Introduction and Objectives: Our aim is to study the effects of these two factors on functional recovery of patients undergoing surgery for extracapsular hip fracture. Materials and Methods: A multi-centre study involving 3 hospitals was done on 163 patients presenting with extracapsular hip fractures who were treated using IMHS sliding nail/screws. Six months of postoperative follow-up was done to evaluate Charlson’s index comorbidity, pre-fracture functionality,and postoperative functionality at 3 and 6 months using Parker and Palmer’s test and the hospitalization index. Functional progression was evaluated in terms of comorbidity using comparison of means. To study the impact of hospitalisation, a comparision of mean scores for hospitalised and non-hospitalised patients was performed. Results: The final analysis was done using data from 127 patients. Of this sample, 109 patients were not hospitalised before the fracture, and 18 had been hospitalised. There were no significant differences in average Charlson’s index scores between hospitalised and non-hospitalised patients. Functionality at 3 months was 3.97 for non-hospitalised patients and 2.0 for hospitalised patients; at 6 months scores were 4.56 for non- hospitalised patients and 2.38 for hospitalised (p< 0.005). Patients with a Charlson score greater than 2 had a loss of function of 2.16 points at 3 months and 1.58 at 6 months (p< 0.005). Patients with a Charlson score less than or equal to 2 had a functional loss of 1.82 points at 3 months and 1.26 at 6 months (p< 0.005). Discussion and Conclusions: Hospitalised patients had greater loss of function than non-hospitalised patients, independent of their previous health status. Patients with greater comorbidity had greater loss of function compared to patients with less severe previous pathology

Increasing incidence of osteoporosis, obesity and an aging population have led to an increase in low energy hip fractures in the elderly. Perceived lower blood loss and lower surgical time, media coverage of minimal invasive surgery and patient expectations unsurprisingly have led to a trend towards intramedullary devices for fixation of extracapsular hip fractures. This is contrary to the Cochrane review of random controlled trials of intramedullary vs extramedullary implants which continues recommends the use of a sliding hip screw (SHS) over other devices. Furthermore, despite published literature of minimally invasive surgery (MIS) of SHS citing benefits such as reduced soft tissue trauma, smaller scar, faster recovery, reduced blood loss, reduced analgesia needs; the uptake of these approaches has been poor. We describe a novel technique one which remains minimally invasive, that not only has a simple learning curve but easily reproducible results. All patients who underwent MIS SHS fixation of extracapsular fractures were included in this study. Technique is shown in Figure 1. We collated data on all intertrochanteric hip fractures that were treated by a single surgeon series during period Jan 2014 to July 2015. Data was collected from electronic patient records and radiographs from Picture Archiving and Communication System (PACS). Surgical time, fluoroscopy time, blood loss, surgical incision length, post-operative transfusion, Tip Apex Distance (TAD) were analyzed. There were 10 patients in this study. All fractures were Orthopaedic Trauma Association (OTA) type A1 or A2. Median surgical time was 36 minutes (25–54). Mean fluoroscopy time was similar to standard incision sliding hip screw fixation. Blood loss estimation with MIS SHS can be undertaken safely and expeditiously for extracapsular hip fractures

Introduction: Despite advances in surgical and anaesthetic techniques the mortality after hip fracture has not significantly changed in the last 40 years. Pre-operative anaemia is a risk factor for peri-operative death. We speculate that a significant proportion of the blood loss related to hip fracture has occurred prior to surgery. Identifying patients at risk of pre-operative anaemia can facilitate appropriate medical optimisation. This study is unique in its attempt to quantify the blood loss associated with the initial hip injury. Methods: In a retrospective study over 12 months all patients with both a diagnosis of hip fracture and an operative delay of > 48 hours were assessed. The information collected included: fracture classification, serial haemoglobins and patient comorbidities. The exclusion criteria included a pre-injury diagnosis of anaemia and gastrointestinal bleeds. Results: 68 intracapsular and 50 extracapsular hip fracture patients had serial haemoglobins and operative delays of > 48hrs (mean 75hrs, range 48–270hrs). The mean lowest recorded haemoglobin prior to surgery for both extracapsular and intracapsular fractures were 95.0 g/L (+/−SEM 2.2) and 108.5 g/L (+/−SEM 2.2) respectively. The difference was statistically significant (Students t-test p< 0.05). The mean haemoglobin drop for male and female patients with extracapsular hip fractures were 15.0 g/l (range 0–40 g/l) and 19.3 g/l (range 0–49 g/l) respectively and the mean haemoglobin drop for male and female intracapsular fracture patients were 10.2 (range 0–59 g/l) and 10.5 g/l (range 0–41 g/l) respectively. Conclusions:. Hip fracture patients have a large drop in haemoglobin that is likely to be associated with the initial trauma. Patients with extracapsular fractures demonstrate a greater haemoglobin loss than those with intracapsular fractures. This highlights the need for anaesthetic and orthopaedic staff to be vigilant to the risk of pre-operative anaemia in this cohort of frail patients

