Condition linked to increased surgery risk, longer hospital stays, higher charges, greater likelihood of discharge to care facility rather than home

ROSEMONT, Ill. – A new study appearing in the November 18 issue of The Journal of Bone & Joint Surgery (JBJS) found a link between obesity and a higher risk for surgery in orthopaedic trauma patients. In addition, researchers found that patients with obesity had longer hospital stays and greater treatment costs. They were also more likely to be discharged to a care facility, rather than to home.

Obesity affects more than 38 percent of the American population. In this study, researchers used computer tomography (CT) scans to measure truncal body mass index (BMI)—body fat volume in a patient’s midsection. They sought to determine whether a possible relationship existed between obesity and an increasing health care burden in patients with multiple orthopaedic traumas.

Researchers identified 301 patients with multiple orthopaedic injuries at a Level I trauma center from 2006 to 2011. Patients with a truncal BMI of less than 30 kg/m2 were categorized as non-obese, and those who measured more than 30 kg/m2 were considered obese.

The patients with obesity were further divided into two classes. Class I included patients with a truncal BMI between 30 kg/m2  and 35 kg/m2; those with a truncal BMI greater than 35 kg/m2 were in Class II.
Their analysis showed the following:

• Obesity increased the risk of surgery: 72 percent of the obese patients required surgical treatment, compared to nearly 55 percent of non-obese patients. The degree of obesity also had an impact on a patients risk for surgery. Although 67 percent of Class I patients had surgery, 93.3 percent of the Class II patients required surgery.
• Patients with a normal truncal BMI had shorter hospital stays. Their mean intensive care unit stay was 7.2 days and the mean total hospital stay was 12.4 days, compared to 9.7 days and 16.4 days for patients diagnosed as obese.
• Mean hospital costs were $160,606.02 for non-obese patients and $234,863.58 for obese patients.
• A greater proportion of Class II patients required discharge to a continuing care facility.

“Overall this study found an association between obesity and increased rates of lower-extremity injuries and orthopaedic surgery,” said study lead author and orthopaedic surgeon Heather Licht, MD. “Obese patients had higher total hospital charges, longer intensive care unit and total hospital stays, and decreased rate of discharge.

“Even when patients have the same severity of injuries, resource utilization is higher among patients with obesity, compared to non-obese patients,” explained Dr. Licht.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution) from a third-party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship in the 36 months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in his work.

Quoted from aaos.org

ROSEMONT, Ill. – Ladders are useful tools. Nearly everyone uses them to reach out-of-the-way objects on pantry shelves or closets, wash windows, clean gutters, or hang holiday lights. Ladders also are potentially dangerous. In 2014, more than 500,000 ladder-related injuries required medical treatment according to the U.S. Consumer Product Safety Commission. The most common injuries are cuts, bruises and fractured bones. However, some injuries are more severe.

Fortunately, many of these injuries can be avoided by following the ladder safety guidelines shown below.

• Use a ladder of proper length to reach the working height that you need. Inside a home, that probably means a low stepladder. For outside chores, you may need a taller stepladder, and for some projects, an even taller single or extension ladder. Keep in mind that, on a stepladder, the highest standing level should be two steps down from the top. On a single or extension ladder, never stand above the third rung from the top.
• Use a ladder according to use and “working load” — the amount of weight the ladder can hold, including yourself and any tools or decorations.

• Never use a ladder that is damaged, broken or bent.
• Check the ladder for any loose screws, hinges or rungs.
• Clean off any mud, grease, oil, snow or other slippery liquids that might have accumulated on the ladder.
• Do not make a temporary repair of broken or missing parts because these repairs could fail while you are high off the ground.

• Be sure the ladder is set up on stable, even ground. Outside ground can become bumpy after cycles of freezing and thawing over the winter months or may be soft or muddy throughout the year.
• If working outside, make sure the ladder is away from electrical wires, tree limbs, or any other obstructions.
• Use the 4-to-1 rule: Make sure the ladder is 1 foot away from the wall for every 4 feet that the ladder rises. For example, if the ladder touches the wall 16 feet above the ground, the feet/base of the ladder should be 4 feet from the wall. If you are going to climb onto a roof, the ladder should extend 3 feet higher than the roof. The upper and lower sections of an extension ladder should overlap to provide stability.
• Whether inside or outside the home, do not place stepladders or utility ladders on boxes, countertops or unstable surfaces to gain additional height.
• Before using a stepladder, make sure it is fully open and that the spreaders or braces between the two sections are fully extended and locked.
• The highest standing level on a stepladder should be two steps down from the top.
• Ladder height versus work height:

• Take time to secure the ladder properly.
• Make sure the soles of your shoes are clean so they do not slip off the ladder rungs. Do not wear leather-soled shoes because they can be slippery.
• Always wear lace-up shoes or boots, rather than sandals or flip-flops. Make sure your shoelaces are securely tied and that your pant legs do not extend under your shoes.
• Face the ladder while climbing, and stay in the center of the rails. Grip both rails securely while climbing.
• It is always better to move the ladder than to overreach.
• Leaning too far to one side, and reaching too far overhead, can make you lose your balance and fall. Your bellybutton should not go beyond the sides of the ladder.
• Never climb a ladder without someone nearby who is able to spot you.
• On a single or extension ladder, never stand above the third rung from the top and never climb above the point where the ladder touches the wall or vertical support.
• On stepladders, never stand on the pail shelf, spreaders or back section.
• Do not stand above the marked level; never stand on the top rung of any ladder.
• Do not overload the ladder. It is meant to be used by one person at a time.
• Do not use a ladder if you tire easily, are subject to fainting spells, or are taking medications or consuming alcohol that may make you dizzy or drowsy.
• Do not use the ladder or the pail shelf as a seat.
• Never use a ladder in high winds.

