Outcomes of ultra-old vs old patients after hip fracture surgery: a matched cohort analysis of 1524 patients.

BACKGROUND: Surgical management of geriatric hip fractures yields improved functional outcomes with decreased morbidity and mortality. Cohort studies have suggested that the older patients within the geriatric age group have worse outcomes with surgery, However, these studies inherently report inflated risks due to poor handling of confounders and have inadequately age-stratified their geriatric population. AIM: This study aims to investigate the effect of age alone on the 1-year mortality and functional status of geriatric patients after hip fracture surgery. METHODS: This is a retrospective single institution cohort study based on the prospectively-maintained registry of hip fracture patients. 2603 patients aged 60 years and above were treated surgically under a geriatric-orthopaedic hip fracture pathway from January 2014 to December 2018. Patients were split into two age groups: ultra-old (≥ 85 years) vs old (< 85 years). Baseline demographics and the ASA (American Society of Anaesthesiologists) status and the Modified Barthel's Index (MBI) were obtained at admission and 1 year after the fracture. Adverse outcomes from the fracture and surgery were recorded during a follow-up period of minimally 2 years. A 2:1 matching process based on the gender, fracture type, ASA status, CCI and MBI categories was conducted. RESULTS: There were 1009 and 515 patients in the old and ultra-old age groups, respectively. 1-year mortality was similar for both age groups (4.0% ultra-old vs 3.6% old, p = 0.703). 30-day morbidity was similar except for higher rates of postoperative pneumonia in the ultra-old (14.0 vs 6.3%, p < 0.001). MBI scores at 1-year were lower in the ultra-old (severe dependence: 16.4 vs 10.0%; p = 0.001). Ultra-old patients were less likely to be community ambulant at 12 months (21.2 vs 36.0%) with the deterioration in ambulatory status significant after correction for baseline status (p < 0.001). CONCLUSION: The 1-year mortality of surgically-managed geriatric hip fracture patients older than 85 years of age is not determined by age alone. Patients aged 85 years and above are at higher risk for pneumonia postoperatively. Ultra-old hip fracture patients with an intertrochanteric fracture are more likely to have poorer function at 1 year after hip fracture surgery.

The effect of COVID-19 lockdowns on paediatric lower limb orthopaedic presentations.

INTRODUCTION: As the COVID-19 pandemic was spreading in 2020, the government imposed national lockdowns. We considered the effects these lockdowns had on the paediatric population, with a specific focus on lower limb orthopaedic trauma. We hypothesise that these restrictions will have altered the mechanisms of injury and reduced the number of referrals. MATERIALS AND METHODS: We retrospectively analysed data from 28/08/19 to 01/04/21, considering the variations in referrals and operations during these times, and analysed these data using an online statistical calculator. We examined the rate of referrals, types of fractures referred to the centre, mechanism of injury, volume of operations performed, and average wait times to undergo an operation. The data were compared in pre-lockdown and lockdown times. RESULTS: 67 paediatric patients with lower limb fractures were included in this study. Throughout the lockdown periods, the mean age of children referred was younger (6.9 from 11.1) and they were less likely to be injured as a result of sport (p = 0.0493). They were more likely to fracture their lower leg (p = 0.0016) when compared with other anatomical regions. The average weekly rate of referrals dropped (0.84-0.68), but the rate of operations almost quartered (0.39-0.16). The average wait times for operations dropped significantly, with patients waiting 80% less time from the date of their injury. CONCLUSION: This study highlights the impact of the coronavirus pandemic on the prevalence and management of lower limb paediatric trauma. The demographics and mechanisms of injury which presented to the trust over the pandemic and associated national lockdowns were significantly different. There was a drop in the number of referrals and a preference to non-operative management when patients did present.

One-stage combined "fix and flap" approach for complex open Gustilo-Anderson IIIB lower limbs fractures: a prospective review of 102 cases.

