Aims. The aim of this study was to perform the first population-based description of the epidemiological and health
Aims. The aim of this study was to investigate the relationship between the Orthopaedic Trauma Society (OTS) classification of open fractures and
Aims. This study aims to estimate
Aims. The aim of this study was to estimate
Aims. The aim of this study was to estimate the cost-effectiveness of negative-pressure wound therapy (NPWT) in comparison with standard wound management after initial surgical wound debridement in adults with severe open fractures of the lower limb. Patients and Methods. An
Aims. To compare the cost-effectiveness of high-dose, dual-antibiotic cement versus single-antibiotic cement for the treatment of displaced intracapsular hip fractures in older adults. Methods. Using data from a multicentre randomized controlled trial (World Hip Trauma Evaluation 8 (WHiTE-8)) in the UK, a within-trial
Aims. 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
Aims. To compare the cost-utility of standard dressing with incisional negative-pressure wound therapy (iNPWT) in adults with closed surgical wounds associated with major trauma to the lower limbs. Methods. A within-trial
The Covid-19 pandemic restricted access to elective arthroplasty theatres. Consequently, there was a staggering rise in waiting times for patients awaiting total hip arthroplasty (THA). Concomitantly, rapidly destructive osteoarthritis (RDOA) incidence also increased. Two cohorts of patients were reviewed: patients undergoing primary THA, pre-pandemic (December 2017-December 2018) and patients with RDOA (ascertained by dual consultant review of pre-operative radiographs) undergoing THA after the pandemic started (March 2020 – March 2022). There were 236 primary THA cases in the pre-pandemic cohort. Out of the 632 primary THA cases post-pandemic, 186 cases (29%) had RDOA. Within this RDOA cohort, the pre-operative mean OHS, EQ5D3L and EQVAS (12.7, 10.5 and 57.6 respectively) were all poorer than in the pre-pandemic population (18.3, 9.4 and 66.7 respectively) (p<0.05). There was no significant difference between the RDOA and pre-pandemic cohort in Patient Reported Outcome Measures (PROMS) at 12 months, perhaps due to their ceiling effect. Within the RDOA cohort, 7 cases required acetabular augments, 1 of which also required femoral shortening. The rate of intra-operative fracture, dislocation, infection, return to theatre, and revision were 2.2%, 2.7%, 4.3%, 3.8% and 2.2% respectively, greater than those reported in the literature. No fractures nor dislocations occurred in robot assisted arthroplasties. With ever increasing waiting lists, RDOA prevalence will continue to rise. Increased surgical challenges and potential use of additional implants generated by its presence excludes these patients from waiting list initiative pathways, potentiating the complexity of the operative procedure. Going forwards, the
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. Patients and Methods. An
Frozen shoulder is a common condition that affects the working population. The longevity and severity of symptoms often results in great
Aims. This 501-patient, multi-centre, randomised controlled trial sought
to establish the effect of low-intensity, pulsed, ultrasound (LIPUS)
on tibial shaft fractures managed with intramedullary nailing. We
conducted an
This prospective, randomized, controlled trial compares patient outcome after non-operative care versus open reduction and tunneled suspension device fixation (ORTSD) for grade III or IV acromioclavicular joint disruptions. Sixty patients aged between sixteen and thirty-five years with an acute grade III or IV AC joint disruption were randomized to receive ORTSD fixation or non-operative treatment. Functional assessment was conducted at six weeks, three months, six months, and one year using the Disabilities of the Arm, Shoulder and Hands (DASH), Oxford Shoulder Scores (OSS) and Short Form (SF-12). Reduction was evaluated using radiographs. Complications were recorded, and an
Aims. The PROximal Fracture of the Humerus Evaluation by Randomisation
(PROFHER) randomised clinical trial compared the operative and non-operative
treatment of adults with a displaced fracture of the proximal humerus
involving the surgical neck. The aim of this study was to determine
the long-term treatment effects beyond the two-year follow-up. Patients and Methods. Of the original 250 trial participants, 176 consented to extended
follow-up and were sent postal questionnaires at three, four and
five years after recruitment to the trial. The Oxford Shoulder Score
(OSS; the primary outcome), EuroQol 5D-3L (EQ-5D-3L), and any recent
shoulder operations and fracture data were collected. Statistical
and
Aims. We reviewed all patients who sustained a fracture of the hip
and were treated in Northern Ireland over a period of 15 years to
identify trends in incidence, the demographics of the patients,
the rates of mortality, the configuration of the fracture and the
