Repair of traumatic muscle herniation with acellular porcine collagen matrix.

BACKGROUND: Muscle hernias are uncommon clinical conditions with no uniform solution of repair. Biocompatible mesh allows for repair of hernias without the donor site morbidity and complications from direct repair under tension. METHODS: Over a 6-month period at a Level 1 Trauma centre, four consecutive symptomatic muscle hernias were identified, two in the forearm and two in the lower limb. Three resulted from high-speed motorbike accidents, one from a mining accident. All patients had hernia repair at a minimum of 4 months post accident. A 10 × 15 cm × 1.0 mm sheet of acellular collagen matrix was fashioned to fit as an underlay of the fascia defect. Patients were clinically followed at the 2-, 6-, 12- and 26-week mark. Final phone contact was made 18 months post-operatively. RESULTS: All patients were pleased with their cosmetic and functional outcomes. All patients returned to work and sport 3 months after reconstruction. CONCLUSION: Symptomatic hernias as a result of trauma can be safely reconstructed with a biological mesh implant. This approach can prevent complications from previously described methods and return to active lifestyles with good results.

Changes in hip fracture incidence, mortality and length of stay over the last decade in an Australian major trauma centre.

PURPOSE: The aim of this study was to describe the population-based longitudinal trends in incidence, 30-day mortality and length of stay of hip fracture patients in a tertiary referral trauma centre in Newcastle, New South Wales, Australia, and identify the factors associated with increased 30-day mortality. METHODS: A retrospective database and chart review was conducted to patients aged ≥65 years with a diagnosis of femoral neck or pertrochanteric fracture admitted to the John Hunter Hospital between 01 January 2002 and 30 December 2011. The main outcome measure was 30-day mortality; secondary outcome was acute length of stay. RESULTS: There were 4,269 eligible patients (427±20 per year) with hip fractures over the 10-year study period. The absolute incidence increased slightly (p=0.1) but the age-adjusted rate decreased (p≤0.0001). The average age (83.5±7.1 years) and percentage of females (73.7%) did not change. Length of stay increased by a factor of 2.5% per year (p<0.0001). Thirty-day mortality decreased from 12.3% in 2002 to 8.20% in 2011 (p=0.0008). Independent risk factors associated with increased 30-day mortality were longer admissions (p<0.0001), increased age (p=0.005), dementia (p=0.01), male gender (p<0.0001), higher American Society of Anaesthesiologists score (p<0.0001), and longer time to operating theatre (p=0.002). CONCLUSIONS: Despite the relative ageing of our population, a decrease in the age-standardised rate of fractured hip in elderly patients has seen the number of admissions remain unchanged in our institution from 2002 to 2011. There was a decrease in 30-day mortality, while length of stay increased.