Identify the trends of post-operative haemoglobin level change and risk factors for blood transfusions in surgically managed neck of femur fractures

Abstract Introduction Iron-deficiency anaemia is a condition that is regularly seen in patients admitted with neck of femur fractures (NOFF) and is associated with increased morbidity peri-operatively. Intravenous ferinject is a method of iron replacement that leads to a more rapid increase in haemoglobin than oral replacement, therefore is often more favourable in this patient group, leading to better patient outcomes. Method A quality improvement project was undertaken. An initial audit was conducted to analyse the demographic of patients with NOFF and to assess the current practice of the orthogeriatric team when managing iron deficiency anaemia. This reviewed NOFF patients admitted in July 2017. The indications and benefits of ferinject were distributed to the medical team, encouraging use clinically, and a further audit was performed 2 years later to compare outcomes and practice, reviewing patients with NOFF admitted July–September 2019. Results It was found that 87% of patients with NOFF are iron-deficient on admission, and that introducing the use of ferinject meant that 50% fewer blood transfusions were required. Additionally, it highlighted that those who received ferinject during their admission had a smaller range of discharge haemoglobin levels than those who did not. Finally, it was found that the use of ferinject did not affect the rates of readmission in the assessed patient cohort. Conclusions The introduction of the use of ferinject in NOFF patients with iron-deficiency anaemia leads to a reduction in the requirement of blood transfusions required and to a reduction of the range of discharge haemoglobin levels. Ferinject therefore aids in improved recovery of NOFF patients. It does not, however, appear to have any effect on readmission rates in this patient group. Further education is required amongst the orthogeriatric team about the indications and benefits of ferinject to ensure that all eligible patient receive ferinject, improving their recovery.

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108 Neck of Femur Fractures: Streamlined Approach to Improve Consenting Practices

British Journal of Surgery ◽

10.1093/bjs/znab259.007 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

O Brown ◽

A Gaukroger ◽

M Raza ◽

R Sturley ◽

M Arnander

Keyword(s):

Risk Factors ◽

Risk Factor ◽

General Medical Council ◽

Mean Value ◽

Medical Council ◽

The Novel ◽

Neck Of Femur ◽

Consent Forms ◽

Femur Fractures ◽

Operative Fixation

Abstract Aim Neck of femur fractures (NOFs) are synonymous with frailty, and successful outcomes are achieved with operative fixation. The United Kingdom’s General Medical Council guidance governing consent highlights the importance of thorough pre-operative discussion of risk with the patient. We aimed to audit consenting practices in NOF patients within our unit against the British Orthopaedic Association’s (BOA) criteria, with the addition of delirium as a risk factor. Method In cycle one all operatively managed NOFs over a two-month period in October-November 2019 were retrospectively reviewed. Consent forms 1 (CF1) and 4 (CF4) were assessed against BOA-endorsed criteria. Our intervention included a standardised sticker detailing 14 important risks was introduced and a departmental seminar on delirium. A second cycle was undertaken from August-October 2020 to close the audit loop Results No consent form documented all BOA-approved risk factors in cycle one (N = 35). Of cycle two’s 35 patients, 70.8% CF1 were completed using the novel sticker. All of these had 100% BOA-approved risk documentation. Consent forms without the sticker in cycle two documented 9/14 risks (mean value). No CF4 had any risks documented in either cycle. Delirium was documented in 51% in total and in 75% patients with CF1. Delirium documentation improved from 2.9% in cycle one to 51.4% in cycle two. Conclusions Clear lapses in operative consenting processes were identified, especially regarding delirium and CF4 documentation. The introduction of a novel consent sticker drastically improved compliance with BOA guidance for CF1. Recognition and departmental education regarding delirium significantly reduced incidence between cycles.

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Suspected coexistent osteoporosis and osteomalacia with atraumatic bilateral neck of femur fractures in a 53-year-old man without apparent risk factors

BMJ Case Reports ◽

10.1136/bcr-2014-205205 ◽

2014 ◽

Vol 2014 (sep04 1) ◽

pp. bcr2014205205-bcr2014205205 ◽

Cited By ~ 1

Author(s):

J. De Marchi ◽

R. Bajwa ◽

S. N. Duggan ◽

P. Magill

Keyword(s):

Risk Factors ◽

Neck Of Femur ◽

Femur Fractures

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Correction to: Hemiarthroplasty for neck of femur fractures: to cement or not? A systematic review of literature and meta-analysis

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-019-02488-2 ◽

2019 ◽

Vol 29 (8) ◽

pp. 1835-1836

Author(s):

Prasoon Kumar ◽

Rajesh Kumar Rajnish ◽

Deepak Neradi ◽

Vishal Kumar ◽

Saurabh Agarwal ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Review Of Literature ◽

Neck Of Femur ◽

Femur Fractures

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Impact of COVID-19 pandemic on hip fractures: the central London experience COVID-related urgent geriatric hip trauma (COUGH) study COVERT ( COVid Emergency-Related Trauma and orthopaedics) collaborative

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-021-02687-z ◽

2021 ◽

Author(s):

Chang Park ◽

Kapil Sugand ◽

Arash Aframian ◽

Catrin Morgan ◽

Nadia Pakroo ◽

...

