bluuebunny/crossref_metadata_2025_split huggingface dataset:
706 Frailty Score Is an Independent Predictor of Outcome Following Fragility Fracture
Authors: Brown R , Gatfield S , Rogers M , Peter N 
Published: October 2021

Abstract

Background
Frailty has been linked to greater hospitalisation, morbidity, and mortality, and is being increasingly recognised as a possible factor affecting outcomes in trauma. A 2017 TARN report identified that further research was needed to determine the effect of frailty on outcomes in trauma patients. With fragility (low energy) fractures now make up a significant burden of trauma within UK hospitals, this retrospective cohort study investigated whether frailty has a significant effect on outcomes in patients presenting with fragility fractures.

Method
Notes from all patients aged &gt;60 admitted to a large District General hospital over 1 year with any fragility fracture were reviewed. Age, injury, length of stay, and mortality were recorded. A Rockwood Clinical Frailty Score (CFS) was assigned retrospectively.

Results
886 patients were reviewed (male:female 266:620, mean age 82.75). CFS was independently associated with a significant increase in mortality, with every step up in CFS increasing 30-day and 1-year odds of death by 54.8% and 56.2% respectively (P &lt; 0.001). Every step up in CFS independently increased percentage length of stay by 10.1%.

Conclusions
CFS independently predicts adverse outcome in hospitalised trauma patients with fragility fractures. CFS should be used routinely to identify patients at risk and may assist in allocating limited orthogeriatric resources and supporting national guidelines. Future research should investigate how resources impact outcomes for patients of varying CFS.
730 Is The Total Hip Arthroplasty For Hip Fracture Comparable With Matched Elective Cohort ? A Prospective Study
Authors: Tan T K , Lim J W , Alkandari N , Ridley D , Sripada S , Jariwala A 
Published: October 2021

Abstract

Aim
Total hip replacement (THR) has been effective in managing osteoarthritis but its effectiveness in managing neck of femur fracture (#NOF) is debatable due to higher risk of morbidity and mortality. We aimed to review the selection criteria for trauma THR and to compare the functional outcomes and complication profiles of trauma THR cohort with elective THR cohorts.

Method
we prospectively reviewed patients undergoing THR for #NOF with follow-up. The functional outcomes, any further complications-related admissions and death within a year were noted for subsequent analysis. All the patients and data collected were subsequently matched with the elective cohort.

Results
Forty-one matched cases were included in our study. The Modified Harris Hip Score (mHHS) was significantly lower pre-operatively in elective cohort (41.4±14.3 VS 60.3±22.2, P &lt; 0.001) and achieved significantly higher score than trauma cohort 1-year post operatively (88.2±10.9 VS 82.6±12.7, P = 0.029). As for the mHHS Function, the trauma cohort achieved similar value with the pre-operative score post-operatively, and no significant difference was witnessed between the trauma and elective cohort post-operatively (35.1±7.4 VS 37.6±7.7, P = 0.142). mHHS Pain score was significantly higher in trauma cohort pre-operatively (19.8±15.3 VS 12.7±6.3, P = 0.034), but the score was significantly higher than trauma cohort 1-year postoperatively (42.7±4.4 VS 40.7±7.7, P = 0.027). Both cohorts had similar complication rate.

Conclusions
Our study further justified the clinical indication of THR for #NOF. With careful selection, trauma THR can achieve similar HHS function and better pain score. Further randomized controlled trials are warranted to justify our findings.
799 Do Not Attempt Cardiopulmonary Resuscitation Decisions in Neck of Femur Fractures – Is Documentation Adequate?
Authors: Williamson T , Hughes K , Osborne-Grinter M , Philip V , Dall G , Raghavan R 
Published: October 2021

Abstract

Introduction
‘Do not attempt cardiopulmonary resuscitation’ (DNACPR) documentation is essential to communicate decisions regarding ceilings of care for patients to the clinical team. Patients admitted to hospital with a fractured neck of femur (#NOF) are often elderly with multiple comorbidities, and so robust and clear anticipatory care plans are especially indicated.

