Femoral fractures in children, is early interventional treatment beneficial?

A protocol of early intervention (flexible intramedullary nails, early hip spica, and external fixation) was started in 1999 and during a 3-year period there were 25 children who sustained a femoral shaft fracture (early intervention group). These were prospectively reviewed with a minimum follow up of 24 months (Range 24-35 months). A historical control group of 41 children was used. These children were injured between February 1996 and February 1999 and were retrospectively reviewed. They had traditional in patient treatments with either Gallows or Thomas splint traction (traditional treatment group). Over the 6-year period from 1996 to 2002 there were a total of 66 femoral shaft fractures in the study that presented to our hospital. The mean length of hospital stay was 29 nights in the traditional group and 10 nights in the early intervention group. This difference is significant (p<0.001). The malunion rate was slightly higher in the early active group at radiological union but most of these remodelled over the 2 years of follow up. The protocol of early intervention used in our institution, of flexible nails, early hip spica or external fixation depended on the age of the child, and has resulted in a shorter hospital stay for the children. This has benefits for the child, the family and the hospital.

Decreasing the blood transfusion rate in elective hip replacement surgery using an autologous drainage system.

INTRODUCTION: This is a prospective study looking at the effectiveness of autologous postoperative drains in primary uncemented total hip replacement (THR) surgery. PATIENTS AND METHODS: A total of 86 patients were studied, with 43 using standard suction drains (normal drain group) and 43 using autologous drains (autologous drain group). RESULTS: Thirty-seven units of homologous blood were transfused in the normal drain group and 5 units in the autologous drain group. The mean number of units of homologous blood transfused per patient was reduced from 0.86 to 0.12 (P < 0.01) with the use of autologous drains and the transfusion rate was reduced from 23% to 6% (P < 0.02). The mean length of hospital stay was also reduced by two nights (P < 0.05). There were no adverse effects from using the autologous system and it does reduce the need for a homologous blood transfusion. CONCLUSIONS: The system is simple and easy to use and we have also found it to be cost effective. Previously, it has not been reported as being effective in hip arthroplasty surgery, unlike knee arthroplasty surgery. We would recommend using autologous postoperative drains in primary THR surgery.

Multidisciplinary integrated care pathway for fractured neck of femur. A prospective trial with improved outcome.

Admitting patients with fractured neck of femur using fast tracking procedure is well established in over 75% of hospitals in the United Kingdom. A retrospective study on 143 patients admitted using such procedure revealed inadequacies in the system. Although the waiting time in the Accident and Emergency Department (A&E) was reduced, it did not contribute much to the other aspects of patients outcome. We conducted a prospective trial using a multidisciplinary integrated care pathway (ICP) for the management of patients with fractured neck of femur. The objective of this study was to assess the effect of this protocol on the outcome compared to the earlier findings. The outcomes measured were admission time, time to surgery, length of in-hospital stay, cancellations, and 30-day mortality. The results showed a significant reduction in the length of hospital stay (P = 0.001). The 30-day mortality (P = 0.056) and number of patients operated within 24 h of admission were better (P = 0.048) but not significant. There was no difference in the time to admission to orthopaedic ward and other related complications between the two groups. This study has shown that a multidisciplinary care pathway for management of patients with fractured neck of femur has potential benefits.

Intra-articular calcification in primary hyperparathyroidism.

We report a case of intra-articular calcification involving the knee joint secondary to primary hyperparathyroidism. This caused significant disability to the patient and following excision of the calcified mass the patients knee function returned to normal. This feature of hyperparathyroidism has not been previously reported.