Our study is to evaluate a new scheme designed to treat at home patients with Prolonged Leakage from wounds after lower limb arthroplasty

A prospective study of a 258 patients with leaking wounds after lower limb arthroplasty was conducted between August 2002 and February 2005. Each patient assessed, if meet the criteria entered the discharge scheme. A trained nurse visited each patient daily to provide wound care. The scheme could accommodate a maximum of 5 patients at any time. If the wound showed signs of infection the treating team was contacted and patient reviewed and treated if appropriate. For each patient Clinical data was collected including personal details, referral details, medical history and their progress. A satisfaction questionnaire was given at the completion of treatment.

Of the 324 patients referred to the scheme, 258 were accepted. 66 refused because the service was full (17), the wound was dry on assessment (6), failed the criteria (16), and patients declined the scheme (27). The average age was 67 years (16–93), 19 (8%)of patient readmitted to hospital, 14(6%) related to wound problems non required further surgery. The average number of home visits were 6, 5% of the patients called for advice. The number of bed days saved assessed as from the day of discharge from hospital to the date wound dry was 232 days. The response rate to questioners was 98%; all patients describe the service as excellent or good.

We concluded that the majority of leaking wounds after lower limb arthroplasty are self-limiting problems. The service provided an excellent way of treating patients at home and resulted in a major increase of available beds for little cost.

We conducted a retrospective analysis of all elective Paediatric Orthopaedics referrals during the period 1998–1999 made by general practitioners to one of the two Paediatric Orthopaedic consultants in a moderate sized district general hospital serving a population of approximately 300, 000 with a delivery rate of approximately 3000 live births per year. This study was taken with a view to assess the spectrum of elective Paediatric Orthopaedic referral quality of work generated and to find out the final outcome and hence try to improve resource utilisation. We found out that majority of cases (85%) needed simple assurances or supportive measures, a task that can be easily shared by a trained clinical assistant along with the consultant and routine clinical cases are not adequately covered in Paediatric Orthopaedics courses for trainees.

During 1999, a total of 120 new elective Paediatric Orthopaedic referrals from GPs were seen in 600 bedded district general hospital by one of the Paediatric Orthopaedics consultants out of the 2 in the hospital. Case notes were analysed for age of patient, sex, joint affected, reason for referral, diagnosis made and the outcome following consultation. The outcome was measured in the form of whether the patient had an operation, was referred to Physiotherapy, orthotics, kept under observation (include masterly inactivity), referred to other subspecialty or reassured and discharged. Mean age of presentation was 7. 8 years and there was near equal presentation of boys and girls. Maximum cases were referred for knee problems 32 (26. 67%), hip 28 (23. 33%), foot 18 (15%), general 18(15%).

Majority of patients referred need simple assurance to parents and majority of patients seen in Clinics need no operation (85%), indicating that Orthopaedic Surgeons need to spend more time on reassuring parents than on operation, a task that can be easily shared by a trained Clinical Assistant.