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Agarwal N, Feng T, Maclullich A, Duckworth A, Clement N. Early mobilisation after hip fracture surgery is associated with improved patient outcomes: A systematic review and meta-analysis. Musculoskeletal Care 2024; 22:e1863. [PMID: 38353351 DOI: 10.1002/msc.1863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 01/21/2024] [Accepted: 01/26/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION The aims of this systematic review and meta-analysis were to determine if after hip fracture surgery (1) early mobilisation is associated with improved clinical outcomes, and if so (2) are benefits directly proportional to how soon after surgery the patient mobilises. METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review was conducted using four databases to identify all studies that compared postoperative early mobilisation with delayed mobilisation, in patients after hip fracture surgery. The Critical Appraisal Skills Programme checklist was employed for critical appraisal and evaluation of all studies that met the inclusion criteria. RESULTS A total of 13 studies, including 297,435 patients were identified, of which 235,275 patients were mobilised early and 62,160 were mobilised late. Six studies assessed 30-day mortality, of which two also investigated 30-day complication rates. Pooled meta-analysis demonstrated that there were significantly lower 30-day mortality rates (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.31-0.41, p < 0.001) and complication rates (OR 0.43, 95% CI 0.36-0.51, p < 0.001) in patients mobilising early after hip fracture surgery. Five studies investigated length of stay (LOS) and meta-analysis revealed no difference between groups (mean difference -0.57 days, 95% CI -1.89-0.74, p = 0.39). CONCLUSION Early mobilisation in hip fracture patients is associated with a reduction in 30-day mortality and complication rates compared to delayed mobilisation, but no difference in LOS. These findings illustrate that early mobilisation is associated with superior post operative outcomes. However, a direct casual effect remains to be demonstrated, and further work on the factors underlying delayed mobilisation is required.
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Affiliation(s)
- Nikhil Agarwal
- Division of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Tony Feng
- Division of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Andrew Duckworth
- Division of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nicholas Clement
- Division of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
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Balakumar B, Nandra RS, Woffenden H, Atkin B, Mahmood A, Cooper G, Cooper J, Hindle P. Mortality risk of surgically managing orthopaedic trauma during the COVID-19 pandemic. Bone Jt Open 2021; 2:330-336. [PMID: 34027674 PMCID: PMC8168546 DOI: 10.1302/2633-1462.25.bjo-2020-0189.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aims It is imperative to understand the risks of operating on urgent cases during the COVID-19 (SARS-Cov-2 virus) pandemic for clinical decision-making and medical resource planning. The primary aim was to determine the mortality risk and associated variables when operating on urgent cases during the COVID-19 pandemic. The secondary objective was to assess differences in the outcome of patients treated between sites treating COVID-19 and a separate surgical site. Methods The primary outcome measure was 30-day mortality. Secondary measures included complications of surgery, COVID-19 infection, and length of stay. Multiple variables were assessed for their contribution to the 30-day mortality. In total, 433 patients were included with a mean age of 65 years; 45% were male, and 90% were Caucasian. Results Overall mortality was 7.6% for all patients and 15.9% for femoral neck fractures. The mortality rate increased from 7.5% to 44.2% in patients with fracture neck of femur and a COVID-19 infection. The COVID-19 rate in the 30-day postoperative period was 11%. COVID-19 infection, age, and Charlson Comorbidity Index were independent risk factor for mortality. Conclusion There was a significant risk of contracting COVID-19 due to being admitted to hospital. Using a site which was not treating COVID-19 respiratory patients for surgery did not identify a difference with respect to mortality, nosocomial COVID-19 infection, or length of stay. The COVID-19 pandemic significantly increases perioperative mortality risk in patients with fractured neck of femora but patients with other injuries were not at increased risk. Cite this article: Bone Jt Open 2021;2(5):330–336.
