A retrospective cohort study comparing outcomes following hip fractures in Australian indigenous patients with non-Australian indigenous patients.

BACKGROUND: Australian Indigenous (AI) populations face significant socioeconomic disadvantage and have poorer health outcomes when compared to their non-AI counterparts. There is a paucity of published literature on outcomes following hip fracture in the AI population. METHODS: We performed a retrospective cohort study comparing outcomes following hip fracture in AI and non- AI patients presenting to a single regional trauma centre. The primary outcome of interest was all-cause mortality. Secondary outcomes of interest were the odds of postoperative delirium and length of stay in hospital. All outcomes were adjusted against collected baseline covariates. RESULTS: One hundred and twenty-seven hip fractures were identified across 125 patients. There were 62 hip fractures in the AI group and 65 in the non-AI group. The adjusted hazard ratio (HR) for all-cause mortality was not statistically significant when comparing Indigenous versus non-Indigenous patients (HR = 2.37, P = 0.055). Adjusted odds of postoperative delirium was lower in Indigenous patients (OR = 0.12; P = 0.018). The AI cohort had a 4 day longer median length of stay, which was not statistically significant when adjusted for covariates. CONCLUSION: AI patients with hip fractures were younger, had a higher Charlson Comorbidity Index Score and American Society of Anaesthesiologists grade, as well as a higher incidence of diabetes and associated end-organ sequalae. There was no difference in all-cause mortality. Odds of postoperative delirium was lower in the AI group. We did not find any difference in the length of hospital stay.

Closing the health gap in Central Australia: reduction in Indigenous Australian inpatient self-discharge rates following routine collaboration with Aboriginal Health Workers.

BACKGROUND: Indigenous Australians experience significant socioeconomic disadvantage and healthcare disparity compared to non-Indigenous Australians. A retrospective cohort study to describe the association between rates of self-discharge in Indigenous orthopaedic patients and the introduction of routine Aboriginal Liaison Officers (ALO) within the Orthopaedic multi-disciplinary team (MDT) was performed. METHODS: ALO were introduced within our routine Orthopaedic MDT on the 22nd of February 2021. Two patient cohorts were analysed, Group 1; patients admitted in the 9-months prior to inclusion of ALO, and Group 2; patients admitted within 9-months thereafter. The primary outcome of interest was the rate of self-discharge among Indigenous patients. Secondary outcomes of interest were the stage of treatment when patients self-discharged, recurrent self-discharge, risk factors for self-discharge and association between self-discharge and length of hospital stay. RESULTS: Introduction of ALO within routine Orthopaedic MDT was associated with a significant 37% reduced risk of self-discharge among Indigenous patients (p = 0·009), and significantly fewer self-discharges before their definitive surgical and medical treatment (p = 0·0024), or before completion of postoperative intravenous antibiotic treatment (p = 0·030). There was no significant change in the risk of recurrent self-discharge (p = 0·557). Risk factors for self-discharge were younger age; pensioners or unemployed; residents of Alice Springs Town-Camps or of communities within 51 to 100 km of Alice Springs; and those diagnosed with lacerations of the upper limb, but without tendon injury, wound and soft tissue infections or osteomyelitis. In Group 2, the odds of self-discharge decreased with increased length of hospital stay (p = 0·040). CONCLUSIONS: Routine inclusion of ALO within the Orthopaedic MDT reduced the risk of self-discharge in Indigenous patients. Those who self-discharged did so only after critical aspects of their care were met.

An Articulating Antibiotic Cement Spacer for First-stage Reconstruction for Infected Total Elbow Arthroplasty.

Management of an infected total elbow replacement is a significant clinical challenge. Although preservation of the prosthesis is ideal, a 2-stage revision is often necessary. Unlike lower limb arthroplasty, antibiotic spacers are not commercially available. Monoblock cement spacers do not allow elbow movements and are therefore associated with severe stiffness and scarring, leading to poor clinical outcomes. In our paper we present a simple and novel technique for constructing an articulating antibiotic-impregnated spacer for use as an implant for a 1-stage revision of an infected elbow arthroplasty.