The homeless orthopaedic trauma patient: Follow-up, emergency room usage, and complications

OBJECTIVES: To review homeless patients with orthopaedic trauma injuries and examine their emergency room (ER) usage, follow-up rates, and complication rates. DESIGN: Retrospective chart review. SETTING: Patients presenting to a level 1 trauma center with orthopaedic trauma injuries from 2001 to 2010. PATIENTS/PARTICIPANTS: Sixty-three uninsured homeless patients and 63 uninsured nonhomeless patients with orthopaedic trauma injuries were included. INTERVENTION: Homeless patients with orthopaedic trauma were identified through ER intake sheets and current procedural terminology code searches. MAIN OUTCOME MEASUREMENTS: 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. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.