Are foot and ankle corticosteroid injections safe during the COVID-19 pandemic? A single center prospective observational study.

BACKGROUND: Intra-articular corticosteroid injections (ICSI) are commonly used in orthopedic practice. Due to concerns about their immunosuppressive effects, we conducted a prospective observational audit, to monitor for COVID-19 infection amongst a group of foot and ankle patients who received an ICSI during the pandemic. PATIENTS AND METHODS: Included were 68 patients (25 males - 43 females, mean age 59.1 years, SD 15.0, range 19 - 90 years) who received a fluoroscopy-guided ICSI within a two-month period during the pandemic. The American Society of Anaesthesiologists (ASA) grade was I in 35 % of patients, II in 58 % and III in 7 %. 16 % of patients had black, Asian or minority ethnic (BAME) background. The dose of methylprednisolone injected was 20 mg for 28 % of the patients, 40 mg for 29 % and 80 mg for 43 %. RESULTS: All patients were available for follow up at one and four weeks post-injection. None reported COVID-19 infection symptoms within this period. The only complication was a flare-up of joint pain. CONCLUSION: Our study showed that the risk of COVID-19 infection to patients receiving foot or ankle ICSI is low. The limitations of this work must be considered, but our findings support the judicious use of corticosteroid injections during the current crisis.

Sustainability of phytoremediation: Post-harvest stratagems and economic opportunities for the produced metals contaminated biomass.

Heavy metals (HMs) are indestructible and non-biodegradable. Phytoremediation presents an opportunity to transfer HMs from environmental matrices into plants, making it easy to translocate from one place to another. The ornate features of HMs' phytoremediation are biophilia and carbon neutrality, compared to the physical and chemical remediation methods. Some recent studies related to LCA also support that phytoremediation is technically more sustainable than competing technologies. However, one major post-application challenge associated with HMs phytoremediation is properly managing HMs contaminated biomass generated. Such a yield presents the problem of reintroducing HMs into the environment due to natural decomposition and release of plant sap from the harvested biomass. The transportation of high yields can also make phytoremediation economically inviable. This review presents the design of a sustainable phytoremediation strategy using an ever-evolving life cycle assessment tool. This review also discusses possible post-phytoremediation biomass management strategies for the HMs contaminated biomass management. These strategies include composting, leachate compaction, gasification, pyrolysis, torrefaction, and metal recovery. Further, the commercial outlook for properly utilizing HMs contaminated biomass was presented.

Multi-step short-term [Formula: see text] forecasting for enactment of proactive environmental regulation strategies.

Particulate matter is one of the key contributors of air pollution and climate change. Long-term exposure to constituents of air pollutants has exerted serious health implications in both humans and plants leading to a detrimental impact on economy. Among the pollutants contributing to air quality determination, particulate matter has been linked to serious health implications causing pulmonary complications, cardiovascular diseases, growth retardation and ultimately death. In agriculture, crop yield is also negatively impacted by the deposition of particulate matter on stomata of the plant which is alarming and can cause food security concerns. The deleterious impact of air pollutants on human health, agricultural and economic well-being highlights the importance of quantifying and forecasting particulate matter. Several deterministic and deep learning models have been employed in the recent years to forecast the concentration of particulate matter. Among them, deep learning models have shown promising results when it comes to modeling time series data and forecasting it. We have explored recurrent neural networks with LSTM model which shows potential to predict the particulate matter ([Formula: see text]) based on multi-step multi-variate data of two of the most polluted regions of South Asia, Beijing, China and Punjab, Pakistan effectively. The LSTM model is tuned using Bayesian optimization technique to employ the appropriate hyper-parameters and weight initialization strategies based on the dataset. The model was able to predict [Formula: see text] for the next hour with root-mean-square error (RMSE) of 0.1913 (91.5% accuracy) and this error gradually increases with the number of time steps with next 24 hours steps prediction having RMSE of 0.7290. While in case of Punjab dataset with data recorded once a day, the RMSE for the next day forecast is 0.2192. These multi-step short-term forecasts would play a pivotal role in establishing an early warning system based on the air quality index (AQI) calculated and enable the government in enacting policies to contain it.

Preoperative Expectations Versus Reality: A Patient Experience Study Following Scarf Osteotomy for Hallux Valgus Correction.

