Introduction

The development of new megaprosthesis for the treatment of large bone defects has offered important opportunities to orthopedic oncologic surgeons for the replacement of skeletal segments such as the long bones of the upper and lower limbs and the relative joints. Our experience, treating non union and severe bone loss, has brought us, sometimes, to be confronted with the reality of some failures after unsuccessful attempts to reconstruct. Faced with certain radiological and / or clinical drastic situations we wanted to apply the principles of Biological Chamber and oncologic surgery with megaprosthetic replacement solutions. We implanted megaprosthesis with either 1 step or 2 steps (previous antibiotated spacer) technique depending on the septic patient conditions. The aim of this study is to retrospectively evaluate both clinical and radiological outcomes in patients underwented to a lower limb megaprosthesis implant and complications were recorded.

To review the effect of MRSA screening, ward ring-fencing and other significant factors on elective orthopaedic operation cancellations: and to study the effect of introducing a multi-disciplinary trauma management system on trauma operation cancellations, we carried out a study at the Royal Gwent Hospital, a district general hospital accepting general emergency admissions. It took the form of a prospective audit of all elective orthopaedic and trauma cancellations from 1 October to 10 November 2002, and in the same period of 2004. Definitions: an ‘elective cancellation’: deemed medically fit at SHO pre-admission assessment; MRSA swabbed with negative results then subsequently cancelled from an elective theatre list under the headings, ‘ward breech by other unscreened patients’, ‘unfit for surgery’ (anaesthetic decision), ‘lack of beds’ and ‘other’ (lack of surgical assistant, theatre time, theatre staff and operation not required). A ‘trauma cancellation’: acute admission with allocation of theatre space; subsequently cancelled under the headings, ‘unfit for surgery’ (anaesthetic decision), ‘lack of theatre time’, ‘surgery not required’ and ‘other’ (patient refused surgery, absconded, incorrect listing, no surgical assistant or theatre staff). Results. In the six week period 198 and 226 elective patients were listed in 2002 and 2004 respectively. 52% were cancelled in 2002 and 35% in 2004, most frequently by ‘ward breech by other unscreened patient’. 234 and 269 trauma cases were listed in 2002 and 2004 respectively. 26% were cancelled in 2002 and 16% in 2004, most frequently in 2002 by ‘unfit for surgery’, and ‘surgery not required’; and in 2004 ‘lack of theatre time’. The MRSA ring-fencing policy was breached frequently by unscreened emergency patients. An elective unit separate from the main hospital may prevent these cancellations. The multi-disciplinary trauma management scheme reduced trauma cancellations, but other factors have reduced theatre efficiency

Since the advent of the COVID-19 pandemic, there has been a technologically based progression to almost every sector of society. This has led to an influx of e-hailing motorcycle drivers (online based consumable transportation platforms) and thus an increase in road traffic accidents. This group experiences an abundance of Orthopaedic related trauma with a considerable economic burden. Therefore, the study aimed to determine the incidence of this study group as well as quantify the severity and cost implications thereof for the sake of public health and epidemiology. This was an observational study whereby a prospective cohort analysis was respectively conducted at a single centre to determine the incidence, of the study group, over a seven-month period. The study included any e-hailing motorcycle driver who sustained Orthopaedic related trauma, whilst on duty, within the catchment area whereas all other patients were excluded and used as a comparator. A descriptive statistical analysis was done to further delineate the severity of injury by comparing the type of injury, anatomical location injured, and management plan incurred. A total of 5096 individuals experienced Orthopaedic related trauma with 60 individuals (1.18%) being e-hailing motorcyclists who sustained injury whilst on duty. The incidence being 118 per 10000 patients. Further analysis revealed that 78.33% of the population experienced fractures or dislocations with 52.31% of these injuries requiring surgical intervention. The Upper limb (53.85%) and Lower limb (43.08%) were the most affected anatomical locations. The Orthopaedic care for this population group places a meaningful burden on the South African Health sector. These drivers work in unsafe environments and sustain high energy impacts, yet very little oversight exists. Therefore, continued research with new regulations needs to be drafted, looking into vehicle safety, working conditions, operative hours, and the need for public awareness

