Aims. Fracture clinics are often characterised by the referral of large
numbers of unselected patients with minor injuries not requiring
investigation or intervention, long waiting times and recurrent
unnecessary reviews. Our experience had been of an unsustainable
system and we implemented a ‘Trauma Triage Clinic’ (TTC) in order
to rationalise and regulate access to our fracture service. The
British Orthopaedic Association’s guidelines have required a prospective evaluation
of this change of practice, and we report our experience and results. Patients and Methods. We review the management of all 12 069 patients referred to our
service in the calendar year 2014, with a minimum of one year follow-up
during the calendar year 2015. . Results. Following the successful introduction of the TTC, only 2836 patients
(23.5%) who would previously have been reviewed in the general fracture
clinic were brought back to such a clinic to be seen by a surgeon.
An additional 2366 patients (19.6%) were brought back to a sub-specialist
injury-specific clinic. Another 2776 patients (23%) with relatively
predictable injuries were reviewed by a nurse practitioner according
to an established protocol or specific consultant instructions.
A further 3222 patients (26.7%) were discharged from the service
without attending the clinic. No significant errors or omissions
occurred with the introduction of the TTC. Conclusion. We have found that our TTC allows large numbers of referrals
to be reviewed and triaged safely and effectively, to the benefit
and satisfaction of patients, consultants,
The aim of this study was to describe the demographic details of patients who sustain a femoral periprosthetic fracture (PPF), the epidemiology of PPFs, PPF characteristics, and the predictors of PPF types in the UK population. This is a multicentre retrospective cohort study including adult patients presenting to hospital with a new PPF between 1 January 2018 and 31 December 2018. Data collected included: patient characteristics, comorbidities, anticoagulant use, social circumstances, level of mobility, fracture characteristics, Unified Classification System (UCS) type, and details of the original implant. Descriptive analysis by fracture location was performed, and predictors of PPF type were assessed using mixed-effects logistic regression models.Aims
Methods
The Open-Fracture Patient Evaluation Nationwide (OPEN) study was performed to provide clarity in open fracture management previously skewed by small, specialist centre studies and large, unfocused registry investigations. We report the current management metrics of open fractures across the UK. Patients admitted to hospital with an open fracture (excluding phalanges or isolated hand injuries) between 1 June 2021 and 30 September 2021 were included. Institutional information governance approval was obtained at the lead site and all data entered using Research Electronic Data Capture software. All domains of the British Orthopaedic Association Standard for Open Fracture Management were recorded.Aims
Method
The management of completely displaced fractures of the distal radius in children remains controversial. This study evaluates the outcomes of surgical and non-surgical management of ‘off-ended’ fractures in children with at least two years of potential growth remaining. A total of 34 boys and 22 girls aged 0 to ten years with a closed, completely displaced metaphyseal distal radial fracture presented between 1 November 2015 and 1 January 2020. After 2018, children aged ten or under were offered treatment in a straight plaster or manipulation under anaesthesia with Kirschner (K-)wire stabilization. Case notes and radiographs were reviewed to evaluate outcomes. In all, 16 underwent treatment in a straight cast and 40 had manipulation under anaesthesia, including 37 stabilized with K-wires.Aims
Methods
The aim of this study was to investigate the hypothesis that a single dose of tranexamic acid (TXA) would reduce blood loss and transfusion rates in elderly patients undergoing surgery for a subcapital or intertrochanteric (IT) fracture of the hip. In this single-centre, randomized controlled trial, elderly patients undergoing surgery for a hip fracture, either hemiarthroplasty for a subcapital fracture or intramedullary nailing for an IT fracture, were screened for inclusion. Patients were randomly allocated to a study group using a sealed envelope. The TXA group consisted of 77 patients, (35 with a subcapital fracture and 42 with an IT fracture), and the control group consisted of 88 patients (29 with a subcapital fracture and 59 with an IT fracture). One dose of 15 mg/kg of intravenous (IV) TXA diluted in 100 ml normal saline (NS,) or one dose of IV placebo 100 ml NS were administered before the incision was made. The haemoglobin (Hb) concentration was measured before surgery and daily until the fourth postoperative day. The primary outcomes were the total blood loss and the rate of transfusion from the time of surgery to the fourth postoperative day.Aims
Methods
The aim of this study was to examine trends in the management of fractures of the distal radius in Ireland over a ten-year period, and to determine if there were any changes in response to the English Distal Radius Acute Fracture Fixation Trial (DRAFFT). Data was grouped into annual intervals from 2008 to 2017. All adult inpatient episodes that involved emergency surgery for fractures of the distal radius were includedAims
Patients and Methods
This study aimed to compare the change in health-related quality
of life of patients receiving a traditional cemented monoblock Thompson
hemiarthroplasty compared with a modern cemented modular polished-taper
stemmed hemiarthroplasty for displaced intracapsular hip fractures. This was a pragmatic, multicentre, multisurgeon, two-arm, parallel
group, randomized standard-of-care controlled trial. It was embedded
within the WHiTE Comprehensive Cohort Study. The sample size was
964 patients. The setting was five National Health Service Trauma
Hospitals in England. A total of 964 patients over 60 years of age who
required hemiarthroplasty of the hip between February 2015 and March
2016 were included. A standardized measure of health outcome, the
EuroQol (EQ-5D-5L) questionnaire, was carried out on admission and
at four months following the operation.Aims
Patients and Methods
To compare the outcomes for trochanteric fractures treated with
a sliding hip screw (SHS) or a cephalomedullary nail. A total of 400 patients with a trochanteric hip fracture were
randomised to receive a SHS or a cephalomedullary nail (Targon PFT).