The relationship between managing patient expectations and postoperative functional outcomes has been studied widely in other areas of orthopedics, but there is a paucity of information in the foot and ankle literature. The primary objective of the study was to identify the most common patient "expectations" from hallux valgus surgery and establish over what time period postsurgery they would meet those goals. A prospective study of 45 consecutive patients was performed at a single center. This included adult patients (>18 years old) that underwent a scarf osteotomy for primary hallux valgus correction. Patients were followed up for 6 months and completed pre- and postoperative Manchester-Oxford Foot Questionnaire and Visual Analogue Scale scores. A separate "expectations" questionnaire was designed and completed assessing the patient's preoperative rehabilitation expectations compared to the actual time taken to achieve those goals. These included 5 domains: pain improvement, return to walking unaided, return to normal foot sensation, return to normal footwear, and return to driving. The postoperative functional scores demonstrated statistically significant improvement postsurgery (p < .001). It also highlighted the overall time frame over which the above expectations were met. On average, patients achieved satisfactory pain improvements 1.4 weeks earlier than expected (p < .001) along with trends toward an earlier return to driving function of patient expectation (p < .05). Patients can thus be reliably informed that their pain symptoms are likely to settle within one month of surgery. This should allow patients to prepare for their rehabilitation more informed, thus facilitating earlier weightbearing and return to function.

Interactive effect of biochar and compost with Poaceae and Fabaceae plants on remediation of total petroleum hydrocarbons in crude oil contaminated soil.

The current study was dedicated to finding the effect of soil amendments (biochar and compost) on plants belonging to Poaceae and Fabaceae families. Plants selected for the phytoremediation experiment included wheat (Triticum aestivum), maize (Zea mays), white clover (Trifolium repens), alfalfa (Medicago sativa), and ryegrass (Lolium multiflorum). The physiological and microbial parameters of plants and soil were affected negatively by the 4 % TPHs soil contamination. The studied physiological parameters were fresh and dried biomass, root and shoot length, and chlorophyll content. Microbial parameters included root and shoot endophytic count. Soil parameters included rhizospheric CFUs and residual TPHs. Biochar with wheat, maize, and ryegrass (Fabaceae family) and compost with white clover and alfalfa (Poaceae family) improved plant growth parameters and showed better phytoremediation of TPHs. Among different plants, the highest TPH removal (68.5 %) was demonstrated by ryegrass with compost, followed by white clover with biochar (68 %). Without any soil amendment, ryegrass and alfalfa showed 59.55 and 35.21 % degradation of TPHs, respectively. Biochar and compost alone removed 27.24 % and 6.01 % TPHs, respectively. The interactive effect of soil amendment and plant type was also noted for studied parameters and TPHs degradation.

Soil conditioners improve rhizodegradation of aged petroleum hydrocarbons and enhance the growth of Lolium multiflorum.

Bioremediation and phytoremediation have demonstrated potential for decontamination of petroleum hydrocarbon-impacted soils. The total petroleum hydrocarbons (TPHs) are known to induce phytotoxicity, reduce water retention in soil, associate hydrophobic nature and contaminants' in situ heterogeneous distribution, limit soil nutrient release and reduce soil aeration and compaction. The ageing of TPHs in contaminated soils further hinders the degradation process. Soil amendments can promote plant growth and enhance the TPH removal from contaminated aged soil. In the present experiment, remediation of TPH-contaminated aged soil was performed by Italian ryegrass, with compost (COM, 5%), biochar (BC, 5%) and immobilized microorganisms' technique (IMT). Results revealed that significantly highest hydrocarbon removal (40%) was noted in mixed amendments (MAA) which contained BC + COM + IMT, followed by COM (36%), compared to vegetative control and other treatments. The higher TPH removal in aged soil corresponds with the stimulated rhizospheric effects, as evidenced by higher root biomass (85-159% increase), and bacterial count compared to NA control. Phyto-stimulants actions of biochar and IMT improved seed germination of Italian ryegrass. The compost co-amendment with other treatments showed improvement in plant physiological status. These results suggested that plant growth and TPH removal from aged, contaminated soils using BC, COM and IMT can improve bioremediation efficiency.

The timing of closed unstable ankle fracture fixation and major wound complications - an observation from a UK major trauma centre.

