There has been extensive research into neck of femur fractures in the elderly. Fragility non-hip femoral fractures share many of the same challenges [1]. Surgical management is complex, patients are frail and mortality rates have been reported as high as 38% [2]. Despite this, relatively little data is available evaluating the level of MDT care provided to non-hip femoral fractures. This audit aimed to evaluate the standard of MDT care provided for patients with non-hip femoral fractures according to the NHFD key performance indicators. The following fractures were included in the dataset: distal femoral, femoral shaft and peri-prosthetic femoral. Patients under 65 were excluded. Data was retrospectively collected using post-operative and medical documentation. Performance was assessed according to five key performance indicators: Did orthogeriatrics review the patient within 72-hours? Was surgery performed within 36-hours? Was the patient weight bearing post-operatively? Was a confusion assessment completed? Was the patient discharged home? 38 patients met the inclusion criteria. 84% of patients were seen by orthogeriatrics within 72 hours of admission. 32% of patients were operated on within 36-hours of admission, with time to theatre exceeding 36-hours in 92% of peri-prosthetic fractures. 37% of patients were not advised to full weight bear post operatively. 84% of patients received a confusion assessment whilst 61% of patients were discharged to their prior place of living. Our results suggest that non-hip femoral fractures do not receive the same standard of MDT care as neck of femur fractures. Greater prioritisation of resources should be given to this patient subset so that care is equivalent to hip-fracture patients. Time to surgery is a particular area for improvement, particularly in peri-prosthetic fractures, a trend that is mirrored nationally. Greater emphasis should be placed on encouraging full-weight bearing post-operatively to prevent post-surgical complications.
To evaluate the correlation between the clinical Kirk Watson test and arthroscopic Geissler classification in scapholunate instability. All patients undergoing wrist arthroscopy between April 2006 and April 2010 were evaluated. Patients were included in the study if they had a Kirk Watson test and a wrist arthroscopy with an assessment of the stability of the scapholunate joint using the Geissler classification. Patients who had a Kirk Watson test performed with subsequent normal scapholunate joint at arthroscopy were included as a control group. Geissler grades 1 and 2 and grades 3 and 4 were grouped for further analysis into low and high grade instability groups respectively.Aim
Methods
The concept of a predetermined first patient on the following days trauma list (the golden patient) was introduced to our hospital in April 2009. The golden patient (GP) should already have been seen by an anaesthetist and be ready to be sent for by theatres early. The aim was to improve theatre start times following disappointing results from a previous in-hospital study. It has been shown by others to improve operation start times and could be used to improve trauma services and meet clinical targets more readily. This prospective study involved the collection of planned trauma lists with the designated GP over November and December 2009. Data was collected from theatre logbooks and included patient demographics, theatre arrival, anaesthetic and operation start times. This was compared with the pre-GP data (January and February 2009). A two sample T-test was used to evaluate statistical significance between groups.Introduction
Methods
More than 60% of patients presenting with a hip fracture have significant medical co-morbidities and a one year mortality rate between 14% and 47%. The rating scale for the American Society of Anaesthetists (ASA) is a reliable predictor of both surgical risk and mortality with ASA 4 patients having 100% mortality at one year.1,2 Our aim was to establish a mortality rate for fractured neck of femur patients at three months and twelve months, and to ascertain the mortality of patients with an ASA 4 grading. Ultimately, should we be operating on this high risk cohort of patients'. We also chose to analyse our current practice in the management of displaced intracapsular neck of femur fractures in patients 90 years of age and over.Introduction
Aims
The concept of the golden patient (GP) was introduced to our busy teaching district general hospital, in April 2009, to improve trauma theatre start times following disappointing results from a previous in-hospital study. The GP is a pre-selected first patient on the following day trauma list who is medically fit with a clear surgical plan. The GP should have already been seen by an anaesthetist and be ready to be sent for by theatres early. It has been shown by others to improve operation start times and could be used to improve trauma services and meet clinical targets more readily. This prospective study involved the collection of planned trauma lists with the designated GP over November and December 2009. Data was collected from the theatre logbooks, including patient demographics, theatre reception, anaesthetic and operation start times. This was compared with the pre-GP data (January and February 2009). Graphs showing the comparative mean start times between pre-GP and GP trauma lists, including the 95% confidence interval for the population mean were created. A two sample T test was used to evaluate significance between groups.Introduction
Methods
