Raju Ahluwalia - Academia.edu (original) (raw)
Papers by Raju Ahluwalia
Orthopaedic proceedings/Journal of bone and joint surgery. British volume. Orthopaedic proceedings, May 16, 2024
Bone & joint open, Mar 22, 2024
Journal of Bone and Joint Surgery-british Volume, Apr 1, 2013
Introduction Ankle replacement is now common in the UK. In a tertiary referral NHS practice, betw... more Introduction Ankle replacement is now common in the UK. In a tertiary referral NHS practice, between 1997–2011 we implanted two types of cementless mobile bearing total ankle replacements (TAR). Methods We reviewed our operative database and electronic patient records and confirmed the number of prosthesis with our theatre records. All case notes and radiographs were reviewed. Failure was taken as revision, and patients were censored due to death or loss to follow-up. The survivorship was calculated using a life table (the Kaplan-Meier method), with 95% confidence intervals. Results We found a total of 358 NHS patients had a TAR from Jan 1997 to April 2012 total ankle replacements; the mean follow up was 76 months. The principle indications for surgery included primary OA (n=146) and inflammatory arthritis in (n=79). Overall survival was 90.9% (94–84) at 10 years. A complication requiring revision developed in 42 ankles and 36 were revised or fused. Thirty-two TAR9s underwent further hind foot fusions which were not attributed as a failure of the prosthesis. We arthroscoped 6 TAR9s for hetrotrophic calcification. When we separated the implants we found the STAR (implanted from 1997–2004) had a 5-year survival of 95.2% (98–91) and the Mobility (implanted from 2004–11) of 92.6% (96–88). We found early failures (within 2 years of implantation) were higher within 2 years of introduction of TAR and on changing our prosthesis. Conclusion In a study of TAR undertaken at one centre principally by an experienced surgeon and team, we have shown a learning curve. Cementless mobile bearing total ankle replacements (TAR) conducted on a routine basis with careful patient selection has a 90.9% survivorship over a 10-year period. The difference in survival for two implants is not statistically significant.
Antibiotics
This study aimed to analyse and compare the vancomycin elution kinetics of four biodegradable, os... more This study aimed to analyse and compare the vancomycin elution kinetics of four biodegradable, osteoconductive antibiotic carriers used in clinical practice within a 42-day in vitro setting. Carriers A and D already contained vancomycin (1.1 g and 0.247 g), whereas carriers B and C were mixed with vancomycin according to the manufacturer’s recommendations (B: 0.83 g and C: 0.305 g). At nine time points, 50% (4.5 mL) of the elution sample was removed and substituted with the same amount of PBS. Probes were analysed with a kinetic microparticle immunoassay. Time-dependent changes in vancomycin concentrations for each carrier and differences between carriers were analysed. Mean initial antibiotic levels were highest for carrier A (37.5 mg/mL) and lowest for carrier B (5.4 mg/mL). We observed time-dependent, strongly negative linear elution kinetics for carriers A (−0.835; p < 0.001), C (−0.793; p < 0.001), and D (−0.853; p < 0.001). Vancomycin concentrations increased from 48 ...
Foot & Ankle International, Jun 1, 2015
Anterolateral impingement associated with intra-articular synovitis, scarring, and fibrosis is a ... more Anterolateral impingement associated with intra-articular synovitis, scarring, and fibrosis is a less recognized feature in patients with chronic lateral ankle instability. The aim of our study was to ascertain the incidence of intra-articular synovitis, osteochondral lesions (OCLs), impingement lesions (both intra- and extra-articular), and other associated pathologies in patients undergoing modified Broström-Gould ankle ligament reconstruction. We performed a retrospective review of all patients who underwent arthroscopically assisted modified Broström-Gould ankle ligament reconstruction for symptomatic recurrent ankle instability. Patients who had previous ankle surgery or inflammatory arthropathy were excluded. Ankle arthroscopy was performed prior to reconstruction in all patients. Data were obtained from clinical and radiological records including magnetic resonance imaging scans. Arthroscopic findings were recorded in detail intraoperatively. A total of 100 patients (53 females and 47 males) with an average age of 37 years (range, 15-65 years) were reviewed over a 10-year period. Sixty-three patients (63%) had intra-articular synovitis mostly in the anterior and/or anterolateral compartment, which required arthroscopic debridement. Seventeen patients (17%) were found to have OCLs, and 12 (12%) patients had anterior bony impingement lesions. This study found a high incidence of anterior/anterolateral synovitis in patients with chronic lateral ankle instability. However, there was a relatively low incidence of anterior bony impingement lesions or OCLs in our series. Level IV, retrospective case series.
