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INTRODUCTION: Understanding the epidemiology and incidence of fractures can help inform policymakers and clinicians about the needs of the population and highlight trends over time, allowing for tailoring of healthcare delivery to the population. This study reports on the lower limb fractures treated at a major trauma centre over a seven-year period. METHODS: We collected data on fracture locations, age, gender, BMI, hospital admission length, and treatment options of all lower limb fractures treated at a level I trauma centre from January 2015 to December 2021. We included data on the femur, tibia, and fibula, which were each split up into distinct regions. Fractures were subdivided by location and graphed, separated by gender, over age group. Finally, each location area's frequency was graphed over the entire study period. RESULTS: A total of 8,511 patients sustained 8,613 fractures, given an overall incidence of 215.9 fractures per 100,000 patients per year. The mean age was 62.3 years, and 56.3% of patients were female. Fractures of the peri trochanteric region of the femur had the highest mean average age (79.9 years), which was closely followed by fractures of the head and neck of the femur (78.2 years). Fractures of the head and neck of the femur and the peri trochanteric region of the femur also had the highest proportion of females suffering from these fractures (67 and 66% female, respectively). Femur shaft fractures had the lowest average age (36.5 years) and the lowest proportion of female patients (29%). On graphing by location, separated by gender, over age group, overall fractures showed a bi-peak distribution of younger males and older, post-menopausal females having their respective peaks. Three further distinct distributions were observed in individual location fractures. CONCLUSION: Identifying the relative incidence and demographic associations with lower limb fractures helps highlight a changing population's needs. There is an absence of such study in literature in the United Kingdom (UK) since 2006. Our study's insights and results aid clinicians and policymakers in the creation of guidelines and the distribution of resources based on the most recent information and elucidate changing healthcare service needs for the population.
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Introduction Understanding the different opioid pain relief requirements between patients with upper limb fractures can be useful in forming specific evidence-based guidelines and balancing patient-clinician prescribing discussions with opioid stewardship. We investigated the predictors for opioid requirements in upper limb fractures. Methods We retrospectively investigated all upper limb fractures from the shoulder to the wrist treated at a major trauma center from January 2015 to January 2022. The data collected consisted of fracture location, demographics, comorbidities, and management options. Post-injury opioid prescriptions in the first post-injury year were calculated every month up to six months and then grouped from the seventh to the 12th month and converted to morphine milligram equivalents (MMEs). We then calculated days requiring at least one medication (representing the "coverage") and relative "strength" in each time period. Results Six thousand four hundred thirteen patients sustaining a combined 9125 fractures were included in the study, with an MME mean of 436. Fracture locations of the scapula, proximal humerus, humeral shaft, distal humerus, and proximal ulna all had significantly higher MME requirements (p<0.05) at the one-year level. The radius shaft and distal radius had significantly lower MME requirements (p<0.05). The patients with depression, diabetes, drug abuse history, obesity, pulmonary circulatory disorder, and rheumatological conditions required higher strength of opioids at the one-year level (p<0.05). The patients with chronic kidney disease, depression, pulmonary circulation disorder, and rheumatological conditions required higher coverage of opioids at the one-year level (p<0.05). Conclusion Our study presents a high-resolution breakdown of the post-injury opioid requirements for patients with upper limb injuries. Fractures of the scapula, proximal humerus, and shaft of the humerus were associated with increases in both opioid strength and coverage. Depression, pulmonary disease, and rheumatological conditions were all associated with increased opioid strength and coverage. This provides a framework for which clinicians and patients can more accurately anticipate the course of the rehabilitation journey and risk stratify appropriately at the outset of injury.
