A Study in Wad Madani, Sudan: Are We Documenting Operation Notes Effectively?

BACKGROUND: Operative notes represent the critical record of a surgical procedure, encompassing comprehensive details encountered throughout the operation. Recognizing the importance of comprehensive documentation, the Royal College of Surgeons (RCS) developed the Good Surgical Practice guidelines, which emphasize accurately recording every procedure and specifying the necessary parameters for each operative note. These guidelines help maintain high standards of surgical care and patient safety. METHODS: A retrospective review of 88 orthopaedic surgery operative notes for fracture neck of femurs was conducted at Gezira Centre for Orthopedic Surgery and Traumatology (GCOST) from March 12 to May 28, 2022. The review assessed 18 parameters against RCS guidelines. Statistical analysis was performed using Statistical Product and Service Solutions (SPSS, version 25.0; IBM SPSS Statistics for Windows, Armonk, NY), which facilitated comprehensive data examination. RESULTS: In 37 cases (42.05%), the operation notes were written by a medical officer. In 29 cases (32.95%), an orthopaedic resident authored the notes. A specialist documented the notes in 21 cases (23.86%), and a consultant wrote the notes in one case (1.14%). Over 90% of the notes included surgeon and assistant names, procedure names, operative diagnoses, operative procedures, prosthesis details, deep vein thrombosis (DVT) and antibiotic prophylaxis, and signatures. The name of the theatre anaesthetist, elective/emergency details, and additional procedures with reasons were absent in all notes. Less than 50% of the notes documented the time of the procedure, type of incision, operative findings, anticipated blood loss, closure technique specifics, and complications. CONCLUSION: The study emphasizes the shortcomings in the operating notes, underscoring the necessity for training initiatives to enhance the recording by medical officers and orthopaedic trainees. Implementing structured templates that adhere to RCS standards can improve the comprehensiveness and consistency of operating notes, effectively resolving existing discrepancies. Regular audits and feedback sessions are essential for identifying and rectifying persistent issues. It is recommended to arrange workshops and seminars to educate medical officials and trainees on the skills of efficient note-taking and thorough documentation procedures.

Informed Consent Practices for Hip Fracture Surgeries at a Tertiary Care Hospital in Wad Madani, Sudan.

INTRODUCTION: An essential component of medical ethics and practice is informed consent. The General Medical Council (GMC) and the Royal College of Surgeons of England (RCS) provide guidelines for obtaining valid consent. Failing to obtain sufficient or valid consent can have legal consequences. MATERIALS AND METHODS: Over a period of two and a half months, from March 12 to May 28, 2022, a retrospective cross-sectional study was conducted to evaluate consenting practices for neck of femur fracture surgeries. A total of 88 patient consent forms were reviewed. The standard consent forms utilized in this study were those endorsed by the British Orthopaedics Association (BOA) and were based on the guidelines provided by the RCS and the GMC. RESULTS: Resident surgical trainees and medical officers obtained the majority of the consents, 31 (35.22%) and 49 (55.68%), respectively. The most frequently reported risks included infection, blood clots (deep vein thrombosis and pulmonary embolism), bleeding, and wound complications. Neurovascular injury was not mentioned in 75 (85.33%) consent forms. Additionally, hip stiffness, prosthetic dislocation, death, and leg length discrepancy were not discussed with any of the patients. Additionally, we observed that the diagnosis or reason for surgery was mentioned in only 60 (68.18%) consent forms. Furthermore, none of the forms specified the intended benefits, the necessity for a blood transfusion, or the patient identification details. CONCLUSION: Our study revealed inadequate documentation of surgical risks in patient consent forms for neck of femur fracture surgeries, with orthopaedic-specific risks often overlooked. This issue likely results from insufficient orthopaedic training among the medical officers and junior resident trainees responsible for obtaining consent. We recommend induction teaching sessions to improve their understanding of standard consenting practices and associated risks, along with implementing patient identification stickers.

Functional Outcomes of a Dynamic Condylar Screw for Unstable Femoral Intertrochanteric Fractures in Patients Above 50.

BACKGROUND: Hip fractures are among the most common fractures encountered in the emergency departments by orthopedic trauma teams. The optimal treatment method and implant choice for unstable intertrochanteric fractures are subject to debate, with various options available, including intramedullary and extramedullary implants. METHODS: In this descriptive cross-sectional study, the researchers examined patients with unstable intertrochanteric fractures (classified as 31A2 according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification) who had undergone open reduction and internal fixation with a 95° dynamic condylar screw (DCS). The study was conducted at the Gezira Centre for Orthopedic Surgery and Traumatology (GCOST) during the latter half of 2022. Functional outcomes were assessed using the modified Harris Hip Score (mHHS). RESULTS: A total of 30 patients were enrolled in this study, with a mean age of 73 ± 12.27 years. Of these, 11 (36.7%) were male, and 19 (63.3%) were female. The mHHS was 73.6 ± 14.654. Among the surveyed patients, seven (23.3%) reported poor outcomes, 13 (43.3%) reported fair outcomes, six (20%) reported good outcomes, and four (13.3%) reported excellent outcomes. The Kruskal-Wallis test revealed statistically differences in mean mHHS scores between gender groups (p = 0.024) and between age groups (p = 0.04). However, no significant differences were found across different modes of trauma groups (p = 0.73), affected hip groups (p = 0.35), comorbidity groups (p = 0.84), or postoperative complication groups (p = 0.06). CONCLUSION: Our study found that DCS treatment for unstable intertrochanteric fractures yielded acceptable functional outcomes, making it a viable and effective treatment option.