Purpose

The aim of this prospective study was to determine the usefulness of a gravity stress view in detecting instability in isolated Weber B fractures of the fibula.

Aim: To propose new guidelines in the management of supracondylar fractures treated by percutaneous Kirschner wires

Subjects and Method: We audited 62 children with displaced, unstable supracondylar fractures of the humerus, which were fixed with Kirschner wire over a period of 2 years. The fractures were classified according to the Wilkins modification of the Gartland system. 10% were type II and 90% type III. The protocol followed was that all unstable fractures that required closed or open reduction must be stabilised with Kirschner wires of adequate thickness used in a crossed configuration and supplemented with back slab. They were then followed up mostly weekly, often with multiple check X-rays until 3 weeks, and for wire removal at 3 weeks. The parameters studied are level of surgeon, adequacy of intra operative reduction, re operation rate, adequacy of intra operative X-rays, out of hour operations, number of post operative X-rays, number of follow ups and any complications.

Results:

Two patients had re operation due to poor intra operative reduction which were performed by junior grade surgeon without supervision during out of hours.

Conclusions: Unnecessary radiation can be avoided by obtaining adequate intra operative X-rays and avoiding check X-ray as no fracture had displaced at follow up.

New guidelines proposed:

Patients with no N-V complications can wait till the morning trauma list.

Background: Hip fractures are common in the elderly population accounting for 20–30% of acute trauma admissions and usually requiring operative treatment. With increasing age the risk of comorbidity increases reflected in higher ASA grades.

Aim: The aim of this study was to evaluate the correlation between ASA grading, morbidity, mortality and functional outcome within one- year from surgery in patients admitted with hip fractures.

Design: A retrospective study in a District General Hospital.

Methods: 155 patients with a mean age 83 years (60 to 102 years) were admitted with hip fractures between June 2001 to May 2002. There were 126 females 29 males. They were assessed for ASA grade, comorbidities, mental test score(MTS), complications and mortality at one year post admission.

Results: ASA 1: 15 patients mean age 79 years – MTS of 8.3, had no postoperative complications, and no mortality in this group.

ASA 2: 66 patients mean age 82 years – MTS 6.3, comorbities 1.8, average time to theatre 36 hours. 15% had injury/implant related complications, one year mortality rate was 4.5%.

ASA 3: 64 patients mean age of 84 years – MTS 3.9, comorbidities 2.7, average time to theatre of 3 days. 6.25% had injury specific complications, one- year mortality rate was 28.13%.

ASA grade 4: 6 Patients mean age 83 years – MTS 5, comorbidities 3. The one-year mortality rate was 83.33%.

Four patients were medically unfit to undergo any form of surgical intervention.

Overall 9% of patients had complications related to the injury/implant that occurred exclusively in ASA 2 and 3 groups and the one year mortality rate was 17.22% for the entire group.

Conclusions: The higher ASA grade in patients admitted with hip fractures results in increased postoperative mortality and morbidity. Despite recent advances in the standards of health care, the comorbid conditions in this aged population will place an ever increasing burden on the health services in the near future.

Background: Minimally Invasive Hip Replacement Surgery (MIS) has been promoted by patient choice. Patients request less trauma, smaller scars and shorter hospital stays. MIS has been randomly defined as incision less than 10cm long. Are we achieving the patients goals and if so are we potentially compromising long term results in the process.

Design: Retrospective study

Setting: Acute District General Hospital.

Method: A retrospective study in a district general hospital using a single surgeons patients was performed. 30 patients underwent total hip replacement surgery via a posterior approach. There were 8 uncemented cups and 22 cemented cups and all stems were Exeter, cemented with modern cementation techniques. 15 patients who had incisions less than 10cm (MIS group – average scar length 9.5 cms) were compared with 15 patients with incisions greater than 10cm (Conventional group – average scar length 23 cms).

Data collected included a Visual analogue pain score (VAS), analgesic requirement in the immediate postoperative period, activity score and oxford hip score at a minimum of six months follow up.

Radiographs were assessed independently and blinded for technique, assessing implant position and quality of cementation using Barrack and Charnley and DeLee classifications.

Results: In the immediate postoperative period there was no statistically significant difference in the pain score and the analgesic requirement between the two groups. Neither the oxford hip scores nor the activity scores demonstrated statistically significant difference between the groups at a short term follow up of six months.

There was a statistically significant difference in the scar length between the two groups (p< 0.05).

There were no intra-operative complications in study groups.

Conclusions: Though we accept that this is a small pilot study, we feel that MIS joint replacement can be safely performed and is more pleasing for the patients. There was no difference in analgesic requirements, blood useage or hospital stay. These advancements in surgical technique require constant monitoring to ensure good long term results.