Hip fractures in young adults are rare but represent an important cohort of patients, of which relatively limited data exists. The aim of this study was to evaluate this distinct subgroup of hip fractures from an epidemiological perspective and assess their subsequent outcomes.

Patients aged 18–50 were identified across an 8 year period from a total of 5326 hip fractures. 46 hip fractures met the inclusion criteria and a retrospective case series analysis was conducted.

25/46 (54%) of fractures were intracapsular and 21/46 (46%) were extracapsular. Only 15/46 (33%) of fractures were sustained from a high energy mechanism and 31/46 (67%) low energy. The low energy cohort was significantly more comorbid with a mean Elixhauser comorbidity score of 1.5 compared to the high energy cohort 0.3 (p<0.0005, unpaired t-test). Alcohol excess was the most prevalent comorbidity present in 24% of patients and was a positive predictor in complication (p=0.006, binary regression). Failure of fixation (non-union/avascular necrosis) in displaced intracapsular fractures sustained following low energy trauma managed by internal fixation 5/11 (45%) was markedly higher than the high energy cohort 0/6 (0%). 5 year mortality was 9% for all hip fractures, six times higher than an aged matched cohort of non-hip fractures (p=0.007, Wilcoxon test).

Representing only 0.86% of all hip fractures in the study period, hip fractures in young adults are rare. A clear sub-division of patients is observed between patients with a low and high energy mechanism, both in terms of level of comorbidity and surgical outcome.

Postgraduate training in orthopaedics has traditionally been delivered through an apprenticeship model. However, junior doctor working patterns have more recently moved away from a team based structure, potentially affecting training experience. We aimed to compare the perceived quality of training between medical students, junior non-orthopaedic trainees and orthopaedic specialty trainees.

We conducted an anonymous questionnaire of all medical students and trainees rotating through our unit over 24 months. The questionnaire contained 6, 10-point Likert rating scale questions and free text responses. Results were collated and analysed according to training stage.

Of 82 questionnaires distributed, 60 (73%) were completed (18 specialty registrars, 22 junior trainees and 20 medical students). Junior trainees consisted of 8 GPSTs and 14 Foundation Year (FY2) doctors, only one of whom had specifically chosen an orthopaedic placement.

Median Likert rating of training experience was (1 = very poor, 10 = excellent): ST4-ST8 = 8 (range 7–9), ST1-ST3 = 7 (6–9), GPSTs/FY2s = 4 (2–5) and medical students = 8 (7–10). Further analysis of junior non-orthopaedic doctors' training experience showed that placement induction, organisation of formal teaching and opportunities for training out with formal sessions were rated as poor. However, content of delivered teaching was rated highly. Free text responses identified several barriers to training including being too busy on wards and no opportunity for protected teaching.

Our study shows that junior non-orthopaedic trainees feel their training experience during orthopaedic placements is much poorer than orthopaedic trainees and medical students. Time constraints and less team based working patterns may detract from their teaching opportunities. In addition, junior doctors rotating through orthopaedic units now have a wider spectrum of career interests with heterogeneous training needs. Therefore, orthopaedic departments may need to adopt a more targeted training programme that recognises individual training needs if junior doctor training is to improve.

Introduction and Aims

Peritrochanteric femur fractures are common and impose major costs on the healthcare system. A fixed angle sliding hip screw is the principle method of treatment, but the rate of mechanical failure associated with these devices can be high; the usual mechanism being the collapse of the neck shaft angle leading to extrusion of the screw from the femoral head, commonly known as “cutout”. Many variables contribute to the risk of cutout, however there is substantial evidence that the “Tip Apex Distance” (a single number that summarises the position and depth of the lag screw on anteroposterior and lateral radiographs after controlling for magnification) is the single best predictor of risk of failure. There is a strong statistical relationship between an increasing tip apex distance (TAD) and the rate of cutout. Specifically, a TAD of 25 mm or less significantly reduces risk of failure. The aim of our study is to assess levels of compliance with a maximum TAD of 25 mm in peritrochanteric femur fractures treated with Dynamic Hip Screws and IM Nails.

It is well recognised that patients with diabetes mellitus have a predisposition towards stenosing flexor tenosynovitis (FTS). However, recent research has suggested an association between the development of FTS and haemoglobin A1c (HbA1c) level which is used as a marker of glycaemic control. National guidelines on management of diabetes suggest treatment should aim to maintain HbA1c at <6.5%.

The aim of our study is to quantify glycaemic control in patients undergoing surgical A1 pulley release.

We retrospectively reviewed the blood results of 78 patients who underwent FTS surgery. 27 of these had an HbA1c checked within 6 months of their surgery and we therefore presumed these patients were diabetic. For diabetic patients the average HbA1c was 7.9% (range 5.3–11.4) and only 7 of the 27 patients had an HbA1c within the recommended range.

In this cohort 33% of patients were presumed diabetic and 74% of these had a documented HbA1c above the national target suggesting a significant number presenting for surgery have poor glycaemic control. Therefore it may be of benefit to screen for this in patients undergoing FTS surgery.