To evaluate the incidence of primary venous thromboembolism (VTE),
epidural haematoma, surgical site infection (SSI), and 90-day mortality
after elective spinal surgery, and the effect of two protocols for
prophylaxis. A total of 2181 adults underwent 2366 elective spinal procedures
between January 2007 and January 2012. All patients wore anti-embolic
stockings, mobilised early and were kept adequately hydrated. In
addition, 29% (689) of these were given low molecular weight heparin
(LMWH) while in hospital. SSI surveillance was undertaken using the
Centers for Disease Control and Prevention criteria.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
The importance of accurate identification and reporting of surgical
site infection (SSI) is well recognised but poorly defined. Public
Health England (PHE) mandated collection of orthopaedic SSI data
in 2004. Data submission is required in one of four categories (hip
prosthesis, knee prosthesis, repair of neck of femur, reduction
of long bone fracture) for one quarter per year. Trusts are encouraged
to carry out post-discharge surveillance but this is not mandatory.
Recent papers in the orthopaedic literature have highlighted the
importance of SSI surveillance and the heterogeneity of surveillance
methods. However, details of current orthopaedic SSI surveillance
practice has not been described or quantified. All 147 NHS trusts in England were audited using a structured
questionnaire. Data was collected in the following categories: data
collection; data submission to PHE; definitions used; resource constraints;
post-discharge surveillance and SSI rates in the four PHE categories.
The response rate was 87.7%.Aims
Patients and Methods
Accurate characterisation of fractures is essential in fracture management trials. However, this is often hampered by poor inter-observer agreement. This article describes the practicalities of defining the fracture population, based on the Neer classification, within a pragmatic multicentre randomised controlled trial in which surgical treatment was compared with non-surgical treatment in adults with displaced fractures of the proximal humerus involving the surgical neck. The trial manual illustrated the Neer classification of proximal humeral fractures. However, in addition to surgical neck displacement, surgeons assessing patient eligibility reported on whether either or both of the tuberosities were involved. Anonymised electronic versions of baseline radiographs were sought for all 250 trial participants. A protocol, data collection tool and training presentation were developed and tested in a pilot study. These were then used in a formal assessment and classification of the trial fractures by two independent senior orthopaedic shoulder trauma surgeons.Objectives
Methods
Surgeons face a substantial risk of infection because of the occupational exposure to blood-borne pathogens (BBPs) from patients undergoing high-risk orthopaedic procedures. This study aimed to determine the seroprevalence of four BBPs among patients undergoing joint arthroplasty in Shanghai, China. In addition, we evaluated the significance of pre-operative screening by calculating a cost-to-benefit ratio. A retrospective observational study of pre-operative screening for BBPs, including hepatitis B and C viruses (HBV and HCV), human immunodeficiency virus (HIV) and Treponema pallidum (TP), was conducted for sequential patients in the orthopaedic department of a large urban teaching hospital between 01 January 2009 and 30 May 2016. Medical records were analysed to verify the seroprevalence of these BBPs among the patients stratified by age, gender, local origin, type of surgery, history of previous transfusion and marital status.Objectives
Methods
Our aim was to investigate the prevalence of A total of 46 patients undergoing either an arthroscopic capsular
release or stabilisation had biopsies taken from the subcutaneous
fat and capsule of the shoulder at the time of surgery. These samples
were sent for culture in enrichment, and also for Nucleic Acid Amplification
testing. The prevalence of Aims
Patients and Methods
Increasing demand for total hip and knee arthroplasty (THA/TKA)
and associated follow-up has placed huge demands on orthopaedic
services. Feasible follow-up mechanisms are therefore essential. We conducted an audit of clinical follow-up decision-making for
THA/TKA based on questionnaire/radiograph review compared with local
practice of Arthroplasty Care Practitioner (ACP)-led outpatient
follow-up. In all 599 patients attending an ACP-led THA/TKA follow-up
clinic had a pelvic/knee radiograph, completed a pain/function questionnaire
and were reviewed by an ACP. An experienced orthopaedic surgeon
reviewed the same radiographs and questionnaires, without patient
contact or knowledge of the ACP’s decision. Each pathway classified
patients into: urgent review, annual monitoring, routine follow-up
or discharge. Aims
Methods
This is a prospective randomised controlled trial comparing the
functional outcomes of plate fixation and elastic stable intramedullary
nailing (ESIN) of completely displaced mid-shaft fractures of the
clavicle in the active adult population. We prospectively recruited 123 patients and randomised them to
either plate fixation or ESIN. Patients completed the Quick Disabilities
of the Arm, Shoulder and Hand (DASH) score at one to six weeks post-operatively.
They were followed up at six weeks, three and six months and one
year with radiographs, and their clinical outcome was assessed using
both the DASH and the Constant Score.Aims
Patients and Methods
Surgical site infection can be a devastating complication of
hemiarthroplasty of the hip, when performed in elderly patients
with a displaced fracture of the femoral neck. It results in a prolonged
stay in hospital, a poor outcome and increased costs. Many studies
have identified risk and prognostic factors for deep infection.
However, most have combined the rates of infection following total
hip arthroplasty and internal fixation as well as hemiarthroplasty, despite
the fact that they are different entities. The aim of this study
was to clarify the risk and prognostic factors causing deep infection
after hemiarthroplasty alone. Data were extracted from a prospective hip fracture database
and completed by retrospective review of the hospital records. A
total of 916 patients undergoing a hemiarthroplasty in two level
II trauma teaching hospitals between 01 January 2011 and
01 May 2016 were included. We analysed the potential peri-operative
risk factors with univariable and multivariable logistic regression
analysis.Aims
Patients and Methods
The purpose of this study was to compare symptomatic treatment
of a fracture of the base of the fifth metatarsal with immobilisation
in a cast. Our null hypothesis was that immobilisation gave better patient
reported outcome measures (PROMs). The alternative hypothesis was
that symptomatic treatment was not inferior. A total of 60 patients were randomised to receive four weeks
of treatment, 36 in a double elasticated bandage (symptomatic treatment
group) and 24 in a below-knee walking cast (immobilisation group).
The primary outcome measure used was the validated Visual Analogue
Scale Foot and Ankle (VAS-FA) Score. Data were analysed by a clinician,
blinded to the form of treatment, at presentation and at four weeks,
three months and six months after injury. Loss to follow-up was
43% at six months. Multiple imputations missing data analysis was performed.Aims
Patients and Methods