BACKGROUND: Management of open fractures is challenging and requires a multidisciplinary team approach. This study aims to evaluate outcomes of open Gustilo-Anderson IIIB fractures managed at a single Ortho-Plastic centre following One-stage "Fix and Flap" approach. METHODS: Prospective data review for patients presenting with Gustilo-Anderson IIIB Fractures to our centre and managed with one-stage "Fix and Flap" approach. Postoperative outcomes are presented only for the patients who had a minimum of 12 months postoperative follow-up. RESULTS: 120 patients were included (83 males and 37 females). Mean age was 43 years (10-96). Tibia diaphysis was the most common site of injury (60%). 55.9% of injuries were road traffic accidents (RTA). 102 out of 120 patients had a minimum of 12 months follow-up (mean follow-up duration 25 months). Meantime from injury until definitive surgery was 7.71 days. Primary union achieved in 86.73%. Delayed union was encountered in 10.20%. 3.06% of patients had non-union. Limb salvage rate was 97.05% and Deep infection rate was only 0.98%. CONCLUSION: Our results showed that low infection rate, high limb salvage rate, and high union rate can be achieved in these complex injuries with meticulous technique, combined Ortho-Plastic (Fix and Flap) approach, and MDT input.

Gastrocnemius Recession in Recalcitrant Plantar Fasciitis: A Systematic Review.

Plantar fasciitis is a common cause of heel pain. Recalcitrant plantar fasciitis can be difficult to manage. Medial gastrocnemius recession is increasingly being used to treat recalcitrant plantar fasciitis, with advocates describing fewer complications and quicker recovery time than other surgical options. This systematic review aimed to determine the effectiveness of gastrocnemius recession for the treatment of patients with recalcitrant plantar fasciitis. Multiple databases were searched using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The level of evidence of each study was assessed according to the American Academy of Orthopaedic Surgeons Levels of Evidence. The level of bias for each study was assessed using the National Institutes of Health (NIH) Study Quality Assessment Tools. Seven studies were retrieved: 3 retrospective case series, 1 retrospective study that compared gastrocnemius recession to open plantar fasciotomy, 1 prospective cohort study (pre-post study with no control group), and 2 randomized controlled trials. All 6 studies that assessed pre- and postoperative pain using the Visual Analogue Scale showed a large reduction in pain postoperatively. Four studies that assessed pain at 12 months postoperatively showed a weighted mean of 76.06 ± 10.65% reduction in pain. No major complications were reported. Minor complications included sural neuritis. This review found a consistent reduction in pain following gastrocnemius release in patients with recalcitrant plantar fasciitis, suggesting it is a very promising treatment. However, the included studies are limited by low quality study designs and inherent biases, limiting the strength of recommendation. Further definitive, well-designed trials are required.

The Effectiveness of Surgical Interventions in the Management of Malunited Calcaneal Fractures: A Systematic Review.

Nonoperative management may result in calcaneal malunion with consequences of pain, deformity, and functional limitation. The aim of this review was to proffer an evidence-based scientific account of the effectiveness of contemporary surgical procedures in the management of malunited calcaneal fractures after initial conservative management. This systematic review included studies that evaluated the surgical procedures in the management of calcaneal malunion and systematically searched studies published between January 2005 and June 2016. The search was conducted using the following search engines: the Cochrane Library, Web of Science, PubMed/ MEDLINE, EMBASE, CINAHL, Academic Search Premier, and Open Grey. Methodologic assessment was conducted using the Cochrane Risk of Bias In nonrandomized Studies- of Interventions assessment tool version 7. Ten observational studies (212 patients) were included in this review. Five articles explored various means of achieving subtalar arthrodesis, 2 articles evaluated joint-sparing osteotomies, 1 examined corrective osteotomy for extra-articular os calcis malunion, and 2 articles explored combined procedures based on the Stephen and Sanders calcaneal malunion classification. Clinical and methodologic heterogeneity did not allow quantitative pooling of results. The overall risk of bias was considered moderate in 7 studies and 3 were considered at high risk of bias. The inability for any study to be considered at low risk of bias in this review might be mainly attributed to the lack of a valid and reliable outcome measure for the assessment of foot and ankle conditions. There is clear evidence that appropriately indicated procedures are effective in terms of pain alleviation, correction of deformity, and improved function. However, long-term outcomes may improve the acceptability to joint-preserving osteotomies, subtalar arthrodesis with the VIRA implant and subtalar distraction osteogenesis.