Traditionally, sports Injuries have been sub-optimally managed through Emergency Departments (ED) in the public health system due to a lack of adequate referral processes. Fractures are ruled out through plain radiographs followed by a reactive process involving patient initiated further follow up and investigation. Consequently, significant soft tissue and chondral injuries can go undiagnosed during periods in which early intervention can significantly affect natural progression. The purpose of this quality improvement project was to assess the efficacy of an innovative Sports Injury Pathway introduced to detect and treat significant soft tissue injuries. A Sports Injury Pathway was introduced at Fiona Stanley Hospital (WA, Australia) in April 2019 as a collaboration between the ED, Physiotherapy and Orthopaedic Departments. ED practitioners were advised to have a low threshold for referral, especially in the presence of a history of a twisting knee injury, shoulder dislocation or any suggestion of a hip tendon injury. All referrals were triaged by the Perth Sports Surgery Fellow with early follow-up in our Sports Trauma Clinics with additional investigations if required. A detailed database of all referrals was maintained, and relevant data was extracted for analysis over the first 3 years of this pathway. 570 patients were included in the final analysis. 54% of injuries occurred while playing sport, with AFL injuries constituting the most common contact-sports injury (13%). Advanced Scope Physiotherapists were the largest source of referrals (60%). A total of 460 MRI scans were eventually ordered comprising 81% of total referrals. Regarding Knee MRIs, 86% identified a significant structural injury with ACL injuries being the most common (33%) followed by isolated meniscal tears (16%) and multi-ligament knee injuries (11%). 95% of Shoulder MRI scans showed significant pathology. 39% of patients required surgical management, and of these 50% were performed within 3 months from injury. The Fiona Stanley Hospital Sports Injury Pathway has demonstrated its clear value in successfully diagnosing and treating an important cohort of patients who present to our Emergency Department. This low threshold/streamlined referral pathway has found that the vast majority of these patients suffer significant structural injuries that may have been otherwise missed, while providing referring practitioners and patients access to prompt imaging and high-quality Orthopaedic sports trauma services. We recommend the implementation of a similar Sports Injury Pathway at all secondary and tertiary Orthopaedic Centres

Abstract. Introduction. Minimising postoperative complications and mortality in COVID-19 patients who were undergoing trauma and orthopaedic surgeries is an international priority. Aim was to develop a predictive nomogram for 30-day morbidity/mortality of COVID-19 infection in patients who underwent orthopaedic and trauma surgery during the coronavirus pandemic in the UK in 2020 compared to a similar period in 2019. Secondary objective was to compare between patients with positive PCR test and those with negative test. Methods. Retrospective multi-center study including 50 hospitals. Patients with suspicion of SARS-CoV-2 infection who had underwent orthopaedic or trauma surgery for any indication during the 2020 pandemic were enrolled in the study (2525 patients). We analysed cases performed on orthopaedic and trauma operative lists in 2019 for comparison (4417). Multivariable Logistic Regression analysis was performed to assess the possible predictors of a fatal outcome. A nomogram was developed with the possible predictors and total point were calculated. Results. Of the 2525 patients admitted for suspicion of COVID-19, 658 patients had negative preoperative test, 151 with positive test and 1716 with unknown preoperative COVID-19 status. Preoperative COVID-19 status, sex, ASA grade, urgency and indication of surgery, use of torniquet, grade of operating surgeon and some comorbidities were independent risk factors associated with 30-day complications/mortality. The 2020 nomogram model exhibited moderate prediction ability. In contrast, the prediction ability of total points of 2019 nomogram model was excellent. Conclusions. Nomograms can be used by orthopaedic and trauma surgeons as a practical and effective tool in postoperative complications and mortality risk estimation

