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The purpose of this multicenter retrospective chart review was to describe demographics, fracture and wound characteristics, and treatments for foot and/or ankle fractures caused by gunshot wounds (GSWs) and identify factors that increase risk of infection in adults treated at 5 urban level 1 trauma centers in South and Midwest regions of the United States. A total of 244 patients sustained GSW-related fractures of the foot/ankle during 2007-2017, of whom 179 had ≥30 days of follow-up data after the initial injury. Most patients were male (95.1%; 232/244) with an average age of 31.2 years. On average, patients sustained 1.3 GSWs (range 1-5) to the foot/ankle. Most GSWs were categorized as low energy (85.1%; 171/201) and the majority (58.2%; 142/244) had retained bullet fragments. Antibiotics were administered at initial presentation to 78.7% (192/244) of patients and 41.8% (102/244) were managed operatively at the time of initial injury. Nerve injury, vascular injury, and infection were documented in, respectively, 8.6% (21/243), 6.6% (16/243), and 17.2% (42/244) of all cases. Multivariable analysis revealed that high-energy injuries and retained bullet fragments increased the risk of infection by 3-fold (odds ratio 3.09, 95% confidence interval 1.16-8.27, p = .025) and 3.5-fold (OR 3.48, 95% CI1.40-8.67; p = .008), respectively. Side of injury, primary injury region, and vascular injury were not significant predictors of infection risk. Further research should examine whether retained bullet fragments are directly associated with infection risk and support the development of guidelines regarding the management of patients with GSW-related fractures to the ankle/foot.

The purpose of this study was to identify the patient, injury, and treatment factors associated with infection of bicondylar plateau fractures and to evaluate whether center variation exists.Retrospective review.Eighteen academic trauma centers.A total of 1,287 patients with 1,297 OTA type 41-C bicondylar tibia plateau fractures who underwent open reduction and internal fixation were included. Exclusion criteria were follow-up less than 120 days, insufficient documentation, and definitive treatment only with external fixation.Open reduction and internal fixation.Superficial and deep infection.One hundred one patients (7.8%) developed an infection. In multivariate regression analysis, diabetes (DM) (OR [odds ratio] 3.24; P ≤ 0.001), alcohol abuse (EtOH) (OR 1.8; P = 0.040), dual plating (OR 1.8; P ≤ 0.001), and temporary external fixation (OR 2.07; P = 0.013) were associated with infection. In a risk-adjusted model, we found center variation in infection rates (P = 0.030).In a large series of patients undergoing open reduction and internal fixation of bicondylar plateau fractures, the infection rate was 7.8%. Infection was associated with DM, EtOH, combined dual plating, and temporary external fixation. Center expertise may also play a role because one center had a statistically lower rate and two trended toward higher rates after adjusting for confounders.Level IV-Therapeutic retrospective cohort study.

Objectives: To identify how implementation strategies impact adoption of a patient education application by orthopaedic trauma providers and patients. Design: Unstructured narrative interview and retrospective review Setting: Four Level 1 Trauma Centers Participants: Seven researchers responsible for enrolling orthopaedic trauma patients Intervention: Development and implementation of a mobile application (app) (http://bit.ly/traumaapp) for patient education regarding orthopaedic trauma at three hospital sites. Main outcome measurements: Unstructured narrative interviews were gathered from seven investigators (attendings n = 3, research personnel n = 4). Standard usage statistics were obtained from the google play and apple app stores including active users, time in app, user download geographic region. Download ratios were calculated from investigator logs of approaches and success. Results: In the 39 months between January 2017 to April 2020, there were 144 downloads by patients at the original center. In the three other centers added in October 2018, there were 404, 109, and 34 downloads over an 18-month period until April 2020. The mean number of downloads per center was 173±161. Quotes from unstructured narrative interviews by investigators described promotional materials as “effective” and the app as “easy to use” with “relevant content.” Additionally, all investigators reported that patients were able to find the app easily and that a majority of patients had devices capable of using the app. Four investigators report that they believe intentional provider interaction with the patient and app increased the download ratio, which ranged from 0.7% to 9.8% of all trauma admissions at each center. Active champions were referenced by all investigators as leading to increased downloads regardless of provider level of the champion. All centers struggled to influence providers beyond the study investigators to adopt the app. All investigators reported poor cell reception and problems with internet connection in hospitals as barriers to facilitating patient downloads. Conclusion: This study documents the successes and challenges of implementing patient education app for orthopaedic trauma patients presenting to four Level 1 trauma centers in the US and UK. At our institutions, downloads were driven by organizational champions at each center who actively promoted the app to patients using standard promotional materials. However, organizational challenges and unreceptive healthcare workers remain a challenge and adoption was not widespread among non-participant providers at each institution. Ultimately, our experience identified iteratively improving implementation strategies and empowering an organizational champion who can lead iterations of implementation, improve relevant technology, and prepare the organization for app adoption as strategies critical to our success. Level of Evidence: IV Keywords: Patient education, technology, mobile application, app, trauma, orthopaedic, champion, iteration, multicenter (J Ortho Business 2022; Volume 2, Issue 3:pages 12-17)

Traumatic events are the leading cause of life-altering disability in adults of working age. The management of patients with traumatic injury has substantially improved due to development of sophisticated trauma centers increasing survival after injury. Unlike the adoption of the trauma system framework, the same has not occurred with specialized trauma recovery services to include mental and social health needs. This literature review will discuss unique issues facing trauma survivors, some current recovery programs available, outcomes and benefits of these programs, and barriers that impair widespread incorporation.Studies have shown that patients with traumatic injury experience reduction in quality of life and concurrent threats to mental health, including post-traumatic stress disorder (PTSD), alcohol use disorder, and recreational substance abuse. Patients with traumatic injury also have high recidivism rates, low pain management satisfaction, and poor engagement in care following injury. Screening efforts for PTSD, mental illness, and alcohol and substance abuse are more widely available interventions. Early coordinated efforts included dedicated multidisciplinary recovery teams. Recently, more methodical and organized programs, such as the Trauma Survivors Network, trauma collaborative care, Trauma Recovery Services, and Center of Trauma Survivorship, have been implemented.The enrollment of patients with traumatic injury in novel programs to enhance recovery has led to heightened self-efficacy, better coping mechanisms, and increased use of mental health services. Additionally, trauma recovery services have been shown to reduce recidivism and have generated cost savings for hospital systems. While positive outcomes have been demonstrated, they are not consistently predictable. Barriers for widespread implementation include limitations of time, funding, and institutional support. This article describes models of successful programs initiated within some trauma centers, which may be duplicated to serve future trauma survivors.

Caring for patients' mental health and their physical health is critical during recovery after trauma. The Orthopaedic Trauma Association has created a patient mental health task force to address the mental health care aspect of our patients' care. This article summarizes the task forces goals and activities to date.