The Dawn Hip - An Effective Strategy to Improve the Management of Traumatic Hip Fractures Traumatic hip fractures are managed with nationwide standards, and are regularly audited and published. A previous audit last year at the William Harvey revealed 66% of hip fractures were operated within 48 hours, compared to the national average of 75%. We implemented a strategy to improve this target by introducing the ‘Dawn Hip’ - a hip fracture operation which is prepared for surgery at 8am on the Emergency (CEPOD) list. Over a two month period after the introduction of the ‘Dawn hip’, the number of hip operations and start time on the CEPOD list were audited. Performance data were extrapolated from the National Hip Fracture Database (NHFD) and compared nationally.Introduction
Methods
Full-thickness burns around the knee can involve the extensor mechanism. The gastrocnemius flap is well described for soft tissue reconstruction around the knee. We describe a method where a Whichita Fusion Nail¯ knee arthrodesis, combined with a medial gastrocnemius muscle flap was used to salvage the knee and preserve the lower leg following a full-thickness contact burn. The gastrocnemius flap for wound coverage of an open knee joint was originally described in 1970 and remains the workhorse for soft tissue knee reconstruction. There are a number of local alternatives including the vastus lateralis, medialis and sartorius flap; and perforator flaps such as the medial sural artery perforator island flap and islanded posterior calf perforator flap, however many of these are unsuitable for larger defects. Full-thickness burns around the knee can put the extensor mechanism at risk and subsequent rupture is a possible consequence. The gastrocnemius flap has been used to cover a medial knee defect with exposed joint cavity following a burn and also been used in post burn contracture release around the knee. The primary indication for Wichita fusion nail is a failed total knee replacement. It allows intramedullary stabilization with compression at the arthrodesis site to stimulate bone union. With fusion rates reported up to 100% and low complication rates as compared to other methods of fusion, the technique has a useful role in limb salvage type procedures. While use of the gastrocnemius flap in knee burns has been described before we believe this is the first time that this combination of techniques, namely knee arthrodesis with soft tissue reconstruction using a gastrocnemius flap, has been reported. Combining these procedures with a multidisciplinary approach provides a useful alternative leading to limb salvage and avoiding the need for an above knee amputation when extensor reconstruction is not possible.
