A comparison between the Major Trauma Centre management of complex open lower limb fractures in children and the elderly

Injury ◽  
2019 ◽  
Vol 50 (7) ◽  
pp. 1376-1381 ◽  
Author(s):  
Muhammad Faheem Khadim ◽  
Ahmed Emam ◽  
Thomas C. Wright ◽  
Thomas W.L. Chapman ◽  
Umraz Khan
Keyword(s):  
Lower Limb ◽  
Major Trauma ◽  
The Elderly ◽  
Trauma Centre ◽  
Lower Limb Fractures ◽  
Fractures In Children ◽  
Major Trauma Centre ◽  
Limb Fractures

scholarly journals A health economic analysis of the management of open lower limb fractures in the elderly

2020 ◽  
Vol 30 (8) ◽  
pp. 1383-1391
Author(s):  
Caitlin Pley ◽  
Katie Purohit ◽  
Matija Krkovic ◽  
Ali Abdulkarim
Keyword(s):  
Lower Limb ◽  
The Elderly ◽  
Trauma Centre ◽  
Median Cost ◽  
Financial Loss ◽  
University Hospitals ◽  
Health Economic Analysis ◽  
Lower Limb Fractures ◽  
Major Trauma Centre ◽  
Limb Fractures

Abstract Aim The aim of this study was to investigate the financial implications of the inpatient management of open lower limb fractures in adults over 65 years old. Further, the study compares the calculated cost to the income received by the hospital for these patients and to the existing body of literature. Methods This study employed direct inpatient costing analysis to estimate the cost of treating the open lower limb fractures incurred by 58 patients over the age of 65 years treated in our centre (Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust) between March 2014 and March 2019. Results The median cost of inpatient care calculated in this study was £20,398 per patient, resulting in a financial loss to the hospital of £5113 per patient. When the results were disaggregated by sex, the median cost for an open lower limb fracture in a male patient was £20,886 compared to £19,304 in a female patient. Data were also disaggregated by the site of injury, which produced a median cost for an open femur fracture of £23,949, and £24,549 and £15,362 for open tibia and ankle fractures, respectively. Conclusion This study provides a valuable estimate of the expense of treating open lower limb fractures in patients over the age of 65 years in a Major Trauma Centre in England. The study highlights the large losses incurred by hospitals in treating these cases, and supports revision of the remuneration structures in the National Health Service to adequately cover their cost.

scholarly journals Management of open fractures of the lower limb during the COVID-19 pandemic: are the standards of treatment being maintained? a study from a major trauma centre in England

2021 ◽  
Author(s):  
Rajan Choudhary ◽  
Madhumita Gupta ◽  
Shahidul Haq ◽  
Wareth Maamoun
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Major Trauma ◽  
Trauma Centre ◽  
Open Fractures ◽  
Trauma Service ◽  
Major Trauma Centre ◽  
Notable Increase ◽  
Definitive Surgery ◽  
Limb Fractures

<p class="abstract"><strong>Background: </strong>Coronavirus disease 2019 (COVID 19) has created an immense strain on the NHS. During the height of the pandemic, trauma services were affected by redeployment, reduced theatre capacity and staff illness, and COVID BOAST guidelines were introduced.</p><p class="abstract"><strong>Methods: </strong>This retrospective study aimed to evaluate the standards of management of open fractures of the lower limb at a Major Trauma Centre in the United Kingdom during the COVID-19 pandemic and compare the same with the pre-pandemic period. Patient demographics, mechanism of injury, timing and mechanism of initial debridement and definitive soft tissue and skeletal fixation were noted. Outcomes including duration of hospital stay, 30 day and 1 year mortality were also assessed.</p><p class="abstract"><strong>Results: </strong>There was an overall 21% reduction in admissions with open lower limb fractures during the pandemic period with a 48% reduction during the first lockdown. There was a significant reduction in time taken from Emergency Department presentation to first debridement as well as a notable increase in operating outside of regular theatre hours. There was little difference in operative technique used for skeletal or soft tissue management at initial and definitive surgery, though fewer cases were performed as a two stage procedure. There was no difference in amputation rate in the two years. Length of stay was reduced from 21 days to 17, and 30 day mortality remained the same.</p><p class="abstract"><strong>Conclusions:</strong> Our study shows this Major Trauma Centre was able to provide a trauma service in accordance to the BOAST4 guidelines despite the increased pressures of the COVID-19 pandemic.</p>

scholarly journals Cycling-related orthopaedic fractures admitted to the Major Trauma Centre in the cycling capital of the UK

2021 ◽  
Author(s):  
Omar Jamil ◽  
Sofyan Al Shdefat ◽  
Zaki Arshad ◽  
Azeem Thahir ◽  
Fahim Anwar ◽  
...  
Keyword(s):  
United Kingdom ◽  
Major Trauma ◽  
Trauma Centre ◽  
Appendicular Skeleton ◽  
The United Kingdom ◽  
Lower Limb Fractures ◽  
Major Trauma Centre ◽  
Safety Interventions ◽  
The Uk ◽  
Limb Fractures

