Aims

The aim of this study was to assess the effect of time to surgical intervention from admission on mortality and morbidity for patients with hip fractures.

Abstract

Aim

The prevention of surgical-site infection (SSI) is of great importance. Airborne particulate correlates with microbial load and SSI. There are many potential sources of airborne particulates in theatre and from an experimental point of view impossible to control. We evaluated the effectiveness of a novel air decontamination-recirculation system (ADRS) in reducing airborne particles in a laboratory environment and controlled the introduction of particulate using diathermy.

London's Air Ambulance (LAA) was first set-up in 1989 as a direct result of a Royal College of Surgeons of England Report highlighting poor trauma care provision. Since its inception, the service's mission is to be an innovative and effective provider of advanced pre-hospital care. The service provides a senior Doctor and senior Paramedic to the scene of any incident within the M25 by helicopter, during the day, and by fast-response car at night. The vast majority of doctors are usually Emergency Medicine Physicians or Anaesthetists. During a 6-month tenure, doctors will usually have completed a number of procedures, which include rapid sequence induction of anaesthesia, pre-hospital blood transfusion, and, procedural sedation. In terms of innovations, the organisation was the first in the UK to provide a 24/7 service. It was also the first to start pre-hospital Rapid Sequence Induction of Anaesthesia for the severely injured; Resuscitative Thoracotomy for the victims of penetrating trauma; and pre-hospital Blood Transfusion for shocked polytrauma patients. The service also has a very thorough induction programme, for new Doctors and Paramedics, and a highly structured Clinical Governance process. The post offers a unique and privileged opportunity to treat the most severely injured at the roadside.

The purpose of the study was to investigate the incidence of surgical site infection following elective paediatric orthopaedic surgery.

A pro forma adopted from a pilot study was filled out preoperatively for each elective operation performed during the study period. Each patient was then followed up for six weeks postoperatively to record any SSI that developed. Data collected included patient demographics, type of operation, grade of Surgeon, type of procedure, wound length, skin preparations, use of tourniquet, any antibiotic prophylaxis and length of operation.

This study collated data on 334 operations with 410 procedural sites over a six month period. Infection were recorded in 19 sites equivalent to a SSI rate of 4.63%. None of the patients developed long-term complications.

The mean age of the participants in the study was 11 years (range 0.5 to 17 years), 57% were males and 43% were females.

The infection were detected between 1 and 38 days after surgery. The outcome was not compromised in any of the patients as none of them required long-term treatment. Statistical analysis was undertaken.

The study proves that the surgical site infection after elective paediatric orthopaedic surgery is low and serve as a bases for consenting patients for surgery.

Introduction: Blood conservation is important in surgery for adolescent idiopathic scoliosis due to the potential for significant blood loss and need to avoid allogeneic transfusion in young, commonly female, patients. Previous studies have shown that a combination of blood conservation methods may be effective in reducing the need for allogeneic blood transfusion. We have carried out a study to investigate if the sole use of intraoperative red cell salvage in surgery for adolescent idiopathic scoliosis is effective and can lead to a reduced rate of allogeneic transfusion.

Patients and Methods: 56 patients aged between 10 and 17 underwent posterior spinal surgery for correction of idiopathic scoliosis. In 34 patients intraoperative cell salvage was used and salvaged blood re-infused perioperatively. This group was compared with a control group of 22 patients in whom only allogeneic blood transfusion was used. All patients underwent hypotensive anaesthesia. Other forms of blood conservation, such as predonation, were not used. Data was gathered on patient demographics, operative details, quantity of blood reinfused, pre and post operative haemoglobin levels and total allogeneic transfusion requirement. Operative data was gathered prospectively and blood transfusion data provided by the transfusion centre.

Results: In the cell salvage group an average of 309mls of blood was reinfused and these patients were transfused an average of 1.8 units less allogeneic blood in the peri-and post-operative period (p< 0.001). 74% of these patients required no allogeneic blood compared with 27% in the control group. There were no complications related to the use of intraoperative red cell salvage.

Conclusion: Intraoperative red cell salvage is effective in reducing the need for allogeneic transfusion in children undergoing posterior surgery for scoliosis correction.

Introduction: Traditionally adolescent anterior knee pain is considered to be a self limiting condition with no long term sequelae. However recently two publications have suggested the condition may be longer lasting. We wish to suggest that adolescent anterior knee pain may lead to patello femoral arthritis.

Method: We have carried out a comparative study assessing the incidence of previous adolescent anterior knee in patients who underwent patello femoral replacement for isolated patello femoral arthritis and have compared them with a matched group of patients who had medial unicompartmental replacement for isolated medial compartment arthritis without patello femoral disease.

All patients were sent a postal questionnaire enquiring about adolescent anterior knee pain, knee injury and patella instability.

Results: Ninety-three PFR patients and 86 UKR patients replied. The incidence of adolescent AKF and patella instability was higher in the PFR.group.

Conclusion: Adolescent anterior knee pain may not always be a benign self limiting condition since this as well as patella injury and instability was associated with subsequent isolated patello femoral arthritis.

Traditional dogma states that anterior knee pain in adolescence does not lead to patello-femoral arthritis. However analysis of 642 new knee referrals seen in one year showed that over 25% had anterior knee pain and that patients were of all ages. This lead to us questioning whether anterior knee pain or adolescent chondromalacia patellae is in fact a benign self limiting condition.

Method: A postal questionnaire was sent to 150 patients who had undergone isolated patello femoral replacement (PFR) enquiring about patella problems earlier in life. The same questionnaire was sent to a matched group of patients who had undergone unicompartmental replacement; because of the selection policy of the unit, these would not have had changes of patellofemoral arthritis.

Results: 118 patients who had undergone PFR retumed the form. 107 were female; the average age at surgery was 66 years. 26 (22%) reported adolescent anterior knee pain at an average age of 18. 112 forms were returned form the UKR group in which females predominated and who had an average age at surgery of 67 years. Only 7 (6%) reported adolescent anterior knee pain, at an average age of 19. 16 (14%) of the PFR group reported adolescent patella instability as opposed to 1 on the UKR group.

Discussion: The finding that significantly more patients with isolated patello-femoral arthritis had suffered from adolescent anterior knee pain suggests a possible causal relationship. Further long-term studies are needed to determine whether adolescent anterior knee pain is benign, as traditionally believed, or whether certain subsets are precursors of patello-femoral arthritis.