Acute Pelvic and Hip Apophyseal Avulsion Fractures in Adolescents: A Summary of 719 Cases.

BACKGROUND: Apophyseal avulsion fractures of the pelvis and hip are common injuries in adolescent athletes. However, high volume comparative studies elucidating the spectrum of injuries are largely absent from the literature. The current study provides a comprehensive analysis of demographic, anatomic, pathophysiological, clinical, and athletic-related variables associated with such injuries in an extensive population of affected adolescents. METHODS: A retrospective review was performed of records of patients presenting to a single tertiary care pediatric hospital between January 1, 2005, and July 31, 2020, collecting variables including patient sex, age, body mass index, fracture location, injury mechanism, sport at the time of injury, and duration of prodromal symptoms. RESULTS: Seven hundred nineteen fractures were identified in 709 patients. The average patient age was 14.6, and 78% of the fractures occurred in male patients. The anterior inferior iliac spine (33.4%), anterior superior iliac spine (30.5%), and ischial tuberosity (19.4%) were the most common fracture sites. The most common injury mechanisms were running (27.8%), kicking (26.7%), and falls (8.8%). The most common sports at the time of injury were soccer (38.1%), football (11.2%), and baseball (10.5%). Fracture site was significantly associated with patient sex, age, body mass index, laterality, mechanism, sport, time from injury, and presence of prodromal symptoms. The annual volume of pelvic avulsion fractures treated at the institution increased significantly from n=17 in 2005 to n=75 in 2019. CONCLUSIONS: Adolescent pelvic and hip avulsion fractures occur during a narrow window of age and skeletal maturation and are frequently sustained during sporting activities. Each fracture location is associated with certain demographic, mechanistic, and patient-specific characteristics. The associations between fracture site and patient-specific or injury-specific variables offer insights into the pathophysiology and possible underlying biomechanical risk factors that contribute to these injuries. LEVEL OF EVIDENCE: This is a level III retrospective study.

Effect of Patient Body Mass Index, Recommendation for Weight Modification, and Nonmodifiable Factors on Patient Satisfaction.

INTRODUCTION: Patient satisfaction serves an increasingly important role in health care. Multiple nonmodifiable patient factors have been found to influence patient satisfaction. To the best of our knowledge, however, no study has investigated the influence of body mass index (BMI) on satisfaction scores. The objective of this study was to evaluate whether BMI and provider recommendation for patient weight modification were associated with patient satisfaction. METHODS: We reviewed Press Ganey patient satisfaction survey scores from 3,044 clinical encounters in an academic orthopaedic center between November 2010 and May 2017. Multiple patient factors, BMI, and recommendation for weight loss, or requirement of weight loss, before surgery were recorded. Patient satisfaction was operationalized as a binary outcome of completely satisfied or not completely satisfied, and multiple logistic regression was used to estimate the odds of being completely satisfied from the subset of potential predictors. RESULTS: White patients (odds ratio [OR] = 1.340, 95% confidence interval [CI]: 1.113 to 1.584, P = 0.0007) and Medicare-insured patients (OR = 1.260, 95% CI: 1.044 to 1.521, P = 0.0164) were more likely to be completely satisfied, whereas patients being seen by a provider for the first time were less likely to be completely satisfied (OR = 0.728, 95% CI: 0.626 to 0.847, P < 0.0001). BMI, recommendation for weight loss, and requirement of weight modification before surgery were not found to be associated with patient satisfaction. DISCUSSION: Neither patient BMI nor provider recommendation for weight loss, or as a requirement for surgery, was associated with patient satisfaction. Race, insurance status, and previous visits with the care provider were identified as nonmodifiable patient factors that influence patient satisfaction. LEVEL OF EVIDENCE: Level III.

The Dimension of the Press Ganey Survey Most Important in Evaluating Patient Satisfaction in the Academic Outpatient Orthopedic Surgery Setting.

