Frailty greatly increases the risk of adverse outcome of trauma in older people. Frailty detection tools appear to be unsuitable for use in traumatically injured older patients. We therefore aimed to develop a method for detecting frailty in older people sustaining trauma using routinely collected clinical data. We analyzed prospectively collected registry data from 2,108 patients aged ≥ 65 years who were admitted to a single major trauma centre over five years (1 October 2015 to 31 July 2020). We divided the sample equally into two, creating derivation and validation samples. In the derivation sample, we performed univariate analyses followed by multivariate regression, starting with 27 clinical variables in the registry to predict Clinical Frailty Scale (CFS; range 1 to 9) scores. Bland-Altman analyses were performed in the validation cohort to evaluate any biases between the Nottingham Trauma Frailty Index (NTFI) and the CFS.Aims
Methods
Heterotopic ossification (HO) is a common complication after elbow trauma and can cause severe upper limb disability. Although multiple prognostic factors have been reported to be associated with the development of post-traumatic HO, no model has yet been able to combine these predictors more succinctly to convey prognostic information and medical measures to patients. Therefore, this study aimed to identify prognostic factors leading to the formation of HO after surgery for elbow trauma, and to establish and validate a nomogram to predict the probability of HO formation in such particular injuries. This multicentre case-control study comprised 200 patients with post-traumatic elbow HO and 229 patients who had elbow trauma but without HO formation between July 2019 and December 2020. Features possibly associated with HO formation were obtained. The least absolute shrinkage and selection operator regression model was used to optimize feature selection. Multivariable logistic regression analysis was applied to build the new nomogram: the Shanghai post-Traumatic Elbow Heterotopic Ossification Prediction model (STEHOP). STEHOP was validated by concordance index (C-index) and calibration plot. Internal validation was conducted using bootstrapping validation.Aims
Methods
This study sought to determine the proportion of older adults with hip fractures captured by a multicentre prospective cohort, the World Hip Trauma Evaluation (WHiTE), whether there was evidence of selection bias during WHiTE recruitment, and the extent to which the WHiTE cohort is representative of the broader population of older adults with hip fractures. The characteristics of patients recruited into the WHiTE cohort study were compared with those treated at WHiTE hospitals during the same timeframe and submitted to the National Hip Fracture Database (NHFD).Aims
Patients and Methods
We present an audit comparing our level I major trauma centre’s
data for a cohort of patients with hip fractures in the National
Hip Fracture Database (NHFD) with locally held data on these patients. A total of 2036 records for episodes between July 2009 and June
2014 were reviewed. Aims
Patients and Methods
There is no absolute method of evaluating healing
of a fracture of the tibial shaft. In this study we sought to validate a
new clinical method based on the systematic observation of gait,
first by assessing the degree of agreement between three independent
observers regarding the gait score for a given patient, and secondly
by determining how such a score might predict healing of a fracture. We used a method of evaluating gait to assess 33 patients (29
men and four women, with a mean age of 29 years (15 to 62)) who
had sustained an isolated fracture of the tibial shaft and had been
treated with a locked intramedullary nail. There were 15 closed
and 18 open fractures (three Gustilo and Anderson grade I, seven
grade II, seven grade IIIA and one grade IIIB). Assessment was carried
out three and six months post-operatively using videos taken with
a digital camera. Gait was graded on a scale ranging from 1 (extreme
difficulty) to 4 (normal gait). Bivariate analysis included analysis
of variance to determine whether the gait score statistically correlated
with previously validated and standardised scores of clinical status
and radiological evidence of union. An association was found between the pattern of gait and all
the other variables. Improvement in gait was associated with the
absence of pain on weight-bearing, reduced tenderness over the fracture,
a higher Radiographic Union Scale in Tibial Fractures score, and
improved functional status, measured using the Brazilian version
of the Short Musculoskeletal Function Assessment questionnaire (all
p <
0.001). Although further study is needed, the analysis of
gait in this way may prove to be a useful clinical tool.
We sought to quantify agreement by different assessors of the AO classification for distal fractures of the radius. Thirty radiographs of acute distal radial fractures were evaluated by 36 assessors of varying clinical experience. Our findings suggest that AO ‘type’ and the presence or absence of articular displacement are measured with high consistency when classification of distal radial fractures is undertaken by experienced observers. Assessors at all experience levels had difficulty agreeing on AO ‘group’ and especially AO ‘subgroup’. To categorise distal radial fractures according to joint displacement and AO type is simple and reproducible. Our study examined only whether distal radial fractures could be consistently classified according to the AO system.
