scholarly journals EP.FRI.300 Equine related trauma: a 20-year district general hospital experience

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Lachlan Dick ◽  
Michael Yule ◽  
James Green ◽  
Jamie Young
Keyword(s):  
Upper Limb ◽  
Significant Proportion ◽  
District General Hospital ◽  
Injury Patterns ◽  
Visceral Injury ◽  
Limb Fracture ◽  
Tertiary Centre ◽  
Horse Riding ◽  
Local Coding ◽  
Limb Fractures

Abstract Introduction Although a popular recreational and competitive sport, horse riding carries risk of injury. We aimed to characterise demographics, injury patterns and outcomes of patients with an equine-related injury over a 20-year period. Methods Patients were identified through local coding. Data relevant to the study aims were extracted. Statistical analysis was used to determine any association between patient demographic with injury pattern or outcome. Results Of the 701 patients included, 71.3% were female and the mean age was 34.9 years. Simple head injury (25.4%) and upper limb fracture (21.3%) were the commonest injuries. Abdominal visceral injury occurred in 1.6% with 2 patients requiring laparotomy and splenectomy. Overall, operations were performed in 32.8%. Open reduction and internal fixation was the commonest procedure (42.4%). 30-day mortality was 0.3% and 3.1% required transfer to a tertiary centre. Older patients were more likely to have a rib (46.3 vs 33.5 years, p = <0.05) or lower limb fracture (37.9 vs 34.5 years, p = 0.04) whilst upper limb fractures were seen in younger patients (30.3 vs 36.1 years, p = <0.05). There was no statistical difference with other injury patterns or gender.  Conclusion Although mortality is rare, a significant proportion of patients sustain injury requiring surgical intervention. Given the predisposition towards orthopaedic injury, adequate rehabilitation facilities need to be available. Continued development and promotion of safety equipment are also required to reduced incidence. 

scholarly journals Management of post-traumatic stiffness of the shoulder following upper limb trauma with manipulation under anaesthetic

2017 ◽  
Vol 9 (4) ◽  
pp. 258-265 ◽  
Author(s):  
Sarah T. Lancaster ◽  
Thomas N. Grove ◽  
David A. Woods
Keyword(s):  
Upper Limb ◽  
Frozen Shoulder ◽  
Standard Technique ◽  
Humeral Fracture ◽  
Limb Fracture ◽  
Significant Difference ◽  
Shoulder Scores ◽  
Post Traumatic ◽  
Upper Limb Fracture ◽  
Limb Fractures

Background A proportion of patients who sustain upper limb fractures develop post-traumatic stiffness (PTS), which may progress in a similar way to primary frozen shoulder (PFS). We have had success in treating PFS with manipulation under anaesthetic (MUA) and therefore treated PTS using MUA. Oxford Shoulder Scores (OSS), range of motion (ROM) data pre- and post-MUA, and the need for repeat procedure were compared. Methods Sixty-four patients with PTS following an upper limb fracture, unresponsive to conservative measures, were seen between 1 January 1999 and 1 November 2015. Thirty-two patients had sustained a proximal humeral fracture, six of whom had a concurrent shoulder dislocation. MUA was performed using a standard technique. The results were compared with 487 PFS patients undergoing the same procedure. Results There was no significant difference in ROM change between the groups. Improvement in OSS was slightly greater in the PFS group (17 versus 14, p = 0.005) but, upon subgroup analysis of the PTS group, no significant difference was found for patients presenting with humeral fractures alone. Conclusions MUA results for PTS following upper limb fracture are comparable to MUA for PFS. We therefore recommend MUA in PTS cases where conservative methods have failed.

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 Southampton Arm Fracture Frailty and Sarcopenia Study (SAFFSS): a study protocol for the feasibility of assessing frailty and sarcopenia among older patients with an upper limb fracture

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e031275
Author(s):  
Kinda Ibrahim ◽  
Mark Mullee ◽  
Guiqing Lily Yao ◽  
Shihua Zhu ◽  
Mark Baxter ◽  
...  
Keyword(s):  
Upper Limb ◽  
Ethics Committee ◽  
University Hospital ◽  
Major Health Problem ◽  
Limb Fracture ◽  
Increased Risk ◽  
Registration Number ◽  
Upper Limb Fracture ◽  
Limb Fractures ◽  
The University

