An assessment of the POSSUM system in orthopaedic surgery.

We describe the development and validation of a scoring system for auditing orthopaedic surgery. It is a minor modification of the POSSUM scoring system widely used in general surgery. The orthopaedic POSSUM system which we have developed gives predictions for mortality and morbidity which correlate well with the observed rates in a sample of 2326 orthopaedic operations over a period of 12 months.

Temporal trends and geographic variations in surgical treatment of femoral neck fractures.

BACKGROUND: The objectives of this study were to examine temporal trends in treatment of femoral neck fractures, factors associated with treatment, and variations in practice patterns among counties and hospitals in Ontario, Canada. METHODS: Hospital discharge data were analyzed. Cases were defined as age > 50 years with a surgically treated femoral neck fracture between 1981 and 1992 (n = 29,391). RESULTS: The age-adjusted and sex-adjusted proportion of patients treated with hemiarthroplasty (HA) increased from 45% in 1981 to 61% in 1992 (p < 0.0001). HA is more likely to be performed among women, older patients, and nursing home patients. Among counties there was a 38-fold variation for total hip arthroplasty (0.5-38%) and a 9-fold variation in use of HA (9-83%). The degree of variation in treatment was mainly the result of individual hospitals. CONCLUSION: The wide regional variations in treatment of femoral neck fractures reflect a lack of consensus in Ontario.

A more stable posterior approach for hemiarthroplasty of the hip.

The dislocation rate following the insertion of a hemiarthroplasty of the hip via the posterior approach is variously quoted as between 8 per cent and 15 per cent. We set out to determine if this could be reduced by preserving the labrum and capsular structures at the time of surgery. We used a modification of the posterior approach, in which the labrum and capsule are preserved which appears not to have been widely reported. This increases the stability of the joint by adding to the depth of the acetabulum. We look prospectively at a series of 150 patients who were treated with an Austin Moore hemiarthroplasty using this technique. There were only two dislocations within 1 year of surgery in the series (one of these being in a patient with a dysplastic acetabulum) making our dislocation rate 1.3 per cent. We conclude that preserving the labrum significantly increases the stability of a hemiarthroplasty when it is inserted via a posterior approach.

The impact and consequences of hip fracture in Ontario.

OBJECTIVES: To assess the magnitude and the burden of hip fracture on the health care system, including time trends in hip fracture rates, in-hospital death rates, length of hospital stay (LHS) and discharge destination. DESIGN: A retrospective study of discharge abstracts. SETTING: The Province of Ontario. PATIENTS: All patients (n = 93,660) over the age of 50 years and with a diagnosis of hip fracture discharged from hospital between 1981 and 1992 (excluding transfers). MAIN OUTCOME MEASURES: Age-sex standardized hip fracture rates per 1000 population, in-hospital death rates and age-adjusted mean LHS. RESULTS: The overall hip fracture rate was 3.3 per 1000 persons (1.7 per 1000 men and 4.6 per 1000 women). There was no change in rates between 1981 and 1992 (p = 0.089), but there have been increases in the numbers of hip fractures. There was no change in the in-hospital death rate over time (p = 0.78). The age-adjusted mean LHS in 1981 was 28.6 days compared with 22.2 days in 1992. The numbers of hip fractures will increase from 8490 in 1990 to 16 963 in 2010. CONCLUSIONS: Despite stable age-adjusted rates of hip fractures, the doubling of the number of hip fractures by the year 2010 due to an aging population will become an increasing burden on the health care system.