Aims

Europe has found itself at the epicentre of the COVID-19 pandemic. Naturally, this has placed added strain onto healthcare systems internationally. It was feared that the impact of the COVID-19 pandemic could overrun the Irish healthcare system. As such, the Irish government opted to introduce a national lockdown on the 27 March 2020 in an attempt to stem the flow of admissions to hospitals. Similar lockdowns in the UK and New Zealand have resulted in reduced emergency department presentations and trauma admissions. The aim of this study is to assess the effect of the national lockdown on trauma presentations to a model-3 hospital in Dublin, Ireland.

Grade III Open fractures of the tibia represent a serious injury. It is recognised that combined management of these cases by experienced orthopaedic and plastic surgeons improves outcomes. Previous studies have not considered the timing of definitive soft tissue cover in relation to the definitive orthopaedic management. We reviewed medical notes of 73 patients with 74 Grade III Open tibia fractures (minimum 1 year follow up), to compare deep infection rates in patients who had a) a single-stage definitive fixation and soft tissue coverage vs. those who had separate operations, and b) those who had definitive treatment completed in < 72 hours vs. > 72 hours.

Of subjects that underwent definitive fixation and coverage in a single procedure, 4.2% developed deep infections, compared with 34.6 % deep infection(p<0.001) in those who underwent definitive treatment at separate operations. Of patients who had definitive treatment completed in < 72-hours, 20.0% developed deep infections a compared with 12.2%(p=0.4919) in the >72-hour group.

Patients with Gustilo III open tibial fractures have lower rates of deep infection if definitive fixation and coverage are performed in a single-stage procedure. Emphasis should be placed on timely transfer to a specialist centre, aiming for a single-stage combined orthoplastic surgery.

Anterior positioning of a cephomedullary nail in the distal femur occurs in up to 88% of cases. This is considered to occur because of a mismatch between the radius of curvature of the femur and that of available implants. The hypothesis for this study was that the relative thicknesses of the cortices of the femur (referenced off the linea aspera) change with age and determine the final position of intramedullary implants.

This study used the data from CT scans undertaken as part of routine clinical practice in 919 patients with intact left femora (median age 66 years, 484 male and 435 female). The linea aspera and transverse intervals were plotted on a template femur between 25% – 60% femoral bone length (5% increments) and mapped automatically to all individual femora in the database with measurements taken in the plane of the linea aspera.

The linea aspera was found to be internally rotated as compared to the sagittal plane referenced off the posterior femoral condyles. An age related change in the posterior/anterior cortical thickness ratio was demonstrated. The >80 year old cohort shows a significantly disproportional posterior/anterior ratio increase of 70.0% from 25–50% bone length as compared to 48.1% for the <40 year old cohort (p<0.05).

This study has shown that assessment in the sagittal plane may be inaccurate because of rotational changes in the linea aspera. The centering influence of the corticies is lost with age with a relative thinning of the anterior cortex and thickening of the posterior cortex moving distally in the femur. This has a direct influence on the positioning of intramedullary implants explaining the preponderance of anterior malpositioning of intramedullary implants in the elderly.

Purpose:

Anterior positioning of a cephomedullary nail (CMN) in the distal femur occurs in up to 88% of cases. Conventionally, this is considered to occur because of a mismatch between the radius of curvature (ROC) of the femur and that of available implants. The hypothesis for this study was that the relative thicknesses of the cortices of the femur, particularly the posterior cortex are important in determining the final position of an intramedullary implant and that the posterior cortical thickness corresponds to the linea aspera anatomically. The aim was to determine if these measurements changed with age.

Introduction

The Western Infirmary/Gartnavel General Hospital orthopaedic department is geographically located next to the Beatson Oncology Centre, a specialist regional oncology unit. Pathological femoral fractures are the commonest reason for surgical intervention in patients referred from the Beatson and we have used them as a model to establish the demographic data, referral patterns, treatment results, and survival characteristics in such a group of patients.

Supracondylar fractures of the humerus have historically been treated as an emergency case and operated on at the earliest opportunity. We undertook a study to examine whether surgical timing affects the need for open reduction or peri-operative complications in the type III injuries.

Between August 1995 and August 2004, 534 patients presented and were referred to our unit with these fractures. Those with closed, type III injuries without vascular compromise were selected (171 patients). These were divided into 2 groups: those undergoing surgery less than 8 hours from presentation (126 patients) and those undergoing surgery more than 8 hours from presentation (45 patients).

The two major differences between the two groups were: the delayed group were more likely to undergo open reduction (33.3% v 11.2%, p<0.05) and the mean length of the surgical procedure was increased (105.1 minutes v 69.2 minutes, p<0.05). Delay in treatment of the type III supracondylar fractures is associated with an increased need for open reduction and a longer procedure. We would recommend treating these injuries at the earliest opportunity.