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Déclaration de liens d’intérêts: Les auteurs n’ont pas précisé leurs éventuels liens d’intérêts.
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Introduction: Each year over 3,700 patients over the age of sixty were hospitalised with a hip fracture in Ireland. The recognition of the growing burden of fragility fractures on the health service needs to be factored into the future development of hospital services. The IHFD is a clinically led, web based audit of hip fracture casemix, care and outcomes. The National Office of Clinical Audit (NOCA) provides operational support and governance for the IHFD. All 16 eligible hospitals in the Republic of Ireland are now entering data. It is clinically supported by the Irish Gerontological Society (IGS) and the Irish Institute of Trauma and Orthopaedics (IITOS). The IHFD has been recording data since 2012 and has captured over 25,000 cases to date. Methods: Data is collected through the Hospital In-Patient Enquiry (HIPE) portal in collaboration with the Healthcare Pricing Office (HPO). The IHFD audit was based originally on the six standards of care as published by the British Orthopaedic Association and British Geriatric Society in the "Blue Book", the Care of Patients With Fragility Fracture (2007), but in 2017 the IHFD published the Irish Hip Fracture Standards (IHFS), in 2018 these standards formed the basis of a Best Practice Tariff (BPT), that is, a payment of €1000 per case that meets the IHFS. In 2021 a new standard for early mobilization will become part of the BPT. Results: 33% of patients were admitted to an orthopaedic ward or went to theatre within four hours, 75% of patients received surgery within 48 hours, 3% of patients developed a pressure ulcer, 56% of patients received a nutritional risk assessment to identify risk of malnutrition, 82% of patients were seen by a geriatrician, IHFS 5: 91% of patients received a bone health assessment, 85% of patients received a specialist falls assessment, 78% of patients were mobilised by a physiotherapist on the day of or day after surgery, 28% of patients were discharged directly home. Median of length of stay: 11 days. Conclusion: The coverage has improved consistently year on year and 99% was achieved in 2020. There has been an improvement in all IHFS with a minor disimprovement in 2020 due to COVID. The focus of the audit going forward will be support the hospitals to recover from the impact of the COVID pandemic, to increase the number of patient care meeting the BPT, to support the hospitals to adopt a culture of quality improvement using the IHFD data and to develop a longer term outcome dataset.
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Introduction The COVID-19 pandemic has affected the types of trauma being operated on by Orthopaedic surgeons. Lifting of restrictions around sports saw a sudden return to play for people after a period of inactivity. Achilles tendon ruptures are associated with these episodic athletes. We hypothesised that easing of “Lockdown” restrictions led to increased presentations of Achilles tendon ruptures vs. the same period in 2019. We conducted a case-control study to investigate. Methods Data from electronic theatre logbooks of all operations performed from 27th March 2020 (Lockdown begins) to 31st July 2020 and 27th March 2019 to 31st July 2019 was collected. All operatively managed Achilles tendon ruptures were included. All other operations were excluded. Results 772 total cases were performed in 2019. There were 17 Achilles tendon ruptures in that period (2.2%). 14 occurred after easing of restrictions. 580 total cases were performed in 2020. There were 13 Achilles tendon ruptures in that period (2.2%). 11 occurred after easing of restrictions and the return of sport. There was a greater incidence of Achilles tendon ruptures in 2019 vs. the equivalent “Lockdown” period in 2020. Conclusion COVID-19 pandemic restrictions and return to play after inactivity does not increase the incidence or rate of Achilles tendon rupture.