According to the Scottish Arthroplasty Project the mean inpatient LoS following a Total Hip Replacement (THR) has fallen from 10.3 days in 2001 to only 3.9 days. This reduction in patient LoS has lead units in the UK to follow the example of centres around the world in offering THR as a day case procedure. In this study we examine data gathered from the first 18 months of day case THR within a district general hospital elective orthopaedics unit. Data was collected prospectively from all patients undergoing THR within our district general hospital elective orthopaedic unit. Patients were selected to day case THR group via consultant review at outpatient clinic and anaesthetic assessment at pre-assessment clinics. Between August 2018 and February 2020 (18 months) 40 patients successfully underwent day case THR. None of the patients discharged home where readmitted within the next 30 days. The average age of successful day case THRs was 60 years old. The at 6 months post-op mean OHS was 45.1 and at 1 year post-op the mean score was 47.2. The average improvement in OHS was 21.1 at 6 months and 26.9 at 1 year post-op. All of the patients successfully discharged as day cases where satisfied with their care and all but one would recommend it to their friends and family. We have shown that day case THR is not only possible within an NHS district general hospital but gives exceptional patient outcomes with excellent patient satisfaction

Aims. This is a multicentre, prospective assessment of a proportion of the overall orthopaedic trauma caseload of the UK. It investigates theatre capacity, cancellations, and time to surgery in a group of hospitals that is representative of the wider population. It identifies barriers to effective practice and will inform system improvements. Methods. Data capture was by collaborative approach. Patients undergoing procedures from 22 August 2022 and operated on before 31 October 2022 were included. Arm one captured weekly caseload and theatre capacity. Arm two concerned patient and injury demographics, and time to surgery for specific injury groups. Results. Data was available from 90 hospitals across 86 data access groups (70 in England, two in Wales, ten in Scotland, and four in Northern Ireland). After exclusions, 709 weeks' of data on theatre capacity and 23,138 operations were analyzed. The average number of cases per operating session was 1.73. Only 5.8% of all theatre sessions were dedicated day surgery sessions, despite 29% of general trauma patients being eligible for such pathways. In addition, 12.3% of patients experienced at least one cancellation. Delays to surgery were longest in Northern Ireland and shortest in England and Scotland. There was marked variance across all fracture types. Open fractures and fragility hip fractures, influenced by guidelines and performance renumeration, had short waits, and varied least. In all, nine hospitals had 40 or more patients waiting for surgery every week, while seven had less than five. Conclusion. There is great variability in operative demand and list provision seen in this study of 90 UK hospitals. There is marked variation in nearly all injuries apart from those associated with performance monitoring. There is no evidence of local network level coordination of care for orthopaedic trauma patients. Day case operating and pathways of care are underused and are an important area for service improvement. Cite this article: Bone Jt Open 2023;4(6):463–471

INTRODUCTION. Hallux Valgus is a common foot condition, which may affect mobility and lifestyle. Corrective surgery is performed as a day case procedure, however, post-operatively; patients remain limited in their ability to drive for a variable period. In the laboratory settings, emergency brake response time after first metatarsal osteotomy has been studied but there is no published study of patients’ experience of driving after this surgery. This study was aimed at assessing patients’ driving ability and comfort after Hallux Valgus corrective surgery. METHODS. Fifty consecutive patients who underwent first metatarsal corrective osteotomy from January 2009 to July 2010 were reviewed. The operation type, foot side operated, postoperative complications and other conditions affecting driving were recorded from charts and operation notes. A telephonic survey was then conducted and information was recorded in a predesigned questionnaire. The questions included driving advice given by the medical staff, time interval to begin driving postoperatively, and how long the patient took to gain full confidence at driving. It was also noted whether patients required changing the type of car from manual to automatic. RESULTS. Of 50 patients, 10 never drove and were excluded. One patient had expired from unrelated health conditions. Two discontinued driving after surgery due to other (social) reasons, and one could not be contacted. The remaining thirty-six patients were analyzed. The mean age was 56.8+/-9.8 years with range of 36–74 years. Most were females (n=33, 91.7%), and the right side was operated upon in 17 (44.4%) patients. SCARF osteotomy was performed in 19 (52.8%) patients, basal osteotomy in 5 (13.9%), chevron osteotomy in 5 (13.9%) and other procedures (bunionectomy, Akin, soft tissue correction etc) were done in 7 (19.4%) patients. Out of the 28 patients driving manual cars, one required changing to automatic vehicle. The average post-operative period when patients resumed driving was 8.6 weeks with a range of 4 to 16 weeks. After SCARF, this average was 8.3 weeks (range 6–16), which was against 7.6(range 6–16) and 7.8 (range 4–12) weeks after basal and chevron procedures respectively (p=0.408). The mean period when patients reported comfortable foot control was 1.06 weeks after they had begun to drive for all groups. With SCARF this was 1.3 weeks, and 1.4 and 2.2 for basal and chevron groups respectively (p=0.162). Of the two patients that resumed driving after 16 weeks, one had infection and swelling of the foot postoperatively and the other had bilateral basal osteotomy performed simultaneously and was on crutches for 16 weeks. CONCLUSION. The mean time to resumption of automobile driving after corrective Hallux Valgus surgery is 8.6 weeks, and, on average patients takes another week to attain full confidence and comfort at driving postoperatively. There is no statistically significant difference between the types of surgery performed

Aim

The aim of this study was to compare the cost-effectiveness of intramedullary nail fixation and ‘locking’ plate fixation in the treatment of extra-articular fractures of the distal tibia.

Aims

The anterior pelvic internal fixator is increasingly used for the treatment of unstable, or displaced, injuries of the anterior pelvic ring. The evidence for its use, however, is limited. The aim of this paper is to describe the indications for its use, how it is applied and its complications.

Aims

A pragmatic multicentre randomised controlled trial (PROFHER) was conducted in United Kingdom National Health Service (NHS) hospitals to evaluate the clinical effectiveness and cost effectiveness of surgery compared with non-surgical treatment for displaced fractures of the proximal humerus involving the surgical neck in adults.

In a randomised trial involving 598 patients with 600 trochanteric fractures of the hip, the fractures were treated with either a sliding hip screw (n = 300) or a Targon PF intramedullary nail (n = 300). The mean age of the patients was 82 years (26 to 104). All surviving patients were reviewed at one year with functional outcome assessed by a research nurse blinded to the treatment used. The intramedullary nail was found to have a slightly increased mean operative time (46 minutes (sd 12.3) versus 49 minutes (sd 12.7), p < 0.001) and an increased mean radiological screening time (0.3 minutes (sd 0.2) versus 0.5 minutes (sd 0.3), p <  0.001). Operative difficulties were more common with the intramedullary nail. There was no statistically significant difference between implants for wound healing complications (p = 1), or need for post-operative blood transfusion (p = 1), and medical complications were similarly distributed in both groups. There was a tendency to fewer revisions of fixation or conversion to an arthroplasty in the nail group, although the difference was not statistically significant (nine versus three cases, p = 0.14). The extent of shortening, loss of hip flexion, mortality and degree of residual pain were similar in both groups. The recovery of mobility was superior for those treated with the intramedullary nails (p = 0.01 at one year from injury).

In summary, both implants produced comparable results but there was a tendency to better return of mobility for those treated with the intramedullary nail.