This study quantified changes in the microbiology of osteomyelitis in a single specialist centre within the UK. The rate of infection with multi-drug-resistant (MDR) bacteria was measured over a ten year period in 388 patients. Patients with confirmed osteomyelitis who received curative surgery from 2013–2017 were included (n=222). Microbiology was compared to patients from a cohort between 2001–2004, using the same diagnostic criteria (n=166).1 The proportion of MDR bacterial pathogens2 from deep tissue culture in these cohorts were compared. Pathogens were analysed according to aetiology and the presence of metal-work.Aim
Method
Both surgeon and hospital volume influence patient outcomes following revision knee arthroplasty. To audit all centres performing revision knee procedures in England and Wales over a 2-year period. All centres were audited against two pre-defined standards linked to hospital volume Operative volume should be greater than 10 revisions per year; More than 2.5 revisions should be performed for every 100 primary arthroplasties implanted.Background
Purpose
The NW Advancing Quality programme is a regional one aimed at improving the delivery of evidence based care. Hip and knee replacement has been one of 5 clinical areas. Over a 3 year period performance at all 24 NW trusts has been measured. For hip and knee replacement patients the evidence based care has been delivery of antibiotic and thromboembolic prophylaxis. Robust data has been collected on the choice and timeliness of prophylaxis and readmission rates for each trust. The programme included financial and reputational (public reporting) rewards for top performing units. Sharing of data and collaborative working has been put in place to improve overall performance Over the 3 years of the programme data has been collected on 47,825 patients. Across the region delivery of the measures has improved from 88 to 96%. Patients achieving all measures and avoiding readmission has improved from 64 to 85%. There has been reduced variation in performance. The biggest improvement in performance has occurred in the initially poorer perfoming trusts (year 1 range 54–97%, year 3 range 86–99%). All cause readmission within 28 days of discharge has fallen from 9 to 7%. The progamme has demonstrated that it is possible to improve delivery of evidence based care and clinical outcomes on a regional basis. It has evolved from a stand alone programme to continue as a regional CQUIN. The programme has had wider benefits. Units report a change of culture producing improved delivery of other protocols. The collaboraive working has created a multidisciplinary network with improvement initiatives widened to include comparing PROMS data, Enhanced Recovery and Shared Decision Making. Challenges have included obtaining consensus regarding the initial and now soon to be introduced updated thromboembolic measures
A retrospective review of 51 consecutive patients undergoing fixation of Scaphoid fractures by two surgeons in a single institution was conducted. Twenty-four patients were treated with a Herbert screw and twenty-seven with an Acutrak screw. This included six patients who underwent acute fixation, three in each group. The remaining cases were for the treatment of non-union and delayed union. There were no significant differences between the two groups in terms of age, side of injury, and mechanism of injury. Fractures were classified as proximal, middle and distal thirds of the Scaphoid and there was no significant difference between the groups regarding the types of fractures treated. The only significant difference between the groups was the time from injury to fixation when considering the cases of delayed union and non union which was greater in the Herbert screw group (7.5 months vs 4 months p=<0.05). There was no significant difference in outcome between the two methods of fixation. Union rates for all cases were 79% for Herbert screws and 81% for Acutrak screws and 82% and 83% respectively when only considering the delayed union/non-union procedures. There was no difference in terms of time to union, further surgery or clinical outcome between the two groups. The Acutrak screw required removal in five patients and the Herbert screw in two due to symptoms from screw prominence. This was not statistically significant. In conclusion there is no significant difference in surgical outcome between these two methods of fixation for Scaphoid fractures. The authors feel that this supports the view that biological factors are more important than the method of fixation in obtaining union of Scaphoid fractures.
