Aims. No randomized comparative study has compared the extensile lateral approach (ELA) and sinus tarsi approach (STA) for Sanders type 2 calcaneal fractures. This randomized comparative study was conducted to confirm whether the STA was prone to fewer wound complications than the ELA. Methods. Between August 2013 and August 2018, 64 patients with Sanders type 2 calcaneus fractures were randomly assigned to receive surgical treatment by the ELA (32 patients) and STA (32 patients). The primary outcome was development of wound complications. The secondary outcomes were postoperative complications, pain scored of a visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, 36-item Short Form health survey, operative duration, subtalar joint range of motion (ROM), Böhler’s angle and calcaneal width, and posterior facet reduction. Results. Although four patients (12.5%) in the ELA groups and none in the STA group experienced complications, the difference was not statistically significant (p = 0.113). VAS and AOFAS score were significantly better in the STA group than in the ELA group at six months (p = 0.017 and p = 0.021), but not at 12 months (p = 0.096 and p = 0.200) after surgery. The operation time was significantly shorter in the STA group than in the ELA group (p < 0.001). The subtalar joint ROM was significantly better in the STA group (p = 0.015). Assessment of the amount of postoperative reduction compared with the uninjured limb showed significant restoration of calcaneal width in the ELA group compared with that in the STA group (p < 0.001). Conclusion. The ELA group showed higher frequency of wound complications than the STA group for Sanders type 2 calcaneal fractures even though this was not statistically significant. Cite this article: Bone Joint J 2021;103-B(2):286–293

Introduction. Unicompartmental arthroplasty is still a controversial issue in knee replacement, mainly due to a marked variation in published survival rates of the implants. The aim of this study was to analyse possible risk factors for revision following Oxford unicompartmental knee arthroplasties (OUKA). Material and methods. Since 1997 data for all patients with primary and revision knee arthroplasties performed in our department have been stored in a database. Selected for the present study was all primary OUKA performed in the period 1997–2006 as well as any revision following these operations until the end of 2008. We got information from The National Health Register and the CPR register about any revision performed at other institutions and date in case of death. Primary OUKA were grouped in three categories according to the experience of the surgeon: 1 for operation done by a surgeon who had performed less than 20 OUKA, 2 for operation by a surgeon who had performed 20–40, and 3 for operation by a surgeon who had performed more than 40. Risk of revision was analysed by Cox regression. Revisions due to pain as the only reason were excluded from the analyses. Age and gender of the patients, previous surgical intervention, operation time, and the experience of the surgeon were included as possible risk factors in the analysis. Results. 445 primary Oxford knee arthroplasties were included. These were followed by 46 revisions. The indications for the revisions were: aseptic loosening 16 knees, progression of the osteoarthritis to the lateral compartment 7 knees, dislocation of the polyethylene meniscus 5 knees, varus-valgus instability 3 knees, fracture of the medial tibia condyle 3 knees, collision of the polyethylene meniscus and the femur condyle 1 knee, and pain as the only reason 11 knees. Age and gender of the patients as well as previous surgical intervention in the knee in question were not correlated to the risk of revision. Operation time was correlated to risk of revision with decreasing risk with increasing operation time (p=0,001). The experience of the surgeon was also correlated to risk of revision with decreasing risk with increasing experience (p=0,02). The 6 years survival rate for an experienced surgeon using an operation time at 90 min. or more was 97,5 % compared to a survival rate at 78,7 % for an inexperienced surgeon with an operation time less than 90 min. Conclusion. OUKA performed by an inexperienced surgeon and OUKA performed with short operation time had marked reduced survival rates. This seems to be an essential information to institutions performing OUKA

