P134 Under the weather: The Meteorological correlation in Orthopaedic Trauma and within Hertfordshire

Abstract Background The paper aims to understand the effect of meteorological factors on the number of referrals and volume of trauma operating cases within our local area. Method Trauma data was analysed in our database: (eTrauma), a digital clinical platform that co-ordinates all admissions and: trauma theatre activity. Data consisted of number of referrals per day, patient: age, mechanism of injury and type of orthopaedic injury. Weather data was: gathered from a local weather station which: records daily weather observations. Results 1160 consultations wereanalysed, 779 required an operative intervention. Neck of femur fractures: and ankle trauma were the two most common cause of trauma, accounting for 27% and 15% respectively. Neck of femur fracture pathology were not significantly correlated with any meteorological factor studied. On the contrary, ankle trauma were the only injuries significantly correlating with temperature (p < 0.03) and due point (p < 0.04). Conclusion Weather has no effect on neck of femur fractures, the most common trauma pathology treated in our department. In all seasons allocated specific trauma lists for the latter should be arranged irrelevant of the weather conditions. We identified the days receiving highest referral rate, using this data to shape the future on call trauma service.

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P16 An audit of elderly patients with a femoral fracture: is the quality of care received by patients affected by where in the femur the fracture occurs?

BJS Open ◽

10.1093/bjsopen/zrab032.015 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

O A Javed ◽

M J Khan ◽

Y Abbas ◽

S Pillai ◽

K Hristova ◽

...

Keyword(s):

Risk Assessment ◽

Elderly Patients ◽

Bone Health ◽

Nutritional Assessment ◽

Femur Fracture ◽

Femoral Fractures ◽

Neck Of Femur ◽

Femur Fractures ◽

Neck Of Femur Fracture ◽

Health Review

Abstract Introduction Elderly patients with femoral fractures are often frail and require a multidisciplinary approach to optimise medical care, rehabilitation and prevention of further injury. Previously, neck of femur fracture patients were the focus of such an approach, but NICE and BOAST guidelines emphasise extending this care to other elderly trauma patients. Methods A retrospective analysis of 43 patients over 60 years old at Gloucestershire Hospitals NHS Foundation Trust in 2019 with a femoral fracture other than a neck of femur fracture. BOAST guideline standards were surgery within 36 hours, orthogeriatric assessment within 72 hours, a documented ceiling of treatment, falls risk assessment, bone health review, nutritional assessment and physiotherapy review. Results Our study showed worse outcomes in all standards for patients with femoral shaft, distal femur and periprosthetic femur fractures compared to neck of femur fractures: surgery within 36 hours (63.9% vs. 66%); orthogeriatric assessment within 72 hours (32.6% vs. 91.9%); falls risk assessment (76.7% vs. 99.6%); bone health review (41.9% vs. 99.7%); nutritional assessment (55.8% vs. 99.6%); physiotherapy review (97.7% vs. 98.9%). The group also had worse outcomes for average length of stay (19 days vs. 14 days) and 30 day mortality (9.3% vs. 8.6%). Discussion Our study showed a discrepancy in care received by elderly patients with femoral fractures other than neck of femur. We will introduce a proforma for all femoral fractures, present our findings to orthogeriatric, bone health and physiotherapy teams to involve them in the care of such patients and re-audit following these recommendations.

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Early recognizing of a hurricanes from public satellite images

Highly available systems ◽

10.18127/j20729472-202102-05 ◽

2021 ◽

Author(s):

A.A. Kuzmitsky ◽

M.I. Truphanov ◽

O.B. Tarasova ◽

D.V. Fedosenko

Keyword(s):

