As of 2019, there were 567,715 Americans without housing, and California reported the largest unhoused population in the country.1 In the past 2 years, the rate of unhoused people in California has risen 16%, which is the second highest in the country.1 Many reports have shown that the unhoused population is particularly vulnerable to infectious disease epidemics and pandemics due to lack of control of their surroundings, disproportionate resource allocation, and broken communication.2 While there have been many initiatives started to try and combat these inequities, there is little research about communication and the dissemination of information to the unhoused population.3 As the guidelines for COVID-19 are constantly changing, there is a need for a better system of communication within this vulnerable population to ensure that they receive timely, accurate updates to help reduce their risk of contracting or spreading COVID-19.

It has been noted that tripping and falling are the greatest source of accidental injury in children with motor disabilities[1]. Tripping most commonly occurs due to a decrease in foot clearance or ineffective limb shortening during the swing phase of gait. Moosabhoy and Gard developed equations based on a planar model of the leg to look directly at joint contributions to foot clearance in the adult population (Fig. 1)[2]. We modified and applied the analytical techniques used by Moosabhoy and Gard to analyze a new population of patients.

Summary

Spinopelvic dissociation injuries are complex injuries defined as discontinuity between the appendicular and axial skeleton. Fracture patterns are variable, but U-type and H-type fractures are common and often present with kyphotic deformity along with translational displacement and impaction. The ideal method of fixation has not been established for these injuries. The goals of treatment include restoration of alignment, stability, and neural decompression as needed. Traditional methods of lumbopelvic fixation have spanned the upper sacral fracture site. Our novel modified method of lumbopelvic fixation directly instruments the S1 body. This allows for direct manipulation of the fracture which we theorize improves reduction and increases stability across the fracture. This article characterizes the injury patterns, outlines the modified technique, and reports the clinical and radiographic outcomes of our modified lumbopelvic fixation technique and construct.

Introduction

Optimal paediatric femoral shaft fracture patterns or lengths amenable to titanium elastic nail stabilization have not been well defined. The purpose of this study is to identify radiographic parameters predictive of treatment failure with flexible intramedullary nails based upon fracture morphology.

Methods

A retrospective review was performed of all femoral shaft fractures treated with flexible intramedullary nails over a five-year period. All patients with at least six weeks of postoperative radiographic imaging were included. Fracture characteristics included location, pattern, length, obliquity, angulation, translation and shortening. Postoperative radiographs were reviewed to determine shortening and angulation.

Results

There were 58 patients with 60 femoral shaft fractures stabilized with titanium nails, with 46 healing within acceptable parameters and 14 considered malunions. Six of the 14 malunions developed complications requiring early unplanned intervention. No patients in the treatment success group had a complication. Between the treatment success and failure groups, fracture pattern, location, length, obliquity, angulation, translation or shortening were not statistically different. Mean nail canal fill was significantly lower in the failure group (0.72 versus 0.81; p = 0.0146), with a receiver operating characteristic curve identifying canal fill 76% as the optimal threshold.

Conclusion

This is the first study to measure the length and obliquity of paediatric femoral shaft fractures and to determine their relationship to radiographic alignment after healing. None of the preoperative fracture characteristics were predictive of malalignment or shortening. We recommend the use of larger nail sizes in the treatment of paediatric femoral shaft fractures, especially if there is concern for residual instability.

Level of evidence

IV.

Socioeconomic status (SES) influences surgical outcomes across many surgical specialties. Much of the literature examining the relationship between SES and orthopaedic surgery outcomes is focused on joint arthroplasties. The following study is a new exploratory study using the Area of Deprivation Index (ADI) as a proxy for SES in orthopaedic trauma. The ADI includes 17 different metrics to assess disadvantages at the neighborhood level based on 9-digit zip codes.

UNLABELLED: Drains are used in plastic surgery to remove excess fluid while ameliorating complications. However, there is a paucity of evidence supporting guiding parameters on when to discontinue a drain. The aim of our study was to determine whether two of the most common parameters, drain volume 24 hours before removal or postoperative day, are valid indicators for drain removal. METHODS: A retrospective chart review was conducted for surgical operations performed by our division between July 2014 and May 2019. Of the 1308 patients, 616 had a drain and a complete record. Demographics, medical history, operative time, antibiotic use, anatomic site, donor/recipient, and complication type were recorded. Complications were defined as events that deviated from expected postoperative course or required pharmacological/procedural intervention. T-test and Chi square were used to analyze data. RESULTS: In total, 544 patients were in the no complication group, and 72 were in the complication group. The complication group patients had drains removed later than patients in the no complication group (15.7 days versus 12.5 days, P = 0.0003) and had similar final 24-hour drain volumes versus patients in the no complication group (16.7 mL versus 18.8 mL, P = 0.2548). The complication group had more operations on the pelvis (11% versus 2.1%; P = 0.000017) or thigh (8.5% versus 3.4%; P = 0.029). CONCLUSIONS: Our data suggest neither postoperative day nor 24-hour volume before drain removal are valid indicators for removal. Late removal correlates with more complications; however, persisting output leading to later removal may be predictive of an impending complication rather than delays in drain removal causing the complication.