal Injuries and Conditions Among Homeless Patients

Musculoskeletal Injuries and Conditions Among Homeless Patients

Ankle fracture surgery in patients experiencing homelessness: a national evaluation of one-year rates of reoperation

Civilian Ballistic Arthrotomies: Infection Rates and Operative vs. Non-operative Management

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