The cost and mortality of hip fractures in centenarians.

BACKGROUND: Centenarians are the fastest rising age group in Ireland. Hip fractures most commonly affect older adults and are associated with significant morbidity and mortality, as well as the financial cost of healthcare resources. Despite this, very little is known regarding hip fractures in centenarians. The aim of this study was to investigate our experience with hip fractures in this group and to record the cost of treating these fractures to identify both the social and economic impact these injuries impose on the health system. METHODS: The study was a retrospective data review at a major trauma centre. Nine proximal femoral fractures from June 2010-2016 were identified through a stepwise analysis of theatre data and patient notes. Time of death was recorded directly from patient records or by contacting the patient's general practitioner. With the assistance of the hospital finance department, individual inpatient costs were calculated using length of stay, theatre time and implant costs. RESULTS: Over the 7-year period we examined nine patients over 100 years of age were managed operatively for hip fractures with an average inpatient cost of €14,898. The mean age at the time of fracture was 101 years and 7 months. Eight of the patients were female and there was one male. Our inpatient, 30-day and 1-year mortality rate were 22, 22, and 71%. CONCLUSIONS: The 1-year mortality rate of any person aged 100 years or older is thought to be 67% for men and 59% for women. This suggests that the 1-year mortality rate of 71% in this current study is only slightly worse than the usual life expectancy of a person older than 100 years of age. Our data suggest that the extreme elderly should be offered operative management.

Expectations of General Practitioners for Patients Undergoing Elective Total Knee Arthroplasty.

Most patients undergoing total knee arthroplasty (TKA) in Ireland are referred to orthopaedic services by their general practitioners (GPs). We aimed to evaluate Irish GPs' expectations for their patients' perioperative experience and post-operative return to function. A questionnaire was mailed to 350 GPs in all provinces. This included questions relating to GPs' expectations for their patients and their knowledge and sources of information on TKA. 111 completed questionnaires were returned (response rate 31.7%). Overall expectations for functional and psychological outcomes were high, especially regarding pain relief (108 (97.3%)) expected relief from most or all pre-operative pain), mobility (108 (97.3%)) expected patients to walk medium or long distances) and psychological wellbeing (95 (85.5%) considered this somewhat or very important). Only 22 (20.2%) reported receiving any relevant information or training within the previous year. Overall expectations for functional outcomes were high, however greater communication between surgeons and GPs may improve GP information,

Radiation safety knowledge and practices among Irish orthopaedic trainees.

INTRODUCTION: Fluoroscopy is frequently used in orthopaedic surgery, particularly in a trauma setting. Exposure of patients and staff to ionising radiation has been studied extensively; however, little work has been done to evaluate current knowledge and practices among orthopaedic trainees. AIMS: This study aimed to investigate the knowledge and practices of Irish orthopaedic trainees regarding use of ionising radiation. METHODS: A confidential internet-based survey on workplace radiation safety practices was distributed via email to 40 higher specialist trainees. Questions included related to radiation safety training and regular work practices. RESULTS: A total of 26 trainees completed the questionnaire (65% response rate). All reported regular exposure to ionising radiation. Compliance with body shields was high (25, 96%), however, other protective measures such as thyroid shields were less frequently employed. The 'as low as reasonably achievable principle' was practised regularly by 14 (54%). Radiation safety training was variable-while just over half (14) respondents felt adequately trained in radiation safety, 17 (65%) had attended a radiation protection course. Use of dosimeters was particularly poor, with only 4 (15%) using them regularly and most citing lack of availability as the main barrier. CONCLUSION: Although most Irish orthopaedic trainees have some knowledge regarding radiation safety, many do not regularly use all available measures to reduce exposure to ionising radiation. Barriers to use of protective mechanisms include lack of availability and perceived impracticality.

A computed tomography evaluation of two hundred normal ankles, to ascertain what anatomical landmarks to use when compressing or placing an ankle syndesmosis screw.

Classical AO teaching recommends that a syndesmosis screw should be inserted at 25-30 degrees to the coronal plane of the ankle. Accurately judging the 25/30 degree angle can be difficult, resulting in poor operative reduction of syndesmosis injuries. The CT scans of 200 normal ankles were retrospectively examined. The centroid of the fibula and tibia in the axial plane 15mm proximal to the talar dome was calculated. A force vector between the centroid of the fibula and the tibia in the axial plane should not displace the fibula relative to the tibia when surfaces are parallel. Therefore, a line connecting the two centroids was postulated to be the ideal syndesmosis line. This line was shown to pass through the fibula within 2.5mm of the lateral cortical apex of the fibula and the anterior half of the medial malleolus in 100% of the ankles studied. The results support the concept that in the operatively reduced syndesmosis, the anterior half of the medial malleolus can be used as a reliable guide for aiming the syndesmosis drill hole, provided that the fibular entry point is at/or adjacent to the lateral fibular apex. The screw should also remain parallel to the tibial plafond in the coronal plane.