Introduction. Although tension band wiring fixation of patellar fracture has been the most widely used technique, the metal implants related complications including implant loosening, postoperative pain are very common and additional surgeries are often necessary. Hypothesis. A totally metal free technique of transosseous suturing method could outperform the traditional fixation technique. Materials & Methods. A total of 25 patients (mean age of 59.60 years) with displaced patellar fracture treated by transosseous suturing technique were compared with a 1:1 matched historical control group who underwent modified tension band wiring fixation of patellar fracture. Union time, union rate, operation time, number of procedures, mean hospitalization days and the complications were compared between cases and controls. Results. Union time (8.43 ±2.92 weeks versus 8.64 ±2.82 weeks) and operation time (69.00 ±19.31 versus 64.89 ±14.27 minutes) were not different between two groups. Mean hospitalization days (4.04 ±1.40 versus 5.76 ±1.50 days; P < 0.001), number of procedures and the frequency of complications were significantly lower among transosseous suturing group (P< 0.001). Conclusions. Transosseous suturing technique is safe and effective in the transverse or comminuted fractures of patella. The complication rate is significantly lower than that of conventional tension band wiring technique

Introduction. Depending on patient's age, risk factors and pretraumatic mobility, a total- or hemiarthroplasty of the hip have become the treatment of choice in femoral neck fractures(1–4). Internal fixation has shown to provide minor results. The majority of these patients are therefore treated by a hemiarthroplasty of the hip. Since the primary goal is to regain the pretraumatic level of mobility as soon as possible(3;5), we sought to investigate, if a minimal invasive anterior approach would be beneficial in regard of perioperative blood loss(6), postoperative pain(7;8) and thus postoperative mobility(9). Patients and methods. In a randomised controlled trial, 48 patients were treated by a hemiarthroplasty of the hip via an anterior or lateral approach in supine position within 72 hours after trauma(10). Apart from parameters like age, ASA-Score or Body-mass-index, the main focus was set on perioperative blood loss, pain and postoperative mobilisation. All data collected were compared between groups to detect statistical significant differences. Additionally the same parameters were checked for significant differences comparing patients with or without complications within their group. Results. A significant difference between groups was found for postoperative pain within the first 72 hours and for operation time, both to the disadvantage of the minimal invasive approach group. Within groups, time of operation and patient's age were significantly higher in patients with complications in the minimal invasive group such as pain at 48 hours was rated higher in patients with complications in the lateral approach group. These results though did not seem to influence postoperative mobility since no significant differences were found between groups at follow-up. Conclusion. Despite some differences in the postoperative course, postoperative mobility does not seem to be greatly influenced by the choice of the approach for hemiarthroplasty of the hip in femoral neck fractures. Still, the operation time was significantly linked to postoperative complications. In this respect, it can be concluded, that the approach an individual surgeon is most familiar with is likely to lead to best results

Introduction. Significant access morbidity with intercostal neuralgia and post-thoracotomy pain syndrome was reported in case that an anterior approach for spondylodesis of fractures of the thoracolumbar spine was used. We describe our experience with thoracoscopical fusion from anterior as a less invasive approach. Patients. Between 02/2007 and 09/2008 in a series of 32 patients (18 male; mean age 43, 17–74yrs) with fractures of the thoracolumbar spine (level Th11: n = 2, level Th12: n = 12, level L1: n = 18; fracture types: A3.1.1: n = 15, A3.2.1: n = 11, A3.3.1: n = 3, B2.1: n = 1 and B2.3: n = 2) thoracoscopical fracture stabilization was performed. A less invasive approach with three portals without an assistant was used facilitated by a new retractor system. In 16 patients fracture stabilization from anterior was supported by an additional spondylodesis using an dorsal approach. For reconstruction of the anterior column a VLIFT-system (n = 19), a Synex- (n = 11) or a Harms-Cage (n = 2) in combination with a MACS-TL (n = 16) or a Arcofix-system (n = 2) were used. Results. Thoracoscopical fusion from anterior was performed about 8 days after the injury (1–73 days), monosegmental in 11 and bisegmental in 21 out of 32 cases. The mean overall operating time was 201min (range 105–380min). The mean overall blood loss was 780ml, in 3/32 patients blood transfusions were required. In one patient epidural bleeding and in another a screw cut-out of the MACS system of the first lumbar vertebral body occurred intraoperatively. Revision surgery was necessary due to failure of the hardware (n = 2) or occurrence of hematothorax (n = 1). In the further follow up period no wound healing disorders, failure of the implants nor intercostal neuralgia were noted. Discussion. The endoscopic view is two-dimensional and may disorientate the less experienced surgeon, and thus, prolong operation time. However, the use of a retractor system allowed for bimanual operation increasing the depth perception, provided an optimal illuminated, and permanent and stable operation field, and was economic as an assistant was not required. Conclusion. The presented technique is a high demanding approach for anterior fusion of fractures of the thoracolumbar spine, however, with the potential to reduce the surgical access trauma to a minimum with an operation time comparable to open surgery. Patients might benefit from a shortened rehabilitation and a early reintegration into professional life

