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  1. Article ; Online: RATeS (Re-Admissions in Trauma and Orthopaedic Surgery): a prospective regional service evaluation of complications and readmissions.

    Ward, Alex E

    Archives of orthopaedic and trauma surgery

    2019  Volume 139, Issue 10, Page(s) 1351–1360

    Abstract: Introduction: All the surgeries carry risks, which may lead to readmission at a later date. At present, there is limited Trauma and Orthopaedic (T&O) specific data in the literature. As a result, a prospective regional service evaluation aimed to ... ...

    Abstract Introduction: All the surgeries carry risks, which may lead to readmission at a later date. At present, there is limited Trauma and Orthopaedic (T&O) specific data in the literature. As a result, a prospective regional service evaluation aimed to discover the current complication and readmission rates across all T&O procedures and identify any factors associated with these outcomes.
    Methods: Data were collected at six sites across Yorkshire and Humber for all T&O procedures during October 2016. Patient demographics and procedure-specific data were collected. Post-operative complications and length of stay were recorded. All the patients were then followed up for 30 days post-discharge to determine if they experienced complications which resulted in readmission and further surgical intervention.
    Results: 1411 patients having a total of 64 operations were recorded with 1391 completing follow-up (98.5%). Overall in-patient complication rate was 8.4% with the readmission rate being 4.4%. An ASA grade of three or more was found to be associated with readmission. Procedure-related factors such as the use of VTE prophylaxis and prophylactic antibiotics, as well as the elective nature of certain operations were negatively associated with readmission. The largest subgroup of patients was those undergoing total hip (THR) or knee replacements (TKR). For these 234 patients, the readmission rate for TKR and THR being 3.77% and 3.13%, respectively.
    Conclusions: This large, multi-centre project describes readmission rates following trauma and orthopaedic surgery. In the presented study, the elective nature of the procedure was associated with a reduced risk of readmission.
    MeSH term(s) Adult ; Aged ; Elective Surgical Procedures/adverse effects ; Elective Surgical Procedures/statistics & numerical data ; England ; Female ; Humans ; Male ; Middle Aged ; Orthopedic Procedures/adverse effects ; Orthopedic Procedures/statistics & numerical data ; Patient Readmission/statistics & numerical data ; Postoperative Complications/etiology ; Prospective Studies ; Risk Factors ; Wounds and Injuries/surgery
    Language English
    Publishing date 2019-03-20
    Publishing country Germany
    Document type Journal Article ; Multicenter Study
    ZDB-ID 80407-1
    ISSN 1434-3916 ; 0003-9330 ; 0344-8444
    ISSN (online) 1434-3916
    ISSN 0003-9330 ; 0344-8444
    DOI 10.1007/s00402-019-03144-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Uk I Zs.58: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
    ab Jg. 2022: Lesesaal (EG)

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  2. Article: The acute management of ankle fractures (Augment) study: A prospective trainee led national collaborative audit of the Boast 12 guidelines.

    Fennelly, Joseph T / Gourbault, Lysander J / Stedman, Tobias / Price, Michael J / Ward, Alex E

    The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

    2021  Volume 19, Issue 5, Page(s) e237–e244

    Abstract: Background: Ankle fractures are one of the most common fractures in adults aged 20-65 years. The British Orthopaedic Association (BOA) and British Orthopaedic Foot and Ankle Society (BOFAS) jointly produced Standards for Trauma (BOAST) BOAST 12, with ... ...

    Abstract Background: Ankle fractures are one of the most common fractures in adults aged 20-65 years. The British Orthopaedic Association (BOA) and British Orthopaedic Foot and Ankle Society (BOFAS) jointly produced Standards for Trauma (BOAST) BOAST 12, with the aim of reducing morbidity by standardising care of these injuries. The primary aim of the AUGMENT study was to determine the extent and clinical effect of variation from BOAST 12.
    Methods: AUGMENT was a multi-centre prospective trainee led audit of consecutive patients presenting with an ankle fracture within a four-week period. Data were collected on patient demographics, comorbidities, management and 12-week outcome. The BOAST 12 standards were divided into four subgroups; documentation, imaging, management and follow-up. Percentage compliance with each subgroup was analysed. A multivariate logistic regression analysis was used to determine impact of overall compliance on likelihood of discharge in follow-up period.
    Findings: 971 patients were included across 52 sites. The overall rate of BOAST 12 compliance was 41.7%. Variations in practice were observed in clinical documentation, especially of neurovascular status, (40.7%) and VTE assessment (61.5%). Patient management compliance with all 16 of the BOAST 12 standards was associated with a higher rate of discharge during the 12-week follow-up period (p = 0.005).
    Conclusion: AUGMENT has demonstrated that the management of ankle fractures is variable across the UK. Over half of patients had aspects of their care that were not BOAST 12 compliant. When compliance was observed, it was associated with earlier discharge from orthopaedic care.
    MeSH term(s) Adult ; Ankle Fractures/therapy ; Fracture Fixation, Internal ; Humans ; Lower Extremity ; Orthopedics ; Prospective Studies
    Language English
    Publishing date 2021-01-05
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 2102927-1
    ISSN 1479-666X
    ISSN 1479-666X
    DOI 10.1016/j.surge.2020.11.001
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 5756: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  3. Article ; Online: Functional Outcomes Following Operative and Nonoperative Management of Weber C Ankle Fractures: A Systematic Review.

