The purpose of this study was (1) to evaluate the adequacy of informed consent documentation in the trauma setting for distal radius fracture surgery compared with the elective setting for total knee arthroplasty (TKA) at a large public hospital and (2) to explore the relevant guidelines in New Zealand relating to consent documentation. Consecutive adult patients (≥16 years) undergoing operations for distal radius fractures and elective TKA over a 12-month period in a single-centre were retrospectively identified. All medical records were reviewed for the risks and complications recorded. The consent form was analysed using the Flesch Reading Ease Score (FRES) and the Simple Measure of Gobbledygook (SMOG) index readability scores. A total of 133 patients undergoing 134 operations for 135 distal radius fractures and 239 patients undergoing 247 TKA were included. Specific risks of surgery were recorded significantly less frequently for distal radius fractures than TKA (43.3% versus 78.5%, P < 0.001). Significantly fewer risks were recorded in the trauma setting compared to the elective (2.35 ± 2.98 versus 4.95 ± 3.33, P < 0.001). The readability of the consent form was 40.5 using the FRES and 10.9 using the SMOG index, indicating a university undergraduate level of reading. This study has shown poor compliance in documenting risks of surgery during the informed consent process in an acute trauma setting compared to elective arthroplasty. Institutions must prioritise improving documentation of informed consent for orthopaedic trauma patients to ensure a patient-centred approach to healthcare

Fragility fractures are an emerging healthcare problem in Sub-Saharan Africa and hip fractures (HFs) are associated with high levels of morbidity, prolonged hospital stays, increased healthcare resources utilization, and mortality. The worldwide average healthcare cost in the first-year post HF was US$43,669 per patient in a 2017 systematic review, however there are no studies quantifying fracture-associated costs within SSA. We estimated direct healthcare costs of HF management in the South African public healthcare system. We conducted a prospective ingredients-based costing study in 200 consecutive consenting HF patients to estimate costs per patient across five regional public sector hospitals in KwaZulu-Natal (KZN). Resource use including staff time, consumables, laboratory investigations, radiographs, operating theatre time, surgical implants, medicines, and inpatient days were collected from presentation to discharge. Counts of resources used were multiplied by relevant unit costs, estimated from KZN Department of Health hospital fees manual 2019/20, in local currency (South African Rand, ZAR). Generalised linear models were used to estimate total covariate adjusted costs and cost predictors. The mean unadjusted cost for HF management was ZAR114,179 (95% CI; ZAR105,468–125,335). The major cost driver was orthopaedics/surgical ward costs ZAR 106.68, contributing to 85% of total cost. The covariate adjusted cost for HF management was ZAR114,696 (95% CI; ZAR111,745–117,931). After covariate adjustment, total costs were higher in patients operated under general anaesthesia compared to surgery under spinal anaesthesia and no surgery. Direct healthcare costs following a HF are substantial: 58% of the gross domestic per capita (US$12,096 in 2020), and six-times greater than per capita spending on health (US$1,187 in 2019) in SA. As the population ages, this significant economic burden to the health system will increase. Further research is required to evaluate direct non-medical, and the indirect costs incurred post HF

Slipped Capital Femoral Epiphysis (SCFE) is a common paediatric disorder with documented racial predilection. No data exists regarding the Australian indigenous and Australian non-indigenous populations. This study provides a comprehensive demographic and epidemiologic analysis of SCFE in South Australia, with emphasis on establishing associations between increasing obesity and incidence. A demographic review of all cases of SCFE managed in South Australian public hospitals between 1988 and 2007 was performed. Clinical presentation, surgical management and complication profile information was collected. Given that obesity is implicated in the biomechanical causation of SCFE due to increased shearing forces, particular emphasis was placed on gathering weight, race, gender and age data. A profile of the incidence and nature of SCFE was generated. Comparisons were then drawn between this profile and existing epidemiologic percentile data of weight, age and gender in South Australia. A rising prevalence of obesity in South Australia corresponded with a rising incidence of SCFE. However, this relationship was not linear as the incidence of SCFE has doubled in the last 20 years and the average weight of SCFE patients has increased markedly. The indigenous population was found to have higher rates of obesity than the non- indigenous population in South Australia. The indigenous population also has a relative risk of developing a SCFE of over three times the non-indigenous population. The overall rate of complications in South Australian public hospitals was low, with avascular necrosis being recognised in our profile. The rise in incidence of SCFE in South Australia; especially noticeable in the indigenous population is associated with an increasing prevalence of obesity. The considerable morbidity associated with SCFE was confirmed in our analysis and further highlights the importance of public health initiatives to tackle obesity in our community