IntroductionFalls are a major health problem for older people; 35% of people aged 65+ years fall every year, leading to fractures in 10%–15%. Upper limb fractures are often the first sign of osteoporosis and routine screening for osteoporosis is recommended by the National Institute for Health and Care Excellence to prevent subsequent hip fractures. However, both frailty and sarcopenia (muscle weakness) are associated with increased risk of falling and fracture but are not routinely identified in this group. The aim of this study is to evaluate the feasibility of assessing and managing frailty and sarcopenia among people aged 65+ years with an upper limb fracture.Methods and analysisThis study will be conducted in three fracture clinics in one acute trust in England. 100 people aged 65+ years with an upper arm fracture will be recruited and assessed using six validated frailty measures and two sarcopenia tools. The prevalence of the two conditions and the best tools to use will be determined. Those with either condition will be referred to geriatric clinical teams for comprehensive geriatric assessment (CGA). We will document the proportion who are referred for CGA and those who receive CGA. Other outcome measures including falls, fractures and healthcare resource use over 6 months will be collected. In-depth interviews with a purposive sample of patients who undergo the frailty and sarcopenia assessments and healthcare professionals in fracture clinics and geriatric services will be carried out to their acceptability of assessing frailty and sarcopenia in a busy environment.Ethics and disseminationThe study was given the relevant ethical approvals from NHS Research Ethics Committee (REC No: 18/NE/0377), the University Hospital Southampton NHS Foundation Trust, and the University of Southampton, Faculty of Medicine Ethics Committee and Research Governance Office. Findings will be published in scientific journals and presented to local, national and international conferences.Trial registration numberISRCTN13848445

scholarly journals Epidemiology of Orthopaedic Trauma Admissions Over One Year in a District General Hospital in England

2015 ◽  
Vol 9 (1) ◽  
pp. 191-193 ◽  
Author(s):  
A Taylor ◽  
A Young
Keyword(s):  
General Hospital ◽  
Upper Limb ◽  
Lower Limb ◽  
District General Hospital ◽  
Bone Involvement ◽  
Trauma Network ◽  
Hospital Data ◽  
Disc Disease ◽  
Vertebral Disc ◽  
Limb Fractures

Introduction : Admission to district general hospitals in England has undergone change in recent years due to both an aging population and the reconfiguration of the major trauma network throughout the United Kingdom. Methods : We utilised a retrospective cohort study to analyse the epidemiology over a 12-month period at a district general hospital. Data was collected and divided into groups: upper limb, lower limb, vertebral disc disease, vertebral fracture, cellulitis without bone involvement and deep infection including metalwork. Results : 2817 patients were admitted over the 12-month period. There were 893 upper limb fractures, 1511 lower limb fractures, 126 vertebral disc disease, 55 vertebral fractures, 108 cellulitis without bone involvement and 124 deep infections with 19 admissions not specified due to coding. AN average of 242 patients were admitted each month with the majority admitted during the summer months. Conclusion : Although fractures make up the majority of the reason for which a person is admitted, there are also many other injuries/morbidities, which may necessitate admission. There is an increasing incidence of elderly osteoporotic fractures in females, which is balancing out the previously more common fractures seen in younger adults and adolescents.

scholarly journals UPPER LIMB FRACTURE

2018 ◽  
Vol 25 (08) ◽  
pp. 1151-1154
Author(s):  
Sajjad Rasool ◽  
Basharat Manzoor ◽  
Ali Amjad
Keyword(s):  
Wound Infection ◽  
Upper Limb ◽  
Superficial Wound Infection ◽  
Limb Fracture ◽  
Suction Drain ◽  
Superficial Wound ◽  
Group A ◽  
Upper Limb Fracture ◽  
Limb Fractures ◽  
Upper Limb Fractures

Introduction: Upper limb fractures are one of the common fractures presentingin Accident and Emergency departments. Some of the upper limb fractures need openreduction and internal fixation. Use of suction drains after upper limb surgery is still debatableissue. Some surgeons routinely use, others never use and few occasionally use. Objectives:Aim of this study was to compare the results of upper limb fracture surgery by using or not usingthe suction drains. Design: Quasi Experimental Design. Settings: Orthopedic department AzizBhatti Shaheed Teaching Hospital Gujrart. Period: From December 2015 to November 2016.Method & Material: Total 120 patients were selected as per selection criteria. In 60 patients weused suction drain post-operatively & remaining 60 patients without Suction drain. Results:In our study we selected 120 patients .Patients divided in two groups. In group A 60 patientsincluded in the study. We did not use suction drain in these patients. In group B we also selected60 patients of upper limb fractures. We used suction drain in these patients. We compared theresults of both groups on the basis of superficial wound infection and pain. In group A, sixpatients developed superficial wound infection while four patients developed superficial woundinfection in group. There was no difference in severity of pain in both groups. Conclusion:We concluded from our study that there is no added advantage of suction drain in upper limbfracture surgery.

