scholarly journals 495 A Retrospective Seven-Year Study on The Incidence of Cruise Ship Orthopaedic Injuries and Their Impact on A Major Trauma Centre (MTC)

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
Z Hayat
Keyword(s):  
Fragility Fractures ◽  
Trauma Centre ◽  
Linear Regression Models ◽  
Neck Of Femur ◽  
Femur Fractures ◽  
Cruise Ships ◽  
Major Trauma Centre ◽  
Limb Injuries ◽  
Orthopaedic Injuries

Abstract Introduction Cruises have increased in popularity worldwide. Falls are the most common seafaring accident, a leading cause of morbidity and mortality. The aim of this, the first UK study, was to analyse the incidence of orthopaedic injuries sustained on cruise ships presenting to an MTC over a seven-year period. Method A retrospective analysis of cruise injuries resulting in admission or ongoing follow up by the orthopaedic department was conducted. Demographic details, injuries sustained, management and length of stay were reviewed. Results Over the seven-year period, 204 patients were identified, 29 a year on average. The median age was 74 with 70.6% female patients. Of the 221 injuries, 80.9% were fractures (n = 179); neck of femur fractures predominated (27.7%,). There were 140 admissions with a total of 1250 days in hospital. Linear regression models showed the increasing number of admissions to be statistically significant (p < 0.05), as was the upward trend in the number of lower limb injuries (p < 0.05). Conclusions The majority of injuries occur in elderly females, where fragility fractures are common. It is vital that cruise ships put measures in place to minimise the risk of such accidents occurring; we hope our findings can assist the formulation of such protocols.

scholarly journals Is There a Role for Early Palliative Intervention in Frail Older Patients With a Neck of Femur Fracture?

2018 ◽  
Vol 9 ◽  
pp. 215145931878223 ◽  
Author(s):  
Andrew Davies ◽  
Thomas Tilston ◽  
Katherine Walsh ◽  
Michael Kelly
Keyword(s):  
Palliative Care ◽  
Femur Fracture ◽  
Trauma Centre ◽  
Care Plan ◽  
X Rays ◽  
Neck Of Femur ◽  
Early Palliative Care ◽  
Multidisciplinary Meeting ◽  
Major Trauma Centre ◽  
Neck Of Femur Fracture

Background: Patients with a neck of femur fracture have a high mortality rate. National outcomes have improved significantly as the management of this patient group is prioritized. In 2016, however, 4398 (6.7%) patients died within 30 days of admission. Objective: To investigate whether palliative care could be integrated early in the care plan for high-risk patients. Methods: All cases of inpatient mortality following neck of femur fracture at North Bristol Major Trauma Centre over a 24-month period were reviewed. A comprehensive assessment of care was performed from the emergency department until death. All investigations, interventions, and management decisions were recorded. A consensus decision regarding expected mortality was made for each case at a multidisciplinary meeting which included surgical, orthogeriatric, nursing, and anesthetic team input. Results: A total of 1033 patients were admitted following a neck of femur fracture. There were 74 inpatient deaths, and 82% were considered predictable at our multidisciplinary meeting. The mean length of stay was 18 days (range: 0-85, median 14). In 42% of cases, mortality was considered predictable on admission, and 40% were considered predictable following acute deterioration. These patients received on average 28 blood tests (range: 4-114) and 6.8 X-rays and computed tomographies (range: 2-20). Of this, 66% received end-of-life care; mean duration 2.3 days (range: 0-17). Conclusions: Mortality rates remain high in a subset of patients. This study demonstrates that intensive investigation and medical management frequently continues until death, including in patients with predictably poor outcomes. Early palliative care input has been integrated successfully into patient management in other specialties. We demonstrate that it is feasible to identify patients with hip fracture who may benefit from this expertise.

scholarly journals Analysis of total hip arthroplasty for displaced intracapsular neck of femur fractures in a tertiary referral trauma centre

Injury Extra ◽  
2012 ◽  
Vol 43 (10) ◽  
pp. 105
Author(s):  
Z. Gamie ◽  
J. Neale ◽  
D. Shields ◽  
J. Claydon ◽  
S. Hazarika ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Trauma Centre ◽  
Tertiary Referral ◽  
Neck Of Femur ◽  
Total Hip ◽  
Femur Fractures

159 The Need Of Six Monthly Follow Up X-Rays Post Total Knee Replacement(TKR)

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
N Baig ◽  
M Ferrari ◽  
A Lukaszewicz
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Trauma Centre ◽  
X Rays ◽  
Data Set ◽  
X Ray ◽  
Major Trauma Centre ◽  
Plain Films ◽  
Total Knee