Method
All patients admitted to a large district general hospital in Scotland with a #NOF over a three-week period between 23/10/2020 and 12/11/2020 were identified prospectively and included in this audit. Patients’ demographic information, DNACPR status and the quality of their DNACPR documentation was recorded.

Results
20 patients (85% Female, 15% Male) were identified and included. Median ASA grade was 3, with 77.8% of patients ASA grade 3 or 4. 63.2% of patients had DNACPR documentation in place, all of which were ASA grade 3 or above. Most DNACPR documentation had patient information clearly identifiable (91.7%), was completed preoperatively (90.9%), and involved either the patient or appropriate relative or power of attorney (91.6%). However, only 75% of patients’ documentation had the rationale for the DNACPR decision documented and only 25% of DNACPR decisions were reviewed by a senior clinician within 72 hours. No DNACPR decisions were documented as having been communicated to the wider healthcare team.

Conclusions
DNACPR documentation is a crucial for anticipatory care planning in #NOF patients. This audit shows improvement is needed in documenting whether decisions have been reviewed by senior clinicians, and if they have been communicated to the wider healthcare team.
873 The Keystone Challenge- Volar Displaced Intra-Articular Distal Radius Fractures with Lunate Fossa Fragment
Authors: Cheruvu M S , Dass D , Ford D J , Roushdi I 
Published: October 2021

Abstract

Aim
Volar displaced fractures of the distal radius are unstable and warrant operative management. A subset of patients with volar displaced fractures also has a separate lunate fossa fragment, a specific injury with greater instability that may precipitate carpal subluxation. We aim to review our long-term experience in the management of this complex injury, exploring surgical technique which may improve treatment.

Method
We retrospectively reviewed all volar displaced distal radius fixations between 2015 and 2020. Inclusion criteria: any displaced intra-articular volar distal radius fracture with lunate fragment involvement undergoing volar fixation and over 16 years of age. Exclusion criteria: shaft fractures, extra-articular fractures, open fractures, fractures fixed using k-wires or external fixation, revision surgery and patients without follow-up. We adapted our surgical approach in order to address this more complex fracture pattern, and all operations were performed by specialist hand surgeons.

Results
468 distal radius fractures were assessed, of which 29 (6%) cases included a lunate fossa fragment. 20 (69%) of patients were female, mean age was 59 years (SD 12.4). Mean length of stay was 5 hours and mean operative time was 96 mins (range 79-95). No patients had carpal subluxation, fracture fixation failure or return to theatre for any reason.

Conclusions
From our experience as a specialist orthopaedic institution, we recommend the extended FCR approach and intra-focal exposure to manage this complex injury. In particular, the lunate fossa fragment is the keystone which requires dedicated reduction prior to tackling the remaining fracture configuration.
940 Neck of Femur Fracture Management and Outcomes during COVID-19: Overview of the Results from a District General Hospital in Wales
Authors: Waterman J , Jayaraju U , Nadimi J , Morgan D 
Published: October 2021

Abstract

Introduction
The COVID-19 pandemic has delivered significant challenges to the Orthopaedic community. Our study aims to assess the impact of COVID-19 on the management and outcomes of patient’s presenting with Hip Fractures to our DGH.

Method
Retrospective data analysis was performed on a cohort of hip fracture patients who presented to our DGH before the COVID-19 pandemic (23/03/2019 to 05/05/2019) and were compared to those who presented during the COVID-19 pandemic (23/03/2020 to 05/05/2020). Minimum follow up was 30 days postoperatively.

Results
38 patients with hip fractures presented to our unit in the pre-COVID-19 period compared to 27 patients in the COVID-19 period. Total time from presentation to discharge, during COVID-19, demonstrated a 70.23% decrease when compared to the pre-COVID cohort. 30-day Mortality rates were higher in the COVID-19 cohort.

Conclusions
During the COVID-19 pandemic our time to theatre and discharge of hip fractures has seen an improvement, with time to discharge decreasing by 70.23%. Comparison of our mortality rates has seen a fourfold increase likely influenced by the detrimental effects of COVID-19. Further work and larger numbers are required to see the true impact of COVID-19 on the management and outcomes of hip fractures in our DGH.
1001 Atraumatic Bilateral Compartment Syndrome; A Case Report
Authors: Warren M , Dhillon G , Abdulkarim A 
Published: October 2021

Abstract

Introduction
We present a rare case of lower leg atraumatic bilateral compartment syndrome (ABCS). To date there have only been three similar cases reported where no cause was identified.

