Does surgical approach affect outcome after fixation of intra-articular fractures of distal humerus? Retrospective cohort study from a level-1 trauma centre in a metropolitan city

Abstract Purpose To compare the rates of ulnar nerve neuropathy following ulnar nerve subcutaneous anterior transposition versus no transposition during open reduction and internal fixation (ORIF) of distal humerus fractures. Methods This was a retrospective cohort study at an academic level I trauma centre. A total of 97 consecutive patients with distal humerus fractures underwent ORIF between 2011 and 2018. All included patients were treated with plates (isolated lateral plates excluded) and had no pre-operative ulnar neuropathy. Subcutaneous ulnar nerve anterior transposition was compared versus no transposition at the time of ORIF. The main outcome measure was the rate of ulnar nerve neuropathy. The secondary outcomes were the severity of the ulnar nerve neuropathy and the rate of ulnar nerve recovery. Results Twenty-eight patients underwent subcutaneous ulnar nerve anterior transposition during ORIF, whereas 69 patients had no transposition. Transposition was associated with significantly higher rates of ulnar nerve neuropathy (10/28 versus 10/69; P = 0.027). An adjusted logistic regression model demonstrated an odds ratio of 4.8 (1.3, 17.5; 95% CI) when transposition was performed. Ulnar nerve neuropathy was classified as McGowan grades 1 and 2 in all neuropathy cases in both groups (P = 0.66). Three out of ten cases recovered in the transposition group, and five out of ten cases recovered in the no transposition group over a mean follow-up of 11.2 months (P = 1.00). Conclusion We do not recommend performing routine subcutaneous ulnar nerve anterior transposition during ORIF of distal humerus fracture as it was associated with a significant 5-fold increase in ulnar nerve neuropathy.

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Risk factors for perioperative blood transfusions after urogenital fistula repair in Uganda: a retrospective cohort study

10.22541/au.161452369.94407512/v1 ◽

2021 ◽

Author(s):

Thrisha Potluri ◽

Lauren Holt ◽

Jean Paul Tanner ◽

Lucien Wasingya ◽

Shane Duffy ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Blood Transfusion ◽

Surgical Approach ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Significant Risk ◽

Blood Transfusions ◽

Fistula Repair ◽

Urogenital Fistula

Objective: To determine the incidence of and risk factors for perioperative blood transfusions after urogenital fistula repairs in Uganda. Design: A retrospective cohort study. Setting: A community hospital in Masaka, Uganda. Population: Women who underwent fistula repair at the Kitovu Hospital between 2013 and 2019. Methods: Retrospective review of demographics, and clinical perioperative characteristics of patients surgically treated for urogenital fistula. Patient characteristics were compared between those who did and did not require a blood transfusion. Main Outcome Measures: need for perioperative blood transfusion, risk factors Results: 546 patients treated for urogenital fistulas were included in this study. The median age was 31.1 ± 13.2. A vaginal surgical approach was used in the majority of patients (84.6%). Complications occurred in 3.5% of surgical repairs, and the incidence of blood transfusions was 6.2%. In multivariable analyses, women with fistula repairs approached abdominally were 4.3 (95% CI: 1.85–10.00) times more likely to require transfusions than vaginal operations. A borderline association was observed between timing of repair and perioperative transfusions such that patients who underwent repair after three months from the time of developing the fistula were at lower risk of perioperative transfusions (aOR: 0.48, 95% CI: 0.22–1.04). Conclusions: The incidence of blood transfusions among urogenital fistula repairs in our population is twice that of developed nations. An abdominal surgical approach to urogenital fistula is a significant risk factor for perioperative blood transfusions. Timing of repair may warrant further study.

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Temporal and geographic patterns of stab injuries in young people: a retrospective cohort study from a UK major trauma centre

BMJ Open ◽

10.1136/bmjopen-2018-023114 ◽

2018 ◽

Vol 8 (10) ◽

pp. e023114 ◽

Cited By ~ 6

Author(s):

Paul Vulliamy ◽

Mark Faulkner ◽

Graham Kirkwood ◽

Anita West ◽

Breda O’Neill ◽

...

Keyword(s):

Cohort Study ◽

Young People ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Major Trauma ◽

Trauma Centre ◽

Targeted Prevention ◽

Major Trauma Centre ◽

School Day ◽

Stab Injuries

ObjectivesTo describe the epidemiology of assaults resulting in stab injuries among young people. We hypothesised that there are specific patterns and risk factors for injury in different age groups.DesignEleven-year retrospective cohort study.SettingUrban major trauma centre in the UK.Participants1824 patients under the age of 25 years presenting to hospital after a stab injury resulting from assault.OutcomesIncident timings and locations were obtained from ambulance service records and triangulated with prospectively collected demographic and injury characteristics recorded in our hospital trauma registry. We used geospatial mapping of individual incidents to investigate the relationships between demographic characteristics and incident timing and location.ResultsThe majority of stabbings occurred in males from deprived communities, with a sharp increase in incidence between the ages of 14 and 18 years. With increasing age, injuries occurred progressively later in the day (r2=0.66, p<0.01) and were less frequent within 5 km of home (r2=0.59, p<0.01). Among children (age <16), a significant peak in injuries occurred between 16:00 and 18:00 hours, accounting for 22% (38/172) of injuries in this group compared with 11% (182/1652) of injuries in young adults. In children, stabbings occurred earlier on school days (hours from 08:00: 11.1 vs non-school day 13.7, p<0.01) and a greater proportion were within 5 km of home (90% vs non-school day 74%, p=0.02). Mapping individual incidents demonstrated that the spike in frequency in the late afternoon and early evening was attributable to incidents occurring on school days and close to home.ConclusionsAge, gender and deprivation status are potent influences on the risk of violent injury in young people. Stab injuries occur in characteristic temporal and geographical patterns according to age group, with the immediate after-school period associated with a spike in incident frequency in children. This represents an opportunity for targeted prevention strategies in this population.

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Readmission and mortality in patients treated by interprofessional student teams at a training ward compared with patients receiving usual care: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2018-022251 ◽

2018 ◽

Vol 8 (10) ◽

pp. e022251 ◽

Cited By ~ 1

Author(s):

Karin Hallin ◽

Max Gordon ◽

Olof Sköldenberg ◽

Peter Henriksson ◽

Anna Kiessling

Keyword(s):

Cohort Study ◽

Usual Care ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Trauma Centre ◽

University Teaching ◽

Student Teams ◽

Level Ii ◽

Interprofessional Training ◽

Patient Readmissions

ObjectiveThis study aimed to compare the rate of patient readmissions and mortality between care provided at an orthopaedic interprofessional training ward (IPTW) and usual care.DesignRetrospective cohort study.SettingOrthopaedic wards at a level II trauma centre at a Swedish university teaching hospital between 2006 and 2011.ParticipantsTwo cohorts were identified: (1) a control cohort that had not received care at the IPTW, and (2) patients who had been treated for at least 1 day at the IPTW.Main outcome measuresReadmission at 90 days and 1-year mortality.ResultsWe included 4652 controls and 1109 in the IPTW group. The mean age was 63 years, and 58% were women. The groups did not differ in any of the outcomes: the readmission rate in the control and IPTW groups was 13.5% and 14.0%, respectively, while mortality was 5.2% and 5.3%, respectively. This lack of difference remained after adjusting for confounders.ConclusionInterprofessional undergraduate training in patient-based settings can be performed in a level II trauma hospital with satisfactory patient safety.

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