Abstract Background There is a longstanding culture of repeat x-rays after total knee replacement (TKR) as part of follow up, often combined with a clinic review. This is to check that the prosthesis is in a satisfactory position. There are inherently a number of issues with this historic approach including exposure of patients to further radiation who may be asymptomatic, time delays in busy clinics or x-ray departments and costs. Objectives The aim of this audit was to assess whether follow up plain films after TKR are methodically undertaken and of benefit to confirm satisfactory appearance if immediate post -operative x-rays were unremarkable. The findings of a six month follow up x-ray was specifically evaluated. The secondary aim was to establish the timing of further follow up x-rays within the department. Method 200 patients were included within the analysis, they all received a TKR at a major trauma centre, over a one-year period between December 2017 and December 2018. Results It was found that 100% of those patients having a post-operative film had a satisfactory appearance. 78% of patients had at least one further follow op x-ray of which 99.4% were satisfactory. Up to five follow up x-rays were taken with 53.5% of patients having a follow up x-ray at 6 months. Conclusions From the above results there is minimal, if any, evidence within the data set to support routine, additional follow up imaging if initial post-operative films are satisfactory, and the patient is asymptomatic.

scholarly journals Paediatric orthopaedics in lockdown

2020 ◽  
Vol 1 (7) ◽  
pp. 424-430
Author(s):  
Ian Baxter ◽  
Graeme Hancock ◽  
Matthew Clark ◽  
Matthew Hampton ◽  
Adelle Fishlock ◽  
...  
Keyword(s):  
Trauma Centre ◽  
Supracondylar Fractures ◽  
Cast Immobilization ◽  
Fracture Clinic ◽  
Clinic Management ◽  
Orthopaedic Patients ◽  
Major Trauma Centre ◽  
Limb Injuries ◽  
Proportional Increase ◽  
The Impact

Aims To determine the impact of COVID-19 on orthopaediatric admissions and fracture clinics within a regional integrated care system (ICS). Methods A retrospective review was performed for all paediatric orthopaedic patients admitted across the region during the recent lockdown period (24 March 2020 to 10 May 2020) and the same period in 2019. Age, sex, mechanism, anatomical region, and treatment modality were compared, as were fracture clinic attendances within the receiving regional major trauma centre (MTC) between the two periods. Results Paediatric trauma admissions across the region fell by 33% (197 vs 132) with a proportional increase to 59% (n = 78) of admissions to the MTC during lockdown compared with 28.4% in 2019 (N = 56). There was a reduction in manipulation under anaesthetic (p = 0.015) and the use of Kirschner wires (K-wires) (p = 0.040) between the two time periods. The median time to surgery remained one day in both (2019 IQR 0 to 2; 2020 IQR 1 to 1). Supracondylar fractures were the most common reason for fracture clinic attendance (17.3%, n = 19) with a proportional increase of 108.4% vs 2019 (2019 n = 20; 2020 n = 19) (p = 0.007). While upper limb injuries and falls from play apparatus, equipment, or height remained the most common indications for admission, there was a reduction in sports injuries (p < 0.001) but an increase in lacerations (p = 0.031). Fracture clinic management changed with 67% (n = 40) of follow-up appointments via telephone and 69% (n = 65) of patients requiring cast immobilization treated with a 3M Soft Cast, enabling self-removal. The safeguarding team saw a 22% reduction in referrals (2019: n = 41, 2020: n = 32). Conclusion During this viral pandemic, the number of trauma cases decreased with a change in the mechanism of injury, median age of presentation, and an increase in referrals to the regional MTC. Adaptions in standard practice led to fewer MUA, and K-wire procedures being performed, more supracondylar fractures managed through clinic and an increase in the use of removable cast. Cite this article: Bone Joint Open 2020;1-7:424–430.

scholarly journals Bilateral Neck of Femur Fractures in a Bilateral Below-Knee Amputee: A Unique Case

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Hannah R. Lancer ◽  
Peter Smitham ◽  
Pinak Ray
Keyword(s):  
Hip Fracture ◽  
Daily Activities ◽  
General Anaesthetic ◽  
Unique Case ◽  
Neck Of Femur ◽  
Femur Fractures ◽  
Total Hip Replacements ◽  
Walking Aids ◽  
Hip Replacements