Scheuermann's kyphosis is a structural deformity of the thoracic or thoracolumbar spine, which can result in severe pain, neurological compromise and cosmetic dissatisfaction. Modern surgical techniques have improved correction through a posterior-only or antero-posterior approach but can result in significant morbidity. We present our results of the surgical management of severe Scheuermann's kyphosis by a single surgeon with respect to deformity correction, global balance parameters, functional outcomes and complications at latest follow-up. We included 49 patients, of which 46 had thoracic and 3 had thoracolumbar kyphosis. Surgical indications included persistent back pain, progressive deformity, neurological compromise and poor self-image. Fourty-seven patients underwent posterior-only and 2 antero-posterior spinal arthrodesis utilising Chevron-type osteotomies and hybrid instrumentation. Mean age at surgery was 16.0 years with mean postoperative follow-up of 4.5 years. Mean kyphosis corrected from 92.1o to 46.9o (p<0.001). Concomitant scoliosis was eliminated in all of the 28 affected patients. Coronal and sagittal balance was corrected in all patients. Mean blood loss was 24% total blood volume. Mean operation time was 4.3 hours with mean inpatient stay of 9 days. SRS-22 questionnaire improved from a mean preoperative score of 3.4 to 4.6 at 2 years, with high treatment satisfaction rates. Complications included one toxic septicaemia episode but otherwise no wound infections, no junctional deformity, no loss of correction and no requirement for re-operation. Posterior spinal arthrodesis with the use of hybrid instrumentation can safely achieve excellent correction of severe Scheuermann's kyphosis helping to relieve back pain, improve functional outcomes and enhance self-image

We treated 108 patients with a pertrochanteric femoral fracture using either the dynamic hip screw or the proximal femoral nail in this prospective, randomised series. We compared walking ability before fracture, intra-operative variables and return to their residence. Patients treated with the proximal femoral nail (n = 42) had regained their pre-operative walking ability significantly (p = 0.04) more often by the four-month review than those treated with the dynamic hip screw (n = 41). Peri-operative or immediate post-operative measures of outcome did not differ between the groups, with the exception of operation time. The dynamic hip screw allowed a significantly greater compression of the fracture during the four-month follow-up, but consolidation of the fracture was comparable between the two groups. Two major losses of reduction were observed in each group, resulting in a total of four revision operations. Our results suggest that the use of the proximal femoral nail may allow a faster postoperative restoration of walking ability, when compared with the dynamic hip screw

Introduction. In most cases of stable type medial femoral neck fracture and some cases of dislocated medial femoral neck fracture, internal fixation was undertaken. Dual SC Screw (DSCS) System is an internal fixation device which has sliding mechanism and preventing mechanism of back out of the screw. The purpose of this study is to evaluate the results and complication of medial femoral neck fracture treated with DSCS. Methods. Fifty two patients operated for fractures of the medial femoral neck with DSCS were identified as the study population. All patients followed up at least 2years. Outcome measures included the period of bone union, revision surgery, operating times and clinical symptoms and complication. Results. The average operation time was 37 minutes and 49 cased achieved union. Moreover all patients could regain the pre-injury walking ability. Three patient did not achieve union and two patients suffered displacement of reduced fracture and three patients had avascular necrosis of the femoral head. However, the cases of subtrochanteric femral fracture or the back out of the screws were not found. The mechanical tests using imitation bone showed the strength of DSCS. Conclusion. Operative treatment with internal fixation using DSCS in femoral neck fracture gives favorable results because of its strong fixation and holding function of the screw. The operative technique was simple and the DSCS thought to be a useful tool for femoral neck fracture

