Supracondylar Humeral Fracture Documentation: A Performance Improvement Study.

BACKGROUND: Supracondylar fractures of the humerus (SCH) are the most common fractures about the elbow in children that require operative stabilization. Considering the possible complications involved including nerve deficit and compartment syndrome, documentation is crucial to good patient care. It also is of prime importance for justification or defense of our care should this arise. One of the common concerns in transition from written documentation to an electronic medical record (EMR) is availability of proper documentation. We sought to develop an established EMR protocol to streamline and improve proper care and documentation for SCH fractures. This was in response to poor documentation in an initial retrospective evaluation. METHODS: Documentation before and after the implementation of a clinical pathway were compared. A retrospective chart review was used to collect documentation information before the implementation of the clinical pathway and a prospective study design was used to collect information after the implementation of the clinical pathway. Proportions of preclinical and postclinical pathway documentation were compared before and after the implementation of the clinical pathway using a χ test, or the Fisher exact test for measures in which at least 20% of the expected frequencies were <5. A 2-sided 0.05 α level was used to define statistical significance. RESULTS: We saw an improvement in documentation after implementation of the clinical pathway, with statistically significant differences in nursing preoperative, physician preoperative, and physician postoperative. Nursing postanesthesia care unit, nursing postoperative, and physician clinic follow-up trended toward improvement but did not meet statistical significance. Although we did see improvement, we still did not meet ideal 100% documentation in all categories. CONCLUSIONS: Documentation is crucial to good medical care and legal defense should any arise. The implementation of a clinical pathway demonstrated significant improvement by physicians and nurses. Although overall improvement was obtained, there were areas associated with EMR identified that still require further improvement. LEVEL OF EVIDENCE: Level III.

Total Hip Arthroplasty in Patients With Multifactorial Perceived Limb Length Discrepancy.

BACKGROUND: Patients with advanced hip arthritis can present with multifactorial limb length discrepancies (LLDs) owing to bony shortening from growth arrest, proximal hip migration, soft-tissue contractures, and pelvic obliquity. The patient perceives an LLD that is a combination of true LLD and apparent LLD. METHODS: We retrospectively reviewed 7 cases with multifactorial mean perceived LLD of 7.7 cm (range, 3.6-11 cm) that underwent primary total hip arthroplasty and auxiliary soft-tissue procedures. Perceived LLD, true LLD, and apparent LLD were defined and were compared before and after surgery in this cohort of patients with a mean follow-up of 57.4 months. RESULTS: The mean perceived LLD at final follow-up was 1.0 ± 0.9 cm compared with that of 7.7 ± 2.6 cm preoperatively (P < .05). Postoperative true LLD was 0.7 ± 0.8 cm compared with that of 3.2 ± 0.8 cm preoperatively (P < .05). At final follow-up, all 7 patients were ambulating without any assistive devices and were satisfied with their surgical outcome. CONCLUSION: With careful preoperative clinical and radiographic assessments as well as planning for multifactorial perceived LLD, this can be adequately corrected with primary total hip arthroplasty and auxiliary soft-tissue procedures resulting in good radiologic and functional outcomes.

Billing and coding knowledge: a comparative survey of professional coders, practicing orthopedic surgeons, and orthopedic residents.

Medical knowledge and surgical skills are necessary to become an effective orthopedic surgeon. To run an efficient practice, the surgeon must also possess a basic understanding of medical business practices, including billing and coding. In this study, we surveyed and compared the level of billing and coding knowledge among current orthopedic residents PGY3 and higher, academic and private practice attending orthopedic surgeons, and orthopedic coding professionals. According to the survey results, residents and fellows have a similar knowledge of coding and billing, regardless of their level of training or type of business education received in residency. Most residents would like formal training in coding, billing, and practice management didactics; this is consistent with data from previous studies.

Incidence of pseudotumor and acute lymphocytic vasculitis associated lesion (ALVAL) reactions in metal-on-metal hip articulations: a meta-analysis.

We systematically reviewed the peer-reviewed literature to determine a pooled estimate of the incidence of pseudotumor and acute lymphocytic vasculitis associated lesions (ALVAL) in adult patients with primary metal-on-metal (MoM) total hip arthroplasty or resurfacing. Fourteen eligible articles were identified, with a total of 13,898 MoM hips. The incidence of pseudotumor/ALVAL ranged from 0% to 6.5% of hips with a mean follow-up ranging from 1.7 to 12.3 years across the studies. The pooled estimated incidence of pseudotumor/ALVAL is 0.6% (95% CI: 0.3% to 1.2%). The rate of revision for any reason ranged from 0% to 14.3% of hips, with a pooled estimate of 3.9% (95% CI: 2.7% to 5.3%).