Purpose: To demonstrate that Rush pin is safe and effective in selected fragility ankle fractures.

Introduction: Fragility ankle fracture is increasing proportionately to their age. It produces not only clinical challenge due to multiple co morbidities but also a challenge to heal the fracture and particularly the skin. We found that early minimal intervention by stabilizing the lateral column with a rush nail is safe, beneficial and acceptable practice in selected cases.

Material & Method: Retrospective case notes & X-rays review of fragility ankle fractures between 1st of January 2005 to 31^st of August 2008 selection using the criteria below

✓ Closed Ankle Fracture

✓ Elderly or fragility fracture

✓ Minimal invasive ORIF

Results:

Seven patients found.

Mean age: 78.2

M: F – 1:5

ASA CLASS: 3–4

All patients had ankle fracture with fragile or damaged skin. All operated within 10 days of injury, including those who were on warfarin or significant medical problems. All underwent closed reduction and or percutaneous medial malleolar fixation and stabilization of the lateral column with Rush Pin through a stab incision under x-ray control. A lightweight plaster was applied for 4–6 weeks. All fracture healed in a acceptable position without any skin complication. One patient who had pre operative ulcer also healed.

Discussion/Conclusion: Minimally invasive treatment has no surgical wound complication. All fracture healed in a satisfactory position. All discharged after mean follow up of 6 month. One death due to unrelated cause after 5 weeks of operation.

Rush pin fixation in fragility fracture is a useful and safe methods of treatment in selected group.

Aim and objectives of the study: To assess the true incidence and reasons for readmission after fracture neck of femur treatment and its effect on Trust star rating.

Introduction: Star ratings (zero to three) show how well a Trust is performing and is awarded against a set of performance indicators (Patient Focus, Capacity and Capability Focus and Clinical Focus) as laid by CHAI

These indicators cover the standards and outcomes of treatment given.

CHAI reports 9% readmission as an emergency within 28 days, and assumes that a proportion of the observed readmissions are potentially avoidable.

Materials and Methods: An audit done by the managers found 15 (19%) cases of readmission of fracture neck of femur during April to October 2004. We did Re audit by reviewing the exact cause for readmissions in all the cases.

Results: Out of 15 cases identified by the managers only 4 (5.19%) were true readmission, which is below the national average.8 readmissions were for medical reasons, 3 for social reasons and rest 4 were related to fracture complications like infection.

Conclusion: Star ratings (zero to three) reflect Trust performance and are awarded against a set of performance indicators, which cover the standards, and outcomes of treatment given (Patient Focus, Capacity and Capability Focus and Clinical Focus) as laid by CHAI.

We conclude that audit should be done as a team-work involving all responsible health care professionals and proper uniform coding system needs to be followed to obtain correct results.

Materials & Methods: A retrospective study. 25 cases of fracture Calcaneum during April 2001–2004 were reviewed for their clinical outcome.

Aim of the study: To assess the clinical and functional outcome of the Management of Intra and Extra articular Calcaneal fractures in district general hospital.

Results: 22 male and 3 female. Intraarticular fractures 15 (60%)of which 10 were displaced and 5 undisplaced.

Extraarticular were 10 (40%) of which displaced and undisplaced were 5 each. Fall from height was seen in 20 (80%)patients. Associated injuries was seen in 10(40%) patients of which 8(32%) of them had fracture spine. All the cases of intaarticular fractures had C.T. scan.

5 cases had MUA and pinning for the extraarticular fracture.

8(32%) displaced intraarticular fractures underwent ORIF.

2((8%) intraarticular displaced fractures were treated conservatively.

The average follow-up one-year.

The final outcome assessed clinical and radiologically.

2 cases of infection, 4 cases of stiffness, 2 cases of deformity seen.1 case had parasthesia.

The final outcome all the fractures treated conservatively were good. Fractures underwent ORIF had better outcome and more complication rate as compared to conservative treatment.

Conclusion: Commonest mode of injury is fall from height and associated injury incidence is usually high.

Even the undisplaced intraarticular fractures of calcaneum do develop residual stiffness and difficulty in walking on uneven ground.

Displaced fractures needs fixation for better results and facilitation for secondary operations.

Wound infection, stiffness and deformity are known complications.

In this small audit all three group did develop stiffness and we recommend a bigger, independent audit.

Aim of the study: to assess the early complication rate following k-wiring of distal radius fractures and their clinical outcome. A retrospective treatment.

METHOD: 48 patients with 50 Distal Radial fractures, number? High velocity (26 Males, 22 Females; Mean age 34 years; Range 4 to 88 years) treated by Closed K-Wiring during the period between January 2005 to June 2005 were assessed in terms of early complications following MUA and K-Wiring and their final outcome. All cases were performed by staff grade or above.

12 patients (24%) had discharge, pin tract granulation, loosening, out of which 4 required antibiotic. Out of 12 only 2 (4%) has positive swab culture requiring Intravenous antibiotics.

3 patients (6%) had symptoms suggesting superficial radial nerve damage of which 2 recovered completely after pin removal. One had residual symptom, put on waiting list but symptoms got better and she refused further treatment.

9 patients (18%) had stiffness out of which only 3 (6%) had residual stiffness at the end of 6 months. However this stiffness can not be attributable to k-wiring alone (?fracture intra articular).

CRPS was noted in 1 patient (2%) and recovered after prompt physiotherapy. There were no cases of deep infection, osteomyelitis, tendon rupture, pin migration or significant loss of position in our study.

CONCLUSION: Our data suggests that though early complication rate of K-wiring is alarming, it does not affect the final outcome of fracture management; and this complication can be avoided by proper technique and care.