The effect of COVID-19 pandemic on the care of fragility hip fracture patients in the United Kingdom. A case control study in a major trauma centre.

INTRODUCTION: Coronavirus disease 2019 is a pandemic that forced a transformation in the services provided by the National Health Service in the United Kingdom. Fragility hip fractures account for over 65,000 cases per year in the elderly population. The study aims to assess the impact of the pandemic on fragility hip fractures. METHODS: A retrospective data gather was performed to identify fragility hip fractures from the 23rd of March 2020 to the 13th of May 2020, and from the 23rd of March 2019 to the 13th of May 19. Two groups were formed and compared over their 30 day follow up. RESULTS: The control group comprised of 97 patients, with a mean age of 82.1 years old (62-102 years) and M:F ratio of 38:59. The case group comprised of 102 patients, with a mean age of 82.3 years old (60-100 years) and a M:F ratio of 16:86. Significant differences between groups were identified for gender (p < 0.001), time to theatre (p = 0.002), length of stay (p < 0.001) and COVID-19 status (p = 0.001). In the Case group, association with mortality was found for male gender (p = 0.041), right side (p = 0.031) and COVID-19 positive test results (p = 0.011). CONCLUSION: Early surgical intervention is advocated wherever possible, and sufficient optimisation, prior to surgery whenever a COVID-19 positive patient is identified. A safe rehabilitation environment is paramount for recovery in this group of patients. Further studies are required to understand the effect of this pandemic on the fragility hip fractures. LEVEL OF EVIDENCE: Level III: Retrospective case-control study.

Function and survival after revision of hip resurfacing.

The purpose of this study was to compare functional outcome and survival of isolated acetabular, isolated femoral and both component revision after failure of primary Birmingham Hip Resurfacing. The Oswestry Outcome Centre prospectively collected data on 5000 hip resurfacing between 1997 and 2002. Of these, 182 hips were revised: 8% had revision of the acetabular component only, 42% had revision of the femoral component only to conventional stemmed prosthesis, and 50% had revision of both components to conventional total hip arthroplasty (THA). We used a postal questionnaire to assess function by Harris and Merle d'Aubigné and Postel hip scores and determined survival using re-revision as an endpoint. In patients with isolated acetabular revision, the median Harris hip score (HHS) was 74 at a mean of 4.5 years follow up. Isolated femoral revision had a median HHS of 82 at a mean of 3.8 years. When both components were revised, the median HHS was 85 at a mean of 4 years. We observed no difference in HHS between the groups. There was an average survival of 92% at 10 years. Survival was significantly lower for isolated acetabular revision (75%) than isolated femoral (93%) or both component revision (96%).

Spontaneous displacement of olecranon fracture through geode salvaged by elbow replacement.

We present a case of pathological fracture of olecranon through a giant geode. Fracture was initially undisplaced and was treated conservatively. It later progressed to a transolecranon dislocation as a result of a pseudarthrosis at the fracture site. The patient presented 4 years later when she developed symptoms of ulnar nerve palsy. She was treated by a total elbow arthroplasty with ulnar nerve transposition. The current report highlights this unusual case and reviews the relevant literature.

Bicycle and cycle rickshaw injury in suburban India.

OBJECTIVES: To study pattern of injury associated with bicycle and cycle rickshaw. METHODS: Between June 2002 and June 2003, a hospital based prospective study was done of patients who presented with injury due to bicycle and cycle rickshaw in emergency department. Age, time of trauma, mode of trauma, contributing factors and type of injury were recorded. RESULTS: Out of total of 41 patients, 23 were injured from bicycle and 18 from cycle rickshaw. In the bicycle group all patients were either traveling on crossbar or rear fender. 91% had sustained injuries due to spokes and 83% had soft tissue injury. In the rickshaw group contributing factors to injury were traveling on rear board and school children traveling on overloaded rickshaw. 78% were injured by rear cogwheel-chain mechanism and 72% patients had only soft tissue injury. CONCLUSIONS: Bicycle and cycle rickshaw injuries have a unique pattern of injury particularly affecting individuals riding them in an unconventional way. Majority of them sustained extensive soft tissue injury to leg and ankle.

Local antibiotics: panacea for long term skeletal traction.

Long periods of skeletal traction are frequently needed in busy tertiary centres due to long waiting lists for surgery. A frequent complication is pin track infection, which leads to revision of pin insertion or switching over to skin traction. A prospective study was conducted on sixty patients with upper tibial pin insertion for various causes. Antibiotic (injection Cephazolin 0.5 g after sensitivity testing--250 mg on each side) was injected on thirty patients at the site of pin insertion and no antibiotic was injected in 30 controls. Only one stage one pin track infection was seen in the study group (3% cases), where as six cases had stage 1 infection, one case had stage 2 infection and two cases had stage 3 infections in the control group (30% cases). This study showed the usefulness of this modification in preventing morbidity in patients who are planned for long-term skeletal traction by temporarily suppressing the local flora.

Giant bone island of femur complicating replacement arthroplasty: a report of two cases.

Bone islands are hamartomatous malformations in the bone that are known to be asymptomatic in nature. Two cases are presented in which the presence of bone islands in the femur led to difficulty with the introduction of a femoral prosthesis. In one case, this led to fracture of the medial part of the cortex, which was fixed with a screw prior to insertion of the prosthesis. In the second case, a window was made in the femur to remove hard bone sufficient for insertion of the prosthesis. This was closed with steel wires prior to insertion of the cemented femoral stem. These cases illustrate the problems that can be encountered during surgery in the presence of bone islands. The surgeon should evaluate the site, size, and location of bone islands during preoperative planning before performing surgery.

Atlantoaxial rotatory fixation secondary to tuberculosis of occiput: a case report.

STUDY DESIGN: A case of nontraumatic rotatory fixation of the atlantoaxial joint associated with tuberculosis of the occipital bone in an adult. OBJECTIVES: To report a rare case of atlantoaxial rotatory subluxation associated with tuberculosis of the occipital bone in an adult and to discuss the mechanism of fixation. SUMMARY OF THE BACKGROUND DATA: Atlantoaxial rotatory fixation in adults is rare and has been reported due to variety of causes. To the authors' best knowledge no case has been reported secondary to tuberculosis of the skull bone. METHODS: A 20-year-old male presented with resistant torticollis with a duration of 5 months. RESULTS: The patient had type 1 atlantoaxial rotatory fixation secondary to tuberculosis of the occipital bone. The subluxation was partially reduced by conservative means, and healing of the occiput lesion was achieved. Thereafter, the patient had no restriction of cervical spine motion and had no reoccurrence of subluxation at a follow-up of one and a half years. CONCLUSIONS: Effusion in the atlantoaxial joint secondary to infection in the occiput due to close proximity with the joint led to the laxity of ligaments and contributed to the subluxation.