Providing Orthopaedic Care for the Incarcerated: Obstacles and Challenges

Abstract

Scant information on healthcare delivery to inmates is available in the medical literature. Healthcare provision to inmates has different rules than that for the general population and presents particular challenges for orthopaedic surgeons because of the nature of this population and restrictions imposed by their confinement. This population is typically of a lower socioeconomic status and is less well educated, has accumulated injuries over a lifetime, and has a considerable prevalence of communicable and blood-borne diseases, along with a high prevalence of smoking and high-risk behavior, such as drug-seeking, abuse, and self-inflicted injury. These variables add levels of complexity of care, including the determination of medical necessity for orthopaedic referral, the logistics of transportation and follow-up, access to durable medical equipment and ancillary services, and the choices the orthopaedic provider must make to optimize care within these limitations.

Management and Complications of Non-Thumb Metacarpal Fractures in the Incarcerated Population

“…Compared to the free world, injuries secondary to assault occur more frequently in the incarcerated population (Sraj, 2016). With blunt assault mechanistic injuries to the hand, the ulnar sided metacarpals are more likely to be injured (Malik & Rosenberg, 2018; Poolman et al, 2005).…”

“…Hand surgeons must balance the duration and degree of immobilization to ensure bony healing while minimizing stiffness as a result of prolonged immobilization. This is particularly prudent and complicated in the incarcerated population as certain social challenges may lead to poor compliance with immobilization, follow-up, and posttreatment rehabilitation (Sraj, 2016).…”

“…Of these, fractures of the fourth and fifth metacarpals occur more frequently secondary to assault or a blunt mechanism. The reported incidence of violent and accident-based orthopedic injuries is higher in the inmate population compared to the free world (Henning et al, 2015; Sraj, 2016). Despite the high incidence of NTMCF in incarcerated patients, there is a paucity of literature available on this protected population (Sraj, 2016).…”

“…The reported incidence of violent and accident-based orthopedic injuries is higher in the inmate population compared to the free world (Henning et al, 2015; Sraj, 2016). Despite the high incidence of NTMCF in incarcerated patients, there is a paucity of literature available on this protected population (Sraj, 2016). In some circumstances, inmates are referred to tertiary centers when the necessary medical care exceeds the capabilities of a local department of corrections infirmary.…”

“…Clinical research regarding this vulnerable, protected patient population bears ethical concerns and simultaneously poses additional barriers to gaining an understanding of outcomes after treatment of metacarpal fractures, among other conditions. To date, only referral patterns and demographic information of inmates has been reported (Henning et al, 2015; Sraj, 2016). Therefore, the purpose of this study was to identify the clinical outcomes of NTMCF in the incarcerated population and to determine the appropriateness of current accepted algorithms for the treatment of NTMCF in this unique patient population.…”