This is a multicentre, prospective assessment of a proportion of the overall orthopaedic trauma caseload of the UK. It investigates theatre capacity, cancellations, and time to surgery in a group of hospitals that is representative of the wider population. It identifies barriers to effective practice and will inform system improvements. Data capture was by collaborative approach. Patients undergoing procedures from 22 August 2022 and operated on before 31 October 2022 were included. Arm one captured weekly caseload and theatre capacity. Arm two concerned patient and injury demographics, and time to surgery for specific injury groups.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 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 purpose of this study was to determine the weightbearing practice of operatively managed fragility fractures in the setting of publically funded health services in the UK and Ireland. The Fragility Fracture Postoperative Mobilisation (FFPOM) multicentre audit included all patients aged 60 years and older undergoing surgery for a fragility fracture of the lower limb between 1 January 2019 and 30 June 2019, and 1 February 2021 and 14 March 2021. Fractures arising from high-energy transfer trauma, patients with multiple injuries, and those associated with metastatic deposits or infection were excluded. We analyzed this patient cohort to determine adherence to the British Orthopaedic Association Standard, “all surgery in the frail patient should be performed to allow full weight-bearing for activities required for daily livingAims
Methods
The aim of this study was to investigate the rate of revision for distal femoral arthroplasty (DFA) performed as a primary procedure for native knee fractures using data from the Australian Orthopaedic Association National Joint Arthroplasty Registry (AOANJRR). Data from the AOANJRR were obtained for DFA performed as primary procedures for native knee fractures from 1 September 1999 to 31 December 2020. Pathological fractures and revision for failed internal fixation were excluded. The five prostheses identified were the Global Modular Arthroplasty System, the Modular Arthroplasty System, the Modular Universal Tumour And Revision System, the Orthopaedic Salvage System, and the Segmental System. Patient demographic data (age, sex, and American Society of Anesthesiologists grade) were obtained, where available. Kaplan-Meier estimates of survival were used to determine the rate of revision, and the reasons for revision and mortality data were examined.Aims
Methods
This study aims to estimate economic outcomes associated with 30-day deep surgical site infection (SSI) from closed surgical wounds in patients with lower limb fractures following major trauma. Data from the Wound Healing in Surgery for Trauma (WHiST) trial, which collected outcomes from 1,547 adult participants using self-completed questionnaires over a six-month period following major trauma, was used as the basis of this empirical investigation. Associations between deep SSI and NHS and personal social services (PSS) costs (£, 2017 to 2018 prices), and between deep SSI and quality-adjusted life years (QALYs), were estimated using descriptive and multivariable analyses. Sensitivity analyses assessed the impact of uncertainty surrounding components of the economic analyses.Aims
Methods
To identify the prevalence of neuropathic pain after lower limb fracture surgery, assess associations with pain severity, quality of life and disability, and determine baseline predictors of chronic neuropathic pain at three and at six months post-injury. Secondary analysis of a UK multicentre randomized controlled trial (Wound Healing in Surgery for Trauma; WHiST) dataset including adults aged 16 years or over following surgery for lower limb major trauma. The trial recruited 1,547 participants from 24 trauma centres. Neuropathic pain was measured at three and six months using the Doleur Neuropathique Questionnaire (DN4); 701 participants provided a DN4 score at three months and 781 at six months. Overall, 933 participants provided DN4 for at least one time point. Physical disability (Disability Rating Index (DRI) 0 to 100) and health-related quality-of-life (EuroQol five-dimension five-level; EQ-5D-5L) were measured. Candidate predictors of neuropathic pain included sex, age, BMI, injury mechanism, concurrent injury, diabetes, smoking, alcohol, analgaesia use pre-injury, index surgery location, fixation type, Injury Severity Score, open injury, and wound care.Aims
