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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 23 - 23
1 Jun 2012
INTRODUCTION OF EGGSHELL TECHNIQUE MINIMISED THE INCIDENCE OF CEMENT LEAK DURING PERCUTANEOUS BALLOON KYPHOPLASTY PROCEDURES
Sidaginamale RP Gunaratne M Fadero P Kotrba M
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Purpose

To evaluate the complications following percutaneous balloon kyphoplasty and assess the advantage of introducing eggshell technique.

Methods and Results

We performed 138 Balloon kyphoplasty procedures in 85 patients during august 2007 to march 2010. Data was collected and analyzed in all these cases. Gender distribution was 60 females and 25 males. Age distribution was 33 to 85 years, with an average age of 67.4 years. Indications of surgery were vertebral fractures due to osteoporosis in 81% of the procedures, trauma in 13% and malignancy in 6%. The most common vertebral levels of the kyphoplasty were at T12 in 32 procedures (23%) and L1 in 28 procedures (20%). Eggshell technique was introduced in 2009 where technical problems were encountered during cementing process.

All patients had reduced pain levels, which was assessed by visual analog score. The average length of hospital stay was 2.5 days. Complications were 9 (6.5%) cement leaks (all within one cm from the vertebral body) in procedures performed before the introduction of eggshell technique and no cement leak following the introduction of eggshell technique, 5 (3.6%) fresh fractures, 2 (1.4%) intra-operative fractures and 1 (0.73%) rupture of balloon. There were no complications of cord compression, motor deficit, infection, allergy to cement or pulmonary embolism noted. 30-day mortality rate was zero.

Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 397 - 397
1 Jul 2010
IMPROVING CARE OF PATIENTS WITH FRACTURED NECK OF FEMUR AT MAYDAY UNIVERSITY HOSPITAL: EARLY RESULTS FROM THE TRAUMA PATHWAY GROUP
Grant O Diggory P Fadero P Howell G Kashif F Nunn G
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Introduction: It is well established that prompt medical management and early surgery for patients with fractured neck of femur has been shown to reduce mortality and reduce hospital length of stay. A Trauma Pathway Group (TPG) was established at Mayday Hospital, in August 2007 to assess local practises and to implement improvements, led by senior clinicians in Orthopaedics, Anaesthetics and Orthogeriatrics, and liaising with senior hospital managers within the trust. Here we present results after one year of the TPG.

Means and methods: We reviewed all patients admitted to Mayday with a fractured neck of femur over 60 years of age at admission between 1st October 2006 and 31st September 2007 (prior to the TPG) and between 1st October 2007 and 31st September 2008 (after the TPG).

We compared these two groups, focussing on pre-operative delays, length of stay in hospital and in-hospital mortality.

Results: There were 185 patients admitted to Mayday University Hospital between 1st October 2006 and 31st September 2007, and 212 between 1st October 07 and 31st September 2008. The average age of patients admitted was 83. 75% were female. There was no significant difference in mean age or sex between the two groups. The mean wait for surgery was reduced from 4.3 days to 1.3 days (p< 0.001). The mean length of stay was reduced from 33.5 days to 26.2 (p< 0.005). The in-hospital mortality was not significantly altered - 14.6% in the first year, and 16.0% in the second.

Discussion: The TPG has had a significant impact on the management of patients with fractured neck of femur. Our figures and feedback from staff and patients has been positive, and the work has increased the prominence of the care of these patients, so has enabled us to significantly improve the care of this extremely vulnerable group.