choice of implant. Patients and Methods. Since 01 January 2001 data about every fracture of the hip sustained
in an adult have been collected centrally in Northern Ireland. All
adults with such a fracture between 2000 and 2015 were included
in the study. Temporal changes in their demographics, the mode of
treatment, and outcomes including mortality were analysed. Results. The incidence of fractures of the hip, in Northern Ireland, rose
from 54 in 100 000 in 2000 to 86 in 100 000 in 2015. If these trends
continue, we predict this rising to 128 in 100 000 in 2030. We found
that these patients are becoming older and increasingly frail, as
assessed by the American Association of Anesthesiology grade. Complex extracapsular
fractures have become more common since 2009, which may explain
the increased use of cephalomedullary nails. Despite increasing
frailty, the 30-day and 12-month rates of mortality fell significantly
(p = 0.002 and 0.001, respectively). Conclusion. Fractures of the hip are becoming more common and more complex
in an aging, increasingly frail population. We expect these trends
to continue. This will place an increasing
The aim of this study was to describe the current pathways of care for patients with a fracture of the hip in five low- and middle-income countries (LMIC) in South Asia (Nepal and Sri Lanka) and Southeast Asia (Malaysia, Thailand, and the Philippines). The World Health Organization Service Availability and Readiness Assessment tool was used to collect data on the care of hip fractures in Malaysia, Thailand, the Philippines, Sri Lanka, and Nepal. Respondents were asked to provide details about the current pathway of care for patients with hip fracture, including pre-hospital transport, time to admission, time to surgery, and time to weightbearing, along with healthcare professionals involved at different stages of care, information on discharge, and patient follow-up.Aims
Methods
There is a lack of published evidence relating to the rate of nonunion seen in occult scaphoid fractures, diagnosed only after MRI. This study reports the rate of delayed union and nonunion in a cohort of patients with MRI-detected acute scaphoid fractures. This multicentre cohort study at eight centres in the UK included all patients with an acute scaphoid fracture diagnosed on MRI having presented acutely following wrist trauma with normal radiographs. Data were gathered retrospectively for a minimum of 12 months at each centre. The primary outcome measures were the rate of acute surgery, delayed union, and nonunion.Aims
Methods
The aim of this study was to examine perioperative blood transfusion practice, and associations with clinical outcomes, in a national cohort of hip fracture patients. A retrospective cohort study was undertaken using linked data from the Scottish Hip Fracture Audit and the Scottish National Blood Transfusion Service between May 2016 and December 2020. All patients aged ≥ 50 years admitted to a Scottish hospital with a hip fracture were included. Assessment of the factors independently associated with red blood cell transfusion (RBCT) during admission was performed, alongside determination of the association between RBCT and hip fracture outcomes.Aims
Methods
Aims. Hip hemiarthroplasty is a standard treatment for intracapsular
proximal femoral fractures in the frail elderly. In this study we
have explored the implications of early return to theatre, within
30 days, on patient outcome following hip hemiarthroplasty. Patients and Methods. We retrospectively reviewed the hospital records of all hip hemiarthroplasties
performed in our unit between January 2010 and January 2015. Demographic
details, medical backround, details of the primary procedure, complications,
subsequent procedures requiring return to theatre, re-admissions,
discharge destination and death were collected. Results. A total of 705 procedures were included; 428 Austin Moore and
277 Exeter Trauma Stems were used. A total of 34 fractures (in 33
patients) required early return to theatre within 30 days. Age,
gender, laterality, time from admission to primary procedure, American
Society of Anesthesiologists grade, and implant type were similar
for those requiring early return to theatre and those who did not.
Early return to theatre was associated with a significantly higher
length of stay (mean 33.6 days (7 to 107) versus 18.6
days (0 to 152), p <
0.001), re-admission rate (38.2% versus 8.6%,
p <
0.001), and subsequent revision rate (17.6% versus 1.3%,
p <
0.001). We found no difference in level of care required
on discharge or mortality. Conclusion. Proximal femoral fractures are common in the elderly population,
with far-reaching medical and
Ankle fracture fixation is commonly performed by junior trainees. Simulation training using cadavers may shorten the learning curve and result in a technically superior surgical performance. We undertook a preliminary, pragmatic, single-blinded, multicentre, randomized controlled trial of cadaveric simulation versus standard training. Primary outcome was fracture reduction on postoperative radiographs.Aims
Methods