The edition · Orthopaedics
Hip fracture surgery delayed only by theatre capacity was linked to higher mortality, most in frail patients
A UK cohort that excluded delays for medical optimisation found waiting beyond 36 hours for lack of theatre space was tied to more deaths. An adductor canal block showed no added benefit over local infiltration after ACL reconstruction, and surgeon and hospital, more than patient risk, explained dual-mobility hip use.
The edition in brief
A UK teaching hospital cohort of 2,358 patients aged 65 or over with hip fracture separated delays caused by lack of theatre capacity from delays for medical reasons, and excluded the latter. Surgery more than 36 hours after arrival for capacity reasons was associated with higher one-year mortality (HR 1.37, 95% CI 1.15–1.63), with the steepest effect in the first 30 days (HR 1.71) and in patients with Clinical Frailty Scale scores above 4. It is observational, but it removes the main confounder that weakened earlier studies, and supports triaging the frailest to the first available list. In a double-blind trial of 100 patients having ACL reconstruction, adding an adductor canal block to local infiltration analgesia did not reduce 24-hour opioid use, pain, quadriceps function or early recovery scores. An analysis of 238,455 English primary hip replacements found that surgeon (32%) and hospital (23%) explained far more of the variation in dual-mobility cup use than patient factors (about 10%), pointing to unwarranted variation. A single-centre series of 160 meniscal allograft transplants reported graft survival of 84% at 10 years and 52% at 25 years. The pearl is on the frailty score as a triage tool for trauma lists.
An adductor canal block showed no added benefit over local infiltration after ACL reconstruction
Consider local infiltration alone for routine ACL reconstruction; this trial found no added benefit from an adductor canal block.
Surgeon and hospital, not patient risk, explained most dual-mobility hip use in England
Consider setting explicit patient criteria for dual-mobility cups in your unit rather than relying on individual preference.
Meniscal allografts survived in 84% at 10 years and about half at 25
Counsel meniscal allograft candidates with long-term survival figures and the gap between graft survival and knee function.
Record the frailty score on every hip fracture admission
Record a Clinical Frailty Scale score on every hip fracture admission and use it when ordering the trauma list.
Waiting for theatre space beyond 36 hours was linked to higher hip fracture mortality
When theatre capacity is short, consider prioritising frail hip fracture patients so they are operated on within 36 hours.
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