Comparing Race/Ethnicity and Zip Code Socioeconomic Status for Surgical versus Nonsurgical Management of Proximal Humerus Fractures in a Medicare Population.

BACKGROUND: This study evaluated the effect of race/ethnicity and socioeconomic status (SES) on surgical utilization after proximal humerus fractures in a large Medicare cohort. METHODS: The PearlDiver Medicare claims database was used to identify patients aged 65years and older with isolated, closed proximal humerus fractures, for whom race/ethnicity data were available (65.5% of identified fractures). Patients with polytrauma or neoplasm were excluded. Patient demographic, race/ethnicity, comorbidity, and median household income were compared for surgical versus nonsurgical management. Univariate and multivariable logistic regressions were used to determine disparities of surgical utilization based on the abovementioned factors. RESULTS: Of 133,218 patients with proximal humerus fracture identified, surgery was conducted for 4446 (3.3%). Those less likely to receive surgery were older (incrementally by increasing age bracket up to 85 years and older odds ratio [OR], 0.16, P < 0.001), male (OR, 0.79, P < 0.001), Black (OR, 0.51, P < 0.001) or Hispanic (0.61, P = 0.005), higher Elixhauser Comorbidity Index (per 2 increase OR, 0.86, P < 0.001), and low median household income (OR, 0.79, P < 0.001). CONCLUSIONS: The independent significance of race/ethnicity and SES point to disparities in surgical decision making/access to care. These findings highlight the need for increased attention on initiatives and policies that seek to eliminate racial disparities and improve health equity independent of SES.

Assessment of complications associated with casting of acute distal radius fractures in adults.

PURPOSE: Controversy exists regarding the closed treatment of distal radius fractures. Circumferential casting of acute distal radius fractures has been shown to be safe in children, however, little research has demonstrated its safety in adults. The purpose of this study was to assess the risk of complications associated with casting acute distal radius fractures in adult patients. METHODS: Patients with a distal radius fracture treated by a single hand surgeon at a level 1 trauma center were retrospectively reviewed over a 3-year period. Patients were evaluated in the emergency room and were provisionally immobilized either with short-arm fiberglass casts or with splints. Patients were followed for a minimum of 4 weeks. Complication rates associated with casting were recorded, including rates of compartment syndrome and acute carpal tunnel syndrome. RESULTS: Eighty-one patients were included in this study. A total of 30 patients met inclusion criteria for placement of a short arm cast in the Emergency Department. Mean patient age was 63.2 years. The majority of patients sustained their injuries from a ground level fall. A minority of patients had radiographic evidence of intra-articular extension or underwent a reduction prior to casting. There were no patients who developed compartment syndrome or acute carpal tunnel syndrome as a result from the casting. The majority of patients did not require a cast change for at least 4 weeks. None of our patients went on to surgery. CONCLUSION: There were no major complications associated with casting of acute, low energy distal radius fractures in this series of 30 adult patients. While further studies with larger numbers of patients are necessary to establish safety of casting, this study suggests that casting may be a safe and effective treatment for low-energy distal radius fractures in adult patients presenting with a normal neurovascular exam. TYPE OF STUDY/LEVEL OF EVIDENCE: Retrospective comparative study, Level III.

Modelling socio-environmental sensitivities: how public responses to low carbon energy technologies could shape the UK energy system.

Low carbon energy technologies are not deployed in a social vacuum; there are a variety of complex ways in which people understand and engage with these technologies and the changing energy system overall. However, the role of the public's socio-environmental sensitivities to low carbon energy technologies and their responses to energy deployments does not receive much serious attention in planning decarbonisation pathways to 2050. Resistance to certain resources and technologies based on particular socio-environmental sensitivities would alter the portfolio of options available which could shape how the energy system achieves decarbonisation (the decarbonisation pathway) as well as affecting the cost and achievability of decarbonisation. Thus, this paper presents a series of three modelled scenarios which illustrate the way that a variety of socio-environmental sensitivities could impact the development of the energy system and the decarbonisation pathway. The scenarios represent risk aversion (DREAD) which avoids deployment of potentially unsafe large-scale technology, local protectionism (NIMBY) that constrains systems to their existing spatial footprint, and environmental awareness (ECO) where protection of natural resources is paramount. Very different solutions for all three sets of constraints are identified; some seem slightly implausible (DREAD) and all show increased cost (especially in ECO).