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.

To review the medium term results of acute repair of rupture of the biceps brachii insertion using a single incision bone anchor anatomical repair.

Three patients with acute biceps brachii tendon insertion ruptures and treated surgically using a single incision bone anchor anatomical repair underwent dynamometer strength assessment of both arms using a KinCom isokinetic dynamometer. This was performed shortly after completion of rehabilitation (7–12 months after surgery) and again at 3.3 years after surgery.

All patients were male (mean age 40.3 years, range 34 to 53). Surgery was performed less than 7 days post injury using the same technique. Isokinetic assessment was performed at a mean of 8.7 months post surgery (range 7 to 12 months) and again at assessment (maintained at medium term assessment). All patients had returned to their full premorbid occupation and level of sporting activity. Dynamometer results of a repaired dominant limb equated to approximately the strength of a normal non dominant limb, a repaired non dominant side equated to two thirds the strength of a normal dominant limb at early assessment. This relationship was maintained at the medium term assessment, however there was a substantial increase in strength in both affected and unaffected arms.

The one incision approach, using bone anchors, is recommended as the method of choice providing an optimal surgical repair with a reduction in the risk factors theoretically associated with anatomical surgical repair. Our short-term results are comparable with other quantitative results published (for both bone anchor and non-bone anchor procedure). The medium term results how a measurable increase in strength of the repaired limb although the strength relative to the uninjured side remains the same as at early assessment.