Introduction. Debate still exists as to the optimum method of fixation for subtrochanteric femoral fractures. Meta-analysis of studies comparing cephalocondylic nails with extramedullary implants for extracapsular hip fractures have suggested that further investigation is required in this area. We present the outcome of the largest series to date of subtrochanteric fractures treated by both methods and with a minimum of one year follow-up. Methods. 244 patients with a subtrochanteric femur fracture were treated at one centre over a 21 year period were prospectively studied. 75 were treated with an extramedullary fixation implant and 168 with an intramedullary nail. Surviving patients were followed up till one year from injury. Results. The mean age of patients was 74 and 71% were female. Fixation failure requiring revision surgery occurred in 4% of those treated with an extramedullary implant and 6% of those treated with an intramedullary nail, a difference that was not statistically significant. Length of surgery was similar for both operations but transfusion requirements were less for those treated by the intramedullary nail (p<0.0001). No notable differences in other outcomes were found. Discussion. In summary both intramedullary and extramedullary fixation produce comparable outcomes for this fracture

Cerebral micro emboli have been noted to occur during both total hip and knee arthroplasty. These micro emboli have been implicated in the causation of postoperative cognitive impairment. The aim of this study was to determine whether cerebral micro emboli occur during hip fracture surgery. 28 patients undergoing hip fracture surgery had transcranial doppler assessment of the middle cerebral artery to detect cerebral micro emboli. Micro embolic signals (MESs) were recorded during the operative procedure. Successful monitoring was carried out in 26 patients. MES were recorded in 16 out of 26 patients. 12 out of 16 patients who had MESs had undergone a cemented hemiarthroplasty; the remainder had a sliding hip screw for an extracapsular hip fracture. 75% (9/12) of patients who had a cemented hemiarthroplasty had the majority of MESs after reaming and cementing. MESs in the patients who had a sliding hip screw occurred throughout the operative procedure. Conclusion: Cerebral micro emboli do occur during hip fracture surgery. These emboli may be responsible for the cognitive dysfunction that occurs in this susceptible group of patients

Introduction and Aims: Cerebral micro emboli have been noted to occur during both total hip and knee arthroplasty. These micro emboli have been implicated in the causation of post-operative cognitive impairment. The aim of this study was to determine whether cerebral micro emboli occur during hip fracture surgery. Method: Twenty-eight patients undergoing hip fracture surgery had transcranial doppler assessment of the middle cerebral artery to detect cerebral micro emboli. Micro embolic signals (MESs) were recorded during the operative procedure. Results: Successful monitoring was carried out in 26 patients. MES were recorded in 16 out of 26 patients. Twelve out of 16 patients who had MESs had undergone a cemented hemiarthroplasty, the remainder had a sliding hip screw for an extracapsular hip fracture. Seventy-five percent (9/12) of patients that had a cemented hemiarthroplasty, had the majority of MESs after reaming and cementing. MESs in the patients that had a sliding hip screw occurred throughout the operative procedure. Conclusion: Cerebral micro emboli do occur during hip fracture surgery. These emboli may be responsible for the cognitive dysfunction that occurs in this susceptible group of patients

