The Victorian state government introduced a trial electronic scooter sharing scheme on 1^st February 2022 in inner city Melbourne. Despite epidemiological data from other jurisdictions that show these devices are associated with significant trauma. This is a descriptive study from the largest trauma centre in Victoria demonstrating the “scope of the problem” after introduction of this government-approved, ride sharing scheme.

Retrospective case series. Our hospital orthopaedic department database was searched from 1/1/2021 to 30/6/22 to identify all presentations associated with electronic scooter trauma, the mechanism of injury and admission information was confirmed via chart review. Data collected included: mode of arrival, alcohol/drug involvement, hospital LOS, injury severity score, ICU admission, list of injuries, operations undertaken, surgical procedures, discharge destination, death.

In the 12 months prior to and 5 months since introduction of the ride share scheme, 43 patients were identified. 18 patients (42% of our cohort) presented in the 5 months since ride sharing was introduced, and 25 patients in the preceding 12 months.

58% were found to be alcohol or drug affected. All patients were admitted to hospital, 14% of which included ICU admission. 44% were polytrauma admissions. Median hospital length of stay was 2 days. The longest individual hospital stay was 69 days. No patients in this series died. There were 49 surgical procedures in 35 patients including neurosurgical, plastics and maxillofacial operations. Mean Injury Severity Score was 10.

Despite data demonstrating their danger in other jurisdictions, the Victorian state government approved a trial of an electronic scooter ride share scheme in inner Melbourne in February 2022. These devices are associated with a significant trauma burden and the rate has increased since the introduction of the ride-sharing scheme. This data may be combined with other hospital data and could be used to inform policy makers.

There is very limited literature describing the outcomes of management for proximal humerus fractures with more than 100% displacement of the head and shaft fragments as a separate entity. This study aimed to compare operative and non-operative management of the translated proximal humerus fracture.

A prospective cohort study was performed including patients managed at a Level 1 trauma centre between January 2010 to December 2018. Patients with 2, 3 and 4-part fractures were included based on the degree of translation of the shaft fragment (≥100%), resulting in no cortical contact between the head and shaft fragments. Outcome measures were the Oxford Shoulder Score (OSS), EQ-5D-5L, and radiological outcomes. Complications recorded included further surgery, loss of position/fixation, and non-union/malunion. Linear and logistic regression models were used to compare management options.

There were 108 patients with a proximal humerus fracture with ≥100% translation; 76 underwent operative management and 32 were managed non-operatively with sling immobilisation. The mean (SD) age in the operative group was 54.3 (±20.2) and in the non-operative group was 73.3 (±15.3) (p<0.001). There was no association between OSS and management options (mean 38.5(±9.5) operative vs mean 41.3 (±8.5) non-operative, p=0.48). Operative management was associated with improved health status outcomes; EQ-5D utility score adjusted mean difference 0.16 (95%CI 0.04-0.27, p=0.008); EQ-5D VAS adjusted mean difference 19.2 (95%CI 5.2-33.2, p=0.008). Operative management was further associated with a lower odds of non-union (adjusted OR 0.30, 95%CI 0.09-0.97, p=0.04), malunion (adjusted OR 0.14, 95%CI 0.04-0.51, p=0.003) and complications (adjusted OR 0.07, 95%CI 0.02-0.32, p=0.001).

Translated proximal humerus fractures with ≥100% displacement demonstrate improved health status and radiological outcomes following surgical fixation. Patients with this injury should be considered for operative intervention.

Proximal humerus fracture dislocations are amongst the most severe proximal humerus injuries, presenting a challenging management problem. The aim of this study was to report on the long-term outcomes of the management of proximal humerus fracture dislocations.

Patients with a proximal humerus fracture dislocation managed at a Level 1 trauma centre from January 2010 to December 2018 were included. Patients with an isolated tuberosity fracture dislocation or a pathological fracture were excluded. Outcome measures were the Oxford Shoulder Score (OSS), EQ-5D-5L, return to work, and radiological outcomes. Complications recorded included further surgery, loss of position/fixation, non-union/malunion, and avascular necrosis.

A total of 69 patients were included with a proximal humerus fracture dislocation in the study period; 48 underwent surgical management and 21 were managed with closed reduction alone. The mean (SD) age of the cohort was 59.7 (±20.4), and 54% were male. Overall patients reported a mean OSS of 39.8 (±10.3), a mean EQ-5D utility score of 0.73 (±0.20), and 78% were able to return to work at a median of 1.2 months. There was a high prevalence of complications in both patients managed operatively or with closed reduction (25% and 38% respectively). In patients undergoing surgical management, 21% required subsequent surgery.

Patient reported outcome measures post proximal humerus fracture dislocations do not return to normal population levels. These injuries are associated with a high prevalence of complications regardless of management. Appropriate patient counselling should be undertaken before embarking on definitive management.

Aims

Acetabular fractures in older adults lead to a high risk of mortality and morbidity. However, only limited data have been published documenting functional outcomes in such patients. The aims of this study were to describe outcomes in patients aged 60 years and older with operatively managed acetabular fractures, and to establish predictors of conversion to total hip arthroplasty (THA).

Purpose: To document outcomes and patient satisfaction in relation to the incision used following clavicle fracture fixation. In literature, the incidence of incisional numbness following operative fixation of clavicle fractures is reported to be between 7–29%. Such wound related problems contribute significantly to the dissatisfaction of patients with operatively treated clavicle fractures. Wound related problems can be bothersome and disabling and this is poorly documented.

