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. COVID-19 necessitated abrupt changes in trauma service delivery. We compare the demographics and outcomes of patients treated during lockdown to a matched period from 2019. Findings have important implications for service development. Methods. A split-site service was introduced, with a COVID-19 free site treating the majority of trauma patients. Polytrauma, spinal, and paediatric trauma patients, plus COVID-19 confirmed or suspicious cases, were managed at another site. Prospective data on all trauma patients undergoing surgery at either site between 16 March 2020 and 31 May 2020 was collated and compared with retrospective review of the same period in 2019. Patient demographics, injury, surgical details, length of stay (LOS), COVID-19 status, and outcome were compared. Results. There were 1,004 urgent orthopaedic trauma patients (604 in 2019; 400 in 2020). Significant reductions in time to theatre and LOS stay were observed. COVID-19 positive status was confirmed in 4.5% (n = 18). The COVID-19 mortality rate was 1.8% (n = 7).
ARI is a busy trauma unit (catchment: 500 000 people). In September 2010 a
The primary aim was to estimate the cost-effectiveness of routine operative fixation for all patients with humeral shaft fractures. The secondary aim was to estimate the health economic implications of using a Radiographic Union Score for HUmeral fractures (RUSHU) of < 8 to facilitate selective fixation for patients at risk of nonunion. From 2008 to 2017, 215 patients (mean age 57 yrs (17 to 18), 61% female (n = 130/215)) with a nonoperatively managed humeral diaphyseal fracture were retrospectively identified. Union was achieved in 77% (n = 165/215) after initial nonoperative management, with 23% (n = 50/215) uniting after surgery for nonunion. The EuroQol five-dimension three-level health index (EQ-5D-3L) was obtained via postal survey. Multiple regression was used to determine the independent influence of patient, injury, and management factors upon the EQ-5D-3L. An incremental cost-effectiveness ratio (ICER) of < £20,000 per quality-adjusted life-year (QALY) gained was considered cost-effective.Aims
Methods
The Open-Fracture Patient Evaluation Nationwide (OPEN) study was performed to provide clarity in open fracture management previously skewed by small, specialist centre studies and large, unfocused registry investigations. We report the current management metrics of open fractures across the UK. Patients admitted to hospital with an open fracture (excluding phalanges or isolated hand injuries) between 1 June 2021 and 30 September 2021 were included. Institutional information governance approval was obtained at the lead site and all data entered using Research Electronic Data Capture software. All domains of the British Orthopaedic Association Standard for Open Fracture Management were recorded.Aims
Method
Fractures of the distal radius are common, and form a considerable proportion of the trauma workload. We conducted a study to examine the patterns of injury and treatment for adult patients presenting with distal radius fractures to a major trauma centre serving an urban population. We undertook a retrospective cohort study to identify all patients treated at our major trauma centre for a distal radius fracture between 1 June 2018 and 1 May 2021. We reviewed the medical records and imaging for each patient to examine patterns of injury and treatment. We undertook a binomial logistic regression to produce a predictive model for operative fixation or inpatient admission.Aims
Methods
We reviewed our results and complications of using a pre-bent 1.6mm Kirschner wire (K-wire) for extra-articular metacarpal fractures. The surgical procedure was indicated for angulation at the fracture site in a true lateral radiograph of at least 30 degrees and/or in the presence of a rotatory deformity. A single K-wire is pre-bent in a lazy-S fashion with a sharp bend at approximately 5 millimetres and a longer smooth curve bent in the opposite direction. An initial entry point is made at the base of the metacarpal using a 2.5mm drill by hand. The K-wire is inserted blunt end first in an antegrade manner and the fracture reduced as the wire is passed across the fracture site. With the wire acting as three-point fixation, early mobilisation is commenced at the metacarpo-phalangeal joint in a Futuro hand splint. The wire is usually removed with pliers post-operatively at four weeks in the fracture clinic. We studied internal fixation of 18 little finger and 2 ring finger metacarpal fractures from November 2007 to August 2009. The average age of the cohort was 25 years with 3 women and 17 men. The predominant mechanism was a punch injury with 5 diaphyseal and 15 metacarpal neck fractures. The time to surgical intervention was a mean 13 days (range 4 to 28 days). All fractures proceeded to bony union. The wire was extracted at an average of 4.4 weeks (range three to six weeks). At an average follow up of 8 weeks, one fracture had to be revised for failed fixation and three superficial wound infections needed antibiotic treatment. With this simple and minimally invasive technique performed as
Introduction. The role of in-situ decompression in patients with severe ulnar nerve compression is still controversial. The authors present a prospective study on the results of in-situ decompression in this selected group of patients treated through a mini open incision (4cms) and complete decompression by appropriate patient positioning. Material/Methods. Thirty patients (20 Male/10 Female) with severe degree of nerve compression, confirmed clinically by Dellon's classification and by abnormal Nerve Conduction Study, underwent simple in-situ decompression under general anaesthesia as a
The primary aim of this study was to establish the cost-effectiveness of the early fixation of displaced midshaft clavicle fractures. A cost analysis was conducted within a randomized controlled trial comparing conservative management (n = 92) Aims
Patients and Methods
A single antegrade Rush nail was used to treat 37 fractures of the distal humerus extending to the olecranon fossa and up to 6.5 cm proximal to it. In order to stabilise the fracture, the bent tip of the Rush nail was directed into the lateral epicondylar ridge. This gave immediate stability. All the fractures united without residual stiffness of the shoulder or elbow.