Case Study
A 33-year-old male presented 12 hours following sudden onset lower leg pain. There was no history of trauma, drug, or alcohol use. On assessment he was in significant pain, not relieved by analgesia, and had clinically tense anterior compartments bilaterally. Both feet were held in fixed dorsiflexion. Creatinine kinase (CK) was 35,166 on admission. X-rays of both legs were normal. He was immediately taken to theatre for bilateral four compartment fasciotomies which revealed significant swelling in the anterior and lateral compartments with patchy pre-necrosis. Post-operatively he deteriorated, required intubation, and was admitted to ITU for acute haemofiltration to treat acute kidney injury secondary to rhabdomyolysis. Multiple operations were required for debridement, resulting in exposed tendons. Closure of the medial wounds was achieved primarily as an inpatient and he was discharged with bilateral lateral VAC dressings in situ. Lateral wounds were closed with Biodegradable Temporising Matrix followed by split skin grafting. In his second admission he suffered a pulmonary embolism.

Literature Review and Discussion
20 case of ABCS have been reported, largely attributable to drugs, alcohol, or leg position. Most cases had an element of diagnostic delay. In addition to compartment pressure monitoring, testing CK can demonstrate muscle necrosis and supports the decision to proceed to surgery.
805 A Dangerous Wait: The Impact of Prolonged Waiting Times in Endocrine Surgery
Authors: Shuttleworth R , Eatock F 
Published: October 2021

Abstract

Aim
In Northern Ireland on 31/12/19 90,514 patients were awaiting admission/day case procedure. The 2019/2020 Ministerial waiting time target states that by March 2020, 55% of patients should not wait longer than 13 weeks for inpatient/day case treatment, and no patient should wait longer than 52 weeks. This audit investigates the impact of long waiting times in endocrine surgery and how they impact patient safety.

Method
Data was collected from the endocrine surgery waiting list in the Royal Victoria Hospital, Belfast, up to 6/2/20. Number of days spent on the waiting list, disease complications and the number of days before they occurred were collated.

Results
118 patients were awaiting endocrine surgery. The average waiting time was 533 days. 21 patients experience 27 complications related to their endocrine disease whilst waiting for surgery. The average duration before complications was 490 days; 4 required admission, 11 required medical intervention and 3 required a surgical intervention.

Conclusions
The average waiting time for endocrine surgery is greater than 52 weeks. In Northern Ireland no one should be waiting more than 52 weeks. The length of the waiting list has resulted in 1 in 5 experiencing complications and prolonged suffering from under-treated disease. This is a significant patient safety concern. Urgent action to address waiting lists is required and the disruption caused by COVID-19 should be used as a catalyst for reform.
1125 Proximal Tibial Giant Cell Tumor in A 25-Year-Old Female Treated with Two Stage Extended Curettage, Cementing and Arthrodesis. Key Words: GCT, Two Stage, Curettage, Cementation, Arthrodesis
Authors: Khadilkar S , Handralmath S 
Published: October 2021

Abstract

Introduction
Giant cell tumor of bone is a benign but locally aggressive tumor accounting for approximately 20% of benign osseous neoplasms. Female gender predominance, common in second to third decade of life. Commonly seen around knee, with the distal femur being more frequently involved.

Method
Presenting a 25year old lady with history of progressive pain and swelling around right knee for 2 years and inability to walk for 6 months. Radiography and biopsy revealed giant cell tumor of the right proximal tibia involving the medial condyle. Two staged procedure planned. Stage 1 extended curettage, cementation of cavity with PMMA and a knee spanning fixator was done. In stage 2 at 12 weeks cement was removed and knee arthrodesis using allograft performed retaining the fixator in place.