Method: All primary clavicle fractures treated with plating at the Alfred Hospital between 01/06/2003 and 01/06/2006 were included in the study. Patients were asked to complete paper-based questionnaires assessing satisfaction, pain, scar satisfaction, presence of numbness and the degree of disability following clavicle fixation. Their clinical notes and X-rays were reviewed for evaluation. The study sample was then divided into two groups; horizontal incision versus vertical incision then the data was analysed.

Results: The response rate was 65% (35/54). 74% of patients reported as having “good” or better outcome following their clavicle fracture fixation. There was no statistically significant difference in pain scores. However, there were statistically significant differences observed in the presence of numbness (vertical 21% versus horizontal 62%) and the disability from the numbness between the two incision types. Overall satisfaction between the two groups was also significantly different.

Conclusion: This study confirms that scar-related problems significantly affect the satisfaction following plating of clavicle fractures and numbness appears to be one of the most significant factors. Vertical incisions appear to reduce the incidence of numbness and lead to better patient satisfaction. Our results suggest that vertical incision is an attractive alternative approach in clavicle fracture fixation.

To assess patient following operative fixation of clavicle fractures. In the literature, the incidence of paraesthesia following operative fixation of clavicle fractures is reported to be between 7–29%. This problem can be bothersome to patients and the degree of disability is poorly documented.

All clavicle fractures (67) treated operatively at the Alfred Hospital between 01/06/2003 and 01/06/2006 were included in the study. Patients were asked to complete paper based questionnaires assessing satisfaction, presence of numbness and degree of disability following clavicle operation. Additionally, they were followed up clinically to assess the area of numbness and scarring.

The response rate was 65% (43/67). Most of the patients were satisfied with the operation and only 15% reported significant problems with the wound. Majority of patients returned to pre-morbid activities and employment. The degree of paraesthesia varied among respondents and it was associated with the type of incision used. There was little difference in patient satisfaction with regard to various surgical devices utilised.

It is important to address wound complications such as scarring and paraesthesia when discussing operative treatments for patients with clavicle fractures. The results suggest that wound related problems can be frequent and a significant percentage of operatively managed patient experience long term numbness. It is possibly an under appreciated problem. Additionally our results suggest that vertical incisions achieve a more favourable outcome compared to horizontal incisions.

To report the results of the intramedullary skeletal kinetic distractor (iskd) in patients with established leg length discrepancy following lower limb trauma.

12 patients with significant leg length discrepancy (> 20mm) following lower limb trauma were operated on using the iskd nail between september 2004 and december 2007. patients were followed up clinically and radiologically at minimum 18 months (mean: 27months range: 18–24 months).

8 femurs and 4 tibias were operated using the iskd nail. all patient in the series had successful completed treatements. the average leg length discrepancy was 38mm (91mm–21mm) and the average gained length was 37mm (76m–22mm). radiological union and bone consolidation were slow to occur. early weight bearing was permitted allowing earlier functional capacity. 6 patients required additional operations; 3 manipulation under anaesthesia for failed lengthening and 3 bone grafting for poor regenerate, 1 patient required more than one additional operation.

The iskd nail is an effective and reliable alternative technique for correcting leg length discrepancy in patients who have suffred lower limb trauma. it appears to mimic the results achieved with the use of a fine wire external fixator or a unilateral external fixator. the convenience of a fully implanted device is substantial. the complications are frequent but manageable with standard techniques.

Introduction and Aims: There is a paucity of comprehensive information regarding the management and outcomes of orthopaedic trauma. The aims of this project are to establish a comprehensive registry of orthopaedic injuries, treatments, complications and outcomes based on admissions to Level One Trauma Centres in Victoria.

Method: The Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) has been established through a collaborative project involving Monash University and the Alfred and Royal Melbourne Hospitals. The registry prospectively collects data on all patients with an orthopaedic (bone or soft tissue) injury that are admitted to Victorian Level One Trauma Centres and are managed or followed-up by an orthopaedic unit or have a spinal injury. Data is collected from the patient’s medical record and includes information on demographics, injury diagnosis and treatment methods. Outcomes are measured at discharge and six and 12 months post-injury using patient-oriented measures.

Results: The VOTOR database was established in 2003. This process involved two key stages. The first stage was based on the development of standardised data collection methodology and quality control processes specific to orthopaedic trauma. The second stage involved the commencement of data collection and the administration of outcome measures. From August 18, 2003 until January 12, 2004, 850 participants were registered on the database and there was a greater than 80% response rate for administration of discharge outcome measures. The participants had a median age of 44 (range 16–104) years. There was a greater percentage of male patients (60%) than female patients (40%) and English was the preferred language for most participants (87%). Fortyfive percent of patients were provided with funding from the Transport Accident Commission (TAC). With respect to pre-injury status, the greatest proportion of participants were retired or pensioners (32%), while 14% were tradespersons and 11% had a professional occupation. Most participants achieved an education level of Year 9–11 (32%), followed by 19 percent that reached Year 12.

Conclusion: The VOTOR database provides a unique opportunity to comprehensively examine the nature of orthopaedic trauma. Patient-oriented outcomes associated with these injuries are currently being collected. This research is essential in determining the efficacy of different treatment methods, improving current management options and ultimately reducing the financial and social costs of orthopaedic trauma.

We describe a congenital deformity of the foot which is characterised by calcaneus at the ankle and valgus at the subtalar joint; spontaneous improvement does not occur and serial casting results in incomplete or impermanent correction of the deformities. Experience with five feet in four children indicates that release of the ligaments and tendons anterior and lateral to the ankle and lateral to the subtalar joint is the minimum surgery necessary; subtalar arthrodesis may be required in addition. The foot deformity described may occur as an isolated condition or in association with multiple congenital anomalies. The possibility of a neurological deficit should always be excluded.