Satellite Images ◽

A Priori ◽

Vortex Formation ◽

Weather Conditions ◽

Local Area ◽

Weather Data ◽

Polar Coordinate System ◽

Practical Implementation ◽

Characteristic Points ◽

Moving Points

One of the key tasks associated with the fast identification of powerful tropical hurricanes, the assessment of the growth of their power, is the formation of such an input dataset, which is based on data that are technically easy and accurately recorded and calculated using existing sources located in the open accessibility. The presented work is based on the analysis of satellite images as the main data sources, and on weather data as peripheral. An obvious advantage of satellite images in comparison with other sources of data on weather conditions is their high spatial resolution, as well as the ability to obtain data from various satellites, which increases the timeliness and accuracy of retrieving primary information. The developed approach consists in performing the following main interconnected iteratively performed groups of subtasks: calculation of feature points describing the location of individual cloud areas at different points in time by using different descriptors; comparison of the same cloud areas at specified times to analyze the local directions of cloud movements; tracking of cloudiness for specified time intervals; calculation of local features for selected points of cloudiness to recognize the origin and analyze turbulence; the formation of the dynamics of changes in the local area near the trajectory of the point; recognition of primary characteristic features characterizing the transformation of local turbulences into a stable vortex formation; identification of signs of the growing of a hurricane and assessment of the primary dynamics of the increase in its power; generalization and refinement of a priori given features by analyzing similar features of known cyclones. To detect points, a modified algorithm for finding them has been introduced. To describe the points, additional descriptors are introduced based on the normalized gradient measured for the neighborhood of neighboring points and cyclically changing in the polar coordinate system. A comparative analysis of the results of applying the created method and algorithm when compared with known similar solutions revealed the following distinctive features: introduction of additional invariant orientations of features when describing characteristic points and greater stability of detecting characteristic points when analyzing cloudiness, identification of cloudiness turbulence and analysis of changes in their local characteristics and movement parameters, formation of a set of generalizing distributions when analyzing a set of moving points for the subsequent recognition of the signs of a hurricane at its initial stages of formation. The developed approach was tested experimentally in the analysis of hurricanes video recordings and their movement in the Atlantic region for the period from 2010 to 2020. The developed general approach and a specific algorithm for estimating hurricane parameters based on cloud analysis are presented. The approach is applicable for practical implementation and allows accumulating data for detecting hurricanes in real time based on publicly available data for the development of a physical and mathematical model.

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Bilateral pathological neck of femur fractures associated with low grade splenic marginal zone lymphoma: Case report, and review of the literature

International Journal of Diagnostic Imaging ◽

10.5430/ijdi.v1n2p47 ◽

2014 ◽

Vol 1 (2) ◽

pp. 47

Author(s):

F Fallahi ◽

A Waton ◽

M Mansha ◽

W Cope ◽

H O’Brien ◽

...

Keyword(s):

Marginal Zone ◽

Marginal Zone Lymphoma ◽

Low Grade ◽

Splenic Marginal Zone Lymphoma ◽

Pathological Fractures ◽

Neck Of Femur ◽

Femur Fractures ◽

Clinical Literature ◽

Current Guidance ◽

Neck Of Femur Fracture

We report a case involving a 64 year old lady with bilateral pathological fractures of the neck of the femur secondary to Low Grade Splenic Marginal Zone Lymphoma, a pathology that has not previously been described in clinical literature. This particular case also highlights the value of the diagnosis and management of patients presenting with subtle and unusual symptoms, and supports the current guidance of the National Institute for Health and Care Excellence regarding the investigation of patients with suspected pathological neck of femur fracture.

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Comparison of functional outcomes between cemented and uncemented bipolar hemiarthroplasty for intracapsular neck femur fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20200743 ◽

2020 ◽

Vol 6 (2) ◽

pp. 333

Author(s):

Harpreet Singh ◽

Tej S. Rudani ◽

Malay P. Gandhi ◽

Aliasgar J. Rampurwala

Keyword(s):