To describe the prevalence and incidence of Methicillin-resistant Staphylococcus aureus (MRSA) colonisation during the patient journey for patients admitted to orthopaedic and trauma wards, we carried out a prospective audit at the University Hospital of North Staffordshire NHS Trust, England. The Study Population comprised patients admitted to the trauma and elective orthopaedic wards, with an expected stay of 48 hours or more between March and May 2003. Patients were swabbed for MRSA colonisation on ward admission, transfer to another ward and discharge from hospital. Elective patients undergoing major joint surgery were also swabbed at a pre-operative assessment clinic. Colonised patients were treated depending on individual risk assessment. Five hundred and fifty-nine eligible patients were admitted to hospital. Of these, 323 (101 elective, 192 trauma and 30 non-orthopaedic) patients were included in the study, of whom 28 elective patients (28%), 43 trauma patients (22%), and seven non-orthopaedic patients (23%) were colonised with MRSA at any time during the audit period. Of the 80 patients identified as negative for MRSA colonisation at pre-assessment screening and included in the audit, ten (9.5%) were found to be colonised on admission. There is a high prevalence of MRSA colonisation in patients admitted to the orthopaedic and trauma wards in our setting. A policy of pre-admission screening, though able to identify MRSA carriage does not guarantee that patients are not colonised in the period between screening and admission. Consideration should be given to screening all patients for MRSA who are admitted to an orthopaedic ward

We have developed a list of 281 competencies deemed to be of importance in the training of orthopaedic surgeons. A stratified, randomised selection of non-university orthopaedic surgeons rated each individual item on a scale 1 to 4 of increasing importance. Summary statistics across all respondents were given. The mean scores and . sd. s were computed. Secondary analyses were computed in general orthopaedics, paediatrics, trauma and adult reconstruction. Of the 156 orthopaedic surgeons approached 131 (84%) responded to the questionnaire. They rated 240 of the 281 items greater than 3.0 suggesting that competence in these was necessary by completion of training. Complex procedures were rated to be less important. The structure, delivery and implementation of the curriculum needs further study. Learning activities are ‘driven’ by the evaluation of competencies and thus competency-based learning may soon be in the forefront of training programmes

INTRODUCTION. Recently the evolution of prosthesis technology allows the surgeon to replace entire limbs. These special prostheses or megaprostheses were born for the treatment of severe oncological bone loss. Recently, however, the indications and applications of these devices are expanding to other orthopaedic and trauma situations. Since some years we are implanting megaprostheses in non-oncological conditions such as septic post-traumatic failures represented by complex non-unions and critical size bone defects. The purpose of this study is to retrospectively evaluate the clinical outcome of this treatment and register all the complications and infection recurrence. MATERIAL AND METHOD. Between January 2008 and January 2016 we have treated 55 patients with septic post-traumatic bone defects In 48/55 cases we perform a 2 steps procedure: 1° step: resection, debridment, devices removal and antibiotic spacer implantation; 2° step: spacer removal and megaprosthesis implantation. In 7/55 patients in whom all the femur was infected, we performed a one step procedure by the complete removal of the femur and a megaprosthesis (Total Femur) implantation. RESULTS. We obtained good results from a clinical, laboratory and radiological point of view with restoration of the function of the affected limb. Only in 5/55 cases the infection recurred. All the Total Femur megaprosthesis implanted in a one step procedure healed without recurrence of infection. CONCLUSION. Megaprosthesis in severe septic bone loss can be considered, in extreme cases appropriately selected, as an available solution for the orthopedic surgeon. The two steps procedure gives the best results with safety and lower infection recurrence creating a membrane (Chamber Induction Technique) that can protect the prosthesis in a safe environment. We can perform a one step procedure only when all the infected segment is entirely removed. This type of complex surgery must be performed in specialized centers where knowledge and technologies are present

