Ankle fractures represent approximately 10% of the fracture workload and are projected to increase due to ageing population. We present our 5 years outcome review post-surgical management of ankle fractures in a large UK Trauma unit. A total of 111 consecutive patients treated for an unstable ankle fracture were entered into a database and prospectively followed up. Baseline patient characteristics, complications, further intervention including additional surgery, functional status were recorded during five-year follow-up. Pre-injury and post-fixation functional outcome measures at 2-years were assessed using Olerud-Molander Ankle Scores (OMAS) and Lower Extremity Functional Scales (LEFS). A p value < 0.05 was considered significant.Introduction
Methods
We evaluated the long-term survival and patient reported outcome of the Copeland mark III humeral resurfacing hemi-arthroplasty (Biomet, Warsaw, Indiana). At a UK District General Hospital 95 shoulder replacements in 85 patients were performed from 1994 to 2003 (mean age 68.9). At the time of follow-up (mean of 12 years, range 8.7–18.0) 49 patients had survived. This study group were posted Oxford Shoulder Score (OSS) and SF-12 questionnaires and their case notes were reviewed. There was an 82% response rate. The responders comprised 46 shoulders in 40 patients. 40 shoulders had a pre-operative diagnosis of osteoarthritis and 6 had other pathologies. The median OSS was 36. The median functional score was 24 (IQR: 9.5), where 32 is the best. The median pain score was 13 (IQR: 7) with 16 being the best score. There was a median SF 12 score of 31 (IQR: 3), where the maximum score is 47. There were 3 revision operations and 95% survivorship at 18 years, according to Kaplan Meier survival analysis. The Copeland mark III hemi-arthroplasty prosthesis has a good long term survival, few post-operative complications and a good functional outcome in an elderly population. We would advocate its use in this patient group.
NICE technology appraisal guidance 157 suggests that the oral anticoagulation medication Dabigatran etexilate can be used for the primary prevention of venous thromboembolic events (VTE's) in adult patients who have undergone elective total hip or knee replacement surgery. The NICE guidance reports that 13.8% of patients receiving recommended doses of Dabigatran experienced adverse bleeding events. In the pivotal hip and knee VTE trial, wound secretion only accounted for 4.9% of patients treated with Dabigatran (cf 3.0% of patients treated with Enoxaparin). We report our wound secretion experience after Dabigatran use at Warwick Hospital from March 2009 to March 2010. Of the 788 lower-limb arthroplasties performed, 55 patients (6.9%) had oozing wounds after discharge (Mean=8 days, Range=1-39 days). This resulted in 226 extra home-visits by discharge nurses, 26 positive microbiology cultures and 5 confirmed wound infections needing antibiotic treatment and/or surgical intervention. Incidentally, there were also 2 known cases each of deep vein thrombosis and pulmonary embolus in this cohort. The number of complications was markedly increased from previous years when LMWH was the VTE prophylaxis used. This data suggests that the use of Dabigatran in Warwick Hospital may significantly increase surgical site morbidity and resource output after lower limb arthroplasty.
