Kwong JW, Miclau KR, Tapp E, Xiao A, Mulakaluri A, sALLud Research Consortium, Shapiro LM. Public Insurance and Language Preferences Are Associated with a Longer Time to Surgery for Distal Radius Fractures. Journal of the American Association of Orthopaedic Surgeons. 2025 [In Press]

This paper evaluates the association of clinical variables, demographic information, and social determinants of health on time to surgery for patients undergoing surgical fixation of distal radius fractures. In this cohort, we find that public insurance and speaking a language other than English were associated with significant delays in time to surgery. We hope that these variables continue to be studied and inform interventions to improve care disparities.

Garcia-Lopez E, Siu J, Kwong J, Schroeder N, Kamal RN, Shapiro LM. A Biomechanical Analysis of Oblique Metacarpal Meta-Diaphyseal Fracture Fixation in a Cadaver Model. J Hand Surg Am. 2024 [In Press]

This paper evaluates the biomechanical stability of various fixation constructs (k-wires vs intra-medullary devices) for the treatment of oblique metacarpal fractures. We demonstrate that noncompressive intramedullary fixation provides a biomechanically superior construct under axial loading compared with crossed K-wire fixation. We hope this investigation helps guide the treatment of metacarpal fractures.  

Gatto A, Atkin D, Tapia JC, Lowenberg M, Kamal RN, Shapiro LM. Implementation of an Electronic Health Record System During Global Surgical Outreach: A Prospective Evaluation of Success and Sustainability. World Journal of Surgery. 2024;48(7):1593-1601.

In this paper we evaluate the implementation of an electronic health record system during a surgical outreach trip in Cuenca, Ecuador. In this investigation, we demonstrate implementation success and sustainability of the electronic health record system for six months after the outreach trip. We hope this paper serves as a guide for those aiming to evaluate safety and quality at point of care and after surgical outreach trips.

Julian KR, Kwong JW, Leversedge C, Zhuang T, Schroeder N, Kamal RN, Shapiro LM. Goal Concordant Care: A Cross-Sectional Study Evaluating Correlates of Concordant Care and Association with Satisfaction and Outcomes. HAND NY. 2024 [In Press]

We aimed to evaluate if there is an association between goal concordant care, patient satisfaction, and patient experience in hand surgical care. We secondarily aimed to evaluate which factors are associated with goal concordant care. We demonstrate that while patients with lower income and those who preferred their care in a language other than English had more than three times the odds of receiving discordant care, concordance was not associated with patient satisfaction or experience. Hopefully this paper highlights the need for improved shared decision making and optimization of care delivery in these patient populations.

Welch JM, Kamal RN, Kozin SH, Dyer GSM, Katarincic JA, Fox PM, Shapiro LM. Clinical Practice Guidelines to Support Capacity Building in Orthopaedic Surgical Outreach: An International Consensus Building Approach. Journal of Bone and Joint Surgery [In Press].

We aim to develop clinical practice guidelines to support capacity building in orthopaeidc surgical outreach utilizing a multi-stakeholder, international voting panel. We validated 7 clinical practice guidelines to support capacity building initiatives. We hope these guidelines will be utilized and further iterated upon to support capacity building and improve the quality and safety of care delivered aboard.

Mulakaluri A, Julian KR, Fernandez A, Kamal RN, Shapiro LM. Are Clinical Practice Guidelines Representative of Patients with Distal Radius Fractures? A Review of Patient Demographics and PROMs Used to Inform Guidelines. J Hand Surg Am. 2024;10:S0363-5023(24)00148-5.

This paper evaluated the reporting of linguistic, racial and ethnic demographic characteristics of the literature utilized to inform the distal radius fracture clinical practice guidelines. We demonstrate that there is minimal reporting of such characteristics in the CPG informing literature. This paper highlights the need for improved and standardized reporting of demographic data and methods of PROM adaptation.  

Julian K, Mulakaluri A, Truong N, Fernandez A, Kamal RN, Shapiro LM. Are Orthopaedic Clinical Trials Linguistically and Culturally Diverse? A Systematic Review. JBJS Reviews. 2024; 12(5):e24.00012.

This paper evaluated the reporting of linguistic, racial and ethnic demographic characteristics of trial participants and the utilization of translated and culturally adapted PROMs in RCTs published in the top five highest impact factor orthopaedic journals. There is minimal reporting of such characteristics. This paper highlights the need for improved and standardized reporting of demographic data and methods of PROM adaptation.  

Siu J, Garcia-Lopez E, Pandya N, Feeley B, Shapiro LM. Are Patient-Reported Outcome Measures for Anterior Cruciate Ligament Injuries Validated for Spanish Language and Culture? A Systematic Review. Orthopaedic Journal of Sports Medicine. 2024;12(8):23259671241256413.

The purpose of this paper was to evaluate the quality and psychometric properties of Spanish-language adaptations of PROMs for patients with ACL injuries. We demonstrate a paucity of PROM instruments available to appropriately support the outcome measurement of Spanish speaking patients with ACL injuries. We hope this highlights the need for PROM tool development, adaptation, and validation in Spanish speaking patients.

Truong NM, Stroud SG, Zhuang T Fernandez A, Kamal RN, Shapiro LM. The Association Between Social Determinants of Health and Distal Radius Fracture Outcomes. J Hand Surg Am. 2024 Jun 24:S0363-5023(24)00201-6.

This paper aims to evaluate if social determinants of health are associated with differential complication rates following surgical fixation of distal radius fractures. We demonstrate that social determinants of health are associated with increased complication rates, even when controlling for demographic and clinical factors. We hope this study informs improvement initiatives to mitigate disparities and risk adjustment for outcome measurement.

Tankersley MP, Zhuang T, Julian K, Fernandez A, Kamal RN, Shapiro LM. Disparities in Treatment of Closed Distal Radius Fractures in Patients Aged 18-64 Years and ≥65 Years by Insurance Type. J Hand Surg Am. 2023;S0363-5023(23)00119-3.

We evaluated the association between insurance type and rate of surgery, time to surgery and complication rate for patients with distal radius fractures. In this cohort, patients with public insurance received differential treatment, undergo surgery in a delayed fashion, and in the younger cohort, have a higher rate of complications. We hope this study raises awareness regarding care disparities and lays the foundation for interventions to mitigate such care disparities.  

Lemos J, Xiao M, Castro Appiani LM, Katz P, Kamal RN, Shapiro LM. Are Patient-Reported Outcome Measures for Distal Radius Fractures Validated for Spanish Language and Culture? A Systematic Review. J Hand Surg Am. 2023;S0363-5023(23)00168-5.

The purpose of this paper was to evaluate the quality and psychometric properties of Spanish-language adaptations of PROMs for distal radius fractures. We demonstrate a paucity of PROM instruments available to appropriately support the outcome measurement of Spanish speaking patients with distal radius fractures. We hope this highlights the need for PROM tool development, adaptation, and validation in Spanish speaking patients.

Truong NM, Zhuang T, Leversedge C, Ma BC, Kamal RN, Shapiro LM. Medicaid Insurance is Associated with Treatment Disparities for Proximal Humerus Fractures in a National Database Analysis. Journal of Shoulder and Elbow Surgery. 2022;S1058-2746(22)00909-0.

In this study, we aimed to evaluate if insurance type was associated with treatment received, time to surgery, and complication in the treatment of proximal humerus fractures. In this cohort, we demonstrate differences in rates of surgery, time to surgery, and complication rates based upon insurance type. We hope this paper highlights opportunities for improvement initiatives to minimize insurance based disparities.