Purpose of study:. To analyse the bacteriological spectrum, identify most appropriate antibiotics for hand infections, and to characterize patterns and sites of hand infections. This information was collected against the background of a high prevalence of HIV infected patients and increasing antibiotic resistance. Description of methods:. This was a prospective, cross-sectional, analytical study done on 66 patients presenting with hand infections at a public hospital from January to June 2009. A standardised treatment protocol was followed in managing these patients. Data was collected from each participant, and laboratory reports were followed up for the identity and antibiotic susceptibility of causative organisms. All patients were counselled for HIV status and consenting participants were tested. Summary of results:. Staphylococcus aureus was the commonest isolate. Results show that Cloxacillin is still an effective first line antibiotic for community acquired hand infections in the absence of immunosuppression. Alternative empiric therapy would be Clindamycin – especially in the B-lactamase intolerant patient. HIV infection played a significant role in the bacteriology of hand infections with an increased incidence of polymicrobial and gram negative infections. Data regarding age, gender, types of infection, mechanism of injury, x-ray findings and laboratory values are also reported. Conclusion:. Hand infections are common conditions that have significant morbidity. Referral is often delayed and infections present late. Immunosuppression seems to play a role in the bacteriology, the incidence of polymicrobial infections and the antibiotic sensitivity. Cloxacillin seems to be an adequate first line treatment for acute community acquired bacterial hand infections in immunocompetent patients in our institution, excluding human bites and farm yard injuries

Rural surgical practice in Australia provides a unique environment to the Orthopaedic Surgeon. Whilst most of the work load mimics that of city practice, the rural surgeon has little choice but to master a broad schema of surgical skills, and keeping up with the current literature and techniques can be challenging. At our public hospital over the last audited twelve month period, 108 primary total knee replacements were performed by 4 surgeons out of 236 joint replacements including revision surgeries. At the Private hospital a total of 215 joint replacements were performed in the same period including revision surgeries, of which 127 were knee arthroplasties. It is recognised that the incidence of complications from arthroplasty can be increased in low volume joint replacement surgeons. This centre is a mid volume centre, but rural and generally underfunded. In light of this, it is not unreasonable to look at techniques or evolving technologies that may improve the ability of an individual surgeon to position a joint replacement in an optimal position and with economic consideration. Conventional navigation has a number of factors associated with it that may make its use in a rural centre less attractive. These include capital cost of both hardware and software; Most rural centres do not have the ability to purchase the hardware and thus the issue of transporting hard ware on site, and representative support, may all be issues. The potential benefit of patient specific implants [PSI] may thus be two-fold in this setting. The surgeon and the patient benefit from the technology, but the technology does not need to be transported to the site. As a result of these considerations, a single surgeon in a rural centre, commenced using PSI's after gaining initial experience with the implant using traditional techniques. This early study looks at this experience and attempts to quantify some of the issues around this technology

Intramedullary nailing (IMN) has been frequently indicated to treat long bone open and closed fractures, but infection following internal fixation may have devastating consequences, with higher costs. Treatment of intramedullary nail-associated infections (IMNI) is challenging and based upon surgery and adequate antibiotic administration, which requires the correct identification of causative microorganisms. However, there have been difficulties for the microbial diagnosis of IMNI, as the peri-prosthetic tissue cultures may show no microbial growth, particularly in patients with previous use of antibiotics. Sonication have shown higher sensitivity and specificity for microbial identification on a variety of orthopedic implant-associated infections. Aim: To compare clinical and microbiological results and sensitivity for the pathogen identification obtained by conventional peri-implant tissue culture samples with culture of samples obtained by sonication of explanted IMN implants, among patients presenting IMNI of long bones. Methods: Longitudinal prospective cohort study performed at a tertiary public hospital, ongoing since August 2011. We analyzed all patients with indication for IMN implant removal, and orthopedic-implant associated infections was defined according to previous publications addressing osteosynthesis-associated infections (Yano 2014). Minimal of 2 samples from the peri-implant tissue were taken and sent under sterile conditions to the laboratory for culture. Statistical analysis was performed McNemar's test for related proportions. Results: We included 26 patients presenting clinical signs of IMNI, of which tissue and sonication cultures were performed for 26 (100%) and 20 (77%) patients, respectively. Among them, 88% were male, with mean age was 35.9 years (range, 19–59 yo). Causes of trauma were mainly motorcycle crashes accounting 54% of accidents; tibia and fibula were affected in 65% and 27%, respectively. Gustilo open fracture classification was grade II (35%) and IIIA (35%). First stage management with external fixation for fracture stabilization was performed in 75% of trauma patients. Sensitivity of peri-prosthetic tissue culture and sonication was 80.7% (21/26), and 95% (19/20) (p< 0.05), respectively. Only one infected patient presented negative tissue and fluid cultures. Gram-positive cocci were isolated in 75% and 79% in tissue and sonication fluid cultures, respectively. Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus sp., were isolated from tissue and sonication culture in 43.5% and 36.3%, 8.7% and 22.7%, 13% and 13.7%, respectively. Polymicrobial infection was diagnosed in 3.8% (1/26) and 15.8% (3/19), patients by tissue and sonication fluid cultures (p< 0,01), respectively. Conclusion: Sonication of retrieved infected intramedullary nails has the potential for improving the microbiological diagnosis of IMNI

