Aim and objectives of the study: To assess the true incidence and reasons for readmission after fracture neck of femur treatment and its effect on Trust star rating.

Introduction: Star ratings (zero to three) show how well a Trust is performing and is awarded against a set of performance indicators (Patient Focus, Capacity and Capability Focus and Clinical Focus) as laid by CHAI

These indicators cover the standards and outcomes of treatment given.

CHAI reports 9% readmission as an emergency within 28 days, and assumes that a proportion of the observed readmissions are potentially avoidable.

Materials and Methods: An audit done by the managers found 15 (19%) cases of readmission of fracture neck of femur during April to October 2004. We did Re audit by reviewing the exact cause for readmissions in all the cases.

Results: Out of 15 cases identified by the managers only 4 (5.19%) were true readmission, which is below the national average.8 readmissions were for medical reasons, 3 for social reasons and rest 4 were related to fracture complications like infection.

Conclusion: Star ratings (zero to three) reflect Trust performance and are awarded against a set of performance indicators, which cover the standards, and outcomes of treatment given (Patient Focus, Capacity and Capability Focus and Clinical Focus) as laid by CHAI.

We conclude that audit should be done as a team-work involving all responsible health care professionals and proper uniform coding system needs to be followed to obtain correct results.

Materials & Methods: A retrospective study. 25 cases of fracture Calcaneum during April 2001–2004 were reviewed for their clinical outcome.

Aim of the study: To assess the clinical and functional outcome of the Management of Intra and Extra articular Calcaneal fractures in district general hospital.

Results: 22 male and 3 female. Intraarticular fractures 15 (60%)of which 10 were displaced and 5 undisplaced.

Extraarticular were 10 (40%) of which displaced and undisplaced were 5 each. Fall from height was seen in 20 (80%)patients. Associated injuries was seen in 10(40%) patients of which 8(32%) of them had fracture spine. All the cases of intaarticular fractures had C.T. scan.

The final outcome all the fractures treated conservatively were good. Fractures underwent ORIF had better outcome and more complication rate as compared to conservative treatment.

Conclusion: Commonest mode of injury is fall from height and associated injury incidence is usually high.

Even the undisplaced intraarticular fractures of calcaneum do develop residual stiffness and difficulty in walking on uneven ground.

Displaced fractures needs fixation for better results and facilitation for secondary operations.

Wound infection, stiffness and deformity are known complications.

In this small audit all three group did develop stiffness and we recommend a bigger, independent audit.

Aim: To evaluate the effect of Warfarin, the prevalence of acceptable level of INR by the anaesthetist, leading to delay of surgery in patients with fracture neck of femur and the outcome of such treatment.

Material and Methods: We retrospectively reviewed all patients admitted with fracture neck of femur who were on Warfarin in the year 2002. In total 9 out of 135 pt were on Warfarin.

Their entire medical records were scrutinised.

A control group of similar age, sex and pre- morbid conditions was identified.

A telephone survey was then conducted

In warfarin group average delay in surgery was 4 days (1 to 7) , needed 76% more blood test, total morphine 40mg and Codeine 960mg, 60% longer stay and after all 78% had General anaesthesia.

The six hospital survey showed the estimated number of such patients averaged 2 (1 to 4) per year, delay in surgery of 2 to 5 days and acceptable INR between 1.5 to under 3.

Conclusion: We found that we under estimate the number of patients on Warfarin. These patient had a significant delay in surgery requiring more analgesic both oral and parental, no significant post- op complications but a much longer hospital stay causing significant increase in morbidity, bed block and expenditure. We were surprised that there is no consistently acceptable level of INR to perform the surgery and type of anaesthesia.