scholarly journals The impact of COVID-19 on trauma and orthopaedic patients requiring surgery during the peak of the pandemic

2020 ◽  
Vol 1 (9) ◽  
pp. 520-529 ◽  
Author(s):  
Nicola D Mackay ◽  
Christopher P Wilding ◽  
Clare R Langley ◽  
Jonathan Young
Keyword(s):  
Spinal Anaesthesia ◽  
Local Anaesthesia ◽  
Young Patients ◽  
Femoral Fractures ◽  
Fragility Fractures ◽  
Minimal Risk ◽  
Proximal Femoral Fractures ◽  
Regional Block ◽  
Orthopaedic Patients ◽  
The Impact

Aims COVID-19 represents one of the greatest global healthcare challenges in a generation. Orthopaedic departments within the UK have shifted care to manage trauma in ways that minimize exposure to COVID-19. As the incidence of COVID-19 decreases, we explore the impact and risk factors of COVID-19 on patient outcomes within our department. Methods We retrospectively included all patients who underwent a trauma or urgent orthopaedic procedure from 23 March to 23 April 2020. Electronic records were reviewed for COVID-19 swab results and mortality, and patients were screened by telephone a minimum 14 days postoperatively for symptoms of COVID-19. Results A total of 214 patients had orthopaedic surgical procedures, with 166 included for analysis. Patients undergoing procedures under general or spinal anaesthesia had a higher risk of contracting perioperative COVID-19 compared to regional/local anaesthesia (p = 0.0058 and p = 0.0007, respectively). In all, 15 patients (9%) had a perioperative diagnosis of COVID-19, 14 of whom had fragility fractures; six died within 30 days of their procedure (40%, 30-day mortality). For proximal femoral fractures, our 30-day mortality was 18.2%, compared to 7% in 2019. Conclusion Based on our findings, patients undergoing procedures under regional or local anaesthesia have minimal risk of developing COVID-19 perioperatively. Those with multiple comorbidities and fragility fractures have a higher morbidity and mortality if they contract COVID-19 perioperatively; therefore, protective care pathways could go some way to mitigate the risk. Our 30-day mortality of proximal femoral fractures was 18.2% during the COVID-19 pandemic in comparison to the annual national average of 6.1% in 2018 and the University Hospital Coventry average of 7% for the same period in 2019, as reported in the National Hip Fracture Database. Patients undergoing procedures under general or spinal anaesthesia at the peak of the pandemic had a higher risk of contracting perioperative COVID-19 compared to regional block or local anaesthesia. We question whether young patients undergoing day-case procedures under regional block or local anaesthesia with minimal comorbidities require fourteen days self-isolation; instead, we advocate that compliance with personal protective equipment, a negative COVID-19 swab three days prior to surgery, and screening questionnaire may be sufficient. Cite this article: Bone Joint Open 2020;1-9:520–529.

scholarly journals The Mental Capacity Act 2005: review of mental capacity assessment in people with proximal femoral fracture

2010 ◽  
Vol 34 (7) ◽  
pp. 284-286 ◽  
Author(s):  
P. Guyver ◽  
P. Hindle ◽  
J. Harrison ◽  
N. Jain ◽  
M. Brinsden
Keyword(s):  
Staff Training ◽  
Femoral Fractures ◽  
Proximal Femoral Fracture ◽  
Mental Capacity ◽  
Clinical Implications ◽  
Proximal Femoral Fractures ◽  
Mental Capacity Act 2005 ◽  
Consent To Treatment ◽  
Mental Capacity Act ◽  
The Impact

Aims and methodTo ascertain whether patients with proximal femoral fractures were being correctly assessed in line with the Mental Capacity Act 2005. Fifty people admitted with proximal femoral fractures were audited to assess whether they had given consent to treatment in accordance with the Act. A Mental Capacity Act 2005 guidance and assessment form was then introduced accompanied by staff training. A re-audit was undertaken to assess the impact.ResultsThe initial audit showed that only one person (2%) had been properly assessed. The re-audit demonstrated that the use of the Mental Capacity Act 2005 assessment form ensured correct assessment.Clinical implicationsOur findings suggest the form is a useful tool in the documentation and assessment of an individual's capacity under the Mental Capacity Act.

