The Unified Classification System (UCS) was introduced because of a growing need to have a standardised universal classification system of periprosthetic fractures. It combines and simplifies many existing classification systems, and can be applied to any fracture around any partial or total joint replacement occurring during or after operation. Our goal was to assess the inter- and intra-observer reliability of the UCS in association with knee replacement when classifying fractures affecting one or more of the femur, tibia or patella.

We used an international panel of ten orthopaedic surgeons with subspecialty fellowship training and expertise in adult hip and knee reconstruction (‘experts’) and ten residents of orthopaedic surgery in the last two years of training (‘pre-experts’). They each received 15 radiographs for evaluation. After six weeks they evaluated the same radiographs again but in a different order.

The reliability was assessed using the Kappa and weighted Kappa values.

The Kappa values for inter-observer reliability for the experts and the pre-experts were 0.741 (95% confidence interval (CI) 0.707 to 0.774) and 0.765 (95% CI 0.733 to 0.797), respectively. The weighted Kappa values for intra-observer reliability for the experts and pre-experts were 0.898 (95% CI 0.846 to 0.950) and 0.878 (95% CI 0.815 to 0.942) respectively.

The UCS has substantial inter-observer reliability and ‘near perfect’ intra-observer reliability when used for periprosthetic fractures in association with knee replacement in the hands of experienced and inexperienced users.

Cite this article: Bone Joint J 2014;96-B:1669–73.

Purpose: Due to bed and resource constraints at the Royal University Hospital in Saskatoon, Saskatchewan, we have seen an increase in utilization of the day surgery program for acute Orthopedic traumatic injuries in ambulatory patients. The purpose of this study was to assess patient satisfaction with the Saskatoon Health Region Orthopedic trauma day surgery program by collecting data pertaining to wait-times, demographics, communication, coping skills at home and pain management.

Method: A patient-oriented questionnaire was devised and administered to eligible adult patients presenting for day surgery Orthopedic Trauma procedures over a three month period. Inclusion criteria included age greater than 18 and written english comprehension. Between July 12 and October 2, 2009, 45 patients consented to participate. The questionnaire was formulated to encapsulate all the potential concerns associated with the day-surgery program, which included expected wait-times, pain control, and communication between the orthopedic surgeon and the patient. Demographics and actual wait-times were obtained from hospital data.

Results: There was a marked discrepancy between the actual and anticipated waiting times for day surgery. However, 64% of the patients were still satisfied with the waiting times despite the difference. Seventy three percent of patients did not think that admission to hospital would lead to earlier surgery. There was an obvious difference in demographics with 53% of patients living outside city limits. Demographics played an important role in patient satisfaction. Patients living within the city limits had a better experience compared to patients living outside city limits. Patients did have difficulty managing at home. The overall satisfaction was 68% at the conclusion of the study.

Conclusion: Patients were overall satisfied with the day surgery program. We have identified several areas where we can improve. This involve better pain management, better communication and assessment of the bio-socioeconomic circumstances of patients. We will also have a lower threshold for admitting non residents of Saskatoon. We will relay a more realistic timeframe for surgery, as calculated in the study, to patients .