Outcome of limb lengthening in fibular hemimelia and a functional foot.

BACKGROUND: The decision to recommend either reconstructive or ablative surgery to the parents of children with fibular hemimelia is difficult and debatable in the orthopaedic literature. METHODS: This is a retrospective study reporting our experience of the treatment of eight children (eight limbs) with fibular hemimelia with limb lengthening using Ilizarov or Taylor spatial frames. All of these children had type 1 or 2a fibular hemimelia (Achterman and Kalamchi). We used the number of rays present in the foot as a guide to decide on the treatment option. Children with more than three rays at the time of presentation were considered for limb reconstruction using Taylor spatial or Ilizarov frames. RESULTS: All patients were ambulatory and mobile with acceptable leg lengths and limb alignment at the time of last follow-up. All of them were satisfied with the outcome. Knee stiffness was a significant problem in the majority of the patients following lengthening. CONCLUSIONS: We conclude that limb reconstruction in children with less severe forms of fibular hemimelia is a good option.

Does the number of trauma lists provided affect care and outcome of patients with fractured neck of femur?

INTRODUCTION: Delay in surgery for fractured neck of femur is associated with increased mortality; it is recommended that patients with fractured neck of femur are operated within 48 h. North West hospitals provide dedicated trauma lists, as recommended by the British Orthopaedic Association, to allow rapid access to surgery. We investigated trauma list provision by each trust and its effects on the time taken to get neck of femur patients to surgery and patient survival. PATIENTS AND METHODS: The number of trauma lists provided by 13 acute trusts was determined by telephone interview with the theatre manager. Data on operating delays, reasons for delay and 30-day mortality were obtained from the Greater Manchester and Wirral fractured neck of femur audit. RESULTS: A total of 883 patients were included in the audit (35-126 per hospital). Overall, 5-15 trauma lists were provided each week, and 80% of lists were consultant-led. Of patients, 31.8% were operated on within 24 h and 36.9% were delayed more than 48 h; 37.7% of delays were for non-medical reasons. The 30-day mortality rates varied between 5-19% (mean, 11.8%). There were no significant relationships between the number of trauma lists and these variables. When divided into hospitals with > 10 lists per week (n = 6) and those with < 10 lists per week (n = 7) there were no significant differences in 48-h delay, non-medical delay or mortality. However, 24-h delay showed a trend to be lower in those with > 10 lists (34.6% of patients versus 28.9%; P = 0.09). CONCLUSIONS: Most trusts provided at least one dedicated daily list. This study shows that extra lists may enable trusts to cope better with fractured neck of femur but do not change mortality.