Infection is among the first reasons for failure of orthopedic implants. Various antibacterial coatings for implanted biomaterials are under study, but only few technologies are currently available in the clinical setting. Previous studies showed the in vitro and in vivo efficacy and safety of a fast resorbable (<96 h) hyaluronic and polylactic acid based hydrogel, loaded with antibiotic or antibiofilm agents (DAC®, Novagenit Srl, Mezzolombardo, TN). Aim of this study is to report the results of the largest clinical trial in trauma and orthopedic patients. In this prospective, controlled, study, a total of 184 patients (86 treated with internal osteosinthesis for closed fractures and 98 undergoing cementless total hip or knee joint prosthesis) were randomly assigned in three European orthopaedic centers to receive antibiotic-loaded DAC coating or to a control group, without coating. Pre- and post-operative assessment of laboratory tests, wound healing (ASEPSIS score), clinical score (SF-12 score) and x-rays were performed at fixed time intervals. Statistical analysis was performed with Fisher exact test or Student's t test. Significance level was set at p<0.05. The study was approved by the local Ethical Committee and all patients provided a written informed consent. On average, wound healing, clinical scores, laboratory tests and radiographic findings did not show any significant difference between the two-groups at a mean 12 months follow-up (min: 6, max: 18 months). Four surgical site infections and two delayed union were observed in the control group compared to none in the treated group. No local or systemic side effects, that could be related to DAC hydrogel coating, were noted and no detectable interference with bone healing or osteointegration could be found. This is the largest study, with the longest follow-up, reporting on clinical results after the use of a fast-resosrbable anti-bacterial hydrogel coating for orthopaedic and trauma implants. Our results show the safety of the tested coating in different indications; although not statistically significant, the data also show a trend towards surgical site infection reduction, as previously demonstrated in the animal models

INTRODUCTION. The hip arthroplasty implant is currently growing up both in orthopedic and trauma practice. This increases the frequency of prosthesis revision due to implant loosening often associated with periprosthetic osteolysis that determine the failure and lead to a loss of bone substance. Nowadays there are numerous biotechnologies seeking to join or substitute the autologous or omologous bone use. These biotechnologies (mesenchymal stromal cells, growth factors and bone substitutes) may be used in such situations, however, the literature doesn't offer class 1 clinical evidences in this field of application. MATERIALS AND METHODS. We performed a literature review using the universally validated search engines in the biomedical field: PubMed / Medline, Google Scholar, Scopus, EMBASE. The keywords used were: “Growth Factors”, “Platelet Rich Plasma”, “OP-1”, “BMP”, “BMP-2”, “BMP-7”, “Demineralized Bone Matrix”, “Stem Cell”, “Bone Marrow”, “Scaffold”, “Bone Substitutes” were crossed with “hip”, “revision”, “replacement” / “arthroplasty”, “bone loss” / “osteolysis.”. RESULTS. The search led to 321 items, of these were considered relevant: as regards the growth factors 21 articles related to in vivo animal studies and 2 articles of human clinical use of BMPs and 1 single article on the use of PRP; as regards the mesenchymal stromal cells 2 items of application in animals; as regards the use of bone substitutes we have analyzed a review of this application. DISCUSSION. The use of biotechnologies in hip prosthetic revisions has produced conflicting results: autologous growth factors (PRP) have definitely been proven effective in maxillofacial surgery, in animal studies the results of BMPs are inconsistent with articles that validate their use and others that don't recommend it. Clinical application has demonstrated, today, the limited use of BMP-7 in revisions with even an increased risk of early re-mobilization, PRP appears to be rather effective only in the early stages of peri-prosthetic osteolysis. The mesenchymal cells can increase the chances of recovery and integration of the grafts but an important variable is the number of cells that are still alive after the impaction of the graft which affects their vitality. The bone substitutes appear to be safe and very useful, particularly if applied in order to implement the omologous bone, which is still the most scaffolds used in this surgery. CONCLUSIONS. The systematic review of the literature has shown an important lack of clinical studies regarding the use of biotechnologies for prosthetic revisions. It is therefore difficult to draw guidelines that regulate the application, prospective randomized clinical studies are therefore needed to validate its effectiveness

