Management of complex fractures poses a significant challenge. Evolving research and changes to national guidelines suggest better outcomes are achieved by transfer to specialist centres. The development of Major Trauma Networks was accompanied by relevant financial arrangements. These do not apply to patients with closed fractures referred for specialist treatment by similar pathways. Despite a surge in cases transferred for care, there is little information available regarding the financial impact on receiving institutions. This retrospective study examines data from a Level 1 trauma centre. Patients were identified from our electronic referral system, used for all referrals. Transferred adult patients, undergoing definitive treatment of acute isolated closed tibial fractures, were included for a 2-year period. Data was collected using our clinical and Patient Level Information and Costing (PLICS) systems including coding, demographics, treatment, length of stay (LOS), total operative time, number of operations, direct healthcare costs, and NHS reimbursements.Introduction
Materials & Methods
The management of upper limb nonunions can be challenging and often with unpredictable outcomes. In the study we present the results of treatment of upper limb nonunions treated in our institution with BMP-7 biological enhancement. Between 2004 and 2011 all consecutive patients who met the inclusion criteria were followed up prospectively. Union was assessed with regular radiological assessment. At the final follow up clinical assessment included the disabilities of the Arm, Shoulder and Hand (DASH) score, range of movement and patient satisfaction. The mean follow up was 12 months (12–36). In total 42 patients met the inclusion criteria with a mean age of 47. Anatomical distribution of the nonunion sites included 19 cases of mid/proximal radius/ulna, 14 humerus, 6 distal radius and 3 clavicles. 5 patients had septic nonunion, 35 had atrophic nonunion, 11 had previous open fractures, and 10 had bone loss (range 1–3 cm). The mean number of operations performed and the mean time from injury to BMP application was 1.5 and 26 months, respectively. 40 patients had both clinical and radiological union whereas 2 had partial radiological union but a pain free range of motion. BMP was applied in isolation in 1 case and 41 cases the application was combined with autologous bone grafting. The range of movement of the affected limb, DASH score and patient satisfaction were optimum at the final follow up. This study supports the use of BMP-7 as a bone stimulating adjunct for the treatment of complex and challenging upper limb nonunions.
Clavicle fractures can cause pain and functional impairment if not managed appropriately. This paper evaluates the prevalence of clavicular fractures, estimates number of cases requiring operative treatment, whether removal of implant is a frequent necessity and compares the final functional outcome of the operative and non-operative group. Between November 2005 and November 2007 patients with clavicular fractures were eligible for participation. Patients below 18 years of age, and pathological fractures were excluded. Operative versus non-operative treatment, radiographic classification (Allman system), complications, implant removal, and functional outcome using the University of California Los Angeles (UCLA) shoulder scores were documented and analysed.Introduction
Materials/Methods
Pelvic fractures are indicators of severe trauma and high energy absorption. They are associated with multiple local or distant concomitant injuries, which explain their high mortality and morbidity. The aim of this study is to investigate the late sequel of traumatic-pelvic-fractures (PFX) focusing on quality-of-life and sexual-function. From a database of prospectively documented data, patients who had suffered a PFX and had been treated operatively in our institution from January 2008–2009 were recruited. Exclusion criteria were patients less than one-year post-injury, pathological-fractures, patients < 18 or >65, and patients with co-morbidities linked to sexual dysfunction. Demographics, injury-mechanisms, fracture-patterns (Young-Burgess classification), injury-severity-score (AIS/05-ISS), urogenital injuries and clinical outcome were recorded and analysed. Health-related-quality-of-life was assessed using the (EuroQol-5D) and sexual-function using the international-index-of-erectile-function and the female-sexual-function-index. The minimum follow-up was 12 months (12–30).Introduction
Methods
Reaming of the canal is an important step in the debridement phase of treating intramedullary infections. Numerous techniques of radical canal debridement have been successfully reported. The use of the Reamer-Irrigation-Aspiration system (RIA-Synthes) is currently expanding to include this clinical scenario. Prospective collection of data related to infected cases treated with the use of the RIA in a tertiary referral centre referring to a 3 year period. Peri-operative details, microbiology results, and follow-up outcome over a minimum period of 12 months post-surgery are reported.Introduction
Materials and methods
The management of non-unions of subtrochanteric femoral fractures with associated implant failure is challenging. This study assessed the outcome of a cohort of patients treated according to the diamond concept. Between 2005–2010 all patients with subtrochanteric aseptic non-unions presented post implant failure (Gamma Nail breakage) were eligible in the absence of severe systemic pathologies and comorbidities. Demographics, initial fracture pattern, method of stabilisation, mode of failure of metal work, time to revision of fixation, complications, time to union, and functional outcome were recorded over a minimum period of follow-up of 12 months. The revision strategy was based on the “diamond concept;” optimising the mechanical and biological environment (revision of fixation, osteoinduction/BMP-7, osteoconduction/RIA harvested graft, and osteogenicity/concentrate of bone marrow aspirate).Background
Methods
To evaluate management, direct-medical-costs and clinical outcome profile of a large trauma unit with respect to simple elbow dislocations. All simple elbow dislocations that were defined as not requiring acute surgical intervention, post-reduction, were considered between Jan-2008 and Dec-2010. Inclusion criteria consisted of age greater than 13; absence of major associated fractures, successful closed reduction, and follow-up as an outpatient. The management of these patients was classified in terms of immobilisation time into: short (< 2weeks), standard (2–3weeks) and prolonged (>3weeks). Direct-medical-costs were calculated based on current tariff rates associated with radiology, admission, theatre time (for reductions and recovery) and outpatient attendances. Clinical outcome was evaluated with respect to complications, secondary procedures, and time before discharge from clinic.Objectives
Methods
The aim of this study was to investigate the differences between open vs closed femoral fractures with regard to the epidemiology, classification and outcome. Data collected prospectively from MTOS and TARN-UK. Between 2001 and 2005, 67,665 trauma patients found and 8,591 were identified having sustained femoral shaft fractures. Demographics, pre and in-hospital data were recorded. The AIS and ISS were calculated. Outcomes and mortality rates were recorded. Four groups of patients were identified namely isolated/open (IO), polytrauma/open (PO), isolated /closed (IC), polytrauma/closed (PC). ANOVA analysis was contacted to determine the effect of fracture classification and severity of trauma to mortality using SPSS 11.0 software.Introduction
Patients & methods
Grade IIIa/b open tibial fractures (OTF) result mostly following high energy trauma and may be accompanied by significant associated injuries. Aim of this study was to compare the characteristics and the outcome of OTF between patients of different injury severities. Retrospective analysis of the records of patients admitted to a level I centre in a 4 year period with an OTF. Epidemiologic data, AO-ASIF classification, method of treatment, complication rates and time to fracture-union have been statistically analysed. An AIS98-ISS threshold (ISS 16) was used to separate OTF in 2 groups (A<16, B>16).Introduction
Materials and methods