A Systematic Review of Plantar Plate Repair in the Management of Lesser Metatarsophalangeal Joint Instability.

The plantar plate is a major structure that maintains metatarsophalangeal joint (MTPJ) stability and has only recently gained attention. Anatomic plantar plate repair can directly address the pathologic entity, rather than relying on indirect reduction of the MTPJ instability by osteotomy or tendon transfer techniques. The present report aimed to determine the effectiveness of plantar plate repair for the treatment of patients with lesser MTPJ instability. Different databases were searched using the guidelines in the Cochrane Handbook and recommendations from the Preferred Reporting Items for Systematic reviews and Meta-Analysis statement. Six case series, describing 162 patients who had undergone plantar plate repair in conjunction with either Weil osteotomy or flexor digitorum longus transfer, were retrieved. Favorable outcomes were described in each of the studies included in the present systematic review. However, these results should be interpreted with caution because of the methodologic limitations and biases inherent in the included studies. More rigorous clinical investigations are required to fully understand the effectiveness of plantar plate repair for the management of lesser MTPJ instability.

Complex ankle arthrodesis with step-cut osteotomy in Charcot arthropathy with bone loss.

We report a case of a complex limb salvage ankle arthrodesis in a patient with Charcot arthropathy. A step-cut osteotomy was performed in order to tackle the issues of anterior tibial bone loss; worsening leg length discrepancy; soft tissue contraction; joint instability and high risk of non-union. The construct formed by the step-cut allowed for the preservation of good bone stock; avoidance of further limb shortening; increased torsional stability and increased surface area for bony union. This resulted in a patient with a stable, plantigrade foot appropriate for footwear. We use this case to highlight this technique as an option in the operative management of complex ankle fusions with sagittal or coronal plane deformity with bone loss and subluxation of the ankle joint.

The metatarsosesamoid joint: an in vitro 3D quantitative assessment.

BACKGROUND: The anatomy of the first metatarsophalangeal (MTP) joint, particularly the metatarsosesamoid articulation, remains poorly understood. Our goal was to quantitatively define the excursion of the sesamoids. METHODS: Seven cadavers were dissected to assess the articulating surfaces throughout a normal range of motion. The dissections were digitally reconstructed in various positions using a MicroScribe. RESULT: For first MTP joint, excursion averaged 14.7mm for the tibial sesamoid in the sagittal plane and 7.5mm for the fibular sesamoid. The sesamoids also moved medially to laterally when the joint was dorsiflexed. For the maximally dorsiflexed joint, excursion averaged 2.8mm for the tibial sesamoid and 3.5mm for the fibular sesamoid. CONCLUSION: Hallucal sesamoids appear to have differential tracking: the tibial sesamoid has greater longitudinal excursion; the fibular sesamoid has greater lateral excursion. The anatomical data will interest those involved with the design of an effective hallux arthroplasty.

The role of compression in the management of soft tissue ankle injuries: a systematic review.

BACKGROUND: Ankle sprains are very common injuries which can lead to long-term pain, swelling and instability. Compression is often used in the treatment of these common injuries but is it effective and how best is it delivered? METHODS: MEDLINE (1966-current), EMBASE (1980-current), Cochrane Library (2011:1) and MEDION were included in our search. Studies evaluating compression in the treatment of ankle sprains were included. Two authors independently reviewed potential studies according to a set eligibility criteria. RESULTS: Twelve studies including 1,701 patients with ankle sprains were identified (level of evidence: four grade 1b; five grade 2b; three grade 4). Intermittent pneumatic compression (IPC), elastic tubular bandage and compression bandaging were all evaluated. Five of the 12 studies reported that compression therapy improves recovery after ankle injury, of which one evaluated IPC, and the remaining four elastic bandages (Elastoplast, class II elastic stockings, wool and crepe, focal compression with air stirrup). Five studies evaluating Tubigrip in ankle sprains concluded that Tubigrip has no positive effect on functional recovery and may increase the requirement for analgesia compared with no intervention. CONCLUSION: Compression may be an effective tool in the management of ankle injuries and has been shown to reduce swelling and improve quality of life in single studies. Definitive conclusions are hampered by the poor quality of evidence and the variety of treatments used. The most effective form of compression to treat ankle sprains or is yet to be determined. Adequately designed randomized control trials are clearly needed.

