Introduction

Dislocated hip hemiarthroplasties (HA) are associated with a 45% revision rate and 40% mortality rate.

Implant selection for HA operations vary with no universally accepted implant choice. The WHiTE3 trial suggested older designs such as the Thompson has equitable outcomes to more modern and expensive implants such as the Exeter V40+Unitrax.

Our multi-centre consecutive series of NOFs patients treated with HA assesses the impact of surgical and patient factors on dislocation risk.

Introduction

We used patient reported outcome measures (PROMS) to evaluate qualitative and societal outcomes of trauma.

Introduction:

Unstable ankle fractures are commonly treated with operative fixation. Isolated lateral malleolus fractures (Weber B) are often operated by orthopaedic trainees. Operative fixation of these fractures is included in the index procedures of procedure based assessment (PBA) of intercollegiate Surgical Curriculum Programme (ISCP). Orthopaedic trainees are expected to be competent in this procedure by the end of their training. Fluoroscopic guidance is essential for adequate reduction and safe fixation of these fractures.

Introduction

Entry into orthopaedic higher surgical training remains extremely competitive, however little evidence exists regarding the validity of short-listing and interviewing for selection. This paper assesses the relative correlations of short-listing and interview scores in predicting subsequent performance as an orthopaedic trainee.

This paper describes an audit loop. We studied patients undergoing hip and knee surgery (arthroplasty and revision arthroplasty). All the patients were ‘complex elective’. I.e. they were either ASA grade 3 or 4, or had a body mass index in excess of 40. We collected data concerning postoperative admissions to HDU, ICU and PACU (planned and unplanned rates of admission, length of stay). We also noted mortality.

In the first part of the study (April 2005 to March 2006) we studied 298 patients. All patients were assessed independently by an anaesthetist on the day of surgery.

A multidisciplinary preoperative assessment clinic commenced in April 2006. After this date all patients were assessed preoperatively by a multidisciplinary anaesthetic lead team (anaesthetist, orthopaedic senior house officer, nurse practitioner). The need for an HDU or ICU bed was assessed and the bed was booked at part of the pre-operative plan.

In the second part of the study (May 2006 to April 2009) a further 1147 arthroplasty patients were studied. Data was again collected regarding HDU, ICU, PACU and mortality as noted above.

We found statistically significant (p=0.001) reductions in the admissions to PACU (22% down to 10%) and in mortality (6.1% down to 1.2%) after the introduction of the pre assessment clinic. There was also statistically significant (p=0.01) reduction in the HDU length of stay(2.1 days to 1.6 days), ITU unplanned admissions (1.3% to 0.4%) and the ITU length of stay in days (2.3 to 1.9 days).

We also estimated cost savings of nearly £50 000 in the second limb of the study. This is based on the average decrease in HDU and ICU length of stay.

We recommend the use of a multidisciplinary pre assessment clinic for complex orthopaedic surgery.

Introduction: Since the first meeting in 1875, and the subsequent introduction of the concept of evidence based medicine in the 1990s, the journal club has become an integral part of keeping abreast with current literature.

There is no study assessing orthopaedic journal clubs amongst training programs across the UK. This study had two aims: the first was to determine whether journal clubs still play an important part in orthopaedic training programs, the second was to evaluate the frequency, format and goals of journal clubs conducted in orthopaedic training programs in the UK.

Method: We surveyed fifty seven hospitals across the UK. This included hospitals from all the orthopaedic teaching regions of which twelve were teaching hospitals and forty five district general hospitals.

Results: A total of 57 hospitals were surveyed. Of these hospitals 28/57(49%) had a journal club programme in place. On average journals clubs were undertaken once a month and lasted about 1 hour. Most occurred during the working day and were chaired by a consultant. Specialist registrars presented the vast majority of papers (average of 1.9 each per session), with the JBJS Br being the most widely used journal (100% of journal clubs).

Of the twelve teaching hospitals questioned, five (42%) had journal clubs, and twenty three of the forty five (51%) district general hospitals had journal clubs. The average number of articles critically appraised by trainees who attended journal clubs was 5 (0–15) compared to 3 (0–18) in those not attending a journal club.

When asked whether there was any alternative way in which a trainee might otherwise learn how to critically appraise an article, fourteen suggested online journal forums and eighteen suggested self-directed learning or personal study.

Although only 49% of hospital had journal clubs, 88% of trainees believed that it formed a valuable part of training and 56% thought it should be compulsory.

Discussion: This study shows that journal clubs occur in around half of the orthopaedic departments surveyed across the country. This is despite the importance trainees’ associate with journal clubs being part of their training.

In contrast, studies from North America show that a regular journal club occurs in 99% of residency programs.

It may therefore be suggested that for those trainees who do not attend a journal club, an alternative method to learning the skills of critical appraisement may have to be sort. One suggested modality is through on-line journal clubs or forums within regions which trainees may be encouraged to undertake from their regional directors.

To compare the actual with the reported incidence of pressure sores to determine the accuracy of data (classification errors) and completeness of data (differences between manual and computer generated figures), retrospective data was collected regarding pressure sore rates following primary elective total hip arthroplasty operations carried out in 2001. Pressure sores rates were noted by nursing staff and entered into a computer database.

Four consultant orthopaedic surgeons were involved, across 2 sites – 1 NHS (PRH) and 1 local private hospital.

Preliminary audit reports indicated an alarmingly high pressure sore rate across the two units – 17/172 (9.9%) PRH and 23/71 (32.4%) private hospital.

Two major errors were revealed. In terms of accuracy of data, grade 1 areas (erythema without active ulceration) were included at both sites. These are only potential sites of pressure sores and should not have been used to calculate actual pressure sore rate. In terms of completeness of data, manual verification of the number of operations performed revealed a discrepancy between the theatres’ logbook entries and private unit computer figures. 97 rather than 71 operations were performed. There was no such discrepancy at the NHS site.

The data was reanalysed to obtain the actual pressure sore rate. For the NHS unit, grade 1areas were subtracted, causing the rate to fall from 32.4% to 1.0%. The two errors caused a dramatic and significant difference between reported and actual pressure sore rate.

Poor data collection leads to inaccurate audit, leading to inappropriate management. The concern is that similar errors, accumulated across key complication targets and specialities, will have a profound impact on NHS star ratings.