• Calmly assess the situation and determine if you are hurt.
• Get up slowly.
• If you feel that an injury has occurred that prevents you from standing or walking, do not panic. Call for assistance. If the injury is serious, call 911.
• If you are not injured, rest awhile and regain your composure before climbing again.

Ladders are useful tools that regularly help with a variety of chores and projects. Ensuring that your ladder is safe, and that you are properly climbing and moving on the ladder, can help prevent injuries.

Quoted from aaos.org

Waterloo/Cedar Falls Courier www.wcfcourier.com

ROSEMONT, Ill. – More than 80 million people in the United States have taken up bicycling for fun, exercise, and transportation.

According to the Consumer Product Safety Commission, more than 1.3 million cycling injuries were reported in 2014.

Common Bicycle Injuries
Bruises and minor cuts are usually the leading types of injuries involving bicycles, followed by fractures, muscle strains, and sprains. However, serious injuries, including death, do occur. Some of the most common cycling injuries that orthopaedic surgeons treat include broken collar bones and wrists.

Tips for Preventing Injuries
To minimize your risk of injury while riding a bicycle:

• Wear a helmet. Studies show that wearing a bike helmet reduces your risk of serious head and brain injury by 85%. Always wear a helmet approved by the American National Standards Institute.
  Make sure the helmet fits snugly but comfortably, and does not obstruct your vision.
  It should have a chin strap and buckles that stay securely fastened.
• Follow the rules of the road. Familiarize yourself with all of the bicycle rules of the road in your city or state. Ride in the direction of traffic. Follow traffic signs and lights. Signal your turns or your intentions so that drivers can anticipate your actions. If you are riding with others, ride single file.
• Ride defensively. Understand that drivers often do not see cyclists, so you must be fully aware of your surroundings and ready to act to avoid a collision. Intersections are especially dangerous because drivers making turns are not necessarily looking for cyclists. Be careful when riding next to parked cars to avoid being hit by an opening door.
• Choose bike routes wisely. Avoid riding on high traffic roads. The most direct route to your destination is often not the safest because more vehicles will also take that route. Select streets with fewer and slower cars.
• Whenever possible, choose streets with designated bicycle lanes. If there is not a bicycle lane, ride on the right shoulder of the road.
• Choose wide streets. When a street lane is too narrow for a vehicle and bicycle to safely ride side-by-side, or if there are several parked cars on the street, you will need to join traffic and ride toward the center of the road. If this causes traffic behind you to jam, or if cars are switching lanes trying to pass you, it is safest to find a different, quieter street.
• Avoid distracted cycling. Do not listen to loud music with head phones, talk on your phone, text, or do anything else that can obstruct your hearing and/or vision while riding.
• Take extra precautions while bicycling at night. Wear bright fluorescent colors and make sure to have rear reflectors. Both a working tail light and headlight should be visible from 500 feet away.
• No drugs or alcohol. Never ride a bicycle while under the influence of drugs or alcohol.
  Never underestimate road conditions. Be cautious of uneven or slippery surfaces.
• Maintain your bicycle. Check your bicycle’s mechanical components on a regular basis (brakes, tires, gears, etc.), just like you would for a car. If your bike is not in good condition, do not ride it.
• Adjust your bicycle to fit. Make certain the bicycle is the proper size for the rider. Appropriately sized frames, handlebar and seat heights will improve your ability to control the bike, and reduce the risk for overuse injuries. If you ride regularly, consider a professional fit from a bike shop.
• Dress appropriately. Avoid loose clothing and wear appropriate footwear. Never wear flip flops. Wear padded gloves. Use appropriately padded cycling shorts for longer rides. Wear sunscreen. If you commute on your bike, carry your belongings in a bag with close fitting straps.
• Pace yourself. Cycling can be vigorous exercise. Make sure you are fit enough to participate before you start pedaling. In addition, make sure you understand how to use the gear systems on your bike to help control your physical exertion level. See your doctor before you begin any exercise program.
• Change riding positions. Slight variations in your position can reduce stress on pressure points on your body and avoid overstressing muscles.
• Hydrate. Be sure to carry water and food on longer rides. Drink a full water bottle each hour you spend on the bike.
• Supervise younger riders at all times. It is recommended that younger children ride only in enclosed areas — away from moving vehicles and traffic.

Quoted from aaos.org