Introduction

Non-unions often arise because of high strain environments at fracture sites. Revision fixation, bone grafting and biologic treatments to treat long bone fracture non-union can be expensive and invasive. Percutaneous strain reduction screws (PSRS) can be inserted as a day-case surgical procedure to supplement primary fixation at a fraction of the cost of traditional treatments. Screw insertion perpendicular to the plane of a non-union can resist shear forces and achieve union by modifying the strain environment. A multi-centre retrospective study was undertaken to confirm the results of the initial published case series, ascertain whether this technique can be adopted outside of the developing institution and assess the financial impact of this technique.

Aims

Type IIIB open tibial fractures are devastating high-energy injuries. At initial debridement, the surgeon will often be faced with large bone fragments with tenuous, if any, soft-tissue attachments. Conventionally these are discarded to avoid infection. We aimed to determine if orthoplastic reconstruction using mechanically relevant devitalized bone (ORDB) was associated with an increased infection rate in type IIIB open tibial shaft fractures.

Introduction: Several patients with fracture neck of femur were noted to have alarmingly low postoperative haemoglobin unexplained by the intra-operative and postoperative blood loss. We conducted this study to determine the magnitude of preoperative fall in haemoglobin in patients with hip fractures.

Methods: Full blood count was repeated after a minimum of 12 hours of fluid resuscitation in 50 consecutive patients admitted with fracture neck of femur. Patients requiring blood transfusion prior to collection of second specimen were excluded. Patients were grouped according to the type of fracture (intracapsular, inter-trochanteric and sub-tro-chanteric).

Results: The average drop in haemoglobin of 0.8 (range,0–2.1), 0.8 (range,0–2.8) and 2.5 (range,0.6–4.9) gm/dl in intracapsular, inter-trochanteric and sub-trochanteric fractures respectively were statistically significant in all three groups (student-t-test, p-value < 0.05) but appears to be clinically significant in only sub-trochanteric group. By close analysis of data it is noted that although average drop in first two groups is low but at least 15 % of patients in both groups dropped their haemoglobin by 2 gm/dl or more. This can be compounded by the drop in haemoglobin following surgery, the average of which was 2.5 gm/dl (range,0–6.4)

Discussion and Conclusion: During this study at least 5 patients were saved from going to theatre with dangerously low haemoglobin with no cross-matched blood. There is clinically significant drop in haemoglobin prior to surgery in patients admitted with fracture neck of femur. On admission haemoglobin can be falsely reassuring. We recommend all patients with sub-trochanteric fracture and all patients with intra-capsular and inter-trochanteric fractures with haemoglobin of 12 gm/dl or less to have a repeat haemoglobin check prior to their surgery. This practice may reduce the morbidity and mortality associated with very low haemoglobin in this group of patients with high pre-existent co-morbidities.