Journal of Bone and Joint Surgery 2015

Treatment

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Diagnostic

1. Licht H, Murray M, Vassaur J et al. The Relationship of Obesity to Increasing Health-Care Burden in the Setting of Orthopaedic Polytrauma. J Bone Joint Surg Am. 2015 Nov 18;97(22):e73. doi: 10.2106/JBJS.O.00046.

CONCLUSIONS: Computed tomographic scans, routinely obtained at the time of admission, can be utilized to calculate truncal adiposity and to investigate the impact of obesity on patients with polytrauma. Obese patients were found to have higher total hospital charges, longer hospital stays, discharge to a continuing-care facility, and a higher rate of orthopaedic surgical intervention. PMID: 26582625

Comments: Obesity is associated with increased mortality in trauma patients.  The greater the amount of mass on abdominal CT (as a proxy for BMI), the more the problems faced in obese patients with polytrauma.  Obesity kills.

 

2. Karl JW, Swart E, Strauch RJ. Diagnosis of Occult Scaphoid Fractures: A Cost-Effectiveness Analysis. J Bone Joint Surg Am. 2015 Nov 18;97(22):1860-8. doi: 10.2106/JBJS.O.00099.

CONCLUSIONS: Given its relatively low cost and high diagnostic accuracy, advanced imaging for suspected scaphoid fractures in the setting of negative radiographs represents a cost-effective strategy for reducing both costs and morbidity. The decision to use CT compared with MRI is a function of individual institutional costs and local test performance characteristics. PMID: 26582616 

Comments: This was surprising to me.  When lost worker productivity and increase need for surgery in non-union were considered, it appears cost-effective to use advanced imaging in equivocal scaphoid fractures.  What is not clear is if there would be benefit in doing this in the ED vs. prompt orthopedic follow up.

Review

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Clinical Prediction Rules

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