Excellent Result ◽

The Elderly ◽

Bipolar Hemiarthroplasty ◽

Neck Of Femur ◽

Femur Fractures ◽

Uncemented Hemiarthroplasty ◽

Duration Of Surgery ◽

The Mean ◽

Neck Of Femur Fracture ◽

Uncemented Group

Background: The neck of femoral fracture is common and leading fracture in orthopaedic practice. The older age group and female are more to prone to develop this fracture.Methods: A prospective, clinical observational, analytical comparative study was undertaken in the department of Orthopaedics of Geetanjali Medical College and Hospital in Udaipur, Rajasthan from January 2018 to June 2019. 52 adult patients with neck of femur fracture, 26 patients in each group. Results: In our study, the mean age was 77.72 years. Female preponderance was seen in our study. In our study mean duration of surgery in uncemented group was 65.78 minutes and mean duration of surgery in cemented group was 79.89 minutes. The mean total HHS in our patient was 86.63 with standard deviation of 6.18. Mean HHS for cemented group was 86 and for uncemented group was 87.23. We found 20 excellent result and 27 good results (35.71% and 51.92% respectively). We also found 5 fair result (12.37%). There were 2 complications, both in cemented group, one had post-operative dislocation and other had a cement reaction.Conclusions: Both cemented and uncemented hemiarthroplasty are equally good options in the treatment of femoral neck fractures in the elderly. However, it is to be noted that the duration of surgery & complications, were both less in the uncemented group as compared to cemented hemiarthroplasty group in our study.

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Improving Administration of Fascia-iliaca Blocks for Patients With a Fractured Neck of Femur by Clinical Audit

10.21203/rs.3.rs-502228/v1 ◽

2021 ◽

Author(s):

Isaac Okereke ◽

Sridhar Rao Sampalli

Keyword(s):

Hip Fracture ◽

Older People ◽

Femur Fracture ◽

Fractured Neck Of Femur ◽

Neck Of Femur ◽

Analgesic Effects ◽

Femur Fractures ◽

Anaesthetic Agents ◽

Number Of Patients ◽

Neck Of Femur Fracture

Abstract BackgroundHip fracture is the most common serious injury in older people. It is also the most common reason for older people to need emergency anaesthesia and surgery, and the commonest cause of death following an accident. A FICB is the injection of anaesthetic agents into the fascia- iliaca compartment with the effect of blocking the lumbar plexus via an anterior approach. FICB is clinically safe and efficient and provides consistent analgesic effects irrespective of the performing doctor's experience of frailty fractures of the proximal femur.Methods Data from the National Hip Fracture Database (NHFD) for all patients admitted with a neck of femur fracture between October 2018 and May 2019 was interrogated and audited. Results of this audit were discussed in the department of Trauma & Orthopaedics' and the Trust's mortality review meetings. Teaching sessions were held for doctors and filling out of the neck of femur fracture proforma to detail administration or not of FICB and a valid reason when the later occurred was encouraged. A re-audit was carried out in May 2020 where a retrospective study of patients admitted with a neck of femur fracture over six months from October 2019 to April 2020 was done to assess improvement in compliance rates of administration of fascia iliaca blocks.Results We noted a statistically significant increase in the number of patients who got a fascia iliaca block on presentation with a fractured neck of the femur from after our second audit (p<0.00001). There were no complications associated with the administration of FICB to patients with neck of femur fractures. ConclusionThis study showed that clinical processes could be improved through audits, staff education and by employing the use of proformas to ensure compliance.

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Novel Conservative Approach to High Surgical Risk Frail Proximal Femur Fractures

Case Reports in Orthopedics ◽

10.1155/2020/8847080 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Alexander Koizia ◽

Ala Abuown ◽

Julie Vowles ◽

Damien Smith ◽

Louis J. Koizia

Keyword(s):

