To compare the cost-effectiveness of high-dose, dual-antibiotic cement versus single-antibiotic cement for the treatment of displaced intracapsular hip fractures in older adults. Using data from a multicentre randomized controlled trial (World Hip Trauma Evaluation 8 (WHiTE-8)) in the UK, a within-trial economic evaluation was conducted. Resource usage was measured over 120 days post randomization, and cost-effectiveness was reported in terms of incremental cost per quality-adjusted life year (QALY), gained from the UK NHS and personal social services (PSS) perspective in the base-case analysis. Methodological uncertainty was addressed using sensitivity analysis, while decision uncertainty was handled using confidence ellipses and cost-effectiveness acceptability curves.Aims
Methods
The aim of this study was to describe the current pathways of care for patients with a fracture of the hip in five low- and middle-income countries (LMIC) in South Asia (Nepal and Sri Lanka) and Southeast Asia (Malaysia, Thailand, and the Philippines). The World Health Organization Service Availability and Readiness Assessment tool was used to collect data on the care of hip fractures in Malaysia, Thailand, the Philippines, Sri Lanka, and Nepal. Respondents were asked to provide details about the current pathway of care for patients with hip fracture, including pre-hospital transport, time to admission, time to surgery, and time to weightbearing, along with healthcare professionals involved at different stages of care, information on discharge, and patient follow-up.Aims
Methods
There has been an increasing use of early operative fixation for scaphoid fractures, despite uncertain evidence. We conducted a meta-analysis to evaluate up-to-date evidence from randomized controlled trials (RCTs), comparing the effectiveness of the operative and nonoperative treatment of undisplaced and minimally displaced (≤ 2 mm displacement) scaphoid fractures. A systematic review of seven databases was performed from the dates of their inception until the end of March 2021 to identify eligible RCTs. Reference lists of the included studies were screened. No language restrictions were applied. The primary outcome was the patient-reported outcome measure of wrist function at 12 months after injury. A meta-analysis was performed for function, pain, range of motion, grip strength, and union. Complications were reported narratively.Aims
Methods
To explore staff experiences of a multicentre pilot randomized controlled trial (RCT) comparing intramedullary nails and circular frame external fixation for segmental tibial fractures. A purposeful sample of 19 staff (nine surgeons) involved in the study participated in an interview. Interviews explored participants’ experience and views of the study and the treatments. The interviews drew on phenomenology, were face-to-face or by telephone, and were analyzed using thematic analysis.Aims
Methods
The Patient Archiving and Communication System (PACS) has revolutionised the way that radiographs are stored and viewed in orthopaedic surgery. A recent advance has been the ability to upload images directly from the image intensifier to PACS. We postulated that this facility may reduce the need for post operative ‘check’ radiographs following many orthopaedic trauma procedures. We performed an audit of post-operative radiographs requested in our University Hospital over three time periods: 31 days immediately before the direct upload facility was introduced, 31 days immediately after and a 31 day period two months later. Details from the operating lists were cross-referenced with image intensifier records to identify cases where it had been used. PACS records were then checked to determine if these images were available to view and if a formal ‘check’ radiograph was performed in the period prior to discharge.Introduction
Patients and Method
Locking compression plate (LCP) fixation is an established method of treatment of distal third tibial fractures. No biomechanical data exists in the literature regarding their use. Additionally no data exists on the biomechanical advantage of locking screw fixation over non-locking screw fixation for these fractures. In this study the axial and torsional stiffness, axial load to failure and fatigue performance of a 3.5 mm LCP medial distal tibia Synthes plate was evaluated for the stabilisation of distal third tibial fractures. Additionally the performance of the plate in uni and bicortical locked mode as well as non-locked mode was evaluated. A standardized oblique fracture pattern was created in the tibial metaphysis of 3rd generation composite tibias, 40 mm from the distal end of the tibia (AO 43-A2.3). A 10mm fracture gap was used to model a comminuted metaphyseal fracture. A 3.5 mm medial distal tibia LCP was applied with bi or unicortical locking or bicortical non-locking screws to 5 tibias respectively. All the bio-mechanical tests were performed on a Bose 3510 Electroforce material testing machine. A ramp to load, loading profile was used to determine the static axial and torsional performance of the construct. Fatigue testing simulated a 6 week gradual weight bearing régime with the load increasing every two weeks by 400N until either 250,000 cycles were completed or the construct failed.Introduction
Methods
