RESUMO
ABSTRACT: Implementation of the Affordable Care Act has increased the number of Americans with health insurance. However, a substantial portion of the population is still considered underserved, including those who are uninsured, underinsured, and those who are enrolled in Medicaid. The patients frequently face substantial access-to-care issues. Many underlying social determinants of health impact this vulnerable, underserved population, and surgeons must understand the nuances of caring for the underserved. There are numerous opportunities to engage with this population, and providing care to the indigent can be rewarding for both the vulnerably underserved patient and their surgeon.
Assuntos
Ortopedia , Patient Protection and Affordable Care Act , Acessibilidade aos Serviços de Saúde , Humanos , Cobertura do Seguro , Seguro Saúde , Medicaid , Pessoas sem Cobertura de Seguro de Saúde , Estados Unidos , Populações VulneráveisRESUMO
BACKGROUND: Nail guns have been employed since 1959 to speed construction work, but with the increased productivity came an increasing number of injuries associated with the device. The majority of reported cases occur to the extremities. METHODS: Our study retrospectively examines 88 cases of nail gun injuries to the extremities collected from a 4-year period. Radiographs and charts were used to collect data on anatomic site, type of treatment, type and duration of antibiotic treatment, and outcomes. RESULTS: We found that infections associated with nail gun injuries were relatively rare (n=3) and in our study were limited to those patients who presented later than the day of injury. The majority of injuries were to the hand and knee (38.6% and 28.1%, respectively). No significant vascular or neurological injuries were encountered. CONCLUSIONS: It appears that simple emergency room removal of the nail with local debridement and a short course of antibiotics is appropriate in most cases. The exception to this is where there is intra-articular or neurovascular involvement, then operative debridement is recommended.
Assuntos
Materiais de Construção/efeitos adversos , Extremidades/lesões , Ferimentos Penetrantes/etiologia , Acidentes de Trabalho , Adulto , Antibacterianos/uso terapêutico , Extremidades/diagnóstico por imagem , Extremidades/cirurgia , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/etiologia , Corpos Estranhos/cirurgia , Traumatismos da Mão/diagnóstico por imagem , Traumatismos da Mão/etiologia , Traumatismos da Mão/cirurgia , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/etiologia , Traumatismos do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Infecção dos Ferimentos/tratamento farmacológico , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/cirurgiaRESUMO
Monteggia fractures represent approximately 1 to 2 percent of forearm fractures, whereas Galeazzi fractures represent 3 to 6 percent. The combination of these injuries in the same extremity is an exceedingly rare occurrence. We report a case of ipsilateral combination Monteggia and Galeazzi fractures in an adult patient. The patient was treated with anatomic reduction and rigid internal fixation. The radius was stabilized with a 3.5-millimeter dynamic compression plate (Synthes USA, Paoli, PA, U.S.A.) and the olecranon with tension band fixation. The radiocapitellar and distal radioulnar joint relationships were restored; the fractures healed; and the patient proceeded to obtain a satisfactory functional result at one year.
