Despite the COVID-19 pandemic, incidence of hip fracture has not changed. Evidence has shown increased mortality rates associated with COVID-19 infection. However, little is known about the outcomes of COVID-19 negative patients in a pandemic environment. In addition, the impact of vitamin D levels on mortality in COVID-19 hip fracture patients has yet to be determined. This multicentre observational study included 1,633 patients who sustained a hip fracture across nine hospital trusts in North West England. Data were collected for three months from March 2020 and for the same period in 2019. Patients were matched by Nottingham Hip Fracture Score (NHFS), hospital, and fracture type. We looked at the mortality outcomes of COVID-19 positive and COVID-19 negative patients sustaining a hip fracture. We also looked to see if vitamin D levels had an impact on mortality.Aims
Methods
The effectiveness of intravenous tranexamic acid (TA) in reducing blood loss and transfusion requirements during total hip replacement (THR) is well recognised. The aim of this study was to assess the effectiveness of a fibrin sealant in comparison to intravenous TA and a control group. We prospectively studied 270 patients with primary hip osteo-arthritis who underwent a straight forward THR between February 2012 and September 2013. The first 70 patients acted as the control group. The next 100 consecutive patients received fibrin sealant spray before closure and the last 100 patients received 1g TA on induction. Demographic data, comorbidities, surgical time, surgeon grade, anaesthetic type, haemoglobin drop post-operative and transfusion requirements were analysed using one-way ANOVA. The demographic characteristics, surgical time, surgeon grade, anaesthetic type and pre-operative haemoglobin of the 3 groups were comparable. Both fibrin sealant and intravenous TA were effective in reducing blood loss during THR (15%, p = 0.04 & 22.5%, p = 0.01, respectively), when compared to the control group. However, neither treatment was found to be superior to the other in preventing blood loss p = 0.39. Tranexamic acid was superior to fibrin sealant in decreasing allogeneic transfusion requirements (0% vs 10%, p = 0.05). The LOS was significantly shorter in the tranexamic acid group than fibrin sealant group and in the fibrin sealant group compared with control group. There was no significant difference between the groups with regards to proportion of patients with wound leaking problems. No other complications (e.g. VTE) were encountered Both fibrin sealant and intravenous tranexamic acid were effective in reducing blood loss. However, tranexamic acid use reduced post-operative transfusion requirements.
To determine whether the amount of fibula resection in fibula osteotomy influences outcome in deformity correction surgery. Retrospective case note and imaging review was performed on a cohort of 45 patients from November 2005 to July 2009 treated with lengthening and/or correction for leg deformity in either an adult or paediatric limb reconstruction centre. Method, extent and level of original fibular resection was recorded, as well as type of fixator, distraction regime and total gap at osteotomy site after distraction. Outcome was measured as premature, expected or non-union and subsequent need for reintervention.Statement of purpose
Methods
Cartilage lesions in chronic lateral ligament deficiency are common with the incidence rates mentioned in the previous literature up to 30%. However, other intra-articular pathologies in the unstable ankle have received little attention. Anterolateral impingement associated with synovitis and scarring is a less recognised feature in the treatment of chronic instability. The aim of our study was to ascertain the incidence of chondral and anterolateral impingement lesions in the symptomatic lateral ligament complex deficiency. We performed a retrospective study of all consecutive patients who underwent modified Brostrom repair for symptomatic recurrent instability of the ankle. All patients underwent a MRI scan prior to surgery. Arthroscopy was performed in all the patients before lateral ligament reconstruction. Seventy seven patients with 78 ankles were included in the study. Patients who had previous ankle surgery or inflammatory arthropathy were excluded. Data was obtained from clinical and radiological records. Arthroscopic findings were recorded in detail during the surgery.Background
Methods
The purpose of the study was to evaluate the results of Expert tibial nailing for distal tibial fractures. All patients who had a distal third or distal end fracture of the tibia treated with the Expert tibial nail over a three year period at our institution were included in the study. A total of 44 distal tibial fractures in the same number of patients were treated with the nailing system. One patient died in the immediate post operative period from complications not directly related to the procedure and 3 were lost to follow up leaving a cohort of 40 patients for evaluation. 31 of the fractures were closed while the remaining 9 were open. The average age group of the cohort was 46.8 years with 26 males and 14 females.Aim
Methods
A single centre, prospective study of 196 closed tibial diaphyseal fractures treated by monolateral external fixation. Surgical management of all patients followed a protocol of the senior author (PBMT), with regard to technique and fracture reduction. Operations were performed by several different surgeons including the senior author. A definitive fixator was used as a reduction tool in 34 cases, and a separate fracture reduction device was used in 162 patients. Follow-up was in a dedicated external fixator clinic by the senior author until one year post-fracture healing. Fracture healing was determined by fracture stiffness measurements. 196 tibial fractures in 196 patients, average age 29 (range 12-80). 111 right sided and 85 left sided. 166 male and 30 female. 116 fractures due to low energy and 80 due to high energy. football 75, fall 52, RTA 49, others 20. 33 patients had an additional 74 injuries: 38 fractures/dislocations (3 open), 7 compartment syndromes, 7 head injuries, 16 chest injuries, 9 soft tissue injuries. According to AO classification system: 33 A1, 47 A2, 42 A3, 15 B1, 46 B2, 7 B3. Time to fracture healing was 19 weeks on average (range 9-87). 15 patients had coronal deformity >5 degrees and 1 also had saggital deformity >10 degrees. One osteotomy for correction of malunion. 279 pin site infections requiring antibiotics in 35 patients. 7 fixators removed early due to pin site infection. One established osteomyelitis-lautenbach. 7 refractures, all healed (5 with pop, 2 with further fixator). Non-union: 5 hypertrophic, 2 atrophic-all healed with further external fixation. Our results show that external fixation of closed tibial fracture is a viable alternative to other treatment methods with regard to healing time and angular deformity. Our study also uses a well validated end point to define fracture healing and does not rely on the difficulty of defining union on clinical and radiological grounds.Mechanism of injury