Orthopaedic Proceedings, Feb 21, 2018
Foot and Ankle Surgery, Sep 1, 2013
Springer eBooks, 2021
Acute fractures in sport are a significant problem for the athlete, given that fractures can resu... more Acute fractures in sport are a significant problem for the athlete, given that fractures can result in one of the longest return times to sport of all injuries.
Annals of The Royal College of Surgeons of England, Aug 20, 2021
Orthopaedic Proceedings, Feb 21, 2018
Journal of clinical orthopaedics and trauma, Nov 1, 2021
Innovations in computer technology and implant design have paved the way for the development of s... more Innovations in computer technology and implant design have paved the way for the development of smart instruments and intelligent implants in trauma and orthopaedics to improve patient-related functional outcomes. Sensor technology uses embedded devices that detect physical, chemical and biological signals and provide a way for these signals to be measured and recorded. Sensor technology applications have been introduced in various fields of medicine in the diagnosis, treatment and monitoring of diseases. Intelligent 'Smart' implants are devices that can provide diagnostic capabilities along with therapeutic benefits. In trauma and orthopaedics, applications of sensors is increasing because of the advances in microchip technologies for implant devices and research designs. It offers real-time monitoring from the signals transmitted by the embedded sensors and thus provides early management solutions. Smart orthopaedic implants have applications in total knee arthroplasty, hip arthroplasty, spine surgery, fracture healing, early detection of infection and implant loosening. Here we have explored the role of Smart sensor implant technology in total knee arthroplasty. Smart sensor assisted can be used intraoperatively to provide objective assessment of ligament and soft tissue balancing whilst maintaining the sagittal and coronal alignment to achieve desired kinematic targets following total knee arthroplasty. It can also provide post-implantation data to monitor implant performance in natural conditions and patient's clinical recovery during rehabilitation. The use of Smart Sensor implant technology in total knee arthroplasty appears to provide superior patient satisfaction rates and improved functional outcomes.
Foot and Ankle Surgery, Jun 1, 2013
Journal of orthopaedics, Sep 1, 2022
Springer eBooks, 1991
Artificial Intelligence (AI) is an emerging technology. Research in AI is focused on developing c... more Artificial Intelligence (AI) is an emerging technology. Research in AI is focused on developing computational approaches to intelligent behaviour. The computer programs with which AI could be associated are primarily symbolic processes associated with complexity, ambiguity, indecisiveness, and uncertainty. One of these computer programs is referred to as Knowledge. based Expert System (KBES) as it represents knowledge acquired from various experts in a particular field of interest to the user. The expert system emulates human behaviour in solving problems thought to require experts for their solution by utilizing computer programs that incorporate experts' heuristic reasoning. In this paper, the application of KBES to aid the design of ball and roller bearings is discussed. The precision rolling-element bearing of the twentieth century is a product of exacting technology and sophisticated science. A bearing supports radial and axial loads, at the same time allowing relative motion between two elements of a machine. Various requirements and steps in the design of baU and roller bearings are discussed. Equations are developed for the relevant design parameters and input into the expert system shell called VP-Expert. The expert system rules are also provided.