A Rare Case of Hallux Saltans Treated using Ultrasound-guided Intralesional Steroid Injection: A Case Report.

Introduction: Stenosing tenosynovitis is a condition characterized by the inflammation and constriction of the tendons within a fibro-osseous tunnel. Case Report: We present a case of a 38-year-old man who presented with hallux saltans, a rare manifestation of this condition which was successfully treated with intralesional steroid injection. The patient experienced significant relief from pain and improved function following the procedure. Conclusion: This case highlights the importance of considering stenosing tenosynovitis as a potential cause of hallux saltans and the efficacy of non-surgical interventions in its management.

The Efficacy of Virtual Fracture Clinics (VFCs) and the Impact of Physician Risk Appetite on Discharge Rates.

Background and objectives Virtual fracture clinics (VFCs) allow the triage of emergency department referrals to identify those requiring further care and those that are suitable for discharge. Appropriate discharge from VFC benefits the patient and the healthcare provider by avoiding unnecessary face-to-face appointments. This study investigates factors associated with VFC discharge rates at our hospital and detects potential areas for improvement. Methodology A retrospective review was conducted on 4819 consecutive VFC referrals between March 17, 2021, and March 16, 2022, from a single hospital. Patient demographics, referral outcomes, and triaging consultant data were collected. Sixteen consultants conducted daily VFCs during the study period. Eleven consultants completed the DOSPERT psychometric test to measure their attitude toward risk. The data was analysed using Spearman's rho and Chi-square tests. Results The mean discharge from VFC was 35.4% (29.6-41.0%). The highest rates of discharge were for back pain (100%), followed by fractures of the pubic ramus (100%), the base of the fifth metatarsal (86.89%), the acetabulum (75%), and the proximal radius (73.03%). Consultant experience was significantly negatively correlated with discharge rate (p<0.05). The frequency of conducting a VFC was not associated with the discharge rate (p=0.758). In subspecialty analysis, 90% of lower limb consultants discharged more lower limb presentations from VFC, compared with upper limb consultants (p=0.001). There was no significant correlation between DOSPERT scores and discharge rates (p=0.65). Conclusions VFC remains an important tool for patient care. Consultant experience is associated with a more cautious approach to discharge; however, there was no relationship between a consultant's risk attitude and their VFC discharge rate in this study. Lower-limb consultants appear to discharge lower-limb injuries more readily when compared with their upper-limb colleagues. These insights could be used to improve emergency department and VFC efficiency.

An Augmented Vision of Our Medical and Surgical Future, Today?

Incorporating consumer electronics into the operating room, we evaluated the Apple Vision Pro (AVP) during limb preservation surgeries, just as we evaluated Google Glass and FaceTime more than a decade ago. Although AVP's real-time mixed-reality data overlay and controls offer potential enhancements to surgical precision and team communication, our assessment recognized limitations in adapting consumer technology to clinical environments. The initial use facilitated intraoperative decision-making and educational interactions with trainees. The current mixed-reality pass-through resolution allows for input but not for highly dexterous surgical interactions. These early observations indicate that while AVP may soon improve aspects of surgical performance and education, further iteration, evaluation, and experience are needed to fully understand its impact on patient outcomes and to refine its integration into clinical practice.

Impact of introducing 3D printing-assisted surgery into clinical practice for traumatic pelvic and acetabular fractures.

