Minimizing the Risk of Surgical Site Infection Following Hip Fracture Operation.

Introduction: Hip fractures are the most common serious injury in the elderly, associated with disability, morbidity, and mortality. Surgical site infection (SSI) is a serious post-operative complication. This prospective cohort study outlines how our center made cumulative improvements in SSI incidence rates, reaching a 12-month average of 0.5%. Methods: All patients undergoing hip fracture operation between 2016 and 2021 were included. The primary outcome measure was confirmed SSI, according to the Public Health England definition. Results were compared with the baseline recordings by an independent SSI team in 2013. Demographic data were compared with National Hip Fracture Database records. Peri-operative infection control and wound management tactics introduced between 2014 and 2021 were collated to gain an overview care bundle. Results: Baseline recordings identified a 9.0% SSI rate in a three-month observation period. In our study, 3,138 hip fracture operative cases were completed between October 2016 and December 2021. There were 9 superficial and 32 deep infections identified, yielding an overall infection rate of 1.3%. However, when analyzing the 12-month average, there was consistent decline in SSI from the baseline 9.0% in 2013 to 0.5% in 2021 (p < 0.05). A peri-operative care bundle included pre-operative bleeding risk assessment. Intra-operatively, double preparation and draping is used for arthroplasty. Broad-spectrum antibiotic agents and tranexamic acid are administered. Meticulous hemostasis and watertight wound closure are observed. Anti-coagulated patients received negative pressure dressings. Post-operatively, a dedicated senior lead team provided daily inpatient review of patients, with urgent consultant review of all wound healing concerns. Conclusion: Patients with a hip fracture have numerous risk factors for SSI. A dedicated multi-focal tactic, adopted by a multi-disciplinary department, can yield substantial risk reduction. Each intervention is evidence based and contributes to cumulative improvement. By prioritizing infection prevention, we have minimized the need for complex infection management interventions and achieved an annual saving of £860,000 for our trust.

Revision of Motec Total Wrist Replacement in the Second Metacarpal.

Wrist arthroplasty is becoming more commonplace, with various implant choices available. The Motec (Swemac Orthopaedics AB, Linköping, Sweden) cementless ball-and-socket system is being increasingly utilised and is designed for the distal component to be implanted into the third metacarpal. However, distal component failure is a recognised complication. We outline our experience with the revision of this component into the second metacarpal. This technical note is presented through our experience of two patients who underwent revision arthroplasty for the management of peri-prosthetic fracture of the third metacarpal. This technique has demonstrated a safe and viable solution to this complication, achieving good anatomical centre of rotation, function, range of movement and patient satisfaction. Level of Evidence: Level V (Therapeutic).

Assessment and management of adult spinal deformities.

Adult spinal deformity is a complex condition, increasing in prevalence, and occurring in a patient population in which it poses unique challenges. This review provides an overview of adult spinal deformity with a particular focus on its clinical evaluation, radiological assessment and classification, reviewing the current literature and amalgamating this with the authors' clinical experience.

Women's Awareness of Periconceptional Use of Folic Acid Before and After Their Antenatal Visits.

OBJECTIVE: The aim of this study is to assess women's awareness of the benefit and use of folic acid during pregnancy and to assess whether their knowledge has improved following hospital visits. METHOD: This is a prospective survey conducted in a large teaching hospital in the UK. The survey questionnaire consisted of 28 questions about demographic variables, behavioral variables, and knowledge about folic acid and neural tube defects (NTDs). RESULT: A total of 603 women participated in this study. Some of them attended for the first time and others had more than one visit, either in their current or previous pregnancies. In about 25% of cases, the pregnancy was not planned. Between 14 and 19% of the women of First and Two+ Visit groups consulted their doctor or other healthcare professional before conception. Nearly 98% of the women stated that they had heard of folic acid, but only 42-52% knew the medical condition it protects against. The main sources of information for women who were aware of folic acid were midwives and general practitioners. Nearly 90% of women who attended their first antenatal visit were taking folic acid. However, only 40% of women knew that they should take it before pregnancy, and only between 36 and 46% knew the dietary sources of folic acid, although about 84% know the foods that should be avoided during pregnancy. This study found that attending antenatal clinic has not increased women's awareness about folic acid. CONCLUSION: There is still a high proportion of women who do not know that folic acid should be taken before pregnancy and continued for the first three months of pregnancy. School education, primary care team, and family planning service should take the lead in providing information to women about folic acid.

Management of Cervical Fibroid during the Reproductive Period.

This is a case report of a 29-year-old lady who presented with excessive vaginal discharge and sessile cervical fibroid arising from the vaginal portion of the cervix. She was not suitable for uterine artery embolization as she has never previously been pregnant before. She was encouraged to get pregnant and to avoid surgical excision which can lead to hysterectomy. Shortly after, she became pregnant. She had many admissions during pregnancy due to bleeding from the fibroid, and in one occasion she had blood transfusions. The fibroid increased in size to become larger than the head of the baby. An emergency caesarean section was performed at 37 weeks when she attended in labour before the date of her elective caesarean section. She was managed conservatively following delivery in the hope that the fibroid becomes smaller making surgery easier. The fibroid degenerated and reduced in size. Vaginal myomectomy was carried out. The patient is now pregnant for the second time and had a cervical suture at 20 weeks gestation. In this educational case report we discuss the different management options of cervical fibroids and review the literature of other similar cases and their outcome.

Recreational cycling and cardiorespiratory fitness in English youth.

PURPOSE: Schoolchildren who cycle to school have higher cardiorespiratory fitness (CRF) than those who are driven or use public transport. The purpose of this study was to determine whether recreational cycling is similarly associated with CRF. METHODS: Participants were 5578 (54% males) English schoolchildren (10.0-15.9 yr). All reported frequency of recreational cycling events via 7-d recall. Responses were categorized as follows: "noncyclists" = 0, "occasional cyclists" = 1-4, or "regular cyclists" = 5+ (times per week). CRF was assessed using the 20-m shuttle run test with performance classified as "fit" or "unfit" based on FITNESSGRAM standards. RESULTS: Overall, 26% of males and 46% of females were noncyclists. Compared with noncyclists, the 40% of males and 42% of females classified as occasional cyclists were more likely to be fit (males: odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.07-1.59; females: OR = 1.41, 95% CI = 1.13-1.76). Regular cyclists (34% males and 12% females) had a greater likelihood still of being classified as fit (males: OR = 1.58, 95% CI = 1.29-1.95; females: OR = 1.55, 95% CI = 1.09-2.20). No odds remained significant after adjusting for physical activity. Removal of participants who cycled to school had little overall effect on the likelihood of being classified as being fit. CONCLUSIONS: Previous research has focused only on young people's commuter cycling habits, at the expense of the more common activity of recreational cycling. Recreational cycling may provide an alternative target for interventions to increase physical activity and improve CRF youth. Recreational cycling could potentially serve as a way to gain cycling confidence and establish habits that act as precursors to commuter cycling.