Methods
To describe a new objective classification for open fractures of the lower limb and to correlate the classification with patient-centred outcomes. The proposed classification was investigated within a cohort of adults with open fractures of the lower limb who were recruited as part of two large clinical trials within the UK Major Trauma Network. The classification was correlated with patient-reported Disability Rating Index (DRI) and EuroQol five-dimension questionnaire (EQ-5D) health-related quality of life in the year after injury, and with deep infection at 30 days, according to the Centers for Disease Control and Prevention definition of a deep surgical site infection.Aims
Methods
The aim of this study was to compare the incidence of anterior knee pain after antegrade tibial nailing using suprapatellar and infrapatellar surgical approaches A total of 95 patients with a tibial fracture requiring an intramedullary nail were randomized to treatment using a supra- or infrapatellar approach. Anterior knee pain was assessed at four and six months, and one year postoperatively, using the Aberdeen Weightbearing Test – Knee (AWT-K) score and a visual analogue scale (VAS) score for pain. The AWT-K is an objective patient-reported outcome measure that uses weight transmitted through the knee when kneeling as a surrogate for anterior knee pain.Aims
Patients and Methods
Little is known about the effect of haemorrhagic shock and resuscitation
on fracture healing. This study used a rabbit model with a femoral
osteotomy and fixation to examine this relationship. A total of 18 male New Zealand white rabbits underwent femoral
osteotomy with intramedullary fixation with ‘shock’ (n = 9) and
control (n = 9) groups. Shock was induced in the study group by
removal of 35% of the total blood volume 45 minutes before resuscitation
with blood and crystalloid. Fracture healing was monitored for eight weeks
using serum markers of healing and radiographs.Aims
Materials and Methods
A high rate of suicide has been reported in patients who sustain
fractures, but the association remains uncertain in the context
of other factors. The aim of this study was to examine the association
between fractures and the risk of suicide in this contextual setting. We performed a case-control study of patients aged 40 years or
older who died by suicide between 2000 and 2011. We included patients’
demographics, physical and mental health problems, and socioeconomic
factors. We performed conditional logistic regression to evaluate
the associations between fractures and the risk of suicide.Aims
Patients and Methods
This study reviews the use of a titanium mesh cage (TMC) as an
adjunct to intramedullary nail or plate reconstruction of an extra-articular
segmental long bone defect. A total of 17 patients (aged 17 to 61 years) treated for a segmental
long bone defect by nail or plate fixation and an adjunctive TMC
were included. The bone defects treated were in the tibia (nine),
femur (six), radius (one), and humerus (one). The mean length of
the segmental bone defect was 8.4 cm (2.2 to 13); the mean length
of the titanium mesh cage was 8.3 cm (2.6 to 13). The clinical and
radiological records of the patients were analyzed retrospectively.Aims
Patients and Methods
In this retrospective observational cohort study,
we describe 17 patients out of 1775 treated for various fractures who
developed mycobacterium tuberculosis (MTB) infection after surgery.
