Brain Natriuretic Peptide levels on hospital admission are a useful predictor of cardiac complications and mortality in geriatric patients with proximal femur fractures.

Purpose: Proximal femur fractures in geriatric patients are associated with increased morbidity and mortality. This study investigates Brain Natriuretic Peptide immunoassay levels taken at the time of hospital admission in predicting cardiac complications and mortality in geriatric patients with a proximal femur fracture. Methods: A single-site prospective cohort study at a large tertiary care, level 1 trauma centre was conducted on all consecutive geriatric patients aged greater than 60 years who sustained a proximal femur fracture. Investigators collected Brain Natriuretic Peptide levels from venous blood samples on admission to the Emergency Department. The main outcome measurements were inpatient cardiovascular complications, and all-cause mortality at 30-day, 90-day, one-year, and nine-years. Results: Over a one-year period, 112 patients were enrolled. The average age was 82.7 years, and the average follow up was 6 years and 6 months (range, 2 days to 9 years). No patients were lost to follow up. There were 44 new or exacerbations of pre-existing cardiac complications requiring management recorded in 30 (26.8%) patients. Mortality at 30 days was 9.8%, 90 days was 16.1%, and one year was 24.1%, with deceased patients having a statistically significant elevated Brain Natriuretic Peptide immunoassay on hospital admission. The Kaplan-Meier graph demonstrated a trend towards increasing Brain Natriuretic Peptide and adverse survivorship risk. The Charlson Comorbidity Index was statistically significant in predicting overall survival probability. Conclusion: Brain Natriuretic Peptide immunoassay on hospital admission may be utilised to identify patients at risk of cardiac complications and mortality to guide further investigations, operative planning, the consent process, and post-operative monitoring.

A comparison of early fixation of distal radius fractures versus late corrective osteotomy of distal radius malunion.

BACKGROUND: Fractures of the distal radius are common. Closed reduction and moulded casting is often the first line treatment. Malunion after casting is not uncommon and can lead to discussion on acute surgical fixation versus delayed corrective osteotomy if symptomatic. However, it is unclear if late surgery will provide similar outcomes as early intervention. METHODS: We performed a single centre, age matched, case series comparison study, comparing outcomes of patients who had undergone early fixation (ORIF) versus those who had undergone late corrective osteotomy (CO) following distal radius fracture. RESULTS: Twenty-six patients were available for review, 13 in each group. Fracture patterns were similar. Reviewing CO versus ORIF; patients achieved a mean DASH; 22 versus 18 (P = 0.355), PRWE; 35 versus 26 (P = 0.237), and VAS 2 versus 2 (P = 0.490). Grip strength was significantly better in those who had undergone ORIF; 2% versus -22% (P ≤ 0.001). Range of motion was generally better with primary fixation but of doubtful clinical importance, reviewing CO versus ORIF; Flexion 46° versus 60° (P = 0.045), extension 55° versus 64° (P = 0.137), pronation 73° versus 85° (P = 0.078), supination 84° versus 84° (P = 0.747), flexion/extension arc 101 versus 124 (P = 0.017), ulnar/radial deviation arc 42° versus 59° (P = 0.01), pronation/supination arc 157° versus 168° (P = 0.118). Ulnar variance was significantly improved in the ORIF group; +0.5 mm versus +2 mm in the CO group (P = 0.023). Radial inclination, radial height and volar tilt were not significantly different between either group. CONCLUSION: Our findings suggest that patient measured outcome of corrective osteotomy is not inferior to early internal fixation. LEVEL OF EVIDENCE: III (Case Series Comparison).

Impact of a major sporting event on local orthopaedic service provision: Commonwealth Games 2018, Gold Coast, Australia.

BACKGROUND: The Gold Coast (Queensland, Australia) held the 2018 Commonwealth Games. Previous studies have focussed on the socio-economic and employment impact of hosting a major sporting event; however, there is limited research available about the provision of medical recourses required of the host city. METHODS: Twelve weeks of data were retrospectively collected from the local health service to quantify the orthopaedic department workload for the period surrounding the 2018 Commonwealth Games. Data collected included referrals to Orthopaedic Fracture Outpatient clinic, theatre cases - emergency and category 1 (scheduled trauma) performed, and entries made into electronic medical records by the on-call orthopaedic staff. RESULTS: A statistically significant increase was found for theatre cases performed during the Commonwealth Games (86 versus 71 cases per week, P = 0.033, 95% confidence interval 1.46-27.5). We found no statistically significant increase in Fracture Outpatient Clinic referrals or medical record entries between peri-games and games periods (P = 0.149 and 0.699, respectively). CONCLUSION: Based on our experience, orthopaedic departments should plan for an increase in operative intervention requirements of at least 20%, in consultation with other local services. Strategic use of pre-existing resources and staff may be sufficient to address the increased workload during the event period.