According to the National Hip Fracture Database, over 64,000 patients were admitted with a hip fracture across England, Wales, and Northern Ireland in 2013, but very few are bilateral, and there are no current cases in the literature of bilateral neck of femur fractures in a patient with bilateral below-knee amputations. We present a case of a 69-year-old bilateral below-knee amputee male admitted to the emergency department with bilateral hip pain and radiological evidence of bilateral displaced neck of femur fractures. The patient subsequently underwent synchronous bilateral total hip replacements under general anaesthetic and an epidural and then went on to make a full recovery. He was discharged 27 days after arrival in hospital. Outpatient follow-up at 3 months has shown that the patient has returned to a similar level of preinjury function and is still able to carry out his daily activities with walking aids and bilateral leg prostheses.

scholarly journals Predictors of direct home discharge following fractured neck of femur

2017 ◽  
Vol 99 (6) ◽  
pp. 444-451 ◽  
Author(s):  
O Salar ◽  
PN Baker ◽  
DP Forward ◽  
BJ Ollivere ◽  
N Weerasuriya ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Trauma Centre ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Mental Test Score ◽  
Hip Fracture Surgery ◽  
Home Discharge ◽  
Walking Aids ◽  
Major Trauma Centre ◽  
Alternative Location

INTRODUCTION Direct home discharge (DHD) following hip fracture surgery represents a challenging proposition. The aim of this study was to identify factors influencing the discharge destination (home vs alternative location) for patients admitted from their own home with a fractured neck of femur. METHODS A retrospective cohort study of prospectively collected major trauma centre data was performed, identifying 10,044 consecutive hip fracture admissions between 2000 and 2012. RESULTS Two-thirds of the patients (n=6,742, 67%) were admitted from their own home. Half of these (n=3,509, 52%) returned directly to their own home while two-fifths (n=2,640, 39%) were discharged to an alternative location; 593 (9%) died. The following were identified as independent variables associated with a higher likelihood of DHD: younger patients, female sex, an abbreviated mental test score of 10, absence of certain co-morbidities, cohabiting, walking independently outdoors, no use of walking aids, no assistance required with basic activities of daily living and intracapsular fracture. CONCLUSIONS Identifying those at risk of being discharged to an alternative location following admission from home on the basis of identified preoperative indices could assist in streamlining the postoperative care phase. Pre-emptive action may help increase the numbers of patients discharged directly home and reduce the number requiring additional rehabilitation prior to discharge home with its associated socioeconomic effect.

scholarly journals Paediatric orthopaedics in lockdown

2020 ◽  
Vol 1 (7) ◽  
pp. 424-430
Author(s):  
Ian Baxter ◽  
Graeme Hancock ◽  
Matthew Clark ◽  
Matthew Hampton ◽  
Adelle Fishlock ◽  
...  
Keyword(s):  
Trauma Centre ◽  
Supracondylar Fractures ◽  
Cast Immobilization ◽  
Fracture Clinic ◽  
Clinic Management ◽  
Orthopaedic Patients ◽  
Major Trauma Centre ◽  
Limb Injuries ◽  
Proportional Increase ◽  
The Impact

Aims To determine the impact of COVID-19 on orthopaediatric admissions and fracture clinics within a regional integrated care system (ICS). Methods A retrospective review was performed for all paediatric orthopaedic patients admitted across the region during the recent lockdown period (24 March 2020 to 10 May 2020) and the same period in 2019. Age, sex, mechanism, anatomical region, and treatment modality were compared, as were fracture clinic attendances within the receiving regional major trauma centre (MTC) between the two periods. Results Paediatric trauma admissions across the region fell by 33% (197 vs 132) with a proportional increase to 59% (n = 78) of admissions to the MTC during lockdown compared with 28.4% in 2019 (N = 56). There was a reduction in manipulation under anaesthetic (p = 0.015) and the use of Kirschner wires (K-wires) (p = 0.040) between the two time periods. The median time to surgery remained one day in both (2019 IQR 0 to 2; 2020 IQR 1 to 1). Supracondylar fractures were the most common reason for fracture clinic attendance (17.3%, n = 19) with a proportional increase of 108.4% vs 2019 (2019 n = 20; 2020 n = 19) (p = 0.007). While upper limb injuries and falls from play apparatus, equipment, or height remained the most common indications for admission, there was a reduction in sports injuries (p < 0.001) but an increase in lacerations (p = 0.031). Fracture clinic management changed with 67% (n = 40) of follow-up appointments via telephone and 69% (n = 65) of patients requiring cast immobilization treated with a 3M Soft Cast, enabling self-removal. The safeguarding team saw a 22% reduction in referrals (2019: n = 41, 2020: n = 32). Conclusion During this viral pandemic, the number of trauma cases decreased with a change in the mechanism of injury, median age of presentation, and an increase in referrals to the regional MTC. Adaptions in standard practice led to fewer MUA, and K-wire procedures being performed, more supracondylar fractures managed through clinic and an increase in the use of removable cast. Cite this article: Bone Joint Open 2020;1-7:424–430.

