The Nottingham Hip Fracture Score (NHFS) is validated to predict mortality after fragility neck of femur fractures (NOF). Risk stratification supports informed consent, peri-operative optimisation and case prioritisation.

With the inclusion of fragility distal femur fractures (DFF) in the BPT, increasing attention is being placed on the outcome of these injuries. Developing on the lessons learnt over the past decades in NOF management is key.

This study assesses the validity of the NHFS in predicting mortality after fragility DFFs.

A multi-centre study of 3 high volume fragility fracture units was performed via a retrospective analysis of prospectively collected databases.

Patients aged 60 years-of-age who presented with AO 33.A/B/C native DFF, or V.3.A/B periprosthetic DFF over an 86-month period between September 2014 and December 2021 and underwent surgical treatment were eligible for inclusion. Open and/or polytrauma (ISS >15) were excluded.

All operations were performed or supervised by Consultant Orthopaedic Surgeons and were reviewed peri-operatively by a 7-day MDT.

Patients with a NHFS of gt;=5 were stratified into a high-risk of 30-day mortality cohort, with all others being œlow-risk.

285 patients were eligible for inclusion with 92 considered to be low-risk of 30-day mortality, these tended to be younger female patients admitted from their own homes.

30-day mortality was 0% in the low-risk cohort and 6.2% (12/193) in the high-risk group. 1-year mortality was 8.7% (8/92) and 35.7% (69/193) in the low and high-risk groups respectively.

Area Under the Curve (AUC) analyses of Receiver Operator Characteristic (ROC) curves demonstrated the greatest ability to predict mortality at 30-days for the high-risk cohort (0.714).

The NHFS demonstrates a good ability to predict 30-day mortality in those patients with a NHFS =5 after a surgically managed fragility DFF. With comparable mortality outcomes to those documented from fragility NOF.

Introduction: Today’s aging population has resulted in an increase in the number of major orthopaedic surgical interventions in the elderly. Total knee replacement (TKR) is one of the commonest operations in orthopaedic practice. The fourth annual report of the National Joint Registry showed that there were 60 986 TKR performed in England and Wales in 2006. The true figure is probably much higher. Literature showed that 20–70% of patients who had TKR needed 1–3 units of blood.

Although safer than ever, allogeneic transfusion is still associated with risks for the recipient (haemolysis, infection, immunosuppression, transfusion-related acute lung injury and even death).

Tranexamic acid (TA) is a synthetic antifibrinolytic agent that has been successfully used to stop bleeding after dental operation, removal of tonsils, prostate surgery, heavy menstrual bleeding, eye injuries and in patients with Haemophilia.

In this study Tranexamic acid was applied topically to the exposed tissue around the knee joint prior to the wound closure and tourniquet release. It is anticipated that this method of administration is quick, easy, associated with less systemic side effect. Also, it provides a higher concentration of the Tranexamic acid at the bleeding site.

Objectives: To find out whether Tranexamic acid can reduce blood loss and subsequent blood transfusion significantly after total knee replacement when applied topically without extra side effects.

Design: A double blind randomised controlled trial of 150 patients who underwent unilateral primary cemented total knee replacement. This number gives a 90% power to detect a 50% reduction in blood loss and 80% power to detect a reduction in blood transfusion from current local standard 30% to 10%.

Outcome Measures: Blood loss, transfusion, Length of stay, complications, Euroqol and Oxford Knee Score.

Results: The two groups were comparable in age, weight, height, BMI, Tourniquet time, and type of anaesthesia. There has been significant differences in the amount of blood loss and blood transfusion in favour of tranexamic acid (p-values are 0.001 and 0.007 respectively). Fourteen patients needed blood transfusion ranged from 2–6 units. Thirteen were in the Placebo group and only one in the Tranexamic acid. There has been no significant difference among other outcomes in particular complications rates such as DVT and pulmonary embolism.

Clinical investigations and tests need to be validated by studying their inter-observer and intra-observer errors, but there has been no documentation of such verification in diagnostic knee arthroscopy. We performed a prospective study to find out to what extent the findings in knee arthroscopy differ between two different surgeons.

Two senior specialist registrars (M.S. and A.J.) who took part in this study worked with the senior author (ACW) for a period of eight and seven months respectively. A total of 78 knee arthroscopies admitted from routine waiting list were studied. The specialist registrar first performed arthroscopy when the supervising consultant stayed away from the operating room. His findings were recorded on a proforma by an independent third person before the consultant returned to the operating room and repeated the EUA and arthroscopy without prior knowledge of the trainee findings. Findings from the consultant arthroscopy were then recorded separately on the same proforma.

The following findings were recorded:

Examination under anaesthesia

The inter-observer variations in diagnostic knee arthroscopy were found to be high. Given the seniority and experience of the two trainee senior registrars involved in the study, and allowing for the Hawthorne effect, the results of the study cast doubt on this procedure being performed un-supervised. It also questions the validity of any therapeutic intervention based on the findings of un-supervised arthroscopies.