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Introduction of the National Hip fracture database, best practice tariff and NICE guidelines has brought uniformity of care to hip fracture patients & consequently improved outcomes. Low energy femoral shaft fractures of the elderly are not within these guidelines, but represent a similar though significantly smaller patient cohort.

A retrospective review was performed at Huddersfield Royal Infirmary using theatre, coding & hip fracture databases. Data was filtered to include patients ≥75, excluding non-femoral injuries. Imaging & notes were then reviewed confirming femoral shaft fractures; excluding open, peri-prosthetic & high energy fractures.

Between September 2008 and July 2016 24 patients were identified and split into two equal cohorts, before June 2011 NICE Guidelines and after. The groups were equal in terms of age (Mean: 85.25:84.67, P=0.) & sex (12 females Pre-NICE, 9 Post-Nice, P= 0.22). Our main outcome measures of length of stay were 31.89 days:26 days (p=0.38), time to surgery was 29.8hours: 28.4 hours (p=0.8) and 1-year survival rate conditional odds ratio of 1.48 (p=1.00). A secondary measure demonstrated a significantly higher proportion of post-NICE patients receiving surgery after midday 5/12:11/12 (P= 0.03).

The infrequency of low energy femoral shaft fractures makes them difficult to study and production of an adequately powered study in a single centre impossible. The authors hope this work can inspire discussion and a coordinated multicentre approach to answer this question. These patients could easily be treated with the same level of enthusiasm as hip fractures.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLIII | Pages 11 - 11
1 Sep 2012
Wells G Haene R Ollivere B Robinson AHN
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Failed Hallux Valgus Surgery Aim

We aim to explore the reasons behind long term failure of hallux valgus surgery.

Patients & Methods

A series of patients with problems following failed hallux valgus surgery presenting to a tertiary referral unit is presented. There were 47 patients with 55 problematic feet, 45 were female. The mean age was 59 years (Range 25–79). The failed bunions were compared to a prospectively collected series of 80 patients with successful 1st metatarsal osteotomies, 40 ludloff and 40 scarf osteotomies.

Before the index surgery, all the patients in the failed group, the predominant symptom was pain. Only 53% admitted deformity was an issue. A wide spectrum of procedures were performed, 13 Wilson's, 11 Keller's, 8 Chevron, 3 Bunionectomy, 2 Scarf, 1 Basal and 1 Mitchell's. In 16 patients the original procedure was unknown. The mean time to developing problems was 9.4 years (Range 0–45) with mean time to presentation 13.6 years. (Range 0–47) Radiographs revealed 2/3 of patients had relative shortening of the first metatarsal. Over 80% of x-rays demonstrated evidence of degenerative change. The mean AOFAS score deteriorated with increased shortening.

The failed bunions had statistically significantly different AOFAS pain scores (15.1 vs 31.9 p < 0.05), function scores (25.02 vs 31.9 p < 0.05). Additionally, the hallux valgus angle was significantly higher (24 vs 11.7 p < 0.05) although there was no change in DMMA between the two groups (13 vs 7.6 p > 0.05). There was a significantly higher incidence of first ray shortening (12% vs 0% p < 0.05).


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_II | Pages 276 - 276
1 May 2006
Gella S Ponnuru R Wells G Tulwa N
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Purpose Of Study: To evaluate the results and functional outcome of use of three lateral K wires in supracondylar fracture fixation in children.

Methods And Results: It is a prospective study of 25 cases of supracondylar fractures over a period of three years from 2001, in children between 2 to 9 years, comprising of closed manipulation and percutaneous fixation with 3 lateral K wires, all done by the same surgeon.

Patients were immobilised for 3 weeks and K wires removed at that time. They were followed up till they regained full range of movements in the elbow.

Of the 25 cases, 2 were previously fixed with crossed K wires and were revised because of displacement . One patient had a delayed fixation because of gross swelling and was initially managed with traction.

Pin tract infection was noted in one case and responded to antibiotic therapy.

All the patients regained full range of movements and no angulatory deformity or loss of fixation was noted at the end of follow up.

Conclusion: Fixation with three lateral K wires is an excellent technique in treating displaced supracondylar fractures in children.