scholarly journals 1514 Higher Mortality in Pelvic Acetabular Fractures Is Associated with Lower Body Mass Index

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Waseem ◽  
J Lenihan ◽  
B Davies ◽  
J Rawal ◽  
P Hull ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Analysis Data ◽  
Trauma Centre ◽  
Acetabular Fractures ◽  
Post Discharge ◽  
Post Injury ◽  
Major Trauma Centre ◽  
Life Threatening ◽  
Low Bmi ◽  
Underweight Patients

Abstract Aim Fractures of the pelvis and acetabulum can be life-threatening or life changing injuries. Multiple factors can contribute to outcome including age, frailty, and baseline nutritional status. The aim of this study was to identify if low BMI (<18.5) was a predictor of outcome for patients with such injuries in terms of morbidity and mortality. Method We retrospectively analysed 1033 patients with pelvic or acetabular fractures referred to a single level 1 major trauma centre over a 4.5-year period (August 2015 - January 2020). Of these patients, 569 were admitted to the centre and included in our analysis. Data was collected on demographics, injury pattern, operative intervention, and complications. Comparison was made between patients that were underweight (BMI<18.5) and patients that were not, for in-hospital and post discharge complications including pulmonary embolus (PE), deep venous thrombosis (DVT), ileus, infection, loss of reduction and mortality at 6 months. Results Underweight patients had a statistically significant increase in mortality both in-hospital (p = 0.019) and at 6 months post injury (p = 0.039) when compared to other BMI groups. No statistical significance was found between these BMI groups comparing morbidity: DVT (p = 0.712), PE (p = 0.736) nor ileus (p = 0.149). Covariate analysis showed that a low BMI was associated with 3 times increased in-hospital mortality after correction for age and energy of injury (adjusted OR 3.028, 95% CI 1.059-8.659). Conclusions This study suggests increased mortality in patients with pelvic or acetabular fractures who are underweight. Surgeons should consider these findings in initiating appropriate peri-operative optimisation for these patients.

Orthopaedic assessment unit: a service model for the delivery of orthopaedic trauma care in a major trauma centre during the global pandemic (COVID-19)

2021 ◽  
Vol 103 (3) ◽  
pp. 167-172
Author(s):  
JW Lim ◽  
H Rehman ◽  
S Gaba ◽  
H Sargeant ◽  
IM Stevenson ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Trauma Care ◽  
Statistical Significance ◽  
High Standard ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Service Model ◽  
Global Pandemic ◽  
Major Trauma Centre ◽  
Assessment Unit

Introduction We describe a new service model, the Orthopaedic Assessment Unit (OAU), designed to provide care for trauma patients during the COVID-19 pandemic. Patients without COVID-19 symptoms and isolated musculoskeletal injuries were redirected to the OAU. Methods We prospectively reviewed patients throughput during the peak of the global pandemic (7 May 2020 to 7 June 2020) and compared with our historic service provision (7 May 2019 to 7 June 2019). The Mann–Whitney and Fisher Exact tests were used to test the statistical significance of data. Results A total of 1,147 patients were seen, with peak attendances between 11am and 2pm; 96% of all referrals were seen within 4h. The majority of patients were seen by orthopaedic registrars (52%) and nurse practitioners (44%). The majority of patients suffered from sprains and strains (39%), followed by fractures (22%) and wounds (20%); 73% of patients were discharged on the same day, 15% given follow up, 8% underwent surgery and 3% were admitted but did not undergo surgery. Our volume of trauma admissions and theatre cases decreased by 22% and 17%, respectively (p=0.058; 0.139). There was a significant reduction of virtual fracture clinic referrals after reconfiguration of services (p<0.001). Conclusions Rapid implementation of a specialist OAU during a pandemic can provide early definitive trauma care while exceeding national waiting time standards. The fall in trauma attendances was lower than anticipated. The retention of orthopaedic staff in the department to staff the unit and maintain a high standard of care is imperative.

scholarly journals 1065 Exposing the Incidence of Ileus in Pelvic and Acetabular Fractures: A Retrospective Case Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Ward ◽  
R Ahmed ◽  
J Adedeji ◽  
J McGregor-Riley
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
High Energy ◽  
Trauma Centre ◽  
Acetabular Fractures ◽  
Retrospective Case ◽  
Visceral Injury ◽  
Bowel Surgery ◽  
Major Trauma Centre ◽  
Fracture Management

