The study by Smith et al. (2010) concluded that clips are associated with 3 times the infection rate compared with subcuticular sutures in orthopaedic surgery (P = .01).For hip surgery, there was a 4-fold increase. We aimed to determine the trends and influences in skin closure and wound care for hip and knee arthroplasty in the northwest region as well as what would change surgeons' current practice. A short online survey was emailed to consultants in the northwest of England enquiring about their current practice in superficial skin closure, what has influenced this, and finally what would change their practice. Returned surveys were then analysed. A total of 45 consultants responded (response rate of 40.2%). In both hip and knee arthroplasty, clips were the most commonly used superficial skin closure material (53% and 63%, respectively). Personal experience was the greatest influence on the choice of closure material in both hip and knees (84% and 93% respectively). A total of 66% of hip and 76% of knee surgeons would change their closure material if there was evidence to support this. Hip and knee arthroplasty surgeons are influenced by their personal experience, and most use clips as their skin closure method. Most would change their practice with evidence of one material over another. We conclude that there is need for a prospective, well-powered, multi-centre randomised control trial to determine the skin closure material that has the lowest return-to-theatre rate in arthroplasty surgery.

No abstract

No abstract

We present the case of a pelvic fracture in a 69-year-old man with Child–Pugh class C cirrhosis who presented to the Accident and Emergency department after a slip on wet grass. After initially being systemically well, he became haemodynamically unstable in the Emergency department requiring resuscitation via the massive transfusion pathway. He was admitted to intensive care unit for resuscitation following a CT angiogram which showed no arterial bleed, but significant retroperitoneal haematoma. He received a prophylactic embolization of the internal iliac artery 2 days later and his acetabular fracture was managed with skeletal traction. He died 7 weeks later as a result of his liver failure. We propose that a high index of suspicion would have led to an earlier diagnosis of his venous bleed and earlier transfusion.

Background: Mortality following revision hip surgery for periprosthetic fracture (PPF) is comparable to neck of femur fractures. Our institution provides a regional “PPF Service”. The aim of this study was to determine the time to surgery and mortality rate for PPF, compared to revision for infection or aseptic loosening. Methods: Revision arthroplasty procedures performed for PPF, infection or aseptic loosening between January 2014 and December 2015 were identified. Comparisons were made between the 3 groups for baseline demographics, admission to higher-level care, length of stay, complications and mortality. Results: There were 37 PPF, 71 infected and 221 aseptic revisions. PPF had a higher proportion of females (65% vs. 39% in infection and 53% in aseptic; p = 0.031) and grade 3 and 4 ASA patients ( p = 0.006). Median time to surgery for PPF was 8 days (95% CI, 6–16). Single-stage procedures were performed in 84% of PPF, 42% of infections and 99% of aseptic revisions ( p < 0.001). 19% of PPF revisions required HDU admission, 1% in the aseptic group and none in the infection group. Median length of stay was significantly different (PPF 10; infection 14; aseptic 8 days ( p < 0.001). The 1-year mortality rate for PPF was 0%, 2.8% for infection and 0.9% in the aseptic group ( p = 0.342). Conclusions: Despite the PPF group having higher ASA grades and more HDU admissions, our 1-year mortality rate was 0% and not significantly different to infection or aseptic loosening. Our low complication and 1-year mortality rate is encouraging and supports the safety of a regional “Periprosthetic Fracture Service”.