Foot & Ankle Orthopaedics, 2022
Category: Ankle Introduction/Purpose: Total ankle replacements (TARs) provide pain relief with pr... more Category: Ankle Introduction/Purpose: Total ankle replacements (TARs) provide pain relief with preservation of movement and function. The most successful TARs are either 2nd or current 3rd generation in design, whilst 4th generation implants are steadily being introduced. This meta-analysis evaluates the survivorship of 2nd, 3rd and 4th generation ankle replacements used today to determine whether any difference between generations and bearing types exist. Methods: A systematic review and meta-analysis of published data from January 2000 to January 2020 was conducted following PRISMA guidelines. Inclusion criteria: English language papers, adult population, &amp;gt;= 20 ankles with a minimum follow up &amp;gt;= 24 months, pre- and post-operative functional scores available. Clinical outcomes of primary TARs were evaluated as well as their associated survivorship. Statistical analyses were undertaken to determine survivorship and complications associated with the second, third and fourth generation implants and the bearing design. Ankle generations were determined from the original studies and confirmed based on literature set definitions. The modified Coleman Methodology Score was used to evaluate the quality of studies. Results: A total of 4642 TARs in 4487patients from 51-studies were included. The mean age was 61.9years and mean follow up of 57.8months. The most common indications were post-traumatic-OA (54.5%), primary-OA (25.5%) and inflammatory-arthropathy (15.2%). Relative-risk calculations showed significant reductions in nerve-injury (p &amp;lt; 0.01), post-operative fracture ( p &amp;lt; 0.01), wound complications (p &amp;lt; 0.01), radiolucencies ( p &amp;lt; 0.01), or heterotopic bone formation (p &amp;lt; 0.01), aseptic loosening (p &amp;lt; 0.01) for later generations. Sensitivity analysis performed for the withdrawal of 2 prostheses showed 2yr survivorship for 2nd, 3rd and 4th generation TARs was 95.3%, 97.9% and 98.9% (p &amp;lt; 0.05). Third-generation TARs had better 10-yr survivorship compared to 2nd generation (83.50% vs. 70.76%) (p &amp;lt; 0.01). Bearing design had little influence on survivorship. Conclusion: In the real world subsequent generations of modern contemporary TAR demonstrate lower rates of complications and improved survivorship independent of bearing design, without reaching designer series levels. Population changes have meant a reduction in mean age at implementation and the commonest pathology for a TAR has become post traumatic OA without a observed detrimental affect in outcomes. Even so, superior short-term survivorship of fourth generation implants is promising for the future of modern TAR surgery.
Orthopaedic Proceedings, Oct 1, 2010
Little data exists on predicting the actual outcome of patients with fracture neck of femur when ... more Little data exists on predicting the actual outcome of patients with fracture neck of femur when aged over 90. This group represents a complex of medical problems and where a delay in surgery can impact on patient recovery. In this study we evaluated the POSSUM scores at time of admission and time of surgery. We aim to define the actual mortality and morbidity of this group, if the possum had any predictive value, and any correlation with outcome. 132 patients over 90 with a fracture where followed from 2005–7, and a control cohort were followed up in 2005–6. A collection form was prepared to collect standard data on physiological status, with a standard scoring system on admission (Ortho possum), at the time of operation, comparing their progress and clinical outcome post-op. It also recorded co-morbidities and other outcomes. Statistical analysis was conducted using SPSS. 132 patient notes were reviewed and 130 patients in the control group. 5 had no surgery and the average age was 93 (90–103) vs. 76 in the control group. The majority of over 90’s were admitted from home by ambulance (n=99); and the cause of the fracture was recorded as a fall (n=68). 74 patients at admission were using a stick or a frame (24 were independent). Only 2 patients were on warfain. At the point of admission the physiological POSSUM score on average was 23.48 (18–44) and at surgery it was 23.52 (16–38). This meant that the predicted mortality increased from 0.103 to 0.104. The average time to surgery was 1.5 days (0–12 days). However delays in surgery increased the POSSUM score and higher Possum scores were correlated with increased number of complications (p>0.002), increased time to mobilisation (p>0.003), and reduced mobility as compared to admission at day 15 and longer hospital admissions (p>0.005). In hospital mortality was 0.068 with a higher total POSSUM score prior to surgery of 36.29 for these patients compared to those patients who died after discharge. 35 patients died in total at 2 years post discharge (36%). Of these patients those within the 30 day mortality post discharge was 0.087 with a higher Total POSSUM score of 28.55 compared with the 120 day mortality post discharge of 0.194 with Total POSSUM score of 27.55; predicted mortality for the whole group was 0.28 using the Possum score (actual 0.27). Of the 35 patients that died 22 had higher Possum scores at surgery than admission. In summary we found that there was no significant difference in the mortality and morbidity in the over 90’s fracture neck of femur group than the control. The Possum scoring system over predicted overall mortality and morbidity. Our results indicate a dedicated team to deal with these patients may well be of benefit to improve surgical Possum scores and outcome.
