Development and efficiency of an acute knee trauma list.

Following acute knee trauma some patients will require urgent arthroscopy. Traditionally surgery is undertaken as in-patient on the general trauma list. This system leads to blockage of beds, repeated starving of the patient and out-of-hour's surgery in many cases. We introduced a dedicated Day Surgery knee trauma list (KTL) to reduce in-patient admissions, waiting time and cost. The typical indications for urgent knee arthroscopy are locked knees secondary to meniscal tears, loose bodies or cruciate ligament ruptures; acute osteochondral fractures; and children with acute meniscal tears. This retrospective review compares the study group: patients on the knee trauma list during the first 8 months following introduction, and the control group: patients on the general in-patient trauma list over a similar period immediately prior to implementation of the new list. There were 49 patients in the control group with an average stay in hospital of 2.5 days. Out-of-hour's operations were performed in 13 patients and 3 patients required a repeat arthroscopy. Fifty-three patients were treated in the knee study group. The significant operations were meniscal repair in 7, fixation of osteochondral fragments in 3. None of the patients required overnight stay. Control group patients were more likely to have surgery performed by inexperienced non-specialist knee surgeons, whereas specialist knee surgeons staffed the knee trauma list. Specialist surgeons were available to staff the knee trauma list. As the majority of the control group had spent an average of 2.2 nights in hospital, there has been considerable savings to the hospital. Introduction of the Day Surgical Knee trauma list has reduced unnecessary admissions per week; episodes of prolonged starving, cost and have improved patient satisfaction and management.

To drain or not drain: literature versus practice.

To evaluate the current use, of and opinion regarding the use of closed suction drains in orthopaedic practice, a literature review and two surveys have been conducted. Recent literature suggests that there is no difference in terms of wound healing, post-operative pyrexia, range of motion, seroma collection, days of hospitalization and infection rate in drained and undrained groups in routine orthopaedic procedures. In the first survey, a questionnaire was sent to all members of the British Orthopaedic Association, to establish the incidence of the use of drains, their placement and the usual duration of drainage. In the second survey, all the orthopaedic consultants of the Mid-Trent Region were interviewed to establish their reasons for using drains. Both surveys indicate that drains are used routinely by the majority of orthopaedic surgeons regardless of the published literature. We conclude that most orthopaedic surgeons in the United Kingdom do not practice 'evidence-based medicine' with regards to wound drainage.