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Background: A growing number of nongovernmental organizations from high-income countries aim to provide surgical outreach for patients in low- and middle-income countries in a manner that builds capacity. There remains, however, a paucity of measurable steps to benchmark and evaluate capacity-building efforts. Based on a framework for capacity building, the present study aimed to develop a Capacity Assessment Tool for orthopaedic surgery (CAT-os) that could be utilized to evaluate and promote capacity building. Methods: To develop the CAT-os tool, we utilized methodological triangulation--an approach that incorporates multiple different types of data. We utilized (1) the results of a systematic review of capacity-building best practices in surgical outreach, (2) the HEALTHQUAL National Organizational Assessment Tool, and (3) 20 semistructured interviews to develop a draft of the CAT-os. We subsequently iteratively used a modified nominal group technique with a consortium of 8 globally experienced surgeons to build consensus, which was followed by validation through member-checking. Results: The CAT-os was developed and validated as a formal instrument with actionable steps in each of 7 domains of capacity building. Each domain includes items that are scaled for scoring. For example, in the domain of partnership, items range from no formalized plans for sustainable, bidirectional relationships (no capacity) to local surgeons and other health-care workers independently participating in annual meetings of surgical professional societies and independently creating partnership with third party organizations (optimal capacity). Conclusions: The CAT-os details steps to assess capacity of a local facility, guide capacity-improvement efforts during surgical outreach, and measure the impact of capacity-building efforts. Capacity building is a frequently cited and commendable approach to surgical outreach, and this tool provides objective measurement to aid in improving the capacity in low and middle-income countries through surgical outreach. [ABSTRACT FROM AUTHOR]

Background: There is no consensus on the optimal fixation method for patients who require a surgical procedure for distal radial fractures. We used cost-effectiveness analyses to determine which of 3 modalities offers the best value: closed reduction and percutaneous pinning, open reduction and internal fixation, or external fixation.Methods: We developed a Markov model that projected short-term and long-term health benefits and costs in patients undergoing a surgical procedure for a distal radial fracture. Simulations began at the patient age of 50 years and were run over the patient's lifetime. The analysis was conducted from health-care payer and societal perspectives. We estimated transition probabilities and quality-of-life values from the literature and determined costs from Medicare reimbursement schedules in 2016 U.S. dollars. Suboptimal postoperative outcomes were determined by rates of reduction loss (4% for closed reduction and percutaneous pinning, 1% for open reduction and internal fixation, and 11% for external fixation) and rates of orthopaedic complications. Procedural costs were $7,638 for closed reduction and percutaneous pinning, $10,170 for open reduction and internal fixation, and $9,886 for external fixation. Outputs were total costs and quality-adjusted life-years (QALYs), discounted at 3% per year. We considered willingness-to-pay thresholds of $50,000 and $100,000. We conducted deterministic and probabilistic sensitivity analyses to evaluate the impact of data uncertainty.Results: From the health-care payer perspective, closed reduction and percutaneous pinning dominated (i.e., produced greater QALYs at lower costs than) open reduction and internal fixation and dominated external fixation. From the societal perspective, the incremental cost-effectiveness ratio for closed reduction and percutaneous pinning compared with open reduction and internal fixation was $21,058 per QALY and external fixation was dominated. In probabilistic sensitivity analysis, open reduction and internal fixation was cost-effective roughly 50% of the time compared with roughly 45% for closed reduction and percutaneous pinning.Conclusions: When considering data uncertainty, there is only a 5% to 10% difference in the frequency of probability combinations that find open reduction and internal fixation to be more cost-effective. The current degree of uncertainty in the data produces difficulty in distinguishing either strategy as being more cost-effective overall and thus it may be left to surgeon and patient shared decision-making.Level Of Evidence: Economic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

➤The burden of musculoskeletal trauma is high worldwide, disproportionately affecting the poor, who have the least access to quality orthopaedic trauma care.➤Orthopaedic trauma care is essential, and must be a priority in the horizontal development of global health systems.➤The education of surgeons, nonphysician clinicians, and ancillary staff in low and middle income countries is central to improving access to and quality of care.➤Volunteer surgical missions from rich countries can sustainably expand and strengthen orthopaedic trauma care only when they serve a local need and build local capacity.➤Innovative business models may help to pay for care of the poor. Examples include reducing costs through process improvements and cross-subsidizing from profitable high-volume activities.➤Resource-poor settings may foster innovations in devices or systems with universal applicability in orthopaedics. [ABSTRACT FROM AUTHOR]

Background: The Internet has become a major resource for patients; however, patient education materials are frequently written at relatively high levels of reading ability. The purpose of this study was to evaluate the readability of patient education materials on the American Academy of Orthopaedic Surgeons (AAOS) web site.Methods: Readability scores were calculated for all patient education articles on the AAOS web site using 5 algorithms: Flesch Reading Ease, Flesch-Kincaid Grade Level, SMOG (Simple Measure of Gobbledygook) Grade, Coleman-Liau Index, and Gunning-Fog Index. The mean readability scores were compared across the anatomic categories to which they pertained.Results: Using a liberal measure of readability, the Flesch-Kincaid Grade Level, 3.9% of articles were written at or below the recommended sixth-grade reading level, and 84% of the articles were written above the eighth-grade reading level. Articles in the present study had a lower mean Flesch-Kincaid Grade Level than those available in 2008 (p < 0.00005). Articles categorized as "Hand & Wrist" or "Foot & Ankle" had significantly lower mean Flesch-Kincaid Grade Level scores than the mean for all categories (p < 0.0005).Conclusions: Regardless of the algorithm used, the mean readability levels of AAOS articles are higher than generally recommended. Although the mean Flesch-Kincaid Grade Level was lower in the present study than it was in 2008, a need remains to improve the readability of AAOS patient education articles.Clinical Relevance: Ensuring that online patient education materials are written at an appropriate reading grade level would be expected to improve physician-patient communication. [ABSTRACT FROM AUTHOR]

Background: Worldwide, road injuries cause over 1.3 million deaths and many more disabilities annually, disproportionately affecting the young and the poor. Approximately one in ten road injuries involves a femoral shaft fracture that is most effectively treated with surgery. Current femoral shaft fracture incidence according to country and age group is unknown and difficult to measure directly but is critical to designing and evaluating interventions. Methods: We modeled femoral shaft fracture incidence from road traffic collisions with use of World Bank, World Health Organization, and Global Burden of Disease Study data for 176 countries and five age groups. We used road traffic death rates, ratios of road traffic deaths to injuries, and proportions of road traffic injuries that were femoral shaft fractures to calculate the fracture incidence. Results: The worldwide annual femoral shaft fracture incidence from road traffic collisions was between 1.0 and 2.9 million. Incidence rates were significantly higher in low and middle income countries compared with high income countries. Overall, low and middle income countries had a mean femoral shaft fracture incidence between 15.7 and 45.5 per 100,000 people per year, with a rate ratio of 2.08 (95% confidence interval, 2.02 to 2.13; p < 0.001) relative to high income countries. Conclusions: Our results demonstrate a substantial worldwide burden and disparities in femoral shaft fracture incidence between low to middle income and high income countries, and the young are disproportionately affected, underscoring the potential impact of improved access to treatment. We believe that the methodology of this study can be applied to estimate the burden of other diseases, allowing for better direction of global health effort. [ABSTRACT FROM AUTHOR]