OBJECTIVE: A retrospective cohort study was performed at a UK major trauma centre to identify whether timing of surgical fixation of closed unstable ankle fracture affected the rate of major wound complications. METHODS: Consecutive cases of unstable ankle fractures treated with open reduction internal fixation (ORIF) between March 2014 to December 2016 were included in this retrospective cohort study. Data were collected from 2018 onwards allowing a minimum follow-up of 2 years. Patients under the age of 18, polytrauma, open fractures and those requiring external fixation were excluded. Timing of ORIF were categorised into early (within 24 hours of injury) and delayed (after 24 hours of injury). Primary outcome was major soft tissue complications (defined as deep wound infections or wound breakdown that required further surgery). Secondary outcomes included fixation failure, and symptomatic metal work requiring removal. RESULTS: A total of 235 consecutive cases were included. There were 108(46%) patients in the early fixation group, and 127(54%) patients in the delayed fixation group. Seven major wound complications were identified. Five of which were in the early group, and 2 in the late group. There was no statistically significant difference in the major wound complication rates between the early and delayed surgery groups (p = 1.000). CONCLUSIONS: No significant difference was observed in the rate of major soft tissue complications between early and delayed fixation for isolated unstable ankle fractures.

Experience of Using Telehealth for Foot and Ankle Examination During The SARS-COV-2 Crisis.

The era of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is rapidly evolving. To comply to the guidelines for social distancing and reducing travel to prevent the spread of disease, many centers made rapid adjustments to conduct follow-up appointments through telehealth mediums. We explore our center's adaptation to the pandemic, reflecting on how we formulated telehealth clinics for our patients. We share our experience, discuss the challenges encountered, the feedback received, as well as consider the future role of telehealth in everyday orthopaedic practice.Levels of Evidence: Level V.

Ornamental plants for the phytoremediation of heavy metals: Present knowledge and future perspectives.

Environmental matrices are polluted with the plethora of contaminants, and among these, the concerns related to heavy metals (HMs) are also included. Due to the low cost in a long-term application and environmental friendliness, the use of biological remediation has gained significant attention in recent decades. The use of ornamental plants (OPs) in the field of phytoremediation is scarcely reported, and the impacts of HMs on OPs have also not been investigated in great depth. The OPs mediated HMs remediation can simultaneously remove contaminants and bring improvement in aesthetics of the site. The biomass of OPs produced after such activities can be used and sold as pot plants, cut flowers, essential oils, perfumes, air fresheners production, metal phytomining, and feedstock in silk production. The OPs also present a lower risk of HMs bioaccumulation compared to crop plants. This review focuses on the current knowledge of HMs toxicity to OPs, their applicability advantages, methods to improve the tolerance of OPs with incremented HMs uptake, challenges in the field, and future application perspectives. The case studies realted to practical application of OPs, from China, Iran, India, Oman, Pakistan, and Turkey, were also discussed. This work fetches the inter-disciplinary features and understanding for the sustainable treatment of HMs in a new novel way, to which no previous review has focused.

Lead tolerant endophyte Trametes hirsuta improved the growth and lead accumulation in the vegetative parts of Triticum aestivum L.

Rapid industrialization and increasing population are continuously adding contaminants to our environment. Among those, heavy metals are considered to be one of the serious threats to the ecosystem due to their persistent nature. Microbe assisted phytoremediation is an effective tool for metal remediation as microbes enhance the metal availability and uptake to the host plants or reduce it by binding them intracellularly or extracellularly. An endophytic fungus, Trametes hirsuta, was isolated from Chenopodium album L. plant growing in the lead (Pb) contaminated soil of an industrial area. This is the first study citing Trametes hirsuta, as a root endophyte of Chenopodium album L. This endophytic fungus was found to be tolerant to high concentration of Pb i.e., 1500 mg L-1, when tested in-vitro. Wheat (Triticum aestivum L.) seedlings were infected by Trametes hirsuta and Pb tolerance was observed. With the fungal inoculation plants cumulative growth and total chlorophyll content increased by 24% and 18%, respectively as compared to their respective non-inoculated controls at 1000 mg kg-1 Pb. Similary, 50% more Pb accumulation was measured in the shoots of fungal inoculated plants at 1500 mg kg-1 Pb as compared to control. Thus, the results of the present study suggest that mutualism with endophytic fungi can improve the survival of host plants in metal contaminated soils, additionally it can also assist the phytoextraction of heavy metals from polluted sites by increasing their uptake by the host plants.

Enhanced uptake of Cd, Cr, and Cu in Catharanthus roseus (L.) G.Don by Bacillus cereus: application of moss and compost to reduce metal availability.

