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The Ponseti Method has dramatically altered the management of clubfoot, with particular implications for limited-resource settings. We sought to describe outcomes of care and risk factors for sub-optimal results using the Ponseti Method in Haiti. We conducted a records review of patients presenting from 2011-2015 to a CURE Clubfoot clinic in Port-au-Prince, Haiti. We report patient characteristics (demographics and clinical), treatment patterns (cast number/duration and tenotomy rates), and outcomes (relapse and complications). We compared treatment with benchmarks in high-income nations and used generalized linear models to identify risk factors for delayed presentation, increased number of casts, and relapse. Amongst 168 children, age at presentation ranged from 0 days (birth) to 4.4 years, 62% were male, 35% were born at home, 63% had bilateral disease, and 46% had idiopathic clubfeet. Prior treatment (RR 6.33, 95% CI 3.18-12.62) was associated with a higher risk of delayed presentation. Risk factors for requiring ≥ 10 casts included having a non-idiopathic diagnosis (RR 2.28, 95% CI 1.08-4.83) and higher Pirani score (RR 2.78 per 0.5 increase, 95% CI 1.17-6.64). Female sex (RR 1.54, 95% CI 1.01-2.34) and higher Pirani score (RR 1.09 per 0.5 increase, 95% CI 1.00-1.17) were risk factors for relapse. Compared to North American benchmarks, children presented later (median 4.1 wks [IQR 1.6-18.1] vs. 1 wk), with longer casting (12.5 wks [SD 9.8] vs. 7.1 wks), and higher relapse (43% vs. 22%). Higher Pirani score, prior treatment, non-idiopathic diagnosis, and female sex were associated with a higher risk of sub-optimal outcomes in this low-resource setting. Compared to high-income nations, serial casting began later, with longer duration and higher relapse. Identifying patients at risk for poor outcomes in a low-resource setting can guide counseling, program development, and resource allocation.

Orthopaedic and related care has the potential to present unique obstacles for patients with a range of autism manifestations. In this review, we aim to describe and analyze the literature on autistic patients' experience within orthopaedics and closely related fields. This literature search utilized the PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature databases. Three major concepts were built into the search terms: (1) patients on the autism spectrum; (2) patient experience; and (3) movement sciences, including orthopaedics, physical medicine and rehabilitation (PM&R), occupational therapy (OT), and physical therapy (PT). Our search yielded 35 topical publications, with the major topic areas addressed as follows: (1) clinical and perioperative management, (2) therapy interventions, (3) participation in exercise and social play, (4) sensory management and accommodations, (5) caregiver/parent training and involvement in care, (6) healthcare needs and barriers to care, and (7) utilization of technology. In the current literature, there are no studies that attempt to directly assess autistic patient experience with care practices and clinical environments in orthopaedics. Rigorous, direct examination of the experience of autistic patients within clinical orthopaedic settings is urgently needed to address this gap.

Abstract Purpose To determine the availability and readability of online patient information (OPI) provided by paediatric hospitals in the United States using clubfoot as a model condition Methods The websites of the top 95 paediatric hospitals identified using US News & World Report were included. The names of paediatric hospitals and the terms “clubfoot”, “clubfeet” and “talipes equinovarus” were entered into the Google search engine. Readability was assessed using five validated metrics and the composite grade level (CGL). The number of unpaid monthly visits was calculated with the Ahrefs Organic Traffic Score (OTS) tool. Data for paediatric hospitals were compared with the same metrics for the top ten Google search results. Results Of 95 paediatric hospitals, 29 (30.5%) did not have at least one web page dedicated to clubfoot. The 128 web pages representing 66 paediatric hospitals had an average CGL of 9.4, representing a readability level requiring some high school education. The mean OTS for all paediatric hospitals was 116 estimated visits per month, which was significantly less than that for the top ten Google clubfoot search results (3035.1; p < 0.0001). Conclusion Paediatric hospital web pages on clubfoot were visited much less frequently than those from the top ten Google search results. Only two web pages (1.6%) from paediatric hospitals offered OPI on clubfoot that met the American Medical Association recommended reading level (sixth-grade level). Paediatric hospitals should create OPI on clubfoot with appropriate readability and accessibility for patient families. Level of Evidence N/A

The practice of overlapping surgery impacts patients, providers, and policy-makers. While several studies have examined the relationship between overlapping surgery and clinical outcomes, a combined analysis of all available data has not been performed. We aimed to evaluate the impact of overlapping surgery on 30-day mortality, morbidity, and length of surgery. A systematic literature review revealed all relevant studies examining outcomes of overlapping versus non-overlapping surgery as of March 2018. A pooled meta-analysis with stratification by study quality grade was performed, and heterogeneity and publication bias were assessed. A total of 14 sets of analyses met inclusion and exclusion criteria. Meta-analysis revealed no significant differences in 30-day mortality (OR = 0.84; p = 0.277) or overall morbidity (OR = 0.96; p = 0.632) between patients who underwent overlapping versus non-overlapping surgery. The standardized mean difference for length of surgery between the groups indicated a small statistically significant increase in length of surgery for the overlapping surgery group (SMD = 0.079, p < 0.05). While further study is warranted, current literature suggests that overlapping surgery is not associated with increased risk of mortality or morbidity. •No difference in 30-day mortality between overlapping and non-overlapping surgery groups.•No difference in overall morbidity between overlapping and non-overlapping surgery groups.•No difference in unplanned reoperation rates between the two groups.•Small increase in length of surgery for the overlapping surgery group.•Results unchanged after stratification by study quality grade.