Aims

There are reports of a marked increase in perioperative mortality in patients admitted to hospital with a fractured hip during the COVID-19 pandemic in the UK, USA, Spain, and Italy. Our study aims to describe the risk of mortality among patients with a fractured neck of femur in England during the early stages of the COVID-19 pandemic.

We performed a prospective ultrasonographic study of tendon healing following Ponseti-type Achilles tenotomy in 27 tendons (20 patients) with idiopathic congenital talipes equinovarus. Serial ultrasound examinations (both static and dynamic) were performed at 3, 6 and 12 weeks post-operatively. Casts were removed routinely 3 weeks post-tenotomy apart from two patients over 24 months of age who remained immobilised for 6 weeks. We observed three differing phases of healing apparent at 3, 6 and 12 weeks post tenotomy. We defined the end point of healing as the observation of tendon homogeneity across the gap zone on ultrasonography. This transition to normal ultra-structure was frequently seen by ultrasonography only at 12 weeks, when the divided ends of the tendon were indistinct. Though there is evidence of continuity of the tendon at the time of cast removal, it remains in the mid-phase of healing. The time taken for complete healing should be considered prior to planning a revision tenotomy.

In two children over the age of 2 years, who had repeat tenotomy, the completion of healing by our criteria took longer than 12 weeks. The tendon gap healing does not appear to occur as readily in children over two years and other Methods: may be preferable to percutaneous tenotomy.

Carpal tunnel syndrome is the most common compressive neuropathy of the upper limb. Various methods are used to diagnose this condition including clinical examination and neurophysiologic tests. The DASH (Disability of Arm, Shoulder and Hand) score is also commonly used to quantify the symptoms from the patients’ perspective. The aim of this study was to determine any correlation between the neurophysiology and the various questions in the DASH score. To the best of our knowledge this potential association has not been studied previously.

Methods: We reviewed 55 patients who underwent carpal tunnel surgery under the care of the senior author. Case notes were reviewed to extract the DASH score, clinical signs and neurophysiology results. DASH questionnaires are routinely given to all our new patients in the hand clinic and we used these questionnaires for the study (pre operative scores). All the patients were examined clinically by the senior author. The clinical signs used included direct compression, Tinel’s and Phalen’s test. Neurophysiologic testing was conducted by two specialists using a standard format which allowed us to extract the data consistently.

Analysis: The data was analysed using linear and logistical regression methods.

Results: Of 55 patients, 9 had bilateral surgery, resulting in 64 sets of data. There were 44 females and 11 males, with a mean age of 62 (range 36 – 86) years. The mean DASH score was 38.0 (range 0.8 – 85.0). The relationship between the component scores of the DASH questionnaire and neurophysiology tests will be presented in further detail.

Conclusion: The results of this study may facilitate an abbreviation of the DASH questionnaire, making it more focused to patients with carpal tunnel syndrome.

The femur is the largest and strongest bone with a very good blood supply. Large forces are required to result in a fracture. However once a fracture does occur, there can be significant displacement due to the strong musculature surrounding it and loss of blood. As a result of this, the patients are prone to neurovascular and circulatory compromise, which can lead to significant mortality and morbidity. In an open fracture, there is the added potential for infection.

We have conducted a case review of military patients with femoral fractures sustained in hostile zones admitted to RCDM for definitive treatment.

Retrospective analysis of military patients with femoral fractures admitted to RCDM. Factors to be considered include mechanism of injury, type of fracture (Gustillo Anderson and AO classification), pre- and post-transfer operative treatment, complications, microbiology, length of hospital stay, and discharge status. The presentation will include case discussion of interesting patients.

Correspondence should be addressed to Major M Butler RAMC, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, Devon.

There is still much debate on the appropriateness of taking post operative radiographs especially in the presence of high quality radiography that image intensifiers now provide. The aim of this study was to determine current UK practice regarding the use of check radiographs and to compare this practice with the implant related complications.

A postal performa was sent to 450 randomly chosen UK Trauma and Orthopaedic Consultants to assess their practice regarding check radiographs following hip fracture surgery. In addition a case note review of all patients undergoing hip fracture surgery over the three years of 2001 to 2003 at Selly Oak Hospital, was performed. Patients undergoing revision surgery in the same admission were identified. The decision to revise was noted to determine whether check radiograph influenced the decision.

Response rate to the performa was 66.7% (300/450). 96% routinely took postoperative radiographs following Hemiarthroplasty. Of these, 87% allowed the patient to mobilise before checking the radiograph. In the DHS group, 61% took check radiographs. Of these, 75% allowed the patient to mobilise prior to reviewing the radiograph. Following Cannulated screw fixation, 58% routinely performed check radiographs and 67% allowed the patient to mobilise before reviewing the radiograph. 1265 hip fracture surgeries were performed in our unit in three years. Only one decision to revise was based on a problem identified on a routine check radiograph.

We highlight the lack of national consensus on the use of post operative radiographs. We recommend the use of post operative radiographs only when clinically indicated, hence sparing the patient from discomfort, unnecessary exposure to radiation as well as allowing more effective utilisation of radiological and human resources.