Results
Patient was able to partially bear weight 6 weeks post 2nd stage of surgery and was able to bear full weight after 12 weeks. A solid arthrodesis was achieved at 5 months post 2nd stage, when the fixator was removed. There is no recurrence at end of one year

Conclusions
This is a novel method of low-cost treatment using bone cement and external fixator for stability. Cement gives immediate structural support and fixator allows ambulation and early weight-bearing. The importance of thorough curettage cannot be overemphasized in preventing recurrence. This can be a viable alternative treatment option for patients presenting with large giant cell tumors around the knee joint who cannot afford options like wide local excision and joint replacement using mega-prosthesis.
1213 Cycling-related Trauma Admissions to the Major Trauma Centre in the Cycling Capital of the United Kingdom
Authors: Arshad Z , majeed M , Thahir A , Anwar F , Rawal J , Hull P , Carrothers A , Chou D 
Published: October 2021

Abstract

Aim
The number of cyclists travelling on roads in the United Kingdom (UK) is increasing. The government has recently introduced initiatives to promote cycling uptake and so these numbers are likely to increase. This study aims to characterise cycling related injuries presenting to a major trauma centre located within a region with the highest rates of cycling in the UK.

Method
A retrospective review of cycling related trauma admissions occurring between January 2012 and June 2020 was performed. All patients were split into three groups based on the mechanism of injury. Our institution’s electronic patient record system was used to collect data including age, gender, mechanism of injury, Glasgow coma scale score on arrival, incident date and time, injured body regions, 30-day mortality, helmet use, and length of stay.

Results
A total of 606 cycling related trauma cases were identified, with 52 being excluded due to incomplete data. The ‘cyclist v vehicle’ group was associated with a significantly higher Injury Severity score (ISS), lower GCS and longer hospital stay than the other two groups. Helmet wearers were significantly older than non-wearers and helmet use was associated with a significantly reduced risk of head injury, lower ISS and higher GCS.

Conclusions
With a likely increase in future cycling uptake, it is crucial that effective interventions are put in place to improve the safety of cyclists. A multi-faceted strategy involving driver and cyclist education, road infrastructure changes and helmet promotion campaigns targeting the younger generation could be employed.
836 DIEP Flap Monitoring Adherence
Authors: Muscat E , Thomson R , Ghattaura A 
Published: October 2021

Abstract

Aim
The popularity of Deep Epigastric Perforator (DIEP) free flaps for breast reconstruction after mastectomies have increased due to their natural aesthetic results and reliability. Free flaps require strict post-operative monitoring by nursing staff during the early post-operative period where they should notify the surgeons to anticipate vascular compromise in order to salvage the flap. To ensure success the DIEP guidelines were introduced to Morriston Hospital, Swansea. This was a first cycle closed loop re-audit.

Method
Interventions from initial audit were implemented in 2018. Retrospective analysis of patient notes over an 8-month period (August 2019- March 2020) and compared with DIEP checklist. Clinical notes, nursing cartex and flap observations and medication charts were reviewed.

Results
100% had bear huggers, antiemetics (87% in 2018), correct thromboprophylaxis (75% in 2018) and laxatives (37% in 2018). 100% had senior reviews daily post op (75% in 2018). 100% had flap observations performed as guidelines immediately post op.

Conclusions
This was a successful re-audit showing significant improvements in adherence rates amongst the surgical and nursing staff in the plastic surgery department. Implementation of the DIEP operation note template may help maintain such adherence amongst staff.
1279 Does Multimorbidity Influence the Outcomes of Total Hip Replacement for Osteoarthritis?
Authors: Ferguson R , Prieto-Alhambra D , Peat G , Jordan K , Valderas J , Yu D , Glyn-Jones S , Silman A 
Published: October 2021

Abstract

Introduction
Limited data are available on the influence of multimorbidity on the outcomes of total hip replacement for patients with hip osteoarthritis, including the rate of complications and degree of functional benefit. The aim of this study was to investigate the influence of multimorbidity on the outcomes of total hip replacement in the UK.

