Falls and fall-related injuries can have devastating health consequences and form a growing economic burden for the healthcare system. To identify individuals at risk for preventive measures and therapies, fall risk assessment scores have been developed. However, they are costly in terms of time and effort and rely on the subjective interpretation of a skilled professional making them less suitable for frequent assessment or in a screening situation. Small wearable sensors as activity monitor can objectively provide movement information during daily-life tasks. It is the aim of this study is to evaluate whether the activity parameters from wearable monitors correlate with fall risk scores and may predict conventional assessment scores. Physical activity data were collected from nineteen home-dwelling frail elderly (n=19, female=10; age=81±5.6 years, GFI=5.4±1.9, MMSE=27.4±1.5) during waking hours of 4 consecutive days, wearing a wearable 9-axis activity monitor (56×40×15mm, 25g) on the lateral side of the right thigh. The signal was analysed using self-developed, previously validated algorithms (Matlab) producing the following parameters: time spent walking, step count, sit-stand-transfer counts, mean cadence (steps/min), count of stair uses and intensity counts >1.5G. Conventional fall risk assessment was performed using the Tinetti sore (range: 0–28=best), a widely used tool directly determining the likelihood of falls and the Short Physical Performance Battery (SPPB, range: 0–12=best) which measures lower extremity performance as a validated proxy of fall risk. The anxiety to fall during activities of daily living was assessed using the self-reported Short Falls Efficacy Scale-International (FES-I, range: 7–28=worst). Correlations between activity parameters and conventional scores were tested using Pearson's r. The activity parameters (daily means) for the 19 participants were 70.8min (SD=28.7; min-max= 22.8–126.6) of walking, 4427 steps (SD=2344; min-max= 1391–8269) with a cadence 79.3 steps per minute (SD=17.1; min-max=52.8–103.9) and 33.3 sit-stand transfers (SD=9.7; min-max=8.8–48.0). The average Tinetti score was 21.2 (SD=5.1; min-max=10.0–27.0), with SPPB scoring 7.8 (SD=2.4; min-max=3.0–12.0), and FES-I 4.6 (SD=5.1; min-max=7.0–23.0). Strong (r≥0.6) and significant correlations existed between the walking cadence and the Tinetti (r=.60, p=<.01) and SPPB (r=.71, p=<.01) scores. No other correlations were found between the activity parameters and the Tinetti, SPPB and none with the psychological FES-I questionnaire. Conventional fall risk scores and activity data are comparable to literature values and thus representative of home-dwelling frail elderly including a wide range covered for both dimensions. No quantitative activity measure had a predictive value for fall risk assessment. Strongly correlated with Tinetti and SPPB, objectively measured cadence as a qualitative parameter seems a useful parameter for remotely identifying fall risk in frail elderly. The perceived anxiety to falls was not correlated to quantitative and qualitative activity parameters suggesting that this psychological aspect hardly affects activity. Wearable activity monitors seem a valid tool to assess fall risk remotely and thus allow low cost, frequent and large group screening of frail elderly towards a health economically viable tool for a growing societal need. The predictive quality of activity monitored data may be increased by deriving additional qualitative measures from the activity data

Background and objectives

The prevention of osteoporotic fractures is a global problem. Key to this strategy is efficient identification of ‘at risk’ patients in order to address the osteoporosis pandemic, including the identification of previously sustained fractures. GP practices are now integrating touch screens as a method of registering patients' attendance for an appointment, so all ages of patients are becoming familiar with this channel of communication. Our touch screen patient administered questionnaire system intends to provide an effective solution.

Introduction. Functional Spine Units (FSUs) play a vital role in understanding biomechanical characteristics of the spine, particularly bone fracture risk assessment. While established models focus on simulating axial compression of individual bones to assess fracture load, recent models underscore the importance of understanding fracture load within FSUs, offering a better representation of physiological conditions. Despite the limited number of FSU fracture studies, they predominantly rely on a linear material model with an annulus fibrosus Young's modulus set at 500 MPa, significantly higher than stiffness values (ca. 4 MPa) utilized in other FSU and spine section biomechanical models. Thus, this study aims to study the effect of varying annulus fibrosus stiffness on FSU fracture load, aiming to identify physiologically relevant biomechanical parameters. Method. Subject-specific geometry and material properties of bones were derived from computed tomography (CT) image data of five human cadaveric FSU specimens. The annulus fibrosus and nucleus pulposus were manually recreated and assigned linear elastic material properties. By subjecting the model to axial compression, the fracture load of the FSU was deduced from the peak of the force-displacement graph. To explore the effect of stiffness of the annulus fibrosus on simulated fracture load, we conducted a parameter study, varying stiffness values from the high 500 MPa to a more physiologically relevant 25 MPa, aiming to approximate values applied in FSU kinematic models while achieving bone fracture. Result. Significant reductions in fracture load were observed, ranging from 23% to 46%, as annulus stiffness decreased from 500MPa to 25MPa. Additionally, a discernible, gradual decline in fracture load was observed with a decrease in stiffness values. Conclusion. The stiffness of the annulus fibrosus significantly influences the simulated fracture load of an FSU. Future investigations should prioritize biomechanically accurate modeling of the intervertebral disc, ensuring alignment with experimental findings regarding FSU fracture load while maintaining biomechanical fidelity

Introduction. In 2011 the Scottish Government published national MRSA screening requirements. A comparison of Orthopaedic and ENT elective surgery intended to juxtapose a specialty known to take MRSA screening seriously with one that has little clinical concern with regards MRSA infection. ENT surgery parallels Orthopaedics in using implants and there potentially being MRSA colonisation at or close to the site of surgery. In Orthopaedics MRSA infection is infrequent, but implant infection with antibiotic resistant bacteria has a particularly poor prognosis. In ENT MRSA infection is rare and colonisation does not influence patient care. Aims. An evaluation of MRSA screening practice for elective Orthopaedics and ENT surgery at Gartnavel General Hospital with regards strategy and implementation. Method. Review of 342 consecutive elective ENT patients and 325 Orthopaedic patients attending for inpatient or day case surgery. The reference standards were the regional and national guidelines on MRSA screening. Results. Overall screening rates were 145 (42%) of 342 ENT patients and 270 (83%) of 326 Orthopaedic patients. 100% of Orthopaedic patients admitted (154) were screened, in compliance with both regional and national policy. 91 (70%) of 130 ENT patients admitted were screened for MRSA, and no risk assessment was carried out, which was not in compliance with either regional or national policy. Discussion. Orthopaedic surgery has an established and reliable practice of screening elective inpatient cases, and when identified MRSA colonisation results in a change in patient management. ENT surgery should have established a similar practice according to existing local guidelines. The Government consider ENT a lower risk speciality for MRSA, but still require as a minimum a documented MRSA risk assessment process

Objectives

Distraction osteogenesis (DO) mobilises bone regenerative potential and avoids the complications of other treatments such as bone graft. The major disadvantage of DO is the length of time required for bone consolidation. Mesenchymal stem cells (MSCs) have been used to promote bone formation with some good results.