Abstract Background Paralytic ileus is a temporary inhibition of gastrointestinal mobility in the absence of mechanical obstruction. Ileus has previously been observed in up to 40% of patients undergoing bowel surgery, leading to increased morbidity and length of stay. Pelvic and acetabular fractures are often caused by high energy trauma and are associated with a risk of visceral injury. This is the first study to report the incidence of and risk factors for ileus following admission with pelvic and/or acetabular fractures. Method All patients over the age of 16 presenting to a major trauma centre throughout 2019 were included. Data included patient demographics, injury pattern, fracture management and presence of ileus. Previous studies identified patients as having ileus if they failed to tolerate an oral diet and open their bowels for more than three days (GI-2). Analysis assessed risk factors for ileus as well as its effect on length of stay. Results An incidence of ileus of 40.35% was observed in the 57 included patients. Ileus was three times more common in patients with a diagnosis of diabetes mellitus (p = 0.56) and 2.5 times more common in the presence of an open pelvic/acetabular fracture (p = 0.73). Length of stay was significantly longer in patients under 65 years identified as having ileus (p = 0.046). Gender, age, opiate use, fracture management and surgical approach were not identified as risk factors. Conclusions The authors have identified the essentiality of early risk factor identification and hope to encourage further research to create a prognostic tool.

scholarly journals 1319 Factors Associated with Mortality in Older Patients Sustaining Pelvic or Acetabular Fractures

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Harrison ◽  
A Ordas Bayon ◽  
M Chimutengwende-Gordon ◽  
M Fortune ◽  
D Chou ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Older Patients ◽  
Trauma Centre ◽  
Research Network ◽  
Acetabular Fractures ◽  
Kaplan Meier ◽  
Major Trauma Centre ◽  
Significant Difference ◽  
Chi Squared ◽  
Potential Factors

Abstract Introduction This study aimed to investigate potential factors, including delay to surgical stabilisation, affecting mortality in older patients sustaining pelvic or acetabular (PA) fractures. Method A retrospective review of the Trauma Audit and Research Network (TARN) database was performed to identify older patients (aged 65 and over) sustaining PA fractures treated surgically in a UK Major Trauma Centre (MTC) between 2015 and 2019. Chi-squared and Fisher tests were used to compare 1-year mortality rates following operative intervention between patients treated within 72-hours and after 72-hours. Kaplan-Meier curves were used to visualise survival probability; significant predictors of survival were found using Cox proportional hazard models. Results Of 564 older patients with PA fractures, 70 met the inclusion criteria. The mean age was 76.1 years. The overall 1-year mortality rate was 20%. When patients were grouped by time to surgery, there was no statistically significant difference in 1-year mortality. Patients whose surgery was delayed more than 72-hours were more likely to have longer hospital stays (p = 0.002) or to have suffered from polytrauma (p = 0.025). Age, Charlson Co-morbidities Index and pre-op mobility status were associated with statistically significant differences in overall mortality. Patient gender, mechanism of injury, polytrauma and head injury were not significant predictors of mortality. Conclusions Surgical intervention within 72-hours of injury did not result in decreased mortality in older patients with PA fractures. The 1–year mortality rate between older PA fractures and hip fractures was comparable. Consideration should be given to a combined multidisciplinary approach to managing these patients.

Primary total hip replacement using Burch-Schneider cages for acetabular fractures

2020 ◽  
pp. 112070002095764 ◽  
Author(s):  
Frank Liaw ◽  
Siddharth Govilkar ◽  
Daniel Banks ◽  
Pradeep Kankanalu ◽  
Bishoy Youssef ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Weight Bearing ◽  
Case Series ◽  
Trauma Centre ◽  
Acetabular Fractures ◽  
Leg Length ◽  
Superior Gluteal Artery ◽  
Total Hip ◽  
Major Trauma Centre

Introduction: Osteoporotic acetabular fractures are common and pose a difficult technical challenge for the trauma surgeon. Acute total hip arthroplasty (THA) using a Burch-Schneider antiprotrusio cage with immediate postoperative weight-bearing is a method to approach these injuries. This case series reports our outcomes of acute THA using Burch-Schneider cages for acetabular fractures from a UK major trauma centre based on length of stay, radiological outcome, complications and outcome scores. Methods: Data were collected from all patients who underwent acute THA with a Burch-Schneider cage for acetabular fractures between June 2006 and August 2015. Patients were followed up clinically, radiologically, and using Oxford Hip Scores (OHS). Results: 20 patients with a median age of 73 (range 60–90 years) were identified. All patients were independent walkers at follow-up, and had achieved radiological union. There were no dislocations, subsidence, revision or deep infections. Significant complications include 1 perioperative death as a result of complications arising from pre-existing pulmonary fibrosis; 1 deep vein thrombosis; 1 intraoperative arterial injury to the superior gluteal artery; and 1 leg-length discrepancy. Mean length of stay was 10 days. The mean OHS was 37/48 at a mean follow-up of 26 months. Conclusions: This case series further validates the use of Burch-Schneider cages with primary THA in acute acetabular fractures.

