We aim to describe mortality in orthopaedic patients with Clostridium difficile associated diarrhoea (CDAD), to identify prognostic factors for 30 day mortality, and to modify a CDAD risk score to fit to orthopaedic patients.

This was a two centre, retrospective, observational study including consecutive patients with a first episode of CDAD between 2005–2007. 79 patients were identified, comprising 11 elective patients (14%) and 68 emergency patients (86%). 73 patients (92%) underwent surgery and all but two patients received broad spectrum antibiotics prior to CDAD. The overall 30 day mortality was 29% (n=26). The predominant diagnosis was a fractured femoral neck (66%, n=52).

The most significant multivariable model in predicting 30 day mortality comprised increasing white cell count (WCC, OR 1.20 [for 10% variable increase]; 95% CI 1.06–1.36 p=0.003) and decreasing albumin (OR 0.86 [for single unit decrease]; 0.86–0.95, p=0.003), with adjustment for age ł80 years (OR 6.39, 1.15–35.52, p=0.04). CRP was found to be not significant. Based on this, modification of the previously described Clostridium difficile prognostic index leads to a point awarded for WCC ł20, albumin Ł20, age ł80, urea ł15 or clinically severe disease (peritonitis, sepsis, ł10 episodes of diarrhoea per day). This produces low (0–1 points), medium (2–3 points) and high (4–5 points) risk of death groups, with mortalities of 15%, 47% and 75% respectively for all orthopaedic patients, and 14%, 41% and 67% respectively in only the validation cohort.

CDAD in orthopaedic patients mainly affects emergency patients, in particular those with fractured femoral neck. Inpatient mortality is high, and a high white count and low albumin are significant predictors of mortality. Modification of an easily remembered scoring system based on this can help identify orthopaedic patients likely to die from an episode of CDAD, allowing early aggressive therapy and early objective referral to gastrointestinal teams.

Introduction: Studies have shown Near Infrared Spectroscopy (NIRS) as being an effective tool in measuring oxygenation non-invasively in tissues. More recently it has been used in clinical settings to assess circulatory and metabolic abnormalities, however, clinical studies in bone are lacking.

Materials and Methods: Ten able-bodied (AB) (5 men and 5 women; age, 23-40 years) and ten spinal cord injured (SCI) (complete cord transection above T10, 5 men and 5 women; age 19–38) participants were matched by age, gender, skin pigmentation and studied.

A spectrometer measured between 498-1000nm, at 0.2Hz , using glass optodes (2mm diameter). Five minutes of resting readings, followed by 3 minutes of below knee arterial occlusion and then 6 minutes post-occlusion were made. The second study, started with 5 minutes of resting readings, vibration loading for 3 minutes at 30 Hz with acceleration of 3g and 6 minutes post-vibration was then conducted.

Results: NIRS showed changes in blood parameters during the hyperemic response (avg. 97% increase in Hb from baseline, p< 0.0001). Able-bodied subjects had significantly quicker (p=0.01) capacity for Hb to return to baseline. There was a significant difference (p=0.001) in the time to peak for Hb following arterial occlusion in the SCI group, 16.6 seconds (sd 4.3), and 10.1 seconds (sd 1.7) in the able bodied.

Conclusion: Our findings suggest that there is a reduction in the bone’s ability to restore oxygenated blood in SCI participants compared to the AB participants. Future studies looking at changes in bone following a range of vibration amplitudes and frequencies in the SCI group should be considered using NIRS in order to optimize potential clinical benefits.

Introduction: The clinical effectiveness of spinal bracing for the conservative treatment of adolescent idiopathic scoliosis is still not fully understood. Cohort studies on clinical effectiveness fail to adequately measure and control for confounding variables including spine flexibility, curve type, magnitude and maturity, distribution of corrective forces and compliance. This paper presents intermediate findings from a longitudinal study to objectively measure brace wear patterns and compliance in users of custom fitted TLSOs in the UK. Braces are fitted with data logging devices to measure temperature and humidity at the skin/brace interface. Previously reported measures of compliance have been in adolescents wearing Boston Braces using questionnaires, strap tension, interface pressure and skin temperature. They have shown compliance reported by the user can significantly over estimate actual compliance.

Methods and results: 20 patients are being studied over 18 months. TLSOs are fitted with data logging devices to measure temperature and humidity at the skin/brace interface. They are discrete sensors inserted into a pocket formed on the posterior of the brace. Measurements are recorded at 16 minute intervals and data downloaded every three to four months. Results clearly demonstrate compliance and daily wear routines. Temperature and humidity at the skin/brace interface during periods of wear are 35°C and > 80%RH respectively. Compliance ranges from 60–98%. Users who stick rigidly to their regime only remove their brace in the evening. Where poorer compliance is evident, the brace is worn sporadically during the day and evening, and worn full time at night.

Conclusion: Measurement of temperature and humidity at the skin/brace interface clearly demonstrates compliance and daily wear routines. Compliance varies from 60–98%. Where poor compliance is an issue it is intended to re-interview these individuals and obtain more detailed information about the reasons why they failed to use the brace.