Knee osteotomy, both high tibial and distal femoral osteotomy, is a well-recognised treatment for young, active patients with unicompartmental knee osteoarthritis. Osteotomy around the knee is usually performed as an inpatient procedure. The aim of this study was to assess the effectiveness and patient satisfaction of our day-case protocol for knee osteotomy. All patients who underwent day-case knee osteotomy at the study unit, over a three-year period, were reviewed to assess the success of ambulatory care for knee osteotomy. Patients were sent questionnaires to assess functional outcome and patient satisfaction with our day-case process.Abstract
Introduction
Methodology
Reduced bone mineral density is recognised as a risk factor for hip fractures and fragility fractures in general. Vitamin D is important in maintaining healthy bone mineral levels and can therefore affect risk of hip fracture. We investigated the correlation between vitamin D levels and bone mineral density, as well as fracture type, in neck of femur fractures and also assessed the relationship of vitamin D and social deprivation. We included all patients admitted to our department, with a neck of femur fracture over one year (October 2013 to October 2014). We analysed vitamin D levels for all patients during admission and compared these to bone mineral density scores, based on DEXA scan results; hip fracture type & comminution, based on admission radiographs; and levels of social deprivation, based on the patient's address.Background
Method
Functional outcomes of conservatively managed, valgus impacted proximal humeral fractures are poor. Operative fixation can improve results but can be technically challenging. We prospectively assessed outcomes following fixation of valgus unstable proximal humeral fractures with a novel hybrid fixed angle blade plate, at a minimum of 12 months follow up. A new hybrid fixed angle blade plate design (Fx Plate, Exactech, Gainesville, USA) was used by the senior author to treat patients with displaced and potentially valgus unstable proximal humeral fractures, at our institution between November 2012 and March 2014. The study was approved by the research and development department. Outcomes were prospectively assessed using the Oxford and Constant shoulder scores and quality of life was assessed using the SF-36 questionnaire. Radiographs were taken at regular intervals to assess fracture healing.Background
Methods
Prospectively assess the degree of finger swelling after shoulder arthroscopy, to determine whether rings should be routinely removed prior to surgery. Patients undergoing shoulder arthroscopic procedures had finger diameters measured prior and post surgery, over a three month period. The study was approved by our Research and Development department. Measurements were taken using a finger circumference gauge (Southpointe, Florida, USA) and were all performed by one researcher in a standard technique, to eliminate inter observer variability. Control measurement, using the contralateral hand, were taken. Statistical analysis was performed, using the Mann Whitney U test. 31 patients undergoing shoulder arthroscopy were included in the study and had finger diameters assessed. The median amount of finger swelling on the operated side was 2.8 mm (IQR 4.6) per digit, compared to 0 mm on the contralateral side (IQR 1.6), which was significantly greater (p=0.0003). There was no statistical difference in the amount of finger swelling when patients undergoing short procedures (less than 30 minutes operating time) were compared to patients undergoing long procedures (greater than 60 minutes).Aim
Method and Results
At our district general hospital in the southwest of England, around 694 total knee replacements (TKR) are performed annually. Since spring 2013 we have been using an enhanced recovery protocol for all TKR patients, yet we have neither assessed compliance with the protocol nor whether its implementation has made a discernible and measurable difference to the delivery of care in this patient population. Enhanced recovery after surgery (ERAS) protocols are multi-modal care pathways designed to aid recovery. They are based on best evidence and promote a multi-disciplinary approach which standardises care and encompasses nutrition, analgesia and early mobilisation throughout the pre, intra and postoperative phases of an inpatient stay. ERAS has been found to reduce length of stay (LOS), readmission rates and analgesic requirements following surgery.1, 2, 3 Additionally, they have been shown to improve range of knee movement following TKR and improve mobility, patient satisfaction whilst reducing mortality and morbidity.4, 5, 6 With these benefits in mind, we sought to investigate how well our trauma and orthopaedic department was complying with a local ERAS protocol and whether we could replicate the benefits seen within the literature. Following approval from our local audit office in September 2015 we generated a patient list of elective TKR patients under the same surgeon before and after the implementation of the ERAS protocol. Using discharge summaries and patient notes we extracted data for 39 patients operated on prior to the ERAS implementation between January 2011 and December 2012 and 27 patients following its introduction between January 2014 and September 2015. Data collected included length of stay, time to discharge from inpatient physiotherapy and use of analgesia and antiemetics. Alongside this we audited the compliance with all facets of the local ERAS protocol. There was no statistically significant difference between the 2 groups in terms of demographics or pre-operative morbidity. Overall compliance with the ERAS protocol was good but there was some variability, especially with intraoperative medication and type of anaesthesia which was likely due to individual patient factors. Compliance with postoperative analgesia was especially good with 93% of patients receiving all 4 suggested analgesics within the ERAS group. Length of stay (LOS) was significantly reduced by 0.5 days per patient (p value < 0.4). Overall compliance with the ERAS protocol was good but there was some variability, especially with intraoperative medication and type of anaesthesia, which was likely due to individual patient factors. Compliance with postoperative analgesia was especially good with 93% of patients receiving all suggested analgesics within the ERAS group. In terms of LOS, we found a statistically significant difference between the pre-ERAS and ERAS group of 0.5 days per patient. Within the context of our DGH, a 0.5 day reduction in LOS translates to around 350 bed days per year and a potential saving of GBP 105,000 (EUR 132,000) making this a clinically significant finding.