scholarly journals Risk factors for intramedullary nail breakage in proximal femoral fractures: a 10-year retrospective review

2017 ◽  
Vol 99 (2) ◽  
pp. 145-150 ◽  
Author(s):  
NA Johnson ◽  
C Uzoigwe ◽  
M Venkatesan ◽  
V Burgula ◽  
A Kulkarni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pathological Fracture ◽  
Treatment Options ◽  
Young Patients ◽  
Femoral Fractures ◽  
Subtrochanteric Fracture ◽  
Proximal Femur Fracture ◽  
Bony Union ◽  
Proximal Femoral Fractures ◽  
Asa Score

INTRODUCTION Intramedullary nailing is a common treatment for proximal femoral fractures. Fracture of the nail is a rare but devastating complication that exposes often frail patients to complex revision surgery. We investigated which risk factors predict nail failure. METHODS We reviewed all cases of nail breakage seen over a 10-year period in a single busy trauma unit; 22 nail fractures were seen in 19 patients. Comparison was made with a group of 209 consecutive patients who underwent intramedullary fixation of a proximal femur fracture with no nail breakage over a 2-year period. RESULTS In the fractured nail group, mean age was 70.4 years (range 55–88 years).The mean time to fracture was 10 months (range 2.5–23 months). Logistical regression was used to show that low American Society of Anesthesiologists (ASA) score, subtrochanteric fracture and pathological fracture were independent risk factors for nail fracture. CONCLUSIONS Young patients with a low ASA score are at highest risk of nail breakage. We advise close follow-up of patients with these risk factors until bony union has been achieved. In addition, there may be merit in considering other treatment options, such as proximal femoral replacement, especially for those with pathological fracture with a good prognosis.

The impact of antegrade intramedullary nailing start site using the SIGN nail in proximal femoral fractures: A prospective cohort study

Injury ◽  
2018 ◽  
Vol 49 (2) ◽  
pp. 323-327 ◽  
Author(s):  
Mohamed Mustafa Diab ◽  
Hao-Hua Wu ◽  
Edmund Eliezer ◽  
Billy Haonga ◽  
Saam Morshed ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intramedullary Nailing ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Femoral Fractures ◽  
Start Site ◽  
Proximal Femoral Fractures ◽  
The Impact

scholarly journals A Multidisciplinary Diagnostic Approach Reveals a Higher Prevalence of Indolent Systemic Mastocytosis: 15-Years’ Experience of the GISM Network

Cancers ◽  
2021 ◽  
Vol 13 (24) ◽  
pp. 6380
Author(s):  
Roberta Zanotti ◽  
Massimiliano Bonifacio ◽  
Cecilia Isolan ◽  
Ilaria Tanasi ◽  
Lara Crosera ◽  
...  
Keyword(s):  
Systemic Mastocytosis ◽  
Adult Population ◽  
Young Patients ◽  
Fragility Fractures ◽  
Veneto Region ◽  
Epidemiology Data ◽  
The Mean ◽  
Cutaneous Mastocytosis ◽  
The Impact ◽  
Indolent Systemic Mastocytosis

Systemic mastocytosis (SM) and other adult clonal mast cell disorders (CMD) are often underestimated, and their epidemiology data are scarce. We aimed at evaluating the impact of the activity of the Interdisciplinary Group for Study of Mastocytosis (GISM) of Verona on the prevalence and incidence of CMD. We examined the data of 502 adult patients diagnosed with CMD and residing in the Veneto Region, consecutively referred to GISM between 2006 and 2020. SM was diagnosed in 431 cases, while 71 patients had cutaneous mastocytosis or other CMD. Indolent SM represented the most frequent SM variant (91.0%), mainly with the characteristics of bone marrow mastocytosis (54.8%). The prevalence of SM in the adult population of the Veneto region and of the Verona province was 10.2 and 17.2/100,000 inhabitants, respectively. The mean incidence of new SM cases in Verona was 1.09/100,000 inhabitants/year. Hymenoptera venom allergy was the main reason (50%) leading to the CMD diagnosis. Osteoporosis, often complicated by fragility fractures, was present in 35% of cases, even in young patients, especially males. Our data show a higher prevalence and incidence of SM than previously reported, confirming that reference centers with multidisciplinary approach are essential for the recognition and early diagnosis of CMD.