Introduction. Femur neck fractures (NOF) in the young could result in mal-union, non-union and avascular necrosis of the femoral head. Osteosynthesis is the standard of management in NOFs in young patient above complications sometimes end in Arthroplasty. The aim of our study is to identify predictors of NOF failures in the young population. Method. A retrospective study conducted in a single center. Patients with NOF fractures below the age of <50y excluding pathological and osteoporotic fractures were assessed in the period from 2005–2008. The mean follow-up was 22 months (6–40). Fractures were classified according to Gardens classification. Our Aim was to identify causative factors for fixation failures. Analysis was done using SPSS 17.0. Results. Within the 4 year period we identified 41 NOF fractures, 24 (75%) fractures were displaced. 7 (25%) out of the displaced fractures went in to failure and required arthroplasty. 3 (42%) went in to avascular necrosis and 2(28.5%) went in to screw cut out and non unions. All failures were primarily fixed with cancellous screws. We identified Male sex (p=0.03), Pre-operative delay of >25h (p=0.04), Chronic alcohol intake (p=0.02) and intra operative time >107min (p=0.001) as the main predictors of NOF failures in the young. Conclusion. Early surgical intervention within 25h, restricting the operation time to less than 107min would reduce the failure rates. We would recommend arthroplasty for patients who are chronic alcoholics

Background. Fibrous dysplasia is a developmental anomaly of bone formation that may exist in a monostotic or polystotic form. Surgical treatment is considered advisable only with presence of significant or progressive deformity or persistent pain. Early surgery is indicated before the tumor expands or fracture occurs. Methods. We reviewed a series of 21 patients, 14 had monostotic whereas 7 had polystotic fibrous dysplasia. There was no case of Mc Cune Albright. We treated all of these patients with curettage and corticocancellous bone graft and also fixation with reconstruction nails. Follow up ranged between 1 and 5 years. Functional and radiographic outcomes were scored. Results. Russel Taylor IM nail and Gamma nail were used in 11 and 10 patients, respectively. Their mean age at the time of diagnosis was 28 years for monostotic for of the disease and 20 years for polystotic ones. Postoperatively, All patients had good bone healing and complete incorporation of the implanted graft, although it last longer in the case of corrective osteotomy for severe varus. Using of Gamma nail was easier for us in addition to shorter operation time. Up to now, no case of recurrency or pathologic fracture has been seen in our patients. Chronic hip pain was the most common problem in these patients but they reported no restriction of activity of daily living. Conclusion. Clinical results of reconstruction nails were safe and satisfactory in patients with fibrous dysplasia of proximal femour

Sacroiliac screw fixation is the method of choice for the definitive treatment of unstable posterior pelvic ring injuries; however this technique is demanding and associated with a high risk of iatrogenic neurovascular damage. We therefore evaluated the outcome, complications, surgical and fluoroscopy time for unstable posterior pelvic ring injuries managed with a transiliac locked compression plate. 23 patients were managed with a transiliac locked compression plate for unstable posterior pelvic injuries at a Level I Trauma Center. 21 patients were available for follow up after an average of 30 months and outcome evaluation was performed with the Pelvic Outcome Score, which is composed of a clinical, radiological, and social integration part. The overall outcome for the pelvic outcome score was excellent in 47.6% (10 patients), good in 19% (4 patients), fair in 28.6% (6 patients) and poor in 4.8% (1 patient). 15 out of 21 patients (71.4%) returned to their normal life, 3 patients (14.3%) were limited at work, and 3 patients (14.3%) were not able to return to work due to their disabilities. The social status was unchanged to the preinjury status in 19 patients (90.5%). 13 patients (62%) stated no changes in spare time and sports activities; 4 patients (19%) had minor and another 4 patients (19%) had major restrictions. The average operation time was 101 min and intraoperative fluoroscopic time averaged 74.2 sec. No iatrogenic neurovascular injuries were observed. Posterior percutaneous plate osteosynthesis may be a good alternative to sacral screw fixation because it is quick, safe, and associated with a good functional outcome

