scholarly journals 206 Audit of Time to Surgical Fixation of Distal Radial Fractures Compared to British Orthopaedic Association Standard for Trauma (BOAST) Guidelines at Busy District General Hospital

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
T Sooriyamoorthy
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
Joint Surface ◽  
Distal Radial Fractures ◽  
Orthopaedic Department ◽  
Articular Fractures ◽  
Surgical Fixation ◽  
Manipulation Under Anaesthesia ◽  
The Difference ◽  
Mean Time

Abstract Aim BOAST guidelines state that intra-articular distal radial fractures should be operated on within 72 hours of injury and extra-articular distal radial fractures which require surgical management should be operated on within 7 days. The aim of this audit was to see how the orthopaedic department at a busy district general hospital compared to these guidelines. Method Retrospectively looked at operations carried out over a 10-month period. All Manipulation Under Anaesthesia, K wire and Open Reduction Internal Fixations of distal radial fractures were included. Results Over the 10-month period, 49 intra-articular and 60 extra-articular fractures were operated on. 65% of intra-articular fractures were fixed within 72 hours and 82% of extra-articular fractures were fixed within one week. Mean time from date of injury to operation was 3.88 days for intra-articular and 2.98 days for extra-articular fractures. Mean time from decision of surgery to operation was 2.32 days for intra-articular and 2.18 days for extra-articular fractures. Conclusions Clearly, the management of extra-articular fractures is closer to the standards set by BOAST guidelines. It can be difficult to establish from an x-ray whether a fracture is extending into a joint surface - this can delay the fracture clinic appointment and the operation. The difference between the mean time of injury to operation and mean time of decision of surgery to operation for intra-articular fractures show that once the decision to operate has been made, it is carried out quickly. Educating A+E and orthopaedic staff on recognising intra-articular fractures could expedite the time to surgery.

scholarly journals 860 Distal Radius Fracture Management in A DGH Do the Guidelines Fit?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Thumbadoo ◽  
B Patel ◽  
J Fennelly ◽  
S Kitaoka ◽  
F Adamu-Biu ◽  
...  
Keyword(s):  
General Hospital ◽  
Distal Radius ◽  
Regional Anaesthesia ◽  
District General Hospital ◽  
Smartphone Application ◽  
Great Difficulty ◽  
Distal Radial Fractures ◽  
Local District ◽  
Retrospective Audit ◽  
Fracture Management

Abstract Aim Distal radial fractures are common injuries within adults at a variety of ages. The best treatment option remains a debated subject. The BOAST guidelines aim to guide the initial management of these fractures in the emergency department we audited against these guidelines in a local district general hospital. Method A retrospective audit was performed of adult patients with distal radius fractures who attended in December 2019, at a local district General Hospital. Patients were identified by using the Orthopaedic Take lists. Notes were reviewed for patient demographics, quality of documentation of neurovascular status, documentation of fracture information, including further management. Results There were 16 cases identified, 87.5% were female with mean age of 63 with over 56 % in the over 65s category. Only 19% of cases had appropriately documented neurovascular status. 57% were lacking specific documentation of each nerve as per BOAST guidelines, as well as 57% had no documentation of radial pulse. With regards to reductions undertaken in ED only 44% were documented if reduction took place. Of the reductions that were documented 66% documented type of analgesia used. 17% used regional anaesthesia as preferred in BOAST guidelines. Conclusions Overall compliance with BOAST guidelines was poor. Several areas to improve were seen, for which the recent launch of a new in-house smartphone application is aimed to improve access to BOAST guidelines. There was great difficulty in achieving the BOAST guidance with regards to the use of regional anaesthesia, nationally most A&E departments reduce these fractures under a haematoma block.

scholarly journals An analysis of functional outcome following conservative versus surgical management in fractures of the distal radius

2017 ◽  
Vol 4 (1) ◽  
pp. 99
Author(s):  
Yeshwanth Subash ◽  
Ravikrishna R. ◽  
Jagadeesh B.
Keyword(s):  
Surgical Management ◽  
Distal Radius ◽  
Treatment Method ◽  
Fracture Pattern ◽  
Distal Radial Fractures ◽  
Orthopaedic Department ◽  
Conservative Group ◽  
Advantages And Disadvantages ◽  
Articular Fractures ◽  
Type 3

