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With the introduction of the World Hip Trauma Evaluation Four clinical trial, fixation of pertrochanteric neck of femur fractures is becoming a hot topic. In this trial, the novel X-Bolt expanding bolt implant is being compared with the current gold standard of a sliding hip screw. We present a previously undescribed complication when inserting the bolt into the femoral head, where the expandable wings penetrate the femoral neck due to misplacement of the bone crusher or the X-Bolt prosthesis. This unforeseen complication required the introduction of several additional corrective intraoperative steps.

Aim The CQC has mandated certain pieces of information are displayed in a clinic and the staff know where to find them. This is in addition to the mandatory training that staff members undergo with increasing repetition. The UK Armed Forces is no exception to this, in addition wall space is often used as opportunistic education for patients. Method We counted the number of posters that were displayed in a CQC good, rated clinic, worked out the average cost to produce, produced a questionnaire of staff and patients to see how many times people engaged with the information and the carbon footprint of compliance. We looked timed how long it took for someone new to the clinic to spot the lifesaving information. Results 140 items of literature took on average 65 minutes ±240 to produce, with an average of 9 pages per item ±190. Average cost was 10 pence per page when lamination was included, totalling £126. At 6000kg CO2/paper page and 1500kg CO2/laminate page, the total carbon footprint was 9,450,000 Kg CO2. Staff members engaged zero times with the literature and only one patient engaged. The time to spot the critical information in a clean room was 0.8 second, in a normal clinic room was 4.3 seconds. Conclusions Distractions can be detrimental in emergency situations and with human factors interplay this can cost people their lives. A 3.5 second delay may seem inconsequential but compounded could be devastating. The cost and Carbon footprint is extraordinary for little benefit.

Aim The UK DMS delivers military CPD at a local level. Medics are taught at the regimental level and GDMO’s can vary from local teaching, regimental teaching, or no teaching. GDMO’s are GMC mandated to have CPD covering all areas of practice. Due to the nature of the deployable role of both staff groups it is difficult to deliver consistent teaching that can be revisited. We aimed to deliver regular, consistent, high-quality teaching delivered by SMEs on military relevant topics. Method A Plan, Do, Study, Act approach was used with predefined measures such as structure, process and outcome elicited via a participant survey. Virtual teaching via MOD Zoom monthly for each group was arranged. Teaching focused on medic portfolio competencies, the GDMO syllabus. Teaching was delivered by tri-service SMEs, the sessions were recorded and edited and subsequently uploaded to the BMJ Military Health website at no cost. Results 16 webinars, 8 to Medics and 8 to GDMOs have been delivered. Maximum attendance has been 130 tri-service participants including reservists. Feedback from 111 SP been positive with 65% and 28% of participants rating the teaching as excellent or very good respectively. 98% stated the teaching is relevant to their practice, and 89% agreed the teaching will change their practice going forward. Conclusions We have demonstrated that it is possible to deliver sustainable high quality, relevant, and practice changing sessions across all three services. This teaching has had active engagement from the user community and senior SMEs within the DMS for minimal cost.