Luxatio erecta is a description for a specific and rare type of shoulder dislocation where the humeral head dislocates directly inferior. This rare form of glenohumeral dislocation accounts for only 0.5% of shoulder dislocations. It is even less common for both shoulders to be bilaterally dislocated inferiorly with the characteristic “hands up” posture. A limited number of these bilateral occurrences are described in the literature to date and most have been from higher energy trauma. We have described a low energy case of bilateral luxatio erecta and the reduction method used and the continued instability following successful reduction under procedural anesthesia.
Introduction: Intertrochanteric proximal femur fractures are common injuries in the elderly. Certain patterns are considered unstable and confer increased risks. Risk factors for these patterns are not well defined. We sought to determine whether increased body mass index (BMI) was associated with increased risk of sustaining an unstable pattern intertrochanteric (IT) fracture following low-energy trauma. Materials and methods : Retrospective case review of all patients presenting to a level-2 trauma center between October 2010 and August 2014 with Intertrochanteric fracture. Fracture pattern (stable or unstable) and BMI were analyzed using odds ratios and age was controlled for. Results: Four hundred fifty-two patients were identified. No difference was found between fracture stability when BMI of 25 was used as a cutoff. However, when a BMI of 30 was used as a cutoff, there was a trend of difference (relative difference 30%) in rates of fracture type favoring unstable patterns in the obese group. This difference approached but did not reach statistical significance ( P = .08). When adjusted for age, the difference remained but still did not reach statistical significance ( P = .11). Discussion: Unstable type IT fractures were found more frequently in the obese cohort (BMI >30) than those who were not obese.
Background: In 2019, the Centers for Medicare and Medicaid Services (CMS) announced that beginning January 1, 2021, hospitals would be required to post pricing information in a usable format for patients via diagnosis-related group (DRG) or charge description master (CDM) sheets. Purpose/Questions: We hypothesized the new price transparency rule would pose challenges for many health care facilities. We therefore sought to find out how much pricing information was available before the rule took effect and how usable it was for patients receiving sports medicine care. Methods: In late 2019, we randomly selected 100 general hospitals (GH) from the CMS hospital list and an additional 21 orthopedic hospitals (OH). The DRG and/or CDM sheets were obtained from hospital websites. Pricing information for 6 sports medicine procedures (rotator cuff repair, shoulder arthroscopy, knee arthroscopy, anterior cruciate ligament reconstruction, meniscal repair, and steroid injection) was evaluated in qualitative and quantitative form. Results: Pricing information was provided by 74% of GH and 86% of OH. The price of steroid injections was frequently reported in usable form, with 80% by GH and 78% by OH. The remaining procedures were reported by less than 27% of GH and 40% of OH. For each procedure, component pricing was provided by at least 60% of GH and 78% of OH. No facility provided a pricing calculator or payer-type specific rates. Conclusions: Prior to the enactment of the new price transparency rule in January 2021, most facilities provided some pricing information to patients. However, reporting rates in sports medicine were low and the available data were of little use to patients.
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