Theatre cancellation is unpleasant experience to patient and it is expensive to service provider. There are various causes for cancellation which are avoidable and unavoidable as well. Nationwide, there has been several measures put in place to reduce avoidable theatre cancellations. We describe retrospective review of 158 cancellations and root cause analysis & solutions in relation to the National standard. Retrospective review of all orthopaedic theatre cancellations, both elective and trauma cases, case notes & registry review as made for the period of 1st of August 2007 to 2005 to 31st of March 2009 in Bassetlaw Hospital. Data was collected and analysed.Introduction
Material & Method
✓ Closed Ankle Fracture ✓ Elderly or fragility fracture ✓ Minimal invasive ORIF
Seven patients found. Mean age: 78.2 M: F – 1:5 ASA CLASS: 3–4 All patients had ankle fracture with fragile or damaged skin. All operated within 10 days of injury, including those who were on warfarin or significant medical problems. All underwent closed reduction and or percutaneous medial malleolar fixation and stabilization of the lateral column with Rush Pin through a stab incision under x-ray control. A lightweight plaster was applied for 4–6 weeks. All fracture healed in a acceptable position without any skin complication. One patient who had pre operative ulcer also healed.
Rush pin fixation in fragility fracture is a useful and safe methods of treatment in selected group.
A modified Kessel trans-acromial approach has been utilised in our Unit for decompression and repair of associated rotator cuff tear for all advanced impingement syndrome (Stage III). This preliminary report aims to review our results, and to assess the complications of this approach. From 1996 to 1999, 22 consecutive patients who were treated surgically using a Trans-acromial approach for advanced impingement syndrome, were reviewed. The diagnosis of impingement syndrome was based on history, physical examination and Lignocaine impingement test, with either an ultrasound scan, arthrogram, or MRI. The modified trans-acromial approach was used involving splitting and raising a periosteal soft tissue flap over the acromion, followed by splitting the acromion in the coronal plane just behind the acromioclavicular joint, this allowed an extensive exposure of the rotator cuff and easy undercutting of the acromion. 20 patients were interviewed and examined specifically for this study, for an average follow up of 17 months. The other two patients were interviewed by telephone. The following parameters were studied: 1) functional assessment:[Constant’s Scoring system, and the UCLA Shoulder rating Scale. 2) Pain relief. 3) Patient satisfaction. 5) Return to preoperative activity. 6) Complication. The results were satisfactory in 17 patients (77%), and unsatisfactory in 5 pt (23%), one of which had cervical spondolysis, and two had new bony formation in the subacromial space. Pain relief was achieved in 78%. All patients returned to their preoperative occupation apart from one. Two patients had persisting impingement and had undergone revision subacromial decompression with satisfactory results. The modified trans-acromial approach is an acceptable alternative to open anterior acromioplasty. It offers adequate decompression of the sub-acromial space, allowing a wide exposure and excellent visualisation of the rotator cuff. This facilitates cuff repair and mobilisation, while maintaining the integrity of the deltoid muscle, which accelerates postoperative rehabilitation.
