How should we manage hip fracture patients on direct oral anticoagulants?

Objective: Currently, there are no national protocols in place for managing hip fracture patients on direct oral anticoagulants (DOACs). Hence, various local management protocols exist. We compared three different local protocols and a control group to assess blood loss and time delay to theatre.

Glucosamine reduces the inhibition of proteoglycan metabolism caused by local anaesthetic solution in human articular cartilage: an in vitro study.

Background: We assessed whether local anaesthetics caused inhibition of proteoglycan metabolism in human articular cartilage and whether the addition of Glucosamine sulphate could prevent or allow recovery from this adverse effect on articular cartilage metabolism.

Methods: Cartilage explants obtained from 13 femoral heads from fracture neck of femur patients (average age 80 years, 10 female) were exposed to either 1% Lidocaine, 2% Lidocaine, 0.25% Bupivacaine, 0.

Articular cartilage and local anaesthetic: A systematic review of the current literature.

Background: Chondrolysis involves the breakdown of cartilage following arthroscopic surgery, most commonly affecting the glenohumeral joint.

Methods: This review summarises all clinical and laboratory studies regarding local anaesthetic (LA) and its association with chondrolysis. We identified 289 papers, 41 of which met our inclusion criteria and were included in the final review.

Use of portable analytical methods to determine the stoichiometry of reaction for hexahydrotriazine-based hydrogen sulfide scavenger operations.

During the reaction between 1,3,5-tris(2-hydroxyethyl)hexahydro-s-triazine and hydrogen sulphide, the principle by-product is the organic sulphide 5-(2-hydroxyethyl)dithiazine. It can be determined by a novel, portable, field-capable ion mobility spectrometry method described herein and enables the "degree spent" to be determined. Dependant upon the level of carbon dioxide in the produced gas, a mixture of ethanolaminium bicarbonate and ethanolamine bisulphide is also produced.

The hip fracture best practice tariff: early surgery and the implications for MRSA screening and antibiotic prophylaxis.

Background: In April 2010, the Department of Health introduced the hip fracture best practice. Among the clinical criteria required to earn remuneration is surgery within 36 h of admission. However, early surgery may mean that methicillin-resistant Staphylococcus aureus (MRSA) colonisation status is not known before surgery, and therefore, appropriate antibiotic prophylaxis may not be administered.

Effect of different irrigation fluids on human articular cartilage: an in vitro study.

Purpose: The goal of this study was to examine the effect of different irrigation fluids on human articular cartilage.

Methods: Femoral heads were obtained from 9 patients with fractured neck of femur (mean age, 89 years; 7 female) and tibial plateaus from 2 female patients at the time of total knee replacement (mean age, 73 years). Chrondral explants were harvested and exposed to 1 of 4 different irrigation fluids for 1 hour: Ringer's solution, normal saline (0.

Impact of organisational changes on fracture neck of femur management.

Introduction: In 2005, University Hospitals of Leicester formed a Fracture Neck of Femur (#NOF) project group to improve care of this group of patients.

Subjects And Methods: The salient changes effected by the group were the appointment of designated orthogeriatricians, trauma co-ordinators, clinical aides, and discharge nurses.

Results: As a result of these measures, the number of patients going to theatre within 48 h of admission rose from 38.

Clostridium difficile in hip fracture patients: prevention, treatment and associated mortality.

Background: A series of infection control measures were introduced at the University Hospitals of Leicester NHS Trust in 2006-2007 to reduce the incidence of Clostridium difficile infection.

Aim: The aim of this study was to assess the impact of these measures on the incidence of C. difficile and to record the associated mortality in hip fracture patients.

Acromial stress fracture in a young wheelchair user with Charcot-Marie-Tooth disease: a case report.

: Acromial stress fractures are rare and have not been highlighted as a potential complication of wheelchair use. We report the case of a 22-year old female wheelchair bound patient with Charcot-Marie-Tooth disease who presented with a four-year history of shoulder pain which impaired mobility and quality of life. Plain radiographs showed a cortical irregularity of the acromion but no double-density sign.

Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales.

This study evaluates the criterion validity of the subjective component of the American Orthopaedic Foot and Ankle Society (AOFAS) clinical rating scales by correlating scores obtained with these rating scales to scores obtained with the Foot Function Index (FFI) in patients with foot and ankle conditions. To date, the AOFAS scoring scales have not been shown to provide valid information despite their popularity. The FFI, on the other hand, has previously been shown to provide valid information in regard to conditions affecting the foot and ankle.

The new consent form: is it any better?

Background: The UK Department of Health (DoH) introduced a new consent form into the National Health Service (NHS) in April 2002 following the Bristol Royal Infirmary Inquiry.

Aim: To compare the efficacy of the new consent form with the old on the quality of consent.

Methods: A questionnaire consisting of 11 questions was distributed to two groups of 100 patients before and after the introduction of the new consent form in the pre-assessment clinic at Glenfield Hospital, Leicester.

Can knee position save blood following total knee replacement?

Previous research showed knee flexion at 70 degrees for 6 h following total knee replacements (TKR) reduced wound drainage by 30%. However, wound drainage may not represent total blood loss and obstruction of the drain in flexion or the relative elevation of the knee could have caused the reduction in drainage. We wished to confirm that this simple, cheap method not only reduced wound drainage but also total haemoglobin loss and determine what part elevation or drain obstruction may play.