Background and Objective

Patients undergoing hip fracture surgery have a high peri-operative mortality rate. We performed a retrospective study to ascertain if there is any relation between postoperative haemoglobin (Hb) decrease and cardiac related events following the surgery.

The use of blood transfusion in elective spinal surgery still remains a topic of debate in spite of several guidelines on transfusion in orthopaedic surgery. We report on a study done to look at the transfusion practice in 64 patients who underwent scoliosis correction surgery in our institution. There were 16 males and 48 females, with an average age of 19.8 years (range 3–70 years). There were 50 patients with idiopathic scoliosis, seven with degenerative scoliosis, five with neuromuscular scoliosis, and one each of congenital and neurologic scolioses. 31 of the patients underwent posterior correction and 13 patients underwent anterior surgery and 11 patients underwent posterior surgery with costoplasty and 5 patients underwent front and back surgery while 4 patients had front and back surgery with costoplasty. 10 patients underwent iliac crest bone grafting. The mean preop haemoglobin was 13.1 g % (range11.3–16.2 g %) and the mean postop haemoglobin was 8.9 g % (5–14.9 g %). The average amount of intraoperative fluids infused was 4100 ml (range: 300–11000 ml). The mean blood loss was 803.3 ml (range: 300–1800 ml). Sixteen patients were transfused in all requiring 32 units of blood, with an average of 2 units per patient. The average duration of hospital stay was 10.1 days (5–45 days). The mean blood loss through drains was 396 ml (10–2000 ml).

Open reduction and internal fixation for displaced intra-articular fractures of the calcaneum has become an established method of treatment. A recent randomised, controlled trial has questioned the benefits of surgery, in particular, pain relief. We reviewed the cases undertaken in our department, complications, which have arisen, and their treatment. We have devised a management plan in conjunction with the department of plastic surgery to minimise the effect of these complications. There were 124 procedures carried out over a 12 years period, 116 unilateral and 4 bilateral in 120 patients (106 males and 14 females, age range [18 to 66]). Two further patients were included who had had surgery in another hospital and had been referred to our plastic surgery unit with significant wound complications. The patients were retrospectively assessed with a case note review and an updated clinical evaluation. The assessment focussed particularly on wound complications including breakdown classified as either major or minor, and association with infection, haematoma and drainage. Neurological symptoms were also noted. There were five major wound complications, three from our unit and two from another hospital. Infection was present in three cases. Four healed uneventfully but one of the infected group subsequently had a below knee amputation for refractory infection. Minor wound breakdown was more common. There was no association with haematoma or drainage but wound breakdown occurred more frequently in patients who smoked. Neurological complications were infrequent and temporary. In conclusion this study confirmed that there is a significant morbidity associated with the surgical management of these fractures, although, the vast majority of patients’ wounds healed uneventfully. With a sensible management plan, which involves working in conjunction with plastic surgeons, even major soft tissue complications may be addressed.