Hip fractures in centenarians: a multicentre review of outcomes.

INTRODUCTION: Advances in healthcare have resulted in an increasing UK population, with the proportion of elderly individuals expanding significantly, including centenarians. Hospitals can expect to see growing numbers of so-called 'super-elderly' patients with trauma, a majority of whom will have hip fractures. We performed a multicentre review of hip fracture outcomes in centenarians to assess whether being an outlier in age correlates with poorer prognosis. METHODS: Centenarians admitted to Basingstoke, Southampton, Dorset, and Salisbury district hospitals with hip fractures between January 2014 and June 2019 were included. Electronic records were searched to obtain demographics, functional status, and admission details. RESULTS: A total of 60 centenarians were included, with a median age of 101 years (range 100-108 years), 85% of whom were female; 29 were admitted from their own home or sheltered housing and 31 from nursing or residential care; 33 had some outdoor mobility, 26 only mobilised indoors, and 1 had no mobility. Common comorbidities were renal and heart disease and dementia. Of the total, 56 underwent surgery, 51 within 36 hours. In terms of accommodation, 63.4% returned to their pre-injury level of independence. At 30 days, three months, and one year, mortality rates were 27% (n = 16), 40% (n = 24) and 55% (n = 33), respectively. CONCLUSION: Trauma in the elderly population is an area of growing interest, yet few studies address centenarians with hip fractures. This work demonstrates that mortality rates within one year of injury were high, but almost half survived beyond a year. Two-thirds of patients regained their pre-injury level of independence, suggesting that functional recovery may not be as poor as previously reported.

Intraoperative imaging in hallux valgus surgery.

BACKGROUND: This prospective study investigates the use of intraoperative fluoroscopy in hallux valgus surgery. To our knowledge there have been no studies questioning the benefit and reliability of intraoperative fluoroscopy in hallux valgus surgery. METHODS: We performed a prospective investigation of 28 consecutive cases undergoing hallux valgus surgery. Fluoroscopic images were examined intraoperatively and any significant findings documented. A comparison was made between these images and weight bearing films 6 weeks postoperatively to examine their reliability. We excluded those patients that went on to have an Akin osteotomy. RESULTS: There were no unforseen intraoperative events that were revealed by the use of fluoroscopy and no surgical modifications were made as a result of the intraoperative images. The intraoperative films were found to be a reliable representation of the postoperative weight bearing films but a small increase in the hallux valgus angle was noted at 6 weeks and this is thought to be due to stretching of the medial soft tissue repair. CONCLUSIONS: Intraoperative fluoroscopy is a reliable technique. This study was performed at a centre which performs approximately 100 hallux valgus operations per year and that should be taken into consideration when reviewing our findings. We conclude that there may be a role for fluoroscopy for surgeons in the early stages of the surgical learning curve and for those that infrequently perform hallux valgus surgery. We cannot, however, recommend that fluoroscopy be used routinely in hallux valgus surgery.

TransLateral ACL reconstruction: a technique for anatomic anterior cruciate ligament reconstruction.

Anatomic placement of the femoral tunnel in anterior cruciate ligament (ACL) reconstruction confers biomechanical advantages over the traditional tunnel position. The anteromedial portal technique for anatomic ACL reconstruction has many well-described technical challenges. This paper describes the TransLateral technique. The technique produces anatomic femoral tunnel placement using direct measurement of the medial wall of the lateral femoral condyle and out to in drilling. All work is carried out through the lateral portal with all viewing via the medial portal. There is no need for an accessory medial portal or hyperflexion of the knee. Level of evidence Expert opinion, Level V.

Cautious observation or blanket scanning? An investigation into paediatric attendances to an emergency department after head injury.

In September 2007, the National Institute for Health and Clinical Excellence (NICE) in the UK issued a newly updated guideline (CG56) on the early care of adults and children with head injuries.(8) The guideline gives some new recommendations, in particular with regards to imaging of children with head injury. We undertook a study to investigate the management of children presenting with head injury to our emergency department and to assess their outcomes and the CT scanning rate. We then retrospectively applied the new NICE guidelines, using information documented in the case notes, to establish whether adherence to the guidelines would significantly affect CT scanning rates. 237 paediatric head injury cases were seen over the 2-month period that was studied. The actual CT scanning rate observed was 2.1%, rising to 18.1% after strictly applying NICE criteria. This increased scanning rate raises some important issues with regards to patient safety and service provision.

Outcomes of trauma in centenarians.

INTRODUCTION: We present the first study specifically investigating outcomes of centenarian (age>100 years) trauma patients. MATERIALS AND METHODS: We conducted a retrospective cohort study over a 2-year period using data from patients' notes. Inclusion criteria were: admission to Poole Hospital, age of 100 years old or greater and history of sustaining trauma. RESULTS: We used the hospital CaMIS database to identify patients aged 100 years and over who had incurred an injury. 24 patients met the entry criteria for the study: accounting for 26 admission episodes. 23 patients were female and 13 had sustained a fractured neck of femur. 10 patients underwent surgery and the rest were managed non-operatively. There were five inpatient deaths and the majority of the discharged patients returned to their original place of residence following treatment and rehabilitation. Overall mortality at 1 year was 10 out of 24. DISCUSSION: Our increasingly elderly population is leading to a growing burden upon the NHS. Admission of the extreme elderly trauma patient is becoming more commonplace and presents us with difficult management decisions. Orthopaedic/geriatric collaborative care is now the norm and should continue to develop and improve in the future. CONCLUSION: The extreme elderly should be afforded the same consideration for operative treatment as younger patients and that age alone should not be relied upon as a determinant of treatment and management in these patients.

Percutaneous and mini-open repair of acute Achilles tendon rupture.

Treatment of acute Achilles tendon rupture is slowly evolving, but a lack of prospective, randomized trials leaves insufficient evidence for a definitive recommendation as to the best treatment. Percutaneous and mini-open techniques certainly have roles in treating the acutely ruptured Achilles tendon, and some trials suggest that these techniques can give results equivalent to or better than those of an open repair, with the added benefit of fewer complications. These findings have been backed up by a recent meta-analysis.