Validity of Nottingham Hip Fracture Score in Different Health Systems and a New Modified Version Validated to the Greek Population.

BACKGROUND The Nottingham Hip Fracture Score (NHFS) is validated as a predictive mortality tool in patients with hip fracture. However, it has not been modified or validated widely other than in the UK NHS health systems. MATERIAL AND METHODS We assessed the predictive capability of the NHFS for 30-day mortality after surgery for hip fracture in the Greek population and then compared the original model to a modified one. We applied the NHFS to the Greek population and created a modified model of the NHFS by including the New Mobility Score (NMS) (Parker and Palmer, 1993) to the evaluated parameters and excluding the parameter of institution. We ran a prospective study over a period of 3 years in our institution, collecting full data from 349 patients. All data were analyzed using SPSS, version 20. RESULTS From all 349 patients, with a mean age of 80.82 years, only 85 (24.4%) were men. All patients were followed up for at least 30 days and the NHFS and modified NHFS prediction were compared with the mortality rate of patients. The area under the ROC curve for both models suggested acceptable accuracy (original NHFS 0.83, modified NHFS 0.84). Calibration was acceptable for both models (Hosmer-Lemeshow p=0.31 and 0.11, respectively). CONCLUSIONS Both the original and the modified NHFS were significant predictors of 30-day mortality. A higher-power study might be able to show superiority of the modified one for the Greek population in the future.

The silicone ring tourniquet in orthopaedic operations of the extremities.

Tourniquets provide a bloodless field in limb operations and their introduction in orthopaedic operative technique has been considered as a landmark. A new tourniquet device, a silicone ring tourniquet (SRT) (HemaClear or S-MART, OHK Medical Devices, Haifa, Israel), was introduced into clinical practice a few years ago. A few clinical studies as well as comparative studies in volunteers have reported its use in a relatively small number of cases. The aim of this prospective study is to report the clinical use of this device in a large number of patients, including all possible applications of a tourniquet. The SRT was used in 536 cases including 337 male and 119 female patients with a mean age of 43.7 years (range 6 to 87 years). The average tourniquet time was 58.5 minutes (range 6 to 180 minutes). It was applied in 362 (67.5%) elective and in 174 (32.5%) trauma cases including fractures (n:109, 62.6%) and soft-tissue injuries (n:65, 37.4%). The most frequent application site was the femur (n:255, 47.6%), followed by the forearm (n:154, 28.7%), humerus (n:65, 12.1%), and calf (n:62, 11.6%). Because the device is sterile it was possible to use it in operations in which the pneumatic tourniquet cannot be used, such as open reduction and internal fixation of humeral shaft and femoral supracondylar fractures. In 14 patients (2.6%), the tourniquet failed intraoperatively, and the cause was an unexpected raised blood pressure. The SRT - with a pre-set pressure according to the size and the tension model - is easy to apply. It is sterile, and occupies a narrow area of the limb. Its application combines three functions at the same time: exsanguination, tourniquet, and stockinet application. Although it cannot entirely replace the classic pneumatic tourniquet, it is a safe and useful device in orthopaedic operations because of its advantages.