Surgeons want to counsel their patients accurately about the risks of rare complications. This is difficult for venous thromboembolism (VTE), as most studies report rates of asymptomatic disease. We calculated the rate of confirmed, symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) after elective lower limb surgery in our hospital.

We scrutinised referrals for venous Doppler ultrasound and computed tomography pulmonary angiography, identifying all cases of DVT or PE over an 18 month period. These patients were cross-referenced with our elective orthopaedic database and Healthcare Resource Group coding data.

Out of 1071 total hip replacements, there were three DVTs and two PEs, giving an incidence of 0.28% for DVT and 0.19% for PE. Out of 1351 total knee replacements, there were four DVTs and three PEs (incidence 0.29% and 0.22% respectively). Out of 1988 non-arthroplasty hip and knee procedures, there were no DVTs and two PEs (incidence 0.1%). For 1763 elective surgical foot procedures, there were five DVTs (incidence 0.28%), and no PEs.

Currently, Rivaroxaban is offered to patients undergoing hip and knee replacement surgery, but other patients do not receive anticoagulants routinely. Our low incidence of VTE supports this policy and is reassuring for surgeons.

An audit was carried out to assess the management of patients with fragility fractures in fracture clinic and primary care. NICE guidelines advise these patients require treatment for osteoporosis if 75 years or older, and a DEXA scan if below this age.

Distal radius and proximal humeral fractures were identified in a retrospective review of letters from 10 fracture clinics. Current medication of all patients ≥ 75 years was accessed and DEXA scan requests identified for patients < 75 years.

There were 69 fragility fractures: 53 distal radius and 16 proximal humerus. 4 letters (6%) mentioned fragility fracture and advised treatment and 3 (3%) correctly advised a DEXA scan. Only 3 of 25 (10%) patients ≥ 75yrs not previously on osteoporosis medication had treatment started by their GPs. 3 of a possible 29 (10%) patients < 75 years were referred for a DEXA scan.

A text box highlighting fragility fractures and NICE guidelines was added to all clinic letters for patient ≥ 50 years old. Re-audits showed an improvement in management of these fractures, with 45% of patients ≥ 75 years being started on treatment and 39% of patients < 75 years being referred for a DEXA scan.