Heavy metals (HMs) being the notorious and toxic are being introduced into the environment credited to natural and anthropogenic activities. The use of ornamental plants is being ignored as potential candidates for HMs phytoremediation. In this study, pot experiments were conducted on Catharanthus roseus (L.) G.Don to evaluate selected heavy metals tolerance and accumulation potential with reference to the bacterial endophyte (Bacillus cereus) and organic amendments (moss and compost at 5% v/v). Results indicated improvement in uptake of Cd (230 mg kg-1), Cu (229 mg kg-1), and Cr (458 mg kg-1) by C. roseus with B. cereus. The concentration of Ni and Pb was found highest in controls (without strain) that were 420 and 904 mg kg-1, respectively. Conversely, the addition of organic amendments enhanced biomass production, as compared to controls, 441, 471, and 763% by peat moss (T3), compost (T4), and peat moss + compost + inoculum treatments (T6), respectively, while reduction of plant HMs content was observed. Microbial-aided phytoremediation/phytoextraction could be a potential method for removal of Cd, Cr, and Cu, while organic amendments can significantly improve plant growth in the presence of heavy metals.

Environmental risk assessment of diclofenac residues in surface waters and wastewater: a hidden global threat to aquatic ecosystem.

Pharmaceuticals are chemical compounds employed as medicinal drugs. They have severe physic-chemical properties which make them destructive for non-target species. Consequently, their continuous addition in the environment may pose hazardous effects. Among these, diclofenac (DCF), a non-steroidal anti-inflammatory drug (NSAID), is extensively used in Pakistan which may lead to its accumulation in both terrestrial and aquatic environment. Present study aims to assess the presence and concentration of pharmaceutically active drug (DCF) in surface water and wastewater of twin cities of Pakistan (Rawalpindi and Islamabad). For this purpose, a validated high-performance liquid chromatography (HPLC) method was adopted involving solid-phase extraction procedure. Wastewater samples were collected from various sites of Rawalpindi and Islamabad. Results of HPLC analysis revealed that DCF was extant with considerably high concentration, not only in wastewater but also in surface water samples. Concentrations as high as 216 µg L-1 was detected in Rawat industrial area and low as 8 µg L-1 was detected in dairy farm wastewater samples collected from Taramri. However, maximum DCF levels in residential wastewater and hospital wastewater were detected to be 105 µg L-1 and 34 µg L-1, respectively. Moreover, the highest detected level (116 µg L-1) was found in surface water of Sawan River. Further, results of ecological risk assessment revealed its possible toxic effects of DCF on various aquatic organisms.

Influence of Pseudomonas japonica and organic amendments on the growth and metal tolerance of Celosia argentea L.

In this study, a pot experiment was piloted in a greenhouse to evaluate the potential of Celosia argentea var. cristata L. for tolerating/accumulating heavy metals in synthetic wastewater in the presence of Pseudomonas japonica and organic amendment, i.e., moss and compost. Two-week-old seedlings were transferred to pots, and after 4 weeks, the bacterial strain was inoculated, then watered with synthetic wastewater for 5 weeks and harvested after 9 weeks. After harvesting, physiological and biochemical parameters, as well as metal contents of plants, were quantified. The results indicated highest growth and biomass production in moss- and compost-associated plants while highest metal uptake has been found in the presence of P. japonica and synthetic wastewater-irrigated plants. Synthetic wastewater-irrigated plants have shown highest Pb uptake of 2899 mg kg-1 DW, while with P. japonica in soil those plants have shown highest Cd, Cu, Ni, and Cr uptake of 962, 1479, 1042, and 956 mg kg-1 DW, respectively. The production of antioxidant enzymes, i.e., catalase (CAT), ascorbate peroxidase (APX), guaiacol peroxidase (GPX), and glutathione-s-transferase (GST), was high in P. japonica-amended plants because of increased uptake of metals. It is concluded that moss and compost have improved growth while P. japonica improved metal accumulation and translocation to aerial parts with little involvement in plant growth.

Reduced growth response of ornamental plant Nicotiana alata L. upon selected heavy metals uptake, with co-application of ethylenediaminetetraacetic acid.