This study aims to ascertain the value of CT in assessing union of complex tibial fractures in patients treated with internal or external fixation. Twenty patients who fit the above criteria were selected from a list of those sent for CT lower leg by the department of Orthopaedics and Trauma at the Royal Infirmary of Edinburgh from 2007–2012. The x-rays chronologically closest to the CTs were assessed by two observers, and the results evaluated for inter-observer agreement. The observers recorded their general impression of whether there was adequate union for fixation removal, and scored the x-rays using the Radiographic Union Scale for Tibial fractures (RUST). There was fair agreement on “general impression” (kappa 0.36, 95% CI 0.08 to 0.64), but there was good agreement using the RUST score (ICC 0.81 95CI 0.12 to 0.96). However, only 45% of the x-rays could be rated by both observers due to obstruction from metalwork. The CT scans were assessed by two orthopaedic surgeons, first giving a general impression of whether there was adequate union for fixation removal, then using a modified RUST score. The inter-observer agreement was moderate in the former (kappa 0.55, 95% CI 0.18 to 0.89) and substantial in the latter (ICC 0.78 95% CI 0.40 to 0.92); only one image was unable to be assessed due to artefact. The author concludes that CT was useful in these patients due to the high number of x-rays in which cortices were obstructed by metalwork. Use of the RUST score improved inter-observer agreement, and would therefore be useful in both future studies and inter-departmental clinical communication. Further research is needed to relate use of the modified RUST score to clinical outcome

INTRODUCTION. The hip arthroplasty implant is currently growing up both in orthopedic and trauma practice. This increases the frequency of prosthesis revision due to implant loosening often associated with periprosthetic osteolysis that determine the failure and lead to a loss of bone substance. Nowadays there are numerous biotechnologies seeking to join or substitute the autologous or omologous bone use. These biotechnologies (mesenchymal stromal cells, growth factors and bone substitutes) may be used in such situations, however, the literature doesn't offer class 1 clinical evidences in this field of application. MATERIALS AND METHODS. We performed a literature review using the universally validated search engines in the biomedical field: PubMed / Medline, Google Scholar, Scopus, EMBASE. The keywords used were: “Growth Factors”, “Platelet Rich Plasma”, “OP-1”, “BMP”, “BMP-2”, “BMP-7”, “Demineralized Bone Matrix”, “Stem Cell”, “Bone Marrow”, “Scaffold”, “Bone Substitutes” were crossed with “hip”, “revision”, “replacement” / “arthroplasty”, “bone loss” / “osteolysis.”. RESULTS. The search led to 321 items, of these were considered relevant: as regards the growth factors 21 articles related to in vivo animal studies and 2 articles of human clinical use of BMPs and 1 single article on the use of PRP; as regards the mesenchymal stromal cells 2 items of application in animals; as regards the use of bone substitutes we have analyzed a review of this application. DISCUSSION. The use of biotechnologies in hip prosthetic revisions has produced conflicting results: autologous growth factors (PRP) have definitely been proven effective in maxillofacial surgery, in animal studies the results of BMPs are inconsistent with articles that validate their use and others that don't recommend it. Clinical application has demonstrated, today, the limited use of BMP-7 in revisions with even an increased risk of early re-mobilization, PRP appears to be rather effective only in the early stages of peri-prosthetic osteolysis. The mesenchymal cells can increase the chances of recovery and integration of the grafts but an important variable is the number of cells that are still alive after the impaction of the graft which affects their vitality. The bone substitutes appear to be safe and very useful, particularly if applied in order to implement the omologous bone, which is still the most scaffolds used in this surgery. CONCLUSIONS. The systematic review of the literature has shown an important lack of clinical studies regarding the use of biotechnologies for prosthetic revisions. It is therefore difficult to draw guidelines that regulate the application, prospective randomized clinical studies are therefore needed to validate its effectiveness