Many studies have examined modifiable and nonmodifiable patient factors influencing patient satisfaction scores. The objective of this study was to evaluate which of the 6 domains making up the Press Ganey Survey had a greater magnitude of relative importance in the expected relationship with patient satisfaction in outpatient orthopedic surgery encounters. Press Ganey Survey satisfaction scores from 4737 clinical encounters from adult reconstructive surgery, sports medicine, hand, foot and ankle, trauma, and general orthopedic clinics at a single academic center from November 2010 to May 2017 were reviewed. Multiple patient factors, modifiable and nonmodifiable, were recorded. The Press Ganey Survey was divided into 6 domains to evaluate the relative importance of each to total patient satisfaction. The standardized parameter estimates from the multiple linear regression revealed that of the 6 domains making up the Press Ganey Survey, care provider had the greatest magnitude of relative importance in the expected relationship with total patient satisfaction (ß=0.53972). Approximately 80% of the variance in total patient satisfaction was accounted for by the care provider. The relative importance of the remaining 5 domains was as follows: access (ß=0.23483), personal issues (ß=0.16796), moving through the visit (ß=0.16795), nurse/assistant (ß=0.10010), and special services/valet (ß=0.06302). A principal components analysis suggested a 6-factor solution for the Press Ganey total satisfaction scale; care provider was the most dominant factor, and valet parking services was the least. The care provider had the most influence on the patient's overall satisfaction. Altogether, access, personal issues, moving through the visit, nurse/assistant, and special services/valet accounted for only approximately 20% of the total variance in patient satisfaction. This knowledge can be used by providers in the current health care climate, where patient consumerism is developing into the driver of care. This could allow resources to be focused on areas of influence, yielding a greater impact on patient satisfaction scores. [Orthopedics. 2019; 42(4):198-204.].

Sleep Disturbance in Orthopaedic Trauma Patients.

OBJECTIVE: To evaluate the prevalence and severity of sleep disturbance experienced by patients who have sustained a traumatic orthopaedic injury, how sleep disturbance affects the patient's perceived health quality, and identify factors associated with sleep disturbance. DESIGN: Cross-sectional cohort study. SETTING: Urban Level I trauma center. PATIENTS/PARTICIPANTS: Three hundred thirty-five nonconsecutive patients who presented to clinic at various stages of treatment for their traumatic orthopaedic injuries. MAIN OUTCOME MEASUREMENTS: Pittsburgh sleep quality index (PSQI) and 36-item short form-36 (SF-36) survey questionnaires; injury severity score (ISS). RESULTS: The average PSQI score was 10.3 (±4.8). Two hundred eighty-eight (86.0%) patients had a PSQI score ≥5, indicating the presence of sleep disturbance. The PSQI score was ≥10 in 183 (54.6%) patients, which is sleep disturbance similar to the level seen in clinical depression. Patients reported an average sleep latency of 38.9 (±37.5) minutes, with a total nightly sleep time of 6.3 (±1.9) hours. Univariate statistical analysis demonstrated that age, time since injury, and all components of the SF-36 were significantly associated with increased PSQI scores. When these variables were assessed with multivariate analysis to control for confounding variables, the bodily pain, vitality, and mental health components of the SF-36 remained independently associated with PSQI (P ≤ 0.001, 0.002, and 0.001, respectively). ISS measurements at the time of presentation were not associated with PSQI scores. CONCLUSIONS: Our findings suggest that sleep disturbance is both highly prevalent (86% PSQI ≥5) and severe (54.6% PSQI ≥10) in patients recovering from a traumatic orthopaedic injury. The bodily pain, vitality, and mental health components of the SF-36 were independently associated with worse sleep quality. The average orthopaedic trauma patient presents with a sleep score similar to that seen in clinical sleep disorders and clinical depression. Interestingly, in our study, the severity of the overall injury burden as measured by ISS and time since injury were not independently associated with the severity of sleep disturbance, as one might expect. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.