    Yap, Rye Y / Babel, Aditi / Phoon, Kar M / Ward, Alex E

    The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons

    2019  Volume 59, Issue 1, Page(s) 105–111

    Abstract: Weber C ankle fractures are unstable ankle fractures occurring above the syndesmosis. These fractures are often managed operatively, although a small population of patients are still selected for nonoperative management. This study primarily aimed to ... ...

    Abstract Weber C ankle fractures are unstable ankle fractures occurring above the syndesmosis. These fractures are often managed operatively, although a small population of patients are still selected for nonoperative management. This study primarily aimed to summarize the current evidence on functional outcomes for Weber C patients managed operatively and nonoperatively. Evidence on secondary outcomes such as complications and radiographic outcomes were also reviewed. This systematic search was conducted according to PRISMA guidelines. A literature search was conducted using the EMBASE, Medline, and Central databases. A total of 26 studies were included in the final analysis. All papers studied the management of Weber C fractures using open reduction and internal fixation (ORIF). Three main functional outcome scores were identified: American Orthopedic Foot and Ankle Society score, Olerud-Molander Ankle Score, and Foot and Ankle Outcome Score. Only 1 study compared operative and conservative management, which showed similar outcomes for either option (median Olerud-Molander Ankle Score 95 [range 20 to 95] vs 100 [70 to 100], respectively). Complications associated with operative management included infection, wound dehiscence, implant failure, and malunion or nonunion. The mean rate of syndesmosis malreduction was 18.2%. This study showed that operative management, regardless of the method of ORIF used, as well as nonoperative management resulted in good functional outcomes, indicating that patient selection for either method is important. However, there is limited evidence on the complications and radiographic outcomes associated with nonoperative management. We recommend further studies to compare all ORIF methods with conservative management and examine the complications associated with nonoperative management.
    MeSH term(s) Ankle Fractures/therapy ; Casts, Surgical ; Fracture Fixation ; Humans ; Recovery of Function ; Treatment Outcome
    Language English
    Publishing date 2019-12-27
    Publishing country United States
    Document type Journal Article ; Systematic Review
    ZDB-ID 1146972-9
    ISSN 1542-2224 ; 1067-2516
    ISSN (online) 1542-2224
    ISSN 1067-2516
    DOI 10.1053/j.jfas.2019.06.005
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1468: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  4. Article ; Online: The impact of COVID-19 on morbidity and mortality in neck of femur fracture patients: a prospective case-control cohort study.

    Ward, Alex E / Tadross, Daniel / Wells, Fiona / Majkowski, Lawrence / Naveed, Umna / Jeyapalan, Rathan / Partridge, David G / Madan, Suvira / Blundell, Chris M

    Bone & joint open

    2020  Volume 1, Issue 11, Page(s) 669–675

    Abstract: Aims: Within the UK, around 70,000 patients suffer neck of femur (NOF) fractures annually. Patients presenting with this injury are often frail, leading to increased morbidity and a 30-day mortality rate of 6.1%. COVID-19 infection has a broad spectrum ... ...

    Abstract Aims: Within the UK, around 70,000 patients suffer neck of femur (NOF) fractures annually. Patients presenting with this injury are often frail, leading to increased morbidity and a 30-day mortality rate of 6.1%. COVID-19 infection has a broad spectrum of clinical presentations with the elderly, and those with pre-existing comorbidities are at a higher risk of severe respiratory compromise and death. Further increased risk has been observed in the postoperative period. The aim of this study was to assess the impact of COVID-19 infection on the complication and mortality rates of NOF fracture patients.
    Methods: All NOF fracture patients presenting between March 2020 and May 2020 were included. Patients were divided into two subgroup: those with or without clinical and/or laboratory diagnosis of COVID-19. Data were collected on patient demographics, pattern of injury, complications, length of stay, and mortality.
    Results: Overall, 132 patients were included. Of these, 34.8% (n = 46) were diagnosed with COVID-19. Bacterial pneumonia was observed at a significantly higher rate in those patients with COVID-19 (56.5% vs 15.1%; p =< 0.000). Non respiratory complications such as acute kidney injury (30.4% vs 9.3%; p =0.002) and urinary tract infection (10.9% vs 3.5%; p =0.126) were also more common in those patients with COVID-19. Length of stay was increased by a median of 21.5 days in patients diagnosed with COVID-19 (p < 0.000). 30-day mortality was significantly higher in patients with COVID-19 (37.0%) when compared to those without (10.5%; p <0.000).
    Conclusion: This study has shown that patients with a neck of femur fracture have a high rate of mortality and complications such as bacterial pneumonia and acute kidney injury when diagnosed with COVID-19 within the perioperative period. We have demonstrated the high risk of in hospital transmission of COVID-19 and the association between the infection and an increased length of stay for the patients affected.Cite this article:
    Language English
    Publishing date 2020-11-02
    Publishing country England
    Document type Journal Article
    ISSN 2633-1462
    ISSN (online) 2633-1462
    DOI 10.1302/2633-1462.111.BJO-2020-0141.R1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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