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
The aim of this study was to measure the effect of
Aims.
Aims. Open fractures of the tibia are a heterogeneous group of injuries that can present a number of challenges to the treating surgeon. Consequently, few surgeons can reliably advise patients and relatives about the expected outcomes. The aim of this study was to determine whether these outcomes are predictable by using the Ganga
This study assessed whether patient satisfaction with their
Introduction. This study evaluates the need for limb reconstruction surgery in Syria and gives examples of how this service has been delivered by UK surgeons. The conflict in Syria has resulted in over 500,000 deaths and 1.2 million injured. There is not yet a centre for limb reconstruction surgery in the country. Injuries from gunshots and shrapnel were not common prior to the civil war resulting in a paucity of experience. Methods. The senior author spent two weeks in Syria to perform limb reconstruction surgery, to help to train local surgeons and assess the capacity of the facilities available to cope with the limb reconstruction workload. Results. 93 outpatients were assessed over the course of ten days, and 72 of these required definitive surgical intervention. 33 of these patients were candidates for intervention with circular frames. As well as outpatient assessment, surgical procedures were carried out on 22 patients. 11 procedures involved the application of circular frames; 4 involved the application of monolateral fixators and there were 2 other frame related procedures. Discussion. The lack of definitive capacity exists because of shortfalls in equipment, training, and surgical time. The outpatient assessments of patients given temporary or no treatment, who require definitive surgical intervention allows a projection of the need for 3900 surgical procedures over the course of a year, for the patients within the catchment area of this
Death during the first year after hip fracture may be influenced by the type of
Rivaroxaban, an oral direct factor Xa inhibitor was introduced for thromboprophylaxis at the Royal Cornwall
Aim. We studied the characteristics of patient attendances at the Camp Bastion Field
Introduction. The length of
National guidelines recommend that trauma centres have a designated consultant for managing metastatic bone disease (MBD). No such system exists in Scotland. We compared MBD cases in a trauma
Between October 2001 and February 2002, 324 healthcare workers were screened for methicillin-resistant Staphylococcus aureus (MRSA) by nose and throat swabs. A positive finding led to activation of a standardised control programme for the affected person who was immediately excluded from work. Family members of those who were MRSA-positive were offered screening free of charge. An eradication programme was carried out in the permanent carriers. MRSA was found in 17 (5.3%) healthcare workers, 11 of whom proved to be permanent carriers, and six temporarily colonised. Three children of a positive healthcare worker showed nasopharyngeal MRSA, the acquisition of which occurred within the
Aims. The aim of this study was to statistically analyse the incidence and distribution of forearm fractures in the adult age group (3rd–10th Decades) between 1997 and 2009. Methods. Records of patients with forearm fractures were retrieved from the
Objectives. To determine the morbidity and mortality outcomes of patients
presenting with a fractured neck of femur in an Australian context.
Peri-operative variables related to unfavourable outcomes were identified
to allow planning of intervention strategies for improving peri-operative
care. Methods. We performed a retrospective observational study of 185 consecutive
adult patients admitted to an Australian metropolitan teaching hospital
with fractured neck of femur between 2009 and 2010. The main outcome
measures were 30-day and one-year mortality rates, major complications
and factors influencing mortality. . Results. The majority of patients were elderly, female and had multiple
comorbidities. Multiple peri-operative medical complications were
observed, including pre-operative hypoxia (17%), post-operative
delirium (25%), anaemia requiring blood transfusion (28%), representation
within 30 days of discharge (18%), congestive cardiac failure (14%),
acute renal impairment (12%) and myocardial infarction (4%). Mortality
rates were 8.1% at 30 days and 21.6% at one year. Factors predictive
of one-year mortality were American Society of Anesthesiologists
(ASA) score (odds ratio (OR) 4.2 (95% confidence interval (CI) 1.5
to 12.2)), general anaesthesia (OR 3.1 (95% CI 1.1 to 8.5)), age
>
90 years (OR 4.5 (95% CI 1.5 to 13.1)) and post-operative oliguria
(OR 3.6 (95% CI 1.1 to 11.7)). Conclusions. Results from an Australian metropolitan teaching
The Whole
Background. With the recent trend towards enhanced care in joint replacement, it has become increasingly important to identify and address the areas that affect early patient length of stay, while ensuring that practice remains safe. As part of an enhanced care program we conducted two prospective studies of factors delaying discharge following hip replacement in 2006 and 2010. Materials and Methods. In each limb of the study data was collected prospectively daily, by an independent observer, on 100 consecutive primary cemented total hip replacements. Reasons for delay to the discharge and variation from the patient pathway were identified and addressed. Results. The mean length of stay in
Previous studies on the timing of surgery for fracture of the hip provide conflicting evidence as to the effect of prolonged delay before operation. We have prospectively reviewed 3628 such fractures in patients older than 60 years of age. Those for whom the delay was for medical reasons were excluded. Patients were followed up for one year or until death. Operation was undertaken within 48 hours in 95.2% and after this in 4.8%. A significant increase in length of stay was found in patients operated on after 48 hours when compared with those in the earlier group (21.6 vs 32.5 days). No increase in
Background:. Lower limb reconstruction is performed in trauma centres where uplifted tariffs support the treatment of severely injured patients. Calculation of Healthcare Resource Groups (HRG4) codes is affected by the accuracy of clinical coding, determining the financial viability of this service in a district general
MHRA guidance for patients with metal on metal hip replacements (MOM) was provided in 2012 and updated in 2017 to assist in the early detection of soft tissue reactions due to metal wear debris. A large number of metal on metal hip replacements were undertaken at our trust. A program of recall for all patients with metal on metal hip replacements was undertaken and MHRA guidelines implemented. Identification and recall of all patients from 2001 with MOM hip replacements using theatre logs, patient records and consultant log books. Two consultant review of X-rays and patient records. Postal questionnaires and GP requests for cobalt & chromium blood tests. Two consultant led MOM review clinics undertaken with metal artefact reduction scans (MARS) performed following consultation in 2017. 674 patients, 297 available for review. 59 refused follow up. 87 moved out of area, 36 untraceable, 26 not MOM, 147 RIP, 22 already revised. From 297 patients 126 female, 171 male, age range 39 – 95 yrs. 126 resurfacing, 171 MOM THR. 26 patients with elevated metal ions, MARS performed of which 17 positive, 9 negative. Of 17 positive scans 10 patients asymptomatic, 7 waiting revision. A time consuming effort and additional resource was needed and supported by the trust. From 297 hips 17 positive MARs were identified (5.7%). A new database registry has been developed to track MOM patients, clinics set up for ongoing follow up with radiological protocols for imaging. An arthroplasty advanced nurse practitioner (ANP) is now trained reviewing patients independently.
Introduction. New methods to reduce inpatient stay, post-operative complications and recovery time are continually being sought in surgery. Many factors affect length of