Dedicated orthopedic trauma theatres: effect on morbidity and mortality in a single trauma centre.

BACKGROUND: A general trend in orthopedic traumatology is the advent of daily, dedicated orthopedic trauma theatres. Availability of trauma theatres is believed to decrease morbidity and mortality, but this remains unproven. We performed a retrospective review comparing morbidity and mortality outcomes at a single institution before and after the establishment of a dedicated trauma room. The purpose was to determine whether a change in outcomes occurred for a single routine procedure with known outcome expectations (hemiarthroplasty of the hip after femoral neck fracture) with the implementation of a designated trauma theatre. METHODS: We examined a cohort of 457 elderly patients (245 before and 212 after trauma theatre implementation) who underwent hemiarthroplasty for displaced low-energy subcapital hip fractures. RESULTS: Patients in both groups were similar in terms of age, sex ratio and ASA classification. We found statistically significant differences favouring the dedicated trauma room system for postoperative morbidity. Despite this outcome, the average time to surgery for these patients significantly increased. We noted no difference in mortality between the 2 groups. CONCLUSION: The hip fracture population can be treated safely in the context of dedicated trauma room time; however, there needs to be prioritization of hip fractures in a tertiary care centre or other trauma cases will tend to take precedence.

Atlantoaxial fusion using anterior transarticular screw fixation of C1-C2: technical innovation and biomechanical study.

This study is an attempt to describe a new technique for anterior transarticular screw fixation of the atlantoaxial joints, and to compare the stability of this construct to posterior transarticular screw fixation with and without laminar cerclage wiring. Nine human cadaveric specimens were included in this study. The C1-C2 motion segment was instrumented using either anterior transarticular screws (group 1), posterior transarticular screws alone (group 2), or posterior screws with interlaminar cerclage wires (group 3). Using an unconstrained mechanical testing machine, the specimens were tested in rotation, lateral bending, and flexion-extension using nondestructive loads of +/-2 N m. The specimens were also tested in translation using nondestructive loads of +/-100 N. All values for the three groups with regards to anterior-posterior displacement, rotation, and lateral bending were similar as determined using a Kruskal-Wallis rank sum test with a significance level of p<0.05. The only significant difference was registered in flexion-extension where the cerclage wire added some strength to the construct. Anterior transarticular screw fixation of the atlantoaxial spine has several advantages over posterior fixation techniques, and is as stable as posterior transarticular fixation in all clinically significant planes of motion. The addition of posterior interlaminar cerclage wiring further improves resistance to flexion-extension forces. Anterior transarticular screw fixation of the atlantoaxial joint is a useful technique for achieving C1-C2 stabilization.