Pediatric Pelvic and Acetabular Fractures: Discerning Severity by Classification and Clinical Management.

BACKGROUND: Existing classification systems may not adequately describe the injury patterns seen pelvic ring and acetabular fractures in the skeletally immature population. Pediatric patients, once stabilized, are often transferred for these injuries. We evaluated which commonly used systems correlate with clinical management in pediatric patients, including transfer patterns based on injury severity. METHODS: A retrospective review of patients aged 1 to 15 treated for traumatic pelvic or acetabular fractures over a 10-year period at an academic level I Pediatric Trauma Center reviewed demographic, radiographic, and clinical data. RESULTS: A total of 188 pediatric patients (average age 10.1 y) were included. Increasing injury severity based on classification Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA P <0.001; Young and Burgess P <0.001; Torode/Zieg P <0.001), increasing Injury Severity Score ( P =0.0017), and decreasing hemoglobin levels ( P =0.0144) were significantly associated with operative management. Injury characteristics did not differ between patients who were transferred versus patients who were brought in directly from the field. Air transport was significantly associated with surgical treatment, pediatric intensive care unit admission, polytrauma, and Torode/Zieg classification ( P =0.036, <0.0001, 0.0297, 0.0003, respectively). CONCLUSIONS: Although not fully descriptive of skeletally immature fracture patterns, the AO/OTA and Young and Burgess classification systems adequately assess the severity of pelvic rings and injuries in pediatric patients and predict management patterns. The Torode and Zieg classification also predicts management. In a large cohort, air transport was significantly associated with surgical treatment, need for pediatric intensive care unit stay, the presence of an additional injury, and instability in the Torode and Zieg classification. These findings suggest that air transfers are being utilized to expedite advanced-level care in more severe injuries. Further studies with long-term follow-up are required to assess the clinical outcomes of both nonoperatively and operatively treated pediatric pelvic fractures and to guide both triage and treatment decisions for these rare but severe injuries. LEVEL OF EVIDENCE: Level III.

A Review of Price Transparency Policy and Evaluation of Hospital Compliance in Orthopedic Sports Medicine.

Background: In 2019, the Centers for Medicare and Medicaid Services (CMS) announced that beginning January 1, 2021, hospitals would be required to post pricing information in a usable format for patients via diagnosis-related group (DRG) or charge description master (CDM) sheets. Purpose/Questions: We hypothesized the new price transparency rule would pose challenges for many health care facilities. We therefore sought to find out how much pricing information was available before the rule took effect and how usable it was for patients receiving sports medicine care. Methods: In late 2019, we randomly selected 100 general hospitals (GH) from the CMS hospital list and an additional 21 orthopedic hospitals (OH). The DRG and/or CDM sheets were obtained from hospital websites. Pricing information for 6 sports medicine procedures (rotator cuff repair, shoulder arthroscopy, knee arthroscopy, anterior cruciate ligament reconstruction, meniscal repair, and steroid injection) was evaluated in qualitative and quantitative form. Results: Pricing information was provided by 74% of GH and 86% of OH. The price of steroid injections was frequently reported in usable form, with 80% by GH and 78% by OH. The remaining procedures were reported by less than 27% of GH and 40% of OH. For each procedure, component pricing was provided by at least 60% of GH and 78% of OH. No facility provided a pricing calculator or payer-type specific rates. Conclusions: Prior to the enactment of the new price transparency rule in January 2021, most facilities provided some pricing information to patients. However, reporting rates in sports medicine were low and the available data were of little use to patients.

How Are Orthopaedic Surgery Residencies Responding to the COVID-19 Pandemic? An Assessment of Resident Experiences in Cities of Major Virus Outbreak.

BACKGROUND: In response to COVID-19, American medical centers have enacted elective case restrictions, markedly affecting the training of orthopaedic residents. Residencies must develop new strategies to provide patient care while ensuring the health and continued education of trainees. We aimed to describe the evolving impact of COVID-19 on orthopaedic surgery residents. METHODS: We surveyed five Accreditation Council for Graduate Medical Education-accredited orthopaedic residency programs within cities highly affected by the COVID-19 pandemic about clinical and curricular changes. An online questionnaire surveyed individual resident experiences related to COVID-19. RESULTS: One hundred twenty-one resident survey responses were collected. Sixty-five percent of the respondents have cared for a COVID-19-positive patient. One in three reported being unable to obtain institutionally recommended personal protective equipment during routine clinical work. All programs have discontinued elective orthopaedic cases and restructured resident rotations. Most have shifted schedules to periods of active clinical duty followed by periods of remote work and self-isolation. Didactic education has continued via videoconferencing. DISCUSSION: COVID-19 has caused unprecedented changes to orthopaedic training; however, residents remain on the front lines of inpatient care. Exposures to COVID-19 are prevalent and residents have fallen ill. Programs currently use a variety of strategies to provide essential orthopaedic care. We recommend continued prioritization of resident safety and necessary training accommodations.

The Prevalence of Obesity and Elevated Blood Pressure in Adolescent Student Athletes From the State of Mississippi.

BACKGROUND: Over the past 30 years, there has been a dramatic increase in the prevalence of childhood obesity and hypertension in the United States. The prevalence of these diagnoses among individuals participating in school-sanctioned sports has not been clearly defined. PURPOSE: To identify the prevalence of obesity and elevated blood pressure (BP) among student athletes and investigate associations between race, sex, type and number of sports played, and the prevalence of these diseases. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Pre-sports participation medical examinations (N = 7705) performed between 2009 and 2013 were reviewed to identify the prevalence of obesity and elevated BP and examine relationships between the type of sports played, participation in multiple sports versus a single sport, and the athlete's body weight and body mass index (BMI). RESULTS: The prevalence of obesity was 23.5%. There was a significant association (P < .001) between the number of sports played by the student and BMI. The risk of obesity among single-sport athletes was more than 2-fold the risk (relative risk [RR], 2.13) compared with ≥3-sport athletes and 1.42 times greater compared with 2-sport athletes (RR, 1.42). The prevalence of elevated BP was 21.2%. There was a significant association (P < .001) between the number of sports played by the student and elevated BP. The risk of elevated BP among single-sport athletes was 1.59 times greater (RR, 1.59) than ≥3-sport athletes and 1.30 times greater compared with 2-sport athletes (RR, 1.30). Finally, obese students were 2.40 times more likely to have elevated BP compared with nonobese students (P < .001). CONCLUSION: The result of this study confirms the progressive nature of the obesity epidemic and identifies the contribution of obesity to the worsening cardiometabolic profiles in student athletes. The study also identifies that participation in multiple sports and running sports decreases the individual's risk for obesity and hypertension. CLINICAL RELEVANCE: The present study emphasizes the importance of screening for obesity and elevated blood pressure during the athlete's preparticipation physical examination.