scholarly journals FRI0617-HPR GRADED MOTOR IMAGERY IN POSTTRAUMATIC STIFFNESS OF THE ELBOW: A PILOT STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 913.2-914
Author(s):  
T. Birinci ◽  
E. Kaya Mutlu ◽  
S. Altun
Keyword(s):  
Pilot Study ◽  
Motor Imagery ◽  
Upper Limb ◽  
Exercise Program ◽  
Control Group ◽  
Elbow Fracture ◽  
Stiff Elbow ◽  
Limb Fractures ◽  
Upper Limb Fractures ◽  
Graded Motor Imagery

Background:Elbow fracture is treated either conservatively or surgically followed by a period of immobilization with casting or splinting. A splint used to immobilize upper limbs for many weeks results in changes in both the peripheral musculature and the central nervous system. It is well known that common complaints after upper limb fractures include weakness, pain, and stiffness; therefore, pain management is important in the early stages of the rehabilitation of upper limb fractures.Objectives:This pilot study aimed to investigate the efficacy of graded motor imaginary (GMI) on pain, range of motion (ROM), and function in patients with posttraumatic stiff elbow.Methods:Fourteen patients with posttraumatic stiff elbow (6 women, mean age: 45.42 ± 11.26 years, mean body mass index: 24.29 ± 3.38 kg\m2and mean duration of immobilization: 4.75 ± 1.03 weeks) were randomly allocated to either GMI or control groups. The GMI group received GMI treatment in addition to a structured exercise program, and the control group received a structured exercise program (two days per week for six weeks) (Figure 1). The assessments included pain at rest and during activity using the visual analog scale (VAS), elbow active ROM with a digital goniometer (Baseline Evaluation Instrument, Fabrication Enterprises, Inc., White Plains, NY), and upper extremity functional status using the Disability of the Arm, Shoulder and Hand Questionnaire (DASH). The assessments were performed at baseline and after the 6-week intervention.Figure 1.Graded motor imagery performed with mirror boxResults:After the 6-week intervention, there was a significant increase in elbow flexion-extension ROM and supination-pronation ROM, and improvement in DASH score in both groups (p<0.05). However, improvement in VAS-rest and VAS-activity was significantly higher in the GMI group than the control group (p=0.03 and p=0.01, respectively).Conclusion:A conservative treatment program consisting of GMI treatment in addition to a structured exercise program applied twice a week for 6 weeks, has been found more effective in decreasing pain in the posttraumatic stiff elbow. It could be concluded that GMI is an effective treatment method for elbow fracture in patients with predominant elbow pain.References:[1] Harris JE, Hebert A. Utilization of motor imagery in upper limb rehabilitation: a systematic scoping review. Clin Rehab. 2015:29(11):1092-1107.[2] Opie GM, Evans A, Ridding MC, Semmler JG. Short-term immobilization influences use-dependent cortical plasticity and fine motor performance. Neuroscience. 2016:330:247-256.[3] Birinci T, Razak Ozdincler A, Altun S, Kural C. A structured exercise programme combined with proprioceptive neuromuscular facilitation stretching or static stretching in posttraumatic stiffness of the elbow: a randomized controlled trial. Clin Rehab. 2019:33(2):241-252.Acknowledgments:The present work was supported by the Scientific Research Projects Coordination Unit of Istanbul University-Cerrahpasa (Project No: TDK-2019-33997).Disclosure of Interests:None declared

scholarly journals A youngest reported case of type II Monteggia lesion associated with a posterior ulnohumeral dislocation

2019 ◽  
Vol 26 (1) ◽  
pp. 23-25
Author(s):  
Avadhoot Kantak
Keyword(s):  
Upper Limb ◽  
Injury Pattern ◽  
Type Ii ◽  
Rare Injury ◽  
Monteggia Lesion ◽  
Injury Mechanisms ◽  
High Incidence ◽  
Limb Fractures ◽  
Upper Limb Fractures

Monteggia fractures are uncommon injuries, despite a high incidence of upper limb fractures in teenage children. We describe a case of a type 2 Monteggia variant in an adolescent. This injury pattern consisted of ulnohumeral dislocation in combination with type 2 Monteggia lesion. We discuss the possible injury mechanisms of this rare injury and review available literature.

Reversing the Friday peak in metastatic cord compression referrals: Not as simple as previously thought?

