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Cemented or uncemented hip hemiarthroplasty?
196 type of injury, and time required for review. An anonymous questionnaire was administered to the attendees to evaluate the review process. Results: Six hundred and four patients were reviewed. M:F ratio was 3:2. The mean number of cases reviewed per day was 10, mean time to review was 18 min. A change in management occurred in 171 (28.1%) cases. The majority of changes were upper limb injuries. Commonest change was delaying follow-up for stable buckle fracture. Missed diagnosis was made in 28 (16.4%) patients mainly for undisplaced distal radius or scaphoid fracture. Immediate admission was required for 25 (14.6%) patients; for unacceptable fracture positions, missed hand dislocations or for repeat X-rays. Fracture clinic appointment was delayed in 44 (25.7%) and brought forward in 30 (17.5%) cases. Wrong diagnosis was commonest for hand injury. Direct discharge was possible for eight (4.6%) patients without any bony injury. Hand injury was the commonest (26%) injury seen, followed by wrist (16%). The majority of attendees felt that daily review was beneficial for patients, and had educational value. However, there was concern that the changes made were not consistent Discussions: A consultant-led daily review of clinic referrals is an effective method. Patients can be easily prioritised, any errors in diagnosis or management corrected at an early stage. It offers educational opportunity for junior doctors and provides excellent feedback. Combined with clear departmental guidelines this review will also help improve consistency of decision-making. Keywords: Fracture clinic review; Missed diagnosis; Wrong diagnosis
Abstract starting on time. Furthermore, only around 55% of total theatre time is spent for operating. The efficiency of trauma theatre utilisation is far from being optimal but seems to correspond with the findings in the general literature. Conclusion: Activity and theatre utilisation in trauma should be monitored regularly in order to assess the time distribution of surgical cases. This monitoring enables the department to highlight causes of inefficiencies and has been shown to improve the activity in trauma theatres. Keywords: Trauma theatres; Efficiency doi:10.1016/j.injury.2007.11.390 [O101] Cemented or uncemented hip hemiarthroplasty? Closing the audit loop after comparing rates of periprosthetic fractures E. Guryel ∗ , S. Palmer Worthing and Southlands NHS Trust, UK Hemiarthroplasty is a very common operation performed for displaced intracapsular fractures of the femoral neck in the elderly patient. There are concerns over the use of cement in a sub-group of these patients with poor cardiovascular reserve. However the rate of peri-prosthetic fracture in those patients undergoing an uncemented hemiarthroplasty is significantly higher than if cement had been used. Audit data from our unit during 2002 demonstrated a periprosthetic fracture rate of 6.9% (uncemented) versus 0.9% (cemented). The audit loop has been closed and we present further data since changing to a cemented implant.
doi:10.1016/j.injury.2007.11.389
Keywords: Hemiarthroplasty; Peri-prosthetic fracture; Uncemented
[O100] A review of 1241 trauma cases: A study of efficiency in trauma theatres
doi:10.1016/j.injury.2007.11.391
C. Mauffrey, E. Collantes, C. Modi ∗
[O102] The proximal femoral nail-␣ (PFNA)—–113 patients, the Norwich experience
University Hospital of Coventry, UK Background: Our trauma department has recently moved to a newly build University hospital. Its geographic situation and the fact that all surgical sub-specialties are represented make it a very busy level 1 trauma centre. Our aim was to assess our activity and efficiency in trauma looking at 1241 consecutive trauma operations over a period of 6 months. Furthermore we evaluate the impact of the move to the new hospital on our activity. Method: A total of 1241 consecutive trauma operations were reviewed, looking at transit times of patients to theatre, the duration of induction of anaesthesia, time to prepare and drape the patients and duration of surgery. Daily starting and finishing times were also analysed. We looked at operations done from April 2006 to July 2006 in our old site and compared the timings to the first 2 months in the new university hospital. In addition, we looked at the most recent 2 months in our new hospital. Results: The mean number of cases done daily and the distribution of time in trauma theatre were not significantly different in the two hospitals. A mean of 4.9 trauma operations are done per day with a mean of 18.6% of trauma lists