Is Buddy Taping as Effective as Plaster Immobilization for Adults With an Uncomplicated Neck of Fifth Metacarpal Fracture? A Randomized Controlled Trial.

STUDY OBJECTIVE: We compare buddy taping with plaster casting for uncomplicated fifth metacarpal (boxer's) fractures. We hypothesize buddy taping will give superior functional outcomes at 12 weeks, defined as a 10-point difference on the Shortened Disabilities of the Arm, Shoulder and Hand (quickDASH) score. METHODS: This randomized controlled trial included patients aged 18 to 70 years, with uncomplicated boxer's fractures in 2 hospitals in Queensland, Australia. The intervention consisted of buddy taping of the ring and little fingers on the affected side, in which the control group received plaster casting. Primary outcome was hand function as measured by quickDASH score (0 to 100, with 0 indicating no disability) at 12 weeks. Secondary outcomes measured at 3, 6, and 12 weeks included time off work and activities, pain, satisfaction, and the EuroQol 5-Dimension 3-Level score (measure of overall health). RESULTS: Ninety-seven patients with primary endpoint data were available for analysis, 48 in the buddy taping group and 49 in the plaster group. At 12 weeks, median quickDASH scores were the same for both groups (buddy 0, interquartile range [IQR] 0 to 2.3; plaster 0, IQR 0 to 4; difference 0; 95% confidence interval of the difference 0 to 0). Patients in the buddy taping group missed a median 0 days (IQR 0 to 7) of work compared with the plaster group's 2 days (IQR 0 to 14). Other secondary outcome measures were the same in both groups. CONCLUSION: We found that patients with boxer's fractures who were randomized to buddy taping had functional outcomes similar to those of patients randomized to plaster cast at 12 weeks. We advocate a minimal intervention such as buddy taping for uncomplicated boxer's fractures.

Collagenase injections for Dupuytren's contracture: prospective cohort study in a public health setting.

BACKGROUND: Dupuytren's disease causes a flexion contracture of the hand that limits hand function and reduces quality of life. Traditional management is surgical excision which is associated with potentially serious complications. A viable alternative is collagenase Clostridium histolyticum (CCH) (Xiaflex®; Pfizer Australia) which is an effective, safe, outpatient treatment that to date has no published data in the Australian public health setting. METHODS: A prospective cohort, single centre study, enrolling 54 patients to treat 81 joints with CCH. Patients received a single dose to the cord followed by joint manipulation 48 h later. Primary endpoint was reduction in contracture to 0 to 5° of full extension assessed 4 weeks after injection. Secondary endpoints included range of motion, patient satisfaction and function as measured by the Southampton Dupuytren's Scoring Scheme (SDSS). RESULTS: Primary endpoint was achieved in 48% of joints (66% metacarpophalangeal and 19% proximal interphalangeal). Mean flexion contracture improved by 40o and 25o for metacarpophalangeal and proximal interphalangeal joints, respectively. Mean active range of motion improved by 39o and 18o , respectively. At 30 days and 12 months, SDSS score demonstrated sustained improvement versus baseline (1.88 versus 8.24 P ≤ 0.0005 and 1.59 versus 8.07 P ≤ 0.0005). Sixty-eight percent of patients were either very satisfied or satisfied at 12-month follow-up. Side effects of treatment were minor; with oedema and bruising the most common (87% and 85%, respectively). CONCLUSION: CCH injections are a viable treatment for Dupuytren's contracture in the Australian public health setting.

Effectiveness of the surgical torque limiter: a model comparing drill- and hand-based screw insertion into locking plates.

BACKGROUND: The objective of this study is to analyse the effectiveness of the surgical torque limiter during operative use. The study also investigates the potential differences in torque between hand and drill-based screw insertion into locking plates using a standardised torque limiter. METHODS: Torque for both hand and power screw insertion was measured through a load cell, registering 6.66 points per second. This was performed in a controlled environment using synthetic bone, a locking plate and locking screws to simulate plate fixation. Screws were inserted by hand and by drill with torque values measured. RESULTS: The surgical torque limiter (1.5 Nm) was effective as the highest recorded reading in the study was 1.409 Nm. Comparatively, there is a statistically significant difference between screw insertion methods. Torque produced for manually driven screw insertion into locking plates was 1.289 Nm (95 % CI 1.269-1.308) with drill-powered screw insertion at 0.740 Nm (95 % CI 0.723-0.757). CONCLUSIONS: The surgical torque limiter proved to be effective as per product specifications. Screws inserted under power produce significantly less torque when compared to manual insertion by hand. This is likely related to the mechanism of the torque limiter when being used at higher speeds for which it was designed. We conclude that screws may be inserted using power to the plate with the addition of a torque limiter. It is recommended that all screws inserted by drill be hand tightened to achieve adequate torque values.