Geriatric orthopaedic surgery & rehabilitation
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Geriatr Orthop Surg Rehabil · Sep 2014
"Tiers of delay": warfarin, hip fractures, and target-driven care.
Anticoagulation reversal is a common cause of operative delay. We sought to establish for the first time the impact this has on best practice tariff (BPT) for patients with hip fracture admitted on warfarin. All patients with hip fracture treated operatively over a 32-month period were reviewed. ⋯ As well as affecting clinical outcome following hip fracture, delay due to anticoagulation causes considerable loss of BPT. Potential loss of revenue due to delays over the study period was £80 000, inspiring the establishment of an "early trigger" anticoagulation protocol. Although it is accepted that there are limitations to this work, it should raise awareness of the real impact of warfarin on patients with hip fracture both in terms of outcome and for the first time, loss of potential revenue.
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Geriatr Orthop Surg Rehabil · Jun 2014
Changing the consultant on calls from a daily to weekly rotation system reduces time to theater for patients with hip fracture to improve quality of care: a retrospective study of 2 cohorts of patients presenting with hip fracture.
To determine whether changing the consultant on-call schedule resulted in a reduction in time to theater for patients presenting with a hip fracture. ⋯ This study demonstrates that changing the schedule to permit a consultant to have a 7-day period of trauma on call at a time instead of only 1 day dramatically reduced the time to theater for patients with hip fracture. This significantly reduced the number of these cases done outside 36 hours and increased trust financial reward.
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Geriatr Orthop Surg Rehabil · Jun 2014
Open reduction and internal fixation versus hemiarthroplasty in the management of proximal humerus fractures.
The purpose of this study was to use a nationally representative database to determine the differences in 30-day outcomes based on procedure type for management of proximal humerus fractures including complications, readmission, operative time, and length of stay. Further, we sought to determine patient characteristics and perioperative factors associated with poor outcomes. ⋯ Patients who undergo hemiarthroplasty for management of proximal humerus fractures are significantly older and often functionally dependent. When compared to ORIF, hemiarthroplasty is associated with longer operative times and greater risk of bleeding complications.
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Geriatr Orthop Surg Rehabil · Mar 2014
Propagation of bisphosphonate-related femoral stress fractures despite femoral nailing: a cautionary tale from 2 cases.
We report 2 cases of atypical femoral fracture displacement despite treatment with intramedullary (IM) nailing. Both patients had received more than 3 years of bisphosphonates. One patient had prophylactic fixation of an atypical femur fracture due to intractable pain. ⋯ Both femoral nails were slotted, cannulated stainless steel piriformis entry designs. These 2 cases are among the first reported failures of IM fixation in preventing displacement of a bisphosphonate stress fracture. We advice caution when using slotted nails in prophylaxis of atypical femur fractures because of its significantly reduced torsional stiffness compared to modern nonopen sectioned nails.
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Geriatr Orthop Surg Rehabil · Dec 2013
Outcomes of total knee arthroplasty in relation to preoperative patient-reported and radiographic measures: data from the osteoarthritis initiative.
Total knee arthroplasty (TKA) is the preferred surgical treatment for end-stage osteoarthritis. However, substantial numbers of patients still experience poor outcomes. Consequently, it is important to identify which patient characteristics are predictive of outcomes in order to guide clinical decisions. Our hypothesis is that preoperative patient-reported outcome measures and radiographic measures may help to predict TKA outcomes. ⋯ All preoperative WOMAC scores demonstrated positive associations with postoperative WOMAC scores, while among the preoperative radiographic measurements only combined KL grades and joint angles showed any correlation with postoperative WOMAC scores. Higher preoperative KL grades and joint angles were associated with better (lower) postoperative WOMAC scores, demonstrating an inverse correlation.