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Affiliation(s)
| | - Rajpal S Nandra
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hugo Woffenden
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Benjamin Atkin
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ansar Mahmood
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - George Cooper
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Julian Cooper
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul Hindle
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Department of Military Surgery and Trauma, Birmingham, UK
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De C, Kainth N, Harbham PK, Brooks M, Agarwal S. Review of orthopaedic trauma surgery during the peak of COVID-19 pandemic - An observational cohort study in the UK. J Clin Orthop Trauma 2021; 20:101422. [PMID: 33903787 PMCID: PMC8059261 DOI: 10.1016/j.jcot.2021.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/23/2021] [Accepted: 04/16/2021] [Indexed: 01/26/2023] Open
Abstract
AIM This study aims to estimate the risk of acquiring medical complication or death from COVID-19 infection in patients who were admitted for orthopaedic trauma surgery during the peak and plateau of pandemic. Unlike other recently published studies, where patient-cohort included a more morbid group and cancer surgeries, we report on a group of patients who had limb surgery and were more akin to elective orthopaedic surgery. METHODS The study included 214 patients who underwent orthopaedic trauma surgeries in the hospital between 12th March and 12th May-2020 when the pandemic was on the rise in the United Kingdom. Data was collected on demographic profile including comorbidities, ASA grade, COVID-19 testing, type of procedures and any readmissions, complications or mortality due to COVID-19. RESULTS There were 7.9% readmissions and 52.9% of it was for respiratory complications. Only one patient had positive COVID-19 test during readmission. 30-day mortality for trauma surgeries was 0% if hip fractures were excluded and 2.8% in all patients. All the mortalities were for proximal femur fracture surgeries and between ASA Grade 3 and 4 or in patients above the age of 70 years. CONCLUSION This study suggests that presence of COVID-19 virus in the community and hospital did not adversely affect the outcome of orthopaedic trauma surgeries or lead to excess mortality or readmissions in patients undergoing limb trauma surgery. The findings also support resumption of elective orthopaedic surgeries with appropriate risk stratification, patient optimization and with adequate infrastructural support amidst the recovery phase of the pandemic.
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Banerjee S, Suresh G, Kale AB, Sathe AH. An audit of admissions and mortality of orthopedic indoor patients in a tertiary care hospital of India. J Clin Orthop Trauma 2020; 11:S518-S521. [PMID: 32774021 PMCID: PMC7394819 DOI: 10.1016/j.jcot.2020.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Mortality in orthopaedics is different in underdeveloped, developing and developed countries depending on the health, orthopaedic and trauma care services, education status and social awareness. Analysis of mortality and causes of death is an important step to identify the risk factor. Such study is invaluable for epidemiological monitoring and health care planning. METHODS Between September 2015 to August 2018 demographic data, timing and primary diagnosis of both mortality and admission were collected retrospectively in a leading tertiary care hospital in the city of Mumbai, India. RESULTS Total admissions of 10,937 in the 3-year period with increased average monthly admission in the month of June, July and August. Trauma to be most common cause of admission and death and Road traffic accident to be the most common cause of trauma followed by slip and fall. The death rate was 0.55 per 100 admissions per year. In males most common age group was 18-60 years and in females above 60 years of age. CONCLUSION There is a link of increased admission rate in the monsoon months (rainy season) in India and road traffic accident and slip and fall. So accident prevention and health care planning and management of trauma victim, improvement of quality of life of general population will reduce trauma and related complications.