Background: Given the novelty of three-dimensional (3D) printing-assisted fracture surgery in orthopaedics, surgeon familiarity is limited and learning curve is high. As such, it is unclear how the introduction of 3D printing into clinical practice for pelvic and acetabular fracture surgery would impact perioperative outcomes. The aim of this study was to determine the impact of introducing 3D printing-assisted surgery on perioperative outcomes for traumatic pelvic and acetabular fractures. Methods: We retrospectively identified consecutive patients who underwent surgical fixation of traumatic pelvic and acetabular fractures from 2018 to 2022 at a single tertiary hospital. The patients included in the study were divided into two groups: (1) 3D printing-assisted surgery and (2) conventional surgery. Baseline demographics and perioperative outcomes of total surgical duration, estimated blood loss, blood transfusion, number fluoroscopy images, fluoroscopy duration and postoperative disposition were recorded and compared between the two groups. Results: In total, 26 patients were included in the present study, with 3D printing-assisted surgery being used in 34.6 % (n = 9) of cases. There were no significant differences in baseline demographics or fracture type between the 3D printing group and conventional group. As compared to patients who underwent conventional surgery, those that underwent 3D printing-assisted surgery had, on average, shorter surgical duration (299.8 ± 88.2 vs 309.1 ± 143.1 min), lesser estimated blood loss (706.3 ± 330.0 vs 800.0 ± 584.2 ml), lower transfusion rates (50.0 % vs 52.9 %), lower number of intraoperative fluoroscopy images (62.8 ± 74.5 vs 71.6 ± 47.9 images) and shorter fluoroscopy duration (235.0 ± 79.2 vs 242.3 ± 83.5 min), although statistical significance was not achieved. None of the patients in the present study developed surgical complications postoperatively. Conclusion: The introduction of 3D printing-assisted surgery in clinical practice for pelvic and acetabular fractures is a safe and viable adjunct in pelvic and acetabular surgery, achieving comparable perioperative outcomes in the initial phase.

Closed, Atraumatic, and Spontaneous Extensor Hallucis Longus Tendon Rupture Following Multiple Steroid Injections and Presence of Talonavicular Osteophyte Repaired using a Turndown Flap: A Case Report.

Introduction: We present a case of spontaneous rupture of the extensor hallucis longus (EHL) tendon with significantly retracted tendon edges in a patient who had received multiple steroid injections to an arthritic talonavicular joint repaired using novel turndown flap technique. Case Report: This case details a patient who came in with a history of spontaneous EHL tendon rupture on a background of chronic pain in the midfoot due to osteoarthritis with osteophytes at the talonavicular joint for which they had received multiple steroid injections in the past. A novel repair technique was employed which involved split lengthening the proximal segment of the ruptured EHL tendon and making a turndown flap of the same by rotating the lengthened segment 180°, bridging the tendon gap. The lengthened tendon is then sutured to the distal segment of the EHL to achieve a tension-free repair. This bypasses any use of bridging allografts and autografts/tendon transfer, removing complications commonly associated with them. Conclusion: This turndown flap technique is easy to perform, reduces surgical time, avoids complications associated with tendon grafting, and results in good functional outcomes for the patient.

Foreign Body Reaction Following Achilles Tendon Reconstruction With the Ligament Advanced Reconstructive System: Patient Outcomes and Clinical Course.

The Ligament Advanced Reinforcement System (LARS) is a common choice for ligament reconstruction in the lower limb due to its good functional and quality of life (QoL)-related outcomes. It is commonly used for Achilles tendon repair following a rupture. While it facilitates tissue ingrowth and boasts good biocompatibility, we report on multiple cases whereby foreign body reactions have led to the growth of granulomas requiring surgical excision and Flexor Hallucis Longus (FHL) transfer. Following these cases, patients have been shown to have excellent functional and QoL-related outcomes using the Manchester Oxford Foot Questionnaire (MOX-FQ) and Foot and Ankle Ability Measure (FAAM). Surgeons should consider FHL transfer as an alternative in patients undergoing Achilles tendon repair and be aware of the risk of foreign body reactions and the impact on ankle function and QoL post-operatively.

Socioeconomic Deprivation as a Predictor of Lower Limb Amputation in Diabetic Foot Disease.

Objective The prevalence of diabetes and its complications are on the rise worldwide. This is particularly prevalent in low- and middle-income countries. The Index of Multiple Deprivation (IMD) is a measure of relative social deprivation. This index classifies England into small subsets called lower layer super output areas (LSOAs) and then ranks these LSOAs into deciles from the most deprived to the least deprived area. We used this to analyse the relationship between deprivation and outcomes in diabetic foot disease (DFD). Methods We evaluated patients admitted to our multidisciplinary unit with DFD over a five-year period. Their postal codes were used to classify these patients into IMD deciles with decile 1 representing the 10% of most deprived LSOAs and decile 10 the least deprived areas in the country. We used this classification to analyse the relationship between deprivation and its influence on surgical outcomes and lower limb amputation. We specifically compared those falling in the top five against the bottom five deciles. Results Our cohort consisted of 70 patients with diabetes who had surgery on their diabetic foot. Of this cohort, 33 (47%) of these underwent amputation. The majority of these procedures were minor amputations conducted on the forefoot (75.6%) and there were no below knee amputations. Of those requiring an amputation, 27 patients (81.8%) had an IMD decile of 5 or below, and only six (18.2%) patients had above 5. Conclusion Our study shows that the likelihood of amputations related to diabetic foot disease is inversely proportional to the index of multiple deprivation.

