Introduction. Four parts inter trochanteric fracture of femur are commonest in elderly people.
The aim of this study is to analyse the radiological outcomes and predictors of avascular necrosis following 2-hole
Background. Dynamic Hip Screw (DHS) is the most frequently used implant in management of intertrochanteric femoral fractures. There is a known statistical relationship between a tip-apex distance (TAD) >25mm and higher rate of implant failure. Our aim was to analyse all
Abstract. Background. The aim of this study is to analyse the radiological outcomes and predictors of avascular necrosis following 2-hole
Introduction. Osteoporotic intertrochanteric fracture (ITF) is frequent injuries affecting elderly, osteoporotic patients leading to significant morbidity and mortality. Successful prognosis including union and alignment is challenging even though initial successful reduction with internal fixation. Although many factors are related to the patient's final prognosis. Well reduction with stable fracture fixation is still the goal of treatment to improve the quality of life and decrease morbidity in patients with hip fractures, but this in turn depends on the type of fracture and bone quality. Poor bone quality is responsible for common complications, such as failure of fixation, varus collapse and lag screw cut-out, in elderly patients. Kim et al. found that the complication rate when using conventional
Introduction. Lag screw cut-out following fixation of unstable intertrochanteric fractures in osteoporotic bone remains an unsolved challenge. A novel new device is the X-Bolt which is an expanding type bolt that may offer superior fixation in osteoporotic bone compared to the standard
The aim of this retrospective study was to evaluate the failure rate among different fixation devices for undisplaced fracture neck of femur. All 52 patients with Garden I and II hip fractures who underwent surgery in a teaching hospital in London from January 2007 to June 2012 were included. Electronic patient records were accessed to collect the patient data. There were 52% females and the mean age of patients was 70 years. Thirty patients had cannulated screws, 18 – dynamic hip screw (DHS) with de-rotation screw and 4 had
Intra-operative Tip-Apex Distance (TAD) estimation optimises dynamic hip screw (DHS) placement during hip fracture fixation, reducing risk of cut-out. Thread-width of a standard
The aim of this study was to establish any association between implant cut-out and a Tip Apex Distance (TAD), ≥25mm, in proximal femoral fractures, following closed reduction and stabilisation, with either a Dynamic Hip Screw (DHS) or Intramedullary Hip Screw (IMHS) device. Furthermore, we investigated whether any difference in cut-out rate was related to fracture configuration or implant type. WE conducted a retrospective review of the full clinical records and radiographs of 65 consecutive patients, who underwent either
A prospective, randomized, controlled trial was performed to compare the outcome of treatment of unstable fractures of the proximal part of the femur with either a sliding hip screw or a short proximal femoral nail antirotation (PFNA-XS, Synthes). Eighty one patients (April 2007 – May 2008) presenting with unstable fracture of the proximal part of the femur were randomized, at the time of admission, to fixation with use of either a short proximal femoral nail antirotation (n=42) or a sliding hip screw (n= 39). The primary outcome measure was reoperation within the first postoperative year and mortality at the end of one year. Operative time, fluoroscopy time, blood loss, and any intra-operative complication were recorded for each patient. Follow-up was undertaken at 3, 6, and 12 postoperative months and yearly thereafter. Plain AP and lateral radiographs were obtained at all visits. All changes in the position of the implant, complications, or fixation failure were recorded. Hip range of motion, pain about the hip and the thigh, walking ability score and return to work status were used to compare the outcomes. There was no significant difference between 1 year mortality rates for the two groups. Mean Operative time was significantly less in PFNA group (Mean 25 min, range 19 – 56 min) than
Introduction. A recent meta-analysis published in the British Medical Journal suggested an increased risk of infection, but none of the studies were large enough to reach statistical significance. A prospective, randomised trial was designed at our institution to investigate the wound healing and complications related to surgery following fracture neck of femur in the elderly. Objectives. The primary aim was to compare the wound problems and infection following two different methods of skin closure: Subcuticular monocryl suture to metal clips for closure of skin. The secondary aim was to look at the duration of surgery after both types of closure. We received ethical approval for this study. We screened and recruited all eligible patients admitted with acute hip fracture undergoing hemi-arthroplasty or dynamic hip screw. We recruited 541 patients in the study over the period of 3.5 years at our institution. Methods. The study was approved by ethics committee. Inclusion Criteria: Age 18 years and above undergoing