Introduction. Various anti-infective agents can be added to the surface of orthopaedic implants to actively kill bacteria and prevent infection. Silver (Ag) is a commonly used agent in various anti-infective applications. Silver disrupts bacterial membranes and binds to bacterial DNA and to the sulfhydryl groups of metabolic enzymes in the bacterial electron transport chain, thus inactivating bacterial replication and key metabolic processes. Recently we are implanting Silver coated megaprosthesis for the treatment of post-traumatic septic non unions/bone defects and for infected hip or knee prosthesis revision. We treat these complications utilizing a two steps procedure: 1° step: devices removal, resection, debridment and antibiotic spacer implantation; 2° step: spacer removal and megaprosthesis implantation. This technique produce a reactive pseudosynovial membrane, well known in traumatology (Masquelet technique), following the Chamber Induction Technique principles. This chamber creates the perfect environment in which implant the prosthesis with safety. We are nowadays investigating if this membrane could optimize the Silver antimicrobical effects reducing the Silver ions dispersion and reducing toxicity on the human body. Objectives. The aim of this study is to perform a review of the literature about Silver coated implants in Orthopaedics and Trauma and to analyze our cases treated with this implants in order to measure their efficacy and the ion dispersion in urine and blood. Methods. We performed a literature review using the universally validated search engines in the biomedical field: PubMed / Medline, Google Scholar, Scopus, EMBASE. The keywords used were: “Silver”, “Silver coating”, “Silver surface”, “were crossed with “Prosthesis”, “Megaprosthesis”, “Infection”, “Sepsis”, “Revision”. We also analized all our patients treated with Silver coated implants measuring Silver dose in blood and urine before implantation, 1 day after implantation and then after 15 days, 3,6,12,24,36 months. Results. The search led to 468 items, of these were considered only article in English with full text available. We found 1 in vitro study, 1 animal study and 2 human studies. The animal study showed a reduction in periprosthetic infection from 47% to 7%, 1 human study in Oncology application of megaprosthesis showed a reduction of septic complications from 17,6% to 5,9%. Te other human study demonstrated that Silver surface implants don't have toxicity cause the blood level of silver Ions were only 56,4 parts per billion. The analysis of our casuistry is giving good results with low level of Silver in the blood and urine, lower concentrations are observed in patients treated with the 2 steps-CIT technique. Conclusions. The use of silver-coated prosthesis can reduce the infection rate in the medium-long term with no toxicity for the patients. Further studies with longer term follow-up periods and larger numbers of patients are warranted in order to confirm these encouraging results most of all in the patients treated with the 2 steps procedure in order to better understand the role of the membrane and of the Chamber Induction Technique in Silver ions dispersions

In order to assess the efficacy of inspection and accreditation by the Specialist Advisory Committee for higher surgical training in orthopaedic surgery and trauma, seven training regions with 109 hospitals and 433 Specialist Registrars were studied over a period of two years. There were initial deficiencies in a mean of 14.8% of required standards (10.3% to 19.2%). This improved following completion of the inspection, with a mean residual deficiency in 8.9% (6.5% to 12.7%.) Overall, 84% of standards were checked, 68% of the units improved and training was withdrawn in 4%. Most units (97%) were deficient on initial assessment. Moderately good rectification was achieved but the process of follow-up and collection of data require improvement. There is an imbalance between the setting of standards and their implementation. Any major revision of the process of accreditation by the new Post-graduate Medical Education and Training Board should recognise the importance of assessment of training by direct inspection on site, of the relationship between service and training, and the advantage of defining mandatory and developmental standards

In 1788, a significant date for Australia, and also for Sir Percival Pott and us, as it was the year Sir Pott fractured his ankle. Wars, as well as individuals like Sir Pott, play a strong role in trauma technique advancement, exemplified by the Thomas splint and the Kuntscher nail. Over the 50 years of my clinical lifetime, a significant period of rapid advancement in knowledge and technology very fortunately occurred and with which I was involved in. In the 1960s, the strong and long ingrained conservative influence of the British Orthopaedic school of trauma care was challenged by the equally long-established but more aggressive European school, in the form of the Swiss AO Foundation (Arbeitsgemeinschaft für Osteosynthesefragen). Australia was ‘a ham in the sandwich’. Which way to go? The pilgrimage to Davos produced some early converts. Phillip Segelov and I were among those and we returned three times to become educators and trainers for the AO Foundation. We convened AO courses in Australia, with our St George-made colour videos (before the Swiss). In 1980 the St George Skills Laboratory was born and became the venue for ongoing technique education. This became known (by some, and not always as a compliment) as the ‘Phil and Bill show’. Almost all who underwent this early training, including Phil and Bill, experienced an initial phase of doubt and rejection. This was metallic madness. However, we had new teachers, new parents, and we learnt to respect them. Interesting and controversial days were to follow. Unfortunately, a number of our very senior Australian colleagues clearly felt deeply confronted. They clinically rejected and in open meeting condemned these aggressive concepts. We were very concerned. This unfortunate circumstance subsided only slowly over time and in concert with the decline of their influence. Interestingly, today, successful trauma unit bed administration and outcomes depend significantly on our use of these concepts and methods. We could not practice modern traumas care without them

Aims

The primary aim of this study was to assess the independent association of the coronavirus disease 2019 (COVID-19) on postoperative mortality for patients undergoing orthopaedic and trauma surgery. The secondary aim was to identify factors that were associated with developing COVID-19 during the postoperative period.