Patterns of injury following equine trauma: a non-trauma centre experience

2021 ◽  
pp. 003693302199426
Author(s):  
Lachlan Dick ◽  
Michael Yule ◽  
James Green ◽  
Jamie Young
Keyword(s):  
Major Trauma ◽  
District General Hospital ◽  
Trauma Centre ◽  
Injury Patterns ◽  
Horse Riding ◽  
Risk Of Injury ◽  
Major Trauma Centre ◽  
Life Threatening ◽  
Patterns Of Injury ◽  
Orthopaedic Injuries

Introduction Horse riding carries risk of injury which can result in fatality. The majority of published literature describes major trauma centre experience. We aimed to characterise injury patterns following equine trauma at a Scottish district general hospital. Methods A retrospective review of admissions following equine trauma was undertaken from 2014 to 2019. Mechanism and nature of injuries were noted. Patient management and outcomes were recorded and analysed to determine correlation. Results Of the 162 patients identified, 121 (74.7 per cent) were female. The commonest mechanism and injury sustained were falling from a horse (86.4 per cent) and head injury (17.9 per cent) respectively. Forty-four (27.2 per cent) had multiple injuries identified. Being crushed or kicked resulted in more abdominal visceral injuries (22.7 vs 0.7 per cent, p = <0.05) and ITU admissions (18.2 vs 6.4 per cent, p = 0.06) when compared with falling from alone. Eight (4.9 per cent) required transfer to a major trauma centre and 30-day mortality was 0.6 per cent. Conclusion Although variable, injuries following equine trauma can be life threatening. Increased awareness and development of safety legislation is needed. In addition, research could be directed at assessing functional outcomes given the large number of orthopaedic injuries.

scholarly journals 122 Penthrox: a service evaluation for methoxyflurane use in an emergency department setting

2020 ◽  
Vol 37 (12) ◽  
pp. 831.2-831
Author(s):  
Jack Ingham ◽  
Gareth Roberts
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Conscious Sedation ◽  
Statistical Significance ◽  
Service Evaluation ◽  
Trauma Centre ◽  
Royal Infirmary ◽  
Pain Scores ◽  
Major Trauma Centre ◽  
Fast Acting

Aims/Objectives/BackgroundIn Manchester Royal Infirmary, a major trauma centre, there are many patient presentations which require fast acting analgesia. Often these presentations, such as shoulder dislocations, require conscious sedation in order to be safely, effectively and humanely treated.Penthrox was introduced to the emergency department in December 2019. It was hoped that it would be used as an alternative to conscious sedation in patients requiring procedures. It was postulated that by having another analgesic method available, patients would have a greater likelihood of being discharged without the requirement for conscious sedation. This would therefore not require waiting for a Resus bed and therefore reduce length of stay in the department.Methods/DesignData was prospectively gathered for patients who received Penthrox in the months of December 2019 to July 2020 using a questionnaire that was filled in by clinicians.Audit forms were collated as well as attendance data (including length of stay) for shoulder dislocations Dec 19 - Feb 19.Pain scores were subjectively scored out of 10 and, using t-tests, compared for significance.Length of stay, checklist completion, progression to concious sedation, further pain relief requirements and indications were also analysed.Results/ConclusionsSubjectively reported pain scores were significantly reduced when comparing before and during procedure (<0.001, 95% CI of a reduction of 1.959 to 5.113) and also before and 10 mins after procedure (p= <0.001, 95% CI 3.96 to 6.33). The distributions of pain scores are demonstrated in the violin plot below.There was no significant association between checklist completion and progression to concious sedation.Difference between length of stay did not quite meet statistical significance (mean = 163.62 using penthrox, mean = 225 without penthrox. p = 0.06).There were no significant adverse events.In conclusion Penthrox is a safe and welcome addition to the ED formulary.

scholarly journals 1085 Equestrian Related Pelvic and Acetabular Fractures – Experience from a Major Trauma Centre in England

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Hussain ◽  
M Ghobrial ◽  
B Davies ◽  
P Hull ◽  
A Carrothers ◽  
...  
Keyword(s):  
Major Trauma ◽  
Weight Bearing ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Open Reduction Internal Fixation ◽  
Trauma Centre ◽  
Acetabular Fractures ◽  
Sufficient Information ◽  
Horse Riding ◽  
Major Trauma Centre