scholarly journals Management of multiple rib fractures-results from a Major Trauma Centre with review of the existing literature

2020 ◽  
Author(s):  
Debkumar Chowdhury ◽  
P. Okoh ◽  
H. Dambappa
Keyword(s):  
Major Trauma ◽  
Significant Proportion ◽  
Fragility Fractures ◽  
Trauma Centre ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Analgesic Requirement ◽  
Multiple Rib Fractures ◽  
Major Trauma Centre ◽  
The Impact

Abstract Introduction Rib fractures are amongst the most common fractures following major trauma presenting to the Emergency Department. It accounts for more than 15% of ED presentations (1) on a global scale. As the population ages the incidence of rib fractures also rises often following falls from a relatively small height being part of fragility fractures. The impact of rib fractures is even more significant in the patient with underlying chronic respiratory conditions.Aim To assess our current management of rib fractures at our trauma centreMethod We collected our data from the TARN Registry primarily focussing on patients with multiple rib fractures. The main components were the analgesic requirement of our patients. We also studied the number of rib fracture stabilisation procedures and the average number of ribs fixed.Results The data was collected retrospectively over a period of 12 months. There were 313 patients identified as having chest wall injuries. From the data, 41.9% (131) of patients were over the age of 65 years. A significant proportion of our patients 34.5% (108) were noted to have multiple rib fractures (>3 Ribs). It was noted that 3% (9) of the 313 patients required operations. The average of the patients included in the study was noted to be 61 years with an age range of 17-92 years.Conclusion The mainstay management of rib fracture is provision of adequate analgesia and the prevention of respiratory complications that can all stem from poor ventilatory function amongst other patient factors and injury patterns. Through the decades, surgical stabilisation has gained pace and has found its niche in the management of rib fractures.

Management of renal injury in a UK major trauma centre

Trauma ◽  
2018 ◽  
Vol 22 (1) ◽  
pp. 26-31
Author(s):  
Robert Torrance ◽  
Abigail Kwok ◽  
David Mathews ◽  
Matthew Elliot ◽  
Andrew Baird ◽  
...  
Keyword(s):  
Renal Injury ◽  
Major Trauma ◽  
Trauma Centre ◽  
University Hospital ◽  
Research Network ◽  
Renal Trauma ◽  
High Grade ◽  
Major Trauma Centre ◽  
Renal Injuries

Introduction This study reviews the type, severity, management and follow-up of renal trauma presenting to a major trauma centre in the northwest of England in the four years following inception of the major trauma centre. Given the recent introduction of major trauma centres nationally, research is needed within every specialty to ensure that the centralisation of services benefits all patients affected by these changes. Methods Patients presenting to Aintree University Hospital with renal trauma between June 2012 and June 2016 were identified using the Trauma Audit and Research Network (TARN) database. The data gathered retrospectively for each patient included mechanism of injury, injury severity score, American Association for the Surgery of Trauma (AAST) grading, management of injury, and follow-up. Results Out of a total of 2595 trauma patients, 33 renal injuries were identified. The 31 patients who received imaging were classified according to AAST grading, with 8 Grade I (25.8%), 4 Grade II (12.9%), 8 Grade III (25.8%), 4 Grade IV (12.9%), and 7 Grade V (22.6%) injuries. Twenty-five out of the 30 surviving patients received conservative treatment, three patients received angioembolisation (AE), one patient received a laparotomy with renal suturing, and one patient required a nephrectomy. Of these 30 surviving patients, seven received urology follow-up in clinic (23%). Conclusion The findings appear to support the growing trend towards the conservative management of high-grade renal injuries, and provide further evidence for the value of AE in renal trauma. The success of AE in this study appears to support the centralisation of services in renal trauma; however, the low nephrectomy rate could be interpreted as suggestive of the opposite. The study revealed that improvements to follow-up are needed, and that further research should seek to inform the optimal radiological follow-up of high-grade renal injury.

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