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e14050-e14050
Author(s):  
Olusola Michael Adeleke ◽  
Rubyyat A Hakim ◽  
Laurence Dean ◽  
Huma Zahid ◽  
Rongyu Lin ◽  
...  
Keyword(s):  
Goodness Of Fit ◽  
Single Point ◽  
District General Hospital ◽  
Cord Compression ◽  
Radiology Reporting ◽  
Goodness Of Fit Test ◽  
Tertiary Centre ◽  
Chi Squared ◽  
Early Case ◽  
The Uk

e14050 Background: Historically, metastatic spinal cord compression (MSCC) referrals trend towards a Friday peak in incidence (Koiter E, Radioth Onc 2013). However, data from a single, tertiary centre in the UK showed a reversal in the Friday peak (Adeleke S, Annals of Oncology 2020). This was attributed to early case referrals and quicker treatment decisions. In this new study, we explored whether a similar pattern was apparent in multiple district general hospital (DGH) settings and attempt to identify underlying causes. DGHs manage a larger proportion of cancer patients in the UK. Methods: 1,069 patients between 1 Jan 2015 and 31 Dec 2020 were identified across 4 hospitals in Kent, UK with a population of 1.6 million people. 220, 181, 182, 159, 134 and 193 MSCC patients were identified annually (2015-2020). Commonest cancers were prostate (24.1%), lung (19.3%) and breast (12.3%). Thoracic and lumbar regions constituted 80% of MSCC sites. Kruskal Wallis was used to compare differences in referrals across weekdays. Data was then dichotomised to Fridays only vs. other days of the week combined, as previously reported (De Bono B, Acta Neurochir 2019). Chi squared was used to compare frequency of referrals between the two groups. Chi squared goodness of fit test was conducted to detect if Friday reflected the day with highest referrals across the week. Results: Across the region, 2015 saw the highest number of Friday referrals relative to other days, p= 0.002. Friday referrals continued to drop, year on year, until 2018 with a corresponding increase in mid-week referrals. After 2018, there was a return in trend to a further Friday peak across the region, though p= 0.836. On an individual hospital basis, the persistent Friday peak in the region was driven by two hospitals. Having a 7-day acute oncology service (AOS), 7-day radiology reporting and single referral point of contact in the department, were factors identified that kept the referrals across the week uniform. On another note, a substantial shift towards a single 8Gy fraction vs. 20Gy in 5 fractions was observed across the region. This change coincided with SCORAD III data (Hoskin P, ASCO 2017) and demonstrates adherence to evidence-based practice in the region. Conclusions: This large multi-centre retrospective study shows a differential referral pattern in the region, with hospitals with 7-day AOS/Radiology reporting and single point of referral (e.g, similar to MSCC coordinator role) having a quicker treatment turnaround and uniform referrals across the week. The MSCC coordinator has been shown to streamline service, ensure timely decision-making and improved survival outcomes (Richards L, Spine J 2017). The role is recommended by NICE UK. DGHs should consider appointing an MSCC coordinator when designing/auditing their service. The shift towards single 8Gy fraction can provide a ‘one-stop’ service where patients are scanned, planned and treated on the same day.

178 Suspected Cauda Equina Syndrome in a District General Hospital

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
L Ellerton ◽  
H Benjamin-Laing ◽  
W J Harrison
Keyword(s):  
General Hospital ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
District General Hospital ◽  
Bladder Function ◽  
Mri Scan ◽  
Eligibility Criteria ◽  
Joint Project ◽  
Tertiary Centre ◽  
Patient Morbidity

Abstract Introduction Cauda Equina Syndrome (CES) is rare but when the diagnosis is delayed patient morbidity is significant. Recently, NICE Clinical Knowledge Summaries have updated their red flags on CES to be more explicit enabling earlier referral and diagnosis. A joint project between Orthopaedics and Radiology departments aimed to assess the current pathway of Cauda Equina Investigation at a District General Hospital. Method Data was collected from the local Radiology database for requests between July 2017 and August 2018. This included both direct requests to assess for CES and implied. Raw data revealed a potential of 600 patients, of which we have analysed 332 patients met the eligibility criteria. Results Only 58 patients had a documented complete bladder function assessment, of those 33% had incomplete or partial bladder emptying. Time to MRI scan ranged from 50mins – 23 hours & 52 mins. 47% had negative scans with CES or Cord compromise on MRI scan was demonstrated on 9%. 23 patients were transferred urgently to the receiving tertiary centre. Conclusions We found that nearly 90% of patients were being incompletely assessed and time to scan ranged significantly. We are producing a trust wide suspected CES pathway to improve patient assessment.

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