th November Oral Presentations – Session 4 – Wednesday 4th
Abstract 15
THE EFFECT OF EDUCATION ON TIP-APEX DISTANCE IN DYNAMIC HIP SCREW NECK OF FEMUR FRACTURE FIXATION MAIN MAIN AUTHOR AUTHOR
Agneish Dutta Royal Stoke University Hospital
CO CO AUTHORS AUTHORS
Parag Raval, Royal Stoke University Hospital Agneish Dutta
PRESENTER PRESENTER
th Oral Oral Presentations Presentations –– Session Session 4 4 –– Wednesday Wednesday 4 4th November November
MAIN MAIN AUTHOR AUTHOR CO CO AUTHORS AUTHORS
PRESENTER PRESENTER OBJECTIVES OBJECTIVES
METHODS METHODS
The dynamic hip screw (DHS) is commonly used for fixation of extracapsular neck of femur fractures. A complication that may occur is cut-out of the screw. Therefore correct positioning of the screw is crucial in preventing failure. Tip-Apex Distance (TAD) is a measurement that is a reliable predictor of cut-out. This audit assessed our centre’s TAD measurements before and after surgeons were informed of the measurement and its benefits. A sample of 129 DHS procedures performed at a large tertiary trauma centre between December 2012 and December 2013 were included in the initial audit. They were provided via the clinical audit team and the TAD score calculated by measurements of radiographs identified and compared as per Baumgartner’s seminal paper on the topic, which also served as our standard. The initial results were presented in a departmental audit meeting and the importance of the TAD highlighted to surgeons of all levels. 100 DHS procedures performed between January and June 2014 at the same centre were then reviewed to close the audit loop.
RESULTS RESULTS
In the first audit cycle, 129 patients were studied, with 79% of patients having TAD scores of less than or equal to 25mm. The second cycle included 100 patients, with 87% of patients having TAD scores below 25mm.
CONCLUSIONS CONCLUSIONS
Following audit and presentation of TAD score results to the department, we have demonstrated an improvement in the TAD scores of subsequent DHS procedures. Evidence shows that this likely leads to better outcomes for patients. We will look to confirm this by assessing cut-out rates in the patients audited. It is important that these standards are upheld, and surgeons continue to be aware of the predictive value of TAD scores in DHS fixation.
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BTS - 25th Annual Scientific Meeting
Abstract Abstract 16 16
WARFARIN WARFARIN REVERSAL REVERSAL IN IN NECK NECK OF OF FEMUR FEMUR FRACTURESFRACTURES- CURRENT CURRENT FAILINGS FAILINGS AND AND FUTURE FUTURE STRATEGIES STRATEGIES
John John E E Lawrence Lawrence Orthopaedic department, department, Addenbrooke’s Orthopaedic Addenbrooke’s Hospital, Hospital, Cambridge, Cambridge, UK UK Daniel Fountain, Fountain, Cambridge Cambridge University University School School for for Clinical Clinical medicine medicine Daniel Andrew Andrew Carrothers, Carrothers, Orthopaedic Orthopaedic department, department, Addenbrooke’s Addenbrooke’s Hospital, Hospital, Cambridge, Cambridge, UK UK Duncan Duncan Cundall-Curry, Cundall-Curry, Orthopaedic Orthopaedic department, department, Addenbrooke’s Addenbrooke’s Hospital, Hospital, Cambridge, Cambridge, UK UK John John E E Lawrence Lawrence
OBJECTIVES OBJECTIVES
At At the the time time of of publication, publication, the the 2007 2007 British British Orthopaedic Orthopaedic Association Association (BOA) (BOA) blue blue book book on on fragility fragility fracture fracture care care highlighted highlighted the the need need to to “develop “develop an an evidence evidence base base for for decisions decisions about patients on warfarin”. Eight years later there remain no formal guidelines on the about patients on warfarin”. Eight years later there remain no formal guidelines on the use use of of warfarin warfarin reversal reversal agents agents in in hip hip fracture fracture patients. patients. This This study study aimed aimed to to analyse analyse warfarin warfarin reversal reversal in in our our centre, centre, and and examine examine its its impact impact on on patient patient outcome. outcome.
METHODS METHODS
A A retrospective retrospective analysis analysis of of data data for for all all patients patients presenting presenting with with fractured fractured neck neck of of femur femur at at Addenbrooke’s Addenbrooke’s Hospital, Hospital, Cambridge, Cambridge, UK UK from from July July 2009 2009 to to July July 2014 2014 was was performed performed using using the the National National Hip Hip Fracture Fracture Database. Database. All All patients patients taking taking warfarin warfarin at at the the time time of of admission admission were were considered considered for for the the study study and and case case notes notes for for these these patients patients were were obtained obtained for for analysis analysis of of the the use use of of reversal reversal agents. agents.
RESULTS RESULTS
1,978 1,978 patients patients presented presented to to our our centre centre during during the the time time period, period, of of which which 9% 9% were were being being treated treated with with warfarin. warfarin. The The warfarinised warfarinised group group were were significantly significantly less less likely likely to to receive receive operative operative treatment treatment before before 36 36 hours hours (p<0.05) (p<0.05) and and had had significantly significantly longer longer stays stays in in hospital hospital (p<0.05). (p<0.05). Survival Survival analysis analysis to to June June 2015 2015 showed showed a a significantly significantly higher higher mortality mortality for for patients patients receiving receiving warfarin warfarin therapy therapy at at the the time time of of admission admission (P<0.05). (P<0.05). There There was was a a consistent consistent delay delay from from presentation presentation to to the the administration administration of of warfarin warfarin reversal reversal agents. agents.
CONCLUSIONS CONCLUSIONS
Patients Patients who who sustain sustain a a fractured fractured neck neck of of femur femur whilst whilst on on warfarin warfarin therapy therapy have have significantly significantly poorer poorer outcomes outcomes than than those those not not on on warfarin. warfarin. Administration Administration of of reversal reversal agents agents was was delayed delayed in in almost almost all all cases. cases. Reversal Reversal of of warfarin warfarin represents represents a a significant significant yet yet avoidable avoidable delay delay in in patient patient care. care. The The poor poor outcomes outcomes for for patients patients receiving receiving warfarin warfarin therapy therapy supports supports a a policy policy of of reversal reversal at at the the point point of of diagnosis. diagnosis. Our Our newly newly implemented implemented neck neck of of femur femur anticoagulation anticoagulation pathway pathway is presented. is presented.
BTS - 25th Annual Scientific Meeting
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