Hip fracture is a common cause of hospital admission and is often followed by reduced quality of life, or by death. International experiences indicate there are many benefits to be gained from national hip fracture registries. This pilot project aims to implement a hip fracture registry at three sites, a large metropolitan public hospital (Flinders Medical Centre), a large metropolitan private hospital (Epworth HealthCare) and a rural regional hospital (Goulburn Valley Health) to assess the feasibility of establishing a national registry. Patients undergoing surgery for a hip fracture will be recruited from the three participating hospitals between March and September 2009. A minimum data set will be collected at discharge, from hospital records. Items include patient demographics, fracture descriptors, length of stay, residential status, mobility, health status, surgical details and discharge destination. A phone interview at four months after surgery will measure outcomes by using the Extended Glasgow Outcomes Scale and documenting residential status, mobility, hip pain and readmissions. Re- operations, if any, will be collected. The availability of data from State Health Departments for validation of hospital case data will be reported. The pilot study is in progress at the time of writing. Ethical approval has been obtained, data collection, transmission and storage systems have been developed and deployed, and case data collection is underway. Case data will be summarised to describe hip fracture at the participating hospitals. Analysis will review the data elements in the pilot data set and assess their priority for inclusion in a national register—taking account of the quality of the data obtained and the time and other resources required for their collection. We will also evaluate the four-month review process. Any potential obstacles to a national registry that are identified during the pilot will be described and ways to overcome them will be proposed. A national hip fracture registry will improve the quality of care and safety of patients following hip fracture by developing an efficient mechanism to compare and improve the effectiveness of acute health care delivery by all hospitals involved in the management of hip fractures

Multimodal analgesia protocols for pain control following total joint arthroplasty can reduce post-operative pain, allow early mobilisation and early discharge from hospital. This study analyses the achievement of functional milestones, patient satisfaction, length of stay and adverse outcomes using a multimodal analgesia protocol in total joint arthroplasty. All patients planned for elective hip and knee arthroplasty in a NSW teaching hospital under one surgeon between July 2007 and January 2009 were included in this prospective study. Patients undergoing revision surgery, bilateral arthroplasty or total hip arthroplasty for fractures were excluded. Unless contraindicated, all patients followed the multimodal analgesia protocol based on the local infiltration analgesia technique described by Kerr and Kohan. Outcomes measurements included. Patient demographics, post operation milestones, visual analogue pain scores (VAS), narcotic consumption, length of stay, discharge destination, patient satisfaction scores and adverse outcomes. Nineteen patients (13 female and 6 male) with an average age 67 years and BMI 33 had total hip arthroplasty surgery. 84% (16/19) ambulated within six hours post operation. 47% (9/19) of patients were discharged home by day 3 post operation (1/19 on day 1, 5/19 on day 2, 3/19 on day 3). Average day post operation for discharge home was 4.5 days. Thirty-one patients (17 female and 14 male) with an average age 68 years and BMI 33 had total knee arthroplasty surgery. 90% (28/31) ambulated within six hours after surgery. 71% (22/31) of patients were discharged home by day three post operation (6/31 on day 1, 8/31 on day 2 and 8/31 on day 3). Average day post operation for discharge home was four days. Ten patients required morphine in addition to protocol analgesia. VAS scores (1 to 10) averaged 3.2 day one post op and 2.6 prior to discharge. Three patients developed nausea and vomiting and one patient developed urinary retention. No infections, DVTs or other adverse effects occurred in either hip or knee arthroplasty groups. Majority of patients were very satisfied according to 24 hour post op pain management survey and six week post op patient satisfaction survey. Local infiltration analgesia in knee and hip arthroplasty surgery is a safe, well-tolerated and effective form of pain control allowing early mobilisation and early discharge from hospital (1,2). This protocol has been successfully implemented in a public hospital

Aims

To assess the impact of the declaration of the state of emergency due to the COVID-19 pandemic on the number of visits to a traumatology emergency department (ED), and on their severity.

In May 2012, in airports across the globe, seven orthopaedic surgeons bravely said goodbye to their loved ones, and slowly turned towards their respective aircraft. Filled with expectation and mild trepidation they stepped into the unknown… the ABC fellowship of 2012.