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Retrospective studies using large databases serve a major purpose in providing evidence in the current literature. However, the quality of medical coding is highly variable. This retrospective cohort study aimed to evaluate the documentation regarding the diagnosis of heterotopic ossification (HO) and the implications it may have for conducting retrospective research using electronic medical records (EMRs). A retrospective chart review using the EMR was performed to identify all patients with a diagnosis of HO within 7 university-affiliated hospital facilities. A limited data set request was conducted for all patients with HO-specific International Classification of Diseases, Ninth Revision (ICD-9) codes and additional nonspecific musculoskeletal codes to capture patients with HO who were improperly coded. A total of 522 patients were identified—26 patients with specific HO codes and 496 patients with nonspecific codes. Imaging and clinical notes were inspected for evidence and location of HO, and histories were reviewed for traumatic injury mechanism. Two-thirds of the patients with HO were discovered by reviewing miscellaneous musculoskeletal ICD-9 codes. Thirty-eight percent of the patients with an HO-specific ICD-9 code had no evidence of HO in their EMR. Thirty-three patients had a clinical history of a traumatic injury preceding HO formation, but only 16 of the 33 had documented ICD-9 codes for the injury. The utility of databases in retrospective research is dependent on the integrity of the coding. This study questions the use of retrospective reviews for patients with uncommon diagnoses and shows how painstaking verification may be necessary to ensure that research conclusions are based on accurate data. [ Orthopedics. 2017; 40(4):237–241.]

Pseudoaneurysms are uncommon in patients with trauma, but can cause diagnostic difficulty and result in significant morbidity. Etiologies range from penetrating and nonpenetrating trauma to operative injury during fracture fixation, arthroscopy, total joint arthroplasty, and hardware loosening and removal. Pseudoaneurysms can conspicuously present as a pulsatile mass with an audible bruit, or as a subtly expanding hematoma. In either case, the complications can be serious if diagnosed late. The authors report a case of a pseudoaneurysm arising from the descending geniculate artery following a tibial plateau fracture. This was suspected following a slowly expanding hematoma and persistent anemia refractory to transfusion. Computed tomography angiography was used for confirmation. Successful treatment was accomplished with embolization, surgical evacuation of the hematoma, delayed skin grafting, and fracture fixation. The postoperative outcome was satisfactory, with complete wound healing, functional but decreased range of motion, normal perfusion distal to the injury, and the sole report of mild intermittent knee pain. [ Orthopedics. 2017; 40(1):e188–e191.]

As nonfatal firearm-related injuries continue to increase, calculating the financial cost these injuries have on an urban trauma center may help justify funding for intervention programs. The impact these injuries have on orthopedic resident education may lead to changes in the training of some urban-based programs. This is a retrospective review of patients with an acute firearm-related injury from 2007 to 2013 at Louisiana State University Interim Public Hospital in New Orleans, Louisiana. All patients with a diagnosis of an acute gunshot wound on presentation to the emergency department were included in the study. Patients with complications from a previous gunshot wound or treatment of that wound were excluded. A total of 3617 patient encounters were identified that met this criteria. The total amount billed by the hospital over the study period was $141,995,682 while collecting $30,922,953. The actual hospital costs from these encounters was $73,572,892, giving the hospital a loss of $42,649,938. Of the 3617 patient encounters, 59% required orthopedic consultation. Of that consultation group, 25% required inpatient orthopedic surgical intervention. Acute gunshot wounds accounted for 23% of orthopedic trauma consultations and 13% of the orthopedic daily census. The financial data provide justification from an economic perspective for funding intervention programs aimed at decreasing firearm-related injury. In addition, the proportion of orthopedic surgical training spent on firearm-related injury provides program directors of urban-based programs with valuable information, although no conclusions can be drawn as to the effect on orthopedic surgical education. [ Orthopedics. 2016; 39(1):e57–e61.]