Abstract Introduction The popularity of cycling in the United Kingdom is increasing, with a further rise likely due to recent government cycling promotion schemes. This study aims to characterise fractures sustained due to cycling-related collisions in patients presenting to a Major Trauma Centre, in the region with the highest cycling rates in the United Kingdom. Methods A retrospective analysis of cycling injuries presenting to our centre between January 2012 and December 2020 was performed using a prospectively collected electronic database. Comparison of fracture characteristics was made according to patient age and mechanism of injury (collision with a motorised vehicle versus collision with a non-motorised object.). Results Of the 737 patients who suffered a cycling-related injury, 292 (39.6%) suffered at least 1 fracture to the appendicular skeleton. Overall, fractures were most commonly seen in those over 50 years of age. Upper limb fractures were more common than lower limb fractures. Fractures sustained during motorised injuries were more likely to require surgical intervention than those sustained during non-motorised collisions. Conclusion This study provides valuable information regarding the nature, epidemiology and treatment of fractures sustained following cycling-related accidents, adding to the paucity of similar literature in the field. Given the likely increase in future cycling uptake, our results are important to clinicians treating patients with cycling-related injuries and policymakers designing safety interventions.

External Fixation Of Lower Limb Fractures In Children

2000 ◽  
Vol 35 (6) ◽  
pp. 851
Author(s):  
Tae Woo Park ◽  
Sung Do Cho ◽  
Yong Sun Cho ◽  
Bum Soo Kim ◽  
Soon Woo Hong ◽  
...  
Keyword(s):  
External Fixation ◽  
Lower Limb ◽  
Lower Limb Fractures ◽  
Fractures In Children ◽  
Limb Fractures

What predicts mortality in the elderly patient presenting as a trauma call? A report from a Major Trauma Centre

The Surgeon ◽  
2020 ◽  
Vol 18 (3) ◽  
pp. 142-149
Author(s):  
Christopher J. Lodge ◽  
Robert M. West ◽  
Peter Giannoudis ◽  
Theodoros H. Tosounidis
Keyword(s):  
Elderly Patient ◽  
Major Trauma ◽  
The Elderly ◽  
Trauma Centre ◽  
Major Trauma Centre

scholarly journals Epidemiological evaluation of traumatic lower limb fractures in children

Medicine ◽  
2019 ◽  
Vol 98 (38) ◽  
pp. e17123
Author(s):  
Huan Liu ◽  
Hongwei Wang ◽  
Bing Shao ◽  
Han Lu ◽  
Song Zhang ◽  
...  
Keyword(s):  
Lower Limb ◽  
Lower Limb Fractures ◽  
Fractures In Children ◽  
Epidemiological Evaluation ◽  
Limb Fractures

scholarly journals Experience of managing open fractures of the lower limb at a major trauma centre

2015 ◽  
Vol 97 (4) ◽  
pp. 287-290 ◽  
Author(s):  
AM Ali ◽  
JM McMaster ◽  
D Noyes ◽  
AJ Brent ◽  
LK Cogswell
Keyword(s):  
Soft Tissue ◽  
Median Time ◽  
Lower Limb ◽  
Major Trauma ◽  
Deep Infection ◽  
Trauma Centre ◽  
Open Fractures ◽  
Trauma Network ◽  
Soft Tissue Cover ◽  
Major Trauma Centre

Introduction In April 2012 the John Radcliffe Hospital in Oxford became a major trauma centre (MTC). The British Orthopaedic Association and British Association of Plastic, Reconstructive and Aesthetic Surgeons joint standards for the management of open fractures of the lower limb (BOAST 4) require system-wide changes in referral practice that may be facilitated by the MTC and its associated major trauma network. Methods From 2008 to 2013 a multistep audit of compliance with BOAST 4 was conducted to assess referral patterns, timing of surgery and outcomes (surgical site infection rates), to determine changes following local intervention and the establishment of the MTC. Results Over the study period, 50 patients had soft tissue cover for an open lower limb fracture and there was a significant increase in the proportion of patients receiving definitive fixation in our centre (p=0.036). The median time from injury to soft tissue cover fell from 6.0 days to 3.5 days (p=0.051) and the median time from definitive fixation to soft tissue cover fell from 5.0 days to 2.0 days (p=0.003). The deep infection rate fell from 27% to 8% (p=0.247). However, in 2013 many patients still experienced a delay of >72 hours between injury and soft tissue cover, primarily owing to a lack of capacity for providing soft tissue cover. Conclusions Our experience may be relevant to other MTCs seeking to identify barriers to optimising the management of patients with these injuries.

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