Background. Patients requiring lower limb reconstruction have often undergone significant trauma. In some patients this is a consequence of self-harm, others develop depression as a result of the accidental trauma that caused their injury. Little is known of the extent of the problem and how it changes over the course of their treatment. Design and Methods. Patients undergoing limb reconstruction in a major trauma centre were asked to complete an online questionnaire on the day of surgery. This included a Zung self-rating depression score, LEFS and EQ5D. They were asked to complete these again at subsequent post-operative time points. Results. Provisional results showed that all 3 outcome measures fluctuated over 6 months. Most patients triggered for at least mild depression on the Zung Self Rating Depression score at one or more time points. Not all patients had completed the questionnaire at all time points. Of those who did complete multiple time points, there was variation in the change in LEFS. Conclusion. Patients undergoing lower limb reconstruction are vulnerable to depression. There may be a correlation between mood and lower limb function. Gaining better understanding of these problems and how they change over time could help direct services to improve support for these patients

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 hospital (DGH). Methods:. A prospective review of coding was performed for 17 sequential patients treated using ring fixation. Relevant clinical codes and HRG4 tariffs were obtained, allowing comparison with operation notes (including pertinent diagnostic information) and implant costs. Hexapod and paediatric cases were excluded. Results:. Mean implant costs were £3,300 and mean tariffs were £9,300. However, the tariffs for the care episodes which did not attract a code for ‘reconstruction’ were lower, averaging £4,300. Clinical outcomes were comparable to published literature. No uplift was received. Discussion:. Despite attempts to avoid mis-coding for the fledgling service and factoring ancillary costs of patient care, the ring fixation procedures which resulted in HRG4 codes other than those for limb reconstruction cost the trust more than it received. Conclusion:. Lower limb reconstruction is barely financially viable even when coding is carefully performed. It is financially easier for this Trust to transfer patients to a trauma centre

Introduction. Open fractures are managed in the UK guided by standards issued by the BOAST-4 standards. A study was undertaken to evaluate compliance with these standards in a regional trauma unit (MTU), and compared following upgrading to a Major Trauma Centre (MTC). Methods. Compliance was assessed against 11 of the 15 BOAST-4 standards (7, 9, 10 and 15 were not assessed). Patients were included with open diaphyseal tibial fractures (AO 42-), admitted to the department in the year before and the year after the Major Trauma Centre opened. Results. A total of 78 patients were evaluated; 30 within the MTU and 48 as a MTC. Of the 11 standards assessed, 6 (at least in part), achieved 100% compliance in the MTU study, and 5 in the MTC study. Compliance was poor for; antibiotic use in relation to definitive wound closure, formulating a joint plan, and undergoing surgery on a planned trauma list. In contrast, following MTC status antibiotic compliance had improved, as had evidence of joint planning, although antibiotic administration time on admission had declined. Consultant-level orthopaedic and plastic surgeon involvement at first intervention had improved, although plastic surgical input remained predominantly registrar-led. Time from injury to definitive stabilisation improved following MTS status. Discussion. This study demonstrates improvements in many aspects of care for open fracture since the MTC opened. However, further improvements can be made, particularly regarding the early treatment pathway. Since this audit a plastic surgeon with specific interest in lower limb reconstruction has been appointed

Specific radiological features identified by Brandser and Marsh were selected for the analysis of acetabular fractures according to the classification of Letournel and Judet. The method employs a binary approach that requires the observer to allocate each radiological feature to one of two groups. The inter- and intra-observer variances were assessed. The presence of articular displacement, marginal impaction, incongruity, intra-articular fragments and osteochondral injuries to the femoral head were analysed by a similar method. These factors were termed ‘modifiers’ and are generally considered when planning operative intervention and, critically, they may influence prognosis.

Six observers independently assessed 30 sets of plain radiographs and CT scans on two separate occasions, 12 weeks apart. They were asked to determine the presence or absence of specific radiological features. This simple binary approach to classification yields an inter- and intra-observer agreement which ranges from moderate to near-perfect (κ = 0.49 to 0.88 and κ = 0.57 to 0.88, respectively). A similar approach to the modifiers yields only slight to fair inter-observer agreement (κ = 0.20 to 0.34) and slight to moderate intra-observer agreement (κ = 0 to 0.55).