Foot & Ankle Orthopaedics, Oct 1, 2022
Foot & Ankle Orthopaedics, Oct 1, 2022
CRC Press eBooks, Apr 2, 2021
Médecine des Maladies Métaboliques, Feb 1, 2021
Resume Introduction Les plaies de pied diabetique (PPD) sont un probleme frequent, associe a un r... more Resume Introduction Les plaies de pied diabetique (PPD) sont un probleme frequent, associe a un risque eleve d’amputation et de mortalite. L’adressage rapide a une structure specialisee du pied diabetique permet d’ameliorer le taux de cicatrisation et de diminuer le risque d’amputation. Une proportion importante de patients avec une PPD sont adresses tardivement vers ces structures specialisees. Un parcours de soins primaires des patients avec une PPD a ete developpe par l’International Diabetic Foot Care Group en collaboration avec le D-Foot International pour ameliorer l’orientation de ces patients vers les structures specialisees. Nous presentons une version adaptee au systeme de soin francais avec pour but de faire connaitre cet outil aux professionnels de sante de premiers recours francophones. Methodes L’orientation des patients se fait en trois niveaux de severite, qui dependent des comorbidites du patient, des caracteristiques de la plaie, de la presence d’une infection et du statut vasculaire. Resultats Les PPD non compliquees sont prises en charge en soins primaires avec mise en place d’une decharge. Une reevaluation de la plaie a 15 jours permet de savoir si le patient doit etre oriente vers une structure specialisee. Les PPD compliquees doivent etre adressees en moins de 48 h vers une structure specialisee, tandis que les plaies de pied en urgence absolue necessitent une hospitalisation en urgence. Conclusion Ce parcours de soins destine aux professionnels de sante en soins primaires a pour but d’ameliorer la prise en charge et le pronostic des patients diabetiques porteurs d’une plaie de pied.
Orthopaedic proceedings/Journal of bone and joint surgery. British volume. Orthopaedic proceedings, May 16, 2024
Bone & joint open, Mar 22, 2024
Journal of Bone and Joint Surgery-british Volume, Apr 1, 2013
Introduction Ankle replacement is now common in the UK. In a tertiary referral NHS practice, betw... more Introduction Ankle replacement is now common in the UK. In a tertiary referral NHS practice, between 1997–2011 we implanted two types of cementless mobile bearing total ankle replacements (TAR). Methods We reviewed our operative database and electronic patient records and confirmed the number of prosthesis with our theatre records. All case notes and radiographs were reviewed. Failure was taken as revision, and patients were censored due to death or loss to follow-up. The survivorship was calculated using a life table (the Kaplan-Meier method), with 95% confidence intervals. Results We found a total of 358 NHS patients had a TAR from Jan 1997 to April 2012 total ankle replacements; the mean follow up was 76 months. The principle indications for surgery included primary OA (n=146) and inflammatory arthritis in (n=79). Overall survival was 90.9% (94–84) at 10 years. A complication requiring revision developed in 42 ankles and 36 were revised or fused. Thirty-two TAR9s underwent further hind foot fusions which were not attributed as a failure of the prosthesis. We arthroscoped 6 TAR9s for hetrotrophic calcification. When we separated the implants we found the STAR (implanted from 1997–2004) had a 5-year survival of 95.2% (98–91) and the Mobility (implanted from 2004–11) of 92.6% (96–88). We found early failures (within 2 years of implantation) were higher within 2 years of introduction of TAR and on changing our prosthesis. Conclusion In a study of TAR undertaken at one centre principally by an experienced surgeon and team, we have shown a learning curve. Cementless mobile bearing total ankle replacements (TAR) conducted on a routine basis with careful patient selection has a 90.9% survivorship over a 10-year period. The difference in survival for two implants is not statistically significant.
