Patients who present with a fractured neck of femur (NOF) have a significant rate of morbidity and mortality. In 2011, the National Institute for Health and Care Excellence (NICE) published clinical guidelines in order to improve these rates. Within this guideline NICE state that surgery should be performed on all NOF fractures within 36 hours. Within ABMU Health board the 1000 Lives Campaign goes a step further and aims to operate on 90% of patients within 24 hours.

This study investigates the effect of an additional NOF theatre list on compliance to these national guidelines.

This retrospective study was performed between October-December 2013 and December-February 2015. The first period of data collection represents a daily trauma list whilst the second period allowed an additional NOF theatre list. Data was collected using the National Hip Fracture Database and the Trauma Theatre List.

The number of patients meeting the national guidelines increased with the presence of an additional theatre list (75.19% v 60%). This represents a reduction to the average time to theatre of 4 hours and 30 minutes (29:47 v 34:17). The additional theatre list improved prioritisation of patients with NOF fractures on the list (29.46% v 13.33% listed first on list) and reduced the rate of cancellations (19.38 v 29.17%).

During this study Morriston Hospital did not meet national guidelines, however an additional theatre list did significantly improve average time to theatre. This study highlights the significant impact a dedicated NOF fracture theatre list can have.

Winner – Best Paper Award

Transferring patient data to the care of the oncoming team is the point at which the patient is most vulnerable on their journey through the healthcare system. Effective handover is vital to protect patient safety and has become increasingly more important after introduction of shift patterns for junior doctors following the implementation of the European Working Time Directive. The aim was to assess whether the introduction of a standardised proforma and traffic light system, would improve weekend handover of patients in our orthopaedic unit.

Data was collected in the form of hand written data, for 3 months, in our department. This was analysed and a standardised handover sheet and traffic light system to highlight patient priority was introduced. Following a 1 week trial, the proformas were reviewed following feedback from colleagues. A re-audit was commenced and data collected for a further 2 months.

There were 108 patients handed over on weekends during the re-audit compared to the 126 in the initial audit. The handover of patient data improved across all areas, with the most improved areas in recording the patients' diagnosis (58.4% to 94.4%) and noting the results of significant or pending investigations (61.2% to 91.7%). The traffic light system improved recording the patient's condition (8.5% to 81.5%) as well as logging the urgency or frequency of patient review (25.9% to 96.8%).

Standardised proformas improve patient data transferred at handover and the traffic light system allows improved prioritisation of patients, thus improving patient safety at weekends.

Controversy exists whether to treat unstable pertrochanteric hip fractures with either intra-medullary or extra-medullary devices. A prospective randomised control trial was performed to compare the outcome of unstable pertrochanteric hip fractures stabilised with either a sliding hip screw or long Gamma Nail. The hypothesis was that there is no difference in outcome between the two modes of treatment.

Over a four year period, 210 patients presenting with an unstable pertrochanteric hip fracture (AO/OTA 31 A2) were recruited into the study. Eligible patients were randomised on admission to either long Gamma Nail or sliding hip screw. Follow-up was arranged for three, six, and twelve months. Primary outcome measures were implant failure or ‘cut-out’. Secondary measures included mortality, length of hospital stay, transfusion rate, change in mobility and residence, and EuroQol outcome score.

Five patients required revision surgery for implant cut-out (2.5%), of which three were long Gamma Nails and two were sliding hip screws (no significant difference). There were no incidences of implant failure or deep infection. Tip apex distance was found to correlate with implant cut-out. There was no statistically significant difference in either the EuroQol outcome scores or mortality rates between the two groups when corrected for mini mental score. There was no difference in transfusion rates, length of hospital stay, and change in mobility or residence. There was a clear cost difference between the implants.

The sliding hip screw remains the gold standard in the treatment of unstable pertrochanteric fractures of the proximal femur.