All surviving patients were followed up to one year from injury.
Functional outcome was assessed by a research nurse blinded to the
implant used.Aims
Patients and Methods
In the time since Letournel popularised the surgical
treatment of acetabular fractures, more than 25 years ago, there
have been many changes within the field, related to patients, surgical
technique, implants and post-operative care. However, the long-term
outcomes appear largely unchanged. Does this represent stasis or
have the advances been mitigated by other negative factors? In this
article we have attempted to document the recent changes within
the surgery of patients with a fracture involving the acetabulum,
outline contemporary management, and identify the major problem
areas where further research is most needed. Cite this article:
Fractures of the distal femur can be challenging to manage and
are on the increase in the elderly osteoporotic population. Management
with casting or bracing can unacceptably limit a patient’s ability
to bear weight, but historically, operative fixation has been associated
with a high rate of re-operation. In this study, we describe the outcomes
of fixation using modern implants within a strategy of early return
to function. All patients treated at our centre with lateral distal femoral
locking plates (LDFLP) between 2009 and 2014 were identified. Fracture
classification and operative information including weight-bearing
status, rates of union, re-operation, failure of implants and mortality
rate, were recorded.Aims
Patients and Methods
The aim of this prospective randomised controlled trial was to
compare non-operative and operative management for acute isolated
displaced fractures of the olecranon in patients aged ≥ 75 years. Patients were randomised to either non-operative management or
operative management with either tension-band wiring or fixation
with a plate. They were reviewed at six weeks, three and six months
and one year after the injury. The primary outcome measure was the
Disabilities of the Arm, Shoulder and Hand (DASH) score at one year.Aims
Patients and Methods
The National Institute for Health and Clinical
Excellence (NICE) guidelines from 2011 recommend the use of cemented
hemi-arthroplasty for appropriate patients with an intracapsular
hip fracture. In our institution all patients who were admitted
with an intracapsular hip fracture and were suitable for a hemi-arthroplasty
between April 2010 and July 2012 received an uncemented prosthesis
according to our established departmental routine practice. A retrospective
analysis of outcome was performed to establish whether the continued
use of an uncemented stem was justified. Patient, surgical and outcome
data were collected on the National Hip Fracture database. A total
of 306 patients received a Cathcart modular head on a Corail uncemented
stem as a hemi-arthroplasty. The mean age of the patients was 83.3
years ( Cite this article:
A fracture of the hip is the most common serious orthopaedic
injury, and surgical site infection (SSI) is one of the most significant
complications, resulting in increased mortality, prolonged hospital
stay and often the need for further surgery. Our aim was to determine
whether high dose dual antibiotic impregnated bone cement decreases the
rate of infection. A quasi-randomised study of 848 patients with an intracapsular
fracture of the hip was conducted in one large teaching hospital
on two sites. All were treated with a hemiarthroplasty. A total
of 448 patients received low dose single-antibiotic impregnated
cement (control group) and 400 patients received high dose dual-antibiotic impregnated
cement (intervention group). The primary outcome measure was deep
SSI at one year after surgery.Aims
Patients and Methods
The aim of this study was to report the outcome following primary
fixation or a staged protocol for type C fractures of the tibial
plafond. We studied all patients who sustained a complex intra-articular
fracture (AO type C) of the distal tibia over an 11-year period.
