In April 2012 National Trauma Networks were introduced in England to optimise the management of major trauma. All patients with an ISS of ≥ 16 should be transferred to the regional Major Trauma Centre (level 1). Our hypothesis was that severe foot and ankle injuries would no longer be managed in Trauma Units (level 2). A retrospective analysis of the epidemiology of severe foot and ankle injuries was performed, analysing the Gloucestershire foot and ankle trauma database, from a Trauma Unit, for a catchment population of 750,000 people. The rate of open fractures, mangled feet and requirements for stabilisation with external fixation were reviewed before and after the introduction. This was compared to the foot and ankle injuries triaged to the regional Major Trauma Centre (MTC) using the TARN database information.Introduction:
Methods:
We studied a series of Endo-Modell(r) rotating hinge knee replacements (RHKRs) to determine indications, implant survival and complication rates. Case notes were audited for a consecutive series of 129 implants performed between 08/12/2002 and 30/01/2009. Indication for use of RHKR was complex primary arthroplasty in 37.8% and revision in 62.2%. For primary arthroplasty with hinge prosthesis, commonest indications were: collateral ligament insufficiency (44.4%); advanced RA (13.9%); supracondylar fracture (5.6%). Indications for revision RHK arthroplasty were: aseptic loosening (40.4%); ligamentous or soft tissue failure (14.0%); periprosthetic fracture (7%); infection (51%). Infection was proven in 21% with 54% of patients requiring a one stage and 46% two stage revision. For revision cases, 74% of primary prostheses were cruciate retaining PFC (Depuy) and in 5%, the primary was itself an Endo-Modell(r) RHKR. Mean time from index to revision procedures was 6.7 years (range 1 year – 23 years). Complications were: deep infection (6.1%) and non-fatal PE (1%). None developed clinically detectable DVT. Transfusion was required in 29 cases (for such cases, an average 3 units was given). 30-day mortality was 1%. For the revision cases, the average length of hospital admission was 11 days. Mean duration of follow up was 45 months (with a minimum of 21 days and maximum of 92 months). During this time 2 RHKRs failed. A total of 7 patients died during the period from complications unrelated to their surgery. 31 cases were lost to follow up. We conclude that in this series of Endo-Modell(r) rotating hinge knee arthroplasties, results are comparable with similar revision procedures. There was a low rate of prosthesis failure, DVT and PE.
