Fracture admission trends in England over a ten-year period.

INTRODUCTION: Fractures are a common reason for admission to hospital around the world. Varying incidences have been reported but these are mainly based on small studies from individual centres. The aim of our study was to analyse fracture admissions in England over a ten-year period. METHODS: Data were collated from the Hospital Episodes Statistics database. Since 2004, data have been collected for all admitted patients in England using the International Classification of Diseases codes for the primary diagnosis. Data were analysed for the ten-year period between 2004-2005 and 2013-2014. RESULTS: There were 2,489,052 fracture admissions in England over the 10-year study period. The risk of admission for fracture was 47.84 per 10,000 population. The rate of fracture admission has remained stable. Hip fractures were the most common fracture requiring hospitalisation (n=641,263), followed by distal radius fractures (n=406,313), ankle fractures (n=332,617) and hand fractures (n=244,013). Hip fractures accounted for 58% of hospital bed days, ankle fractures for 10%, and femoral shaft fractures and subtrochanteric femoral fractures for 5% each. The number of bed days per year for hip fractures has reduced from 1,549,939 bed days in 2004-2005 to 1,319,642 in 2013-2014. CONCLUSIONS: This study provides an updated picture of the incidence of fractures that required hospital admission over a ten-year period in England. It may be used as a platform from which the effect of modern patient treatment pathways can be monitored.

Thomas Eshelby (1769-1811), Nelson's Surgeon.

Horatio Nelson is an icon of British naval history. His above-elbow amputation by Thomas Eshelby remains one of the most famous surgical procedures ever performed. Yet the surgeon himself remains relatively obscure and uncelebrated. We present a vignette of this young Yorkshireman and reflect on his life and times. Eshelby was a competent and conscientious surgeon and was certainly held in high regard by Nelson. Quite a few documents pertaining to his tour of duty in the Mediterranean and to his later appointment at Plymouth have been archived. These shed valuable light on his professional life, betraying his clinical acumen, his conscientious and pragmatic nature and his demeanour toward both his peers and his superiors. Eshelby was also the patriarch of an enterprising family including three generations of surgeons and others with eponymous discoveries in the fields of geography and science.

Oxford elbow scores in an asymptomatic population.

INTRODUCTION: Patient reported outcome measures (PROMs) are being used increasingly to assess the quality of healthcare delivery in the UK. It is important when using PROMs to know the score of the background population against which any clinical intervention may be benchmarked. The purpose of this study was to measure an elbow specific PROM for the population of the South West Peninsula. METHODS: A cross-sectional survey was undertaken of patients and healthcare professionals from the South West Peninsula population. Participants were asked to complete a simple demographic questionnaire and an Oxford elbow score for each elbow. Respondents with a history of elbow surgery, elbow injury, chronic elbow problems or an incomplete dataset were excluded from the study. RESULTS: A total of 1,765 respondents (3,530 elbows) completed the survey but 567 questionnaires were excluded due to incomplete datasets, pre-existing elbow pathology or age criteria, leaving 1,198 individuals (2,396 elbows) for analysis. The median scores for each decade group were 48, with mean scores ranging from 46.74 to 47.94. There was no significant clinical difference in the scores for age, sex or hand dominance. CONCLUSIONS: When using the Oxford elbow score to assess outcomes after surgery, a normal score should be used as the benchmark. This benchmark is independent of age, sex and hand dominance.

Patient reported outcome measures in military patients with shoulder instability.

OBJECTIVES: The Oxford Shoulder Instability Score (OSIS) is a measure of functional impairment of the upper limb, but it is unclear how it translates into military patients where lower scores, implying higher function, may still be insufficient to meet the increased demands of military service and necessitating surgery. This study aimed to compare OSIS in military and civilian patients undergoing shoulder stabilisation surgery. METHODS: We undertook a prospective, blinded cohort-controlled study with a null hypothesis that there was no difference in the Oxford Instability Scores between military and civilian patient groups. 40 patients were required in each group. A prospective clinical data base (iParrot, ByResults, Oxford, UK) was interrogated for consecutive patients undergoing shoulder stabilisation surgery at a single centre. The senior author-blinded to the outcome score-matched patients according to age, gender and diagnosis. Statistical analysis showed the data to be normally distributed and a paired samples t test was used to compare the two groups. RESULTS: 110 patients were required to provide a matched cohort of 40 in each group (70 male, 10 female subjects). Age distribution was 16-19 years (n=6); 20-24 years (n=28); 25-29 (n=16); 30-34 (n=12); 35-49 (n=12); and 40-44 (n=6). 72 patients (90%) had polar group 1 instability and eight patients (10%) had polar group 2 instability. The mean OSIS in the civilian group was 17.25 and in the military group 18.25. There was no statistical difference between the two groups (p=0.395). CONCLUSIONS: This study supports the use of the OSIS to assess military patients with shoulder instability and monitor the progress of their condition.

"It's good to talk"--an audit of the communication of post-operative thromboembolic complications.

The risk of venous thromboembolism after surgery, with its associated morbidity and mortality, is an important component of obtaining informed consent for a surgical procedure. This risk of thromboembolic complications extends beyond the post-operative hospital stay; patients suffering such complications after discharge are generally not re-admitted under the care of the operating surgeon. A retrospective opening loop audit was undertaken to investigate the communication of post-operative thromboembolic complications between specialties in a large district general hospital. The operating surgeon was unaware of 87% of cases of pulmonary embolism and 20% of cases of deep vein thrombosis affecting patients in their post-operative period. The inter-specialty communication of post-operative complications is important to maintain a high standard of patient care and allow surgeons to make informed decisions about clinical practice.

Lisfranc injury--surgical fixation facilities an early return to work.

BACKGROUND: Lisfranc injury is rare and the diagnosis maybe easily missed. This study reviews the experience of a single centre. METHODS: A prospective review of patients with Lisfranc injuries presenting to a single surgeon with a specialist interest in foot and ankle surgery over a one year period. RESULTS: Five patients were identified--four men and one woman with a median age of 31 years (range 22-50 years). Presentation was a mean of 25 days after injury (range 3-56 days). The left foot was affected in three cases and the right in two. There was joint diastasis in four patients and fracture-dislocation in one. Three patients presented early and were treated by internal fixation and two presented late and were managed conservatively. Mean follow-up was eight months (range 4.5-12 months). Surgery resulted in a return to work by 6 months with no symptoms. The two patients managed conservatively continued to experience pain at 12 months and were unable to return to their original occupations. CONCLUSION: Injury to the Lisfranc joint should be excluded in any foot injury. Early diagnosis and internal fixation appears to result in an earlier return to work when compared to non-operative management.

Lightning: the multisystem group injuries.

In this article, we present our experience of group lightning injury. Individual injuries are most common after single strikes. The largest group previously reported was 10 patients. In our series, 17 victims were hit by a single strike; 11 were admitted to the hospital and 6 were discharged from the accident and emergency department. Although injured under the same circumstances, these patients presented with a wide range of symptoms and signs. We also describe a characteristic burn pattern, the "tip-toe sign."