Journal of orthopaedic trauma
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The American Academy of Orthopedic Surgeons and the Orthopedic Trauma Association have released guidelines for the provision of orthopedic trauma services such as adequate stipends, designated operating rooms, ancillary staff, and guaranteed reimbursement for indigent care. One recommendation included a provision for hospital-based physician assistants (PAs). Given current reimbursement arrangements, PA collections for billable services may not meet their salary and benefit expenses. However, their actions may indirectly affect emergency room, operating room, and hospital reimbursement and patient care itself. The purpose of our study is to define the true impact of hospital-based PAs on orthopaedic trauma care at a level II community hospital. ⋯ Although the PA's collections do not cover their costs, the indirect economic and patient care impacts are clear. By increasing emergency room pull through and decreasing times to Operating Room (OR), operative times, lengths of stay, and complications, their existence is clearly beneficial to hospitals, physicians, and patients as well.
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Posterolateral tibial plateau shear fractures often require buttress plating, which can be performed through a posterolateral approach. The purpose of this study was to provide accurate data about the inferior limit of dissection. ⋯ Displaced posterolateral tibial plateau fractures require anatomic reduction and stabilization with a buttress plate. This can be achieved by gaining access to the posterolateral tibial cortex. The distal limit of this dissection can be as little as 27 mm distal to the lateral tibial plateau. Dissection in this region should be carried out with caution.
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This study describes a minimally invasive plate osteosynthesis technique to treat acute displaced clavicular midshaft fractures using anterior-inferior plating. The technique assesses the fracture via a medial window and a lateral window without opening the fracture area itself. A 3.5-mm locking reconstruction plate is applied to fix the clavicle fracture, and reduction is achieved with a joystick technique using 2 threaded k-wires. The clinical outcomes of 19 patients with clavicle midshaft fractures treated using this technique are also described.
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This study aimed to evaluate the incidence and severity of pin tract infections in a series of patients treated by Closed reduction external fixation (CREF) for proximal humeral fractures. ⋯ Most pin tract infections were managed with systemic antibiotics with good results. The occurrence of pin tract infection did not require a change of the stabilization method and none of the patients required revision of their CREF.
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To determine the prevalence and identify the risk factors for heterotopic ossification (HO) formation in high-grade open fractures sustained during combat and to report on the results of HO excision. ⋯ Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.