title: The homeless orthopaedic trauma patient: follow-up, emergency room usage, and complications.
abstract: OBJECTIVE
  To review homeless patients with orthopaedic trauma injuries and examine their emergency room (ER) usage, follow-up rates, and complication rates.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Patients presenting to a level 1 trauma center with orthopaedic trauma injuries from 2001 to 2010.
  
  
  METHODS
  Sixty-three uninsured homeless patients and 63 uninsured nonhomeless patients with orthopaedic trauma injuries were included.
  
  
  METHODS
  Homeless patients with orthopaedic trauma were identified through ER intake sheets and current procedural terminology code searches.
  
  
  METHODS
  ER usage, orthopaedic clinic follow-up, and complications.
  
  
  RESULTS
  After the index visit to the ER for their orthopaedic trauma injuries, homeless patients demonstrated more ER visits and had fewer orthopaedic clinic follow-up visits than nonhomeless patients (P < 0.001). There were no significant differences among the type of complications (none, infection, hardware failure, and nonunion) between the homeless and the nonhomeless patients (P = 0.23). Operative homeless patients returned to the orthopaedic clinic for follow-up more than nonoperative homeless patients (mean = 5.4, SD = 7.6; and mean = 1.2, SD = 1.5, respectively; P < 0.001).
  
  
  CONCLUSIONS
  Our data are the first to examine the problems associated with homelessness in the patient with orthopaedic trauma and demonstrate an increased challenge in the follow-up care. The orthopaedic surgeon must consider these issues in managing this complex patient population.
  
  
  METHODS
  Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Vanderbilt Department of Orthopaedic Surgery, Vanderbilt Orthopaedic Institute, Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: Harrison F
authors.initials: HF
authors.lastname: Kay
authors.forename: Vasanth
authors.initials: V
authors.lastname: Sathiyakumar
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Archer
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Mathis
authors.forename: Jordan C
authors.initials: JC
authors.lastname: Apfeld
authors.forename: Young M
authors.initials: YM
authors.lastname: Lee
authors.forename: A Alex
authors.initials: AA
authors.lastname: Jahangir
authors.forename: Jesse
authors.initials: J
authors.lastname: Ehrenfeld
authors.forename: William T
authors.initials: WT
authors.lastname: Obremskey
authors.forename: Manish K
authors.initials: MK
authors.lastname: Sethi
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D009141:Musculoskeletal System / Q000293:injuries*; D012189:Retrospective Studies; D013714:Tennessee / Q000453:epidemiology; D014193:Trauma Centers / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000601:surgery / Q000628:therapy