Abstract

Introduction and Objective

Dislocation of a hip hemiarthroplasty is a significant complication with a high mortality rate in elderly patients. Previous studies have shown a higher risk of dislocation in patients with neuromuscular conditions. In this study, we reviewed our larger cohort of patients to identify if there is a link between neuromuscular disorders and dislocation of hip hemiarthroplasty in patients with neuromuscular conditions.

The modified Glasgow Prognostic Score (mGPS) is a validated prognostic indicator in various carcinomas as demonstrated by several meta-analyses.

The mGPS includes pre-operative CRP and albumin values to calculate a score from 0–2 that correlates with overall outcome. Scores of 2 are associated with a poorer outcome.

Our aim was to assess if the mGPS is reliable as a prognostic indicator for soft tissue sarcoma (STS) patients.

All patients with a STS diagnosed during years 2010–2014 were identified using our prospectively collected MSK oncology database. We performed a retrospective case note review examining demographics, preoperative blood results and outcomes (no recurrence, local recurrence, metastatic disease and death).

94 patients were included. 56% were female and 53% were over 50 years. 91% of tumours were high grade (Trojani 2/3) and 73% were >5cm. 45 patients had an mGPS score of 0, 16 were mGPS 1 and 33 were mGPS 2. On univariate analysis, an mGPS of 0 or 2 was statically significant with regards to outcome (p=0.012 and p=0.005 respectively).

We have demonstrated that pre-treatment mGPS is an important factor in predicting oncological outcome. A score of 0 relates to an improved prognosis whilst a score of 2 relates to an increased risk of developing metastases and death. mGPS as a prognostic indicator was not affected by either the tumour size or grade.

We believe that a pre-operative mGPS should be calculated to help predict oncological outcome and in turn influence management. Further work is being undertaken with a larger cohort.

Objective

To determine differences in fracture stability and functional outcome between synthetic bone graft and allograft/autograft with internal fixation of tibia plateau metaphyseal defects.

Introduction: Patients can vary widely in their illness perceptions and subsequently, the manner in which they respond and adapt to health threats. A patient’s perception about his/her hand injury may explain their health behaviours such as adherence to post-operative therapy, coping, emotional response and eventual clinical outcome.

Aims: To examine illness beliefs in patients with hand injuries in the acute trauma setting.

Methods: The disability and severity of injury were determined using the DASH questionnaire and HISS score. The revised Illness Perception Questionnaire(IPQR) was used to explore the patient’s illness perception.

Results: Fifty seven patients were recruited. There was no correlation between the DASH and HISS scores, or their correlation with the different components of the IPQ-R scores. The cohort was optimistic about their treatment and duration of recovery. There was some evidence to suggest that patients with more severe injury were over-optimistic about recovery. Beliefs of negative consequences, chronic, cyclical duration and low illness coherence were linked with negative emotional response. Female patients and dominant hand injuries reported higher subjective disability.

Conclusions: The lack of correlations suggests that illness perceptions were not influenced by the severity of the injury. Patients in this cohort were optimistic about recovery, particularly in those with more severe injury (over-optimistic). These findings suggest that there could be a role for psychological intervention in hand injury. Longitudinal research is needed to evaluate illness beliefs in hand injury during the post-operative period.