Method
A cohort study was performed, with cohort comprised of all patients over 65 years with a diagnosis of hip osteoarthritis recorded in Clinical Practice Research Datalink and receipt of primary total hip replacement recorded in Hospital Episode Statistics Admitted Patient Care. Severity of multimorbidity burden was measured using four different scores (Charlson Comorbidity Index, Electronic Frailty Index, count of drugs prescribed, count of primary care interactions). The outcomes were (i) the risks of total hip replacement, assessed by serious post-operative complications within 90 days (analysed with logistic regression), and (ii) the benefits of surgery, assessed by post-operative Oxford Hip Score (OHS) and EQ-5D quality of life score (analysed with linear regression).

Results
6,682 patients were included. The rate of complications was 3.2%. Patients with severe multimorbidity burden were at 1.5 to 2.5 times increased risk of complications than patients without multimorbidity. There was no clinically meaningful difference in the benefits of surgery between patients with and without multimorbidity, irrespective of the method of scoring multimorbidity.

Conclusions
Even for patients with severe multimorbidity burden, the potential benefits of total hip replacement for osteoarthritis remain substantial, while the increase in risk is relatively small.
1283 The Management of Multiple Morton’s Neuromas in the Same Foot: A Systematic Review
Authors: Arshad Z , Alshawani A , Bhatia M 
Published: October 2021

Abstract

Aim
The optimal treatment strategy for the presentation of multiple Morton’s neuromas in adjacent intermetatarsal spaces of the same foot is yet to be determined. This systematic review aims to summarise and assess the efficacy of current treatment strategies.

Method
A systematic review was performed using the PRISMA guidelines. The review is registered in the international prospective register of systematic reviews (CRD42020213631). A computer-based search was completed in PubMed, Embase, Cinahl, Web of Science, Scopus and Emcare, for articles reporting the treatment of multiple neuromas in the same foot. Two authors independently performed title/abstract and full text screening according to a-priori selection criteria. Considering the four studies reporting treatment of a cohort containing both patients with a single neuroma and those with multiple neuromas, the proportion of cases in the latter group was 51/354 (14.41%).

Results
A total of 253 articles were identified, with 7 articles, involving 383 patients being included in the review. The most common treatment strategy reported was simultaneous neuroma excision using a single incision, whilst two studies each describe simultaneous excision with two separate incisions and delayed excision, respectively. The proportion of patients

Discussion
There is no strong evidence favouring use of delayed excision or multiple incisions. However, there is currently a lack of evidence focusing on this presentation of neuroma specifically. A number of studies fail to separate results of single and multiple neuroma excision. Further high-quality research is therefore required to make more definitive conclusions and future research should investigate other strategies such as non-operative treatment.
1300 Version Abnormalities of the Femur and Acetabulum in Patients with Femoroacetabular Impingement: A Systematic Review
Authors: Arshad Z , Maughan H D , Pettit M H , Kumar K H S , Arora A , Khanduja V 
Published: October 2021

Abstract

Aim
This systematic review aims to understand the relationship between version abnormalities of the femur and acetabulum in patients with primary and secondary femoroacetabular impingement (FAI).

Method
A systematic review was conducted according to PRISMA guidelines. A computer-based search was performed using the EMBASE, MEDLINE, PubMed and Cochrane databases for articles relating to version and torsional abnormalities in FAI, Legg-Calve-Perthes disease (LCPD) and slipped capital femoral epiphysis (SCFE). The study was registered in the Open Science Framework. Two authors independently performed title/abstract and full text screening according to predetermined inclusion criteria.

Results
A total of 1206 articles were identified 55 articles, involving 10, 091 hips, met the inclusion criteria. All studies evaluating femoral/acetabular version in FAI reported ‘normal’ mean version values (10o to 25o). However, distribution analysis revealed that an estimated 31.4% and 51.3% of patients with FAI displayed abnormal acetabular and femoral version, respectively. Abnormal femoral version was reported in an estimated 74.5% of hips with LCPD, and abnormal acetabular version in an estimated 20%. Acetabular version was significantly lower in hips with SCFE compared to controls (Z=-3.26, P &lt; 0.01).

Conclusions
Patients presenting with hip pain attributed to FAI are likely to display an abnormality in femoral or acetabular version. This highlights the importance of evaluating these parameters during assessment of these patients, in order to guide clinical decision making.