Antibiotics
This study aimed to analyse and compare the vancomycin elution kinetics of four biodegradable, os... more This study aimed to analyse and compare the vancomycin elution kinetics of four biodegradable, osteoconductive antibiotic carriers used in clinical practice within a 42-day in vitro setting. Carriers A and D already contained vancomycin (1.1 g and 0.247 g), whereas carriers B and C were mixed with vancomycin according to the manufacturer’s recommendations (B: 0.83 g and C: 0.305 g). At nine time points, 50% (4.5 mL) of the elution sample was removed and substituted with the same amount of PBS. Probes were analysed with a kinetic microparticle immunoassay. Time-dependent changes in vancomycin concentrations for each carrier and differences between carriers were analysed. Mean initial antibiotic levels were highest for carrier A (37.5 mg/mL) and lowest for carrier B (5.4 mg/mL). We observed time-dependent, strongly negative linear elution kinetics for carriers A (−0.835; p < 0.001), C (−0.793; p < 0.001), and D (−0.853; p < 0.001). Vancomycin concentrations increased from 48 ...
Foot & Ankle International, Jun 1, 2015
Anterolateral impingement associated with intra-articular synovitis, scarring, and fibrosis is a ... more Anterolateral impingement associated with intra-articular synovitis, scarring, and fibrosis is a less recognized feature in patients with chronic lateral ankle instability. The aim of our study was to ascertain the incidence of intra-articular synovitis, osteochondral lesions (OCLs), impingement lesions (both intra- and extra-articular), and other associated pathologies in patients undergoing modified Broström-Gould ankle ligament reconstruction. We performed a retrospective review of all patients who underwent arthroscopically assisted modified Broström-Gould ankle ligament reconstruction for symptomatic recurrent ankle instability. Patients who had previous ankle surgery or inflammatory arthropathy were excluded. Ankle arthroscopy was performed prior to reconstruction in all patients. Data were obtained from clinical and radiological records including magnetic resonance imaging scans. Arthroscopic findings were recorded in detail intraoperatively. A total of 100 patients (53 females and 47 males) with an average age of 37 years (range, 15-65 years) were reviewed over a 10-year period. Sixty-three patients (63%) had intra-articular synovitis mostly in the anterior and/or anterolateral compartment, which required arthroscopic debridement. Seventeen patients (17%) were found to have OCLs, and 12 (12%) patients had anterior bony impingement lesions. This study found a high incidence of anterior/anterolateral synovitis in patients with chronic lateral ankle instability. However, there was a relatively low incidence of anterior bony impingement lesions or OCLs in our series. Level IV, retrospective case series.
Orthopaedic Proceedings, Feb 21, 2018
Foot and Ankle Surgery, Sep 1, 2013
Springer eBooks, 2021
Acute fractures in sport are a significant problem for the athlete, given that fractures can resu... more Acute fractures in sport are a significant problem for the athlete, given that fractures can result in one of the longest return times to sport of all injuries.
Annals of The Royal College of Surgeons of England, Aug 20, 2021
Orthopaedic Proceedings, Feb 21, 2018
Journal of clinical orthopaedics and trauma, Nov 1, 2021
Innovations in computer technology and implant design have paved the way for the development of s... more Innovations in computer technology and implant design have paved the way for the development of smart instruments and intelligent implants in trauma and orthopaedics to improve patient-related functional outcomes. Sensor technology uses embedded devices that detect physical, chemical and biological signals and provide a way for these signals to be measured and recorded. Sensor technology applications have been introduced in various fields of medicine in the diagnosis, treatment and monitoring of diseases. Intelligent 'Smart' implants are devices that can provide diagnostic capabilities along with therapeutic benefits. In trauma and orthopaedics, applications of sensors is increasing because of the advances in microchip technologies for implant devices and research designs. It offers real-time monitoring from the signals transmitted by the embedded sensors and thus provides early management solutions. Smart orthopaedic implants have applications in total knee arthroplasty, hip arthroplasty, spine surgery, fracture healing, early detection of infection and implant loosening. Here we have explored the role of Smart sensor implant technology in total knee arthroplasty. Smart sensor assisted can be used intraoperatively to provide objective assessment of ligament and soft tissue balancing whilst maintaining the sagittal and coronal alignment to achieve desired kinematic targets following total knee arthroplasty. It can also provide post-implantation data to monitor implant performance in natural conditions and patient's clinical recovery during rehabilitation. The use of Smart Sensor implant technology in total knee arthroplasty appears to provide superior patient satisfaction rates and improved functional outcomes.