Neck Of Femur ◽

Femur Fractures ◽

Palliative Procedure ◽

Time Out ◽

Novel Approach ◽

Reduce Life Expectancy ◽

Ongoing Pain ◽

Discharge From Hospital ◽

Neck Of Femur Fracture ◽

Prolonged Hospital

One of the major impacts following a neck of femur fracture is pain. Most patients (nearly all) undergo an operation. This usually includes the frailest terminal patients and deemed a palliative procedure to reduce ongoing pain. The operation comes with risks and can reduce life expectancy in these patients and result in prolonged hospital admission, delirium, and postoperative complications. This case highlights a novel approach to managing the frailest end-of-life patients that does not require them to undergo a conventional operation. The case resulted in a quick discharge from hospital and for the patient and family to maximise the time out of hospital, with a reduced analgesic burden and a peaceful passing away. We feel that this could be an alternative, more humane option for such patients.

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The effect of time to surgery in neck of femur fracture patients with ASA Grade of 3 and above

Hip International ◽

10.1177/1120700020972025 ◽

2020 ◽

pp. 112070002097202

Author(s):

Hiba Khan ◽

Al-Achraf Khoriati ◽

Stefan Lazic ◽

Jack Navein ◽

Ritesh Sharma ◽

...

Keyword(s):

High Risk ◽

Femur Fracture ◽

Mortality Rates ◽

Time Frame ◽

Neck Of Femur ◽

Time To Surgery ◽

Femur Fractures ◽

American Society ◽

Neck Of Femur Fracture ◽

The Impact

Introduction: Hip fractures are an important cause of morbidity and mortality. Early surgery has been shown to reduce mortality rates and surgical complications. The American Society of Anesthesiologists (ASA) grade is a widely used tool to assess preoperative health of patients. This study aims to assess is whether delay in surgical time has a greater impact on the mortality rates for high risk patients. Method: Retrospective study using the National Hip Fracture Database (NHFD) of 4883 neck of femur fracture patients. Time of surgery, ASA grade, reason for delay and mortality at 120 days was analysed, using statistical analysis software. Results: There was a significant increase in mortality ( p < 0.001) with increasing ASA grade. Surgical delays of more than 36 hours increased mortality by 2.9%. The impact of delaying surgery became more pronounced as the ASA grade increased. ASA 3 and above had an optimum time to surgery of between 12 and 24 hours giving the statistically significant lowest mortality rate ( p = 0.004). Discussion: Surgical delay beyond the 36-hour target for surgery has a greater impact on mortality for patients with higher ASA grades. The effect is most profound in the high-risk ASA grade 5 patients with delayed patients showing a 37.5% increase in mortality in this group. This would imply that by prioritising this higher risk group and operating on it within a specific time frame there would be a subsequent fall in mortality associated with neck of femur fractures.

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The effects of weather on runway use by rodents

Canadian Journal of Zoology ◽

10.1139/z87-309 ◽

1987 ◽

Vol 65 (8) ◽

pp. 2035-2038 ◽

Cited By ~ 7

Author(s):

Remi Gauthier ◽

J. Roger Bider

Keyword(s):

Deer Mouse ◽

Principal Component ◽

Weather Conditions ◽

Microtus Pennsylvanicus ◽

Meadow Vole ◽

Weather Data ◽

Weather Factors ◽

Activity Data ◽

Napaeozapus Insignis ◽

Animal Activity

The effects of weather on runway use by four species of rodents were investigated using animal activity data obtained from a sand track. Species studied were meadow vole (Microtus pennsylvanicus), deer mouse (Peromyscus maniculatus), meadow jumping mouse (Zapus hudsonius), and woodland jumping mouse (Napaeozapus insignis). Runway use was quantified using the quotient of the activity inside to the activity outside the runway. The weather data were analyzed using a principal component analysis. The degree of concordance between the weather factors and runway use index was assessed by canonical correlation. Results showed that runway use decreases during warm, rainy, moonless nights. During these weather conditions, a predator's ability to find small rodents may be impaired, and the rodents could explore outside their runways to find new food patches.

