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.

The burden of Finke Desert race-related trauma: A 10-year retrospective descriptive analysis.

INTRODUCTION: The Finke Desert Race is an annual motorsport race (motorbikes, cars and buggies) held in Alice Springs resulting in a significant major trauma burden. This imposes unique challenges in one of the world's most remote healthcare settings. OBJECTIVES: To quantify the volume and characteristics of Finke Desert Race-related trauma presenting to the Alice Springs Hospital. DESIGN: A retrospective descriptive study was undertaken to review all patients presenting to the Alice Springs Hospital with Finke Desert Race-related trauma over a 10-year period. Information collected included demographic data, injury characteristics, patient disposition and required management. FINDINGS: Over the 9 years the event was held, 325 patients were admitted to the Alice Springs Hospital. Patients were almost exclusively male (98.8%), with a mean age of 34.75 and residing outside of Alice Springs (82.2%). There were a total of 460 distinct injuries with the clavicle, spine and ribs the three most commonly injured sites. A total of 129 operations were required, of which 19 required retrieval to an interstate centre. DISCUSSION: Alice Springs is one of the most remote and geographically isolated centres on Earth. This rurality poses unique challenges when trying to coordinate medical and retrieval services, exacerbated for a concentrated, yet highly resource intensive event such as Finke. It has far reaching impacts, placing additional stresses on all aspects of healthcare provision. CONCLUSION: This review has quantified the trauma burden of the event for the first time, enabling local and interstate stakeholders' ability to plan an adequate and sustainable response while also enabling the future effectiveness evaluation of recent safety reforms.

Capital Femoral Epiphysis with Acute Unstable Valgus Type Slip Managed with Closed Reduction and Percutaneous Fixation: A Case Report.

Case: We present a case of acute unstable valgus slipped capital femoral epiphysis (SCFE) in an 8-year-old female who presented after a trip and fall. The patient was managed with emergent closed reduction and percutaneous screw fixation and prophylactic fixation of contralateral side after 6 weeks. At 18-month follow-up, the patient was symptom free with a good range of movement and no evidence of slip progression, chondrolysis or avascular necrosis of the femoral head. Conclusion: We demonstrate that, in this case, closed reduction and percutaneous fixation provided satisfactory outcome at 18-month follow-up. This case highlights the need for both anteroposterior and lateral radiographs.

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.

Is the modified Dunn's procedure superior to in situ fixation? A systematic review and meta-analysis of comparative studies for management of moderate and severe slipped capital femoral epiphysis.

Purpose: The management of moderate and severe slipped capital femoral epiphysis is controversial. While in situ fixation is commonly used, the modified Dunn's procedure is increasingly popular within high-volume centers. We compared the clinical and radiological outcomes, as well as the rates of femoral head avascular necrosis or chondrolysis in patients managed with either modified Dunn's procedure or in situ fixation. Methods: A systematic search of the PubMed, Embase, The Cochrane Library, Science Direct, and Web of Science was performed in August 2021. Studies comparing outcomes and complications of modified Dunn's procedure versus in situ fixation in patients with moderate or severe slipped capital femoral epiphysis were included. Results: A total of four studies were included in the final analysis. Modified Dunn's procedure did not result in improved clinical outcomes. However, radiological outcomes as measured using Southwick angles and Alpha angles were significantly improved in the modified Dunn's procedure group, with a mean difference of -14.68 (p < 0.00001) and -34.26 degrees (p < 0.00001), respectively, compared to in situ fixation. There was no difference in the odds of femoral head avascular necrosis or chondrolysis, with odds ratio of 0.99 (p = 0.97). Conclusion: Within the limits of our study, modified Dunn's procedure did not improve clinical outcomes. There were significantly improved radiological outcomes without higher odds of femoral head avascular necrosis or chondrolysis. Further long-term studies are required to better guide management of moderate and severe slipped capital femoral epiphysis, especially in unstable slips. In the meantime, we recommend that the modified Dunn's procedure, if done, be restricted to high-volume centers with low complication rates. Level of evidence: Level III-Systematic review of Level III studies. Prospero Registration No: CRD42021279503.

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.

Functional outcome of corpectomy in cervical spondylotic myelopathy.

BACKGROUND: Cervical spondylotic myelopathy (CSM) is serious consequence of cervical intervertebral disk degeneration. Morbidity ranges from chronic neck pain, radicular pain, headache, myelopathy leading to weakness, and impaired fine motor coordination to quadriparesis and/or sphincter dysfunction. Surgical treatment remains the mainstay of treatment once myelopathy develops. Compared to more conventional surgical techniques for spinal cord decompression, such as anterior cervical discectomy and fusion, laminectomy, and laminoplasty, patients treated with corpectomy have better neurological recovery, less axial neck pain, and lower incidences of postoperative loss of sagittal plane alignment. The objective of this study was to analyze the outcome of corpectomy in cervical spondylotic myelopathy, to assess their improvement of symptoms, and to highlight complications of the procedure. MATERIALS AND METHODS: Twenty-four patients underwent cervical corpectomy for cervical spondylotic myelopathy during June 1999 to July 2005.The anterior approach was used. Each patient was graded according to the Nuricks Grade (1972) and the modified Japanese Orthopaedic Association (mJOA) Scale (1991), and the recovery rate was calculated. RESULTS: Preoperative patients had a mean Nurick's grade of 3.83, which was 1.67 postoperatively. Preoperative patients had a mean mJOA score of 9.67, whereas postoperatively it was 14.50. The mean recovery rate of patients postoperatively was 62.35% at a mean follow-up of 1 year (range, 8 months to 5 years).The complications included one case (4.17%) of radiculopathy, two cases (8.33%) of graft displacement, and two cases (8.33%) of screw back out/failure. CONCLUSIONS: Cervical corpectomy is a reliable and rewarding procedure for CSM, with functional improvement in most patients.