Impact of concomitant injuries in geriatric patients with proximal femur fracture

2021 ◽  
Vol 103-B (9) ◽  
pp. 1526-1533
Author(s):  
Carsten Schoeneberg ◽  
Bastian Pass ◽  
Ludwig Oberkircher ◽  
Katherine Rascher ◽  
Matthias Knobe ◽  
...  
Keyword(s):  
Upper Limb ◽  
Proximal Femur ◽  
Cohort Analysis ◽  
Femoral Fractures ◽  
Walking Ability ◽  
Proximal Femoral Fractures ◽  
Concomitant Injuries ◽  
Femur Fractures ◽  
Concomitant Injury ◽  
The Impact

Aims The impact of concomitant injuries in patients with proximal femoral fractures has rarely been studied. To date, the few studies published have been mostly single-centre research focusing on the influence of upper limb fractures. A retrospective cohort analysis was, therefore, conducted to identify the impact and distribution of concomitant injuries in patients with proximal femoral fractures. Methods A retrospective, multicentre registry-based study was undertaken. Between 1 January 2016 and 31 December 2019, data for 24,919 patients from 100 hospitals were collected in the Registry for Geriatric Trauma. This information was queried and patient groups with and without concomitant injury were compared using linear and logistic regression models. In addition, we analyzed the influence of the different types of additional injuries. Results A total of 22,602 patients met the inclusion criteria. The overall prevalence of a concomitant injury was 8.2% with a predominance of female patients (8.7% vs 6.9%; p < 0.001). Most common were fractures of the ipsilateral upper limb. Concomitant injuries resulted in prolonged time-to-surgery (by 3.4 hours (95 confidence interval (CI) 2.14 to 4.69)) and extended length of stay in hospital by 2.2 days (95% CI 1.74 to 2.61). Mortality during the admission was significantly higher in the concomitant injury group (7.4% vs 5.3%; p < 0.001). Additionally, walking ability and quality of life were reduced in these patients at discharge. More patients were discharged to a nursing home instead of their own home compared to patients without additional injuries (25.8% vs 30.3%; p < 0.001). Conclusion With a prevalence of 8.2%, the appearance of a concomitant injury is common in elderly patients with hip fracture. These patients are at a greater risk for death during the admission, longer hospital stays, and delayed surgery. This knowledge is clinically important for all who are involved in the treatment of proximal femur fractures. Cite this article: Bone Joint J 2021;103-B(9):1526–1533.

scholarly journals A study on the ease of placement of spinal needle in relation to height, weight and BMI in a geriatric population of Eastern India

2018 ◽  
Vol 6 (7) ◽  
pp. 2508
Author(s):  
Anirban Sadhu ◽  
Santanu Kumar Khanra ◽  
Hironmoy Mondal ◽  
Rudradev Meyur
Keyword(s):  
Spinal Anaesthesia ◽  
Statistical Tests ◽  
Young Patients ◽  
Significant Risk ◽  
The Elderly ◽  
Spinal Needle ◽  
Geriatric Population ◽  
Time Period ◽  
Common Causes ◽  
The Impact

Background: Spinal anaesthesia is the procedure of choice for infraumbilical surgery worldwide. This is usually very easy in young patients but fraught with difficulties in the elderly. Such difficulties may lead to pain, haematoma and infection, all of which pose a significant risk in the elderly. Hence it is imperative to study the common causes of such problems faced during introduction of the spinal needle for the same This will ensure a better management of the problem. The study was done to assess the impact of height, weight and BMI on the ease of introduction of spinal needle for anaesthesia in patients above 65 years of age.Methods: A 500 patients above 65 years of age were selected for the study based on some well-defined inclusion and exclusion criteria. The time period for the study was 1 year. Their height, weight and BMI were then recorded. Then the number of redirections and level (s) required for successful placement of spinal needle were noted for each patient. ≤3 redirections and <1 levels were considered as easy placement of spinal needle. The latter were tabulated separately against the height, weight and BMI of each patient. Relevant statistical tests were also done to ascertain the significance of the findings.Results: Patients with lesser height, weight and BMI took <3 redirections and <1 level for placement of spinal needle and these were statistically significant.Conclusions: Spinal anaesthesia is relatively easy in elderly patients with lesser height, weight and BMI.

