The main problem in revision hip arthroplasty is bone loss. Every attempt should be made to conserve the existing bone and restore the missing bone where possible during reconstruction of the acetabulum and femur. Femoral impaction grafting is a demanding but powerful technique to restore the bone loss and prepare for any further revisions in future. It allows the use of a cemented stem which loads the cancellous bed of the graft and helps in neo-osteogenesis. We report our technique of using this technique in femoral revisions.
from April 2003 to April 2007. Then we ascertained in-hospital mortality rates at 30 days and at one year following admission to hospital using Hospital Episode Statistics (HES). Unplanned hospital readmission rates for all causes (including episodes of thromboembolism and bleeding)within 30 days (all years) and one year (2003–2005) were also established. A total of 150 hospitals were contacted and data gathered from 62 hospitals (response rate 41.3%). There were 255,841 patients with neck of femur fractures during this five year period who were assessed for morbidity andmortality correlating it to the thromboprophylaxis policy. There was no significant difference in hospital readmission within 30 days or diagnosis of thromboembolism or haemorrhage among hospitals of different thromboprophylaxis policies. The hospitals using LMWH in half the dose recommended by the BritishNational Formulary had significantly reducedmortality in-hospital (odds ratio (OR) 0.79, 95% CI 0.69–0.90, P=0.0006), at 30 days (OR 0.8 (0.70–0.92), P=0.001) and at one year (OR 0.89 (0.80–1.00), P=0.050) compared with no policy. Our data suggest that the thromboprophylaxis regimen for patients with fracture neck of femur should be half dose LMWH for the duration of the hospital stay.
We report a case of dorsal radiocarpal fracture dislocation with dissociation of the distal radioulnar joint. Closed reduction was unsuccessful due to interposition of the osteochondral fragments and open reduction and fixation was carried out with a satisfactory end result. The advantages of volar approach and use of external fixator in the management of this injury are discussed.
Aims: To compare the results between intramedullary hip screw (IMHS) and dynamic hip screw (DHS) regarding operative time and radiation exposure time Methods: We reviewed radiation exposure times obtained during the fixation of 281 extracapsular proximal femoral fractures. Dynamic hip screw was used in 148, and intramedullary hip screw was used in 133. Results: The results showed that there was no statistical difference in ionising radiation exposure in closed reduction of these fractures regardless of fracture configuration or surgical experience of the surgeon, but there was a statistical difference in implant insertion time and radiation exposure (p= Conclusions: We conclude that intramed-ullary implant takes more radiation exposure because they take more time for insertion, which is irrespective of surgical experience and complexity of fracture.
Aims The exact risk to patients undergoing surgery who develop COVID-19 is not yet fully known. This study aims to provide the current data to allow adequate consent regarding the risks of post-surgery COVID-19 infection and subsequent COVID-19-related mortality. Methods All orthopaedic trauma cases at the Wrightington Wigan and Leigh NHS Foundation Trust from ‘lockdown’ (23 March 2020) to date (15 June 2020) were collated and split into three groups. Adult ambulatory trauma surgeries (upper limb trauma, ankle fracture, tibial plateau fracture) and regional-specific referrals (periprosthetic hip fracture) were performed at a stand-alone elective site that accepted COVID-19-negative patients. Neck of femur fractures (NOFF) and all remaining non-NOFF (paediatric trauma, long bone injury) surgeries were performed at an acute site hospital (mixed green/blue site). Patients were swabbed for COVID-19 before surgery on both sites. Age, sex, nature of surgery, American Society of Anaesthesiologists (ASA) grade, associated comorbidity, length of stay, development of post-surgical COVID-19 infection, and post-surgical COVID-19-related deaths were collected. Results At the elective site, 225 patients underwent orthopaedic trauma surgery; two became COVID-19-positive (0.9%) in the immediate perioperative period, neither of which was fatal. At the acute site, 93 patients underwent non-NOFF trauma surgery, of whom six became COVID-19-positive (6.5%) and three died. A further 84 patients underwent NOFF surgery, seven becoming COVID-19 positive (8.3%) and five died. Conclusion At the elective site, the rate of COVID-19 infection following orthopaedic trauma surgery was low, at 0.9%. At the acute mixed site (typical district general hospital), for non-NOFF surgery there was a 6.5% incidence of post-surgical COVID-19 infection (seven-fold higher risk) with 50% COVID-19 mortality; for NOFF surgery, there was an 8.3% incidence of post-surgical COVID-19 infection, with 71% COVID-19 mortality. This is likely to have significance when planning a resumption of elective orthopaedic surgery and for consent to the patient. Cite this article: Bone Joint Open 2020;1-9:556–561.
Morbidity and mortality from alcohol related liver disease (ALD) has increased significantly in England. We aimed to assess the impact of the change in the alcohol licensing law in 2005 on hospital admission as well as morbidity and mortality from ALD.
Methods
This was a retrospective study between Jan 2006 to Dec 2011. Patients were identified using the ALD code (K70). Our institute is a teaching hospital in South-East England with a referral base of ~300,000 patients. Biochemical, radiological and microbiology data were collected for each patient from computerised records. The reason for hospital presentation, including the length-of-stay (and ITU stay) were collected. The data was analysed using the t test.
Results
During the study period there were a total of 294 admissions due to ALD. Amongst these, 33% presented to hospital with one admission and 67% had more than 1 admission. 69% were men (201/294), 31%(93/294) were women. The median age of the women and men in 2006 and 2007 was 56 and 52 years respectively. However, between 2008–2011, the median age of women presenting was 49 years. There was a rise in the number of admissions related to ALD each year: 40%(116/294) in 2006, 45%(133/294) in 2007, 59%(172/294) in 2008, 59%(171/294) in 2009, 66%(193/294) in 2010 and 68%(201/294) in 2011. Presentation with hyperbilirubinaemia was the most common cause of hospital admission at 72%(211/294), followed by gastrointestinal bleeding at 60%(179/294). Spontaneous bacterial peritonitis contributed to 22%(66/294) of admissions. 17%(51/294) had gram-negative and 6%(17/294) presented with gram-positive sepsis, whereas 15%(46/294) had infection of unknown origin. 28%(82/294) warranted ITU admission for organ support. The overall in-hospital mortality was 33%(96/294). The MELD in patients who died was 25 ± 0.9 vs 16.94 ± 0.2 in those that survived (p < 0.0001) each year. The percentage of failing organs each year is shown in the table below.
Conclusion
A rise in the number of admissions and re-admissions with ALD in particular with acute on chronic liver failure is a major burden on health services. It is associated with high mortality and with multi-organ failure. Increasing awareness of alcohol as a health hazard needs to be a public health priority. Early recognition of acute on chronic liver failure and timely intervention to prevent its progression is required.
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