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Adar A, Onalan O, Cakan F, Akbay E, Colluoglu T, Dasar U, Mutlu T. A strong and reliable indicator for early postoperative major cardiac events after elective orthopedic surgery: Aortic arch calcification. Heart Lung 2019; 48:446-451. [PMID: 30595343 DOI: 10.1016/j.hrtlng.2018.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/28/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cardiovascular events after orthopedic surgery may result in mortality. Therefore, predictors of early cardiovascular events after elective orthopedic surgery are required. AIM The aim of this study is to investigate the relationship between aortic arch calcification and 30-day major adverse cardiac events following elective orthopedic surgery. METHODS Patients who had undergone orthopedic surgery were screened. Preoperative detailed anamnesis was taken. Echocardiography and standard chest x-ray were performed.Patients were followed in terms of perioperative 30-days major cardiac events and were classified into two groups according to development of perioperative major adverse cardiac events.Aortic arch calcification was evaluated by two cardiologists, blinded to study findings and was graded as 0 to 3 on chest x-ray. RESULTS A total of 1060 patients were approached for the study participation. Of these 714 were included in the study (mean age: 70.43, 65% female). Cardiovascular events occurred in 33 patients. As compared to the patients without cardiac events, the prevalence of aortic arch calcification, coronary artery disease, hypertension, and smoking were higher in patients with cardiac events. In addition, Lee index, left ventricular end-systolic, end-diastolic and left atrial diameter were significantly higher, GFR values were significantly lower in the group with cardiac events.Multivariate regression analysis showed that smoking (OR 5.031, 95% CI 1.602 to 15.794), presence of hypertension (OR 5.133, 95% CI 1.297 to 20.308) and aortic arch calcification (OR 6.920, 95% CI 3.890 to 12.310) are independent predictors of major cardiac events within 30-day of elective orthopedic surgery. CONCLUSIONS Presence of aortic arch calcification is associated with development of major cardiac events within 30-days after elective orthopedic surgery.
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Affiliation(s)
- Adem Adar
- Karabuk University Faculty of Medicine, Department of Cardiology, Karabuk, Turkey.
| | - Orhan Onalan
- Karabuk University Faculty of Medicine, Department of Cardiology, Karabuk, Turkey
| | - Fahri Cakan
- Karabuk University Faculty of Medicine, Department of Cardiology, Karabuk, Turkey
| | - Ertan Akbay
- Karabuk University Faculty of Medicine, Department of Cardiology, Karabuk, Turkey
| | - Tugce Colluoglu
- Karabuk University Faculty of Medicine, Department of Cardiology, Karabuk, Turkey
| | - Uygar Dasar
- Karabuk University Faculty of Medicine, Department of Orthopaedic Surgery, Karabuk, Turkey
| | - Tansel Mutlu
- Karabuk University Faculty of Medicine, Department of Orthopaedic Surgery, Karabuk, Turkey
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Bala M, Willner D, Klauzni D, Bdolah-Abram T, Rivkind AI, Gazala MA, Elazary R, Almogy G. Pre-hospital and admission parameters predict in-hospital mortality among patients 60 years and older following severe trauma. Scand J Trauma Resusc Emerg Med 2013; 21:91. [PMID: 24360246 PMCID: PMC3878042 DOI: 10.1186/1757-7241-21-91] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 12/03/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Gidon Almogy
- Department of Surgery and Trauma Unit, Hadassah University Hospital, Ein Kerem, pob 12000, Jerusalem, 91120, Israel.
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Long term outcomes following pretibial injury: mortality and effects on social care. Injury 2008; 39:781-5. [PMID: 18187135 DOI: 10.1016/j.injury.2007.08.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2007] [Revised: 08/08/2007] [Accepted: 08/09/2007] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Pretibial injuries are common, and those patients requiring hospital admission are often elderly with significant comorbidity. The long term impact on social care and associated mortality seen in this patient group has not been reported previously. It was our impression that pretibial injury is often a marker of increasing social and/or medical needs of the patient, and that a significant proportion of these patients underwent long term changes in social circumstances following injury. METHODS A review of 109 patients with pretibial injuries over a 3-year period admitted to the Plastic Surgery Unit at Derriford Hospital, Plymouth, UK. Overall mortality and changes in social circumstances within a 6-month period following discharge from hospital were recorded. RESULTS The overall mortality was 11%. Twenty-five percent of patients underwent an escalation of their social care requirements immediately on discharge from hospital. At 6 months only 78% of patients who were living independently at home prior to admission had returned home. Increasing age, cardiovascular comorbidities, length of time to operation were significantly associated with deterioration in social circumstances and death. CONCLUSIONS Mortality following pretibial injury is higher than that expected for the population. A sizeable proportion of patients with pretibial injuries can be expected to need significant long term changes in social input after injury. Whether this change is directly due to injury, or is a reflection of underlying medical and social deterioration identified by the hospital admission process is unclear. In either respect, close liaison with medical and social care teams is essential to facilitate optimum care in this patient group.
