Resuscitation decisions are part of routine practice and raise difficult, sensitive issues. We present experience of Do-Not-Attempt-Resuscitation (DNAR) decision-making in our unit. Patients and staff (medical, nursing) completed a questionnaire to ascertain current practice, knowledge, and patient feeling regarding DNAR decisions. Consultants and Registrars make DNAR decisions, junior-doctors and nurses feel they have insufficient knowledge. Senior-doctors were most familiar with BMA and Trust guidelines. The majority of all staff felt every patient should be asked. Consultants thought DNAR decision-making was least necessary. Half of patients felt doctors had not explained the necessity of DNAR decisions and half felt conversations could have been handled better. Half said they had not been asked their opinion. Two-thirds would like more visual information. UK-wide figures show 15% survival to discharge of in-hospital arrest; a-third of medical staff knew this. Registrars were most optimistic and consultants and ward doctors most pessimistic. All patients believed survival rate was 50%. Important DNAR decisions are based on poor knowledge and communication. We developed an education programme for staff and information-video for patients and relatives to improve service. Video for DNAR discussions has not been previously used; it will provide a framework on which to approach this sensitive issue

External fixation is widely used in orthopaedic and trauma surgery. Infections around pin or wire sites, which are usually localised, non-invasive, and are easily managed, are common. Occasionally, more serious invasive complications such as necrotising fasciitis (NF) and toxic shock syndrome (TSS) may occur.

We retrospectively reviewed all patients who underwent external fixation between 1997 and 2012 in our limb lengthening and reconstruction programme. A total of eight patients (seven female and one male) with a mean age of 20 years (5 to 45) in which pin/wire track infections became limb- or life-threatening were identified. Of these, four were due to TSS and four to NF. Their management is described. A satisfactory outcome was obtained with early diagnosis and aggressive medical and surgical treatment.

Clinicians caring for patients who have external fixation and in whom infection has developed should be aware of the possibility of these more serious complications. Early diagnosis and aggressive treatment are required in order to obtain a satisfactory outcome.

Cite this article: Bone Joint J 2015;97-B:1296–1300.