The ‘Best Practice Tariff‘ (BPT) was developed to improve hip fracture care by incentivising hospitals to provide timely multidisciplinary care to patients sustaining these injuries. The current literature examining the association between BPT and patient outcomes is conflicting and underpowered. We aimed to determine if achieving BPT has an impact on 30-day mortality and postoperative length of stay.

A retrospective analysis for patients admitted to a major trauma centre (MTC) was performed between 01/01/2013 to 31/12/2020. Data were extracted from the National Hip Fracture Database. The study population was divided into two groups: those who achieved all BPT criteria (BPT-passed) and those who did not (BPT-failed). The primary outcomes of interest included the 30-day mortality rate and postoperative length of stay (LOS). As a secondary objective, we aimed to assess factors that predict perioperative mortality by utilising a logistic regression model.

4397 cases were included for analysis. 3422 (78%) met the BPT criteria, whereas 973 (22%) did not. The mean LOS in the BPT-achieving group was 17.2 days compared with 18.6 in the BPT-failed group, p<0.001. 30-day mortality was significantly lower in the BPT-achieving group i.e., 4.3% in BPT-achieved vs. 12.1% in BPT-failed, p<0.001. Logistic regression modelling demonstrated that attainment of BPT was associated with significantly lower 30-day mortality (OR: 0.32; 95% CI:0.24–0.41; p<0.001).

To our knowledge, this is the largest study to investigate the association between BPT attainment and 30-day mortality as well as the length of stay. The present study demonstrates that achieving BPT in hip fracture patients is associated with a significant reduction in the average length of stay and 30-day mortality rates. Our crude calculations revealed that achieving BPT for 3422 patients earned our hospital trust >£4 million over 8 years. Findings from this study suggest that achieving BPT not only improves 30-day survival in patients with hip fractures but also aids cost-effectiveness by reducing LOS and helps generate NHS Trusts a significant amount of financial reward.

Aim

To describe the epidemiology, clinical features and outcomes of native joint septic arthritis in adults admitted to Middlemore Hospital in Auckland, New Zealand.

Introduction: Studies suggest pedicle screw constructs are more effective than hybrid or hook constructs for AIS correction. This study assessed the efficacy of three methods of spinal instrumentation in patients treated at the WCH.

Methodology: 30 AIS patients who underwent posterior spinal surgery were matched according to age, fusion levels, and Lenke curve. Three constructs were assessed, hook-exclusive, screw-exclusive and hybrid constructs, with 10 patients in each group. Endpoints included radiographic measures, operative time and complications.

Results: Mean pre-operative Cobb angle was 56.1°, 52.2° and 56.7° for the screw, hybrid and hook group respectively.

Structural curve correction was 63.6°, 60.2° and 58.5° for each group respectively. Compensatory curve correction favoured the hybrid and screw groups.

Thoracic kyphosis correction was 20.7° (most improved), 19.9°, and 15.5° for the screw, hook, and hybrid groups respectively.

Coronal alignment favoured the screw construct group.

Comparison of operative time revealed no significant difference, and complication rates were similar in nature and incidence for all three groups.

Conclusions: Results demonstrate improved correction of structural curve, kyphosis, and coronal alignment in the screw instrumentation group. No additional complications were observed with this method of AIS curve correction.

Introduction The biomechanical properties of biologic cages made of femoral ring allograft in providing immediate stability for lumbar fusion as compared to bovine xenograft, titanium and polyethylether ketone (PEEK) cages are unknown. Biomechanical comparisons were done of lumbar constructs to determine their adequacy in providing immediate stability for fusion mass and demonstrate the need for supplemental posterior fixation.

Methods Fusion constructs were evaluated in 40 Merino sheep as lumbar spine models. Discectomy was performed on multisegmental specimens. Femoral ring allograft, bovine xenograft, titanium cage (Syncage) and Polyethylether ketone / PEEK cage (Plivios) were inserted. Dual X ray absorptiometry assessment of bone mineral content was performed .Testing was one for insertional torque and pullout strengths. Static testing consisted of flexion and extension 2Nm moment and100Nm compression load, bilateral axial rotation pure 5.5 Nm moment and lateral bending pure moments 1.1Nm moment and100Nm compression loads. Dynamic testing was done to detemine long term properties of the construct.

Results Interbody cages performed equivalently to femoral ring allograft. Bovine xenograft had lower stability compared to the rest. Posterior supplemental transpedicular fixation achieved increased stability in flexion, extension & lateral bending. Reduced stability was observed in all contructs with cyclical loading. The stabilizing effects were affected by the disc space distraction and facet joints. The titanium cage had significantly greater median pullout force compared to the others.

Discussion Femoral ring allograft is valid alternative to titanium and PEEK cages. It is able to provide adequate immediate stability. Supplemental posterior fixation resulted in further rigidity of the constructs.