Objectives. Juxtafacet cysts of the spine can cause radicular pain, neurological symptoms and are often associated with spinal degeneration. The mainstay of treatment of juxtafacet cysts is surgical resection with laminotomy and resection of the cyst. Other methods, including epidural steroid and facet injections are mostly temporarily effective. The aim of this study is the sufficient decompression with reduced traumatization and destabilization with the full-endoscopic interlaminar and transforaminal technique. Methods. 60 patients with unilateral, single-level juxtafacet cysts were included in this study. 30 Patients (group 1) were operated in full-endoscopic technique (22 interlaminar, 8 trans-/extraforaminal) and 30 Patients (group 2) with conventional microscopic-assisted technique. The full-endoscopic operation was performed with 6.9-mm endoscopes with 4.1-mm intra-endoscopic working canal. The follow-up was 18 months. 27 (91%) patients were followed. Additionally to general parameters validated scores were used. Results. No intraoperative complications occurred. 2 patient in group 1 and 4 patients in group 2 showed transient dysaesthesia. The mean operation time in group 1 was 32 minutes, in group 2 56 minutes. There was no measurable blood loss in group 1, and a mean blood loss of 85 ml in group 2. The follow-up showed satisfactory subjective results in 53 patients. There were no significant differences between the two groups or within group 1 between the transforaminal and interlaminar technique in the clinical results. Group 1 showed significant advantages in different clinical, technical and economical parameters. The maximum time in hospital for group 1 patients was 3 days and 6 days in group 2. No recurrence of the cyst was found in the follow up. Conclusion. The full-endoscopic operation of lumbar facet cysts with full-endoscopic technique is an alternative to the conventional microscopic-assisted procedure for sufficient decompression of juxtafacet cyst. It enables selective procedure with direct visualization, sufficient decompression and less traumatization of the access pathway and the spinal canal structures

Introduction. The usefulness of minimal invasive hip replacement is frequently discussed but there is a lack of data on the effect of the surgical approach on early results. We wanted to study the effect of the surgical approach on the peri- and early postoperative outcome. Material/Methods. In a prospective case control study 315 elective hip replacements were performed between January 2008 and March 2010. Until March 2009 a lateral transgluteal approach (STD) was used, then the approach was changed to a minimal invasive anterior approach (MIS). All operations were performed in the same routine setting not affected by the approach. Duration of operation, complications and bloodloss were assessed. 1 week postoperatively, independent mobility, stairs, central analgetics were analysed and length of stay was recorded. At 6 and 12 weeks, pain and patients satisfaction (VAS) and the Harris Hip Score were assessed. Pre- and postoperative radiographs were compared for component position and orientation (EBRA). Results. 6 patients (hips) refused participation, 4 were excluded for other reasons. 174 (57%) hips belonged to STD and 131 (43%) to MIS. There were no demographic differences between both groups. Operation time was longer for MIS (109 vs. 123 min, p=.001). At 1 week, MIS patients were more mobile (rising up from bed, p=.009; stairs, p=.015) and time of hospitalisation became shorter (p=.001). At 6 weeks, MIS patients had less pain at motion (p=.013), less limb (p=.001), a higher HHS (p=.007) and were more satisfied (p=.046). The differences remained unchanged after 12 weeks. There was no difference in implant positioning between the groups. Inclination was higher in group MIS [39° (SD 6°) vs. 38° (SD 7°), p=.030], anteversion was lower [21° (SD 8°) vs. 24° (SD 8°), p=.010]. Conclusion. The introduction of the MIS anterior approach was safe. Early rehabilitation was facilitated and clinical results were better. Radiographical results were not impaired by the new approach. We see no disadvantage of the MIS anterior approach. Adaptions in the clinical setup might further facilitate rehabilitation

