Introduction

The aim of the study was to analyze the outcome of AO cannulated screws for fractures neck of femur at our institute.

The Ilizarov technique can be used to achieve bony union in high energy trauma and in non-union. There is much interest in the augmentation of bone healing using growth factors, GPS II collects the patients own platelets into a highly concentrated formula. Activated platelets release growth factors that may stimulate fracture healing.

We used the GPS II system in 13 cases of either high-energy trauma (2 cases) of non-union (11 cases) treated with the Ilizarov Circular frame in our institution. The group included two tibial fractures, eight tibial, one femoral and two ulnar non-unions. The minimum follow up of a year. The average age of the patient was 45 (22–66). We observed complications and measured time to clinical and radiological union from the start of treatment with circular frame.

No complications associated with GPS. One patient had an infection remotely in the limb resulting in amputation. All fractures and non-unions went on to solid bony union. The average time to radiological union was 21 weeks (range 13–36 weeks). Frame removal in these cases was 6.5 months (range 4–10 months). No patient underwent any further surgical intervention.

This pilot study features a heterogenous group of patients in which it is difficult to assess the role of GPS II. The use of GPS II, however, was uncomplicated in our study. The use of GPS II may act as a adjuvant therapy in the treatment of high energy trauma and non-union treated with the Ilizarov technique. Furthers studies are required to investigate the efficacy of GPS II in the management of non-union.

Introduction: The aim of the study was to analyze the outcome of AO cannulated screws for fractures neck of femur in patients with Diabetes mellitus.

Methods: of study: 62 patients aged 50 years or more (17 males & 45 females) who underwent AO screws for fracture neck of femur over 7 yrs (1999–2005) and followed-up for a minimum of 2 yrs formed the study population. A retrospective review of data from electronic patient record (EPR), clinical coding, clinic & GP letters was made. Age, residential placement, Garden’s classification of fracture, mode of injury, associated other co morbidities, pre-admission mobilisation status, allergies, addictions and anticoagulation status details were collected. An in depth study was conducted to look into delays for surgery, length of stay in hospital, complications and treatment of these complications. Reasons for re-admissions, re-operations and comorbidities developing as a result of these interventions were critically analysed. Post-op physiotherapy, proportion of patients sustaining contra-lateral fracture NOF & its management and mortality statistics were reviewed.

Results: The mean age of patients was 67 yrs (range 52–96 yrs). 11 patients died in 2 years time. 41 patients were less than 75 years of age and 21 patients were more than 75 years of age. All the patients more than 75 years of age had undisplaced intracapsular fractures. 13 patients were type 1 and 49 patients were type 2 diabetic. Non-union & avascular necrosis occurred in 9 (17%) & 13 (26%) patients respectively. Revision surgery in the form of total hip replacement or hemiarthroplasty were performed in 21 (41%) cases. The incidence of avascular necrosis following osteosynthesis at 1 yr was 14%. Age, control of diabetes, post-operative complications, pre-fracture mobilization status and degree of impaction on AP & version on lateral radiographs were of statistical significance in predicting fracture healing and its associated complications. Complications like wound infection etc were more principally in patients who had poorly controlled diabetes.

Conclusion: Patients with diabetes mellitus have metabolic bone disease due to vasculitis. This increases the risk of complications associated with fracture fixation such as non-union, cut-through and avascular necrosis (AVN). The complications and revision surgery rate was high in patients with displaced fractures and with poorly controlled diabetes. Comorbidities like diabetes & patient’s age were also strong predictors of healing in addition to fracture configuration. Looking at very high complication and reoperation rate, our recommendation in patients with diabetes is primary hemiarthroplasty irrespective of femoral head displacement, if there is age more than 75 years.

Purpose: To review the existing coding for knee surgery and ascertain its appropriateness & accuracy for surgical procedures, associated co-morbidities and complications.

Methods: A retrospective review of 100 consecutive knee surgeries (50 arthroplasties and 50 arthroscopies) performed between July-August 2007 was undertaken. The coding data excel sheet and comprehensive hospital records were analysed.

Results: The accuracy of primary procedural codes was 100% & 88% respectively for arthroplasty & arthroscopy. However this respectively fell down to 56 & 60% when the accuracy for entire description of surgical procedure was taken into consideration. The procedural codes did not specifically reflect the surgery performed and lacked reproducibility esp. for arthroscopies. In arthroplasties, patients had similar codes irrespective of whether they had patellar resurfacing or not. Co-morbidities were coded appropriately in 24% of arthroplasty & 36% of arthroscopy patients. The common co-morbidities missed were drug allergies, hypercholesterolemia, heart conditions (IHD, MI, AF, valvular pathologies) and h/o malignancy & deep vein thrombosis. Post-op adverse events were coded in only 2/5 arthroplasties (40%) and 0/3 arthroscopies (0%) respectively.

Conclusion: Coding is a universal language of communication amongst healthcare professionals. Its accuracy is important not just for reimbursement but also for data quality and audit. Coding database also serves as a powerful research tool. The financial implications with respect to generation of appropriate reimbursement i.e. healthcare resource group (HRG) codes (which are dictated by official population and census survey procedural [OPCS4.4] & international classification of diseases [ICD–10] co-morbidity codes) are discussed. The limitations of the existing coding system are highlighted and discussed. Literature emphasizes on the qualification of coders, legible & comprehensive documentation of surgeries & co-morbidities by treating physicians and regular interaction between coders and clinicians. Reimbursement for arthroscopy is less in the NHS unlike in BUPA where it is on par with open surgeries.