The availability and usage of portable image intensifiers has revolutionised routine orthopaedic practice. Many procedures have become simpler, easier, less invasive and less time-consuming. Extensive use of fluoroscopy can, however, result in significant radiation exposure to operating staff. An accumulated dose of 65 (Sv after multiple exposures has been reported to increase the risk of thyroid cancer many years later. Previous studies have shown that it is possible to exceed this dose during various orthopaedic procedures. Though thyroid shields are extensively available most orthopaedic surgeons do not use them. The present study was aimed at measuring the scattered dose to thyroid during
Aim. This study aimed to identify risk factors for development of deep periprosthetic joint infection (PJI) in patients following surgical treatment of neck of femur fracture. Method. This study identified a consecutive series of 2,822 (2,052 female, 73%) patients who underwent either hemiarthroplasty (n=1,825, 65%) or fixation (DHS) (n=997, 35%) for fractured neck of femur performed between January 2009 and June 2015 at our institution. Full patient demographics, co-morbidity and peri-operative complication data were determined. The majority of patients were either ASA 2 (n=663, 23%) or ASA 3 (n=1,521, 54%), mean age = 81.3 years (SD 10.3). All patients were followed up post-operatively by a dedicated surgical site infection (SSI) monitoring team in order to identify patients who developed a PJI within 1 year. A stepwise multivariable logistic regression model was used to identify patient and surgical factors associated with increased risk of infection. Predictors with a p-value of <0.20 in the univariate analysis were included in the multivariate analysis. Results. Thirty-nine (39) cases of deep periprosthetic infection were identified (hemiarthroplasty n=35,
Recent reports observe that orthopaedic surgeons lack essential knowledge about ionising radiation. We aim to demonstrate perceived use of image-intensifiers by surgeons and awareness of radiation doses used during fractured neck of femur surgery. Surgeons at a regional trauma centre were sent an online questionnaire. They were shown two neck of femur fracture radiographs and asked the total number of images they would use to reduce and fix the fracture with a dynamic-hip-screw / inter-medullary nail respectively. They were asked the maximum safe radiation dose, and that of ‘hip pining’ compared to CXR as outlined by the Ionising Radiation Regulations 1999. For a
The use of fluoroscopy in orthopaedic surgery creates risk of radiation exposure to surgeons. Appropriate personal protective equipment (PPE) can help mitigate this. The primary aim of this study was to assess if current radiation protection in orthopaedic trauma is safe. The secondary aims were to describe normative data of radiation exposure during common orthopaedic procedures, evaluate ways to improve any deficits in protection, and validate the use of electronic personal dosimeters (EPDs) in assessing radiation dose in orthopaedic surgery. Radiation exposure to surgeons during common orthopaedic trauma operations was prospectively assessed using EPDs and thermoluminescent dosimeters (TLDs). Normative data for each operation type were calculated and compared to recommended guidelines.Aims
Methods
In June 2012 the Orthopaedic Speciality Advisory of the Joint Committee on Surgical Training defined ‘minimum indicative numbers’ that trainees would have to meet before completion of specialist training. It has been speculated that regions have varied in their ability to provide operative opportunities to their trainees. This study aims to test the hypothesis that there are regional differences in operative training experience. The eLogbook database was interrogated for cases over a 12 month period from 7 August 2013 to 5 August 2015. Within each region, the mean of the cases registered by orthopaedic trainees in each year of training during the study period was calculated and summed to give a representative surgical experience for the years ST3-8. First surgeon only cases were analysed for 11 index procedures in 30 T&O rotations. Considerable variation in training existed across rotations. In three index procedures, including
