Injury
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Wrist and scaphoid fractures are common injuries seen and treated in everyday orthopaedic practice. The purpose of the study was to assess the trends and reasons for litigation related to wrist and scaphoid fractures within the NHS. Under a freedom of information (FOI) request, data from 1995 to 2012 were provided by the National Health Service Litigation Authority (NHSLA) on all litigation claims made as a result of wrist and scaphoid fractures. ⋯ Alleged mismanagement (29.5%), poor care (10.1%) and incompetent surgery (8.0%) were other common causes for litigation. This paper augments previous work published in this area and explores litigation trends specific to wrist and scaphoid fractures. We discuss the trends and reasons for litigation in this area, suggesting areas for improvement that may aid health-care professionals who deal with these injuries and potentially help reduce future litigation.
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We hypothesized that resident participation in a hands-on fracture fixation course leads to significant improvement in their performance as assessed in a simulated fracture fixation model. ⋯ Participation in a formal surgical skills course significantly improved practical operative skills as assessed by the simulation. The benefits of the course were maintained to 6 months with residents who completed the training earlier continuing to demonstrate an advantage in skills. Such courses are a valuable training resource which directly impact resident performance.
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Comparative Study
A comparison of 30-day complications following plate fixation versus intramedullary nailing of closed extra-articular tibia fractures.
Tibial shaft fractures are often treated by intramedullary nailing (IMN) or plate fixation. Our purpose was to compare the 30-day complication rates between IMN and plate fixation of extra-articular tibial fractures. ⋯ We found no difference in 30-day postoperative complications between plate fixation and intramedullary nailing of isolated extra-articular tibia fractures with the exception of decreased postoperative transfusion requirements with plate fixation. We conclude that both procedures offer a similar short-term complication profile.
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There is no definite radiographic landmark in plain radiographs for proximal humeral rotation, which is an important parameter for avoiding rotational malalignment during fracture fixation. Here, we used radiographic images of cadaveric humeri to determine whether the landmark of the crest of lesser tuberosity (CoLT) in plain radiographs could be used to determine humeral rotation. ⋯ The projection of the CoLT in plain radiographs can be used as an important landmark to assess humeral head rotation and will be a useful landmark for rotational control of fracture fixation.
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Although recent literature has demonstrated the utility of the ASA score in predicting postoperative length of stay, complication risk and potential utilization of other hospital resources, the ASA score has been inconsistently assigned by anaesthesia providers. This study tested the reliability of assignment of the ASA score classification by both attending anaesthesiologists and anaesthesia residents specifically among the orthopaedic trauma patient population. ⋯ This study shows substantial agreement strength for reliability of the ASA score among anaesthesiologists when evaluating orthopaedic trauma patients. The significant increase in inter-rater reliability based on anaesthesiologists' comfort with the ASA scoring method implies a need for further evaluation of ASA assessment training and routine use on the ground. These findings support the use of the ASA score as a statistically reliable tool in orthopaedic trauma.