Injury
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The United Kingdom (UK) Major Trauma Network has encouraged cohorting of significantly injured patients with specific injury patterns. Complex injuries to the limbs is a key area of this patient population. Funding and clinician resource allocation, have not been appropriately adjusted to take account of this approach. We assessed the orthoplastic trauma workload in our unit over a 12 month period, taking into account the resource burden of each admission in comparison to the funding received. ⋯ Tariff payments barely cover the cost of a hospital bed and theatre time. Materials costs, as well as the additional costs associated with providing a high quality specialist service mean that our orthoplastic service is currently being run at a significant loss. The benefits for patients in having a well-established orthoplastic unit are numerous and well documented. This study provides evidence to support negotiation for a tariff uplift to allow ongoing provision of a high quality orthoplastic service without detriment to hospital budgets.
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Nonunion is a quite common complication of open tibial shaft fractures. This prospective case series investigates the use of the gentamicin-coated titanium intramedullary tibial nail, in association with the RIA system, in patients with tibial exposed nonunions. ⋯ The use of gentamicin-coated nails in association with the RIA system demonstrated a safe and effective treatment of tibial non-unions.
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Very distal tears of the Achilles tendon are uncommon, and poor quality tendinous tissue of the calcaneal stump can compromise healing. Little has been published about the characteristics and surgical management of such injuries. We present a surgical technique, developed by the senior author, to restore continuity of the gastrosoleus-Achilles tendon-calcaneus complex using a free ipsilateral semitendinosus graft, and clinical outcomes of a case series of 28 consecutive patients. Our hypothesis was that this is a safe technique, and patients can return to pre-injury occupation and athletic activities. ⋯ This minimally invasive technique was safe, and allowed most of patients to return to preinjury daily and sport activities within 9 months from surgery.