Improving Rates of Pneumococcal Vaccination in a Skilled Nursing Facility.

The pneumonia vaccine is the best way to prevent pneumococcal disease and the high cost of readmission for patients and payors. The readmission rate at a skilled nursing facility (SNF) for a patient with a diagnosis of pneumonia was 24%, whereas the vaccination rate at the SNF was only 28%. This finding is significant because patients aged ≥65 years have a 35% reduction in pneumonia influenzas and all-cause mortality with appropriate pneumococcal vaccination. The current initiative sought to increase the pneumococcal vaccine rate at a SNF through implementation of a structured vaccine initiative. After implementation of a pneumococcal vaccination bundle, vaccine uptake increased from 28% to 66%. The success of the pneumococcal vaccination bundle showed that a focused effort using context-specific, evidence-based interventions can increase vaccine uptake. Adapting an evidence-based bundle to fit the needs of the user's context is an important component to the success of vaccination initiatives. [Journal of Gerontological Nursing, 48(12), 52-56.].

An Applicant's Residency Program Region May Influence Where They Complete Fellowship.

The primary goal of this study was to determine if an applicant's geographic region of residency was associated with where they matched for fellowship. San Francisco Match (SF Match) provided results regarding applicant data and match results from 2014-2018 for orthopaedic subspecialties except hand and shoulder and elbow. Residency programs were divided into five regions: (Northeast [NE], Southeast [SE], Midwest [MW], Southwest [SW] and West [W]). The MW region had the fewest number of fellowship positions per applicant (0.62), the W region had the most (1.7). Applicants from each region were significantly (p < 0.0001) more likely to complete fellowship in the same region where they completed residency, and there were significant (p < 0.05) differences between regions for specific subspecialties. There are imbalances in terms of the number of applicants and specific fellowship spots available in each region. This imbalance seems important considering the strong associations found between the region in which an applicant completes residency and fellowship. Level of Evidence: Level 3. (Journal of Surgical Orthopaedic Advances 30(1):030-035, 2021).

How the Reputation of Orthopaedic Residency Programs Is Associated with Orthopaedic Fellowship Match Results.

BACKGROUND: The primary goal of the present study was to determine if applicants from higher-ranking U.S. orthopaedic surgery residency programs match at a more desired position on their fellowship match-rank list compared with those applicants from lower-ranked residency programs. METHODS: San Francisco Match provided results regarding applicant data and match results from 2014 to 2018 for all orthopaedic subspecialties except the hand and the shoulder and elbow. Unmatched applicants and international medical graduates were excluded. Residency programs were divided into 5 tiers (with tier 1 being the highest-ranked residency programs and tier 5 being the lowest-ranked programs) on the basis of 2018 Doximity rankings of orthopaedic residency programs. Statistical analysis consisted of descriptive statistics, chi-square tests, and analysis of variance. RESULTS: Two thousand eight hundred and eleven applicants met inclusion criteria. Applicants from residency programs in tiers 1 and 2 applied to significantly fewer programs than those from tiers 3, 4, or 5 (p < 0.0001). Applicants from each tier were significantly more likely to attain interviews than applicants from all tiers below them (p < 0.01). Applicants from tier-1 residency programs matched at a significantly higher position on their rank list (p < 0.001) and were more desirably ranked by fellowship programs (p = 0.003) compared with all other tiers. CONCLUSIONS: Applicants from the highest-ranking residency programs apply to fewer programs, interview at a greater percentage of these programs, and are more likely to match to 1 of their top-ranking programs than applicants from lower-ranking programs. However, the association of the applicant match position with the program ranking appears to be most pronounced when it comes to fellowships selecting which applicants to interview. These findings may help future applicants when determining which programs to apply to during the match.

Maximizing outcomes in a Gustilo-Anderson type IIIB open tibia fracture with segmental bone loss: A case report and review of the literature.

INTRODUCTION: Gustilo-Anderson type IIIB open fractures are severe injuries associated with multiple complications and threaten the viability of the limb. In addition, large segmental bone defects pose reconstructive challenges when treating open fractures and outcomes can be unpredictable. This case report highlights a good outcome in a patient with a type IIIB open tibia fracture with segmental bone loss that was successfully treated with a staged induced membrane technique and latissimus dorsi free flap. CASE REPORT: A 17-year-old female sustained a Gustilo-Anderson type IIIB open tibia fracture with segmental bone loss after a motor vehicle collision. While amputation seemed inevitable, her extremity was able to be salvaged using the staged induced membrane technique and free flap coverage. She made an exceptional recovery and at 24-month follow-up, her short form-12 scores and foot and ankle outcome scores were close to the average for a healthy adult. CONCLUSION: Our patient's outcome represents the benefits of a shared decision-making process with a multidisciplinary approach and highlights the benefit of limb salvage in a healthy patient.

Posterior wall acetabulum fracture-dislocation with subsequent ipsilateral pipkin IV fracture-dislocation: How many hits can a hip take?

The treatment of acetabulum fractures is a technically-demanding task for orthopaedic trauma surgeons. The treatment of femoral head fractures associated with acetabulum fractures, pipkin IV fractures, presents difficulty as usually the femoral head fracture requires treatment through an anterior approach and the acetabulum fracture, which is commonly a posterior wall fracture, requires treatment through a posterior approach. Recently, surgical dislocation of the hip has become an accepted option for treatment of these fractures as it allows treatment of the femoral head fracture and posterior wall acetabulum fracture through one approach. However, dual anterior and posterior approaches are acceptable. We present 15 year follow up of an 18 year old female who underwent open reduction internal fixation of a posterior wall acetabulum fracture through a Kocher-Langenbeck approach. Four months later the patient sustained a second fracture dislocation of the same hip, this time a femoral head fracture with an associated posterior wall acetabulum fracture that was treated with a Kocher-Langenbeck approach for the revision acetabulum and a approach for the femoral head fracture. At fifteen years the patient had a Merle d'Aubigne score of 15 and a Harris hip score of 71. She was gainfully employed and subjectively happy with her surgical result. While treatment of pipkin IV fracture dislocations can be treated through a surgical dislocation of the hip, dual surgical approaches are a viable option in certain cases.