Keyword(s):

Best Practice ◽

Neck Of Femur ◽

Health Crisis ◽

Femur Fractures ◽

Time Period ◽

Vulnerable Patients ◽

Significant Difference ◽

Usual Residence ◽

Hip Trauma ◽

The Impact

Abstract Introduction COVID-19 has been recognized as the unprecedented global health crisis in modern times. The purpose of this study was to assess the impact of COVID-19 on treatment of neck of femur fractures (NOFF) against the current guidelines and meeting best practice key performance indicators (KPIs) according to the National Hip Fracture Database (NHFD) in two large central London hospitals. Materials and methods A multi-center, longitudinal, retrospective, observational study of NOFF patients was performed for the first ‘golden’ month following the lockdown measures introduced in mid-March 2020. This was compared to the same time period in 2019. Results A total of 78 cases were observed. NOFFs accounted for 11% more of all acute referrals during the COVID era. There were fewer overall breaches in KPIs in time to theatre in 2020 and also for those awaiting an orthogeriatric review. Time to discharge from the trust during the pandemic was improved by 54% (p < 0.00001) but patients were 51% less likely to return to their usual residence (p = 0.007). The odds ratio was significantly higher for consultant surgeon-led operations and consultant orthogeriatric-led review in the post-COVID era. There was no significant difference in using aerosol-generating anaesthetic procedures or immortality rates between both years. Conclusion The impact of COVID-19 pandemic has not adversely affected the KPIs for the treatment of NOFF patients with significant improvement in numerous care domains. These findings may represent the efforts to ensure that these vulnerable patients are treated promptly to minimize their risks from the coronavirus.

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Malarial Infection in HIV Infected Pregnant Women Attending a Rural Antenatal Clinic in Nigeria

Advances in Epidemiology ◽

10.1155/2014/694213 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

R. S. Houmsou ◽

B. E. Wama ◽

S. O. Elkanah ◽

L. C. Garba ◽

T. D. Hile ◽

...

Keyword(s):

Risk Factors ◽

Haemoglobin Level ◽

Pregnant Women ◽

Rural Areas ◽

First Trimester ◽

Antenatal Clinic ◽

Severe Anaemia ◽

Sub Saharan Africa ◽

Malarial Infection ◽

Sub Saharan

Malaria still remains a challenging infection affecting the lives of several HIV infected pregnant women in sub-Saharan Africa. This study was undertaken to determine malarial infection in HIV infected pregnant women in relation to sociodemographic and obstetrical factors. The study also assessed relationship between malarial infection and haemoglobin level, CD4+ counts, and ART regimen, as well as predisposing risk factors that influenced occurrence of malarial infection in the women. Thick and thin blood smears were prepared and stained with Giemsa. Haemoglobin level was determined using a hematology analyzer, while the flow cytometry was used to measure CD4+ counts. Sociodemographic and obstetrical parameters were obtained through the administration of questionnaires. Of the 159 HIV infected pregnant women examined, 33.3% (59/159) had malarial infection. Malarial infection was significantly higher in pregnant women who were divorced, 40.24% (33/82) (χ2=5.72; P=0.05), were at their first trimester (4–12 weeks), 54.8% (17/31) (χ2=14.85; P=0.01), had CD4+ = [201–500 cells/μL], 42.42% (42/99) (χ2=10.13; P=0.00), and those that had severe anaemia (<8 dg/L), 100.00% (χ2= 45.75; P=0.00). However, risk factors that influenced the occurrence of malarial infection in the pregnant women were occupation (farming) (AOR=0.226; P=0.03), marital status (divorced) (AOR=2.80; P=0.02), gestation (first trimester) (AOR=0.33; P=0.00), haemoglobin level (Hb < 8 dg/L) (AOR=0.02; P=0.00), and CD4+ counts (low CD4+) (OR=0.40; P=0.05). The study reported endemicity of malaria in HIV infected pregnant women living in rural areas of Benue State, Nigeria. Malarial infection was higher in women that were divorced, and at their first trimester, had low CD4+ count, and had severe anaemia. Farming, divorce, gestation, severe anaemia, and low CD4+ counts were predisposing risk factors that influenced malaria occurrence in the HIV infected pregnant women. It is advocated that HIV infected pregnant women should be properly and thoroughly educated on malaria preventive measures in rural areas so as to avoid unpleasant effect of malaria during their pregnancies.

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