BackgroundProximal femur fracture (PFF) carries significant morbidity, mortality, and cost implications to the health system. Subsequent contralateral fracture further decreases patient performance and increases the healthcare burden. This study aimed to identify and evaluate potential risk factors for consecutive PFF. MethodologyPilgrim Hospital PFF database from 2012 to 2019 was retrospectively analyzed. Patients over 60 years with low-energy fractures were included. Pathological and atypical fractures and polytrauma were excluded. ResultsThere were 114 patients (4.18%) with contralateral hip fractures out of a total of 2727 PFF patients; 80% were females. The mean age was 82 years for the first hip fracture and 85 years for the second. The average time interval between fractures was 36 months. The fracture pattern was the same on both sides in 74.3% of patients (P<0.0001). Out of 53 patients with cemented hip hemiarthroplasty (CHH) on one side, 31 patients (59%) had a second CHH for the contralateral side. Likewise, out of 48 patients who had dynamic hip screw fixation during the first admission, 33 patients (69%) had the same procedure on the contralateral side too.During the two consecutive admissions, the length of hospital stay was not significantly different (P=0.30), median American Society of Anesthesiologists (ASA) grades were 3, hyponatremia increased from 25% to 29% (P=0.5), mean decline in abbreviated mental test score (AMTS) was 0.4, deterioration of Clinical Frailty Score and Charlson morbidity index were from 4.5 to 5.9 (P<0.0001), and from 5.4 to 6.1, respectively, and institutional residency was increased from 23 to 46 (P>0.0014). ConclusionThe similarity of fracture pattern bilaterally requiring similar surgical procedures is comparable with other literature. Even though there is minimal or no change in the ASA, AMTS, and hospital stay between the two admissions, there is a significant decline in clinical frailty, mobility status, and an increase in residential dependency following a subsequent fracture. Our findings demonstrate the importance of emphasizing secondary preventive measures to prevent a consecutive fracture.

Introduction Neck of femur fracture (NOFF) carries significant morbidity, mortality, and cost implication to the health system. Subsequent contralateral fracture(SCNOFF) further decreases patient performance and increases healthcare burden. The aim of this study was to identify and evaluate potential risk factors and effects of SCNOFF. Method Retrospectively analysed NOFF database from 2012 to 2019 was. Inclusion criteria were patients over 60 years with low energy fractures. Polytrauma, pathological and atypical fractures were excluded. Results There were 114 patients (4.18%) with contralateral hip fractures out of 2727 total NOFF patients. Mean age was 82 years old for the first hip fracture and 85 years for the second. Average time interval between fractures was 36 months. During the two admissions, mean decline in Abbreviated Mental Test Score(AMTS) was 0.4, deterioration of Clinical Fragility Score and Charlson Morbidity Index were from 4.5 to 5.9 (P &lt; 0.0001), and from 5.4 to 6.1 respectively. Mobility was dropped by one level. institutional residency was increased from 23 to 46 (P &gt; 0.0014). Conclusions There is a drastic decline in clinical frailty, mobility status and increase residential dependency following a subsequent fracture. Our findings demonstrate the importance of emphasizing preventive measures to reduce the incidence of SCNOFF.

Background Enhanced Recovery Programme(ERP) is structured process of patient education, appropriate analgesia and early mobilisation. ERP was introduced to address, demand for surgical beds and cancellation of orthopaedic procedures. Objectives of this study were to evaluate efficacy and safety of ERP. Method This was prospective study, over three months. Included, all lower limb arthroplasty patients eligible for ERP(all primary arthroplasty patient with lower anaesthetic risk). Pre-medication, intra-operative local anaesthetics infiltration, same day post-operative radiograph, combinations of analgesics, early mobilisation, and discharge back to the usual place of abode. Results 201 patients, mean age was 71 years (42-87), 22 ASA (American Society of Anaesthesia) 1, 147 ASA 2 and 23 ASA 3 patients. Performed 121 total knee replacements and 80 total hip replacements. Average duration of weight bearing was1.04 days. Mean date of discharge was 1.37days (0-5). 8 patients were re-admitted (0.039%), they were, one with surgical site infection, another one for manipulation, 5 patients, suspected deep vein thrombosis (DVT) (all were excluded DVT). There was no failed discharge. Conclusions ERP is very safe and effective way of increasing performance of hip and knee arthroplasties by optimising availability of ring-fencing surgical beds and reducing the hospital stay.