Introduction. The postoperative management of patients after total hip replacement traditionally includes restrictions of movements and the use of aids (toiletelevation, sleeping pillow, a.o.) in the first 3 months after operation. Few studies have investigated the benefit of such restrictions. The aim of the present study was to evaluate how patients with total hip replacements (THR) are doing with and without restrictions in the first 3 months after surgery, and if walking ability and patients satisfaction was influenced by the postoperative regime. Patients and Methods. 80 patients undergoing primary uncemented THR were randomized to either the conventional regime with restrictions of movement and obligatory use of aids, or a postoperative regime without restrictions. Surgery was performed through a posterolateral short incision. The femoral component was the uncemented Bimetric prosthesis, non collared with HA coating, and a 36 mm femoral head. The cup was the Trilogy cup with a highly crosslinked polyethylen liner. No postoperative drainage was used and immediate weight bearing was allowed in both groups. We monitored walking speed, TUG score (timed up and go) and VAS pain score. The patients were scored by a trained physiotherapist preoperatively, 2 times each day during admission, and 14 and 90 days after surgery. Radiographic examination was performed after 3 days and after 3 months. At the 3 months evaluation a SF-36 score was registered. Results. The two groups were similar in age, operation time blood loss, and position of the prosthesis. None of the patients had postoperative dislocation. No significant difference was seen in any of the registered parameters (p< 0,05). The two groups were not similar regarding pain score. Preoperatively there was a significant higher pain score(p<0,05) in the group without restrictions and this difference was present throughout the first postoperative days. Accordingly they spent more time walking 10m during the first postoperative days, though this difference was not statistically significant. After 3 months the results in the two groups were similar and the SF-36 score was without significant difference. Conclusion. There is no significant difference in TUG test, 10m test, SF 36 score and VAS score the first 3 months after THR in the 2 groups. We did not see an increase in postoperative complications, which implies that postoperative mobilisation without restrictions, can be allowed without the risk of increased complications, and the use of aids in activities of daily living are not necessary. This also implies the possibility of savings in the rehabilitation of patients after THR

Introduction. Unstable intertrochanteric hip fractures (AO 31A2) continue to be a challenge, as non-locking implants have shown a considerable rate of loss of reduction. Intramedullary fixation has been recommended, although screw cut-out has been identified as problematic. This study was performed to ascertain whether treatments with the established proximal femoral nail (PFN) and the newer PFNA with blade design (proximal femoral nail antirotation) have advantages over the use of the Percutaneous Compression Plate (PCCP, developed by Gotfried). Methods. Cohort study. Between March 2003 and March 2008, 134 patients with unstable fractures were treated with a PCCP, (n=44, 78.3 yrs, ASA 2.8), a PFN (n=50, 77.2 yrs, ASA 2.8), or a PFNA (n=40, 75.8 yrs, ASA 2.6). The patients (31 PCCP, 33 PFN, 30 PFNA) were then reexamined clinically and radiologically after approximately 21 months. Results. The PCCP was found to require less implantation time than the PFN and the PFNA (60 vs. 80 vs. 84 min, p<0.001) and less radiation exposition time (PCCP 139 vs. PFN 283 vs. PFNA 188 seconds, p<0.001). The rate of reoperations due to wound infections and hematomas amounted to 2% for the PCCP, 4% for the PFN, and 5% for the PFNA (p=0.799). Due to mechanical complications, 9% of patients implanted with a PCCP, 13% of those implanted with a PFN, and 5% of those implanted with a PFNA had to be reoperated (p=0.353). The cut-out rate was 2% after implantation of the PCCP, 4% after the PFN, and 5% after implantation of the PFNA (p=0.799). In one case, the shaft was fractured intraoperatively (PFNA). The tip-apex distance for the lower femoral neck screw (PCCP 22mm vs. PFN 30mm vs. PFNA 30mm, p<0.001), stress-related varisation of the collodiaphyseal (CCD) angle (4° for all implants), impaction (PCCP 5mm vs. PFN 5mm vs. PFNA 6mm, p=0.662) and femoral shortening (PCCP 3mm vs. PFN 3mm vs. PFNA 4mm, p=0.876) were not determinants of the postoperative function. On the basis of their scores according to Merle d'Aubigné and Harris, there was no variation in the results of the follow-up examinations. Conclusions. The use of the PCCP for the treatment of unstable trochanteric fractures presents a minimally invasive method of implantation, as well as a promising therapy option with regards to operation time, radiologic examination time, and rate of complications. Processes of impaction due to stress are seldom observed. No benefits could be established in an intramedullary treatment with the PFN or the PFNA; thus, it appears that the higher cost of these implants is avoidable