Arthroscopic management of large subchondral talar cyst: a novel treatment strategy.

Subchondroplasty is a novel and minimally invasive technique used to treat large subchondral talar cysts. It avoids soft tissue scarring, the need for osteotomies, bone grafting and its associated complications as seen with conventional approaches. Subchondroplasty involves arthroscopically approaching the cyst and injecting it with calcium phosphate paste injection, which undergoes an endothermic process and crystallizes in a manner that resembles cancellous bone to fill the defect. This case series presents two patients who underwent subchondroplasty: a 44-year-old female nurse with atraumatic right ankle pain of 2 years with a CT scan revealing a large subchondral cyst over the medial talar dome and a 55-year-old male chemical plant worker with left ankle pain following a biking accident 6 years ago whose CT scan too showed a large subchondral cyst in the medial talus. Both tolerated the surgery well, with significant reductions noted in MOXFQ scores at the 1-year follow-up.

Brace for Impact: A Retrospective Analysis of the Modified Broström-Gould Procedure With and Without Internal Brace Augmentation.

Background Chronic lateral ankle instability (CLAI) is caused by lateral ankle ligament weakness or rupture secondary to recurrent sprains. The surgical management has traditionally involved a modified Broström-Gould (MBG) procedure with or without internal brace (IB) augmentation. This study aims to demonstrate the improved outcomes for patients undergoing an MBG procedure with IB augmentation for CLAI. Methodology A retrospective analysis was performed among 40 patients undergoing an MBG procedure with or without IB for CLAI at a large teaching hospital between January 2012 and June 2019. Functional outcomes were measured using the Manchester-Oxford Foot Questionnaire (MOxFQ). Clinic letters were reviewed to assess additional outcomes including postoperative complications, revision surgery rate, time in a plaster cast, and time to full weight-bearing. Results A total of 23 patients were included in the study, with seven undergoing both MBG and IB procedures and 16 undergoing MBG intervention alone. The average age was 37.1 years in the IB group and 35.7 years in the MBG group. The mean MOxFQ overall raw scores (10.9 vs. 33.6, p < 0.016), standing and walking MOxFQ subscale (4 vs. 15.2, p < 0.012), pain MOxFQ subscale (4.86 vs. 10.9, p < 0.042), and social interaction subscale (2 vs. 7.5 p < 0.023) all showed significantly better results for the IB group versus the MBG group. Patients in the IB group had significantly less number of weeks in plaster than the MBG group and were able to fully weight bear sooner (4.14 vs. 6, p < 0.01). The MBG group suffered a postoperative complication in seven patients compared to zero in the IB group (p < 0.057). There were three re-ruptures in the MBG group requiring further revision surgery compared to zero in the IB group (3 vs. 0, p < 0.53). Conclusions MBG surgery with IB augmentation for CLAI appears to have better outcomes in terms of overall function and may have fewer overall complications. The IB group displayed a lower recurrence of pain, less time in a plaster cast, and a quicker return to walking.

Can a Fully Electronic Patient Record-Based Virtual Fracture Clinic Increase Compliance With British Orthopaedic Association Guidelines for the Assessment of Acute Orthopaedic Trauma Patients?