Abstract Introduction Equestrianism is enjoyed by three million people in the UK; however, there is a lack of literature on pelvic and acetabular (P&A) injuries incurred through the sport. We aim to describe P&A injuries sustained in equestrian accidents, discuss management, and establish their outcomes. Method Data was extracted from a prospectively collected database of referrals to the P&A Service of a Major Trauma Centre (MTC) from 01/01/2016 to 31/12/2020 and cross-referenced with medical records. Results 60 of the 1,218 P&A referrals were secondary to horse-riding accidents. Mean age 45 (SD 16.59); 46 female; 33 managed non-operatively and 27 managed operatively at the MTC. There was sufficient information for 59 cases to be classified; 46 of the injuries were pelvic fractures (10 anterior-posterior compression; 29 lateral compression; 4 sacral and 3 pubic rami fractures) and 13 were acetabular (2 anterior column; 1 anterior wall; 2 associated both columns; 1 posterior column and posterior wall; 1 posterior wall; 2 T-shaped and 4 transverse fractures). The operative group were managed by examination under anaesthesia (n = 3), open reduction internal fixation (n = 22) or percutaneous fixation (n = 2). Mean hospitalisation was 9.2 days (SD 5.44). 81% were non-weight-bearing post-operatively and mean time to independent mobilisation was 12.6 weeks (SD 7.09). Return-to-riding information was available for 8 patients with a mean of 29.5 weeks (SD 11.55). Conclusions Equestrianism can result in significant P&A injuries. Patients should be counselled that they may have a long recovery, a protracted return-to-riding time and some may never return to the sport.

OPERATIONS FOR ANEURISM OF THE ABDOMINAL AORTIC DEPARTMENT - RESECTION WITH THE FOLLOWING PROSTHETICS AND ENDOPROSTHETICS: A COMPARATIVE ANALYSIS OF COMPLICATIONS

2020 ◽  
pp. 43-49
Author(s):  
Андрей Анатольевич Иванов ◽  
Александр Иванович Жданов ◽  
Максим Сергеевич Шевелин ◽  
Александр Сергеевич Брежнев
Keyword(s):  
Comparative Analysis ◽  
Postoperative Complications ◽  
Statistical Significance ◽  
Aortic Aneurysms ◽  
Surgical Interventions ◽  
Vein Thrombosis ◽  
Scientific Hypothesis ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
High Level

В статье представлены данные оригинального исследования по улучшению хирургического лечения аневризм брюшного отдела аорты. С этой целью произведен сравнительный анализ двух альтернативных друг другу операций: 1) резекции аневризмы с последующим протезированием аорты; 2) эндопротезирования аорты. Сформулировано научное предположение о том, что замена «классических» операций резекции аневризмы на «альтернативные» операции эндопротезирования приведет к принципиальному снижению уровня послеоперационных осложнений. В независимых группах пациентов с использованием сравниваемых хирургических вмешательств произведена точная качественная и количественная оценка послеоперационных осложнений: нетромботических - кардиальных, пульмональных, ренальных и тромботических - тромбозов глубоких вен и тромбозов браншей протеза. После реализации исследования было установлено, что замена «классических» операций на «альтернативные» достоверно приводит к принципиальному снижению уровня наиболее жизнеопасных осложнений - кардиальных (острых форм ишемической болезни сердца, нарушений сердечного ритма), пульмональных (пневмоний, тромбоэмболии легочной артерии, респираторного дистресс-синдрома взрослых) и ренальных (острой почечной недостаточности). Некоторое исключение составили менее жизнеопасные тромботические осложнения. Полученные результаты имеют высокий уровень статистической значимости, что позволяет рекомендовать их к рассмотрению к использованию в практике сосудистой хирургии The article presents data from an original study to improve the surgical treatment of abdominal aortic aneurysms. For this purpose, a comparative analysis of two alternate operations was performed: 1) aneurysm resection followed by aortic prosthetics; 2) aortic endoprosthetics. The scientific hypothesis is formulated that the replacement of the «classical» operations of resection of the aneurysm with «alternative» operations of endoprosthetics will lead to a fundamental decrease in the level of postoperative complications. In independent groups of patients using the compared surgical interventions, an accurate qualitative and quantitative assessment of postoperative complications was made: non-thrombotic - cardiac, pulmonary, renal and thrombotic - deep vein thrombosis and prosthetic jaw thrombosis. After the study was completed, it was found that the fundamental replacement of «classical» operations with «alternative» reliably leads to a fundamental decrease in the level of the most life-threatening complications - cardiac (acute forms of coronary heart disease, cardiac arrhythmias), pulmonary (pneumonia, pulmonary thromboembolism, respiratory distress syndrome of adults) and renal (acute renal failure). Some exceptions were less life-threatening thrombotic complications. The results obtained have a high level of statistical significance, which allows us to recommend them for consideration in the practice of vascular surgery

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