877 Improving Daily Inpatient Neck of Femur Fracture (NOFF) Patient Care Using a Focused Review Proforma

Aim

The National Hip Fracture Database (NHFD) encompasses key parameters to reduce mortality and improve care in NOFF patients. Current practice across the NHS incorporates several different inpatient orthogeriatric models. Our quality improvement project sought to improve inpatient care delivered by orthopaedic staff with a geriatric targeted focus.

Method

An initial audit on 50 patients was conducted and key areas of concern were highlighted. A focussed proforma for daily reviews was implemented which encompassed local and national (NHFD) recommendations and this was re audited for a further 50 patients.

Results

Documentation of demographics, comoribidites and pre-operative social parameters improved from 70 to 100%. Examination of general health systems improved from 80 to 100%. Identification of nutritional abnormalities improved from 66 to 95%. Documentation of skin condition including wound care and pressure ulcers improved from 55 to 90%. Management of perioperative indwelling urinary catheters improved from 55 to 90%. Identification of unwell patients and thromboembolic risk assessments improved from 65 and 70 to 90 and 95% respectively.

Conclusions

Our targeted focused proforma facilitated an easy and comprehensive daily review for vulnernable geriatric patients. Additionally, it formed a basis for daily handover amongst juniors changing wards and was adopted formally and adapted for other geriatric services.

139 Absence of Coding in an Outpatient Paediatric Orthopaedic Department – Where Does the Money Go?

Aim

Paediatric orthopaedics conditions are often managed in the outpatient department (OPD) setting. Due to the lack of official coding for these minor procedures in our OPD, the hospital receives neither financial benefit nor evidence for a formal auditing process. With the Paediatric Get It Right First Time (GIRFT) report underway, we have looked at building a coding pathway for paediatric interventions in our OPD.

Method

The number of paediatric orthopaedic interventions were collated and grouped in a 6-month period, and a clinical outcome form was created accordingly. After consulting with the coding department, a cost analysis of prospective earnings was conducted, as well as comparisons to current standard tariff rates for OPD attendance.

Results

From January 2021 to June 2021, 100 interventions were performed in our OPD with the breakdown of: 21 clubfoot serial casting, 70 serial casting for pathology such as tip toe walkers, 6 Botox injections in spastic contracture limbs and 3 Pavlik harnesses for developmental dysplasia of the hip. With the assistance of coding department, a new paediatric procedural coding form was created with 14 relevant interventions listed. A loss of £6110 was calculated due to tariff rates being solely attendance based compared to interventional based.

Conclusions

Paediatric orthopaedic OPD should have clinical coding outcomes in place for each intervention that is performed to ensure that the hospital trust receives appropriate financial commission as well as ensure a formal audit trial can be produced.

Is there a sex difference in palm print ridge density?

BACKGROUND

Analysis of fingerprints and palm prints at the crime scene is vital to identify the suspect and establish a crime. Dermatoglyphics can even be valuable in identification of a dismembered hand during medicolegal investigations to establish the identity of an individual in cases of mass disasters/mass homicides.

METHODS

The present research studies the variation in ridge density in different areas of the palm prints among men and women. The four prominent areas were analysed on the palm prints that included central prominent part of the thenar eminence (P1), hypothenar region; inner to the proximal axial triradius (P2), medial mount; proximal to the triradius of the second digit (P3) and lateral mount; proximal to the triradius of the fifth digit (P4).

RESULTS

The mean palm print ridge density was significantly higher among women than men in all the designated areas in both hands except for the P3 area in the right hand. Statistically significant differences were observed in the palm print ridge density between the different palm areas in men and women in right and left hands. No significant right-left differences were observed in the palm print ridge density in any of the four areas of palm prints among men. In women, right-left differences were observed only in the P3 and P4 areas of palm prints.

CONCLUSIONS

This preliminary study indicates that though the palm print ridge density is a sexually dimorphic variable, its utility for estimation of sex in forensic identification may be limited owing to significant overlapping of values.

Variations in the insertion of peroneus longus tendon-a cadaver study

BACKGROUND

The insertion of peroneus longus is traditionally described to the plantar surface of the 1st cuneiform and 1st metatarsal. It is thought to be the main contributor to the plantarflexed first ray seen in cavus feet.

METHODS

We studied the insertion of peroneus longus in 26 feet from 14 adult cadavers. The insertional points, presence of sesamoid bone and variations in insertion were noted.

RESULTS

The main insertion was to the base of the 1st metatarsal and the medial cuneiform in the majority of feet but variations were observed. A sesamoid bone was present within the tendon under the cuboid in 16 feet, 12 of which had additional lateral insertion bands.

CONCLUSIONS

Variations in the insertion of peroneus longus were found and we have described two new lateral bands.

SIMULTANEOUS DORSAL DISLOCATION OF THE INTERPHALANGEAL JOINTS IN RING FINGER WITH PROXIMAL INTERPHALANGEAL JOINT DISLOCATION OF THE MIDDLE FINGER: CASE REPORT AND REVIEW OF THE LITERATURE

A 30-year-old amateur goalkeeper sustained simultaneous dislocation of the proximal and distal interphalangeal joints of the ring finger and of the proximal interphalangeal joint of the middle finger following a hyperextension injury. This was reduced under a local anaesthetic. Neighbour finger strapping and early mobilisation achieved an excellent functional outcome when reviewed at eight weeks after the initial injury.

The use of multi-media messaging in the referral of musculoskeletal limb injuries to a tertiary trauma unit using: a 1-month evaluation

OBJECTIVES

New developments in telecommunications will have a profound effect on the delivery of medical care throughout the world. In Northern Ireland three trauma centres provide fracture care for their own and surrounding Emergency Departments. All trauma referrals are currently taken by telephone. It is our experience that the verbal description of the radiographs of a musculoskeletal limb injury can be inaccurate, necessitating us to view the plain films of the patient. By utilising a recent advance in telecommunications technology, the launch of mobile handsets with multi-media messaging (MMS) service capability, it is now possible to digitally capture and instantly send an image of a plain film.

PURPOSE

To evaluate the use of multi-media messaging as a supplement to the telephone referral of musculoskeletal limb injures.

METHOD

: Following a referral using, the emergency physician and the trauma surgeon evaluated the multi-media consult through a survey questionnaire.

RESULTS

Between the 1st December 2003 and the 1st January 2004, 46 multi-media consultations were performed. Picture quality was acceptable in all but one of the referrals. In 35 of the 46 referrals the multi-media image of the plain films was felt to improve the management of the patient. In 8 of the 46 referrals the multi-media image of the plain films was felt to change the management of the patient.

CONCLUSION

A multi-media messaging store- and forward telemedicine system has potential to facilitate the rapid, cost-effective management of musculoskeletal limb injuries thereby enhancing clinical care.