The cost of electric-scooter related orthopaedic surgery.

AIM: To highlight the growing cost of electric-scooter (e-scooter) related injuries necessitating surgical intervention by the Auckland City Hospital Orthopaedic Department. METHODS: Retrospective audit of operations by the Auckland City Hospital Orthopaedic Department from 15 October 2018 up to and inclusive of 22 February 2019. Inclusion criteria was that the direct cause of injury necessitating surgery was secondary to an e-scooter accident. Further demographic data was collected including injury sustained and operation details. The surgical costs were calculated, including anaesthetic time, surgical time, staffing, implants used and inpatient stay as well as clinic follow-up. RESULTS: Over the 19-week period of this study there were 21 patients requiring 23 operations as a direct result of e-scooters. The summative anaesthetic, theatre suite and staffing costs of these operations was $162,901. Implants required to fix the fractures totalled $39,898. Ninety-three inpatient nights and 61 follow-up clinic appointments were required incurring an additional expense of $141,639 and $16,119 respectively. Overall, these 23 cases cost a total of $360,557. The extrapolated loss of income was $44,368 secondary to these injuries. This represents a total economic cost of $404,925, or $19,282 per person. CONCLUSION: This study highlights that there can be serious consequences of e-scooter travel. High energy trauma not previously associated with scooter injuries is becoming increasingly prevalent as a result of readily available e-scooters. Many of the injuries identified represent significant morbidity to patients in terms of pain, lengthy rehabilitation and loss of income. Furthermore, the socioeconomic costs for DHBs continues to climb and adds to the acute surgical burden in an already busy healthcare system. The hazards of e-scooters should not be underestimated by both the general public and policy-makers.

Correction to: The quadriceps active ratio: a dynamic MRI-based assessment of patellar height.

In the online version of the original article, one of the white lines was not accurately drawn in Fig. 1.

The quadriceps active ratio: a dynamic MRI-based assessment of patellar height.

INTRODUCTION: Patella alta (PA) is one of the primary correctable risk factors for patellofemoral instability (PFI). Both an accurate diagnosis of PA and a clinically relevant target for correction are necessary for optimal treatment. An ideal test for PA should relate the position of the patella to the femur rather than tibia, should do so with the quadriceps contracted and the patellar tendon under tension and should have good sensitivity and specificity. None of the currently used radiographic tests PA meet these criteria, most of which are based on the position of the patella relative to the tibia with diagnostic cutoffs based on 2 standard deviations from the mean rather than optimal sensitivity and specificity. The authors describe the quadriceps active ratio (Q+R), an MRI-based assessment of PA based on patellofemoral contact under quadriceps activated with a cutoff based on optimal sensitivity a specificity for PFI. MATERIAL-METHODS: Ninety-four participants investigated for knee pain or instability with a clinically indicated MRI were recruited. Routine MRI sequences were obtained, with the addition of a quadriceps contracted sagittal T1-weighted sequence. Participants presenting with PFI were identified. Those with trochlear dysplasia were identified and excluded from analysis so that patellar height could be assessed against PFI without being confounded by trochlear dysplasia. Q+R and patellotrochlear index (PTI) were calculated from the remaining 78 scans by 3 consultant orthopaedic surgeons at three time points. In 54 of these cases, a lateral radiograph was available from which the Insall-Salvati, modified Insall-Salvati, Caton-Deschamps and Blackburn-Peel ratios were also calculated. Intra- and inter-observer reliability was assessed for the Q+R. A cutoff value for the Q+R based on optimal sensitivity and specificity for the diagnosis of PFI was calculated from receiver-operator characteristic (ROC) curves and compared to the PTI. The cutoff for the Q+R was compared for sensitivity and specificity for the diagnosis of PFI against the radiographic ratios. RESULTS: The Q+R had satisfactory or better ICC values across time points and surgeons. The Q+R was superior to the PTI on area under curve ROC analysis (0.76 vs 0.74). A cutoff value of 0.12 for the Q+R gave sensitivity of 79% and specificity of 55% for the diagnosis of PFI. The radiographic indices were generally insensitive for this diagnosis of PFI with sensitivities ranging from 0-66%. CONCLUSION: The Q+R is a reliable diagnostic test for patellar height assessment, showing good intra- and inter-rater consistency, and greater diagnostic accuracy than the PTI. A Q+R value of 0.12 is a good test for clinically significant PA. Of the radiographic indices, the Insall-Salvati ratio had the best diagnostic accuracy.