Hemiarthroplasty and proximal femoral fixation are common procedures performed in trauma units, but there is very little information regarding post-operative pain experience. Pain control is a keystone in the successful management of hip fractures. A sound strategy of pain management is easier to implement in patients where pain levels can be predicted, allowing for an effective balanced analgesic regime. Analysis was performed on patients presenting with a hip fracture in two hospitals. Patients with a diagnosis of dementia were excluded. Post-operative pain scores were taken from patient observation charts using a verbal analogue scale. Post-operative opiate consumption was calculated from inpatient drug charts. 357 patients were included, 205 patients underwent a cemented hemiarthroplasty (HG) and 152 had fixation with a dynamic hip screw (DG). No significant difference was found in the length of hospital stay. HG patients recorded a mean morphine requirement of 20.2mg compared with 40.3mg for the DG group. Although the early pain score difference was significant (p=0.009), after 4 days, the scores were equivalent. This may support the notion of non-surgical factors determining the total length of hospital stay. The reason for the elevated pain scores and higher morphine requirement in the
Introduction. The aim of the study was to analyze the outcome of AO cannulated screws for fractures neck of femur at our institute. Methods. 412 patients (101 males/311 females) who underwent AO screws for fracture neck of femur over 5 years (2000 -2004) and followed-up for a minimum of 2 yrs formed the study population. A retrospective review of data from electronic patient record (EPR), clinical coding, clinic and GP letters was made. Age, residential placement, Garden's classification, mode of injury, associated comorbidities, pre-admission mobilisation status, allergies, addictions and anticoagulation status details were collected. Reasons for re-admissions, re-operations and comorbidities developing as a result of these interventions were critically analysed. Post-op physiotherapy, proportion of patients sustaining contra-lateral fracture NOF and its management and mortality statistics were reviewed. Results. The mean age of patients was 68 yrs (range 18-96 yrs). Mean length of stay in hospital was 12.3 days (range2- 51 days) and mean time to operate from admission was 51 hrs (median 24 hrs). Second Surgery in form of hemiarthroplasty was required in 36,
Introduction. There is conflicting evidence in the literature regarding outcome of patients living in their own home prior to a fracture neck of femur, when using discharge destination and rehabilitation as measures of outcome. We investigated the factors predicting outcome following neck of femur (NOF) fractures, in patients previously living in their own home. Method. Medical records of all 292 patients admitted to Royal Derby Hospital between January and October 2010 with a fractured NOF (who lived in their own home prior to admission) were obtained retrospectively. Data included patient demographics; type of surgical intervention; mobility status and level of independence before admission; nature of fracture and patients' ASA grade. Outcome measures including: number of days spent in hospital; number of days spent in rehabilitation; mortality; mobility on discharge; and discharge destination, were also sought. Data was analysed using SPSS Version 18. Results. On discharge from the trust 101 (34.6%) patients returned to their own home. Twelve patients died before discharge from the trust. 5 patients (1.7%) needed nursing home care and one patient (0.3%) needed residential home care. Prior to their fracture 164 (56.2%) patients were able to walk indoors with no aids, which dropped dramatically to four (1.4%) patients at discharge.150 patients needed a median number of 28 days of extended rehabilitation period. Higher pre-operative ASA grades were associated with a higher median number of days spent in hospital. Conclusion. A delay in surgery due to the patient being medically unfit was associated with a longer hospital stay, delay in surgery for administrative and logistical reasons however did not increase the median number of days spent in hospital. A longer extended rehabilitation period was associated with internal fixation with
Epidemiologic studies project an increase of hip fractures worldwide. They are an important cause of morbidity and mortality in the elderly and represent an increasing burden on a country's health service. The aim of the study was to evaluate the mortality of hip fractures admitted to a regional hospital in Australia and calculate the relative risk ratio of morbidity variables on mortality. This retrospective review included all patients admitted from 2003 to 2008 to a regional Queensland hospital with a hip fracture. The relative risk ratio for the probability of death was calculated for the following variables: previous mobility (independent, home with help, nursing home), type of treatment (hemiarthroplasty, ORIF,