Epidemiology of Shoulder Dislocation Treated at Emergency Departments in the United States Between 1997 and 2021.

Background: The exact incidence of shoulder dislocation in the general population of the United States (US) has yet to be well studied. Purpose: To establish the current incidence and patterns of shoulder dislocations in the US, especially regarding sports-related activity. Study Design: Descriptive epidemiology study. Methods: This was a retrospective analysis of shoulder dislocations encountered in emergency departments in the US between 1997 and 2021 as recorded in the National Electronic Injury Surveillance System (NEISS). Data were further analyzed according to patient age, sex, and sports participation. Information from the United States Census Bureau was used to determine the overall incidence of dislocations. Results: A total of 46,855 shoulder dislocations were identified in the NEISS database, representing a national estimate of 1,915,975 dislocations (mean 25.2 per 100,000 person-years). The mean patient age was 35.3 years. More than half of the dislocations (52.5%) were sports-related, and basketball (16.4%), American football (15.6%), and cycling (9%) were the sports most commonly associated with dislocation. Most dislocations (72.1%) occurred in men. This disparity by sex was more significant for sports-related dislocations (86.1% in men) than nonsports-related dislocations (56.7% in men; P < .001). With sports-related dislocations, people <21 years experienced a significantly higher proportion versus those >39 years (44.6% vs 14.9%; P < .001), while the opposite distribution was seen with nonsports-related dislocations (<21 years: 12% vs >39 years: 51.7%; P < .001). Women outnumbered men with shoulder dislocation among people >61 years. Conclusion: Sports-related shoulder dislocations were more common among younger and male individuals than older and female individuals. Contact sports such as basketball and American football were associated with more shoulder dislocations compared with noncontact sports.

Gait and strength assessment following surgical repair by intramedullary nailing of isolated tibial shaft fracture.

The objective of the study was to evaluate the long-term strength and gait outcomes after intramedullary nailing of isolated tibial diaphyseal fractures. This retrospective cohort study was conducted at an academic Level I trauma center. Fifteen participants with isolated tibial diaphyseal fractures (OTA/AO 42) at least 2 years postoperative from intramedullary nailing (IMN) provided informed consent. The average age was 40 ± 14 (range, 24-69); there were nine men and six women. Knee flexion-extension strength data were collected. Temporal-spatial, kinematic, and kinetic gait parameters were measured and compared to historic control data. Participants completed the SF-36 and shortened musculoskeletal function assessment questionnaires. The mean length of follow-up between surgery and gait analysis was 6 ± 2 years. The fractured limb demonstrated deficits in quadriceps strength between 9.8% and 23.4% compared to the unaffected limb. Temporal-spatial parameters revealed slower walking speed, shorter stride length, decreased cadence, and shorter single-limb support time in the fractured limb. Altered kinematic and kinetic findings included a knee extension shift during stance, with an increased knee flexor moment demand and decreased total knee power during loading and midstance. These findings represent deficits in concentric and eccentric knee extensor activity. Additionally, the fractured limb demonstrated decreased ankle dorsiflexion during stance and diminished ankle push-off power. Long-term outcomes after IMN of tibial diaphyseal fractures demonstrate decreased quadriceps strength and altered gait parameters that may have implications to the high incidence of knee and ankle pain in the fractured limb.

Creating a culture of quality: our experience with providing feedback to frontline hospitalists.

BACKGROUND: One way to provide performance feedback to hospitalists is through the use of dashboards, which deliver data based on agreed-upon standards. Despite the growing trend on feedback performance on quality metrics, there remain limited data on the means, frequency and content of feedback that should be provided to frontline hospitalists. OBJECTIVE: The objective of our research is to report our experience with a comprehensive feedback system for frontline hospitalists, as well as report the change in our quality metrics after implementation. DESIGN, SETTING AND PARTICIPANTS: This quality improvement project was conducted at a tertiary academic medical centre among our hospitalist group consisting of 46 full-time faculty members. INTERVENTION OR EXPOSURE: A monthly performance feedback report was distributed to provide ongoing feedback to our hospitalist faculty, including an individual dashboard and a peer comparison report, complemented by coaching to incorporate process improvement tactics into providers' daily workflow. MAIN OUTCOMES AND MEASURES: The main outcome of our study is the change in quality metrics after implementation of the monthly performance feedback report RESULTS: The dashboard and rank order list were sent to all faculty members every month. An improvement was seen in the following quality metrics: length of stay index, 30-day readmission rate, catheter-associated urinary tract infections, central line-associated bloodstream infections, provider component of Healthcare Consumer Assessment of Healthcare Providers and Systems scores, attendance at care coordination rounds and percentage of discharge orders placed by 10:00. CONCLUSIONS: Implementation of a monthly performance feedback report for hospitalists, complemented by peer comparison and guidance on tactics to achieve these metrics, created a culture of quality and improvement in the quality of care delivered.