Femoral neck fractures are an increasingly common injury in the elderly. Frequently these patients present taking Clopidogrel, an irreversible inhibitor of platelet aggregation. Although this is associated with an increased risk of intra-operative bleeding and also an increased risk of spinal haematoma where regional anaesthesia is employed, the recent SIGN (Scottish Intercollegiate Guidance Network) guidelines recommend that surgery should not be delayed. We conducted a retrospective review of consecutive patients admitted with femoral neck fractures between April 2008 and October 2009. Patients on Clopidogrel were identified and data including ASA grade, time to operation, medical co-morbidities, and post-admission complications were recorded. Comparative information from the National Hip Fracture Database was used.Introduction
Methods
The aim of this study was to evaluate the association between chondral injury and interval from anterior cruciate ligament (ACL) tear to surgical reconstruction (ACLr). Between January 2012 and January 2022, 1,840 consecutive ACLrs were performed and included in a single-centre retrospective cohort. Exclusion criteria were partial tears, multiligament knee injuries, prior ipsilateral knee surgery, concomitant unicompartmental knee arthroplasty or high tibial osteotomy, ACL agenesis, and unknown date of tear. A total of 1,317 patients were included in the final analysis, with a median age of 29 years (interquartile range (IQR) 23 to 38). The median preoperative Tegner Activity Score (TAS) was 6 (IQR 6 to 7). Patients were categorized into four groups according to the delay to ACLr: < three months (427; 32%), three to six months (388; 29%), > six to 12 months (248; 19%), and > 12 months (254; 19%). Chondral injury was assessed during arthroscopy using the International Cartilage Regeneration and Joint Preservation Society classification, and its association with delay to ACLr was analyzed using multivariable analysis.Aims
Methods
Adverse weather conditions during the winter months put increased pressure on orthopaedic trauma departments across the country. The increased incidence of injuries has resulted in a strain on resources at a local level and a situation can arise whereby cases need to be prioritised according to clinical need and fitness of the patient. Ankle fractures, frequently caused by slipping in adverse weather conditions, tend to be an injury where a high proportion of patients are young and active and can therefore cope better physiologically waiting several days for their operation. It is well documented that there is a window of opportunity when operating on ankle fractures, during which the swelling will permit fixation. We aimed to establish whether a link exists between delay to surgery for ankle fractures, the length of post-op hospital stay and the rate of complications. We included all patients who underwent surgical fixation of an ankle fracture over a three month period between 1.1.10 and 31.01.11. Data was obtained through theatre records, discharge and clinic letters and from the local PACS X-ray system. Basic patient data, admission, theatre and discharge dates were collected along with details regarding mechanism of injury, type of fracture, fixation and documented complications. Patients were subdivided into two groups: those who underwent surgery within 48 hours of injury and those who waited longer than 48 hours. Many of the patients in the delayed surgery group remained inpatient until after their surgery whilst those more capable of mobilising with crutches were allowed home to elevate. 64 patients underwent fixation of an acute ankle fracture during the three month study period. 28 patients (44%) had a documented fall on ice or snow. 29 patients were operated upon within 48 hours. 35 patients surgery was delayed by a mean of 9 days (3-28). The mean length of post op hospital stay for the early surgery group was 3.00 days. In the delayed surgery group the mean length of stay was 4.28 days (p=0147). There were 4 complications in the early group (14%) compared with 7 in the delayed group (20%).
Objective: To assess the safety and outcome of laminectomy in patients with spinal stenosis operated at the age of 65 years or older. The relation between the duration of the symptoms and results was investigated. Study Design: A retrospective chart analysis with up to 10 years follow-up. Setting: The Spinal Care Unit, Meir Medical Center, Kfar Saba, Israel. Material and Methods: The medical records of all patients who had laminectomy for spinal stenosis at the age of 65 or more in a 10 years period were reviewed. Assessment of pain, ability to perform the basic activities of daily living, transferring dressing and basing before and after the operation was done by a telephone interview. Patient’s self-estimation of the final result of the surgery was also recorded. Results: Two hundred eight-three patients were eligible to participate in the study. They were allocated into 3 groups according to the duration of symptoms before surgery. Group A with symptoms lasting up to 24 months, B with 25–48 months and C with symptoms lasting for more than 48 months. The average age at the time of the operation was 68.9, 72.6 and 71.3 years, respectively. Forty-eight patients died and 18 refused or were not able to participate in the study. The average time of follow-up was 43.3 months, 42.2 in group A, 47.4 in B and 42.8 in C. No significant differences were noticed in the demographic, anesthetic and surgical parameters among the 3 groups. There were no mortality cases in the immediate postoperative period. The overall complication rate was 43.5%, nearly identical in all 3 groups. Two patients had cerebrovascular accident and 5 had myocardial ischemia but no one turned into infarction. Mild complications included 11 urinary retention, 24 urinary tract infections and 11 patients with superficial wound infection. Twenty-two patients were re-operated along the follow-up period. There was remarkable improvement in the perception of pain, walking distances and in the ability to perform basic activities of daily living in all 3 groups. Self-assessment of the final results disclosed 70% satisfied patients in group A, 67% in B and 67% in C. Conclusion: Surgery for spinal stenosis in elderly patients is safe and often lead to significant relief of pain and improvement in the quality of life.
The aim of this study was to assess medium-term improvements following total hip arthroplasty (THA), and to evaluate what effect different preoperative Oxford Hip Score (OHS) thresholds for treatment may have on patients’ access to THA and outcomes. Patients undergoing primary THA at our institution with an OHS both preoperatively and at least four years postoperatively were included. Rationing thresholds were explored to identify possible deprivation of OHS improvement.Aims
Methods
This review considers the surgical treatment
of displaced fractures involving the knee in elderly, osteoporotic patients.
The goals of treatment include pain control, early mobilisation,
avoidance of complications and minimising the need for further surgery.
Open reduction and internal fixation (ORIF) frequently results in
loss of reduction, which can result in post-traumatic arthritis
and the occasional conversion to total knee replacement (TKR). TKR
after failed internal fixation is challenging, with modest functional
outcomes and high complication rates. TKR undertaken as treatment
of the initial fracture has better results to late TKR, but does
not match the outcome of primary TKR without complications. Given
the relatively infrequent need for late TKR following failed fixation,
ORIF is the preferred management for most cases. Early TKR can be
considered for those patients with pre-existing arthritis, bicondylar
femoral fractures, those who would be unable to comply with weight-bearing restrictions,
or where a single definitive procedure is required.
Necrotising fasciitis is a rapidly spreading, life-threatening condition. We report a case of necrotising fasciitis in a 71-year-old woman after a primary total hip replacement which became deeply infected as a result.