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Rethnam U, Cordell-Smith J, Kumar TM, Sinha A. Complex proximal femoral fractures in the elderly managed by reconstruction nailing - complications & outcomes: a retrospective analysis. J Trauma Manag Outcomes 2007; 1:7. [PMID: 18271998 PMCID: PMC2241768 DOI: 10.1186/1752-2897-1-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Accepted: 12/10/2007] [Indexed: 05/25/2023]
Abstract
BACKGROUND Unstable proximal femoral fractures and pathological lesions involving the trochanteric region in the elderly comprise an increasing workload for the trauma surgeon as the ageing population increases. This study aims to evaluate use of the Russell-Taylor reconstruction nail (RTRN) in this group with regard to mortality risk, complication rates and final outcome. METHODS Retrospective evaluation of 42 patients aged over 60 years who were treated by reconstruction nailing for proximal femoral fractures over a 4 year period. RESULTS Over two-thirds of patients were high anaesthetic risk (ASA > 3) with ischemic heart disease the most common co-morbidity. 4 patients died within 30 days of surgery and 4 patients required further surgery for implant related failure. Majority of patients failed to regain their pre-injury mobility status and fewer than half the patients returned to their original domestic residence. CONCLUSION Favourable fixation of unstable complex femoral fractures in the elderly population can be achieved with the Russell-Taylor reconstruction nail. However, use of this device in this frail population was associated with a high implant complication and mortality rate that undoubtedly reflected the severity of the injury sustained, co-morbidity within the group and the stress of a major surgical procedure.
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Affiliation(s)
- Ulfin Rethnam
- Department of Orthopaedics, Glan Clwyd Hospital, Bodelwyddan, UK
- 11 Ffordd Parc Castell, Bodelwyddan, Rhyl, LL18 5WD, UK
| | | | | | - Amit Sinha
- Department of Orthopaedics, Glan Clwyd Hospital, Bodelwyddan, UK
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Deakin DE, Boulton C, Moran CG. Mortality and causes of death among patients with isolated limb and pelvic fractures. Injury 2007; 38:312-7. [PMID: 17141780 DOI: 10.1016/j.injury.2006.09.024] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Revised: 07/15/2006] [Accepted: 09/24/2006] [Indexed: 02/02/2023]
Abstract
Between May 2001 and May 2005, all 8834 adults admitted to our hospital with fractures to the limbs and pelvis were prospectively entered onto a database. Information was cross-referenced with the Office of National Statistics, and all patients who died during the study period were identified. Mortality rates were adjusted for age, gender and type of injury and cause of death was identified from hospital records. Neck of femur fractures accounted for 32% of admissions. Younger patients were more likely to be male and older patients more likely to be female. Overall 30-day and 1-year mortalities were 4.5 and 13%, respectively. Increased mortality was associated with age, male gender and fractures of the femur or pelvis.
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Affiliation(s)
- D E Deakin
- Department of Trauma and Orthopaedics, University Hospital, Nottingham, UK
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Urquhart DM, Williamson OD, Gabbe BJ, Cicuttini FM, Cameron PA, Richardson MD, Edwards ER. Outcomes of patients with orthopaedic trauma admitted to level 1 trauma centres. ANZ J Surg 2006; 76:600-6. [PMID: 16813626 DOI: 10.1111/j.1445-2197.2006.03785.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although orthopaedic trauma results in significant disability and substantial financial cost, there is a paucity of large cohort studies that collectively describe the functional outcomes of a variety of these injuries. The current study aimed to investigate the outcomes of patients admitted with a range of orthopaedic injuries to adult Level 1 trauma centres. METHODS Patients were recruited from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR), which included all patients with orthopaedic trauma admitted to the two adult Level 1 trauma centres in Victoria (Australia). Patients were categorised into three groups; isolated orthopaedic injuries, multiple orthopaedic injuries and orthopaedic and other injuries. Demographic and injury data were collected from the medical record and hospital/trauma databases, and functional outcome instruments were given at 6 months post-injury. RESULTS Of the 1303 patients recruited for VOTOR over a 12-month period, 1181 patients were eligible for the study and a response rate of 75.6% was obtained at 6 months post-injury. Patients reported ongoing pain (moderate-severe: 37.2%), disability (79.5%) and inability to return to work (35.2%). Poorer outcomes were evident in patients with orthopaedic and other injuries than those with single or multiple orthopaedic injuries alone. CONCLUSION A large percentage of patients have ongoing pain and disability and a reduced capacity to return to work 6 months after orthopaedic trauma. Further research into the long-term outcomes of patients with orthopaedic injuries is required to identify patient subgroups and specific injuries and procedures that result in high morbidity.