M.D. Wijeratna ∗ , A.D. Patel Norfolk & Norwich University Hospital NHS Trust, UK The proximal femoral nail-␣ is a new intramedullary fixation device for intertrochanteric hip fractures. It is a new implant requiring a unique surgical technique. In the early stages there were some technical operative problems but once these were overcome the implant has been used by all grades of surgeon. We present our results of the use of this implant and the early complications. Between September 2005 and May 2007 patients were included in a prospective non-randomised study when the implant was introduced and used according to consultant preference. All patients with an unstable intertrochanteric fracture were eligible to be included and a total of 113 patients were enrolled. The mean age was 82 (range 29—101) with a male:female ratio of 1:4.2. Both long and short versions of the nail were used as treatment with a total of 31 long nails being used. The majority of patients were ASA grading 2 or 3 and the mean operative time from cut to stitch was
Abstract starting on time. Furthermore, only around 55% of total theatre time is spent for operating. The efficiency of trauma theatre utilisation is far from being optimal but seems to correspond with the findings in the general literature. Conclusion: Activity and theatre utilisation in trauma should be monitored regularly in order to assess the time distribution of surgical cases. This monitoring enables the department to highlight causes of inefficiencies and has been shown to improve the activity in trauma theatres. Keywords: Trauma theatres; Efficiency doi:10.1016/j.injury.2007.11.390 [O101] Cemented or uncemented hip hemiarthroplasty? Closing the audit loop after comparing rates of periprosthetic fractures E. Guryel ∗ , S. Palmer Worthing and Southlands NHS Trust, UK Hemiarthroplasty is a very common operation performed for displaced intracapsular fractures of the femoral neck in the elderly patient. There are concerns over the use of cement in a sub-group of these patients with poor cardiovascular reserve. However the rate of peri-prosthetic fracture in those patients undergoing an uncemented hemiarthroplasty is significantly higher than if cement had been used. Audit data from our unit during 2002 demonstrated a periprosthetic fracture rate of 6.9% (uncemented) versus 0.9% (cemented). The audit loop has been closed and we present further data since changing to a cemented implant.
doi:10.1016/j.injury.2007.11.389
Keywords: Hemiarthroplasty; Peri-prosthetic fracture; Uncemented
[O100] A review of 1241 trauma cases: A study of efficiency in trauma theatres
doi:10.1016/j.injury.2007.11.391
C. Mauffrey, E. Collantes, C. Modi ∗
[O102] The proximal femoral nail-␣ (PFNA)—–113 patients, the Norwich experience
University Hospital of Coventry, UK Background: Our trauma department has recently moved to a newly build University hospital. Its geographic situation and the fact that all surgical sub-specialties are represented make it a very busy level 1 trauma centre. Our aim was to assess our activity and efficiency in trauma looking at 1241 consecutive trauma operations over a period of 6 months. Furthermore we evaluate the impact of the move to the new hospital on our activity. Method: A total of 1241 consecutive trauma operations were reviewed, looking at transit times of patients to theatre, the duration of induction of anaesthesia, time to prepare and drape the patients and duration of surgery. Daily starting and finishing times were also analysed. We looked at operations done from April 2006 to July 2006 in our old site and compared the timings to the first 2 months in the new university hospital. In addition, we looked at the most recent 2 months in our new hospital. Results: The mean number of cases done daily and the distribution of time in trauma theatre were not significantly different in the two hospitals. A mean of 4.9 trauma operations are done per day with a mean of 18.6% of trauma lists
M.D. Wijeratna ∗ , A.D. Patel Norfolk & Norwich University Hospital NHS Trust, UK The proximal femoral nail-␣ is a new intramedullary fixation device for intertrochanteric hip fractures. It is a new implant requiring a unique surgical technique. In the early stages there were some technical operative problems but once these were overcome the implant has been used by all grades of surgeon. We present our results of the use of this implant and the early complications. Between September 2005 and May 2007 patients were included in a prospective non-randomised study when the implant was introduced and used according to consultant preference. All patients with an unstable intertrochanteric fracture were eligible to be included and a total of 113 patients were enrolled. The mean age was 82 (range 29—101) with a male:female ratio of 1:4.2. Both long and short versions of the nail were used as treatment with a total of 31 long nails being used. The majority of patients were ASA grading 2 or 3 and the mean operative time from cut to stitch was