Best of Both Worlds? Fixation of Distal Femur Fractures with the Nail-Plate Construct.

OBJECTIVES: Distal femoral fractures are a significant injury sustained by low- and high-energy trauma. Common treatment practices are lateral locking plate or intramedullary nail fixation, with disadvantages including risk of non and malunion and limited post-operative weightbearing status. Combining both techniques as a nail-plate construct (NPC) theoretically achieves enhanced fixation to allow immediate weightbearing. The aim of this study is to examine radiographic union, malunion and patient-reported outcomes in distal femur NPC fixation. METHODS: Single-center retrospective study including all patients >18 years who sustained distal femur fractures treated with NPC. Primary outcomes were radiographic union, malunion and patient reported outcome measures at minimum 1-year follow-up. Secondary outcome measures included post-operative mobility, length of stay and complications. Relevant variables of normality are reported as mean with standard deviation. Subgroup analysis of patients aged <65 and ≥65 years are provided. RESULTS: Sixteen patients were included in the study. Rate of radiographic union was 100%. There was no case of malunion. All patients were allowed to bear full weight immediately post-operatively. Mean length of stay was 9.50 days, with 37.5% of patients discharged directly home. The majority (85.7%) of patients returned to pre-injury mobility. Early post-operative complications occurred in three patients. Three patients returned to theater. The mean EQ-5D-5L index value was 0.713, with 71.4% describing no problems with self-care and 85.7% reporting no or slight problems with usual daily activities. CONCLUSION: The NPC provided stable fixation permitting full weightbearing post-operatively with no cases of non or malunion. Return to pre-injury mobility and activity are encouraging. Based on these results we support the use of nail-plate construct fixation in the management of distal femur fractures.

Increased orthopaedic presentations as a result of COVID-19-related social restrictions in a regional setting, despite local and global trends.

BACKGROUND: The coronavirus (COVID-19) pandemic has affected the utilisation of emergency department (ED) services worldwide. The aim of this study was to assess the impact of COVID-19-related public health measures on orthopaedic presentations to a regional Australian hospital. METHODS: A case-control study was performed at a regional trauma hospital in New South Wales (NSW), Australia. Data was collected prospectively from patients that required orthopaedic review in the period corresponding to a declaration of a global pandemic to the end of the NSW lockdown, and compared with retrospective data from the corresponding period in 2019. The five-year average of orthopaedic presentations to ED during the study period were obtained for comparison. The primary outcomes were overall number of presentations, mechanism and anatomical location of injuries, operative versus non-operative management and disposition. RESULTS: During the study period in 2020, presentations requiring orthopaedic review were significantly more frequent than 2019 (496 vs. 280, p < 0.0001), with more requiring admission in 2020 (p < 0.0001). The absolute number of patients managed operatively was higher (p = 0.0002) and significantly more patients were referred for community follow-up (p < 0.0001). There was a 20% increase of consults in 2020 compared to the average number of referrals during the same period in the previous five years. CONCLUSIONS: Contrary to other published literature, lockdown conditions imposed during the COVID-19 pandemic resulted in a surprising 77% increase in orthopaedic presentations to this regional Australian hospital. These findings can be used to better direct resources, preparation and staff education in the current and for future pandemics.

Safe and rapid implementation of telemedicine fracture clinics: the impact of the COVID-19 pandemic.

BACKGROUND: The coronavirus disease outbreak in December 2019 rapidly spread around the world with profound effects on healthcare systems. In March 2020, all elective surgery and elective outpatient clinics were cancelled in our institution, a regional hospital in Northern New South Wales, Australia. With regard to orthopaedic fracture clinics, a telehealth system was implemented on an emergency basis for patient and staff safety to prevent disease transmission. The aim of our study was to investigate whether rapid implementation of telehealth for orthopaedic fracture clinics resulted in an increase in complications. METHODS: A retrospective cohort study of all patients with orthopaedic fracture clinic appointments at a regional New South Wales hospital between 17 March and 8 May 2020 was undertaken. There were 191 patients, including 390 appointments of which 23.1% were conducted via telehealth, namely by phone call. Complications requiring phone calls to the orthopaedic team, presentations to the emergency department, admission to hospital or return to theatre, were recorded. RESULTS: There was no increase in complications following emergent implementation of telehealth for orthopaedic fracture clinic follow-up in our institution. Patients in the telehealth group were significantly older than those in the clinic group. CONCLUSION: The study demonstrates that application of telehealth fracture clinics in a regional Australian setting can be achieved without increasing complication rates and can be used to formulate a rapid telehealth implementation plan if a similar scenario occurs in the future.

Errors and Predictors of Confidence in Condom Use amongst Young Australians Attending a Music Festival.

Objectives. To determine the confidence and ability to use condoms correctly and consistently and the predictors of confidence in young Australians attending a festival. Methods. 288 young people aged 18 to 29 attending a mixed-genre music festival completed a survey measuring demographics, self-reported confidence using condoms, ability to use condoms, and issues experienced when using condoms in the past 12 months. Results. Self-reported confidence using condoms was high (77%). Multivariate analyses showed confidence was associated with being male (P < 0.001) and having had five or more lifetime sexual partners (P = 0.038). Reading packet instructions was associated with increased condom use confidence (P = 0.011). Amongst participants who had used a condom in the last year, 37% had experienced the condom breaking and 48% had experienced the condom slipping off during intercourse and 51% when withdrawing the penis after sex. Conclusion. This population of young people are experiencing high rates of condom failures and are using them inconsistently or incorrectly, demonstrating the need to improve attitudes, behaviour, and knowledge about correct and consistent condom usage. There is a need to empower young Australians, particularly females, with knowledge and confidence in order to improve condom use self-efficacy.