The cohort comprised 15 men and two women with a mean age of 40
years (24 to 70). A total of ten fractures were open and seven were
closed. Of these, seven patients underwent intramedullary nailing
of a fracture of the long bone, seven had fractures fixed with plates,
two with Kirschner-wires and screws, and one had a hemiarthroplasty
of the hip with an Austin Moore prosthesis. All patients were followed-up
for two years. In all patients, the infection resolved, and in 14
the fractures united. Nonunion was seen in two patients one of whom
underwent two-stage total hip arthroplasty (THA) and the other patient
was treated using excision arthoplasty. Another patient was treated
using two-stage THA. With only sporadic case reports in the literature,
MTB infection is rarely clinically suspected, even in underdeveloped
and developing countries, where pulmonary and other forms of TB
are endemic. In developed countries there is also an increased incidence
among immunocompromised patients. In this paper we discuss the pathogenesis
and incidence of MTB infection after surgical management of fractures
and suggest protocols for early diagnosis and management. Cite this article:
We evaluated the outcome of treatment of nonunion
of an intracapsular fracture of the femoral neck in young patients
using two cannulated screws and a vascularised bone graft. A total
of 32 patients (15 women and 17 men, with a mean age of 36.5 years;
20 to 50) with failed internal fixation of an intracapsular fracture
were included in the study. Following removal of the primary fixation,
two cannulated compression screws were inserted with a vascularised
iliac crest bone graft based on the ascending branch of the lateral
femoral circumflex artery. At a mean follow-up of 6.8 years (4 to 10), union was achieved
in 27 hips (84%). A total of five patients with a mean age of 40.5
years (35 to 50) had a persistent nonunion and underwent total hip
arthroplasty as also did two patients whose fracture united but
who developed osteonecrosis of the femoral head two years post-operatively. Statistical
analysis showed that younger patients achieved earlier and more
reliable union (p <
0.001). The functional outcome, as assessed
by the Harris Hip score, was better in patients aged <
45 years
compared with those aged >
45 years (p <
0.001). These findings suggest that further fixation using two cannulated
compression screws and a vascularised iliac crest bone graft is
an effective salvage treatment in patients aged <
45 years, in
whom osteosynthesis of a displaced intracapsular fractures of the
femoral neck has failed. Cite this article:
Radiological evidence of post-traumatic osteoarthritis
(PTOA) after fracture of the tibial plateau is common but end-stage arthritis
which requires total knee arthroplasty is much rarer. The aim of this study was to examine the indications for, and
outcomes of, total knee arthroplasty after fracture of the tibial
plateau and to compare this with an age and gender-matched cohort
of TKAs carried out for primary osteoarthritis. Between 1997 and 2011, 31 consecutive patients (23 women, eight
men) with a mean age of 65 years (40 to 89) underwent TKA at a mean
of 24 months (2 to 124) after a fracture of the tibial plateau.
Of these, 24 had undergone ORIF and seven had been treated non-operatively.
Patients were assessed pre-operatively and at 6, 12 and >
60 months
using the Short Form-12, Oxford Knee Score and a patient satisfaction
score. Patients with instability or nonunion needed total knee arthroplasty
earlier (14 and 13.3 months post-injury) than those with intra-articular
malunion (50 months, p <
0.001). Primary cruciate-retaining implants
were used in 27 (87%) patients. Complication rates were higher in
the PTOA cohort and included wound complications (13% Total knee arthroplasty undertaken after fracture of the tibial
plateau has a higher rate of complications than that undertaken
for primary osteoarthritis, but patient-reported outcomes and satisfaction
are comparable. Cite this article:
Fractures in patients aged ≥ 65 years constitute
an increasing burden on health and social care and are associated with
a high morbidity and mortality. There is little accurate information
about the epidemiology of fractures in the elderly. We have analysed
prospectively collected data on 4786 in- and out-patients who presented
with a fracture over two one-year periods. Analysis shows that there
are six patterns of the incidence of fractures in patients aged ≥ 65
years. In males six types of fracture increase in incidence after
the age of 65 years and 11 types increase in females aged over 65
years. Five types of fracture decrease in incidence after the age
of 65 years. Multiple fractures increase in incidence in both males
and females aged ≥ 65 years, as do fractures related to falls. Analysis of the incidence of fractures, together with life expectancy,
shows that the probability of males and females aged ≥ 65 years
having a fracture during the rest of their life is 18.5% and 52.0%,
respectively. The equivalent figures for males and females aged ≥ 80
years are 13.3% and 34.8%, respectively. Cite this article:
Coronal plane fractures of the posterior femoral
condyle, also known as Hoffa fractures, are rare. Lateral fractures are
three times more common than medial fractures, although the reason
for this is not clear. The exact mechanism of injury is likely to
be a vertical shear force on the posterior femoral condyle with
varying degrees of knee flexion. These fractures are commonly associated
with high-energy trauma and are a diagnostic and surgical challenge. Hoffa
fractures are often associated with inter- or supracondylar distal
femoral fractures and CT scans are useful in delineating the coronal
shear component, which can easily be missed. There are few recommendations
in the literature regarding the surgical approach and methods of
fixation that may be used for this injury. Non-operative treatment
has been associated with poor outcomes. The goals of treatment are
anatomical reduction of the articular surface with rigid, stable
fixation to allow early mobilisation in order to restore function.