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Affiliation(s)
- Donna M Urquhart
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
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Neary WD, McCrirrick A, Foy C, Heather BP, Earnshaw JJ. Lessons learned from a randomised controlled study of perioperative beta blockade in high risk patients undergoing emergency surgery. Surgeon 2006; 4:139-43. [PMID: 16764198 DOI: 10.1016/s1479-666x(06)80083-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Perioperative beta blockade has been shown to reduce mortality after major elective surgery. The aim of this study was to determine whether it could reduce the rate of death and morbidity from cardiac complications in high risk patients undergoing emergency surgery. METHODS Over a one-year interval all patients undergoing major non-elective orthopaedic or general surgery were screened to identify those at high risk of cardiac complications. Consenting, high risk patients were randomly allocated atenolol or placebo for seven days, commencing at anaesthetic induction. Deaths and cardiac complications within 30 days were recorded. RESULTS Some 2351 patients had an emergency operation; 145 were at high risk and eligible for the study. Of 89 patients approached, 57 initially consented. Only 38 patients, however, completed the study protocol, 19 were withdrawn. Of those who completed the study, 5/20 patients in the placebo group and 3/18 in the treatment group died before hospital discharge (p=0.520). Four others in the placebo group and two in the atenolol group had post-operative non-fatal cardiac events (positive troponin T), p=0.311. CONCLUSIONS This study of emergency surgery proved more difficult than similar trials in elective surgery. The final study groups were small and there were no significant differences in outcomes. A much larger study is required for a definitive answer.
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Affiliation(s)
- W D Neary
- Gloucestershire Vascular Group, Gloucestershire Royal Hospital
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Urquhart DM, Edwards ER, Graves SE, Williamson OD, McNeil JJ, Kossmann T, Richardson MD, Harrison DJ, Hart MJ, Cicuttini FM. Characterisation of orthopaedic trauma admitted to adult level 1 trauma centres. Injury 2006; 37:120-7. [PMID: 16414050 DOI: 10.1016/j.injury.2005.10.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Accepted: 10/19/2005] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite the vast number of traumatic injuries that are orthopaedic in nature, comprehensive epidemiological data that characterise orthopaedic trauma are limited. The aim of this study was to investigate the nature of orthopaedic trauma admitted to adult Level 1 Trauma Centres. METHODS Data were obtained from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR), which includes all patients with orthopaedic trauma admitted to the two adult Level 1 Trauma Centres in Victoria (Australia). Information was collected from the medical record and hospital databases on patients' demographics and injury event, diagnoses and management. RESULTS Data were analysed on 784 patients recruited between August 2003 and March 2004. Patients were mainly young (<65 years) (70.7%), male (59.1%) and injured in a transport collision (51.3%). Fractures of the femur (23.7%) and spine (23.5%) were the most common injuries and were predominately managed with operative (87.6%) and conservative (78.8%) methods, respectively. Differences in most parameters were evident between younger (<65 years) and older (> or =65 years) patients. CONCLUSIONS This study presents epidemiological data on patients with orthopaedic trauma who were admitted to adult Level 1 Trauma Centres. This information is critical for the future monitoring and evaluation of the outcomes of orthopaedic trauma.
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Affiliation(s)
- D M Urquhart
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia.
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