Foot and Ankle Surgery, Jun 1, 2013
Journal of orthopaedics, Sep 1, 2022
Springer eBooks, 1991
Artificial Intelligence (AI) is an emerging technology. Research in AI is focused on developing c... more Artificial Intelligence (AI) is an emerging technology. Research in AI is focused on developing computational approaches to intelligent behaviour. The computer programs with which AI could be associated are primarily symbolic processes associated with complexity, ambiguity, indecisiveness, and uncertainty. One of these computer programs is referred to as Knowledge. based Expert System (KBES) as it represents knowledge acquired from various experts in a particular field of interest to the user. The expert system emulates human behaviour in solving problems thought to require experts for their solution by utilizing computer programs that incorporate experts' heuristic reasoning. In this paper, the application of KBES to aid the design of ball and roller bearings is discussed. The precision rolling-element bearing of the twentieth century is a product of exacting technology and sophisticated science. A bearing supports radial and axial loads, at the same time allowing relative motion between two elements of a machine. Various requirements and steps in the design of baU and roller bearings are discussed. Equations are developed for the relevant design parameters and input into the expert system shell called VP-Expert. The expert system rules are also provided.
Foot & Ankle Orthopaedics, 2022
Category: Ankle Introduction/Purpose: Total ankle replacements (TARs) provide pain relief with pr... more Category: Ankle Introduction/Purpose: Total ankle replacements (TARs) provide pain relief with preservation of movement and function. The most successful TARs are either 2nd or current 3rd generation in design, whilst 4th generation implants are steadily being introduced. This meta-analysis evaluates the survivorship of 2nd, 3rd and 4th generation ankle replacements used today to determine whether any difference between generations and bearing types exist. Methods: A systematic review and meta-analysis of published data from January 2000 to January 2020 was conducted following PRISMA guidelines. Inclusion criteria: English language papers, adult population, &amp;gt;= 20 ankles with a minimum follow up &amp;gt;= 24 months, pre- and post-operative functional scores available. Clinical outcomes of primary TARs were evaluated as well as their associated survivorship. Statistical analyses were undertaken to determine survivorship and complications associated with the second, third and fourth generation implants and the bearing design. Ankle generations were determined from the original studies and confirmed based on literature set definitions. The modified Coleman Methodology Score was used to evaluate the quality of studies. Results: A total of 4642 TARs in 4487patients from 51-studies were included. The mean age was 61.9years and mean follow up of 57.8months. The most common indications were post-traumatic-OA (54.5%), primary-OA (25.5%) and inflammatory-arthropathy (15.2%). Relative-risk calculations showed significant reductions in nerve-injury (p &amp;lt; 0.01), post-operative fracture ( p &amp;lt; 0.01), wound complications (p &amp;lt; 0.01), radiolucencies ( p &amp;lt; 0.01), or heterotopic bone formation (p &amp;lt; 0.01), aseptic loosening (p &amp;lt; 0.01) for later generations. Sensitivity analysis performed for the withdrawal of 2 prostheses showed 2yr survivorship for 2nd, 3rd and 4th generation TARs was 95.3%, 97.9% and 98.9% (p &amp;lt; 0.05). Third-generation TARs had better 10-yr survivorship compared to 2nd generation (83.50% vs. 70.76%) (p &amp;lt; 0.01). Bearing design had little influence on survivorship. Conclusion: In the real world subsequent generations of modern contemporary TAR demonstrate lower rates of complications and improved survivorship independent of bearing design, without reaching designer series levels. Population changes have meant a reduction in mean age at implementation and the commonest pathology for a TAR has become post traumatic OA without a observed detrimental affect in outcomes. Even so, superior short-term survivorship of fourth generation implants is promising for the future of modern TAR surgery.