<p class="abstract"><strong>Background:</strong> <span lang="EN-GB">Distal radial fractures are one of the most common injuries seen in the orthopaedic department, which can be managed both conservatively and surgically. There are advantages and disadvantages in each method of management. The aim of this study was to compare the functional and radiological outcomes of intra-articular fractures of the distal end of the radius with conservative and surgical management</span><span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-GB">80 cases of intra articular fractures of the distal radius managed by both conservative and surgical means were studied between January 2011 to January 2013 and were followed up for a minimum period of two years</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-GB">In our series of 80 patients, there 53 males and 27 females. Most of the patients were between 20-30 years of age with the mean age being 40.35 years. RTA was the most common mode of injury (45%). Frykman’s type 3 (41.7%) was the most common fracture type seen followed by type 8. All fractures united by the end of 6 months. Excellent results were seen in 47.5% of cases in the surgical group and 30% of cases in the conservative group</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-GB">From this study, we conclude that surgical management is better than conservative in the treatment of intra articular fractures of the distal end of radius. Therefore, one treatment method of treatment cannot be generalized for all types of fractures and treatment should be individualized to a particular fracture in terms of age, fracture pattern, degree of displacement and amount of communition present</span><span lang="EN-IN">.</span></p><p class="abstract"> </p>

scholarly journals P239 A study to evaluate uptake of PROMS for IBD patients on Biologics: a sample United Kingdom district general hospital experience

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S284-S285
Author(s):  
T Mahmood ◽  
Q Muhammad
Keyword(s):  
United Kingdom ◽  
General Hospital ◽  
Leisure Activity ◽  
District General Hospital ◽  
Medical Product ◽  
Biologic Treatment ◽  
The Difference ◽  
Healthcare Interventions ◽  
One Year

Abstract Background In order to guide industry on medical product development, FDA developed an instrument to measure effectiveness as an endpoint of clinical trials. This patient oriented tool is called “Patient Related Outcomes Measures”. (PROMS). In 2009 NHS England adopted PROMS declaring that “the purpose is to collect information, from patients themselves, about how well the health service is treating them. Moreover “PROMs allows to understand the difference that healthcare interventions make to people’s quality of life”. Initially related to only certain surgical procedures, it eventually rolled out to many other conditions including IBD. This research looks at degree of success in implementation of PROMS for IBD patients on treatment with biologics in a sample district hospital of United Kingdom. Methods The IBD PROMs questionnaire is filled by patients themselves when treated with biologics. The questionnaire asks overall health status, treatment of bowel condition, effectiveness in controlling bowel condition, satisfaction with quality of treatment, Crohn’s and Colitis questionnaire CCQ12 and uses 12 dimensions: sleeping, appetite, energy level, rushing to the toilet, being bloated, incomplete emptying of bowels, blood in stool, generally unwell, faecal incontinence, nocturnal diarrhoea, passing wind and effect on leisure activity. It also has questions for patients with a stoma. We collected data from a sample district general hospital in United Kingdom for one year in retrospect and analysed the implementation of PROMS. We hoped at least 90% of patients would fill the PROMS questionnaire. Results 45 patients with IBD who were on biologics were recruited in the study. They had repeated admissions for treatment and we kept check points at 3, 6 and 12 month follow up treatments. There were 21 patients on infliximab, 23 on vedolizumab, and 1 on ustekinumab with overall total number of infusions being 352 due to their recurrent admissions for biologic treatment. A minimum of 45 PROM responses could have been achieved and maximum of 352 for good implementation. In our data only 4 were filled (8.89% of minimum and 1.1 of maximum required). Thus PROMS for IBD was not implemented to any useful extent. Conclusion Our study did not look at the outcomes, but simply whether the PROMS was utilised sufficiently for IBD patients on biologics. We demonstrated low uptake by one sample district general hospital of United Kingdom. Further studies to evaluate practice of other IBD units in the country would help to understand the situation better. There can be various reasons for this low uptake including lack of resource, not knowing importance of PROMS or deficient motivation in staff.

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