Introduction. The concept of the golden patient (GP) was introduced to our busy teaching district general hospital, in April 2009, to improve trauma theatre start times following disappointing results from a previous in-hospital study. The GP is a pre-selected first patient on the following day trauma list who is medically fit with a clear surgical plan. The GP should have already been seen by an anaesthetist and be ready to be sent for by theatres early. It has been shown by others to improve operation start times and could be used to improve trauma services and meet clinical targets more readily. Methods. This prospective study involved the collection of planned trauma lists with the designated GP over November and December 2009. Data was collected from the theatre logbooks, including patient demographics, theatre reception, anaesthetic and operation start times. This was compared with the pre-GP data (January and February 2009). Graphs showing the comparative mean start times between pre-GP and GP trauma lists, including the 95% confidence interval for the population mean were created. A two sample T test was used to evaluate significance between groups. Results. Of the 55 planned trauma lists analysed, 42 had a designated GP on it (76%), 37 of which remained first on the actual trauma list (88%). The mean theatre reception arrival time for the pre-GP lists was 09:25 compared to 09:01 for the actual GP lists (P<0.001). The mean anaesthetic start time for the pre-GP lists was 09:35 compared to 09:09 for the actual GP lists (P<0.001). The mean operation start time for the pre-GP lists was 10:03 compared to 09:33 for the actual GP lists (P<0.001); the mean operation start time was reduced by 30 minutes if the GP remained first on the trauma list. The reception, anaesthetic and operation start times for pre-GP lists compared with lists where no GP was selected were not statistically significant suggesting that the GP was the cause of the significance. The mean anaesthetic review time was 08:31. Conclusion. The concept of the GP has made a significant improvement to theatre start times. By implementing the GP for each trauma list and obtaining a timely anaesthetic review our research indicates that the times could be improved by a further 31 minutes, resulting in a 61 minute improvement in overall operation start times. The GP has benefitted orthopaedic surgeons, anaesthetists, theatre staff and importantly patients. A more planned approach has improved efficiency and taken the stress away from organising and conducting a trauma list. Our experience supports this concept being used widely to improve trauma care in the UK setting

