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Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_31 | Pages 19 - 19
1 Aug 2013
Dolan R Burns L Lindsay J
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Utilization of nerve conduction studies in the investigation and management of carpal tunnel syndrome varies according to their perceived usefulness and availability. The use of steroid injections and splinting also varies according to service availability and their perceived effectiveness. We present a three year follow up of 230 patients managed in an environment where nerve conduction testing was not readily available. The majority received splinting and a steroid injection in an effort to manage their symptoms conservatively in the first instance.

Our results show that a clear majority of patients who were treated with initial splinting and steroid injections saw a recurrence of their symptoms (71.9% and 79.7% respectively) requiring eventual surgical decompression. These results would seem to suggest that conservative management of carpal tunnel does not produce the desired curative results and that there may be an argument for proceeding directly to surgery.

We also showed that 55% of patients referred for Nerve Conduction Studies seem to progress to surgical decompression. This would seem to suggest that Nerve Conduction Studies could form a robust part of the standard investigation of carpal tunnel in order to identify those who would benefit from surgery.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_31 | Pages 11 - 11
1 Aug 2013
Harding T Dolan R Hannah S Anthony I Halifax R Brooksbank A
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Aims

Isolated greater tuberosity fractures make up 17–21% of proximal humeral fractures, 30% are associated with shoulder dislocation. Conservative management of minimally displaced fractures (<5 mm) is recommended. There are few guides to which and how many fractures displace over time.

Methods

A retrospective analysis of isolated greater tuberosity fractures presenting to a shoulder fracture clinic over 1 year was performed. Patients were identified from shoulder fracture clinic lists and a bluespier database. Radiological fracture displacement was measured from the edge of the defect in the humeral head to the closest edge of the greater tuberosity. All measurements were performed by three oberservers on two occasions. Data was analysed to study the relationship between initial displacement and fracture stability and between concurrent dislocation and fracture stability. Inter-observer analysis was performed.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_31 | Pages 47 - 47
1 Aug 2013
McLean M Dolan R Jack E Hendrix M
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The Caledonian Technique TM has been widely accepted as a safe and effective way of improving post-operative recovery and reducing length of stay following total knee arthroplasty. In keeping with the principles of the enhanced recovery programme its use has slowly spread from specialised units into district general hospitals. There is little evidence using PROMs that supports the use of the Caledonian Technique in the DGH setting. The primary aim of this study was to find out whether the Caledonian Technique was being successfully implemented in this district general setting for TKA. The secondary aim was to identify whether there was a difference in the patients’ perspectives of success post discharge.

This is a prospective questionnaire-based cohort study of patients undergoing total elective TKA in this DGH. It was carried out at Forth Valley Royal Hospital, Larbert, Scotland between June 2011 and 2012. All patients undergoing elective TKA were asked to complete a questionnaire assessing pain, mobilisation, function and satisfaction at 6 weeks post-operatively. Case notes of all returned questionnaires were reviewed and surgeon, protocol followed (Caledonian or non-Caledonian), length of stay, analgesic requirements, discharge analgesia and complications recorded.

We have shown that length of stay, analgesic requirement and cost were all less in the Caledonian group (n=17) compared to non-Caledonian (n=17). In addition there were statistically significant increases in patients mobilising on day 1 and achieving opiate free discharge in the Caledonian group. Patient satisfaction was higher in 11 out of 12 PROMs post discharge.

This confirms that previously shown improvements in length of stay and early mobilisation seen in specialised units can also be achieved in the DGH setting. Secondly it also shows that there is no negative impact on patient satisfaction and outcomes following early mobilisation and discharge.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_30 | Pages 13 - 13
1 Aug 2013
Klenka S Dolan R
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Collection of new data for the Scottish hip fracture audit stopped in December 2008. The proposed standard of operating on 98% of all hip fractures within 24 hours of admission, subject to medical fitness and during safe operating hours should now be maintained.

Methods

We prospectively collected data from 102 consecutive hip fracture patients documenting the patient's journey from admission to discharge from the orthopaedic ward to look at whether the standard had been maintained.

Results

50% of patients get to theatre 24hrs or earlier with 60% catheterised perioperatively.50% of patients were moved from the acute orthopaedic facility at a week with less than 20% of these getting back to their usual place of residence. 25% were still on the acute ward at two weeks and 3% died in the immediate post operative period. However, the number of co-morbidities did not seem to correlate with time to discharge. The majority of patients transferred to onward care moved to the geriatric rehabilitation ward within the hospital.

Prioritisation of hip fracture patients on the trauma list needs to be continued along with improvements in the availability of rehabilitation beds. Pre-operative medical work up for patients with reversible illness and post-operative geriatric care will improve the outcomes for these frail patients.