Tibial shaft fractures have a high incidence of delayed and non-union, often requiring multiple procedures. Pulsed electromagnetic field (PEMF) stimulation is a safe and effective treatment for tibial non union but little is known about the efficacy of PEMF in preventing non-union in acute fractures.

Between August 2005 and December 2008, eligible patients presenting at six major metropolitan hospitals with acute tibial shaft fractures (AO classification 4-2) were included. Participants were randomised by an independent allocation centre to identical active or inactive PEMF devices, both prescribed to be worn ten hours daily for twelve weeks. Baseline data were collected, and patients and surgeons were surveyed serially via post and/or phone at three, six and twelve months. Participants, data collectors and data analysts were blinded. The main outcome was any surgical intervention for delayed/non union.

Data from 150 patients (76 active and 74 inactive) were available for analysis (12 month follow up 78%). There was no between-group difference in age, gender, mechanism of injury, open grade, smoking status, or compliance with the device (hours of use). Overall compliance was moderate (5.7 hours daily use). Fifteen of 76 (20%) of active device patients required surgery for delayed/non-union vs. 8 of 74 (11%) in the placebo group; odds ratio of surgery=2.03, p=0.13, 95% CI 0.80 to 5.12. An intention to treat analysis adjusted for open grade and hours the device was used showed an odds ratio of requiring surgery of 1.78 (p=0.24, 95% CI 0.68 to 4.64). A sub-group analysis of 80 compliant patients (defined a priori as a minimum average of six hours daily use) was performed. Nine of 35 (26%) patients with an active device required surgery for delayed/non-union vs. 3 of 45 (7%) in the placebo group; odds ratio of surgery=7.60 (p=0.017, 95% CI 1.43 to 40.24).

Based on these unexpected initial results, PEMF stimulation does not prevent revision surgery for delayed/non-union in acute fractures of the tibial shaft.

To examine surgeon supervision in orthopaedic trauma in Australia.

An Australia-wide cross-sectional survey was performed using a mass electronic mail-out distributed to members of the Australian Orthopaedic Association. Rates of supervision for six common operations (tibial nailing, femoral nailing, hip hemiarthroplasty, hip fracture fixation, ankle fracture fixation, paediatric supracondylar fracture). Other factors recorded included; payment type, hospital type, state, seniority, theatre availability, and trauma load. Responses were tabulated and analysed using SAS software.

21.9% of surgeons completed the survey, out of 739 surgeons who were sent the e-mail invitation. Univariate analysis showed increased supervision to be associated with; more junior consultants, regional and rural hospitals, state (NSW and Victoria), and method of payment (fee for service). However, multivariate analysis showed that fee for service payment (compared to sessional payment) was the only factor significantly associated with increased supervision for all operations surveyed.

Higher remuneration for surgeons may increase supervision rates of trainees.

We aimed to examine the influence of nursing home residency on mortality after sustaining an acute hip fracture in patients presenting to a metropolitan trauma centre. A prospective study of all adults aged 65 years and over who presented to a single tertiary referral hospital for management of a fracture of the proximal femur between July 2003 and September 2006. Residential status was obtained at admission. Patients were followed up to September 2007. Relative risk values for mortality were calculated comparing nursing home residents with non-nursing home residents. Survival analysis was performed.

Relative risk of death was higher in nursing home patients compared to non-nursing home patients. This was particularly so in the first 30 days (RR 1.9). Survival analysis showed that 25% of patients in the nursing home group died by 96 days post-injury, compared with 435 days post-injury in the non-nursing home group. The age-adjusted hazard ratio for death in nursing home patients was 1.5 (95% CI: 1.1–2.1), however the effect of nursing home status decreased over the first 12–24 months.

Nursing home residence confers an increased risk of death following hip fractures, especially in the immediate post-injury period. However, the relative risk of death decreased over time. This study provides some indication of the mortality risk in an easily definable population, without requiring an alternative assessment of comorbidities.