The use of ornamental plant will increase with the improvement in living standards in green and blue-green infrastructure of urban settings. Nicotiana alata is an ornamental plant, frequently grown as a model plant for horticulture, medicine, and scientific research studies throughout the world. Despite its popularity, little is known about the response of N. alata against heavy metals (HMs). This work is based on the hydroponic study to identify the impacts of selected HMs (Cd, Cr, Cu, Ni and Pb) on N. alata, at 0, 50 and 100 µM concentration, with the co-application of EDTA, at 0 and 2.5 mM in hydroponics system. The HMs uptake was found to be dose dependent, with significant higher uptake at 100 µM of respective HM. Highest cumulative uptake (mg kg-1 of HMs in root, shoot, and leaf dried weight) noted were 767.50 ±â€¯50.83, 862.30 ±â€¯23.83, 271.29 ±â€¯18.68, 1117.49 ±â€¯46.10 and 2166.81 ±â€¯102.09, for Cd, Cr, Cu, Ni, and Pb at 100 µM, respectively. It was identified that EDTA co-application with HMs resulted in boosted HMs uptake, with cumulative uptake percentage increment of 41.62, 54.67, 53.98, 34.48 and 19.92% for 100 µM of Cd, Cr, Cu, Ni, and Pb, respectively. Higher uptake led to negative impact on plant physiology, photosynthetic pigments, and higher lipid peroxidation, H2O2 contents, and electrolyte leakage that increased the stress. Higher HMs uptake induced higher antioxidant enzymatic response. It is recommended to incorporate appropriate soil modification to grow N. alata in sustainable infrastructures.

Soil amendments enhanced the growth of Nicotiana alata L. and Petunia hydrida L. by stabilizing heavy metals from wastewater.

Due to the non-degradable nature of heavy metals (HMs), the industrial effluent, whether treated or untreated, carrying HMs, eventually end up into the water bodies, soil, and sediments. Numerous countermeasures were applied, but the use of ornamental plants for the stress mitigation associated with HMs on the environment is a neglected research domain. The composition of wastewater influences bioremediation strategies. As the wastewater is contaminated with multiple HMs, many lab studies, with the plants, failed in the industrial field. This work focuses on the potential of Nicotiana alata L. and Petunia hydrida L. against multiple HMs contaminated synthetic wastewater. To improve plant tolerance, soil amendments (biochar, compost, and moss, each at 5% v/v in soil) were used, individually and in combination. After 6 weeks of the exposure, plant physiological, biochemical and enzymatic parameters, as well as the distribution of HMs, (Cd, Cr, Cu, Pb, Mn, Ni, and Zn) in the plant (flower, leaves, root, and shoot) and soil, were measured. The HMs uptake positivity influenced the malondialdehyde content, hydrogen peroxide content and electrolyte leakage, while negatively to photosynthetic pigments, and resulted in increased catalase, guaiacol peroxidase, glutathione s-transferase, ascorbate peroxidase, while reduced superoxide dismutase activity. It was found that all amendments improved the plant growth by metal stabilization, and best results were obtained with the combined application of biochar + compost + moss. So, HMs stabilization can be achieved by growing ornamental plants, like Nicotiana alata L. and Petunia hydrida L. along with soil amendments.

Combined application of selected heavy metals and EDTA reduced the growth of Petunia hybrida L.

Up till now, despite of well-developed ornamental market, very little information is available on Petunia hybrida L. tolerance against heavy metals (HMs), which can contribute in both beautification of urban dwellings, as well as potential in phytoremediation. Therefore, hydroponic study was conducted to check the effects of Cd, Cr, Cu, Ni and Pb individually (50 and 100 µM) and with co-application of EDTA (2.5 mM) in Hoagland's nutrient solution. Results indicated higher uptake of Cd, Cr, Ni and Pb in above ground parts, and Cu in roots, further the co-application of EDTA enhanced HMs uptake in P. hybrida L. This uptake accompanied changes in biochemical stress indicators, included significantly higher MDA, H2O2 contents and electrolyte leakage with reduced chlorophyll a, chlorophyll b, total chlorophyll and carotenoid content. Upon exposure to HMs increased antioxidant enzyme activities (CAT, POX, GST, APX, and SOD) were noted. Though selected HMs can be removed by using P. hybrida L., the findings of current study indicated that the direct exposure of P. hybrida L. to Cd, Cr, Cu, Ni and Pb damaged the plant's aesthetics, and to use P. hybrida L. for beautification of urban landscape or phytoremediation, appropriate soil modification should be included.

Systematic Review of Stress Radiographic Modalities Stability Assessment in Supination External Rotation Ankle Fractures.

