Background The Lancet Commission on Global Surgery established the Three Delays framework, categorising delays in accessing timely surgical care into delays in seeking care (First Delay), reaching care (Second Delay), and receiving care (Third Delay). Globally, knowledge gaps regarding delays for fracture care, and the lack of large prospective studies informed the rationale for our international observational study. We investigated delays in hospital admission as a surrogate for accessing timely fracture care and explored factors associated with delayed hospital admission. MethodsIn this prospective observational substudy of the ongoing International Orthopaedic Multicenter Study in Fracture Care (INORMUS), we enrolled patients with fracture across 49 hospitals in 18 low-income and middle-income countries, categorised into the regions of China, Africa, India, south and east Asia, and Latin America. Eligible patients were aged 18 years or older and had been admitted to a hospital within 3 months of sustaining an orthopaedic trauma. We collected demographic injury data and time to hospital admission. Our primary outcome was the number of patients with open and closed fractures who were delayed in their admission to a treating hospital. Delays for patients with open fractures were defined as being more than 2 h from the time of injury (in accordance with the Lancet Commission on Global Surgery) and for those with closed fractures as being a delay of more than 24 h. Secondary outcomes were reasons for delay for all patients with either open or closed fractures who were delayed for more than 24 h. We did logistic regression analyses to identify risk factors of delays of more than 2 h in patients with open fractures and delays of more than 24 h in patients with closed fractures. Logistic regressions were adjusted for region, age, employment, urban living, health insurance, interfacility referral, method of transportation, number of fractures, mechanism of injury, and fracture location. We further calculated adjusted relative risk (RR) from adjusted odds ratios, adjusted for the same variables. This study was registered with ClinicalTrials.gov, NCT02150980, and is ongoing. Findings Between April 3, 2014, and May 10, 2019, we enrolled 31 255 patients with fractures, with a median age of 45 years (IQR 31-62), of whom 19 937 (63•8%) were men, and 14 524 (46•5%) had lower limb fractures, making them the most common fractures. Of 5256 patients with open fractures, 3778 (71•9%) were not admitted to hospital within 2 h. Of 25 999 patients with closed fractures, 7141 (27•5%) were delayed by more than 24 h. Of all regions, Latin America had the greatest proportions of patients with delays (173 [88•7%] of 195 patients with open fractures; 426 [44•7%] of 952 with closed fractures). Among patients delayed by more than 24 h, the most common reason for delays were interfacility referrals (3755 [47•7%] of 7875) and Third Delays (cumulatively interfacility referral and delay in emergency department: 3974 [50•5%]), while Second Delays ...

Aneurysmal bone cysts are benign, locally aggressive osteolytic neoplasms that usually affect individuals in their second decade. Majority of aneurysmal bone cysts occur in metaphysis of long bones and vertebra. Clavicle is an uncommon location and only few cases have been reported in literature. We present a case of 17 year old male who presented with gradually progressive painful swelling in left shoulder region. Xray and CT scan showed expansile osteolytic swelling. Excision of the lesion with subtotal claviculectomy was done. On follow up, patient was able to perform his daily activities without any restriction and no recurrence was noted on ten year follow up.

The purpose of this study is to realize the challenges experienced by elderly patients with hip fracture and their caregivers after discharge. A total of 65 files of elderly hip fracture operated patients were assessed and out of them responses from 53 patients collected through telephonic conversation over a period of 3 weeks. The responses received from the patient and their attendants were evaluated using the EQ-5D quality of life tool and their challenges noted. The most common fractures reported in the elderly are at the wrist, spine and hip. Hip fractures in elderly generally occur after a simple fall. If timely medical attention is not provided or appropriate care not taken the future of the patient after a hip fracture is certain – a dramatic reduction in the quality of life and possibly the beginning of the end of life. The purpose of this study is to evaluate the outcomes of elderly patients with hip fracture following surgery and the challenges they experienced after discharge from the hospital. A total of 53 patients were selected for the study who underwent hip surgery at Indian Spinal Injuries Centre. This is a descriptive study carried over a period of 13 months from August 2019 to August 2020. EQ-5D is used to characterize current health status of the patients. It consists of five domains and a visual analogue score. Feedback was collected from the patients and their attendants over telephone with a minimum follow up of 3 months. VAS score was calculated for every patient individually. Collected data was entered in MS Excel sheet. Challenges faced by the patients and their caregivers were documented. Out of 53 patients, 12 had died (22.6%), 07 patients responded themselves to the call and 34 calls were responded by the care givers. Most of the patients had intertrochanteric fractures 56.6% (30 patients) followed by neck femur fracture 24.5% (13 patients). On average every patient was suffering from a minimum of two comorbidities. The average length of hospitalization was 6.8 days. : This study suggests that integrated care involving geriatricians in pre-operative optimization of the patient should come in immediate practice. The role of post-surgery rehabilitation is invaluable but often an underestimated modality. The concerns of the patients and their family members regarding home care after discharge are genuine and need to be addressed. Information sharing is the key to reducing anxiety. Consideration for a cost-effective step-down facility must be considered by private institutes and government authorities.

Locking compression plate technology needs perfect seating of the locking screw head in the corresponding recess in the plate hole for a stable construct. The purpose of this study is to quantify screw-plate angle. In this study, a total of 750 locking screws of different lengths were placed by six residents. The measured angles were compared with Repeated Measures ANOVA method. Significant differences were seen for 40mm, 50mm, 70mm and 80mm screw length (p < 0.05) to assess the deviation of angle in pre-training, post-training and final experiment. The placement of locking screws precisely can help avoid an easily preventable surgical risk factor for fixation failure. The evolution of Locking Compression Plate (LCP) technology has radically changed the practice of fracture fixation. This technology mandates meticulous detail in surgical technique in placing the locking screw. It demands perfect seating of the locking screw head in the corresponding recess in the plate hole. The purpose of this study is to quantify screw-plate angle i.e., off-axis screw trajectory and its change with an increase in the length of screw and strength of the surgeons.Six orthopaedic residents were selected. The surgeons were familiarized with the instrumentation. A total of 750 locking screws of different lengths were placed in a locking plate in osteoporotic saw bone models using a torque measuring screw driver. The deviation was assessed for 150 screws inserted in pre-training, post-training and the final test under the supervision of the senior author. Immediate feedback on the performance and objective proof of precision was given within an hour by measuring the angle of deviation on X-ray using InstaPACS.Collected data was entered in MS Excel sheet. Descriptive statistics were presented in mean ±SD for continuous variables and count with percentage for Categorical variables. Repeated Measures ANOVA was used to assess the difference in deviation of angle pre-training, post-training and final experiment with the length of the screw. IBM SPSS 25.0 software was used for data analysis. Surgeon grip strength and torque applied had no significant association with the angle of deviation. The surgeons exceeded 10 Newton meter torque in pretraining. This applied torque decreased after training in the post-training and final experiments. The length of the screw and angle of deviation were found to positively correlate in pre-training and final experiment. In this study, 40 out of 150 (26%) studied screw insertions were off-axis. Most of the deviations (29) were only one degree (19.33%). The remaining 11 were more than 2 degrees (6.67%). The maximum off-axis was 4.3 degrees. Significant differences were seen for 40mm, 50mm, 70mm and 80mm screw length (p < 0.05) in pre-training, post-training and the final experiment. : This study signifies that practice under supervision with immediate and objective feedback is a valuable learning tool. Real time feedback definitely improves the surgical confidence that will result in better patient outcome in placing locking screws. The placement of locking screws precisely can help avoid an easily preventable surgical risk factor for fixation failure.