A surgical approach that allows access to the posterior aspect of
the femoral condyle is described and the use of postero-anterior
lag screws with or without an additional buttress plate for fixation
of these difficult fractures. Cite this article:
Osteochondral injuries, if not treated adequately, often lead
to severe osteoarthritis. Possible treatment options include refixation
of the fragment or replacement therapies such as Pridie drilling,
microfracture or osteochondral grafts, all of which have certain
disadvantages. Only refixation of the fragment can produce a smooth
and resilient joint surface. The aim of this study was the evaluation
of an ultrasound-activated bioresorbable pin for the refixation of
osteochondral fragments under physiological conditions. In 16 Merino sheep, specific osteochondral fragments of the medial
femoral condyle were produced and refixed with one of conventional
bioresorbable pins, titanium screws or ultrasound-activated pins.
Macro- and microscopic scoring was undertaken after three months. Objectives
Methods
This is a case series of prospectively gathered
data characterising the injuries, surgical treatment and outcomes
of consecutive British service personnel who underwent a unilateral
lower limb amputation following combat injury. Patients with primary,
unilateral loss of the lower limb sustained between March 2004 and
March 2010 were identified from the United Kingdom Military Trauma
Registry. Patients were asked to complete a Short-Form (SF)-36 questionnaire.
A total of 48 patients were identified: 21 had a trans-tibial amputation,
nine had a knee disarticulation and 18 had an amputation at the
trans-femoral level. The median New Injury Severity Score was 24 (mean
27.4 (9 to 75)) and the median number of procedures per residual
limb was 4 (mean 5 (2 to 11)). Minimum two-year SF-36 scores were
completed by 39 patients (81%) at a mean follow-up of 40 months
(25 to 75). The physical component of the SF-36 varied significantly
between different levels of amputation (p = 0.01). Mental component
scores did not vary between amputation levels (p = 0.114). Pain
(p = 0.332), use of prosthesis (p = 0.503), rate of re-admission
(p = 0.228) and mobility (p = 0.087) did not vary between amputation
levels. These findings illustrate the significant impact of these injuries
and the considerable surgical burden associated with their treatment.
Quality of life is improved with a longer residual limb, and these
results support surgical attempts to maximise residual limb length. Cite this article:
We present the prevalence of multiple fractures
in the elderly in a single catchment population of 780 000 treated over
a 12-month period and describe the mechanisms of injury, common
patterns of occurrence, management, and the associated mortality
rate. A total of 2335 patients, aged ≥ 65 years of age, were prospectively
assessed and of these 119 patients (5.1%) presented with multiple
fractures. Distal radial (odds ratio (OR) 5.1, p <
0.0001), proximal humeral
(OR 2.2, p <
0.0001) and pelvic (OR 4.9, p <
0.0001) fractures
were associated with an increased risk of sustaining associated
fractures. Only 4.5% of patients sustained multiple fractures after
a simple fall, but due to the frequency of falls in the elderly
this mechanism resulted in 80.7% of all multiple fractures. Most
patients required admission (>
80%), of whom 42% did not need an
operation but more than half needed an increased level of care before
discharge (54%). The standardised mortality rate at one year was
significantly greater after sustaining multiple fractures that included
fractures of the pelvis, proximal humerus or proximal femur (p <
0.001). This mortality risk increased further if patients were <
80 years of age, indicating that the existence of multiple fractures after
low-energy trauma is a marker of mortality.