Orthopaedic Proceedings, Oct 1, 2010
Little data exists on predicting the actual outcome of patients with fracture neck of femur when ... more Little data exists on predicting the actual outcome of patients with fracture neck of femur when aged over 90. This group represents a complex of medical problems and where a delay in surgery can impact on patient recovery. In this study we evaluated the POSSUM scores at time of admission and time of surgery. We aim to define the actual mortality and morbidity of this group, if the possum had any predictive value, and any correlation with outcome. 132 patients over 90 with a fracture where followed from 2005–7, and a control cohort were followed up in 2005–6. A collection form was prepared to collect standard data on physiological status, with a standard scoring system on admission (Ortho possum), at the time of operation, comparing their progress and clinical outcome post-op. It also recorded co-morbidities and other outcomes. Statistical analysis was conducted using SPSS. 132 patient notes were reviewed and 130 patients in the control group. 5 had no surgery and the average age was 93 (90–103) vs. 76 in the control group. The majority of over 90’s were admitted from home by ambulance (n=99); and the cause of the fracture was recorded as a fall (n=68). 74 patients at admission were using a stick or a frame (24 were independent). Only 2 patients were on warfain. At the point of admission the physiological POSSUM score on average was 23.48 (18–44) and at surgery it was 23.52 (16–38). This meant that the predicted mortality increased from 0.103 to 0.104. The average time to surgery was 1.5 days (0–12 days). However delays in surgery increased the POSSUM score and higher Possum scores were correlated with increased number of complications (p>0.002), increased time to mobilisation (p>0.003), and reduced mobility as compared to admission at day 15 and longer hospital admissions (p>0.005). In hospital mortality was 0.068 with a higher total POSSUM score prior to surgery of 36.29 for these patients compared to those patients who died after discharge. 35 patients died in total at 2 years post discharge (36%). Of these patients those within the 30 day mortality post discharge was 0.087 with a higher Total POSSUM score of 28.55 compared with the 120 day mortality post discharge of 0.194 with Total POSSUM score of 27.55; predicted mortality for the whole group was 0.28 using the Possum score (actual 0.27). Of the 35 patients that died 22 had higher Possum scores at surgery than admission. In summary we found that there was no significant difference in the mortality and morbidity in the over 90’s fracture neck of femur group than the control. The Possum scoring system over predicted overall mortality and morbidity. Our results indicate a dedicated team to deal with these patients may well be of benefit to improve surgical Possum scores and outcome.
Foot & Ankle Orthopaedics, Oct 1, 2022
Foot & Ankle Orthopaedics, Oct 1, 2022
CRC Press eBooks, Apr 2, 2021
Médecine des Maladies Métaboliques, Feb 1, 2021
Resume Introduction Les plaies de pied diabetique (PPD) sont un probleme frequent, associe a un r... more Resume Introduction Les plaies de pied diabetique (PPD) sont un probleme frequent, associe a un risque eleve d’amputation et de mortalite. L’adressage rapide a une structure specialisee du pied diabetique permet d’ameliorer le taux de cicatrisation et de diminuer le risque d’amputation. Une proportion importante de patients avec une PPD sont adresses tardivement vers ces structures specialisees. Un parcours de soins primaires des patients avec une PPD a ete developpe par l’International Diabetic Foot Care Group en collaboration avec le D-Foot International pour ameliorer l’orientation de ces patients vers les structures specialisees. Nous presentons une version adaptee au systeme de soin francais avec pour but de faire connaitre cet outil aux professionnels de sante de premiers recours francophones. Methodes L’orientation des patients se fait en trois niveaux de severite, qui dependent des comorbidites du patient, des caracteristiques de la plaie, de la presence d’une infection et du statut vasculaire. Resultats Les PPD non compliquees sont prises en charge en soins primaires avec mise en place d’une decharge. Une reevaluation de la plaie a 15 jours permet de savoir si le patient doit etre oriente vers une structure specialisee. Les PPD compliquees doivent etre adressees en moins de 48 h vers une structure specialisee, tandis que les plaies de pied en urgence absolue necessitent une hospitalisation en urgence. Conclusion Ce parcours de soins destine aux professionnels de sante en soins primaires a pour but d’ameliorer la prise en charge et le pronostic des patients diabetiques porteurs d’une plaie de pied.