Introduction There is clear guidance for the follow-up of acute orthopaedic trauma patients within 72 hours of presentation as per British Orthopaedic Association (BOA) guidelines. The virtual fracture clinic (VFC) model has been adopted nationwide to increase compliance with these guidelines. Traditionally our VFC was paper-based, but recently it has been made completely electronic with the introduction of Hive which is a comprehensive electronic patient record (EPR). The aim of this audit was to assess the effectiveness of the Hive VFC and to see the impact it has on improving the patient experience. Methods Data was collected retrospectively by looking at referrals to the Hive VFC across a seven-month period from its date of introduction. No patients were excluded and data was collected for 2,158 patients. Patient demographics, referral details, and outcomes were recorded on a Microsoft Excel version 16.0 for Windows spreadsheet (Microsoft Corporation, Washington, United States). Data was analysed using Microsoft Excel. Results Data was collected for 2,158 patients between September 9, 2022, and March 31, 2023, in the Hive VFC. The largest proportion of injuries was found in the foot and ankle region with 32% of referrals (n=688), followed by hand and wrist with 30% (n=651), upper limb with 28% (n=595), and lower limb with 7% (n=142). There was a 50.4% (n=125) increase in the number of patients seen in the VFC across the study period with 248 patients being seen in September 2022, increasing to 373 in March 2023. The number of patients with acute traumatic orthopaedic injuries that were assessed within 72 hours on average was 94.5% per month. There was an increase of 7.3% during the study period from September 2022 to March 2023, 89.9% to 96.5%, respectively. Conclusion We believe that Hive VFC is a clinically sound and effective way of assessing acute traumatic orthopaedic patients and increasing compliance with BOA and NICE guidelines. The number of patients needing acute orthopaedic assessment is rising steadily, and this should alert us to find more convenient, time and cost-saving methods of delivering safe and effective patient care.

The Impact of COVID-19 on the Neck of Femur Fracture Service in a Tertiary Care Hospital in the United Kingdom.

Introduction The emergence of the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in late 2019 ushered in a global crisis that profoundly impacted healthcare systems worldwide. In the United Kingdom, COVID-19 resulted in a significant toll on public health and the National Health Service (NHS). As the virus surged, the NHS faced unprecedented challenges, including surges in COVID-19 cases, a dire need for medical equipment, and a strain on intensive care units. Simultaneously, stringent nationwide lockdowns were imposed to curb the virus's spread, disrupting daily life and healthcare access. Amid this crisis, the interactions between COVID-19 and other prevalent health conditions came to the forefront of medical research, sparking interest in understanding their connections. This study delves into the intriguing interplay between COVID-19 and neck of femur (NoF) fractures, exploring shared risk factors, resource implications, and potential alterations in patient pathways. Given the severity of both conditions and their impact on the vulnerable elderly population, elucidating these connections is crucial for comprehensive patient care and resource allocation within the healthcare system. Methods This study used data from the National Hip Fracture Audit (NHFA) database, focusing on NoF fracture patients at Wythenshawe Hospital. We examined two cohorts: pre-pandemic (from March 2019 to March 2020) and pandemic (from March 2020 to March 2021). We compared key parameters and incorporated COVID-19 data. Graphs showed trends and cohort similarities. We also analyzed demographic data (age, gender, fracture type, times, COVID-19 status, and mortality), removing outliers for accuracy. Results The data revealed that while certain factors such as patient age and mobilization remained largely unaffected, there was a modest association between COVID-19 incidence and NoF fracture patients. Notably, regional lockdown measures had a substantial impact on patient care. The initial lockdown effectively reduced COVID-19-positive cases upon admission but led to prolonged intervals and surgical delays. However, the second lockdown showed improvements, attributed to lessons learned, increased resource allocation, and better familiarity with hospital-specific lockdown measures. This research sheds light on the intricate relationship between a global pandemic and orthopedic patient care, highlighting the importance of adapting healthcare systems to evolving challenges. Conclusion This study explores the impact of COVID-19 on neck of femur (NoF) fracture patients, highlighting key findings from Wythenshawe Hospital. It uncovers a dynamic relationship between the pandemic and patient care, with increased COVID-19 cases coinciding with reduced NoF fracture rates. Lockdowns influenced outcomes, with the first causing delays and higher post-discharge mortality, while the second improved efficiency and safety. These insights extend beyond Wythenshawe Hospital, offering implications for healthcare practices in the United Kingdom and beyond, especially in countries with limited vaccination resources. This research underscores the need for tailored strategies to optimize NoF fracture patient outcomes during pandemics and lockdowns.