Success treating AIS with bracing is related to time worn and scoliosis severity. Temperature monitoring can help patients comply with their orthotic prescription. Routinely collected temperature data from the start of first brace treatment was reviewed for 14 patients. All were female with an average age of 12.4 years (range 10.3–14.6) and average 49o Cobb angle (30–64).

Our current service recommendation is brace wear for 20 hours a day. Patients complied with this prescription 38.0% of the time, with four patients averaging this or more. Average brace wear was 16.3 hours per day (3.5–22.2).

There were 13 patients who had completed brace treatment. The majority had surgery (7/13; 54%) or were considering surgery (1/13; 8%). There were 5 who did not wish surgery at discharge (5/13; 38%); 1 achieved a 40o Cobb angle, with 4 larger (53o;53o;54o;68o). The Bracing in AIS Trial (BrAIST) study measured “success” as less than a 50o Cobb angle, so using this metric our cohort has had a single “success”.

Temperature monitors allowed an analysis of when patients were achieving their brace wear. When comparing daywear (8am-8pm) to nightwear (8pm-8am), patients wore their brace an average of 7.6 hours a day (2.5–11.2) and 8.7 hours a night (0.4–11.5).

We conclude the minority of our patients comply with our current 20 hour orthotic prescription. The “success” of brace treatment is lower than comparison studies despite higher average compliance but starting with a larger scoliosis. Brace wear is achieved during both the day and night.

The arrival of major trauma centres (MTC) to Scotland highlights the need for structured management of polytrauma patients. The aim was to report the epidemiological profile of polytrauma patients (Injury Severity Score (ISS) 15) admitted to a large trauma unit in the UK and gather information about the initial management of this severely injured cohort.

Prospectively collected data from the Scottish Trauma Audit Group (STAG) database of 366 polytrauma patients (ISS <15 & aged ≥13 years) admitted to a single trauma unit, from 1st January 2013 to 31st October 2017 was analysed. Data included patient demographics, injury characteristics, length of stay (LOS) and survivorship.

The median age was 49 years (range 13–93) and females made up 31.1% of the population. There was a mean ISS of 25.7 (range 15–75) and mean LOS of 19 days. The overall mortality rate was 21%. Higher mortality occurred among females (p<0.001), patients ≥60 years age (p<0.001), patients who sustained their injury at home (p<0.0001), and those with head injuries (p<0.01). Orthopaedic injuries were present in 187 patients (51.1%) with a mortality rate of 10.7%. The most common mechanism of injury was road traffic collision (41.5%) and these patients had a significantly higher ISS (p<0.01). A fall from height <2m was associated with higher mortality (p=0.01).

This study is the largest of its kind and presents a detailed epidemiological profile of patients attending a large UK trauma unit. This knowledge will help guide initial management and aid in resource and capacity planning for the future.

Study Design: A retrospective analysis of prospectively collected data on 18 consecutive patients undergoing en bloc resection of primary bronchogenic tumours that locally invaded the adjacent spinal column with a minimum of 12 months follow-up.

Objectives: To report on operative details, outcome scores, survival and satisfaction in this group of patients.

Summary of Background: Primary thoracic tumours with direct spinal extension have traditionally been regarded as being unresectable and thus, associated with a poor prognosis. However, en bloc surgery is now emerging as being the goal of primary tumor surgery offering the best results for survival.

Methods: We reviewed 18 consecutive patients undergoing concomitant lung and vertebral resection performed by a combined team of an orthopedic surgeon and a thoracic surgeon during 2002–2006. All patients had negative staging for systemic disease (T4 N0 M0).

Results: Mean age of patients was 62.5 +/−11.6 years (33–76 years) with a mean follow-up of 26.1 months (13–60 months). Seven patients had a one-stage procedure and 11 had en bloc resections in two stages. Mean length of operation was 995.8 minutes (280–1965 minutes). Mean estimated blood loss was 5425.8 mls (1430–12830 mls). Mean length of hospital stay was 31 days (range 9–122 days). In total, an average of 3.0 (range 2–4) vertebrae were resected – two patients had a partial vertebrectomy, 10 had a hemivertebrectomy, 2 had a total vertebrectomy and 4 had a combination. Three patients had a ‘palliative’ procedure as a result of local tumour invasion (around the great vessels and dura). The remaining 15 patients were operated with ‘curative’ intent.

The ODI (Oswestry Disability Index) score was 27.4 (+/−13) preoperatively and 42.2 (+/−10.9) post operatively (p=0.004). The scores for SF-36 (Short Form-36) were 34.0 (+/−10.9) preoperatively and 29.7 (+/−6.3) post-operatively (physical component summary; p=0.3); 39.2 (+/−7.9) preoperative and 40.6 (+/− 14.9) postoperative (mental component summary; p=0.85).

There were 6 major complications (1- wound break-down, 3 – required extended respiratory support of which 1 required thoracotomy for lung re-expansion, 1- developed severe distal junctional kyphosis requiring revision, 1 – recurrent laryngeal palsy needing thoraco-plasty) and 3 minor (2- dural tears, 1-chyle leak).

The survival in the ‘curative’ group was 10/15 (67%) with a mean follow-up of 27.3 months; five patients died at a mean of 115 days (86–129 days) due to respiratory complications. All ten surviving patients reported that they were satisfied/very satisfied with surgery. The survival in the ‘palliative’ group was 192 days (48–360).

Conclusions: There is a significant complication rate following en-bloc tumour surgery (> 50%), but curative resections are achievable at the expense of pain and function.