Aims

COVID-19-related patient care delays have resulted in an unprecedented patient care backlog in the field of orthopaedics. The objective of this study is to examine orthopaedic provider preferences regarding the patient care backlog and financial recovery initiatives in response to the COVID-19 pandemic.

Aims. Now that we are in the deceleration phase of the COVID-19 pandemic, the focus has shifted to how to safely reinstate elective operating. Regional and speciality specific data is important to guide this decision-making process. This study aimed to review 30-day mortality for all patients undergoing orthopaedic surgery during the peak of the pandemic within our region. Methods. This multicentre study reviewed data on all patients undergoing trauma and orthopaedic surgery in a region from 18 March 2020 to 27 April 2020. Information was collated from regional databases. Patients were COVID-19-positive if they had positive laboratory testing and/or imaging consistent with the infection. 30-day mortality was assessed for all patients. Secondly, 30-day mortality in fracture neck of femur patients was compared to the same time period in 2019. Results. Overall, 496 operations were carried out in 484 patients. The overall 30-day mortality was 1.9%. Seven out of nine deceased patients underwent surgery for a fractured neck of femur. In all, 27 patients contracted COVID-19 in the peri-operative period; of these, four patients died within 30 days (14.8%). In addition, 21 of the 27 patients in this group had a fractured neck of femur, 22 were over the age of 70 years (81.5%). Patients with American Society of Anesthesiologists (ASA) grade > 3 and/or age > 75 years were at significantly higher risk of death if they contracted COVID-19 within the study period. Conclusion. Overall 30-day postoperative mortality in trauma and orthopaedic surgery patients remains low at 1.9%. There was no 30-day mortality in patients ASA 1 or 2. Patients with significant comorbidities, increasing age, and ASA 3 or above remain at the highest risk. For patients with COVID-19 infection, postoperative 30-day mortality was 14.8%. The reintroduction of elective services should consider individual patient risk profile (including for ASA grade). Effective postoperative strategies should also be employed to try and reduce postoperative exposure to the virus. Cite this article: Bone Joint Open 2020;1-7:392–397

Aims

Informed patient consent is a legal prerequisite endorsed by multiple regulatory institutions including the Royal College of Surgeons and the General Medical Council. It is also recommended that the provision of written information is available and may take the form of a Patient Information Leaflet (PIL) with multiple PILs available from leading orthopaedic institutions. PILs may empower the patient, improve compliance, and improve the patient experience. The national reading age in the United Kingdom is less than 12 years and therefore PILs should be written at a readability level not exceeding 12 years old. We aim to assess the readability of PILs currently provided by United Kingdom orthopaedic institutions.

It is unusual, if not unique, for three major research papers concerned with the management of the fractured neck of femur (FNOF) to be published in a short period of time, each describing large prospective randomized clinical trials. These studies were conducted in up to 17 countries worldwide, involving up to 80 surgical centers and include large numbers of patients (up to 2,900) with FNOF. Each article investigated common clinical dilemmas; the first paper comparing total hip arthroplasty versus hemiarthroplasty for FNOF, the second as to whether ‘fast track’ care offers improved clinical outcomes and the third, compares sliding hip with multiple cancellous hip screws. Each paper has been deemed of sufficient quality and importance to warrant publication in The Lancet or the New England Journal of Medicine. Although ‘premier’ journals, they only occationally contain orthopaedic studies and thus may not be routinely read by the busy orthopaedic/surgical clinician of any grade. It is therefore our intention with this present article to accurately summarize and combine the results of all three papers, presenting, in our opinion, the most important clinically relevant facts.

Cite this article: Bone Joint Open 2020;1-6:198–202.