BACKGROUND. Osteoporosis with subsequent osteoporotic vertebral compression fractures is an increasingly important disease due not only to its significant economic impact but also to the increasing age of our population. Pain reduction and stabilization are of primary importance with osteoporotic vertebral compression fractures. OBJECTIVE. To compare the efficacy and safety of balloon kyphoplasty and vertebroplasty for the treatment of vertebral compression fractures. MATERIALS & METHODS. From January 2004 to December 2009, 142 patients (32 males and 110 females), from 54 to 84 years old (mean age 67.4) were treated for 185 osteoporotic vertebral fractures of the thoracic or lumbar spine (level of fracture at Th5 or lower), with back pain for more than 8 weeks, and a visual analogue scale (VAS) score of 5 or more. Twenty-two patients (29 fractures) were lost at follow-up period and excluded. Patients were randomly allocated to percutaneous kyphoplasty (64%) or vertebroplasty (36%). All fractures were analyzed for improvement in sagittal alignment (Cobb angle, kyphotic angle, sagittal index, vertebral height). The patients were evaluated using the visual analog scale (VAS) and the Oswestry Disability Score. Radiographs were performed postoperatively, and at 1, 3, 6, and 12 months. RESULTS. The score according to pain, the patient's ability to ambulate independently and without difficulty, and the need for medications improved significantly (P < 0.001) after kyphoplasty or vertebroplasty. No significant difference could be found between both groups for the mean VAS and ODI preoperative and postoperative. Vertebral body height and kyphotic wedge angle of the T-L spine were also improved (p < 0.001); although kyphosis correction seems to be improved better in kyphoplasty than vertebroplasty. The rate of leakage was 12% for kyphoplasty and 32% for vertebroplasty; nevertheless most of the leakage was clinically asymptomatic and the rate of serious problems remained low (pulmonary embolism 0.01% kyphoplasty vs 0.6% vertebroplasty). New fractures in the next 6 months at the adjacent vertebrae were observed ∼ 15% in both groups. More PMMA was used in the kyphoplasty group than in the vertebroplasty group (5.5 +/− 0.8 vs. 4.1 +/− 0.5 mL, p < 0.001). Operation time was longer in balloon kyphoplasty compared to vertebroplasty (mean time 20±5min/vertebral fracture in group B vs 30±5min in group A). CONCLUSION. Both balloon kyphoplasty and vertebroplasty provided a safe and effective treatment for pain and disability in patients with vertebral compression fractures due to trauma or osteoporosis. Balloon kyphoplasty led to an ongoing reduction of fractured vertebrae and was followed by a lower rate of cement leakage

Aims

Low haemoglobin (Hb) at admission has been identified as a risk factor for mortality for elderly patients with hip fractures in some studies. However, this remains controversial. This study aims to analyze the association between Hb level at admission and mortality in elderly patients with hip fracture undergoing surgery.

ARI is a busy trauma unit (catchment: 500 000 people). In September 2010 a day-case Hand Trauma Service (HTS) started. Previously cases were often postponed due to prioritisation of orthopaedic emergencies; therefore increasing inpatient stay and associated costs. We aim to characterise presenting cases, evaluate improvements in service provision and financial costs. Data was collected from the first HTS year (Sept 10–11), and the preceding year (Sept 09–10). Data was collected on patient characteristics, operation, operative time, anaesthetic type and number of inpatient days. The cost of inpatient stay was calculated from the NHS Scotland resource allocation committee data. Pre HTS there were 410 cases (500 operative hours). 141 wound explorations, 22 nail-bed repairs, 34 metacarpal ORIF, 68 phalangeal ORIF, 5 scaphoid fixations, 69 tendon repairs, 30 terminalisations, 5 MUA, 19 nerve repairs, 17 unclassified. Accounting for 510 inpatient nights (mean: 1.25, range: 0–8), costing £204,387.60 (mean: £500.95). 123 cases required image intensification (II). Most patients had GA. During the first HTS year there were 282 operations. Most operations were day-case. 77 cases were performed under LA, 81 regional blocks and 34 under GA. During this year cases requiring II continued to be performed in the main theatre. The HTS has increased time available in main theatres. It has reduced inpatient stay costs, potentially saving £141,267.90. Performing more operations under LA/regional block decreases the risks associated with anaesthesia. Provision of II for the HTS would permit more cases to be performed, improving the service provision and further reducing costs

Aims

The aim of this study was to evaluate the outcomes of a salvage procedure using a 95° angled blade plate for failed osteosynthesis of atypical subtrochanteric femoral fractures associated with the long-term use of bisphosphonates. These were compared with those for failed osteosynthesis of subtrochanteric fractures not associated with bisphosphonate treatment.