Background: Cerebral micro emboli have been noted to occur during both total hip and knee arthroplasty. These micro emboli have been implicated in the causation of post-operative cognitive impairment. The aim of this study was to determine whether cerebral micro emboli occur during hip fracture surgery. Method: 28 patients undergoing hip fracture surgery had transcranial doppler assessment of the middle cerebral artery to detect cerebral micro emboli. Micro embolic signals (MES’s) were recorded during the operative procedure. Results: Successful monitoring was carried out in 26 patients. MES were recorded in 16 out of 26 patients. 12 out of 16 patients who had MES’s had undergone a cemented hemiarthroplasty the remainder had a sliding hip screw for an extracapsular hip fracture. 75% (9/12) of patients that had a cemented hemiarthroplasty, had the majority of MES’s after reaming and cementing. MES’s in the patients that had a sliding hip screw occurred throughout the operative procedure. Conclusion: Cerebral micro emboli do occur during hip fracture surgery. These emboli may be responsible for the cognitive dysfunction that occurs in this susceptible group of patients

While hidden blood loss has been shown to occur in hip fractures the timing and cause have not yet been demonstrated. This study investigated the degree of pre-operative blood loss within the first 24hrs after intertrochanteric hip fracture. 188 patients with extracapsular hip fractures had their full blood count taken on admission and after 24 hours. The haemoglobin (Hb) and haematocrit (Hct) were noted at each time. Fractures were grouped as undisplaced or displaced. Those who were operated on prior to the 24hr blood sample were excluded. All patients with intracapsular or sub-trochanteric fractures were excluded, as were any who received a blood transfusion prior to their 24hr blood sample being taken. The tests for differences between blood samples and the existence of displacement were performed using paired and independent Student’s t-test. The level of significance was set at P< 0.05. All data was analysed using SPSS statistical software version 11. The overall fall in the Hb within 24hr was significant (1.6 g/dl, P< 0.001), as was the fall in the haematocrit (0.05, P< 0.05). Displaced fractures had a significantly lower Hb at 24hrs than undisplaced (10.6g/dl vs 11.8 g/dl, P=0.001). The fall in Hb was significantly greater in displaced fractures compared to undisplaced (1.7g/dl vs 1.2g/dl, P< 0.05). Changes in the Hct mirrored those of the Hb. This study identified a significant blood loss that occurs within the first 24hrs after an intertrochanteric hip fracture, prior to theatre. The cause is unlikely to be secondary to dehydration as the Hct fell with the Hb. Thus the most likely cause is the trauma itself. The admission Hb is possibly an inaccurate measure of the true value and patients may be more shocked than first thought. A more liberal resuscitation policy may be warranted

Aims

To identify factors influencing clinicians’ decisions to undertake a nonoperative hip fracture management approach among older people, and to determine whether there is global heterogeneity regarding these factors between clinicians from high-income countries (HIC) and low- and middle-income countries (LMIC).

Aims

Patients with A1 and A2 trochanteric hip fractures represent a substantial proportion of trauma caseload, and national guidelines recommend that sliding hip screws (SHS) should be used for these injuries. Despite this, intramedullary nails (IMNs) are routinely implanted in many hospitals, at extra cost and with unproven patient outcome benefit. We have used data from the National Hip Fracture Database (NHFD) to examine the use of SHS and IMN for A1 and A2 hip fractures at a national level, and to define the cost implications of management decisions that run counter to national guidelines.

Aims

The primary aim of this study was to determine the rates of return to work (RTW) and sport (RTS) following a humeral shaft fracture. The secondary aim was to identify factors independently associated with failure to RTW or RTS.

Aims

Our rural orthopaedic service has undergone service restructure during the COVID-19 pandemic in order to sustain hip fracture care. All adult trauma care has been centralised to the Royal Shrewsbury Hospital for assessment and medical input, before transferring those requiring operative intervention to the Robert Jones and Agnes Hunt Orthopaedic Hospital. We aim to review the impact of COVID-19 on hip fracture workload and service changes upon management of hip fractures.

Things have not been quiet in the Cochrane Collaboration in the four months since the last 'Cochrane Corner', with the publication of six new or updated reviews summarised here, all conducted with the bulletproof Collaboration's methodology representing the pinnacle of evidence relevant to orthopaedic surgeons.