The risk of Covid-19 community and hospital acquired infection (HAI) on patient outcomes in trauma is still relevant. Patient's should be routinely consented for this risk to ensure informed consent for perioperative contraction. A prospective audit was completed from December-March 2022 examining a consecutive series of patient admissions with capacity to consent. The standards for compliance was RCOS Toolkit 5#3 stating the importance of enhanced consent for risk of contraction, in operating and changes to care pathways. The target was 95% compliance. 2/2 contingency tables were generated to determine odds ratio for compliance versus Covid+ rate.Abstract
Introduction
Method
Although tantalum is a well recognised implant material used for revision arthroplasty, little is known regarding the use of the same in primary total hip arthroplasty. A literature search was performed to find all relevant clinical studies until March 2020, which then underwent a further selection criteria. The inclusion criteria was set as follows: Reporting on human patients undergoing primary total hip arthroplasty; Direct comparison between tantalum acetabular cups with conventional acetabular cups for use in primary total hip arthroplasty; Radiological evaluation (cup migration, osteointegration); Clinical (functional scores, need for subsequent revision, patient-reported outcomes; Post-operative complications; Reporting findings in the English Language. After a thorough search a total of six studies were included in the review. The primary outcome measures were clinical outcomes, implant migration, change in bone mineral density and rate of revision and infection.Abstract
Background
Methods
There has been an exponential increase in the use of direct thrombin (DT) and factor Xa inhibitors (FXI) in patients with cardiovascular problems. Premature cessation of DT/FXI in patients with cardiac conditions can increase the risk of coronary events. Our aim was to ascertain whether it is necessary to stop DT and FXI preoperatively to avoid postoperative complications following hip fracture surgery. Prospective data was collected from 189 patients with ongoing DT/FXI therapy and patients not on DT/FXI who underwent hip fracture surgery. Statistical comparison on pre- and postoperative haemoglobin (Hb), ASA grades, comorbidities, operative times, transfusion requirements, hospital length of stay (LOS), wound infection, haematoma and reoperation rates between the two groups was undertaken.Background of study
Materials and Methods
Surgical training has been greatly affected by the challenges of reduced training opportunities, shortened working hours, and financial pressures. There is an increased need for the use of training system in developing psychomotor skills of the surgical trainee for fracture fixation. The training system was developed to simulate dynamic hip screw fixation. 12 orthopaedic senior house officers performed dynamic hip screw fixation before and after the training on training system. The results were assessed based on the scoring system that included the amount of time taken, accuracy of guide wire placement and the number of exposures requested to complete the procedure. The result shows a significant improvement in amount of time taken, accuracy of fixation and the number of exposures after the training on simulator system. This was statistically significant using paired student t-test (p-value <0.05). Computer navigated training system appears to be a good training tool for young orthopaedic trainees The system has the potential to be used in various other orthopaedic procedures for learning of technical skills aimed at ensuring a smooth escalation in task complexity leading to the better performance of procedures in the operating theatre.
There are no published studies investigating predictive values of psychological distress on effectiveness of epidural injection. To evaluate response to epidural injection (EI) in patients with chronic lower back pain (CLBP) with and without psychological distress.Background
Aims
Clavicle fractures can cause pain and functional impairment if not managed appropriately. This paper evaluates the prevalence of clavicular fractures, estimates number of cases requiring operative treatment, whether removal of implant is a frequent necessity and compares the final functional outcome of the operative and non-operative group. Between November 2005 and November 2007 patients with clavicular fractures were eligible for participation. Patients below 18 years of age, and pathological fractures were excluded. Operative versus non-operative treatment, radiographic classification (Allman system), complications, implant removal, and functional outcome using the University of California Los Angeles (UCLA) shoulder scores were documented and analysed.Introduction
Materials/Methods
Clavicle fractures accounting for 3–5% of all adult fractures are usually treated non-operatively. There is an increasing trend towards their surgical fixation. The aim of our study was to investigate the outcome following titanium elastic stable intramedullary nailing (ESIN) for midshaft non-comminuted clavicle fractures with >20mm shortening/displacement.Introduction
Objective
Premature cessation of clopidogrel in certain patients with cardiac conditions is associated with an increased risk of recurrent coronary events. Such patients often present with proximal femoral fractures requiring surgical intervention. Our aim was to ascertain whether it is necessary to stop clopidogrel preoperatively to avoid postoperative complications following hip hemiarthroplasty surgery. A retrospective review of 102 patients with ongoing clopidogrel therapy and patients not on clopidogrel who underwent hip hemiarthroplasty for an intracapsular proximal femoral fracture was undertaken. Statistical comparison on pre- and postoperative haemoglobin (Hb), ASA grades, comorbidities, operative times, transfusion requirements, hospital length of stay (LOS), wound infection, haematoma and reoperation rates between the two groups was undertaken.Introduction
Methods
With the ever increasing rate of total hip replacement and life span of these patients, there has been an upward trend towards the incidence of peri-prosthetic fractures. Previous studies does suggest the implant cost to as high as 30% of the total reimbursement in primary hip arthroplasty but this figure is much higher in periprosthetic fractures where long stem revisions are commonly used A prospective comparative study analyzing the total cost of hospital stay for a cohort of 52 consecutive patients with peri-prosthetic fractures of long bones treated in two hospitals from October 2007 to march 2009 was conducted. Demographic data, fracture classification and method of surgical treatment along with the length of hospital stay were recorded in detail. The total cost calculated was then compared to the range of reimbursement price based on HRG (human Resource Group) coding. The implant cost was determined from the buying cost by each institution. 52 patients were available for review. Average age of the patients operated was 78.5 years. 69 percent of the peri-prosthetic fractures in our series were around the proximal femur. The average cost of stay was £ 16453 (£ 1425- 26345). The reimbursement to the hospital ranged from £ 1983 to £ 8735. Hospital source utilization for peri prosthetic fractures is quite high compared to the reimbursement being given to hospitals for treating such patients. This can be as low as £ 1500 as acute phase tariff to £ 9100 for elective revisions and the implant cost can vary from 50% to 200% of the total reimbursement cost. Current recording system for peri-prosthetic fracture is unclear resulting in discrepancy between resource utilization and reimbursement thus resulting in substantial financial losses for hospitals that perform these procedures.
