Lost in the Shuffle: Low Health Literacy in Geriatric Fracture Patients and Families Regarding Post-Acute Care-A Prospective Study.

INTRODUCTION: This study aims to evaluate health literacy (HL) in geriatric orthopaedic trauma patients and their families as it relates to their post-acute care (PAC) in skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs). METHODS: This nonrandomized controlled clinical trial included patients aged 65 years and older treated for acute fracture at a Level 1 trauma center and discharged to either IRF or SNF. First 106 patients enrolled served as the control group and received standard discharge instructions. The second 101 patients were given a set of oral and written instructions regarding PAC detailing important questions to ask upon arrival to their facility. RESULTS: The mean HL score for all patients/families was 2.4 out of 5. No significant difference was noted in HL scores (2.4 versus 2.3) or median LOS (22 versus 28 days) between the control and intervention groups. Family involvement (68%) slightly improved HL scores (2.6 versus 1.9, P < 0.001). Patients discharged to IRF had better HL scores (3.4 versus 2.3, P < 0.001), shorter LOS (median 15 vs 30 days, P < 0.001), and trended toward improved knowledge of discharge goals (48.1% versus 35.6%) than those in SNF. CONCLUSION: System-wide solutions are necessary to improve geriatric HL and optimize outcomes in orthopaedic trauma.

Acromial fractures following reverse shoulder arthroplasty: the role of the acromial morphology and a comparison of clinical outcomes.

BACKGROUND: The purpose was to evaluate the relationship between acromial morphology and the location of acromial fractures following reverse shoulder arthroplasty and determine whether fracture location and displacement impact clinical outcomes. METHODS: We performed a multicenter retrospective review of reverse shoulder arthroplasties complicated by acromial fractures. Radiographs were compared to determine the differences in acromial morphology, as well as fracture orientation and pattern, between patients with Levy type I (n = 17) and Levy type II (n = 25) fractures. Patients with a minimum of 2 years' follow-up were selected to examine the association between clinical outcomes and fracture location and displacement. Twenty-two patients were stratified based on whether they achieved the minimal clinically important difference (MCID) in the American Shoulder and Elbow Surgeons score (20 points). The groups were then compared regarding fracture location and displacement using measurements such as the acromiohumeral distance. RESULTS: The Levy type I group had a higher acromial slope than the Levy type II group (127° vs. 117°, P < .001). Levy type I fractures had a transverse pattern occurring in the coronal plane, whereas Levy type II fractures had an oblique pattern occurring in the sagittal plane (P < .001). At final follow-up, 12 of 22 patients (55%) achieved the MCID. Those who did not achieve the MCID had more displaced fractures including a lower acromiohumeral distance (8 mm vs. 20 mm, P = .007). There was no difference in the distribution of Levy type I and type II fractures based on the MCID cutoff (P = .093). CONCLUSION: An increased acromial slope is associated with transverse fractures in the Levy I region, whereas a lower acromial slope is associated with oblique fractures in the Levy II region. Overall, 55% of patients achieved the MCID at mid-term follow-up. The outcomes of those who did not achieve the MCID became worse postoperatively, and this was associated with increased fracture displacement.

Twenty-Year Trends in Upper-Extremity Infections at a Single Urban Institution.

Purpose: Empiric antibiotic therapy for hand and upper-extremity infections aims to cover the most common causative organisms, which may change over time. The purpose of this study was to investigate the changes in the bacterial profile of upper-extremity infections over 2 decades at our institution. Methods: We performed a retrospective chart review of patients with upper-extremity infections treated at a single level 1 trauma center between 2001 and 2019. Patients older than 18 years who underwent surgical treatment for infection with operative cultures available were included. Patient demographics, comorbidities, and culture results were reviewed. Then, the distribution of organisms was analyzed for overall prevalence, and the profile of 2001-2010 was compared with that of 2010-2019 using a chi-square test. Results: A total of 237 patients (mean age, 43 years) met the criteria and were included in the study. Over the entire study period, the most isolated organism was Staphylococcus aureus, specifically the methicillin-resistant species. Methicillin-resistant S aureus remained the most common organism in both decades but declined over time from 47% in 2001-2010 to 27% in 2010-2019 (P < .05). There was a significant increase in the proportion of Streptococcus infections (from 6% to 17%; P < .05) and in polymicrobial infections (aerobic 8% to 28%, anaerobic 0% to 14%; P < .05). Enterobacter species were not isolated in 2001-2010 but comprised 13% of infections in the second decade (P < .05). Conclusions: Methicillin-resistant S aureus remains the most common organism isolated from upper-extremity infections, though there has been a decline over the last 20 years. Conversely, Streptococcal spp., Enterobacter spp. and polymicrobial infections have increased. This study demonstrates longitudinal shifts in the distribution of bacteria responsible for upper-extremity infections at our institution, and these trends can be considered when choosing future empiric therapy. Type of study/level of evidence: Prognostic IV.

Quality of Reduction of Displaced Intra-articular Calcaneal Fractures Using a Sinus Tarsi Versus Extensile Lateral Approach.

OBJECTIVE: To evaluate the difference in the quality of fracture reduction between the sinus tarsi approach (STA) and extensile lateral approach (ELA) using postoperative Computed Tomography (CT) scans in displaced intra-articular calcaneal fractures (DIACFs). DESIGN: Retrospective. SETTING: Level 1 and level 2 academic centers. PATIENTS: Consecutive patients undergoing operative fixation of DIACFs with postoperative CT scans and standard radiographs. METHODS: Patients were identified based on Current Procedural Terminology code and chart review. All operative calcaneal fractures treated between 2012 and 2018 by fellowship-trained orthopaedic trauma surgeons were evaluated. Those with both postoperative CT scans and radiographs were included. Exclusion criteria included extra-articular fractures, malunions, percutaneous fixation, ORIF and primary fusion, and those patients without a postoperative CT scan. The Sanders classification was used. Cases were divided into 2 groups based on ELA versus STA. Bohler angle and Gissane angle were evaluated on plain radiographs. CT reduction quality grading included articular step off/gap within the posterior facet, and varus angulation of the tuberosity: CT reduction grading included: excellent (E): no gap, no step, and no angulation; good (G): <1 mm step, <5 mm gap, and/or <5° of angulation, fair (F): 1-3 mm step, 5-10 mm gap, and/or 5-15° angulation; and poor (P): >3 mm step, >10 mm gap, and/or >15° angulation. RESULTS: Seventy-seven patients with 83 fractures were included. Average age was 42 years (range, 18-74 years), with 57 men. Four fractures were open. There were 37 Sanders II and 46 Sanders III fractures; 36 fractures were fixed using the STA, whereas 47 used the ELA. Average days to surgery were 5 for STA and 14 for ELA (P < 0.001). A normal Bohler angle was achieved more often with the ELA (91.5%) than with STA (77.8%) (P < 0.001). There was no difference by approach for Gissane angle (P = 0.5). ELA had better overall reduction quality (P = 0.02). For Sanders II, there was no difference in reduction quality with STA versus ELA (P = 0.51). For Sanders III, ELA trended toward better reduction quality (P = 0.06). CONCLUSIONS: The ELA had a better overall reduction of Bohler angle on plain radiographs and of the posterior facet and tuberosity on postoperative CT scans. For Sanders type II DIACFs, there was no difference between STA and ELA. Importantly, for Sanders III DIACFs, ELA trended toward better reduction quality. In addition to fracture reduction, surgeon learning curve, early wound complications, and long-term outcomes must be considered in future studies comparing the ELA and STA. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.