BACKGROUND: Isolated distal fibular fractures resulting from supination external rotation (SER) injuries without evidence of obvious talar shift on standard radiographs present a diagnostic dilemma for clinicians. The status of the deep deltoid ligament, the main stabilizer of the ankle joint, is assessed by an increase in medial clear space (MCS) on radiographs. Therefore, these injuries can be either stable or unstable. In recent years, considerable clinical and research efforts have been made to determine ankle stability following SER fracture. The purpose of this systematic review was to evaluate and compare the role of different stress radiograph modalities in assessing stability of the ankle with SER fractures with no obvious talar subluxation on standard radiographs. METHODS: The electronic databases MEDLINE, EMBASE, Ovid, Cochrane Central, CINAHL, and Google Scholar were searched from January 2000 to January 2018 to identify literature relating to radiologic assessment of stability of SER ankle fractures. RESULTS: Our literature search revealed 10 peer-reviewed articles that fulfilled inclusion criteria. This yielded a total of 698 patients. The systematic review found 3 broad categories of radiographic investigations in the assessment of ankle joint stability: external rotation (ER) stress radiographs, gravity stress views (GSV), and weightbearing (WB) radiographs. Proponents of WB radiographs have demonstrated how axial load can normalize ankle joint alignment in cases of proven instability. There was a consistently high grade of evidence for using a medial clear space (MCS) value of more than 4 to 5 mm to indicate an unstable ankle following SER fracture. CONCLUSION: In conclusion, the results of this systematic review support an MCS value of less than 4 to 5 mm as a good indicator of stability, regardless of choice of stress imaging modality. These patients can be allowed early weightbearing with expected good functional outcomes. Recent published literature favors WB stress radiographs as a reliable and safe technique for assessing stability in SER ankle fractures. However, it should be kept in mind that this is based on studies with relatively low grades of evidence. LEVEL OF EVIDENCE: Level II, systematic review of variable quality studies.

The acute Charcot foot in diabetics: Diagnosis and management.

Acute Charcot foot is a diagnostic challenge.The exact pathophysiology is not fully understood.Acute Charcot foot is often present with a history of trauma or cellulitis which does not respond to antibiotics.The condition is best managed within a multidisciplinary team.The mainstay of the treatment is mechanical off-loading and total contact casting.Surgery is reserved for select cases. Cite this article: EFORT Open Rev 2018;3:568-573. DOI: 10.1302/2058-5241.3.180003.

Temperature drives the assembly of endophytic communities' seasonal succession.

Endophytic microorganisms asymptomatically colonise plant tissues. Exploring the assembly dynamics of bacterial endophytic communities is essential to understand the functioning of the plant holobiont and to optimise their possible use as biopesticides or plant biostimulants. The variation in endophytic communities in above and below-ground organs in Vitis vinifera in the field were studied. To understand the specific effect of temperature on endophytic communities, a separate experiment was set up where grapevine cuttings were grown under controlled conditions at three different temperatures. The findings revealed the succession of endophytic communities over the year. Endophytic communities of roots and stems differ in terms of composition and dynamic response to temperature. Noticeably, compositional differences during the seasons affected bacterial taxa more in stems than in roots, suggesting that roots offer a more stable and less easily perturbed environment. Correlation abundance networks showed that the presence of several taxa (including Bradyrhizobium, Burkholderia, Dyella, Mesorhizobium, Propionibacterium and Ralstonia) is linked in both the field and the greenhouse.

Hospital stay and blood transfusion in elderly patients with hip fractures.

Neck of femur (NOF) fractures in elderly patients are the most frequent condition which an orthopaedic surgeon confronts nowadays. The incidence of these fractures is increasing as the population continues to age. These patients absorb the majority of the resources in the hospitals, as their healthcare demands are increased. This study included all patients who were admitted to our hospital between January and October 2015 following a neck of femur fracture. A total of 336 patients were included (72.3% female). We gathered demographic and hospitalisation data from patients' files. Haemoglobin (Hb) levels at admission and transfusion data were also collected. Male patients appeared to have a relatively higher risk of mortality than females (p=0.01). Patients with high ASA grade (IV) had a higher mortality rate (p=0.01). Age, delay of surgery, type of surgery, AMTS and Hb at admission and type of fracture on the other hand did not have a significant impact on mortality (p>0.05). Patients who needed transfusion during their hospitalisation had significantly lower Hb at admission (p=0.044). More specifically, patients who had Hb<110 at admission were more likely to need transfusion (p<0.001). Hospitalisation of patients who needed transfusion was significantly prolonged. In our effort to deliver the best services to our patients, this study considers transfusing the elderly patients with low Hb at admission (Hb<110) pre-operatively, with a view to increasing their reserves for the operation and potentially speeding up the rehabilitation process and decreasing their hospitalisation time.