The primary short-term outcome was infection. The primary long-term
outcome was the Foot and Ankle Outcome Score (FAOS).Aims
Patients and Methods
National Institute of Clinical Excellence guidelines
state that cemented stems with an Orthopaedic Data Evaluation Panel
(ODEP) rating of >
3B should be used for hemiarthroplasty when treating
an intracapsular fracture of the femoral neck. These recommendations
are based on studies in which most, if not all stems, did not hold
such a rating. This case-control study compared the outcome of hemiarthroplasty
using a cemented (Exeter) or uncemented (Corail) femoral stem. These
are the two prostheses most commonly used in hip arthroplasty in
the UK. Data were obtained from two centres; most patients had undergone
hemiarthroplasty using a cemented Exeter stem (n = 292/412). Patients
were matched for all factors that have been shown to influence mortality
after an intracapsular fracture of the neck of the femur. Outcome
measures included: complications, re-operations and mortality rates
at two, seven, 30 and 365 days post-operatively. Comparable outcomes
for the two stems were seen. There were more intra-operative complications in the uncemented
group (13% This study therefore supports the use of both cemented and uncemented
stems of proven design, with an ODEP rating of 10A, in patients
with an intracapsular fracture of the neck of the femur. Cite this article:
The aims of this study were to estimate the cost of surgical
treatment of fractures of the proximal humerus using a micro-costing
methodology, contrast this cost with the national reimbursement
tariff and establish the major determinants of cost. A detailed inpatient treatment pathway was constructed using
semi-structured interviews with 32 members of hospital staff. Its
content validity was established through a Delphi panel evaluation.
Costs were calculated using time-driven activity-based costing (TDABC)
and sensitivity analysis was performed to evaluate the determinants
of costAims
Methods
We performed a retrospective study of a departmental database to assess the efficacy of a new model of orthopaedic care on the outcome of patients with a fracture of the proximal femur. All 1578 patients admitted to a university teaching hospital with a fracture of the proximal femur between December 2007 and December 2009 were included. The allocation of Foundation doctors years 1 and 2 was restructured from individual teams covering several wards to pairs covering individual wards. No alterations were made in the numbers of doctors, their hours, out-of-hours cover, or any other aspect of standard patient care. Outcome measures comprised 30-day mortality and cause, complications and length of stay. Mortality was reduced from 11.7% to 7.6% (p = 0.007, Cox’s regression analysis); adjusted odds ratio was 1.559 (95% confidence interval 1.128 to 2.156). Reductions were seen in These findings may have implications for all specialties caring for patients on several wards, and we believe they justify a prospective trial to further assess this effect.
We compared a new fixation system, the Targon
Femoral Neck (TFN) hip screw, with the current standard treatment of
cannulated screw fixation. This was a single-centre, participant-blinded,
randomised controlled trial. Patients aged 65 years and over with
either a displaced or undisplaced intracapsular fracture of the
hip were eligible. The primary outcome was the risk of revision
surgery within one year of fixation. A total of 174 participants were included in the trial. The absolute
reduction in risk of revision was of 4.7% (95% CI 14.2 to 22.5)
in favour of the TFN hip screw (chi-squared test, p = 0.741), which
was less than the pre-specified level of minimum clinically important
difference. There were no significant differences in any of the
secondary outcome measures. We found no evidence of a clinical difference in the risk of
revision surgery between the TFN hip screw and cannulated screw
fixation for patients with an intracapsular fracture of the hip. Cite this article:
United Kingdom National Institute for Health
and Clinical Excellence guidelines recommend the use of total hip replacement
(THR) for displaced intracapsular fractures of the femoral neck
in cognitively intact patients, who were independently mobile prior
to the injury. This study aimed to analyse the risk factors associated
with revision of the implant and mortality following THR, and to
quantify risk. National Joint Registry data recording a THR performed
for acute fracture of the femoral neck between 2003 and 2010 were
analysed. Cox proportional hazards models were used to investigate
the extent to which risk of revision was related to specific covariates.
Multivariable logistic regression was used to analyse factors affecting
peri-operative mortality (<
90 days). A total of 4323 procedures
were studied. There were 80 patients who had undergone revision
surgery at the time of censoring (five-year revision rate 3.25%, 95%
confidence interval 2.44 to 4.07) and 137 patients (3.2%) patients
died within 90 days. After adjusting for patient and surgeon characteristics,
an increased risk of revision was associated with the use of cementless
prostheses compared with cemented (hazard ratio (HR) 1.33, p = 0.021).
Revision was independent of bearing surface and head size. The risk
of mortality within 90 days was significantly increased with higher
American Society of Anesthesiologists (ASA) grade (grade 3: odds
ratio (OR) 4.04, p <
0.001; grade 4/5: OR 20.26, p <
0.001;
both compared with grades 1/2) and older age (≥ 75 years: OR 1.65,
p = 0.025), but reduced over the study period (9% relative risk reduction
per year). THR is a good option in patients aged <
75 years and with
ASA 1/2. Cementation of the femoral component does not adversely
affect peri-operative mortality but improves survival of the implant
in the mid-term when compared with cementless femoral components.
There are no benefits of using head sizes >
28 mm or bearings other
than metal-on-polyethylene. More research is required to determine
the benefits of THR over hemiarthroplasty in older patients and
those with ASA grades >
2.