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1671 The Effect Of COVID-19 On the Management and Outcome of Neck of Femur Fractures in A District General Hospital - A Comparative Study

British Journal of Surgery ◽

10.1093/bjs/znab259.1066 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

P Linardatou Novak ◽

B Davies ◽

A Bacon ◽

A MacDowell

Keyword(s):

Length Of Stay ◽

Femur Fracture ◽

Average Length ◽

Multidisciplinary Care ◽

District General Hospital ◽

Neck Of Femur ◽

Time To Surgery ◽

Average Length Of Stay ◽

Femur Fractures ◽

Neck Of Femur Fracture

Abstract Aim We wanted to see how the virus has impacted the management and outcome of our neck of femur fracture patients during Spring 2020. Method We performed a retrospective study of all neck of femur fracture patients presenting to our hospital from 23rd March 2020 (start of official lockdown in UK) until the end of May 2020 and compared them to patients presenting in the same time period in 2019. We recorded patient demographics, COVID-19 swab results, time to surgery, length of stay, transfers between wards, and 30-day mortality rates. Results We identified 75 patients in 2020 compared to 88 in 2019. Average length of stay was 11.4 days compared to 14.3 a year earlier. Mean time to surgery was 32.3 hours compared to 31.6 in 2019. The 30-day mortality increased significantly from 5.7% (5/88) in 2019 to 16% (12/75) in 2020 (p < 0.05) From 73 patients tested for COVID-19, 3 had a positive swab. Of these, 2 died. During their admission, 14 patients were transferred to 3 or more wards; in this group, 30-day mortality was 42.9% (6/14). Conclusions There has been a significant increase in 30-day mortality during COVID-19. Despite maintaining our time to surgery and reducing overall length of stay, we saw an increase in mortality, associated with multiple ward transfers rather than a high number of COVID-19 positive swab cases. Changes in pathways and wards configurations led to some patients requiring multiple transfers. This can cause difficulties in coordinated, multidisciplinary care for patients with NOF Fractures.

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Acetabular erosion after hemiarthroplasty

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20175140 ◽

2017 ◽

Vol 4 (1) ◽

pp. 53

Author(s):

Venkatesh Kumar N. ◽

Arvind Kumar S. M. ◽

Vinayagamoorthy . ◽

Sairamakrishnan S.

Keyword(s):

Functional Activity ◽

Activity Level ◽

Clinical Activity ◽

Bipolar Hemiarthroplasty ◽

Neck Of Femur ◽

Femur Fractures ◽

Ucla Score ◽

Cemented Bipolar Hemiarthroplasty ◽

Neck Of Femur Fracture ◽

Acetabular Erosion

Background: Neck of femur fractures are one of the devastating injuries in the old age. Their incidence is on the rise causing immense stress on the society. One of the most commonly done procedure is bipolar hemiarthroplasty. In our study we have evaluated the acetabular erosion after hemiarthroplasty, in neck of femur fracture patients after a minimum period of 2 years and have tried to correlate it with activity level of the patient.The aim of the study were early detection of acetabular erosion; to assess the functional outcome after minimum of 2 years after hemiarthroplasty by modified UCLA score; to correlate the functional activity level and radiological acetabular erosion.Methods: This is a retrospective radiological and clinical study. The post hemiarthroplasty plain radiographs, showing AP view of hip joint taken in the Department of Radiodiagnosis, PSGIMS&R will be studied along with activity level assessment. By Convenient sampling method, all the patients undergone cemented bipolar hemiarthroplasty, for fracture neck of femur after minimum of 2 years were assessed both radiologically and clinically. Functional activity level was assessed by Modified UCLA scoring system.Results: By this study we suggest an easy and effective way of evaluating acetabular erosion and clinical activity. There is significant increase in acetabular erosion as the duration after surgery increases. Conclusions: By this study we suggest an easy and effective way of evaluating acetabular erosion and clinical activity. There is significant increase in acetabular erosion as the duration after surgery increases. The clinical activity is by and large not significantly altered as the erosion progress at mid-term follow up.

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