Background Necrotising otitis externa is a severe ear infection for which there are no established diagnostic or treatment guidelines. Method This study described clinical characteristics, management and outcomes for patients managed as necrotising otitis externa cases at a UK tertiary referral centre. Results A total of 58 (63 per cent) patients were classified as definite necrotising otitis externa cases, 31 (34 per cent) as probable cases and 3 (3 per cent) as possible cases. Median duration of intravenous and oral antimicrobial therapy was 6.0 weeks (0.49–44.9 weeks). Six per cent of patients relapsed a median of 16.4 weeks (interquartile range, 23–121) after stopping antimicrobials. Twenty-eight per cent of cases had complex disease. These patients were older (p = 0.042), had a longer duration of symptoms prior to imaging (p < 0.0001) and higher C-reactive protein at diagnosis (p = 0.005). Despite longer courses of intravenous antimicrobials (23 vs 14 days; p = 0.032), complex cases were more likely to relapse (p = 0.016). Conclusion A standardised case-definition of necrotising otitis externa is needed to optimise diagnosis, management and research.

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• Background – During the initial peak of the COVID-19 pandemic in the United Kingdom (UK) admissions related to acute proximal femoral fracture (APFF) remained consistent.• Aims – This aim of this research is to demonstrate the impact of the COVID-19 pandemic on this cohort of high-risk patients and provide revenues for improvement in their care as we globally progress through further peaks of viral transmission and illness.• Methods– Retrospective, observational, cohort study of 112 patients with APFF; sustained during the first peak of the pandemic (1st March – 15th May, 2020). Following ethical approval, data was collected from electronic records. Included patients were those who had been admitted to one of two district general hospitals in Northwest England. Only patients with APFF were included – chronic, peri-prosthetic, femoral shaft and open fractures were excluded. Patients were split into two groups: COVID-positive (N = 17) and COVID-negative (N = 95) with the primary outcome measure being 30-day mortality.• Results – 17.9% overall mortality (29.4% for COVID-positive and 15.7% for COVID-negative). The odds ratio for mortality was 2.2 in the COVID-positive group compared to the COVID-negative group (95% confidence level; 0.68–7.23).• Conclusions – Patients with APFF suffered increased mortality during the initial peak of the COVID-19 pandemic. However, increased mortality in COVID-positive patients, compared to the COVID-negative patients, was not statistically significant. Increased mortality in COVID-negative patients may have been due to other pandemic related factors including: undiagnosed COVID-19; patient demographics and the effects of changes to the service provision structure of the orthopaedic department during this time. Moving forward, as the global fight against COVID-19 continues, we provide the below recommendations as suggested revenues to improve 30-day mortality for these patients during pandemic times:• repeated COVID-19 testing for all APFF patients;• strict separation of COVID-suspected, COVID-positive, and COVID-negative patients;• preservation of acute trauma services, including protected theatre time; and• maintenance of experienced orthopaedic teams on wards throughout periods of re-deployment.Further research with larger sample sizes is needed to assess the national and international applicability of these recommendations.