To determine whether a delay of greater than 6 hrs from injury to initial surgical debridement and the timing of antibiotic administration affect infection rates in open long-bone fractures in a typical district general hospital in the UK. In a prospective study, 248 consecutive open long-bone fractures (248 patients) were recruited over a 10-year period between 1996 and 2005. The data were collected in weekly audit meetings. Patients were followed until clinical or radiological union occurred or until a secondary procedure for non-union or infection was performed. The timing of the injury, initial surgical debridement, timing of antibiotic administration, and definitive procedures were all recorded. We also recorded the bone involved and the Gustillo and Anderson (GA) score. Patients who died within 3 months from the injury or who were transferred for definitive treatment were excluded.Aims
Methods
To assess the efficacy and ease of use of the Oxford Knee Score (OKS) in soft tissue knee pathology. In a prospective study, we compared the OKS against the International Knee Documentation Committee 2000 (IKDC) and the Lysholm Scores (Lys). We also assessed the OKS with retrograde (Reversed OKS: 48=worst symptoms, 0=asymptomatic) and antegrade (as currently used in Oxford) numbering. All patients completed 3 questionnaires (OKS, Lys, and IKDC, or RevOKS, Lys, and IKDC) stating which was the simplest from their perspective. We recruited 93 patients from the orthopaedic and physiotherapy clinics. All patients between the ages of 15 and 45 with soft tissue knee derangements, such as ligamentous, and meniscal injuries were included. Exclusions were made in patients with degenerative and/or inflammatory arthritidis. Patients who had sustained bony injuries or underwent bony surgery were also excluded.Aim
Method
To devise a simple clinical risk classification system for patients undergoing primary total knee arthroplasty (PTKR) to facilitate risk and cost estimation, and aid pre-operative planning. We retrospectively reviewed a series of consecutive PTKRs performed by the senior author. A classification system was devised to take account of principal risk factors in PTKR. Four groups were devised: 1) Non complex PTKR (CP0): no local or systemic complicating factors; 2) CPI: Locally complex: Severe or fixed deformity and/or bone loss, previous bony surgery or trauma, or ligamentous instability; 3) CPII Systemic complicating factors: Medical co-morbidity, steroid or immunosuppressant therapy, High BMI, (equivalent to ASA of III or more); 3) CPIII: Combination of local and systemic complicating factors (CPI+CPII). The patients were grouped accordingly and the following were compared: 1) length of stay, 2) post-operative complications, and 3) early post-discharge follow-up assessment. The complications were divided into local (wound problems, DVT, sepsis) and systemic (cardiopulmonary, metabolic, and systemic thromboembolic) complications.Aims
Methods
We have come up with a 4-part stratification based on the patient’s primary condition and comorbidities and have evaluated this for a single-surgeon cohort of TKR patients and a multi-surgeon group of THR patients. We present the results and the implications of the findings and highlight the usability of the system.
1) To determine the predictive value of a simple stability test in children’s wrist fractures treated with simple manipulation and plaster of Paris (PoP) cast immobilisation. 2) To determine the effect of cast quality as reflected in the skin cast distance (distance between the cast and the skin in the plane of major displacement or angulation) and the cast index (the inside diameter of the cast in the sagittal plane divided by the inside diameter in the coronal plane) on re-displacement rates in children’s wrist fractures treated with simple manipulation and plaster of Paris (PoP) cast immobilisation.
We have previously noted that patients undergoing primary knee arthroplasty can be broadly divided into standard and complex. Complexity can be further subdivided into local site of surgery issues, general co-morbidity problems or both. On this basis, we devised a simple to apply four-part classification system for patients undergoing primary total knee replacecments (PTKR) to facilitate cumulative risk estimation:
Complex 0 (C0): “Standard” knee replacement in a fit patient with a simple pattern of arthritis. Complex I (CI): A fit patient with a locally complex arthritis pattern. Complex II (CII): Medically unfit patient with a simple pattern of arthritis. Complex III (CIII): Medically unfit patient with a complex arthritis pattern. When a series of consecutive PTKR’s performed by the senior author was grouped according to our classification, all early postoperative complications and length of stay were evaluated and compared. Compared to “standard C0 PTKR patients, we found a 3-fold increase in the cumulative complication risk in the CII group (p<
0.001), a 4-fold increase in the CIII group (p<
0.001) and an increased length of stay in the CIII group (p<
0.001). There were similar trends between C0 and other groups. Further local studies to quantify the cost differentials of treating complex patients and their longer term outcomes and satisfaction are underway. The senior author would like to discuss with the attending members of this BASK meeting the desirability of adopting such a system regionally or nationally, with the potential benefits for individual patients, surgeons, departments, Trusts and the healthcare system as a whole, and whether minor changes could and should be made to the National Joint Registry forms to accommodate this.
We devised a four-part clinical risk classification system for patients undergoing primary total knee arthroplasty (PTKR) to facilitate risk estimation. We retrospectively reviewed a series of consecutive PTKRs performed by the senior author. A classification system was devised to take account of principal risk factors in PTKR (Table 1). The patients were grouped accordingly, and the following were compared:
Length of stay Postoperative complications Early post discharge follow-up assessment Multiple regression analysis was performed. This revealed:
Similar complication rates in the NCP and CPI groups. 3-fold and 4-fold increase in the cumulative risk in the CPII, and CPIII groups respectively (p<
0.001) Increased length of stay in the CPIII group (p<
0.001).