Uncomplicated adult inguinal hernia repair under local anaesthesia and spinal anaesthesia

2020 ◽  
Vol 11 (3) ◽  
pp. 3212-3221
Author(s):  
Naniwadekar R G
Keyword(s):  
Inguinal Hernia ◽  
Hospital Stay ◽  
Spinal Anaesthesia ◽  
Local Anaesthesia ◽  
Control Group ◽  
Early Ambulation ◽  
Inguinal Hernias ◽  
Hernia Inguinal ◽  
The Subject ◽  
Prolonged Hospital

Multiple researchers have given numerous guidelines in the clinical management of this disorder in the late nineteenth and twentieth centuries, after comprehensive works on the subject. As a result, a very wide variety of surgical procedures are now available to the surgeon to suit the requirement. There have been numerous advances in the management of inguinal hernia. Inguinal hernias can conveniently be repaired under all kinds of anaesthesia, namely general, spinal and local. Whereas the general anaesthesia requires the services of an experienced anaesthetist and new devices and spinal anaesthesia requires postoperative impairment while local anaesthesia is safe to prescribe, easy and efficient and does not cause postoperative complications. This work consisted of a study group of twenty-five adult patients of uncomplicated inguinal hernias, who after repair of hernias, which after repair of hernias were allowed early ambulation and had a short hospital, stay of one day post operatively. The second control group consisted of similar twenty-five patients who are subjected to conventional delayed ambulation and prolonged hospital stay. The results of repair in the two groups were compared; the available literature on the subject was reviewed. The implementation of ”shortstay surgery” not only relieves the waiting list in hospitals but also offers an economic boost and provides the patient with some social advantages.

scholarly journals Early-Onset Osteoporosis

2021 ◽  
Author(s):  
Outi Mäkitie ◽  
M. Carola Zillikens
Keyword(s):  
Young Adults ◽  
Early Onset ◽  
Type I Collagen ◽  
Young Patients ◽  
Fragility Fractures ◽  
Underlying Disease ◽  
Bone Fragility ◽  
Sphingolipid Metabolism ◽  
Type I ◽  
Loss Of Function

AbstractOsteoporosis is a skeletal disorder with enhanced bone fragility, usually affecting the elderly. It is very rare in children and young adults and the definition is not only based on a low BMD (a Z-score < − 2.0 in growing children and a Z-score ≤ − 2.0 or a T-score ≤ − 2.5 in young adults) but also on the occurrence of fragility fractures and/or the existence of underlying chronic diseases or secondary factors such as use of glucocorticoids. In the absence of a known chronic disease, fragility fractures and low BMD should prompt extensive screening for secondary causes, which can be found in up to 90% of cases. When fragility fractures occur in childhood or young adulthood without an evident secondary cause, investigations should explore the possibility of an underlying monogenetic bone disease, where bone fragility is caused by a single variant in a gene that has a major role in the skeleton. Several monogenic forms relate to type I collagen, but other forms also exist. Loss-of-function variants in LRP5 and WNT1 may lead to early-onset osteoporosis. The X-chromosomal osteoporosis caused by PLS3 gene mutations affects especially males. Another recently discovered form relates to disturbed sphingolipid metabolism due to SGMS2 mutations, underscoring the complexity of molecular pathology in monogenic early-onset osteoporosis. Management of young patients consists of treatment of secondary factors, optimizing lifestyle factors including calcium and vitamin D and physical exercise. Treatment with bone-active medication should be discussed on a personalized basis, considering the severity of osteoporosis and underlying disease versus the absence of evidence on anti-fracture efficacy and potential harmful effects in pregnancy.

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