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Introduction Understanding the incidence and epidemiology can inform clinicians and policymakers about the population's needs. Our study reports on upper limb fractures treated at a major trauma center over 7.5 years. Methods We collected data on fracture locations, age, gender, Charlson Comorbidity index (CCI), and treatment options of all upper limb fractures treated at a Level I Trauma Centre from January 1, 2015 to June 30, 2022. Humerus, radius, and ulna fractures were each classified as proximal, diaphyseal, and distal. Results About 9,915 patients sustained 12,790 fractures, given an overall incidence of 303.2 fractures per 100,000 patients per year. The most common fracture site was the distal radius (60.1 fractures per 100,000 patients per year, whereas carpal and metacarpal bones had the lowest incidence. The mean age and CCI were 46.4 years and 1.54, respectively. 58.1% of patients were male. All bone fractures distal to the elbow were associated with an age younger than the mean (all p<0.001), with humerus fracture patients having the oldest mean age (54.6 years). Compared to the mean gender ratio, except for ulna (no association), humerus (55% female), and radius (51% female), all other locations showed significantly higher incidences of males (all p<0.001). When plotting the incidence based on the age of injury, the entire cohort, along with radius and ulna fracture subgroups, demonstrated a bi-peak distribution. This pattern revealed that younger males and older postmenopausal females had the highest incidence rates. Conclusion To our knowledge, this represents the first study of this type in the UK since 2006. We sought to elucidate relative incidence and demographic associations with fractures to highlight changing population needs and allow policymakers and services at a regional and national level to operate with up-to-date information.
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Introduction Poller screws optimise fracture alignment in those fractures managed with intramedullary (IM) nails. They enhance stability, control nail insertion, and prevent translation. Indications encompass acute fractures, delayed unions/non-unions, and deformity. Classified into four generations, they've shown positive outcomes: improved alignment, reduced complications, and shorter healing. However, their pain management impact is understudied. This retrospective cohort study aimed to compare opioid medication needs in tibial fractures managed with IM nails with and without poller screws. Methods Between January 2015 and December 2022, a retrospective analysis was conducted on tibial fractures treated at a major trauma centre. Patients primarily treated with IM nails were included. Patient and operation notes as well as radiographs, were reviewed to identify poller screw utilisation. Opioid medication data was collected and converted to "coverage" (days) and "strength" (morphine milligrams equivalent or MME). Two-tailed independent samples T-tests were performed to determine differences between patients treated with (n=205) and without poller screws (n=540). Results Patients with poller screws had fewer days with opioid prescriptions in the second post-operative month (6.8 vs. 8.9 days, p=0.038) and significantly lower opioid strength requirements across the first post-operative year (688.4 vs. 1295.4 MME, p=0.001), except the first month. Conclusion There is limited research on the connection between poller screws and pain. This study discusses their potential to reduce post-operative pain in tibial fractures. The results highlight the importance of using poller screws alongside IM. This combination appears to be effective in improving post-operative pain management and enhancing overall patient outcomes.
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PURPOSE: Intertrochanteric fractures can be classified as stable (AO-OTA 31-A1) or unstable (AO-OTA 31-A2/3). For A3 fractures there is no recommended treatment, often fixed with either an intramedullary nail (IMN) or a dynamic hip screw and trochanteric stabilisation plate (DHS/TSP). This study retrospectively reviews peri-operative outcomes of patients treated with either fixator. METHODS: Pre-operative demographics, operative information and patient outcome data from 213 patients who suffered intertrochanteric fractures and were treated with either DHS/TSP or IMN at a major trauma centre from 01/2015 to 01/2022 was collected. Unpaired T tests were performed to assess levels of significance between peri-operative outcomes. RESULTS: The mean age for DHS/TSP-treated patients was 2.63 years greater than IMN-treated (P = 0.039). There were no other significant differences in pre-operative characteristics. We found a significantly shorter mean operative time in the DHS/TSP group (88.05 min, 95% CI: 82.1-94.0) compared to IMN counterparts (100.8 min, 95% CI: 92.7-109.0, P = 0.012), but no statistically significant difference in length of hospital stay or patient mortality, blood transfusion, re-operation or complication rates. When A3 fractures were analysed, a statistically significant greater proportion of IMN patients required blood transfusions (DHS/TSP: 35.90%, IMN: 65.00%, P = 0.0093). All other factors were found to have no significant differences. CONCLUSION: This study provides evidence to support the national guidelines regarding A1 fractures and suggests that DHS/TSP is a valid alternative to the IMN in A3 intertrochanteric fractures, with reduced blood loss. With the flexibility to add the TSP intraoperatively to prevent femoral head medialisation, and cheaper implant costs, the DHS/TSP may become the preferred method of internal fixation.
