Injury
-
It is recommended that process indicators (PI) for trauma-care be validated in the setting where they are applied for quality assurance (QA) and quality improvement (QI). In a pilot attempt at trauma QA and QI, we evaluated pre-hospital time (PT) and emergency department disposition time (EDt) as possible PIs in three Italian trauma-referral hospitals. ⋯ Although PT and EDt were significantly shorter in the hospital with best outcome performances, we could not confirm at the patient level their expected independent association with outcome. More evidence is needed before these indicators can be validated as standard tools for system analysis in our setting.
-
The aim of this study was to adjust the Harris Hip Score for evaluation of acetabular fracture treatment. The discriminating quality of the score was assessed. ⋯ The discrimination of the modified score was improved, with the 90th percentile giving top points. Differences in treatment outcome of acetabular fractures will be easier to detect with the modified score.
-
We have established a nationwide directory of the specialist surgical units and their Lead Consultants with expertise in acetabular fracture surgery throughout the UK. Our directory has facilitated an estimation of the total numbers of operative acetabular fracture cases managed annually in the UK, as reported by those actually providing this specialist service. Previously the total number of acetabular injuries admitted and operated on in the UK was not known and there was no directory of acetabular surgeons in the UK. ⋯ Our study has found that 748 acetabular fracture fixation cases were performed at 33 NHS hospitals in the UK in this study period. The total difference between the DoH operated cases and those confirmed by our study was 490. The hospital care for an operative acetabular fracture case may cost approximately 14,830, pounds if the actual numbers are under-reported to or by the DoH are 490, then approximately 7,266,700 pounds has been lost by these centres due to incorrect proportioning of resources.
-
To compare the cost implications of treatment of persistent fracture non-unions before and after application of recombinant human bone morphogenetic protein-7 (BMP-7). ⋯ Treating fracture non-unions is costly, but this could be reduced by early BMP-7 administration when a complex or persistent fracture non-union is present or anticipated.
-
Docking sites are the result of a classic bone transport technique for dealing with bone loss. Union may prove to be the rate-limiting step in the duration of treatment. ⋯ Other techniques for improving union involve compression, alternate compression-distraction, and bone grafts, all of which induce union to a variable degree. The application of external stimulators and bone morphogenetic proteins, the use of which is supported in fracture healing and even regenerate formation, is as yet unproven at docking sites.